00 1003006214 0 DORFMAN AARON 2018303 9999999 B 10 1003006214 0 100 E PENN SQ FL 9 PHILADELPHIA PA 191073377 20 1003006214 0 Physicians Anesthesia Services 20 1003006214 0 Physicians Fluoride varnish 20 1003006214 0 Physicians Healthy Kids Services 20 1003006214 0 Physicians Optical Supplies 20 1003006214 0 Physicians Physician Services 00 1003006701 0 GVOZDJAN DRAGOSLAV 2010305 9999999 B 10 1003006701 0 228 E LAKE ST ADDISON IL 601012889 20 1003006701 0 Physicians Anesthesia Services 20 1003006701 0 Physicians Healthy Kids Services 20 1003006701 0 Physicians Optical Supplies 20 1003006701 0 Physicians Physician Services 20 1003006701 0 Physicians Physicians Psychiatric Services 00 1003007170 0 DANCIU SORIN C 2008245 9999999 B 10 1003007170 0 29373 NETWORK PL CHICAGO IL 606733039 20 1003007170 0 Physicians Anesthesia Services 20 1003007170 0 Physicians Fluoride varnish 20 1003007170 0 Physicians Healthy Kids Services 20 1003007170 0 Physicians Optical Supplies 20 1003007170 0 Physicians Physician Services 00 1003007345 0 HARLOW MICHAEL 2016328 9999999 B 10 1003007345 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1003007345 0 Physicians Anesthesia Services 20 1003007345 0 Physicians Healthy Kids Services 20 1003007345 0 Physicians Optical Supplies 20 1003007345 0 Physicians Physician Services 20 1003007345 0 Physicians Physicians Psychiatric Services 00 1003007550 0 SCHNEIDER BROOKE 2024318 9999999 B 10 1003007550 0 5225 OLD ORCHARD RD STE 15 SKOKIE IL 600771027 20 1003007550 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1003010059 0 PARDO ANDREA C 2015182 9999999 B 10 1003010059 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1003010059 0 Physicians Anesthesia Services 20 1003010059 0 Physicians Fluoride varnish 20 1003010059 0 Physicians Healthy Kids Services 20 1003010059 0 Physicians Optical Supplies 20 1003010059 0 Physicians Physician Services 20 1003010059 0 Physicians 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OH 452024121 20 1003024175 0 Physicians Anesthesia Services 20 1003024175 0 Physicians Fluoride varnish 20 1003024175 0 Physicians Healthy Kids Services 20 1003024175 0 Physicians Optical Supplies 20 1003024175 0 Physicians Physician Services 00 1003025032 0 EL ABIAD RAMI G 2014337 9999999 B 10 1003025032 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1003025032 0 Physicians Anesthesia Services 20 1003025032 0 Physicians Fluoride varnish 20 1003025032 0 Physicians Healthy Kids Services 20 1003025032 0 Physicians Optical Supplies 20 1003025032 0 Physicians Physician Services 00 1003025438 0 HUSSAIN AYESHA 2007227 9999999 B 10 1003025438 0 6301 N WESTERN AVE CHICAGO IL 606592009 20 1003025438 0 Physicians Anesthesia Services 20 1003025438 0 Physicians Fluoride varnish 20 1003025438 0 Physicians Healthy Kids Services 20 1003025438 0 Physicians Optical Supplies 20 1003025438 0 Physicians Physician Services 00 1003025511 0 COLLIER MELISSA 2023349 9999999 B 10 1003025511 0 250 N SHADELAND AVE 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DU QUOIN IL 628322451 20 1003027244 0 Physical Therapists Medical Supplies 20 1003027244 0 Physical Therapists Medical equipment/prosthetic devices 20 1003027244 0 Physical Therapists Physical Therapy Services 00 1003027947 0 CHAN HOI 2022107 9999999 B 10 1003027947 0 5121 MARYLAND WAY STE 300 BRENTWOOD TN 370277516 20 1003027947 0 Physicians Anesthesia Services 20 1003027947 0 Physicians Healthy Kids Services 20 1003027947 0 Physicians Optical Supplies 20 1003027947 0 Physicians Physician Services 00 1003028150 0 WIRTH-RISSMAN JILL 2008085 9999999 B 10 1003028150 0 221 NE GLEN OAK AVE ATTN: STEPHEN CIRONE GOMP 100 PEORIA IL 616360001 20 1003028150 0 Physicians Anesthesia Services 20 1003028150 0 Physicians Fluoride varnish 20 1003028150 0 Physicians Healthy Kids Services 20 1003028150 0 Physicians Optical Supplies 20 1003028150 0 Physicians Physician Services 00 1003029141 0 TROHKIMOINEN JEFFREY B 2017153 9999999 B 10 1003029141 0 515 22ND AVE MONROE WI 535661569 20 1003029141 0 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1003035122 0 Physicians Fluoride varnish 20 1003035122 0 Physicians Healthy Kids Services 20 1003035122 0 Physicians Optical Supplies 20 1003035122 0 Physicians Physician Services 00 1003035254 0 RAY CARRIE 2024226 9999999 B 10 1003035254 0 PO BOX 710 DECATUR IL 625250710 20 1003035254 0 Other behavior health professional LCPC/LMFT services 00 1003035593 0 MURPHY CARA 2021040 9999999 B 10 1003035593 0 4714 GETTYSBURG RD MECHANICSBURG PA 170554325 20 1003035593 0 Physical Therapists Medical Supplies 20 1003035593 0 Physical Therapists Medical equipment/prosthetic devices 20 1003035593 0 Physical Therapists Physical Therapy Services 00 1003037169 0 CUDONE LORI 2011178 9999999 B 10 1003037169 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1003037169 0 Physicians All Kids application agent 20 1003037169 0 Physicians Anesthesia Services 20 1003037169 0 Physicians Healthy Kids Services 20 1003037169 0 Physicians Optical Supplies 20 1003037169 0 Physicians Physician Services 00 1003038043 0 DUCKWORTH EDWARD 2007182 9999999 B 10 1003038043 0 190 E BANNOCK ST BOISE ID 837126241 20 1003038043 0 Physicians Anesthesia Services 20 1003038043 0 Physicians Healthy Kids Services 20 1003038043 0 Physicians Optical Supplies 20 1003038043 0 Physicians Physician Services 00 1003038423 0 GURNSEY ZACHARIAH 2009182 9999999 B 10 1003038423 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1003038423 0 Physicians Anesthesia Services 20 1003038423 0 Physicians Fluoride varnish 20 1003038423 0 Physicians Healthy Kids Services 20 1003038423 0 Physicians Optical Supplies 20 1003038423 0 Physicians Physician Services 00 1003038688 0 MLYNARCZYK ELIZABETH 2009194 9999999 B 10 1003038688 0 370 SUMMIT ST # 1 ELGIN IL 601203843 20 1003038688 0 Physicians Anesthesia Services 20 1003038688 0 Physicians Healthy Kids Services 20 1003038688 0 Physicians Optical Supplies 20 1003038688 0 Physicians Physician Services 00 1003038746 0 TAVES ADAM 2012183 9999999 B 10 1003038746 0 220 COMPASS POINT DR SAINT CHARLES MO 633014405 20 1003038746 0 Physicians Anesthesia Services 20 1003038746 0 Physicians Healthy Kids Services 20 1003038746 0 Physicians Optical Supplies 20 1003038746 0 Physicians Physician Services 00 1003039678 0 DOLAN LYNN E 2014322 9999999 A 10 1003039678 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1003039678 0 Physicians Anesthesia Services 20 1003039678 0 Physicians Fluoride varnish 20 1003039678 0 Physicians Healthy Kids Services 20 1003039678 0 Physicians Optical Supplies 20 1003039678 0 Physicians Physician Services 00 1003040106 0 BECK BRYON L 2018128 9999999 B 10 1003040106 0 3015 N BALLAS RD SAINT LOUIS MO 631312329 20 1003040106 0 Physician Assistant Only Fluoride varnish 20 1003040106 0 Physician Assistant Only Healthy Kids Services 20 1003040106 0 Physician Assistant Only Physician Services 00 1003041476 0 LINDGREN KEVIN 2012214 9999999 B 10 1003041476 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1003041476 0 Physicians Anesthesia Services 20 1003041476 0 Physicians Fluoride varnish 20 1003041476 0 Physicians Healthy Kids Services 20 1003041476 0 Physicians Optical Supplies 20 1003041476 0 Physicians Physician Services 00 1003042920 0 AMADI CHIEMEZIE C 2022181 9999999 B 10 1003042920 0 3621 S STATE ST ANN ARBOR MI 481081633 20 1003042920 0 Physicians Anesthesia Services 20 1003042920 0 Physicians Healthy Kids Services 20 1003042920 0 Physicians Optical Supplies 20 1003042920 0 Physicians Physician Services 00 1003043167 0 WANG MARK C 2014182 9999999 B 10 1003043167 0 44000 GARFIELD RD CLINTON TOWNSHI MI 480381125 20 1003043167 0 Physicians Anesthesia Services 20 1003043167 0 Physicians Healthy Kids Services 20 1003043167 0 Physicians Optical Supplies 20 1003043167 0 Physicians Physician Services 00 1003043837 0 MEYER BENJAMIN 2021235 9999999 B 10 1003043837 0 PO BOX 208807 DALLAS TX 753208807 20 1003043837 0 Physicians Anesthesia Services 20 1003043837 0 Physicians Healthy Kids Services 20 1003043837 0 Physicians Optical 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GETTYSBURG RD MECHANICSBURG PA 170554325 20 1003109380 0 Speech Therapists Medical Supplies 20 1003109380 0 Speech Therapists Medical equipment/prosthetic devices 20 1003109380 0 Speech Therapists Speech Therapy/Pathology Services 00 1003109653 0 HAWKINS ANNE L 2017041 9999999 B 10 1003109653 0 5901 LINCOLN DR EDINA MN 554361611 20 1003109653 0 Nurse Practitioners Fluoride varnish 20 1003109653 0 Nurse Practitioners Healthy Kids Services 20 1003109653 0 Nurse Practitioners Nurse Practitioners Services 20 1003109653 0 Nurse Practitioners Physician Services 00 1003109828 0 ANACIUS ELISABETH 2021333 9999999 B 10 1003109828 0 PO BOX 1257 HANNIBAL MO 634011257 20 1003109828 0 Physicians Anesthesia Services 20 1003109828 0 Physicians Fluoride varnish 20 1003109828 0 Physicians Healthy Kids Services 20 1003109828 0 Physicians Optical Supplies 20 1003109828 0 Physicians Physician Services 00 1003110313 0 SCHOLTEN ERIC 2021080 9999999 B 10 1003110313 0 190 E BANNOCK ST BOISE ID 837126241 20 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2020157 9999999 B 10 1003122151 0 1000 N ALLEN ST ROBINSON IL 624541114 20 1003122151 0 Physicians Anesthesia Services 20 1003122151 0 Physicians Fluoride varnish 20 1003122151 0 Physicians Healthy Kids Services 20 1003122151 0 Physicians Optical Supplies 20 1003122151 0 Physicians Physician Services 00 1003123167 0 MIKOSZ THERESA 2014268 9999999 H 10 1003123167 0 3436 N KENNICOTT AVE ARLINGTON HTS IL 600047814 20 1003123167 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1003124280 0 MARTINEZMATEO MELISSA A 2015317 9999999 B 10 1003124280 0 611 W PARK ST URBANA IL 618012529 20 1003124280 0 Physicians Anesthesia Services 20 1003124280 0 Physicians Fluoride varnish 20 1003124280 0 Physicians Healthy Kids Services 20 1003124280 0 Physicians Optical Supplies 20 1003124280 0 Physicians Physician Services 00 1003127093 0 MARTINEZ ARMANDO L 2023008 9999999 B 10 1003127093 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 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Physicians Physician Services 00 1003132002 0 LUNA MAXIMILIANO 2013156 9999999 B 10 1003132002 0 2001 S CALIFORNIA AVE # 100 CHICAGO IL 606082486 20 1003132002 0 Physicians All Kids application agent 20 1003132002 0 Physicians Anesthesia Services 20 1003132002 0 Physicians Fluoride varnish 20 1003132002 0 Physicians Healthy Kids Services 20 1003132002 0 Physicians Optical Supplies 20 1003132002 0 Physicians Physician Services 00 1003132549 0 DESAI VIKAS 2016214 9999999 B 10 1003132549 0 5777 DEPT CAROL STREAM IL 601220021 20 1003132549 0 Physicians Anesthesia Services 20 1003132549 0 Physicians Healthy Kids Services 20 1003132549 0 Physicians Optical Supplies 20 1003132549 0 Physicians Physician Services 00 1003132788 0 BRAZILL KEVIN 2015230 9999999 B 10 1003132788 0 800 E LOCUST ST OLNEY IL 624502553 20 1003132788 0 Physicians Anesthesia Services 20 1003132788 0 Physicians Fluoride varnish 20 1003132788 0 Physicians Healthy Kids Services 20 1003132788 0 Physicians Optical Supplies 20 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varnish 20 1003155375 0 Nurse Practitioners Healthy Kids Services 20 1003155375 0 Nurse Practitioners Nurse Practitioners Services 20 1003155375 0 Nurse Practitioners Physician Services 00 1003155573 0 MATTSON KELSEY 2014076 9999999 B 10 1003155573 0 863 CENTER CT UNIT D SHOREWOOD IL 604048512 20 1003155573 0 Speech Therapists Medical Supplies 20 1003155573 0 Speech Therapists Medical equipment/prosthetic devices 20 1003155573 0 Speech Therapists Speech Therapy/Pathology Services 00 1003155995 0 YODER ALVA 2020232 9999999 B 10 1003155995 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1003155995 0 Nurse Practitioners Fluoride varnish 20 1003155995 0 Nurse Practitioners Healthy Kids Services 20 1003155995 0 Nurse Practitioners Nurse Practitioners Services 20 1003155995 0 Nurse Practitioners Physician Services 00 1003156209 0 GUERRA DEL CASTILLO ROBERTO 2021078 9999999 B 10 1003156209 0 PO BOX 41220 PHOENIX AZ 850801220 20 1003156209 0 Physicians Anesthesia Services 20 1003156209 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Services 20 1003158403 0 Physicians Optical Supplies 20 1003158403 0 Physicians Physician Services 00 1003158650 0 DILLON ROBERT 2016244 9999999 B 10 1003158650 0 325 IL ROUTE 2 DIXON IL 610219118 20 1003158650 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1003159021 0 DAWSON MATTHEW N 2022021 9999999 B 10 1003159021 0 355 E ERIE ST CHICAGO IL 606113167 20 1003159021 0 Physicians Anesthesia Services 20 1003159021 0 Physicians Healthy Kids Services 20 1003159021 0 Physicians Optical Supplies 20 1003159021 0 Physicians Physician Services 00 1003159153 0 KOMINSKY MATTHEW S 2019248 9999999 B 10 1003159153 0 5777 DEPT CAROL STREAM IL 601220021 20 1003159153 0 Physicians Anesthesia Services 20 1003159153 0 Physicians Healthy Kids Services 20 1003159153 0 Physicians Optical Supplies 20 1003159153 0 Physicians Physician Services 00 1003159450 0 MASSEY KRISTEN NICOLE 2013154 9999999 B 10 1003159450 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1003159450 0 Nurse Practitioners Healthy Kids Services 20 1003159450 0 Nurse Practitioners Nurse Practitioners Services 20 1003159450 0 Nurse Practitioners Physician Services 00 1003159781 0 KANG HEEEUN 2024193 9999999 B 10 1003159781 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1003159781 0 Physicians Anesthesia Services 20 1003159781 0 Physicians Fluoride varnish 20 1003159781 0 Physicians Healthy Kids Services 20 1003159781 0 Physicians Optical Supplies 20 1003159781 0 Physicians Physician Services 00 1003160243 0 KAO GRACE A 2003097 9999999 B 10 1003160243 0 4015 N OAK PARK AVE BLDG B CHICAGO IL 606347197 20 1003160243 0 Physicians Anesthesia Services 20 1003160243 0 Physicians Fluoride varnish 20 1003160243 0 Physicians Healthy Kids Services 20 1003160243 0 Physicians Optical Supplies 20 1003160243 0 Physicians Physician Services 00 1003161993 0 BARRON ANASTASIA 2018201 9999999 B 10 1003161993 0 1901 W HARRISON ST CHICAGO IL 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2019001 9999999 B 10 1003163403 0 901 E 5TH ST WASHINGTON MO 630903127 20 1003163403 0 Physicians Anesthesia Services 20 1003163403 0 Physicians Healthy Kids Services 20 1003163403 0 Physicians Optical Supplies 20 1003163403 0 Physicians Physician Services 00 1003163676 0 MCCLURE JACQUELINE R 2012001 9999999 B 10 1003163676 0 275 S UNIVERSITY ST 211 RACHEL COOPER CAMPUS BOX 4 NORMAL IL 617904720 20 1003163676 0 Speech Therapists Medical Supplies 20 1003163676 0 Speech Therapists Medical equipment/prosthetic devices 20 1003163676 0 Speech Therapists Speech Therapy/Pathology Services 00 1003164443 0 BUDDHADEV PAKHADI H 2022068 9999999 B 10 1003164443 0 5777 DEPT CAROL STREAM IL 601220021 20 1003164443 0 Physicians Anesthesia Services 20 1003164443 0 Physicians Fluoride varnish 20 1003164443 0 Physicians Healthy Kids Services 20 1003164443 0 Physicians Optical Supplies 20 1003164443 0 Physicians Physician Services 00 1003164617 0 HAJOSTEK MELISSA K 2016004 9999999 B 10 1003164617 0 124 SW 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Practitioners Healthy Kids Services 20 1003484015 0 Nurse Practitioners Nurse Practitioners Services 20 1003484015 0 Nurse Practitioners Physician Services 00 1003484809 0 ROJAS JOSEPH R 2021226 9999999 B 10 1003484809 0 75 REMITTANCE DR DEPT 1620 SUITE 1620 CHICAGO IL 606751620 20 1003484809 0 Physicians Anesthesia Services 20 1003484809 0 Physicians Fluoride varnish 20 1003484809 0 Physicians Healthy Kids Services 20 1003484809 0 Physicians Optical Supplies 20 1003484809 0 Physicians Physician Services 00 1003485947 0 RANDHAWA LOVEPREET 2024222 9999999 B 10 1003485947 0 901 E 5TH ST WASHINGTON MO 630903127 20 1003485947 0 Physicians Anesthesia Services 20 1003485947 0 Physicians Fluoride varnish 20 1003485947 0 Physicians Healthy Kids Services 20 1003485947 0 Physicians Optical Supplies 20 1003485947 0 Physicians Physician Services 00 1003485970 0 WALSH KYLE 2021174 9999999 B 10 1003485970 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1003485970 0 Physicians Anesthesia Services 20 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DAYTON ST MCHENRY IL 600508377 20 1003494758 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1003496175 0 PATEL MEERA R 2024191 9999999 B 10 1003496175 0 5777 DEPT CAROL STREAM IL 601220021 20 1003496175 0 Physicians Anesthesia Services 20 1003496175 0 Physicians Healthy Kids Services 20 1003496175 0 Physicians Optical Supplies 20 1003496175 0 Physicians Physician Services 00 1003496225 0 SOUSA CLAIRA 2022047 9999999 B 10 1003496225 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1003496225 0 Nurse Practitioners Anesthesia Services 20 1003496225 0 Nurse Practitioners Nurse Practitioners Services 20 1003496225 0 Nurse Practitioners Physician Services 00 1003496431 0 BUCHER MEGAN A 2021113 9999999 B 10 1003496431 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1003496431 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1003496449 0 CHIDAMBARAM VIGNESH 2024218 9999999 B 10 1003496449 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1003496449 0 Physicians Anesthesia Services 20 1003496449 0 Physicians Fluoride varnish 20 1003496449 0 Physicians Healthy Kids Services 20 1003496449 0 Physicians Optical Supplies 20 1003496449 0 Physicians Physician Services 00 1003496597 0 BHATIA JASKIRAT SINGH 2024234 9999999 B 10 1003496597 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1003496597 0 Physicians Anesthesia Services 20 1003496597 0 Physicians Fluoride varnish 20 1003496597 0 Physicians Healthy Kids Services 20 1003496597 0 Physicians Optical Supplies 20 1003496597 0 Physicians Physician Services 00 1003497116 0 OLSON DEREK 2024137 9999999 B 10 1003497116 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1003497116 0 Physical Therapists Medical Supplies 20 1003497116 0 Physical Therapists Medical equipment/prosthetic devices 20 1003497116 0 Physical Therapists Physical Therapy Services 00 1003499021 0 ROSS TIFFANEY W 2024228 9999999 B 10 1003499021 0 4601 SAUK TRL RICHTON PARK IL 604711470 20 1003499021 0 Speech Therapists Speech Therapy/Pathology Services 00 1003499278 0 ENRICO ANTHONY M 2021175 9999999 B 10 1003499278 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1003499278 0 Nurse Practitioners Anesthesia Services 20 1003499278 0 Nurse Practitioners Nurse Practitioners Services 20 1003499278 0 Nurse Practitioners Physician Services 00 1003500331 0 SINHA JIAQIU 2023255 9999999 B 10 1003500331 0 800 E LOCUST ST OLNEY IL 624502553 20 1003500331 0 Nurse Practitioners Healthy Kids Services 20 1003500331 0 Nurse Practitioners Nurse Practitioners Services 20 1003500331 0 Nurse Practitioners Physician Services 00 1003500794 0 LOPEZ RODRIGUEZ ANGELICA 2023236 9999999 B 10 1003500794 0 303 N JACKSON ST MORRISON IL 612703042 20 1003500794 0 Nurse Practitioners Healthy Kids Services 20 1003500794 0 Nurse Practitioners Nurse Practitioners Services 20 1003500794 0 Nurse Practitioners Physician Services 00 1003500810 0 SAEED SARA 2024144 2026181 B 10 1003500810 0 6420 CLAYTON RD SAINT LOUIS MO 631171811 20 1003500810 0 Physicians Anesthesia Services 20 1003500810 0 Physicians Fluoride varnish 20 1003500810 0 Physicians Healthy Kids Services 20 1003500810 0 Physicians Optical Supplies 20 1003500810 0 Physicians Physician Services 00 1003501974 0 AMPARAN ERIC T 2023298 9999999 B 10 1003501974 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1003501974 0 Physicians Anesthesia Services 20 1003501974 0 Physicians Fluoride varnish 20 1003501974 0 Physicians Healthy Kids Services 20 1003501974 0 Physicians Optical Supplies 20 1003501974 0 Physicians Physician Services 00 1003502782 0 CHARVET CHRISTIAN 2023318 9999999 B 10 1003502782 0 5777 DEPT CAROL STREAM IL 601220021 20 1003502782 0 Nurse Practitioners Healthy Kids Services 20 1003502782 0 Nurse Practitioners Nurse Practitioners Services 20 1003502782 0 Nurse Practitioners Physician Services 00 1003503699 0 SHIM BYEOL 2023128 9999999 B 10 1003503699 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1003503699 0 Other behavior health professional LCPC/LMFT services 00 1003505314 0 MEHTA DHARA 2025063 9999999 B 10 1003505314 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1003505314 0 Nurse Practitioners Fluoride varnish 20 1003505314 0 Nurse Practitioners Healthy Kids Services 20 1003505314 0 Nurse Practitioners Nurse Practitioners Services 20 1003505314 0 Nurse Practitioners Physician Services 00 1003505967 0 WILLIAMS CHRISTOPHER P 2023237 9999999 B 10 1003505967 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1003505967 0 Psychologist Psychologist service 00 1003507252 0 PERINCHERY MALAVIKA K 2025001 9999999 B 10 1003507252 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1003507252 0 Physicians Anesthesia Services 20 1003507252 0 Physicians Healthy Kids Services 20 1003507252 0 Physicians Optical Supplies 20 1003507252 0 Physicians Physician Services 00 1003507906 0 STEWART GENEVA 2023244 9999999 B 10 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varnish 20 1003966615 0 Physician Assistant Only Healthy Kids Services 20 1003966615 0 Physician Assistant Only Physician Services 00 1003967027 0 CONNOLLY KATHERINE C 2007186 9999999 B 10 1003967027 0 319 E MADISON ST STE 3B SPRINGFIELD IL 627013124 20 1003967027 0 Other behavior health professional LCPC/LMFT services 00 1003967084 0 KELLY THOMAS J 1998182 9999999 B 10 1003967084 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1003967084 0 Physicians Anesthesia Services 20 1003967084 0 Physicians Healthy Kids Services 20 1003967084 0 Physicians Optical Supplies 20 1003967084 0 Physicians Physician Services 20 1003967084 0 Physicians Physicians Psychiatric Services 00 1003967977 0 KHAN IQBAL A 2020247 9999999 B 10 1003967977 0 1005 BROADWAY ST QUINCY IL 623012834 20 1003967977 0 Physicians Anesthesia Services 20 1003967977 0 Physicians Healthy Kids Services 20 1003967977 0 Physicians Optical Supplies 20 1003967977 0 Physicians Physician Services 20 1003967977 0 Physicians 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CHARLES MO 633012894 20 1003979758 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1003982257 0 GAO WEI 2005172 9999999 B 10 1003982257 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112386 20 1003982257 0 Dentists Dental Services 20 1003982257 0 Dentists Physician Services 00 1003982877 0 SHAIKH AHMARI 1984144 9999999 B 10 1003982877 0 33 W HIGGINS RD HOFFMAN ESTATES IL 601694911 20 1003982877 0 Physicians Anesthesia Services 20 1003982877 0 Physicians Fluoride varnish 20 1003982877 0 Physicians Healthy Kids Services 20 1003982877 0 Physicians Optical Supplies 20 1003982877 0 Physicians Physician Services 00 1003985284 0 DUBRAY KANSAS 2018335 9999999 B 10 1003985284 0 515 22ND AVE MONROE WI 535661569 20 1003985284 0 Physicians Anesthesia Services 20 1003985284 0 Physicians Healthy Kids Services 20 1003985284 0 Physicians Optical Supplies 20 1003985284 0 Physicians Physician Services 00 1003985771 0 TODD MICHAEL J 2021120 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1013113539 0 Physicians Healthy Kids Services 20 1013113539 0 Physicians Optical Supplies 20 1013113539 0 Physicians Physician Services 00 1013114453 0 ANDELIN CLARK O 2019060 9999999 B 10 1013114453 0 1102 N COUNTY ROAD 700 WARSAW IL 623793011 20 1013114453 0 Physicians Anesthesia Services 20 1013114453 0 Physicians Healthy Kids Services 20 1013114453 0 Physicians Optical Supplies 20 1013114453 0 Physicians Physician Services 00 1013115039 0 SHWAIKI WASSIM 2007001 9999999 B 10 1013115039 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1013115039 0 Physicians Anesthesia Services 20 1013115039 0 Physicians Fluoride varnish 20 1013115039 0 Physicians Healthy Kids Services 20 1013115039 0 Physicians Optical Supplies 20 1013115039 0 Physicians Physician Services 00 1013115955 0 REYNOLDS MELANIE 2007191 9999999 B 10 1013115955 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1013115955 0 Nurse Practitioners Fluoride varnish 20 1013115955 0 Nurse Practitioners Healthy Kids Services 20 1013115955 0 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1013195650 0 PO BOX 5081 JANESVILLE WI 535475081 20 1013195650 0 Physicians Anesthesia Services 20 1013195650 0 Physicians Fluoride varnish 20 1013195650 0 Physicians Healthy Kids Services 20 1013195650 0 Physicians Optical Supplies 20 1013195650 0 Physicians Physician Services 00 1013196682 0 JAEGLE COURTNEY 2016258 9999999 B 10 1013196682 0 221 NE GLEN OAK AVE ATTN: STEPHEN CIRONE GOMP 100 PEORIA IL 616360001 20 1013196682 0 Physician Assistant Only Fluoride varnish 20 1013196682 0 Physician Assistant Only Healthy Kids Services 20 1013196682 0 Physician Assistant Only Physician Services 00 1013197110 0 PJEVCEVIC KELLY 2017354 9999999 B 10 1013197110 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1013197110 0 Physician Assistant Only Fluoride varnish 20 1013197110 0 Physician Assistant Only Healthy Kids Services 20 1013197110 0 Physician Assistant Only Physician Services 00 1013198696 0 TOLIA VAISHAL 2008231 9999999 B 10 1013198696 0 440 STEVENS AVE STE 150 SOLANA BEACH 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1013199926 0 Registered nurse Nurse Practitioners Services 00 1013200872 0 JACKSON DAVID M 2022182 9999999 B 10 1013200872 0 8300 W 38TH AVE WHEAT RIDGE CO 800336005 20 1013200872 0 Physicians Anesthesia Services 20 1013200872 0 Physicians Healthy Kids Services 20 1013200872 0 Physicians Optical Supplies 20 1013200872 0 Physicians Physician Services 00 1013201375 0 DAISY EMMA 2015289 9999999 B 10 1013201375 0 1301 W DEVON AVE CHICAGO IL 606601329 20 1013201375 0 Physicians Anesthesia Services 20 1013201375 0 Physicians Fluoride varnish 20 1013201375 0 Physicians Healthy Kids Services 20 1013201375 0 Physicians Optical Supplies 20 1013201375 0 Physicians Physician Services 00 1013202142 0 FENG LUMING 2017191 9999999 B 10 1013202142 0 6821 S HALSTED ST CHICAGO IL 606211833 20 1013202142 0 Physicians Anesthesia Services 20 1013202142 0 Physicians Fluoride varnish 20 1013202142 0 Physicians Healthy Kids Services 20 1013202142 0 Physicians Optical Supplies 20 1013202142 0 Physicians 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621 S NEW BALLAS RD STE 7020 SAINT LOUIS MO 631418232 20 1013203454 0 Physicians Anesthesia Services 20 1013203454 0 Physicians Fluoride varnish 20 1013203454 0 Physicians Healthy Kids Services 20 1013203454 0 Physicians Optical Supplies 20 1013203454 0 Physicians Physician Services 00 1013203561 0 HAMADAH ABDURRAHMAN M 2017216 9999999 B 10 1013203561 0 2250 N ILLINOIS AVE CARBONDALE IL 629015612 20 1013203561 0 Physicians Anesthesia Services 20 1013203561 0 Physicians Fluoride varnish 20 1013203561 0 Physicians Healthy Kids Services 20 1013203561 0 Physicians Optical Supplies 20 1013203561 0 Physicians Physician Services 00 1013203652 0 TAKALA CHRISTOPHER 2017274 9999999 B 10 1013203652 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1013203652 0 Physicians Anesthesia Services 20 1013203652 0 Physicians Healthy Kids Services 20 1013203652 0 Physicians Optical Supplies 20 1013203652 0 Physicians Physician Services 20 1013203652 0 Physicians Physicians Psychiatric Services 00 1013203660 0 KREZALEK MONIKA A 2019217 9999999 B 10 1013203660 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1013203660 0 Physicians Anesthesia Services 20 1013203660 0 Physicians Healthy Kids Services 20 1013203660 0 Physicians Optical Supplies 20 1013203660 0 Physicians Physician Services 00 1013203686 0 SIM YUNG 2015296 9999999 B 10 1013203686 0 1395 NW 167TH ST MIAMI FL 331695710 20 1013203686 0 Physicians Anesthesia Services 20 1013203686 0 Physicians Fluoride varnish 20 1013203686 0 Physicians Healthy Kids Services 20 1013203686 0 Physicians Optical Supplies 20 1013203686 0 Physicians Physician Services 00 1013204031 0 SHEIKH SAIMA 2011182 9999999 B 10 1013204031 0 1114 LEE ST DES PLAINES IL 600166517 20 1013204031 0 Dentists Dental Services 20 1013204031 0 Dentists Physician Services 00 1013204072 0 MILLER JUSTIN GRIFFITH 2022208 2099365 B 10 1013204072 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1013204072 0 Physicians Anesthesia Services 20 1013204072 0 Physicians Healthy Kids Services 20 1013204072 0 Physicians Optical Supplies 20 1013204072 0 Physicians Physician Services 00 1013204163 0 CHANNA ROOMASA 2020241 9999999 B 10 1013204163 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1013204163 0 Physicians Anesthesia Services 20 1013204163 0 Physicians Healthy Kids Services 20 1013204163 0 Physicians Optical Supplies 20 1013204163 0 Physicians Physician Services 00 1013204262 0 BHATTARAI MUKUL 2014182 9999999 B 10 1013204262 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1013204262 0 Physicians Anesthesia Services 20 1013204262 0 Physicians Fluoride varnish 20 1013204262 0 Physicians Healthy Kids Services 20 1013204262 0 Physicians Optical Supplies 20 1013204262 0 Physicians Physician Services 00 1013204387 0 BLAIR SUSAN K 2017202 9999999 B 10 1013204387 0 1812 N 19TH AVE MELROSE PARK IL 601602039 20 1013204387 0 Dentists Dental Services 20 1013204387 0 Dentists Physician Services 00 1013205046 0 TANTOCO JAMEE CASTILLO 2014182 9999999 B 10 1013205046 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1013205046 0 Physicians Anesthesia Services 20 1013205046 0 Physicians Healthy Kids Services 20 1013205046 0 Physicians Optical Supplies 20 1013205046 0 Physicians Physician Services 00 1013205202 0 DANIEL KIMBERLY E 2019191 9999999 B 10 1013205202 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1013205202 0 Physicians Anesthesia Services 20 1013205202 0 Physicians Fluoride varnish 20 1013205202 0 Physicians Healthy Kids Services 20 1013205202 0 Physicians Optical Supplies 20 1013205202 0 Physicians Physician Services 00 1013205285 0 NON LEMUEL BENEDICT R 2016098 9999999 B 10 1013205285 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1013205285 0 Physicians Anesthesia Services 20 1013205285 0 Physicians Fluoride varnish 20 1013205285 0 Physicians Healthy Kids Services 20 1013205285 0 Physicians Optical Supplies 20 1013205285 0 Physicians Physician Services 00 1013205657 0 DUNN RHONDA 2021242 9999999 B 10 1013205657 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1013205657 0 Nurse Practitioners Healthy Kids Services 20 1013205657 0 Nurse Practitioners Nurse Practitioners Services 20 1013205657 0 Nurse Practitioners Physician Services 00 1013206556 0 MARIANI HANNA 2017018 9999999 B 10 1013206556 0 6308 8TH AVE KENOSHA WI 531435031 20 1013206556 0 Physicians Anesthesia Services 20 1013206556 0 Physicians Fluoride varnish 20 1013206556 0 Physicians Healthy Kids Services 20 1013206556 0 Physicians Optical Supplies 20 1013206556 0 Physicians Physician Services 00 1013206747 0 DUDAR AMAL K 2018001 9999999 B 10 1013206747 0 4535 DRESSLER RD NW CANTON OH 447182545 20 1013206747 0 Physician Assistant Only Fluoride varnish 20 1013206747 0 Physician Assistant Only Healthy Kids Services 20 1013206747 0 Physician Assistant Only Physician Services 00 1013207331 0 JEELANI SEEMA 2017062 2025365 B 10 1013207331 0 801 S WASHINGTON ST NAPERVILLE IL 605407430 20 1013207331 0 Physicians Anesthesia Services 20 1013207331 0 Physicians Healthy Kids Services 20 1013207331 0 Physicians Optical Supplies 20 1013207331 0 Physicians Physician Services 00 1013208412 0 SAID ALBARA 2014196 9999999 B 10 1013208412 0 PO BOX 3877 JOLIET IL 604343877 20 1013208412 0 Physicians Anesthesia Services 20 1013208412 0 Physicians Fluoride varnish 20 1013208412 0 Physicians Healthy Kids Services 20 1013208412 0 Physicians Optical Supplies 20 1013208412 0 Physicians Physician Services 00 1013208958 0 COOPER MOUNGAR E 2019060 9999999 B 10 1013208958 0 PO BOX 34266 BELFAST ME 049150620 20 1013208958 0 Physicians Anesthesia Services 20 1013208958 0 Physicians Healthy Kids Services 20 1013208958 0 Physicians Optical Supplies 20 1013208958 0 Physicians Physician Services 00 1013210194 0 TALAPATRA POORVA 2016043 9999999 B 10 1013210194 0 109 CALIFORNIA ST CARTERVILLE IL 629181923 20 1013210194 0 Other behavior health professional LCPC/LMFT services 00 1013210822 0 KLOCEK KELLY 2021281 9999999 B 10 1013210822 0 5665 NEW NORTHSIDE DR ATLANTA GA 303285831 20 1013210822 0 Physicians Anesthesia Services 20 1013210822 0 Physicians Healthy Kids Services 20 1013210822 0 Physicians Optical Supplies 20 1013210822 0 Physicians Physician Services 00 1013211168 0 BOULWARE JASON 2020231 9999999 B 10 1013211168 0 515 VALLEY ST STE 203 MAPLEWOOD NJ 070404300 20 1013211168 0 Physicians Anesthesia Services 20 1013211168 0 Physicians Healthy Kids Services 20 1013211168 0 Physicians Optical Supplies 20 1013211168 0 Physicians Physician Services 00 1013211432 0 BONGIORNO JOSEPH 2024114 9999999 B 10 1013211432 0 800 W FULTON MARKET FL 12 CHICAGO IL 606071302 20 1013211432 0 Physician Assistant Only Fluoride varnish 20 1013211432 0 Physician Assistant Only Healthy Kids Services 20 1013211432 0 Physician Assistant Only Physician Services 00 1013212869 0 SCHAPIRO ANDREW 2017276 9999999 B 10 1013212869 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1013212869 0 Physicians Anesthesia Services 20 1013212869 0 Physicians Healthy Kids Services 20 1013212869 0 Physicians Optical Supplies 20 1013212869 0 Physicians Physician Services 00 1013214576 0 BICIOCCHI MISTY D 2011108 9999999 B 10 1013214576 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1013214576 0 Nurse Practitioners Fluoride varnish 20 1013214576 0 Nurse Practitioners Healthy Kids Services 20 1013214576 0 Nurse Practitioners Nurse Practitioners Services 20 1013214576 0 Nurse Practitioners Physician Services 00 1013215607 0 SAVIANO TRICIA 2024149 9999999 B 10 1013215607 0 1585 N MILWAUKEE AVE STE 116 LIBERTYVILLE IL 600481359 20 1013215607 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1013215714 0 KELDAHL HEATHER 2023059 9999999 B 10 1013215714 0 29373 NETWORK PL CHICAGO IL 606733039 20 1013215714 0 Nurse Practitioners Anesthesia Services 20 1013215714 0 Nurse Practitioners Nurse Practitioners Services 20 1013215714 0 Nurse Practitioners Physician Services 00 1013219757 0 FJELD ROSE H 2021018 9999999 B 10 1013219757 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1013219757 0 Nurse Practitioners Healthy Kids Services 20 1013219757 0 Nurse Practitioners Nurse Practitioners Services 20 1013219757 0 Nurse Practitioners Physician Services 00 1013222694 0 MCELROY COURTNEY 2017134 9999999 B 10 1013222694 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1013222694 0 Physicians Anesthesia Services 20 1013222694 0 Physicians Healthy Kids Services 20 1013222694 0 Physicians Optical Supplies 20 1013222694 0 Physicians Physician Services 00 1013222983 0 TANZ MICHELE 2010252 9999999 B 10 1013222983 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1013222983 0 Nurse Practitioners Fluoride varnish 20 1013222983 0 Nurse Practitioners Healthy Kids Services 20 1013222983 0 Nurse Practitioners Nurse Practitioners Services 20 1013222983 0 Nurse Practitioners Physician Services 00 1013224153 0 BOWER-LEWIS REBECCA 1998182 9999999 B 10 1013224153 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 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Nurse Practitioners Nurse Practitioners Services 20 1013226794 0 Nurse Practitioners Physician Services 00 1013226869 0 MATAPATHI UMA 2024257 9999999 B 10 1013226869 0 PO BOX 959794 SAINT LOUIS MO 631959794 20 1013226869 0 Physicians Anesthesia Services 20 1013226869 0 Physicians Healthy Kids Services 20 1013226869 0 Physicians Optical Supplies 20 1013226869 0 Physicians Physician Services 00 1013227024 0 FERGUSON LESLIE M 2016306 9999999 B 10 1013227024 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1013227024 0 Nurse Practitioners Healthy Kids Services 20 1013227024 0 Nurse Practitioners Nurse Practitioners Services 20 1013227024 0 Nurse Practitioners Physician Services 00 1013227511 0 SARMIENTO GUPANA PRISCILLA 2011220 9999999 B 10 1013227511 0 400 N HIGHLAND AVE AURORA IL 605063814 20 1013227511 0 Physicians Anesthesia Services 20 1013227511 0 Physicians Fluoride varnish 20 1013227511 0 Physicians Healthy Kids Services 20 1013227511 0 Physicians Optical Supplies 20 1013227511 0 Physicians Physician Services 00 1013228592 0 PRUITT JAMES A 2022198 9999999 B 10 1013228592 0 PO BOX 43230 PHOENIX AZ 850803230 20 1013228592 0 Physicians Anesthesia Services 20 1013228592 0 Physicians Healthy Kids Services 20 1013228592 0 Physicians Optical Supplies 20 1013228592 0 Physicians Physician Services 00 1013228642 0 PILLAI SHAJI 2024075 9999999 B 10 1013228642 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1013228642 0 Physicians Anesthesia Services 20 1013228642 0 Physicians Fluoride varnish 20 1013228642 0 Physicians Healthy Kids Services 20 1013228642 0 Physicians Optical Supplies 20 1013228642 0 Physicians Physician Services 00 1013228873 0 PICKER DAVID M 2016195 9999999 B 10 1013228873 0 12101 WOODCREST EXECUTIVE DR S SAINT LOUIS MO 631415047 20 1013228873 0 Physicians Anesthesia Services 20 1013228873 0 Physicians Fluoride varnish 20 1013228873 0 Physicians Healthy Kids Services 20 1013228873 0 Physicians Optical Supplies 20 1013228873 0 Physicians Physician Services 00 1013228881 0 CARICATO JOSEPH J 2020279 9999999 B 10 1013228881 0 2547 PLAINFIELD NAPERVILLE RD NAPERVILLE IL 605648701 20 1013228881 0 Physical Therapists Medical Supplies 20 1013228881 0 Physical Therapists Medical equipment/prosthetic devices 20 1013228881 0 Physical Therapists Physical Therapy Services 00 1013228907 0 BRUCE TIMOTHY P 2019008 9999999 B 10 1013228907 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1013228907 0 Physicians Anesthesia Services 20 1013228907 0 Physicians Healthy Kids Services 20 1013228907 0 Physicians Optical Supplies 20 1013228907 0 Physicians Physician Services 00 1013229095 0 REAMS NICOLE D 2015166 9999999 B 10 1013229095 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1013229095 0 Physicians Anesthesia Services 20 1013229095 0 Physicians Healthy Kids Services 20 1013229095 0 Physicians Optical Supplies 20 1013229095 0 Physicians Physician Services 20 1013229095 0 Physicians Physicians Psychiatric Services 00 1013229178 0 SANTUCCI JESSICA A 2022202 9999999 B 10 1013229178 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1013229178 0 Physicians Anesthesia Services 20 1013229178 0 Physicians Healthy Kids Services 20 1013229178 0 Physicians Optical Supplies 20 1013229178 0 Physicians Physician Services 00 1013229368 0 TITSWORTH WILLIAM L 2017200 9999999 B 10 1013229368 0 2605 KENTUCKY AVE STE 306 PADUCAH KY 420033802 20 1013229368 0 Physicians Anesthesia Services 20 1013229368 0 Physicians Healthy Kids Services 20 1013229368 0 Physicians Optical Supplies 20 1013229368 0 Physicians Physician Services 00 1013229988 0 ABDEL JABER ABDEL KADER H 2013196 9999999 B 10 1013229988 0 PO BOX 3988 CARBONDALE IL 629023988 20 1013229988 0 Physicians Anesthesia Services 20 1013229988 0 Physicians Fluoride varnish 20 1013229988 0 Physicians Healthy Kids Services 20 1013229988 0 Physicians Optical Supplies 20 1013229988 0 Physicians Physician Services 00 1013230119 0 BLUE DAVID 2010021 9999999 B 10 1013230119 0 1900 STATE ST CHESTER IL 622331116 20 1013230119 0 Nurse Practitioners Anesthesia Services 20 1013230119 0 Nurse Practitioners Nurse Practitioners Services 20 1013230119 0 Nurse Practitioners Physician Services 00 1013233006 0 ESPARZA NEREIDA 2013189 9999999 B 10 1013233006 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1013233006 0 Physicians Anesthesia Services 20 1013233006 0 Physicians Fluoride varnish 20 1013233006 0 Physicians Healthy Kids Services 20 1013233006 0 Physicians Optical Supplies 20 1013233006 0 Physicians Physician Services 00 1013233022 0 WEHRHEIM KARLA K 2017233 9999999 B 10 1013233022 0 29373 NETWORK PL CHICAGO IL 606733039 20 1013233022 0 Physicians Anesthesia Services 20 1013233022 0 Physicians Fluoride varnish 20 1013233022 0 Physicians Healthy Kids Services 20 1013233022 0 Physicians Optical Supplies 20 1013233022 0 Physicians Physician Services 00 1013233279 0 PARNELL JAMES A 2017213 9999999 B 10 1013233279 0 5380 TECH DATA DR STE 101 CLEARWATER FL 337603122 20 1013233279 0 Physicians Anesthesia Services 20 1013233279 0 Physicians Healthy Kids Services 20 1013233279 0 Physicians Optical Supplies 20 1013233279 0 Physicians Physician Services 00 1013234368 0 GHANAAT MAHYAR 2023248 9999999 B 10 1013234368 0 PO BOX 208807 DALLAS TX 753208807 20 1013234368 0 Physicians Anesthesia Services 20 1013234368 0 Physicians Healthy Kids Services 20 1013234368 0 Physicians Optical Supplies 20 1013234368 0 Physicians Physician Services 00 1013236405 0 MEDINA-GARCIA LUIS 2020356 9999999 B 10 1013236405 0 1800 W CHARLESTON BLVD LAS VEGAS NV 891022329 20 1013236405 0 Physicians Anesthesia Services 20 1013236405 0 Physicians Fluoride varnish 20 1013236405 0 Physicians Healthy Kids Services 20 1013236405 0 Physicians Optical Supplies 20 1013236405 0 Physicians Physician Services 00 1013237122 0 PAWAR ROHIT 2017223 9999999 B 10 1013237122 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1013237122 0 Physicians Anesthesia Services 20 1013237122 0 Physicians Healthy Kids Services 20 1013237122 0 Physicians Optical Supplies 20 1013237122 0 Physicians Physician Services 20 1013237122 0 Physicians Physicians Psychiatric Services 00 1013237825 0 CELESTE JORDAN 2020055 9999999 B 10 1013237825 0 PO BOX 43230 PHOENIX AZ 850803230 20 1013237825 0 Physicians Anesthesia Services 20 1013237825 0 Physicians Healthy Kids Services 20 1013237825 0 Physicians Optical Supplies 20 1013237825 0 Physicians Physician Services 00 1013238005 0 VANCE DAWN 2023087 9999999 B 10 1013238005 0 PO BOX 748465 ATLANTA GA 303748465 20 1013238005 0 Other behavior health professional LCPC/LMFT services 00 1013238278 0 KIM HYO-JIN 2013238 9999999 B 10 1013238278 0 29373 NETWORK PL CHICAGO IL 606733039 20 1013238278 0 Physicians Anesthesia Services 20 1013238278 0 Physicians Fluoride varnish 20 1013238278 0 Physicians Healthy Kids Services 20 1013238278 0 Physicians Optical Supplies 20 1013238278 0 Physicians Physician Services 00 1013238310 0 HOQUE SARAH 2014245 9999999 B 10 1013238310 0 2001 S CALIFORNIA AVE # 100 CHICAGO IL 606082486 20 1013238310 0 Physicians Anesthesia Services 20 1013238310 0 Physicians Healthy Kids Services 20 1013238310 0 Physicians Optical Supplies 20 1013238310 0 Physicians Physician Services 00 1013239896 0 BARNES WILLIAM 2018362 9999999 B 10 1013239896 0 1361 W FREMONT ST GALESBURG IL 614012436 20 1013239896 0 Clinical Social Worker Social work service 00 1013240597 0 PURVIANCE DONNA 2009243 9999999 B 10 1013240597 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1013240597 0 Nurse Practitioners Fluoride varnish 20 1013240597 0 Nurse Practitioners Healthy Kids Services 20 1013240597 0 Nurse Practitioners Nurse Practitioners Services 20 1013240597 0 Nurse Practitioners Physician Services 00 1013241686 0 MOHRMANN CAROLINE E 2009362 9999999 B 10 1013241686 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1013241686 0 Nurse Practitioners Fluoride varnish 20 1013241686 0 Nurse Practitioners Healthy Kids Services 20 1013241686 0 Nurse Practitioners Nurse Practitioners Services 20 1013241686 0 Nurse Practitioners Physician Services 00 1013243112 0 BRANDSMA ERIK 2024153 9999999 B 10 1013243112 0 100 E PENN SQ FL 9 PHILADELPHIA PA 191073377 20 1013243112 0 Physicians Anesthesia Services 20 1013243112 0 Physicians Fluoride varnish 20 1013243112 0 Physicians Healthy Kids Services 20 1013243112 0 Physicians Optical Supplies 20 1013243112 0 Physicians Physician Services 00 1013243161 0 KALLADANTHYIL ANN S 2016266 9999999 B 10 1013243161 0 2017 75TH ST WOODRIDGE IL 605172308 20 1013243161 0 Optometrists Optical Supplies 20 1013243161 0 Optometrists Optometric Services 20 1013243161 0 Optometrists Physician Services 00 1013243476 0 KHAIROVA RUSHANIYA 2013224 9999999 B 10 1013243476 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1013243476 0 Physicians Anesthesia Services 20 1013243476 0 Physicians Healthy Kids Services 20 1013243476 0 Physicians Optical Supplies 20 1013243476 0 Physicians Physician Services 20 1013243476 0 Physicians Physicians Psychiatric Services 00 1013243765 0 OLPINSKI MARIAN 2011307 9999999 B 10 1013243765 0 800 BIESTERFIELD RD STE 408 ELK GROVE VILLA IL 600073378 20 1013243765 0 Physicians Anesthesia Services 20 1013243765 0 Physicians Healthy Kids Services 20 1013243765 0 Physicians Optical Supplies 20 1013243765 0 Physicians Physician Services 00 1013244334 0 ROSALES MIRIAM 2015338 9999999 B 10 1013244334 0 5341 W CERMAK RD CICERO IL 608042817 20 1013244334 0 Other behavior health professional LCPC/LMFT services 20 1013244334 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1013245968 0 RAHMAN SHAHNAZ 2023179 9999999 B 10 1013245968 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1013245968 0 Physicians Anesthesia Services 20 1013245968 0 Physicians Healthy Kids Services 20 1013245968 0 Physicians Optical Supplies 20 1013245968 0 Physicians Physician Services 00 1013247733 0 LARSEN JESSICA A 2016158 9999999 B 10 1013247733 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1013247733 0 Physician Assistant Only Fluoride varnish 20 1013247733 0 Physician Assistant Only Healthy Kids Services 20 1013247733 0 Physician Assistant Only Physician Services 00 1013248681 0 ALTARABSHEH SALAH ELDIEN 2024291 9999999 B 10 1013248681 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1013248681 0 Physicians Anesthesia Services 20 1013248681 0 Physicians Fluoride varnish 20 1013248681 0 Physicians Healthy Kids Services 20 1013248681 0 Physicians Optical Supplies 20 1013248681 0 Physicians Physician Services 00 1013249879 0 LARSON ANN 2010056 9999999 B 10 1013249879 0 201 E PLEASANT ST TAYLORVILLE IL 625681562 20 1013249879 0 Nurse Practitioners Anesthesia Services 20 1013249879 0 Nurse Practitioners Nurse Practitioners Services 20 1013249879 0 Nurse Practitioners Physician Services 00 1013250315 0 MURUGAPPAN KADHIRESAN 2022287 9999999 B 10 1013250315 0 PO BOX 411637 SAINT LOUIS MO 631411637 20 1013250315 0 Physicians Anesthesia Services 20 1013250315 0 Physicians Healthy Kids Services 20 1013250315 0 Physicians Optical Supplies 20 1013250315 0 Physicians Physician Services 00 1013250521 0 RABON LYDIA 2020334 9999999 B 10 1013250521 0 PO BOX 43230 PHOENIX AZ 850803230 20 1013250521 0 Physicians Anesthesia Services 20 1013250521 0 Physicians Fluoride varnish 20 1013250521 0 Physicians Healthy Kids Services 20 1013250521 0 Physicians Optical Supplies 20 1013250521 0 Physicians Physician Services 00 1013250695 0 HENDLER STEVEN 2019227 9999999 B 10 1013250695 0 1400 S MICHIGAN AVE APT 1203 CHICAGO IL 606053720 20 1013250695 0 Physicians Anesthesia Services 20 1013250695 0 Physicians Fluoride varnish 20 1013250695 0 Physicians Healthy Kids Services 20 1013250695 0 Physicians Optical Supplies 20 1013250695 0 Physicians Physician Services 00 1013250737 0 JOHNSON BRAD A 2019312 9999999 B 10 1013250737 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1013250737 0 Physicians Anesthesia Services 20 1013250737 0 Physicians Healthy Kids Services 20 1013250737 0 Physicians Optical Supplies 20 1013250737 0 Physicians Physician Services 00 1013250885 0 HAHN GRANT R 2019121 9999999 B 10 1013250885 0 6501 S PROMONTORY DR CHICAGO IL 606491003 20 1013250885 0 Physicians Anesthesia Services 20 1013250885 0 Physicians Fluoride varnish 20 1013250885 0 Physicians Healthy Kids Services 20 1013250885 0 Physicians Optical Supplies 20 1013250885 0 Physicians Physician Services 00 1013251057 0 SWAMINATHAN ARUN X 2020022 9999999 B 10 1013251057 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1013251057 0 Physicians Anesthesia Services 20 1013251057 0 Physicians Healthy Kids Services 20 1013251057 0 Physicians Optical Supplies 20 1013251057 0 Physicians Physician Services 20 1013251057 0 Physicians Physicians Psychiatric Services 00 1013251347 0 KHAN FARHAN 2022228 9999999 B 10 1013251347 0 5665 NEW NORTHSIDE DR STE 320 ATLANTA GA 303285834 20 1013251347 0 Physicians Anesthesia Services 20 1013251347 0 Physicians Fluoride varnish 20 1013251347 0 Physicians Healthy Kids Services 20 1013251347 0 Physicians Optical Supplies 20 1013251347 0 Physicians Physician Services 00 1013251693 0 PHIPPS HELEN 2012331 9999999 B 10 1013251693 0 PO BOX 684 BEDFORD PARK IL 604990684 20 1013251693 0 Nurse Practitioners Healthy Kids Services 20 1013251693 0 Nurse Practitioners Nurse Practitioners Services 20 1013251693 0 Nurse Practitioners Physician Services 00 1013253384 0 PETRUSEVSKA ELENA 2015264 9999999 B 10 1013253384 0 PO BOX 775231 CHICAGO IL 606775231 20 1013253384 0 Physician Assistant Only Fluoride varnish 20 1013253384 0 Physician Assistant Only Healthy Kids Services 20 1013253384 0 Physician Assistant Only Physician Services 00 1013253970 0 BOIRE AFOUSSATOU 2012355 9999999 B 10 1013253970 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1013253970 0 Nurse Practitioners Healthy Kids Services 20 1013253970 0 Nurse Practitioners Nurse Practitioners Services 20 1013253970 0 Nurse Practitioners Physician Services 00 1013254259 0 JOHNSON KELLY 2012365 9999999 B 10 1013254259 0 611 W PARK ST URBANA IL 618012529 20 1013254259 0 Nurse Practitioners Healthy Kids Services 20 1013254259 0 Nurse Practitioners Nurse Practitioners Services 20 1013254259 0 Nurse Practitioners Physician Services 00 1013254333 0 SANTELLA MARY KAY 1999179 9999999 B 10 1013254333 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1013254333 0 Physical Therapists Medical Supplies 20 1013254333 0 Physical Therapists Medical equipment/prosthetic devices 20 1013254333 0 Physical Therapists Physical Therapy Services 00 1013255975 0 DIAMOND RUTH 2013352 9999999 B 10 1013255975 0 2361 PAYSPHERE CIR CHICAGO IL 606740023 20 1013255975 0 Nurse Practitioners Fluoride varnish 20 1013255975 0 Nurse Practitioners Healthy Kids Services 20 1013255975 0 Nurse Practitioners Nurse Practitioners Services 20 1013255975 0 Nurse Practitioners Physician Services 00 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136TH AVE STE 100 SUNRISE FL 333232857 20 1013362334 0 Physicians Anesthesia Services 20 1013362334 0 Physicians Fluoride varnish 20 1013362334 0 Physicians Healthy Kids Services 20 1013362334 0 Physicians Optical Supplies 20 1013362334 0 Physicians Physician Services 00 1013362672 0 WILEY LORI 2017282 9999999 B 10 1013362672 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1013362672 0 Nurse Practitioners Healthy Kids Services 20 1013362672 0 Nurse Practitioners Nurse Practitioners Services 20 1013362672 0 Nurse Practitioners Physician Services 00 1013362888 0 THOMAS CATHERINE J 2020008 9999999 B 10 1013362888 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1013362888 0 Physicians Anesthesia Services 20 1013362888 0 Physicians Healthy Kids Services 20 1013362888 0 Physicians Optical Supplies 20 1013362888 0 Physicians Physician Services 00 1013363290 0 DIVENTI CRISTINA 2018199 9999999 B 10 1013363290 0 1200 W STATE ST ROCKFORD IL 611022112 20 1013363290 0 Clinical Social 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HEMMELE BRITTANY N 2016199 9999999 B 10 1013369149 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1013369149 0 Nurse Practitioners Fluoride varnish 20 1013369149 0 Nurse Practitioners Healthy Kids Services 20 1013369149 0 Nurse Practitioners Nurse Practitioners Services 20 1013369149 0 Nurse Practitioners Physician Services 00 1013369578 0 HAUSER MEIR 2020061 9999999 B 10 1013369578 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1013369578 0 Psychologist Psychologist service 00 1013369628 0 MASSIE CHARLES J 2017184 9999999 B 10 1013369628 0 1003 MARTIN LUTHER KING DR BLOOMINGTON IL 617011429 20 1013369628 0 Other behavior health professional LCPC/LMFT services 00 1013370022 0 DENNEY LINDSEY ANN SHARP 2018244 9999999 B 10 1013370022 0 5380 TECH DATA DR STE 101 CLEARWATER FL 337603122 20 1013370022 0 Physicians Anesthesia Services 20 1013370022 0 Physicians Healthy Kids Services 20 1013370022 0 Physicians Optical Supplies 20 1013370022 0 Physicians Physician Services 00 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Physician Services 00 1013371483 0 MAXEY TICHIYA 2017318 9999999 B 10 1013371483 0 6912 MAIN ST STE 123 DOWNERS GROVE IL 605163440 20 1013371483 0 Clinical Social Worker Social work service 00 1013371996 0 LAROY VALERIE A 2020061 9999999 B 10 1013371996 0 29373 NETWORK PL CHICAGO IL 606733039 20 1013371996 0 Nurse Practitioners Fluoride varnish 20 1013371996 0 Nurse Practitioners Healthy Kids Services 20 1013371996 0 Nurse Practitioners Nurse Practitioners Services 20 1013371996 0 Nurse Practitioners Physician Services 00 1013373588 0 EVANS JASMINE 2019182 9999999 B 10 1013373588 0 101 E STATE ST KENNETT SQUARE PA 193483109 20 1013373588 0 Physical Therapists Medical Supplies 20 1013373588 0 Physical Therapists Medical equipment/prosthetic devices 20 1013373588 0 Physical Therapists Physical Therapy Services 00 1013374677 0 MEHTA HETALBEN 2023283 9999999 B 10 1013374677 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1013374677 0 Physical Therapists Medical Supplies 20 1013374677 0 Physical Therapists Medical equipment/prosthetic devices 20 1013374677 0 Physical Therapists Physical Therapy Services 00 1013375351 0 SHEA MELANIE 2016124 9999999 B 10 1013375351 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1013375351 0 Physician Assistant Only Fluoride varnish 20 1013375351 0 Physician Assistant Only Healthy Kids Services 20 1013375351 0 Physician Assistant Only Physician Services 00 1013376201 0 NEWBURN VERONICA 2021200 9999999 B 10 1013376201 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1013376201 0 Physician Assistant Only Fluoride varnish 20 1013376201 0 Physician Assistant Only Healthy Kids Services 20 1013376201 0 Physician Assistant Only Physician Services 00 1013376581 0 TURNER JACQUELINE 2016104 9999999 B 10 1013376581 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1013376581 0 Nurse Practitioners Fluoride varnish 20 1013376581 0 Nurse Practitioners Healthy Kids Services 20 1013376581 0 Nurse Practitioners Nurse Practitioners Services 20 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20 1013585397 0 Physicians Optical Supplies 20 1013585397 0 Physicians Physician Services 00 1013585736 0 SOM AVIRA 2021231 9999999 B 10 1013585736 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1013585736 0 Physicians Anesthesia Services 20 1013585736 0 Physicians Fluoride varnish 20 1013585736 0 Physicians Healthy Kids Services 20 1013585736 0 Physicians Optical Supplies 20 1013585736 0 Physicians Physician Services 00 1013586064 0 OZMINKOWSKI ERIN 2023158 9999999 B 10 1013586064 0 4701 DEPT CAROL STREAM IL 601220021 20 1013586064 0 Physicians Anesthesia Services 20 1013586064 0 Physicians Fluoride varnish 20 1013586064 0 Physicians Healthy Kids Services 20 1013586064 0 Physicians Optical Supplies 20 1013586064 0 Physicians Physician Services 00 1013586114 0 SPENCER MADELINE 2021179 9999999 B 10 1013586114 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1013586114 0 Physicians Anesthesia Services 20 1013586114 0 Physicians Fluoride varnish 20 1013586114 0 Physicians Healthy Kids Services 20 1013586114 0 Physicians Optical Supplies 20 1013586114 0 Physicians Physician Services 00 1013586916 0 BURTLE ADDIE S 2021222 9999999 B 10 1013586916 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1013586916 0 Physicians Anesthesia Services 20 1013586916 0 Physicians Healthy Kids Services 20 1013586916 0 Physicians Optical Supplies 20 1013586916 0 Physicians Physician Services 00 1013587252 0 THARP BRITNI 2023048 9999999 B 10 1013587252 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1013587252 0 Nurse Practitioners Anesthesia Services 20 1013587252 0 Nurse Practitioners Nurse Practitioners Services 20 1013587252 0 Nurse Practitioners Physician Services 00 1013587658 0 CHEN REBECCA S 2021216 9999999 B 10 1013587658 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1013587658 0 Physicians Anesthesia Services 20 1013587658 0 Physicians Healthy Kids Services 20 1013587658 0 Physicians Optical Supplies 20 1013587658 0 Physicians Physician Services 00 1013588607 0 PEDIAN AUSTINAH 2021193 9999999 B 10 1013588607 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1013588607 0 Physician Assistant Only Fluoride varnish 20 1013588607 0 Physician Assistant Only Healthy Kids Services 20 1013588607 0 Physician Assistant Only Physician Services 00 1013588698 0 KURAMITSU KENJI 2021187 9999999 B 10 1013588698 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1013588698 0 Clinical Social Worker Social work service 00 1013588995 0 VANNOY KADAR 2021187 9999999 B 10 1013588995 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1013588995 0 Physicians Anesthesia Services 20 1013588995 0 Physicians Fluoride varnish 20 1013588995 0 Physicians Healthy Kids Services 20 1013588995 0 Physicians Optical Supplies 20 1013588995 0 Physicians Physician Services 00 1013591502 0 MONTGOMERY ERIN 2023128 9999999 B 10 1013591502 0 PO BOX 781076 DETROIT MI 482781076 20 1013591502 0 Physician Assistant Only Fluoride varnish 20 1013591502 0 Physician Assistant Only Healthy Kids Services 20 1013591502 0 Physician Assistant Only Physician Services 00 1013591726 0 BUIRAT OSAYD S 2022118 9999999 B 10 1013591726 0 PO BOX 3039 OAK BROOK IL 605223039 20 1013591726 0 Physicians Anesthesia Services 20 1013591726 0 Physicians Fluoride varnish 20 1013591726 0 Physicians Healthy Kids Services 20 1013591726 0 Physicians Optical Supplies 20 1013591726 0 Physicians Physician Services 00 1013592104 0 CHO TIMOTHY 2021200 9999999 B 10 1013592104 0 611 W PARK ST URBANA IL 618012529 20 1013592104 0 Physicians Anesthesia Services 20 1013592104 0 Physicians Healthy Kids Services 20 1013592104 0 Physicians Optical Supplies 20 1013592104 0 Physicians Physician Services 00 1013592740 0 KEE SUMMER 2022208 9999999 B 10 1013592740 0 501 W OGDEN AVE STE 1 HINSDALE IL 605213184 20 1013592740 0 Nurse Practitioners Fluoride varnish 20 1013592740 0 Nurse Practitioners Healthy Kids Services 20 1013592740 0 Nurse Practitioners Nurse Practitioners Services 20 1013592740 0 Nurse Practitioners Physician Services 00 1013593532 0 POELLINGER NICHOLAS J 2021216 9999999 B 10 1013593532 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1013593532 0 Physicians Anesthesia Services 20 1013593532 0 Physicians Fluoride varnish 20 1013593532 0 Physicians Healthy Kids Services 20 1013593532 0 Physicians Optical Supplies 20 1013593532 0 Physicians Physician Services 00 1013593938 0 PATEL JULIE 2021316 9999999 B 10 1013593938 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1013593938 0 Physicians Anesthesia Services 20 1013593938 0 Physicians Healthy Kids Services 20 1013593938 0 Physicians Optical Supplies 20 1013593938 0 Physicians Physician Services 00 1013593995 0 ORAKZAI SHERAYAR 2021182 9999999 B 10 1013593995 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1013593995 0 Physicians Anesthesia Services 20 1013593995 0 Physicians Healthy Kids Services 20 1013593995 0 Physicians Optical Supplies 20 1013593995 0 Physicians Physician Services 00 1013594084 0 PLUMMER KALLI 2023075 9999999 B 10 1013594084 0 PO BOX 5588 BELFAST ME 049155500 20 1013594084 0 Physicians Anesthesia Services 20 1013594084 0 Physicians Healthy Kids Services 20 1013594084 0 Physicians Optical Supplies 20 1013594084 0 Physicians Physician Services 00 1013594472 0 PFEIFER ETHAN 2022144 9999999 B 10 1013594472 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1013594472 0 Physicians Anesthesia Services 20 1013594472 0 Physicians Fluoride varnish 20 1013594472 0 Physicians Healthy Kids Services 20 1013594472 0 Physicians Optical Supplies 20 1013594472 0 Physicians Physician Services 00 1013594571 0 CLARKE KREGOR ALEXANDRIA P 2021139 9999999 B 10 1013594571 0 29373 NETWORK PL CHICAGO IL 606733039 20 1013594571 0 Physicians Anesthesia Services 20 1013594571 0 Physicians Fluoride varnish 20 1013594571 0 Physicians Healthy Kids Services 20 1013594571 0 Physicians Optical Supplies 20 1013594571 0 Physicians Physician Services 00 1013594639 0 DROBATZ LIANNA M 2024183 9999999 B 10 1013594639 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1013594639 0 Physicians Anesthesia Services 20 1013594639 0 Physicians Fluoride varnish 20 1013594639 0 Physicians Healthy Kids Services 20 1013594639 0 Physicians Optical Supplies 20 1013594639 0 Physicians Physician Services 00 1013594803 0 GUPTA RAHUL 2024197 9999999 B 10 1013594803 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1013594803 0 Physicians Anesthesia Services 20 1013594803 0 Physicians Healthy Kids Services 20 1013594803 0 Physicians Optical Supplies 20 1013594803 0 Physicians Physician Services 00 1013595289 0 MIRANDA ESTEBAN 2021182 9999999 B 10 1013595289 0 836 W WELLINGTON AVE CHICAGO IL 606575147 20 1013595289 0 Physicians Anesthesia Services 20 1013595289 0 Physicians Fluoride varnish 20 1013595289 0 Physicians Healthy Kids Services 20 1013595289 0 Physicians Optical Supplies 20 1013595289 0 Physicians Physician Services 00 1013596030 0 LE ELIZABETH 2024287 9999999 B 10 1013596030 0 PO BOX 43230 PHOENIX AZ 850803230 20 1013596030 0 Physicians Anesthesia Services 20 1013596030 0 Physicians Healthy Kids Services 20 1013596030 0 Physicians Optical Supplies 20 1013596030 0 Physicians Physician Services 00 1013596246 0 KHAN ABIGAIL 2021215 9999999 B 10 1013596246 0 2215 SANDERS RD STE 105 SUITE 105 NORTHBROOK IL 600626194 20 1013596246 0 Physicians Anesthesia Services 20 1013596246 0 Physicians Fluoride varnish 20 1013596246 0 Physicians Healthy Kids Services 20 1013596246 0 Physicians Optical Supplies 20 1013596246 0 Physicians Physician Services 00 1013596386 0 QADDOUR NOOR 2021182 9999999 B 10 1013596386 0 4440 W 95TH ST OAK LAWN IL 604532600 20 1013596386 0 Physicians Anesthesia Services 20 1013596386 0 Physicians Fluoride varnish 20 1013596386 0 Physicians Healthy Kids Services 20 1013596386 0 Physicians Optical Supplies 20 1013596386 0 Physicians Physician Services 00 1013596485 0 KOOPMANN HEATHER A 2021168 9999999 B 10 1013596485 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1013596485 0 Audiologists Audiology Services 20 1013596485 0 Audiologists Medical Supplies 20 1013596485 0 Audiologists Medical equipment/prosthetic devices 00 1013596543 0 KERR LAURA 2022346 9999999 B 10 1013596543 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1013596543 0 Physical Therapists Medical Supplies 20 1013596543 0 Physical Therapists Medical equipment/prosthetic devices 20 1013596543 0 Physical Therapists Physical Therapy Services 00 1013596584 0 SEKARAN KANITHRA C 2024199 9999999 B 10 1013596584 0 5777 DEPT CAROL STREAM IL 601220021 20 1013596584 0 Physicians Anesthesia Services 20 1013596584 0 Physicians Healthy Kids Services 20 1013596584 0 Physicians Optical Supplies 20 1013596584 0 Physicians Physician Services 00 1013596733 0 EKWEMPU CHUKWUNONYELUM 2024247 9999999 B 10 1013596733 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1013596733 0 Physicians Anesthesia Services 20 1013596733 0 Physicians Healthy Kids Services 20 1013596733 0 Physicians Optical Supplies 20 1013596733 0 Physicians Physician Services 00 1013597681 0 GOLDEN MATTHEW E 2022195 9999999 B 10 1013597681 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1013597681 0 Physicians Anesthesia Services 20 1013597681 0 Physicians Fluoride varnish 20 1013597681 0 Physicians Healthy Kids Services 20 1013597681 0 Physicians Optical Supplies 20 1013597681 0 Physicians Physician Services 00 1013597996 0 QUEVEDO GABRIELLA KRISTINA 2021186 9999999 B 10 1013597996 0 7732 SOLUTION CENTER CHICAGO IL 606777007 20 1013597996 0 Dentists Dental Services 20 1013597996 0 Dentists Physician Services 00 1013598267 0 AHMED SAIRA 2022307 9999999 B 10 1013598267 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1013598267 0 Physicians Anesthesia Services 20 1013598267 0 Physicians Healthy Kids Services 20 1013598267 0 Physicians Optical Supplies 20 1013598267 0 Physicians Physician Services 00 1013599182 0 WARAICH SAAD 2021223 9999999 B 10 1013599182 0 4698 DEPT CAROL STREAM IL 601224698 20 1013599182 0 Physicians Anesthesia Services 20 1013599182 0 Physicians Fluoride varnish 20 1013599182 0 Physicians Healthy Kids Services 20 1013599182 0 Physicians Optical Supplies 20 1013599182 0 Physicians Physician Services 00 1013600295 0 PANG CALEB 2024193 9999999 B 10 1013600295 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1013600295 0 Physicians Anesthesia Services 20 1013600295 0 Physicians Healthy Kids Services 20 1013600295 0 Physicians Optical Supplies 20 1013600295 0 Physicians Physician Services 00 1013601574 0 CHAUDHARI GANESH P 2024022 9999999 B 10 1013601574 0 17W679 ROOSEVELT RD OAKBROOK TERRAC IL 601813545 20 1013601574 0 Dentists Dental Services 20 1013601574 0 Dentists Physician Services 00 1013601632 0 BOSE SHREE 2023194 9999999 B 10 1013601632 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1013601632 0 Physicians Anesthesia Services 20 1013601632 0 Physicians Fluoride varnish 20 1013601632 0 Physicians Healthy Kids Services 20 1013601632 0 Physicians Optical Supplies 20 1013601632 0 Physicians Physician Services 00 1013604636 0 BENDEL BRIAN C 2023200 9999999 B 10 1013604636 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1013604636 0 Nurse Practitioners Anesthesia Services 20 1013604636 0 Nurse Practitioners Nurse Practitioners Services 20 1013604636 0 Nurse Practitioners Physician Services 00 1013604990 0 TEYTELBAUM DAVID 2023194 9999999 B 10 1013604990 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1013604990 0 Physicians Anesthesia Services 20 1013604990 0 Physicians Healthy Kids Services 20 1013604990 0 Physicians Optical Supplies 20 1013604990 0 Physicians Physician Services 00 1013606011 0 GREER DONALD E 2024241 9999999 B 10 1013606011 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1013606011 0 Nurse Practitioners Fluoride varnish 20 1013606011 0 Nurse Practitioners Healthy Kids Services 20 1013606011 0 Nurse Practitioners Nurse Practitioners Services 20 1013606011 0 Nurse Practitioners Physician Services 00 1013606136 0 DESHPANDE ABHISHEK 2024046 9999999 B 10 1013606136 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1013606136 0 Physicians Anesthesia Services 20 1013606136 0 Physicians Healthy Kids Services 20 1013606136 0 Physicians Optical Supplies 20 1013606136 0 Physicians Physician Services 00 1013606433 0 CONWAY FAITH 2024324 9999999 B 10 1013606433 0 4835 MANHATTAN DR ROCKFORD IL 611082265 20 1013606433 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1013607381 0 MEDINA PAMELA 2024219 9999999 B 10 1013607381 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1013607381 0 Physical Therapists HIV Counseling svcs 20 1013607381 0 Physical Therapists Medical Supplies 20 1013607381 0 Physical Therapists Medical equipment/prosthetic devices 20 1013607381 0 Physical Therapists Physical Therapy Services 00 1013607589 0 ZUNIGA ELLA P 2023308 9999999 B 10 1013607589 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1013607589 0 Nurse Practitioners Fluoride varnish 20 1013607589 0 Nurse Practitioners Healthy Kids Services 20 1013607589 0 Nurse Practitioners Nurse Practitioners Services 20 1013607589 0 Nurse Practitioners Physician Services 00 1013608033 0 LI ALICE 2023177 9999999 B 10 1013608033 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1013608033 0 Physicians Anesthesia Services 20 1013608033 0 Physicians Healthy Kids Services 20 1013608033 0 Physicians Optical Supplies 20 1013608033 0 Physicians Physician Services 20 1013608033 0 Physicians Physicians Psychiatric Services 00 1013608876 0 GROVER SUNITA L 2023144 9999999 B 10 1013608876 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1013608876 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1013610856 0 KATZ SAMANTHA 2023257 9999999 B 10 1013610856 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1013610856 0 Physicians Anesthesia Services 20 1013610856 0 Physicians Fluoride varnish 20 1013610856 0 Physicians Healthy Kids Services 20 1013610856 0 Physicians Optical Supplies 20 1013610856 0 Physicians Physician Services 00 1013610971 0 JERUSAL SAMANTHA 2023251 9999999 B 10 1013610971 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1013610971 0 Nurse Practitioners Fluoride varnish 20 1013610971 0 Nurse Practitioners Healthy Kids Services 20 1013610971 0 Nurse Practitioners Nurse Practitioners Services 20 1013610971 0 Nurse Practitioners Physician Services 00 1013611029 0 MCKOWN HANNA 2023224 2026181 B 10 1013611029 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1013611029 0 Physicians Anesthesia Services 20 1013611029 0 Physicians Fluoride varnish 20 1013611029 0 Physicians Healthy Kids Services 20 1013611029 0 Physicians Optical Supplies 20 1013611029 0 Physicians Physician Services 00 1013611730 0 YAO CHRISTOPHER JASON 2023182 9999999 B 10 1013611730 0 PO BOX 3039 OAK BROOK IL 605223039 20 1013611730 0 Physicians Anesthesia Services 20 1013611730 0 Physicians Fluoride varnish 20 1013611730 0 Physicians Healthy Kids Services 20 1013611730 0 Physicians Optical Supplies 20 1013611730 0 Physicians Physician Services 00 1013611987 0 AYORINDE MOJISOLA 2023236 9999999 B 10 1013611987 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1013611987 0 Nurse Practitioners Healthy Kids Services 20 1013611987 0 Nurse Practitioners Nurse Practitioners Services 20 1013611987 0 Nurse Practitioners Physician Services 00 1013612944 0 MARDER EMILY J 2023100 9999999 B 10 1013612944 0 42 W MADISON ST FL 2 CHICAGO IL 606024309 20 1013612944 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1013614304 0 CLARK JACOB 2023255 9999999 B 10 1013614304 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1013614304 0 Physician Assistant Only Fluoride varnish 20 1013614304 0 Physician Assistant Only Healthy Kids Services 20 1013614304 0 Physician Assistant Only Physician Services 00 1013617646 0 FERMANICH CHRISTINA 2023088 9999999 B 10 1013617646 0 7108 S KANNER HWY STUART FL 349977462 20 1013617646 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1013618347 0 LIEDL HENRY 2024197 9999999 B 10 1013618347 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1013618347 0 Physicians Anesthesia Services 20 1013618347 0 Physicians Healthy Kids Services 20 1013618347 0 Physicians Optical Supplies 20 1013618347 0 Physicians Physician Services 00 1013619154 0 LUCK MARISA ELAINE 2023217 9999999 B 10 1013619154 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1013619154 0 Physicians Anesthesia Services 20 1013619154 0 Physicians Fluoride varnish 20 1013619154 0 Physicians Healthy Kids Services 20 1013619154 0 Physicians Optical Supplies 20 1013619154 0 Physicians Physician Services 00 1013619691 0 KALINOWSKA VANESSA 2023188 9999999 B 10 1013619691 0 4698 DEPT CAROL STREAM IL 601220021 20 1013619691 0 Physicians Anesthesia Services 20 1013619691 0 Physicians Healthy Kids Services 20 1013619691 0 Physicians Optical Supplies 20 1013619691 0 Physicians Physician Services 00 1013620376 0 JOHNSON HANNAH D 2023117 9999999 B 10 1013620376 0 611 W PARK ST URBANA IL 618012529 20 1013620376 0 Nurse Practitioners Healthy Kids Services 20 1013620376 0 Nurse Practitioners Nurse Practitioners Services 20 1013620376 0 Nurse Practitioners Physician Services 00 1013621283 0 RAJU JOHN 2023051 9999999 B 10 1013621283 0 PO BOX 2477 SHELTON CT 064841477 20 1013621283 0 Nurse Practitioners Fluoride varnish 20 1013621283 0 Nurse Practitioners Healthy Kids Services 20 1013621283 0 Nurse Practitioners Nurse Practitioners Services 20 1013621283 0 Nurse Practitioners Physician Services 00 1013625185 0 ELMAHASSNI JOANN 2023338 9999999 B 10 1013625185 0 1220 HOBSON RD STE 232 NAPERVILLE IL 605408138 20 1013625185 0 Nurse Practitioners Fluoride varnish 20 1013625185 0 Nurse Practitioners Healthy Kids Services 20 1013625185 0 Nurse Practitioners Nurse Practitioners Services 20 1013625185 0 Nurse Practitioners Physician Services 00 1013626720 0 KHAN WAJAHAT 2022348 9999999 B 10 1013626720 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1013626720 0 Physician Assistant Only Fluoride varnish 20 1013626720 0 Physician Assistant Only Healthy Kids Services 20 1013626720 0 Physician Assistant Only Physician Services 00 1013633544 0 DRISCOLL KRISTY L 2023303 9999999 B 10 1013633544 0 424 DES PLAINES AVE FOREST PARK IL 601301718 20 1013633544 0 Speech Therapists Medical Supplies 20 1013633544 0 Speech Therapists Medical equipment/prosthetic devices 20 1013633544 0 Speech Therapists Speech Therapy/Pathology Services 00 1013635234 0 CAVANAUGH MATTHEW 2023090 9999999 B 10 1013635234 0 938 N CALIFORNIA AVE CHICAGO IL 606224462 20 1013635234 0 Clinical Social Worker Social work service 00 1013635465 0 MARSH SALITHIA 2022259 9999999 B 10 1013635465 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1013635465 0 Nurse Practitioners Fluoride varnish 20 1013635465 0 Nurse Practitioners Healthy Kids Services 20 1013635465 0 Nurse Practitioners Nurse Practitioners Services 20 1013635465 0 Nurse Practitioners Physician Services 00 1013637867 0 DEHNING LARISSA R 2023062 9999999 B 10 1013637867 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1013637867 0 Physician Assistant Only Fluoride varnish 20 1013637867 0 Physician Assistant Only Healthy Kids Services 20 1013637867 0 Physician Assistant Only Physician Services 00 1013638352 0 PATTY NATALIE 2023293 9999999 B 10 1013638352 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1013638352 0 Physician Assistant Only Fluoride varnish 20 1013638352 0 Physician Assistant Only Healthy Kids Services 20 1013638352 0 Physician Assistant Only Physician Services 00 1013639376 0 FIFE CASSANDRA 2023058 9999999 B 10 1013639376 0 6 WESTPORT CT BLOOMINGTON IL 617048233 20 1013639376 0 Nurse Practitioners Healthy Kids Services 20 1013639376 0 Nurse Practitioners Midwife Services 20 1013639376 0 Nurse Practitioners Nurse Practitioners Services 20 1013639376 0 Nurse Practitioners Physician Services 00 1013639392 0 POTTS-DANIEL TIFFANY M 2024214 9999999 B 10 1013639392 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1013639392 0 Psychologist Psychologist service 00 1013640440 0 DECAMP LAUREN 2023065 9999999 B 10 1013640440 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1013640440 0 Nurse Practitioners Fluoride varnish 20 1013640440 0 Nurse Practitioners Healthy Kids Services 20 1013640440 0 Nurse Practitioners Nurse Practitioners Services 20 1013640440 0 Nurse Practitioners Physician Services 00 1013641539 0 FIGUEROA JESSICA 2022238 9999999 B 10 1013641539 0 1400 S MICHIGAN AVE APT 1203 CHICAGO IL 606053720 20 1013641539 0 Physician Assistant Only Fluoride varnish 20 1013641539 0 Physician Assistant Only Healthy Kids Services 20 1013641539 0 Physician Assistant Only Physician Services 00 1013642560 0 BAILEY STEPHANIE A 2022249 9999999 B 10 1013642560 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1013642560 0 Clinical Social Worker Social work service 00 1013643238 0 CARLSON ANDREA 2023234 9999999 B 10 1013643238 0 1400 W GREENLEAF AVE CHICAGO IL 606262805 20 1013643238 0 Occupational Therapists Medical Supplies 20 1013643238 0 Occupational Therapists Medical equipment/prosthetic devices 20 1013643238 0 Occupational Therapists Occupational Therapy Services 00 1013643378 0 PATEL DHARA 2023353 9999999 B 10 1013643378 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1013643378 0 Nurse Practitioners Fluoride varnish 20 1013643378 0 Nurse Practitioners Healthy Kids Services 20 1013643378 0 Nurse Practitioners Nurse Practitioners Services 20 1013643378 0 Nurse Practitioners Physician Services 00 1013643386 0 ROBBINS ANNA 2022236 9999999 B 10 1013643386 0 355 RIDGE AVE EVANSTON IL 602023328 20 1013643386 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1013643790 0 YEHIA MADELEINE Y 2022277 9999999 B 10 1013643790 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1013643790 0 Physicians Anesthesia Services 20 1013643790 0 Physicians Healthy Kids Services 20 1013643790 0 Physicians Optical Supplies 20 1013643790 0 Physicians Physician Services 00 1013644103 0 PARGAL ARUN 2025043 9999999 B 10 1013644103 0 29373 NETWORK PL CHICAGO IL 606733039 20 1013644103 0 Physical Therapists Medical Supplies 20 1013644103 0 Physical Therapists Medical equipment/prosthetic devices 20 1013644103 0 Physical Therapists Physical Therapy Services 00 1013645720 0 LAWSON MIYOSHI Y 2022223 9999999 H 10 1013645720 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1013645720 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1013646033 0 AFREEN KASMANI ESHA 2022200 9999999 B 10 1013646033 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1013646033 0 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20 1013672856 0 Nurse Practitioners Healthy Kids Services 20 1013672856 0 Nurse Practitioners Nurse Practitioners Services 20 1013672856 0 Nurse Practitioners Physician Services 00 1013674100 0 STEINHORST KAYLA M 2022028 9999999 B 10 1013674100 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1013674100 0 Nurse Practitioners Anesthesia Services 20 1013674100 0 Nurse Practitioners Nurse Practitioners Services 20 1013674100 0 Nurse Practitioners Physician Services 00 1013674142 0 DUVALL MELISSA J 2022010 9999999 B 10 1013674142 0 PO BOX 1430 PORTAGE IN 463689230 20 1013674142 0 Chiropractors Chiropractic Services 00 1013674407 0 JACKSON-JONES ESSENCE 2022003 9999999 B 10 1013674407 0 1411 DUDLEY AVE MUSKEGON MI 494422204 20 1013674407 0 Other behavior health professional LCPC/LMFT services 00 1013674993 0 ANDERSON KELLEY M 2022081 9999999 B 10 1013674993 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1013674993 0 Nurse Practitioners Fluoride varnish 20 1013674993 0 Nurse Practitioners 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Physician Services 00 1013677921 0 WAZIR HINA 2024229 9999999 B 10 1013677921 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1013677921 0 Physicians Anesthesia Services 20 1013677921 0 Physicians Fluoride varnish 20 1013677921 0 Physicians Healthy Kids Services 20 1013677921 0 Physicians Optical Supplies 20 1013677921 0 Physicians Physician Services 00 1013678564 0 CASTEEL JASON 2024116 9999999 B 10 1013678564 0 328C N NEIL ST CHAMPAIGN IL 618203614 20 1013678564 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1013678655 0 DE MIGUEL ALBERTO 2023229 9999999 B 10 1013678655 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1013678655 0 Physician Assistant Only Fluoride varnish 20 1013678655 0 Physician Assistant Only Healthy Kids Services 20 1013678655 0 Physician Assistant Only Physician Services 00 1013679299 0 CASTILLO ANDRES 2021286 9999999 B 10 1013679299 0 5777 DEPT CAROL STREAM IL 601220021 20 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Physician Services 00 1013680933 0 GONZALEZ MARTINEZ PEDRO ANDRES 2022129 9999999 B 10 1013680933 0 PO BOX 3039 OAK BROOK IL 605223039 20 1013680933 0 Physicians Anesthesia Services 20 1013680933 0 Physicians Fluoride varnish 20 1013680933 0 Physicians Healthy Kids Services 20 1013680933 0 Physicians Optical Supplies 20 1013680933 0 Physicians Physician Services 00 1013681667 0 REVELES REYES LIZETTE 2021285 9999999 H 10 1013681667 0 333 N LA GRANGE RD STE 1 SUITE ONE LA GRANGE PARK IL 605265653 20 1013681667 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1013682145 0 SCHACHT SARAH 2024218 9999999 B 10 1013682145 0 8 S MICHIGAN AVE FL 7 CHICAGO IL 606033357 20 1013682145 0 Other behavior health professional LCPC/LMFT services 00 1013682525 0 MOORE STEPHANIE 2021231 9999999 B 10 1013682525 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1013682525 0 Clinical Social Worker Social work service 00 1013682632 0 HEARNDEN 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606123228 20 1013691591 0 Physicians Anesthesia Services 20 1013691591 0 Physicians Fluoride varnish 20 1013691591 0 Physicians Healthy Kids Services 20 1013691591 0 Physicians Optical Supplies 20 1013691591 0 Physicians Physician Services 00 1013691831 0 EDMUNDS JANE S 2023191 9999999 B 10 1013691831 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1013691831 0 Physicians Anesthesia Services 20 1013691831 0 Physicians Fluoride varnish 20 1013691831 0 Physicians Healthy Kids Services 20 1013691831 0 Physicians Optical Supplies 20 1013691831 0 Physicians Physician Services 00 1013692466 0 CKUJ NATALIE M 2023173 9999999 B 10 1013692466 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1013692466 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1013692524 0 VIGILIA DENISE 2024151 9999999 B 10 1013692524 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1013692524 0 Nurse Practitioners Fluoride varnish 20 1013692524 0 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Physicians Healthy Kids Services 20 1023097102 0 Physicians Optical Supplies 20 1023097102 0 Physicians Physician Services 00 1023097292 0 RAGHAVAN VINITHA 1999032 9999999 B 10 1023097292 0 210 S DESPLAINES ST CHICAGO IL 606615500 20 1023097292 0 Physicians Anesthesia Services 20 1023097292 0 Physicians Fluoride varnish 20 1023097292 0 Physicians Healthy Kids Services 20 1023097292 0 Physicians Optical Supplies 20 1023097292 0 Physicians Physician Services 00 1023097441 0 ILLOVSKY MICHAEL A 2023139 9999999 B 10 1023097441 0 16220 N SCOTTSDALE RD STE 600 SCOTTSDALE AZ 852541804 20 1023097441 0 Physicians Anesthesia Services 20 1023097441 0 Physicians Fluoride varnish 20 1023097441 0 Physicians Healthy Kids Services 20 1023097441 0 Physicians Optical Supplies 20 1023097441 0 Physicians Physician Services 00 1023097706 0 MARTINEZ CARLOS 2004153 9999999 B 10 1023097706 0 PO BOX 120288 DALLAS TX 753120288 20 1023097706 0 Physicians Anesthesia Services 20 1023097706 0 Physicians Healthy Kids 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0 MONCRIEF AUBREY F 1992001 9999999 B 10 1023101383 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1023101383 0 Nurse Practitioners Anesthesia Services 20 1023101383 0 Nurse Practitioners Nurse Practitioners Services 20 1023101383 0 Nurse Practitioners Physician Services 00 1023101524 0 CORUM MICHAEL 2023263 9999999 B 10 1023101524 0 1499 WINDHORST WAY STE 100 GREENWOOD IN 461438800 20 1023101524 0 Dentists Dental Services 20 1023101524 0 Dentists Physician Services 00 1023102472 0 SCOTT LASHONDA D 2003316 9999999 B 10 1023102472 0 75 REMITTANCE DR DEPT 1620 SUITE 1620 CHICAGO IL 606751620 20 1023102472 0 Physicians Anesthesia Services 20 1023102472 0 Physicians Fluoride varnish 20 1023102472 0 Physicians Healthy Kids Services 20 1023102472 0 Physicians Optical Supplies 20 1023102472 0 Physicians Physician Services 00 1023102951 0 STEINER STEPHEN T 1992153 9999999 B 10 1023102951 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1023102951 0 Physicians Anesthesia Services 20 1023102951 0 Physicians Fluoride varnish 20 1023102951 0 Physicians Healthy Kids Services 20 1023102951 0 Physicians Optical Supplies 20 1023102951 0 Physicians Physician Services 00 1023103306 0 FOLEY PATRICK 2017335 9999999 B 10 1023103306 0 777 S MAIN ST STE 100 CLINTON IN 478422493 20 1023103306 0 Physicians Anesthesia Services 20 1023103306 0 Physicians Fluoride varnish 20 1023103306 0 Physicians Healthy Kids Services 20 1023103306 0 Physicians Optical Supplies 20 1023103306 0 Physicians Physician Services 00 1023103439 0 BOULAY BRIAN R 2010213 9999999 B 10 1023103439 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1023103439 0 Physicians Anesthesia Services 20 1023103439 0 Physicians Fluoride varnish 20 1023103439 0 Physicians Healthy Kids Services 20 1023103439 0 Physicians Optical Supplies 20 1023103439 0 Physicians Physician Services 00 1023104015 0 DOPPALAPUDI ANIL V 2007194 9999999 B 10 1023104015 0 PO BOX 9237 NAPERVILLE IL 605670237 20 1023104015 0 Physicians 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1023111259 0 HOLLY JASON-SCOTT 2018242 9999999 B 10 1023111259 0 14425 COLLEGE BLVD STE 130 LENEXA KS 662152317 20 1023111259 0 Physicians Anesthesia Services 20 1023111259 0 Physicians Healthy Kids Services 20 1023111259 0 Physicians Optical Supplies 20 1023111259 0 Physicians Physician Services 00 1023111283 0 ODONNELL DANIEL 2016001 9999999 B 10 1023111283 0 5777 DEPT CAROL STREAM IL 601228942 20 1023111283 0 Physician Assistant Only Fluoride varnish 20 1023111283 0 Physician Assistant Only Healthy Kids Services 20 1023111283 0 Physician Assistant Only Physician Services 00 1023113743 0 MUNGEE SUDHIR 2006335 9999999 B 10 1023113743 0 5405 N KNOXVILLE AVE PEORIA IL 616145016 20 1023113743 0 Physicians Anesthesia Services 20 1023113743 0 Physicians Fluoride varnish 20 1023113743 0 Physicians Healthy Kids Services 20 1023113743 0 Physicians Optical Supplies 20 1023113743 0 Physicians Physician Services 00 1023114287 0 WILKERSON MARK D 2021361 9999999 B 10 1023114287 0 5701 W TALAVI BLVD GLENDALE AZ 853061886 20 1023114287 0 Physicians Anesthesia Services 20 1023114287 0 Physicians Healthy Kids Services 20 1023114287 0 Physicians Optical Supplies 20 1023114287 0 Physicians Physician Services 00 1023116993 0 OBERT ALAN 2009305 9999999 B 10 1023116993 0 1005 BROADWAY ST QUINCY IL 623012834 20 1023116993 0 Clinical Social Worker Social work service 00 1023118627 0 MALHOTRA AJAY K 2017230 9999999 B 10 1023118627 0 PO BOX 208807 DALLAS TX 753208807 20 1023118627 0 Physicians Anesthesia Services 20 1023118627 0 Physicians Healthy Kids Services 20 1023118627 0 Physicians Optical Supplies 20 1023118627 0 Physicians Physician Services 00 1023118692 0 CHEN EDWARD 2005180 9999999 B 10 1023118692 0 5665 NEW NORTHSIDE DR STE 320 ATLANTA GA 303285834 20 1023118692 0 Physicians Anesthesia Services 20 1023118692 0 Physicians Healthy Kids Services 20 1023118692 0 Physicians Optical Supplies 20 1023118692 0 Physicians Physician Services 00 1023118718 0 SOLER SUSAN 1981258 9999999 B 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IA 522421009 20 1023120276 0 Psychologist Psychologist service 00 1023120599 0 ROSENTHAL DANIEL 2000186 9999999 B 10 1023120599 0 9933 LAWLER AVE STE 227 SKOKIE IL 600773701 20 1023120599 0 Physicians Anesthesia Services 20 1023120599 0 Physicians Healthy Kids Services 20 1023120599 0 Physicians Optical Supplies 20 1023120599 0 Physicians Physician Services 20 1023120599 0 Physicians Physicians Psychiatric Services 00 1023120623 0 ADEOYE OPEOLU M 2021026 9999999 B 10 1023120623 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1023120623 0 Physicians Anesthesia Services 20 1023120623 0 Physicians Fluoride varnish 20 1023120623 0 Physicians Healthy Kids Services 20 1023120623 0 Physicians Optical Supplies 20 1023120623 0 Physicians Physician Services 00 1023121167 0 GOODE MARK 1999182 9999999 B 10 1023121167 0 5601 S COUNTY LINE RD HINSDALE IL 605214875 20 1023121167 0 Physicians Anesthesia Services 20 1023121167 0 Physicians Fluoride varnish 20 1023121167 0 Physicians 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Physicians Optical Supplies 20 1023245859 0 Physicians Physician Services 00 1023245925 0 RIZVI ASGHAR 2016201 9999999 B 10 1023245925 0 PO BOX 631 LAKE FOREST IL 600450631 20 1023245925 0 Physicians Anesthesia Services 20 1023245925 0 Physicians Healthy Kids Services 20 1023245925 0 Physicians Optical Supplies 20 1023245925 0 Physicians Physician Services 00 1023246261 0 BARDOWELL RACHEL H 2012183 9999999 B 10 1023246261 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1023246261 0 Physicians Anesthesia Services 20 1023246261 0 Physicians Fluoride varnish 20 1023246261 0 Physicians Healthy Kids Services 20 1023246261 0 Physicians Optical Supplies 20 1023246261 0 Physicians Physician Services 00 1023246980 0 ROBINSON RICHMOND 2013105 9999999 B 10 1023246980 0 3471 GREEN BAY RD NORTH CHICAGO IL 600643090 20 1023246980 0 Podiatrists Podiatric Services 00 1023247236 0 JENKINS VOGEL MARY TILLEY 2016197 9999999 B 10 1023247236 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1023247236 0 Physicians Anesthesia Services 20 1023247236 0 Physicians Healthy Kids Services 20 1023247236 0 Physicians Optical Supplies 20 1023247236 0 Physicians Physician Services 00 1023247566 0 MCCLINTON ERNEST J 2023057 9999999 B 10 1023247566 0 PO BOX 43230 PHOENIX AZ 850803230 20 1023247566 0 Nurse Practitioners Anesthesia Services 20 1023247566 0 Nurse Practitioners Healthy Kids Services 20 1023247566 0 Nurse Practitioners Optical Supplies 20 1023247566 0 Nurse Practitioners Physician Services 00 1023247699 0 WANG PEGGY 2012340 9999999 B 10 1023247699 0 2424 W PETERSON AVE CHICAGO IL 606594100 20 1023247699 0 Physicians Anesthesia Services 20 1023247699 0 Physicians Fluoride varnish 20 1023247699 0 Physicians Healthy Kids Services 20 1023247699 0 Physicians Optical Supplies 20 1023247699 0 Physicians Physician Services 00 1023247970 0 BROWN ANNA 2024345 9999999 B 10 1023247970 0 DEPT AT 40379 ATLANTA GA 311920379 20 1023247970 0 Licensed Practical Nurses Nursing service 00 1023248184 0 MATTHEWS SURUCHI 2010231 9999999 B 10 1023248184 0 29373 NETWORK PL CHICAGO IL 606733039 20 1023248184 0 Speech Therapists Medical Supplies 20 1023248184 0 Speech Therapists Medical equipment/prosthetic devices 20 1023248184 0 Speech Therapists Speech Therapy/Pathology Services 00 1023249075 0 HUGHES CARLETHA C 2010305 9999999 B 10 1023249075 0 165 W 10TH ST CHICAGO HEIGHTS IL 604112000 20 1023249075 0 Physicians Anesthesia Services 20 1023249075 0 Physicians Fluoride varnish 20 1023249075 0 Physicians Healthy Kids Services 20 1023249075 0 Physicians Optical Supplies 20 1023249075 0 Physicians Physician Services 00 1023250511 0 TANNOUS PAUL 2017121 9999999 B 10 1023250511 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1023250511 0 Physicians Anesthesia Services 20 1023250511 0 Physicians Fluoride varnish 20 1023250511 0 Physicians Healthy Kids Services 20 1023250511 0 Physicians Optical Supplies 20 1023250511 0 Physicians Physician Services 00 1023250677 0 HAHN DANITA 2012159 9999999 B 10 1023250677 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1023250677 0 Physicians Anesthesia Services 20 1023250677 0 Physicians Fluoride varnish 20 1023250677 0 Physicians Healthy Kids Services 20 1023250677 0 Physicians Optical Supplies 20 1023250677 0 Physicians Physician Services 00 1023251428 0 COHEN JASON MATTHEW 2016273 9999999 B 10 1023251428 0 18167 US HIGHWAY 19 N STE 650 CLEARWATER FL 337646576 20 1023251428 0 Physician Assistant Only Fluoride varnish 20 1023251428 0 Physician Assistant Only Healthy Kids Services 20 1023251428 0 Physician Assistant Only Physician Services 00 1023251709 0 TEGGATZ ERIC 2014237 9999999 B 10 1023251709 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1023251709 0 Physicians Anesthesia Services 20 1023251709 0 Physicians Healthy Kids Services 20 1023251709 0 Physicians Optical Supplies 20 1023251709 0 Physicians Physician Services 00 1023251832 0 ATTY CORINNE 2015281 9999999 B 10 1023251832 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1023251832 0 Physicians Anesthesia Services 20 1023251832 0 Physicians Healthy Kids Services 20 1023251832 0 Physicians Optical Supplies 20 1023251832 0 Physicians Physician Services 00 1023252780 0 SULLIVAN MEGAN E 2009182 9999999 B 10 1023252780 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1023252780 0 Physicians Anesthesia Services 20 1023252780 0 Physicians Healthy Kids Services 20 1023252780 0 Physicians Optical Supplies 20 1023252780 0 Physicians Physician Services 00 1023253879 0 DHAWAN ANKUR A 2009121 9999999 B 10 1023253879 0 5777 DEPT CAROL STREAM IL 601220021 20 1023253879 0 Physicians Anesthesia Services 20 1023253879 0 Physicians Fluoride varnish 20 1023253879 0 Physicians Healthy Kids Services 20 1023253879 0 Physicians Optical Supplies 20 1023253879 0 Physicians Physician Services 00 1023257581 0 LWANGA NASAAZI M 2018351 9999999 B 10 1023257581 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1023257581 0 Physician Assistant Only Fluoride varnish 20 1023257581 0 Physician Assistant Only Healthy Kids Services 20 1023257581 0 Physician Assistant Only Physician Services 00 1023258928 0 JESUCA FLORE 2021201 9999999 B 10 1023258928 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1023258928 0 Nurse Practitioners Fluoride varnish 20 1023258928 0 Nurse Practitioners Healthy Kids Services 20 1023258928 0 Nurse Practitioners Nurse Practitioners Services 20 1023258928 0 Nurse Practitioners Physician Services 00 1023259553 0 PATEL REENA 2010182 9999999 B 10 1023259553 0 1601 CUMMINS DR STE 4 MODESTO CA 953586405 20 1023259553 0 Physicians Anesthesia Services 20 1023259553 0 Physicians Fluoride varnish 20 1023259553 0 Physicians Healthy Kids Services 20 1023259553 0 Physicians Optical Supplies 20 1023259553 0 Physicians Physician Services 00 1023259751 0 FELDMAN LAWRENCE 1981227 9999999 B 10 1023259751 0 5549 N BROADWAY ST CHICAGO IL 606401432 20 1023259751 0 Dentists Dental Services 20 1023259751 0 Dentists Physician Services 00 1023259777 0 BALLANY WASSIM 2016325 9999999 B 10 1023259777 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1023259777 0 Physicians Anesthesia Services 20 1023259777 0 Physicians Fluoride varnish 20 1023259777 0 Physicians Healthy Kids Services 20 1023259777 0 Physicians Optical Supplies 20 1023259777 0 Physicians Physician Services 00 1023259967 0 HARGRAVE VICTORIA A 2014188 9999999 B 10 1023259967 0 390 MAPLE SUMMIT RD JERSEYVILLE IL 620522000 20 1023259967 0 Nurse Practitioners Fluoride varnish 20 1023259967 0 Nurse Practitioners Healthy Kids Services 20 1023259967 0 Nurse Practitioners Nurse Practitioners Services 20 1023259967 0 Nurse Practitioners Physician Services 00 1023261138 0 SONABEND WORTHALTER ADAM M 2017193 9999999 B 10 1023261138 0 5777 DEPT CAROL STREAM IL 601220021 20 1023261138 0 Physicians Anesthesia Services 20 1023261138 0 Physicians Healthy Kids Services 20 1023261138 0 Physicians Optical Supplies 20 1023261138 0 Physicians Physician Services 00 1023261708 0 KITE DAVID 2015291 9999999 B 10 1023261708 0 PO BOX 343918 MILWAUKEE WI 532343918 20 1023261708 0 Physician Assistant Only Fluoride varnish 20 1023261708 0 Physician Assistant Only Healthy Kids Services 20 1023261708 0 Physician Assistant Only Physician Services 00 1023261716 0 LICKERMAN DAVID S 2009306 9999999 B 10 1023261716 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1023261716 0 Physicians Anesthesia Services 20 1023261716 0 Physicians Healthy Kids Services 20 1023261716 0 Physicians Optical Supplies 20 1023261716 0 Physicians Physician Services 00 1023262466 0 GELBARD ALEXANDER 2025036 9999999 B 10 1023262466 0 DEPT AT 40379 ATLANTA GA 311920379 20 1023262466 0 Physicians Anesthesia Services 20 1023262466 0 Physicians Healthy Kids Services 20 1023262466 0 Physicians Optical Supplies 20 1023262466 0 Physicians Physician Services 00 1023262771 0 BASHORUN JILL MAREE 2023355 9999999 B 10 1023262771 0 2521 E 15TH ST CASPER WY 826094126 20 1023262771 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1023262805 0 LOOK ANNE 2011001 9999999 B 10 1023262805 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1023262805 0 Nurse Practitioners Healthy Kids Services 20 1023262805 0 Nurse Practitioners Nurse Practitioners Services 20 1023262805 0 Nurse Practitioners Physician Services 00 1023263084 0 KESSLER-SANTICCIOLI JACQUELINE 2011040 9999999 B 10 1023263084 0 PO BOX 631278 CINCINNATI OH 452631278 20 1023263084 0 Speech Therapists Medical Supplies 20 1023263084 0 Speech Therapists Medical equipment/prosthetic devices 20 1023263084 0 Speech Therapists Speech Therapy/Pathology Services 00 1023264157 0 ZHANG KAN K 2024137 9999999 B 10 1023264157 0 11475 OLDE CABIN RD STE 200 SAINT LOUIS MO 631417129 20 1023264157 0 Physicians Anesthesia Services 20 1023264157 0 Physicians Healthy Kids Services 20 1023264157 0 Physicians Optical Supplies 20 1023264157 0 Physicians Physician Services 00 1023264173 0 WELTER JACQUELINE 2009182 9999999 B 10 1023264173 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1023264173 0 Physicians Anesthesia Services 20 1023264173 0 Physicians Fluoride varnish 20 1023264173 0 Physicians Healthy Kids Services 20 1023264173 0 Physicians Optical Supplies 20 1023264173 0 Physicians Physician Services 00 1023264272 0 SINGH ANTERPREET 2023228 9999999 B 10 1023264272 0 29373 NETWORK PL CHICAGO IL 606733039 20 1023264272 0 Physicians Anesthesia Services 20 1023264272 0 Physicians Healthy Kids Services 20 1023264272 0 Physicians Optical Supplies 20 1023264272 0 Physicians Physician Services 00 1023264371 0 DEDHIA RUPEL 2010182 9999999 B 10 1023264371 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1023264371 0 Physicians Anesthesia Services 20 1023264371 0 Physicians Fluoride varnish 20 1023264371 0 Physicians Healthy Kids Services 20 1023264371 0 Physicians Optical Supplies 20 1023264371 0 Physicians Physician Services 00 1023264546 0 OZA VISHAL S 2008238 9999999 B 10 1023264546 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1023264546 0 Physicians Anesthesia Services 20 1023264546 0 Physicians Healthy Kids Services 20 1023264546 0 Physicians Optical Supplies 20 1023264546 0 Physicians Physician Services 00 1023264819 0 BHARDWAJ ANITA 2011032 9999999 B 10 1023264819 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1023264819 0 Physicians Anesthesia Services 20 1023264819 0 Physicians Fluoride varnish 20 1023264819 0 Physicians Healthy Kids Services 20 1023264819 0 Physicians Optical Supplies 20 1023264819 0 Physicians Physician Services 00 1023265147 0 GREMMINGER DEBRA K 2010301 9999999 B 10 1023265147 0 500 PORTER AVE AURORA MO 656052365 20 1023265147 0 Nurse Practitioners Fluoride varnish 20 1023265147 0 Nurse Practitioners Healthy Kids Services 20 1023265147 0 Nurse Practitioners Nurse Practitioners Services 20 1023265147 0 Nurse Practitioners Physician Services 00 1023265337 0 VANCURA BENJAMIN 2013196 9999999 B 10 1023265337 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1023265337 0 Physicians Anesthesia Services 20 1023265337 0 Physicians Fluoride varnish 20 1023265337 0 Physicians Healthy Kids Services 20 1023265337 0 Physicians Optical Supplies 20 1023265337 0 Physicians Physician Services 00 1023265543 0 GHAFOURI MANIJEH 2009121 9999999 B 10 1023265543 0 29373 NETWORK PL CHICAGO IL 606733039 20 1023265543 0 Nurse Practitioners Fluoride varnish 20 1023265543 0 Nurse Practitioners Healthy Kids Services 20 1023265543 0 Nurse Practitioners Nurse Practitioners Services 20 1023265543 0 Nurse Practitioners Physician Services 00 1023266541 0 SAMALA NIHARIKA R 2022036 9999999 B 10 1023266541 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1023266541 0 Physicians Anesthesia Services 20 1023266541 0 Physicians Fluoride varnish 20 1023266541 0 Physicians Healthy Kids Services 20 1023266541 0 Physicians Optical Supplies 20 1023266541 0 Physicians Physician Services 00 1023267184 0 METTERNICH CAROLYN J 2022329 9999999 B 10 1023267184 0 313 N PLANKINTON AVE STE 211 MILWAUKEE WI 532033104 20 1023267184 0 Nurse Practitioners Healthy Kids Services 20 1023267184 0 Nurse Practitioners Nurse Practitioners Services 20 1023267184 0 Nurse Practitioners Physician Services 00 1023269446 0 KOCH ELIZABETH 2016238 9999999 B 10 1023269446 0 1 WESTBROOK CORPORATE CTR STE WESTCHESTER IL 601545714 20 1023269446 0 Physician Assistant Only Fluoride varnish 20 1023269446 0 Physician Assistant Only Healthy Kids Services 20 1023269446 0 Physician Assistant Only Physician Services 00 1023269701 0 METIREDDY MANASA 2014244 9999999 B 10 1023269701 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1023269701 0 Physicians Anesthesia Services 20 1023269701 0 Physicians Fluoride varnish 20 1023269701 0 Physicians Healthy Kids Services 20 1023269701 0 Physicians Optical Supplies 20 1023269701 0 Physicians Physician Services 00 1023270279 0 GANGOPADHYAY NOOPUR 2016337 9999999 B 10 1023270279 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1023270279 0 Physicians Anesthesia Services 20 1023270279 0 Physicians Healthy Kids Services 20 1023270279 0 Physicians Optical Supplies 20 1023270279 0 Physicians Physician Services 00 1023270469 0 JAMIE PRATHER 2017272 9999999 B 10 1023270469 0 1910 SOUTH AVE LA CROSSE WI 546015467 20 1023270469 0 Physicians Anesthesia Services 20 1023270469 0 Physicians Healthy Kids Services 20 1023270469 0 Physicians Optical Supplies 20 1023270469 0 Physicians Physician Services 00 1023270899 0 LESCHER REBECCA L 2011244 9999999 B 10 1023270899 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1023270899 0 Physicians Anesthesia Services 20 1023270899 0 Physicians Fluoride varnish 20 1023270899 0 Physicians Healthy Kids Services 20 1023270899 0 Physicians Optical Supplies 20 1023270899 0 Physicians Physician Services 00 1023270998 0 HUTCHINS RACHEL 2017335 9999999 B 10 1023270998 0 96 W NORTHWEST HWY PALATINE IL 600673571 20 1023270998 0 Optometrists Optical Supplies 20 1023270998 0 Optometrists Optometric Services 20 1023270998 0 Optometrists Physician Services 00 1023271087 0 TESSIER JOSHUA 2023252 9999999 B 10 1023271087 0 PO BOX 43230 PHOENIX AZ 850803230 20 1023271087 0 Physicians Anesthesia Services 20 1023271087 0 Physicians Fluoride varnish 20 1023271087 0 Physicians Healthy Kids Services 20 1023271087 0 Physicians Optical Supplies 20 1023271087 0 Physicians Physician Services 00 1023271137 0 CARLSON RUSSELL 2011182 9999999 B 10 1023271137 0 PO BOX 772294 DETROIT MI 482772294 20 1023271137 0 Podiatrists Podiatric Services 00 1023271780 0 BUSH JELANIE 2011182 9999999 B 10 1023271780 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1023271780 0 Physicians Anesthesia Services 20 1023271780 0 Physicians Fluoride varnish 20 1023271780 0 Physicians Healthy Kids Services 20 1023271780 0 Physicians Optical Supplies 20 1023271780 0 Physicians Physician Services 00 1023271947 0 MARTINEZ BRANDON K 2018327 9999999 B 10 1023271947 0 PO BOX 208807 DALLAS TX 753208807 20 1023271947 0 Physicians Anesthesia Services 20 1023271947 0 Physicians Healthy Kids Services 20 1023271947 0 Physicians Optical Supplies 20 1023271947 0 Physicians Physician Services 00 1023272515 0 SCHWARTZ GEOFFREY 2023317 2045365 B 10 1023272515 0 222 S GREENLEAF ST STE 102 GURNEE IL 600315705 20 1023272515 0 Physicians Anesthesia Services 20 1023272515 0 Physicians Healthy Kids Services 20 1023272515 0 Physicians Optical Supplies 20 1023272515 0 Physicians Physician Services 00 1023272812 0 CORPREW ROBERT 2013351 9999999 B 10 1023272812 0 PO BOX 860362 MINNEAPOLIS MN 554860362 20 1023272812 0 Physicians Anesthesia Services 20 1023272812 0 Physicians Healthy Kids Services 20 1023272812 0 Physicians Optical Supplies 20 1023272812 0 Physicians Physician Services 00 1023272861 0 KARKI MASKEY MITU 2024081 9999999 B 10 1023272861 0 PO BOX 43230 PHOENIX AZ 850803230 20 1023272861 0 Physicians Anesthesia Services 20 1023272861 0 Physicians Fluoride varnish 20 1023272861 0 Physicians Healthy Kids Services 20 1023272861 0 Physicians Optical Supplies 20 1023272861 0 Physicians Physician Services 00 1023273901 0 COTTON JONATHAN 2014213 9999999 B 10 1023273901 0 350 N WALL ST KANKAKEE IL 609012901 20 1023273901 0 Physicians Anesthesia Services 20 1023273901 0 Physicians Healthy Kids Services 20 1023273901 0 Physicians Optical Supplies 20 1023273901 0 Physicians Physician Services 00 1023274131 0 TRIPLET RENEE 2020246 9999999 B 10 1023274131 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1023274131 0 Physicians Anesthesia Services 20 1023274131 0 Physicians Fluoride varnish 20 1023274131 0 Physicians Healthy Kids Services 20 1023274131 0 Physicians Optical Supplies 20 1023274131 0 Physicians Physician Services 00 1023274677 0 CHAN SHERWIN S 2019322 9999999 B 10 1023274677 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1023274677 0 Physicians Anesthesia Services 20 1023274677 0 Physicians Healthy Kids Services 20 1023274677 0 Physicians Optical Supplies 20 1023274677 0 Physicians Physician Services 00 1023274891 0 CHINTHAGADA PRASANTH 2009121 9999999 B 10 1023274891 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1023274891 0 Physicians Anesthesia Services 20 1023274891 0 Physicians Healthy Kids Services 20 1023274891 0 Physicians Optical Supplies 20 1023274891 0 Physicians Physician Services 00 1023276060 0 WISSEL JUDY 2017257 9999999 B 10 1023276060 0 1418 COLLEGE DR MOUNT CARMEL IL 628632638 20 1023276060 0 Other behavior health professional LCPC/LMFT services 00 1023276763 0 JONES ALVIN 2024031 9999999 B 10 1023276763 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1023276763 0 Physicians Anesthesia Services 20 1023276763 0 Physicians Healthy Kids Services 20 1023276763 0 Physicians Optical Supplies 20 1023276763 0 Physicians Physician Services 00 1023277399 0 ASH DENISE MARIE 2021166 9999999 B 10 1023277399 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1023277399 0 Nurse Practitioners Fluoride varnish 20 1023277399 0 Nurse Practitioners Healthy Kids Services 20 1023277399 0 Nurse Practitioners Nurse Practitioners Services 20 1023277399 0 Nurse Practitioners Physician Services 00 1023277738 0 DAVIS CHRYSANTHEMUM M 2020167 9999999 B 10 1023277738 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1023277738 0 Nurse Practitioners Fluoride varnish 20 1023277738 0 Nurse Practitioners Healthy Kids Services 20 1023277738 0 Nurse Practitioners Nurse Practitioners Services 20 1023277738 0 Nurse Practitioners Physician Services 00 1023278769 0 TSARAS GEOFFREY 2010201 9999999 B 10 1023278769 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1023278769 0 Physicians Anesthesia Services 20 1023278769 0 Physicians Fluoride varnish 20 1023278769 0 Physicians Healthy Kids Services 20 1023278769 0 Physicians Optical Supplies 20 1023278769 0 Physicians Physician Services 00 1023278892 0 NATHAN SUNITA 2008217 9999999 B 10 1023278892 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 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Anesthesia Services 20 1023280831 0 Physicians Fluoride varnish 20 1023280831 0 Physicians Healthy Kids Services 20 1023280831 0 Physicians Optical Supplies 20 1023280831 0 Physicians Physician Services 00 1023282043 0 SNEDDEN THERESA 2013001 9999999 B 10 1023282043 0 6501 N SHERIDAN RD PEORIA IL 616142932 20 1023282043 0 Physical Therapists Medical Supplies 20 1023282043 0 Physical Therapists Medical equipment/prosthetic devices 20 1023282043 0 Physical Therapists Physical Therapy Services 00 1023282217 0 BALAN SIMONA 2000208 9999999 B 10 1023282217 0 719 BARRON BLVD GRAYSLAKE IL 600303314 20 1023282217 0 Dentists Dental Services 20 1023282217 0 Dentists Physician Services 00 1023283512 0 VILLAMOR CHRISTINE Y 2005031 9999999 B 10 1023283512 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1023283512 0 Physical Therapists Medical Supplies 20 1023283512 0 Physical Therapists Medical equipment/prosthetic devices 20 1023283512 0 Physical Therapists Physical Therapy Services 00 1023283611 0 CHOH MARK 2009182 9999999 B 10 1023283611 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1023283611 0 Physicians Anesthesia Services 20 1023283611 0 Physicians Healthy Kids Services 20 1023283611 0 Physicians Optical Supplies 20 1023283611 0 Physicians Physician Services 00 1023283900 0 PEARISO KATRINA 2020332 9999999 B 10 1023283900 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1023283900 0 Physicians Anesthesia Services 20 1023283900 0 Physicians Healthy Kids Services 20 1023283900 0 Physicians Optical Supplies 20 1023283900 0 Physicians Physician Services 20 1023283900 0 Physicians Physicians Psychiatric Services 00 1023284627 0 WHITAKER AMY K 2008214 9999999 B 10 1023284627 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1023284627 0 Physicians Anesthesia Services 20 1023284627 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1023284627 0 Physicians Family Planning Counseling 20 1023284627 0 Physicians Healthy Kids Services 20 1023284627 0 Physicians Optical Supplies 20 1023284627 0 Physicians Physician Services 00 1023285145 0 AGGARWAL ANSHUL 2014244 9999999 B 10 1023285145 0 800 BIESTERFIELD RD STE G01 ELK GROVE VILLA IL 600073372 20 1023285145 0 Physicians Anesthesia Services 20 1023285145 0 Physicians Fluoride varnish 20 1023285145 0 Physicians Healthy Kids Services 20 1023285145 0 Physicians Optical Supplies 20 1023285145 0 Physicians Physician Services 00 1023287745 0 CAMPBELL WILLIAM C 2008078 9999999 B 10 1023287745 0 16650 HARLEM AVE TINLEY PARK IL 604771847 20 1023287745 0 Physicians Anesthesia Services 20 1023287745 0 Physicians Fluoride varnish 20 1023287745 0 Physicians Healthy Kids Services 20 1023287745 0 Physicians Optical Supplies 20 1023287745 0 Physicians Physician Services 00 1023288420 0 ANADKAT JAGRUTI D 2011244 9999999 B 10 1023288420 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1023288420 0 Physicians Anesthesia Services 20 1023288420 0 Physicians Fluoride varnish 20 1023288420 0 Physicians Healthy Kids Services 20 1023288420 0 Physicians Optical Supplies 20 1023288420 0 Physicians Physician Services 00 1023288479 0 VERA CYNTHIA 1998278 9999999 B 10 1023288479 0 1106 NEAL AVE JOLIET IL 604332548 20 1023288479 0 Physicians Anesthesia Services 20 1023288479 0 Physicians Healthy Kids Services 20 1023288479 0 Physicians Optical Supplies 20 1023288479 0 Physicians Physician Services 00 1023289394 0 MOORE SHARON 2014037 9999999 H 10 1023289394 0 12517 S QUINN DR ALSIP IL 608031098 20 1023289394 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1023289410 0 ROY ELLEN 2015345 9999999 B 10 1023289410 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1023289410 0 Physician Assistant Only Fluoride varnish 20 1023289410 0 Physician Assistant Only Healthy Kids Services 20 1023289410 0 Physician Assistant Only Physician Services 00 1023289444 0 LEE HONG S 2008183 9999999 B 10 1023289444 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1023289444 0 Physicians Anesthesia Services 20 1023289444 0 Physicians Fluoride varnish 20 1023289444 0 Physicians Healthy Kids Services 20 1023289444 0 Physicians Optical Supplies 20 1023289444 0 Physicians Physician Services 00 1023290681 0 WADE TERENCE 2018182 9999999 B 10 1023290681 0 111 OAKWOOD RD EAST PEORIA IL 616111853 20 1023290681 0 Physicians Anesthesia Services 20 1023290681 0 Physicians Healthy Kids Services 20 1023290681 0 Physicians Optical Supplies 20 1023290681 0 Physicians Physician Services 00 1023292976 0 AHMED YASIR 2020047 9999999 B 10 1023292976 0 PO BOX 14099 BELFAST ME 049154034 20 1023292976 0 Physicians Anesthesia Services 20 1023292976 0 Physicians Fluoride varnish 20 1023292976 0 Physicians Healthy Kids Services 20 1023292976 0 Physicians Optical Supplies 20 1023292976 0 Physicians Physician Services 00 1023293289 0 CABBABE AMY 2011003 9999999 B 10 1023293289 0 PO BOX 22407 SAINT LOUIS MO 631260407 20 1023293289 0 Physicians Anesthesia Services 20 1023293289 0 Physicians Healthy Kids Services 20 1023293289 0 Physicians Optical Supplies 20 1023293289 0 Physicians Physician Services 00 1023294642 0 TURBAY RAFAEL 2011213 9999999 B 10 1023294642 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1023294642 0 Physicians Anesthesia Services 20 1023294642 0 Physicians Healthy Kids Services 20 1023294642 0 Physicians Optical Supplies 20 1023294642 0 Physicians Physician Services 00 1023298734 0 DE VALK SCOTT 2011286 9999999 B 10 1023298734 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1023298734 0 Clinical Social Worker Social work service 00 1023298742 0 MOONEY AMY M 2012153 9999999 B 10 1023298742 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1023298742 0 Nurse Practitioners Healthy Kids Services 20 1023298742 0 Nurse Practitioners Nurse Practitioners Services 20 1023298742 0 Nurse Practitioners Physician Services 00 1023299393 0 SANTOS CARLOS 2009182 9999999 B 10 1023299393 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1023299393 0 Physicians Anesthesia Services 20 1023299393 0 Physicians Fluoride varnish 20 1023299393 0 Physicians Healthy Kids Services 20 1023299393 0 Physicians Optical Supplies 20 1023299393 0 Physicians Physician Services 00 1023299435 0 IVEY-BROWN JACQUELINE R 2008156 9999999 B 10 1023299435 0 PO BOX 343918 MILWAUKEE WI 532343918 20 1023299435 0 Physicians Anesthesia Services 20 1023299435 0 Physicians Fluoride varnish 20 1023299435 0 Physicians Healthy Kids Services 20 1023299435 0 Physicians Optical Supplies 20 1023299435 0 Physicians Physician Services 00 1023299468 0 MURTAUGH PATRICIA J 2008001 9999999 B 10 1023299468 0 PO BOX 443 BEDFORD PARK IL 604990443 20 1023299468 0 Nurse Practitioners Anesthesia Services 20 1023299468 0 Nurse Practitioners Nurse Practitioners Services 20 1023299468 0 Nurse Practitioners Physician Services 00 1023299765 0 DE GRANDVILLE CATHERINE 2016001 9999999 B 10 1023299765 0 1020 N 12TH ST MILWAUKEE WI 532331308 20 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10 1023306578 0 500 PORTER AVE AURORA MO 656052365 20 1023306578 0 Physicians Anesthesia Services 20 1023306578 0 Physicians Healthy Kids Services 20 1023306578 0 Physicians Optical Supplies 20 1023306578 0 Physicians Physician Services 00 1023306859 0 REVAK THOMAS J 2015218 9999999 B 10 1023306859 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1023306859 0 Physicians Anesthesia Services 20 1023306859 0 Physicians Healthy Kids Services 20 1023306859 0 Physicians Optical Supplies 20 1023306859 0 Physicians Physician Services 00 1023307105 0 KIM PEGGY 2016253 9999999 B 10 1023307105 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1023307105 0 Physicians Anesthesia Services 20 1023307105 0 Physicians Healthy Kids Services 20 1023307105 0 Physicians Optical Supplies 20 1023307105 0 Physicians Physician Services 00 1023307154 0 DAI DAO-FU 2017193 9999999 B 10 1023307154 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1023307154 0 Physicians Anesthesia Services 20 1023307154 0 Physicians Healthy Kids 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0 Physicians Fluoride varnish 20 1023351509 0 Physicians Healthy Kids Services 20 1023351509 0 Physicians Optical Supplies 20 1023351509 0 Physicians Physician Services 00 1023351608 0 EITEL JACOB 2021206 9999999 B 10 1023351608 0 PO BOX 208807 DALLAS TX 753208807 20 1023351608 0 Physicians Anesthesia Services 20 1023351608 0 Physicians Healthy Kids Services 20 1023351608 0 Physicians Optical Supplies 20 1023351608 0 Physicians Physician Services 00 1023351616 0 LAUDON MATTHEW 2016306 9999999 B 10 1023351616 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1023351616 0 Physicians Anesthesia Services 20 1023351616 0 Physicians Healthy Kids Services 20 1023351616 0 Physicians Optical Supplies 20 1023351616 0 Physicians Physician Services 00 1023351673 0 FISCHER-VALUCK BENJAMIN 2021103 9999999 B 10 1023351673 0 1025 MAINE ST QUINCY IL 623014038 20 1023351673 0 Physicians Anesthesia Services 20 1023351673 0 Physicians Healthy Kids Services 20 1023351673 0 Physicians Optical 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1023384377 0 LIU LIFANG 2017142 9999999 B 10 1023384377 0 4701 DEPT CAROL STREAM IL 601220021 20 1023384377 0 Physicians Anesthesia Services 20 1023384377 0 Physicians Healthy Kids Services 20 1023384377 0 Physicians Optical Supplies 20 1023384377 0 Physicians Physician Services 00 1023384831 0 TIETJENS JEREMY R 2020233 9999999 B 10 1023384831 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1023384831 0 Physicians Anesthesia Services 20 1023384831 0 Physicians Fluoride varnish 20 1023384831 0 Physicians Healthy Kids Services 20 1023384831 0 Physicians Optical Supplies 20 1023384831 0 Physicians Physician Services 00 1023385796 0 CACCIATORE CRISTINA 2013196 9999999 B 10 1023385796 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1023385796 0 Nurse Practitioners Fluoride varnish 20 1023385796 0 Nurse Practitioners Healthy Kids Services 20 1023385796 0 Nurse Practitioners Nurse Practitioners Services 20 1023385796 0 Nurse Practitioners Physician Services 00 1023388931 0 COVELLI DIANA 2018230 9999999 B 10 1023388931 0 3631 N HARLEM AVE CHICAGO IL 606342237 20 1023388931 0 Podiatrists Podiatric Services 00 1023390176 0 VELASCO JACQUELINE 2023255 9999999 B 10 1023390176 0 611 W PARK ST URBANA IL 618012529 20 1023390176 0 Physicians Anesthesia Services 20 1023390176 0 Physicians Fluoride varnish 20 1023390176 0 Physicians Healthy Kids Services 20 1023390176 0 Physicians Optical Supplies 20 1023390176 0 Physicians Physician Services 00 1023393865 0 CHEETHIRALA VIJAYA 2011258 9999999 B 10 1023393865 0 155 N NELTNOR BLVD WEST CHICAGO IL 601852315 20 1023393865 0 Dentists Dental Services 20 1023393865 0 Dentists Physician Services 00 1023395134 0 AHMED SARAH L 2011213 9999999 B 10 1023395134 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1023395134 0 Nurse Practitioners Anesthesia Services 20 1023395134 0 Nurse Practitioners Nurse Practitioners Services 20 1023395134 0 Nurse Practitioners Physician Services 00 1023395225 0 LONGNECKER LAURA 2012122 9999999 B 10 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Physicians Healthy Kids Services 20 1023500154 0 Physicians Optical Supplies 20 1023500154 0 Physicians Physician Services 00 1023500287 0 TAMEZ DEBRA 2020198 9999999 B 10 1023500287 0 684 S BARRINGTON RD STE 112 STREAMWOOD IL 601071841 20 1023500287 0 Clinical Social Worker Social work service 00 1023500949 0 FRANK MATTHEW 2021302 9999999 H 10 1023500949 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1023500949 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1023501079 0 WINK MELANIE A 2018319 9999999 H 10 1023501079 0 2339 N CALIFORNIA AVE UNIT 479 CHICAGO IL 606470360 20 1023501079 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1023501574 0 JIBAWI FEDA 2018240 2099240 B 10 1023501574 0 8021 W 79TH ST JUSTICE IL 604581607 20 1023501574 0 Dentists Dental Services 20 1023501574 0 Dentists Physician Services 00 1023501608 0 YANEZ-SILLER JUAN CARLOS 2024183 9999999 B 10 1023501608 0 4698 DEPT CAROL STREAM IL 601220021 20 1023501608 0 Physicians Anesthesia Services 20 1023501608 0 Physicians Healthy Kids Services 20 1023501608 0 Physicians Optical Supplies 20 1023501608 0 Physicians Physician Services 00 1023502028 0 KILIAN SCOTT 2019002 9999999 B 10 1023502028 0 500 PORTER AVE AURORA MO 656052365 20 1023502028 0 Physicians Anesthesia Services 20 1023502028 0 Physicians Healthy Kids Services 20 1023502028 0 Physicians Optical Supplies 20 1023502028 0 Physicians Physician Services 00 1023502416 0 SUNDAY KIRSTYN L 2018177 9999999 B 10 1023502416 0 5777 DEPT CAROL STREAM IL 601220021 20 1023502416 0 Speech Therapists Medical Supplies 20 1023502416 0 Speech Therapists Medical equipment/prosthetic devices 20 1023502416 0 Speech Therapists Speech Therapy/Pathology Services 00 1023502622 0 AMBRISCO JESICAH E 2021202 9999999 B 10 1023502622 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1023502622 0 Physicians Anesthesia Services 20 1023502622 0 Physicians Fluoride varnish 20 1023502622 0 Physicians Healthy Kids Services 20 1023502622 0 Physicians Optical Supplies 20 1023502622 0 Physicians Physician Services 00 1023503380 0 MUELLER JERRICA N 2021230 9999999 B 10 1023503380 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1023503380 0 Physicians Anesthesia Services 20 1023503380 0 Physicians Healthy Kids Services 20 1023503380 0 Physicians Optical Supplies 20 1023503380 0 Physicians Physician Services 00 1023503448 0 BOURJAS LINA 2022151 9999999 B 10 1023503448 0 19990 GOVERNORS HWY OLYMPIA FIELDS IL 604611021 20 1023503448 0 Physicians Anesthesia Services 20 1023503448 0 Physicians Fluoride varnish 20 1023503448 0 Physicians Healthy Kids Services 20 1023503448 0 Physicians Optical Supplies 20 1023503448 0 Physicians Physician Services 00 1023503851 0 CRAIG ETHAN 2018362 9999999 B 10 1023503851 0 607 S NEW BALLAS RD STE 2300 SAINT LOUIS MO 631418234 20 1023503851 0 Physicians Anesthesia Services 20 1023503851 0 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NIKHIL 2023331 9999999 B 10 1023505773 0 1900 W POLK ST STE 220C CHICAGO IL 60612 20 1023505773 0 Physicians Anesthesia Services 20 1023505773 0 Physicians Healthy Kids Services 20 1023505773 0 Physicians Optical Supplies 20 1023505773 0 Physicians Physician Services 20 1023505773 0 Physicians Physicians Psychiatric Services 00 1023507530 0 ORNELAS LOREN 2020226 9999999 B 10 1023507530 0 75 REMITTANCE DR DEPT 1611 CHICAGO IL 606751611 20 1023507530 0 Clinical Social Worker Social work service 00 1023508769 0 BIRMINGHAM STEPHANIE 2018182 9999999 B 10 1023508769 0 4701 DEPT CAROL STREAM IL 601220021 20 1023508769 0 Nurse Practitioners Healthy Kids Services 20 1023508769 0 Nurse Practitioners Nurse Practitioners Services 20 1023508769 0 Nurse Practitioners Physician Services 00 1023509320 0 HARPER THEODORE R 2020035 9999999 B 10 1023509320 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1023509320 0 Physicians Anesthesia Services 20 1023509320 0 Physicians Healthy Kids Services 20 1023509320 0 Physicians Optical Supplies 20 1023509320 0 Physicians Physician Services 00 1023509510 0 AHMAD AROOJ 2024112 9999999 B 10 1023509510 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1023509510 0 Physicians Anesthesia Services 20 1023509510 0 Physicians Healthy Kids Services 20 1023509510 0 Physicians Optical Supplies 20 1023509510 0 Physicians Physician Services 20 1023509510 0 Physicians Physicians Psychiatric Services 00 1023512191 0 DODDS MELISSA A 2024100 9999999 B 10 1023512191 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1023512191 0 Physicians Anesthesia Services 20 1023512191 0 Physicians Healthy Kids Services 20 1023512191 0 Physicians Optical Supplies 20 1023512191 0 Physicians Physician Services 00 1023512274 0 KILEY CATHERINE E 2018106 9999999 B 10 1023512274 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1023512274 0 Nurse Practitioners Fluoride varnish 20 1023512274 0 Nurse Practitioners Healthy Kids Services 20 1023512274 0 Nurse Practitioners Nurse Practitioners Services 20 1023512274 0 Nurse Practitioners Physician Services 00 1023512316 0 PHALKE NEELAM 2024150 9999999 B 10 1023512316 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1023512316 0 Physicians Anesthesia Services 20 1023512316 0 Physicians Healthy Kids Services 20 1023512316 0 Physicians Optical Supplies 20 1023512316 0 Physicians Physician Services 00 1023512795 0 RASMUSSEN ZACHARY 2021155 9999999 B 10 1023512795 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1023512795 0 Physicians Anesthesia Services 20 1023512795 0 Physicians Healthy Kids Services 20 1023512795 0 Physicians Optical Supplies 20 1023512795 0 Physicians Physician Services 00 1023513025 0 NAVARRETE DEYGER J 2018196 9999999 B 10 1023513025 0 5777 DEPT CAROL STREAM IL 601220021 20 1023513025 0 Physicians Anesthesia Services 20 1023513025 0 Physicians Fluoride varnish 20 1023513025 0 Physicians Healthy Kids Services 20 1023513025 0 Physicians Optical Supplies 20 1023513025 0 Physicians Physician Services 00 1023513074 0 KENNEDY SARAH 2018198 9999999 B 10 1023513074 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1023513074 0 Physicians Anesthesia Services 20 1023513074 0 Physicians Healthy Kids Services 20 1023513074 0 Physicians Optical Supplies 20 1023513074 0 Physicians Physician Services 00 1023513173 0 LEHNE RAMIER J 2022363 9999999 B 10 1023513173 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1023513173 0 Physicians Anesthesia Services 20 1023513173 0 Physicians Fluoride varnish 20 1023513173 0 Physicians Healthy Kids Services 20 1023513173 0 Physicians Optical Supplies 20 1023513173 0 Physicians Physician Services 00 1023513249 0 VOLK MICHAEL 2022177 9999999 B 10 1023513249 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1023513249 0 Physicians Anesthesia Services 20 1023513249 0 Physicians Healthy Kids Services 20 1023513249 0 Physicians Optical Supplies 20 1023513249 0 Physicians Physician Services 20 1023513249 0 Physicians Physicians Psychiatric Services 00 1023513264 0 SEEDAT ZED 2023191 9999999 B 10 1023513264 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1023513264 0 Physicians Anesthesia Services 20 1023513264 0 Physicians Fluoride varnish 20 1023513264 0 Physicians Healthy Kids Services 20 1023513264 0 Physicians Optical Supplies 20 1023513264 0 Physicians Physician Services 00 1023513355 0 CLEMENTI JAMIE L 2023151 9999999 B 10 1023513355 0 PO BOX 3039 OAK BROOK IL 605223039 20 1023513355 0 Physicians Anesthesia Services 20 1023513355 0 Physicians Healthy Kids Services 20 1023513355 0 Physicians Optical Supplies 20 1023513355 0 Physicians Physician Services 00 1023513546 0 OSKUEI PEYMAN FARHANGI 2020017 9999999 B 10 1023513546 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1023513546 0 Physicians Anesthesia Services 20 1023513546 0 Physicians Healthy Kids Services 20 1023513546 0 Physicians Optical Supplies 20 1023513546 0 Physicians Physician Services 00 1023513645 0 CHIN DAVID 2024176 9999999 B 10 1023513645 0 29373 NETWORK PL CHICAGO IL 606733039 20 1023513645 0 Physicians Anesthesia Services 20 1023513645 0 Physicians Healthy Kids Services 20 1023513645 0 Physicians Optical Supplies 20 1023513645 0 Physicians Physician Services 00 1023513850 0 WEISHAAR JEFFREY R 2020014 9999999 B 10 1023513850 0 2201 GLENWOOD AVE JOLIET IL 604355574 20 1023513850 0 Physicians Anesthesia Services 20 1023513850 0 Physicians Healthy Kids Services 20 1023513850 0 Physicians Optical Supplies 20 1023513850 0 Physicians Physician Services 00 1023514478 0 LU ZHEYU 2022021 9999999 B 10 1023514478 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1023514478 0 Physicians Anesthesia Services 20 1023514478 0 Physicians Fluoride varnish 20 1023514478 0 Physicians Healthy Kids Services 20 1023514478 0 Physicians Optical Supplies 20 1023514478 0 Physicians Physician Services 00 1023514593 0 CHAN HINGKIU 2019225 9999999 B 10 1023514593 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1023514593 0 Physicians Anesthesia Services 20 1023514593 0 Physicians Healthy Kids Services 20 1023514593 0 Physicians Optical Supplies 20 1023514593 0 Physicians Physician Services 00 1023514718 0 STARK ASHLEY C 2024137 9999999 B 10 1023514718 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1023514718 0 Physicians Anesthesia Services 20 1023514718 0 Physicians Fluoride varnish 20 1023514718 0 Physicians Healthy Kids Services 20 1023514718 0 Physicians Optical Supplies 20 1023514718 0 Physicians Physician Services 00 1023514791 0 CRAFT JOSHUA F 2023332 9999999 B 10 1023514791 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1023514791 0 Physicians Anesthesia Services 20 1023514791 0 Physicians Fluoride varnish 20 1023514791 0 Physicians Healthy Kids Services 20 1023514791 0 Physicians Optical Supplies 20 1023514791 0 Physicians Physician Services 00 1023514833 0 HOLSAPPLE TYLER C 2021165 9999999 B 10 1023514833 0 515 22ND AVE MONROE WI 535661569 20 1023514833 0 Physicians Anesthesia Services 20 1023514833 0 Physicians Healthy Kids Services 20 1023514833 0 Physicians Optical Supplies 20 1023514833 0 Physicians Physician Services 00 1023514999 0 IQBAL FARRUKH 2021290 9999999 B 10 1023514999 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1023514999 0 Physicians Anesthesia Services 20 1023514999 0 Physicians Fluoride varnish 20 1023514999 0 Physicians Healthy Kids Services 20 1023514999 0 Physicians Optical Supplies 20 1023514999 0 Physicians Physician Services 00 1023515509 0 LEE CHENG-HAN 2024213 9999999 B 10 1023515509 0 1000 MEDICAL CENTER DR MONTICELLO IL 618562116 20 1023515509 0 Physicians Anesthesia Services 20 1023515509 0 Physicians Healthy Kids Services 20 1023515509 0 Physicians Optical Supplies 20 1023515509 0 Physicians Physician Services 00 1023515921 0 GILBERT DAKOTA 2021201 9999999 B 10 1023515921 0 1200 E TREMONT ST HILLSBORO IL 620491912 20 1023515921 0 Physicians Anesthesia Services 20 1023515921 0 Physicians Fluoride varnish 20 1023515921 0 Physicians Healthy Kids Services 20 1023515921 0 Physicians Optical Supplies 20 1023515921 0 Physicians Physician Services 00 1023516010 0 SPEER HARRY 2018205 9999999 B 10 1023516010 0 175 E HAWTHORN PKWY STE 235 VERNON HILLS IL 600611454 20 1023516010 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1023517109 0 HUBBARD PAULA K 2018050 9999999 B 10 1023517109 0 3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047452 20 1023517109 0 Nurse Practitioners Healthy Kids Services 20 1023517109 0 Nurse Practitioners Nurse Practitioners Services 20 1023517109 0 Nurse Practitioners Physician Services 00 1023519097 0 MCGRUDER-MILLER RONDA 2018057 9999999 B 10 1023519097 0 17746 OAK PARK AVE TINLEY PARK IL 604773936 20 1023519097 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1023520699 0 ELOWE REBECCA 2024173 9999999 B 10 1023520699 0 6557 N LINCOLN AVE LINCOLNWOOD IL 607123934 20 1023520699 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1023520855 0 ESCATEL PRISCILLA 2017307 9999999 B 10 1023520855 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1023520855 0 Speech Therapists Medical Supplies 20 1023520855 0 Speech Therapists Medical equipment/prosthetic devices 20 1023520855 0 Speech Therapists Speech Therapy/Pathology Services 00 1023521200 0 MILLER JOSIAH J 2019161 9999999 B 10 1023521200 0 4354 N SACRAMENTO AVE UNIT 1 CHICAGO IL 606181408 20 1023521200 0 Psychologist Psychologist service 00 1023521457 0 KNUDTSON CRAIG 2021153 9999999 B 10 1023521457 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1023521457 0 Nurse Practitioners Anesthesia Services 20 1023521457 0 Nurse Practitioners Nurse Practitioners Services 20 1023521457 0 Nurse Practitioners Physician Services 00 1023521531 0 GUENSBURG ANDREA 2022357 9999999 B 10 1023521531 0 525 PARK ST STE 300 SUITE 300 SAINT PAUL MN 551032197 20 1023521531 0 Physician Assistant Only Fluoride varnish 20 1023521531 0 Physician Assistant Only Healthy Kids Services 20 1023521531 0 Physician Assistant Only Physician Services 00 1023521705 0 PORTER AMY J 2017335 9999999 B 10 1023521705 0 118 E WASHINGTON ST O FALLON IL 622691419 20 1023521705 0 Speech Therapists Medical Supplies 20 1023521705 0 Speech Therapists Medical equipment/prosthetic devices 20 1023521705 0 Speech Therapists Speech Therapy/Pathology Services 00 1023522125 0 VIRGL JENNIFER 2019062 9999999 B 10 1023522125 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1023522125 0 Nurse Practitioners Healthy Kids Services 20 1023522125 0 Nurse Practitioners Nurse Practitioners Services 20 1023522125 0 Nurse Practitioners Physician Services 00 1023522976 0 DRIESBACH SARAH K 2019053 9999999 B 10 1023522976 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1023522976 0 Nurse Practitioners Fluoride varnish 20 1023522976 0 Nurse Practitioners Healthy Kids Services 20 1023522976 0 Nurse Practitioners Nurse Practitioners Services 20 1023522976 0 Nurse Practitioners Physician Services 00 1023523313 0 GIOVANNINI CARLA 2001052 9999999 B 10 1023523313 0 15732 S HOWARD ST PLAINFIELD IL 605442399 20 1023523313 0 Speech Therapists Medical Supplies 20 1023523313 0 Speech Therapists Medical equipment/prosthetic devices 20 1023523313 0 Speech Therapists Speech Therapy/Pathology Services 00 1023524469 0 HOLLIE BREANNA B 2021048 9999999 B 10 1023524469 0 900 RIDGE RD STE 1S HOMEWOOD IL 604301934 20 1023524469 0 Clinical Social Worker Social work service 00 1023524485 0 KINYANJUI NANCY S 2018004 9999999 B 10 1023524485 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1023524485 0 Nurse Practitioners Healthy Kids Services 20 1023524485 0 Nurse Practitioners Nurse Practitioners Services 20 1023524485 0 Nurse Practitioners Physician Services 00 1023525102 0 REINACHER KAREN 2020147 9999999 B 10 1023525102 0 10110 OLD LINCOLN TRL FAIRVIEW HTS IL 622082422 20 1023525102 0 Speech Therapists Medical Supplies 20 1023525102 0 Speech Therapists Medical equipment/prosthetic devices 20 1023525102 0 Speech Therapists Speech Therapy/Pathology Services 00 1023525292 0 JOHNSON KARLI 2024058 9999999 B 10 1023525292 0 200 W MONROE ST BLOOMINGTON IL 617013997 20 1023525292 0 Other behavior health professional LCPC/LMFT services 00 1023525615 0 HICKMAN BROOKE A 2018046 9999999 B 10 1023525615 0 1318 W 6TH ST KEWANEE IL 614431261 20 1023525615 0 Speech Therapists Medical Supplies 20 1023525615 0 Speech Therapists Medical equipment/prosthetic devices 20 1023525615 0 Speech Therapists Speech Therapy/Pathology Services 00 1023526027 0 WOLODKIEWICZ ELIZABETH 2017282 9999999 B 10 1023526027 0 2222 CHURCH ST JOHNSBURG IL 600515910 20 1023526027 0 Speech Therapists Medical Supplies 20 1023526027 0 Speech Therapists Medical equipment/prosthetic devices 20 1023526027 0 Speech Therapists Speech Therapy/Pathology Services 00 1023526647 0 REINERT MARLENE 2017240 9999999 B 10 1023526647 0 8324 SKOKIE BLVD SKOKIE IL 600772545 20 1023526647 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1023527207 0 SEPER ERIC C 2018334 9999999 B 10 1023527207 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1023527207 0 Audiologists Audiology Services 20 1023527207 0 Audiologists Medical Supplies 20 1023527207 0 Audiologists Medical equipment/prosthetic devices 00 1023527595 0 HECHT SUE 2017272 9999999 B 10 1023527595 0 18300 GREENBAY AVE LANSING IL 604383009 20 1023527595 0 Speech Therapists Medical Supplies 20 1023527595 0 Speech Therapists Medical equipment/prosthetic devices 20 1023527595 0 Speech Therapists Speech Therapy/Pathology Services 00 1023528411 0 MARRANDINO MAUREEN P. 2017340 9999999 B 10 1023528411 0 1900 W LE FEVRE RD STE A STERLING IL 610819202 20 1023528411 0 Speech Therapists Medical Supplies 20 1023528411 0 Speech Therapists Medical equipment/prosthetic devices 20 1023528411 0 Speech Therapists Speech Therapy/Pathology Services 00 1023528767 0 LYDON KAYLA M 2024184 9999999 B 10 1023528767 0 1650 LYNDON FARM CT STE 300 LOUISVILLE KY 402235005 20 1023528767 0 Physical Therapists Medical Supplies 20 1023528767 0 Physical Therapists Medical equipment/prosthetic devices 20 1023528767 0 Physical Therapists Physical Therapy Services 00 1023528940 0 HAWLEY MELINDA K 2020213 9999999 B 10 1023528940 0 2411 PATHWAYS XING BELLEVILLE IL 622215885 20 1023528940 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1023528981 0 NELSON JACLYN 2017116 9999999 B 10 1023528981 0 1350 GRAND AVE BEARDSTOWN IL 626188092 20 1023528981 0 Speech Therapists Medical Supplies 20 1023528981 0 Speech Therapists Medical equipment/prosthetic devices 20 1023528981 0 Speech Therapists Speech Therapy/Pathology Services 00 1023529054 0 VENCES INDIRA 2024108 9999999 B 10 1023529054 0 119 E PALATINE RD STE 207 PALATINE IL 600675132 20 1023529054 0 Clinical Social Worker Social work service 00 1023529252 0 SHAH PAYAL P 2017342 9999999 B 10 1023529252 0 801 ILLINI DR SILVIS IL 612821804 20 1023529252 0 Physician Assistant Only Fluoride varnish 20 1023529252 0 Physician Assistant Only Healthy Kids Services 20 1023529252 0 Physician Assistant Only Physician Services 00 1023529468 0 HULSEN MOLLY 2020076 9999999 B 10 1023529468 0 901 PATIENTS FIRST DR WASHINGTON MO 630904700 20 1023529468 0 Nurse Practitioners Healthy Kids Services 20 1023529468 0 Nurse Practitioners Nurse Practitioners Services 20 1023529468 0 Nurse Practitioners Physician Services 00 1023529971 0 BRUNI LIZA 2021152 9999999 B 10 1023529971 0 102 S CEDAR RD NEW LENOX IL 604511702 20 1023529971 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1023530078 0 ESPINOZA MARGARET 2017121 9999999 B 10 1023530078 0 5220 EAST AVE COUNTRYSIDE IL 605253133 20 1023530078 0 Other behavior health professional LCPC/LMFT services 00 1023530896 0 DEPTULA KIMBERLY A 2019018 9999999 B 10 1023530896 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1023530896 0 Nurse Practitioners Healthy Kids Services 20 1023530896 0 Nurse Practitioners Nurse Practitioners Services 20 1023530896 0 Nurse Practitioners Physician Services 00 1023531142 0 CUNNINGHAM KELSI D 2017335 9999999 B 10 1023531142 0 525 E GRANT ST MACOMB IL 614553313 20 1023531142 0 Nurse Practitioners Fluoride varnish 20 1023531142 0 Nurse Practitioners Healthy Kids Services 20 1023531142 0 Nurse Practitioners Nurse Practitioners Services 20 1023531142 0 Nurse Practitioners Physician Services 00 1023532603 0 PEREZ HOLLY C 2022200 9999999 B 10 1023532603 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1023532603 0 Physicians Anesthesia Services 20 1023532603 0 Physicians Fluoride varnish 20 1023532603 0 Physicians Healthy Kids Services 20 1023532603 0 Physicians Optical Supplies 20 1023532603 0 Physicians Physician Services 00 1023533122 0 DEMLER WENDY 2017221 9999999 B 10 1023533122 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1023533122 0 Nurse Practitioners Fluoride varnish 20 1023533122 0 Nurse Practitioners Healthy Kids Services 20 1023533122 0 Nurse Practitioners Nurse Practitioners Services 20 1023533122 0 Nurse Practitioners Physician Services 00 1023533403 0 ALKHASONEH MOTASEM 2021225 9999999 B 10 1023533403 0 335 E MAHN CT OAK CREEK WI 531542155 20 1023533403 0 Physicians Anesthesia Services 20 1023533403 0 Physicians Fluoride varnish 20 1023533403 0 Physicians Healthy Kids Services 20 1023533403 0 Physicians Optical Supplies 20 1023533403 0 Physicians Physician Services 00 1023533528 0 HAGEN KRISTINE L 2017305 9999999 B 10 1023533528 0 501 E LORENA AVE WOOD RIVER IL 620952123 20 1023533528 0 Speech Therapists Medical Supplies 20 1023533528 0 Speech Therapists Medical equipment/prosthetic devices 20 1023533528 0 Speech Therapists Speech Therapy/Pathology Services 00 1023534872 0 KOCH MONICA J 2017249 9999999 B 10 1023534872 0 224 S LOCUST ST CENTRALIA IL 628013509 20 1023534872 0 Speech Therapists Medical Supplies 20 1023534872 0 Speech Therapists Medical equipment/prosthetic devices 20 1023534872 0 Speech Therapists Speech Therapy/Pathology Services 00 1023534930 0 HOLDERBY SARA 2017236 9999999 B 10 1023534930 0 97 W 5TH ST EL PASO IL 617381049 20 1023534930 0 Speech Therapists Medical Supplies 20 1023534930 0 Speech Therapists Medical equipment/prosthetic devices 20 1023534930 0 Speech Therapists Speech Therapy/Pathology Services 00 1023536125 0 BORGES KRISTY Y 2018087 9999999 B 10 1023536125 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1023536125 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1023536455 0 NOLAN ASHLEY 2018278 9999999 H 10 1023536455 0 1120 E MAIN ST ST CHARLES IL 601742287 20 1023536455 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 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Optometrists Optical Supplies 20 1023537750 0 Optometrists Optometric Services 20 1023537750 0 Optometrists Physician Services 00 1023538659 0 GEDDES LAURIE 2018215 9999999 B 10 1023538659 0 701 PARK AVE MINNEAPOLIS MN 554151623 20 1023538659 0 Nurse Practitioners Healthy Kids Services 20 1023538659 0 Nurse Practitioners Nurse Practitioners Services 20 1023538659 0 Nurse Practitioners Physician Services 00 1023538915 0 JONES MEGAN 2017307 9999999 B 10 1023538915 0 715 LAKE ST STE 800 OAK PARK IL 603011417 20 1023538915 0 Clinical Social Worker Social work service 00 1023539004 0 LUTZ HEATHER L 2022137 9999999 B 10 1023539004 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1023539004 0 Nurse Practitioners Fluoride varnish 20 1023539004 0 Nurse Practitioners Healthy Kids Services 20 1023539004 0 Nurse Practitioners Nurse Practitioners Services 20 1023539004 0 Nurse Practitioners Physician Services 00 1023539848 0 ZAVALA JEFFREY 2023212 9999999 B 10 1023539848 0 200 HAWKINS DR 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9999999 B 10 1023543865 0 1431 CENTERPOINT BLVD STE 100 KNOXVILLE TN 379321983 20 1023543865 0 Nurse Practitioners Healthy Kids Services 20 1023543865 0 Nurse Practitioners Nurse Practitioners Services 20 1023543865 0 Nurse Practitioners Physician Services 00 1023544137 0 MESSIAH SHADI 2019193 9999999 B 10 1023544137 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1023544137 0 Physicians Anesthesia Services 20 1023544137 0 Physicians Healthy Kids Services 20 1023544137 0 Physicians Optical Supplies 20 1023544137 0 Physicians Physician Services 00 1023544186 0 MAZUR STEPHANY L 2018248 9999999 B 10 1023544186 0 44000 GARFIELD RD CLINTON TOWNSHI MI 480381125 20 1023544186 0 Physicians Anesthesia Services 20 1023544186 0 Physicians Healthy Kids Services 20 1023544186 0 Physicians Optical Supplies 20 1023544186 0 Physicians Physician Services 00 1023544475 0 EDGE PRESTON 2024226 9999999 B 10 1023544475 0 PO BOX 637273 CINCINNATI OH 452637273 20 1023544475 0 Physicians Anesthesia Services 20 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Physicians Physician Services 00 1023559978 0 JAMES COLLEEN 2017212 9999999 B 10 1023559978 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1023559978 0 Occupational Therapists Medical Supplies 20 1023559978 0 Occupational Therapists Medical equipment/prosthetic devices 20 1023559978 0 Occupational Therapists Occupational Therapy Services 00 1023560067 0 SUSTE KAYLYNN 2016336 9999999 B 10 1023560067 0 150 W HIGH ST MORRIS IL 604501463 20 1023560067 0 Nurse Practitioners Fluoride varnish 20 1023560067 0 Nurse Practitioners Healthy Kids Services 20 1023560067 0 Nurse Practitioners Nurse Practitioners Services 20 1023560067 0 Nurse Practitioners Physician Services 00 1023560372 0 JONES PEGGY 2016323 9999999 B 10 1023560372 0 515 E GRANT ST STE 111 MACOMB IL 614553315 20 1023560372 0 Nurse Practitioners Fluoride varnish 20 1023560372 0 Nurse Practitioners Healthy Kids Services 20 1023560372 0 Nurse Practitioners Nurse Practitioners Services 20 1023560372 0 Nurse Practitioners 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Physicians Anesthesia Services 20 1023564176 0 Physicians Fluoride varnish 20 1023564176 0 Physicians Healthy Kids Services 20 1023564176 0 Physicians Optical Supplies 20 1023564176 0 Physicians Physician Services 00 1023564432 0 POLISTCHUK MARIANA 2017143 9999999 B 10 1023564432 0 1238 REGENT DR MUNDELEIN IL 600602062 20 1023564432 0 Speech Therapists Medical Supplies 20 1023564432 0 Speech Therapists Medical equipment/prosthetic devices 20 1023564432 0 Speech Therapists Speech Therapy/Pathology Services 00 1023566551 0 THOMAS JUDY A 2016275 9999999 B 10 1023566551 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1023566551 0 Clinical Social Worker Social work service 00 1023566726 0 IYER CHRISTINA 2016257 9999999 B 10 1023566726 0 55 E JACKSON BLVD STE 1500 CHICAGO IL 606044184 20 1023566726 0 Nurse Practitioners Healthy Kids Services 20 1023566726 0 Nurse Practitioners Nurse Practitioners Services 20 1023566726 0 Nurse Practitioners Physician Services 00 1023569282 0 WHITNEY 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PARK ST URBANA IL 618012529 20 1023592524 0 Nurse Practitioners Fluoride varnish 20 1023592524 0 Nurse Practitioners Healthy Kids Services 20 1023592524 0 Nurse Practitioners Nurse Practitioners Services 20 1023592524 0 Nurse Practitioners Physician Services 00 1023593282 0 BREEN SALLY 2024131 9999999 B 10 1023593282 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1023593282 0 Nurse Practitioners Fluoride varnish 20 1023593282 0 Nurse Practitioners Healthy Kids Services 20 1023593282 0 Nurse Practitioners Nurse Practitioners Services 20 1023593282 0 Nurse Practitioners Physician Services 00 1023593332 0 BABARINDE MUYIWA A 2019042 9999999 B 10 1023593332 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1023593332 0 Nurse Practitioners Fluoride varnish 20 1023593332 0 Nurse Practitioners Healthy Kids Services 20 1023593332 0 Nurse Practitioners Nurse Practitioners Services 20 1023593332 0 Nurse Practitioners Physician Services 00 1023594447 0 PASCUAL GUIA STEPHANIE 2024191 9999999 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1023663614 0 2003 W FULTON ST STE 303 CHICAGO IL 606122345 20 1023663614 0 Physician Assistant Only Fluoride varnish 20 1023663614 0 Physician Assistant Only Healthy Kids Services 20 1023663614 0 Physician Assistant Only Physician Services 00 1023664257 0 KOWAL EMILY R 2023198 9999999 B 10 1023664257 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1023664257 0 Physicians Anesthesia Services 20 1023664257 0 Physicians Fluoride varnish 20 1023664257 0 Physicians Healthy Kids Services 20 1023664257 0 Physicians Optical Supplies 20 1023664257 0 Physicians Physician Services 00 1023665924 0 GANDT ROYA 2020111 9999999 B 10 1023665924 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1023665924 0 Nurse Practitioners Healthy Kids Services 20 1023665924 0 Nurse Practitioners Nurse Practitioners Services 20 1023665924 0 Nurse Practitioners Physician Services 00 1023666062 0 DRULIA SHAWN 2024155 9999999 B 10 1023666062 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1023666062 0 Physician Assistant Only Fluoride varnish 20 1023666062 0 Physician Assistant Only Healthy Kids Services 20 1023666062 0 Physician Assistant Only Physician Services 00 1023666120 0 KUDOWOR MESPHINA 2024290 9999999 B 10 1023666120 0 1757 N KIMBALL AVE STE 202 CHICAGO IL 606474805 20 1023666120 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1023666229 0 ZAVALA MAGALLY 2019246 9999999 B 10 1023666229 0 70 S RIVER ST AURORA IL 605065185 20 1023666229 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1023666401 0 RUSHING ELIZABETH 2019274 9999999 B 10 1023666401 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1023666401 0 Physician Assistant Only Fluoride varnish 20 1023666401 0 Physician Assistant Only Healthy Kids Services 20 1023666401 0 Physician Assistant Only Physician Services 00 1023668522 0 WILTON KELLY M 2023081 9999999 B 10 1023668522 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1023668522 0 Speech Therapists Medical Supplies 20 1023668522 0 Speech Therapists Medical equipment/prosthetic devices 20 1023668522 0 Speech Therapists Speech Therapy/Pathology Services 00 1023669504 0 GALLARDO STEPHANIE 2024017 9999999 B 10 1023669504 0 PO BOX 775254 CHICAGO IL 606775254 20 1023669504 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1023669538 0 NJEH JULIUS 2020160 9999999 B 10 1023669538 0 6033 N SHERIDAN RD STE N6 SUITE N6 CHICAGO IL 606603013 20 1023669538 0 Nurse Practitioners Fluoride varnish 20 1023669538 0 Nurse Practitioners Healthy Kids Services 20 1023669538 0 Nurse Practitioners Nurse Practitioners Services 20 1023669538 0 Nurse Practitioners Physician Services 00 1023670247 0 WILLIS KIRSTI R 2019253 9999999 B 10 1023670247 0 PO BOX 85297 CHICAGO IL 606895297 20 1023670247 0 Nurse Practitioners Healthy Kids Services 20 1023670247 0 Nurse Practitioners Nurse Practitioners Services 20 1023670247 0 Nurse Practitioners Physician Services 00 1023670817 0 JACOB JENNA 2022244 9999999 B 10 1023670817 0 5425 W LAKE ST CHICAGO IL 606442342 20 1023670817 0 Clinical Social Worker Social work service 00 1023671575 0 PHILLIPS ALLIE C 2024365 9999999 B 10 1023671575 0 312 E ARCHER AVE MONMOUTH IL 614621837 20 1023671575 0 Chiropractors Chiropractic Services 00 1023672409 0 BLOECHER PATRICK A 2023263 9999999 B 10 1023672409 0 2041 GOOSE LAKE RD SAUGET IL 622062822 20 1023672409 0 Physicians Anesthesia Services 20 1023672409 0 Physicians Fluoride varnish 20 1023672409 0 Physicians Healthy Kids Services 20 1023672409 0 Physicians Optical Supplies 20 1023672409 0 Physicians Physician Services 00 1023674769 0 WHITE JENNA 2019203 9999999 B 10 1023674769 0 122 S MICHIGAN AVE STE 1450 CHICAGO IL 606036176 20 1023674769 0 Other behavior health professional LCPC/LMFT services 00 1023674801 0 KOLATA IAN Q 2021183 9999999 B 10 1023674801 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1023674801 0 Physicians Anesthesia Services 20 1023674801 0 Physicians Healthy Kids Services 20 1023674801 0 Physicians Optical Supplies 20 1023674801 0 Physicians Physician Services 00 1023675741 0 TATE-ODOM AISHA 2020196 9999999 B 10 1023675741 0 900 N BROAD ST UNIT 338 GRIFFITH IN 463193539 20 1023675741 0 Nurse Practitioners Fluoride varnish 20 1023675741 0 Nurse Practitioners Healthy Kids Services 20 1023675741 0 Nurse Practitioners Nurse Practitioners Services 20 1023675741 0 Nurse Practitioners Physician Services 00 1023675766 0 ALINGER JOSHUA B 2022174 9999999 B 10 1023675766 0 4698 DEPT CAROL STREAM IL 601220021 20 1023675766 0 Physicians Anesthesia Services 20 1023675766 0 Physicians Healthy Kids Services 20 1023675766 0 Physicians Optical Supplies 20 1023675766 0 Physicians Physician Services 00 1023675840 0 HANRAHAN JORDAN R 2023221 9999999 B 10 1023675840 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1023675840 0 Physicians Anesthesia Services 20 1023675840 0 Physicians Healthy Kids Services 20 1023675840 0 Physicians Optical Supplies 20 1023675840 0 Physicians Physician Services 00 1023677010 0 PATEL KISHAN PRAVIN 2022195 9999999 B 10 1023677010 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1023677010 0 Physicians Anesthesia Services 20 1023677010 0 Physicians Fluoride varnish 20 1023677010 0 Physicians Healthy Kids Services 20 1023677010 0 Physicians Optical Supplies 20 1023677010 0 Physicians Physician Services 00 1023677051 0 BENDER ALVIE 2019204 9999999 B 10 1023677051 0 4939 W FULLERTON AVE CHICAGO IL 606392505 20 1023677051 0 Clinical Social Worker Social work service 00 1023678042 0 DORESCA PASCALE F-A 2019277 9999999 B 10 1023678042 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1023678042 0 Nurse Practitioners Healthy Kids Services 20 1023678042 0 Nurse Practitioners Nurse Practitioners Services 20 1023678042 0 Nurse Practitioners Physician Services 00 1023678596 0 ABUSALIM ABDUL-RAHMAN I 2019299 9999999 B 10 1023678596 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1023678596 0 Physicians Anesthesia Services 20 1023678596 0 Physicians Fluoride varnish 20 1023678596 0 Physicians Healthy Kids Services 20 1023678596 0 Physicians Optical Supplies 20 1023678596 0 Physicians Physician Services 00 1023678638 0 WEBER MATTHEW 2019182 9999999 B 10 1023678638 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1023678638 0 Physicians Anesthesia Services 20 1023678638 0 Physicians Healthy Kids Services 20 1023678638 0 Physicians Optical Supplies 20 1023678638 0 Physicians Physician Services 00 1023679024 0 HAFSA SAMI M 2023214 9999999 B 10 1023679024 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1023679024 0 Physicians Anesthesia Services 20 1023679024 0 Physicians Healthy Kids Services 20 1023679024 0 Physicians Optical Supplies 20 1023679024 0 Physicians Physician Services 00 1023679073 0 CARTLEDGE JULIA E 2019326 9999999 B 10 1023679073 0 2740 W FOSTER AVE LL7 CHICAGO IL 606253500 20 1023679073 0 Physicians Anesthesia Services 20 1023679073 0 Physicians Healthy Kids Services 20 1023679073 0 Physicians Optical Supplies 20 1023679073 0 Physicians Physician Services 00 1023680766 0 SZRAMEK ALLISON 2021203 9999999 B 10 1023680766 0 25775 W HIGHWAY 134 INGLESIDE IL 600419587 20 1023680766 0 Speech Therapists Medical Supplies 20 1023680766 0 Speech Therapists Medical equipment/prosthetic devices 20 1023680766 0 Speech Therapists Speech Therapy/Pathology Services 00 1023680972 0 COMPTON JAMIE 2021195 9999999 B 10 1023680972 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1023680972 0 Nurse Practitioners Anesthesia Services 20 1023680972 0 Nurse Practitioners Nurse Practitioners Services 20 1023680972 0 Nurse Practitioners Physician Services 00 1023681079 0 ANDERSON JESSICA 2022109 9999999 B 10 1023681079 0 2010 S ARLINGTON HEIGHTS RD ST ARLINGTON HEIGH IL 600054100 20 1023681079 0 Nurse Practitioners Healthy Kids Services 20 1023681079 0 Nurse Practitioners Nurse Practitioners Services 20 1023681079 0 Nurse Practitioners Physician Services 00 1023681418 0 DEMPSEY SHANNON 2022250 9999999 B 10 1023681418 0 20100 S SPRUCE DR FRANKFORT IL 604237099 20 1023681418 0 Speech Therapists Medical Supplies 20 1023681418 0 Speech Therapists Medical equipment/prosthetic devices 20 1023681418 0 Speech Therapists Speech Therapy/Pathology Services 00 1023681434 0 MIRALDA WENDY 2021204 9999999 B 10 1023681434 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1023681434 0 Nurse Practitioners Nursing service 20 1023681434 0 Nurse Practitioners Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1023681434 0 Nurse Practitioners Physician Services 20 1023681434 0 Nurse Practitioners Waiver service 00 1023681855 0 HOLLERAN MARLEE 2023307 9999999 B 10 1023681855 0 800 W FULTON MARKET FL 12 CHICAGO IL 606071302 20 1023681855 0 Physician Assistant Only Physician Services 00 1023682648 0 SAINI NITIN 2021194 9999999 B 10 1023682648 0 320 E CENTRAL AVE DECATUR IL 625214665 20 1023682648 0 Physicians Anesthesia Services 20 1023682648 0 Physicians Fluoride varnish 20 1023682648 0 Physicians Healthy Kids Services 20 1023682648 0 Physicians Optical Supplies 20 1023682648 0 Physicians Physician Services 00 1023682663 0 MUSLEH IBRAHEIM 2021194 9999999 B 10 1023682663 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1023682663 0 Physicians Anesthesia Services 20 1023682663 0 Physicians Fluoride varnish 20 1023682663 0 Physicians Healthy Kids Services 20 1023682663 0 Physicians Optical Supplies 20 1023682663 0 Physicians Physician Services 00 1023682838 0 RIDENBARK BROOKE L 2023130 9999999 B 10 1023682838 0 390 MAPLE SUMMIT RD JERSEYVILLE IL 620522000 20 1023682838 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1023683091 0 MARRUFO ANGELICA 2023292 9999999 B 10 1023683091 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1023683091 0 Other behavior health professional LCPC/LMFT services 00 1023684461 0 LONERGAN LAUREN E 2021188 9999999 B 10 1023684461 0 12050 S FLAMBEAU DR PALOS HEIGHTS IL 604631658 20 1023684461 0 Occupational Therapists Medical Supplies 20 1023684461 0 Occupational Therapists Medical equipment/prosthetic devices 20 1023684461 0 Occupational Therapists Occupational Therapy Services 00 1023685112 0 ROSINSKI CLAYTON L 2024214 2028182 B 10 1023685112 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1023685112 0 Physicians Anesthesia Services 20 1023685112 0 Physicians Healthy Kids Services 20 1023685112 0 Physicians Optical Supplies 20 1023685112 0 Physicians Physician Services 00 1023685377 0 ANDERSON RACHEL 2024204 9999999 B 10 1023685377 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1023685377 0 Physicians Anesthesia Services 20 1023685377 0 Physicians Fluoride varnish 20 1023685377 0 Physicians Healthy Kids Services 20 1023685377 0 Physicians Optical Supplies 20 1023685377 0 Physicians Physician Services 00 1023685948 0 GLASER VON 2024054 9999999 B 10 1023685948 0 850 43RD AVE STE 100 MOLINE IL 612658401 20 1023685948 0 Physical Therapists Medical Supplies 20 1023685948 0 Physical Therapists Medical equipment/prosthetic devices 20 1023685948 0 Physical Therapists Physical Therapy Services 00 1023686128 0 SHOEMAKER SARAH 2021231 9999999 B 10 1023686128 0 2111 E OAKLAND AVE STE B STE B BLOOMINGTON IL 617015783 20 1023686128 0 Nurse Practitioners Healthy Kids Services 20 1023686128 0 Nurse Practitioners Midwife Services 20 1023686128 0 Nurse Practitioners Nurse Practitioners Services 20 1023686128 0 Nurse Practitioners Physician Services 00 1023686359 0 REHM PRUDENCE 2021168 9999999 B 10 1023686359 0 854 TECHNOLOGY WAY LIBERTYVILLE IL 600485350 20 1023686359 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1023686722 0 JOSHI HIRVA D 2021230 9999999 B 10 1023686722 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1023686722 0 Physicians Anesthesia Services 20 1023686722 0 Physicians Fluoride varnish 20 1023686722 0 Physicians Healthy Kids Services 20 1023686722 0 Physicians Optical Supplies 20 1023686722 0 Physicians Physician Services 00 1023687605 0 HANNIGAN TIMOTHY 2024096 9999999 B 10 1023687605 0 975 W HAWTHORN DR ITASCA IL 601432056 20 1023687605 0 Other behavior health professional Adaptive behavior support technician services 00 1023688223 0 EL ALAM CHANTALE J 2021242 9999999 B 10 1023688223 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1023688223 0 Physicians Anesthesia Services 20 1023688223 0 Physicians Healthy Kids Services 20 1023688223 0 Physicians Optical Supplies 20 1023688223 0 Physicians Physician Services 20 1023688223 0 Physicians Physicians Psychiatric Services 00 1023688371 0 PATEL NIKESH K 2024124 9999999 B 10 1023688371 0 124 SW ADAMS ST PEORIA IL 616021308 20 1023688371 0 Physicians Anesthesia Services 20 1023688371 0 Physicians Fluoride varnish 20 1023688371 0 Physicians Healthy Kids Services 20 1023688371 0 Physicians Optical Supplies 20 1023688371 0 Physicians Physician Services 00 1023688892 0 CHAPAGAIN UDITA 2021204 9999999 B 10 1023688892 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1023688892 0 Physicians Anesthesia Services 20 1023688892 0 Physicians Healthy Kids Services 20 1023688892 0 Physicians Optical Supplies 20 1023688892 0 Physicians Physician Services 00 1023689064 0 COOK CYNTHIA A 2021204 9999999 B 10 1023689064 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1023689064 0 Occupational Therapists Medical Supplies 20 1023689064 0 Occupational Therapists Medical equipment/prosthetic devices 20 1023689064 0 Occupational Therapists Occupational Therapy Services 00 1023689213 0 ARON SAMANTHA 2022102 9999999 B 10 1023689213 0 1739 N ELSTON AVE CHICAGO IL 606421544 20 1023689213 0 Speech Therapists Medical Supplies 20 1023689213 0 Speech Therapists Medical equipment/prosthetic devices 20 1023689213 0 Speech Therapists Speech Therapy/Pathology Services 00 1023690161 0 WASHINGTON TAMIKA P 2021145 9999999 B 10 1023690161 0 1415 W 22ND ST OAK BROOK IL 605232074 20 1023690161 0 Clinical Social Worker Social work service 00 1023691300 0 EASTBURG NILS 2023182 9999999 B 10 1023691300 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1023691300 0 Physicians Anesthesia Services 20 1023691300 0 Physicians Fluoride varnish 20 1023691300 0 Physicians Healthy Kids Services 20 1023691300 0 Physicians Optical Supplies 20 1023691300 0 Physicians Physician Services 00 1023692597 0 JOSEPH BENJAMIN 2021229 9999999 B 10 1023692597 0 3425 S KING DR CHICAGO IL 606164108 20 1023692597 0 Dentists Dental Services 20 1023692597 0 Dentists Physician Services 00 1023694064 0 SMITH HUNTER G 2021125 9999999 B 10 1023694064 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1023694064 0 Physicians Anesthesia Services 20 1023694064 0 Physicians Fluoride varnish 20 1023694064 0 Physicians Healthy Kids Services 20 1023694064 0 Physicians Optical Supplies 20 1023694064 0 Physicians Physician Services 00 1023694395 0 SHAH ARIHA 2024338 9999999 B 10 1023694395 0 29373 NETWORK PL CHICAGO IL 606733039 20 1023694395 0 Psychologist Psychologist service 00 1023694460 0 ROARK SPENCER C 2024183 9999999 B 10 1023694460 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1023694460 0 Dentists Dental Services 20 1023694460 0 Dentists Physician Services 00 1023694809 0 MAILHES JENNA 2024341 9999999 B 10 1023694809 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1023694809 0 Physicians Anesthesia Services 20 1023694809 0 Physicians Healthy Kids Services 20 1023694809 0 Physicians Optical Supplies 20 1023694809 0 Physicians Physician Services 00 1023695129 0 EL BADAOUI JOSEPH 2023201 9999999 B 10 1023695129 0 611 W PARK ST URBANA IL 618012529 20 1023695129 0 Physicians Anesthesia Services 20 1023695129 0 Physicians Healthy Kids Services 20 1023695129 0 Physicians Optical Supplies 20 1023695129 0 Physicians Physician Services 00 1023695137 0 EPPURATH ATUL 2021167 9999999 B 10 1023695137 0 PO BOX 855795 MINNEAPOLIS MN 554851296 20 1023695137 0 Physicians Anesthesia Services 20 1023695137 0 Physicians Healthy Kids Services 20 1023695137 0 Physicians Optical Supplies 20 1023695137 0 Physicians Physician Services 00 1023696135 0 TRENNEPOHL CHRISTOPHER JORDAN 2021176 9999999 B 10 1023696135 0 7825 SOLUTION CTR CHICAGO IL 606777007 20 1023696135 0 Physicians Anesthesia Services 20 1023696135 0 Physicians Healthy Kids Services 20 1023696135 0 Physicians Optical Supplies 20 1023696135 0 Physicians Physician Services 20 1023696135 0 Physicians Physicians Psychiatric Services 00 1023696499 0 NAYAK POOJA 2021176 9999999 B 10 1023696499 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1023696499 0 Physicians Anesthesia Services 20 1023696499 0 Physicians Fluoride varnish 20 1023696499 0 Physicians Healthy Kids Services 20 1023696499 0 Physicians Optical Supplies 20 1023696499 0 Physicians Physician Services 00 1023696507 0 AFZAL SOHA 2024289 9999999 B 10 1023696507 0 1400 US HIGHWAY 61 FESTUS MO 630284100 20 1023696507 0 Physicians Anesthesia Services 20 1023696507 0 Physicians Fluoride varnish 20 1023696507 0 Physicians Healthy Kids Services 20 1023696507 0 Physicians Optical Supplies 20 1023696507 0 Physicians Physician Services 00 1023696978 0 HAGAN MATTHEW J 2023157 9999999 B 10 1023696978 0 4698 DEPT CAROL STREAM IL 601220021 20 1023696978 0 Physicians Anesthesia Services 20 1023696978 0 Physicians Healthy Kids Services 20 1023696978 0 Physicians Optical Supplies 20 1023696978 0 Physicians Physician Services 00 1023696986 0 RESNIKOFF ALISSA R 2022207 9999999 B 10 1023696986 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1023696986 0 Physicians Anesthesia Services 20 1023696986 0 Physicians Healthy Kids Services 20 1023696986 0 Physicians Optical Supplies 20 1023696986 0 Physicians Physician Services 20 1023696986 0 Physicians Physicians Psychiatric Services 00 1023697224 0 HAYES ELIZABETH M 2021182 9999999 B 10 1023697224 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1023697224 0 Physicians Anesthesia Services 20 1023697224 0 Physicians Fluoride varnish 20 1023697224 0 Physicians Healthy Kids Services 20 1023697224 0 Physicians Optical Supplies 20 1023697224 0 Physicians Physician Services 00 1023697281 0 ZIMMERMAN HALEY 2021187 9999999 B 10 1023697281 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1023697281 0 Physicians Anesthesia Services 20 1023697281 0 Physicians Fluoride varnish 20 1023697281 0 Physicians Healthy Kids Services 20 1023697281 0 Physicians Optical Supplies 20 1023697281 0 Physicians Physician Services 00 1023698446 0 YOUNG RICHARD 2022199 9999999 B 10 1023698446 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1023698446 0 Physicians Anesthesia Services 20 1023698446 0 Physicians Healthy Kids Services 20 1023698446 0 Physicians Optical Supplies 20 1023698446 0 Physicians Physician Services 00 1023699220 0 EVANS ELIZABETH A 2024164 9999999 B 10 1023699220 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1023699220 0 Physicians Anesthesia Services 20 1023699220 0 Physicians Fluoride varnish 20 1023699220 0 Physicians Healthy Kids Services 20 1023699220 0 Physicians Optical Supplies 20 1023699220 0 Physicians Physician Services 00 1023699394 0 HAYS SARAH B 2021175 9999999 B 10 1023699394 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1023699394 0 Physicians Anesthesia Services 20 1023699394 0 Physicians Healthy Kids Services 20 1023699394 0 Physicians Optical Supplies 20 1023699394 0 Physicians Physician Services 00 1023699931 0 WONG RYAN 2021224 9999999 B 10 1023699931 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1023699931 0 Physicians Anesthesia Services 20 1023699931 0 Physicians Healthy Kids Services 20 1023699931 0 Physicians Optical Supplies 20 1023699931 0 Physicians Physician Services 00 1023700242 0 CHIOU TOMMY T 2023208 9999999 B 10 1023700242 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1023700242 0 Physicians Anesthesia Services 20 1023700242 0 Physicians Fluoride varnish 20 1023700242 0 Physicians Healthy Kids Services 20 1023700242 0 Physicians Optical Supplies 20 1023700242 0 Physicians Physician Services 00 1023700523 0 SAKAKURA KAZUKI 2023206 9999999 B 10 1023700523 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1023700523 0 Physicians Anesthesia Services 20 1023700523 0 Physicians Healthy Kids Services 20 1023700523 0 Physicians Optical Supplies 20 1023700523 0 Physicians Physician Services 00 1023701505 0 BERRY VINCE E 2023160 9999999 B 10 1023701505 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1023701505 0 Physicians Anesthesia Services 20 1023701505 0 Physicians Healthy Kids Services 20 1023701505 0 Physicians Optical Supplies 20 1023701505 0 Physicians Physician Services 00 1023701653 0 SPERLING CONNOR A 2024016 9999999 B 10 1023701653 0 5777 DEPT CAROL STREAM IL 601220021 20 1023701653 0 Physical Therapists Medical Supplies 20 1023701653 0 Physical Therapists Medical equipment/prosthetic devices 20 1023701653 0 Physical Therapists Physical Therapy Services 00 1023702909 0 MOROBE RORISANG P 2023172 9999999 B 10 1023702909 0 190 E DELAWARE PL CHICAGO IL 606111813 20 1023702909 0 Physicians Anesthesia Services 20 1023702909 0 Physicians Fluoride varnish 20 1023702909 0 Physicians Healthy Kids Services 20 1023702909 0 Physicians Optical Supplies 20 1023702909 0 Physicians Physician Services 00 1023703535 0 SYED OMAIR ARSHAD 2023155 9999999 B 10 1023703535 0 PO BOX 3039 OAK BROOK IL 605223039 20 1023703535 0 Physicians Anesthesia Services 20 1023703535 0 Physicians Fluoride varnish 20 1023703535 0 Physicians Healthy Kids Services 20 1023703535 0 Physicians Optical Supplies 20 1023703535 0 Physicians Physician Services 00 1023703766 0 BARON SHEKINAH 2023192 9999999 B 10 1023703766 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1023703766 0 Physicians Anesthesia Services 20 1023703766 0 Physicians Healthy Kids Services 20 1023703766 0 Physicians Optical Supplies 20 1023703766 0 Physicians Physician Services 00 1023704921 0 ZHU SIHAN 2024212 9999999 B 10 1023704921 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1023704921 0 Physicians Anesthesia Services 20 1023704921 0 Physicians Healthy Kids Services 20 1023704921 0 Physicians Optical Supplies 20 1023704921 0 Physicians Physician Services 00 1023705233 0 ALSAKKAL SANDRA 2023193 9999999 B 10 1023705233 0 PO BOX 775257 CHICAGO IL 606775257 20 1023705233 0 Physicians Anesthesia Services 20 1023705233 0 Physicians Fluoride varnish 20 1023705233 0 Physicians Healthy Kids Services 20 1023705233 0 Physicians Optical Supplies 20 1023705233 0 Physicians Physician Services 00 1023705878 0 SHETH AMBER M 2023301 9999999 B 10 1023705878 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1023705878 0 Physicians Anesthesia Services 20 1023705878 0 Physicians Healthy Kids Services 20 1023705878 0 Physicians Optical Supplies 20 1023705878 0 Physicians Physician Services 00 1023706405 0 SALAH MOHAMMAD R 2023175 9999999 B 10 1023706405 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1023706405 0 Physicians Anesthesia Services 20 1023706405 0 Physicians Fluoride varnish 20 1023706405 0 Physicians Healthy Kids Services 20 1023706405 0 Physicians Optical Supplies 20 1023706405 0 Physicians Physician Services 00 1023706744 0 ALBRECHT BENJAMIN 2023213 9999999 B 10 1023706744 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1023706744 0 Physician Assistant Only Fluoride varnish 20 1023706744 0 Physician Assistant Only Healthy Kids Services 20 1023706744 0 Physician Assistant Only Physician Services 00 1023707163 0 SUSSMAN ALLYSON K 2023284 9999999 B 10 1023707163 0 1409 W CARROLL AVE CHICAGO IL 606071105 20 1023707163 0 Speech Therapists Medical Supplies 20 1023707163 0 Speech Therapists Medical equipment/prosthetic devices 20 1023707163 0 Speech Therapists Speech Therapy/Pathology Services 00 1023707387 0 PORTELLES TONY 2023186 9999999 B 10 1023707387 0 5917 S PULASKI RD CHICAGO IL 606294515 20 1023707387 0 Dentists Dental Services 20 1023707387 0 Dentists Physician Services 00 1023709466 0 BRUTON JAMES R 2023144 9999999 B 10 1023709466 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1023709466 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1023710274 0 DAVIS-RUPERTO NEAL F 2024026 9999999 B 10 1023710274 0 712 N DEARBORN ST FL 1 CHICAGO IL 606543846 20 1023710274 0 Audiologists Audiology Services 20 1023710274 0 Audiologists Medical Supplies 20 1023710274 0 Audiologists Medical equipment/prosthetic devices 00 1023711066 0 LIN KEVIN 2023181 9999999 B 10 1023711066 0 PO BOX 3039 OAK BROOK IL 605223039 20 1023711066 0 Physicians Anesthesia Services 20 1023711066 0 Physicians Fluoride varnish 20 1023711066 0 Physicians Healthy Kids Services 20 1023711066 0 Physicians Optical Supplies 20 1023711066 0 Physicians Physician Services 00 1023711330 0 LI JIALING 2023215 9999999 B 10 1023711330 0 1220 S WOOD ST CHICAGO IL 606081202 20 1023711330 0 Physicians Anesthesia Services 20 1023711330 0 Physicians Fluoride varnish 20 1023711330 0 Physicians Healthy Kids Services 20 1023711330 0 Physicians Optical Supplies 20 1023711330 0 Physicians Physician Services 00 1023711371 0 MENDONCA NINOSHKA 2023192 9999999 B 10 1023711371 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1023711371 0 Physicians Anesthesia Services 20 1023711371 0 Physicians Fluoride varnish 20 1023711371 0 Physicians Healthy Kids Services 20 1023711371 0 Physicians Optical Supplies 20 1023711371 0 Physicians Physician Services 00 1023711454 0 CAREY MICHAEL 2023191 9999999 B 10 1023711454 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1023711454 0 Physicians Anesthesia Services 20 1023711454 0 Physicians Healthy Kids Services 20 1023711454 0 Physicians Optical Supplies 20 1023711454 0 Physicians Physician Services 00 1023711785 0 VERMA RANU 2023174 9999999 B 10 1023711785 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1023711785 0 Physicians Anesthesia Services 20 1023711785 0 Physicians Fluoride varnish 20 1023711785 0 Physicians Healthy Kids Services 20 1023711785 0 Physicians Optical Supplies 20 1023711785 0 Physicians Physician Services 00 1023711868 0 GOLDSHER JAY 2023174 9999999 B 10 1023711868 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1023711868 0 Physicians Anesthesia Services 20 1023711868 0 Physicians Fluoride varnish 20 1023711868 0 Physicians Healthy Kids Services 20 1023711868 0 Physicians Optical Supplies 20 1023711868 0 Physicians Physician Services 00 1023712296 0 BROWN ALEXANDRA MARGARET 2023173 9999999 B 10 1023712296 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1023712296 0 Physicians Anesthesia Services 20 1023712296 0 Physicians Healthy Kids Services 20 1023712296 0 Physicians Optical Supplies 20 1023712296 0 Physicians Physician Services 00 1023712304 0 GARIMELLA VISHAL 2024002 9999999 B 10 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# 1223 EVANSTON IL 602011700 20 1023781887 0 Other behavior health professional LCPC/LMFT services 00 1023782075 0 GOEL MANISHA 2023256 9999999 B 10 1023782075 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1023782075 0 Physicians Anesthesia Services 20 1023782075 0 Physicians Healthy Kids Services 20 1023782075 0 Physicians Optical Supplies 20 1023782075 0 Physicians Physician Services 00 1023782646 0 NAVIGATO ANNA K 2022039 9999999 B 10 1023782646 0 5777 DEPT CAROL STREAM IL 601228942 20 1023782646 0 Physician Assistant Only Fluoride varnish 20 1023782646 0 Physician Assistant Only Healthy Kids Services 20 1023782646 0 Physician Assistant Only Physician Services 00 1023783917 0 TOLLAS MAISON 2024002 9999999 B 10 1023783917 0 28100 TORCH PKWY STE 600 WARRENVILLE IL 605554030 20 1023783917 0 Speech Therapists Medical Supplies 20 1023783917 0 Speech Therapists Medical equipment/prosthetic devices 20 1023783917 0 Speech Therapists Speech Therapy/Pathology Services 00 1023784220 0 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1033220652 0 5777 DEPT CAROL STREAM IL 601220021 20 1033220652 0 Physicians Anesthesia Services 20 1033220652 0 Physicians Healthy Kids Services 20 1033220652 0 Physicians Optical Supplies 20 1033220652 0 Physicians Physician Services 00 1033220678 0 HASAN ASHRAF S 2003213 9999999 B 10 1033220678 0 124 SW ADAMS ST FL 2 PEORIA IL 616021308 20 1033220678 0 Physicians Anesthesia Services 20 1033220678 0 Physicians Healthy Kids Services 20 1033220678 0 Physicians Optical Supplies 20 1033220678 0 Physicians Physician Services 00 1033221916 0 LETZ ADRIAN 2016047 9999999 B 10 1033221916 0 1515 DELHI ST STE 100 DUBUQUE IA 520016320 20 1033221916 0 Physicians Anesthesia Services 20 1033221916 0 Physicians Fluoride varnish 20 1033221916 0 Physicians Healthy Kids Services 20 1033221916 0 Physicians Optical Supplies 20 1033221916 0 Physicians Physician Services 00 1033222070 0 DUNN CARRIE 2023202 9999999 B 10 1033222070 0 PO BOX 43230 PHOENIX AZ 850803230 20 1033222070 0 Physicians Anesthesia Services 20 1033222070 0 Physicians Healthy Kids Services 20 1033222070 0 Physicians Optical Supplies 20 1033222070 0 Physicians Physician Services 00 1033222104 0 KISIEL BEATA 2008352 2099365 B 10 1033222104 0 120 W 22ND ST OAK BROOK IL 605231557 20 1033222104 0 Physicians Anesthesia Services 20 1033222104 0 Physicians Fluoride varnish 20 1033222104 0 Physicians Healthy Kids Services 20 1033222104 0 Physicians Optical Supplies 20 1033222104 0 Physicians Physician Services 00 1033222625 0 KNOX DAVID 2025104 9999999 B 10 1033222625 0 363 N WEST ST OLNEY IL 624501160 20 1033222625 0 Physicians Anesthesia Services 20 1033222625 0 Physicians Fluoride varnish 20 1033222625 0 Physicians Healthy Kids Services 20 1033222625 0 Physicians Optical Supplies 20 1033222625 0 Physicians Physician Services 00 1033223318 0 NICHOLSON CRAIG 2022290 9999999 B 10 1033223318 0 PO BOX 1510 EVANSVILLE IN 477061510 20 1033223318 0 Physicians Anesthesia Services 20 1033223318 0 Physicians Healthy Kids Services 20 1033223318 0 Physicians Optical Supplies 20 1033223318 0 Physicians Physician Services 00 1033223854 0 WILSON PATRICIA 2015152 9999999 B 10 1033223854 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1033223854 0 Nurse Practitioners Healthy Kids Services 20 1033223854 0 Nurse Practitioners Nurse Practitioners Services 20 1033223854 0 Nurse Practitioners Physician Services 00 1033223961 0 LENTINE KRISTA 2004275 9999999 B 10 1033223961 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1033223961 0 Physicians Anesthesia Services 20 1033223961 0 Physicians Fluoride varnish 20 1033223961 0 Physicians Healthy Kids Services 20 1033223961 0 Physicians Optical Supplies 20 1033223961 0 Physicians Physician Services 00 1033224308 0 ARTHUR JILL 2024070 9999999 B 10 1033224308 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1033224308 0 Physicians Anesthesia Services 20 1033224308 0 Physicians Healthy Kids Services 20 1033224308 0 Physicians Optical Supplies 20 1033224308 0 Physicians Physician Services 00 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Physicians Fluoride varnish 20 1033229224 0 Physicians Healthy Kids Services 20 1033229224 0 Physicians Optical Supplies 20 1033229224 0 Physicians Physician Services 00 1033230016 0 FREY HEATHER 2008210 9999999 B 10 1033230016 0 5665 NEW NORTHSIDE DR ATLANTA GA 303285831 20 1033230016 0 Nurse Practitioners Fluoride varnish 20 1033230016 0 Nurse Practitioners Healthy Kids Services 20 1033230016 0 Nurse Practitioners Nurse Practitioners Services 20 1033230016 0 Nurse Practitioners Physician Services 00 1033230156 0 JACOBS MINDY L 2007060 9999999 B 10 1033230156 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1033230156 0 Nurse Practitioners Healthy Kids Services 20 1033230156 0 Nurse Practitioners Nurse Practitioners Services 20 1033230156 0 Nurse Practitioners Physician Services 00 1033231857 0 PALIVOS LISA R 2010274 9999999 B 10 1033231857 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1033231857 0 Physicians Anesthesia Services 20 1033231857 0 Physicians Healthy Kids Services 20 1033231857 0 Physicians Optical Supplies 20 1033231857 0 Physicians Physician Services 00 1033232749 0 BYRD JENNIFER 2002231 9999999 B 10 1033232749 0 1909 CHEKER SQ # SECTA EAST HAZEL CRES IL 604291442 20 1033232749 0 Physicians Anesthesia Services 20 1033232749 0 Physicians Fluoride varnish 20 1033232749 0 Physicians Healthy Kids Services 20 1033232749 0 Physicians Optical Supplies 20 1033232749 0 Physicians Physician Services 00 1033234737 0 SCHMALE SIMONE 2016163 9999999 B 10 1033234737 0 650 E DIEHL RD STE 121 NAPERVILLE IL 605634812 20 1033234737 0 Other behavior health professional LCPC/LMFT services 00 1033235882 0 BLACKMON BRIAN B 2017163 9999999 B 10 1033235882 0 5777 DEPT CAROL STREAM IL 601228942 20 1033235882 0 Physicians Anesthesia Services 20 1033235882 0 Physicians Healthy Kids Services 20 1033235882 0 Physicians Optical Supplies 20 1033235882 0 Physicians Physician Services 20 1033235882 0 Physicians Physicians Psychiatric Services 00 1033236633 0 HORTENSTINE JANA C 2007075 9999999 B 10 1033236633 0 1701 CHARLESTON AVE MATTOON IL 619383936 20 1033236633 0 Speech Therapists Medical Supplies 20 1033236633 0 Speech Therapists Medical equipment/prosthetic devices 20 1033236633 0 Speech Therapists Speech Therapy/Pathology Services 00 1033238191 0 FREEBERG JEANINE 2000021 9999999 B 10 1033238191 0 10501 S SAINT LOUIS AVE CHICAGO IL 606552528 20 1033238191 0 Physical Therapists Medical Supplies 20 1033238191 0 Physical Therapists Medical equipment/prosthetic devices 20 1033238191 0 Physical Therapists Physical Therapy Services 00 1033239041 0 BARTSCHER JAMES 2023284 9999999 B 10 1033239041 0 PO BOX 781076 DETROIT MI 482781076 20 1033239041 0 Physicians Anesthesia Services 20 1033239041 0 Physicians Healthy Kids Services 20 1033239041 0 Physicians Optical Supplies 20 1033239041 0 Physicians Physician Services 20 1033239041 0 Physicians Physicians Psychiatric Services 00 1033239496 0 EL AMIN WENDI REBECCA 2013280 9999999 B 10 1033239496 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1033239496 0 Physicians Anesthesia Services 20 1033239496 0 Physicians Fluoride varnish 20 1033239496 0 Physicians Healthy Kids Services 20 1033239496 0 Physicians Optical Supplies 20 1033239496 0 Physicians Physician Services 00 1033240411 0 CHANG GENE L 2020162 9999999 B 10 1033240411 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1033240411 0 Physicians Anesthesia Services 20 1033240411 0 Physicians Fluoride varnish 20 1033240411 0 Physicians Healthy Kids Services 20 1033240411 0 Physicians Optical Supplies 20 1033240411 0 Physicians Physician Services 00 1033240676 0 GOTTER BRENDA G 2009244 9999999 B 10 1033240676 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1033240676 0 Audiologists Audiology Services 20 1033240676 0 Audiologists Medical Supplies 20 1033240676 0 Audiologists Medical equipment/prosthetic devices 00 1033240783 0 REULAND CARYN 2005056 9999999 B 10 1033240783 0 675 COLONY AVE LINDENHURST IL 600467830 20 1033240783 0 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Anesthesia Services 20 1033245139 0 Physicians Fluoride varnish 20 1033245139 0 Physicians Healthy Kids Services 20 1033245139 0 Physicians Optical Supplies 20 1033245139 0 Physicians Physician Services 00 1033245725 0 LAMATTINA JOHN C 2008183 9999999 B 10 1033245725 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1033245725 0 Physicians Anesthesia Services 20 1033245725 0 Physicians Healthy Kids Services 20 1033245725 0 Physicians Optical Supplies 20 1033245725 0 Physicians Physician Services 00 1033248935 0 DOOLEY-HASH SUZANNE L 2021058 9999999 B 10 1033248935 0 700 KMS PL ANN ARBOR MI 481081652 20 1033248935 0 Physicians Anesthesia Services 20 1033248935 0 Physicians Healthy Kids Services 20 1033248935 0 Physicians Optical Supplies 20 1033248935 0 Physicians Physician Services 00 1033249677 0 GARRETSON CARA B 2012118 9999999 B 10 1033249677 0 5777 DEPT CAROL STREAM IL 601220021 20 1033249677 0 Physicians Anesthesia Services 20 1033249677 0 Physicians Healthy Kids Services 20 1033249677 0 Physicians Optical Supplies 20 1033249677 0 Physicians Physician Services 00 1033250576 0 JOHNSON NICOLE A 2018091 9999999 B 10 1033250576 0 13000 DEERFIELD PKWY STE 100 ALPHARETTA GA 300046118 20 1033250576 0 Physician Assistant Only Fluoride varnish 20 1033250576 0 Physician Assistant Only Healthy Kids Services 20 1033250576 0 Physician Assistant Only Physician Services 00 1033252838 0 SCHNEIDER DANIELLE 2003305 9999999 B 10 1033252838 0 2900 OGDEN AVE LISLE IL 605321631 20 1033252838 0 Speech Therapists Medical Supplies 20 1033252838 0 Speech Therapists Medical equipment/prosthetic devices 20 1033252838 0 Speech Therapists Speech Therapy/Pathology Services 00 1033253539 0 MCDONALD LYNN 1998341 9999999 B 10 1033253539 0 1550 BISHOP CT MOUNT PROSPECT IL 600566039 20 1033253539 0 Physicians Anesthesia Services 20 1033253539 0 Physicians Healthy Kids Services 20 1033253539 0 Physicians Optical Supplies 20 1033253539 0 Physicians Physician Services 00 1033253620 0 MYLES LISA 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1033263173 0 2424 N 8TH ST PEKIN IL 615541547 20 1033263173 0 Dentists Dental Services 20 1033263173 0 Dentists Physician Services 00 1033266044 0 CHOPRA ARCHANA 2002274 9999999 B 10 1033266044 0 1921 N MARKET ST MONTICELLO IL 618568144 20 1033266044 0 Physicians All Kids application agent 20 1033266044 0 Physicians Anesthesia Services 20 1033266044 0 Physicians Healthy Kids Services 20 1033266044 0 Physicians Optical Supplies 20 1033266044 0 Physicians Physician Services 20 1033266044 0 Physicians Physicians Psychiatric Services 00 1033266473 0 MELBY DEREK A 2019324 9999999 B 10 1033266473 0 29373 NETWORK PL CHICAGO IL 606733039 20 1033266473 0 Physicians Anesthesia Services 20 1033266473 0 Physicians Fluoride varnish 20 1033266473 0 Physicians Healthy Kids Services 20 1033266473 0 Physicians Optical Supplies 20 1033266473 0 Physicians Physician Services 00 1033266820 0 VANDERPOOL CHARLES P B 2011213 9999999 B 10 1033266820 0 PO BOX 778912 CHICAGO IL 606778912 20 1033266820 0 Physicians Anesthesia Services 20 1033266820 0 Physicians Fluoride varnish 20 1033266820 0 Physicians Healthy Kids Services 20 1033266820 0 Physicians Optical Supplies 20 1033266820 0 Physicians Physician Services 00 1033269071 0 PAIK SANGHYUN M 1989212 9999999 B 10 1033269071 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1033269071 0 Physicians Anesthesia Services 20 1033269071 0 Physicians Fluoride varnish 20 1033269071 0 Physicians Healthy Kids Services 20 1033269071 0 Physicians Optical Supplies 20 1033269071 0 Physicians Physician Services 00 1033270046 0 GORDEUK VICTOR R 2011335 9999999 B 10 1033270046 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1033270046 0 Physicians Anesthesia Services 20 1033270046 0 Physicians Fluoride varnish 20 1033270046 0 Physicians Healthy Kids Services 20 1033270046 0 Physicians Optical Supplies 20 1033270046 0 Physicians Physician Services 00 1033270533 0 MCFADDEN DAVID 1994001 9999999 B 10 1033270533 0 1499 LAKEWOOD DR STE B MORRIS IL 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1033272323 0 Physicians Anesthesia Services 20 1033272323 0 Physicians Fluoride varnish 20 1033272323 0 Physicians Healthy Kids Services 20 1033272323 0 Physicians Optical Supplies 20 1033272323 0 Physicians Physician Services 00 1033272547 0 STADLER WALTER 1991182 9999999 B 10 1033272547 0 2361 PAYSPHERE CIR CHICAGO IL 606740023 20 1033272547 0 Physicians Anesthesia Services 20 1033272547 0 Physicians Fluoride varnish 20 1033272547 0 Physicians Healthy Kids Services 20 1033272547 0 Physicians Optical Supplies 20 1033272547 0 Physicians Physician Services 00 1033272554 0 TE HELEN 1996109 9999999 B 10 1033272554 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1033272554 0 Physicians Anesthesia Services 20 1033272554 0 Physicians Fluoride varnish 20 1033272554 0 Physicians Healthy Kids Services 20 1033272554 0 Physicians Optical Supplies 20 1033272554 0 Physicians Physician Services 00 1033272943 0 NOWAK MARIE 1998032 9999999 B 10 1033272943 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1033272943 0 Physicians Anesthesia Services 20 1033272943 0 Physicians Fluoride varnish 20 1033272943 0 Physicians Healthy Kids Services 20 1033272943 0 Physicians Optical Supplies 20 1033272943 0 Physicians Physician Services 00 1033274840 0 WEISS BRIAN 2025140 9999999 B 10 1033274840 0 PO BOX 778912 CHICAGO IL 606778912 20 1033274840 0 Physicians Anesthesia Services 20 1033274840 0 Physicians Fluoride varnish 20 1033274840 0 Physicians Healthy Kids Services 20 1033274840 0 Physicians Optical Supplies 20 1033274840 0 Physicians Physician Services 00 1033275052 0 BAKER-EL ABIAD KIMBERLY M 2008198 9999999 B 10 1033275052 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1033275052 0 Physicians Anesthesia Services 20 1033275052 0 Physicians Fluoride varnish 20 1033275052 0 Physicians Healthy Kids Services 20 1033275052 0 Physicians Optical Supplies 20 1033275052 0 Physicians Physician Services 00 1033275276 0 OH THOMAS 2009314 9999999 B 10 1033275276 0 1 MEDICAL CENTER DR GALENA IL 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20 1033281506 0 Physicians Healthy Kids Services 20 1033281506 0 Physicians Optical Supplies 20 1033281506 0 Physicians Physician Services 00 1033283411 0 WRIGHT HEATHER G 2004181 9999999 B 10 1033283411 0 301 W WOODSTOCK ST CRYSTAL LAKE IL 600144231 20 1033283411 0 Speech Therapists Medical Supplies 20 1033283411 0 Speech Therapists Medical equipment/prosthetic devices 20 1033283411 0 Speech Therapists Speech Therapy/Pathology Services 00 1033284179 0 MCCULLOUGH WAYNE 2018134 9999999 B 10 1033284179 0 11801 SOUTHWEST HWY STE 3N PALOS HEIGHTS IL 604631069 20 1033284179 0 Podiatrists Podiatric Services 00 1033284526 0 WINKELMAN DANIEL 2000222 9999999 B 10 1033284526 0 PO BOX 5588 BELFAST ME 049155500 20 1033284526 0 Physicians Anesthesia Services 20 1033284526 0 Physicians Healthy Kids Services 20 1033284526 0 Physicians Optical Supplies 20 1033284526 0 Physicians Physician Services 00 1033286232 0 DURBIN JODI C 2021313 9999999 B 10 1033286232 0 PO BOX 43230 PHOENIX AZ 850803230 20 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STATE ST CHICAGO IL 606043900 20 1033430228 0 Psychologist Psychologist service 00 1033430624 0 ALVARADO JOAN 2013224 9999999 B 10 1033430624 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1033430624 0 Physicians Anesthesia Services 20 1033430624 0 Physicians Fluoride varnish 20 1033430624 0 Physicians Healthy Kids Services 20 1033430624 0 Physicians Optical Supplies 20 1033430624 0 Physicians Physician Services 00 1033431580 0 OAKLEY DIANA 2011010 9999999 B 10 1033431580 0 412 NW 3RD ST CASEY IL 624201014 20 1033431580 0 Nurse Practitioners Fluoride varnish 20 1033431580 0 Nurse Practitioners Healthy Kids Services 20 1033431580 0 Nurse Practitioners Nurse Practitioners Services 20 1033431580 0 Nurse Practitioners Physician Services 00 1033431788 0 LIND MICHAEL A 2018182 9999999 B 10 1033431788 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1033431788 0 Psychologist Psychologist service 00 1033432109 0 AGARWAL GAURAV 2013182 9999999 B 10 1033432109 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO 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9999999 B 10 1033448147 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1033448147 0 Physicians Anesthesia Services 20 1033448147 0 Physicians Fluoride varnish 20 1033448147 0 Physicians Healthy Kids Services 20 1033448147 0 Physicians Optical Supplies 20 1033448147 0 Physicians Physician Services 00 1033450580 0 HOWELLS SARAH 2023159 9999999 B 10 1033450580 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1033450580 0 Physical Therapists Medical Supplies 20 1033450580 0 Physical Therapists Medical equipment/prosthetic devices 20 1033450580 0 Physical Therapists Physical Therapy Services 00 1033450697 0 BURRUS SARAH K 2016161 9999999 B 10 1033450697 0 PO BOX 503900 SAINT LOUIS MO 631503900 20 1033450697 0 Nurse Practitioners Fluoride varnish 20 1033450697 0 Nurse Practitioners Healthy Kids Services 20 1033450697 0 Nurse Practitioners Nurse Practitioners Services 20 1033450697 0 Nurse Practitioners Nursing service 20 1033450697 0 Nurse Practitioners Physician Services 20 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1033462445 0 Nurse Practitioners Healthy Kids Services 20 1033462445 0 Nurse Practitioners Nurse Practitioners Services 20 1033462445 0 Nurse Practitioners Physician Services 00 1033462643 0 CUCA AMANDA 2012245 9999999 B 10 1033462643 0 5777 DEPT CAROL STREAM IL 601220021 20 1033462643 0 Nurse Practitioners Healthy Kids Services 20 1033462643 0 Nurse Practitioners Nurse Practitioners Services 20 1033462643 0 Nurse Practitioners Physician Services 00 1033464888 0 MALLI AHMAD 2022001 9999999 B 10 1033464888 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1033464888 0 Physicians Anesthesia Services 20 1033464888 0 Physicians Fluoride varnish 20 1033464888 0 Physicians Healthy Kids Services 20 1033464888 0 Physicians Optical Supplies 20 1033464888 0 Physicians Physician Services 00 1033464987 0 JOHNSON JOYCE 2015288 9999999 B 10 1033464987 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1033464987 0 Physicians Anesthesia Services 20 1033464987 0 Physicians Fluoride varnish 20 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HETFLEISCH CARLY 2012249 9999999 B 10 1033468418 0 1000 REMINGTON BLVD STE 110 SUITE 110 BOLINGBROOK IL 604404708 20 1033468418 0 Speech Therapists Medical Supplies 20 1033468418 0 Speech Therapists Medical equipment/prosthetic devices 20 1033468418 0 Speech Therapists Speech Therapy/Pathology Services 00 1033469309 0 WHITE MARISSA E 2021280 9999999 B 10 1033469309 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1033469309 0 Speech Therapists Medical Supplies 20 1033469309 0 Speech Therapists Medical equipment/prosthetic devices 20 1033469309 0 Speech Therapists Speech Therapy/Pathology Services 00 1033470604 0 CASTER JOSEPH M 2017196 9999999 B 10 1033470604 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1033470604 0 Physicians Anesthesia Services 20 1033470604 0 Physicians Healthy Kids Services 20 1033470604 0 Physicians Optical Supplies 20 1033470604 0 Physicians Physician Services 00 1033471131 0 MILLS KATHRYN A 2017231 9999999 B 10 1033471131 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1033471131 0 Physicians Anesthesia Services 20 1033471131 0 Physicians Healthy Kids Services 20 1033471131 0 Physicians Optical Supplies 20 1033471131 0 Physicians Physician Services 00 1033473970 0 THOMAS JONATHAN F 2017066 9999999 B 10 1033473970 0 5121 MARYLAND WAY STE 300 BRENTWOOD TN 370277516 20 1033473970 0 Physicians Anesthesia Services 20 1033473970 0 Physicians Healthy Kids Services 20 1033473970 0 Physicians Optical Supplies 20 1033473970 0 Physicians Physician Services 00 1033474192 0 CHRISINGER JOHN SPELLMAN ARAN 2017145 9999999 B 10 1033474192 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1033474192 0 Physicians Anesthesia Services 20 1033474192 0 Physicians Healthy Kids Services 20 1033474192 0 Physicians Optical Supplies 20 1033474192 0 Physicians Physician Services 00 1033474333 0 TSEMUNHU NYARADZO 2020287 9999999 B 10 1033474333 0 611 W PARK ST URBANA IL 618012529 20 1033474333 0 Physician Assistant Only Fluoride varnish 20 1033474333 0 Physician 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1033505607 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1033505607 0 Physicians Anesthesia Services 20 1033505607 0 Physicians Healthy Kids Services 20 1033505607 0 Physicians Optical Supplies 20 1033505607 0 Physicians Physician Services 00 1033506332 0 UZOEGWU AKWAUGO T 2019268 9999999 B 10 1033506332 0 PO BOX 632281 CINCINNATI OH 452632281 20 1033506332 0 Physicians Anesthesia Services 20 1033506332 0 Physicians Fluoride varnish 20 1033506332 0 Physicians Healthy Kids Services 20 1033506332 0 Physicians Optical Supplies 20 1033506332 0 Physicians Physician Services 00 1033506555 0 MCCREARY KATHERINE A 2018228 9999999 B 10 1033506555 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1033506555 0 Physicians Anesthesia Services 20 1033506555 0 Physicians Fluoride varnish 20 1033506555 0 Physicians Healthy Kids Services 20 1033506555 0 Physicians Optical Supplies 20 1033506555 0 Physicians Physician Services 00 1033506910 0 BOSCHUETZ NICOLE A 2023219 9999999 B 10 1033506910 0 7974 UW HEALTH 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Services 00 1033508981 0 PILECKI MATTHEW 2019182 9999999 B 10 1033508981 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1033508981 0 Physicians Anesthesia Services 20 1033508981 0 Physicians Healthy Kids Services 20 1033508981 0 Physicians Optical Supplies 20 1033508981 0 Physicians Physician Services 00 1033510532 0 KARVALA CRAIG T 2015001 2099001 B 10 1033510532 0 232 MAIN ST NW STE 201 SUITE 201 BOURBONNAIS IL 609141877 20 1033510532 0 Chiropractors Chiropractic Services 00 1033510763 0 YOUSAF QURRAT-UL-ANNE 2017032 9999999 B 10 1033510763 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112386 20 1033510763 0 Dentists Dental Services 20 1033510763 0 Dentists Physician Services 00 1033512207 0 BELLEAVIA MEGAN B 2014310 9999999 B 10 1033512207 0 PO BOX 713388 CHICAGO IL 606771525 20 1033512207 0 Nurse Practitioners Family Planning Counseling 20 1033512207 0 Nurse Practitioners Healthy Kids Services 20 1033512207 0 Nurse Practitioners Midwife Services 20 1033512207 0 Nurse Practitioners 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Physician Services 00 1033520457 0 LURK JODY 2018060 9999999 B 10 1033520457 0 PO BOX 146 WATERLOO IL 622980146 20 1033520457 0 Other behavior health professional LCPC/LMFT services 00 1033520804 0 ZARLING RACHEL P 2019137 9999999 B 10 1033520804 0 29373 NETWORK PL CHICAGO IL 606733039 20 1033520804 0 Physicians Anesthesia Services 20 1033520804 0 Physicians Healthy Kids Services 20 1033520804 0 Physicians Optical Supplies 20 1033520804 0 Physicians Physician Services 00 1033522008 0 ZMUDA KRISTEN A 2022227 9999999 B 10 1033522008 0 PO BOX 3990 NAPERVILLE IL 605673990 20 1033522008 0 Speech Therapists Medical Supplies 20 1033522008 0 Speech Therapists Medical equipment/prosthetic devices 20 1033522008 0 Speech Therapists Speech Therapy/Pathology Services 00 1033523097 0 DETERS MEGHAN 2017278 9999999 B 10 1033523097 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1033523097 0 Physical Therapists Medical Supplies 20 1033523097 0 Physical Therapists Medical equipment/prosthetic devices 20 1033523097 0 Physical Therapists Physical Therapy Services 00 1033523501 0 QVAVADZE TEAH 2023240 9999999 B 10 1033523501 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1033523501 0 Physicians Anesthesia Services 20 1033523501 0 Physicians Healthy Kids Services 20 1033523501 0 Physicians Optical Supplies 20 1033523501 0 Physicians Physician Services 00 1033524350 0 MILLER KAYLA 2018157 9999999 B 10 1033524350 0 PO BOX 530 HAVANA IL 626440530 20 1033524350 0 Physicians Anesthesia Services 20 1033524350 0 Physicians Fluoride varnish 20 1033524350 0 Physicians Healthy Kids Services 20 1033524350 0 Physicians Optical Supplies 20 1033524350 0 Physicians Physician Services 00 1033524368 0 ADIL UMAMA S 2021204 9999999 B 10 1033524368 0 1005 BROADWAY ST QUINCY IL 623012834 20 1033524368 0 Physicians Anesthesia Services 20 1033524368 0 Physicians Fluoride varnish 20 1033524368 0 Physicians Healthy Kids Services 20 1033524368 0 Physicians Optical Supplies 20 1033524368 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9999999 B 10 1033527874 0 5121 MARYLAND WAY STE 300 BRENTWOOD TN 370277516 20 1033527874 0 Physicians Anesthesia Services 20 1033527874 0 Physicians Fluoride varnish 20 1033527874 0 Physicians Healthy Kids Services 20 1033527874 0 Physicians Optical Supplies 20 1033527874 0 Physicians Physician Services 00 1033530548 0 SOLOMON MELISSA 2024022 9999999 B 10 1033530548 0 2215 SANDERS RD STE 105 SUITE 105 NORTHBROOK IL 600626194 20 1033530548 0 Nurse Practitioners Fluoride varnish 20 1033530548 0 Nurse Practitioners Healthy Kids Services 20 1033530548 0 Nurse Practitioners Nurse Practitioners Services 20 1033530548 0 Nurse Practitioners Physician Services 00 1033531736 0 FORD WANISSA 2014029 9999999 B 10 1033531736 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1033531736 0 Nurse Practitioners Fluoride varnish 20 1033531736 0 Nurse Practitioners Healthy Kids Services 20 1033531736 0 Nurse Practitioners Nurse Practitioners Services 20 1033531736 0 Nurse Practitioners Physician Services 00 1033532809 0 FRENCH DIANE 2015058 9999999 H 10 1033532809 0 527 W SOUTH STREET WOODSTOCK IL 600983756 20 1033532809 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1033534037 0 URBANIK SAAMANTHA D 2016202 9999999 B 10 1033534037 0 34135 N NEEDLEGRASS DR ROUND LAKE IL 600735210 20 1033534037 0 Occupational Therapists Medical Supplies 20 1033534037 0 Occupational Therapists Medical equipment/prosthetic devices 20 1033534037 0 Occupational Therapists Occupational Therapy Services 00 1033535307 0 STEFANI ANGELA L 2018083 9999999 B 10 1033535307 0 3010 GRAND AVE WAUKEGAN IL 600852321 20 1033535307 0 Other behavior health professional LCPC/LMFT services 00 1033535968 0 KURIA KEVIN 2015001 9999999 B 10 1033535968 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1033535968 0 Nurse Practitioners Healthy Kids Services 20 1033535968 0 Nurse Practitioners Nurse Practitioners Services 20 1033535968 0 Nurse 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1033537097 0 KROSIN MATTHEW 2020320 9999999 B 10 1033537097 0 250 N SHADELAND AVE STE 200 INDIANAPOLIS IN 462194959 20 1033537097 0 Physicians Anesthesia Services 20 1033537097 0 Physicians Healthy Kids Services 20 1033537097 0 Physicians Optical Supplies 20 1033537097 0 Physicians Physician Services 00 1033537352 0 STANDFIELD SHEILA 2014121 9999999 B 10 1033537352 0 5666 E STATE ST ROCKFORD IL 611082425 20 1033537352 0 Nurse Practitioners Healthy Kids Services 20 1033537352 0 Nurse Practitioners Nurse Practitioners Services 20 1033537352 0 Nurse Practitioners Physician Services 00 1033537378 0 MIAN ISTIAQ 2022006 9999999 B 10 1033537378 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1033537378 0 Physicians Anesthesia Services 20 1033537378 0 Physicians Healthy Kids Services 20 1033537378 0 Physicians Optical Supplies 20 1033537378 0 Physicians Physician Services 00 1033538210 0 OLSON ANDREA 2017001 9999999 B 10 1033538210 0 5334 WILLIAMS DR ROSCOE IL 610737320 20 1033538210 0 Clinical 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Nurse Practitioners Physician Services 00 1033538590 0 JAIN PANKAJ 2020136 9999999 B 10 1033538590 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1033538590 0 Physicians Anesthesia Services 20 1033538590 0 Physicians Fluoride varnish 20 1033538590 0 Physicians Healthy Kids Services 20 1033538590 0 Physicians Optical Supplies 20 1033538590 0 Physicians Physician Services 00 1033538616 0 EJIMOFOR EBIKABOERE L 2022152 9999999 B 10 1033538616 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1033538616 0 Physicians Anesthesia Services 20 1033538616 0 Physicians Fluoride varnish 20 1033538616 0 Physicians Healthy Kids Services 20 1033538616 0 Physicians Optical Supplies 20 1033538616 0 Physicians Physician Services 00 1033538632 0 KWAK KEVIN 2017252 9999999 B 10 1033538632 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1033538632 0 Physicians Anesthesia Services 20 1033538632 0 Physicians Fluoride varnish 20 1033538632 0 Physicians Healthy Kids Services 20 1033538632 0 Physicians Optical Supplies 20 1033538632 0 Physicians Physician Services 00 1033538830 0 TEUBER JULIE 2023180 9999999 B 10 1033538830 0 PO BOX 43230 PHOENIX AZ 850803230 20 1033538830 0 Physicians Anesthesia Services 20 1033538830 0 Physicians Healthy Kids Services 20 1033538830 0 Physicians Optical Supplies 20 1033538830 0 Physicians Physician Services 00 1033539416 0 BHUMBRA SAMINA 2020184 9999999 B 10 1033539416 0 PO BOX 778912 CHICAGO IL 606778912 20 1033539416 0 Physicians Anesthesia Services 20 1033539416 0 Physicians Fluoride varnish 20 1033539416 0 Physicians Healthy Kids Services 20 1033539416 0 Physicians Optical Supplies 20 1033539416 0 Physicians Physician Services 00 1033539630 0 ISSA MOHAMMAD A 2019233 9999999 B 10 1033539630 0 350 N WALL ST KANKAKEE IL 609012901 20 1033539630 0 Physicians Anesthesia Services 20 1033539630 0 Physicians Healthy Kids Services 20 1033539630 0 Physicians Optical Supplies 20 1033539630 0 Physicians Physician Services 00 1033539721 0 BARTINDALE MATTHEW R 2020021 9999999 B 10 1033539721 0 2201 GLENWOOD AVE JOLIET IL 604355574 20 1033539721 0 Physicians Anesthesia Services 20 1033539721 0 Physicians Healthy Kids Services 20 1033539721 0 Physicians Optical Supplies 20 1033539721 0 Physicians Physician Services 00 1033540646 0 SHERWANI UBAID 2017164 9999999 B 10 1033540646 0 221 NE GLEN OAK AVE PEORIA IL 616360002 20 1033540646 0 Physicians Anesthesia Services 20 1033540646 0 Physicians Fluoride varnish 20 1033540646 0 Physicians Healthy Kids Services 20 1033540646 0 Physicians Optical Supplies 20 1033540646 0 Physicians Physician Services 00 1033542022 0 DESAI KUSH M 2016214 9999999 B 10 1033542022 0 75 REMITTANCE DR DEPT 1620 SUITE 1620 CHICAGO IL 606751620 20 1033542022 0 Physicians Anesthesia Services 20 1033542022 0 Physicians Fluoride varnish 20 1033542022 0 Physicians Healthy Kids Services 20 1033542022 0 Physicians Optical Supplies 20 1033542022 0 Physicians Physician Services 00 1033542287 0 VANMETER SARAH 2016134 9999999 B 10 1033542287 0 PO BOX 4698 CAROL STREAM IL 601224698 20 1033542287 0 Other behavior health professional Social work service 00 1033543129 0 NICKLES MAGALY 2014001 9999999 B 10 1033543129 0 5777 DEPT CAROL STREAM IL 601220021 20 1033543129 0 Nurse Practitioners Fluoride varnish 20 1033543129 0 Nurse Practitioners Healthy Kids Services 20 1033543129 0 Nurse Practitioners Nurse Practitioners Services 20 1033543129 0 Nurse Practitioners Physician Services 00 1033543244 0 DOBKOWSKI JAMIE L 2016147 9999999 H 10 1033543244 0 355 RIDGE AVE EVANSTON IL 602023328 20 1033543244 0 Other behavior health professional Social work service 00 1033543293 0 RHOADES STACY 2014098 9999999 H 10 1033543293 0 10537 S ROBERTS RD PALOS HILLS IL 604651933 20 1033543293 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1033543822 0 MADLEM ELIZABETH A 2015335 9999999 B 10 1033543822 0 611 W PARK ST URBANA IL 618012529 20 1033543822 0 Nurse Practitioners Healthy Kids Services 20 1033543822 0 Nurse Practitioners Nurse Practitioners Services 20 1033543822 0 Nurse Practitioners Physician Services 00 1033544242 0 MOY SHIRLEY 2014032 9999999 B 10 1033544242 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1033544242 0 Nurse Practitioners Fluoride varnish 20 1033544242 0 Nurse Practitioners Healthy Kids Services 20 1033544242 0 Nurse Practitioners Nurse Practitioners Services 20 1033544242 0 Nurse Practitioners Physician Services 00 1033545009 0 ATTEBERY JENNIFER B 2013266 9999999 B 10 1033545009 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1033545009 0 Nurse Practitioners Healthy Kids Services 20 1033545009 0 Nurse Practitioners Nurse Practitioners Services 20 1033545009 0 Nurse Practitioners Physician Services 00 1033545850 0 EPPERSON JESSICA L 2015274 9999999 B 10 1033545850 0 2041 GOOSE LAKE RD SAUGET IL 622062822 20 1033545850 0 Other behavior health professional Social work 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9999999 B 10 1033732466 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1033732466 0 Physicians Anesthesia Services 20 1033732466 0 Physicians Healthy Kids Services 20 1033732466 0 Physicians Optical Supplies 20 1033732466 0 Physicians Physician Services 00 1033733548 0 LIEBERMAN MELISSA 2022019 9999999 B 10 1033733548 0 29373 NETWORK PL CHICAGO IL 606733039 20 1033733548 0 Physician Assistant Only Fluoride varnish 20 1033733548 0 Physician Assistant Only Healthy Kids Services 20 1033733548 0 Physician Assistant Only Physician Services 00 1033733910 0 KHAING MANADA 2020195 9999999 B 10 1033733910 0 611 W PARK ST URBANA IL 618012529 20 1033733910 0 Physicians Anesthesia Services 20 1033733910 0 Physicians Fluoride varnish 20 1033733910 0 Physicians Healthy Kids Services 20 1033733910 0 Physicians Optical Supplies 20 1033733910 0 Physicians Physician Services 00 1033734272 0 KLAVERKAMP KRISTINA 2021288 9999999 B 10 1033734272 0 510 LINCOLN DR HERRIN IL 629486334 20 1033734272 0 Physician Assistant Only Fluoride varnish 20 1033734272 0 Physician Assistant Only Healthy Kids Services 20 1033734272 0 Physician Assistant Only Physician Services 00 1033734413 0 COBB TRAVIS 2023272 9999999 B 10 1033734413 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1033734413 0 Physicians Anesthesia Services 20 1033734413 0 Physicians Fluoride varnish 20 1033734413 0 Physicians Healthy Kids Services 20 1033734413 0 Physicians Optical Supplies 20 1033734413 0 Physicians Physician Services 00 1033734637 0 MURCIA HANS 2020191 9999999 B 10 1033734637 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1033734637 0 Physicians Anesthesia Services 20 1033734637 0 Physicians Healthy Kids Services 20 1033734637 0 Physicians Optical Supplies 20 1033734637 0 Physicians Physician Services 00 1033735022 0 KROLIKOWSKI PIOTR PIOTR 2023213 9999999 B 10 1033735022 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1033735022 0 Physicians Anesthesia Services 20 1033735022 0 Physicians 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1033744081 0 Physicians Anesthesia Services 20 1033744081 0 Physicians Fluoride varnish 20 1033744081 0 Physicians Healthy Kids Services 20 1033744081 0 Physicians Optical Supplies 20 1033744081 0 Physicians Physician Services 00 1033744610 0 SMITHBACK PAIGE C 2022200 9999999 B 10 1033744610 0 PO BOX 80269 PHILADELPHIA PA 191011269 20 1033744610 0 Physician Assistant Only Fluoride varnish 20 1033744610 0 Physician Assistant Only Healthy Kids Services 20 1033744610 0 Physician Assistant Only Physician Services 00 1033745427 0 TRNINIC SYLWIA K 2020084 9999999 B 10 1033745427 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1033745427 0 Nurse Practitioners Fluoride varnish 20 1033745427 0 Nurse Practitioners Healthy Kids Services 20 1033745427 0 Nurse Practitioners Nurse Practitioners Services 20 1033745427 0 Nurse Practitioners Physician Services 00 1033745948 0 GORE AARON 2020224 9999999 B 10 1033745948 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1033745948 0 Physician Assistant 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STE 161 CHICAGO IL 606123228 20 1033774336 0 Physicians Anesthesia Services 20 1033774336 0 Physicians Healthy Kids Services 20 1033774336 0 Physicians Optical Supplies 20 1033774336 0 Physicians Physician Services 20 1033774336 0 Physicians Physicians Psychiatric Services 00 1033775259 0 DINI ERIN K 2024201 9999999 B 10 1033775259 0 2171 W EXECUTIVE DR STE 500 ADDISON IL 601015626 20 1033775259 0 Speech Therapists Medical Supplies 20 1033775259 0 Speech Therapists Medical equipment/prosthetic devices 20 1033775259 0 Speech Therapists Speech Therapy/Pathology Services 00 1033775945 0 SAFFAR VALERIE R 2019210 9999999 B 10 1033775945 0 800 W FULTON MARKET FL 12 CHICAGO IL 606071302 20 1033775945 0 Nurse Practitioners Fluoride varnish 20 1033775945 0 Nurse Practitioners Healthy Kids Services 20 1033775945 0 Nurse Practitioners Nurse Practitioners Services 20 1033775945 0 Nurse Practitioners Physician Services 00 1033777032 0 JUPITER ROBERT 2019277 9999999 B 10 1033777032 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1033777032 0 Physicians Anesthesia Services 20 1033777032 0 Physicians Fluoride varnish 20 1033777032 0 Physicians Healthy Kids Services 20 1033777032 0 Physicians Optical Supplies 20 1033777032 0 Physicians Physician Services 00 1033777263 0 SIBLEY GARA 2021153 9999999 B 10 1033777263 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1033777263 0 Nurse Practitioners Anesthesia Services 20 1033777263 0 Nurse Practitioners Nurse Practitioners Services 20 1033777263 0 Nurse Practitioners Physician Services 00 1033777347 0 WEBER GRETA C 2022193 9999999 B 10 1033777347 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1033777347 0 Physicians Anesthesia Services 20 1033777347 0 Physicians Fluoride varnish 20 1033777347 0 Physicians Healthy Kids Services 20 1033777347 0 Physicians Optical Supplies 20 1033777347 0 Physicians Physician Services 00 1033777578 0 SALOMONE JOHN 2024215 9999999 B 10 1033777578 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1033777578 0 Physicians Anesthesia Services 20 1033777578 0 Physicians Healthy Kids Services 20 1033777578 0 Physicians Optical Supplies 20 1033777578 0 Physicians Physician Services 00 1033777818 0 BHATTI IRFON 2019191 9999999 B 10 1033777818 0 2875 W 19TH ST CHICAGO IL 606233501 20 1033777818 0 Physicians Anesthesia Services 20 1033777818 0 Physicians Fluoride varnish 20 1033777818 0 Physicians Healthy Kids Services 20 1033777818 0 Physicians Optical Supplies 20 1033777818 0 Physicians Physician Services 00 1033777909 0 BATTISTA MEGHAN 2019282 9999999 B 10 1033777909 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1033777909 0 Nurse Practitioners Healthy Kids Services 20 1033777909 0 Nurse Practitioners Nurse Practitioners Services 20 1033777909 0 Nurse Practitioners Physician Services 00 1033778717 0 TATUM ELIZABETH 2019192 9999999 B 10 1033778717 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1033778717 0 Physicians Anesthesia Services 20 1033778717 0 Physicians Fluoride varnish 20 1033778717 0 Physicians Healthy Kids Services 20 1033778717 0 Physicians Optical Supplies 20 1033778717 0 Physicians Physician Services 00 1033779509 0 JELINEK ALYSSA 2024005 9999999 B 10 1033779509 0 PO BOX 1790 BROOKFIELD WI 530081790 20 1033779509 0 Nurse Practitioners Healthy Kids Services 20 1033779509 0 Nurse Practitioners Nurse Practitioners Services 20 1033779509 0 Nurse Practitioners Physician Services 00 1033779798 0 MICHAEL ABENET 2024172 9999999 B 10 1033779798 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1033779798 0 Physicians Anesthesia Services 20 1033779798 0 Physicians Healthy Kids Services 20 1033779798 0 Physicians Optical Supplies 20 1033779798 0 Physicians Physician Services 00 1033780317 0 SELNER KATELIN M 2021305 9999999 B 10 1033780317 0 PO BOX 28900 GREEN BAY WI 543240900 20 1033780317 0 Physician Assistant Only Fluoride varnish 20 1033780317 0 Physician Assistant Only Healthy Kids Services 20 1033780317 0 Physician Assistant Only Physician Services 00 1033781315 0 VASILIADIS ERIN 2021300 9999999 B 10 1033781315 0 6474 N OLYMPIA AVE CHICAGO IL 606311519 20 1033781315 0 Speech Therapists Medical Supplies 20 1033781315 0 Speech Therapists Medical equipment/prosthetic devices 20 1033781315 0 Speech Therapists Speech Therapy/Pathology Services 00 1033781562 0 HARVI SHWETA 2021350 9999999 B 10 1033781562 0 8309 N KNOXVILLE AVE PEORIA IL 616152170 20 1033781562 0 Optometrists Optical Supplies 20 1033781562 0 Optometrists Optometric Services 20 1033781562 0 Optometrists Physician Services 00 1033781752 0 BIELAGA EMILY 2021194 9999999 B 10 1033781752 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1033781752 0 Physical Therapists Medical Supplies 20 1033781752 0 Physical Therapists Medical equipment/prosthetic devices 20 1033781752 0 Physical Therapists Physical Therapy Services 00 1033782271 0 EISHO MAZEN 2023081 9999999 B 10 1033782271 0 6972 N CLARK ST CHICAGO IL 606263221 20 1033782271 0 Dentists Dental Services 20 1033782271 0 Dentists Physician Services 00 1033783717 0 HARKLESS JOSHUA 2021179 9999999 B 10 1033783717 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1033783717 0 Physicians Anesthesia Services 20 1033783717 0 Physicians Healthy Kids Services 20 1033783717 0 Physicians Optical Supplies 20 1033783717 0 Physicians Physician Services 00 1033784384 0 LJUBIC ZORICA 2021147 9999999 B 10 1033784384 0 PO BOX 855795 MINNEAPOLIS MN 554851296 20 1033784384 0 Physicians Anesthesia Services 20 1033784384 0 Physicians Fluoride varnish 20 1033784384 0 Physicians Healthy Kids Services 20 1033784384 0 Physicians Optical Supplies 20 1033784384 0 Physicians Physician Services 00 1033784897 0 GRADY-WILLIAMS DIAMOND 2021299 9999999 B 10 1033784897 0 7732 SOLUTION CENTER CHICAGO IL 606777007 20 1033784897 0 Dentists Dental Services 20 1033784897 0 Dentists Physician Services 00 1033785464 0 PHELPS ABIGAIL C 2021320 9999999 H 10 1033785464 0 325 IL ROUTE 2 DIXON IL 610219118 20 1033785464 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1033786710 0 GARAEVA ALINA 2022004 9999999 B 10 1033786710 0 4959 GOLF RD SKOKIE IL 600771537 20 1033786710 0 Nurse Practitioners Healthy Kids Services 20 1033786710 0 Nurse Practitioners Nurse Practitioners Services 20 1033786710 0 Nurse Practitioners Physician Services 00 1033787437 0 KERN SOPHIE 2021186 9999999 B 10 1033787437 0 2211 N ELSTON AVE STE 301 CHICAGO IL 606149278 20 1033787437 0 Physicians Anesthesia Services 20 1033787437 0 Physicians Fluoride varnish 20 1033787437 0 Physicians Healthy Kids Services 20 1033787437 0 Physicians Optical Supplies 20 1033787437 0 Physicians Physician Services 00 1033787759 0 FEI SHANGNON 2021349 9999999 B 10 1033787759 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1033787759 0 Physicians Anesthesia Services 20 1033787759 0 Physicians Fluoride varnish 20 1033787759 0 Physicians Healthy Kids Services 20 1033787759 0 Physicians Optical Supplies 20 1033787759 0 Physicians Physician Services 00 1033788245 0 BRITO ELIZABETH 2022017 9999999 B 10 1033788245 0 819 BLOOMINGTON RD CHAMPAIGN IL 618202101 20 1033788245 0 Dentists Dental Services 20 1033788245 0 Dentists Physician Services 00 1033788872 0 DUDZINSKI JACOB 2022206 9999999 B 10 1033788872 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1033788872 0 Physicians Anesthesia Services 20 1033788872 0 Physicians Healthy Kids Services 20 1033788872 0 Physicians Optical Supplies 20 1033788872 0 Physicians Physician Services 00 1033789391 0 TORRES CALLIE E 2021204 9999999 B 10 1033789391 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1033789391 0 Physicians Anesthesia Services 20 1033789391 0 Physicians Healthy Kids Services 20 1033789391 0 Physicians Optical Supplies 20 1033789391 0 Physicians Physician Services 00 1033789904 0 KREUTZER BETH 2024155 9999999 B 10 1033789904 0 PO BOX 735041 CHICAGO IL 606735041 20 1033789904 0 Physicians Anesthesia Services 20 1033789904 0 Physicians Healthy Kids Services 20 1033789904 0 Physicians Optical Supplies 20 1033789904 0 Physicians Physician Services 00 1033789987 0 LAVAGNOLLI PRISCILLA 2023223 9999999 B 10 1033789987 0 1812 N 19TH AVE MELROSE PARK IL 601602039 20 1033789987 0 Dentists Dental Services 20 1033789987 0 Dentists Physician Services 00 1033790407 0 AKINTORIN SIMILOLU 2024211 9999999 B 10 1033790407 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1033790407 0 Physicians Anesthesia Services 20 1033790407 0 Physicians Fluoride varnish 20 1033790407 0 Physicians Healthy Kids Services 20 1033790407 0 Physicians Optical Supplies 20 1033790407 0 Physicians Physician Services 00 1033791116 0 WARREN OAKLEY 2022080 9999999 H 10 1033791116 0 206 W 5TH ST METROPOLIS IL 629601810 20 1033791116 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1033791801 0 SMITH STEVEN H 2023326 9999999 B 10 1033791801 0 4698 DEPT CAROL STREAM IL 601220021 20 1033791801 0 Physicians Anesthesia Services 20 1033791801 0 Physicians Healthy Kids Services 20 1033791801 0 Physicians Optical Supplies 20 1033791801 0 Physicians Physician Services 00 1033792304 0 JONES ALEXIS 2021180 9999999 B 10 1033792304 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1033792304 0 Nurse Practitioners Anesthesia Services 20 1033792304 0 Nurse Practitioners Nurse Practitioners Services 20 1033792304 0 Nurse Practitioners Physician Services 00 1033792437 0 SOLTANISHIRAZI VIDA 2021126 9999999 B 10 1033792437 0 6636 S PULASKI RD STE B CHICAGO IL 606295138 20 1033792437 0 Dentists Dental Services 20 1033792437 0 Dentists Physician Services 00 1033792841 0 NORRIS SHANA 2021197 9999999 B 10 1033792841 0 PO BOX 637273 CINCINNATI OH 452637273 20 1033792841 0 Nurse Practitioners Healthy Kids Services 20 1033792841 0 Nurse Practitioners Nurse Practitioners Services 20 1033792841 0 Nurse Practitioners Physician Services 00 1033793195 0 PEREZ-ALVAREZ IDANIS M 2021182 9999999 B 10 1033793195 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1033793195 0 Physicians Anesthesia Services 20 1033793195 0 Physicians Healthy Kids Services 20 1033793195 0 Physicians Optical Supplies 20 1033793195 0 Physicians Physician Services 00 1033793641 0 WAUNA MARIE ROCHELLE G 2023297 9999999 B 10 1033793641 0 PO BOX 775253 CHICAGO IL 606775253 20 1033793641 0 Nurse Practitioners Fluoride varnish 20 1033793641 0 Nurse Practitioners Healthy Kids Services 20 1033793641 0 Nurse Practitioners Nurse Practitioners Services 20 1033793641 0 Nurse Practitioners Physician Services 00 1033793856 0 HALTOM JOHN P 2024035 9999999 B 10 1033793856 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1033793856 0 Nurse Practitioners Anesthesia Services 20 1033793856 0 Nurse Practitioners Nurse Practitioners Services 20 1033793856 0 Nurse Practitioners Physician Services 00 1033795133 0 CHURILLA TRAVIS 2021174 9999999 B 10 1033795133 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1033795133 0 Physicians Anesthesia Services 20 1033795133 0 Physicians Fluoride varnish 20 1033795133 0 Physicians Healthy Kids Services 20 1033795133 0 Physicians Optical Supplies 20 1033795133 0 Physicians Physician Services 00 1033795497 0 HONG PAUL 2021215 9999999 B 10 1033795497 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1033795497 0 Physicians Anesthesia Services 20 1033795497 0 Physicians Fluoride varnish 20 1033795497 0 Physicians Healthy Kids Services 20 1033795497 0 Physicians Optical Supplies 20 1033795497 0 Physicians Physician Services 00 1033795802 0 MATA ANDRES 2024142 9999999 B 10 1033795802 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1033795802 0 Physicians Anesthesia Services 20 1033795802 0 Physicians Fluoride varnish 20 1033795802 0 Physicians Healthy Kids Services 20 1033795802 0 Physicians Optical Supplies 20 1033795802 0 Physicians Physician Services 00 1033795992 0 DELAY OLIVIA 2021159 9999999 B 10 1033795992 0 201 E MADISON ST STE 328 SPRINGFIELD IL 627025131 20 1033795992 0 Nurse Practitioners Fluoride varnish 20 1033795992 0 Nurse Practitioners Healthy Kids Services 20 1033795992 0 Nurse Practitioners Nurse Practitioners Services 20 1033795992 0 Nurse Practitioners Physician Services 00 1033796644 0 PRICE EVAN 2024238 9999999 B 10 1033796644 0 124 SW ADAMS ST PEORIA IL 616021308 20 1033796644 0 Physicians Anesthesia Services 20 1033796644 0 Physicians Fluoride varnish 20 1033796644 0 Physicians Healthy Kids Services 20 1033796644 0 Physicians Optical Supplies 20 1033796644 0 Physicians Physician Services 00 1033796701 0 GHAREEBIAN TALEEN 2021201 9999999 B 10 1033796701 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1033796701 0 Physicians Anesthesia Services 20 1033796701 0 Physicians Fluoride varnish 20 1033796701 0 Physicians Healthy Kids Services 20 1033796701 0 Physicians Optical Supplies 20 1033796701 0 Physicians Physician Services 00 1033796750 0 COSTELLO JILLIAN 2021247 9999999 B 10 1033796750 0 124 SW ADAMS ST PEORIA IL 616021308 20 1033796750 0 Physicians Anesthesia Services 20 1033796750 0 Physicians Fluoride varnish 20 1033796750 0 Physicians Healthy Kids Services 20 1033796750 0 Physicians Optical Supplies 20 1033796750 0 Physicians Physician Services 00 1033797493 0 BLUFORD DONELL JR 2024208 9999999 B 10 1033797493 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1033797493 0 Clinical Social Worker Social work service 00 1033797782 0 ZHANG HELEN 2021176 9999999 B 10 1033797782 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1033797782 0 Physicians Anesthesia Services 20 1033797782 0 Physicians Fluoride varnish 20 1033797782 0 Physicians Healthy Kids Services 20 1033797782 0 Physicians Optical Supplies 20 1033797782 0 Physicians Physician Services 00 1033798236 0 FAYAZZADEH EHSAN 2022195 9999999 B 10 1033798236 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1033798236 0 Physicians Anesthesia Services 20 1033798236 0 Physicians Healthy Kids Services 20 1033798236 0 Physicians Optical Supplies 20 1033798236 0 Physicians Physician Services 00 1033798269 0 KWARK MICHAEL 2024205 9999999 B 10 1033798269 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1033798269 0 Physicians Anesthesia Services 20 1033798269 0 Physicians Fluoride varnish 20 1033798269 0 Physicians Healthy Kids Services 20 1033798269 0 Physicians Optical Supplies 20 1033798269 0 Physicians Physician Services 00 1033798418 0 ESCHBACH JOSIAH 2021176 9999999 B 10 1033798418 0 29373 NETWORK PL CHICAGO IL 606733039 20 1033798418 0 Physicians Anesthesia Services 20 1033798418 0 Physicians Fluoride varnish 20 1033798418 0 Physicians Healthy Kids Services 20 1033798418 0 Physicians Optical Supplies 20 1033798418 0 Physicians Physician Services 00 1033798442 0 CASTEEL CHRISTIAN O 2021182 9999999 B 10 1033798442 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1033798442 0 Physicians Anesthesia Services 20 1033798442 0 Physicians Healthy Kids Services 20 1033798442 0 Physicians Optical Supplies 20 1033798442 0 Physicians Physician Services 00 1033798905 0 GELETU ABESELOM 2024183 9999999 B 10 1033798905 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1033798905 0 Physicians Anesthesia Services 20 1033798905 0 Physicians Fluoride varnish 20 1033798905 0 Physicians Healthy Kids Services 20 1033798905 0 Physicians Optical Supplies 20 1033798905 0 Physicians Physician Services 00 1033799168 0 HUQ RUKAN N 2021188 9999999 B 10 1033799168 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1033799168 0 Physicians Anesthesia Services 20 1033799168 0 Physicians Healthy Kids Services 20 1033799168 0 Physicians Optical Supplies 20 1033799168 0 Physicians Physician Services 20 1033799168 0 Physicians Physicians Psychiatric Services 00 1033799531 0 ECKELMANN BRADLEY 2024159 9999999 B 10 1033799531 0 4701 DEPT CAROL STREAM IL 601220021 20 1033799531 0 Physicians Anesthesia Services 20 1033799531 0 Physicians Healthy Kids Services 20 1033799531 0 Physicians Optical Supplies 20 1033799531 0 Physicians Physician Services 00 1033799713 0 TKACZ MATEUSZ 2021182 9999999 B 10 1033799713 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1033799713 0 Physicians Anesthesia Services 20 1033799713 0 Physicians Fluoride varnish 20 1033799713 0 Physicians Healthy Kids Services 20 1033799713 0 Physicians Optical Supplies 20 1033799713 0 Physicians Physician Services 00 1033799929 0 KNAPP SAMANTHA 2022112 9999999 B 10 1033799929 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1033799929 0 Physical Therapists Medical Supplies 20 1033799929 0 Physical Therapists Medical equipment/prosthetic devices 20 1033799929 0 Physical Therapists Physical Therapy Services 00 1033800412 0 JOHNSON RYAN B 2023193 9999999 B 10 1033800412 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1033800412 0 Physicians Anesthesia Services 20 1033800412 0 Physicians Healthy Kids Services 20 1033800412 0 Physicians Optical Supplies 20 1033800412 0 Physicians Physician Services 00 1033801022 0 DONDIEGO IRMA 2023339 9999999 B 10 1033801022 0 PO BOX 775253 CHICAGO IL 606775253 20 1033801022 0 Nurse Practitioners Healthy Kids Services 20 1033801022 0 Nurse Practitioners Nurse Practitioners Services 20 1033801022 0 Nurse Practitioners Physician Services 00 1033801089 0 LUCHOWSKI LINDY K 2023180 9999999 B 10 1033801089 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1033801089 0 Nurse Practitioners Healthy Kids Services 20 1033801089 0 Nurse Practitioners Nurse Practitioners Services 20 1033801089 0 Nurse Practitioners Physician Services 00 1033804273 0 SAWHNEY SAMRITA 2023182 9999999 B 10 1033804273 0 PO BOX 3039 OAK BROOK IL 605223039 20 1033804273 0 Physicians Anesthesia Services 20 1033804273 0 Physicians Fluoride varnish 20 1033804273 0 Physicians Healthy Kids Services 20 1033804273 0 Physicians Optical Supplies 20 1033804273 0 Physicians Physician Services 00 1033804851 0 PANGANIBAN ALYSSA 2024177 9999999 B 10 1033804851 0 PO BOX 3039 OAK BROOK IL 605223039 20 1033804851 0 Physicians Anesthesia Services 20 1033804851 0 Physicians Fluoride varnish 20 1033804851 0 Physicians Healthy Kids Services 20 1033804851 0 Physicians Optical Supplies 20 1033804851 0 Physicians Physician Services 00 1033805072 0 HAMIDPOUR ROXANNA 2023193 9999999 B 10 1033805072 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1033805072 0 Physicians Anesthesia Services 20 1033805072 0 Physicians Healthy Kids Services 20 1033805072 0 Physicians Optical Supplies 20 1033805072 0 Physicians Physician Services 00 1033805213 0 MO SAMUEL H 2023195 9999999 B 10 1033805213 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1033805213 0 Physicians Anesthesia Services 20 1033805213 0 Physicians Fluoride varnish 20 1033805213 0 Physicians Healthy Kids Services 20 1033805213 0 Physicians Optical Supplies 20 1033805213 0 Physicians Physician Services 00 1033805999 0 YATES SETH B 2024205 2027178 B 10 1033805999 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1033805999 0 Physicians Anesthesia Services 20 1033805999 0 Physicians Fluoride varnish 20 1033805999 0 Physicians Healthy Kids Services 20 1033805999 0 Physicians Optical Supplies 20 1033805999 0 Physicians Physician Services 00 1033806161 0 GETZ LAUREN 2023276 9999999 B 10 1033806161 0 850 43RD AVE STE 100 MOLINE IL 612658401 20 1033806161 0 Physical Therapists Medical Supplies 20 1033806161 0 Physical Therapists Medical equipment/prosthetic devices 20 1033806161 0 Physical Therapists Physical Therapy Services 00 1033806237 0 RENNER CARINE 2023180 9999999 B 10 1033806237 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1033806237 0 Physicians Anesthesia Services 20 1033806237 0 Physicians Fluoride varnish 20 1033806237 0 Physicians Healthy Kids Services 20 1033806237 0 Physicians Optical Supplies 20 1033806237 0 Physicians Physician Services 00 1033807680 0 BLASHOCK SIERRA R 2023177 9999999 B 10 1033807680 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1033807680 0 Physicians Anesthesia Services 20 1033807680 0 Physicians Fluoride varnish 20 1033807680 0 Physicians Healthy Kids Services 20 1033807680 0 Physicians Optical Supplies 20 1033807680 0 Physicians Physician Services 00 1033808712 0 KIM JEONG HYE 2024087 9999999 B 10 1033808712 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1033808712 0 Psychologist Psychologist service 00 1033809074 0 FATTAH MINA 2024002 9999999 B 10 1033809074 0 4698 DEPT CAROL STREAM IL 601224698 20 1033809074 0 Physicians Anesthesia Services 20 1033809074 0 Physicians Fluoride varnish 20 1033809074 0 Physicians Healthy Kids Services 20 1033809074 0 Physicians Optical Supplies 20 1033809074 0 Physicians Physician Services 00 1033809231 0 CHOKSHI NIKI 2024180 9999999 B 10 1033809231 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1033809231 0 Physician Assistant Only Fluoride varnish 20 1033809231 0 Physician Assistant Only Healthy Kids Services 20 1033809231 0 Physician Assistant Only Physician Services 00 1033809553 0 SCHICK TIFFANY 2025027 9999999 B 10 1033809553 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1033809553 0 Physician Assistant Only Fluoride varnish 20 1033809553 0 Physician Assistant Only Healthy Kids Services 20 1033809553 0 Physician Assistant Only Physician Services 00 1033809835 0 PATEL JILL B 2023143 9999999 B 10 1033809835 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1033809835 0 Physician Assistant Only Fluoride varnish 20 1033809835 0 Physician Assistant Only Healthy Kids Services 20 1033809835 0 Physician Assistant Only Physician Services 00 1033811252 0 REDMOND JAMES 2023191 9999999 B 10 1033811252 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1033811252 0 Physicians Anesthesia Services 20 1033811252 0 Physicians Healthy Kids Services 20 1033811252 0 Physicians Optical Supplies 20 1033811252 0 Physicians Physician Services 00 1033811666 0 MARFIN MARK 2024185 9999999 B 10 1033811666 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1033811666 0 Physicians Anesthesia Services 20 1033811666 0 Physicians Fluoride varnish 20 1033811666 0 Physicians Healthy Kids Services 20 1033811666 0 Physicians Optical Supplies 20 1033811666 0 Physicians Physician Services 00 1033812078 0 KAPPAGANTU ADITI 2023198 9999999 B 10 1033812078 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1033812078 0 Physicians Anesthesia Services 20 1033812078 0 Physicians Healthy Kids Services 20 1033812078 0 Physicians Optical Supplies 20 1033812078 0 Physicians Physician Services 20 1033812078 0 Physicians Physicians Psychiatric Services 00 1033812169 0 DAS ANTRA 2023174 9999999 B 10 1033812169 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1033812169 0 Physicians Anesthesia Services 20 1033812169 0 Physicians Fluoride varnish 20 1033812169 0 Physicians Healthy Kids Services 20 1033812169 0 Physicians Optical Supplies 20 1033812169 0 Physicians Physician Services 00 1033813373 0 GREEN CAROLINE L 2023096 9999999 B 10 1033813373 0 PO BOX 3039 OAK BROOK IL 605223039 20 1033813373 0 Dentists Dental Services 20 1033813373 0 Dentists Physician Services 00 1033813720 0 ALCARRAZ BEDRILLANA ANGELA DIA 2023240 9999999 B 10 1033813720 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1033813720 0 Physicians Anesthesia Services 20 1033813720 0 Physicians Fluoride varnish 20 1033813720 0 Physicians Healthy Kids Services 20 1033813720 0 Physicians Optical Supplies 20 1033813720 0 Physicians Physician Services 00 1033814173 0 JENTZ BRITTINI 2024116 9999999 B 10 1033814173 0 909 RIDGEBROOK RD STE 300 SPARKS MD 211529477 20 1033814173 0 Nurse Practitioners Fluoride varnish 20 1033814173 0 Nurse Practitioners Healthy Kids Services 20 1033814173 0 Nurse Practitioners Nurse Practitioners Services 20 1033814173 0 Nurse Practitioners Physician Services 00 1033814736 0 GOODMAN COURTNEY 2023257 9999999 B 10 1033814736 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1033814736 0 Physicians Anesthesia Services 20 1033814736 0 Physicians Healthy Kids Services 20 1033814736 0 Physicians Optical Supplies 20 1033814736 0 Physicians Physician 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9999999 B 10 1033849138 0 PO BOX 4912 WHEATON IL 601894912 20 1033849138 0 Nurse Practitioners Fluoride varnish 20 1033849138 0 Nurse Practitioners Healthy Kids Services 20 1033849138 0 Nurse Practitioners Nurse Practitioners Services 20 1033849138 0 Nurse Practitioners Physician Services 00 1033849617 0 AUGUSTIN AJIT 2022189 9999999 B 10 1033849617 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1033849617 0 Physicians Anesthesia Services 20 1033849617 0 Physicians Healthy Kids Services 20 1033849617 0 Physicians Optical Supplies 20 1033849617 0 Physicians Physician Services 20 1033849617 0 Physicians Physicians Psychiatric Services 00 1033849641 0 MANN ARIEL M 2022238 9999999 B 10 1033849641 0 5010 ROSE LN COULTERVILLE IL 622372746 20 1033849641 0 Clinical Social Worker Social work service 00 1033850219 0 OWUSUWAAH DANIELLA N 2022178 9999999 B 10 1033850219 0 PO BOX 70508 CHICAGO IL 606730508 20 1033850219 0 Physicians Anesthesia Services 20 1033850219 0 Physicians Fluoride 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1033852454 0 Physician Assistant Only Fluoride varnish 20 1033852454 0 Physician Assistant Only Healthy Kids Services 20 1033852454 0 Physician Assistant Only Physician Services 00 1033853817 0 ROSINE ANNAMARIE 2022199 9999999 B 10 1033853817 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1033853817 0 Nurse Practitioners Fluoride varnish 20 1033853817 0 Nurse Practitioners Healthy Kids Services 20 1033853817 0 Nurse Practitioners Nurse Practitioners Services 20 1033853817 0 Nurse Practitioners Physician Services 00 1033854286 0 OLAKOWSKI PETER 2022229 9999999 B 10 1033854286 0 29373 NETWORK PL CHICAGO IL 606733039 20 1033854286 0 Nurse Practitioners Anesthesia Services 20 1033854286 0 Nurse Practitioners Nurse Practitioners Services 20 1033854286 0 Nurse Practitioners Physician Services 00 1033854757 0 MARTENS CHAD R 2022200 9999999 B 10 1033854757 0 403 E 1ST ST DIXON IL 610213116 20 1033854757 0 Physicians Anesthesia Services 20 1033854757 0 Physicians Fluoride varnish 20 1033854757 0 Physicians Healthy Kids Services 20 1033854757 0 Physicians Optical Supplies 20 1033854757 0 Physicians Physician Services 00 1033854955 0 HENNINGSEN ANNA M 2024214 9999999 B 10 1033854955 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1033854955 0 Nurse Practitioners Anesthesia Services 20 1033854955 0 Nurse Practitioners Nurse Practitioners Services 20 1033854955 0 Nurse Practitioners Physician Services 00 1033855465 0 APPLER JOSEPH 2022301 9999999 H 10 1033855465 0 4600 3RD ST MOLINE IL 612656106 20 1033855465 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1033855689 0 RAEHSLER ASHLEY 2024085 9999999 B 10 1033855689 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1033855689 0 Physical Therapists Medical Supplies 20 1033855689 0 Physical Therapists Medical equipment/prosthetic devices 20 1033855689 0 Physical Therapists Physical Therapy Services 00 1033855861 0 KOWYNIA ELIZABETH 2023226 9999999 B 10 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2022212 9999999 B 10 1033859905 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1033859905 0 Physicians Anesthesia Services 20 1033859905 0 Physicians Healthy Kids Services 20 1033859905 0 Physicians Optical Supplies 20 1033859905 0 Physicians Physician Services 00 1033861042 0 LANGOSCH JAIME 2024024 9999999 B 10 1033861042 0 211 E LAKE ST STE 1B ADDISON IL 601012877 20 1033861042 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1033861067 0 EBORU NGOZI S 2022228 9999999 B 10 1033861067 0 1643 NW 136TH AVE STE 200 SUNRISE FL 333232857 20 1033861067 0 Nurse Practitioners Healthy Kids Services 20 1033861067 0 Nurse Practitioners Nurse Practitioners Services 20 1033861067 0 Nurse Practitioners Physician Services 00 1033864061 0 VANAUTREVE JENNIFER M 2022171 9999999 B 10 1033864061 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1033864061 0 Nurse Practitioners Fluoride varnish 20 1033864061 0 Nurse Practitioners Healthy Kids 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OAK BROOK IL 605223039 20 1033869235 0 Physicians Anesthesia Services 20 1033869235 0 Physicians Fluoride varnish 20 1033869235 0 Physicians Healthy Kids Services 20 1033869235 0 Physicians Optical Supplies 20 1033869235 0 Physicians Physician Services 00 1033869300 0 KLAFTA KIMBERLY 2022174 9999999 B 10 1033869300 0 4698 DEPT CAROL STREAM IL 601220021 20 1033869300 0 Physicians Anesthesia Services 20 1033869300 0 Physicians Healthy Kids Services 20 1033869300 0 Physicians Optical Supplies 20 1033869300 0 Physicians Physician Services 00 1033870464 0 COMBS CARLIE 2023226 9999999 B 10 1033870464 0 5875 E RIVERSIDE BLVD ROCKFORD IL 611144937 20 1033870464 0 Physician Assistant Only Fluoride varnish 20 1033870464 0 Physician Assistant Only Healthy Kids Services 20 1033870464 0 Physician Assistant Only Physician Services 00 1033871173 0 HUSKEY ABIGAIL B 2021291 9999999 B 10 1033871173 0 4025 TAMPA RD STE 1106 OLDSMAR FL 346773213 20 1033871173 0 Speech Therapists Medical Supplies 20 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9999999 B 10 1033934708 0 4701 DEPT CAROL STREAM IL 601220021 20 1033934708 0 Nurse Practitioners Healthy Kids Services 20 1033934708 0 Nurse Practitioners Nurse Practitioners Services 20 1033934708 0 Nurse Practitioners Physician Services 00 1033936133 0 PEARISON LINDSEY M 2024283 9999999 B 10 1033936133 0 4199 GATEWAY BLVD STE 2400 NEWBURGH IN 476307972 20 1033936133 0 Nurse Practitioners Fluoride varnish 20 1033936133 0 Nurse Practitioners Healthy Kids Services 20 1033936133 0 Nurse Practitioners Nurse Practitioners Services 20 1033936133 0 Nurse Practitioners Physician Services 00 1033937404 0 HETH JODI 2024332 9999999 B 10 1033937404 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1033937404 0 Nurse Practitioners Fluoride varnish 20 1033937404 0 Nurse Practitioners Healthy Kids Services 20 1033937404 0 Nurse Practitioners Nurse Practitioners Services 20 1033937404 0 Nurse Practitioners Physician Services 00 1033937743 0 ANDERSON RACHEL N 2024281 9999999 B 10 1033937743 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1033937743 0 Nurse Practitioners Fluoride varnish 20 1033937743 0 Nurse Practitioners Healthy Kids Services 20 1033937743 0 Nurse Practitioners Nurse Practitioners Services 20 1033937743 0 Nurse Practitioners Physician Services 00 1033939749 0 RANDOLPH KATE 2025031 9999999 B 10 1033939749 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1033939749 0 Physician Assistant Only Fluoride varnish 20 1033939749 0 Physician Assistant Only Healthy Kids Services 20 1033939749 0 Physician Assistant Only Physician Services 00 1033942602 0 MENDOZA LORENA 2024234 9999999 B 10 1033942602 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1033942602 0 Registered nurse Nursing service 20 1033942602 0 Registered nurse Waiver service 00 1033945605 0 FLETCHER DELANIE 2024256 9999999 B 10 1033945605 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1033945605 0 Nurse Practitioners Fluoride varnish 20 1033945605 0 Nurse Practitioners Healthy Kids Services 20 1033945605 0 Nurse Practitioners 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1043211451 0 Physicians Healthy Kids Services 20 1043211451 0 Physicians Optical Supplies 20 1043211451 0 Physicians Physician Services 00 1043212418 0 MURPHY KIMBERLY 1995275 9999999 B 10 1043212418 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1043212418 0 Physicians Anesthesia Services 20 1043212418 0 Physicians Healthy Kids Services 20 1043212418 0 Physicians Optical Supplies 20 1043212418 0 Physicians Physician Services 00 1043212608 0 SWETLAND BETH 2004047 9999999 B 10 1043212608 0 2537 PLAINFIELD RD JOLIET IL 604351463 20 1043212608 0 Optometrists Optical Supplies 20 1043212608 0 Optometrists Optometric Services 20 1043212608 0 Optometrists Physician Services 00 1043213390 0 MARTIN TONI M 2020086 9999999 B 10 1043213390 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1043213390 0 Nurse Practitioners Fluoride varnish 20 1043213390 0 Nurse Practitioners Healthy Kids Services 20 1043213390 0 Nurse Practitioners Nurse Practitioners Services 20 1043213390 0 Nurse Practitioners Physician 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1043417892 0 BONEBRAKE LAURA K 2014152 9999999 B 10 1043417892 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1043417892 0 Physicians Anesthesia Services 20 1043417892 0 Physicians Healthy Kids Services 20 1043417892 0 Physicians Optical Supplies 20 1043417892 0 Physicians Physician Services 00 1043418809 0 CILIBERTO MICHAEL A 2011182 9999999 B 10 1043418809 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1043418809 0 Physicians Anesthesia Services 20 1043418809 0 Physicians Healthy Kids Services 20 1043418809 0 Physicians Optical Supplies 20 1043418809 0 Physicians Physician Services 20 1043418809 0 Physicians Physicians Psychiatric Services 00 1043419948 0 ESPINOZA JANA 2016244 9999999 B 10 1043419948 0 325 IL ROUTE 2 DIXON IL 610219118 20 1043419948 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1043420078 0 HAVENER JENNIFER 2008209 9999999 B 10 1043420078 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 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9999999 H 10 1043434061 0 505 W UNIVERSITY AVE SUITE 2 CHAMPAIGN IL 618203915 20 1043434061 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1043434665 0 HARRINGTON SILAS 1988183 9999999 B 10 1043434665 0 PO BOX 548 INDIANAPOLIS IN 462060548 20 1043434665 0 Physicians Anesthesia Services 20 1043434665 0 Physicians Healthy Kids Services 20 1043434665 0 Physicians Optical Supplies 20 1043434665 0 Physicians Physician Services 00 1043434798 0 O''CONNELL DANIEL M 2014182 9999999 B 10 1043434798 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1043434798 0 Physicians Anesthesia Services 20 1043434798 0 Physicians Fluoride varnish 20 1043434798 0 Physicians Healthy Kids Services 20 1043434798 0 Physicians Optical Supplies 20 1043434798 0 Physicians Physician Services 00 1043435910 0 LAIB ROBERT 2024164 9999999 B 10 1043435910 0 1021 N MULFORD RD ROCKFORD IL 611073874 20 1043435910 0 Other behavior health professional LCPC/LMFT 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Physicians Healthy Kids Services 20 1043438625 0 Physicians Optical Supplies 20 1043438625 0 Physicians Physician Services 00 1043440316 0 TREPS VANESSA 2016241 9999999 B 10 1043440316 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1043440316 0 Nurse Practitioners Fluoride varnish 20 1043440316 0 Nurse Practitioners Healthy Kids Services 20 1043440316 0 Nurse Practitioners Nurse Practitioners Services 20 1043440316 0 Nurse Practitioners Physician Services 00 1043442544 0 DUSAK MEGAN 2018152 9999999 B 10 1043442544 0 PO BOX 500 ELLICOTTVILLE NY 147310500 20 1043442544 0 Physician Assistant Only Fluoride varnish 20 1043442544 0 Physician Assistant Only Healthy Kids Services 20 1043442544 0 Physician Assistant Only Physician Services 00 1043443377 0 RAMIREZ DOMINGUEZ TATIANA 2015253 9999999 B 10 1043443377 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1043443377 0 Physicians Anesthesia Services 20 1043443377 0 Physicians Healthy Kids Services 20 1043443377 0 Physicians Optical 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D 2015187 9999999 B 10 1043447402 0 28594 NETWORK PL CHICAGO IL 606731081 20 1043447402 0 Physicians Anesthesia Services 20 1043447402 0 Physicians Healthy Kids Services 20 1043447402 0 Physicians Optical Supplies 20 1043447402 0 Physicians Physician Services 00 1043447774 0 SOUDAGAR ABDUS S 2015182 9999999 B 10 1043447774 0 5777 DEPT CAROL STREAM IL 601220021 20 1043447774 0 Physicians All Kids application agent 20 1043447774 0 Physicians Anesthesia Services 20 1043447774 0 Physicians Fluoride varnish 20 1043447774 0 Physicians Healthy Kids Services 20 1043447774 0 Physicians Optical Supplies 20 1043447774 0 Physicians Physician Services 00 1043448111 0 SHANMUGAM RAJU M 2012306 9999999 B 10 1043448111 0 4701 DEPT CAROL STREAM IL 601220021 20 1043448111 0 Physicians Anesthesia Services 20 1043448111 0 Physicians Fluoride varnish 20 1043448111 0 Physicians Healthy Kids Services 20 1043448111 0 Physicians Optical Supplies 20 1043448111 0 Physicians Physician Services 00 1043448491 0 BARSKY YELANA 2009182 9999999 B 10 1043448491 0 201 E STRONG ST STE 2 WHEELING IL 600902979 20 1043448491 0 Podiatrists Podiatric Services 00 1043449259 0 ILES ZACHARY 2012045 9999999 B 10 1043449259 0 2250 N ILLINOIS AVE CARBONDALE IL 629015612 20 1043449259 0 Physicians Anesthesia Services 20 1043449259 0 Physicians Healthy Kids Services 20 1043449259 0 Physicians Optical Supplies 20 1043449259 0 Physicians Physician Services 00 1043449317 0 APPLEWHITE MEGAN K 2023226 9999999 B 10 1043449317 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1043449317 0 Physicians Anesthesia Services 20 1043449317 0 Physicians Healthy Kids Services 20 1043449317 0 Physicians Optical Supplies 20 1043449317 0 Physicians Physician Services 00 1043449457 0 RICHMOND STACIE 2017274 9999999 B 10 1043449457 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1043449457 0 Nurse Practitioners Nursing service 20 1043449457 0 Nurse Practitioners Waiver service 00 1043449689 0 BUTLER RACHEL R 2012184 9999999 B 10 1043449689 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1043449689 0 Physicians Anesthesia Services 20 1043449689 0 Physicians Fluoride varnish 20 1043449689 0 Physicians Healthy Kids Services 20 1043449689 0 Physicians Optical Supplies 20 1043449689 0 Physicians Physician Services 00 1043449770 0 PEREZ CHRISTIAN 2016251 9999999 B 10 1043449770 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1043449770 0 Physicians Anesthesia Services 20 1043449770 0 Physicians Healthy Kids Services 20 1043449770 0 Physicians Optical Supplies 20 1043449770 0 Physicians Physician Services 00 1043451081 0 TRESLEY JONATHAN 2015182 9999999 B 10 1043451081 0 44000 GARFIELD RD CLINTON TOWNSHI MI 480381125 20 1043451081 0 Physicians Anesthesia Services 20 1043451081 0 Physicians Healthy Kids Services 20 1043451081 0 Physicians Optical Supplies 20 1043451081 0 Physicians Physician Services 00 1043451537 0 SHAH PRATIK P 2010152 9999999 B 10 1043451537 0 PO BOX 85442 CHICAGO IL 606895442 20 1043451537 0 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equipment/prosthetic devices 20 1043458219 0 Occupational Therapists Occupational Therapy Services 00 1043460686 0 RAMOS YANERYS 2019032 9999999 B 10 1043460686 0 5901 LINCOLN DR EDINA MN 554361611 20 1043460686 0 Physicians Anesthesia Services 20 1043460686 0 Physicians Healthy Kids Services 20 1043460686 0 Physicians Optical Supplies 20 1043460686 0 Physicians Physician Services 00 1043460728 0 KLEIN KATHLYN A 2018001 9999999 B 10 1043460728 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1043460728 0 Physician Assistant Only Fluoride varnish 20 1043460728 0 Physician Assistant Only Healthy Kids Services 20 1043460728 0 Physician Assistant Only Physician Services 00 1043460850 0 WITTKOPF JUSTIN 2009196 9999999 B 10 1043460850 0 10001 W INNOVATION DR STE 200 WAUWATOSA WI 532264851 20 1043460850 0 Physicians Anesthesia Services 20 1043460850 0 Physicians Healthy Kids Services 20 1043460850 0 Physicians Optical Supplies 20 1043460850 0 Physicians Physician Services 00 1043460868 0 AUGUSTYN LISA 2017235 9999999 B 10 1043460868 0 24014 W RENWICK RD PLAINFIELD IL 605448708 20 1043460868 0 Physical Therapists Medical Supplies 20 1043460868 0 Physical Therapists Medical equipment/prosthetic devices 20 1043460868 0 Physical Therapists Physical Therapy Services 00 1043461924 0 RIHERD DANIEL 2014182 9999999 B 10 1043461924 0 350 W COLUMBIA ST STE 420 EVANSVILLE IN 477101782 20 1043461924 0 Physicians Anesthesia Services 20 1043461924 0 Physicians Healthy Kids Services 20 1043461924 0 Physicians Optical Supplies 20 1043461924 0 Physicians Physician Services 00 1043465263 0 JAVED AHMED 2021112 9999999 B 10 1043465263 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1043465263 0 Physicians Anesthesia Services 20 1043465263 0 Physicians Healthy Kids Services 20 1043465263 0 Physicians Optical Supplies 20 1043465263 0 Physicians Physician Services 20 1043465263 0 Physicians Physicians Psychiatric Services 00 1043466543 0 HANLEY MARY 2009244 9999999 B 10 1043466543 0 917 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0 Physicians Anesthesia Services 20 1043467871 0 Physicians Healthy Kids Services 20 1043467871 0 Physicians Optical Supplies 20 1043467871 0 Physicians Physician Services 20 1043467871 0 Physicians Physicians Psychiatric Services 00 1043469471 0 PENUMETSA MARUTHI SRIKANTH 2017101 9999999 B 10 1043469471 0 PO BOX 1230 EVANSVILLE IN 477061230 20 1043469471 0 Physicians Anesthesia Services 20 1043469471 0 Physicians Fluoride varnish 20 1043469471 0 Physicians Healthy Kids Services 20 1043469471 0 Physicians Optical Supplies 20 1043469471 0 Physicians Physician Services 00 1043469992 0 PILIKA ASTI 2013271 9999999 B 10 1043469992 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1043469992 0 Physicians Anesthesia Services 20 1043469992 0 Physicians Healthy Kids Services 20 1043469992 0 Physicians Optical Supplies 20 1043469992 0 Physicians Physician Services 00 1043470016 0 KOZYAK BENJAMIN W 2022001 9999999 B 10 1043470016 0 100 E PENN SQ PHILADELPHIA PA 191073323 20 1043470016 0 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Physician Services 00 1043472798 0 LEE THOMAS 2008175 9999999 B 10 1043472798 0 120 E LAKE ST ADDISON IL 601012821 20 1043472798 0 Dentists Dental Services 20 1043472798 0 Dentists Physician Services 00 1043474042 0 LIU JIJUN 2012153 9999999 B 10 1043474042 0 8940 N WOOD SAGE RD PEORIA IL 616157822 20 1043474042 0 Physicians Anesthesia Services 20 1043474042 0 Physicians Fluoride varnish 20 1043474042 0 Physicians Healthy Kids Services 20 1043474042 0 Physicians Optical Supplies 20 1043474042 0 Physicians Physician Services 00 1043474505 0 TIGGES CODY R 2015253 9999999 B 10 1043474505 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1043474505 0 Physicians Anesthesia Services 20 1043474505 0 Physicians Fluoride varnish 20 1043474505 0 Physicians Healthy Kids Services 20 1043474505 0 Physicians Optical Supplies 20 1043474505 0 Physicians Physician Services 00 1043474562 0 LEMMON ADAM J 2011274 9999999 B 10 1043474562 0 PO BOX 6069 INDIANAPOLIS IN 462066069 20 1043474562 0 Physicians 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ST STE 500 CHICAGO IL 606023384 20 1043478670 0 Physicians Anesthesia Services 20 1043478670 0 Physicians Family Planning Counseling 20 1043478670 0 Physicians Fluoride varnish 20 1043478670 0 Physicians Healthy Kids Services 20 1043478670 0 Physicians Optical Supplies 20 1043478670 0 Physicians Physician Services 00 1043478902 0 NATION JAVAN 2024359 9999999 B 10 1043478902 0 PO BOX 43230 PHOENIX AZ 850803230 20 1043478902 0 Physicians Anesthesia Services 20 1043478902 0 Physicians Healthy Kids Services 20 1043478902 0 Physicians Optical Supplies 20 1043478902 0 Physicians Physician Services 00 1043479322 0 RAO ROOPA 2024326 9999999 B 10 1043479322 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1043479322 0 Physicians Anesthesia Services 20 1043479322 0 Physicians Fluoride varnish 20 1043479322 0 Physicians Healthy Kids Services 20 1043479322 0 Physicians Optical Supplies 20 1043479322 0 Physicians Physician Services 00 1043479348 0 FARMER JEFFREY 2012183 9999999 B 10 1043479348 0 950 N 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1043508526 0 Nurse Practitioners Healthy Kids Services 20 1043508526 0 Nurse Practitioners Nurse Practitioners Services 20 1043508526 0 Nurse Practitioners Physician Services 00 1043508765 0 YUEN ROBERT A 2017107 9999999 B 10 1043508765 0 11475 OLDE CABIN RD STE 200 SAINT LOUIS MO 631417129 20 1043508765 0 Physicians Anesthesia Services 20 1043508765 0 Physicians Healthy Kids Services 20 1043508765 0 Physicians Optical Supplies 20 1043508765 0 Physicians Physician Services 00 1043509607 0 MAMTORA SEEMA R 2017067 9999999 B 10 1043509607 0 5777 DEPT CAROL STREAM IL 601220021 20 1043509607 0 Physician Assistant Only Fluoride varnish 20 1043509607 0 Physician Assistant Only Healthy Kids Services 20 1043509607 0 Physician Assistant Only Physician Services 00 1043509680 0 HAMIDI MASSIHULLAH 2017166 9999999 B 10 1043509680 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1043509680 0 Physicians Anesthesia Services 20 1043509680 0 Physicians Healthy Kids Services 20 1043509680 0 Physicians 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20 1043586076 0 Physicians Healthy Kids Services 20 1043586076 0 Physicians Optical Supplies 20 1043586076 0 Physicians Physician Services 00 1043586480 0 KNEY ADAM K 2018152 9999999 B 10 1043586480 0 4701 DEPT CAROL STREAM IL 601220021 20 1043586480 0 Physicians Anesthesia Services 20 1043586480 0 Physicians Healthy Kids Services 20 1043586480 0 Physicians Optical Supplies 20 1043586480 0 Physicians Physician Services 20 1043586480 0 Physicians Physicians Psychiatric Services 00 1043586522 0 WINKLER KATHRYN 2018190 9999999 B 10 1043586522 0 940 LEE ST DES PLAINES IL 600166555 20 1043586522 0 Physicians Anesthesia Services 20 1043586522 0 Physicians Healthy Kids Services 20 1043586522 0 Physicians Optical Supplies 20 1043586522 0 Physicians Physician Services 00 1043588296 0 PURNELL THOMAS 2023131 9999999 B 10 1043588296 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1043588296 0 Other behavior health professional LCPC/LMFT services 00 1043588494 0 AL-ZAIDY SAMIAH A 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COLLEEN 2013335 9999999 B 10 1043597131 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1043597131 0 Nurse Practitioners Healthy Kids Services 20 1043597131 0 Nurse Practitioners Nurse Practitioners Services 20 1043597131 0 Nurse Practitioners Physician Services 00 1043598956 0 CHAN WAI-YAN 2020070 9999999 B 10 1043598956 0 PO BOX 43230 PHOENIX AZ 850803230 20 1043598956 0 Physician Assistant Only Fluoride varnish 20 1043598956 0 Physician Assistant Only Healthy Kids Services 20 1043598956 0 Physician Assistant Only Physician Services 00 1043599152 0 MENDELSON SCOTT J 2017164 9999999 B 10 1043599152 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1043599152 0 Physicians Anesthesia Services 20 1043599152 0 Physicians Healthy Kids Services 20 1043599152 0 Physicians Optical Supplies 20 1043599152 0 Physicians Physician Services 20 1043599152 0 Physicians Physicians Psychiatric Services 00 1043600190 0 GLICKMAN HALEY D 2015037 9999999 B 10 1043600190 0 2650 RIDGE AVE 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Services 00 1043606999 0 LAUER ZACHARY 2020214 9999999 B 10 1043606999 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1043606999 0 Physicians Anesthesia Services 20 1043606999 0 Physicians Fluoride varnish 20 1043606999 0 Physicians Healthy Kids Services 20 1043606999 0 Physicians Optical Supplies 20 1043606999 0 Physicians Physician Services 00 1043607534 0 SYLVE REBECCA 2016053 9999999 B 10 1043607534 0 15709 SCOTSGLEN RD ORLAND PARK IL 604622876 20 1043607534 0 Speech Therapists Medical Supplies 20 1043607534 0 Speech Therapists Medical equipment/prosthetic devices 20 1043607534 0 Speech Therapists Speech Therapy/Pathology Services 00 1043607856 0 RESCHKE AGNES 2024320 9999999 B 10 1043607856 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1043607856 0 Physicians Anesthesia Services 20 1043607856 0 Physicians Fluoride varnish 20 1043607856 0 Physicians Healthy Kids Services 20 1043607856 0 Physicians Optical Supplies 20 1043607856 0 Physicians Physician Services 00 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Services 00 1043646482 0 GONZALEZ KATHERINE 2015350 9999999 B 10 1043646482 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1043646482 0 Other behavior health professional All Kids application agent 20 1043646482 0 Other behavior health professional LCPC/LMFT services 00 1043648140 0 BARNETT ANDRIETTA 2024085 9999999 B 10 1043648140 0 99 HAWLEY LN STE 1102 STRATFORD CT 066141204 20 1043648140 0 Nurse Practitioners Healthy Kids Services 20 1043648140 0 Nurse Practitioners Nurse Practitioners Services 20 1043648140 0 Nurse Practitioners Physician Services 00 1043648710 0 SWANBERG LAUREN M 2015238 9999999 B 10 1043648710 0 15118 W AUSTIN DR LOCKPORT IL 604411331 20 1043648710 0 Speech Therapists Medical Supplies 20 1043648710 0 Speech Therapists Medical equipment/prosthetic devices 20 1043648710 0 Speech Therapists Speech Therapy/Pathology Services 00 1043649106 0 MATTHEWS ERIN 2023121 9999999 B 10 1043649106 0 1934 N CALIFORNIA AVE CHICAGO IL 606474247 20 1043649106 0 Clinical Social 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2015001 9999999 B 10 1043654080 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1043654080 0 Nurse Practitioners Healthy Kids Services 20 1043654080 0 Nurse Practitioners Nurse Practitioners Services 20 1043654080 0 Nurse Practitioners Physician Services 00 1043654734 0 MONTOYA CASSANDRA R 2019091 9999999 B 10 1043654734 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1043654734 0 Physicians Anesthesia Services 20 1043654734 0 Physicians Fluoride varnish 20 1043654734 0 Physicians Healthy Kids Services 20 1043654734 0 Physicians Optical Supplies 20 1043654734 0 Physicians Physician Services 00 1043655210 0 KINDER ALLISON 2013126 9999999 B 10 1043655210 0 5132 N ELSTON AVE CHICAGO IL 606302429 20 1043655210 0 Nurse Practitioners Healthy Kids Services 20 1043655210 0 Nurse Practitioners Nurse Practitioners Services 20 1043655210 0 Nurse Practitioners Physician Services 00 1043656499 0 SMALL BEN JOHN 2017184 9999999 B 10 1043656499 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 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20 1043658412 0 Physicians Anesthesia Services 20 1043658412 0 Physicians Fluoride varnish 20 1043658412 0 Physicians Healthy Kids Services 20 1043658412 0 Physicians Optical Supplies 20 1043658412 0 Physicians Physician Services 00 1043658743 0 HODEL EDWARD 2017192 9999999 B 10 1043658743 0 PO BOX 504469 SAINT LOUIS MO 631504469 20 1043658743 0 Physical Therapists Medical Supplies 20 1043658743 0 Physical Therapists Medical equipment/prosthetic devices 20 1043658743 0 Physical Therapists Physical Therapy Services 00 1043658818 0 YESENSKY JESSICA ANN 2021263 9999999 B 10 1043658818 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1043658818 0 Physicians Anesthesia Services 20 1043658818 0 Physicians Healthy Kids Services 20 1043658818 0 Physicians Optical Supplies 20 1043658818 0 Physicians Physician Services 00 1043659071 0 KACZOR SONIA K 2016203 9999999 B 10 1043659071 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1043659071 0 Physicians Anesthesia Services 20 1043659071 0 Physicians Fluoride varnish 20 1043659071 0 Physicians Healthy Kids Services 20 1043659071 0 Physicians Optical Supplies 20 1043659071 0 Physicians Physician Services 00 1043659238 0 CHOE DANIEL J 2020118 9999999 B 10 1043659238 0 11475 OLDE CABIN RD STE 200 SAINT LOUIS MO 631417129 20 1043659238 0 Physicians Anesthesia Services 20 1043659238 0 Physicians Healthy Kids Services 20 1043659238 0 Physicians Optical Supplies 20 1043659238 0 Physicians Physician Services 00 1043659303 0 RILEY ABIGAIL 2018001 9999999 B 10 1043659303 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1043659303 0 Nurse Practitioners Fluoride varnish 20 1043659303 0 Nurse Practitioners Healthy Kids Services 20 1043659303 0 Nurse Practitioners Nurse Practitioners Services 20 1043659303 0 Nurse Practitioners Physician Services 00 1043659352 0 LANG DENISHA 2017347 9999999 B 10 1043659352 0 29373 NETWORK PL CHICAGO IL 606733039 20 1043659352 0 Nurse Practitioners Healthy Kids Services 20 1043659352 0 Nurse Practitioners Nurse Practitioners Services 20 1043659352 0 Nurse Practitioners Physician Services 00 1043659436 0 AHMED JAYME 2020326 9999999 B 10 1043659436 0 PO BOX 43230 PHOENIX AZ 850803230 20 1043659436 0 Physicians Anesthesia Services 20 1043659436 0 Physicians Healthy Kids Services 20 1043659436 0 Physicians Optical Supplies 20 1043659436 0 Physicians Physician Services 20 1043659436 0 Physicians Physicians Psychiatric Services 00 1043659907 0 CATARINICCHIA ANGELA BAJA 2019256 9999999 B 10 1043659907 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1043659907 0 Physicians Anesthesia Services 20 1043659907 0 Physicians Healthy Kids Services 20 1043659907 0 Physicians Optical Supplies 20 1043659907 0 Physicians Physician Services 00 1043660210 0 YANG KEVIN 2021321 9999999 B 10 1043660210 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1043660210 0 Physicians Anesthesia Services 20 1043660210 0 Physicians Healthy Kids Services 20 1043660210 0 Physicians Optical Supplies 20 1043660210 0 Physicians Physician Services 00 1043660285 0 CHAUDHRY THYMUR 2017086 9999999 B 10 1043660285 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1043660285 0 Physicians Anesthesia Services 20 1043660285 0 Physicians Fluoride varnish 20 1043660285 0 Physicians Healthy Kids Services 20 1043660285 0 Physicians Optical Supplies 20 1043660285 0 Physicians Physician Services 00 1043660350 0 ZHU TINA T 2018355 9999999 B 10 1043660350 0 850 W IRVING PARK RD CHICAGO IL 606133077 20 1043660350 0 Physicians Anesthesia Services 20 1043660350 0 Physicians Fluoride varnish 20 1043660350 0 Physicians Healthy Kids Services 20 1043660350 0 Physicians Optical Supplies 20 1043660350 0 Physicians Physician Services 00 1043660780 0 BONACORSI LOUIS 2022061 9999999 B 10 1043660780 0 PO BOX 60352 SAINT LOUIS MO 631600352 20 1043660780 0 Physicians Anesthesia Services 20 1043660780 0 Physicians Healthy Kids Services 20 1043660780 0 Physicians Optical Supplies 20 1043660780 0 Physicians Physician Services 00 1043660848 0 WEBER BRIAN L 2019301 9999999 B 10 1043660848 0 339 CONSORT DR BALLWIN MO 630114439 20 1043660848 0 Physicians Anesthesia Services 20 1043660848 0 Physicians Healthy Kids Services 20 1043660848 0 Physicians Optical Supplies 20 1043660848 0 Physicians Physician Services 00 1043662067 0 SUN LULU 2019158 9999999 B 10 1043662067 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1043662067 0 Physicians Anesthesia Services 20 1043662067 0 Physicians Healthy Kids Services 20 1043662067 0 Physicians Optical Supplies 20 1043662067 0 Physicians Physician Services 00 1043662505 0 ARVIN MEGAN 2022136 9999999 B 10 1043662505 0 1525 W CYPRESS CREEK RD FORT LAUDERDALE FL 333091831 20 1043662505 0 Physician Assistant Only Fluoride varnish 20 1043662505 0 Physician Assistant Only Healthy Kids Services 20 1043662505 0 Physician Assistant Only Physician Services 00 1043662612 0 PRATT ABDULLAH H 2018353 9999999 B 10 1043662612 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1043662612 0 Physicians Anesthesia Services 20 1043662612 0 Physicians Healthy Kids Services 20 1043662612 0 Physicians Optical Supplies 20 1043662612 0 Physicians Physician Services 00 1043662620 0 BENNETT EMILY 2017213 9999999 B 10 1043662620 0 5318 135TH ST CRESTWOOD IL 604451504 20 1043662620 0 Speech Therapists Medical Supplies 20 1043662620 0 Speech Therapists Medical equipment/prosthetic devices 20 1043662620 0 Speech Therapists Speech Therapy/Pathology Services 00 1043662679 0 VELDMAN KRISTEN 2017109 9999999 B 10 1043662679 0 901 MCCLINTOCK DR STE 202 SUITE 202 BURR RIDGE IL 605270872 20 1043662679 0 Physician Assistant Only Fluoride varnish 20 1043662679 0 Physician Assistant Only Healthy Kids Services 20 1043662679 0 Physician Assistant Only Physician Services 00 1043663818 0 BAKER KELLY 2021027 9999999 B 10 1043663818 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1043663818 0 Physician Assistant Only Fluoride varnish 20 1043663818 0 Physician Assistant Only Healthy Kids Services 20 1043663818 0 Physician Assistant Only Physician Services 00 1043663834 0 PATEL AMEE 2016204 9999999 B 10 1043663834 0 830 W DIVERSEY PKWY FL 2 CHICAGO IL 606141454 20 1043663834 0 Dentists Dental Services 20 1043663834 0 Dentists Physician Services 00 1043663917 0 LARRISON JOHN W 2016244 9999999 B 10 1043663917 0 PO BOX 850 METROPOLIS IL 629600850 20 1043663917 0 Nurse Practitioners Fluoride varnish 20 1043663917 0 Nurse Practitioners Healthy Kids Services 20 1043663917 0 Nurse Practitioners Nurse Practitioners Services 20 1043663917 0 Nurse Practitioners Physician Services 00 1043664410 0 IGNATIUK DANIEL 2023213 9999999 B 10 1043664410 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1043664410 0 Physicians Anesthesia Services 20 1043664410 0 Physicians Fluoride varnish 20 1043664410 0 Physicians Healthy Kids Services 20 1043664410 0 Physicians Optical Supplies 20 1043664410 0 Physicians Physician Services 00 1043665060 0 FARINA DOMENICO A 2019364 9999999 B 10 1043665060 0 5777 DEPT CAROL STREAM IL 601220021 20 1043665060 0 Physicians Anesthesia Services 20 1043665060 0 Physicians Fluoride varnish 20 1043665060 0 Physicians Healthy Kids Services 20 1043665060 0 Physicians Optical Supplies 20 1043665060 0 Physicians Physician Services 00 1043665300 0 MIDHA KRISTINA I 2016177 9999999 B 10 1043665300 0 5777 DEPT CAROL STREAM IL 601228942 20 1043665300 0 Nurse Practitioners Healthy Kids Services 20 1043665300 0 Nurse Practitioners Nurse Practitioners Services 20 1043665300 0 Nurse Practitioners Physician Services 00 1043665656 0 KHAJURIA BHAVIK 2018066 9999999 B 10 1043665656 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1043665656 0 Physicians Anesthesia Services 20 1043665656 0 Physicians Fluoride varnish 20 1043665656 0 Physicians Healthy Kids Services 20 1043665656 0 Physicians Optical Supplies 20 1043665656 0 Physicians Physician Services 00 1043665987 0 MILES TAYLOR M 2020183 9999999 B 10 1043665987 0 5121 MARYLAND WAY STE 300 BRENTWOOD TN 370277516 20 1043665987 0 Physicians Anesthesia Services 20 1043665987 0 Physicians Fluoride varnish 20 1043665987 0 Physicians Healthy Kids Services 20 1043665987 0 Physicians Optical Supplies 20 1043665987 0 Physicians Physician Services 00 1043666381 0 MUNOZ CHRISTINE 2023086 9999999 B 10 1043666381 0 PO BOX 1437 COLUMBUS GA 319021437 20 1043666381 0 Physicians Anesthesia Services 20 1043666381 0 Physicians Fluoride varnish 20 1043666381 0 Physicians Healthy Kids Services 20 1043666381 0 Physicians Optical Supplies 20 1043666381 0 Physicians Physician Services 00 1043666985 0 AVERSA JOHN G 2023173 9999999 B 10 1043666985 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1043666985 0 Physicians Anesthesia Services 20 1043666985 0 Physicians Healthy Kids Services 20 1043666985 0 Physicians Optical Supplies 20 1043666985 0 Physicians Physician Services 00 1043667355 0 LUNDY ADAM S 2022165 9999999 B 10 1043667355 0 250 W 96TH ST STE 520 INDIANAPOLIS IN 462601317 20 1043667355 0 Physicians Anesthesia Services 20 1043667355 0 Physicians Fluoride varnish 20 1043667355 0 Physicians Healthy Kids Services 20 1043667355 0 Physicians Optical Supplies 20 1043667355 0 Physicians Physician Services 00 1043667397 0 MOHAMMED ZUBAIR ALI 2018283 9999999 B 10 1043667397 0 10114 GRAND AVE FRANKLIN PARK IL 601312549 20 1043667397 0 Dentists Dental Services 20 1043667397 0 Dentists Physician Services 00 1043668239 0 GRAHAM EDITH 2019221 9999999 B 10 1043668239 0 5777 DEPT CAROL STREAM IL 601220021 20 1043668239 0 Physicians Anesthesia Services 20 1043668239 0 Physicians Healthy Kids Services 20 1043668239 0 Physicians Optical Supplies 20 1043668239 0 Physicians Physician Services 20 1043668239 0 Physicians Physicians Psychiatric Services 00 1043668387 0 WAXMAN ZACHARY M 2019001 9999999 B 10 1043668387 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1043668387 0 Physicians Anesthesia Services 20 1043668387 0 Physicians Healthy Kids Services 20 1043668387 0 Physicians Optical Supplies 20 1043668387 0 Physicians Physician Services 00 1043669393 0 KOESTNER BRYAN P 2019182 9999999 B 10 1043669393 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1043669393 0 Physicians Anesthesia Services 20 1043669393 0 Physicians Fluoride varnish 20 1043669393 0 Physicians Healthy Kids Services 20 1043669393 0 Physicians Optical Supplies 20 1043669393 0 Physicians Physician Services 00 1043669419 0 AL OBAIDI MUSTAFA 2016155 9999999 B 10 1043669419 0 300 S MCLEAN BLVD STE M ELGIN IL 601231023 20 1043669419 0 Dentists Dental Services 20 1043669419 0 Dentists Physician Services 00 1043669781 0 CLARK CHRISTOPHER 2023243 9999999 B 10 1043669781 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1043669781 0 Physicians Anesthesia Services 20 1043669781 0 Physicians Healthy Kids Services 20 1043669781 0 Physicians Optical Supplies 20 1043669781 0 Physicians Physician Services 00 1043671068 0 TAYLOR JACLYN G 2016153 9999999 B 10 1043671068 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1043671068 0 Nurse Practitioners Anesthesia Services 20 1043671068 0 Nurse Practitioners Nurse Practitioners Services 20 1043671068 0 Nurse Practitioners Physician Services 00 1043672256 0 EASTEP KASI A 2021305 9999999 B 10 1043672256 0 PO BOX 43230 LOUISVILLE KY 402530230 20 1043672256 0 Physicians Anesthesia Services 20 1043672256 0 Physicians Fluoride varnish 20 1043672256 0 Physicians Healthy Kids Services 20 1043672256 0 Physicians Optical Supplies 20 1043672256 0 Physicians Physician Services 00 1043672421 0 CHEUNG ERIC 2017278 9999999 B 10 1043672421 0 7825 SOLUTION CTR CHICAGO IL 606777007 20 1043672421 0 Physicians Anesthesia Services 20 1043672421 0 Physicians Healthy Kids Services 20 1043672421 0 Physicians Optical Supplies 20 1043672421 0 Physicians Physician Services 20 1043672421 0 Physicians Physicians Psychiatric Services 00 1043672512 0 AMBURN ASHLEY D 2017181 9999999 B 10 1043672512 0 448 WYLIE DR NORMAL IL 617615405 20 1043672512 0 Other behavior health professional LCPC/LMFT services 00 1043673742 0 CARR JOSEPH L 2020214 9999999 B 10 1043673742 0 6149 E COLUMBIA ST EVANSVILLE IN 477159134 20 1043673742 0 Physicians Anesthesia Services 20 1043673742 0 Physicians Healthy Kids Services 20 1043673742 0 Physicians Optical Supplies 20 1043673742 0 Physicians Physician Services 00 1043673817 0 PARUCHURI ARPANA 2019273 9999999 B 10 1043673817 0 5777 DEPT CAROL STREAM IL 601228942 20 1043673817 0 Physicians Anesthesia Services 20 1043673817 0 Physicians Fluoride varnish 20 1043673817 0 Physicians Healthy Kids Services 20 1043673817 0 Physicians Optical Supplies 20 1043673817 0 Physicians Physician Services 00 1043674138 0 HUSHKA ELIZABETH 2018075 9999999 B 10 1043674138 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1043674138 0 Nurse Practitioners Fluoride varnish 20 1043674138 0 Nurse Practitioners Healthy Kids Services 20 1043674138 0 Nurse Practitioners Nurse Practitioners Services 20 1043674138 0 Nurse Practitioners Physician Services 00 1043674468 0 EBONE JOHN 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varnish 20 1043676109 0 Physician Assistant Only Healthy Kids Services 20 1043676109 0 Physician Assistant Only Physician Services 00 1043676166 0 GOODRICH AMBER L 2019189 9999999 B 10 1043676166 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1043676166 0 Nurse Practitioners Healthy Kids Services 20 1043676166 0 Nurse Practitioners Midwife Services 20 1043676166 0 Nurse Practitioners Nurse Practitioners Services 20 1043676166 0 Nurse Practitioners Physician Services 00 1043676448 0 BRANN KAREN 2023233 9999999 B 10 1043676448 0 10400 SOUTHWEST HWY CHICAGO RIDGE IL 604151367 20 1043676448 0 Nurse Practitioners Fluoride varnish 20 1043676448 0 Nurse Practitioners Healthy Kids Services 20 1043676448 0 Nurse Practitioners Nurse Practitioners Services 20 1043676448 0 Nurse Practitioners Physician Services 00 1043677156 0 WYLIE LESLIE 2022075 9999999 B 10 1043677156 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1043677156 0 Nurse Practitioners Anesthesia Services 20 1043677156 0 Nurse Practitioners 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2023356 9999999 B 10 1043828635 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1043828635 0 Nurse Practitioners Fluoride varnish 20 1043828635 0 Nurse Practitioners Healthy Kids Services 20 1043828635 0 Nurse Practitioners Nurse Practitioners Services 20 1043828635 0 Nurse Practitioners Physician Services 00 1043829369 0 VORDERER CHARLES A 2020288 9999999 B 10 1043829369 0 4209 W SHAMROCK LN UNIT C MCHENRY IL 600508700 20 1043829369 0 Psychologist Psychologist service 00 1043829690 0 HEUER CAROLINE 2021012 9999999 B 10 1043829690 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1043829690 0 Nurse Practitioners Fluoride varnish 20 1043829690 0 Nurse Practitioners Healthy Kids Services 20 1043829690 0 Nurse Practitioners Nurse Practitioners Services 20 1043829690 0 Nurse Practitioners Physician Services 00 1043829732 0 GUERRA NICOLE L 2022222 9999999 B 10 1043829732 0 25440 S GOUGAR RD MANHATTAN IL 604429511 20 1043829732 0 Speech Therapists Medical Supplies 20 1043829732 0 Speech 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and LMFT IMPACT specialties) 00 1043830698 0 ASAMOAH CLEMENTINA 2024192 9999999 B 10 1043830698 0 350 N WALL ST KANKAKEE IL 609012901 20 1043830698 0 Physicians Anesthesia Services 20 1043830698 0 Physicians Healthy Kids Services 20 1043830698 0 Physicians Optical Supplies 20 1043830698 0 Physicians Physician Services 00 1043831407 0 PRASAD SONIKA 2021060 9999999 B 10 1043831407 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1043831407 0 Physicians Anesthesia Services 20 1043831407 0 Physicians Fluoride varnish 20 1043831407 0 Physicians Healthy Kids Services 20 1043831407 0 Physicians Optical Supplies 20 1043831407 0 Physicians Physician Services 00 1043831787 0 WELCH REED F 2021172 9999999 B 10 1043831787 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1043831787 0 Physician Assistant Only Fluoride varnish 20 1043831787 0 Physician Assistant Only Healthy Kids Services 20 1043831787 0 Physician Assistant Only Physician Services 00 1043831811 0 SAYEED MUSTAFA A 2020181 9999999 B 10 1043831811 0 1919 S HIGHLAND AVE STE 300B LOMBARD IL 601484979 20 1043831811 0 Physicians Anesthesia Services 20 1043831811 0 Physicians Fluoride varnish 20 1043831811 0 Physicians Healthy Kids Services 20 1043831811 0 Physicians Optical Supplies 20 1043831811 0 Physicians Physician Services 00 1043831894 0 KIM INAE J 2020184 9999999 B 10 1043831894 0 5777 DEPT CAROL STREAM IL 601220021 20 1043831894 0 Physicians Anesthesia Services 20 1043831894 0 Physicians Fluoride varnish 20 1043831894 0 Physicians Healthy Kids Services 20 1043831894 0 Physicians Optical Supplies 20 1043831894 0 Physicians Physician Services 00 1043832371 0 HEWELL KERRILYN 2020183 9999999 B 10 1043832371 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1043832371 0 Physicians Anesthesia Services 20 1043832371 0 Physicians Healthy Kids Services 20 1043832371 0 Physicians Optical Supplies 20 1043832371 0 Physicians Physician Services 00 1043832785 0 WEGLARZ MELANIE J 2020198 9999999 B 10 1043832785 0 355 E ERIE ST CHICAGO IL 606113167 20 1043832785 0 Nurse Practitioners Healthy Kids Services 20 1043832785 0 Nurse Practitioners Nurse Practitioners Services 20 1043832785 0 Nurse Practitioners Physician Services 00 1043833486 0 FLANAGAN ALEXANDRA 2023184 9999999 B 10 1043833486 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1043833486 0 Physicians Anesthesia Services 20 1043833486 0 Physicians Fluoride varnish 20 1043833486 0 Physicians Healthy Kids Services 20 1043833486 0 Physicians Optical Supplies 20 1043833486 0 Physicians Physician Services 00 1043833544 0 FAYNE RACHEL 2024148 9999999 B 10 1043833544 0 4698 DEPT CAROL STREAM IL 601220021 20 1043833544 0 Physicians Anesthesia Services 20 1043833544 0 Physicians Healthy Kids Services 20 1043833544 0 Physicians Optical Supplies 20 1043833544 0 Physicians Physician Services 00 1043833593 0 MOREFIELD SUMMER 2020198 9999999 B 10 1043833593 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1043833593 0 Other behavior health professional Other 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1043834435 0 4021 W 63RD ST STE C CHICAGO IL 606294642 20 1043834435 0 Nurse Practitioners Fluoride varnish 20 1043834435 0 Nurse Practitioners Healthy Kids Services 20 1043834435 0 Nurse Practitioners Nurse Practitioners Services 20 1043834435 0 Nurse Practitioners Physician Services 00 1043835341 0 RICHELIEU JESSICA C 2020196 9999999 B 10 1043835341 0 PO BOX 411637 SAINT LOUIS MO 631411637 20 1043835341 0 Physicians Anesthesia Services 20 1043835341 0 Physicians Healthy Kids Services 20 1043835341 0 Physicians Optical Supplies 20 1043835341 0 Physicians Physician Services 00 1043835580 0 MCCOY MATTHEW 2022258 9999999 B 10 1043835580 0 211 E BROADWAY ALTON IL 620026220 20 1043835580 0 Optometrists Optical Supplies 20 1043835580 0 Optometrists Optometric Services 20 1043835580 0 Optometrists Physician Services 00 1043835598 0 HERNANDEZ ASHLEY L 2021286 9999999 B 10 1043835598 0 1325 SYCAMORE RD DEKALB IL 601152483 20 1043835598 0 Other behavior health professional Other Behavioral 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1043836109 0 Physicians Physician Services 00 1043838543 0 LIVERA DANIEL JOSEPH 2024184 9999999 B 10 1043838543 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1043838543 0 Physicians Anesthesia Services 20 1043838543 0 Physicians Fluoride varnish 20 1043838543 0 Physicians Healthy Kids Services 20 1043838543 0 Physicians Optical Supplies 20 1043838543 0 Physicians Physician Services 00 1043839160 0 BECK NICKLAS 2024227 9999999 B 10 1043839160 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1043839160 0 Physicians Anesthesia Services 20 1043839160 0 Physicians Healthy Kids Services 20 1043839160 0 Physicians Optical Supplies 20 1043839160 0 Physicians Physician Services 00 1043839681 0 ANDRUSZKIEWICZ PETER 2020140 9999999 B 10 1043839681 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1043839681 0 Physicians Anesthesia Services 20 1043839681 0 Physicians Fluoride varnish 20 1043839681 0 Physicians Healthy Kids Services 20 1043839681 0 Physicians Optical Supplies 20 1043839681 0 Physicians Physician Services 00 1043840812 0 WILSON WHITNEY N 2020113 9999999 B 10 1043840812 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1043840812 0 Nurse Practitioners Fluoride varnish 20 1043840812 0 Nurse Practitioners Healthy Kids Services 20 1043840812 0 Nurse Practitioners Nurse Practitioners Services 20 1043840812 0 Nurse Practitioners Physician Services 00 1043841711 0 KAMINSKI MEGAN 2021229 9999999 B 10 1043841711 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1043841711 0 Physical Therapists Medical Supplies 20 1043841711 0 Physical Therapists Medical equipment/prosthetic devices 20 1043841711 0 Physical Therapists Physical Therapy Services 00 1043842172 0 SENTHILATHIBAN VIDHYA 2020056 9999999 B 10 1043842172 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112386 20 1043842172 0 Dentists Dental Services 20 1043842172 0 Dentists Physician Services 00 1043843592 0 OWINGS BRIAN 2020345 9999999 B 10 1043843592 0 6308 8TH AVE KENOSHA WI 531435031 20 1043843592 0 Physician Assistant Only Fluoride varnish 20 1043843592 0 Physician Assistant Only Healthy Kids Services 20 1043843592 0 Physician Assistant Only Physician Services 00 1043843832 0 MOSES CAMILLE 2020063 9999999 B 10 1043843832 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1043843832 0 Nurse Practitioners Healthy Kids Services 20 1043843832 0 Nurse Practitioners Nurse Practitioners Services 20 1043843832 0 Nurse Practitioners Physician Services 00 1043845027 0 MAMARIL ROSS 2020073 9999999 B 10 1043845027 0 PO BOX 1541 NORTHBROOK IL 600651541 20 1043845027 0 Nurse Practitioners Fluoride varnish 20 1043845027 0 Nurse Practitioners Healthy Kids Services 20 1043845027 0 Nurse Practitioners Nurse Practitioners Services 20 1043845027 0 Nurse Practitioners Physician Services 00 1043845456 0 ORZEL JOANNA 2021172 9999999 B 10 1043845456 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1043845456 0 Physicians Anesthesia Services 20 1043845456 0 Physicians Healthy Kids Services 20 1043845456 0 Physicians Optical Supplies 20 1043845456 0 Physicians Physician Services 00 1043846041 0 ERDMANN AMANDA 2022018 9999999 B 10 1043846041 0 PO BOX 772 MC2295 WOONSOCKET RI 028950784 20 1043846041 0 Nurse Practitioners Fluoride varnish 20 1043846041 0 Nurse Practitioners Healthy Kids Services 20 1043846041 0 Nurse Practitioners Nurse Practitioners Services 20 1043846041 0 Nurse Practitioners Physician Services 00 1043846421 0 CASOLARI LINDSAY 2020078 9999999 B 10 1043846421 0 PO BOX 192 900 N WASHINGTON ST DU QUOIN IL 628320192 20 1043846421 0 Nurse Practitioners Healthy Kids Services 20 1043846421 0 Nurse Practitioners Nurse Practitioners Services 20 1043846421 0 Nurse Practitioners Physician Services 00 1043847320 0 MULTANI MANEET 2024222 9999999 B 10 1043847320 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1043847320 0 Physicians Anesthesia Services 20 1043847320 0 Physicians Healthy Kids Services 20 1043847320 0 Physicians Optical Supplies 20 1043847320 0 Physicians Physician Services 00 1043847403 0 PATTERSON STEPHEN 2020266 9999999 B 10 1043847403 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1043847403 0 Dentists Dental Services 20 1043847403 0 Dentists Physician Services 00 1043847445 0 BREWER DANIELLE 2023179 9999999 B 10 1043847445 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1043847445 0 Physicians Anesthesia Services 20 1043847445 0 Physicians Fluoride varnish 20 1043847445 0 Physicians Healthy Kids Services 20 1043847445 0 Physicians Optical Supplies 20 1043847445 0 Physicians Physician Services 00 1043847577 0 LALA JANELLE 2021097 9999999 B 10 1043847577 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1043847577 0 Physician Assistant Only Fluoride varnish 20 1043847577 0 Physician Assistant Only Healthy Kids Services 20 1043847577 0 Physician Assistant Only Physician Services 00 1043847734 0 CLARDY EMMA 2020226 9999999 B 10 1043847734 0 2041 GOOSE LAKE RD SAUGET IL 622062822 20 1043847734 0 Physicians Anesthesia Services 20 1043847734 0 Physicians Fluoride varnish 20 1043847734 0 Physicians Healthy Kids Services 20 1043847734 0 Physicians Optical Supplies 20 1043847734 0 Physicians Physician Services 00 1043848120 0 LONG DYLAN JASPER 2024010 9999999 B 10 1043848120 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1043848120 0 Physicians Anesthesia Services 20 1043848120 0 Physicians Healthy Kids Services 20 1043848120 0 Physicians Optical Supplies 20 1043848120 0 Physicians Physician Services 00 1043848310 0 FIGUEROA JUSTIN HENRY H 2020177 9999999 B 10 1043848310 0 29373 NETWORK PL CHICAGO IL 606733039 20 1043848310 0 Physicians Anesthesia Services 20 1043848310 0 Physicians Fluoride varnish 20 1043848310 0 Physicians Healthy Kids Services 20 1043848310 0 Physicians Optical Supplies 20 1043848310 0 Physicians Physician Services 00 1043848328 0 HAIDER NABIHA 2020183 9999999 B 10 1043848328 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1043848328 0 Physicians Anesthesia Services 20 1043848328 0 Physicians Fluoride varnish 20 1043848328 0 Physicians Healthy Kids Services 20 1043848328 0 Physicians Optical Supplies 20 1043848328 0 Physicians Physician Services 00 1043848344 0 ONISHCHENKO ELIZABETH E 2020177 9999999 B 10 1043848344 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1043848344 0 Physicians Anesthesia Services 20 1043848344 0 Physicians Fluoride varnish 20 1043848344 0 Physicians Healthy Kids Services 20 1043848344 0 Physicians Optical Supplies 20 1043848344 0 Physicians Physician Services 00 1043848443 0 CHO DANNY 2020177 9999999 B 10 1043848443 0 PO BOX 3039 OAK BROOK IL 605223039 20 1043848443 0 Physicians Anesthesia Services 20 1043848443 0 Physicians Fluoride varnish 20 1043848443 0 Physicians Healthy Kids Services 20 1043848443 0 Physicians Optical Supplies 20 1043848443 0 Physicians Physician Services 00 1043848625 0 LU RACHAEL D 2020173 9999999 B 10 1043848625 0 5777 DEPT CAROL STREAM IL 601220021 20 1043848625 0 Physicians Anesthesia Services 20 1043848625 0 Physicians Healthy Kids Services 20 1043848625 0 Physicians Optical Supplies 20 1043848625 0 Physicians Physician Services 00 1043848823 0 BENNETT ANDRE N 2020197 9999999 B 10 1043848823 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1043848823 0 Nurse Practitioners Anesthesia Services 20 1043848823 0 Nurse Practitioners Nurse Practitioners Services 20 1043848823 0 Nurse Practitioners Physician Services 00 1043849078 0 BHARGAVA SIDDHARTH 2024179 9999999 B 10 1043849078 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1043849078 0 Physicians Anesthesia Services 20 1043849078 0 Physicians Healthy Kids Services 20 1043849078 0 Physicians Optical Supplies 20 1043849078 0 Physicians Physician Services 00 1043849441 0 ARONOV AVI 2020230 9999999 B 10 1043849441 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1043849441 0 Physicians Anesthesia Services 20 1043849441 0 Physicians Fluoride varnish 20 1043849441 0 Physicians Healthy Kids Services 20 1043849441 0 Physicians Optical Supplies 20 1043849441 0 Physicians Physician Services 00 1043849482 0 CAMPBELL KATELYN MARGARET 2020260 9999999 B 10 1043849482 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1043849482 0 Physicians Anesthesia Services 20 1043849482 0 Physicians Fluoride varnish 20 1043849482 0 Physicians Healthy Kids Services 20 1043849482 0 Physicians Optical Supplies 20 1043849482 0 Physicians Physician Services 00 1043849540 0 KENEALY BRIAN 2023257 9999999 B 10 1043849540 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1043849540 0 Physicians Anesthesia Services 20 1043849540 0 Physicians Fluoride varnish 20 1043849540 0 Physicians Healthy Kids Services 20 1043849540 0 Physicians Optical Supplies 20 1043849540 0 Physicians Physician Services 00 1043849714 0 SANCHEZ ASHLEY 2021214 9999999 B 10 1043849714 0 4698 DEPT CAROL STREAM IL 601220021 20 1043849714 0 Physicians Anesthesia Services 20 1043849714 0 Physicians Healthy Kids Services 20 1043849714 0 Physicians Optical Supplies 20 1043849714 0 Physicians Physician Services 00 1043849839 0 NOEL CARLY 2024240 9999999 B 10 1043849839 0 29373 NETWORK PL CHICAGO IL 606733039 20 1043849839 0 Physicians Anesthesia Services 20 1043849839 0 Physicians Fluoride varnish 20 1043849839 0 Physicians Healthy Kids Services 20 1043849839 0 Physicians Optical Supplies 20 1043849839 0 Physicians Physician Services 00 1043850068 0 BELL LAUREN E 2020008 9999999 B 10 1043850068 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1043850068 0 Nurse Practitioners Fluoride varnish 20 1043850068 0 Nurse Practitioners Healthy Kids Services 20 1043850068 0 Nurse Practitioners Nurse Practitioners Services 20 1043850068 0 Nurse Practitioners Physician Services 00 1043850472 0 SOHN DIANA 2020189 9999999 B 10 1043850472 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1043850472 0 Nurse Practitioners Anesthesia Services 20 1043850472 0 Nurse Practitioners Nurse Practitioners Services 20 1043850472 0 Nurse Practitioners Physician Services 00 1043850878 0 LEMANCIK ANNETTE 2024193 9999999 B 10 1043850878 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1043850878 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1043851660 0 BONILLA KATIE 2023189 9999999 B 10 1043851660 0 211 E LAKE ST STE 1B ADDISON IL 601012877 20 1043851660 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1043856701 0 HENSON MALLORY J 2019339 9999999 B 10 1043856701 0 12855 N 40 DR STE 375 SAINT LOUIS MO 631418657 20 1043856701 0 Physician Assistant Only Fluoride varnish 20 1043856701 0 Physician Assistant Only Healthy Kids Services 20 1043856701 0 Physician Assistant Only Physician Services 00 1043856867 0 STUEDEMANN TAELOR A 2020064 9999999 B 10 1043856867 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1043856867 0 Nurse Practitioners Fluoride varnish 20 1043856867 0 Nurse Practitioners Healthy Kids Services 20 1043856867 0 Nurse Practitioners Nurse Practitioners Services 20 1043856867 0 Nurse Practitioners Physician Services 00 1043857493 0 JANET CALLIE LYNN 2020073 9999999 B 10 1043857493 0 1400 S MICHIGAN AVE APT 1203 CHICAGO IL 606053720 20 1043857493 0 Physician Assistant Only Fluoride varnish 20 1043857493 0 Physician Assistant Only Healthy Kids Services 20 1043857493 0 Physician Assistant Only Physician Services 00 1043858152 0 FUQUA JUSTIN K 2024156 9999999 B 10 1043858152 0 3015 N BALLAS RD SAINT LOUIS MO 631312329 20 1043858152 0 Nurse Practitioners Anesthesia Services 20 1043858152 0 Nurse Practitioners Nurse Practitioners Services 20 1043858152 0 Nurse Practitioners Physician Services 00 1043859473 0 MARTIN LINDSEY M 2020042 9999999 B 10 1043859473 0 29373 NETWORK PL CHICAGO IL 606733039 20 1043859473 0 Nurse Practitioners Anesthesia Services 20 1043859473 0 Nurse Practitioners Nurse Practitioners Services 20 1043859473 0 Nurse Practitioners Physician Services 00 1043860034 0 SUMMERS NICOLE M 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HARDIEK EMILY N 2019291 9999999 B 10 1043867419 0 611 W PARK ST URBANA IL 618012529 20 1043867419 0 Nurse Practitioners Fluoride varnish 20 1043867419 0 Nurse Practitioners Healthy Kids Services 20 1043867419 0 Nurse Practitioners Nurse Practitioners Services 20 1043867419 0 Nurse Practitioners Physician Services 00 1043867591 0 ANDREKUS JENNIFER 2022096 9999999 B 10 1043867591 0 4201 W 93RD ST OAK LAWN IL 604531998 20 1043867591 0 Speech Therapists Speech Therapy/Pathology Services 00 1043868136 0 NORWOOD SAGE M 2021019 9999999 B 10 1043868136 0 5875 E RIVERSIDE BLVD ROCKFORD IL 611144937 20 1043868136 0 Physician Assistant Only Fluoride varnish 20 1043868136 0 Physician Assistant Only Healthy Kids Services 20 1043868136 0 Physician Assistant Only Physician Services 00 1043868953 0 NEWMAN KRISTI 2019252 9999999 B 10 1043868953 0 6809 MCCULLOM LAKE RD WONDER LAKE IL 600979546 20 1043868953 0 Speech Therapists Medical Supplies 20 1043868953 0 Speech Therapists Medical 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0 Physicians Optical Supplies 20 1043870736 0 Physicians Physician Services 00 1043870868 0 VANBECKUM DANIELLE R 2022110 9999999 B 10 1043870868 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1043870868 0 Physicians Anesthesia Services 20 1043870868 0 Physicians Fluoride varnish 20 1043870868 0 Physicians Healthy Kids Services 20 1043870868 0 Physicians Optical Supplies 20 1043870868 0 Physicians Physician Services 00 1043871676 0 SALK ALLISON C 2019326 9999999 B 10 1043871676 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1043871676 0 Physicians Anesthesia Services 20 1043871676 0 Physicians Healthy Kids Services 20 1043871676 0 Physicians Optical Supplies 20 1043871676 0 Physicians Physician Services 00 1043871973 0 JONES INGRID 2022042 9999999 B 10 1043871973 0 6303 BLUE LAGOON DR STE 400 MIAMI FL 331266040 20 1043871973 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1043872112 0 BAITY CHENA 2023202 9999999 B 10 1043872112 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1043872112 0 Licensed Practical Nurses Nursing service 00 1043872708 0 AKRAM SABA 2020029 9999999 B 10 1043872708 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1043872708 0 Physicians Anesthesia Services 20 1043872708 0 Physicians Fluoride varnish 20 1043872708 0 Physicians Healthy Kids Services 20 1043872708 0 Physicians Optical Supplies 20 1043872708 0 Physicians Physician Services 00 1043874183 0 VRTIKAPA DEJAN 2023073 9999999 B 10 1043874183 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1043874183 0 Physicians Anesthesia Services 20 1043874183 0 Physicians Fluoride varnish 20 1043874183 0 Physicians Healthy Kids Services 20 1043874183 0 Physicians Optical Supplies 20 1043874183 0 Physicians Physician Services 00 1043874761 0 GAZDA ALEXIS C 2019211 9999999 B 10 1043874761 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1043874761 0 Physicians Anesthesia Services 20 1043874761 0 Physicians Healthy Kids Services 20 1043874761 0 Physicians Optical Supplies 20 1043874761 0 Physicians Physician Services 00 1043875396 0 AIRD ALLISON 2021226 9999999 B 10 1043875396 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1043875396 0 Nurse Practitioners Anesthesia Services 20 1043875396 0 Nurse Practitioners Nurse Practitioners Services 20 1043875396 0 Nurse Practitioners Physician Services 00 1043877301 0 JAIN SURBHI 2019254 9999999 B 10 1043877301 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1043877301 0 Physicians Anesthesia Services 20 1043877301 0 Physicians Healthy Kids Services 20 1043877301 0 Physicians Optical Supplies 20 1043877301 0 Physicians Physician Services 00 1043878945 0 MUENCH MAXWELL R 2019324 9999999 B 10 1043878945 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1043878945 0 Physicians Anesthesia Services 20 1043878945 0 Physicians Healthy Kids Services 20 1043878945 0 Physicians Optical Supplies 20 1043878945 0 Physicians Physician Services 00 1043880768 0 ASUNCION RIA MONICA DELOS SANT 2021293 9999999 B 10 1043880768 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1043880768 0 Physicians Anesthesia Services 20 1043880768 0 Physicians Healthy Kids Services 20 1043880768 0 Physicians Optical Supplies 20 1043880768 0 Physicians Physician Services 20 1043880768 0 Physicians Physicians Psychiatric Services 00 1043882590 0 HOEHN KELSEY 2021223 9999999 B 10 1043882590 0 607 S NEW BALLAS RD STE 2350 SAINT LOUIS MO 631410001 20 1043882590 0 Nurse Practitioners Family Planning Counseling 20 1043882590 0 Nurse Practitioners Healthy Kids Services 20 1043882590 0 Nurse Practitioners Nurse Practitioners Services 20 1043882590 0 Nurse Practitioners Physician Services 00 1043882855 0 HILLMAN ELISA 2024274 9999999 B 10 1043882855 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1043882855 0 Nurse Practitioners Anesthesia Services 20 1043882855 0 Nurse Practitioners Nurse Practitioners Services 20 1043882855 0 Nurse Practitioners Physician Services 00 1043883697 0 RASHID MOHAMMED Y 2023309 9999999 B 10 1043883697 0 PO BOX 3039 OAK BROOK IL 605223039 20 1043883697 0 Physicians Anesthesia Services 20 1043883697 0 Physicians Healthy Kids Services 20 1043883697 0 Physicians Optical Supplies 20 1043883697 0 Physicians Physician Services 00 1043886062 0 VINTONYAK HANNA 2021166 9999999 B 10 1043886062 0 8777 VELOCITY DR MACHESNEY PARK IL 611158002 20 1043886062 0 Nurse Practitioners Fluoride varnish 20 1043886062 0 Nurse Practitioners Healthy Kids Services 20 1043886062 0 Nurse Practitioners Nurse Practitioners Services 20 1043886062 0 Nurse Practitioners Physician Services 00 1043888076 0 WATKINS MIA 2021263 9999999 B 10 1043888076 0 29373 NETWORK PL CHICAGO IL 606733039 20 1043888076 0 Nurse Practitioners Healthy Kids Services 20 1043888076 0 Nurse Practitioners Nurse Practitioners Services 20 1043888076 0 Nurse Practitioners Physician Services 00 1043889397 0 KAYA GIZEM 2024206 9999999 B 10 1043889397 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1043889397 0 Physicians Anesthesia Services 20 1043889397 0 Physicians Fluoride varnish 20 1043889397 0 Physicians Healthy Kids Services 20 1043889397 0 Physicians Optical Supplies 20 1043889397 0 Physicians Physician Services 00 1043889454 0 HANEY LAUREN 2021201 9999999 B 10 1043889454 0 611 W PARK ST URBANA IL 618012529 20 1043889454 0 Physicians Anesthesia Services 20 1043889454 0 Physicians Healthy Kids Services 20 1043889454 0 Physicians Optical Supplies 20 1043889454 0 Physicians Physician Services 00 1043889553 0 BURTIS CAYLEY 2021181 9999999 B 10 1043889553 0 PO BOX 3988 CARBONDALE IL 629023988 20 1043889553 0 Physician Assistant Only Fluoride varnish 20 1043889553 0 Physician Assistant Only Healthy Kids Services 20 1043889553 0 Physician Assistant Only Physician Services 00 1043889637 0 HAN THAW T 2021179 9999999 B 10 1043889637 0 190 E DELAWARE PL CHICAGO IL 606111813 20 1043889637 0 Physicians Anesthesia Services 20 1043889637 0 Physicians Fluoride varnish 20 1043889637 0 Physicians Healthy Kids Services 20 1043889637 0 Physicians Optical Supplies 20 1043889637 0 Physicians Physician Services 00 1043890304 0 BOLTON MYCHAL 2025050 9999999 B 10 1043890304 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1043890304 0 Physicians Anesthesia Services 20 1043890304 0 Physicians Healthy Kids Services 20 1043890304 0 Physicians Optical Supplies 20 1043890304 0 Physicians Physician Services 20 1043890304 0 Physicians Physicians Psychiatric Services 00 1043890460 0 AHUJA NEHA 2022347 9999999 B 10 1043890460 0 29373 NETWORK PL CHICAGO IL 606733039 20 1043890460 0 Physical Therapists Medical Supplies 20 1043890460 0 Physical Therapists Medical equipment/prosthetic devices 20 1043890460 0 Physical Therapists Physical Therapy Services 00 1043890510 0 FOREMAN REBECCA 2021182 9999999 B 10 1043890510 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1043890510 0 Physicians Anesthesia Services 20 1043890510 0 Physicians Fluoride varnish 20 1043890510 0 Physicians Healthy Kids Services 20 1043890510 0 Physicians Optical Supplies 20 1043890510 0 Physicians Physician Services 00 1043891682 0 VOOGT BRITTANY 2021216 9999999 B 10 1043891682 0 PO BOX 775342 CHICAGO IL 606775342 20 1043891682 0 Nurse Practitioners Fluoride varnish 20 1043891682 0 Nurse Practitioners Healthy Kids Services 20 1043891682 0 Nurse Practitioners Nurse Practitioners Services 20 1043891682 0 Nurse Practitioners Physician Services 00 1043892524 0 MARTE JHONATAN 2022285 9999999 B 10 1043892524 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1043892524 0 Physicians Anesthesia Services 20 1043892524 0 Physicians Healthy Kids Services 20 1043892524 0 Physicians Optical Supplies 20 1043892524 0 Physicians Physician Services 20 1043892524 0 Physicians Physicians Psychiatric Services 00 1043894785 0 WIDMAN MEAGHAN L 2023234 9999999 B 10 1043894785 0 100 LINCOLN AVE JERSEYVILLE IL 620521473 20 1043894785 0 Speech Therapists Medical Supplies 20 1043894785 0 Speech Therapists Medical equipment/prosthetic devices 20 1043894785 0 Speech Therapists Speech Therapy/Pathology Services 00 1043896145 0 FLEMING JENNA 2021123 9999999 B 10 1043896145 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1043896145 0 Physicians Anesthesia Services 20 1043896145 0 Physicians Fluoride varnish 20 1043896145 0 Physicians Healthy Kids Services 20 1043896145 0 Physicians Optical Supplies 20 1043896145 0 Physicians Physician Services 00 1043896749 0 ZYLSTRA ZACHARY 2021221 9999999 B 10 1043896749 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1043896749 0 Physicians Anesthesia Services 20 1043896749 0 Physicians Healthy Kids Services 20 1043896749 0 Physicians Optical Supplies 20 1043896749 0 Physicians Physician Services 00 1043896772 0 HANNA REWAIS 2021174 9999999 B 10 1043896772 0 541 N FAIRBANKS CT PFS 25TH FLOOR CHICAGO IL 606113319 20 1043896772 0 Physicians Anesthesia Services 20 1043896772 0 Physicians Healthy Kids Services 20 1043896772 0 Physicians Optical Supplies 20 1043896772 0 Physicians Physician Services 00 1043896947 0 AHMED OMAR 2021316 9999999 B 10 1043896947 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1043896947 0 Physicians Anesthesia Services 20 1043896947 0 Physicians Healthy Kids Services 20 1043896947 0 Physicians Optical Supplies 20 1043896947 0 Physicians Physician Services 00 1043897267 0 SMITH BRITTANY A 2022176 9999999 B 10 1043897267 0 PO BOX 3039 OAK BROOK IL 605223039 20 1043897267 0 Physicians Anesthesia Services 20 1043897267 0 Physicians Healthy Kids Services 20 1043897267 0 Physicians Optical Supplies 20 1043897267 0 Physicians Physician Services 00 1043897713 0 CHOO JANICE 2021095 9999999 B 10 1043897713 0 PO BOX 3039 OAK BROOK IL 605223039 20 1043897713 0 Dentists Dental Services 20 1043897713 0 Dentists Physician Services 00 1043898182 0 ELGAMIL ALYELDIN 2021182 9999999 B 10 1043898182 0 PO BOX 3039 OAK BROOK IL 605223039 20 1043898182 0 Physicians Anesthesia Services 20 1043898182 0 Physicians Healthy Kids Services 20 1043898182 0 Physicians Optical Supplies 20 1043898182 0 Physicians Physician Services 00 1043898414 0 GARCIA PRISCILLA M 2021175 9999999 B 10 1043898414 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1043898414 0 Physicians Anesthesia Services 20 1043898414 0 Physicians Fluoride varnish 20 1043898414 0 Physicians Healthy Kids Services 20 1043898414 0 Physicians Optical Supplies 20 1043898414 0 Physicians Physician Services 00 1043898489 0 CUMMINS MATTHEW 2024156 9999999 B 10 1043898489 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1043898489 0 Physicians Anesthesia Services 20 1043898489 0 Physicians Fluoride varnish 20 1043898489 0 Physicians Healthy Kids Services 20 1043898489 0 Physicians Optical Supplies 20 1043898489 0 Physicians Physician Services 00 1043898588 0 VAN BUREN STEPHANIE J 2024274 9999999 B 10 1043898588 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1043898588 0 Physicians Anesthesia Services 20 1043898588 0 Physicians Fluoride varnish 20 1043898588 0 Physicians Healthy Kids Services 20 1043898588 0 Physicians Optical Supplies 20 1043898588 0 Physicians Physician Services 00 1043898844 0 BOSCH ELIZABETH A 2021209 9999999 B 10 1043898844 0 611 W PARK ST URBANA IL 618012529 20 1043898844 0 Nurse Practitioners Fluoride varnish 20 1043898844 0 Nurse Practitioners Healthy Kids Services 20 1043898844 0 Nurse Practitioners Nurse Practitioners Services 20 1043898844 0 Nurse Practitioners Physician Services 00 1043899180 0 HAYNES MONIQUE S 2021187 9999999 B 10 1043899180 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1043899180 0 Physicians Anesthesia Services 20 1043899180 0 Physicians Healthy Kids Services 20 1043899180 0 Physicians Optical Supplies 20 1043899180 0 Physicians Physician Services 00 1043899255 0 SCHUETTE ALLISON 2024282 9999999 B 10 1043899255 0 1010 S WASHINGTON ST MANITO IL 615469474 20 1043899255 0 Speech Therapists Medical Supplies 20 1043899255 0 Speech Therapists Medical equipment/prosthetic devices 20 1043899255 0 Speech Therapists Speech Therapy/Pathology Services 00 1043899412 0 BAUER JENNIFER 2024135 9999999 B 10 1043899412 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1043899412 0 Physicians Anesthesia Services 20 1043899412 0 Physicians Fluoride varnish 20 1043899412 0 Physicians Healthy Kids Services 20 1043899412 0 Physicians Optical Supplies 20 1043899412 0 Physicians Physician Services 00 1043899545 0 ABASOLO LOPEZ ESTEFANIA 2024188 9999999 B 10 1043899545 0 4698 DEPT CAROL STREAM IL 601220021 20 1043899545 0 Physicians Anesthesia Services 20 1043899545 0 Physicians Fluoride varnish 20 1043899545 0 Physicians Healthy Kids Services 20 1043899545 0 Physicians Optical Supplies 20 1043899545 0 Physicians Physician Services 00 1043899594 0 WHITMAN ABBIE 2024180 9999999 B 10 1043899594 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1043899594 0 Physicians Anesthesia Services 20 1043899594 0 Physicians Fluoride varnish 20 1043899594 0 Physicians Healthy Kids Services 20 1043899594 0 Physicians Optical Supplies 20 1043899594 0 Physicians Physician Services 00 1043899636 0 BLACKSHEAR STEVEN R 2022195 9999999 B 10 1043899636 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1043899636 0 Physicians Anesthesia Services 20 1043899636 0 Physicians Healthy Kids Services 20 1043899636 0 Physicians Optical Supplies 20 1043899636 0 Physicians Physician Services 00 1043899651 0 BAGHDADI SOROUSH 2023213 9999999 B 10 1043899651 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1043899651 0 Physicians Anesthesia Services 20 1043899651 0 Physicians Healthy Kids Services 20 1043899651 0 Physicians Optical Supplies 20 1043899651 0 Physicians Physician Services 00 1043900434 0 EL-KHOURY HABIB 2023176 9999999 B 10 1043900434 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1043900434 0 Physicians Anesthesia Services 20 1043900434 0 Physicians Fluoride varnish 20 1043900434 0 Physicians Healthy Kids Services 20 1043900434 0 Physicians Optical Supplies 20 1043900434 0 Physicians Physician Services 00 1043900608 0 ALTENBURG HAYLEE M 2024299 9999999 B 10 1043900608 0 370 SUMMIT ST # 1 ELGIN IL 601203843 20 1043900608 0 Physician Assistant Only Fluoride varnish 20 1043900608 0 Physician Assistant Only Healthy Kids Services 20 1043900608 0 Physician Assistant Only Physician Services 00 1043900814 0 HOYLE JOSEPH 2024194 9999999 B 10 1043900814 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1043900814 0 Physicians Anesthesia Services 20 1043900814 0 Physicians Healthy Kids Services 20 1043900814 0 Physicians Optical Supplies 20 1043900814 0 Physicians Physician Services 00 1043901531 0 ORAHA ATUR 2024207 9999999 B 10 1043901531 0 3320 LINCOLN ST FRANKLIN PARK IL 601311514 20 1043901531 0 Speech Therapists Medical Supplies 20 1043901531 0 Speech Therapists Medical equipment/prosthetic devices 20 1043901531 0 Speech Therapists Speech Therapy/Pathology Services 00 1043901622 0 HAWTHORNE DANIELLE R 2023195 9999999 B 10 1043901622 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1043901622 0 Physicians Anesthesia Services 20 1043901622 0 Physicians Healthy Kids Services 20 1043901622 0 Physicians Optical Supplies 20 1043901622 0 Physicians Physician Services 00 1043901697 0 KUHLMAN KALEIGH C 2023269 9999999 B 10 1043901697 0 1025 MAINE ST QUINCY IL 623014038 20 1043901697 0 Nurse Practitioners Anesthesia Services 20 1043901697 0 Nurse Practitioners Nurse Practitioners Services 20 1043901697 0 Nurse Practitioners Physician Services 00 1043902919 0 EBERLY SCOTT D 2023191 9999999 B 10 1043902919 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1043902919 0 Physicians Anesthesia Services 20 1043902919 0 Physicians Healthy Kids Services 20 1043902919 0 Physicians Optical Supplies 20 1043902919 0 Physicians Physician Services 00 1043903248 0 ASHIMI RASHIDAT 2023182 9999999 B 10 1043903248 0 1901 W HARRISON ST CHICAGO IL 60612 20 1043903248 0 Physicians Anesthesia Services 20 1043903248 0 Physicians Fluoride varnish 20 1043903248 0 Physicians Healthy Kids Services 20 1043903248 0 Physicians Optical Supplies 20 1043903248 0 Physicians Physician Services 00 1043903891 0 AHSAN OSAMA N 2023232 9999999 B 10 1043903891 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1043903891 0 Physicians Anesthesia Services 20 1043903891 0 Physicians Fluoride varnish 20 1043903891 0 Physicians Healthy Kids Services 20 1043903891 0 Physicians Optical Supplies 20 1043903891 0 Physicians Physician Services 00 1043905268 0 GRONSET DYLAN T 2023298 9999999 B 10 1043905268 0 124 SW ADAMS ST PEORIA IL 616021308 20 1043905268 0 Physicians Anesthesia Services 20 1043905268 0 Physicians Healthy Kids Services 20 1043905268 0 Physicians Optical Supplies 20 1043905268 0 Physicians Physician Services 00 1043905508 0 MORRIS KELLY R 2023123 9999999 B 10 1043905508 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1043905508 0 Nurse Practitioners Fluoride varnish 20 1043905508 0 Nurse Practitioners Healthy Kids Services 20 1043905508 0 Nurse Practitioners Nurse Practitioners Services 20 1043905508 0 Nurse Practitioners Physician Services 00 1043905706 0 GWIN CAROL C 2023145 9999999 B 10 1043905706 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1043905706 0 Nurse Practitioners Healthy Kids Services 20 1043905706 0 Nurse Practitioners Nurse Practitioners Services 20 1043905706 0 Nurse Practitioners Physician Services 00 1043906381 0 WILLIAMS SAVANNAH 2023338 9999999 B 10 1043906381 0 625 MASSACHUSETTS AVE FL 2 CAMBRIDGE MA 021393357 20 1043906381 0 Other behavior health professional LCPC/LMFT services 00 1043906894 0 KERANALLI PRAJWAL 2023193 9999999 B 10 1043906894 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1043906894 0 Physicians Anesthesia Services 20 1043906894 0 Physicians Healthy Kids Services 20 1043906894 0 Physicians Optical Supplies 20 1043906894 0 Physicians Physician Services 00 1043906969 0 GEEVARGHESE ELIZABETH 2023193 9999999 B 10 1043906969 0 PO BOX 775257 CHICAGO IL 606775257 20 1043906969 0 Physicians Anesthesia Services 20 1043906969 0 Physicians Fluoride varnish 20 1043906969 0 Physicians Healthy Kids Services 20 1043906969 0 Physicians Optical Supplies 20 1043906969 0 Physicians Physician Services 00 1043907116 0 ADERELE HANNAH A 2023121 9999999 B 10 1043907116 0 7101 N CICERO AVE STE 202 LINCOLNWOOD IL 607122143 20 1043907116 0 Nurse Practitioners Healthy Kids Services 20 1043907116 0 Nurse Practitioners Nurse Practitioners Services 20 1043907116 0 Nurse Practitioners Physician Services 00 1043907249 0 SIMPSON REBECCA M 2023110 9999999 B 10 1043907249 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1043907249 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1043907942 0 WINTERS GAGE 2023208 9999999 B 10 1043907942 0 PO BOX 855671 MINNEAPOLIS MN 554851153 20 1043907942 0 Podiatrists Podiatric Services 00 1043908551 0 KHAN AYESHA 2023201 9999999 B 10 1043908551 0 PO BOX 778791 CHICAGO IL 606776473 20 1043908551 0 Physicians Anesthesia Services 20 1043908551 0 Physicians Fluoride varnish 20 1043908551 0 Physicians Healthy Kids Services 20 1043908551 0 Physicians Optical Supplies 20 1043908551 0 Physicians Physician Services 00 1043909203 0 WENDT JOSEPH A 2024211 9999999 B 10 1043909203 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1043909203 0 Physicians Anesthesia Services 20 1043909203 0 Physicians Healthy Kids Services 20 1043909203 0 Physicians Optical Supplies 20 1043909203 0 Physicians Physician Services 00 1043909641 0 KRONE COURTNEY 2023269 9999999 B 10 1043909641 0 3015 N BALLAS RD SAINT LOUIS MO 631312329 20 1043909641 0 Nurse Practitioners Anesthesia Services 20 1043909641 0 Nurse Practitioners Nurse Practitioners Services 20 1043909641 0 Nurse Practitioners Physician Services 00 1043909757 0 INTERIAL MONICA L 2024095 9999999 B 10 1043909757 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1043909757 0 Nurse Practitioners Fluoride varnish 20 1043909757 0 Nurse Practitioners Healthy Kids Services 20 1043909757 0 Nurse Practitioners Nurse Practitioners Services 20 1043909757 0 Nurse Practitioners Physician Services 00 1043910698 0 CORBIER DE LARA DANIEL 2024179 9999999 B 10 1043910698 0 PO BOX 3039 OAK BROOK IL 605223039 20 1043910698 0 Physicians Anesthesia Services 20 1043910698 0 Physicians Fluoride varnish 20 1043910698 0 Physicians Healthy Kids Services 20 1043910698 0 Physicians Optical Supplies 20 1043910698 0 Physicians Physician Services 00 1043911043 0 EZEANA MICHEAL 2025035 9999999 B 10 1043911043 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1043911043 0 Physicians Anesthesia Services 20 1043911043 0 Physicians Healthy Kids Services 20 1043911043 0 Physicians Optical Supplies 20 1043911043 0 Physicians Physician Services 00 1043912058 0 LUAN JING 2023339 9999999 B 10 1043912058 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1043912058 0 Physicians Anesthesia Services 20 1043912058 0 Physicians Fluoride varnish 20 1043912058 0 Physicians Healthy Kids Services 20 1043912058 0 Physicians Optical Supplies 20 1043912058 0 Physicians Physician Services 00 1043912843 0 EKANEM UNYIME 2023209 9999999 B 10 1043912843 0 9718 S HALSTED ST CHICAGO IL 606281007 20 1043912843 0 Nurse Practitioners Fluoride varnish 20 1043912843 0 Nurse Practitioners Healthy Kids Services 20 1043912843 0 Nurse Practitioners Nurse Practitioners Services 20 1043912843 0 Nurse Practitioners Physician Services 00 1043913296 0 FURUKAWA SARA 2024180 9999999 B 10 1043913296 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1043913296 0 Physicians Anesthesia Services 20 1043913296 0 Physicians Fluoride varnish 20 1043913296 0 Physicians Healthy Kids Services 20 1043913296 0 Physicians Optical Supplies 20 1043913296 0 Physicians Physician Services 00 1043913304 0 WAGIEALLA RAWAN 2023213 9999999 B 10 1043913304 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1043913304 0 Physicians Anesthesia Services 20 1043913304 0 Physicians Fluoride varnish 20 1043913304 0 Physicians Healthy Kids Services 20 1043913304 0 Physicians Optical Supplies 20 1043913304 0 Physicians Physician Services 00 1043913783 0 GAJUREL PARAG 2023159 9999999 B 10 1043913783 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1043913783 0 Physicians Anesthesia Services 20 1043913783 0 Physicians Fluoride varnish 20 1043913783 0 Physicians Healthy Kids Services 20 1043913783 0 Physicians Optical Supplies 20 1043913783 0 Physicians Physician Services 00 1043915416 0 HUICOCHEA JENNIFER JOSEFINA 2023096 9999999 B 10 1043915416 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1043915416 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1043915515 0 GARY ALEXANDRA 2023172 9999999 B 10 1043915515 0 PO BOX 3039 OAK BROOK IL 605223039 20 1043915515 0 Physicians Anesthesia Services 20 1043915515 0 Physicians Fluoride varnish 20 1043915515 0 Physicians Healthy Kids Services 20 1043915515 0 Physicians Optical Supplies 20 1043915515 0 Physicians Physician Services 00 1043916232 0 NAJERA ALMA 2023065 9999999 B 10 1043916232 0 42 W MADISON ST FL 2 CHICAGO IL 606024309 20 1043916232 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1043916257 0 MCGINN ERIN L 2023033 9999999 B 10 1043916257 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1043916257 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1043919673 0 HANNIKAINEN PAAVALI A 2024175 9999999 B 10 1043919673 0 4698 DEPT CAROL STREAM IL 601220021 20 1043919673 0 Physicians Anesthesia Services 20 1043919673 0 Physicians Healthy Kids Services 20 1043919673 0 Physicians Optical Supplies 20 1043919673 0 Physicians Physician Services 00 1043920036 0 BRANCH NATHANIEL 2022334 9999999 B 10 1043920036 0 PO BOX 1109 DEKALB IL 601157109 20 1043920036 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1043920929 0 CARTER KEITH 2024304 9999999 B 10 1043920929 0 30 N MICHIGAN AVE STE 424 CHICAGO IL 606023844 20 1043920929 0 Nurse Practitioners Healthy Kids Services 20 1043920929 0 Nurse Practitioners Nurse Practitioners Services 20 1043920929 0 Nurse Practitioners Physician Services 00 1043924285 0 HAMDAN MALAK 2024036 9999999 B 10 1043924285 0 3020 WOODCREEK DR STE A2 DOWNERS GROVE IL 605155416 20 1043924285 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1043924590 0 HAWKINS JASMINE C 2023024 9999999 B 10 1043924590 0 18350 CROSSING DR TINLEY PARK IL 604876294 20 1043924590 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1043924814 0 BOUIE ARIEL L 2023018 9999999 B 10 1043924814 0 10001 GRAND AVE ATTN: BILLING DEPARTMENT FRANKLIN PARK IL 601312563 20 1043924814 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1043926405 0 HANEWALL MEGHAN 2023066 9999999 B 10 1043926405 0 62647 COLLECTION CENTER DR CHICAGO IL 606930626 20 1043926405 0 Physician Assistant Only Fluoride varnish 20 1043926405 0 Physician Assistant Only Healthy Kids Services 20 1043926405 0 Physician Assistant Only Physician Services 00 1043927023 0 KILIMAN DAVID B 2023059 9999999 B 10 1043927023 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1043927023 0 Nurse Practitioners Healthy Kids Services 20 1043927023 0 Nurse Practitioners Nurse Practitioners Services 20 1043927023 0 Nurse Practitioners Physician Services 00 1043927080 0 OWENS BRIDGET 2024285 9999999 B 10 1043927080 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1043927080 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1043927098 0 HUYNH KIMBERLY N 2022353 9999999 B 10 1043927098 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1043927098 0 Physician Assistant Only Fluoride varnish 20 1043927098 0 Physician Assistant Only Healthy Kids Services 20 1043927098 0 Physician Assistant Only Physician Services 00 1043927163 0 HA AMANDA M 2022305 9999999 B 10 1043927163 0 3350 W SALT CREEK LN STE 115 ARLINGTON HEIGH IL 600051089 20 1043927163 0 Speech Therapists Medical Supplies 20 1043927163 0 Speech Therapists Medical equipment/prosthetic devices 20 1043927163 0 Speech Therapists Speech Therapy/Pathology Services 00 1043927734 0 TRANCHITA ALYSSA 2023152 9999999 B 10 1043927734 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1043927734 0 Nurse Practitioners Fluoride varnish 20 1043927734 0 Nurse Practitioners Healthy Kids Services 20 1043927734 0 Nurse Practitioners Nurse Practitioners Services 20 1043927734 0 Nurse Practitioners Physician Services 00 1043927874 0 OKOLIE ADANNA 2023277 9999999 B 10 1043927874 0 475 DOXBURY LN NEW LENOX IL 604513454 20 1043927874 0 Nurse Practitioners Fluoride varnish 20 1043927874 0 Nurse Practitioners Healthy Kids Services 20 1043927874 0 Nurse Practitioners Nurse Practitioners Services 20 1043927874 0 Nurse Practitioners Physician Services 00 1043927957 0 BOWEN KAYLEE A 2022321 9999999 B 10 1043927957 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1043927957 0 Nurse Practitioners Fluoride varnish 20 1043927957 0 Nurse Practitioners Healthy Kids Services 20 1043927957 0 Nurse Practitioners Nurse Practitioners Services 20 1043927957 0 Nurse Practitioners Physician Services 00 1043928328 0 VIOLA KAREN M 2022348 9999999 B 10 1043928328 0 355 E ERIE ST CHICAGO IL 606113167 20 1043928328 0 Nurse Practitioners Fluoride varnish 20 1043928328 0 Nurse Practitioners Healthy Kids Services 20 1043928328 0 Nurse Practitioners Nurse Practitioners Services 20 1043928328 0 Nurse Practitioners Physician Services 00 1043929292 0 BOSAK DIANNA L 2023307 9999999 B 10 1043929292 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1043929292 0 Occupational Therapists Medical Supplies 20 1043929292 0 Occupational Therapists Medical equipment/prosthetic devices 20 1043929292 0 Occupational Therapists Occupational Therapy Services 00 1043929680 0 WROBLEWSKI KATHRYN 2023039 9999999 B 10 1043929680 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1043929680 0 Nurse Practitioners Healthy Kids Services 20 1043929680 0 Nurse Practitioners Nurse Practitioners Services 20 1043929680 0 Nurse Practitioners Physician Services 00 1043929847 0 JERZAK LAUREN D 2023009 9999999 B 10 1043929847 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1043929847 0 Nurse Practitioners Healthy Kids Services 20 1043929847 0 Nurse Practitioners Nurse Practitioners Services 20 1043929847 0 Nurse Practitioners Physician Services 00 1043930795 0 SIEGER LORNA 2022250 9999999 B 10 1043930795 0 PO BOX 775253 CHICAGO IL 606775253 20 1043930795 0 Nurse Practitioners Fluoride varnish 20 1043930795 0 Nurse Practitioners Healthy Kids Services 20 1043930795 0 Nurse Practitioners Nurse Practitioners Services 20 1043930795 0 Nurse Practitioners Physician Services 00 1043931231 0 PALMER PAGEL E 2022266 9999999 B 10 1043931231 0 1325 SYCAMORE RD DEKALB IL 601152483 20 1043931231 0 Other behavior health professional LCPC/LMFT services 20 1043931231 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1043931488 0 DIEC BRITTANY 2024096 9999999 B 10 1043931488 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1043931488 0 Physician Assistant Only Fluoride varnish 20 1043931488 0 Physician Assistant Only Healthy Kids Services 20 1043931488 0 Physician Assistant Only Physician Services 00 1043932403 0 KEENAN KYRIAKI M 2024184 9999999 B 10 1043932403 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1043932403 0 Physician Assistant Only Fluoride varnish 20 1043932403 0 Physician Assistant Only Healthy Kids Services 20 1043932403 0 Physician Assistant Only Physician Services 00 1043932452 0 TERRAZAS NOE 2022256 9999999 H 10 1043932452 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1043932452 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1043933559 0 DANIELS MARQUESA 2022255 9999999 B 10 1043933559 0 3010 GRAND AVE WAUKEGAN IL 600852321 20 1043933559 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1043933864 0 HAUGER LEAH G 2023006 9999999 B 10 1043933864 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1043933864 0 Nurse Practitioners Fluoride varnish 20 1043933864 0 Nurse Practitioners Healthy Kids Services 20 1043933864 0 Nurse Practitioners Nurse Practitioners Services 20 1043933864 0 Nurse Practitioners Physician Services 00 1043937931 0 GOODE MAGGIE 2024228 9999999 B 10 1043937931 0 2605 KENTUCKY AVE STE 306 PADUCAH KY 420033802 20 1043937931 0 Nurse Practitioners Fluoride varnish 20 1043937931 0 Nurse Practitioners Healthy Kids Services 20 1043937931 0 Nurse Practitioners Nurse Practitioners Services 20 1043937931 0 Nurse Practitioners Physician Services 00 1043938814 0 HINDERS ELIZABETH 2024196 9999999 B 10 1043938814 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1043938814 0 Nurse Practitioners Healthy Kids Services 20 1043938814 0 Nurse Practitioners Nurse Practitioners Services 20 1043938814 0 Nurse Practitioners Physician Services 00 1043939747 0 BASIC KATRINA L 2023214 9999999 B 10 1043939747 0 PO BOX 83287 CHICAGO IL 606910287 20 1043939747 0 Nurse Practitioners Fluoride varnish 20 1043939747 0 Nurse Practitioners Healthy Kids Services 20 1043939747 0 Nurse Practitioners Nurse Practitioners Services 20 1043939747 0 Nurse Practitioners Physician Services 00 1043940620 0 LISKE KACIE 2023066 9999999 B 10 1043940620 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1043940620 0 Physician Assistant Only Fluoride varnish 20 1043940620 0 Physician Assistant Only Healthy Kids Services 20 1043940620 0 Physician Assistant Only Physician Services 00 1043940646 0 HAZEL BRADLEY S 2022236 9999999 B 10 1043940646 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1043940646 0 Nurse Practitioners Fluoride varnish 20 1043940646 0 Nurse Practitioners Healthy Kids Services 20 1043940646 0 Nurse Practitioners Nurse Practitioners Services 20 1043940646 0 Nurse Practitioners Physician Services 00 1043940984 0 STANFORD BETH E 2022165 9999999 H 10 1043940984 0 PO BOX 146 WATERLOO IL 622980146 20 1043940984 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1043941123 0 WEIBLEY CHRISTINA 2023221 9999999 B 10 1043941123 0 3230 VETERANS MEMORIAL DR MOUNT VERNON IL 628645950 20 1043941123 0 Nurse Practitioners Healthy Kids Services 20 1043941123 0 Nurse Practitioners Nurse Practitioners Services 20 1043941123 0 Nurse Practitioners Physician Services 00 1043943830 0 RAMIREZ MELISSA E 2023172 9999999 B 10 1043943830 0 124 SW ADAMS ST PEORIA IL 616021320 20 1043943830 0 Nurse Practitioners Fluoride varnish 20 1043943830 0 Nurse Practitioners Healthy Kids Services 20 1043943830 0 Nurse Practitioners Nurse Practitioners Services 20 1043943830 0 Nurse Practitioners Physician Services 00 1043943939 0 JACKSON TAYLOR N 2022223 9999999 B 10 1043943939 0 7732 SOLUTION CENTER CHICAGO IL 606777007 20 1043943939 0 Dentists Dental Services 20 1043943939 0 Dentists Physician Services 00 1043944796 0 ELBOGHDADY YARA M 2024116 9999999 B 10 1043944796 0 5777 DEPT CAROL STREAM IL 601228942 20 1043944796 0 Physician Assistant Only Fluoride varnish 20 1043944796 0 Physician Assistant Only Healthy Kids Services 20 1043944796 0 Physician Assistant Only Physician Services 00 1043948243 0 MAYS ERIN J 2022231 9999999 B 10 1043948243 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1043948243 0 Nurse Practitioners Healthy Kids Services 20 1043948243 0 Nurse Practitioners Nurse Practitioners Services 20 1043948243 0 Nurse Practitioners Physician Services 00 1043949258 0 GOODLIN EMILY 2022182 9999999 B 10 1043949258 0 PO BOX 855795 MINNEAPOLIS MN 554851296 20 1043949258 0 Physicians Anesthesia Services 20 1043949258 0 Physicians Fluoride varnish 20 1043949258 0 Physicians Healthy Kids Services 20 1043949258 0 Physicians Optical Supplies 20 1043949258 0 Physicians Physician Services 00 1043949951 0 PEARSON STEPHANIE D 2022206 9999999 B 10 1043949951 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1043949951 0 Physicians Anesthesia Services 20 1043949951 0 Physicians Healthy Kids Services 20 1043949951 0 Physicians Optical Supplies 20 1043949951 0 Physicians Physician Services 00 1043950025 0 BODEPUDI ALAYA 2022171 9999999 B 10 1043950025 0 PO BOX 3039 OAK BROOK IL 605223039 20 1043950025 0 Physicians Anesthesia Services 20 1043950025 0 Physicians Fluoride varnish 20 1043950025 0 Physicians Healthy Kids Services 20 1043950025 0 Physicians Optical Supplies 20 1043950025 0 Physicians Physician Services 00 1043950066 0 TRAPPS ANTOINE 2022088 9999999 H 10 1043950066 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1043950066 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1043950488 0 MANOJ MRIDULA 2022178 9999999 B 10 1043950488 0 22393 NETWORK PL CHICAGO IL 606735147 20 1043950488 0 Dentists Dental Services 20 1043950488 0 Dentists Physician Services 00 1043950900 0 DUNCAN JESSIE 2024127 9999999 B 10 1043950900 0 1945 W WILSON AVE STE 6114 CHICAGO IL 606405259 20 1043950900 0 Other behavior health professional LCPC/LMFT services 00 1043951908 0 WILLIAMS JESSICA 2022096 9999999 B 10 1043951908 0 PO BOX 1109 DEKALB IL 601157109 20 1043951908 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1043953193 0 SAMARDZIJA TANJA 2022217 9999999 B 10 1043953193 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1043953193 0 Physician Assistant Only Fluoride varnish 20 1043953193 0 Physician Assistant Only Healthy Kids Services 20 1043953193 0 Physician Assistant Only Physician Services 00 1043953292 0 YANK MEGAN 2024291 9999999 B 10 1043953292 0 PO BOX 431 JANESVILLE WI 535470431 20 1043953292 0 Physicians Anesthesia Services 20 1043953292 0 Physicians Healthy Kids Services 20 1043953292 0 Physicians Optical Supplies 20 1043953292 0 Physicians Physician Services 00 1043954407 0 OSMANI KASHIF R 2022187 9999999 B 10 1043954407 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1043954407 0 Physicians Anesthesia Services 20 1043954407 0 Physicians Fluoride varnish 20 1043954407 0 Physicians Healthy Kids Services 20 1043954407 0 Physicians Optical Supplies 20 1043954407 0 Physicians Physician Services 00 1043954779 0 ALSADAH SARAH 2022250 9999999 B 10 1043954779 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1043954779 0 Physicians Anesthesia Services 20 1043954779 0 Physicians Fluoride varnish 20 1043954779 0 Physicians Healthy Kids Services 20 1043954779 0 Physicians Optical Supplies 20 1043954779 0 Physicians Physician Services 00 1043954985 0 MEIER OLIVIA R 2024284 9999999 B 10 1043954985 0 3200 E CAMELBACK RD STE 250 PHOENIX AZ 850182327 20 1043954985 0 Nurse Practitioners Fluoride varnish 20 1043954985 0 Nurse Practitioners Healthy Kids Services 20 1043954985 0 Nurse Practitioners Nurse Practitioners Services 20 1043954985 0 Nurse Practitioners Physician Services 00 1043955107 0 SMITH BROOKE 2022215 9999999 B 10 1043955107 0 PO BOX 1230 EVANSVILLE IN 477061230 20 1043955107 0 Physician Assistant Only Fluoride varnish 20 1043955107 0 Physician Assistant Only Healthy Kids Services 20 1043955107 0 Physician Assistant Only Physician Services 00 1043955214 0 MANGANARO ANNE 2024232 9999999 B 10 1043955214 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1043955214 0 Nurse Practitioners Anesthesia Services 20 1043955214 0 Nurse Practitioners Nurse Practitioners Services 20 1043955214 0 Nurse Practitioners Physician Services 00 1043955768 0 COOK DAVID A 2022200 9999999 B 10 1043955768 0 PO BOX 737 DIXON IL 610210737 20 1043955768 0 Physicians Anesthesia Services 20 1043955768 0 Physicians Fluoride varnish 20 1043955768 0 Physicians Healthy Kids Services 20 1043955768 0 Physicians Optical Supplies 20 1043955768 0 Physicians Physician Services 00 1043955818 0 GUZMAN YESENIA 2022278 9999999 B 10 1043955818 0 370 SUMMIT ST # 1 ELGIN IL 601203843 20 1043955818 0 Physician Assistant Only Fluoride varnish 20 1043955818 0 Physician Assistant Only Healthy Kids Services 20 1043955818 0 Physician Assistant Only Physician Services 00 1043956402 0 STAUNTON BRIEDA 2024278 9999999 B 10 1043956402 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1043956402 0 Nurse Practitioners Healthy Kids Services 20 1043956402 0 Nurse Practitioners Nurse Practitioners Services 20 1043956402 0 Nurse Practitioners Physician Services 00 1043956600 0 NEGRIS OLIVIA R 2024242 9999999 B 10 1043956600 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1043956600 0 Physicians Anesthesia Services 20 1043956600 0 Physicians Fluoride varnish 20 1043956600 0 Physicians Healthy Kids Services 20 1043956600 0 Physicians Optical Supplies 20 1043956600 0 Physicians Physician Services 00 1043956808 0 WHITTAKER RACHEL M 2022179 9999999 B 10 1043956808 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1043956808 0 Physicians Anesthesia Services 20 1043956808 0 Physicians Healthy Kids Services 20 1043956808 0 Physicians Optical Supplies 20 1043956808 0 Physicians Physician Services 00 1043957194 0 KANNENWISCHER DOMINIK S 2022165 9999999 B 10 1043957194 0 70 S RIVER ST AURORA IL 605065185 20 1043957194 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1043957517 0 CHAN ISRAELLA 2022188 9999999 B 10 1043957517 0 2211 N ELSTON AVE STE 301 CHICAGO IL 606149278 20 1043957517 0 Physicians Anesthesia Services 20 1043957517 0 Physicians Fluoride varnish 20 1043957517 0 Physicians Healthy Kids Services 20 1043957517 0 Physicians Optical Supplies 20 1043957517 0 Physicians Physician Services 00 1043957913 0 IZHAKOFF NICOLE 2022195 9999999 B 10 1043957913 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1043957913 0 Physicians Anesthesia Services 20 1043957913 0 Physicians Healthy Kids Services 20 1043957913 0 Physicians Optical Supplies 20 1043957913 0 Physicians Physician Services 00 1043960040 0 ALLAM MOUNIKA LAKSMI 2022173 9999999 B 10 1043960040 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1043960040 0 Physicians Anesthesia Services 20 1043960040 0 Physicians Fluoride varnish 20 1043960040 0 Physicians Healthy Kids Services 20 1043960040 0 Physicians Optical Supplies 20 1043960040 0 Physicians Physician Services 00 1043960156 0 BLACKBOURN LISLE 2022246 9999999 B 10 1043960156 0 124 SW ADAMS ST PEORIA IL 616021308 20 1043960156 0 Physicians Anesthesia Services 20 1043960156 0 Physicians Healthy Kids Services 20 1043960156 0 Physicians Optical Supplies 20 1043960156 0 Physicians Physician Services 20 1043960156 0 Physicians Physicians Psychiatric Services 00 1043960362 0 BARI RUHI 2022278 9999999 B 10 1043960362 0 4701 DEPT CAROL STREAM IL 601220021 20 1043960362 0 Physicians Anesthesia Services 20 1043960362 0 Physicians Fluoride varnish 20 1043960362 0 Physicians Healthy Kids Services 20 1043960362 0 Physicians Optical Supplies 20 1043960362 0 Physicians Physician Services 00 1043960412 0 SIROTZKI AMANDA 2022168 9999999 B 10 1043960412 0 PO BOX 3039 OAK BROOK IL 605223039 20 1043960412 0 Physicians Anesthesia Services 20 1043960412 0 Physicians Fluoride varnish 20 1043960412 0 Physicians Healthy Kids Services 20 1043960412 0 Physicians Optical Supplies 20 1043960412 0 Physicians Physician Services 00 1043960594 0 NALLANI ANKITA 2022181 9999999 B 10 1043960594 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1043960594 0 Physicians Anesthesia Services 20 1043960594 0 Physicians Fluoride varnish 20 1043960594 0 Physicians Healthy Kids Services 20 1043960594 0 Physicians Optical Supplies 20 1043960594 0 Physicians Physician Services 00 1043961006 0 BRIDGEMAN MADELINE 2022080 9999999 B 10 1043961006 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1043961006 0 Physical Therapists Medical Supplies 20 1043961006 0 Physical Therapists Medical equipment/prosthetic devices 20 1043961006 0 Physical Therapists Physical Therapy Services 00 1043962046 0 HAYWOOD VALDA 2022147 9999999 B 10 1043962046 0 4020 GREEN MOUNT CROSSING DR S SHILOH IL 622697287 20 1043962046 0 Clinical Social Worker Social work service 00 1043962103 0 ROWEN SIMONE 2024206 9999999 B 10 1043962103 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1043962103 0 Nurse Practitioners Healthy Kids Services 20 1043962103 0 Nurse Practitioners Midwife Services 20 1043962103 0 Nurse Practitioners Nurse Practitioners Services 20 1043962103 0 Nurse Practitioners Physician Services 00 1043962194 0 KEMPFER MATTHEW J 2022060 9999999 B 10 1043962194 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1043962194 0 Nurse Practitioners Healthy Kids Services 20 1043962194 0 Nurse Practitioners Nurse Practitioners Services 20 1043962194 0 Nurse Practitioners Physician Services 00 1043962582 0 CHRISTIAN LLOBRERA 2022031 9999999 B 10 1043962582 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1043962582 0 Physical Therapists Medical Supplies 20 1043962582 0 Physical Therapists Medical equipment/prosthetic devices 20 1043962582 0 Physical Therapists Physical Therapy Services 00 1043963952 0 ETRENNE REBECCA 2022042 9999999 B 10 1043963952 0 3 PEMBROKE LN OAK BROOK IL 605231726 20 1043963952 0 Nurse Practitioners Fluoride varnish 20 1043963952 0 Nurse Practitioners Healthy Kids Services 20 1043963952 0 Nurse Practitioners Nurse Practitioners Services 20 1043963952 0 Nurse Practitioners Physician Services 00 1043964851 0 CROTINGER ABIGAIL G 2023339 9999999 B 10 1043964851 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 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Physicians Optical Supplies 20 1043967201 0 Physicians Physician Services 00 1043967763 0 JAHAN SAMIA 2024234 9999999 B 10 1043967763 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1043967763 0 Physicians Anesthesia Services 20 1043967763 0 Physicians Fluoride varnish 20 1043967763 0 Physicians Healthy Kids Services 20 1043967763 0 Physicians Optical Supplies 20 1043967763 0 Physicians Physician Services 00 1043968001 0 AHRENHOLZ WILLIAM CHRISSTIAN 2022257 9999999 B 10 1043968001 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1043968001 0 Physician Assistant Only Fluoride varnish 20 1043968001 0 Physician Assistant Only Healthy Kids Services 20 1043968001 0 Physician Assistant Only Physician Services 00 1043968670 0 ABOTALEB SOHA O 2023194 9999999 B 10 1043968670 0 PO BOX 775248 CHICAGO IL 606775248 20 1043968670 0 Physicians Anesthesia Services 20 1043968670 0 Physicians Fluoride varnish 20 1043968670 0 Physicians Healthy Kids Services 20 1043968670 0 Physicians Optical Supplies 20 1043968670 0 Physicians Physician Services 00 1043968761 0 DEBETTENCOURT MARK FRANCIS 2023174 9999999 B 10 1043968761 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1043968761 0 Physicians Anesthesia Services 20 1043968761 0 Physicians Fluoride varnish 20 1043968761 0 Physicians Healthy Kids Services 20 1043968761 0 Physicians Optical Supplies 20 1043968761 0 Physicians Physician Services 00 1043969272 0 RUBIN YAIR 2022124 9999999 B 10 1043969272 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1043969272 0 Physicians Anesthesia Services 20 1043969272 0 Physicians Healthy Kids Services 20 1043969272 0 Physicians Optical Supplies 20 1043969272 0 Physicians Physician Services 00 1043969355 0 TONG WENDY 2022145 9999999 B 10 1043969355 0 4698 DEPT CAROL STREAM IL 601220021 20 1043969355 0 Physicians Anesthesia Services 20 1043969355 0 Physicians Fluoride varnish 20 1043969355 0 Physicians Healthy Kids Services 20 1043969355 0 Physicians Optical Supplies 20 1043969355 0 Physicians Physician Services 00 1043969454 0 ELIOPOULOS ELIZABETH S 2022157 9999999 B 10 1043969454 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1043969454 0 Nurse Practitioners Healthy Kids Services 20 1043969454 0 Nurse Practitioners Nurse Practitioners Services 20 1043969454 0 Nurse Practitioners Physician Services 00 1043969710 0 MICHAEL JAMIE 2022178 9999999 B 10 1043969710 0 4698 DEPT CAROL STREAM IL 601220021 20 1043969710 0 Physicians Anesthesia Services 20 1043969710 0 Physicians Healthy Kids Services 20 1043969710 0 Physicians Optical Supplies 20 1043969710 0 Physicians Physician Services 00 1043971435 0 GILFILLAN SARAH A 2023137 9999999 B 10 1043971435 0 1400 S MICHIGAN AVE APT 1203 CHICAGO IL 606053720 20 1043971435 0 Physician Assistant Only Fluoride varnish 20 1043971435 0 Physician Assistant Only Healthy Kids Services 20 1043971435 0 Physician Assistant Only Physician Services 00 1043971815 0 WELLS JORDAN 2023100 9999999 B 10 1043971815 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 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CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1053051896 0 Physicians Anesthesia Services 20 1053051896 0 Physicians Healthy Kids Services 20 1053051896 0 Physicians Optical Supplies 20 1053051896 0 Physicians Physician Services 00 1053051938 0 INCANDELA ANDREW 2022199 9999999 B 10 1053051938 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1053051938 0 Physicians Anesthesia Services 20 1053051938 0 Physicians Fluoride varnish 20 1053051938 0 Physicians Healthy Kids Services 20 1053051938 0 Physicians Optical Supplies 20 1053051938 0 Physicians Physician Services 00 1053051946 0 FIORINO MICHAEL A 2022174 9999999 B 10 1053051946 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1053051946 0 Physicians Anesthesia Services 20 1053051946 0 Physicians Healthy Kids Services 20 1053051946 0 Physicians Optical Supplies 20 1053051946 0 Physicians Physician Services 00 1053052027 0 SOBOTA ROSEMARY J 2022132 9999999 B 10 1053052027 0 5777 DEPT CAROL STREAM IL 601228942 20 1053052027 0 Nurse Practitioners Healthy Kids Services 20 1053052027 0 Nurse Practitioners Nurse Practitioners Services 20 1053052027 0 Nurse Practitioners Physician Services 00 1053052092 0 HART JAKAYLA 2024192 9999999 B 10 1053052092 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1053052092 0 Physicians Anesthesia Services 20 1053052092 0 Physicians Healthy Kids Services 20 1053052092 0 Physicians Optical Supplies 20 1053052092 0 Physicians Physician Services 20 1053052092 0 Physicians Physicians Psychiatric Services 00 1053052977 0 LUCAS ALEX D 2022180 9999999 B 10 1053052977 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1053052977 0 Physicians Anesthesia Services 20 1053052977 0 Physicians Healthy Kids Services 20 1053052977 0 Physicians Optical Supplies 20 1053052977 0 Physicians Physician Services 00 1053052993 0 ALSAQRI ALQASEM 2022182 9999999 B 10 1053052993 0 PO BOX 3039 OAK BROOK IL 605223039 20 1053052993 0 Physicians Anesthesia Services 20 1053052993 0 Physicians Fluoride varnish 20 1053052993 0 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PL CHICAGO IL 606733039 20 1053063529 0 Nurse Practitioners Fluoride varnish 20 1053063529 0 Nurse Practitioners Healthy Kids Services 20 1053063529 0 Nurse Practitioners Nurse Practitioners Services 20 1053063529 0 Nurse Practitioners Physician Services 00 1053063933 0 WELLEHAN LYNN 2023082 9999999 B 10 1053063933 0 PO BOX 500 ELLICOTTVILLE NY 147310500 20 1053063933 0 Physician Assistant Only Fluoride varnish 20 1053063933 0 Physician Assistant Only Healthy Kids Services 20 1053063933 0 Physician Assistant Only Physician Services 00 1053064113 0 BURNHAM ANDRE 2024180 9999999 B 10 1053064113 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1053064113 0 Physicians Anesthesia Services 20 1053064113 0 Physicians Healthy Kids Services 20 1053064113 0 Physicians Optical Supplies 20 1053064113 0 Physicians Physician Services 00 1053065623 0 GHIGLIERI STACY 2022181 9999999 B 10 1053065623 0 1S450 SUMMIT AVE STE 270 OAKBROOK TERRAC IL 601813959 20 1053065623 0 Nurse Practitioners Fluoride varnish 20 1053065623 0 Nurse Practitioners Healthy Kids Services 20 1053065623 0 Nurse Practitioners Nurse Practitioners Services 20 1053065623 0 Nurse Practitioners Physician Services 00 1053069013 0 ANDERSON ISABELLE R 2022081 9999999 B 10 1053069013 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1053069013 0 Physician Assistant Only Fluoride varnish 20 1053069013 0 Physician Assistant Only Healthy Kids Services 20 1053069013 0 Physician Assistant Only Physician Services 00 1053070110 0 JACKSON KELLY A 2023320 9999999 B 10 1053070110 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1053070110 0 Nurse Practitioners Fluoride varnish 20 1053070110 0 Nurse Practitioners Healthy Kids Services 20 1053070110 0 Nurse Practitioners Nurse Practitioners Services 20 1053070110 0 Nurse Practitioners Physician Services 00 1053070912 0 BLASKE HANNAH 2022038 9999999 B 10 1053070912 0 850 43RD AVE STE 100 MOLINE IL 612658401 20 1053070912 0 Physical Therapists Medical Supplies 20 1053070912 0 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BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1053349159 0 Physicians Anesthesia Services 20 1053349159 0 Physicians Fluoride varnish 20 1053349159 0 Physicians Healthy Kids Services 20 1053349159 0 Physicians Optical Supplies 20 1053349159 0 Physicians Physician Services 00 1053349167 0 RAMESH PRADEEP M 2021163 9999999 B 10 1053349167 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1053349167 0 Physicians Anesthesia Services 20 1053349167 0 Physicians Fluoride varnish 20 1053349167 0 Physicians Healthy Kids Services 20 1053349167 0 Physicians Optical Supplies 20 1053349167 0 Physicians Physician Services 00 1053349639 0 TOIA JACQUIE 2007182 9999999 B 10 1053349639 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1053349639 0 Nurse Practitioners Healthy Kids Services 20 1053349639 0 Nurse Practitioners Nurse Practitioners Services 20 1053349639 0 Nurse Practitioners Physician Services 00 1053349720 0 LLERENA REINHOLD 1998104 9999999 B 10 1053349720 0 PO BOX 5588 BELFAST ME 049155500 20 1053349720 0 Physicians Anesthesia Services 20 1053349720 0 Physicians Fluoride varnish 20 1053349720 0 Physicians Healthy Kids Services 20 1053349720 0 Physicians Optical Supplies 20 1053349720 0 Physicians Physician Services 00 1053349886 0 HARRIS MAX 1983004 9999999 B 10 1053349886 0 4646 N MARINE DR CHICAGO IL 606405759 20 1053349886 0 Physicians Anesthesia Services 20 1053349886 0 Physicians Fluoride varnish 20 1053349886 0 Physicians Healthy Kids Services 20 1053349886 0 Physicians Optical Supplies 20 1053349886 0 Physicians Physician Services 00 1053349969 0 LEMBKE CHRISTEL E 1981227 9999999 B 10 1053349969 0 1000 REMINGTON BLVD STE 110 BOLINGBROOK IL 604404708 20 1053349969 0 Physicians Anesthesia Services 20 1053349969 0 Physicians Healthy Kids Services 20 1053349969 0 Physicians Optical Supplies 20 1053349969 0 Physicians Physician Services 20 1053349969 0 Physicians Physicians Psychiatric Services 00 1053350140 0 ANWAR KARIM 2022342 9999999 B 10 1053350140 0 1160 E SAINT CLAIR ST VINCENNES IN 475914853 20 1053350140 0 Physicians Anesthesia Services 20 1053350140 0 Physicians Fluoride varnish 20 1053350140 0 Physicians Healthy Kids Services 20 1053350140 0 Physicians Optical Supplies 20 1053350140 0 Physicians Physician Services 00 1053350983 0 KOTAGAL PRAKASH 2019109 9999999 B 10 1053350983 0 6801 BRECKSVILLE RD INDEPENDENCE OH 441315032 20 1053350983 0 Physicians Anesthesia Services 20 1053350983 0 Physicians Healthy Kids Services 20 1053350983 0 Physicians Optical Supplies 20 1053350983 0 Physicians Physician Services 20 1053350983 0 Physicians Physicians Psychiatric Services 00 1053351189 0 CALDERWOOD DAVID A 2017156 9999999 B 10 1053351189 0 1431 CENTERPOINT BLVD STE 100 KNOXVILLE TN 379321983 20 1053351189 0 Physicians Anesthesia Services 20 1053351189 0 Physicians Fluoride varnish 20 1053351189 0 Physicians Healthy Kids Services 20 1053351189 0 Physicians Optical Supplies 20 1053351189 0 Physicians Physician Services 00 1053351338 0 AL-HOSNI MOHAMAD 2000112 9999999 B 10 1053351338 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1053351338 0 Physicians Anesthesia Services 20 1053351338 0 Physicians Healthy Kids Services 20 1053351338 0 Physicians Optical Supplies 20 1053351338 0 Physicians Physician Services 00 1053353169 0 BORKAR MONICA S 2006095 9999999 B 10 1053353169 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1053353169 0 Physicians Anesthesia Services 20 1053353169 0 Physicians Fluoride varnish 20 1053353169 0 Physicians Healthy Kids Services 20 1053353169 0 Physicians Optical Supplies 20 1053353169 0 Physicians Physician Services 00 1053354472 0 LEAKER CYNTHIA H 2013246 9999999 B 10 1053354472 0 5777 DEPT CAROL STREAM IL 601220021 20 1053354472 0 Nurse Practitioners Fluoride varnish 20 1053354472 0 Nurse Practitioners Healthy Kids Services 20 1053354472 0 Nurse Practitioners Nurse Practitioners Services 20 1053354472 0 Nurse Practitioners Physician Services 00 1053355198 0 NG ANGUS Y 2018278 9999999 B 10 1053355198 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1053355198 0 Physicians Anesthesia Services 20 1053355198 0 Physicians Healthy Kids Services 20 1053355198 0 Physicians Optical Supplies 20 1053355198 0 Physicians Physician Services 00 1053356659 0 FURLAN ANTHONY 2021113 9999999 B 10 1053356659 0 PO BOX 43230 PHOENIX AZ 850803230 20 1053356659 0 Physicians Anesthesia Services 20 1053356659 0 Physicians Healthy Kids Services 20 1053356659 0 Physicians Optical Supplies 20 1053356659 0 Physicians Physician Services 20 1053356659 0 Physicians Physicians Psychiatric Services 00 1053358523 0 ADELGAIS KATHLEEN M 2017213 9999999 B 10 1053358523 0 PO BOX 110429 AURORA CO 800420429 20 1053358523 0 Physicians Anesthesia Services 20 1053358523 0 Physicians Healthy Kids Services 20 1053358523 0 Physicians Optical Supplies 20 1053358523 0 Physicians Physician Services 00 1053358580 0 MUSLEH RAMI 2018145 9999999 B 10 1053358580 0 PO BOX 500 ELLICOTTVILLE NY 147310500 20 1053358580 0 Physician Assistant Only Fluoride varnish 20 1053358580 0 Physician Assistant Only Healthy Kids Services 20 1053358580 0 Physician Assistant Only Physician Services 00 1053358671 0 GADI VIJAYAKRISHNA 2020066 9999999 B 10 1053358671 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1053358671 0 Physicians Anesthesia Services 20 1053358671 0 Physicians Fluoride varnish 20 1053358671 0 Physicians Healthy Kids Services 20 1053358671 0 Physicians Optical Supplies 20 1053358671 0 Physicians Physician Services 00 1053360354 0 SCHLITTLER KEVIN M 2016141 9999999 B 10 1053360354 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1053360354 0 Physician Assistant Only Fluoride varnish 20 1053360354 0 Physician Assistant Only Healthy Kids Services 20 1053360354 0 Physician Assistant Only Physician Services 00 1053360610 0 WOS THERESE 1998001 9999999 B 10 1053360610 0 29373 NETWORK PL CHICAGO IL 606733039 20 1053360610 0 Physicians Anesthesia Services 20 1053360610 0 Physicians Healthy Kids Services 20 1053360610 0 Physicians Optical Supplies 20 1053360610 0 Physicians Physician Services 00 1053360735 0 CHAN WALLACE 1994121 9999999 B 10 1053360735 0 2126A S ARCHER AVE CHICAGO IL 606161514 20 1053360735 0 Optometrists Optical Supplies 20 1053360735 0 Optometrists Optometric Services 20 1053360735 0 Optometrists Physician Services 00 1053360792 0 MINER D SCOTT 2024157 9999999 B 10 1053360792 0 8300 W 38TH AVE WHEAT RIDGE CO 800336005 20 1053360792 0 Physicians Anesthesia Services 20 1053360792 0 Physicians Healthy Kids Services 20 1053360792 0 Physicians Optical Supplies 20 1053360792 0 Physicians Physician Services 00 1053360974 0 SELIP DEBRA 2008183 9999999 B 10 1053360974 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1053360974 0 Physicians Anesthesia Services 20 1053360974 0 Physicians Fluoride varnish 20 1053360974 0 Physicians Healthy Kids Services 20 1053360974 0 Physicians Optical Supplies 20 1053360974 0 Physicians Physician Services 00 1053361121 0 SKAREDOFF MICHAEL 1992183 9999999 B 10 1053361121 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1053361121 0 Physicians Anesthesia Services 20 1053361121 0 Physicians Healthy Kids Services 20 1053361121 0 Physicians Optical Supplies 20 1053361121 0 Physicians Physician Services 00 1053361246 0 SIRAGUSA JENIFER A 2021092 9999999 B 10 1053361246 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1053361246 0 Physicians Anesthesia Services 20 1053361246 0 Physicians Fluoride varnish 20 1053361246 0 Physicians Healthy Kids Services 20 1053361246 0 Physicians Optical Supplies 20 1053361246 0 Physicians Physician Services 00 1053361832 0 BERGER JOSEPH 1999213 9999999 B 10 1053361832 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1053361832 0 Physicians Anesthesia Services 20 1053361832 0 Physicians Healthy Kids Services 20 1053361832 0 Physicians Optical Supplies 20 1053361832 0 Physicians Physician Services 00 1053362004 0 EARING MICHAEL G 2004183 9999999 B 10 1053362004 0 6501 S PROMONTORY DR CHICAGO IL 606491003 20 1053362004 0 Physicians Anesthesia Services 20 1053362004 0 Physicians Fluoride varnish 20 1053362004 0 Physicians Healthy Kids Services 20 1053362004 0 Physicians Optical Supplies 20 1053362004 0 Physicians Physician Services 00 1053362582 0 GRINDEL STEVEN I 2002078 9999999 B 10 1053362582 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1053362582 0 Physicians Anesthesia Services 20 1053362582 0 Physicians Fluoride varnish 20 1053362582 0 Physicians Healthy Kids Services 20 1053362582 0 Physicians Optical Supplies 20 1053362582 0 Physicians Physician Services 00 1053362897 0 KOOP OLSTA JENNIFER 2017001 9999999 B 10 1053362897 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1053362897 0 Psychologist Psychologist service 00 1053363903 0 KOENIGS MARY 2006226 9999999 B 10 1053363903 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1053363903 0 Physicians Anesthesia Services 20 1053363903 0 Physicians Fluoride varnish 20 1053363903 0 Physicians Healthy Kids Services 20 1053363903 0 Physicians Optical Supplies 20 1053363903 0 Physicians Physician Services 00 1053364042 0 KOGAN NEPHTALI 1994182 9999999 B 10 1053364042 0 800 BIESTERFIELD RD STE G01 ELK GROVE VILLA IL 600073372 20 1053364042 0 Physicians Anesthesia Services 20 1053364042 0 Physicians Fluoride varnish 20 1053364042 0 Physicians Healthy Kids Services 20 1053364042 0 Physicians Optical Supplies 20 1053364042 0 Physicians Physician Services 00 1053364349 0 AGUERO MEDINA CARLOS 2006248 9999999 B 10 1053364349 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1053364349 0 Physicians Anesthesia Services 20 1053364349 0 Physicians Fluoride varnish 20 1053364349 0 Physicians Healthy Kids Services 20 1053364349 0 Physicians Optical Supplies 20 1053364349 0 Physicians Physician Services 00 1053365437 0 KONCHADA RAVISHANKAR S 2018091 9999999 B 10 1053365437 0 5110 E CLINTON WAY FRESNO CA 937272040 20 1053365437 0 Physicians Anesthesia Services 20 1053365437 0 Physicians Healthy Kids Services 20 1053365437 0 Physicians Optical Supplies 20 1053365437 0 Physicians Physician Services 00 1053365577 0 SCIGACZ BOZENA E 2006121 9999999 B 10 1053365577 0 28 W LAKE ST STE 2 ADDISON IL 601012709 20 1053365577 0 Physicians Anesthesia Services 20 1053365577 0 Physicians Fluoride varnish 20 1053365577 0 Physicians Healthy Kids Services 20 1053365577 0 Physicians Optical Supplies 20 1053365577 0 Physicians Physician Services 00 1053365619 0 GLINSKI JEFFREY 2022042 9999999 B 10 1053365619 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1053365619 0 Physicians Anesthesia Services 20 1053365619 0 Physicians Healthy Kids Services 20 1053365619 0 Physicians Optical Supplies 20 1053365619 0 Physicians Physician Services 00 1053365932 0 GONZALEZ JORGE A 2003333 9999999 B 10 1053365932 0 PO BOX 88848 CAROL STREAM IL 601880848 20 1053365932 0 Physicians Anesthesia Services 20 1053365932 0 Physicians Healthy Kids Services 20 1053365932 0 Physicians Optical Supplies 20 1053365932 0 Physicians Physician Services 00 1053366591 0 FACCHIANO VINCENT 2017207 9999999 B 10 1053366591 0 7200 HARRISON AVE UNIT E265 ROCKFORD IL 611121017 20 1053366591 0 Optometrists Optical Supplies 20 1053366591 0 Optometrists Optometric Services 20 1053366591 0 Optometrists Physician Services 00 1053367169 0 AVILA LUIS A 2022101 9999999 B 10 1053367169 0 PO BOX 43230 PHOENIX AZ 850803230 20 1053367169 0 Physicians Anesthesia Services 20 1053367169 0 Physicians Healthy Kids Services 20 1053367169 0 Physicians Optical Supplies 20 1053367169 0 Physicians Physician Services 00 1053367243 0 SYED VAQAR 2000183 9999999 B 10 1053367243 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1053367243 0 Physicians Anesthesia Services 20 1053367243 0 Physicians Healthy Kids Services 20 1053367243 0 Physicians Optical Supplies 20 1053367243 0 Physicians Physician Services 00 1053368316 0 CHAFFIN CINDY 2016026 9999999 B 10 1053368316 0 100 W 15TH ST BEARDSTOWN IL 626181774 20 1053368316 0 Nurse Practitioners Healthy Kids Services 20 1053368316 0 Nurse Practitioners Nurse Practitioners Services 20 1053368316 0 Nurse Practitioners Physician Services 00 1053368415 0 YAO IRENE C 2004215 9999999 B 10 1053368415 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1053368415 0 Physicians Anesthesia Services 20 1053368415 0 Physicians Healthy Kids Services 20 1053368415 0 Physicians Optical Supplies 20 1053368415 0 Physicians Physician Services 00 1053368456 0 SHORT DANIEL J 1990145 9999999 B 10 1053368456 0 387 SHUMAN BLVD STE 275 NAPERVILLE IL 605638450 20 1053368456 0 Physicians Anesthesia Services 20 1053368456 0 Physicians Healthy Kids Services 20 1053368456 0 Physicians Optical Supplies 20 1053368456 0 Physicians Physician Services 00 1053369066 0 TU RONG SHANG 1981258 9999999 B 10 1053369066 0 2340 S HIGHLAND AVE STE 230 SUITE 230 LOMBARD IL 601485396 20 1053369066 0 Physicians Anesthesia Services 20 1053369066 0 Physicians Fluoride varnish 20 1053369066 0 Physicians Healthy Kids Services 20 1053369066 0 Physicians Optical Supplies 20 1053369066 0 Physicians Physician Services 00 1053369124 0 CHEN MERI 1995001 9999999 B 10 1053369124 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1053369124 0 Physicians Anesthesia Services 20 1053369124 0 Physicians Healthy Kids Services 20 1053369124 0 Physicians Optical Supplies 20 1053369124 0 Physicians Physician Services 00 1053369546 0 JACQUOT BRIAN 2017104 9999999 B 10 1053369546 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1053369546 0 Physician Assistant Only Fluoride varnish 20 1053369546 0 Physician Assistant Only Healthy Kids Services 20 1053369546 0 Physician Assistant Only Physician Services 00 1053369967 0 PHILLIPS SCOTT 1994032 9999999 B 10 1053369967 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1053369967 0 Physicians Anesthesia Services 20 1053369967 0 Physicians Healthy Kids Services 20 1053369967 0 Physicians Optical Supplies 20 1053369967 0 Physicians Physician Services 00 1053370163 0 RANNIN BRUCE A 2020125 9999999 B 10 1053370163 0 1105 HIDDEN SPRING DR NAPERVILLE IL 605404111 20 1053370163 0 Dentists Dental Services 20 1053370163 0 Dentists Physician Services 00 1053370353 0 YANG STEVEN S 2018068 9999999 B 10 1053370353 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1053370353 0 Physicians Anesthesia Services 20 1053370353 0 Physicians Fluoride varnish 20 1053370353 0 Physicians Healthy Kids Services 20 1053370353 0 Physicians Optical Supplies 20 1053370353 0 Physicians Physician Services 00 1053370759 0 SODERSTROM CARL W W 1981258 9999999 B 10 1053370759 0 4909 N GLEN PARK PLACE RD PEORIA IL 616144676 20 1053370759 0 Physicians Anesthesia Services 20 1053370759 0 Physicians Healthy Kids Services 20 1053370759 0 Physicians Optical Supplies 20 1053370759 0 Physicians Physician Services 00 1053370890 0 CHAMLIN SARAH 2001032 2099365 B 10 1053370890 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1053370890 0 Physicians Anesthesia Services 20 1053370890 0 Physicians Fluoride varnish 20 1053370890 0 Physicians Healthy Kids Services 20 1053370890 0 Physicians Optical Supplies 20 1053370890 0 Physicians Physician Services 00 1053371039 0 HAMMOND MICHAEL K 2008122 9999999 B 10 1053371039 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1053371039 0 Physicians Anesthesia Services 20 1053371039 0 Physicians Healthy Kids Services 20 1053371039 0 Physicians Optical Supplies 20 1053371039 0 Physicians Physician Services 00 1053371849 0 KOPALA CARRIE L 2021165 9999999 B 10 1053371849 0 5777 DEPT CAROL STREAM IL 601228942 20 1053371849 0 Physician Assistant Only Fluoride varnish 20 1053371849 0 Physician Assistant Only Healthy Kids Services 20 1053371849 0 Physician Assistant Only Physician Services 00 1053372847 0 HINGST MARK 2024047 9999999 B 10 1053372847 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1053372847 0 Physicians Anesthesia Services 20 1053372847 0 Physicians Fluoride varnish 20 1053372847 0 Physicians Healthy Kids Services 20 1053372847 0 Physicians Optical Supplies 20 1053372847 0 Physicians Physician Services 00 1053373274 0 PALACIOS JEFF 2018120 9999999 B 10 1053373274 0 101 MADISON ST STE 300 OAK PARK IL 603024210 20 1053373274 0 Physicians Anesthesia Services 20 1053373274 0 Physicians Healthy Kids Services 20 1053373274 0 Physicians Optical Supplies 20 1053373274 0 Physicians Physician Services 20 1053373274 0 Physicians Physicians Psychiatric Services 00 1053373720 0 CHRISMAN HOWARD B 1997182 9999999 B 10 1053373720 0 5777 DEPT CAROL STREAM IL 601220021 20 1053373720 0 Physicians Anesthesia Services 20 1053373720 0 Physicians Healthy Kids Services 20 1053373720 0 Physicians Optical Supplies 20 1053373720 0 Physicians Physician Services 00 1053374561 0 MORRISON CARRIE C 2001305 9999999 B 10 1053374561 0 510 S KINGSHIGHWAY BLVD SAINT LOUIS MO 631101016 20 1053374561 0 Physicians Anesthesia Services 20 1053374561 0 Physicians Healthy Kids Services 20 1053374561 0 Physicians Optical Supplies 20 1053374561 0 Physicians Physician Services 00 1053376681 0 VERGES DENISE 1992183 9999999 B 10 1053376681 0 5777 DEPT CAROL STREAM IL 601220021 20 1053376681 0 Physicians Anesthesia Services 20 1053376681 0 Physicians Fluoride varnish 20 1053376681 0 Physicians Healthy Kids Services 20 1053376681 0 Physicians Optical Supplies 20 1053376681 0 Physicians Physician Services 00 1053376962 0 FLOOD WENDY E 2017349 9999999 B 10 1053376962 0 3248 VANDEVER AVE PEKIN IL 615546257 20 1053376962 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1053377515 0 KIND JONATHAN D 1989182 9999999 B 10 1053377515 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1053377515 0 Physicians Anesthesia Services 20 1053377515 0 Physicians Healthy Kids Services 20 1053377515 0 Physicians Optical Supplies 20 1053377515 0 Physicians Physician Services 00 1053377663 0 PINTO JUAN C 2001305 9999999 B 10 1053377663 0 691 COLLINS ST JOLIET IL 604321825 20 1053377663 0 Physicians Anesthesia Services 20 1053377663 0 Physicians Fluoride varnish 20 1053377663 0 Physicians Healthy Kids Services 20 1053377663 0 Physicians Optical Supplies 20 1053377663 0 Physicians Physician Services 00 1053378158 0 MCMONIGAL RICHARD S 2020330 9999999 B 10 1053378158 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1053378158 0 Physicians Anesthesia Services 20 1053378158 0 Physicians Healthy Kids Services 20 1053378158 0 Physicians Optical Supplies 20 1053378158 0 Physicians Physician Services 00 1053378331 0 EWING JOHN 2005164 9999999 B 10 1053378331 0 202 S PARK ST MADISON WI 537151507 20 1053378331 0 Physicians Anesthesia Services 20 1053378331 0 Physicians Fluoride varnish 20 1053378331 0 Physicians Healthy Kids Services 20 1053378331 0 Physicians Optical Supplies 20 1053378331 0 Physicians Physician Services 00 1053378364 0 ZELBY ANDREW S 1994182 9999999 B 10 1053378364 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1053378364 0 Physicians Anesthesia Services 20 1053378364 0 Physicians Healthy Kids Services 20 1053378364 0 Physicians Optical Supplies 20 1053378364 0 Physicians Physician Services 00 1053379396 0 PUCH CATHERINE 2017254 9999999 B 10 1053379396 0 350 W 154TH ST SOUTH HOLLAND IL 604731229 20 1053379396 0 Speech Therapists Medical Supplies 20 1053379396 0 Speech Therapists Medical equipment/prosthetic devices 20 1053379396 0 Speech Therapists Speech Therapy/Pathology Services 00 1053379438 0 HELWANI MOHAMMAD 2006182 9999999 B 10 1053379438 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1053379438 0 Physicians Anesthesia Services 20 1053379438 0 Physicians Healthy Kids Services 20 1053379438 0 Physicians Optical Supplies 20 1053379438 0 Physicians Physician Services 00 1053379578 0 PAREJA XAVIER 2003060 9999999 B 10 1053379578 0 1044 N FRANCISCO AVE CHICAGO IL 606222743 20 1053379578 0 Physicians Anesthesia Services 20 1053379578 0 Physicians Healthy Kids Services 20 1053379578 0 Physicians Optical Supplies 20 1053379578 0 Physicians Physician Services 00 1053379594 0 SULKES SHELIA 2016239 9999999 B 10 1053379594 0 333 S STATE ST STE 200 CHICAGO IL 606043946 20 1053379594 0 Psychologist Psychologist service 00 1053379677 0 YEACKLE WESLEY 2021130 9999999 B 10 1053379677 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1053379677 0 Physicians Anesthesia Services 20 1053379677 0 Physicians Healthy Kids Services 20 1053379677 0 Physicians Optical Supplies 20 1053379677 0 Physicians Physician Services 00 1053380345 0 STEWART KATHARINA 1998194 9999999 B 10 1053380345 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1053380345 0 Physicians Anesthesia Services 20 1053380345 0 Physicians Healthy Kids Services 20 1053380345 0 Physicians Optical Supplies 20 1053380345 0 Physicians Physician Services 00 1053380428 0 EGLASH ANNE R 2014001 9999999 B 10 1053380428 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1053380428 0 Physicians Anesthesia Services 20 1053380428 0 Physicians Fluoride varnish 20 1053380428 0 Physicians Healthy Kids Services 20 1053380428 0 Physicians Optical Supplies 20 1053380428 0 Physicians Physician Services 00 1053380642 0 DIGIULIO THOMAS A 1989304 9999999 B 10 1053380642 0 29373 NETWORK PL CHICAGO IL 606733039 20 1053380642 0 Physicians Anesthesia Services 20 1053380642 0 Physicians Healthy Kids Services 20 1053380642 0 Physicians Optical Supplies 20 1053380642 0 Physicians Physician Services 00 1053380774 0 MARTIN-SIMMERMAN PHYLLIS 2018001 9999999 B 10 1053380774 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1053380774 0 Physicians Anesthesia Services 20 1053380774 0 Physicians Healthy Kids Services 20 1053380774 0 Physicians Optical Supplies 20 1053380774 0 Physicians Physician Services 00 1053380931 0 POZNIAK MYRON 1984195 9999999 B 10 1053380931 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1053380931 0 Physicians Anesthesia Services 20 1053380931 0 Physicians Healthy Kids Services 20 1053380931 0 Physicians Optical Supplies 20 1053380931 0 Physicians Physician Services 00 1053381103 0 CORTEZ JOSEPH EMILIO 1995121 9999999 B 10 1053381103 0 PO BOX 1027 BEDFORD PARK IL 604991027 20 1053381103 0 Physicians Anesthesia Services 20 1053381103 0 Physicians Healthy Kids Services 20 1053381103 0 Physicians Optical Supplies 20 1053381103 0 Physicians Physician Services 00 1053381160 0 PIERCE THOMAS H 2023338 9999999 B 10 1053381160 0 3388 KENNEDY CIR STE F DUBUQUE IA 520023903 20 1053381160 0 Nurse Practitioners Anesthesia Services 20 1053381160 0 Nurse Practitioners Nurse Practitioners Services 20 1053381160 0 Nurse Practitioners Physician Services 00 1053381699 0 MASON ALBERT D 2017265 9999999 B 10 1053381699 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1053381699 0 Physicians Anesthesia Services 20 1053381699 0 Physicians Healthy Kids Services 20 1053381699 0 Physicians Optical Supplies 20 1053381699 0 Physicians Physician Services 00 1053382036 0 JOY JAREMY 2019226 9999999 B 10 1053382036 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1053382036 0 Physicians Anesthesia Services 20 1053382036 0 Physicians Healthy Kids Services 20 1053382036 0 Physicians Optical Supplies 20 1053382036 0 Physicians Physician Services 00 1053383125 0 DHILLON KIRAN 2005335 9999999 B 10 1053383125 0 PO BOX 578220 CHICAGO IL 606577303 20 1053383125 0 Physicians Anesthesia Services 20 1053383125 0 Physicians Fluoride varnish 20 1053383125 0 Physicians Healthy Kids Services 20 1053383125 0 Physicians Optical Supplies 20 1053383125 0 Physicians Physician Services 00 1053383471 0 NALL BARBARA 2009032 9999999 B 10 1053383471 0 3300 W WILLOW KNOLLS DR STE 2 PEORIA IL 616148133 20 1053383471 0 Nurse Practitioners Healthy Kids Services 20 1053383471 0 Nurse Practitioners Nurse Practitioners Services 20 1053383471 0 Nurse Practitioners Physician Services 00 1053383646 0 LONG MICHAEL J 2021077 9999999 B 10 1053383646 0 N17W24100 RIVERWOOD DR WAUKESHA WI 531881127 20 1053383646 0 Physicians Anesthesia Services 20 1053383646 0 Physicians Fluoride 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1053383992 0 Physicians Healthy Kids Services 20 1053383992 0 Physicians Optical Supplies 20 1053383992 0 Physicians Physician Services 00 1053384412 0 SEARLES ERICKA 2008126 9999999 B 10 1053384412 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1053384412 0 Physicians Anesthesia Services 20 1053384412 0 Physicians Healthy Kids Services 20 1053384412 0 Physicians Optical Supplies 20 1053384412 0 Physicians Physician Services 00 1053384644 0 WILLIAMS JOSEPH P 2020161 9999999 B 10 1053384644 0 340 MIDLAND RD STE 120 JANESVILLE WI 535462339 20 1053384644 0 Physicians Anesthesia Services 20 1053384644 0 Physicians Healthy Kids Services 20 1053384644 0 Physicians Optical Supplies 20 1053384644 0 Physicians Physician Services 00 1053384701 0 BENISH SARAH 2019288 9999999 B 10 1053384701 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1053384701 0 Physicians Anesthesia Services 20 1053384701 0 Physicians Healthy Kids Services 20 1053384701 0 Physicians Optical Supplies 20 1053384701 0 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Physicians Psychiatric Services 00 1053419168 0 WOLLBRINCK TODD 2014293 9999999 B 10 1053419168 0 400 JUNCTION DR GLEN CARBON IL 620344323 20 1053419168 0 Optometrists Optical Supplies 20 1053419168 0 Optometrists Optometric Services 20 1053419168 0 Optometrists Physician Services 00 1053420422 0 ARUN DEEPA 2006178 9999999 B 10 1053420422 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1053420422 0 Physicians Anesthesia Services 20 1053420422 0 Physicians Healthy Kids Services 20 1053420422 0 Physicians Optical Supplies 20 1053420422 0 Physicians Physician Services 20 1053420422 0 Physicians Physicians Psychiatric Services 00 1053420893 0 LAMBERTI PAUL 2003268 9999999 B 10 1053420893 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1053420893 0 Physicians Anesthesia Services 20 1053420893 0 Physicians Healthy Kids Services 20 1053420893 0 Physicians Optical Supplies 20 1053420893 0 Physicians Physician Services 00 1053421065 0 GRUS BRIAN A 2015289 9999999 B 10 1053421065 0 660 MASON RIDGE 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1053426809 0 OSTERLOH JOAN F 2017249 9999999 B 10 1053426809 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1053426809 0 Nurse Practitioners Fluoride varnish 20 1053426809 0 Nurse Practitioners Healthy Kids Services 20 1053426809 0 Nurse Practitioners Nurse Practitioners Services 20 1053426809 0 Nurse Practitioners Physician Services 00 1053427039 0 JUDGE KIMBERLY 2002133 9999999 B 10 1053427039 0 17008 CREIGHTON DR LOCKPORT IL 604411325 20 1053427039 0 Speech Therapists Medical Supplies 20 1053427039 0 Speech Therapists Medical equipment/prosthetic devices 20 1053427039 0 Speech Therapists Speech Therapy/Pathology Services 00 1053427252 0 WHITE KAREN 2006188 9999999 B 10 1053427252 0 800 E LOCUST ST OLNEY IL 624502553 20 1053427252 0 Physicians Anesthesia Services 20 1053427252 0 Physicians Fluoride varnish 20 1053427252 0 Physicians Healthy Kids Services 20 1053427252 0 Physicians Optical Supplies 20 1053427252 0 Physicians Physician Services 00 1053427344 0 BRINKMAN MARK J 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Optical Supplies 20 1053545863 0 Physicians Physician Services 00 1053545962 0 MACKEBEN LORNA 2009120 9999999 B 10 1053545962 0 4698 DEPT CAROL STREAM IL 601220021 20 1053545962 0 Nurse Practitioners Healthy Kids Services 20 1053545962 0 Nurse Practitioners Nurse Practitioners Services 20 1053545962 0 Nurse Practitioners Physician Services 00 1053546226 0 ELKINS MARY JO 2011169 9999999 B 10 1053546226 0 PO BOX 96208 OKLAHOMA CITY OK 731436208 20 1053546226 0 Nurse Practitioners Healthy Kids Services 20 1053546226 0 Nurse Practitioners Nurse Practitioners Services 20 1053546226 0 Nurse Practitioners Physician Services 00 1053546531 0 CECCHINI VERONICA 2009097 9999999 B 10 1053546531 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1053546531 0 Physical Therapists Medical Supplies 20 1053546531 0 Physical Therapists Medical equipment/prosthetic devices 20 1053546531 0 Physical Therapists Physical Therapy Services 00 1053546564 0 DESAI ZANKHANA M 2018309 9999999 B 10 1053546564 0 PO BOX 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Physicians Healthy Kids Services 20 1053553768 0 Physicians Optical Supplies 20 1053553768 0 Physicians Physician Services 00 1053553859 0 ALHANDALOUS CHAHER H 2013244 9999999 B 10 1053553859 0 5777 DEPT CAROL STREAM IL 601228942 20 1053553859 0 Physicians Anesthesia Services 20 1053553859 0 Physicians Fluoride varnish 20 1053553859 0 Physicians Healthy Kids Services 20 1053553859 0 Physicians Optical Supplies 20 1053553859 0 Physicians Physician Services 00 1053553883 0 HAN MICHELLE S 2017164 9999999 B 10 1053553883 0 5777 DEPT CAROL STREAM IL 601220021 20 1053553883 0 Physicians Anesthesia Services 20 1053553883 0 Physicians Healthy Kids Services 20 1053553883 0 Physicians Optical Supplies 20 1053553883 0 Physicians Physician Services 00 1053554071 0 RELWANI RESHMA L 2013006 9999999 B 10 1053554071 0 PO BOX 775231 CHICAGO IL 606775231 20 1053554071 0 Physicians Anesthesia Services 20 1053554071 0 Physicians Fluoride varnish 20 1053554071 0 Physicians Healthy Kids Services 20 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1053576686 0 Physicians Optical Supplies 20 1053576686 0 Physicians Physician Services 00 1053576827 0 BOSS JEFFREY 2013182 9999999 B 10 1053576827 0 70 DOCTORS PARK CAPE GIRARDEAU MO 637034928 20 1053576827 0 Physicians Anesthesia Services 20 1053576827 0 Physicians Healthy Kids Services 20 1053576827 0 Physicians Optical Supplies 20 1053576827 0 Physicians Physician Services 00 1053577890 0 BHATTI ZAGUM 2022306 9999999 B 10 1053577890 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1053577890 0 Physicians Anesthesia Services 20 1053577890 0 Physicians Healthy Kids Services 20 1053577890 0 Physicians Optical Supplies 20 1053577890 0 Physicians Physician Services 00 1053579094 0 SHAMI SALWAT 2015338 9999999 B 10 1053579094 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1053579094 0 Physicians Anesthesia Services 20 1053579094 0 Physicians Fluoride varnish 20 1053579094 0 Physicians Healthy Kids Services 20 1053579094 0 Physicians Optical Supplies 20 1053579094 0 Physicians 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20 1053585463 0 Physicians Healthy Kids Services 20 1053585463 0 Physicians Optical Supplies 20 1053585463 0 Physicians Physician Services 00 1053585604 0 GREEN JARED 2014152 9999999 B 10 1053585604 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1053585604 0 Physicians Anesthesia Services 20 1053585604 0 Physicians Healthy Kids Services 20 1053585604 0 Physicians Optical Supplies 20 1053585604 0 Physicians Physician Services 00 1053587279 0 THURMAN TYLER D 2016042 9999999 B 10 1053587279 0 2041 GOOSE LAKE RD SAUGET IL 622062822 20 1053587279 0 Other behavior health professional LCPC/LMFT services 00 1053587402 0 BUCK AMY M 2008336 9999999 B 10 1053587402 0 3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047452 20 1053587402 0 Nurse Practitioners Fluoride varnish 20 1053587402 0 Nurse Practitioners Healthy Kids Services 20 1053587402 0 Nurse Practitioners Nurse Practitioners Services 20 1053587402 0 Nurse Practitioners Physician Services 00 1053587964 0 CHEN HONG 2009182 9999999 B 10 1053587964 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1053587964 0 Physicians Anesthesia Services 20 1053587964 0 Physicians Fluoride varnish 20 1053587964 0 Physicians Healthy Kids Services 20 1053587964 0 Physicians Optical Supplies 20 1053587964 0 Physicians Physician Services 00 1053589457 0 GEHRING GERVASE MICHELLE 2017258 9999999 B 10 1053589457 0 6202 VOLLMER RD MATTESON IL 604431058 20 1053589457 0 Speech Therapists Medical Supplies 20 1053589457 0 Speech Therapists Medical equipment/prosthetic devices 20 1053589457 0 Speech Therapists Speech Therapy/Pathology Services 00 1053590216 0 RACADIO GRACE 2007208 9999999 B 10 1053590216 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1053590216 0 Physical Therapists Medical Supplies 20 1053590216 0 Physical Therapists Medical equipment/prosthetic devices 20 1053590216 0 Physical Therapists Physical Therapy Services 00 1053590398 0 KRAHN SANDRA 2008092 9999999 B 10 1053590398 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1053590398 0 Nurse 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1053600585 0 8170 33RD AVE S MINNEAPOLIS MN 554254516 20 1053600585 0 Physicians Anesthesia Services 20 1053600585 0 Physicians Fluoride varnish 20 1053600585 0 Physicians Healthy Kids Services 20 1053600585 0 Physicians Optical Supplies 20 1053600585 0 Physicians Physician Services 00 1053600676 0 BISINGER ALEXA D 2022146 9999999 B 10 1053600676 0 5777 DEPT CAROL STREAM IL 601220021 20 1053600676 0 Physicians Anesthesia Services 20 1053600676 0 Physicians Healthy Kids Services 20 1053600676 0 Physicians Optical Supplies 20 1053600676 0 Physicians Physician Services 00 1053600932 0 FITZGERALD MELINDA 2015299 9999999 B 10 1053600932 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1053600932 0 Nurse Practitioners Electronic Home Response/EHR Installation, MPE Certification 20 1053600932 0 Nurse Practitioners Fluoride varnish 20 1053600932 0 Nurse Practitioners Healthy Kids Services 20 1053600932 0 Nurse Practitioners Nurse Practitioners Services 20 1053600932 0 Nurse Practitioners Physician Services 00 1053601112 0 JELENC BRIANA L 2014247 9999999 B 10 1053601112 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1053601112 0 Physicians Anesthesia Services 20 1053601112 0 Physicians Fluoride varnish 20 1053601112 0 Physicians Healthy Kids Services 20 1053601112 0 Physicians Optical Supplies 20 1053601112 0 Physicians Physician Services 00 1053601146 0 ORWIG JOSHUA L 2017187 9999999 B 10 1053601146 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1053601146 0 Physicians Anesthesia Services 20 1053601146 0 Physicians Healthy Kids Services 20 1053601146 0 Physicians Optical Supplies 20 1053601146 0 Physicians Physician Services 00 1053601500 0 TEXLER CARA E 2023188 9999999 B 10 1053601500 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1053601500 0 Physicians Anesthesia Services 20 1053601500 0 Physicians Fluoride varnish 20 1053601500 0 Physicians Healthy Kids Services 20 1053601500 0 Physicians Optical Supplies 20 1053601500 0 Physicians Physician Services 00 1053601567 0 CRAWFORD STEPHANIE 2011121 9999999 B 10 1053601567 0 4701 DEPT CAROL STREAM IL 601220021 20 1053601567 0 Nurse Practitioners All Kids application agent 20 1053601567 0 Nurse Practitioners Fluoride varnish 20 1053601567 0 Nurse Practitioners Healthy Kids Services 20 1053601567 0 Nurse Practitioners Nurse Practitioners Services 20 1053601567 0 Nurse Practitioners Physician Services 00 1053601583 0 BOUNDAOUI OUSSAMA 2016245 9999999 B 10 1053601583 0 130 S MAIN ST STE 303 LOMBARD IL 601482670 20 1053601583 0 Physicians Anesthesia Services 20 1053601583 0 Physicians Healthy Kids Services 20 1053601583 0 Physicians Optical Supplies 20 1053601583 0 Physicians Physician Services 00 1053601682 0 FIFE LUKE P 2023166 9999999 B 10 1053601682 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1053601682 0 Physicians Anesthesia Services 20 1053601682 0 Physicians Healthy Kids Services 20 1053601682 0 Physicians Optical Supplies 20 1053601682 0 Physicians Physician Services 00 1053602342 0 EMAMEKHOO HAMID 2016208 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Physicians Healthy Kids Services 20 1053604868 0 Physicians Optical Supplies 20 1053604868 0 Physicians Physician Services 00 1053605550 0 VITALI JOHN 2025060 9999999 B 10 1053605550 0 PO BOX 638704 CINCINNATI OH 452638704 20 1053605550 0 Physicians Anesthesia Services 20 1053605550 0 Physicians Healthy Kids Services 20 1053605550 0 Physicians Optical Supplies 20 1053605550 0 Physicians Physician Services 00 1053605873 0 DABROWSKI ELIZABETH 2022243 9999999 B 10 1053605873 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1053605873 0 Physicians Anesthesia Services 20 1053605873 0 Physicians Fluoride varnish 20 1053605873 0 Physicians Healthy Kids Services 20 1053605873 0 Physicians Optical Supplies 20 1053605873 0 Physicians Physician Services 00 1053606657 0 FREDERIKSEN KALA 2016015 9999999 B 10 1053606657 0 520 VALLEY VIEW DR MOLINE IL 612656152 20 1053606657 0 Physical Therapists Medical Supplies 20 1053606657 0 Physical Therapists Medical equipment/prosthetic devices 20 1053606657 0 Physical Therapists Physical Therapy Services 00 1053607333 0 NAIK DHARA S 2015244 9999999 B 10 1053607333 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1053607333 0 Physicians Anesthesia Services 20 1053607333 0 Physicians Fluoride varnish 20 1053607333 0 Physicians Healthy Kids Services 20 1053607333 0 Physicians Optical Supplies 20 1053607333 0 Physicians Physician Services 00 1053607424 0 LOUDON TRACY ANNE 2016266 9999999 B 10 1053607424 0 4535 DRESSLER RD NW CANTON OH 447182545 20 1053607424 0 Physicians Anesthesia Services 20 1053607424 0 Physicians Healthy Kids Services 20 1053607424 0 Physicians Optical Supplies 20 1053607424 0 Physicians Physician Services 00 1053607580 0 DHEYAB ABDULJABBAR A 2023073 9999999 B 10 1053607580 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1053607580 0 Physicians Anesthesia Services 20 1053607580 0 Physicians Fluoride varnish 20 1053607580 0 Physicians Healthy Kids Services 20 1053607580 0 Physicians Optical Supplies 20 1053607580 0 Physicians Physician Services 00 1053608190 0 SOMMERFIELD MEGAN M 2022077 9999999 B 10 1053608190 0 14959 PULASKI RD MIDLOTHIAN IL 604453436 20 1053608190 0 Speech Therapists Medical Supplies 20 1053608190 0 Speech Therapists Medical equipment/prosthetic devices 20 1053608190 0 Speech Therapists Speech Therapy/Pathology Services 00 1053608208 0 PARULKAR SURAJ 2016214 9999999 B 10 1053608208 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1053608208 0 Physicians Anesthesia Services 20 1053608208 0 Physicians Healthy Kids Services 20 1053608208 0 Physicians Optical Supplies 20 1053608208 0 Physicians Physician Services 00 1053609248 0 DAVID GELBMANN 2016326 9999999 B 10 1053609248 0 PO BOX 83242 CHICAGO IL 606910242 20 1053609248 0 Podiatrists Podiatric Services 00 1053609685 0 DHADWAL SUSHANT 2012177 9999999 B 10 1053609685 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112386 20 1053609685 0 Dentists Dental Services 20 1053609685 0 Dentists Physician Services 00 1053611319 0 JARDELEZA RHEE ANNE 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1053620120 0 SOORYA LATHA V 2018001 9999999 B 10 1053620120 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1053620120 0 Psychologist Psychologist service 00 1053620930 0 KISTENFEGER CAMI J 2016267 9999999 B 10 1053620930 0 2905 N MAIN ST STE G DECATUR IL 625264274 20 1053620930 0 Physician Assistant Only Fluoride varnish 20 1053620930 0 Physician Assistant Only Healthy Kids Services 20 1053620930 0 Physician Assistant Only Physician Services 00 1053622290 0 WALKER HOLLIS 2016225 9999999 B 10 1053622290 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1053622290 0 Physicians Anesthesia Services 20 1053622290 0 Physicians Fluoride varnish 20 1053622290 0 Physicians Healthy Kids Services 20 1053622290 0 Physicians Optical Supplies 20 1053622290 0 Physicians Physician Services 00 1053622399 0 KEBEDE MIKIAS A 2023166 9999999 B 10 1053622399 0 PO BOX 735041 CHICAGO IL 606736519 20 1053622399 0 Physicians Anesthesia Services 20 1053622399 0 Physicians Fluoride varnish 20 1053622399 0 Physicians Healthy Kids Services 20 1053622399 0 Physicians Optical Supplies 20 1053622399 0 Physicians Physician Services 00 1053622647 0 EVENS ZABRINA 2020164 9999999 B 10 1053622647 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1053622647 0 Physicians Anesthesia Services 20 1053622647 0 Physicians Healthy Kids Services 20 1053622647 0 Physicians Optical Supplies 20 1053622647 0 Physicians Physician Services 00 1053622928 0 KAKODKAR AKTA SEHGAL 2015229 9999999 B 10 1053622928 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1053622928 0 Physicians Anesthesia Services 20 1053622928 0 Physicians Healthy Kids Services 20 1053622928 0 Physicians Optical Supplies 20 1053622928 0 Physicians Physician Services 00 1053623330 0 HOLSCHBACH JUSTIN 2013217 9999999 B 10 1053623330 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1053623330 0 Physicians Anesthesia Services 20 1053623330 0 Physicians Fluoride varnish 20 1053623330 0 Physicians Healthy Kids Services 20 1053623330 0 Physicians Optical Supplies 20 1053623330 0 Physicians Physician Services 00 1053623504 0 SHUSTER DMITRY 2017129 9999999 B 10 1053623504 0 PO BOX 3988 CARBONDALE IL 629023988 20 1053623504 0 Physicians Anesthesia Services 20 1053623504 0 Physicians Fluoride varnish 20 1053623504 0 Physicians Healthy Kids Services 20 1053623504 0 Physicians Optical Supplies 20 1053623504 0 Physicians Physician Services 00 1053623686 0 MANZUK MELISSA A 2016012 9999999 B 10 1053623686 0 29373 NETWORK PL CHICAGO IL 606733039 20 1053623686 0 Physician Assistant Only Fluoride varnish 20 1053623686 0 Physician Assistant Only Healthy Kids Services 20 1053623686 0 Physician Assistant Only Physician Services 00 1053623868 0 AHMED MOHAMMED MOHSIN 2017248 9999999 B 10 1053623868 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1053623868 0 Physicians Anesthesia Services 20 1053623868 0 Physicians Healthy Kids Services 20 1053623868 0 Physicians Optical Supplies 20 1053623868 0 Physicians Physician Services 00 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0 350 N WALL ST KANKAKEE IL 609012901 20 1053629881 0 Physicians Anesthesia Services 20 1053629881 0 Physicians Fluoride varnish 20 1053629881 0 Physicians Healthy Kids Services 20 1053629881 0 Physicians Optical Supplies 20 1053629881 0 Physicians Physician Services 00 1053630103 0 TRACY MAURIE 2022182 9999999 B 10 1053630103 0 PO BOX 410823 SAINT LOUIS MO 631410823 20 1053630103 0 Nurse Practitioners Healthy Kids Services 20 1053630103 0 Nurse Practitioners Nurse Practitioners Services 20 1053630103 0 Nurse Practitioners Physician Services 00 1053631267 0 HERMAN CATHERINE 2018334 9999999 B 10 1053631267 0 850 43RD AVE STE 100 MOLINE IL 612658401 20 1053631267 0 Physical Therapists Medical Supplies 20 1053631267 0 Physical Therapists Medical equipment/prosthetic devices 20 1053631267 0 Physical Therapists Physical Therapy Services 00 1053631465 0 RAJKOWSKI SAMUEL 2020034 9999999 B 10 1053631465 0 44000 GARFIELD RD CLINTON TOWNSHI MI 480381125 20 1053631465 0 Physicians Anesthesia 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Psychologist Psychologist service 00 1053694075 0 RUETTIGER ERIN 2018268 9999999 B 10 1053694075 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1053694075 0 Other behavior health professional LCPC/LMFT services 00 1053694828 0 PHAM THERESA 2011258 9999999 B 10 1053694828 0 4647 W 103RD ST STE 1M OAK LAWN IL 604534874 20 1053694828 0 Dentists Dental Services 20 1053694828 0 Dentists Physician Services 00 1053695528 0 MCFEGGAN SARAH E 2003238 9999999 B 10 1053695528 0 603 SALCEDA DR MUNDELEIN IL 600604839 20 1053695528 0 Speech Therapists Medical Supplies 20 1053695528 0 Speech Therapists Medical equipment/prosthetic devices 20 1053695528 0 Speech Therapists Speech Therapy/Pathology Services 00 1053695940 0 WATSON KERRIE AAA 2004188 9999999 B 10 1053695940 0 1101 S CAPITAL OF TEXAS HWY ST WEST LAKE HILLS TX 787466445 20 1053695940 0 Occupational Therapists Occupational Therapy Services 00 1053697235 0 GREAVES MEGHAN 2023248 9999999 B 10 1053697235 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE 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service 00 1053703603 0 CARTER ANNE 2023156 9999999 B 10 1053703603 0 30 N MICHIGAN AVE STE 424 CHICAGO IL 606023844 20 1053703603 0 Clinical Social Worker Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1053703603 0 Clinical Social Worker Social work service 00 1053704262 0 HONG ALEX S 2018352 9999999 B 10 1053704262 0 5777 DEPT CAROL STREAM IL 601220021 20 1053704262 0 Physicians Anesthesia Services 20 1053704262 0 Physicians Healthy Kids Services 20 1053704262 0 Physicians Optical Supplies 20 1053704262 0 Physicians Physician Services 00 1053706150 0 PALMER JENNIFER ROSE 2018050 9999999 B 10 1053706150 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1053706150 0 Psychologist Psychologist service 00 1053706200 0 VOLDEN DANE 2018212 9999999 B 10 1053706200 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1053706200 0 Physicians Anesthesia Services 20 1053706200 0 Physicians Fluoride varnish 20 1053706200 0 Physicians Healthy Kids Services 20 1053706200 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1053708065 0 PO BOX 778912 CHICAGO IL 606778912 20 1053708065 0 Physicians Anesthesia Services 20 1053708065 0 Physicians Fluoride varnish 20 1053708065 0 Physicians Healthy Kids Services 20 1053708065 0 Physicians Optical Supplies 20 1053708065 0 Physicians Physician Services 00 1053708255 0 KIRK KATHRYN 2016259 9999999 B 10 1053708255 0 319 E MADISON ST STE 3B SPRINGFIELD IL 627013124 20 1053708255 0 Other behavior health professional LCPC/LMFT services 00 1053708594 0 BALLARD DAVID H 2019016 9999999 B 10 1053708594 0 510 S KINGSHIGHWAY BLVD SAINT LOUIS MO 631101016 20 1053708594 0 Physicians Anesthesia Services 20 1053708594 0 Physicians Healthy Kids Services 20 1053708594 0 Physicians Optical Supplies 20 1053708594 0 Physicians Physician Services 00 1053708651 0 EISENHART DEBRA 2015352 9999999 B 10 1053708651 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1053708651 0 Registered nurse All Kids application agent 20 1053708651 0 Registered nurse Nursing service 20 1053708651 0 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WADDELL BEAU E 2014330 9999999 B 10 1053713636 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1053713636 0 Physicians Anesthesia Services 20 1053713636 0 Physicians Fluoride varnish 20 1053713636 0 Physicians Healthy Kids Services 20 1053713636 0 Physicians Optical Supplies 20 1053713636 0 Physicians Physician Services 00 1053714147 0 CAPARAS GARCIA CHRISTINE-JUNE 2017338 9999999 B 10 1053714147 0 342 S MILWAUKEE AVE BILLING DEPT. 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Practitioners Nurse Practitioners Services 20 1053717033 0 Nurse Practitioners Physician Services 00 1053717165 0 HEISE STEPHANIE 2021362 9999999 B 10 1053717165 0 1700 E HIGGINS RD STE 600 DES PLAINES IL 600185621 20 1053717165 0 Physician Assistant Only Fluoride varnish 20 1053717165 0 Physician Assistant Only Healthy Kids Services 20 1053717165 0 Physician Assistant Only Physician Services 00 1053717421 0 TURNER SABRINA 2022334 9999999 B 10 1053717421 0 14074 E DUTCH HENRY RD LEWISTOWN IL 615428338 20 1053717421 0 Other behavior health professional LCPC/LMFT services 00 1053718437 0 FREEL JULIA N 2020003 9999999 B 10 1053718437 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1053718437 0 Nurse Practitioners Fluoride varnish 20 1053718437 0 Nurse Practitioners Healthy Kids Services 20 1053718437 0 Nurse Practitioners Nurse Practitioners Services 20 1053718437 0 Nurse Practitioners Physician Services 00 1053718700 0 MURPHY SARA D 2016314 9999999 B 10 1053718700 0 PO BOX 19248 SPRINGFIELD 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1053725531 0 Physicians Physician Services 20 1053725531 0 Physicians Physicians Psychiatric Services 00 1053725606 0 VLAGOS KRISTEN 2017038 9999999 B 10 1053725606 0 7732 SOLUTION CENTER CHICAGO IL 606777007 20 1053725606 0 Dentists Dental Services 20 1053725606 0 Dentists Physician Services 00 1053725788 0 BROWN CARLOS E 2018059 9999999 B 10 1053725788 0 611 W PARK ST URBANA IL 618012529 20 1053725788 0 Physicians Anesthesia Services 20 1053725788 0 Physicians Healthy Kids Services 20 1053725788 0 Physicians Optical Supplies 20 1053725788 0 Physicians Physician Services 00 1053725994 0 HENRIQUEZ HANS J 2017173 9999999 B 10 1053725994 0 1841 W ARMY TRAIL RD ADDISON IL 601011901 20 1053725994 0 Physicians Anesthesia Services 20 1053725994 0 Physicians Fluoride varnish 20 1053725994 0 Physicians Healthy Kids Services 20 1053725994 0 Physicians Optical Supplies 20 1053725994 0 Physicians Physician Services 00 1053726026 0 HOFMEISTER MICHELLE M 2024153 9999999 B 10 1053726026 0 3301 W 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631322907 20 1053745521 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1053745703 0 LEVASSEUR SANCHEZ EMILL 2024219 9999999 B 10 1053745703 0 2261 MARKET ST STE 10450 SAN FRANCISCO CA 941141612 20 1053745703 0 Physicians Anesthesia Services 20 1053745703 0 Physicians Fluoride varnish 20 1053745703 0 Physicians Healthy Kids Services 20 1053745703 0 Physicians Optical Supplies 20 1053745703 0 Physicians Physician Services 00 1053747816 0 BROOKS SARAH W 2016077 9999999 B 10 1053747816 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1053747816 0 Physician Assistant Only Fluoride varnish 20 1053747816 0 Physician Assistant Only Healthy Kids Services 20 1053747816 0 Physician Assistant Only Physician Services 00 1053747899 0 WETTER RACHEL M 2021230 9999999 B 10 1053747899 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1053747899 0 Physical Therapists Medical Supplies 20 1053747899 0 Physical Therapists Medical equipment/prosthetic 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Practitioners Physician Services 00 1053750802 0 ALDRIDGE GEORGINA M 2017186 9999999 B 10 1053750802 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1053750802 0 Physicians Anesthesia Services 20 1053750802 0 Physicians Healthy Kids Services 20 1053750802 0 Physicians Optical Supplies 20 1053750802 0 Physicians Physician Services 20 1053750802 0 Physicians Physicians Psychiatric Services 00 1053750851 0 MACDONALD ASHLEY 2016245 9999999 B 10 1053750851 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1053750851 0 Physicians Anesthesia Services 20 1053750851 0 Physicians Fluoride varnish 20 1053750851 0 Physicians Healthy Kids Services 20 1053750851 0 Physicians Optical Supplies 20 1053750851 0 Physicians Physician Services 00 1053750935 0 KHAN IMRAN 2018205 9999999 B 10 1053750935 0 238 S CONGRESS ST RUSHVILLE IL 626811465 20 1053750935 0 Physicians Anesthesia Services 20 1053750935 0 Physicians Fluoride varnish 20 1053750935 0 Physicians Healthy Kids Services 20 1053750935 0 Physicians Optical Supplies 20 1053750935 0 Physicians Physician Services 00 1053751719 0 SHARMA BIPIN 2014083 9999999 B 10 1053751719 0 2019 S CHICAGO ST JOLIET IL 604363168 20 1053751719 0 Other behavior health professional LCPC/LMFT services 00 1053753020 0 CHESLA ANN M 2005193 9999999 B 10 1053753020 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1053753020 0 Speech Therapists Medical Supplies 20 1053753020 0 Speech Therapists Medical equipment/prosthetic devices 20 1053753020 0 Speech Therapists Speech Therapy/Pathology Services 00 1053753129 0 GERA GOPAL ANJALI 2019274 9999999 B 10 1053753129 0 5777 DEPT CAROL STREAM IL 601220021 20 1053753129 0 Physicians Anesthesia Services 20 1053753129 0 Physicians Healthy Kids Services 20 1053753129 0 Physicians Optical Supplies 20 1053753129 0 Physicians Physician Services 20 1053753129 0 Physicians Physicians Psychiatric Services 00 1053753608 0 RAO RAGHAVENDRA 2022032 9999999 B 10 1053753608 0 222 N PACIFIC COAST HWY STE 21 EL SEGUNDO CA 902455639 20 1053753608 0 Physicians Anesthesia Services 20 1053753608 0 Physicians Healthy Kids Services 20 1053753608 0 Physicians Optical Supplies 20 1053753608 0 Physicians Physician Services 00 1053754549 0 SPAGGIARI MARIO 2016306 9999999 B 10 1053754549 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1053754549 0 Physicians Anesthesia Services 20 1053754549 0 Physicians Healthy Kids Services 20 1053754549 0 Physicians Optical Supplies 20 1053754549 0 Physicians Physician Services 00 1053755660 0 SHAHID MADHIA 2023263 9999999 B 10 1053755660 0 3200 E CAMELBACK RD STE 250 PHOENIX AZ 850182327 20 1053755660 0 Physicians Anesthesia Services 20 1053755660 0 Physicians Fluoride varnish 20 1053755660 0 Physicians Healthy Kids Services 20 1053755660 0 Physicians Optical Supplies 20 1053755660 0 Physicians Physician Services 00 1053755926 0 REIS JESSICA A 2022017 9999999 B 10 1053755926 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1053755926 0 Physicians Anesthesia Services 20 1053755926 0 Physicians Healthy Kids Services 20 1053755926 0 Physicians Optical Supplies 20 1053755926 0 Physicians Physician Services 20 1053755926 0 Physicians Physicians Psychiatric Services 00 1053757161 0 NIMTZ ABIGAIL 2022146 9999999 B 10 1053757161 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1053757161 0 Speech Therapists Medical Supplies 20 1053757161 0 Speech Therapists Medical equipment/prosthetic devices 20 1053757161 0 Speech Therapists Speech Therapy/Pathology Services 00 1053757484 0 MUEGGE BRIAN D 2019309 9999999 B 10 1053757484 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1053757484 0 Physicians Anesthesia Services 20 1053757484 0 Physicians Fluoride varnish 20 1053757484 0 Physicians Healthy Kids Services 20 1053757484 0 Physicians Optical Supplies 20 1053757484 0 Physicians Physician Services 00 1053758029 0 BAYOUMI MOHAMED 2016183 9999999 B 10 1053758029 0 5777 DEPT CAROL STREAM IL 601220021 20 1053758029 0 Physicians Anesthesia Services 20 1053758029 0 Physicians Healthy Kids Services 20 1053758029 0 Physicians Optical Supplies 20 1053758029 0 Physicians Physician Services 00 1053758144 0 CHAPLIN KELLY 2021020 9999999 B 10 1053758144 0 5777 DEPT CAROL STREAM IL 601220021 20 1053758144 0 Physical Therapists Medical Supplies 20 1053758144 0 Physical Therapists Medical equipment/prosthetic devices 20 1053758144 0 Physical Therapists Physical Therapy Services 00 1053758557 0 WELCH SARAH KAY 2016182 9999999 B 10 1053758557 0 PO BOX 775257 CHICAGO IL 606775257 20 1053758557 0 Physicians Anesthesia Services 20 1053758557 0 Physicians Fluoride varnish 20 1053758557 0 Physicians Healthy Kids Services 20 1053758557 0 Physicians Optical Supplies 20 1053758557 0 Physicians Physician Services 00 1053759142 0 CHOWDHURY ASM L 2017305 9999999 B 10 1053759142 0 500 PORTER AVE AURORA MO 656052365 20 1053759142 0 Physicians Anesthesia Services 20 1053759142 0 Physicians Fluoride varnish 20 1053759142 0 Physicians Healthy Kids Services 20 1053759142 0 Physicians Optical Supplies 20 1053759142 0 Physicians Physician Services 00 1053759191 0 DIETZ-HARRIS DANIELLE 2013161 9999999 B 10 1053759191 0 2374 SHERMER RD NORTHBROOK IL 600626729 20 1053759191 0 Speech Therapists Medical Supplies 20 1053759191 0 Speech Therapists Medical equipment/prosthetic devices 20 1053759191 0 Speech Therapists Speech Therapy/Pathology Services 00 1053760132 0 RICHGELS JOHN 2018352 9999999 B 10 1053760132 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1053760132 0 Physicians Anesthesia Services 20 1053760132 0 Physicians Healthy Kids Services 20 1053760132 0 Physicians Optical Supplies 20 1053760132 0 Physicians Physician Services 00 1053760355 0 KASPER ROBERT J 2017080 9999999 B 10 1053760355 0 5777 DEPT CAROL STREAM IL 601228942 20 1053760355 0 Physicians Anesthesia Services 20 1053760355 0 Physicians Fluoride varnish 20 1053760355 0 Physicians Healthy Kids Services 20 1053760355 0 Physicians Optical Supplies 20 1053760355 0 Physicians Physician Services 00 1053761122 0 HANOWSKY STEPHEN 2022140 9999999 B 10 1053761122 0 175 E HOUSTON ST SAN ANTONIO TX 782052255 20 1053761122 0 Optometrists Optical Supplies 20 1053761122 0 Optometrists Optometric Services 20 1053761122 0 Optometrists Physician Services 00 1053761221 0 CHEN JUSTIN C 2020182 9999999 B 10 1053761221 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1053761221 0 Physicians Anesthesia Services 20 1053761221 0 Physicians Fluoride varnish 20 1053761221 0 Physicians Healthy Kids Services 20 1053761221 0 Physicians Optical Supplies 20 1053761221 0 Physicians Physician Services 00 1053761346 0 KUMAR SHIVANI 2018351 9999999 B 10 1053761346 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1053761346 0 Physicians Anesthesia Services 20 1053761346 0 Physicians Healthy Kids Services 20 1053761346 0 Physicians Optical Supplies 20 1053761346 0 Physicians Physician Services 20 1053761346 0 Physicians Physicians Psychiatric Services 00 1053761445 0 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Physicians Healthy Kids Services 20 1053762807 0 Physicians Optical Supplies 20 1053762807 0 Physicians Physician Services 20 1053762807 0 Physicians Physicians Psychiatric Services 00 1053763177 0 MCGUIRE KEVIN 2016285 9999999 B 10 1053763177 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1053763177 0 Physical Therapists Medical Supplies 20 1053763177 0 Physical Therapists Medical equipment/prosthetic devices 20 1053763177 0 Physical Therapists Physical Therapy Services 00 1053763664 0 SWANSON KYLE D 2019150 9999999 B 10 1053763664 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1053763664 0 Podiatrists Podiatric Services 00 1053764365 0 STEPHENS MICHELLE M 2016242 9999999 B 10 1053764365 0 124 SW ADAMS ST FL 2 PEORIA IL 616021308 20 1053764365 0 Nurse Practitioners Fluoride varnish 20 1053764365 0 Nurse Practitioners Healthy Kids Services 20 1053764365 0 Nurse Practitioners Nurse Practitioners Services 20 1053764365 0 Nurse Practitioners Physician Services 00 1053764878 0 PATEL PINKI 2017182 9999999 B 10 1053764878 0 5777 DEPT CAROL STREAM IL 601220021 20 1053764878 0 Nurse Practitioners Fluoride varnish 20 1053764878 0 Nurse Practitioners Healthy Kids Services 20 1053764878 0 Nurse Practitioners Nurse Practitioners Services 20 1053764878 0 Nurse Practitioners Physician Services 00 1053764936 0 DICOSTANZO MICHELLE 2021325 9999999 B 10 1053764936 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1053764936 0 Physicians Anesthesia Services 20 1053764936 0 Physicians Fluoride varnish 20 1053764936 0 Physicians Healthy Kids Services 20 1053764936 0 Physicians Optical Supplies 20 1053764936 0 Physicians Physician Services 00 1053765040 0 HO CHRISTOPHER ALLEN 2018340 9999999 B 10 1053765040 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1053765040 0 Physicians Anesthesia Services 20 1053765040 0 Physicians Fluoride varnish 20 1053765040 0 Physicians Healthy Kids Services 20 1053765040 0 Physicians Optical Supplies 20 1053765040 0 Physicians Physician Services 00 1053765172 0 SILVA EMANUEL 2022300 9999999 B 10 1053765172 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1053765172 0 Physicians Anesthesia Services 20 1053765172 0 Physicians Healthy Kids Services 20 1053765172 0 Physicians Optical Supplies 20 1053765172 0 Physicians Physician Services 00 1053765214 0 LEHMANN JESSICA 2020036 9999999 B 10 1053765214 0 PO BOX 776084 CHICAGO IL 606776084 20 1053765214 0 Physicians Anesthesia Services 20 1053765214 0 Physicians Healthy Kids Services 20 1053765214 0 Physicians Optical Supplies 20 1053765214 0 Physicians Physician Services 00 1053765222 0 RAY BRITTANY E 2018051 9999999 B 10 1053765222 0 7358 N LINCOLN AVE STE 170 LINCOLNWOOD IL 607121710 20 1053765222 0 Speech Therapists Medical Supplies 20 1053765222 0 Speech Therapists Medical equipment/prosthetic devices 20 1053765222 0 Speech Therapists Speech Therapy/Pathology Services 00 1053765685 0 CORAGLIO VICTORIA J 2018253 9999999 B 10 1053765685 0 3601 SW 160TH AVE STE 250 SUITE 250 MIRAMAR FL 330276314 20 1053765685 0 Physicians Anesthesia Services 20 1053765685 0 Physicians Fluoride varnish 20 1053765685 0 Physicians Healthy Kids Services 20 1053765685 0 Physicians Optical Supplies 20 1053765685 0 Physicians Physician Services 00 1053766550 0 JOSE JESSICA N 2016190 9999999 B 10 1053766550 0 3450 LACEY RD DOWNERS GROVE IL 605155430 20 1053766550 0 Optometrists Optical Supplies 20 1053766550 0 Optometrists Optometric Services 20 1053766550 0 Optometrists Physician Services 00 1053766840 0 MUNOZ ANASTASIA 2019213 9999999 B 10 1053766840 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1053766840 0 Physicians Anesthesia Services 20 1053766840 0 Physicians Fluoride varnish 20 1053766840 0 Physicians Healthy Kids Services 20 1053766840 0 Physicians Optical Supplies 20 1053766840 0 Physicians Physician Services 00 1053767046 0 BUGENHAGEN SCOTT M 2019296 9999999 B 10 1053767046 0 PO BOX 60352 SAINT LOUIS MO 631600352 20 1053767046 0 Physicians Anesthesia Services 20 1053767046 0 Physicians Healthy Kids Services 20 1053767046 0 Physicians Optical Supplies 20 1053767046 0 Physicians Physician Services 00 1053767970 0 BOYD DANNA J 2016293 9999999 B 10 1053767970 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1053767970 0 Nurse Practitioners Fluoride varnish 20 1053767970 0 Nurse Practitioners Healthy Kids Services 20 1053767970 0 Nurse Practitioners Nurse Practitioners Services 20 1053767970 0 Nurse Practitioners Physician Services 00 1053768051 0 MILKEVITCH BRETT 2016130 9999999 B 10 1053768051 0 PO BOX 781076 DETROIT MI 482781076 20 1053768051 0 Nurse Practitioners Fluoride varnish 20 1053768051 0 Nurse Practitioners Healthy Kids Services 20 1053768051 0 Nurse Practitioners Nurse Practitioners Services 20 1053768051 0 Nurse Practitioners Physician Services 00 1053768234 0 HEMMER JARROD 2020190 9999999 B 10 1053768234 0 621 S NEW BALLAS RD STE 7020 SAINT LOUIS MO 631418232 20 1053768234 0 Nurse Practitioners Healthy Kids Services 20 1053768234 0 Nurse Practitioners 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varnish 20 1053775239 0 Physicians Healthy Kids Services 20 1053775239 0 Physicians Optical Supplies 20 1053775239 0 Physicians Physician Services 00 1053776179 0 PERKINS DEBORAH 2024119 9999999 B 10 1053776179 0 607 S NEW BALLAS RD STE 3300 SAINT LOUIS MO 631418219 20 1053776179 0 Nurse Practitioners Fluoride varnish 20 1053776179 0 Nurse Practitioners Healthy Kids Services 20 1053776179 0 Nurse Practitioners Nurse Practitioners Services 20 1053776179 0 Nurse Practitioners Physician Services 00 1053778456 0 ANTICEVICH JAMIE 2018155 9999999 B 10 1053778456 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1053778456 0 Physician Assistant Only Fluoride varnish 20 1053778456 0 Physician Assistant Only Healthy Kids Services 20 1053778456 0 Physician Assistant Only Physician Services 00 1053778464 0 WOODWORTH KYLE P 2017296 9999999 B 10 1053778464 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1053778464 0 Physician Assistant Only Fluoride varnish 20 1053778464 0 Physician Assistant Only Healthy Kids Services 20 1053778464 0 Physician Assistant Only Physician Services 00 1053779751 0 JAHNS CORINNE R 2016060 9999999 B 10 1053779751 0 2239 E COOK ST SPRINGFIELD IL 627031944 20 1053779751 0 Nurse Practitioners Fluoride varnish 20 1053779751 0 Nurse Practitioners Healthy Kids Services 20 1053779751 0 Nurse Practitioners Nurse Practitioners Services 20 1053779751 0 Nurse Practitioners Physician Services 00 1053780080 0 PATEL RIDHI 2018211 9999999 B 10 1053780080 0 1950 OLD GALLOWS RD STE 520 VIENNA VA 221823970 20 1053780080 0 Optometrists Optical Supplies 20 1053780080 0 Optometrists Optometric Services 20 1053780080 0 Optometrists Physician Services 00 1053781278 0 MUELLER KATIE T 2016095 9999999 B 10 1053781278 0 104 MARIE WAY NORMAL IL 617613220 20 1053781278 0 Speech Therapists Medical Supplies 20 1053781278 0 Speech Therapists Medical equipment/prosthetic devices 20 1053781278 0 Speech Therapists Speech Therapy/Pathology Services 00 1053782276 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professional Social work service 00 1053785675 0 BARRETT ABBY 2021251 9999999 B 10 1053785675 0 727 E COURT ST PARIS IL 619442460 20 1053785675 0 Clinical Social Worker Social work service 00 1053785790 0 KROOS AMY L 2016001 9999999 B 10 1053785790 0 124 SW ADAMS ST PEORIA IL 616021308 20 1053785790 0 Nurse Practitioners Healthy Kids Services 20 1053785790 0 Nurse Practitioners Nurse Practitioners Services 20 1053785790 0 Nurse Practitioners Physician Services 00 1053785956 0 ARMS ALANA 2022334 9999999 B 10 1053785956 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1053785956 0 Clinical Social Worker Social work service 00 1053786269 0 POLLARD SHELLI 2020340 9999999 B 10 1053786269 0 PO BOX 1861 WOODSTOCK IL 600981861 20 1053786269 0 Clinical Social Worker Social work service 00 1053787234 0 KIENE JEANE E 2020168 9999999 B 10 1053787234 0 901 PATIENTS FIRST DR WASHINGTON MO 630904700 20 1053787234 0 Nurse Practitioners Fluoride varnish 20 1053787234 0 Nurse Practitioners Healthy Kids Services 20 1053787234 0 Nurse Practitioners Nurse Practitioners Services 20 1053787234 0 Nurse Practitioners Physician Services 00 1053787499 0 VIDA ALISON 2024149 9999999 B 10 1053787499 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1053787499 0 Nurse Practitioners Healthy Kids Services 20 1053787499 0 Nurse Practitioners Nurse Practitioners Services 20 1053787499 0 Nurse Practitioners Physician Services 00 1053787630 0 NALEWAY AIMEE L 2016001 9999999 B 10 1053787630 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1053787630 0 Physician Assistant Only Fluoride varnish 20 1053787630 0 Physician Assistant Only Healthy Kids Services 20 1053787630 0 Physician Assistant Only Physician Services 00 1053788430 0 MCCARTHY KATIJA R 2015251 9999999 B 10 1053788430 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1053788430 0 Nurse Practitioners All Kids application agent 20 1053788430 0 Nurse Practitioners Fluoride varnish 20 1053788430 0 Nurse Practitioners Healthy Kids Services 20 1053788430 0 Nurse Practitioners Nurse Practitioners Services 20 1053788430 0 Nurse Practitioners Physician Services 00 1053789149 0 DERBY REBECCA D 2023013 9999999 B 10 1053789149 0 5121 MARYLAND WAY STE 300 BRENTWOOD TN 370277516 20 1053789149 0 Nurse Practitioners Healthy Kids Services 20 1053789149 0 Nurse Practitioners Nurse Practitioners Services 20 1053789149 0 Nurse Practitioners Physician Services 00 1053790139 0 MA DI 2018124 9999999 B 10 1053790139 0 29373 NETWORK PL CHICAGO IL 606733039 20 1053790139 0 Physicians Anesthesia Services 20 1053790139 0 Physicians Fluoride varnish 20 1053790139 0 Physicians Healthy Kids Services 20 1053790139 0 Physicians Optical Supplies 20 1053790139 0 Physicians Physician Services 00 1053790170 0 MOSAMMAPARAST NIMA 2023139 9999999 B 10 1053790170 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1053790170 0 Physicians Anesthesia Services 20 1053790170 0 Physicians Healthy Kids Services 20 1053790170 0 Physicians Optical Supplies 20 1053790170 0 Physicians Physician Services 00 1053790345 0 STULL CATHERINE LYNN 2016012 9999999 B 10 1053790345 0 100 CROSSING BLVD STE 300 FRAMINGHAM MA 017025555 20 1053790345 0 Nurse Practitioners Fluoride varnish 20 1053790345 0 Nurse Practitioners Healthy Kids Services 20 1053790345 0 Nurse Practitioners Nurse Practitioners Services 20 1053790345 0 Nurse Practitioners Physician Services 00 1053790816 0 KOMOLAFE GRACE IYABO 2022080 9999999 B 10 1053790816 0 119 S WESTERN AVE UNIT 1 CHICAGO IL 606124644 20 1053790816 0 Physicians Anesthesia Services 20 1053790816 0 Physicians Fluoride varnish 20 1053790816 0 Physicians Healthy Kids Services 20 1053790816 0 Physicians Optical Supplies 20 1053790816 0 Physicians Physician Services 00 1053791848 0 LEWANDOWSKI ALYSSA S 2019333 9999999 B 10 1053791848 0 800 E LOCUST ST OLNEY IL 624502553 20 1053791848 0 Physicians Anesthesia Services 20 1053791848 0 Physicians Fluoride varnish 20 1053791848 0 Physicians Healthy Kids Services 20 1053791848 0 Physicians Optical Supplies 20 1053791848 0 Physicians Physician Services 00 1053792325 0 BLIGARD KATHERINE 2018179 9999999 B 10 1053792325 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1053792325 0 Physicians Anesthesia Services 20 1053792325 0 Physicians Healthy Kids Services 20 1053792325 0 Physicians Optical Supplies 20 1053792325 0 Physicians Physician Services 00 1053792515 0 FAMINA SVETLANA 2023040 9999999 B 10 1053792515 0 1530 LONE OAK RD PADUCAH KY 420037901 20 1053792515 0 Physicians Anesthesia Services 20 1053792515 0 Physicians Healthy Kids Services 20 1053792515 0 Physicians Optical Supplies 20 1053792515 0 Physicians Physician Services 20 1053792515 0 Physicians Physicians Psychiatric Services 00 1053792846 0 DALEY CATHERINE 2024275 9999999 B 10 1053792846 0 5777 DEPT CAROL STREAM IL 601220021 20 1053792846 0 Physicians Anesthesia Services 20 1053792846 0 Physicians Healthy Kids Services 20 1053792846 0 Physicians Optical Supplies 20 1053792846 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Physicians Optical Supplies 20 1053793273 0 Physicians Physician Services 00 1053793315 0 KAHN MAX 2019266 9999999 B 10 1053793315 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1053793315 0 Physicians Anesthesia Services 20 1053793315 0 Physicians Healthy Kids Services 20 1053793315 0 Physicians Optical Supplies 20 1053793315 0 Physicians Physician Services 00 1053793703 0 DAY RYAN 2022154 9999999 B 10 1053793703 0 PO BOX 43230 PHOENIX AZ 850803230 20 1053793703 0 Physicians Anesthesia Services 20 1053793703 0 Physicians Healthy Kids Services 20 1053793703 0 Physicians Optical Supplies 20 1053793703 0 Physicians Physician Services 00 1053794792 0 HARRISON JAMES 2022300 9999999 B 10 1053794792 0 PO BOX 1346 PEORIA IL 616541346 20 1053794792 0 Physicians Anesthesia Services 20 1053794792 0 Physicians Healthy Kids Services 20 1053794792 0 Physicians Optical Supplies 20 1053794792 0 Physicians Physician Services 20 1053794792 0 Physicians Physicians Psychiatric Services 00 1053794859 0 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Physicians Optical Supplies 20 1053798884 0 Physicians Physician Services 00 1053798967 0 SCHUMACHER NICHOLAS P 2023159 9999999 B 10 1053798967 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1053798967 0 Nurse Practitioners Healthy Kids Services 20 1053798967 0 Nurse Practitioners Nurse Practitioners Services 20 1053798967 0 Nurse Practitioners Physician Services 00 1053799015 0 RUSCH DANA 2015361 9999999 B 10 1053799015 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1053799015 0 Psychologist Psychologist service 00 1053799072 0 RAMAKRISHNAN ADITI 2022237 9999999 B 10 1053799072 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1053799072 0 Physicians Anesthesia Services 20 1053799072 0 Physicians Fluoride varnish 20 1053799072 0 Physicians Healthy Kids Services 20 1053799072 0 Physicians Optical Supplies 20 1053799072 0 Physicians Physician Services 00 1053799163 0 ASONGWE FRIDA 2017279 9999999 B 10 1053799163 0 17746 OAK PARK AVE TINLEY PARK IL 604773936 20 1053799163 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1053799296 0 LUPU SIMONA I 2021088 9999999 B 10 1053799296 0 268 W HOSPITALITY LN STE 300 SAN BERNARDINO CA 924083234 20 1053799296 0 Physicians Anesthesia Services 20 1053799296 0 Physicians Healthy Kids Services 20 1053799296 0 Physicians Optical Supplies 20 1053799296 0 Physicians Physician Services 00 1053799460 0 TSAUR JYH-YAU 2022213 9999999 B 10 1053799460 0 1406 6TH AVE N SAINT CLOUD MN 563031900 20 1053799460 0 Physicians Anesthesia Services 20 1053799460 0 Physicians Fluoride varnish 20 1053799460 0 Physicians Healthy Kids Services 20 1053799460 0 Physicians Optical Supplies 20 1053799460 0 Physicians Physician Services 00 1053800011 0 AKRAM UMAIMA 2020019 9999999 B 10 1053800011 0 29373 NETWORK PL CHICAGO IL 606733039 20 1053800011 0 Physicians Anesthesia Services 20 1053800011 0 Physicians Fluoride varnish 20 1053800011 0 Physicians Healthy Kids 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COUNTY FARM RD WHEATON IL 601873977 20 1053801258 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1053801464 0 DANG XUAN KHOI TRAN 2020231 9999999 B 10 1053801464 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1053801464 0 Physicians Anesthesia Services 20 1053801464 0 Physicians Healthy Kids Services 20 1053801464 0 Physicians Optical Supplies 20 1053801464 0 Physicians Physician Services 00 1053802538 0 VALLOT PATRICE L 2020035 9999999 B 10 1053802538 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1053802538 0 Physicians Anesthesia Services 20 1053802538 0 Physicians Healthy Kids Services 20 1053802538 0 Physicians Optical Supplies 20 1053802538 0 Physicians Physician Services 00 1053802975 0 SCHAD AIMEE 2019190 9999999 B 10 1053802975 0 29373 NETWORK PL CHICAGO IL 606733039 20 1053802975 0 Physicians Anesthesia Services 20 1053802975 0 Physicians Fluoride varnish 20 1053802975 0 Physicians Healthy Kids Services 20 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1053806844 0 500 PORTER AVE AURORA MO 656052365 20 1053806844 0 Physicians Anesthesia Services 20 1053806844 0 Physicians Healthy Kids Services 20 1053806844 0 Physicians Optical Supplies 20 1053806844 0 Physicians Physician Services 00 1053806927 0 MARKOV ALEXANDER M 2022245 9999999 B 10 1053806927 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1053806927 0 Physicians Anesthesia Services 20 1053806927 0 Physicians Fluoride varnish 20 1053806927 0 Physicians Healthy Kids Services 20 1053806927 0 Physicians Optical Supplies 20 1053806927 0 Physicians Physician Services 00 1053807065 0 JOSHUA LEHR 2023170 9999999 B 10 1053807065 0 PO BOX 5081 JANESVILLE WI 535475081 20 1053807065 0 Physical Therapists Medical Supplies 20 1053807065 0 Physical Therapists Medical equipment/prosthetic devices 20 1053807065 0 Physical Therapists Physical Therapy Services 00 1053808220 0 BOEVERS SOLVERSON EMILY 2022323 9999999 B 10 1053808220 0 818 5TH AVE STE 200 DES MOINES IA 503091307 20 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M 2022255 9999999 B 10 1063038461 0 2407 N MILWAUKEE AVE STE 101 CHICAGO IL 606476859 20 1063038461 0 Dentists Dental Services 20 1063038461 0 Dentists Physician Services 00 1063038669 0 FORBRIGER ARTHUR W 2023265 9999999 B 10 1063038669 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1063038669 0 Physicians Anesthesia Services 20 1063038669 0 Physicians Healthy Kids Services 20 1063038669 0 Physicians Optical Supplies 20 1063038669 0 Physicians Physician Services 00 1063039311 0 FLENTGE GAVIN L 2024066 9999999 B 10 1063039311 0 2100 MADISON AVE STE 301 GRANITE CITY IL 620404713 20 1063039311 0 Nurse Practitioners Healthy Kids Services 20 1063039311 0 Nurse Practitioners Nurse Practitioners Services 20 1063039311 0 Nurse Practitioners Physician Services 00 1063039378 0 RICHARDSON SAMANTHA 2021092 9999999 B 10 1063039378 0 PO BOX 5009 BRENTWOOD TN 370245009 20 1063039378 0 Nurse Practitioners Fluoride varnish 20 1063039378 0 Nurse Practitioners Healthy Kids Services 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Services 00 1063040673 0 BADDOUR JOHN 2020177 9999999 B 10 1063040673 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1063040673 0 Physicians Anesthesia Services 20 1063040673 0 Physicians Healthy Kids Services 20 1063040673 0 Physicians Optical Supplies 20 1063040673 0 Physicians Physician Services 00 1063040855 0 SUCHY JORDAN M 2020177 9999999 B 10 1063040855 0 PO BOX 3039 OAK BROOK IL 605223039 20 1063040855 0 Physicians Anesthesia Services 20 1063040855 0 Physicians Healthy Kids Services 20 1063040855 0 Physicians Optical Supplies 20 1063040855 0 Physicians Physician Services 20 1063040855 0 Physicians Physicians Psychiatric Services 00 1063040889 0 NGUYEN DOAN V 2023286 9999999 B 10 1063040889 0 238 S CONGRESS ST RUSHVILLE IL 626811465 20 1063040889 0 Physicians Anesthesia Services 20 1063040889 0 Physicians Fluoride varnish 20 1063040889 0 Physicians Healthy Kids Services 20 1063040889 0 Physicians Optical Supplies 20 1063040889 0 Physicians Physician Services 00 1063042844 0 ADEYEMI OLAYEMI 2020246 9999999 B 10 1063042844 0 17746 OAK PARK AVE TINLEY PARK IL 604773936 20 1063042844 0 Nurse Practitioners Fluoride varnish 20 1063042844 0 Nurse Practitioners Healthy Kids Services 20 1063042844 0 Nurse Practitioners Nurse Practitioners Services 20 1063042844 0 Nurse Practitioners Physician Services 00 1063043180 0 CORBIN CATHERINE M 2024047 9999999 B 10 1063043180 0 822 MEADOWRIDGE DR AURORA IL 605045356 20 1063043180 0 Other behavior health professional LCPC/LMFT services 00 1063046092 0 OGUNFOWOKAN MAYOWA 2020139 9999999 B 10 1063046092 0 5777 DEPT CAROL STREAM IL 601220021 20 1063046092 0 Nurse Practitioners Healthy Kids Services 20 1063046092 0 Nurse Practitioners Nurse Practitioners Services 20 1063046092 0 Nurse Practitioners Physician Services 00 1063046464 0 WAGNER DARA M 2021250 9999999 B 10 1063046464 0 180 S MAIN ST CANTON IL 615202608 20 1063046464 0 Nurse Practitioners Fluoride varnish 20 1063046464 0 Nurse Practitioners Healthy Kids Services 20 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NATALIA 2020240 9999999 B 10 1063049138 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1063049138 0 Physicians Anesthesia Services 20 1063049138 0 Physicians Fluoride varnish 20 1063049138 0 Physicians Healthy Kids Services 20 1063049138 0 Physicians Optical Supplies 20 1063049138 0 Physicians Physician Services 00 1063049468 0 ESPINOSA NICOLAS M 2020175 9999999 B 10 1063049468 0 4698 DEPT CAROL STREAM IL 601220021 20 1063049468 0 Physicians Anesthesia Services 20 1063049468 0 Physicians Healthy Kids Services 20 1063049468 0 Physicians Optical Supplies 20 1063049468 0 Physicians Physician Services 00 1063049898 0 ZAKIKHANI ARYANA 2020301 9999999 B 10 1063049898 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1063049898 0 Physicians Anesthesia Services 20 1063049898 0 Physicians Fluoride varnish 20 1063049898 0 Physicians Healthy Kids Services 20 1063049898 0 Physicians Optical Supplies 20 1063049898 0 Physicians Physician Services 00 1063052231 0 WALLS BETHANY 2023115 9999999 B 10 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0 Physicians Anesthesia Services 20 1063445864 0 Physicians Healthy Kids Services 20 1063445864 0 Physicians Optical Supplies 20 1063445864 0 Physicians Physician Services 00 1063446128 0 KEPP PHILIP B. 1981258 9999999 B 10 1063446128 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1063446128 0 Dentists Dental Services 20 1063446128 0 Dentists Physician Services 00 1063446193 0 BERLIN RICHARD 1992183 9999999 B 10 1063446193 0 611 W PARK ST URBANA IL 618012529 20 1063446193 0 Physicians Anesthesia Services 20 1063446193 0 Physicians Healthy Kids Services 20 1063446193 0 Physicians Optical Supplies 20 1063446193 0 Physicians Physician Services 00 1063446318 0 FOGO SHANE 2004245 9999999 B 10 1063446318 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1063446318 0 Physicians Anesthesia Services 20 1063446318 0 Physicians Fluoride varnish 20 1063446318 0 Physicians Healthy Kids Services 20 1063446318 0 Physicians Optical Supplies 20 1063446318 0 Physicians Physician Services 00 1063447803 0 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0 BOUTROS RAMI A 2011198 9999999 B 10 1063477024 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1063477024 0 Physicians Anesthesia Services 20 1063477024 0 Physicians Fluoride varnish 20 1063477024 0 Physicians Healthy Kids Services 20 1063477024 0 Physicians Optical Supplies 20 1063477024 0 Physicians Physician Services 00 1063477057 0 SCHROEDER KRISTOPHER M 2007182 9999999 B 10 1063477057 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1063477057 0 Physicians Anesthesia Services 20 1063477057 0 Physicians Healthy Kids Services 20 1063477057 0 Physicians Optical Supplies 20 1063477057 0 Physicians Physician Services 00 1063477073 0 GREIST ANNE 1985001 9999999 B 10 1063477073 0 8326 NAAB RD INDIANAPOLIS IN 462601920 20 1063477073 0 Physicians Anesthesia Services 20 1063477073 0 Physicians Fluoride varnish 20 1063477073 0 Physicians Healthy Kids Services 20 1063477073 0 Physicians Optical Supplies 20 1063477073 0 Physicians Physician Services 00 1063477438 0 KERN BRIAN 1986182 9999999 B 10 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WI 535625531 20 1063480291 0 Physicians Anesthesia Services 20 1063480291 0 Physicians Healthy Kids Services 20 1063480291 0 Physicians Optical Supplies 20 1063480291 0 Physicians Physician Services 00 1063480630 0 WHITFORD THEODORE 2022364 9999999 B 10 1063480630 0 1000 N ALLEN ST ROBINSON IL 624541114 20 1063480630 0 Physicians Anesthesia Services 20 1063480630 0 Physicians Healthy Kids Services 20 1063480630 0 Physicians Optical Supplies 20 1063480630 0 Physicians Physician Services 00 1063481398 0 ROSNER HOWARD M 2020212 9999999 B 10 1063481398 0 930 RIDGEBROOK RD FL 3 SPARKS GLENCOE MD 211529481 20 1063481398 0 Physicians Anesthesia Services 20 1063481398 0 Physicians Healthy Kids Services 20 1063481398 0 Physicians Optical Supplies 20 1063481398 0 Physicians Physician Services 00 1063481802 0 CROTTY STEPHEN 2003182 9999999 B 10 1063481802 0 801 S WASHINGTON ST NAPERVILLE IL 605407430 20 1063481802 0 Physicians Anesthesia Services 20 1063481802 0 Physicians Fluoride varnish 20 1063481802 0 Physicians Healthy Kids Services 20 1063481802 0 Physicians Optical Supplies 20 1063481802 0 Physicians Physician Services 00 1063482073 0 VAZQUEZ JOHNNY 2022109 9999999 B 10 1063482073 0 PO BOX 10010 GLENDALE AZ 853180010 20 1063482073 0 Physicians Anesthesia Services 20 1063482073 0 Physicians Healthy Kids Services 20 1063482073 0 Physicians Optical Supplies 20 1063482073 0 Physicians Physician Services 00 1063483139 0 HAFENRICHTER DANIEL G 2023235 9999999 B 10 1063483139 0 3015 N BALLAS RD SAINT LOUIS MO 631312329 20 1063483139 0 Physicians Anesthesia Services 20 1063483139 0 Physicians Healthy Kids Services 20 1063483139 0 Physicians Optical Supplies 20 1063483139 0 Physicians Physician Services 00 1063484616 0 COHLAN BARBARA A 1986213 9999999 B 10 1063484616 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1063484616 0 Physicians Anesthesia Services 20 1063484616 0 Physicians Fluoride varnish 20 1063484616 0 Physicians Healthy Kids Services 20 1063484616 0 Physicians Optical Supplies 20 1063484616 0 Physicians Physician Services 00 1063484764 0 PARASU NARAYANA R 2018111 9999999 B 10 1063484764 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1063484764 0 Physicians Anesthesia Services 20 1063484764 0 Physicians Fluoride varnish 20 1063484764 0 Physicians Healthy Kids Services 20 1063484764 0 Physicians Optical Supplies 20 1063484764 0 Physicians Physician Services 00 1063485746 0 STEHMAN CHRISTINE R 2011305 9999999 B 10 1063485746 0 124 SW ADAMS ST PEORIA IL 616021308 20 1063485746 0 Physicians Anesthesia Services 20 1063485746 0 Physicians Healthy Kids Services 20 1063485746 0 Physicians Optical Supplies 20 1063485746 0 Physicians Physician Services 00 1063485779 0 SHELLINGTON DAVID K 2017225 9999999 B 10 1063485779 0 1500 CONCORD TER SUNRISE FL 333232815 20 1063485779 0 Physicians Anesthesia Services 20 1063485779 0 Physicians Fluoride varnish 20 1063485779 0 Physicians Healthy Kids Services 20 1063485779 0 Physicians 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Services 00 1063487023 0 WELLS HOWARD 2023348 9999999 B 10 1063487023 0 8686 NEW TRAILS DR THE WOODLANDS TX 773811188 20 1063487023 0 Physicians Anesthesia Services 20 1063487023 0 Physicians Fluoride varnish 20 1063487023 0 Physicians Healthy Kids Services 20 1063487023 0 Physicians Optical Supplies 20 1063487023 0 Physicians Physician Services 00 1063487502 0 GRAU MARGARET A 2016047 9999999 B 10 1063487502 0 1600 DEMPSTER ST STE 216 PARK RIDGE IL 600681172 20 1063487502 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1063488138 0 MATHUR SAMEER K 2005244 9999999 B 10 1063488138 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1063488138 0 Physicians Anesthesia Services 20 1063488138 0 Physicians Fluoride varnish 20 1063488138 0 Physicians Healthy Kids Services 20 1063488138 0 Physicians Optical Supplies 20 1063488138 0 Physicians Physician Services 00 1063488419 0 WALD ARNOLD 2006032 9999999 B 10 1063488419 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1063488419 0 Physicians Anesthesia Services 20 1063488419 0 Physicians Fluoride varnish 20 1063488419 0 Physicians Healthy Kids Services 20 1063488419 0 Physicians Optical Supplies 20 1063488419 0 Physicians Physician Services 00 1063489029 0 KUMASAKA PETER 1999001 9999999 B 10 1063489029 0 525 PARK ST STE 300 SUITE 300 SAINT PAUL MN 551032197 20 1063489029 0 Physicians Anesthesia Services 20 1063489029 0 Physicians Healthy Kids Services 20 1063489029 0 Physicians Optical Supplies 20 1063489029 0 Physicians Physician Services 00 1063489615 0 TUMULURI RAMAGOPAL 2002203 9999999 B 10 1063489615 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1063489615 0 Physicians Anesthesia Services 20 1063489615 0 Physicians Fluoride varnish 20 1063489615 0 Physicians Healthy Kids Services 20 1063489615 0 Physicians Optical Supplies 20 1063489615 0 Physicians Physician Services 00 1063490043 0 DECKER DAVID L 1988020 9999999 B 10 1063490043 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1063490043 0 Physicians Anesthesia Services 20 1063490043 0 Physicians Healthy Kids Services 20 1063490043 0 Physicians Optical Supplies 20 1063490043 0 Physicians Physician Services 20 1063490043 0 Physicians Physicians Psychiatric Services 00 1063490183 0 HENRY KEVIN 2006091 9999999 B 10 1063490183 0 180 S MAIN ST CANTON IL 615202608 20 1063490183 0 Physicians Anesthesia Services 20 1063490183 0 Physicians Healthy Kids Services 20 1063490183 0 Physicians Optical Supplies 20 1063490183 0 Physicians Physician Services 00 1063490548 0 BEAMSLEY ALAN 1994301 9999999 B 10 1063490548 0 PO BOX 43230 PHOENIX AZ 850803230 20 1063490548 0 Physicians Anesthesia Services 20 1063490548 0 Physicians Healthy Kids Services 20 1063490548 0 Physicians Optical Supplies 20 1063490548 0 Physicians Physician Services 00 1063490605 0 DANIELS CHRISTIAN 1987213 9999999 B 10 1063490605 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1063490605 0 Physicians Anesthesia Services 20 1063490605 0 Physicians Fluoride varnish 20 1063490605 0 Physicians Healthy Kids Services 20 1063490605 0 Physicians Optical Supplies 20 1063490605 0 Physicians Physician Services 00 1063491009 0 STROBACH ROBERT S 2018168 9999999 B 10 1063491009 0 14425 COLLEGE BLVD STE 130 LENEXA KS 662152317 20 1063491009 0 Physicians Anesthesia Services 20 1063491009 0 Physicians Healthy Kids Services 20 1063491009 0 Physicians Optical Supplies 20 1063491009 0 Physicians Physician Services 00 1063491553 0 ARCE YOLANDA 2013226 9999999 B 10 1063491553 0 8309 N KNOXVILLE AVE PEORIA IL 616152170 20 1063491553 0 Optometrists Optical Supplies 20 1063491553 0 Optometrists Optometric Services 20 1063491553 0 Optometrists Physician Services 00 1063491777 0 AHMAD ZIA 1996309 9999999 B 10 1063491777 0 PO BOX 66940 SAINT LOUIS MO 631666940 20 1063491777 0 Physicians Anesthesia Services 20 1063491777 0 Physicians Fluoride varnish 20 1063491777 0 Physicians Healthy Kids Services 20 1063491777 0 Physicians Optical 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varnish 20 1063503704 0 Physicians Healthy Kids Services 20 1063503704 0 Physicians Optical Supplies 20 1063503704 0 Physicians Physician Services 00 1063504819 0 GUTHRIE MICHAEL A 1996219 9999999 B 10 1063504819 0 2241 THEODORE ST CREST HILL IL 604031881 20 1063504819 0 Dentists Dental Services 20 1063504819 0 Dentists Physician Services 00 1063506392 0 DEHDASHTI FARROKH 2002182 9999999 B 10 1063506392 0 PO BOX 60352 SAINT LOUIS MO 631600352 20 1063506392 0 Physicians Anesthesia Services 20 1063506392 0 Physicians Healthy Kids Services 20 1063506392 0 Physicians Optical Supplies 20 1063506392 0 Physicians Physician Services 00 1063506566 0 ALONSO JAMES E 2015230 9999999 B 10 1063506566 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1063506566 0 Physicians Anesthesia Services 20 1063506566 0 Physicians Healthy Kids Services 20 1063506566 0 Physicians Optical Supplies 20 1063506566 0 Physicians Physician Services 20 1063506566 0 Physicians Physicians Psychiatric Services 00 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20 1063516797 0 Physicians Healthy Kids Services 20 1063516797 0 Physicians Optical Supplies 20 1063516797 0 Physicians Physician Services 00 1063518744 0 BIALOWAS STANLEY 1986182 9999999 B 10 1063518744 0 3902 W DIVERSEY AVE CHICAGO IL 606471021 20 1063518744 0 Physicians Anesthesia Services 20 1063518744 0 Physicians Fluoride varnish 20 1063518744 0 Physicians Healthy Kids Services 20 1063518744 0 Physicians Optical Supplies 20 1063518744 0 Physicians Physician Services 00 1063519718 0 RAO MOHAN 2024179 9999999 B 10 1063519718 0 PO BOX 632122 CINCINNATI OH 452632122 20 1063519718 0 Physicians Anesthesia Services 20 1063519718 0 Physicians Healthy Kids Services 20 1063519718 0 Physicians Optical Supplies 20 1063519718 0 Physicians Physician Services 00 1063520781 0 GERSHON ELLIOT S 1998167 9999999 B 10 1063520781 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1063520781 0 Physicians Anesthesia Services 20 1063520781 0 Physicians Healthy Kids Services 20 1063520781 0 Physicians Optical Supplies 20 1063520781 0 Physicians Physician Services 20 1063520781 0 Physicians Physicians Psychiatric Services 00 1063521078 0 LAVALLE MATTHEW A 2001217 9999999 A 10 1063521078 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1063521078 0 Physicians Anesthesia Services 20 1063521078 0 Physicians Healthy Kids Services 20 1063521078 0 Physicians Optical Supplies 20 1063521078 0 Physicians Physician Services 00 1063521169 0 RINK CHRISTOPHER J 2001337 9999999 B 10 1063521169 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1063521169 0 Physicians Anesthesia Services 20 1063521169 0 Physicians Healthy Kids Services 20 1063521169 0 Physicians Optical Supplies 20 1063521169 0 Physicians Physician Services 00 1063521441 0 HERRELL JENNIFER R 2006310 9999999 B 10 1063521441 0 250 W 96TH ST STE 520 INDIANAPOLIS IN 462601317 20 1063521441 0 Physicians Anesthesia Services 20 1063521441 0 Physicians Healthy Kids Services 20 1063521441 0 Physicians Optical Supplies 20 1063521441 0 Physicians Physician Services 00 1063522241 0 BEAVES SARAH 1999213 9999999 B 10 1063522241 0 PO BOX 857 FREEPORT IL 610320857 20 1063522241 0 Physicians All Kids application agent 20 1063522241 0 Physicians Anesthesia Services 20 1063522241 0 Physicians Fluoride varnish 20 1063522241 0 Physicians Healthy Kids Services 20 1063522241 0 Physicians Optical Supplies 20 1063522241 0 Physicians Physician Services 00 1063523579 0 OLSEN MARYLU 1996275 9999999 B 10 1063523579 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1063523579 0 Occupational Therapists Medical Supplies 20 1063523579 0 Occupational Therapists Medical equipment/prosthetic devices 20 1063523579 0 Occupational Therapists Occupational Therapy Services 00 1063523728 0 RYON JOEL 2016090 9999999 B 10 1063523728 0 407 S WHITE ST MT PLEASANT IA 526412263 20 1063523728 0 Physicians Anesthesia Services 20 1063523728 0 Physicians Fluoride varnish 20 1063523728 0 Physicians Healthy Kids Services 20 1063523728 0 Physicians Optical Supplies 20 1063523728 0 Physicians Physician Services 00 1063524023 0 FRITZ JULIE IRELAND 2016001 9999999 B 10 1063524023 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1063524023 0 Physician Assistant Only Fluoride varnish 20 1063524023 0 Physician Assistant Only Healthy Kids Services 20 1063524023 0 Physician Assistant Only Physician Services 00 1063524502 0 JAIN LEELA 1981258 9999999 B 10 1063524502 0 621 PLAINFIELD RD STE 107 SUITE 107 OTHER IL 605275385 20 1063524502 0 Physicians Anesthesia Services 20 1063524502 0 Physicians Fluoride varnish 20 1063524502 0 Physicians Healthy Kids Services 20 1063524502 0 Physicians Optical Supplies 20 1063524502 0 Physicians Physician Services 00 1063524676 0 RAJAGOPAL NIMMI 2005350 9999999 B 10 1063524676 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1063524676 0 Physicians Anesthesia Services 20 1063524676 0 Physicians Healthy Kids Services 20 1063524676 0 Physicians Optical Supplies 20 1063524676 0 Physicians Physician Services 00 1063524718 0 HEISCHMIDT PAUL A 1997001 9999999 B 10 1063524718 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1063524718 0 Nurse Practitioners Anesthesia Services 20 1063524718 0 Nurse Practitioners Nurse Practitioners Services 20 1063524718 0 Nurse Practitioners Physician Services 00 1063525160 0 BASLER JOSEPH 2000153 9999999 B 10 1063525160 0 PO BOX 843033 KANSAS CITY MO 641843033 20 1063525160 0 Physicians Anesthesia Services 20 1063525160 0 Physicians Healthy Kids Services 20 1063525160 0 Physicians Optical Supplies 20 1063525160 0 Physicians Physician Services 00 1063526093 0 BEYZER ALEXANDER 1999195 9999999 B 10 1063526093 0 10420 OLD OLIVE STREET RD STE SAINT LOUIS MO 631415914 20 1063526093 0 Physicians Anesthesia Services 20 1063526093 0 Physicians Healthy Kids Services 20 1063526093 0 Physicians Optical Supplies 20 1063526093 0 Physicians Physician Services 00 1063526242 0 BELL EVELYN M 1997363 9999999 B 10 1063526242 0 PO BOX 343918 MILWAUKEE WI 532343918 20 1063526242 0 Physicians Anesthesia Services 20 1063526242 0 Physicians Fluoride varnish 20 1063526242 0 Physicians Healthy Kids Services 20 1063526242 0 Physicians Optical Supplies 20 1063526242 0 Physicians Physician Services 00 1063526978 0 KENNEDY DONALD 1984032 9999999 B 10 1063526978 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1063526978 0 Physicians Anesthesia Services 20 1063526978 0 Physicians Fluoride varnish 20 1063526978 0 Physicians Healthy Kids Services 20 1063526978 0 Physicians Optical Supplies 20 1063526978 0 Physicians Physician Services 00 1063527547 0 ESTER JOHN B 2021103 9999999 B 10 1063527547 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1063527547 0 Physicians Anesthesia Services 20 1063527547 0 Physicians Healthy Kids Services 20 1063527547 0 Physicians Optical Supplies 20 1063527547 0 Physicians Physician Services 00 1063529022 0 COY LYNN 2015091 9999999 B 10 1063529022 0 100 WITMER RD STE 220 HORSHAM PA 190442279 20 1063529022 0 Physicians Anesthesia Services 20 1063529022 0 Physicians Healthy Kids Services 20 1063529022 0 Physicians Optical Supplies 20 1063529022 0 Physicians Physician Services 00 1063529568 0 O'MEARA KEVIN F 2020290 9999999 B 10 1063529568 0 5665 NEW NORTHSIDE DR STE 320 ATLANTA GA 303285834 20 1063529568 0 Physicians Anesthesia Services 20 1063529568 0 Physicians Healthy Kids Services 20 1063529568 0 Physicians Optical Supplies 20 1063529568 0 Physicians Physician Services 00 1063529717 0 MCMANUS MARY 2006314 9999999 B 10 1063529717 0 1 CVS DR # MC2295 WOONSOCKET RI 028956146 20 1063529717 0 Nurse Practitioners Fluoride varnish 20 1063529717 0 Nurse Practitioners Healthy Kids Services 20 1063529717 0 Nurse Practitioners Nurse Practitioners Services 20 1063529717 0 Nurse Practitioners Physician Services 00 1063529832 0 GOEL ARCHANA 1996245 9999999 B 10 1063529832 0 29373 NETWORK PL CHICAGO IL 606733039 20 1063529832 0 Physicians Anesthesia Services 20 1063529832 0 Physicians Fluoride varnish 20 1063529832 0 Physicians Healthy Kids Services 20 1063529832 0 Physicians Optical Supplies 20 1063529832 0 Physicians Physician Services 00 1063530368 0 LEDESMA MIREYA 2015345 9999999 B 10 1063530368 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1063530368 0 Physician Assistant Only Fluoride varnish 20 1063530368 0 Physician Assistant Only Healthy Kids Services 20 1063530368 0 Physician Assistant Only Physician Services 00 1063530749 0 VAN SHIRLEY L 2024050 9999999 B 10 1063530749 0 4909 N GLEN PARK PLACE RD PEORIA IL 616144676 20 1063530749 0 Physicians Anesthesia Services 20 1063530749 0 Physicians Healthy Kids Services 20 1063530749 0 Physicians Optical Supplies 20 1063530749 0 Physicians Physician Services 00 1063530954 0 SOMAND DAVID M 2022361 9999999 B 10 1063530954 0 700 KMS PL ANN ARBOR MI 481081652 20 1063530954 0 Physicians Anesthesia Services 20 1063530954 0 Physicians Healthy Kids Services 20 1063530954 0 Physicians Optical Supplies 20 1063530954 0 Physicians Physician Services 00 1063531457 0 SKOLARUS TED A 2022276 9999999 B 10 1063531457 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1063531457 0 Physicians Anesthesia Services 20 1063531457 0 Physicians Healthy Kids Services 20 1063531457 0 Physicians Optical Supplies 20 1063531457 0 Physicians Physician Services 00 1063531804 0 WILLS DELINDA 2023130 9999999 B 10 1063531804 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1063531804 0 Physicians Anesthesia Services 20 1063531804 0 Physicians Healthy Kids Services 20 1063531804 0 Physicians Optical Supplies 20 1063531804 0 Physicians Physician Services 00 1063531887 0 BURCHARDT CAROL JEAN 2015125 9999999 B 10 1063531887 0 1403 CHARLOTTE CT ROCKFORD IL 611084109 20 1063531887 0 Other behavior health professional LCPC/LMFT services 00 1063533172 0 HOLMES CASANDRA L 2017203 9999999 B 10 1063533172 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1063533172 0 Physical Therapists Medical Supplies 20 1063533172 0 Physical Therapists Medical equipment/prosthetic devices 20 1063533172 0 Physical Therapists Physical Therapy Services 00 1063533388 0 SONGKUM JANTANEE 2011213 9999999 B 10 1063533388 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1063533388 0 Nurse Practitioners Healthy Kids Services 20 1063533388 0 Nurse Practitioners Nurse Practitioners Services 20 1063533388 0 Nurse Practitioners Physician Services 00 1063534121 0 RARANG ALEJANDRO M 1981227 9999999 B 10 1063534121 0 2400 E DEVON AVE STE 286 DES PLAINES IL 600184618 20 1063534121 0 Physicians Anesthesia Services 20 1063534121 0 Physicians Fluoride varnish 20 1063534121 0 Physicians Healthy Kids Services 20 1063534121 0 Physicians Optical Supplies 20 1063534121 0 Physicians Physician Services 00 1063535029 0 HANY LUCINDA 2007239 9999999 B 10 1063535029 0 777 LOWNDES HILL RD BLDG 1 GREENVILLE SC 296072101 20 1063535029 0 Physicians Anesthesia Services 20 1063535029 0 Physicians Healthy Kids Services 20 1063535029 0 Physicians Optical Supplies 20 1063535029 0 Physicians Physician Services 00 1063535417 0 TRAGER JASON H 2008214 9999999 B 10 1063535417 0 124 SW ADAMS ST FL 2 PEORIA IL 616021308 20 1063535417 0 Physicians Anesthesia Services 20 1063535417 0 Physicians Fluoride varnish 20 1063535417 0 Physicians Healthy Kids Services 20 1063535417 0 Physicians Optical Supplies 20 1063535417 0 Physicians Physician Services 00 1063535979 0 RAGON WILLIAM STANSUL 2020178 9999999 B 10 1063535979 0 PO BOX 43230 PHOENIX AZ 850803230 20 1063535979 0 Physicians Anesthesia Services 20 1063535979 0 Physicians Healthy Kids Services 20 1063535979 0 Physicians Optical Supplies 20 1063535979 0 Physicians Physician Services 00 1063535995 0 SHAH SAMIR 2018001 9999999 B 10 1063535995 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1063535995 0 Physicians Anesthesia Services 20 1063535995 0 Physicians Healthy Kids Services 20 1063535995 0 Physicians Optical Supplies 20 1063535995 0 Physicians Physician Services 00 1063537736 0 SLOAN HEIDI 2001033 9999999 B 10 1063537736 0 4115 LINDENWOOD LN NORTHBROOK IL 600621127 20 1063537736 0 Speech Therapists Medical Supplies 20 1063537736 0 Speech Therapists Medical equipment/prosthetic devices 20 1063537736 0 Speech Therapists Speech Therapy/Pathology Services 00 1063537769 0 HILDEBRAND DARLENE 1999060 9999999 B 10 1063537769 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1063537769 0 Dentists Dental Services 20 1063537769 0 Dentists Physician Services 00 1063538015 0 FOLKERT GREGORY 2008336 9999999 B 10 1063538015 0 1431 CENTERPOINT BLVD STE 100 KNOXVILLE TN 379321983 20 1063538015 0 Physicians Anesthesia Services 20 1063538015 0 Physicians Healthy Kids Services 20 1063538015 0 Physicians Optical Supplies 20 1063538015 0 Physicians Physician Services 00 1063538171 0 SCHERTLER CARRIE 2003309 9999999 B 10 1063538171 0 29373 NETWORK PL CHICAGO IL 606733039 20 1063538171 0 Physical Therapists Medical Supplies 20 1063538171 0 Physical Therapists Medical equipment/prosthetic devices 20 1063538171 0 Physical Therapists Physical Therapy Services 00 1063538353 0 JABRI MOHAMED N. 1992183 9999999 B 10 1063538353 0 203 INDIAN TRAIL RD OAK BROOK IL 605232797 20 1063538353 0 Physicians Anesthesia Services 20 1063538353 0 Physicians Fluoride varnish 20 1063538353 0 Physicians Healthy Kids Services 20 1063538353 0 Physicians Optical Supplies 20 1063538353 0 Physicians Physician Services 00 1063539211 0 GUIRGUIS ALFRED S 2007182 9999999 B 10 1063539211 0 62647 COLLECTION CENTER DR CHICAGO IL 606930626 20 1063539211 0 Physicians Anesthesia Services 20 1063539211 0 Physicians Healthy Kids Services 20 1063539211 0 Physicians Optical Supplies 20 1063539211 0 Physicians Physician Services 00 1063539625 0 BERRY DONALD STUART 2024249 9999999 B 10 1063539625 0 4701 DEPT CAROL STREAM IL 601220021 20 1063539625 0 Physicians Anesthesia Services 20 1063539625 0 Physicians Fluoride varnish 20 1063539625 0 Physicians Healthy Kids Services 20 1063539625 0 Physicians Optical Supplies 20 1063539625 0 Physicians Physician Services 00 1063541241 0 PRUEMER ERIC 2012092 9999999 B 10 1063541241 0 1701 LACEY ST CAPE GIRARDEAU MO 637015230 20 1063541241 0 Nurse Practitioners Anesthesia Services 20 1063541241 0 Nurse Practitioners Nurse Practitioners Services 20 1063541241 0 Nurse Practitioners Physician Services 00 1063543601 0 BECKER ANGELA 1999111 9999999 B 10 1063543601 0 14345 FLAT BRANCH RD CARLYLE IL 622316328 20 1063543601 0 Speech Therapists Medical Supplies 20 1063543601 0 Speech Therapists Medical equipment/prosthetic devices 20 1063543601 0 Speech Therapists Speech Therapy/Pathology Services 00 1063545317 0 BYRNES MATTHEW 2025041 9999999 B 10 1063545317 0 PO BOX 631797 CINCINNATI OH 452631797 20 1063545317 0 Physicians Anesthesia Services 20 1063545317 0 Physicians Fluoride varnish 20 1063545317 0 Physicians Healthy Kids Services 20 1063545317 0 Physicians Optical Supplies 20 1063545317 0 Physicians Physician Services 00 1063546109 0 TAYLOR TIMOTHY 2020220 9999999 B 10 1063546109 0 1137 N EOLA RD STE 109 AURORA IL 605027097 20 1063546109 0 Dentists Dental Services 20 1063546109 0 Dentists Physician Services 00 1063546240 0 PEOPLES BRUCE 1997307 9999999 B 10 1063546240 0 55 E JACKSON BLVD STE 1500 CHICAGO IL 606044184 20 1063546240 0 Physicians Anesthesia Services 20 1063546240 0 Physicians Fluoride varnish 20 1063546240 0 Physicians Healthy Kids Services 20 1063546240 0 Physicians Optical Supplies 20 1063546240 0 Physicians Physician Services 00 1063546257 0 KILPATRICK MARCIA A 1998091 9999999 B 10 1063546257 0 4945 DOUGLAS RD APT 1N DOWNERS GROVE IL 605153825 20 1063546257 0 Occupational Therapists Medical Supplies 20 1063546257 0 Occupational Therapists Medical equipment/prosthetic devices 20 1063546257 0 Occupational Therapists Occupational Therapy Services 00 1063546265 0 MCCLURE KRISTIN 1998118 9999999 B 10 1063546265 0 507 E ARMSTRONG AVE PEORIA IL 616033201 20 1063546265 0 Speech Therapists Development Therapy, Orientation and Mobility Services 20 1063546265 0 Speech Therapists Early Intervention Services 20 1063546265 0 Speech Therapists Medical Supplies 20 1063546265 0 Speech Therapists Medical equipment/prosthetic devices 20 1063546265 0 Speech Therapists Speech Therapy/Pathology Services 20 1063546265 0 Speech Therapists Targeted case management service 00 1063547982 0 HUEBNER JODY A 1993244 9999999 B 10 1063547982 0 2414 KOHLER MEMORIAL DR SHEBOYGAN WI 530813129 20 1063547982 0 Audiologists Audiology Services 20 1063547982 0 Audiologists Medical Supplies 20 1063547982 0 Audiologists Medical equipment/prosthetic devices 00 1063548030 0 SKAAR STEPHANIE 2002274 9999999 B 10 1063548030 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1063548030 0 Nurse Practitioners Anesthesia Services 20 1063548030 0 Nurse Practitioners Nurse Practitioners Services 20 1063548030 0 Nurse Practitioners Physician Services 00 1063549194 0 REINGLASS STEVEN D 1987152 9999999 B 10 1063549194 0 310 S GREENLEAF ST STE 209 GURNEE IL 600315708 20 1063549194 0 Physicians Anesthesia Services 20 1063549194 0 Physicians 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9999999 B 10 1063552479 0 5777 DEPT CAROL STREAM IL 601220021 20 1063552479 0 Physicians Anesthesia Services 20 1063552479 0 Physicians Fluoride varnish 20 1063552479 0 Physicians Healthy Kids Services 20 1063552479 0 Physicians Optical Supplies 20 1063552479 0 Physicians Physician Services 00 1063552990 0 FLORIDO GONZALO 1992283 9999999 B 10 1063552990 0 200 E FAIRMAN AVE WATSEKA IL 609701644 20 1063552990 0 Physicians Anesthesia Services 20 1063552990 0 Physicians Fluoride varnish 20 1063552990 0 Physicians Healthy Kids Services 20 1063552990 0 Physicians Optical Supplies 20 1063552990 0 Physicians Physician Services 00 1063553196 0 BARNES TERESA 2023041 9999999 B 10 1063553196 0 4701 DEPT CAROL STREAM IL 601220021 20 1063553196 0 Clinical Social Worker Social work service 00 1063553303 0 CHBEIR ELIE A 2009215 9999999 B 10 1063553303 0 238 S CONGRESS ST RUSHVILLE IL 626811465 20 1063553303 0 Physicians Anesthesia Services 20 1063553303 0 Physicians Fluoride varnish 20 1063553303 0 Physicians Healthy Kids Services 20 1063553303 0 Physicians Optical Supplies 20 1063553303 0 Physicians Physician Services 00 1063553477 0 MEHTA ASHOK 1988183 9999999 B 10 1063553477 0 29373 NETWORK PL CHICAGO IL 606733039 20 1063553477 0 Physicians Anesthesia Services 20 1063553477 0 Physicians Fluoride varnish 20 1063553477 0 Physicians Healthy Kids Services 20 1063553477 0 Physicians Optical Supplies 20 1063553477 0 Physicians Physician Services 00 1063554681 0 NGUYEN LINH T 2005274 9999999 B 10 1063554681 0 1005 BROADWAY ST QUINCY IL 623012834 20 1063554681 0 Physicians Anesthesia Services 20 1063554681 0 Physicians Healthy Kids Services 20 1063554681 0 Physicians Optical Supplies 20 1063554681 0 Physicians Physician Services 00 1063555167 0 THOMPSON MICHELLE 2002268 9999999 B 10 1063555167 0 2000 LEWIS AVE NORTH CHICAGO IL 600642543 20 1063555167 0 Speech Therapists Medical Supplies 20 1063555167 0 Speech Therapists Medical equipment/prosthetic devices 20 1063555167 0 Speech Therapists Speech Therapy/Pathology Services 00 1063555944 0 RATHBURN PENNY 2009060 9999999 B 10 1063555944 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1063555944 0 Physicians Anesthesia Services 20 1063555944 0 Physicians Fluoride varnish 20 1063555944 0 Physicians Healthy Kids Services 20 1063555944 0 Physicians Optical Supplies 20 1063555944 0 Physicians Physician Services 00 1063556991 0 DESAI BELA D 2000214 9999999 B 10 1063556991 0 1400 E GOLF RD STE 207 DES PLAINES IL 600161252 20 1063556991 0 Physicians Anesthesia Services 20 1063556991 0 Physicians Fluoride varnish 20 1063556991 0 Physicians Healthy Kids Services 20 1063556991 0 Physicians Optical Supplies 20 1063556991 0 Physicians Physician Services 00 1063557312 0 PALIDER KERRY A 2001081 9999999 B 10 1063557312 0 6211 W 64TH ST CHICAGO IL 606385015 20 1063557312 0 Speech Therapists Medical Supplies 20 1063557312 0 Speech Therapists Medical equipment/prosthetic devices 20 1063557312 0 Speech Therapists Speech Therapy/Pathology Services 00 1063559318 0 HOLMES JENNIFER 2016155 9999999 B 10 1063559318 0 PO BOX 110429 AURORA CO 800420429 20 1063559318 0 Physicians Anesthesia Services 20 1063559318 0 Physicians Healthy Kids Services 20 1063559318 0 Physicians Optical Supplies 20 1063559318 0 Physicians Physician Services 00 1063561546 0 ARORA MEETA 2020085 9999999 B 10 1063561546 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1063561546 0 Physical Therapists Medical Supplies 20 1063561546 0 Physical Therapists Medical equipment/prosthetic devices 20 1063561546 0 Physical Therapists Physical Therapy Services 00 1063562080 0 GANDHIRAJ BINDU 2006182 9999999 B 10 1063562080 0 400 N HIGHLAND AVE AURORA IL 605063814 20 1063562080 0 Physicians Anesthesia Services 20 1063562080 0 Physicians Healthy Kids Services 20 1063562080 0 Physicians Optical Supplies 20 1063562080 0 Physicians Physician Services 20 1063562080 0 Physicians Physicians Psychiatric Services 00 1063562734 0 AL-SAYED LAURA E 1995244 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Physicians Anesthesia Services 20 1063564268 0 Physicians Fluoride varnish 20 1063564268 0 Physicians Healthy Kids Services 20 1063564268 0 Physicians Optical Supplies 20 1063564268 0 Physicians Physician Services 00 1063565760 0 HARRIS MELANIE 2010256 9999999 B 10 1063565760 0 PO BOX 781076 DETROIT MI 482781076 20 1063565760 0 Physicians Anesthesia Services 20 1063565760 0 Physicians Fluoride varnish 20 1063565760 0 Physicians Healthy Kids Services 20 1063565760 0 Physicians Optical Supplies 20 1063565760 0 Physicians Physician Services 00 1063566073 0 VOLK KIM 2016134 9999999 B 10 1063566073 0 PO BOX 1109 DEKALB IL 601157109 20 1063566073 0 Other behavior health professional LCPC/LMFT services 00 1063566727 0 SPIZZIRRI SARAH 2009208 9999999 B 10 1063566727 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1063566727 0 Podiatrists Podiatric Services 00 1063568202 0 ANDERSON DANIELLE L 2007232 9999999 B 10 1063568202 0 5777 DEPT CAROL STREAM IL 601220021 20 1063568202 0 Physicians Anesthesia Services 20 1063568202 0 Physicians Healthy Kids Services 20 1063568202 0 Physicians Optical Supplies 20 1063568202 0 Physicians Physician Services 20 1063568202 0 Physicians Physicians Psychiatric Services 00 1063568335 0 CROUCH JOHN E 2016082 9999999 B 10 1063568335 0 340 MIDLAND RD STE 120 JANESVILLE WI 535462339 20 1063568335 0 Physicians Anesthesia Services 20 1063568335 0 Physicians Healthy Kids Services 20 1063568335 0 Physicians Optical Supplies 20 1063568335 0 Physicians Physician Services 00 1063568640 0 VERRY CHRISTIAN 2012275 9999999 B 10 1063568640 0 300 WINDING WOODS DR STE 200 O FALLON MO 633665081 20 1063568640 0 Physicians Anesthesia Services 20 1063568640 0 Physicians Fluoride varnish 20 1063568640 0 Physicians Healthy Kids Services 20 1063568640 0 Physicians Optical Supplies 20 1063568640 0 Physicians Physician Services 00 1063571420 0 WALTON GINA 2021197 9999999 B 10 1063571420 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1063571420 0 Physicians Anesthesia Services 20 1063571420 0 Physicians Healthy Kids Services 20 1063571420 0 Physicians Optical Supplies 20 1063571420 0 Physicians Physician Services 00 1063573038 0 SERLIN SVETLANA 2002204 9999999 B 10 1063573038 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1063573038 0 Physicians Anesthesia Services 20 1063573038 0 Physicians Fluoride varnish 20 1063573038 0 Physicians Healthy Kids Services 20 1063573038 0 Physicians Optical Supplies 20 1063573038 0 Physicians Physician Services 00 1063574523 0 DAUGHERTY CHRISTOPHER K 1996200 9999999 B 10 1063574523 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1063574523 0 Physicians Anesthesia Services 20 1063574523 0 Physicians Fluoride varnish 20 1063574523 0 Physicians Healthy Kids Services 20 1063574523 0 Physicians Optical Supplies 20 1063574523 0 Physicians Physician Services 00 1063575181 0 SAED FARZAD 1987274 9999999 B 10 1063575181 0 126 WASHINGTON AVE HIGHWOOD IL 600401122 20 1063575181 0 Dentists Dental 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1063756138 0 Nurse Practitioners Nurse Practitioners Services 20 1063756138 0 Nurse Practitioners Physician Services 00 1063756492 0 STAKER AMY 2012345 9999999 B 10 1063756492 0 150 W HIGH ST MORRIS IL 604501463 20 1063756492 0 Nurse Practitioners Fluoride varnish 20 1063756492 0 Nurse Practitioners Healthy Kids Services 20 1063756492 0 Nurse Practitioners Nurse Practitioners Services 20 1063756492 0 Nurse Practitioners Physician Services 00 1063758894 0 WALLEN ASHLEY 2013005 9999999 B 10 1063758894 0 8550 W BRYN MAWR AVE STE 800 SUITE 800 CHICAGO IL 606313222 20 1063758894 0 Nurse Practitioners Healthy Kids Services 20 1063758894 0 Nurse Practitioners Nurse Practitioners Services 20 1063758894 0 Nurse Practitioners Physician Services 00 1063760023 0 NAYLOR KENNETH J 2017164 9999999 B 10 1063760023 0 851 E 5TH ST STE 226 WASHINGTON MO 630903129 20 1063760023 0 Physicians Anesthesia Services 20 1063760023 0 Physicians Fluoride varnish 20 1063760023 0 Physicians Healthy Kids Services 20 1063760023 0 Physicians Optical Supplies 20 1063760023 0 Physicians Physician Services 00 1063760080 0 SHAH DHAVAL 2017001 9999999 B 10 1063760080 0 1933 FRANCISCAN WAY WEST CHICAGO IL 601856201 20 1063760080 0 Dentists Dental Services 20 1063760080 0 Dentists Physician Services 00 1063761070 0 BOHANNON MARY K 2017013 9999999 B 10 1063761070 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1063761070 0 Clinical Social Worker Electronic Home Response/EHR Installation, MPE Certification 20 1063761070 0 Clinical Social Worker Social work service 00 1063761104 0 PUGH MELISSA L 2019277 9999999 B 10 1063761104 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1063761104 0 Physical Therapists Medical Supplies 20 1063761104 0 Physical Therapists Medical equipment/prosthetic devices 20 1063761104 0 Physical Therapists Physical Therapy Services 00 1063761724 0 BILLINGSLEY KELLY N 2012240 9999999 B 10 1063761724 0 29373 NETWORK PL CHICAGO IL 606733039 20 1063761724 0 Nurse Practitioners Fluoride varnish 20 1063761724 0 Nurse Practitioners Healthy Kids Services 20 1063761724 0 Nurse Practitioners Nurse Practitioners Services 20 1063761724 0 Nurse Practitioners Physician Services 00 1063762433 0 SHAKIR MUNIRA 2024008 9999999 B 10 1063762433 0 15 SPINNING WHEEL RD STE 118 HINSDALE IL 605212983 20 1063762433 0 Occupational Therapists Medical Supplies 20 1063762433 0 Occupational Therapists Medical equipment/prosthetic devices 20 1063762433 0 Occupational Therapists Occupational Therapy Services 00 1063763332 0 LAWRENCE AMY 2023007 9999999 B 10 1063763332 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1063763332 0 Nurse Practitioners Healthy Kids Services 20 1063763332 0 Nurse Practitioners Nurse Practitioners Services 20 1063763332 0 Nurse Practitioners Physician Services 00 1063764405 0 JACKSON LINDSAY 2012046 9999999 B 10 1063764405 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1063764405 0 Nurse Practitioners Healthy Kids Services 20 1063764405 0 Nurse Practitioners Nurse Practitioners Services 20 1063764405 0 Nurse Practitioners Physician Services 00 1063765303 0 HIPPLER MALLORY R 2016144 9999999 B 10 1063765303 0 1361 W FREMONT ST GALESBURG IL 614012436 20 1063765303 0 Other behavior health professional LCPC/LMFT services 00 1063766830 0 SMITH JESSIE R 2022199 9999999 B 10 1063766830 0 929 STACEY BURK DR PO BOX 40 FLORA IL 628393241 20 1063766830 0 Clinical Social Worker Social work service 00 1063767937 0 MALONEY CAROLINE 2023254 9999999 B 10 1063767937 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1063767937 0 Physicians Anesthesia Services 20 1063767937 0 Physicians Healthy Kids Services 20 1063767937 0 Physicians Optical Supplies 20 1063767937 0 Physicians Physician Services 00 1063768463 0 BJORKLUND KIM A 2023310 9999999 B 10 1063768463 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1063768463 0 Physicians Anesthesia Services 20 1063768463 0 Physicians Healthy Kids Services 20 1063768463 0 Physicians Optical Supplies 20 1063768463 0 Physicians Physician Services 00 1063768513 0 SHELEY ANDREA C 2012254 9999999 B 10 1063768513 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1063768513 0 Nurse Practitioners Fluoride varnish 20 1063768513 0 Nurse Practitioners Healthy Kids Services 20 1063768513 0 Nurse Practitioners Nurse Practitioners Services 20 1063768513 0 Nurse Practitioners Physician Services 00 1063768976 0 GUSTAF ERIANNE M 2022213 9999999 B 10 1063768976 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1063768976 0 Physical Therapists Medical Supplies 20 1063768976 0 Physical Therapists Medical equipment/prosthetic devices 20 1063768976 0 Physical Therapists Physical Therapy Services 00 1063769917 0 KRAMER SARAH S 2024149 9999999 B 10 1063769917 0 5777 DEPT CAROL STREAM IL 601220021 20 1063769917 0 Speech Therapists Medical Supplies 20 1063769917 0 Speech Therapists Medical equipment/prosthetic devices 20 1063769917 0 Speech Therapists Speech Therapy/Pathology Services 00 1063770097 0 THOMSEN TIMOTHY W 2016183 9999999 B 10 1063770097 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1063770097 0 Physicians Anesthesia Services 20 1063770097 0 Physicians Healthy Kids Services 20 1063770097 0 Physicians Optical Supplies 20 1063770097 0 Physicians Physician Services 00 1063770469 0 RATHI SIDDARTH 2023143 9999999 B 10 1063770469 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1063770469 0 Physicians Anesthesia Services 20 1063770469 0 Physicians Healthy Kids Services 20 1063770469 0 Physicians Optical Supplies 20 1063770469 0 Physicians Physician Services 00 1063770816 0 POWELL NATASHA Y 2024005 9999999 B 10 1063770816 0 8110 GATEHOUSE RD STE 400 FALLS CHURCH VA 220421252 20 1063770816 0 Physicians Anesthesia Services 20 1063770816 0 Physicians Healthy Kids Services 20 1063770816 0 Physicians Optical Supplies 20 1063770816 0 Physicians Physician Services 00 1063771228 0 IRRER DANA J 2022224 9999999 B 10 1063771228 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1063771228 0 Physicians Anesthesia Services 20 1063771228 0 Physicians Fluoride varnish 20 1063771228 0 Physicians Healthy Kids Services 20 1063771228 0 Physicians Optical Supplies 20 1063771228 0 Physicians Physician Services 00 1063772010 0 SYERS ERIN 2024159 9999999 B 10 1063772010 0 14502 W MEEKER BLVD SUN CITY AZ 853755282 20 1063772010 0 Physicians Anesthesia Services 20 1063772010 0 Physicians Healthy Kids Services 20 1063772010 0 Physicians Optical Supplies 20 1063772010 0 Physicians Physician Services 00 1063772101 0 BAKER RODERICK M 2023009 9999999 B 10 1063772101 0 PO BOX 43230 PHOENIX AZ 850803230 20 1063772101 0 Physicians Anesthesia Services 20 1063772101 0 Physicians Healthy Kids Services 20 1063772101 0 Physicians Optical Supplies 20 1063772101 0 Physicians Physician Services 00 1063772275 0 WIRTZ MARK 2019213 9999999 B 10 1063772275 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1063772275 0 Physicians Anesthesia Services 20 1063772275 0 Physicians Fluoride varnish 20 1063772275 0 Physicians Healthy Kids Services 20 1063772275 0 Physicians Optical Supplies 20 1063772275 0 Physicians Physician Services 00 1063772440 0 TAYLOR BEATRICE V 2018246 9999999 B 10 1063772440 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1063772440 0 Physicians Anesthesia Services 20 1063772440 0 Physicians Fluoride varnish 20 1063772440 0 Physicians Healthy Kids Services 20 1063772440 0 Physicians Optical Supplies 20 1063772440 0 Physicians Physician Services 00 1063772572 0 JONAS EMILY K 2017136 9999999 B 10 1063772572 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1063772572 0 Physicians Anesthesia Services 20 1063772572 0 Physicians Fluoride varnish 20 1063772572 0 Physicians Healthy Kids Services 20 1063772572 0 Physicians Optical Supplies 20 1063772572 0 Physicians Physician Services 00 1063773216 0 SHAKIR IRSHAD A 2022139 9999999 B 10 1063773216 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1063773216 0 Physicians Anesthesia Services 20 1063773216 0 Physicians Healthy 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9999999 B 10 1063776771 0 5777 DEPT CAROL STREAM IL 601220021 20 1063776771 0 Physicians Anesthesia Services 20 1063776771 0 Physicians Fluoride varnish 20 1063776771 0 Physicians Healthy Kids Services 20 1063776771 0 Physicians Optical Supplies 20 1063776771 0 Physicians Physician Services 00 1063776938 0 GHIGNONE ERICA 2017242 9999999 B 10 1063776938 0 4025 N SHERIDAN RD CHICAGO IL 606132010 20 1063776938 0 Physicians Anesthesia Services 20 1063776938 0 Physicians Healthy Kids Services 20 1063776938 0 Physicians Optical Supplies 20 1063776938 0 Physicians Physician Services 20 1063776938 0 Physicians Physicians Psychiatric Services 00 1063778413 0 KARAS VASILI 2017125 9999999 B 10 1063778413 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1063778413 0 Physicians Anesthesia Services 20 1063778413 0 Physicians Healthy Kids Services 20 1063778413 0 Physicians Optical Supplies 20 1063778413 0 Physicians Physician Services 00 1063778462 0 PRATIVADI RAMANUJAM 2019269 9999999 B 10 1063778462 0 5777 DEPT CAROL STREAM IL 601220021 20 1063778462 0 Physicians Anesthesia Services 20 1063778462 0 Physicians Healthy Kids Services 20 1063778462 0 Physicians Optical Supplies 20 1063778462 0 Physicians Physician Services 00 1063778900 0 BABA-AHMED FERTIKH NASSIMA 2020133 9999999 B 10 1063778900 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1063778900 0 Physicians Anesthesia Services 20 1063778900 0 Physicians Healthy Kids Services 20 1063778900 0 Physicians Optical Supplies 20 1063778900 0 Physicians Physician Services 20 1063778900 0 Physicians Physicians Psychiatric Services 00 1063779270 0 CERMAK STEPHANIE J 2021196 9999999 B 10 1063779270 0 2850 W 95TH ST STE 400 EVERGREEN PARK IL 608052755 20 1063779270 0 Physician Assistant Only Fluoride varnish 20 1063779270 0 Physician Assistant Only Healthy Kids Services 20 1063779270 0 Physician Assistant Only Physician Services 00 1063779601 0 SANNAGOWDARA KUMAR 2017001 9999999 B 10 1063779601 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1063779601 0 Physicians Anesthesia Services 20 1063779601 0 Physicians Healthy Kids Services 20 1063779601 0 Physicians Optical Supplies 20 1063779601 0 Physicians Physician Services 20 1063779601 0 Physicians Physicians Psychiatric Services 00 1063780385 0 TANNA BHAIRAVI 2013121 9999999 B 10 1063780385 0 PO BOX 504469 SAINT LOUIS MO 631504469 20 1063780385 0 Speech Therapists Medical Supplies 20 1063780385 0 Speech Therapists Medical equipment/prosthetic devices 20 1063780385 0 Speech Therapists Speech Therapy/Pathology Services 00 1063783272 0 BORCHETTA KRISTEN 2022040 9999999 B 10 1063783272 0 246 OAKHURST CIR KISSIMMEE FL 347444752 20 1063783272 0 Physicians Anesthesia Services 20 1063783272 0 Physicians Fluoride varnish 20 1063783272 0 Physicians Healthy Kids Services 20 1063783272 0 Physicians Optical Supplies 20 1063783272 0 Physicians Physician Services 00 1063783363 0 APPLEWHITE VERONICA 2020209 9999999 B 10 1063783363 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1063783363 0 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RIDGE AVE # 1223 EVANSTON IL 602011700 20 1063787398 0 Physicians Anesthesia Services 20 1063787398 0 Physicians Fluoride varnish 20 1063787398 0 Physicians Healthy Kids Services 20 1063787398 0 Physicians Optical Supplies 20 1063787398 0 Physicians Physician Services 00 1063788107 0 TOMMASO LAURA H 2015305 9999999 B 10 1063788107 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1063788107 0 Physicians Anesthesia Services 20 1063788107 0 Physicians Fluoride varnish 20 1063788107 0 Physicians Healthy Kids Services 20 1063788107 0 Physicians Optical Supplies 20 1063788107 0 Physicians Physician Services 00 1063788149 0 KASKAVAGE JILLIAN 2015169 9999999 B 10 1063788149 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1063788149 0 Physicians Anesthesia Services 20 1063788149 0 Physicians Fluoride varnish 20 1063788149 0 Physicians Healthy Kids Services 20 1063788149 0 Physicians Optical Supplies 20 1063788149 0 Physicians Physician Services 00 1063789071 0 HANDA JENNY RS 2011305 9999999 B 10 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1063802676 0 DIAZ BAEZ YUDITH 2018258 9999999 B 10 1063802676 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1063802676 0 Physicians Anesthesia Services 20 1063802676 0 Physicians Healthy Kids Services 20 1063802676 0 Physicians Optical Supplies 20 1063802676 0 Physicians Physician Services 00 1063802874 0 FLETCHER MICHAEL A 2015261 9999999 B 10 1063802874 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1063802874 0 Other behavior health professional LCPC/LMFT services 00 1063803476 0 HYON KATHERINE S 2017069 9999999 B 10 1063803476 0 5777 DEPT CAROL STREAM IL 601228942 20 1063803476 0 Physicians Anesthesia Services 20 1063803476 0 Physicians Healthy Kids Services 20 1063803476 0 Physicians Optical Supplies 20 1063803476 0 Physicians Physician Services 00 1063806412 0 LOVIN NICOLE M 2016213 9999999 B 10 1063806412 0 6300 RIDGLEA PL STE 201 FORT WORTH TX 761165707 20 1063806412 0 Nurse Practitioners Fluoride varnish 20 1063806412 0 Nurse Practitioners Healthy Kids 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CHICAGO IL 606123714 20 1063823078 0 Physicians Anesthesia Services 20 1063823078 0 Physicians Fluoride varnish 20 1063823078 0 Physicians Healthy Kids Services 20 1063823078 0 Physicians Optical Supplies 20 1063823078 0 Physicians Physician Services 00 1063823193 0 JEAN HENDY B 2023220 9999999 B 10 1063823193 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1063823193 0 Physicians Anesthesia Services 20 1063823193 0 Physicians Fluoride varnish 20 1063823193 0 Physicians Healthy Kids Services 20 1063823193 0 Physicians Optical Supplies 20 1063823193 0 Physicians Physician Services 00 1063823466 0 NETTEY RALPH 2021081 9999999 B 10 1063823466 0 PO BOX 43230 PHOENIX AZ 850803230 20 1063823466 0 Physicians Anesthesia Services 20 1063823466 0 Physicians Fluoride varnish 20 1063823466 0 Physicians Healthy Kids Services 20 1063823466 0 Physicians Optical Supplies 20 1063823466 0 Physicians Physician Services 00 1063823763 0 LEONBERGER PATRICK 2020043 9999999 B 10 1063823763 0 3310 FIELDS SOUTH DR 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PATRICK 2019292 9999999 B 10 1063875995 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1063875995 0 Physicians Anesthesia Services 20 1063875995 0 Physicians Fluoride varnish 20 1063875995 0 Physicians Healthy Kids Services 20 1063875995 0 Physicians Optical Supplies 20 1063875995 0 Physicians Physician Services 00 1063876175 0 YAKOVLEVA ALLA 2016201 9999999 B 10 1063876175 0 4712 LAUREL AVE GLENVIEW IL 600251419 20 1063876175 0 Nurse Practitioners Fluoride varnish 20 1063876175 0 Nurse Practitioners Healthy Kids Services 20 1063876175 0 Nurse Practitioners Nurse Practitioners Services 20 1063876175 0 Nurse Practitioners Physician Services 00 1063876530 0 MAMALIS CHRISTINA 2023215 9999999 B 10 1063876530 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1063876530 0 Physicians Anesthesia Services 20 1063876530 0 Physicians Healthy Kids Services 20 1063876530 0 Physicians Optical Supplies 20 1063876530 0 Physicians Physician Services 00 1063878189 0 JOHNSON LORI A 2024323 9999999 B 10 1063878189 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1063878189 0 Nurse Practitioners Fluoride varnish 20 1063878189 0 Nurse Practitioners Healthy Kids Services 20 1063878189 0 Nurse Practitioners Nurse Practitioners Services 20 1063878189 0 Nurse Practitioners Physician Services 00 1063878643 0 PIERRE LAURA 2021131 9999999 B 10 1063878643 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1063878643 0 Nurse Practitioners Fluoride varnish 20 1063878643 0 Nurse Practitioners Healthy Kids Services 20 1063878643 0 Nurse Practitioners Nurse Practitioners Services 20 1063878643 0 Nurse Practitioners Physician Services 00 1063880284 0 CARLISLE JEANETTE M 2016146 9999999 B 10 1063880284 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1063880284 0 Occupational Therapists Medical Supplies 20 1063880284 0 Occupational Therapists Medical equipment/prosthetic devices 20 1063880284 0 Occupational Therapists Occupational Therapy Services 00 1063882090 0 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Practitioners Physician Services 00 1063952620 0 CLEVENGER MELISSA BETH 2019038 9999999 B 10 1063952620 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1063952620 0 Nurse Practitioners Fluoride varnish 20 1063952620 0 Nurse Practitioners Healthy Kids Services 20 1063952620 0 Nurse Practitioners Nurse Practitioners Services 20 1063952620 0 Nurse Practitioners Physician Services 00 1063953016 0 POWELL CHRISTINA 2017094 9999999 B 10 1063953016 0 5665 NEW NORTHSIDE DR ATLANTA GA 303285831 20 1063953016 0 Nurse Practitioners Fluoride varnish 20 1063953016 0 Nurse Practitioners Healthy Kids Services 20 1063953016 0 Nurse Practitioners Nurse Practitioners Services 20 1063953016 0 Nurse Practitioners Physician Services 00 1063953313 0 MILLER DANIEL J 2020245 9999999 B 10 1063953313 0 PO BOX 28900 GREEN BAY WI 543240900 20 1063953313 0 Physicians Anesthesia Services 20 1063953313 0 Physicians Healthy Kids Services 20 1063953313 0 Physicians Optical Supplies 20 1063953313 0 Physicians Physician 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Practitioners Services 20 1063961985 0 Nurse Practitioners Physician Services 00 1063962710 0 OFORI OYAKHIRE 2016285 2025365 B 10 1063962710 0 801 ILLINI DR SILVIS IL 612821804 20 1063962710 0 Physicians Anesthesia Services 20 1063962710 0 Physicians Fluoride varnish 20 1063962710 0 Physicians Healthy Kids Services 20 1063962710 0 Physicians Optical Supplies 20 1063962710 0 Physicians Physician Services 00 1063965424 0 JALUKAR SUPRIYA 2021025 9999999 B 10 1063965424 0 3537 N RETA AVE APT 1 CHICAGO IL 606579252 20 1063965424 0 Occupational Therapists Medical Supplies 20 1063965424 0 Occupational Therapists Medical equipment/prosthetic devices 20 1063965424 0 Occupational Therapists Occupational Therapy Services 00 1063965515 0 WILSHIRE LAURA E 2016215 9999999 B 10 1063965515 0 8309 N KNOXVILLE AVE PEORIA IL 616152170 20 1063965515 0 Optometrists Optical Supplies 20 1063965515 0 Optometrists Optometric Services 20 1063965515 0 Optometrists Physician Services 00 1063965614 0 HABIBI 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Physicians Fluoride varnish 20 1063998862 0 Physicians Healthy Kids Services 20 1063998862 0 Physicians Optical Supplies 20 1063998862 0 Physicians Physician Services 00 1063999241 0 THOMAS LISA V 2020328 9999999 B 10 1063999241 0 411 N CLARENDON CT SAVOY IL 618746012 20 1063999241 0 Other behavior health professional LCPC/LMFT services 00 1073000410 0 PATEL TRISHA 2020029 9999999 B 10 1073000410 0 210 S DESPLAINES ST CHICAGO IL 606615500 20 1073000410 0 Physicians Anesthesia Services 20 1073000410 0 Physicians Fluoride varnish 20 1073000410 0 Physicians Healthy Kids Services 20 1073000410 0 Physicians Optical Supplies 20 1073000410 0 Physicians Physician Services 00 1073000691 0 WIJATYK ANNA I 2021230 9999999 B 10 1073000691 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1073000691 0 Physicians Anesthesia Services 20 1073000691 0 Physicians Fluoride varnish 20 1073000691 0 Physicians Healthy Kids Services 20 1073000691 0 Physicians Optical Supplies 20 1073000691 0 Physicians Physician Services 00 1073001160 0 NELSON MARGARET E 2021187 9999999 B 10 1073001160 0 2215 SANDERS RD STE 105 SUITE 105 NORTHBROOK IL 600626194 20 1073001160 0 Physicians Anesthesia Services 20 1073001160 0 Physicians Fluoride varnish 20 1073001160 0 Physicians Healthy Kids Services 20 1073001160 0 Physicians Optical Supplies 20 1073001160 0 Physicians Physician Services 00 1073003430 0 SELUZICKI WEST JENNIFER 2019261 9999999 B 10 1073003430 0 1812 N 19TH AVE MELROSE PARK IL 601602039 20 1073003430 0 Dentists Dental Services 20 1073003430 0 Dentists Physician Services 00 1073003463 0 FRITH JESSICA LYNN 2018260 9999999 B 10 1073003463 0 430 E 162ND ST SOUTH HOLLAND IL 604732258 20 1073003463 0 Nurse Practitioners Fluoride varnish 20 1073003463 0 Nurse Practitioners Healthy Kids Services 20 1073003463 0 Nurse Practitioners Nurse Practitioners Services 20 1073003463 0 Nurse Practitioners Physician Services 00 1073003588 0 THACKER MICHELLE 2018169 9999999 B 10 1073003588 0 800 E LOCUST ST OLNEY IL 624502553 20 1073003588 0 Nurse Practitioners Fluoride varnish 20 1073003588 0 Nurse Practitioners Healthy Kids Services 20 1073003588 0 Nurse Practitioners Nurse Practitioners Services 20 1073003588 0 Nurse Practitioners Physician Services 00 1073003877 0 DAVE AMI 2019141 9999999 B 10 1073003877 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1073003877 0 Physicians Anesthesia Services 20 1073003877 0 Physicians Fluoride varnish 20 1073003877 0 Physicians Healthy Kids Services 20 1073003877 0 Physicians Optical Supplies 20 1073003877 0 Physicians Physician Services 00 1073004222 0 CASSIDY-WESCOTT KYLE A 2024127 9999999 B 10 1073004222 0 611 W PARK ST URBANA IL 618012529 20 1073004222 0 Physicians Anesthesia Services 20 1073004222 0 Physicians Fluoride varnish 20 1073004222 0 Physicians Healthy Kids Services 20 1073004222 0 Physicians Optical Supplies 20 1073004222 0 Physicians Physician Services 00 1073004610 0 CAI WENJING 2024274 9999999 B 10 1073004610 0 6308 8TH AVE KENOSHA 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Kids Services 20 1073524328 0 Physician Assistant Only Physician Services 00 1073525200 0 MEYER-JONES MARY A 2024319 9999999 B 10 1073525200 0 777 LOWNDES HILL RD BLDG 1 GREENVILLE SC 296072101 20 1073525200 0 Physicians Anesthesia Services 20 1073525200 0 Physicians Healthy Kids Services 20 1073525200 0 Physicians Optical Supplies 20 1073525200 0 Physicians Physician Services 00 1073525770 0 VARMA RAJEEV 2006152 9999999 B 10 1073525770 0 PO BOX 5009 BRENTWOOD TN 370245009 20 1073525770 0 Physicians Anesthesia Services 20 1073525770 0 Physicians Fluoride varnish 20 1073525770 0 Physicians Healthy Kids Services 20 1073525770 0 Physicians Optical Supplies 20 1073525770 0 Physicians Physician Services 00 1073525994 0 KADKOL SHRIHARI 2002213 9999999 B 10 1073525994 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1073525994 0 Physicians Anesthesia Services 20 1073525994 0 Physicians Healthy Kids Services 20 1073525994 0 Physicians Optical Supplies 20 1073525994 0 Physicians Physician Services 00 1073526240 0 BRAATZ TIMOTHY 2015032 9999999 B 10 1073526240 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1073526240 0 Physicians Anesthesia Services 20 1073526240 0 Physicians Healthy Kids Services 20 1073526240 0 Physicians Optical Supplies 20 1073526240 0 Physicians Physician Services 00 1073526257 0 NADKARNI VINAY 2013339 9999999 B 10 1073526257 0 100 E PENN SQ PHILADELPHIA PA 191073323 20 1073526257 0 Physicians Anesthesia Services 20 1073526257 0 Physicians Fluoride varnish 20 1073526257 0 Physicians Healthy Kids Services 20 1073526257 0 Physicians Optical Supplies 20 1073526257 0 Physicians Physician Services 00 1073526463 0 SCANLON KIMBERLY 1997244 9999999 B 10 1073526463 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1073526463 0 Physicians Anesthesia Services 20 1073526463 0 Physicians Fluoride varnish 20 1073526463 0 Physicians Healthy Kids Services 20 1073526463 0 Physicians Optical Supplies 20 1073526463 0 Physicians Physician Services 00 1073527511 0 REARDON THOMAS E 2016032 9999999 B 10 1073527511 0 PO BOX 5588 BELFAST ME 049155500 20 1073527511 0 Physician Assistant Only Fluoride varnish 20 1073527511 0 Physician Assistant Only Healthy Kids Services 20 1073527511 0 Physician Assistant Only Physician Services 00 1073527552 0 PHILLIPS NANCY 1990182 9999999 B 10 1073527552 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1073527552 0 Physicians Anesthesia Services 20 1073527552 0 Physicians Healthy Kids Services 20 1073527552 0 Physicians Optical Supplies 20 1073527552 0 Physicians Physician Services 00 1073527578 0 MIAN WAQAR 1994001 9999999 B 10 1073527578 0 29373 NETWORK PL CHICAGO IL 606733039 20 1073527578 0 Physicians Anesthesia Services 20 1073527578 0 Physicians Fluoride varnish 20 1073527578 0 Physicians Healthy Kids Services 20 1073527578 0 Physicians Optical Supplies 20 1073527578 0 Physicians Physician Services 00 1073528543 0 TROOST NEIL 2010060 9999999 B 10 1073528543 0 PO BOX 8742 FORT WORTH TX 761240742 20 1073528543 0 Physicians Anesthesia Services 20 1073528543 0 Physicians Healthy Kids Services 20 1073528543 0 Physicians Optical Supplies 20 1073528543 0 Physicians Physician Services 00 1073529384 0 OETTING MARGUERITE H 2008092 9999999 B 10 1073529384 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1073529384 0 Physicians Anesthesia Services 20 1073529384 0 Physicians Fluoride varnish 20 1073529384 0 Physicians Healthy Kids Services 20 1073529384 0 Physicians Optical Supplies 20 1073529384 0 Physicians Physician Services 00 1073530572 0 JUNGHEIM EMILY 2005182 9999999 B 10 1073530572 0 5777 DEPT CAROL STREAM IL 601220021 20 1073530572 0 Physicians Anesthesia Services 20 1073530572 0 Physicians Healthy Kids Services 20 1073530572 0 Physicians Optical Supplies 20 1073530572 0 Physicians Physician Services 00 1073530580 0 SCHWARTZ DAVID B 1994182 9999999 B 10 1073530580 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1073530580 0 Physicians Anesthesia Services 20 1073530580 0 Physicians Fluoride varnish 20 1073530580 0 Physicians Healthy Kids Services 20 1073530580 0 Physicians Optical Supplies 20 1073530580 0 Physicians Physician Services 00 1073530606 0 ROTHSCHILD JULIE 2004183 9999999 B 10 1073530606 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1073530606 0 Physicians Anesthesia Services 20 1073530606 0 Physicians Healthy Kids Services 20 1073530606 0 Physicians Optical Supplies 20 1073530606 0 Physicians Physician Services 00 1073530929 0 PATRIANAKOS THOMAS 2007226 9999999 B 10 1073530929 0 1042 HAPP RD NORTHFIELD IL 600931009 20 1073530929 0 Physicians Anesthesia Services 20 1073530929 0 Physicians Healthy Kids Services 20 1073530929 0 Physicians Optical Supplies 20 1073530929 0 Physicians Physician Services 00 1073531497 0 BERNAL CARLOS 2003032 9999999 B 10 1073531497 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1073531497 0 Physicians Anesthesia Services 20 1073531497 0 Physicians Fluoride varnish 20 1073531497 0 Physicians Healthy Kids Services 20 1073531497 0 Physicians Optical Supplies 20 1073531497 0 Physicians Physician Services 00 1073531521 0 CLUTTER WILLIAM E 1981182 9999999 B 10 1073531521 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1073531521 0 Physicians Anesthesia Services 20 1073531521 0 Physicians Fluoride varnish 20 1073531521 0 Physicians Healthy Kids Services 20 1073531521 0 Physicians Optical Supplies 20 1073531521 0 Physicians Physician Services 00 1073531547 0 ORTEGA MICHELLE G 2015295 9999999 B 10 1073531547 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1073531547 0 Nurse Practitioners Healthy Kids Services 20 1073531547 0 Nurse Practitioners Nurse Practitioners Services 20 1073531547 0 Nurse Practitioners Physician Services 00 1073531570 0 DUDEK JANUSZ 1995244 9999999 B 10 1073531570 0 5777 DEPT CAROL STREAM IL 601220021 20 1073531570 0 Physicians Anesthesia Services 20 1073531570 0 Physicians Fluoride varnish 20 1073531570 0 Physicians Healthy Kids Services 20 1073531570 0 Physicians Optical Supplies 20 1073531570 0 Physicians Physician Services 00 1073531760 0 WOELTJE KEITH F 1997182 9999999 B 10 1073531760 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1073531760 0 Physicians Anesthesia Services 20 1073531760 0 Physicians Fluoride varnish 20 1073531760 0 Physicians Healthy Kids Services 20 1073531760 0 Physicians Optical Supplies 20 1073531760 0 Physicians Physician Services 00 1073531802 0 JUTZY KENNETH 2020164 9999999 B 10 1073531802 0 268 W HOSPITALITY LN STE 300 SAN BERNARDINO CA 924083234 20 1073531802 0 Physicians Anesthesia Services 20 1073531802 0 Physicians Fluoride varnish 20 1073531802 0 Physicians Healthy Kids Services 20 1073531802 0 Physicians Optical Supplies 20 1073531802 0 Physicians Physician Services 00 1073532511 0 DAGEFOERDE NANCY 2000003 9999999 B 10 1073532511 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1073532511 0 Nurse Practitioners Fluoride varnish 20 1073532511 0 Nurse Practitioners Healthy Kids Services 20 1073532511 0 Nurse Practitioners Nurse Practitioners Services 20 1073532511 0 Nurse Practitioners Physician Services 00 1073533626 0 LANG PAMELA J 2017212 9999999 B 10 1073533626 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1073533626 0 Physicians Anesthesia Services 20 1073533626 0 Physicians Healthy Kids Services 20 1073533626 0 Physicians Optical Supplies 20 1073533626 0 Physicians Physician Services 00 1073533857 0 KAZA CHANDRAREKHA 2000061 9999999 B 10 1073533857 0 29373 NETWORK PL CHICAGO IL 606733039 20 1073533857 0 Physicians Anesthesia Services 20 1073533857 0 Physicians Fluoride varnish 20 1073533857 0 Physicians Healthy Kids Services 20 1073533857 0 Physicians Optical Supplies 20 1073533857 0 Physicians Physician Services 00 1073534681 0 KOPPE SEAN W P 2007182 9999999 B 10 1073534681 0 5777 DEPT CAROL STREAM IL 601228942 20 1073534681 0 Physicians Anesthesia Services 20 1073534681 0 Physicians Fluoride varnish 20 1073534681 0 Physicians Healthy Kids Services 20 1073534681 0 Physicians Optical Supplies 20 1073534681 0 Physicians Physician Services 00 1073537304 0 FELDMAN JOSEPH LARRY 1981227 9999999 B 10 1073537304 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1073537304 0 Physicians Anesthesia Services 20 1073537304 0 Physicians Healthy Kids Services 20 1073537304 0 Physicians Optical Supplies 20 1073537304 0 Physicians Physician Services 00 1073537643 0 SAM RONALD E 1998274 9999999 B 10 1073537643 0 PO BOX 80309 PHILADELPHIA PA 191011309 20 1073537643 0 Physicians Anesthesia Services 20 1073537643 0 Physicians Fluoride varnish 20 1073537643 0 Physicians Healthy Kids Services 20 1073537643 0 Physicians Optical Supplies 20 1073537643 0 Physicians Physician Services 00 1073538302 0 HALLAZGO JEFFREY J 2009177 9999999 B 10 1073538302 0 300 WINDING WOODS DR STE 200 O FALLON MO 633665081 20 1073538302 0 Physicians Anesthesia Services 20 1073538302 0 Physicians Healthy Kids Services 20 1073538302 0 Physicians Optical Supplies 20 1073538302 0 Physicians Physician Services 00 1073538880 0 SARRAJ AL A 1992031 9999999 B 10 1073538880 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1073538880 0 Physicians Anesthesia Services 20 1073538880 0 Physicians Fluoride varnish 20 1073538880 0 Physicians Healthy Kids Services 20 1073538880 0 Physicians Optical Supplies 20 1073538880 0 Physicians Physician Services 00 1073539292 0 DAUD YASMEEN N 2003182 9999999 B 10 1073539292 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1073539292 0 Physicians Anesthesia Services 20 1073539292 0 Physicians Fluoride varnish 20 1073539292 0 Physicians Healthy Kids Services 20 1073539292 0 Physicians Optical Supplies 20 1073539292 0 Physicians Physician Services 00 1073539680 0 MCKENNA RAJALAXMI 1981227 9999999 B 10 1073539680 0 10458 S PULASKI RD OAK LAWN IL 604534933 20 1073539680 0 Physicians Anesthesia Services 20 1073539680 0 Physicians Fluoride varnish 20 1073539680 0 Physicians Healthy Kids Services 20 1073539680 0 Physicians Optical Supplies 20 1073539680 0 Physicians Physician Services 00 1073539730 0 CABATU AMABEL-JOVAN 2023146 9999999 B 10 1073539730 0 PO BOX 43230 PHOENIX AZ 850803230 20 1073539730 0 Physicians Anesthesia Services 20 1073539730 0 Physicians Healthy Kids Services 20 1073539730 0 Physicians Optical Supplies 20 1073539730 0 Physicians Physician Services 00 1073540431 0 AUER CHARLES E 1996032 9999999 B 10 1073540431 0 2100 POWELL ST STE 900 EMERYVILLE CA 946081844 20 1073540431 0 Physicians Anesthesia Services 20 1073540431 0 Physicians Healthy Kids Services 20 1073540431 0 Physicians Optical Supplies 20 1073540431 0 Physicians Physician Services 00 1073540951 0 HOFF JOHN 2014152 9999999 B 10 1073540951 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1073540951 0 Physicians Anesthesia Services 20 1073540951 0 Physicians Healthy Kids Services 20 1073540951 0 Physicians Optical Supplies 20 1073540951 0 Physicians Physician Services 00 1073541041 0 SITKA GREGORY 2016183 9999999 B 10 1073541041 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1073541041 0 Physicians Anesthesia Services 20 1073541041 0 Physicians Healthy Kids Services 20 1073541041 0 Physicians Optical Supplies 20 1073541041 0 Physicians Physician Services 20 1073541041 0 Physicians Physicians Psychiatric Services 00 1073542221 0 BELLG LAURIN A 2018160 9999999 B 10 1073542221 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1073542221 0 Physicians Anesthesia Services 20 1073542221 0 Physicians Fluoride varnish 20 1073542221 0 Physicians Healthy Kids Services 20 1073542221 0 Physicians Optical Supplies 20 1073542221 0 Physicians Physician Services 00 1073542585 0 GUPTA SAMIR K 1999186 9999999 B 10 1073542585 0 1418 COLLEGE DR MOUNT CARMEL IL 628632638 20 1073542585 0 Physicians Anesthesia Services 20 1073542585 0 Physicians Healthy Kids Services 20 1073542585 0 Physicians Optical Supplies 20 1073542585 0 Physicians Physician Services 00 1073543112 0 BENZIGER KEITH 2000245 9999999 B 10 1073543112 0 28594 NETWORK PL CHICAGO IL 606731285 20 1073543112 0 Physicians Anesthesia Services 20 1073543112 0 Physicians Fluoride varnish 20 1073543112 0 Physicians Healthy Kids Services 20 1073543112 0 Physicians Optical Supplies 20 1073543112 0 Physicians Physician Services 00 1073543427 0 MAHLER EILEEN 2022151 9999999 B 10 1073543427 0 PO BOX 713388 CHICAGO IL 606771525 20 1073543427 0 Nurse Practitioners Healthy Kids Services 20 1073543427 0 Nurse Practitioners Nurse Practitioners Services 20 1073543427 0 Nurse Practitioners Physician Services 00 1073543880 0 MAALOUF VICTOR A 1996291 9999999 B 10 1073543880 0 6000 HOSPITAL DR HANNIBAL MO 634016887 20 1073543880 0 Physicians Anesthesia Services 20 1073543880 0 Physicians Healthy Kids Services 20 1073543880 0 Physicians Optical Supplies 20 1073543880 0 Physicians Physician Services 00 1073543906 0 ELTON ERIC 1997227 9999999 B 10 1073543906 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1073543906 0 Physicians Anesthesia Services 20 1073543906 0 Physicians Fluoride varnish 20 1073543906 0 Physicians Healthy Kids Services 20 1073543906 0 Physicians Optical Supplies 20 1073543906 0 Physicians Physician Services 00 1073544292 0 RITTER STEVEN 2025063 9999999 B 10 1073544292 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1073544292 0 Physicians Anesthesia Services 20 1073544292 0 Physicians Fluoride varnish 20 1073544292 0 Physicians Healthy Kids Services 20 1073544292 0 Physicians Optical Supplies 20 1073544292 0 Physicians Physician Services 00 1073544615 0 OWEN ROBERT C 2021092 9999999 B 10 1073544615 0 PO BOX 15722 HATTIESBURG MS 394045722 20 1073544615 0 Physicians Anesthesia Services 20 1073544615 0 Physicians Healthy Kids Services 20 1073544615 0 Physicians Optical Supplies 20 1073544615 0 Physicians Physician Services 00 1073547303 0 JAMPOL LEE 1981227 9999999 B 10 1073547303 0 5777 DEPT CAROL STREAM IL 601220021 20 1073547303 0 Physicians Anesthesia Services 20 1073547303 0 Physicians Healthy Kids Services 20 1073547303 0 Physicians Optical Supplies 20 1073547303 0 Physicians Physician Services 00 1073547469 0 CARLINS ALLEN H 2010121 9999999 B 10 1073547469 0 5777 DEPT CAROL STREAM IL 601220021 20 1073547469 0 Physicians Anesthesia Services 20 1073547469 0 Physicians Healthy Kids Services 20 1073547469 0 Physicians Optical Supplies 20 1073547469 0 Physicians Physician Services 00 1073547659 0 CABIN MARK 1997216 9999999 B 10 1073547659 0 1555 BARRINGTON RD STE 120 HOFFMAN ESTATES IL 601691062 20 1073547659 0 Physicians Anesthesia Services 20 1073547659 0 Physicians Healthy Kids Services 20 1073547659 0 Physicians Optical Supplies 20 1073547659 0 Physicians Physician Services 00 1073547741 0 FINKEL RICHARD 1993121 9999999 B 10 1073547741 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1073547741 0 Physicians Anesthesia Services 20 1073547741 0 Physicians Healthy Kids Services 20 1073547741 0 Physicians Optical Supplies 20 1073547741 0 Physicians Physician Services 20 1073547741 0 Physicians Physicians Psychiatric Services 00 1073548194 0 GIR KHURSHEED B 1995001 9999999 B 10 1073548194 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1073548194 0 Physicians Anesthesia Services 20 1073548194 0 Physicians Fluoride varnish 20 1073548194 0 Physicians Healthy Kids Services 20 1073548194 0 Physicians Optical Supplies 20 1073548194 0 Physicians Physician Services 00 1073548277 0 KIM HENRY C 1995333 9999999 B 10 1073548277 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1073548277 0 Physicians Anesthesia Services 20 1073548277 0 Physicians Healthy Kids Services 20 1073548277 0 Physicians Optical Supplies 20 1073548277 0 Physicians Physician Services 00 1073548483 0 THAKKAR SANJAY 2002182 9999999 B 10 1073548483 0 234 GARDEN ST YORKVILLE IL 605608921 20 1073548483 0 Physicians Anesthesia Services 20 1073548483 0 Physicians Fluoride varnish 20 1073548483 0 Physicians Healthy Kids Services 20 1073548483 0 Physicians Optical Supplies 20 1073548483 0 Physicians Physician Services 00 1073548970 0 CHEN PHILBERT 1991121 9999999 B 10 1073548970 0 611 W PARK ST URBANA IL 618012529 20 1073548970 0 Physicians Anesthesia Services 20 1073548970 0 Physicians Healthy Kids Services 20 1073548970 0 Physicians Optical Supplies 20 1073548970 0 Physicians Physician Services 00 1073549028 0 RIEGER MATTHEW 2017001 9999999 B 10 1073549028 0 PO BOX 66973 SLOT 303125 CHICAGO IL 606660973 20 1073549028 0 Physician Assistant Only Fluoride varnish 20 1073549028 0 Physician Assistant Only Healthy Kids Services 20 1073549028 0 Physician Assistant Only Physician Services 00 1073550034 0 CHRISTIAN SHARON 2023209 9999999 B 10 1073550034 0 PO BOX 486 SAN JACINTO CA 925810486 20 1073550034 0 Physicians Anesthesia Services 20 1073550034 0 Physicians Healthy Kids Services 20 1073550034 0 Physicians Optical Supplies 20 1073550034 0 Physicians Physician Services 00 1073551594 0 SHABBIR MOHAMMED 2000245 9999999 B 10 1073551594 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1073551594 0 Physicians Anesthesia Services 20 1073551594 0 Physicians Fluoride varnish 20 1073551594 0 Physicians Healthy Kids Services 20 1073551594 0 Physicians Optical Supplies 20 1073551594 0 Physicians Physician Services 00 1073552527 0 HUGHES DENNIS M 2022327 9999999 B 10 1073552527 0 PO BOX 43230 PHOENIX AZ 850803230 20 1073552527 0 Physicians Anesthesia Services 20 1073552527 0 Physicians Healthy Kids Services 20 1073552527 0 Physicians Optical Supplies 20 1073552527 0 Physicians Physician Services 20 1073552527 0 Physicians Physicians Psychiatric Services 00 1073554085 0 SPALDING JOSEPH 2009213 9999999 B 10 1073554085 0 118 N 2ND ST STE 200 SAINT CHARLES MO 633012894 20 1073554085 0 Physicians Anesthesia Services 20 1073554085 0 Physicians Healthy Kids Services 20 1073554085 0 Physicians Optical Supplies 20 1073554085 0 Physicians Physician Services 20 1073554085 0 Physicians Physicians Psychiatric Services 00 1073555488 0 KUGANESWARAN ELIATHAMBY 2001335 9999999 B 10 1073555488 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1073555488 0 Physicians Anesthesia Services 20 1073555488 0 Physicians Fluoride varnish 20 1073555488 0 Physicians Healthy Kids Services 20 1073555488 0 Physicians Optical Supplies 20 1073555488 0 Physicians Physician Services 00 1073556304 0 GROVER IAN 2018032 9999999 B 10 1073556304 0 5090 S FORT APACHE RD LAS VEGAS NV 891481714 20 1073556304 0 Physicians Anesthesia Services 20 1073556304 0 Physicians Healthy Kids Services 20 1073556304 0 Physicians Optical Supplies 20 1073556304 0 Physicians Physician Services 00 1073556700 0 EVENS ROBERT J 2019172 9999999 B 10 1073556700 0 500 PORTER AVE AURORA MO 656052365 20 1073556700 0 Physicians Anesthesia Services 20 1073556700 0 Physicians Healthy Kids Services 20 1073556700 0 Physicians Optical Supplies 20 1073556700 0 Physicians Physician Services 00 1073557229 0 WAGNER JAMIE R 1999179 9999999 B 10 1073557229 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1073557229 0 Other behavior health professional LCPC/LMFT services 00 1073557310 0 YASSIN-KASSAB MOUNZER 2016336 9999999 B 10 1073557310 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1073557310 0 Physicians Anesthesia Services 20 1073557310 0 Physicians Healthy Kids Services 20 1073557310 0 Physicians Optical Supplies 20 1073557310 0 Physicians Physician Services 20 1073557310 0 Physicians Physicians Psychiatric Services 00 1073557401 0 EWALD GREGORY A 1994121 9999999 B 10 1073557401 0 1020 N MASON RD STE 210 CREVE COEUR MO 631416300 20 1073557401 0 Physicians Anesthesia Services 20 1073557401 0 Physicians Fluoride varnish 20 1073557401 0 Physicians Healthy Kids Services 20 1073557401 0 Physicians Optical Supplies 20 1073557401 0 Physicians Physician Services 00 1073557757 0 DEL RIO MICHAEL 2023267 9999999 B 10 1073557757 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1073557757 0 Physicians Anesthesia Services 20 1073557757 0 Physicians Healthy Kids Services 20 1073557757 0 Physicians Optical Supplies 20 1073557757 0 Physicians Physician Services 00 1073558177 0 FALER LANCE C 2022173 9999999 B 10 1073558177 0 70 DOCTORS PARK CAPE GIRARDEAU MO 637034928 20 1073558177 0 Physicians Anesthesia Services 20 1073558177 0 Physicians Healthy Kids Services 20 1073558177 0 Physicians Optical Supplies 20 1073558177 0 Physicians Physician Services 00 1073558276 0 KANSAL PREETI 2004183 9999999 B 10 1073558276 0 5777 DEPT CAROL STREAM IL 601220021 20 1073558276 0 Physicians Anesthesia Services 20 1073558276 0 Physicians Fluoride varnish 20 1073558276 0 Physicians Healthy Kids Services 20 1073558276 0 Physicians Optical Supplies 20 1073558276 0 Physicians Physician Services 00 1073558383 0 KURAPATI SURENDER 2015335 9999999 B 10 1073558383 0 1044 N FRANCISCO AVE CHICAGO IL 606222743 20 1073558383 0 Physicians Anesthesia Services 20 1073558383 0 Physicians Healthy Kids Services 20 1073558383 0 Physicians Optical Supplies 20 1073558383 0 Physicians Physician Services 00 1073558466 0 JAVERI ASAVARI 2002228 9999999 B 10 1073558466 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1073558466 0 Physicians Anesthesia Services 20 1073558466 0 Physicians Fluoride varnish 20 1073558466 0 Physicians Healthy Kids Services 20 1073558466 0 Physicians Optical Supplies 20 1073558466 0 Physicians Physician Services 00 1073559027 0 ABERNATHY MARY PELL 1996001 9999999 B 10 1073559027 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1073559027 0 Physicians Anesthesia Services 20 1073559027 0 Physicians Healthy Kids Services 20 1073559027 0 Physicians Optical Supplies 20 1073559027 0 Physicians Physician Services 00 1073560512 0 SALDANHA RITA P 1997335 9999999 B 10 1073560512 0 9680 GOLF RD FL 2 DES PLAINES IL 600161522 20 1073560512 0 Physicians Anesthesia Services 20 1073560512 0 Physicians Fluoride varnish 20 1073560512 0 Physicians Healthy Kids Services 20 1073560512 0 Physicians Optical Supplies 20 1073560512 0 Physicians Physician Services 00 1073560751 0 DEWEERT THOMAS M 1990157 9999999 B 10 1073560751 0 611 W PARK ST URBANA IL 618012529 20 1073560751 0 Physicians Anesthesia Services 20 1073560751 0 Physicians Fluoride varnish 20 1073560751 0 Physicians Healthy Kids Services 20 1073560751 0 Physicians Optical Supplies 20 1073560751 0 Physicians Physician Services 00 1073561023 0 PANG KENNETH C 1994182 9999999 B 10 1073561023 0 PO BOX 776473 CHICAGO IL 606776473 20 1073561023 0 Physicians Anesthesia Services 20 1073561023 0 Physicians Healthy Kids Services 20 1073561023 0 Physicians Optical Supplies 20 1073561023 0 Physicians Physician Services 00 1073561577 0 SIPPEL REBECCA S 2007182 9999999 B 10 1073561577 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1073561577 0 Physicians Anesthesia Services 20 1073561577 0 Physicians Healthy Kids Services 20 1073561577 0 Physicians Optical Supplies 20 1073561577 0 Physicians Physician Services 00 1073561858 0 GADDAM ELIYAZAR 1992275 9999999 B 10 1073561858 0 PO BOX 83287 CHICAGO IL 606910287 20 1073561858 0 Physicians Anesthesia Services 20 1073561858 0 Physicians Fluoride varnish 20 1073561858 0 Physicians Healthy Kids Services 20 1073561858 0 Physicians Optical Supplies 20 1073561858 0 Physicians Physician Services 00 1073561908 0 BECKER MICHAEL L 2022168 9999999 B 10 1073561908 0 6024 RIDGE AVE STE 116-356 PHILADELPHIA PA 191281601 20 1073561908 0 Physicians Anesthesia Services 20 1073561908 0 Physicians Healthy Kids Services 20 1073561908 0 Physicians Optical Supplies 20 1073561908 0 Physicians Physician Services 00 1073562179 0 ISAACSON DAVID R 2012092 9999999 B 10 1073562179 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1073562179 0 Physicians Anesthesia Services 20 1073562179 0 Physicians Fluoride varnish 20 1073562179 0 Physicians Healthy Kids Services 20 1073562179 0 Physicians Optical Supplies 20 1073562179 0 Physicians Physician Services 00 1073562393 0 MEYER WILLIAM 1989182 9999999 B 10 1073562393 0 PO BOX 713388 CHICAGO IL 606771525 20 1073562393 0 Physicians Anesthesia Services 20 1073562393 0 Physicians Healthy Kids Services 20 1073562393 0 Physicians Optical Supplies 20 1073562393 0 Physicians Physician Services 00 1073562518 0 CABOTT CHRISTINA M 2008344 9999999 B 10 1073562518 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1073562518 0 Physicians Anesthesia Services 20 1073562518 0 Physicians Healthy Kids Services 20 1073562518 0 Physicians Optical Supplies 20 1073562518 0 Physicians Physician Services 00 1073562617 0 SINGH SANTOSH KUMAR 2003213 9999999 B 10 1073562617 0 5777 DEPT CAROL STREAM IL 601220021 20 1073562617 0 Physicians Anesthesia Services 20 1073562617 0 Physicians Healthy Kids Services 20 1073562617 0 Physicians Optical Supplies 20 1073562617 0 Physicians Physician Services 00 1073562724 0 RAFIQUE MUHAMMAD 2020349 9999999 B 10 1073562724 0 29373 NETWORK PL CHICAGO IL 606733039 20 1073562724 0 Physicians Anesthesia Services 20 1073562724 0 Physicians Healthy Kids Services 20 1073562724 0 Physicians Optical Supplies 20 1073562724 0 Physicians Physician Services 00 1073562955 0 CHEUNG DICKSON S 1997001 9999999 B 10 1073562955 0 PO BOX 110429 AURORA CO 800420429 20 1073562955 0 Physicians Anesthesia Services 20 1073562955 0 Physicians Healthy Kids Services 20 1073562955 0 Physicians Optical Supplies 20 1073562955 0 Physicians Physician Services 00 1073563581 0 BAWAMIA ALI 2007351 9999999 B 10 1073563581 0 PO BOX 34098 LOUISVILLE KY 402324098 20 1073563581 0 Physicians Anesthesia Services 20 1073563581 0 Physicians Fluoride varnish 20 1073563581 0 Physicians Healthy Kids Services 20 1073563581 0 Physicians Optical Supplies 20 1073563581 0 Physicians Physician Services 00 1073563730 0 REGEHR MICHELLE 2006001 9999999 B 10 1073563730 0 7725 N KNOXVILLE AVE PEORIA IL 616142079 20 1073563730 0 Nurse Practitioners Healthy Kids Services 20 1073563730 0 Nurse Practitioners Nurse Practitioners Services 20 1073563730 0 Nurse Practitioners Physician Services 00 1073563821 0 WALKER JACQUELINE 1996275 9999999 B 10 1073563821 0 PO BOX 713388 CHICAGO IL 606771525 20 1073563821 0 Physicians Anesthesia Services 20 1073563821 0 Physicians Fluoride varnish 20 1073563821 0 Physicians Healthy Kids Services 20 1073563821 0 Physicians Optical Supplies 20 1073563821 0 Physicians Physician Services 00 1073564332 0 WATKINS CATHERINE M 2010116 9999999 B 10 1073564332 0 171 SANTA FE LN WILLOW SPRINGS IL 604801624 20 1073564332 0 Clinical Social Worker Social work service 00 1073564795 0 BILAK PAUL S 2015245 9999999 B 10 1073564795 0 2200 JEFFERSON AVE TOLEDO OH 436047101 20 1073564795 0 Nurse Practitioners Fluoride varnish 20 1073564795 0 Nurse Practitioners Healthy Kids Services 20 1073564795 0 Nurse Practitioners Nurse Practitioners Services 20 1073564795 0 Nurse Practitioners Physician Services 00 1073565545 0 IPPOLITO JOHN J 1992347 9999999 B 10 1073565545 0 678 CEDAR CROSSINGS DR NEW LENOX IL 604515200 20 1073565545 0 Physicians Anesthesia Services 20 1073565545 0 Physicians Healthy Kids Services 20 1073565545 0 Physicians Optical Supplies 20 1073565545 0 Physicians Physician Services 00 1073565784 0 MORAN MICHAEL 1992183 9999999 B 10 1073565784 0 611 W PARK ST URBANA IL 618012529 20 1073565784 0 Physicians Anesthesia Services 20 1073565784 0 Physicians Healthy Kids Services 20 1073565784 0 Physicians Optical Supplies 20 1073565784 0 Physicians Physician Services 00 1073565867 0 GLUSMAN MARIANA 1996244 9999999 B 10 1073565867 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1073565867 0 Physicians Anesthesia Services 20 1073565867 0 Physicians Fluoride varnish 20 1073565867 0 Physicians Healthy Kids Services 20 1073565867 0 Physicians Optical Supplies 20 1073565867 0 Physicians Physician Services 00 1073566576 0 MARRAN MEREDITH M 2006001 9999999 B 10 1073566576 0 5777 DEPT CAROL STREAM IL 601220021 20 1073566576 0 Nurse Practitioners Anesthesia Services 20 1073566576 0 Nurse Practitioners Nurse Practitioners Services 20 1073566576 0 Nurse Practitioners Physician Services 00 1073567152 0 MCPHAUL ASHLEY R 2023038 9999999 B 10 1073567152 0 6742 N FROSTWOOD PKWY PEORIA IL 616152402 20 1073567152 0 Nurse Practitioners Anesthesia Services 20 1073567152 0 Nurse Practitioners Nurse Practitioners Services 20 1073567152 0 Nurse Practitioners Physician Services 00 1073567871 0 FOREMAN JASON R 2016001 9999999 B 10 1073567871 0 2100 POWELL ST STE 900 EMERYVILLE CA 946081844 20 1073567871 0 Physicians Anesthesia Services 20 1073567871 0 Physicians Healthy Kids Services 20 1073567871 0 Physicians Optical Supplies 20 1073567871 0 Physicians Physician Services 00 1073568044 0 FERRY-ROONEY RAECHEL 2014309 9999999 B 10 1073568044 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1073568044 0 Nurse Practitioners Healthy Kids Services 20 1073568044 0 Nurse Practitioners Nurse Practitioners Services 20 1073568044 0 Nurse Practitioners Physician Services 00 1073568259 0 KHURANA AMAN 2014227 9999999 B 10 1073568259 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1073568259 0 Physicians Anesthesia Services 20 1073568259 0 Physicians Fluoride varnish 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Physicians Anesthesia Services 20 1073576922 0 Physicians Fluoride varnish 20 1073576922 0 Physicians Healthy Kids Services 20 1073576922 0 Physicians Optical Supplies 20 1073576922 0 Physicians Physician Services 00 1073577045 0 ATZEFF KRISTOPHER N 2002213 9999999 B 10 1073577045 0 5777 DEPT CAROL STREAM IL 601220021 20 1073577045 0 Physicians Anesthesia Services 20 1073577045 0 Physicians Healthy Kids Services 20 1073577045 0 Physicians Optical Supplies 20 1073577045 0 Physicians Physician Services 00 1073577193 0 GOLZAR JAAFER A 2006182 9999999 B 10 1073577193 0 28594 NETWORK PL CHICAGO IL 606731081 20 1073577193 0 Physicians Anesthesia Services 20 1073577193 0 Physicians Fluoride varnish 20 1073577193 0 Physicians Healthy Kids Services 20 1073577193 0 Physicians Optical Supplies 20 1073577193 0 Physicians Physician Services 00 1073578456 0 JOHNSON AMY 2023044 9999999 B 10 1073578456 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1073578456 0 Physicians Anesthesia Services 20 1073578456 0 Physicians Fluoride varnish 20 1073578456 0 Physicians Healthy Kids Services 20 1073578456 0 Physicians Optical Supplies 20 1073578456 0 Physicians Physician Services 00 1073578753 0 AWAN AMJAD 2024228 9999999 B 10 1073578753 0 2605 KENTUCKY AVE STE 306 PADUCAH KY 420033802 20 1073578753 0 Physicians Anesthesia Services 20 1073578753 0 Physicians Fluoride varnish 20 1073578753 0 Physicians Healthy Kids Services 20 1073578753 0 Physicians Optical Supplies 20 1073578753 0 Physicians Physician Services 00 1073579314 0 TWYMAN CAROL 2017235 9999999 B 10 1073579314 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1073579314 0 Physicians Anesthesia Services 20 1073579314 0 Physicians Fluoride varnish 20 1073579314 0 Physicians Healthy Kids Services 20 1073579314 0 Physicians Optical Supplies 20 1073579314 0 Physicians Physician Services 00 1073579397 0 JOHNSON ROBERT B 2013001 9999999 B 10 1073579397 0 29373 NETWORK PL CHICAGO IL 606733039 20 1073579397 0 Physicians Anesthesia Services 20 1073579397 0 Physicians Fluoride varnish 20 1073579397 0 Physicians Healthy Kids Services 20 1073579397 0 Physicians Optical Supplies 20 1073579397 0 Physicians Physician Services 00 1073580098 0 BURGOS JOSELITO 2021277 9999999 B 10 1073580098 0 200 BUNKER HILL DR AITKIN MN 564311865 20 1073580098 0 Physicians Anesthesia Services 20 1073580098 0 Physicians Fluoride varnish 20 1073580098 0 Physicians Healthy Kids Services 20 1073580098 0 Physicians Optical Supplies 20 1073580098 0 Physicians Physician Services 00 1073580122 0 ROHRSCHEIB SIDNEY P 1995186 9999999 B 10 1073580122 0 422 W WHITE ST CLINTON IL 617272272 20 1073580122 0 Physicians Anesthesia Services 20 1073580122 0 Physicians Healthy Kids Services 20 1073580122 0 Physicians Optical Supplies 20 1073580122 0 Physicians Physician Services 00 1073580676 0 TRIELOFF DEBRA A 2021171 9999999 B 10 1073580676 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1073580676 0 Physician Assistant Only Fluoride varnish 20 1073580676 0 Physician Assistant Only Healthy Kids Services 20 1073580676 0 Physician Assistant Only Physician Services 00 1073580700 0 DOWLING PATRICK 2008245 9999999 B 10 1073580700 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1073580700 0 Physicians Anesthesia Services 20 1073580700 0 Physicians Fluoride varnish 20 1073580700 0 Physicians Healthy Kids Services 20 1073580700 0 Physicians Optical Supplies 20 1073580700 0 Physicians Physician Services 00 1073581146 0 VIGLIONE MICHAEL 2003244 9999999 B 10 1073581146 0 28100 N ASHLEY CIR STE 106 LIBERTYVILLE IL 600489478 20 1073581146 0 Physicians Anesthesia Services 20 1073581146 0 Physicians Healthy Kids Services 20 1073581146 0 Physicians Optical Supplies 20 1073581146 0 Physicians Physician Services 00 1073581393 0 JONES NORMAN E 1990152 9999999 B 10 1073581393 0 3600 MINNESOTA DR STE 800 MINNEAPOLIS MN 554357915 20 1073581393 0 Physicians Anesthesia Services 20 1073581393 0 Physicians Healthy Kids Services 20 1073581393 0 Physicians Optical Supplies 20 1073581393 0 Physicians Physician Services 00 1073581971 0 RIVERA MARIA LOURDES PE 1996021 9999999 B 10 1073581971 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1073581971 0 Physicians Anesthesia Services 20 1073581971 0 Physicians Fluoride varnish 20 1073581971 0 Physicians Healthy Kids Services 20 1073581971 0 Physicians Optical Supplies 20 1073581971 0 Physicians Physician Services 00 1073582102 0 SCHMIDT GREGORY A 1984188 9999999 B 10 1073582102 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1073582102 0 Physicians Anesthesia Services 20 1073582102 0 Physicians Fluoride varnish 20 1073582102 0 Physicians Healthy Kids Services 20 1073582102 0 Physicians Optical Supplies 20 1073582102 0 Physicians Physician Services 00 1073583068 0 SIMON HOWARD 2020157 9999999 B 10 1073583068 0 16220 N SCOTTSDALE RD STE 600 SCOTTSDALE AZ 852541804 20 1073583068 0 Physicians Anesthesia Services 20 1073583068 0 Physicians Healthy Kids Services 20 1073583068 0 Physicians 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MARK CHARLES 2020042 9999999 B 10 1073586848 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1073586848 0 Physicians Anesthesia Services 20 1073586848 0 Physicians Fluoride varnish 20 1073586848 0 Physicians Healthy Kids Services 20 1073586848 0 Physicians Optical Supplies 20 1073586848 0 Physicians Physician Services 00 1073588802 0 LAVACCARE JOHN 2001335 9999999 B 10 1073588802 0 1555 BARRINGTON RD STE 205 HOFFMAN ESTATES IL 601691063 20 1073588802 0 Physicians Anesthesia Services 20 1073588802 0 Physicians Healthy Kids Services 20 1073588802 0 Physicians Optical Supplies 20 1073588802 0 Physicians Physician Services 20 1073588802 0 Physicians Physicians Psychiatric Services 00 1073588935 0 SULLIVAN ERIN A 2019241 9999999 B 10 1073588935 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1073588935 0 Physicians Anesthesia Services 20 1073588935 0 Physicians Healthy Kids Services 20 1073588935 0 Physicians Optical Supplies 20 1073588935 0 Physicians Physician Services 00 1073589545 0 BRADFIELD YASMIN S 2003279 9999999 B 10 1073589545 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1073589545 0 Physicians Anesthesia Services 20 1073589545 0 Physicians Healthy Kids Services 20 1073589545 0 Physicians Optical Supplies 20 1073589545 0 Physicians Physician Services 00 1073589727 0 KLEIN BRUCE S 1986167 9999999 B 10 1073589727 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1073589727 0 Physicians Anesthesia Services 20 1073589727 0 Physicians Fluoride varnish 20 1073589727 0 Physicians Healthy Kids Services 20 1073589727 0 Physicians Optical Supplies 20 1073589727 0 Physicians Physician Services 00 1073590204 0 BUZZARD TERRY L 1991256 9999999 B 10 1073590204 0 PO BOX 500 ELLICOTTVILLE NY 147310500 20 1073590204 0 Physicians Anesthesia Services 20 1073590204 0 Physicians Fluoride varnish 20 1073590204 0 Physicians Healthy Kids Services 20 1073590204 0 Physicians Optical Supplies 20 1073590204 0 Physicians Physician Services 00 1073590212 0 KELLY MARY 1999363 9999999 B 10 1073590212 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1073590212 0 Physical Therapists Medical Supplies 20 1073590212 0 Physical Therapists Medical equipment/prosthetic devices 20 1073590212 0 Physical Therapists Physical Therapy Services 00 1073590337 0 LU JIM ZB 2012153 9999999 B 10 1073590337 0 525 VALLEY VIEW DR MOLINE IL 612656138 20 1073590337 0 Physicians Anesthesia Services 20 1073590337 0 Physicians Healthy Kids Services 20 1073590337 0 Physicians Optical Supplies 20 1073590337 0 Physicians Physician Services 00 1073591657 0 WITKOFF MAURY 2020257 9999999 B 10 1073591657 0 PO BOX 43230 PHOENIX AZ 850803230 20 1073591657 0 Physicians Anesthesia Services 20 1073591657 0 Physicians Healthy Kids Services 20 1073591657 0 Physicians Optical Supplies 20 1073591657 0 Physicians Physician Services 00 1073592325 0 CRAIG JIM C 2022001 9999999 B 10 1073592325 0 PO BOX 43230 PHOENIX AZ 850803230 20 1073592325 0 Physicians Anesthesia Services 20 1073592325 0 Physicians Healthy Kids Services 20 1073592325 0 Physicians Optical Supplies 20 1073592325 0 Physicians Physician Services 00 1073592648 0 CHIEN DAVID 1997032 9999999 B 10 1073592648 0 PO BOX 22407 SAINT LOUIS MO 631260407 20 1073592648 0 Physicians Anesthesia Services 20 1073592648 0 Physicians Healthy Kids Services 20 1073592648 0 Physicians Optical Supplies 20 1073592648 0 Physicians Physician Services 00 1073592960 0 MYERS MARK 2024218 9999999 B 10 1073592960 0 5775 WAYZATA BLVD STE 400 SAINT LOUIS PAR MN 554161271 20 1073592960 0 Physicians Anesthesia Services 20 1073592960 0 Physicians Healthy Kids Services 20 1073592960 0 Physicians Optical Supplies 20 1073592960 0 Physicians Physician Services 00 1073593034 0 CHAKRABARTI CHANDRAMA 2024075 9999999 B 10 1073593034 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1073593034 0 Physicians Anesthesia Services 20 1073593034 0 Physicians Fluoride varnish 20 1073593034 0 Physicians Healthy Kids Services 20 1073593034 0 Physicians Optical Supplies 20 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0 Physicians Anesthesia Services 20 1073596698 0 Physicians Healthy Kids Services 20 1073596698 0 Physicians Optical Supplies 20 1073596698 0 Physicians Physician Services 00 1073596730 0 STEVENS ROM A 2016183 9999999 B 10 1073596730 0 2334 MOMENTUM PL CHICAGO IL 606895325 20 1073596730 0 Physicians Anesthesia Services 20 1073596730 0 Physicians Healthy Kids Services 20 1073596730 0 Physicians Optical Supplies 20 1073596730 0 Physicians Physician Services 00 1073596896 0 HUTSON RICK 1998274 9999999 B 10 1073596896 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1073596896 0 Physicians Anesthesia Services 20 1073596896 0 Physicians Healthy Kids Services 20 1073596896 0 Physicians Optical Supplies 20 1073596896 0 Physicians Physician Services 00 1073597142 0 MASUTTI VERA 1992321 9999999 B 10 1073597142 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1073597142 0 Physicians Anesthesia Services 20 1073597142 0 Physicians Healthy Kids Services 20 1073597142 0 Physicians Optical Supplies 20 1073597142 0 Physicians Physician Services 00 1073597340 0 BADOV MITKO 2022193 9999999 B 10 1073597340 0 PO BOX 43230 PHOENIX AZ 850803230 20 1073597340 0 Physicians Anesthesia Services 20 1073597340 0 Physicians Healthy Kids Services 20 1073597340 0 Physicians Optical Supplies 20 1073597340 0 Physicians Physician Services 00 1073597498 0 GUNTHER PETER 2019126 9999999 B 10 1073597498 0 7427 LAKE ST RIVER FOREST IL 603051817 20 1073597498 0 Optometrists Optical Supplies 20 1073597498 0 Optometrists Optometric Services 20 1073597498 0 Optometrists Physician Services 00 1073597795 0 GELLER STEVEN 1988198 9999999 B 10 1073597795 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1073597795 0 Physicians Anesthesia Services 20 1073597795 0 Physicians Fluoride varnish 20 1073597795 0 Physicians Healthy Kids Services 20 1073597795 0 Physicians Optical Supplies 20 1073597795 0 Physicians Physician Services 00 1073597894 0 JACHTOROWYCZ MARKO 1993138 9999999 B 10 1073597894 0 PO BOX 5588 BELFAST ME 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Physician Services 00 1073826715 0 DUCTAN KERLINE 2013332 9999999 B 10 1073826715 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1073826715 0 Physicians Anesthesia Services 20 1073826715 0 Physicians Fluoride varnish 20 1073826715 0 Physicians Healthy Kids Services 20 1073826715 0 Physicians Optical Supplies 20 1073826715 0 Physicians Physician Services 00 1073827267 0 BLUMMER STEFANIE L 2015177 9999999 B 10 1073827267 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1073827267 0 Nurse Practitioners Healthy Kids Services 20 1073827267 0 Nurse Practitioners Nurse Practitioners Services 20 1073827267 0 Nurse Practitioners Physician Services 00 1073827721 0 POWERS BRADEN CHRISTOPHER 2016196 9999999 B 10 1073827721 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1073827721 0 Physicians Anesthesia Services 20 1073827721 0 Physicians Fluoride varnish 20 1073827721 0 Physicians Healthy Kids Services 20 1073827721 0 Physicians Optical Supplies 20 1073827721 0 Physicians Physician 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Physicians Physicians Psychiatric Services 00 1073889242 0 DOWNING JOHN T 2016161 9999999 B 10 1073889242 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1073889242 0 Physicians Anesthesia Services 20 1073889242 0 Physicians Healthy Kids Services 20 1073889242 0 Physicians Optical Supplies 20 1073889242 0 Physicians Physician Services 00 1073889382 0 OSIPOVA ANASTASIA 2012245 9999999 B 10 1073889382 0 5777 DEPT CAROL STREAM IL 601228942 20 1073889382 0 Physicians Anesthesia Services 20 1073889382 0 Physicians Healthy Kids Services 20 1073889382 0 Physicians Optical Supplies 20 1073889382 0 Physicians Physician Services 00 1073891107 0 RAINWATER DANIEL J 2014227 9999999 B 10 1073891107 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1073891107 0 Physicians Anesthesia Services 20 1073891107 0 Physicians Fluoride varnish 20 1073891107 0 Physicians Healthy Kids Services 20 1073891107 0 Physicians Optical Supplies 20 1073891107 0 Physicians Physician Services 00 1073891149 0 SHERRY CHARNAI 2017211 9999999 B 10 1073891149 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1073891149 0 Physician Assistant Only Fluoride varnish 20 1073891149 0 Physician Assistant Only Healthy Kids Services 20 1073891149 0 Physician Assistant Only Physician Services 00 1073892253 0 SINGH NIMARTA 2018335 9999999 B 10 1073892253 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1073892253 0 Physicians Anesthesia Services 20 1073892253 0 Physicians Healthy Kids Services 20 1073892253 0 Physicians Optical Supplies 20 1073892253 0 Physicians Physician Services 00 1073893434 0 LEE EUN HYE 2011220 9999999 B 10 1073893434 0 4224 W LAWRENCE AVE CHICAGO IL 606302729 20 1073893434 0 Dentists Dental Services 20 1073893434 0 Dentists Physician Services 00 1073894283 0 ROBERTS RENE M 2022131 9999999 B 10 1073894283 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1073894283 0 Physicians Anesthesia Services 20 1073894283 0 Physicians Fluoride varnish 20 1073894283 0 Physicians Healthy Kids Services 20 1073894283 0 Physicians Optical Supplies 20 1073894283 0 Physicians Physician Services 00 1073894481 0 MCDERMOTT NICOLE M 2015284 9999999 B 10 1073894481 0 678 CEDAR CROSSINGS DR NEW LENOX IL 604515200 20 1073894481 0 Nurse Practitioners Anesthesia Services 20 1073894481 0 Nurse Practitioners Nurse Practitioners Services 20 1073894481 0 Nurse Practitioners Physician Services 00 1073894812 0 BERRY JENNIFER 2011182 9999999 B 10 1073894812 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1073894812 0 Audiologists Audiology Services 20 1073894812 0 Audiologists Medical Supplies 20 1073894812 0 Audiologists Medical equipment/prosthetic devices 00 1073897302 0 HAWKINS KRISTIN 2017276 9999999 B 10 1073897302 0 5400 W 77TH ST BURBANK IL 604591816 20 1073897302 0 Speech Therapists Medical Supplies 20 1073897302 0 Speech Therapists Medical equipment/prosthetic devices 20 1073897302 0 Speech Therapists Speech Therapy/Pathology Services 00 1073897369 0 HO PHOUC 2024225 9999999 B 10 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606740018 20 1073899548 0 Physician Assistant Only Fluoride varnish 20 1073899548 0 Physician Assistant Only Healthy Kids Services 20 1073899548 0 Physician Assistant Only Physician Services 00 1073900536 0 BERNARDI MARK THOMAS 2018351 9999999 B 10 1073900536 0 5635 S ARCHER AVE CHICAGO IL 606381673 20 1073900536 0 Physicians Anesthesia Services 20 1073900536 0 Physicians Healthy Kids Services 20 1073900536 0 Physicians Optical Supplies 20 1073900536 0 Physicians Physician Services 00 1073902755 0 PAK NANCY 2015108 9999999 B 10 1073902755 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1073902755 0 Nurse Practitioners Fluoride varnish 20 1073902755 0 Nurse Practitioners Healthy Kids Services 20 1073902755 0 Nurse Practitioners Nurse Practitioners Services 20 1073902755 0 Nurse Practitioners Physician Services 00 1073903241 0 JOHNS DAWN M 2019019 9999999 B 10 1073903241 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1073903241 0 Nurse Practitioners Healthy Kids Services 20 1073903241 0 Nurse Practitioners Nurse Practitioners Services 20 1073903241 0 Nurse Practitioners Physician Services 00 1073904256 0 EWBANK ANDREW P 2020034 9999999 B 10 1073904256 0 777 LOWNDES HILL RD BLDG 1 GREENVILLE SC 296072101 20 1073904256 0 Physicians Anesthesia Services 20 1073904256 0 Physicians Healthy Kids Services 20 1073904256 0 Physicians Optical Supplies 20 1073904256 0 Physicians Physician Services 00 1073904348 0 DEES-MCMAHON REBEKAH F 2017314 9999999 B 10 1073904348 0 2323 WINDISH DR GALESBURG IL 614019780 20 1073904348 0 Other behavior health professional LCPC/LMFT services 00 1073905089 0 PACHNIK SHANNON 2015214 9999999 B 10 1073905089 0 16001 108TH AVE ORLAND PARK IL 604678788 20 1073905089 0 Nurse Practitioners Fluoride varnish 20 1073905089 0 Nurse Practitioners Healthy Kids Services 20 1073905089 0 Nurse Practitioners Nurse Practitioners Services 20 1073905089 0 Nurse Practitioners Physician Services 00 1073906814 0 MARINESCU CLAUDIA S 2016225 9999999 B 10 1073906814 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1073906814 0 Dentists Dental Services 20 1073906814 0 Dentists Physician Services 00 1073907341 0 GANDHI SHWETA H 2018137 9999999 B 10 1073907341 0 29373 NETWORK PL CHICAGO IL 606733039 20 1073907341 0 Physicians Anesthesia Services 20 1073907341 0 Physicians Fluoride varnish 20 1073907341 0 Physicians Healthy Kids Services 20 1073907341 0 Physicians Optical Supplies 20 1073907341 0 Physicians Physician Services 00 1073907663 0 GRAFF LINDSEY E 2019220 9999999 B 10 1073907663 0 2801 LAKESIDE DR STE 209 BANNOCKBURN IL 600151271 20 1073907663 0 Physicians Anesthesia Services 20 1073907663 0 Physicians Healthy Kids Services 20 1073907663 0 Physicians Optical Supplies 20 1073907663 0 Physicians Physician Services 00 1073907978 0 TA KAREN 2021291 9999999 B 10 1073907978 0 5701 W TALAVI BLVD STE 120 GLENDALE AZ 853061888 20 1073907978 0 Physicians Anesthesia Services 20 1073907978 0 Physicians Healthy Kids Services 20 1073907978 0 Physicians Optical Supplies 20 1073907978 0 Physicians Physician Services 00 1073909123 0 KYRIAKOPOULOS EUGENIA 2018170 9999999 B 10 1073909123 0 5777 DEPT CAROL STREAM IL 601228942 20 1073909123 0 Physicians Anesthesia Services 20 1073909123 0 Physicians Fluoride varnish 20 1073909123 0 Physicians Healthy Kids Services 20 1073909123 0 Physicians Optical Supplies 20 1073909123 0 Physicians Physician Services 00 1073909149 0 MCGHEE KATHRYN D 2024056 9999999 B 10 1073909149 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1073909149 0 Physicians Anesthesia Services 20 1073909149 0 Physicians Healthy Kids Services 20 1073909149 0 Physicians Optical Supplies 20 1073909149 0 Physicians Physician Services 00 1073909214 0 MONTAVON BRITTANY 2018088 9999999 B 10 1073909214 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1073909214 0 Physicians Anesthesia Services 20 1073909214 0 Physicians Fluoride varnish 20 1073909214 0 Physicians Healthy Kids Services 20 1073909214 0 Physicians 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1073925723 0 Clinical Social Worker Social work service 00 1073925863 0 NEWTSON ANDREEA 2025009 9999999 B 10 1073925863 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1073925863 0 Physicians Anesthesia Services 20 1073925863 0 Physicians Healthy Kids Services 20 1073925863 0 Physicians Optical Supplies 20 1073925863 0 Physicians Physician Services 00 1073926234 0 SCHUMACHER THOMAS R 2015149 9999999 B 10 1073926234 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1073926234 0 Physicians Anesthesia Services 20 1073926234 0 Physicians Fluoride varnish 20 1073926234 0 Physicians Healthy Kids Services 20 1073926234 0 Physicians Optical Supplies 20 1073926234 0 Physicians Physician Services 00 1073926846 0 BELAY ABEL RG 2021194 9999999 B 10 1073926846 0 70 DOCTORS PARK CAPE GIRARDEAU MO 637034928 20 1073926846 0 Physicians Anesthesia Services 20 1073926846 0 Physicians Healthy Kids Services 20 1073926846 0 Physicians Optical Supplies 20 1073926846 0 Physicians Physician Services 00 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1073927745 0 Physicians Healthy Kids Services 20 1073927745 0 Physicians Optical Supplies 20 1073927745 0 Physicians Physician Services 00 1073927794 0 WEITZEL LAURA J 2017177 9999999 B 10 1073927794 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1073927794 0 Physicians Anesthesia Services 20 1073927794 0 Physicians Fluoride varnish 20 1073927794 0 Physicians Healthy Kids Services 20 1073927794 0 Physicians Optical Supplies 20 1073927794 0 Physicians Physician Services 00 1073928776 0 MIRZA ARSLAN 2021130 9999999 B 10 1073928776 0 201 BAILEY LN BENTON IL 628121969 20 1073928776 0 Physicians Anesthesia Services 20 1073928776 0 Physicians Fluoride varnish 20 1073928776 0 Physicians Healthy Kids Services 20 1073928776 0 Physicians Optical Supplies 20 1073928776 0 Physicians Physician Services 00 1073929352 0 NEAULT SARAH 2016245 9999999 B 10 1073929352 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1073929352 0 Nurse Practitioners Healthy Kids Services 20 1073929352 0 Nurse 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0 ELLIOTT AUSTIN 2016294 9999999 B 10 1073935334 0 PO BOX 2416 LEESBURG VA 201777703 20 1073935334 0 Nurse Practitioners Anesthesia Services 20 1073935334 0 Nurse Practitioners Nurse Practitioners Services 20 1073935334 0 Nurse Practitioners Physician Services 00 1073935813 0 CARTER JILLIAN L 2017027 9999999 B 10 1073935813 0 PO BOX 781076 DETROIT MI 482781076 20 1073935813 0 Nurse Practitioners Fluoride varnish 20 1073935813 0 Nurse Practitioners Healthy Kids Services 20 1073935813 0 Nurse Practitioners Nurse Practitioners Services 20 1073935813 0 Nurse Practitioners Physician Services 00 1073937132 0 RUSSELL TIMOTHY 2021245 9999999 B 10 1073937132 0 PO BOX 3272 INDIANAPOLIS IN 462063272 20 1073937132 0 Physicians Anesthesia Services 20 1073937132 0 Physicians Healthy Kids Services 20 1073937132 0 Physicians Optical Supplies 20 1073937132 0 Physicians Physician Services 00 1073938841 0 EVERLY ERIN M 2016244 9999999 B 10 1073938841 0 2103 E WASHINGTON ST STE 2G BLOOMINGTON IL 617014365 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1073953204 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1073953204 0 Physicians Anesthesia Services 20 1073953204 0 Physicians Healthy Kids Services 20 1073953204 0 Physicians Optical Supplies 20 1073953204 0 Physicians Physician Services 00 1073953667 0 SISK BRYAN A 2016275 9999999 B 10 1073953667 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1073953667 0 Physicians Anesthesia Services 20 1073953667 0 Physicians Fluoride varnish 20 1073953667 0 Physicians Healthy Kids Services 20 1073953667 0 Physicians Optical Supplies 20 1073953667 0 Physicians Physician Services 00 1073953972 0 WENRICH DEVIN 2016147 9999999 B 10 1073953972 0 PO BOX 708760 SANDY UT 840708760 20 1073953972 0 Physicians Anesthesia Services 20 1073953972 0 Physicians Fluoride varnish 20 1073953972 0 Physicians Healthy Kids Services 20 1073953972 0 Physicians Optical Supplies 20 1073953972 0 Physicians Physician Services 00 1073955381 0 MERRILL MATTHEW S 2022036 9999999 B 10 1073955381 0 PO BOX 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Physician Services 00 1083101877 0 HAMMOND TIANNA 2018216 9999999 B 10 1083101877 0 5220 EAST AVE COUNTRYSIDE IL 605253133 20 1083101877 0 Other behavior health professional LCPC/LMFT services 20 1083101877 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1083102172 0 ROUNTREE AMELIA K. 2018152 9999999 B 10 1083102172 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1083102172 0 Nurse Practitioners Fluoride varnish 20 1083102172 0 Nurse Practitioners Healthy Kids Services 20 1083102172 0 Nurse Practitioners Nurse Practitioners Services 20 1083102172 0 Nurse Practitioners Physician Services 00 1083102206 0 MERIWEATHER ALEXIS D 2021340 9999999 B 10 1083102206 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1083102206 0 Nurse Practitioners Anesthesia Services 20 1083102206 0 Nurse Practitioners Healthy Kids Services 20 1083102206 0 Nurse Practitioners Optical Supplies 20 1083102206 0 Nurse Practitioners Physician Services 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631600352 20 1083256143 0 Physician Assistant Only Fluoride varnish 20 1083256143 0 Physician Assistant Only Healthy Kids Services 20 1083256143 0 Physician Assistant Only Physician Services 00 1083257695 0 SWOPES KEVA 2021160 9999999 B 10 1083257695 0 55 E 86TH AVE STE E SUITE E MERRILLVILLE IN 464106265 20 1083257695 0 Nurse Practitioners Fluoride varnish 20 1083257695 0 Nurse Practitioners Healthy Kids Services 20 1083257695 0 Nurse Practitioners Nurse Practitioners Services 20 1083257695 0 Nurse Practitioners Physician Services 00 1083258008 0 JENKINS DAWYN 2020283 9999999 B 10 1083258008 0 600 HOLIDAY PLAZA DR STE 200 MATTESON IL 604432237 20 1083258008 0 Nurse Practitioners Fluoride varnish 20 1083258008 0 Nurse Practitioners Healthy Kids Services 20 1083258008 0 Nurse Practitioners Nurse Practitioners Services 20 1083258008 0 Nurse Practitioners Physician Services 00 1083258420 0 CHURCHILL CAITLIN 2021027 9999999 B 10 1083258420 0 723 INSIGHT AVE STE 300 O FALLON IL 622692197 20 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Physicians Physician Services 00 1083307920 0 YACOUB MONICA 2024166 9999999 B 10 1083307920 0 460 MAIN ST STE B METUCHEN NJ 088401834 20 1083307920 0 Dentists Dental Services 20 1083307920 0 Dentists Physician Services 00 1083308043 0 ARCIBAL LAICA 2023182 9999999 B 10 1083308043 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1083308043 0 Physicians Anesthesia Services 20 1083308043 0 Physicians Fluoride varnish 20 1083308043 0 Physicians Healthy Kids Services 20 1083308043 0 Physicians Optical Supplies 20 1083308043 0 Physicians Physician Services 00 1083309868 0 NGUYEN CINDY 2024176 9999999 B 10 1083309868 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1083309868 0 Physicians Anesthesia Services 20 1083309868 0 Physicians Healthy Kids Services 20 1083309868 0 Physicians Optical Supplies 20 1083309868 0 Physicians Physician Services 00 1083309918 0 OOSTERBAAN CLAIRE 2023307 9999999 B 10 1083309918 0 PO BOX 3039 OAK BROOK IL 605223039 20 1083309918 0 Physicians Anesthesia Services 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1083311393 0 Nurse Practitioners Nurse Practitioners Services 20 1083311393 0 Nurse Practitioners Physician Services 00 1083311435 0 VAMOS VICTORIA 2023286 9999999 B 10 1083311435 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1083311435 0 Physician Assistant Only Fluoride varnish 20 1083311435 0 Physician Assistant Only Healthy Kids Services 20 1083311435 0 Physician Assistant Only Physician Services 00 1083312094 0 FRESNO CAMILA URZUA 2024250 9999999 B 10 1083312094 0 PO BOX 110429 AURORA CO 800420429 20 1083312094 0 Physicians Anesthesia Services 20 1083312094 0 Physicians Healthy Kids Services 20 1083312094 0 Physicians Optical Supplies 20 1083312094 0 Physicians Physician Services 00 1083312953 0 MORESCO CHRISTIAN 2023304 9999999 B 10 1083312953 0 684 S BARRINGTON RD STE 112 STREAMWOOD IL 601071841 20 1083312953 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1083315030 0 POLOVNEFF ALEXANDRA O 2024272 9999999 B 10 1083315030 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1083315030 0 Physicians Anesthesia Services 20 1083315030 0 Physicians Healthy Kids Services 20 1083315030 0 Physicians Optical Supplies 20 1083315030 0 Physicians Physician Services 00 1083315212 0 TEMPLE TYUS 2024183 9999999 B 10 1083315212 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1083315212 0 Physicians Anesthesia Services 20 1083315212 0 Physicians Fluoride varnish 20 1083315212 0 Physicians Healthy Kids Services 20 1083315212 0 Physicians Optical Supplies 20 1083315212 0 Physicians Physician Services 00 1083316129 0 KANDUKURI PRATHIMA 2024191 9999999 B 10 1083316129 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1083316129 0 Physicians Anesthesia Services 20 1083316129 0 Physicians Healthy Kids Services 20 1083316129 0 Physicians Optical Supplies 20 1083316129 0 Physicians Physician Services 00 1083316657 0 ISSAWI RANEEM 2023199 9999999 B 10 1083316657 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1083316657 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Physicians Fluoride varnish 20 1083317275 0 Physicians Healthy Kids Services 20 1083317275 0 Physicians Optical Supplies 20 1083317275 0 Physicians Physician Services 00 1083317614 0 MCLEMORE ANN 2023200 9999999 B 10 1083317614 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1083317614 0 Physicians Anesthesia Services 20 1083317614 0 Physicians Fluoride varnish 20 1083317614 0 Physicians Healthy Kids Services 20 1083317614 0 Physicians Optical Supplies 20 1083317614 0 Physicians Physician Services 00 1083317721 0 MARA JAMIE N 2024192 9999999 B 10 1083317721 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1083317721 0 Physicians Anesthesia Services 20 1083317721 0 Physicians Fluoride varnish 20 1083317721 0 Physicians Healthy Kids Services 20 1083317721 0 Physicians Optical Supplies 20 1083317721 0 Physicians Physician Services 00 1083319826 0 JEAN-BAPTISTE AMYOLA 2023257 9999999 B 10 1083319826 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1083319826 0 Physicians Anesthesia Services 20 1083319826 0 Physicians Fluoride varnish 20 1083319826 0 Physicians Healthy Kids Services 20 1083319826 0 Physicians Optical Supplies 20 1083319826 0 Physicians Physician Services 00 1083323406 0 MAYA DEEPTHI 2024067 9999999 B 10 1083323406 0 777 S MAIN ST STE 100 CLINTON IN 478422493 20 1083323406 0 Dentists Dental Services 20 1083323406 0 Dentists Physician Services 00 1083323638 0 SHERIDAN ASHLEE 2022364 9999999 B 10 1083323638 0 621 S ILLINOIS AVE STE 103 MASON CITY IA 504015489 20 1083323638 0 Nurse Practitioners Fluoride varnish 20 1083323638 0 Nurse Practitioners Healthy Kids Services 20 1083323638 0 Nurse Practitioners Nurse Practitioners Services 20 1083323638 0 Nurse Practitioners Physician Services 00 1083324867 0 PARK KAITLIN 2023038 9999999 B 10 1083324867 0 PO BOX 781076 DETROIT MI 482781076 20 1083324867 0 Nurse Practitioners Fluoride varnish 20 1083324867 0 Nurse Practitioners Healthy Kids Services 20 1083324867 0 Nurse Practitioners Nurse Practitioners Services 20 1083324867 0 Nurse Practitioners Physician Services 00 1083327019 0 BRETSCHNEIDER ANNA M 2023096 9999999 B 10 1083327019 0 8311 ROOSEVELT RD FOREST PARK IL 601302529 20 1083327019 0 Nurse Practitioners Healthy Kids Services 20 1083327019 0 Nurse Practitioners Nurse Practitioners Services 20 1083327019 0 Nurse Practitioners Physician Services 00 1083327571 0 HENSON CASSIDY L 2023059 9999999 B 10 1083327571 0 PO BOX 776084 CHICAGO IL 606776084 20 1083327571 0 Nurse Practitioners Healthy Kids Services 20 1083327571 0 Nurse Practitioners Nurse Practitioners Services 20 1083327571 0 Nurse Practitioners Physician Services 00 1083329189 0 FIELDER REBECCA E 2023062 9999999 B 10 1083329189 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1083329189 0 Clinical Social Worker Social work service 00 1083329361 0 ORELLANA PATRICIA 2023026 9999999 B 10 1083329361 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1083329361 0 Other behavior health professional Other Behavioral Health Services 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Practitioners Nurse Practitioners Services 20 1083339642 0 Nurse Practitioners Physician Services 00 1083341390 0 PARK HAN NA 2022362 9999999 B 10 1083341390 0 401 N VETERANS PKWY STE 4 BLOOMINGTON IL 617047716 20 1083341390 0 Dentists Dental Services 20 1083341390 0 Dentists Physician Services 00 1083343016 0 PLATTNER HALEY 2022206 9999999 B 10 1083343016 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1083343016 0 Physicians Anesthesia Services 20 1083343016 0 Physicians Healthy Kids Services 20 1083343016 0 Physicians Optical Supplies 20 1083343016 0 Physicians Physician Services 00 1083343453 0 DAHM MOLLY 2022182 9999999 B 10 1083343453 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1083343453 0 Nurse Practitioners Fluoride varnish 20 1083343453 0 Nurse Practitioners Healthy Kids Services 20 1083343453 0 Nurse Practitioners Nurse Practitioners Services 20 1083343453 0 Nurse Practitioners Physician Services 00 1083343529 0 REHFUS ZACHARY A 2022207 9999999 B 10 1083343529 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1083343529 0 Physicians Anesthesia Services 20 1083343529 0 Physicians Fluoride varnish 20 1083343529 0 Physicians Healthy Kids Services 20 1083343529 0 Physicians Optical Supplies 20 1083343529 0 Physicians Physician Services 00 1083343909 0 BERES THOMAS V 2022192 9999999 B 10 1083343909 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1083343909 0 Physicians Anesthesia Services 20 1083343909 0 Physicians Healthy Kids Services 20 1083343909 0 Physicians Optical Supplies 20 1083343909 0 Physicians Physician Services 00 1083344279 0 JONES ELIZABETH 2022174 9999999 B 10 1083344279 0 507 E ARMSTRONG AVE PEORIA IL 616033201 20 1083344279 0 Speech Therapists Medical Supplies 20 1083344279 0 Speech Therapists Medical equipment/prosthetic devices 20 1083344279 0 Speech Therapists Speech Therapy/Pathology Services 00 1083344360 0 LEMRISE-HALL MICHELE 2022167 9999999 B 10 1083344360 0 2570 FOXFIELD RD STE 101 SAINT CHARLES IL 601741406 20 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Physician Assistant Only Physician Services 00 1083348353 0 FERIEND WILLIAM 2022219 9999999 B 10 1083348353 0 6233 CERMAK RD BERWYN IL 604022317 20 1083348353 0 Optometrists Optical Supplies 20 1083348353 0 Optometrists Optometric Services 20 1083348353 0 Optometrists Physician Services 00 1083348775 0 ALIOUALLA NAJOUA 2024199 9999999 B 10 1083348775 0 611 W PARK ST URBANA IL 618012529 20 1083348775 0 Physicians Anesthesia Services 20 1083348775 0 Physicians Healthy Kids Services 20 1083348775 0 Physicians Optical Supplies 20 1083348775 0 Physicians Physician Services 20 1083348775 0 Physicians Physicians Psychiatric Services 00 1083351878 0 SACHAR RYAN 2022175 9999999 B 10 1083351878 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1083351878 0 Physicians Anesthesia Services 20 1083351878 0 Physicians Fluoride varnish 20 1083351878 0 Physicians Healthy Kids Services 20 1083351878 0 Physicians Optical Supplies 20 1083351878 0 Physicians Physician Services 00 1083352389 0 ERICKSON 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Practitioners Healthy Kids Services 20 1083432413 0 Nurse Practitioners Nurse Practitioners Services 20 1083432413 0 Nurse Practitioners Physician Services 00 1083432660 0 O'CONNOR KELSEY C 2024348 9999999 B 10 1083432660 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1083432660 0 Nurse Practitioners Healthy Kids Services 20 1083432660 0 Nurse Practitioners Nurse Practitioners Services 20 1083432660 0 Nurse Practitioners Physician Services 00 1083433023 0 HARVEY WHITNEY 2024337 9999999 B 10 1083433023 0 2723 S 7TH ST STE A TERRE HAUTE IN 478023558 20 1083433023 0 Nurse Practitioners Fluoride varnish 20 1083433023 0 Nurse Practitioners Healthy Kids Services 20 1083433023 0 Nurse Practitioners Nurse Practitioners Services 20 1083433023 0 Nurse Practitioners Physician Services 00 1083435325 0 SCHROER ABIGAIL MARIE ANDERSON 2024299 9999999 B 10 1083435325 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1083435325 0 Nurse Practitioners Healthy Kids Services 20 1083435325 0 Nurse Practitioners 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1083465355 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1083465355 0 Physicians Anesthesia Services 20 1083465355 0 Physicians Healthy Kids Services 20 1083465355 0 Physicians Optical Supplies 20 1083465355 0 Physicians Physician Services 00 1083465603 0 OO SAMUEL 2024199 9999999 B 10 1083465603 0 3249 OAK PARK AVE BERWYN IL 604023429 20 1083465603 0 Physicians Anesthesia Services 20 1083465603 0 Physicians Fluoride varnish 20 1083465603 0 Physicians Healthy Kids Services 20 1083465603 0 Physicians Optical Supplies 20 1083465603 0 Physicians Physician Services 00 1083465819 0 ZAKRAJSEK JONATHAN 2024176 9999999 B 10 1083465819 0 4698 DEPT CAROL STREAM IL 601220021 20 1083465819 0 Physicians Anesthesia Services 20 1083465819 0 Physicians Healthy Kids Services 20 1083465819 0 Physicians Optical Supplies 20 1083465819 0 Physicians Physician Services 00 1083466197 0 SFREDDO HANNAH 2024198 9999999 B 10 1083466197 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1083466197 0 Physicians Anesthesia Services 20 1083466197 0 Physicians Healthy Kids Services 20 1083466197 0 Physicians Optical Supplies 20 1083466197 0 Physicians Physician Services 00 1083467203 0 QADRI OMAR 2024257 2027174 B 10 1083467203 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1083467203 0 Physicians Anesthesia Services 20 1083467203 0 Physicians Healthy Kids Services 20 1083467203 0 Physicians Optical Supplies 20 1083467203 0 Physicians Physician Services 00 1083467484 0 ARIKAWA KINJI 2024240 9999999 B 10 1083467484 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1083467484 0 Physicians Anesthesia Services 20 1083467484 0 Physicians Fluoride varnish 20 1083467484 0 Physicians Healthy Kids Services 20 1083467484 0 Physicians Optical Supplies 20 1083467484 0 Physicians Physician Services 00 1083467823 0 BELL JESSICA 2024114 9999999 B 10 1083467823 0 2610 W RICHWOODS BLVD PEORIA IL 616047112 20 1083467823 0 Clinical Social Worker Social work service 00 1083468078 0 GRAGAS ANNA 2024191 9999999 B 10 1083468078 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1083468078 0 Physicians Anesthesia Services 20 1083468078 0 Physicians Healthy Kids Services 20 1083468078 0 Physicians Optical Supplies 20 1083468078 0 Physicians Physician Services 00 1083468631 0 KRAVETS ALEXANDER MARK 2024184 9999999 B 10 1083468631 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1083468631 0 Physicians Anesthesia Services 20 1083468631 0 Physicians Healthy Kids Services 20 1083468631 0 Physicians Optical Supplies 20 1083468631 0 Physicians Physician Services 00 1083469142 0 NATHAN SAMUEL R 2024193 9999999 B 10 1083469142 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1083469142 0 Physician Assistant Only Fluoride varnish 20 1083469142 0 Physician Assistant Only Healthy Kids Services 20 1083469142 0 Physician Assistant Only Physician Services 00 1083470058 0 JOSEPH ARUN A 2024151 9999999 B 10 1083470058 0 PO BOX 235019 MONTGOMERY AL 361235019 20 1083470058 0 Nurse Practitioners Anesthesia Services 20 1083470058 0 Nurse Practitioners Nurse Practitioners Services 20 1083470058 0 Nurse Practitioners Physician Services 00 1083470983 0 BONNETT LEIGHANNE 2024100 9999999 B 10 1083470983 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1083470983 0 Nurse Practitioners Healthy Kids Services 20 1083470983 0 Nurse Practitioners Nurse Practitioners Services 20 1083470983 0 Nurse Practitioners Physician Services 00 1083472468 0 MCNALLEN NICHOLAS 2024227 9999999 B 10 1083472468 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1083472468 0 Physician Assistant Only Fluoride varnish 20 1083472468 0 Physician Assistant Only Healthy Kids Services 20 1083472468 0 Physician Assistant Only Physician Services 00 1083473326 0 KRISHNA RAO PALLAVI 2024180 9999999 B 10 1083473326 0 4698 DEPT CAROL STREAM IL 601220021 20 1083473326 0 Physicians Anesthesia Services 20 1083473326 0 Physicians Fluoride varnish 20 1083473326 0 Physicians Healthy Kids Services 20 1083473326 0 Physicians Optical Supplies 20 1083473326 0 Physicians Physician Services 00 1083473979 0 PEARLMAN MATTHEW 2024078 9999999 B 10 1083473979 0 5906 ELAINE DR STE 103 ROCKFORD IL 611082467 20 1083473979 0 Clinical Social Worker Social work service 00 1083474464 0 MILAD HANNAH 2024191 9999999 B 10 1083474464 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1083474464 0 Physicians Anesthesia Services 20 1083474464 0 Physicians Healthy Kids Services 20 1083474464 0 Physicians Optical Supplies 20 1083474464 0 Physicians Physician Services 00 1083474993 0 PARK MICHAEL 2024176 9999999 B 10 1083474993 0 4698 DEPT CAROL STREAM IL 601220021 20 1083474993 0 Physicians Anesthesia Services 20 1083474993 0 Physicians Healthy Kids Services 20 1083474993 0 Physicians Optical Supplies 20 1083474993 0 Physicians Physician Services 20 1083474993 0 Physicians Physicians Psychiatric Services 00 1083475354 0 DAHMS LAUREN 2024053 9999999 B 10 1083475354 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1083475354 0 Nurse Practitioners Healthy Kids Services 20 1083475354 0 Nurse Practitioners Nurse Practitioners Services 20 1083475354 0 Nurse Practitioners Physician Services 00 1083476006 0 MCCARTHY-HESSEL JANE E 2024213 9999999 B 10 1083476006 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1083476006 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1083477368 0 KRIEG LAUREN 2024208 9999999 B 10 1083477368 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1083477368 0 Physician Assistant Only Fluoride varnish 20 1083477368 0 Physician Assistant Only Healthy Kids Services 20 1083477368 0 Physician Assistant Only Physician Services 00 1083479414 0 LUKA JACOB 2024100 9999999 B 10 1083479414 0 5741 W CERMAK RD CICERO IL 608042129 20 1083479414 0 Physician Assistant Only Fluoride varnish 20 1083479414 0 Physician Assistant Only Healthy Kids Services 20 1083479414 0 Physician Assistant Only Physician Services 00 1083480669 0 COLLINS BRENNA 2024108 9999999 B 10 1083480669 0 400 S ELM ST CENTRALIA IL 628013910 20 1083480669 0 Speech Therapists Speech Therapy/Pathology Services 00 1083482392 0 BRESINGHAM MICHELLE 2024070 9999999 B 10 1083482392 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1083482392 0 Physician Assistant Only Fluoride varnish 20 1083482392 0 Physician Assistant Only Healthy Kids Services 20 1083482392 0 Physician Assistant Only Physician Services 00 1083486344 0 BAE JOHN 2024177 9999999 B 10 1083486344 0 2201 MAIN ST EVANSTON IL 602021519 20 1083486344 0 Nurse Practitioners Healthy Kids Services 20 1083486344 0 Nurse Practitioners Nurse Practitioners Services 20 1083486344 0 Nurse Practitioners Physician Services 00 1083487011 0 ARIZMENDI ESTRADA YANELI 2023318 9999999 B 10 1083487011 0 1220 S WOOD ST CHICAGO IL 606081202 20 1083487011 0 Nurse Practitioners Healthy Kids Services 20 1083487011 0 Nurse Practitioners Midwife Services 20 1083487011 0 Nurse Practitioners Nurse Practitioners Services 20 1083487011 0 Nurse Practitioners Physician Services 00 1083488241 0 KONSOR MADELINE 2023313 9999999 B 10 1083488241 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1083488241 0 Psychologist Psychologist service 00 1083488605 0 ROMERO ALEXIS 2023318 9999999 B 10 1083488605 0 3436 N KENNICOTT AVE STE 114 STE 114 ARLINGTON HEIGH IL 600047814 20 1083488605 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1083488696 0 CAPUTO TAYLOR 2024256 9999999 B 10 1083488696 0 127 S LIBERTY ST RUSHVILLE IL 626811419 20 1083488696 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1083488993 0 BOOTH JENNIFER LEAH 2024156 9999999 B 10 1083488993 0 4698 DEPT CAROL STREAM IL 601220021 20 1083488993 0 Other behavior health professional LCPC/LMFT services 00 1083491526 0 LARKIN CLARA 2023331 9999999 B 10 1083491526 0 2751 TARPON CT HOMEWOOD IL 604301425 20 1083491526 0 Nurse Practitioners Healthy Kids Services 20 1083491526 0 Nurse Practitioners Nurse Practitioners Services 20 1083491526 0 Nurse Practitioners Physician Services 00 1083493001 0 LANGMEYER KURT 2023335 9999999 B 10 1083493001 0 412 W 31ST ST CHICAGO IL 606163116 20 1083493001 0 Physical Therapists Medical Supplies 20 1083493001 0 Physical Therapists Medical equipment/prosthetic devices 20 1083493001 0 Physical Therapists Physical Therapy Services 00 1083494256 0 HAMILTON JOANNE 2023304 9999999 B 10 1083494256 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1083494256 0 Nurse Practitioners Fluoride varnish 20 1083494256 0 Nurse Practitioners Healthy Kids Services 20 1083494256 0 Nurse Practitioners Nurse Practitioners Services 20 1083494256 0 Nurse Practitioners Physician Services 00 1083499370 0 JARKA JUDITH D 2024155 9999999 B 10 1083499370 0 607 S LINCOLN ST TREMONT IL 615688671 20 1083499370 0 Speech Therapists Medical Supplies 20 1083499370 0 Speech Therapists Medical equipment/prosthetic devices 20 1083499370 0 Speech Therapists Speech Therapy/Pathology Services 00 1083499388 0 GIPPE EMILY 2023269 9999999 B 10 1083499388 0 800 W FULTON MARKET FL 12 CHICAGO IL 606071302 20 1083499388 0 Nurse Practitioners Fluoride varnish 20 1083499388 0 Nurse Practitioners Healthy Kids Services 20 1083499388 0 Nurse Practitioners Nurse Practitioners Services 20 1083499388 0 Nurse Practitioners Physician Services 00 1083600050 0 CASTRO ROBERTO 1997244 9999999 B 10 1083600050 0 1940 S WESTERN AVE STE 205 CHICAGO IL 606082503 20 1083600050 0 Physicians Anesthesia Services 20 1083600050 0 Physicians Fluoride varnish 20 1083600050 0 Physicians Healthy Kids Services 20 1083600050 0 Physicians Optical Supplies 20 1083600050 0 Physicians Physician Services 00 1083600415 0 BOWMAN ROBIN 1997182 9999999 B 10 1083600415 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1083600415 0 Physicians Anesthesia Services 20 1083600415 0 Physicians Healthy Kids Services 20 1083600415 0 Physicians Optical Supplies 20 1083600415 0 Physicians Physician Services 00 1083600738 0 BECKER STEVEN 1988350 9999999 B 10 1083600738 0 PO BOX 436 HENDERSON KY 424190436 20 1083600738 0 Physicians Anesthesia Services 20 1083600738 0 Physicians Healthy Kids Services 20 1083600738 0 Physicians Optical Supplies 20 1083600738 0 Physicians Physician Services 00 1083601637 0 BUEHLER DONALD 1992238 9999999 B 10 1083601637 0 8921 N WOOD SAGE RD PEORIA IL 616157822 20 1083601637 0 Optometrists Optical Supplies 20 1083601637 0 Optometrists Optometric Services 20 1083601637 0 Optometrists Physician Services 00 1083601645 0 BARTOS STEPHEN R 2014001 9999999 B 10 1083601645 0 1111 DELAFIELD ST STE 209 WAUKESHA WI 531883403 20 1083601645 0 Physicians Anesthesia Services 20 1083601645 0 Physicians Healthy Kids Services 20 1083601645 0 Physicians Optical Supplies 20 1083601645 0 Physicians Physician Services 00 1083602551 0 DOPPENBERG EGON 2005182 9999999 B 10 1083602551 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1083602551 0 Physicians Anesthesia Services 20 1083602551 0 Physicians Healthy Kids Services 20 1083602551 0 Physicians Optical Supplies 20 1083602551 0 Physicians Physician Services 00 1083603773 0 STAPLETON JACK T 1986169 9999999 B 10 1083603773 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1083603773 0 Physicians Anesthesia Services 20 1083603773 0 Physicians Fluoride varnish 20 1083603773 0 Physicians Healthy Kids Services 20 1083603773 0 Physicians Optical Supplies 20 1083603773 0 Physicians Physician Services 00 1083603872 0 AMIN HETAL 1999004 9999999 B 10 1083603872 0 55 E JACKSON BLVD STE 1500 CHICAGO IL 606044184 20 1083603872 0 Physicians Anesthesia Services 20 1083603872 0 Physicians Healthy Kids Services 20 1083603872 0 Physicians Optical Supplies 20 1083603872 0 Physicians Physician Services 20 1083603872 0 Physicians Physicians Psychiatric Services 00 1083604185 0 GAONKAR TUSHAR 1997335 9999999 B 10 1083604185 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1083604185 0 Physicians 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Services 20 1083605034 0 Physicians Healthy Kids Services 20 1083605034 0 Physicians Optical Supplies 20 1083605034 0 Physicians Physician Services 00 1083605067 0 YAJNIK SANTOSH V 2004183 9999999 B 10 1083605067 0 5777 DEPT CAROL STREAM IL 601220021 20 1083605067 0 Physicians Anesthesia Services 20 1083605067 0 Physicians Healthy Kids Services 20 1083605067 0 Physicians Optical Supplies 20 1083605067 0 Physicians Physician Services 00 1083606560 0 KIM JENNIFER JIYEUN 2002001 9999999 B 10 1083606560 0 2801 LAKESIDE DR STE 209 BANNOCKBURN IL 600151271 20 1083606560 0 Physicians Anesthesia Services 20 1083606560 0 Physicians Healthy Kids Services 20 1083606560 0 Physicians Optical Supplies 20 1083606560 0 Physicians Physician Services 00 1083607428 0 GONZALES LEARNED 2025041 9999999 B 10 1083607428 0 PO BOX 631917 CINCINNATI OH 452631917 20 1083607428 0 Physicians Anesthesia Services 20 1083607428 0 Physicians Fluoride varnish 20 1083607428 0 Physicians Healthy Kids Services 20 1083607428 0 Physicians Optical Supplies 20 1083607428 0 Physicians Physician Services 00 1083607881 0 GLICK NANCY 1998182 9999999 B 10 1083607881 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1083607881 0 Physicians Anesthesia Services 20 1083607881 0 Physicians Family Planning Counseling 20 1083607881 0 Physicians Fluoride varnish 20 1083607881 0 Physicians Healthy Kids Services 20 1083607881 0 Physicians Optical Supplies 20 1083607881 0 Physicians Physician Services 00 1083608038 0 AGRAWAL RISHI 2005182 9999999 B 10 1083608038 0 6501 S PROMONTORY DR CHICAGO IL 606491003 20 1083608038 0 Physicians Anesthesia Services 20 1083608038 0 Physicians Fluoride varnish 20 1083608038 0 Physicians Healthy Kids Services 20 1083608038 0 Physicians Optical Supplies 20 1083608038 0 Physicians Physician Services 00 1083608343 0 LEVIN CYNTHIA ANN 2024241 9999999 B 10 1083608343 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1083608343 0 Psychologist Psychologist service 00 1083608772 0 KATZ LOUIS M 1983001 9999999 B 10 1083608772 0 1701 RIVER DR STE 110 MOLINE IL 612651384 20 1083608772 0 Physicians Anesthesia Services 20 1083608772 0 Physicians Fluoride varnish 20 1083608772 0 Physicians Healthy Kids Services 20 1083608772 0 Physicians Optical Supplies 20 1083608772 0 Physicians Physician Services 00 1083609002 0 MCAVOY DIANE 2023255 9999999 B 10 1083609002 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1083609002 0 Physician Assistant Only Fluoride varnish 20 1083609002 0 Physician Assistant Only Healthy Kids Services 20 1083609002 0 Physician Assistant Only Physician Services 00 1083609614 0 ODEGARD KEITH J 2016016 9999999 B 10 1083609614 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1083609614 0 Physicians Anesthesia Services 20 1083609614 0 Physicians Healthy Kids Services 20 1083609614 0 Physicians Optical Supplies 20 1083609614 0 Physicians Physician Services 00 1083609747 0 MONTGOMERY BENJAMIN 2009274 9999999 B 10 1083609747 0 1600 W WALNUT ST JACKSONVILLE IL 626501136 20 1083609747 0 Physicians Anesthesia Services 20 1083609747 0 Physicians Fluoride varnish 20 1083609747 0 Physicians Healthy Kids Services 20 1083609747 0 Physicians Optical Supplies 20 1083609747 0 Physicians Physician Services 00 1083609986 0 VOEGEL VICTORIA C 2019275 9999999 B 10 1083609986 0 1414 WOODBINE RD BLOOMINGTON IL 617042817 20 1083609986 0 Physician Assistant Only Fluoride varnish 20 1083609986 0 Physician Assistant Only Healthy Kids Services 20 1083609986 0 Physician Assistant Only Physician Services 00 1083609994 0 TAO RICHARD 2001363 9999999 B 10 1083609994 0 238 S CONGRESS ST RUSHVILLE IL 626811465 20 1083609994 0 Physicians Anesthesia Services 20 1083609994 0 Physicians Fluoride varnish 20 1083609994 0 Physicians Healthy Kids Services 20 1083609994 0 Physicians Optical Supplies 20 1083609994 0 Physicians Physician Services 00 1083610612 0 HALL ROBERT F 1984072 9999999 B 10 1083610612 0 406 FRONT ST STE A MCHENRY IL 600505593 20 1083610612 0 Physicians Anesthesia Services 20 1083610612 0 Physicians Healthy Kids Services 20 1083610612 0 Physicians Optical Supplies 20 1083610612 0 Physicians Physician Services 00 1083610943 0 SEHGAL VIVEK 1998182 9999999 B 10 1083610943 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1083610943 0 Physicians Anesthesia Services 20 1083610943 0 Physicians Healthy Kids Services 20 1083610943 0 Physicians Optical Supplies 20 1083610943 0 Physicians Physician Services 00 1083611511 0 POMPUTIUS WILLIAM F 2024024 9999999 B 10 1083611511 0 5901 LINCOLN DR EDINA MN 554361611 20 1083611511 0 Physicians Anesthesia Services 20 1083611511 0 Physicians Fluoride varnish 20 1083611511 0 Physicians Healthy Kids Services 20 1083611511 0 Physicians Optical Supplies 20 1083611511 0 Physicians Physician Services 00 1083612329 0 BEUSSE WALTER J 1993188 9999999 B 10 1083612329 0 824 W BARTLETT RD BARTLETT IL 601034402 20 1083612329 0 Physicians Anesthesia Services 20 1083612329 0 Physicians Fluoride varnish 20 1083612329 0 Physicians Healthy Kids Services 20 1083612329 0 Physicians Optical Supplies 20 1083612329 0 Physicians Physician Services 00 1083612683 0 BORRELLI ANTHONY 1986035 9999999 B 10 1083612683 0 1660 FEEHANVILLE DR STE 450 MOUNT PROSPECT IL 600566023 20 1083612683 0 Podiatrists Podiatric Services 00 1083612758 0 AUN JOSE 2023009 9999999 B 10 1083612758 0 777 LOWNDES HILL RD BLDG 1 GREENVILLE SC 296072101 20 1083612758 0 Physicians Anesthesia Services 20 1083612758 0 Physicians Healthy Kids Services 20 1083612758 0 Physicians Optical Supplies 20 1083612758 0 Physicians Physician Services 00 1083612857 0 JACKSON DOUGLAS 1995335 9999999 B 10 1083612857 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1083612857 0 Physicians Anesthesia Services 20 1083612857 0 Physicians Healthy Kids Services 20 1083612857 0 Physicians Optical Supplies 20 1083612857 0 Physicians Physician Services 00 1083613293 0 DECEANNE ANTHONY 1992001 9999999 B 10 1083613293 0 5017 N GLEN PARK PLACE RD PEORIA IL 616144677 20 1083613293 0 Podiatrists Podiatric Services 00 1083614259 0 PITTMAN SHOLAH 2024268 9999999 B 10 1083614259 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1083614259 0 Physicians Anesthesia Services 20 1083614259 0 Physicians Healthy Kids Services 20 1083614259 0 Physicians Optical Supplies 20 1083614259 0 Physicians Physician Services 00 1083614333 0 HELLER ROSS 1988001 9999999 B 10 1083614333 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1083614333 0 Physicians Anesthesia Services 20 1083614333 0 Physicians Healthy Kids Services 20 1083614333 0 Physicians Optical Supplies 20 1083614333 0 Physicians Physician Services 00 1083614762 0 SONG ALBERT 2005091 9999999 B 10 1083614762 0 5665 NEW NORTHSIDE DR STE 320 ATLANTA GA 303285834 20 1083614762 0 Physicians Anesthesia Services 20 1083614762 0 Physicians Healthy Kids Services 20 1083614762 0 Physicians Optical Supplies 20 1083614762 0 Physicians Physician Services 00 1083615454 0 KERN JOHN W 2023247 9999999 B 10 1083615454 0 8400 LOUISIANA ST MERRILLVILLE IN 464106385 20 1083615454 0 Physicians Anesthesia Services 20 1083615454 0 Physicians Healthy Kids Services 20 1083615454 0 Physicians Optical Supplies 20 1083615454 0 Physicians Physician Services 20 1083615454 0 Physicians Physicians Psychiatric Services 00 1083616346 0 LEVI ROBERTO E 1981227 9999999 B 10 1083616346 0 32705 COLLECTION CENTER DR CHICAGO IL 606930327 20 1083616346 0 Physicians Anesthesia Services 20 1083616346 0 Physicians Healthy Kids Services 20 1083616346 0 Physicians Optical Supplies 20 1083616346 0 Physicians Physician Services 00 1083616460 0 SHIEH TED 1999001 9999999 B 10 1083616460 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1083616460 0 Physicians Anesthesia Services 20 1083616460 0 Physicians Healthy Kids Services 20 1083616460 0 Physicians Optical Supplies 20 1083616460 0 Physicians Physician Services 00 1083616759 0 BAILEY ANDREW 2024201 9999999 B 10 1083616759 0 2605 KENTUCKY AVE STE 306 PADUCAH KY 420033802 20 1083616759 0 Physicians Anesthesia Services 20 1083616759 0 Physicians Fluoride varnish 20 1083616759 0 Physicians Healthy Kids Services 20 1083616759 0 Physicians Optical Supplies 20 1083616759 0 Physicians Physician Services 00 1083617294 0 HANSON MORIN M 2021061 9999999 B 10 1083617294 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1083617294 0 Physicians Anesthesia Services 20 1083617294 0 Physicians Healthy Kids Services 20 1083617294 0 Physicians Optical Supplies 20 1083617294 0 Physicians Physician Services 00 1083617971 0 HAUSMANN JAMES 2020242 9999999 B 10 1083617971 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1083617971 0 Physicians Anesthesia Services 20 1083617971 0 Physicians Healthy Kids Services 20 1083617971 0 Physicians Optical Supplies 20 1083617971 0 Physicians Physician Services 00 1083618904 0 JACKSON FARRIS 1988183 9999999 B 10 1083618904 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1083618904 0 Physicians Anesthesia Services 20 1083618904 0 Physicians Fluoride varnish 20 1083618904 0 Physicians Healthy Kids Services 20 1083618904 0 Physicians Optical Supplies 20 1083618904 0 Physicians Physician Services 00 1083619134 0 CADY BRIAN 1997245 9999999 B 10 1083619134 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1083619134 0 Physicians Anesthesia Services 20 1083619134 0 Physicians Fluoride varnish 20 1083619134 0 Physicians Healthy Kids Services 20 1083619134 0 Physicians Optical Supplies 20 1083619134 0 Physicians Physician Services 00 1083619571 0 KAYALI NAZIR 2000046 9999999 B 10 1083619571 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1083619571 0 Physicians Anesthesia Services 20 1083619571 0 Physicians Fluoride varnish 20 1083619571 0 Physicians Healthy Kids Services 20 1083619571 0 Physicians Optical Supplies 20 1083619571 0 Physicians Physician Services 00 1083619951 0 NARAYAN DWAYNE A 2024051 9999999 B 10 1083619951 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1083619951 0 Physicians Anesthesia Services 20 1083619951 0 Physicians Healthy 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Physicians Physician Services 00 1083875959 0 VATCHEVA TSVETA 2008211 9999999 B 10 1083875959 0 1464 TOWNLINE RD MUNDELEIN IL 600604433 20 1083875959 0 Dentists Dental Services 20 1083875959 0 Dentists Physician Services 00 1083876056 0 MORGAN KELLY 2021024 9999999 B 10 1083876056 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1083876056 0 Physicians Anesthesia Services 20 1083876056 0 Physicians Healthy Kids Services 20 1083876056 0 Physicians Optical Supplies 20 1083876056 0 Physicians Physician Services 00 1083876395 0 VOELKER JULIE L 2013252 9999999 B 10 1083876395 0 4200 6TH AVE ROCK ISLAND IL 612012109 20 1083876395 0 Physicians Anesthesia Services 20 1083876395 0 Physicians Fluoride varnish 20 1083876395 0 Physicians Healthy Kids Services 20 1083876395 0 Physicians Optical Supplies 20 1083876395 0 Physicians Physician Services 20 1083876395 0 Physicians Physicians Psychiatric Services 00 1083877088 0 LEADBETTER KRISTEN 2014182 9999999 B 10 1083877088 0 3051 HOLLIS DR 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Physicians Healthy Kids Services 20 1083879480 0 Physicians Optical Supplies 20 1083879480 0 Physicians Physician Services 00 1083880546 0 RAMIREZ ESMILKRYS B 2011091 9999999 B 10 1083880546 0 29373 NETWORK PL CHICAGO IL 606733039 20 1083880546 0 Physicians Anesthesia Services 20 1083880546 0 Physicians Family Planning Counseling 20 1083880546 0 Physicians Fluoride varnish 20 1083880546 0 Physicians Healthy Kids Services 20 1083880546 0 Physicians Optical Supplies 20 1083880546 0 Physicians Physician Services 00 1083881650 0 MITCHELL DIANA 2010118 9999999 B 10 1083881650 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1083881650 0 Physicians Anesthesia Services 20 1083881650 0 Physicians Fluoride varnish 20 1083881650 0 Physicians Healthy Kids Services 20 1083881650 0 Physicians Optical Supplies 20 1083881650 0 Physicians Physician Services 00 1083882948 0 WOLFE JOHN W 2009121 9999999 B 10 1083882948 0 PO BOX 6069 INDIANAPOLIS IN 462066069 20 1083882948 0 Physicians Anesthesia Services 20 1083882948 0 Physicians Healthy Kids Services 20 1083882948 0 Physicians Optical Supplies 20 1083882948 0 Physicians Physician Services 00 1083883870 0 D'AMICO TERRY LEE 2018046 9999999 B 10 1083883870 0 15750 S BELL RD STE 1A HOMER GLEN IL 604918420 20 1083883870 0 Other behavior health professional LCPC/LMFT services 00 1083884308 0 BUCK TROY 2008203 9999999 B 10 1083884308 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1083884308 0 Physicians Anesthesia Services 20 1083884308 0 Physicians Healthy Kids Services 20 1083884308 0 Physicians Optical Supplies 20 1083884308 0 Physicians Physician Services 00 1083888762 0 NGUYEN DAVID T 1999060 9999999 B 10 1083888762 0 620 W ROOSEVELT RD STE A1 WHEATON IL 601872305 20 1083888762 0 Dentists Dental Services 20 1083888762 0 Dentists Physician Services 00 1083889406 0 ANDERSEN AARON 2013221 9999999 B 10 1083889406 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1083889406 0 Physicians Anesthesia Services 20 1083889406 0 Physicians Healthy Kids Services 20 1083889406 0 Physicians Optical Supplies 20 1083889406 0 Physicians Physician Services 00 1083890156 0 TRAEGER AARON R 2010187 9999999 B 10 1083890156 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1083890156 0 Physicians Anesthesia Services 20 1083890156 0 Physicians Fluoride varnish 20 1083890156 0 Physicians Healthy Kids Services 20 1083890156 0 Physicians Optical Supplies 20 1083890156 0 Physicians Physician Services 00 1083891675 0 FRIESSEN ANDREW J 2014091 9999999 B 10 1083891675 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1083891675 0 Physicians Anesthesia Services 20 1083891675 0 Physicians Healthy Kids Services 20 1083891675 0 Physicians Optical Supplies 20 1083891675 0 Physicians Physician Services 00 1083891758 0 ARGOTE-ROMERO GRACIELA 2017094 9999999 B 10 1083891758 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1083891758 0 Physicians Anesthesia Services 20 1083891758 0 Physicians Healthy Kids Services 20 1083891758 0 Physicians Optical Supplies 20 1083891758 0 Physicians Physician Services 00 1083894703 0 DOROBA LORI 2010229 9999999 B 10 1083894703 0 1830 6TH AVE MOLINE IL 612652105 20 1083894703 0 Dentists Dental Services 20 1083894703 0 Dentists Physician Services 00 1083895379 0 GARCIA-ROJAS XAVIER 2021226 9999999 B 10 1083895379 0 PO BOX 776473 CHICAGO IL 606776473 20 1083895379 0 Physicians Anesthesia Services 20 1083895379 0 Physicians Healthy Kids Services 20 1083895379 0 Physicians Optical Supplies 20 1083895379 0 Physicians Physician Services 00 1083897888 0 HO VIVIEN 2008021 9999999 B 10 1083897888 0 2357 SEQUOIA DR AURORA IL 605066222 20 1083897888 0 Physicians Anesthesia Services 20 1083897888 0 Physicians Fluoride varnish 20 1083897888 0 Physicians Healthy Kids Services 20 1083897888 0 Physicians Optical Supplies 20 1083897888 0 Physicians Physician Services 00 1083898555 0 SNYDER SUZANNE 2021104 9999999 B 10 1083898555 0 6150 E BROAD ST COLUMBUS OH 432131574 20 1083898555 0 Physicians Anesthesia Services 20 1083898555 0 Physicians Fluoride varnish 20 1083898555 0 Physicians Healthy Kids Services 20 1083898555 0 Physicians Optical Supplies 20 1083898555 0 Physicians Physician Services 00 1083899710 0 BROOKS HOLLY 2016258 9999999 B 10 1083899710 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1083899710 0 Physician Assistant Only Fluoride varnish 20 1083899710 0 Physician Assistant Only Healthy Kids Services 20 1083899710 0 Physician Assistant Only Physician Services 00 1083899769 0 ATHAR NAVEEDA 2014059 9999999 H 10 1083899769 0 228 E LAKE ST ADDISON IL 601012889 20 1083899769 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1083900195 0 POLINOVSKY PAVEL 2016001 9999999 B 10 1083900195 0 5777 DEPT CAROL STREAM IL 601220021 20 1083900195 0 Physician Assistant Only Fluoride varnish 20 1083900195 0 Physician Assistant Only Healthy Kids Services 20 1083900195 0 Physician Assistant Only Physician Services 00 1083900294 0 ABRAHAM CHRISTOPHER DOUGALS 2016245 9999999 B 10 1083900294 0 PO BOX 7412011 CHICAGO IL 606742011 20 1083900294 0 Physicians Anesthesia Services 20 1083900294 0 Physicians Healthy Kids Services 20 1083900294 0 Physicians Optical Supplies 20 1083900294 0 Physicians Physician Services 00 1083900476 0 BADUI CANTISANO ERNESTO J 2022121 9999999 B 10 1083900476 0 PO BOX 43230 PHOENIX AZ 850803230 20 1083900476 0 Physicians Anesthesia Services 20 1083900476 0 Physicians Fluoride varnish 20 1083900476 0 Physicians Healthy Kids Services 20 1083900476 0 Physicians Optical Supplies 20 1083900476 0 Physicians Physician Services 00 1083900559 0 YOUSSEF AMR A 2021175 9999999 B 10 1083900559 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1083900559 0 Physicians Anesthesia Services 20 1083900559 0 Physicians Fluoride varnish 20 1083900559 0 Physicians Healthy Kids Services 20 1083900559 0 Physicians Optical Supplies 20 1083900559 0 Physicians Physician Services 00 1083900732 0 LOPEZ SANCHEZ RAFAEL 2018316 9999999 B 10 1083900732 0 2001 S CALIFORNIA AVE STE 100 SUITE 100 CHICAGO IL 606082486 20 1083900732 0 Physicians Anesthesia Services 20 1083900732 0 Physicians Healthy Kids Services 20 1083900732 0 Physicians Optical Supplies 20 1083900732 0 Physicians Physician Services 20 1083900732 0 Physicians Physicians Psychiatric Services 00 1083900856 0 MARKEY SARA 2011165 9999999 B 10 1083900856 0 5 STATE AND 8TH PLZ QUINCY IL 623014960 20 1083900856 0 Speech Therapists Medical Supplies 20 1083900856 0 Speech Therapists Medical equipment/prosthetic devices 20 1083900856 0 Speech Therapists Speech Therapy/Pathology Services 00 1083900906 0 BALLIS JANE 2016120 9999999 B 10 1083900906 0 2504 WASHINGTON ST STE 403 WAUKEGAN IL 600854960 20 1083900906 0 Other behavior health professional LCPC/LMFT services 00 1083900989 0 ROSENBERG JONATHAN REUBEN 2016336 9999999 B 10 1083900989 0 2740 W FOSTER AVE LL7 CHICAGO IL 606253500 20 1083900989 0 Physicians Anesthesia Services 20 1083900989 0 Physicians Fluoride varnish 20 1083900989 0 Physicians Healthy Kids Services 20 1083900989 0 Physicians Optical Supplies 20 1083900989 0 Physicians Physician Services 00 1083901151 0 SAJNANI PREET 2014197 9999999 B 10 1083901151 0 7000 MANNHEIM RD ROSEMONT IL 600183621 20 1083901151 0 Optometrists Optical Supplies 20 1083901151 0 Optometrists Optometric Services 20 1083901151 0 Optometrists Physician Services 00 1083901375 0 SHETH TEJAS 2015240 9999999 B 10 1083901375 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1083901375 0 Physicians Anesthesia Services 20 1083901375 0 Physicians Healthy Kids Services 20 1083901375 0 Physicians Optical Supplies 20 1083901375 0 Physicians Physician Services 00 1083902563 0 CAI WEN 2012026 9999999 B 10 1083902563 0 3800 VENETIAN WAY NEWBURGH IN 476308257 20 1083902563 0 Nurse Practitioners Healthy Kids Services 20 1083902563 0 Nurse Practitioners Nurse Practitioners Services 20 1083902563 0 Nurse Practitioners Physician Services 00 1083902852 0 SANDHU GURDARSHAN 2011335 9999999 B 10 1083902852 0 1005 BROADWAY ST QUINCY IL 623012834 20 1083902852 0 Physicians Anesthesia Services 20 1083902852 0 Physicians Healthy Kids Services 20 1083902852 0 Physicians Optical Supplies 20 1083902852 0 Physicians Physician Services 00 1083902894 0 MADNI ARSHIA 2023315 9999999 B 10 1083902894 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1083902894 0 Physicians Anesthesia Services 20 1083902894 0 Physicians Fluoride varnish 20 1083902894 0 Physicians Healthy Kids Services 20 1083902894 0 Physicians Optical Supplies 20 1083902894 0 Physicians Physician Services 00 1083903447 0 SIMPSON NICHOLAS 2017136 9999999 B 10 1083903447 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1083903447 0 Physicians Anesthesia Services 20 1083903447 0 Physicians Healthy Kids Services 20 1083903447 0 Physicians Optical Supplies 20 1083903447 0 Physicians Physician Services 00 1083903645 0 AL-HEETI OMAR M 2014252 9999999 B 10 1083903645 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1083903645 0 Physicians All Kids application agent 20 1083903645 0 Physicians Anesthesia Services 20 1083903645 0 Physicians Fluoride varnish 20 1083903645 0 Physicians Healthy Kids Services 20 1083903645 0 Physicians Optical Supplies 20 1083903645 0 Physicians Physician Services 00 1083903785 0 MADDEN NICHOLAS 2021068 9999999 B 10 1083903785 0 PO BOX 43230 PHOENIX AZ 850803230 20 1083903785 0 Physicians Anesthesia Services 20 1083903785 0 Physicians Healthy Kids Services 20 1083903785 0 Physicians Optical Supplies 20 1083903785 0 Physicians Physician Services 00 1083904981 0 COTTRELL TOGAN L 2017270 9999999 B 10 1083904981 0 PO BOX 155 CHRISTOPHER IL 628220155 20 1083904981 0 Physician Assistant Only Fluoride varnish 20 1083904981 0 Physician Assistant Only Healthy Kids Services 20 1083904981 0 Physician Assistant Only Physician Services 00 1083905095 0 ANDERSON DANA M 2022333 9999999 B 10 1083905095 0 1301 W DEVON AVE CHICAGO IL 606601329 20 1083905095 0 Nurse Practitioners Healthy Kids Services 20 1083905095 0 Nurse Practitioners Nurse Practitioners Services 20 1083905095 0 Nurse Practitioners Physician Services 00 1083905426 0 BAILEY ALICEA 2018142 9999999 B 10 1083905426 0 215 REMINGTON BLVD STE 2G-2 BOLINGBROOK IL 604403656 20 1083905426 0 Other behavior health professional LCPC/LMFT services 20 1083905426 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1083906242 0 NAJAFI KAVEH 2022324 9999999 B 10 1083906242 0 PO BOX 43230 PHOENIX AZ 850803230 20 1083906242 0 Physicians Anesthesia Services 20 1083906242 0 Physicians Healthy Kids Services 20 1083906242 0 Physicians Optical Supplies 20 1083906242 0 Physicians Physician Services 00 1083906382 0 GOYAL GAGANDEEP 2018001 9999999 B 10 1083906382 0 1639 N ALPINE RD STE 400 ROCKFORD IL 611071449 20 1083906382 0 Physicians Anesthesia Services 20 1083906382 0 Physicians Healthy Kids Services 20 1083906382 0 Physicians Optical Supplies 20 1083906382 0 Physicians Physician Services 00 1083906838 0 WEMHOFF MICHAEL P 2018239 9999999 B 10 1083906838 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1083906838 0 Physicians Anesthesia Services 20 1083906838 0 Physicians Healthy Kids Services 20 1083906838 0 Physicians Optical Supplies 20 1083906838 0 Physicians Physician Services 00 1083906879 0 REDDY RAHUL D 2017169 9999999 B 10 1083906879 0 8558 BROADWAY MERRILLVILLE IN 464107032 20 1083906879 0 Physicians Anesthesia Services 20 1083906879 0 Physicians Healthy Kids Services 20 1083906879 0 Physicians Optical Supplies 20 1083906879 0 Physicians Physician Services 00 1083907828 0 RIYAL TARIQ 2011151 9999999 B 10 1083907828 0 2333 W CHICAGO AVE CHICAGO IL 606224723 20 1083907828 0 Dentists Dental Services 20 1083907828 0 Dentists Physician Services 00 1083907844 0 STEINER HOLLY L 2013213 9999999 B 10 1083907844 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1083907844 0 Physicians Anesthesia Services 20 1083907844 0 Physicians Healthy Kids Services 20 1083907844 0 Physicians Optical Supplies 20 1083907844 0 Physicians Physician Services 00 1083908073 0 HANEY BRANDON M 2022361 9999999 B 10 1083908073 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1083908073 0 Physicians Anesthesia Services 20 1083908073 0 Physicians Healthy Kids Services 20 1083908073 0 Physicians Optical Supplies 20 1083908073 0 Physicians Physician Services 00 1083908503 0 WINEINGER KEVIN 2017241 9999999 B 10 1083908503 0 PO BOX 781076 DETROIT MI 482781076 20 1083908503 0 Physicians Anesthesia Services 20 1083908503 0 Physicians Fluoride varnish 20 1083908503 0 Physicians Healthy Kids Services 20 1083908503 0 Physicians Optical Supplies 20 1083908503 0 Physicians Physician Services 00 1083908552 0 SERUYA ABBY H 2016133 9999999 B 10 1083908552 0 2801 LAKESIDE DR STE 209 BANNOCKBURN IL 600151271 20 1083908552 0 Physicians Anesthesia Services 20 1083908552 0 Physicians Healthy Kids Services 20 1083908552 0 Physicians Optical Supplies 20 1083908552 0 Physicians Physician Services 00 1083909089 0 LEWIS O'DENE 2024338 9999999 B 10 1083909089 0 PO BOX 708760 SANDY UT 840708760 20 1083909089 0 Physicians Anesthesia Services 20 1083909089 0 Physicians Fluoride varnish 20 1083909089 0 Physicians Healthy Kids Services 20 1083909089 0 Physicians Optical Supplies 20 1083909089 0 Physicians Physician Services 00 1083909733 0 WRATKOWSKI PAUL 2023046 9999999 B 10 1083909733 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1083909733 0 Physicians Anesthesia Services 20 1083909733 0 Physicians Fluoride varnish 20 1083909733 0 Physicians Healthy Kids Services 20 1083909733 0 Physicians Optical Supplies 20 1083909733 0 Physicians Physician Services 00 1083909956 0 KADOW TIFFANY 2018208 9999999 B 10 1083909956 0 5777 DEPT CAROL STREAM IL 601228942 20 1083909956 0 Physicians Anesthesia Services 20 1083909956 0 Physicians Healthy Kids Services 20 1083909956 0 Physicians Optical Supplies 20 1083909956 0 Physicians Physician Services 00 1083910483 0 KURUP SINDHU 2012002 9999999 B 10 1083910483 0 3880 SALEM LAKE DR STE F STE F LONG GROVE IL 600475292 20 1083910483 0 Physicians Anesthesia Services 20 1083910483 0 Physicians Fluoride varnish 20 1083910483 0 Physicians Healthy Kids Services 20 1083910483 0 Physicians Optical Supplies 20 1083910483 0 Physicians Physician Services 00 1083913180 0 NAKAGAWA JENNA 2024078 9999999 B 10 1083913180 0 1100 SPRING ST NW STE 460 ATLANTA GA 303092813 20 1083913180 0 Physician Assistant Only Fluoride varnish 20 1083913180 0 Physician Assistant Only Healthy Kids Services 20 1083913180 0 Physician Assistant Only Physician Services 00 1083913255 0 BALANEY BHAVNA 2021033 9999999 B 10 1083913255 0 1395 NW 167TH ST MIAMI FL 331695710 20 1083913255 0 Physicians Anesthesia Services 20 1083913255 0 Physicians Fluoride varnish 20 1083913255 0 Physicians Healthy Kids Services 20 1083913255 0 Physicians Optical Supplies 20 1083913255 0 Physicians Physician Services 00 1083917090 0 ALSABBAGH MOHAMMED EYAD Y 2017091 9999999 B 10 1083917090 0 615 S NEW BALLAS RD STE 1200 SAINT LOUIS MO 631418221 20 1083917090 0 Physicians Anesthesia Services 20 1083917090 0 Physicians Fluoride varnish 20 1083917090 0 Physicians Healthy Kids Services 20 1083917090 0 Physicians Optical Supplies 20 1083917090 0 Physicians Physician Services 00 1083918163 0 OKEKE OKECHUKWU J 2015130 9999999 B 10 1083918163 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1083918163 0 Physicians Anesthesia Services 20 1083918163 0 Physicians Fluoride varnish 20 1083918163 0 Physicians Healthy Kids Services 20 1083918163 0 Physicians Optical Supplies 20 1083918163 0 Physicians Physician Services 00 1083918486 0 ALBARILLO FRITZIE 2015182 9999999 B 10 1083918486 0 7400 N MILWAUKEE AVE # 231A NILES IL 607143708 20 1083918486 0 Physicians Anesthesia Services 20 1083918486 0 Physicians Fluoride varnish 20 1083918486 0 Physicians Healthy Kids Services 20 1083918486 0 Physicians Optical Supplies 20 1083918486 0 Physicians Physician Services 00 1083918502 0 BILLUPS JESSICA 2011094 9999999 B 10 1083918502 0 17746 OAK PARK AVE TINLEY PARK IL 604773936 20 1083918502 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1083918874 0 MEDEIROS ALMEIDA DANIEL 2021101 9999999 B 10 1083918874 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1083918874 0 Physicians Anesthesia Services 20 1083918874 0 Physicians Healthy Kids Services 20 1083918874 0 Physicians Optical Supplies 20 1083918874 0 Physicians Physician Services 20 1083918874 0 Physicians Physicians Psychiatric Services 00 1083919864 0 KAMPANATKOSOL RONALD 2012243 9999999 B 10 1083919864 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1083919864 0 Physicians Anesthesia Services 20 1083919864 0 Physicians Fluoride varnish 20 1083919864 0 Physicians Healthy Kids Services 20 1083919864 0 Physicians Optical Supplies 20 1083919864 0 Physicians Physician Services 00 1083920227 0 CALLAHAN NICHOLAS 2018228 9999999 B 10 1083920227 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1083920227 0 Dentists All Kids application agent 20 1083920227 0 Dentists Dental Services 20 1083920227 0 Dentists Physician Services 00 1083921076 0 ELIA BETH 2018029 9999999 B 10 1083921076 0 7272 WURZBACH RD STE 601 SAN ANTONIO TX 782404803 20 1083921076 0 Psychologist Psychologist service 00 1083923668 0 MANN BRADLEY 2021179 9999999 B 10 1083923668 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1083923668 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1083924559 0 ORONA KATHRYN N 2010300 9999999 B 10 1083924559 0 5777 DEPT CAROL STREAM IL 601220021 20 1083924559 0 Nurse Practitioners Anesthesia Services 20 1083924559 0 Nurse Practitioners Nurse Practitioners Services 20 1083924559 0 Nurse Practitioners Physician Services 00 1083924740 0 BRASEL MICAH 2010305 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Services 20 1083926125 0 Physicians Fluoride varnish 20 1083926125 0 Physicians Healthy Kids Services 20 1083926125 0 Physicians Optical Supplies 20 1083926125 0 Physicians Physician Services 00 1083926281 0 OLROYD BRANDY 2016214 9999999 B 10 1083926281 0 3301 GREENBRIAR AVE GODFREY IL 620353236 20 1083926281 0 Speech Therapists Medical Supplies 20 1083926281 0 Speech Therapists Medical equipment/prosthetic devices 20 1083926281 0 Speech Therapists Speech Therapy/Pathology Services 00 1083926745 0 SAOUD RANI 2022214 9999999 B 10 1083926745 0 202 S PARK ST MADISON WI 537151507 20 1083926745 0 Physicians Anesthesia Services 20 1083926745 0 Physicians Healthy Kids Services 20 1083926745 0 Physicians Optical Supplies 20 1083926745 0 Physicians Physician Services 00 1083927321 0 GOMEZ SUSAN 2021243 9999999 B 10 1083927321 0 8550 W BRYN MAWR AVE STE 800 STE 800 CHICAGO IL 606313222 20 1083927321 0 Physician Assistant Only Fluoride varnish 20 1083927321 0 Physician Assistant Only Healthy Kids 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ANDERSON LAURA 2017103 9999999 B 10 1093110306 0 74 ECLIPSE CTR BELOIT WI 535113550 20 1093110306 0 Nurse Practitioners Fluoride varnish 20 1093110306 0 Nurse Practitioners Healthy Kids Services 20 1093110306 0 Nurse Practitioners Nurse Practitioners Services 20 1093110306 0 Nurse Practitioners Physician Services 00 1093110827 0 WEIRICH JENNIFER 2019289 9999999 B 10 1093110827 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1093110827 0 Physician Assistant Only Fluoride varnish 20 1093110827 0 Physician Assistant Only Healthy Kids Services 20 1093110827 0 Physician Assistant Only Physician Services 00 1093111825 0 KEMP LAURA C 2016266 9999999 B 10 1093111825 0 17 N STATE ST STE 500 CHICAGO IL 606023384 20 1093111825 0 Nurse Practitioners Family Planning Counseling 20 1093111825 0 Nurse Practitioners Fluoride varnish 20 1093111825 0 Nurse Practitioners Healthy Kids Services 20 1093111825 0 Nurse Practitioners Nurse Practitioners Services 20 1093111825 0 Nurse Practitioners Physician 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Services 00 1093129835 0 RHYNE CHRISTOPHER P 2017047 9999999 B 10 1093129835 0 303 N JACKSON ST MORRISON IL 612703042 20 1093129835 0 Physicians Anesthesia Services 20 1093129835 0 Physicians Fluoride varnish 20 1093129835 0 Physicians Healthy Kids Services 20 1093129835 0 Physicians Optical Supplies 20 1093129835 0 Physicians Physician Services 00 1093130486 0 GAUTHIER ANGELA 2024302 9999999 B 10 1093130486 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1093130486 0 Physician Assistant Only Fluoride varnish 20 1093130486 0 Physician Assistant Only Healthy Kids Services 20 1093130486 0 Physician Assistant Only Physician Services 00 1093132086 0 SCHMITZ ANNA H 2018168 9999999 B 10 1093132086 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1093132086 0 Physicians Anesthesia Services 20 1093132086 0 Physicians Fluoride varnish 20 1093132086 0 Physicians Healthy Kids Services 20 1093132086 0 Physicians Optical Supplies 20 1093132086 0 Physicians Physician Services 00 1093132151 0 SEO SUZANNE E 2025010 9999999 B 10 1093132151 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1093132151 0 Physicians Anesthesia Services 20 1093132151 0 Physicians Healthy Kids Services 20 1093132151 0 Physicians Optical Supplies 20 1093132151 0 Physicians Physician Services 00 1093132193 0 PATEL ROMY M 2018213 9999999 B 10 1093132193 0 387 SHUMAN BLVD STE 240W NAPERVILLE IL 605638113 20 1093132193 0 Physicians Anesthesia Services 20 1093132193 0 Physicians Healthy Kids Services 20 1093132193 0 Physicians Optical Supplies 20 1093132193 0 Physicians Physician Services 00 1093132235 0 SIPAHI SEVGI 2018261 9999999 B 10 1093132235 0 29373 NETWORK PL CHICAGO IL 606733039 20 1093132235 0 Physicians Anesthesia Services 20 1093132235 0 Physicians Healthy Kids Services 20 1093132235 0 Physicians Optical Supplies 20 1093132235 0 Physicians Physician Services 00 1093132284 0 SITA ELIZABETH E 2018247 9999999 B 10 1093132284 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1093132284 0 Physicians Anesthesia Services 20 1093132284 0 Physicians Healthy Kids Services 20 1093132284 0 Physicians Optical Supplies 20 1093132284 0 Physicians Physician Services 20 1093132284 0 Physicians Physicians Psychiatric Services 00 1093133126 0 JACOBSON NANCY 2018091 9999999 B 10 1093133126 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1093133126 0 Physicians Anesthesia Services 20 1093133126 0 Physicians Healthy Kids Services 20 1093133126 0 Physicians Optical Supplies 20 1093133126 0 Physicians Physician Services 00 1093133548 0 KHALSA HARPREET 2021223 9999999 B 10 1093133548 0 6845 STANLEY AVE BERWYN IL 604023041 20 1093133548 0 Podiatrists Podiatric Services 00 1093133779 0 STOPAK JOSHUA K 2019182 9999999 B 10 1093133779 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1093133779 0 Physicians Anesthesia Services 20 1093133779 0 Physicians Healthy Kids Services 20 1093133779 0 Physicians Optical Supplies 20 1093133779 0 Physicians Physician Services 00 1093133886 0 SMITH MALLORY B 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1093134884 0 Physicians Healthy Kids Services 20 1093134884 0 Physicians Optical Supplies 20 1093134884 0 Physicians Physician Services 00 1093134934 0 GREENING HEIDI G 2014182 9999999 B 10 1093134934 0 29373 NETWORK PL CHICAGO IL 606733039 20 1093134934 0 Physicians Anesthesia Services 20 1093134934 0 Physicians Fluoride varnish 20 1093134934 0 Physicians Healthy Kids Services 20 1093134934 0 Physicians Optical Supplies 20 1093134934 0 Physicians Physician Services 00 1093135808 0 ALLEYNE BRENDAN 2021178 9999999 B 10 1093135808 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1093135808 0 Physicians Anesthesia Services 20 1093135808 0 Physicians Healthy Kids Services 20 1093135808 0 Physicians Optical Supplies 20 1093135808 0 Physicians Physician Services 00 1093135980 0 ZWILLING DANIEL M 2020015 9999999 B 10 1093135980 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1093135980 0 Physician Assistant Only Fluoride varnish 20 1093135980 0 Physician Assistant Only Healthy 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MI 480991239 20 1093142226 0 Nurse Practitioners Fluoride varnish 20 1093142226 0 Nurse Practitioners Healthy Kids Services 20 1093142226 0 Nurse Practitioners Nurse Practitioners Services 20 1093142226 0 Nurse Practitioners Physician Services 00 1093142754 0 KALITA TIFFANY C 2014182 9999999 B 10 1093142754 0 5777 DEPT CAROL STREAM IL 601220021 20 1093142754 0 Nurse Practitioners Fluoride varnish 20 1093142754 0 Nurse Practitioners Healthy Kids Services 20 1093142754 0 Nurse Practitioners Nurse Practitioners Services 20 1093142754 0 Nurse Practitioners Physician Services 00 1093142978 0 SANNA UNKNOWN 2018312 9999999 B 10 1093142978 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1093142978 0 Physicians Anesthesia Services 20 1093142978 0 Physicians Fluoride varnish 20 1093142978 0 Physicians Healthy Kids Services 20 1093142978 0 Physicians Optical Supplies 20 1093142978 0 Physicians Physician Services 00 1093143604 0 CHEN DIANE 2017059 9999999 B 10 1093143604 0 225 E CHICAGO AVE # 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1093149734 0 FRANCISCO KRISTINE G 2013274 9999999 B 10 1093149734 0 307 S EVERGREEN AVE WOODBURY NJ 080962739 20 1093149734 0 Nurse Practitioners Fluoride varnish 20 1093149734 0 Nurse Practitioners Healthy Kids Services 20 1093149734 0 Nurse Practitioners Nurse Practitioners Services 20 1093149734 0 Nurse Practitioners Physician Services 00 1093149890 0 MARSH MARY 2017164 9999999 B 10 1093149890 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1093149890 0 Physical Therapists Medical Supplies 20 1093149890 0 Physical Therapists Medical equipment/prosthetic devices 20 1093149890 0 Physical Therapists Physical Therapy Services 00 1093150427 0 STOLLARD JESSICA 2018001 9999999 B 10 1093150427 0 205 N ADAMS ST FLANAGAN IL 617409036 20 1093150427 0 Speech Therapists Medical Supplies 20 1093150427 0 Speech Therapists Medical equipment/prosthetic devices 20 1093150427 0 Speech Therapists Speech Therapy/Pathology Services 00 1093150898 0 HOFFMAN KEVIN 2020143 9999999 B 10 1093150898 0 PO BOX 43230 PHOENIX AZ 850803230 20 1093150898 0 Physicians Anesthesia Services 20 1093150898 0 Physicians Healthy Kids Services 20 1093150898 0 Physicians Optical Supplies 20 1093150898 0 Physicians Physician Services 00 1093151151 0 LANGALIYA BHRANTI C 2016154 9999999 B 10 1093151151 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1093151151 0 Physicians Anesthesia Services 20 1093151151 0 Physicians Fluoride varnish 20 1093151151 0 Physicians Healthy Kids Services 20 1093151151 0 Physicians Optical Supplies 20 1093151151 0 Physicians Physician Services 00 1093151573 0 GOGAWALE PUJA SHETH 2017247 9999999 B 10 1093151573 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1093151573 0 Physicians Anesthesia Services 20 1093151573 0 Physicians Healthy Kids Services 20 1093151573 0 Physicians Optical Supplies 20 1093151573 0 Physicians Physician Services 00 1093152480 0 SIMMS ANDREW T 2018182 9999999 B 10 1093152480 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1093152480 0 Physicians Anesthesia Services 20 1093152480 0 Physicians Fluoride varnish 20 1093152480 0 Physicians Healthy Kids Services 20 1093152480 0 Physicians Optical Supplies 20 1093152480 0 Physicians Physician Services 00 1093152548 0 ROY MEGHANA 2018182 9999999 B 10 1093152548 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1093152548 0 Physicians Anesthesia Services 20 1093152548 0 Physicians Healthy Kids Services 20 1093152548 0 Physicians Optical Supplies 20 1093152548 0 Physicians Physician Services 00 1093153066 0 DEVINE MEHGAN KATHLEEN 2014358 9999999 B 10 1093153066 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1093153066 0 Psychologist Psychologist service 00 1093154080 0 THAKRAL SHARDA 2024289 9999999 B 10 1093154080 0 5777 DEPT CAROL STREAM IL 601220021 20 1093154080 0 Physicians Anesthesia Services 20 1093154080 0 Physicians Healthy Kids Services 20 1093154080 0 Physicians Optical Supplies 20 1093154080 0 Physicians Physician Services 00 1093154254 0 MOORE NATHAN H 2016246 9999999 B 10 1093154254 0 3015 N BALLAS RD ADMINISTRATION SAINT LOUIS MO 631312329 20 1093154254 0 Physicians Anesthesia Services 20 1093154254 0 Physicians Fluoride varnish 20 1093154254 0 Physicians Healthy Kids Services 20 1093154254 0 Physicians Optical Supplies 20 1093154254 0 Physicians Physician Services 00 1093154809 0 DISTERHOFT JUDITH 2015341 9999999 B 10 1093154809 0 4259 S BERKELEY AVE CHICAGO IL 606533030 20 1093154809 0 Physicians Anesthesia Services 20 1093154809 0 Physicians Fluoride varnish 20 1093154809 0 Physicians Healthy Kids Services 20 1093154809 0 Physicians Optical Supplies 20 1093154809 0 Physicians Physician Services 00 1093155400 0 TRAPP NICHOLAS T 2017186 9999999 B 10 1093155400 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1093155400 0 Physicians Anesthesia Services 20 1093155400 0 Physicians Healthy Kids Services 20 1093155400 0 Physicians Optical Supplies 20 1093155400 0 Physicians Physician Services 20 1093155400 0 Physicians Physicians Psychiatric Services 00 1093155632 0 PITMAN RYAN T 2019001 9999999 B 10 1093155632 0 PO BOX 778912 CHICAGO IL 606778912 20 1093155632 0 Physicians Anesthesia Services 20 1093155632 0 Physicians Fluoride varnish 20 1093155632 0 Physicians Healthy Kids Services 20 1093155632 0 Physicians Optical Supplies 20 1093155632 0 Physicians Physician Services 00 1093155772 0 SHAKEEL FAIZAN 2016183 9999999 B 10 1093155772 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1093155772 0 Physicians Anesthesia Services 20 1093155772 0 Physicians Healthy Kids Services 20 1093155772 0 Physicians Optical Supplies 20 1093155772 0 Physicians Physician Services 00 1093155996 0 SINGHANIA SUMEGHA 2018274 9999999 B 10 1093155996 0 3750 W 26TH ST CHICAGO IL 606233826 20 1093155996 0 Dentists Dental Services 20 1093155996 0 Dentists Physician Services 00 1093156408 0 BAKOSH STEPHANIE J 2014162 9999999 B 10 1093156408 0 6701 159TH ST STE 2 TINLEY PARK IL 604771758 20 1093156408 0 Nurse Practitioners Healthy Kids 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1093159865 0 GESELL MITCHELL 2020182 9999999 B 10 1093159865 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1093159865 0 Physicians Anesthesia Services 20 1093159865 0 Physicians Healthy Kids Services 20 1093159865 0 Physicians Optical Supplies 20 1093159865 0 Physicians Physician Services 00 1093160210 0 PATEL ASHIS 2022234 9999999 B 10 1093160210 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1093160210 0 Physicians Anesthesia Services 20 1093160210 0 Physicians Healthy Kids Services 20 1093160210 0 Physicians Optical Supplies 20 1093160210 0 Physicians Physician Services 00 1093162653 0 BABARINDE IMOLEAYO T 2022357 9999999 B 10 1093162653 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1093162653 0 Nurse Practitioners Fluoride varnish 20 1093162653 0 Nurse Practitioners Healthy Kids Services 20 1093162653 0 Nurse Practitioners Nurse Practitioners Services 20 1093162653 0 Nurse Practitioners Physician Services 00 1093163180 0 KALINA MICHAEL LAWRENCE 2017261 9999999 B 10 1093163180 0 5777 DEPT CAROL STREAM IL 601220021 20 1093163180 0 Physicians Anesthesia Services 20 1093163180 0 Physicians Healthy Kids Services 20 1093163180 0 Physicians Optical Supplies 20 1093163180 0 Physicians Physician Services 00 1093164154 0 JIMENEZ ABRAHAM 2018181 9999999 B 10 1093164154 0 1800 N HERMITAGE AVE ATTN: PAM DAVIS CHICAGO IL 606221161 20 1093164154 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1093164238 0 GREENWALD MARTIN L 2018351 9999999 B 10 1093164238 0 5777 DEPT CAROL STREAM IL 601228942 20 1093164238 0 Physicians Anesthesia Services 20 1093164238 0 Physicians Healthy Kids Services 20 1093164238 0 Physicians Optical Supplies 20 1093164238 0 Physicians Physician Services 20 1093164238 0 Physicians Physicians Psychiatric Services 00 1093164337 0 HUGHES KRISTINA 2018169 9999999 B 10 1093164337 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1093164337 0 Nurse Practitioners Fluoride varnish 20 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349977462 20 1093166589 0 Other behavior health professional Adaptive behavior support clinician services 00 1093166894 0 LESTER ALYCIA M 2024266 9999999 B 10 1093166894 0 115 OMAHA ST HIGHLAND PARK IL 600356406 20 1093166894 0 Other behavior health professional Adaptive behavior support clinician services 00 1093167322 0 GROVER RUBY K 2016245 9999999 B 10 1093167322 0 PO BOX 500 ELLICOTTVILLE NY 147310500 20 1093167322 0 Physician Assistant Only Fluoride varnish 20 1093167322 0 Physician Assistant Only Healthy Kids Services 20 1093167322 0 Physician Assistant Only Physician Services 00 1093167678 0 REED JENNIFER J 2021277 9999999 B 10 1093167678 0 725 SCHOOL ST STE A MORRIS IL 604501207 20 1093167678 0 Other behavior health professional LCPC/LMFT services 00 1093167843 0 NANCE CHRISTINE E 2017044 9999999 B 10 1093167843 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1093167843 0 Nurse Practitioners Anesthesia Services 20 1093167843 0 Nurse Practitioners Nurse Practitioners Services 20 1093167843 0 Nurse Practitioners Physician Services 00 1093168189 0 WHITEHOUSE MELISSA M 2018300 9999999 B 10 1093168189 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1093168189 0 Physician Assistant Only Fluoride varnish 20 1093168189 0 Physician Assistant Only Healthy Kids Services 20 1093168189 0 Physician Assistant Only Physician Services 00 1093168775 0 RAFF MARIKA 2020010 9999999 B 10 1093168775 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1093168775 0 Physicians Anesthesia Services 20 1093168775 0 Physicians Healthy Kids Services 20 1093168775 0 Physicians Optical Supplies 20 1093168775 0 Physicians Physician Services 00 1093169187 0 GORSKI DANIEL P 2022145 9999999 B 10 1093169187 0 PO BOX 1790 BROOKFIELD WI 530081790 20 1093169187 0 Physicians Anesthesia Services 20 1093169187 0 Physicians Fluoride varnish 20 1093169187 0 Physicians Healthy Kids Services 20 1093169187 0 Physicians Optical Supplies 20 1093169187 0 Physicians Physician Services 00 1093169419 0 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Practitioners Nurse Practitioners Services 20 1093175630 0 Nurse Practitioners Physician Services 00 1093175762 0 WALLACE ELIZABETH 2016067 9999999 B 10 1093175762 0 4740 N CLARK ST CHICAGO IL 606404689 20 1093175762 0 Other behavior health professional Social work service 00 1093177024 0 MICHALISZYN PIOTR 2019203 9999999 B 10 1093177024 0 29373 NETWORK PL CHICAGO IL 606733039 20 1093177024 0 Physicians Anesthesia Services 20 1093177024 0 Physicians Fluoride varnish 20 1093177024 0 Physicians Healthy Kids Services 20 1093177024 0 Physicians Optical Supplies 20 1093177024 0 Physicians Physician Services 00 1093177230 0 MANK MICHAEL G 2018059 9999999 B 10 1093177230 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1093177230 0 Physicians Anesthesia Services 20 1093177230 0 Physicians Fluoride varnish 20 1093177230 0 Physicians Healthy Kids Services 20 1093177230 0 Physicians Optical Supplies 20 1093177230 0 Physicians Physician Services 00 1093178576 0 KRUSE MICHAEL 2016122 9999999 B 10 1093178576 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1093178576 0 Nurse Practitioners Fluoride varnish 20 1093178576 0 Nurse Practitioners Healthy Kids Services 20 1093178576 0 Nurse Practitioners Nurse Practitioners Services 20 1093178576 0 Nurse Practitioners Physician Services 00 1093178790 0 CHAMBERS MARIAH D 2020007 9999999 B 10 1093178790 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1093178790 0 Physicians Anesthesia Services 20 1093178790 0 Physicians Fluoride varnish 20 1093178790 0 Physicians Healthy Kids Services 20 1093178790 0 Physicians Optical Supplies 20 1093178790 0 Physicians Physician Services 00 1093178824 0 RODRIGUEZ HERNANDEZ ALBERTO 2019190 9999999 B 10 1093178824 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1093178824 0 Physicians Anesthesia Services 20 1093178824 0 Physicians Healthy Kids Services 20 1093178824 0 Physicians Optical Supplies 20 1093178824 0 Physicians Physician Services 00 1093179046 0 TABALDIEV SABYR K 2023326 9999999 B 10 1093179046 0 PO 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20 1093342388 0 Physicians Anesthesia Services 20 1093342388 0 Physicians Fluoride varnish 20 1093342388 0 Physicians Healthy Kids Services 20 1093342388 0 Physicians Optical Supplies 20 1093342388 0 Physicians Physician Services 00 1093342446 0 CHAUDHRY TALIB 2020199 9999999 B 10 1093342446 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1093342446 0 Physicians Anesthesia Services 20 1093342446 0 Physicians Healthy Kids Services 20 1093342446 0 Physicians Optical Supplies 20 1093342446 0 Physicians Physician Services 00 1093342719 0 LAMOUR DANIELLA 2024018 9999999 B 10 1093342719 0 PO BOX 41220 PHOENIX AZ 850801220 20 1093342719 0 Physicians Anesthesia Services 20 1093342719 0 Physicians Healthy Kids Services 20 1093342719 0 Physicians Optical Supplies 20 1093342719 0 Physicians Physician Services 00 1093343063 0 GUI EVAN Z 2024169 9999999 B 10 1093343063 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1093343063 0 Physicians Anesthesia Services 20 1093343063 0 Physicians 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IL 627621000 20 1093367575 0 Nurse Practitioners Healthy Kids Services 20 1093367575 0 Nurse Practitioners Nurse Practitioners Services 20 1093367575 0 Nurse Practitioners Physician Services 00 1093368425 0 MOFFIT CONNIE M 2019294 9999999 B 10 1093368425 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1093368425 0 Nurse Practitioners Healthy Kids Services 20 1093368425 0 Nurse Practitioners Nurse Practitioners Services 20 1093368425 0 Nurse Practitioners Physician Services 00 1093368862 0 SWARTZ AMANDA 2019224 9999999 B 10 1093368862 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1093368862 0 Physical Therapists Medical Supplies 20 1093368862 0 Physical Therapists Medical equipment/prosthetic devices 20 1093368862 0 Physical Therapists Physical Therapy Services 00 1093369589 0 CANRIGHT JACOB T 2019262 9999999 B 10 1093369589 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1093369589 0 Physical Therapists Medical Supplies 20 1093369589 0 Physical Therapists Medical equipment/prosthetic devices 20 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MEDINA MARTIN J 2023241 9999999 B 10 1093375883 0 PO BOX 500 ELLICOTTVILLE NY 147310500 20 1093375883 0 Physician Assistant Only Fluoride varnish 20 1093375883 0 Physician Assistant Only Healthy Kids Services 20 1093375883 0 Physician Assistant Only Physician Services 00 1093376568 0 SMITH ELIZABETH 2020008 9999999 B 10 1093376568 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1093376568 0 Physicians Anesthesia Services 20 1093376568 0 Physicians Healthy Kids Services 20 1093376568 0 Physicians Optical Supplies 20 1093376568 0 Physicians Physician Services 00 1093377376 0 SHEETS JESSICA M 2021294 9999999 B 10 1093377376 0 5665 NEW NORTHSIDE DR STE 320 ATLANTA GA 303285834 20 1093377376 0 Nurse Practitioners Fluoride varnish 20 1093377376 0 Nurse Practitioners Healthy Kids Services 20 1093377376 0 Nurse Practitioners Nurse Practitioners Services 20 1093377376 0 Nurse Practitioners Physician Services 00 1093377905 0 CLARK NICHOLE N 2019183 9999999 B 10 1093377905 0 29373 NETWORK PL CHICAGO IL 606733039 20 1093377905 0 Nurse Practitioners Fluoride varnish 20 1093377905 0 Nurse Practitioners Healthy Kids Services 20 1093377905 0 Nurse Practitioners Nurse Practitioners Services 20 1093377905 0 Nurse Practitioners Physician Services 00 1093378093 0 HARTMAN KALEE 2023258 9999999 B 10 1093378093 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1093378093 0 Physician Assistant Only Fluoride varnish 20 1093378093 0 Physician Assistant Only Healthy Kids Services 20 1093378093 0 Physician Assistant Only Physician Services 00 1093378986 0 JOHNSON TRUDY J 2019164 9999999 B 10 1093378986 0 6501 S PROMONTORY DR CHICAGO IL 606491003 20 1093378986 0 Nurse Practitioners Fluoride varnish 20 1093378986 0 Nurse Practitioners Healthy Kids Services 20 1093378986 0 Nurse Practitioners Nurse Practitioners Services 20 1093378986 0 Nurse Practitioners Physician Services 00 1093378994 0 ZOU GUANGCHEN 2024218 9999999 B 10 1093378994 0 621 S NEW BALLAS RD STE 3015B SAINT LOUIS MO 631418267 20 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00 1093382152 0 OLIVARES ANDRES J 2021321 9999999 B 10 1093382152 0 50 S MAIN ST STE 200 NAPERVILLE IL 605405485 20 1093382152 0 Occupational Therapists Medical Supplies 20 1093382152 0 Occupational Therapists Medical equipment/prosthetic devices 20 1093382152 0 Occupational Therapists Occupational Therapy Services 00 1093382731 0 JAFRI ZAIN 2022117 9999999 B 10 1093382731 0 836 W WELLINGTON AVE CHICAGO IL 606575147 20 1093382731 0 Physicians Anesthesia Services 20 1093382731 0 Physicians Fluoride varnish 20 1093382731 0 Physicians Healthy Kids Services 20 1093382731 0 Physicians Optical Supplies 20 1093382731 0 Physicians Physician Services 00 1093382970 0 BYERS FALISA 2023278 9999999 B 10 1093382970 0 211 E LAKE ST STE 1B ADDISON IL 601012877 20 1093382970 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1093383028 0 SULLIVAN JAMES P 2024122 9999999 B 10 1093383028 0 PO BOX 3988 CARBONDALE IL 629023988 20 1093383028 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Physicians Anesthesia Services 20 1093392409 0 Physicians Healthy Kids Services 20 1093392409 0 Physicians Optical Supplies 20 1093392409 0 Physicians Physician Services 00 1093392466 0 STIPPICH SIERRA 2021215 9999999 B 10 1093392466 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1093392466 0 Physicians Anesthesia Services 20 1093392466 0 Physicians Fluoride varnish 20 1093392466 0 Physicians Healthy Kids Services 20 1093392466 0 Physicians Optical Supplies 20 1093392466 0 Physicians Physician Services 00 1093392649 0 SIMONS JOSHUA 2021218 9999999 B 10 1093392649 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1093392649 0 Physicians Anesthesia Services 20 1093392649 0 Physicians Healthy Kids Services 20 1093392649 0 Physicians Optical Supplies 20 1093392649 0 Physicians Physician Services 00 1093392821 0 KAULA SHARIKA 2021197 9999999 B 10 1093392821 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1093392821 0 Physicians Anesthesia Services 20 1093392821 0 Physicians Healthy Kids Services 20 1093392821 0 Physicians Optical Supplies 20 1093392821 0 Physicians Physician Services 00 1093392847 0 UPTON LAURA 2021224 9999999 B 10 1093392847 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1093392847 0 Physicians Anesthesia Services 20 1093392847 0 Physicians Fluoride varnish 20 1093392847 0 Physicians Healthy Kids Services 20 1093392847 0 Physicians Optical Supplies 20 1093392847 0 Physicians Physician Services 00 1093393118 0 REVIS ANGELICA 2021178 9999999 B 10 1093393118 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1093393118 0 Physicians Anesthesia Services 20 1093393118 0 Physicians Fluoride varnish 20 1093393118 0 Physicians Healthy Kids Services 20 1093393118 0 Physicians Optical Supplies 20 1093393118 0 Physicians Physician Services 00 1093393134 0 YAO REBECCA 2024206 9999999 B 10 1093393134 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1093393134 0 Physicians Anesthesia Services 20 1093393134 0 Physicians Fluoride varnish 20 1093393134 0 Physicians Healthy Kids Services 20 1093393134 0 Physicians Optical Supplies 20 1093393134 0 Physicians Physician Services 00 1093393225 0 SINGLETERRY SYDNEY ALEXANDRIA 2021176 9999999 B 10 1093393225 0 7825 SOLUTION CTR CHICAGO IL 606777007 20 1093393225 0 Physicians Anesthesia Services 20 1093393225 0 Physicians Healthy Kids Services 20 1093393225 0 Physicians Optical Supplies 20 1093393225 0 Physicians Physician Services 20 1093393225 0 Physicians Physicians Psychiatric Services 00 1093393308 0 SESSELMANN MADELINE A 2021139 9999999 B 10 1093393308 0 1775 DEMPSTER ST PARK RIDGE IL 600681143 20 1093393308 0 Physicians Anesthesia Services 20 1093393308 0 Physicians Fluoride varnish 20 1093393308 0 Physicians Healthy Kids Services 20 1093393308 0 Physicians Optical Supplies 20 1093393308 0 Physicians Physician Services 00 1093394819 0 DUNTON ASHLEY C 2021182 9999999 B 10 1093394819 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1093394819 0 Physicians Anesthesia Services 20 1093394819 0 Physicians Fluoride varnish 20 1093394819 0 Physicians Healthy Kids Services 20 1093394819 0 Physicians Optical Supplies 20 1093394819 0 Physicians Physician Services 00 1093394975 0 GUASTELLA ANGELO F 2021182 9999999 B 10 1093394975 0 836 W WELLINGTON AVE CHICAGO IL 606575147 20 1093394975 0 Physicians Anesthesia Services 20 1093394975 0 Physicians Healthy Kids Services 20 1093394975 0 Physicians Optical Supplies 20 1093394975 0 Physicians Physician Services 00 1093395022 0 BURRIS MARGARET C 2022133 9999999 B 10 1093395022 0 1201 RICKER RD SALEM IL 628814263 20 1093395022 0 Nurse Practitioners Fluoride varnish 20 1093395022 0 Nurse Practitioners Healthy Kids Services 20 1093395022 0 Nurse Practitioners Nurse Practitioners Services 20 1093395022 0 Nurse Practitioners Physician Services 00 1093395998 0 HUH JENNIFER 2021183 9999999 B 10 1093395998 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1093395998 0 Physicians Anesthesia Services 20 1093395998 0 Physicians Healthy Kids Services 20 1093395998 0 Physicians Optical Supplies 20 1093395998 0 Physicians Physician Services 00 1093396012 0 HAIBE YOLLA 2023213 9999999 B 10 1093396012 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1093396012 0 Physicians Anesthesia Services 20 1093396012 0 Physicians Fluoride varnish 20 1093396012 0 Physicians Healthy Kids Services 20 1093396012 0 Physicians Optical Supplies 20 1093396012 0 Physicians Physician Services 00 1093396400 0 KHERALLAH RAGHAD 2021188 9999999 B 10 1093396400 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1093396400 0 Physicians Anesthesia Services 20 1093396400 0 Physicians Healthy Kids Services 20 1093396400 0 Physicians Optical Supplies 20 1093396400 0 Physicians Physician Services 00 1093396632 0 PATEL KISHAN M 2024275 9999999 B 10 1093396632 0 4698 DEPT CAROL STREAM IL 601220021 20 1093396632 0 Physicians Anesthesia Services 20 1093396632 0 Physicians Healthy Kids Services 20 1093396632 0 Physicians Optical Supplies 20 1093396632 0 Physicians Physician Services 00 1093396798 0 VESELACK TERESA M 2022208 9999999 B 10 1093396798 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1093396798 0 Physicians Anesthesia Services 20 1093396798 0 Physicians Healthy Kids Services 20 1093396798 0 Physicians Optical Supplies 20 1093396798 0 Physicians Physician Services 00 1093398687 0 HOSSAIN MUHAMMAD M 2022158 9999999 B 10 1093398687 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1093398687 0 Physicians Anesthesia Services 20 1093398687 0 Physicians Healthy Kids Services 20 1093398687 0 Physicians Optical Supplies 20 1093398687 0 Physicians Physician Services 00 1093399487 0 SWEIDAN HISHAM 2024195 9999999 B 10 1093399487 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1093399487 0 Physicians Anesthesia Services 20 1093399487 0 Physicians Healthy Kids Services 20 1093399487 0 Physicians Optical Supplies 20 1093399487 0 Physicians Physician Services 00 1093399933 0 KOTLO SRISHA 2022181 9999999 B 10 1093399933 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1093399933 0 Physicians Anesthesia Services 20 1093399933 0 Physicians Fluoride varnish 20 1093399933 0 Physicians Healthy Kids Services 20 1093399933 0 Physicians Optical Supplies 20 1093399933 0 Physicians Physician Services 00 1093400160 0 PHEN JONATHAN 2023138 9999999 B 10 1093400160 0 502 RIVERSIDE DR EAST PEORIA IL 616112068 20 1093400160 0 Dentists Dental Services 20 1093400160 0 Dentists Physician Services 00 1093403362 0 SARAT PAULINA A 2023205 9999999 B 10 1093403362 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1093403362 0 Nurse Practitioners Fluoride varnish 20 1093403362 0 Nurse Practitioners Healthy Kids Services 20 1093403362 0 Nurse Practitioners Nurse Practitioners Services 20 1093403362 0 Nurse Practitioners Physician Services 00 1093403461 0 TISDELL AUSTIN J 2023208 9999999 B 10 1093403461 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1093403461 0 Physicians Anesthesia Services 20 1093403461 0 Physicians Healthy Kids Services 20 1093403461 0 Physicians Optical Supplies 20 1093403461 0 Physicians Physician Services 00 1093404345 0 CANIGLIA JOHN 2023207 9999999 B 10 1093404345 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1093404345 0 Physicians Anesthesia Services 20 1093404345 0 Physicians Fluoride varnish 20 1093404345 0 Physicians Healthy Kids Services 20 1093404345 0 Physicians Optical Supplies 20 1093404345 0 Physicians Physician Services 00 1093405037 0 LINEBERGER SHELLY S 2023219 9999999 B 10 1093405037 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1093405037 0 Nurse Practitioners Healthy Kids Services 20 1093405037 0 Nurse Practitioners Nurse Practitioners Services 20 1093405037 0 Nurse Practitioners Physician Services 00 1093405789 0 HAGUEWOOD ERIN 2023181 9999999 B 10 1093405789 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1093405789 0 Occupational Therapists Medical Supplies 20 1093405789 0 Occupational Therapists Medical equipment/prosthetic devices 20 1093405789 0 Occupational Therapists Occupational Therapy Services 00 1093406225 0 QUEVEDO RAMIREZ ANDRES 2023182 9999999 B 10 1093406225 0 1900 W POLK ST STE 220C CHICAGO IL 60612 20 1093406225 0 Physicians Anesthesia Services 20 1093406225 0 Physicians Fluoride varnish 20 1093406225 0 Physicians Healthy Kids Services 20 1093406225 0 Physicians Optical Supplies 20 1093406225 0 Physicians Physician Services 00 1093406373 0 LIS PAULINA M 2023213 9999999 B 10 1093406373 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1093406373 0 Physicians Anesthesia Services 20 1093406373 0 Physicians Fluoride varnish 20 1093406373 0 Physicians Healthy Kids Services 20 1093406373 0 Physicians Optical Supplies 20 1093406373 0 Physicians Physician Services 00 1093406522 0 KOWALCZYK MARTHA J 2023183 9999999 B 10 1093406522 0 917 W WASHINGTON BLVD CHICAGO IL 606072203 20 1093406522 0 Psychologist Psychologist service 00 1093406837 0 KOSKOTAS KATLYN D 2023167 9999999 B 10 1093406837 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1093406837 0 Nurse Practitioners Fluoride varnish 20 1093406837 0 Nurse Practitioners Healthy Kids Services 20 1093406837 0 Nurse Practitioners Nurse Practitioners Services 20 1093406837 0 Nurse Practitioners Physician Services 00 1093407868 0 ADESIDA ADEBOWALE 2023229 9999999 B 10 1093407868 0 13450 S KEDZIE AVE ROBBINS IL 60472 20 1093407868 0 Physician Assistant Only Fluoride varnish 20 1093407868 0 Physician Assistant Only Healthy Kids Services 20 1093407868 0 Physician Assistant Only Physician Services 00 1093409948 0 WU JOANNA 2023194 9999999 B 10 1093409948 0 5145 N CALIFORNIA AVE CHICAGO IL 606253661 20 1093409948 0 Physicians Anesthesia Services 20 1093409948 0 Physicians Fluoride varnish 20 1093409948 0 Physicians Healthy Kids Services 20 1093409948 0 Physicians Optical Supplies 20 1093409948 0 Physicians Physician Services 00 1093410557 0 JONES JASMINE 2024191 9999999 B 10 1093410557 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1093410557 0 Physicians Anesthesia Services 20 1093410557 0 Physicians Healthy Kids Services 20 1093410557 0 Physicians Optical Supplies 20 1093410557 0 Physicians Physician Services 00 1093412728 0 ROGERS TATIANA K 2023080 9999999 B 10 1093412728 0 5777 DEPT CAROL STREAM IL 601220021 20 1093412728 0 Psychologist Psychologist service 00 1093413197 0 STEELE MONIQUE 2023194 9999999 B 10 1093413197 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1093413197 0 Occupational Therapists Medical Supplies 20 1093413197 0 Occupational Therapists Medical equipment/prosthetic devices 20 1093413197 0 Occupational Therapists Occupational Therapy Services 00 1093416240 0 FONKEM SOLANGE 2023300 9999999 B 10 1093416240 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1093416240 0 Nurse Practitioners Anesthesia Services 20 1093416240 0 Nurse Practitioners Nurse Practitioners Services 20 1093416240 0 Nurse Practitioners Physician Services 00 1093416331 0 STAVROPOULOS DEMETRA LEE 2023233 9999999 B 10 1093416331 0 1201 N SHERIDAN RD WAUKEGAN IL 600852081 20 1093416331 0 Speech Therapists Medical Supplies 20 1093416331 0 Speech Therapists Medical equipment/prosthetic devices 20 1093416331 0 Speech Therapists Speech Therapy/Pathology Services 00 1093416620 0 PEREZ ANGALYNN M 2023151 9999999 B 10 1093416620 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1093416620 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1093417354 0 ABOU KHALIL ELISSA 2023216 9999999 B 10 1093417354 0 4698 DEPT CAROL STREAM IL 601220021 20 1093417354 0 Physicians Anesthesia Services 20 1093417354 0 Physicians Healthy Kids Services 20 1093417354 0 Physicians Optical Supplies 20 1093417354 0 Physicians Physician Services 00 1093417651 0 SAPETTI LARYN 2023183 9999999 B 10 1093417651 0 4698 DEPT CAROL STREAM IL 601224698 20 1093417651 0 Physicians Anesthesia Services 20 1093417651 0 Physicians Fluoride varnish 20 1093417651 0 Physicians Healthy Kids Services 20 1093417651 0 Physicians Optical Supplies 20 1093417651 0 Physicians Physician Services 00 1093417743 0 MURPHY-BELCASTER MEGAN 2023190 9999999 B 10 1093417743 0 4698 DEPT CAROL STREAM IL 601220021 20 1093417743 0 Physicians Anesthesia Services 20 1093417743 0 Physicians Healthy Kids Services 20 1093417743 0 Physicians Optical Supplies 20 1093417743 0 Physicians Physician Services 00 1093418139 0 KEYES CASEY-JOHN 2024047 9999999 B 10 1093418139 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1093418139 0 Physicians Anesthesia Services 20 1093418139 0 Physicians Healthy Kids Services 20 1093418139 0 Physicians Optical Supplies 20 1093418139 0 Physicians Physician Services 00 1093419327 0 MARGULIES SHAE 2024194 9999999 B 10 1093419327 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1093419327 0 Physicians Anesthesia Services 20 1093419327 0 Physicians Fluoride varnish 20 1093419327 0 Physicians Healthy Kids Services 20 1093419327 0 Physicians Optical Supplies 20 1093419327 0 Physicians Physician Services 00 1093419939 0 LANDGRAF GRETCHEN 2023199 9999999 B 10 1093419939 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1093419939 0 Physicians Anesthesia Services 20 1093419939 0 Physicians Fluoride varnish 20 1093419939 0 Physicians Healthy Kids Services 20 1093419939 0 Physicians Optical Supplies 20 1093419939 0 Physicians Physician Services 00 1093420853 0 HOLDEN JESSICA 2023305 9999999 B 10 1093420853 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1093420853 0 Nurse Practitioners Fluoride varnish 20 1093420853 0 Nurse Practitioners Healthy Kids Services 20 1093420853 0 Nurse Practitioners Nurse Practitioners Services 20 1093420853 0 Nurse Practitioners Physician Services 00 1093420887 0 HASSABALLA YOMNA 2023018 9999999 B 10 1093420887 0 100 SAUNDERS RD STE 150 LAKE FOREST IL 600452526 20 1093420887 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1093421018 0 ARTEAGA JENNIFER 2024208 9999999 B 10 1093421018 0 29373 NETWORK PL CHICAGO IL 606733039 20 1093421018 0 Physical Therapists Medical Supplies 20 1093421018 0 Physical Therapists Medical equipment/prosthetic devices 20 1093421018 0 Physical Therapists Physical Therapy Services 00 1093422057 0 MAY CASEY 2022304 9999999 B 10 1093422057 0 4025 N SHERIDAN RD CHICAGO IL 606132010 20 1093422057 0 Nurse Practitioners Healthy Kids Services 20 1093422057 0 Nurse Practitioners Nurse Practitioners Services 20 1093422057 0 Nurse Practitioners Physician Services 00 1093423667 0 GUMMADI ANKITA 2023038 9999999 B 10 1093423667 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112386 20 1093423667 0 Dentists Dental Services 20 1093423667 0 Dentists Physician Services 00 1093423832 0 TITE KATHRYN 2023130 9999999 B 10 1093423832 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1093423832 0 Nurse Practitioners Fluoride varnish 20 1093423832 0 Nurse Practitioners Healthy Kids Services 20 1093423832 0 Nurse Practitioners Nurse Practitioners Services 20 1093423832 0 Nurse Practitioners Physician Services 00 1093424095 0 TRIVELINE SARAH 2023013 9999999 B 10 1093424095 0 29373 NETWORK PL CHICAGO IL 606733039 20 1093424095 0 Physician Assistant Only Fluoride varnish 20 1093424095 0 Physician Assistant Only Healthy Kids Services 20 1093424095 0 Physician Assistant Only Physician Services 00 1093425423 0 CARREON MARISOL 2022340 9999999 B 10 1093425423 0 3010 GRAND AVE WAUKEGAN IL 600852321 20 1093425423 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1093427718 0 KOMANIECKI PAMELA 2022348 9999999 B 10 1093427718 0 PO BOX 1109 DEKALB IL 601157109 20 1093427718 0 Nurse Practitioners Healthy Kids Services 20 1093427718 0 Nurse Practitioners Nurse Practitioners Services 20 1093427718 0 Nurse Practitioners Physician Services 00 1093428955 0 GOMEZ PATRICIA A 2024100 9999999 B 10 1093428955 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1093428955 0 Clinical Social Worker Social work service 00 1093429300 0 BEALS KAYLEE M 2024191 9999999 B 10 1093429300 0 210 W MCKINLEY AVE STE 1 DECATUR IL 625265858 20 1093429300 0 Nurse Practitioners Fluoride varnish 20 1093429300 0 Nurse Practitioners Healthy Kids Services 20 1093429300 0 Nurse Practitioners Nurse Practitioners Services 20 1093429300 0 Nurse Practitioners Physician Services 00 1093430027 0 ZEMANN KATHERINE M 2022343 9999999 B 10 1093430027 0 5777 DEPT CAROL STREAM IL 601220021 20 1093430027 0 Nurse Practitioners Healthy Kids Services 20 1093430027 0 Nurse Practitioners Nurse Practitioners Services 20 1093430027 0 Nurse Practitioners Physician Services 00 1093430365 0 MOLA JENNIFER E 2022313 9999999 B 10 1093430365 0 PO BOX 734352 CHICAGO IL 606734352 20 1093430365 0 Nurse Practitioners Healthy Kids Services 20 1093430365 0 Nurse Practitioners Nurse Practitioners Services 20 1093430365 0 Nurse Practitioners Physician Services 00 1093431173 0 UDONKANG IMAOBONG P 2022313 9999999 B 10 1093431173 0 35318 EAGLE WAY CHICAGO IL 606781353 20 1093431173 0 Nurse Practitioners Healthy Kids Services 20 1093431173 0 Nurse Practitioners Nurse Practitioners Services 20 1093431173 0 Nurse Practitioners Physician Services 00 1093433120 0 GREENE BRITTANY D 2022266 9999999 B 10 1093433120 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1093433120 0 Physicians Anesthesia Services 20 1093433120 0 Physicians Healthy Kids Services 20 1093433120 0 Physicians Optical Supplies 20 1093433120 0 Physicians Physician Services 00 1093434078 0 RUIZ ARIANA 2022238 9999999 B 10 1093434078 0 10150 DEE RD DES PLAINES IL 600161512 20 1093434078 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1093434185 0 WINSTON BARRETT 2022236 9999999 H 10 1093434185 0 10150 DEE RD DES PLAINES IL 600161512 20 1093434185 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 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Physicians Anesthesia Services 20 1093437105 0 Physicians Fluoride varnish 20 1093437105 0 Physicians Healthy Kids Services 20 1093437105 0 Physicians Optical Supplies 20 1093437105 0 Physicians Physician Services 00 1093437964 0 TZVI MIRETZKY KEVIN 2025037 9999999 B 10 1093437964 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1093437964 0 Clinical Social Worker Social work service 00 1093438772 0 LIU ISABELLA E 2022350 9999999 B 10 1093438772 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1093438772 0 Physician Assistant Only Fluoride varnish 20 1093438772 0 Physician Assistant Only Healthy Kids Services 20 1093438772 0 Physician Assistant Only Physician Services 00 1093439622 0 BERRY-GBEKOU VICTORINE 2024271 9999999 B 10 1093439622 0 100 CROSSING BLVD STE 300 FRAMINGHAM MA 017025555 20 1093439622 0 Nurse Practitioners Healthy Kids Services 20 1093439622 0 Nurse Practitioners Nurse Practitioners Services 20 1093439622 0 Nurse Practitioners Physician Services 00 1093440406 0 SENESE KATHERINE A 2023340 9999999 B 10 1093440406 0 29373 NETWORK PL CHICAGO IL 606733039 20 1093440406 0 Physician Assistant Only Fluoride varnish 20 1093440406 0 Physician Assistant Only Healthy Kids Services 20 1093440406 0 Physician Assistant Only Physician Services 00 1093441255 0 CARBAJAL CANDY 2022220 9999999 B 10 1093441255 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1093441255 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1093441297 0 DUY MARIBEL 2023143 9999999 B 10 1093441297 0 13 FAIRLANE DR JOLIET IL 604356483 20 1093441297 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1093442527 0 BATES ANDRIA 2023003 9999999 B 10 1093442527 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1093442527 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1093442626 0 VILLALOBOS ISABEL F 2022251 9999999 H 10 1093442626 0 721 N LA SALLE DR CHICAGO IL 606543503 20 1093442626 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1093442642 0 PAGAN GLORIA 2022237 9999999 B 10 1093442642 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1093442642 0 Speech Therapists Medical Supplies 20 1093442642 0 Speech Therapists Medical equipment/prosthetic devices 20 1093442642 0 Speech Therapists Speech Therapy/Pathology Services 00 1093443251 0 NOVELLY CARLY 2024298 9999999 B 10 1093443251 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1093443251 0 Speech Therapists Medical Supplies 20 1093443251 0 Speech Therapists Medical equipment/prosthetic devices 20 1093443251 0 Speech Therapists Speech Therapy/Pathology Services 00 1093443541 0 ZOLNIK OLIVIA 2024045 9999999 B 10 1093443541 0 28594 NETWORK PL CHICAGO IL 606731285 20 1093443541 0 Optometrists Optical Supplies 20 1093443541 0 Optometrists Optometric Services 20 1093443541 0 Optometrists Physician Services 00 1093444259 0 CASHEL RUSTIN W 2022239 9999999 B 10 1093444259 0 124 SW ADAMS ST PEORIA IL 616021308 20 1093444259 0 Physicians Anesthesia Services 20 1093444259 0 Physicians Healthy Kids Services 20 1093444259 0 Physicians Optical Supplies 20 1093444259 0 Physicians Physician Services 00 1093444267 0 STURGIS MORGAN R 2022207 9999999 B 10 1093444267 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1093444267 0 Physicians Anesthesia Services 20 1093444267 0 Physicians Healthy Kids Services 20 1093444267 0 Physicians Optical Supplies 20 1093444267 0 Physicians Physician Services 00 1093444903 0 BREJ MAGDALENE 2022188 9999999 B 10 1093444903 0 2211 N ELSTON AVE STE 301 CHICAGO IL 606149278 20 1093444903 0 Physicians Anesthesia Services 20 1093444903 0 Physicians Fluoride varnish 20 1093444903 0 Physicians Healthy Kids Services 20 1093444903 0 Physicians Optical Supplies 20 1093444903 0 Physicians Physician Services 00 1093445249 0 TIPPY SAMANTHA J 2024282 9999999 B 10 1093445249 0 210 N HAMMES AVE STE 205 SUITE 205 JOLIET IL 604358139 20 1093445249 0 Psychologist Psychologist service 00 1093445645 0 HALEEM HEBA 2023177 9999999 B 10 1093445645 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1093445645 0 Physicians Anesthesia Services 20 1093445645 0 Physicians Healthy Kids Services 20 1093445645 0 Physicians Optical Supplies 20 1093445645 0 Physicians Physician Services 20 1093445645 0 Physicians Physicians Psychiatric Services 00 1093445694 0 BAE JUNU 2023340 9999999 B 10 1093445694 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1093445694 0 Physicians Anesthesia Services 20 1093445694 0 Physicians Fluoride varnish 20 1093445694 0 Physicians Healthy Kids Services 20 1093445694 0 Physicians Optical Supplies 20 1093445694 0 Physicians Physician Services 00 1093446239 0 BIRKEY JESSICA 2022243 9999999 B 10 1093446239 0 101 E MILLER RD STERLING IL 610811252 20 1093446239 0 Audiologists Audiology Services 20 1093446239 0 Audiologists Medical Supplies 20 1093446239 0 Audiologists Medical equipment/prosthetic devices 00 1093446668 0 KARSON LINDSAY 2022187 9999999 B 10 1093446668 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1093446668 0 Physicians Anesthesia Services 20 1093446668 0 Physicians Fluoride varnish 20 1093446668 0 Physicians Healthy Kids Services 20 1093446668 0 Physicians Optical Supplies 20 1093446668 0 Physicians Physician Services 00 1093448417 0 VILLANUEVA LORENA 2022236 9999999 B 10 1093448417 0 1642 E BARBERRY LN MOUNT PROSPECT IL 600561512 20 1093448417 0 Speech Therapists Medical Supplies 20 1093448417 0 Speech Therapists Medical equipment/prosthetic devices 20 1093448417 0 Speech Therapists Speech Therapy/Pathology Services 00 1093448524 0 PATTERSON JOANNE J 2022205 9999999 H 10 1093448524 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1093448524 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1093448839 0 SHANLE KAITLYN 2024032 9999999 B 10 1093448839 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1093448839 0 Physician Assistant Only Fluoride varnish 20 1093448839 0 Physician Assistant Only Healthy Kids Services 20 1093448839 0 Physician Assistant Only Physician Services 00 1093449126 0 COMER ROMAN 2023254 9999999 B 10 1093449126 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1093449126 0 Nurse Practitioners Anesthesia Services 20 1093449126 0 Nurse Practitioners Nurse Practitioners Services 20 1093449126 0 Nurse Practitioners Physician Services 00 1093449845 0 PANERU RENU 2024198 9999999 B 10 1093449845 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1093449845 0 Physicians Anesthesia Services 20 1093449845 0 Physicians Healthy Kids Services 20 1093449845 0 Physicians Optical Supplies 20 1093449845 0 Physicians Physician Services 00 1093449894 0 ANYANWU CHIBUZOR 2022297 9999999 B 10 1093449894 0 8311 ROOSEVELT RD FOREST PARK IL 601302529 20 1093449894 0 Nurse Practitioners Healthy Kids Services 20 1093449894 0 Nurse Practitioners Nurse Practitioners Services 20 1093449894 0 Nurse Practitioners Physician Services 00 1093450272 0 RAJAGOPAL GEETHANJALI 2022177 9999999 B 10 1093450272 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1093450272 0 Physicians Anesthesia Services 20 1093450272 0 Physicians Fluoride varnish 20 1093450272 0 Physicians Healthy Kids Services 20 1093450272 0 Physicians Optical Supplies 20 1093450272 0 Physicians Physician Services 00 1093450728 0 RENFROE REBECCA E 2022314 9999999 B 10 1093450728 0 PO BOX 3988 CARBONDALE IL 629023988 20 1093450728 0 Nurse Practitioners Healthy Kids Services 20 1093450728 0 Nurse Practitioners Nurse Practitioners Services 20 1093450728 0 Nurse Practitioners Physician Services 00 1093451064 0 LIU CHRISTINA 2022213 9999999 B 10 1093451064 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1093451064 0 Physicians Anesthesia Services 20 1093451064 0 Physicians Fluoride varnish 20 1093451064 0 Physicians Healthy Kids Services 20 1093451064 0 Physicians Optical Supplies 20 1093451064 0 Physicians Physician Services 00 1093451197 0 ALKHAWAGA DALIA E 2022200 9999999 B 10 1093451197 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1093451197 0 Physicians Anesthesia Services 20 1093451197 0 Physicians Fluoride varnish 20 1093451197 0 Physicians Healthy Kids Services 20 1093451197 0 Physicians Optical Supplies 20 1093451197 0 Physicians Physician Services 00 1093451338 0 BREWER MELISSA K 2023300 9999999 B 10 1093451338 0 1370 MULHOLLAND ST NAUVOO IL 623541010 20 1093451338 0 Nurse Practitioners Fluoride varnish 20 1093451338 0 Nurse Practitioners Healthy Kids Services 20 1093451338 0 Nurse Practitioners Nurse Practitioners Services 20 1093451338 0 Nurse Practitioners Physician Services 00 1093451452 0 BIGELOW EMMA 2022141 9999999 H 10 1093451452 0 3010 GRAND AVE WAUKEGAN IL 60085 20 1093451452 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1093452112 0 PHAM ANTHONY 2022182 9999999 B 10 1093452112 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1093452112 0 Physicians Anesthesia Services 20 1093452112 0 Physicians Fluoride varnish 20 1093452112 0 Physicians Healthy Kids Services 20 1093452112 0 Physicians Optical Supplies 20 1093452112 0 Physicians Physician Services 00 1093453029 0 MATOS SOPHIA 2022180 9999999 B 10 1093453029 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1093453029 0 Physicians Anesthesia Services 20 1093453029 0 Physicians Healthy Kids Services 20 1093453029 0 Physicians Optical Supplies 20 1093453029 0 Physicians Physician Services 00 1093453490 0 GORDON DARREN M 2022179 9999999 B 10 1093453490 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1093453490 0 Physicians Anesthesia Services 20 1093453490 0 Physicians Healthy Kids Services 20 1093453490 0 Physicians Optical Supplies 20 1093453490 0 Physicians Physician Services 00 1093455230 0 LIPPOLD BRANDON 2023198 9999999 B 10 1093455230 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1093455230 0 Physicians Anesthesia Services 20 1093455230 0 Physicians Healthy Kids Services 20 1093455230 0 Physicians Optical Supplies 20 1093455230 0 Physicians Physician Services 00 1093455636 0 JOHNSON CHRISTY 2024033 9999999 B 10 1093455636 0 621 S ILLINOIS AVE STE 103 MASON CITY IA 504015489 20 1093455636 0 Physician Assistant Only Fluoride varnish 20 1093455636 0 Physician Assistant Only Healthy Kids Services 20 1093455636 0 Physician Assistant Only Physician Services 00 1093456568 0 ABUTAHA NOOR A 2022284 9999999 B 10 1093456568 0 PO BOX 7230 WESTCHESTER IL 601547230 20 1093456568 0 Nurse Practitioners Fluoride varnish 20 1093456568 0 Nurse Practitioners Healthy Kids Services 20 1093456568 0 Nurse Practitioners Nurse Practitioners Services 20 1093456568 0 Nurse Practitioners Physician Services 00 1093456717 0 JANSSEN MADINAH 2022182 9999999 B 10 1093456717 0 PO BOX 3039 OAK BROOK IL 605223039 20 1093456717 0 Physicians Anesthesia Services 20 1093456717 0 Physicians Fluoride varnish 20 1093456717 0 Physicians Healthy Kids Services 20 1093456717 0 Physicians Optical Supplies 20 1093456717 0 Physicians Physician Services 00 1093456774 0 HUSTON JORDYN 2022160 9999999 B 10 1093456774 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1093456774 0 Physicians Anesthesia Services 20 1093456774 0 Physicians Fluoride varnish 20 1093456774 0 Physicians Healthy Kids Services 20 1093456774 0 Physicians Optical Supplies 20 1093456774 0 Physicians Physician Services 00 1093456907 0 BORCHARDT NOAH J 2022235 9999999 B 10 1093456907 0 7825 SOLUTION CTR CHICAGO IL 606777007 20 1093456907 0 Physicians Anesthesia Services 20 1093456907 0 Physicians Healthy Kids Services 20 1093456907 0 Physicians Optical Supplies 20 1093456907 0 Physicians Physician Services 20 1093456907 0 Physicians Physicians Psychiatric Services 00 1093457608 0 WETZELL KIRSTIN 2022103 9999999 H 10 1093457608 0 PO BOX 1109 DEKALB IL 601157109 20 1093457608 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1093459299 0 KHOKHAR NASIRUDDIN 1981258 9999999 B 10 1093459299 0 1404 EASTLAND DR STE 103 BLOOMINGTON IL 617017904 20 1093459299 0 Physicians Anesthesia Services 20 1093459299 0 Physicians Fluoride varnish 20 1093459299 0 Physicians Healthy Kids Services 20 1093459299 0 Physicians Optical Supplies 20 1093459299 0 Physicians Physician Services 00 1093459471 0 PATEL KOMAL 2022178 9999999 B 10 1093459471 0 2601 NAVISTAR DR LISLE IL 605323661 20 1093459471 0 Physicians Anesthesia Services 20 1093459471 0 Physicians Fluoride varnish 20 1093459471 0 Physicians Healthy Kids Services 20 1093459471 0 Physicians Optical Supplies 20 1093459471 0 Physicians Physician Services 00 1093459695 0 FIORDA DIAZ JUAN 2024226 9999999 B 10 1093459695 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1093459695 0 Physicians Anesthesia Services 20 1093459695 0 Physicians Healthy Kids Services 20 1093459695 0 Physicians Optical Supplies 20 1093459695 0 Physicians Physician Services 00 1093460818 0 STRICKLER ANDREA C 2022147 9999999 B 10 1093460818 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1093460818 0 Other behavior health professional LCPC/LMFT services 00 1093462251 0 MCDONNELL KENNEDY 2023263 9999999 B 10 1093462251 0 1900 W POLK ST STE 220C CHICAGO IL 60612 20 1093462251 0 Physician Assistant Only Fluoride varnish 20 1093462251 0 Physician Assistant Only Healthy Kids Services 20 1093462251 0 Physician Assistant Only Physician Services 00 1093463077 0 SALEEM ARSLAN 2022278 9999999 B 10 1093463077 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1093463077 0 Physician Assistant Only Fluoride varnish 20 1093463077 0 Physician Assistant Only Healthy Kids Services 20 1093463077 0 Physician Assistant Only Physician Services 00 1093463531 0 WUSTERBARTH EMILY S 2023212 9999999 B 10 1093463531 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1093463531 0 Physicians Anesthesia Services 20 1093463531 0 Physicians Healthy Kids Services 20 1093463531 0 Physicians Optical Supplies 20 1093463531 0 Physicians Physician Services 00 1093464125 0 MASKALUNAS CAITLYN 2023209 9999999 B 10 1093464125 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1093464125 0 Speech Therapists Medical Supplies 20 1093464125 0 Speech Therapists Medical equipment/prosthetic devices 20 1093464125 0 Speech Therapists Speech Therapy/Pathology Services 00 1093464232 0 RILEY MARISSA 2022339 9999999 B 10 1093464232 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1093464232 0 Physicians Anesthesia Services 20 1093464232 0 Physicians Fluoride varnish 20 1093464232 0 Physicians Healthy Kids Services 20 1093464232 0 Physicians Optical Supplies 20 1093464232 0 Physicians Physician Services 00 1093464349 0 GOODMAN ERIKA 2022198 9999999 B 10 1093464349 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1093464349 0 Physicians Anesthesia Services 20 1093464349 0 Physicians Fluoride varnish 20 1093464349 0 Physicians Healthy Kids Services 20 1093464349 0 Physicians Optical Supplies 20 1093464349 0 Physicians Physician Services 00 1093464448 0 REDFIELD KRISTINE 2022125 9999999 B 10 1093464448 0 611 W PARK ST URBANA IL 618012529 20 1093464448 0 Nurse Practitioners Healthy Kids Services 20 1093464448 0 Nurse Practitioners Nurse Practitioners Services 20 1093464448 0 Nurse Practitioners Physician Services 00 1093464620 0 MARRACHE MOHAMAD K 2022160 9999999 B 10 1093464620 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1093464620 0 Physicians Anesthesia Services 20 1093464620 0 Physicians Fluoride varnish 20 1093464620 0 Physicians Healthy Kids Services 20 1093464620 0 Physicians Optical Supplies 20 1093464620 0 Physicians Physician Services 00 1093464729 0 SYRETT MICHAEL K 2022199 9999999 B 10 1093464729 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1093464729 0 Physicians Anesthesia Services 20 1093464729 0 Physicians Fluoride varnish 20 1093464729 0 Physicians Healthy Kids Services 20 1093464729 0 Physicians Optical Supplies 20 1093464729 0 Physicians Physician Services 00 1093464992 0 MACARI RACHEL R 2022196 9999999 B 10 1093464992 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1093464992 0 Physicians Anesthesia Services 20 1093464992 0 Physicians Fluoride varnish 20 1093464992 0 Physicians Healthy Kids Services 20 1093464992 0 Physicians Optical Supplies 20 1093464992 0 Physicians Physician Services 00 1093465239 0 POKALA NIKHILA 2022195 9999999 B 10 1093465239 0 4698 DEPT CAROL STREAM IL 601220021 20 1093465239 0 Physicians Anesthesia Services 20 1093465239 0 Physicians Healthy Kids Services 20 1093465239 0 Physicians Optical Supplies 20 1093465239 0 Physicians Physician Services 00 1093465833 0 RODRIGUEZ GONZALEZ DANIELA 2022187 9999999 B 10 1093465833 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1093465833 0 Physicians Anesthesia Services 20 1093465833 0 Physicians Fluoride varnish 20 1093465833 0 Physicians Healthy Kids Services 20 1093465833 0 Physicians Optical Supplies 20 1093465833 0 Physicians Physician Services 00 1093466922 0 BREWTON EVELYN A 2022288 9999999 B 10 1093466922 0 15 SPINNING WHEEL RD STE 30 HINSDALE IL 605217651 20 1093466922 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1093467219 0 LYON EMILY 2022101 9999999 B 10 1093467219 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1093467219 0 Physician Assistant Only Fluoride varnish 20 1093467219 0 Physician Assistant Only Healthy Kids Services 20 1093467219 0 Physician Assistant Only Physician Services 00 1093468282 0 CAMERON SAMANTHA J 2023136 9999999 B 10 1093468282 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1093468282 0 Occupational Therapists Medical Supplies 20 1093468282 0 Occupational Therapists Medical equipment/prosthetic devices 20 1093468282 0 Occupational Therapists Occupational Therapy Services 00 1093469173 0 GARCIA GABRIEL 2023003 9999999 B 10 1093469173 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1093469173 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1093469249 0 TATTEGRAIN DIANE 2023079 9999999 B 10 1093469249 0 1400 W GREENLEAF AVE CHICAGO IL 606262805 20 1093469249 0 Clinical Social Worker Social work service 00 1093471245 0 SEARLES VALERIE 2021321 9999999 B 10 1093471245 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1093471245 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1093472110 0 GARZA STEPHANIE JANE 2022243 9999999 B 10 1093472110 0 4663 W 95TH ST OAK LAWN IL 604532540 20 1093472110 0 Optometrists Optical Supplies 20 1093472110 0 Optometrists Optometric Services 20 1093472110 0 Optometrists Physician Services 00 1093473506 0 GORDON ZANU A 2022021 9999999 B 10 1093473506 0 42 W MADISON ST FL 2 CHICAGO IL 606024309 20 1093473506 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1093473548 0 MADRIZ MARIANA 2022052 9999999 B 10 1093473548 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1093473548 0 Nurse Practitioners Fluoride varnish 20 1093473548 0 Nurse Practitioners Healthy Kids Services 20 1093473548 0 Nurse Practitioners Nurse Practitioners Services 20 1093473548 0 Nurse Practitioners Physician Services 00 1093474942 0 ROGERS KRISTIN 2025027 9999999 B 10 1093474942 0 3545 W 95TH ST EVERGREEN PARK IL 608052135 20 1093474942 0 Nurse Practitioners Healthy Kids Services 20 1093474942 0 Nurse Practitioners Nurse Practitioners Services 20 1093474942 0 Nurse Practitioners Physician Services 00 1093475428 0 MERCER NATALIE 2023340 9999999 B 10 1093475428 0 684 S BARRINGTON RD STE 112 STREAMWOOD IL 601071841 20 1093475428 0 Other behavior health professional LCPC/LMFT services 00 1093477242 0 PLUMMER GABRIELLE M 2022130 9999999 B 10 1093477242 0 1101 W LIBERTY ST ADMINISTRATION FARMINGTON MO 636401921 20 1093477242 0 Nurse Practitioners Fluoride varnish 20 1093477242 0 Nurse Practitioners Healthy Kids Services 20 1093477242 0 Nurse Practitioners Nurse Practitioners Services 20 1093477242 0 Nurse Practitioners Physician Services 00 1093478711 0 MARTINEZ OSCAR C 2021305 9999999 H 10 1093478711 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1093478711 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1093481798 0 RAMEY EDNESHA 2022259 9999999 B 10 1093481798 0 7300 W COLLEGE DR PALOS HEIGHTS IL 604631152 20 1093481798 0 Nurse Practitioners Fluoride varnish 20 1093481798 0 Nurse Practitioners Healthy Kids Services 20 1093481798 0 Nurse Practitioners Nurse Practitioners Services 20 1093481798 0 Nurse Practitioners Physician Services 00 1093483760 0 BELL CAITLIN 2023341 9999999 B 10 1093483760 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1093483760 0 Physical Therapists Medical Supplies 20 1093483760 0 Physical Therapists Medical equipment/prosthetic devices 20 1093483760 0 Physical Therapists Physical Therapy Services 00 1093484461 0 ARMSTRONG ERICA 2022271 9999999 B 10 1093484461 0 100 E LEFEVRE RD STERLING IL 610811278 20 1093484461 0 Speech Therapists Medical Supplies 20 1093484461 0 Speech Therapists Medical equipment/prosthetic devices 20 1093484461 0 Speech Therapists Speech Therapy/Pathology Services 00 1093485948 0 WILLIAMS ERIN D 2021286 9999999 B 10 1093485948 0 PO BOX 772 MC2295 WOONSOCKET RI 028950784 20 1093485948 0 Nurse Practitioners Fluoride varnish 20 1093485948 0 Nurse Practitioners Healthy Kids Services 20 1093485948 0 Nurse Practitioners Nurse Practitioners Services 20 1093485948 0 Nurse Practitioners Physician Services 00 1093486011 0 JONES JARED 2021273 9999999 B 10 1093486011 0 510 LINCOLN DR HERRIN IL 629486334 20 1093486011 0 Physical Therapists Medical Supplies 20 1093486011 0 Physical Therapists Medical equipment/prosthetic devices 20 1093486011 0 Physical Therapists Physical Therapy Services 00 1093486615 0 SCHLEDER KELLI 2021298 9999999 B 10 1093486615 0 PO BOX 781076 DETROIT MI 482781076 20 1093486615 0 Nurse Practitioners Fluoride varnish 20 1093486615 0 Nurse Practitioners Healthy Kids Services 20 1093486615 0 Nurse Practitioners Nurse Practitioners Services 20 1093486615 0 Nurse Practitioners Physician Services 00 1093487951 0 GOLDSMITH KATHLEEN 2022207 9999999 B 10 1093487951 0 370 LARRY POWER RD STE 1 BOURBONNAIS IL 609145194 20 1093487951 0 Nurse Practitioners Fluoride varnish 20 1093487951 0 Nurse Practitioners Healthy Kids Services 20 1093487951 0 Nurse Practitioners Nurse Practitioners Services 20 1093487951 0 Nurse Practitioners Physician Services 00 1093489353 0 KUSMA MOLLY 2021286 9999999 B 10 1093489353 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1093489353 0 Nurse Practitioners Fluoride varnish 20 1093489353 0 Nurse Practitioners Healthy Kids Services 20 1093489353 0 Nurse Practitioners Nurse Practitioners Services 20 1093489353 0 Nurse Practitioners Physician Services 00 1093489841 0 DAMM DANIEL 2021331 9999999 B 10 1093489841 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1093489841 0 Physician Assistant Only Fluoride varnish 20 1093489841 0 Physician Assistant Only Healthy Kids Services 20 1093489841 0 Physician Assistant Only Physician Services 00 1093490625 0 SPROW HOLLY 2023200 9999999 B 10 1093490625 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1093490625 0 Physicians Anesthesia Services 20 1093490625 0 Physicians Healthy Kids Services 20 1093490625 0 Physicians Optical Supplies 20 1093490625 0 Physicians Physician Services 00 1093490682 0 HINDERA OLIVIA E 2023195 9999999 B 10 1093490682 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1093490682 0 Physicians Anesthesia Services 20 1093490682 0 Physicians Healthy Kids Services 20 1093490682 0 Physicians Optical Supplies 20 1093490682 0 Physicians Physician Services 20 1093490682 0 Physicians Physicians Psychiatric Services 00 1093491029 0 ANDERSON SIERRA K 2023186 9999999 B 10 1093491029 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1093491029 0 Physicians Anesthesia Services 20 1093491029 0 Physicians Fluoride varnish 20 1093491029 0 Physicians Healthy Kids Services 20 1093491029 0 Physicians Optical Supplies 20 1093491029 0 Physicians Physician Services 00 1093491227 0 TORRES SHIRLEY C 2024245 9999999 B 10 1093491227 0 9133 S STONY ISLAND AVE STE 1 CHICAGO IL 606173512 20 1093491227 0 Nurse Practitioners Fluoride varnish 20 1093491227 0 Nurse Practitioners Healthy Kids Services 20 1093491227 0 Nurse Practitioners Nurse Practitioners Services 20 1093491227 0 Nurse Practitioners Physician Services 00 1093491300 0 KODGULE ROHAN 2023205 9999999 B 10 1093491300 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1093491300 0 Physicians Anesthesia Services 20 1093491300 0 Physicians Healthy Kids Services 20 1093491300 0 Physicians Optical Supplies 20 1093491300 0 Physicians Physician Services 00 1093491383 0 CHIN HOK LEONG 2024200 9999999 B 10 1093491383 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1093491383 0 Physicians Anesthesia Services 20 1093491383 0 Physicians Fluoride varnish 20 1093491383 0 Physicians Healthy Kids Services 20 1093491383 0 Physicians Optical Supplies 20 1093491383 0 Physicians Physician Services 00 1093492456 0 STRUCK MELISSA 2023180 9999999 B 10 1093492456 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1093492456 0 Audiologists Audiology Services 20 1093492456 0 Audiologists Medical Supplies 20 1093492456 0 Audiologists Medical equipment/prosthetic devices 00 1093493108 0 DUONG JENNIFER 2023275 9999999 B 10 1093493108 0 1560 CARLEMONT DR CRYSTAL LAKE IL 600142740 20 1093493108 0 Dentists Dental Services 20 1093493108 0 Dentists Physician Services 00 1093493371 0 DOAN THAO T 2023220 9999999 B 10 1093493371 0 PO BOX 778912 CHICAGO IL 606778912 20 1093493371 0 Nurse Practitioners Fluoride varnish 20 1093493371 0 Nurse Practitioners Healthy Kids Services 20 1093493371 0 Nurse Practitioners Nurse Practitioners Services 20 1093493371 0 Nurse Practitioners Physician Services 00 1093495012 0 HOSKINS KENNIESHA S 2023250 9999999 B 10 1093495012 0 2041 GOOSE LAKE RD SAUGET IL 622062822 20 1093495012 0 Nurse Practitioners Fluoride varnish 20 1093495012 0 Nurse Practitioners Healthy Kids Services 20 1093495012 0 Nurse Practitioners Nurse Practitioners Services 20 1093495012 0 Nurse Practitioners Physician Services 00 1093495293 0 PANNO REBECCA 2024086 9999999 B 10 1093495293 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1093495293 0 Speech Therapists Medical Supplies 20 1093495293 0 Speech Therapists Medical equipment/prosthetic devices 20 1093495293 0 Speech Therapists Speech Therapy/Pathology Services 00 1093495947 0 ALVI MUHAMMAD SOHAIB 2023222 9999999 B 10 1093495947 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1093495947 0 Physicians Anesthesia Services 20 1093495947 0 Physicians Fluoride varnish 20 1093495947 0 Physicians Healthy Kids Services 20 1093495947 0 Physicians Optical Supplies 20 1093495947 0 Physicians Physician Services 00 1093499311 0 ANAYA DAHUD LIZDA L 2023297 9999999 B 10 1093499311 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1093499311 0 Physicians Anesthesia Services 20 1093499311 0 Physicians Healthy Kids Services 20 1093499311 0 Physicians Optical Supplies 20 1093499311 0 Physicians Physician Services 00 1093499626 0 LAI CECELIA 2023200 9999999 B 10 1093499626 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1093499626 0 Physicians Anesthesia Services 20 1093499626 0 Physicians Fluoride varnish 20 1093499626 0 Physicians Healthy Kids Services 20 1093499626 0 Physicians Optical Supplies 20 1093499626 0 Physicians Physician Services 00 1093499790 0 PAPAYANIS PHILIP N 2023202 9999999 B 10 1093499790 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1093499790 0 Physicians Anesthesia Services 20 1093499790 0 Physicians Fluoride varnish 20 1093499790 0 Physicians Healthy Kids Services 20 1093499790 0 Physicians Optical Supplies 20 1093499790 0 Physicians Physician Services 00 1093511883 0 CURFS LISA 2025058 9999999 B 10 1093511883 0 1039 BROOK FOREST AVE SHOREWOOD IL 604048849 20 1093511883 0 Physician Assistant Only Fluoride varnish 20 1093511883 0 Physician Assistant Only Healthy Kids Services 20 1093511883 0 Physician Assistant Only Physician Services 00 1093521007 0 ALDAMA BRIANA A 2024344 9999999 B 10 1093521007 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1093521007 0 Occupational Therapists Medical Supplies 20 1093521007 0 Occupational Therapists Medical equipment/prosthetic devices 20 1093521007 0 Occupational Therapists Occupational Therapy Services 00 1093521726 0 LEMBRIKOV ILYA 2025013 9999999 B 10 1093521726 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1093521726 0 Physicians Anesthesia Services 20 1093521726 0 Physicians Healthy Kids Services 20 1093521726 0 Physicians Optical Supplies 20 1093521726 0 Physicians Physician Services 00 1093525198 0 HENNESSY MAEVE 2025010 9999999 B 10 1093525198 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1093525198 0 Physicians Anesthesia Services 20 1093525198 0 Physicians Fluoride varnish 20 1093525198 0 Physicians Healthy Kids Services 20 1093525198 0 Physicians Optical Supplies 20 1093525198 0 Physicians Physician Services 00 1093525479 0 COLLINS KAYLEE 2025008 9999999 B 10 1093525479 0 510 W ELM ST GILLESPIE IL 620331167 20 1093525479 0 Speech Therapists Medical Supplies 20 1093525479 0 Speech Therapists Medical equipment/prosthetic devices 20 1093525479 0 Speech Therapists Speech Therapy/Pathology Services 00 1093526360 0 KORNEGAY SHAWANDA 2025016 9999999 B 10 1093526360 0 1414 MAIN ST MELROSE PARK IL 601603902 20 1093526360 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1093529380 0 NELSON MICHELLE J 2025051 9999999 B 10 1093529380 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1093529380 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1093530362 0 MEDINA MADISON C 2025036 9999999 B 10 1093530362 0 5777 DEPT CAROL STREAM IL 601228942 20 1093530362 0 Physician Assistant Only Fluoride varnish 20 1093530362 0 Physician Assistant Only Healthy Kids Services 20 1093530362 0 Physician Assistant Only Physician Services 00 1093535429 0 LI CAILING 2025006 9999999 B 10 1093535429 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1093535429 0 Nurse Practitioners Fluoride varnish 20 1093535429 0 Nurse Practitioners Healthy Kids Services 20 1093535429 0 Nurse Practitioners Nurse Practitioners Services 20 1093535429 0 Nurse Practitioners Physician Services 00 1093537250 0 JIANG JINGYUAN 2025006 9999999 B 10 1093537250 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1093537250 0 Nurse 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20 1093756017 0 Physicians Anesthesia Services 20 1093756017 0 Physicians Fluoride varnish 20 1093756017 0 Physicians Healthy Kids Services 20 1093756017 0 Physicians Optical Supplies 20 1093756017 0 Physicians Physician Services 00 1093759185 0 KRUEGER EDITHA 2021110 9999999 B 10 1093759185 0 124 SW ADAMS ST PEORIA IL 616021320 20 1093759185 0 Physicians Anesthesia Services 20 1093759185 0 Physicians Healthy Kids Services 20 1093759185 0 Physicians Optical Supplies 20 1093759185 0 Physicians Physician Services 00 1093759417 0 YANG JOHN 2023324 9999999 B 10 1093759417 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1093759417 0 Physicians Anesthesia Services 20 1093759417 0 Physicians Fluoride varnish 20 1093759417 0 Physicians Healthy Kids Services 20 1093759417 0 Physicians Optical Supplies 20 1093759417 0 Physicians Physician Services 00 1093759490 0 LEE JENNY K 1999193 9999999 B 10 1093759490 0 5777 DEPT CAROL STREAM IL 601220021 20 1093759490 0 Physicians Anesthesia Services 20 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1093763740 0 SCHNEIDER DEREK T 2022143 9999999 B 10 1093763740 0 6024 RIDGE AVE STE 116-356 PHILADELPHIA PA 191281601 20 1093763740 0 Physicians Anesthesia Services 20 1093763740 0 Physicians Healthy Kids Services 20 1093763740 0 Physicians Optical Supplies 20 1093763740 0 Physicians Physician Services 00 1093763799 0 MANUEL-RUBIO MARIA 2002182 9999999 B 10 1093763799 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1093763799 0 Nurse Practitioners Fluoride varnish 20 1093763799 0 Nurse Practitioners Healthy Kids Services 20 1093763799 0 Nurse Practitioners Nurse Practitioners Services 20 1093763799 0 Nurse Practitioners Physician Services 00 1093764193 0 HEYDARPOUR KAMRAN 1997204 9999999 B 10 1093764193 0 2875 W 19TH ST CHICAGO IL 606233501 20 1093764193 0 Physicians Anesthesia Services 20 1093764193 0 Physicians Fluoride varnish 20 1093764193 0 Physicians Healthy Kids Services 20 1093764193 0 Physicians Optical Supplies 20 1093764193 0 Physicians Physician Services 00 1093764417 0 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TN 370245009 20 1093770257 0 Physicians Anesthesia Services 20 1093770257 0 Physicians Fluoride varnish 20 1093770257 0 Physicians Healthy Kids Services 20 1093770257 0 Physicians Optical Supplies 20 1093770257 0 Physicians Physician Services 00 1093770422 0 BARTELS CHRISTIE 2007182 9999999 B 10 1093770422 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1093770422 0 Physicians Anesthesia Services 20 1093770422 0 Physicians Fluoride varnish 20 1093770422 0 Physicians Healthy Kids Services 20 1093770422 0 Physicians Optical Supplies 20 1093770422 0 Physicians Physician Services 00 1093770943 0 HAYES JOHN 1991182 9999999 B 10 1093770943 0 5777 DEPT CAROL STREAM IL 601220021 20 1093770943 0 Physicians Anesthesia Services 20 1093770943 0 Physicians Healthy Kids Services 20 1093770943 0 Physicians Optical Supplies 20 1093770943 0 Physicians Physician Services 00 1093771099 0 SORIANO ALEJANDRO L 2021364 9999999 B 10 1093771099 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1093771099 0 Physicians 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1093772311 0 Physicians Fluoride varnish 20 1093772311 0 Physicians Healthy Kids Services 20 1093772311 0 Physicians Optical Supplies 20 1093772311 0 Physicians Physician Services 00 1093772378 0 WEAVER DENISE 1992183 9999999 B 10 1093772378 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1093772378 0 Physicians Anesthesia Services 20 1093772378 0 Physicians Fluoride varnish 20 1093772378 0 Physicians Healthy Kids Services 20 1093772378 0 Physicians Optical Supplies 20 1093772378 0 Physicians Physician Services 00 1093772543 0 SEMIN MICHELE D 2017118 9999999 B 10 1093772543 0 901 MACARTHUR BLVD MUNSTER IN 463212901 20 1093772543 0 Physicians Anesthesia Services 20 1093772543 0 Physicians Healthy Kids Services 20 1093772543 0 Physicians Optical Supplies 20 1093772543 0 Physicians Physician Services 00 1093772923 0 ISMAIL MOHAMMAD K 2005274 9999999 B 10 1093772923 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1093772923 0 Physicians Anesthesia Services 20 1093772923 0 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1093774705 0 Physician Assistant Only Physician Services 00 1093776460 0 SHA BEVERLY E 1989177 9999999 B 10 1093776460 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1093776460 0 Physicians Anesthesia Services 20 1093776460 0 Physicians Healthy Kids Services 20 1093776460 0 Physicians Optical Supplies 20 1093776460 0 Physicians Physician Services 00 1093776585 0 MCCONAHAY THOMAS E 2017227 9999999 B 10 1093776585 0 3200 E CAMELBACK RD STE 250 PHOENIX AZ 850182327 20 1093776585 0 Physicians Anesthesia Services 20 1093776585 0 Physicians Fluoride varnish 20 1093776585 0 Physicians Healthy Kids Services 20 1093776585 0 Physicians Optical Supplies 20 1093776585 0 Physicians Physician Services 00 1093776627 0 GUSTIS MELISSA 2001277 9999999 B 10 1093776627 0 2800 CARPENTER CT WOODRIDGE IL 605171636 20 1093776627 0 Physical Therapists Medical Supplies 20 1093776627 0 Physical Therapists Medical equipment/prosthetic devices 20 1093776627 0 Physical Therapists Physical Therapy Services 00 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Services 00 1093777500 0 WISNOUSKY BRADFORD C 2000192 9999999 B 10 1093777500 0 PO BOX 909 WASHINGTON IA 523530909 20 1093777500 0 Physicians Anesthesia Services 20 1093777500 0 Physicians Healthy Kids Services 20 1093777500 0 Physicians Optical Supplies 20 1093777500 0 Physicians Physician Services 00 1093777518 0 MILLER JOANNE 2010182 9999999 B 10 1093777518 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1093777518 0 Physicians Anesthesia Services 20 1093777518 0 Physicians Healthy Kids Services 20 1093777518 0 Physicians Optical Supplies 20 1093777518 0 Physicians Physician Services 00 1093777880 0 DIDWANIA SURESH 1996214 9999999 B 10 1093777880 0 555 W COURT ST STE 400 KANKAKEE IL 609013675 20 1093777880 0 Physicians Anesthesia Services 20 1093777880 0 Physicians Healthy Kids Services 20 1093777880 0 Physicians Optical Supplies 20 1093777880 0 Physicians Physician Services 00 1093779084 0 CHIOU DAVID 2002130 9999999 B 10 1093779084 0 2534 ELIM AVE ZION IL 600992661 20 1093779084 0 Physicians Anesthesia Services 20 1093779084 0 Physicians Fluoride varnish 20 1093779084 0 Physicians Healthy Kids Services 20 1093779084 0 Physicians Optical Supplies 20 1093779084 0 Physicians Physician Services 00 1093779647 0 CUSICK DAVID A 1997182 9999999 B 10 1093779647 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1093779647 0 Physicians Anesthesia Services 20 1093779647 0 Physicians Fluoride varnish 20 1093779647 0 Physicians Healthy Kids Services 20 1093779647 0 Physicians Optical Supplies 20 1093779647 0 Physicians Physician Services 00 1093779688 0 BONIFAS ERIK 2015308 9999999 B 10 1093779688 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1093779688 0 Physician Assistant Only Fluoride varnish 20 1093779688 0 Physician Assistant Only Healthy Kids Services 20 1093779688 0 Physician Assistant Only Physician Services 00 1093779829 0 HASNAIN MOHSIN 2022332 9999999 B 10 1093779829 0 5121 MARYLAND WAY STE 300 BRENTWOOD TN 370277516 20 1093779829 0 Physicians Anesthesia Services 20 1093779829 0 Physicians Fluoride varnish 20 1093779829 0 Physicians Healthy Kids Services 20 1093779829 0 Physicians Optical Supplies 20 1093779829 0 Physicians Physician Services 00 1093781163 0 MOSS MARK 1997184 9999999 B 10 1093781163 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1093781163 0 Physicians Anesthesia Services 20 1093781163 0 Physicians Fluoride varnish 20 1093781163 0 Physicians Healthy Kids Services 20 1093781163 0 Physicians Optical Supplies 20 1093781163 0 Physicians Physician Services 20 1093781163 0 Physicians Physicians Psychiatric Services 00 1093781585 0 HEAD DIANE E 1999277 9999999 B 10 1093781585 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1093781585 0 Physicians Anesthesia Services 20 1093781585 0 Physicians Healthy Kids Services 20 1093781585 0 Physicians Optical Supplies 20 1093781585 0 Physicians Physician Services 00 1093781817 0 COX ROBERT 2003191 9999999 B 10 1093781817 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1093781817 0 Nurse Practitioners Anesthesia Services 20 1093781817 0 Nurse Practitioners Nurse Practitioners Services 20 1093781817 0 Nurse Practitioners Physician Services 00 1093782096 0 HUTSON CHRISTOPHER L 2024212 9999999 B 10 1093782096 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1093782096 0 Physicians Anesthesia Services 20 1093782096 0 Physicians Healthy Kids Services 20 1093782096 0 Physicians Optical Supplies 20 1093782096 0 Physicians Physician Services 00 1093782146 0 SHAIKH-ABBASI IRAM 2007176 9999999 B 10 1093782146 0 1415 W 47TH ST LA GRANGE IL 605256136 20 1093782146 0 Physicians Anesthesia Services 20 1093782146 0 Physicians Fluoride varnish 20 1093782146 0 Physicians Healthy Kids Services 20 1093782146 0 Physicians Optical Supplies 20 1093782146 0 Physicians Physician Services 00 1093782245 0 ECKENRODE JOHN 2022200 9999999 B 10 1093782245 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1093782245 0 Physicians Anesthesia Services 20 1093782245 0 Physicians Fluoride varnish 20 1093782245 0 Physicians Healthy Kids Services 20 1093782245 0 Physicians Optical Supplies 20 1093782245 0 Physicians Physician Services 00 1093782617 0 MATHEWS- KUKLA PANOREA 2002182 9999999 B 10 1093782617 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1093782617 0 Physicians Anesthesia Services 20 1093782617 0 Physicians Fluoride varnish 20 1093782617 0 Physicians Healthy Kids Services 20 1093782617 0 Physicians Optical Supplies 20 1093782617 0 Physicians Physician Services 00 1093782666 0 GILL MICHAEL 2001182 9999999 B 10 1093782666 0 29373 NETWORK PL CHICAGO IL 606733039 20 1093782666 0 Physicians Anesthesia Services 20 1093782666 0 Physicians Fluoride varnish 20 1093782666 0 Physicians Healthy Kids Services 20 1093782666 0 Physicians Optical Supplies 20 1093782666 0 Physicians Physician Services 00 1093782740 0 MIKESKA MARVIN 2022357 9999999 B 10 1093782740 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1093782740 0 Physicians Anesthesia Services 20 1093782740 0 Physicians Healthy Kids Services 20 1093782740 0 Physicians Optical Supplies 20 1093782740 0 Physicians Physician Services 00 1093782765 0 CHILDERS-OKAS HEATHER 2001182 9999999 B 10 1093782765 0 202 S PARK ST MADISON WI 537151507 20 1093782765 0 Physicians Anesthesia Services 20 1093782765 0 Physicians Fluoride varnish 20 1093782765 0 Physicians Healthy Kids Services 20 1093782765 0 Physicians Optical Supplies 20 1093782765 0 Physicians Physician Services 00 1093782831 0 MCDONNELL JAMES 1990182 9999999 B 10 1093782831 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1093782831 0 Physicians Anesthesia Services 20 1093782831 0 Physicians Healthy Kids Services 20 1093782831 0 Physicians Optical Supplies 20 1093782831 0 Physicians Physician Services 00 1093782849 0 LIN YI E 2006060 9999999 B 10 1093782849 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1093782849 0 Physicians Anesthesia Services 20 1093782849 0 Physicians Healthy Kids Services 20 1093782849 0 Physicians Optical Supplies 20 1093782849 0 Physicians Physician Services 00 1093782898 0 PICA RICHARD 2023004 9999999 B 10 1093782898 0 1000 N ALLEN ST ROBINSON IL 624541114 20 1093782898 0 Physicians Anesthesia Services 20 1093782898 0 Physicians Healthy Kids Services 20 1093782898 0 Physicians Optical Supplies 20 1093782898 0 Physicians Physician Services 00 1093783714 0 YEAGER DAVID 2003182 9999999 B 10 1093783714 0 303 N JACKSON ST MORRISON IL 612703042 20 1093783714 0 Podiatrists Podiatric Services 00 1093783987 0 SADOWSKI ELIZABETH 2001182 9999999 B 10 1093783987 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1093783987 0 Physicians Anesthesia Services 20 1093783987 0 Physicians Healthy Kids Services 20 1093783987 0 Physicians Optical Supplies 20 1093783987 0 Physicians Physician Services 00 1093784001 0 CANTZLER RYAN 2020210 9999999 B 10 1093784001 0 PO BOX 43230 PHOENIX AZ 850803230 20 1093784001 0 Physicians Anesthesia Services 20 1093784001 0 Physicians Healthy Kids Services 20 1093784001 0 Physicians Optical Supplies 20 1093784001 0 Physicians Physician Services 00 1093784241 0 BERNHARDT DAVID T 1992183 9999999 B 10 1093784241 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1093784241 0 Physicians Anesthesia Services 20 1093784241 0 Physicians Fluoride varnish 20 1093784241 0 Physicians Healthy Kids Services 20 1093784241 0 Physicians Optical Supplies 20 1093784241 0 Physicians Physician Services 00 1093784316 0 WENDT GARY 1997182 9999999 B 10 1093784316 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1093784316 0 Physicians Anesthesia Services 20 1093784316 0 Physicians Healthy Kids Services 20 1093784316 0 Physicians Optical Supplies 20 1093784316 0 Physicians Physician Services 00 1093784944 0 DUNSEATH RODNEY A 2018085 9999999 B 10 1093784944 0 250 N SHADELAND AVE STE 200 INDIANAPOLIS IN 462194959 20 1093784944 0 Physicians Anesthesia Services 20 1093784944 0 Physicians Healthy Kids Services 20 1093784944 0 Physicians Optical Supplies 20 1093784944 0 Physicians Physician Services 00 1093785982 0 FOLLWELL JENNIFER R 2005335 9999999 B 10 1093785982 0 6810 STATE ROUTE 162 STE 215 MARYVILLE IL 620628566 20 1093785982 0 Physicians Anesthesia Services 20 1093785982 0 Physicians Fluoride varnish 20 1093785982 0 Physicians Healthy Kids Services 20 1093785982 0 Physicians Optical Supplies 20 1093785982 0 Physicians Physician Services 00 1093786014 0 SECEMSKY SOLOMON I 1981227 9999999 B 10 1093786014 0 8550 W BRYN MAWR AVE STE 800 SUITE 800 CHICAGO IL 606313222 20 1093786014 0 Physicians Anesthesia Services 20 1093786014 0 Physicians Fluoride varnish 20 1093786014 0 Physicians Healthy Kids Services 20 1093786014 0 Physicians Optical Supplies 20 1093786014 0 Physicians Physician Services 00 1093788457 0 KRSTEVSKI LAZO 2010032 9999999 B 10 1093788457 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1093788457 0 Physicians Anesthesia Services 20 1093788457 0 Physicians Healthy Kids Services 20 1093788457 0 Physicians Optical Supplies 20 1093788457 0 Physicians Physician Services 00 1093788762 0 MATLOCK ERIC V A 2005296 9999999 B 10 1093788762 0 901 E 5TH ST WASHINGTON MO 630903127 20 1093788762 0 Physicians Anesthesia Services 20 1093788762 0 Physicians Fluoride varnish 20 1093788762 0 Physicians Healthy Kids Services 20 1093788762 0 Physicians Optical Supplies 20 1093788762 0 Physicians Physician Services 00 1093788804 0 LAW KAROLYN D 2007001 9999999 B 10 1093788804 0 1331 W 75TH ST STE 300 NAPERVILLE IL 605409310 20 1093788804 0 Physicians Anesthesia Services 20 1093788804 0 Physicians Fluoride varnish 20 1093788804 0 Physicians Healthy Kids Services 20 1093788804 0 Physicians Optical Supplies 20 1093788804 0 Physicians Physician Services 00 1093789034 0 MALLICK MEHER S 1995152 9999999 B 10 1093789034 0 PO BOX 34266 BELFAST ME 049150620 20 1093789034 0 Physicians Anesthesia Services 20 1093789034 0 Physicians Fluoride varnish 20 1093789034 0 Physicians Healthy Kids Services 20 1093789034 0 Physicians Optical Supplies 20 1093789034 0 Physicians Physician Services 00 1093789125 0 SISBARRO DANIEL 1997196 9999999 B 10 1093789125 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1093789125 0 Physicians Anesthesia Services 20 1093789125 0 Physicians Fluoride varnish 20 1093789125 0 Physicians Healthy Kids Services 20 1093789125 0 Physicians Optical Supplies 20 1093789125 0 Physicians Physician Services 00 1093790073 0 GAPINSKI CONNIE JOAN 2002182 9999999 B 10 1093790073 0 250 N SHADELAND AVE STE 200 INDIANAPOLIS IN 462194959 20 1093790073 0 Physicians Anesthesia Services 20 1093790073 0 Physicians Healthy Kids Services 20 1093790073 0 Physicians Optical Supplies 20 1093790073 0 Physicians Physician Services 00 1093790289 0 ENTRESS JEFFREY 1986305 9999999 B 10 1093790289 0 225 S EXECUTIVE DR BROOKFIELD WI 530054257 20 1093790289 0 Physicians Anesthesia Services 20 1093790289 0 Physicians Healthy Kids Services 20 1093790289 0 Physicians Optical Supplies 20 1093790289 0 Physicians Physician Services 00 1093790347 0 SCHULTZ SCOTT J 1996024 9999999 B 10 1093790347 0 4151 W ORLEANS ST MCHENRY IL 600503973 20 1093790347 0 Physical Therapists Physical Therapy Services 00 1093790487 0 BAKER BRADLEY K 1990220 9999999 B 10 1093790487 0 11475 OLDE CABIN RD STE 200 SAINT LOUIS MO 631417129 20 1093790487 0 Physicians Anesthesia Services 20 1093790487 0 Physicians Healthy Kids Services 20 1093790487 0 Physicians Optical Supplies 20 1093790487 0 Physicians Physician Services 00 1093790594 0 ROSENBLATT MARK I 2015166 9999999 B 10 1093790594 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1093790594 0 Physicians Anesthesia Services 20 1093790594 0 Physicians Healthy Kids Services 20 1093790594 0 Physicians Optical Supplies 20 1093790594 0 Physicians Physician Services 00 1093791261 0 MCGLOTHLIN-BOGGS CHRISTINA 2022001 9999999 B 10 1093791261 0 PO BOX 43230 PHOENIX AZ 850803230 20 1093791261 0 Nurse Practitioners Fluoride varnish 20 1093791261 0 Nurse Practitioners Healthy Kids Services 20 1093791261 0 Nurse Practitioners Nurse Practitioners Services 20 1093791261 0 Nurse Practitioners Physician Services 00 1093791857 0 YOUNG MARC E 2000361 9999999 B 10 1093791857 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1093791857 0 Physicians Anesthesia Services 20 1093791857 0 Physicians Healthy Kids Services 20 1093791857 0 Physicians Optical Supplies 20 1093791857 0 Physicians Physician Services 00 1093792707 0 ALISCHOEWSKI KERSTIN 1998182 9999999 B 10 1093792707 0 912 GREENWOOD ST EVANSTON IL 602016524 20 1093792707 0 Physicians Anesthesia Services 20 1093792707 0 Physicians Fluoride varnish 20 1093792707 0 Physicians Healthy Kids Services 20 1093792707 0 Physicians Optical Supplies 20 1093792707 0 Physicians Physician Services 00 1093792806 0 EDELSTEIN STEVE R 1998335 9999999 B 10 1093792806 0 5777 DEPT CAROL STREAM IL 601220021 20 1093792806 0 Physicians Anesthesia Services 20 1093792806 0 Physicians Fluoride varnish 20 1093792806 0 Physicians Healthy Kids Services 20 1093792806 0 Physicians Optical Supplies 20 1093792806 0 Physicians Physician Services 00 1093792913 0 ROSENGARTEN JEFFREY 2025154 9999999 B 10 1093792913 0 PO BOX 772555 DETROIT MI 482772555 20 1093792913 0 Physicians Anesthesia Services 20 1093792913 0 Physicians Healthy Kids Services 20 1093792913 0 Physicians Optical Supplies 20 1093792913 0 Physicians Physician Services 00 1093793895 0 FASBINDER JOHN 2024156 9999999 B 10 1093793895 0 9709 LAKESIDE BLVD STE 350 SPRING TX 773811213 20 1093793895 0 Dentists Dental Services 20 1093793895 0 Dentists Physician Services 00 1093793929 0 RICHARDSON NORBERT 2015041 9999999 B 10 1093793929 0 3933 S BROADWAY SAINT LOUIS MO 631184601 20 1093793929 0 Physicians Anesthesia Services 20 1093793929 0 Physicians Healthy Kids Services 20 1093793929 0 Physicians Optical Supplies 20 1093793929 0 Physicians Physician Services 00 1093794620 0 MAJMUNDAR AMEE R 2010244 9999999 B 10 1093794620 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1093794620 0 Physicians Anesthesia Services 20 1093794620 0 Physicians Healthy Kids Services 20 1093794620 0 Physicians Optical Supplies 20 1093794620 0 Physicians Physician Services 00 1093794802 0 ESCONTRIAS WENDY 2015327 9999999 B 10 1093794802 0 1236 E RUSHOLME ST STE 300 DAVENPORT IA 528032473 20 1093794802 0 Nurse Practitioners Fluoride varnish 20 1093794802 0 Nurse Practitioners Healthy Kids Services 20 1093794802 0 Nurse Practitioners Nurse Practitioners Services 20 1093794802 0 Nurse Practitioners Physician Services 00 1093794844 0 HOLM ADRIAN N 2010182 9999999 B 10 1093794844 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1093794844 0 Physicians Anesthesia Services 20 1093794844 0 Physicians Fluoride varnish 20 1093794844 0 Physicians Healthy Kids Services 20 1093794844 0 Physicians Optical Supplies 20 1093794844 0 Physicians Physician Services 00 1093795007 0 GRIFFITH ERIN M 2006150 9999999 B 10 1093795007 0 PO BOX 22407 SAINT LOUIS MO 631260407 20 1093795007 0 Nurse Practitioners Anesthesia Services 20 1093795007 0 Nurse Practitioners Nurse Practitioners Services 20 1093795007 0 Nurse Practitioners Physician Services 00 1093795023 0 JANAS STEPHEN F 2008183 9999999 B 10 1093795023 0 PO BOX 28900 GREEN BAY WI 543240900 20 1093795023 0 Physicians Anesthesia Services 20 1093795023 0 Physicians Healthy Kids Services 20 1093795023 0 Physicians Optical Supplies 20 1093795023 0 Physicians Physician Services 00 1093795627 0 MATHEW VERGHESE 2016214 9999999 B 10 1093795627 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1093795627 0 Physicians Anesthesia Services 20 1093795627 0 Physicians Fluoride varnish 20 1093795627 0 Physicians Healthy Kids Services 20 1093795627 0 Physicians Optical Supplies 20 1093795627 0 Physicians Physician Services 00 1093795924 0 CHESTER STEPHEN E 2001305 9999999 B 10 1093795924 0 2250 N ILLINOIS AVE CARBONDALE IL 629015612 20 1093795924 0 Physicians Anesthesia Services 20 1093795924 0 Physicians Healthy Kids Services 20 1093795924 0 Physicians Optical Supplies 20 1093795924 0 Physicians Physician Services 00 1093795973 0 BOGOST GREGG 1999001 9999999 B 10 1093795973 0 340 MIDLAND RD STE 120 JANESVILLE WI 535462339 20 1093795973 0 Physicians Anesthesia Services 20 1093795973 0 Physicians Healthy Kids Services 20 1093795973 0 Physicians Optical Supplies 20 1093795973 0 Physicians Physician Services 00 1093796575 0 COLEY RAYMOND 2017137 9999999 B 10 1093796575 0 8941 S WESTERN AVE CHICAGO IL 606436432 20 1093796575 0 Other behavior health professional LCPC/LMFT services 20 1093796575 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1093796617 0 RUTER STEPHANIE 2001288 9999999 B 10 1093796617 0 13545 BARRETT PARKWAY DR STE 1 BALLWIN MO 630213823 20 1093796617 0 Nurse Practitioners Anesthesia Services 20 1093796617 0 Nurse Practitioners Nurse Practitioners Services 20 1093796617 0 Nurse Practitioners Physician Services 00 1093797250 0 GROESSL KRISTIN M 2016149 9999999 B 10 1093797250 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1093797250 0 Physician Assistant Only Fluoride varnish 20 1093797250 0 Physician Assistant Only Healthy Kids Services 20 1093797250 0 Physician Assistant Only Physician Services 00 1093797987 0 TSARWHAS DEAN G 1993184 9999999 B 10 1093797987 0 5777 DEPT CAROL STREAM IL 601220021 20 1093797987 0 Physicians Anesthesia Services 20 1093797987 0 Physicians Fluoride varnish 20 1093797987 0 Physicians Healthy Kids Services 20 1093797987 0 Physicians Optical Supplies 20 1093797987 0 Physicians Physician Services 00 1093798431 0 NOURANIFAR RABIN 2021119 9999999 B 10 1093798431 0 4701 DEPT CAROL STREAM IL 601220021 20 1093798431 0 Physicians Anesthesia Services 20 1093798431 0 Physicians Healthy Kids Services 20 1093798431 0 Physicians Optical Supplies 20 1093798431 0 Physicians Physician Services 00 1093798662 0 ALBOVIAS MICHELLE 2004183 9999999 B 10 1093798662 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1093798662 0 Physicians Anesthesia Services 20 1093798662 0 Physicians Healthy Kids Services 20 1093798662 0 Physicians Optical Supplies 20 1093798662 0 Physicians Physician Services 00 1093799157 0 MONTGOMERY PAUL 2019158 9999999 B 10 1093799157 0 28594 NETWORK PL CHICAGO IL 606731081 20 1093799157 0 Physicians Anesthesia Services 20 1093799157 0 Physicians Healthy Kids Services 20 1093799157 0 Physicians Optical Supplies 20 1093799157 0 Physicians Physician Services 00 1093799256 0 REDLEAF MIRIAM I 1992155 9999999 B 10 1093799256 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1093799256 0 Physicians Anesthesia Services 20 1093799256 0 Physicians Healthy Kids Services 20 1093799256 0 Physicians Optical Supplies 20 1093799256 0 Physicians Physician Services 00 1093799504 0 LAWAL ADEGBOYEGA 2011198 9999999 B 10 1093799504 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1093799504 0 Physicians Anesthesia Services 20 1093799504 0 Physicians Healthy Kids Services 20 1093799504 0 Physicians Optical Supplies 20 1093799504 0 Physicians Physician Services 00 1093799884 0 DEW LINDA 1988183 9999999 B 10 1093799884 0 850 W IRVING PARK RD CHICAGO IL 606133077 20 1093799884 0 Physicians Anesthesia Services 20 1093799884 0 Physicians Healthy Kids Services 20 1093799884 0 Physicians Optical Supplies 20 1093799884 0 Physicians Physician Services 00 1093800245 0 BLAKE SIDNEY A 2019037 9999999 B 10 1093800245 0 PO BOX 5009 BRENTWOOD TN 370245009 20 1093800245 0 Physicians Anesthesia Services 20 1093800245 0 Physicians Fluoride varnish 20 1093800245 0 Physicians Healthy Kids Services 20 1093800245 0 Physicians Optical Supplies 20 1093800245 0 Physicians Physician Services 00 1093802001 0 FULFER JAMIE 2008224 9999999 B 10 1093802001 0 819 BLOOMINGTON RD CHAMPAIGN IL 618202101 20 1093802001 0 Physicians Anesthesia Services 20 1093802001 0 Physicians Healthy Kids Services 20 1093802001 0 Physicians Optical Supplies 20 1093802001 0 Physicians Physician Services 00 1093802944 0 GALE ERIC 1993228 9999999 B 10 1093802944 0 403 E 1ST ST DIXON IL 610213116 20 1093802944 0 Physicians Anesthesia Services 20 1093802944 0 Physicians Fluoride varnish 20 1093802944 0 Physicians Healthy Kids Services 20 1093802944 0 Physicians Optical Supplies 20 1093802944 0 Physicians Physician Services 00 1093804833 0 GALARZA EDWARD 1999356 9999999 B 10 1093804833 0 28100 TORCH PKWY STE 600 WARRENVILLE IL 605554030 20 1093804833 0 Physical Therapists Medical Supplies 20 1093804833 0 Physical Therapists Medical equipment/prosthetic devices 20 1093804833 0 Physical Therapists Physical Therapy Services 00 1093804874 0 SHAH DIPEN 2011244 9999999 B 10 1093804874 0 2100 POWELL ST STE 400 EMERYVILLE CA 946081872 20 1093804874 0 Physicians Anesthesia Services 20 1093804874 0 Physicians Fluoride varnish 20 1093804874 0 Physicians Healthy Kids Services 20 1093804874 0 Physicians Optical Supplies 20 1093804874 0 Physicians Physician Services 00 1093806424 0 KRING GINA L 2003267 9999999 B 10 1093806424 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1093806424 0 Physicians Anesthesia Services 20 1093806424 0 Physicians Fluoride varnish 20 1093806424 0 Physicians Healthy Kids Services 20 1093806424 0 Physicians Optical Supplies 20 1093806424 0 Physicians Physician Services 00 1093806689 0 KHAN NAVEED 2006152 9999999 B 10 1093806689 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1093806689 0 Physicians Anesthesia Services 20 1093806689 0 Physicians Fluoride varnish 20 1093806689 0 Physicians Healthy Kids Services 20 1093806689 0 Physicians Optical Supplies 20 1093806689 0 Physicians Physician Services 00 1093809089 0 SILAS DEAN N 1990211 9999999 B 10 1093809089 0 29373 NETWORK PL CHICAGO IL 606733039 20 1093809089 0 Physicians Anesthesia Services 20 1093809089 0 Physicians Fluoride varnish 20 1093809089 0 Physicians Healthy Kids Services 20 1093809089 0 Physicians Optical Supplies 20 1093809089 0 Physicians Physician Services 00 1093809832 0 SZACHNOWSKI PETER 1994221 9999999 B 10 1093809832 0 515 22ND AVE MONROE WI 535661569 20 1093809832 0 Physicians Anesthesia Services 20 1093809832 0 Physicians Fluoride varnish 20 1093809832 0 Physicians Healthy Kids Services 20 1093809832 0 Physicians Optical Supplies 20 1093809832 0 Physicians Physician Services 00 1093811374 0 AHMAD TANVEER 1986189 9999999 B 10 1093811374 0 21807 W GRANT HWY MARENGO IL 601522944 20 1093811374 0 Physicians Anesthesia Services 20 1093811374 0 Physicians Fluoride varnish 20 1093811374 0 Physicians Healthy Kids Services 20 1093811374 0 Physicians Optical Supplies 20 1093811374 0 Physicians Physician Services 00 1093812877 0 KORTBEIN ERIC J 2022066 9999999 B 10 1093812877 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1093812877 0 Physician Assistant Only Fluoride varnish 20 1093812877 0 Physician Assistant Only Healthy Kids Services 20 1093812877 0 Physician Assistant Only Physician Services 00 1093813024 0 KREMER MICHAEL J 2014217 9999999 B 10 1093813024 0 12413 S HARLEM AVE PALOS HEIGHTS IL 604631442 20 1093813024 0 Nurse Practitioners Anesthesia Services 20 1093813024 0 Nurse Practitioners Nurse Practitioners Services 20 1093813024 0 Nurse Practitioners Physician Services 00 1093813099 0 LABONTE CHRISTOPHER T 2006121 9999999 B 10 1093813099 0 13131 TESSON FERRY RD STE 220 SAINT LOUIS MO 631283887 20 1093813099 0 Physicians Anesthesia Services 20 1093813099 0 Physicians Fluoride varnish 20 1093813099 0 Physicians Healthy Kids Services 20 1093813099 0 Physicians Optical Supplies 20 1093813099 0 Physicians Physician Services 00 1093813156 0 OO SAW MYINT 2003244 9999999 B 10 1093813156 0 370 LARRY POWER RD STE 2 BOURBONNAIS IL 609145195 20 1093813156 0 Physicians Anesthesia Services 20 1093813156 0 Physicians Fluoride varnish 20 1093813156 0 Physicians Healthy Kids Services 20 1093813156 0 Physicians Optical Supplies 20 1093813156 0 Physicians Physician Services 00 1093813172 0 BRADY PATRICK 2008007 9999999 B 10 1093813172 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1093813172 0 Physicians Anesthesia Services 20 1093813172 0 Physicians Fluoride varnish 20 1093813172 0 Physicians Healthy Kids Services 20 1093813172 0 Physicians Optical Supplies 20 1093813172 0 Physicians Physician Services 00 1093813388 0 CHON MARIA 1995305 9999999 B 10 1093813388 0 414 S OAK PARK AVE OAK PARK IL 603023892 20 1093813388 0 Podiatrists Podiatric Services 00 1093813594 0 JOHNSON WILLIAM 1984214 9999999 B 10 1093813594 0 8120 KATY LN ORLAND PARK IL 604626112 20 1093813594 0 Dentists Dental Services 20 1093813594 0 Dentists Physician Services 00 1093813750 0 GRADE MATTHEW P 2016236 9999999 B 10 1093813750 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1093813750 0 Physicians Anesthesia Services 20 1093813750 0 Physicians Fluoride varnish 20 1093813750 0 Physicians Healthy Kids Services 20 1093813750 0 Physicians Optical Supplies 20 1093813750 0 Physicians Physician Services 00 1093815458 0 KOMAR THOMAS 2008183 9999999 B 10 1093815458 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1093815458 0 Physicians Anesthesia Services 20 1093815458 0 Physicians Healthy Kids Services 20 1093815458 0 Physicians Optical Supplies 20 1093815458 0 Physicians Physician Services 00 1093815680 0 VENIGALLA PRAMILA 2002001 9999999 B 10 1093815680 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1093815680 0 Physicians Anesthesia Services 20 1093815680 0 Physicians Fluoride varnish 20 1093815680 0 Physicians Healthy Kids Services 20 1093815680 0 Physicians Optical Supplies 20 1093815680 0 Physicians Physician Services 00 1093816522 0 KEENAN KIMBERLY A 2018248 9999999 B 10 1093816522 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1093816522 0 Clinical Social Worker Social work service 00 1093817249 0 NEUMANN CARLOS E 1999250 9999999 B 10 1093817249 0 268 W HOSPITALITY LN STE 300 SAN BERNARDINO CA 924083234 20 1093817249 0 Physicians Anesthesia Services 20 1093817249 0 Physicians Healthy Kids Services 20 1093817249 0 Physicians Optical Supplies 20 1093817249 0 Physicians Physician Services 00 1093817355 0 VANDORN MICHELLE 2002242 9999999 B 10 1093817355 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1093817355 0 Physicians Anesthesia Services 20 1093817355 0 Physicians Fluoride varnish 20 1093817355 0 Physicians Healthy Kids Services 20 1093817355 0 Physicians Optical Supplies 20 1093817355 0 Physicians Physician Services 00 1093820045 0 KARG MICHAEL P 2016011 9999999 B 10 1093820045 0 5875 E RIVERSIDE BLVD ROCKFORD IL 611144937 20 1093820045 0 Physician Assistant Only Fluoride varnish 20 1093820045 0 Physician Assistant Only Healthy Kids Services 20 1093820045 0 Physician Assistant Only Physician Services 00 1093820409 0 HUANG XIURONG 1999213 9999999 B 10 1093820409 0 PO BOX 167207 CHICAGO IL 606167207 20 1093820409 0 Physicians Anesthesia Services 20 1093820409 0 Physicians Fluoride varnish 20 1093820409 0 Physicians Healthy Kids Services 20 1093820409 0 Physicians Optical Supplies 20 1093820409 0 Physicians Physician Services 00 1093820730 0 RASKE MOLLY E 2009032 9999999 B 10 1093820730 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1093820730 0 Physicians Anesthesia Services 20 1093820730 0 Physicians Healthy Kids Services 20 1093820730 0 Physicians Optical Supplies 20 1093820730 0 Physicians Physician Services 00 1093821670 0 MATORY JOANN E 1982001 9999999 B 10 1093821670 0 PO BOX 778912 CHICAGO IL 606778912 20 1093821670 0 Physicians Anesthesia Services 20 1093821670 0 Physicians Fluoride varnish 20 1093821670 0 Physicians Healthy Kids Services 20 1093821670 0 Physicians Optical Supplies 20 1093821670 0 Physicians Physician Services 00 1093822298 0 IQBAL WAHEEDA 1994349 9999999 B 10 1093822298 0 2054 W DEVON AVE CHICAGO IL 606592128 20 1093822298 0 Physicians Anesthesia Services 20 1093822298 0 Physicians Healthy Kids Services 20 1093822298 0 Physicians Optical Supplies 20 1093822298 0 Physicians Physician Services 00 1093822389 0 BOLAND KATHLEEN 2013121 9999999 B 10 1093822389 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1093822389 0 Optometrists Optical Supplies 20 1093822389 0 Optometrists Optometric Services 20 1093822389 0 Optometrists Physician Services 00 1093825192 0 WILLIAMS JENNIFER 1997001 9999999 B 10 1093825192 0 5814 SHADOWOOD DR CRYSTAL LAKE IL 600121359 20 1093825192 0 Physical Therapists Medical Supplies 20 1093825192 0 Physical Therapists Medical equipment/prosthetic devices 20 1093825192 0 Physical Therapists Physical Therapy Services 00 1093825283 0 RHODES SHARON 2000214 9999999 B 10 1093825283 0 4701 DEPT CAROL STREAM IL 601220021 20 1093825283 0 Physicians All Kids application agent 20 1093825283 0 Physicians Anesthesia Services 20 1093825283 0 Physicians Family Planning Counseling 20 1093825283 0 Physicians Fluoride varnish 20 1093825283 0 Physicians Healthy Kids Services 20 1093825283 0 Physicians Optical Supplies 20 1093825283 0 Physicians Physician Services 00 1093825390 0 KENKRE PRABHAV 2008221 9999999 B 10 1093825390 0 7974 UW HEALTH CT MIDDLETON 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1093827628 0 BINGNER ERIC 2018311 9999999 B 10 1093827628 0 2202 HARLEM RD LOVES PARK IL 611112754 20 1093827628 0 Nurse Practitioners Anesthesia Services 20 1093827628 0 Nurse Practitioners Nurse Practitioners Services 20 1093827628 0 Nurse Practitioners Physician Services 00 1093827685 0 LEISEBERG KEVIN A 2006001 9999999 B 10 1093827685 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1093827685 0 Physical Therapists Medical Supplies 20 1093827685 0 Physical Therapists Medical equipment/prosthetic devices 20 1093827685 0 Physical Therapists Physical Therapy Services 00 1093827727 0 TRINH CHANTE T 2004197 9999999 B 10 1093827727 0 PO BOX 4458 DEPT 194 HOUSTON TX 772104458 20 1093827727 0 Physicians Anesthesia Services 20 1093827727 0 Physicians Healthy Kids Services 20 1093827727 0 Physicians Optical Supplies 20 1093827727 0 Physicians Physician Services 00 1093828212 0 YETURU SUDHAKAR R 1994001 9999999 B 10 1093828212 0 PO BOX 343918 MILWAUKEE WI 532343918 20 1093828212 0 Physicians Anesthesia Services 20 1093828212 0 Physicians Fluoride varnish 20 1093828212 0 Physicians Healthy Kids Services 20 1093828212 0 Physicians Optical Supplies 20 1093828212 0 Physicians Physician Services 00 1093829566 0 DANZIGER ROBERT 2003335 9999999 B 10 1093829566 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1093829566 0 Physicians Anesthesia Services 20 1093829566 0 Physicians Fluoride varnish 20 1093829566 0 Physicians Healthy Kids Services 20 1093829566 0 Physicians Optical Supplies 20 1093829566 0 Physicians Physician Services 00 1093829970 0 THORNTON CHRISTOPHER 1999182 9999999 B 10 1093829970 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1093829970 0 Physicians Anesthesia Services 20 1093829970 0 Physicians Healthy Kids Services 20 1093829970 0 Physicians Optical Supplies 20 1093829970 0 Physicians Physician Services 00 1093831042 0 WEISENBERG BRIAN 2008336 9999999 B 10 1093831042 0 1570 W BATTLEFIELD ST STE 110 SPRINGFIELD MO 658074163 20 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Therapists Medical equipment/prosthetic devices 20 1093831653 0 Physical Therapists Physical Therapy Services 00 1093831703 0 GARMON TINA 2005167 9999999 B 10 1093831703 0 607 S LINCOLN ST TREMONT IL 615688671 20 1093831703 0 Speech Therapists Medical Supplies 20 1093831703 0 Speech Therapists Medical equipment/prosthetic devices 20 1093831703 0 Speech Therapists Speech Therapy/Pathology Services 00 1093832131 0 DANDEKAR MONISHA N 2018240 9999999 B 10 1093832131 0 14425 COLLEGE BLVD STE 130 LENEXA KS 662152317 20 1093832131 0 Physicians Anesthesia Services 20 1093832131 0 Physicians Healthy Kids Services 20 1093832131 0 Physicians Optical Supplies 20 1093832131 0 Physicians Physician Services 00 1093834228 0 STANTON SHEILA 1999328 9999999 B 10 1093834228 0 8701 MENARD AVE MORTON GROVE IL 600533052 20 1093834228 0 Speech Therapists Medical Supplies 20 1093834228 0 Speech Therapists Medical equipment/prosthetic devices 20 1093834228 0 Speech Therapists Speech Therapy/Pathology Services 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Physician Services 00 1093836728 0 HALL MEDRIC M 2011199 9999999 B 10 1093836728 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1093836728 0 Physicians Anesthesia Services 20 1093836728 0 Physicians Healthy Kids Services 20 1093836728 0 Physicians Optical Supplies 20 1093836728 0 Physicians Physician Services 00 1093839300 0 MILOS STEVEN 2007182 9999999 B 10 1093839300 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1093839300 0 Physicians Anesthesia Services 20 1093839300 0 Physicians Healthy Kids Services 20 1093839300 0 Physicians Optical Supplies 20 1093839300 0 Physicians Physician Services 00 1093839441 0 GEISS ROBERT 2012073 9999999 B 10 1093839441 0 4200 EUCLID AVE ROLLING MEADOWS IL 600082083 20 1093839441 0 Other behavior health professional LCPC/LMFT services 00 1093842890 0 RICH KAROLYN R 2001100 9999999 B 10 1093842890 0 217 BRUCE RD LOCKPORT IL 604414906 20 1093842890 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1093842890 0 Other behavior health professional Social work service 00 1093843542 0 ELWART KRISTIN 2008001 9999999 B 10 1093843542 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1093843542 0 Nurse Practitioners Fluoride varnish 20 1093843542 0 Nurse Practitioners Healthy Kids Services 20 1093843542 0 Nurse Practitioners Nurse Practitioners Services 20 1093843542 0 Nurse Practitioners Physician Services 00 1093843583 0 JOHNSON TYLER 2001235 9999999 B 10 1093843583 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1093843583 0 Speech Therapists Medical Supplies 20 1093843583 0 Speech Therapists Medical equipment/prosthetic devices 20 1093843583 0 Speech Therapists Speech Therapy/Pathology Services 00 1093847600 0 DESUTTER JULIE 2016258 9999999 B 10 1093847600 0 600 S 13TH ST PEKIN IL 615544936 20 1093847600 0 Physician Assistant Only Fluoride varnish 20 1093847600 0 Physician Assistant Only Healthy Kids Services 20 1093847600 0 Physician Assistant Only Physician Services 00 1093848475 0 KEEHN ANGELA 2020311 9999999 B 10 1093848475 0 225 E CHICAGO AVE CHICAGO IL 606112991 20 1093848475 0 Nurse Practitioners Anesthesia Services 20 1093848475 0 Nurse Practitioners Nurse Practitioners Services 20 1093848475 0 Nurse Practitioners Physician Services 00 1093849127 0 LIEBESKIND ABRAHAM 2018017 9999999 B 10 1093849127 0 PO BOX 10035 GREEN BAY WI 543070035 20 1093849127 0 Physicians Anesthesia Services 20 1093849127 0 Physicians Fluoride varnish 20 1093849127 0 Physicians Healthy Kids Services 20 1093849127 0 Physicians Optical Supplies 20 1093849127 0 Physicians Physician Services 00 1093850182 0 HAHN ANGELA 2021062 9999999 B 10 1093850182 0 119 S WESTERN AVE UNIT 1 CHICAGO IL 606124644 20 1093850182 0 Physicians Anesthesia Services 20 1093850182 0 Physicians Fluoride varnish 20 1093850182 0 Physicians Healthy Kids Services 20 1093850182 0 Physicians Optical Supplies 20 1093850182 0 Physicians Physician Services 00 1093850554 0 PETERSON COURTNEY 2016308 9999999 B 10 1093850554 0 2604 DEMPSTER ST STE 307 PARK RIDGE IL 600688427 20 1093850554 0 Clinical Social Worker Social work service 00 1093851909 0 FURESZ SUZANNE 2008306 9999999 B 10 1093851909 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1093851909 0 Physicians Anesthesia Services 20 1093851909 0 Physicians Fluoride varnish 20 1093851909 0 Physicians Healthy Kids Services 20 1093851909 0 Physicians Optical Supplies 20 1093851909 0 Physicians Physician Services 00 1093852410 0 BARNETT LYNN 1983186 9999999 B 10 1093852410 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1093852410 0 Physicians Anesthesia Services 20 1093852410 0 Physicians Healthy Kids Services 20 1093852410 0 Physicians Optical Supplies 20 1093852410 0 Physicians Physician Services 20 1093852410 0 Physicians Physicians Psychiatric Services 00 1093855835 0 NELSON SENORA 2002091 9999999 B 10 1093855835 0 29373 NETWORK PL CHICAGO IL 606733039 20 1093855835 0 Physicians Anesthesia Services 20 1093855835 0 Physicians Fluoride varnish 20 1093855835 0 Physicians Healthy Kids Services 20 1093855835 0 Physicians Optical Supplies 20 1093855835 0 Physicians Physician Services 00 1093856858 0 BISHOP JAMES 1990008 9999999 B 10 1093856858 0 1701 RIVER DR MOLINE IL 612651384 20 1093856858 0 Dentists Dental Services 20 1093856858 0 Dentists Physician Services 00 1093857849 0 THOMPSON MICHAEL I 2015264 9999999 B 10 1093857849 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1093857849 0 Physical Therapists Medical Supplies 20 1093857849 0 Physical Therapists Medical equipment/prosthetic devices 20 1093857849 0 Physical Therapists Physical Therapy Services 00 1093858045 0 WOLFE STINE LINDA M 1998267 9999999 B 10 1093858045 0 615 CLINTON AVE OAK PARK IL 603041112 20 1093858045 0 Occupational Therapists Medical Supplies 20 1093858045 0 Occupational Therapists Medical equipment/prosthetic devices 20 1093858045 0 Occupational Therapists Occupational Therapy Services 00 1093858581 0 RICHTER GRESHAM T 2020245 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1093860892 0 Physicians Anesthesia Services 20 1093860892 0 Physicians Healthy Kids Services 20 1093860892 0 Physicians Optical Supplies 20 1093860892 0 Physicians Physician Services 00 1093863367 0 BOARDMAN KERRI D 2023095 9999999 B 10 1093863367 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1093863367 0 Physical Therapists Medical Supplies 20 1093863367 0 Physical Therapists Medical equipment/prosthetic devices 20 1093863367 0 Physical Therapists Physical Therapy Services 00 1093864118 0 ELLINGSON ANDREW 2007091 9999999 B 10 1093864118 0 PO BOX 3272 INDIANAPOLIS IN 462063272 20 1093864118 0 Physicians Anesthesia Services 20 1093864118 0 Physicians Healthy Kids Services 20 1093864118 0 Physicians Optical Supplies 20 1093864118 0 Physicians Physician Services 00 1093864886 0 CUPURO PATRICIA A 2009211 9999999 B 10 1093864886 0 29373 NETWORK PL CHICAGO IL 606733039 20 1093864886 0 Nurse Practitioners Fluoride varnish 20 1093864886 0 Nurse Practitioners Healthy Kids Services 20 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Physical Therapists Medical equipment/prosthetic devices 20 1093868069 0 Physical Therapists Physical Therapy Services 00 1093868127 0 COLE JAMES W 2018330 9999999 B 10 1093868127 0 1200 N EAST ST OLNEY IL 624502432 20 1093868127 0 Physicians Anesthesia Services 20 1093868127 0 Physicians Healthy Kids Services 20 1093868127 0 Physicians Optical Supplies 20 1093868127 0 Physicians Physician Services 20 1093868127 0 Physicians Physicians Psychiatric Services 00 1093868796 0 BROWNE LORIN 2009213 9999999 B 10 1093868796 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1093868796 0 Physicians Anesthesia Services 20 1093868796 0 Physicians Fluoride varnish 20 1093868796 0 Physicians Healthy Kids Services 20 1093868796 0 Physicians Optical Supplies 20 1093868796 0 Physicians Physician Services 00 1093869141 0 CRUZ ELIZABETH 1993244 9999999 B 10 1093869141 0 840 W IRVING PARK RD STE 305 CHICAGO IL 606133011 20 1093869141 0 Physicians Anesthesia Services 20 1093869141 0 Physicians Fluoride 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Kids Services 20 1093874075 0 Physicians Optical Supplies 20 1093874075 0 Physicians Physician Services 00 1093875171 0 THOMPSON FERNANDEZ JACQUELINE 1984214 9999999 B 10 1093875171 0 109 FAIRFIELD WAY STE 204 BLOOMINGDALE IL 601081500 20 1093875171 0 Dentists Dental Services 20 1093875171 0 Dentists Physician Services 00 1093876534 0 PADEN ARLENE A 2023073 9999999 B 10 1093876534 0 8400 LOUISIANA ST MERRILLVILLE IN 464106385 20 1093876534 0 Physicians Anesthesia Services 20 1093876534 0 Physicians Healthy Kids Services 20 1093876534 0 Physicians Optical Supplies 20 1093876534 0 Physicians Physician Services 20 1093876534 0 Physicians Physicians Psychiatric Services 00 1093877102 0 CHACON ARCENIO 2020295 9999999 B 10 1093877102 0 PO BOX 43230 PHOENIX AZ 850803230 20 1093877102 0 Physicians Anesthesia Services 20 1093877102 0 Physicians Fluoride varnish 20 1093877102 0 Physicians Healthy Kids Services 20 1093877102 0 Physicians Optical Supplies 20 1093877102 0 Physicians Physician 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SPRINGFIELD IL 627949639 20 1093887366 0 Dentists Dental Services 20 1093887366 0 Dentists Physician Services 00 1093889081 0 DURHAM ANN H 2017009 9999999 B 10 1093889081 0 225 MEDICAL CENTER DR STE 405 PADUCAH KY 420037914 20 1093889081 0 Nurse Practitioners Anesthesia Services 20 1093889081 0 Nurse Practitioners Nurse Practitioners Services 20 1093889081 0 Nurse Practitioners Physician Services 00 1093889560 0 GUPTA SONAL 2006305 9999999 B 10 1093889560 0 911 MIDWEST CLUB PKWY OAK BROOK IL 605232533 20 1093889560 0 Physicians Anesthesia Services 20 1093889560 0 Physicians Healthy Kids Services 20 1093889560 0 Physicians Optical Supplies 20 1093889560 0 Physicians Physician Services 20 1093889560 0 Physicians Physicians Psychiatric Services 00 1093889792 0 NIMKE ANGELA C 2016228 9999999 B 10 1093889792 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1093889792 0 Clinical Social Worker Social work service 00 1093895849 0 PARDO-ISAAC HELENE 2017299 9999999 B 10 1093895849 0 PO BOX 70 LAKE 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1093896326 0 Physician Assistant Only Healthy Kids Services 20 1093896326 0 Physician Assistant Only Physician Services 00 1093899619 0 PARIKH PRATIK 2011220 9999999 B 10 1093899619 0 801 S WASHINGTON ST NAPERVILLE IL 605407430 20 1093899619 0 Physicians Anesthesia Services 20 1093899619 0 Physicians Fluoride varnish 20 1093899619 0 Physicians Healthy Kids Services 20 1093899619 0 Physicians Optical Supplies 20 1093899619 0 Physicians Physician Services 00 1093900771 0 BANSAL KAPURIA VIJAYTA G 2014213 9999999 B 10 1093900771 0 1860 W WINCHESTER RD STE 106 LIBERTYVILLE IL 600485312 20 1093900771 0 Physicians Anesthesia Services 20 1093900771 0 Physicians Healthy Kids Services 20 1093900771 0 Physicians Optical Supplies 20 1093900771 0 Physicians Physician Services 20 1093900771 0 Physicians Physicians Psychiatric Services 00 1093902249 0 THOMPSON STEPHANIE M 2007305 9999999 B 10 1093902249 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1093902249 0 Nurse Practitioners Healthy Kids Services 20 1093902249 0 Nurse Practitioners Nurse Practitioners Services 20 1093902249 0 Nurse Practitioners Physician Services 00 1093902561 0 FITZPATRICK JENNIFER 2007355 9999999 B 10 1093902561 0 5318 135TH ST CRESTWOOD IL 604451504 20 1093902561 0 Speech Therapists Medical Supplies 20 1093902561 0 Speech Therapists Medical equipment/prosthetic devices 20 1093902561 0 Speech Therapists Speech Therapy/Pathology Services 00 1093902744 0 FLIER LISA 2007267 9999999 B 10 1093902744 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1093902744 0 Nurse Practitioners Healthy Kids Services 20 1093902744 0 Nurse Practitioners Nurse Practitioners Services 20 1093902744 0 Nurse Practitioners Physician Services 00 1093902892 0 LEE KAREN E 2006135 9999999 B 10 1093902892 0 623 E ADAMS ST SPRINGFIELD IL 627011614 20 1093902892 0 Occupational Therapists Medical Supplies 20 1093902892 0 Occupational Therapists Medical equipment/prosthetic devices 20 1093902892 0 Occupational Therapists Occupational Therapy Services 00 1093903353 0 PHAM TU 2017187 9999999 B 10 1093903353 0 PO BOX 371863 PITTSBURGH PA 152507863 20 1093903353 0 Physicians Anesthesia Services 20 1093903353 0 Physicians Healthy Kids Services 20 1093903353 0 Physicians Optical Supplies 20 1093903353 0 Physicians Physician Services 00 1093904179 0 IMBODEN ANNIE D 2007309 9999999 B 10 1093904179 0 3412 OFFICE PARK DR MARION IL 629596477 20 1093904179 0 Nurse Practitioners Fluoride varnish 20 1093904179 0 Nurse Practitioners Healthy Kids Services 20 1093904179 0 Nurse Practitioners Nurse Practitioners Services 20 1093904179 0 Nurse Practitioners Physician Services 00 1093904443 0 NOVAK MARY B 2015176 9999999 B 10 1093904443 0 16555 WEBER RD CREST HILL IL 604038719 20 1093904443 0 Other behavior health professional LCPC/LMFT services 00 1093906364 0 BROWN MELISSA L 2008183 9999999 B 10 1093906364 0 339 CONSORT DR BALLWIN MO 630114439 20 1093906364 0 Physicians Anesthesia Services 20 1093906364 0 Physicians Healthy Kids Services 20 1093906364 0 Physicians Optical Supplies 20 1093906364 0 Physicians Physician Services 00 1093908485 0 HEHIR DAVID A 2008245 9999999 B 10 1093908485 0 100 E PENN SQ PHILADELPHIA PA 191073323 20 1093908485 0 Physicians Anesthesia Services 20 1093908485 0 Physicians Fluoride varnish 20 1093908485 0 Physicians Healthy Kids Services 20 1093908485 0 Physicians Optical Supplies 20 1093908485 0 Physicians Physician Services 00 1093908493 0 HILTON JOSHUA 2011335 9999999 B 10 1093908493 0 5777 DEPT CAROL STREAM IL 601220021 20 1093908493 0 Physicians Anesthesia Services 20 1093908493 0 Physicians Healthy Kids Services 20 1093908493 0 Physicians Optical Supplies 20 1093908493 0 Physicians Physician Services 00 1093909210 0 FERRER-MARRERO TIRSA 2015213 9999999 B 10 1093909210 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1093909210 0 Physicians Anesthesia Services 20 1093909210 0 Physicians Fluoride varnish 20 1093909210 0 Physicians Healthy Kids Services 20 1093909210 0 Physicians Optical Supplies 20 1093909210 0 Physicians Physician Services 00 1093909962 0 CHEONG ALICE P 2010186 9999999 B 10 1093909962 0 5777 DEPT CAROL STREAM IL 601220021 20 1093909962 0 Physicians Anesthesia Services 20 1093909962 0 Physicians Fluoride varnish 20 1093909962 0 Physicians Healthy Kids Services 20 1093909962 0 Physicians Optical Supplies 20 1093909962 0 Physicians Physician Services 00 1093911307 0 AHN EUGENE 2014305 9999999 B 10 1093911307 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1093911307 0 Physicians Anesthesia Services 20 1093911307 0 Physicians Fluoride varnish 20 1093911307 0 Physicians Healthy Kids Services 20 1093911307 0 Physicians Optical Supplies 20 1093911307 0 Physicians Physician Services 00 1093912644 0 MIRO DONALD JOSEPH 2018295 9999999 B 10 1093912644 0 8170 MCCORMICK BLVD STE 204 SKOKIE IL 600762914 20 1093912644 0 Psychologist Psychologist service 00 1093912818 0 PHILIP ANDREW 2013246 9999999 B 10 1093912818 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1093912818 0 Physicians Anesthesia Services 20 1093912818 0 Physicians Healthy Kids Services 20 1093912818 0 Physicians Optical Supplies 20 1093912818 0 Physicians Physician Services 00 1093912909 0 ALI MOHSIN 2022126 9999999 B 10 1093912909 0 62311 COLLECTION CENTER DR CHICAGO IL 606930001 20 1093912909 0 Physicians Anesthesia Services 20 1093912909 0 Physicians Healthy Kids Services 20 1093912909 0 Physicians Optical Supplies 20 1093912909 0 Physicians Physician Services 20 1093912909 0 Physicians Physicians Psychiatric Services 00 1093912917 0 HEPPERMANN BETH M 2010216 9999999 B 10 1093912917 0 2100 POWELL ST STE 900 EMERYVILLE CA 946081844 20 1093912917 0 Physicians Anesthesia Services 20 1093912917 0 Physicians Healthy Kids Services 20 1093912917 0 Physicians Optical Supplies 20 1093912917 0 Physicians Physician Services 00 1093913220 0 SHAIKH ARSHAD 2007197 9999999 B 10 1093913220 0 PO BOX 857 FREEPORT IL 610320857 20 1093913220 0 Physicians Anesthesia Services 20 1093913220 0 Physicians Fluoride varnish 20 1093913220 0 Physicians Healthy Kids Services 20 1093913220 0 Physicians Optical Supplies 20 1093913220 0 Physicians Physician Services 00 1093913337 0 SCHLEIS RHONDA 2002197 9999999 B 10 1093913337 0 310 AMHERST CT VERNON HILLS IL 600611708 20 1093913337 0 Occupational Therapists Medical Supplies 20 1093913337 0 Occupational Therapists Medical equipment/prosthetic devices 20 1093913337 0 Occupational Therapists Occupational Therapy Services 00 1093914731 0 KASTENMEIER ANDREW 2011249 9999999 B 10 1093914731 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1093914731 0 Physicians Anesthesia Services 20 1093914731 0 Physicians Healthy Kids Services 20 1093914731 0 Physicians Optical Supplies 20 1093914731 0 Physicians Physician Services 00 1093914905 0 GAREE AMY M 2020167 9999999 B 10 1093914905 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1093914905 0 Nurse Practitioners Fluoride varnish 20 1093914905 0 Nurse Practitioners Healthy Kids Services 20 1093914905 0 Nurse Practitioners Nurse Practitioners Services 20 1093914905 0 Nurse Practitioners Physician Services 00 1093915423 0 LIN XIAOQI 2007182 9999999 B 10 1093915423 0 5777 DEPT CAROL STREAM IL 601220021 20 1093915423 0 Physicians Anesthesia Services 20 1093915423 0 Physicians Healthy Kids Services 20 1093915423 0 Physicians Optical Supplies 20 1093915423 0 Physicians Physician Services 00 1093915787 0 DARLING GINGER 2004183 9999999 B 10 1093915787 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1093915787 0 Physicians Anesthesia Services 20 1093915787 0 Physicians Fluoride varnish 20 1093915787 0 Physicians Healthy Kids Services 20 1093915787 0 Physicians Optical Supplies 20 1093915787 0 Physicians Physician Services 00 1093915902 0 LITTLE MICHAEL B 2012214 9999999 B 10 1093915902 0 1400 PIN OAK DR CARTERVILLE IL 629181600 20 1093915902 0 Physicians Anesthesia Services 20 1093915902 0 Physicians Healthy Kids Services 20 1093915902 0 Physicians Optical Supplies 20 1093915902 0 Physicians Physician Services 00 1093916595 0 CIECIERSKI RAFAL G 2019084 9999999 B 10 1093916595 0 801 ILLINI DR SILVIS IL 612821804 20 1093916595 0 Physicians Anesthesia Services 20 1093916595 0 Physicians Fluoride varnish 20 1093916595 0 Physicians Healthy Kids Services 20 1093916595 0 Physicians Optical Supplies 20 1093916595 0 Physicians Physician Services 00 1093917114 0 FERNANDEZ ALEXANDER 2018086 9999999 B 10 1093917114 0 PO BOX 404406 ATLANTA GA 303844406 20 1093917114 0 Physicians Anesthesia Services 20 1093917114 0 Physicians Healthy Kids Services 20 1093917114 0 Physicians Optical Supplies 20 1093917114 0 Physicians Physician Services 00 1093917130 0 MEHROTRA PUJA 2007213 9999999 B 10 1093917130 0 29373 NETWORK PL CHICAGO IL 606733039 20 1093917130 0 Physicians Anesthesia Services 20 1093917130 0 Physicians Fluoride varnish 20 1093917130 0 Physicians Healthy Kids Services 20 1093917130 0 Physicians Optical Supplies 20 1093917130 0 Physicians Physician Services 00 1093918161 0 BENNETT SARAH 2017313 9999999 B 10 1093918161 0 2111 OGDEN AVE AURORA IL 605047597 20 1093918161 0 Nurse Practitioners Healthy Kids Services 20 1093918161 0 Nurse Practitioners Nurse Practitioners Services 20 1093918161 0 Nurse Practitioners Physician Services 00 1093918203 0 SESHADRI VENKAT 2013244 9999999 B 10 1093918203 0 19801 GOVERNORS HWY STE 160 FLOSSMOOR IL 604224363 20 1093918203 0 Physicians Anesthesia Services 20 1093918203 0 Physicians Healthy Kids Services 20 1093918203 0 Physicians Optical Supplies 20 1093918203 0 Physicians Physician Services 00 1093918831 0 PUTZEL JENNA M 2022285 9999999 B 10 1093918831 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1093918831 0 Physicians Anesthesia Services 20 1093918831 0 Physicians Fluoride varnish 20 1093918831 0 Physicians Healthy Kids Services 20 1093918831 0 Physicians Optical Supplies 20 1093918831 0 Physicians Physician Services 00 1093919706 0 BANKS BRETT A 2023233 9999999 B 10 1093919706 0 PO BOX 43230 PHOENIX AZ 850803230 20 1093919706 0 Physicians Anesthesia Services 20 1093919706 0 Physicians Healthy Kids Services 20 1093919706 0 Physicians Optical Supplies 20 1093919706 0 Physicians Physician Services 00 1093919714 0 HOUSTON LILLIAN J 2020239 9999999 B 10 1093919714 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1093919714 0 Physicians Anesthesia Services 20 1093919714 0 Physicians Healthy Kids Services 20 1093919714 0 Physicians Optical Supplies 20 1093919714 0 Physicians Physician Services 20 1093919714 0 Physicians Physicians Psychiatric Services 00 1093920118 0 KRIVICKAS PAUL J 2009182 9999999 B 10 1093920118 0 5777 DEPT CAROL STREAM IL 601220021 20 1093920118 0 Physicians Anesthesia Services 20 1093920118 0 Physicians Healthy Kids Services 20 1093920118 0 Physicians Optical Supplies 20 1093920118 0 Physicians Physician Services 00 1093920191 0 GUPTA VISHAL 2010060 9999999 B 10 1093920191 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1093920191 0 Physicians Anesthesia Services 20 1093920191 0 Physicians Healthy Kids Services 20 1093920191 0 Physicians Optical Supplies 20 1093920191 0 Physicians Physician Services 00 1093920332 0 SCIFRES CHRISTINA M 2007182 9999999 B 10 1093920332 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1093920332 0 Physicians Anesthesia Services 20 1093920332 0 Physicians Healthy Kids Services 20 1093920332 0 Physicians Optical Supplies 20 1093920332 0 Physicians Physician Services 00 1093922346 0 PECHTER BRADLEY 1994244 9999999 B 10 1093922346 0 350 N WALL ST KANKAKEE IL 609012901 20 1093922346 0 Physicians Anesthesia Services 20 1093922346 0 Physicians Healthy Kids Services 20 1093922346 0 Physicians Optical Supplies 20 1093922346 0 Physicians Physician Services 00 1093924003 0 OU JIAFU 2015001 9999999 B 10 1093924003 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1093924003 0 Physicians Anesthesia Services 20 1093924003 0 Physicians Fluoride varnish 20 1093924003 0 Physicians Healthy Kids Services 20 1093924003 0 Physicians Optical Supplies 20 1093924003 0 Physicians Physician Services 00 1093925588 0 ZIMMERMANN AMY C 2009213 9999999 B 10 1093925588 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1093925588 0 Physicians Anesthesia Services 20 1093925588 0 Physicians Healthy Kids Services 20 1093925588 0 Physicians Optical Supplies 20 1093925588 0 Physicians Physician Services 00 1093925679 0 VANDERHEYDEN ANDREW D 2009181 9999999 B 10 1093925679 0 7083 GRAND NATIONAL DR STE 102 ORLANDO FL 328198942 20 1093925679 0 Physicians Anesthesia Services 20 1093925679 0 Physicians Healthy Kids Services 20 1093925679 0 Physicians Optical Supplies 20 1093925679 0 Physicians Physician Services 00 1093926602 0 GUZMAN MIGUEL 2011182 9999999 B 10 1093926602 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1093926602 0 Physicians Anesthesia Services 20 1093926602 0 Physicians Healthy Kids Services 20 1093926602 0 Physicians Optical Supplies 20 1093926602 0 Physicians Physician Services 00 1093927840 0 BAIG SAHER 2023254 9999999 B 10 1093927840 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1093927840 0 Physician Assistant Only Fluoride varnish 20 1093927840 0 Physician Assistant Only Healthy Kids Services 20 1093927840 0 Physician Assistant Only Physician Services 00 1093928285 0 BROWN KIMBERLY THERESE 2013305 9999999 B 10 1093928285 0 2329 S MICHIGAN AVE CHICAGO IL 606162104 20 1093928285 0 Physicians Anesthesia Services 20 1093928285 0 Physicians Fluoride varnish 20 1093928285 0 Physicians Healthy Kids Services 20 1093928285 0 Physicians Optical Supplies 20 1093928285 0 Physicians Physician Services 00 1093928483 0 DHARMARAJAN SEKHAR 2008358 9999999 B 10 1093928483 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1093928483 0 Physicians Anesthesia Services 20 1093928483 0 Physicians Healthy Kids Services 20 1093928483 0 Physicians Optical Supplies 20 1093928483 0 Physicians Physician Services 00 1093928525 0 PALIGA ROBIN E 2007121 9999999 B 10 1093928525 0 29373 NETWORK PL CHICAGO IL 606733039 20 1093928525 0 Nurse Practitioners Healthy Kids Services 20 1093928525 0 Nurse Practitioners Nurse Practitioners Services 20 1093928525 0 Nurse Practitioners Physician Services 00 1093928566 0 FRASER M TERESA C 1994244 9999999 B 10 1093928566 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1093928566 0 Physicians Anesthesia Services 20 1093928566 0 Physicians Healthy Kids Services 20 1093928566 0 Physicians Optical Supplies 20 1093928566 0 Physicians Physician Services 20 1093928566 0 Physicians Physicians Psychiatric Services 00 1093931198 0 JORDAN TAMAJAH M 2007201 9999999 B 10 1093931198 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1093931198 0 Physicians Anesthesia Services 20 1093931198 0 Physicians Fluoride varnish 20 1093931198 0 Physicians Healthy Kids Services 20 1093931198 0 Physicians Optical Supplies 20 1093931198 0 Physicians Physician Services 00 1093931305 0 JAMES ABBY M 2006136 9999999 B 10 1093931305 0 6611 171ST ST TINLEY PARK IL 604773514 20 1093931305 0 Speech Therapists Medical Supplies 20 1093931305 0 Speech Therapists Medical equipment/prosthetic devices 20 1093931305 0 Speech Therapists Speech Therapy/Pathology Services 00 1093931909 0 FLORES JUAN G 2005305 9999999 B 10 1093931909 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1093931909 0 Physicians Anesthesia Services 20 1093931909 0 Physicians Fluoride varnish 20 1093931909 0 Physicians Healthy Kids Services 20 1093931909 0 Physicians Optical Supplies 20 1093931909 0 Physicians Physician Services 00 1093932436 0 OLIVER JUNE 2011335 9999999 B 10 1093932436 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1093932436 0 Nurse Practitioners Healthy Kids Services 20 1093932436 0 Nurse Practitioners Nurse Practitioners Services 20 1093932436 0 Nurse Practitioners Physician Services 00 1093933285 0 PATEL NEAL 2007182 9999999 B 10 1093933285 0 500 PORTER AVE AURORA MO 656052365 20 1093933285 0 Physicians Anesthesia Services 20 1093933285 0 Physicians Healthy Kids Services 20 1093933285 0 Physicians Optical Supplies 20 1093933285 0 Physicians Physician Services 00 1093933665 0 NGUYEN BINH 2014182 9999999 B 10 1093933665 0 PO BOX 280 911 STACY BURK DR FLORA IL 628390280 20 1093933665 0 Physicians Anesthesia Services 20 1093933665 0 Physicians Fluoride varnish 20 1093933665 0 Physicians Healthy Kids Services 20 1093933665 0 Physicians Optical Supplies 20 1093933665 0 Physicians Physician Services 00 1093936627 0 CURRY MARY 2009182 9999999 B 10 1093936627 0 1000 N ALLEN ST ROBINSON IL 624541114 20 1093936627 0 Physicians Anesthesia Services 20 1093936627 0 Physicians Healthy Kids Services 20 1093936627 0 Physicians Optical Supplies 20 1093936627 0 Physicians Physician Services 00 1093936635 0 FIGUERRES EILEEN 2010182 9999999 B 10 1093936635 0 1000 N ALLEN ST ROBINSON IL 624541114 20 1093936635 0 Physicians Anesthesia Services 20 1093936635 0 Physicians Healthy Kids Services 20 1093936635 0 Physicians Optical 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Physician Services 00 1093939167 0 WILLIAMS PHILLIP R 1991182 9999999 B 10 1093939167 0 5777 DEPT CAROL STREAM IL 601220021 20 1093939167 0 Physicians Anesthesia Services 20 1093939167 0 Physicians Healthy Kids Services 20 1093939167 0 Physicians Optical Supplies 20 1093939167 0 Physicians Physician Services 00 1093939225 0 BERNARDINO ELIZABETH V 1986076 9999999 B 10 1093939225 0 7055 VETERANS BLVD STE C BURR RIDGE IL 605275641 20 1093939225 0 Physicians Anesthesia Services 20 1093939225 0 Physicians Healthy Kids Services 20 1093939225 0 Physicians Optical Supplies 20 1093939225 0 Physicians Physician Services 20 1093939225 0 Physicians Physicians Psychiatric Services 00 1093939258 0 SUKHIJA RISHI 2023343 9999999 B 10 1093939258 0 PO BOX 43230 CINCINNATI OH 452430230 20 1093939258 0 Physicians Anesthesia Services 20 1093939258 0 Physicians Fluoride varnish 20 1093939258 0 Physicians Healthy Kids Services 20 1093939258 0 Physicians Optical Supplies 20 1093939258 0 Physicians Physician Services 00 1093940132 0 KIM MINJEE 2015182 9999999 B 10 1093940132 0 5777 DEPT CAROL STREAM IL 601220021 20 1093940132 0 Physicians Anesthesia Services 20 1093940132 0 Physicians Healthy Kids Services 20 1093940132 0 Physicians Optical Supplies 20 1093940132 0 Physicians Physician Services 20 1093940132 0 Physicians Physicians Psychiatric Services 00 1093940611 0 KIZHAKEPUNNUR LENNEY G 2013231 9999999 B 10 1093940611 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1093940611 0 Physicians Anesthesia Services 20 1093940611 0 Physicians Healthy Kids Services 20 1093940611 0 Physicians Optical Supplies 20 1093940611 0 Physicians Physician Services 00 1093940751 0 MALONE JAY R 2016183 9999999 B 10 1093940751 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1093940751 0 Physicians Anesthesia Services 20 1093940751 0 Physicians Fluoride varnish 20 1093940751 0 Physicians Healthy Kids Services 20 1093940751 0 Physicians Optical Supplies 20 1093940751 0 Physicians 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DETROIT MI 482781076 20 1093942708 0 Physicians Anesthesia Services 20 1093942708 0 Physicians Healthy Kids Services 20 1093942708 0 Physicians Optical Supplies 20 1093942708 0 Physicians Physician Services 20 1093942708 0 Physicians Physicians Psychiatric Services 00 1093942997 0 GLASS LEAH R 2016001 9999999 B 10 1093942997 0 300 WINDING WOODS DR STE 200 O FALLON MO 633665081 20 1093942997 0 Physicians Anesthesia Services 20 1093942997 0 Physicians Healthy Kids Services 20 1093942997 0 Physicians Optical Supplies 20 1093942997 0 Physicians Physician Services 00 1093943953 0 KOOPMAN EDAN 2011060 9999999 B 10 1093943953 0 5777 DEPT CAROL STREAM IL 601220021 20 1093943953 0 Occupational Therapists Medical Supplies 20 1093943953 0 Occupational Therapists Medical equipment/prosthetic devices 20 1093943953 0 Occupational Therapists Occupational Therapy Services 00 1093944324 0 ALI IMRAN 2009236 9999999 B 10 1093944324 0 187 W IRVING PARK RD ROSELLE IL 601721119 20 1093944324 0 Optometrists 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1104027697 0 Physicians Anesthesia Services 20 1104027697 0 Physicians Healthy Kids Services 20 1104027697 0 Physicians Optical Supplies 20 1104027697 0 Physicians Physician Services 00 1104028059 0 GOLDRING ANNAMEIKA E 2022044 9999999 B 10 1104028059 0 PO BOX 4037 PORTLAND OR 972084037 20 1104028059 0 Physicians Anesthesia Services 20 1104028059 0 Physicians Healthy Kids Services 20 1104028059 0 Physicians Optical Supplies 20 1104028059 0 Physicians Physician Services 00 1104028786 0 JOYNT MADDOX KAREN E 2017182 9999999 B 10 1104028786 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1104028786 0 Physicians Anesthesia Services 20 1104028786 0 Physicians Fluoride varnish 20 1104028786 0 Physicians Healthy Kids Services 20 1104028786 0 Physicians Optical Supplies 20 1104028786 0 Physicians Physician Services 00 1104028836 0 GRIPE AMANDA M 2008306 9999999 B 10 1104028836 0 PO BOX 778912 CHICAGO IL 606778912 20 1104028836 0 Physicians Anesthesia Services 20 1104028836 0 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1104074483 0 Physicians Physician Services 00 1104074590 0 COPP JESSICA 2009244 9999999 B 10 1104074590 0 212 BARNEY DR JOLIET IL 604355271 20 1104074590 0 Speech Therapists Medical Supplies 20 1104074590 0 Speech Therapists Medical equipment/prosthetic devices 20 1104074590 0 Speech Therapists Speech Therapy/Pathology Services 00 1104074749 0 SIERRA-FERNANDEZ HERNAN 2012061 9999999 B 10 1104074749 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1104074749 0 Physicians Anesthesia Services 20 1104074749 0 Physicians Fluoride varnish 20 1104074749 0 Physicians Healthy Kids Services 20 1104074749 0 Physicians Optical Supplies 20 1104074749 0 Physicians Physician Services 00 1104075035 0 BELVADI YASHASWI 2015182 9999999 B 10 1104075035 0 2100 POWELL ST STE 900 EMERYVILLE CA 946081844 20 1104075035 0 Physicians Anesthesia Services 20 1104075035 0 Physicians Fluoride varnish 20 1104075035 0 Physicians Healthy Kids Services 20 1104075035 0 Physicians Optical Supplies 20 1104075035 0 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1104105139 0 Physicians Physician Services 20 1104105139 0 Physicians Physicians Psychiatric Services 00 1104106145 0 PERRI ELIZABETH 2015135 9999999 B 10 1104106145 0 800 E NORTHWEST HWY STE 106 MOUNT PROSPECT IL 600563457 20 1104106145 0 Psychologist Psychologist service 00 1104106558 0 PEZZO JESSICA 2016001 9999999 B 10 1104106558 0 1 WESTBROOK CORPORATE CTR STE 240 WESTCHESTER IL 601545745 20 1104106558 0 Physician Assistant Only Fluoride varnish 20 1104106558 0 Physician Assistant Only Healthy Kids Services 20 1104106558 0 Physician Assistant Only Physician Services 00 1104106608 0 SARANGI SIDDHARTH 2020069 9999999 B 10 1104106608 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1104106608 0 Physicians Anesthesia Services 20 1104106608 0 Physicians Healthy Kids Services 20 1104106608 0 Physicians Optical Supplies 20 1104106608 0 Physicians Physician Services 00 1104110170 0 WHITE KIRSTEN 2023364 9999999 B 10 1104110170 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1104110170 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Physicians Anesthesia Services 20 1104110832 0 Physicians Fluoride varnish 20 1104110832 0 Physicians Healthy Kids Services 20 1104110832 0 Physicians Optical Supplies 20 1104110832 0 Physicians Physician Services 00 1104111350 0 FEELEY STEPHANIE A 2022160 9999999 B 10 1104111350 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1104111350 0 Occupational Therapists Medical Supplies 20 1104111350 0 Occupational Therapists Medical equipment/prosthetic devices 20 1104111350 0 Occupational Therapists Occupational Therapy Services 00 1104111376 0 BAURES TIMOTHY 2016275 9999999 B 10 1104111376 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1104111376 0 Physicians Anesthesia Services 20 1104111376 0 Physicians Fluoride varnish 20 1104111376 0 Physicians Healthy Kids Services 20 1104111376 0 Physicians Optical Supplies 20 1104111376 0 Physicians Physician Services 00 1104111400 0 SCHIMPKE SCOTT W 2018226 9999999 B 10 1104111400 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 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Physicians Fluoride varnish 20 1104112341 0 Physicians Healthy Kids Services 20 1104112341 0 Physicians Optical Supplies 20 1104112341 0 Physicians Physician Services 00 1104112994 0 LING GUOYU 2014182 9999999 B 10 1104112994 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1104112994 0 Physicians Anesthesia Services 20 1104112994 0 Physicians Fluoride varnish 20 1104112994 0 Physicians Healthy Kids Services 20 1104112994 0 Physicians Optical Supplies 20 1104112994 0 Physicians Physician Services 00 1104113091 0 PATEL NILAM B 2018099 9999999 B 10 1104113091 0 2357 SEQUOIA DR AURORA IL 605066222 20 1104113091 0 Physicians Anesthesia Services 20 1104113091 0 Physicians Fluoride varnish 20 1104113091 0 Physicians Healthy Kids Services 20 1104113091 0 Physicians Optical Supplies 20 1104113091 0 Physicians Physician Services 00 1104113117 0 GELLHAUS PAUL T 2017230 9999999 B 10 1104113117 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1104113117 0 Physicians Anesthesia Services 20 1104113117 0 Physicians Healthy Kids Services 20 1104113117 0 Physicians Optical Supplies 20 1104113117 0 Physicians Physician Services 00 1104113141 0 LAKE-MELTON STEPHANIE 2022249 9999999 B 10 1104113141 0 74 ECLIPSE CTR BELOIT WI 535113550 20 1104113141 0 Physician Assistant Only Fluoride varnish 20 1104113141 0 Physician Assistant Only Healthy Kids Services 20 1104113141 0 Physician Assistant Only Physician Services 00 1104113398 0 CHARBEK EDWARD 2017182 9999999 B 10 1104113398 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1104113398 0 Physicians Anesthesia Services 20 1104113398 0 Physicians Fluoride varnish 20 1104113398 0 Physicians Healthy Kids Services 20 1104113398 0 Physicians Optical Supplies 20 1104113398 0 Physicians Physician Services 00 1104113653 0 RAUT PRACHI B 2021176 9999999 B 10 1104113653 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1104113653 0 Physicians Anesthesia Services 20 1104113653 0 Physicians Healthy Kids Services 20 1104113653 0 Physicians Optical Supplies 20 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GOPIKA 2014152 9999999 B 10 1104114826 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1104114826 0 Physicians Anesthesia Services 20 1104114826 0 Physicians Fluoride varnish 20 1104114826 0 Physicians Healthy Kids Services 20 1104114826 0 Physicians Optical Supplies 20 1104114826 0 Physicians Physician Services 00 1104115492 0 FINE ANANDA-KRIIYA 2020190 9999999 B 10 1104115492 0 29373 NETWORK PL CHICAGO IL 606733039 20 1104115492 0 Physicians Anesthesia Services 20 1104115492 0 Physicians Healthy Kids Services 20 1104115492 0 Physicians Optical Supplies 20 1104115492 0 Physicians Physician Services 20 1104115492 0 Physicians Physicians Psychiatric Services 00 1104115542 0 COLANESE JUSTIN P 2016173 9999999 B 10 1104115542 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1104115542 0 Physicians Anesthesia Services 20 1104115542 0 Physicians Healthy Kids Services 20 1104115542 0 Physicians Optical Supplies 20 1104115542 0 Physicians Physician Services 00 1104116151 0 SCHWARTZ BRIAN E 2017107 9999999 B 10 1104116151 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1104116151 0 Physicians Anesthesia Services 20 1104116151 0 Physicians Healthy Kids Services 20 1104116151 0 Physicians Optical Supplies 20 1104116151 0 Physicians Physician Services 00 1104116847 0 LAI YING HAO 2016244 9999999 B 10 1104116847 0 29373 NETWORK PL CHICAGO IL 606733039 20 1104116847 0 Physicians Anesthesia Services 20 1104116847 0 Physicians Healthy Kids Services 20 1104116847 0 Physicians Optical Supplies 20 1104116847 0 Physicians Physician Services 00 1104116938 0 FRASCA KATHERINE L 2020183 9999999 B 10 1104116938 0 PO BOX 110429 AURORA CO 800420429 20 1104116938 0 Physicians Anesthesia Services 20 1104116938 0 Physicians Fluoride varnish 20 1104116938 0 Physicians Healthy Kids Services 20 1104116938 0 Physicians Optical Supplies 20 1104116938 0 Physicians Physician Services 00 1104117266 0 SMITH JESSICA LEIGH 2018208 9999999 B 10 1104117266 0 250 N SHADELAND AVE STE 200 INDIANAPOLIS IN 462194959 20 1104117266 0 Physicians Anesthesia Services 20 1104117266 0 Physicians Healthy Kids Services 20 1104117266 0 Physicians Optical Supplies 20 1104117266 0 Physicians Physician Services 00 1104117423 0 SHIRAZI ABDUL 2015215 9999999 B 10 1104117423 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1104117423 0 Physicians Anesthesia Services 20 1104117423 0 Physicians Healthy Kids Services 20 1104117423 0 Physicians Optical Supplies 20 1104117423 0 Physicians Physician Services 00 1104118249 0 HARRISON KALLIE L 2015194 9999999 B 10 1104118249 0 615 S NEW BALLAS RD STE 1400 SAINT LOUIS MO 631418221 20 1104118249 0 Physicians Anesthesia Services 20 1104118249 0 Physicians Healthy Kids Services 20 1104118249 0 Physicians Optical Supplies 20 1104118249 0 Physicians Physician Services 00 1104118629 0 PARHAM DANIELLE 2018152 9999999 B 10 1104118629 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1104118629 0 Physicians Anesthesia Services 20 1104118629 0 Physicians Fluoride varnish 20 1104118629 0 Physicians Healthy Kids Services 20 1104118629 0 Physicians Optical Supplies 20 1104118629 0 Physicians Physician Services 00 1104118892 0 HOWE ERIN R 2014182 9999999 B 10 1104118892 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1104118892 0 Physicians Anesthesia Services 20 1104118892 0 Physicians Fluoride varnish 20 1104118892 0 Physicians Healthy Kids Services 20 1104118892 0 Physicians Optical Supplies 20 1104118892 0 Physicians Physician Services 00 1104119379 0 DORKA MEGHAN 2011186 9999999 B 10 1104119379 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1104119379 0 Speech Therapists Medical Supplies 20 1104119379 0 Speech Therapists Medical equipment/prosthetic devices 20 1104119379 0 Speech Therapists Speech Therapy/Pathology Services 00 1104119965 0 LIMOGES MAGGIE 2024106 9999999 B 10 1104119965 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1104119965 0 Physicians Anesthesia Services 20 1104119965 0 Physicians Healthy Kids 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Physician Services 00 1104131648 0 LOFTUS JACQUELINE 2010236 9999999 B 10 1104131648 0 1301 W COSSITT AVE LA GRANGE IL 605252145 20 1104131648 0 Speech Therapists Medical Supplies 20 1104131648 0 Speech Therapists Medical equipment/prosthetic devices 20 1104131648 0 Speech Therapists Speech Therapy/Pathology Services 00 1104132331 0 AGRAWAL GARIMA 2014182 9999999 B 10 1104132331 0 PO BOX 3272 INDIANAPOLIS IN 462063272 20 1104132331 0 Physicians Anesthesia Services 20 1104132331 0 Physicians Healthy Kids Services 20 1104132331 0 Physicians Optical Supplies 20 1104132331 0 Physicians Physician Services 00 1104132414 0 GENTRY EMILY 2011087 9999999 B 10 1104132414 0 501 S LOCUST ST MANTENO IL 609501654 20 1104132414 0 Optometrists Optical Supplies 20 1104132414 0 Optometrists Optometric Services 20 1104132414 0 Optometrists Physician Services 00 1104132554 0 PODDAR PIYUSH 2024010 9999999 B 10 1104132554 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1104132554 0 Physicians 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RILPUOU ROBERT B 2011244 9999999 B 10 1104146372 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1104146372 0 Physicians Anesthesia Services 20 1104146372 0 Physicians Fluoride varnish 20 1104146372 0 Physicians Healthy Kids Services 20 1104146372 0 Physicians Optical Supplies 20 1104146372 0 Physicians Physician Services 00 1104146505 0 WAHEED SALMAN A 2016214 9999999 B 10 1104146505 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1104146505 0 Physicians Anesthesia Services 20 1104146505 0 Physicians Fluoride varnish 20 1104146505 0 Physicians Healthy Kids Services 20 1104146505 0 Physicians Optical Supplies 20 1104146505 0 Physicians Physician Services 00 1104146539 0 GIAMALVA ANDREA N 2013308 9999999 B 10 1104146539 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1104146539 0 Physicians Anesthesia Services 20 1104146539 0 Physicians Fluoride varnish 20 1104146539 0 Physicians Healthy Kids Services 20 1104146539 0 Physicians Optical Supplies 20 1104146539 0 Physicians Physician 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1104148972 0 MEHTA VIKAS 2015182 9999999 B 10 1104148972 0 5777 DEPT CAROL STREAM IL 601220021 20 1104148972 0 Physicians Anesthesia Services 20 1104148972 0 Physicians Healthy Kids Services 20 1104148972 0 Physicians Optical Supplies 20 1104148972 0 Physicians Physician Services 00 1104149392 0 BURNS IVY R 2012249 9999999 B 10 1104149392 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1104149392 0 Nurse Practitioners Anesthesia Services 20 1104149392 0 Nurse Practitioners Nurse Practitioners Services 20 1104149392 0 Nurse Practitioners Physician Services 00 1104150382 0 RODRIGUEZ CHRISTINE 2016001 9999999 B 10 1104150382 0 5777 DEPT CAROL STREAM IL 601228942 20 1104150382 0 Physician Assistant Only Fluoride varnish 20 1104150382 0 Physician Assistant Only Healthy Kids Services 20 1104150382 0 Physician Assistant Only Physician Services 00 1104152867 0 WILK LYDIA 2023342 9999999 B 10 1104152867 0 5777 DEPT CAROL STREAM IL 601220021 20 1104152867 0 Physical Therapists Medical Supplies 20 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1104172782 0 HARTMAN ERIC J 2016205 9999999 B 10 1104172782 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1104172782 0 Physicians Anesthesia Services 20 1104172782 0 Physicians Healthy Kids Services 20 1104172782 0 Physicians Optical Supplies 20 1104172782 0 Physicians Physician Services 00 1104173103 0 CHEGONDI MADHURADHAR 2018262 9999999 B 10 1104173103 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1104173103 0 Physicians Anesthesia Services 20 1104173103 0 Physicians Fluoride varnish 20 1104173103 0 Physicians Healthy Kids Services 20 1104173103 0 Physicians Optical Supplies 20 1104173103 0 Physicians Physician Services 00 1104173384 0 WOLF JOSHUA 2015274 9999999 B 10 1104173384 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1104173384 0 Physicians Anesthesia Services 20 1104173384 0 Physicians Fluoride varnish 20 1104173384 0 Physicians Healthy Kids Services 20 1104173384 0 Physicians Optical Supplies 20 1104173384 0 Physicians Physician Services 00 1104174721 0 STRZELCZYK THERESA 2012245 9999999 B 10 1104174721 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1104174721 0 Nurse Practitioners Healthy Kids Services 20 1104174721 0 Nurse Practitioners Nurse Practitioners Services 20 1104174721 0 Nurse Practitioners Physician Services 00 1104175330 0 DESALVO KATHRYN 2013218 9999999 B 10 1104175330 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1104175330 0 Speech Therapists Medical Supplies 20 1104175330 0 Speech Therapists Medical equipment/prosthetic devices 20 1104175330 0 Speech Therapists Speech Therapy/Pathology Services 00 1104176262 0 OKIGAWA ASHLEY 2017048 9999999 B 10 1104176262 0 5777 DEPT CAROL STREAM IL 601228942 20 1104176262 0 Physician Assistant Only Fluoride varnish 20 1104176262 0 Physician Assistant Only Healthy Kids Services 20 1104176262 0 Physician Assistant Only Physician Services 00 1104177260 0 ROMAN LAUREN 2013168 9999999 B 10 1104177260 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1104177260 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Services 00 1104179795 0 ROACH JASON 2015317 9999999 B 10 1104179795 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1104179795 0 Physician Assistant Only Fluoride varnish 20 1104179795 0 Physician Assistant Only Healthy Kids Services 20 1104179795 0 Physician Assistant Only Physician Services 00 1104180173 0 PASTEUR NICHOLAS A 2015176 9999999 B 10 1104180173 0 PO BOX 3988 CARBONDALE IL 629023988 20 1104180173 0 Physicians Anesthesia Services 20 1104180173 0 Physicians Healthy Kids Services 20 1104180173 0 Physicians Optical Supplies 20 1104180173 0 Physicians Physician Services 00 1104180298 0 SHAFER JENNIFER R 2019017 9999999 B 10 1104180298 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1104180298 0 Physicians Anesthesia Services 20 1104180298 0 Physicians Fluoride varnish 20 1104180298 0 Physicians Healthy Kids Services 20 1104180298 0 Physicians Optical Supplies 20 1104180298 0 Physicians Physician Services 00 1104180652 0 MAKHOUL GEORGE 2021032 9999999 B 10 1104180652 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1104180652 0 Physicians Anesthesia Services 20 1104180652 0 Physicians Fluoride varnish 20 1104180652 0 Physicians Healthy Kids Services 20 1104180652 0 Physicians Optical Supplies 20 1104180652 0 Physicians Physician Services 00 1104182245 0 BITTNER HARTMUTH 2022152 9999999 B 10 1104182245 0 PO BOX 5081 JANESVILLE WI 535475081 20 1104182245 0 Physicians Anesthesia Services 20 1104182245 0 Physicians Healthy Kids Services 20 1104182245 0 Physicians Optical Supplies 20 1104182245 0 Physicians Physician Services 00 1104182831 0 COTTERELL SPENCER 2016208 9999999 B 10 1104182831 0 300 WINDING WOODS DR STE 200 O FALLON MO 633665081 20 1104182831 0 Physicians Anesthesia Services 20 1104182831 0 Physicians Healthy Kids Services 20 1104182831 0 Physicians Optical Supplies 20 1104182831 0 Physicians Physician Services 00 1104183169 0 SIPE WHITNEY 2017088 9999999 B 10 1104183169 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1104183169 0 Physicians Anesthesia Services 20 1104183169 0 Physicians Healthy Kids Services 20 1104183169 0 Physicians Optical Supplies 20 1104183169 0 Physicians Physician Services 00 1104183417 0 HUANG JONATHAN H 2018183 9999999 B 10 1104183417 0 2000 OGDEN AVE AURORA IL 605047222 20 1104183417 0 Physicians Anesthesia Services 20 1104183417 0 Physicians Healthy Kids Services 20 1104183417 0 Physicians Optical Supplies 20 1104183417 0 Physicians Physician Services 00 1104183482 0 BEAVER BRYAN P 2021143 9999999 B 10 1104183482 0 4000 CAMBRIDGE ST KANSAS CITY KS 661600001 20 1104183482 0 Physicians Anesthesia Services 20 1104183482 0 Physicians Healthy Kids Services 20 1104183482 0 Physicians Optical Supplies 20 1104183482 0 Physicians Physician Services 00 1104183516 0 JANDRIN LACEY 2022115 9999999 B 10 1104183516 0 PO BOX 28900 GREEN BAY WI 543240900 20 1104183516 0 Physician Assistant Only Fluoride varnish 20 1104183516 0 Physician Assistant Only Healthy Kids Services 20 1104183516 0 Physician 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Services 00 1104184878 0 COULTER KATHERINE 2012183 9999999 B 10 1104184878 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1104184878 0 Nurse Practitioners Fluoride varnish 20 1104184878 0 Nurse Practitioners Healthy Kids Services 20 1104184878 0 Nurse Practitioners Nurse Practitioners Services 20 1104184878 0 Nurse Practitioners Physician Services 00 1104185065 0 KRZYMINSKI REBECCA 2024003 9999999 B 10 1104185065 0 PO BOX 1437 COLUMBUS GA 319021437 20 1104185065 0 Physicians Anesthesia Services 20 1104185065 0 Physicians Healthy Kids Services 20 1104185065 0 Physicians Optical Supplies 20 1104185065 0 Physicians Physician Services 00 1104185511 0 BUCHANAN SHEENA 2024193 9999999 B 10 1104185511 0 PO BOX 632122 CINCINNATI OH 452632122 20 1104185511 0 Physicians Anesthesia Services 20 1104185511 0 Physicians Fluoride varnish 20 1104185511 0 Physicians Healthy Kids Services 20 1104185511 0 Physicians Optical Supplies 20 1104185511 0 Physicians Physician Services 00 1104186584 0 IPSARO ANNA 2018001 9999999 B 10 1104186584 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1104186584 0 Physicians Anesthesia Services 20 1104186584 0 Physicians Fluoride varnish 20 1104186584 0 Physicians Healthy Kids Services 20 1104186584 0 Physicians Optical Supplies 20 1104186584 0 Physicians Physician Services 00 1104187145 0 MONTGOMERY SACHA 2024024 9999999 B 10 1104187145 0 2348 POST RD STE 107 WARWICK RI 028862271 20 1104187145 0 Other behavior health professional LCPC/LMFT services 00 1104188267 0 KHAN ASAM 2015201 9999999 B 10 1104188267 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1104188267 0 Physicians Anesthesia Services 20 1104188267 0 Physicians Fluoride varnish 20 1104188267 0 Physicians Healthy Kids Services 20 1104188267 0 Physicians Optical Supplies 20 1104188267 0 Physicians Physician Services 00 1104188416 0 STYSLY BRET 2024024 9999999 B 10 1104188416 0 29980 NETWORK PL CHICAGO IL 606730968 20 1104188416 0 Physicians Anesthesia Services 20 1104188416 0 Physicians 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Fluoride varnish 20 1104190057 0 Nurse Practitioners Healthy Kids Services 20 1104190057 0 Nurse Practitioners Nurse Practitioners Services 20 1104190057 0 Nurse Practitioners Physician Services 00 1104190867 0 NELSON LISA 2016069 9999999 B 10 1104190867 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1104190867 0 Other behavior health professional All Kids application agent 20 1104190867 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1104191253 0 MEIER JAMES 2014156 9999999 B 10 1104191253 0 28594 NETWORK PL CHICAGO IL 606731285 20 1104191253 0 Clinical Social Worker Social work service 00 1104191444 0 AHMED SAMEER 2018156 9999999 B 10 1104191444 0 PO BOX 778791 CHICAGO IL 606776473 20 1104191444 0 Physicians Anesthesia Services 20 1104191444 0 Physicians Healthy Kids Services 20 1104191444 0 Physicians Optical Supplies 20 1104191444 0 Physicians Physician Services 00 1104191881 0 GARCIA MIRYAM N 2018072 9999999 B 10 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20 1104195973 0 Physicians Fluoride varnish 20 1104195973 0 Physicians Healthy Kids Services 20 1104195973 0 Physicians Optical Supplies 20 1104195973 0 Physicians Physician Services 00 1104196294 0 GOOD JEREMY 2016280 9999999 B 10 1104196294 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1104196294 0 Physician Assistant Only Fluoride varnish 20 1104196294 0 Physician Assistant Only Healthy Kids Services 20 1104196294 0 Physician Assistant Only Physician Services 00 1104196641 0 ADEKOLA HENRY 2017125 9999999 B 10 1104196641 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1104196641 0 Physicians Anesthesia Services 20 1104196641 0 Physicians Healthy Kids Services 20 1104196641 0 Physicians Optical Supplies 20 1104196641 0 Physicians Physician Services 00 1104200625 0 KETCHUM ALYSSA B 2016237 9999999 B 10 1104200625 0 5777 DEPT CAROL STREAM IL 601220021 20 1104200625 0 Physician Assistant Only Fluoride varnish 20 1104200625 0 Physician Assistant Only Healthy Kids Services 20 1104200625 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Services 20 1104213560 0 Physicians Optical Supplies 20 1104213560 0 Physicians Physician Services 00 1104214287 0 HIDALGO CRISCIEL P 2015001 9999999 B 10 1104214287 0 PO BOX 2477 SHELTON CT 064841477 20 1104214287 0 Nurse Practitioners Healthy Kids Services 20 1104214287 0 Nurse Practitioners Nurse Practitioners Services 20 1104214287 0 Nurse Practitioners Physician Services 00 1104215441 0 RUSSO JOSEPH 2024016 9999999 B 10 1104215441 0 29373 NETWORK PL CHICAGO IL 606733039 20 1104215441 0 Physical Therapists Medical Supplies 20 1104215441 0 Physical Therapists Medical equipment/prosthetic devices 20 1104215441 0 Physical Therapists Physical Therapy Services 00 1104216704 0 MORENO REBECCA R 2016041 9999999 B 10 1104216704 0 4600 3RD ST MOLINE IL 612656106 20 1104216704 0 Other behavior health professional LCPC/LMFT services 00 1104216944 0 BARRETT WALLACE H 2015040 9999999 B 10 1104216944 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1104216944 0 Nurse Practitioners 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Practitioners Nurse Practitioners Services 20 1104224575 0 Nurse Practitioners Physician Services 00 1104225648 0 CHIPEPO MWEEMBA 2020060 9999999 B 10 1104225648 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1104225648 0 Nurse Practitioners Healthy Kids Services 20 1104225648 0 Nurse Practitioners Nurse Practitioners Services 20 1104225648 0 Nurse Practitioners Physician Services 00 1104226166 0 DOYLE KURT P 2015148 9999999 B 10 1104226166 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1104226166 0 Other behavior health professional Social work service 00 1104226562 0 KLUETER AMELIA 2020269 9999999 B 10 1104226562 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1104226562 0 Nurse Practitioners Healthy Kids Services 20 1104226562 0 Nurse Practitioners Nurse Practitioners Services 20 1104226562 0 Nurse Practitioners Physician Services 00 1104227115 0 FREEMAN SARAH E 2014305 9999999 B 10 1104227115 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1104227115 0 Nurse Practitioners Healthy Kids Services 20 1104227115 0 Nurse Practitioners Nurse Practitioners Services 20 1104227115 0 Nurse Practitioners Physician Services 00 1104227313 0 HUNTER BASS SANDRA 2015295 9999999 B 10 1104227313 0 6127 S UNIVERSITY AVE CHICAGO IL 606375894 20 1104227313 0 Clinical Social Worker Social work service 00 1104230218 0 TALEB AMEEN 2017194 9999999 B 10 1104230218 0 515 22ND AVE MONROE WI 535661569 20 1104230218 0 Physicians Anesthesia Services 20 1104230218 0 Physicians Healthy Kids Services 20 1104230218 0 Physicians Optical Supplies 20 1104230218 0 Physicians Physician Services 00 1104230523 0 WHITE GARY 2019137 9999999 B 10 1104230523 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1104230523 0 Physicians Anesthesia Services 20 1104230523 0 Physicians Healthy Kids Services 20 1104230523 0 Physicians Optical Supplies 20 1104230523 0 Physicians Physician Services 00 1104230580 0 KURIAN ELIZABETH M 2018246 9999999 B 10 1104230580 0 8311 ROOSEVELT RD FOREST PARK IL 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Services 20 1104234053 0 Nurse Practitioners Physician Services 00 1104234087 0 MCCARTHY LAUREN 2014182 9999999 B 10 1104234087 0 PO BOX 772 MC2295 WOONSOCKET RI 028950784 20 1104234087 0 Nurse Practitioners Fluoride varnish 20 1104234087 0 Nurse Practitioners Healthy Kids Services 20 1104234087 0 Nurse Practitioners Nurse Practitioners Services 20 1104234087 0 Nurse Practitioners Physician Services 00 1104234129 0 MILCZARSKI JENNIFER N 2024030 9999999 B 10 1104234129 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1104234129 0 Nurse Practitioners Anesthesia Services 20 1104234129 0 Nurse Practitioners Nurse Practitioners Services 20 1104234129 0 Nurse Practitioners Physician Services 00 1104235308 0 KOIRALA PRADHAN SHANTI 2020329 9999999 B 10 1104235308 0 PO BOX 43230 PHOENIX AZ 850803230 20 1104235308 0 Physicians Anesthesia Services 20 1104235308 0 Physicians Fluoride varnish 20 1104235308 0 Physicians Healthy Kids Services 20 1104235308 0 Physicians Optical Supplies 20 1104235308 0 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1104253319 0 2011 N KNOXVILLE AVE PEORIA IL 616032414 20 1104253319 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1104253616 0 ESPINOSA JULIA A 2014056 9999999 B 10 1104253616 0 9033 27TH ST BROOKFIELD IL 605131011 20 1104253616 0 Speech Therapists Medical Supplies 20 1104253616 0 Speech Therapists Medical equipment/prosthetic devices 20 1104253616 0 Speech Therapists Speech Therapy/Pathology Services 00 1104253806 0 GOMEZ CHRISTY A 2015348 9999999 B 10 1104253806 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1104253806 0 Nurse Practitioners Healthy Kids Services 20 1104253806 0 Nurse Practitioners Nurse Practitioners Services 20 1104253806 0 Nurse Practitioners Physician Services 00 1104253830 0 CALDERON JESSICA 2014246 9999999 B 10 1104253830 0 11943 PINE AVE LEMONT IL 604394507 20 1104253830 0 Speech Therapists Medical Supplies 20 1104253830 0 Speech Therapists Medical equipment/prosthetic devices 20 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3039 OAK BROOK IL 605223039 20 1104263193 0 Dentists Anesthesia Services 20 1104263193 0 Dentists Dental Services 20 1104263193 0 Dentists Physician Services 00 1104263490 0 WARCHOL JORDAN M 2020029 9999999 B 10 1104263490 0 988102 NEBRASKA MEDICAL CTR OMAHA NE 681988102 20 1104263490 0 Physicians Anesthesia Services 20 1104263490 0 Physicians Healthy Kids Services 20 1104263490 0 Physicians Optical Supplies 20 1104263490 0 Physicians Physician Services 00 1104263573 0 BAWANY SALMAN 2023221 9999999 B 10 1104263573 0 PO BOX 43230 PHOENIX AZ 850803230 20 1104263573 0 Physicians Anesthesia Services 20 1104263573 0 Physicians Healthy Kids Services 20 1104263573 0 Physicians Optical Supplies 20 1104263573 0 Physicians Physician Services 00 1104264506 0 PATEL YOGEN 2018320 9999999 B 10 1104264506 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1104264506 0 Physicians Anesthesia Services 20 1104264506 0 Physicians Healthy Kids Services 20 1104264506 0 Physicians Optical Supplies 20 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606118709 20 1104314921 0 Physicians Anesthesia Services 20 1104314921 0 Physicians Healthy Kids Services 20 1104314921 0 Physicians Optical Supplies 20 1104314921 0 Physicians Physician Services 00 1104315571 0 MEDICI KATHLEEN 2018162 9999999 B 10 1104315571 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1104315571 0 Nurse Practitioners Fluoride varnish 20 1104315571 0 Nurse Practitioners Healthy Kids Services 20 1104315571 0 Nurse Practitioners Nurse Practitioners Services 20 1104315571 0 Nurse Practitioners Physician Services 00 1104316058 0 SOUTHERLAND DANIELLE M 2021188 9999999 B 10 1104316058 0 5777 DEPT CAROL STREAM IL 601228942 20 1104316058 0 Physicians Anesthesia Services 20 1104316058 0 Physicians Fluoride varnish 20 1104316058 0 Physicians Healthy Kids Services 20 1104316058 0 Physicians Optical Supplies 20 1104316058 0 Physicians Physician Services 00 1104316363 0 MONPARA POOJA 2021299 9999999 B 10 1104316363 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1104316363 0 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Physicians Anesthesia Services 20 1104320191 0 Physicians Fluoride varnish 20 1104320191 0 Physicians Healthy Kids Services 20 1104320191 0 Physicians Optical Supplies 20 1104320191 0 Physicians Physician Services 00 1104320225 0 WHITE MELISSA 2023237 9999999 B 10 1104320225 0 PO BOX 959794 SAINT LOUIS MO 631959794 20 1104320225 0 Nurse Practitioners Anesthesia Services 20 1104320225 0 Nurse Practitioners Fluoride varnish 20 1104320225 0 Nurse Practitioners Healthy Kids Services 20 1104320225 0 Nurse Practitioners Optical Supplies 20 1104320225 0 Nurse Practitioners Physician Services 00 1104321090 0 JORDAN ADAM T 2021162 9999999 B 10 1104321090 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1104321090 0 Physicians Anesthesia Services 20 1104321090 0 Physicians Fluoride varnish 20 1104321090 0 Physicians Healthy Kids Services 20 1104321090 0 Physicians Optical Supplies 20 1104321090 0 Physicians Physician Services 00 1104321272 0 HALEY BRIDGET M 2018176 9999999 B 10 1104321272 0 29373 NETWORK PL CHICAGO IL 606733039 20 1104321272 0 Physicians Anesthesia Services 20 1104321272 0 Physicians Fluoride varnish 20 1104321272 0 Physicians Healthy Kids Services 20 1104321272 0 Physicians Optical Supplies 20 1104321272 0 Physicians Physician Services 00 1104321421 0 ONSEN LEONARD T 2018198 9999999 B 10 1104321421 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1104321421 0 Physicians Anesthesia Services 20 1104321421 0 Physicians Healthy Kids Services 20 1104321421 0 Physicians Optical Supplies 20 1104321421 0 Physicians Physician Services 00 1104321884 0 ABDO NICOLE 2022284 9999999 B 10 1104321884 0 1232 W STATE ROAD 2 LA PORTE IN 463505469 20 1104321884 0 Physicians Anesthesia Services 20 1104321884 0 Physicians Healthy Kids Services 20 1104321884 0 Physicians Optical Supplies 20 1104321884 0 Physicians Physician Services 00 1104322676 0 SLATEN ALEXANDER 2021179 9999999 B 10 1104322676 0 250 W 96TH ST STE 520 INDIANAPOLIS IN 462601316 20 1104322676 0 Physicians Anesthesia 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Physicians Fluoride varnish 20 1104323658 0 Physicians Healthy Kids Services 20 1104323658 0 Physicians Optical Supplies 20 1104323658 0 Physicians Physician Services 00 1104323666 0 MULLER BRITTANY N 2021274 9999999 B 10 1104323666 0 PO BOX 843033 KANSAS CITY MO 641843033 20 1104323666 0 Physicians Anesthesia Services 20 1104323666 0 Physicians Healthy Kids Services 20 1104323666 0 Physicians Optical Supplies 20 1104323666 0 Physicians Physician Services 00 1104324342 0 SILVER MELISSA 2018001 9999999 B 10 1104324342 0 445 SHERIDAN RD HIGHWOOD IL 600401317 20 1104324342 0 Speech Therapists Medical Supplies 20 1104324342 0 Speech Therapists Medical equipment/prosthetic devices 20 1104324342 0 Speech Therapists Speech Therapy/Pathology Services 00 1104324615 0 FLORES ELIZABETH NMN 2020042 9999999 B 10 1104324615 0 PO BOX 14099 BELFAST ME 049154034 20 1104324615 0 Nurse Practitioners Healthy Kids Services 20 1104324615 0 Nurse Practitioners Nurse Practitioners Services 20 1104324615 0 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2018057 9999999 B 10 1104334945 0 2801 NETWORK BLVD STE 505 FRISCO TX 750341895 20 1104334945 0 Nurse Practitioners Fluoride varnish 20 1104334945 0 Nurse Practitioners Healthy Kids Services 20 1104334945 0 Nurse Practitioners Nurse Practitioners Services 20 1104334945 0 Nurse Practitioners Physician Services 00 1104335546 0 SPANGLER LINDSEY M 2017305 9999999 B 10 1104335546 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1104335546 0 Nurse Practitioners Healthy Kids Services 20 1104335546 0 Nurse Practitioners Nurse Practitioners Services 20 1104335546 0 Nurse Practitioners Physician Services 00 1104335660 0 THETFORD MARK 2023269 9999999 B 10 1104335660 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1104335660 0 Nurse Practitioners Anesthesia Services 20 1104335660 0 Nurse Practitioners Nurse Practitioners Services 20 1104335660 0 Nurse Practitioners Physician Services 00 1104336023 0 POST TIFFANY R 2021257 9999999 B 10 1104336023 0 221 NE GLEN OAK AVE ATTN: STEPHEN CIRONE GOMP 100 PEORIA 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Nurse Practitioners Healthy Kids Services 20 1104337369 0 Nurse Practitioners Nurse Practitioners Services 20 1104337369 0 Nurse Practitioners Physician Services 00 1104337757 0 BELITZ JENNIFER L 2017324 9999999 B 10 1104337757 0 10480 NEBRASKA ST FRANKFORT IL 604232235 20 1104337757 0 Speech Therapists Medical Supplies 20 1104337757 0 Speech Therapists Medical equipment/prosthetic devices 20 1104337757 0 Speech Therapists Speech Therapy/Pathology Services 00 1104337872 0 SHAH KOMAL 2019084 9999999 H 10 1104337872 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1104337872 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1104337948 0 GREEN LYDIA 2017332 9999999 B 10 1104337948 0 410 E WASHINGTON ST DOWNS IL 617369380 20 1104337948 0 Speech Therapists Medical Supplies 20 1104337948 0 Speech Therapists Medical equipment/prosthetic devices 20 1104337948 0 Speech Therapists Speech Therapy/Pathology Services 00 1104338318 0 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IL 611075090 20 1104356831 0 Physicians Anesthesia Services 20 1104356831 0 Physicians Healthy Kids Services 20 1104356831 0 Physicians Optical Supplies 20 1104356831 0 Physicians Physician Services 00 1104356997 0 KRACIUN MATTHEW K 2020182 9999999 B 10 1104356997 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1104356997 0 Physicians Anesthesia Services 20 1104356997 0 Physicians Fluoride varnish 20 1104356997 0 Physicians Healthy Kids Services 20 1104356997 0 Physicians Optical Supplies 20 1104356997 0 Physicians Physician Services 00 1104357391 0 PURUSHOTHAMAN PRIYA 2018346 9999999 B 10 1104357391 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1104357391 0 Physicians Anesthesia Services 20 1104357391 0 Physicians Fluoride varnish 20 1104357391 0 Physicians Healthy Kids Services 20 1104357391 0 Physicians Optical Supplies 20 1104357391 0 Physicians Physician Services 20 1104357391 0 Physicians Physicians Psychiatric Services 00 1104357466 0 MINGA IVA 2018352 9999999 B 10 1104357466 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Practitioners Physician Services 00 1104370519 0 SHARMA RITIKA 2023038 9999999 B 10 1104370519 0 101 E 9TH ST PANA IL 625571716 20 1104370519 0 Physicians Anesthesia Services 20 1104370519 0 Physicians Fluoride varnish 20 1104370519 0 Physicians Healthy Kids Services 20 1104370519 0 Physicians Optical Supplies 20 1104370519 0 Physicians Physician Services 00 1104370998 0 SCHMIDT ALYSSA 2016342 9999999 B 10 1104370998 0 4230 11TH ST ROCK ISLAND IL 612016746 20 1104370998 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1104372952 0 ZEZNANSKI AMY M 2018073 9999999 B 10 1104372952 0 6742 N FROSTWOOD PKWY PEORIA IL 616152402 20 1104372952 0 Nurse Practitioners Anesthesia Services 20 1104372952 0 Nurse Practitioners Nurse Practitioners Services 20 1104372952 0 Nurse Practitioners Physician Services 00 1104373596 0 GUTIERREZ MICHAEL 2016267 9999999 H 10 1104373596 0 10001 GRAND AVE ATTN: BILLING DEPARTMENT FRANKLIN PARK IL 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Optical Supplies 20 1104384791 0 Physicians Physician Services 00 1104385046 0 SHEHERYAR QURATULANNE 2019182 9999999 B 10 1104385046 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1104385046 0 Physicians Anesthesia Services 20 1104385046 0 Physicians Healthy Kids Services 20 1104385046 0 Physicians Optical Supplies 20 1104385046 0 Physicians Physician Services 20 1104385046 0 Physicians Physicians Psychiatric Services 00 1104385103 0 LEE JONATHAN B 2024244 9999999 B 10 1104385103 0 500 PASTEUR DR PALO ALTO CA 943041048 20 1104385103 0 Physicians Anesthesia Services 20 1104385103 0 Physicians Healthy Kids Services 20 1104385103 0 Physicians Optical Supplies 20 1104385103 0 Physicians Physician Services 00 1104385376 0 WARWAR SAMANTHA 2018346 9999999 B 10 1104385376 0 4698 DEPT CAROL STREAM IL 601220021 20 1104385376 0 Physicians Anesthesia Services 20 1104385376 0 Physicians Healthy Kids Services 20 1104385376 0 Physicians Optical Supplies 20 1104385376 0 Physicians Physician Services 00 1104385541 0 DULANTO ANDREINA 2023262 9999999 B 10 1104385541 0 2001 S CALIFORNIA AVE CHICAGO IL 606082486 20 1104385541 0 Dentists Dental Services 20 1104385541 0 Dentists Physician Services 00 1104386366 0 MELFI GIANA 2021019 9999999 B 10 1104386366 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1104386366 0 Psychologist Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1104387166 0 JANI RONAK 2020216 9999999 B 10 1104387166 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1104387166 0 Physicians Anesthesia Services 20 1104387166 0 Physicians Healthy Kids Services 20 1104387166 0 Physicians Optical Supplies 20 1104387166 0 Physicians Physician Services 00 1104387505 0 IRISH AMANDA 2023226 9999999 B 10 1104387505 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1104387505 0 Physicians Anesthesia Services 20 1104387505 0 Physicians Healthy Kids Services 20 1104387505 0 Physicians Optical Supplies 20 1104387505 0 Physicians Physician Services 00 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1611 CHICAGO IL 606751611 20 1104392380 0 Clinical Social Worker Social work service 00 1104392497 0 KETHCART MICHELLE 2018305 9999999 B 10 1104392497 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1104392497 0 Nurse Practitioners Fluoride varnish 20 1104392497 0 Nurse Practitioners Healthy Kids Services 20 1104392497 0 Nurse Practitioners Nurse Practitioners Services 20 1104392497 0 Nurse Practitioners Physician Services 00 1104392729 0 LOGTERMAN NATASHA 2024072 9999999 B 10 1104392729 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1104392729 0 Registered nurse Nursing service 20 1104392729 0 Registered nurse Waiver service 00 1104392828 0 DAHLEH AMINA 2018339 9999999 B 10 1104392828 0 17430 92ND AVE TINLEY PARK IL 604875235 20 1104392828 0 Other behavior health professional LCPC/LMFT services 00 1104393115 0 THOMAS LAURALEA 2021054 9999999 B 10 1104393115 0 201 S GRAND AVE E SPRINGFIELD IL 627631000 20 1104393115 0 Nurse Practitioners Fluoride varnish 20 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1104478080 0 Physician Assistant Only Healthy Kids Services 20 1104478080 0 Physician Assistant Only Physician Services 00 1104478494 0 BENDER JEANNETTE M 2021147 9999999 B 10 1104478494 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1104478494 0 Nurse Practitioners Fluoride varnish 20 1104478494 0 Nurse Practitioners Healthy Kids Services 20 1104478494 0 Nurse Practitioners Nurse Practitioners Services 20 1104478494 0 Nurse Practitioners Physician Services 00 1104478932 0 WINDHAM BENJAMIN 2024275 9999999 B 10 1104478932 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1104478932 0 Nurse Practitioners Fluoride varnish 20 1104478932 0 Nurse Practitioners Healthy Kids Services 20 1104478932 0 Nurse Practitioners Nurse Practitioners Services 20 1104478932 0 Nurse Practitioners Physician Services 00 1104479070 0 BOSS TRAVIS 2024347 9999999 B 10 1104479070 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1104479070 0 Other behavior health professional Other Behavioral Health 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9999999 B 10 1104480995 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1104480995 0 Nurse Practitioners Fluoride varnish 20 1104480995 0 Nurse Practitioners Healthy Kids Services 20 1104480995 0 Nurse Practitioners Nurse Practitioners Services 20 1104480995 0 Nurse Practitioners Physician Services 00 1104481332 0 BUCK AMANDA L 2019226 9999999 B 10 1104481332 0 777 LOWNDES HILL RD BLDG 1 GREENVILLE SC 296072101 20 1104481332 0 Physicians Anesthesia Services 20 1104481332 0 Physicians Healthy Kids Services 20 1104481332 0 Physicians Optical Supplies 20 1104481332 0 Physicians Physician Services 00 1104484328 0 ROZO MARIA C 2023157 9999999 B 10 1104484328 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1104484328 0 Physicians Anesthesia Services 20 1104484328 0 Physicians Fluoride varnish 20 1104484328 0 Physicians Healthy Kids Services 20 1104484328 0 Physicians Optical Supplies 20 1104484328 0 Physicians Physician Services 00 1104484633 0 GOAD COURTNEY E 2019284 9999999 B 10 1104484633 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1104484633 0 Physician Assistant Only Fluoride varnish 20 1104484633 0 Physician Assistant Only Healthy Kids Services 20 1104484633 0 Physician Assistant Only Physician Services 00 1104485978 0 KUXHAUSE JESSICA A 2024005 9999999 B 10 1104485978 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1104485978 0 Physicians Anesthesia Services 20 1104485978 0 Physicians Healthy Kids Services 20 1104485978 0 Physicians Optical Supplies 20 1104485978 0 Physicians Physician Services 00 1104486075 0 STEINBEISSER SADIE A 2024254 9999999 B 10 1104486075 0 1641 N MILWAUKEE AVE STE 10 LIBERTYVILLE IL 600481350 20 1104486075 0 Optometrists Optical Supplies 20 1104486075 0 Optometrists Optometric Services 20 1104486075 0 Optometrists Physician Services 00 1104487495 0 OPENLANDER BRIAN 2022179 9999999 B 10 1104487495 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1104487495 0 Physicians Anesthesia Services 20 1104487495 0 Physicians Healthy Kids Services 20 1104487495 0 Physicians Optical Supplies 20 1104487495 0 Physicians Physician Services 00 1104487826 0 AHMAD AHMAD 2019182 9999999 B 10 1104487826 0 1120 N MELVIN ST GIBSON CITY IL 609361477 20 1104487826 0 Dentists Dental Services 20 1104487826 0 Dentists Physician Services 00 1104488360 0 DATON MEGAN K 2021018 9999999 B 10 1104488360 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1104488360 0 Nurse Practitioners Healthy Kids Services 20 1104488360 0 Nurse Practitioners Nurse Practitioners Services 20 1104488360 0 Nurse Practitioners Physician Services 00 1104488865 0 HELD ADAM 2020029 9999999 B 10 1104488865 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1104488865 0 Physicians Anesthesia Services 20 1104488865 0 Physicians Fluoride varnish 20 1104488865 0 Physicians Healthy Kids Services 20 1104488865 0 Physicians Optical Supplies 20 1104488865 0 Physicians Physician Services 00 1104489251 0 KURUVILLA MICHELLE 2022242 9999999 B 10 1104489251 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1104489251 0 Physicians Anesthesia Services 20 1104489251 0 Physicians Fluoride varnish 20 1104489251 0 Physicians Healthy Kids Services 20 1104489251 0 Physicians Optical Supplies 20 1104489251 0 Physicians Physician Services 00 1104489624 0 CHANDAN NAINA 2020076 9999999 B 10 1104489624 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1104489624 0 Physicians Anesthesia Services 20 1104489624 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1104489624 0 Physicians Fluoride varnish 20 1104489624 0 Physicians Healthy Kids Services 20 1104489624 0 Physicians Optical Supplies 20 1104489624 0 Physicians Physician Services 00 1104492107 0 SIGURDARDOTTIR ESTER 2021154 9999999 B 10 1104492107 0 2003 W FULTON ST STE 303 CHICAGO IL 606122345 20 1104492107 0 Psychologist Psychologist service 00 1104492958 0 SALTOW KIMBERLY M 2024253 9999999 B 10 1104492958 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1104492958 0 Nurse Practitioners Healthy Kids Services 20 1104492958 0 Nurse Practitioners Nurse Practitioners Services 20 1104492958 0 Nurse Practitioners Physician Services 00 1104494558 0 BALSAMELLO JENNIFER 2022361 9999999 B 10 1104494558 0 238 S CONGRESS ST RUSHVILLE IL 626811465 20 1104494558 0 Nurse Practitioners Fluoride varnish 20 1104494558 0 Nurse Practitioners Healthy Kids Services 20 1104494558 0 Nurse Practitioners Nurse Practitioners Services 20 1104494558 0 Nurse Practitioners Physician Services 00 1104494665 0 MORA HERNANDEZ STEPHANIE 2021265 9999999 B 10 1104494665 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1104494665 0 Nurse Practitioners Healthy Kids Services 20 1104494665 0 Nurse Practitioners Nurse Practitioners Services 20 1104494665 0 Nurse Practitioners Physician Services 00 1104494673 0 WHEAT EMILY 2023087 9999999 B 10 1104494673 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1104494673 0 Physicians Anesthesia Services 20 1104494673 0 Physicians Fluoride varnish 20 1104494673 0 Physicians Healthy Kids Services 20 1104494673 0 Physicians Optical Supplies 20 1104494673 0 Physicians Physician Services 00 1104494699 0 GANNON MARGARET 2021221 9999999 B 10 1104494699 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1104494699 0 Physicians Anesthesia Services 20 1104494699 0 Physicians Healthy Kids Services 20 1104494699 0 Physicians Optical Supplies 20 1104494699 0 Physicians Physician Services 00 1104494798 0 WILLIAMS KENDRICK 2021182 9999999 B 10 1104494798 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1104494798 0 Physicians Anesthesia Services 20 1104494798 0 Physicians Fluoride varnish 20 1104494798 0 Physicians Healthy Kids Services 20 1104494798 0 Physicians Optical Supplies 20 1104494798 0 Physicians Physician Services 00 1104494863 0 LOH FRANCIS E 2023339 9999999 B 10 1104494863 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1104494863 0 Physicians Anesthesia Services 20 1104494863 0 Physicians Fluoride varnish 20 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Physicians Healthy Kids Services 20 1104496454 0 Physicians Optical Supplies 20 1104496454 0 Physicians Physician Services 00 1104498047 0 KESEL CHELSEA 2023164 9999999 B 10 1104498047 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1104498047 0 Speech Therapists Medical Supplies 20 1104498047 0 Speech Therapists Medical equipment/prosthetic devices 20 1104498047 0 Speech Therapists Speech Therapy/Pathology Services 00 1104498369 0 LOHBECK BRADLEY 2024298 9999999 B 10 1104498369 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1104498369 0 Physical Therapists Medical Supplies 20 1104498369 0 Physical Therapists Medical equipment/prosthetic devices 20 1104498369 0 Physical Therapists Physical Therapy Services 00 1104499102 0 BAZZANELLA NINA 2023031 9999999 B 10 1104499102 0 719 N MARION ST OAK PARK IL 603021530 20 1104499102 0 Speech Therapists Medical Supplies 20 1104499102 0 Speech Therapists Medical equipment/prosthetic devices 20 1104499102 0 Speech Therapists Speech 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Physicians Healthy Kids Services 20 1104672815 0 Physicians Optical Supplies 20 1104672815 0 Physicians Physician Services 00 1104672914 0 AKHRAS LUAI 2024170 9999999 B 10 1104672914 0 2500 W NORTH AVE CHICAGO IL 606475202 20 1104672914 0 Dentists Dental Services 20 1104672914 0 Dentists Physician Services 00 1104674050 0 VENTURA EVIE S 2024180 9999999 B 10 1104674050 0 5113 S HARPER AVE STE 2C CHICAGO IL 606154119 20 1104674050 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1104674423 0 MITCHELL NIA A 2024190 9999999 B 10 1104674423 0 5113 S HARPER AVE STE 2C CHICAGO IL 606154119 20 1104674423 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1104674969 0 ZIELINSKI BRIGIT 2024177 9999999 B 10 1104674969 0 5777 DEPT CAROL STREAM IL 601220021 20 1104674969 0 Nurse Practitioners Healthy Kids Services 20 1104674969 0 Nurse Practitioners Nurse 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Services 00 1104677954 0 KOZIOL SOPHIA 2024184 9999999 B 10 1104677954 0 PO BOX 3039 OAK BROOK IL 605223039 20 1104677954 0 Physicians Anesthesia Services 20 1104677954 0 Physicians Fluoride varnish 20 1104677954 0 Physicians Healthy Kids Services 20 1104677954 0 Physicians Optical Supplies 20 1104677954 0 Physicians Physician Services 00 1104678093 0 HABTEMARIAM MICHAEL SEMERE 2024324 9999999 B 10 1104678093 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1104678093 0 Physicians Anesthesia Services 20 1104678093 0 Physicians Fluoride varnish 20 1104678093 0 Physicians Healthy Kids Services 20 1104678093 0 Physicians Optical Supplies 20 1104678093 0 Physicians Physician Services 00 1104681808 0 SNOW TIFFANY N 2024298 9999999 B 10 1104681808 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1104681808 0 Physician Assistant Only Fluoride varnish 20 1104681808 0 Physician Assistant Only Healthy Kids Services 20 1104681808 0 Physician Assistant Only Physician Services 00 1104683762 0 FISH MEGAN 2024116 9999999 B 10 1104683762 0 5777 DEPT CAROL STREAM IL 601228942 20 1104683762 0 Nurse Practitioners Healthy Kids Services 20 1104683762 0 Nurse Practitioners Nurse Practitioners Services 20 1104683762 0 Nurse Practitioners Physician Services 00 1104685312 0 ORLANDO VANESSA 2024191 9999999 B 10 1104685312 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1104685312 0 Physicians Anesthesia Services 20 1104685312 0 Physicians Healthy Kids Services 20 1104685312 0 Physicians Optical Supplies 20 1104685312 0 Physicians Physician Services 00 1104685411 0 TARA SEYEDEH 2024197 9999999 B 10 1104685411 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1104685411 0 Physicians Anesthesia Services 20 1104685411 0 Physicians Fluoride varnish 20 1104685411 0 Physicians Healthy Kids Services 20 1104685411 0 Physicians Optical Supplies 20 1104685411 0 Physicians Physician Services 00 1104686203 0 MANRIQUE MIRIAM 2024081 9999999 B 10 1104686203 0 5220 EAST AVE COUNTRYSIDE IL 605253133 20 1104686203 0 Nurse Practitioners Fluoride varnish 20 1104686203 0 Nurse Practitioners Healthy Kids Services 20 1104686203 0 Nurse Practitioners Nurse Practitioners Services 20 1104686203 0 Nurse Practitioners Physician Services 00 1104686534 0 HURT GRANT M 2024174 9999999 B 10 1104686534 0 4698 DEPT CAROL STREAM IL 601220021 20 1104686534 0 Physicians Anesthesia Services 20 1104686534 0 Physicians Healthy Kids Services 20 1104686534 0 Physicians Optical Supplies 20 1104686534 0 Physicians Physician Services 00 1104686922 0 FLORES EMMA PAIGE 2024080 9999999 B 10 1104686922 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1104686922 0 Clinical Social Worker Social work service 00 1104687904 0 NORMAN JESSICA 2024039 9999999 B 10 1104687904 0 350 N WALL ST KANKAKEE IL 609012901 20 1104687904 0 Nurse Practitioners Fluoride varnish 20 1104687904 0 Nurse Practitioners Healthy Kids Services 20 1104687904 0 Nurse Practitioners Nurse Practitioners Services 20 1104687904 0 Nurse Practitioners Physician Services 00 1104689017 0 KEEGAN ABAGAIL M 2024282 9999999 B 10 1104689017 0 5290 WILLIAMS DR ROSCOE IL 610739222 20 1104689017 0 Clinical Social Worker Social work service 00 1104691815 0 LOVE SHIRLISA 2024079 9999999 B 10 1104691815 0 10257 STATE ROUTE 3 RED BUD IL 622784418 20 1104691815 0 Nurse Practitioners Healthy Kids Services 20 1104691815 0 Nurse Practitioners Nurse Practitioners Services 20 1104691815 0 Nurse Practitioners Physician Services 00 1104691955 0 TRESTKA KAROLINE 2024130 9999999 B 10 1104691955 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1104691955 0 Nurse Practitioners Healthy Kids Services 20 1104691955 0 Nurse Practitioners Nurse Practitioners Services 20 1104691955 0 Nurse Practitioners Physician Services 00 1104693878 0 YANG HEE CHUL 2024001 9999999 B 10 1104693878 0 4698 DEPT CAROL STREAM IL 601220021 20 1104693878 0 Physicians Anesthesia Services 20 1104693878 0 Physicians Healthy Kids Services 20 1104693878 0 Physicians Optical Supplies 20 1104693878 0 Physicians Physician Services 00 1104694272 0 NIEZGODA RENATA K 2023361 9999999 B 10 1104694272 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1104694272 0 Registered nurse Nursing service 20 1104694272 0 Registered nurse Waiver service 00 1104697036 0 KOZLOWSKI ALEXIS 2024071 9999999 B 10 1104697036 0 1S450 SUMMIT AVE STE 270 OAKBROOK TERRAC IL 601813959 20 1104697036 0 Nurse Practitioners Fluoride varnish 20 1104697036 0 Nurse Practitioners Healthy Kids Services 20 1104697036 0 Nurse Practitioners Nurse Practitioners Services 20 1104697036 0 Nurse Practitioners Physician Services 00 1104697317 0 BRALEY MONICA M 2024016 9999999 B 10 1104697317 0 5220 6TH STREET FRONTAGE RD E SPRINGFIELD IL 627035771 20 1104697317 0 Other behavior health professional Adaptive behavior support technician services 00 1104800044 0 BYRKIT GRETCHEN 2000031 9999999 B 10 1104800044 0 1 MEMORIAL DR STE 216 DECATUR IL 625266321 20 1104800044 0 Physicians Anesthesia Services 20 1104800044 0 Physicians Healthy Kids Services 20 1104800044 0 Physicians Optical Supplies 20 1104800044 0 Physicians Physician Services 00 1104800416 0 JOHNSON BRIAN C 2009016 9999999 B 10 1104800416 0 225 S EXECUTIVE DR BROOKFIELD WI 530054257 20 1104800416 0 Physicians Anesthesia Services 20 1104800416 0 Physicians Healthy Kids Services 20 1104800416 0 Physicians Optical Supplies 20 1104800416 0 Physicians Physician Services 00 1104802016 0 GIRARDOT JEFFREY 1995101 9999999 B 10 1104802016 0 9500 BRYN MAWR AVE STE 300 ROSEMONT IL 600185257 20 1104802016 0 Physicians Anesthesia Services 20 1104802016 0 Physicians Healthy Kids Services 20 1104802016 0 Physicians Optical Supplies 20 1104802016 0 Physicians Physician Services 00 1104802156 0 ROSENTHAL ARNOLD N 1994196 9999999 B 10 1104802156 0 260 26TH ST PRAIRIE DU SAC WI 535782203 20 1104802156 0 Physicians Anesthesia Services 20 1104802156 0 Physicians Healthy Kids Services 20 1104802156 0 Physicians Optical Supplies 20 1104802156 0 Physicians Physician Services 00 1104802305 0 AHMAD ASHIK N 2023091 9999999 B 10 1104802305 0 PO BOX 43230 PHOENIX AZ 850803230 20 1104802305 0 Physicians Anesthesia Services 20 1104802305 0 Physicians Healthy Kids Services 20 1104802305 0 Physicians Optical Supplies 20 1104802305 0 Physicians Physician Services 00 1104802479 0 CRAVENS WILLIAM 2022195 9999999 B 10 1104802479 0 PO BOX 43230 PHOENIX AZ 850803230 20 1104802479 0 Physicians Anesthesia Services 20 1104802479 0 Physicians Fluoride varnish 20 1104802479 0 Physicians Healthy Kids Services 20 1104802479 0 Physicians Optical Supplies 20 1104802479 0 Physicians Physician Services 00 1104803105 0 HOFMEISTER ELIZABETH 2024345 9999999 B 10 1104803105 0 2825 W DIVISION ST MANTENO IL 609501002 20 1104803105 0 Podiatrists Podiatric Services 00 1104803295 0 NASSER TONY 1996001 9999999 B 10 1104803295 0 721 E COURT ST PARIS IL 619442460 20 1104803295 0 Physicians Anesthesia Services 20 1104803295 0 Physicians Fluoride varnish 20 1104803295 0 Physicians Healthy Kids Services 20 1104803295 0 Physicians Optical Supplies 20 1104803295 0 Physicians Physician Services 00 1104804038 0 WEED BRENT 2016145 9999999 B 10 1104804038 0 801 YORK ST MANITOWOC WI 542204630 20 1104804038 0 Physicians Anesthesia Services 20 1104804038 0 Physicians Healthy Kids Services 20 1104804038 0 Physicians Optical Supplies 20 1104804038 0 Physicians Physician Services 00 1104805092 0 MANAZIR FARAZ 1999213 9999999 B 10 1104805092 0 303 N JACKSON ST MORRISON IL 612703042 20 1104805092 0 Physicians Anesthesia Services 20 1104805092 0 Physicians Fluoride varnish 20 1104805092 0 Physicians Healthy Kids Services 20 1104805092 0 Physicians Optical Supplies 20 1104805092 0 Physicians Physician Services 00 1104808625 0 SHUMAN JOHN 2019001 9999999 B 10 1104808625 0 500 PORTER AVE AURORA MO 656052365 20 1104808625 0 Physician Assistant Only Fluoride varnish 20 1104808625 0 Physician Assistant Only Healthy Kids Services 20 1104808625 0 Physician Assistant Only Physician Services 00 1104809227 0 FITZSIMONS RICHARD 1987182 9999999 B 10 1104809227 0 10733 165TH ST ORLAND PARK IL 604678713 20 1104809227 0 Physicians Anesthesia Services 20 1104809227 0 Physicians Healthy Kids Services 20 1104809227 0 Physicians Optical Supplies 20 1104809227 0 Physicians Physician Services 00 1104809409 0 FEOLA ERICA 2023030 9999999 B 10 1104809409 0 800 W FULTON MARKET FL 12 CHICAGO IL 606071302 20 1104809409 0 Physician Assistant Only Fluoride varnish 20 1104809409 0 Physician Assistant Only Healthy Kids Services 20 1104809409 0 Physician Assistant Only Physician Services 00 1104809920 0 SPIRO DAVID 2023275 9999999 B 10 1104809920 0 PO BOX 959794 SAINT LOUIS MO 631959794 20 1104809920 0 Physicians Anesthesia Services 20 1104809920 0 Physicians Fluoride varnish 20 1104809920 0 Physicians Healthy Kids Services 20 1104809920 0 Physicians Optical Supplies 20 1104809920 0 Physicians Physician Services 00 1104810167 0 DART BENJAMIN W. 2016309 9999999 B 10 1104810167 0 979 E 3RD ST STE 300 CHATTANOOGA TN 374032187 20 1104810167 0 Physicians Anesthesia Services 20 1104810167 0 Physicians Healthy Kids Services 20 1104810167 0 Physicians Optical Supplies 20 1104810167 0 Physicians Physician Services 00 1104810191 0 NAGAR CHARULATHA P 2001182 9999999 B 10 1104810191 0 5777 DEPT CAROL STREAM IL 601220021 20 1104810191 0 Physicians Anesthesia Services 20 1104810191 0 Physicians Healthy Kids Services 20 1104810191 0 Physicians Optical Supplies 20 1104810191 0 Physicians Physician Services 20 1104810191 0 Physicians Physicians Psychiatric Services 00 1104810456 0 FILIPIUK DOROTA M 2005274 9999999 B 10 1104810456 0 355 RIDGE AVE EVANSTON IL 602023328 20 1104810456 0 Physicians Anesthesia Services 20 1104810456 0 Physicians Healthy Kids Services 20 1104810456 0 Physicians Optical Supplies 20 1104810456 0 Physicians Physician Services 00 1104811009 0 YAYLAYAN SHAHNOUR 1991177 9999999 B 10 1104811009 0 PO BOX 781076 DETROIT MI 482781076 20 1104811009 0 Physicians Anesthesia Services 20 1104811009 0 Physicians Healthy Kids Services 20 1104811009 0 Physicians Optical Supplies 20 1104811009 0 Physicians Physician Services 20 1104811009 0 Physicians Physicians Psychiatric Services 00 1104811223 0 STERN DARRYL A 2001130 9999999 B 10 1104811223 0 9669 KENTON AVE STE 203 SKOKIE IL 600761227 20 1104811223 0 Physicians Anesthesia Services 20 1104811223 0 Physicians Fluoride varnish 20 1104811223 0 Physicians Healthy Kids Services 20 1104811223 0 Physicians Optical Supplies 20 1104811223 0 Physicians Physician Services 00 1104811637 0 BARANCYK SNEZANA 2020205 9999999 B 10 1104811637 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1104811637 0 Nurse Practitioners Fluoride varnish 20 1104811637 0 Nurse Practitioners Healthy Kids Services 20 1104811637 0 Nurse Practitioners Nurse Practitioners Services 20 1104811637 0 Nurse Practitioners Physician Services 00 1104811678 0 CADMUS MAUREEN T 2016125 9999999 B 10 1104811678 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1104811678 0 Nurse Practitioners Healthy Kids Services 20 1104811678 0 Nurse Practitioners Nurse Practitioners Services 20 1104811678 0 Nurse Practitioners Physician Services 00 1104811876 0 STEIGER CHARLES 2020351 9999999 B 10 1104811876 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1104811876 0 Physicians Anesthesia Services 20 1104811876 0 Physicians Healthy Kids Services 20 1104811876 0 Physicians Optical Supplies 20 1104811876 0 Physicians Physician Services 00 1104812155 0 WILLIAMS JAMES 1999213 9999999 B 10 1104812155 0 6000 N ALLEN RD PEORIA IL 616143294 20 1104812155 0 Physicians Anesthesia Services 20 1104812155 0 Physicians Healthy Kids Services 20 1104812155 0 Physicians Optical Supplies 20 1104812155 0 Physicians Physician Services 00 1104812486 0 YELDANDI VIJAY 1988190 9999999 B 10 1104812486 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1104812486 0 Physicians Anesthesia Services 20 1104812486 0 Physicians Fluoride varnish 20 1104812486 0 Physicians Healthy Kids Services 20 1104812486 0 Physicians Optical Supplies 20 1104812486 0 Physicians Physician Services 00 1104812510 0 STRICKLAND JAMES C 2017001 9999999 B 10 1104812510 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1104812510 0 Physicians Anesthesia Services 20 1104812510 0 Physicians Healthy Kids Services 20 1104812510 0 Physicians Optical Supplies 20 1104812510 0 Physicians Physician Services 00 1104812528 0 BROBBEY WAHAB 2004275 9999999 B 10 1104812528 0 901 MCCLINTOCK DR STE 202 SUITE 202 BURR RIDGE IL 605270872 20 1104812528 0 Physicians Anesthesia Services 20 1104812528 0 Physicians Fluoride varnish 20 1104812528 0 Physicians Healthy Kids Services 20 1104812528 0 Physicians Optical Supplies 20 1104812528 0 Physicians Physician Services 00 1104813435 0 WHITE THOMAS 1986213 9999999 B 10 1104813435 0 2357 SEQUOIA DR AURORA IL 605066222 20 1104813435 0 Physicians Anesthesia Services 20 1104813435 0 Physicians Healthy Kids Services 20 1104813435 0 Physicians Optical Supplies 20 1104813435 0 Physicians Physician Services 00 1104813849 0 WRIGHT KEVIN R 2017068 9999999 B 10 1104813849 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1104813849 0 Physician Assistant Only Fluoride varnish 20 1104813849 0 Physician Assistant Only Healthy Kids Services 20 1104813849 0 Physician Assistant Only Physician Services 00 1104813997 0 AYCOCK SHARON E 2016001 9999999 B 10 1104813997 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1104813997 0 Physician Assistant Only Fluoride varnish 20 1104813997 0 Physician Assistant Only Healthy Kids Services 20 1104813997 0 Physician Assistant Only Physician Services 00 1104814839 0 MCDONALD ANN G 2016218 9999999 B 10 1104814839 0 PO BOX 4028 ROCK ISLAND IL 612044028 20 1104814839 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1104814912 0 COOK J WESLEY 1991156 9999999 B 10 1104814912 0 115 N PARKSIDE AVE CHICAGO IL 606443040 20 1104814912 0 Physicians Anesthesia Services 20 1104814912 0 Physicians Fluoride varnish 20 1104814912 0 Physicians Healthy Kids Services 20 1104814912 0 Physicians Optical Supplies 20 1104814912 0 Physicians Physician Services 00 1104815117 0 AGOSTINI-MIRANDA ALEX A 2018178 9999999 B 10 1104815117 0 1431 CENTERPOINT BLVD STE 100 KNOXVILLE TN 379321983 20 1104815117 0 Physicians Anesthesia Services 20 1104815117 0 Physicians Fluoride varnish 20 1104815117 0 Physicians Healthy Kids Services 20 1104815117 0 Physicians Optical Supplies 20 1104815117 0 Physicians Physician Services 00 1104815240 0 SCHWARTZ DANIEL M 2005182 9999999 B 10 1104815240 0 PO BOX 8500 LOCKBOX 7642 PHILADELPHIA PA 191787642 20 1104815240 0 Physicians Anesthesia Services 20 1104815240 0 Physicians Healthy Kids Services 20 1104815240 0 Physicians Optical Supplies 20 1104815240 0 Physicians Physician Services 00 1104815323 0 MITCHELL WINSTON 2001015 9999999 B 10 1104815323 0 2502 E EMPIRE ST BLOOMINGTON IL 617043738 20 1104815323 0 Physicians Anesthesia Services 20 1104815323 0 Physicians Healthy Kids Services 20 1104815323 0 Physicians Optical Supplies 20 1104815323 0 Physicians Physician Services 00 1104815562 0 MAYER CARL ERIC 1981258 9999999 B 10 1104815562 0 9716 US HIGHWAY 12 RICHMOND IL 600719253 20 1104815562 0 Dentists Dental Services 20 1104815562 0 Dentists Physician Services 00 1104815596 0 ROSI DAVID 1981227 9999999 B 10 1104815596 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1104815596 0 Physicians Anesthesia Services 20 1104815596 0 Physicians Fluoride varnish 20 1104815596 0 Physicians Healthy Kids Services 20 1104815596 0 Physicians Optical Supplies 20 1104815596 0 Physicians Physician Services 00 1104816958 0 ALRAYYAN NAJLA 2001060 9999999 B 10 1104816958 0 125 E IRVING PARK RD STREAMWOOD IL 601072950 20 1104816958 0 Dentists Dental Services 20 1104816958 0 Dentists Physician Services 00 1104817121 0 CHANDLER FRITZ JOSE 2012259 9999999 B 10 1104817121 0 29373 NETWORK PL CHICAGO IL 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Physicians Anesthesia Services 20 1104818053 0 Physicians Healthy Kids Services 20 1104818053 0 Physicians Optical Supplies 20 1104818053 0 Physicians Physician Services 00 1104818897 0 WESTMORELAND JAMES B 2022147 9999999 B 10 1104818897 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1104818897 0 Physicians Anesthesia Services 20 1104818897 0 Physicians Healthy Kids Services 20 1104818897 0 Physicians Optical Supplies 20 1104818897 0 Physicians Physician Services 00 1104820786 0 LUEKING CHRIS 2000214 9999999 B 10 1104820786 0 1818 N 6TH ST TERRE HAUTE IN 478044021 20 1104820786 0 Physicians Anesthesia Services 20 1104820786 0 Physicians Healthy Kids Services 20 1104820786 0 Physicians Optical Supplies 20 1104820786 0 Physicians Physician Services 00 1104821446 0 HARDEN SHARIE M 2016135 9999999 B 10 1104821446 0 124 SW ADAMS ST PEORIA IL 616021308 20 1104821446 0 Nurse Practitioners Healthy Kids Services 20 1104821446 0 Nurse Practitioners Midwife Services 20 1104821446 0 Nurse 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Only Physician Services 00 1104822691 0 REID HELENA A 1998182 9999999 B 10 1104822691 0 600 JOHN DEERE RD STE 200 MOLINE IL 612656812 20 1104822691 0 Podiatrists Podiatric Services 00 1104822725 0 SWEET FRIEND ELIZABETH M 2005073 9999999 B 10 1104822725 0 4241 HIGHWAY 14 W PO BOX 155 CHRISTOPHER IL 628221037 20 1104822725 0 Physicians Anesthesia Services 20 1104822725 0 Physicians Family Planning Counseling 20 1104822725 0 Physicians Healthy Kids Services 20 1104822725 0 Physicians Optical Supplies 20 1104822725 0 Physicians Physician Services 00 1104823004 0 SABAU DRAGOS 2007001 9999999 B 10 1104823004 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1104823004 0 Physicians Anesthesia Services 20 1104823004 0 Physicians Healthy Kids Services 20 1104823004 0 Physicians Optical Supplies 20 1104823004 0 Physicians Physician Services 20 1104823004 0 Physicians Physicians Psychiatric Services 00 1104823251 0 VOEGTLE KAREN A 2019316 9999999 B 10 1104823251 0 660 MASON RIDGE CENTER DR STE 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Physicians Anesthesia Services 20 1104824085 0 Physicians Fluoride varnish 20 1104824085 0 Physicians Healthy Kids Services 20 1104824085 0 Physicians Optical Supplies 20 1104824085 0 Physicians Physician Services 00 1104824135 0 RUDA SUSAN 2007032 9999999 B 10 1104824135 0 7600 W COLLEGE DR PALOS HEIGHTS IL 604631001 20 1104824135 0 Nurse Practitioners Healthy Kids Services 20 1104824135 0 Nurse Practitioners Nurse Practitioners Services 20 1104824135 0 Nurse Practitioners Physician Services 00 1104824549 0 RUBIN IRA S 1987187 9999999 B 10 1104824549 0 10 MARTIN AVE STE 2 NAPERVILLE IL 605406567 20 1104824549 0 Physicians Anesthesia Services 20 1104824549 0 Physicians Healthy Kids Services 20 1104824549 0 Physicians Optical Supplies 20 1104824549 0 Physicians Physician Services 00 1104824598 0 REACH BRIAN 1999182 9999999 B 10 1104824598 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1104824598 0 Physicians Anesthesia Services 20 1104824598 0 Physicians Fluoride varnish 20 1104824598 0 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Physician Services 00 1104825967 0 FOX MICHAEL 1994152 9999999 B 10 1104825967 0 PO BOX 7784 CAROL STREAM IL 601977784 20 1104825967 0 Physicians Anesthesia Services 20 1104825967 0 Physicians Healthy Kids Services 20 1104825967 0 Physicians Optical Supplies 20 1104825967 0 Physicians Physician Services 00 1104826288 0 ABERNETHY HEATHER 2020128 9999999 B 10 1104826288 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1104826288 0 Physicians Anesthesia Services 20 1104826288 0 Physicians Healthy Kids Services 20 1104826288 0 Physicians Optical Supplies 20 1104826288 0 Physicians Physician Services 00 1104826361 0 BARTZ CHRISTINA C 2016289 9999999 B 10 1104826361 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1104826361 0 Physician Assistant Only Fluoride varnish 20 1104826361 0 Physician Assistant Only Healthy Kids Services 20 1104826361 0 Physician Assistant Only Physician Services 00 1104826544 0 SHANKAR LAVANYA G 2005182 9999999 B 10 1104826544 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1104826544 0 Physicians Anesthesia Services 20 1104826544 0 Physicians Fluoride varnish 20 1104826544 0 Physicians Healthy Kids Services 20 1104826544 0 Physicians Optical Supplies 20 1104826544 0 Physicians Physician Services 00 1104826676 0 LEGASPI JOSEPH 2018347 9999999 B 10 1104826676 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1104826676 0 Physicians Anesthesia Services 20 1104826676 0 Physicians Fluoride varnish 20 1104826676 0 Physicians Healthy Kids Services 20 1104826676 0 Physicians Optical Supplies 20 1104826676 0 Physicians Physician Services 00 1104827427 0 STIM JAMES 1995142 9999999 B 10 1104827427 0 612 ROXBURY RD ROCKFORD IL 611075089 20 1104827427 0 Physicians Anesthesia Services 20 1104827427 0 Physicians Fluoride varnish 20 1104827427 0 Physicians Healthy Kids Services 20 1104827427 0 Physicians Optical Supplies 20 1104827427 0 Physicians Physician Services 00 1104827641 0 SCHILLER THOMAS M 1993274 9999999 B 10 1104827641 0 1220 S WOOD ST CHICAGO IL 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Fluoride varnish 20 1104828532 0 Physicians Healthy Kids Services 20 1104828532 0 Physicians Optical Supplies 20 1104828532 0 Physicians Physician Services 00 1104828771 0 KEMP MICHELE L. 2006121 9999999 B 10 1104828771 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1104828771 0 Physicians Anesthesia Services 20 1104828771 0 Physicians Fluoride varnish 20 1104828771 0 Physicians Healthy Kids Services 20 1104828771 0 Physicians Optical Supplies 20 1104828771 0 Physicians Physician Services 00 1104829886 0 TURGUT TANSEL 2006213 9999999 B 10 1104829886 0 PO BOX 781076 DETROIT MI 482781076 20 1104829886 0 Physicians Anesthesia Services 20 1104829886 0 Physicians Fluoride varnish 20 1104829886 0 Physicians Healthy Kids Services 20 1104829886 0 Physicians Optical Supplies 20 1104829886 0 Physicians Physician Services 00 1104831072 0 DABOVA-MISSOVA SEVDALINA 2020283 9999999 B 10 1104831072 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1104831072 0 Physicians 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1104832278 0 Physicians Optical Supplies 20 1104832278 0 Physicians Physician Services 00 1104832294 0 MILLER DANIEL 2000290 9999999 B 10 1104832294 0 3136 NAMEOKI RD GRANITE CITY IL 620405013 20 1104832294 0 Chiropractors Chiropractic Services 00 1104832658 0 DAVIS MICHAEL S 2011213 9999999 B 10 1104832658 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1104832658 0 Physicians Anesthesia Services 20 1104832658 0 Physicians Healthy Kids Services 20 1104832658 0 Physicians Optical Supplies 20 1104832658 0 Physicians Physician Services 00 1104833292 0 KRYGSHELD TIMOTHY J 2008197 9999999 B 10 1104833292 0 5777 DEPT CAROL STREAM IL 601220021 20 1104833292 0 Podiatrists Podiatric Services 00 1104833664 0 BROWN MICHAEL 1990002 9999999 B 10 1104833664 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1104833664 0 Audiologists Audiology Services 20 1104833664 0 Audiologists Medical Supplies 20 1104833664 0 Audiologists Medical equipment/prosthetic devices 00 1104833722 0 FORREST MARCIA 2014073 9999999 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1104848332 0 Physicians Anesthesia Services 20 1104848332 0 Physicians Fluoride varnish 20 1104848332 0 Physicians Healthy Kids Services 20 1104848332 0 Physicians Optical Supplies 20 1104848332 0 Physicians Physician Services 00 1104848662 0 NELLESTEIN MICHAEL E 2016365 9999999 B 10 1104848662 0 1005 BROADWAY ST QUINCY IL 623012834 20 1104848662 0 Physicians Anesthesia Services 20 1104848662 0 Physicians Healthy Kids Services 20 1104848662 0 Physicians Optical Supplies 20 1104848662 0 Physicians Physician Services 00 1104849595 0 BUENVENIDA CARISSA 1996153 9999999 B 10 1104849595 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1104849595 0 Physicians Anesthesia Services 20 1104849595 0 Physicians Fluoride varnish 20 1104849595 0 Physicians Healthy Kids Services 20 1104849595 0 Physicians Optical Supplies 20 1104849595 0 Physicians Physician Services 00 1104849983 0 BARTON-SCHERDER ANGELA R 2021319 9999999 B 10 1104849983 0 118 N 2ND ST STE 200 SAINT CHARLES MO 633012894 20 1104849983 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1104849991 0 PATEL AMITKUMAR 2010207 9999999 B 10 1104849991 0 5777 DEPT CAROL STREAM IL 601220021 20 1104849991 0 Physicians Anesthesia Services 20 1104849991 0 Physicians Fluoride varnish 20 1104849991 0 Physicians Healthy Kids Services 20 1104849991 0 Physicians Optical Supplies 20 1104849991 0 Physicians Physician Services 00 1104851591 0 HIJAZ TAREK 2006213 9999999 B 10 1104851591 0 5777 DEPT CAROL STREAM IL 601220021 20 1104851591 0 Physicians Anesthesia Services 20 1104851591 0 Physicians Healthy Kids Services 20 1104851591 0 Physicians Optical Supplies 20 1104851591 0 Physicians Physician Services 00 1104851864 0 KAPLAN HENRY 2020304 9999999 B 10 1104851864 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1104851864 0 Physicians Anesthesia Services 20 1104851864 0 Physicians Healthy Kids Services 20 1104851864 0 Physicians Optical Supplies 20 1104851864 0 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43230 PHOENIX AZ 850803230 20 1104853506 0 Physicians Anesthesia Services 20 1104853506 0 Physicians Healthy Kids Services 20 1104853506 0 Physicians Optical Supplies 20 1104853506 0 Physicians Physician Services 00 1104853878 0 BURTON KAREN 1985196 9999999 B 10 1104853878 0 917 SHERWOOD DR LAKE BLUFF IL 600442203 20 1104853878 0 Physicians Anesthesia Services 20 1104853878 0 Physicians Fluoride varnish 20 1104853878 0 Physicians Healthy Kids Services 20 1104853878 0 Physicians Optical Supplies 20 1104853878 0 Physicians Physician Services 00 1104854363 0 MATHAI MATHEW G 2018041 9999999 B 10 1104854363 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1104854363 0 Physicians Anesthesia Services 20 1104854363 0 Physicians Fluoride varnish 20 1104854363 0 Physicians Healthy Kids Services 20 1104854363 0 Physicians Optical Supplies 20 1104854363 0 Physicians Physician Services 00 1104854439 0 ELMORE TODD D 2014300 9999999 B 10 1104854439 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1104854439 0 Physicians Anesthesia Services 20 1104854439 0 Physicians Healthy Kids Services 20 1104854439 0 Physicians Optical Supplies 20 1104854439 0 Physicians Physician Services 20 1104854439 0 Physicians Physicians Psychiatric Services 00 1104854470 0 SCHWIND DIANE M 2012092 9999999 B 10 1104854470 0 PO BOX 5009 BRENTWOOD TN 370245009 20 1104854470 0 Nurse Practitioners Healthy Kids Services 20 1104854470 0 Nurse Practitioners Nurse Practitioners Services 20 1104854470 0 Nurse Practitioners Physician Services 00 1104854785 0 KEITH REBECCA S 2005199 9999999 B 10 1104854785 0 355 W NORTHWEST HWY PALATINE IL 600672414 20 1104854785 0 Physicians Anesthesia Services 20 1104854785 0 Physicians Healthy Kids Services 20 1104854785 0 Physicians Optical Supplies 20 1104854785 0 Physicians Physician Services 00 1104854892 0 FLETCHER TONY ALLEN A 2015135 9999999 B 10 1104854892 0 29373 NETWORK PL CHICAGO IL 606733039 20 1104854892 0 Psychologist Psychologist service 00 1104854918 0 CHEN HWA 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1104856608 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1104856608 0 Physicians Anesthesia Services 20 1104856608 0 Physicians Fluoride varnish 20 1104856608 0 Physicians Healthy Kids Services 20 1104856608 0 Physicians Optical Supplies 20 1104856608 0 Physicians Physician Services 00 1104857127 0 TAN THOO H 2023333 9999999 B 10 1104857127 0 PO BOX 43230 PHOENIX AZ 850803230 20 1104857127 0 Physicians Anesthesia Services 20 1104857127 0 Physicians Healthy Kids Services 20 1104857127 0 Physicians Optical Supplies 20 1104857127 0 Physicians Physician Services 00 1104857465 0 GONCHAROVA IRINA 2006226 9999999 B 10 1104857465 0 PO BOX 5081 JANESVILLE WI 535475081 20 1104857465 0 Physicians Anesthesia Services 20 1104857465 0 Physicians Healthy Kids Services 20 1104857465 0 Physicians Optical Supplies 20 1104857465 0 Physicians Physician Services 00 1104857473 0 RITTMANN STEPHEN 1981227 9999999 B 10 1104857473 0 PO BOX 5588 BELFAST ME 049155500 20 1104857473 0 Physicians 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1104859107 0 Physicians Healthy Kids Services 20 1104859107 0 Physicians Optical Supplies 20 1104859107 0 Physicians Physician Services 00 1104859370 0 GUNDAMRAJ YOGANAND 2024032 9999999 B 10 1104859370 0 PO BOX 343918 MILWAUKEE WI 532343918 20 1104859370 0 Physicians Anesthesia Services 20 1104859370 0 Physicians Fluoride varnish 20 1104859370 0 Physicians Healthy Kids Services 20 1104859370 0 Physicians Optical Supplies 20 1104859370 0 Physicians Physician Services 00 1104859818 0 ORTWIG DEYAN 2003319 9999999 B 10 1104859818 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1104859818 0 Nurse Practitioners Fluoride varnish 20 1104859818 0 Nurse Practitioners Healthy Kids Services 20 1104859818 0 Nurse Practitioners Nurse Practitioners Services 20 1104859818 0 Nurse Practitioners Physician Services 00 1104859933 0 MARREN ELISE 2000321 9999999 B 10 1104859933 0 5777 DEPT CAROL STREAM IL 601220021 20 1104859933 0 Nurse Practitioners Anesthesia Services 20 1104859933 0 Nurse Practitioners 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Fluoride varnish 20 1114029196 0 Physicians Healthy Kids Services 20 1114029196 0 Physicians Optical Supplies 20 1114029196 0 Physicians Physician Services 00 1114030251 0 WELTER DONNA M 2024281 9999999 B 10 1114030251 0 9435 BORMET DR STE 5 MOKENA IL 604487401 20 1114030251 0 Clinical Social Worker Social work service 00 1114030384 0 PETERSON MARK 2004201 9999999 B 10 1114030384 0 28594 NETWORK PL CHICAGO IL 606731285 20 1114030384 0 Physicians Anesthesia Services 20 1114030384 0 Physicians Fluoride varnish 20 1114030384 0 Physicians Healthy Kids Services 20 1114030384 0 Physicians Optical Supplies 20 1114030384 0 Physicians Physician Services 00 1114031382 0 HOSAIN FARZANA S 1994274 9999999 B 10 1114031382 0 165 S STATE ST HAMPSHIRE IL 601407000 20 1114031382 0 Physicians Anesthesia Services 20 1114031382 0 Physicians Fluoride varnish 20 1114031382 0 Physicians Healthy Kids Services 20 1114031382 0 Physicians Optical Supplies 20 1114031382 0 Physicians Physician Services 00 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1999244 9999999 B 10 1114033669 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1114033669 0 Physicians Anesthesia Services 20 1114033669 0 Physicians Fluoride varnish 20 1114033669 0 Physicians Healthy Kids Services 20 1114033669 0 Physicians Optical Supplies 20 1114033669 0 Physicians Physician Services 00 1114034352 0 MAMI AHMED 2020013 9999999 B 10 1114034352 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1114034352 0 Physicians Anesthesia Services 20 1114034352 0 Physicians Healthy Kids Services 20 1114034352 0 Physicians Optical Supplies 20 1114034352 0 Physicians Physician Services 00 1114034931 0 GUNAPOOTI MAHENDRA 2004327 9999999 B 10 1114034931 0 PO BOX 650 EDWARDSVILLE IL 620250650 20 1114034931 0 Physicians Anesthesia Services 20 1114034931 0 Physicians Healthy Kids Services 20 1114034931 0 Physicians Optical Supplies 20 1114034931 0 Physicians Physician Services 00 1114035425 0 PADELA AASIM I 2011182 9999999 B 10 1114035425 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1114035425 0 Physicians Anesthesia Services 20 1114035425 0 Physicians Healthy Kids Services 20 1114035425 0 Physicians Optical Supplies 20 1114035425 0 Physicians Physician Services 00 1114036860 0 MUSKOPF KURT 2018026 9999999 B 10 1114036860 0 1350 GRAND AVE BEARDSTOWN IL 626188092 20 1114036860 0 Occupational Therapists Medical Supplies 20 1114036860 0 Occupational Therapists Medical equipment/prosthetic devices 20 1114036860 0 Occupational Therapists Occupational Therapy Services 00 1114038072 0 AUER LINDA 1998251 9999999 B 10 1114038072 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1114038072 0 Physicians Anesthesia Services 20 1114038072 0 Physicians Healthy Kids Services 20 1114038072 0 Physicians Optical Supplies 20 1114038072 0 Physicians Physician Services 00 1114038403 0 TALMAGE MARK 2023202 9999999 B 10 1114038403 0 101 E MILLER RD STERLING IL 610811252 20 1114038403 0 Physicians Anesthesia Services 20 1114038403 0 Physicians Fluoride varnish 20 1114038403 0 Physicians 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Therapists Speech Therapy/Pathology Services 00 1114161908 0 NUNNEWAR SACHIN S 2009182 9999999 B 10 1114161908 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1114161908 0 Physicians Anesthesia Services 20 1114161908 0 Physicians Fluoride varnish 20 1114161908 0 Physicians Healthy Kids Services 20 1114161908 0 Physicians Optical Supplies 20 1114161908 0 Physicians Physician Services 00 1114162864 0 FAIRLEY HOLBACH SUSAN J 2009244 9999999 B 10 1114162864 0 7725 W RENO AVE STE 330 OKLAHOMA CITY OK 731279742 20 1114162864 0 Nurse Practitioners Healthy Kids Services 20 1114162864 0 Nurse Practitioners Nurse Practitioners Services 20 1114162864 0 Nurse Practitioners Nursing service 20 1114162864 0 Nurse Practitioners Physician Services 20 1114162864 0 Nurse Practitioners Waiver service 00 1114162948 0 KIZILBASH MOHAMMAD A 2009320 9999999 B 10 1114162948 0 5777 DEPT CAROL STREAM IL 601220021 20 1114162948 0 Physicians Anesthesia Services 20 1114162948 0 Physicians Fluoride varnish 20 1114162948 0 Physicians Healthy Kids Services 20 1114162948 0 Physicians Optical Supplies 20 1114162948 0 Physicians Physician Services 00 1114165388 0 ENGLISH MOLLY L 2023268 9999999 B 10 1114165388 0 PO BOX 486 SAN JACINTO CA 925810486 20 1114165388 0 Physicians Anesthesia Services 20 1114165388 0 Physicians Healthy Kids Services 20 1114165388 0 Physicians Optical Supplies 20 1114165388 0 Physicians Physician Services 00 1114165453 0 DISSANAYAKE VINODINEE 2011154 9999999 B 10 1114165453 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1114165453 0 Physicians Anesthesia Services 20 1114165453 0 Physicians Healthy Kids Services 20 1114165453 0 Physicians Optical Supplies 20 1114165453 0 Physicians Physician Services 00 1114165479 0 BARTH KRISTIN P 2009019 9999999 B 10 1114165479 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1114165479 0 Nurse Practitioners Anesthesia Services 20 1114165479 0 Nurse Practitioners Nurse Practitioners Services 20 1114165479 0 Nurse Practitioners Physician Services 00 1114168549 0 MCCAUGHEY JOSHUA 2020259 9999999 B 10 1114168549 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1114168549 0 Physicians Anesthesia Services 20 1114168549 0 Physicians Healthy Kids Services 20 1114168549 0 Physicians Optical Supplies 20 1114168549 0 Physicians Physician Services 00 1114168937 0 PORTER JAIME 2015327 9999999 B 10 1114168937 0 1921 N MARKET ST MONTICELLO IL 618568144 20 1114168937 0 Other behavior health professional Social work service 00 1114168937 0 PORTER JAIME 2025079 9999999 B 10 1114168937 0 1921 N MARKET ST MONTICELLO IL 618568144 20 1114168937 0 Clinical Social Worker Social work service 00 1114169265 0 EPURE CRISTINA 2011305 9999999 B 10 1114169265 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1114169265 0 Physicians Anesthesia Services 20 1114169265 0 Physicians Healthy Kids Services 20 1114169265 0 Physicians Optical Supplies 20 1114169265 0 Physicians Physician Services 00 1114169869 0 SHOW JEFFERY 2010201 9999999 B 10 1114169869 0 PO BOX 1412 SOUTH BEND IN 466241412 20 1114169869 0 Physicians Anesthesia Services 20 1114169869 0 Physicians Healthy Kids Services 20 1114169869 0 Physicians Optical Supplies 20 1114169869 0 Physicians Physician Services 00 1114169893 0 JAVADI POORIA 2016265 9999999 B 10 1114169893 0 800 E LOCUST ST OLNEY IL 624502553 20 1114169893 0 Physicians Anesthesia Services 20 1114169893 0 Physicians Healthy Kids Services 20 1114169893 0 Physicians Optical Supplies 20 1114169893 0 Physicians Physician Services 00 1114170065 0 TREDE SUSAN A 2009182 9999999 B 10 1114170065 0 2060 ABERDEEN CT STE B SYCAMORE IL 601783161 20 1114170065 0 Speech Therapists Medical Supplies 20 1114170065 0 Speech Therapists Medical equipment/prosthetic devices 20 1114170065 0 Speech Therapists Speech Therapy/Pathology Services 00 1114170073 0 USMANI REHMAN 2009152 9999999 B 10 1114170073 0 221 NE GLEN OAK AVE PEORIA IL 616360002 20 1114170073 0 Physicians Anesthesia Services 20 1114170073 0 Physicians Fluoride varnish 20 1114170073 0 Physicians Healthy Kids Services 20 1114170073 0 Physicians Optical Supplies 20 1114170073 0 Physicians Physician Services 00 1114170289 0 MONAHAN DENISE 2012183 9999999 B 10 1114170289 0 5777 DEPT CAROL STREAM IL 601220021 20 1114170289 0 Physicians Anesthesia Services 20 1114170289 0 Physicians Healthy Kids Services 20 1114170289 0 Physicians Optical Supplies 20 1114170289 0 Physicians Physician Services 00 1114170941 0 PIERCE WENDY Y 2016189 9999999 B 10 1114170941 0 PO BOX 110429 AURORA CO 800420429 20 1114170941 0 Physicians Anesthesia Services 20 1114170941 0 Physicians Healthy Kids Services 20 1114170941 0 Physicians Optical Supplies 20 1114170941 0 Physicians Physician Services 00 1114172004 0 BOYD KEVIN P. 2012159 9999999 B 10 1114172004 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1114172004 0 Physicians Anesthesia Services 20 1114172004 0 Physicians Healthy Kids Services 20 1114172004 0 Physicians Optical Supplies 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ALEKSICH SHERRY TAYLOR 2016288 9999999 B 10 1114173523 0 684 S BARRINGTON RD STE 112 STREAMWOOD IL 601071841 20 1114173523 0 Nurse Practitioners Healthy Kids Services 20 1114173523 0 Nurse Practitioners Nurse Practitioners Services 20 1114173523 0 Nurse Practitioners Physician Services 00 1114173978 0 RODRIGUEZ VANESSA M 2019077 9999999 B 10 1114173978 0 55 E 86TH AVE MERRILLVILLE IN 464106382 20 1114173978 0 Physician Assistant Only Fluoride varnish 20 1114173978 0 Physician Assistant Only Healthy Kids Services 20 1114173978 0 Physician Assistant Only Physician Services 00 1114174265 0 NELSON GREGORY N 2022180 9999999 B 10 1114174265 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1114174265 0 Physicians Anesthesia Services 20 1114174265 0 Physicians Healthy Kids Services 20 1114174265 0 Physicians Optical Supplies 20 1114174265 0 Physicians Physician Services 00 1114174364 0 PAULSEN LINDSAY 2013335 9999999 B 10 1114174364 0 412 W 31ST ST CHICAGO IL 606163116 20 1114174364 0 Physical Therapists Medical Supplies 20 1114174364 0 Physical Therapists Medical equipment/prosthetic devices 20 1114174364 0 Physical Therapists Physical Therapy Services 00 1114174562 0 KATSOULI ANTHI 2013128 9999999 B 10 1114174562 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1114174562 0 Physicians Anesthesia Services 20 1114174562 0 Physicians Fluoride varnish 20 1114174562 0 Physicians Healthy Kids Services 20 1114174562 0 Physicians Optical Supplies 20 1114174562 0 Physicians Physician Services 00 1114174828 0 PETERSON SARAH C 2010182 9999999 B 10 1114174828 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1114174828 0 Physicians Anesthesia Services 20 1114174828 0 Physicians Healthy Kids Services 20 1114174828 0 Physicians Optical Supplies 20 1114174828 0 Physicians Physician Services 00 1114176708 0 KHAN MUHAMMAD 2019130 9999999 B 10 1114176708 0 101 E 9TH ST PANA IL 625571716 20 1114176708 0 Physicians Anesthesia Services 20 1114176708 0 Physicians Fluoride varnish 20 1114176708 0 Physicians Healthy Kids Services 20 1114176708 0 Physicians Optical Supplies 20 1114176708 0 Physicians Physician Services 00 1114176773 0 MOHAN GEETIKA 2020260 9999999 B 10 1114176773 0 1900 W POLK ST STE 220 AATTN SCOTT ANDRIE CHICAGO IL 60612 20 1114176773 0 Physicians Anesthesia Services 20 1114176773 0 Physicians Healthy Kids Services 20 1114176773 0 Physicians Optical Supplies 20 1114176773 0 Physicians Physician Services 00 1114177102 0 KONRAD AARON 2011268 9999999 B 10 1114177102 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1114177102 0 Physicians Anesthesia Services 20 1114177102 0 Physicians Healthy Kids Services 20 1114177102 0 Physicians Optical Supplies 20 1114177102 0 Physicians Physician Services 00 1114177896 0 GIUBERGIA ADOLFO 2024303 9999999 B 10 1114177896 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1114177896 0 Nurse Practitioners Anesthesia Services 20 1114177896 0 Nurse Practitioners Nurse Practitioners Services 20 1114177896 0 Nurse Practitioners Physician Services 00 1114179702 0 SEKHADIA LIPI 2010277 9999999 B 10 1114179702 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1114179702 0 Physicians Anesthesia Services 20 1114179702 0 Physicians Fluoride varnish 20 1114179702 0 Physicians Healthy Kids Services 20 1114179702 0 Physicians Optical Supplies 20 1114179702 0 Physicians Physician Services 00 1114180296 0 DRINKA EVA K 2015026 9999999 B 10 1114180296 0 1401 E STATE ST ROCKFORD IL 611042315 20 1114180296 0 Physicians Anesthesia Services 20 1114180296 0 Physicians Fluoride varnish 20 1114180296 0 Physicians Healthy Kids Services 20 1114180296 0 Physicians Optical Supplies 20 1114180296 0 Physicians Physician Services 00 1114180312 0 KIM EUNHEA 2013214 9999999 B 10 1114180312 0 PO BOX 43230 PHOENIX AZ 850803230 20 1114180312 0 Physicians Anesthesia Services 20 1114180312 0 Physicians Healthy Kids Services 20 1114180312 0 Physicians Optical Supplies 20 1114180312 0 Physicians Physician Services 00 1114180452 0 HOSSAIN TANIA 2012003 9999999 B 10 1114180452 0 1301 W DEVON AVE CHICAGO IL 606601329 20 1114180452 0 Physicians Anesthesia Services 20 1114180452 0 Physicians Fluoride varnish 20 1114180452 0 Physicians Healthy Kids Services 20 1114180452 0 Physicians Optical Supplies 20 1114180452 0 Physicians Physician Services 00 1114180643 0 AYYAGARI SRIKALA 2018120 9999999 B 10 1114180643 0 1301 W DEVON AVE CHICAGO IL 606601329 20 1114180643 0 Physicians Anesthesia Services 20 1114180643 0 Physicians Fluoride varnish 20 1114180643 0 Physicians Healthy Kids Services 20 1114180643 0 Physicians Optical Supplies 20 1114180643 0 Physicians Physician Services 00 1114181310 0 PANOMITROS NICHOLAS 1989237 9999999 B 10 1114181310 0 6020 W DIVERSEY AVE CHICAGO IL 606391108 20 1114181310 0 Dentists Dental Services 20 1114181310 0 Dentists Physician Services 00 1114181658 0 KELDAHL MARK L 2011182 9999999 B 10 1114181658 0 29373 NETWORK PL CHICAGO IL 606733039 20 1114181658 0 Physicians Anesthesia Services 20 1114181658 0 Physicians Healthy Kids Services 20 1114181658 0 Physicians Optical Supplies 20 1114181658 0 Physicians Physician Services 00 1114181948 0 BRINKER TIMOTHY 2013091 9999999 B 10 1114181948 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1114181948 0 Physicians Anesthesia Services 20 1114181948 0 Physicians Fluoride varnish 20 1114181948 0 Physicians Healthy Kids Services 20 1114181948 0 Physicians Optical Supplies 20 1114181948 0 Physicians Physician Services 00 1114182045 0 MARSH GABRIEL 2011305 9999999 B 10 1114182045 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1114182045 0 Physicians Anesthesia Services 20 1114182045 0 Physicians Healthy Kids Services 20 1114182045 0 Physicians Optical Supplies 20 1114182045 0 Physicians Physician Services 00 1114182045 0 MARSH GABRIEL L 2023087 9999999 B 10 1114182045 0 1910 SOUTH AVE LA CROSSE WI 546015467 20 1114182045 0 Physicians Anesthesia Services 20 1114182045 0 Physicians Healthy Kids Services 20 1114182045 0 Physicians Optical Supplies 20 1114182045 0 Physicians Physician Services 00 1114182698 0 SOLOMON LISA P 2013196 9999999 B 10 1114182698 0 PO BOX 411637 SAINT LOUIS MO 631411637 20 1114182698 0 Physicians Anesthesia Services 20 1114182698 0 Physicians Healthy Kids Services 20 1114182698 0 Physicians Optical Supplies 20 1114182698 0 Physicians Physician Services 00 1114182961 0 MANSOUR RANA 2023257 9999999 B 10 1114182961 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1114182961 0 Physicians Anesthesia Services 20 1114182961 0 Physicians Fluoride varnish 20 1114182961 0 Physicians Healthy Kids Services 20 1114182961 0 Physicians Optical Supplies 20 1114182961 0 Physicians Physician Services 00 1114183290 0 ABUTALIB SYED A 2008183 9999999 B 10 1114183290 0 29373 NETWORK PL CHICAGO IL 606733039 20 1114183290 0 Physicians Anesthesia Services 20 1114183290 0 Physicians Fluoride varnish 20 1114183290 0 Physicians Healthy Kids Services 20 1114183290 0 Physicians Optical Supplies 20 1114183290 0 Physicians Physician Services 00 1114183415 0 LAUTZ TIMOTHY 2015182 9999999 B 10 1114183415 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1114183415 0 Physicians Anesthesia Services 20 1114183415 0 Physicians Healthy Kids Services 20 1114183415 0 Physicians Optical Supplies 20 1114183415 0 Physicians Physician Services 00 1114183514 0 TEPPER JOSHUA ADAM 2010182 9999999 B 10 1114183514 0 5777 DEPT CAROL STREAM IL 601220021 20 1114183514 0 Physicians Anesthesia Services 20 1114183514 0 Physicians Healthy Kids Services 20 1114183514 0 Physicians Optical Supplies 20 1114183514 0 Physicians Physician Services 00 1114183738 0 HILO HAZEL 2011213 9999999 B 10 1114183738 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1114183738 0 Physicians Anesthesia Services 20 1114183738 0 Physicians Fluoride varnish 20 1114183738 0 Physicians Healthy Kids Services 20 1114183738 0 Physicians Optical Supplies 20 1114183738 0 Physicians Physician Services 00 1114184058 0 NAM DENIS 2013210 9999999 B 10 1114184058 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1114184058 0 Physicians Anesthesia Services 20 1114184058 0 Physicians Healthy Kids Services 20 1114184058 0 Physicians Optical Supplies 20 1114184058 0 Physicians Physician Services 00 1114184660 0 GRIMM THERESA L 2019224 9999999 B 10 1114184660 0 1608 W COLONIAL PKWY STE LL101 INVERNESS IL 600674755 20 1114184660 0 Other behavior health professional LCPC/LMFT services 00 1114185055 0 MOSHER HILARY 2011182 9999999 B 10 1114185055 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1114185055 0 Physicians Anesthesia Services 20 1114185055 0 Physicians Healthy Kids Services 20 1114185055 0 Physicians Optical Supplies 20 1114185055 0 Physicians Physician Services 00 1114185154 0 VARGAS MARCELO P 2023328 9999999 B 10 1114185154 0 5901 LINCOLN DR EDINA MN 554361611 20 1114185154 0 Physicians Anesthesia Services 20 1114185154 0 Physicians Healthy Kids Services 20 1114185154 0 Physicians Optical Supplies 20 1114185154 0 Physicians Physician Services 00 1114185394 0 TADROS NICHOLAS 2017251 9999999 B 10 1114185394 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1114185394 0 Physicians Anesthesia Services 20 1114185394 0 Physicians Healthy Kids Services 20 1114185394 0 Physicians Optical Supplies 20 1114185394 0 Physicians Physician Services 00 1114185519 0 KHAN ALIFIA 2009182 9999999 B 10 1114185519 0 PO BOX 3024 EVANSVILLE IN 477303024 20 1114185519 0 Physicians Anesthesia Services 20 1114185519 0 Physicians Healthy Kids Services 20 1114185519 0 Physicians Optical Supplies 20 1114185519 0 Physicians Physician Services 00 1114186038 0 GOODALL MCDONALD WENDY C 2011335 9999999 B 10 1114186038 0 900 N KINGSBURY ST STE 130N CHICAGO IL 606107457 20 1114186038 0 Physicians Anesthesia Services 20 1114186038 0 Physicians Healthy Kids Services 20 1114186038 0 Physicians Optical Supplies 20 1114186038 0 Physicians Physician Services 00 1114187200 0 ARORA RACHNA 2010048 9999999 B 10 1114187200 0 28594 NETWORK PL CHICAGO IL 606731285 20 1114187200 0 Physicians Anesthesia Services 20 1114187200 0 Physicians Fluoride varnish 20 1114187200 0 Physicians Healthy Kids Services 20 1114187200 0 Physicians Optical Supplies 20 1114187200 0 Physicians Physician Services 00 1114187507 0 JIMENEZ NORMIDARIS 2018091 9999999 B 10 1114187507 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1114187507 0 Physicians Anesthesia Services 20 1114187507 0 Physicians Healthy Kids Services 20 1114187507 0 Physicians Optical Supplies 20 1114187507 0 Physicians Physician Services 00 1114187531 0 ANJUM RUBEENA 2014013 9999999 B 10 1114187531 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1114187531 0 Physicians Anesthesia Services 20 1114187531 0 Physicians Fluoride varnish 20 1114187531 0 Physicians Healthy Kids Services 20 1114187531 0 Physicians Optical Supplies 20 1114187531 0 Physicians Physician Services 00 1114187705 0 KELLY MOLLY 2012233 9999999 B 10 1114187705 0 124 SW ADAMS ST PEORIA IL 616021308 20 1114187705 0 Physicians Anesthesia Services 20 1114187705 0 Physicians Healthy Kids Services 20 1114187705 0 Physicians Optical Supplies 20 1114187705 0 Physicians Physician Services 00 1114188489 0 VINDEL JASMINE 2009278 9999999 B 10 1114188489 0 2900 OGDEN AVE LISLE IL 605321676 20 1114188489 0 Speech Therapists Medical Supplies 20 1114188489 0 Speech Therapists Medical equipment/prosthetic devices 20 1114188489 0 Speech Therapists Speech Therapy/Pathology Services 00 1114188828 0 MILLARD LISA M 2012219 9999999 B 10 1114188828 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1114188828 0 Physicians Anesthesia Services 20 1114188828 0 Physicians Healthy Kids Services 20 1114188828 0 Physicians Optical Supplies 20 1114188828 0 Physicians Physician Services 00 1114189305 0 ELMAADAWI AHMED Z 2019070 9999999 B 10 1114189305 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1114189305 0 Physicians Anesthesia Services 20 1114189305 0 Physicians Healthy Kids Services 20 1114189305 0 Physicians Optical Supplies 20 1114189305 0 Physicians Physician Services 20 1114189305 0 Physicians Physicians Psychiatric Services 00 1114189917 0 ORPHANIDIS STEPHANOS P 2022014 9999999 B 10 1114189917 0 5701 W TALAVI BLVD STE 120 GLENDALE AZ 853061888 20 1114189917 0 Physicians Anesthesia Services 20 1114189917 0 Physicians Healthy Kids Services 20 1114189917 0 Physicians Optical Supplies 20 1114189917 0 Physicians Physician Services 00 1114190261 0 ASAMBADZE EKATERINE 2022101 9999999 B 10 1114190261 0 1800 W CHARLESTON BLVD LAS VEGAS NV 891022329 20 1114190261 0 Physicians Anesthesia Services 20 1114190261 0 Physicians Fluoride varnish 20 1114190261 0 Physicians Healthy Kids Services 20 1114190261 0 Physicians Optical Supplies 20 1114190261 0 Physicians Physician Services 00 1114190782 0 BARAKAT OMAR J 2014315 9999999 B 10 1114190782 0 5777 DEPT CAROL STREAM IL 601220021 20 1114190782 0 Physicians Anesthesia Services 20 1114190782 0 Physicians Healthy Kids Services 20 1114190782 0 Physicians Optical Supplies 20 1114190782 0 Physicians Physician Services 00 1114190915 0 HURST KRISTEN 2024351 9999999 B 10 1114190915 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1114190915 0 Physicians Anesthesia Services 20 1114190915 0 Physicians Fluoride varnish 20 1114190915 0 Physicians Healthy Kids Services 20 1114190915 0 Physicians Optical Supplies 20 1114190915 0 Physicians Physician Services 00 1114191061 0 STINAUER JESSE 2008001 9999999 B 10 1114191061 0 148 N 5TH AVE CANTON IL 615202800 20 1114191061 0 Dentists Dental Services 20 1114191061 0 Dentists Physician Services 00 1114191228 0 HAMILTON SARA 2010279 9999999 B 10 1114191228 0 124 SW ADAMS ST PEORIA IL 616021308 20 1114191228 0 Physical Therapists Medical Supplies 20 1114191228 0 Physical Therapists Medical equipment/prosthetic devices 20 1114191228 0 Physical Therapists Physical Therapy Services 00 1114191327 0 RABBAT MARK 2012240 9999999 B 10 1114191327 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1114191327 0 Physicians Anesthesia Services 20 1114191327 0 Physicians Fluoride varnish 20 1114191327 0 Physicians Healthy Kids Services 20 1114191327 0 Physicians Optical Supplies 20 1114191327 0 Physicians Physician Services 00 1114191632 0 PECK ANDREW 2010182 9999999 B 10 1114191632 0 120 W 22ND ST OAK BROOK IL 605231557 20 1114191632 0 Physicians Anesthesia Services 20 1114191632 0 Physicians Fluoride varnish 20 1114191632 0 Physicians Healthy Kids Services 20 1114191632 0 Physicians Optical Supplies 20 1114191632 0 Physicians Physician Services 00 1114191822 0 ROGERS MICHELLE 2010326 9999999 B 10 1114191822 0 2813 ROBERT DR COLUMBIA IL 622362671 20 1114191822 0 Speech Therapists Medical Supplies 20 1114191822 0 Speech Therapists Medical equipment/prosthetic devices 20 1114191822 0 Speech Therapists Speech Therapy/Pathology Services 00 1114192093 0 DYE THOMAS 2019182 9999999 B 10 1114192093 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1114192093 0 Physicians Anesthesia Services 20 1114192093 0 Physicians Healthy Kids Services 20 1114192093 0 Physicians Optical Supplies 20 1114192093 0 Physicians Physician Services 20 1114192093 0 Physicians Physicians Psychiatric Services 00 1114192416 0 WILKE-ALLEN STEFANIE 1996001 9999999 B 10 1114192416 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1114192416 0 Audiologists Audiology Services 20 1114192416 0 Audiologists Medical Supplies 20 1114192416 0 Audiologists Medical equipment/prosthetic devices 00 1114192994 0 SELKE LYNN 2013001 9999999 B 10 1114192994 0 6501 N SHERIDAN RD PEORIA IL 616142932 20 1114192994 0 Occupational Therapists Medical Supplies 20 1114192994 0 Occupational Therapists Medical equipment/prosthetic devices 20 1114192994 0 Occupational Therapists Occupational Therapy Services 00 1114193125 0 AL-QAMARI ALEFIYA 2021123 9999999 B 10 1114193125 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1114193125 0 Physicians Anesthesia Services 20 1114193125 0 Physicians Fluoride varnish 20 1114193125 0 Physicians Healthy Kids Services 20 1114193125 0 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0 BERRY TERI J 2021190 9999999 B 10 1114298437 0 PO BOX 15490 SCOTTSDALE AZ 852675490 20 1114298437 0 Nurse Practitioners Fluoride varnish 20 1114298437 0 Nurse Practitioners Healthy Kids Services 20 1114298437 0 Nurse Practitioners Nurse Practitioners Services 20 1114298437 0 Nurse Practitioners Physician Services 00 1114298833 0 PETRU THERESA 2017296 9999999 B 10 1114298833 0 1301 W COSSITT AVE LA GRANGE IL 605252145 20 1114298833 0 Speech Therapists Medical Supplies 20 1114298833 0 Speech Therapists Medical equipment/prosthetic devices 20 1114298833 0 Speech Therapists Speech Therapy/Pathology Services 00 1114299419 0 ELLIOTT LUCY 2015213 9999999 B 10 1114299419 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1114299419 0 Physician Assistant Only Fluoride varnish 20 1114299419 0 Physician Assistant Only Healthy Kids Services 20 1114299419 0 Physician Assistant Only Physician Services 00 1114299443 0 WILLIS KANDEE 2016238 9999999 B 10 1114299443 0 70 S RIVER ST AURORA IL 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Services 00 1114302452 0 HASAN NOUR 2023045 9999999 B 10 1114302452 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1114302452 0 Physicians Anesthesia Services 20 1114302452 0 Physicians Fluoride varnish 20 1114302452 0 Physicians Healthy Kids Services 20 1114302452 0 Physicians Optical Supplies 20 1114302452 0 Physicians Physician Services 00 1114303732 0 JABER SARAH D 2016004 9999999 B 10 1114303732 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1114303732 0 Nurse Practitioners Healthy Kids Services 20 1114303732 0 Nurse Practitioners Nurse Practitioners Services 20 1114303732 0 Nurse Practitioners Physician Services 00 1114304466 0 PALENCIA CORTNEY S 2019154 9999999 B 10 1114304466 0 5121 MARYLAND WAY STE 300 BRENTWOOD TN 370277516 20 1114304466 0 Physicians Anesthesia Services 20 1114304466 0 Physicians Healthy Kids Services 20 1114304466 0 Physicians Optical Supplies 20 1114304466 0 Physicians Physician Services 00 1114304565 0 FIGURA RENEE M 2022074 9999999 B 10 1114304565 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1114304565 0 Nurse Practitioners Healthy Kids Services 20 1114304565 0 Nurse Practitioners Nurse Practitioners Services 20 1114304565 0 Nurse Practitioners Physician Services 00 1114306396 0 BAO LIHUA 2018213 9999999 B 10 1114306396 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1114306396 0 Physicians Anesthesia Services 20 1114306396 0 Physicians Fluoride varnish 20 1114306396 0 Physicians Healthy Kids Services 20 1114306396 0 Physicians Optical Supplies 20 1114306396 0 Physicians Physician Services 00 1114306537 0 GONZALEZ JAIME A 2022244 9999999 B 10 1114306537 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1114306537 0 Physicians Anesthesia Services 20 1114306537 0 Physicians Fluoride varnish 20 1114306537 0 Physicians Healthy Kids Services 20 1114306537 0 Physicians Optical Supplies 20 1114306537 0 Physicians Physician Services 00 1114307030 0 BIESTERVELD BEN E 2022213 9999999 B 10 1114307030 0 7974 UW HEALTH CT 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Physicians Anesthesia Services 20 1114308558 0 Physicians Healthy Kids Services 20 1114308558 0 Physicians Optical Supplies 20 1114308558 0 Physicians Physician Services 00 1114308574 0 GRIBBEN PAUL F 2023041 9999999 B 10 1114308574 0 988102 NEBRASKA MEDICAL CTR OMAHA NE 681988102 20 1114308574 0 Physicians Anesthesia Services 20 1114308574 0 Physicians Healthy Kids Services 20 1114308574 0 Physicians Optical Supplies 20 1114308574 0 Physicians Physician Services 00 1114308608 0 MANGINI MATTHEW 2024115 9999999 B 10 1114308608 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1114308608 0 Physicians Anesthesia Services 20 1114308608 0 Physicians Healthy Kids Services 20 1114308608 0 Physicians Optical Supplies 20 1114308608 0 Physicians Physician Services 00 1114309176 0 ODESANYA TEMITAYO 2022073 9999999 B 10 1114309176 0 1400 US HIGHWAY 61 FESTUS MO 630284100 20 1114309176 0 Physicians Anesthesia Services 20 1114309176 0 Physicians Fluoride varnish 20 1114309176 0 Physicians Healthy Kids Services 20 1114309176 0 Physicians Optical Supplies 20 1114309176 0 Physicians Physician Services 00 1114311131 0 ISAAC HIRAM EFRAIN 2017142 9999999 B 10 1114311131 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1114311131 0 Physicians Anesthesia Services 20 1114311131 0 Physicians Healthy Kids Services 20 1114311131 0 Physicians Optical Supplies 20 1114311131 0 Physicians Physician Services 00 1114311677 0 KAUR JASKARIN 2023001 9999999 B 10 1114311677 0 PO BOX 848775 LOS ANGELES CA 900848775 20 1114311677 0 Physicians Anesthesia Services 20 1114311677 0 Physicians Fluoride varnish 20 1114311677 0 Physicians Healthy Kids Services 20 1114311677 0 Physicians Optical Supplies 20 1114311677 0 Physicians Physician Services 00 1114312337 0 OWEN JENNIFER L 2020177 9999999 B 10 1114312337 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1114312337 0 Occupational Therapists Medical Supplies 20 1114312337 0 Occupational Therapists Medical equipment/prosthetic devices 20 1114312337 0 Occupational Therapists Occupational Therapy Services 00 1114313210 0 KHAZAEI SHAYAN 2019329 9999999 B 10 1114313210 0 5777 DEPT CAROL STREAM IL 601228942 20 1114313210 0 Physicians Anesthesia Services 20 1114313210 0 Physicians Healthy Kids Services 20 1114313210 0 Physicians Optical Supplies 20 1114313210 0 Physicians Physician Services 20 1114313210 0 Physicians Physicians Psychiatric Services 00 1114313400 0 FESMIRE ALYSSA 2024122 9999999 B 10 1114313400 0 PO BOX 43230 PHOENIX AZ 850803230 20 1114313400 0 Physicians Anesthesia Services 20 1114313400 0 Physicians Healthy Kids Services 20 1114313400 0 Physicians Optical Supplies 20 1114313400 0 Physicians Physician Services 00 1114313434 0 MCCULLEY DANIEL J 2018299 9999999 B 10 1114313434 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1114313434 0 Physicians Anesthesia Services 20 1114313434 0 Physicians Healthy Kids Services 20 1114313434 0 Physicians Optical Supplies 20 1114313434 0 Physicians Physician Services 00 1114313905 0 NAIR GATHA 2019324 9999999 B 10 1114313905 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1114313905 0 Physicians Anesthesia Services 20 1114313905 0 Physicians Fluoride varnish 20 1114313905 0 Physicians Healthy Kids Services 20 1114313905 0 Physicians Optical Supplies 20 1114313905 0 Physicians Physician Services 00 1114314374 0 BORAD VEDANT 2021211 9999999 B 10 1114314374 0 PO BOX 1510 EVANSVILLE IN 477061510 20 1114314374 0 Physicians Anesthesia Services 20 1114314374 0 Physicians Healthy Kids Services 20 1114314374 0 Physicians Optical Supplies 20 1114314374 0 Physicians Physician Services 00 1114315116 0 RICHARDSON LAUREN 2018108 9999999 B 10 1114315116 0 PO BOX 637273 CINCINNATI OH 452637273 20 1114315116 0 Physician Assistant Only Fluoride varnish 20 1114315116 0 Physician Assistant Only Healthy Kids Services 20 1114315116 0 Physician Assistant Only Physician Services 00 1114316189 0 KLOPACK ERIN 2015040 9999999 B 10 1114316189 0 5777 DEPT CAROL STREAM IL 601220021 20 1114316189 0 Nurse Practitioners Fluoride varnish 20 1114316189 0 Nurse Practitioners Healthy Kids Services 20 1114316189 0 Nurse Practitioners Nurse Practitioners Services 20 1114316189 0 Nurse Practitioners Physician Services 00 1114316775 0 FALDER MEGAN B 2016048 9999999 B 10 1114316775 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1114316775 0 Nurse Practitioners Anesthesia Services 20 1114316775 0 Nurse Practitioners Nurse Practitioners Services 20 1114316775 0 Nurse Practitioners Physician Services 00 1114318466 0 DISALVO PHILIP 2021144 9999999 B 10 1114318466 0 611 W PARK ST URBANA IL 618012529 20 1114318466 0 Physicians Anesthesia Services 20 1114318466 0 Physicians Healthy Kids Services 20 1114318466 0 Physicians Optical Supplies 20 1114318466 0 Physicians Physician Services 00 1114318953 0 SCIORTINO MARIA 2016353 9999999 B 10 1114318953 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1114318953 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114319852 0 CHMIELEWSKI JOSEPH C 2019174 9999999 B 10 1114319852 0 5777 DEPT CAROL STREAM IL 601220021 20 1114319852 0 Physicians Anesthesia Services 20 1114319852 0 Physicians Fluoride varnish 20 1114319852 0 Physicians Healthy Kids Services 20 1114319852 0 Physicians Optical Supplies 20 1114319852 0 Physicians Physician Services 00 1114320413 0 ABREGO TIFFANY C. 2016286 9999999 B 10 1114320413 0 1 ILLINI DR PEORIA IL 616052576 20 1114320413 0 Psychologist Psychologist service 00 1114322682 0 ORVINO RENEE 2024017 9999999 B 10 1114322682 0 2171 W EXECUTIVE DR STE 500 ADDISON IL 601015626 20 1114322682 0 Occupational Therapists Medical Supplies 20 1114322682 0 Occupational Therapists Medical equipment/prosthetic devices 20 1114322682 0 Occupational Therapists Occupational Therapy Services 00 1114322823 0 IMANLIHEN IYARE 2018001 9999999 B 10 1114322823 0 5658 S KOLIN AVE UNIT 2 CHICAGO IL 606294839 20 1114322823 0 Clinical Social Worker Social work service 00 1114324324 0 VARANDA MELISSA 2016320 9999999 B 10 1114324324 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1114324324 0 Nurse Practitioners Fluoride varnish 20 1114324324 0 Nurse Practitioners Healthy Kids Services 20 1114324324 0 Nurse Practitioners Nurse Practitioners Services 20 1114324324 0 Nurse Practitioners Physician Services 00 1114325735 0 MARANO JENNIFER M 2016046 9999999 H 10 1114325735 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1114325735 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114328275 0 RATZ KELLY L 2015344 9999999 B 10 1114328275 0 PO BOX 146 WATERLOO IL 622980146 20 1114328275 0 Nurse Practitioners Fluoride varnish 20 1114328275 0 Nurse Practitioners Healthy Kids Services 20 1114328275 0 Nurse Practitioners Nurse Practitioners Services 20 1114328275 0 Nurse Practitioners Physician Services 00 1114331451 0 SON DANIEL 2020213 9999999 B 10 1114331451 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1114331451 0 Physicians Anesthesia Services 20 1114331451 0 Physicians Healthy Kids Services 20 1114331451 0 Physicians Optical Supplies 20 1114331451 0 Physicians Physician Services 00 1114331600 0 PELIKAN ANDREW 2023024 9999999 B 10 1114331600 0 1 HOSPITAL DR COLUMBIA MO 652120001 20 1114331600 0 Physicians Anesthesia Services 20 1114331600 0 Physicians Healthy Kids Services 20 1114331600 0 Physicians Optical Supplies 20 1114331600 0 Physicians Physician Services 00 1114331634 0 DAVIS DIANNE S 2022241 9999999 B 10 1114331634 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1114331634 0 Physicians Anesthesia Services 20 1114331634 0 Physicians Healthy Kids Services 20 1114331634 0 Physicians Optical Supplies 20 1114331634 0 Physicians Physician Services 00 1114332152 0 YEN EUGENE C 2018211 9999999 B 10 1114332152 0 611 W PARK ST URBANA IL 618012529 20 1114332152 0 Physicians Anesthesia Services 20 1114332152 0 Physicians Healthy Kids Services 20 1114332152 0 Physicians Optical Supplies 20 1114332152 0 Physicians Physician Services 00 1114332459 0 BODINE WILLIAM J 2016187 9999999 B 10 1114332459 0 PO BOX 781076 DETROIT MI 482781076 20 1114332459 0 Physicians Anesthesia Services 20 1114332459 0 Physicians Fluoride varnish 20 1114332459 0 Physicians Healthy Kids Services 20 1114332459 0 Physicians Optical Supplies 20 1114332459 0 Physicians Physician Services 00 1114333671 0 SHARBIDRE KEDAR 2023215 9999999 B 10 1114333671 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1114333671 0 Physicians Anesthesia Services 20 1114333671 0 Physicians Healthy Kids Services 20 1114333671 0 Physicians Optical Supplies 20 1114333671 0 Physicians Physician Services 00 1114333978 0 WILSON SENETTA 2017146 9999999 B 10 1114333978 0 PO BOX 775253 CHICAGO IL 606775253 20 1114333978 0 Physicians Anesthesia Services 20 1114333978 0 Physicians Fluoride varnish 20 1114333978 0 Physicians Healthy Kids Services 20 1114333978 0 Physicians Optical Supplies 20 1114333978 0 Physicians Physician Services 00 1114334224 0 ALCEDO JENNIFER 2024044 9999999 B 10 1114334224 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1114334224 0 Physical Therapists Medical Supplies 20 1114334224 0 Physical Therapists Medical equipment/prosthetic devices 20 1114334224 0 Physical Therapists Physical Therapy Services 00 1114334679 0 CHERIAN REENA J 2023044 9999999 B 10 1114334679 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1114334679 0 Physical Therapists Medical Supplies 20 1114334679 0 Physical Therapists Medical equipment/prosthetic devices 20 1114334679 0 Physical Therapists Physical Therapy Services 00 1114334695 0 ZENG YUZHEN 2014182 9999999 B 10 1114334695 0 1S450 SUMMIT AVE STE 270 OAKBROOK TERRAC IL 601813959 20 1114334695 0 Nurse Practitioners Fluoride varnish 20 1114334695 0 Nurse Practitioners Healthy Kids Services 20 1114334695 0 Nurse Practitioners Nurse Practitioners Services 20 1114334695 0 Nurse Practitioners Physician Services 00 1114335353 0 MARLEY DUSTIN 2024205 9999999 B 10 1114335353 0 5777 DEPT CAROL STREAM IL 601220021 20 1114335353 0 Physician Assistant Only Fluoride varnish 20 1114335353 0 Physician Assistant Only Healthy Kids Services 20 1114335353 0 Physician Assistant Only Physician Services 00 1114336948 0 WALLIN KRISTINA J 2017340 9999999 B 10 1114336948 0 1165 SAINT VINCENT AVE LA SALLE IL 613011628 20 1114336948 0 Speech Therapists Medical Supplies 20 1114336948 0 Speech Therapists Medical equipment/prosthetic devices 20 1114336948 0 Speech Therapists Speech Therapy/Pathology Services 00 1114337805 0 PARIKH RONAK AMRISH 2017108 9999999 B 10 1114337805 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1114337805 0 Physicians Anesthesia Services 20 1114337805 0 Physicians Fluoride varnish 20 1114337805 0 Physicians Healthy Kids Services 20 1114337805 0 Physicians Optical Supplies 20 1114337805 0 Physicians Physician Services 00 1114338126 0 SANJUAN ANGIELYN MAUREEN 2021229 9999999 B 10 1114338126 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1114338126 0 Physicians Anesthesia Services 20 1114338126 0 Physicians Healthy Kids Services 20 1114338126 0 Physicians Optical Supplies 20 1114338126 0 Physicians Physician Services 00 1114339512 0 MONTEILH CECILIA M 2021348 9999999 B 10 1114339512 0 3200 E CAMELBACK RD STE 250 PHOENIX AZ 850182327 20 1114339512 0 Physicians Anesthesia Services 20 1114339512 0 Physicians Fluoride varnish 20 1114339512 0 Physicians Healthy Kids Services 20 1114339512 0 Physicians Optical Supplies 20 1114339512 0 Physicians Physician Services 00 1114343225 0 LANZ JENNIFER L 2014104 9999999 B 10 1114343225 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1114343225 0 Nurse Practitioners Healthy Kids Services 20 1114343225 0 Nurse Practitioners Nurse Practitioners Services 20 1114343225 0 Nurse Practitioners Physician Services 00 1114344298 0 TOPPER THOMAS 2016061 9999999 B 10 1114344298 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1114344298 0 Physician Assistant Only Fluoride varnish 20 1114344298 0 Physician Assistant Only Healthy Kids Services 20 1114344298 0 Physician Assistant Only Physician Services 00 1114344322 0 ZIDER BRIAN 2020254 9999999 B 10 1114344322 0 387 SHUMAN BLVD STE 240W NAPERVILLE IL 605638113 20 1114344322 0 Physicians Anesthesia Services 20 1114344322 0 Physicians Healthy Kids Services 20 1114344322 0 Physicians Optical Supplies 20 1114344322 0 Physicians Physician Services 00 1114345170 0 LAWRENZ JOSHUA 2024001 9999999 B 10 1114345170 0 DEPT AT 40379 ATLANTA GA 311920001 20 1114345170 0 Physicians Anesthesia Services 20 1114345170 0 Physicians Healthy Kids Services 20 1114345170 0 Physicians Optical Supplies 20 1114345170 0 Physicians Physician Services 00 1114345576 0 MCNITT WILLIAM C 2023354 9999999 B 10 1114345576 0 500 ELDORADO BLVD STE 6250 BROOMFIELD CO 800213421 20 1114345576 0 Physicians Anesthesia Services 20 1114345576 0 Physicians Healthy Kids Services 20 1114345576 0 Physicians Optical Supplies 20 1114345576 0 Physicians Physician Services 00 1114345584 0 TENNANT DAVID 2017228 9999999 B 10 1114345584 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1114345584 0 Physicians Anesthesia Services 20 1114345584 0 Physicians Fluoride varnish 20 1114345584 0 Physicians Healthy Kids Services 20 1114345584 0 Physicians Optical Supplies 20 1114345584 0 Physicians Physician Services 00 1114345964 0 KATHOL DYLAN J 2018107 9999999 B 10 1114345964 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1114345964 0 Physicians Anesthesia Services 20 1114345964 0 Physicians Healthy Kids Services 20 1114345964 0 Physicians Optical Supplies 20 1114345964 0 Physicians Physician Services 20 1114345964 0 Physicians Physicians Psychiatric Services 00 1114346558 0 ANANTAMONGKOL UTCHARIYA 2024346 9999999 B 10 1114346558 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1114346558 0 Physicians Anesthesia Services 20 1114346558 0 Physicians Healthy Kids Services 20 1114346558 0 Physicians Optical Supplies 20 1114346558 0 Physicians Physician Services 00 1114346822 0 DUNCAN FRANCESCA 2023089 9999999 B 10 1114346822 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1114346822 0 Physicians Anesthesia Services 20 1114346822 0 Physicians Fluoride varnish 20 1114346822 0 Physicians Healthy Kids Services 20 1114346822 0 Physicians Optical Supplies 20 1114346822 0 Physicians Physician Services 00 1114346905 0 THOMPSON KENNETH R 2024020 9999999 B 10 1114346905 0 PO BOX 43230 CINCINNATI OH 452430230 20 1114346905 0 Physicians Anesthesia Services 20 1114346905 0 Physicians Healthy Kids Services 20 1114346905 0 Physicians Optical Supplies 20 1114346905 0 Physicians Physician Services 00 1114346921 0 ROEWE RAYMOND F 2019240 9999999 B 10 1114346921 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1114346921 0 Physicians Anesthesia Services 20 1114346921 0 Physicians Healthy Kids Services 20 1114346921 0 Physicians Optical Supplies 20 1114346921 0 Physicians Physician Services 00 1114347283 0 KUDER PAUL 2018182 9999999 B 10 1114347283 0 900 N KINGSBURY ST STE 130N CHICAGO IL 606107457 20 1114347283 0 Physicians Anesthesia Services 20 1114347283 0 Physicians Healthy Kids Services 20 1114347283 0 Physicians Optical Supplies 20 1114347283 0 Physicians Physician Services 00 1114347366 0 DENZIN TESSA 2021301 9999999 B 10 1114347366 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1114347366 0 Physician Assistant Only Fluoride varnish 20 1114347366 0 Physician Assistant Only Healthy Kids Services 20 1114347366 0 Physician Assistant Only Physician Services 00 1114348620 0 DOMINIQUE SARAH E 2013364 9999999 B 10 1114348620 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1114348620 0 Nurse Practitioners Fluoride varnish 20 1114348620 0 Nurse Practitioners Healthy Kids Services 20 1114348620 0 Nurse Practitioners Nurse Practitioners Services 20 1114348620 0 Nurse Practitioners Physician Services 00 1114348786 0 GILLESPIE KAITLIN C 2018336 9999999 B 10 1114348786 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1114348786 0 Physical Therapists Medical Supplies 20 1114348786 0 Physical Therapists Medical equipment/prosthetic devices 20 1114348786 0 Physical Therapists Physical Therapy Services 00 1114349420 0 DRYSDALE SARA E 2014007 9999999 B 10 1114349420 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1114349420 0 Nurse Practitioners Healthy Kids Services 20 1114349420 0 Nurse Practitioners Nurse Practitioners Services 20 1114349420 0 Nurse Practitioners Physician Services 00 1114351806 0 JAROSZ TRACEY 2017255 9999999 B 10 1114351806 0 5801 W CERMAK RD CICERO IL 608042102 20 1114351806 0 Speech Therapists Medical Supplies 20 1114351806 0 Speech Therapists Medical equipment/prosthetic devices 20 1114351806 0 Speech Therapists Speech Therapy/Pathology Services 00 1114352010 0 DUNN RYAN 2013305 9999999 B 10 1114352010 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1114352010 0 Nurse Practitioners Anesthesia Services 20 1114352010 0 Nurse Practitioners Nurse Practitioners Services 20 1114352010 0 Nurse Practitioners Physician Services 00 1114356607 0 PECHACEK DEREK E 2014288 9999999 B 10 1114356607 0 PO BOX 378 SPARTA IL 622860378 20 1114356607 0 Nurse Practitioners Fluoride varnish 20 1114356607 0 Nurse Practitioners Healthy Kids Services 20 1114356607 0 Nurse Practitioners Nurse Practitioners Services 20 1114356607 0 Nurse Practitioners Physician Services 00 1114358603 0 MEREDITH MEGAN 2015327 9999999 B 10 1114358603 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1114358603 0 Nurse Practitioners Anesthesia Services 20 1114358603 0 Nurse Practitioners Healthy Kids Services 20 1114358603 0 Nurse Practitioners Nurse Practitioners Services 20 1114358603 0 Nurse Practitioners Physician Services 00 1114360005 0 SHEIKH SYEMA I 2018351 9999999 B 10 1114360005 0 22285 N PEPPER RD STE 401 LAKE BARRINGTON IL 600102542 20 1114360005 0 Physicians Anesthesia Services 20 1114360005 0 Physicians Healthy Kids Services 20 1114360005 0 Physicians Optical Supplies 20 1114360005 0 Physicians Physician Services 20 1114360005 0 Physicians Physicians Psychiatric Services 00 1114360013 0 SMITH STEVEN JOHN 2016122 9999999 B 10 1114360013 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1114360013 0 Physicians Anesthesia Services 20 1114360013 0 Physicians Fluoride varnish 20 1114360013 0 Physicians Healthy Kids Services 20 1114360013 0 Physicians Optical Supplies 20 1114360013 0 Physicians Physician Services 00 1114360252 0 IVES LAUREN A 2016278 9999999 B 10 1114360252 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1114360252 0 Physicians Anesthesia Services 20 1114360252 0 Physicians Fluoride varnish 20 1114360252 0 Physicians Healthy Kids Services 20 1114360252 0 Physicians Optical Supplies 20 1114360252 0 Physicians Physician Services 00 1114360328 0 ANDERSON SARAH ESTHER 2017230 9999999 B 10 1114360328 0 7825 SOLUTION CTR CHICAGO IL 606777007 20 1114360328 0 Physicians Anesthesia Services 20 1114360328 0 Physicians Healthy Kids Services 20 1114360328 0 Physicians Optical Supplies 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1114367778 0 Physicians Anesthesia Services 20 1114367778 0 Physicians Healthy Kids Services 20 1114367778 0 Physicians Optical Supplies 20 1114367778 0 Physicians Physician Services 00 1114368511 0 CHAMPAGNE JESSE A 2016126 9999999 B 10 1114368511 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1114368511 0 Nurse Practitioners Fluoride varnish 20 1114368511 0 Nurse Practitioners Healthy Kids Services 20 1114368511 0 Nurse Practitioners Nurse Practitioners Services 20 1114368511 0 Nurse Practitioners Physician Services 00 1114369170 0 ISMAIL IMTIAZ 2017037 9999999 B 10 1114369170 0 1005 BROADWAY ST QUINCY IL 623012834 20 1114369170 0 Physicians Anesthesia Services 20 1114369170 0 Physicians Fluoride varnish 20 1114369170 0 Physicians Healthy Kids Services 20 1114369170 0 Physicians Optical Supplies 20 1114369170 0 Physicians Physician Services 00 1114369881 0 SAWANO KEIKO 2016102 9999999 B 10 1114369881 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 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60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1114372703 0 Physicians Anesthesia Services 20 1114372703 0 Physicians Healthy Kids Services 20 1114372703 0 Physicians Optical Supplies 20 1114372703 0 Physicians Physician Services 00 1114373610 0 PIZZUTO LAUREN 2020169 9999999 B 10 1114373610 0 33900 HARPER AVE STE 104 CLINTON TOWNSHI MI 480354258 20 1114373610 0 Physical Therapists Medical Supplies 20 1114373610 0 Physical Therapists Medical equipment/prosthetic devices 20 1114373610 0 Physical Therapists Physical Therapy Services 00 1114373941 0 BREITE MATTHEW D 2023248 9999999 B 10 1114373941 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1114373941 0 Physicians Anesthesia Services 20 1114373941 0 Physicians Healthy Kids Services 20 1114373941 0 Physicians Optical Supplies 20 1114373941 0 Physicians Physician Services 00 1114374139 0 CALDWELL TESHICA 2016327 9999999 B 10 1114374139 0 3344 W PETERSON AVE STE 102 CHICAGO IL 606593529 20 1114374139 0 Nurse 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301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1114378692 0 Physicians Anesthesia Services 20 1114378692 0 Physicians Healthy Kids Services 20 1114378692 0 Physicians Optical Supplies 20 1114378692 0 Physicians Physician Services 20 1114378692 0 Physicians Physicians Psychiatric Services 00 1114378882 0 GRAY WILLIAM R 2019254 9999999 B 10 1114378882 0 PO BOX 34266 BELFAST ME 049150620 20 1114378882 0 Physicians Anesthesia Services 20 1114378882 0 Physicians Fluoride varnish 20 1114378882 0 Physicians Healthy Kids Services 20 1114378882 0 Physicians Optical Supplies 20 1114378882 0 Physicians Physician Services 00 1114379617 0 STERCZEK ANNA B 2022070 9999999 B 10 1114379617 0 175 E HOUSTON ST SAN ANTONIO TX 782052255 20 1114379617 0 Optometrists Optical Supplies 20 1114379617 0 Optometrists Optometric Services 20 1114379617 0 Optometrists Physician Services 00 1114379732 0 O'BRIEN MEAGAN K 2016202 9999999 B 10 1114379732 0 611 W PARK ST URBANA IL 618012529 20 1114379732 0 Physician Assistant Only Fluoride varnish 20 1114379732 0 Physician Assistant Only Healthy Kids Services 20 1114379732 0 Physician Assistant Only Physician Services 00 1114380011 0 HAGELE MOLLY S 2016323 9999999 B 10 1114380011 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1114380011 0 Nurse Practitioners Anesthesia Services 20 1114380011 0 Nurse Practitioners Nurse Practitioners Services 20 1114380011 0 Nurse Practitioners Physician Services 00 1114380235 0 FRANCIS ELIZABETH C 2016316 9999999 B 10 1114380235 0 29373 NETWORK PL CHICAGO IL 606733039 20 1114380235 0 Nurse Practitioners Healthy Kids Services 20 1114380235 0 Nurse Practitioners Nurse Practitioners Services 20 1114380235 0 Nurse Practitioners Physician Services 00 1114380318 0 ESPINAL AMY E 2019182 9999999 B 10 1114380318 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1114380318 0 Physicians Anesthesia Services 20 1114380318 0 Physicians Healthy Kids Services 20 1114380318 0 Physicians Optical Supplies 20 1114380318 0 Physicians Physician Services 20 1114380318 0 Physicians Physicians Psychiatric Services 00 1114380524 0 SCHWARTZ ANDREW 2022231 9999999 B 10 1114380524 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1114380524 0 Physicians Anesthesia Services 20 1114380524 0 Physicians Healthy Kids Services 20 1114380524 0 Physicians Optical Supplies 20 1114380524 0 Physicians Physician Services 00 1114380540 0 DEMCHUK NATHAN 2024011 9999999 B 10 1114380540 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1114380540 0 Physicians Anesthesia Services 20 1114380540 0 Physicians Fluoride varnish 20 1114380540 0 Physicians Healthy Kids Services 20 1114380540 0 Physicians Optical Supplies 20 1114380540 0 Physicians Physician Services 00 1114381373 0 DENDULURI SAHITYA 2022222 9999999 B 10 1114381373 0 PO BOX 8500 LOCKBOX 7642 PHILADELPHIA PA 191787642 20 1114381373 0 Physicians Anesthesia Services 20 1114381373 0 Physicians Healthy Kids Services 20 1114381373 0 Physicians Optical Supplies 20 1114381373 0 Physicians Physician Services 00 1114381514 0 METZGER EMILY 2019280 9999999 B 10 1114381514 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1114381514 0 Physicians Anesthesia Services 20 1114381514 0 Physicians Fluoride varnish 20 1114381514 0 Physicians Healthy Kids Services 20 1114381514 0 Physicians Optical Supplies 20 1114381514 0 Physicians Physician Services 00 1114381530 0 CRUISE ALEXANDER 2018064 9999999 B 10 1114381530 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1114381530 0 Physicians Anesthesia Services 20 1114381530 0 Physicians Fluoride varnish 20 1114381530 0 Physicians Healthy Kids Services 20 1114381530 0 Physicians Optical Supplies 20 1114381530 0 Physicians Physician Services 00 1114381647 0 GRZYBOWSKI JEFFREY S 2020154 9999999 B 10 1114381647 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1114381647 0 Physicians Anesthesia Services 20 1114381647 0 Physicians Healthy Kids Services 20 1114381647 0 Physicians Optical Supplies 20 1114381647 0 Physicians Physician Services 00 1114381738 0 CAUDILL ELIZABETH 2025038 9999999 B 10 1114381738 0 PO BOX 3550 MCALESTER OK 745023550 20 1114381738 0 Physicians Anesthesia Services 20 1114381738 0 Physicians Healthy Kids Services 20 1114381738 0 Physicians Optical Supplies 20 1114381738 0 Physicians Physician Services 00 1114381779 0 BONURA ERICA 2019182 9999999 B 10 1114381779 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1114381779 0 Physicians Anesthesia Services 20 1114381779 0 Physicians Fluoride varnish 20 1114381779 0 Physicians Healthy Kids Services 20 1114381779 0 Physicians Optical Supplies 20 1114381779 0 Physicians Physician Services 00 1114382355 0 LYNCH CONNOR 2020244 9999999 B 10 1114382355 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1114382355 0 Physicians Anesthesia Services 20 1114382355 0 Physicians Fluoride varnish 20 1114382355 0 Physicians Healthy Kids Services 20 1114382355 0 Physicians Optical Supplies 20 1114382355 0 Physicians Physician Services 00 1114385705 0 BALIKIAN JULIA K 2016082 9999999 B 10 1114385705 0 611 W PARK ST URBANA IL 618012529 20 1114385705 0 Physician Assistant Only Fluoride varnish 20 1114385705 0 Physician Assistant Only Healthy Kids Services 20 1114385705 0 Physician Assistant Only Physician Services 00 1114385994 0 SHULTS CAROLINE 2021096 9999999 B 10 1114385994 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1114385994 0 Nurse Practitioners Healthy Kids Services 20 1114385994 0 Nurse Practitioners Nurse Practitioners Services 20 1114385994 0 Nurse Practitioners Physician Services 00 1114388709 0 CORBITT LEAH 2016061 9999999 B 10 1114388709 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1114388709 0 Nurse Practitioners Anesthesia Services 20 1114388709 0 Nurse Practitioners Nurse Practitioners Services 20 1114388709 0 Nurse Practitioners Physician Services 00 1114389160 0 GUTSELL PHILIP C 2016322 9999999 B 10 1114389160 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1114389160 0 Physicians All Kids application agent 20 1114389160 0 Physicians Anesthesia Services 20 1114389160 0 Physicians Fluoride varnish 20 1114389160 0 Physicians Healthy Kids Services 20 1114389160 0 Physicians Optical Supplies 20 1114389160 0 Physicians Physician Services 00 1114389228 0 CERTO MICHAEL 2023249 9999999 B 10 1114389228 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1114389228 0 Physicians Anesthesia Services 20 1114389228 0 Physicians Fluoride varnish 20 1114389228 0 Physicians Healthy Kids Services 20 1114389228 0 Physicians Optical Supplies 20 1114389228 0 Physicians Physician Services 00 1114389418 0 PELKA MARK 2020014 9999999 B 10 1114389418 0 PO BOX 4176 HOUMA LA 703614176 20 1114389418 0 Physicians Anesthesia Services 20 1114389418 0 Physicians Fluoride varnish 20 1114389418 0 Physicians Healthy Kids Services 20 1114389418 0 Physicians Optical Supplies 20 1114389418 0 Physicians Physician Services 00 1114390663 0 WILLIAMSON ALLISON R 2016001 9999999 B 10 1114390663 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1114390663 0 Nurse Practitioners Healthy Kids Services 20 1114390663 0 Nurse Practitioners Nurse Practitioners Services 20 1114390663 0 Nurse Practitioners Physician Services 00 1114390788 0 EYDELMAN KATHERINE 2018260 9999999 B 10 1114390788 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1114390788 0 Nurse Practitioners Fluoride varnish 20 1114390788 0 Nurse Practitioners Healthy Kids Services 20 1114390788 0 Nurse Practitioners Nurse Practitioners Services 20 1114390788 0 Nurse Practitioners Physician Services 00 1114391067 0 MORAN AMY E 2022029 9999999 B 10 1114391067 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1114391067 0 Nurse Practitioners Healthy Kids Services 20 1114391067 0 Nurse Practitioners Nurse Practitioners Services 20 1114391067 0 Nurse Practitioners Physician Services 00 1114391281 0 HENDRIX MELINDA 2019066 9999999 B 10 1114391281 0 1436 LOCUST ST TERRE HAUTE IN 478071648 20 1114391281 0 Nurse Practitioners Fluoride varnish 20 1114391281 0 Nurse Practitioners 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1114394491 0 4600 3RD ST MOLINE IL 612656106 20 1114394491 0 Nurse Practitioners Fluoride varnish 20 1114394491 0 Nurse Practitioners Healthy Kids Services 20 1114394491 0 Nurse Practitioners Nurse Practitioners Services 20 1114394491 0 Nurse Practitioners Physician Services 00 1114395985 0 LATIFI SABAAHATH 2022223 9999999 B 10 1114395985 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1114395985 0 Other behavior health professional LCPC/LMFT services 00 1114397353 0 SMITH JESSICA LEIGH 2016014 9999999 B 10 1114397353 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1114397353 0 Physician Assistant Only Fluoride varnish 20 1114397353 0 Physician Assistant Only Healthy Kids Services 20 1114397353 0 Physician Assistant Only Physician Services 00 1114398930 0 MECWAN NORMAN J 2016067 9999999 B 10 1114398930 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1114398930 0 Physical Therapists Medical Supplies 20 1114398930 0 Physical Therapists Medical equipment/prosthetic devices 20 1114398930 0 Physical Therapists Physical Therapy Services 00 1114401452 0 KAHL CALLI 2024116 9999999 B 10 1114401452 0 850 43RD AVE STE 100 MOLINE IL 612658401 20 1114401452 0 Speech Therapists Medical Supplies 20 1114401452 0 Speech Therapists Medical equipment/prosthetic devices 20 1114401452 0 Speech Therapists Occupational Therapy Services 00 1114401833 0 TARVESTAD JENNIFER M 2018298 9999999 B 10 1114401833 0 5777 DEPT CAROL STREAM IL 601228942 20 1114401833 0 Nurse Practitioners Healthy Kids Services 20 1114401833 0 Nurse Practitioners Nurse Practitioners Services 20 1114401833 0 Nurse Practitioners Physician Services 00 1114402518 0 GEISS MICHELLE D 2018270 9999999 B 10 1114402518 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1114402518 0 Nurse Practitioners Fluoride varnish 20 1114402518 0 Nurse Practitioners Healthy Kids Services 20 1114402518 0 Nurse Practitioners Nurse Practitioners Services 20 1114402518 0 Nurse Practitioners Physician Services 00 1114402724 0 GILLETTE NADIA M 2020273 9999999 B 10 1114402724 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1114402724 0 Nurse Practitioners Healthy Kids Services 20 1114402724 0 Nurse Practitioners Nurse Practitioners Services 20 1114402724 0 Nurse Practitioners Physician Services 00 1114403623 0 GONZALEZ CALDITO ELENA 2018134 9999999 B 10 1114403623 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1114403623 0 Physicians Anesthesia Services 20 1114403623 0 Physicians Fluoride varnish 20 1114403623 0 Physicians Healthy Kids Services 20 1114403623 0 Physicians Optical Supplies 20 1114403623 0 Physicians Physician Services 00 1114403680 0 ADAMS CHRISTINA 2018199 9999999 B 10 1114403680 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1114403680 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114403821 0 KHAN SHAYAN A 2021025 9999999 B 10 1114403821 0 2511 N MILWAUKEE AVE CHICAGO IL 606472629 20 1114403821 0 Dentists Dental Services 20 1114403821 0 Dentists Physician Services 00 1114404118 0 DYREK ALLISON E 2018228 9999999 B 10 1114404118 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1114404118 0 Nurse Practitioners Healthy Kids Services 20 1114404118 0 Nurse Practitioners Nurse Practitioners Services 20 1114404118 0 Nurse Practitioners Physician Services 00 1114404811 0 FRENCH JENNIFER T 2021341 9999999 B 10 1114404811 0 1265 GRAHAM RD STE 1 FLORISSANT MO 630318018 20 1114404811 0 Nurse Practitioners Healthy Kids Services 20 1114404811 0 Nurse Practitioners Nurse Practitioners Services 20 1114404811 0 Nurse Practitioners Physician Services 00 1114405164 0 TAPIA KATYA 2018235 9999999 B 10 1114405164 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1114405164 0 Nurse Practitioners Fluoride varnish 20 1114405164 0 Nurse Practitioners Healthy Kids Services 20 1114405164 0 Nurse Practitioners Nurse Practitioners Services 20 1114405164 0 Nurse Practitioners Physician Services 00 1114406741 0 BRIGHT JESSICA 2018216 9999999 H 10 1114406741 0 333 N LA GRANGE RD STE 1 SUITE ONE LA GRANGE PARK IL 605265653 20 1114406741 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114408598 0 APPIAH JAMES 2024256 9999999 B 10 1114408598 0 519 N CASS AVE STE 102 WESTMONT IL 605591589 20 1114408598 0 Dentists Anesthesia Services 20 1114408598 0 Dentists Dental Services 20 1114408598 0 Dentists Physician Services 00 1114409018 0 FLEMING BRIDGET 2019312 9999999 B 10 1114409018 0 2900 OGDEN AVE LISLE IL 605321676 20 1114409018 0 Speech Therapists Medical Supplies 20 1114409018 0 Speech Therapists Medical equipment/prosthetic devices 20 1114409018 0 Speech Therapists Speech Therapy/Pathology Services 00 1114409430 0 FORE CANDACE 2018248 9999999 B 10 1114409430 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1114409430 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114410412 0 BUTT FREDERICK 2018177 9999999 B 10 1114410412 0 70 DOCTORS PARK CAPE GIRARDEAU MO 637034928 20 1114410412 0 Physicians Anesthesia Services 20 1114410412 0 Physicians Fluoride varnish 20 1114410412 0 Physicians Healthy Kids Services 20 1114410412 0 Physicians Optical Supplies 20 1114410412 0 Physicians Physician Services 00 1114410891 0 BOND MATTHEW 2024269 9999999 B 10 1114410891 0 PO BOX 43230 PHOENIX AZ 850803230 20 1114410891 0 Physicians Anesthesia Services 20 1114410891 0 Physicians Healthy Kids Services 20 1114410891 0 Physicians Optical Supplies 20 1114410891 0 Physicians Physician Services 20 1114410891 0 Physicians Physicians Psychiatric Services 00 1114410982 0 THAKORE RACHEL V 2022146 9999999 B 10 1114410982 0 903 COMMERCE DR STE 333 OAK BROOK IL 605238723 20 1114410982 0 Physicians Anesthesia Services 20 1114410982 0 Physicians Healthy Kids Services 20 1114410982 0 Physicians Optical Supplies 20 1114410982 0 Physicians Physician Services 00 1114411410 0 UPADHYAY UNNATI 2018182 9999999 B 10 1114411410 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1114411410 0 Physicians Anesthesia Services 20 1114411410 0 Physicians Fluoride varnish 20 1114411410 0 Physicians Healthy Kids Services 20 1114411410 0 Physicians Optical Supplies 20 1114411410 0 Physicians Physician Services 00 1114411584 0 NGUYEN KEVIN J 2020008 9999999 B 10 1114411584 0 PO BOX 857 FREEPORT IL 610320857 20 1114411584 0 Physicians Anesthesia Services 20 1114411584 0 Physicians Healthy Kids Services 20 1114411584 0 Physicians Optical Supplies 20 1114411584 0 Physicians Physician Services 00 1114412087 0 TARTAKOVSKY ALEKSANDER 2021168 9999999 B 10 1114412087 0 5777 DEPT CAROL STREAM IL 601220021 20 1114412087 0 Physicians Anesthesia Services 20 1114412087 0 Physicians Fluoride varnish 20 1114412087 0 Physicians Healthy Kids Services 20 1114412087 0 Physicians Optical Supplies 20 1114412087 0 Physicians Physician Services 00 1114412228 0 PETERSON CRAIG A 2018276 9999999 B 10 1114412228 0 515 22ND AVE MONROE WI 535661569 20 1114412228 0 Nurse Practitioners Anesthesia Services 20 1114412228 0 Nurse Practitioners Nurse Practitioners Services 20 1114412228 0 Nurse Practitioners Physician Services 00 1114412798 0 JI SIHAN 2022230 9999999 B 10 1114412798 0 PO BOX 3039 OAK BROOK IL 605223039 20 1114412798 0 Physicians Anesthesia Services 20 1114412798 0 Physicians Fluoride varnish 20 1114412798 0 Physicians Healthy Kids Services 20 1114412798 0 Physicians Optical Supplies 20 1114412798 0 Physicians Physician Services 00 1114412939 0 BOGARD MICHAEL STEPHEN 2023244 9999999 B 10 1114412939 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1114412939 0 Physicians Anesthesia Services 20 1114412939 0 Physicians Healthy Kids Services 20 1114412939 0 Physicians Optical Supplies 20 1114412939 0 Physicians Physician Services 00 1114412947 0 STEERS LAURA 2022250 9999999 B 10 1114412947 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1114412947 0 Physicians Anesthesia Services 20 1114412947 0 Physicians Healthy Kids Services 20 1114412947 0 Physicians Optical Supplies 20 1114412947 0 Physicians Physician Services 00 1114413515 0 RYAN MICHELLE 2018190 9999999 B 10 1114413515 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1114413515 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114413804 0 BONAPARTE ARTRICIA 2020267 9999999 B 10 1114413804 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1114413804 0 Nurse Practitioners Fluoride varnish 20 1114413804 0 Nurse Practitioners Healthy Kids Services 20 1114413804 0 Nurse Practitioners Nurse Practitioners Services 20 1114413804 0 Nurse Practitioners Physician Services 00 1114413978 0 PATEL MANALI 2020041 9999999 B 10 1114413978 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1114413978 0 Optometrists Optical Supplies 20 1114413978 0 Optometrists Optometric Services 20 1114413978 0 Optometrists Physician Services 00 1114414307 0 PELLETIER BRANDON A 2023039 9999999 B 10 1114414307 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1114414307 0 Physicians Anesthesia Services 20 1114414307 0 Physicians Healthy Kids Services 20 1114414307 0 Physicians Optical Supplies 20 1114414307 0 Physicians Physician Services 00 1114414935 0 HUGHES DANIELLE RAE 2024193 9999999 B 10 1114414935 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1114414935 0 Physicians Anesthesia Services 20 1114414935 0 Physicians Fluoride varnish 20 1114414935 0 Physicians Healthy Kids Services 20 1114414935 0 Physicians Optical Supplies 20 1114414935 0 Physicians Physician Services 00 1114415205 0 LUNDGREN KAITLYN J 2018123 9999999 B 10 1114415205 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1114415205 0 Nurse Practitioners Fluoride varnish 20 1114415205 0 Nurse Practitioners Healthy Kids Services 20 1114415205 0 Nurse Practitioners Nurse Practitioners Services 20 1114415205 0 Nurse Practitioners Physician Services 00 1114415460 0 KODJI BISMARK 2021167 9999999 B 10 1114415460 0 PO BOX 708760 SANDY UT 840708760 20 1114415460 0 Physicians Anesthesia Services 20 1114415460 0 Physicians Fluoride varnish 20 1114415460 0 Physicians Healthy Kids Services 20 1114415460 0 Physicians Optical Supplies 20 1114415460 0 Physicians Physician Services 00 1114415882 0 COKER TESS N 2021167 9999999 B 10 1114415882 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1114415882 0 Physicians Anesthesia Services 20 1114415882 0 Physicians Fluoride varnish 20 1114415882 0 Physicians Healthy Kids Services 20 1114415882 0 Physicians Optical Supplies 20 1114415882 0 Physicians Physician Services 00 1114416146 0 ARONSON MATTHEW R 2020122 9999999 B 10 1114416146 0 28592 NETWORK PL CHICAGO IL 606731285 20 1114416146 0 Physicians Anesthesia Services 20 1114416146 0 Physicians Healthy Kids Services 20 1114416146 0 Physicians Optical Supplies 20 1114416146 0 Physicians Physician Services 00 1114416674 0 HIZEL ALICIA 2022137 9999999 B 10 1114416674 0 2900 OGDEN AVE LISLE IL 605321631 20 1114416674 0 Speech Therapists Medical Supplies 20 1114416674 0 Speech Therapists Medical equipment/prosthetic devices 20 1114416674 0 Speech Therapists Speech Therapy/Pathology Services 00 1114417136 0 ORTIZ JENNIFER L 2020267 9999999 B 10 1114417136 0 5059 W OAKDALE AVE CHICAGO IL 606415016 20 1114417136 0 Other behavior health professional Adaptive behavior support clinician services 20 1114417136 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114417391 0 BAIRD TAMARA 2018182 9999999 B 10 1114417391 0 PO BOX 1109 CROWN POINT IN 463081109 20 1114417391 0 Nurse Practitioners Fluoride varnish 20 1114417391 0 Nurse Practitioners Healthy Kids Services 20 1114417391 0 Nurse Practitioners Nurse Practitioners Services 20 1114417391 0 Nurse Practitioners Physician Services 00 1114417615 0 BELTRAN NICOLE 2018152 9999999 B 10 1114417615 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1114417615 0 Nurse Practitioners Fluoride varnish 20 1114417615 0 Nurse Practitioners Healthy Kids Services 20 1114417615 0 Nurse Practitioners Nurse Practitioners Services 20 1114417615 0 Nurse Practitioners Physician Services 00 1114417862 0 ASHOURI KENAN 2023213 9999999 B 10 1114417862 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1114417862 0 Physicians Anesthesia Services 20 1114417862 0 Physicians Healthy Kids Services 20 1114417862 0 Physicians Optical Supplies 20 1114417862 0 Physicians Physician Services 00 1114418456 0 HARRISON REBECCA P 2018151 9999999 B 10 1114418456 0 PO BOX 458 SAVOY IL 618740458 20 1114418456 0 Other behavior health professional LCPC/LMFT services 00 1114418803 0 VARKEY CHINNU 2019281 9999999 B 10 1114418803 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1114418803 0 Nurse Practitioners Fluoride varnish 20 1114418803 0 Nurse Practitioners Healthy Kids Services 20 1114418803 0 Nurse Practitioners Nurse Practitioners Services 20 1114418803 0 Nurse Practitioners Physician Services 00 1114418910 0 SCHROEDER MEGAN ELIZABETH 2021245 9999999 B 10 1114418910 0 29373 NETWORK PL CHICAGO IL 606733039 20 1114418910 0 Physician Assistant Only Fluoride varnish 20 1114418910 0 Physician Assistant Only Healthy Kids Services 20 1114418910 0 Physician Assistant Only Physician Services 00 1114418951 0 BEASON AUSTIN 2020209 9999999 B 10 1114418951 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1114418951 0 Physicians Anesthesia Services 20 1114418951 0 Physicians Healthy Kids Services 20 1114418951 0 Physicians Optical Supplies 20 1114418951 0 Physicians Physician Services 00 1114421286 0 HANRAHAN ALEXANDRA M 2020013 9999999 B 10 1114421286 0 5777 DEPT CAROL STREAM IL 601220021 20 1114421286 0 Physicians Anesthesia Services 20 1114421286 0 Physicians Fluoride varnish 20 1114421286 0 Physicians Healthy Kids Services 20 1114421286 0 Physicians Optical Supplies 20 1114421286 0 Physicians Physician Services 00 1114421369 0 WHALEY EVAN 2021081 9999999 B 10 1114421369 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1114421369 0 Physical Therapists Medical Supplies 20 1114421369 0 Physical Therapists Medical equipment/prosthetic devices 20 1114421369 0 Physical Therapists Physical Therapy Services 00 1114421898 0 CHAREST TAYLOR ANNE 2018182 9999999 B 10 1114421898 0 1220 S WOOD ST CHICAGO IL 606081202 20 1114421898 0 Physicians Anesthesia Services 20 1114421898 0 Physicians Fluoride varnish 20 1114421898 0 Physicians Healthy Kids Services 20 1114421898 0 Physicians Optical Supplies 20 1114421898 0 Physicians Physician Services 00 1114422268 0 WILHELMSTOETTER ASHTIN B 2023248 9999999 B 10 1114422268 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1114422268 0 Physicians Anesthesia Services 20 1114422268 0 Physicians Healthy Kids Services 20 1114422268 0 Physicians Optical Supplies 20 1114422268 0 Physicians Physician Services 00 1114422367 0 POWERS INNA 2024240 9999999 B 10 1114422367 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1114422367 0 Physicians Anesthesia Services 20 1114422367 0 Physicians Fluoride varnish 20 1114422367 0 Physicians Healthy Kids Services 20 1114422367 0 Physicians Optical Supplies 20 1114422367 0 Physicians Physician Services 00 1114422961 0 ALLALI-BIERMAN TAVOR 2020013 9999999 B 10 1114422961 0 2215 SANDERS RD STE 105 SUITE 105 NORTHBROOK IL 600626194 20 1114422961 0 Physicians Anesthesia Services 20 1114422961 0 Physicians Fluoride varnish 20 1114422961 0 Physicians Healthy Kids Services 20 1114422961 0 Physicians Optical Supplies 20 1114422961 0 Physicians Physician Services 00 1114423043 0 CHANG FRANKLIN R 2020072 9999999 B 10 1114423043 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1114423043 0 Physicians Anesthesia Services 20 1114423043 0 Physicians Fluoride varnish 20 1114423043 0 Physicians Healthy Kids Services 20 1114423043 0 Physicians Optical Supplies 20 1114423043 0 Physicians Physician Services 00 1114423266 0 GONDRA-SANABRIA STEPHANIE 2022228 9999999 B 10 1114423266 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1114423266 0 Physicians Anesthesia Services 20 1114423266 0 Physicians Fluoride varnish 20 1114423266 0 Physicians Healthy Kids Services 20 1114423266 0 Physicians Optical Supplies 20 1114423266 0 Physicians Physician Services 00 1114423597 0 ORIONZI BAKO A 2019175 9999999 B 10 1114423597 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1114423597 0 Physicians Anesthesia Services 20 1114423597 0 Physicians Fluoride varnish 20 1114423597 0 Physicians Healthy Kids Services 20 1114423597 0 Physicians Optical Supplies 20 1114423597 0 Physicians Physician Services 00 1114424264 0 RADEMAN MIGNON 2023245 9999999 B 10 1114424264 0 1000 N OAK AVE MARSHFIELD WI 544495703 20 1114424264 0 Physicians Anesthesia Services 20 1114424264 0 Physicians Healthy Kids Services 20 1114424264 0 Physicians Optical Supplies 20 1114424264 0 Physicians Physician Services 00 1114425154 0 FIGUEROA JESSICA 2018024 9999999 B 10 1114425154 0 2200 BETHESDA BLVD ZION IL 600992352 20 1114425154 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114425618 0 KHUDEIRA NEDA 2018043 9999999 H 10 1114425618 0 8071 S CICERO AVE CHICAGO IL 606522003 20 1114425618 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114425873 0 NUNEZ ALLISON 2021162 9999999 B 10 1114425873 0 1706 W AGENCY RD WEST BURLINGTON IA 526551667 20 1114425873 0 Physician Assistant Only Fluoride varnish 20 1114425873 0 Physician Assistant Only Healthy Kids Services 20 1114425873 0 Physician Assistant Only Physician Services 00 1114426194 0 PAQUETTE MICHAEL 2024008 9999999 B 10 1114426194 0 8021 KRISTO LN ORLAND PARK IL 604626110 20 1114426194 0 Other behavior health professional LCPC/LMFT services 00 1114426202 0 MATHEWS CHRISTINE D 2018201 9999999 B 10 1114426202 0 1570 W BATTLEFIELD ST STE 110 SPRINGFIELD MO 658074163 20 1114426202 0 Nurse Practitioners Fluoride varnish 20 1114426202 0 Nurse Practitioners Healthy Kids Services 20 1114426202 0 Nurse Practitioners Nurse Practitioners Services 20 1114426202 0 Nurse Practitioners Physician Services 00 1114426491 0 GLAZA KAREN L 2019240 9999999 B 10 1114426491 0 612 S WESTERN AVE CHICAGO IL 606124680 20 1114426491 0 Clinical Social Worker Social work service 00 1114429446 0 MORALES BRISEYDA 2018082 9999999 B 10 1114429446 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1114429446 0 Nurse Practitioners Fluoride varnish 20 1114429446 0 Nurse Practitioners Healthy Kids Services 20 1114429446 0 Nurse Practitioners Nurse Practitioners Services 20 1114429446 0 Nurse Practitioners Physician Services 00 1114430196 0 VAUGHN MOLLY 2018001 9999999 B 10 1114430196 0 164 EUCLID AVE BLOOMINGDALE IL 601081634 20 1114430196 0 Speech Therapists Medical Supplies 20 1114430196 0 Speech Therapists Medical equipment/prosthetic devices 20 1114430196 0 Speech Therapists Speech Therapy/Pathology Services 00 1114430337 0 TODD TIFFANY 2022140 9999999 B 10 1114430337 0 47 W POLK ST STE 250 CHICAGO IL 606052765 20 1114430337 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114431277 0 LAMPS ANGIE M 2020129 9999999 B 10 1114431277 0 1800 CHURCH ST PERU IL 613541615 20 1114431277 0 Speech Therapists Medical Supplies 20 1114431277 0 Speech Therapists Medical equipment/prosthetic devices 20 1114431277 0 Speech Therapists Speech Therapy/Pathology Services 00 1114431764 0 O'NEAL KYLA S 2023038 9999999 B 10 1114431764 0 14484 JOHN HUMPHREY DR ORLAND PARK IL 604622638 20 1114431764 0 Other behavior health professional LCPC/LMFT services 00 1114433356 0 JOHNSON ALYSSA 2023255 9999999 B 10 1114433356 0 720 E CULVER CT GENESEO IL 612541851 20 1114433356 0 Other behavior health professional Adaptive behavior support clinician services 00 1114433463 0 PHAN KELLEY T 2022249 9999999 B 10 1114433463 0 5777 DEPT CAROL STREAM IL 601220021 20 1114433463 0 Psychologist Psychologist service 00 1114433968 0 CHAPMAN CATHERINE 2018004 9999999 B 10 1114433968 0 600 E WATER ST PINCKNEYVILLE IL 622741472 20 1114433968 0 Registered nurse Nursing service 20 1114433968 0 Registered nurse Waiver service 00 1114434479 0 WILSON STEVEN LAWRENCE 2018009 9999999 B 10 1114434479 0 1500 N CLYBOURN AVE UNIT C105 CHICAGO IL 606102295 20 1114434479 0 Speech Therapists Medical Supplies 20 1114434479 0 Speech Therapists Medical equipment/prosthetic devices 20 1114434479 0 Speech Therapists Speech Therapy/Pathology Services 00 1114435526 0 BLUM ALLISON 2021152 9999999 B 10 1114435526 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1114435526 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114435559 0 LANTZ CAROL J 2018075 9999999 B 10 1114435559 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1114435559 0 Nurse Practitioners Fluoride varnish 20 1114435559 0 Nurse Practitioners Healthy Kids Services 20 1114435559 0 Nurse Practitioners Nurse Practitioners Services 20 1114435559 0 Nurse Practitioners Physician Services 00 1114435740 0 RIEHL-DITSWORTH JENNY 2017253 9999999 B 10 1114435740 0 4600 3RD ST MOLINE IL 612656106 20 1114435740 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114436573 0 PANDYA BANSRI 2021091 9999999 B 10 1114436573 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1114436573 0 Physical Therapists Medical Supplies 20 1114436573 0 Physical Therapists Medical equipment/prosthetic devices 20 1114436573 0 Physical Therapists Physical Therapy Services 00 1114437902 0 KEESEE TAMARA A 2018255 9999999 B 10 1114437902 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1114437902 0 Nurse Practitioners Fluoride varnish 20 1114437902 0 Nurse Practitioners Healthy Kids Services 20 1114437902 0 Nurse Practitioners Nurse Practitioners Services 20 1114437902 0 Nurse Practitioners Physician Services 00 1114438249 0 ST VICTOR LUCKETT LYNN 2017293 9999999 B 10 1114438249 0 7101 N CICERO AVE STE 202 LINCOLNWOOD IL 607122143 20 1114438249 0 Nurse Practitioners Fluoride varnish 20 1114438249 0 Nurse Practitioners Healthy Kids Services 20 1114438249 0 Nurse Practitioners Nurse Practitioners Services 20 1114438249 0 Nurse Practitioners Physician Services 00 1114438447 0 FRAZIER-COOK NATELIE R 2018178 9999999 B 10 1114438447 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1114438447 0 Nurse Practitioners Fluoride varnish 20 1114438447 0 Nurse Practitioners Healthy Kids Services 20 1114438447 0 Nurse Practitioners Nurse Practitioners Services 20 1114438447 0 Nurse Practitioners Physician Services 00 1114438884 0 MILLER MELINDA 2021001 9999999 B 10 1114438884 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1114438884 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114440179 0 BASS KEITH 2017203 9999999 B 10 1114440179 0 1003 E 5TH ST METROPOLIS 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Kids Services 20 1114446515 0 Nurse Practitioners Nurse Practitioners Services 20 1114446515 0 Nurse Practitioners Physician Services 00 1114446754 0 HOFFMANN STEPHEN 2018059 9999999 B 10 1114446754 0 1120 RANDALL CT GENEVA IL 601343911 20 1114446754 0 Clinical Social Worker Social work service 00 1114446978 0 MILDER KIMBERLY 2017256 9999999 B 10 1114446978 0 401 FREMONT ST LENA IL 610488610 20 1114446978 0 Speech Therapists Medical Supplies 20 1114446978 0 Speech Therapists Medical equipment/prosthetic devices 20 1114446978 0 Speech Therapists Speech Therapy/Pathology Services 00 1114448040 0 HOFFMAN KIMBERLY 2022105 9999999 B 10 1114448040 0 611 W PARK ST URBANA IL 618012529 20 1114448040 0 Nurse Practitioners Fluoride varnish 20 1114448040 0 Nurse Practitioners Healthy Kids Services 20 1114448040 0 Nurse Practitioners Nurse Practitioners Services 20 1114448040 0 Nurse Practitioners Physician Services 00 1114448305 0 IGLESIA MICHAEL 2019158 9999999 B 10 1114448305 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1114448305 0 Physicians Anesthesia Services 20 1114448305 0 Physicians Fluoride varnish 20 1114448305 0 Physicians Healthy Kids Services 20 1114448305 0 Physicians Optical Supplies 20 1114448305 0 Physicians Physician Services 00 1114448578 0 MAGALLANES JACQUELINE 2017195 9999999 B 10 1114448578 0 7124 W DIVERSEY AVE CHICAGO IL 607071601 20 1114448578 0 Dentists Dental Services 20 1114448578 0 Dentists Physician Services 00 1114448974 0 LAVIOLETTE KATHRYN E 2020027 9999999 B 10 1114448974 0 8550 W BRYN MAWR AVE STE 800 STE 800 CHICAGO IL 606313222 20 1114448974 0 Podiatrists Podiatric Services 00 1114449519 0 SHIRO LYNDA A 2017191 9999999 B 10 1114449519 0 PO BOX 857 FREEPORT IL 610320857 20 1114449519 0 Nurse Practitioners Fluoride varnish 20 1114449519 0 Nurse Practitioners Healthy Kids Services 20 1114449519 0 Nurse Practitioners Nurse Practitioners Services 20 1114449519 0 Nurse Practitioners Physician Services 00 1114449774 0 IRONS JULIA R 2018001 9999999 B 10 1114449774 0 445 SHERIDAN RD HIGHWOOD IL 600401317 20 1114449774 0 Speech Therapists Medical Supplies 20 1114449774 0 Speech Therapists Medical equipment/prosthetic devices 20 1114449774 0 Speech Therapists Speech Therapy/Pathology Services 00 1114450228 0 SAONA CENTENO JORGE E 2024337 9999999 B 10 1114450228 0 3901 S 7TH ST TERRE HAUTE IN 478025709 20 1114450228 0 Physicians Anesthesia Services 20 1114450228 0 Physicians Fluoride varnish 20 1114450228 0 Physicians Healthy Kids Services 20 1114450228 0 Physicians Optical Supplies 20 1114450228 0 Physicians Physician Services 00 1114450988 0 EA DENNIS 2020281 9999999 B 10 1114450988 0 2434 W DIVISION ST CHICAGO IL 606222942 20 1114450988 0 Physicians Anesthesia Services 20 1114450988 0 Physicians Fluoride varnish 20 1114450988 0 Physicians Healthy Kids Services 20 1114450988 0 Physicians Optical Supplies 20 1114450988 0 Physicians Physician Services 00 1114451036 0 HENDERSHOTT KRISTI A 2017256 9999999 B 10 1114451036 0 PO BOX 504 HERSCHER IL 609410504 20 1114451036 0 Speech Therapists Medical Supplies 20 1114451036 0 Speech Therapists Medical equipment/prosthetic devices 20 1114451036 0 Speech Therapists Speech Therapy/Pathology Services 00 1114451135 0 UWAH MARTIN 2024275 9999999 B 10 1114451135 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1114451135 0 Physicians Anesthesia Services 20 1114451135 0 Physicians Healthy Kids Services 20 1114451135 0 Physicians Optical Supplies 20 1114451135 0 Physicians Physician Services 00 1114451820 0 SHAH HARSH R 2023254 9999999 B 10 1114451820 0 6742 N FROSTWOOD PKWY PEORIA IL 616152402 20 1114451820 0 Physicians Anesthesia Services 20 1114451820 0 Physicians Healthy Kids Services 20 1114451820 0 Physicians Optical Supplies 20 1114451820 0 Physicians Physician Services 00 1114452026 0 PEARSON DONNA 2024079 9999999 B 10 1114452026 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1114452026 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114452927 0 KENDRICK ZACHARY W 2022094 9999999 B 10 1114452927 0 1000 N OAK AVE MARSHFIELD WI 544495703 20 1114452927 0 Physicians Anesthesia Services 20 1114452927 0 Physicians Healthy Kids Services 20 1114452927 0 Physicians Optical Supplies 20 1114452927 0 Physicians Physician Services 00 1114453446 0 REDDY PRERANA 2020230 9999999 B 10 1114453446 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1114453446 0 Physicians Anesthesia Services 20 1114453446 0 Physicians Fluoride varnish 20 1114453446 0 Physicians Healthy Kids Services 20 1114453446 0 Physicians Optical Supplies 20 1114453446 0 Physicians Physician Services 00 1114453750 0 LEDONNE ASHLEY A. 2017219 9999999 B 10 1114453750 0 29373 NETWORK PL CHICAGO IL 606733039 20 1114453750 0 Nurse Practitioners Fluoride varnish 20 1114453750 0 Nurse Practitioners Healthy Kids Services 20 1114453750 0 Nurse Practitioners Nurse Practitioners Services 20 1114453750 0 Nurse Practitioners Physician Services 00 1114453768 0 O''CONNELL NAILA 2017156 9999999 B 10 1114453768 0 7725 W RENO AVE OKLAHOMA CITY OK 731279711 20 1114453768 0 Nurse Practitioners Fluoride varnish 20 1114453768 0 Nurse Practitioners Healthy Kids Services 20 1114453768 0 Nurse Practitioners Nurse Practitioners Services 20 1114453768 0 Nurse Practitioners Physician Services 00 1114453917 0 PAINTER BRIANA M 2017274 9999999 B 10 1114453917 0 5777 DEPT CAROL STREAM IL 601228942 20 1114453917 0 Physician Assistant Only Fluoride varnish 20 1114453917 0 Physician Assistant Only Healthy Kids Services 20 1114453917 0 Physician Assistant Only Physician Services 00 1114453974 0 GUZMAN OMAR 2018197 9999999 B 10 1114453974 0 800 E 55TH ST CHICAGO IL 606154906 20 1114453974 0 Clinical Social Worker Social work service 00 1114454113 0 DARJI BELLA 2017234 9999999 B 10 1114454113 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1114454113 0 Nurse Practitioners Fluoride varnish 20 1114454113 0 Nurse Practitioners Healthy Kids Services 20 1114454113 0 Nurse Practitioners Nurse Practitioners Services 20 1114454113 0 Nurse Practitioners Physician Services 00 1114454543 0 DEUMIC SHULTZ EMIRA 2022221 9999999 B 10 1114454543 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1114454543 0 Physicians Anesthesia Services 20 1114454543 0 Physicians Healthy Kids Services 20 1114454543 0 Physicians Optical Supplies 20 1114454543 0 Physicians Physician Services 20 1114454543 0 Physicians Physicians Psychiatric Services 00 1114454733 0 BARAJAS MICHAEL 2017152 9999999 B 10 1114454733 0 2525 CHARLESTON RD STE 104 MOUNTAIN VIEW CA 940431636 20 1114454733 0 Physician Assistant Only Fluoride varnish 20 1114454733 0 Physician Assistant Only Healthy Kids Services 20 1114454733 0 Physician Assistant Only Physician Services 00 1114455094 0 SACHAK STANLEY K 2024036 9999999 B 10 1114455094 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1114455094 0 Physicians Anesthesia Services 20 1114455094 0 Physicians Fluoride varnish 20 1114455094 0 Physicians Healthy Kids Services 20 1114455094 0 Physicians Optical Supplies 20 1114455094 0 Physicians Physician Services 00 1114455573 0 BRENART ROBERT F 2017177 9999999 B 10 1114455573 0 120 E COUNTRYSIDE PKWY YORKVILLE IL 605601877 20 1114455573 0 Optometrists Optical Supplies 20 1114455573 0 Optometrists Optometric Services 20 1114455573 0 Optometrists Physician Services 00 1114455680 0 KENTOR MITCHELL NATHAN 2020024 9999999 B 10 1114455680 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1114455680 0 Physicians Anesthesia Services 20 1114455680 0 Physicians Healthy Kids Services 20 1114455680 0 Physicians Optical Supplies 20 1114455680 0 Physicians Physician Services 00 1114456134 0 GRIFFIN JOANNA V 2017125 9999999 B 10 1114456134 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1114456134 0 Clinical Social Worker Social work service 00 1114456183 0 HATFILL BAILEY 2017208 9999999 B 10 1114456183 0 615 N PROMENADE ST # 530 HAVANA IL 626441243 20 1114456183 0 Speech Therapists Medical Supplies 20 1114456183 0 Speech Therapists Medical equipment/prosthetic devices 20 1114456183 0 Speech Therapists Speech Therapy/Pathology Services 00 1114456258 0 BURLAND COURTNEY P 2017304 9999999 B 10 1114456258 0 5777 DEPT CAROL STREAM IL 601228942 20 1114456258 0 Physician Assistant Only Fluoride varnish 20 1114456258 0 Physician Assistant Only Healthy Kids Services 20 1114456258 0 Physician Assistant Only Physician Services 00 1114456704 0 STERENSTEIN ANDREA 2019200 9999999 B 10 1114456704 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1114456704 0 Physicians Anesthesia Services 20 1114456704 0 Physicians Healthy Kids Services 20 1114456704 0 Physicians Optical Supplies 20 1114456704 0 Physicians Physician Services 20 1114456704 0 Physicians Physicians Psychiatric Services 00 1114456712 0 WINGATE MELISSA A 2017237 9999999 B 10 1114456712 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1114456712 0 Psychologist Psychologist service 00 1114456902 0 GAYED MATTHEW J 2018352 9999999 B 10 1114456902 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1114456902 0 Physicians Anesthesia Services 20 1114456902 0 Physicians Healthy Kids Services 20 1114456902 0 Physicians Optical Supplies 20 1114456902 0 Physicians Physician Services 00 1114457330 0 EGLEY BRITTANY 2017179 9999999 B 10 1114457330 0 1005 BROADWAY ST QUINCY IL 623012834 20 1114457330 0 Nurse Practitioners Fluoride varnish 20 1114457330 0 Nurse Practitioners Healthy Kids Services 20 1114457330 0 Nurse Practitioners Nurse Practitioners Services 20 1114457330 0 Nurse Practitioners Physician Services 00 1114457611 0 STEVENS TIFFANY M 2017216 9999999 B 10 1114457611 0 1136 S DELANO CT W STE B201 CHICAGO IL 606053734 20 1114457611 0 Other behavior health professional LCPC/LMFT services 20 1114457611 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114457769 0 AZU CRYSTAL N 2024243 9999999 B 10 1114457769 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1114457769 0 Physicians Anesthesia Services 20 1114457769 0 Physicians Fluoride varnish 20 1114457769 0 Physicians Healthy Kids Services 20 1114457769 0 Physicians Optical Supplies 20 1114457769 0 Physicians Physician Services 00 1114458023 0 LEE DAVID 2022283 9999999 B 10 1114458023 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1114458023 0 Physicians Anesthesia Services 20 1114458023 0 Physicians Fluoride varnish 20 1114458023 0 Physicians Healthy Kids Services 20 1114458023 0 Physicians Optical Supplies 20 1114458023 0 Physicians Physician Services 00 1114459013 0 BIRD AMANDA 2017114 9999999 B 10 1114459013 0 1436 W RANDOLPH ST STE 204 CHICAGO IL 606071415 20 1114459013 0 Speech Therapists Medical Supplies 20 1114459013 0 Speech Therapists Medical equipment/prosthetic devices 20 1114459013 0 Speech Therapists Speech Therapy/Pathology Services 00 1114459146 0 ALTHIDE MARGARET R 2018324 9999999 B 10 1114459146 0 1005 BROADWAY ST QUINCY IL 623012834 20 1114459146 0 Clinical Social Worker Social work service 00 1114459500 0 CALDWELL SAMANTHA 2022262 9999999 B 10 1114459500 0 930 MADISON AVE STE 200 MEMPHIS TN 381033452 20 1114459500 0 Physicians Anesthesia Services 20 1114459500 0 Physicians Fluoride varnish 20 1114459500 0 Physicians Healthy Kids Services 20 1114459500 0 Physicians Optical Supplies 20 1114459500 0 Physicians Physician Services 00 1114459856 0 ZHANG HANCI 2023179 9999999 B 10 1114459856 0 929 W HIGGINS RD SCHAUMBURG IL 601953203 20 1114459856 0 Physicians Anesthesia Services 20 1114459856 0 Physicians Healthy Kids Services 20 1114459856 0 Physicians Optical Supplies 20 1114459856 0 Physicians Physician Services 00 1114460995 0 BRANDENBURG LAURA L 2017001 9999999 B 10 1114460995 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1114460995 0 Nurse Practitioners Fluoride varnish 20 1114460995 0 Nurse Practitioners Healthy Kids Services 20 1114460995 0 Nurse Practitioners Nurse Practitioners Services 20 1114460995 0 Nurse Practitioners Physician Services 00 1114461019 0 WESTON LAUREN 2017033 9999999 B 10 1114461019 0 5777 DEPT CAROL STREAM IL 601220021 20 1114461019 0 Physician Assistant Only Fluoride varnish 20 1114461019 0 Physician Assistant Only Healthy Kids Services 20 1114461019 0 Physician Assistant Only Physician Services 00 1114461282 0 TRASATTI CASEY K 2020224 9999999 H 10 1114461282 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1114461282 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114462033 0 TURNER KAITLIN 2023136 9999999 B 10 1114462033 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1114462033 0 Speech Therapists Medical Supplies 20 1114462033 0 Speech Therapists Medical equipment/prosthetic devices 20 1114462033 0 Speech Therapists Speech Therapy/Pathology Services 00 1114463049 0 LONG DYMOND D 2017332 9999999 B 10 1114463049 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1114463049 0 Nurse Practitioners Fluoride varnish 20 1114463049 0 Nurse Practitioners Healthy Kids Services 20 1114463049 0 Nurse Practitioners Nurse Practitioners Services 20 1114463049 0 Nurse Practitioners Physician Services 00 1114463502 0 FAGAN KAREN J 2017124 9999999 B 10 1114463502 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1114463502 0 Nurse Practitioners Healthy Kids Services 20 1114463502 0 Nurse Practitioners Nurse Practitioners Services 20 1114463502 0 Nurse Practitioners Physician Services 00 1114464625 0 TER SAAKYANTS MILA 2017109 9999999 B 10 1114464625 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1114464625 0 Nurse Practitioners Fluoride varnish 20 1114464625 0 Nurse Practitioners Healthy Kids Services 20 1114464625 0 Nurse Practitioners Nurse Practitioners Services 20 1114464625 0 Nurse Practitioners Physician Services 00 1114466885 0 BADSHAH MOAVIZ B 2020247 9999999 B 10 1114466885 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1114466885 0 Physicians Anesthesia Services 20 1114466885 0 Physicians Fluoride varnish 20 1114466885 0 Physicians Healthy Kids Services 20 1114466885 0 Physicians Optical Supplies 20 1114466885 0 Physicians Physician Services 00 1114467636 0 INCE NATALIE J 2016308 9999999 B 10 1114467636 0 1051 W SOUTH ST KEWANEE IL 614438354 20 1114467636 0 Nurse Practitioners Anesthesia Services 20 1114467636 0 Nurse Practitioners Nurse Practitioners Services 20 1114467636 0 Nurse Practitioners Physician Services 00 1114468501 0 PYKE VICTORIA A 2023254 9999999 B 10 1114468501 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1114468501 0 Nurse Practitioners Fluoride varnish 20 1114468501 0 Nurse Practitioners Healthy Kids Services 20 1114468501 0 Nurse Practitioners Nurse Practitioners Services 20 1114468501 0 Nurse Practitioners Physician Services 00 1114469384 0 NUNEZ BENJAMIN 2018270 9999999 B 10 1114469384 0 5220 EAST AVE COUNTRYSIDE IL 605253133 20 1114469384 0 Other behavior health professional LCPC/LMFT services 00 1114469715 0 O'SHEA JENNIFER R 2018335 9999999 B 10 1114469715 0 901 MCCLINTOCK DR STE 202 SUITE 202 BURR RIDGE IL 605270872 20 1114469715 0 Physician Assistant Only Fluoride varnish 20 1114469715 0 Physician Assistant Only Healthy Kids Services 20 1114469715 0 Physician Assistant Only Physician Services 00 1114470028 0 NORRIS KIMBERLY 2017151 9999999 B 10 1114470028 0 PO BOX 4827 DES MOINES IA 503054827 20 1114470028 0 Nurse Practitioners Healthy Kids Services 20 1114470028 0 Nurse Practitioners Nurse Practitioners Services 20 1114470028 0 Nurse Practitioners Physician Services 00 1114470283 0 MOON STEVE S 2016218 9999999 B 10 1114470283 0 4953 W FULLERTON AVE CHICAGO IL 606392505 20 1114470283 0 Dentists Dental Services 20 1114470283 0 Dentists Physician Services 00 1114470408 0 XIONG YEE 2024013 9999999 B 10 1114470408 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1114470408 0 Physicians Anesthesia Services 20 1114470408 0 Physicians Healthy Kids Services 20 1114470408 0 Physicians Optical Supplies 20 1114470408 0 Physicians Physician Services 20 1114470408 0 Physicians Physicians Psychiatric Services 00 1114470481 0 STENGREVICS JENNIFER 2022123 9999999 B 10 1114470481 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1114470481 0 Physician Assistant Only Fluoride varnish 20 1114470481 0 Physician Assistant Only Healthy Kids Services 20 1114470481 0 Physician Assistant Only Physician Services 00 1114471745 0 BECKER KARL N 2018001 9999999 B 10 1114471745 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1114471745 0 Physicians Anesthesia Services 20 1114471745 0 Physicians Healthy Kids Services 20 1114471745 0 Physicians Optical Supplies 20 1114471745 0 Physicians Physician Services 00 1114471869 0 GROTE KAYDIANNE J 2016245 9999999 B 10 1114471869 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1114471869 0 Dentists Dental Services 20 1114471869 0 Dentists Physician Services 00 1114472271 0 BURKE SALLY 2017051 9999999 B 10 1114472271 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1114472271 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114472610 0 GIBBS TARAH 2016267 9999999 B 10 1114472610 0 PO BOX 1109 CROWN POINT IN 463081109 20 1114472610 0 Nurse Practitioners Fluoride varnish 20 1114472610 0 Nurse Practitioners Healthy Kids Services 20 1114472610 0 Nurse Practitioners Nurse Practitioners Services 20 1114472610 0 Nurse Practitioners Physician Services 00 1114472867 0 BYRD MARCUS 2022165 9999999 B 10 1114472867 0 4698 DEPT CAROL STREAM IL 601220021 20 1114472867 0 Physicians Anesthesia Services 20 1114472867 0 Physicians Healthy Kids Services 20 1114472867 0 Physicians Optical Supplies 20 1114472867 0 Physicians Physician Services 20 1114472867 0 Physicians Physicians Psychiatric Services 00 1114473451 0 BOYET TYLER 2021207 9999999 B 10 1114473451 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1114473451 0 Physicians Anesthesia Services 20 1114473451 0 Physicians Healthy Kids Services 20 1114473451 0 Physicians Optical Supplies 20 1114473451 0 Physicians Physician Services 00 1114475597 0 JOHNSTON LINDSEY A 2016275 9999999 B 10 1114475597 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1114475597 0 Nurse Practitioners Fluoride varnish 20 1114475597 0 Nurse Practitioners Healthy Kids Services 20 1114475597 0 Nurse Practitioners Nurse Practitioners Services 20 1114475597 0 Nurse Practitioners Physician Services 00 1114476835 0 RODHEIM HANNAH J 2017312 9999999 B 10 1114476835 0 1618 W BEACH AVE CHICAGO IL 606222231 20 1114476835 0 Speech Therapists Medical Supplies 20 1114476835 0 Speech Therapists Medical equipment/prosthetic devices 20 1114476835 0 Speech Therapists Speech Therapy/Pathology Services 00 1114478955 0 JACOBS JENNIFER M 2016321 9999999 B 10 1114478955 0 616 N NORTH CT STE 110 PALATINE IL 600678121 20 1114478955 0 Nurse Practitioners Healthy Kids Services 20 1114478955 0 Nurse Practitioners Nurse Practitioners Services 20 1114478955 0 Nurse Practitioners Physician Services 00 1114479052 0 CLARK JENNIFER E 2017182 9999999 B 10 1114479052 0 1890 SILVER CROSS BLVD STE 410 NEW LENOX IL 604519547 20 1114479052 0 Physician Assistant Only Fluoride varnish 20 1114479052 0 Physician Assistant Only Healthy Kids Services 20 1114479052 0 Physician Assistant Only Physician Services 00 1114479748 0 PATEL AAPTI 2019302 9999999 B 10 1114479748 0 PO BOX 5081 JANESVILLE WI 535475081 20 1114479748 0 Physical Therapists Medical Supplies 20 1114479748 0 Physical Therapists Medical equipment/prosthetic devices 20 1114479748 0 Physical Therapists Physical Therapy Services 00 1114480001 0 JACKSON SAMUEL W 2024323 9999999 B 10 1114480001 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1114480001 0 Physicians Anesthesia Services 20 1114480001 0 Physicians Healthy Kids Services 20 1114480001 0 Physicians Optical Supplies 20 1114480001 0 Physicians Physician Services 20 1114480001 0 Physicians Physicians Psychiatric Services 00 1114480696 0 COLLINS JENNIFER 2024205 9999999 B 10 1114480696 0 515 22ND AVE MONROE WI 535661569 20 1114480696 0 Physicians Anesthesia Services 20 1114480696 0 Physicians Healthy Kids Services 20 1114480696 0 Physicians Optical Supplies 20 1114480696 0 Physicians Physician Services 20 1114480696 0 Physicians Physicians Psychiatric Services 00 1114480886 0 MACKEY KYLE 2025035 9999999 B 10 1114480886 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1114480886 0 Physicians Anesthesia Services 20 1114480886 0 Physicians Healthy Kids Services 20 1114480886 0 Physicians Optical Supplies 20 1114480886 0 Physicians Physician Services 00 1114481421 0 SIMS SABHIA 2019031 9999999 B 10 1114481421 0 PO BOX 1109 DEKALB IL 601157109 20 1114481421 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114484938 0 AGNE JULIE 2019067 9999999 B 10 1114484938 0 1520 MAPLE AVE NORTHBROOK IL 600625475 20 1114484938 0 Occupational Therapists Medical Supplies 20 1114484938 0 Occupational Therapists Medical equipment/prosthetic devices 20 1114484938 0 Occupational Therapists Occupational Therapy Services 00 1114485695 0 WILLOUGHBY LAUREN 2022178 9999999 B 10 1114485695 0 PO BOX 431 JANESVILLE WI 535470431 20 1114485695 0 Physicians Anesthesia Services 20 1114485695 0 Physicians Healthy Kids Services 20 1114485695 0 Physicians Optical Supplies 20 1114485695 0 Physicians Physician Services 00 1114486115 0 MINNETTE MATTHEW 2019205 9999999 B 10 1114486115 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1114486115 0 Physicians Anesthesia Services 20 1114486115 0 Physicians Fluoride varnish 20 1114486115 0 Physicians Healthy Kids Services 20 1114486115 0 Physicians Optical Supplies 20 1114486115 0 Physicians Physician Services 00 1114486149 0 HARIHARAN DIVYA 2019182 9999999 B 10 1114486149 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1114486149 0 Physicians Anesthesia Services 20 1114486149 0 Physicians Healthy Kids Services 20 1114486149 0 Physicians Optical Supplies 20 1114486149 0 Physicians Physician Services 00 1114487055 0 PATEL AMIR S 2024129 9999999 B 10 1114487055 0 5777 DEPT CAROL STREAM IL 601220021 20 1114487055 0 Physicians Anesthesia Services 20 1114487055 0 Physicians Healthy Kids Services 20 1114487055 0 Physicians Optical Supplies 20 1114487055 0 Physicians Physician Services 00 1114487162 0 HILL MEGHAN LEAH 2022208 9999999 B 10 1114487162 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1114487162 0 Physicians Anesthesia Services 20 1114487162 0 Physicians Fluoride varnish 20 1114487162 0 Physicians Healthy Kids Services 20 1114487162 0 Physicians Optical Supplies 20 1114487162 0 Physicians Physician Services 00 1114487527 0 DALCHAND ELIZABETH 2023104 9999999 B 10 1114487527 0 PO BOX 43230 PHOENIX AZ 850803230 20 1114487527 0 Physicians Anesthesia Services 20 1114487527 0 Physicians Healthy Kids Services 20 1114487527 0 Physicians Optical Supplies 20 1114487527 0 Physicians Physician Services 00 1114487675 0 KHERANI SALEEMA 2023190 9999999 B 10 1114487675 0 4698 DEPT CAROL STREAM IL 601220021 20 1114487675 0 Physicians Anesthesia Services 20 1114487675 0 Physicians Healthy Kids Services 20 1114487675 0 Physicians Optical Supplies 20 1114487675 0 Physicians Physician Services 00 1114488368 0 FREESE MIKAYLA 2020014 9999999 B 10 1114488368 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1114488368 0 Physicians Anesthesia Services 20 1114488368 0 Physicians Healthy Kids Services 20 1114488368 0 Physicians Optical Supplies 20 1114488368 0 Physicians Physician Services 00 1114489408 0 IP CALVIN K 2021116 9999999 B 10 1114489408 0 5777 DEPT CAROL STREAM IL 601220021 20 1114489408 0 Physical Therapists Medical Supplies 20 1114489408 0 Physical Therapists Medical equipment/prosthetic devices 20 1114489408 0 Physical Therapists Physical Therapy Services 00 1114489960 0 KWART ARIEL 2024177 9999999 B 10 1114489960 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1114489960 0 Physicians Anesthesia Services 20 1114489960 0 Physicians Healthy Kids Services 20 1114489960 0 Physicians Optical Supplies 20 1114489960 0 Physicians Physician Services 00 1114490224 0 BERGAN KYLE 2022056 9999999 B 10 1114490224 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1114490224 0 Nurse Practitioners Healthy Kids Services 20 1114490224 0 Nurse Practitioners Nurse Practitioners Services 20 1114490224 0 Nurse Practitioners Physician Services 00 1114491164 0 BOOTHE ALLISON 2021168 9999999 B 10 1114491164 0 854 TECHNOLOGY WAY LIBERTYVILLE IL 600485350 20 1114491164 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114492303 0 WOLFRAM CARLY 2019157 9999999 B 10 1114492303 0 5404 W ELM ST STE H MCHENRY IL 600504007 20 1114492303 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114492311 0 STROCK JAMIE 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9999999 B 10 1114552494 0 1531 WELTON CT NAPERVILLE IL 605654168 20 1114552494 0 Physical Therapists Medical Supplies 20 1114552494 0 Physical Therapists Medical equipment/prosthetic devices 20 1114552494 0 Physical Therapists Physical Therapy Services 00 1114552908 0 BARAJAS DORIS 2020203 9999999 B 10 1114552908 0 PO BOX 775253 CHICAGO IL 606775253 20 1114552908 0 Nurse Practitioners Fluoride varnish 20 1114552908 0 Nurse Practitioners Healthy Kids Services 20 1114552908 0 Nurse Practitioners Nurse Practitioners Services 20 1114552908 0 Nurse Practitioners Physician Services 00 1114553021 0 GOCZALK MELISSA 2020170 9999999 B 10 1114553021 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1114553021 0 Physicians Anesthesia Services 20 1114553021 0 Physicians Healthy Kids Services 20 1114553021 0 Physicians Optical Supplies 20 1114553021 0 Physicians Physician Services 00 1114553138 0 FRASER SCOTT 2023145 9999999 B 10 1114553138 0 1160 E SAINT CLAIR ST VINCENNES IN 475914853 20 1114553138 0 Physicians Anesthesia Services 20 1114553138 0 Physicians Fluoride varnish 20 1114553138 0 Physicians Healthy Kids Services 20 1114553138 0 Physicians Optical Supplies 20 1114553138 0 Physicians Physician Services 00 1114553641 0 DONNELLY JOSEPH C 2023186 9999999 B 10 1114553641 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1114553641 0 Physicians Anesthesia Services 20 1114553641 0 Physicians Healthy Kids Services 20 1114553641 0 Physicians Optical Supplies 20 1114553641 0 Physicians Physician Services 00 1114553880 0 TEHENG RYAN E 2021305 9999999 B 10 1114553880 0 1025 MAINE ST QUINCY IL 623014038 20 1114553880 0 Nurse Practitioners Anesthesia Services 20 1114553880 0 Nurse Practitioners Nurse Practitioners Services 20 1114553880 0 Nurse Practitioners Physician Services 00 1114554078 0 SMITH SHELBY 2020219 9999999 B 10 1114554078 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1114554078 0 Physicians Anesthesia Services 20 1114554078 0 Physicians Healthy 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1114554383 0 Physicians Physician Services 00 1114554391 0 NAUGHER KIRK 2021217 9999999 B 10 1114554391 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1114554391 0 Physicians Anesthesia Services 20 1114554391 0 Physicians Healthy Kids Services 20 1114554391 0 Physicians Optical Supplies 20 1114554391 0 Physicians Physician Services 00 1114554862 0 JONES ANDREW 2020248 9999999 B 10 1114554862 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1114554862 0 Physicians Anesthesia Services 20 1114554862 0 Physicians Fluoride varnish 20 1114554862 0 Physicians Healthy Kids Services 20 1114554862 0 Physicians Optical Supplies 20 1114554862 0 Physicians Physician Services 00 1114554870 0 CHANDAN NEHA 2020239 9999999 B 10 1114554870 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1114554870 0 Physicians Anesthesia Services 20 1114554870 0 Physicians Healthy Kids Services 20 1114554870 0 Physicians Optical Supplies 20 1114554870 0 Physicians Physician Services 00 1114555059 0 LEVINE EMMA 2024192 9999999 B 10 1114555059 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1114555059 0 Physicians Anesthesia Services 20 1114555059 0 Physicians Fluoride varnish 20 1114555059 0 Physicians Healthy Kids Services 20 1114555059 0 Physicians Optical Supplies 20 1114555059 0 Physicians Physician Services 00 1114555216 0 ANTONY NEENU 2023264 9999999 B 10 1114555216 0 101 MADISON ST STE 300 OAK PARK IL 603024210 20 1114555216 0 Physicians Anesthesia Services 20 1114555216 0 Physicians Fluoride varnish 20 1114555216 0 Physicians Healthy Kids Services 20 1114555216 0 Physicians Optical Supplies 20 1114555216 0 Physicians Physician Services 00 1114555349 0 LEONG JOSEPH 2020218 9999999 B 10 1114555349 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1114555349 0 Physicians Anesthesia Services 20 1114555349 0 Physicians Healthy Kids Services 20 1114555349 0 Physicians Optical Supplies 20 1114555349 0 Physicians Physician Services 00 1114555448 0 LUCHETTI JEFFREY 2020220 9999999 B 10 1114555448 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1114555448 0 Dentists Dental Services 20 1114555448 0 Dentists Physician Services 00 1114555927 0 COLLINS SAMANTHA J 2023244 9999999 B 10 1114555927 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1114555927 0 Physicians Anesthesia Services 20 1114555927 0 Physicians Fluoride varnish 20 1114555927 0 Physicians Healthy Kids Services 20 1114555927 0 Physicians Optical Supplies 20 1114555927 0 Physicians Physician Services 00 1114556073 0 RAJA UZAIR 2023291 9999999 B 10 1114556073 0 PO BOX 486 SAN JACINTO CA 925810486 20 1114556073 0 Physicians Anesthesia Services 20 1114556073 0 Physicians Healthy Kids Services 20 1114556073 0 Physicians Optical Supplies 20 1114556073 0 Physicians Physician Services 00 1114556164 0 ROBERTSON MARISSA 2020276 9999999 B 10 1114556164 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1114556164 0 Physicians Anesthesia Services 20 1114556164 0 Physicians Healthy Kids Services 20 1114556164 0 Physicians Optical Supplies 20 1114556164 0 Physicians Physician Services 20 1114556164 0 Physicians Physicians Psychiatric Services 00 1114556826 0 MATHEW TRICIA G 2021234 9999999 B 10 1114556826 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1114556826 0 Physicians Anesthesia Services 20 1114556826 0 Physicians Fluoride varnish 20 1114556826 0 Physicians Healthy Kids Services 20 1114556826 0 Physicians Optical Supplies 20 1114556826 0 Physicians Physician Services 00 1114556875 0 ENGLE KAITLYN E 2023205 9999999 B 10 1114556875 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1114556875 0 Physicians Anesthesia Services 20 1114556875 0 Physicians Fluoride varnish 20 1114556875 0 Physicians Healthy Kids Services 20 1114556875 0 Physicians Optical Supplies 20 1114556875 0 Physicians Physician Services 00 1114556941 0 PURVIS KATELYN N 2024228 9999999 B 10 1114556941 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1114556941 0 Physicians Anesthesia Services 20 1114556941 0 Physicians Fluoride varnish 20 1114556941 0 Physicians Healthy Kids Services 20 1114556941 0 Physicians Optical Supplies 20 1114556941 0 Physicians Physician Services 00 1114557717 0 LAPP KEVIN J 2020023 9999999 B 10 1114557717 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1114557717 0 Physician Assistant Only Fluoride varnish 20 1114557717 0 Physician Assistant Only Healthy Kids Services 20 1114557717 0 Physician Assistant Only Physician Services 00 1114558145 0 AZIZ HOSSAM ABDEL NADER 2023202 9999999 B 10 1114558145 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1114558145 0 Physicians Anesthesia Services 20 1114558145 0 Physicians Fluoride varnish 20 1114558145 0 Physicians Healthy Kids Services 20 1114558145 0 Physicians Optical Supplies 20 1114558145 0 Physicians Physician Services 00 1114558632 0 HEILENBACH ALLISON K 2020062 9999999 B 10 1114558632 0 1000 REMINGTON BLVD STE 110 BOLINGBROOK IL 604404708 20 1114558632 0 Nurse Practitioners Fluoride varnish 20 1114558632 0 Nurse Practitioners Healthy Kids Services 20 1114558632 0 Nurse Practitioners Nurse Practitioners Services 20 1114558632 0 Nurse Practitioners Physician Services 00 1114559044 0 MILANO SARA 2020061 9999999 B 10 1114559044 0 715 W LAKE ST STE 104 ADDISON IL 601012082 20 1114559044 0 Nurse Practitioners Healthy Kids Services 20 1114559044 0 Nurse Practitioners Nurse Practitioners Services 20 1114559044 0 Nurse Practitioners Physician Services 00 1114559242 0 JARRETT AFOLASADE J 2020048 9999999 B 10 1114559242 0 1111 SUPERIOR ST STE 507 MELROSE PARK IL 601604159 20 1114559242 0 Nurse Practitioners Healthy Kids Services 20 1114559242 0 Nurse Practitioners Nurse Practitioners Services 20 1114559242 0 Nurse Practitioners Physician Services 00 1114559598 0 DOYLE MEGAN 2021013 9999999 B 10 1114559598 0 1400 W GREENLEAF AVE CHICAGO IL 606262805 20 1114559598 0 Clinical Social Worker Social work service 00 1114560539 0 JUNIOUS LYON MICHELE 2021060 9999999 B 10 1114560539 0 1009 WINDCROSS CT STE 101 FRANKLIN TN 370672678 20 1114560539 0 Nurse Practitioners Fluoride varnish 20 1114560539 0 Nurse Practitioners Healthy Kids Services 20 1114560539 0 Nurse Practitioners Nurse Practitioners Services 20 1114560539 0 Nurse Practitioners Physician Services 00 1114560695 0 ELLSTROM ALEXIS 2019333 9999999 B 10 1114560695 0 401 N MICHIGAN AVE STE 1200 CHICAGO IL 606114264 20 1114560695 0 Physician Assistant Only Fluoride varnish 20 1114560695 0 Physician Assistant Only Healthy Kids Services 20 1114560695 0 Physician Assistant Only Physician Services 00 1114560836 0 STOVALL MORGAN 2024306 9999999 B 10 1114560836 0 211 E LAKE ST STE 1B ADDISON IL 601012877 20 1114560836 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114562709 0 RUETZ COLLEEN 2022089 9999999 B 10 1114562709 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1114562709 0 Nurse Practitioners Fluoride varnish 20 1114562709 0 Nurse Practitioners Healthy Kids Services 20 1114562709 0 Nurse Practitioners Nurse Practitioners Services 20 1114562709 0 Nurse Practitioners Physician Services 00 1114563640 0 KIESEWETTER MARY 2019365 9999999 B 10 1114563640 0 611 W PARK ST URBANA IL 618012529 20 1114563640 0 Nurse Practitioners Healthy Kids Services 20 1114563640 0 Nurse Practitioners Nurse Practitioners Services 20 1114563640 0 Nurse Practitioners Physician Services 00 1114564317 0 STEELE SHERI K 2020100 9999999 B 10 1114564317 0 5777 DEPT CAROL STREAM IL 601228942 20 1114564317 0 Nurse Practitioners Healthy Kids Services 20 1114564317 0 Nurse Practitioners Nurse Practitioners Services 20 1114564317 0 Nurse Practitioners Physician Services 00 1114565041 0 SHAMS SHAFAY 2020147 9999999 B 10 1114565041 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1114565041 0 Physicians Anesthesia Services 20 1114565041 0 Physicians Fluoride varnish 20 1114565041 0 Physicians Healthy Kids Services 20 1114565041 0 Physicians Optical Supplies 20 1114565041 0 Physicians Physician Services 00 1114565835 0 RODRIGUEZ II GLORIA ANN ELIO 2020061 9999999 B 10 1114565835 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1114565835 0 Nurse Practitioners Healthy Kids Services 20 1114565835 0 Nurse Practitioners Nurse Practitioners Services 20 1114565835 0 Nurse Practitioners Physician Services 00 1114566270 0 EUBANKS MARIANNA 2024268 9999999 B 10 1114566270 0 3015 N BALLAS RD SAINT LOUIS MO 631312329 20 1114566270 0 Nurse Practitioners Anesthesia Services 20 1114566270 0 Nurse Practitioners Nurse Practitioners Services 20 1114566270 0 Nurse Practitioners Physician Services 00 1114566379 0 SARICH JESSICA 2022322 9999999 B 10 1114566379 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1114566379 0 Nurse Practitioners Healthy Kids Services 20 1114566379 0 Nurse Practitioners Nurse Practitioners Services 20 1114566379 0 Nurse Practitioners Physician Services 00 1114567724 0 LINGAMPALLI NITHYA 2021214 9999999 B 10 1114567724 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1114567724 0 Physicians Anesthesia Services 20 1114567724 0 Physicians Healthy Kids Services 20 1114567724 0 Physicians Optical Supplies 20 1114567724 0 Physicians Physician Services 00 1114567880 0 SLANSKY DANIELLE C 2020105 9999999 B 10 1114567880 0 5S446 ARLINGTON AVE NAPERVILLE IL 605403817 20 1114567880 0 Speech Therapists Medical Supplies 20 1114567880 0 Speech Therapists Medical equipment/prosthetic devices 20 1114567880 0 Speech Therapists Speech Therapy/Pathology Services 00 1114568367 0 ESPOSITO CANDACE J 2019346 9999999 B 10 1114568367 0 5777 DEPT CAROL STREAM IL 601220021 20 1114568367 0 Nurse Practitioners Healthy Kids Services 20 1114568367 0 Nurse Practitioners Nurse Practitioners Services 20 1114568367 0 Nurse Practitioners Physician Services 00 1114569175 0 HOMERIN AMY A 2019284 9999999 B 10 1114569175 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1114569175 0 Nurse Practitioners Healthy Kids Services 20 1114569175 0 Nurse Practitioners Nurse Practitioners Services 20 1114569175 0 Nurse Practitioners Physician Services 00 1114569415 0 ALTEPETER DANIELLE 2020006 9999999 B 10 1114569415 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1114569415 0 Nurse Practitioners Fluoride varnish 20 1114569415 0 Nurse Practitioners Healthy Kids Services 20 1114569415 0 Nurse Practitioners Nurse Practitioners Services 20 1114569415 0 Nurse Practitioners Physician Services 00 1114571445 0 SHEPHERD MICHELLE 2020056 9999999 B 10 1114571445 0 2701 17TH ST ROCK ISLAND IL 612015351 20 1114571445 0 Nurse Practitioners Healthy Kids Services 20 1114571445 0 Nurse Practitioners Nurse Practitioners Services 20 1114571445 0 Nurse Practitioners Physician Services 00 1114573193 0 LEWIS TOYMESIA 2019291 9999999 B 10 1114573193 0 2201 MAIN ST EVANSTON IL 602021519 20 1114573193 0 Nurse Practitioners Fluoride varnish 20 1114573193 0 Nurse Practitioners Healthy Kids Services 20 1114573193 0 Nurse Practitioners Nurse Practitioners Services 20 1114573193 0 Nurse Practitioners Physician Services 00 1114574191 0 HOLMES JENNIFER A 2022292 9999999 B 10 1114574191 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1114574191 0 Nurse Practitioners Fluoride varnish 20 1114574191 0 Nurse Practitioners Healthy Kids Services 20 1114574191 0 Nurse Practitioners Nurse Practitioners Services 20 1114574191 0 Nurse Practitioners Physician Services 00 1114574837 0 BICKHAUS ALEXANDRA 2020176 9999999 B 10 1114574837 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1114574837 0 Nurse Practitioners Fluoride varnish 20 1114574837 0 Nurse Practitioners Healthy Kids Services 20 1114574837 0 Nurse Practitioners Nurse Practitioners Services 20 1114574837 0 Nurse Practitioners Physician Services 00 1114576584 0 CARMAN CATHERINE E 2019322 9999999 B 10 1114576584 0 5777 DEPT CAROL STREAM IL 601220021 20 1114576584 0 Nurse Practitioners Anesthesia Services 20 1114576584 0 Nurse Practitioners Nurse Practitioners Services 20 1114576584 0 Nurse Practitioners Physician Services 00 1114576840 0 SLEEZER LISA 2023011 9999999 B 10 1114576840 0 811 W JOHN ST YORKVILLE IL 605609249 20 1114576840 0 Other behavior health professional LCPC/LMFT services 00 1114577285 0 SOMMER MARIJKE A 2024229 9999999 B 10 1114577285 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1114577285 0 Clinical Social Worker Social work service 00 1114578499 0 TANTUWAYA SONAM 2019281 9999999 B 10 1114578499 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1114578499 0 Physician Assistant Only Fluoride varnish 20 1114578499 0 Physician Assistant Only Healthy Kids Services 20 1114578499 0 Physician Assistant Only Physician Services 00 1114579125 0 ATIYA SAMIR 2024185 9999999 B 10 1114579125 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1114579125 0 Physicians Anesthesia Services 20 1114579125 0 Physicians Healthy Kids Services 20 1114579125 0 Physicians Optical Supplies 20 1114579125 0 Physicians Physician Services 00 1114580115 0 BOUNYONG NATHAN P 2019365 9999999 B 10 1114580115 0 1301 W DEVON AVE CHICAGO IL 606601329 20 1114580115 0 Physicians Anesthesia Services 20 1114580115 0 Physicians Fluoride varnish 20 1114580115 0 Physicians Healthy Kids Services 20 1114580115 0 Physicians Optical Supplies 20 1114580115 0 Physicians Physician Services 00 1114580321 0 MARRERO KATIE 2020030 9999999 B 10 1114580321 0 611 W PARK ST URBANA IL 618012529 20 1114580321 0 Physicians Anesthesia Services 20 1114580321 0 Physicians Healthy Kids Services 20 1114580321 0 Physicians Optical Supplies 20 1114580321 0 Physicians Physician Services 00 1114581154 0 TOLIVER KENDRA A 2019302 9999999 B 10 1114581154 0 10001 GRAND AVE ATTN: BILLING DEPARTMENT FRANKLIN PARK IL 601312563 20 1114581154 0 Other behavior health professional Social work service 00 1114581501 0 FOURNIER CHELSEA L 2021229 9999999 B 10 1114581501 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1114581501 0 Physicians Anesthesia Services 20 1114581501 0 Physicians Fluoride varnish 20 1114581501 0 Physicians Healthy Kids Services 20 1114581501 0 Physicians Optical Supplies 20 1114581501 0 Physicians Physician Services 00 1114581584 0 WORNHOFF REBECCA 2024213 9999999 B 10 1114581584 0 1940 S WESTERN AVE STE 205 CHICAGO IL 606082503 20 1114581584 0 Physicians Anesthesia Services 20 1114581584 0 Physicians Fluoride varnish 20 1114581584 0 Physicians Healthy Kids Services 20 1114581584 0 Physicians Optical Supplies 20 1114581584 0 Physicians Physician Services 00 1114581683 0 LITI ALBANA 2019127 9999999 B 10 1114581683 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1114581683 0 Nurse Practitioners Healthy Kids Services 20 1114581683 0 Nurse Practitioners Nurse Practitioners Services 20 1114581683 0 Nurse Practitioners Physician Services 00 1114581998 0 YONTZ RACHEL A 2002140 9999999 B 10 1114581998 0 14615 W FOX CREEK CT BRIMFIELD IL 615179529 20 1114581998 0 Speech Therapists Medical Supplies 20 1114581998 0 Speech Therapists Medical equipment/prosthetic devices 20 1114581998 0 Speech Therapists Speech Therapy/Pathology Services 00 1114582541 0 TRAINOR MICHAEL 2021165 9999999 B 10 1114582541 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1114582541 0 Physician Assistant Only Fluoride varnish 20 1114582541 0 Physician Assistant Only Healthy Kids Services 20 1114582541 0 Physician Assistant Only Physician Services 00 1114583481 0 SAHLOUL JAMAL 2021145 9999999 B 10 1114583481 0 7441 SOUTHWEST HWY WORTH IL 604821005 20 1114583481 0 Dentists Dental Services 20 1114583481 0 Dentists Physician Services 00 1114585080 0 FERRER GONZALEZ DANIELA 2024229 9999999 B 10 1114585080 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1114585080 0 Physicians Anesthesia Services 20 1114585080 0 Physicians Healthy Kids Services 20 1114585080 0 Physicians Optical Supplies 20 1114585080 0 Physicians Physician Services 00 1114585767 0 BIELENSTEIN ERIKA J 2019150 9999999 B 10 1114585767 0 4025 N SHERIDAN RD CHICAGO IL 606132010 20 1114585767 0 Other behavior health professional All Kids application agent 20 1114585767 0 Other behavior health professional LCPC/LMFT services 00 1114586328 0 CRAIGIN CODY 2019121 9999999 B 10 1114586328 0 3513 BRIGHTON BLVD STE 320 DENVER CO 802163789 20 1114586328 0 Nurse Practitioners Fluoride varnish 20 1114586328 0 Nurse Practitioners Healthy Kids Services 20 1114586328 0 Nurse Practitioners Nurse Practitioners Services 20 1114586328 0 Nurse Practitioners Physician Services 00 1114587490 0 LYNCH CHRISTIE A 2021337 9999999 B 10 1114587490 0 621 S ILLINOIS AVE STE 103 MASON CITY IA 504015489 20 1114587490 0 Podiatrists Podiatric Services 00 1114587904 0 MASSUTTI THOMAS 2019192 9999999 B 10 1114587904 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1114587904 0 Physicians Anesthesia Services 20 1114587904 0 Physicians Fluoride varnish 20 1114587904 0 Physicians Healthy Kids Services 20 1114587904 0 Physicians Optical Supplies 20 1114587904 0 Physicians Physician Services 00 1114588597 0 SCOTT MEREDITH 2020008 9999999 B 10 1114588597 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1114588597 0 Physicians Anesthesia Services 20 1114588597 0 Physicians Healthy Kids Services 20 1114588597 0 Physicians Optical Supplies 20 1114588597 0 Physicians Physician Services 00 1114588712 0 BICHUCHER NATALIE ZIEL 2024298 9999999 B 10 1114588712 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1114588712 0 Physicians Anesthesia Services 20 1114588712 0 Physicians Fluoride varnish 20 1114588712 0 Physicians Healthy Kids Services 20 1114588712 0 Physicians Optical Supplies 20 1114588712 0 Physicians Physician Services 00 1114588720 0 SALIK MUNNI 2024205 9999999 B 10 1114588720 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1114588720 0 Physician Assistant Only Fluoride varnish 20 1114588720 0 Physician Assistant Only Healthy Kids Services 20 1114588720 0 Physician Assistant Only Physician Services 00 1114588910 0 OWENS ROBERT C 2011353 9999999 H 10 1114588910 0 925 KILLARNEY DR DYER IN 463111292 20 1114588910 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114591674 0 HASHIM RAND 2023183 9999999 B 10 1114591674 0 PO BOX 3039 OAK BROOK IL 605223039 20 1114591674 0 Physicians Anesthesia Services 20 1114591674 0 Physicians Fluoride varnish 20 1114591674 0 Physicians Healthy Kids Services 20 1114591674 0 Physicians Optical Supplies 20 1114591674 0 Physicians Physician Services 00 1114591880 0 BENJAMIN RACHEL A 2021200 9999999 B 10 1114591880 0 400 MAPLE SUMMIT RD JERSEYVILLE IL 620522028 20 1114591880 0 Nurse Practitioners Fluoride varnish 20 1114591880 0 Nurse Practitioners Healthy Kids Services 20 1114591880 0 Nurse Practitioners Nurse Practitioners Services 20 1114591880 0 Nurse Practitioners Physician Services 00 1114592466 0 LIN JAIMIE 2024342 9999999 B 10 1114592466 0 4698 DEPT CAROL STREAM IL 601220021 20 1114592466 0 Physicians Anesthesia Services 20 1114592466 0 Physicians Fluoride varnish 20 1114592466 0 Physicians Healthy Kids Services 20 1114592466 0 Physicians Optical Supplies 20 1114592466 0 Physicians Physician Services 00 1114595147 0 REEVES MARY GRACE R 2021231 9999999 B 10 1114595147 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1114595147 0 Physicians Anesthesia Services 20 1114595147 0 Physicians Fluoride varnish 20 1114595147 0 Physicians Healthy Kids Services 20 1114595147 0 Physicians Optical Supplies 20 1114595147 0 Physicians Physician Services 00 1114595493 0 CANDA CLAIRE MARIE 2021182 9999999 B 10 1114595493 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1114595493 0 Physicians Anesthesia Services 20 1114595493 0 Physicians Fluoride varnish 20 1114595493 0 Physicians Healthy Kids Services 20 1114595493 0 Physicians Optical Supplies 20 1114595493 0 Physicians Physician Services 00 1114595774 0 GARCIA SANDRA 2021166 9999999 B 10 1114595774 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1114595774 0 Registered nurse Nursing service 20 1114595774 0 Registered nurse Waiver service 00 1114597846 0 CHILL HENRY 2021209 9999999 B 10 1114597846 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1114597846 0 Physicians Anesthesia Services 20 1114597846 0 Physicians Healthy Kids Services 20 1114597846 0 Physicians Optical Supplies 20 1114597846 0 Physicians Physician Services 00 1114598778 0 TESTER BRENDA E 2023114 9999999 B 10 1114598778 0 PO BOX 3039 OAK BROOK IL 605223039 20 1114598778 0 Physicians Anesthesia Services 20 1114598778 0 Physicians Fluoride varnish 20 1114598778 0 Physicians Healthy Kids Services 20 1114598778 0 Physicians Optical Supplies 20 1114598778 0 Physicians Physician Services 00 1114599107 0 LEAVEY BRETT D 2021208 9999999 B 10 1114599107 0 2633 CHATHAM RD SPRINGFIELD IL 627044185 20 1114599107 0 Dentists Dental Services 20 1114599107 0 Dentists Physician Services 00 1114599248 0 DUE ZOE A 2021251 9999999 B 10 1114599248 0 611 W PARK ST URBANA IL 618012529 20 1114599248 0 Nurse Practitioners Healthy Kids Services 20 1114599248 0 Nurse Practitioners Midwife Services 20 1114599248 0 Nurse Practitioners Nurse Practitioners Services 20 1114599248 0 Nurse Practitioners Physician Services 00 1114599768 0 ALMULHIM ABDULAZIZ 2024319 9999999 B 10 1114599768 0 4698 DEPT CAROL STREAM IL 601220021 20 1114599768 0 Physicians Anesthesia Services 20 1114599768 0 Physicians Fluoride varnish 20 1114599768 0 Physicians Healthy Kids Services 20 1114599768 0 Physicians Optical Supplies 20 1114599768 0 Physicians Physician Services 00 1114601051 0 BROWN ASHLEY 2024179 9999999 B 10 1114601051 0 205 OAKLAND AVE CARLINVILLE IL 626261921 20 1114601051 0 Dentists Dental Services 20 1114601051 0 Dentists Physician Services 00 1114601986 0 WARNER BRANDY 2023233 9999999 B 10 1114601986 0 PO BOX 702 MONTGOMERY IL 605380702 20 1114601986 0 Speech Therapists Medical Supplies 20 1114601986 0 Speech Therapists Medical equipment/prosthetic devices 20 1114601986 0 Speech Therapists Speech Therapy/Pathology Services 00 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service 20 1114604543 0 Registered nurse Waiver service 00 1114606514 0 PARIKH CHARMY 2023206 9999999 B 10 1114606514 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1114606514 0 Physicians Anesthesia Services 20 1114606514 0 Physicians Fluoride varnish 20 1114606514 0 Physicians Healthy Kids Services 20 1114606514 0 Physicians Optical Supplies 20 1114606514 0 Physicians Physician Services 00 1114607744 0 ZAKARIJA JACKIE 2023243 9999999 B 10 1114607744 0 74 ECLIPSE CTR BELOIT WI 535113550 20 1114607744 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114609195 0 STILES BRITTANY 2023269 9999999 B 10 1114609195 0 1700 E HIGGINS RD STE 600 DES PLAINES IL 600185621 20 1114609195 0 Nurse Practitioners Fluoride varnish 20 1114609195 0 Nurse Practitioners Healthy Kids Services 20 1114609195 0 Nurse Practitioners Nurse Practitioners Services 20 1114609195 0 Nurse Practitioners Physician Services 00 1114609906 0 JOHNSON EMELINA IDA 2023223 9999999 B 10 1114609906 0 PO BOX 5944 ROCKFORD IL 611250944 20 1114609906 0 Audiologists Audiology Services 20 1114609906 0 Audiologists Medical Supplies 20 1114609906 0 Audiologists Medical equipment/prosthetic devices 00 1114612611 0 SHAMOUN SEREEN NORELHUDA 2023213 9999999 B 10 1114612611 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1114612611 0 Physicians Anesthesia Services 20 1114612611 0 Physicians Fluoride varnish 20 1114612611 0 Physicians Healthy Kids Services 20 1114612611 0 Physicians Optical Supplies 20 1114612611 0 Physicians Physician Services 00 1114612629 0 MASOUD AMANI 2023192 9999999 B 10 1114612629 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1114612629 0 Physicians Anesthesia Services 20 1114612629 0 Physicians Fluoride varnish 20 1114612629 0 Physicians Healthy Kids Services 20 1114612629 0 Physicians Optical Supplies 20 1114612629 0 Physicians Physician Services 00 1114615374 0 NASIR SIDDIQI MAJID 2023331 9999999 B 10 1114615374 0 29373 NETWORK PL CHICAGO IL 606733039 20 1114615374 0 Nurse Practitioners Anesthesia Services 20 1114615374 0 Nurse Practitioners Nurse Practitioners Services 20 1114615374 0 Nurse Practitioners Physician Services 00 1114615499 0 ABUHAMDA DIMA 2025003 9999999 B 10 1114615499 0 17W679 ROOSEVELT RD OAKBROOK TERRAC IL 601813545 20 1114615499 0 Dentists Dental Services 20 1114615499 0 Dentists Physician Services 00 1114615523 0 WILLIAMS ASHANTI 2023207 9999999 B 10 1114615523 0 PO BOX 1109 DEKALB IL 601157109 20 1114615523 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114616133 0 COUNTERMAN NICHOLAS 2023257 9999999 B 10 1114616133 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1114616133 0 Physician Assistant Only Fluoride varnish 20 1114616133 0 Physician Assistant Only Healthy Kids Services 20 1114616133 0 Physician Assistant Only Physician Services 00 1114618022 0 VAILLANCOURT MASON 2023177 9999999 B 10 1114618022 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1114618022 0 Physicians Anesthesia Services 20 1114618022 0 Physicians Healthy Kids Services 20 1114618022 0 Physicians Optical Supplies 20 1114618022 0 Physicians Physician Services 00 1114618725 0 BERNARD JOSEPH 2023191 9999999 B 10 1114618725 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1114618725 0 Physicians Anesthesia Services 20 1114618725 0 Physicians Healthy Kids Services 20 1114618725 0 Physicians Optical Supplies 20 1114618725 0 Physicians Physician Services 00 1114620192 0 DAVIDSON MICHAEL F 2023177 9999999 B 10 1114620192 0 PO BOX 3039 OAK BROOK IL 605223039 20 1114620192 0 Physicians Anesthesia Services 20 1114620192 0 Physicians Fluoride varnish 20 1114620192 0 Physicians Healthy Kids Services 20 1114620192 0 Physicians Optical Supplies 20 1114620192 0 Physicians Physician Services 00 1114620374 0 ZITOUNI ASMA 2023363 9999999 B 10 1114620374 0 124 SW ADAMS ST PEORIA IL 616021308 20 1114620374 0 Physicians Anesthesia Services 20 1114620374 0 Physicians Healthy Kids Services 20 1114620374 0 Physicians Optical Supplies 20 1114620374 0 Physicians Physician Services 20 1114620374 0 Physicians Physicians Psychiatric Services 00 1114620754 0 TORVE MEGAN 2023192 9999999 B 10 1114620754 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1114620754 0 Physicians Anesthesia Services 20 1114620754 0 Physicians Fluoride varnish 20 1114620754 0 Physicians Healthy Kids Services 20 1114620754 0 Physicians Optical Supplies 20 1114620754 0 Physicians Physician Services 00 1114620937 0 HURTADO ALEXANDER M 2023172 9999999 B 10 1114620937 0 4698 DEPT CAROL STREAM IL 601220021 20 1114620937 0 Physicians Anesthesia Services 20 1114620937 0 Physicians Fluoride varnish 20 1114620937 0 Physicians Healthy Kids Services 20 1114620937 0 Physicians Optical Supplies 20 1114620937 0 Physicians Physician Services 00 1114622008 0 CHUECOS ESCALANTE SARAI S 2023187 9999999 B 10 1114622008 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1114622008 0 Physicians Anesthesia Services 20 1114622008 0 Physicians Fluoride varnish 20 1114622008 0 Physicians Healthy Kids Services 20 1114622008 0 Physicians Optical Supplies 20 1114622008 0 Physicians Physician Services 00 1114623048 0 FELLENZ REBECCA A 2024245 9999999 B 10 1114623048 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1114623048 0 Nurse Practitioners Healthy Kids Services 20 1114623048 0 Nurse Practitioners Nurse Practitioners Services 20 1114623048 0 Nurse Practitioners Physician Services 00 1114623691 0 GROSS STEPHANIE 2023117 9999999 B 10 1114623691 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1114623691 0 Nurse Practitioners Fluoride varnish 20 1114623691 0 Nurse Practitioners Healthy Kids Services 20 1114623691 0 Nurse Practitioners Nurse Practitioners Services 20 1114623691 0 Nurse Practitioners Physician Services 00 1114625779 0 MAGILL TAYLOR 2024310 9999999 B 10 1114625779 0 335 E MAHN CT OAK CREEK WI 531542155 20 1114625779 0 Physician Assistant Only Fluoride varnish 20 1114625779 0 Physician Assistant Only Healthy Kids Services 20 1114625779 0 Physician Assistant Only Physician Services 00 1114626967 0 NAMUWANGA STELLA J 2023065 9999999 B 10 1114626967 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1114626967 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114627601 0 ALVAREZ SARAI 2024039 9999999 B 10 1114627601 0 414 W LAKE ST ADDISON IL 601012305 20 1114627601 0 Physician Assistant Only Fluoride varnish 20 1114627601 0 Physician Assistant Only Healthy Kids Services 20 1114627601 0 Physician Assistant Only Physician Services 00 1114628195 0 AL-TARSHAN YAZAN 2024179 9999999 B 10 1114628195 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1114628195 0 Physicians Anesthesia Services 20 1114628195 0 Physicians Healthy Kids Services 20 1114628195 0 Physicians Optical Supplies 20 1114628195 0 Physicians Physician Services 00 1114629482 0 GOEI JULIA 2024178 9999999 B 10 1114629482 0 4698 DEPT CAROL STREAM IL 601220021 20 1114629482 0 Dentists Dental Services 20 1114629482 0 Dentists Physician Services 00 1114629862 0 CORTES ERIKA N 2023093 9999999 B 10 1114629862 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1114629862 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114630886 0 SANER SHERRYWIN 2023108 9999999 B 10 1114630886 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1114630886 0 Nurse Practitioners Fluoride varnish 20 1114630886 0 Nurse Practitioners Healthy Kids Services 20 1114630886 0 Nurse Practitioners Nurse Practitioners Services 20 1114630886 0 Nurse Practitioners Physician Services 00 1114631728 0 CLARK LAURA C 2023235 9999999 B 10 1114631728 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1114631728 0 Physician Assistant Only Fluoride varnish 20 1114631728 0 Physician Assistant Only Healthy Kids Services 20 1114631728 0 Physician Assistant Only Physician Services 00 1114633997 0 ROMANS SARAH C 2024236 9999999 B 10 1114633997 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1114633997 0 Physicians Anesthesia Services 20 1114633997 0 Physicians Healthy Kids Services 20 1114633997 0 Physicians Optical Supplies 20 1114633997 0 Physicians Physician Services 00 1114634805 0 GALLOWAY VANESSA E 2022313 9999999 B 10 1114634805 0 120 W 22ND ST OAK BROOK IL 605231557 20 1114634805 0 Nurse Practitioners Healthy Kids Services 20 1114634805 0 Nurse Practitioners Nurse Practitioners Services 20 1114634805 0 Nurse Practitioners Physician Services 00 1114636313 0 CHOKLAD LINDSEY 2024164 9999999 B 10 1114636313 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1114636313 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114637899 0 DEANGELIS SARA 2022339 9999999 B 10 1114637899 0 2374 SHERMER RD NORTHBROOK IL 600626729 20 1114637899 0 Occupational Therapists Medical 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1114644622 0 Nurse Practitioners Healthy Kids Services 20 1114644622 0 Nurse Practitioners Nurse Practitioners Services 20 1114644622 0 Nurse Practitioners Physician Services 00 1114644986 0 RICHEY REBECCA 2024089 9999999 B 10 1114644986 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1114644986 0 Physician Assistant Only Physician Services 00 1114645140 0 NAIDOFF EMILIE M 2023140 9999999 B 10 1114645140 0 2045 W GRAND AVE STE B CHICAGO IL 606121577 20 1114645140 0 Speech Therapists Medical Supplies 20 1114645140 0 Speech Therapists Medical equipment/prosthetic devices 20 1114645140 0 Speech Therapists Speech Therapy/Pathology Services 00 1114645652 0 DUNNE KELLY 2022318 9999999 B 10 1114645652 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1114645652 0 Nurse Practitioners Fluoride varnish 20 1114645652 0 Nurse Practitioners Healthy Kids Services 20 1114645652 0 Nurse Practitioners Nurse Practitioners Services 20 1114645652 0 Nurse Practitioners Physician Services 00 1114647039 0 BOURGETTE KAYCE J 2022304 9999999 B 10 1114647039 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1114647039 0 Nurse Practitioners Fluoride varnish 20 1114647039 0 Nurse Practitioners Healthy Kids Services 20 1114647039 0 Nurse Practitioners Nurse Practitioners Services 20 1114647039 0 Nurse Practitioners Physician Services 00 1114647443 0 SAFIR SALMON 2022241 9999999 H 10 1114647443 0 411 E PARK ST STE 106 CHAMPAIGN IL 618203862 20 1114647443 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114648631 0 HARLAN KATRINA 2023187 9999999 B 10 1114648631 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1114648631 0 Nurse Practitioners Anesthesia Services 20 1114648631 0 Nurse Practitioners Nurse Practitioners Services 20 1114648631 0 Nurse Practitioners Physician Services 00 1114649076 0 HULL MORGAN 2022259 9999999 B 10 1114649076 0 PO BOX 146 WATERLOO IL 622980146 20 1114649076 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114650413 0 GREEN JACLYN 2024260 9999999 B 10 1114650413 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1114650413 0 Physician Assistant Only Fluoride varnish 20 1114650413 0 Physician Assistant Only Healthy Kids Services 20 1114650413 0 Physician Assistant Only Physician Services 00 1114650496 0 OGENT ANNA 2023100 9999999 B 10 1114650496 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1114650496 0 Physical Therapists Medical Supplies 20 1114650496 0 Physical Therapists Medical equipment/prosthetic devices 20 1114650496 0 Physical Therapists Speech Therapy/Pathology Services 00 1114650868 0 FRANKLIN SARAH 2022218 9999999 B 10 1114650868 0 3600 N PROW RD BLOOMINGTON IN 474041616 20 1114650868 0 Nurse Practitioners Healthy Kids Services 20 1114650868 0 Nurse Practitioners Nurse Practitioners Services 20 1114650868 0 Nurse Practitioners Physician Services 00 1114651650 0 IBRAHIM MUHAMMAD BILAL 2022252 9999999 B 10 1114651650 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1114651650 0 Physicians Anesthesia Services 20 1114651650 0 Physicians Fluoride varnish 20 1114651650 0 Physicians Healthy Kids Services 20 1114651650 0 Physicians Optical Supplies 20 1114651650 0 Physicians Physician Services 00 1114652997 0 RICHMOND ABIGAIL 2022256 9999999 B 10 1114652997 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1114652997 0 Nurse Practitioners Fluoride varnish 20 1114652997 0 Nurse Practitioners Healthy Kids Services 20 1114652997 0 Nurse Practitioners Nurse Practitioners Services 20 1114652997 0 Nurse Practitioners Physician Services 00 1114655024 0 PIERCE STEPHANIE M 2023184 9999999 B 10 1114655024 0 5701 W TALAVI BLVD STE 120 GLENDALE AZ 853061888 20 1114655024 0 Nurse Practitioners Fluoride varnish 20 1114655024 0 Nurse Practitioners Healthy Kids Services 20 1114655024 0 Nurse Practitioners Nurse Practitioners Services 20 1114655024 0 Nurse Practitioners Physician Services 00 1114657046 0 PATEL AMISHA 2022206 9999999 B 10 1114657046 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1114657046 0 Physicians Anesthesia Services 20 1114657046 0 Physicians Fluoride varnish 20 1114657046 0 Physicians Healthy Kids Services 20 1114657046 0 Physicians Optical Supplies 20 1114657046 0 Physicians Physician Services 00 1114657723 0 MONTES MARCUS 2022299 9999999 B 10 1114657723 0 29373 NETWORK PL CHICAGO IL 606733039 20 1114657723 0 Physical Therapists Medical Supplies 20 1114657723 0 Physical Therapists Medical equipment/prosthetic devices 20 1114657723 0 Physical Therapists Physical Therapy Services 00 1114658085 0 GIBBS ELIZABETH 2022230 9999999 B 10 1114658085 0 1 WESTBROOK CORPORATE CTR STE 240 WESTCHESTER IL 601545745 20 1114658085 0 Occupational Therapists Medical Supplies 20 1114658085 0 Occupational Therapists Medical equipment/prosthetic devices 20 1114658085 0 Occupational Therapists Occupational Therapy Services 00 1114659455 0 MCDOWELL MOIRA 2022238 9999999 B 10 1114659455 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1114659455 0 Nurse Practitioners Healthy Kids Services 20 1114659455 0 Nurse Practitioners Nurse Practitioners Services 20 1114659455 0 Nurse Practitioners Physician Services 00 1114659703 0 FELCHLIA JENNIFER 2022266 9999999 B 10 1114659703 0 909 RIDGEBROOK RD STE 300 SPARKS MD 211529477 20 1114659703 0 Nurse Practitioners Fluoride varnish 20 1114659703 0 Nurse Practitioners Healthy Kids Services 20 1114659703 0 Nurse Practitioners Nurse Practitioners Services 20 1114659703 0 Nurse Practitioners Physician Services 00 1114659919 0 FREUND WHITNEY 2023191 9999999 B 10 1114659919 0 14522 ASH ST ORLAND PARK IL 604622608 20 1114659919 0 Clinical Social Worker Social work service 00 1114660297 0 BARAJAS JOSHUA C 2022217 9999999 B 10 1114660297 0 520 MARY ST STE 520 EVANSVILLE IN 477101682 20 1114660297 0 Physician Assistant Only Fluoride varnish 20 1114660297 0 Physician Assistant Only Healthy Kids Services 20 1114660297 0 Physician Assistant Only Physician Services 00 1114662863 0 SECK AWA P 2022264 9999999 B 10 1114662863 0 7732 SOLUTION CENTER CHICAGO IL 606777007 20 1114662863 0 Dentists Dental Services 20 1114662863 0 Dentists Physician Services 00 1114663077 0 ROSUNALLY MUHAMMAD W 2022193 2025181 B 10 1114663077 0 1220 S WOOD ST CHICAGO IL 606081202 20 1114663077 0 Physicians Anesthesia Services 20 1114663077 0 Physicians Fluoride varnish 20 1114663077 0 Physicians Healthy Kids Services 20 1114663077 0 Physicians Optical Supplies 20 1114663077 0 Physicians Physician Services 00 1114663416 0 RAVASIO ALANA R 2024170 9999999 B 10 1114663416 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1114663416 0 Physicians Anesthesia Services 20 1114663416 0 Physicians Healthy Kids Services 20 1114663416 0 Physicians Optical Supplies 20 1114663416 0 Physicians Physician Services 00 1114663572 0 LI ZHIYUAN 2023202 9999999 B 10 1114663572 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1114663572 0 Physicians Anesthesia Services 20 1114663572 0 Physicians Fluoride varnish 20 1114663572 0 Physicians Healthy Kids Services 20 1114663572 0 Physicians Optical Supplies 20 1114663572 0 Physicians Physician Services 00 1114664042 0 MAURER COURTNEY M 2022146 9999999 B 10 1114664042 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1114664042 0 Nurse Practitioners Healthy Kids Services 20 1114664042 0 Nurse Practitioners Nurse Practitioners Services 20 1114664042 0 Nurse Practitioners Physician Services 00 1114664414 0 CUARTAS MARIA C 2022210 9999999 B 10 1114664414 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1114664414 0 Physicians Anesthesia Services 20 1114664414 0 Physicians Fluoride varnish 20 1114664414 0 Physicians Healthy Kids Services 20 1114664414 0 Physicians Optical Supplies 20 1114664414 0 Physicians Physician Services 00 1114664596 0 LEE CORY H 2022173 9999999 B 10 1114664596 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1114664596 0 Physicians Anesthesia 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1114665072 0 Physicians Optical Supplies 20 1114665072 0 Physicians Physician Services 20 1114665072 0 Physicians Physicians Psychiatric Services 00 1114665627 0 SANCHEZ DERICK J 2023317 9999999 B 10 1114665627 0 PO BOX 3039 OAK BROOK IL 605223039 20 1114665627 0 Physicians Anesthesia Services 20 1114665627 0 Physicians Healthy Kids Services 20 1114665627 0 Physicians Optical Supplies 20 1114665627 0 Physicians Physician Services 00 1114665866 0 FARLEY LEAH R 2023025 9999999 B 10 1114665866 0 PO BOX 3988 CARBONDALE IL 629023988 20 1114665866 0 Nurse Practitioners Healthy Kids Services 20 1114665866 0 Nurse Practitioners Nurse Practitioners Services 20 1114665866 0 Nurse Practitioners Physician Services 00 1114667912 0 XIA THOMAS 2022173 9999999 B 10 1114667912 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1114667912 0 Physicians Anesthesia Services 20 1114667912 0 Physicians Healthy Kids Services 20 1114667912 0 Physicians Optical Supplies 20 1114667912 0 Physicians Physician Services 00 1114668365 0 CHOPRA AMIT 2022241 9999999 B 10 1114668365 0 124 SW ADAMS ST PEORIA IL 616021308 20 1114668365 0 Physicians Anesthesia Services 20 1114668365 0 Physicians Fluoride varnish 20 1114668365 0 Physicians Healthy Kids Services 20 1114668365 0 Physicians Optical Supplies 20 1114668365 0 Physicians Physician Services 00 1114669173 0 HABERMANN JOSHUA R 2022208 9999999 B 10 1114669173 0 7732 SOLUTION CENTER CHICAGO IL 606777007 20 1114669173 0 Dentists Dental Services 20 1114669173 0 Dentists Physician Services 00 1114670031 0 WINN SHELBY 2025037 9999999 B 10 1114670031 0 88 S MAIN ST STE 2 GLEN CARBON IL 620341415 20 1114670031 0 Other behavior health professional LCPC/LMFT services 00 1114670429 0 HILTZ SUZANNE M 2023299 9999999 B 10 1114670429 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1114670429 0 Physician Assistant Only Fluoride varnish 20 1114670429 0 Physician Assistant Only Healthy Kids Services 20 1114670429 0 Physician Assistant Only Physician Services 00 1114670775 0 THOMPSON JACOB S 2022234 9999999 B 10 1114670775 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1114670775 0 Physicians Anesthesia Services 20 1114670775 0 Physicians Fluoride varnish 20 1114670775 0 Physicians Healthy Kids Services 20 1114670775 0 Physicians Optical Supplies 20 1114670775 0 Physicians Physician Services 00 1114671427 0 LUNA LILLIAM 2022144 9999999 B 10 1114671427 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1114671427 0 Clinical Social Worker Social work service 00 1114673225 0 PAPILLON JEREMY 2022061 9999999 B 10 1114673225 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1114673225 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114674710 0 SHULMAN ASHLEY M 2022241 9999999 B 10 1114674710 0 3015 N BALLAS RD SAINT LOUIS MO 631312329 20 1114674710 0 Nurse Practitioners Anesthesia Services 20 1114674710 0 Nurse Practitioners Nurse Practitioners Services 20 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Physicians Fluoride varnish 20 1114929981 0 Physicians Healthy Kids Services 20 1114929981 0 Physicians Optical Supplies 20 1114929981 0 Physicians Physician Services 00 1114930096 0 SHERMAN JODY 2021159 9999999 B 10 1114930096 0 525 PARK ST STE 300 SUITE 300 SAINT PAUL MN 551032197 20 1114930096 0 Physician Assistant Only Fluoride varnish 20 1114930096 0 Physician Assistant Only Healthy Kids Services 20 1114930096 0 Physician Assistant Only Physician Services 00 1114931375 0 CARROLL META 1998201 9999999 B 10 1114931375 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1114931375 0 Physicians Anesthesia Services 20 1114931375 0 Physicians Healthy Kids Services 20 1114931375 0 Physicians Optical Supplies 20 1114931375 0 Physicians Physician Services 00 1114931623 0 ALLEN MARY E 2012092 9999999 B 10 1114931623 0 1120 N MELVIN ST GIBSON CITY IL 609361477 20 1114931623 0 Nurse Practitioners Fluoride varnish 20 1114931623 0 Nurse Practitioners Healthy Kids Services 20 1114931623 0 Nurse 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1114932589 0 Physicians Physician Services 00 1114933686 0 HOBELMANN CHARLES 2017335 9999999 B 10 1114933686 0 2250 N ILLINOIS AVE CARBONDALE IL 629015612 20 1114933686 0 Physicians Anesthesia Services 20 1114933686 0 Physicians Healthy Kids Services 20 1114933686 0 Physicians Optical Supplies 20 1114933686 0 Physicians Physician Services 00 1114934676 0 MCCORMACK MICHAEL T 2021216 9999999 B 10 1114934676 0 PO BOX 43230 PHOENIX AZ 850803230 20 1114934676 0 Physicians Anesthesia Services 20 1114934676 0 Physicians Fluoride varnish 20 1114934676 0 Physicians Healthy Kids Services 20 1114934676 0 Physicians Optical Supplies 20 1114934676 0 Physicians Physician Services 00 1114934759 0 BALLINGER KEITH 2015340 9999999 B 10 1114934759 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1114934759 0 Physician Assistant Only Fluoride varnish 20 1114934759 0 Physician Assistant Only Healthy Kids Services 20 1114934759 0 Physician Assistant Only Physician Services 00 1114935442 0 WAHLHEIM PAUL S 2023348 9999999 B 10 1114935442 0 PO BOX 41220 PHOENIX AZ 850801220 20 1114935442 0 Physicians Anesthesia Services 20 1114935442 0 Physicians Healthy Kids Services 20 1114935442 0 Physicians Optical Supplies 20 1114935442 0 Physicians Physician Services 00 1114936077 0 STORRS PAUL 1987098 9999999 B 10 1114936077 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1114936077 0 Physicians Anesthesia Services 20 1114936077 0 Physicians Healthy Kids Services 20 1114936077 0 Physicians Optical Supplies 20 1114936077 0 Physicians Physician Services 00 1114936549 0 AYDT MATTHEW J 2016120 9999999 B 10 1114936549 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1114936549 0 Nurse Practitioners Anesthesia Services 20 1114936549 0 Nurse Practitioners Nurse Practitioners Services 20 1114936549 0 Nurse Practitioners Physician Services 00 1114936556 0 PFETCHER HEIDI 2012061 9999999 B 10 1114936556 0 2215 SANDERS RD STE 105 NORTHBROOK IL 600626194 20 1114936556 0 Physicians Anesthesia Services 20 1114936556 0 Physicians Healthy Kids Services 20 1114936556 0 Physicians Optical Supplies 20 1114936556 0 Physicians Physician Services 00 1114936820 0 BRUECKERT KURT 2000336 9999999 B 10 1114936820 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1114936820 0 Physicians Anesthesia Services 20 1114936820 0 Physicians Fluoride varnish 20 1114936820 0 Physicians Healthy Kids Services 20 1114936820 0 Physicians Optical Supplies 20 1114936820 0 Physicians Physician Services 00 1114937091 0 PORTUGAL LOUIS G 1993182 9999999 B 10 1114937091 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1114937091 0 Physicians Anesthesia Services 20 1114937091 0 Physicians Healthy Kids Services 20 1114937091 0 Physicians Optical Supplies 20 1114937091 0 Physicians Physician Services 00 1114937562 0 PETERS CONSTANTINE 2002213 9999999 B 10 1114937562 0 12251 S 80TH AVE STE 1630 PALOS HEIGHTS IL 604631256 20 1114937562 0 Physicians Anesthesia Services 20 1114937562 0 Physicians Fluoride varnish 20 1114937562 0 Physicians Healthy Kids Services 20 1114937562 0 Physicians Optical Supplies 20 1114937562 0 Physicians Physician Services 00 1114937687 0 MIZERA CECYLIA K 2006152 9999999 B 10 1114937687 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1114937687 0 Physicians Anesthesia Services 20 1114937687 0 Physicians Healthy Kids Services 20 1114937687 0 Physicians Optical Supplies 20 1114937687 0 Physicians Physician Services 00 1114937711 0 KNUTSEN ALAN 1981182 9999999 B 10 1114937711 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1114937711 0 Physicians Anesthesia Services 20 1114937711 0 Physicians Fluoride varnish 20 1114937711 0 Physicians Healthy Kids Services 20 1114937711 0 Physicians Optical Supplies 20 1114937711 0 Physicians Physician Services 00 1114938578 0 CHOI CHANG HYUN M 2018060 9999999 B 10 1114938578 0 3495 HACKS CROSS RD MEMPHIS TN 381258803 20 1114938578 0 Physicians Anesthesia Services 20 1114938578 0 Physicians Healthy Kids Services 20 1114938578 0 Physicians Optical Supplies 20 1114938578 0 Physicians Physician Services 00 1114939428 0 APRILL KAREN 2014176 9999999 H 10 1114939428 0 1401 REGENCY DR EAST SUITE E SAVOY IL 618749312 20 1114939428 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1114940236 0 COLLINS KAREN L 1983164 9999999 B 10 1114940236 0 1051 W RAND RD STE 101 ARLINGTON HEIGH IL 600042315 20 1114940236 0 Physicians Anesthesia Services 20 1114940236 0 Physicians Healthy Kids Services 20 1114940236 0 Physicians Optical Supplies 20 1114940236 0 Physicians Physician Services 00 1114942174 0 WULLER JUDITH L 1992197 9999999 B 10 1114942174 0 6300 RIDGLEA PL STE 201 FORT WORTH TX 761165707 20 1114942174 0 Physicians Anesthesia Services 20 1114942174 0 Physicians Fluoride varnish 20 1114942174 0 Physicians Healthy Kids Services 20 1114942174 0 Physicians Optical Supplies 20 1114942174 0 Physicians Physician Services 00 1114942612 0 FLYNN KAREN E 2021044 9999999 B 10 1114942612 0 PO BOX 1437 COLUMBUS GA 319021437 20 1114942612 0 Physicians Anesthesia Services 20 1114942612 0 Physicians Healthy Kids Services 20 1114942612 0 Physicians Optical Supplies 20 1114942612 0 Physicians Physician Services 00 1114943057 0 BARNELL PHILLIP 1991121 9999999 B 10 1114943057 0 422 W WHITE ST CLINTON IL 617272272 20 1114943057 0 Physicians Anesthesia Services 20 1114943057 0 Physicians Healthy Kids Services 20 1114943057 0 Physicians Optical Supplies 20 1114943057 0 Physicians Physician Services 00 1114943065 0 NICHAMIN HENRY 1990032 9999999 B 10 1114943065 0 705 E GOLF RD SCHAUMBURG IL 601734511 20 1114943065 0 Physicians Anesthesia Services 20 1114943065 0 Physicians Fluoride varnish 20 1114943065 0 Physicians Healthy Kids Services 20 1114943065 0 Physicians Optical Supplies 20 1114943065 0 Physicians Physician Services 00 1114943081 0 SULLIVAN PATRICIA A 2004201 9999999 B 10 1114943081 0 29373 NETWORK PL CHICAGO IL 606733039 20 1114943081 0 Nurse Practitioners Healthy Kids Services 20 1114943081 0 Nurse Practitioners Nurse Practitioners Services 20 1114943081 0 Nurse Practitioners Physician Services 00 1114943412 0 DOBBS KRISTIN L 2005032 9999999 B 10 1114943412 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1114943412 0 Nurse Practitioners Anesthesia Services 20 1114943412 0 Nurse Practitioners Nurse Practitioners Services 20 1114943412 0 Nurse Practitioners Physician Services 00 1114945276 0 ANGELES JENNIFER L 2006182 9999999 B 10 1114945276 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1114945276 0 Physicians Anesthesia Services 20 1114945276 0 Physicians Fluoride varnish 20 1114945276 0 Physicians Healthy Kids Services 20 1114945276 0 Physicians Optical Supplies 20 1114945276 0 Physicians Physician Services 00 1114945540 0 SANTIAGO PAUL 2003213 9999999 B 10 1114945540 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1114945540 0 Physicians Anesthesia Services 20 1114945540 0 Physicians Healthy Kids Services 20 1114945540 0 Physicians Optical Supplies 20 1114945540 0 Physicians Physician Services 00 1114945813 0 OSTLUND RICHARD E 1981182 9999999 B 10 1114945813 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1114945813 0 Physicians Anesthesia Services 20 1114945813 0 Physicians Fluoride varnish 20 1114945813 0 Physicians Healthy Kids Services 20 1114945813 0 Physicians Optical Supplies 20 1114945813 0 Physicians Physician Services 00 1114946738 0 BRUNETTI MARISSA ANN 2017273 9999999 B 10 1114946738 0 100 E PENN SQ PHILADELPHIA PA 191073323 20 1114946738 0 Physicians Anesthesia Services 20 1114946738 0 Physicians Fluoride varnish 20 1114946738 0 Physicians Healthy Kids Services 20 1114946738 0 Physicians Optical Supplies 20 1114946738 0 Physicians Physician Services 00 1114946852 0 STEWART CHRISTOPHER L 2022363 9999999 B 10 1114946852 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1114946852 0 Nurse Practitioners Anesthesia Services 20 1114946852 0 Nurse Practitioners Nurse Practitioners Services 20 1114946852 0 Nurse Practitioners Physician Services 00 1114947124 0 SPRAGUE STUART MICHAEL 1989138 9999999 B 10 1114947124 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1114947124 0 Physicians Anesthesia Services 20 1114947124 0 Physicians Fluoride varnish 20 1114947124 0 Physicians Healthy Kids Services 20 1114947124 0 Physicians Optical Supplies 20 1114947124 0 Physicians Physician Services 00 1114947744 0 KUHN TERESA 2003091 9999999 B 10 1114947744 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1114947744 0 Physical Therapists Medical Supplies 20 1114947744 0 Physical Therapists Medical equipment/prosthetic devices 20 1114947744 0 Physical Therapists Physical Therapy Services 00 1114947801 0 MILOVANI CHRISTINE K 2017283 9999999 B 10 1114947801 0 515 22ND AVE MONROE WI 535661569 20 1114947801 0 Clinical Social Worker Social work service 00 1114947876 0 MICHALSEN THOMAS L 1983195 9999999 B 10 1114947876 0 1848 DAIMLER RD ROCKFORD IL 611121019 20 1114947876 0 Physicians Anesthesia Services 20 1114947876 0 Physicians Fluoride varnish 20 1114947876 0 Physicians Healthy Kids Services 20 1114947876 0 Physicians Optical Supplies 20 1114947876 0 Physicians Physician Services 00 1114948486 0 KRYNICKI MICHAL 2025001 9999999 B 10 1114948486 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1114948486 0 Physicians Anesthesia Services 20 1114948486 0 Physicians Fluoride varnish 20 1114948486 0 Physicians Healthy Kids Services 20 1114948486 0 Physicians Optical Supplies 20 1114948486 0 Physicians Physician Services 00 1114948544 0 GUNZEL DAVID A 1993182 9999999 B 10 1114948544 0 1201 PINE ST ELDORADO IL 629301634 20 1114948544 0 Podiatrists Podiatric Services 00 1114950813 0 ALKHAN MUHAMMAD B 1995182 9999999 B 10 1114950813 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1114950813 0 Physicians Anesthesia Services 20 1114950813 0 Physicians Fluoride varnish 20 1114950813 0 Physicians Healthy Kids Services 20 1114950813 0 Physicians Optical Supplies 20 1114950813 0 Physicians Physician Services 00 1114950987 0 BENSON MARK 2005182 9999999 B 10 1114950987 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1114950987 0 Physicians Anesthesia Services 20 1114950987 0 Physicians Fluoride varnish 20 1114950987 0 Physicians Healthy Kids Services 20 1114950987 0 Physicians Optical Supplies 20 1114950987 0 Physicians Physician Services 00 1114951233 0 FROELKE BRIAN 2006182 9999999 B 10 1114951233 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1114951233 0 Physicians Anesthesia Services 20 1114951233 0 Physicians Healthy Kids Services 20 1114951233 0 Physicians Optical Supplies 20 1114951233 0 Physicians Physician Services 00 1114951548 0 SALMI ALLEN 2020283 9999999 B 10 1114951548 0 835 S VAN BUREN ST GREEN BAY WI 543013526 20 1114951548 0 Physicians Anesthesia Services 20 1114951548 0 Physicians Healthy Kids Services 20 1114951548 0 Physicians Optical Supplies 20 1114951548 0 Physicians Physician Services 00 1114952504 0 KOWALCZYK BUDZIAKOWS BEATA 2002182 9999999 B 10 1114952504 0 3115 N HARLEM AVE STE 201 CHICAGO IL 606344683 20 1114952504 0 Physicians Anesthesia Services 20 1114952504 0 Physicians Fluoride varnish 20 1114952504 0 Physicians Healthy Kids Services 20 1114952504 0 Physicians Optical Supplies 20 1114952504 0 Physicians Physician Services 00 1114952520 0 SCHERMER CAROL R 2014023 9999999 B 10 1114952520 0 2300 N EDWARD ST DECATUR IL 625264163 20 1114952520 0 Physicians Anesthesia Services 20 1114952520 0 Physicians Healthy Kids Services 20 1114952520 0 Physicians Optical Supplies 20 1114952520 0 Physicians Physician Services 00 1114953791 0 PASTORE ROBIN L 1998182 9999999 B 10 1114953791 0 1N141 COUNTY FARM RD STE 100 WINFIELD IL 601902032 20 1114953791 0 Podiatrists Podiatric Services 00 1114953825 0 BHATHENA YASMIN K 2003175 9999999 B 10 1114953825 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1114953825 0 Physicians Anesthesia Services 20 1114953825 0 Physicians Fluoride varnish 20 1114953825 0 Physicians Healthy Kids Services 20 1114953825 0 Physicians Optical Supplies 20 1114953825 0 Physicians Physician Services 00 1114954260 0 KENNEBECK STEPHANIE 2005335 9999999 B 10 1114954260 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1114954260 0 Physicians Anesthesia Services 20 1114954260 0 Physicians Fluoride varnish 20 1114954260 0 Physicians Healthy Kids Services 20 1114954260 0 Physicians Optical Supplies 20 1114954260 0 Physicians Physician Services 00 1114954708 0 SCHULTZ MICHELLE 2008306 9999999 B 10 1114954708 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1114954708 0 Physicians Anesthesia Services 20 1114954708 0 Physicians Fluoride varnish 20 1114954708 0 Physicians Healthy Kids Services 20 1114954708 0 Physicians Optical Supplies 20 1114954708 0 Physicians Physician Services 00 1114955960 0 IMBURGIA DOMINIC 1984108 9999999 B 10 1114955960 0 901 N MAPLE ST EFFINGHAM IL 624016427 20 1114955960 0 Physicians Anesthesia Services 20 1114955960 0 Physicians Healthy Kids Services 20 1114955960 0 Physicians Optical Supplies 20 1114955960 0 Physicians Physician Services 00 1114956885 0 PICCONE CONNIE 2020254 9999999 B 10 1114956885 0 611 W PARK ST URBANA IL 618012529 20 1114956885 0 Physicians Anesthesia Services 20 1114956885 0 Physicians Fluoride varnish 20 1114956885 0 Physicians Healthy Kids Services 20 1114956885 0 Physicians Optical Supplies 20 1114956885 0 Physicians Physician Services 00 1114957198 0 MCKISSACK MARINA M 2022154 9999999 B 10 1114957198 0 1000 N OAK AVE MARSHFIELD WI 544495703 20 1114957198 0 Physician Assistant Only Fluoride varnish 20 1114957198 0 Physician Assistant Only Healthy Kids Services 20 1114957198 0 Physician Assistant Only Physician Services 00 1114958048 0 ARZON MAYRA A 1989305 9999999 B 10 1114958048 0 1 MEMORIAL DR STE 101 DECATUR IL 625266313 20 1114958048 0 Physicians Anesthesia Services 20 1114958048 0 Physicians Fluoride varnish 20 1114958048 0 Physicians Healthy Kids Services 20 1114958048 0 Physicians Optical Supplies 20 1114958048 0 Physicians Physician Services 00 1114958121 0 PUTHUMANA JYOTHY 2004237 9999999 B 10 1114958121 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1114958121 0 Physicians Anesthesia Services 20 1114958121 0 Physicians Fluoride varnish 20 1114958121 0 Physicians Healthy Kids Services 20 1114958121 0 Physicians Optical Supplies 20 1114958121 0 Physicians Physician Services 00 1114959517 0 GINDE KUMUDINI H 2000245 9999999 B 10 1114959517 0 PO BOX 17632 BELFAST ME 049154071 20 1114959517 0 Physicians Anesthesia Services 20 1114959517 0 Physicians Healthy Kids Services 20 1114959517 0 Physicians Optical Supplies 20 1114959517 0 Physicians Physician Services 20 1114959517 0 Physicians Physicians Psychiatric Services 00 1114959913 0 FRANCIS LEE 1991210 9999999 B 10 1114959913 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1114959913 0 Physicians All Kids application agent 20 1114959913 0 Physicians Anesthesia Services 20 1114959913 0 Physicians Fluoride varnish 20 1114959913 0 Physicians Healthy Kids Services 20 1114959913 0 Physicians Optical Supplies 20 1114959913 0 Physicians Physician Services 00 1114959947 0 BERNHEIM BRUCE S 1986121 9999999 B 10 1114959947 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1114959947 0 Physicians Anesthesia Services 20 1114959947 0 Physicians Fluoride varnish 20 1114959947 0 Physicians Healthy Kids Services 20 1114959947 0 Physicians Optical Supplies 20 1114959947 0 Physicians Physician Services 00 1114961026 0 SHAMASH MICHELLE P 1999336 9999999 B 10 1114961026 0 24014 W RENWICK RD PLAINFIELD IL 605448708 20 1114961026 0 Occupational Therapists Medical Supplies 20 1114961026 0 Occupational Therapists Medical equipment/prosthetic devices 20 1114961026 0 Occupational Therapists Occupational Therapy Services 00 1114961208 0 DZIUBA ELIZABETH 1996092 9999999 B 10 1114961208 0 373 N WOOD DALE RD WOOD DALE IL 601911531 20 1114961208 0 Optometrists Optical Supplies 20 1114961208 0 Optometrists Optometric Services 20 1114961208 0 Optometrists Physician Services 00 1114963394 0 LIU ZHAO 2016355 9999999 B 10 1114963394 0 1 ILLINI DR PEORIA IL 616052576 20 1114963394 0 Physicians Anesthesia Services 20 1114963394 0 Physicians Healthy Kids Services 20 1114963394 0 Physicians Optical Supplies 20 1114963394 0 Physicians Physician Services 20 1114963394 0 Physicians Physicians Psychiatric Services 00 1114964566 0 POTEAT THENA 2004183 9999999 B 10 1114964566 0 1301 CONCORDIA CT SPRINGFIELD IL 627025643 20 1114964566 0 Physicians Anesthesia Services 20 1114964566 0 Physicians Healthy Kids Services 20 1114964566 0 Physicians Optical Supplies 20 1114964566 0 Physicians Physician Services 20 1114964566 0 Physicians Physicians Psychiatric Services 00 1114964574 0 SUTTERER KENT 2010194 9999999 B 10 1114964574 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1114964574 0 Physicians Anesthesia Services 20 1114964574 0 Physicians Fluoride varnish 20 1114964574 0 Physicians Healthy Kids Services 20 1114964574 0 Physicians Optical Supplies 20 1114964574 0 Physicians Physician Services 00 1114964673 0 ASONYE UDOCHUKWU 1981227 9999999 B 10 1114964673 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1114964673 0 Physicians Anesthesia Services 20 1114964673 0 Physicians Fluoride varnish 20 1114964673 0 Physicians Healthy Kids Services 20 1114964673 0 Physicians Optical Supplies 20 1114964673 0 Physicians Physician Services 00 1114964772 0 KELLER JOHN A 1996245 9999999 B 10 1114964772 0 PO BOX 3276 EVANSVILLE IN 477313276 20 1114964772 0 Nurse Practitioners Anesthesia Services 20 1114964772 0 Nurse Practitioners Nurse Practitioners Services 20 1114964772 0 Nurse Practitioners Physician Services 00 1114965225 0 ROSSI PHILLIP 1994182 9999999 B 10 1114965225 0 107 TREMONT ST HOPEDALE IL 617477525 20 1114965225 0 Physicians Anesthesia Services 20 1114965225 0 Physicians Fluoride varnish 20 1114965225 0 Physicians Healthy Kids Services 20 1114965225 0 Physicians Optical Supplies 20 1114965225 0 Physicians Physician Services 00 1114966447 0 KOLKA JAMES 1995335 9999999 B 10 1114966447 0 PO BOX 857 FREEPORT IL 610320857 20 1114966447 0 Physicians Anesthesia Services 20 1114966447 0 Physicians Healthy Kids Services 20 1114966447 0 Physicians Optical Supplies 20 1114966447 0 Physicians Physician Services 00 1114966611 0 NYQUIST DAVID J 1989200 9999999 B 10 1114966611 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1114966611 0 Physicians Anesthesia Services 20 1114966611 0 Physicians Fluoride varnish 20 1114966611 0 Physicians Healthy Kids Services 20 1114966611 0 Physicians Optical Supplies 20 1114966611 0 Physicians Physician Services 00 1114966801 0 CAFARO JOHN A 2017001 9999999 B 10 1114966801 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1114966801 0 Physicians Anesthesia Services 20 1114966801 0 Physicians Fluoride varnish 20 1114966801 0 Physicians Healthy Kids Services 20 1114966801 0 Physicians Optical Supplies 20 1114966801 0 Physicians Physician Services 00 1114967767 0 BROOM MATTHEW 2006182 9999999 B 10 1114967767 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1114967767 0 Physicians Anesthesia Services 20 1114967767 0 Physicians Fluoride varnish 20 1114967767 0 Physicians Healthy Kids Services 20 1114967767 0 Physicians Optical Supplies 20 1114967767 0 Physicians Physician Services 00 1114968435 0 PETERSEN ANNE E 2017054 9999999 B 10 1114968435 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1114968435 0 Physicians Anesthesia Services 20 1114968435 0 Physicians Healthy Kids Services 20 1114968435 0 Physicians Optical Supplies 20 1114968435 0 Physicians Physician Services 00 1114969136 0 MOLOKIE ROBERT E 1991001 9999999 B 10 1114969136 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1114969136 0 Physicians Anesthesia Services 20 1114969136 0 Physicians Fluoride varnish 20 1114969136 0 Physicians Healthy Kids Services 20 1114969136 0 Physicians Optical Supplies 20 1114969136 0 Physicians Physician Services 00 1114969144 0 SWANSON ROBERT G 2017091 9999999 B 10 1114969144 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1114969144 0 Physicians Anesthesia Services 20 1114969144 0 Physicians Healthy Kids Services 20 1114969144 0 Physicians Optical Supplies 20 1114969144 0 Physicians Physician Services 00 1114969383 0 LUTZ DAVID 2016282 9999999 B 10 1114969383 0 18167 US HIGHWAY 19 N STE 650 CLEARWATER FL 337646576 20 1114969383 0 Physician Assistant Only Fluoride varnish 20 1114969383 0 Physician Assistant Only Healthy Kids Services 20 1114969383 0 Physician Assistant Only Physician Services 00 1114969573 0 JAYACHANDRAN VIJAYALAKSHMI 2021148 9999999 B 10 1114969573 0 PO BOX 1430 PORTAGE IN 463689230 20 1114969573 0 Physicians Anesthesia Services 20 1114969573 0 Physicians Healthy Kids Services 20 1114969573 0 Physicians Optical Supplies 20 1114969573 0 Physicians Physician Services 20 1114969573 0 Physicians Physicians Psychiatric Services 00 1114969813 0 NATYSHOK STEPHANIE 2016239 9999999 B 10 1114969813 0 220 N PARK AVE STE 2 HERRIN IL 629483150 20 1114969813 0 Physician Assistant Only Fluoride varnish 20 1114969813 0 Physician Assistant Only Healthy Kids Services 20 1114969813 0 Physician Assistant Only Physician Services 00 1114970795 0 BRAUER ERNESTO 1989121 9999999 B 10 1114970795 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1114970795 0 Physicians Anesthesia Services 20 1114970795 0 Physicians Fluoride varnish 20 1114970795 0 Physicians Healthy Kids Services 20 1114970795 0 Physicians Optical Supplies 20 1114970795 0 Physicians Physician Services 00 1114971256 0 TIMMEL KEVIN 2023091 9999999 B 10 1114971256 0 190 E BANNOCK ST BOISE ID 837126241 20 1114971256 0 Physicians Anesthesia Services 20 1114971256 0 Physicians Healthy Kids Services 20 1114971256 0 Physicians Optical Supplies 20 1114971256 0 Physicians Physician Services 00 1114971652 0 DEMONT BRUCE 1995186 9999999 B 10 1114971652 0 201 E PLEASANT ST TAYLORVILLE IL 625681562 20 1114971652 0 Physicians Anesthesia Services 20 1114971652 0 Physicians Fluoride varnish 20 1114971652 0 Physicians Healthy Kids Services 20 1114971652 0 Physicians Optical Supplies 20 1114971652 0 Physicians Physician Services 00 1114971678 0 TRENNEPOHL KAREN J 2018290 9999999 B 10 1114971678 0 250 W 96TH ST STE 520 INDIANAPOLIS IN 462601317 20 1114971678 0 Nurse Practitioners Fluoride varnish 20 1114971678 0 Nurse Practitioners Healthy Kids Services 20 1114971678 0 Nurse Practitioners Nurse Practitioners Services 20 1114971678 0 Nurse Practitioners Physician Services 00 1114971959 0 SCHMIDT KEVIN J 1990182 9999999 B 10 1114971959 0 387 SHUMAN BLVD STE 240W NAPERVILLE IL 605638113 20 1114971959 0 Physicians Anesthesia Services 20 1114971959 0 Physicians Healthy Kids Services 20 1114971959 0 Physicians Optical Supplies 20 1114971959 0 Physicians Physician Services 00 1114971983 0 CALABRESE DAWN M 2024073 9999999 B 10 1114971983 0 PO BOX 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Physicians Anesthesia Services 20 1114973427 0 Physicians Fluoride varnish 20 1114973427 0 Physicians Healthy Kids Services 20 1114973427 0 Physicians Optical Supplies 20 1114973427 0 Physicians Physician Services 00 1114974441 0 SEKAR VENKAT E 1988008 9999999 B 10 1114974441 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1114974441 0 Physicians Anesthesia Services 20 1114974441 0 Physicians Fluoride varnish 20 1114974441 0 Physicians Healthy Kids Services 20 1114974441 0 Physicians Optical Supplies 20 1114974441 0 Physicians Physician Services 00 1114974532 0 CZARNIK BRUCE 2006182 9999999 B 10 1114974532 0 901 PATIENTS FIRST DR WASHINGTON MO 630904700 20 1114974532 0 Physicians Anesthesia Services 20 1114974532 0 Physicians Fluoride varnish 20 1114974532 0 Physicians Healthy Kids Services 20 1114974532 0 Physicians Optical Supplies 20 1114974532 0 Physicians Physician Services 00 1114974557 0 YANG LINDA C 2012183 9999999 B 10 1114974557 0 5777 DEPT CAROL STREAM IL 601220021 20 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Physicians Physician Services 00 1114977311 0 DONG SHENG-JING 2009036 9999999 B 10 1114977311 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1114977311 0 Physicians Anesthesia Services 20 1114977311 0 Physicians Fluoride varnish 20 1114977311 0 Physicians Healthy Kids Services 20 1114977311 0 Physicians Optical Supplies 20 1114977311 0 Physicians Physician Services 00 1114977352 0 SCHMELKA KATHLEEN 2001182 9999999 B 10 1114977352 0 900 N 2ND ST ROCHELLE IL 610681764 20 1114977352 0 Physicians Anesthesia Services 20 1114977352 0 Physicians Healthy Kids Services 20 1114977352 0 Physicians Optical Supplies 20 1114977352 0 Physicians Physician Services 00 1114977915 0 KLINE BROOKE 2021089 9999999 B 10 1114977915 0 PO BOX 328 EVANSVILLE IN 477020328 20 1114977915 0 Physician Assistant Only Fluoride varnish 20 1114977915 0 Physician Assistant Only Healthy Kids Services 20 1114977915 0 Physician Assistant Only Physician Services 00 1114978087 0 RAHMAN AMER 1996183 9999999 B 10 1114978087 0 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DETROIT MI 482781076 20 1114978798 0 Physicians Anesthesia Services 20 1114978798 0 Physicians Fluoride varnish 20 1114978798 0 Physicians Healthy Kids Services 20 1114978798 0 Physicians Optical Supplies 20 1114978798 0 Physicians Physician Services 00 1114978822 0 MINGO TINA 2005152 9999999 B 10 1114978822 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1114978822 0 Nurse Practitioners Healthy Kids Services 20 1114978822 0 Nurse Practitioners Midwife Services 20 1114978822 0 Nurse Practitioners Nurse Practitioners Services 20 1114978822 0 Nurse Practitioners Physician Services 00 1114979036 0 PARA PATRICK F 1996183 9999999 B 10 1114979036 0 44000 GARFIELD RD CLINTON TOWNSHI MI 480381125 20 1114979036 0 Physicians Anesthesia Services 20 1114979036 0 Physicians Healthy Kids Services 20 1114979036 0 Physicians Optical Supplies 20 1114979036 0 Physicians Physician Services 00 1114981008 0 DUNDOO GAYATHRI 2006213 9999999 B 10 1114981008 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1114981008 0 Physicians Anesthesia Services 20 1114981008 0 Physicians Fluoride varnish 20 1114981008 0 Physicians Healthy Kids Services 20 1114981008 0 Physicians Optical Supplies 20 1114981008 0 Physicians Physician Services 00 1114981032 0 OLIVER ROBERT 1998121 9999999 B 10 1114981032 0 P O BOX 771858 CHICAGO IL 606770001 20 1114981032 0 Physicians Anesthesia Services 20 1114981032 0 Physicians Fluoride varnish 20 1114981032 0 Physicians Healthy Kids Services 20 1114981032 0 Physicians Optical Supplies 20 1114981032 0 Physicians Physician Services 00 1114981933 0 DREYER GARY L 2000001 9999999 B 10 1114981933 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1114981933 0 Physicians Anesthesia Services 20 1114981933 0 Physicians Fluoride varnish 20 1114981933 0 Physicians Healthy Kids Services 20 1114981933 0 Physicians Optical Supplies 20 1114981933 0 Physicians Physician Services 00 1114982048 0 BRIGNONI CATHERINE 2005060 9999999 B 10 1114982048 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 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1124349337 0 Physicians Anesthesia Services 20 1124349337 0 Physicians Fluoride varnish 20 1124349337 0 Physicians Healthy Kids Services 20 1124349337 0 Physicians Optical Supplies 20 1124349337 0 Physicians Physician Services 00 1124349550 0 TSIEN MARGARET Z 2014182 9999999 B 10 1124349550 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1124349550 0 Physicians Anesthesia Services 20 1124349550 0 Physicians Fluoride varnish 20 1124349550 0 Physicians Healthy Kids Services 20 1124349550 0 Physicians Optical Supplies 20 1124349550 0 Physicians Physician Services 00 1124349857 0 SHARMA SURANGAMA 2014309 9999999 B 10 1124349857 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1124349857 0 Physicians Anesthesia Services 20 1124349857 0 Physicians Healthy Kids Services 20 1124349857 0 Physicians Optical Supplies 20 1124349857 0 Physicians Physician Services 00 1124350418 0 RAVIV TALI 2017062 9999999 B 10 1124350418 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1124350418 0 Psychologist Psychologist service 00 1124358221 0 OWENS SPAHN GINA M 2010264 9999999 B 10 1124358221 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1124358221 0 Other behavior health professional LCPC/LMFT services 00 1124360219 0 BAUER SARAH 2017159 9999999 B 10 1124360219 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1124360219 0 Physicians Anesthesia Services 20 1124360219 0 Physicians Fluoride varnish 20 1124360219 0 Physicians Healthy Kids Services 20 1124360219 0 Physicians Optical Supplies 20 1124360219 0 Physicians Physician Services 00 1124360425 0 BANNIS DILLION J 2017265 9999999 B 10 1124360425 0 PO BOX 778791 CHICAGO IL 606776473 20 1124360425 0 Physicians Anesthesia Services 20 1124360425 0 Physicians Healthy Kids Services 20 1124360425 0 Physicians Optical Supplies 20 1124360425 0 Physicians Physician Services 00 1124361159 0 SUTTON ANGELA 2019213 9999999 B 10 1124361159 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1124361159 0 Physicians Anesthesia Services 20 1124361159 0 Physicians Healthy Kids Services 20 1124361159 0 Physicians Optical Supplies 20 1124361159 0 Physicians Physician Services 00 1124361274 0 KAIRYS CAITLIN 2023090 9999999 B 10 1124361274 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1124361274 0 Physician Assistant Only Fluoride varnish 20 1124361274 0 Physician Assistant Only Healthy Kids Services 20 1124361274 0 Physician Assistant Only Physician Services 00 1124361324 0 ABBOUD SAMIR F 2018194 9999999 B 10 1124361324 0 PO BOX 5588 BELFAST ME 049155500 20 1124361324 0 Physicians Anesthesia Services 20 1124361324 0 Physicians Healthy Kids Services 20 1124361324 0 Physicians Optical Supplies 20 1124361324 0 Physicians Physician Services 00 1124361605 0 ZWICK SHANNA 2016309 9999999 B 10 1124361605 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1124361605 0 Physician Assistant Only Fluoride varnish 20 1124361605 0 Physician Assistant Only Healthy Kids Services 20 1124361605 0 Physician Assistant Only Physician Services 00 1124361704 0 THILL SARAH 2017274 9999999 B 10 1124361704 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1124361704 0 Physicians Anesthesia Services 20 1124361704 0 Physicians Fluoride varnish 20 1124361704 0 Physicians Healthy Kids Services 20 1124361704 0 Physicians Optical Supplies 20 1124361704 0 Physicians Physician Services 00 1124361746 0 MAHASNEH OMAR 2017355 9999999 B 10 1124361746 0 670 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418573 20 1124361746 0 Physicians Anesthesia Services 20 1124361746 0 Physicians Fluoride varnish 20 1124361746 0 Physicians Healthy Kids Services 20 1124361746 0 Physicians Optical Supplies 20 1124361746 0 Physicians Physician Services 00 1124362538 0 VOYLES AUDREY B 2016001 9999999 B 10 1124362538 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1124362538 0 Physician Assistant Only Fluoride varnish 20 1124362538 0 Physician Assistant Only Healthy Kids Services 20 1124362538 0 Physician Assistant Only Physician Services 00 1124363049 0 THIELEN KRISTYN L. 2016245 9999999 B 10 1124363049 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1124363049 0 Nurse Practitioners Healthy Kids Services 20 1124363049 0 Nurse Practitioners Nurse Practitioners Services 20 1124363049 0 Nurse Practitioners Physician Services 00 1124364310 0 COHEN CHERYL 2018229 9999999 B 10 1124364310 0 7360 N LINCOLN AVE STE 110 LINCOLNWOOD IL 607121705 20 1124364310 0 Occupational Therapists Medical Supplies 20 1124364310 0 Occupational Therapists Medical equipment/prosthetic devices 20 1124364310 0 Occupational Therapists Occupational Therapy Services 00 1124364708 0 WALKER SARAH B 2019273 9999999 B 10 1124364708 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1124364708 0 Physicians Anesthesia Services 20 1124364708 0 Physicians Fluoride varnish 20 1124364708 0 Physicians Healthy Kids Services 20 1124364708 0 Physicians Optical Supplies 20 1124364708 0 Physicians Physician Services 00 1124364948 0 STRUCK KENDRA K 2018213 9999999 B 10 1124364948 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1124364948 0 Nurse Practitioners Fluoride varnish 20 1124364948 0 Nurse Practitioners Healthy Kids Services 20 1124364948 0 Nurse Practitioners Nurse Practitioners Services 20 1124364948 0 Nurse Practitioners Physician Services 00 1124365051 0 KRAINSON MELISSA 2017001 9999999 B 10 1124365051 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1124365051 0 Physician Assistant Only Fluoride varnish 20 1124365051 0 Physician Assistant Only Healthy Kids Services 20 1124365051 0 Physician Assistant Only Physician Services 00 1124367990 0 CHWARCZINSKI JULIE B 2013060 9999999 B 10 1124367990 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1124367990 0 Nurse Practitioners Healthy Kids Services 20 1124367990 0 Nurse Practitioners Nurse Practitioners Services 20 1124367990 0 Nurse Practitioners Physician Services 00 1124368360 0 KAMER BRIAN 2020297 9999999 B 10 1124368360 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1124368360 0 Physicians Anesthesia Services 20 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Healthy Kids Services 20 1124371067 0 Physicians Optical Supplies 20 1124371067 0 Physicians Physician Services 00 1124373253 0 IMAM SYED HAIDER 2022144 2099365 B 10 1124373253 0 28594 NETWORK PL CHICAGO IL 606731081 20 1124373253 0 Physicians Anesthesia Services 20 1124373253 0 Physicians Fluoride varnish 20 1124373253 0 Physicians Healthy Kids Services 20 1124373253 0 Physicians Optical Supplies 20 1124373253 0 Physicians Physician Services 00 1124373295 0 SIGALA WHITNEY J 2017033 9999999 B 10 1124373295 0 16011 108TH AVE ORLAND PARK IL 604678786 20 1124373295 0 Physicians Anesthesia Services 20 1124373295 0 Physicians Healthy Kids Services 20 1124373295 0 Physicians Optical Supplies 20 1124373295 0 Physicians Physician Services 00 1124373899 0 LAWAL ADEWALE 2013091 9999999 B 10 1124373899 0 800 N KEDZIE AVE CHICAGO IL 606514100 20 1124373899 0 Dentists Dental Services 20 1124373899 0 Dentists Physician Services 00 1124375274 0 BLOCK ALEC 2017131 9999999 B 10 1124375274 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1124375274 0 Physicians Anesthesia Services 20 1124375274 0 Physicians Healthy Kids Services 20 1124375274 0 Physicians Optical Supplies 20 1124375274 0 Physicians Physician Services 00 1124375928 0 JOSTES PHILIP R 2018323 9999999 B 10 1124375928 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1124375928 0 Occupational Therapists Medical Supplies 20 1124375928 0 Occupational Therapists Medical equipment/prosthetic devices 20 1124375928 0 Occupational Therapists Occupational Therapy Services 00 1124376223 0 SALOMON TARA E 2019076 9999999 B 10 1124376223 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1124376223 0 Speech Therapists Medical Supplies 20 1124376223 0 Speech Therapists Medical equipment/prosthetic devices 20 1124376223 0 Speech Therapists Speech Therapy/Pathology Services 00 1124376892 0 BOTHFELD NATHANIEL S 2016087 9999999 B 10 1124376892 0 1969 W HART RD BELOIT WI 535112230 20 1124376892 0 Physical Therapists Medical Supplies 20 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Occupational Therapists Occupational Therapy Services 00 1124380332 0 BAUMANN ALEXANDRA 2019123 9999999 B 10 1124380332 0 5777 DEPT CAROL STREAM IL 601220021 20 1124380332 0 Physicians Anesthesia Services 20 1124380332 0 Physicians Fluoride varnish 20 1124380332 0 Physicians Healthy Kids Services 20 1124380332 0 Physicians Optical Supplies 20 1124380332 0 Physicians Physician Services 00 1124380753 0 YAN YU 2015305 9999999 B 10 1124380753 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1124380753 0 Physicians Anesthesia Services 20 1124380753 0 Physicians Fluoride varnish 20 1124380753 0 Physicians Healthy Kids Services 20 1124380753 0 Physicians Optical Supplies 20 1124380753 0 Physicians Physician Services 00 1124380803 0 HOLETS SARAH L 2023347 9999999 B 10 1124380803 0 1000 N OAK AVE MARSHFIELD WI 544495703 20 1124380803 0 Physicians Anesthesia Services 20 1124380803 0 Physicians Fluoride varnish 20 1124380803 0 Physicians Healthy Kids Services 20 1124380803 0 Physicians Optical 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Supplies 20 1124384326 0 Physicians Physician Services 00 1124384391 0 PRELOGER ERIN 2018200 9999999 B 10 1124384391 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1124384391 0 Physicians Anesthesia Services 20 1124384391 0 Physicians Fluoride varnish 20 1124384391 0 Physicians Healthy Kids Services 20 1124384391 0 Physicians Optical Supplies 20 1124384391 0 Physicians Physician Services 00 1124384706 0 KIM JOHN 2024005 9999999 B 10 1124384706 0 850 W CENTRAL TEXAS EXPY HARKER HEIGHTS TX 765481890 20 1124384706 0 Physicians Anesthesia Services 20 1124384706 0 Physicians Healthy Kids Services 20 1124384706 0 Physicians Optical Supplies 20 1124384706 0 Physicians Physician Services 00 1124384946 0 CLARK SHARON SANTOSO 2017030 9999999 B 10 1124384946 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1124384946 0 Physicians Anesthesia Services 20 1124384946 0 Physicians Fluoride varnish 20 1124384946 0 Physicians Healthy Kids Services 20 1124384946 0 Physicians Optical Supplies 20 1124384946 0 Physicians Physician Services 00 1124386057 0 SETHI MEHAK 2015250 9999999 B 10 1124386057 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1124386057 0 Physicians Anesthesia Services 20 1124386057 0 Physicians Fluoride varnish 20 1124386057 0 Physicians Healthy Kids Services 20 1124386057 0 Physicians Optical Supplies 20 1124386057 0 Physicians Physician Services 00 1124386156 0 DRAGICEVIC NATASA 2024056 9999999 B 10 1124386156 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1124386156 0 Physicians Anesthesia Services 20 1124386156 0 Physicians Healthy Kids Services 20 1124386156 0 Physicians Optical Supplies 20 1124386156 0 Physicians Physician Services 20 1124386156 0 Physicians Physicians Psychiatric Services 00 1124386669 0 LIPSY PETER 2018036 9999999 B 10 1124386669 0 PO BOX 708760 SANDY UT 840708760 20 1124386669 0 Physicians Anesthesia Services 20 1124386669 0 Physicians Fluoride varnish 20 1124386669 0 Physicians Healthy Kids Services 20 1124386669 0 Physicians Optical Supplies 20 1124386669 0 Physicians Physician Services 00 1124386891 0 CHARTYNOWICZ AGNIESZKA 2023272 9999999 B 10 1124386891 0 625 N MICHIGAN AVE STE 210 CHICAGO IL 606113162 20 1124386891 0 Physician Assistant Only Fluoride varnish 20 1124386891 0 Physician Assistant Only Healthy Kids Services 20 1124386891 0 Physician Assistant Only Physician Services 00 1124387352 0 PERFETTI CATHRYN 2013140 9999999 B 10 1124387352 0 265 STONEGATE RD STE 102 ALGONQUIN IL 601025614 20 1124387352 0 Other behavior health professional LCPC/LMFT services 00 1124387675 0 PODDAR NISHANT 2012336 9999999 B 10 1124387675 0 PO BOX 955860 SAINT LOUIS MO 631955860 20 1124387675 0 Physicians Anesthesia Services 20 1124387675 0 Physicians Fluoride varnish 20 1124387675 0 Physicians Healthy Kids Services 20 1124387675 0 Physicians Optical Supplies 20 1124387675 0 Physicians Physician Services 00 1124388566 0 LI YINAN 2020176 9999999 B 10 1124388566 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1124388566 0 Physicians Anesthesia Services 20 1124388566 0 Physicians Healthy Kids Services 20 1124388566 0 Physicians Optical Supplies 20 1124388566 0 Physicians Physician Services 00 1124389069 0 WAHEED MOHAMED 2012177 9999999 B 10 1124389069 0 2333 W CHICAGO AVE CHICAGO IL 606224723 20 1124389069 0 Dentists Dental Services 20 1124389069 0 Dentists Physician Services 00 1124389176 0 KASPER STACIE A 2015336 9999999 B 10 1124389176 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1124389176 0 Physicians Anesthesia Services 20 1124389176 0 Physicians Fluoride varnish 20 1124389176 0 Physicians Healthy Kids Services 20 1124389176 0 Physicians Optical Supplies 20 1124389176 0 Physicians Physician Services 00 1124389861 0 NOE COLLEEN M 2016306 9999999 B 10 1124389861 0 3626 E STATE ST ROCKFORD IL 611081916 20 1124389861 0 Chiropractors Chiropractic Services 00 1124390869 0 MAHBOUB VICTORIA 2012142 9999999 B 10 1124390869 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1124390869 0 Clinical 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1124394853 0 Physicians Healthy Kids Services 20 1124394853 0 Physicians Optical Supplies 20 1124394853 0 Physicians Physician Services 00 1124396072 0 MANNA SANDRA 2021055 9999999 B 10 1124396072 0 2054 GRANT ST GARY IN 464043060 20 1124396072 0 Nurse Practitioners Fluoride varnish 20 1124396072 0 Nurse Practitioners Healthy Kids Services 20 1124396072 0 Nurse Practitioners Nurse Practitioners Services 20 1124396072 0 Nurse Practitioners Physician Services 00 1124396221 0 JURETSCHKE LINDA 2011274 9999999 B 10 1124396221 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1124396221 0 Nurse Practitioners Healthy Kids Services 20 1124396221 0 Nurse Practitioners Nurse Practitioners Services 20 1124396221 0 Nurse Practitioners Physician Services 00 1124400221 0 STRACK BIANCA 2015217 9999999 B 10 1124400221 0 728 WESTGATE ST IOWA CITY IA 522464642 20 1124400221 0 Nurse Practitioners Healthy Kids Services 20 1124400221 0 Nurse Practitioners Nurse Practitioners Services 20 1124400221 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00 1124406145 0 EMBREE LEAH 2021266 9999999 B 10 1124406145 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1124406145 0 Physicians Anesthesia Services 20 1124406145 0 Physicians Fluoride varnish 20 1124406145 0 Physicians Healthy Kids Services 20 1124406145 0 Physicians Optical Supplies 20 1124406145 0 Physicians Physician Services 00 1124406764 0 ABEJUELA MICHELLE L 2015184 9999999 B 10 1124406764 0 6906 MASON HILL RD MCHENRY IL 600506411 20 1124406764 0 Occupational Therapists Medical Supplies 20 1124406764 0 Occupational Therapists Medical equipment/prosthetic devices 20 1124406764 0 Occupational Therapists Occupational Therapy Services 00 1124407952 0 ALESANDRINI ANNE 2016118 9999999 B 10 1124407952 0 PO BOX 1109 DEKALB IL 601157109 20 1124407952 0 Other behavior health professional LCPC/LMFT services 20 1124407952 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1124408893 0 GRACE ALLISON 2022042 9999999 B 10 1124408893 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1124408893 0 Physicians Anesthesia Services 20 1124408893 0 Physicians Healthy Kids Services 20 1124408893 0 Physicians Optical Supplies 20 1124408893 0 Physicians Physician Services 00 1124408976 0 SHARMA SANDEEP 2019269 9999999 B 10 1124408976 0 6301 N WESTERN AVE CHICAGO IL 606592009 20 1124408976 0 Physicians Anesthesia Services 20 1124408976 0 Physicians Fluoride varnish 20 1124408976 0 Physicians Healthy Kids Services 20 1124408976 0 Physicians Optical Supplies 20 1124408976 0 Physicians Physician Services 00 1124409537 0 SHU JUDITH 2015305 9999999 B 10 1124409537 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1124409537 0 Nurse Practitioners Healthy Kids Services 20 1124409537 0 Nurse Practitioners Nurse Practitioners Services 20 1124409537 0 Nurse Practitioners Physician Services 00 1124409578 0 CAPITO JACOB 2022087 9999999 B 10 1124409578 0 5121 MARYLAND WAY STE 300 BRENTWOOD TN 370277516 20 1124409578 0 Physicians Anesthesia Services 20 1124409578 0 Physicians Healthy Kids Services 20 1124409578 0 Physicians Optical Supplies 20 1124409578 0 Physicians Physician Services 00 1124409891 0 JACKSON SARAH R 2018304 9999999 B 10 1124409891 0 7272 WURZBACH RD STE 601 SAN ANTONIO TX 782404803 20 1124409891 0 Clinical Social Worker Social work service 00 1124411020 0 WERESZCZYNSKA KATHY 2017077 9999999 B 10 1124411020 0 155 N MICHIGAN AVE STE 9012 CHICAGO IL 606017713 20 1124411020 0 Other behavior health professional LCPC/LMFT services 00 1124411673 0 PAUL KRISTIN 2015067 9999999 B 10 1124411673 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1124411673 0 Nurse Practitioners Fluoride varnish 20 1124411673 0 Nurse Practitioners Healthy Kids Services 20 1124411673 0 Nurse Practitioners Nurse Practitioners Services 20 1124411673 0 Nurse Practitioners Physician Services 00 1124412085 0 CANNON VICTORIA A 2023319 9999999 B 10 1124412085 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1124412085 0 Physicians Anesthesia Services 20 1124412085 0 Physicians Healthy Kids Services 20 1124412085 0 Physicians Optical Supplies 20 1124412085 0 Physicians Physician Services 20 1124412085 0 Physicians Physicians Psychiatric Services 00 1124412374 0 NICOL LARA K 2018170 9999999 B 10 1124412374 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1124412374 0 Physicians Anesthesia Services 20 1124412374 0 Physicians Fluoride varnish 20 1124412374 0 Physicians Healthy Kids Services 20 1124412374 0 Physicians Optical Supplies 20 1124412374 0 Physicians Physician Services 00 1124412416 0 STOLBERG NISSIM GEDALIAH 2017254 9999999 B 10 1124412416 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1124412416 0 Physicians Anesthesia Services 20 1124412416 0 Physicians Fluoride varnish 20 1124412416 0 Physicians Healthy Kids Services 20 1124412416 0 Physicians Optical Supplies 20 1124412416 0 Physicians Physician Services 00 1124412424 0 STRAUSS REBECCA 2016266 9999999 B 10 1124412424 0 8324 SKOKIE BLVD SKOKIE IL 600772545 20 1124412424 0 Clinical Social Worker Social work service 00 1124412663 0 KAMP MEGAN 2018014 9999999 B 10 1124412663 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1124412663 0 Physical Therapists Medical Supplies 20 1124412663 0 Physical Therapists Medical equipment/prosthetic devices 20 1124412663 0 Physical Therapists Physical Therapy Services 00 1124413034 0 KAPS CRISTOPHER JONATHAN 2023114 9999999 B 10 1124413034 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1124413034 0 Physicians Anesthesia Services 20 1124413034 0 Physicians Healthy Kids Services 20 1124413034 0 Physicians Optical Supplies 20 1124413034 0 Physicians Physician Services 20 1124413034 0 Physicians Physicians Psychiatric Services 00 1124413422 0 LINDSAY DANIEL P 2023013 9999999 B 10 1124413422 0 11516 N PORT WASHINGTON RD STE MEQUON WI 530923441 20 1124413422 0 Physicians Anesthesia Services 20 1124413422 0 Physicians Healthy Kids Services 20 1124413422 0 Physicians Optical Supplies 20 1124413422 0 Physicians Physician Services 00 1124414388 0 KUNAPAREDDY JUNE C 2019238 9999999 B 10 1124414388 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1124414388 0 Physicians Anesthesia Services 20 1124414388 0 Physicians Healthy Kids Services 20 1124414388 0 Physicians Optical Supplies 20 1124414388 0 Physicians Physician Services 00 1124414669 0 SU YOURONG S 2024306 9999999 B 10 1124414669 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1124414669 0 Physicians Anesthesia Services 20 1124414669 0 Physicians Healthy Kids Services 20 1124414669 0 Physicians Optical Supplies 20 1124414669 0 Physicians Physician Services 00 1124414834 0 ELIASON RACHEL 2022313 9999999 B 10 1124414834 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1124414834 0 Physicians Anesthesia Services 20 1124414834 0 Physicians Healthy Kids Services 20 1124414834 0 Physicians Optical Supplies 20 1124414834 0 Physicians Physician Services 00 1124414859 0 SPAHO LIDIA 2021188 9999999 B 10 1124414859 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1124414859 0 Physicians Anesthesia Services 20 1124414859 0 Physicians Fluoride varnish 20 1124414859 0 Physicians Healthy Kids Services 20 1124414859 0 Physicians Optical Supplies 20 1124414859 0 Physicians Physician Services 00 1124414982 0 BIELMEIER RACHEL L 2016222 9999999 B 10 1124414982 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1124414982 0 Physician Assistant Only Fluoride varnish 20 1124414982 0 Physician Assistant Only Healthy Kids Services 20 1124414982 0 Physician Assistant Only Physician Services 00 1124416904 0 ARROYO MICHELLE 2016112 9999999 B 10 1124416904 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1124416904 0 Nurse Practitioners Healthy Kids Services 20 1124416904 0 Nurse Practitioners Nurse Practitioners Services 20 1124416904 0 Nurse Practitioners Physician Services 00 1124417795 0 STRAUSS BENJAMIN B 2018354 9999999 B 10 1124417795 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1124417795 0 Physicians Anesthesia Services 20 1124417795 0 Physicians Healthy Kids Services 20 1124417795 0 Physicians Optical Supplies 20 1124417795 0 Physicians Physician Services 00 1124418314 0 KANE ALEXANDRA J 2017331 9999999 B 10 1124418314 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1124418314 0 Other behavior health professional LCPC/LMFT services 20 1124418314 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1124418447 0 GRAHAM ALEXIS 2023165 9999999 B 10 1124418447 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1124418447 0 Physicians Anesthesia Services 20 1124418447 0 Physicians Healthy Kids Services 20 1124418447 0 Physicians Optical Supplies 20 1124418447 0 Physicians Physician Services 00 1124418678 0 VILLAGOMEZ SILVIA 2018204 9999999 B 10 1124418678 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1124418678 0 Nurse Practitioners Healthy Kids Services 20 1124418678 0 Nurse Practitioners Nurse Practitioners Services 20 1124418678 0 Nurse Practitioners Physician Services 00 1124419502 0 SALAMONE LINDSAY 2023188 9999999 B 10 1124419502 0 PO BOX 4912 WHEATON IL 601894912 20 1124419502 0 Speech Therapists Medical Supplies 20 1124419502 0 Speech Therapists Medical equipment/prosthetic devices 20 1124419502 0 Speech Therapists Speech Therapy/Pathology Services 00 1124421458 0 KON ALICIA A 2011342 9999999 B 10 1124421458 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1124421458 0 Other behavior health professional LCPC/LMFT services 00 1124423645 0 OLSEN THOMAS S 2017310 9999999 B 10 1124423645 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1124423645 0 Physical Therapists Medical Supplies 20 1124423645 0 Physical Therapists Medical equipment/prosthetic devices 20 1124423645 0 Physical Therapists Physical Therapy Services 00 1124424445 0 KALMAN HEIDI ERIN 2021300 9999999 B 10 1124424445 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1124424445 0 Clinical Social Worker Social work service 00 1124424882 0 WALTERS ELIZABETH A 2018004 9999999 B 10 1124424882 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1124424882 0 Physician Assistant Only Fluoride varnish 20 1124424882 0 Physician Assistant Only Healthy Kids Services 20 1124424882 0 Physician Assistant Only Physician Services 00 1124424932 0 SALIGAN RICA 2014322 9999999 B 10 1124424932 0 611 W PARK ST URBANA IL 618012529 20 1124424932 0 Nurse Practitioners Fluoride varnish 20 1124424932 0 Nurse Practitioners Healthy Kids Services 20 1124424932 0 Nurse Practitioners Nurse Practitioners Services 20 1124424932 0 Nurse Practitioners Physician Services 00 1124425681 0 SHERER ALYSSA 2024234 9999999 B 10 1124425681 0 1449 S MICHIGAN AVE STE 13006 CHICAGO IL 606052810 20 1124425681 0 Nurse Practitioners Healthy Kids Services 20 1124425681 0 Nurse Practitioners Nurse Practitioners Services 20 1124425681 0 Nurse Practitioners Physician Services 00 1124427497 0 FIELDS MARLENE ANN 1995244 9999999 B 10 1124427497 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1124427497 0 Occupational Therapists Medical Supplies 20 1124427497 0 Occupational Therapists Medical equipment/prosthetic devices 20 1124427497 0 Occupational Therapists Occupational Therapy Services 00 1124428222 0 SCOTT JILL 2018253 9999999 B 10 1124428222 0 4600 3RD ST MOLINE IL 612656106 20 1124428222 0 Nurse Practitioners Healthy Kids Services 20 1124428222 0 Nurse Practitioners Nurse Practitioners Services 20 1124428222 0 Nurse Practitioners Physician Services 00 1124428453 0 ZAHNISER ANN L 2022032 9999999 B 10 1124428453 0 1000 RED BALL TRL GREENVILLE IL 622462781 20 1124428453 0 Nurse Practitioners Fluoride varnish 20 1124428453 0 Nurse Practitioners Healthy Kids Services 20 1124428453 0 Nurse Practitioners Nurse Practitioners Services 20 1124428453 0 Nurse Practitioners Physician Services 00 1124428990 0 AUSTIN LATANIA 2022096 9999999 B 10 1124428990 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1124428990 0 Nurse Practitioners Anesthesia Services 20 1124428990 0 Nurse Practitioners Nurse Practitioners Services 20 1124428990 0 Nurse Practitioners Physician Services 00 1124429246 0 DAVIS BRITTNEY 2016015 9999999 B 10 1124429246 0 850 43RD AVE STE 100 MOLINE IL 612658401 20 1124429246 0 Physical Therapists Medical Supplies 20 1124429246 0 Physical Therapists Medical equipment/prosthetic devices 20 1124429246 0 Physical Therapists Physical Therapy Services 00 1124431895 0 MAALOUF MONICA 2017212 9999999 B 10 1124431895 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1124431895 0 Physicians Anesthesia Services 20 1124431895 0 Physicians Fluoride varnish 20 1124431895 0 Physicians Healthy Kids Services 20 1124431895 0 Physicians Optical Supplies 20 1124431895 0 Physicians Physician Services 00 1124432216 0 MALCOLM JOHN F 2023019 9999999 B 10 1124432216 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1124432216 0 Physicians Anesthesia Services 20 1124432216 0 Physicians Fluoride varnish 20 1124432216 0 Physicians Healthy Kids Services 20 1124432216 0 Physicians Optical Supplies 20 1124432216 0 Physicians Physician Services 00 1124432497 0 PETRUSIC ERIN M 2017009 9999999 B 10 1124432497 0 1140 N MILWAUKEE AVE CHICAGO IL 606424096 20 1124432497 0 Nurse Practitioners Healthy Kids Services 20 1124432497 0 Nurse Practitioners Nurse Practitioners Services 20 1124432497 0 Nurse Practitioners Physician Services 00 1124432737 0 KLEIN JORDAN 2023139 9999999 B 10 1124432737 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1124432737 0 Physicians Anesthesia Services 20 1124432737 0 Physicians Fluoride varnish 20 1124432737 0 Physicians Healthy Kids Services 20 1124432737 0 Physicians Optical Supplies 20 1124432737 0 Physicians Physician Services 00 1124432901 0 KORPICS JACQUELINE 2017108 9999999 B 10 1124432901 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1124432901 0 Physicians Anesthesia Services 20 1124432901 0 Physicians Family Planning Counseling 20 1124432901 0 Physicians Fluoride varnish 20 1124432901 0 Physicians Healthy Kids Services 20 1124432901 0 Physicians Optical Supplies 20 1124432901 0 Physicians Physician Services 00 1124433107 0 BRAMATI MICHAEL P 2022355 9999999 B 10 1124433107 0 PO BOX 43230 PHOENIX AZ 850803230 20 1124433107 0 Physicians Anesthesia Services 20 1124433107 0 Physicians Healthy Kids Services 20 1124433107 0 Physicians Optical Supplies 20 1124433107 0 Physicians Physician Services 00 1124433230 0 SOLIZ LUIS J 2018254 9999999 B 10 1124433230 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1124433230 0 Physicians Anesthesia Services 20 1124433230 0 Physicians Healthy Kids Services 20 1124433230 0 Physicians Optical Supplies 20 1124433230 0 Physicians Physician Services 00 1124434014 0 ROSS KATHRYN 2019315 9999999 B 10 1124434014 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1124434014 0 Physician Assistant Only Fluoride varnish 20 1124434014 0 Physician Assistant Only Healthy Kids Services 20 1124434014 0 Physician Assistant Only Physician Services 00 1124434048 0 MAXWELL LAURA 2014202 9999999 B 10 1124434048 0 11053 S MILLARD AVE CHICAGO IL 606553327 20 1124434048 0 Speech Therapists Medical Supplies 20 1124434048 0 Speech Therapists Medical equipment/prosthetic devices 20 1124434048 0 Speech Therapists Speech Therapy/Pathology Services 00 1124434436 0 SHAH NAMRATA 2014286 9999999 B 10 1124434436 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1124434436 0 Occupational Therapists Medical Supplies 20 1124434436 0 Occupational Therapists Medical equipment/prosthetic devices 20 1124434436 0 Occupational Therapists Occupational Therapy Services 00 1124434477 0 CHOI TAE HO 2022241 9999999 B 10 1124434477 0 29373 NETWORK PL CHICAGO IL 606733039 20 1124434477 0 Physicians Anesthesia Services 20 1124434477 0 Physicians Fluoride varnish 20 1124434477 0 Physicians Healthy Kids Services 20 1124434477 0 Physicians Optical Supplies 20 1124434477 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Dental Services 20 1124436472 0 Dentists Physician Services 00 1124438064 0 MAAMARI ROBI N 2018142 9999999 B 10 1124438064 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1124438064 0 Physicians Anesthesia Services 20 1124438064 0 Physicians Healthy Kids Services 20 1124438064 0 Physicians Optical Supplies 20 1124438064 0 Physicians Physician Services 00 1124438346 0 ALAM FARZANA 2019206 9999999 B 10 1124438346 0 1400 E IRVING PARK RD STREAMWOOD IL 601073201 20 1124438346 0 Physicians Anesthesia Services 20 1124438346 0 Physicians Healthy Kids Services 20 1124438346 0 Physicians Optical Supplies 20 1124438346 0 Physicians Physician Services 20 1124438346 0 Physicians Physicians Psychiatric Services 00 1124438411 0 FABIAN MADONNA 2017206 9999999 B 10 1124438411 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1124438411 0 Physicians Anesthesia Services 20 1124438411 0 Physicians Fluoride varnish 20 1124438411 0 Physicians Healthy Kids Services 20 1124438411 0 Physicians Optical Supplies 20 1124438411 0 Physicians Physician Services 00 1124438643 0 PATEL GAYATRI BHAKTI 2020126 9999999 B 10 1124438643 0 5777 DEPT CAROL STREAM IL 601220021 20 1124438643 0 Physicians Anesthesia Services 20 1124438643 0 Physicians Healthy Kids Services 20 1124438643 0 Physicians Optical Supplies 20 1124438643 0 Physicians Physician Services 00 1124439252 0 ROBERTSON NATHAN 2017182 9999999 B 10 1124439252 0 1400 US HIGHWAY 61 FESTUS MO 630284100 20 1124439252 0 Physicians Anesthesia Services 20 1124439252 0 Physicians Fluoride varnish 20 1124439252 0 Physicians Healthy Kids Services 20 1124439252 0 Physicians Optical Supplies 20 1124439252 0 Physicians Physician Services 00 1124439690 0 NAUMAN MEGAN 2014202 9999999 B 10 1124439690 0 3202 N WISCONSIN AVE PEORIA IL 616031260 20 1124439690 0 Speech Therapists Medical Supplies 20 1124439690 0 Speech Therapists Medical equipment/prosthetic devices 20 1124439690 0 Speech Therapists Speech Therapy/Pathology Services 00 1124439864 0 DENEGA TATIANA 2022353 9999999 B 10 1124439864 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1124439864 0 Physicians Anesthesia Services 20 1124439864 0 Physicians Healthy Kids Services 20 1124439864 0 Physicians Optical Supplies 20 1124439864 0 Physicians Physician Services 00 1124440102 0 KINDIG ALISA 2020299 9999999 B 10 1124440102 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1124440102 0 Nurse Practitioners Healthy Kids Services 20 1124440102 0 Nurse Practitioners Nurse Practitioners Services 20 1124440102 0 Nurse Practitioners Physician Services 00 1124441068 0 FERNANDEZ LIZABETH 2016295 9999999 B 10 1124441068 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1124441068 0 Clinical Social Worker Social work service 00 1124441753 0 MELAMED MATTHEW J 2018150 9999999 B 10 1124441753 0 2100 POWELL ST STE 400 EMERYVILLE CA 946081826 20 1124441753 0 Physicians Anesthesia Services 20 1124441753 0 Physicians Healthy Kids Services 20 1124441753 0 Physicians Optical Supplies 20 1124441753 0 Physicians Physician Services 00 1124443031 0 CHIRAYIL TANYA TREASA 2014286 9999999 B 10 1124443031 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1124443031 0 Nurse Practitioners Fluoride varnish 20 1124443031 0 Nurse Practitioners Healthy Kids Services 20 1124443031 0 Nurse Practitioners Nurse Practitioners Services 20 1124443031 0 Nurse Practitioners Physician Services 00 1124445077 0 CHEN LU 2022221 9999999 B 10 1124445077 0 5777 DEPT CAROL STREAM IL 601220021 20 1124445077 0 Physicians Anesthesia Services 20 1124445077 0 Physicians Healthy Kids Services 20 1124445077 0 Physicians Optical Supplies 20 1124445077 0 Physicians Physician Services 00 1124445689 0 JODRY DOMINIQUE J 2020183 9999999 B 10 1124445689 0 PO BOX 110429 AURORA CO 800420429 20 1124445689 0 Physicians Anesthesia Services 20 1124445689 0 Physicians Healthy Kids Services 20 1124445689 0 Physicians Optical Supplies 20 1124445689 0 Physicians Physician Services 00 1124445952 0 SODERSTROM DAWN 2014062 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Therapists Medical equipment/prosthetic devices 20 1124546601 0 Speech Therapists Speech Therapy/Pathology Services 00 1124546635 0 MAY AMANDA 2017248 9999999 B 10 1124546635 0 300 CEDAR ST PEKIN IL 615547009 20 1124546635 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1124546767 0 ALLISON VICKIE 2017184 9999999 B 10 1124546767 0 PO BOX 781076 DETROIT MI 482781076 20 1124546767 0 Nurse Practitioners Fluoride varnish 20 1124546767 0 Nurse Practitioners Healthy Kids Services 20 1124546767 0 Nurse Practitioners Nurse Practitioners Services 20 1124546767 0 Nurse Practitioners Physician Services 00 1124547450 0 KOSTECKI JULIANN 2017125 9999999 B 10 1124547450 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1124547450 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1124547567 0 DEWS ARIEL M 2020307 9999999 B 10 1124547567 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 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Practitioners Healthy Kids Services 20 1124559299 0 Nurse Practitioners Nurse Practitioners Services 20 1124559299 0 Nurse Practitioners Physician Services 00 1124559463 0 GRIGGS THEODOR FRANK 2017187 9999999 B 10 1124559463 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1124559463 0 Physicians Anesthesia Services 20 1124559463 0 Physicians Fluoride varnish 20 1124559463 0 Physicians Healthy Kids Services 20 1124559463 0 Physicians Optical Supplies 20 1124559463 0 Physicians Physician Services 00 1124559810 0 SAYGIN CANER 2020274 9999999 B 10 1124559810 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1124559810 0 Physicians Anesthesia Services 20 1124559810 0 Physicians Fluoride varnish 20 1124559810 0 Physicians Healthy Kids Services 20 1124559810 0 Physicians Optical Supplies 20 1124559810 0 Physicians Physician Services 00 1124560206 0 HANSEN VICKI 2016333 9999999 B 10 1124560206 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1124560206 0 Nurse Practitioners Fluoride varnish 20 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LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1124589619 0 Physicians Anesthesia Services 20 1124589619 0 Physicians Healthy Kids Services 20 1124589619 0 Physicians Optical Supplies 20 1124589619 0 Physicians Physician Services 00 1124589858 0 AKHIGBE CYNTHIA S 2020237 9999999 B 10 1124589858 0 29373 NETWORK PL CHICAGO IL 606733039 20 1124589858 0 Physicians Anesthesia Services 20 1124589858 0 Physicians Fluoride varnish 20 1124589858 0 Physicians Healthy Kids Services 20 1124589858 0 Physicians Optical Supplies 20 1124589858 0 Physicians Physician Services 00 1124589908 0 COOK ALEX E 2024155 9999999 B 10 1124589908 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1124589908 0 Physicians Anesthesia Services 20 1124589908 0 Physicians Healthy Kids Services 20 1124589908 0 Physicians Optical Supplies 20 1124589908 0 Physicians Physician Services 00 1124590153 0 ROBERTSON LEAH C 2018335 9999999 B 10 1124590153 0 805 E JOHNS AVE DECATUR IL 625212681 20 1124590153 0 Other behavior health 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Physician Services 00 1124602230 0 AHMED SYED 2021225 9999999 B 10 1124602230 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1124602230 0 Physicians Anesthesia Services 20 1124602230 0 Physicians Healthy Kids Services 20 1124602230 0 Physicians Optical Supplies 20 1124602230 0 Physicians Physician Services 20 1124602230 0 Physicians Physicians Psychiatric Services 00 1124602800 0 SUMMERISE JAZMIN O 2021173 9999999 B 10 1124602800 0 777 JOYCE RD JOLIET IL 604361876 20 1124602800 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1124603089 0 SHARP KATHERYNE J 2021099 9999999 B 10 1124603089 0 338 BROADWAY ST STE 301 CAPE GIRARDEAU MO 637017331 20 1124603089 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1124604061 0 WALLACE JACOB 2021223 9999999 B 10 1124604061 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1124604061 0 Physicians Anesthesia Services 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STREAM IL 601220021 20 1124606041 0 Physicians Anesthesia Services 20 1124606041 0 Physicians Fluoride varnish 20 1124606041 0 Physicians Healthy Kids Services 20 1124606041 0 Physicians Optical Supplies 20 1124606041 0 Physicians Physician Services 00 1124606132 0 STRZYZEWSKI LAUREN 2021141 9999999 B 10 1124606132 0 836 W WELLINGTON AVE CHICAGO IL 606575147 20 1124606132 0 Physicians Anesthesia Services 20 1124606132 0 Physicians Healthy Kids Services 20 1124606132 0 Physicians Optical Supplies 20 1124606132 0 Physicians Physician Services 00 1124606165 0 DODD ASHLEY 2021197 9999999 B 10 1124606165 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1124606165 0 Physicians Anesthesia Services 20 1124606165 0 Physicians Healthy Kids Services 20 1124606165 0 Physicians Optical Supplies 20 1124606165 0 Physicians Physician Services 00 1124606199 0 LEONG MICHELLE 2021222 9999999 B 10 1124606199 0 3249 OAK PARK AVE BERWYN IL 604023429 20 1124606199 0 Physicians Anesthesia Services 20 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Physicians Anesthesia Services 20 1124607049 0 Physicians Healthy Kids Services 20 1124607049 0 Physicians Optical Supplies 20 1124607049 0 Physicians Physician Services 00 1124607056 0 PATEL PRACHI 2021264 9999999 B 10 1124607056 0 200 OCEANGATE STE 100 LONG BEACH CA 908024317 20 1124607056 0 Nurse Practitioners Fluoride varnish 20 1124607056 0 Nurse Practitioners Healthy Kids Services 20 1124607056 0 Nurse Practitioners Nurse Practitioners Services 20 1124607056 0 Nurse Practitioners Physician Services 00 1124607320 0 ENRIQUEZ EMILY A 2021176 9999999 B 10 1124607320 0 29373 NETWORK PL CHICAGO IL 606733039 20 1124607320 0 Physicians Anesthesia Services 20 1124607320 0 Physicians Fluoride varnish 20 1124607320 0 Physicians Healthy Kids Services 20 1124607320 0 Physicians Optical Supplies 20 1124607320 0 Physicians Physician Services 00 1124607635 0 ALMONTE TAHLIANNA 2024249 9999999 B 10 1124607635 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1124607635 0 Physicians Anesthesia Services 20 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Physicians Physician Services 20 1124609094 0 Physicians Physicians Psychiatric Services 00 1124611256 0 LINDGREN SHERRI 2021078 9999999 B 10 1124611256 0 201 E MADISON ST STE 300 SPRINGFIELD IL 627025131 20 1124611256 0 Nurse Practitioners Healthy Kids Services 20 1124611256 0 Nurse Practitioners Nurse Practitioners Services 20 1124611256 0 Nurse Practitioners Physician Services 00 1124611686 0 HAUCK CARRIE A 2021090 9999999 B 10 1124611686 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1124611686 0 Nurse Practitioners Healthy Kids Services 20 1124611686 0 Nurse Practitioners Nurse Practitioners Services 20 1124611686 0 Nurse Practitioners Physician Services 00 1124612445 0 BEARD KELSEY M 2023228 9999999 B 10 1124612445 0 2041 GOOSE LAKE RD SAUGET IL 622062822 20 1124612445 0 Nurse Practitioners Fluoride varnish 20 1124612445 0 Nurse Practitioners Healthy Kids Services 20 1124612445 0 Nurse Practitioners Nurse Practitioners Services 20 1124612445 0 Nurse 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1124703954 0 Physicians Optical Supplies 20 1124703954 0 Physicians Physician Services 00 1124704366 0 MERANT-HILL NANCY 2023257 9999999 B 10 1124704366 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1124704366 0 Nurse Practitioners Fluoride varnish 20 1124704366 0 Nurse Practitioners Healthy Kids Services 20 1124704366 0 Nurse Practitioners Nurse Practitioners Services 20 1124704366 0 Nurse Practitioners Physician Services 00 1124704820 0 MULU FEVEN 2023193 9999999 B 10 1124704820 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1124704820 0 Physicians Anesthesia Services 20 1124704820 0 Physicians Healthy Kids Services 20 1124704820 0 Physicians Optical Supplies 20 1124704820 0 Physicians Physician Services 20 1124704820 0 Physicians Physicians Psychiatric Services 00 1124705116 0 MILLS-HOFFMAN ARTEMUS H 2023187 9999999 B 10 1124705116 0 201 E MADISON ST STE 300 SPRINGFIELD IL 627025131 20 1124705116 0 Physicians Anesthesia Services 20 1124705116 0 Physicians Fluoride varnish 20 1124705116 0 Physicians Healthy Kids Services 20 1124705116 0 Physicians Optical Supplies 20 1124705116 0 Physicians Physician Services 00 1124706122 0 SHARMA PRIYANKA 2024323 9999999 B 10 1124706122 0 210 N BOLINGBROOK DR BOLINGBROOK IL 604402386 20 1124706122 0 Dentists Dental Services 20 1124706122 0 Dentists Physician Services 00 1124706999 0 BHIMANI SANJANA 2023200 2026181 B 10 1124706999 0 611 W PARK ST URBANA IL 618012529 20 1124706999 0 Physicians Anesthesia Services 20 1124706999 0 Physicians Fluoride varnish 20 1124706999 0 Physicians Healthy Kids Services 20 1124706999 0 Physicians Optical Supplies 20 1124706999 0 Physicians Physician Services 00 1124707682 0 QADDORAH SEBA A 2023206 9999999 B 10 1124707682 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1124707682 0 Physicians Anesthesia Services 20 1124707682 0 Physicians Fluoride varnish 20 1124707682 0 Physicians Healthy Kids Services 20 1124707682 0 Physicians Optical Supplies 20 1124707682 0 Physicians Physician Services 00 1124708318 0 GADELTAYEB FATIMAH 2023206 9999999 B 10 1124708318 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1124708318 0 Physicians Anesthesia Services 20 1124708318 0 Physicians Fluoride varnish 20 1124708318 0 Physicians Healthy Kids Services 20 1124708318 0 Physicians Optical Supplies 20 1124708318 0 Physicians Physician Services 00 1124709183 0 MANZOOR SUBHAN 2023345 9999999 B 10 1124709183 0 8021 W 79TH ST JUSTICE IL 604581607 20 1124709183 0 Dentists Dental Services 20 1124709183 0 Dentists Physician Services 00 1124709258 0 EDENS SHELBI L 2024345 9999999 B 10 1124709258 0 4101 N RAVENSWOOD AVE CHICAGO IL 606132193 20 1124709258 0 Other behavior health professional LCPC/LMFT services 00 1124710082 0 BATARSEH TAMARA R 2023187 9999999 B 10 1124710082 0 5145 N CALIFORNIA AVE CHICAGO IL 606253661 20 1124710082 0 Physicians Anesthesia Services 20 1124710082 0 Physicians Fluoride varnish 20 1124710082 0 Physicians Healthy Kids Services 20 1124710082 0 Physicians Optical Supplies 20 1124710082 0 Physicians Physician Services 00 1124710405 0 GILLCRIST MICHAEL 2023158 9999999 B 10 1124710405 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1124710405 0 Physical Therapists Medical Supplies 20 1124710405 0 Physical Therapists Medical equipment/prosthetic devices 20 1124710405 0 Physical Therapists Physical Therapy Services 00 1124710520 0 KARASNEH GHADAH 2024289 9999999 B 10 1124710520 0 3560 S 4TH ST TERRE HAUTE IN 478025540 20 1124710520 0 Physician Assistant Only Fluoride varnish 20 1124710520 0 Physician Assistant Only Healthy Kids Services 20 1124710520 0 Physician Assistant Only Physician Services 00 1124711023 0 SINGH RAJANBIR 2023195 9999999 B 10 1124711023 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1124711023 0 Physicians Anesthesia Services 20 1124711023 0 Physicians Fluoride varnish 20 1124711023 0 Physicians Healthy Kids Services 20 1124711023 0 Physicians Optical Supplies 20 1124711023 0 Physicians Physician Services 00 1124711239 0 SMITH BRITTANY A 2023153 9999999 B 10 1124711239 0 18160 W GAGES LAKE RD GAGES LAKE IL 600301819 20 1124711239 0 Speech Therapists Medical Supplies 20 1124711239 0 Speech Therapists Medical equipment/prosthetic devices 20 1124711239 0 Speech Therapists Speech Therapy/Pathology Services 00 1124712336 0 GOC CHRISTOPHER E 2023198 9999999 B 10 1124712336 0 3012 W FULLERTON AVE CHICAGO IL 606472940 20 1124712336 0 Dentists Dental Services 20 1124712336 0 Dentists Physician Services 00 1124712468 0 WILLIAMS AMBER 2023334 9999999 B 10 1124712468 0 1951 NW 7TH AVE STE 300 MIAMI FL 331361112 20 1124712468 0 Other behavior health professional LCPC/LMFT services 00 1124712864 0 DANKHA CHRISTINE 2023171 9999999 B 10 1124712864 0 PO BOX 855795 MINNEAPOLIS MN 554851296 20 1124712864 0 Physicians Anesthesia Services 20 1124712864 0 Physicians Fluoride varnish 20 1124712864 0 Physicians Healthy Kids Services 20 1124712864 0 Physicians Optical Supplies 20 1124712864 0 Physicians Physician Services 00 1124712880 0 TYL EMILY 2024235 9999999 B 10 1124712880 0 71 W 156TH ST STE 305 HARVEY IL 604264264 20 1124712880 0 Nurse Practitioners Healthy Kids Services 20 1124712880 0 Nurse Practitioners Nurse Practitioners Services 20 1124712880 0 Nurse Practitioners Physician Services 00 1124713219 0 AGUWA CHIBUZO 2024173 9999999 B 10 1124713219 0 4698 DEPT CAROL STREAM IL 601220021 20 1124713219 0 Physicians Anesthesia Services 20 1124713219 0 Physicians Healthy Kids Services 20 1124713219 0 Physicians Optical Supplies 20 1124713219 0 Physicians Physician Services 00 1124713235 0 BDAIR ALA 2023177 9999999 B 10 1124713235 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1124713235 0 Physicians Anesthesia Services 20 1124713235 0 Physicians Fluoride varnish 20 1124713235 0 Physicians Healthy Kids Services 20 1124713235 0 Physicians Optical Supplies 20 1124713235 0 Physicians Physician Services 00 1124713342 0 SLUZINSKI STEPHANIE ELIZABETH 2024262 9999999 B 10 1124713342 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1124713342 0 Nurse Practitioners Healthy Kids Services 20 1124713342 0 Nurse Practitioners Nurse Practitioners Services 20 1124713342 0 Nurse Practitioners Physician Services 00 1124714639 0 DELACROIX BLAKE 2024214 9999999 B 10 1124714639 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1124714639 0 Physicians Anesthesia Services 20 1124714639 0 Physicians Healthy Kids Services 20 1124714639 0 Physicians Optical Supplies 20 1124714639 0 Physicians Physician Services 00 1124717772 0 GARNER IVORY 2023121 9999999 B 10 1124717772 0 42 W MADISON ST FL 2 CHICAGO IL 606024309 20 1124717772 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1124717962 0 SAMPSON EUGENE 2024207 9999999 B 10 1124717962 0 8 S MICHIGAN AVE FL 7 CHICAGO IL 606033357 20 1124717962 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1124718416 0 SUN MICHAEL J 2023186 9999999 B 10 1124718416 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1124718416 0 Physicians Anesthesia Services 20 1124718416 0 Physicians Fluoride varnish 20 1124718416 0 Physicians Healthy Kids Services 20 1124718416 0 Physicians Optical Supplies 20 1124718416 0 Physicians Physician Services 00 1124718960 0 WENKER JASMINE N 2023214 9999999 B 10 1124718960 0 370 SUMMIT ST # 1 ELGIN IL 601203843 20 1124718960 0 Physician Assistant Only Fluoride varnish 20 1124718960 0 Physician Assistant Only Healthy Kids Services 20 1124718960 0 Physician Assistant Only Physician Services 00 1124718994 0 ADKINS DENISE 2023181 9999999 B 10 1124718994 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1124718994 0 Speech Therapists Medical Supplies 20 1124718994 0 Speech Therapists Medical equipment/prosthetic devices 20 1124718994 0 Speech Therapists Speech Therapy/Pathology Services 00 1124719109 0 ABDULAMEER ZAHRAA 2023255 9999999 B 10 1124719109 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1124719109 0 Physicians Anesthesia Services 20 1124719109 0 Physicians Fluoride varnish 20 1124719109 0 Physicians Healthy Kids Services 20 1124719109 0 Physicians Optical Supplies 20 1124719109 0 Physicians Physician Services 00 1124719117 0 ABDIN ZAIN U 2023187 9999999 B 10 1124719117 0 190 E DELAWARE PL CHICAGO IL 606111813 20 1124719117 0 Physicians Anesthesia Services 20 1124719117 0 Physicians Fluoride varnish 20 1124719117 0 Physicians Healthy Kids Services 20 1124719117 0 Physicians Optical Supplies 20 1124719117 0 Physicians Physician Services 00 1124719463 0 TINDLE SARA MARIA 2023144 9999999 B 10 1124719463 0 10001 GRAND AVE ATTN: BILLING DEPARTMENT FRANKLIN PARK IL 601312563 20 1124719463 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1124720479 0 ARDOR GOKCE D 2023181 9999999 B 10 1124720479 0 4698 DEPT CAROL STREAM IL 601220021 20 1124720479 0 Physicians Anesthesia Services 20 1124720479 0 Physicians Healthy Kids Services 20 1124720479 0 Physicians Optical Supplies 20 1124720479 0 Physicians Physician Services 00 1124720859 0 KIM SUMIN 2023208 9999999 B 10 1124720859 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112386 20 1124720859 0 Dentists Dental Services 20 1124720859 0 Dentists Physician Services 00 1124721154 0 ALWAN SEEM 2023136 9999999 B 10 1124721154 0 PO BOX 3039 OAK BROOK IL 605223039 20 1124721154 0 Physicians Anesthesia Services 20 1124721154 0 Physicians Fluoride varnish 20 1124721154 0 Physicians Healthy Kids Services 20 1124721154 0 Physicians Optical Supplies 20 1124721154 0 Physicians Physician Services 00 1124722061 0 KREMER LEXI 2023199 9999999 B 10 1124722061 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1124722061 0 Physicians Anesthesia Services 20 1124722061 0 Physicians Fluoride varnish 20 1124722061 0 Physicians Healthy Kids Services 20 1124722061 0 Physicians Optical Supplies 20 1124722061 0 Physicians Physician Services 00 1124722855 0 PATEL HIREN 2023277 9999999 B 10 1124722855 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1124722855 0 Physicians Anesthesia Services 20 1124722855 0 Physicians Fluoride varnish 20 1124722855 0 Physicians Healthy Kids Services 20 1124722855 0 Physicians Optical Supplies 20 1124722855 0 Physicians Physician Services 00 1124723036 0 UCHE CHUKWUNONYELUM 2023227 2026181 B 10 1124723036 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1124723036 0 Physicians Anesthesia Services 20 1124723036 0 Physicians Fluoride varnish 20 1124723036 0 Physicians Healthy Kids Services 20 1124723036 0 Physicians Optical Supplies 20 1124723036 0 Physicians Physician Services 00 1124723374 0 HEARNS TODD 2023166 9999999 B 10 1124723374 0 PO BOX 3039 OAK BROOK IL 605223039 20 1124723374 0 Dentists Anesthesia Services 20 1124723374 0 Dentists Dental Services 20 1124723374 0 Dentists Physician Services 00 1124723622 0 LEUCK CONNOR 2023199 9999999 B 10 1124723622 0 5145 N CALIFORNIA AVE CHICAGO IL 606253661 20 1124723622 0 Physicians Anesthesia Services 20 1124723622 0 Physicians Healthy Kids Services 20 1124723622 0 Physicians Optical Supplies 20 1124723622 0 Physicians Physician Services 00 1124723994 0 SHAH MISHA 2023199 9999999 B 10 1124723994 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1124723994 0 Physicians Anesthesia Services 20 1124723994 0 Physicians Fluoride varnish 20 1124723994 0 Physicians Healthy Kids Services 20 1124723994 0 Physicians Optical Supplies 20 1124723994 0 Physicians Physician Services 00 1124724240 0 RODRIGUEZ CHRISTINE 2023227 9999999 B 10 1124724240 0 616 N NORTH CT STE 110 PALATINE IL 600678121 20 1124724240 0 Nurse Practitioners Healthy Kids Services 20 1124724240 0 Nurse Practitioners Nurse Practitioners Services 20 1124724240 0 Nurse Practitioners Physician Services 00 1124724471 0 MADERA LILLIAN 2023053 9999999 B 10 1124724471 0 3436 N KENNICOTT AVE STE 114 STE 114 ARLINGTON HEIGH IL 600047814 20 1124724471 0 Registered nurse Nursing service 20 1124724471 0 Registered nurse Waiver service 00 1124724760 0 TESSER MICHELLE D 2025021 9999999 B 10 1124724760 0 5665 NEW NORTHSIDE DR ATLANTA GA 303285831 20 1124724760 0 Nurse Practitioners Fluoride varnish 20 1124724760 0 Nurse Practitioners Healthy Kids Services 20 1124724760 0 Nurse Practitioners Nurse Practitioners Services 20 1124724760 0 Nurse Practitioners Physician Services 00 1124725676 0 ASZTALOS RILEY ASHLEY 2023117 9999999 B 10 1124725676 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1124725676 0 Nurse Practitioners Fluoride varnish 20 1124725676 0 Nurse Practitioners Healthy Kids Services 20 1124725676 0 Nurse Practitioners Nurse Practitioners Services 20 1124725676 0 Nurse Practitioners Physician Services 00 1124725791 0 VELASCO EUGENIA 2023045 9999999 B 10 1124725791 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1124725791 0 Physical Therapists Medical Supplies 20 1124725791 0 Physical Therapists Medical equipment/prosthetic devices 20 1124725791 0 Physical Therapists Physical Therapy Services 00 1124725965 0 HONSA CAMERON 2023044 9999999 B 10 1124725965 0 3436 N KENNICOTT AVE STE 114 STE 114 ARLINGTON HEIGH IL 600047814 20 1124725965 0 Occupational Therapists Medical Supplies 20 1124725965 0 Occupational Therapists Medical equipment/prosthetic devices 20 1124725965 0 Occupational Therapists Occupational Therapy Services 00 1124726195 0 CARROLL BROOKE K 2023237 9999999 B 10 1124726195 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1124726195 0 Physician Assistant Only Fluoride varnish 20 1124726195 0 Physician Assistant Only Healthy Kids Services 20 1124726195 0 Physician Assistant Only Physician Services 00 1124726559 0 BUNDOGJI NOUR K 2023215 9999999 B 10 1124726559 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1124726559 0 Physicians Anesthesia Services 20 1124726559 0 Physicians Healthy Kids Services 20 1124726559 0 Physicians Optical Supplies 20 1124726559 0 Physicians Physician Services 00 1124726740 0 HLAVIN KAILEY 2024341 9999999 B 10 1124726740 0 712 S MILWAUKEE AVE LIBERTYVILLE IL 600483279 20 1124726740 0 Physician Assistant Only Fluoride varnish 20 1124726740 0 Physician Assistant Only Healthy Kids Services 20 1124726740 0 Physician Assistant Only Physician Services 00 1124726765 0 WRIGHT DAWN M 2024059 9999999 B 10 1124726765 0 PO BOX 43230 PHOENIX AZ 850803230 20 1124726765 0 Nurse Practitioners Healthy Kids Services 20 1124726765 0 Nurse Practitioners Midwife Services 20 1124726765 0 Nurse Practitioners Nurse Practitioners Services 20 1124726765 0 Nurse Practitioners Physician Services 00 1124727011 0 EUBANKS TERESA BETH 2024296 9999999 B 10 1124727011 0 611 W PARK ST URBANA IL 618012529 20 1124727011 0 Other behavior health professional Social work service 00 1124727227 0 RUDOLPH LADWINA 2023240 9999999 B 10 1124727227 0 2259 W TAYLOR ST CHICAGO IL 606124233 20 1124727227 0 Psychologist Psychologist service 00 1124728050 0 JENKINS SARAH K 2023286 9999999 B 10 1124728050 0 PO BOX 1230 EVANSVILLE IN 477061230 20 1124728050 0 Nurse Practitioners Healthy Kids Services 20 1124728050 0 Nurse Practitioners Nurse Practitioners Services 20 1124728050 0 Nurse Practitioners Physician Services 00 1124733704 0 PRICE FONTELLA ELAINE 2023018 9999999 B 10 1124733704 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1124733704 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1124736897 0 MORRISON SARAH 2023182 9999999 B 10 1124736897 0 1160 E SAINT CLAIR ST VINCENNES IN 475914853 20 1124736897 0 Nurse Practitioners Fluoride varnish 20 1124736897 0 Nurse Practitioners Healthy Kids Services 20 1124736897 0 Nurse Practitioners Nurse Practitioners Services 20 1124736897 0 Nurse Practitioners Physician Services 00 1124737119 0 METCALF KELLY LYNN 2022353 9999999 B 10 1124737119 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1124737119 0 Nurse Practitioners Healthy Kids Services 20 1124737119 0 Nurse Practitioners Nurse Practitioners Services 20 1124737119 0 Nurse Practitioners Physician Services 00 1124737168 0 FISHER EMILY 2024331 9999999 B 10 1124737168 0 16001 108TH AVE ORLAND PARK IL 604678788 20 1124737168 0 Audiologists Audiology Services 20 1124737168 0 Audiologists Medical Supplies 20 1124737168 0 Audiologists Medical equipment/prosthetic devices 00 1124737325 0 MCCLOUGHAN JANE P 2024016 9999999 B 10 1124737325 0 28100 TORCH PKWY STE 600 WARRENVILLE IL 605554030 20 1124737325 0 Speech Therapists Medical Supplies 20 1124737325 0 Speech Therapists Medical equipment/prosthetic devices 20 1124737325 0 Speech Therapists Speech Therapy/Pathology Services 00 1124739008 0 ROACH ELIZABETH 2023253 9999999 B 10 1124739008 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1124739008 0 Physician Assistant Only Fluoride varnish 20 1124739008 0 Physician Assistant Only Healthy Kids Services 20 1124739008 0 Physician Assistant Only Physician Services 00 1124741814 0 TUTEN TAYLOR 2022311 9999999 B 10 1124741814 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1124741814 0 Physician Assistant Only Fluoride varnish 20 1124741814 0 Physician Assistant Only Healthy Kids Services 20 1124741814 0 Physician Assistant Only Physician Services 00 1124742903 0 VANDENBOOGAARD BROOKE 2024288 9999999 B 10 1124742903 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1124742903 0 Nurse Practitioners Fluoride varnish 20 1124742903 0 Nurse Practitioners Healthy Kids Services 20 1124742903 0 Nurse Practitioners Nurse Practitioners Services 20 1124742903 0 Nurse Practitioners Physician Services 00 1124743158 0 DIXON-JOHNSON JENNIFER 2024239 9999999 B 10 1124743158 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1124743158 0 Nurse Practitioners Healthy Kids Services 20 1124743158 0 Nurse Practitioners Nurse Practitioners Services 20 1124743158 0 Nurse Practitioners Physician Services 00 1124744974 0 NIZNIK SUZANNE 1997169 9999999 B 10 1124744974 0 50 S MAIN ST STE 200 NAPERVILLE IL 605405485 20 1124744974 0 Occupational Therapists Medical Supplies 20 1124744974 0 Occupational Therapists Medical equipment/prosthetic devices 20 1124744974 0 Occupational Therapists Occupational Therapy Services 00 1124746037 0 BOHAN EDWARD J 2022238 9999999 H 10 1124746037 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1124746037 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1124747456 0 KRAJCI CARLY 2022350 9999999 B 10 1124747456 0 29373 NETWORK PL CHICAGO IL 606733039 20 1124747456 0 Nurse Practitioners Healthy Kids Services 20 1124747456 0 Nurse Practitioners Nurse Practitioners Services 20 1124747456 0 Nurse Practitioners Physician Services 00 1124748009 0 GRESHAM MADELINE J 2022277 9999999 B 10 1124748009 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1124748009 0 Nurse Practitioners Healthy Kids Services 20 1124748009 0 Nurse Practitioners Nurse Practitioners Services 20 1124748009 0 Nurse Practitioners Physician Services 00 1124748405 0 CHRISTIDIS KENDALL D S 2022271 9999999 B 10 1124748405 0 74 ECLIPSE CTR BELOIT WI 535113550 20 1124748405 0 Nurse Practitioners Fluoride varnish 20 1124748405 0 Nurse Practitioners Healthy Kids Services 20 1124748405 0 Nurse Practitioners Nurse Practitioners Services 20 1124748405 0 Nurse Practitioners Physician Services 00 1124751094 0 ZIMMERMAN DANA 2022308 9999999 B 10 1124751094 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1124751094 0 Nurse Practitioners Fluoride varnish 20 1124751094 0 Nurse Practitioners Healthy Kids Services 20 1124751094 0 Nurse Practitioners Nurse Practitioners Services 20 1124751094 0 Nurse Practitioners Physician Services 00 1124751128 0 CICCOLARI MICALDI GRETA 2022215 9999999 B 10 1124751128 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1124751128 0 Physicians Anesthesia Services 20 1124751128 0 Physicians Fluoride varnish 20 1124751128 0 Physicians Healthy Kids Services 20 1124751128 0 Physicians Optical Supplies 20 1124751128 0 Physicians Physician Services 00 1124751797 0 HOPPMAN ALEXYS E 2024194 9999999 B 10 1124751797 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1124751797 0 Physician Assistant Only Fluoride varnish 20 1124751797 0 Physician Assistant Only Healthy Kids Services 20 1124751797 0 Physician Assistant Only Physician Services 00 1124751946 0 SMITH MELISSA 2022363 9999999 B 10 1124751946 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1124751946 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1124752092 0 MAREK LORI 2022276 9999999 B 10 1124752092 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1124752092 0 Nurse Practitioners Healthy Kids Services 20 1124752092 0 Nurse Practitioners Nurse Practitioners Services 20 1124752092 0 Nurse Practitioners Physician Services 00 1124752647 0 AZIM TAMANNA 2022285 9999999 B 10 1124752647 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112323 20 1124752647 0 Dentists Dental Services 20 1124752647 0 Dentists Physician Services 00 1124752779 0 CARROLL NATHAN 2022217 9999999 B 10 1124752779 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1124752779 0 Nurse Practitioners Anesthesia Services 20 1124752779 0 Nurse Practitioners Nurse Practitioners Services 20 1124752779 0 Nurse Practitioners Physician Services 00 1124752928 0 TAHIR NIMRA BINTE 2023260 9999999 B 10 1124752928 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1124752928 0 Physicians Anesthesia Services 20 1124752928 0 Physicians Healthy Kids Services 20 1124752928 0 Physicians Optical Supplies 20 1124752928 0 Physicians Physician Services 00 1124753876 0 SALAPATAS NIKOLAOS A 2022214 9999999 B 10 1124753876 0 5825 S KEDZIE AVE CHICAGO IL 606293212 20 1124753876 0 Dentists Dental Services 20 1124753876 0 Dentists Physician Services 00 1124754486 0 OBERNESSER KAYLA R 2023047 9999999 B 10 1124754486 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1124754486 0 Physician Assistant Only Fluoride varnish 20 1124754486 0 Physician Assistant Only Healthy Kids Services 20 1124754486 0 Physician Assistant Only Physician Services 00 1124756408 0 BADER RIZWAN 2023145 9999999 B 10 1124756408 0 5430 S KEDZIE AVE CHICAGO IL 606322620 20 1124756408 0 Dentists Dental Services 20 1124756408 0 Dentists Physician Services 00 1124757752 0 CRUZ JONATHAN 2022241 9999999 B 10 1124757752 0 2900 FOXFIELD RD STE 102 ST CHARLES IL 601745799 20 1124757752 0 Occupational Therapists Medical Supplies 20 1124757752 0 Occupational Therapists Medical equipment/prosthetic devices 20 1124757752 0 Occupational Therapists Occupational Therapy Services 00 1124758156 0 REVES-SOHN CASSIDY 2024311 9999999 B 10 1124758156 0 3701 W LUNT AVE LINCOLNWOOD IL 607122615 20 1124758156 0 Clinical Social Worker Social work service 00 1124758313 0 KRAS FELICITY 2023150 9999999 B 10 1124758313 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1124758313 0 Nurse Practitioners Healthy Kids Services 20 1124758313 0 Nurse Practitioners Nurse Practitioners Services 20 1124758313 0 Nurse Practitioners Physician Services 00 1124759063 0 MAHESH SHWETA 2022196 9999999 B 10 1124759063 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1124759063 0 Physicians Anesthesia Services 20 1124759063 0 Physicians Fluoride varnish 20 1124759063 0 Physicians Healthy Kids Services 20 1124759063 0 Physicians Optical Supplies 20 1124759063 0 Physicians Physician Services 00 1124759683 0 BAFTIROVSKI EMIL 2022215 9999999 B 10 1124759683 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1124759683 0 Physicians Anesthesia Services 20 1124759683 0 Physicians Healthy Kids Services 20 1124759683 0 Physicians Optical Supplies 20 1124759683 0 Physicians Physician Services 00 1124759998 0 GHOSH BINITA 2024149 9999999 B 10 1124759998 0 6420 CLAYTON RD SAINT LOUIS MO 631171811 20 1124759998 0 Physicians Anesthesia Services 20 1124759998 0 Physicians Fluoride varnish 20 1124759998 0 Physicians Healthy Kids Services 20 1124759998 0 Physicians Optical Supplies 20 1124759998 0 Physicians Physician Services 00 1124760244 0 MUKHTAROVA NARMIN 2022181 2025181 B 10 1124760244 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1124760244 0 Physicians Anesthesia Services 20 1124760244 0 Physicians Fluoride varnish 20 1124760244 0 Physicians Healthy Kids Services 20 1124760244 0 Physicians Optical Supplies 20 1124760244 0 Physicians Physician Services 00 1124761085 0 BROWN SABRINA S 2022157 9999999 B 10 1124761085 0 29373 NETWORK PL CHICAGO IL 606733039 20 1124761085 0 Nurse Practitioners Fluoride varnish 20 1124761085 0 Nurse Practitioners Healthy Kids Services 20 1124761085 0 Nurse Practitioners Nurse Practitioners Services 20 1124761085 0 Nurse Practitioners Physician Services 00 1124761283 0 BRADY CLAIRE H 2022210 9999999 B 10 1124761283 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1124761283 0 Physicians Anesthesia Services 20 1124761283 0 Physicians Fluoride varnish 20 1124761283 0 Physicians Healthy Kids Services 20 1124761283 0 Physicians Optical Supplies 20 1124761283 0 Physicians Physician Services 00 1124761614 0 BERG MADELINE 2022339 9999999 B 10 1124761614 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1124761614 0 Speech Therapists Medical Supplies 20 1124761614 0 Speech Therapists Medical equipment/prosthetic devices 20 1124761614 0 Speech Therapists Speech Therapy/Pathology Services 00 1124762489 0 DAVID LISA 2023165 9999999 B 10 1124762489 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1124762489 0 Physicians Anesthesia Services 20 1124762489 0 Physicians Healthy Kids Services 20 1124762489 0 Physicians Optical Supplies 20 1124762489 0 Physicians Physician Services 20 1124762489 0 Physicians Physicians Psychiatric Services 00 1124762687 0 MCGINNIS JAMES R 2022222 9999999 B 10 1124762687 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1124762687 0 Physicians Anesthesia Services 20 1124762687 0 Physicians Healthy Kids Services 20 1124762687 0 Physicians Optical Supplies 20 1124762687 0 Physicians Physician Services 00 1124764543 0 CHRISTENSEN KELSEY NICOLE 2022313 9999999 B 10 1124764543 0 5777 DEPT CAROL STREAM IL 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1134142615 0 HEILI MICHAEL 2021361 9999999 B 10 1134142615 0 3100 SUPERIOR AVE SHEBOYGAN WI 530811948 20 1134142615 0 Physicians Anesthesia Services 20 1134142615 0 Physicians Healthy Kids Services 20 1134142615 0 Physicians Optical Supplies 20 1134142615 0 Physicians Physician Services 00 1134142722 0 GRIFFIN JAMES H 1997188 9999999 B 10 1134142722 0 29373 NETWORK PL CHICAGO IL 606733039 20 1134142722 0 Physicians Anesthesia Services 20 1134142722 0 Physicians Healthy Kids Services 20 1134142722 0 Physicians Optical Supplies 20 1134142722 0 Physicians Physician Services 00 1134143555 0 MORTON DOUGLAS 2005283 9999999 B 10 1134143555 0 210 W WALNUT ST CANTON IL 615202444 20 1134143555 0 Physicians Anesthesia Services 20 1134143555 0 Physicians Healthy Kids Services 20 1134143555 0 Physicians Optical Supplies 20 1134143555 0 Physicians Physician Services 00 1134143852 0 HAGADORN SCOT E 2020342 9999999 B 10 1134143852 0 PO BOX 781076 DETROIT MI 482781076 20 1134143852 0 Physicians 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PETERSON AVE CHICAGO IL 606593505 20 1134348584 0 Dentists Dental Services 20 1134348584 0 Dentists Physician Services 00 1134348824 0 SCHAEFFER STEVEN 2005353 9999999 B 10 1134348824 0 PO BOX 548 INDIANAPOLIS IN 462060548 20 1134348824 0 Nurse Practitioners Anesthesia Services 20 1134348824 0 Nurse Practitioners Nurse Practitioners Services 20 1134348824 0 Nurse Practitioners Physician Services 00 1134350366 0 BERNHARDT NICOLETTE M 2017027 9999999 B 10 1134350366 0 5777 DEPT CAROL STREAM IL 601228942 20 1134350366 0 Psychologist Psychologist service 00 1134350820 0 PLATT PAMELA 2024338 9999999 B 10 1134350820 0 412 W 31ST ST CHICAGO IL 606163116 20 1134350820 0 Physical Therapists Medical Supplies 20 1134350820 0 Physical Therapists Medical equipment/prosthetic devices 20 1134350820 0 Physical Therapists Physical Therapy Services 00 1134350846 0 MESSINGER GILLIAN B 2017205 9999999 B 10 1134350846 0 22440 N PRAIRIE LN KILDEER IL 600479764 20 1134350846 0 Psychologist Psychologist 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1134415516 0 Physicians Physician Services 00 1134415565 0 DAVIS MAURICE A 2016259 9999999 B 10 1134415565 0 3407 MOMENTUM PL CHICAGO IL 606890001 20 1134415565 0 Physicians Anesthesia Services 20 1134415565 0 Physicians Healthy Kids Services 20 1134415565 0 Physicians Optical Supplies 20 1134415565 0 Physicians Physician Services 00 1134415805 0 LI PULSAR 2016223 9999999 B 10 1134415805 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1134415805 0 Physicians Anesthesia Services 20 1134415805 0 Physicians Healthy Kids Services 20 1134415805 0 Physicians Optical Supplies 20 1134415805 0 Physicians Physician Services 00 1134415821 0 MUELLER JASON BENJAMIN 2017174 9999999 B 10 1134415821 0 1970 E 53RD ST DAVENPORT IA 528072710 20 1134415821 0 Physicians Anesthesia Services 20 1134415821 0 Physicians Healthy Kids Services 20 1134415821 0 Physicians Optical Supplies 20 1134415821 0 Physicians Physician Services 00 1134415979 0 SEREMBYTSKY IRYNA 2014245 9999999 B 10 1134415979 0 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ASSOCIATES DR DUBUQUE IA 520022201 20 1134417330 0 Speech Therapists Medical Supplies 20 1134417330 0 Speech Therapists Medical equipment/prosthetic devices 20 1134417330 0 Speech Therapists Speech Therapy/Pathology Services 00 1134418130 0 BESZKA MONICA 2015182 9999999 B 10 1134418130 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1134418130 0 Physicians Anesthesia Services 20 1134418130 0 Physicians Healthy Kids Services 20 1134418130 0 Physicians Optical Supplies 20 1134418130 0 Physicians Physician Services 00 1134418221 0 EINHORN LISA M 2023023 9999999 B 10 1134418221 0 5213 S ALSTON AVE DURHAM NC 277134430 20 1134418221 0 Physicians Anesthesia Services 20 1134418221 0 Physicians Healthy Kids Services 20 1134418221 0 Physicians Optical Supplies 20 1134418221 0 Physicians Physician Services 00 1134418486 0 LOCHEN MATTHEW 2021159 9999999 B 10 1134418486 0 PO BOX 88276 MILWAUKEE WI 532888276 20 1134418486 0 Physicians Anesthesia Services 20 1134418486 0 Physicians Healthy Kids 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Physician Services 00 1134422058 0 BARNES STACY C 2011019 9999999 B 10 1134422058 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1134422058 0 Nurse Practitioners Anesthesia Services 20 1134422058 0 Nurse Practitioners Nurse Practitioners Services 20 1134422058 0 Nurse Practitioners Physician Services 00 1134422652 0 CHARLES MARIAH K 2012181 9999999 B 10 1134422652 0 705 S GRAND ST NASHVILLE IL 622631534 20 1134422652 0 Nurse Practitioners Fluoride varnish 20 1134422652 0 Nurse Practitioners Healthy Kids Services 20 1134422652 0 Nurse Practitioners Nurse Practitioners Services 20 1134422652 0 Nurse Practitioners Physician Services 00 1134423742 0 ALLEN DOUGLAS L 2011090 9999999 H 10 1134423742 0 226 W ONTARIO ST STE 400C CHICAGO IL 606543619 20 1134423742 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1134425085 0 BOSHRA NASSER A 2013182 9999999 B 10 1134425085 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1134425085 0 Physicians Anesthesia Services 20 1134425085 0 Physicians Fluoride varnish 20 1134425085 0 Physicians Healthy Kids Services 20 1134425085 0 Physicians Optical Supplies 20 1134425085 0 Physicians Physician Services 00 1134428451 0 ZHORNE DEREK J 2014182 9999999 B 10 1134428451 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1134428451 0 Physicians Anesthesia Services 20 1134428451 0 Physicians Fluoride varnish 20 1134428451 0 Physicians Healthy Kids Services 20 1134428451 0 Physicians Optical Supplies 20 1134428451 0 Physicians Physician Services 00 1134428683 0 BRETZ KAREN 2012174 9999999 B 10 1134428683 0 29373 NETWORK PL CHICAGO IL 606733039 20 1134428683 0 Nurse Practitioners Fluoride varnish 20 1134428683 0 Nurse Practitioners Healthy Kids Services 20 1134428683 0 Nurse Practitioners Nurse Practitioners Services 20 1134428683 0 Nurse Practitioners Physician Services 00 1134428758 0 PET MITCHELL A 2018128 9999999 B 10 1134428758 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 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varnish 20 1134562150 0 Physicians Healthy Kids Services 20 1134562150 0 Physicians Optical Supplies 20 1134562150 0 Physicians Physician Services 00 1134562408 0 BRIGHT STEVEN B 2022234 9999999 B 10 1134562408 0 500 ELDORADO BLVD STE 6250 BROOMFIELD CO 800213421 20 1134562408 0 Physicians Anesthesia Services 20 1134562408 0 Physicians Healthy Kids Services 20 1134562408 0 Physicians Optical Supplies 20 1134562408 0 Physicians Physician Services 00 1134562424 0 FLORES KELLY L 2013105 9999999 B 10 1134562424 0 611 W PARK ST URBANA IL 618012529 20 1134562424 0 Nurse Practitioners Anesthesia Services 20 1134562424 0 Nurse Practitioners Nurse Practitioners Services 20 1134562424 0 Nurse Practitioners Physician Services 00 1134562614 0 MANTELL BENJAMIN 2024324 9999999 B 10 1134562614 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1134562614 0 Physicians Anesthesia Services 20 1134562614 0 Physicians Fluoride varnish 20 1134562614 0 Physicians Healthy Kids Services 20 1134562614 0 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1134567084 0 15740 S OUTER 40 RD CHESTERFIELD MO 630172004 20 1134567084 0 Physicians Anesthesia Services 20 1134567084 0 Physicians Healthy Kids Services 20 1134567084 0 Physicians Optical Supplies 20 1134567084 0 Physicians Physician Services 00 1134567134 0 CHAU VINH Q 2020245 9999999 B 10 1134567134 0 PO BOX 775231 CHICAGO IL 606775231 20 1134567134 0 Physicians Anesthesia Services 20 1134567134 0 Physicians Fluoride varnish 20 1134567134 0 Physicians Healthy Kids Services 20 1134567134 0 Physicians Optical Supplies 20 1134567134 0 Physicians Physician Services 00 1134567225 0 PAK ANGELA 2014001 9999999 B 10 1134567225 0 329 W 18TH ST STE 311 CHICAGO IL 606165132 20 1134567225 0 Optometrists Optical Supplies 20 1134567225 0 Optometrists Optometric Services 20 1134567225 0 Optometrists Physician Services 00 1134567415 0 WILSON BRYAN 2020221 9999999 B 10 1134567415 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1134567415 0 Physicians Anesthesia Services 20 1134567415 0 Physicians Healthy Kids Services 20 1134567415 0 Physicians Optical Supplies 20 1134567415 0 Physicians Physician Services 00 1134567498 0 HAUGSDAL JACLYN M 2018182 9999999 B 10 1134567498 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1134567498 0 Physicians Anesthesia Services 20 1134567498 0 Physicians Healthy Kids Services 20 1134567498 0 Physicians Optical Supplies 20 1134567498 0 Physicians Physician Services 00 1134570401 0 RODGERS EMILY 2018007 9999999 B 10 1134570401 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1134570401 0 Physicians Anesthesia Services 20 1134570401 0 Physicians Healthy Kids Services 20 1134570401 0 Physicians Optical Supplies 20 1134570401 0 Physicians Physician Services 20 1134570401 0 Physicians Physicians Psychiatric Services 00 1134571037 0 NASH MARYELLEN 2016242 9999999 B 10 1134571037 0 671 S LEWIS AVE WAUKEGAN IL 600856101 20 1134571037 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1134571136 0 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43230 PHOENIX AZ 850803230 20 1134575988 0 Physicians Anesthesia Services 20 1134575988 0 Physicians Healthy Kids Services 20 1134575988 0 Physicians Optical Supplies 20 1134575988 0 Physicians Physician Services 00 1134576358 0 KARMIN ALISON JANE 2017041 9999999 B 10 1134576358 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1134576358 0 Physician Assistant Only Fluoride varnish 20 1134576358 0 Physician Assistant Only Healthy Kids Services 20 1134576358 0 Physician Assistant Only Physician Services 00 1134576523 0 THOMPSON NICOLE 2017094 9999999 H 10 1134576523 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1134576523 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1134576531 0 WARD NAJIM 2019152 9999999 B 10 1134576531 0 PO BOX 8742 FORT WORTH TX 761240742 20 1134576531 0 Physicians Anesthesia Services 20 1134576531 0 Physicians Healthy Kids Services 20 1134576531 0 Physicians Optical Supplies 20 1134576531 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MIHELCIC JOHN A 2020195 9999999 B 10 1134582521 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1134582521 0 Physicians Anesthesia Services 20 1134582521 0 Physicians Fluoride varnish 20 1134582521 0 Physicians Healthy Kids Services 20 1134582521 0 Physicians Optical Supplies 20 1134582521 0 Physicians Physician Services 00 1134583750 0 TSAI OWENS MICHELE S 2024024 9999999 B 10 1134583750 0 PO BOX 778912 CHICAGO IL 606778912 20 1134583750 0 Psychologist Psychologist service 00 1134583925 0 BALL LEIGH R 2019303 9999999 B 10 1134583925 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1134583925 0 Physicians Anesthesia Services 20 1134583925 0 Physicians Fluoride varnish 20 1134583925 0 Physicians Healthy Kids Services 20 1134583925 0 Physicians Optical Supplies 20 1134583925 0 Physicians Physician Services 20 1134583925 0 Physicians Physicians Psychiatric Services 00 1134584568 0 LEE KRISTEN A 2020239 9999999 B 10 1134584568 0 4698 DEPT CAROL STREAM IL 601220021 20 1134584568 0 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Optometrists Physician Services 00 1134676109 0 WANKI JOSEPHINE 2016244 9999999 B 10 1134676109 0 4950 MADISON ST UNIT 1391 SKOKIE IL 600767637 20 1134676109 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1134676109 0 Other behavior health professional Social work service 00 1134677651 0 SMITH ROGER S 2024176 9999999 B 10 1134677651 0 4698 DEPT CAROL STREAM IL 601220021 20 1134677651 0 Physicians Anesthesia Services 20 1134677651 0 Physicians Fluoride varnish 20 1134677651 0 Physicians Healthy Kids Services 20 1134677651 0 Physicians Optical Supplies 20 1134677651 0 Physicians Physician Services 00 1134677842 0 PEREZ MICHELE B 2020268 9999999 B 10 1134677842 0 205 W RANDOLPH ST STE 2222 CHICAGO IL 606061814 20 1134677842 0 Nurse Practitioners Fluoride varnish 20 1134677842 0 Nurse Practitioners Healthy Kids Services 20 1134677842 0 Nurse Practitioners Nurse Practitioners Services 20 1134677842 0 Nurse Practitioners 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Healthy Kids Services 20 1134843659 0 Nurse Practitioners Nurse Practitioners Services 20 1134843659 0 Nurse Practitioners Physician Services 00 1134843782 0 ALSHEIKH SHADA 2023160 9999999 B 10 1134843782 0 17008 CREIGHTON DR LOCKPORT IL 604411325 20 1134843782 0 Speech Therapists Medical Supplies 20 1134843782 0 Speech Therapists Medical equipment/prosthetic devices 20 1134843782 0 Speech Therapists Speech Therapy/Pathology Services 00 1134845803 0 STRYJEWSKI DEBORAH 2022297 9999999 B 10 1134845803 0 1500 S SANGAMON ST CRETE IL 604172831 20 1134845803 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1134846090 0 MURPHY GWEN 2022306 9999999 B 10 1134846090 0 1400 W GREENLEAF AVE CHICAGO IL 606262805 20 1134846090 0 Clinical Social Worker Social work service 00 1134846124 0 OTUWA CHRISTIANA 2023131 9999999 B 10 1134846124 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1134846124 0 Nurse Practitioners Healthy Kids 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Services 00 1134873672 0 NIEDERGERKE TAYLOR 2022217 9999999 B 10 1134873672 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1134873672 0 Nurse Practitioners Anesthesia Services 20 1134873672 0 Nurse Practitioners Nurse Practitioners Services 20 1134873672 0 Nurse Practitioners Physician Services 00 1134875057 0 LOPEZ LICIA A 2023123 9999999 B 10 1134875057 0 PO BOX 3039 OAK BROOK IL 605223039 20 1134875057 0 Physicians Anesthesia Services 20 1134875057 0 Physicians Fluoride varnish 20 1134875057 0 Physicians Healthy Kids Services 20 1134875057 0 Physicians Optical Supplies 20 1134875057 0 Physicians Physician Services 00 1134875081 0 CALIENDO MARINA M 2022212 9999999 B 10 1134875081 0 6024 RIDGE AVE STE 116-356 PHILADELPHIA PA 191281601 20 1134875081 0 Physician Assistant Only Fluoride varnish 20 1134875081 0 Physician Assistant Only Healthy Kids Services 20 1134875081 0 Physician Assistant Only Physician Services 00 1134876097 0 AWAN NABEEL 2023335 9999999 B 10 1134876097 0 2250 N ILLINOIS AVE CARBONDALE IL 629015612 20 1134876097 0 Nurse Practitioners Fluoride varnish 20 1134876097 0 Nurse Practitioners Healthy Kids Services 20 1134876097 0 Nurse Practitioners Nurse Practitioners Services 20 1134876097 0 Nurse Practitioners Physician Services 00 1134876733 0 KUHNERT CHELSEA M 2022063 9999999 B 10 1134876733 0 5383 STATE ROUTE 154 PINCKNEYVILLE IL 622743342 20 1134876733 0 Nurse Practitioners Fluoride varnish 20 1134876733 0 Nurse Practitioners Healthy Kids Services 20 1134876733 0 Nurse Practitioners Nurse Practitioners Services 20 1134876733 0 Nurse Practitioners Physician Services 00 1134876956 0 DONALDSON STILES T 2023151 9999999 B 10 1134876956 0 4698 DEPT CAROL STREAM IL 601220021 20 1134876956 0 Physicians Anesthesia Services 20 1134876956 0 Physicians Healthy Kids Services 20 1134876956 0 Physicians Optical Supplies 20 1134876956 0 Physicians Physician Services 00 1134877939 0 THOMPSON DEANDRA 2022215 9999999 B 10 1134877939 0 303 NW 11TH ST FAIRFIELD IL 628371203 20 1134877939 0 Physician Assistant Only Fluoride varnish 20 1134877939 0 Physician Assistant Only Healthy Kids Services 20 1134877939 0 Physician Assistant Only Physician Services 00 1134878051 0 AKINYEMI PIPELAYO GRACE 2022273 9999999 B 10 1134878051 0 331 W SURF ST STE 708 CHICAGO IL 606577227 20 1134878051 0 Nurse Practitioners Healthy Kids Services 20 1134878051 0 Nurse Practitioners Nurse Practitioners Services 20 1134878051 0 Nurse Practitioners Physician Services 00 1134878424 0 THEDINGER WILLIAM BARRETT 2022237 9999999 B 10 1134878424 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1134878424 0 Physicians Anesthesia Services 20 1134878424 0 Physicians Healthy Kids Services 20 1134878424 0 Physicians Optical Supplies 20 1134878424 0 Physicians Physician Services 00 1134879349 0 FAYNGOR ROCHELLE A 2022187 9999999 B 10 1134879349 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1134879349 0 Physicians Anesthesia Services 20 1134879349 0 Physicians Fluoride varnish 20 1134879349 0 Physicians Healthy Kids Services 20 1134879349 0 Physicians Optical Supplies 20 1134879349 0 Physicians Physician Services 00 1134879430 0 KAZI BASIL 2022256 9999999 B 10 1134879430 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1134879430 0 Physicians Anesthesia Services 20 1134879430 0 Physicians Fluoride varnish 20 1134879430 0 Physicians Healthy Kids Services 20 1134879430 0 Physicians Optical Supplies 20 1134879430 0 Physicians Physician Services 00 1134879729 0 OSMUNDSON PEYTON M 2022176 9999999 B 10 1134879729 0 PO BOX 3039 OAK BROOK IL 605223039 20 1134879729 0 Physicians Anesthesia Services 20 1134879729 0 Physicians Fluoride varnish 20 1134879729 0 Physicians Healthy Kids Services 20 1134879729 0 Physicians Optical Supplies 20 1134879729 0 Physicians Physician Services 00 1134879760 0 ROGOZINSKI THADDEUS 2022146 9999999 B 10 1134879760 0 PO BOX 3039 OAK BROOK IL 605223039 20 1134879760 0 Physicians Anesthesia Services 20 1134879760 0 Physicians Healthy Kids Services 20 1134879760 0 Physicians Optical Supplies 20 1134879760 0 Physicians Physician Services 00 1134879851 0 REESE JAMES DANIEL 2022251 9999999 B 10 1134879851 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1134879851 0 Physicians Anesthesia Services 20 1134879851 0 Physicians Healthy Kids Services 20 1134879851 0 Physicians Optical Supplies 20 1134879851 0 Physicians Physician Services 00 1134883101 0 HACKNEY CHASADE 2022277 9999999 B 10 1134883101 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1134883101 0 Nurse Practitioners Fluoride varnish 20 1134883101 0 Nurse Practitioners Healthy Kids Services 20 1134883101 0 Nurse Practitioners Nurse Practitioners Services 20 1134883101 0 Nurse Practitioners Physician Services 00 1134883622 0 CALDWELL MELISSA 2022010 9999999 B 10 1134883622 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1134883622 0 Nurse Practitioners Fluoride varnish 20 1134883622 0 Nurse Practitioners Healthy Kids Services 20 1134883622 0 Nurse Practitioners Nurse Practitioners Services 20 1134883622 0 Nurse Practitioners Physician Services 00 1134883788 0 FOX-HALL KATHERINE M 2023131 9999999 B 10 1134883788 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1134883788 0 Physician Assistant Only Fluoride varnish 20 1134883788 0 Physician Assistant Only Healthy Kids Services 20 1134883788 0 Physician Assistant Only Physician Services 00 1134885726 0 OUTTEN RACHEL 2021335 9999999 B 10 1134885726 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1134885726 0 Physical Therapists Medical Supplies 20 1134885726 0 Physical Therapists Medical equipment/prosthetic devices 20 1134885726 0 Physical Therapists Physical Therapy Services 00 1134886393 0 SAMANSKY MICHELLE 2021334 9999999 B 10 1134886393 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1134886393 0 Occupational Therapists Medical Supplies 20 1134886393 0 Occupational Therapists Medical equipment/prosthetic devices 20 1134886393 0 Occupational Therapists Occupational Therapy Services 00 1134886864 0 ESPINOSA-RAVI ILIANA 2021334 9999999 B 10 1134886864 0 7702 SOLUTION CENTER CHICAGO IL 606777007 20 1134886864 0 Clinical Social Worker Social work service 00 1134887623 0 OMOLABI RUKAYAT 2022047 9999999 B 10 1134887623 0 777 JOYCE RD JOLIET IL 604361876 20 1134887623 0 Nurse Practitioners Healthy Kids Services 20 1134887623 0 Nurse Practitioners Nurse Practitioners Services 20 1134887623 0 Nurse Practitioners Nursing service 20 1134887623 0 Nurse Practitioners Physician Services 20 1134887623 0 Nurse Practitioners Waiver service 00 1134888597 0 STORY GRANT R 2021362 9999999 B 10 1134888597 0 1160 E SAINT CLAIR ST VINCENNES IN 475914853 20 1134888597 0 Physician Assistant Only Fluoride varnish 20 1134888597 0 Physician Assistant Only Healthy Kids Services 20 1134888597 0 Physician Assistant Only Physician Services 00 1134889132 0 CHAKKUMCAL CHRISTEENA 2022053 9999999 B 10 1134889132 0 PO BOX 17632 BELFAST ME 049154071 20 1134889132 0 Nurse Practitioners Healthy Kids Services 20 1134889132 0 Nurse Practitioners Nurse Practitioners Services 20 1134889132 0 Nurse Practitioners Physician Services 00 1134890171 0 NERIE WILFREDO V 2024002 9999999 B 10 1134890171 0 28100 TORCH PKWY STE 600 WARRENVILLE IL 605554030 20 1134890171 0 Physical Therapists Medical Supplies 20 1134890171 0 Physical Therapists Medical equipment/prosthetic devices 20 1134890171 0 Physical Therapists Physical Therapy Services 00 1134890197 0 HAMMERLY JENNA M 2022111 9999999 B 10 1134890197 0 631 N LONGWOOD ST STE 103 ROCKFORD IL 611074263 20 1134890197 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1134891435 0 WALTON ASIA R 2023235 9999999 B 10 1134891435 0 6843 S CHAPPEL AVE CHICAGO IL 606491606 20 1134891435 0 Occupational Therapists Medical Supplies 20 1134891435 0 Occupational Therapists Medical equipment/prosthetic devices 20 1134891435 0 Occupational Therapists Occupational Therapy Services 00 1134891500 0 STOMPANATO KRISTEN 2023026 9999999 B 10 1134891500 0 929 W HIGGINS RD SCHAUMBURG IL 601953203 20 1134891500 0 Nurse Practitioners Fluoride varnish 20 1134891500 0 Nurse Practitioners Healthy Kids Services 20 1134891500 0 Nurse Practitioners Nurse Practitioners Services 20 1134891500 0 Nurse Practitioners Physician Services 00 1134894017 0 WILLARD LISA 2021232 9999999 B 10 1134894017 0 1120 N MELVIN ST GIBSON CITY IL 609361477 20 1134894017 0 Physical Therapists Medical Supplies 20 1134894017 0 Physical Therapists Medical equipment/prosthetic devices 20 1134894017 0 Physical Therapists Physical Therapy Services 00 1134894025 0 STATZ BRANDEN 2021322 9999999 B 10 1134894025 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1134894025 0 Physician Assistant Only Fluoride varnish 20 1134894025 0 Physician Assistant Only Healthy Kids Services 20 1134894025 0 Physician Assistant Only Physician Services 00 1134895188 0 SCHUMACHER SHELLE 2023095 9999999 B 10 1134895188 0 124 SW ADAMS ST FL 2 PEORIA IL 616021308 20 1134895188 0 Physician Assistant Only Fluoride varnish 20 1134895188 0 Physician Assistant Only Healthy Kids Services 20 1134895188 0 Physician Assistant Only Physician Services 00 1134895196 0 EHRLICH EWA Z 2021309 9999999 B 10 1134895196 0 2875 W 19TH ST CHICAGO IL 606233501 20 1134895196 0 Nurse Practitioners Healthy Kids Services 20 1134895196 0 Nurse Practitioners Nurse Practitioners Services 20 1134895196 0 Nurse Practitioners Physician Services 00 1134895675 0 BOLLES RUBI 2021238 9999999 B 10 1134895675 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1134895675 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1134895675 0 Other behavior health professional Social work service 00 1134895758 0 BHANDARI MENAL 2022202 9999999 B 10 1134895758 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1134895758 0 Physicians Anesthesia Services 20 1134895758 0 Physicians Healthy Kids Services 20 1134895758 0 Physicians Optical Supplies 20 1134895758 0 Physicians Physician Services 00 1134896558 0 TRAINO GILLIAN 2024192 9999999 B 10 1134896558 0 317 SALEM PL FAIRVIEW HEIGHT IL 622081367 20 1134896558 0 Physician Assistant Only Fluoride varnish 20 1134896558 0 Physician Assistant Only Healthy Kids Services 20 1134896558 0 Physician Assistant Only Physician Services 00 1134898778 0 NEIL AMBER SIMONE 2023234 9999999 B 10 1134898778 0 PO BOX 790126 SAINT LOUIS MO 631790126 20 1134898778 0 Nurse Practitioners Anesthesia Services 20 1134898778 0 Nurse Practitioners Nurse Practitioners Services 20 1134898778 0 Nurse Practitioners Physician Services 00 1134899818 0 NGUYEN AN THUY HONG 2021307 9999999 B 10 1134899818 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1134899818 0 Physician Assistant Only Fluoride varnish 20 1134899818 0 Physician Assistant Only Healthy Kids Services 20 1134899818 0 Physician Assistant Only Physician Services 00 1134900400 0 BORDWELL AMY RENEE 2025009 9999999 B 10 1134900400 0 935 175TH ST STE 307 HOMEWOOD IL 604302073 20 1134900400 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1134902968 0 BELER BRITTANY 2024269 9999999 B 10 1134902968 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1134902968 0 Nurse Practitioners Fluoride varnish 20 1134902968 0 Nurse Practitioners Healthy Kids Services 20 1134902968 0 Nurse Practitioners Nurse Practitioners Services 20 1134902968 0 Nurse Practitioners Physician Services 00 1134903537 0 SCHWARTZMAN ELIANA 2024157 9999999 B 10 1134903537 0 111 W JACKSON BLVD CHICAGO IL 606043589 20 1134903537 0 Clinical Social Worker Social work service 00 1134903990 0 LEVY RAVEN 2023272 9999999 B 10 1134903990 0 PO BOX 734352 CHICAGO IL 606734352 20 1134903990 0 Nurse Practitioners Fluoride varnish 20 1134903990 0 Nurse Practitioners Healthy Kids Services 20 1134903990 0 Nurse Practitioners Nurse Practitioners Services 20 1134903990 0 Nurse Practitioners Physician Services 00 1134904147 0 DOW ANTHONY 2023270 9999999 B 10 1134904147 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1134904147 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1134904428 0 DEAN ATALISSA J 2023257 9999999 B 10 1134904428 0 414 PLAZA DR STE 301 WESTMONT IL 605595508 20 1134904428 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1134906464 0 SOLIMAN MONIKA 2023256 9999999 B 10 1134906464 0 800 KIRTS BLVD STE 650 TROY MI 480844878 20 1134906464 0 Dentists Dental Services 20 1134906464 0 Dentists Physician Services 00 1134908429 0 DHAN VINCENT 2024110 9999999 B 10 1134908429 0 PO BOX 1109 DEKALB IL 601157109 20 1134908429 0 Clinical Social Worker Social work service 00 1134930027 0 JOLLIFF SYDNEY R 2025038 9999999 B 10 1134930027 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1134930027 0 Nurse Practitioners Fluoride varnish 20 1134930027 0 Nurse Practitioners Healthy Kids Services 20 1134930027 0 Nurse Practitioners Nurse Practitioners Services 20 1134930027 0 Nurse Practitioners Physician Services 00 1134937386 0 DOGARU CLAUDIA 2025021 9999999 B 10 1134937386 0 300 N OTTAWA ST JOLIET IL 604324009 20 1134937386 0 Nurse Practitioners Fluoride varnish 20 1134937386 0 Nurse Practitioners Healthy Kids Services 20 1134937386 0 Nurse Practitioners Nurse Practitioners Services 20 1134937386 0 Nurse Practitioners Physician Services 00 1134937907 0 TOENNIES KATE 2025022 9999999 B 10 1134937907 0 1350 GRAND AVE BEARDSTOWN IL 626188092 20 1134937907 0 Occupational Therapists Medical Supplies 20 1134937907 0 Occupational Therapists Medical equipment/prosthetic devices 20 1134937907 0 Occupational Therapists Occupational Therapy Services 00 1134938848 0 MALOOF MARGARET 2025045 9999999 B 10 1134938848 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1134938848 0 Nurse Practitioners Fluoride varnish 20 1134938848 0 Nurse Practitioners Healthy Kids Services 20 1134938848 0 Nurse Practitioners Nurse Practitioners Services 20 1134938848 0 Nurse Practitioners Physician Services 00 1134939085 0 MATHENY BREANNA 2025016 9999999 B 10 1134939085 0 PO BOX 734352 CHICAGO IL 606734352 20 1134939085 0 Nurse Practitioners Healthy Kids Services 20 1134939085 0 Nurse Practitioners Nurse Practitioners Services 20 1134939085 0 Nurse Practitioners Physician Services 00 1134947153 0 THORNTON VIRGINIA 2024275 9999999 B 10 1134947153 0 1951 NW 7TH AVE STE 300 MIAMI FL 331361112 20 1134947153 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1134948052 0 CREE AMY 2024313 9999999 B 10 1134948052 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1134948052 0 Nurse Practitioners Fluoride varnish 20 1134948052 0 Nurse Practitioners Healthy Kids Services 20 1134948052 0 Nurse Practitioners Nurse Practitioners Services 20 1134948052 0 Nurse Practitioners Physician Services 00 1134949324 0 MENTING EMILY J 2025007 9999999 B 10 1134949324 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1134949324 0 Nurse Practitioners Fluoride varnish 20 1134949324 0 Nurse Practitioners Healthy Kids Services 20 1134949324 0 Nurse Practitioners Nurse Practitioners Services 20 1134949324 0 Nurse Practitioners Physician Services 00 1134952948 0 SCOTT KAILEY R 2024270 9999999 B 10 1134952948 0 611 W PARK ST URBANA IL 618012529 20 1134952948 0 Physician Assistant Only Fluoride varnish 20 1134952948 0 Physician Assistant Only Healthy Kids Services 20 1134952948 0 Physician Assistant Only Physician Services 00 1134958341 0 HUNTSMAN JOSLYN 2024303 9999999 B 10 1134958341 0 6653 WEAVER RD STE 112 ROCKFORD IL 611148052 20 1134958341 0 Clinical Social Worker Social work service 00 1134959216 0 SCHUETZ JORDAN E 2024269 9999999 B 10 1134959216 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1134959216 0 Physician Assistant Only Fluoride varnish 20 1134959216 0 Physician Assistant Only Healthy Kids Services 20 1134959216 0 Physician Assistant Only Physician Services 00 1134962400 0 FLAHARTY KATHRYN 2024168 9999999 B 10 1134962400 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1134962400 0 Physicians Anesthesia Services 20 1134962400 0 Physicians Fluoride varnish 20 1134962400 0 Physicians Healthy Kids Services 20 1134962400 0 Physicians Optical Supplies 20 1134962400 0 Physicians Physician Services 00 1134962509 0 PARMELY JUSTIN L 2024169 9999999 B 10 1134962509 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1134962509 0 Physicians Anesthesia Services 20 1134962509 0 Physicians Fluoride varnish 20 1134962509 0 Physicians Healthy Kids Services 20 1134962509 0 Physicians Optical Supplies 20 1134962509 0 Physicians Physician Services 00 1134962756 0 ARANETA JULIA 2024165 9999999 B 10 1134962756 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1134962756 0 Physicians Anesthesia Services 20 1134962756 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Services 00 1134967987 0 PERRY LASHUNDA 2024248 9999999 B 10 1134967987 0 1400 W GREENLEAF AVE CHICAGO IL 606262805 20 1134967987 0 Clinical Social Worker Social work service 00 1134968266 0 ANDREWS CHRISTOPHER 2024165 9999999 B 10 1134968266 0 5220 EAST AVE COUNTRYSIDE IL 605253133 20 1134968266 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1134974702 0 ATHIYAMAN ADEE 2024238 9999999 B 10 1134974702 0 124 SW ADAMS ST PEORIA IL 616021308 20 1134974702 0 Physicians Anesthesia Services 20 1134974702 0 Physicians Fluoride varnish 20 1134974702 0 Physicians Healthy Kids Services 20 1134974702 0 Physicians Optical Supplies 20 1134974702 0 Physicians Physician Services 00 1134976038 0 COOMBES KYLE 2024268 9999999 B 10 1134976038 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1134976038 0 Physicians Anesthesia Services 20 1134976038 0 Physicians Fluoride varnish 20 1134976038 0 Physicians Healthy Kids Services 20 1134976038 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Services 20 1134979396 0 Physicians Fluoride varnish 20 1134979396 0 Physicians Healthy Kids Services 20 1134979396 0 Physicians Optical Supplies 20 1134979396 0 Physicians Physician Services 00 1134979537 0 CHANG CHRISTOPHER 2024320 9999999 B 10 1134979537 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1134979537 0 Physicians Anesthesia Services 20 1134979537 0 Physicians Fluoride varnish 20 1134979537 0 Physicians Healthy Kids Services 20 1134979537 0 Physicians Optical Supplies 20 1134979537 0 Physicians Physician Services 00 1134979560 0 PATEL ANISH 2024206 9999999 B 10 1134979560 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1134979560 0 Physicians Anesthesia Services 20 1134979560 0 Physicians Fluoride varnish 20 1134979560 0 Physicians Healthy Kids Services 20 1134979560 0 Physicians Optical Supplies 20 1134979560 0 Physicians Physician Services 00 1134981038 0 CHALUPA CASSIDY 2024080 9999999 B 10 1134981038 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1134981038 0 Nurse Practitioners Fluoride varnish 20 1134981038 0 Nurse Practitioners Healthy Kids Services 20 1134981038 0 Nurse Practitioners Nurse Practitioners Services 20 1134981038 0 Nurse Practitioners Physician Services 00 1134981434 0 LAWRENCE MARY F 2024040 9999999 B 10 1134981434 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1134981434 0 Nurse Practitioners Fluoride varnish 20 1134981434 0 Nurse Practitioners Healthy Kids Services 20 1134981434 0 Nurse Practitioners Nurse Practitioners Services 20 1134981434 0 Nurse Practitioners Physician Services 00 1134984511 0 GROSS MOLLY 2024060 9999999 B 10 1134984511 0 719 N MARION ST OAK PARK IL 603021530 20 1134984511 0 Occupational Therapists Medical Supplies 20 1134984511 0 Occupational Therapists Medical equipment/prosthetic devices 20 1134984511 0 Occupational Therapists Occupational Therapy Services 00 1134986789 0 KARNUTH FRANCES 2024152 9999999 B 10 1134986789 0 705 S GRAND ST NASHVILLE IL 622631534 20 1134986789 0 Nurse Practitioners Fluoride varnish 20 1134986789 0 Nurse Practitioners Healthy Kids Services 20 1134986789 0 Nurse Practitioners Nurse Practitioners Services 20 1134986789 0 Nurse Practitioners Physician Services 00 1134988413 0 GARVEY JOSEPH 2024180 9999999 B 10 1134988413 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1134988413 0 Physicians Anesthesia Services 20 1134988413 0 Physicians Fluoride varnish 20 1134988413 0 Physicians Healthy Kids Services 20 1134988413 0 Physicians Optical Supplies 20 1134988413 0 Physicians Physician Services 00 1134988454 0 WANG MELINDA 2024175 9999999 B 10 1134988454 0 4698 DEPT CAROL STREAM IL 601220021 20 1134988454 0 Physicians Anesthesia Services 20 1134988454 0 Physicians Healthy Kids Services 20 1134988454 0 Physicians Optical Supplies 20 1134988454 0 Physicians Physician Services 20 1134988454 0 Physicians Physicians Psychiatric Services 00 1134989965 0 ZARAGOZA GABRIELA 2024115 9999999 B 10 1134989965 0 PO BOX 21844 BELFAST ME 049154115 20 1134989965 0 Clinical 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Services 00 1144203753 0 KABBANI HAIDAR 2016305 9999999 B 10 1144203753 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1144203753 0 Physicians Anesthesia Services 20 1144203753 0 Physicians Healthy Kids Services 20 1144203753 0 Physicians Optical Supplies 20 1144203753 0 Physicians Physician Services 20 1144203753 0 Physicians Physicians Psychiatric Services 00 1144203795 0 ANDREWS BRIAN 2021293 9999999 B 10 1144203795 0 2 PROGRESS POINT PKWY O FALLON MO 633682205 20 1144203795 0 Physicians Anesthesia Services 20 1144203795 0 Physicians Healthy Kids Services 20 1144203795 0 Physicians Optical Supplies 20 1144203795 0 Physicians Physician Services 00 1144204397 0 CHAN ROBISON 2015292 9999999 B 10 1144204397 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1144204397 0 Physicians Anesthesia Services 20 1144204397 0 Physicians Healthy Kids Services 20 1144204397 0 Physicians Optical Supplies 20 1144204397 0 Physicians Physician Services 00 1144204769 0 RAJANAHALLY RATNAKAR 1996275 9999999 B 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Physicians Optical Supplies 20 1144333121 0 Physicians Physician Services 00 1144333196 0 FIGUEROA EVELYN 2005276 9999999 B 10 1144333196 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1144333196 0 Physicians Anesthesia Services 20 1144333196 0 Physicians Fluoride varnish 20 1144333196 0 Physicians Healthy Kids Services 20 1144333196 0 Physicians Optical Supplies 20 1144333196 0 Physicians Physician Services 00 1144333626 0 WATZKE JAMES 2019311 9999999 B 10 1144333626 0 12919 S 86TH AVE PALOS PARK IL 604641818 20 1144333626 0 Psychologist Psychologist service 00 1144335373 0 MUNRO CATHY L 1990213 9999999 B 10 1144335373 0 5777 DEPT CAROL STREAM IL 601225777 20 1144335373 0 Physicians Anesthesia Services 20 1144335373 0 Physicians Fluoride varnish 20 1144335373 0 Physicians Healthy Kids Services 20 1144335373 0 Physicians Optical Supplies 20 1144335373 0 Physicians Physician Services 00 1144335761 0 PFEFFERKORN MARIAN D 1998182 9999999 B 10 1144335761 0 PO BOX 778912 CHICAGO IL 606778912 20 1144335761 0 Physicians Anesthesia Services 20 1144335761 0 Physicians Fluoride varnish 20 1144335761 0 Physicians Healthy Kids Services 20 1144335761 0 Physicians Optical Supplies 20 1144335761 0 Physicians Physician Services 00 1144336009 0 MATHEW MANOJ 2003258 9999999 B 10 1144336009 0 1029 E 130TH ST CHICAGO IL 606286908 20 1144336009 0 Physicians Anesthesia Services 20 1144336009 0 Physicians Fluoride varnish 20 1144336009 0 Physicians Healthy Kids Services 20 1144336009 0 Physicians Optical Supplies 20 1144336009 0 Physicians Physician Services 00 1144336074 0 CHOI TONY J 2009244 9999999 B 10 1144336074 0 5777 DEPT CAROL STREAM IL 601228942 20 1144336074 0 Physicians Anesthesia Services 20 1144336074 0 Physicians Healthy Kids Services 20 1144336074 0 Physicians Optical Supplies 20 1144336074 0 Physicians Physician Services 00 1144336173 0 CISNEROS ALFRED 2024213 9999999 B 10 1144336173 0 4777 N HARLEM AVE HARWOOD HEIGHTS IL 607064658 20 1144336173 0 Physicians Anesthesia Services 20 1144336173 0 Physicians Fluoride varnish 20 1144336173 0 Physicians Healthy Kids Services 20 1144336173 0 Physicians Optical Supplies 20 1144336173 0 Physicians Physician Services 00 1144336280 0 BARKAUSKI PATRICIA A 1999293 9999999 B 10 1144336280 0 25210 WAGON WHEEL LN FRANKFORT IL 604237419 20 1144336280 0 Speech Therapists Medical Supplies 20 1144336280 0 Speech Therapists Medical equipment/prosthetic devices 20 1144336280 0 Speech Therapists Speech Therapy/Pathology Services 00 1144336744 0 JEFFREY CHRISTINE M 2010060 9999999 B 10 1144336744 0 8601 W DODGE RD OMAHA NE 681143457 20 1144336744 0 Physicians Anesthesia Services 20 1144336744 0 Physicians Fluoride varnish 20 1144336744 0 Physicians Healthy Kids Services 20 1144336744 0 Physicians Optical Supplies 20 1144336744 0 Physicians Physician Services 00 1144336751 0 SCOCCIA HUMBERTO 1987182 9999999 B 10 1144336751 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1144336751 0 Physicians Anesthesia Services 20 1144336751 0 Physicians Healthy Kids Services 20 1144336751 0 Physicians Optical Supplies 20 1144336751 0 Physicians Physician Services 00 1144337403 0 TABER REX 2021089 9999999 B 10 1144337403 0 PO BOX 43230 PHOENIX AZ 850803230 20 1144337403 0 Physicians Anesthesia Services 20 1144337403 0 Physicians Healthy Kids Services 20 1144337403 0 Physicians Optical Supplies 20 1144337403 0 Physicians Physician Services 20 1144337403 0 Physicians Physicians Psychiatric Services 00 1144337411 0 SADAKA FARID 2005244 9999999 B 10 1144337411 0 621 S NEW BALLAS RD STE 7020 SAINT LOUIS MO 631418232 20 1144337411 0 Physicians Anesthesia Services 20 1144337411 0 Physicians Fluoride varnish 20 1144337411 0 Physicians Healthy Kids Services 20 1144337411 0 Physicians Optical Supplies 20 1144337411 0 Physicians Physician Services 00 1144337767 0 WINOGRAD DAVID 1997167 9999999 B 10 1144337767 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1144337767 0 Physicians All Kids application agent 20 1144337767 0 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Psychologist service 00 1144343435 0 HOGAN ERIC 2024170 9999999 B 10 1144343435 0 1118 11TH ST DE WITT IA 527421353 20 1144343435 0 Physicians Anesthesia Services 20 1144343435 0 Physicians Fluoride varnish 20 1144343435 0 Physicians Healthy Kids Services 20 1144343435 0 Physicians Optical Supplies 20 1144343435 0 Physicians Physician Services 00 1144343658 0 SANCHEZ LUIS M 2017093 9999999 B 10 1144343658 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1144343658 0 Physician Assistant Only Fluoride varnish 20 1144343658 0 Physician Assistant Only Healthy Kids Services 20 1144343658 0 Physician Assistant Only Physician Services 00 1144345075 0 AHMED LUBNA 2022250 9999999 B 10 1144345075 0 PO BOX 778912 CHICAGO IL 606778912 20 1144345075 0 Physicians Anesthesia Services 20 1144345075 0 Physicians Fluoride varnish 20 1144345075 0 Physicians Healthy Kids Services 20 1144345075 0 Physicians Optical Supplies 20 1144345075 0 Physicians Physician Services 00 1144345364 0 ALLEN CHARLES T 2016167 9999999 B 10 1144345364 0 5700 S KEDZIE AVE CHICAGO IL 606292408 20 1144345364 0 Podiatrists Podiatric Services 00 1144347410 0 ABRAMS CHARLES 2015320 9999999 B 10 1144347410 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1144347410 0 Physicians Anesthesia Services 20 1144347410 0 Physicians Healthy Kids Services 20 1144347410 0 Physicians Optical Supplies 20 1144347410 0 Physicians Physician Services 20 1144347410 0 Physicians Physicians Psychiatric Services 00 1144347717 0 LOWE DIANA L 2008095 9999999 B 10 1144347717 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1144347717 0 Nurse Practitioners Anesthesia Services 20 1144347717 0 Nurse Practitioners Nurse Practitioners Services 20 1144347717 0 Nurse Practitioners Physician Services 00 1144348038 0 PREPEJCHAL REBECCA 2025002 9999999 B 10 1144348038 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1144348038 0 Physicians Anesthesia Services 20 1144348038 0 Physicians Healthy Kids Services 20 1144348038 0 Physicians Optical Supplies 20 1144348038 0 Physicians Physician Services 00 1144349002 0 CHELETTE-CUNNINGHAM ANITA THER 2017098 9999999 B 10 1144349002 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1144349002 0 Physical Therapists Medical Supplies 20 1144349002 0 Physical Therapists Medical equipment/prosthetic devices 20 1144349002 0 Physical Therapists Physical Therapy Services 00 1144352212 0 ANDERSON CARRIE J 2017199 9999999 B 10 1144352212 0 448 WYLIE DR NORMAL IL 617615405 20 1144352212 0 Other behavior health professional LCPC/LMFT services 00 1144352626 0 ROSZKOWSKI JOSEPH M 2024241 9999999 B 10 1144352626 0 28W671 GARYS MILL RD WINFIELD IL 601901564 20 1144352626 0 Psychologist Psychologist service 00 1144352899 0 OMSBERG KELLY A 2016001 9999999 B 10 1144352899 0 5777 DEPT CAROL STREAM IL 601228942 20 1144352899 0 Physician Assistant Only Fluoride varnish 20 1144352899 0 Physician Assistant Only Healthy Kids Services 20 1144352899 0 Physician Assistant Only Physician Services 00 1144355215 0 MCDONALD TAMARA C 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1144362773 0 Physicians Optical Supplies 20 1144362773 0 Physicians Physician Services 00 1144363367 0 BLOCKI WILLIAM G 2022101 9999999 B 10 1144363367 0 8031 N MILWAUKEE AVE NILES IL 607142827 20 1144363367 0 Dentists Dental Services 20 1144363367 0 Dentists Physician Services 00 1144364167 0 HALUM KURT 1999049 9999999 B 10 1144364167 0 2303 45TH ST HIGHLAND IN 463222602 20 1144364167 0 Dentists Dental Services 20 1144364167 0 Dentists Physician Services 00 1144364829 0 ROBINSON SCOTT 2018310 9999999 B 10 1144364829 0 2100 POWELL ST STE 400 EMERYVILLE CA 946081826 20 1144364829 0 Physicians Anesthesia Services 20 1144364829 0 Physicians Healthy Kids Services 20 1144364829 0 Physicians Optical Supplies 20 1144364829 0 Physicians Physician Services 00 1144366196 0 CHOO-KANG LEE R 2001182 9999999 B 10 1144366196 0 621 S NEW BALLAS RD STE 382A SAINT LOUIS MO 631418214 20 1144366196 0 Physicians Anesthesia Services 20 1144366196 0 Physicians Fluoride varnish 20 1144366196 0 Physicians 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Physical Therapists Physical Therapy Services 00 1144370990 0 HENRIQUEZ ROLANDO 1994182 9999999 B 10 1144370990 0 1841 W ARMY TRAIL RD ADDISON IL 601011901 20 1144370990 0 Physicians Anesthesia Services 20 1144370990 0 Physicians Fluoride varnish 20 1144370990 0 Physicians Healthy Kids Services 20 1144370990 0 Physicians Optical Supplies 20 1144370990 0 Physicians Physician Services 00 1144371212 0 MATSON STACEY 2006310 9999999 B 10 1144371212 0 200 2ND AVE S STE 356 SAINT PETERSBUR FL 337014313 20 1144371212 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1144371519 0 ROJAS DAHL CATHERINE 2011018 9999999 B 10 1144371519 0 1555 N RAND RD PALATINE IL 600742919 20 1144371519 0 Optometrists Optical Supplies 20 1144371519 0 Optometrists Optometric Services 20 1144371519 0 Optometrists Physician Services 00 1144372129 0 DURGA ANITA 2008258 9999999 B 10 1144372129 0 2604 SHEEHAN CT UNIT 102 NAPERVILLE IL 605644737 20 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00 1144376872 0 SHULRUFF REEVA 1987050 9999999 B 10 1144376872 0 2850 S WABASH AVE STE 203 CHICAGO IL 606162492 20 1144376872 0 Physicians Anesthesia Services 20 1144376872 0 Physicians Healthy Kids Services 20 1144376872 0 Physicians Optical Supplies 20 1144376872 0 Physicians Physician Services 00 1144379116 0 PETERSON CHRISTINE 2024029 9999999 B 10 1144379116 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1144379116 0 Nurse Practitioners Fluoride varnish 20 1144379116 0 Nurse Practitioners Healthy Kids Services 20 1144379116 0 Nurse Practitioners Nurse Practitioners Services 20 1144379116 0 Nurse Practitioners Physician Services 00 1144379280 0 SHLEYFER-VISHNEVSKIY LARISA 2016308 9999999 B 10 1144379280 0 5101 WASHINGTON ST STE 19 GURNEE IL 600312988 20 1144379280 0 Optometrists Optical Supplies 20 1144379280 0 Optometrists Optometric Services 20 1144379280 0 Optometrists Physician Services 00 1144379363 0 GROCH JOHN S 1992153 9999999 B 10 1144379363 0 1200 HARGER RD STE 408 OAK BROOK IL 605231818 20 1144379363 0 Physicians All Kids application agent 20 1144379363 0 Physicians Anesthesia Services 20 1144379363 0 Physicians Healthy Kids Services 20 1144379363 0 Physicians Optical Supplies 20 1144379363 0 Physicians Physician Services 00 1144380049 0 BAIMA JOSEPH 2008183 9999999 B 10 1144380049 0 1000 N ALLEN ST ROBINSON IL 624541114 20 1144380049 0 Physicians Anesthesia Services 20 1144380049 0 Physicians Healthy Kids Services 20 1144380049 0 Physicians Optical Supplies 20 1144380049 0 Physicians Physician Services 00 1144380577 0 HARDEN DON A 1989247 9999999 B 10 1144380577 0 10640 165TH ST ORLAND PARK IL 604678734 20 1144380577 0 Physicians Anesthesia Services 20 1144380577 0 Physicians Healthy Kids Services 20 1144380577 0 Physicians Optical Supplies 20 1144380577 0 Physicians Physician Services 00 1144381823 0 FRAZER AMY 2015272 9999999 B 10 1144381823 0 5777 DEPT CAROL STREAM IL 601228942 20 1144381823 0 Physician Assistant Only Fluoride varnish 20 1144381823 0 Physician Assistant Only Healthy Kids Services 20 1144381823 0 Physician Assistant Only Physician Services 00 1144385352 0 MANGIN TERESA 2016001 9999999 B 10 1144385352 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1144385352 0 Physicians Anesthesia Services 20 1144385352 0 Physicians Healthy Kids Services 20 1144385352 0 Physicians Optical Supplies 20 1144385352 0 Physicians Physician Services 20 1144385352 0 Physicians Physicians Psychiatric Services 00 1144386095 0 MAVES JENNIFER N 2018001 9999999 B 10 1144386095 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1144386095 0 Occupational Therapists Medical Supplies 20 1144386095 0 Occupational Therapists Medical equipment/prosthetic devices 20 1144386095 0 Occupational Therapists Occupational Therapy Services 00 1144386277 0 STARUCK COLLEEN M 2006284 9999999 B 10 1144386277 0 549 TAYLOR AVE GLEN ELLYN IL 601374242 20 1144386277 0 Speech Therapists Medical Supplies 20 1144386277 0 Speech Therapists Medical equipment/prosthetic devices 20 1144386277 0 Speech Therapists Speech Therapy/Pathology Services 00 1144388232 0 HEYSER-PATTI MELISSA D 2005164 9999999 B 10 1144388232 0 130 W PARK AVE WHEATON IL 601896460 20 1144388232 0 Speech Therapists Medical Supplies 20 1144388232 0 Speech Therapists Medical equipment/prosthetic devices 20 1144388232 0 Speech Therapists Speech Therapy/Pathology Services 00 1144389297 0 LATA JEFFREY L 2011286 9999999 B 10 1144389297 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1144389297 0 Other behavior health professional LCPC/LMFT services 00 1144390402 0 MITROVIC TATIANA 2010110 9999999 B 10 1144390402 0 1950 W CERMAK RD CHICAGO IL 606084204 20 1144390402 0 Dentists Dental Services 20 1144390402 0 Dentists Physician Services 00 1144391939 0 LOUNSBURY DORAN E 2020176 9999999 B 10 1144391939 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1144391939 0 Physical Therapists Medical Supplies 20 1144391939 0 Physical Therapists Medical equipment/prosthetic devices 20 1144391939 0 Physical Therapists Physical Therapy Services 00 1144394511 0 DEPAUW KARI 2018240 9999999 B 10 1144394511 0 515 22ND AVE MONROE WI 535661569 20 1144394511 0 Physician Assistant Only Fluoride varnish 20 1144394511 0 Physician Assistant Only Healthy Kids Services 20 1144394511 0 Physician Assistant Only Physician Services 00 1144395849 0 VATEV DANAIL 2002059 9999999 B 10 1144395849 0 9518 FRANKLIN AVE FRANKLIN PARK IL 601312705 20 1144395849 0 Physicians Anesthesia Services 20 1144395849 0 Physicians Fluoride varnish 20 1144395849 0 Physicians Healthy Kids Services 20 1144395849 0 Physicians Optical Supplies 20 1144395849 0 Physicians Physician Services 00 1144398520 0 JACKSON ALAN L 1994182 9999999 B 10 1144398520 0 1395 NW 167TH ST MIAMI FL 331695710 20 1144398520 0 Physicians Anesthesia Services 20 1144398520 0 Physicians Fluoride varnish 20 1144398520 0 Physicians Healthy Kids Services 20 1144398520 0 Physicians Optical Supplies 20 1144398520 0 Physicians Physician Services 00 1144399296 0 VENKATARAMAN PRIYA 2006324 9999999 B 10 1144399296 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1144399296 0 Physicians Anesthesia Services 20 1144399296 0 Physicians Fluoride varnish 20 1144399296 0 Physicians Healthy Kids Services 20 1144399296 0 Physicians Optical Supplies 20 1144399296 0 Physicians Physician Services 00 1144399957 0 HEFFERNAN THERESA A 2002098 9999999 B 10 1144399957 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1144399957 0 Nurse Practitioners Anesthesia Services 20 1144399957 0 Nurse Practitioners Nurse Practitioners Services 20 1144399957 0 Nurse Practitioners Physician Services 00 1144401126 0 HEAD HAYDEN 2021257 9999999 B 10 1144401126 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1144401126 0 Physicians Anesthesia Services 20 1144401126 0 Physicians Healthy Kids Services 20 1144401126 0 Physicians Optical Supplies 20 1144401126 0 Physicians Physician Services 00 1144401175 0 HAVENS PAM 2023233 9999999 B 10 1144401175 0 100 S GRAND 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Practitioners Nurse Practitioners Services 20 1144409707 0 Nurse Practitioners Physician Services 00 1144410283 0 STEADMAN BRENT T 2019295 9999999 B 10 1144410283 0 1025 MAINE ST QUINCY IL 623014038 20 1144410283 0 Physicians Anesthesia Services 20 1144410283 0 Physicians Healthy Kids Services 20 1144410283 0 Physicians Optical Supplies 20 1144410283 0 Physicians Physician Services 00 1144410317 0 BHATT AMIT K 2010263 9999999 B 10 1144410317 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1144410317 0 Physicians Anesthesia Services 20 1144410317 0 Physicians Healthy Kids Services 20 1144410317 0 Physicians Optical Supplies 20 1144410317 0 Physicians Physician Services 00 1144410762 0 MORGAN ANNA 2009213 9999999 B 10 1144410762 0 4727 N CLARK ST STE 1N CHICAGO IL 606407554 20 1144410762 0 Physicians Anesthesia Services 20 1144410762 0 Physicians Fluoride varnish 20 1144410762 0 Physicians Healthy Kids Services 20 1144410762 0 Physicians Optical Supplies 20 1144410762 0 Physicians Physician Services 00 1144411653 0 ALSAWAF MHD ANAS 2017214 9999999 B 10 1144411653 0 6308 8TH AVE KENOSHA WI 531435031 20 1144411653 0 Physicians Anesthesia Services 20 1144411653 0 Physicians Healthy Kids Services 20 1144411653 0 Physicians Optical Supplies 20 1144411653 0 Physicians Physician Services 00 1144412065 0 PATEL TRUSHAR 1981227 9999999 B 10 1144412065 0 4008 W 26TH ST CHICAGO IL 606233708 20 1144412065 0 Dentists Dental Services 20 1144412065 0 Dentists Physician Services 00 1144412859 0 KHAN MUHAMMAD A 2015213 9999999 B 10 1144412859 0 1239 E MAIN ST CARBONDALE IL 629013175 20 1144412859 0 Physicians Anesthesia Services 20 1144412859 0 Physicians Fluoride varnish 20 1144412859 0 Physicians Healthy Kids Services 20 1144412859 0 Physicians Optical Supplies 20 1144412859 0 Physicians Physician Services 00 1144413568 0 MILLER STEPHANIE 2010182 9999999 B 10 1144413568 0 PO BOX 776084 CHICAGO IL 606776084 20 1144413568 0 Physicians Anesthesia Services 20 1144413568 0 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Optical Supplies 20 1144419896 0 Physicians Physician Services 00 1144420365 0 RAMIC ALMA 2009001 9999999 B 10 1144420365 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1144420365 0 Physicians Anesthesia Services 20 1144420365 0 Physicians Healthy Kids Services 20 1144420365 0 Physicians Optical Supplies 20 1144420365 0 Physicians Physician Services 20 1144420365 0 Physicians Physicians Psychiatric Services 00 1144421694 0 TERHARK AIMEE J 2016077 9999999 B 10 1144421694 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1144421694 0 Nurse Practitioners Fluoride varnish 20 1144421694 0 Nurse Practitioners Healthy Kids Services 20 1144421694 0 Nurse Practitioners Nurse Practitioners Services 20 1144421694 0 Nurse Practitioners Physician Services 00 1144421991 0 BERG ERICA 2023123 9999999 B 10 1144421991 0 PO BOX 713160 CHICAGO IL 606770360 20 1144421991 0 Physicians Anesthesia Services 20 1144421991 0 Physicians Healthy Kids Services 20 1144421991 0 Physicians Optical Supplies 20 1144421991 0 Physicians Physician Services 00 1144422635 0 ERNST-RIZKALLAH LONA 2015342 9999999 B 10 1144422635 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1144422635 0 Physician Assistant Only Electronic Home Response/EHR Installation, MPE Certification 20 1144422635 0 Physician Assistant Only Fluoride varnish 20 1144422635 0 Physician Assistant Only Healthy Kids Services 20 1144422635 0 Physician Assistant Only Physician Services 00 1144423526 0 OLSEN MICHAEL S 2009213 9999999 B 10 1144423526 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1144423526 0 Physicians Anesthesia Services 20 1144423526 0 Physicians Healthy Kids Services 20 1144423526 0 Physicians Optical Supplies 20 1144423526 0 Physicians Physician Services 00 1144423963 0 WAISATH THERON C. 2010179 9999999 B 10 1144423963 0 611 W PARK ST URBANA IL 618012529 20 1144423963 0 Dentists Dental Services 20 1144423963 0 Dentists Physician Services 00 1144424649 0 PETERSON ANTHONY 2008001 9999999 B 10 1144424649 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1144424649 0 Physicians Anesthesia Services 20 1144424649 0 Physicians Fluoride varnish 20 1144424649 0 Physicians Healthy Kids Services 20 1144424649 0 Physicians Optical Supplies 20 1144424649 0 Physicians Physician Services 00 1144425174 0 TANCK ALLISON R 2012233 9999999 B 10 1144425174 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1144425174 0 Physicians Anesthesia Services 20 1144425174 0 Physicians Healthy Kids Services 20 1144425174 0 Physicians Optical Supplies 20 1144425174 0 Physicians Physician Services 00 1144425224 0 LOPATA DAVID 2011244 9999999 B 10 1144425224 0 PO BOX 75081 CHICAGO IL 606755081 20 1144425224 0 Physicians Anesthesia Services 20 1144425224 0 Physicians Healthy Kids Services 20 1144425224 0 Physicians Optical Supplies 20 1144425224 0 Physicians Physician Services 00 1144425505 0 CHERENFANT LUCOT 2023124 9999999 B 10 1144425505 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1144425505 0 Physicians Anesthesia Services 20 1144425505 0 Physicians Healthy Kids Services 20 1144425505 0 Physicians Optical Supplies 20 1144425505 0 Physicians Physician Services 00 1144425547 0 SHARMA RAHUL 2007182 9999999 B 10 1144425547 0 401 N MICHIGAN AVE STE 1200 CHICAGO IL 606114264 20 1144425547 0 Physicians Anesthesia Services 20 1144425547 0 Physicians Healthy Kids Services 20 1144425547 0 Physicians Optical Supplies 20 1144425547 0 Physicians Physician Services 00 1144428038 0 WAGNER COREY 2013203 9999999 B 10 1144428038 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1144428038 0 Physicians Anesthesia Services 20 1144428038 0 Physicians Healthy Kids Services 20 1144428038 0 Physicians Optical Supplies 20 1144428038 0 Physicians Physician Services 00 1144428483 0 YEN JACK 2014013 9999999 B 10 1144428483 0 4 FOSTER PLZ PITTSBURGH PA 152202749 20 1144428483 0 Physicians Anesthesia Services 20 1144428483 0 Physicians Healthy Kids Services 20 1144428483 0 Physicians Optical Supplies 20 1144428483 0 Physicians Physician Services 20 1144428483 0 Physicians Physicians Psychiatric Services 00 1144429317 0 NEITLICH TYLER M 2022340 9999999 B 10 1144429317 0 1120 N MELVIN ST GIBSON CITY IL 609361477 20 1144429317 0 Physicians Anesthesia Services 20 1144429317 0 Physicians Healthy Kids Services 20 1144429317 0 Physicians Optical Supplies 20 1144429317 0 Physicians Physician Services 00 1144429663 0 SAKORAFAS LOIS UDO 2024319 9999999 B 10 1144429663 0 PO BOX 5081 JANESVILLE WI 535475081 20 1144429663 0 Physicians Anesthesia Services 20 1144429663 0 Physicians Healthy Kids Services 20 1144429663 0 Physicians Optical Supplies 20 1144429663 0 Physicians Physician Services 00 1144430323 0 AUSTIN JULIE 2009201 9999999 B 10 1144430323 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1144430323 0 Nurse Practitioners Fluoride varnish 20 1144430323 0 Nurse Practitioners Healthy Kids Services 20 1144430323 0 Nurse Practitioners Nurse Practitioners Services 20 1144430323 0 Nurse Practitioners Physician Services 00 1144430612 0 GARRETTO CHRISTINA A 2013053 9999999 B 10 1144430612 0 500 PORTER AVE AURORA MO 656052365 20 1144430612 0 Physicians Anesthesia Services 20 1144430612 0 Physicians Fluoride varnish 20 1144430612 0 Physicians Healthy Kids Services 20 1144430612 0 Physicians Optical Supplies 20 1144430612 0 Physicians Physician Services 00 1144431925 0 MALIK MOHAMMAD 2015274 9999999 B 10 1144431925 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1144431925 0 Physicians Anesthesia Services 20 1144431925 0 Physicians Fluoride varnish 20 1144431925 0 Physicians Healthy Kids Services 20 1144431925 0 Physicians Optical Supplies 20 1144431925 0 Physicians Physician Services 00 1144432188 0 SAMIRUDDIN MOHAMMED 2009152 9999999 B 10 1144432188 0 PO BOX 1897 LOMBARD IL 601488897 20 1144432188 0 Physicians Anesthesia Services 20 1144432188 0 Physicians Fluoride varnish 20 1144432188 0 Physicians Healthy Kids Services 20 1144432188 0 Physicians Optical Supplies 20 1144432188 0 Physicians Physician Services 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1144451105 0 29373 NETWORK PL CHICAGO IL 606733039 20 1144451105 0 Physicians Anesthesia Services 20 1144451105 0 Physicians Healthy Kids Services 20 1144451105 0 Physicians Optical Supplies 20 1144451105 0 Physicians Physician Services 00 1144452327 0 MARITOTE AMY L 2016001 9999999 B 10 1144452327 0 5777 DEPT CAROL STREAM IL 601220021 20 1144452327 0 Physician Assistant Only Fluoride varnish 20 1144452327 0 Physician Assistant Only Healthy Kids Services 20 1144452327 0 Physician Assistant Only Physician Services 00 1144453416 0 ADAMS ERIN E 2009215 9999999 B 10 1144453416 0 1025 MAINE ST QUINCY IL 623014038 20 1144453416 0 Occupational Therapists Medical Supplies 20 1144453416 0 Occupational Therapists Medical equipment/prosthetic devices 20 1144453416 0 Occupational Therapists Occupational Therapy Services 00 1144454091 0 NAVARATNAM MANCHULA 2021130 9999999 B 10 1144454091 0 500 PASTEUR DR PALO ALTO CA 943041048 20 1144454091 0 Physicians Anesthesia Services 20 1144454091 0 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P 2013189 9999999 B 10 1144457169 0 12860 TROXLER AVE HIGHLAND IL 622492898 20 1144457169 0 Physicians Anesthesia Services 20 1144457169 0 Physicians Fluoride varnish 20 1144457169 0 Physicians Healthy Kids Services 20 1144457169 0 Physicians Optical Supplies 20 1144457169 0 Physicians Physician Services 00 1144458126 0 MATHEW SHAKILA 2017166 9999999 B 10 1144458126 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1144458126 0 Physicians Anesthesia Services 20 1144458126 0 Physicians Fluoride varnish 20 1144458126 0 Physicians Healthy Kids Services 20 1144458126 0 Physicians Optical Supplies 20 1144458126 0 Physicians Physician Services 00 1144459512 0 KIM ALBERT 2013182 9999999 B 10 1144459512 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1144459512 0 Physicians Anesthesia Services 20 1144459512 0 Physicians Fluoride varnish 20 1144459512 0 Physicians Healthy Kids Services 20 1144459512 0 Physicians Optical Supplies 20 1144459512 0 Physicians 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Podiatrists Podiatric Services 00 1144472895 0 BAGCHI SHASHWATEE 2023152 9999999 B 10 1144472895 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1144472895 0 Physicians Anesthesia Services 20 1144472895 0 Physicians Fluoride varnish 20 1144472895 0 Physicians Healthy Kids Services 20 1144472895 0 Physicians Optical Supplies 20 1144472895 0 Physicians Physician Services 00 1144473109 0 GOMEZ ANA L 2011124 9999999 B 10 1144473109 0 2110 W DEVON AVE CHICAGO IL 606592106 20 1144473109 0 Physician Assistant Only All Kids application agent 20 1144473109 0 Physician Assistant Only Fluoride varnish 20 1144473109 0 Physician Assistant Only Healthy Kids Services 20 1144473109 0 Physician Assistant Only Physician Services 00 1144473190 0 CHOW SELINA 2014346 9999999 B 10 1144473190 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1144473190 0 Physicians Anesthesia Services 20 1144473190 0 Physicians Fluoride varnish 20 1144473190 0 Physicians Healthy Kids Services 20 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0 1 HOLLOW LN STE 301 NEW HYDE PARK NY 110421215 20 1144476516 0 Physicians Anesthesia Services 20 1144476516 0 Physicians Healthy Kids Services 20 1144476516 0 Physicians Optical Supplies 20 1144476516 0 Physicians Physician Services 00 1144476607 0 COATES BRIA M 2011182 9999999 B 10 1144476607 0 5777 DEPT CAROL STREAM IL 601220021 20 1144476607 0 Physicians Anesthesia Services 20 1144476607 0 Physicians Fluoride varnish 20 1144476607 0 Physicians Healthy Kids Services 20 1144476607 0 Physicians Optical Supplies 20 1144476607 0 Physicians Physician Services 00 1144476912 0 RAJU PRIYA 2010182 9999999 B 10 1144476912 0 120 W 22ND ST OAK BROOK IL 605231557 20 1144476912 0 Physicians Anesthesia Services 20 1144476912 0 Physicians Fluoride varnish 20 1144476912 0 Physicians Healthy Kids Services 20 1144476912 0 Physicians Optical Supplies 20 1144476912 0 Physicians Physician Services 00 1144476938 0 MORENO JAIME 2010182 9999999 B 10 1144476938 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1144476938 0 Physicians Anesthesia Services 20 1144476938 0 Physicians Healthy Kids Services 20 1144476938 0 Physicians Optical Supplies 20 1144476938 0 Physicians Physician Services 00 1144477068 0 MCEVOY COLLEEN 2014182 9999999 B 10 1144477068 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1144477068 0 Physicians Anesthesia Services 20 1144477068 0 Physicians Fluoride varnish 20 1144477068 0 Physicians Healthy Kids Services 20 1144477068 0 Physicians Optical Supplies 20 1144477068 0 Physicians Physician Services 00 1144478173 0 ANGELILLI ADAM T 2008214 9999999 B 10 1144478173 0 PO BOX 268 FREEPORT IL 610320268 20 1144478173 0 Physicians Anesthesia Services 20 1144478173 0 Physicians Fluoride varnish 20 1144478173 0 Physicians Healthy Kids Services 20 1144478173 0 Physicians Optical Supplies 20 1144478173 0 Physicians Physician Services 00 1144479064 0 JORDAN MARY ANN 2003341 9999999 B 10 1144479064 0 8780 W GOLF RD STE 200 SUITE 200 NILES IL 607145611 20 1144479064 0 Audiologists Audiology Services 20 1144479064 0 Audiologists Medical Supplies 20 1144479064 0 Audiologists Medical equipment/prosthetic devices 00 1144479619 0 POETTKER NEELY 2008345 9999999 B 10 1144479619 0 14163 JEM DR AVISTON IL 622163646 20 1144479619 0 Occupational Therapists Medical Supplies 20 1144479619 0 Occupational Therapists Medical equipment/prosthetic devices 20 1144479619 0 Occupational Therapists Occupational Therapy Services 00 1144480484 0 KOH JOYCE 2023352 9999999 B 10 1144480484 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1144480484 0 Physicians Anesthesia Services 20 1144480484 0 Physicians Fluoride varnish 20 1144480484 0 Physicians Healthy Kids Services 20 1144480484 0 Physicians Optical Supplies 20 1144480484 0 Physicians Physician Services 00 1144480971 0 TELLO-SKJERSETH CHRISTINA 2016239 9999999 B 10 1144480971 0 PO BOX 2010 FARGO ND 581222484 20 1144480971 0 Physicians Anesthesia Services 20 1144480971 0 Physicians Healthy Kids Services 20 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Therapists Physical Therapy Services 00 1144502949 0 PANT RUMMY 2011285 9999999 B 10 1144502949 0 319 E MADISON ST STE 3B SPRINGFIELD IL 627013124 20 1144502949 0 Other behavior health professional LCPC/LMFT services 00 1144504226 0 DROUSIAS KERRA M 2011255 9999999 B 10 1144504226 0 5112 W 105TH PL OAK LAWN IL 604535124 20 1144504226 0 Occupational Therapists Medical Supplies 20 1144504226 0 Occupational Therapists Medical equipment/prosthetic devices 20 1144504226 0 Occupational Therapists Occupational Therapy Services 00 1144504242 0 QUINONES LIZETTE H 2012006 9999999 B 10 1144504242 0 1305 MAPLE AVE BERWYN IL 604021250 20 1144504242 0 Occupational Therapists Medical Supplies 20 1144504242 0 Occupational Therapists Medical equipment/prosthetic devices 20 1144504242 0 Occupational Therapists Occupational Therapy Services 00 1144508151 0 WHITE ERINN E 2018312 9999999 B 10 1144508151 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1144508151 0 Physician Assistant Only 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MAJUMDER ARNAB 2019213 9999999 B 10 1144514423 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1144514423 0 Physicians Anesthesia Services 20 1144514423 0 Physicians Healthy Kids Services 20 1144514423 0 Physicians Optical Supplies 20 1144514423 0 Physicians Physician Services 00 1144514613 0 DIVALERIO KATHERINE T 2012235 9999999 B 10 1144514613 0 289 WAGNER RD NORTHFIELD IL 600933248 20 1144514613 0 Speech Therapists Medical Supplies 20 1144514613 0 Speech Therapists Medical equipment/prosthetic devices 20 1144514613 0 Speech Therapists Speech Therapy/Pathology Services 00 1144515115 0 NAYANI RAHUL 2017020 9999999 B 10 1144515115 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1144515115 0 Physicians Anesthesia Services 20 1144515115 0 Physicians Fluoride varnish 20 1144515115 0 Physicians Healthy Kids Services 20 1144515115 0 Physicians Optical Supplies 20 1144515115 0 Physicians Physician Services 00 1144516097 0 LARSON JEFFREY D 2014217 9999999 B 10 1144516097 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1144516097 0 Physicians All Kids application agent 20 1144516097 0 Physicians Anesthesia Services 20 1144516097 0 Physicians Fluoride varnish 20 1144516097 0 Physicians Healthy Kids Services 20 1144516097 0 Physicians Optical Supplies 20 1144516097 0 Physicians Physician Services 00 1144516568 0 ASROW ALEXANDRA 2014182 9999999 B 10 1144516568 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1144516568 0 Physicians Anesthesia Services 20 1144516568 0 Physicians Healthy Kids Services 20 1144516568 0 Physicians Optical Supplies 20 1144516568 0 Physicians Physician Services 00 1144516675 0 DE LA PUENTE RAFAEL 2024181 9999999 B 10 1144516675 0 PO BOX 43230 PHOENIX AZ 850803230 20 1144516675 0 Physicians Anesthesia Services 20 1144516675 0 Physicians Healthy Kids Services 20 1144516675 0 Physicians Optical Supplies 20 1144516675 0 Physicians Physician Services 00 1144517020 0 BHAMBRI AMIT 2014319 9999999 B 10 1144517020 0 1700 E WEST RD CALUMET CITY IL 604095415 20 1144517020 0 Optometrists Optical Supplies 20 1144517020 0 Optometrists Optometric Services 20 1144517020 0 Optometrists Physician Services 00 1144517707 0 SHODUNKE TEMITOPE 2017214 9999999 B 10 1144517707 0 800 E LOCUST ST OLNEY IL 624502553 20 1144517707 0 Physicians Anesthesia Services 20 1144517707 0 Physicians Fluoride varnish 20 1144517707 0 Physicians Healthy Kids Services 20 1144517707 0 Physicians Optical Supplies 20 1144517707 0 Physicians Physician Services 00 1144517731 0 VAKIL PURVI S 2016061 9999999 B 10 1144517731 0 57 E DOWNER PL AURORA IL 605053340 20 1144517731 0 Dentists Dental Services 20 1144517731 0 Dentists Physician Services 00 1144518069 0 MCKEE ALEXIS 2016123 9999999 B 10 1144518069 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1144518069 0 Physicians Anesthesia Services 20 1144518069 0 Physicians Fluoride varnish 20 1144518069 0 Physicians Healthy Kids Services 20 1144518069 0 Physicians Optical Supplies 20 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2022192 9999999 B 10 1144520867 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1144520867 0 Physicians Anesthesia Services 20 1144520867 0 Physicians Healthy Kids Services 20 1144520867 0 Physicians Optical Supplies 20 1144520867 0 Physicians Physician Services 00 1144522053 0 JOHNSON DAVID 2012183 9999999 B 10 1144522053 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1144522053 0 Physical Therapists Medical Supplies 20 1144522053 0 Physical Therapists Medical equipment/prosthetic devices 20 1144522053 0 Physical Therapists Physical Therapy Services 00 1144522426 0 ZELENSKI JULIE 2017346 9999999 B 10 1144522426 0 15732 S HOWARD ST PLAINFIELD IL 605442399 20 1144522426 0 Speech Therapists Medical Supplies 20 1144522426 0 Speech Therapists Medical equipment/prosthetic devices 20 1144522426 0 Speech Therapists Speech Therapy/Pathology Services 00 1144523630 0 KAZAKOV JORDAN ATANASOV 2022213 9999999 B 10 1144523630 0 5777 DEPT CAROL STREAM IL 601228942 20 1144523630 0 Physicians Anesthesia 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1144527235 0 Nurse Practitioners Healthy Kids Services 20 1144527235 0 Nurse Practitioners Nurse Practitioners Services 20 1144527235 0 Nurse Practitioners Physician Services 00 1144529900 0 ENEMCHUKWU CHIBUZO 2020273 9999999 B 10 1144529900 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1144529900 0 Physicians Anesthesia Services 20 1144529900 0 Physicians Fluoride varnish 20 1144529900 0 Physicians Healthy Kids Services 20 1144529900 0 Physicians Optical Supplies 20 1144529900 0 Physicians Physician Services 00 1144531096 0 FONTAINE EMILY M 2015188 9999999 B 10 1144531096 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1144531096 0 Physicians Anesthesia Services 20 1144531096 0 Physicians Fluoride varnish 20 1144531096 0 Physicians Healthy Kids Services 20 1144531096 0 Physicians Optical Supplies 20 1144531096 0 Physicians Physician Services 00 1144531237 0 MADUEKWE UMA 2020014 9999999 B 10 1144531237 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1144531237 0 Physicians Anesthesia 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HEALTH CT MIDDLETON WI 535625531 20 1144555947 0 Physicians Anesthesia Services 20 1144555947 0 Physicians Healthy Kids Services 20 1144555947 0 Physicians Optical Supplies 20 1144555947 0 Physicians Physician Services 00 1144556028 0 TERWELP LAUREN 2010032 9999999 B 10 1144556028 0 1005 BROADWAY ST QUINCY IL 623012834 20 1144556028 0 Occupational Therapists Occupational Therapy Services 00 1144556499 0 BHATTI FAIZA 2020239 9999999 B 10 1144556499 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1144556499 0 Physicians Anesthesia Services 20 1144556499 0 Physicians Fluoride varnish 20 1144556499 0 Physicians Healthy Kids Services 20 1144556499 0 Physicians Optical Supplies 20 1144556499 0 Physicians Physician Services 00 1144557125 0 GAST KATHERINE 2017172 9999999 B 10 1144557125 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1144557125 0 Physicians Anesthesia Services 20 1144557125 0 Physicians Healthy Kids Services 20 1144557125 0 Physicians Optical Supplies 20 1144557125 0 Physicians 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ANTALICK AMY E 2012058 9999999 B 10 1144599796 0 PO BOX 8500 LOCKBOX #7642 PHILADELPHIA PA 191787642 20 1144599796 0 Nurse Practitioners Anesthesia Services 20 1144599796 0 Nurse Practitioners Nurse Practitioners Services 20 1144599796 0 Nurse Practitioners Physician Services 00 1144600016 0 CARROLL JAMES A 2022259 9999999 B 10 1144600016 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1144600016 0 Physicians Anesthesia Services 20 1144600016 0 Physicians Fluoride varnish 20 1144600016 0 Physicians Healthy Kids Services 20 1144600016 0 Physicians Optical Supplies 20 1144600016 0 Physicians Physician Services 00 1144600040 0 HOFFMANN NATALIE 2019317 9999999 B 10 1144600040 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1144600040 0 Physicians Anesthesia Services 20 1144600040 0 Physicians Fluoride varnish 20 1144600040 0 Physicians Healthy Kids Services 20 1144600040 0 Physicians Optical Supplies 20 1144600040 0 Physicians Physician Services 00 1144600669 0 SCHAUBERT STEPHANIE 2015335 9999999 B 10 1144600669 0 4121 VETERANS MEMORIAL DR MOUNT VERNON IL 628646262 20 1144600669 0 Physical Therapists Medical Supplies 20 1144600669 0 Physical Therapists Medical equipment/prosthetic devices 20 1144600669 0 Physical Therapists Physical Therapy Services 00 1144600768 0 FELDMAN TANNA 2020301 9999999 B 10 1144600768 0 PO BOX 43230 PHOENIX AZ 850803230 20 1144600768 0 Physicians Anesthesia Services 20 1144600768 0 Physicians Healthy Kids Services 20 1144600768 0 Physicians Optical Supplies 20 1144600768 0 Physicians Physician Services 20 1144600768 0 Physicians Physicians Psychiatric Services 00 1144601386 0 KHAN MAHEEN Q 2020114 9999999 B 10 1144601386 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1144601386 0 Physicians Anesthesia Services 20 1144601386 0 Physicians Healthy Kids Services 20 1144601386 0 Physicians Optical Supplies 20 1144601386 0 Physicians Physician Services 00 1144601428 0 MENDELSOHN-MEYERS KATHRYN 2017061 9999999 B 10 1144601428 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1144601428 0 Psychologist Psychologist service 00 1144603093 0 JHAVERI NAMAN A 2018277 9999999 B 10 1144603093 0 901 MCCLINTOCK DR STE 202 SUITE 202 BURR RIDGE IL 605270872 20 1144603093 0 Physicians All Kids application agent 20 1144603093 0 Physicians Anesthesia Services 20 1144603093 0 Physicians Fluoride varnish 20 1144603093 0 Physicians Healthy Kids Services 20 1144603093 0 Physicians Optical Supplies 20 1144603093 0 Physicians Physician Services 00 1144603499 0 BLINDERMAN POLINA 2017200 9999999 B 10 1144603499 0 5777 DEPT CAROL STREAM IL 601220021 20 1144603499 0 Clinical Social Worker Social work service 00 1144603929 0 ALKHAWAJA MUSTAFA 2016191 9999999 B 10 1144603929 0 11 W DOWNER PL AURORA IL 605065134 20 1144603929 0 Dentists Dental Services 20 1144603929 0 Dentists Physician Services 00 1144604323 0 NOONE TINA 2023054 9999999 B 10 1144604323 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1144604323 0 Nurse Practitioners Healthy Kids Services 20 1144604323 0 Nurse Practitioners Nurse Practitioners Services 20 1144604323 0 Nurse Practitioners Physician Services 00 1144604604 0 ROZELL DANA 2019203 9999999 B 10 1144604604 0 PO BOX 207163 DALLAS TX 753207154 20 1144604604 0 Optometrists Optical Supplies 20 1144604604 0 Optometrists Optometric Services 20 1144604604 0 Optometrists Physician Services 00 1144604919 0 THEISS KEVIN 2017121 9999999 B 10 1144604919 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112323 20 1144604919 0 Dentists Dental Services 20 1144604919 0 Dentists Physician Services 00 1144604976 0 KOPPELMANN TAL 2022339 9999999 B 10 1144604976 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1144604976 0 Physicians Anesthesia Services 20 1144604976 0 Physicians Healthy Kids Services 20 1144604976 0 Physicians Optical Supplies 20 1144604976 0 Physicians Physician Services 00 1144605262 0 SYED JUWAIRIYA 2015336 9999999 B 10 1144605262 0 904 ROOSEVELT RD GLEN ELLYN IL 601377829 20 1144605262 0 Dentists Dental Services 20 1144605262 0 Dentists Physician Services 00 1144606195 0 WALLACE JAMI M 2016038 9999999 B 10 1144606195 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1144606195 0 Nurse Practitioners Fluoride varnish 20 1144606195 0 Nurse Practitioners Healthy Kids Services 20 1144606195 0 Nurse Practitioners Nurse Practitioners Services 20 1144606195 0 Nurse Practitioners Physician Services 00 1144606385 0 PESCH SERENA 2016267 9999999 B 10 1144606385 0 455 E MAIN ST EAST DUNDEE IL 601181529 20 1144606385 0 Clinical Social Worker Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1144606583 0 BHANDARI AMIT 2019213 9999999 B 10 1144606583 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1144606583 0 Physicians Anesthesia Services 20 1144606583 0 Physicians Healthy Kids Services 20 1144606583 0 Physicians Optical Supplies 20 1144606583 0 Physicians Physician Services 00 1144607854 0 BUEHNE SADIE R 2017084 9999999 B 10 1144607854 0 400 BROADWAY HIGHLAND IL 622492024 20 1144607854 0 Speech Therapists Medical Supplies 20 1144607854 0 Speech Therapists Medical equipment/prosthetic devices 20 1144607854 0 Speech Therapists Speech Therapy/Pathology Services 00 1144608605 0 SHULTS TABITHA A 2015279 9999999 B 10 1144608605 0 PO BOX 1230 EVANSVILLE IN 477061230 20 1144608605 0 Nurse Practitioners Healthy Kids Services 20 1144608605 0 Nurse Practitioners Nurse Practitioners Services 20 1144608605 0 Nurse Practitioners Physician Services 00 1144609033 0 SORIANO PAMELA C 2022137 9999999 B 10 1144609033 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1144609033 0 Physicians Anesthesia Services 20 1144609033 0 Physicians Fluoride varnish 20 1144609033 0 Physicians Healthy Kids Services 20 1144609033 0 Physicians Optical Supplies 20 1144609033 0 Physicians Physician Services 00 1144609256 0 PEARSON STEVEN D 2018340 9999999 B 10 1144609256 0 5777 DEPT CAROL STREAM IL 601228942 20 1144609256 0 Physicians Anesthesia Services 20 1144609256 0 Physicians Fluoride varnish 20 1144609256 0 Physicians Healthy Kids Services 20 1144609256 0 Physicians Optical Supplies 20 1144609256 0 Physicians Physician Services 00 1144609678 0 SPENNER ERIC M 2016035 9999999 B 10 1144609678 0 PO BOX 20556 SPRINGFIELD IL 627080556 20 1144609678 0 Physician Assistant Only Fluoride varnish 20 1144609678 0 Physician Assistant Only Healthy Kids Services 20 1144609678 0 Physician Assistant Only Physician Services 00 1144610379 0 GIGLIOTTI NATASHA V 2025021 9999999 B 10 1144610379 0 8707 SKOKIE BLVD SKOKIE IL 600772269 20 1144610379 0 Speech Therapists Medical Supplies 20 1144610379 0 Speech Therapists Medical equipment/prosthetic devices 20 1144610379 0 Speech Therapists Speech Therapy/Pathology Services 00 1144612920 0 BOHNE MARY F 2015069 9999999 B 10 1144612920 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1144612920 0 Nurse Practitioners Healthy Kids Services 20 1144612920 0 Nurse Practitioners Nurse Practitioners Services 20 1144612920 0 Nurse Practitioners Physician Services 00 1144613431 0 MATTERN JESSICA 2016160 9999999 B 10 1144613431 0 1812 N 19TH AVE MELROSE PARK IL 601602039 20 1144613431 0 Dentists Dental Services 20 1144613431 0 Dentists Physician Services 00 1144614454 0 CASTRO JESSIE W 2018331 9999999 B 10 1144614454 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1144614454 0 Physicians Anesthesia Services 20 1144614454 0 Physicians Fluoride varnish 20 1144614454 0 Physicians Healthy Kids Services 20 1144614454 0 Physicians Optical Supplies 20 1144614454 0 Physicians Physician Services 00 1144614488 0 WARMACK MELISSA K 2017224 9999999 B 10 1144614488 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1144614488 0 Nurse Practitioners Fluoride varnish 20 1144614488 0 Nurse Practitioners Healthy Kids Services 20 1144614488 0 Nurse Practitioners Nurse Practitioners Services 20 1144614488 0 Nurse Practitioners Physician Services 00 1144614504 0 DAWSON MEGAN M 2022060 9999999 B 10 1144614504 0 3621 S STATE ST ANN ARBOR MI 481081633 20 1144614504 0 Physicians Anesthesia Services 20 1144614504 0 Physicians Healthy Kids Services 20 1144614504 0 Physicians Optical Supplies 20 1144614504 0 Physicians Physician Services 20 1144614504 0 Physicians Physicians Psychiatric Services 00 1144614603 0 KRIEDERMANN JACOB 2020070 9999999 B 10 1144614603 0 877 JEFFERSON AVE MEMPHIS TN 381032807 20 1144614603 0 Physicians Anesthesia Services 20 1144614603 0 Physicians Healthy Kids Services 20 1144614603 0 Physicians Optical Supplies 20 1144614603 0 Physicians Physician Services 00 1144615014 0 LIPMAN MICHELLE 2023274 9999999 B 10 1144615014 0 PO BOX 301208 DALLAS TX 753031208 20 1144615014 0 Physicians Anesthesia Services 20 1144615014 0 Physicians Healthy Kids Services 20 1144615014 0 Physicians Optical Supplies 20 1144615014 0 Physicians Physician Services 00 1144615428 0 TULLOCK MELISSA 2021312 9999999 B 10 1144615428 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1144615428 0 Physicians Anesthesia Services 20 1144615428 0 Physicians Fluoride varnish 20 1144615428 0 Physicians Healthy Kids Services 20 1144615428 0 Physicians Optical Supplies 20 1144615428 0 Physicians Physician Services 00 1144615436 0 PEDONE ERIC 2020015 9999999 B 10 1144615436 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1144615436 0 Physicians Anesthesia Services 20 1144615436 0 Physicians Healthy Kids Services 20 1144615436 0 Physicians Optical Supplies 20 1144615436 0 Physicians Physician Services 00 1144615469 0 FARJO PETER 2023186 9999999 B 10 1144615469 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1144615469 0 Physicians Anesthesia Services 20 1144615469 0 Physicians Fluoride varnish 20 1144615469 0 Physicians Healthy Kids Services 20 1144615469 0 Physicians Optical Supplies 20 1144615469 0 Physicians Physician Services 00 1144616103 0 NEW ANDREW C 2023131 9999999 B 10 1144616103 0 5777 DEPT CAROL STREAM IL 601220021 20 1144616103 0 Physicians Anesthesia Services 20 1144616103 0 Physicians Healthy Kids Services 20 1144616103 0 Physicians Optical Supplies 20 1144616103 0 Physicians Physician Services 20 1144616103 0 Physicians Physicians Psychiatric Services 00 1144616327 0 GRYZBEK ANGELA N 2015152 9999999 B 10 1144616327 0 5777 DEPT CAROL STREAM IL 601220021 20 1144616327 0 Nurse Practitioners Healthy Kids Services 20 1144616327 0 Nurse Practitioners Nurse Practitioners Services 20 1144616327 0 Nurse Practitioners Physician Services 00 1144616954 0 LANGNER KARL 2018295 9999999 B 10 1144616954 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1144616954 0 Physicians Anesthesia Services 20 1144616954 0 Physicians Fluoride varnish 20 1144616954 0 Physicians Healthy Kids Services 20 1144616954 0 Physicians Optical Supplies 20 1144616954 0 Physicians Physician Services 00 1144617044 0 EDWARDS PRICE 2021221 9999999 B 10 1144617044 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1144617044 0 Physicians Anesthesia Services 20 1144617044 0 Physicians Fluoride varnish 20 1144617044 0 Physicians Healthy Kids Services 20 1144617044 0 Physicians Optical Supplies 20 1144617044 0 Physicians Physician Services 00 1144617283 0 FINSTAD STEVEN J 2023135 9999999 B 10 1144617283 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1144617283 0 Physicians Anesthesia Services 20 1144617283 0 Physicians Fluoride varnish 20 1144617283 0 Physicians Healthy Kids Services 20 1144617283 0 Physicians Optical Supplies 20 1144617283 0 Physicians Physician Services 00 1144617788 0 THAKADIYIL SANDY M 2018288 9999999 B 10 1144617788 0 PO BOX 840532 DALLAS TX 752840532 20 1144617788 0 Physicians Anesthesia Services 20 1144617788 0 Physicians Fluoride varnish 20 1144617788 0 Physicians Healthy Kids Services 20 1144617788 0 Physicians Optical Supplies 20 1144617788 0 Physicians Physician Services 00 1144617846 0 PUTATUNDA SUJATA 2023283 9999999 B 10 1144617846 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1144617846 0 Physicians Anesthesia Services 20 1144617846 0 Physicians Fluoride varnish 20 1144617846 0 Physicians Healthy Kids Services 20 1144617846 0 Physicians Optical Supplies 20 1144617846 0 Physicians Physician Services 00 1144617978 0 ENOCHS WILLIAM 2024009 9999999 B 10 1144617978 0 1601 OLD SOUTH RIVER RD SAINT CHARLES MO 633034120 20 1144617978 0 Physicians Anesthesia Services 20 1144617978 0 Physicians Healthy Kids Services 20 1144617978 0 Physicians Optical Supplies 20 1144617978 0 Physicians Physician Services 20 1144617978 0 Physicians Physicians Psychiatric Services 00 1144618414 0 DOHAR SHEENA 2024194 9999999 B 10 1144618414 0 801 ADLAI STEVENSON DR SPRINGFIELD IL 627034261 20 1144618414 0 Physicians Anesthesia Services 20 1144618414 0 Physicians Healthy Kids Services 20 1144618414 0 Physicians Optical Supplies 20 1144618414 0 Physicians Physician Services 20 1144618414 0 Physicians Physicians Psychiatric Services 00 1144618539 0 DANIELS LAURA L 2022073 9999999 B 10 1144618539 0 29373 NETWORK PL CHICAGO IL 606733039 20 1144618539 0 Nurse Practitioners Fluoride varnish 20 1144618539 0 Nurse Practitioners Healthy Kids Services 20 1144618539 0 Nurse Practitioners Nurse Practitioners Services 20 1144618539 0 Nurse Practitioners Physician Services 00 1144619123 0 RODRIGUEZ CARLA 2015033 9999999 B 10 1144619123 0 1395 NW 167TH ST MIAMI FL 331695710 20 1144619123 0 Nurse Practitioners Fluoride varnish 20 1144619123 0 Nurse Practitioners Healthy Kids Services 20 1144619123 0 Nurse Practitioners Nurse Practitioners Services 20 1144619123 0 Nurse Practitioners Physician Services 00 1144620139 0 WASHINGTON ERICA L 2021260 9999999 B 10 1144620139 0 930 175TH ST STE 1E HOMEWOOD IL 604302078 20 1144620139 0 Other behavior health professional LCPC/LMFT services 00 1144620642 0 HUNT ALISON D 2015285 9999999 B 10 1144620642 0 PO BOX 689 LAKE FOREST IL 600450689 20 1144620642 0 Nurse Practitioners Anesthesia Services 20 1144620642 0 Nurse Practitioners Nurse Practitioners Services 20 1144620642 0 Nurse Practitioners Physician Services 00 1144620824 0 CALVERT FANISHA 2018268 9999999 B 10 1144620824 0 5220 EAST AVE COUNTRYSIDE IL 605253133 20 1144620824 0 Other behavior health professional Social work service 00 1144622457 0 SUNSERI ELIZABETH M 2018197 9999999 B 10 1144622457 0 2506 N CLARK ST # 158 CHICAGO IL 606141848 20 1144622457 0 Physical Therapists Medical Supplies 20 1144622457 0 Physical Therapists Medical equipment/prosthetic devices 20 1144622457 0 Physical Therapists Physical Therapy Services 00 1144622572 0 GEORGES ERIN B 2015334 9999999 B 10 1144622572 0 PO BOX 1510 EVANSVILLE IN 477061510 20 1144622572 0 Nurse Practitioners Fluoride varnish 20 1144622572 0 Nurse Practitioners Healthy Kids Services 20 1144622572 0 Nurse Practitioners Nurse Practitioners Services 20 1144622572 0 Nurse Practitioners Physician Services 00 1144622705 0 RADEMACHER LINDSAY R 2014274 9999999 B 10 1144622705 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1144622705 0 Nurse Practitioners Healthy Kids Services 20 1144622705 0 Nurse Practitioners Nurse Practitioners Services 20 1144622705 0 Nurse Practitioners Physician Services 00 1144623422 0 COCHRAN ANNALISA B 2017095 9999999 B 10 1144623422 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1144623422 0 Nurse Practitioners Fluoride varnish 20 1144623422 0 Nurse Practitioners Healthy Kids Services 20 1144623422 0 Nurse Practitioners Nurse Practitioners Services 20 1144623422 0 Nurse Practitioners Physician Services 00 1144623752 0 BIANZON MICHELLE 2017048 9999999 B 10 1144623752 0 1243 RICKERT DR NAPERVILLE IL 605400954 20 1144623752 0 Nurse Practitioners Healthy Kids Services 20 1144623752 0 Nurse Practitioners Nurse Practitioners Services 20 1144623752 0 Nurse Practitioners Physician Services 00 1144624768 0 PARKS PEARL 2024167 9999999 B 10 1144624768 0 4137 SAUK TRL STE 148 RICHTON PARK IL 604711253 20 1144624768 0 Other behavior health professional LCPC/LMFT services 00 1144624891 0 RAINS-EATON TIFFANEY K 2015287 9999999 B 10 1144624891 0 1025 MAINE ST QUINCY IL 623014038 20 1144624891 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1144625039 0 SARLI MICHELLE E 2014335 9999999 B 10 1144625039 0 500 PORTER AVE AURORA MO 656052365 20 1144625039 0 Nurse Practitioners Fluoride varnish 20 1144625039 0 Nurse Practitioners Healthy Kids Services 20 1144625039 0 Nurse Practitioners Nurse Practitioners Services 20 1144625039 0 Nurse Practitioners Physician Services 00 1144625815 0 MORALES ALICIA 2022313 9999999 B 10 1144625815 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1144625815 0 Nurse Practitioners Fluoride varnish 20 1144625815 0 Nurse Practitioners Healthy Kids Services 20 1144625815 0 Nurse Practitioners Nurse Practitioners Services 20 1144625815 0 Nurse Practitioners Physician Services 00 1144626664 0 WU SHELLY S 2024218 9999999 B 10 1144626664 0 5777 DEPT CAROL STREAM IL 601220021 20 1144626664 0 Physical Therapists Medical Supplies 20 1144626664 0 Physical Therapists Medical 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Services 00 1144627837 0 FUENTES PENA CLAUDIA C 2016148 9999999 B 10 1144627837 0 447 SUTTER ST STE 405 SAN FRANCISCO CA 941084618 20 1144627837 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1144628348 0 KHINE THINZAR 2016214 9999999 B 10 1144628348 0 PO BOX 500 ELLICOTTVILLE NY 147310500 20 1144628348 0 Physician Assistant Only Fluoride varnish 20 1144628348 0 Physician Assistant Only Healthy Kids Services 20 1144628348 0 Physician Assistant Only Physician Services 00 1144628371 0 GROSHEK CASSI JO 2022290 9999999 B 10 1144628371 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1144628371 0 Physician Assistant Only Fluoride varnish 20 1144628371 0 Physician Assistant Only Healthy Kids Services 20 1144628371 0 Physician Assistant Only Physician Services 00 1144628512 0 HOFFMANN ABIGAIL 2016263 9999999 B 10 1144628512 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1144628512 0 Other behavior health 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20 1144637380 0 Physicians Anesthesia Services 20 1144637380 0 Physicians Fluoride varnish 20 1144637380 0 Physicians Healthy Kids Services 20 1144637380 0 Physicians Optical Supplies 20 1144637380 0 Physicians Physician Services 00 1144637794 0 HOELSCHER AMANDA E 2015152 9999999 B 10 1144637794 0 607 W ORCHARD ST VANDALIA IL 624711234 20 1144637794 0 Dentists Dental Services 20 1144637794 0 Dentists Physician Services 00 1144638461 0 CHAPMAN COLLEEN M 2022223 9999999 B 10 1144638461 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1144638461 0 Physical Therapists Medical Supplies 20 1144638461 0 Physical Therapists Medical equipment/prosthetic devices 20 1144638461 0 Physical Therapists Physical Therapy Services 00 1144638487 0 DE LA CRUZ GEMMA 2014202 9999999 B 10 1144638487 0 19990 GOVERNORS HWY OLYMPIA FIELDS IL 604611021 20 1144638487 0 Nurse Practitioners Fluoride varnish 20 1144638487 0 Nurse Practitioners Healthy Kids Services 20 1144638487 0 Nurse Practitioners Nurse 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1144665654 0 Physicians Physician Services 00 1144665878 0 GRADIANU MARIUS 2021277 9999999 B 10 1144665878 0 1300 N ARLINGTON HEIGHTS RD ST ITASCA IL 601433128 20 1144665878 0 Physicians Anesthesia Services 20 1144665878 0 Physicians Healthy Kids Services 20 1144665878 0 Physicians Optical Supplies 20 1144665878 0 Physicians Physician Services 00 1144665993 0 TRIVEDI MEHUL 2017205 9999999 B 10 1144665993 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1144665993 0 Psychologist Psychologist service 00 1144666348 0 POLSTER SEAN P 2019001 9999999 B 10 1144666348 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1144666348 0 Physicians Anesthesia Services 20 1144666348 0 Physicians Healthy Kids Services 20 1144666348 0 Physicians Optical Supplies 20 1144666348 0 Physicians Physician Services 00 1144667825 0 HAMSTRA PRAIRIE DYANNA JM 2020174 9999999 B 10 1144667825 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1144667825 0 Speech Therapists Medical Supplies 20 1144667825 0 Speech Therapists 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Practitioners Nurse Practitioners Services 20 1144730904 0 Nurse Practitioners Physician Services 00 1144731316 0 OVERHOLT ANGELA M 2018213 9999999 B 10 1144731316 0 1120 N MELVIN ST GIBSON CITY IL 609361477 20 1144731316 0 Clinical Social Worker Social work service 00 1144731498 0 GARCIA PAUL R 2017307 9999999 B 10 1144731498 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1144731498 0 Physicians Anesthesia Services 20 1144731498 0 Physicians Fluoride varnish 20 1144731498 0 Physicians Healthy Kids Services 20 1144731498 0 Physicians Optical Supplies 20 1144731498 0 Physicians Physician Services 00 1144731993 0 KOLLROSS SANDY J 2017324 9999999 B 10 1144731993 0 300 S HARRISON ST COLFAX IL 617289216 20 1144731993 0 Speech Therapists Medical Supplies 20 1144731993 0 Speech Therapists Medical equipment/prosthetic devices 20 1144731993 0 Speech Therapists Speech Therapy/Pathology Services 00 1144732140 0 SHEPPARD CAROLINE 2017335 9999999 B 10 1144732140 0 150 HARVESTER DR STE 300 BURR 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20 1144733783 0 Nurse Practitioners Nurse Practitioners Services 20 1144733783 0 Nurse Practitioners Physician Services 00 1144734427 0 IBRAHIM JILL A 2017305 9999999 B 10 1144734427 0 5665 NEW NORTHSIDE DR STE 320 ATLANTA GA 303285834 20 1144734427 0 Nurse Practitioners Healthy Kids Services 20 1144734427 0 Nurse Practitioners Nurse Practitioners Services 20 1144734427 0 Nurse Practitioners Physician Services 00 1144734849 0 MCGING KRISTEN N 2020176 9999999 B 10 1144734849 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1144734849 0 Nurse Practitioners Fluoride varnish 20 1144734849 0 Nurse Practitioners Healthy Kids Services 20 1144734849 0 Nurse Practitioners Nurse Practitioners Services 20 1144734849 0 Nurse Practitioners Physician Services 00 1144735010 0 SABAL LORI 2017347 9999999 B 10 1144735010 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1144735010 0 Speech Therapists Medical Supplies 20 1144735010 0 Speech Therapists Medical equipment/prosthetic devices 20 1144735010 0 Speech Therapists Speech Therapy/Pathology Services 00 1144735150 0 SCHECTER NOEL M 2024338 9999999 B 10 1144735150 0 42 W MADISON ST FL 2 CHICAGO IL 606024309 20 1144735150 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1144736026 0 BALTRUSIS BRIANNA J 2018202 9999999 B 10 1144736026 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1144736026 0 Speech Therapists Medical Supplies 20 1144736026 0 Speech Therapists Medical equipment/prosthetic devices 20 1144736026 0 Speech Therapists Speech Therapy/Pathology Services 00 1144736695 0 SCHMITT COURTNEY L 2017360 9999999 B 10 1144736695 0 12300 GREENWOOD AVE BLUE ISLAND IL 604061558 20 1144736695 0 Speech Therapists Medical Supplies 20 1144736695 0 Speech Therapists Medical equipment/prosthetic devices 20 1144736695 0 Speech Therapists Speech Therapy/Pathology Services 00 1144737123 0 CAMPO TARA A 2018015 9999999 B 10 1144737123 0 350 N WALL ST KANKAKEE IL 609012901 20 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SPRINGFIELD IL 627621000 20 1144739210 0 Nurse Practitioners Anesthesia Services 20 1144739210 0 Nurse Practitioners Nurse Practitioners Services 20 1144739210 0 Nurse Practitioners Physician Services 00 1144739640 0 BIELMAN AMANDA 2017345 9999999 B 10 1144739640 0 PO BOX 500 ELLICOTTVILLE NY 147310500 20 1144739640 0 Physician Assistant Only Fluoride varnish 20 1144739640 0 Physician Assistant Only Healthy Kids Services 20 1144739640 0 Physician Assistant Only Physician Services 00 1144740200 0 SLADE MICHAEL J 2019027 9999999 B 10 1144740200 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1144740200 0 Physicians Anesthesia Services 20 1144740200 0 Physicians Fluoride varnish 20 1144740200 0 Physicians Healthy Kids Services 20 1144740200 0 Physicians Optical Supplies 20 1144740200 0 Physicians Physician Services 00 1144740549 0 MAVER DAVID B 2017233 9999999 B 10 1144740549 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1144740549 0 Nurse Practitioners Healthy Kids Services 20 1144740549 0 Nurse Practitioners Nurse Practitioners Services 20 1144740549 0 Nurse Practitioners Physician Services 00 1144740598 0 SPELLMAN KEVIN 2023066 9999999 B 10 1144740598 0 225 E CHICAGO AVE CHICAGO IL 606112991 20 1144740598 0 Physicians Anesthesia Services 20 1144740598 0 Physicians Healthy Kids Services 20 1144740598 0 Physicians Optical Supplies 20 1144740598 0 Physicians Physician Services 00 1144740804 0 WU JINGSHING 2024245 9999999 B 10 1144740804 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1144740804 0 Physicians Anesthesia Services 20 1144740804 0 Physicians Fluoride varnish 20 1144740804 0 Physicians Healthy Kids Services 20 1144740804 0 Physicians Optical Supplies 20 1144740804 0 Physicians Physician Services 00 1144740820 0 ZHAO DIANA 2019177 9999999 B 10 1144740820 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1144740820 0 Physicians Anesthesia Services 20 1144740820 0 Physicians Fluoride varnish 20 1144740820 0 Physicians Healthy Kids 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Psychiatric Services 00 1144742495 0 BROWN BRITTANY C 2017229 9999999 B 10 1144742495 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1144742495 0 Nurse Practitioners Healthy Kids Services 20 1144742495 0 Nurse Practitioners Nurse Practitioners Services 20 1144742495 0 Nurse Practitioners Physician Services 00 1144743030 0 PANI MEGAN L 2018344 9999999 B 10 1144743030 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1144743030 0 Speech Therapists Medical Supplies 20 1144743030 0 Speech Therapists Medical equipment/prosthetic devices 20 1144743030 0 Speech Therapists Speech Therapy/Pathology Services 00 1144743360 0 PETERSON ANASTASIA 2023018 9999999 B 10 1144743360 0 PO BOX 1455 DES MOINES IA 503061455 20 1144743360 0 Physician Assistant Only Fluoride varnish 20 1144743360 0 Physician Assistant Only Healthy Kids Services 20 1144743360 0 Physician Assistant Only Physician Services 00 1144743444 0 BANKS CAITLYN 2022333 9999999 B 10 1144743444 0 231 E INDIAN TRL AURORA IL 605051732 20 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1144744095 0 Nurse Practitioners Physician Services 00 1144745100 0 PATTEN AMANDA 2018240 9999999 B 10 1144745100 0 550 S CARBON HILL RD COAL CITY IL 604169526 20 1144745100 0 Speech Therapists Medical Supplies 20 1144745100 0 Speech Therapists Medical equipment/prosthetic devices 20 1144745100 0 Speech Therapists Speech Therapy/Pathology Services 00 1144747858 0 HAGERMAN LOGAN 2017317 9999999 B 10 1144747858 0 4230 11TH ST ROCK ISLAND IL 612016746 20 1144747858 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1144748179 0 CURTIN MARTHA A 2017310 9999999 B 10 1144748179 0 PO BOX 3988 CARBONDALE IL 629023988 20 1144748179 0 Physician Assistant Only Fluoride varnish 20 1144748179 0 Physician Assistant Only Healthy Kids Services 20 1144748179 0 Physician Assistant Only Physician Services 00 1144748237 0 WALTERS HEATHER 2017263 9999999 B 10 1144748237 0 1318 W 6TH ST KEWANEE IL 614431261 20 1144748237 0 Speech Therapists Medical Supplies 20 1144748237 0 Speech Therapists Medical equipment/prosthetic devices 20 1144748237 0 Speech Therapists Speech Therapy/Pathology Services 00 1144748435 0 WALKER NATALIE A 2017300 9999999 B 10 1144748435 0 1062 BOSKYDELL RD CARBONDALE IL 629027743 20 1144748435 0 Speech Therapists Medical Supplies 20 1144748435 0 Speech Therapists Medical equipment/prosthetic devices 20 1144748435 0 Speech Therapists Speech Therapy/Pathology Services 00 1144749268 0 FUENTES STEPHANY 2018084 9999999 B 10 1144749268 0 3010 GRAND AVE WAUKEGAN IL 600852321 20 1144749268 0 Other behavior health professional Social work service 00 1144750092 0 HAYS KRISTINE M 2017256 9999999 B 10 1144750092 0 PO BOX 631767 CINCINNATI OH 452631767 20 1144750092 0 Nurse Practitioners Healthy Kids Services 20 1144750092 0 Nurse Practitioners Nurse Practitioners Services 20 1144750092 0 Nurse Practitioners Physician Services 00 1144750423 0 INGLES LAUREN A. 2017244 9999999 B 10 1144750423 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1144750423 0 Physician Assistant Only Fluoride varnish 20 1144750423 0 Physician Assistant Only Healthy Kids Services 20 1144750423 0 Physician Assistant Only Physician Services 00 1144750456 0 RISSMAN CODY 2022143 9999999 B 10 1144750456 0 901 MACARTHUR BLVD MUNSTER IN 463212901 20 1144750456 0 Physicians Anesthesia Services 20 1144750456 0 Physicians Healthy Kids Services 20 1144750456 0 Physicians Optical Supplies 20 1144750456 0 Physicians Physician Services 00 1144750605 0 SALAH REBECCA L 2017187 9999999 B 10 1144750605 0 4969 BENCHMARK CENTRE DR STE 1 STE 100 SWANSEA IL 622268928 20 1144750605 0 Other behavior health professional LCPC/LMFT services 00 1144750894 0 WARD EMILY 2023317 9999999 B 10 1144750894 0 PO BOX 530 HAVANA IL 626440530 20 1144750894 0 Physician Assistant Only Fluoride varnish 20 1144750894 0 Physician Assistant Only Healthy Kids Services 20 1144750894 0 Physician Assistant Only Physician Services 00 1144751116 0 BARRETT-ENGLERT MEGHAN 2023226 9999999 B 10 1144751116 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1144751116 0 Physicians Anesthesia Services 20 1144751116 0 Physicians Fluoride varnish 20 1144751116 0 Physicians Healthy Kids Services 20 1144751116 0 Physicians Optical Supplies 20 1144751116 0 Physicians Physician Services 00 1144751181 0 SIMMONS MARCI 2003237 9999999 B 10 1144751181 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1144751181 0 Occupational Therapists Medical Supplies 20 1144751181 0 Occupational Therapists Medical equipment/prosthetic devices 20 1144751181 0 Occupational Therapists Occupational Therapy Services 00 1144751249 0 MASSEL DUSTIN H 2022115 9999999 B 10 1144751249 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1144751249 0 Physicians Anesthesia Services 20 1144751249 0 Physicians Healthy Kids Services 20 1144751249 0 Physicians Optical Supplies 20 1144751249 0 Physicians Physician Services 00 1144751256 0 KOEHLER MAYA 2017177 9999999 B 10 1144751256 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1144751256 0 Physicians Anesthesia Services 20 1144751256 0 Physicians Fluoride varnish 20 1144751256 0 Physicians Healthy Kids Services 20 1144751256 0 Physicians Optical Supplies 20 1144751256 0 Physicians Physician Services 00 1144751744 0 GRIFFIN BRIANNE 2017089 9999999 B 10 1144751744 0 2901 FINLEY RD STE 102 DOWNERS GROVE IL 605151774 20 1144751744 0 Occupational Therapists Medical Supplies 20 1144751744 0 Occupational Therapists Medical equipment/prosthetic devices 20 1144751744 0 Occupational Therapists Occupational Therapy Services 00 1144751751 0 PLIKAS DIMITRI 2020089 9999999 B 10 1144751751 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1144751751 0 Physicians Anesthesia Services 20 1144751751 0 Physicians Fluoride varnish 20 1144751751 0 Physicians Healthy Kids Services 20 1144751751 0 Physicians Optical Supplies 20 1144751751 0 Physicians Physician Services 00 1144751827 0 PETTERS EKANGA S 2022221 9999999 B 10 1144751827 0 2300 N EDWARD ST DECATUR IL 625264163 20 1144751827 0 Physicians Anesthesia Services 20 1144751827 0 Physicians Fluoride varnish 20 1144751827 0 Physicians Healthy Kids Services 20 1144751827 0 Physicians Optical Supplies 20 1144751827 0 Physicians Physician Services 00 1144751967 0 ORDING JEFFREY C 2020253 9999999 B 10 1144751967 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1144751967 0 Physicians Anesthesia Services 20 1144751967 0 Physicians Fluoride varnish 20 1144751967 0 Physicians Healthy Kids Services 20 1144751967 0 Physicians Optical Supplies 20 1144751967 0 Physicians Physician Services 00 1144752007 0 ROBINSON XAVIER A 2023085 9999999 B 10 1144752007 0 220 COMPASS POINT DR SAINT CHARLES MO 633014405 20 1144752007 0 Physicians Anesthesia Services 20 1144752007 0 Physicians Healthy Kids Services 20 1144752007 0 Physicians Optical Supplies 20 1144752007 0 Physicians Physician Services 00 1144752288 0 MILLER BRADFORD T 2023180 9999999 B 10 1144752288 0 PO 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29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1144752528 0 Physicians Anesthesia Services 20 1144752528 0 Physicians Fluoride varnish 20 1144752528 0 Physicians Healthy Kids Services 20 1144752528 0 Physicians Optical Supplies 20 1144752528 0 Physicians Physician Services 00 1144752627 0 KHAN ATIF H 2022236 9999999 B 10 1144752627 0 5777 DEPT CAROL STREAM IL 601220021 20 1144752627 0 Physicians Anesthesia Services 20 1144752627 0 Physicians Healthy Kids Services 20 1144752627 0 Physicians Optical Supplies 20 1144752627 0 Physicians Physician Services 00 1144753062 0 BALOCH LUQMAN 2020135 9999999 B 10 1144753062 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1144753062 0 Physicians Anesthesia Services 20 1144753062 0 Physicians Fluoride varnish 20 1144753062 0 Physicians Healthy Kids Services 20 1144753062 0 Physicians Optical Supplies 20 1144753062 0 Physicians Physician Services 00 1144753237 0 SAUER MEGAN 2018001 9999999 B 10 1144753237 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1144753237 0 Physicians Anesthesia Services 20 1144753237 0 Physicians Healthy Kids Services 20 1144753237 0 Physicians Optical Supplies 20 1144753237 0 Physicians Physician Services 00 1144753385 0 EAST NICOLE 2017222 9999999 B 10 1144753385 0 800 W FULTON MARKET FL 12 CHICAGO IL 606071302 20 1144753385 0 Nurse Practitioners Fluoride varnish 20 1144753385 0 Nurse Practitioners Healthy Kids Services 20 1144753385 0 Nurse Practitioners Nurse Practitioners Services 20 1144753385 0 Nurse Practitioners Nursing service 20 1144753385 0 Nurse Practitioners Physician Services 00 1144753500 0 KEEN JAMIE 2021188 9999999 B 10 1144753500 0 940 LEE ST DES PLAINES IL 600166555 20 1144753500 0 Physicians Anesthesia Services 20 1144753500 0 Physicians Healthy Kids Services 20 1144753500 0 Physicians Optical Supplies 20 1144753500 0 Physicians Physician Services 00 1144754276 0 RANA SEHRISH N 2017191 9999999 B 10 1144754276 0 400 N HIGHLAND AVE AURORA IL 605063814 20 1144754276 0 Podiatrists Podiatric Services 00 1144754524 0 ADATIA KAVITA RAVI 2024071 9999999 B 10 1144754524 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1144754524 0 Other behavior health professional LCPC/LMFT services 00 1144754573 0 HEINRICH KELLI 2020163 9999999 B 10 1144754573 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1144754573 0 Physicians Anesthesia Services 20 1144754573 0 Physicians Fluoride varnish 20 1144754573 0 Physicians Healthy Kids Services 20 1144754573 0 Physicians Optical Supplies 20 1144754573 0 Physicians Physician Services 00 1144754607 0 PHAM KEVIN K 2021265 9999999 B 10 1144754607 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1144754607 0 Physicians Anesthesia Services 20 1144754607 0 Physicians Fluoride varnish 20 1144754607 0 Physicians Healthy Kids Services 20 1144754607 0 Physicians Optical Supplies 20 1144754607 0 Physicians Physician Services 00 1144754946 0 LINTON EDWARD F 2021188 9999999 B 10 1144754946 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1144754946 0 Physicians Anesthesia Services 20 1144754946 0 Physicians Healthy Kids Services 20 1144754946 0 Physicians Optical Supplies 20 1144754946 0 Physicians Physician Services 00 1144754995 0 DOERR OPENLANDER BRIDGET E 2017187 9999999 B 10 1144754995 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1144754995 0 Nurse Practitioners Fluoride varnish 20 1144754995 0 Nurse Practitioners Healthy Kids Services 20 1144754995 0 Nurse Practitioners Nurse Practitioners Services 20 1144754995 0 Nurse Practitioners Physician Services 00 1144755323 0 CASH-O'BANNON NAILAH W 2024264 9999999 B 10 1144755323 0 29373 NETWORK PL CHICAGO IL 606733039 20 1144755323 0 Physicians Anesthesia Services 20 1144755323 0 Physicians Fluoride varnish 20 1144755323 0 Physicians Healthy Kids Services 20 1144755323 0 Physicians Optical Supplies 20 1144755323 0 Physicians Physician Services 00 1144755802 0 BROWN TRACI 2017121 9999999 B 10 1144755802 0 70 S RIVER ST AURORA IL 605065185 20 1144755802 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1144756438 0 KRUSE CARLY S 2017294 9999999 B 10 1144756438 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1144756438 0 Physicians Anesthesia Services 20 1144756438 0 Physicians Healthy Kids Services 20 1144756438 0 Physicians Optical Supplies 20 1144756438 0 Physicians Physician Services 00 1144756453 0 ZAMBON KIRSTEN 2022236 9999999 B 10 1144756453 0 PO BOX 781076 DETROIT MI 482781076 20 1144756453 0 Physical Therapists Medical Supplies 20 1144756453 0 Physical Therapists Medical equipment/prosthetic devices 20 1144756453 0 Physical Therapists Physical Therapy Services 00 1144756867 0 WILLIAMS STEPHANIE E 2022277 9999999 B 10 1144756867 0 1250 JUDY AVE BRIDGEPORT IL 624171321 20 1144756867 0 Speech Therapists Medical Supplies 20 1144756867 0 Speech Therapists Medical equipment/prosthetic devices 20 1144756867 0 Speech Therapists Speech Therapy/Pathology Services 00 1144757154 0 ALIJOSKI BUKURIJE 2018261 9999999 B 10 1144757154 0 5777 DEPT CAROL STREAM IL 601220021 20 1144757154 0 Nurse Practitioners Fluoride varnish 20 1144757154 0 Nurse Practitioners Healthy Kids Services 20 1144757154 0 Nurse Practitioners Nurse Practitioners Services 20 1144757154 0 Nurse Practitioners Physician Services 00 1144757238 0 SPIRGEN DUSTIN RAE 2021182 9999999 B 10 1144757238 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1144757238 0 Physicians Anesthesia Services 20 1144757238 0 Physicians Fluoride varnish 20 1144757238 0 Physicians Healthy Kids Services 20 1144757238 0 Physicians Optical Supplies 20 1144757238 0 Physicians Physician Services 00 1144757436 0 SYMMES ANNA G 2023335 9999999 B 10 1144757436 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1144757436 0 Physicians Anesthesia Services 20 1144757436 0 Physicians Fluoride varnish 20 1144757436 0 Physicians Healthy Kids Services 20 1144757436 0 Physicians Optical Supplies 20 1144757436 0 Physicians Physician Services 00 1144757717 0 MCCOY EMMA 2017135 9999999 B 10 1144757717 0 325 IL ROUTE 2 DIXON IL 610219118 20 1144757717 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1144757907 0 WOLFE NOLAN 2017233 9999999 B 10 1144757907 0 101 E MILLER RD STERLING IL 610811252 20 1144757907 0 Physical Therapists Medical Supplies 20 1144757907 0 Physical Therapists Medical equipment/prosthetic devices 20 1144757907 0 Physical Therapists Physical Therapy Services 00 1144758178 0 LYGHT MEGAN 2019154 9999999 B 10 1144758178 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1144758178 0 Physician Assistant Only Fluoride varnish 20 1144758178 0 Physician Assistant Only Healthy Kids Services 20 1144758178 0 Physician Assistant Only Physician Services 00 1144758459 0 SATPUTE ANKITA 2023167 9999999 B 10 1144758459 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1144758459 0 Physicians Anesthesia Services 20 1144758459 0 Physicians Healthy Kids Services 20 1144758459 0 Physicians Optical Supplies 20 1144758459 0 Physicians Physician Services 00 1144758491 0 ROYCE RAJI 2019168 9999999 B 10 1144758491 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1144758491 0 Nurse Practitioners Fluoride varnish 20 1144758491 0 Nurse Practitioners Healthy Kids Services 20 1144758491 0 Nurse Practitioners Nurse Practitioners Services 20 1144758491 0 Nurse Practitioners Physician Services 00 1144758855 0 MILANO ANDREW J 2017145 9999999 B 10 1144758855 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1144758855 0 Nurse Practitioners Anesthesia Services 20 1144758855 0 Nurse Practitioners Nurse Practitioners Services 20 1144758855 0 Nurse Practitioners Physician Services 00 1144760836 0 KOERNER REBECCA C 2017129 9999999 B 10 1144760836 0 5665 NEW NORTHSIDE DR STE 320 ATLANTA GA 303285834 20 1144760836 0 Nurse Practitioners Fluoride varnish 20 1144760836 0 Nurse Practitioners Healthy Kids Services 20 1144760836 0 Nurse Practitioners Nurse Practitioners Services 20 1144760836 0 Nurse Practitioners Physician Services 00 1144761438 0 KHAMBHATI SHRAVYA 2024247 9999999 B 10 1144761438 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1144761438 0 Physicians Anesthesia Services 20 1144761438 0 Physicians Fluoride varnish 20 1144761438 0 Physicians Healthy Kids Services 20 1144761438 0 Physicians Optical Supplies 20 1144761438 0 Physicians Physician Services 00 1144761446 0 TSEUMAH CORDELIA 2018227 9999999 B 10 1144761446 0 600 HOLIDAY PLAZA DR STE 200 MATTESON IL 604432237 20 1144761446 0 Nurse Practitioners Fluoride varnish 20 1144761446 0 Nurse Practitioners Healthy Kids Services 20 1144761446 0 Nurse Practitioners Nurse Practitioners Services 20 1144761446 0 Nurse Practitioners Physician Services 00 1144761495 0 DAVE ZUBAIR F 2020174 9999999 B 10 1144761495 0 5121 MARYLAND WAY STE 300 BRENTWOOD TN 370277516 20 1144761495 0 Physicians Anesthesia Services 20 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Physicians Healthy Kids Services 20 1144800038 0 Physicians Optical Supplies 20 1144800038 0 Physicians Physician Services 00 1144801408 0 BUNTING SAMUEL R 2021179 9999999 B 10 1144801408 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1144801408 0 Physicians Anesthesia Services 20 1144801408 0 Physicians Healthy Kids Services 20 1144801408 0 Physicians Optical Supplies 20 1144801408 0 Physicians Physician Services 20 1144801408 0 Physicians Physicians Psychiatric Services 00 1144801531 0 YANG XIAOYAN 2024241 9999999 B 10 1144801531 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1144801531 0 Physicians Anesthesia Services 20 1144801531 0 Physicians Healthy Kids Services 20 1144801531 0 Physicians Optical Supplies 20 1144801531 0 Physicians Physician Services 00 1144801804 0 COLBURN TATUM 2021247 9999999 B 10 1144801804 0 530 NE GLEN OAK AVE PEORIA IL 616370001 20 1144801804 0 Physicians Anesthesia Services 20 1144801804 0 Physicians Fluoride varnish 20 1144801804 0 Physicians 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1144856089 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1144856089 0 Physicians Anesthesia Services 20 1144856089 0 Physicians Fluoride varnish 20 1144856089 0 Physicians Healthy Kids Services 20 1144856089 0 Physicians Optical Supplies 20 1144856089 0 Physicians Physician Services 00 1144856451 0 REESE TYLER O 2024164 9999999 B 10 1144856451 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1144856451 0 Physicians Anesthesia Services 20 1144856451 0 Physicians Fluoride varnish 20 1144856451 0 Physicians Healthy Kids Services 20 1144856451 0 Physicians Optical Supplies 20 1144856451 0 Physicians Physician Services 00 1144856683 0 TONDINI ANDREW 2023034 9999999 B 10 1144856683 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1144856683 0 Physical Therapists Medical Supplies 20 1144856683 0 Physical Therapists Medical equipment/prosthetic devices 20 1144856683 0 Physical Therapists Physical Therapy Services 00 1144857285 0 DECKER MORGAN ELLIS 2021182 9999999 B 10 1144857285 0 75 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Physicians Healthy Kids Services 20 1144924259 0 Physicians Optical Supplies 20 1144924259 0 Physicians Physician Services 00 1144924846 0 LICHTIG ASHER 2024339 9999999 B 10 1144924846 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1144924846 0 Physicians Anesthesia Services 20 1144924846 0 Physicians Healthy Kids Services 20 1144924846 0 Physicians Optical Supplies 20 1144924846 0 Physicians Physician Services 00 1144927435 0 WOLINSKI HANNAH 2023039 9999999 B 10 1144927435 0 1005 BROADWAY ST QUINCY IL 623012834 20 1144927435 0 Nurse Practitioners Anesthesia Services 20 1144927435 0 Nurse Practitioners Nurse Practitioners Services 20 1144927435 0 Nurse Practitioners Physician Services 00 1144929167 0 CHURCH KALEB 2024232 9999999 B 10 1144929167 0 2525 KANEVILLE RD GENEVA IL 601342578 20 1144929167 0 Physician Assistant Only Fluoride varnish 20 1144929167 0 Physician Assistant Only Healthy Kids Services 20 1144929167 0 Physician Assistant Only Physician Services 00 1144930298 0 KANELLIS 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1144941857 0 Physician Assistant Only Healthy Kids Services 20 1144941857 0 Physician Assistant Only Physician Services 00 1144941907 0 CRESPO MELANIE 2023076 9999999 B 10 1144941907 0 2900 OGDEN AVE LISLE IL 605321676 20 1144941907 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1144944109 0 MILLER KASEY R 2023004 9999999 B 10 1144944109 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1144944109 0 Nurse Practitioners Healthy Kids Services 20 1144944109 0 Nurse Practitioners Midwife Services 20 1144944109 0 Nurse Practitioners Nurse Practitioners Services 20 1144944109 0 Nurse Practitioners Physician Services 00 1144944695 0 JOHNSON MALLORY N 2023361 9999999 B 10 1144944695 0 620 E GARFIELD AVE DECATUR IL 625264550 20 1144944695 0 Speech Therapists Medical Supplies 20 1144944695 0 Speech Therapists Medical equipment/prosthetic devices 20 1144944695 0 Speech Therapists Speech Therapy/Pathology Services 00 1144945767 0 BRIGHT SYDNEY 2024060 9999999 B 10 1144945767 0 281 W JOHN CASEY RD BOURBONNAIS IL 609141392 20 1144945767 0 Speech Therapists Medical Supplies 20 1144945767 0 Speech Therapists Medical equipment/prosthetic devices 20 1144945767 0 Speech Therapists Speech Therapy/Pathology Services 00 1144947383 0 LONGHENRY LAUREN 2022301 9999999 B 10 1144947383 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1144947383 0 Audiologists Audiology Services 20 1144947383 0 Audiologists Medical Supplies 20 1144947383 0 Audiologists Medical equipment/prosthetic devices 00 1144948159 0 CLAYTON EMALEE 2023121 9999999 B 10 1144948159 0 1000 11TH AVE PO BOX 189 ORION IL 612739624 20 1144948159 0 Speech Therapists Medical Supplies 20 1144948159 0 Speech Therapists Medical equipment/prosthetic devices 20 1144948159 0 Speech Therapists Speech Therapy/Pathology Services 00 1144948670 0 MURPHY GARCIA LAURA 2023227 9999999 B 10 1144948670 0 1414 MAIN ST MELROSE PARK IL 601603902 20 1144948670 0 Other behavior health professional LCPC/LMFT services 00 1144949181 0 DELID MARCIAL D 2022307 9999999 B 10 1144949181 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1144949181 0 Nurse Practitioners Healthy Kids Services 20 1144949181 0 Nurse Practitioners Nurse Practitioners Services 20 1144949181 0 Nurse Practitioners Physician Services 00 1144949405 0 COOPER CARLY 2023298 9999999 B 10 1144949405 0 5777 DEPT CAROL STREAM IL 601228942 20 1144949405 0 Physician Assistant Only Fluoride varnish 20 1144949405 0 Physician Assistant Only Healthy Kids Services 20 1144949405 0 Physician Assistant Only Physician Services 00 1144949678 0 AHMAD AHMAD 2024250 9999999 B 10 1144949678 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1144949678 0 Nurse Practitioners Anesthesia Services 20 1144949678 0 Nurse Practitioners Nurse Practitioners Services 20 1144949678 0 Nurse Practitioners Physician Services 00 1144950643 0 ALBISHARA RENE 2022167 9999999 B 10 1144950643 0 55 S COMMONS DR AURORA IL 605044432 20 1144950643 0 Dentists Dental Services 20 1144950643 0 Dentists Physician Services 00 1144950973 0 ALI RUBAB Z 2023262 9999999 B 10 1144950973 0 17W679 ROOSEVELT RD OAKBROOK TERRAC IL 601813545 20 1144950973 0 Dentists Dental Services 20 1144950973 0 Dentists Physician Services 00 1144951005 0 MEWES MICHELLE C 2023118 9999999 B 10 1144951005 0 3330 SKOKIE VALLEY RD STE 200 HIGHLAND PARK IL 600351041 20 1144951005 0 Nurse Practitioners Fluoride varnish 20 1144951005 0 Nurse Practitioners Healthy Kids Services 20 1144951005 0 Nurse Practitioners Nurse Practitioners Services 20 1144951005 0 Nurse Practitioners Physician Services 00 1144951682 0 PRITHIVIRAJAN UMAMAHESWARI 2024254 9999999 B 10 1144951682 0 2424 W PETERSON AVE CHICAGO IL 606594100 20 1144951682 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1144953977 0 VISSEPO BRITTANY N 2022245 9999999 B 10 1144953977 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1144953977 0 Nurse Practitioners Healthy Kids Services 20 1144953977 0 Nurse Practitioners Nurse Practitioners Services 20 1144953977 0 Nurse Practitioners Physician Services 00 1144954504 0 THOMPSON ANDREW 2024254 9999999 B 10 1144954504 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1144954504 0 Physician Assistant Only Fluoride varnish 20 1144954504 0 Physician Assistant Only Healthy Kids Services 20 1144954504 0 Physician Assistant Only Physician Services 00 1144955618 0 TORRES LIBET 2023121 9999999 B 10 1144955618 0 3410 W ROOSEVELT RD CHICAGO IL 606244343 20 1144955618 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1144955675 0 MICHEL LAUREN 2024054 9999999 B 10 1144955675 0 PO BOX 1109 DEKALB IL 601157109 20 1144955675 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1144955741 0 MEIXNER EDWARD E 2022237 9999999 B 10 1144955741 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1144955741 0 Nurse Practitioners Fluoride varnish 20 1144955741 0 Nurse Practitioners Healthy Kids Services 20 1144955741 0 Nurse Practitioners Nurse Practitioners Services 20 1144955741 0 Nurse Practitioners Physician Services 00 1144957200 0 COLON BETHZAIDA 2023019 9999999 B 10 1144957200 0 10001 GRAND AVE ATTN: BILLING DEPARTMENT FRANKLIN PARK IL 601312563 20 1144957200 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1144959073 0 SEXTON MCKENNA 2024226 9999999 B 10 1144959073 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1144959073 0 Physicians Anesthesia Services 20 1144959073 0 Physicians Fluoride varnish 20 1144959073 0 Physicians Healthy Kids Services 20 1144959073 0 Physicians Optical Supplies 20 1144959073 0 Physicians Physician Services 00 1144959412 0 ZHENG CHENYI 2022263 9999999 B 10 1144959412 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1144959412 0 Nurse Practitioners Healthy Kids Services 20 1144959412 0 Nurse Practitioners Midwife Services 20 1144959412 0 Nurse Practitioners Nurse Practitioners Services 20 1144959412 0 Nurse Practitioners Physician Services 00 1144960493 0 SANCHEZ JOHN 2022154 9999999 B 10 1144960493 0 1005 BROADWAY ST QUINCY IL 623012834 20 1144960493 0 Nurse Practitioners Healthy Kids Services 20 1144960493 0 Nurse Practitioners Nurse Practitioners Services 20 1144960493 0 Nurse Practitioners Physician Services 00 1144960584 0 ADAMS JOSHUA 2024163 9999999 B 10 1144960584 0 520 VALLEY VIEW DR MOLINE IL 612656152 20 1144960584 0 Physical Therapists Medical Supplies 20 1144960584 0 Physical Therapists Medical equipment/prosthetic devices 20 1144960584 0 Physical Therapists Physical Therapy Services 00 1144961673 0 HINDS BAILEE A 2022108 9999999 B 10 1144961673 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1144961673 0 Nurse Practitioners Fluoride varnish 20 1144961673 0 Nurse Practitioners Healthy Kids Services 20 1144961673 0 Nurse Practitioners Nurse Practitioners Services 20 1144961673 0 Nurse Practitioners Physician Services 00 1144961871 0 GONZALEZ ANDREA I 2022212 9999999 B 10 1144961871 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1144961871 0 Physicians Anesthesia Services 20 1144961871 0 Physicians Healthy Kids Services 20 1144961871 0 Physicians Optical Supplies 20 1144961871 0 Physicians Physician Services 00 1144962416 0 JUSTICE TOM 2022251 9999999 B 10 1144962416 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1144962416 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1144962622 0 NICANOR ESMERALDA 2022154 9999999 H 10 1144962622 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1144962622 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1144962861 0 NORDNESS MICHAEL E 2022179 9999999 B 10 1144962861 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1144962861 0 Physicians Anesthesia Services 20 1144962861 0 Physicians Fluoride varnish 20 1144962861 0 Physicians Healthy Kids Services 20 1144962861 0 Physicians Optical Supplies 20 1144962861 0 Physicians Physician Services 00 1144963414 0 SAREDDY SNEHA 2022180 9999999 B 10 1144963414 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1144963414 0 Physicians Anesthesia Services 20 1144963414 0 Physicians Healthy Kids Services 20 1144963414 0 Physicians Optical Supplies 20 1144963414 0 Physicians Physician Services 00 1144965245 0 DARNELL BRIANNA 2023244 9999999 B 10 1144965245 0 PO BOX 3988 CARBONDALE IL 629023988 20 1144965245 0 Nurse Practitioners Healthy Kids Services 20 1144965245 0 Nurse Practitioners Nurse Practitioners Services 20 1144965245 0 Nurse Practitioners Physician Services 00 1144965286 0 OBERHELMAN NICHOLAS 2022177 9999999 B 10 1144965286 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1144965286 0 Physicians Anesthesia Services 20 1144965286 0 Physicians Healthy Kids Services 20 1144965286 0 Physicians Optical Supplies 20 1144965286 0 Physicians Physician Services 00 1144965583 0 FRANCISCO NATALIA M 2022132 9999999 B 10 1144965583 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1144965583 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1144965740 0 SCHAFFER MARGARET M 2022200 9999999 B 10 1144965740 0 29373 NETWORK PL CHICAGO IL 606733039 20 1144965740 0 Nurse Practitioners Healthy Kids Services 20 1144965740 0 Nurse Practitioners Nurse Practitioners Services 20 1144965740 0 Nurse Practitioners Physician Services 00 1144966359 0 HERNANDEZ CARLA 2022178 9999999 B 10 1144966359 0 8311 ROOSEVELT RD FOREST PARK IL 601302529 20 1144966359 0 Clinical Social Worker Social work service 00 1144966961 0 TARAWNEH AMMAR 2022278 9999999 B 10 1144966961 0 4701 DEPT CAROL STREAM IL 601220021 20 1144966961 0 Physicians Anesthesia Services 20 1144966961 0 Physicians Fluoride varnish 20 1144966961 0 Physicians Healthy Kids Services 20 1144966961 0 Physicians Optical Supplies 20 1144966961 0 Physicians Physician Services 00 1144967399 0 REITZ JESSICA 2023113 9999999 B 10 1144967399 0 PO BOX 708760 SANDY UT 840708760 20 1144967399 0 Nurse Practitioners Nursing service 20 1144967399 0 Nurse Practitioners Waiver service 00 1144968256 0 DUGGINS LAUREN 2024064 9999999 B 10 1144968256 0 1503 HALO DR MAHOMET IL 618537440 20 1144968256 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1144968876 0 MACARULAY ANNE C 2022182 9999999 B 10 1144968876 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1144968876 0 Physicians Anesthesia Services 20 1144968876 0 Physicians Fluoride varnish 20 1144968876 0 Physicians Healthy Kids Services 20 1144968876 0 Physicians Optical Supplies 20 1144968876 0 Physicians Physician Services 00 1144970021 0 BOOHER BENJAMIN 2022241 9999999 B 10 1144970021 0 124 SW ADAMS ST PEORIA IL 616021308 20 1144970021 0 Physicians Anesthesia Services 20 1144970021 0 Physicians Fluoride varnish 20 1144970021 0 Physicians Healthy Kids Services 20 1144970021 0 Physicians Optical Supplies 20 1144970021 0 Physicians Physician Services 00 1144970732 0 MANDATO MARGARET 2022174 9999999 B 10 1144970732 0 4698 DEPT CAROL STREAM IL 601220021 20 1144970732 0 Physicians Anesthesia Services 20 1144970732 0 Physicians Healthy Kids Services 20 1144970732 0 Physicians Optical Supplies 20 1144970732 0 Physicians Physician Services 00 1144971797 0 WALSH KRISTI L 2023252 9999999 B 10 1144971797 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1144971797 0 Physical Therapists Fluoride varnish 20 1144971797 0 Physical Therapists Healthy Kids Services 20 1144971797 0 Physical Therapists Physician Services 00 1144972191 0 ODUNUYI OLAJUMOKE 2022101 9999999 B 10 1144972191 0 29373 NETWORK PL CHICAGO IL 606733039 20 1144972191 0 Nurse Practitioners Healthy Kids Services 20 1144972191 0 Nurse Practitioners Nurse Practitioners Services 20 1144972191 0 Nurse Practitioners Physician Services 00 1144972514 0 HURRELBRINK JESSICA 2022187 9999999 B 10 1144972514 0 634 N MAIN ST STE 3 O FALLON IL 622693746 20 1144972514 0 Speech Therapists Medical Supplies 20 1144972514 0 Speech Therapists Medical equipment/prosthetic devices 20 1144972514 0 Speech Therapists Speech Therapy/Pathology Services 00 1144974346 0 PECORA ANGELA M 2022042 9999999 B 10 1144974346 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1144974346 0 Physician Assistant Only Fluoride varnish 20 1144974346 0 Physician Assistant Only Healthy Kids Services 20 1144974346 0 Physician Assistant Only Physician Services 00 1144974809 0 WEBER EMILY A 2022055 9999999 B 10 1144974809 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1144974809 0 Nurse Practitioners Fluoride varnish 20 1144974809 0 Nurse Practitioners Healthy Kids Services 20 1144974809 0 Nurse Practitioners Nurse Practitioners Services 20 1144974809 0 Nurse Practitioners Physician Services 00 1144975319 0 SWANSON DAVID 2024054 9999999 B 10 1144975319 0 9944 S ROBERTS RD STE 202 PALOS HILLS IL 604651558 20 1144975319 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1144975814 0 DOSE RACHEL 2022129 9999999 H 10 1144975814 0 535 ELM PL STE 7 PRINCETON IL 613561458 20 1144975814 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1144976416 0 ROTROFF MELISSA 2022291 9999999 B 10 1144976416 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1144976416 0 Nurse Practitioners Anesthesia Services 20 1144976416 0 Nurse Practitioners Nurse Practitioners Services 20 1144976416 0 Nurse Practitioners Physician Services 00 1144976507 0 MORGAN KARYN 2023131 9999999 B 10 1144976507 0 PO BOX 345 SUMMIT ARGO IL 605010345 20 1144976507 0 Nurse Practitioners Healthy Kids Services 20 1144976507 0 Nurse Practitioners Nurse Practitioners Services 20 1144976507 0 Nurse Practitioners Physician Services 00 1144977463 0 PARK SI-MIN 2022321 9999999 B 10 1144977463 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1144977463 0 Physicians Anesthesia Services 20 1144977463 0 Physicians Healthy Kids Services 20 1144977463 0 Physicians Optical Supplies 20 1144977463 0 Physicians Physician Services 00 1144977935 0 WILLIAMS TIERRA 2022173 9999999 B 10 1144977935 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1144977935 0 Nurse Practitioners Healthy Kids Services 20 1144977935 0 Nurse Practitioners Nurse Practitioners Services 20 1144977935 0 Nurse Practitioners Physician Services 00 1144978396 0 PRIMAS MADISYN A 2023175 9999999 B 10 1144978396 0 4698 DEPT CAROL STREAM IL 601220021 20 1144978396 0 Physicians Anesthesia Services 20 1144978396 0 Physicians Healthy Kids Services 20 1144978396 0 Physicians Optical Supplies 20 1144978396 0 Physicians Physician Services 00 1144978701 0 MCGREGOR ANNIE I 2023198 9999999 B 10 1144978701 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1144978701 0 Physicians Anesthesia Services 20 1144978701 0 Physicians Fluoride varnish 20 1144978701 0 Physicians Healthy Kids Services 20 1144978701 0 Physicians Optical Supplies 20 1144978701 0 Physicians Physician Services 00 1144979121 0 HORN SAMANTHA 2025044 9999999 B 10 1144979121 0 PO BOX 778912 CHICAGO IL 606778912 20 1144979121 0 Physician Assistant Only Fluoride varnish 20 1144979121 0 Physician Assistant Only Healthy Kids Services 20 1144979121 0 Physician Assistant Only Physician Services 00 1144979469 0 COLIN ESCOBAR JESSICA 2022180 9999999 B 10 1144979469 0 4698 DEPT CAROL STREAM IL 601220021 20 1144979469 0 Physicians Anesthesia Services 20 1144979469 0 Physicians Healthy Kids Services 20 1144979469 0 Physicians Optical Supplies 20 1144979469 0 Physicians Physician Services 00 1144980053 0 MADEJ KELSEY 2022210 9999999 B 10 1144980053 0 PO BOX 684 BEDFORD PARK IL 604990684 20 1144980053 0 Nurse Practitioners Fluoride varnish 20 1144980053 0 Nurse Practitioners Healthy Kids Services 20 1144980053 0 Nurse Practitioners Nurse Practitioners Services 20 1144980053 0 Nurse Practitioners Physician Services 00 1144983131 0 DIXON MEGAN 2021292 9999999 B 10 1144983131 0 PO BOX 1109 DEKALB IL 601157109 20 1144983131 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1144983131 0 Other behavior health professional Social work service 00 1144984915 0 IHEJIETO DORIS 2021334 9999999 B 10 1144984915 0 1276 N CLYBOURN AVE CHICAGO IL 606102089 20 1144984915 0 Nurse Practitioners Fluoride varnish 20 1144984915 0 Nurse Practitioners Healthy Kids Services 20 1144984915 0 Nurse Practitioners Nurse Practitioners Services 20 1144984915 0 Nurse Practitioners Physician Services 00 1144985417 0 OTTO NATALIE B 2022202 9999999 B 10 1144985417 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1144985417 0 Physicians Anesthesia Services 20 1144985417 0 Physicians Fluoride varnish 20 1144985417 0 Physicians Healthy Kids Services 20 1144985417 0 Physicians Optical Supplies 20 1144985417 0 Physicians Physician Services 00 1144986571 0 AUTENZIO NATALIE T 2024122 9999999 B 10 1144986571 0 5777 DEPT CAROL STREAM IL 601220021 20 1144986571 0 Nurse Practitioners Fluoride varnish 20 1144986571 0 Nurse Practitioners Healthy Kids Services 20 1144986571 0 Nurse Practitioners Nurse Practitioners Services 20 1144986571 0 Nurse Practitioners Physician Services 00 1144986670 0 FRIEDRICH CALEB H 2024302 9999999 B 10 1144986670 0 900 MAIN ST STE 580 PEORIA IL 616021065 20 1144986670 0 Clinical Social Worker Social work service 00 1144987983 0 WALKER JESSICA R 2021336 9999999 B 10 1144987983 0 727 E COURT ST PARIS IL 619442460 20 1144987983 0 Nurse Practitioners Fluoride varnish 20 1144987983 0 Nurse Practitioners Healthy Kids Services 20 1144987983 0 Nurse Practitioners Nurse Practitioners Services 20 1144987983 0 Nurse Practitioners Physician Services 00 1144988205 0 HOPSON TANEISHA 2022188 9999999 B 10 1144988205 0 1550 S INDIANA AVE STE 2NE CHICAGO IL 606052857 20 1144988205 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1144988858 0 GUADARRAMA FLOR 2021343 9999999 B 10 1144988858 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1144988858 0 Registered nurse Nursing service 20 1144988858 0 Registered nurse Waiver service 00 1144989849 0 JAUCIAN EDITH 2021349 9999999 B 10 1144989849 0 684 S BARRINGTON RD STE 112 STREAMWOOD IL 601071841 20 1144989849 0 Clinical Social Worker Social work service 00 1144990425 0 SHAFFER JENNIFER 2021265 9999999 B 10 1144990425 0 906 WALTON ST MELROSE PARK IL 601603540 20 1144990425 0 Speech Therapists Medical Supplies 20 1144990425 0 Speech Therapists Medical equipment/prosthetic devices 20 1144990425 0 Speech Therapists Speech Therapy/Pathology Services 00 1144990888 0 SYEDA KAINAT Z 2021263 9999999 B 10 1144990888 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1144990888 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1144992074 0 SCHUMACHER EMILY 2024352 9999999 B 10 1144992074 0 42 W MADISON ST FL 2 CHICAGO IL 606024309 20 1144992074 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1144992264 0 GAC MEGAN 2022104 9999999 B 10 1144992264 0 PO BOX 781076 DETROIT MI 482781076 20 1144992264 0 Nurse Practitioners Fluoride varnish 20 1144992264 0 Nurse Practitioners Healthy Kids Services 20 1144992264 0 Nurse Practitioners Nurse Practitioners Services 20 1144992264 0 Nurse Practitioners Physician Services 00 1144993833 0 PARIKH DHRUVI 2022151 9999999 B 10 1144993833 0 2235 SYCAMORE RD DEKALB IL 601152046 20 1144993833 0 Dentists Dental Services 20 1144993833 0 Dentists Physician Services 00 1144994427 0 BOROWSKI KONSTANTINA 2021217 9999999 B 10 1144994427 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1144994427 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1144995812 0 HINDS DELANIE E 2021252 9999999 B 10 1144995812 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1144995812 0 Nurse Practitioners Fluoride varnish 20 1144995812 0 Nurse Practitioners Healthy Kids Services 20 1144995812 0 Nurse Practitioners Nurse Practitioners Services 20 1144995812 0 Nurse Practitioners Physician Services 00 1144996059 0 AGUADA LORRAINE H 2021273 9999999 B 10 1144996059 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1144996059 0 Nurse Practitioners Healthy Kids Services 20 1144996059 0 Nurse Practitioners Nurse Practitioners Services 20 1144996059 0 Nurse Practitioners Physician Services 00 1144996224 0 FULAZA DIANA 2022066 9999999 B 10 1144996224 0 1643 NW 136TH AVE STE 100 SUNRISE FL 333232857 20 1144996224 0 Nurse Practitioners Fluoride varnish 20 1144996224 0 Nurse Practitioners Healthy Kids Services 20 1144996224 0 Nurse Practitioners Nurse Practitioners Services 20 1144996224 0 Nurse Practitioners Physician Services 00 1144997164 0 SANDERS LEVI AUSTIN 2024260 9999999 B 10 1144997164 0 PO BOX 18412 PALATINE IL 600558412 20 1144997164 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1144997610 0 BRABOY DIVINE 2023070 9999999 B 10 1144997610 0 15 SPINNING WHEEL RD STE 30 HINSDALE IL 605217651 20 1144997610 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1154000404 0 DIXIT ESHANI 2023201 9999999 B 10 1154000404 0 611 W PARK ST URBANA IL 618012529 20 1154000404 0 Physicians Anesthesia Services 20 1154000404 0 Physicians Healthy Kids Services 20 1154000404 0 Physicians Optical Supplies 20 1154000404 0 Physicians Physician Services 00 1154001527 0 CORTES NANCY 2023306 9999999 B 10 1154001527 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1154001527 0 Physician Assistant Only Fluoride varnish 20 1154001527 0 Physician Assistant Only Healthy Kids Services 20 1154001527 0 Physician Assistant Only Physician Services 00 1154001790 0 LITTLE HEATHER N 2023251 9999999 B 10 1154001790 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1154001790 0 Nurse Practitioners Healthy Kids Services 20 1154001790 0 Nurse Practitioners Nurse Practitioners Services 20 1154001790 0 Nurse Practitioners Physician Services 00 1154002277 0 SAUNDERS STACYE ALLINE 2024227 9999999 B 10 1154002277 0 211 E LAKE ST STE 1B ADDISON IL 601012877 20 1154002277 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1154002657 0 DOMACK NATALIE 2023325 9999999 B 10 1154002657 0 909 RIDGEBROOK RD STE 300 SPARKS MD 211529477 20 1154002657 0 Nurse Practitioners Fluoride varnish 20 1154002657 0 Nurse Practitioners Healthy Kids Services 20 1154002657 0 Nurse Practitioners Nurse Practitioners Services 20 1154002657 0 Nurse Practitioners Physician Services 00 1154002996 0 SALUD MARTINA ISABEL P 2023213 9999999 B 10 1154002996 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1154002996 0 Physicians Anesthesia Services 20 1154002996 0 Physicians Fluoride varnish 20 1154002996 0 Physicians Healthy Kids Services 20 1154002996 0 Physicians Optical Supplies 20 1154002996 0 Physicians Physician Services 00 1154003580 0 LEHRKE COURTNEY 2023234 9999999 B 10 1154003580 0 PO BOX 5081 JANESVILLE WI 535475081 20 1154003580 0 Nurse Practitioners Healthy Kids Services 20 1154003580 0 Nurse Practitioners Nurse Practitioners Services 20 1154003580 0 Nurse Practitioners Physician Services 00 1154004919 0 BHARANI SREEKA 2023237 9999999 B 10 1154004919 0 11447 2ND ST STE 9B ROSCOE IL 610739522 20 1154004919 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1154006336 0 REWIS KAITLYN 2023206 9999999 B 10 1154006336 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1154006336 0 Physicians Anesthesia Services 20 1154006336 0 Physicians Healthy Kids Services 20 1154006336 0 Physicians Optical Supplies 20 1154006336 0 Physicians Physician Services 00 1154006716 0 VASWANI ZAMEER G 2023198 9999999 B 10 1154006716 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1154006716 0 Physicians Anesthesia Services 20 1154006716 0 Physicians Healthy Kids Services 20 1154006716 0 Physicians Optical Supplies 20 1154006716 0 Physicians Physician Services 00 1154006955 0 ISIKTAS GIZEM 2023195 9999999 B 10 1154006955 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1154006955 0 Physicians Anesthesia Services 20 1154006955 0 Physicians Healthy Kids Services 20 1154006955 0 Physicians Optical Supplies 20 1154006955 0 Physicians Physician Services 20 1154006955 0 Physicians Physicians Psychiatric Services 00 1154006963 0 MOHAN DIPIKA 2024004 9999999 B 10 1154006963 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1154006963 0 Physicians Anesthesia Services 20 1154006963 0 Physicians Fluoride varnish 20 1154006963 0 Physicians Healthy Kids Services 20 1154006963 0 Physicians Optical Supplies 20 1154006963 0 Physicians Physician Services 00 1154007334 0 NILDHURI SESHADRI B 2023192 9999999 B 10 1154007334 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1154007334 0 Physicians Anesthesia Services 20 1154007334 0 Physicians Fluoride varnish 20 1154007334 0 Physicians Healthy Kids Services 20 1154007334 0 Physicians Optical Supplies 20 1154007334 0 Physicians Physician Services 00 1154007698 0 DONOVAN JULIA M 2024327 9999999 B 10 1154007698 0 9423 HOLY CROSS LN STE 111 BREESE IL 622303510 20 1154007698 0 Nurse Practitioners Fluoride varnish 20 1154007698 0 Nurse Practitioners Healthy Kids Services 20 1154007698 0 Nurse Practitioners Nurse Practitioners Services 20 1154007698 0 Nurse Practitioners Physician Services 00 1154007748 0 YI ERIC 2023341 9999999 B 10 1154007748 0 1203 W AUGUSTA BLVD UNIT 1 CHICAGO IL 606424327 20 1154007748 0 Nurse Practitioners Healthy Kids Services 20 1154007748 0 Nurse Practitioners Nurse Practitioners Services 20 1154007748 0 Nurse Practitioners Physician Services 00 1154007938 0 RYBERG JAMES 2024214 9999999 B 10 1154007938 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1154007938 0 Physicians Anesthesia Services 20 1154007938 0 Physicians Healthy Kids Services 20 1154007938 0 Physicians Optical Supplies 20 1154007938 0 Physicians Physician Services 00 1154008654 0 RODRIGUEZ KARLA 2024162 9999999 B 10 1154008654 0 900 OGDEN AVE # 112 DOWNERS GROVE IL 605152829 20 1154008654 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1154010353 0 ESTRELLA MARINA A 2023363 9999999 B 10 1154010353 0 2504 WASHINGTON ST STE 401C WAUKEGAN IL 600854960 20 1154010353 0 Nurse Practitioners Fluoride varnish 20 1154010353 0 Nurse Practitioners Healthy Kids Services 20 1154010353 0 Nurse Practitioners Nurse Practitioners Services 20 1154010353 0 Nurse Practitioners Physician Services 00 1154011831 0 DABROWSKI NICHOLET 2024080 9999999 B 10 1154011831 0 44 N VIRGINIA ST STE 3B CRYSTAL LAKE IL 600144154 20 1154011831 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1154013324 0 EBERLIN CHRISTOPHER T 2023173 9999999 B 10 1154013324 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1154013324 0 Physicians Anesthesia Services 20 1154013324 0 Physicians Healthy Kids Services 20 1154013324 0 Physicians Optical Supplies 20 1154013324 0 Physicians Physician Services 00 1154013662 0 STEIN CALEB I 2023205 9999999 B 10 1154013662 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1154013662 0 Physician Assistant Only Fluoride varnish 20 1154013662 0 Physician Assistant Only Healthy Kids Services 20 1154013662 0 Physician Assistant Only Physician Services 00 1154014025 0 GURSAY D'ANDREW 2023206 9999999 B 10 1154014025 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1154014025 0 Physicians Anesthesia Services 20 1154014025 0 Physicians Healthy Kids Services 20 1154014025 0 Physicians Optical Supplies 20 1154014025 0 Physicians Physician Services 00 1154014199 0 STAGG DAIVD B 2023204 9999999 B 10 1154014199 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1154014199 0 Physicians Anesthesia Services 20 1154014199 0 Physicians Fluoride varnish 20 1154014199 0 Physicians Healthy Kids Services 20 1154014199 0 Physicians Optical Supplies 20 1154014199 0 Physicians Physician Services 00 1154014520 0 IQBAL HIBA 2023179 9999999 B 10 1154014520 0 1730 PARK ST STE 106 NAPERVILLE IL 605632609 20 1154014520 0 Dentists Dental Services 20 1154014520 0 Dentists Physician Services 00 1154016251 0 KUMAR SANTHANAM 2023182 9999999 B 10 1154016251 0 4701 DEPT CAROL STREAM IL 601220021 20 1154016251 0 Physicians Anesthesia Services 20 1154016251 0 Physicians Fluoride varnish 20 1154016251 0 Physicians Healthy Kids Services 20 1154016251 0 Physicians Optical Supplies 20 1154016251 0 Physicians Physician Services 00 1154017051 0 AGUILUZ CORNEJO GABRIELA 2024130 9999999 B 10 1154017051 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1154017051 0 Physicians Anesthesia Services 20 1154017051 0 Physicians Healthy Kids Services 20 1154017051 0 Physicians Optical Supplies 20 1154017051 0 Physicians Physician Services 00 1154017705 0 STA CRUZ REGINO I 2023111 9999999 B 10 1154017705 0 5290 WILLIAMS DR ROSCOE IL 610739222 20 1154017705 0 Physician Assistant Only Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1154017713 0 KIM KRISTINE C 2024010 9999999 B 10 1154017713 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1154017713 0 Physicians Anesthesia Services 20 1154017713 0 Physicians Fluoride varnish 20 1154017713 0 Physicians Healthy Kids Services 20 1154017713 0 Physicians Optical Supplies 20 1154017713 0 Physicians Physician Services 00 1154018745 0 KIRKMAN BARSUN U 2024234 9999999 B 10 1154018745 0 201 E MADISON ST STE 300 SPRINGFIELD IL 627025131 20 1154018745 0 Physicians Anesthesia Services 20 1154018745 0 Physicians Fluoride varnish 20 1154018745 0 Physicians Healthy Kids Services 20 1154018745 0 Physicians Optical Supplies 20 1154018745 0 Physicians Physician Services 00 1154019131 0 KRUEGER JORDAN 2023182 9999999 B 10 1154019131 0 1900 W POLK ST STE 220C CHICAGO IL 60612 20 1154019131 0 Physicians Anesthesia Services 20 1154019131 0 Physicians Fluoride varnish 20 1154019131 0 Physicians Healthy Kids Services 20 1154019131 0 Physicians Optical Supplies 20 1154019131 0 Physicians Physician Services 00 1154021558 0 ROBERTS SAMANTHA 2024195 9999999 B 10 1154021558 0 7732 SOLUTION CTR MC 776 CHICAGO IL 606777007 20 1154021558 0 Physicians Anesthesia Services 20 1154021558 0 Physicians Healthy Kids Services 20 1154021558 0 Physicians Optical Supplies 20 1154021558 0 Physicians Physician Services 00 1154021566 0 RAUH ELIZABETH A 2023222 9999999 B 10 1154021566 0 5777 DEPT CAROL STREAM IL 601220021 20 1154021566 0 Nurse Practitioners Fluoride varnish 20 1154021566 0 Nurse Practitioners Healthy Kids Services 20 1154021566 0 Nurse Practitioners Nurse Practitioners Services 20 1154021566 0 Nurse Practitioners Physician Services 00 1154022168 0 TURNER AMANDA 2023137 9999999 B 10 1154022168 0 1900 POLK ST. STE 200 CHICAGO IL 60612 20 1154022168 0 Clinical Social Worker Social work service 00 1154022978 0 DUNLAP ALISON 2023080 9999999 B 10 1154022978 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1154022978 0 Nurse Practitioners Healthy Kids Services 20 1154022978 0 Nurse Practitioners Nurse Practitioners Services 20 1154022978 0 Nurse Practitioners Physician Services 00 1154023281 0 KOCHAN KIRSTEN SARAH 2023208 9999999 B 10 1154023281 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1154023281 0 Physicians Anesthesia Services 20 1154023281 0 Physicians Fluoride varnish 20 1154023281 0 Physicians Healthy Kids Services 20 1154023281 0 Physicians Optical Supplies 20 1154023281 0 Physicians Physician Services 00 1154023588 0 LUGO MICHAEL 2023192 9999999 B 10 1154023588 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1154023588 0 Physicians Anesthesia Services 20 1154023588 0 Physicians Healthy Kids Services 20 1154023588 0 Physicians Optical Supplies 20 1154023588 0 Physicians Physician Services 00 1154024107 0 CHU JAINA 2023183 9999999 B 10 1154024107 0 PO BOX 3039 OAK BROOK IL 605223039 20 1154024107 0 Physicians Anesthesia Services 20 1154024107 0 Physicians Healthy Kids Services 20 1154024107 0 Physicians Optical Supplies 20 1154024107 0 Physicians Physician Services 20 1154024107 0 Physicians Physicians Psychiatric Services 00 1154024164 0 CRUZ ALVAREZ CINDY JHOVANNA 2023174 9999999 B 10 1154024164 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1154024164 0 Physicians Anesthesia Services 20 1154024164 0 Physicians Healthy Kids Services 20 1154024164 0 Physicians Optical Supplies 20 1154024164 0 Physicians Physician Services 00 1154024586 0 BOUCHONVILLE KELLY 2024122 9999999 B 10 1154024586 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1154024586 0 Physician Assistant Only Fluoride varnish 20 1154024586 0 Physician Assistant Only Healthy Kids Services 20 1154024586 0 Physician Assistant Only Physician Services 00 1154024776 0 OBI NKIRU 2023200 9999999 B 10 1154024776 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1154024776 0 Physicians Anesthesia Services 20 1154024776 0 Physicians Fluoride varnish 20 1154024776 0 Physicians Healthy Kids Services 20 1154024776 0 Physicians Optical Supplies 20 1154024776 0 Physicians Physician Services 00 1154025062 0 KOTIAN ALESHA 2024322 9999999 B 10 1154025062 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1154025062 0 Physicians Anesthesia Services 20 1154025062 0 Physicians Healthy Kids Services 20 1154025062 0 Physicians Optical Supplies 20 1154025062 0 Physicians Physician Services 00 1154026367 0 RODRIGUEZ MARCO 2023362 9999999 B 10 1154026367 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1154026367 0 Physician Assistant Only Fluoride varnish 20 1154026367 0 Physician Assistant Only Healthy Kids Services 20 1154026367 0 Physician Assistant Only Physician Services 00 1154026607 0 STEPHEN JERRY 2023191 9999999 B 10 1154026607 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1154026607 0 Physicians Anesthesia Services 20 1154026607 0 Physicians Healthy Kids Services 20 1154026607 0 Physicians Optical Supplies 20 1154026607 0 Physicians Physician Services 00 1154027233 0 BUNTING LEAH 2023136 9999999 B 10 1154027233 0 15 APEX DR HIGHLAND IL 622491282 20 1154027233 0 Occupational Therapists Medical Supplies 20 1154027233 0 Occupational Therapists Medical equipment/prosthetic devices 20 1154027233 0 Occupational Therapists Occupational Therapy Services 00 1154028413 0 GROFF ROBERT 2023193 9999999 B 10 1154028413 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1154028413 0 Physicians Anesthesia Services 20 1154028413 0 Physicians Fluoride varnish 20 1154028413 0 Physicians Healthy Kids Services 20 1154028413 0 Physicians Optical Supplies 20 1154028413 0 Physicians Physician Services 00 1154028462 0 JODY JASMINE 2024174 9999999 B 10 1154028462 0 PO BOX 3039 OAK BROOK IL 605223039 20 1154028462 0 Physicians Anesthesia Services 20 1154028462 0 Physicians Healthy Kids Services 20 1154028462 0 Physicians Optical Supplies 20 1154028462 0 Physicians Physician Services 00 1154029817 0 DUDEK MACKENZIE T 2024004 9999999 B 10 1154029817 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1154029817 0 Physician Assistant Only Fluoride varnish 20 1154029817 0 Physician Assistant Only Healthy Kids Services 20 1154029817 0 Physician Assistant Only Physician Services 00 1154031474 0 SCHROEDER AIMEE 2023055 9999999 B 10 1154031474 0 3900 GABRIELLE LN UNIT 9130 AURORA IL 605984335 20 1154031474 0 Physician Assistant Only Fluoride varnish 20 1154031474 0 Physician Assistant Only Healthy Kids Services 20 1154031474 0 Physician Assistant Only Physician Services 00 1154031995 0 LARSON TRISHA M 2022354 9999999 B 10 1154031995 0 2339 N CALIFORNIA AVE UNIT 479 CHICAGO IL 606470360 20 1154031995 0 Occupational Therapists Medical Supplies 20 1154031995 0 Occupational Therapists Medical equipment/prosthetic devices 20 1154031995 0 Occupational Therapists Occupational Therapy Services 00 1154032829 0 HARKINS JAMES 2023003 9999999 B 10 1154032829 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1154032829 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1154033272 0 COLLARD ALEXANDRA N 2023182 9999999 B 10 1154033272 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1154033272 0 Nurse Practitioners Healthy Kids Services 20 1154033272 0 Nurse Practitioners Nurse Practitioners Services 20 1154033272 0 Nurse Practitioners Physician Services 00 1154034734 0 PARKER MISTY 2023019 9999999 B 10 1154034734 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1154034734 0 Clinical Social Worker Social work service 00 1154034973 0 MCMANUS KATHLEEN 2023192 9999999 B 10 1154034973 0 1975 MC DOWELL RD STE 101 NAPERVILLE IL 605636533 20 1154034973 0 Other behavior health professional Adaptive behavior support technician services 20 1154034973 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1154035111 0 BUTTERFIELD ISABEL 2023241 9999999 B 10 1154035111 0 2239 E COOK ST SPRINGFIELD IL 627031944 20 1154035111 0 Nurse Practitioners Fluoride varnish 20 1154035111 0 Nurse Practitioners Healthy Kids Services 20 1154035111 0 Nurse Practitioners Nurse Practitioners Services 20 1154035111 0 Nurse Practitioners Physician Services 00 1154035434 0 BERNARDO AILEEN 2023025 9999999 B 10 1154035434 0 800 W FULTON MARKET FL 12 CHICAGO IL 606071302 20 1154035434 0 Nurse Practitioners Fluoride varnish 20 1154035434 0 Nurse Practitioners Healthy Kids Services 20 1154035434 0 Nurse Practitioners Nurse Practitioners Services 20 1154035434 0 Nurse Practitioners Physician Services 00 1154035913 0 STOLLER JENNIFER R 2023037 9999999 B 10 1154035913 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1154035913 0 Nurse Practitioners Healthy Kids Services 20 1154035913 0 Nurse Practitioners Nurse Practitioners Services 20 1154035913 0 Nurse Practitioners Physician Services 00 1154036192 0 RUDE JESSICA 2024183 9999999 B 10 1154036192 0 PO BOX 4028 ROCK ISLAND IL 612044028 20 1154036192 0 Nurse Practitioners Fluoride varnish 20 1154036192 0 Nurse Practitioners Healthy Kids Services 20 1154036192 0 Nurse Practitioners Nurse Practitioners Services 20 1154036192 0 Nurse Practitioners Physician Services 00 1154037018 0 ERIGUEL JACQUELINE 2023033 9999999 B 10 1154037018 0 3855 W NORTH AVE CHICAGO IL 606474640 20 1154037018 0 Dentists Dental Services 20 1154037018 0 Dentists Physician Services 00 1154039709 0 DALY SUSAN 2022325 9999999 B 10 1154039709 0 PO BOX 7951 BELFAST ME 049157900 20 1154039709 0 Nurse Practitioners Healthy Kids Services 20 1154039709 0 Nurse Practitioners Nurse Practitioners Services 20 1154039709 0 Nurse Practitioners Physician Services 00 1154041077 0 SOUKHONE BRITTNEY 2022322 9999999 B 10 1154041077 0 PO BOX 314 VALPARAISO IN 463840314 20 1154041077 0 Clinical Social Worker Social work service 00 1154041119 0 LUIGS PAIGE 2022223 9999999 B 10 1154041119 0 250 W 96TH ST STE 520 INDIANAPOLIS IN 462601317 20 1154041119 0 Speech Therapists Medical Supplies 20 1154041119 0 Speech Therapists Medical equipment/prosthetic devices 20 1154041119 0 Speech Therapists Physical Therapy Services 00 1154041614 0 WEISS MADISON 2023291 9999999 B 10 1154041614 0 2100 POWELL ST STE 400 EMERYVILLE CA 946081872 20 1154041614 0 Physician Assistant Only Fluoride varnish 20 1154041614 0 Physician Assistant Only Healthy Kids Services 20 1154041614 0 Physician Assistant Only Physician Services 00 1154041960 0 BAKER SINCLAIRE 2022243 9999999 B 10 1154041960 0 1325 SYCAMORE RD DEKALB IL 601152483 20 1154041960 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1154042117 0 KARSTENS AIMEE 2024362 9999999 B 10 1154042117 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1154042117 0 Psychologist Psychologist service 00 1154042398 0 PFEIFFER SARA 2022294 9999999 B 10 1154042398 0 7358 N LINCOLN AVE STE 170 LINCOLNWOOD IL 607121710 20 1154042398 0 Speech Therapists Medical Supplies 20 1154042398 0 Speech Therapists Medical equipment/prosthetic devices 20 1154042398 0 Speech Therapists Speech Therapy/Pathology Services 00 1154043115 0 HAMILTON LAUREN 2024044 9999999 B 10 1154043115 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1154043115 0 Physicians Anesthesia Services 20 1154043115 0 Physicians Fluoride varnish 20 1154043115 0 Physicians Healthy Kids Services 20 1154043115 0 Physicians Optical Supplies 20 1154043115 0 Physicians Physician Services 00 1154044485 0 SCHUMMER MEGAN V 2022276 9999999 H 10 1154044485 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1154044485 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1154044543 0 BAGINSKI CAROLINE 2022265 9999999 B 10 1154044543 0 17301 CENTRAL AVE OAK FOREST IL 604524920 20 1154044543 0 Speech Therapists Medical Supplies 20 1154044543 0 Speech Therapists Medical equipment/prosthetic devices 20 1154044543 0 Speech Therapists Speech Therapy/Pathology Services 00 1154044964 0 BREWER HALEY T 2024025 9999999 B 10 1154044964 0 3880 SALEM LAKE DR STE F STE F LONG GROVE IL 600475292 20 1154044964 0 Physician Assistant Only Fluoride varnish 20 1154044964 0 Physician Assistant Only Healthy Kids Services 20 1154044964 0 Physician Assistant Only Physician Services 00 1154046886 0 PARKER ALYSA 2023003 9999999 B 10 1154046886 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1154046886 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1154047926 0 COLLAO HANNAH R 2023198 9999999 B 10 1154047926 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1154047926 0 Nurse Practitioners Healthy Kids Services 20 1154047926 0 Nurse Practitioners Nurse Practitioners Services 20 1154047926 0 Nurse Practitioners Physician Services 00 1154049559 0 AMJAD MANAL 2022306 9999999 B 10 1154049559 0 1042 MAPLE AVE LISLE IL 605322329 20 1154049559 0 Other behavior health professional Adaptive behavior support technician services 20 1154049559 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1154049799 0 ANDERSON BETHANY 2023003 9999999 B 10 1154049799 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1154049799 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1154050235 0 TOMASZEK LAUREN 2022339 9999999 B 10 1154050235 0 120 S MARION ST OAK PARK IL 603022809 20 1154050235 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1154051365 0 PATEL PARINDA 2022187 9999999 B 10 1154051365 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1154051365 0 Nurse Practitioners Fluoride varnish 20 1154051365 0 Nurse Practitioners Healthy Kids Services 20 1154051365 0 Nurse Practitioners Nurse Practitioners Services 20 1154051365 0 Nurse Practitioners Physician Services 00 1154052819 0 TEPEDE KABIRAT O 2022244 9999999 B 10 1154052819 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1154052819 0 Nurse Practitioners Healthy Kids Services 20 1154052819 0 Nurse Practitioners Midwife Services 20 1154052819 0 Nurse Practitioners Nurse Practitioners Services 20 1154052819 0 Nurse Practitioners Physician Services 00 1154053122 0 TEAIMA TAHA A 2022212 9999999 B 10 1154053122 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1154053122 0 Physicians Anesthesia Services 20 1154053122 0 Physicians Fluoride varnish 20 1154053122 0 Physicians Healthy Kids Services 20 1154053122 0 Physicians Optical Supplies 20 1154053122 0 Physicians Physician Services 00 1154053411 0 VICKSTROM CASEY 2022216 9999999 B 10 1154053411 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1154053411 0 Physicians Anesthesia Services 20 1154053411 0 Physicians Fluoride varnish 20 1154053411 0 Physicians Healthy Kids Services 20 1154053411 0 Physicians Optical Supplies 20 1154053411 0 Physicians Physician Services 00 1154053718 0 FELDMAN-SCHULTZ OREN 2022194 9999999 B 10 1154053718 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1154053718 0 Physicians Anesthesia Services 20 1154053718 0 Physicians Healthy Kids Services 20 1154053718 0 Physicians Optical Supplies 20 1154053718 0 Physicians Physician Services 00 1154053767 0 FOLEY CHRISTOPHER C 2022182 9999999 H 10 1154053767 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1154053767 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1154053775 0 COUCH SARAH E 2022270 9999999 B 10 1154053775 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1154053775 0 Nurse Practitioners Fluoride varnish 20 1154053775 0 Nurse Practitioners Healthy Kids Services 20 1154053775 0 Nurse Practitioners Nurse Practitioners Services 20 1154053775 0 Nurse Practitioners Physician Services 00 1154054054 0 MILLER AUSTIN K 2022341 9999999 B 10 1154054054 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1154054054 0 Nurse Practitioners Anesthesia Services 20 1154054054 0 Nurse Practitioners Nurse Practitioners Services 20 1154054054 0 Nurse Practitioners Physician Services 00 1154054450 0 SHERRY EMILY A 2022265 9999999 B 10 1154054450 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1154054450 0 Nurse Practitioners Healthy Kids Services 20 1154054450 0 Nurse Practitioners Nurse Practitioners Services 20 1154054450 0 Nurse Practitioners Physician Services 00 1154054690 0 ZAHER ELI A 2022270 9999999 B 10 1154054690 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1154054690 0 Physicians Anesthesia Services 20 1154054690 0 Physicians Fluoride varnish 20 1154054690 0 Physicians Healthy Kids Services 20 1154054690 0 Physicians Optical Supplies 20 1154054690 0 Physicians Physician Services 00 1154054740 0 KELLY REBEKKA 2022188 9999999 B 10 1154054740 0 6501 S PROMONTORY DR CHICAGO IL 606491003 20 1154054740 0 Physical Therapists Medical Supplies 20 1154054740 0 Physical Therapists Medical equipment/prosthetic devices 20 1154054740 0 Physical Therapists Physical Therapy Services 00 1154055218 0 CHOATE REBECCA L 2022206 9999999 B 10 1154055218 0 50 NORTHGATE INDUSTRIAL DR GRANITE CITY IL 620406805 20 1154055218 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1154055952 0 OGAR UFEH A 2022218 9999999 B 10 1154055952 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1154055952 0 Physicians Anesthesia Services 20 1154055952 0 Physicians Fluoride varnish 20 1154055952 0 Physicians Healthy Kids Services 20 1154055952 0 Physicians Optical Supplies 20 1154055952 0 Physicians Physician Services 00 1154058220 0 KELLER LAURA L 2022273 9999999 B 10 1154058220 0 800 E LOCUST ST OLNEY IL 624502553 20 1154058220 0 Nurse Practitioners Fluoride varnish 20 1154058220 0 Nurse Practitioners Healthy Kids Services 20 1154058220 0 Nurse Practitioners Nurse Practitioners Services 20 1154058220 0 Nurse Practitioners Physician Services 00 1154058493 0 ZAGORSKI CHRISTINA M 2022348 9999999 B 10 1154058493 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1154058493 0 Nurse Practitioners Healthy Kids Services 20 1154058493 0 Nurse Practitioners Midwife Services 20 1154058493 0 Nurse Practitioners Nurse Practitioners Services 20 1154058493 0 Nurse Practitioners Physician Services 00 1154060796 0 RILEY MEGAN E 2022194 9999999 B 10 1154060796 0 3350 W SALT CREEK LN STE 115 ARLINGTON HEIGH IL 600051089 20 1154060796 0 Speech Therapists Medical Supplies 20 1154060796 0 Speech Therapists Medical equipment/prosthetic devices 20 1154060796 0 Speech Therapists Speech Therapy/Pathology Services 00 1154061521 0 PAUNOVICH BRYANNA SIERRA 2022158 9999999 B 10 1154061521 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1154061521 0 Physicians Anesthesia Services 20 1154061521 0 Physicians Fluoride varnish 20 1154061521 0 Physicians Healthy Kids Services 20 1154061521 0 Physicians Optical Supplies 20 1154061521 0 Physicians Physician Services 00 1154061620 0 RODRIGUEZ CELIN MARIA DE LAS M 2022223 9999999 B 10 1154061620 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1154061620 0 Physicians Anesthesia Services 20 1154061620 0 Physicians Fluoride varnish 20 1154061620 0 Physicians Healthy Kids Services 20 1154061620 0 Physicians Optical Supplies 20 1154061620 0 Physicians Physician Services 00 1154062354 0 GUBAREVA POLINA G 2022179 9999999 B 10 1154062354 0 PO BOX 3039 OAK BROOK IL 605223039 20 1154062354 0 Dentists Dental Services 20 1154062354 0 Dentists Physician Services 00 1154062453 0 OSEA KATHLEEN 2023199 9999999 B 10 1154062453 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1154062453 0 Physicians Anesthesia Services 20 1154062453 0 Physicians Fluoride varnish 20 1154062453 0 Physicians Healthy Kids Services 20 1154062453 0 Physicians Optical Supplies 20 1154062453 0 Physicians Physician Services 00 1154062578 0 PARK CHRISTINE J 2022196 9999999 B 10 1154062578 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1154062578 0 Physicians Anesthesia Services 20 1154062578 0 Physicians Fluoride varnish 20 1154062578 0 Physicians Healthy Kids Services 20 1154062578 0 Physicians Optical Supplies 20 1154062578 0 Physicians Physician Services 00 1154063618 0 MYLES TAMEKA 2022118 9999999 B 10 1154063618 0 17 N STATE ST STE 500 CHICAGO IL 606023384 20 1154063618 0 Nurse Practitioners Family Planning Counseling 20 1154063618 0 Nurse Practitioners Healthy Kids Services 20 1154063618 0 Nurse Practitioners Nurse Practitioners Services 20 1154063618 0 Nurse Practitioners Physician Services 00 1154063667 0 CYBULSKI EVA 2022118 9999999 B 10 1154063667 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1154063667 0 Nurse Practitioners Fluoride varnish 20 1154063667 0 Nurse Practitioners Healthy Kids Services 20 1154063667 0 Nurse Practitioners Nurse Practitioners Services 20 1154063667 0 Nurse Practitioners Physician Services 00 1154064368 0 MOQEET SANA 2022242 9999999 B 10 1154064368 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1154064368 0 Physicians Anesthesia Services 20 1154064368 0 Physicians Fluoride varnish 20 1154064368 0 Physicians Healthy Kids Services 20 1154064368 0 Physicians Optical Supplies 20 1154064368 0 Physicians Physician Services 00 1154064574 0 PORTER MATTHEW R 2022342 9999999 B 10 1154064574 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1154064574 0 Physicians Anesthesia Services 20 1154064574 0 Physicians Healthy Kids Services 20 1154064574 0 Physicians Optical Supplies 20 1154064574 0 Physicians Physician Services 00 1154065167 0 CLARKE EMILY S 2022262 9999999 B 10 1154065167 0 29373 NETWORK PL CHICAGO IL 606733039 20 1154065167 0 Nurse Practitioners Fluoride varnish 20 1154065167 0 Nurse Practitioners Healthy Kids Services 20 1154065167 0 Nurse Practitioners Nurse Practitioners Services 20 1154065167 0 Nurse Practitioners Physician Services 00 1154065605 0 NEKKANTI ANKITA 2022239 9999999 B 10 1154065605 0 124 SW ADAMS ST PEORIA IL 616021308 20 1154065605 0 Physicians Anesthesia Services 20 1154065605 0 Physicians Fluoride varnish 20 1154065605 0 Physicians Healthy Kids Services 20 1154065605 0 Physicians Optical Supplies 20 1154065605 0 Physicians Physician Services 00 1154066769 0 MURRAY ERIKA 2023131 2099001 B 10 1154066769 0 PO BOX 1239 TROY MI 480991239 20 1154066769 0 Nurse Practitioners Fluoride varnish 20 1154066769 0 Nurse Practitioners Healthy Kids Services 20 1154066769 0 Nurse Practitioners Nurse Practitioners Services 20 1154066769 0 Nurse Practitioners Physician Services 00 1154066827 0 GONZALEZ ALEJANDRO 2022200 9999999 B 10 1154066827 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1154066827 0 Physicians Anesthesia Services 20 1154066827 0 Physicians Fluoride varnish 20 1154066827 0 Physicians Healthy Kids Services 20 1154066827 0 Physicians Optical Supplies 20 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SPRINGFIELD IL 627621000 20 1154452530 0 Occupational Therapists Medical Supplies 20 1154452530 0 Occupational Therapists Medical equipment/prosthetic devices 20 1154452530 0 Occupational Therapists Occupational Therapy Services 00 1154453454 0 COGGIN TIMOTHY 2002259 9999999 B 10 1154453454 0 45 W 111TH ST CHICAGO IL 606284200 20 1154453454 0 Physicians Anesthesia Services 20 1154453454 0 Physicians Healthy Kids Services 20 1154453454 0 Physicians Optical Supplies 20 1154453454 0 Physicians Physician Services 00 1154454635 0 DOMB BENJAMIN GILBERT 2008001 9999999 B 10 1154454635 0 999 E TOUHY AVE STE 450 DES PLAINES IL 600182748 20 1154454635 0 Physicians Anesthesia Services 20 1154454635 0 Physicians Healthy Kids Services 20 1154454635 0 Physicians Optical Supplies 20 1154454635 0 Physicians Physician Services 00 1154455210 0 HAMPTON TONY A 1998182 9999999 B 10 1154455210 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1154455210 0 Physicians Anesthesia Services 20 1154455210 0 Physicians Fluoride varnish 20 1154455210 0 Physicians Healthy Kids Services 20 1154455210 0 Physicians Optical Supplies 20 1154455210 0 Physicians Physician Services 00 1154456929 0 JOHNSON BETSY O 1996275 9999999 B 10 1154456929 0 4701 DEPT CAROL STREAM IL 601220021 20 1154456929 0 Occupational Therapists Medical Supplies 20 1154456929 0 Occupational Therapists Medical equipment/prosthetic devices 20 1154456929 0 Occupational Therapists Occupational Therapy Services 00 1154457596 0 POPOVICH TANJA 2014171 9999999 B 10 1154457596 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1154457596 0 Occupational Therapists Medical Supplies 20 1154457596 0 Occupational Therapists Medical equipment/prosthetic devices 20 1154457596 0 Occupational Therapists Occupational Therapy Services 00 1154458321 0 NOVAK RICHARD B 2003335 9999999 B 10 1154458321 0 401 E NORTH AVE STE 5 VILLA PARK IL 601811218 20 1154458321 0 Physicians Anesthesia Services 20 1154458321 0 Physicians Fluoride varnish 20 1154458321 0 Physicians Healthy Kids Services 20 1154458321 0 Physicians Optical Supplies 20 1154458321 0 Physicians Physician Services 00 1154458545 0 ZELINKA PETER B 2016061 9999999 B 10 1154458545 0 2361 PAYSPHERE CIR CHICAGO IL 606740023 20 1154458545 0 Physicians Anesthesia Services 20 1154458545 0 Physicians Healthy Kids Services 20 1154458545 0 Physicians Optical Supplies 20 1154458545 0 Physicians Physician Services 00 1154458941 0 NICHOLS KAREN L 2008007 9999999 B 10 1154458941 0 29373 NETWORK PL CHICAGO IL 606733039 20 1154458941 0 Nurse Practitioners Healthy Kids Services 20 1154458941 0 Nurse Practitioners Nurse Practitioners Services 20 1154458941 0 Nurse Practitioners Physician Services 00 1154459824 0 LUKECART KIMBERLY 2006083 9999999 B 10 1154459824 0 2700 W THOMAS ST UNIT 1 CHICAGO IL 606223445 20 1154459824 0 Occupational Therapists Medical Supplies 20 1154459824 0 Occupational Therapists Medical equipment/prosthetic devices 20 1154459824 0 Occupational Therapists Occupational Therapy Services 00 1154459915 0 HOLTZ PETER 1997202 9999999 B 10 1154459915 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1154459915 0 Physicians Anesthesia Services 20 1154459915 0 Physicians Healthy Kids Services 20 1154459915 0 Physicians Optical Supplies 20 1154459915 0 Physicians Physician Services 00 1154460160 0 SMITH JESSICA K 2009247 9999999 B 10 1154460160 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1154460160 0 Physicians Anesthesia Services 20 1154460160 0 Physicians Healthy Kids Services 20 1154460160 0 Physicians Optical Supplies 20 1154460160 0 Physicians Physician Services 00 1154460517 0 LIBKE DANIEL 2020118 9999999 B 10 1154460517 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1154460517 0 Physicians Anesthesia Services 20 1154460517 0 Physicians Healthy Kids Services 20 1154460517 0 Physicians Optical Supplies 20 1154460517 0 Physicians Physician Services 00 1154460954 0 MCQUIRTER VINCENT 2023283 9999999 B 10 1154460954 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1154460954 0 Physical Therapists Medical Supplies 20 1154460954 0 Physical Therapists Medical equipment/prosthetic devices 20 1154460954 0 Physical Therapists Physical Therapy Services 00 1154461424 0 WALLENBERG DEBRA 2002337 9999999 B 10 1154461424 0 29W571 SAINT THOMAS WAY WEST CHICAGO IL 601851298 20 1154461424 0 Occupational Therapists Medical Supplies 20 1154461424 0 Occupational Therapists Medical equipment/prosthetic devices 20 1154461424 0 Occupational Therapists Occupational Therapy Services 00 1154461978 0 REYES CRISANTO 1994195 9999999 B 10 1154461978 0 110 N LOCUST ST ONARGA IL 609551213 20 1154461978 0 Physicians Anesthesia Services 20 1154461978 0 Physicians Fluoride varnish 20 1154461978 0 Physicians Healthy Kids Services 20 1154461978 0 Physicians Optical Supplies 20 1154461978 0 Physicians Physician Services 00 1154462224 0 ALLA RAJESH 2007182 9999999 B 10 1154462224 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1154462224 0 Physicians Anesthesia Services 20 1154462224 0 Physicians Fluoride varnish 20 1154462224 0 Physicians Healthy Kids Services 20 1154462224 0 Physicians Optical Supplies 20 1154462224 0 Physicians Physician Services 00 1154466035 0 PHILLIPS JEANNINE 2004072 9999999 B 10 1154466035 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1154466035 0 Speech Therapists Medical Supplies 20 1154466035 0 Speech Therapists Medical equipment/prosthetic devices 20 1154466035 0 Speech Therapists Speech Therapy/Pathology Services 00 1154467702 0 PRASUN MARILYN 2006001 9999999 B 10 1154467702 0 200 STAHLHUT DR LINCOLN IL 626565066 20 1154467702 0 Nurse Practitioners Fluoride varnish 20 1154467702 0 Nurse Practitioners Healthy Kids Services 20 1154467702 0 Nurse Practitioners Nurse Practitioners Services 20 1154467702 0 Nurse Practitioners Physician Services 00 1154467850 0 SCHNEEBERGER STEPHANIE 2016214 9999999 B 10 1154467850 0 1414 MAIN ST MELROSE PARK IL 601603902 20 1154467850 0 Other behavior health professional LCPC/LMFT services 00 1154476273 0 MORRIS CURTIS 2012179 9999999 B 10 1154476273 0 PO BOX 155 CHRISTOPHER IL 628220155 20 1154476273 0 Physician Assistant Only Electronic Home Response/EHR Installation, MPE Certification 20 1154476273 0 Physician Assistant Only Family Planning Counseling 20 1154476273 0 Physician Assistant Only Fluoride varnish 20 1154476273 0 Physician Assistant Only Healthy Kids Services 20 1154476273 0 Physician Assistant Only Physician Services 00 1154477743 0 CAPOCELLI KELLEY E 2016264 9999999 B 10 1154477743 0 PO BOX 110429 AURORA CO 800420429 20 1154477743 0 Physicians Anesthesia Services 20 1154477743 0 Physicians Healthy Kids Services 20 1154477743 0 Physicians Optical Supplies 20 1154477743 0 Physicians Physician Services 00 1154477834 0 LAETSCH THEODORE 2024129 9999999 B 10 1154477834 0 100 E PENN SQ FL 9 PHILADELPHIA PA 191073377 20 1154477834 0 Physicians Anesthesia Services 20 1154477834 0 Physicians Fluoride varnish 20 1154477834 0 Physicians Healthy Kids Services 20 1154477834 0 Physicians Optical Supplies 20 1154477834 0 Physicians Physician Services 00 1154478832 0 MOYNIHAN CATHY 2008123 9999999 B 10 1154478832 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1154478832 0 Nurse Practitioners Fluoride varnish 20 1154478832 0 Nurse Practitioners Healthy Kids Services 20 1154478832 0 Nurse Practitioners Nurse Practitioners Services 20 1154478832 0 Nurse Practitioners Physician Services 00 1154481364 0 STATEN PATRICE 2002274 9999999 B 10 1154481364 0 6810 STATE ROUTE 162 STE 215 MARYVILLE IL 620628566 20 1154481364 0 Physicians Anesthesia Services 20 1154481364 0 Physicians Healthy Kids Services 20 1154481364 0 Physicians Optical Supplies 20 1154481364 0 Physicians Physician Services 00 1154482024 0 SIMMONS GAYLE 1988245 9999999 B 10 1154482024 0 PO BOX 713388 CHICAGO IL 606771525 20 1154482024 0 Physicians Anesthesia Services 20 1154482024 0 Physicians Healthy Kids Services 20 1154482024 0 Physicians Optical Supplies 20 1154482024 0 Physicians Physician Services 00 1154482131 0 PATEL SATYEN V 2007351 9999999 B 10 1154482131 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1154482131 0 Physicians Anesthesia Services 20 1154482131 0 Physicians Fluoride varnish 20 1154482131 0 Physicians Healthy Kids Services 20 1154482131 0 Physicians Optical Supplies 20 1154482131 0 Physicians Physician Services 00 1154483618 0 CURRAN JAMES J 1987121 9999999 B 10 1154483618 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1154483618 0 Physicians Anesthesia Services 20 1154483618 0 Physicians Fluoride varnish 20 1154483618 0 Physicians Healthy Kids Services 20 1154483618 0 Physicians Optical Supplies 20 1154483618 0 Physicians Physician Services 00 1154484673 0 RODIN MIRIAM 1989310 9999999 B 10 1154484673 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1154484673 0 Physicians Anesthesia Services 20 1154484673 0 Physicians Fluoride varnish 20 1154484673 0 Physicians Healthy Kids Services 20 1154484673 0 Physicians Optical Supplies 20 1154484673 0 Physicians Physician Services 00 1154485316 0 JACOBY CARMEN Y 1996309 9999999 B 10 1154485316 0 607 W OAK ST WEST FRANKFORT IL 628962537 20 1154485316 0 Chiropractors Chiropractic Services 00 1154487395 0 PARKER EDWARD 1996190 9999999 B 10 1154487395 0 155 E BRUSH HILL RD 155 E BRUSH HILL RD ELMHURST IL 601265658 20 1154487395 0 Physicians Anesthesia Services 20 1154487395 0 Physicians Healthy Kids Services 20 1154487395 0 Physicians Optical Supplies 20 1154487395 0 Physicians Physician Services 00 1154488369 0 SARY MEREDITH R 2020050 9999999 B 10 1154488369 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1154488369 0 Other behavior health professional LCPC/LMFT services 00 1154490647 0 DAMRELL XI Z 2021352 9999999 B 10 1154490647 0 5701 W TALAVI BLVD STE 120 GLENDALE AZ 853061888 20 1154490647 0 Physicians Anesthesia Services 20 1154490647 0 Physicians Healthy Kids Services 20 1154490647 0 Physicians Optical Supplies 20 1154490647 0 Physicians Physician Services 00 1154491959 0 HIRSCH GERALD 1981227 9999999 B 10 1154491959 0 96 N KENNEDY DR STE 205 CARPENTERSVILLE IL 601101674 20 1154491959 0 Dentists Dental Services 20 1154491959 0 Dentists Physician Services 00 1154492312 0 ECKBURG JOSEPH 1995288 9999999 B 10 1154492312 0 4701 DEPT CAROL STREAM IL 601220021 20 1154492312 0 Physicians Anesthesia Services 20 1154492312 0 Physicians Healthy Kids Services 20 1154492312 0 Physicians Optical Supplies 20 1154492312 0 Physicians Physician Services 00 1154493039 0 CASTRO VALERIA C 2017340 9999999 B 10 1154493039 0 175 E HOUSTON ST SAN ANTONIO TX 782052255 20 1154493039 0 Optometrists Optical Supplies 20 1154493039 0 Optometrists Optometric Services 20 1154493039 0 Optometrists Physician Services 00 1154494334 0 JACHIMEK JULIE 2014213 9999999 B 10 1154494334 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1154494334 0 Physical Therapists Medical Supplies 20 1154494334 0 Physical Therapists Medical equipment/prosthetic devices 20 1154494334 0 Physical Therapists Physical Therapy Services 00 1154495174 0 DIAB MOHAMED ALAA 2001152 9999999 B 10 1154495174 0 3545 ROSE ST FRANKLIN PARK IL 601312068 20 1154495174 0 Physical Therapists Medical Supplies 20 1154495174 0 Physical Therapists Medical equipment/prosthetic devices 20 1154495174 0 Physical Therapists Physical Therapy Services 00 1154495380 0 SEEBRUCH SHELLI 2000273 9999999 B 10 1154495380 0 114 BARNEY DR JOLIET IL 604356404 20 1154495380 0 Physicians Anesthesia Services 20 1154495380 0 Physicians Fluoride varnish 20 1154495380 0 Physicians Healthy Kids Services 20 1154495380 0 Physicians Optical Supplies 20 1154495380 0 Physicians Physician Services 00 1154495448 0 KELLEHER MICHAEL 1993182 9999999 B 10 1154495448 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1154495448 0 Physicians Anesthesia Services 20 1154495448 0 Physicians Fluoride varnish 20 1154495448 0 Physicians Healthy Kids Services 20 1154495448 0 Physicians Optical Supplies 20 1154495448 0 Physicians Physician Services 00 1154495786 0 HENZE MARLENE K 1996212 9999999 B 10 1154495786 0 5901 PEACHTREE DUNWOODY RD STE SUITE C-350 ATLANTA GA 303287159 20 1154495786 0 Physicians Anesthesia Services 20 1154495786 0 Physicians Fluoride varnish 20 1154495786 0 Physicians Healthy Kids Services 20 1154495786 0 Physicians Optical Supplies 20 1154495786 0 Physicians Physician Services 00 1154497063 0 THOMAS ALFONZO 2016306 9999999 B 10 1154497063 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1154497063 0 Physical Therapists Medical Supplies 20 1154497063 0 Physical Therapists Medical equipment/prosthetic devices 20 1154497063 0 Physical Therapists Physical Therapy Services 00 1154499317 0 SFIKAS JOHN 1992001 9999999 B 10 1154499317 0 1499 WINDHORST WAY STE 100 GREENWOOD IN 461438800 20 1154499317 0 Dentists Dental Services 20 1154499317 0 Dentists Physician Services 00 1154500031 0 FLORCZAKWIESER LINDA S 2007347 9999999 B 10 1154500031 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1154500031 0 Occupational Therapists Medical Supplies 20 1154500031 0 Occupational Therapists Medical equipment/prosthetic devices 20 1154500031 0 Occupational Therapists Occupational Therapy Services 00 1154501245 0 KAPOOR ROGER 2011220 9999999 B 10 1154501245 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1154501245 0 Physicians Anesthesia Services 20 1154501245 0 Physicians Healthy Kids Services 20 1154501245 0 Physicians Optical Supplies 20 1154501245 0 Physicians Physician Services 00 1154501393 0 THOMAS MICHAEL 2013182 9999999 B 10 1154501393 0 70 DOCTORS PARK CAPE GIRARDEAU MO 637034928 20 1154501393 0 Physicians Anesthesia Services 20 1154501393 0 Physicians Healthy Kids Services 20 1154501393 0 Physicians Optical Supplies 20 1154501393 0 Physicians Physician Services 00 1154501443 0 RISER ADAM 2016279 9999999 B 10 1154501443 0 18167 US HIGHWAY 19 N STE 650 CLEARWATER FL 337646576 20 1154501443 0 Physician Assistant Only Fluoride varnish 20 1154501443 0 Physician Assistant Only Healthy Kids Services 20 1154501443 0 Physician Assistant Only Physician Services 00 1154502045 0 LEE JOHN 2020253 9999999 B 10 1154502045 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1154502045 0 Physicians Anesthesia Services 20 1154502045 0 Physicians Fluoride varnish 20 1154502045 0 Physicians Healthy Kids Services 20 1154502045 0 Physicians Optical Supplies 20 1154502045 0 Physicians Physician Services 00 1154502367 0 STRIPLING CARRIE 2011241 9999999 B 10 1154502367 0 PO BOX 43230 PHOENIX AZ 850803230 20 1154502367 0 Physicians Anesthesia Services 20 1154502367 0 Physicians Healthy Kids Services 20 1154502367 0 Physicians Optical Supplies 20 1154502367 0 Physicians Physician Services 00 1154506582 0 JOSHI DEEPAK 2022049 9999999 B 10 1154506582 0 PO BOX 781076 DETROIT MI 482781076 20 1154506582 0 Physicians Anesthesia Services 20 1154506582 0 Physicians Fluoride varnish 20 1154506582 0 Physicians Healthy Kids Services 20 1154506582 0 Physicians Optical Supplies 20 1154506582 0 Physicians Physician Services 00 1154506731 0 MERING MARK 2018222 9999999 B 10 1154506731 0 PO BOX 500 ELLICOTTVILLE NY 147310500 20 1154506731 0 Physician Assistant Only Fluoride varnish 20 1154506731 0 Physician Assistant Only Healthy Kids Services 20 1154506731 0 Physician Assistant Only Physician Services 00 1154508547 0 ALFORD JAMES LOUIS 2012183 9999999 B 10 1154508547 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1154508547 0 Physicians Anesthesia Services 20 1154508547 0 Physicians Healthy Kids Services 20 1154508547 0 Physicians Optical Supplies 20 1154508547 0 Physicians Physician Services 00 1154508570 0 DIHU JAMIL 2013152 9999999 B 10 1154508570 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1154508570 0 Physicians Anesthesia Services 20 1154508570 0 Physicians Fluoride varnish 20 1154508570 0 Physicians Healthy Kids Services 20 1154508570 0 Physicians Optical Supplies 20 1154508570 0 Physicians Physician Services 00 1154508885 0 KARSTENS MARY 2018305 9999999 B 10 1154508885 0 2045 W GRAND AVE STE B CHICAGO IL 606121577 20 1154508885 0 Clinical Social Worker Social work service 00 1154510311 0 BATHLA BALJINDER S 2008007 9999999 B 10 1154510311 0 1550 S INDIANA AVE STE 100 CHICAGO IL 606054835 20 1154510311 0 Physicians Anesthesia Services 20 1154510311 0 Physicians Healthy Kids Services 20 1154510311 0 Physicians Optical Supplies 20 1154510311 0 Physicians Physician Services 00 1154511434 0 KEPROS CHRISTOPHER 2022354 9999999 B 10 1154511434 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1154511434 0 Dentists Dental Services 20 1154511434 0 Dentists Physician Services 00 1154511517 0 SULLIVAN DONALD N 2013213 9999999 B 10 1154511517 0 101 E 9TH ST PANA IL 625571716 20 1154511517 0 Physicians Anesthesia Services 20 1154511517 0 Physicians Healthy Kids Services 20 1154511517 0 Physicians Optical Supplies 20 1154511517 0 Physicians Physician Services 00 1154511970 0 WARD ANDREA 2007334 9999999 B 10 1154511970 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1154511970 0 Physicians Anesthesia Services 20 1154511970 0 Physicians Healthy Kids Services 20 1154511970 0 Physicians Optical Supplies 20 1154511970 0 Physicians Physician Services 00 1154513505 0 PETRUS VAIDOTAS 2007001 9999999 B 10 1154513505 0 2740 W FOSTER AVE LL7 CHICAGO IL 606253500 20 1154513505 0 Physicians All Kids application agent 20 1154513505 0 Physicians Anesthesia Services 20 1154513505 0 Physicians Fluoride varnish 20 1154513505 0 Physicians Healthy Kids Services 20 1154513505 0 Physicians Optical Supplies 20 1154513505 0 Physicians Physician Services 00 1154514529 0 OMOTOSO OMOLOLA 2020045 9999999 B 10 1154514529 0 PO BOX 1257 HANNIBAL MO 634011257 20 1154514529 0 Physicians Anesthesia Services 20 1154514529 0 Physicians Healthy Kids Services 20 1154514529 0 Physicians Optical Supplies 20 1154514529 0 Physicians Physician Services 00 1154514867 0 WILLIAMSON MARGARET K 2011213 9999999 B 10 1154514867 0 29373 NETWORK PL CHICAGO IL 606733039 20 1154514867 0 Physicians Anesthesia Services 20 1154514867 0 Physicians Healthy Kids Services 20 1154514867 0 Physicians Optical Supplies 20 1154514867 0 Physicians Physician Services 00 1154515849 0 CRUZ MEREDITH O 2009213 9999999 B 10 1154515849 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1154515849 0 Physicians Anesthesia Services 20 1154515849 0 Physicians Healthy Kids Services 20 1154515849 0 Physicians Optical Supplies 20 1154515849 0 Physicians Physician Services 00 1154517712 0 JAKUBAS LESLIE 2024365 9999999 B 10 1154517712 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1154517712 0 Nurse Practitioners Anesthesia Services 20 1154517712 0 Nurse Practitioners Nurse Practitioners Services 20 1154517712 0 Nurse Practitioners Physician Services 00 1154519650 0 TUCKER RYAN D 2014213 9999999 B 10 1154519650 0 PO BOX 638704 CINCINNATI OH 452638704 20 1154519650 0 Physicians Anesthesia Services 20 1154519650 0 Physicians Healthy Kids Services 20 1154519650 0 Physicians Optical Supplies 20 1154519650 0 Physicians Physician Services 00 1154520096 0 NOVOTA GABRIELA B 2007152 9999999 B 10 1154520096 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1154520096 0 Physicians All Kids application agent 20 1154520096 0 Physicians Anesthesia Services 20 1154520096 0 Physicians Fluoride varnish 20 1154520096 0 Physicians Healthy Kids Services 20 1154520096 0 Physicians Optical Supplies 20 1154520096 0 Physicians Physician Services 00 1154520179 0 LARSON JOSHUA 2011186 9999999 B 10 1154520179 0 200 HAWKINS DRIVE IOWA CITY IA 522421009 20 1154520179 0 Physicians Anesthesia Services 20 1154520179 0 Physicians Healthy Kids Services 20 1154520179 0 Physicians Optical Supplies 20 1154520179 0 Physicians Physician Services 00 1154520344 0 THORN REBECCA C 2008140 9999999 B 10 1154520344 0 1732 ROBERT LN NAPERVILLE IL 605647125 20 1154520344 0 Speech Therapists Medical Supplies 20 1154520344 0 Speech Therapists Medical equipment/prosthetic devices 20 1154520344 0 Speech Therapists Speech Therapy/Pathology Services 00 1154520369 0 HOLCOMBE RHIANNON M 2017261 9999999 B 10 1154520369 0 957 S MANNHEIM RD STE 1N WESTCHESTER IL 601542544 20 1154520369 0 Dentists Dental Services 20 1154520369 0 Dentists Physician Services 00 1154521342 0 ABDULHADI MIKE A 2013280 9999999 B 10 1154521342 0 5901 LINCOLN DR EDINA MN 554361611 20 1154521342 0 Physicians Anesthesia Services 20 1154521342 0 Physicians Healthy Kids Services 20 1154521342 0 Physicians Optical Supplies 20 1154521342 0 Physicians Physician Services 00 1154521367 0 MEHTA ANKIT 2014297 9999999 B 10 1154521367 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1154521367 0 Physicians Anesthesia Services 20 1154521367 0 Physicians Healthy Kids Services 20 1154521367 0 Physicians Optical Supplies 20 1154521367 0 Physicians Physician Services 00 1154521425 0 REPPLINGER MICHAEL 2010182 9999999 B 10 1154521425 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1154521425 0 Physicians Anesthesia Services 20 1154521425 0 Physicians Healthy Kids Services 20 1154521425 0 Physicians Optical Supplies 20 1154521425 0 Physicians Physician Services 00 1154522274 0 KING MARY MARGARET 2016011 9999999 B 10 1154522274 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1154522274 0 Physician Assistant Only Fluoride varnish 20 1154522274 0 Physician Assistant Only Healthy Kids Services 20 1154522274 0 Physician Assistant Only Physician Services 00 1154523330 0 SANFORD STACY D 2017001 9999999 B 10 1154523330 0 5777 DEPT CAROL STREAM IL 601220021 20 1154523330 0 Psychologist Psychologist service 00 1154523355 0 SCHRANTZ STEPHEN J 2008156 9999999 B 10 1154523355 0 800 E 55TH ST CHICAGO IL 606154906 20 1154523355 0 Physicians Anesthesia Services 20 1154523355 0 Physicians Fluoride varnish 20 1154523355 0 Physicians Healthy Kids Services 20 1154523355 0 Physicians Optical Supplies 20 1154523355 0 Physicians Physician Services 00 1154524742 0 JOHNSON MICHAEL E 2008217 9999999 B 10 1154524742 0 14050 NW 14TH ST STE 190 SUNRISE FL 333232851 20 1154524742 0 Physicians Anesthesia Services 20 1154524742 0 Physicians Fluoride varnish 20 1154524742 0 Physicians Healthy Kids Services 20 1154524742 0 Physicians Optical Supplies 20 1154524742 0 Physicians Physician Services 00 1154524973 0 NAM MOON-WOO 2016173 9999999 B 10 1154524973 0 PO BOX 578 PARK RIDGE IL 600680578 20 1154524973 0 Physicians Anesthesia Services 20 1154524973 0 Physicians Healthy Kids Services 20 1154524973 0 Physicians Optical Supplies 20 1154524973 0 Physicians Physician Services 00 1154525707 0 HUSAIN ALI 2008214 9999999 B 10 1154525707 0 1400 US HIGHWAY 61 FESTUS MO 630284100 20 1154525707 0 Physicians Anesthesia Services 20 1154525707 0 Physicians Fluoride varnish 20 1154525707 0 Physicians Healthy Kids Services 20 1154525707 0 Physicians Optical Supplies 20 1154525707 0 Physicians Physician Services 00 1154526119 0 BLUDGEN ANNE K 2024038 9999999 B 10 1154526119 0 465 E 170TH ST SOUTH HOLLAND IL 604733400 20 1154526119 0 Speech Therapists Speech Therapy/Pathology Services 00 1154526739 0 MENDEL JESSICA N 2019080 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ST # 520 INDIANAPOLIS IN 462601316 20 1154527760 0 Physicians Anesthesia Services 20 1154527760 0 Physicians Healthy Kids Services 20 1154527760 0 Physicians Optical Supplies 20 1154527760 0 Physicians Physician Services 20 1154527760 0 Physicians Physicians Psychiatric Services 00 1154528834 0 TENFELDE SANDI M. 2015007 9999999 B 10 1154528834 0 1276 N CLYBOURN AVE CHICAGO IL 606102089 20 1154528834 0 Nurse Practitioners Healthy Kids Services 20 1154528834 0 Nurse Practitioners Nurse Practitioners Services 20 1154528834 0 Nurse Practitioners Physician Services 00 1154529105 0 OMER MUHAMMAD 2013335 9999999 B 10 1154529105 0 1395 NW 167TH ST MIAMI FL 331695710 20 1154529105 0 Physicians Anesthesia Services 20 1154529105 0 Physicians Fluoride varnish 20 1154529105 0 Physicians Healthy Kids Services 20 1154529105 0 Physicians Optical Supplies 20 1154529105 0 Physicians Physician Services 00 1154529238 0 WARREN RAMONA C 2022196 9999999 B 10 1154529238 0 317 MARTIN LUTHER KING JR WAY TACOMA 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Physicians Physician Services 00 1154682433 0 BEHNAN LEGORRETA ELIZABETH 2012254 9999999 B 10 1154682433 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1154682433 0 Nurse Practitioners Fluoride varnish 20 1154682433 0 Nurse Practitioners Healthy Kids Services 20 1154682433 0 Nurse Practitioners Nurse Practitioners Services 20 1154682433 0 Nurse Practitioners Physician Services 00 1154683456 0 DANAWALA SEJAL 2017145 9999999 B 10 1154683456 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1154683456 0 Physicians Anesthesia Services 20 1154683456 0 Physicians Fluoride varnish 20 1154683456 0 Physicians Healthy Kids Services 20 1154683456 0 Physicians Optical Supplies 20 1154683456 0 Physicians Physician Services 00 1154683860 0 CRAWFORD JEMILA 2015213 9999999 B 10 1154683860 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1154683860 0 Physicians Anesthesia Services 20 1154683860 0 Physicians Healthy Kids Services 20 1154683860 0 Physicians Optical Supplies 20 1154683860 0 Physicians Physician Services 00 1154684140 0 GRIPENTROG DREW 2024347 9999999 B 10 1154684140 0 811 W WELLINGTON AVE CHICAGO IL 606575123 20 1154684140 0 Dentists Dental Services 20 1154684140 0 Dentists Physician Services 00 1154684728 0 GONZALEZ MARITZA G 2019182 9999999 B 10 1154684728 0 5777 DEPT CAROL STREAM IL 601228942 20 1154684728 0 Physicians Anesthesia Services 20 1154684728 0 Physicians Healthy Kids Services 20 1154684728 0 Physicians Optical Supplies 20 1154684728 0 Physicians Physician Services 00 1154684975 0 HENSON ADAM J 2015182 9999999 B 10 1154684975 0 PO BOX 192 900 N WASHINGTON ST DU QUOIN IL 628320192 20 1154684975 0 Physicians Anesthesia Services 20 1154684975 0 Physicians Fluoride varnish 20 1154684975 0 Physicians Healthy Kids Services 20 1154684975 0 Physicians Optical Supplies 20 1154684975 0 Physicians Physician Services 00 1154685089 0 MOHIUDDIN MOHD NOMAN 2012214 9999999 B 10 1154685089 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1154685089 0 Physicians Anesthesia Services 20 1154685089 0 Physicians Fluoride varnish 20 1154685089 0 Physicians Healthy Kids Services 20 1154685089 0 Physicians Optical Supplies 20 1154685089 0 Physicians Physician Services 00 1154686681 0 AZHAR NAAZIA 2016270 9999999 B 10 1154686681 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1154686681 0 Physicians Anesthesia Services 20 1154686681 0 Physicians Healthy Kids Services 20 1154686681 0 Physicians Optical Supplies 20 1154686681 0 Physicians Physician Services 20 1154686681 0 Physicians Physicians Psychiatric Services 00 1154686897 0 HASENOUR GRANT J 2024177 9999999 B 10 1154686897 0 1650 LYNDON FARM CT STE 300 LOUISVILLE KY 402235005 20 1154686897 0 Occupational Therapists Medical Supplies 20 1154686897 0 Occupational Therapists Medical equipment/prosthetic devices 20 1154686897 0 Occupational Therapists Occupational Therapy Services 00 1154687549 0 SULLIVAN THOMAS 2020090 9999999 B 10 1154687549 0 645 S CENTRAL AVE CHICAGO IL 606445059 20 1154687549 0 Physicians Anesthesia Services 20 1154687549 0 Physicians Healthy Kids Services 20 1154687549 0 Physicians Optical Supplies 20 1154687549 0 Physicians Physician Services 00 1154688604 0 QUERUBIN JYES A 2022284 9999999 B 10 1154688604 0 24 S WEBER ST STE 200 COLORADO SPRING CO 809031928 20 1154688604 0 Physicians Anesthesia Services 20 1154688604 0 Physicians Healthy Kids Services 20 1154688604 0 Physicians Optical Supplies 20 1154688604 0 Physicians Physician Services 20 1154688604 0 Physicians Physicians Psychiatric Services 00 1154688620 0 JOHNSON LEAH E 2023233 9999999 B 10 1154688620 0 2695 ROCKY MOUNTAIN AVE STE 15 LOVELAND CO 805389071 20 1154688620 0 Physician Assistant Only Fluoride varnish 20 1154688620 0 Physician Assistant Only Healthy Kids Services 20 1154688620 0 Physician Assistant Only Physician Services 00 1154688752 0 WEIER KARI A 2019336 9999999 B 10 1154688752 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1154688752 0 Nurse Practitioners Fluoride varnish 20 1154688752 0 Nurse Practitioners Healthy Kids Services 20 1154688752 0 Nurse Practitioners Nurse Practitioners Services 20 1154688752 0 Nurse Practitioners Physician Services 00 1154690626 0 DUA SUMEET G 2014182 9999999 B 10 1154690626 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1154690626 0 Physicians Anesthesia Services 20 1154690626 0 Physicians Healthy Kids Services 20 1154690626 0 Physicians Optical Supplies 20 1154690626 0 Physicians Physician Services 00 1154690980 0 LAIRD KATHERINE 2012275 9999999 B 10 1154690980 0 900 N WASHINGTON ST DU QUOIN IL 628321233 20 1154690980 0 Nurse Practitioners Healthy Kids Services 20 1154690980 0 Nurse Practitioners Nurse Practitioners Services 20 1154690980 0 Nurse Practitioners Physician Services 00 1154691319 0 CARLILE CASEY L 2012001 9999999 B 10 1154691319 0 1201 PINE ST ELDORADO IL 629301634 20 1154691319 0 Nurse Practitioners Family Planning Counseling 20 1154691319 0 Nurse Practitioners Healthy Kids Services 20 1154691319 0 Nurse Practitioners Nurse Practitioners Services 20 1154691319 0 Nurse Practitioners Physician Services 00 1154692028 0 GUMMERSHEIMER SABRINA 2014098 9999999 B 10 1154692028 0 PO BOX 146 WATERLOO IL 622980146 20 1154692028 0 Other behavior health professional LCPC/LMFT services 00 1154692127 0 MENDOZA BRIAN 2016230 9999999 B 10 1154692127 0 275 N YORK ST STE 301 ELMHURST IL 601262784 20 1154692127 0 Chiropractors Chiropractic Services 00 1154695427 0 SIMANIS STACY 2012101 9999999 B 10 1154695427 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1154695427 0 Physical Therapists Medical Supplies 20 1154695427 0 Physical Therapists Medical equipment/prosthetic devices 20 1154695427 0 Physical Therapists Physical Therapy Services 00 1154695997 0 ALIKAH MAUREEN 2021121 9999999 B 10 1154695997 0 PO BOX 301208 DALLAS TX 753031501 20 1154695997 0 Physicians Anesthesia Services 20 1154695997 0 Physicians Healthy Kids Services 20 1154695997 0 Physicians Optical Supplies 20 1154695997 0 Physicians Physician Services 00 1154697175 0 HALENDA GREGORY M 2017182 9999999 B 10 1154697175 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1154697175 0 Physicians Anesthesia Services 20 1154697175 0 Physicians Healthy Kids Services 20 1154697175 0 Physicians Optical Supplies 20 1154697175 0 Physicians Physician Services 00 1154697233 0 MORRISON JAYNE A 2012106 9999999 B 10 1154697233 0 PO BOX 860362 MINNEAPOLIS MN 554860362 20 1154697233 0 Nurse Practitioners Fluoride varnish 20 1154697233 0 Nurse Practitioners Healthy Kids Services 20 1154697233 0 Nurse Practitioners Nurse Practitioners Services 20 1154697233 0 Nurse Practitioners Physician Services 00 1154697274 0 MOIOLI EDUARDO K 2017244 9999999 B 10 1154697274 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1154697274 0 Physicians Anesthesia Services 20 1154697274 0 Physicians Healthy Kids Services 20 1154697274 0 Physicians Optical Supplies 20 1154697274 0 Physicians Physician Services 00 1154697779 0 NAGLE SCHALES 2017307 9999999 B 10 1154697779 0 101 E 9TH ST PANA IL 625571716 20 1154697779 0 Clinical Social Worker Social work service 00 1154699148 0 VAN VELDHUISEN KATHLEEN M 2011335 9999999 B 10 1154699148 0 PO BOX 5081 JANESVILLE WI 535475081 20 1154699148 0 Nurse Practitioners Healthy Kids Services 20 1154699148 0 Nurse Practitioners Nurse Practitioners Services 20 1154699148 0 Nurse Practitioners Physician Services 00 1154700961 0 COLLIER SANDRICKA 2020230 9999999 B 10 1154700961 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1154700961 0 Physicians Anesthesia Services 20 1154700961 0 Physicians Healthy Kids Services 20 1154700961 0 Physicians Optical Supplies 20 1154700961 0 Physicians Physician Services 00 1154701506 0 MARTINEZ LINDSEY 2016243 9999999 B 10 1154701506 0 4025 TAMPA RD STE 1106 OLDSMAR FL 346773213 20 1154701506 0 Occupational Therapists Medical Supplies 20 1154701506 0 Occupational Therapists Medical equipment/prosthetic devices 20 1154701506 0 Occupational Therapists Occupational Therapy Services 00 1154702082 0 AKKARI LANA 2018267 9999999 B 10 1154702082 0 PO BOX 776473 CHICAGO IL 606776473 20 1154702082 0 Physicians Anesthesia Services 20 1154702082 0 Physicians Healthy Kids Services 20 1154702082 0 Physicians Optical Supplies 20 1154702082 0 Physicians Physician Services 00 1154702116 0 SIDDIQUI NABEEL 2017069 9999999 B 10 1154702116 0 5777 DEPT CAROL STREAM IL 601220021 20 1154702116 0 Physicians Anesthesia Services 20 1154702116 0 Physicians Fluoride varnish 20 1154702116 0 Physicians Healthy Kids Services 20 1154702116 0 Physicians Optical Supplies 20 1154702116 0 Physicians Physician Services 00 1154702231 0 SYED SOHAIL H 2023279 9999999 B 10 1154702231 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1154702231 0 Physicians Anesthesia Services 20 1154702231 0 Physicians Healthy Kids Services 20 1154702231 0 Physicians Optical Supplies 20 1154702231 0 Physicians Physician Services 00 1154702421 0 DEFFENBACHER KAREN E 2018244 9999999 B 10 1154702421 0 71 W 156TH ST STE 305 HARVEY IL 604264264 20 1154702421 0 Physicians Anesthesia Services 20 1154702421 0 Physicians Fluoride varnish 20 1154702421 0 Physicians Healthy Kids Services 20 1154702421 0 Physicians Optical Supplies 20 1154702421 0 Physicians Physician Services 00 1154705002 0 EBERLE MARY C 2017272 9999999 B 10 1154705002 0 PO BOX 781076 DETROIT MI 482781076 20 1154705002 0 Clinical Social Worker Social work service 00 1154705093 0 BEIN LAURA A 2015246 9999999 B 10 1154705093 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1154705093 0 Psychologist Psychologist service 00 1154706364 0 GARCIA ANDRE 2016012 9999999 B 10 1154706364 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1154706364 0 Dentists Dental Services 20 1154706364 0 Dentists Physician Services 00 1154707024 0 JAIDEV PRAVEENA USHA 2018182 9999999 B 10 1154707024 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1154707024 0 Physicians Anesthesia Services 20 1154707024 0 Physicians Fluoride varnish 20 1154707024 0 Physicians Healthy Kids Services 20 1154707024 0 Physicians Optical Supplies 20 1154707024 0 Physicians Physician Services 00 1154707388 0 NASTASE DORINA 2015212 9999999 B 10 1154707388 0 200 W LAKE ST ADDISON IL 601012513 20 1154707388 0 Dentists Dental Services 20 1154707388 0 Dentists Physician Services 00 1154709731 0 NANDAM JANAKI 2019144 9999999 B 10 1154709731 0 PO BOX 713388 CHICAGO IL 606771525 20 1154709731 0 Physicians Anesthesia Services 20 1154709731 0 Physicians Healthy Kids Services 20 1154709731 0 Physicians Optical Supplies 20 1154709731 0 Physicians Physician Services 00 1154709756 0 JOHN JESWIN B 2019225 9999999 B 10 1154709756 0 800 E LOCUST ST OLNEY IL 624502553 20 1154709756 0 Physicians Anesthesia Services 20 1154709756 0 Physicians Fluoride varnish 20 1154709756 0 Physicians Healthy Kids Services 20 1154709756 0 Physicians Optical Supplies 20 1154709756 0 Physicians Physician Services 00 1154711307 0 FLETCHER SARAH 2021012 9999999 B 10 1154711307 0 1400 W GREENLEAF AVE CHICAGO IL 606262805 20 1154711307 0 Clinical Social Worker Social work service 00 1154712743 0 MCKAIN DANICA B 2015075 9999999 B 10 1154712743 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1154712743 0 Nurse Practitioners Fluoride varnish 20 1154712743 0 Nurse Practitioners Healthy Kids Services 20 1154712743 0 Nurse Practitioners Nurse Practitioners Services 20 1154712743 0 Nurse Practitioners Physician Services 00 1154713899 0 FLOOD KELSEY S 2022271 9999999 B 10 1154713899 0 5777 DEPT CAROL STREAM IL 601220021 20 1154713899 0 Physicians Anesthesia Services 20 1154713899 0 Physicians Healthy Kids Services 20 1154713899 0 Physicians Optical Supplies 20 1154713899 0 Physicians Physician Services 00 1154714202 0 ROEDER HEIDI E 2016306 9999999 B 10 1154714202 0 621 S NEW BALLAS RD STE 560A SUITE 560A SAINT LOUIS MO 631418261 20 1154714202 0 Physician Assistant Only Fluoride varnish 20 1154714202 0 Physician Assistant Only Healthy Kids Services 20 1154714202 0 Physician Assistant Only Physician Services 00 1154716280 0 BAZZELL ANDREA D 2016063 9999999 B 10 1154716280 0 2605 KENTUCKY AVE STE 306 PADUCAH KY 420033802 20 1154716280 0 Nurse Practitioners Fluoride varnish 20 1154716280 0 Nurse Practitioners Healthy Kids Services 20 1154716280 0 Nurse Practitioners Nurse Practitioners Services 20 1154716280 0 Nurse Practitioners Physician Services 00 1154716306 0 BROWN KIMBERLY 2022340 9999999 B 10 1154716306 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1154716306 0 Physicians Anesthesia Services 20 1154716306 0 Physicians Healthy Kids Services 20 1154716306 0 Physicians Optical Supplies 20 1154716306 0 Physicians Physician Services 00 1154716330 0 BRENER ALINA 2018257 9999999 B 10 1154716330 0 1000 MEDICAL CENTER DR MONTICELLO IL 618562116 20 1154716330 0 Physicians Anesthesia Services 20 1154716330 0 Physicians Fluoride varnish 20 1154716330 0 Physicians Healthy Kids Services 20 1154716330 0 Physicians Optical Supplies 20 1154716330 0 Physicians Physician Services 00 1154716629 0 RAWAL RACHNA 2018068 9999999 B 10 1154716629 0 5777 DEPT CAROL STREAM IL 601220021 20 1154716629 0 Physicians Anesthesia Services 20 1154716629 0 Physicians Fluoride varnish 20 1154716629 0 Physicians Healthy Kids Services 20 1154716629 0 Physicians Optical Supplies 20 1154716629 0 Physicians Physician Services 00 1154717569 0 HORNADAY KRISTIN M 2016239 9999999 B 10 1154717569 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1154717569 0 Physician Assistant Only Fluoride varnish 20 1154717569 0 Physician Assistant Only Healthy Kids Services 20 1154717569 0 Physician Assistant Only Physician Services 00 1154717684 0 GUTTIKONDA DHARANI 2020010 9999999 B 10 1154717684 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1154717684 0 Physicians Anesthesia Services 20 1154717684 0 Physicians Fluoride varnish 20 1154717684 0 Physicians Healthy Kids Services 20 1154717684 0 Physicians Optical Supplies 20 1154717684 0 Physicians Physician Services 00 1154717809 0 LEHMANN CHRISTOPHER J 2019282 9999999 B 10 1154717809 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1154717809 0 Physicians Anesthesia Services 20 1154717809 0 Physicians Fluoride varnish 20 1154717809 0 Physicians Healthy Kids Services 20 1154717809 0 Physicians Optical Supplies 20 1154717809 0 Physicians Physician Services 00 1154717916 0 WEN FENG 2016256 9999999 B 10 1154717916 0 741 S MCHENRY AVE CRYSTAL LAKE IL 600147445 20 1154717916 0 Physician Assistant Only Fluoride varnish 20 1154717916 0 Physician Assistant Only Healthy Kids Services 20 1154717916 0 Physician Assistant Only Physician Services 00 1154718716 0 MADSEN LIANA R 2015131 9999999 B 10 1154718716 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1154718716 0 Nurse Practitioners Anesthesia Services 20 1154718716 0 Nurse Practitioners Nurse Practitioners Services 20 1154718716 0 Nurse Practitioners Physician Services 00 1154720811 0 EVETT JUSTINE 2014267 9999999 B 10 1154720811 0 826 N MARSHFIELD AVE APT 1N CHICAGO IL 606220037 20 1154720811 0 Speech Therapists Medical Supplies 20 1154720811 0 Speech Therapists Medical equipment/prosthetic devices 20 1154720811 0 Speech Therapists Speech Therapy/Pathology Services 00 1154721579 0 MEDLIN AMY JO 2024053 9999999 B 10 1154721579 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1154721579 0 Other behavior health professional LCPC/LMFT services 00 1154723229 0 CYRUS AMY 2019338 9999999 B 10 1154723229 0 1003 MARTIN LUTHER KING DR BLOOMINGTON IL 617011429 20 1154723229 0 Nurse Practitioners Fluoride varnish 20 1154723229 0 Nurse Practitioners Healthy Kids Services 20 1154723229 0 Nurse Practitioners Nurse Practitioners Services 20 1154723229 0 Nurse Practitioners Physician Services 00 1154724623 0 MAISON-BICE JOANITA A 2017024 9999999 B 10 1154724623 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1154724623 0 Nurse Practitioners Fluoride varnish 20 1154724623 0 Nurse Practitioners Healthy 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1154726511 0 SCHULER SUMMER 2014301 9999999 B 10 1154726511 0 4701 DEPT CAROL STREAM IL 601220021 20 1154726511 0 Nurse Practitioners Fluoride varnish 20 1154726511 0 Nurse Practitioners Healthy Kids Services 20 1154726511 0 Nurse Practitioners Nurse Practitioners Services 20 1154726511 0 Nurse Practitioners Physician Services 00 1154727097 0 PACINI TRACY J 2015343 9999999 B 10 1154727097 0 1320 UNION ST MORRIS IL 604502426 20 1154727097 0 Nurse Practitioners All Kids application agent 20 1154727097 0 Nurse Practitioners Fluoride varnish 20 1154727097 0 Nurse Practitioners Healthy Kids Services 20 1154727097 0 Nurse Practitioners Nurse Practitioners Services 20 1154727097 0 Nurse Practitioners Physician Services 00 1154727394 0 HARRINGTON COREY 2014335 9999999 B 10 1154727394 0 109 CALIFORNIA ST CARTERVILLE IL 629181923 20 1154727394 0 Dentists Dental Services 20 1154727394 0 Dentists Physician Services 00 1154727923 0 GERST GARY 2023005 9999999 B 10 1154727923 0 509 E WATERS EDGE DR 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1154828259 0 Physicians Anesthesia Services 20 1154828259 0 Physicians Healthy Kids Services 20 1154828259 0 Physicians Optical Supplies 20 1154828259 0 Physicians Physician Services 00 1154828390 0 SACA DANIEL R 2019297 9999999 B 10 1154828390 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1154828390 0 Physicians Anesthesia Services 20 1154828390 0 Physicians Fluoride varnish 20 1154828390 0 Physicians Healthy Kids Services 20 1154828390 0 Physicians Optical Supplies 20 1154828390 0 Physicians Physician Services 00 1154828440 0 HARMON LORRIE R 2018113 9999999 B 10 1154828440 0 124 SW ADAMS ST FL 2 PEORIA IL 616021308 20 1154828440 0 Nurse Practitioners Fluoride varnish 20 1154828440 0 Nurse Practitioners Healthy Kids Services 20 1154828440 0 Nurse Practitioners Nurse Practitioners Services 20 1154828440 0 Nurse Practitioners Physician Services 00 1154828507 0 MASCARI JOHN 2022119 9999999 B 10 1154828507 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1154828507 0 Physicians 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ANDERSON KORTNEY 2021232 9999999 B 10 1154844488 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1154844488 0 Physician Assistant Only Fluoride varnish 20 1154844488 0 Physician Assistant Only Healthy Kids Services 20 1154844488 0 Physician Assistant Only Physician Services 00 1154846087 0 MANGIERI MADELINE 2017306 9999999 B 10 1154846087 0 1501 W CONEFLOWER DR APT 2106 PEORIA IL 616157459 20 1154846087 0 Speech Therapists Medical Supplies 20 1154846087 0 Speech Therapists Medical equipment/prosthetic devices 20 1154846087 0 Speech Therapists Speech Therapy/Pathology Services 00 1154846707 0 COOPER MARY E 2021306 9999999 B 10 1154846707 0 1025 MAINE ST QUINCY IL 623014038 20 1154846707 0 Nurse Practitioners Anesthesia Services 20 1154846707 0 Nurse Practitioners Nurse Practitioners Services 20 1154846707 0 Nurse Practitioners Physician Services 00 1154847358 0 VICE RACHAEL M 2017152 9999999 B 10 1154847358 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1154847358 0 Physical 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Services 00 1154870277 0 KAMMERER KAITLYN 2016274 9999999 B 10 1154870277 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1154870277 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1154870673 0 SMITH STEVI 2016180 9999999 B 10 1154870673 0 1005 BROADWAY ST QUINCY IL 623012834 20 1154870673 0 Speech Therapists Medical Supplies 20 1154870673 0 Speech Therapists Medical equipment/prosthetic devices 20 1154870673 0 Speech Therapists Speech Therapy/Pathology Services 00 1154870707 0 BISHOP TEAGAN 2018284 9999999 B 10 1154870707 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1154870707 0 Physician Assistant Only Fluoride varnish 20 1154870707 0 Physician Assistant Only Healthy Kids Services 20 1154870707 0 Physician Assistant Only Physician Services 00 1154872497 0 KORDUS SARAH KATHERINE 2022192 9999999 B 10 1154872497 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1154872497 0 Nurse Practitioners Fluoride varnish 20 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1154956498 0 Physician Assistant Only Fluoride varnish 20 1154956498 0 Physician Assistant Only Healthy Kids Services 20 1154956498 0 Physician Assistant Only Physician Services 00 1154958171 0 WANG RUI 2024184 9999999 B 10 1154958171 0 PO BOX 60394 SAINT LOUIS MO 631600394 20 1154958171 0 Physicians Anesthesia Services 20 1154958171 0 Physicians Healthy Kids Services 20 1154958171 0 Physicians Optical Supplies 20 1154958171 0 Physicians Physician Services 00 1154958502 0 SHAH RUTVI 2023186 9999999 B 10 1154958502 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1154958502 0 Physicians Anesthesia Services 20 1154958502 0 Physicians Fluoride varnish 20 1154958502 0 Physicians Healthy Kids Services 20 1154958502 0 Physicians Optical Supplies 20 1154958502 0 Physicians Physician Services 00 1154958544 0 GEARLDS JOERISSA N 2020100 9999999 B 10 1154958544 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1154958544 0 Physician Assistant Only Fluoride varnish 20 1154958544 0 Physician Assistant Only Healthy Kids Services 20 1154958544 0 Physician Assistant Only Physician Services 00 1154958627 0 LO MATTHEW 2020213 9999999 B 10 1154958627 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1154958627 0 Physicians Anesthesia Services 20 1154958627 0 Physicians Fluoride varnish 20 1154958627 0 Physicians Healthy Kids Services 20 1154958627 0 Physicians Optical Supplies 20 1154958627 0 Physicians Physician Services 00 1154958734 0 ZHANG JIAMING 2020227 9999999 B 10 1154958734 0 7825 SOLUTION CTR CHICAGO IL 606777007 20 1154958734 0 Physicians Anesthesia Services 20 1154958734 0 Physicians Healthy Kids Services 20 1154958734 0 Physicians Optical Supplies 20 1154958734 0 Physicians Physician Services 20 1154958734 0 Physicians Physicians Psychiatric Services 00 1154958775 0 WATKINS ALLISON 2020224 9999999 B 10 1154958775 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1154958775 0 Physicians Anesthesia Services 20 1154958775 0 Physicians Healthy Kids Services 20 1154958775 0 Physicians Optical Supplies 20 1154958775 0 Physicians Physician Services 00 1154958874 0 MCENERY BRENDAN 2020247 9999999 B 10 1154958874 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1154958874 0 Physicians Anesthesia Services 20 1154958874 0 Physicians Fluoride varnish 20 1154958874 0 Physicians Healthy Kids Services 20 1154958874 0 Physicians Optical Supplies 20 1154958874 0 Physicians Physician Services 00 1154958908 0 MEYER CHASE L 2023200 9999999 B 10 1154958908 0 1400 US HIGHWAY 61 FESTUS MO 630284100 20 1154958908 0 Physicians Anesthesia Services 20 1154958908 0 Physicians Fluoride varnish 20 1154958908 0 Physicians Healthy Kids Services 20 1154958908 0 Physicians Optical Supplies 20 1154958908 0 Physicians Physician Services 00 1154959054 0 LOFTUS MARY R 2020181 9999999 B 10 1154959054 0 2875 W 19TH ST CHICAGO IL 606233501 20 1154959054 0 Physicians Anesthesia Services 20 1154959054 0 Physicians Fluoride varnish 20 1154959054 0 Physicians Healthy Kids Services 20 1154959054 0 Physicians Optical Supplies 20 1154959054 0 Physicians Physician Services 00 1154959278 0 BARTELT KYLE 2020213 9999999 B 10 1154959278 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1154959278 0 Physicians Anesthesia Services 20 1154959278 0 Physicians Healthy Kids Services 20 1154959278 0 Physicians Optical Supplies 20 1154959278 0 Physicians Physician Services 00 1154959435 0 PATEL KAVITA 2020213 9999999 B 10 1154959435 0 29373 NETWORK PL CHICAGO IL 606733039 20 1154959435 0 Physicians Anesthesia Services 20 1154959435 0 Physicians Fluoride varnish 20 1154959435 0 Physicians Healthy Kids Services 20 1154959435 0 Physicians Optical Supplies 20 1154959435 0 Physicians Physician Services 00 1154959682 0 CAKIR OMER 2021216 9999999 B 10 1154959682 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1154959682 0 Physicians Anesthesia Services 20 1154959682 0 Physicians Healthy Kids Services 20 1154959682 0 Physicians Optical Supplies 20 1154959682 0 Physicians Physician Services 00 1154959690 0 ALTURKMANI ADIB 2020175 9999999 B 10 1154959690 0 6742 N FROSTWOOD PKWY PEORIA IL 616152402 20 1154959690 0 Physicians Anesthesia Services 20 1154959690 0 Physicians Fluoride varnish 20 1154959690 0 Physicians Healthy Kids Services 20 1154959690 0 Physicians Optical Supplies 20 1154959690 0 Physicians Physician Services 00 1154960813 0 SHEA DENNIS I 2021263 9999999 B 10 1154960813 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1154960813 0 Physician Assistant Only Fluoride varnish 20 1154960813 0 Physician Assistant Only Healthy Kids Services 20 1154960813 0 Physician Assistant Only Physician Services 00 1154961969 0 BEAMER HANNAH M 2020029 9999999 B 10 1154961969 0 5777 DEPT CAROL STREAM IL 601220021 20 1154961969 0 Nurse Practitioners Fluoride varnish 20 1154961969 0 Nurse Practitioners Healthy Kids Services 20 1154961969 0 Nurse Practitioners Nurse Practitioners Services 20 1154961969 0 Nurse Practitioners Physician Services 00 1154962249 0 LASTER LAURA A 2019308 9999999 B 10 1154962249 0 PO BOX 1239 TROY MI 480991239 20 1154962249 0 Nurse Practitioners Fluoride varnish 20 1154962249 0 Nurse Practitioners Healthy Kids Services 20 1154962249 0 Nurse Practitioners Nurse Practitioners Services 20 1154962249 0 Nurse Practitioners Physician Services 00 1154962900 0 HOPPE JANNA L 2019344 9999999 B 10 1154962900 0 24600 W 127TH ST BLDG B PLAINFIELD IL 605859509 20 1154962900 0 Nurse Practitioners Fluoride varnish 20 1154962900 0 Nurse Practitioners Healthy Kids Services 20 1154962900 0 Nurse Practitioners Nurse Practitioners Services 20 1154962900 0 Nurse Practitioners Physician Services 00 1154962983 0 WULF MEGAN E 2020274 9999999 B 10 1154962983 0 520 VALLEY VIEW DR MOLINE IL 612656152 20 1154962983 0 Physician Assistant Only Fluoride varnish 20 1154962983 0 Physician Assistant Only Healthy Kids Services 20 1154962983 0 Physician Assistant Only Physician Services 00 1154963379 0 ALLEN CARA 2019283 9999999 B 10 1154963379 0 2323 WINDISH DR GALESBURG IL 614019780 20 1154963379 0 Clinical Social Worker Social work service 00 1154963429 0 LEE SUSAN M 2019282 9999999 B 10 1154963429 0 26177 W GRASS LAKE RD ANTIOCH IL 600029613 20 1154963429 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1154963544 0 GULSHAD BAGUM 2021299 9999999 B 10 1154963544 0 PO BOX 684 BEDFORD PARK IL 604990684 20 1154963544 0 Nurse Practitioners Healthy Kids Services 20 1154963544 0 Nurse Practitioners Nurse Practitioners Services 20 1154963544 0 Nurse Practitioners Physician Services 00 1154964054 0 PARUSZKIEWICZ REBECCA 2023031 9999999 B 10 1154964054 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1154964054 0 Other behavior health professional LCPC/LMFT services 00 1154964740 0 LOCKMAN DALE 2023065 9999999 B 10 1154964740 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1154964740 0 Physician Assistant Only Fluoride varnish 20 1154964740 0 Physician Assistant Only Healthy Kids Services 20 1154964740 0 Physician Assistant Only Physician Services 00 1154964922 0 MASTERS MEGAN 2021322 9999999 B 10 1154964922 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1154964922 0 Nurse Practitioners Fluoride varnish 20 1154964922 0 Nurse Practitioners Healthy Kids Services 20 1154964922 0 Nurse Practitioners Nurse Practitioners Services 20 1154964922 0 Nurse Practitioners Physician Services 00 1154965416 0 SULLIVAN HANNAH R 2022075 9999999 B 10 1154965416 0 15 SPINNING WHEEL RD STE 30 HINSDALE IL 605217651 20 1154965416 0 Other behavior health professional LCPC/LMFT services 00 1154967123 0 HIGBY BAILEY E 2020006 9999999 B 10 1154967123 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1154967123 0 Nurse Practitioners Fluoride varnish 20 1154967123 0 Nurse Practitioners Healthy Kids Services 20 1154967123 0 Nurse Practitioners Nurse Practitioners Services 20 1154967123 0 Nurse Practitioners Physician Services 00 1154967230 0 FADONOUGBO RISKAT O 2020029 9999999 B 10 1154967230 0 25 W 47TH ST CHICAGO IL 606094627 20 1154967230 0 Nurse Practitioners Healthy Kids Services 20 1154967230 0 Nurse Practitioners Nurse Practitioners Services 20 1154967230 0 Nurse Practitioners Physician Services 00 1154968675 0 FITZGERALD ERICA A 2019343 9999999 B 10 1154968675 0 1025 MAINE ST QUINCY IL 623014038 20 1154968675 0 Nurse Practitioners Fluoride varnish 20 1154968675 0 Nurse Practitioners Healthy Kids Services 20 1154968675 0 Nurse Practitioners Nurse Practitioners Services 20 1154968675 0 Nurse Practitioners Physician Services 00 1154969103 0 LIM-DWYER SARAH J 2023160 9999999 B 10 1154969103 0 PO BOX 1239 TROY MI 480991239 20 1154969103 0 Nurse Practitioners Fluoride varnish 20 1154969103 0 Nurse Practitioners Healthy Kids Services 20 1154969103 0 Nurse Practitioners Nurse Practitioners Services 20 1154969103 0 Nurse Practitioners Physician Services 00 1154970671 0 BAHENA AIDA 2019255 9999999 B 10 1154970671 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1154970671 0 Registered 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Practitioners Physician Services 00 1154977825 0 ROUMELIOTIS ANASTASIOS G 2023174 9999999 B 10 1154977825 0 4698 DEPT CAROL STREAM IL 601220021 20 1154977825 0 Physicians Anesthesia Services 20 1154977825 0 Physicians Healthy Kids Services 20 1154977825 0 Physicians Optical Supplies 20 1154977825 0 Physicians Physician Services 00 1154978161 0 LIM BRANDON J 2020307 9999999 B 10 1154978161 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1154978161 0 Physician Assistant Only Fluoride varnish 20 1154978161 0 Physician Assistant Only Healthy Kids Services 20 1154978161 0 Physician Assistant Only Physician Services 00 1154978740 0 VLIET ANGELA 2019270 9999999 B 10 1154978740 0 800 E LOCUST ST OLNEY IL 624502553 20 1154978740 0 Nurse Practitioners Fluoride varnish 20 1154978740 0 Nurse Practitioners Healthy Kids Services 20 1154978740 0 Nurse Practitioners Nurse Practitioners Services 20 1154978740 0 Nurse Practitioners Physician Services 00 1154980001 0 WARNER NATHAN D 2019276 9999999 B 10 1154980001 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1154980001 0 Physician Assistant Only Fluoride varnish 20 1154980001 0 Physician Assistant Only Healthy Kids Services 20 1154980001 0 Physician Assistant Only Physician Services 00 1154980274 0 PLUTE KELLI 2023346 9999999 B 10 1154980274 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1154980274 0 Speech Therapists Medical Supplies 20 1154980274 0 Speech Therapists Medical equipment/prosthetic devices 20 1154980274 0 Speech Therapists Speech Therapy/Pathology Services 00 1154980951 0 KEILSON CHRISTINA M 2021075 9999999 B 10 1154980951 0 9845 W ROOSEVELT RD WESTCHESTER IL 601542758 20 1154980951 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1154981645 0 CHOUDHARI RISHABH 2020252 9999999 B 10 1154981645 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1154981645 0 Physicians Anesthesia Services 20 1154981645 0 Physicians Healthy Kids Services 20 1154981645 0 Physicians Optical Supplies 20 1154981645 0 Physicians Physician Services 00 1154982254 0 CHAMBERLAIN LUCAS 2019182 9999999 B 10 1154982254 0 PO BOX 857 FREEPORT IL 610320857 20 1154982254 0 Physicians Anesthesia Services 20 1154982254 0 Physicians Fluoride varnish 20 1154982254 0 Physicians Healthy Kids Services 20 1154982254 0 Physicians Optical Supplies 20 1154982254 0 Physicians Physician Services 00 1154982924 0 DYKOWSKI SARA 2024170 9999999 B 10 1154982924 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1154982924 0 Physicians Anesthesia Services 20 1154982924 0 Physicians Healthy Kids Services 20 1154982924 0 Physicians Optical Supplies 20 1154982924 0 Physicians Physician Services 00 1154983666 0 ARIF ABDUL WAHAB 2019282 9999999 B 10 1154983666 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1154983666 0 Physicians Anesthesia Services 20 1154983666 0 Physicians Fluoride varnish 20 1154983666 0 Physicians Healthy Kids Services 20 1154983666 0 Physicians 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20 1154987097 0 Nurse Practitioners Nurse Practitioners Services 20 1154987097 0 Nurse Practitioners Physician Services 00 1154987626 0 FURUKAWA MASASHI 2024116 9999999 B 10 1154987626 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1154987626 0 Physicians Anesthesia Services 20 1154987626 0 Physicians Healthy Kids Services 20 1154987626 0 Physicians Optical Supplies 20 1154987626 0 Physicians Physician Services 00 1154987972 0 MCGOVERN TAYLOR R 2023277 9999999 B 10 1154987972 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1154987972 0 Speech Therapists Medical Supplies 20 1154987972 0 Speech Therapists Medical equipment/prosthetic devices 20 1154987972 0 Speech Therapists Speech Therapy/Pathology Services 00 1154988392 0 AGUBOSIM CHINONSO 2024170 9999999 B 10 1154988392 0 2000 S MAIN ST FAIRFIELD IA 525569572 20 1154988392 0 Physicians Anesthesia Services 20 1154988392 0 Physicians Healthy Kids Services 20 1154988392 0 Physicians Optical Supplies 20 1154988392 0 Physicians Physician 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1164120127 0 CRUM JOSHUA 2024190 9999999 B 10 1164120127 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1164120127 0 Physicians Anesthesia Services 20 1164120127 0 Physicians Fluoride varnish 20 1164120127 0 Physicians Healthy Kids Services 20 1164120127 0 Physicians Optical Supplies 20 1164120127 0 Physicians Physician Services 00 1164120846 0 GENSLAK MONICA 2023279 9999999 B 10 1164120846 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1164120846 0 Physician Assistant Only Fluoride varnish 20 1164120846 0 Physician Assistant Only Healthy Kids Services 20 1164120846 0 Physician Assistant Only Physician Services 00 1164122974 0 THERIEN JESSICA R 2023104 9999999 B 10 1164122974 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1164122974 0 Nurse Practitioners Fluoride varnish 20 1164122974 0 Nurse Practitioners Healthy Kids Services 20 1164122974 0 Nurse Practitioners Nurse Practitioners Services 20 1164122974 0 Nurse Practitioners Physician Services 00 1164123022 0 THOMAS MILES 2024184 9999999 B 10 1164123022 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1164123022 0 Physicians Anesthesia Services 20 1164123022 0 Physicians Fluoride varnish 20 1164123022 0 Physicians Healthy Kids Services 20 1164123022 0 Physicians Optical Supplies 20 1164123022 0 Physicians Physician Services 00 1164123063 0 LEONTYEV ANGELA 2024185 9999999 B 10 1164123063 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1164123063 0 Physicians Anesthesia Services 20 1164123063 0 Physicians Healthy Kids Services 20 1164123063 0 Physicians Optical Supplies 20 1164123063 0 Physicians Physician Services 00 1164124475 0 LINGO VERONICA 2023202 9999999 B 10 1164124475 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1164124475 0 Physicians Anesthesia Services 20 1164124475 0 Physicians Fluoride varnish 20 1164124475 0 Physicians Healthy Kids Services 20 1164124475 0 Physicians Optical Supplies 20 1164124475 0 Physicians Physician Services 00 1164124574 0 VANDENBERG TAYLOR 2023167 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Anesthesia Services 20 1164126124 0 Physicians Healthy Kids Services 20 1164126124 0 Physicians Optical Supplies 20 1164126124 0 Physicians Physician Services 00 1164126181 0 GRIGSON MARY L 2024162 9999999 B 10 1164126181 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1164126181 0 Nurse Practitioners Healthy Kids Services 20 1164126181 0 Nurse Practitioners Nurse Practitioners Services 20 1164126181 0 Nurse Practitioners Physician Services 00 1164126595 0 SIDDIQUE LABIBA A 2024204 9999999 B 10 1164126595 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1164126595 0 Physicians Anesthesia Services 20 1164126595 0 Physicians Healthy Kids Services 20 1164126595 0 Physicians Optical Supplies 20 1164126595 0 Physicians Physician Services 00 1164126652 0 SPACZAI JULIA 2023198 9999999 B 10 1164126652 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1164126652 0 Physicians Anesthesia Services 20 1164126652 0 Physicians Healthy Kids Services 20 1164126652 0 Physicians Optical Supplies 20 1164126652 0 Physicians Physician Services 20 1164126652 0 Physicians Physicians Psychiatric Services 00 1164126793 0 STACKS MOLLY J 2023208 9999999 B 10 1164126793 0 PO BOX 207163 DALLAS TX 753207154 20 1164126793 0 Optometrists Optical Supplies 20 1164126793 0 Optometrists Optometric Services 20 1164126793 0 Optometrists Physician Services 00 1164127049 0 GADDIPATI ADITYA 2023257 9999999 B 10 1164127049 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1164127049 0 Physicians Anesthesia Services 20 1164127049 0 Physicians Healthy Kids Services 20 1164127049 0 Physicians Optical Supplies 20 1164127049 0 Physicians Physician Services 00 1164127247 0 HELIAS BRUNHILDE J 2024283 9999999 B 10 1164127247 0 611 W PARK ST URBANA IL 618012529 20 1164127247 0 Physicians Anesthesia Services 20 1164127247 0 Physicians Fluoride varnish 20 1164127247 0 Physicians Healthy Kids Services 20 1164127247 0 Physicians Optical Supplies 20 1164127247 0 Physicians Physician Services 00 1164128781 0 FERNANDEZ ANGELA 2024109 9999999 B 10 1164128781 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1164128781 0 Physical Therapists Medical Supplies 20 1164128781 0 Physical Therapists Medical equipment/prosthetic devices 20 1164128781 0 Physical Therapists Physical Therapy Services 00 1164129417 0 RAMIREZ GLORIA 2023046 9999999 B 10 1164129417 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1164129417 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1164129458 0 BERNARDI REBECCA GLORIA 2023107 9999999 B 10 1164129458 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1164129458 0 Nurse Practitioners Healthy Kids Services 20 1164129458 0 Nurse Practitioners Nurse Practitioners Services 20 1164129458 0 Nurse Practitioners Physician Services 00 1164130316 0 DIAZ-ROBLES MONINA 2022313 9999999 B 10 1164130316 0 5220 EAST AVE COUNTRYSIDE IL 605253133 20 1164130316 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1164132072 0 SZOSTAK JESSICA 2023003 9999999 B 10 1164132072 0 PO BOX 5588 BELFAST ME 049155500 20 1164132072 0 Nurse Practitioners Fluoride varnish 20 1164132072 0 Nurse Practitioners Healthy Kids Services 20 1164132072 0 Nurse Practitioners Nurse Practitioners Services 20 1164132072 0 Nurse Practitioners Physician Services 00 1164132700 0 DAVIS MOLLY K 2022342 9999999 B 10 1164132700 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1164132700 0 Nurse Practitioners Healthy Kids Services 20 1164132700 0 Nurse Practitioners Nurse Practitioners Services 20 1164132700 0 Nurse Practitioners Physician Services 00 1164133658 0 TOWNER ARIANE 2023017 9999999 B 10 1164133658 0 PO BOX 775342 CHICAGO IL 606775342 20 1164133658 0 Physician Assistant Only Fluoride varnish 20 1164133658 0 Physician Assistant Only Healthy Kids Services 20 1164133658 0 Physician Assistant Only Physician Services 00 1164135927 0 PEIXOTO HONORATO VANESSA 2022360 9999999 B 10 1164135927 0 411 CHICAGO AVE OAK PARK IL 603022233 20 1164135927 0 Occupational Therapists Medical Supplies 20 1164135927 0 Occupational Therapists Medical equipment/prosthetic devices 20 1164135927 0 Occupational Therapists Occupational Therapy Services 00 1164141214 0 THOMAS DINO 2023004 9999999 B 10 1164141214 0 1350 GRAND AVE BEARDSTOWN IL 626188092 20 1164141214 0 Physical Therapists Medical Supplies 20 1164141214 0 Physical Therapists Medical equipment/prosthetic devices 20 1164141214 0 Physical Therapists Physical Therapy Services 00 1164141586 0 JACOBS SARAH 2023079 9999999 B 10 1164141586 0 800 W FULTON MARKET FL 12 CHICAGO IL 606071302 20 1164141586 0 Nurse Practitioners Fluoride varnish 20 1164141586 0 Nurse Practitioners Healthy Kids Services 20 1164141586 0 Nurse Practitioners Nurse Practitioners Services 20 1164141586 0 Nurse Practitioners Physician Services 00 1164143806 0 JOHANSSON ELIZABETH 2024164 9999999 B 10 1164143806 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1164143806 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1164148201 0 WEBSTER ABBIGAIL 2022304 9999999 B 10 1164148201 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1164148201 0 Physician Assistant Only Fluoride varnish 20 1164148201 0 Physician Assistant Only Healthy Kids Services 20 1164148201 0 Physician Assistant Only Physician Services 00 1164150561 0 BOLSER MORGAN P 2022332 9999999 B 10 1164150561 0 611 W PARK ST URBANA IL 618012529 20 1164150561 0 Nurse Practitioners Healthy Kids Services 20 1164150561 0 Nurse Practitioners Nurse Practitioners Services 20 1164150561 0 Nurse Practitioners Physician Services 00 1164151171 0 REMY MARJORIE 2022263 9999999 B 10 1164151171 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1164151171 0 Nurse Practitioners Fluoride varnish 20 1164151171 0 Nurse Practitioners Healthy Kids Services 20 1164151171 0 Nurse Practitioners Nurse Practitioners Services 20 1164151171 0 Nurse Practitioners Physician Services 00 1164151395 0 POITRAS MARK 2024080 9999999 B 10 1164151395 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1164151395 0 Physician Assistant Only Fluoride varnish 20 1164151395 0 Physician Assistant Only Healthy Kids Services 20 1164151395 0 Physician Assistant Only Physician Services 00 1164153631 0 FERGUSON ALLANA L 2023254 9999999 B 10 1164153631 0 5777 DEPT CAROL STREAM IL 601220021 20 1164153631 0 Clinical Social Worker Social work service 00 1164154878 0 OMO-EBOH OMOVAUDO 2022273 9999999 B 10 1164154878 0 190 E DELAWARE PL CHICAGO IL 606111813 20 1164154878 0 Physicians Anesthesia Services 20 1164154878 0 Physicians Fluoride varnish 20 1164154878 0 Physicians Healthy Kids Services 20 1164154878 0 Physicians Optical Supplies 20 1164154878 0 Physicians Physician Services 00 1164155719 0 SCHUELKE ANNE C 2023209 9999999 B 10 1164155719 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1164155719 0 Physician Assistant Only Fluoride varnish 20 1164155719 0 Physician Assistant Only Healthy Kids Services 20 1164155719 0 Physician Assistant Only Physician Services 00 1164155859 0 ISMAIL AMANDA 2024002 9999999 B 10 1164155859 0 2348 POST RD STE 107 WARWICK RI 028862271 20 1164155859 0 Nurse Practitioners Healthy Kids Services 20 1164155859 0 Nurse Practitioners Nurse Practitioners Services 20 1164155859 0 Nurse Practitioners Physician Services 00 1164156832 0 MORRIS RACHEL C 2023182 9999999 B 10 1164156832 0 PO BOX 3039 OAK BROOK IL 605223039 20 1164156832 0 Physicians Anesthesia Services 20 1164156832 0 Physicians Fluoride varnish 20 1164156832 0 Physicians Healthy Kids Services 20 1164156832 0 Physicians Optical Supplies 20 1164156832 0 Physicians Physician Services 00 1164157038 0 HOOT AMBER 2023258 9999999 B 10 1164157038 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1164157038 0 Physician Assistant Only Fluoride varnish 20 1164157038 0 Physician Assistant Only Healthy Kids Services 20 1164157038 0 Physician Assistant Only Physician Services 00 1164157665 0 MOORE ANGELICA 2022250 9999999 B 10 1164157665 0 12528 E NAVAJO DR PALOS HEIGHTS IL 604631758 20 1164157665 0 Nurse Practitioners Healthy Kids Services 20 1164157665 0 Nurse Practitioners Nurse Practitioners Services 20 1164157665 0 Nurse Practitioners Physician Services 00 1164157731 0 FERREIRA DALLA PRIA HANNA RAFA 2023186 9999999 B 10 1164157731 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1164157731 0 Physicians Anesthesia Services 20 1164157731 0 Physicians Healthy Kids Services 20 1164157731 0 Physicians Optical Supplies 20 1164157731 0 Physicians Physician Services 00 1164158580 0 CONNOLLY TIFFANY M 2024278 9999999 B 10 1164158580 0 600 JOHN DEERE RD STE 200 MOLINE IL 612656812 20 1164158580 0 Physician Assistant Only Physician Services 00 1164158812 0 BERLAND MORGAN C 2024129 9999999 B 10 1164158812 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1164158812 0 Physician Assistant Only Fluoride varnish 20 1164158812 0 Physician Assistant Only Healthy Kids Services 20 1164158812 0 Physician Assistant Only Physician Services 00 1164158929 0 THOMAS MICHAEL 2022255 9999999 B 10 1164158929 0 9701 W HIGGINS RD STE 270 STE 270 ROSEMONT IL 600184703 20 1164158929 0 Physician Assistant Only Fluoride varnish 20 1164158929 0 Physician Assistant Only Healthy Kids Services 20 1164158929 0 Physician Assistant Only Physician Services 00 1164159265 0 BIZIOREK KATHERINE A 2024058 9999999 B 10 1164159265 0 9649 W 55TH ST COUNTRYSIDE IL 605253632 20 1164159265 0 Speech Therapists Medical Supplies 20 1164159265 0 Speech Therapists Medical equipment/prosthetic devices 20 1164159265 0 Speech Therapists Speech Therapy/Pathology Services 00 1164160701 0 BONDOC JASPER MARC G 2022182 9999999 B 10 1164160701 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1164160701 0 Physicians Anesthesia Services 20 1164160701 0 Physicians Fluoride varnish 20 1164160701 0 Physicians Healthy Kids Services 20 1164160701 0 Physicians Optical Supplies 20 1164160701 0 Physicians Physician Services 00 1164161097 0 HALEY NINA 2022182 9999999 B 10 1164161097 0 2348 POST RD STE 107 WARWICK RI 028862271 20 1164161097 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1164162830 0 SHAH KRUPA M 2022214 9999999 B 10 1164162830 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1164162830 0 Physicians Anesthesia Services 20 1164162830 0 Physicians Fluoride varnish 20 1164162830 0 Physicians Healthy Kids Services 20 1164162830 0 Physicians Optical Supplies 20 1164162830 0 Physicians Physician Services 00 1164162947 0 MALARVANNAN POORNAASHRI 2022196 9999999 B 10 1164162947 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1164162947 0 Physicians Anesthesia Services 20 1164162947 0 Physicians Fluoride varnish 20 1164162947 0 Physicians Healthy Kids Services 20 1164162947 0 Physicians Optical Supplies 20 1164162947 0 Physicians Physician Services 00 1164163028 0 TERLAP EMILY 2024004 9999999 B 10 1164163028 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1164163028 0 Physicians Anesthesia Services 20 1164163028 0 Physicians Fluoride varnish 20 1164163028 0 Physicians Healthy Kids Services 20 1164163028 0 Physicians Optical Supplies 20 1164163028 0 Physicians Physician Services 00 1164164299 0 OLASH BARTHOLOMEW M 2024193 9999999 B 10 1164164299 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1164164299 0 Physicians Anesthesia Services 20 1164164299 0 Physicians Fluoride varnish 20 1164164299 0 Physicians Healthy Kids Services 20 1164164299 0 Physicians Optical Supplies 20 1164164299 0 Physicians Physician Services 00 1164164562 0 OCASIO HANSSON SANDRA I 1998218 9999999 B 10 1164164562 0 4025 TAMPA RD STE 1106 OLDSMAR FL 346773213 20 1164164562 0 Occupational Therapists Medical Supplies 20 1164164562 0 Occupational Therapists Medical equipment/prosthetic devices 20 1164164562 0 Occupational Therapists Occupational Therapy Services 00 1164164604 0 KOYANAGI KELSEY 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Physicians Optical Supplies 20 1164167458 0 Physicians Physician Services 00 1164168043 0 OGDEN AMI R 2022132 9999999 B 10 1164168043 0 PO BOX 146 WATERLOO IL 622980146 20 1164168043 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1164169439 0 YATES SARA CATHERINE 2024178 9999999 B 10 1164169439 0 PO BOX 632122 CINCINNATI OH 452632122 20 1164169439 0 Nurse Practitioners Fluoride varnish 20 1164169439 0 Nurse Practitioners Healthy Kids Services 20 1164169439 0 Nurse Practitioners Nurse Practitioners Services 20 1164169439 0 Nurse Practitioners Physician Services 00 1164169892 0 GEREW DAVIS 2023220 9999999 B 10 1164169892 0 611 W PARK ST URBANA IL 618012529 20 1164169892 0 Physicians Anesthesia Services 20 1164169892 0 Physicians Healthy Kids Services 20 1164169892 0 Physicians Optical Supplies 20 1164169892 0 Physicians Physician Services 20 1164169892 0 Physicians Physicians Psychiatric Services 00 1164170254 0 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1164428165 0 Physicians Anesthesia Services 20 1164428165 0 Physicians Fluoride varnish 20 1164428165 0 Physicians Healthy Kids Services 20 1164428165 0 Physicians Optical Supplies 20 1164428165 0 Physicians Physician Services 00 1164428389 0 NAJAF TASNIM A 1999001 9999999 B 10 1164428389 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1164428389 0 Physicians Anesthesia Services 20 1164428389 0 Physicians Fluoride varnish 20 1164428389 0 Physicians Healthy Kids Services 20 1164428389 0 Physicians Optical Supplies 20 1164428389 0 Physicians Physician Services 00 1164429213 0 STUKUS DAVID R 2016109 9999999 B 10 1164429213 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1164429213 0 Physicians Anesthesia Services 20 1164429213 0 Physicians Healthy Kids Services 20 1164429213 0 Physicians Optical Supplies 20 1164429213 0 Physicians Physician Services 00 1164429254 0 RAID-WITTHOEFT LAURA J 2002231 9999999 B 10 1164429254 0 1500 DELHI ST STE 3100 DUBUQUE IA 520016361 20 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Services 20 1164463782 0 Nurse Practitioners Nurse Practitioners Services 20 1164463782 0 Nurse Practitioners Physician Services 00 1164463899 0 POSTHUMUS JERRIE 2006335 9999999 B 10 1164463899 0 19624 GOVERNORS HWY STE 6&7 FLOSSMOOR IL 604222077 20 1164463899 0 Nurse Practitioners Anesthesia Services 20 1164463899 0 Nurse Practitioners Nurse Practitioners Services 20 1164463899 0 Nurse Practitioners Physician Services 00 1164465183 0 WINTERS RITA M 2008001 9999999 B 10 1164465183 0 PO BOX 631767 CINCINNATI OH 452631767 20 1164465183 0 Nurse Practitioners Healthy Kids Services 20 1164465183 0 Nurse Practitioners Nurse Practitioners Services 20 1164465183 0 Nurse Practitioners Physician Services 00 1164465688 0 DIAMOND KENNETH L 2023353 9999999 B 10 1164465688 0 29373 NETWORK PL CHICAGO IL 606733039 20 1164465688 0 Physicians Anesthesia Services 20 1164465688 0 Physicians Fluoride varnish 20 1164465688 0 Physicians Healthy Kids Services 20 1164465688 0 Physicians Optical Supplies 20 1164465688 0 Physicians Physician Services 00 1164468021 0 COMSULEA OLEZIA 2006213 9999999 B 10 1164468021 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1164468021 0 Physicians Anesthesia Services 20 1164468021 0 Physicians Healthy Kids Services 20 1164468021 0 Physicians Optical Supplies 20 1164468021 0 Physicians Physician Services 00 1164468393 0 BARCLAY JAMES C 2022284 9999999 B 10 1164468393 0 100 E LEFEVRE RD STERLING IL 610811278 20 1164468393 0 Physicians Anesthesia Services 20 1164468393 0 Physicians Healthy Kids Services 20 1164468393 0 Physicians Optical Supplies 20 1164468393 0 Physicians Physician Services 20 1164468393 0 Physicians Physicians Psychiatric Services 00 1164468583 0 BASS JOHN 2019060 9999999 B 10 1164468583 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1164468583 0 Physicians Anesthesia Services 20 1164468583 0 Physicians Fluoride varnish 20 1164468583 0 Physicians Healthy Kids Services 20 1164468583 0 Physicians Optical Supplies 20 1164468583 0 Physicians Physician Services 00 1164469029 0 DESOUKY SAMY 2010167 9999999 B 10 1164469029 0 515 22ND AVE MONROE WI 535661569 20 1164469029 0 Physicians Anesthesia Services 20 1164469029 0 Physicians Healthy Kids Services 20 1164469029 0 Physicians Optical Supplies 20 1164469029 0 Physicians Physician Services 00 1164469235 0 HASKINS ROBERT D 2005083 9999999 B 10 1164469235 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1164469235 0 Physicians Anesthesia Services 20 1164469235 0 Physicians Healthy Kids Services 20 1164469235 0 Physicians Optical Supplies 20 1164469235 0 Physicians Physician Services 00 1164469722 0 HOFF TERRY M 1996245 9999999 B 10 1164469722 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1164469722 0 Nurse Practitioners Anesthesia Services 20 1164469722 0 Nurse Practitioners Nurse Practitioners Services 20 1164469722 0 Nurse Practitioners Physician Services 00 1164470027 0 JIOTIS STEVEN 1995205 9999999 B 10 1164470027 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1164470027 0 Physicians Anesthesia Services 20 1164470027 0 Physicians Healthy Kids Services 20 1164470027 0 Physicians Optical Supplies 20 1164470027 0 Physicians Physician Services 00 1164470209 0 MAHMOUD MOHAMED 2008284 9999999 B 10 1164470209 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1164470209 0 Physicians Anesthesia Services 20 1164470209 0 Physicians Healthy Kids Services 20 1164470209 0 Physicians Optical Supplies 20 1164470209 0 Physicians Physician Services 00 1164470258 0 PELLEY ELAINE 2006244 9999999 B 10 1164470258 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1164470258 0 Physicians Anesthesia Services 20 1164470258 0 Physicians Fluoride varnish 20 1164470258 0 Physicians Healthy Kids Services 20 1164470258 0 Physicians Optical Supplies 20 1164470258 0 Physicians Physician Services 00 1164470662 0 OROURKE ANN P 2010244 9999999 B 10 1164470662 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1164470662 0 Physicians Anesthesia Services 20 1164470662 0 Physicians Healthy Kids Services 20 1164470662 0 Physicians Optical Supplies 20 1164470662 0 Physicians Physician Services 00 1164470670 0 GUNNELL KATE 1995244 9999999 B 10 1164470670 0 2211 N ELSTON AVE STE 301 CHICAGO IL 606149278 20 1164470670 0 Physicians Anesthesia Services 20 1164470670 0 Physicians Fluoride varnish 20 1164470670 0 Physicians Healthy Kids Services 20 1164470670 0 Physicians Optical Supplies 20 1164470670 0 Physicians Physician Services 00 1164470779 0 MCDONALD MEGAN E 2020115 9999999 B 10 1164470779 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1164470779 0 Physicians Anesthesia Services 20 1164470779 0 Physicians Healthy Kids Services 20 1164470779 0 Physicians Optical Supplies 20 1164470779 0 Physicians Physician Services 00 1164471124 0 GIRI MINAL 2002290 9999999 B 10 1164471124 0 2215 SANDERS RD STE 105 SUITE 105 NORTHBROOK IL 600626194 20 1164471124 0 Physicians Anesthesia Services 20 1164471124 0 Physicians Fluoride varnish 20 1164471124 0 Physicians Healthy Kids Services 20 1164471124 0 Physicians Optical Supplies 20 1164471124 0 Physicians Physician Services 00 1164471256 0 OETTINGER LORI A 2010152 9999999 B 10 1164471256 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1164471256 0 Nurse Practitioners Healthy Kids Services 20 1164471256 0 Nurse Practitioners Nurse Practitioners Services 20 1164471256 0 Nurse Practitioners Physician Services 00 1164471736 0 KNUDSON JUDITH R 2020027 9999999 B 10 1164471736 0 PO BOX 110429 AURORA CO 800420429 20 1164471736 0 Physician Assistant Only Fluoride varnish 20 1164471736 0 Physician Assistant Only Healthy Kids Services 20 1164471736 0 Physician Assistant Only Physician Services 00 1164471876 0 SWARTZ KARIN 2017060 9999999 B 10 1164471876 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1164471876 0 Physicians Anesthesia Services 20 1164471876 0 Physicians Healthy Kids Services 20 1164471876 0 Physicians Optical Supplies 20 1164471876 0 Physicians Physician Services 00 1164472155 0 LANE DAVID 1997153 9999999 B 10 1164472155 0 PO BOX 34266 BELFAST ME 049150620 20 1164472155 0 Audiologists Audiology Services 20 1164472155 0 Audiologists Medical Supplies 20 1164472155 0 Audiologists Medical equipment/prosthetic devices 00 1164472205 0 LYONS NICHOLAS J 2020129 9999999 B 10 1164472205 0 751 SAPPINGTON BRIDGE RD SULLIVAN MO 630802354 20 1164472205 0 Nurse Practitioners Anesthesia Services 20 1164472205 0 Nurse Practitioners Nurse Practitioners Services 20 1164472205 0 Nurse Practitioners Physician Services 00 1164472312 0 MCKELVEY STACEY 2015103 9999999 B 10 1164472312 0 200 FOX GLEN CT BARRINGTON IL 600101809 20 1164472312 0 Physicians Anesthesia Services 20 1164472312 0 Physicians Fluoride varnish 20 1164472312 0 Physicians Healthy Kids Services 20 1164472312 0 Physicians Optical Supplies 20 1164472312 0 Physicians Physician Services 00 1164472783 0 BROCK TARA 2005274 9999999 B 10 1164472783 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1164472783 0 Podiatrists Podiatric Services 00 1164473567 0 CINQUEGRANI MICHAEL P 1986032 9999999 B 10 1164473567 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1164473567 0 Physicians Anesthesia Services 20 1164473567 0 Physicians Fluoride varnish 20 1164473567 0 Physicians Healthy Kids Services 20 1164473567 0 Physicians Optical Supplies 20 1164473567 0 Physicians Physician Services 00 1164474409 0 VAUGHAN JULIE D 2001063 9999999 B 10 1164474409 0 988102 NEBRASKA MEDICAL CTR OMAHA NE 681988102 20 1164474409 0 Nurse Practitioners Anesthesia Services 20 1164474409 0 Nurse Practitioners Nurse Practitioners Services 20 1164474409 0 Nurse Practitioners Physician Services 00 1164474763 0 BAUER JOHN 2005060 9999999 B 10 1164474763 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1164474763 0 Physicians Anesthesia Services 20 1164474763 0 Physicians Fluoride varnish 20 1164474763 0 Physicians Healthy Kids Services 20 1164474763 0 Physicians Optical Supplies 20 1164474763 0 Physicians Physician Services 00 1164474896 0 PAN CYNTHIA 1988001 9999999 B 10 1164474896 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1164474896 0 Physicians Anesthesia Services 20 1164474896 0 Physicians Fluoride varnish 20 1164474896 0 Physicians Healthy Kids Services 20 1164474896 0 Physicians Optical Supplies 20 1164474896 0 Physicians Physician Services 00 1164474979 0 SUMMERVILLE BRUCE 1995213 9999999 B 10 1164474979 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1164474979 0 Physicians Anesthesia Services 20 1164474979 0 Physicians Healthy Kids Services 20 1164474979 0 Physicians Optical Supplies 20 1164474979 0 Physicians Physician Services 00 1164475505 0 ISSA SAKEBA N 2006191 9999999 B 10 1164475505 0 80 W HILLCREST BLVD SCHAUMBURG IL 601953106 20 1164475505 0 Physicians Anesthesia Services 20 1164475505 0 Physicians Fluoride varnish 20 1164475505 0 Physicians Healthy Kids Services 20 1164475505 0 Physicians Optical Supplies 20 1164475505 0 Physicians Physician Services 00 1164475877 0 MISRA VIJAYLAXMI 2011001 9999999 B 10 1164475877 0 20 TOWER CT STE F SUITE F GURNEE IL 600315711 20 1164475877 0 Physicians Anesthesia Services 20 1164475877 0 Physicians Fluoride varnish 20 1164475877 0 Physicians Healthy Kids Services 20 1164475877 0 Physicians Optical Supplies 20 1164475877 0 Physicians Physician Services 00 1164476313 0 ALFRED GREGORY J 2024178 9999999 B 10 1164476313 0 PO BOX 41220 PHOENIX AZ 850801220 20 1164476313 0 Physicians Anesthesia Services 20 1164476313 0 Physicians Healthy Kids Services 20 1164476313 0 Physicians Optical Supplies 20 1164476313 0 Physicians Physician Services 00 1164476388 0 DIMAGGIO MARJORIE 2008026 9999999 B 10 1164476388 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1164476388 0 Physicians Anesthesia Services 20 1164476388 0 Physicians Fluoride varnish 20 1164476388 0 Physicians Healthy Kids Services 20 1164476388 0 Physicians Optical Supplies 20 1164476388 0 Physicians Physician Services 00 1164476453 0 WOLF MARGARET 1996032 9999999 B 10 1164476453 0 621 S ILLINOIS AVE STE 103 MASON CITY IA 504015489 20 1164476453 0 Physicians Anesthesia Services 20 1164476453 0 Physicians Healthy Kids Services 20 1164476453 0 Physicians Optical Supplies 20 1164476453 0 Physicians Physician Services 00 1164476750 0 HEAPS NATHAN 2023109 9999999 B 10 1164476750 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1164476750 0 Physicians Anesthesia Services 20 1164476750 0 Physicians Healthy Kids Services 20 1164476750 0 Physicians Optical Supplies 20 1164476750 0 Physicians Physician Services 00 1164477113 0 RODRIGUEZ JOSE M 1995144 9999999 B 10 1164477113 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1164477113 0 Physicians All Kids application agent 20 1164477113 0 Physicians Anesthesia Services 20 1164477113 0 Physicians Family Planning Counseling 20 1164477113 0 Physicians Fluoride varnish 20 1164477113 0 Physicians Healthy Kids Services 20 1164477113 0 Physicians Optical Supplies 20 1164477113 0 Physicians Physician Services 00 1164477204 0 LEAHY CONSTANCE 2024251 9999999 B 10 1164477204 0 PO BOX 486 SAN JACINTO CA 925810486 20 1164477204 0 Physicians Anesthesia Services 20 1164477204 0 Physicians Healthy Kids Services 20 1164477204 0 Physicians Optical Supplies 20 1164477204 0 Physicians Physician Services 00 1164477246 0 SIMPSON MINDY 2006182 9999999 B 10 1164477246 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1164477246 0 Physicians Anesthesia Services 20 1164477246 0 Physicians Fluoride varnish 20 1164477246 0 Physicians Healthy Kids Services 20 1164477246 0 Physicians Optical Supplies 20 1164477246 0 Physicians Physician Services 00 1164477535 0 MELIA JAMES B 1992214 9999999 B 10 1164477535 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1164477535 0 Physicians Anesthesia Services 20 1164477535 0 Physicians Fluoride varnish 20 1164477535 0 Physicians Healthy Kids Services 20 1164477535 0 Physicians Optical Supplies 20 1164477535 0 Physicians Physician Services 00 1164477626 0 PESAVENTO MARI JO 1994152 9999999 B 10 1164477626 0 3417 W 115TH PL CHICAGO IL 606553622 20 1164477626 0 Physical Therapists Development Therapy, Orientation and Mobility Services 20 1164477626 0 Physical Therapists Early Intervention Services 20 1164477626 0 Physical Therapists Medical Supplies 20 1164477626 0 Physical Therapists Medical equipment/prosthetic devices 20 1164477626 0 Physical Therapists Physical Therapy Services 20 1164477626 0 Physical Therapists Targeted case management service 00 1164477733 0 ZERRUDO JOSEPH D 1994186 9999999 B 10 1164477733 0 5777 DEPT CAROL STREAM IL 601228942 20 1164477733 0 Physicians Anesthesia Services 20 1164477733 0 Physicians Fluoride varnish 20 1164477733 0 Physicians Healthy Kids Services 20 1164477733 0 Physicians Optical Supplies 20 1164477733 0 Physicians Physician Services 00 1164477758 0 GEHRING JAMES 2023091 9999999 B 10 1164477758 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1164477758 0 Physicians Anesthesia Services 20 1164477758 0 Physicians Fluoride varnish 20 1164477758 0 Physicians Healthy Kids Services 20 1164477758 0 Physicians Optical Supplies 20 1164477758 0 Physicians Physician Services 00 1164477766 0 KAYEMBE TSHISWAKA B 1987182 9999999 B 10 1164477766 0 101 E MILLER RD STERLING IL 610811252 20 1164477766 0 Physicians Anesthesia Services 20 1164477766 0 Physicians Fluoride varnish 20 1164477766 0 Physicians Healthy Kids Services 20 1164477766 0 Physicians Optical Supplies 20 1164477766 0 Physicians Physician Services 00 1164478384 0 MILLS ELIZABETH 2016365 9999999 B 10 1164478384 0 1442 N 8TH ST STE C STE C VANDALIA IL 624711027 20 1164478384 0 Physician Assistant Only Fluoride varnish 20 1164478384 0 Physician Assistant Only Healthy Kids Services 20 1164478384 0 Physician Assistant Only Physician Services 00 1164478616 0 NAEEM SAIMA 2006254 9999999 B 10 1164478616 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1164478616 0 Physicians Anesthesia Services 20 1164478616 0 Physicians Fluoride varnish 20 1164478616 0 Physicians Healthy Kids Services 20 1164478616 0 Physicians Optical Supplies 20 1164478616 0 Physicians Physician Services 00 1164479424 0 LAGOSKI CHARLES 2025104 9999999 B 10 1164479424 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1164479424 0 Physicians Anesthesia Services 20 1164479424 0 Physicians Healthy Kids Services 20 1164479424 0 Physicians Optical Supplies 20 1164479424 0 Physicians Physician Services 00 1164479788 0 RODRIGUEZ GILMER J 2020254 9999999 B 10 1164479788 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1164479788 0 Physicians Anesthesia Services 20 1164479788 0 Physicians Fluoride varnish 20 1164479788 0 Physicians Healthy Kids Services 20 1164479788 0 Physicians Optical Supplies 20 1164479788 0 Physicians Physician Services 00 1164480059 0 DEMOS SASHA M 2004001 9999999 B 10 1164480059 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1164480059 0 Physicians Anesthesia Services 20 1164480059 0 Physicians Healthy Kids Services 20 1164480059 0 Physicians Optical Supplies 20 1164480059 0 Physicians Physician Services 00 1164480505 0 VACEK ROBERT D 1983024 9999999 B 10 1164480505 0 5777 DEPT CAROL STREAM IL 601228942 20 1164480505 0 Physicians Anesthesia Services 20 1164480505 0 Physicians Fluoride varnish 20 1164480505 0 Physicians Healthy Kids Services 20 1164480505 0 Physicians Optical Supplies 20 1164480505 0 Physicians Physician Services 00 1164480513 0 DAVIS DAWN 2008183 9999999 B 10 1164480513 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1164480513 0 Physicians Anesthesia Services 20 1164480513 0 Physicians Fluoride varnish 20 1164480513 0 Physicians Healthy Kids Services 20 1164480513 0 Physicians Optical Supplies 20 1164480513 0 Physicians Physician Services 00 1164480877 0 SZOPA BERNARD 2005335 9999999 B 10 1164480877 0 1414 CROSS ST STE 330 O FALLON IL 622692941 20 1164480877 0 Physicians Anesthesia Services 20 1164480877 0 Physicians Healthy Kids Services 20 1164480877 0 Physicians Optical Supplies 20 1164480877 0 Physicians Physician Services 00 1164481412 0 HALLMEYER SIGRUN 2005244 9999999 B 10 1164481412 0 29373 NETWORK PL CHICAGO IL 606733039 20 1164481412 0 Physicians Anesthesia Services 20 1164481412 0 Physicians Fluoride varnish 20 1164481412 0 Physicians Healthy Kids Services 20 1164481412 0 Physicians Optical Supplies 20 1164481412 0 Physicians Physician Services 00 1164482295 0 BRODD ANDERS 2001124 9999999 B 10 1164482295 0 1625 AVENUE OF THE CITIES MOLINE IL 612654856 20 1164482295 0 Physicians Anesthesia Services 20 1164482295 0 Physicians Fluoride varnish 20 1164482295 0 Physicians Healthy Kids Services 20 1164482295 0 Physicians Optical Supplies 20 1164482295 0 Physicians Physician Services 00 1164482303 0 CLANCY KEITH D 2017362 9999999 B 10 1164482303 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1164482303 0 Physicians Anesthesia Services 20 1164482303 0 Physicians Healthy Kids Services 20 1164482303 0 Physicians Optical Supplies 20 1164482303 0 Physicians Physician Services 00 1164482410 0 KURAKULA SATYA 2023035 9999999 B 10 1164482410 0 PO BOX 43230 PHOENIX AZ 850803230 20 1164482410 0 Physicians Anesthesia Services 20 1164482410 0 Physicians Fluoride varnish 20 1164482410 0 Physicians Healthy Kids Services 20 1164482410 0 Physicians Optical Supplies 20 1164482410 0 Physicians Physician Services 00 1164482923 0 DONALDSON DEIRDRE 2019163 9999999 B 10 1164482923 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1164482923 0 Physicians Anesthesia Services 20 1164482923 0 Physicians Healthy Kids Services 20 1164482923 0 Physicians Optical Supplies 20 1164482923 0 Physicians Physician Services 20 1164482923 0 Physicians Physicians Psychiatric Services 00 1164483087 0 COLLINS DIANNE 1997113 9999999 B 10 1164483087 0 5435 S BLACKSTONE AVE CHICAGO IL 606155406 20 1164483087 0 Physicians Anesthesia Services 20 1164483087 0 Physicians Fluoride varnish 20 1164483087 0 Physicians Healthy Kids Services 20 1164483087 0 Physicians Optical Supplies 20 1164483087 0 Physicians Physician Services 00 1164483111 0 PARVEN STEPHEN 2020272 9999999 B 10 1164483111 0 PO BOX 3272 INDIANAPOLIS IN 462063272 20 1164483111 0 Physicians Anesthesia Services 20 1164483111 0 Physicians Healthy Kids Services 20 1164483111 0 Physicians Optical Supplies 20 1164483111 0 Physicians Physician Services 00 1164483145 0 JABBARZADEH MEHRAN 2004183 9999999 B 10 1164483145 0 29373 NETWORK PL CHICAGO IL 606733039 20 1164483145 0 Physicians Anesthesia Services 20 1164483145 0 Physicians Fluoride varnish 20 1164483145 0 Physicians Healthy Kids Services 20 1164483145 0 Physicians Optical Supplies 20 1164483145 0 Physicians Physician Services 00 1164483731 0 DAVIS LISA 2010182 9999999 B 10 1164483731 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1164483731 0 Physicians Anesthesia Services 20 1164483731 0 Physicians Healthy Kids Services 20 1164483731 0 Physicians Optical Supplies 20 1164483731 0 Physicians Physician Services 00 1164484267 0 WILSON CHARLES 1981258 9999999 B 10 1164484267 0 PO BOX 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0 Physicians Healthy Kids Services 20 1164484846 0 Physicians Optical Supplies 20 1164484846 0 Physicians Physician Services 00 1164484994 0 HACKER KENNETH A 2020139 9999999 B 10 1164484994 0 10 HOSPITAL DR SAINT PETERS MO 633761659 20 1164484994 0 Physicians Anesthesia Services 20 1164484994 0 Physicians Healthy Kids Services 20 1164484994 0 Physicians Optical Supplies 20 1164484994 0 Physicians Physician Services 00 1164486338 0 WITTENBERG AARON 2022348 9999999 B 10 1164486338 0 1200 HARGER RD STE 408 OAK BROOK IL 605231818 20 1164486338 0 Physicians Anesthesia Services 20 1164486338 0 Physicians Healthy Kids Services 20 1164486338 0 Physicians Optical Supplies 20 1164486338 0 Physicians Physician Services 00 1164486684 0 FOGEL EVAN 2005173 9999999 B 10 1164486684 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1164486684 0 Physicians Anesthesia Services 20 1164486684 0 Physicians Healthy Kids Services 20 1164486684 0 Physicians Optical Supplies 20 1164486684 0 Physicians Physician Services 00 1164486932 0 GIRICZ KRISTOPH Y 2006001 9999999 B 10 1164486932 0 606 LINCOLNWAY VALPARAISO IN 463835728 20 1164486932 0 Physicians Anesthesia Services 20 1164486932 0 Physicians Fluoride varnish 20 1164486932 0 Physicians Healthy Kids Services 20 1164486932 0 Physicians Optical Supplies 20 1164486932 0 Physicians Physician Services 00 1164487088 0 FRIEDMAN NEIL R 1981227 9999999 B 10 1164487088 0 3201 OLD GLENVIEW RD STE 130 WILMETTE IL 600912964 20 1164487088 0 Physicians Anesthesia Services 20 1164487088 0 Physicians Healthy Kids Services 20 1164487088 0 Physicians Optical Supplies 20 1164487088 0 Physicians Physician Services 00 1164487153 0 STEPHENSON LIANNE 2009002 9999999 B 10 1164487153 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1164487153 0 Physicians Anesthesia Services 20 1164487153 0 Physicians Healthy Kids Services 20 1164487153 0 Physicians Optical Supplies 20 1164487153 0 Physicians Physician Services 00 1164487344 0 DOUGHERTY TIMOTHY J 2020256 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20 1164488748 0 Physicians Anesthesia Services 20 1164488748 0 Physicians Healthy Kids Services 20 1164488748 0 Physicians Optical Supplies 20 1164488748 0 Physicians Physician Services 00 1164488763 0 BAJAJ VIMI 1998328 9999999 B 10 1164488763 0 640 S WASHINGTON ST STE 220 NAPERVILLE IL 605406790 20 1164488763 0 Physicians Anesthesia Services 20 1164488763 0 Physicians Healthy Kids Services 20 1164488763 0 Physicians Optical Supplies 20 1164488763 0 Physicians Physician Services 00 1164488946 0 BOWERSOX JON 2023013 9999999 B 10 1164488946 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1164488946 0 Physicians Anesthesia Services 20 1164488946 0 Physicians Healthy Kids Services 20 1164488946 0 Physicians Optical Supplies 20 1164488946 0 Physicians Physician Services 00 1164489241 0 JOUBRAN RIM 1999152 9999999 B 10 1164489241 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1164489241 0 Physicians Anesthesia Services 20 1164489241 0 Physicians Fluoride varnish 20 1164489241 0 Physicians Healthy Kids Services 20 1164489241 0 Physicians Optical Supplies 20 1164489241 0 Physicians Physician Services 00 1164490066 0 PAPESCH JAMES M 2005182 9999999 B 10 1164490066 0 36104 TREASURY CTR CHICAGO IL 606946100 20 1164490066 0 Physicians Anesthesia Services 20 1164490066 0 Physicians Healthy Kids Services 20 1164490066 0 Physicians Optical Supplies 20 1164490066 0 Physicians Physician Services 00 1164490256 0 SANCHEZ CARLOS H 1983166 9999999 B 10 1164490256 0 6300 RIDGLEA PL STE 201 SUITE 201 FORT WORTH TX 761165707 20 1164490256 0 Physicians Anesthesia Services 20 1164490256 0 Physicians Fluoride varnish 20 1164490256 0 Physicians Healthy Kids Services 20 1164490256 0 Physicians Optical Supplies 20 1164490256 0 Physicians Physician Services 00 1164491296 0 PAGE DEAN 2021253 9999999 B 10 1164491296 0 3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047452 20 1164491296 0 Physicians Anesthesia Services 20 1164491296 0 Physicians Healthy Kids Services 20 1164491296 0 Physicians 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1164711081 0 Physicians Healthy Kids Services 20 1164711081 0 Physicians Optical Supplies 20 1164711081 0 Physicians Physician Services 00 1164711107 0 PATEL AMIT ISHWARLAL 2016125 9999999 B 10 1164711107 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1164711107 0 Physicians Anesthesia Services 20 1164711107 0 Physicians Healthy Kids Services 20 1164711107 0 Physicians Optical Supplies 20 1164711107 0 Physicians Physician Services 00 1164711487 0 LAMEKA KATARZYNA 2023048 9999999 B 10 1164711487 0 PO BOX 3272 INDIANAPOLIS IN 462063272 20 1164711487 0 Physicians Anesthesia Services 20 1164711487 0 Physicians Healthy Kids Services 20 1164711487 0 Physicians Optical Supplies 20 1164711487 0 Physicians Physician Services 00 1164711511 0 BLAIR NATHAN M 2016228 9999999 B 10 1164711511 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1164711511 0 Physicians Anesthesia Services 20 1164711511 0 Physicians Healthy Kids Services 20 1164711511 0 Physicians Optical Supplies 20 1164711511 0 Physicians 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1164716742 0 Physicians Healthy Kids Services 20 1164716742 0 Physicians Optical Supplies 20 1164716742 0 Physicians Physician Services 00 1164716833 0 ZHENG SOPHY C 2015236 9999999 B 10 1164716833 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1164716833 0 Physicians Anesthesia Services 20 1164716833 0 Physicians Healthy Kids Services 20 1164716833 0 Physicians Optical Supplies 20 1164716833 0 Physicians Physician Services 00 1164717278 0 MCCORMICK KRAJEWSKI ANNA C 2018274 9999999 B 10 1164717278 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1164717278 0 Physicians Anesthesia Services 20 1164717278 0 Physicians Healthy Kids Services 20 1164717278 0 Physicians Optical Supplies 20 1164717278 0 Physicians Physician Services 00 1164717542 0 LAROCCO NICOLE L 2015245 9999999 B 10 1164717542 0 15 SPINNING WHEEL RD STE 418 HINSDALE IL 605217665 20 1164717542 0 Other behavior health professional LCPC/LMFT services 00 1164717989 0 CORWIN CLAUDIA L 1993167 9999999 B 10 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WHITMAN RD STE 300 MELVILLE NY 117474300 20 1164719050 0 Physicians Anesthesia Services 20 1164719050 0 Physicians Healthy Kids Services 20 1164719050 0 Physicians Optical Supplies 20 1164719050 0 Physicians Physician Services 00 1164719613 0 MELNIKOV ANDREY 2014202 9999999 B 10 1164719613 0 3631 N HARLEM AVE CHICAGO IL 606342237 20 1164719613 0 Podiatrists Podiatric Services 00 1164719720 0 SIEDLARZ MONIKA 2021173 9999999 B 10 1164719720 0 14933 FOUNDERS XING HOMER GLEN IL 604916712 20 1164719720 0 Physicians Anesthesia Services 20 1164719720 0 Physicians Fluoride varnish 20 1164719720 0 Physicians Healthy Kids Services 20 1164719720 0 Physicians Optical Supplies 20 1164719720 0 Physicians Physician Services 00 1164719951 0 COLLANDER MATTHEW 2014182 9999999 B 10 1164719951 0 PO BOX 85297 CHICAGO IL 606895297 20 1164719951 0 Physicians Anesthesia Services 20 1164719951 0 Physicians Healthy Kids Services 20 1164719951 0 Physicians Optical Supplies 20 1164719951 0 Physicians Physician Services 00 1164720215 0 MCBRIDE DESPINA 2014365 9999999 H 10 1164720215 0 527 W SOUTH STREET WOODSTOCK IL 600983756 20 1164720215 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1164721528 0 FAVILA EMMANUEL 2016204 9999999 B 10 1164721528 0 29373 NETWORK PL CHICAGO IL 606733039 20 1164721528 0 Physicians Anesthesia Services 20 1164721528 0 Physicians Fluoride varnish 20 1164721528 0 Physicians Healthy Kids Services 20 1164721528 0 Physicians Optical Supplies 20 1164721528 0 Physicians Physician Services 00 1164722955 0 GROSSO STEPHANIE E 2015244 9999999 B 10 1164722955 0 29373 NETWORK PL CHICAGO IL 606733039 20 1164722955 0 Physician Assistant Only Fluoride varnish 20 1164722955 0 Physician Assistant Only Healthy Kids Services 20 1164722955 0 Physician Assistant Only Physician Services 00 1164723110 0 MALUNHAO ANA MARIE B 2016110 9999999 B 10 1164723110 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1164723110 0 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1164728127 0 4600 3RD ST MOLINE IL 612656106 20 1164728127 0 Clinical Social Worker Social work service 00 1164728127 0 LEEBOLD BOBBY 2015170 9999999 B 10 1164728127 0 4600 3RD ST MOLINE IL 612656106 20 1164728127 0 Other behavior health professional Social work service 00 1164728721 0 REYNOLDS PAMELA N 2018341 9999999 B 10 1164728721 0 PO BOX 28900 GREEN BAY WI 543240900 20 1164728721 0 Nurse Practitioners Anesthesia Services 20 1164728721 0 Nurse Practitioners Nurse Practitioners Services 20 1164728721 0 Nurse Practitioners Physician Services 00 1164731311 0 KADELA KINGA 2023137 9999999 B 10 1164731311 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1164731311 0 Physical Therapists Medical Supplies 20 1164731311 0 Physical Therapists Medical equipment/prosthetic devices 20 1164731311 0 Physical Therapists Physical Therapy Services 00 1164732038 0 MIAH BAHAR 2021089 9999999 B 10 1164732038 0 PO BOX 43230 PHOENIX AZ 850803230 20 1164732038 0 Physicians Anesthesia Services 20 1164732038 0 Physicians Healthy Kids Services 20 1164732038 0 Physicians Optical Supplies 20 1164732038 0 Physicians Physician Services 00 1164733440 0 WIEBE ERICA 2016222 9999999 B 10 1164733440 0 800 E LOCUST ST OLNEY IL 624502553 20 1164733440 0 Physicians Anesthesia Services 20 1164733440 0 Physicians Fluoride varnish 20 1164733440 0 Physicians Healthy Kids Services 20 1164733440 0 Physicians Optical Supplies 20 1164733440 0 Physicians Physician Services 00 1164734570 0 KAKKANATT AMY 2021173 9999999 B 10 1164734570 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1164734570 0 Physicians Anesthesia Services 20 1164734570 0 Physicians Fluoride varnish 20 1164734570 0 Physicians Healthy Kids Services 20 1164734570 0 Physicians Optical Supplies 20 1164734570 0 Physicians Physician Services 00 1164734935 0 SAVARAPU ANIL KUMAR 2022271 9999999 B 10 1164734935 0 PO BOX 32861 CHARLOTTE NC 282322861 20 1164734935 0 Physicians Anesthesia Services 20 1164734935 0 Physicians Healthy Kids Services 20 1164734935 0 Physicians Optical Supplies 20 1164734935 0 Physicians Physician Services 00 1164735346 0 MCCULLUM-JOHNSON TYHILYA K 2010291 9999999 B 10 1164735346 0 10540 S WESTERN AVE CHICAGO IL 606432536 20 1164735346 0 Other behavior health professional LCPC/LMFT services 00 1164735403 0 JASINSKI GREGORY B 2016207 9999999 B 10 1164735403 0 PO BOX 955860 SAINT LOUIS MO 631955860 20 1164735403 0 Physicians Anesthesia Services 20 1164735403 0 Physicians Healthy Kids Services 20 1164735403 0 Physicians Optical Supplies 20 1164735403 0 Physicians Physician Services 20 1164735403 0 Physicians Physicians Psychiatric Services 00 1164735502 0 GAZTAMBIDE-RODRIGUEZ HERMAN 2023212 9999999 B 10 1164735502 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1164735502 0 Physicians Anesthesia Services 20 1164735502 0 Physicians Fluoride varnish 20 1164735502 0 Physicians HIV Counseling svcs 20 1164735502 0 Physicians Healthy Kids Services 20 1164735502 0 Physicians Optical Supplies 20 1164735502 0 Physicians Physician Services 00 1164736047 0 SMITH SUSAN B 2010152 9999999 B 10 1164736047 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1164736047 0 Nurse Practitioners Healthy Kids Services 20 1164736047 0 Nurse Practitioners Nurse Practitioners Services 20 1164736047 0 Nurse Practitioners Physician Services 00 1164736294 0 GRIMES EPHRIAM T 2011258 9999999 B 10 1164736294 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1164736294 0 Physicians Anesthesia Services 20 1164736294 0 Physicians Healthy Kids Services 20 1164736294 0 Physicians Optical Supplies 20 1164736294 0 Physicians Physician Services 00 1164737490 0 EDUPUGANTI MOHAN M 2019018 9999999 B 10 1164737490 0 901 PATIENTS FIRST DR WASHINGTON MO 630904700 20 1164737490 0 Physicians Anesthesia Services 20 1164737490 0 Physicians Fluoride varnish 20 1164737490 0 Physicians Healthy Kids Services 20 1164737490 0 Physicians Optical Supplies 20 1164737490 0 Physicians Physician Services 00 1164738787 0 STEINBECK JENNIFER 2016028 9999999 B 10 1164738787 0 880 W CENTRAL RD STE 8100 ARLINGTON HEIGH IL 600052391 20 1164738787 0 Physicians Anesthesia Services 20 1164738787 0 Physicians Fluoride varnish 20 1164738787 0 Physicians Healthy Kids Services 20 1164738787 0 Physicians Optical Supplies 20 1164738787 0 Physicians Physician Services 00 1164740122 0 VALLABHANENI SRIDHAR 2015121 9999999 B 10 1164740122 0 2450 WOLF RD STE D STE. 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1164740999 0 Physicians Healthy Kids Services 20 1164740999 0 Physicians Optical Supplies 20 1164740999 0 Physicians Physician Services 20 1164740999 0 Physicians Physicians Psychiatric Services 00 1164741419 0 TRETTIN REED E 2021145 9999999 B 10 1164741419 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1164741419 0 Physician Assistant Only Fluoride varnish 20 1164741419 0 Physician Assistant Only Healthy Kids Services 20 1164741419 0 Physician Assistant Only Physician Services 00 1164742722 0 BENNETT JENNIFER A 2018182 9999999 B 10 1164742722 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1164742722 0 Physicians Anesthesia Services 20 1164742722 0 Physicians Healthy Kids Services 20 1164742722 0 Physicians Optical Supplies 20 1164742722 0 Physicians Physician Services 00 1164743118 0 SAPER DAVID 2016214 9999999 B 10 1164743118 0 4433 W TOUHY AVE STE 301 LINCOLNWOOD IL 607121832 20 1164743118 0 Physicians Anesthesia Services 20 1164743118 0 Physicians Healthy Kids Services 20 1164743118 0 Physicians Optical Supplies 20 1164743118 0 Physicians Physician Services 00 1164743241 0 DSCHIDA DOROTHY 2013196 9999999 B 10 1164743241 0 PO BOX 21844 BELFAST ME 049154115 20 1164743241 0 Physicians All Kids application agent 20 1164743241 0 Physicians Anesthesia Services 20 1164743241 0 Physicians Fluoride varnish 20 1164743241 0 Physicians Healthy Kids Services 20 1164743241 0 Physicians Optical Supplies 20 1164743241 0 Physicians Physician Services 00 1164743415 0 HALL TYLER 2019266 9999999 B 10 1164743415 0 PO BOX 43230 PHOENIX AZ 850803230 20 1164743415 0 Physicians Anesthesia Services 20 1164743415 0 Physicians Healthy Kids Services 20 1164743415 0 Physicians Optical Supplies 20 1164743415 0 Physicians Physician Services 00 1164743787 0 ROMANELLI MARK G 2013246 9999999 B 10 1164743787 0 5777 DEPT CAROL STREAM IL 601220021 20 1164743787 0 Physicians Anesthesia Services 20 1164743787 0 Physicians Healthy Kids Services 20 1164743787 0 Physicians Optical Supplies 20 1164743787 0 Physicians Physician Services 00 1164744199 0 BRICK SCOTT 2023114 9999999 B 10 1164744199 0 PO BOX 43230 PHOENIX AZ 850803230 20 1164744199 0 Physicians Anesthesia Services 20 1164744199 0 Physicians Healthy Kids Services 20 1164744199 0 Physicians Optical Supplies 20 1164744199 0 Physicians Physician Services 00 1164746905 0 BOLOTIN DIANA 2011182 9999999 B 10 1164746905 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1164746905 0 Physicians Anesthesia Services 20 1164746905 0 Physicians Healthy Kids Services 20 1164746905 0 Physicians Optical Supplies 20 1164746905 0 Physicians Physician Services 00 1164747390 0 ARNOLD-LLOYD TRAVIS 2021300 9999999 B 10 1164747390 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1164747390 0 Physicians Anesthesia Services 20 1164747390 0 Physicians Healthy Kids Services 20 1164747390 0 Physicians Optical Supplies 20 1164747390 0 Physicians Physician Services 00 1164747754 0 PATEL RIDDHI 2014223 9999999 B 10 1164747754 0 5777 DEPT CAROL STREAM IL 601228942 20 1164747754 0 Physicians Anesthesia Services 20 1164747754 0 Physicians Healthy Kids Services 20 1164747754 0 Physicians Optical Supplies 20 1164747754 0 Physicians Physician Services 00 1164748026 0 SPENCER DREW A 2017143 9999999 B 10 1164748026 0 3471 EAGLE WAY CHICAGO IL 606781034 20 1164748026 0 Physicians Anesthesia Services 20 1164748026 0 Physicians Healthy Kids Services 20 1164748026 0 Physicians Optical Supplies 20 1164748026 0 Physicians Physician Services 00 1164748505 0 OFTADEH MINA 2015182 9999999 B 10 1164748505 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1164748505 0 Physicians Anesthesia Services 20 1164748505 0 Physicians Healthy Kids Services 20 1164748505 0 Physicians Optical Supplies 20 1164748505 0 Physicians Physician Services 00 1164748646 0 KINNEY TARA M 2011269 9999999 B 10 1164748646 0 PO BOX 689 LAKE FOREST IL 600450689 20 1164748646 0 Nurse Practitioners Anesthesia Services 20 1164748646 0 Nurse 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Anesthesia Services 20 1164752754 0 Physicians Fluoride varnish 20 1164752754 0 Physicians Healthy Kids Services 20 1164752754 0 Physicians Optical Supplies 20 1164752754 0 Physicians Physician Services 00 1164753273 0 KRISHNAMOORTHY ASWIN K 2014182 9999999 B 10 1164753273 0 4062 DEPARTMENT CAROL STREAM IL 601224062 20 1164753273 0 Physicians Anesthesia Services 20 1164753273 0 Physicians Healthy Kids Services 20 1164753273 0 Physicians Optical Supplies 20 1164753273 0 Physicians Physician Services 00 1164753281 0 ADAMS GREENWALT LINDSEY M 2017080 9999999 B 10 1164753281 0 3600 S WATER TOWER PL MOUNT VERNON IL 628646589 20 1164753281 0 Clinical Social Worker Social work service 00 1164754743 0 MORENO YVONNE CESENA 2018109 9999999 B 10 1164754743 0 111 OAKWOOD RD EAST PEORIA IL 616111853 20 1164754743 0 Physicians Anesthesia Services 20 1164754743 0 Physicians Healthy Kids Services 20 1164754743 0 Physicians Optical Supplies 20 1164754743 0 Physicians Physician Services 00 1164756102 0 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Nurse Practitioners Fluoride varnish 20 1164776688 0 Nurse Practitioners Healthy Kids Services 20 1164776688 0 Nurse Practitioners Nurse Practitioners Services 20 1164776688 0 Nurse Practitioners Physician Services 00 1164777223 0 BRIDEN KELLEIGH E 2018142 9999999 B 10 1164777223 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1164777223 0 Physicians Anesthesia Services 20 1164777223 0 Physicians Fluoride varnish 20 1164777223 0 Physicians Healthy Kids Services 20 1164777223 0 Physicians Optical Supplies 20 1164777223 0 Physicians Physician Services 00 1164777694 0 WIELE BENJAMIN 2018205 9999999 B 10 1164777694 0 901 PATIENTS FIRST DR WASHINGTON MO 630904700 20 1164777694 0 Physicians Anesthesia Services 20 1164777694 0 Physicians Fluoride varnish 20 1164777694 0 Physicians Healthy Kids Services 20 1164777694 0 Physicians Optical Supplies 20 1164777694 0 Physicians Physician Services 00 1164777835 0 BRENART HEATHER R 2012340 9999999 B 10 1164777835 0 40 SHUMAN BLVD 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Physicians Optical Supplies 20 1164787149 0 Physicians Physician Services 00 1164787263 0 AHMED FATIMA 2016238 9999999 B 10 1164787263 0 87 N AIRLITE ST STE 130 ELGIN IL 601234991 20 1164787263 0 Physicians Anesthesia Services 20 1164787263 0 Physicians Fluoride varnish 20 1164787263 0 Physicians Healthy Kids Services 20 1164787263 0 Physicians Optical Supplies 20 1164787263 0 Physicians Physician Services 00 1164787792 0 HASHMI SYED AFFAN UL HAQ 2017081 9999999 B 10 1164787792 0 PO BOX 3877 JOLIET IL 604343877 20 1164787792 0 Physicians Anesthesia Services 20 1164787792 0 Physicians Fluoride varnish 20 1164787792 0 Physicians Healthy Kids Services 20 1164787792 0 Physicians Optical Supplies 20 1164787792 0 Physicians Physician Services 00 1164788188 0 BRUMLEY ERIN 2015186 9999999 B 10 1164788188 0 PO BOX 736216 DALLAS TX 753736216 20 1164788188 0 Physicians Anesthesia Services 20 1164788188 0 Physicians Healthy Kids Services 20 1164788188 0 Physicians Optical Supplies 20 1164788188 0 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2019273 9999999 B 10 1164814851 0 PO BOX 775342 CHICAGO IL 606775342 20 1164814851 0 Nurse Practitioners Fluoride varnish 20 1164814851 0 Nurse Practitioners Healthy Kids Services 20 1164814851 0 Nurse Practitioners Nurse Practitioners Services 20 1164814851 0 Nurse Practitioners Physician Services 00 1164815619 0 MILES KATRINA 2016244 9999999 B 10 1164815619 0 325 IL ROUTE 2 DIXON IL 610219118 20 1164815619 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1164815684 0 CAVOTO LORAINE M 2024169 9999999 B 10 1164815684 0 13550 S ROUTE 30 STE 100 PLAINFIELD IL 605445686 20 1164815684 0 Nurse Practitioners Fluoride varnish 20 1164815684 0 Nurse Practitioners Healthy Kids Services 20 1164815684 0 Nurse Practitioners Nurse Practitioners Services 20 1164815684 0 Nurse Practitioners Physician Services 00 1164816500 0 MOORE NATHANIEL 2024201 9999999 B 10 1164816500 0 PO BOX 1649 CHEYENNE WY 820031649 20 1164816500 0 Physicians 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2017114 9999999 B 10 1164827333 0 PO BOX 776926 CHICAGO IL 606776926 20 1164827333 0 Physician Assistant Only Fluoride varnish 20 1164827333 0 Physician Assistant Only Healthy Kids Services 20 1164827333 0 Physician Assistant Only Physician Services 00 1164829735 0 MAHVISH FARHA 2021013 9999999 B 10 1164829735 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1164829735 0 Physicians Anesthesia Services 20 1164829735 0 Physicians Fluoride varnish 20 1164829735 0 Physicians Healthy Kids Services 20 1164829735 0 Physicians Optical Supplies 20 1164829735 0 Physicians Physician Services 00 1164831186 0 SAMUEL ESHAN M 2019340 9999999 B 10 1164831186 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1164831186 0 Physicians Anesthesia Services 20 1164831186 0 Physicians Fluoride varnish 20 1164831186 0 Physicians Healthy Kids Services 20 1164831186 0 Physicians Optical Supplies 20 1164831186 0 Physicians Physician Services 00 1164831251 0 PATEL SHIVANI 2019063 9999999 B 10 1164831251 0 213 N 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0 Physicians Healthy Kids Services 20 1164836052 0 Physicians Optical Supplies 20 1164836052 0 Physicians Physician Services 00 1164836409 0 SCHRAM ANDREW W 2017209 9999999 B 10 1164836409 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1164836409 0 Physicians Anesthesia Services 20 1164836409 0 Physicians Fluoride varnish 20 1164836409 0 Physicians Healthy Kids Services 20 1164836409 0 Physicians Optical Supplies 20 1164836409 0 Physicians Physician Services 00 1164836433 0 NJIE ABDOULIE 2018001 9999999 B 10 1164836433 0 801 ILLINI DR SILVIS IL 612821804 20 1164836433 0 Physicians Anesthesia Services 20 1164836433 0 Physicians Healthy Kids Services 20 1164836433 0 Physicians Optical Supplies 20 1164836433 0 Physicians Physician Services 00 1164836722 0 SYED TAHA 2017250 9999999 B 10 1164836722 0 611 W PARK ST URBANA IL 618012529 20 1164836722 0 Physicians Anesthesia Services 20 1164836722 0 Physicians Fluoride varnish 20 1164836722 0 Physicians Healthy Kids Services 20 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1174245179 0 WINSLOW SAMANTHA 2022301 9999999 B 10 1174245179 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1174245179 0 Physician Assistant Only Fluoride varnish 20 1174245179 0 Physician Assistant Only Healthy Kids Services 20 1174245179 0 Physician Assistant Only Physician Services 00 1174245385 0 GAVYN STYS 2023058 9999999 B 10 1174245385 0 PO BOX 790379 SAINT LOUIS MO 631790379 20 1174245385 0 Clinical Social Worker Social work service 00 1174247233 0 MATHEW ALEX 2023230 9999999 B 10 1174247233 0 3926 W TOUHY AVE STE 372 LINCOLNWOOD IL 607121028 20 1174247233 0 Nurse Practitioners Fluoride varnish 20 1174247233 0 Nurse Practitioners Healthy Kids Services 20 1174247233 0 Nurse Practitioners Nurse Practitioners Services 20 1174247233 0 Nurse Practitioners Physician Services 00 1174248405 0 PETTY SAMANTHA N 2023005 9999999 B 10 1174248405 0 1717 MAIN ST STE 5850 DALLAS TX 752017317 20 1174248405 0 Nurse Practitioners Healthy Kids Services 20 1174248405 0 Nurse Practitioners Nurse Practitioners Services 20 1174248405 0 Nurse Practitioners Physician Services 00 1174249593 0 RAWAL JOSHME 2023089 9999999 B 10 1174249593 0 PO BOX 34266 BELFAST ME 049150620 20 1174249593 0 Nurse Practitioners Healthy Kids Services 20 1174249593 0 Nurse Practitioners Nurse Practitioners Services 20 1174249593 0 Nurse Practitioners Physician Services 00 1174249742 0 PATZ TAYLOR M 2022304 9999999 B 10 1174249742 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1174249742 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1174251656 0 BOWE MACKENZIE 2022266 9999999 B 10 1174251656 0 5777 DEPT CAROL STREAM IL 601220021 20 1174251656 0 Clinical Social Worker Social work service 00 1174252001 0 SOMPALLI VINOOTNA 2022207 9999999 B 10 1174252001 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1174252001 0 Physicians Anesthesia Services 20 1174252001 0 Physicians Healthy Kids Services 20 1174252001 0 Physicians Optical Supplies 20 1174252001 0 Physicians Physician Services 00 1174252738 0 CAO JESSICA L 2022178 9999999 B 10 1174252738 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1174252738 0 Physicians Anesthesia Services 20 1174252738 0 Physicians Healthy Kids Services 20 1174252738 0 Physicians Optical Supplies 20 1174252738 0 Physicians Physician Services 00 1174252860 0 ABRAHAM NIHIL 2024253 9999999 B 10 1174252860 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1174252860 0 Physicians Anesthesia Services 20 1174252860 0 Physicians Fluoride varnish 20 1174252860 0 Physicians Healthy Kids Services 20 1174252860 0 Physicians Optical Supplies 20 1174252860 0 Physicians Physician Services 00 1174253629 0 SHEHATA DANNY 2022185 9999999 B 10 1174253629 0 1 MEMORIAL DR ALTON IL 620026722 20 1174253629 0 Physicians Anesthesia Services 20 1174253629 0 Physicians Fluoride varnish 20 1174253629 0 Physicians Healthy Kids Services 20 1174253629 0 Physicians Optical Supplies 20 1174253629 0 Physicians Physician Services 00 1174253660 0 KUMAR ANEEL 2024038 9999999 B 10 1174253660 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1174253660 0 Physicians Anesthesia Services 20 1174253660 0 Physicians Healthy Kids Services 20 1174253660 0 Physicians Optical Supplies 20 1174253660 0 Physicians Physician Services 20 1174253660 0 Physicians Physicians Psychiatric Services 00 1174254247 0 HAHN BENJAMIN M 2023199 9999999 B 10 1174254247 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1174254247 0 Physician Assistant Only Fluoride varnish 20 1174254247 0 Physician Assistant Only Healthy Kids Services 20 1174254247 0 Physician Assistant Only Physician Services 00 1174254650 0 ENGER FRANCES 2022213 9999999 B 10 1174254650 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1174254650 0 Physicians Anesthesia Services 20 1174254650 0 Physicians Fluoride varnish 20 1174254650 0 Physicians Healthy Kids Services 20 1174254650 0 Physicians Optical Supplies 20 1174254650 0 Physicians Physician Services 00 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0 ATIEH RAMA 2022234 9999999 B 10 1174257893 0 998 N LOMBARD RD LOMBARD IL 601481264 20 1174257893 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1174258081 0 O'BRYAN MAUREEN 2022227 9999999 B 10 1174258081 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1174258081 0 Speech Therapists Medical Supplies 20 1174258081 0 Speech Therapists Medical equipment/prosthetic devices 20 1174258081 0 Speech Therapists Speech Therapy/Pathology Services 00 1174258743 0 CABALKA NICOLLE 2024073 9999999 B 10 1174258743 0 850 43RD AVE STE 100 MOLINE IL 612658401 20 1174258743 0 Physical Therapists Medical Supplies 20 1174258743 0 Physical Therapists Medical equipment/prosthetic devices 20 1174258743 0 Physical Therapists Physical Therapy Services 00 1174261044 0 MILES SHANTEL B 2022200 9999999 B 10 1174261044 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1174261044 0 Nurse Practitioners Fluoride varnish 20 1174261044 0 Nurse Practitioners Healthy Kids Services 20 1174261044 0 Nurse Practitioners Nurse Practitioners Services 20 1174261044 0 Nurse Practitioners Physician Services 00 1174262133 0 RYAN MARY 2022189 9999999 B 10 1174262133 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1174262133 0 Physicians Anesthesia Services 20 1174262133 0 Physicians Fluoride varnish 20 1174262133 0 Physicians Healthy Kids Services 20 1174262133 0 Physicians Optical Supplies 20 1174262133 0 Physicians Physician Services 00 1174262174 0 ZENO HANI 2022180 9999999 B 10 1174262174 0 1812 N 19TH AVE MELROSE PARK IL 601602039 20 1174262174 0 Dentists Dental Services 20 1174262174 0 Dentists Physician Services 00 1174262323 0 NAZIB ASHFIQUE 2022202 9999999 B 10 1174262323 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1174262323 0 Physicians Anesthesia Services 20 1174262323 0 Physicians Healthy Kids Services 20 1174262323 0 Physicians Optical Supplies 20 1174262323 0 Physicians Physician Services 00 1174263206 0 WILSON HAYLEY E 2022095 9999999 B 10 1174263206 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1174263206 0 Nurse Practitioners Fluoride varnish 20 1174263206 0 Nurse Practitioners Healthy Kids Services 20 1174263206 0 Nurse Practitioners Nurse Practitioners Services 20 1174263206 0 Nurse Practitioners Physician Services 00 1174263552 0 OFODILE PRECIOUS CHISOM 2022182 9999999 B 10 1174263552 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1174263552 0 Physicians Anesthesia Services 20 1174263552 0 Physicians Fluoride varnish 20 1174263552 0 Physicians Healthy Kids Services 20 1174263552 0 Physicians Optical Supplies 20 1174263552 0 Physicians Physician Services 00 1174264915 0 KIM JEE HWAN 2023298 9999999 B 10 1174264915 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112386 20 1174264915 0 Dentists Dental Services 20 1174264915 0 Dentists Physician Services 00 1174266878 0 ROCK STEVEN W 2022286 9999999 B 10 1174266878 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1174266878 0 Physician Assistant Only Fluoride varnish 20 1174266878 0 Physician Assistant Only Healthy Kids Services 20 1174266878 0 Physician Assistant Only Physician Services 00 1174267256 0 HARB AHMAD 2022353 9999999 B 10 1174267256 0 4698 DEPT CAROL STREAM IL 601224698 20 1174267256 0 Physicians Anesthesia Services 20 1174267256 0 Physicians Fluoride varnish 20 1174267256 0 Physicians Healthy Kids Services 20 1174267256 0 Physicians Optical Supplies 20 1174267256 0 Physicians Physician Services 00 1174267371 0 UJJAINWALA AMMAR L 2022244 9999999 B 10 1174267371 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1174267371 0 Physicians Anesthesia Services 20 1174267371 0 Physicians Healthy Kids Services 20 1174267371 0 Physicians Optical Supplies 20 1174267371 0 Physicians Physician Services 20 1174267371 0 Physicians Physicians Psychiatric Services 00 1174267579 0 UYGUN IBRAHIM 2022260 9999999 B 10 1174267579 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1174267579 0 Physicians Anesthesia Services 20 1174267579 0 Physicians Fluoride varnish 20 1174267579 0 Physicians Healthy Kids Services 20 1174267579 0 Physicians Optical Supplies 20 1174267579 0 Physicians Physician Services 00 1174267637 0 SHARMA NEAL 2022254 9999999 B 10 1174267637 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1174267637 0 Physicians Anesthesia Services 20 1174267637 0 Physicians Fluoride varnish 20 1174267637 0 Physicians Healthy Kids Services 20 1174267637 0 Physicians Optical Supplies 20 1174267637 0 Physicians Physician Services 00 1174267728 0 SOLECKI ROMAN S 2024211 9999999 B 10 1174267728 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1174267728 0 Physicians Anesthesia Services 20 1174267728 0 Physicians Healthy Kids Services 20 1174267728 0 Physicians Optical Supplies 20 1174267728 0 Physicians Physician Services 00 1174268791 0 ZUCKERMAN HANNAH 2022157 9999999 B 10 1174268791 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1174268791 0 Physicians Anesthesia Services 20 1174268791 0 Physicians Fluoride varnish 20 1174268791 0 Physicians Healthy Kids Services 20 1174268791 0 Physicians Optical Supplies 20 1174268791 0 Physicians Physician Services 00 1174269823 0 SAWYER JEFFREY 2022182 9999999 B 10 1174269823 0 29373 NETWORK PL CHICAGO IL 606733039 20 1174269823 0 Nurse Practitioners Anesthesia Services 20 1174269823 0 Nurse Practitioners Nurse Practitioners Services 20 1174269823 0 Nurse Practitioners Physician Services 00 1174270524 0 ALDINGER JONATHAN 2023156 9999999 B 10 1174270524 0 4698 DEPT CAROL STREAM IL 601220021 20 1174270524 0 Physicians Anesthesia Services 20 1174270524 0 Physicians Healthy Kids Services 20 1174270524 0 Physicians Optical Supplies 20 1174270524 0 Physicians Physician Services 00 1174270540 0 BIEHLE MARISA R 2023235 9999999 B 10 1174270540 0 520 MARY ST STE 520 EVANSVILLE IN 477101682 20 1174270540 0 Physician Assistant Only Fluoride varnish 20 1174270540 0 Physician Assistant Only Healthy Kids Services 20 1174270540 0 Physician Assistant Only Physician Services 00 1174270649 0 WATTS KEISHA 2022119 9999999 B 10 1174270649 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1174270649 0 Physician Assistant Only Fluoride varnish 20 1174270649 0 Physician Assistant Only Healthy Kids Services 20 1174270649 0 Physician Assistant Only Physician Services 00 1174271043 0 LOWE JAMIE J 2022201 9999999 B 10 1174271043 0 2003 W FULTON ST STE 303 CHICAGO IL 606122345 20 1174271043 0 Nurse Practitioners Fluoride varnish 20 1174271043 0 Nurse Practitioners Healthy Kids Services 20 1174271043 0 Nurse Practitioners Nurse Practitioners Services 20 1174271043 0 Nurse Practitioners Physician Services 00 1174271472 0 ZORUB EYAS 2023145 9999999 B 10 1174271472 0 PO BOX 3039 OAK BROOK IL 605223039 20 1174271472 0 Physicians Anesthesia Services 20 1174271472 0 Physicians Fluoride varnish 20 1174271472 0 Physicians Healthy Kids Services 20 1174271472 0 Physicians Optical Supplies 20 1174271472 0 Physicians Physician Services 00 1174271662 0 POHL-SMITH KIMBERLY 2022075 9999999 B 10 1174271662 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1174271662 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1174272066 0 LUTTER BETHANY 2022171 9999999 B 10 1174272066 0 4698 DEPT CAROL STREAM IL 601220021 20 1174272066 0 Physicians Anesthesia Services 20 1174272066 0 Physicians Healthy Kids Services 20 1174272066 0 Physicians Optical Supplies 20 1174272066 0 Physicians Physician Services 00 1174272629 0 REYNOLDS AUSTIN 2024183 9999999 B 10 1174272629 0 1901 W HARRISON ST CHICAGO IL 60612 20 1174272629 0 Physicians Anesthesia Services 20 1174272629 0 Physicians Healthy Kids Services 20 1174272629 0 Physicians Optical Supplies 20 1174272629 0 Physicians Physician Services 00 1174273015 0 CHUI MINDY 2022171 9999999 B 10 1174273015 0 1812 N 19TH AVE MELROSE PARK IL 601602039 20 1174273015 0 Dentists Dental Services 20 1174273015 0 Dentists Physician Services 00 1174275077 0 DAVIS BRIANA 2025036 9999999 B 10 1174275077 0 PO BOX 1510 EVANSVILLE IN 477061510 20 1174275077 0 Nurse Practitioners Healthy Kids Services 20 1174275077 0 Nurse Practitioners Nurse Practitioners Services 20 1174275077 0 Nurse Practitioners Physician Services 00 1174276505 0 SYLESTER DALORIS 2023239 9999999 B 10 1174276505 0 PO BOX 708760 SANDY UT 840708760 20 1174276505 0 Nurse Practitioners Healthy Kids Services 20 1174276505 0 Nurse Practitioners Nurse Practitioners Services 20 1174276505 0 Nurse Practitioners Physician Services 00 1174277305 0 GAUDANI SHAILY 2023279 9999999 B 10 1174277305 0 PO BOX 6037 WAUCONDA IL 600846037 20 1174277305 0 Physician Assistant Only Fluoride varnish 20 1174277305 0 Physician Assistant Only Healthy Kids Services 20 1174277305 0 Physician Assistant Only Physician Services 00 1174277529 0 O''DONOGHUE KATHERINE A 2022094 9999999 B 10 1174277529 0 PO BOX 1239 TROY MI 480991239 20 1174277529 0 Nurse Practitioners Fluoride varnish 20 1174277529 0 Nurse Practitioners Healthy Kids Services 20 1174277529 0 Nurse Practitioners Nurse Practitioners Services 20 1174277529 0 Nurse Practitioners Physician Services 00 1174277958 0 GREGERSEN ISABEL 2022105 9999999 B 10 1174277958 0 122 S MICHIGAN AVE STE 1441 CHICAGO IL 606036173 20 1174277958 0 Clinical Social Worker Social work service 00 1174278618 0 KUHN JOHNSON TIFFANIE M 2022207 9999999 B 10 1174278618 0 29373 NETWORK PL CHICAGO IL 606733039 20 1174278618 0 Nurse Practitioners Healthy Kids Services 20 1174278618 0 Nurse Practitioners Nurse Practitioners Services 20 1174278618 0 Nurse Practitioners Physician Services 00 1174278675 0 BROWN FRETTINA 2022049 9999999 B 10 1174278675 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1174278675 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1174281158 0 LONG JOANN 2022025 9999999 B 10 1174281158 0 7974 UW HEALTH CT MIDDLETON 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1174285118 0 SMITH HANNAH LEIGH 2022340 9999999 B 10 1174285118 0 231 E INDIAN TRL AURORA IL 605051732 20 1174285118 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1174285787 0 FELDMAN NICHOLE A 2021301 9999999 B 10 1174285787 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1174285787 0 Nurse Practitioners Fluoride varnish 20 1174285787 0 Nurse Practitioners Healthy Kids Services 20 1174285787 0 Nurse Practitioners Nurse Practitioners Services 20 1174285787 0 Nurse Practitioners Physician Services 00 1174286876 0 ENRIGHT BRIDGET 2021313 9999999 B 10 1174286876 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1174286876 0 Nurse Practitioners Healthy Kids Services 20 1174286876 0 Nurse Practitioners Nurse Practitioners Services 20 1174286876 0 Nurse Practitioners Physician Services 00 1174287304 0 MARTIN KATHERINE T 2022014 9999999 B 10 1174287304 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1174287304 0 Nurse Practitioners Healthy Kids Services 20 1174287304 0 Nurse Practitioners Nurse Practitioners Services 20 1174287304 0 Nurse Practitioners Physician Services 00 1174287734 0 KINNIN TORI 2024081 9999999 B 10 1174287734 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1174287734 0 Nurse Practitioners Healthy Kids Services 20 1174287734 0 Nurse Practitioners Nurse Practitioners Services 20 1174287734 0 Nurse Practitioners Physician Services 00 1174289128 0 JANI MAITHILEE 2022026 9999999 B 10 1174289128 0 1137 N EOLA RD STE 109 AURORA IL 605027097 20 1174289128 0 Dentists Dental Services 20 1174289128 0 Dentists Physician Services 00 1174290142 0 STROBEL SAVANNAH L 2022339 9999999 B 10 1174290142 0 11943 PINE AVE LEMONT IL 604394507 20 1174290142 0 Speech Therapists Medical Supplies 20 1174290142 0 Speech Therapists Medical equipment/prosthetic devices 20 1174290142 0 Speech Therapists Speech Therapy/Pathology Services 00 1174292908 0 SIERANT DAVID 2023333 9999999 B 10 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20 1174294789 0 Nurse Practitioners Healthy Kids Services 20 1174294789 0 Nurse Practitioners Nurse Practitioners Services 20 1174294789 0 Nurse Practitioners Physician Services 00 1174295034 0 DISMER HANNAH 2021294 9999999 B 10 1174295034 0 1602 21ST ST GRANITE CITY IL 620405304 20 1174295034 0 Clinical Social Worker Social work service 00 1174295083 0 LYKE ANGELA R 2023182 9999999 B 10 1174295083 0 PO BOX 556 VINCENNES IN 475910556 20 1174295083 0 Nurse Practitioners Healthy Kids Services 20 1174295083 0 Nurse Practitioners Nurse Practitioners Services 20 1174295083 0 Nurse Practitioners Physician Services 00 1174295323 0 FENELON SENADA 2023236 9999999 B 10 1174295323 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1174295323 0 Nurse Practitioners Healthy Kids Services 20 1174295323 0 Nurse Practitioners Nurse Practitioners Services 20 1174295323 0 Nurse Practitioners Physician Services 00 1174295729 0 HORAK JERRY 2022250 9999999 B 10 1174295729 0 200 HAWKINS DR 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Physician Services 00 1174512859 0 TUETKEN REBECCA S 1995172 9999999 B 10 1174512859 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1174512859 0 Physicians Anesthesia Services 20 1174512859 0 Physicians Fluoride varnish 20 1174512859 0 Physicians Healthy Kids Services 20 1174512859 0 Physicians Optical Supplies 20 1174512859 0 Physicians Physician Services 00 1174512917 0 BHAGAVAN MYSORE 1998191 9999999 B 10 1174512917 0 645 S CENTRAL AVE CHICAGO IL 606445059 20 1174512917 0 Physicians Anesthesia Services 20 1174512917 0 Physicians Fluoride varnish 20 1174512917 0 Physicians Healthy Kids Services 20 1174512917 0 Physicians Optical Supplies 20 1174512917 0 Physicians Physician Services 00 1174512925 0 GORDON RANDALL J 1987205 9999999 B 10 1174512925 0 17495 LA GRANGE RD TINLEY PARK IL 604877581 20 1174512925 0 Physicians Anesthesia Services 20 1174512925 0 Physicians Healthy Kids Services 20 1174512925 0 Physicians Optical Supplies 20 1174512925 0 Physicians Physician Services 00 1174513253 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1174588628 0 Physicians Physician Services 00 1174589501 0 VILLANUEVA MIRKO 2023339 9999999 B 10 1174589501 0 5410 MARYLAND WAY STE 300 BRENTWOOD TN 370275339 20 1174589501 0 Physicians Anesthesia Services 20 1174589501 0 Physicians Fluoride varnish 20 1174589501 0 Physicians Healthy Kids Services 20 1174589501 0 Physicians Optical Supplies 20 1174589501 0 Physicians Physician Services 00 1174589576 0 DAWOOD MOHAMMED 2004280 9999999 B 10 1174589576 0 2300 N EDWARD ST DECATUR IL 625264163 20 1174589576 0 Physicians Anesthesia Services 20 1174589576 0 Physicians Fluoride varnish 20 1174589576 0 Physicians Healthy Kids Services 20 1174589576 0 Physicians Optical Supplies 20 1174589576 0 Physicians Physician Services 00 1174589774 0 SCHULTZ JEFFREY 1997032 9999999 B 10 1174589774 0 4227 LINCOLNSHIRE DR MOUNT VERNON IL 628642157 20 1174589774 0 Physicians Anesthesia Services 20 1174589774 0 Physicians Healthy Kids Services 20 1174589774 0 Physicians Optical Supplies 20 1174589774 0 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1174591374 0 Physicians Healthy Kids Services 20 1174591374 0 Physicians Optical Supplies 20 1174591374 0 Physicians Physician Services 00 1174591531 0 SEVERINO MICHAEL J 1995182 9999999 B 10 1174591531 0 5777 DEPT CAROL STREAM IL 601220021 20 1174591531 0 Physicians Anesthesia Services 20 1174591531 0 Physicians Fluoride varnish 20 1174591531 0 Physicians Healthy Kids Services 20 1174591531 0 Physicians Optical Supplies 20 1174591531 0 Physicians Physician Services 00 1174591549 0 HANNISH MAJDA 2016233 9999999 B 10 1174591549 0 130 TOWN CENTER DR TROY MI 480841744 20 1174591549 0 Physicians Anesthesia Services 20 1174591549 0 Physicians Fluoride varnish 20 1174591549 0 Physicians Healthy Kids Services 20 1174591549 0 Physicians Optical Supplies 20 1174591549 0 Physicians Physician Services 00 1174591580 0 ALI MUHAMMAD I 2021337 9999999 B 10 1174591580 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1174591580 0 Physicians Anesthesia Services 20 1174591580 0 Physicians Fluoride 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Services 00 1174620157 0 THILL RODNEY 1995186 9999999 B 10 1174620157 0 29373 NETWORK PL CHICAGO IL 606733039 20 1174620157 0 Physicians Anesthesia Services 20 1174620157 0 Physicians Healthy Kids Services 20 1174620157 0 Physicians Optical Supplies 20 1174620157 0 Physicians Physician Services 00 1174620959 0 SOLLIDAY LAURA L 2022067 9999999 B 10 1174620959 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1174620959 0 Physician Assistant Only Fluoride varnish 20 1174620959 0 Physician Assistant Only Healthy Kids Services 20 1174620959 0 Physician Assistant Only Physician Services 00 1174622757 0 POGUE FRANCES 2018130 9999999 B 10 1174622757 0 202 S PARK ST MADISON WI 537151507 20 1174622757 0 Physicians Anesthesia Services 20 1174622757 0 Physicians Fluoride varnish 20 1174622757 0 Physicians Healthy Kids Services 20 1174622757 0 Physicians Optical Supplies 20 1174622757 0 Physicians Physician Services 00 1174623599 0 REED ALAN I 1989182 9999999 B 10 1174623599 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1174623599 0 Physicians Anesthesia Services 20 1174623599 0 Physicians Healthy Kids Services 20 1174623599 0 Physicians Optical Supplies 20 1174623599 0 Physicians Physician Services 00 1174623664 0 LUTZ THOMAS A 2022080 9999999 B 10 1174623664 0 1670 CAPITAL ST STE 500 ELGIN IL 601248079 20 1174623664 0 Physicians Anesthesia Services 20 1174623664 0 Physicians Fluoride varnish 20 1174623664 0 Physicians Healthy Kids Services 20 1174623664 0 Physicians Optical Supplies 20 1174623664 0 Physicians Physician Services 00 1174623854 0 PETERSON WILLIAM 1991231 9999999 B 10 1174623854 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1174623854 0 Physicians Anesthesia Services 20 1174623854 0 Physicians Fluoride varnish 20 1174623854 0 Physicians Healthy Kids Services 20 1174623854 0 Physicians Optical Supplies 20 1174623854 0 Physicians Physician Services 00 1174624241 0 KUNG AMIINAH Y 2015195 9999999 B 10 1174624241 0 5777 DEPT CAROL STREAM IL 601228942 20 1174624241 0 Physicians Anesthesia Services 20 1174624241 0 Physicians Fluoride varnish 20 1174624241 0 Physicians Healthy Kids Services 20 1174624241 0 Physicians Optical Supplies 20 1174624241 0 Physicians Physician Services 00 1174624415 0 STEPHEN JACOB 2016280 9999999 B 10 1174624415 0 5777 DEPT CAROL STREAM IL 601220021 20 1174624415 0 Physicians Anesthesia Services 20 1174624415 0 Physicians Fluoride varnish 20 1174624415 0 Physicians Healthy Kids Services 20 1174624415 0 Physicians Optical Supplies 20 1174624415 0 Physicians Physician Services 00 1174625867 0 SAXENA SANJAY 1998362 9999999 B 10 1174625867 0 2427 MALONEY DR BLOOMINGTON IL 617043750 20 1174625867 0 Physicians Anesthesia Services 20 1174625867 0 Physicians Fluoride varnish 20 1174625867 0 Physicians Healthy Kids Services 20 1174625867 0 Physicians Optical Supplies 20 1174625867 0 Physicians Physician Services 00 1174627178 0 BEYER JEFFREY D 2016001 9999999 B 10 1174627178 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1174627178 0 Physician Assistant Only Fluoride varnish 20 1174627178 0 Physician Assistant Only Healthy Kids Services 20 1174627178 0 Physician Assistant Only Physician Services 00 1174630099 0 PATEL NEETIN 1994182 9999999 B 10 1174630099 0 12255 DE PAUL DR STE 737 BRIDGETON MO 630442530 20 1174630099 0 Physicians Anesthesia Services 20 1174630099 0 Physicians Healthy Kids Services 20 1174630099 0 Physicians Optical Supplies 20 1174630099 0 Physicians Physician Services 00 1174631188 0 FISTER JAMES S 1984198 9999999 B 10 1174631188 0 2350 ROYAL BLVD STE 200 200 ELGIN IL 601234718 20 1174631188 0 Physicians Anesthesia Services 20 1174631188 0 Physicians Healthy Kids Services 20 1174631188 0 Physicians Optical Supplies 20 1174631188 0 Physicians Physician Services 00 1174631337 0 HOLTHAUS SUZANNE E 2000220 9999999 B 10 1174631337 0 210 W WALNUT ST CANTON IL 615202444 20 1174631337 0 Physicians Anesthesia Services 20 1174631337 0 Physicians Fluoride varnish 20 1174631337 0 Physicians Healthy Kids Services 20 1174631337 0 Physicians Optical Supplies 20 1174631337 0 Physicians Physician Services 00 1174632129 0 MACKE JEFFREY D 1994110 9999999 B 10 1174632129 0 PO BOX 1510 EVANSVILLE IN 477061510 20 1174632129 0 Physicians Anesthesia Services 20 1174632129 0 Physicians Fluoride varnish 20 1174632129 0 Physicians Healthy Kids Services 20 1174632129 0 Physicians Optical Supplies 20 1174632129 0 Physicians Physician Services 00 1174633135 0 WINTER ROBERT 2016348 9999999 B 10 1174633135 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1174633135 0 Physicians Anesthesia Services 20 1174633135 0 Physicians Healthy Kids Services 20 1174633135 0 Physicians Optical Supplies 20 1174633135 0 Physicians Physician Services 00 1174633218 0 WEISER SIDNEY 1987334 9999999 B 10 1174633218 0 7025 BERACASA WAY STE 102G BOCA RATON FL 334333428 20 1174633218 0 Podiatrists Podiatric Services 00 1174633366 0 STRUTZENBERG JON 1998213 9999999 B 10 1174633366 0 4701 DEPT CAROL STREAM IL 601220021 20 1174633366 0 Physicians All Kids application agent 20 1174633366 0 Physicians Anesthesia Services 20 1174633366 0 Physicians Family Planning Counseling 20 1174633366 0 Physicians Fluoride varnish 20 1174633366 0 Physicians Healthy Kids Services 20 1174633366 0 Physicians Optical Supplies 20 1174633366 0 Physicians Physician Services 00 1174633564 0 DAVIS LARRY J 1994274 9999999 B 10 1174633564 0 1 UNIVERSITY BLVD SAINT LOUIS MO 631214400 20 1174633564 0 Optometrists Optical Supplies 20 1174633564 0 Optometrists Optometric Services 20 1174633564 0 Optometrists Physician Services 00 1174633572 0 ESTABROOK MICHELE M 2008214 9999999 B 10 1174633572 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1174633572 0 Physicians Anesthesia Services 20 1174633572 0 Physicians Fluoride varnish 20 1174633572 0 Physicians Healthy Kids Services 20 1174633572 0 Physicians Optical Supplies 20 1174633572 0 Physicians Physician Services 00 1174633960 0 LIM HAN 1991121 9999999 B 10 1174633960 0 5140 N CALIFORNIA AVE STE 565 CHICAGO IL 606256955 20 1174633960 0 Physicians Anesthesia Services 20 1174633960 0 Physicians Healthy Kids Services 20 1174633960 0 Physicians Optical Supplies 20 1174633960 0 Physicians Physician Services 00 1174634612 0 WRIGHT JUDITH A 2007358 9999999 B 10 1174634612 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1174634612 0 Physicians Anesthesia Services 20 1174634612 0 Physicians Healthy Kids Services 20 1174634612 0 Physicians Optical Supplies 20 1174634612 0 Physicians Physician Services 00 1174634893 0 SYED NASREEN 2001247 9999999 B 10 1174634893 0 611 W PARK ST URBANA IL 618012529 20 1174634893 0 Physicians Anesthesia Services 20 1174634893 0 Physicians Fluoride varnish 20 1174634893 0 Physicians Healthy Kids Services 20 1174634893 0 Physicians Optical Supplies 20 1174634893 0 Physicians Physician Services 00 1174634927 0 ANGSPATT SOMPONGSE 1981227 9999999 B 10 1174634927 0 5601 VICTORIA DR OAK FOREST IL 604522134 20 1174634927 0 Physicians Anesthesia Services 20 1174634927 0 Physicians Fluoride varnish 20 1174634927 0 Physicians Healthy Kids Services 20 1174634927 0 Physicians Optical Supplies 20 1174634927 0 Physicians Physician Services 00 1174635718 0 ORGAIN JAVETTE C 1987050 9999999 B 10 1174635718 0 1220 S WOOD ST CHICAGO IL 606081202 20 1174635718 0 Physicians All Kids application agent 20 1174635718 0 Physicians Anesthesia Services 20 1174635718 0 Physicians Fluoride varnish 20 1174635718 0 Physicians Healthy Kids Services 20 1174635718 0 Physicians Optical Supplies 20 1174635718 0 Physicians Physician Services 00 1174636013 0 KHAN MOHSIN 2007213 9999999 B 10 1174636013 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1174636013 0 Physicians All Kids application agent 20 1174636013 0 Physicians Anesthesia Services 20 1174636013 0 Physicians Healthy Kids Services 20 1174636013 0 Physicians Optical Supplies 20 1174636013 0 Physicians Physician Services 20 1174636013 0 Physicians Physicians Psychiatric Services 00 1174636914 0 LEE MICHAEL 2008092 9999999 B 10 1174636914 0 200 S BOLINGBROOK DR BOLINGBROOK IL 604402932 20 1174636914 0 Optometrists Optical Supplies 20 1174636914 0 Optometrists Optometric Services 20 1174636914 0 Optometrists Physician Services 00 1174636989 0 HAYNES ROY GARLAND 2003182 9999999 B 10 1174636989 0 PO BOX 557 DECATUR IL 625250557 20 1174636989 0 Nurse Practitioners Anesthesia Services 20 1174636989 0 Nurse Practitioners Nurse Practitioners Services 20 1174636989 0 Nurse Practitioners Physician Services 00 1174639603 0 NUSSBAUM CHRISTOPHER K 2022143 9999999 B 10 1174639603 0 6024 RIDGE AVE STE 116-356 PHILADELPHIA PA 191281601 20 1174639603 0 Physicians Anesthesia Services 20 1174639603 0 Physicians Healthy Kids Services 20 1174639603 0 Physicians Optical Supplies 20 1174639603 0 Physicians Physician Services 00 1174639645 0 PORTER KENNETH 1988214 9999999 B 10 1174639645 0 16W485 S FRONTAGE RD STE 320 BURR RIDGE IL 605277112 20 1174639645 0 Physicians Anesthesia Services 20 1174639645 0 Physicians Fluoride varnish 20 1174639645 0 Physicians Healthy Kids Services 20 1174639645 0 Physicians Optical Supplies 20 1174639645 0 Physicians Physician Services 00 1174640114 0 GOLDBERG SETH 2009182 9999999 B 10 1174640114 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1174640114 0 Physicians Anesthesia Services 20 1174640114 0 Physicians Fluoride varnish 20 1174640114 0 Physicians Healthy Kids Services 20 1174640114 0 Physicians Optical Supplies 20 1174640114 0 Physicians Physician Services 00 1174640361 0 SINGH VICKY 2017001 9999999 B 10 1174640361 0 5777 DEPT CAROL STREAM IL 601220021 20 1174640361 0 Psychologist Psychologist service 00 1174641393 0 COHEN CLAUDETTE R 2016288 9999999 B 10 1174641393 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1174641393 0 Physician Assistant Only Electronic Home Response/EHR Installation, MPE Certification 20 1174641393 0 Physician Assistant Only Fluoride varnish 20 1174641393 0 Physician Assistant Only Healthy Kids Services 20 1174641393 0 Physician Assistant Only Physician Services 00 1174642763 0 RODRIGUEZ LAURA 2014260 9999999 B 10 1174642763 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1174642763 0 Nurse Practitioners Fluoride varnish 20 1174642763 0 Nurse Practitioners Healthy Kids Services 20 1174642763 0 Nurse Practitioners Nurse Practitioners Services 20 1174642763 0 Nurse Practitioners Physician Services 00 1174643290 0 ZAW-MON CHRISTOPHER S 2022354 9999999 B 10 1174643290 0 500 ELDORADO BLVD STE 6250 BROOMFIELD CO 800213421 20 1174643290 0 Physicians Anesthesia Services 20 1174643290 0 Physicians Healthy Kids Services 20 1174643290 0 Physicians Optical Supplies 20 1174643290 0 Physicians Physician Services 00 1174643951 0 AABERG MAYUMI 2006335 9999999 B 10 1174643951 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1174643951 0 Occupational Therapists Medical Supplies 20 1174643951 0 Occupational Therapists Medical equipment/prosthetic devices 20 1174643951 0 Occupational Therapists Occupational Therapy Services 00 1174645568 0 WALSH ROBERT J 2017310 9999999 B 10 1174645568 0 5962 N ELSTON AVE CHICAGO IL 606465540 20 1174645568 0 Physician Assistant Only Fluoride varnish 20 1174645568 0 Physician Assistant Only Healthy Kids Services 20 1174645568 0 Physician Assistant Only Physician Services 00 1174647135 0 RUBIO GELSYS 2016153 9999999 B 10 1174647135 0 5801C N PULASKI RD CHICAGO IL 606466051 20 1174647135 0 Other behavior health professional LCPC/LMFT services 00 1174649628 0 PICA GERALD 1997229 9999999 B 10 1174649628 0 611 W PARK ST BWPC URBANA IL 618012529 20 1174649628 0 Physical Therapists Medical Supplies 20 1174649628 0 Physical Therapists Medical equipment/prosthetic devices 20 1174649628 0 Physical Therapists Physical Therapy Services 00 1174650535 0 BUTCHER BRAD W 2020102 9999999 B 10 1174650535 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1174650535 0 Physicians Anesthesia Services 20 1174650535 0 Physicians Fluoride varnish 20 1174650535 0 Physicians Healthy Kids Services 20 1174650535 0 Physicians Optical Supplies 20 1174650535 0 Physicians Physician Services 00 1174651848 0 NELLORE MALLEESWARI 2020301 9999999 B 10 1174651848 0 10275 LITTLE PATUXENT PKWY STE COLUMBIA MD 210443445 20 1174651848 0 Physicians Anesthesia Services 20 1174651848 0 Physicians Healthy Kids Services 20 1174651848 0 Physicians Optical Supplies 20 1174651848 0 Physicians Physician Services 20 1174651848 0 Physicians Physicians Psychiatric Services 00 1174652382 0 SCHAEFER ELIZABETH 2011001 9999999 B 10 1174652382 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1174652382 0 Physicians Anesthesia Services 20 1174652382 0 Physicians Fluoride varnish 20 1174652382 0 Physicians Healthy Kids Services 20 1174652382 0 Physicians Optical Supplies 20 1174652382 0 Physicians Physician Services 00 1174652457 0 CROTTS MARTHA E 1995004 9999999 B 10 1174652457 0 11711 TYSON DR ROCKFORD IL 611146897 20 1174652457 0 Physicians Anesthesia Services 20 1174652457 0 Physicians Healthy Kids Services 20 1174652457 0 Physicians Optical Supplies 20 1174652457 0 Physicians Physician Services 20 1174652457 0 Physicians Physicians Psychiatric Services 00 1174653158 0 ACCURSO BRENT 2020108 9999999 B 10 1174653158 0 PO BOX 670114 DETROIT MI 482670114 20 1174653158 0 Dentists Dental Services 20 1174653158 0 Dentists Physician Services 00 1174657274 0 PATEL PRANAV Y 2003305 9999999 B 10 1174657274 0 319 S BARRINGTON RD SCHAUMBURG IL 601935345 20 1174657274 0 Dentists Dental Services 20 1174657274 0 Dentists Physician Services 00 1174657746 0 LYONS RACHEL L 2008301 9999999 B 10 1174657746 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1174657746 0 Nurse Practitioners Fluoride varnish 20 1174657746 0 Nurse Practitioners Healthy Kids Services 20 1174657746 0 Nurse Practitioners Nurse Practitioners Services 20 1174657746 0 Nurse Practitioners Physician Services 00 1174658629 0 OLSON KIYA N 2003342 9999999 B 10 1174658629 0 1811 HIGH GROVE LN STE 239 NAPERVILLE IL 605409109 20 1174658629 0 Other behavior health professional Adaptive behavior support clinician services 20 1174658629 0 Other behavior health professional Development Therapy, Orientation and Mobility Services 20 1174658629 0 Other behavior health professional Early Intervention Services 20 1174658629 0 Other behavior health professional LCPC/LMFT services 20 1174658629 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1174658629 0 Other behavior health professional Targeted case management service 00 1174659601 0 SCOTT JOHN P 2008035 9999999 B 10 1174659601 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1174659601 0 Physicians Anesthesia Services 20 1174659601 0 Physicians Fluoride varnish 20 1174659601 0 Physicians Healthy Kids Services 20 1174659601 0 Physicians Optical Supplies 20 1174659601 0 Physicians Physician Services 00 1174662621 0 GARDNER JON R 1994001 9999999 B 10 1174662621 0 2100 E LAKE COOK RD STE 1000 BUFFALO GROVE IL 600891999 20 1174662621 0 Dentists Dental Services 20 1174662621 0 Dentists Physician Services 00 1174663413 0 MORRIS DAVID E 2006305 9999999 B 10 1174663413 0 7732 SOLUTION CENTER CHICAGO IL 606770001 20 1174663413 0 Physicians Anesthesia Services 20 1174663413 0 Physicians Healthy Kids Services 20 1174663413 0 Physicians Optical Supplies 20 1174663413 0 Physicians Physician Services 00 1174663678 0 ROTH KRISTIN 2007274 9999999 B 10 1174663678 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1174663678 0 Speech Therapists Medical Supplies 20 1174663678 0 Speech Therapists Medical equipment/prosthetic devices 20 1174663678 0 Speech Therapists Speech Therapy/Pathology Services 00 1174666051 0 FORBES MEGGAN M 2007001 9999999 B 10 1174666051 0 PO BOX 38096 PHILADELPHIA PA 191011547 20 1174666051 0 Nurse Practitioners Fluoride varnish 20 1174666051 0 Nurse Practitioners Healthy Kids Services 20 1174666051 0 Nurse Practitioners Nurse Practitioners Services 20 1174666051 0 Nurse Practitioners Physician Services 00 1174666721 0 KRABER KELLEN A 2009292 9999999 B 10 1174666721 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1174666721 0 Nurse Practitioners Anesthesia Services 20 1174666721 0 Nurse Practitioners Nurse Practitioners Services 20 1174666721 0 Nurse Practitioners Physician Services 00 1174667059 0 GOLDMAN LORI A 2004336 9999999 B 10 1174667059 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1174667059 0 Nurse Practitioners Anesthesia Services 20 1174667059 0 Nurse Practitioners Nurse Practitioners Services 20 1174667059 0 Nurse Practitioners Physician Services 00 1174667745 0 EDWARDS BRIDGETTE L 2019170 9999999 B 10 1174667745 0 4818 INDIANAPOLIS BLVD EAST CHICAGO IN 463123433 20 1174667745 0 Clinical Social Worker Social work service 00 1174670368 0 HOBSON TAMIKA 2018057 9999999 B 10 1174670368 0 PO BOX 500 ELLICOTTVILLE NY 147310500 20 1174670368 0 Physician Assistant Only Fluoride varnish 20 1174670368 0 Physician Assistant Only Healthy Kids Services 20 1174670368 0 Physician Assistant Only Physician Services 00 1174671333 0 WITTMAYER BRIAN 2010327 9999999 B 10 1174671333 0 401 E 162ND ST STE 101 SOUTH HOLLAND IL 604732237 20 1174671333 0 Podiatrists Podiatric Services 00 1174671937 0 SROKOWSKI TOMASZ 2009272 9999999 B 10 1174671937 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1174671937 0 Physicians Anesthesia Services 20 1174671937 0 Physicians Fluoride varnish 20 1174671937 0 Physicians Healthy Kids Services 20 1174671937 0 Physicians Optical Supplies 20 1174671937 0 Physicians Physician Services 00 1174672026 0 IKEZUAGU OJAKU B 2016223 9999999 B 10 1174672026 0 1431 CENTERPOINT BLVD STE 100 KNOXVILLE TN 379321983 20 1174672026 0 Physicians Anesthesia Services 20 1174672026 0 Physicians Fluoride varnish 20 1174672026 0 Physicians Healthy Kids Services 20 1174672026 0 Physicians Optical Supplies 20 1174672026 0 Physicians Physician Services 00 1174672331 0 SHAY THANAD S 1981258 9999999 B 10 1174672331 0 1201 N NORTH ST PEORIA IL 616061533 20 1174672331 0 Physicians Anesthesia Services 20 1174672331 0 Physicians Healthy Kids Services 20 1174672331 0 Physicians Optical Supplies 20 1174672331 0 Physicians Physician Services 00 1174673107 0 BENJAMIN HOLLY J 1997183 9999999 B 10 1174673107 0 124 SW ADAMS ST PEORIA IL 616021320 20 1174673107 0 Physicians Anesthesia Services 20 1174673107 0 Physicians Fluoride varnish 20 1174673107 0 Physicians Healthy Kids Services 20 1174673107 0 Physicians Optical Supplies 20 1174673107 0 Physicians Physician Services 00 1174673123 0 ZIMMERMAN FRANK J 1997244 9999999 B 10 1174673123 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1174673123 0 Physicians Anesthesia Services 20 1174673123 0 Physicians Fluoride varnish 20 1174673123 0 Physicians Healthy Kids Services 20 1174673123 0 Physicians Optical Supplies 20 1174673123 0 Physicians Physician Services 00 1174674147 0 LEEF JEFFREY A 1991182 9999999 B 10 1174674147 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1174674147 0 Physicians Anesthesia Services 20 1174674147 0 Physicians Healthy Kids Services 20 1174674147 0 Physicians Optical Supplies 20 1174674147 0 Physicians Physician Services 00 1174674154 0 TAO JAMES X 2002182 9999999 B 10 1174674154 0 1239 E MAIN ST CARBONDALE IL 629013175 20 1174674154 0 Physicians Anesthesia Services 20 1174674154 0 Physicians Healthy Kids Services 20 1174674154 0 Physicians Optical Supplies 20 1174674154 0 Physicians Physician Services 20 1174674154 0 Physicians Physicians Psychiatric Services 00 1174675318 0 SCHROEDER ALAN R 2025022 9999999 B 10 1174675318 0 500 PASTEUR DR PALO ALTO CA 943041048 20 1174675318 0 Physicians Anesthesia Services 20 1174675318 0 Physicians Fluoride varnish 20 1174675318 0 Physicians Healthy Kids Services 20 1174675318 0 Physicians Optical Supplies 20 1174675318 0 Physicians Physician Services 00 1174676928 0 HAVERLAND GINA 2007033 9999999 B 10 1174676928 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1174676928 0 Clinical Social Worker Social work service 00 1174677975 0 NGUYEN KHANH 2022257 9999999 B 10 1174677975 0 101 E MILLER RD STERLING IL 610811252 20 1174677975 0 Physicians Anesthesia Services 20 1174677975 0 Physicians Healthy Kids Services 20 1174677975 0 Physicians Optical Supplies 20 1174677975 0 Physicians Physician Services 20 1174677975 0 Physicians Physicians Psychiatric Services 00 1174678684 0 MCGINNIS PATRICK L 1981227 9999999 B 10 1174678684 0 2614 W JEFFERSON ST JOLIET IL 604356433 20 1174678684 0 Physicians Anesthesia Services 20 1174678684 0 Physicians Healthy Kids Services 20 1174678684 0 Physicians Optical Supplies 20 1174678684 0 Physicians Physician Services 00 1174679237 0 DAY MARK 2007057 9999999 B 10 1174679237 0 1200 E TREMONT ST HILLSBORO IL 620491912 20 1174679237 0 Physicians Anesthesia Services 20 1174679237 0 Physicians Fluoride varnish 20 1174679237 0 Physicians Healthy Kids Services 20 1174679237 0 Physicians 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20 1174681605 0 Physicians Anesthesia Services 20 1174681605 0 Physicians Fluoride varnish 20 1174681605 0 Physicians Healthy Kids Services 20 1174681605 0 Physicians Optical Supplies 20 1174681605 0 Physicians Physician Services 00 1174682637 0 REVIS JOHN MARK 2004214 9999999 B 10 1174682637 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1174682637 0 Physicians Anesthesia Services 20 1174682637 0 Physicians Fluoride varnish 20 1174682637 0 Physicians Healthy Kids Services 20 1174682637 0 Physicians Optical Supplies 20 1174682637 0 Physicians Physician Services 00 1174683130 0 ATTERBERRY BETHANY 2006282 9999999 B 10 1174683130 0 124 SW ADAMS ST PEORIA IL 616021308 20 1174683130 0 Physical Therapists Medical Supplies 20 1174683130 0 Physical Therapists Medical equipment/prosthetic devices 20 1174683130 0 Physical Therapists Physical Therapy Services 00 1174683726 0 TADROS SAMEH 2009213 9999999 B 10 1174683726 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1174683726 0 Physicians 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Physician Services 20 1174752000 0 Physicians Physicians Psychiatric Services 00 1174752554 0 ILONZE ONYEDIKA J 2023348 9999999 B 10 1174752554 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1174752554 0 Physicians Anesthesia Services 20 1174752554 0 Physicians Fluoride varnish 20 1174752554 0 Physicians Healthy Kids Services 20 1174752554 0 Physicians Optical Supplies 20 1174752554 0 Physicians Physician Services 00 1174752588 0 GOLDEN DANIEL 2013182 9999999 B 10 1174752588 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1174752588 0 Physicians Anesthesia Services 20 1174752588 0 Physicians Healthy Kids Services 20 1174752588 0 Physicians Optical Supplies 20 1174752588 0 Physicians Physician Services 00 1174752802 0 NOBLE LANE A 2017241 9999999 B 10 1174752802 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1174752802 0 Physicians Anesthesia Services 20 1174752802 0 Physicians Fluoride varnish 20 1174752802 0 Physicians Healthy Kids Services 20 1174752802 0 Physicians 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PLZ STE 300 SUITE 300 SAINT LOUIS MO 631463119 20 1174753982 0 Physicians Anesthesia Services 20 1174753982 0 Physicians Healthy Kids Services 20 1174753982 0 Physicians Optical Supplies 20 1174753982 0 Physicians Physician Services 00 1174754139 0 LEITZEN KEITH P 2019155 9999999 B 10 1174754139 0 5777 DEPT CAROL STREAM IL 601220021 20 1174754139 0 Physicians Anesthesia Services 20 1174754139 0 Physicians Healthy Kids Services 20 1174754139 0 Physicians Optical Supplies 20 1174754139 0 Physicians Physician Services 00 1174755243 0 GARRETSON CHRISTINE 1992153 9999999 B 10 1174755243 0 201 CHICAGO ST MARSEILLES IL 613412058 20 1174755243 0 Speech Therapists Medical Supplies 20 1174755243 0 Speech Therapists Medical equipment/prosthetic devices 20 1174755243 0 Speech Therapists Speech Therapy/Pathology Services 00 1174755615 0 SETTY ARVEITY R 2016056 9999999 B 10 1174755615 0 PO BOX 2010 FARGO ND 581222484 20 1174755615 0 Physicians Anesthesia Services 20 1174755615 0 Physicians Fluoride varnish 20 1174755615 0 Physicians Healthy Kids Services 20 1174755615 0 Physicians Optical Supplies 20 1174755615 0 Physicians Physician Services 00 1174755714 0 SINGH KAMALDEEP 2022091 9999999 B 10 1174755714 0 PO BOX 43230 PHOENIX AZ 850803230 20 1174755714 0 Physicians Anesthesia Services 20 1174755714 0 Physicians Fluoride varnish 20 1174755714 0 Physicians Healthy Kids Services 20 1174755714 0 Physicians Optical Supplies 20 1174755714 0 Physicians Physician Services 00 1174756639 0 CARRIER ERIC M 2016035 9999999 B 10 1174756639 0 PO BOX 20556 SPRINGFIELD IL 627080556 20 1174756639 0 Physician Assistant Only Fluoride varnish 20 1174756639 0 Physician Assistant Only Healthy Kids Services 20 1174756639 0 Physician Assistant Only Physician Services 00 1174758163 0 PATEL SAMIR K 2014244 9999999 B 10 1174758163 0 5777 DEPT CAROL STREAM IL 601220021 20 1174758163 0 Physicians Anesthesia Services 20 1174758163 0 Physicians Healthy Kids Services 20 1174758163 0 Physicians Optical Supplies 20 1174758163 0 Physicians Physician Services 00 1174759328 0 JOHNSON BRINGA M 2014286 9999999 B 10 1174759328 0 PO BOX 5081 JANESVILLE WI 535475081 20 1174759328 0 Physical Therapists Medical Supplies 20 1174759328 0 Physical Therapists Medical equipment/prosthetic devices 20 1174759328 0 Physical Therapists Physical Therapy Services 00 1174759559 0 GAROZA JONATHAN A 2011213 9999999 B 10 1174759559 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1174759559 0 Physicians Anesthesia Services 20 1174759559 0 Physicians Healthy Kids Services 20 1174759559 0 Physicians Optical Supplies 20 1174759559 0 Physicians Physician Services 00 1174759625 0 LAUFTER ANNA 2012256 9999999 B 10 1174759625 0 2215 SANDERS RD STE 105 SUITE 105 NORTHBROOK IL 600626194 20 1174759625 0 Physicians Anesthesia Services 20 1174759625 0 Physicians Fluoride varnish 20 1174759625 0 Physicians Healthy Kids Services 20 1174759625 0 Physicians Optical Supplies 20 1174759625 0 Physicians Physician Services 00 1174759740 0 CORNELDER DAVID 2024140 9999999 B 10 1174759740 0 1229 C AVE E OSKALOOSA IA 525774246 20 1174759740 0 Physicians Anesthesia Services 20 1174759740 0 Physicians Fluoride varnish 20 1174759740 0 Physicians Healthy Kids Services 20 1174759740 0 Physicians Optical Supplies 20 1174759740 0 Physicians Physician Services 00 1174760003 0 MCNUTT KRISTIN 2023117 9999999 B 10 1174760003 0 1406 6TH AVE N SAINT CLOUD MN 563031900 20 1174760003 0 Physician Assistant Only Fluoride varnish 20 1174760003 0 Physician Assistant Only Healthy Kids Services 20 1174760003 0 Physician Assistant Only Physician Services 00 1174761506 0 MCCLAIN DIANE 2017304 9999999 B 10 1174761506 0 800 E NORTHWEST HWY STE 106 MOUNT PROSPECT IL 600563457 20 1174761506 0 Clinical Social Worker Social work service 00 1174761514 0 HIPSKIND JILL 2009020 9999999 B 10 1174761514 0 850 43RD AVE STE 100 MOLINE IL 612658401 20 1174761514 0 Physical Therapists Medical Supplies 20 1174761514 0 Physical Therapists Medical 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W 2022362 9999999 B 10 1174765648 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1174765648 0 Physicians Anesthesia Services 20 1174765648 0 Physicians Healthy Kids Services 20 1174765648 0 Physicians Optical Supplies 20 1174765648 0 Physicians Physician Services 20 1174765648 0 Physicians Physicians Psychiatric Services 00 1174765721 0 BUONACCORSI JANEEN N 2015236 9999999 B 10 1174765721 0 530 NE GLEN OAK AVE PEORIA IL 616370001 20 1174765721 0 Physicians Anesthesia Services 20 1174765721 0 Physicians Healthy Kids Services 20 1174765721 0 Physicians Optical Supplies 20 1174765721 0 Physicians Physician Services 00 1174765747 0 FRETT MICHAEL 2015213 9999999 B 10 1174765747 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1174765747 0 Physicians Anesthesia Services 20 1174765747 0 Physicians Healthy Kids Services 20 1174765747 0 Physicians Optical Supplies 20 1174765747 0 Physicians Physician Services 00 1174766745 0 MARTIN ANISHA S 2015168 9999999 B 10 1174766745 0 PO BOX 3272 INDIANAPOLIS IN 462063272 20 1174766745 0 Physicians Anesthesia Services 20 1174766745 0 Physicians Healthy Kids Services 20 1174766745 0 Physicians Optical Supplies 20 1174766745 0 Physicians Physician Services 00 1174767081 0 BOYLE DEBORAH 2013014 9999999 B 10 1174767081 0 4121 FAIRVIEW AVE STE 100 DOWNERS GROVE IL 605152266 20 1174767081 0 Physicians Anesthesia Services 20 1174767081 0 Physicians Fluoride varnish 20 1174767081 0 Physicians Healthy Kids Services 20 1174767081 0 Physicians Optical Supplies 20 1174767081 0 Physicians Physician Services 00 1174767149 0 PETRINSKA GALINA S 2022274 9999999 B 10 1174767149 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1174767149 0 Physicians Anesthesia Services 20 1174767149 0 Physicians Healthy Kids Services 20 1174767149 0 Physicians Optical Supplies 20 1174767149 0 Physicians Physician Services 00 1174767230 0 RODRIGUES DANIALD 2017242 9999999 B 10 1174767230 0 100 MICHIGAN ST NE GRAND RAPIDS MI 495032560 20 1174767230 0 Physicians Anesthesia 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Physicians Optical Supplies 20 1174771836 0 Physicians Physician Services 00 1174772156 0 MARCANTONI JODIE R 2010244 9999999 B 10 1174772156 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1174772156 0 Nurse Practitioners Fluoride varnish 20 1174772156 0 Nurse Practitioners Healthy Kids Services 20 1174772156 0 Nurse Practitioners Nurse Practitioners Services 20 1174772156 0 Nurse Practitioners Physician Services 00 1174772552 0 KANG KRISTIN A 2016259 9999999 B 10 1174772552 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1174772552 0 Nurse Practitioners Fluoride varnish 20 1174772552 0 Nurse Practitioners Healthy Kids Services 20 1174772552 0 Nurse Practitioners Nurse Practitioners Services 20 1174772552 0 Nurse Practitioners Physician Services 00 1174772594 0 KENYON DIANA 2016275 9999999 B 10 1174772594 0 4701 DEPT CAROL STREAM IL 601220021 20 1174772594 0 Physicians Anesthesia Services 20 1174772594 0 Physicians Healthy Kids Services 20 1174772594 0 Physicians 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Psychologist service 00 1174777072 0 SCHAPKER ANGELA L 2011143 9999999 B 10 1174777072 0 PO BOX 1510 EVANSVILLE IN 477061510 20 1174777072 0 Nurse Practitioners Healthy Kids Services 20 1174777072 0 Nurse Practitioners Nurse Practitioners Services 20 1174777072 0 Nurse Practitioners Physician Services 00 1174778195 0 WOODS SANDRA L 2018038 9999999 B 10 1174778195 0 2323 WINDISH DR GALESBURG IL 614019780 20 1174778195 0 Registered nurse Nursing service 20 1174778195 0 Registered nurse Waiver service 00 1174779474 0 PERRON NATHAN CD 2018007 9999999 B 10 1174779474 0 1600 E LINCOLN HWY STE D DEKALB IL 601153905 20 1174779474 0 Other behavior health professional LCPC/LMFT services 00 1174779664 0 GINDE SALIL 2009182 9999999 B 10 1174779664 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1174779664 0 Physicians Anesthesia Services 20 1174779664 0 Physicians Fluoride varnish 20 1174779664 0 Physicians Healthy Kids Services 20 1174779664 0 Physicians Optical Supplies 20 1174779664 0 Physicians Physician Services 00 1174779755 0 CARLSSON THORN GUNILLA S 2013274 9999999 B 10 1174779755 0 5777 DEPT CAROL STREAM IL 601228942 20 1174779755 0 Physicians Anesthesia Services 20 1174779755 0 Physicians Healthy Kids Services 20 1174779755 0 Physicians Optical Supplies 20 1174779755 0 Physicians Physician Services 00 1174780035 0 HENNING AMY A 2008196 9999999 B 10 1174780035 0 5777 DEPT CAROL STREAM IL 601220021 20 1174780035 0 Physicians Anesthesia Services 20 1174780035 0 Physicians Fluoride varnish 20 1174780035 0 Physicians Healthy Kids Services 20 1174780035 0 Physicians Optical Supplies 20 1174780035 0 Physicians Physician Services 00 1174780159 0 JAFFERY MALIHA J 2009213 9999999 B 10 1174780159 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1174780159 0 Physicians Anesthesia Services 20 1174780159 0 Physicians Fluoride varnish 20 1174780159 0 Physicians Healthy Kids Services 20 1174780159 0 Physicians Optical Supplies 20 1174780159 0 Physicians Physician Services 00 1174780621 0 REDDY BRIJESH 2024232 9999999 B 10 1174780621 0 1890 SILVER CROSS BLVD STE 255 NEW LENOX IL 604519528 20 1174780621 0 Physicians Anesthesia Services 20 1174780621 0 Physicians Healthy Kids Services 20 1174780621 0 Physicians Optical Supplies 20 1174780621 0 Physicians Physician Services 00 1174782437 0 BRENNAN GILLIAN M 2012183 9999999 B 10 1174782437 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1174782437 0 Physicians Anesthesia Services 20 1174782437 0 Physicians Fluoride varnish 20 1174782437 0 Physicians Healthy Kids Services 20 1174782437 0 Physicians Optical Supplies 20 1174782437 0 Physicians Physician Services 00 1174782916 0 HANSON MATTHEW 2010274 9999999 B 10 1174782916 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1174782916 0 Physicians Anesthesia Services 20 1174782916 0 Physicians Healthy Kids Services 20 1174782916 0 Physicians Optical Supplies 20 1174782916 0 Physicians Physician Services 00 1174783765 0 POSTIN AMBER 2009243 9999999 B 10 1174783765 0 884 192ND AVE MONMOUTH IL 614629218 20 1174783765 0 Speech Therapists Medical Supplies 20 1174783765 0 Speech Therapists Medical equipment/prosthetic devices 20 1174783765 0 Speech Therapists Speech Therapy/Pathology Services 00 1174783880 0 ARMSTRONG LUCAS C 2014290 9999999 B 10 1174783880 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1174783880 0 Physicians Anesthesia Services 20 1174783880 0 Physicians Healthy Kids Services 20 1174783880 0 Physicians Optical Supplies 20 1174783880 0 Physicians Physician Services 00 1174784086 0 JAYARAMAIAH POORNIMA 2010214 9999999 B 10 1174784086 0 3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047452 20 1174784086 0 Physicians Anesthesia Services 20 1174784086 0 Physicians Fluoride varnish 20 1174784086 0 Physicians Healthy Kids Services 20 1174784086 0 Physicians Optical Supplies 20 1174784086 0 Physicians Physician Services 00 1174784961 0 KHATOON ANJUM 2010182 9999999 B 10 1174784961 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1174784961 0 Physicians All Kids application agent 20 1174784961 0 Physicians Anesthesia Services 20 1174784961 0 Physicians Healthy Kids Services 20 1174784961 0 Physicians Optical Supplies 20 1174784961 0 Physicians Physician Services 20 1174784961 0 Physicians Physicians Psychiatric Services 00 1174785505 0 TRESSEL WILLIAM D 2020349 9999999 B 10 1174785505 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1174785505 0 Physicians Anesthesia Services 20 1174785505 0 Physicians Healthy Kids Services 20 1174785505 0 Physicians Optical Supplies 20 1174785505 0 Physicians Physician Services 00 1174787162 0 KELLER JESSE W 2016124 9999999 B 10 1174787162 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1174787162 0 Physicians Anesthesia Services 20 1174787162 0 Physicians Fluoride varnish 20 1174787162 0 Physicians Healthy Kids Services 20 1174787162 0 Physicians Optical Supplies 20 1174787162 0 Physicians Physician Services 00 1174787535 0 BOYLAND DANA 2017091 9999999 B 10 1174787535 0 7272 WURZBACH RD STE 601 SAN ANTONIO TX 782404803 20 1174787535 0 Clinical Social Worker Social work service 00 1174787857 0 CIMO SABRINA 2009215 9999999 B 10 1174787857 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1174787857 0 Physicians Anesthesia Services 20 1174787857 0 Physicians Fluoride varnish 20 1174787857 0 Physicians Healthy Kids Services 20 1174787857 0 Physicians Optical Supplies 20 1174787857 0 Physicians Physician Services 00 1174788095 0 BURATTO SUSAN 2011248 9999999 B 10 1174788095 0 4101 N RAVENSWOOD AVE CHICAGO IL 606132193 20 1174788095 0 Physicians Anesthesia Services 20 1174788095 0 Physicians Healthy Kids Services 20 1174788095 0 Physicians Optical Supplies 20 1174788095 0 Physicians Physician Services 20 1174788095 0 Physicians Physicians Psychiatric Services 00 1174788129 0 ZAHEDI SYEDA 2011263 9999999 B 10 1174788129 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1174788129 0 Physicians Anesthesia Services 20 1174788129 0 Physicians Healthy Kids Services 20 1174788129 0 Physicians Optical Supplies 20 1174788129 0 Physicians Physician Services 00 1174788186 0 AFTAB MEHR N 2012245 9999999 B 10 1174788186 0 3407 MOMENTUM PL CHICAGO IL 606890001 20 1174788186 0 Physicians Anesthesia Services 20 1174788186 0 Physicians Healthy Kids Services 20 1174788186 0 Physicians Optical Supplies 20 1174788186 0 Physicians Physician Services 00 1174788558 0 ORMSBY CHRISTINE B 2018064 9999999 B 10 1174788558 0 11475 OLDE CABIN RD STE 200 SAINT LOUIS MO 631417129 20 1174788558 0 Physicians Anesthesia Services 20 1174788558 0 Physicians Healthy Kids Services 20 1174788558 0 Physicians Optical Supplies 20 1174788558 0 Physicians Physician Services 00 1174788756 0 HOPPER REBECCA D 2020301 9999999 B 10 1174788756 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1174788756 0 Physicians Anesthesia Services 20 1174788756 0 Physicians Fluoride varnish 20 1174788756 0 Physicians Healthy Kids Services 20 1174788756 0 Physicians Optical Supplies 20 1174788756 0 Physicians Physician Services 00 1174789283 0 SHAH BREANNE 2011181 9999999 B 10 1174789283 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1174789283 0 Physicians Anesthesia Services 20 1174789283 0 Physicians Fluoride varnish 20 1174789283 0 Physicians Healthy Kids Services 20 1174789283 0 Physicians Optical Supplies 20 1174789283 0 Physicians Physician Services 00 1174789564 0 MANTRAVADI AVINASH 2021016 9999999 B 10 1174789564 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1174789564 0 Physicians Anesthesia Services 20 1174789564 0 Physicians Healthy Kids Services 20 1174789564 0 Physicians Optical Supplies 20 1174789564 0 Physicians Physician Services 00 1174789747 0 WULFF SHEPHALI 2021300 9999999 B 10 1174789747 0 PO BOX 504934 SAINT LOUIS MO 631504934 20 1174789747 0 Physicians Anesthesia Services 20 1174789747 0 Physicians Fluoride varnish 20 1174789747 0 Physicians Healthy Kids Services 20 1174789747 0 Physicians Optical Supplies 20 1174789747 0 Physicians Physician Services 00 1174789770 0 DHARIA SHIMONI K 2009182 9999999 B 10 1174789770 0 29373 NETWORK PL CHICAGO IL 606733039 20 1174789770 0 Physicians Anesthesia Services 20 1174789770 0 Physicians Fluoride varnish 20 1174789770 0 Physicians Healthy Kids Services 20 1174789770 0 Physicians Optical Supplies 20 1174789770 0 Physicians Physician Services 00 1174789853 0 NOBLE LESLIE DEITCH 2011001 9999999 B 10 1174789853 0 2215 SANDERS RD STE 105 SUITE 105 NORTHBROOK IL 600626194 20 1174789853 0 Physicians Anesthesia Services 20 1174789853 0 Physicians Fluoride varnish 20 1174789853 0 Physicians Healthy Kids Services 20 1174789853 0 Physicians Optical Supplies 20 1174789853 0 Physicians Physician Services 00 1174790141 0 CONNOLLY MARY C 2009244 9999999 B 10 1174790141 0 725 SCHOOL ST STE A MORRIS IL 604501207 20 1174790141 0 Physicians Anesthesia Services 20 1174790141 0 Physicians Fluoride varnish 20 1174790141 0 Physicians Healthy Kids Services 20 1174790141 0 Physicians Optical Supplies 20 1174790141 0 Physicians Physician Services 00 1174790463 0 KRCIK JAMES A 1996333 9999999 B 10 1174790463 0 29373 NETWORK PL CHICAGO IL 606733039 20 1174790463 0 Physicians Anesthesia Services 20 1174790463 0 Physicians Fluoride varnish 20 1174790463 0 Physicians Healthy Kids Services 20 1174790463 0 Physicians Optical Supplies 20 1174790463 0 Physicians Physician Services 00 1174790745 0 BAUER SARAH C 2009293 9999999 B 10 1174790745 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1174790745 0 Physicians Anesthesia Services 20 1174790745 0 Physicians Fluoride varnish 20 1174790745 0 Physicians Healthy Kids Services 20 1174790745 0 Physicians Optical Supplies 20 1174790745 0 Physicians Physician Services 00 1174792915 0 SEDAGHAT-YAZDI FARSHAD 2012001 9999999 B 10 1174792915 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1174792915 0 Physicians Anesthesia Services 20 1174792915 0 Physicians Fluoride varnish 20 1174792915 0 Physicians Healthy Kids Services 20 1174792915 0 Physicians Optical Supplies 20 1174792915 0 Physicians Physician Services 00 1174793160 0 ALCARAZ RENATO 2008252 9999999 B 10 1174793160 0 611 W PARK ST URBANA IL 618012529 20 1174793160 0 Physicians Anesthesia Services 20 1174793160 0 Physicians Fluoride varnish 20 1174793160 0 Physicians Healthy Kids Services 20 1174793160 0 Physicians Optical Supplies 20 1174793160 0 Physicians Physician Services 00 1174793814 0 JABI FERAAS 2017325 9999999 B 10 1174793814 0 55 W PORT PLZ STE 300 SUITE 300 SAINT LOUIS MO 631463119 20 1174793814 0 Physicians Anesthesia Services 20 1174793814 0 Physicians Healthy Kids Services 20 1174793814 0 Physicians Optical Supplies 20 1174793814 0 Physicians Physician Services 00 1174794689 0 TOY BONNIE 2020244 9999999 B 10 1174794689 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1174794689 0 Nurse Practitioners Fluoride varnish 20 1174794689 0 Nurse Practitioners Healthy Kids Services 20 1174794689 0 Nurse Practitioners Nurse Practitioners Services 20 1174794689 0 Nurse Practitioners Physician Services 00 1174796478 0 KLEIN JEFFREY 2010331 9999999 B 10 1174796478 0 340 MIDLAND RD STE 120 JANESVILLE WI 535462339 20 1174796478 0 Physicians Anesthesia Services 20 1174796478 0 Physicians Healthy Kids Services 20 1174796478 0 Physicians Optical Supplies 20 1174796478 0 Physicians Physician Services 00 1174796494 0 LEEDY MELISSA B 2017279 9999999 B 10 1174796494 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1174796494 0 Physicians Anesthesia Services 20 1174796494 0 Physicians Fluoride varnish 20 1174796494 0 Physicians Healthy Kids Services 20 1174796494 0 Physicians Optical Supplies 20 1174796494 0 Physicians Physician Services 00 1174797112 0 SCHAEFER MELISSA 2003303 9999999 B 10 1174797112 0 4450 48TH AVENUE CT ROCK ISLAND IL 612019213 20 1174797112 0 Speech Therapists Medical Supplies 20 1174797112 0 Speech Therapists Medical equipment/prosthetic devices 20 1174797112 0 Speech Therapists Speech Therapy/Pathology 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PAYSPHERE CIR CHICAGO IL 606740018 20 1174800155 0 Physicians Anesthesia Services 20 1174800155 0 Physicians Fluoride varnish 20 1174800155 0 Physicians Healthy Kids Services 20 1174800155 0 Physicians Optical Supplies 20 1174800155 0 Physicians Physician Services 00 1174801567 0 POLETTI JORGE 2012027 9999999 B 10 1174801567 0 1414 MAIN ST MELROSE PARK IL 601603902 20 1174801567 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1174801724 0 DONAMARIA NOELIA 2019291 9999999 B 10 1174801724 0 5777 DEPT CAROL STREAM IL 601228942 20 1174801724 0 Physicians Anesthesia Services 20 1174801724 0 Physicians Healthy Kids Services 20 1174801724 0 Physicians Optical Supplies 20 1174801724 0 Physicians Physician Services 00 1174802342 0 TURNER NASHONNA 2015021 9999999 B 10 1174802342 0 2835 BELVIDERE RD WAUKEGAN IL 600856046 20 1174802342 0 Other behavior health professional LCPC/LMFT services 00 1174802482 0 ELLEGOOD MICHELENE 2011249 9999999 B 10 1174802482 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1174802482 0 Nurse Practitioners Fluoride varnish 20 1174802482 0 Nurse Practitioners Healthy Kids Services 20 1174802482 0 Nurse Practitioners Nurse Practitioners Services 20 1174802482 0 Nurse Practitioners Physician Services 00 1174802730 0 BAUMAN KELLY J 2013184 9999999 H 10 1174802730 0 5777 DEPT CAROL STREAM IL 601228942 20 1174802730 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1174802805 0 PETERSON JOE 2025063 9999999 B 10 1174802805 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1174802805 0 Physician Assistant Only Fluoride varnish 20 1174802805 0 Physician Assistant Only Healthy Kids Services 20 1174802805 0 Physician Assistant Only Physician Services 00 1174803696 0 LEWANDOWSKA KAROLINA 2012001 9999999 B 10 1174803696 0 4860 OAKTON ST SKOKIE IL 600772953 20 1174803696 0 Nurse Practitioners Fluoride varnish 20 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1174808851 0 Physical Therapists Medical equipment/prosthetic devices 20 1174808851 0 Physical Therapists Physical Therapy Services 00 1174809586 0 RETA ANITA 2021182 9999999 B 10 1174809586 0 1542 W DEVON AVE CHICAGO IL 606601344 20 1174809586 0 Physicians Anesthesia Services 20 1174809586 0 Physicians Fluoride varnish 20 1174809586 0 Physicians Healthy Kids Services 20 1174809586 0 Physicians Optical Supplies 20 1174809586 0 Physicians Physician Services 00 1174809636 0 DZIK BONNIE 2011322 9999999 B 10 1174809636 0 604 HICKORY AVE OGLESBY IL 613481192 20 1174809636 0 Speech Therapists Medical Supplies 20 1174809636 0 Speech Therapists Medical equipment/prosthetic devices 20 1174809636 0 Speech Therapists Speech Therapy/Pathology Services 00 1174810188 0 NAG SUKRITI 2011182 9999999 B 10 1174810188 0 5700 SOUTHWYCK BLVD TOLEDO OH 436141509 20 1174810188 0 Physicians Anesthesia Services 20 1174810188 0 Physicians Healthy Kids Services 20 1174810188 0 Physicians Optical Supplies 20 1174810188 0 Physicians Physician Services 00 1174811640 0 YADAVA JUHI 2013301 9999999 B 10 1174811640 0 1090 NORTHCHASE PKWY SE MARIETTA GA 300676405 20 1174811640 0 Dentists Dental Services 20 1174811640 0 Dentists Physician Services 00 1174811905 0 MILLER DAVID D 2016193 9999999 B 10 1174811905 0 1160 E SAINT CLAIR ST VINCENNES IN 475914853 20 1174811905 0 Physicians Anesthesia Services 20 1174811905 0 Physicians Healthy Kids Services 20 1174811905 0 Physicians Optical Supplies 20 1174811905 0 Physicians Physician Services 00 1174812267 0 AYUB NAZIA 2014258 9999999 B 10 1174812267 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1174812267 0 Physicians Anesthesia Services 20 1174812267 0 Physicians Fluoride varnish 20 1174812267 0 Physicians Healthy Kids Services 20 1174812267 0 Physicians Optical Supplies 20 1174812267 0 Physicians Physician Services 00 1174812374 0 KRISHNAN SIVAKAMI 2014244 9999999 B 10 1174812374 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1174812374 0 Physicians Anesthesia Services 20 1174812374 0 Physicians Fluoride varnish 20 1174812374 0 Physicians Healthy Kids Services 20 1174812374 0 Physicians Optical Supplies 20 1174812374 0 Physicians Physician Services 00 1174812804 0 MYINT ALEX 2019243 9999999 B 10 1174812804 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1174812804 0 Physicians Anesthesia Services 20 1174812804 0 Physicians Fluoride varnish 20 1174812804 0 Physicians Healthy Kids Services 20 1174812804 0 Physicians Optical Supplies 20 1174812804 0 Physicians Physician Services 00 1174812853 0 THAKKAR RUCHIR L 2014349 9999999 B 10 1174812853 0 741 S MCHENRY AVE CRYSTAL LAKE IL 600147445 20 1174812853 0 Physicians Anesthesia Services 20 1174812853 0 Physicians Fluoride varnish 20 1174812853 0 Physicians Healthy Kids Services 20 1174812853 0 Physicians Optical Supplies 20 1174812853 0 Physicians Physician Services 00 1174813133 0 WALENTIK ANNE C 2015305 9999999 B 10 1174813133 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1174813133 0 Physicians Anesthesia Services 20 1174813133 0 Physicians Fluoride varnish 20 1174813133 0 Physicians Healthy Kids Services 20 1174813133 0 Physicians Optical Supplies 20 1174813133 0 Physicians Physician Services 00 1174814644 0 CHIAPAIKEO DAVID 2024088 9999999 B 10 1174814644 0 801 ILLINI DR SILVIS IL 612821804 20 1174814644 0 Physicians Anesthesia Services 20 1174814644 0 Physicians Healthy Kids Services 20 1174814644 0 Physicians Optical Supplies 20 1174814644 0 Physicians Physician Services 00 1174815955 0 BYLOW KRISTOFFER J 2018234 9999999 B 10 1174815955 0 PO BOX 962 MCALESTER OK 745020962 20 1174815955 0 Physicians Anesthesia Services 20 1174815955 0 Physicians Healthy Kids Services 20 1174815955 0 Physicians Optical Supplies 20 1174815955 0 Physicians Physician Services 00 1174816516 0 WISEHART TROY A 2017239 9999999 B 10 1174816516 0 545 BARNHILL DR # EH215 INDIANAPOLIS IN 462025112 20 1174816516 0 Physician Assistant Only Fluoride varnish 20 1174816516 0 Physician Assistant Only Healthy Kids Services 20 1174816516 0 Physician Assistant Only Physician Services 00 1174816664 0 SAFRANSKI RACHEL 2017076 9999999 B 10 1174816664 0 PO BOX 1085 LAKE VILLA IL 600461085 20 1174816664 0 Clinical Social Worker Social work service 00 1174816797 0 BENN JO A 2017071 9999999 B 10 1174816797 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1174816797 0 Nurse Practitioners Fluoride varnish 20 1174816797 0 Nurse Practitioners Healthy Kids Services 20 1174816797 0 Nurse Practitioners Nurse Practitioners Services 20 1174816797 0 Nurse Practitioners Physician Services 00 1174816805 0 WHITE WILLIAM R G 2014037 9999999 H 10 1174816805 0 10537 S ROBERTS RD PALOS HILLS IL 604651933 20 1174816805 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1174818272 0 THORUD JAKOB C 2016132 9999999 B 10 1174818272 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1174818272 0 Podiatrists Podiatric Services 00 1174818454 0 REDONDO RAQUEL 2018206 9999999 B 10 1174818454 0 PO BOX 781076 DETROIT MI 482781076 20 1174818454 0 Physicians Anesthesia Services 20 1174818454 0 Physicians Healthy Kids Services 20 1174818454 0 Physicians Optical Supplies 20 1174818454 0 Physicians Physician Services 00 1174818736 0 FILIPEK ELIZABETH 2024071 9999999 B 10 1174818736 0 801 YORK ST MANITOWOC WI 542204630 20 1174818736 0 Physician Assistant Only Fluoride varnish 20 1174818736 0 Physician Assistant Only Healthy Kids Services 20 1174818736 0 Physician Assistant Only Physician Services 00 1174818983 0 PESSIN TRACY G 2015274 9999999 B 10 1174818983 0 339 CONSORT DR BALLWIN MO 630114439 20 1174818983 0 Physicians Anesthesia Services 20 1174818983 0 Physicians Healthy Kids Services 20 1174818983 0 Physicians Optical Supplies 20 1174818983 0 Physicians Physician Services 00 1174819254 0 STOCK MEGAN E 2014258 9999999 B 10 1174819254 0 29373 NETWORK PL CHICAGO IL 606733039 20 1174819254 0 Physicians Anesthesia Services 20 1174819254 0 Physicians Fluoride varnish 20 1174819254 0 Physicians Healthy Kids Services 20 1174819254 0 Physicians Optical Supplies 20 1174819254 0 Physicians Physician Services 00 1174819320 0 SUTTON JASON M 2016165 9999999 B 10 1174819320 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1174819320 0 Other behavior health professional LCPC/LMFT services 00 1174821177 0 RASHID YAMEEN 2014244 2099365 B 10 1174821177 0 PO BOX 781076 DETROIT MI 482781076 20 1174821177 0 Physicians Anesthesia Services 20 1174821177 0 Physicians Fluoride varnish 20 1174821177 0 Physicians Healthy Kids Services 20 1174821177 0 Physicians Optical Supplies 20 1174821177 0 Physicians Physician Services 00 1174821540 0 PYLE NATHAN 2014117 9999999 B 10 1174821540 0 2300 N EDWARD ST DECATUR IL 625264163 20 1174821540 0 Physicians Anesthesia Services 20 1174821540 0 Physicians Fluoride varnish 20 1174821540 0 Physicians Healthy Kids Services 20 1174821540 0 Physicians Optical Supplies 20 1174821540 0 Physicians Physician Services 00 1174821805 0 DAWODU TANWA 2022011 9999999 B 10 1174821805 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1174821805 0 Nurse Practitioners Fluoride varnish 20 1174821805 0 Nurse Practitioners Healthy Kids Services 20 1174821805 0 Nurse Practitioners Nurse Practitioners Services 20 1174821805 0 Nurse Practitioners Physician Services 00 1174822340 0 KIM HOWARD S 2015182 9999999 B 10 1174822340 0 PO BOX 78000 DEPT 78769 DETROIT MI 482780769 20 1174822340 0 Physicians Anesthesia Services 20 1174822340 0 Physicians Healthy Kids Services 20 1174822340 0 Physicians Optical Supplies 20 1174822340 0 Physicians Physician Services 00 1174822985 0 BENEDETTI DANIEL 2023191 9999999 B 10 1174822985 0 DEPT AT 40379 ATLANTA GA 311920001 20 1174822985 0 Physicians Anesthesia Services 20 1174822985 0 Physicians Fluoride varnish 20 1174822985 0 Physicians Healthy Kids Services 20 1174822985 0 Physicians Optical Supplies 20 1174822985 0 Physicians Physician Services 00 1174822993 0 KOLIMAS NANDINI 2017165 9999999 B 10 1174822993 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1174822993 0 Physician Assistant Only Fluoride varnish 20 1174822993 0 Physician Assistant Only Healthy Kids Services 20 1174822993 0 Physician Assistant Only Physician Services 00 1174824205 0 TIMMERMAN ANDREA 2021037 9999999 B 10 1174824205 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1174824205 0 Nurse Practitioners Fluoride varnish 20 1174824205 0 Nurse Practitioners Healthy Kids Services 20 1174824205 0 Nurse Practitioners Nurse Practitioners Services 20 1174824205 0 Nurse Practitioners Physician Services 00 1174826119 0 TUCKEY SUSAN 2001182 9999999 B 10 1174826119 0 1051 W RAND RD STE 103 ARLINGTON HEIGH IL 600042315 20 1174826119 0 Nurse Practitioners Fluoride varnish 20 1174826119 0 Nurse Practitioners Healthy Kids Services 20 1174826119 0 Nurse Practitioners Nurse Practitioners Services 20 1174826119 0 Nurse Practitioners Physician Services 00 1174829626 0 MCFAUL JOANNA L 2011091 9999999 B 10 1174829626 0 711 ELM CT ITASCA IL 601431430 20 1174829626 0 Physical Therapists Medical Supplies 20 1174829626 0 Physical Therapists Medical equipment/prosthetic devices 20 1174829626 0 Physical Therapists Physical Therapy Services 00 1174830236 0 SABUDA JENNIFER J 2020224 9999999 B 10 1174830236 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1174830236 0 Nurse Practitioners Fluoride varnish 20 1174830236 0 Nurse Practitioners Healthy Kids Services 20 1174830236 0 Nurse Practitioners Nurse Practitioners Services 20 1174830236 0 Nurse Practitioners Physician Services 00 1174831168 0 CHARTRE KATHYA 2013182 9999999 B 10 1174831168 0 4025 N SHERIDAN RD CHICAGO IL 606132010 20 1174831168 0 Physicians Anesthesia Services 20 1174831168 0 Physicians Fluoride varnish 20 1174831168 0 Physicians Healthy Kids Services 20 1174831168 0 Physicians Optical Supplies 20 1174831168 0 Physicians Physician Services 00 1174831259 0 HELZER ERICA 2011084 9999999 B 10 1174831259 0 23346 W LIBERTY AVE LAKE VILLA IL 600468763 20 1174831259 0 Clinical Social Worker Social work service 00 1174832257 0 SWARBRICK KIMBERLY L 2011202 9999999 B 10 1174832257 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1174832257 0 Physician Assistant Only Fluoride varnish 20 1174832257 0 Physician Assistant Only Healthy Kids Services 20 1174832257 0 Physician Assistant Only Physician Services 00 1174832646 0 DUFFY ANNA 2017001 9999999 B 10 1174832646 0 PO BOX 88667 CHICAGO IL 606801667 20 1174832646 0 Physician Assistant Only Fluoride varnish 20 1174832646 0 Physician Assistant Only Healthy Kids Services 20 1174832646 0 Physician Assistant Only Physician Services 00 1174832893 0 REANEY AMANDA 2016244 9999999 B 10 1174832893 0 PO BOX 365 CARBONDALE IL 629030365 20 1174832893 0 Physician Assistant Only Fluoride varnish 20 1174832893 0 Physician Assistant Only Healthy Kids Services 20 1174832893 0 Physician Assistant Only Physician Services 00 1174833370 0 LOPEZ VASQUEZ KATY C 2023262 9999999 B 10 1174833370 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1174833370 0 Physicians Anesthesia Services 20 1174833370 0 Physicians Fluoride varnish 20 1174833370 0 Physicians Healthy Kids Services 20 1174833370 0 Physicians Optical Supplies 20 1174833370 0 Physicians Physician Services 00 1174834428 0 CLAYTON BRITTANY 2010207 9999999 B 10 1174834428 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1174834428 0 Physical Therapists Medical Supplies 20 1174834428 0 Physical Therapists Medical equipment/prosthetic devices 20 1174834428 0 Physical Therapists Physical Therapy Services 00 1174834931 0 DREDAR AHMID 2022261 9999999 B 10 1174834931 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1174834931 0 Physicians Anesthesia Services 20 1174834931 0 Physicians Fluoride varnish 20 1174834931 0 Physicians Healthy Kids Services 20 1174834931 0 Physicians Optical Supplies 20 1174834931 0 Physicians Physician Services 00 1174835706 0 DANDAN ALVIN J 2020001 9999999 B 10 1174835706 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1174835706 0 Physicians Anesthesia Services 20 1174835706 0 Physicians Fluoride varnish 20 1174835706 0 Physicians Healthy Kids Services 20 1174835706 0 Physicians Optical Supplies 20 1174835706 0 Physicians Physician Services 00 1174836209 0 RAI PARUL 2018275 9999999 B 10 1174836209 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1174836209 0 Physicians Anesthesia Services 20 1174836209 0 Physicians Fluoride varnish 20 1174836209 0 Physicians Healthy Kids Services 20 1174836209 0 Physicians Optical Supplies 20 1174836209 0 Physicians Physician Services 00 1174836548 0 ANDRZEJEWSKI TIFFANY M 2011331 9999999 B 10 1174836548 0 806 CENTRAL AVE STE 300 HIGHLAND PARK IL 600355613 20 1174836548 0 Optometrists Optical Supplies 20 1174836548 0 Optometrists Optometric Services 20 1174836548 0 Optometrists Physician Services 00 1174837140 0 DAVIDSON JOANNA W 2013182 9999999 B 10 1174837140 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1174837140 0 Physicians Anesthesia Services 20 1174837140 0 Physicians Healthy Kids Services 20 1174837140 0 Physicians Optical Supplies 20 1174837140 0 Physicians Physician Services 00 1174838577 0 CATIIS ALLSSA 2014188 9999999 B 10 1174838577 0 4025 N SHERIDAN RD CHICAGO IL 606132010 20 1174838577 0 Clinical Social Worker All Kids application agent 20 1174838577 0 Clinical Social Worker Social work service 00 1174839229 0 YODER JEFFREY 2013182 9999999 B 10 1174839229 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1174839229 0 Physicians Anesthesia Services 20 1174839229 0 Physicians Healthy Kids Services 20 1174839229 0 Physicians Optical Supplies 20 1174839229 0 Physicians Physician Services 00 1174840193 0 DURBIN MATTHEW D 2016181 9999999 B 10 1174840193 0 PO BOX 778912 CHICAGO IL 606778912 20 1174840193 0 Physicians Anesthesia Services 20 1174840193 0 Physicians Fluoride varnish 20 1174840193 0 Physicians Healthy Kids Services 20 1174840193 0 Physicians Optical Supplies 20 1174840193 0 Physicians Physician Services 00 1174841076 0 MIESFELD JESSICA 2024285 9999999 B 10 1174841076 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1174841076 0 Physicians Anesthesia Services 20 1174841076 0 Physicians Fluoride varnish 20 1174841076 0 Physicians Healthy Kids Services 20 1174841076 0 Physicians Optical Supplies 20 1174841076 0 Physicians Physician Services 00 1174841316 0 JANUSZYK JAMIE S 2014209 9999999 B 10 1174841316 0 29373 NETWORK PL CHICAGO IL 606733039 20 1174841316 0 Physicians Anesthesia Services 20 1174841316 0 Physicians Healthy Kids Services 20 1174841316 0 Physicians Optical Supplies 20 1174841316 0 Physicians Physician Services 00 1174841357 0 LOWDENBACK RACHEL STONE 2017101 9999999 B 10 1174841357 0 2200 JEFFERSON AVE TOLEDO OH 436047101 20 1174841357 0 Physicians Anesthesia Services 20 1174841357 0 Physicians Fluoride varnish 20 1174841357 0 Physicians Healthy Kids Services 20 1174841357 0 Physicians Optical Supplies 20 1174841357 0 Physicians Physician Services 00 1174842868 0 LERNER MEGAN 2017063 9999999 B 10 1174842868 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1174842868 0 Clinical Social Worker Social work service 00 1174842926 0 PATEL ISHANI P 2016315 9999999 B 10 1174842926 0 820 SPRINGER DR LOMBARD IL 601486413 20 1174842926 0 Physician Assistant Only Fluoride varnish 20 1174842926 0 Physician Assistant Only Healthy Kids Services 20 1174842926 0 Physician Assistant Only Physician Services 00 1174843478 0 THRELKELD MELODY R 2019325 9999999 B 10 1174843478 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1174843478 0 Physicians Anesthesia Services 20 1174843478 0 Physicians Healthy Kids Services 20 1174843478 0 Physicians Optical Supplies 20 1174843478 0 Physicians Physician Services 00 1174843635 0 WALKER BREANNA L 2014216 9999999 B 10 1174843635 0 5777 DEPT CAROL STREAM IL 601228942 20 1174843635 0 Physicians Anesthesia Services 20 1174843635 0 Physicians Healthy Kids Services 20 1174843635 0 Physicians Optical Supplies 20 1174843635 0 Physicians Physician Services 00 1174844096 0 ABEL GRETA L 2016001 9999999 B 10 1174844096 0 5777 DEPT CAROL STREAM IL 601228942 20 1174844096 0 Physician Assistant Only Fluoride varnish 20 1174844096 0 Physician Assistant Only Healthy Kids Services 20 1174844096 0 Physician Assistant Only Physician Services 00 1174844138 0 CLARK BRANDON E 2023225 9999999 B 10 1174844138 0 PO BOX 43230 PHOENIX AZ 850803230 20 1174844138 0 Physicians Anesthesia Services 20 1174844138 0 Physicians Healthy Kids Services 20 1174844138 0 Physicians Optical Supplies 20 1174844138 0 Physicians Physician Services 00 1174844245 0 REESE JEREMY N 2021207 9999999 B 10 1174844245 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1174844245 0 Physicians Anesthesia Services 20 1174844245 0 Physicians Healthy Kids Services 20 1174844245 0 Physicians Optical Supplies 20 1174844245 0 Physicians Physician Services 00 1174846141 0 PREPEJCHAL JOY A 2014059 9999999 B 10 1174846141 0 5777 DEPT CAROL STREAM IL 601228942 20 1174846141 0 Psychologist Psychologist service 00 1174846554 0 FOWLER MARY V 2018057 9999999 B 10 1174846554 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1174846554 0 Nurse Practitioners Fluoride varnish 20 1174846554 0 Nurse Practitioners Healthy Kids Services 20 1174846554 0 Nurse Practitioners Nurse Practitioners Services 20 1174846554 0 Nurse Practitioners Physician Services 00 1174847107 0 NG MICHEL 2022039 9999999 B 10 1174847107 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1174847107 0 Nurse Practitioners Healthy Kids Services 20 1174847107 0 Nurse Practitioners Nurse Practitioners Services 20 1174847107 0 Nurse Practitioners Physician Services 00 1174847867 0 WANG DAJUN 2018001 9999999 B 10 1174847867 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1174847867 0 Physicians Anesthesia Services 20 1174847867 0 Physicians Fluoride varnish 20 1174847867 0 Physicians Healthy Kids Services 20 1174847867 0 Physicians Optical Supplies 20 1174847867 0 Physicians Physician Services 00 1174848626 0 KOLONDA KILPATRICK FATHIMA ZAI 2014237 9999999 B 10 1174848626 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1174848626 0 Physicians Anesthesia Services 20 1174848626 0 Physicians Healthy Kids Services 20 1174848626 0 Physicians Optical Supplies 20 1174848626 0 Physicians Physician Services 00 1174849368 0 CRUZ BRAVO PAULINA 2015214 9999999 B 10 1174849368 0 11 SILVER ST MIDDLETOWN CT 064579994 20 1174849368 0 Physicians Anesthesia Services 20 1174849368 0 Physicians Fluoride varnish 20 1174849368 0 Physicians Healthy Kids Services 20 1174849368 0 Physicians Optical Supplies 20 1174849368 0 Physicians Physician Services 00 1174849657 0 RAPOFF JUSTIN 2013208 9999999 B 10 1174849657 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1174849657 0 Physicians Anesthesia Services 20 1174849657 0 Physicians Healthy Kids Services 20 1174849657 0 Physicians Optical Supplies 20 1174849657 0 Physicians Physician Services 00 1174856785 0 KOEHLER KRISTIE 2021188 9999999 B 10 1174856785 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1174856785 0 Physicians Anesthesia Services 20 1174856785 0 Physicians Fluoride varnish 20 1174856785 0 Physicians Healthy Kids Services 20 1174856785 0 Physicians Optical Supplies 20 1174856785 0 Physicians Physician Services 00 1174858583 0 RAMOS ABEL 2024195 9999999 B 10 1174858583 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1174858583 0 Physicians Anesthesia Services 20 1174858583 0 Physicians Fluoride varnish 20 1174858583 0 Physicians Healthy Kids Services 20 1174858583 0 Physicians Optical Supplies 20 1174858583 0 Physicians Physician Services 00 1174859284 0 NIEDZWIECKI MATTHEW J 2018142 9999999 B 10 1174859284 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1174859284 0 Physicians Anesthesia Services 20 1174859284 0 Physicians Healthy Kids Services 20 1174859284 0 Physicians Optical Supplies 20 1174859284 0 Physicians Physician Services 20 1174859284 0 Physicians Physicians Psychiatric Services 00 1174859409 0 KADNER MILLICENT GAY 2018045 9999999 B 10 1174859409 0 2200 JEFFERSON AVE TOLEDO OH 436047101 20 1174859409 0 Nurse Practitioners Fluoride varnish 20 1174859409 0 Nurse Practitioners Healthy Kids Services 20 1174859409 0 Nurse Practitioners Nurse Practitioners Services 20 1174859409 0 Nurse Practitioners Physician Services 00 1174860498 0 ODOKA OKECHI U 2013060 9999999 B 10 1174860498 0 17855 DALLAS PKWY STE 200 DALLAS TX 752876857 20 1174860498 0 Nurse Practitioners Healthy Kids Services 20 1174860498 0 Nurse Practitioners Nurse Practitioners Services 20 1174860498 0 Nurse Practitioners Physician Services 00 1174861736 0 ZEITNER SUSAN 2021203 9999999 B 10 1174861736 0 PO BOX 748465 ATLANTA GA 303748465 20 1174861736 0 Clinical Social Worker Social work service 00 1174862148 0 STOLL HALEY D 2016342 9999999 B 10 1174862148 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1174862148 0 Nurse Practitioners Fluoride varnish 20 1174862148 0 Nurse Practitioners Healthy Kids Services 20 1174862148 0 Nurse Practitioners Nurse Practitioners Services 20 1174862148 0 Nurse Practitioners Physician Services 00 1174863831 0 HALKIN DANIEL 2017053 9999999 B 10 1174863831 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1174863831 0 Physical Therapists Medical Supplies 20 1174863831 0 Physical Therapists Medical equipment/prosthetic devices 20 1174863831 0 Physical Therapists Physical Therapy Services 00 1174865208 0 GIBLY ROMIE 2019152 9999999 B 10 1174865208 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1174865208 0 Physicians Anesthesia Services 20 1174865208 0 Physicians Healthy Kids Services 20 1174865208 0 Physicians Optical Supplies 20 1174865208 0 Physicians Physician Services 00 1174865323 0 WERNER MIA D 2017314 9999999 B 10 1174865323 0 5777 DEPT CAROL STREAM IL 601220021 20 1174865323 0 Physician Assistant Only Fluoride varnish 20 1174865323 0 Physician Assistant Only Healthy Kids Services 20 1174865323 0 Physician Assistant Only Physician Services 00 1174865489 0 ROGERS BRIAN A 2018032 9999999 B 10 1174865489 0 5777 DEPT CAROL STREAM IL 601220021 20 1174865489 0 Physicians Anesthesia Services 20 1174865489 0 Physicians Healthy Kids Services 20 1174865489 0 Physicians Optical Supplies 20 1174865489 0 Physicians Physician Services 00 1174866750 0 PATEL NEHUL 2021056 9999999 B 10 1174866750 0 387 SHUMAN BLVD STE 275 NAPERVILLE IL 605638450 20 1174866750 0 Physicians Anesthesia Services 20 1174866750 0 Physicians Healthy Kids Services 20 1174866750 0 Physicians Optical Supplies 20 1174866750 0 Physicians Physician Services 00 1174866800 0 ASHAI AYESHA 2019178 9999999 B 10 1174866800 0 1021 N MULFORD RD ATTN: CONTRACTING DEPT. ROCKFORD IL 611073877 20 1174866800 0 Physicians Anesthesia Services 20 1174866800 0 Physicians Healthy Kids Services 20 1174866800 0 Physicians Optical Supplies 20 1174866800 0 Physicians Physician Services 20 1174866800 0 Physicians Physicians Psychiatric Services 00 1174866834 0 BROWN WENDELL 2017299 9999999 B 10 1174866834 0 17746 OAK PARK AVE TINLEY PARK IL 604773936 20 1174866834 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1174866859 0 CHANG WAN TAN 2016292 9999999 B 10 1174866859 0 611 W PARK ST URBANA IL 618012529 20 1174866859 0 Physicians Anesthesia Services 20 1174866859 0 Physicians Fluoride varnish 20 1174866859 0 Physicians Healthy Kids Services 20 1174866859 0 Physicians Optical Supplies 20 1174866859 0 Physicians Physician Services 00 1174866891 0 NELSON MARQUITA N 2016214 9999999 B 10 1174866891 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1174866891 0 Physicians Anesthesia Services 20 1174866891 0 Physicians Fluoride varnish 20 1174866891 0 Physicians Healthy Kids Services 20 1174866891 0 Physicians Optical Supplies 20 1174866891 0 Physicians Physician Services 00 1174866917 0 KARAM JOSEPH 2017135 9999999 B 10 1174866917 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1174866917 0 Physicians Anesthesia Services 20 1174866917 0 Physicians Healthy Kids Services 20 1174866917 0 Physicians Optical Supplies 20 1174866917 0 Physicians Physician Services 00 1174869408 0 LOWRANCE DEBRA L 2013217 9999999 B 10 1174869408 0 12188 N 920TH ST ROBINSON IL 624544314 20 1174869408 0 Nurse Practitioners Healthy Kids Services 20 1174869408 0 Nurse Practitioners Midwife Services 20 1174869408 0 Nurse Practitioners Nurse Practitioners Services 20 1174869408 0 Nurse Practitioners Physician Services 00 1174869952 0 MURPHY TRACY 1998182 9999999 B 10 1174869952 0 1005 BROADWAY ST QUINCY IL 623012834 20 1174869952 0 Physicians Anesthesia Services 20 1174869952 0 Physicians Healthy Kids Services 20 1174869952 0 Physicians Optical Supplies 20 1174869952 0 Physicians Physician Services 00 1174869994 0 PETTIGREW LYNDA 2013204 9999999 B 10 1174869994 0 520 N RIDGEWAY AVE CHICAGO IL 606241232 20 1174869994 0 Nurse Practitioners Healthy Kids Services 20 1174869994 0 Nurse Practitioners Nurse Practitioners Services 20 1174869994 0 Nurse Practitioners Physician Services 00 1174870778 0 MILLS NATHANIEL 2012247 9999999 B 10 1174870778 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1174870778 0 Nurse Practitioners Healthy Kids Services 20 1174870778 0 Nurse Practitioners Nurse Practitioners Services 20 1174870778 0 Nurse Practitioners Physician Services 00 1174872162 0 SAHA SANTU 2022210 9999999 B 10 1174872162 0 14050 NW 14TH ST STE 190 SUNRISE FL 333232851 20 1174872162 0 Nurse Practitioners Anesthesia Services 20 1174872162 0 Nurse Practitioners Fluoride varnish 20 1174872162 0 Nurse Practitioners Healthy Kids Services 20 1174872162 0 Nurse Practitioners Optical Supplies 20 1174872162 0 Nurse Practitioners Physician Services 00 1174872188 0 SWINGLER ERIN M 2013319 9999999 B 10 1174872188 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1174872188 0 Nurse Practitioners Fluoride varnish 20 1174872188 0 Nurse Practitioners Healthy Kids Services 20 1174872188 0 Nurse Practitioners Nurse Practitioners Services 20 1174872188 0 Nurse Practitioners Physician Services 00 1174872519 0 SLABAUGH DANA 2000258 9999999 B 10 1174872519 0 10510 VENTURA BLVD MACHESNEY PARK IL 611151263 20 1174872519 0 Physical Therapists Medical Supplies 20 1174872519 0 Physical Therapists Medical equipment/prosthetic devices 20 1174872519 0 Physical Therapists Physical Therapy Services 00 1174872550 0 TARANTUR NATALIE 2012312 9999999 B 10 1174872550 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1174872550 0 Nurse Practitioners Anesthesia Services 20 1174872550 0 Nurse Practitioners Nurse Practitioners Services 20 1174872550 0 Nurse Practitioners Physician Services 00 1174872972 0 REYNA ESTER 2016244 9999999 B 10 1174872972 0 325 IL ROUTE 2 DIXON IL 610219118 20 1174872972 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1174874291 0 JAFRI SYED 2015230 9999999 B 10 1174874291 0 800 W FULTON MARKET FL 12 CHICAGO IL 606071302 20 1174874291 0 Physicians Anesthesia Services 20 1174874291 0 Physicians Healthy Kids Services 20 1174874291 0 Physicians Optical Supplies 20 1174874291 0 Physicians Physician Services 00 1174874861 0 KOEBCKE TRACIE 2015121 9999999 B 10 1174874861 0 PO BOX 1000 DEPT 71 ATTN: DANA CANNON MEMPHIS TN 381480001 20 1174874861 0 Physician Assistant Only Fluoride varnish 20 1174874861 0 Physician Assistant Only Healthy Kids Services 20 1174874861 0 Physician Assistant Only Physician Services 00 1174875223 0 SMITH AMY 2017335 9999999 B 10 1174875223 0 2300 N EDWARD ST DECATUR IL 625264163 20 1174875223 0 Physician Assistant Only Fluoride varnish 20 1174875223 0 Physician Assistant Only Healthy Kids Services 20 1174875223 0 Physician Assistant Only Physician Services 00 1174875967 0 TUTAJ LISA A 2016291 9999999 B 10 1174875967 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1174875967 0 Physician Assistant Only Fluoride varnish 20 1174875967 0 Physician Assistant Only Healthy Kids Services 20 1174875967 0 Physician Assistant Only Physician Services 00 1174876577 0 AIZIGOV RONI 2018149 9999999 B 10 1174876577 0 12413 S HARLEM AVE PALOS HEIGHTS IL 604631442 20 1174876577 0 Nurse Practitioners Anesthesia Services 20 1174876577 0 Nurse Practitioners Nurse Practitioners Services 20 1174876577 0 Nurse Practitioners Physician Services 00 1174876585 0 LIM JUSTINE 2023244 9999999 B 10 1174876585 0 1256 WATERFORD DR STE 230 AURORA IL 605044511 20 1174876585 0 Physician Assistant Only Fluoride varnish 20 1174876585 0 Physician Assistant Only Healthy Kids Services 20 1174876585 0 Physician Assistant Only Physician Services 00 1174877377 0 HENDERSON WESLEY A 2018243 9999999 B 10 1174877377 0 1418 COLLEGE DR MOUNT CARMEL IL 628632638 20 1174877377 0 Nurse Practitioners Anesthesia Services 20 1174877377 0 Nurse Practitioners Nurse Practitioners Services 20 1174877377 0 Nurse Practitioners Physician Services 00 1174878409 0 APODACA AMY 2021244 9999999 B 10 1174878409 0 1400 US HIGHWAY 61 FESTUS MO 630284100 20 1174878409 0 Physicians Anesthesia Services 20 1174878409 0 Physicians Fluoride varnish 20 1174878409 0 Physicians Healthy Kids Services 20 1174878409 0 Physicians Optical Supplies 20 1174878409 0 Physicians Physician Services 00 1174879399 0 HAGLAGE EMILY 2013352 9999999 B 10 1174879399 0 1 WESTBROOK CORPORATE CTR STE 240 WESTCHESTER IL 601545745 20 1174879399 0 Physical Therapists Physical Therapy Services 00 1174880744 0 RUNGE JADE L 2016309 9999999 B 10 1174880744 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1174880744 0 Nurse Practitioners Healthy Kids Services 20 1174880744 0 Nurse Practitioners Nurse Practitioners Services 20 1174880744 0 Nurse Practitioners Physician Services 00 1174881437 0 WHEALAN JEANINE 2017213 9999999 B 10 1174881437 0 5318 135TH ST CRESTWOOD IL 604451504 20 1174881437 0 Speech Therapists Medical Supplies 20 1174881437 0 Speech Therapists Medical equipment/prosthetic devices 20 1174881437 0 Speech Therapists Speech Therapy/Pathology Services 00 1174882658 0 LEARCH ROBERT J 2016221 9999999 B 10 1174882658 0 2605 KENTUCKY AVE STE 306 PADUCAH KY 420033802 20 1174882658 0 Physicians Anesthesia Services 20 1174882658 0 Physicians Fluoride varnish 20 1174882658 0 Physicians Healthy Kids Services 20 1174882658 0 Physicians Optical Supplies 20 1174882658 0 Physicians Physician Services 00 1174883722 0 ABRAHAM SHAUN A 2022060 9999999 B 10 1174883722 0 PO BOX 43230 PHOENIX AZ 850803230 20 1174883722 0 Physicians Anesthesia Services 20 1174883722 0 Physicians Fluoride varnish 20 1174883722 0 Physicians Healthy Kids Services 20 1174883722 0 Physicians Optical Supplies 20 1174883722 0 Physicians Physician Services 00 1174885735 0 PAUL-MUNIE MOLLY 2024214 9999999 B 10 1174885735 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1174885735 0 Speech Therapists Medical Supplies 20 1174885735 0 Speech Therapists Medical equipment/prosthetic devices 20 1174885735 0 Speech Therapists Speech Therapy/Pathology Services 00 1174885792 0 WELLISCH LAWREN 2017062 9999999 B 10 1174885792 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1174885792 0 Physicians Anesthesia Services 20 1174885792 0 Physicians Healthy Kids Services 20 1174885792 0 Physicians Optical Supplies 20 1174885792 0 Physicians Physician Services 00 1174886493 0 KURKIEWICZ ANDREW J 2023223 9999999 B 10 1174886493 0 800 W FULTON MARKET FL 12 CHICAGO IL 606071302 20 1174886493 0 Physician Assistant Only Fluoride varnish 20 1174886493 0 Physician Assistant Only Healthy Kids Services 20 1174886493 0 Physician Assistant Only Physician Services 00 1174887020 0 HUANG JINGTAO 2016194 9999999 B 10 1174887020 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1174887020 0 Physicians Anesthesia Services 20 1174887020 0 Physicians Family Planning Counseling 20 1174887020 0 Physicians Fluoride varnish 20 1174887020 0 Physicians Healthy Kids Services 20 1174887020 0 Physicians Optical Supplies 20 1174887020 0 Physicians Physician Services 00 1174887350 0 SOUTHARD KARA 2012219 9999999 B 10 1174887350 0 5777 DEPT CAROL STREAM IL 601220021 20 1174887350 0 Nurse Practitioners Anesthesia Services 20 1174887350 0 Nurse Practitioners Nurse Practitioners Services 20 1174887350 0 Nurse Practitioners Physician Services 00 1174887384 0 ALBRECHT MATTHEW 2015011 9999999 B 10 1174887384 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1174887384 0 Physicians Anesthesia Services 20 1174887384 0 Physicians Healthy Kids Services 20 1174887384 0 Physicians Optical Supplies 20 1174887384 0 Physicians Physician Services 00 1174887509 0 LUTES KELSEY 2012233 9999999 B 10 1174887509 0 507 E ARMSTRONG AVE PEORIA IL 616033201 20 1174887509 0 Speech Therapists Medical Supplies 20 1174887509 0 Speech Therapists Medical equipment/prosthetic devices 20 1174887509 0 Speech Therapists Speech Therapy/Pathology Services 00 1174887871 0 ZLATAROV NIKOLAY 2015236 9999999 B 10 1174887871 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1174887871 0 Physicians Anesthesia Services 20 1174887871 0 Physicians Fluoride varnish 20 1174887871 0 Physicians Healthy Kids Services 20 1174887871 0 Physicians Optical Supplies 20 1174887871 0 Physicians Physician Services 00 1174887921 0 SHERWANI AFSHEEN 2018180 9999999 B 10 1174887921 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1174887921 0 Physicians Anesthesia Services 20 1174887921 0 Physicians Healthy Kids Services 20 1174887921 0 Physicians Optical Supplies 20 1174887921 0 Physicians Physician Services 00 1174888176 0 PAPPAS MELISSA 2023136 9999999 B 10 1174888176 0 801 N WALNUT ST CHAMPAIGN IL 618203055 20 1174888176 0 Other behavior health professional LCPC/LMFT services 00 1174888945 0 KABBANY MOHAMMAD TAREK 2021021 9999999 B 10 1174888945 0 3545 W 95TH ST EVERGREEN PARK IL 608052135 20 1174888945 0 Physicians Anesthesia Services 20 1174888945 0 Physicians Fluoride varnish 20 1174888945 0 Physicians Healthy Kids Services 20 1174888945 0 Physicians Optical Supplies 20 1174888945 0 Physicians Physician Services 00 1174889091 0 DOWLATSHAHI CAMERON R 2024240 9999999 B 10 1174889091 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1174889091 0 Physicians Anesthesia Services 20 1174889091 0 Physicians Healthy Kids Services 20 1174889091 0 Physicians Optical Supplies 20 1174889091 0 Physicians Physician Services 00 1174891436 0 TRIOLA LAURA 2011274 9999999 B 10 1174891436 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1174891436 0 Nurse Practitioners Healthy Kids Services 20 1174891436 0 Nurse Practitioners Nurse Practitioners Services 20 1174891436 0 Nurse Practitioners Physician Services 00 1174892731 0 COLEMAN ANDRE 2011361 9999999 B 10 1174892731 0 4714 GETTYSBURG RD MECHANICSBURG PA 170554325 20 1174892731 0 Occupational Therapists Medical Supplies 20 1174892731 0 Occupational Therapists Medical equipment/prosthetic devices 20 1174892731 0 Occupational Therapists Occupational Therapy Services 00 1174893358 0 BAYLIS CHRISTOPHER 2021338 9999999 B 10 1174893358 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1174893358 0 Registered nurse Nursing service 20 1174893358 0 Registered nurse Waiver service 00 1174896633 0 LAVIGNE JOSHUA C 2017047 9999999 B 10 1174896633 0 659 RIDGEVIEW DR MCHENRY IL 600507012 20 1174896633 0 Psychologist Psychologist service 00 1174897987 0 FAIN PATRICIA 2018240 9999999 B 10 1174897987 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1174897987 0 Registered nurse Nursing service 20 1174897987 0 Registered nurse Waiver service 00 1174899066 0 LEE VICTORIA 2019240 9999999 B 10 1174899066 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1174899066 0 Physicians Anesthesia Services 20 1174899066 0 Physicians Healthy Kids Services 20 1174899066 0 Physicians Optical Supplies 20 1174899066 0 Physicians Physician Services 00 1174899207 0 WALLACE SARA J 2017128 9999999 B 10 1174899207 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1174899207 0 Physicians Anesthesia Services 20 1174899207 0 Physicians Healthy Kids Services 20 1174899207 0 Physicians Optical Supplies 20 1174899207 0 Physicians Physician Services 00 1174899678 0 GRAY JOSHUA D 2021337 9999999 B 10 1174899678 0 1232 W STATE ROAD 2 LA PORTE IN 463505469 20 1174899678 0 Physicians Anesthesia Services 20 1174899678 0 Physicians Healthy Kids Services 20 1174899678 0 Physicians Optical Supplies 20 1174899678 0 Physicians Physician Services 00 1174899967 0 VINCENT NERINE T 2017274 9999999 B 10 1174899967 0 5777 DEPT CAROL STREAM IL 601228942 20 1174899967 0 Physicians Anesthesia Services 20 1174899967 0 Physicians Fluoride varnish 20 1174899967 0 Physicians Healthy Kids Services 20 1174899967 0 Physicians Optical Supplies 20 1174899967 0 Physicians Physician Services 00 1174900120 0 ABUZEID OMAR 2023193 9999999 B 10 1174900120 0 PO BOX 781076 DETROIT MI 482781076 20 1174900120 0 Physicians Anesthesia Services 20 1174900120 0 Physicians Healthy Kids Services 20 1174900120 0 Physicians Optical Supplies 20 1174900120 0 Physicians Physician Services 00 1174900153 0 GILROY AMY 2016244 9999999 B 10 1174900153 0 325 IL ROUTE 2 DIXON IL 610219118 20 1174900153 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1174900286 0 BURDS JOSEPH H 2017199 9999999 B 10 1174900286 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1174900286 0 Nurse Practitioners Anesthesia Services 20 1174900286 0 Nurse Practitioners Nurse Practitioners Services 20 1174900286 0 Nurse Practitioners Physician Services 00 1174900450 0 FRICKS JOYCE 2021055 9999999 B 10 1174900450 0 4701 DEPT CAROL STREAM IL 601220021 20 1174900450 0 Nurse Practitioners Healthy Kids Services 20 1174900450 0 Nurse Practitioners Nurse Practitioners Services 20 1174900450 0 Nurse Practitioners Physician Services 00 1174900997 0 KALANT STEPHANIE I 2022195 9999999 B 10 1174900997 0 2000 OGDEN AVE AURORA IL 605047222 20 1174900997 0 Physicians Anesthesia Services 20 1174900997 0 Physicians Fluoride varnish 20 1174900997 0 Physicians Healthy Kids Services 20 1174900997 0 Physicians Optical Supplies 20 1174900997 0 Physicians Physician Services 00 1174902472 0 STANFORD VALERIE R 2019014 9999999 B 10 1174902472 0 8550 W BRYN MAWR AVE STE 800 STE 800 CHICAGO IL 606313222 20 1174902472 0 Physicians Anesthesia Services 20 1174902472 0 Physicians Fluoride varnish 20 1174902472 0 Physicians Healthy Kids Services 20 1174902472 0 Physicians Optical Supplies 20 1174902472 0 Physicians Physician Services 00 1174902696 0 MARMON ASHLEY R 2015227 9999999 B 10 1174902696 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1174902696 0 Nurse Practitioners Fluoride varnish 20 1174902696 0 Nurse Practitioners Healthy Kids Services 20 1174902696 0 Nurse Practitioners Nurse Practitioners Services 20 1174902696 0 Nurse Practitioners Physician Services 00 1174902746 0 CRONIN TIMOTHY 2015246 9999999 B 10 1174902746 0 611 W PARK ST URBANA IL 618012529 20 1174902746 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1174903488 0 RHEINHARDT SAMUEL 2020217 9999999 B 10 1174903488 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1174903488 0 Physicians Anesthesia Services 20 1174903488 0 Physicians Healthy Kids Services 20 1174903488 0 Physicians Optical Supplies 20 1174903488 0 Physicians Physician Services 00 1174903793 0 RANGANATHAN MANJARI 2017080 9999999 B 10 1174903793 0 PO BOX 713388 CHICAGO IL 606771525 20 1174903793 0 Physicians Anesthesia Services 20 1174903793 0 Physicians Fluoride varnish 20 1174903793 0 Physicians Healthy Kids Services 20 1174903793 0 Physicians Optical Supplies 20 1174903793 0 Physicians Physician Services 00 1174903843 0 CHMIEL KATHLEEN A 2017080 9999999 B 10 1174903843 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1174903843 0 Physicians Anesthesia Services 20 1174903843 0 Physicians Fluoride varnish 20 1174903843 0 Physicians Healthy Kids Services 20 1174903843 0 Physicians Optical Supplies 20 1174903843 0 Physicians Physician Services 00 1174904304 0 LIU SEBAN 2021209 9999999 B 10 1174904304 0 350 N WALL ST KANKAKEE IL 609012901 20 1174904304 0 Physicians Anesthesia Services 20 1174904304 0 Physicians Fluoride varnish 20 1174904304 0 Physicians Healthy Kids Services 20 1174904304 0 Physicians Optical Supplies 20 1174904304 0 Physicians Physician Services 00 1174904494 0 BERNS DANA M 2018254 9999999 B 10 1174904494 0 6701 W 95TH ST OAK LAWN IL 604532105 20 1174904494 0 Podiatrists Podiatric Services 00 1174904502 0 SCHMITT ERICA G. 2019001 9999999 B 10 1174904502 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1174904502 0 Physicians Anesthesia Services 20 1174904502 0 Physicians Fluoride varnish 20 1174904502 0 Physicians Healthy Kids Services 20 1174904502 0 Physicians Optical Supplies 20 1174904502 0 Physicians Physician Services 00 1174904635 0 COLLISON LORA 2018082 9999999 B 10 1174904635 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1174904635 0 Speech Therapists Medical Supplies 20 1174904635 0 Speech Therapists Medical equipment/prosthetic devices 20 1174904635 0 Speech Therapists Speech Therapy/Pathology Services 00 1174904809 0 LEE DANIEL 2019274 9999999 B 10 1174904809 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1174904809 0 Physicians Anesthesia Services 20 1174904809 0 Physicians Healthy Kids Services 20 1174904809 0 Physicians Optical Supplies 20 1174904809 0 Physicians Physician Services 00 1174904890 0 SCHWALJE ADAM 2022193 9999999 B 10 1174904890 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1174904890 0 Physicians Anesthesia Services 20 1174904890 0 Physicians Healthy Kids Services 20 1174904890 0 Physicians Optical Supplies 20 1174904890 0 Physicians Physician Services 00 1174905277 0 MIRZA MURTAZA A 2019213 9999999 B 10 1174905277 0 2875 W 19TH ST CHICAGO IL 606233501 20 1174905277 0 Physicians Anesthesia Services 20 1174905277 0 Physicians Fluoride varnish 20 1174905277 0 Physicians Healthy Kids Services 20 1174905277 0 Physicians Optical Supplies 20 1174905277 0 Physicians Physician Services 00 1174905574 0 YAZDANI SAHAR 2018127 9999999 B 10 1174905574 0 3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047452 20 1174905574 0 Physicians Anesthesia Services 20 1174905574 0 Physicians Fluoride varnish 20 1174905574 0 Physicians Healthy Kids Services 20 1174905574 0 Physicians Optical Supplies 20 1174905574 0 Physicians Physician Services 00 1174905772 0 BENN WESLEY R 2018361 9999999 B 10 1174905772 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1174905772 0 Nurse Practitioners Healthy Kids Services 20 1174905772 0 Nurse Practitioners Nurse Practitioners Services 20 1174905772 0 Nurse Practitioners Physician Services 00 1174905814 0 ABDULAMEER SHAHAD 2020016 9999999 B 10 1174905814 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1174905814 0 Physicians Anesthesia Services 20 1174905814 0 Physicians Healthy Kids Services 20 1174905814 0 Physicians Optical Supplies 20 1174905814 0 Physicians Physician Services 00 1174906515 0 DOSHETTY RAKESH V 2018232 9999999 B 10 1174906515 0 # 8496 CHICAGO IL 606778004 20 1174906515 0 Physicians Anesthesia Services 20 1174906515 0 Physicians Fluoride varnish 20 1174906515 0 Physicians Healthy Kids Services 20 1174906515 0 Physicians Optical Supplies 20 1174906515 0 Physicians Physician Services 00 1174907026 0 FAROOQ ALI U 2023230 9999999 B 10 1174907026 0 PO BOX 776084 CHICAGO IL 606776084 20 1174907026 0 Physicians Anesthesia Services 20 1174907026 0 Physicians Fluoride varnish 20 1174907026 0 Physicians Healthy Kids Services 20 1174907026 0 Physicians Optical Supplies 20 1174907026 0 Physicians Physician Services 00 1174907646 0 WACLAW BRITTANY 2018279 9999999 B 10 1174907646 0 2650 WARRENVILLE RD STE 280 DOWNERS GROVE IL 605152075 20 1174907646 0 Physician Assistant Only Fluoride varnish 20 1174907646 0 Physician Assistant Only Healthy Kids Services 20 1174907646 0 Physician Assistant Only Physician Services 00 1174910178 0 CHENEY ADAM 2020148 9999999 B 10 1174910178 0 611 W PARK ST BWPC URBANA IL 618012529 20 1174910178 0 Physical Therapists Medical Supplies 20 1174910178 0 Physical Therapists Medical equipment/prosthetic devices 20 1174910178 0 Physical Therapists Physical Therapy Services 00 1174910608 0 WALSH LAUREN H 2023013 9999999 B 10 1174910608 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1174910608 0 Physicians Anesthesia Services 20 1174910608 0 Physicians Fluoride varnish 20 1174910608 0 Physicians Healthy Kids Services 20 1174910608 0 Physicians Optical Supplies 20 1174910608 0 Physicians Physician Services 00 1174910665 0 MASLOWSKI JUSTIN A 2014305 9999999 B 10 1174910665 0 1250 S MICHIGAN AVE CHICAGO IL 606052548 20 1174910665 0 Nurse Practitioners Anesthesia Services 20 1174910665 0 Nurse Practitioners Nurse Practitioners Services 20 1174910665 0 Nurse Practitioners Physician Services 00 1174911242 0 JONES NICHOLE M 2016245 9999999 B 10 1174911242 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1174911242 0 Nurse Practitioners Fluoride varnish 20 1174911242 0 Nurse Practitioners Healthy Kids Services 20 1174911242 0 Nurse Practitioners Nurse Practitioners Services 20 1174911242 0 Nurse Practitioners Physician Services 00 1174911713 0 OTT KIMBERLY 2023038 9999999 B 10 1174911713 0 200 E FAIRMAN AVE WATSEKA IL 609701644 20 1174911713 0 Nurse Practitioners Fluoride varnish 20 1174911713 0 Nurse Practitioners Healthy Kids Services 20 1174911713 0 Nurse Practitioners Nurse Practitioners Services 20 1174911713 0 Nurse Practitioners Physician Services 00 1174911762 0 BUTLER FIELDS STEPHANIE 2017296 9999999 B 10 1174911762 0 17746 OAK PARK AVE TINLEY PARK IL 604773936 20 1174911762 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1174912364 0 HEIL JESSICA 2015056 9999999 B 10 1174912364 0 20733 N BROAD ST CARLINVILLE IL 626263710 20 1174912364 0 Nurse Practitioners Fluoride varnish 20 1174912364 0 Nurse Practitioners Healthy Kids Services 20 1174912364 0 Nurse Practitioners Nurse Practitioners Services 20 1174912364 0 Nurse Practitioners Physician Services 00 1174913768 0 ROWE SAMUEL 2015065 9999999 B 10 1174913768 0 850 43RD AVE STE 100 MOLINE IL 612658401 20 1174913768 0 Physical Therapists Medical Supplies 20 1174913768 0 Physical Therapists Medical equipment/prosthetic devices 20 1174913768 0 Physical Therapists Physical Therapy Services 00 1174913917 0 COFFEY PATRICK 2025095 9999999 B 10 1174913917 0 8505 183RD ST STE A TINLEY PARK IL 604879354 20 1174913917 0 Physicians Anesthesia Services 20 1174913917 0 Physicians Healthy Kids Services 20 1174913917 0 Physicians Optical Supplies 20 1174913917 0 Physicians Physician Services 00 1174914246 0 TAYLOR LISA 2015075 9999999 B 10 1174914246 0 PO BOX 713388 CHICAGO IL 606771525 20 1174914246 0 Nurse Practitioners Fluoride varnish 20 1174914246 0 Nurse Practitioners Healthy Kids Services 20 1174914246 0 Nurse Practitioners Nurse Practitioners Services 20 1174914246 0 Nurse Practitioners Physician Services 00 1174914840 0 HU-WANG EILEEN 2019364 9999999 B 10 1174914840 0 5777 DEPT CAROL STREAM IL 601220021 20 1174914840 0 Physicians Anesthesia Services 20 1174914840 0 Physicians Fluoride varnish 20 1174914840 0 Physicians Healthy Kids Services 20 1174914840 0 Physicians Optical Supplies 20 1174914840 0 Physicians Physician Services 00 1174916746 0 OYON DANIEL 2019067 9999999 B 10 1174916746 0 4698 DEPT CAROL STREAM IL 601220021 20 1174916746 0 Physicians Anesthesia Services 20 1174916746 0 Physicians Healthy Kids Services 20 1174916746 0 Physicians Optical Supplies 20 1174916746 0 Physicians Physician 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1174918809 0 DUFFY JUSTIN 2023229 9999999 B 10 1174918809 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1174918809 0 Physician Assistant Only Fluoride varnish 20 1174918809 0 Physician Assistant Only Healthy Kids Services 20 1174918809 0 Physician Assistant Only Physician Services 00 1174918957 0 LEIDNER ALEXANDER S 2019290 9999999 B 10 1174918957 0 5777 DEPT CAROL STREAM IL 601220021 20 1174918957 0 Physicians Anesthesia Services 20 1174918957 0 Physicians Fluoride varnish 20 1174918957 0 Physicians Healthy Kids Services 20 1174918957 0 Physicians Optical Supplies 20 1174918957 0 Physicians Physician Services 00 1174919229 0 KRUKOWSKI MARLA 2018211 9999999 B 10 1174919229 0 PO BOX 781076 DETROIT MI 482781076 20 1174919229 0 Physicians Anesthesia Services 20 1174919229 0 Physicians Fluoride varnish 20 1174919229 0 Physicians Healthy Kids Services 20 1174919229 0 Physicians Optical Supplies 20 1174919229 0 Physicians Physician Services 00 1174919575 0 OSTERMEIER AUSTIN J 2021182 9999999 B 10 1174919575 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1174919575 0 Physicians Anesthesia Services 20 1174919575 0 Physicians Fluoride varnish 20 1174919575 0 Physicians Healthy Kids Services 20 1174919575 0 Physicians Optical Supplies 20 1174919575 0 Physicians Physician Services 00 1174919591 0 BUEHLER JENNIFER N 2018152 9999999 B 10 1174919591 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1174919591 0 Physicians Anesthesia Services 20 1174919591 0 Physicians Fluoride varnish 20 1174919591 0 Physicians Healthy Kids Services 20 1174919591 0 Physicians Optical Supplies 20 1174919591 0 Physicians Physician Services 00 1174919724 0 BODNAR TAYLOR R 2019319 9999999 B 10 1174919724 0 2920 VETERANS MEMORIAL DR MOUNT VERNON IL 628645924 20 1174919724 0 Nurse Practitioners Fluoride varnish 20 1174919724 0 Nurse Practitioners Healthy Kids Services 20 1174919724 0 Nurse Practitioners Nurse Practitioners Services 20 1174919724 0 Nurse Practitioners Physician Services 00 1174919765 0 LIN SAUNDERS 2022166 9999999 B 10 1174919765 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1174919765 0 Physicians Anesthesia Services 20 1174919765 0 Physicians Healthy Kids Services 20 1174919765 0 Physicians Optical Supplies 20 1174919765 0 Physicians Physician Services 00 1174919807 0 HERMANSON BENJAMIN 2021019 9999999 B 10 1174919807 0 36500 AURORA DR SUMMIT WI 530664899 20 1174919807 0 Physicians Anesthesia Services 20 1174919807 0 Physicians Healthy Kids Services 20 1174919807 0 Physicians Optical Supplies 20 1174919807 0 Physicians Physician Services 00 1174919831 0 HOPKINS JOSEPH B 2018082 9999999 B 10 1174919831 0 1969 W HART RD BELOIT WI 535112230 20 1174919831 0 Physicians Anesthesia Services 20 1174919831 0 Physicians Healthy Kids Services 20 1174919831 0 Physicians Optical Supplies 20 1174919831 0 Physicians Physician Services 00 1174920037 0 DUPPEN MARION 2016123 9999999 B 10 1174920037 0 70 S RIVER ST AURORA IL 605065185 20 1174920037 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1174920268 0 KONIOR KRISTYNA 2016250 9999999 B 10 1174920268 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112386 20 1174920268 0 Dentists Dental Services 20 1174920268 0 Dentists Physician Services 00 1174921787 0 ALONGE-OBE OLANIKE 2022200 9999999 B 10 1174921787 0 PO BOX 43230 PHOENIX AZ 850803230 20 1174921787 0 Physicians Anesthesia Services 20 1174921787 0 Physicians Healthy Kids Services 20 1174921787 0 Physicians Optical Supplies 20 1174921787 0 Physicians Physician Services 00 1174922470 0 LEADER LARISA 2017025 9999999 B 10 1174922470 0 800 E NORTHWEST HWY STE 106B MOUNT PROSPECT IL 600563457 20 1174922470 0 Clinical Social Worker Social work service 00 1174923452 0 PEREZ CYNTHIA C 2022159 9999999 B 10 1174923452 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1174923452 0 Nurse Practitioners Anesthesia Services 20 1174923452 0 Nurse Practitioners Nurse Practitioners Services 20 1174923452 0 Nurse Practitioners Physician Services 00 1174927222 0 GARCIA MARLEN 2014303 9999999 B 10 1174927222 0 PO BOX 775254 CHICAGO IL 606775254 20 1174927222 0 Occupational Therapists Medical Supplies 20 1174927222 0 Occupational Therapists Medical equipment/prosthetic devices 20 1174927222 0 Occupational Therapists Occupational Therapy Services 00 1174929335 0 BAUMGART NORA R 2017037 9999999 B 10 1174929335 0 5777 DEPT CAROL STREAM IL 601220021 20 1174929335 0 Physician Assistant Only Fluoride varnish 20 1174929335 0 Physician Assistant Only Healthy Kids Services 20 1174929335 0 Physician Assistant Only Physician Services 00 1174929368 0 WERNER EMILY M 2019121 9999999 B 10 1174929368 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1174929368 0 Nurse Practitioners Fluoride varnish 20 1174929368 0 Nurse Practitioners Healthy Kids Services 20 1174929368 0 Nurse Practitioners Nurse Practitioners Services 20 1174929368 0 Nurse Practitioners Physician Services 00 1174930077 0 MCMILLEN DENIKA 2015176 9999999 B 10 1174930077 0 1665 LARKIN AVE ELGIN IL 601235977 20 1174930077 0 Clinical Social Worker Social work service 00 1174930754 0 BIRK LINDSEY 2017110 9999999 B 10 1174930754 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1174930754 0 Nurse Practitioners Fluoride varnish 20 1174930754 0 Nurse Practitioners Healthy Kids Services 20 1174930754 0 Nurse Practitioners Nurse Practitioners Services 20 1174930754 0 Nurse Practitioners Physician Services 00 1174930796 0 BLEVINS GRETCHEN 2015352 9999999 B 10 1174930796 0 777 S MAIN ST STE 100 CLINTON IN 478422493 20 1174930796 0 Nurse Practitioners Fluoride varnish 20 1174930796 0 Nurse Practitioners Healthy Kids Services 20 1174930796 0 Nurse Practitioners Nurse Practitioners Services 20 1174930796 0 Nurse Practitioners Physician Services 00 1174930887 0 DZIDZA THOMPSON 2016204 9999999 B 10 1174930887 0 933 E HYDE PARK BLVD CHICAGO IL 606152722 20 1174930887 0 Physician Assistant Only Fluoride varnish 20 1174930887 0 Physician Assistant Only Healthy Kids Services 20 1174930887 0 Physician Assistant Only Physician Services 00 1174932057 0 BARANSKI RACHEL 2017201 9999999 B 10 1174932057 0 319 E MADISON ST STE 3B SPRINGFIELD IL 627013124 20 1174932057 0 Other behavior health professional LCPC/LMFT services 00 1174933022 0 CHATMAN CLELLAND 2020192 9999999 B 10 1174933022 0 12255 DE PAUL DR STE 737 BRIDGETON MO 630442530 20 1174933022 0 Physicians Anesthesia Services 20 1174933022 0 Physicians Healthy Kids Services 20 1174933022 0 Physicians Optical Supplies 20 1174933022 0 Physicians Physician Services 00 1174933089 0 LAU ANDREW C 2022116 9999999 B 10 1174933089 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1174933089 0 Physicians Anesthesia Services 20 1174933089 0 Physicians Healthy Kids Services 20 1174933089 0 Physicians Optical Supplies 20 1174933089 0 Physicians Physician Services 00 1174933410 0 COSTIGAN MICHELLE 2014269 9999999 H 10 1174933410 0 PO BOX 1109 DEKALB IL 601157109 20 1174933410 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1174933618 0 PUFFER SARAH M 2017167 9999999 B 10 1174933618 0 PO BOX 778912 CHICAGO IL 606778912 20 1174933618 0 Physicians Anesthesia Services 20 1174933618 0 Physicians Fluoride varnish 20 1174933618 0 Physicians Healthy Kids Services 20 1174933618 0 Physicians Optical Supplies 20 1174933618 0 Physicians Physician Services 00 1174933667 0 PIERCE ANN M 2019162 9999999 B 10 1174933667 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1174933667 0 Nurse Practitioners Fluoride varnish 20 1174933667 0 Nurse Practitioners Healthy Kids Services 20 1174933667 0 Nurse Practitioners Nurse Practitioners Services 20 1174933667 0 Nurse Practitioners Physician Services 00 1174933675 0 DEMOTT ROZA 2014335 9999999 B 10 1174933675 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1174933675 0 Nurse Practitioners Healthy Kids Services 20 1174933675 0 Nurse Practitioners Nurse Practitioners Services 20 1174933675 0 Nurse Practitioners Physician Services 00 1174934087 0 PENDER LEANNE M 2021256 9999999 B 10 1174934087 0 1301 W COSSITT AVE LA GRANGE IL 605252145 20 1174934087 0 Speech Therapists Medical Supplies 20 1174934087 0 Speech Therapists Medical equipment/prosthetic devices 20 1174934087 0 Speech Therapists Speech Therapy/Pathology Services 00 1174935019 0 WONG JONATHAN 2022126 9999999 B 10 1174935019 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1174935019 0 Physicians Anesthesia Services 20 1174935019 0 Physicians Fluoride varnish 20 1174935019 0 Physicians Healthy Kids Services 20 1174935019 0 Physicians Optical Supplies 20 1174935019 0 Physicians Physician Services 00 1174935217 0 BLAY EDDIE 2024218 9999999 B 10 1174935217 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1174935217 0 Physicians Anesthesia Services 20 1174935217 0 Physicians Healthy Kids Services 20 1174935217 0 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1174938278 0 Physicians Healthy Kids Services 20 1174938278 0 Physicians Optical Supplies 20 1174938278 0 Physicians Physician Services 00 1174938369 0 GURBA KATHARINE N 2018149 9999999 B 10 1174938369 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1174938369 0 Physicians Anesthesia Services 20 1174938369 0 Physicians Healthy Kids Services 20 1174938369 0 Physicians Optical Supplies 20 1174938369 0 Physicians Physician Services 00 1174938575 0 HOMMES LINDA L 2015260 9999999 B 10 1174938575 0 5777 DEPT CAROL STREAM IL 601220021 20 1174938575 0 Nurse Practitioners Healthy Kids Services 20 1174938575 0 Nurse Practitioners Nurse Practitioners Services 20 1174938575 0 Nurse Practitioners Physician Services 00 1174938591 0 MARTINEZ MARIA G 2020281 9999999 B 10 1174938591 0 29373 NETWORK PL CHICAGO IL 606733039 20 1174938591 0 Physicians Anesthesia Services 20 1174938591 0 Physicians Healthy Kids Services 20 1174938591 0 Physicians Optical Supplies 20 1174938591 0 Physicians Physician Services 00 1174938690 0 KELLY MALLORY J 2018182 9999999 B 10 1174938690 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1174938690 0 Physicians Anesthesia Services 20 1174938690 0 Physicians Fluoride varnish 20 1174938690 0 Physicians Healthy Kids Services 20 1174938690 0 Physicians Optical Supplies 20 1174938690 0 Physicians Physician Services 00 1174938740 0 GRIFFITHS TRICIA 2020210 9999999 B 10 1174938740 0 6308 8TH AVE KENOSHA WI 531435031 20 1174938740 0 Physicians Anesthesia Services 20 1174938740 0 Physicians Fluoride varnish 20 1174938740 0 Physicians Healthy Kids Services 20 1174938740 0 Physicians Optical Supplies 20 1174938740 0 Physicians Physician Services 00 1174939466 0 PEKOVIC SVETLANA 2021350 9999999 B 10 1174939466 0 3624 W 26TH ST CHICAGO IL 606233936 20 1174939466 0 Optometrists Optical Supplies 20 1174939466 0 Optometrists Optometric Services 20 1174939466 0 Optometrists Physician Services 00 1174939540 0 ELROKHSI SALAHEDDIN 2021116 9999999 B 10 1174939540 0 PO BOX 43230 PHOENIX AZ 850803230 20 1174939540 0 Physicians Anesthesia Services 20 1174939540 0 Physicians Fluoride varnish 20 1174939540 0 Physicians Healthy Kids Services 20 1174939540 0 Physicians Optical Supplies 20 1174939540 0 Physicians Physician Services 00 1174939649 0 ABDULHAI MOHAMAD 2022061 9999999 B 10 1174939649 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1174939649 0 Physicians Anesthesia Services 20 1174939649 0 Physicians Healthy Kids Services 20 1174939649 0 Physicians Optical Supplies 20 1174939649 0 Physicians Physician Services 00 1174940001 0 WOLFORD KATHRYN A 2017177 9999999 B 10 1174940001 0 29373 NETWORK PL CHICAGO IL 606733039 20 1174940001 0 Physicians Anesthesia Services 20 1174940001 0 Physicians Healthy Kids Services 20 1174940001 0 Physicians Optical Supplies 20 1174940001 0 Physicians Physician Services 00 1174940522 0 RANDALL EMILY 2022241 9999999 B 10 1174940522 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1174940522 0 Physical Therapists Medical Supplies 20 1174940522 0 Physical Therapists Medical equipment/prosthetic devices 20 1174940522 0 Physical Therapists Physical Therapy Services 00 1174941140 0 MILLER LAURA 2022077 9999999 B 10 1174941140 0 PO BOX 1327 BROOKFIELD WI 530081327 20 1174941140 0 Physicians Anesthesia Services 20 1174941140 0 Physicians Fluoride varnish 20 1174941140 0 Physicians Healthy Kids Services 20 1174941140 0 Physicians Optical Supplies 20 1174941140 0 Physicians Physician Services 00 1174941488 0 ADIL MALIK 2022298 9999999 B 10 1174941488 0 801 ILLINI DR SILVIS IL 612821804 20 1174941488 0 Physicians Anesthesia Services 20 1174941488 0 Physicians Healthy Kids Services 20 1174941488 0 Physicians Optical Supplies 20 1174941488 0 Physicians Physician Services 20 1174941488 0 Physicians Physicians Psychiatric Services 00 1174941769 0 HOULIHAN MATTHEW DANIEL 2018063 9999999 B 10 1174941769 0 35318 EAGLE WAY CHICAGO IL 606781353 20 1174941769 0 Physicians Anesthesia Services 20 1174941769 0 Physicians Healthy Kids Services 20 1174941769 0 Physicians Optical Supplies 20 1174941769 0 Physicians Physician Services 00 1174942668 0 CONVERSE HILARY E 2014091 9999999 B 10 1174942668 0 3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047452 20 1174942668 0 Nurse Practitioners Fluoride varnish 20 1174942668 0 Nurse Practitioners Healthy Kids Services 20 1174942668 0 Nurse Practitioners Nurse Practitioners Services 20 1174942668 0 Nurse Practitioners Physician Services 00 1174943583 0 BACHMAN ANDREW 2022322 9999999 B 10 1174943583 0 PO BOX 98366 PHOENIX AZ 850380366 20 1174943583 0 Physicians Anesthesia Services 20 1174943583 0 Physicians Healthy Kids Services 20 1174943583 0 Physicians Optical Supplies 20 1174943583 0 Physicians Physician Services 00 1174943666 0 BECKER AMANDA C 2019364 9999999 B 10 1174943666 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1174943666 0 Physicians Anesthesia Services 20 1174943666 0 Physicians Fluoride varnish 20 1174943666 0 Physicians Healthy Kids Services 20 1174943666 0 Physicians Optical Supplies 20 1174943666 0 Physicians Physician Services 00 1174943732 0 ARSHED DANIAL K 2023033 9999999 B 10 1174943732 0 5410 MARYLAND WAY STE 300 BRENTWOOD TN 370275339 20 1174943732 0 Physicians Anesthesia Services 20 1174943732 0 Physicians Fluoride varnish 20 1174943732 0 Physicians Healthy Kids Services 20 1174943732 0 Physicians Optical Supplies 20 1174943732 0 Physicians Physician Services 00 1174943831 0 KUDEK MATTHEW 2021131 9999999 B 10 1174943831 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1174943831 0 Physicians Anesthesia Services 20 1174943831 0 Physicians Fluoride varnish 20 1174943831 0 Physicians Healthy Kids Services 20 1174943831 0 Physicians Optical Supplies 20 1174943831 0 Physicians Physician Services 00 1174943948 0 MUKHERJEE SUCHARITA 2018339 9999999 B 10 1174943948 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1174943948 0 Physicians Anesthesia Services 20 1174943948 0 Physicians Fluoride varnish 20 1174943948 0 Physicians Healthy Kids Services 20 1174943948 0 Physicians Optical Supplies 20 1174943948 0 Physicians Physician Services 00 1174947675 0 SONI SWETA 2020195 9999999 B 10 1174947675 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1174947675 0 Speech Therapists Medical Supplies 20 1174947675 0 Speech Therapists Medical equipment/prosthetic devices 20 1174947675 0 Speech Therapists Speech Therapy/Pathology Services 00 1174948004 0 KAKAREKA MICHAEL 2021130 9999999 B 10 1174948004 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1174948004 0 Physicians Anesthesia Services 20 1174948004 0 Physicians Healthy Kids Services 20 1174948004 0 Physicians Optical Supplies 20 1174948004 0 Physicians Physician Services 00 1174950661 0 BRUNSON JACK 2016001 9999999 B 10 1174950661 0 2100 POWELL ST STE 900 EMERYVILLE CA 946081844 20 1174950661 0 Physician Assistant Only Fluoride varnish 20 1174950661 0 Physician Assistant Only Healthy Kids Services 20 1174950661 0 Physician Assistant Only Physician Services 00 1174952089 0 ANASTAS JAMIE L 2013305 9999999 B 10 1174952089 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1174952089 0 Nurse Practitioners Healthy Kids Services 20 1174952089 0 Nurse Practitioners Nurse Practitioners Services 20 1174952089 0 Nurse Practitioners Physician Services 00 1174953012 0 LUCCHESE LISA 2016290 9999999 B 10 1174953012 0 2500 W HIGGINS RD STE 105 HOFFMAN ESTATES IL 601692040 20 1174953012 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1174953053 0 SALACUP MICHAEL 2023138 9999999 B 10 1174953053 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1174953053 0 Physical Therapists Medical Supplies 20 1174953053 0 Physical Therapists Medical equipment/prosthetic devices 20 1174953053 0 Physical Therapists Physical Therapy Services 00 1174953137 0 WARREN KASHARA V 2016061 9999999 B 10 1174953137 0 600 W FULTON ST STE 200 CHICAGO IL 606611262 20 1174953137 0 Other behavior health professional All Kids application agent 20 1174953137 0 Other behavior health professional Social work service 00 1174953582 0 BRUNO CHERYL 2014117 9999999 B 10 1174953582 0 1320 UNION ST MORRIS IL 604502426 20 1174953582 0 Nurse Practitioners Healthy Kids Services 20 1174953582 0 Nurse Practitioners Nurse Practitioners Services 20 1174953582 0 Nurse Practitioners Physician Services 00 1174954069 0 MANDELL CHERYL K 2020345 9999999 B 10 1174954069 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1174954069 0 Nurse Practitioners Healthy Kids Services 20 1174954069 0 Nurse Practitioners Nurse Practitioners Services 20 1174954069 0 Nurse Practitioners Physician Services 00 1174956494 0 KOENEMAN HEIDI M 2017188 9999999 B 10 1174956494 0 29373 NETWORK PL CHICAGO IL 606733039 20 1174956494 0 Speech Therapists Medical Supplies 20 1174956494 0 Speech Therapists Medical equipment/prosthetic devices 20 1174956494 0 Speech Therapists Speech 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Anesthesia Services 20 1174960744 0 Physicians Fluoride varnish 20 1174960744 0 Physicians Healthy Kids Services 20 1174960744 0 Physicians Optical Supplies 20 1174960744 0 Physicians Physician Services 00 1174961999 0 KASSIM OLUFEMI 2018352 9999999 B 10 1174961999 0 5777 DEPT CAROL STREAM IL 601220021 20 1174961999 0 Physicians Anesthesia Services 20 1174961999 0 Physicians Fluoride varnish 20 1174961999 0 Physicians Healthy Kids Services 20 1174961999 0 Physicians Optical Supplies 20 1174961999 0 Physicians Physician Services 00 1174962187 0 HAMMOUD KHALED 2022032 9999999 B 10 1174962187 0 PO BOX 778791 CHICAGO IL 606776473 20 1174962187 0 Physicians Anesthesia Services 20 1174962187 0 Physicians Healthy Kids Services 20 1174962187 0 Physicians Optical Supplies 20 1174962187 0 Physicians Physician Services 00 1174962732 0 EFAM TOLULOPE T 2016356 9999999 B 10 1174962732 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1174962732 0 Physicians Anesthesia Services 20 1174962732 0 Physicians Fluoride varnish 20 1174962732 0 Physicians Healthy Kids Services 20 1174962732 0 Physicians Optical Supplies 20 1174962732 0 Physicians Physician Services 00 1174963920 0 ABBAS MALIHA 2020317 9999999 B 10 1174963920 0 5777 DEPT CAROL STREAM IL 601220021 20 1174963920 0 Physicians Anesthesia Services 20 1174963920 0 Physicians Fluoride varnish 20 1174963920 0 Physicians Healthy Kids Services 20 1174963920 0 Physicians Optical Supplies 20 1174963920 0 Physicians Physician Services 00 1174964951 0 MANI VISHNU RAJ KUMAR 2022250 9999999 B 10 1174964951 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1174964951 0 Physicians Anesthesia Services 20 1174964951 0 Physicians Healthy Kids Services 20 1174964951 0 Physicians Optical Supplies 20 1174964951 0 Physicians Physician Services 00 1174965164 0 JAYME ALISON 2022026 9999999 B 10 1174965164 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1174965164 0 Nurse Practitioners Healthy Kids Services 20 1174965164 0 Nurse Practitioners 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2019303 9999999 B 10 1174974315 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1174974315 0 Nurse Practitioners Fluoride varnish 20 1174974315 0 Nurse Practitioners Healthy Kids Services 20 1174974315 0 Nurse Practitioners Nurse Practitioners Services 20 1174974315 0 Nurse Practitioners Physician Services 00 1174974661 0 LARSEN GLADYS L 2017118 9999999 B 10 1174974661 0 PO BOX 4238 ROCK ISLAND IL 612044238 20 1174974661 0 Nurse Practitioners Healthy Kids Services 20 1174974661 0 Nurse Practitioners Nurse Practitioners Services 20 1174974661 0 Nurse Practitioners Physician Services 00 1174976286 0 PANOZZO NEELIE M 2016275 9999999 B 10 1174976286 0 PO BOX 73488 PUYALLUP WA 983730488 20 1174976286 0 Nurse Practitioners Healthy Kids Services 20 1174976286 0 Nurse Practitioners Nurse Practitioners Services 20 1174976286 0 Nurse Practitioners Physician Services 00 1174976567 0 TALAVERA SYDNEY 2018268 9999999 B 10 1174976567 0 5220 EAST AVE COUNTRYSIDE IL 605253133 20 1174976567 0 Other behavior 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NORTHWEST HWY PALATINE IL 600672414 20 1184008799 0 Dentists Dental Services 20 1184008799 0 Dentists Physician Services 00 1184009102 0 CATALDO JENNIFER 2016327 9999999 B 10 1184009102 0 1325 SYCAMORE RD DEKALB IL 601152483 20 1184009102 0 Other behavior health professional LCPC/LMFT services 00 1184010308 0 KIERNAN CLAIRE 2021049 9999999 B 10 1184010308 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1184010308 0 Physicians Anesthesia Services 20 1184010308 0 Physicians Healthy Kids Services 20 1184010308 0 Physicians Optical Supplies 20 1184010308 0 Physicians Physician Services 00 1184010365 0 GEORGE KEVIN 2020292 9999999 B 10 1184010365 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1184010365 0 Physicians Anesthesia Services 20 1184010365 0 Physicians Healthy Kids Services 20 1184010365 0 Physicians Optical Supplies 20 1184010365 0 Physicians Physician Services 00 1184010589 0 BROWN MICAHLA C 2018182 9999999 B 10 1184010589 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1184010589 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2018226 9999999 B 10 1184103707 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1184103707 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1184104036 0 LORENZ SAMANTHA J 2018256 9999999 B 10 1184104036 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1184104036 0 Physician Assistant Only Fluoride varnish 20 1184104036 0 Physician Assistant Only Healthy Kids Services 20 1184104036 0 Physician Assistant Only Physician Services 00 1184105207 0 NOVAK-CZECH ELIZABETH A 2019097 9999999 B 10 1184105207 0 8707 SKOKIE BLVD SKOKIE IL 600772269 20 1184105207 0 Speech Therapists Medical Supplies 20 1184105207 0 Speech Therapists Medical equipment/prosthetic devices 20 1184105207 0 Speech Therapists Speech Therapy/Pathology Services 00 1184106338 0 ANSARI SAMEENA 2025050 9999999 B 10 1184106338 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1184106338 0 Clinical Social Worker Social work service 00 1184106395 0 HERRON LORRAINE 2018247 9999999 B 10 1184106395 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1184106395 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1184107385 0 KUMMERER MEGHAN 2023222 9999999 B 10 1184107385 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1184107385 0 Physical Therapists Medical Supplies 20 1184107385 0 Physical Therapists Medical equipment/prosthetic devices 20 1184107385 0 Physical Therapists Physical Therapy Services 00 1184108185 0 HOFFMAN ASHLEY 2018264 9999999 B 10 1184108185 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1184108185 0 Physical Therapists Medical Supplies 20 1184108185 0 Physical Therapists Medical equipment/prosthetic devices 20 1184108185 0 Physical Therapists Physical Therapy Services 00 1184108227 0 MCDEVITT ERIN 2018267 9999999 B 10 1184108227 0 PO BOX 130 2803 S BANKER EFFINGHAM IL 624010130 20 1184108227 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring 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Physicians Physician Services 00 1184112484 0 SWANSON CHARLES 2018213 9999999 B 10 1184112484 0 5701 W TALAVI BLVD GLENDALE AZ 853061886 20 1184112484 0 Physicians All Kids application agent 20 1184112484 0 Physicians Anesthesia Services 20 1184112484 0 Physicians Fluoride varnish 20 1184112484 0 Physicians Healthy Kids Services 20 1184112484 0 Physicians Optical Supplies 20 1184112484 0 Physicians Physician Services 00 1184112781 0 KEAN KATHRYN 2024082 9999999 B 10 1184112781 0 9 EXECUTIVE CAMPUS CHERRY HILL NJ 080024502 20 1184112781 0 Physicians Anesthesia Services 20 1184112781 0 Physicians Fluoride varnish 20 1184112781 0 Physicians Healthy Kids Services 20 1184112781 0 Physicians Optical Supplies 20 1184112781 0 Physicians Physician Services 00 1184113318 0 SCHLUPP JESSICA 2018176 9999999 B 10 1184113318 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1184113318 0 Nurse Practitioners Fluoride varnish 20 1184113318 0 Nurse Practitioners Healthy Kids Services 20 1184113318 0 Nurse Practitioners Nurse Practitioners Services 20 1184113318 0 Nurse Practitioners Physician Services 00 1184115289 0 BURKHART RACHEL 2021167 9999999 B 10 1184115289 0 7660 GROSS POINT RD SKOKIE IL 600772613 20 1184115289 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1184115339 0 DEWASWALA NAKEYA K 2024274 9999999 B 10 1184115339 0 2300 N EDWARD ST DECATUR IL 625264163 20 1184115339 0 Physicians Anesthesia Services 20 1184115339 0 Physicians Fluoride varnish 20 1184115339 0 Physicians Healthy Kids Services 20 1184115339 0 Physicians Optical Supplies 20 1184115339 0 Physicians Physician Services 00 1184115495 0 DUGDALE BROOKE 2022035 9999999 B 10 1184115495 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1184115495 0 Physicians Anesthesia Services 20 1184115495 0 Physicians Healthy Kids Services 20 1184115495 0 Physicians Optical Supplies 20 1184115495 0 Physicians Physician Services 00 1184115917 0 NEETI LUKE P 2025037 9999999 B 10 1184115917 0 5901 LINCOLN DR EDINA MN 554361611 20 1184115917 0 Physicians Anesthesia Services 20 1184115917 0 Physicians Fluoride varnish 20 1184115917 0 Physicians Healthy Kids Services 20 1184115917 0 Physicians Optical Supplies 20 1184115917 0 Physicians Physician Services 00 1184116139 0 HASSE EILEEN 2019168 9999999 B 10 1184116139 0 901 MCCLINTOCK DR STE 202 SUITE 202 BURR RIDGE IL 605270872 20 1184116139 0 Physicians Anesthesia Services 20 1184116139 0 Physicians Fluoride varnish 20 1184116139 0 Physicians Healthy Kids Services 20 1184116139 0 Physicians Optical Supplies 20 1184116139 0 Physicians Physician Services 00 1184116220 0 PUYRAIMOND ZEMMOUR DAVID 2022364 9999999 B 10 1184116220 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1184116220 0 Physicians Anesthesia Services 20 1184116220 0 Physicians Healthy Kids Services 20 1184116220 0 Physicians Optical Supplies 20 1184116220 0 Physicians Physician Services 00 1184116386 0 WAUTLET ARNAUD 2019213 9999999 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RACHEL 2018232 9999999 B 10 1184130551 0 1301 W COSSITT AVE LA GRANGE IL 605252145 20 1184130551 0 Speech Therapists Medical Supplies 20 1184130551 0 Speech Therapists Medical equipment/prosthetic devices 20 1184130551 0 Speech Therapists Speech Therapy/Pathology Services 00 1184131500 0 GELANI HATEM 2018281 9999999 B 10 1184131500 0 8777 PURDUE RD STE 115 INDIANAPOLIS IN 462683104 20 1184131500 0 Dentists Dental Services 20 1184131500 0 Dentists Physician Services 00 1184132748 0 STEWART LEAH MARIE 2024293 9999999 B 10 1184132748 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1184132748 0 Other behavior health professional LCPC/LMFT services 00 1184133266 0 RHOADES EMILY 2017112 9999999 B 10 1184133266 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1184133266 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1184134140 0 MILLICAN KELLI 2017305 9999999 B 10 1184134140 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 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COLLEGE DR MOUNT CARMEL IL 628632638 20 1184144727 0 Podiatrists Podiatric Services 00 1184146078 0 WALKER WILLIAM M 2019190 9999999 B 10 1184146078 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1184146078 0 Physicians Anesthesia Services 20 1184146078 0 Physicians Fluoride varnish 20 1184146078 0 Physicians Healthy Kids Services 20 1184146078 0 Physicians Optical Supplies 20 1184146078 0 Physicians Physician Services 00 1184146433 0 TROXELL TONYA 2017195 9999999 B 10 1184146433 0 PO BOX 504469 SAINT LOUIS MO 631504469 20 1184146433 0 Occupational Therapists Medical Supplies 20 1184146433 0 Occupational Therapists Medical equipment/prosthetic devices 20 1184146433 0 Occupational Therapists Occupational Therapy Services 00 1184148967 0 ALTMAN ERICA 2023360 9999999 B 10 1184148967 0 6700 WASHINGTON AVE S EDEN PRAIRIE MN 553443405 20 1184148967 0 Audiologists Audiology Services 20 1184148967 0 Audiologists Medical Supplies 20 1184148967 0 Audiologists Medical equipment/prosthetic devices 00 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2021132 9999999 B 10 1184159550 0 452 N EOLA RD STE C AURORA IL 605029110 20 1184159550 0 Dentists Dental Services 20 1184159550 0 Dentists Physician Services 00 1184159642 0 FOYDL MEREDITH 2019094 9999999 B 10 1184159642 0 5404 W ELM ST STE H MCHENRY IL 600504007 20 1184159642 0 Clinical Social Worker Social work service 00 1184160855 0 WARREN MORGAN 2020269 9999999 B 10 1184160855 0 PO BOX 429 MC LEANSBORO IL 628590429 20 1184160855 0 Nurse Practitioners Fluoride varnish 20 1184160855 0 Nurse Practitioners Healthy Kids Services 20 1184160855 0 Nurse Practitioners Nurse Practitioners Services 20 1184160855 0 Nurse Practitioners Physician Services 00 1184161499 0 NEWTOFF JOSEPH 2020252 9999999 B 10 1184161499 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1184161499 0 Physician Assistant Only Fluoride varnish 20 1184161499 0 Physician Assistant Only Healthy Kids Services 20 1184161499 0 Physician Assistant Only Physician Services 00 1184162737 0 RYLEY JORDAN 2017097 9999999 B 10 1184162737 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1184162737 0 Nurse Practitioners Fluoride varnish 20 1184162737 0 Nurse Practitioners Healthy Kids Services 20 1184162737 0 Nurse Practitioners Nurse Practitioners Services 20 1184162737 0 Nurse Practitioners Physician Services 00 1184164006 0 MIAN AMARA 2020016 9999999 B 10 1184164006 0 5777 DEPT CAROL STREAM IL 601220021 20 1184164006 0 Physicians Anesthesia Services 20 1184164006 0 Physicians Healthy Kids Services 20 1184164006 0 Physicians Optical Supplies 20 1184164006 0 Physicians Physician Services 20 1184164006 0 Physicians Physicians Psychiatric Services 00 1184165359 0 KERNS GILLIAN C 2020038 9999999 B 10 1184165359 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1184165359 0 Clinical Social Worker Social work service 00 1184165433 0 MOSES-KESSLER RYDER 2019162 9999999 B 10 1184165433 0 401 N MICHIGAN AVE STE 1200 CHICAGO IL 606114264 20 1184165433 0 Physicians Anesthesia Services 20 1184165433 0 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PRAPIS B 2016271 9999999 B 10 1184170391 0 611 W PARK ST URBANA IL 618012529 20 1184170391 0 Nurse Practitioners Healthy Kids Services 20 1184170391 0 Nurse Practitioners Nurse Practitioners Services 20 1184170391 0 Nurse Practitioners Physician Services 00 1184170615 0 LYNCH CAITLIN 2017018 9999999 B 10 1184170615 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1184170615 0 Clinical Social Worker Social work service 00 1184171779 0 RAY RUCHI 2016272 9999999 B 10 1184171779 0 3436 N KENNICOTT AVE STE 114 STE 114 ARLINGTON HEIGH IL 600047814 20 1184171779 0 Other behavior health professional LCPC/LMFT services 00 1184172140 0 HALAC RITA ANNE 2016275 9999999 B 10 1184172140 0 PO BOX 781076 DETROIT MI 482781076 20 1184172140 0 Nurse Practitioners Fluoride varnish 20 1184172140 0 Nurse Practitioners Healthy Kids Services 20 1184172140 0 Nurse Practitioners Nurse Practitioners Services 20 1184172140 0 Nurse Practitioners Physician Services 00 1184174203 0 SUNKARA PRASUDHA K 2016306 9999999 B 10 1184174203 0 155 N NELTNOR BLVD WEST CHICAGO IL 601852315 20 1184174203 0 Dentists Dental Services 20 1184174203 0 Dentists Physician Services 00 1184176893 0 WILLCOX AMELIA 2018082 9999999 B 10 1184176893 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1184176893 0 Speech Therapists Medical Supplies 20 1184176893 0 Speech Therapists Medical equipment/prosthetic devices 20 1184176893 0 Speech Therapists Speech Therapy/Pathology Services 00 1184177297 0 BELLIGAN MARK J 2020024 9999999 B 10 1184177297 0 1446 N RANDALL AVE JANESVILLE WI 535451122 20 1184177297 0 Physician Assistant Only Fluoride varnish 20 1184177297 0 Physician Assistant Only Healthy Kids Services 20 1184177297 0 Physician Assistant Only Physician Services 00 1184177370 0 STEINGRABER DARRAH 2023069 9999999 B 10 1184177370 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1184177370 0 Nurse Practitioners Healthy Kids Services 20 1184177370 0 Nurse Practitioners Midwife Services 20 1184177370 0 Nurse Practitioners Nurse Practitioners Services 20 1184177370 0 Nurse Practitioners Physician Services 00 1184177412 0 HERNANDEZ CARVAJAL JULIAN D 2016221 9999999 B 10 1184177412 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1184177412 0 Physician Assistant Only Fluoride varnish 20 1184177412 0 Physician Assistant Only Healthy Kids Services 20 1184177412 0 Physician Assistant Only Physician Services 00 1184178824 0 CROWELL JULIA 2016221 9999999 H 10 1184178824 0 1506 E ROOSEVELT RD WHEATON IL 601876806 20 1184178824 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1184179251 0 UNRAU AMANDA E 2022260 9999999 B 10 1184179251 0 811 E WASHINGTON AVE STE 400 MADISON WI 537034028 20 1184179251 0 Speech Therapists Medical Supplies 20 1184179251 0 Speech Therapists Medical equipment/prosthetic devices 20 1184179251 0 Speech Therapists Speech Therapy/Pathology Services 00 1184179335 0 KALLURI ARAVIND 2023151 9999999 B 10 1184179335 0 4698 DEPT CAROL STREAM IL 601220021 20 1184179335 0 Physicians Anesthesia Services 20 1184179335 0 Physicians Fluoride varnish 20 1184179335 0 Physicians Healthy Kids Services 20 1184179335 0 Physicians Optical Supplies 20 1184179335 0 Physicians Physician Services 00 1184180051 0 BARLOW COURTNEY N 2019240 9999999 B 10 1184180051 0 5023 N ILLINOIS ST FAIRVIEW HEIGHT IL 622083453 20 1184180051 0 Nurse Practitioners Healthy Kids Services 20 1184180051 0 Nurse Practitioners Nurse Practitioners Services 20 1184180051 0 Nurse Practitioners Physician Services 00 1184180267 0 MOSER KARA 2021282 9999999 B 10 1184180267 0 607 S NEW BALLAS RD STE 3100 SAINT LOUIS MO 631418219 20 1184180267 0 Physician Assistant Only Fluoride varnish 20 1184180267 0 Physician Assistant Only Healthy Kids Services 20 1184180267 0 Physician Assistant Only Physician Services 00 1184180432 0 LIBERATORE MATT 2024085 9999999 B 10 1184180432 0 3166 N LINCOLN AVE STE 310 CHICAGO IL 606573119 20 1184180432 0 Other behavior health professional LCPC/LMFT services 00 1184182305 0 ANDERSON RYAN E 2021148 9999999 B 10 1184182305 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1184182305 0 Physician Assistant Only Fluoride varnish 20 1184182305 0 Physician Assistant Only Healthy Kids Services 20 1184182305 0 Physician Assistant Only Physician Services 00 1184182669 0 THOMAS-CRAFT LISA D 2019140 9999999 B 10 1184182669 0 29373 NETWORK PL CHICAGO IL 606733039 20 1184182669 0 Nurse Practitioners Fluoride varnish 20 1184182669 0 Nurse Practitioners Healthy Kids Services 20 1184182669 0 Nurse Practitioners Nurse Practitioners Services 20 1184182669 0 Nurse Practitioners Physician Services 00 1184183261 0 KEMENY HANNA ROZA 2019175 9999999 B 10 1184183261 0 4698 DEPT CAROL STREAM IL 601220021 20 1184183261 0 Physicians Anesthesia Services 20 1184183261 0 Physicians Healthy Kids Services 20 1184183261 0 Physicians Optical Supplies 20 1184183261 0 Physicians Physician Services 00 1184183329 0 TRIPU RENUKA D 2022201 9999999 B 10 1184183329 0 5777 DEPT CAROL STREAM IL 601220021 20 1184183329 0 Physicians Anesthesia Services 20 1184183329 0 Physicians Fluoride varnish 20 1184183329 0 Physicians Healthy Kids Services 20 1184183329 0 Physicians Optical Supplies 20 1184183329 0 Physicians Physician Services 00 1184184038 0 GETZ DANIEL R 2019217 9999999 B 10 1184184038 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1184184038 0 Physicians Anesthesia Services 20 1184184038 0 Physicians Healthy Kids Services 20 1184184038 0 Physicians Optical Supplies 20 1184184038 0 Physicians Physician Services 20 1184184038 0 Physicians Physicians Psychiatric Services 00 1184184293 0 PRZYDZIAL PAULINA M 2024263 9999999 B 10 1184184293 0 5777 DEPT CAROL STREAM IL 601220021 20 1184184293 0 Physicians Anesthesia Services 20 1184184293 0 Physicians Healthy Kids Services 20 1184184293 0 Physicians Optical Supplies 20 1184184293 0 Physicians Physician Services 20 1184184293 0 Physicians Physicians Psychiatric Services 00 1184184525 0 FLETCHER ZACHARY 2022200 9999999 B 10 1184184525 0 1400 US HIGHWAY 61 FESTUS MO 630284100 20 1184184525 0 Physicians Anesthesia Services 20 1184184525 0 Physicians Fluoride varnish 20 1184184525 0 Physicians Healthy Kids Services 20 1184184525 0 Physicians Optical Supplies 20 1184184525 0 Physicians Physician Services 00 1184184657 0 MUNIR KIRAN 2024120 9999999 B 10 1184184657 0 120 W 22ND ST OAK BROOK IL 605231557 20 1184184657 0 Physicians Anesthesia Services 20 1184184657 0 Physicians Fluoride varnish 20 1184184657 0 Physicians Healthy Kids Services 20 1184184657 0 Physicians Optical Supplies 20 1184184657 0 Physicians Physician Services 00 1184185498 0 JABATI SALLU 2023201 9999999 B 10 1184185498 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1184185498 0 Physicians Anesthesia Services 20 1184185498 0 Physicians Healthy Kids Services 20 1184185498 0 Physicians Optical Supplies 20 1184185498 0 Physicians Physician Services 00 1184185530 0 COLLIE MARK 2023319 9999999 B 10 1184185530 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1184185530 0 Physicians Anesthesia Services 20 1184185530 0 Physicians Healthy Kids Services 20 1184185530 0 Physicians Optical Supplies 20 1184185530 0 Physicians Physician Services 00 1184185845 0 KINZA SAMEEN 2024231 9999999 B 10 1184185845 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1184185845 0 Physicians Anesthesia Services 20 1184185845 0 Physicians Healthy Kids Services 20 1184185845 0 Physicians Optical Supplies 20 1184185845 0 Physicians Physician Services 00 1184186207 0 HERO TAYLOR G 2024141 9999999 B 10 1184186207 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1184186207 0 Physicians Anesthesia Services 20 1184186207 0 Physicians Healthy Kids Services 20 1184186207 0 Physicians Optical Supplies 20 1184186207 0 Physicians Physician Services 00 1184186702 0 STEUER MEREDITH 2023178 9999999 B 10 1184186702 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1184186702 0 Physicians Anesthesia Services 20 1184186702 0 Physicians Healthy Kids Services 20 1184186702 0 Physicians Optical Supplies 20 1184186702 0 Physicians Physician Services 00 1184187767 0 ESTRADA-O''BRIEN MARITZA Y 2020016 9999999 B 10 1184187767 0 1401 E 12TH ST MENDOTA IL 613429216 20 1184187767 0 Physicians Anesthesia Services 20 1184187767 0 Physicians Fluoride varnish 20 1184187767 0 Physicians Healthy Kids Services 20 1184187767 0 Physicians Optical Supplies 20 1184187767 0 Physicians Physician Services 00 1184188807 0 JACOBY ALEXANDRA M 2019038 9999999 B 10 1184188807 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1184188807 0 Nurse Practitioners Healthy Kids Services 20 1184188807 0 Nurse Practitioners Nurse Practitioners Services 20 1184188807 0 Nurse Practitioners Physician Services 00 1184190829 0 BROWN MATTHEW D 2019276 9999999 B 10 1184190829 0 PO BOX 3988 CARBONDALE IL 629023988 20 1184190829 0 Physician Assistant Only Fluoride varnish 20 1184190829 0 Physician Assistant Only Healthy Kids Services 20 1184190829 0 Physician Assistant Only Physician Services 00 1184191363 0 ELLIS JEANETTE I 2018335 9999999 B 10 1184191363 0 1005 BROADWAY ST QUINCY IL 623012834 20 1184191363 0 Nurse Practitioners Anesthesia Services 20 1184191363 0 Nurse Practitioners Nurse Practitioners Services 20 1184191363 0 Nurse Practitioners Physician Services 00 1184194144 0 MCCORMICK BRIDGETTE M 2024163 9999999 B 10 1184194144 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1184194144 0 Physicians Anesthesia Services 20 1184194144 0 Physicians Fluoride varnish 20 1184194144 0 Physicians Healthy Kids Services 20 1184194144 0 Physicians Optical Supplies 20 1184194144 0 Physicians Physician Services 00 1184194813 0 VLADIKA ABBY R 2018318 9999999 B 10 1184194813 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1184194813 0 Nurse Practitioners Fluoride varnish 20 1184194813 0 Nurse Practitioners Healthy Kids Services 20 1184194813 0 Nurse Practitioners Nurse Practitioners Services 20 1184194813 0 Nurse Practitioners Physician Services 00 1184196693 0 PRESUTTI MEGAN E 2019063 9999999 B 10 1184196693 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1184196693 0 Nurse Practitioners Fluoride varnish 20 1184196693 0 Nurse Practitioners Healthy Kids Services 20 1184196693 0 Nurse Practitioners Nurse Practitioners Services 20 1184196693 0 Nurse Practitioners Physician Services 00 1184196883 0 HICKMAN LESLIE A 2019060 9999999 B 10 1184196883 0 PO BOX 3988 CARBONDALE IL 629023988 20 1184196883 0 Nurse Practitioners Fluoride varnish 20 1184196883 0 Nurse Practitioners Healthy Kids Services 20 1184196883 0 Nurse Practitioners Nurse Practitioners Services 20 1184196883 0 Nurse Practitioners Physician Services 00 1184197410 0 OLUGBILE MUSTAPHA 2019015 9999999 B 10 1184197410 0 332 S MICHIGAN AVE STE 121 CHICAGO IL 606044302 20 1184197410 0 Nurse Practitioners Healthy Kids Services 20 1184197410 0 Nurse Practitioners Nurse Practitioners Services 20 1184197410 0 Nurse Practitioners Physician Services 00 1184199143 0 VAYALIL MEJO 2018335 9999999 B 10 1184199143 0 6900 S MADISON ST STE 101 WILLOWBROOK IL 605278433 20 1184199143 0 Nurse Practitioners Fluoride varnish 20 1184199143 0 Nurse Practitioners Healthy Kids Services 20 1184199143 0 Nurse Practitioners Nurse Practitioners Services 20 1184199143 0 Nurse Practitioners Physician Services 00 1184199531 0 SABBATH LAUREN 2019290 9999999 B 10 1184199531 0 4025 N SHERIDAN RD CHICAGO IL 606132010 20 1184199531 0 Nurse Practitioners Electronic Home Response/EHR Installation, MPE Certification 20 1184199531 0 Nurse Practitioners Healthy Kids Services 20 1184199531 0 Nurse Practitioners Nurse Practitioners Services 20 1184199531 0 Nurse Practitioners Nursing service 20 1184199531 0 Nurse Practitioners Physician Services 20 1184199531 0 Nurse Practitioners Waiver service 00 1184200412 0 GARCES MARILYN 2025036 9999999 B 10 1184200412 0 5777 DEPT CAROL STREAM IL 601220021 20 1184200412 0 Speech Therapists Medical Supplies 20 1184200412 0 Speech Therapists Medical equipment/prosthetic devices 20 1184200412 0 Speech Therapists Speech Therapy/Pathology Services 00 1184201493 0 MURPHY NATHANIEL P 2021172 9999999 B 10 1184201493 0 4698 DEPT CAROL STREAM IL 601220021 20 1184201493 0 Physicians Anesthesia Services 20 1184201493 0 Physicians Fluoride varnish 20 1184201493 0 Physicians Healthy Kids Services 20 1184201493 0 Physicians Optical Supplies 20 1184201493 0 Physicians Physician Services 00 1184202921 0 BLUMENSTEIN NICOLE R 2021176 9999999 B 10 1184202921 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1184202921 0 Physicians Anesthesia Services 20 1184202921 0 Physicians Healthy Kids Services 20 1184202921 0 Physicians Optical Supplies 20 1184202921 0 Physicians Physician Services 00 1184203341 0 DAVIS RENITA D 2021226 9999999 B 10 1184203341 0 200 W COUNTRY WALK DR ROUND LAKE BEAC IL 600734009 20 1184203341 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1184203556 0 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Practitioners Services 20 1184235384 0 Nurse Practitioners Physician Services 00 1184235541 0 UNDERWOOD TAYLOR J 2020287 9999999 B 10 1184235541 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1184235541 0 Clinical Social Worker Social work service 00 1184238511 0 JORDAN BRITTANY 2023298 9999999 B 10 1184238511 0 520 VALLEY VIEW DR MOLINE IL 612656152 20 1184238511 0 Physical Therapists Medical Supplies 20 1184238511 0 Physical Therapists Medical equipment/prosthetic devices 20 1184238511 0 Physical Therapists Physical Therapy Services 00 1184239386 0 HULEY PRISCILLA 2024256 9999999 B 10 1184239386 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1184239386 0 Other behavior health professional LCPC/LMFT services 00 1184239667 0 RATHBUN MATTHEW DAVID 2023003 9999999 B 10 1184239667 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1184239667 0 Nurse Practitioners Healthy Kids Services 20 1184239667 0 Nurse Practitioners Nurse Practitioners Services 20 1184239667 0 Nurse Practitioners Physician Services 00 1184240079 0 KUBICKI DANIELLE M 2023153 9999999 B 10 1184240079 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1184240079 0 Physicians Anesthesia Services 20 1184240079 0 Physicians Fluoride varnish 20 1184240079 0 Physicians Healthy Kids Services 20 1184240079 0 Physicians Optical Supplies 20 1184240079 0 Physicians Physician Services 00 1184240772 0 KATBAMNA BHAVESH BHAGIRATH 2023191 9999999 B 10 1184240772 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1184240772 0 Physicians Anesthesia Services 20 1184240772 0 Physicians Fluoride varnish 20 1184240772 0 Physicians Healthy Kids Services 20 1184240772 0 Physicians Optical Supplies 20 1184240772 0 Physicians Physician Services 00 1184240970 0 GIBIAN JOSEPH T 2020267 9999999 B 10 1184240970 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1184240970 0 Physicians Anesthesia Services 20 1184240970 0 Physicians Healthy Kids Services 20 1184240970 0 Physicians Optical Supplies 20 1184240970 0 Physicians Physician Services 00 1184241143 0 MITCHELL GABRIELLE 2019275 9999999 B 10 1184241143 0 6501 S PROMONTORY DR CHICAGO IL 606491003 20 1184241143 0 Clinical Social Worker Social work service 00 1184241887 0 BOUCHIE CURTIS 2021184 9999999 B 10 1184241887 0 250 W 96TH ST STE 520 INDIANAPOLIS IN 462601317 20 1184241887 0 Occupational Therapists Medical Supplies 20 1184241887 0 Occupational Therapists Medical equipment/prosthetic devices 20 1184241887 0 Occupational Therapists Occupational Therapy Services 00 1184242802 0 AMATO ALEX J 2022347 9999999 B 10 1184242802 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1184242802 0 Nurse Practitioners Anesthesia Services 20 1184242802 0 Nurse Practitioners Nurse Practitioners Services 20 1184242802 0 Nurse Practitioners Physician Services 00 1184243289 0 COUGHLIN CAROLINE R 2023118 9999999 B 10 1184243289 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1184243289 0 Nurse Practitioners Healthy Kids Services 20 1184243289 0 Nurse Practitioners Nurse Practitioners Services 20 1184243289 0 Nurse Practitioners Physician Services 00 1184244089 0 WILCOX KATHARINE H 2020223 9999999 B 10 1184244089 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1184244089 0 Physicians Anesthesia Services 20 1184244089 0 Physicians Fluoride varnish 20 1184244089 0 Physicians Healthy Kids Services 20 1184244089 0 Physicians Optical Supplies 20 1184244089 0 Physicians Physician Services 00 1184244584 0 DEFRANCE MARY A 2024085 9999999 B 10 1184244584 0 801 ILLINI DR SILVIS IL 612821804 20 1184244584 0 Physicians Anesthesia Services 20 1184244584 0 Physicians Fluoride varnish 20 1184244584 0 Physicians Healthy Kids Services 20 1184244584 0 Physicians Optical Supplies 20 1184244584 0 Physicians Physician Services 00 1184244683 0 FELLMANN JONATHON 2020125 9999999 B 10 1184244683 0 611 W PARK ST URBANA IL 618012529 20 1184244683 0 Physical Therapists Medical Supplies 20 1184244683 0 Physical Therapists Medical equipment/prosthetic devices 20 1184244683 0 Physical Therapists Physical Therapy Services 00 1184246191 0 TOMPKINS SEAN C 2020244 9999999 B 10 1184246191 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1184246191 0 Physicians Anesthesia Services 20 1184246191 0 Physicians Fluoride varnish 20 1184246191 0 Physicians Healthy Kids Services 20 1184246191 0 Physicians Optical Supplies 20 1184246191 0 Physicians Physician Services 00 1184247165 0 JACOBSON JENNA 2021288 9999999 B 10 1184247165 0 39465 W 14 MILE RD NOVI MI 483771600 20 1184247165 0 Physician Assistant Only Fluoride varnish 20 1184247165 0 Physician Assistant Only Healthy Kids Services 20 1184247165 0 Physician Assistant Only Physician Services 00 1184247389 0 CUPLER ALEXANDRE E 2022236 9999999 B 10 1184247389 0 233 E 13TH ST APT 2406 CHICAGO IL 606053264 20 1184247389 0 Physicians Anesthesia Services 20 1184247389 0 Physicians Healthy Kids Services 20 1184247389 0 Physicians Optical Supplies 20 1184247389 0 Physicians Physician Services 20 1184247389 0 Physicians Physicians Psychiatric Services 00 1184247595 0 AMER MONA 2023193 9999999 B 10 1184247595 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1184247595 0 Physicians Anesthesia Services 20 1184247595 0 Physicians Healthy Kids Services 20 1184247595 0 Physicians Optical Supplies 20 1184247595 0 Physicians Physician Services 00 1184248213 0 ABDELSALAM HOSSAM 2020185 9999999 B 10 1184248213 0 47 CLOCK TOWER PLZ ELGIN IL 601207800 20 1184248213 0 Dentists Dental Services 20 1184248213 0 Dentists Physician Services 00 1184248627 0 MASLOVSKY SERHIY 2021271 9999999 B 10 1184248627 0 PO BOX 3988 CARBONDALE IL 629023988 20 1184248627 0 Physician Assistant Only Fluoride varnish 20 1184248627 0 Physician Assistant Only Healthy Kids Services 20 1184248627 0 Physician Assistant Only Physician Services 00 1184249443 0 TADAVARTHI YASASVI 2021222 9999999 B 10 1184249443 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1184249443 0 Physicians Anesthesia Services 20 1184249443 0 Physicians Healthy Kids Services 20 1184249443 0 Physicians Optical Supplies 20 1184249443 0 Physicians Physician Services 00 1184250466 0 OVERSTREET KAITLIN 2022304 9999999 B 10 1184250466 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1184250466 0 Nurse Practitioners Anesthesia Services 20 1184250466 0 Nurse Practitioners Nurse Practitioners Services 20 1184250466 0 Nurse Practitioners Physician Services 00 1184251027 0 COHEN ELYSSA F 2020143 9999999 B 10 1184251027 0 4698 DEPT CAROL STREAM IL 601220021 20 1184251027 0 Physicians Anesthesia Services 20 1184251027 0 Physicians Fluoride varnish 20 1184251027 0 Physicians Healthy Kids Services 20 1184251027 0 Physicians Optical Supplies 20 1184251027 0 Physicians Physician Services 00 1184251134 0 LEE JOSHUA 2020246 9999999 B 10 1184251134 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1184251134 0 Physicians Anesthesia Services 20 1184251134 0 Physicians Healthy Kids Services 20 1184251134 0 Physicians Optical Supplies 20 1184251134 0 Physicians Physician Services 00 1184251266 0 VELASQUEZ ADRIAN R 2020183 9999999 B 10 1184251266 0 4701 DEPT CAROL STREAM IL 601220021 20 1184251266 0 Physicians Anesthesia Services 20 1184251266 0 Physicians Fluoride varnish 20 1184251266 0 Physicians Healthy Kids Services 20 1184251266 0 Physicians Optical Supplies 20 1184251266 0 Physicians Physician Services 00 1184251563 0 AGUIRRE NATASHA 2020168 9999999 B 10 1184251563 0 4698 DEPT CAROL STREAM IL 601220021 20 1184251563 0 Physicians Anesthesia Services 20 1184251563 0 Physicians Healthy Kids Services 20 1184251563 0 Physicians Optical Supplies 20 1184251563 0 Physicians Physician Services 00 1184251597 0 THOMPSON JASMINE 2024169 9999999 B 10 1184251597 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1184251597 0 Physicians Anesthesia Services 20 1184251597 0 Physicians Healthy Kids Services 20 1184251597 0 Physicians Optical Supplies 20 1184251597 0 Physicians Physician Services 00 1184252785 0 BROWN DEREK W 2020147 9999999 B 10 1184252785 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1184252785 0 Physicians Anesthesia Services 20 1184252785 0 Physicians Healthy Kids Services 20 1184252785 0 Physicians Optical Supplies 20 1184252785 0 Physicians Physician Services 20 1184252785 0 Physicians Physicians Psychiatric Services 00 1184252850 0 NILSEN JESSICA 2020161 9999999 B 10 1184252850 0 1051 W RAND RD STE 103 ARLINGTON HEIGH IL 600042315 20 1184252850 0 Physicians Anesthesia Services 20 1184252850 0 Physicians Fluoride varnish 20 1184252850 0 Physicians Healthy Kids Services 20 1184252850 0 Physicians Optical Supplies 20 1184252850 0 Physicians Physician Services 00 1184253544 0 KHAN AYESHA 2023285 9999999 B 10 1184253544 0 29373 NETWORK PL CHICAGO IL 606733039 20 1184253544 0 Physicians Anesthesia Services 20 1184253544 0 Physicians Fluoride varnish 20 1184253544 0 Physicians Healthy Kids Services 20 1184253544 0 Physicians Optical Supplies 20 1184253544 0 Physicians Physician Services 00 1184253775 0 RICKER-BOUCHE MELISSA 2023172 9999999 B 10 1184253775 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1184253775 0 Physicians Anesthesia Services 20 1184253775 0 Physicians Fluoride varnish 20 1184253775 0 Physicians Healthy Kids Services 20 1184253775 0 Physicians Optical Supplies 20 1184253775 0 Physicians Physician Services 00 1184255432 0 GROUNDS COURTNEY L 2021062 9999999 B 10 1184255432 0 PO BOX 781076 DETROIT MI 482781076 20 1184255432 0 Occupational Therapists Medical Supplies 20 1184255432 0 Occupational Therapists Medical equipment/prosthetic devices 20 1184255432 0 Occupational Therapists Occupational Therapy Services 00 1184255440 0 JONES LATASHA 2021048 9999999 B 10 1184255440 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1184255440 0 Nurse Practitioners Fluoride varnish 20 1184255440 0 Nurse Practitioners Healthy Kids Services 20 1184255440 0 Nurse Practitioners Nurse Practitioners Services 20 1184255440 0 Nurse Practitioners Physician Services 00 1184255648 0 SANTOS EDDY H 2020042 9999999 B 10 1184255648 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1184255648 0 Other behavior health professional All Kids application agent 20 1184255648 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1184256000 0 STRIDE HERBERT P 2024271 9999999 B 10 1184256000 0 4698 DEPT CAROL STREAM IL 601220021 20 1184256000 0 Physicians Anesthesia Services 20 1184256000 0 Physicians Healthy Kids Services 20 1184256000 0 Physicians Optical Supplies 20 1184256000 0 Physicians Physician Services 00 1184256232 0 BACON BETHANY 2023089 9999999 B 10 1184256232 0 30 N MICHIGAN AVE STE 424 CHICAGO IL 606023844 20 1184256232 0 Clinical Social Worker Social work service 00 1184258626 0 SIEGEL MATTHEW ALAN 2021176 2026174 B 10 1184258626 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1184258626 0 Physicians Anesthesia Services 20 1184258626 0 Physicians Healthy Kids Services 20 1184258626 0 Physicians Optical Supplies 20 1184258626 0 Physicians Physician Services 00 1184258857 0 RUSNAK SALLYAN 2021207 9999999 B 10 1184258857 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1184258857 0 Physicians Anesthesia Services 20 1184258857 0 Physicians Healthy Kids Services 20 1184258857 0 Physicians Optical Supplies 20 1184258857 0 Physicians Physician Services 00 1184259038 0 KLINEFELTER AIMEE 2020099 9999999 B 10 1184259038 0 7047 NORTH AVE OAK PARK IL 603021015 20 1184259038 0 Physician Assistant Only Fluoride varnish 20 1184259038 0 Physician Assistant Only Healthy Kids Services 20 1184259038 0 Physician Assistant Only Physician Services 00 1184259269 0 IBRAHIM SAMIRA 2024260 9999999 B 10 1184259269 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1184259269 0 Physicians Anesthesia Services 20 1184259269 0 Physicians Healthy Kids Services 20 1184259269 0 Physicians Optical Supplies 20 1184259269 0 Physicians Physician Services 00 1184260424 0 MILLER HEATHER D 2021200 9999999 B 10 1184260424 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1184260424 0 Nurse Practitioners Fluoride varnish 20 1184260424 0 Nurse Practitioners Healthy Kids Services 20 1184260424 0 Nurse Practitioners Nurse Practitioners Services 20 1184260424 0 Nurse Practitioners Physician Services 00 1184260762 0 BINDIGANAVLE APARNA S 2019364 9999999 B 10 1184260762 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1184260762 0 Nurse Practitioners Fluoride varnish 20 1184260762 0 Nurse Practitioners Healthy Kids Services 20 1184260762 0 Nurse Practitioners Nurse Practitioners Services 20 1184260762 0 Nurse Practitioners Physician Services 00 1184262206 0 LOWETH LISA 2020268 9999999 B 10 1184262206 0 1809 SHERIDAN RD NORTH CHICAGO IL 600642235 20 1184262206 0 Physician Assistant Only Fluoride varnish 20 1184262206 0 Physician Assistant Only Healthy Kids Services 20 1184262206 0 Physician Assistant Only Physician Services 00 1184263105 0 OWEN STEPHANIE 2022104 9999999 B 10 1184263105 0 PO BOX 775342 CHICAGO IL 606775342 20 1184263105 0 Nurse Practitioners Fluoride varnish 20 1184263105 0 Nurse Practitioners Healthy Kids Services 20 1184263105 0 Nurse Practitioners Nurse Practitioners Services 20 1184263105 0 Nurse Practitioners Physician Services 00 1184263600 0 CARLSGAARD TAYLOR 2024128 9999999 B 10 1184263600 0 PO BOX 781076 DETROIT MI 482781076 20 1184263600 0 Nurse Practitioners Fluoride varnish 20 1184263600 0 Nurse Practitioners Healthy Kids Services 20 1184263600 0 Nurse Practitioners Nurse Practitioners Services 20 1184263600 0 Nurse Practitioners Physician Services 00 1184265738 0 SALTER BROOKE 2020021 9999999 B 10 1184265738 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1184265738 0 Nurse Practitioners Healthy Kids Services 20 1184265738 0 Nurse Practitioners Nurse Practitioners Services 20 1184265738 0 Nurse Practitioners Physician Services 00 1184265753 0 ROGERS KELLY 2019338 9999999 B 10 1184265753 0 16555 MANCHESTER RD STE 110 GROVER MO 630401220 20 1184265753 0 Nurse Practitioners Fluoride varnish 20 1184265753 0 Nurse Practitioners Healthy Kids Services 20 1184265753 0 Nurse Practitioners Nurse Practitioners Services 20 1184265753 0 Nurse Practitioners Physician Services 00 1184266769 0 LUBELCHEK JENNIFER 2022306 9999999 B 10 1184266769 0 122 S MICHIGAN AVE STE 1441 CHICAGO IL 606036173 20 1184266769 0 Clinical Social Worker Social work service 00 1184266827 0 ODERO BETHANY 2024005 9999999 B 10 1184266827 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1184266827 0 Nurse Practitioners Healthy Kids Services 20 1184266827 0 Nurse Practitioners Nurse Practitioners Services 20 1184266827 0 Nurse Practitioners Physician Services 00 1184267759 0 LEISHER TAYLOR 2022315 9999999 B 10 1184267759 0 122 S MICHIGAN AVE STE 1441 CHICAGO IL 606036173 20 1184267759 0 Other behavior health professional LCPC/LMFT services 20 1184267759 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1184268286 0 DOYLE KAITLYN 2019308 9999999 B 10 1184268286 0 14615 W FOX CREEK CT BRIMFIELD IL 615179529 20 1184268286 0 Occupational Therapists Medical Supplies 20 1184268286 0 Occupational Therapists Medical equipment/prosthetic devices 20 1184268286 0 Occupational Therapists Occupational Therapy Services 00 1184269086 0 FOTOPOULOS HALEY 2023289 9999999 B 10 1184269086 0 28100 TORCH PKWY STE 600 WARRENVILLE IL 605554030 20 1184269086 0 Occupational Therapists Medical Supplies 20 1184269086 0 Occupational Therapists Medical equipment/prosthetic devices 20 1184269086 0 Occupational Therapists Occupational Therapy Services 00 1184270316 0 FALTUSHANSKIY ZALMAN 2023179 9999999 B 10 1184270316 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1184270316 0 Physicians Anesthesia Services 20 1184270316 0 Physicians Fluoride varnish 20 1184270316 0 Physicians Healthy Kids Services 20 1184270316 0 Physicians Optical Supplies 20 1184270316 0 Physicians Physician Services 00 1184270506 0 KOONCE LISA E 2019274 9999999 B 10 1184270506 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1184270506 0 Nurse Practitioners Fluoride varnish 20 1184270506 0 Nurse Practitioners Healthy Kids Services 20 1184270506 0 Nurse Practitioners Nurse Practitioners Services 20 1184270506 0 Nurse Practitioners Physician Services 00 1184271538 0 BROWNE COURTNEY G 2019255 9999999 B 10 1184271538 0 5777 DEPT CAROL STREAM IL 601220021 20 1184271538 0 Physician Assistant Only Fluoride varnish 20 1184271538 0 Physician Assistant Only Healthy Kids Services 20 1184271538 0 Physician Assistant Only Physician Services 00 1184272973 0 NESTLER JENI 2022175 9999999 H 10 1184272973 0 74 ECLIPSE CTR BELOIT WI 535113550 20 1184272973 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1184273427 0 MOORE DEBBIE L 2022251 9999999 B 10 1184273427 0 2950 GLENWOOD DYER RD LYNWOOD IL 604119755 20 1184273427 0 Speech Therapists Medical Supplies 20 1184273427 0 Speech Therapists Medical equipment/prosthetic devices 20 1184273427 0 Speech Therapists Speech Therapy/Pathology Services 00 1184274474 0 WILLIAMS JASMYNE N 2024298 9999999 B 10 1184274474 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1184274474 0 Other behavior health professional LCPC/LMFT services 00 1184276297 0 NIEMASZYK KELLY 2019168 9999999 B 10 1184276297 0 29373 NETWORK PL CHICAGO IL 606733039 20 1184276297 0 Physician Assistant Only Fluoride varnish 20 1184276297 0 Physician Assistant Only Healthy Kids Services 20 1184276297 0 Physician Assistant Only Physician Services 00 1184279044 0 AJEEL RONYA ABED 2022349 9999999 B 10 1184279044 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1184279044 0 Nurse Practitioners Healthy Kids Services 20 1184279044 0 Nurse Practitioners Nurse Practitioners Services 20 1184279044 0 Nurse Practitioners Physician Services 00 1184280547 0 GADDAM RAJESH 2024064 9999999 B 10 1184280547 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1184280547 0 Physicians Anesthesia Services 20 1184280547 0 Physicians Healthy Kids Services 20 1184280547 0 Physicians Optical Supplies 20 1184280547 0 Physicians Physician Services 20 1184280547 0 Physicians Physicians Psychiatric Services 00 1184280794 0 FARRIS ALEX T 2019304 9999999 B 10 1184280794 0 29373 NETWORK PL CHICAGO IL 606733039 20 1184280794 0 Physicians Anesthesia Services 20 1184280794 0 Physicians Healthy Kids Services 20 1184280794 0 Physicians Optical Supplies 20 1184280794 0 Physicians Physician Services 20 1184280794 0 Physicians Physicians Psychiatric Services 00 1184281909 0 PERKINS JORDAN 2021223 9999999 B 10 1184281909 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1184281909 0 Physicians Anesthesia Services 20 1184281909 0 Physicians Healthy Kids Services 20 1184281909 0 Physicians Optical Supplies 20 1184281909 0 Physicians Physician Services 00 1184282048 0 KENDALL EMERSON S 2023159 9999999 B 10 1184282048 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1184282048 0 Physicians Anesthesia Services 20 1184282048 0 Physicians Healthy Kids Services 20 1184282048 0 Physicians Optical Supplies 20 1184282048 0 Physicians Physician Services 00 1184282063 0 AKGUL NIL 2022196 9999999 B 10 1184282063 0 4701 DEPT CAROL STREAM IL 601220021 20 1184282063 0 Physicians Anesthesia Services 20 1184282063 0 Physicians Healthy Kids Services 20 1184282063 0 Physicians Optical Supplies 20 1184282063 0 Physicians Physician Services 00 1184282212 0 LARSON KELLY 2019183 9999999 B 10 1184282212 0 3504 COMMERCIAL AVE NORTHBROOK IL 600621821 20 1184282212 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1184283590 0 PARAYAO JACLYN 2020008 9999999 B 10 1184283590 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1184283590 0 Physicians Anesthesia Services 20 1184283590 0 Physicians Fluoride varnish 20 1184283590 0 Physicians Healthy Kids Services 20 1184283590 0 Physicians Optical Supplies 20 1184283590 0 Physicians Physician Services 00 1184284440 0 O''MALLEY SEAN 2019176 9999999 B 10 1184284440 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1184284440 0 Physicians Anesthesia Services 20 1184284440 0 Physicians Healthy Kids Services 20 1184284440 0 Physicians Optical Supplies 20 1184284440 0 Physicians Physician Services 00 1184285017 0 ABEBE TSEHAY B 2019172 9999999 B 10 1184285017 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1184285017 0 Physicians Anesthesia Services 20 1184285017 0 Physicians Healthy Kids Services 20 1184285017 0 Physicians Optical Supplies 20 1184285017 0 Physicians Physician Services 00 1184285926 0 GUILLIAMS APRIL M 2019182 9999999 B 10 1184285926 0 1050 COUNTRY CLUB RD UNIT 386 WOODSTOCK IL 600985585 20 1184285926 0 Nurse Practitioners Healthy Kids Services 20 1184285926 0 Nurse Practitioners Nurse Practitioners Services 20 1184285926 0 Nurse Practitioners Physician Services 00 1184286791 0 CALLAHAN CASEY J 2019343 9999999 B 10 1184286791 0 PO BOX 778912 CHICAGO IL 606778912 20 1184286791 0 Nurse Practitioners Healthy Kids Services 20 1184286791 0 Nurse Practitioners Nurse Practitioners Services 20 1184286791 0 Nurse Practitioners Physician Services 00 1184287047 0 FILLER RYAN 2024164 9999999 B 10 1184287047 0 4698 DEPT CAROL STREAM IL 601220021 20 1184287047 0 Physicians Anesthesia Services 20 1184287047 0 Physicians Healthy Kids Services 20 1184287047 0 Physicians Optical Supplies 20 1184287047 0 Physicians Physician Services 00 1184287302 0 WALSH JODI 2020055 9999999 B 10 1184287302 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1184287302 0 Nurse Practitioners Healthy Kids Services 20 1184287302 0 Nurse Practitioners Nurse Practitioners Services 20 1184287302 0 Nurse Practitioners Physician Services 00 1184287666 0 RINGER AUDREY R 2022014 9999999 B 10 1184287666 0 3010 GRAND AVE WAUKEGAN IL 600852321 20 1184287666 0 Registered nurse Nursing service 20 1184287666 0 Registered nurse Waiver service 00 1184288094 0 PICKETT KATHRYN E 2021313 9999999 B 10 1184288094 0 PO BOX 5081 JANESVILLE WI 535475081 20 1184288094 0 Physical Therapists Medical Supplies 20 1184288094 0 Physical Therapists Medical equipment/prosthetic devices 20 1184288094 0 Physical Therapists Physical Therapy Services 00 1184288557 0 COLLAZO ROMAN MARIELYS 2021244 9999999 B 10 1184288557 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1184288557 0 Physicians Anesthesia Services 20 1184288557 0 Physicians Fluoride varnish 20 1184288557 0 Physicians Healthy Kids Services 20 1184288557 0 Physicians Optical Supplies 20 1184288557 0 Physicians Physician Services 00 1184289241 0 MONCADA JULIAN 2021186 9999999 B 10 1184289241 0 29373 NETWORK PL CHICAGO IL 606733039 20 1184289241 0 Physicians Anesthesia Services 20 1184289241 0 Physicians Healthy Kids Services 20 1184289241 0 Physicians Optical Supplies 20 1184289241 0 Physicians Physician Services 00 1184289779 0 WILSON CHRISTOPHER 2020230 9999999 H 10 1184289779 0 1135 W 69TH CHICAGO IL 60621 20 1184289779 0 Clinical Social Worker Social work service 00 1184290025 0 AJAYI SHERIE 2021218 9999999 B 10 1184290025 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1184290025 0 Nurse Practitioners Fluoride varnish 20 1184290025 0 Nurse Practitioners Healthy Kids Services 20 1184290025 0 Nurse Practitioners Nurse Practitioners Services 20 1184290025 0 Nurse Practitioners Physician Services 00 1184290256 0 VINTIKA BRIANA 2024220 9999999 B 10 1184290256 0 70 S RIVER ST AURORA IL 605065185 20 1184290256 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1184291163 0 AGRAWAL DIKSHA 2021179 9999999 B 10 1184291163 0 1730 PARK ST STE 106 NAPERVILLE IL 605632609 20 1184291163 0 Dentists Dental Services 20 1184291163 0 Dentists Physician Services 00 1184291502 0 LIPTAK RILEY JAMES 2022224 9999999 B 10 1184291502 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1184291502 0 Physicians Anesthesia Services 20 1184291502 0 Physicians Healthy Kids Services 20 1184291502 0 Physicians Optical Supplies 20 1184291502 0 Physicians Physician Services 00 1184292583 0 SWAIL KATIE I 2021347 9999999 B 10 1184292583 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1184292583 0 Audiologists Audiology Services 20 1184292583 0 Audiologists Medical Supplies 20 1184292583 0 Audiologists Medical equipment/prosthetic devices 00 1184294316 0 MENOS STEPHANIE 2022095 9999999 B 10 1184294316 0 7108 S KANNER HWY STUART FL 349977462 20 1184294316 0 Clinical Social Worker Social work service 00 1184295032 0 MEISNER KELLEY 2023249 9999999 B 10 1184295032 0 PO BOX 336 ALGONQUIN IL 601020336 20 1184295032 0 Physician Assistant Only Fluoride varnish 20 1184295032 0 Physician Assistant Only Healthy Kids Services 20 1184295032 0 Physician Assistant Only Physician Services 00 1184295206 0 MEMON ALIZA 2021271 9999999 B 10 1184295206 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1184295206 0 Physicians Anesthesia Services 20 1184295206 0 Physicians Fluoride varnish 20 1184295206 0 Physicians Healthy Kids Services 20 1184295206 0 Physicians Optical Supplies 20 1184295206 0 Physicians Physician Services 00 1184296097 0 MILLER DUANE 2022181 9999999 B 10 1184296097 0 PO BOX 1412 SOUTH BEND IN 466241412 20 1184296097 0 Nurse Practitioners Fluoride varnish 20 1184296097 0 Nurse Practitioners Healthy Kids Services 20 1184296097 0 Nurse Practitioners Nurse Practitioners Services 20 1184296097 0 Nurse Practitioners Physician Services 00 1184296303 0 JENT NATHAN 2022339 9999999 B 10 1184296303 0 5875 E RIVERSIDE BLVD ROCKFORD IL 611144937 20 1184296303 0 Physician Assistant Only Fluoride varnish 20 1184296303 0 Physician Assistant Only Healthy Kids Services 20 1184296303 0 Physician Assistant Only Physician Services 00 1184296634 0 PORCHEZHIAN AMUDHA 2024234 9999999 B 10 1184296634 0 1044 N FRANCISCO AVE CHICAGO IL 606222743 20 1184296634 0 Physicians Anesthesia Services 20 1184296634 0 Physicians Fluoride varnish 20 1184296634 0 Physicians Healthy Kids Services 20 1184296634 0 Physicians Optical Supplies 20 1184296634 0 Physicians Physician Services 00 1184297517 0 ZALUCKYJ JENNIFER 2023059 9999999 B 10 1184297517 0 5906 ELAINE DR STE 103 ROCKFORD IL 611082467 20 1184297517 0 Clinical Social Worker Social work service 00 1184297632 0 BISSON MEGAN G 2023037 9999999 B 10 1184297632 0 PO BOX 28900 GREEN BAY WI 543240900 20 1184297632 0 Nurse Practitioners Anesthesia Services 20 1184297632 0 Nurse Practitioners Nurse Practitioners Services 20 1184297632 0 Nurse Practitioners Physician Services 00 1184300691 0 SAIRAFI PARISA 2024015 9999999 B 10 1184300691 0 1044 N FRANCISCO AVE CHICAGO IL 606222743 20 1184300691 0 Physicians Anesthesia Services 20 1184300691 0 Physicians Fluoride varnish 20 1184300691 0 Physicians Healthy Kids Services 20 1184300691 0 Physicians Optical Supplies 20 1184300691 0 Physicians Physician Services 00 1184300709 0 BULATOVA YULIYA 2023299 9999999 B 10 1184300709 0 1345 WILEY RD STE 111 SCHAUMBURG IL 601734356 20 1184300709 0 Nurse Practitioners Fluoride varnish 20 1184300709 0 Nurse Practitioners Healthy Kids Services 20 1184300709 0 Nurse Practitioners Nurse Practitioners Services 20 1184300709 0 Nurse Practitioners Physician Services 00 1184300717 0 TWIDWELL JULIE E 2023212 9999999 B 10 1184300717 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1184300717 0 Nurse Practitioners Healthy Kids Services 20 1184300717 0 Nurse Practitioners Nurse Practitioners Services 20 1184300717 0 Nurse Practitioners Physician Services 00 1184301012 0 PUPO SHELBY CATHERINE 2025009 9999999 B 10 1184301012 0 935 175TH ST STE 307 HOMEWOOD IL 604302073 20 1184301012 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1184301426 0 MYERS RACHEL E 2023191 9999999 B 10 1184301426 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1184301426 0 Physicians Anesthesia Services 20 1184301426 0 Physicians Fluoride varnish 20 1184301426 0 Physicians Healthy Kids Services 20 1184301426 0 Physicians Optical Supplies 20 1184301426 0 Physicians Physician Services 00 1184302556 0 NAGELBERG MARIN E 2023230 9999999 B 10 1184302556 0 3241 S MICHIGAN AVE CHICAGO IL 606164201 20 1184302556 0 Optometrists Optical Supplies 20 1184302556 0 Optometrists Optometric Services 20 1184302556 0 Optometrists Physician Services 00 1184302804 0 GUINSBURG KAYLENE 2023199 9999999 B 10 1184302804 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1184302804 0 Nurse Practitioners Healthy Kids Services 20 1184302804 0 Nurse Practitioners Nurse Practitioners Services 20 1184302804 0 Nurse Practitioners Physician Services 00 1184303315 0 PARKER KRISTA S 2023296 9999999 B 10 1184303315 0 851 E 5TH ST STE 226 WASHINGTON MO 630903129 20 1184303315 0 Physician Assistant Only Fluoride varnish 20 1184303315 0 Physician Assistant Only Healthy Kids Services 20 1184303315 0 Physician Assistant Only Physician Services 00 1184304586 0 EDQUIST LAURA 2024124 9999999 B 10 1184304586 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1184304586 0 Nurse Practitioners Fluoride varnish 20 1184304586 0 Nurse Practitioners Healthy Kids Services 20 1184304586 0 Nurse Practitioners Nurse Practitioners Services 20 1184304586 0 Nurse Practitioners Physician Services 00 1184305021 0 MCKEE MEGHAN 2023233 9999999 B 10 1184305021 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1184305021 0 Nurse Practitioners Healthy Kids Services 20 1184305021 0 Nurse Practitioners Nurse Practitioners Services 20 1184305021 0 Nurse Practitioners Physician Services 00 1184305930 0 DICRISTOFANO VANESSA G 2024012 9999999 B 10 1184305930 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1184305930 0 Nurse Practitioners Fluoride varnish 20 1184305930 0 Nurse Practitioners Healthy Kids Services 20 1184305930 0 Nurse Practitioners Nurse Practitioners Services 20 1184305930 0 Nurse Practitioners Physician Services 00 1184306524 0 NUSSBAUM JESSICA 2023220 9999999 B 10 1184306524 0 6810 STATE ROUTE 162 STE 215 MARYVILLE IL 620628566 20 1184306524 0 Physician Assistant Only Fluoride varnish 20 1184306524 0 Physician Assistant Only Healthy Kids Services 20 1184306524 0 Physician Assistant Only Physician Services 00 1184307332 0 CLIFTON KARA 2024347 9999999 B 10 1184307332 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1184307332 0 Nurse Practitioners Fluoride varnish 20 1184307332 0 Nurse Practitioners Healthy Kids Services 20 1184307332 0 Nurse Practitioners Nurse Practitioners Services 20 1184307332 0 Nurse Practitioners Physician Services 00 1184308520 0 ARNDT EMILY J 2023263 9999999 B 10 1184308520 0 PO BOX 155 CHRISTOPHER IL 628220155 20 1184308520 0 Nurse Practitioners Fluoride varnish 20 1184308520 0 Nurse Practitioners Healthy Kids Services 20 1184308520 0 Nurse Practitioners Nurse Practitioners Services 20 1184308520 0 Nurse Practitioners Physician Services 00 1184308637 0 NARAYAN SWATHI 2023272 9999999 B 10 1184308637 0 7732 SOLUTION CENTER CHICAGO IL 606777007 20 1184308637 0 Dentists Dental Services 20 1184308637 0 Dentists Physician Services 00 1184312522 0 HANVIRIYAPUNT STUART 2023175 9999999 B 10 1184312522 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1184312522 0 Physicians Anesthesia Services 20 1184312522 0 Physicians Healthy Kids Services 20 1184312522 0 Physicians Optical Supplies 20 1184312522 0 Physicians Physician Services 00 1184314809 0 SCHULMAN STEPHANIE 2023208 9999999 B 10 1184314809 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1184314809 0 Physicians Anesthesia Services 20 1184314809 0 Physicians Fluoride varnish 20 1184314809 0 Physicians Healthy Kids Services 20 1184314809 0 Physicians Optical Supplies 20 1184314809 0 Physicians Physician Services 00 1184315046 0 LUITEL DEEPA 2023198 9999999 B 10 1184315046 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1184315046 0 Physicians Anesthesia Services 20 1184315046 0 Physicians Healthy Kids Services 20 1184315046 0 Physicians Optical Supplies 20 1184315046 0 Physicians Physician Services 00 1184316085 0 GARCIA ELSA A 2023192 9999999 B 10 1184316085 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1184316085 0 Physicians Anesthesia Services 20 1184316085 0 Physicians Fluoride varnish 20 1184316085 0 Physicians Healthy Kids Services 20 1184316085 0 Physicians Optical Supplies 20 1184316085 0 Physicians Physician Services 00 1184316374 0 ALVAREZ MARIA ELENA 2023152 9999999 B 10 1184316374 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1184316374 0 Registered nurse Nursing service 20 1184316374 0 Registered nurse Waiver service 00 1184316549 0 OOSTEN JAMES 2023277 9999999 B 10 1184316549 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1184316549 0 Physicians Anesthesia Services 20 1184316549 0 Physicians Healthy Kids Services 20 1184316549 0 Physicians Optical Supplies 20 1184316549 0 Physicians Physician Services 00 1184317166 0 VICTORIO RAFAEL 2023212 9999999 B 10 1184317166 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1184317166 0 Physicians Anesthesia Services 20 1184317166 0 Physicians Healthy Kids Services 20 1184317166 0 Physicians Optical Supplies 20 1184317166 0 Physicians Physician Services 00 1184318446 0 WILLIAMS GRANT W 2024212 9999999 B 10 1184318446 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1184318446 0 Physicians Anesthesia Services 20 1184318446 0 Physicians Healthy Kids Services 20 1184318446 0 Physicians Optical Supplies 20 1184318446 0 Physicians Physician Services 20 1184318446 0 Physicians Physicians Psychiatric Services 00 1184318529 0 AKHURST KATELYN 2023160 9999999 B 10 1184318529 0 2506 N CLARK ST # 158 CHICAGO IL 606141848 20 1184318529 0 Physical Therapists Medical Supplies 20 1184318529 0 Physical Therapists Medical equipment/prosthetic devices 20 1184318529 0 Physical Therapists Physical Therapy Services 00 1184318545 0 YARLAGADDA PRABHAVSAILALITPREE 2023171 9999999 B 10 1184318545 0 PO BOX 855795 MINNEAPOLIS MN 554851296 20 1184318545 0 Physicians Anesthesia Services 20 1184318545 0 Physicians Fluoride varnish 20 1184318545 0 Physicians Healthy Kids Services 20 1184318545 0 Physicians Optical Supplies 20 1184318545 0 Physicians Physician Services 00 1184319642 0 PICKERILL KATHERINE A 2023116 9999999 B 10 1184319642 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1184319642 0 Physical Therapists Medical Supplies 20 1184319642 0 Physical Therapists Medical equipment/prosthetic devices 20 1184319642 0 Physical Therapists Physical Therapy Services 00 1184320343 0 RODRIGUEZ ELIAS K 2023103 9999999 B 10 1184320343 0 988102 NEBRASKA MEDICAL CTR OMAHA NE 681988102 20 1184320343 0 Nurse Practitioners Anesthesia Services 20 1184320343 0 Nurse Practitioners Nurse Practitioners Services 20 1184320343 0 Nurse Practitioners Physician Services 00 1184322166 0 KAUFENBERG MIKAYLA 2023240 9999999 B 10 1184322166 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1184322166 0 Physician Assistant Only Fluoride varnish 20 1184322166 0 Physician Assistant Only Healthy Kids Services 20 1184322166 0 Physician Assistant Only Physician Services 00 1184324956 0 KURAS GIANNA 2023103 9999999 B 10 1184324956 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1184324956 0 Nurse Practitioners Fluoride varnish 20 1184324956 0 Nurse Practitioners Healthy Kids Services 20 1184324956 0 Nurse Practitioners Nurse Practitioners Services 20 1184324956 0 Nurse Practitioners Physician Services 00 1184325334 0 ADIMI NICK H 2024194 9999999 B 10 1184325334 0 PO BOX 3039 OAK BROOK IL 605223039 20 1184325334 0 Physicians Anesthesia Services 20 1184325334 0 Physicians Fluoride varnish 20 1184325334 0 Physicians Healthy Kids Services 20 1184325334 0 Physicians Optical Supplies 20 1184325334 0 Physicians Physician Services 00 1184325573 0 HORSLEY JOSEPHINE G 2023104 9999999 B 10 1184325573 0 265 STONEGATE RD STE 102 ALGONQUIN IL 601025614 20 1184325573 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1184326050 0 LIU JESSICA 2023179 9999999 B 10 1184326050 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1184326050 0 Physicians Anesthesia Services 20 1184326050 0 Physicians Fluoride varnish 20 1184326050 0 Physicians Healthy Kids Services 20 1184326050 0 Physicians Optical Supplies 20 1184326050 0 Physicians Physician Services 00 1184326076 0 WANJIKU EMMY 2023160 9999999 B 10 1184326076 0 4698 DEPT CAROL STREAM IL 601220021 20 1184326076 0 Physicians Anesthesia Services 20 1184326076 0 Physicians Fluoride varnish 20 1184326076 0 Physicians Healthy Kids Services 20 1184326076 0 Physicians Optical Supplies 20 1184326076 0 Physicians Physician Services 00 1184326175 0 MCCAULEY LESLIE K 2024175 9999999 B 10 1184326175 0 4698 DEPT CAROL STREAM IL 601220021 20 1184326175 0 Physicians Anesthesia Services 20 1184326175 0 Physicians Healthy Kids Services 20 1184326175 0 Physicians Optical Supplies 20 1184326175 0 Physicians Physician Services 00 1184326365 0 PATEL HETAL 2024206 9999999 B 10 1184326365 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1184326365 0 Physicians Anesthesia Services 20 1184326365 0 Physicians Fluoride varnish 20 1184326365 0 Physicians Healthy Kids Services 20 1184326365 0 Physicians Optical Supplies 20 1184326365 0 Physicians Physician Services 00 1184327264 0 KWOK WAN Y 2023198 9999999 B 10 1184327264 0 7825 SOLUTION CTR CHICAGO IL 606777007 20 1184327264 0 Physicians Anesthesia Services 20 1184327264 0 Physicians Healthy Kids Services 20 1184327264 0 Physicians Optical Supplies 20 1184327264 0 Physicians Physician Services 20 1184327264 0 Physicians Physicians Psychiatric Services 00 1184328353 0 BUITER STEPHAN 2023249 9999999 B 10 1184328353 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1184328353 0 Physicians Anesthesia Services 20 1184328353 0 Physicians Healthy Kids Services 20 1184328353 0 Physicians Optical Supplies 20 1184328353 0 Physicians Physician Services 00 1184328619 0 DE LA TORRE AMY B 2023188 9999999 B 10 1184328619 0 7825 SOLUTION CTR CHICAGO IL 606777007 20 1184328619 0 Physicians Anesthesia Services 20 1184328619 0 Physicians Healthy Kids Services 20 1184328619 0 Physicians Optical Supplies 20 1184328619 0 Physicians Physician Services 20 1184328619 0 Physicians Physicians Psychiatric Services 00 1184328684 0 HATCH LIAM THOMAS 2023206 9999999 B 10 1184328684 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1184328684 0 Physicians Anesthesia Services 20 1184328684 0 Physicians Healthy Kids Services 20 1184328684 0 Physicians Optical Supplies 20 1184328684 0 Physicians Physician Services 00 1184328726 0 LA VIGNE DANIELLE M 2023094 9999999 B 10 1184328726 0 PO BOX 3039 OAK BROOK IL 605223039 20 1184328726 0 Physicians Anesthesia Services 20 1184328726 0 Physicians Healthy Kids Services 20 1184328726 0 Physicians Optical Supplies 20 1184328726 0 Physicians Physician Services 00 1184328734 0 LOE ELISABETH 2023150 9999999 B 10 1184328734 0 PO BOX 3039 OAK BROOK IL 605223039 20 1184328734 0 Physicians Anesthesia Services 20 1184328734 0 Physicians Fluoride varnish 20 1184328734 0 Physicians Healthy Kids Services 20 1184328734 0 Physicians Optical Supplies 20 1184328734 0 Physicians Physician Services 00 1184331522 0 WIDJAJA ELYSA 2023004 9999999 B 10 1184331522 0 5777 DEPT CAROL STREAM IL 601220021 20 1184331522 0 Physicians Anesthesia Services 20 1184331522 0 Physicians Healthy Kids Services 20 1184331522 0 Physicians Optical Supplies 20 1184331522 0 Physicians Physician Services 00 1184331902 0 FATAWU JELYA 2024323 9999999 B 10 1184331902 0 20855 S LAGRANGE RD STE 205 FRANKFORT IL 604232043 20 1184331902 0 Nurse Practitioners Healthy Kids Services 20 1184331902 0 Nurse Practitioners Nurse Practitioners Services 20 1184331902 0 Nurse Practitioners Physician Services 00 1184333627 0 KULA NICOLE 2023058 9999999 B 10 1184333627 0 741 S MCHENRY AVE CRYSTAL LAKE IL 600147445 20 1184333627 0 Physician Assistant Only Fluoride varnish 20 1184333627 0 Physician Assistant Only Healthy Kids Services 20 1184333627 0 Physician Assistant Only Physician Services 00 1184333775 0 VOLTCHEK ELENA 2023061 9999999 B 10 1184333775 0 2970 MARIA AVE STE 210 NORTHBROOK IL 600622024 20 1184333775 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1184337032 0 HAHN GANAN 2024100 9999999 B 10 1184337032 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1184337032 0 Physician Assistant Only Fluoride varnish 20 1184337032 0 Physician Assistant Only Healthy Kids Services 20 1184337032 0 Physician Assistant Only Physician Services 00 1184337222 0 MELBY SARAH 2023129 9999999 B 10 1184337222 0 3030 W SALT CREEK LN STE 200 ARLINGTON HEIGH IL 600055002 20 1184337222 0 Nurse Practitioners Fluoride varnish 20 1184337222 0 Nurse Practitioners Healthy Kids Services 20 1184337222 0 Nurse Practitioners Nurse Practitioners Services 20 1184337222 0 Nurse Practitioners Physician Services 00 1184338857 0 RENDLEMAN ELIZABETH A 2023125 9999999 B 10 1184338857 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1184338857 0 Nurse Practitioners Fluoride varnish 20 1184338857 0 Nurse Practitioners Healthy Kids Services 20 1184338857 0 Nurse Practitioners Nurse Practitioners Services 20 1184338857 0 Nurse Practitioners Physician Services 00 1184342610 0 FOX ANNE K 2022234 9999999 B 10 1184342610 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1184342610 0 Clinical Social Worker Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1184343378 0 HENREID CARLY 2022237 9999999 B 10 1184343378 0 10150 DEE RD DES PLAINES IL 600161512 20 1184343378 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1184344335 0 SNYDER MARISA G 2022251 9999999 B 10 1184344335 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1184344335 0 Occupational Therapists Medical Supplies 20 1184344335 0 Occupational Therapists Medical equipment/prosthetic devices 20 1184344335 0 Occupational Therapists Occupational Therapy Services 00 1184345431 0 HENDERSON MEGAN 2024115 9999999 B 10 1184345431 0 PO BOX 781076 DETROIT MI 482781076 20 1184345431 0 Nurse Practitioners Fluoride varnish 20 1184345431 0 Nurse Practitioners Healthy Kids Services 20 1184345431 0 Nurse Practitioners Nurse Practitioners Services 20 1184345431 0 Nurse Practitioners Physician Services 00 1184345530 0 KONDIC ADILA 2022319 9999999 B 10 1184345530 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1184345530 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1184345829 0 CORNELIUS MELINDA 2024051 9999999 B 10 1184345829 0 727 E COURT ST PARIS IL 619442460 20 1184345829 0 Nurse Practitioners Fluoride varnish 20 1184345829 0 Nurse Practitioners Healthy Kids Services 20 1184345829 0 Nurse Practitioners Nurse Practitioners Services 20 1184345829 0 Nurse Practitioners Physician Services 00 1184346272 0 NABHANI ZAHRAA 2022312 9999999 B 10 1184346272 0 800 KIRTS BLVD STE 650 TROY MI 480844878 20 1184346272 0 Dentists Dental Services 20 1184346272 0 Dentists Physician Services 00 1184347072 0 SAWYER SADIE 2022269 9999999 B 10 1184347072 0 200 STAHLHUT DR LINCOLN IL 626565066 20 1184347072 0 Physician Assistant Only Fluoride varnish 20 1184347072 0 Physician Assistant Only Healthy Kids Services 20 1184347072 0 Physician Assistant Only Physician Services 00 1184347403 0 SCHAEFER RACHEL 2022265 9999999 B 10 1184347403 0 120 S MARION ST OAK PARK IL 603022809 20 1184347403 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1184352940 0 LAYTON JENNIFER R 2022270 9999999 B 10 1184352940 0 5010 ROSE LN COULTERVILLE IL 622372746 20 1184352940 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1184353641 0 BLACKWELL JANELLE 2023321 9999999 B 10 1184353641 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1184353641 0 Occupational Therapists Medical Supplies 20 1184353641 0 Occupational Therapists Medical equipment/prosthetic devices 20 1184353641 0 Occupational Therapists Occupational Therapy Services 00 1184353716 0 GOU CHRISTINE 2022271 9999999 B 10 1184353716 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1184353716 0 Physicians Anesthesia Services 20 1184353716 0 Physicians Healthy Kids Services 20 1184353716 0 Physicians Optical Supplies 20 1184353716 0 Physicians Physician Services 00 1184354078 0 TYREE ANITA 2024089 9999999 B 10 1184354078 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1184354078 0 Occupational Therapists Medical Supplies 20 1184354078 0 Occupational Therapists Medical equipment/prosthetic devices 20 1184354078 0 Occupational Therapists Occupational Therapy Services 00 1184354169 0 HICKS KAAMAL 2022185 9999999 B 10 1184354169 0 1 MEMORIAL DR ALTON IL 620026722 20 1184354169 0 Physicians Anesthesia Services 20 1184354169 0 Physicians Fluoride varnish 20 1184354169 0 Physicians Healthy Kids Services 20 1184354169 0 Physicians Optical Supplies 20 1184354169 0 Physicians Physician Services 00 1184354318 0 VAN ITEN BRENDAN J 2022208 9999999 B 10 1184354318 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1184354318 0 Physicians Anesthesia Services 20 1184354318 0 Physicians Healthy Kids Services 20 1184354318 0 Physicians Optical Supplies 20 1184354318 0 Physicians Physician Services 00 1184354862 0 DHANIREDDY BHARGAVI 2022196 9999999 B 10 1184354862 0 611 W PARK ST URBANA IL 618012529 20 1184354862 0 Physicians Anesthesia Services 20 1184354862 0 Physicians Family Planning Counseling 20 1184354862 0 Physicians Healthy Kids Services 20 1184354862 0 Physicians Optical Supplies 20 1184354862 0 Physicians Physician Services 00 1184355117 0 PERRY JESSICA 2023205 9999999 B 10 1184355117 0 302 N JACKSON ST MILWAUKEE WI 532025904 20 1184355117 0 Nurse Practitioners Fluoride varnish 20 1184355117 0 Nurse Practitioners Healthy Kids Services 20 1184355117 0 Nurse Practitioners Nurse Practitioners Services 20 1184355117 0 Nurse Practitioners Physician Services 00 1184355174 0 ALALI FAISAL 2022353 9999999 B 10 1184355174 0 4698 DEPT CAROL STREAM IL 601224698 20 1184355174 0 Physicians Anesthesia Services 20 1184355174 0 Physicians Fluoride varnish 20 1184355174 0 Physicians Healthy Kids Services 20 1184355174 0 Physicians Optical Supplies 20 1184355174 0 Physicians Physician Services 00 1184355729 0 ZAIDI AHMAD A 2022179 9999999 B 10 1184355729 0 4317 S ASHLAND AVE CHICAGO IL 606093140 20 1184355729 0 Dentists Dental Services 20 1184355729 0 Dentists Physician Services 00 1184356396 0 RUEDA GABRIELA A 2022213 9999999 B 10 1184356396 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1184356396 0 Physicians Anesthesia Services 20 1184356396 0 Physicians Fluoride varnish 20 1184356396 0 Physicians Healthy Kids Services 20 1184356396 0 Physicians Optical Supplies 20 1184356396 0 Physicians Physician Services 00 1184356784 0 KATZ JULIA D 2022188 9999999 B 10 1184356784 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1184356784 0 Physicians Anesthesia Services 20 1184356784 0 Physicians Fluoride varnish 20 1184356784 0 Physicians Healthy Kids Services 20 1184356784 0 Physicians Optical Supplies 20 1184356784 0 Physicians Physician Services 00 1184356958 0 REDIGER AMANDA 2022182 9999999 B 10 1184356958 0 110 N BURR BLVD KEWANEE IL 614432214 20 1184356958 0 Nurse Practitioners Family Planning Counseling 20 1184356958 0 Nurse Practitioners Fluoride varnish 20 1184356958 0 Nurse Practitioners Healthy Kids Services 20 1184356958 0 Nurse Practitioners Nurse Practitioners Services 20 1184356958 0 Nurse Practitioners Physician Services 00 1184357832 0 AUDET JESSICA 2023030 9999999 B 10 1184357832 0 2020 OGDEN AVE STE 360 SUITE 360 AURORA IL 605046486 20 1184357832 0 Physicians Anesthesia Services 20 1184357832 0 Physicians Fluoride varnish 20 1184357832 0 Physicians Healthy Kids Services 20 1184357832 0 Physicians Optical Supplies 20 1184357832 0 Physicians Physician Services 00 1184357865 0 FALETI CHRISTIANA O 2022196 9999999 B 10 1184357865 0 201 E MADISON ST STE 300 SPRINGFIELD IL 627025131 20 1184357865 0 Physicians Anesthesia Services 20 1184357865 0 Physicians Fluoride varnish 20 1184357865 0 Physicians Healthy Kids Services 20 1184357865 0 Physicians Optical Supplies 20 1184357865 0 Physicians Physician Services 00 1184358616 0 RASHID MOHAMMAD HARUN 2023202 2028182 B 10 1184358616 0 611 W PARK ST URBANA IL 618012529 20 1184358616 0 Physicians Anesthesia Services 20 1184358616 0 Physicians Fluoride varnish 20 1184358616 0 Physicians Healthy Kids Services 20 1184358616 0 Physicians Optical Supplies 20 1184358616 0 Physicians Physician Services 00 1184358814 0 BONOMI SAMUELE 2022244 9999999 B 10 1184358814 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1184358814 0 Physicians Anesthesia Services 20 1184358814 0 Physicians Healthy Kids Services 20 1184358814 0 Physicians Optical Supplies 20 1184358814 0 Physicians Physician Services 20 1184358814 0 Physicians Physicians Psychiatric Services 00 1184358855 0 HENRIQUEZ MARCOS RAFAEL 2022227 9999999 B 10 1184358855 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1184358855 0 Physicians Anesthesia Services 20 1184358855 0 Physicians Healthy Kids Services 20 1184358855 0 Physicians Optical Supplies 20 1184358855 0 Physicians Physician Services 00 1184359762 0 HUSSAINI HADIYA 2022322 9999999 B 10 1184359762 0 9701 W HIGGINS RD STE 270 STE 270 ROSEMONT IL 600184703 20 1184359762 0 Nurse Practitioners Fluoride varnish 20 1184359762 0 Nurse Practitioners Healthy Kids Services 20 1184359762 0 Nurse Practitioners Nurse Practitioners Services 20 1184359762 0 Nurse Practitioners Physician Services 00 1184360927 0 DREWNIAK TOMASZ 2023250 9999999 B 10 1184360927 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1184360927 0 Physical Therapists Medical Supplies 20 1184360927 0 Physical Therapists Medical equipment/prosthetic devices 20 1184360927 0 Physical Therapists Physical Therapy Services 00 1184360968 0 VERHAGEN METMAN ROLF H 2024176 9999999 B 10 1184360968 0 4698 DEPT CAROL STREAM IL 601220021 20 1184360968 0 Physicians Anesthesia Services 20 1184360968 0 Physicians Fluoride varnish 20 1184360968 0 Physicians Healthy Kids Services 20 1184360968 0 Physicians Optical Supplies 20 1184360968 0 Physicians Physician Services 00 1184361057 0 BAGUISA DANICA 2022206 9999999 B 10 1184361057 0 4714 GETTYSBURG RD MECHANICSBURG PA 170554325 20 1184361057 0 Occupational Therapists Medical Supplies 20 1184361057 0 Occupational Therapists Medical equipment/prosthetic devices 20 1184361057 0 Occupational Therapists Occupational Therapy Services 00 1184361578 0 LEARY STEVEN 2022165 9999999 B 10 1184361578 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1184361578 0 Physicians Anesthesia Services 20 1184361578 0 Physicians 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1184385320 0 Physician Assistant Only Physician Services 00 1184386880 0 SRIVASTAVA SWATI 2021315 9999999 B 10 1184386880 0 7421 MADISON ST FOREST PARK IL 601301575 20 1184386880 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1184387086 0 JONES MARIA 2022063 9999999 B 10 1184387086 0 3229 W 47TH PL CHICAGO IL 606323011 20 1184387086 0 Dentists Dental Services 20 1184387086 0 Dentists Physician Services 00 1184387227 0 PARSLEY LARRY 2021288 9999999 B 10 1184387227 0 PO BOX 146 WATERLOO IL 622980146 20 1184387227 0 Registered nurse Nursing service 20 1184387227 0 Registered nurse Waiver service 00 1184387813 0 LAM JOANNE 2021322 9999999 B 10 1184387813 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1184387813 0 Nurse Practitioners Fluoride varnish 20 1184387813 0 Nurse Practitioners Healthy Kids Services 20 1184387813 0 Nurse Practitioners Nurse Practitioners Services 20 1184387813 0 Nurse Practitioners Physician Services 00 1184389728 0 DENNIS LINDSEY 2022112 9999999 B 10 1184389728 0 2055 CRAIGSHIRE RD STE 230 SAINT LOUIS MO 631464012 20 1184389728 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1184389934 0 JENSEN ADRIENNE 2024008 9999999 B 10 1184389934 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1184389934 0 Nurse Practitioners Healthy Kids Services 20 1184389934 0 Nurse Practitioners Nurse Practitioners Services 20 1184389934 0 Nurse Practitioners Physician Services 00 1184390148 0 GALVAN ARIANA J 2022343 9999999 B 10 1184390148 0 28594 NETWORK PL CHICAGO IL 606731285 20 1184390148 0 Occupational Therapists Medical Supplies 20 1184390148 0 Occupational Therapists Medical equipment/prosthetic devices 20 1184390148 0 Occupational Therapists Occupational Therapy Services 00 1184390767 0 ALEGRIA SALLY 2021236 9999999 B 10 1184390767 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1184390767 0 Other behavior health professional 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KELEHER KACI 2024170 9999999 B 10 1184474769 0 PO BOX 3039 OAK BROOK IL 605223039 20 1184474769 0 Physicians Anesthesia Services 20 1184474769 0 Physicians Healthy Kids Services 20 1184474769 0 Physicians Optical Supplies 20 1184474769 0 Physicians Physician Services 00 1184474843 0 ADKISSON FABIOLA 2024204 9999999 B 10 1184474843 0 PO BOX 3039 OAK BROOK IL 605223039 20 1184474843 0 Physicians Anesthesia Services 20 1184474843 0 Physicians Fluoride varnish 20 1184474843 0 Physicians Healthy Kids Services 20 1184474843 0 Physicians Optical Supplies 20 1184474843 0 Physicians Physician Services 00 1184475063 0 BODNAR THOMAS 2024157 9999999 B 10 1184475063 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1184475063 0 Physicians Anesthesia Services 20 1184475063 0 Physicians Fluoride varnish 20 1184475063 0 Physicians Healthy Kids Services 20 1184475063 0 Physicians Optical Supplies 20 1184475063 0 Physicians Physician Services 00 1184475964 0 SONI PRIYA 2024179 9999999 B 10 1184475964 0 PO BOX 3039 OAK BROOK IL 605223039 20 1184475964 0 Physicians Anesthesia Services 20 1184475964 0 Physicians Fluoride varnish 20 1184475964 0 Physicians Healthy Kids Services 20 1184475964 0 Physicians Optical Supplies 20 1184475964 0 Physicians Physician Services 00 1184475972 0 KADAMANDLA NOEL R 2024181 9999999 B 10 1184475972 0 PO BOX 3039 OAK BROOK IL 605223039 20 1184475972 0 Physicians Anesthesia Services 20 1184475972 0 Physicians Fluoride varnish 20 1184475972 0 Physicians Healthy Kids Services 20 1184475972 0 Physicians Optical Supplies 20 1184475972 0 Physicians Physician Services 00 1184476608 0 FRASER CONNOR C 2024238 9999999 B 10 1184476608 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1184476608 0 Physicians Anesthesia Services 20 1184476608 0 Physicians Healthy Kids Services 20 1184476608 0 Physicians Optical Supplies 20 1184476608 0 Physicians Physician Services 00 1184477051 0 NAIR PRIYA 2024181 9999999 B 10 1184477051 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 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1184477465 0 Physicians Fluoride varnish 20 1184477465 0 Physicians Healthy Kids Services 20 1184477465 0 Physicians Optical Supplies 20 1184477465 0 Physicians Physician Services 00 1184478471 0 LIVINGSTON TORIE 2024181 9999999 B 10 1184478471 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1184478471 0 Physicians Anesthesia Services 20 1184478471 0 Physicians Fluoride varnish 20 1184478471 0 Physicians Healthy Kids Services 20 1184478471 0 Physicians Optical Supplies 20 1184478471 0 Physicians Physician Services 00 1184478877 0 JASIONOWSKI THOMAS 2024193 9999999 B 10 1184478877 0 221 NE GLEN OAK AVE PEORIA IL 616360002 20 1184478877 0 Physicians Anesthesia Services 20 1184478877 0 Physicians Healthy Kids Services 20 1184478877 0 Physicians Optical Supplies 20 1184478877 0 Physicians Physician Services 20 1184478877 0 Physicians Physicians Psychiatric Services 00 1184479842 0 CHAUDHARY POOJA 2024261 9999999 B 10 1184479842 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1184479842 0 Physicians Anesthesia Services 20 1184479842 0 Physicians Healthy Kids Services 20 1184479842 0 Physicians Optical Supplies 20 1184479842 0 Physicians Physician Services 20 1184479842 0 Physicians Physicians Psychiatric Services 00 1184486953 0 YUN JIHO 2024078 9999999 B 10 1184486953 0 727 RIDGEVIEW DR MCHENRY IL 600507054 20 1184486953 0 Dentists Dental Services 20 1184486953 0 Dentists Physician Services 00 1184487118 0 NGUYEN PAUL 2024200 9999999 B 10 1184487118 0 331 S MAIN ST VIRGINIA IL 626911571 20 1184487118 0 Dentists Dental Services 20 1184487118 0 Dentists Physician Services 00 1184487548 0 RUSSELL KIMBERLY ANN 2024032 9999999 B 10 1184487548 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1184487548 0 Physician Assistant Only Fluoride varnish 20 1184487548 0 Physician Assistant Only Healthy Kids Services 20 1184487548 0 Physician Assistant Only Physician Services 00 1184488645 0 COLAZO JUAN M 2024173 9999999 B 10 1184488645 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1184488645 0 Physicians Anesthesia Services 20 1184488645 0 Physicians Healthy Kids Services 20 1184488645 0 Physicians Optical Supplies 20 1184488645 0 Physicians Physician Services 00 1184491839 0 FRICKELTON KRISTA 2024025 9999999 B 10 1184491839 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1184491839 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1184492548 0 PUTHENVEETIL REEJA R 2024214 9999999 B 10 1184492548 0 2340 S HIGHLAND AVE STE 230 SUITE 230 LOMBARD IL 601485396 20 1184492548 0 Nurse Practitioners Fluoride varnish 20 1184492548 0 Nurse Practitioners Healthy Kids Services 20 1184492548 0 Nurse Practitioners Nurse Practitioners Services 20 1184492548 0 Nurse Practitioners Physician Services 00 1184493439 0 BROWN DRAKARI 2023363 9999999 B 10 1184493439 0 PO BOX 1109 DEKALB IL 601157109 20 1184493439 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1184493819 0 LYON JESSICA L 2024081 9999999 B 10 1184493819 0 PO BOX 778912 CHICAGO IL 606778912 20 1184493819 0 Nurse Practitioners Fluoride varnish 20 1184493819 0 Nurse Practitioners Healthy Kids Services 20 1184493819 0 Nurse Practitioners Nurse Practitioners Services 20 1184493819 0 Nurse Practitioners Physician Services 00 1184498529 0 ZALDIVAR-GARCIA PAOLA 2024121 9999999 B 10 1184498529 0 PO BOX 1510 EVANSVILLE IN 477061510 20 1184498529 0 Nurse Practitioners Healthy Kids Services 20 1184498529 0 Nurse Practitioners Nurse Practitioners Services 20 1184498529 0 Nurse Practitioners Physician Services 00 1184499345 0 POROD THERESE 2024067 9999999 B 10 1184499345 0 7450 WOLF RD BURR RIDGE IL 605277714 20 1184499345 0 Speech Therapists Medical Supplies 20 1184499345 0 Speech Therapists Medical equipment/prosthetic devices 20 1184499345 0 Speech Therapists Speech Therapy/Pathology Services 00 1184600991 0 GUPTA ROOP R 1988183 9999999 B 10 1184600991 0 PO BOX 776473 CHICAGO IL 606776473 20 1184600991 0 Physicians Anesthesia Services 20 1184600991 0 Physicians Fluoride varnish 20 1184600991 0 Physicians Healthy Kids Services 20 1184600991 0 Physicians Optical Supplies 20 1184600991 0 Physicians Physician Services 00 1184601452 0 JOHNSON STUART 1993220 9999999 B 10 1184601452 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1184601452 0 Physicians Anesthesia Services 20 1184601452 0 Physicians Fluoride varnish 20 1184601452 0 Physicians Healthy Kids Services 20 1184601452 0 Physicians Optical Supplies 20 1184601452 0 Physicians Physician Services 00 1184601577 0 DARMADI MICHAEL H 1998196 9999999 B 10 1184601577 0 1003 N 8TH ST VANDALIA IL 624711238 20 1184601577 0 Physicians Anesthesia Services 20 1184601577 0 Physicians Fluoride varnish 20 1184601577 0 Physicians Healthy Kids Services 20 1184601577 0 Physicians Optical Supplies 20 1184601577 0 Physicians Physician Services 00 1184602013 0 SHORT RODNEY A 2001157 9999999 B 10 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CAROL STREAM IL 601220021 20 1184602732 0 Physicians Anesthesia Services 20 1184602732 0 Physicians Fluoride varnish 20 1184602732 0 Physicians Healthy Kids Services 20 1184602732 0 Physicians Optical Supplies 20 1184602732 0 Physicians Physician Services 00 1184603961 0 KOZYCKYJ ROMAN O 1984013 9999999 B 10 1184603961 0 4700 W 95TH ST STE 206 SUITE 206 OAK LAWN IL 604532574 20 1184603961 0 Physicians Anesthesia Services 20 1184603961 0 Physicians Fluoride varnish 20 1184603961 0 Physicians Healthy Kids Services 20 1184603961 0 Physicians Optical Supplies 20 1184603961 0 Physicians Physician Services 00 1184604282 0 MCCLURKIN CLARK 1989182 9999999 B 10 1184604282 0 210 S DESPLAINES ST CHICAGO IL 606615500 20 1184604282 0 Physicians Anesthesia Services 20 1184604282 0 Physicians Fluoride varnish 20 1184604282 0 Physicians Healthy Kids Services 20 1184604282 0 Physicians Optical Supplies 20 1184604282 0 Physicians Physician Services 00 1184605248 0 DANS MARIA C 2007305 9999999 B 10 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1184608929 0 Physicians Physician Services 00 1184609224 0 BHORADE RAJEEV M 2002182 9999999 B 10 1184609224 0 645 S CENTRAL AVE CHICAGO IL 606445059 20 1184609224 0 Physicians Anesthesia Services 20 1184609224 0 Physicians Healthy Kids Services 20 1184609224 0 Physicians Optical Supplies 20 1184609224 0 Physicians Physician Services 00 1184610107 0 IBRAHIM LUCY 1989205 9999999 B 10 1184610107 0 201 E OGDEN AVE STE 220 HINSDALE IL 605213661 20 1184610107 0 Physicians Anesthesia Services 20 1184610107 0 Physicians Healthy Kids Services 20 1184610107 0 Physicians Optical Supplies 20 1184610107 0 Physicians Physician Services 20 1184610107 0 Physicians Physicians Psychiatric Services 00 1184610206 0 GROSE CHARLES F 1984348 9999999 B 10 1184610206 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1184610206 0 Physicians Anesthesia Services 20 1184610206 0 Physicians Fluoride varnish 20 1184610206 0 Physicians Healthy Kids Services 20 1184610206 0 Physicians Optical Supplies 20 1184610206 0 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1184614653 0 Podiatrists Podiatric Services 00 1184614711 0 MIKATI ISSAM A 2005244 9999999 B 10 1184614711 0 5777 DEPT CAROL STREAM IL 601220021 20 1184614711 0 Physicians Anesthesia Services 20 1184614711 0 Physicians Fluoride varnish 20 1184614711 0 Physicians Healthy Kids Services 20 1184614711 0 Physicians Optical Supplies 20 1184614711 0 Physicians Physician Services 00 1184615080 0 HODGES CHRISTOPHER R 2017032 9999999 B 10 1184615080 0 2605 KENTUCKY AVE STE 306 SUITE 306 PADUCAH KY 420033802 20 1184615080 0 Physician Assistant Only Fluoride varnish 20 1184615080 0 Physician Assistant Only Healthy Kids Services 20 1184615080 0 Physician Assistant Only Physician Services 00 1184615866 0 COTNER DANNA 1995013 9999999 B 10 1184615866 0 1365 DOUGLAS DR CARBONDALE IL 629012583 20 1184615866 0 Dentists Dental Services 20 1184615866 0 Dentists Physician Services 00 1184616120 0 JOHNSON JOY L 2010182 9999999 B 10 1184616120 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1184616120 0 Physicians Anesthesia Services 20 1184616120 0 Physicians Fluoride varnish 20 1184616120 0 Physicians Healthy Kids Services 20 1184616120 0 Physicians Optical Supplies 20 1184616120 0 Physicians Physician Services 00 1184616187 0 KRAKLOW WILLIAM 1997274 9999999 B 10 1184616187 0 335 E MAHN CT OAK CREEK WI 531542155 20 1184616187 0 Physicians Anesthesia Services 20 1184616187 0 Physicians Fluoride varnish 20 1184616187 0 Physicians Healthy Kids Services 20 1184616187 0 Physicians Optical Supplies 20 1184616187 0 Physicians Physician Services 00 1184616286 0 FELDOTT-JOHNSON DEBRA 2000153 9999999 B 10 1184616286 0 1250 MERCANTILE DR HIGHLAND IL 622491239 20 1184616286 0 Physicians Anesthesia Services 20 1184616286 0 Physicians Fluoride varnish 20 1184616286 0 Physicians Healthy Kids Services 20 1184616286 0 Physicians Optical Supplies 20 1184616286 0 Physicians Physician Services 00 1184616864 0 HORTON MICHAEL G 1999244 9999999 B 10 1184616864 0 5777 DEPT CAROL STREAM IL 601220021 20 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Services 20 1184617995 0 Physicians Healthy Kids Services 20 1184617995 0 Physicians Optical Supplies 20 1184617995 0 Physicians Physician Services 20 1184617995 0 Physicians Physicians Psychiatric Services 00 1184618258 0 BREWER BENJAMIN E 1995182 9999999 B 10 1184618258 0 1120 N MELVIN ST GIBSON CITY IL 609361477 20 1184618258 0 Physicians Anesthesia Services 20 1184618258 0 Physicians Fluoride varnish 20 1184618258 0 Physicians Healthy Kids Services 20 1184618258 0 Physicians Optical Supplies 20 1184618258 0 Physicians Physician Services 00 1184618415 0 HIBBARD ANNE L 2015294 9999999 B 10 1184618415 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1184618415 0 Physicians Anesthesia Services 20 1184618415 0 Physicians Fluoride varnish 20 1184618415 0 Physicians Healthy Kids Services 20 1184618415 0 Physicians Optical Supplies 20 1184618415 0 Physicians Physician Services 00 1184618662 0 PHILOBOS MARIE 1996050 9999999 B 10 1184618662 0 1860 PAYSPHERE CIR CHICAGO IL 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1184619785 0 Physicians Healthy Kids Services 20 1184619785 0 Physicians Optical Supplies 20 1184619785 0 Physicians Physician Services 00 1184619900 0 LORIMER MONICA L 2007253 9999999 B 10 1184619900 0 5777 DEPT CAROL STREAM IL 601228942 20 1184619900 0 Physicians Anesthesia Services 20 1184619900 0 Physicians Healthy Kids Services 20 1184619900 0 Physicians Optical Supplies 20 1184619900 0 Physicians Physician Services 00 1184620569 0 SAAK THOMAS 1997182 9999999 B 10 1184620569 0 339 CONSORT DR BALLWIN MO 630114439 20 1184620569 0 Physicians Anesthesia Services 20 1184620569 0 Physicians Healthy Kids Services 20 1184620569 0 Physicians Optical Supplies 20 1184620569 0 Physicians Physician Services 00 1184621021 0 DYESS DEREK S 2022304 9999999 B 10 1184621021 0 1000 N ALLEN ST ROBINSON IL 624541114 20 1184621021 0 Physicians Anesthesia Services 20 1184621021 0 Physicians Healthy Kids Services 20 1184621021 0 Physicians Optical Supplies 20 1184621021 0 Physicians Physician Services 00 1184621823 0 CASINO W PHILIP R 1997245 9999999 B 10 1184621823 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1184621823 0 Physicians Anesthesia Services 20 1184621823 0 Physicians Fluoride varnish 20 1184621823 0 Physicians Healthy Kids Services 20 1184621823 0 Physicians Optical Supplies 20 1184621823 0 Physicians Physician Services 00 1184622169 0 BRANN DONALD D 1988091 9999999 B 10 1184622169 0 16523 106TH CT ORLAND PARK IL 604674545 20 1184622169 0 Podiatrists Podiatric Services 00 1184622359 0 PARIKH SHITAL 2024061 9999999 B 10 1184622359 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1184622359 0 Physicians Anesthesia Services 20 1184622359 0 Physicians Healthy Kids Services 20 1184622359 0 Physicians Optical Supplies 20 1184622359 0 Physicians Physician Services 00 1184623241 0 SHIVER MAX 2020139 9999999 B 10 1184623241 0 PO BOX 1380 ANNISTON AL 362021380 20 1184623241 0 Physicians Anesthesia Services 20 1184623241 0 Physicians Fluoride varnish 20 1184623241 0 Physicians Healthy Kids Services 20 1184623241 0 Physicians Optical Supplies 20 1184623241 0 Physicians Physician Services 00 1184623746 0 PEACHEY KEITH E 1990213 9999999 B 10 1184623746 0 124 SW ADAMS ST FL 2 PEORIA IL 616021308 20 1184623746 0 Physicians Anesthesia Services 20 1184623746 0 Physicians Healthy Kids Services 20 1184623746 0 Physicians Optical Supplies 20 1184623746 0 Physicians Physician Services 00 1184624074 0 SPERELAKIS ANTOINETTE 2001121 9999999 B 10 1184624074 0 PO BOX 5959 CAROL STREAM IL 601975959 20 1184624074 0 Physicians Anesthesia Services 20 1184624074 0 Physicians Healthy Kids Services 20 1184624074 0 Physicians Optical Supplies 20 1184624074 0 Physicians Physician Services 00 1184624280 0 LIZER ROBERT 1996245 9999999 B 10 1184624280 0 PO BOX 1346 PEORIA IL 616541346 20 1184624280 0 Physicians Anesthesia Services 20 1184624280 0 Physicians Fluoride varnish 20 1184624280 0 Physicians Healthy Kids Services 20 1184624280 0 Physicians Optical Supplies 20 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PO BOX 84992 CHICAGO IL 606894992 20 1184624819 0 Physicians Anesthesia Services 20 1184624819 0 Physicians Healthy Kids Services 20 1184624819 0 Physicians Optical Supplies 20 1184624819 0 Physicians Physician Services 00 1184625600 0 RUBIN RACHEL L 2004336 9999999 B 10 1184625600 0 5777 DEPT CAROL STREAM IL 601220021 20 1184625600 0 Physicians Anesthesia Services 20 1184625600 0 Physicians Healthy Kids Services 20 1184625600 0 Physicians Optical Supplies 20 1184625600 0 Physicians Physician Services 00 1184626244 0 ELLISON PATRICK KEM 2001335 9999999 B 10 1184626244 0 2200 JEFFERSON AVE TOLEDO OH 436047101 20 1184626244 0 Physicians Anesthesia Services 20 1184626244 0 Physicians Healthy Kids Services 20 1184626244 0 Physicians Optical Supplies 20 1184626244 0 Physicians Physician Services 00 1184626277 0 BOWLING DERRICK 2023031 9999999 B 10 1184626277 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1184626277 0 Physicians Anesthesia Services 20 1184626277 0 Physicians 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SANCKEN ELLEN 2002120 9999999 B 10 1184630428 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1184630428 0 Occupational Therapists Medical Supplies 20 1184630428 0 Occupational Therapists Medical equipment/prosthetic devices 20 1184630428 0 Occupational Therapists Occupational Therapy Services 00 1184630741 0 NUESSLE NANETTE 1994001 9999999 B 10 1184630741 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1184630741 0 Physicians Anesthesia Services 20 1184630741 0 Physicians Fluoride varnish 20 1184630741 0 Physicians Healthy Kids Services 20 1184630741 0 Physicians Optical Supplies 20 1184630741 0 Physicians Physician Services 00 1184630923 0 FERRO MARIA 2020113 9999999 B 10 1184630923 0 2111 OGDEN AVE AURORA IL 605047597 20 1184630923 0 Physician Assistant Only Fluoride varnish 20 1184630923 0 Physician Assistant Only Healthy Kids Services 20 1184630923 0 Physician Assistant Only Physician Services 00 1184631715 0 EVANS WAYNE 2006182 9999999 B 10 1184631715 0 2550 CHARLES ST 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1184635864 0 Physical Therapists Development Therapy, Orientation and Mobility Services 20 1184635864 0 Physical Therapists Early Intervention Services 20 1184635864 0 Physical Therapists Medical Supplies 20 1184635864 0 Physical Therapists Medical equipment/prosthetic devices 20 1184635864 0 Physical Therapists Physical Therapy Services 20 1184635864 0 Physical Therapists Targeted case management service 00 1184636052 0 MCCORVEY BARBARA M 2011333 9999999 B 10 1184636052 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1184636052 0 Physicians Anesthesia Services 20 1184636052 0 Physicians Healthy Kids Services 20 1184636052 0 Physicians Optical Supplies 20 1184636052 0 Physicians Physician Services 00 1184636474 0 ROY PATRICIA 1995001 9999999 B 10 1184636474 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1184636474 0 Physicians Anesthesia Services 20 1184636474 0 Physicians Healthy Kids Services 20 1184636474 0 Physicians Optical Supplies 20 1184636474 0 Physicians Physician Services 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20 1184661407 0 Physicians Healthy Kids Services 20 1184661407 0 Physicians Optical Supplies 20 1184661407 0 Physicians Physician Services 20 1184661407 0 Physicians Physicians Psychiatric Services 00 1184661530 0 MEDALLE EMELIE 2004183 9999999 B 10 1184661530 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1184661530 0 Physicians Anesthesia Services 20 1184661530 0 Physicians Fluoride varnish 20 1184661530 0 Physicians Healthy Kids Services 20 1184661530 0 Physicians Optical Supplies 20 1184661530 0 Physicians Physician Services 00 1184661779 0 SAVAGE MARK A 1998131 9999999 B 10 1184661779 0 6300 RIDGLEA PL STE 201 FORT WORTH TX 761165707 20 1184661779 0 Physicians Anesthesia Services 20 1184661779 0 Physicians Fluoride varnish 20 1184661779 0 Physicians Healthy Kids Services 20 1184661779 0 Physicians Optical Supplies 20 1184661779 0 Physicians Physician Services 00 1184662207 0 ROWLEY JAMES A 2023107 9999999 B 10 1184662207 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1184662207 0 Physicians Anesthesia Services 20 1184662207 0 Physicians Fluoride varnish 20 1184662207 0 Physicians Healthy Kids Services 20 1184662207 0 Physicians Optical Supplies 20 1184662207 0 Physicians Physician Services 00 1184663247 0 KARAVATTUVEETIL REENI 1996001 9999999 B 10 1184663247 0 1890 SILVER CROSS BLVD STE 255 NEW LENOX IL 604519528 20 1184663247 0 Physicians Anesthesia Services 20 1184663247 0 Physicians Healthy Kids Services 20 1184663247 0 Physicians Optical Supplies 20 1184663247 0 Physicians Physician Services 00 1184663742 0 GARG SHAMILA 2019007 9999999 B 10 1184663742 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1184663742 0 Physicians Anesthesia Services 20 1184663742 0 Physicians Fluoride varnish 20 1184663742 0 Physicians Healthy Kids Services 20 1184663742 0 Physicians Optical Supplies 20 1184663742 0 Physicians Physician Services 00 1184664427 0 KREINDLER FELISSA B 1997305 9999999 B 10 1184664427 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1184664427 0 Physicians Anesthesia Services 20 1184664427 0 Physicians Fluoride varnish 20 1184664427 0 Physicians Healthy Kids Services 20 1184664427 0 Physicians Optical Supplies 20 1184664427 0 Physicians Physician Services 00 1184664773 0 KING NOREEN R 2016236 9999999 B 10 1184664773 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1184664773 0 Physicians Anesthesia Services 20 1184664773 0 Physicians Healthy Kids Services 20 1184664773 0 Physicians Optical Supplies 20 1184664773 0 Physicians Physician Services 00 1184665424 0 AMIN HETAL S 2014182 9999999 B 10 1184665424 0 725 SCHOOL ST STE A MORRIS IL 604501207 20 1184665424 0 Physicians Anesthesia Services 20 1184665424 0 Physicians Healthy Kids Services 20 1184665424 0 Physicians Optical Supplies 20 1184665424 0 Physicians Physician Services 00 1184668204 0 SETABUTR PETE 2006182 9999999 B 10 1184668204 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1184668204 0 Physicians Anesthesia Services 20 1184668204 0 Physicians Healthy Kids 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1184670622 0 Physicians Optical Supplies 20 1184670622 0 Physicians Physician Services 00 1184670671 0 SIDDIQUI ARSHEA 2002238 9999999 B 10 1184670671 0 603 E 170TH ST SOUTH HOLLAND IL 604733408 20 1184670671 0 Physicians Anesthesia Services 20 1184670671 0 Physicians Fluoride varnish 20 1184670671 0 Physicians Healthy Kids Services 20 1184670671 0 Physicians Optical Supplies 20 1184670671 0 Physicians Physician Services 00 1184670713 0 FLEISHMAN DARRYL 1994152 9999999 B 10 1184670713 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1184670713 0 Physicians Anesthesia Services 20 1184670713 0 Physicians Healthy Kids Services 20 1184670713 0 Physicians Optical Supplies 20 1184670713 0 Physicians Physician Services 00 1184671323 0 RAJCHERT DONNA 2002122 9999999 B 10 1184671323 0 3407 MOMENTUM PL CHICAGO IL 606890001 20 1184671323 0 Physicians Anesthesia Services 20 1184671323 0 Physicians Healthy Kids Services 20 1184671323 0 Physicians Optical Supplies 20 1184671323 0 Physicians Physician Services 00 1184671588 0 EHLERT RACHEL 2005032 9999999 B 10 1184671588 0 850 43RD AVE STE 100 MOLINE IL 612658401 20 1184671588 0 Physical Therapists Medical Supplies 20 1184671588 0 Physical Therapists Medical equipment/prosthetic devices 20 1184671588 0 Physical Therapists Physical Therapy Services 00 1184672016 0 KIM CHARLES C 1995182 9999999 B 10 1184672016 0 PO BOX 713388 CHICAGO IL 606771525 20 1184672016 0 Physicians Anesthesia Services 20 1184672016 0 Physicians Healthy Kids Services 20 1184672016 0 Physicians Optical Supplies 20 1184672016 0 Physicians Physician Services 00 1184672586 0 FINNEY BARBARA K 2015340 9999999 B 10 1184672586 0 2200 JEFFERSON AVE TOLEDO OH 436047101 20 1184672586 0 Nurse Practitioners Fluoride varnish 20 1184672586 0 Nurse Practitioners Healthy Kids Services 20 1184672586 0 Nurse Practitioners Nurse Practitioners Services 20 1184672586 0 Nurse Practitioners Physician Services 00 1184672628 0 WILDEMAN JACKI L 2016326 9999999 B 10 1184672628 0 PO BOX 1230 EVANSVILLE IN 477061230 20 1184672628 0 Nurse Practitioners Healthy Kids Services 20 1184672628 0 Nurse Practitioners Nurse Practitioners Services 20 1184672628 0 Nurse Practitioners Physician Services 00 1184673089 0 RAMADURAI GOVIND 1998182 9999999 B 10 1184673089 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1184673089 0 Physicians Anesthesia Services 20 1184673089 0 Physicians Fluoride varnish 20 1184673089 0 Physicians Healthy Kids Services 20 1184673089 0 Physicians Optical Supplies 20 1184673089 0 Physicians Physician Services 00 1184673147 0 AMANULLAH JAMALUDDIN 2011157 9999999 B 10 1184673147 0 101 E 9TH ST PANA IL 625571716 20 1184673147 0 Physicians Anesthesia Services 20 1184673147 0 Physicians Fluoride varnish 20 1184673147 0 Physicians Healthy Kids Services 20 1184673147 0 Physicians Optical Supplies 20 1184673147 0 Physicians Physician Services 00 1184674236 0 KEMPF ROBERT 1992001 9999999 B 10 1184674236 0 PO BOX 120288 DALLAS TX 753120288 20 1184674236 0 Physicians Anesthesia Services 20 1184674236 0 Physicians Healthy Kids Services 20 1184674236 0 Physicians Optical Supplies 20 1184674236 0 Physicians Physician Services 00 1184674376 0 KANDEL NINEL 1995191 9999999 B 10 1184674376 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1184674376 0 Physicians Anesthesia Services 20 1184674376 0 Physicians Fluoride varnish 20 1184674376 0 Physicians Healthy Kids Services 20 1184674376 0 Physicians Optical Supplies 20 1184674376 0 Physicians Physician Services 00 1184675258 0 KIM JALPA B 2023069 9999999 B 10 1184675258 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1184675258 0 Physicians Anesthesia Services 20 1184675258 0 Physicians Healthy Kids Services 20 1184675258 0 Physicians Optical Supplies 20 1184675258 0 Physicians Physician Services 00 1184675571 0 WARD BLAKELEY 2025050 9999999 B 10 1184675571 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1184675571 0 Nurse Practitioners Anesthesia Services 20 1184675571 0 Nurse Practitioners Nurse Practitioners Services 20 1184675571 0 Nurse Practitioners Physician Services 00 1184675605 0 CRIPE LINDA H 1995182 9999999 B 10 1184675605 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1184675605 0 Physicians Anesthesia Services 20 1184675605 0 Physicians Fluoride varnish 20 1184675605 0 Physicians Healthy Kids Services 20 1184675605 0 Physicians Optical Supplies 20 1184675605 0 Physicians Physician Services 00 1184675696 0 ABAD SANTOS LYNN 2019059 9999999 B 10 1184675696 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1184675696 0 Nurse Practitioners Fluoride varnish 20 1184675696 0 Nurse Practitioners Healthy Kids Services 20 1184675696 0 Nurse Practitioners Nurse Practitioners Services 20 1184675696 0 Nurse Practitioners Physician Services 00 1184675944 0 CHAMS ROGER 1999123 9999999 B 10 1184675944 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1184675944 0 Physicians Anesthesia Services 20 1184675944 0 Physicians Healthy Kids Services 20 1184675944 0 Physicians Optical 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OAK AVE PEORIA IL 616360001 20 1184676926 0 Physicians Anesthesia Services 20 1184676926 0 Physicians Fluoride varnish 20 1184676926 0 Physicians Healthy Kids Services 20 1184676926 0 Physicians Optical Supplies 20 1184676926 0 Physicians Physician Services 00 1184678336 0 MILLER RANDALL S 2020305 9999999 B 10 1184678336 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1184678336 0 Physicians Anesthesia Services 20 1184678336 0 Physicians Healthy Kids Services 20 1184678336 0 Physicians Optical Supplies 20 1184678336 0 Physicians Physician Services 00 1184678393 0 PAN MIN 2016079 9999999 B 10 1184678393 0 10176 CORPORATE SQUARE DR STE SAINT LOUIS MO 631322924 20 1184678393 0 Physicians Anesthesia Services 20 1184678393 0 Physicians Healthy Kids Services 20 1184678393 0 Physicians Optical Supplies 20 1184678393 0 Physicians Physician Services 20 1184678393 0 Physicians Physicians Psychiatric Services 00 1184678625 0 PONZILLO KATHARINE 2016169 9999999 B 10 1184678625 0 10176 CORPORATE SQUARE DR STE SAINT LOUIS MO 631322924 20 1184678625 0 Physicians Anesthesia Services 20 1184678625 0 Physicians Fluoride varnish 20 1184678625 0 Physicians Healthy Kids Services 20 1184678625 0 Physicians Optical Supplies 20 1184678625 0 Physicians Physician Services 00 1184678823 0 GARAPATI RAJEEV 2003244 9999999 B 10 1184678823 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1184678823 0 Physicians Anesthesia Services 20 1184678823 0 Physicians Healthy Kids Services 20 1184678823 0 Physicians Optical Supplies 20 1184678823 0 Physicians Physician Services 00 1184679193 0 MEMMEL MITIDIERO HEIDI C 2006186 9999999 B 10 1184679193 0 5777 DEPT CAROL STREAM IL 601220021 20 1184679193 0 Physicians Anesthesia Services 20 1184679193 0 Physicians Healthy Kids Services 20 1184679193 0 Physicians Optical Supplies 20 1184679193 0 Physicians Physician Services 00 1184679326 0 HALL CARY L 2017306 9999999 B 10 1184679326 0 9735 LANDMARK PARKWAY DR STE 2 SAINT LOUIS MO 631271666 20 1184679326 0 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1184681637 0 Physicians Fluoride varnish 20 1184681637 0 Physicians Healthy Kids Services 20 1184681637 0 Physicians Optical Supplies 20 1184681637 0 Physicians Physician Services 00 1184682015 0 GULZAR SOHAIL 1997182 9999999 B 10 1184682015 0 6000 HOSPITAL DR HANNIBAL MO 634016887 20 1184682015 0 Physicians Anesthesia Services 20 1184682015 0 Physicians Fluoride varnish 20 1184682015 0 Physicians Healthy Kids Services 20 1184682015 0 Physicians Optical Supplies 20 1184682015 0 Physicians Physician Services 00 1184682072 0 BIBBY ROBERT C. 2017252 9999999 B 10 1184682072 0 2019 W ALDER DR HOFFMAN ESTATES IL 601921509 20 1184682072 0 Psychologist Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1184682072 0 Psychologist Psychologist service 00 1184682635 0 JAMES JEFFREY 2002182 9999999 B 10 1184682635 0 515 22ND AVE MONROE WI 535661569 20 1184682635 0 Optometrists Optical Supplies 20 1184682635 0 Optometrists Optometric Services 20 1184682635 0 Optometrists Physician Services 00 1184683237 0 JOING TODD 2022287 9999999 B 10 1184683237 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1184683237 0 Physicians Anesthesia Services 20 1184683237 0 Physicians Healthy Kids Services 20 1184683237 0 Physicians Optical Supplies 20 1184683237 0 Physicians Physician Services 00 1184683310 0 KLING JAMIE J 2006244 9999999 B 10 1184683310 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1184683310 0 Physicians Anesthesia Services 20 1184683310 0 Physicians Fluoride varnish 20 1184683310 0 Physicians Healthy Kids Services 20 1184683310 0 Physicians Optical Supplies 20 1184683310 0 Physicians Physician Services 00 1184683849 0 RAZZAQUE MOHAMMAD 1996001 9999999 B 10 1184683849 0 3228 W 95TH ST EVERGREEN PARK IL 608052314 20 1184683849 0 Physicians Anesthesia Services 20 1184683849 0 Physicians Fluoride varnish 20 1184683849 0 Physicians Healthy Kids Services 20 1184683849 0 Physicians Optical Supplies 20 1184683849 0 Physicians Physician Services 00 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AIMEN 2002182 9999999 B 10 1184688756 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1184688756 0 Physicians Anesthesia Services 20 1184688756 0 Physicians Healthy Kids Services 20 1184688756 0 Physicians Optical Supplies 20 1184688756 0 Physicians Physician Services 00 1184688806 0 HAMAN DAVID G 2020092 9999999 B 10 1184688806 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1184688806 0 Physicians Anesthesia Services 20 1184688806 0 Physicians Healthy Kids Services 20 1184688806 0 Physicians Optical Supplies 20 1184688806 0 Physicians Physician Services 00 1184689549 0 ZIAEE ALI E 2000183 9999999 B 10 1184689549 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1184689549 0 Physicians Anesthesia Services 20 1184689549 0 Physicians Healthy Kids Services 20 1184689549 0 Physicians Optical Supplies 20 1184689549 0 Physicians Physician Services 00 1184689556 0 PARSONS KATHRYN 2024297 9999999 B 10 1184689556 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1184689556 0 Nurse 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Services 00 1184828170 0 CHAIET SCOTT R 2013182 9999999 B 10 1184828170 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1184828170 0 Physicians Anesthesia Services 20 1184828170 0 Physicians Healthy Kids Services 20 1184828170 0 Physicians Optical Supplies 20 1184828170 0 Physicians Physician Services 00 1184828360 0 MAKSIMOVIC JANE 2012183 9999999 B 10 1184828360 0 111 OAKWOOD RD EAST PEORIA IL 616111853 20 1184828360 0 Physicians Anesthesia Services 20 1184828360 0 Physicians Healthy Kids Services 20 1184828360 0 Physicians Optical Supplies 20 1184828360 0 Physicians Physician Services 00 1184828600 0 CHEN YING 2010182 9999999 B 10 1184828600 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1184828600 0 Physicians Anesthesia Services 20 1184828600 0 Physicians Fluoride varnish 20 1184828600 0 Physicians Healthy Kids Services 20 1184828600 0 Physicians Optical Supplies 20 1184828600 0 Physicians Physician Services 00 1184829137 0 HAYES MANDY L. 2019001 9999999 B 10 1184829137 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1184829137 0 Physicians Anesthesia Services 20 1184829137 0 Physicians Fluoride varnish 20 1184829137 0 Physicians Healthy Kids Services 20 1184829137 0 Physicians Optical Supplies 20 1184829137 0 Physicians Physician Services 00 1184829301 0 CREARY SUSAN E 2018004 9999999 B 10 1184829301 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1184829301 0 Physicians Anesthesia Services 20 1184829301 0 Physicians Fluoride varnish 20 1184829301 0 Physicians Healthy Kids Services 20 1184829301 0 Physicians Optical Supplies 20 1184829301 0 Physicians Physician Services 00 1184829475 0 KHITHA JAYANT 2010335 9999999 B 10 1184829475 0 PO BOX 735044 CHICAGO IL 606735044 20 1184829475 0 Physicians Anesthesia Services 20 1184829475 0 Physicians Fluoride varnish 20 1184829475 0 Physicians Healthy Kids Services 20 1184829475 0 Physicians Optical Supplies 20 1184829475 0 Physicians Physician Services 00 1184831869 0 CHAMBERS CHRISTOPHER 2022098 9999999 B 10 1184831869 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1184831869 0 Physicians Anesthesia Services 20 1184831869 0 Physicians Healthy Kids Services 20 1184831869 0 Physicians Optical Supplies 20 1184831869 0 Physicians Physician Services 00 1184832271 0 JOHNSTON SAMUEL L 2012235 9999999 B 10 1184832271 0 101 E MILLER RD STERLING IL 610811252 20 1184832271 0 Physicians Anesthesia Services 20 1184832271 0 Physicians Fluoride varnish 20 1184832271 0 Physicians Healthy Kids Services 20 1184832271 0 Physicians Optical Supplies 20 1184832271 0 Physicians Physician Services 00 1184832701 0 TURNER MATTHEW 2020153 9999999 B 10 1184832701 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1184832701 0 Physicians Anesthesia Services 20 1184832701 0 Physicians Healthy Kids Services 20 1184832701 0 Physicians Optical Supplies 20 1184832701 0 Physicians Physician Services 00 1184834236 0 LEVIN JOSHUA 2007182 9999999 B 10 1184834236 0 2215 SANDERS RD STE 105 SUITE 105 NORTHBROOK IL 600626194 20 1184834236 0 Physicians Anesthesia Services 20 1184834236 0 Physicians Fluoride varnish 20 1184834236 0 Physicians Healthy Kids Services 20 1184834236 0 Physicians Optical Supplies 20 1184834236 0 Physicians Physician Services 00 1184834244 0 RYAN SUSAN D 2007121 9999999 B 10 1184834244 0 5777 DEPT CAROL STREAM IL 601220021 20 1184834244 0 Nurse Practitioners Healthy Kids Services 20 1184834244 0 Nurse Practitioners Nurse Practitioners Services 20 1184834244 0 Nurse Practitioners Physician Services 00 1184834467 0 LYMAN DIANE 2016356 9999999 B 10 1184834467 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1184834467 0 Physician Assistant Only Fluoride varnish 20 1184834467 0 Physician Assistant Only Healthy Kids Services 20 1184834467 0 Physician Assistant Only Physician Services 00 1184834624 0 KNOCHE ERIC 2009180 9999999 B 10 1184834624 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1184834624 0 Physicians Anesthesia Services 20 1184834624 0 Physicians Fluoride varnish 20 1184834624 0 Physicians Healthy Kids Services 20 1184834624 0 Physicians Optical Supplies 20 1184834624 0 Physicians Physician Services 00 1184834939 0 MALAK PAUL 2022032 9999999 B 10 1184834939 0 500 PORTER AVE AURORA MO 656052365 20 1184834939 0 Physicians Anesthesia Services 20 1184834939 0 Physicians Fluoride varnish 20 1184834939 0 Physicians Healthy Kids Services 20 1184834939 0 Physicians Optical Supplies 20 1184834939 0 Physicians Physician Services 00 1184835480 0 FERNANDEZ FRANCISCO 2018018 9999999 B 10 1184835480 0 2830 VICTORY PKWY STE 119 CINCINNATI OH 452061785 20 1184835480 0 Physicians Anesthesia Services 20 1184835480 0 Physicians Healthy Kids Services 20 1184835480 0 Physicians Optical Supplies 20 1184835480 0 Physicians Physician Services 00 1184835951 0 SGROI MADELAINE 2011305 9999999 B 10 1184835951 0 1160 E SAINT CLAIR ST VINCENNES IN 475914853 20 1184835951 0 Physicians Anesthesia Services 20 1184835951 0 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1184838575 0 Physicians Optical Supplies 20 1184838575 0 Physicians Physician Services 00 1184839011 0 KUO SHERRY 2017269 9999999 B 10 1184839011 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1184839011 0 Physicians Anesthesia Services 20 1184839011 0 Physicians Fluoride varnish 20 1184839011 0 Physicians Healthy Kids Services 20 1184839011 0 Physicians Optical Supplies 20 1184839011 0 Physicians Physician Services 00 1184839656 0 FISHMAN MARYANNE 2018346 9999999 B 10 1184839656 0 5777 DEPT CAROL STREAM IL 601220021 20 1184839656 0 Nurse Practitioners Healthy Kids Services 20 1184839656 0 Nurse Practitioners Nurse Practitioners Services 20 1184839656 0 Nurse Practitioners Physician Services 00 1184840175 0 COHEN SCOTT B 2011153 9999999 B 10 1184840175 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1184840175 0 Physicians Anesthesia Services 20 1184840175 0 Physicians Fluoride varnish 20 1184840175 0 Physicians Healthy Kids Services 20 1184840175 0 Physicians Optical Supplies 20 1184840175 0 Physicians Physician Services 00 1184840290 0 SCHIRF BRIAN 2018213 9999999 B 10 1184840290 0 1660 FEEHANVILLE DR # 190 MT PROSPECT IL 600566019 20 1184840290 0 Physicians Anesthesia Services 20 1184840290 0 Physicians Healthy Kids Services 20 1184840290 0 Physicians Optical Supplies 20 1184840290 0 Physicians Physician Services 00 1184841009 0 ROSSETTO REGINA 2008173 9999999 B 10 1184841009 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1184841009 0 Clinical Social Worker Social work service 00 1184842528 0 KIM ELIZABETH 2015082 9999999 B 10 1184842528 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1184842528 0 Physicians Anesthesia Services 20 1184842528 0 Physicians Fluoride varnish 20 1184842528 0 Physicians Healthy Kids Services 20 1184842528 0 Physicians Optical Supplies 20 1184842528 0 Physicians Physician Services 00 1184843328 0 SOIFER ELIZABETH 2015001 9999999 B 10 1184843328 0 543 ORCHARD ST ANTIOCH IL 600023107 20 1184843328 0 Physicians Anesthesia 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1184848145 0 Physicians Optical Supplies 20 1184848145 0 Physicians Physician Services 20 1184848145 0 Physicians Physicians Psychiatric Services 00 1184849747 0 AHDAB TAREK M 2002117 9999999 B 10 1184849747 0 28594 NETWORK PL CHICAGO IL 606731081 20 1184849747 0 Physicians Anesthesia Services 20 1184849747 0 Physicians Fluoride varnish 20 1184849747 0 Physicians Healthy Kids Services 20 1184849747 0 Physicians Optical Supplies 20 1184849747 0 Physicians Physician Services 00 1184850661 0 DESAI MANISHA 2009182 9999999 B 10 1184850661 0 5521 S KEDZIE AVE STE 105 CHICAGO IL 606292403 20 1184850661 0 Dentists Dental Services 20 1184850661 0 Dentists Physician Services 00 1184851792 0 CHOWDHURY NAGIB H 2024277 9999999 B 10 1184851792 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1184851792 0 Physicians Anesthesia Services 20 1184851792 0 Physicians Healthy Kids Services 20 1184851792 0 Physicians Optical Supplies 20 1184851792 0 Physicians Physician Services 20 1184851792 0 Physicians Physicians Psychiatric Services 00 1184852089 0 SIDDIQUE MOMIN S 2015215 9999999 B 10 1184852089 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1184852089 0 Physicians Anesthesia Services 20 1184852089 0 Physicians Fluoride varnish 20 1184852089 0 Physicians Healthy Kids Services 20 1184852089 0 Physicians Optical Supplies 20 1184852089 0 Physicians Physician Services 00 1184852162 0 OBRIEN AMANDA 2013273 9999999 B 10 1184852162 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1184852162 0 Physicians Anesthesia Services 20 1184852162 0 Physicians Healthy Kids Services 20 1184852162 0 Physicians Optical Supplies 20 1184852162 0 Physicians Physician Services 00 1184852592 0 JACKSON GAYLA ESTELLE 2020090 9999999 B 10 1184852592 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1184852592 0 Physicians Anesthesia Services 20 1184852592 0 Physicians Fluoride varnish 20 1184852592 0 Physicians Healthy Kids Services 20 1184852592 0 Physicians Optical Supplies 20 1184852592 0 Physicians Physician Services 00 1184852998 0 WORTH CHRIS 2009182 9999999 B 10 1184852998 0 2001 S CALIFORNIA AVE CHICAGO IL 606082486 20 1184852998 0 Dentists Dental Services 20 1184852998 0 Dentists Physician Services 00 1184853152 0 ZHU TONG 2013244 9999999 B 10 1184853152 0 PO BOX 297 SPARTA IL 622860297 20 1184853152 0 Physicians Anesthesia Services 20 1184853152 0 Physicians Healthy Kids Services 20 1184853152 0 Physicians Optical Supplies 20 1184853152 0 Physicians Physician Services 00 1184853798 0 WEISS-FELDKAMP TIFFANY A 2023218 9999999 B 10 1184853798 0 PO BOX 43230 PHOENIX AZ 850803230 20 1184853798 0 Physicians Anesthesia Services 20 1184853798 0 Physicians Healthy Kids Services 20 1184853798 0 Physicians Optical Supplies 20 1184853798 0 Physicians Physician Services 00 1184854838 0 IRONSTONE SUSAN A 2014213 9999999 B 10 1184854838 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1184854838 0 Physicians Anesthesia Services 20 1184854838 0 Physicians Healthy Kids 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SADIQUE 2010221 9999999 B 10 1184857500 0 1315 N HIGHLAND AVE STE 203 AURORA IL 605061460 20 1184857500 0 Nurse Practitioners Anesthesia Services 20 1184857500 0 Nurse Practitioners Nurse Practitioners Services 20 1184857500 0 Nurse Practitioners Physician Services 00 1184858326 0 MEISEL ADAM F 2015239 9999999 B 10 1184858326 0 8550 W BRYN MAWR AVE STE 800 STE 800 CHICAGO IL 606313222 20 1184858326 0 Physicians Anesthesia Services 20 1184858326 0 Physicians Healthy Kids Services 20 1184858326 0 Physicians Optical Supplies 20 1184858326 0 Physicians Physician Services 00 1184859985 0 DRABKIN KRISTINA D 2013244 9999999 B 10 1184859985 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1184859985 0 Physicians Anesthesia Services 20 1184859985 0 Physicians Healthy Kids Services 20 1184859985 0 Physicians Optical Supplies 20 1184859985 0 Physicians Physician Services 00 1184861197 0 YPIL MAE A 2002092 9999999 B 10 1184861197 0 233 OAKWOOD DR WOOD DALE IL 601911953 20 1184861197 0 Other 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1184866592 0 Physical Therapists Medical Supplies 20 1184866592 0 Physical Therapists Medical equipment/prosthetic devices 20 1184866592 0 Physical Therapists Physical Therapy Services 00 1184869125 0 MATHEW NIBY 2009182 9999999 B 10 1184869125 0 350 N WALL ST KANKAKEE IL 609012901 20 1184869125 0 Physicians Anesthesia Services 20 1184869125 0 Physicians Fluoride varnish 20 1184869125 0 Physicians Healthy Kids Services 20 1184869125 0 Physicians Optical Supplies 20 1184869125 0 Physicians Physician Services 00 1184870131 0 RIKERT DEJAN 2009213 9999999 B 10 1184870131 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1184870131 0 Physicians Anesthesia Services 20 1184870131 0 Physicians Fluoride varnish 20 1184870131 0 Physicians Healthy Kids Services 20 1184870131 0 Physicians Optical Supplies 20 1184870131 0 Physicians Physician Services 00 1184870545 0 RUSINAK DAVID 2011182 9999999 B 10 1184870545 0 5777 DEPT CAROL STREAM IL 601220021 20 1184870545 0 Physicians Anesthesia Services 20 1184870545 0 Physicians Healthy Kids Services 20 1184870545 0 Physicians Optical Supplies 20 1184870545 0 Physicians Physician Services 00 1184870818 0 GOLDMAN KARA 2019028 9999999 B 10 1184870818 0 5777 DEPT CAROL STREAM IL 601220021 20 1184870818 0 Physicians Anesthesia Services 20 1184870818 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1184870818 0 Physicians Healthy Kids Services 20 1184870818 0 Physicians Optical Supplies 20 1184870818 0 Physicians Physician Services 00 1184870958 0 SHAH NAMRATA S 2008259 9999999 B 10 1184870958 0 51 N DUNLAP ST # G145 MEMPHIS TN 381054625 20 1184870958 0 Physicians Anesthesia Services 20 1184870958 0 Physicians Fluoride varnish 20 1184870958 0 Physicians Healthy Kids Services 20 1184870958 0 Physicians Optical Supplies 20 1184870958 0 Physicians Physician Services 00 1184871634 0 BARNES NANCY 2012290 9999999 B 10 1184871634 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1184871634 0 Occupational Therapists 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1184874935 0 Physicians Physician Services 00 1184875072 0 KAUR AMANDEEP 2011182 9999999 B 10 1184875072 0 245 PRAIRIE HILL RD SOUTH BELOIT IL 610802579 20 1184875072 0 Physicians Anesthesia Services 20 1184875072 0 Physicians Fluoride varnish 20 1184875072 0 Physicians Healthy Kids Services 20 1184875072 0 Physicians Optical Supplies 20 1184875072 0 Physicians Physician Services 00 1184875254 0 MAXWELL JOHN L 2018019 9999999 B 10 1184875254 0 2111 OGDEN AVE AURORA IL 605047597 20 1184875254 0 Physical Therapists Medical Supplies 20 1184875254 0 Physical Therapists Medical equipment/prosthetic devices 20 1184875254 0 Physical Therapists Physical Therapy Services 00 1184875262 0 ELHADI SARAH E 2016264 9999999 B 10 1184875262 0 29373 NETWORK PL CHICAGO IL 606733039 20 1184875262 0 Physicians Anesthesia Services 20 1184875262 0 Physicians Fluoride varnish 20 1184875262 0 Physicians Healthy Kids Services 20 1184875262 0 Physicians Optical Supplies 20 1184875262 0 Physicians Physician 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Physicians Anesthesia Services 20 1194015503 0 Physicians Healthy Kids Services 20 1194015503 0 Physicians Optical Supplies 20 1194015503 0 Physicians Physician Services 00 1194016444 0 MCHENRY MEGAN S 2014182 9999999 B 10 1194016444 0 PO BOX 1510 EVANSVILLE IN 477061510 20 1194016444 0 Physicians Anesthesia Services 20 1194016444 0 Physicians Fluoride varnish 20 1194016444 0 Physicians Healthy Kids Services 20 1194016444 0 Physicians Optical Supplies 20 1194016444 0 Physicians Physician Services 00 1194016659 0 LONGENECKER LOREN G 2022243 9999999 B 10 1194016659 0 1 MEDICAL CENTER DR GALENA IL 610368118 20 1194016659 0 Physicians Anesthesia Services 20 1194016659 0 Physicians Healthy Kids Services 20 1194016659 0 Physicians Optical Supplies 20 1194016659 0 Physicians Physician Services 00 1194016758 0 NIRAVEL BINDU 2018199 9999999 B 10 1194016758 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1194016758 0 Physicians Anesthesia Services 20 1194016758 0 Physicians Healthy Kids Services 20 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Physician Services 00 1194386375 0 LIBBY EMMA 2024229 9999999 B 10 1194386375 0 607 S NEW BALLAS RD STE 3100 SAINT LOUIS MO 631418219 20 1194386375 0 Physicians Anesthesia Services 20 1194386375 0 Physicians Healthy Kids Services 20 1194386375 0 Physicians Optical Supplies 20 1194386375 0 Physicians Physician Services 00 1194386573 0 HOPF MELANIE 2019324 9999999 B 10 1194386573 0 120 EXECUTIVE PARK LOUISVILLE KY 402074201 20 1194386573 0 Physician Assistant Only Fluoride varnish 20 1194386573 0 Physician Assistant Only Healthy Kids Services 20 1194386573 0 Physician Assistant Only Physician Services 00 1194387142 0 ZAFAR SHEEMA 2023228 9999999 B 10 1194387142 0 PO BOX 708760 SANDY UT 840708760 20 1194387142 0 Physicians Anesthesia Services 20 1194387142 0 Physicians Fluoride varnish 20 1194387142 0 Physicians Healthy Kids Services 20 1194387142 0 Physicians Optical Supplies 20 1194387142 0 Physicians Physician Services 00 1194387225 0 ASWANI YASHANT 2021019 9999999 B 10 1194387225 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1194387225 0 Physicians Anesthesia Services 20 1194387225 0 Physicians Healthy Kids Services 20 1194387225 0 Physicians Optical Supplies 20 1194387225 0 Physicians Physician Services 00 1194387399 0 MACLIN TWANIQUA 2019308 9999999 B 10 1194387399 0 9718 S HALSTED ST CHICAGO IL 606281007 20 1194387399 0 Nurse Practitioners Fluoride varnish 20 1194387399 0 Nurse Practitioners Healthy Kids Services 20 1194387399 0 Nurse Practitioners Nurse Practitioners Services 20 1194387399 0 Nurse Practitioners Physician Services 00 1194387720 0 KHAN MARIHA 2022229 9999999 B 10 1194387720 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1194387720 0 Physicians Anesthesia Services 20 1194387720 0 Physicians Fluoride varnish 20 1194387720 0 Physicians Healthy Kids Services 20 1194387720 0 Physicians Optical Supplies 20 1194387720 0 Physicians Physician Services 00 1194388330 0 BATTY BEAU 2023192 9999999 B 10 1194388330 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1194388330 0 Physicians Anesthesia Services 20 1194388330 0 Physicians Healthy Kids Services 20 1194388330 0 Physicians Optical Supplies 20 1194388330 0 Physicians Physician Services 20 1194388330 0 Physicians Physicians Psychiatric Services 00 1194388710 0 MOHAMMED OMAR 2022102 9999999 B 10 1194388710 0 5777 DEPT CAROL STREAM IL 601228942 20 1194388710 0 Physicians Anesthesia Services 20 1194388710 0 Physicians Healthy Kids Services 20 1194388710 0 Physicians Optical Supplies 20 1194388710 0 Physicians Physician Services 00 1194389031 0 PATEL KHUSBU 2023216 9999999 B 10 1194389031 0 1455 US HIGHWAY 61 FESTUS MO 630284157 20 1194389031 0 Podiatrists Podiatric Services 00 1194389312 0 PUTNAM ROY 2024283 9999999 B 10 1194389312 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1194389312 0 Physicians Anesthesia Services 20 1194389312 0 Physicians Fluoride varnish 20 1194389312 0 Physicians Healthy Kids Services 20 1194389312 0 Physicians Optical Supplies 20 1194389312 0 Physicians Physician Services 00 1194391235 0 EASTER JAMES 2021193 9999999 B 10 1194391235 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1194391235 0 Physicians Anesthesia Services 20 1194391235 0 Physicians Fluoride varnish 20 1194391235 0 Physicians Healthy Kids Services 20 1194391235 0 Physicians Optical Supplies 20 1194391235 0 Physicians Physician Services 00 1194391631 0 MILLER ZACHARY 2024214 9999999 B 10 1194391631 0 2824 ORCHARD LN WILMETTE IL 600912144 20 1194391631 0 Clinical Social Worker Social work service 00 1194391854 0 HUTCHISON MONICA 2021209 9999999 B 10 1194391854 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1194391854 0 Occupational Therapists Medical Supplies 20 1194391854 0 Occupational Therapists Medical equipment/prosthetic devices 20 1194391854 0 Occupational Therapists Occupational Therapy Services 00 1194392100 0 MOHAMED AHMED 2023328 9999999 B 10 1194392100 0 4698 DEPT CAROL STREAM IL 601220021 20 1194392100 0 Physicians Anesthesia Services 20 1194392100 0 Physicians Healthy Kids Services 20 1194392100 0 Physicians Optical Supplies 20 1194392100 0 Physicians Physician Services 00 1194392654 0 KENNEDY CHRISTY 2021362 9999999 B 10 1194392654 0 PO BOX 850 METROPOLIS IL 629600850 20 1194392654 0 Nurse Practitioners Fluoride varnish 20 1194392654 0 Nurse Practitioners Healthy Kids Services 20 1194392654 0 Nurse Practitioners Nurse Practitioners Services 20 1194392654 0 Nurse Practitioners Physician Services 00 1194393140 0 SETZKE DANIEL 2021221 9999999 B 10 1194393140 0 611 W PARK ST URBANA IL 618012529 20 1194393140 0 Dentists Dental Services 20 1194393140 0 Dentists Physician Services 00 1194393231 0 CARDONA CECILIA 2021187 9999999 B 10 1194393231 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1194393231 0 Licensed Practical Nurses Nursing service 00 1194394296 0 GARVEY WHATLEY MEGAN 2021176 9999999 B 10 1194394296 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1194394296 0 Physicians Anesthesia Services 20 1194394296 0 Physicians Fluoride varnish 20 1194394296 0 Physicians Healthy Kids Services 20 1194394296 0 Physicians Optical Supplies 20 1194394296 0 Physicians Physician Services 00 1194396895 0 YAYAH FAISAL M 2021348 9999999 B 10 1194396895 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1194396895 0 Physicians Anesthesia Services 20 1194396895 0 Physicians Healthy Kids Services 20 1194396895 0 Physicians Optical Supplies 20 1194396895 0 Physicians Physician Services 00 1194398206 0 ALESHNIC HANA 2024274 9999999 B 10 1194398206 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1194398206 0 Nurse Practitioners Healthy Kids Services 20 1194398206 0 Nurse Practitioners Midwife Services 20 1194398206 0 Nurse Practitioners Nurse Practitioners Services 20 1194398206 0 Nurse Practitioners Physician Services 00 1194398248 0 FOLINO SARAH 2021356 9999999 B 10 1194398248 0 5777 DEPT CAROL STREAM IL 601228942 20 1194398248 0 Nurse Practitioners Fluoride varnish 20 1194398248 0 Nurse Practitioners Healthy Kids Services 20 1194398248 0 Nurse Practitioners Nurse Practitioners Services 20 1194398248 0 Nurse Practitioners Physician Services 00 1194398446 0 ALBERS CORIE R 2021224 9999999 B 10 1194398446 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1194398446 0 Nurse Practitioners Healthy Kids Services 20 1194398446 0 Nurse Practitioners Nurse Practitioners Services 20 1194398446 0 Nurse Practitioners Physician Services 00 1194398545 0 RHEE JULIE 2021230 9999999 B 10 1194398545 0 2843 W IRVING PARK RD CHICAGO IL 606183624 20 1194398545 0 Dentists Dental Services 20 1194398545 0 Dentists Physician Services 00 1194398594 0 KHALID FARHAN 2024261 9999999 B 10 1194398594 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1194398594 0 Physicians Anesthesia Services 20 1194398594 0 Physicians Fluoride varnish 20 1194398594 0 Physicians Healthy Kids Services 20 1194398594 0 Physicians Optical Supplies 20 1194398594 0 Physicians Physician Services 00 1194399071 0 VORHEES ELIZABETH A 2021294 9999999 B 10 1194399071 0 29373 NETWORK PL CHICAGO IL 606733039 20 1194399071 0 Nurse Practitioners Healthy Kids Services 20 1194399071 0 Nurse Practitioners Nurse Practitioners Services 20 1194399071 0 Nurse Practitioners Physician Services 00 1194399139 0 ALKARMI AYHAM 2024310 9999999 B 10 1194399139 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1194399139 0 Physicians Anesthesia Services 20 1194399139 0 Physicians Healthy Kids Services 20 1194399139 0 Physicians Optical Supplies 20 1194399139 0 Physicians Physician Services 00 1194399279 0 BICHLER JUSTIN 2024220 9999999 B 10 1194399279 0 750 E TERRA COTTA AVE STE C CRYSTAL LAKE IL 600143621 20 1194399279 0 Podiatrists Podiatric Services 00 1194400267 0 STUART KATHERINE 2023195 9999999 B 10 1194400267 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1194400267 0 Physicians Anesthesia Services 20 1194400267 0 Physicians Healthy Kids Services 20 1194400267 0 Physicians Optical Supplies 20 1194400267 0 Physicians Physician Services 00 1194400879 0 ALI MIR Y 2023218 9999999 B 10 1194400879 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1194400879 0 Physicians Anesthesia Services 20 1194400879 0 Physicians Fluoride varnish 20 1194400879 0 Physicians Healthy Kids Services 20 1194400879 0 Physicians Optical Supplies 20 1194400879 0 Physicians Physician Services 00 1194400994 0 TARRASCH JEFFREY 2023343 9999999 B 10 1194400994 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1194400994 0 Physicians Anesthesia Services 20 1194400994 0 Physicians Fluoride varnish 20 1194400994 0 Physicians Healthy Kids Services 20 1194400994 0 Physicians Optical Supplies 20 1194400994 0 Physicians Physician Services 00 1194402016 0 VERMA MOHINI 2024103 9999999 B 10 1194402016 0 425 E IRVING PARK RD WOOD DALE IL 601911639 20 1194402016 0 Dentists Dental Services 20 1194402016 0 Dentists Physician Services 00 1194402636 0 PUYAT SVYATOSLAV 2023195 9999999 B 10 1194402636 0 6000 N ALLEN RD PEORIA IL 616143294 20 1194402636 0 Physician Assistant Only Fluoride varnish 20 1194402636 0 Physician Assistant Only Healthy Kids Services 20 1194402636 0 Physician Assistant Only Physician Services 00 1194402826 0 SIMMONS VEDA 2023200 9999999 B 10 1194402826 0 414 PLAZA DR STE 301 WESTMONT IL 605595508 20 1194402826 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1194406686 0 RUPAR RAMONA 2023208 9999999 B 10 1194406686 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1194406686 0 Audiologists Audiology Services 20 1194406686 0 Audiologists Medical Supplies 20 1194406686 0 Audiologists Medical equipment/prosthetic devices 00 1194406777 0 CRAIG ASHLEY 2023254 9999999 B 10 1194406777 0 PO BOX 3988 CARBONDALE IL 629023988 20 1194406777 0 Nurse Practitioners Healthy Kids Services 20 1194406777 0 Nurse Practitioners Nurse Practitioners Services 20 1194406777 0 Nurse Practitioners Physician Services 00 1194408021 0 PUK TRACI E 2023275 9999999 B 10 1194408021 0 PO BOX 4176 HOUMA LA 703614176 20 1194408021 0 Nurse Practitioners Healthy Kids Services 20 1194408021 0 Nurse Practitioners Nurse Practitioners Services 20 1194408021 0 Nurse Practitioners Physician Services 00 1194408153 0 BENGTSSON HILLARY 2023241 9999999 B 10 1194408153 0 5777 DEPT CAROL STREAM IL 601220021 20 1194408153 0 Nurse Practitioners Healthy Kids Services 20 1194408153 0 Nurse Practitioners Nurse Practitioners Services 20 1194408153 0 Nurse Practitioners Physician Services 00 1194409409 0 CATEDRAL PAUL 2024047 9999999 B 10 1194409409 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1194409409 0 Physicians Anesthesia Services 20 1194409409 0 Physicians Healthy Kids Services 20 1194409409 0 Physicians Optical Supplies 20 1194409409 0 Physicians Physician Services 00 1194409789 0 BARR ELIZABETH 2023166 9999999 B 10 1194409789 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1194409789 0 Nurse Practitioners Medical Supplies 20 1194409789 0 Nurse Practitioners Medical equipment/prosthetic devices 20 1194409789 0 Nurse Practitioners Occupational Therapy Services 00 1194409946 0 SHAH UNNATI 2024292 9999999 B 10 1194409946 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1194409946 0 Occupational Therapists Medical Supplies 20 1194409946 0 Occupational Therapists Medical equipment/prosthetic devices 20 1194409946 0 Occupational Therapists Occupational Therapy Services 00 1194411751 0 ANDERSON SARAH E 2024235 9999999 B 10 1194411751 0 PO BOX 5081 JANESVILLE WI 535475081 20 1194411751 0 Physician Assistant Only Fluoride varnish 20 1194411751 0 Physician Assistant Only Healthy Kids Services 20 1194411751 0 Physician Assistant Only Physician Services 00 1194411942 0 TABIBI TARA 2024183 9999999 B 10 1194411942 0 4698 DEPT CAROL STREAM IL 601220021 20 1194411942 0 Physicians Anesthesia Services 20 1194411942 0 Physicians Healthy Kids Services 20 1194411942 0 Physicians Optical Supplies 20 1194411942 0 Physicians Physician Services 00 1194412957 0 STAHL MARIA M 2023114 9999999 B 10 1194412957 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1194412957 0 Nurse Practitioners Healthy Kids Services 20 1194412957 0 Nurse Practitioners Nurse Practitioners Services 20 1194412957 0 Nurse Practitioners Physician Services 00 1194413385 0 WOODS BIANCA JENNIFER 2023123 9999999 B 10 1194413385 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1194413385 0 Clinical Social Worker Social work service 00 1194415034 0 GREENE CATHERINE 2023326 9999999 B 10 1194415034 0 1 MEMORIAL DR ALTON IL 620026722 20 1194415034 0 Physicians Anesthesia Services 20 1194415034 0 Physicians Fluoride varnish 20 1194415034 0 Physicians Healthy Kids Services 20 1194415034 0 Physicians Optical Supplies 20 1194415034 0 Physicians Physician Services 00 1194415042 0 PAGE JULIE LORRAINE 2023156 9999999 B 10 1194415042 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1194415042 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1194418186 0 KIM SUNG HOON 2023237 9999999 B 10 1194418186 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1194418186 0 Physicians Anesthesia Services 20 1194418186 0 Physicians Healthy Kids Services 20 1194418186 0 Physicians Optical Supplies 20 1194418186 0 Physicians Physician Services 00 1194418988 0 BENENATI KATHERINE E 2023229 9999999 B 10 1194418988 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1194418988 0 Nurse Practitioners Healthy Kids Services 20 1194418988 0 Nurse Practitioners Nurse Practitioners Services 20 1194418988 0 Nurse Practitioners Physician Services 00 1194419242 0 ZEIGER ZOEY R 2023324 9999999 B 10 1194419242 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1194419242 0 Occupational Therapists Medical Supplies 20 1194419242 0 Occupational Therapists Medical equipment/prosthetic devices 20 1194419242 0 Occupational Therapists Occupational Therapy Services 00 1194419648 0 TRAVIS BRIANA 2024053 9999999 B 10 1194419648 0 331 S MAIN ST VIRGINIA IL 626911571 20 1194419648 0 Dentists Dental Services 20 1194419648 0 Dentists Physician Services 00 1194419861 0 MILLER ERIN D 2025042 9999999 B 10 1194419861 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1194419861 0 Nurse Practitioners Healthy Kids Services 20 1194419861 0 Nurse Practitioners Nurse Practitioners Services 20 1194419861 0 Nurse Practitioners Physician Services 00 1194422816 0 SHACKELFORD SYDNEY 2023061 9999999 B 10 1194422816 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1194422816 0 Nurse Practitioners Fluoride varnish 20 1194422816 0 Nurse Practitioners Healthy Kids Services 20 1194422816 0 Nurse Practitioners Nurse Practitioners Services 20 1194422816 0 Nurse Practitioners Physician Services 00 1194426635 0 JOHNSON KRISTINA 2023135 9999999 B 10 1194426635 0 5777 DEPT CAROL STREAM IL 601220021 20 1194426635 0 Psychologist Psychologist service 00 1194426809 0 POLKE LINDSEY 2023163 9999999 B 10 1194426809 0 29373 NETWORK PL CHICAGO IL 606733039 20 1194426809 0 Nurse Practitioners Healthy Kids Services 20 1194426809 0 Nurse Practitioners Nurse Practitioners Services 20 1194426809 0 Nurse Practitioners Physician Services 00 1194427013 0 SHWE WENDY 2024183 9999999 B 10 1194427013 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1194427013 0 Physicians Anesthesia Services 20 1194427013 0 Physicians Healthy Kids Services 20 1194427013 0 Physicians Optical Supplies 20 1194427013 0 Physicians Physician Services 00 1194428326 0 FOLGA BARBARA ANNA 2023174 9999999 B 10 1194428326 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1194428326 0 Physicians Anesthesia Services 20 1194428326 0 Physicians Fluoride varnish 20 1194428326 0 Physicians Healthy Kids Services 20 1194428326 0 Physicians Optical Supplies 20 1194428326 0 Physicians Physician Services 00 1194428714 0 KULKARNI NEHA 2023200 9999999 B 10 1194428714 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1194428714 0 Physicians Anesthesia Services 20 1194428714 0 Physicians Fluoride varnish 20 1194428714 0 Physicians Healthy Kids Services 20 1194428714 0 Physicians Optical Supplies 20 1194428714 0 Physicians Physician Services 00 1194428755 0 ELIZONDO ERIC 2023200 9999999 B 10 1194428755 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1194428755 0 Physicians Anesthesia Services 20 1194428755 0 Physicians Healthy Kids Services 20 1194428755 0 Physicians Optical Supplies 20 1194428755 0 Physicians Physician Services 20 1194428755 0 Physicians Physicians Psychiatric Services 00 1194429134 0 HAMMOCK JAMES A 2023174 9999999 B 10 1194429134 0 4698 DEPT CAROL STREAM IL 601220021 20 1194429134 0 Physicians Anesthesia Services 20 1194429134 0 Physicians Healthy Kids Services 20 1194429134 0 Physicians Optical Supplies 20 1194429134 0 Physicians Physician Services 20 1194429134 0 Physicians Physicians Psychiatric Services 00 1194429472 0 SERRANO ANNA C 2023275 9999999 B 10 1194429472 0 PO BOX 3039 OAK BROOK IL 605223039 20 1194429472 0 Physicians Anesthesia Services 20 1194429472 0 Physicians Fluoride varnish 20 1194429472 0 Physicians Healthy Kids Services 20 1194429472 0 Physicians Optical Supplies 20 1194429472 0 Physicians Physician Services 00 1194429696 0 WATT BENJAMIN 2023164 2026181 B 10 1194429696 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1194429696 0 Physicians Anesthesia Services 20 1194429696 0 Physicians Fluoride varnish 20 1194429696 0 Physicians Healthy Kids Services 20 1194429696 0 Physicians Optical Supplies 20 1194429696 0 Physicians Physician Services 00 1194429761 0 SALDANA MIGUEL 2023227 2026181 B 10 1194429761 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1194429761 0 Physicians Anesthesia Services 20 1194429761 0 Physicians Fluoride varnish 20 1194429761 0 Physicians Healthy Kids Services 20 1194429761 0 Physicians Optical Supplies 20 1194429761 0 Physicians Physician Services 00 1194430595 0 ELLIOTT LAUREN E 2023039 9999999 B 10 1194430595 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1194430595 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200 HAWKINS DR IOWA CITY IA 522421009 20 1194719401 0 Physicians Anesthesia Services 20 1194719401 0 Physicians Healthy Kids Services 20 1194719401 0 Physicians Optical Supplies 20 1194719401 0 Physicians Physician Services 00 1194719435 0 CHARITON CHRISTINE 2023325 9999999 B 10 1194719435 0 8051 186TH ST TINLEY PARK IL 604879341 20 1194719435 0 Clinical Social Worker Social work service 00 1194719534 0 BELFORD MARY E 1994199 9999999 B 10 1194719534 0 5777 DEPT CAROL STREAM IL 601228942 20 1194719534 0 Physicians Anesthesia Services 20 1194719534 0 Physicians Healthy Kids Services 20 1194719534 0 Physicians Optical Supplies 20 1194719534 0 Physicians Physician Services 20 1194719534 0 Physicians Physicians Psychiatric Services 00 1194719690 0 RAO ANJALI S 2003152 9999999 B 10 1194719690 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1194719690 0 Physicians Anesthesia Services 20 1194719690 0 Physicians Fluoride varnish 20 1194719690 0 Physicians Healthy Kids Services 20 1194719690 0 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1194768838 0 Physicians Healthy Kids Services 20 1194768838 0 Physicians Optical Supplies 20 1194768838 0 Physicians Physician Services 00 1194768903 0 EASTMAN MICHAEL 2018035 9999999 B 10 1194768903 0 801 N LINCOLN AVE MONETT MO 657081641 20 1194768903 0 Physicians Anesthesia Services 20 1194768903 0 Physicians Fluoride varnish 20 1194768903 0 Physicians Healthy Kids Services 20 1194768903 0 Physicians Optical Supplies 20 1194768903 0 Physicians Physician Services 00 1194769273 0 SKAGGS KATHERINE K 1993182 9999999 B 10 1194769273 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1194769273 0 Physicians Anesthesia Services 20 1194769273 0 Physicians Healthy Kids Services 20 1194769273 0 Physicians Optical Supplies 20 1194769273 0 Physicians Physician Services 00 1194770198 0 KIMURA IBUKI A 2008040 9999999 B 10 1194770198 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1194770198 0 Physicians Anesthesia Services 20 1194770198 0 Physicians Fluoride varnish 20 1194770198 0 Physicians 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00 1194773275 0 CHARBONEAU SUSAN A 2018143 9999999 B 10 1194773275 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1194773275 0 Physicians Anesthesia Services 20 1194773275 0 Physicians Healthy Kids Services 20 1194773275 0 Physicians Optical Supplies 20 1194773275 0 Physicians Physician Services 00 1194773374 0 BARROW FIRAS 2016214 9999999 B 10 1194773374 0 800 BIESTERFIELD RD STE G01 ELK GROVE VILLA IL 600073372 20 1194773374 0 Physicians Anesthesia Services 20 1194773374 0 Physicians Fluoride varnish 20 1194773374 0 Physicians Healthy Kids Services 20 1194773374 0 Physicians Optical Supplies 20 1194773374 0 Physicians Physician Services 00 1194773465 0 LYON PAUL 1995213 9999999 B 10 1194773465 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1194773465 0 Physicians Anesthesia Services 20 1194773465 0 Physicians Healthy Kids Services 20 1194773465 0 Physicians Optical Supplies 20 1194773465 0 Physicians Physician Services 00 1194773499 0 RUETTEN TIMOTHY J 1994213 9999999 B 10 1194773499 0 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1194775064 0 Physicians Physician Services 00 1194775445 0 LUNDEEN BRIAN E 1999176 9999999 B 10 1194775445 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1194775445 0 Physicians Anesthesia Services 20 1194775445 0 Physicians Healthy Kids Services 20 1194775445 0 Physicians Optical Supplies 20 1194775445 0 Physicians Physician Services 00 1194775544 0 ZAWODNIAK KASEY 2019346 9999999 B 10 1194775544 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1194775544 0 Nurse Practitioners Fluoride varnish 20 1194775544 0 Nurse Practitioners Healthy Kids Services 20 1194775544 0 Nurse Practitioners Nurse Practitioners Services 20 1194775544 0 Nurse Practitioners Physician Services 00 1194775957 0 VILLASENOR CHRISTIAN Q 2006360 9999999 B 10 1194775957 0 1007 FRANKLIN AVE RIVER FOREST IL 603051339 20 1194775957 0 Nurse Practitioners Anesthesia Services 20 1194775957 0 Nurse Practitioners Nurse Practitioners Services 20 1194775957 0 Nurse Practitioners Physician Services 00 1194776377 0 BAIG MIRZA 1983102 9999999 B 10 1194776377 0 PO BOX 343918 MILWAUKEE WI 532343918 20 1194776377 0 Physicians Anesthesia Services 20 1194776377 0 Physicians Fluoride varnish 20 1194776377 0 Physicians Healthy Kids Services 20 1194776377 0 Physicians Optical Supplies 20 1194776377 0 Physicians Physician Services 00 1194776492 0 GROCHOWSKI SANDRA 2007001 9999999 B 10 1194776492 0 727 E COURT ST PARIS IL 619442460 20 1194776492 0 Physicians Anesthesia Services 20 1194776492 0 Physicians Healthy Kids Services 20 1194776492 0 Physicians Optical Supplies 20 1194776492 0 Physicians Physician Services 00 1194776971 0 GIMENEZ LESLIE M 2002045 9999999 B 10 1194776971 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1194776971 0 Physicians Anesthesia Services 20 1194776971 0 Physicians Fluoride varnish 20 1194776971 0 Physicians Healthy Kids Services 20 1194776971 0 Physicians Optical Supplies 20 1194776971 0 Physicians Physician Services 00 1194777060 0 WILLIAMS JOSEPH HOWARD 2025073 9999999 B 10 1194777060 0 PO BOX 5081 JANESVILLE WI 535475081 20 1194777060 0 Physicians Anesthesia Services 20 1194777060 0 Physicians Healthy Kids Services 20 1194777060 0 Physicians Optical Supplies 20 1194777060 0 Physicians Physician Services 00 1194777193 0 DAMBA DWAYNE N 2015305 9999999 B 10 1194777193 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1194777193 0 Physicians Anesthesia Services 20 1194777193 0 Physicians Healthy Kids Services 20 1194777193 0 Physicians Optical Supplies 20 1194777193 0 Physicians Physician Services 00 1194777888 0 OBRIEN MICHAEL P 2007335 9999999 B 10 1194777888 0 PO BOX 713160 CHICAGO IL 606770360 20 1194777888 0 Physicians Anesthesia Services 20 1194777888 0 Physicians Healthy Kids Services 20 1194777888 0 Physicians Optical Supplies 20 1194777888 0 Physicians Physician Services 00 1194777946 0 BERNSTEIN NORMAN 2016057 9999999 B 10 1194777946 0 PO BOX 7421 MERRIFIELD VA 221167421 20 1194777946 0 Physicians Anesthesia Services 20 1194777946 0 Physicians 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specialties) 00 1194780700 0 HENRY MARY BETH 2009182 9999999 B 10 1194780700 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1194780700 0 Nurse Practitioners Healthy Kids Services 20 1194780700 0 Nurse Practitioners Nurse Practitioners Services 20 1194780700 0 Nurse Practitioners Physician Services 00 1194780718 0 LARSON PATRICIA R 2013353 9999999 H 10 1194780718 0 3248 VANDEVER AVE PEKIN IL 615546257 20 1194780718 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1194781047 0 BINSTADT EMILY 2022336 9999999 B 10 1194781047 0 8170 33RD AVE S MINNEAPOLIS MN 554254516 20 1194781047 0 Physicians Anesthesia Services 20 1194781047 0 Physicians Healthy Kids Services 20 1194781047 0 Physicians Optical Supplies 20 1194781047 0 Physicians Physician Services 00 1194781112 0 ISKANDER SAFWAT 2001111 9999999 B 10 1194781112 0 400 N WALL ST STE 312 KANKAKEE IL 609012964 20 1194781112 0 Physicians Anesthesia Services 20 1194781112 0 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1194783217 0 Physicians Healthy Kids Services 20 1194783217 0 Physicians Optical Supplies 20 1194783217 0 Physicians Physician Services 00 1194783274 0 KUMAR YUVARAJ 2024008 9999999 B 10 1194783274 0 2636 S LOOP W STE 400 HOUSTON TX 770542680 20 1194783274 0 Physicians Anesthesia Services 20 1194783274 0 Physicians Fluoride varnish 20 1194783274 0 Physicians Healthy Kids Services 20 1194783274 0 Physicians Optical Supplies 20 1194783274 0 Physicians Physician Services 00 1194783480 0 THAKKAR MARTA 2006001 9999999 B 10 1194783480 0 PO BOX 1327 BROOKFIELD WI 530081327 20 1194783480 0 Physicians Anesthesia Services 20 1194783480 0 Physicians Fluoride varnish 20 1194783480 0 Physicians Healthy Kids Services 20 1194783480 0 Physicians Optical Supplies 20 1194783480 0 Physicians Physician Services 00 1194784470 0 MAHAIRI AMJAD 1995040 9999999 B 10 1194784470 0 1768 W ALGONQUIN RD ARLINGTON HEIGH IL 600053405 20 1194784470 0 Dentists Dental Services 20 1194784470 0 Dentists Physician Services 00 1194784645 0 BLUMENSTEIN BRIAN 1998182 9999999 B 10 1194784645 0 20 TOWER CT STE F SUITE F GURNEE IL 600315711 20 1194784645 0 Physicians Anesthesia Services 20 1194784645 0 Physicians Fluoride varnish 20 1194784645 0 Physicians Healthy Kids Services 20 1194784645 0 Physicians Optical Supplies 20 1194784645 0 Physicians Physician Services 00 1194785295 0 PETERSON TERRI JO 2016030 9999999 B 10 1194785295 0 350 N GRANDVIEW AVE DUBUQUE IA 520016388 20 1194785295 0 Nurse Practitioners Healthy Kids Services 20 1194785295 0 Nurse Practitioners Nurse Practitioners Services 20 1194785295 0 Nurse Practitioners Physician Services 00 1194785394 0 BLACKWELDER LAUREN D 2008183 9999999 B 10 1194785394 0 5121 MARYLAND WAY STE 300 BRENTWOOD TN 370277516 20 1194785394 0 Physicians Anesthesia Services 20 1194785394 0 Physicians Healthy Kids Services 20 1194785394 0 Physicians Optical Supplies 20 1194785394 0 Physicians Physician Services 00 1194786434 0 DEWEY KATHERINE M 1998281 9999999 B 10 1194786434 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1194786434 0 Physicians Anesthesia Services 20 1194786434 0 Physicians Healthy Kids Services 20 1194786434 0 Physicians Optical Supplies 20 1194786434 0 Physicians Physician Services 00 1194786871 0 QUINONES RICHARD 1991001 9999999 B 10 1194786871 0 2640 183RD ST HOMEWOOD IL 604302914 20 1194786871 0 Physicians Anesthesia Services 20 1194786871 0 Physicians Healthy Kids Services 20 1194786871 0 Physicians Optical Supplies 20 1194786871 0 Physicians Physician Services 00 1194787341 0 BOCKELOH JAMES A 2015359 9999999 B 10 1194787341 0 515 22ND AVE MONROE WI 535661569 20 1194787341 0 Nurse Practitioners Fluoride varnish 20 1194787341 0 Nurse Practitioners Healthy Kids Services 20 1194787341 0 Nurse Practitioners Nurse Practitioners Services 20 1194787341 0 Nurse Practitioners Physician Services 00 1194787754 0 GAUTHIER GREGORY 2006182 9999999 B 10 1194787754 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1194787754 0 Physicians 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1993038 9999999 B 10 1194795591 0 PO BOX 37918 PHILADELPHIA PA 191010515 20 1194795591 0 Physicians Anesthesia Services 20 1194795591 0 Physicians Fluoride varnish 20 1194795591 0 Physicians Healthy Kids Services 20 1194795591 0 Physicians Optical Supplies 20 1194795591 0 Physicians Physician Services 00 1194795609 0 FAGEN KIMBERLY E 2017335 9999999 B 10 1194795609 0 44000 GARFIELD RD CLINTON TOWNSHI MI 480381125 20 1194795609 0 Physicians Anesthesia Services 20 1194795609 0 Physicians Healthy Kids Services 20 1194795609 0 Physicians Optical Supplies 20 1194795609 0 Physicians Physician Services 00 1194797266 0 CAO THOMAS L 2001182 9999999 B 10 1194797266 0 1345 WILEY RD STE 111 SCHAUMBURG IL 601734356 20 1194797266 0 Physicians Anesthesia Services 20 1194797266 0 Physicians Fluoride varnish 20 1194797266 0 Physicians Healthy Kids Services 20 1194797266 0 Physicians Optical Supplies 20 1194797266 0 Physicians Physician Services 00 1194797902 0 SIMS SCOTT 1995001 9999999 B 10 1194797902 0 2250 N ILLINOIS AVE CARBONDALE IL 629015612 20 1194797902 0 Physicians Anesthesia Services 20 1194797902 0 Physicians Healthy Kids Services 20 1194797902 0 Physicians Optical Supplies 20 1194797902 0 Physicians Physician Services 00 1194798033 0 SUAREZ-SOLAR PEDRO 2002126 9999999 B 10 1194798033 0 500 PORTER AVE AURORA MO 656052365 20 1194798033 0 Physicians Anesthesia Services 20 1194798033 0 Physicians Fluoride varnish 20 1194798033 0 Physicians Healthy Kids Services 20 1194798033 0 Physicians Optical Supplies 20 1194798033 0 Physicians Physician Services 00 1194799577 0 RILEY MICHAEL 1998001 9999999 B 10 1194799577 0 1 MEDICAL CENTER DR GALENA IL 610368118 20 1194799577 0 Physicians Anesthesia Services 20 1194799577 0 Physicians Healthy Kids Services 20 1194799577 0 Physicians Optical Supplies 20 1194799577 0 Physicians Physician Services 00 1194799684 0 WANG MU 2007190 9999999 B 10 1194799684 0 611 W PARK ST URBANA IL 618012529 20 1194799684 0 Physicians Anesthesia Services 20 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1194826115 0 Physicians Healthy Kids Services 20 1194826115 0 Physicians Optical Supplies 20 1194826115 0 Physicians Physician Services 00 1194827014 0 SPEULDA GARY 2012304 9999999 B 10 1194827014 0 2S468 LLOYD AVE LOMBARD IL 601485222 20 1194827014 0 Psychologist Psychologist service 00 1194827808 0 EVANS JERRY 2024094 9999999 B 10 1194827808 0 PO BOX 486 SAN JACINTO CA 925810486 20 1194827808 0 Physicians Anesthesia Services 20 1194827808 0 Physicians Healthy Kids Services 20 1194827808 0 Physicians Optical Supplies 20 1194827808 0 Physicians Physician Services 00 1194829408 0 RZUCIDLO JOZEF 1998274 9999999 B 10 1194829408 0 5838 S HARLEM AVE SUMMIT ARGO IL 605011407 20 1194829408 0 Physicians Anesthesia Services 20 1194829408 0 Physicians Fluoride varnish 20 1194829408 0 Physicians Healthy Kids Services 20 1194829408 0 Physicians Optical Supplies 20 1194829408 0 Physicians Physician Services 00 1194829515 0 HORNBACH MARK D 1988270 9999999 B 10 1194829515 0 4701 DEPT CAROL STREAM IL 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KALAMAZOO MI 490075295 20 1194843508 0 Physicians Anesthesia Services 20 1194843508 0 Physicians Healthy Kids Services 20 1194843508 0 Physicians Optical Supplies 20 1194843508 0 Physicians Physician Services 00 1194843649 0 JELEV TANYU 2011213 9999999 B 10 1194843649 0 190 E DELAWARE PL CHICAGO IL 606111813 20 1194843649 0 Physicians Anesthesia Services 20 1194843649 0 Physicians Healthy Kids Services 20 1194843649 0 Physicians Optical Supplies 20 1194843649 0 Physicians Physician Services 00 1194844019 0 LEWICKY GAUPP CHRISTINA E 2009274 9999999 B 10 1194844019 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1194844019 0 Physicians Anesthesia Services 20 1194844019 0 Physicians Healthy Kids Services 20 1194844019 0 Physicians Optical Supplies 20 1194844019 0 Physicians Physician Services 00 1194845180 0 EIPERS AMIE 2019124 9999999 B 10 1194845180 0 29 S WEBSTER ST STE 395 NAPERVILLE IL 605403101 20 1194845180 0 Clinical Social Worker Social work service 00 1194845511 0 YUNDT 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1194850149 0 Physical Therapists Medical Supplies 20 1194850149 0 Physical Therapists Medical equipment/prosthetic devices 20 1194850149 0 Physical Therapists Physical Therapy Services 00 1194850206 0 LEE JEEHYUN 2005213 9999999 B 10 1194850206 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1194850206 0 Physicians Anesthesia Services 20 1194850206 0 Physicians Healthy Kids Services 20 1194850206 0 Physicians Optical Supplies 20 1194850206 0 Physicians Physician Services 00 1194851121 0 STONE ARIN 2014218 9999999 B 10 1194851121 0 1467 N ELSTON AVE STE 203 CHICAGO IL 606422449 20 1194851121 0 Psychologist Psychologist service 00 1194854299 0 COHEN CHERYL 2022117 9999999 B 10 1194854299 0 PO BOX 781076 DETROIT MI 482781076 20 1194854299 0 Physical Therapists Medical Supplies 20 1194854299 0 Physical Therapists Medical equipment/prosthetic devices 20 1194854299 0 Physical Therapists Physical Therapy Services 00 1194854919 0 PAKENHAM MARCIA K 1999309 9999999 B 10 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1194975813 0 Nurse Practitioners Healthy Kids Services 20 1194975813 0 Nurse Practitioners Nurse Practitioners Services 20 1194975813 0 Nurse Practitioners Physician Services 00 1194976415 0 IRONS SUSAN 2008246 9999999 B 10 1194976415 0 611 W PARK ST BWPC URBANA IL 618012529 20 1194976415 0 Speech Therapists Medical Supplies 20 1194976415 0 Speech Therapists Medical equipment/prosthetic devices 20 1194976415 0 Speech Therapists Speech Therapy/Pathology Services 00 1194978387 0 GANDHI STELLA 2024155 9999999 B 10 1194978387 0 340 11TH ST APT 4A BROOKLYN NY 112154056 20 1194978387 0 Physicians Anesthesia Services 20 1194978387 0 Physicians Fluoride varnish 20 1194978387 0 Physicians Healthy Kids Services 20 1194978387 0 Physicians Optical Supplies 20 1194978387 0 Physicians Physician Services 00 1194978817 0 GUTIERREZ CEZARIO 2020141 9999999 B 10 1194978817 0 611 W PARK ST URBANA IL 618012529 20 1194978817 0 Physical Therapists Medical Supplies 20 1194978817 0 Physical Therapists Medical 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1194980318 0 Physicians Physician Services 00 1194980607 0 FANTER NATHAN 2012061 9999999 B 10 1194980607 0 1120 N MELVIN ST GIBSON CITY IL 609361477 20 1194980607 0 Physicians Anesthesia Services 20 1194980607 0 Physicians Healthy Kids Services 20 1194980607 0 Physicians Optical Supplies 20 1194980607 0 Physicians Physician Services 00 1194981019 0 BLOMGREN JOSHUA 2010213 9999999 B 10 1194981019 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1194981019 0 Physicians Anesthesia Services 20 1194981019 0 Physicians Fluoride varnish 20 1194981019 0 Physicians Healthy Kids Services 20 1194981019 0 Physicians Optical Supplies 20 1194981019 0 Physicians Physician Services 00 1194981043 0 QAMAR NASHMIA 2014001 9999999 B 10 1194981043 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1194981043 0 Physicians Anesthesia Services 20 1194981043 0 Physicians Fluoride varnish 20 1194981043 0 Physicians Healthy Kids Services 20 1194981043 0 Physicians Optical Supplies 20 1194981043 0 Physicians Physician Services 00 1194981100 0 KOTHARI AMI 2009244 9999999 B 10 1194981100 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1194981100 0 Physicians Anesthesia Services 20 1194981100 0 Physicians Fluoride varnish 20 1194981100 0 Physicians Healthy Kids Services 20 1194981100 0 Physicians Optical Supplies 20 1194981100 0 Physicians Physician Services 00 1194981472 0 MALKANI RONEIL 2011297 9999999 B 10 1194981472 0 5777 DEPT CAROL STREAM IL 601220021 20 1194981472 0 Physicians Anesthesia Services 20 1194981472 0 Physicians Healthy Kids Services 20 1194981472 0 Physicians Optical Supplies 20 1194981472 0 Physicians Physician Services 20 1194981472 0 Physicians Physicians Psychiatric Services 00 1194981514 0 JONES AMANDA 2009182 9999999 B 10 1194981514 0 5777 DEPT CAROL STREAM IL 601220021 20 1194981514 0 Physicians Anesthesia Services 20 1194981514 0 Physicians Fluoride varnish 20 1194981514 0 Physicians Healthy Kids Services 20 1194981514 0 Physicians Optical Supplies 20 1194981514 0 Physicians Physician Services 00 1194981563 0 SHARMA SONIA 2010250 9999999 B 10 1194981563 0 5777 DEPT CAROL STREAM IL 601228942 20 1194981563 0 Physicians Anesthesia Services 20 1194981563 0 Physicians Fluoride varnish 20 1194981563 0 Physicians Healthy Kids Services 20 1194981563 0 Physicians Optical Supplies 20 1194981563 0 Physicians Physician Services 00 1194982454 0 JHAJHRIA SUNIL J 2018113 9999999 B 10 1194982454 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1194982454 0 Physicians Anesthesia Services 20 1194982454 0 Physicians Fluoride varnish 20 1194982454 0 Physicians Healthy Kids Services 20 1194982454 0 Physicians Optical Supplies 20 1194982454 0 Physicians Physician Services 00 1194982488 0 HERMANN SZILARD 2009182 9999999 B 10 1194982488 0 1744 W MONTROSE AVE CHICAGO IL 606131113 20 1194982488 0 Dentists Dental Services 20 1194982488 0 Dentists Physician Services 00 1194982850 0 BARRAGAN LORENA 2010211 9999999 B 10 1194982850 0 2355 S WESTERN AVE CHICAGO IL 606083837 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1194985564 0 NIERZWICKI ROBERT S 2012219 9999999 B 10 1194985564 0 5777 DEPT CAROL STREAM IL 601220021 20 1194985564 0 Physicians Anesthesia Services 20 1194985564 0 Physicians Fluoride varnish 20 1194985564 0 Physicians Healthy Kids Services 20 1194985564 0 Physicians Optical Supplies 20 1194985564 0 Physicians Physician Services 00 1194985838 0 DAGO-OC JOSEPH 2024228 9999999 B 10 1194985838 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1194985838 0 Physicians Anesthesia Services 20 1194985838 0 Physicians Healthy Kids Services 20 1194985838 0 Physicians Optical Supplies 20 1194985838 0 Physicians Physician Services 00 1194986109 0 HUANG NELSON 2023177 9999999 B 10 1194986109 0 4057 RURAL PLAINS CIR STE 400 FRANKLIN TN 370641953 20 1194986109 0 Physicians Anesthesia Services 20 1194986109 0 Physicians Healthy Kids Services 20 1194986109 0 Physicians Optical Supplies 20 1194986109 0 Physicians Physician Services 00 1194986240 0 OSAN MARIA F 1981227 9999999 B 10 1194986240 0 PO BOX 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1194986489 0 ABBASI NADEEM 2012212 9999999 B 10 1194986489 0 611 W PARK ST BWPC URBANA IL 618012529 20 1194986489 0 Physicians Anesthesia Services 20 1194986489 0 Physicians Fluoride varnish 20 1194986489 0 Physicians Healthy Kids Services 20 1194986489 0 Physicians Optical Supplies 20 1194986489 0 Physicians Physician Services 00 1194986695 0 ARORA MOHIT 2010200 9999999 B 10 1194986695 0 5777 DEPT CAROL STREAM IL 601220021 20 1194986695 0 Physicians Anesthesia Services 20 1194986695 0 Physicians Fluoride varnish 20 1194986695 0 Physicians Healthy Kids Services 20 1194986695 0 Physicians Optical Supplies 20 1194986695 0 Physicians Physician Services 00 1194986703 0 MYRE BRIAN C 2016078 9999999 B 10 1194986703 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1194986703 0 Physicians Anesthesia Services 20 1194986703 0 Physicians Fluoride varnish 20 1194986703 0 Physicians Healthy Kids Services 20 1194986703 0 Physicians Optical Supplies 20 1194986703 0 Physicians Physician Services 00 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EUCLID AVENUE SAINT LOUIS MO 631600352 20 1194987081 0 Physicians Anesthesia Services 20 1194987081 0 Physicians Fluoride varnish 20 1194987081 0 Physicians Healthy Kids Services 20 1194987081 0 Physicians Optical Supplies 20 1194987081 0 Physicians Physician Services 00 1194987289 0 NELSON KYLE 2016265 9999999 B 10 1194987289 0 2925 CHICAGO AVE MINNEAPOLIS MN 554071321 20 1194987289 0 Physicians Anesthesia Services 20 1194987289 0 Physicians Healthy Kids Services 20 1194987289 0 Physicians Optical Supplies 20 1194987289 0 Physicians Physician Services 00 1194987859 0 CSUTAK BARBARA 2009044 9999999 B 10 1194987859 0 203 W HILLSIDE RD NAPERVILLE IL 605406500 20 1194987859 0 Occupational Therapists Medical Supplies 20 1194987859 0 Occupational Therapists Medical equipment/prosthetic devices 20 1194987859 0 Occupational Therapists Occupational Therapy Services 00 1194988493 0 POITER MICHAEL 2016062 9999999 B 10 1194988493 0 PO BOX 192 900 N WASHINGTON ST DU QUOIN IL 628320192 20 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Services 00 1194989475 0 CARTAYA JULIA 2011182 9999999 B 10 1194989475 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1194989475 0 Physicians Anesthesia Services 20 1194989475 0 Physicians Fluoride varnish 20 1194989475 0 Physicians Healthy Kids Services 20 1194989475 0 Physicians Optical Supplies 20 1194989475 0 Physicians Physician Services 00 1194989491 0 HUANG WENYU 2012310 9999999 B 10 1194989491 0 5777 DEPT CAROL STREAM IL 601220021 20 1194989491 0 Physicians Anesthesia Services 20 1194989491 0 Physicians Fluoride varnish 20 1194989491 0 Physicians Healthy Kids Services 20 1194989491 0 Physicians Optical Supplies 20 1194989491 0 Physicians Physician Services 00 1194989822 0 MORRISON ANDREA 2010182 9999999 B 10 1194989822 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1194989822 0 Physicians Anesthesia Services 20 1194989822 0 Physicians Fluoride varnish 20 1194989822 0 Physicians Healthy Kids Services 20 1194989822 0 Physicians Optical Supplies 20 1194989822 0 Physicians 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20 1205053998 0 Physicians Fluoride varnish 20 1205053998 0 Physicians Healthy Kids Services 20 1205053998 0 Physicians Optical Supplies 20 1205053998 0 Physicians Physician Services 00 1205054608 0 MEHTA SHITAL 2003104 9999999 B 10 1205054608 0 1029 E 130TH ST CHICAGO IL 606286908 20 1205054608 0 Physicians Anesthesia Services 20 1205054608 0 Physicians Healthy Kids Services 20 1205054608 0 Physicians Optical Supplies 20 1205054608 0 Physicians Physician Services 20 1205054608 0 Physicians Physicians Psychiatric Services 00 1205056199 0 LOVITZ LORI E 2010257 9999999 B 10 1205056199 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1205056199 0 Physicians Anesthesia Services 20 1205056199 0 Physicians Healthy Kids Services 20 1205056199 0 Physicians Optical Supplies 20 1205056199 0 Physicians Physician Services 20 1205056199 0 Physicians Physicians Psychiatric Services 00 1205056413 0 SANDUSKY ROBERT 2007305 9999999 B 10 1205056413 0 3229 W 47TH PL CHICAGO IL 606323011 20 1205056413 0 Dentists Dental Services 20 1205056413 0 Dentists Physician Services 00 1205056660 0 GANDHI UMESH I 2009180 9999999 B 10 1205056660 0 9735 LANDMARK PARKWAY DR STE 2 SAINT LOUIS MO 631271666 20 1205056660 0 Physicians Anesthesia Services 20 1205056660 0 Physicians Fluoride varnish 20 1205056660 0 Physicians Healthy Kids Services 20 1205056660 0 Physicians Optical Supplies 20 1205056660 0 Physicians Physician Services 00 1205057254 0 PARIS BRAD 2009251 9999999 B 10 1205057254 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1205057254 0 Physicians Anesthesia Services 20 1205057254 0 Physicians Healthy Kids Services 20 1205057254 0 Physicians Optical Supplies 20 1205057254 0 Physicians Physician Services 00 1205058799 0 ODONNELL MD SCOTT 2009213 9999999 B 10 1205058799 0 1701 W WISE RD SCHAUMBURG IL 601933553 20 1205058799 0 Physicians Anesthesia Services 20 1205058799 0 Physicians Fluoride varnish 20 1205058799 0 Physicians Healthy Kids Services 20 1205058799 0 Physicians Optical Supplies 20 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1205062239 0 PO BOX 174 FORT MADISON IA 526270174 20 1205062239 0 Physicians Anesthesia Services 20 1205062239 0 Physicians Fluoride varnish 20 1205062239 0 Physicians Healthy Kids Services 20 1205062239 0 Physicians Optical Supplies 20 1205062239 0 Physicians Physician Services 00 1205062759 0 MAYES KARA 2018032 9999999 B 10 1205062759 0 300 WINDING WOODS DR STE 200 O FALLON MO 633665081 20 1205062759 0 Physicians Anesthesia Services 20 1205062759 0 Physicians Fluoride varnish 20 1205062759 0 Physicians Healthy Kids Services 20 1205062759 0 Physicians Optical Supplies 20 1205062759 0 Physicians Physician Services 00 1205062791 0 KAZMI YASIR 2013083 9999999 B 10 1205062791 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1205062791 0 Physicians Anesthesia Services 20 1205062791 0 Physicians Fluoride varnish 20 1205062791 0 Physicians Healthy Kids Services 20 1205062791 0 Physicians Optical Supplies 20 1205062791 0 Physicians Physician Services 00 1205062825 0 LI LORETTA S 2019266 9999999 B 10 1205062825 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1205062825 0 Physicians Anesthesia Services 20 1205062825 0 Physicians Fluoride varnish 20 1205062825 0 Physicians Healthy Kids Services 20 1205062825 0 Physicians Optical Supplies 20 1205062825 0 Physicians Physician Services 00 1205062833 0 WATTS ANA LIDIA 2022070 9999999 B 10 1205062833 0 1201 RICKER RD SALEM IL 628814263 20 1205062833 0 Physicians Anesthesia Services 20 1205062833 0 Physicians Healthy Kids Services 20 1205062833 0 Physicians Optical Supplies 20 1205062833 0 Physicians Physician Services 00 1205063302 0 DIMARIA CHARISSE A 2009201 9999999 B 10 1205063302 0 29373 NETWORK PL CHICAGO IL 606733039 20 1205063302 0 Nurse Practitioners Healthy Kids Services 20 1205063302 0 Nurse Practitioners Nurse Practitioners Services 20 1205063302 0 Nurse Practitioners Physician Services 00 1205063781 0 ANDERSON JILL C 2013246 9999999 B 10 1205063781 0 5777 DEPT CAROL STREAM IL 601220021 20 1205063781 0 Physicians 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1205064458 0 Physicians Healthy Kids Services 20 1205064458 0 Physicians Optical Supplies 20 1205064458 0 Physicians Physician Services 00 1205064748 0 RASTOGI PRERNA 2014321 9999999 B 10 1205064748 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1205064748 0 Physicians Anesthesia Services 20 1205064748 0 Physicians Healthy Kids Services 20 1205064748 0 Physicians Optical Supplies 20 1205064748 0 Physicians Physician Services 00 1205065471 0 UWAH AUGUSTA 2021319 9999999 B 10 1205065471 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1205065471 0 Physicians Anesthesia Services 20 1205065471 0 Physicians Fluoride varnish 20 1205065471 0 Physicians Healthy Kids Services 20 1205065471 0 Physicians Optical Supplies 20 1205065471 0 Physicians Physician Services 00 1205065620 0 JUDGE QUINN 2009235 9999999 B 10 1205065620 0 1000 KIWANIS DR FREEPORT IL 610326921 20 1205065620 0 Optometrists Optical Supplies 20 1205065620 0 Optometrists Optometric Services 20 1205065620 0 Optometrists Physician Services 00 1205065737 0 EL LAKKIS IASS 2020216 9999999 B 10 1205065737 0 PO BOX 1510 EVANSVILLE IN 477061510 20 1205065737 0 Physicians Anesthesia Services 20 1205065737 0 Physicians Fluoride varnish 20 1205065737 0 Physicians Healthy Kids Services 20 1205065737 0 Physicians Optical Supplies 20 1205065737 0 Physicians Physician Services 00 1205066594 0 BROWER LAURA 2022221 9999999 B 10 1205066594 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1205066594 0 Physicians Anesthesia Services 20 1205066594 0 Physicians Fluoride varnish 20 1205066594 0 Physicians Healthy Kids Services 20 1205066594 0 Physicians Optical Supplies 20 1205066594 0 Physicians Physician Services 00 1205067162 0 AZMAT AWAIS 2012245 9999999 B 10 1205067162 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1205067162 0 Physicians Anesthesia Services 20 1205067162 0 Physicians Healthy Kids Services 20 1205067162 0 Physicians Optical Supplies 20 1205067162 0 Physicians Physician Services 00 1205068053 0 JEETWANI AJAY L 2013253 9999999 B 10 1205068053 0 4500 COLLEGE AVE ALTON IL 620025012 20 1205068053 0 Physicians Anesthesia Services 20 1205068053 0 Physicians Healthy Kids Services 20 1205068053 0 Physicians Optical Supplies 20 1205068053 0 Physicians Physician Services 20 1205068053 0 Physicians Physicians Psychiatric Services 00 1205070075 0 SANTIAGO TERESA C. B. 2014301 9999999 B 10 1205070075 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1205070075 0 Physicians Anesthesia Services 20 1205070075 0 Physicians Healthy Kids Services 20 1205070075 0 Physicians Optical Supplies 20 1205070075 0 Physicians Physician Services 00 1205070836 0 KLUCKEY KEDRA 2020111 9999999 B 10 1205070836 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1205070836 0 Nurse Practitioners Healthy Kids Services 20 1205070836 0 Nurse Practitioners Nurse Practitioners Services 20 1205070836 0 Nurse Practitioners Physician Services 00 1205071065 0 ROLLE TIMOTHY 2025022 9999999 B 10 1205071065 0 PO BOX 678268 DALLAS TX 752678268 20 1205071065 0 Physicians Anesthesia Services 20 1205071065 0 Physicians Healthy Kids Services 20 1205071065 0 Physicians Optical Supplies 20 1205071065 0 Physicians Physician Services 00 1205074267 0 BENTLER MARY CATHERINE 2016277 9999999 B 10 1205074267 0 1225 S GEAR AVE STE 153 SUITE 153 WEST BURLINGTON IA 526551686 20 1205074267 0 Physician Assistant Only Fluoride varnish 20 1205074267 0 Physician Assistant Only Healthy Kids Services 20 1205074267 0 Physician Assistant Only Physician Services 00 1205078565 0 CHOWNING RUSSELL T 2017233 9999999 B 10 1205078565 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1205078565 0 Physicians Anesthesia Services 20 1205078565 0 Physicians Fluoride varnish 20 1205078565 0 Physicians Healthy Kids Services 20 1205078565 0 Physicians Optical Supplies 20 1205078565 0 Physicians Physician Services 00 1205078987 0 RUXER JOHN T 2015182 9999999 B 10 1205078987 0 4645 VILLAGE SQUARE DR STE C PADUCAH KY 420017448 20 1205078987 0 Physicians Anesthesia Services 20 1205078987 0 Physicians Healthy Kids Services 20 1205078987 0 Physicians Optical Supplies 20 1205078987 0 Physicians Physician Services 00 1205081288 0 DAS APARAJITA 2015244 9999999 B 10 1205081288 0 155 E BRUSH HILL RD 155 E BRUSH HILL RD ELMHURST IL 601265658 20 1205081288 0 Physicians Anesthesia Services 20 1205081288 0 Physicians 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Therapists Speech Therapy/Pathology Services 00 1205083409 0 SAINI SURBHI 2019269 9999999 B 10 1205083409 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1205083409 0 Physicians Anesthesia Services 20 1205083409 0 Physicians Fluoride varnish 20 1205083409 0 Physicians Healthy Kids Services 20 1205083409 0 Physicians Optical Supplies 20 1205083409 0 Physicians Physician Services 00 1205083995 0 GRIFFITHS ANNE G 2010001 9999999 B 10 1205083995 0 2530 CHICAGO AVE STE 400 MINNEAPOLIS MN 554044387 20 1205083995 0 Physicians Anesthesia Services 20 1205083995 0 Physicians Fluoride varnish 20 1205083995 0 Physicians Healthy Kids Services 20 1205083995 0 Physicians Optical Supplies 20 1205083995 0 Physicians Physician Services 00 1205084555 0 REEVES RUTH 2023263 9999999 B 10 1205084555 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1205084555 0 Physicians Anesthesia Services 20 1205084555 0 Physicians Fluoride varnish 20 1205084555 0 Physicians Healthy Kids Services 20 1205084555 0 Physicians Optical Supplies 20 1205084555 0 Physicians Physician Services 00 1205085255 0 MESSER THOMAS 2011213 9999999 B 10 1205085255 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1205085255 0 Physicians Anesthesia Services 20 1205085255 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1205085255 0 Physicians Healthy Kids Services 20 1205085255 0 Physicians Optical Supplies 20 1205085255 0 Physicians Physician Services 00 1205086998 0 ABBAS SHAZIA 2014304 9999999 B 10 1205086998 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1205086998 0 Physicians Anesthesia Services 20 1205086998 0 Physicians Fluoride varnish 20 1205086998 0 Physicians Healthy Kids Services 20 1205086998 0 Physicians Optical Supplies 20 1205086998 0 Physicians Physician Services 00 1205088713 0 CHAUDHRY SHAHLA 2017038 9999999 B 10 1205088713 0 PO BOX 95279 DEPT A CHICAGO IL 606945279 20 1205088713 0 Physician Assistant Only Fluoride varnish 20 1205088713 0 Physician Assistant Only Healthy Kids Services 20 1205088713 0 Physician Assistant Only Physician Services 00 1205089166 0 COOKSEY JESSICA A 2016001 9999999 B 10 1205089166 0 5777 DEPT CAROL STREAM IL 601220021 20 1205089166 0 Physicians Anesthesia Services 20 1205089166 0 Physicians Fluoride varnish 20 1205089166 0 Physicians Healthy Kids Services 20 1205089166 0 Physicians Optical Supplies 20 1205089166 0 Physicians Physician Services 00 1205090339 0 WEGER NATALIE S 2018213 9999999 B 10 1205090339 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1205090339 0 Physicians Anesthesia Services 20 1205090339 0 Physicians Healthy Kids Services 20 1205090339 0 Physicians Optical Supplies 20 1205090339 0 Physicians Physician Services 00 1205091097 0 EADIE JAMES A 2012122 9999999 B 10 1205091097 0 8679 CONNECTICUT ST STE A MERRILLVILLE IN 464106383 20 1205091097 0 Physicians Anesthesia Services 20 1205091097 0 Physicians Healthy Kids Services 20 1205091097 0 Physicians Optical Supplies 20 1205091097 0 Physicians Physician Services 00 1205091428 0 UCUZIAN ARECK AVEDIS 2024339 9999999 B 10 1205091428 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1205091428 0 Physicians Anesthesia Services 20 1205091428 0 Physicians Healthy Kids Services 20 1205091428 0 Physicians Optical Supplies 20 1205091428 0 Physicians Physician Services 00 1205092400 0 WAGNER COURTNEY REGAN 2014213 9999999 B 10 1205092400 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1205092400 0 Physicians Anesthesia Services 20 1205092400 0 Physicians Fluoride varnish 20 1205092400 0 Physicians Healthy Kids Services 20 1205092400 0 Physicians Optical Supplies 20 1205092400 0 Physicians Physician Services 00 1205092764 0 VILLASENOR LYNDON 2015032 9999999 B 10 1205092764 0 7 BLANCHARD CIR STE 201 WHEATON IL 601892039 20 1205092764 0 Physicians Anesthesia Services 20 1205092764 0 Physicians Healthy Kids Services 20 1205092764 0 Physicians Optical Supplies 20 1205092764 0 Physicians Physician Services 20 1205092764 0 Physicians Physicians Psychiatric Services 00 1205092889 0 HAMMERSLEY SUSIE A 2023205 9999999 B 10 1205092889 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1205092889 0 Speech Therapists Medical Supplies 20 1205092889 0 Speech Therapists Medical equipment/prosthetic devices 20 1205092889 0 Speech Therapists Speech Therapy/Pathology Services 00 1205092897 0 PIERCE LAUREN 2013213 9999999 B 10 1205092897 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1205092897 0 Physicians Anesthesia Services 20 1205092897 0 Physicians Healthy Kids Services 20 1205092897 0 Physicians Optical Supplies 20 1205092897 0 Physicians Physician Services 00 1205092939 0 PATEL RONAK 2014244 9999999 B 10 1205092939 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1205092939 0 Physicians Anesthesia Services 20 1205092939 0 Physicians Healthy Kids Services 20 1205092939 0 Physicians Optical Supplies 20 1205092939 0 Physicians Physician Services 00 1205093473 0 BHUTTO ASIF 2008183 9999999 B 10 1205093473 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1205093473 0 Physicians Anesthesia Services 20 1205093473 0 Physicians Fluoride varnish 20 1205093473 0 Physicians Healthy Kids Services 20 1205093473 0 Physicians Optical Supplies 20 1205093473 0 Physicians Physician Services 00 1205093804 0 FYNN THEODORA 2024169 9999999 B 10 1205093804 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1205093804 0 Physicians Anesthesia Services 20 1205093804 0 Physicians Fluoride varnish 20 1205093804 0 Physicians Healthy Kids Services 20 1205093804 0 Physicians Optical Supplies 20 1205093804 0 Physicians Physician Services 00 1205093812 0 STABRAWA BONNIE 2011280 9999999 B 10 1205093812 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1205093812 0 Physicians Anesthesia Services 20 1205093812 0 Physicians Fluoride varnish 20 1205093812 0 Physicians Healthy Kids Services 20 1205093812 0 Physicians Optical Supplies 20 1205093812 0 Physicians Physician Services 00 1205093952 0 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1205095916 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1205095916 0 Physicians Anesthesia Services 20 1205095916 0 Physicians Healthy Kids Services 20 1205095916 0 Physicians Optical Supplies 20 1205095916 0 Physicians Physician Services 20 1205095916 0 Physicians Physicians Psychiatric Services 00 1205095940 0 NAPIERALA BRENDA M 2021018 9999999 B 10 1205095940 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1205095940 0 Nurse Practitioners Healthy Kids Services 20 1205095940 0 Nurse Practitioners Nurse Practitioners Services 20 1205095940 0 Nurse Practitioners Physician Services 00 1205095999 0 ADIGHIBE ANDREA 2018152 9999999 B 10 1205095999 0 2001 BUTTERFIELD RD STE 1600 DOWNERS GROVE IL 605151211 20 1205095999 0 Occupational Therapists Medical Supplies 20 1205095999 0 Occupational Therapists Medical equipment/prosthetic devices 20 1205095999 0 Occupational Therapists Occupational Therapy Services 00 1205096070 0 WEINBERG RICHARD L 2021183 9999999 B 10 1205096070 0 5777 DEPT CAROL STREAM IL 601220021 20 1205096070 0 Physicians Anesthesia Services 20 1205096070 0 Physicians Fluoride varnish 20 1205096070 0 Physicians Healthy Kids Services 20 1205096070 0 Physicians Optical Supplies 20 1205096070 0 Physicians Physician Services 00 1205096609 0 ABAZEED MOHAMED 2019337 9999999 B 10 1205096609 0 5777 DEPT CAROL STREAM IL 601220021 20 1205096609 0 Physicians Anesthesia Services 20 1205096609 0 Physicians Healthy Kids Services 20 1205096609 0 Physicians Optical Supplies 20 1205096609 0 Physicians Physician Services 00 1205096963 0 GANESAN RANI 2008228 9999999 B 10 1205096963 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1205096963 0 Physicians Anesthesia Services 20 1205096963 0 Physicians Fluoride varnish 20 1205096963 0 Physicians Healthy Kids Services 20 1205096963 0 Physicians Optical Supplies 20 1205096963 0 Physicians Physician Services 00 1205097052 0 WILLIAMS MICHAEL T 2023253 9999999 B 10 1205097052 0 PO BOX 43230 PHOENIX AZ 850803230 20 1205097052 0 Physicians Anesthesia Services 20 1205097052 0 Physicians Healthy Kids Services 20 1205097052 0 Physicians Optical Supplies 20 1205097052 0 Physicians Physician Services 00 1205097102 0 VALI FAISAL S 2010213 9999999 B 10 1205097102 0 35318 EAGLE WAY CHICAGO IL 606781353 20 1205097102 0 Physicians Anesthesia Services 20 1205097102 0 Physicians Healthy Kids Services 20 1205097102 0 Physicians Optical Supplies 20 1205097102 0 Physicians Physician Services 00 1205097607 0 WEISBERG MICHAEL P 2009152 9999999 B 10 1205097607 0 6233 CERMAK RD BERWYN IL 604022317 20 1205097607 0 Physicians Anesthesia Services 20 1205097607 0 Physicians Healthy Kids Services 20 1205097607 0 Physicians Optical Supplies 20 1205097607 0 Physicians Physician Services 00 1205098480 0 HARMS LINDSAY R 2017001 9999999 B 10 1205098480 0 2511 N MAIN ST EAST PEORIA IL 616111783 20 1205098480 0 Other behavior health professional LCPC/LMFT services 00 1205098738 0 LONG DANXUAN 2012008 9999999 B 10 1205098738 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1205098738 0 Physicians Anesthesia Services 20 1205098738 0 Physicians Fluoride varnish 20 1205098738 0 Physicians Healthy Kids Services 20 1205098738 0 Physicians Optical Supplies 20 1205098738 0 Physicians Physician Services 00 1205099157 0 LEWIS BRETT 2020233 9999999 B 10 1205099157 0 PO BOX 43230 PHOENIX AZ 850803230 20 1205099157 0 Physicians Anesthesia Services 20 1205099157 0 Physicians Healthy Kids Services 20 1205099157 0 Physicians Optical Supplies 20 1205099157 0 Physicians Physician Services 00 1205099298 0 VELDMAN PETER B 2017182 9999999 B 10 1205099298 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1205099298 0 Physicians Anesthesia Services 20 1205099298 0 Physicians Healthy Kids Services 20 1205099298 0 Physicians Optical Supplies 20 1205099298 0 Physicians Physician Services 00 1205099652 0 THIBOS JULIE 2015001 9999999 B 10 1205099652 0 12640 S ROUTE 59 UNIT 110 PLAINFIELD IL 605855408 20 1205099652 0 Physical 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20 1205101334 0 Physicians Optical Supplies 20 1205101334 0 Physicians Physician Services 00 1205101409 0 JOERGENS ANNE 2016053 9999999 B 10 1205101409 0 PO BOX 504469 SAINT LOUIS MO 631504469 20 1205101409 0 Physical Therapists Medical Supplies 20 1205101409 0 Physical Therapists Medical equipment/prosthetic devices 20 1205101409 0 Physical Therapists Physical Therapy Services 00 1205102019 0 RAMAHI FIRAS 2018149 9999999 B 10 1205102019 0 44000 GARFIELD RD CLINTON TOWNSHI MI 480381125 20 1205102019 0 Physicians Anesthesia Services 20 1205102019 0 Physicians Healthy Kids Services 20 1205102019 0 Physicians Optical Supplies 20 1205102019 0 Physicians Physician Services 00 1205103363 0 SANFORD EMILIE E 2011332 9999999 B 10 1205103363 0 PO BOX 95369 LOCKBOX # 95369 CHICAGO IL 606948979 20 1205103363 0 Nurse Practitioners Anesthesia Services 20 1205103363 0 Nurse Practitioners Nurse Practitioners Services 20 1205103363 0 Nurse Practitioners Physician Services 00 1205106291 0 GAGE ALLISON E 2021082 9999999 B 10 1205106291 0 5425 SOUTHFIELD CTR STE 165 SAINT LOUIS MO 631235984 20 1205106291 0 Nurse Practitioners Healthy Kids Services 20 1205106291 0 Nurse Practitioners Nurse Practitioners Services 20 1205106291 0 Nurse Practitioners Physician Services 00 1205106341 0 COOK ERICA S 2015182 9999999 B 10 1205106341 0 4701 DEPT CAROL STREAM IL 601220021 20 1205106341 0 Nurse Practitioners Healthy Kids Services 20 1205106341 0 Nurse Practitioners Nurse Practitioners Services 20 1205106341 0 Nurse Practitioners Physician Services 00 1205107687 0 ZWILLING BRANDY C 2020028 9999999 B 10 1205107687 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1205107687 0 Physician Assistant Only Fluoride varnish 20 1205107687 0 Physician Assistant Only Healthy Kids Services 20 1205107687 0 Physician Assistant Only Physician Services 00 1205109675 0 BOYER CHRISTOPHER T 2021193 9999999 B 10 1205109675 0 500 PORTER AVE AURORA MO 656052365 20 1205109675 0 Physicians Anesthesia Services 20 1205109675 0 Physicians Fluoride varnish 20 1205109675 0 Physicians Healthy Kids Services 20 1205109675 0 Physicians Optical Supplies 20 1205109675 0 Physicians Physician Services 00 1205109964 0 MANZKE CYNTHIA M 2015152 9999999 B 10 1205109964 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1205109964 0 Nurse Practitioners Anesthesia Services 20 1205109964 0 Nurse Practitioners Nurse Practitioners Services 20 1205109964 0 Nurse Practitioners Physician Services 00 1205110186 0 MORENO LANIE R 2013072 9999999 B 10 1205110186 0 863 CENTER CT UNIT D SHOREWOOD IL 604048512 20 1205110186 0 Physical Therapists Medical Supplies 20 1205110186 0 Physical Therapists Medical equipment/prosthetic devices 20 1205110186 0 Physical Therapists Physical Therapy Services 00 1205113339 0 LUCAS BRIDGET M 2020288 9999999 B 10 1205113339 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1205113339 0 Nurse Practitioners Fluoride varnish 20 1205113339 0 Nurse Practitioners Healthy Kids Services 20 1205113339 0 Nurse Practitioners Nurse Practitioners Services 20 1205113339 0 Nurse Practitioners Physician Services 00 1205114238 0 NADLER ARIELLA 2023025 9999999 B 10 1205114238 0 29373 NETWORK PL CHICAGO IL 606733039 20 1205114238 0 Physicians Anesthesia Services 20 1205114238 0 Physicians Fluoride varnish 20 1205114238 0 Physicians Healthy Kids Services 20 1205114238 0 Physicians Optical Supplies 20 1205114238 0 Physicians Physician Services 00 1205114329 0 LAVIN KELLY A 2014305 9999999 B 10 1205114329 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1205114329 0 Physicians Anesthesia Services 20 1205114329 0 Physicians Fluoride varnish 20 1205114329 0 Physicians Healthy Kids Services 20 1205114329 0 Physicians Optical Supplies 20 1205114329 0 Physicians Physician Services 00 1205114477 0 MIYATA KANA 2020209 9999999 B 10 1205114477 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1205114477 0 Physicians Anesthesia Services 20 1205114477 0 Physicians Fluoride varnish 20 1205114477 0 Physicians Healthy Kids 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Physician Services 00 1205117058 0 DODDS KELLY J 2011314 9999999 B 10 1205117058 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1205117058 0 Nurse Practitioners Healthy Kids Services 20 1205117058 0 Nurse Practitioners Nurse Practitioners Services 20 1205117058 0 Nurse Practitioners Physician Services 00 1205119971 0 WITT EVAN 2011262 9999999 B 10 1205119971 0 520 VALLEY VIEW DR MOLINE IL 612656152 20 1205119971 0 Physician Assistant Only Fluoride varnish 20 1205119971 0 Physician Assistant Only Healthy Kids Services 20 1205119971 0 Physician Assistant Only Physician Services 00 1205120136 0 DWIVEDI ANJANA 2015305 9999999 B 10 1205120136 0 1007 FRANKLIN AVE RIVER FOREST IL 603051339 20 1205120136 0 Physicians Anesthesia Services 20 1205120136 0 Physicians Healthy Kids Services 20 1205120136 0 Physicians Optical Supplies 20 1205120136 0 Physicians Physician Services 00 1205121423 0 DEMEO MICHAEL 2022129 9999999 B 10 1205121423 0 14050 NW 14TH ST STE 190 SUNRISE FL 333232851 20 1205121423 0 Physicians Anesthesia Services 20 1205121423 0 Physicians Fluoride varnish 20 1205121423 0 Physicians Healthy Kids Services 20 1205121423 0 Physicians Optical Supplies 20 1205121423 0 Physicians Physician Services 00 1205121878 0 LEE JULIA 2020230 9999999 B 10 1205121878 0 515 VALLEY ST STE 203 MAPLEWOOD NJ 070404300 20 1205121878 0 Physicians Anesthesia Services 20 1205121878 0 Physicians Healthy Kids Services 20 1205121878 0 Physicians Optical Supplies 20 1205121878 0 Physicians Physician Services 00 1205122074 0 CHISHOLM SMITH ANN 2016183 9999999 B 10 1205122074 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1205122074 0 Physicians Anesthesia Services 20 1205122074 0 Physicians Healthy Kids Services 20 1205122074 0 Physicians Optical Supplies 20 1205122074 0 Physicians Physician Services 00 1205122496 0 KUNREDDY REENA 2016207 9999999 B 10 1205122496 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1205122496 0 Physicians Anesthesia Services 20 1205122496 0 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1205127255 0 Physicians Anesthesia Services 20 1205127255 0 Physicians Fluoride varnish 20 1205127255 0 Physicians Healthy Kids Services 20 1205127255 0 Physicians Optical Supplies 20 1205127255 0 Physicians Physician Services 00 1205127339 0 BARBAS BRIAN 2013203 9999999 B 10 1205127339 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1205127339 0 Physicians Anesthesia Services 20 1205127339 0 Physicians Healthy Kids Services 20 1205127339 0 Physicians Optical Supplies 20 1205127339 0 Physicians Physician Services 00 1205129590 0 HASSAN MUNEER 2025063 9999999 B 10 1205129590 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1205129590 0 Physicians Anesthesia Services 20 1205129590 0 Physicians Healthy Kids Services 20 1205129590 0 Physicians Optical Supplies 20 1205129590 0 Physicians Physician Services 20 1205129590 0 Physicians Physicians Psychiatric Services 00 1205133634 0 SHAH RICKIN 2014182 9999999 B 10 1205133634 0 7231 SOLUTIONS CTR CHICAGO IL 606777002 20 1205133634 0 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B 10 1205145976 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1205145976 0 Dentists Dental Services 20 1205145976 0 Dentists Physician Services 00 1205146958 0 LEFFEL JOHN E 2014132 9999999 B 10 1205146958 0 PO BOX 35 LIBERTYVILLE IL 600480035 20 1205146958 0 Psychologist Psychologist service 00 1205147360 0 PRIGGE DAVID 2017037 9999999 B 10 1205147360 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1205147360 0 Physicians Anesthesia Services 20 1205147360 0 Physicians Healthy Kids Services 20 1205147360 0 Physicians Optical Supplies 20 1205147360 0 Physicians Physician Services 00 1205148293 0 MALO BASSAM 2022252 9999999 B 10 1205148293 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1205148293 0 Physicians Anesthesia Services 20 1205148293 0 Physicians Healthy Kids Services 20 1205148293 0 Physicians Optical Supplies 20 1205148293 0 Physicians Physician Services 20 1205148293 0 Physicians Physicians Psychiatric Services 00 1205148806 0 CONDIE JESSICA 2010213 9999999 B 10 1205148806 0 1000 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1205149325 0 Physicians Healthy Kids Services 20 1205149325 0 Physicians Optical Supplies 20 1205149325 0 Physicians Physician Services 00 1205149366 0 COLEMAN CATHY M 2011121 9999999 B 10 1205149366 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1205149366 0 Nurse Practitioners Healthy Kids Services 20 1205149366 0 Nurse Practitioners Nurse Practitioners Services 20 1205149366 0 Nurse Practitioners Physician Services 00 1205149952 0 HEYER KAMALDEEP 2013182 9999999 B 10 1205149952 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1205149952 0 Physicians Anesthesia Services 20 1205149952 0 Physicians Healthy Kids Services 20 1205149952 0 Physicians Optical Supplies 20 1205149952 0 Physicians Physician Services 00 1205151172 0 FARID NIKDOKHT 2021101 9999999 B 10 1205151172 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1205151172 0 Physicians Anesthesia Services 20 1205151172 0 Physicians Healthy Kids Services 20 1205151172 0 Physicians Optical Supplies 20 1205151172 0 Physicians Physician Services 00 1205151198 0 KUKREJA GAUTAM 2010182 9999999 B 10 1205151198 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1205151198 0 Physicians Anesthesia Services 20 1205151198 0 Physicians Fluoride varnish 20 1205151198 0 Physicians Healthy Kids Services 20 1205151198 0 Physicians Optical Supplies 20 1205151198 0 Physicians Physician Services 00 1205153053 0 KHAN BASHARATH M 2013196 9999999 B 10 1205153053 0 2000 GOLF RD ROLLING MEADOWS IL 600084216 20 1205153053 0 Physicians Anesthesia Services 20 1205153053 0 Physicians Fluoride varnish 20 1205153053 0 Physicians Healthy Kids Services 20 1205153053 0 Physicians Optical Supplies 20 1205153053 0 Physicians Physician Services 00 1205154028 0 TUCKA JAMES 2018021 9999999 H 10 1205154028 0 PO BOX 233 13245 KESSLER RD CAIRO IL 629140233 20 1205154028 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205154820 0 WALKER CHANTEL 2020069 9999999 B 10 1205154820 0 500 PORTER AVE AURORA MO 656052365 20 1205154820 0 Physicians Anesthesia Services 20 1205154820 0 Physicians Healthy Kids Services 20 1205154820 0 Physicians Optical Supplies 20 1205154820 0 Physicians Physician Services 00 1205156429 0 ROSS JAMAL R 2014182 9999999 B 10 1205156429 0 9500 BRYN MAWR AVE STE 300 ROSEMONT IL 600185257 20 1205156429 0 Physicians Anesthesia Services 20 1205156429 0 Physicians Fluoride varnish 20 1205156429 0 Physicians Healthy Kids Services 20 1205156429 0 Physicians Optical Supplies 20 1205156429 0 Physicians Physician Services 00 1205156668 0 ODUALA OMOLADE O 2019330 9999999 B 10 1205156668 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1205156668 0 Physicians Anesthesia Services 20 1205156668 0 Physicians Family Planning Counseling 20 1205156668 0 Physicians Fluoride varnish 20 1205156668 0 Physicians Healthy Kids Services 20 1205156668 0 Physicians Optical Supplies 20 1205156668 0 Physicians Physician Services 00 1205156940 0 MOHAMMED ASLAM 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KIEFER-MCELWRATH MELISSA J 2015292 9999999 B 10 1205157807 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1205157807 0 Nurse Practitioners Healthy Kids Services 20 1205157807 0 Nurse Practitioners Nurse Practitioners Services 20 1205157807 0 Nurse Practitioners Physician Services 00 1205157815 0 LEE BOGUN 2014345 9999999 B 10 1205157815 0 1090 NORTHCHASE PKWY SE MARIETTA GA 300676405 20 1205157815 0 Dentists Dental Services 20 1205157815 0 Dentists Physician Services 00 1205157997 0 NAVARRO-LEAHY ANN K 2017152 9999999 B 10 1205157997 0 PO BOX 110429 AURORA CO 800420429 20 1205157997 0 Physicians Anesthesia Services 20 1205157997 0 Physicians Fluoride varnish 20 1205157997 0 Physicians Healthy Kids Services 20 1205157997 0 Physicians Optical Supplies 20 1205157997 0 Physicians Physician Services 00 1205162781 0 BARUDIN AMY G 2009288 9999999 B 10 1205162781 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1205162781 0 Nurse Practitioners Fluoride varnish 20 1205162781 0 Nurse 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1205217825 0 Physicians Fluoride varnish 20 1205217825 0 Physicians Healthy Kids Services 20 1205217825 0 Physicians Optical Supplies 20 1205217825 0 Physicians Physician Services 00 1205218658 0 KWAK YE EUN 2018341 9999999 B 10 1205218658 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1205218658 0 Physicians Anesthesia Services 20 1205218658 0 Physicians Fluoride varnish 20 1205218658 0 Physicians Healthy Kids Services 20 1205218658 0 Physicians Optical Supplies 20 1205218658 0 Physicians Physician Services 00 1205218823 0 SAPRON ANDREA N 2015229 9999999 B 10 1205218823 0 124 SW ADAMS ST FL 2 PEORIA IL 616021308 20 1205218823 0 Nurse Practitioners Fluoride varnish 20 1205218823 0 Nurse Practitioners Healthy Kids Services 20 1205218823 0 Nurse Practitioners Nurse Practitioners Services 20 1205218823 0 Nurse Practitioners Physician Services 00 1205218914 0 MURRAY AMANDA 2022158 9999999 B 10 1205218914 0 PO BOX 781076 DETROIT MI 482781076 20 1205218914 0 Physician Assistant Only Fluoride varnish 20 1205218914 0 Physician Assistant Only Healthy Kids Services 20 1205218914 0 Physician Assistant Only Physician Services 00 1205218948 0 MENSAH MICHAEL 2021219 9999999 B 10 1205218948 0 PO BOX 736216 DALLAS TX 753736216 20 1205218948 0 Physicians Anesthesia Services 20 1205218948 0 Physicians Fluoride varnish 20 1205218948 0 Physicians Healthy Kids Services 20 1205218948 0 Physicians Optical Supplies 20 1205218948 0 Physicians Physician Services 00 1205219300 0 BAKER GAYATRI 2019330 9999999 B 10 1205219300 0 1001 E TOUHY AVE STE 170 DES PLAINES IL 600185800 20 1205219300 0 Physicians Anesthesia Services 20 1205219300 0 Physicians Healthy Kids Services 20 1205219300 0 Physicians Optical Supplies 20 1205219300 0 Physicians Physician Services 20 1205219300 0 Physicians Physicians Psychiatric Services 00 1205219607 0 KRIEGER-JOHNSEN MICHELE L 2016001 9999999 B 10 1205219607 0 124 SW ADAMS ST PEORIA IL 616021308 20 1205219607 0 Nurse Practitioners Fluoride varnish 20 1205219607 0 Nurse Practitioners Healthy Kids Services 20 1205219607 0 Nurse Practitioners Nurse Practitioners Services 20 1205219607 0 Nurse Practitioners Physician Services 00 1205219912 0 BAYSINGER CHARLES 2022272 9999999 B 10 1205219912 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1205219912 0 Physicians Anesthesia Services 20 1205219912 0 Physicians Healthy Kids Services 20 1205219912 0 Physicians Optical Supplies 20 1205219912 0 Physicians Physician Services 00 1205220597 0 SIWAK JENNAH 2015176 9999999 B 10 1205220597 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1205220597 0 Physicians Anesthesia Services 20 1205220597 0 Physicians Fluoride varnish 20 1205220597 0 Physicians Healthy Kids Services 20 1205220597 0 Physicians Optical Supplies 20 1205220597 0 Physicians Physician Services 00 1205220605 0 MCGEE KELLY 2020106 9999999 H 10 1205220605 0 15010 S RAVINIA AVE STE 15 ORLAND PARK IL 604625353 20 1205220605 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205221215 0 SMELSER KATELYN 2022152 9999999 B 10 1205221215 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1205221215 0 Physicians Anesthesia Services 20 1205221215 0 Physicians Fluoride varnish 20 1205221215 0 Physicians Healthy Kids Services 20 1205221215 0 Physicians Optical Supplies 20 1205221215 0 Physicians Physician Services 00 1205221314 0 WOZNICA EDGAR 2022223 9999999 B 10 1205221314 0 5777 DEPT CAROL STREAM IL 601220021 20 1205221314 0 Physicians Anesthesia Services 20 1205221314 0 Physicians Healthy Kids Services 20 1205221314 0 Physicians Optical Supplies 20 1205221314 0 Physicians Physician Services 20 1205221314 0 Physicians Physicians Psychiatric Services 00 1205221587 0 GARDNER JENNIFER 2017094 9999999 B 10 1205221587 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1205221587 0 Nurse Practitioners Fluoride varnish 20 1205221587 0 Nurse Practitioners Healthy Kids Services 20 1205221587 0 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1205223708 0 COUTURE ALLISON D 2018254 9999999 B 10 1205223708 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1205223708 0 Physicians Anesthesia Services 20 1205223708 0 Physicians Fluoride varnish 20 1205223708 0 Physicians Healthy Kids Services 20 1205223708 0 Physicians Optical Supplies 20 1205223708 0 Physicians Physician Services 00 1205223906 0 YU MINYONG 2019198 9999999 B 10 1205223906 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1205223906 0 Physicians Anesthesia Services 20 1205223906 0 Physicians Fluoride varnish 20 1205223906 0 Physicians Healthy Kids Services 20 1205223906 0 Physicians Optical Supplies 20 1205223906 0 Physicians Physician Services 00 1205223997 0 HANKS LAURA 2022118 9999999 B 10 1205223997 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1205223997 0 Physicians Anesthesia Services 20 1205223997 0 Physicians Healthy Kids Services 20 1205223997 0 Physicians Optical Supplies 20 1205223997 0 Physicians Physician Services 00 1205224052 0 WHITE KATHERINE E 2015090 9999999 B 10 1205224052 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1205224052 0 Nurse Practitioners Anesthesia Services 20 1205224052 0 Nurse Practitioners Nurse Practitioners Services 20 1205224052 0 Nurse Practitioners Physician Services 00 1205224748 0 HATCHER RYAN B 2023320 9999999 B 10 1205224748 0 145 W BURLINGTON AVE BURLINGTON IA 526011983 20 1205224748 0 Chiropractors Chiropractic Services 00 1205225125 0 GONZALEZ ERIN 2022270 9999999 B 10 1205225125 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1205225125 0 Nurse Practitioners Healthy Kids Services 20 1205225125 0 Nurse Practitioners Nurse Practitioners Services 20 1205225125 0 Nurse Practitioners Physician Services 00 1205225554 0 KIM MINSUN 2016336 9999999 B 10 1205225554 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1205225554 0 Nurse Practitioners Healthy Kids Services 20 1205225554 0 Nurse Practitioners Nurse Practitioners Services 20 1205225554 0 Nurse Practitioners Physician Services 00 1205226560 0 CHEEMA ISMAT 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BALLAS RD STE 7020 SAINT LOUIS MO 631418232 20 1205228723 0 Physicians Anesthesia Services 20 1205228723 0 Physicians Fluoride varnish 20 1205228723 0 Physicians Healthy Kids Services 20 1205228723 0 Physicians Optical Supplies 20 1205228723 0 Physicians Physician Services 00 1205229515 0 KOVACS STEPHANIE 2018232 9999999 B 10 1205229515 0 8707 SKOKIE BLVD STE 402 SKOKIE IL 600772269 20 1205229515 0 Occupational Therapists Medical Supplies 20 1205229515 0 Occupational Therapists Medical equipment/prosthetic devices 20 1205229515 0 Occupational Therapists Occupational Therapy Services 00 1205229747 0 XIAO NICHOLAS 2019278 9999999 B 10 1205229747 0 4698 DEPT CAROL STREAM IL 601220021 20 1205229747 0 Physicians Anesthesia Services 20 1205229747 0 Physicians Healthy Kids Services 20 1205229747 0 Physicians Optical Supplies 20 1205229747 0 Physicians Physician Services 00 1205233707 0 GALLAGHER KELLY 2015182 9999999 B 10 1205233707 0 PO BOX 411637 SAINT LOUIS MO 631411637 20 1205233707 0 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EUCLID AVENUE SAINT LOUIS MO 631600352 20 1205240520 0 Physicians Anesthesia Services 20 1205240520 0 Physicians Fluoride varnish 20 1205240520 0 Physicians Healthy Kids Services 20 1205240520 0 Physicians Optical Supplies 20 1205240520 0 Physicians Physician Services 00 1205240538 0 BRANCHECK JOSEPH 2017177 9999999 B 10 1205240538 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1205240538 0 Physicians Anesthesia Services 20 1205240538 0 Physicians Fluoride varnish 20 1205240538 0 Physicians Healthy Kids Services 20 1205240538 0 Physicians Optical Supplies 20 1205240538 0 Physicians Physician Services 00 1205242716 0 CIAMPA VINCENT M 2023328 9999999 B 10 1205242716 0 PO BOX 43230 PHOENIX AZ 850803230 20 1205242716 0 Physicians Anesthesia Services 20 1205242716 0 Physicians Fluoride varnish 20 1205242716 0 Physicians Healthy Kids Services 20 1205242716 0 Physicians Optical Supplies 20 1205242716 0 Physicians Physician Services 00 1205242732 0 AMAZA ILIYA P 2019253 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340 MIDLAND RD STE 120 JANESVILLE WI 535462339 20 1205260668 0 Physicians Anesthesia Services 20 1205260668 0 Physicians Healthy Kids Services 20 1205260668 0 Physicians Optical Supplies 20 1205260668 0 Physicians Physician Services 00 1205261682 0 MARCIN GINA 2014244 9999999 B 10 1205261682 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1205261682 0 Nurse Practitioners Healthy Kids Services 20 1205261682 0 Nurse Practitioners Midwife Services 20 1205261682 0 Nurse Practitioners Nurse Practitioners Services 20 1205261682 0 Nurse Practitioners Physician Services 00 1205261724 0 CLEVELAND MICHELLE 2013262 9999999 B 10 1205261724 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1205261724 0 Nurse Practitioners All Kids application agent 20 1205261724 0 Nurse Practitioners Healthy Kids Services 20 1205261724 0 Nurse Practitioners Nurse Practitioners Services 20 1205261724 0 Nurse Practitioners Physician Services 00 1205261880 0 HERRERA ERIN L 2014058 9999999 B 10 1205261880 0 4251 FOREST PARK AVE SAINT LOUIS MO 631082810 20 1205261880 0 Nurse Practitioners Anesthesia Services 20 1205261880 0 Nurse Practitioners Nurse Practitioners Services 20 1205261880 0 Nurse Practitioners Physician Services 00 1205262052 0 WASKOSKY AKSANA 2014075 9999999 B 10 1205262052 0 PO BOX 778912 CHICAGO IL 606778912 20 1205262052 0 Nurse Practitioners Fluoride varnish 20 1205262052 0 Nurse Practitioners Healthy Kids Services 20 1205262052 0 Nurse Practitioners Nurse Practitioners Services 20 1205262052 0 Nurse Practitioners Physician Services 00 1205262169 0 GOLKO CAROLINE 2024067 9999999 B 10 1205262169 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1205262169 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205262508 0 LYNN ASHLEY I 2016140 9999999 B 10 1205262508 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1205262508 0 Nurse Practitioners Fluoride varnish 20 1205262508 0 Nurse Practitioners Healthy Kids Services 20 1205262508 0 Nurse Practitioners Nurse Practitioners Services 20 1205262508 0 Nurse Practitioners Physician Services 00 1205263019 0 MORRILL TIMOTHY D 2017317 9999999 B 10 1205263019 0 4711 GOLF RD STE 1200 SKOKIE IL 600761200 20 1205263019 0 Nurse Practitioners Healthy Kids Services 20 1205263019 0 Nurse Practitioners Nurse Practitioners Services 20 1205263019 0 Nurse Practitioners Physician Services 00 1205263373 0 SWEENEY CHRISTINA M 2017174 9999999 B 10 1205263373 0 3051 HOLLIS DR SPRINGFIELD IL 627047452 20 1205263373 0 Nurse Practitioners Healthy Kids Services 20 1205263373 0 Nurse Practitioners Nurse Practitioners Services 20 1205263373 0 Nurse Practitioners Physician Services 00 1205263589 0 MIHELCIC MEGAN 2013274 9999999 B 10 1205263589 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1205263589 0 Nurse Practitioners Fluoride varnish 20 1205263589 0 Nurse Practitioners Healthy Kids Services 20 1205263589 0 Nurse Practitioners Nurse Practitioners Services 20 1205263589 0 Nurse Practitioners Physician Services 00 1205265915 0 ANDERSON-EHRMAN ELISE 2016031 9999999 B 10 1205265915 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1205265915 0 Physician Assistant Only Fluoride varnish 20 1205265915 0 Physician Assistant Only Healthy Kids Services 20 1205265915 0 Physician Assistant Only Physician Services 00 1205267267 0 KRAUS SHERI 2018004 9999999 B 10 1205267267 0 118 E WASHINGTON ST O FALLON IL 622691419 20 1205267267 0 Speech Therapists Medical Supplies 20 1205267267 0 Speech Therapists Medical equipment/prosthetic devices 20 1205267267 0 Speech Therapists Speech Therapy/Pathology Services 00 1205268588 0 ALSAID ALKHREISAT MUSTAFA A 2023277 9999999 B 10 1205268588 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1205268588 0 Physicians Anesthesia Services 20 1205268588 0 Physicians Fluoride varnish 20 1205268588 0 Physicians Healthy Kids Services 20 1205268588 0 Physicians Optical Supplies 20 1205268588 0 Physicians Physician Services 00 1205268687 0 LISS CASSANDRA J 2021292 9999999 B 10 1205268687 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1205268687 0 Nurse Practitioners Healthy Kids Services 20 1205268687 0 Nurse Practitioners Midwife Services 20 1205268687 0 Nurse Practitioners Nurse Practitioners Services 20 1205268687 0 Nurse Practitioners Physician Services 00 1205269818 0 SANDOVAL CHRISTOPHER A 2022221 9999999 B 10 1205269818 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1205269818 0 Physicians Anesthesia Services 20 1205269818 0 Physicians Healthy Kids Services 20 1205269818 0 Physicians Optical Supplies 20 1205269818 0 Physicians Physician Services 00 1205270261 0 SMRHA ANA VICTORIA 2017146 9999999 B 10 1205270261 0 7825 SOLUTION CTR CHICAGO IL 606777007 20 1205270261 0 Physicians Anesthesia Services 20 1205270261 0 Physicians Healthy Kids Services 20 1205270261 0 Physicians Optical Supplies 20 1205270261 0 Physicians Physician Services 20 1205270261 0 Physicians Physicians Psychiatric Services 00 1205270626 0 BELEAN CATALINA 2013182 9999999 B 10 1205270626 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1205270626 0 Physicians Anesthesia Services 20 1205270626 0 Physicians Healthy Kids Services 20 1205270626 0 Physicians Optical Supplies 20 1205270626 0 Physicians Physician Services 20 1205270626 0 Physicians Physicians Psychiatric Services 00 1205270964 0 KHALIL MOHAMED 2020167 9999999 B 10 1205270964 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1205270964 0 Physicians Anesthesia Services 20 1205270964 0 Physicians Fluoride varnish 20 1205270964 0 Physicians Healthy Kids Services 20 1205270964 0 Physicians Optical Supplies 20 1205270964 0 Physicians Physician Services 00 1205271129 0 PASKARADEVAN JANAKI 2021117 9999999 B 10 1205271129 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1205271129 0 Physicians Anesthesia Services 20 1205271129 0 Physicians Fluoride varnish 20 1205271129 0 Physicians Healthy Kids Services 20 1205271129 0 Physicians Optical Supplies 20 1205271129 0 Physicians Physician Services 00 1205271400 0 JOSHI RUTWIJ KAUTILYA 2024269 9999999 B 10 1205271400 0 14050 NW 14TH ST STE 190 SUNRISE FL 333232851 20 1205271400 0 Physicians Anesthesia Services 20 1205271400 0 Physicians Fluoride varnish 20 1205271400 0 Physicians Healthy Kids Services 20 1205271400 0 Physicians Optical Supplies 20 1205271400 0 Physicians Physician Services 00 1205271632 0 HASAN AYESHA 2020204 9999999 B 10 1205271632 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1205271632 0 Physicians Anesthesia Services 20 1205271632 0 Physicians Healthy Kids Services 20 1205271632 0 Physicians Optical Supplies 20 1205271632 0 Physicians Physician Services 00 1205271764 0 TOMICH DAVID C 2021229 9999999 B 10 1205271764 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1205271764 0 Physicians Anesthesia Services 20 1205271764 0 Physicians Healthy Kids Services 20 1205271764 0 Physicians Optical Supplies 20 1205271764 0 Physicians Physician Services 00 1205271954 0 WEINER LUKASZ D 2019182 9999999 B 10 1205271954 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1205271954 0 Physicians Anesthesia Services 20 1205271954 0 Physicians Fluoride varnish 20 1205271954 0 Physicians Healthy Kids Services 20 1205271954 0 Physicians Optical Supplies 20 1205271954 0 Physicians Physician Services 00 1205272317 0 VIG KARA S 2015182 9999999 B 10 1205272317 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1205272317 0 Physicians Anesthesia Services 20 1205272317 0 Physicians Fluoride varnish 20 1205272317 0 Physicians Healthy Kids Services 20 1205272317 0 Physicians Optical Supplies 20 1205272317 0 Physicians Physician Services 00 1205272341 0 MASSA KATHERINE 2017182 9999999 B 10 1205272341 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1205272341 0 Physicians Anesthesia Services 20 1205272341 0 Physicians Healthy Kids Services 20 1205272341 0 Physicians Optical Supplies 20 1205272341 0 Physicians Physician Services 00 1205272507 0 TAN TIMOTHY 2019304 9999999 B 10 1205272507 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1205272507 0 Physicians Anesthesia Services 20 1205272507 0 Physicians Healthy Kids Services 20 1205272507 0 Physicians Optical Supplies 20 1205272507 0 Physicians Physician Services 00 1205272614 0 KLIMPL DAVID 2020101 9999999 B 10 1205272614 0 PO BOX 110429 AURORA CO 800420429 20 1205272614 0 Physicians Anesthesia Services 20 1205272614 0 Physicians Fluoride varnish 20 1205272614 0 Physicians Healthy Kids Services 20 1205272614 0 Physicians Optical Supplies 20 1205272614 0 Physicians Physician Services 00 1205272960 0 KESHARY SANJEEV R 2017139 9999999 B 10 1205272960 0 29373 NETWORK PL CHICAGO IL 606733039 20 1205272960 0 Physicians Anesthesia Services 20 1205272960 0 Physicians Healthy Kids Services 20 1205272960 0 Physicians Optical Supplies 20 1205272960 0 Physicians Physician Services 20 1205272960 0 Physicians Physicians Psychiatric Services 00 1205273083 0 COBURN JOHN 2018192 9999999 B 10 1205273083 0 7974 UW HEALTH CT 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1205274131 0 Physicians Healthy Kids Services 20 1205274131 0 Physicians Optical Supplies 20 1205274131 0 Physicians Physician Services 00 1205274925 0 MELNUK JASON R 2022040 9999999 B 10 1205274925 0 1 KISH HOSPITAL DR DEKALB IL 601159602 20 1205274925 0 Nurse Practitioners Anesthesia Services 20 1205274925 0 Nurse Practitioners Nurse Practitioners Services 20 1205274925 0 Nurse Practitioners Physician Services 00 1205275377 0 CHAN PHILIP 2017123 9999999 B 10 1205275377 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1205275377 0 Physicians Anesthesia Services 20 1205275377 0 Physicians Fluoride varnish 20 1205275377 0 Physicians Healthy Kids Services 20 1205275377 0 Physicians Optical Supplies 20 1205275377 0 Physicians Physician Services 00 1205275534 0 DEVGUN JASON 2016162 9999999 B 10 1205275534 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1205275534 0 Physicians Anesthesia Services 20 1205275534 0 Physicians Fluoride varnish 20 1205275534 0 Physicians Healthy Kids Services 20 1205275534 0 Physicians Optical Supplies 20 1205275534 0 Physicians Physician Services 00 1205275807 0 GABRIEL MAGDA Z 2015020 9999999 B 10 1205275807 0 5777 DEPT CAROL STREAM IL 601220021 20 1205275807 0 Physicians Anesthesia Services 20 1205275807 0 Physicians Fluoride varnish 20 1205275807 0 Physicians Healthy Kids Services 20 1205275807 0 Physicians Optical Supplies 20 1205275807 0 Physicians Physician Services 00 1205275849 0 SLAGLE CARA L 2023164 9999999 B 10 1205275849 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1205275849 0 Physicians Anesthesia Services 20 1205275849 0 Physicians Fluoride varnish 20 1205275849 0 Physicians Healthy Kids Services 20 1205275849 0 Physicians Optical Supplies 20 1205275849 0 Physicians Physician Services 00 1205276011 0 VLAMING JESSICA K 2016001 9999999 B 10 1205276011 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1205276011 0 Physician Assistant Only Fluoride varnish 20 1205276011 0 Physician Assistant Only Healthy Kids Services 20 1205276011 0 Physician Assistant Only Physician Services 00 1205276136 0 KANG DAVID 2016118 9999999 B 10 1205276136 0 2002 N PULASKI RD CHICAGO IL 606393767 20 1205276136 0 Physicians Anesthesia Services 20 1205276136 0 Physicians Fluoride varnish 20 1205276136 0 Physicians Healthy Kids Services 20 1205276136 0 Physicians Optical Supplies 20 1205276136 0 Physicians Physician Services 00 1205276664 0 GOMES THEOTONIUS J 2017151 9999999 B 10 1205276664 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1205276664 0 Physicians Anesthesia Services 20 1205276664 0 Physicians Fluoride varnish 20 1205276664 0 Physicians Healthy Kids Services 20 1205276664 0 Physicians Optical Supplies 20 1205276664 0 Physicians Physician Services 00 1205276698 0 MESSER ELIZABETH S 2016183 9999999 B 10 1205276698 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1205276698 0 Physicians Anesthesia Services 20 1205276698 0 Physicians Fluoride varnish 20 1205276698 0 Physicians Healthy Kids Services 20 1205276698 0 Physicians Optical Supplies 20 1205276698 0 Physicians Physician Services 00 1205278496 0 DIVITO DEVON M 2018088 9999999 B 10 1205278496 0 5777 DEPT CAROL STREAM IL 601220021 20 1205278496 0 Physicians Anesthesia Services 20 1205278496 0 Physicians Healthy Kids Services 20 1205278496 0 Physicians Optical Supplies 20 1205278496 0 Physicians Physician Services 00 1205279353 0 AFELD DYLAN R 2017097 9999999 B 10 1205279353 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1205279353 0 Physicians Anesthesia Services 20 1205279353 0 Physicians Healthy Kids Services 20 1205279353 0 Physicians Optical Supplies 20 1205279353 0 Physicians Physician Services 00 1205279650 0 BACH LOREN 2019244 9999999 B 10 1205279650 0 701 S NEW BALLAS RD STE 310 SAINT LOUIS MO 631418701 20 1205279650 0 Physicians Anesthesia Services 20 1205279650 0 Physicians Healthy Kids Services 20 1205279650 0 Physicians Optical Supplies 20 1205279650 0 Physicians Physician Services 00 1205280294 0 HAIDAR MOHAMMAD B 2020080 9999999 B 10 1205280294 0 2875 W 19TH ST CHICAGO IL 606233501 20 1205280294 0 Physicians Anesthesia Services 20 1205280294 0 Physicians Healthy Kids Services 20 1205280294 0 Physicians Optical Supplies 20 1205280294 0 Physicians Physician Services 00 1205280468 0 HASSELBLAD NAOMI M 2019247 9999999 B 10 1205280468 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1205280468 0 Physicians Anesthesia Services 20 1205280468 0 Physicians Fluoride varnish 20 1205280468 0 Physicians Healthy Kids Services 20 1205280468 0 Physicians Optical Supplies 20 1205280468 0 Physicians Physician Services 00 1205280674 0 DAOUD MAGDALENA 2016131 9999999 B 10 1205280674 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1205280674 0 Nurse Practitioners Healthy Kids Services 20 1205280674 0 Nurse Practitioners Nurse Practitioners Services 20 1205280674 0 Nurse Practitioners Physician Services 00 1205280922 0 KEMPEGOWDA HARISH 2019280 9999999 B 10 1205280922 0 727 E COURT ST 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2024283 9999999 B 10 1205286358 0 1201 N SHERIDAN RD WAUKEGAN IL 600852081 20 1205286358 0 Speech Therapists Speech Therapy/Pathology Services 00 1205286747 0 UMALI SHIRLENE A 2016034 9999999 B 10 1205286747 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1205286747 0 Nurse Practitioners Anesthesia Services 20 1205286747 0 Nurse Practitioners Nurse Practitioners Services 20 1205286747 0 Nurse Practitioners Physician Services 00 1205287612 0 JENSEN NICHELLE E 2016223 9999999 B 10 1205287612 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1205287612 0 Nurse Practitioners Fluoride varnish 20 1205287612 0 Nurse Practitioners Healthy Kids Services 20 1205287612 0 Nurse Practitioners Nurse Practitioners Services 20 1205287612 0 Nurse Practitioners Physician Services 00 1205287836 0 POWERS ANDREA L 2016202 9999999 B 10 1205287836 0 PO BOX 778912 CHICAGO IL 606778912 20 1205287836 0 Nurse Practitioners Fluoride varnish 20 1205287836 0 Nurse Practitioners Healthy Kids Services 20 1205287836 0 Nurse Practitioners Nurse Practitioners Services 20 1205287836 0 Nurse Practitioners Physician Services 00 1205290319 0 ROSALES RODRIGUEZ JERAMIE L 2020205 9999999 B 10 1205290319 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1205290319 0 Physicians Anesthesia Services 20 1205290319 0 Physicians Healthy Kids Services 20 1205290319 0 Physicians Optical Supplies 20 1205290319 0 Physicians Physician Services 20 1205290319 0 Physicians Physicians Psychiatric Services 00 1205290442 0 THYSSEN BRITTNEY 2024268 9999999 B 10 1205290442 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1205290442 0 Nurse Practitioners Fluoride varnish 20 1205290442 0 Nurse Practitioners Healthy Kids Services 20 1205290442 0 Nurse Practitioners Nurse Practitioners Services 20 1205290442 0 Nurse Practitioners Physician Services 00 1205292059 0 JOHNSON BROOKE 2018214 9999999 B 10 1205292059 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1205292059 0 Physician Assistant Only Fluoride varnish 20 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AMANDA 2017059 9999999 B 10 1205297868 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1205297868 0 Nurse Practitioners Fluoride varnish 20 1205297868 0 Nurse Practitioners Healthy Kids Services 20 1205297868 0 Nurse Practitioners Nurse Practitioners Services 20 1205297868 0 Nurse Practitioners Physician Services 00 1205298213 0 WINDSOR NATHAN S 2019203 9999999 B 10 1205298213 0 PO BOX 781076 DETROIT MI 482781076 20 1205298213 0 Podiatrists Podiatric Services 00 1205298577 0 WEINSTEIN BRIELLE 2022151 9999999 B 10 1205298577 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1205298577 0 Physicians Anesthesia Services 20 1205298577 0 Physicians Healthy Kids Services 20 1205298577 0 Physicians Optical Supplies 20 1205298577 0 Physicians Physician Services 00 1205298593 0 CORCORAN CONNOR 2024096 9999999 B 10 1205298593 0 7344 SOLUTIONS CTR CHICAGO IL 606777003 20 1205298593 0 Physicians Anesthesia Services 20 1205298593 0 Physicians Fluoride varnish 20 1205298593 0 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Services 00 1205455763 0 PITCHFORD KERRY L 2020176 9999999 B 10 1205455763 0 PO BOX 955860 SAINT LOUIS MO 631955860 20 1205455763 0 Nurse Practitioners Fluoride varnish 20 1205455763 0 Nurse Practitioners Healthy Kids Services 20 1205455763 0 Nurse Practitioners Nurse Practitioners Services 20 1205455763 0 Nurse Practitioners Physician Services 00 1205455953 0 JOHNSON BRIDGET R 2024197 9999999 B 10 1205455953 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1205455953 0 Nurse Practitioners Healthy Kids Services 20 1205455953 0 Nurse Practitioners Nurse Practitioners Services 20 1205455953 0 Nurse Practitioners Physician Services 00 1205456381 0 JOHNSON CAMILLE A 2020182 9999999 B 10 1205456381 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1205456381 0 Physicians Anesthesia Services 20 1205456381 0 Physicians Healthy Kids Services 20 1205456381 0 Physicians Optical Supplies 20 1205456381 0 Physicians Physician Services 00 1205456779 0 NUDELMAN MATTHEW J 2023270 9999999 B 10 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Healthy Kids Services 20 1205458650 0 Physicians Optical Supplies 20 1205458650 0 Physicians Physician Services 00 1205458874 0 NOTTKE TAYLOR C 2020192 9999999 B 10 1205458874 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1205458874 0 Physicians Anesthesia Services 20 1205458874 0 Physicians Fluoride varnish 20 1205458874 0 Physicians Healthy Kids Services 20 1205458874 0 Physicians Optical Supplies 20 1205458874 0 Physicians Physician Services 00 1205459922 0 MILLER ANNA 2024166 9999999 B 10 1205459922 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1205459922 0 Physicians Anesthesia Services 20 1205459922 0 Physicians Healthy Kids Services 20 1205459922 0 Physicians Optical Supplies 20 1205459922 0 Physicians Physician Services 00 1205461332 0 MEHTA SNEHA 2020069 9999999 B 10 1205461332 0 355 E ERIE ST CHICAGO IL 606113167 20 1205461332 0 Physical Therapists Medical Supplies 20 1205461332 0 Physical Therapists Medical equipment/prosthetic devices 20 1205461332 0 Physical Therapists Physical Therapy Services 00 1205462942 0 COSTER JILL E 2023236 9999999 B 10 1205462942 0 2041 GOOSE LAKE RD SAUGET IL 622062822 20 1205462942 0 Physicians Anesthesia Services 20 1205462942 0 Physicians Fluoride varnish 20 1205462942 0 Physicians Healthy Kids Services 20 1205462942 0 Physicians Optical Supplies 20 1205462942 0 Physicians Physician Services 00 1205463502 0 OGBANGA IBIFURO 2020239 9999999 B 10 1205463502 0 7732 SOLUTION CENTER CHICAGO IL 606777007 20 1205463502 0 Dentists Dental Services 20 1205463502 0 Dentists Physician Services 00 1205463528 0 CERASIELLO SAMANTHA 2020183 9999999 B 10 1205463528 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1205463528 0 Physicians Anesthesia Services 20 1205463528 0 Physicians Healthy Kids Services 20 1205463528 0 Physicians Optical Supplies 20 1205463528 0 Physicians Physician Services 00 1205463981 0 HOSSAIN MUHAIMEEN 2023215 9999999 B 10 1205463981 0 1643 NW 136TH AVE STE 200 SUNRISE FL 333232857 20 1205463981 0 Physicians 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1205464245 0 Physicians Healthy Kids Services 20 1205464245 0 Physicians Optical Supplies 20 1205464245 0 Physicians Physician Services 00 1205464443 0 KHAN HUSNA 2020233 9999999 B 10 1205464443 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1205464443 0 Physicians Anesthesia Services 20 1205464443 0 Physicians Fluoride varnish 20 1205464443 0 Physicians Healthy Kids Services 20 1205464443 0 Physicians Optical Supplies 20 1205464443 0 Physicians Physician Services 00 1205464492 0 BASTIN TAYLOR 2020234 9999999 B 10 1205464492 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1205464492 0 Physicians Anesthesia Services 20 1205464492 0 Physicians Fluoride varnish 20 1205464492 0 Physicians Healthy Kids Services 20 1205464492 0 Physicians Optical Supplies 20 1205464492 0 Physicians Physician Services 00 1205464625 0 REINGOLD LAURA J 2020174 9999999 B 10 1205464625 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1205464625 0 Physicians Anesthesia Services 20 1205464625 0 Physicians Healthy Kids Services 20 1205464625 0 Physicians Optical Supplies 20 1205464625 0 Physicians Physician Services 00 1205464815 0 VACA ELIZABETH 2020181 9999999 B 10 1205464815 0 PO BOX 3039 OAK BROOK IL 605223039 20 1205464815 0 Physicians Anesthesia Services 20 1205464815 0 Physicians Fluoride varnish 20 1205464815 0 Physicians Healthy Kids Services 20 1205464815 0 Physicians Optical Supplies 20 1205464815 0 Physicians Physician Services 00 1205464831 0 CAVLOVIC MARLEE R 2023276 9999999 B 10 1205464831 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1205464831 0 Physician Assistant Only Fluoride varnish 20 1205464831 0 Physician Assistant Only Healthy Kids Services 20 1205464831 0 Physician Assistant Only Physician Services 00 1205465234 0 VEST MALLORIE K 2023334 9999999 B 10 1205465234 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1205465234 0 Physicians Anesthesia Services 20 1205465234 0 Physicians Fluoride varnish 20 1205465234 0 Physicians Healthy Kids 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146 WATERLOO IL 622980146 20 1205485661 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205486388 0 GLIM GABRIELLE 2024011 9999999 B 10 1205486388 0 2171 W EXECUTIVE DR STE 500 ADDISON IL 601015626 20 1205486388 0 Speech Therapists Medical Supplies 20 1205486388 0 Speech Therapists Medical equipment/prosthetic devices 20 1205486388 0 Speech Therapists Speech Therapy/Pathology Services 00 1205488293 0 MEMON BURHAN 2019365 9999999 B 10 1205488293 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1205488293 0 Physicians Anesthesia Services 20 1205488293 0 Physicians Fluoride varnish 20 1205488293 0 Physicians Healthy Kids Services 20 1205488293 0 Physicians Optical Supplies 20 1205488293 0 Physicians Physician Services 00 1205488301 0 SINGERMAN WILLIAM 2024008 9999999 B 10 1205488301 0 53 W JACKSON BLVD STE 1028 CHICAGO IL 606043648 20 1205488301 0 Other behavior health professional LCPC/LMFT services 00 1205488467 0 HUIBONHOA ROBERT M 2022362 9999999 B 10 1205488467 0 1 ILLINI DR PEORIA IL 616052576 20 1205488467 0 Physicians Anesthesia Services 20 1205488467 0 Physicians Fluoride varnish 20 1205488467 0 Physicians Healthy Kids Services 20 1205488467 0 Physicians Optical Supplies 20 1205488467 0 Physicians Physician Services 00 1205489135 0 KOVURI PRANITHA 2019266 9999999 B 10 1205489135 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1205489135 0 Physicians Anesthesia Services 20 1205489135 0 Physicians Fluoride varnish 20 1205489135 0 Physicians Healthy Kids Services 20 1205489135 0 Physicians Optical Supplies 20 1205489135 0 Physicians Physician Services 00 1205489945 0 CULICH RACHEL C 2022131 9999999 B 10 1205489945 0 19990 GOVERNORS HWY OLYMPIA FIELDS IL 604611021 20 1205489945 0 Clinical Social Worker Social work service 00 1205490075 0 CAMERON ERYN LEE 2022061 9999999 B 10 1205490075 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1205490075 0 Physicians Anesthesia Services 20 1205490075 0 Physicians Fluoride varnish 20 1205490075 0 Physicians Healthy Kids Services 20 1205490075 0 Physicians Optical Supplies 20 1205490075 0 Physicians Physician Services 00 1205490380 0 SAYLORS CYNTHIA D 2025091 9999999 B 10 1205490380 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1205490380 0 Nurse Practitioners Fluoride varnish 20 1205490380 0 Nurse Practitioners Healthy Kids Services 20 1205490380 0 Nurse Practitioners Nurse Practitioners Services 20 1205490380 0 Nurse Practitioners Physician Services 00 1205491461 0 WALSH ANNA M 2023184 9999999 B 10 1205491461 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1205491461 0 Physicians Anesthesia Services 20 1205491461 0 Physicians Healthy Kids Services 20 1205491461 0 Physicians Optical Supplies 20 1205491461 0 Physicians Physician Services 00 1205491859 0 BURNIA PAIGE G 2019226 9999999 B 10 1205491859 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1205491859 0 Physicians Anesthesia Services 20 1205491859 0 Physicians Healthy Kids Services 20 1205491859 0 Physicians Optical Supplies 20 1205491859 0 Physicians Physician Services 00 1205491875 0 NKWOCHA CORNELIA 2019361 9999999 B 10 1205491875 0 1643 NW 136TH AVE BLDG H SUNRISE FL 333232857 20 1205491875 0 Nurse Practitioners Fluoride varnish 20 1205491875 0 Nurse Practitioners Healthy Kids Services 20 1205491875 0 Nurse Practitioners Nurse Practitioners Services 20 1205491875 0 Nurse Practitioners Physician Services 00 1205492097 0 HOBSON GRACE 2022144 9999999 B 10 1205492097 0 9718 S HALSTED ST CHICAGO IL 606281007 20 1205492097 0 Other behavior health professional LCPC/LMFT services 00 1205493723 0 COKER CANAAN K 2019329 9999999 B 10 1205493723 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1205493723 0 Physicians Anesthesia Services 20 1205493723 0 Physicians Fluoride varnish 20 1205493723 0 Physicians Healthy Kids Services 20 1205493723 0 Physicians Optical Supplies 20 1205493723 0 Physicians Physician Services 20 1205493723 0 Physicians Physicians Psychiatric Services 00 1205495397 0 ALLEN SADIE 2020273 9999999 B 10 1205495397 0 245 W ROOSEVELT RD STE 103 WEST CHICAGO IL 601854819 20 1205495397 0 Speech Therapists Medical Supplies 20 1205495397 0 Speech Therapists Medical equipment/prosthetic devices 20 1205495397 0 Speech Therapists Speech Therapy/Pathology Services 00 1205495439 0 TOWNSEND SAMANTHA 2024071 9999999 B 10 1205495439 0 350 N GRANDVIEW AVE DUBUQUE IA 520016388 20 1205495439 0 Physicians Anesthesia Services 20 1205495439 0 Physicians Fluoride varnish 20 1205495439 0 Physicians Healthy Kids Services 20 1205495439 0 Physicians Optical Supplies 20 1205495439 0 Physicians Physician Services 00 1205495728 0 MARTY PLACENCIA DAISY A 2022182 9999999 B 10 1205495728 0 29373 NETWORK PL CHICAGO IL 606733039 20 1205495728 0 Physicians Anesthesia Services 20 1205495728 0 Physicians Fluoride varnish 20 1205495728 0 Physicians Healthy Kids Services 20 1205495728 0 Physicians Optical Supplies 20 1205495728 0 Physicians Physician Services 00 1205495736 0 FRAEHLICH ALISON E 2021343 9999999 B 10 1205495736 0 PO BOX 4028 ROCK ISLAND IL 612044028 20 1205495736 0 Physicians Anesthesia Services 20 1205495736 0 Physicians Fluoride varnish 20 1205495736 0 Physicians Healthy Kids Services 20 1205495736 0 Physicians Optical Supplies 20 1205495736 0 Physicians Physician Services 00 1205496197 0 KHOSHKISH ALI 2021174 9999999 B 10 1205496197 0 233 E 13TH ST APT 2406 CHICAGO IL 606053264 20 1205496197 0 Physicians Anesthesia Services 20 1205496197 0 Physicians Healthy Kids Services 20 1205496197 0 Physicians Optical Supplies 20 1205496197 0 Physicians Physician Services 20 1205496197 0 Physicians Physicians Psychiatric Services 00 1205497070 0 ALMAJALI FAWWAZ 2019276 9999999 B 10 1205497070 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1205497070 0 Physicians Anesthesia Services 20 1205497070 0 Physicians Healthy Kids Services 20 1205497070 0 Physicians Optical Supplies 20 1205497070 0 Physicians Physician Services 00 1205497146 0 STOKES LAUREN 2023235 9999999 B 10 1205497146 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1205497146 0 Physicians Anesthesia Services 20 1205497146 0 Physicians Healthy Kids Services 20 1205497146 0 Physicians Optical Supplies 20 1205497146 0 Physicians Physician Services 00 1205498029 0 ALDIABAT MOHAMMAD A Y 2023159 9999999 B 10 1205498029 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1205498029 0 Physicians Anesthesia Services 20 1205498029 0 Physicians Fluoride varnish 20 1205498029 0 Physicians Healthy Kids Services 20 1205498029 0 Physicians Optical Supplies 20 1205498029 0 Physicians Physician Services 00 1205498862 0 YARBROUGH AMANDA 2022189 9999999 B 10 1205498862 0 PO BOX 775342 CHICAGO IL 606775342 20 1205498862 0 Nurse Practitioners Fluoride varnish 20 1205498862 0 Nurse Practitioners Healthy Kids Services 20 1205498862 0 Nurse Practitioners Nurse Practitioners Services 20 1205498862 0 Nurse Practitioners Physician Services 00 1205498920 0 ONYENEKWU CHINELO P 2024138 9999999 B 10 1205498920 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1205498920 0 Physicians Anesthesia Services 20 1205498920 0 Physicians Healthy Kids Services 20 1205498920 0 Physicians Optical Supplies 20 1205498920 0 Physicians Physician Services 00 1205499373 0 GOLDSMITH MATTHEW M 2022224 9999999 B 10 1205499373 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1205499373 0 Physicians Anesthesia Services 20 1205499373 0 Physicians Fluoride varnish 20 1205499373 0 Physicians Healthy Kids Services 20 1205499373 0 Physicians Optical Supplies 20 1205499373 0 Physicians Physician Services 00 1205500246 0 MCCORVEY JESSICA L 2021286 9999999 B 10 1205500246 0 2041 GOOSE LAKE RD SAUGET IL 622062822 20 1205500246 0 Nurse Practitioners Healthy Kids Services 20 1205500246 0 Nurse Practitioners Nurse Practitioners Services 20 1205500246 0 Nurse Practitioners Physician Services 00 1205500725 0 FEELEY STACEY MARTIN 2022241 9999999 B 10 1205500725 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1205500725 0 Psychologist Psychologist service 00 1205503687 0 KURTH CARLY J 2021265 9999999 B 10 1205503687 0 515 22ND AVE MONROE WI 535661569 20 1205503687 0 Nurse Practitioners Healthy Kids Services 20 1205503687 0 Nurse Practitioners Nurse Practitioners Services 20 1205503687 0 Nurse Practitioners Physician Services 00 1205504529 0 HABERKORN NICOLE 2021321 9999999 B 10 1205504529 0 5777 DEPT CAROL STREAM IL 601220021 20 1205504529 0 Nurse Practitioners Fluoride varnish 20 1205504529 0 Nurse Practitioners Healthy Kids Services 20 1205504529 0 Nurse Practitioners Nurse Practitioners Services 20 1205504529 0 Nurse Practitioners Physician Services 00 1205504552 0 GAMBOA JOBELLE 2021250 9999999 B 10 1205504552 0 101 E MILLER RD STERLING IL 610811252 20 1205504552 0 Nurse Practitioners Healthy Kids Services 20 1205504552 0 Nurse Practitioners Nurse Practitioners Services 20 1205504552 0 Nurse Practitioners Physician Services 00 1205509262 0 MORALES CAMILO 2024296 9999999 B 10 1205509262 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1205509262 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205509437 0 CRAIG NATHANIEL J 2021267 9999999 B 10 1205509437 0 611 W PARK ST URBANA IL 618012529 20 1205509437 0 Nurse Practitioners Fluoride varnish 20 1205509437 0 Nurse Practitioners Healthy Kids Services 20 1205509437 0 Nurse Practitioners Nurse Practitioners Services 20 1205509437 0 Nurse Practitioners Physician Services 00 1205509726 0 METTS LESLEY 2021305 9999999 B 10 1205509726 0 PO BOX 1412 SOUTH BEND IN 466241412 20 1205509726 0 Nurse Practitioners Fluoride varnish 20 1205509726 0 Nurse Practitioners Healthy Kids Services 20 1205509726 0 Nurse Practitioners Nurse Practitioners Services 20 1205509726 0 Nurse Practitioners Physician Services 00 1205509924 0 SEO MINJEONG 2022128 9999999 B 10 1205509924 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1205509924 0 Nurse Practitioners Healthy Kids Services 20 1205509924 0 Nurse Practitioners Nurse Practitioners Services 20 1205509924 0 Nurse Practitioners Physician Services 00 1205510153 0 VALMIKI SURBHI 2023285 9999999 B 10 1205510153 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1205510153 0 Physicians Anesthesia Services 20 1205510153 0 Physicians Fluoride varnish 20 1205510153 0 Physicians Healthy Kids Services 20 1205510153 0 Physicians Optical Supplies 20 1205510153 0 Physicians Physician Services 00 1205510880 0 ALBARRAN DANIEL 2023186 9999999 B 10 1205510880 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1205510880 0 Physicians Anesthesia Services 20 1205510880 0 Physicians Fluoride varnish 20 1205510880 0 Physicians Healthy Kids Services 20 1205510880 0 Physicians Optical Supplies 20 1205510880 0 Physicians Physician Services 00 1205511003 0 PHAM TRI 2023193 9999999 B 10 1205511003 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1205511003 0 Physicians Anesthesia Services 20 1205511003 0 Physicians Fluoride varnish 20 1205511003 0 Physicians Healthy Kids Services 20 1205511003 0 Physicians Optical Supplies 20 1205511003 0 Physicians Physician Services 00 1205511037 0 SHIVAKUMAR NIRMALA 2023339 9999999 B 10 1205511037 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1205511037 0 Physicians Anesthesia Services 20 1205511037 0 Physicians Fluoride varnish 20 1205511037 0 Physicians Healthy Kids Services 20 1205511037 0 Physicians Optical Supplies 20 1205511037 0 Physicians Physician Services 00 1205511193 0 LUCAS HANNAH R 2023191 9999999 B 10 1205511193 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1205511193 0 Physicians Anesthesia Services 20 1205511193 0 Physicians Fluoride varnish 20 1205511193 0 Physicians Healthy Kids Services 20 1205511193 0 Physicians Optical Supplies 20 1205511193 0 Physicians Physician Services 00 1205513066 0 OVERMYER EMMA C 2023362 9999999 B 10 1205513066 0 PO BOX 1412 SOUTH BEND IN 466241412 20 1205513066 0 Physician Assistant Only Fluoride varnish 20 1205513066 0 Physician Assistant Only Healthy Kids Services 20 1205513066 0 Physician Assistant Only Physician Services 00 1205513355 0 MURILLO DAVID 2023187 9999999 B 10 1205513355 0 PO BOX 1109 DEKALB IL 601157109 20 1205513355 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205513983 0 SAIYED ALIYAH 2023222 9999999 B 10 1205513983 0 2964 COMMERCE DR MCHENRY IL 600515409 20 1205513983 0 Dentists Dental Services 20 1205513983 0 Dentists Physician Services 00 1205516176 0 KUPFER CARRIE L 2024291 9999999 B 10 1205516176 0 233 OAKWOOD DR WOOD DALE IL 601911953 20 1205516176 0 Clinical Social Worker Social work service 00 1205517471 0 KIEKHAEFER CAITLYN A 2023354 9999999 B 10 1205517471 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1205517471 0 Physician Assistant Only Fluoride varnish 20 1205517471 0 Physician Assistant Only Healthy Kids Services 20 1205517471 0 Physician Assistant Only Physician Services 00 1205519626 0 SCHLABACH GAYLE 2024319 9999999 B 10 1205519626 0 611 W PARK ST URBANA IL 618012529 20 1205519626 0 Nurse Practitioners Healthy Kids Services 20 1205519626 0 Nurse Practitioners Nurse Practitioners Services 20 1205519626 0 Nurse Practitioners Physician Services 00 1205519832 0 CAPRARU ANETA 2023335 9999999 B 10 1205519832 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1205519832 0 Nurse Practitioners Healthy Kids Services 20 1205519832 0 Nurse Practitioners Nurse Practitioners Services 20 1205519832 0 Nurse Practitioners Physician Services 00 1205522364 0 VEMAGANTI HIRANMAYI 2024004 9999999 B 10 1205522364 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1205522364 0 Physicians Anesthesia Services 20 1205522364 0 Physicians Healthy Kids Services 20 1205522364 0 Physicians Optical Supplies 20 1205522364 0 Physicians Physician Services 00 1205523222 0 BICEK BRIDGET 2023117 9999999 B 10 1205523222 0 414 PLAZA DR STE 301 WESTMONT IL 605595508 20 1205523222 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205523651 0 MAYS LAUREN 2023200 9999999 B 10 1205523651 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1205523651 0 Physicians Anesthesia Services 20 1205523651 0 Physicians Healthy Kids Services 20 1205523651 0 Physicians Optical Supplies 20 1205523651 0 Physicians Physician Services 00 1205524469 0 CAMARENA ERICA 2024228 9999999 B 10 1205524469 0 PO BOX 322 323 WEST MULBERRY ST WATSEKA IL 609700322 20 1205524469 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205525920 0 RHEINLANDER ELLE R 2023270 9999999 B 10 1205525920 0 1418 COLLEGE DR MOUNT CARMEL IL 628632638 20 1205525920 0 Physician Assistant Only Fluoride varnish 20 1205525920 0 Physician Assistant Only Healthy Kids Services 20 1205525920 0 Physician Assistant Only Physician Services 00 1205526720 0 FOSTER OLIVIA 2023213 9999999 B 10 1205526720 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1205526720 0 Nurse Practitioners Healthy Kids Services 20 1205526720 0 Nurse Practitioners Nurse Practitioners Services 20 1205526720 0 Nurse Practitioners Physician Services 00 1205527058 0 COTHERN SARA 2023143 9999999 B 10 1205527058 0 151 N MAIN ST DECATUR IL 625231206 20 1205527058 0 Clinical Social Worker Social work service 00 1205527249 0 PLATOU DEBBIE W 2023286 9999999 B 10 1205527249 0 2601 NETWORK BLVD STE 102 FRISCO TX 750349092 20 1205527249 0 Physical Therapists Medical Supplies 20 1205527249 0 Physical Therapists Medical equipment/prosthetic devices 20 1205527249 0 Physical Therapists Physical Therapy Services 00 1205527348 0 VIRATYOSIN TAYVIN 2024091 9999999 B 10 1205527348 0 2020 OGDEN AVE STE 325 AURORA IL 605045897 20 1205527348 0 Physicians Anesthesia Services 20 1205527348 0 Physicians Fluoride varnish 20 1205527348 0 Physicians Healthy Kids Services 20 1205527348 0 Physicians Optical Supplies 20 1205527348 0 Physicians Physician Services 00 1205528148 0 MCILRATH MATTHEW 2023171 9999999 B 10 1205528148 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1205528148 0 Physicians Anesthesia Services 20 1205528148 0 Physicians Healthy Kids Services 20 1205528148 0 Physicians Optical Supplies 20 1205528148 0 Physicians Physician Services 00 1205528189 0 VAN SON SARAH 2024166 9999999 B 10 1205528189 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1205528189 0 Physicians Anesthesia Services 20 1205528189 0 Physicians Healthy Kids Services 20 1205528189 0 Physicians Optical Supplies 20 1205528189 0 Physicians Physician Services 00 1205528726 0 ACHESON JOHN C 2023186 9999999 B 10 1205528726 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1205528726 0 Physicians Anesthesia Services 20 1205528726 0 Physicians Healthy Kids Services 20 1205528726 0 Physicians Optical Supplies 20 1205528726 0 Physicians Physician Services 00 1205529120 0 KELLY CLARENCE 2023152 9999999 B 10 1205529120 0 4101 N RAVENSWOOD AVE CHICAGO IL 606132193 20 1205529120 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205529492 0 VADLAMANI ROHIT 2023300 9999999 B 10 1205529492 0 2050 E ALGONQUIN RD STE 610 SCHAUMBURG IL 601734166 20 1205529492 0 Dentists Dental Services 20 1205529492 0 Dentists Physician Services 00 1205529906 0 SIDOR JULIA 2023204 9999999 B 10 1205529906 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1205529906 0 Physicians Anesthesia Services 20 1205529906 0 Physicians Healthy Kids Services 20 1205529906 0 Physicians Optical Supplies 20 1205529906 0 Physicians Physician Services 00 1205530300 0 GOODRICH JORDAN 2023257 9999999 B 10 1205530300 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1205530300 0 Physicians Anesthesia Services 20 1205530300 0 Physicians Healthy Kids Services 20 1205530300 0 Physicians Optical Supplies 20 1205530300 0 Physicians Physician Services 20 1205530300 0 Physicians Physicians Psychiatric Services 00 1205530425 0 SCOTT CULLEN W 2023152 9999999 B 10 1205530425 0 PO BOX 3039 OAK BROOK IL 605223039 20 1205530425 0 Physicians Anesthesia Services 20 1205530425 0 Physicians Fluoride varnish 20 1205530425 0 Physicians Healthy Kids Services 20 1205530425 0 Physicians Optical Supplies 20 1205530425 0 Physicians Physician Services 00 1205530557 0 COLWELL JENNA KATHERINE 2023174 9999999 B 10 1205530557 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1205530557 0 Physicians Anesthesia Services 20 1205530557 0 Physicians Fluoride varnish 20 1205530557 0 Physicians Healthy Kids Services 20 1205530557 0 Physicians Optical Supplies 20 1205530557 0 Physicians Physician Services 00 1205530656 0 SOLINSKI MARK A 2023149 9999999 B 10 1205530656 0 4698 DEPT CAROL STREAM IL 601220021 20 1205530656 0 Physicians Anesthesia Services 20 1205530656 0 Physicians Fluoride varnish 20 1205530656 0 Physicians Healthy Kids Services 20 1205530656 0 Physicians Optical Supplies 20 1205530656 0 Physicians Physician Services 00 1205530706 0 BHUVANAGIRI SUPRIYA 2023171 9999999 B 10 1205530706 0 4701 DEPT CAROL STREAM IL 601220021 20 1205530706 0 Physicians Anesthesia Services 20 1205530706 0 Physicians Fluoride varnish 20 1205530706 0 Physicians Healthy Kids Services 20 1205530706 0 Physicians Optical Supplies 20 1205530706 0 Physicians Physician Services 00 1205531092 0 KIM-WANG SOPHIA Y 2024183 9999999 B 10 1205531092 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1205531092 0 Physicians Anesthesia Services 20 1205531092 0 Physicians Healthy Kids Services 20 1205531092 0 Physicians Optical Supplies 20 1205531092 0 Physicians Physician Services 00 1205532041 0 PERDUE KRYSTAL 2023051 9999999 B 10 1205532041 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1205532041 0 Nurse Practitioners Healthy Kids Services 20 1205532041 0 Nurse Practitioners Nurse Practitioners Services 20 1205532041 0 Nurse Practitioners Physician Services 00 1205534674 0 JONITES PAIGE L 2024177 9999999 B 10 1205534674 0 16105 S LA GRANGE RD ORLAND PARK IL 604675503 20 1205534674 0 Physician Assistant Only Fluoride varnish 20 1205534674 0 Physician Assistant Only Healthy Kids Services 20 1205534674 0 Physician Assistant Only Physician Services 00 1205536349 0 COLAKOVIC ERICKA 2023115 9999999 B 10 1205536349 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1205536349 0 Nurse Practitioners Healthy Kids Services 20 1205536349 0 Nurse Practitioners Nurse Practitioners Services 20 1205536349 0 Nurse Practitioners Physician Services 00 1205538444 0 ARMSTRONG AUSTIN 2023199 9999999 B 10 1205538444 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1205538444 0 Physicians Anesthesia Services 20 1205538444 0 Physicians Healthy Kids Services 20 1205538444 0 Physicians Optical Supplies 20 1205538444 0 Physicians Physician Services 00 1205538980 0 KOUATLI YAMAN 2023193 9999999 B 10 1205538980 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1205538980 0 Physicians Anesthesia Services 20 1205538980 0 Physicians Fluoride varnish 20 1205538980 0 Physicians Healthy Kids Services 20 1205538980 0 Physicians Optical Supplies 20 1205538980 0 Physicians Physician Services 00 1205539012 0 WHITE HANNAH 2024215 9999999 B 10 1205539012 0 PO BOX 637273 CINCINNATI OH 452637273 20 1205539012 0 Physician Assistant Only Fluoride varnish 20 1205539012 0 Physician Assistant Only Healthy Kids Services 20 1205539012 0 Physician Assistant Only Physician Services 00 1205540184 0 GUTIERREZ VANESSA 2023129 9999999 B 10 1205540184 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1205540184 0 Speech Therapists Medical Supplies 20 1205540184 0 Speech Therapists Medical equipment/prosthetic devices 20 1205540184 0 Speech Therapists Speech Therapy/Pathology Services 00 1205542297 0 OSISANYA ADEBOWALE 2023135 9999999 B 10 1205542297 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1205542297 0 Nurse Practitioners Healthy Kids Services 20 1205542297 0 Nurse Practitioners Nurse Practitioners Services 20 1205542297 0 Nurse Practitioners Physician Services 00 1205542586 0 BUSH MEGAN E 2023030 9999999 B 10 1205542586 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1205542586 0 Nurse Practitioners Fluoride varnish 20 1205542586 0 Nurse Practitioners Healthy Kids Services 20 1205542586 0 Nurse Practitioners Nurse Practitioners Services 20 1205542586 0 Nurse Practitioners Physician Services 00 1205542958 0 BESWICK BRADLEY D 2023100 9999999 B 10 1205542958 0 1005 BROADWAY ST QUINCY IL 623012834 20 1205542958 0 Nurse Practitioners Fluoride varnish 20 1205542958 0 Nurse Practitioners Healthy Kids Services 20 1205542958 0 Nurse Practitioners Nurse Practitioners Services 20 1205542958 0 Nurse Practitioners Physician Services 00 1205543899 0 WAVRA MICHELLE 2023059 9999999 B 10 1205543899 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1205543899 0 Nurse Practitioners Healthy Kids Services 20 1205543899 0 Nurse Practitioners Nurse Practitioners Services 20 1205543899 0 Nurse Practitioners Physician Services 00 1205544582 0 KILGORE TINIKA 2022320 9999999 B 10 1205544582 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1205544582 0 Nurse Practitioners Healthy Kids Services 20 1205544582 0 Nurse Practitioners Nurse Practitioners Services 20 1205544582 0 Nurse Practitioners Physician Services 00 1205544988 0 DIERINGER KADY E 2023103 9999999 B 10 1205544988 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1205544988 0 Physical Therapists Medical Supplies 20 1205544988 0 Physical Therapists Medical equipment/prosthetic devices 20 1205544988 0 Physical Therapists Physical Therapy Services 00 1205545092 0 CORBIN ANNE 2023114 9999999 B 10 1205545092 0 PO BOX 889430 LOS ANGELES CA 900889430 20 1205545092 0 Physician Assistant Only Fluoride varnish 20 1205545092 0 Physician Assistant Only Healthy Kids Services 20 1205545092 0 Physician Assistant Only Physician Services 00 1205545639 0 SUGGS ASHLEY 2023018 9999999 B 10 1205545639 0 PO BOX 790 METROPOLIS IL 629600790 20 1205545639 0 Nurse Practitioners Healthy Kids Services 20 1205545639 0 Nurse Practitioners Nurse Practitioners Services 20 1205545639 0 Nurse Practitioners Physician Services 00 1205546298 0 RUEMELIN MELISSA A 2022340 9999999 B 10 1205546298 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1205546298 0 Physical Therapists Medical Supplies 20 1205546298 0 Physical Therapists Medical equipment/prosthetic devices 20 1205546298 0 Physical Therapists Physical Therapy Services 00 1205546512 0 NICHOLAS ROBIN 2022361 9999999 B 10 1205546512 0 1414 MAIN ST MELROSE PARK IL 601603902 20 1205546512 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205547197 0 HUDZIK STEVEN 2023011 9999999 B 10 1205547197 0 325 IL ROUTE 2 DIXON IL 610219118 20 1205547197 0 Other behavior health professional LCPC/LMFT services 00 1205548088 0 SOHAL RAJWANT 2023222 9999999 B 10 1205548088 0 800 W FULTON MARKET FL 12 CHICAGO IL 606071302 20 1205548088 0 Nurse Practitioners Fluoride varnish 20 1205548088 0 Nurse Practitioners Healthy Kids Services 20 1205548088 0 Nurse Practitioners Nurse Practitioners Services 20 1205548088 0 Nurse Practitioners Physician Services 00 1205548591 0 CURRY JARED 2024016 9999999 B 10 1205548591 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1205548591 0 Physician Assistant Only Fluoride varnish 20 1205548591 0 Physician Assistant Only Healthy Kids Services 20 1205548591 0 Physician Assistant Only Physician Services 00 1205549136 0 LAMKEMEYER SHELBY L 2024080 9999999 B 10 1205549136 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1205549136 0 Physician Assistant Only Fluoride varnish 20 1205549136 0 Physician Assistant Only Healthy Kids Services 20 1205549136 0 Physician Assistant Only Physician Services 00 1205550167 0 BASS DANIEL A 2022279 9999999 B 10 1205550167 0 7272 WURZBACH RD STE 601 SAN ANTONIO TX 782404803 20 1205550167 0 Clinical Social Worker Social work service 00 1205552114 0 EBEYWA ELIZABETH A 2022293 9999999 B 10 1205552114 0 29373 NETWORK PL CHICAGO IL 606733039 20 1205552114 0 Nurse Practitioners Healthy Kids Services 20 1205552114 0 Nurse Practitioners Nurse Practitioners Services 20 1205552114 0 Nurse Practitioners Physician Services 00 1205552379 0 BENIPAL BRINDERJIT 2022341 9999999 B 10 1205552379 0 100 CROSSING BLVD STE 300 FRAMINGHAM MA 017025555 20 1205552379 0 Nurse Practitioners Fluoride varnish 20 1205552379 0 Nurse Practitioners Healthy Kids Services 20 1205552379 0 Nurse Practitioners Nurse Practitioners Services 20 1205552379 0 Nurse Practitioners Physician Services 00 1205553021 0 KIM SE YUN 2023114 9999999 B 10 1205553021 0 4326 W MONTROSE AVE CHICAGO IL 606412016 20 1205553021 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205553690 0 ESCHKER EMMA 2022320 9999999 B 10 1205553690 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1205553690 0 Nurse Practitioners Fluoride varnish 20 1205553690 0 Nurse Practitioners Healthy Kids Services 20 1205553690 0 Nurse Practitioners Nurse Practitioners Services 20 1205553690 0 Nurse Practitioners Physician Services 00 1205553773 0 CRAFT LUCAS 2023019 9999999 B 10 1205553773 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1205553773 0 Physician Assistant Only Fluoride varnish 20 1205553773 0 Physician Assistant Only Healthy Kids Services 20 1205553773 0 Physician Assistant Only Physician Services 00 1205557378 0 CHENG CASEYLIN 2023334 9999999 B 10 1205557378 0 2500 S HIGHLAND AVE STE 230 LOMBARD IL 601485363 20 1205557378 0 Physician Assistant Only Fluoride varnish 20 1205557378 0 Physician Assistant Only Healthy Kids Services 20 1205557378 0 Physician Assistant Only Physician Services 00 1205557600 0 BURANDT MICHAELA 2023314 9999999 B 10 1205557600 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1205557600 0 Physician Assistant Only Fluoride varnish 20 1205557600 0 Physician Assistant Only Healthy Kids Services 20 1205557600 0 Physician Assistant Only Physician Services 00 1205557980 0 HILL ONETHA L 2022266 9999999 B 10 1205557980 0 1325 SYCAMORE RD DEKALB IL 601152483 20 1205557980 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205559242 0 FARRAR ALYSE D 2023109 9999999 B 10 1205559242 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1205559242 0 Physician Assistant Only Fluoride varnish 20 1205559242 0 Physician Assistant Only Healthy Kids Services 20 1205559242 0 Physician Assistant Only Physician Services 00 1205559796 0 AMONI CHRISTINE 2022264 9999999 B 10 1205559796 0 PO BOX 1109 DEKALB IL 601157109 20 1205559796 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205560745 0 KIM HSIEH SU 2022215 9999999 B 10 1205560745 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1205560745 0 Physicians Anesthesia Services 20 1205560745 0 Physicians Healthy Kids Services 20 1205560745 0 Physicians Optical Supplies 20 1205560745 0 Physicians Physician Services 00 1205561412 0 MURPHY ELLIE ANNE 2024361 9999999 B 10 1205561412 0 2901 FINLEY RD STE 102 DOWNERS GROVE IL 605151774 20 1205561412 0 Speech Therapists Medical Supplies 20 1205561412 0 Speech Therapists Medical equipment/prosthetic devices 20 1205561412 0 Speech Therapists Speech Therapy/Pathology Services 00 1205561560 0 TESSON KATHERINE 2022245 9999999 B 10 1205561560 0 901 PATIENTS FIRST DR WASHINGTON MO 630904700 20 1205561560 0 Nurse Practitioners Fluoride varnish 20 1205561560 0 Nurse Practitioners Healthy Kids Services 20 1205561560 0 Nurse Practitioners Nurse Practitioners Services 20 1205561560 0 Nurse Practitioners Physician Services 00 1205561867 0 KUPPLER JESSICA 2022231 9999999 B 10 1205561867 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1205561867 0 Nurse Practitioners Healthy Kids Services 20 1205561867 0 Nurse Practitioners Nurse Practitioners Services 20 1205561867 0 Nurse Practitioners Physician Services 00 1205564101 0 FRITZ EMILY 2023087 9999999 B 10 1205564101 0 PO BOX 781076 DETROIT MI 482781076 20 1205564101 0 Nurse Practitioners Fluoride varnish 20 1205564101 0 Nurse Practitioners Healthy Kids Services 20 1205564101 0 Nurse Practitioners Nurse Practitioners Services 20 1205564101 0 Nurse Practitioners Physician Services 00 1205565967 0 WANG CAROLINE K 2022209 9999999 B 10 1205565967 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1205565967 0 Physicians Anesthesia Services 20 1205565967 0 Physicians Fluoride varnish 20 1205565967 0 Physicians Healthy Kids Services 20 1205565967 0 Physicians Optical Supplies 20 1205565967 0 Physicians Physician Services 00 1205566692 0 DORLEANS-REYES LISA 2022213 9999999 B 10 1205566692 0 5844 ELAINE DR STE 101 ROCKFORD IL 611082494 20 1205566692 0 Clinical Social Worker Social work service 00 1205566775 0 ZAZA LAYAN 2024071 9999999 B 10 1205566775 0 7300 N WESTERN AVE STE J CHICAGO IL 606451833 20 1205566775 0 Dentists Dental Services 20 1205566775 0 Dentists Physician Services 00 1205568235 0 ABUSAOUD BARAA 2022196 9999999 B 10 1205568235 0 11 W DOWNER PL AURORA IL 605065134 20 1205568235 0 Dentists Dental Services 20 1205568235 0 Dentists Physician Services 00 1205568409 0 GANDRABUR ALINA 2022241 9999999 B 10 1205568409 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1205568409 0 Physicians Anesthesia Services 20 1205568409 0 Physicians Healthy Kids Services 20 1205568409 0 Physicians Optical Supplies 20 1205568409 0 Physicians Physician Services 00 1205568565 0 VAUGHN COURTNEY M 2022189 9999999 B 10 1205568565 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1205568565 0 Physicians Anesthesia Services 20 1205568565 0 Physicians Fluoride varnish 20 1205568565 0 Physicians Healthy Kids Services 20 1205568565 0 Physicians Optical Supplies 20 1205568565 0 Physicians Physician Services 00 1205568771 0 GRIFFIN JOHN F 2022188 9999999 B 10 1205568771 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1205568771 0 Physicians Anesthesia Services 20 1205568771 0 Physicians Fluoride varnish 20 1205568771 0 Physicians Healthy Kids Services 20 1205568771 0 Physicians Optical Supplies 20 1205568771 0 Physicians Physician Services 00 1205568904 0 SINADA SAMI MAM 2024262 9999999 B 10 1205568904 0 7531 S STONY ISLAND AVE CHICAGO IL 606493954 20 1205568904 0 Physicians Anesthesia Services 20 1205568904 0 Physicians Fluoride varnish 20 1205568904 0 Physicians Healthy Kids Services 20 1205568904 0 Physicians Optical Supplies 20 1205568904 0 Physicians Physician Services 00 1205568912 0 BOMKAMP KORL 2022195 9999999 B 10 1205568912 0 PO BOX 5081 JANESVILLE WI 535475081 20 1205568912 0 Physical Therapists Medical Supplies 20 1205568912 0 Physical Therapists Medical equipment/prosthetic devices 20 1205568912 0 Physical Therapists Physical Therapy Services 00 1205569548 0 AGUAYO HERRERA JOSE L 2022194 9999999 B 10 1205569548 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1205569548 0 Physicians Anesthesia Services 20 1205569548 0 Physicians Fluoride varnish 20 1205569548 0 Physicians Healthy Kids Services 20 1205569548 0 Physicians Optical Supplies 20 1205569548 0 Physicians Physician Services 00 1205571171 0 ZAVALA JOSE B 2024142 9999999 B 10 1205571171 0 1940 S WESTERN AVE STE 205 CHICAGO IL 606082503 20 1205571171 0 Clinical Social Worker Social work service 00 1205572096 0 BAIRD ALI M 2024184 9999999 B 10 1205572096 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1205572096 0 Physicians Anesthesia Services 20 1205572096 0 Physicians Healthy Kids Services 20 1205572096 0 Physicians Optical Supplies 20 1205572096 0 Physicians Physician Services 00 1205572831 0 JONES KODY B 2024205 9999999 B 10 1205572831 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1205572831 0 Physicians Anesthesia Services 20 1205572831 0 Physicians Healthy Kids Services 20 1205572831 0 Physicians Optical Supplies 20 1205572831 0 Physicians Physician Services 00 1205573094 0 DELESTRY DANIEL J 2024156 9999999 B 10 1205573094 0 PO BOX 3039 OAK BROOK IL 605223039 20 1205573094 0 Podiatrists Podiatric Services 00 1205574456 0 ALVIA JORDAN 2022188 9999999 B 10 1205574456 0 2211 N ELSTON AVE STE 301 CHICAGO IL 606149278 20 1205574456 0 Physicians Anesthesia Services 20 1205574456 0 Physicians Fluoride varnish 20 1205574456 0 Physicians Healthy Kids Services 20 1205574456 0 Physicians Optical Supplies 20 1205574456 0 Physicians Physician Services 00 1205574860 0 O'DOWD ANNE 2023048 9999999 B 10 1205574860 0 830 S ADDISON AVE VILLA PARK IL 601812877 20 1205574860 0 Speech Therapists Medical Supplies 20 1205574860 0 Speech Therapists Medical equipment/prosthetic devices 20 1205574860 0 Speech Therapists Speech Therapy/Pathology Services 00 1205574902 0 RELIFORD SAMANTHA R 2023269 9999999 B 10 1205574902 0 1 ILLINI DR PEORIA IL 616052576 20 1205574902 0 Nurse Practitioners Healthy Kids Services 20 1205574902 0 Nurse Practitioners Nurse Practitioners Services 20 1205574902 0 Nurse Practitioners Physician Services 00 1205575024 0 GEORGE EMILY 2024192 9999999 B 10 1205575024 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1205575024 0 Physicians Anesthesia Services 20 1205575024 0 Physicians Healthy Kids Services 20 1205575024 0 Physicians Optical Supplies 20 1205575024 0 Physicians Physician Services 00 1205575164 0 GUZEK RYAN H 2022172 9999999 B 10 1205575164 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1205575164 0 Physicians Anesthesia Services 20 1205575164 0 Physicians Healthy Kids Services 20 1205575164 0 Physicians Optical Supplies 20 1205575164 0 Physicians Physician Services 00 1205575230 0 OBAOYE JOANNA 2023218 9999999 B 10 1205575230 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1205575230 0 Physicians Anesthesia Services 20 1205575230 0 Physicians Fluoride varnish 20 1205575230 0 Physicians Healthy Kids Services 20 1205575230 0 Physicians Optical Supplies 20 1205575230 0 Physicians Physician Services 00 1205576097 0 COCHRAN KENYATTA 2022103 9999999 B 10 1205576097 0 10910 KILPATRICK AVE OAK LAWN IL 604535671 20 1205576097 0 Occupational Therapists Medical Supplies 20 1205576097 0 Occupational Therapists Medical equipment/prosthetic devices 20 1205576097 0 Occupational Therapists Occupational Therapy Services 00 1205576154 0 PATEL NIRALI 2022182 9999999 B 10 1205576154 0 PO BOX 3039 OAK BROOK IL 605223039 20 1205576154 0 Physicians Anesthesia Services 20 1205576154 0 Physicians Fluoride varnish 20 1205576154 0 Physicians Healthy Kids Services 20 1205576154 0 Physicians Optical Supplies 20 1205576154 0 Physicians Physician Services 00 1205576212 0 BROWN DANNIELLE 2023179 9999999 B 10 1205576212 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1205576212 0 Physicians Anesthesia Services 20 1205576212 0 Physicians Fluoride varnish 20 1205576212 0 Physicians Healthy Kids Services 20 1205576212 0 Physicians Optical Supplies 20 1205576212 0 Physicians Physician Services 00 1205576691 0 SAJJADI ZAYNABSADAT L 2022234 9999999 B 10 1205576691 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1205576691 0 Physicians Anesthesia Services 20 1205576691 0 Physicians Healthy Kids Services 20 1205576691 0 Physicians Optical Supplies 20 1205576691 0 Physicians Physician Services 00 1205576956 0 COX RACHEL 2022158 9999999 B 10 1205576956 0 PO BOX 955860 SAINT LOUIS MO 631955860 20 1205576956 0 Nurse Practitioners Fluoride varnish 20 1205576956 0 Nurse Practitioners Healthy Kids Services 20 1205576956 0 Nurse Practitioners Nurse Practitioners Services 20 1205576956 0 Nurse Practitioners Physician Services 00 1205577434 0 PALM MATTHEW T 2022176 9999999 B 10 1205577434 0 PO BOX 3039 OAK BROOK IL 605223039 20 1205577434 0 Physicians Anesthesia Services 20 1205577434 0 Physicians Fluoride varnish 20 1205577434 0 Physicians Healthy Kids Services 20 1205577434 0 Physicians Optical Supplies 20 1205577434 0 Physicians Physician Services 00 1205577483 0 VAHTRA MADLI 2023075 2026181 B 10 1205577483 0 PO BOX 5588 BELFAST ME 049155500 20 1205577483 0 Physicians Anesthesia Services 20 1205577483 0 Physicians Healthy Kids Services 20 1205577483 0 Physicians Optical Supplies 20 1205577483 0 Physicians Physician Services 00 1205577582 0 JOLAOYE OLADOYIN 2022239 9999999 B 10 1205577582 0 530 NE GLEN OAK AVE PEORIA IL 616370001 20 1205577582 0 Physicians Anesthesia Services 20 1205577582 0 Physicians Fluoride varnish 20 1205577582 0 Physicians Healthy Kids Services 20 1205577582 0 Physicians Optical Supplies 20 1205577582 0 Physicians Physician Services 00 1205577715 0 KOTHAWALA SAAD 2022239 9999999 B 10 1205577715 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1205577715 0 Physicians Anesthesia Services 20 1205577715 0 Physicians Healthy Kids Services 20 1205577715 0 Physicians Optical Supplies 20 1205577715 0 Physicians Physician Services 00 1205577939 0 STATHOPOULOS JOHN 2023208 9999999 B 10 1205577939 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1205577939 0 Physicians Anesthesia Services 20 1205577939 0 Physicians Fluoride varnish 20 1205577939 0 Physicians Healthy Kids Services 20 1205577939 0 Physicians Optical Supplies 20 1205577939 0 Physicians Physician Services 00 1205578275 0 HYLA JESSICA M 2022189 9999999 B 10 1205578275 0 PO BOX 3039 OAK BROOK IL 605223039 20 1205578275 0 Physicians Anesthesia Services 20 1205578275 0 Physicians Fluoride varnish 20 1205578275 0 Physicians Healthy Kids Services 20 1205578275 0 Physicians Optical Supplies 20 1205578275 0 Physicians Physician Services 00 1205579364 0 GOMEZ DAISY 2024332 9999999 B 10 1205579364 0 5220 EAST AVE COUNTRYSIDE IL 605253133 20 1205579364 0 Other behavior health professional LCPC/LMFT services 00 1205579505 0 CHEN MARK 2023188 9999999 B 10 1205579505 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1205579505 0 Physicians Anesthesia Services 20 1205579505 0 Physicians Healthy Kids Services 20 1205579505 0 Physicians Optical Supplies 20 1205579505 0 Physicians Physician Services 00 1205579661 0 YUAN LEAH 2022210 9999999 B 10 1205579661 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1205579661 0 Physicians Anesthesia Services 20 1205579661 0 Physicians Fluoride varnish 20 1205579661 0 Physicians Healthy Kids Services 20 1205579661 0 Physicians Optical Supplies 20 1205579661 0 Physicians Physician Services 00 1205580313 0 ANDERSON KYLE M 2024190 9999999 B 10 1205580313 0 1910 SOUTH AVE LA CROSSE WI 546015467 20 1205580313 0 Nurse Practitioners Anesthesia Services 20 1205580313 0 Nurse Practitioners Nurse Practitioners Services 20 1205580313 0 Nurse Practitioners Physician Services 00 1205582079 0 NATERA ANDREA 2023292 9999999 B 10 1205582079 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1205582079 0 Physicians Anesthesia Services 20 1205582079 0 Physicians Healthy Kids Services 20 1205582079 0 Physicians Optical Supplies 20 1205582079 0 Physicians Physician Services 00 1205582921 0 MCDONOUGH TIMOTHY H 2022280 9999999 B 10 1205582921 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1205582921 0 Physician Assistant Only Fluoride varnish 20 1205582921 0 Physician Assistant Only Healthy Kids Services 20 1205582921 0 Physician Assistant Only Physician Services 00 1205583085 0 COOK LILLIE 2024318 9999999 B 10 1205583085 0 1S280 SUMMIT AVE STE A1 OAKBROOK TERRAC IL 601813936 20 1205583085 0 Physician Assistant Only Physician Services 00 1205584083 0 ULANOWSKI GABRIELLE ANN 2022076 9999999 B 10 1205584083 0 212 BARNEY DR JOLIET IL 604355271 20 1205584083 0 Occupational Therapists Medical Supplies 20 1205584083 0 Occupational Therapists Medical equipment/prosthetic devices 20 1205584083 0 Occupational Therapists Occupational Therapy Services 00 1205585213 0 BERNANKE ALYSSA G 2024088 9999999 B 10 1205585213 0 4698 DEPT CAROL STREAM IL 601220021 20 1205585213 0 Physicians Anesthesia Services 20 1205585213 0 Physicians Healthy Kids Services 20 1205585213 0 Physicians Optical Supplies 20 1205585213 0 Physicians Physician Services 20 1205585213 0 Physicians Physicians Psychiatric Services 00 1205586112 0 HUFF KIRSTEN M 2024019 9999999 B 10 1205586112 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1205586112 0 Nurse Practitioners Healthy Kids Services 20 1205586112 0 Nurse Practitioners Nurse Practitioners Services 20 1205586112 0 Nurse Practitioners Physician Services 00 1205588472 0 LONG SAMUEL 2022143 9999999 B 10 1205588472 0 850 43RD AVE STE 100 MOLINE IL 612658401 20 1205588472 0 Physical Therapists Medical Supplies 20 1205588472 0 Physical Therapists Medical equipment/prosthetic devices 20 1205588472 0 Physical Therapists Physical Therapy Services 00 1205589504 0 ZAKRZEWSKA EWA 2022090 9999999 B 10 1205589504 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1205589504 0 Nurse Practitioners Healthy Kids Services 20 1205589504 0 Nurse Practitioners Nurse Practitioners Services 20 1205589504 0 Nurse Practitioners Physician Services 00 1205590007 0 JANKOWSKI JESSICA 2021322 9999999 B 10 1205590007 0 216 W JACKSON BLVD STE 700 CHICAGO IL 606066921 20 1205590007 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205590254 0 MADONIA SHANNON M 2022025 9999999 B 10 1205590254 0 PO BOX 4176 HOUMA LA 703614176 20 1205590254 0 Nurse Practitioners Fluoride varnish 20 1205590254 0 Nurse Practitioners Healthy Kids Services 20 1205590254 0 Nurse Practitioners Nurse Practitioners Services 20 1205590254 0 Nurse Practitioners Physician Services 00 1205591138 0 OSHIBAJO ADERONKE 2022012 9999999 B 10 1205591138 0 PO BOX 37846 BELFAST ME 049151220 20 1205591138 0 Nurse Practitioners Fluoride varnish 20 1205591138 0 Nurse Practitioners Healthy Kids Services 20 1205591138 0 Nurse Practitioners Nurse Practitioners Services 20 1205591138 0 Nurse Practitioners Physician Services 00 1205592938 0 THROGMORTON SHANNON 2023220 9999999 B 10 1205592938 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1205592938 0 Speech Therapists Medical Supplies 20 1205592938 0 Speech Therapists Medical equipment/prosthetic devices 20 1205592938 0 Speech Therapists Speech Therapy/Pathology Services 00 1205594660 0 BRADY SEAN 2021343 9999999 H 10 1205594660 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1205594660 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205594793 0 WIEBE SUSAN 2024183 9999999 B 10 1205594793 0 1481 MCDONALD AVE BROOKLYN NY 112304667 20 1205594793 0 Nurse Practitioners Fluoride varnish 20 1205594793 0 Nurse Practitioners Healthy Kids Services 20 1205594793 0 Nurse Practitioners Nurse Practitioners Services 20 1205594793 0 Nurse Practitioners Physician Services 00 1205595329 0 NAIR RAKESH 2022200 9999999 H 10 1205595329 0 13450 S KEDZIE AVE ROBBINS IL 60472 20 1205595329 0 Psychologist Psychologist service 00 1205597549 0 THOMAS TERRI 2022066 9999999 H 10 1205597549 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1205597549 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205598372 0 FRENCH LAUREN 2022189 9999999 B 10 1205598372 0 PO BOX 1510 EVANSVILLE IN 477061510 20 1205598372 0 Nurse Practitioners Healthy Kids Services 20 1205598372 0 Nurse Practitioners Nurse Practitioners Services 20 1205598372 0 Nurse Practitioners Physician Services 00 1205598943 0 MACHUTA KRISTIN 2021333 9999999 B 10 1205598943 0 39465 W 14 MILE RD NOVI MI 483771600 20 1205598943 0 Clinical Social Worker Social work service 00 1205602083 0 WAGONER ALANA 2024239 9999999 B 10 1205602083 0 1975 MC DOWELL RD STE 101 NAPERVILLE IL 605636533 20 1205602083 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205603834 0 VACHACHIRA ANISSA B 2024019 9999999 B 10 1205603834 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1205603834 0 Nurse Practitioners Fluoride varnish 20 1205603834 0 Nurse Practitioners Healthy Kids Services 20 1205603834 0 Nurse Practitioners Nurse Practitioners Services 20 1205603834 0 Nurse Practitioners Physician Services 00 1205605235 0 BALOGUN ABIDEMI O 2024024 9999999 B 10 1205605235 0 331 W SURF ST STE 708 CHICAGO IL 606577227 20 1205605235 0 Nurse Practitioners Healthy Kids Services 20 1205605235 0 Nurse Practitioners Nurse Practitioners Services 20 1205605235 0 Nurse Practitioners Physician Services 00 1205608338 0 HUGHES RAVEN 2023306 9999999 B 10 1205608338 0 70 S RIVER ST AURORA IL 605065185 20 1205608338 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205608577 0 GARMON LINDSAY K 2023332 9999999 B 10 1205608577 0 2323 WINDISH DR GALESBURG IL 614019780 20 1205608577 0 Nurse Practitioners Healthy Kids Services 20 1205608577 0 Nurse Practitioners Nurse Practitioners Services 20 1205608577 0 Nurse Practitioners Physician Services 00 1205609229 0 BAMOUNI SERAPHIN 2024046 9999999 B 10 1205609229 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1205609229 0 Nurse Practitioners Fluoride varnish 20 1205609229 0 Nurse Practitioners Healthy Kids Services 20 1205609229 0 Nurse Practitioners Nurse Practitioners Services 20 1205609229 0 Nurse Practitioners Physician Services 00 1205609336 0 RIPPL CHRISTINA R 2023317 9999999 B 10 1205609336 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1205609336 0 Nurse Practitioners Healthy Kids Services 20 1205609336 0 Nurse Practitioners Nurse Practitioners Services 20 1205609336 0 Nurse Practitioners Physician Services 00 1205609351 0 PEREZ-MARTINEZ MAYRA K 2024004 9999999 B 10 1205609351 0 5777 DEPT CAROL STREAM IL 601220021 20 1205609351 0 Nurse Practitioners Healthy Kids Services 20 1205609351 0 Nurse Practitioners Nurse Practitioners Services 20 1205609351 0 Nurse Practitioners Physician Services 00 1205609732 0 PIERRE ERICA 2023311 9999999 B 10 1205609732 0 70 S RIVER ST AURORA IL 605065185 20 1205609732 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205610730 0 SALVIATO NESPOLI VITOR 2023255 9999999 B 10 1205610730 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1205610730 0 Physicians Anesthesia Services 20 1205610730 0 Physicians Healthy Kids Services 20 1205610730 0 Physicians Optical Supplies 20 1205610730 0 Physicians Physician Services 00 1205611621 0 GARCIA-TELLEZ SINDY 2023250 9999999 B 10 1205611621 0 909 RIDGEBROOK RD STE 300 SPARKS MD 211529477 20 1205611621 0 Nurse Practitioners Fluoride varnish 20 1205611621 0 Nurse Practitioners Healthy Kids Services 20 1205611621 0 Nurse Practitioners Nurse Practitioners Services 20 1205611621 0 Nurse Practitioners Physician Services 00 1205612173 0 KARERAKATTIL TELMA 2023310 9999999 B 10 1205612173 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1205612173 0 Nurse Practitioners Anesthesia Services 20 1205612173 0 Nurse Practitioners Nurse Practitioners Services 20 1205612173 0 Nurse Practitioners Physician Services 00 1205615226 0 JESSEN APRIL 2023334 9999999 B 10 1205615226 0 PO BOX 268 FREEPORT IL 610320268 20 1205615226 0 Nurse Practitioners Fluoride varnish 20 1205615226 0 Nurse Practitioners Healthy Kids Services 20 1205615226 0 Nurse Practitioners Nurse Practitioners Services 20 1205615226 0 Nurse Practitioners Physician Services 00 1205616448 0 GASQUOINE BRITTANY M 2024094 9999999 B 10 1205616448 0 29373 NETWORK PL CHICAGO IL 606733039 20 1205616448 0 Nurse Practitioners Healthy Kids Services 20 1205616448 0 Nurse Practitioners Nurse Practitioners Services 20 1205616448 0 Nurse Practitioners Physician Services 00 1205617891 0 VALENTE EMILY 2023304 9999999 B 10 1205617891 0 1256 WATERFORD DR STE 230 AURORA IL 605044511 20 1205617891 0 Physician Assistant Only Fluoride varnish 20 1205617891 0 Physician Assistant Only Healthy Kids Services 20 1205617891 0 Physician Assistant Only Physician Services 00 1205618030 0 REDDINGER BRENDA 2024048 9999999 B 10 1205618030 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1205618030 0 Nurse Practitioners Fluoride varnish 20 1205618030 0 Nurse Practitioners Healthy Kids Services 20 1205618030 0 Nurse Practitioners Nurse Practitioners Services 20 1205618030 0 Nurse Practitioners Physician Services 00 1205642964 0 FRANK EMILY KAITLYN 2025022 9999999 B 10 1205642964 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1205642964 0 Physician Assistant Only Fluoride varnish 20 1205642964 0 Physician Assistant Only Healthy Kids Services 20 1205642964 0 Physician Assistant Only Physician Services 00 1205644010 0 FLINN FAYTHE 2025014 9999999 B 10 1205644010 0 1165 CENTRAL PARK DR UNIT 107 CRYSTAL LAKE IL 600148229 20 1205644010 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205650546 0 PEREZ MITZY 2024326 9999999 B 10 1205650546 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1205650546 0 Occupational Therapists Medical Supplies 20 1205650546 0 Occupational Therapists Medical equipment/prosthetic devices 20 1205650546 0 Occupational Therapists Occupational Therapy Services 00 1205651825 0 KANE MICHAELA 2025052 9999999 B 10 1205651825 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1205651825 0 Nurse Practitioners Healthy Kids Services 20 1205651825 0 Nurse Practitioners Midwife Services 20 1205651825 0 Nurse Practitioners Nurse Practitioners Services 20 1205651825 0 Nurse Practitioners Physician Services 00 1205654878 0 CLARK AMANDA 2024316 9999999 B 10 1205654878 0 5777 DEPT CAROL STREAM IL 601220021 20 1205654878 0 Nurse Practitioners Fluoride varnish 20 1205654878 0 Nurse Practitioners Healthy Kids Services 20 1205654878 0 Nurse Practitioners Nurse Practitioners Services 20 1205654878 0 Nurse Practitioners Physician Services 00 1205655974 0 MENDOZA LOPEZ ANA M 2025022 9999999 B 10 1205655974 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1205655974 0 Physician Assistant Only Fluoride varnish 20 1205655974 0 Physician Assistant Only Healthy Kids Services 20 1205655974 0 Physician Assistant Only Physician Services 00 1205656626 0 TAPAK ALLISON A 2025013 9999999 B 10 1205656626 0 29373 NETWORK PL CHICAGO IL 606733039 20 1205656626 0 Nurse Practitioners Healthy Kids Services 20 1205656626 0 Nurse Practitioners Nurse Practitioners Services 20 1205656626 0 Nurse Practitioners Physician Services 00 1205658531 0 MAIER MICHELLE 2024304 9999999 B 10 1205658531 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1205658531 0 Clinical Social Worker Social work service 00 1205659513 0 CAGIRAN ZEYNEP 2024341 9999999 B 10 1205659513 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1205659513 0 Physicians Anesthesia Services 20 1205659513 0 Physicians Healthy Kids Services 20 1205659513 0 Physicians Optical Supplies 20 1205659513 0 Physicians Physician Services 00 1205660578 0 BILA NICHOLAS 2024304 9999999 B 10 1205660578 0 29373 NETWORK PL CHICAGO IL 606733039 20 1205660578 0 Physician Assistant Only Fluoride varnish 20 1205660578 0 Physician Assistant Only Healthy Kids Services 20 1205660578 0 Physician Assistant Only Physician Services 00 1205661139 0 HUTCHISON HANNAH 2024326 9999999 B 10 1205661139 0 1110 W SCHICK RD BARTLETT IL 601033007 20 1205661139 0 Physician Assistant Only Fluoride varnish 20 1205661139 0 Physician Assistant Only Healthy Kids Services 20 1205661139 0 Physician Assistant Only Physician Services 00 1205661816 0 MILLER DEVYN N 2024309 9999999 B 10 1205661816 0 19801 GOVERNORS HWY STE 160 FLOSSMOOR IL 604224363 20 1205661816 0 Physician Assistant Only Fluoride varnish 20 1205661816 0 Physician Assistant Only Healthy Kids Services 20 1205661816 0 Physician Assistant Only Physician Services 00 1205662194 0 FLORES PETRA 2024260 9999999 B 10 1205662194 0 124 SW ADAMS ST FL 2 PEORIA IL 616021308 20 1205662194 0 Nurse Practitioners Fluoride varnish 20 1205662194 0 Nurse Practitioners Healthy Kids Services 20 1205662194 0 Nurse Practitioners Nurse Practitioners Services 20 1205662194 0 Nurse Practitioners Physician Services 00 1205662400 0 CUNNINGHAM JENNIFER M 2024302 9999999 B 10 1205662400 0 1 ILLINI DR PEORIA IL 616052576 20 1205662400 0 Nurse Practitioners Fluoride varnish 20 1205662400 0 Nurse Practitioners Healthy Kids Services 20 1205662400 0 Nurse Practitioners Nurse Practitioners Services 20 1205662400 0 Nurse Practitioners Physician Services 00 1205662723 0 ALESSIA GABRIELLE 2024327 9999999 B 10 1205662723 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1205662723 0 Physician Assistant Only Fluoride varnish 20 1205662723 0 Physician Assistant Only Healthy Kids Services 20 1205662723 0 Physician Assistant Only Physician Services 00 1205665478 0 SHIMEK MICHELLE 2024239 9999999 B 10 1205665478 0 5777 DEPT CAROL STREAM IL 601220021 20 1205665478 0 Nurse Practitioners Healthy Kids Services 20 1205665478 0 Nurse Practitioners Nurse Practitioners Services 20 1205665478 0 Nurse Practitioners Physician Services 00 1205667565 0 FISHER TRACY 2024222 9999999 B 10 1205667565 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1205667565 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205670775 0 KHAN YASIR A 2024213 9999999 B 10 1205670775 0 448 WYLIE DR NORMAL IL 617615405 20 1205670775 0 Physicians Anesthesia Services 20 1205670775 0 Physicians Fluoride varnish 20 1205670775 0 Physicians Healthy Kids Services 20 1205670775 0 Physicians Optical Supplies 20 1205670775 0 Physicians Physician Services 00 1205670981 0 ADEEB MAHAM 2024218 9999999 B 10 1205670981 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1205670981 0 Physicians Anesthesia Services 20 1205670981 0 Physicians Healthy Kids Services 20 1205670981 0 Physicians Optical Supplies 20 1205670981 0 Physicians Physician Services 20 1205670981 0 Physicians Physicians Psychiatric Services 00 1205671914 0 PAINTER ANDREA N 2024256 9999999 B 10 1205671914 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1205671914 0 Physician Assistant Only Fluoride varnish 20 1205671914 0 Physician Assistant Only Healthy Kids Services 20 1205671914 0 Physician Assistant Only Physician Services 00 1205673860 0 HINES MAYA 2024243 9999999 B 10 1205673860 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1205673860 0 Physicians Anesthesia Services 20 1205673860 0 Physicians Healthy Kids Services 20 1205673860 0 Physicians Optical Supplies 20 1205673860 0 Physicians Physician Services 00 1205675444 0 HULING MAGGIE M 2024185 9999999 B 10 1205675444 0 2635 LINCOLN WAY STE A CLINTON IA 527327229 20 1205675444 0 Nurse Practitioners Fluoride varnish 20 1205675444 0 Nurse Practitioners Healthy Kids Services 20 1205675444 0 Nurse Practitioners Nurse Practitioners Services 20 1205675444 0 Nurse Practitioners Physician Services 00 1205675683 0 KHANDEKAR NITIKA N 2024191 9999999 B 10 1205675683 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1205675683 0 Physicians Anesthesia Services 20 1205675683 0 Physicians Healthy Kids Services 20 1205675683 0 Physicians Optical Supplies 20 1205675683 0 Physicians Physician Services 00 1205677754 0 OSISIOMA CHIMDIYA 2024323 9999999 B 10 1205677754 0 20855 S LAGRANGE RD STE 205 FRANKFORT IL 604232043 20 1205677754 0 Nurse Practitioners Healthy Kids Services 20 1205677754 0 Nurse Practitioners Nurse Practitioners Services 20 1205677754 0 Nurse Practitioners Physician Services 00 1205677788 0 ZAMORANO DARIO 2025013 9999999 B 10 1205677788 0 625 MASSACHUSETTS AVE FL 2 CAMBRIDGE MA 021393357 20 1205677788 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205679065 0 RICHARDSON ADRI 2024303 9999999 B 10 1205679065 0 PO BOX 775253 CHICAGO IL 606775253 20 1205679065 0 Nurse Practitioners Healthy Kids Services 20 1205679065 0 Nurse Practitioners Nurse Practitioners Services 20 1205679065 0 Nurse Practitioners Physician Services 00 1205679156 0 AWAH-KANNEH JOSEPHINE 2024191 9999999 B 10 1205679156 0 PO BOX 775257 CHICAGO IL 606775257 20 1205679156 0 Physicians Anesthesia Services 20 1205679156 0 Physicians Fluoride varnish 20 1205679156 0 Physicians Healthy Kids Services 20 1205679156 0 Physicians Optical Supplies 20 1205679156 0 Physicians Physician Services 00 1205679669 0 SINHA DRISHTI D 2024166 9999999 B 10 1205679669 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1205679669 0 Physicians Anesthesia Services 20 1205679669 0 Physicians Healthy Kids Services 20 1205679669 0 Physicians Optical Supplies 20 1205679669 0 Physicians Physician Services 00 1205681764 0 HONG RAYMOND Y 2024129 9999999 B 10 1205681764 0 5876 E STATE ST ROCKFORD IL 611082428 20 1205681764 0 Dentists Dental Services 20 1205681764 0 Dentists Physician Services 00 1205683885 0 NIXON PHOEBE K 2024271 9999999 B 10 1205683885 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1205683885 0 Nurse Practitioners Healthy Kids Services 20 1205683885 0 Nurse Practitioners Nurse Practitioners Services 20 1205683885 0 Nurse Practitioners Physician Services 00 1205686060 0 DAVIS DONNA 2024136 9999999 B 10 1205686060 0 70 S RIVER ST AURORA IL 605065185 20 1205686060 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205686235 0 GOODWIN TIMOTHY 2024183 9999999 B 10 1205686235 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1205686235 0 Physicians Anesthesia Services 20 1205686235 0 Physicians Healthy Kids Services 20 1205686235 0 Physicians Optical Supplies 20 1205686235 0 Physicians Physician Services 00 1205686375 0 STALLION NICHOLAS 2024177 9999999 B 10 1205686375 0 PO BOX 3039 OAK BROOK IL 605223039 20 1205686375 0 Physicians Anesthesia Services 20 1205686375 0 Physicians Fluoride varnish 20 1205686375 0 Physicians Healthy Kids Services 20 1205686375 0 Physicians Optical Supplies 20 1205686375 0 Physicians Physician Services 00 1205687449 0 PENUMALEE LEENA S 2024176 9999999 B 10 1205687449 0 4698 DEPT CAROL STREAM IL 601220021 20 1205687449 0 Physicians Anesthesia Services 20 1205687449 0 Physicians Fluoride varnish 20 1205687449 0 Physicians Healthy Kids Services 20 1205687449 0 Physicians Optical Supplies 20 1205687449 0 Physicians Physician Services 00 1205688280 0 PATEL SWITI S 2025008 9999999 B 10 1205688280 0 804 E WOODFIELD RD STE 300 SCHAUMBURG IL 601734776 20 1205688280 0 Nurse Practitioners Fluoride varnish 20 1205688280 0 Nurse Practitioners Healthy Kids Services 20 1205688280 0 Nurse Practitioners Nurse Practitioners Services 20 1205688280 0 Nurse Practitioners Physician Services 00 1205688587 0 KHAN ALI SAIF 2024191 9999999 B 10 1205688587 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1205688587 0 Physicians Anesthesia Services 20 1205688587 0 Physicians Healthy Kids Services 20 1205688587 0 Physicians Optical Supplies 20 1205688587 0 Physicians Physician Services 00 1205688967 0 MOUNTAIN JOSEPH 2024242 9999999 B 10 1205688967 0 # 8496 CHICAGO IL 606778004 20 1205688967 0 Physician Assistant Only Family Planning Counseling 20 1205688967 0 Physician Assistant Only Fluoride varnish 20 1205688967 0 Physician Assistant Only Healthy Kids Services 20 1205688967 0 Physician Assistant Only Physician Services 00 1205690013 0 GARCIA ROSANELLY 2025041 9999999 B 10 1205690013 0 1000 ESSINGTON RD JOLIET IL 604352841 20 1205690013 0 Clinical Social Worker Social work service 00 1205690195 0 STEFFAN BRIANNE 2024200 9999999 B 10 1205690195 0 PO BOX 775342 CHICAGO IL 606775342 20 1205690195 0 Nurse Practitioners Fluoride varnish 20 1205690195 0 Nurse Practitioners Healthy Kids Services 20 1205690195 0 Nurse Practitioners Nurse Practitioners Services 20 1205690195 0 Nurse Practitioners Physician Services 00 1205691425 0 PAYNE SHELBY L 2024052 9999999 B 10 1205691425 0 PO BOX 3988 CARBONDALE IL 629023988 20 1205691425 0 Clinical Social Worker Social work service 00 1205693769 0 OMAN TYLER 2024061 9999999 B 10 1205693769 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1205693769 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1205694585 0 MCCARTHY DREW 2024083 9999999 B 10 1205694585 0 11813 FORD CT PLAINFIELD IL 605852203 20 1205694585 0 Occupational Therapists Medical Supplies 20 1205694585 0 Occupational Therapists Medical equipment/prosthetic devices 20 1205694585 0 Occupational Therapists Occupational Therapy Services 00 1205695517 0 DIAB SARA 2024179 9999999 B 10 1205695517 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1205695517 0 Physicians Anesthesia Services 20 1205695517 0 Physicians Healthy Kids Services 20 1205695517 0 Physicians Optical Supplies 20 1205695517 0 Physicians Physician Services 20 1205695517 0 Physicians Physicians Psychiatric Services 00 1205695566 0 THADANI AANCHAL 2024176 9999999 B 10 1205695566 0 4698 DEPT CAROL STREAM IL 601220021 20 1205695566 0 Physicians Anesthesia Services 20 1205695566 0 Physicians Healthy Kids Services 20 1205695566 0 Physicians Optical Supplies 20 1205695566 0 Physicians Physician Services 00 1205695608 0 CALLAHAN SEAN 2024157 9999999 B 10 1205695608 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1205695608 0 Physicians Anesthesia Services 20 1205695608 0 Physicians Fluoride varnish 20 1205695608 0 Physicians Healthy Kids Services 20 1205695608 0 Physicians Optical Supplies 20 1205695608 0 Physicians Physician Services 00 1205695640 0 BOLEN JORDAN 2024187 9999999 B 10 1205695640 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1205695640 0 Physicians Anesthesia Services 20 1205695640 0 Physicians Fluoride varnish 20 1205695640 0 Physicians Healthy Kids Services 20 1205695640 0 Physicians Optical Supplies 20 1205695640 0 Physicians Physician Services 00 1205695681 0 BIENIEK VERONICA L 2024086 9999999 B 10 1205695681 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1205695681 0 Speech Therapists Medical Supplies 20 1205695681 0 Speech Therapists Medical equipment/prosthetic devices 20 1205695681 0 Speech Therapists Speech Therapy/Pathology Services 00 1205696952 0 PONOMAREVA NATALYA I 2024176 9999999 B 10 1205696952 0 355 E ERIE ST CHICAGO IL 606113167 20 1205696952 0 Physicians Anesthesia Services 20 1205696952 0 Physicians Healthy Kids Services 20 1205696952 0 Physicians Optical Supplies 20 1205696952 0 Physicians Physician Services 00 1205800513 0 FITZ MATTHEW 2003182 9999999 B 10 1205800513 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1205800513 0 Physicians Anesthesia Services 20 1205800513 0 Physicians Fluoride varnish 20 1205800513 0 Physicians Healthy Kids Services 20 1205800513 0 Physicians Optical Supplies 20 1205800513 0 Physicians Physician Services 00 1205800679 0 ARVANITIS STEVE J 2000178 9999999 B 10 1205800679 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1205800679 0 Physicians Anesthesia Services 20 1205800679 0 Physicians Fluoride varnish 20 1205800679 0 Physicians Healthy Kids Services 20 1205800679 0 Physicians Optical Supplies 20 1205800679 0 Physicians Physician Services 00 1205801115 0 SEEMANN CHRISTEL L 2016083 9999999 B 10 1205801115 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1205801115 0 Physicians Anesthesia Services 20 1205801115 0 Physicians Fluoride varnish 20 1205801115 0 Physicians Healthy Kids Services 20 1205801115 0 Physicians Optical Supplies 20 1205801115 0 Physicians Physician Services 00 1205801313 0 CASTILLO SAMUEL F 2010063 9999999 B 10 1205801313 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1205801313 0 Physicians Anesthesia Services 20 1205801313 0 Physicians Fluoride varnish 20 1205801313 0 Physicians Healthy Kids Services 20 1205801313 0 Physicians Optical Supplies 20 1205801313 0 Physicians Physician Services 00 1205801354 0 ESPINOSA EDWIN 2001197 9999999 B 10 1205801354 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1205801354 0 Physicians Anesthesia Services 20 1205801354 0 Physicians Fluoride varnish 20 1205801354 0 Physicians Healthy Kids Services 20 1205801354 0 Physicians Optical Supplies 20 1205801354 0 Physicians Physician Services 00 1205802022 0 BLACK CARA 2021365 9999999 B 10 1205802022 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1205802022 0 Physicians Anesthesia Services 20 1205802022 0 Physicians Healthy Kids Services 20 1205802022 0 Physicians Optical Supplies 20 1205802022 0 Physicians Physician Services 00 1205802071 0 AGRAWAL REKHA 1986203 9999999 B 10 1205802071 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1205802071 0 Physicians Anesthesia Services 20 1205802071 0 Physicians Fluoride varnish 20 1205802071 0 Physicians Healthy Kids Services 20 1205802071 0 Physicians Optical Supplies 20 1205802071 0 Physicians Physician Services 00 1205802147 0 GRASSLE JEFFREY 1993253 9999999 B 10 1205802147 0 100 WITMER RD STE 220 HORSHAM PA 190442279 20 1205802147 0 Physicians Anesthesia Services 20 1205802147 0 Physicians Healthy Kids Services 20 1205802147 0 Physicians Optical Supplies 20 1205802147 0 Physicians Physician Services 00 1205802154 0 REIS MARTIN N 2012183 9999999 B 10 1205802154 0 PO BOX 7412011 CHICAGO IL 606742011 20 1205802154 0 Physicians Anesthesia Services 20 1205802154 0 Physicians Healthy Kids Services 20 1205802154 0 Physicians Optical Supplies 20 1205802154 0 Physicians Physician Services 00 1205802360 0 SONDEL PAUL 1981258 9999999 B 10 1205802360 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1205802360 0 Physicians Anesthesia Services 20 1205802360 0 Physicians Fluoride varnish 20 1205802360 0 Physicians Healthy Kids Services 20 1205802360 0 Physicians Optical Supplies 20 1205802360 0 Physicians Physician Services 00 1205802998 0 REISENAUER CHRISTIN S 2022207 9999999 B 10 1205802998 0 PO BOX 5594 CAROL STREAM IL 601975594 20 1205802998 0 Physicians Anesthesia Services 20 1205802998 0 Physicians Healthy Kids Services 20 1205802998 0 Physicians Optical Supplies 20 1205802998 0 Physicians Physician Services 00 1205803178 0 LABOTKA DAVID 1988138 9999999 B 10 1205803178 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1205803178 0 Physicians Anesthesia Services 20 1205803178 0 Physicians Fluoride varnish 20 1205803178 0 Physicians Healthy Kids Services 20 1205803178 0 Physicians Optical Supplies 20 1205803178 0 Physicians Physician Services 00 1205803293 0 MORRIS DAVID 1987216 9999999 B 10 1205803293 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1205803293 0 Physicians Anesthesia Services 20 1205803293 0 Physicians Fluoride varnish 20 1205803293 0 Physicians Healthy Kids Services 20 1205803293 0 Physicians Optical Supplies 20 1205803293 0 Physicians Physician Services 00 1205804010 0 SRINIVASAN SHARDHA 2001060 9999999 B 10 1205804010 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1205804010 0 Physicians Anesthesia Services 20 1205804010 0 Physicians Fluoride varnish 20 1205804010 0 Physicians Healthy Kids Services 20 1205804010 0 Physicians Optical Supplies 20 1205804010 0 Physicians Physician Services 00 1205805678 0 SPINELLA PHILIP C 2011182 9999999 B 10 1205805678 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1205805678 0 Physicians Anesthesia Services 20 1205805678 0 Physicians Fluoride varnish 20 1205805678 0 Physicians Healthy Kids Services 20 1205805678 0 Physicians Optical Supplies 20 1205805678 0 Physicians Physician Services 00 1205805777 0 MCKEGNEY CATHERINE 2023125 9999999 B 10 1205805777 0 818 5TH AVE STE 200 DES MOINES IA 503091307 20 1205805777 0 Physicians Anesthesia Services 20 1205805777 0 Physicians Fluoride varnish 20 1205805777 0 Physicians Healthy Kids Services 20 1205805777 0 Physicians Optical Supplies 20 1205805777 0 Physicians Physician Services 00 1205806197 0 NAPAWAN CHIRADEJ 1989244 9999999 B 10 1205806197 0 855 ILLINI DR STE 201 SILVIS IL 612822904 20 1205806197 0 Physicians Anesthesia Services 20 1205806197 0 Physicians Healthy Kids Services 20 1205806197 0 Physicians Optical Supplies 20 1205806197 0 Physicians Physician Services 00 1205806940 0 BOLLIMPALLI SRINIVAS S 2024318 9999999 B 10 1205806940 0 5777 DEPT CAROL STREAM IL 601220021 20 1205806940 0 Physicians Anesthesia Services 20 1205806940 0 Physicians Healthy Kids Services 20 1205806940 0 Physicians Optical Supplies 20 1205806940 0 Physicians Physician Services 00 1205807328 0 LOTSOFF DAVID 2012068 9999999 B 10 1205807328 0 615 S NEW BALLAS RD STE 1200 SAINT LOUIS MO 631418221 20 1205807328 0 Physicians Anesthesia Services 20 1205807328 0 Physicians Fluoride varnish 20 1205807328 0 Physicians Healthy Kids Services 20 1205807328 0 Physicians Optical Supplies 20 1205807328 0 Physicians Physician Services 00 1205807658 0 BAUMWELL STERLING 1981258 9999999 B 10 1205807658 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1205807658 0 Physicians All Kids application agent 20 1205807658 0 Physicians Anesthesia Services 20 1205807658 0 Physicians Healthy Kids Services 20 1205807658 0 Physicians Optical Supplies 20 1205807658 0 Physicians Physician Services 00 1205808102 0 THOTA JYOTHI 2007227 9999999 B 10 1205808102 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1205808102 0 Physicians Anesthesia Services 20 1205808102 0 Physicians Healthy Kids Services 20 1205808102 0 Physicians Optical Supplies 20 1205808102 0 Physicians Physician Services 00 1205808201 0 SIMS KATHERINE M 2004223 9999999 B 10 1205808201 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1205808201 0 Nurse Practitioners Anesthesia Services 20 1205808201 0 Nurse Practitioners Nurse Practitioners Services 20 1205808201 0 Nurse Practitioners Physician Services 00 1205808433 0 WALD MOSHE 2004245 9999999 B 10 1205808433 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1205808433 0 Physicians Anesthesia Services 20 1205808433 0 Physicians Healthy Kids Services 20 1205808433 0 Physicians Optical Supplies 20 1205808433 0 Physicians Physician Services 00 1205808961 0 BARNES BARRY B 1994182 9999999 B 10 1205808961 0 PO BOX 857 FREEPORT IL 610320857 20 1205808961 0 Physicians Anesthesia Services 20 1205808961 0 Physicians Healthy Kids Services 20 1205808961 0 Physicians Optical Supplies 20 1205808961 0 Physicians Physician Services 00 1205809175 0 FREDMAN CAREY S 1990212 9999999 B 10 1205809175 0 PO BOX 952273 SAINT LOUIS MO 631952273 20 1205809175 0 Physicians Anesthesia Services 20 1205809175 0 Physicians Fluoride varnish 20 1205809175 0 Physicians Healthy Kids Services 20 1205809175 0 Physicians Optical Supplies 20 1205809175 0 Physicians Physician Services 00 1205809209 0 QUAST TIMOTHY M 2024182 9999999 B 10 1205809209 0 4698 DEPT CAROL STREAM IL 601220021 20 1205809209 0 Physicians Anesthesia Services 20 1205809209 0 Physicians Fluoride varnish 20 1205809209 0 Physicians Healthy Kids Services 20 1205809209 0 Physicians Optical Supplies 20 1205809209 0 Physicians Physician Services 00 1205810413 0 AZAR DIMITRI 2006213 9999999 B 10 1205810413 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1205810413 0 Physicians Anesthesia Services 20 1205810413 0 Physicians Healthy Kids Services 20 1205810413 0 Physicians Optical Supplies 20 1205810413 0 Physicians Physician Services 00 1205810512 0 WHITE BRAD C 1997352 9999999 B 10 1205810512 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1205810512 0 Physicians Anesthesia Services 20 1205810512 0 Physicians Healthy Kids Services 20 1205810512 0 Physicians Optical Supplies 20 1205810512 0 Physicians Physician Services 00 1205810520 0 SPELLMAN MATTHEW 2003182 9999999 B 10 1205810520 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1205810520 0 Physicians Anesthesia Services 20 1205810520 0 Physicians Healthy Kids Services 20 1205810520 0 Physicians Optical Supplies 20 1205810520 0 Physicians Physician Services 00 1205810926 0 MARULENDRA SHIVAPRASAD 2016316 9999999 B 10 1205810926 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1205810926 0 Physicians Anesthesia Services 20 1205810926 0 Physicians Fluoride varnish 20 1205810926 0 Physicians Healthy Kids Services 20 1205810926 0 Physicians Optical Supplies 20 1205810926 0 Physicians Physician Services 00 1205811569 0 STRONG BENJAMIN W 2008122 9999999 B 10 1205811569 0 2330 UTAH AVE STE 200 EL SEGUNDO CA 902454817 20 1205811569 0 Physicians Anesthesia Services 20 1205811569 0 Physicians Healthy Kids Services 20 1205811569 0 Physicians Optical Supplies 20 1205811569 0 Physicians Physician Services 00 1205813656 0 DEBOER ERIN 2018138 9999999 B 10 1205813656 0 29373 NETWORK PL CHICAGO IL 606733039 20 1205813656 0 Physician Assistant Only Fluoride varnish 20 1205813656 0 Physician Assistant Only Healthy Kids Services 20 1205813656 0 Physician Assistant Only Physician Services 00 1205813714 0 HUSSAIN SYED 1997059 9999999 B 10 1205813714 0 PO BOX 843033 KANSAS CITY MO 641842326 20 1205813714 0 Physicians Anesthesia Services 20 1205813714 0 Physicians Fluoride varnish 20 1205813714 0 Physicians Healthy Kids Services 20 1205813714 0 Physicians Optical Supplies 20 1205813714 0 Physicians Physician Services 00 1205813912 0 WEIS ROBERT F 1981258 9999999 B 10 1205813912 0 1518 MULBERRY AVE MUSCATINE IA 527613433 20 1205813912 0 Physicians Anesthesia Services 20 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# 520 INDIANAPOLIS IN 462601316 20 1215268230 0 Physicians Anesthesia Services 20 1215268230 0 Physicians Fluoride varnish 20 1215268230 0 Physicians Healthy Kids Services 20 1215268230 0 Physicians Optical Supplies 20 1215268230 0 Physicians Physician Services 00 1215269766 0 CHESTLER CATHY 2018084 9999999 B 10 1215269766 0 3010 GRAND AVE WAUKEGAN IL 600852321 20 1215269766 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1215270160 0 SHEEHAN CLAIRE 2013255 9999999 B 10 1215270160 0 2550 W ADDISON ST STE 17 CHICAGO IL 606185952 20 1215270160 0 Dentists Dental Services 20 1215270160 0 Dentists Physician Services 00 1215270178 0 CRUZ CELESTE GERALDINA 2017143 9999999 B 10 1215270178 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1215270178 0 Physicians Anesthesia Services 20 1215270178 0 Physicians Healthy Kids Services 20 1215270178 0 Physicians Optical Supplies 20 1215270178 0 Physicians Physician Services 00 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1607 VISA DR STE B NORMAL IL 617612137 20 1215338157 0 Podiatrists Podiatric Services 00 1215338215 0 CLER PAIGE 2014266 9999999 B 10 1215338215 0 611 W PARK ST URBANA IL 618012529 20 1215338215 0 Nurse Practitioners Healthy Kids Services 20 1215338215 0 Nurse Practitioners Nurse Practitioners Services 20 1215338215 0 Nurse Practitioners Physician Services 00 1215339221 0 FAROOQ TALIYA 2022019 9999999 B 10 1215339221 0 PO BOX 578 PARK RIDGE IL 600680578 20 1215339221 0 Physicians Anesthesia Services 20 1215339221 0 Physicians Healthy Kids Services 20 1215339221 0 Physicians Optical Supplies 20 1215339221 0 Physicians Physician Services 00 1215339510 0 SCHMINSKI ANN L 2018098 9999999 B 10 1215339510 0 200 UNIVERSITY AVE E SAINT PAUL MN 551012507 20 1215339510 0 Nurse Practitioners Fluoride varnish 20 1215339510 0 Nurse Practitioners Healthy Kids Services 20 1215339510 0 Nurse Practitioners Nurse Practitioners Services 20 1215339510 0 Nurse Practitioners Physician Services 00 1215339932 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DOYLE CT ORLAND PARK IL 604671928 20 1215482286 0 Speech Therapists Medical Supplies 20 1215482286 0 Speech Therapists Medical equipment/prosthetic devices 20 1215482286 0 Speech Therapists Speech Therapy/Pathology Services 00 1215483151 0 BENDER KARA 2016316 9999999 B 10 1215483151 0 2740 W FOSTER AVE LL7 CHICAGO IL 606253500 20 1215483151 0 Nurse Practitioners Fluoride varnish 20 1215483151 0 Nurse Practitioners Healthy Kids Services 20 1215483151 0 Nurse Practitioners Nurse Practitioners Services 20 1215483151 0 Nurse Practitioners Physician Services 00 1215483193 0 CARRIER KATLYN E 2016288 9999999 B 10 1215483193 0 201 BAILEY LN BENTON IL 628121969 20 1215483193 0 Physician Assistant Only Fluoride varnish 20 1215483193 0 Physician Assistant Only Healthy Kids Services 20 1215483193 0 Physician Assistant Only Physician Services 00 1215484605 0 CHUNG CHRISTOPHER 2024170 9999999 B 10 1215484605 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1215484605 0 Physicians Anesthesia Services 20 1215484605 0 Physicians Healthy Kids Services 20 1215484605 0 Physicians Optical Supplies 20 1215484605 0 Physicians Physician Services 00 1215484662 0 FARR KARLY R 2024218 9999999 B 10 1215484662 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1215484662 0 Physicians Anesthesia Services 20 1215484662 0 Physicians Healthy Kids Services 20 1215484662 0 Physicians Optical Supplies 20 1215484662 0 Physicians Physician Services 00 1215484787 0 CADY AMY 2016265 9999999 B 10 1215484787 0 1776 MOON LAKE BLVD HOFFMAN ESTATES IL 601691010 20 1215484787 0 Clinical Social Worker Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1215484787 0 Clinical Social Worker Social work service 00 1215484837 0 FABIAN ELIA 2018001 9999999 B 10 1215484837 0 5341 W CERMAK RD CICERO IL 608042817 20 1215484837 0 Other behavior health professional LCPC/LMFT services 00 1215485040 0 CONWAY TINA M 2016342 9999999 B 10 1215485040 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1215485040 0 Physician Assistant Only Fluoride varnish 20 1215485040 0 Physician Assistant Only Healthy Kids Services 20 1215485040 0 Physician Assistant Only Physician Services 00 1215485743 0 MONTGOMERY LAURA A 2016358 9999999 B 10 1215485743 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1215485743 0 Clinical Social Worker Social work service 00 1215486196 0 ROMERO EDNA 2016320 9999999 B 10 1215486196 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1215486196 0 Psychologist Psychologist service 00 1215486782 0 EMMEL SCOTT 2017180 9999999 B 10 1215486782 0 10001 GRAND AVE ATTN: BILLING DEPARTMENT FRANKLIN PARK IL 601312563 20 1215486782 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1215487269 0 COLETTO KATHRYN 2016321 9999999 B 10 1215487269 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1215487269 0 Nurse Practitioners Anesthesia Services 20 1215487269 0 Nurse Practitioners Nurse Practitioners Services 20 1215487269 0 Nurse Practitioners Physician Services 00 1215487830 0 DAVISSON RYAN 2016336 9999999 B 10 1215487830 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1215487830 0 Physician Assistant Only Fluoride varnish 20 1215487830 0 Physician Assistant Only Healthy Kids Services 20 1215487830 0 Physician Assistant Only Physician Services 00 1215487863 0 LANDGRAF RACHEL L 2016312 9999999 B 10 1215487863 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1215487863 0 Nurse Practitioners Fluoride varnish 20 1215487863 0 Nurse Practitioners Healthy Kids Services 20 1215487863 0 Nurse Practitioners Nurse Practitioners Services 20 1215487863 0 Nurse Practitioners Physician Services 00 1215488697 0 TOAL JACQUELINE J 2016351 9999999 B 10 1215488697 0 600 FAYETTE ST PEORIA IL 616033610 20 1215488697 0 Nurse Practitioners Healthy Kids Services 20 1215488697 0 Nurse Practitioners Nurse Practitioners Services 20 1215488697 0 Nurse Practitioners Physician Services 00 1215488903 0 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Nurse Practitioners Nurse Practitioners Services 20 1215491915 0 Nurse Practitioners Physician Services 00 1215492491 0 REED JAKEYLA 2019085 9999999 B 10 1215492491 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1215492491 0 Nurse Practitioners Healthy Kids Services 20 1215492491 0 Nurse Practitioners Nurse Practitioners Services 20 1215492491 0 Nurse Practitioners Physician Services 00 1215494331 0 MCGEE CHRISTINA M 2022042 9999999 B 10 1215494331 0 PO BOX 781076 DETROIT MI 482781076 20 1215494331 0 Nurse Practitioners Fluoride varnish 20 1215494331 0 Nurse Practitioners Healthy Kids Services 20 1215494331 0 Nurse Practitioners Nurse Practitioners Services 20 1215494331 0 Nurse Practitioners Physician Services 00 1215494869 0 NGUYEN HILARY L 2024103 9999999 B 10 1215494869 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1215494869 0 Nurse Practitioners Anesthesia Services 20 1215494869 0 Nurse Practitioners Nurse Practitioners Services 20 1215494869 0 Nurse Practitioners Physician Services 00 1215496187 0 BAIOCCO JOSEPH 2024205 9999999 B 10 1215496187 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1215496187 0 Physicians Anesthesia Services 20 1215496187 0 Physicians Healthy Kids Services 20 1215496187 0 Physicians Optical Supplies 20 1215496187 0 Physicians Physician Services 00 1215496211 0 STEPHENS LUKE BRENNAN 2019182 9999999 B 10 1215496211 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1215496211 0 Physicians Anesthesia Services 20 1215496211 0 Physicians Fluoride varnish 20 1215496211 0 Physicians Healthy Kids Services 20 1215496211 0 Physicians Optical Supplies 20 1215496211 0 Physicians Physician Services 00 1215496237 0 LUGO ADRIAN 2024087 9999999 B 10 1215496237 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1215496237 0 Physicians Anesthesia Services 20 1215496237 0 Physicians Fluoride varnish 20 1215496237 0 Physicians Healthy Kids Services 20 1215496237 0 Physicians Optical Supplies 20 1215496237 0 Physicians Physician Services 00 1215496914 0 ZOOK ELIZABETH C 2019190 9999999 B 10 1215496914 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1215496914 0 Nurse Practitioners Fluoride varnish 20 1215496914 0 Nurse Practitioners Healthy Kids Services 20 1215496914 0 Nurse Practitioners Nurse Practitioners Services 20 1215496914 0 Nurse Practitioners Physician Services 00 1215497284 0 MAYERS ALEXANDER 2024183 9999999 B 10 1215497284 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1215497284 0 Physicians Anesthesia Services 20 1215497284 0 Physicians Healthy Kids Services 20 1215497284 0 Physicians Optical Supplies 20 1215497284 0 Physicians Physician Services 00 1215497326 0 MAYAR ESMAEL 2020026 9999999 B 10 1215497326 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1215497326 0 Physicians Anesthesia Services 20 1215497326 0 Physicians Healthy Kids Services 20 1215497326 0 Physicians Optical Supplies 20 1215497326 0 Physicians Physician Services 00 1215497342 0 BASAPPA ERIC 2020182 9999999 B 10 1215497342 0 75 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STANCI 2019137 9999999 B 10 1215498290 0 7444 W WILSON AVE STE 102 HARWOOD HEIGHTS IL 607064500 20 1215498290 0 Nurse Practitioners Fluoride varnish 20 1215498290 0 Nurse Practitioners Healthy Kids Services 20 1215498290 0 Nurse Practitioners Nurse Practitioners Services 00 1215498357 0 MIYAZAKI KYLE 2024153 9999999 B 10 1215498357 0 4698 DEPT CAROL STREAM IL 601220021 20 1215498357 0 Physicians Anesthesia Services 20 1215498357 0 Physicians Fluoride varnish 20 1215498357 0 Physicians Healthy Kids Services 20 1215498357 0 Physicians Optical Supplies 20 1215498357 0 Physicians Physician Services 00 1215498431 0 KHATTAB AHMAD 2024159 9999999 B 10 1215498431 0 29373 NETWORK PL CHICAGO IL 606733039 20 1215498431 0 Physicians Anesthesia Services 20 1215498431 0 Physicians Healthy Kids Services 20 1215498431 0 Physicians Optical Supplies 20 1215498431 0 Physicians Physician Services 20 1215498431 0 Physicians Physicians Psychiatric Services 00 1215498563 0 FLAUBERT MARK 2020014 9999999 B 10 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Physicians Physician Services 00 1215630157 0 RYALS LOGAN 2024177 9999999 B 10 1215630157 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1215630157 0 Physicians Anesthesia Services 20 1215630157 0 Physicians Fluoride varnish 20 1215630157 0 Physicians Healthy Kids Services 20 1215630157 0 Physicians Optical Supplies 20 1215630157 0 Physicians Physician Services 00 1215630371 0 SESHADRI SUSHAS 2023227 2026181 B 10 1215630371 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1215630371 0 Physicians Anesthesia Services 20 1215630371 0 Physicians Fluoride varnish 20 1215630371 0 Physicians Healthy Kids Services 20 1215630371 0 Physicians Optical Supplies 20 1215630371 0 Physicians Physician Services 00 1215630405 0 RAHMAN HAMID U 2023182 9999999 B 10 1215630405 0 PO BOX 3039 OAK BROOK IL 605223039 20 1215630405 0 Physicians Anesthesia Services 20 1215630405 0 Physicians Fluoride varnish 20 1215630405 0 Physicians Healthy Kids Services 20 1215630405 0 Physicians Optical Supplies 20 1215630405 0 Physicians Physician Services 00 1215631106 0 SPRINGER DEAN E 2023308 9999999 B 10 1215631106 0 124 SW ADAMS ST PEORIA IL 616021308 20 1215631106 0 Physicians Anesthesia Services 20 1215631106 0 Physicians Fluoride varnish 20 1215631106 0 Physicians Healthy Kids Services 20 1215631106 0 Physicians Optical Supplies 20 1215631106 0 Physicians Physician Services 00 1215631189 0 VELDMAN KIEJA JO 2023217 9999999 B 10 1215631189 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1215631189 0 Physicians Anesthesia Services 20 1215631189 0 Physicians Fluoride varnish 20 1215631189 0 Physicians Healthy Kids Services 20 1215631189 0 Physicians Optical Supplies 20 1215631189 0 Physicians Physician Services 00 1215632872 0 NOOR AHMED 2023296 2026181 B 10 1215632872 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1215632872 0 Physicians Anesthesia Services 20 1215632872 0 Physicians Fluoride varnish 20 1215632872 0 Physicians Healthy Kids Services 20 1215632872 0 Physicians Optical Supplies 20 1215632872 0 Physicians Physician Services 00 1215635172 0 UBAYUBAY KEITEL COLLEEN N 2023130 9999999 B 10 1215635172 0 5820 W IRVING PARK RD CHICAGO IL 606342616 20 1215635172 0 Physical Therapists Medical Supplies 20 1215635172 0 Physical Therapists Medical equipment/prosthetic devices 20 1215635172 0 Physical Therapists Physical Therapy Services 00 1215635214 0 MULLEN MARISSA 2023258 9999999 B 10 1215635214 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1215635214 0 Physician Assistant Only Fluoride varnish 20 1215635214 0 Physician Assistant Only Healthy Kids Services 20 1215635214 0 Physician Assistant Only Physician Services 00 1215635594 0 ODEH AMEER 2024176 9999999 B 10 1215635594 0 4698 DEPT CAROL STREAM IL 601220021 20 1215635594 0 Physicians Anesthesia Services 20 1215635594 0 Physicians Fluoride varnish 20 1215635594 0 Physicians Healthy Kids Services 20 1215635594 0 Physicians Optical Supplies 20 1215635594 0 Physicians Physician Services 00 1215636949 0 GRAY KATLIN 2023229 9999999 B 10 1215636949 0 621 S NEW BALLAS RD STE 560A SUITE 560A SAINT LOUIS MO 631418261 20 1215636949 0 Physician Assistant Only Fluoride varnish 20 1215636949 0 Physician Assistant Only Healthy Kids Services 20 1215636949 0 Physician Assistant Only Physician Services 00 1215639471 0 KAHSAY RUTH 2023179 9999999 B 10 1215639471 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1215639471 0 Nurse Practitioners Anesthesia Services 20 1215639471 0 Nurse Practitioners Fluoride varnish 20 1215639471 0 Nurse Practitioners Healthy Kids Services 20 1215639471 0 Nurse Practitioners Optical Supplies 20 1215639471 0 Nurse Practitioners Physician Services 00 1215639794 0 KHAN SUMRAH 2023201 9999999 B 10 1215639794 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1215639794 0 Physicians Anesthesia Services 20 1215639794 0 Physicians Fluoride varnish 20 1215639794 0 Physicians Healthy Kids Services 20 1215639794 0 Physicians Optical Supplies 20 1215639794 0 Physicians Physician Services 00 1215639802 0 YU TERESA 2023223 9999999 B 10 1215639802 0 145 S VIRGINIA ST STE C CRYSTAL LAKE IL 600147226 20 1215639802 0 Other behavior health professional LCPC/LMFT services 00 1215639992 0 MOZER CHRISTINE 2023174 9999999 B 10 1215639992 0 4698 DEPT CAROL STREAM IL 601220021 20 1215639992 0 Physicians Anesthesia Services 20 1215639992 0 Physicians Healthy Kids Services 20 1215639992 0 Physicians Optical Supplies 20 1215639992 0 Physicians Physician Services 20 1215639992 0 Physicians Physicians Psychiatric Services 00 1215640685 0 KELLY CHELSIE 2023199 9999999 B 10 1215640685 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1215640685 0 Occupational Therapists Medical Supplies 20 1215640685 0 Occupational Therapists Medical equipment/prosthetic devices 20 1215640685 0 Occupational Therapists Occupational Therapy Services 00 1215640768 0 DIVANBEIGI TARANEH 2023024 9999999 B 10 1215640768 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1215640768 0 Nurse Practitioners Fluoride varnish 20 1215640768 0 Nurse Practitioners Healthy Kids Services 20 1215640768 0 Nurse Practitioners Nurse Practitioners Services 20 1215640768 0 Nurse Practitioners Physician Services 00 1215641352 0 SA GLORIA A 2023062 9999999 B 10 1215641352 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1215641352 0 Nurse Practitioners Fluoride varnish 20 1215641352 0 Nurse Practitioners Healthy Kids Services 20 1215641352 0 Nurse Practitioners Nurse Practitioners Services 20 1215641352 0 Nurse Practitioners Physician Services 00 1215642368 0 CHAVEZ DUARTE JUAN ARMANDO 2023125 9999999 B 10 1215642368 0 5777 DEPT CAROL STREAM IL 601228942 20 1215642368 0 Nurse Practitioners Fluoride varnish 20 1215642368 0 Nurse Practitioners Healthy Kids Services 20 1215642368 0 Nurse Practitioners Nurse Practitioners Services 20 1215642368 0 Nurse Practitioners Physician Services 00 1215644869 0 BURKE ERIN O 2024072 9999999 B 10 1215644869 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1215644869 0 Nurse Practitioners Healthy Kids Services 20 1215644869 0 Nurse Practitioners Nurse Practitioners Services 20 1215644869 0 Nurse Practitioners Physician Services 00 1215645585 0 VALLONE ELISABETH 2024015 9999999 B 10 1215645585 0 800 W FULTON MARKET FL 12 CHICAGO IL 606071302 20 1215645585 0 Physician Assistant Only Fluoride varnish 20 1215645585 0 Physician Assistant Only Healthy Kids Services 20 1215645585 0 Physician Assistant Only Physician Services 00 1215645981 0 GREGORY JOHANNA 2022314 9999999 B 10 1215645981 0 13400 S ROUTE 59 STE 116-326 PLAINFIELD IL 605855826 20 1215645981 0 Occupational Therapists Medical Supplies 20 1215645981 0 Occupational Therapists Medical equipment/prosthetic devices 20 1215645981 0 Occupational Therapists Occupational Therapy Services 00 1215647375 0 COLLINS MIRANDA 2023254 9999999 B 10 1215647375 0 1436 LOCUST ST TERRE HAUTE IN 478071648 20 1215647375 0 Nurse Practitioners Healthy Kids Services 20 1215647375 0 Nurse Practitioners Nurse Practitioners Services 20 1215647375 0 Nurse Practitioners Physician Services 00 1215648514 0 WILSON MEGAN 2023017 9999999 B 10 1215648514 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1215648514 0 Nurse Practitioners Fluoride varnish 20 1215648514 0 Nurse Practitioners Healthy Kids Services 20 1215648514 0 Nurse Practitioners Nurse Practitioners Services 20 1215648514 0 Nurse Practitioners Physician Services 00 1215649413 0 OFFUTT CHAPMAN 2024228 9999999 B 10 1215649413 0 2605 KENTUCKY AVE STE 306 PADUCAH KY 420033802 20 1215649413 0 Nurse Practitioners Fluoride varnish 20 1215649413 0 Nurse Practitioners Healthy Kids Services 20 1215649413 0 Nurse Practitioners Nurse Practitioners Services 20 1215649413 0 Nurse Practitioners Physician Services 00 1215650445 0 FINCH LEVI 2022279 9999999 B 10 1215650445 0 3010 GRAND AVE WAUKEGAN IL 600852321 20 1215650445 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1215650478 0 ALI MAKENZIE 2022298 9999999 B 10 1215650478 0 PO BOX 1027 BEDFORD PARK IL 604991027 20 1215650478 0 Nurse Practitioners Healthy Kids Services 20 1215650478 0 Nurse Practitioners Nurse Practitioners Services 20 1215650478 0 Nurse Practitioners Physician Services 00 1215651021 0 ORLANDO SANDRA L 2022354 9999999 B 10 1215651021 0 29373 NETWORK PL CHICAGO IL 606733039 20 1215651021 0 Nurse Practitioners Healthy Kids Services 20 1215651021 0 Nurse Practitioners Nurse Practitioners Services 20 1215651021 0 Nurse Practitioners Physician Services 00 1215651260 0 BRIGGS MARIE 2022291 9999999 B 10 1215651260 0 333 N SUMMIT ST FL 7 TOLEDO OH 436041531 20 1215651260 0 Nurse Practitioners Fluoride varnish 20 1215651260 0 Nurse Practitioners Healthy Kids Services 20 1215651260 0 Nurse Practitioners Nurse Practitioners Services 20 1215651260 0 Nurse Practitioners Physician Services 00 1215652243 0 AHMED RAYHANA 2022304 9999999 B 10 1215652243 0 550 W GLADYS AVE ELMHURST IL 601261816 20 1215652243 0 Other behavior health professional Adaptive behavior support clinician services 00 1215652540 0 GREEN MADELINE 2022332 9999999 B 10 1215652540 0 611 W PARK ST BWPC URBANA IL 618012529 20 1215652540 0 Physical Therapists Medical Supplies 20 1215652540 0 Physical Therapists Medical equipment/prosthetic devices 20 1215652540 0 Physical Therapists Physical Therapy Services 00 1215652771 0 DAVIS ANGELA 2023152 9999999 B 10 1215652771 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1215652771 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1215653027 0 WESTEL EMILY 2023069 9999999 B 10 1215653027 0 370 SUMMIT ST # 1 ELGIN IL 601203843 20 1215653027 0 Physician Assistant Only Fluoride varnish 20 1215653027 0 Physician Assistant Only Healthy Kids Services 20 1215653027 0 Physician Assistant Only Physician Services 00 1215653282 0 SOLTAN MOHAMED 2024354 9999999 B 10 1215653282 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1215653282 0 Physicians Anesthesia Services 20 1215653282 0 Physicians Healthy Kids Services 20 1215653282 0 Physicians Optical Supplies 20 1215653282 0 Physicians Physician Services 00 1215653555 0 SWENCKI KARIN 2023003 9999999 B 10 1215653555 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1215653555 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1215655568 0 ACEVIZ OMAR 2023180 9999999 B 10 1215655568 0 801 ILLINI DR SILVIS IL 612821804 20 1215655568 0 Nurse Practitioners Fluoride varnish 20 1215655568 0 Nurse Practitioners Healthy Kids Services 20 1215655568 0 Nurse Practitioners Nurse Practitioners Services 20 1215655568 0 Nurse Practitioners Physician Services 00 1215657069 0 CORLESS SARAH E 2024232 9999999 B 10 1215657069 0 5777 DEPT CAROL STREAM IL 601220021 20 1215657069 0 Nurse Practitioners Anesthesia Services 20 1215657069 0 Nurse Practitioners Nurse Practitioners Services 20 1215657069 0 Nurse Practitioners Physician Services 00 1215658273 0 GOVANI AARTI 2022251 9999999 B 10 1215658273 0 63 WOODSIDE RD RIVERSIDE IL 605461974 20 1215658273 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1215658356 0 MEDINA KIANNE 2022256 9999999 B 10 1215658356 0 212 BARNEY DR JOLIET IL 604355271 20 1215658356 0 Occupational Therapists Medical Supplies 20 1215658356 0 Occupational Therapists Medical equipment/prosthetic devices 20 1215658356 0 Occupational Therapists Occupational Therapy Services 00 1215658596 0 PUZZELLA KATHRYN 2024051 9999999 H 10 1215658596 0 1900 W POLK ST STE 220C CHICAGO IL 60612 20 1215658596 0 Physician Assistant Only Fluoride varnish 20 1215658596 0 Physician Assistant Only Healthy Kids Services 20 1215658596 0 Physician Assistant Only Physician Services 00 1215658885 0 MOLLENHAUER SAMANTHA 2023276 9999999 B 10 1215658885 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1215658885 0 Physician Assistant Only Fluoride varnish 20 1215658885 0 Physician Assistant Only Healthy Kids Services 20 1215658885 0 Physician Assistant Only Physician Services 00 1215659487 0 WELSH LARRY J 2023126 9999999 B 10 1215659487 0 PO BOX 372 MATTOON IL 619380372 20 1215659487 0 Other behavior health professional LCPC/LMFT services 00 1215659925 0 MIRZA SAMREEN 2022326 9999999 B 10 1215659925 0 17W685 ROOSEVELT RD OAKBROOK TERRAC IL 601813545 20 1215659925 0 Optometrists Optical Supplies 20 1215659925 0 Optometrists Optometric Services 20 1215659925 0 Optometrists Physician Services 00 1215660469 0 OMATTO BRIANA M 2023094 9999999 B 10 1215660469 0 1051 ESSINGTON RD STE 210 JOLIET IL 604352812 20 1215660469 0 Nurse Practitioners Fluoride varnish 20 1215660469 0 Nurse Practitioners Healthy Kids Services 20 1215660469 0 Nurse Practitioners Nurse Practitioners Services 20 1215660469 0 Nurse Practitioners Physician Services 00 1215660717 0 FULK CAITLIN G 2022202 9999999 B 10 1215660717 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1215660717 0 Dentists Dental Services 20 1215660717 0 Dentists Physician Services 00 1215661293 0 OLAIZ AMPHONE S 2022200 9999999 B 10 1215661293 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1215661293 0 Registered nurse Nursing service 20 1215661293 0 Registered nurse Waiver service 00 1215662085 0 KOBARI ADEYEMI 2023272 9999999 B 10 1215662085 0 309 NEW INDIAN TRAIL CT AURORA IL 605062411 20 1215662085 0 Nurse Practitioners Healthy Kids Services 20 1215662085 0 Nurse Practitioners Nurse Practitioners Services 20 1215662085 0 Nurse Practitioners Physician Services 00 1215663687 0 RODGERS JENNIFER 2024262 9999999 B 10 1215663687 0 2201 MAIN ST EVANSTON IL 602021519 20 1215663687 0 Clinical Social Worker Social work service 00 1215665120 0 NIJJAR SANDIP 2022265 9999999 B 10 1215665120 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1215665120 0 Nurse Practitioners Healthy Kids Services 20 1215665120 0 Nurse Practitioners Nurse Practitioners Services 20 1215665120 0 Nurse Practitioners Physician Services 00 1215665294 0 KEELAPANDAL GANESH MAHATHI 2022346 9999999 B 10 1215665294 0 611 W PARK ST URBANA IL 618012529 20 1215665294 0 Physicians Anesthesia Services 20 1215665294 0 Physicians Fluoride varnish 20 1215665294 0 Physicians Healthy Kids Services 20 1215665294 0 Physicians Optical Supplies 20 1215665294 0 Physicians Physician Services 00 1215665856 0 VOELSKE TERRY J 2023196 9999999 B 10 1215665856 0 6024 RIDGE AVE STE 116-356 PHILADELPHIA PA 191281601 20 1215665856 0 Physician Assistant Only Fluoride varnish 20 1215665856 0 Physician Assistant Only Healthy Kids Services 20 1215665856 0 Physician Assistant Only Physician Services 00 1215666037 0 REINEN LARISSA L 2022207 9999999 B 10 1215666037 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1215666037 0 Nurse Practitioners Healthy Kids Services 20 1215666037 0 Nurse Practitioners Nurse Practitioners Services 20 1215666037 0 Nurse Practitioners Physician Services 00 1215666110 0 SOAP JOSIAH 2025036 9999999 B 10 1215666110 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1215666110 0 Nurse Practitioners Anesthesia Services 20 1215666110 0 Nurse Practitioners Nurse Practitioners Services 20 1215666110 0 Nurse Practitioners Physician Services 00 1215667464 0 JOHNSON ANITA 2025016 9999999 B 10 1215667464 0 8245 PECAN PL FRANKFORT IL 604231768 20 1215667464 0 Clinical Social Worker Social work service 00 1215667746 0 MCCAREY COLIN 2023219 9999999 B 10 1215667746 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1215667746 0 Physical Therapists Medical Supplies 20 1215667746 0 Physical Therapists Medical equipment/prosthetic devices 20 1215667746 0 Physical Therapists Physical Therapy Services 00 1215668322 0 JAMES KYLE A 2022187 9999999 H 10 1215668322 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1215668322 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1215669007 0 AHLBRAND ASHLEY D 2022193 9999999 B 10 1215669007 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1215669007 0 Optometrists Optical Supplies 20 1215669007 0 Optometrists Optometric Services 20 1215669007 0 Optometrists Physician Services 00 1215670286 0 PATRICK CHRISTOPHER A P 2022184 9999999 B 10 1215670286 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1215670286 0 Physicians Anesthesia Services 20 1215670286 0 Physicians Healthy Kids Services 20 1215670286 0 Physicians Optical Supplies 20 1215670286 0 Physicians Physician Services 00 1215671060 0 FERNANDEZ GABRIELLE M 2022290 9999999 B 10 1215671060 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1215671060 0 Physicians Anesthesia Services 20 1215671060 0 Physicians Healthy Kids Services 20 1215671060 0 Physicians Optical Supplies 20 1215671060 0 Physicians Physician Services 00 1215671177 0 REID MELANYE 2022118 9999999 B 10 1215671177 0 4939 W FULLERTON AVE CHICAGO IL 606392505 20 1215671177 0 Other behavior health professional LCPC/LMFT services 00 1215671433 0 PETRANY MICHAEL J 2023142 9999999 B 10 1215671433 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1215671433 0 Physicians Anesthesia Services 20 1215671433 0 Physicians Healthy Kids Services 20 1215671433 0 Physicians Optical Supplies 20 1215671433 0 Physicians Physician Services 20 1215671433 0 Physicians Physicians Psychiatric Services 00 1215671623 0 CANALES RICHARD 2023183 9999999 B 10 1215671623 0 4698 DEPT CAROL STREAM IL 601224698 20 1215671623 0 Physicians Anesthesia Services 20 1215671623 0 Physicians Fluoride varnish 20 1215671623 0 Physicians Healthy Kids Services 20 1215671623 0 Physicians Optical Supplies 20 1215671623 0 Physicians Physician Services 00 1215672738 0 CHERIAN ANNA 2023351 9999999 B 10 1215672738 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1215672738 0 Physicians Anesthesia Services 20 1215672738 0 Physicians Fluoride varnish 20 1215672738 0 Physicians Healthy Kids Services 20 1215672738 0 Physicians Optical Supplies 20 1215672738 0 Physicians Physician Services 00 1215673041 0 PAPAKONSTANTINOU MICHAEL 2022196 9999999 B 10 1215673041 0 5145 N CALIFORNIA AVE CHICAGO IL 606253661 20 1215673041 0 Physicians Anesthesia Services 20 1215673041 0 Physicians Fluoride varnish 20 1215673041 0 Physicians Healthy Kids Services 20 1215673041 0 Physicians Optical Supplies 20 1215673041 0 Physicians Physician Services 00 1215673082 0 LAFOLLETTE JOHN W 2023361 9999999 B 10 1215673082 0 127 S 1ST ST STE 205 GENEVA IL 601342644 20 1215673082 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1215673348 0 LAWS DANIELLE L 2023291 9999999 B 10 1215673348 0 219 W CHICAGO AVE STE 200 CHICAGO IL 606545600 20 1215673348 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1215675798 0 BERKEY RYAN 2022307 9999999 B 10 1215675798 0 1919 W TAYLOR ST CHICAGO IL 606127246 20 1215675798 0 Physical Therapists Medical Supplies 20 1215675798 0 Physical Therapists Medical equipment/prosthetic devices 20 1215675798 0 Physical Therapists Physical Therapy Services 00 1215677091 0 MBA CHUKWUEMEKA 2022199 9999999 B 10 1215677091 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1215677091 0 Physicians Anesthesia Services 20 1215677091 0 Physicians Fluoride varnish 20 1215677091 0 Physicians Healthy Kids Services 20 1215677091 0 Physicians Optical Supplies 20 1215677091 0 Physicians Physician Services 00 1215677299 0 KELLY KATHLEEN 2022196 9999999 B 10 1215677299 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1215677299 0 Physicians Anesthesia Services 20 1215677299 0 Physicians Fluoride varnish 20 1215677299 0 Physicians Healthy Kids Services 20 1215677299 0 Physicians Optical Supplies 20 1215677299 0 Physicians Physician Services 00 1215677695 0 QIAO VICTOR 2022187 9999999 B 10 1215677695 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1215677695 0 Physicians Anesthesia Services 20 1215677695 0 Physicians Fluoride varnish 20 1215677695 0 Physicians Healthy Kids Services 20 1215677695 0 Physicians Optical Supplies 20 1215677695 0 Physicians Physician Services 00 1215678412 0 MUKAI RENATA 2022212 9999999 B 10 1215678412 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1215678412 0 Physicians Anesthesia Services 20 1215678412 0 Physicians Healthy Kids Services 20 1215678412 0 Physicians Optical Supplies 20 1215678412 0 Physicians Physician Services 00 1215678610 0 BHASKAR AISHWARYA 2022198 9999999 B 10 1215678610 0 PO BOX 3039 OAK BROOK IL 605223039 20 1215678610 0 Physicians Anesthesia Services 20 1215678610 0 Physicians Fluoride varnish 20 1215678610 0 Physicians Healthy Kids Services 20 1215678610 0 Physicians Optical Supplies 20 1215678610 0 Physicians Physician Services 00 1215680939 0 WEISS BETH A 2024224 9999999 B 10 1215680939 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1215680939 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1215682075 0 PATEL ANJALI 2022363 9999999 B 10 1215682075 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1215682075 0 Physician Assistant Only Fluoride varnish 20 1215682075 0 Physician Assistant Only Healthy Kids Services 20 1215682075 0 Physician Assistant Only Physician Services 00 1215685086 0 FARLEY CHARLOTTE 2023150 9999999 B 10 1215685086 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1215685086 0 Physicians Anesthesia Services 20 1215685086 0 Physicians Healthy Kids Services 20 1215685086 0 Physicians Optical Supplies 20 1215685086 0 Physicians Physician Services 00 1215685755 0 GARCIA JULIA 2022363 9999999 B 10 1215685755 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1215685755 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1215685912 0 HILOW HENRY 2023174 9999999 B 10 1215685912 0 4698 DEPT CAROL STREAM IL 601220021 20 1215685912 0 Physicians Anesthesia Services 20 1215685912 0 Physicians Healthy Kids Services 20 1215685912 0 Physicians Optical Supplies 20 1215685912 0 Physicians Physician Services 00 1215687181 0 PATEL GHANSHYAM 2022280 9999999 B 10 1215687181 0 4701 DEPT CAROL STREAM IL 601220021 20 1215687181 0 Physicians Anesthesia Services 20 1215687181 0 Physicians Fluoride varnish 20 1215687181 0 Physicians Healthy Kids Services 20 1215687181 0 Physicians Optical Supplies 20 1215687181 0 Physicians Physician Services 00 1215687298 0 UBERU WHITNEY 2022192 9999999 B 10 1215687298 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1215687298 0 Physicians Anesthesia Services 20 1215687298 0 Physicians Healthy Kids Services 20 1215687298 0 Physicians Optical Supplies 20 1215687298 0 Physicians Physician Services 00 1215687504 0 EMUCHAY KELECHI 2022278 9999999 B 10 1215687504 0 4701 DEPT CAROL STREAM IL 601220021 20 1215687504 0 Physicians Anesthesia Services 20 1215687504 0 Physicians Fluoride varnish 20 1215687504 0 Physicians Healthy Kids Services 20 1215687504 0 Physicians Optical Supplies 20 1215687504 0 Physicians Physician Services 00 1215687801 0 DOMJAHN BRIYANA T 2022181 9999999 B 10 1215687801 0 PO BOX 3039 OAK BROOK IL 605223039 20 1215687801 0 Physicians Anesthesia Services 20 1215687801 0 Physicians Fluoride varnish 20 1215687801 0 Physicians Healthy Kids Services 20 1215687801 0 Physicians Optical Supplies 20 1215687801 0 Physicians Physician Services 00 1215692041 0 SHEIN ALYSSA C 2022006 9999999 B 10 1215692041 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1215692041 0 Nurse Practitioners Fluoride varnish 20 1215692041 0 Nurse Practitioners Healthy Kids Services 20 1215692041 0 Nurse Practitioners Nurse Practitioners Services 20 1215692041 0 Nurse Practitioners Physician Services 00 1215693254 0 BARRIENTOS SARA 2023263 9999999 B 10 1215693254 0 238 S CONGRESS ST RUSHVILLE IL 626811465 20 1215693254 0 Clinical Social Worker Social work service 00 1215693528 0 RYBA CAITLYN 2022187 9999999 B 10 1215693528 0 2900 OGDEN AVE LISLE IL 605321631 20 1215693528 0 Speech Therapists Medical Supplies 20 1215693528 0 Speech Therapists Medical equipment/prosthetic devices 20 1215693528 0 Speech Therapists Speech Therapy/Pathology Services 00 1215694047 0 UMBARGER KARA 2022216 9999999 B 10 1215694047 0 611 W PARK ST URBANA IL 618012529 20 1215694047 0 Nurse Practitioners Healthy Kids Services 20 1215694047 0 Nurse Practitioners Nurse Practitioners Services 20 1215694047 0 Nurse Practitioners Physician Services 00 1215699814 0 MARLOW JENNA L 2021295 9999999 B 10 1215699814 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1215699814 0 Nurse Practitioners Healthy Kids Services 20 1215699814 0 Nurse Practitioners Nurse Practitioners Services 20 1215699814 0 Nurse Practitioners Physician Services 00 1215701982 0 WASHINGTON AYANNA 2024067 9999999 B 10 1215701982 0 1 TIFFANY PT STE 106 BLOOMINGDALE IL 601082915 20 1215701982 0 Nurse Practitioners Healthy Kids Services 20 1215701982 0 Nurse Practitioners Nurse Practitioners Services 20 1215701982 0 Nurse Practitioners Physician Services 00 1215702048 0 BIACHI CHELSEY 2025009 9999999 B 10 1215702048 0 PO BOX 4028 ROCK ISLAND IL 612044028 20 1215702048 0 Nurse Practitioners Fluoride varnish 20 1215702048 0 Nurse Practitioners Healthy Kids Services 20 1215702048 0 Nurse Practitioners Nurse Practitioners Services 20 1215702048 0 Nurse Practitioners Physician Services 00 1215703566 0 GALLOSA REYMAR CRAIG 2024025 9999999 B 10 1215703566 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1215703566 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1215705017 0 KLEIST CAITLIN 2023347 9999999 B 10 1215705017 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1215705017 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1215705900 0 HALL KELLEE L 2024066 9999999 B 10 1215705900 0 3301 W FOREST HOME AVE MILWAUKEE WI 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1225291347 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1225291347 0 Dentists Dental Services 20 1225291347 0 Dentists Physician Services 00 1225291453 0 SCHUBKEGEL TODD 2015258 9999999 B 10 1225291453 0 8550 W BRYN MAWR AVE STE 800 STE 800 CHICAGO IL 606313222 20 1225291453 0 Physicians Anesthesia Services 20 1225291453 0 Physicians Healthy Kids Services 20 1225291453 0 Physicians Optical Supplies 20 1225291453 0 Physicians Physician Services 00 1225291545 0 SHUKLA PINAK Y 2023249 9999999 B 10 1225291545 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1225291545 0 Physicians Anesthesia Services 20 1225291545 0 Physicians Healthy Kids Services 20 1225291545 0 Physicians Optical Supplies 20 1225291545 0 Physicians Physician Services 00 1225291636 0 GOLDKAMP JENNIFER 2012183 9999999 B 10 1225291636 0 PO BOX 504604 SAINT LOUIS MO 631504604 20 1225291636 0 Physicians Anesthesia Services 20 1225291636 0 Physicians Healthy Kids Services 20 1225291636 0 Physicians Optical Supplies 20 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1225296247 0 CONTRERAS KARENROSE 2009182 9999999 B 10 1225296247 0 4199 GATEWAY BLVD STE 3100 NEWBURGH IN 476307906 20 1225296247 0 Physicians Anesthesia Services 20 1225296247 0 Physicians Healthy Kids Services 20 1225296247 0 Physicians Optical Supplies 20 1225296247 0 Physicians Physician Services 00 1225296411 0 SALHAB SAMER 2019339 9999999 B 10 1225296411 0 44000 GARFIELD RD CLINTON TOWNSHI MI 480381125 20 1225296411 0 Physicians Anesthesia Services 20 1225296411 0 Physicians Healthy Kids Services 20 1225296411 0 Physicians Optical Supplies 20 1225296411 0 Physicians Physician Services 00 1225297484 0 HEISEL-WOLTER JULIE R 2008183 9999999 B 10 1225297484 0 PO BOX 557 DECATUR IL 625250557 20 1225297484 0 Nurse Practitioners Anesthesia Services 20 1225297484 0 Nurse Practitioners Nurse Practitioners Services 20 1225297484 0 Nurse Practitioners Physician Services 00 1225297807 0 CUMMINGS SCHVON 2011302 9999999 B 10 1225297807 0 1005 BROADWAY ST QUINCY IL 623012834 20 1225297807 0 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Physicians Optical Supplies 20 1225300346 0 Physicians Physician Services 00 1225300510 0 KULCZYSKI KEVIN 2017274 9999999 B 10 1225300510 0 1283 W DUNDEE RD BUFFALO GROVE IL 600894009 20 1225300510 0 Chiropractors Chiropractic Services 00 1225303191 0 COURTER ROBIN 2022263 9999999 B 10 1225303191 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1225303191 0 Occupational Therapists Medical Supplies 20 1225303191 0 Occupational Therapists Medical equipment/prosthetic devices 20 1225303191 0 Occupational Therapists Occupational Therapy Services 00 1225303407 0 FENERAN ASHLEY N 2016183 9999999 B 10 1225303407 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1225303407 0 Physicians Anesthesia Services 20 1225303407 0 Physicians Healthy Kids Services 20 1225303407 0 Physicians Optical Supplies 20 1225303407 0 Physicians Physician Services 00 1225303910 0 ST. 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1225309529 0 REBECCA ROBERT F 2016235 9999999 B 10 1225309529 0 1301 W DEVON AVE CHICAGO IL 606601329 20 1225309529 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1225311368 0 MARTIN ERIN K 2018001 9999999 B 10 1225311368 0 5777 DEPT CAROL STREAM IL 601220021 20 1225311368 0 Physician Assistant Only Fluoride varnish 20 1225311368 0 Physician Assistant Only Healthy Kids Services 20 1225311368 0 Physician Assistant Only Physician Services 00 1225311665 0 MOHAMAD BASHAR 2024243 9999999 B 10 1225311665 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1225311665 0 Physicians Anesthesia Services 20 1225311665 0 Physicians Fluoride varnish 20 1225311665 0 Physicians Healthy Kids Services 20 1225311665 0 Physicians Optical Supplies 20 1225311665 0 Physicians Physician Services 00 1225312184 0 REYES ROCIO 2017045 9999999 B 10 1225312184 0 10001 GRAND AVE ATTN: BILLING DEPARTMENT FRANKLIN PARK IL 601312563 20 1225312184 0 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9999999 B 10 1225316524 0 24014 W RENWICK RD PLAINFIELD IL 605448708 20 1225316524 0 Physical Therapists Medical Supplies 20 1225316524 0 Physical Therapists Medical equipment/prosthetic devices 20 1225316524 0 Physical Therapists Physical Therapy Services 00 1225316557 0 MOLLOY MARGARET E 2012068 9999999 B 10 1225316557 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1225316557 0 Audiologists Audiology Services 20 1225316557 0 Audiologists Medical Supplies 20 1225316557 0 Audiologists Medical equipment/prosthetic devices 00 1225317464 0 KHAN MARIAM ALI 2018192 9999999 B 10 1225317464 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1225317464 0 Physicians Anesthesia Services 20 1225317464 0 Physicians Fluoride varnish 20 1225317464 0 Physicians Healthy Kids Services 20 1225317464 0 Physicians Optical Supplies 20 1225317464 0 Physicians Physician Services 00 1225318181 0 MISRA SARTHAK B 2019177 9999999 B 10 1225318181 0 4009 N BROADWAY ST CHICAGO IL 606132110 20 1225318181 0 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Physician Services 00 1225321771 0 SCHWARTZ MAGAN M 2011201 9999999 B 10 1225321771 0 5777 DEPT CAROL STREAM IL 601220021 20 1225321771 0 Nurse Practitioners Healthy Kids Services 20 1225321771 0 Nurse Practitioners Nurse Practitioners Services 20 1225321771 0 Nurse Practitioners Physician Services 00 1225322068 0 PATEL KALPESH 2024345 9999999 B 10 1225322068 0 100 E LEFEVRE RD STERLING IL 610811278 20 1225322068 0 Physicians Anesthesia Services 20 1225322068 0 Physicians Fluoride varnish 20 1225322068 0 Physicians Healthy Kids Services 20 1225322068 0 Physicians Optical Supplies 20 1225322068 0 Physicians Physician Services 00 1225322266 0 MELICK EMILY 2012214 9999999 B 10 1225322266 0 11365 DORSETT RD MARYLAND HEIGHT MO 630433411 20 1225322266 0 Nurse Practitioners Fluoride varnish 20 1225322266 0 Nurse Practitioners Healthy Kids Services 20 1225322266 0 Nurse Practitioners Nurse Practitioners Services 20 1225322266 0 Nurse Practitioners Physician Services 00 1225322761 0 BECK MICHELLE 2011213 9999999 B 10 1225322761 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1225322761 0 Optometrists Optical Supplies 20 1225322761 0 Optometrists Optometric Services 20 1225322761 0 Optometrists Physician Services 00 1225323371 0 LEE YUN CHAU B 2022173 9999999 B 10 1225323371 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1225323371 0 Physicians Anesthesia Services 20 1225323371 0 Physicians Fluoride varnish 20 1225323371 0 Physicians Healthy Kids Services 20 1225323371 0 Physicians Optical Supplies 20 1225323371 0 Physicians Physician Services 00 1225323942 0 KUHL TAFTEN LOGAN 2015204 9999999 B 10 1225323942 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1225323942 0 Physicians Anesthesia Services 20 1225323942 0 Physicians Healthy Kids Services 20 1225323942 0 Physicians Optical Supplies 20 1225323942 0 Physicians Physician Services 00 1225324569 0 JUDILLA AMANDA G 2022153 9999999 B 10 1225324569 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 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1225337009 0 Dentists Dental Services 20 1225337009 0 Dentists Physician Services 00 1225337017 0 DIXIT KARAN S 2016187 9999999 B 10 1225337017 0 5777 DEPT CAROL STREAM IL 601228942 20 1225337017 0 Physicians Anesthesia Services 20 1225337017 0 Physicians Fluoride varnish 20 1225337017 0 Physicians Healthy Kids Services 20 1225337017 0 Physicians Optical Supplies 20 1225337017 0 Physicians Physician Services 00 1225337496 0 EDMUNDSON MEGHAN 2016280 9999999 B 10 1225337496 0 1301 W DEVON AVE CHICAGO IL 606601329 20 1225337496 0 Physicians Anesthesia Services 20 1225337496 0 Physicians Fluoride varnish 20 1225337496 0 Physicians Healthy Kids Services 20 1225337496 0 Physicians Optical Supplies 20 1225337496 0 Physicians Physician Services 00 1225340045 0 ANEGONDHI SUDHINDRA PRAVEEN R 2017124 2026305 B 10 1225340045 0 901 MCCLINTOCK DR STE 202 SUITE 202 BURR RIDGE IL 605270872 20 1225340045 0 Physicians Anesthesia Services 20 1225340045 0 Physicians Fluoride varnish 20 1225340045 0 Physicians Healthy Kids Services 20 1225340045 0 Physicians Optical Supplies 20 1225340045 0 Physicians Physician Services 00 1225340078 0 MESKIMEN SCOTT 2011262 9999999 B 10 1225340078 0 1625 AVENUE OF THE CITIES MOLINE IL 612654856 20 1225340078 0 Nurse Practitioners Fluoride varnish 20 1225340078 0 Nurse Practitioners Healthy Kids Services 20 1225340078 0 Nurse Practitioners Nurse Practitioners Services 20 1225340078 0 Nurse Practitioners Physician Services 00 1225340151 0 FIELDS MATTHEW 2024190 9999999 B 10 1225340151 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1225340151 0 Physicians Anesthesia Services 20 1225340151 0 Physicians Healthy Kids Services 20 1225340151 0 Physicians Optical Supplies 20 1225340151 0 Physicians Physician Services 00 1225340565 0 KRUSE KATHERINE E 2018001 9999999 B 10 1225340565 0 2530 CHICAGO AVE STE 400 MINNEAPOLIS MN 554044387 20 1225340565 0 Physicians Anesthesia Services 20 1225340565 0 Physicians Fluoride varnish 20 1225340565 0 Physicians Healthy 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20 1225342769 0 Dentists Dental Services 20 1225342769 0 Dentists Physician Services 00 1225342884 0 ENGLOF ILA 2013183 9999999 B 10 1225342884 0 5665 NEW NORTHSIDE DR ATLANTA GA 303285831 20 1225342884 0 Physicians Anesthesia Services 20 1225342884 0 Physicians Healthy Kids Services 20 1225342884 0 Physicians Optical Supplies 20 1225342884 0 Physicians Physician Services 00 1225343171 0 MUELLER DANIEL R 2015121 9999999 B 10 1225343171 0 800 E LOCUST ST OLNEY IL 624502553 20 1225343171 0 Physicians Anesthesia Services 20 1225343171 0 Physicians Healthy Kids Services 20 1225343171 0 Physicians Optical Supplies 20 1225343171 0 Physicians Physician Services 00 1225344013 0 SINGH JASMEET 2013244 9999999 B 10 1225344013 0 611 W PARK ST URBANA IL 618012529 20 1225344013 0 Physicians Anesthesia Services 20 1225344013 0 Physicians Fluoride varnish 20 1225344013 0 Physicians Healthy Kids Services 20 1225344013 0 Physicians Optical Supplies 20 1225344013 0 Physicians Physician Services 00 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2019353 9999999 B 10 1225346414 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1225346414 0 Physicians Anesthesia Services 20 1225346414 0 Physicians Fluoride varnish 20 1225346414 0 Physicians Healthy Kids Services 20 1225346414 0 Physicians Optical Supplies 20 1225346414 0 Physicians Physician Services 00 1225347362 0 KAPLON-JONES MICHELE C 2010292 9999999 B 10 1225347362 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1225347362 0 Nurse Practitioners Healthy Kids Services 20 1225347362 0 Nurse Practitioners Nurse Practitioners Services 20 1225347362 0 Nurse Practitioners Physician Services 00 1225347578 0 FRAMKE LISA 2015305 9999999 B 10 1225347578 0 1300 W 2ND ST ROCK FALLS IL 610711005 20 1225347578 0 Other behavior health professional LCPC/LMFT services 00 1225348154 0 MAYER ANNE 2016083 9999999 B 10 1225348154 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1225348154 0 Physician Assistant Only Fluoride varnish 20 1225348154 0 Physician Assistant Only Healthy Kids Services 20 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Practitioners Nurse Practitioners Services 20 1225629447 0 Nurse Practitioners Physician Services 00 1225629975 0 WHIPPLE JUSTIN R 2021175 9999999 B 10 1225629975 0 PO BOX 3988 CARBONDALE IL 629023988 20 1225629975 0 Nurse Practitioners Fluoride varnish 20 1225629975 0 Nurse Practitioners Healthy Kids Services 20 1225629975 0 Nurse Practitioners Nurse Practitioners Services 20 1225629975 0 Nurse Practitioners Physician Services 00 1225632110 0 GROSE JUSTIN 2025036 9999999 B 10 1225632110 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1225632110 0 Nurse Practitioners Healthy Kids Services 20 1225632110 0 Nurse Practitioners Nurse Practitioners Services 20 1225632110 0 Nurse Practitioners Physician Services 00 1225632623 0 SHOWALTER KRISTI 2020338 9999999 B 10 1225632623 0 1200 W STATE ST ROCKFORD IL 611022112 20 1225632623 0 Nurse Practitioners Fluoride varnish 20 1225632623 0 Nurse Practitioners Healthy Kids Services 20 1225632623 0 Nurse Practitioners Nurse Practitioners Services 20 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Optical Supplies 20 1225650773 0 Physicians Physician Services 00 1225651623 0 SHANNON-ADAMS AMBER 2022137 9999999 B 10 1225651623 0 8616 S NORMAL AVE CHICAGO IL 606202153 20 1225651623 0 Occupational Therapists Medical Supplies 20 1225651623 0 Occupational Therapists Medical equipment/prosthetic devices 20 1225651623 0 Occupational Therapists Occupational Therapy Services 00 1225652258 0 TERNIK RACHEL 2024105 9999999 B 10 1225652258 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1225652258 0 Physician Assistant Only Physician Services 00 1225652449 0 KALUZNY JOSHUA 2021063 9999999 B 10 1225652449 0 8777 PURDUE RD STE 115 INDIANAPOLIS IN 462683104 20 1225652449 0 Dentists Dental Services 20 1225652449 0 Dentists Physician Services 00 1225652530 0 NEGRETE ALEJANDRO 2020190 9999999 B 10 1225652530 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1225652530 0 Physicians Anesthesia Services 20 1225652530 0 Physicians Healthy Kids Services 20 1225652530 0 Physicians Optical 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Physicians Optical Supplies 20 1225653942 0 Physicians Physician Services 00 1225654189 0 PULLIN NICHOLE 2023124 9999999 B 10 1225654189 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1225654189 0 Physician Assistant Only Fluoride varnish 20 1225654189 0 Physician Assistant Only Healthy Kids Services 20 1225654189 0 Physician Assistant Only Physician Services 00 1225654635 0 ROBERTS SOPHIA H 2020347 9999999 B 10 1225654635 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1225654635 0 Physicians Anesthesia Services 20 1225654635 0 Physicians Healthy Kids Services 20 1225654635 0 Physicians Optical Supplies 20 1225654635 0 Physicians Physician Services 00 1225654734 0 PATEL HETAL 2021281 9999999 B 10 1225654734 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1225654734 0 Physicians Anesthesia Services 20 1225654734 0 Physicians Healthy Kids Services 20 1225654734 0 Physicians Optical Supplies 20 1225654734 0 Physicians Physician Services 20 1225654734 0 Physicians Physicians Psychiatric Services 00 1225654841 0 SHELTON GEORGIA 2022274 9999999 B 10 1225654841 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1225654841 0 Physicians Anesthesia Services 20 1225654841 0 Physicians Healthy Kids Services 20 1225654841 0 Physicians Optical Supplies 20 1225654841 0 Physicians Physician Services 20 1225654841 0 Physicians Physicians Psychiatric Services 00 1225655657 0 RUGGERI JEFFREY 2022299 9999999 B 10 1225655657 0 500 PORTER AVE AURORA MO 656052365 20 1225655657 0 Physicians Anesthesia Services 20 1225655657 0 Physicians Healthy Kids Services 20 1225655657 0 Physicians Optical Supplies 20 1225655657 0 Physicians Physician Services 00 1225656432 0 KIM JESSICA S 2022070 9999999 B 10 1225656432 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1225656432 0 Nurse Practitioners Healthy Kids Services 20 1225656432 0 Nurse Practitioners Nurse Practitioners Services 20 1225656432 0 Nurse Practitioners Physician Services 00 1225656556 0 GREEN LESLEY 2024031 9999999 B 10 1225656556 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1225656556 0 Physicians Anesthesia Services 20 1225656556 0 Physicians Fluoride varnish 20 1225656556 0 Physicians Healthy Kids Services 20 1225656556 0 Physicians Optical Supplies 20 1225656556 0 Physicians Physician Services 00 1225657042 0 YAN LULU EMILY 2021189 9999999 B 10 1225657042 0 7825 SOLUTION CTR CHICAGO IL 606777007 20 1225657042 0 Physicians Anesthesia Services 20 1225657042 0 Physicians Healthy Kids Services 20 1225657042 0 Physicians Optical Supplies 20 1225657042 0 Physicians Physician Services 20 1225657042 0 Physicians Physicians Psychiatric Services 00 1225657125 0 MATHEWS EDWIN R 2023228 9999999 B 10 1225657125 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1225657125 0 Physicians Anesthesia Services 20 1225657125 0 Physicians Fluoride varnish 20 1225657125 0 Physicians Healthy Kids Services 20 1225657125 0 Physicians Optical Supplies 20 1225657125 0 Physicians Physician Services 00 1225657497 0 VALDIVIA YESENIA 2020213 9999999 B 10 1225657497 0 1940 S WESTERN AVE STE 205 CHICAGO IL 606082503 20 1225657497 0 Physicians Anesthesia Services 20 1225657497 0 Physicians Fluoride varnish 20 1225657497 0 Physicians Healthy Kids Services 20 1225657497 0 Physicians Optical Supplies 20 1225657497 0 Physicians Physician Services 00 1225658404 0 MALESKA NICHOLAS 2023311 9999999 B 10 1225658404 0 8170 33RD AVE S MINNEAPOLIS MN 554254516 20 1225658404 0 Physicians Anesthesia Services 20 1225658404 0 Physicians Healthy Kids Services 20 1225658404 0 Physicians Optical Supplies 20 1225658404 0 Physicians Physician Services 00 1225658768 0 CHAN JENNIFER M 2020134 9999999 B 10 1225658768 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1225658768 0 Physician Assistant Only Fluoride varnish 20 1225658768 0 Physician Assistant Only Healthy Kids Services 20 1225658768 0 Physician Assistant Only Physician Services 00 1225659139 0 GOSTYUZHEV IGOR 2024180 9999999 B 10 1225659139 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1225659139 0 Physicians Anesthesia Services 20 1225659139 0 Physicians Healthy Kids Services 20 1225659139 0 Physicians Optical Supplies 20 1225659139 0 Physicians Physician Services 00 1225659444 0 VELLAICHAMY GAUTHAM 2024282 9999999 B 10 1225659444 0 820 SPRINGER DR LOMBARD IL 601486413 20 1225659444 0 Physicians Anesthesia Services 20 1225659444 0 Physicians Healthy Kids Services 20 1225659444 0 Physicians Optical Supplies 20 1225659444 0 Physicians Physician Services 00 1225660160 0 SERDENA NICOLE A 2022159 9999999 B 10 1225660160 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1225660160 0 Nurse Practitioners Anesthesia Services 20 1225660160 0 Nurse Practitioners Nurse Practitioners Services 20 1225660160 0 Nurse Practitioners Physician Services 00 1225660517 0 BINDLER MELANIE 2020039 9999999 B 10 1225660517 0 1957 W DICKENS AVE UNIT 1 CHICAGO IL 606143934 20 1225660517 0 Speech Therapists Medical Supplies 20 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Physician Services 00 1225664220 0 BERNICKY AUTUMN E 2020188 9999999 B 10 1225664220 0 5777 DEPT CAROL STREAM IL 601228942 20 1225664220 0 Physicians Anesthesia Services 20 1225664220 0 Physicians Fluoride varnish 20 1225664220 0 Physicians Healthy Kids Services 20 1225664220 0 Physicians Optical Supplies 20 1225664220 0 Physicians Physician Services 00 1225664337 0 MASOOD WAJIHA 2021158 9999999 B 10 1225664337 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1225664337 0 Physician Assistant Only Fluoride varnish 20 1225664337 0 Physician Assistant Only Healthy Kids Services 20 1225664337 0 Physician Assistant Only Physician Services 00 1225664998 0 ZAVALA KELLIE 2020169 9999999 B 10 1225664998 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1225664998 0 Physician Assistant Only Fluoride varnish 20 1225664998 0 Physician Assistant Only Healthy Kids Services 20 1225664998 0 Physician Assistant Only Physician Services 00 1225665086 0 RAZMINIA POUYAN 2023141 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COUNTY FARM RD WHEATON IL 601873977 20 1225665656 0 Physicians Anesthesia Services 20 1225665656 0 Physicians Fluoride varnish 20 1225665656 0 Physicians Healthy Kids Services 20 1225665656 0 Physicians Optical Supplies 20 1225665656 0 Physicians Physician Services 00 1225665730 0 MUSIC STEPHEN C 2021182 9999999 B 10 1225665730 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1225665730 0 Physicians Anesthesia Services 20 1225665730 0 Physicians Healthy Kids Services 20 1225665730 0 Physicians Optical Supplies 20 1225665730 0 Physicians Physician Services 00 1225665862 0 ALOMGIR MOHAMMED 2023156 9999999 B 10 1225665862 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1225665862 0 Physicians Anesthesia Services 20 1225665862 0 Physicians Fluoride varnish 20 1225665862 0 Physicians Healthy Kids Services 20 1225665862 0 Physicians Optical Supplies 20 1225665862 0 Physicians Physician Services 00 1225665979 0 MAJEWSKI ELIZABETH M 2024275 9999999 B 10 1225665979 0 5777 DEPT CAROL STREAM IL 601220021 20 1225665979 0 Physicians Anesthesia Services 20 1225665979 0 Physicians Healthy Kids Services 20 1225665979 0 Physicians Optical Supplies 20 1225665979 0 Physicians Physician Services 00 1225666134 0 WATERS CHLOE 2020233 9999999 B 10 1225666134 0 PO BOX 776473 CHICAGO IL 606776473 20 1225666134 0 Physicians Anesthesia Services 20 1225666134 0 Physicians Fluoride varnish 20 1225666134 0 Physicians Healthy Kids Services 20 1225666134 0 Physicians Optical Supplies 20 1225666134 0 Physicians Physician Services 00 1225666464 0 OH COYIN 2024105 9999999 B 10 1225666464 0 4698 DEPT CAROL STREAM IL 601220021 20 1225666464 0 Physicians Anesthesia Services 20 1225666464 0 Physicians Fluoride varnish 20 1225666464 0 Physicians Healthy Kids Services 20 1225666464 0 Physicians Optical Supplies 20 1225666464 0 Physicians Physician Services 00 1225666571 0 HEMANI AZIM 2020233 9999999 B 10 1225666571 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1225666571 0 Physicians Anesthesia Services 20 1225666571 0 Physicians Fluoride varnish 20 1225666571 0 Physicians Healthy Kids Services 20 1225666571 0 Physicians Optical Supplies 20 1225666571 0 Physicians Physician Services 20 1225666571 0 Physicians Physicians Psychiatric Services 00 1225667256 0 SCHMITTDIEL THOMAS 2020166 9999999 B 10 1225667256 0 PO BOX 781076 DETROIT MI 482781076 20 1225667256 0 Physicians Anesthesia Services 20 1225667256 0 Physicians Fluoride varnish 20 1225667256 0 Physicians Healthy Kids Services 20 1225667256 0 Physicians Optical Supplies 20 1225667256 0 Physicians Physician Services 00 1225668890 0 GREEN ELAN H 2020166 9999999 B 10 1225668890 0 PO BOX 3039 OAK BROOK IL 605223039 20 1225668890 0 Physicians Anesthesia Services 20 1225668890 0 Physicians Fluoride varnish 20 1225668890 0 Physicians Healthy Kids Services 20 1225668890 0 Physicians Optical Supplies 20 1225668890 0 Physicians Physician Services 00 1225670433 0 BLAIR JENNIFER M 2019306 9999999 B 10 1225670433 0 PO BOX 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devices 20 1225673239 0 Speech Therapists Physical Therapy Services 00 1225674674 0 DONOVAN KIM 2020177 9999999 B 10 1225674674 0 11447 2ND ST STE 9B ROSCOE IL 610739522 20 1225674674 0 Clinical Social Worker Social work service 00 1225674914 0 IHEANYICHUKWU QUINETTE I 2020003 9999999 B 10 1225674914 0 145 S VIRGINIA ST CRYSTAL LAKE IL 600147226 20 1225674914 0 Nurse Practitioners Healthy Kids Services 20 1225674914 0 Nurse Practitioners Nurse Practitioners Services 20 1225674914 0 Nurse Practitioners Physician Services 00 1225675325 0 BORCHERS JULIETTE 2019345 9999999 B 10 1225675325 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1225675325 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1225676992 0 POWELL AMANDA J 2021049 9999999 B 10 1225676992 0 2525 KANEVILLE RD GENEVA IL 601342578 20 1225676992 0 Nurse Practitioners Fluoride varnish 20 1225676992 0 Nurse Practitioners Healthy Kids Services 20 1225676992 0 Nurse Practitioners Nurse Practitioners Services 20 1225676992 0 Nurse Practitioners Physician Services 00 1225677677 0 MCGRAW MARTHA A 2020062 9999999 B 10 1225677677 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1225677677 0 Nurse Practitioners Anesthesia Services 20 1225677677 0 Nurse Practitioners Nurse Practitioners Services 20 1225677677 0 Nurse Practitioners Physician Services 00 1225681455 0 JOSS JINU 2020225 9999999 B 10 1225681455 0 1551 BOND ST STE 151 NAPERVILLE IL 605630137 20 1225681455 0 Nurse Practitioners Healthy Kids Services 20 1225681455 0 Nurse Practitioners Nurse Practitioners Services 20 1225681455 0 Nurse Practitioners Physician Services 00 1225682248 0 THOMPSON CHRISTINA 2023201 9999999 B 10 1225682248 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1225682248 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1225683121 0 IPPOLITO DEANNA K 2021021 9999999 B 10 1225683121 0 4182 NAMEOKI RD GRANITE CITY IL 620402330 20 1225683121 0 Optometrists Optical Supplies 20 1225683121 0 Optometrists Optometric Services 20 1225683121 0 Optometrists Physician Services 00 1225684400 0 OGBUEFI NONYE 2023125 9999999 B 10 1225684400 0 4698 DEPT CAROL STREAM IL 601220021 20 1225684400 0 Physicians Anesthesia Services 20 1225684400 0 Physicians Healthy Kids Services 20 1225684400 0 Physicians Optical Supplies 20 1225684400 0 Physicians Physician Services 00 1225684434 0 KRIPAS JACLYN A 2020062 9999999 B 10 1225684434 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1225684434 0 Nurse Practitioners Fluoride varnish 20 1225684434 0 Nurse Practitioners Healthy Kids Services 20 1225684434 0 Nurse Practitioners Nurse Practitioners Services 20 1225684434 0 Nurse Practitioners Physician Services 00 1225685183 0 WINFIELD JONATHAN M 2020216 9999999 B 10 1225685183 0 3229 W 47TH PL CHICAGO IL 606323011 20 1225685183 0 Dentists Dental Services 20 1225685183 0 Dentists Physician 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1225696982 0 Physicians Anesthesia Services 20 1225696982 0 Physicians Fluoride varnish 20 1225696982 0 Physicians Healthy Kids Services 20 1225696982 0 Physicians Optical Supplies 20 1225696982 0 Physicians Physician Services 00 1225697634 0 VENEZIA KATHERYN 2019217 9999999 B 10 1225697634 0 PO BOX 1239 TROY MI 480991239 20 1225697634 0 Nurse Practitioners Fluoride varnish 20 1225697634 0 Nurse Practitioners Healthy Kids Services 20 1225697634 0 Nurse Practitioners Nurse Practitioners Services 20 1225697634 0 Nurse Practitioners Physician Services 00 1225697956 0 SANDERS JOSEPH 2019168 9999999 B 10 1225697956 0 2045 W GRAND AVE STE B CHICAGO IL 606121577 20 1225697956 0 Clinical Social Worker Social work service 00 1225698137 0 WARFORD KARYN 2019315 9999999 B 10 1225698137 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1225698137 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1225698293 0 MCINTURF WILLIAM 2024222 9999999 B 10 1225698293 0 2636 S LOOP W STE 400 HOUSTON TX 770542680 20 1225698293 0 Physicians Anesthesia Services 20 1225698293 0 Physicians Healthy Kids Services 20 1225698293 0 Physicians Optical Supplies 20 1225698293 0 Physicians Physician Services 20 1225698293 0 Physicians Physicians Psychiatric Services 00 1225699499 0 CHAPS MAURA 2022283 9999999 B 10 1225699499 0 5777 DEPT CAROL STREAM IL 601220021 20 1225699499 0 Occupational Therapists Medical Supplies 20 1225699499 0 Occupational Therapists Medical equipment/prosthetic devices 20 1225699499 0 Occupational Therapists Occupational Therapy Services 00 1225699531 0 WALKER LAQUIATA 2024194 9999999 B 10 1225699531 0 447 SUTTER ST STE 405 SAN FRANCISCO CA 941084618 20 1225699531 0 Clinical Social Worker Social work service 00 1225699820 0 RUFF KATHERINE E 2020330 9999999 B 10 1225699820 0 1515 DELHI ST STE 100 DUBUQUE IA 520016320 20 1225699820 0 Nurse Practitioners Fluoride varnish 20 1225699820 0 Nurse Practitioners 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1225701675 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1225701675 0 Physician Assistant Only Fluoride varnish 20 1225701675 0 Physician Assistant Only Healthy Kids Services 20 1225701675 0 Physician Assistant Only Physician Services 00 1225701758 0 ROBERTS CHARLES L 2021292 9999999 B 10 1225701758 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1225701758 0 Nurse Practitioners Healthy Kids Services 20 1225701758 0 Nurse Practitioners Nurse Practitioners Services 20 1225701758 0 Nurse Practitioners Physician Services 00 1225703432 0 BROWN CRISTINA 2021223 9999999 B 10 1225703432 0 2500 W BRADLEY PL STE 109 CHICAGO IL 606184716 20 1225703432 0 Occupational Therapists Medical Supplies 20 1225703432 0 Occupational Therapists Medical equipment/prosthetic devices 20 1225703432 0 Occupational Therapists Occupational Therapy Services 00 1225703770 0 VAN LAEKEN BRITTNEY LEIGH 2021305 9999999 B 10 1225703770 0 452 OLD CORYDON RD HENDERSON KY 424204645 20 1225703770 0 Nurse Practitioners Healthy Kids Services 20 1225703770 0 Nurse Practitioners Nurse Practitioners Services 20 1225703770 0 Nurse Practitioners Physician Services 00 1225703879 0 FORSYTHE LINDSAY 2023269 9999999 B 10 1225703879 0 101 E STATE ST KENNETT SQUARE PA 193483109 20 1225703879 0 Speech Therapists Medical Supplies 20 1225703879 0 Speech Therapists Medical equipment/prosthetic devices 20 1225703879 0 Speech Therapists Speech Therapy/Pathology Services 00 1225704471 0 CONN SARA N 2021306 9999999 B 10 1225704471 0 727 E COURT ST PARIS IL 619442460 20 1225704471 0 Nurse Practitioners Fluoride varnish 20 1225704471 0 Nurse Practitioners Healthy Kids Services 20 1225704471 0 Nurse Practitioners Nurse Practitioners Services 20 1225704471 0 Nurse Practitioners Physician Services 00 1225704927 0 FONG LERONE 2023093 9999999 B 10 1225704927 0 29373 NETWORK PL CHICAGO IL 606733039 20 1225704927 0 Nurse Practitioners Anesthesia Services 20 1225704927 0 Nurse Practitioners Nurse 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Services 20 1225729650 0 Physicians Optical Supplies 20 1225729650 0 Physicians Physician Services 00 1225731292 0 SINGH SIMREN 2023185 9999999 B 10 1225731292 0 PO BOX 3039 OAK BROOK IL 605223039 20 1225731292 0 Physicians Anesthesia Services 20 1225731292 0 Physicians Fluoride varnish 20 1225731292 0 Physicians Healthy Kids Services 20 1225731292 0 Physicians Optical Supplies 20 1225731292 0 Physicians Physician Services 00 1225731391 0 CHAVEZ DIANA 2023160 9999999 B 10 1225731391 0 PO BOX 3039 OAK BROOK IL 605223039 20 1225731391 0 Physicians Anesthesia Services 20 1225731391 0 Physicians Fluoride varnish 20 1225731391 0 Physicians Healthy Kids Services 20 1225731391 0 Physicians Optical Supplies 20 1225731391 0 Physicians Physician Services 00 1225731433 0 ROSSI WALTER A 2023173 9999999 B 10 1225731433 0 4698 DEPT CAROL STREAM IL 601220021 20 1225731433 0 Physicians Anesthesia Services 20 1225731433 0 Physicians Fluoride varnish 20 1225731433 0 Physicians Healthy Kids Services 20 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1235102062 0 Physicians Healthy Kids Services 20 1235102062 0 Physicians Optical Supplies 20 1235102062 0 Physicians Physician Services 00 1235102567 0 KURTH KEVIN 1995001 9999999 B 10 1235102567 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1235102567 0 Physicians Anesthesia Services 20 1235102567 0 Physicians Healthy Kids Services 20 1235102567 0 Physicians Optical Supplies 20 1235102567 0 Physicians Physician Services 00 1235102724 0 ALLARD MARK M 2024023 9999999 B 10 1235102724 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1235102724 0 Physicians Anesthesia Services 20 1235102724 0 Physicians Healthy Kids Services 20 1235102724 0 Physicians Optical Supplies 20 1235102724 0 Physicians Physician Services 00 1235103110 0 HERNANDEZ HECTOR 2002182 9999999 B 10 1235103110 0 29373 NETWORK PL CHICAGO IL 606733039 20 1235103110 0 Physicians Anesthesia Services 20 1235103110 0 Physicians Fluoride varnish 20 1235103110 0 Physicians Healthy Kids Services 20 1235103110 0 Physicians Optical Supplies 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CHARLES 2004222 9999999 B 10 1235235938 0 350 N WALL ST KANKAKEE IL 609012901 20 1235235938 0 Physicians Anesthesia Services 20 1235235938 0 Physicians Healthy Kids Services 20 1235235938 0 Physicians Optical Supplies 20 1235235938 0 Physicians Physician Services 20 1235235938 0 Physicians Physicians Psychiatric Services 00 1235236308 0 JACKSON DAVID 2021068 9999999 B 10 1235236308 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1235236308 0 Physicians Anesthesia Services 20 1235236308 0 Physicians Healthy Kids Services 20 1235236308 0 Physicians Optical Supplies 20 1235236308 0 Physicians Physician Services 00 1235236530 0 SIDDIQUI FAREED 2023107 9999999 B 10 1235236530 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1235236530 0 Physicians Anesthesia Services 20 1235236530 0 Physicians Healthy Kids Services 20 1235236530 0 Physicians Optical Supplies 20 1235236530 0 Physicians Physician Services 00 1235237405 0 FRAZER TERESA 2021215 9999999 B 10 1235237405 0 29624 NETWORK PL 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1235346941 0 Physicians Anesthesia Services 20 1235346941 0 Physicians Healthy Kids Services 20 1235346941 0 Physicians Optical Supplies 20 1235346941 0 Physicians Physician Services 20 1235346941 0 Physicians Physicians Psychiatric Services 00 1235347741 0 LARRY AMY J 2012183 9999999 B 10 1235347741 0 2300 N EDWARD ST DECATUR IL 625264163 20 1235347741 0 Physical Therapists Medical Supplies 20 1235347741 0 Physical Therapists Medical equipment/prosthetic devices 20 1235347741 0 Physical Therapists Physical Therapy Services 00 1235348061 0 DELONG REBECCA 2007267 9999999 B 10 1235348061 0 PO BOX 1245 BETTENDORF IA 527220021 20 1235348061 0 Physicians Anesthesia Services 20 1235348061 0 Physicians Healthy Kids Services 20 1235348061 0 Physicians Optical Supplies 20 1235348061 0 Physicians Physician Services 00 1235348194 0 MATTINGLY BENJAMIN 2022357 9999999 B 10 1235348194 0 5121 MARYLAND WAY STE 300 BRENTWOOD TN 370277516 20 1235348194 0 Physicians Anesthesia Services 20 1235348194 0 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1235353830 0 Physicians Physician Services 00 1235355462 0 KEARNS JANICE B 2014305 9999999 B 10 1235355462 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1235355462 0 Nurse Practitioners Healthy Kids Services 20 1235355462 0 Nurse Practitioners Nurse Practitioners Services 20 1235355462 0 Nurse Practitioners Physician Services 00 1235355496 0 GHEITH AYMAN A 2018046 9999999 B 10 1235355496 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1235355496 0 Physicians Anesthesia Services 20 1235355496 0 Physicians Healthy Kids Services 20 1235355496 0 Physicians Optical Supplies 20 1235355496 0 Physicians Physician Services 20 1235355496 0 Physicians Physicians Psychiatric Services 00 1235356072 0 AGARWAL ATUL 2009213 9999999 B 10 1235356072 0 250 N SHADELAND AVE STE 200 INDIANAPOLIS IN 462194959 20 1235356072 0 Physicians Anesthesia Services 20 1235356072 0 Physicians Healthy Kids Services 20 1235356072 0 Physicians Optical Supplies 20 1235356072 0 Physicians Physician Services 00 1235357013 0 RIPPER MARY 2021324 9999999 B 10 1235357013 0 1005 BROADWAY ST QUINCY IL 623012834 20 1235357013 0 Clinical Social Worker Social work service 00 1235358599 0 VOROVICH ESTHER E 2015274 9999999 B 10 1235358599 0 5777 DEPT CAROL STREAM IL 601228942 20 1235358599 0 Physicians Anesthesia Services 20 1235358599 0 Physicians Fluoride varnish 20 1235358599 0 Physicians Healthy Kids Services 20 1235358599 0 Physicians Optical Supplies 20 1235358599 0 Physicians Physician Services 00 1235360165 0 BUSSELL AVIDA N 2012032 9999999 B 10 1235360165 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1235360165 0 Physicians Anesthesia Services 20 1235360165 0 Physicians Healthy Kids Services 20 1235360165 0 Physicians Optical Supplies 20 1235360165 0 Physicians Physician Services 00 1235360199 0 DALTON RACHEL MH 2011192 9999999 B 10 1235360199 0 201 S GRAND AVE E SPRINGFIELD IL 627631000 20 1235360199 0 Physicians Anesthesia Services 20 1235360199 0 Physicians Healthy Kids 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20 1235365586 0 Physicians Physician Services 00 1235365594 0 ROMMEL JENNEE 2018113 9999999 B 10 1235365594 0 750 W LAKE COOK RD STE 270 BUFFALO GROVE IL 600892069 20 1235365594 0 Physicians Anesthesia Services 20 1235365594 0 Physicians Fluoride varnish 20 1235365594 0 Physicians Healthy Kids Services 20 1235365594 0 Physicians Optical Supplies 20 1235365594 0 Physicians Physician Services 00 1235365776 0 HERLETH DANIEL R 2015001 9999999 B 10 1235365776 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1235365776 0 Physicians Anesthesia Services 20 1235365776 0 Physicians Fluoride varnish 20 1235365776 0 Physicians Healthy Kids Services 20 1235365776 0 Physicians Optical Supplies 20 1235365776 0 Physicians Physician Services 00 1235365834 0 MIRZA FARHEEN 2014314 9999999 B 10 1235365834 0 5777 DEPT CAROL STREAM IL 601228942 20 1235365834 0 Physicians Anesthesia Services 20 1235365834 0 Physicians Healthy Kids Services 20 1235365834 0 Physicians Optical Supplies 20 1235365834 0 Physicians Physician Services 00 1235366402 0 PUCHALSKI MARY 2010046 9999999 B 10 1235366402 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1235366402 0 Nurse Practitioners Electronic Home Response/EHR Installation, MPE Certification 20 1235366402 0 Nurse Practitioners Healthy Kids Services 20 1235366402 0 Nurse Practitioners Nurse Practitioners Services 20 1235366402 0 Nurse Practitioners Physician Services 00 1235366576 0 LAUCK SARA M 2012215 9999999 B 10 1235366576 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1235366576 0 Physicians Anesthesia Services 20 1235366576 0 Physicians Fluoride varnish 20 1235366576 0 Physicians Healthy Kids Services 20 1235366576 0 Physicians Optical Supplies 20 1235366576 0 Physicians Physician Services 00 1235366725 0 NOLAN SARAH 2021089 9999999 B 10 1235366725 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1235366725 0 Physician Assistant Only Fluoride varnish 20 1235366725 0 Physician Assistant Only Healthy Kids Services 20 1235366725 0 Physician Assistant Only Physician Services 00 1235367160 0 VO THANHMAI 2014182 9999999 B 10 1235367160 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1235367160 0 Physicians Anesthesia Services 20 1235367160 0 Physicians Fluoride varnish 20 1235367160 0 Physicians Healthy Kids Services 20 1235367160 0 Physicians Optical Supplies 20 1235367160 0 Physicians Physician Services 00 1235367467 0 AMIN RUCHITA D 2013182 9999999 B 10 1235367467 0 8679 CONNECTICUT ST STE A MERRILLVILLE IN 464106383 20 1235367467 0 Physicians Anesthesia Services 20 1235367467 0 Physicians Healthy Kids Services 20 1235367467 0 Physicians Optical Supplies 20 1235367467 0 Physicians Physician Services 00 1235367590 0 TAWIL JUSTIN N 2019035 9999999 B 10 1235367590 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1235367590 0 Physicians Anesthesia Services 20 1235367590 0 Physicians Healthy Kids Services 20 1235367590 0 Physicians Optical Supplies 20 1235367590 0 Physicians Physician Services 00 1235367715 0 BANKS-VENEGONI AMY 2017242 9999999 B 10 1235367715 0 100 MICHIGAN ST NE GRAND RAPIDS MI 495032560 20 1235367715 0 Physicians Anesthesia Services 20 1235367715 0 Physicians Healthy Kids Services 20 1235367715 0 Physicians Optical Supplies 20 1235367715 0 Physicians Physician Services 00 1235367731 0 GALLIEN JOHN 2023236 9999999 B 10 1235367731 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1235367731 0 Physicians Anesthesia Services 20 1235367731 0 Physicians Healthy Kids Services 20 1235367731 0 Physicians Optical Supplies 20 1235367731 0 Physicians Physician Services 00 1235368036 0 PIERCE JESSICA M 2015260 9999999 B 10 1235368036 0 3621 S STATE ST ANN ARBOR MI 481081633 20 1235368036 0 Physicians Anesthesia Services 20 1235368036 0 Physicians Healthy Kids Services 20 1235368036 0 Physicians Optical Supplies 20 1235368036 0 Physicians Physician Services 20 1235368036 0 Physicians Physicians Psychiatric Services 00 1235371741 0 BRITO KATHERINE Z 2010309 9999999 B 10 1235371741 0 1000 RANDALL RD STE 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20 1235372616 0 Physicians Healthy Kids Services 20 1235372616 0 Physicians Optical Supplies 20 1235372616 0 Physicians Physician Services 00 1235372996 0 ROBB RAREY CANDACE 2012245 9999999 B 10 1235372996 0 5777 DEPT CAROL STREAM IL 601228942 20 1235372996 0 Physicians Anesthesia Services 20 1235372996 0 Physicians Fluoride varnish 20 1235372996 0 Physicians Healthy Kids Services 20 1235372996 0 Physicians Optical Supplies 20 1235372996 0 Physicians Physician Services 00 1235374315 0 TEJADA MARIA A 2012143 9999999 B 10 1235374315 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1235374315 0 Nurse Practitioners Electronic Home Response/EHR Installation, MPE Certification 20 1235374315 0 Nurse Practitioners Healthy Kids Services 20 1235374315 0 Nurse Practitioners Midwife Services 20 1235374315 0 Nurse Practitioners Nurse Practitioners Services 20 1235374315 0 Nurse Practitioners Physician Services 00 1235375650 0 MONTERUBIANESI LORENA 2011213 9999999 B 10 1235375650 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1235375650 0 Physicians Anesthesia Services 20 1235375650 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1235375650 0 Physicians Fluoride varnish 20 1235375650 0 Physicians Healthy Kids Services 20 1235375650 0 Physicians Optical Supplies 20 1235375650 0 Physicians Physician Services 00 1235377318 0 AMIN MALEEHA 2009032 9999999 B 10 1235377318 0 1740 W ALGONQUIN RD MT PROSPECT IL 600565469 20 1235377318 0 Dentists Dental Services 20 1235377318 0 Dentists Physician Services 00 1235377391 0 GEORGE ANTONY V 2011335 9999999 B 10 1235377391 0 36500 AURORA DR SUMMIT WI 530664899 20 1235377391 0 Physicians Anesthesia Services 20 1235377391 0 Physicians Healthy Kids Services 20 1235377391 0 Physicians Optical Supplies 20 1235377391 0 Physicians Physician Services 00 1235378043 0 CHAPMAN CHRISTOPHER 2011182 9999999 B 10 1235378043 0 PO BOX 268 FREEPORT IL 610320268 20 1235378043 0 Physicians Anesthesia Services 20 1235378043 0 Physicians 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Supplies 20 1235382011 0 Physicians Physician Services 00 1235383274 0 RYAN COLLEEN 2009121 9999999 B 10 1235383274 0 4730 N WINTHROP AVE CHICAGO IL 606405034 20 1235383274 0 Nurse Practitioners Fluoride varnish 20 1235383274 0 Nurse Practitioners Healthy Kids Services 20 1235383274 0 Nurse Practitioners Nurse Practitioners Services 20 1235383274 0 Nurse Practitioners Physician Services 00 1235383456 0 SINGLA RUCHI 2011153 9999999 B 10 1235383456 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1235383456 0 Physicians Anesthesia Services 20 1235383456 0 Physicians Fluoride varnish 20 1235383456 0 Physicians Healthy Kids Services 20 1235383456 0 Physicians Optical Supplies 20 1235383456 0 Physicians Physician Services 00 1235384298 0 COOKE JONATHAN E 2012061 9999999 B 10 1235384298 0 5777 DEPT CAROL STREAM IL 601228942 20 1235384298 0 Physicians Anesthesia Services 20 1235384298 0 Physicians Fluoride varnish 20 1235384298 0 Physicians Healthy Kids Services 20 1235384298 0 Physicians 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Physicians Optical Supplies 20 1235386160 0 Physicians Physician Services 00 1235386236 0 MATCZAK JENNIFER 2011318 9999999 B 10 1235386236 0 6501 S PROMONTORY DR CHICAGO IL 606491003 20 1235386236 0 Physicians Anesthesia Services 20 1235386236 0 Physicians Fluoride varnish 20 1235386236 0 Physicians Healthy Kids Services 20 1235386236 0 Physicians Optical Supplies 20 1235386236 0 Physicians Physician Services 00 1235386392 0 LEE DANIEL C 2022305 9999999 B 10 1235386392 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1235386392 0 Physicians Anesthesia Services 20 1235386392 0 Physicians Healthy Kids Services 20 1235386392 0 Physicians Optical Supplies 20 1235386392 0 Physicians Physician Services 00 1235386863 0 FOTOPOULOS KERRI 2023222 9999999 B 10 1235386863 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1235386863 0 Physical Therapists Medical Supplies 20 1235386863 0 Physical Therapists Medical equipment/prosthetic devices 20 1235386863 0 Physical Therapists Physical Therapy Services 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1235391897 0 100 E PENN SQ PHILADELPHIA PA 191073323 20 1235391897 0 Physicians Anesthesia Services 20 1235391897 0 Physicians Healthy Kids Services 20 1235391897 0 Physicians Optical Supplies 20 1235391897 0 Physicians Physician Services 00 1235391921 0 DURKIN MICHAEL J 2011182 9999999 B 10 1235391921 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1235391921 0 Physicians Anesthesia Services 20 1235391921 0 Physicians Fluoride varnish 20 1235391921 0 Physicians Healthy Kids Services 20 1235391921 0 Physicians Optical Supplies 20 1235391921 0 Physicians Physician Services 00 1235392184 0 SHARP KRISTEN M 2015342 9999999 B 10 1235392184 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1235392184 0 Physicians Anesthesia Services 20 1235392184 0 Physicians Healthy Kids Services 20 1235392184 0 Physicians Optical Supplies 20 1235392184 0 Physicians Physician Services 00 1235392218 0 KONTSEVYY BOHDAN 2019280 9999999 B 10 1235392218 0 1S376 SUMMIT AVE STE 4C OAKBROOK TERRAC IL 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9999999 B 10 1235707944 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1235707944 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1235708355 0 PAL REETI 2021242 9999999 B 10 1235708355 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1235708355 0 Physicians Anesthesia Services 20 1235708355 0 Physicians Healthy Kids Services 20 1235708355 0 Physicians Optical Supplies 20 1235708355 0 Physicians Physician Services 20 1235708355 0 Physicians Physicians Psychiatric Services 00 1235708785 0 NAASEH ARIANA 2021228 9999999 B 10 1235708785 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1235708785 0 Physicians Anesthesia Services 20 1235708785 0 Physicians Healthy Kids Services 20 1235708785 0 Physicians Optical Supplies 20 1235708785 0 Physicians Physician Services 00 1235709213 0 URIBE CARDENAS CARMEN 2022210 9999999 B 10 1235709213 0 302 E SAINT CHARLES RD STE A VILLA PARK IL 601812473 20 1235709213 0 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Services 20 1235710583 0 Physicians Optical Supplies 20 1235710583 0 Physicians Physician Services 00 1235710617 0 MCCOWN SHANNON 2024200 9999999 B 10 1235710617 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1235710617 0 Physicians Anesthesia Services 20 1235710617 0 Physicians Healthy Kids Services 20 1235710617 0 Physicians Optical Supplies 20 1235710617 0 Physicians Physician Services 00 1235711730 0 LUKAN ABDULKAREEM O 2022133 9999999 B 10 1235711730 0 22393 NETWORK PL CHICAGO IL 606735147 20 1235711730 0 Physicians Anesthesia Services 20 1235711730 0 Physicians Fluoride varnish 20 1235711730 0 Physicians Healthy Kids Services 20 1235711730 0 Physicians Optical Supplies 20 1235711730 0 Physicians Physician Services 00 1235712431 0 MATHIS ROSA I 2021210 9999999 B 10 1235712431 0 29373 NETWORK PL CHICAGO IL 606733039 20 1235712431 0 Nurse Practitioners Healthy Kids Services 20 1235712431 0 Nurse Practitioners Nurse Practitioners Services 20 1235712431 0 Nurse Practitioners 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5200 VIRGINIA WAY BRENTWOOD TN 370277569 20 1235807900 0 Nurse Practitioners Fluoride varnish 20 1235807900 0 Nurse Practitioners Healthy Kids Services 20 1235807900 0 Nurse Practitioners Nurse Practitioners Services 20 1235807900 0 Nurse Practitioners Nursing service 20 1235807900 0 Nurse Practitioners Physician Services 20 1235807900 0 Nurse Practitioners Waiver service 00 1235808585 0 SALOW SAMANTHA J 2021287 9999999 B 10 1235808585 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1235808585 0 Nurse Practitioners Fluoride varnish 20 1235808585 0 Nurse Practitioners Healthy Kids Services 20 1235808585 0 Nurse Practitioners Nurse Practitioners Services 20 1235808585 0 Nurse Practitioners Physician Services 00 1235809393 0 LANOU KELSEY 2021319 9999999 B 10 1235809393 0 4835 MANHATTAN DR ROCKFORD IL 611082265 20 1235809393 0 Clinical Social Worker Social work service 00 1235809773 0 GUATELARA KATHERINA 2021312 9999999 B 10 1235809773 0 1256 WATERFORD DR STE 230 AURORA IL 605044511 20 1235809773 0 Nurse Practitioners Fluoride varnish 20 1235809773 0 Nurse Practitioners Healthy Kids Services 20 1235809773 0 Nurse Practitioners Nurse Practitioners Services 20 1235809773 0 Nurse Practitioners Physician Services 00 1235810318 0 LOMAX LAUREN LOMAX 2023230 9999999 B 10 1235810318 0 7929 W CERMAK RD STE C RIVERSIDE IL 605461378 20 1235810318 0 Occupational Therapists Medical Supplies 20 1235810318 0 Occupational Therapists Medical equipment/prosthetic devices 20 1235810318 0 Occupational Therapists Occupational Therapy Services 00 1235810557 0 CHAUDHARI PUJA 2023233 9999999 B 10 1235810557 0 6930 S PULASKI RD CHICAGO IL 606294223 20 1235810557 0 Dentists Dental Services 20 1235810557 0 Dentists Physician Services 00 1235812363 0 GORNY KENDRA T 2023303 9999999 B 10 1235812363 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1235812363 0 Nurse Practitioners Fluoride varnish 20 1235812363 0 Nurse Practitioners Healthy Kids Services 20 1235812363 0 Nurse Practitioners Nurse Practitioners Services 20 1235812363 0 Nurse Practitioners Physician Services 00 1235814047 0 HORNBUCKLE KASEY 2023340 9999999 B 10 1235814047 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1235814047 0 Physicians Anesthesia Services 20 1235814047 0 Physicians Fluoride varnish 20 1235814047 0 Physicians Healthy Kids Services 20 1235814047 0 Physicians Optical Supplies 20 1235814047 0 Physicians Physician Services 00 1235814849 0 CHIBUEZE STANLEY S 2023193 9999999 B 10 1235814849 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1235814849 0 Physicians Anesthesia Services 20 1235814849 0 Physicians Healthy Kids Services 20 1235814849 0 Physicians Optical Supplies 20 1235814849 0 Physicians Physician Services 20 1235814849 0 Physicians Physicians Psychiatric Services 00 1235815796 0 STARR KAITLYN 2023223 9999999 B 10 1235815796 0 1414 MAIN ST MELROSE PARK IL 601603902 20 1235815796 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1235817545 0 FAROOQUI AHMED ABBAS 2024366 9999999 B 10 1235817545 0 PO BOX 778791 CHICAGO IL 606776473 20 1235817545 0 Physicians Anesthesia Services 20 1235817545 0 Physicians Fluoride varnish 20 1235817545 0 Physicians Healthy Kids Services 20 1235817545 0 Physicians Optical Supplies 20 1235817545 0 Physicians Physician Services 00 1235819012 0 WRIGHT ELIZABETH 2025028 9999999 B 10 1235819012 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1235819012 0 Nurse Practitioners Anesthesia Services 20 1235819012 0 Nurse Practitioners Nurse Practitioners Services 20 1235819012 0 Nurse Practitioners Physician Services 00 1235819525 0 TRAITZ BROOKE T 2023201 9999999 B 10 1235819525 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1235819525 0 Speech Therapists Medical Supplies 20 1235819525 0 Speech Therapists Medical equipment/prosthetic devices 20 1235819525 0 Speech Therapists Speech Therapy/Pathology Services 00 1235820200 0 SMITH SARAH 2023331 9999999 B 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2023156 9999999 B 10 1235821109 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1235821109 0 Physicians Anesthesia Services 20 1235821109 0 Physicians Fluoride varnish 20 1235821109 0 Physicians Healthy Kids Services 20 1235821109 0 Physicians Optical Supplies 20 1235821109 0 Physicians Physician Services 00 1235821471 0 SICHLING ANDREW 2023271 9999999 B 10 1235821471 0 4600 3RD ST MOLINE IL 612656106 20 1235821471 0 Other behavior health professional HIV Counseling svcs 20 1235821471 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1235822024 0 BOYDSTON OLIVIA 2024061 9999999 B 10 1235822024 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1235822024 0 Physician Assistant Only Fluoride varnish 20 1235822024 0 Physician Assistant Only Healthy Kids Services 20 1235822024 0 Physician Assistant Only Physician Services 00 1235822313 0 KIM GRACE 2023199 9999999 B 10 1235822313 0 PO BOX 3039 OAK BROOK IL 605223039 20 1235822313 0 Physicians Anesthesia Services 20 1235822313 0 Physicians Healthy Kids Services 20 1235822313 0 Physicians Optical Supplies 20 1235822313 0 Physicians Physician Services 00 1235822891 0 ELMALEH STEPHANIE 2024179 9999999 B 10 1235822891 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1235822891 0 Physical Therapists Medical Supplies 20 1235822891 0 Physical Therapists Medical equipment/prosthetic devices 20 1235822891 0 Physical Therapists Physical Therapy Services 00 1235823782 0 ABRAMOWICZ JAKE M 2023186 9999999 B 10 1235823782 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1235823782 0 Physicians Anesthesia Services 20 1235823782 0 Physicians Healthy Kids Services 20 1235823782 0 Physicians Optical Supplies 20 1235823782 0 Physicians Physician Services 00 1235824418 0 WINGATE JACOB D 2023298 9999999 B 10 1235824418 0 124 SW ADAMS ST PEORIA IL 616021308 20 1235824418 0 Physicians Anesthesia Services 20 1235824418 0 Physicians Healthy Kids Services 20 1235824418 0 Physicians 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1235827866 0 MORADO RAQUEL 2023151 9999999 B 10 1235827866 0 400 N HIGHLAND AVE AURORA IL 605063814 20 1235827866 0 Nurse Practitioners Fluoride varnish 20 1235827866 0 Nurse Practitioners Healthy Kids Services 20 1235827866 0 Nurse Practitioners Nurse Practitioners Services 20 1235827866 0 Nurse Practitioners Physician Services 00 1235830472 0 RUEDAS STARLETTE 2023128 9999999 B 10 1235830472 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1235830472 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1235830472 0 Other behavior health professional Social work service 00 1235830472 0 RUEDAS STARLETTE 2023128 9999999 B 10 1235830472 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1235830472 0 Clinical Social Worker Social work service 00 1235830498 0 DOBRIKOV DAYANA 2024185 9999999 B 10 1235830498 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1235830498 0 Physicians Anesthesia Services 20 1235830498 0 Physicians Fluoride varnish 20 1235830498 0 Physicians Healthy Kids Services 20 1235830498 0 Physicians Optical Supplies 20 1235830498 0 Physicians Physician Services 00 1235830993 0 ALDALLAL MOHAMED S 2024189 9999999 B 10 1235830993 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1235830993 0 Physicians Anesthesia Services 20 1235830993 0 Physicians Healthy Kids Services 20 1235830993 0 Physicians Optical Supplies 20 1235830993 0 Physicians Physician Services 00 1235831348 0 CHIU KIRK PATRICK 2023217 9999999 B 10 1235831348 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1235831348 0 Physicians Anesthesia Services 20 1235831348 0 Physicians Fluoride varnish 20 1235831348 0 Physicians Healthy Kids Services 20 1235831348 0 Physicians Optical Supplies 20 1235831348 0 Physicians Physician Services 00 1235831868 0 FEINBERG CHARLES C 2024176 9999999 B 10 1235831868 0 4698 DEPT CAROL STREAM IL 601220021 20 1235831868 0 Physicians Anesthesia Services 20 1235831868 0 Physicians Healthy Kids Services 20 1235831868 0 Physicians Optical Supplies 20 1235831868 0 Physicians Physician Services 00 1235832270 0 OMAR WALEED 2023277 9999999 B 10 1235832270 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1235832270 0 Physicians Anesthesia Services 20 1235832270 0 Physicians Fluoride varnish 20 1235832270 0 Physicians Healthy Kids Services 20 1235832270 0 Physicians Optical Supplies 20 1235832270 0 Physicians Physician Services 00 1235833260 0 RICHARD KELSI M 2023088 9999999 B 10 1235833260 0 124 SW ADAMS ST FL 2 PEORIA IL 616021308 20 1235833260 0 Nurse Practitioners Fluoride varnish 20 1235833260 0 Nurse Practitioners Healthy Kids Services 20 1235833260 0 Nurse Practitioners Nurse Practitioners Services 20 1235833260 0 Nurse Practitioners Physician Services 00 1235833641 0 PACE SHAHAAD 2023213 9999999 B 10 1235833641 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1235833641 0 Physicians Anesthesia Services 20 1235833641 0 Physicians Healthy Kids Services 20 1235833641 0 Physicians Optical Supplies 20 1235833641 0 Physicians Physician Services 00 1235834185 0 RONAI MATTHEW 2023177 9999999 B 10 1235834185 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1235834185 0 Physician Assistant Only Fluoride varnish 20 1235834185 0 Physician Assistant Only Healthy Kids Services 20 1235834185 0 Physician Assistant Only Physician Services 00 1235834326 0 YOUNG KIRSTEN L 2023182 9999999 B 10 1235834326 0 4698 DEPT CAROL STREAM IL 601224698 20 1235834326 0 Physicians Anesthesia Services 20 1235834326 0 Physicians Fluoride varnish 20 1235834326 0 Physicians Healthy Kids Services 20 1235834326 0 Physicians Optical Supplies 20 1235834326 0 Physicians Physician Services 00 1235834920 0 BARRON HAILEY 2023178 9999999 B 10 1235834920 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1235834920 0 Nurse Practitioners Fluoride varnish 20 1235834920 0 Nurse Practitioners Healthy Kids Services 20 1235834920 0 Nurse Practitioners Nurse Practitioners Services 20 1235834920 0 Nurse Practitioners Physician Services 00 1235835869 0 ROLL EMILY 2023131 9999999 B 10 1235835869 0 28592 NETWORK PL CHICAGO IL 606731285 20 1235835869 0 Nurse Practitioners Healthy Kids Services 20 1235835869 0 Nurse Practitioners Nurse Practitioners Services 20 1235835869 0 Nurse Practitioners Physician Services 00 1235836982 0 BOUDA PIBI J 2023090 9999999 B 10 1235836982 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1235836982 0 Nurse Practitioners Healthy Kids Services 20 1235836982 0 Nurse Practitioners Nurse Practitioners Services 20 1235836982 0 Nurse Practitioners Physician Services 00 1235838020 0 FLORA NICOLE PATRIARCA 2023275 9999999 B 10 1235838020 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1235838020 0 Physician Assistant Only Fluoride varnish 20 1235838020 0 Physician Assistant Only Healthy Kids Services 20 1235838020 0 Physician Assistant Only Physician Services 00 1235838764 0 SCHEFELKER KEATYN E 2023073 9999999 B 10 1235838764 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 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1235879438 0 4698 DEPT CAROL STREAM IL 601220021 20 1235879438 0 Physicians Anesthesia Services 20 1235879438 0 Physicians Healthy Kids Services 20 1235879438 0 Physicians Optical Supplies 20 1235879438 0 Physicians Physician Services 00 1235879990 0 WICKHAM JOHN 2022152 9999999 B 10 1235879990 0 4025 N SHERIDAN RD CHICAGO IL 606132010 20 1235879990 0 Clinical Social Worker Social work service 00 1235881194 0 SANKARA SHOMARI A 2024253 9999999 B 10 1235881194 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1235881194 0 Physicians Anesthesia Services 20 1235881194 0 Physicians Healthy Kids Services 20 1235881194 0 Physicians Optical Supplies 20 1235881194 0 Physicians Physician Services 20 1235881194 0 Physicians Physicians Psychiatric Services 00 1235881921 0 SULLIVAN TERESA 2022213 9999999 B 10 1235881921 0 5547 N RAVENSWOOD AVE STE 103 CHICAGO IL 606401125 20 1235881921 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1235881954 0 LOVETT REBECCA M 2022217 9999999 B 10 1235881954 0 5777 DEPT CAROL STREAM IL 601220021 20 1235881954 0 Psychologist Psychologist service 00 1235882333 0 KARADIS ALEXANDRA 2023289 9999999 B 10 1235882333 0 909 RIDGEBROOK RD STE 300 SPARKS MD 211529477 20 1235882333 0 Nurse Practitioners Healthy Kids Services 20 1235882333 0 Nurse Practitioners Midwife Services 20 1235882333 0 Nurse Practitioners Nurse Practitioners Services 20 1235882333 0 Nurse Practitioners Physician Services 00 1235883661 0 SONG YOONMEE 2022049 9999999 B 10 1235883661 0 5440 CORPORATE DR STE 400 TROY MI 480982645 20 1235883661 0 Nurse Practitioners Fluoride varnish 20 1235883661 0 Nurse Practitioners Healthy Kids Services 20 1235883661 0 Nurse Practitioners Nurse Practitioners Services 20 1235883661 0 Nurse Practitioners Physician Services 00 1235884560 0 RIVERA CECILIA Y 2023095 9999999 B 10 1235884560 0 5N233 BLUFF DR S ST CHARLES IL 601755189 20 1235884560 0 Clinical Social Worker 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1235886342 0 Nurse Practitioners Healthy Kids Services 20 1235886342 0 Nurse Practitioners Nurse Practitioners Services 20 1235886342 0 Nurse Practitioners Physician Services 00 1235887779 0 CARRINGTON ADEJIMI 2022096 9999999 B 10 1235887779 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1235887779 0 Nurse Practitioners Fluoride varnish 20 1235887779 0 Nurse Practitioners Healthy Kids Services 20 1235887779 0 Nurse Practitioners Nurse Practitioners Services 20 1235887779 0 Nurse Practitioners Physician Services 00 1235888041 0 MCFADDEN BRANDON L 2022175 9999999 B 10 1235888041 0 4698 DEPT CAROL STREAM IL 601220021 20 1235888041 0 Physicians Anesthesia Services 20 1235888041 0 Physicians Healthy Kids Services 20 1235888041 0 Physicians Optical Supplies 20 1235888041 0 Physicians Physician Services 00 1235888116 0 YOUNG JOSEPH A 2022174 9999999 B 10 1235888116 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1235888116 0 Physicians Anesthesia Services 20 1235888116 0 Physicians Fluoride varnish 20 1235888116 0 Physicians Healthy Kids Services 20 1235888116 0 Physicians Optical Supplies 20 1235888116 0 Physicians Physician Services 00 1235888173 0 GRUDZINSKI KEVIN 2022144 9999999 B 10 1235888173 0 4698 DEPT CAROL STREAM IL 601220021 20 1235888173 0 Physicians Anesthesia Services 20 1235888173 0 Physicians Fluoride varnish 20 1235888173 0 Physicians Healthy Kids Services 20 1235888173 0 Physicians Optical Supplies 20 1235888173 0 Physicians Physician Services 00 1235888504 0 WANG ROBIN HAILEI 2023209 9999999 B 10 1235888504 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1235888504 0 Physicians Anesthesia Services 20 1235888504 0 Physicians Healthy Kids Services 20 1235888504 0 Physicians Optical Supplies 20 1235888504 0 Physicians Physician Services 00 1235888629 0 RUTHERFORD MARSHALL DILLION 2024249 9999999 B 10 1235888629 0 PO BOX 5081 JANESVILLE WI 535475081 20 1235888629 0 Physicians Anesthesia Services 20 1235888629 0 Physicians Fluoride varnish 20 1235888629 0 Physicians Healthy Kids Services 20 1235888629 0 Physicians Optical Supplies 20 1235888629 0 Physicians Physician Services 00 1235889858 0 KOZENY JAMES 2022189 9999999 B 10 1235889858 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1235889858 0 Podiatrists Podiatric Services 00 1235892431 0 THOMAS NICOLAS 2021301 9999999 B 10 1235892431 0 611 HUNTER LN LAKE FOREST IL 600454905 20 1235892431 0 Nurse Practitioners Fluoride varnish 20 1235892431 0 Nurse Practitioners Healthy Kids Services 20 1235892431 0 Nurse Practitioners Nurse Practitioners Services 20 1235892431 0 Nurse Practitioners Physician Services 00 1235894882 0 KUTZ EMILY 2021313 9999999 B 10 1235894882 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1235894882 0 Nurse Practitioners Healthy Kids Services 20 1235894882 0 Nurse Practitioners Nurse Practitioners Services 20 1235894882 0 Nurse Practitioners Physician Services 00 1235895335 0 HARRIS BREA R 2022006 9999999 B 10 1235895335 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1235895335 0 Nurse Practitioners Healthy Kids Services 20 1235895335 0 Nurse Practitioners Nurse Practitioners Services 20 1235895335 0 Nurse Practitioners Physician Services 00 1235896242 0 BRISKI ALANNA V 2021347 9999999 B 10 1235896242 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1235896242 0 Nurse Practitioners Healthy Kids Services 20 1235896242 0 Nurse Practitioners Nurse Practitioners Services 20 1235896242 0 Nurse Practitioners Physician Services 00 1235896473 0 BERGERON LAURA E 2025010 9999999 B 10 1235896473 0 8170 MCCORMICK BLVD STE 112 SKOKIE IL 600762914 20 1235896473 0 Physical Therapists Medical Supplies 20 1235896473 0 Physical Therapists Medical equipment/prosthetic devices 20 1235896473 0 Physical Therapists Physical Therapy Services 00 1235900333 0 GOSSETT KAITE A 2024151 9999999 B 10 1235900333 0 PO BOX 3988 CARBONDALE IL 629023988 20 1235900333 0 Nurse Practitioners Healthy Kids Services 20 1235900333 0 Nurse Practitioners Nurse Practitioners Services 20 1235900333 0 Nurse Practitioners Physician Services 00 1235900531 0 RIGSBY JOSIE 2024135 9999999 B 10 1235900531 0 PO BOX 775253 CHICAGO IL 606775253 20 1235900531 0 Nurse Practitioners Fluoride varnish 20 1235900531 0 Nurse Practitioners Healthy Kids Services 20 1235900531 0 Nurse Practitioners Nurse Practitioners Services 20 1235900531 0 Nurse Practitioners Physician Services 00 1235908229 0 KRISHNAN DIANA 2024039 9999999 B 10 1235908229 0 2015 W CERMAK RD BASMT CHICAGO IL 60608 20 1235908229 0 Nurse Practitioners Healthy Kids Services 20 1235908229 0 Nurse Practitioners Nurse Practitioners Services 20 1235908229 0 Nurse Practitioners Physician Services 00 1235909102 0 MCINNIS MALAYNA M 2024044 9999999 B 10 1235909102 0 520 MARY ST STE 520 EVANSVILLE IN 477101682 20 1235909102 0 Nurse Practitioners Fluoride varnish 20 1235909102 0 Nurse Practitioners Healthy Kids Services 20 1235909102 0 Nurse Practitioners Nurse Practitioners Services 20 1235909102 0 Nurse Practitioners Physician 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9999999 B 10 1235989013 0 PO BOX 3039 OAK BROOK IL 605223039 20 1235989013 0 Physicians Anesthesia Services 20 1235989013 0 Physicians Fluoride varnish 20 1235989013 0 Physicians Healthy Kids Services 20 1235989013 0 Physicians Optical Supplies 20 1235989013 0 Physicians Physician Services 00 1235989302 0 CARNATHAN ALEXANDRA J 2024354 9999999 B 10 1235989302 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1235989302 0 Physician Assistant Only Fluoride varnish 20 1235989302 0 Physician Assistant Only Healthy Kids Services 20 1235989302 0 Physician Assistant Only Physician Services 00 1235989484 0 GALLO RYAN 2024209 9999999 B 10 1235989484 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1235989484 0 Physicians Anesthesia Services 20 1235989484 0 Physicians Healthy Kids Services 20 1235989484 0 Physicians Optical Supplies 20 1235989484 0 Physicians Physician Services 00 1235989716 0 MARKEWYCZ HANNA 2024199 9999999 B 10 1235989716 0 3249 OAK PARK AVE BERWYN IL 604023429 20 1235989716 0 Physicians 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0 Physicians Anesthesia Services 20 1245235100 0 Physicians Fluoride varnish 20 1245235100 0 Physicians Healthy Kids Services 20 1245235100 0 Physicians Optical Supplies 20 1245235100 0 Physicians Physician Services 00 1245235290 0 MUNOZ GILBERTO 2025129 9999999 B 10 1245235290 0 5777 DEPT CAROL STREAM IL 601220021 20 1245235290 0 Physicians Anesthesia Services 20 1245235290 0 Physicians Fluoride varnish 20 1245235290 0 Physicians Healthy Kids Services 20 1245235290 0 Physicians Optical Supplies 20 1245235290 0 Physicians Physician Services 00 1245236157 0 YINGLING DAVID G 1991182 9999999 B 10 1245236157 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1245236157 0 Physicians Anesthesia Services 20 1245236157 0 Physicians Healthy Kids Services 20 1245236157 0 Physicians Optical Supplies 20 1245236157 0 Physicians Physician Services 00 1245236363 0 SCHUBERT ROBERT W 1991182 9999999 B 10 1245236363 0 62311 COLLECTION CENTER DR CHICAGO IL 606930001 20 1245236363 0 Physicians Anesthesia 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PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1245303064 0 Physicians Anesthesia Services 20 1245303064 0 Physicians Fluoride varnish 20 1245303064 0 Physicians Healthy Kids Services 20 1245303064 0 Physicians Optical Supplies 20 1245303064 0 Physicians Physician Services 00 1245304989 0 PATRASCU OANA 2005213 9999999 B 10 1245304989 0 1256 WATERFORD DR STE 230 AURORA IL 605044511 20 1245304989 0 Physicians Anesthesia Services 20 1245304989 0 Physicians Fluoride varnish 20 1245304989 0 Physicians Healthy Kids Services 20 1245304989 0 Physicians Optical Supplies 20 1245304989 0 Physicians Physician Services 00 1245305051 0 AMFAHR CAROL A 2020296 9999999 B 10 1245305051 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1245305051 0 Nurse Practitioners Healthy Kids Services 20 1245305051 0 Nurse Practitioners Nurse Practitioners Services 20 1245305051 0 Nurse Practitioners Physician Services 00 1245306166 0 HANSEN PAMELA 2018102 9999999 B 10 1245306166 0 1420 W PIONEER PKWY 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0 Physicians Optical Supplies 20 1245310655 0 Physicians Physician Services 00 1245311778 0 CHAVALI MALINI 2001213 9999999 B 10 1245311778 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1245311778 0 Physicians Anesthesia Services 20 1245311778 0 Physicians Fluoride varnish 20 1245311778 0 Physicians Healthy Kids Services 20 1245311778 0 Physicians Optical Supplies 20 1245311778 0 Physicians Physician Services 00 1245312529 0 KATHOLI RICHARD 1986258 9999999 B 10 1245312529 0 800 SCHOOL ST CARROLLTON IL 620161436 20 1245312529 0 Physicians Anesthesia Services 20 1245312529 0 Physicians Fluoride varnish 20 1245312529 0 Physicians Healthy Kids Services 20 1245312529 0 Physicians Optical Supplies 20 1245312529 0 Physicians Physician Services 00 1245312701 0 ZUIDEMA JULIE 2000336 9999999 B 10 1245312701 0 100 E LEFEVRE RD STERLING IL 610811278 20 1245312701 0 Physical Therapists Medical Supplies 20 1245312701 0 Physical Therapists Medical equipment/prosthetic devices 20 1245312701 0 Physical 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9999999 B 10 1245380880 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1245380880 0 Physicians Anesthesia Services 20 1245380880 0 Physicians Fluoride varnish 20 1245380880 0 Physicians Healthy Kids Services 20 1245380880 0 Physicians Optical Supplies 20 1245380880 0 Physicians Physician Services 00 1245381201 0 VERZOLA EDWARDO 2016197 9999999 B 10 1245381201 0 615 S NEW BALLAS RD STE 1200 SAINT LOUIS MO 631418221 20 1245381201 0 Physicians Anesthesia Services 20 1245381201 0 Physicians Fluoride varnish 20 1245381201 0 Physicians Healthy Kids Services 20 1245381201 0 Physicians Optical Supplies 20 1245381201 0 Physicians Physician Services 00 1245381433 0 DAVEY KATHRYN J 2008001 9999999 B 10 1245381433 0 PO BOX 5081 JANESVILLE WI 535475081 20 1245381433 0 Physical Therapists Medical Supplies 20 1245381433 0 Physical Therapists Medical equipment/prosthetic devices 20 1245381433 0 Physical Therapists Physical Therapy Services 00 1245382852 0 ARNALDO FABIAN 2024274 9999999 B 10 1245382852 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1245382852 0 Physicians Anesthesia Services 20 1245382852 0 Physicians Fluoride varnish 20 1245382852 0 Physicians Healthy Kids Services 20 1245382852 0 Physicians Optical Supplies 20 1245382852 0 Physicians Physician Services 00 1245383090 0 HUFFMAN EMILY 2007150 9999999 B 10 1245383090 0 29373 NETWORK PL CHICAGO IL 606733039 20 1245383090 0 Physical Therapists Medical Supplies 20 1245383090 0 Physical Therapists Medical equipment/prosthetic devices 20 1245383090 0 Physical Therapists Physical Therapy Services 00 1245383371 0 MAIN ROBERT J 1981258 9999999 B 10 1245383371 0 1504 SIOUX DR MARION IL 629595209 20 1245383371 0 Dentists Dental Services 20 1245383371 0 Dentists Physician Services 00 1245384130 0 LUGOWSKI ERIN 1992336 9999999 B 10 1245384130 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1245384130 0 Nurse Practitioners Anesthesia Services 20 1245384130 0 Nurse Practitioners Nurse Practitioners Services 20 1245384130 0 Nurse Practitioners Physician Services 00 1245384171 0 PACIAN LORA 2018270 9999999 B 10 1245384171 0 5220 EAST AVE STE 1 COUNTRYSIDE IL 605253133 20 1245384171 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1245384239 0 SWEDBERG LYNETTE 2015322 9999999 B 10 1245384239 0 PO BOX 4698 CAROL STREAM IL 601224698 20 1245384239 0 Registered nurse Nursing service 20 1245384239 0 Registered nurse Waiver service 00 1245385699 0 VARGAS LEONARDO M 2001068 9999999 B 10 1245385699 0 5777 DEPT CAROL STREAM IL 601220021 20 1245385699 0 Physicians Anesthesia Services 20 1245385699 0 Physicians Fluoride varnish 20 1245385699 0 Physicians Healthy Kids Services 20 1245385699 0 Physicians Optical Supplies 20 1245385699 0 Physicians Physician Services 00 1245385715 0 CHEBLI RAMONA 2009274 9999999 B 10 1245385715 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1245385715 0 Nurse Practitioners Healthy Kids Services 20 1245385715 0 Nurse Practitioners Nurse Practitioners Services 20 1245385715 0 Nurse Practitioners Physician Services 00 1245386226 0 LA RUE STEVEN L 2017178 9999999 B 10 1245386226 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1245386226 0 Physicians Anesthesia Services 20 1245386226 0 Physicians Healthy Kids Services 20 1245386226 0 Physicians Optical Supplies 20 1245386226 0 Physicians Physician Services 00 1245387422 0 BARTLE JUDY A 2017213 9999999 B 10 1245387422 0 965 MATTOX DR SULLIVAN MO 630802365 20 1245387422 0 Nurse Practitioners Fluoride varnish 20 1245387422 0 Nurse Practitioners Healthy Kids Services 20 1245387422 0 Nurse Practitioners Nurse Practitioners Services 20 1245387422 0 Nurse Practitioners Physician Services 00 1245388545 0 VERON JUAN P 2016018 9999999 B 10 1245388545 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1245388545 0 Physician Assistant Only Fluoride varnish 20 1245388545 0 Physician Assistant Only Healthy Kids Services 20 1245388545 0 Physician Assistant Only Physician Services 00 1245389857 0 WICKREMA CHERYL 2000110 9999999 B 10 1245389857 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1245389857 0 Occupational Therapists Medical Supplies 20 1245389857 0 Occupational Therapists Medical equipment/prosthetic devices 20 1245389857 0 Occupational Therapists Occupational Therapy Services 00 1245390897 0 SULLIVAN KEVIN L 1987075 9999999 B 10 1245390897 0 7421 N MILWAUKEE AVE NILES IL 607143707 20 1245390897 0 Physicians Anesthesia Services 20 1245390897 0 Physicians Healthy Kids Services 20 1245390897 0 Physicians Optical Supplies 20 1245390897 0 Physicians Physician Services 00 1245390947 0 MAXWELL STEFANIE 2012095 9999999 B 10 1245390947 0 36494 VIA VERDE TEMECULA CA 925927844 20 1245390947 0 Psychologist Psychologist service 00 1245391432 0 TELLEZ RACHEL WALLACE 2023333 9999999 B 10 1245391432 0 246 OAKHURST CIR KISSIMMEE FL 347444752 20 1245391432 0 Physicians Anesthesia Services 20 1245391432 0 Physicians Fluoride varnish 20 1245391432 0 Physicians Healthy Kids Services 20 1245391432 0 Physicians Optical Supplies 20 1245391432 0 Physicians Physician Services 00 1245393677 0 HEINZ KERRY A 2019136 9999999 B 10 1245393677 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1245393677 0 Other behavior health professional LCPC/LMFT services 00 1245395466 0 GLICK DAVID 2002182 9999999 B 10 1245395466 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1245395466 0 Physicians Anesthesia Services 20 1245395466 0 Physicians Healthy Kids Services 20 1245395466 0 Physicians Optical Supplies 20 1245395466 0 Physicians Physician Services 00 1245395946 0 KHALID CARL 1984048 9999999 B 10 1245395946 0 2054 W DEVON CHICAGO CHICAGO IL 606690001 20 1245395946 0 Dentists Dental Services 20 1245395946 0 Dentists Physician Services 00 1245396233 0 MASLOWSKY BETH 2002232 9999999 B 10 1245396233 0 708 CASSIN RD NAPERVILLE IL 605653429 20 1245396233 0 Speech Therapists Medical Supplies 20 1245396233 0 Speech Therapists Medical equipment/prosthetic devices 20 1245396233 0 Speech Therapists Speech Therapy/Pathology Services 00 1245396852 0 ANDERSSON JULIE 2021323 9999999 B 10 1245396852 0 257 W SAINT GEORGE AVE GRANTSBURG WI 548407827 20 1245396852 0 Physician Assistant Only Fluoride varnish 20 1245396852 0 Physician Assistant Only Healthy Kids Services 20 1245396852 0 Physician Assistant Only Physician Services 00 1245398221 0 STILLWELL-BARKER LATONDRA 2016231 9999999 B 10 1245398221 0 611 W PARK ST URBANA IL 618012529 20 1245398221 0 Physician Assistant Only Fluoride varnish 20 1245398221 0 Physician Assistant Only Healthy Kids Services 20 1245398221 0 Physician Assistant Only Physician Services 00 1245398981 0 MCFADDEN LEE A 2015201 9999999 B 10 1245398981 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1245398981 0 Physicians Anesthesia Services 20 1245398981 0 Physicians Healthy Kids Services 20 1245398981 0 Physicians Optical Supplies 20 1245398981 0 Physicians Physician Services 00 1245399898 0 ALLGAIER BERNHARD H 1998274 9999999 B 10 1245399898 0 2740 W FOSTER AVE LL7 CHICAGO IL 606253500 20 1245399898 0 Physicians Anesthesia Services 20 1245399898 0 Physicians Fluoride varnish 20 1245399898 0 Physicians Healthy Kids Services 20 1245399898 0 Physicians Optical Supplies 20 1245399898 0 Physicians Physician Services 00 1245400290 0 SYED MUNEER K 2008061 9999999 B 10 1245400290 0 3030 NW EXPRESSWAY STE 1000 OKLAHOMA CITY OK 731125468 20 1245400290 0 Physicians Anesthesia Services 20 1245400290 0 Physicians Fluoride varnish 20 1245400290 0 Physicians Healthy Kids Services 20 1245400290 0 Physicians Optical Supplies 20 1245400290 0 Physicians Physician Services 00 1245400571 0 DEWITT JOE-LA DANILE 2021076 2099365 B 10 1245400571 0 777 LOWNDES HILL RD BLDG 1 GREENVILLE SC 296072101 20 1245400571 0 Physicians Anesthesia Services 20 1245400571 0 Physicians Healthy Kids Services 20 1245400571 0 Physicians Optical Supplies 20 1245400571 0 Physicians Physician Services 00 1245402080 0 GOWDA CHETAN N 2017224 9999999 B 10 1245402080 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1245402080 0 Physicians All Kids application agent 20 1245402080 0 Physicians Anesthesia Services 20 1245402080 0 Physicians Healthy Kids Services 20 1245402080 0 Physicians Optical Supplies 20 1245402080 0 Physicians Physician Services 00 1245402353 0 TENNANT PAUL A 2022060 9999999 B 10 1245402353 0 PO BOX 3988 CARBONDALE IL 629023988 20 1245402353 0 Physicians Anesthesia Services 20 1245402353 0 Physicians Healthy Kids Services 20 1245402353 0 Physicians Optical Supplies 20 1245402353 0 Physicians Physician Services 00 1245402932 0 CHORVAT KAREN 2008189 9999999 B 10 1245402932 0 28594 NETWORK PL CHICAGO IL 606731285 20 1245402932 0 Physicians Anesthesia Services 20 1245402932 0 Physicians Fluoride varnish 20 1245402932 0 Physicians Healthy Kids Services 20 1245402932 0 Physicians Optical Supplies 20 1245402932 0 Physicians Physician Services 00 1245404656 0 CORDTS CASEY 2021348 9999999 B 10 1245404656 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1245404656 0 Physicians Anesthesia Services 20 1245404656 0 Physicians Fluoride varnish 20 1245404656 0 Physicians Healthy Kids Services 20 1245404656 0 Physicians Optical Supplies 20 1245404656 0 Physicians Physician Services 00 1245404755 0 ALI SYED S 2018213 9999999 B 10 1245404755 0 1315 N HIGHLAND AVE STE 203 AURORA IL 605061460 20 1245404755 0 Physicians Anesthesia Services 20 1245404755 0 Physicians Healthy Kids Services 20 1245404755 0 Physicians Optical Supplies 20 1245404755 0 Physicians Physician Services 00 1245405497 0 ORTEL BERNHARD J 2008232 9999999 B 10 1245405497 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1245405497 0 Physicians Anesthesia Services 20 1245405497 0 Physicians Healthy Kids Services 20 1245405497 0 Physicians Optical Supplies 20 1245405497 0 Physicians Physician Services 00 1245405604 0 COOPER MEGAN A. 2010182 9999999 B 10 1245405604 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1245405604 0 Physicians Anesthesia Services 20 1245405604 0 Physicians Fluoride varnish 20 1245405604 0 Physicians Healthy Kids Services 20 1245405604 0 Physicians Optical Supplies 20 1245405604 0 Physicians Physician Services 00 1245406339 0 KING ERIN E 2023205 9999999 B 10 1245406339 0 6501 S PROMONTORY DR CHICAGO IL 606491003 20 1245406339 0 Physicians Anesthesia Services 20 1245406339 0 Physicians Fluoride varnish 20 1245406339 0 Physicians Healthy Kids Services 20 1245406339 0 Physicians Optical Supplies 20 1245406339 0 Physicians Physician Services 00 1245406453 0 HEIMANN LIZA MARIE O 2022056 9999999 B 10 1245406453 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1245406453 0 Nurse Practitioners Fluoride varnish 20 1245406453 0 Nurse Practitioners Healthy Kids Services 20 1245406453 0 Nurse Practitioners Nurse Practitioners Services 20 1245406453 0 Nurse Practitioners Physician Services 00 1245407592 0 PATERSON RYAN D 2023116 9999999 B 10 1245407592 0 500 ELDORADO BLVD STE 6250 BROOMFIELD CO 800213421 20 1245407592 0 Physicians Anesthesia Services 20 1245407592 0 Physicians Healthy Kids Services 20 1245407592 0 Physicians Optical Supplies 20 1245407592 0 Physicians Physician Services 00 1245409747 0 TANG ELIZABETH A 2016015 9999999 B 10 1245409747 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1245409747 0 Physician Assistant Only Fluoride varnish 20 1245409747 0 Physician Assistant Only Healthy Kids Services 20 1245409747 0 Physician Assistant Only Physician Services 00 1245410638 0 RODENBECK RACHEL 2022099 9999999 B 10 1245410638 0 5121 MARYLAND WAY STE 300 BRENTWOOD TN 370277516 20 1245410638 0 Physician Assistant Only Fluoride varnish 20 1245410638 0 Physician Assistant Only Healthy Kids Services 20 1245410638 0 Physician Assistant Only Physician Services 00 1245410984 0 PHILIP RITA D 2012320 9999999 B 10 1245410984 0 19990 GOVERNORS HWY OLYMPIA FIELDS IL 604611021 20 1245410984 0 Dentists Dental Services 20 1245410984 0 Dentists Physician Services 00 1245411156 0 ROBINSON TRISTA D 2008275 9999999 B 10 1245411156 0 100 FOREST PL APT P36 OAK PARK IL 603011188 20 1245411156 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1245412238 0 KATARIYA NITIN N 2009091 9999999 B 10 1245412238 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1245412238 0 Physicians Anesthesia Services 20 1245412238 0 Physicians Healthy Kids Services 20 1245412238 0 Physicians Optical Supplies 20 1245412238 0 Physicians Physician Services 00 1245413574 0 AVALOS FRANCISCO 2010091 9999999 B 10 1245413574 0 6013 W CERMAK RD CICERO IL 608042018 20 1245413574 0 Physicians Anesthesia Services 20 1245413574 0 Physicians Fluoride varnish 20 1245413574 0 Physicians Healthy Kids Services 20 1245413574 0 Physicians Optical Supplies 20 1245413574 0 Physicians Physician Services 00 1245413707 0 ODEN TARA R 2024362 9999999 B 10 1245413707 0 6300 RIDGLEA PL STE 201 FORT WORTH TX 761165707 20 1245413707 0 Physicians Anesthesia Services 20 1245413707 0 Physicians Healthy Kids Services 20 1245413707 0 Physicians Optical Supplies 20 1245413707 0 Physicians Physician Services 00 1245414432 0 WEISS CURTIS H 2012245 9999999 B 10 1245414432 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1245414432 0 Physicians Anesthesia Services 20 1245414432 0 Physicians Fluoride varnish 20 1245414432 0 Physicians Healthy Kids Services 20 1245414432 0 Physicians Optical Supplies 20 1245414432 0 Physicians Physician Services 00 1245414572 0 RHODES AMY W 2008232 9999999 B 10 1245414572 0 250 N SHADELAND AVE STE 200 INDIANAPOLIS IN 462194959 20 1245414572 0 Physicians Anesthesia Services 20 1245414572 0 Physicians Healthy Kids Services 20 1245414572 0 Physicians Optical Supplies 20 1245414572 0 Physicians Physician Services 00 1245414887 0 REINARMAN CHERYL A 2010305 9999999 B 10 1245414887 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1245414887 0 Nurse Practitioners Healthy Kids Services 20 1245414887 0 Nurse Practitioners Nurse Practitioners Services 20 1245414887 0 Nurse Practitioners Physician Services 00 1245416502 0 SCHNAUTZ LYNN S 2018228 9999999 B 10 1245416502 0 PO BOX 1230 EVANSVILLE IN 477061230 20 1245416502 0 Nurse Practitioners Healthy Kids Services 20 1245416502 0 Nurse Practitioners Nurse Practitioners Services 20 1245416502 0 Nurse Practitioners Physician Services 00 1245417070 0 ABDUL HUSSAIN MAYSA H 2009285 9999999 B 10 1245417070 0 326 W 64TH ST CHICAGO IL 606213114 20 1245417070 0 Physicians Anesthesia Services 20 1245417070 0 Physicians Fluoride varnish 20 1245417070 0 Physicians Healthy Kids Services 20 1245417070 0 Physicians Optical Supplies 20 1245417070 0 Physicians Physician Services 00 1245418508 0 RAKESTRAW AMY L 2022350 9999999 B 10 1245418508 0 PO BOX 1026 INDIANAPOLIS IN 462061026 20 1245418508 0 Physical Therapists Medical Supplies 20 1245418508 0 Physical Therapists Medical equipment/prosthetic devices 20 1245418508 0 Physical Therapists Physical Therapy Services 00 1245419415 0 HERRMAN SARA K 2022236 9999999 B 10 1245419415 0 PO BOX 778912 CHICAGO IL 606778912 20 1245419415 0 Physician Assistant Only Fluoride varnish 20 1245419415 0 Physician Assistant Only Healthy Kids Services 20 1245419415 0 Physician Assistant Only Physician Services 00 1245420116 0 MUSCO JONATHAN 2022194 9999999 B 10 1245420116 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1245420116 0 Physicians Anesthesia Services 20 1245420116 0 Physicians Healthy Kids Services 20 1245420116 0 Physicians Optical Supplies 20 1245420116 0 Physicians Physician Services 00 1245420181 0 AGARWAL VIKAS 2019325 9999999 B 10 1245420181 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1245420181 0 Physicians Anesthesia Services 20 1245420181 0 Physicians Healthy Kids Services 20 1245420181 0 Physicians Optical Supplies 20 1245420181 0 Physicians Physician Services 00 1245422666 0 PUDUSSERI LISA 2014288 9999999 B 10 1245422666 0 5777 DEPT CAROL STREAM IL 601220021 20 1245422666 0 Physicians Anesthesia Services 20 1245422666 0 Physicians Fluoride varnish 20 1245422666 0 Physicians Healthy Kids Services 20 1245422666 0 Physicians Optical Supplies 20 1245422666 0 Physicians Physician Services 00 1245423193 0 CHIANG TENDY 2017079 9999999 B 10 1245423193 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1245423193 0 Physicians Anesthesia Services 20 1245423193 0 Physicians Healthy Kids Services 20 1245423193 0 Physicians Optical Supplies 20 1245423193 0 Physicians Physician Services 00 1245423284 0 LIU LIN 2007182 9999999 B 10 1245423284 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1245423284 0 Physicians Anesthesia Services 20 1245423284 0 Physicians Healthy Kids Services 20 1245423284 0 Physicians Optical Supplies 20 1245423284 0 Physicians Physician Services 00 1245423474 0 TAUKE KIMBERLY A 2009274 9999999 B 10 1245423474 0 8940 N WOOD SAGE RD PEORIA IL 616157822 20 1245423474 0 Nurse Practitioners Fluoride varnish 20 1245423474 0 Nurse Practitioners Healthy Kids Services 20 1245423474 0 Nurse Practitioners Nurse Practitioners Services 20 1245423474 0 Nurse Practitioners Physician Services 00 1245423573 0 GUPTA AMIT KUMAR 2021200 9999999 B 10 1245423573 0 5665 NEW NORTHSIDE DR STE 320 ATLANTA GA 303285834 20 1245423573 0 Physicians Anesthesia Services 20 1245423573 0 Physicians Healthy Kids Services 20 1245423573 0 Physicians Optical Supplies 20 1245423573 0 Physicians Physician Services 00 1245423953 0 VARMA RASHI 2013121 9999999 B 10 1245423953 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1245423953 0 Physicians Anesthesia Services 20 1245423953 0 Physicians Fluoride varnish 20 1245423953 0 Physicians Healthy Kids Services 20 1245423953 0 Physicians Optical Supplies 20 1245423953 0 Physicians Physician Services 00 1245426691 0 MUHAMMAD ARSHI J 2023265 9999999 B 10 1245426691 0 3300 OAKDALE AVE N ROBBINSDALE MN 554222926 20 1245426691 0 Psychologist Psychologist service 00 1245426980 0 BARKATULLAH SAMEER 2008163 9999999 B 10 1245426980 0 PO BOX 713388 CHICAGO IL 606771525 20 1245426980 0 Physicians Anesthesia Services 20 1245426980 0 Physicians Fluoride varnish 20 1245426980 0 Physicians Healthy Kids Services 20 1245426980 0 Physicians Optical Supplies 20 1245426980 0 Physicians Physician Services 00 1245427475 0 WEISSMUELLER JACQUELINE J 2007318 9999999 B 10 1245427475 0 1 STEVENSON DR LINCOLNSHIRE IL 600692824 20 1245427475 0 Speech Therapists Medical Supplies 20 1245427475 0 Speech Therapists Medical equipment/prosthetic devices 20 1245427475 0 Speech Therapists Speech Therapy/Pathology Services 00 1245428184 0 TOENJES ANNE M 2007182 9999999 B 10 1245428184 0 PO BOX 503900 SAINT LOUIS MO 631503900 20 1245428184 0 Nurse Practitioners Fluoride varnish 20 1245428184 0 Nurse Practitioners Healthy Kids Services 20 1245428184 0 Nurse Practitioners Nurse Practitioners Services 20 1245428184 0 Nurse Practitioners Physician Services 00 1245431014 0 SILVER RENA L 2016118 9999999 B 10 1245431014 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1245431014 0 Nurse Practitioners Healthy Kids Services 20 1245431014 0 Nurse Practitioners Nurse Practitioners Services 20 1245431014 0 Nurse Practitioners Physician Services 00 1245431022 0 CRUM JOHN P 2016061 9999999 B 10 1245431022 0 205 OAKLAND AVE CARLINVILLE IL 626261921 20 1245431022 0 Other behavior health professional LCPC/LMFT services 00 1245431105 0 SHIPPEY KELLEY 2023179 9999999 B 10 1245431105 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1245431105 0 Physicians Anesthesia Services 20 1245431105 0 Physicians Fluoride varnish 20 1245431105 0 Physicians Healthy Kids Services 20 1245431105 0 Physicians Optical Supplies 20 1245431105 0 Physicians Physician Services 00 1245431220 0 MCHALE MATTHEW 2021232 9999999 B 10 1245431220 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1245431220 0 Physicians Anesthesia Services 20 1245431220 0 Physicians Healthy Kids Services 20 1245431220 0 Physicians Optical Supplies 20 1245431220 0 Physicians Physician Services 00 1245431246 0 AVILA VICTORIANO 2010307 9999999 B 10 1245431246 0 6218 CERMAK RD BERWYN IL 604022322 20 1245431246 0 Dentists Dental Services 20 1245431246 0 Dentists Physician Services 00 1245431576 0 ROLOFF CHRISTINE 2010182 9999999 B 10 1245431576 0 PO BOX 6685 CAROL STREAM IL 601976685 20 1245431576 0 Physicians Anesthesia Services 20 1245431576 0 Physicians Healthy Kids Services 20 1245431576 0 Physicians Optical Supplies 20 1245431576 0 Physicians Physician Services 00 1245432079 0 WILLIAMS BRADLEY 2007182 9999999 B 10 1245432079 0 PO BOX 631771 CINCINNATI OH 452630139 20 1245432079 0 Physicians Anesthesia Services 20 1245432079 0 Physicians Healthy Kids Services 20 1245432079 0 Physicians Optical Supplies 20 1245432079 0 Physicians Physician Services 00 1245432244 0 COUNCIL MARTHA L 2010182 9999999 B 10 1245432244 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1245432244 0 Physicians Anesthesia Services 20 1245432244 0 Physicians Healthy Kids Services 20 1245432244 0 Physicians Optical Supplies 20 1245432244 0 Physicians Physician Services 00 1245433416 0 GANG GYU I 2017191 9999999 B 10 1245433416 0 5777 DEPT CAROL STREAM IL 601228942 20 1245433416 0 Physicians Anesthesia Services 20 1245433416 0 Physicians Healthy Kids Services 20 1245433416 0 Physicians Optical Supplies 20 1245433416 0 Physicians Physician Services 00 1245433465 0 HODGES JENNIFER 2021103 9999999 B 10 1245433465 0 12605 E 16TH AVE AURORA CO 800452545 20 1245433465 0 Physicians Anesthesia Services 20 1245433465 0 Physicians Healthy Kids Services 20 1245433465 0 Physicians Optical Supplies 20 1245433465 0 Physicians Physician Services 00 1245434851 0 BATISTE ROSEMARIE 2007294 9999999 B 10 1245434851 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1245434851 0 Nurse Practitioners Healthy Kids Services 20 1245434851 0 Nurse Practitioners Nurse Practitioners Services 20 1245434851 0 Nurse Practitioners Physician Services 00 1245434976 0 TURNER KRISTEN M 2017161 9999999 B 10 1245434976 0 PO BOX 100445 ATLANTA GA 303847279 20 1245434976 0 Physicians Anesthesia Services 20 1245434976 0 Physicians Fluoride varnish 20 1245434976 0 Physicians Healthy Kids Services 20 1245434976 0 Physicians Optical Supplies 20 1245434976 0 Physicians Physician Services 00 1245435312 0 VAZQUEZ ELIZABET 2022016 9999999 B 10 1245435312 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1245435312 0 Physicians Anesthesia Services 20 1245435312 0 Physicians Healthy Kids Services 20 1245435312 0 Physicians Optical Supplies 20 1245435312 0 Physicians Physician Services 00 1245435767 0 NG JOSHUA 2024339 9999999 B 10 1245435767 0 29373 NETWORK PL CHICAGO IL 606733039 20 1245435767 0 Physicians Anesthesia Services 20 1245435767 0 Physicians Healthy Kids Services 20 1245435767 0 Physicians Optical Supplies 20 1245435767 0 Physicians Physician Services 00 1245437086 0 AWAD SAWSAN 2007215 9999999 B 10 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STEPHEN D 2013063 9999999 B 10 1245457308 0 24014 W RENWICK RD PLAINFIELD IL 605448708 20 1245457308 0 Physical Therapists Medical Supplies 20 1245457308 0 Physical Therapists Medical equipment/prosthetic devices 20 1245457308 0 Physical Therapists Physical Therapy Services 00 1245458496 0 CHAUDHURY SONALI 2025153 9999999 B 10 1245458496 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1245458496 0 Physicians Anesthesia Services 20 1245458496 0 Physicians Fluoride varnish 20 1245458496 0 Physicians Healthy Kids Services 20 1245458496 0 Physicians Optical Supplies 20 1245458496 0 Physicians Physician Services 00 1245458595 0 YUAN HARRY 2020224 9999999 B 10 1245458595 0 1 ILLINI DR PEORIA IL 616052576 20 1245458595 0 Physicians Anesthesia Services 20 1245458595 0 Physicians Fluoride varnish 20 1245458595 0 Physicians Healthy Kids Services 20 1245458595 0 Physicians Optical Supplies 20 1245458595 0 Physicians Physician Services 00 1245458868 0 RICO-HERRERA LETICIA 2009243 9999999 B 10 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1245496561 0 Physicians Optical Supplies 20 1245496561 0 Physicians Physician Services 00 1245496694 0 BARDEZBANIAN BRYCE J 2009196 9999999 B 10 1245496694 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1245496694 0 Physicians Anesthesia Services 20 1245496694 0 Physicians Healthy Kids Services 20 1245496694 0 Physicians Optical Supplies 20 1245496694 0 Physicians Physician Services 00 1245496736 0 CHIZMAS DIANNA 2022060 9999999 B 10 1245496736 0 PO BOX 43230 PHOENIX AZ 850803230 20 1245496736 0 Nurse Practitioners Fluoride varnish 20 1245496736 0 Nurse Practitioners Healthy Kids Services 20 1245496736 0 Nurse Practitioners Nurse Practitioners Services 20 1245496736 0 Nurse Practitioners Physician Services 00 1245496819 0 COSTELLO HEATHER H 2009182 9999999 B 10 1245496819 0 PO BOX 17633 BELFAST ME 049154071 20 1245496819 0 Physicians Anesthesia Services 20 1245496819 0 Physicians Healthy Kids Services 20 1245496819 0 Physicians Optical Supplies 20 1245496819 0 Physicians Physician Services 00 1245496850 0 PODJASEK JOSHUA O 2014314 9999999 B 10 1245496850 0 8110 CASS AVE DARIEN IL 605615013 20 1245496850 0 Physicians Anesthesia Services 20 1245496850 0 Physicians Healthy Kids Services 20 1245496850 0 Physicians Optical Supplies 20 1245496850 0 Physicians Physician Services 00 1245496868 0 HANNAN JENNIFER L 2025115 9999999 B 10 1245496868 0 3825 HIGHLAND AVE STE 3K DOWNERS GROVE IL 605151549 20 1245496868 0 Physicians Anesthesia Services 20 1245496868 0 Physicians Healthy Kids Services 20 1245496868 0 Physicians Optical Supplies 20 1245496868 0 Physicians Physician Services 00 1245497510 0 KUMAR MUKESH 2014321 9999999 B 10 1245497510 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1245497510 0 Physicians Anesthesia Services 20 1245497510 0 Physicians Fluoride varnish 20 1245497510 0 Physicians Healthy Kids Services 20 1245497510 0 Physicians Optical Supplies 20 1245497510 0 Physicians Physician Services 00 1245498344 0 ARSHAD MEHREEN 2018277 9999999 B 10 1245498344 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1245498344 0 Physicians Anesthesia Services 20 1245498344 0 Physicians Fluoride varnish 20 1245498344 0 Physicians Healthy Kids Services 20 1245498344 0 Physicians Optical Supplies 20 1245498344 0 Physicians Physician Services 00 1245498658 0 SISCO MARK 2009121 9999999 B 10 1245498658 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1245498658 0 Physicians Anesthesia Services 20 1245498658 0 Physicians Healthy Kids Services 20 1245498658 0 Physicians Optical Supplies 20 1245498658 0 Physicians Physician Services 00 1245498906 0 UDDIN IMAD 2024222 9999999 B 10 1245498906 0 1160 E SAINT CLAIR ST VINCENNES IN 475914853 20 1245498906 0 Physicians Anesthesia Services 20 1245498906 0 Physicians Fluoride varnish 20 1245498906 0 Physicians Healthy Kids Services 20 1245498906 0 Physicians Optical Supplies 20 1245498906 0 Physicians Physician Services 00 1245499672 0 PUHER REBECCA 2015237 9999999 B 10 1245499672 0 611 W PARK ST URBANA IL 618012529 20 1245499672 0 Physicians Anesthesia Services 20 1245499672 0 Physicians Fluoride varnish 20 1245499672 0 Physicians Healthy Kids Services 20 1245499672 0 Physicians Optical Supplies 20 1245499672 0 Physicians Physician Services 00 1245499706 0 SIMS JUSTIN B 2015039 9999999 B 10 1245499706 0 250 N SHADELAND AVE STE 200 INDIANAPOLIS IN 462194959 20 1245499706 0 Physicians Anesthesia Services 20 1245499706 0 Physicians Healthy Kids Services 20 1245499706 0 Physicians Optical Supplies 20 1245499706 0 Physicians Physician Services 00 1245503978 0 KRUSE DENA 2022015 9999999 B 10 1245503978 0 901 PATIENTS FIRST DR WASHINGTON MO 630904700 20 1245503978 0 Nurse Practitioners Healthy Kids Services 20 1245503978 0 Nurse Practitioners Nurse Practitioners Services 20 1245503978 0 Nurse Practitioners Physician Services 00 1245504836 0 MORGAN SYLVIA 2012142 9999999 H 10 1245504836 0 3010 GRAND AVE WAUKEGAN IL 600852321 20 1245504836 0 Other behavior health professional Other 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1245507839 0 Physician Assistant Only Healthy Kids Services 20 1245507839 0 Physician Assistant Only Physician Services 00 1245508365 0 TRACY JULIE 2017193 9999999 B 10 1245508365 0 1111 W 14TH PL CHICAGO IL 606082795 20 1245508365 0 Speech Therapists Medical Supplies 20 1245508365 0 Speech Therapists Medical equipment/prosthetic devices 20 1245508365 0 Speech Therapists Speech Therapy/Pathology Services 00 1245508522 0 STONE LORI K 2011339 9999999 B 10 1245508522 0 6742 N FROSTWOOD PKWY PEORIA IL 616152402 20 1245508522 0 Nurse Practitioners Anesthesia Services 20 1245508522 0 Nurse Practitioners Nurse Practitioners Services 20 1245508522 0 Nurse Practitioners Physician Services 00 1245509926 0 TINDALL RACHEL P 2023205 9999999 B 10 1245509926 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1245509926 0 Physicians Anesthesia Services 20 1245509926 0 Physicians Healthy Kids Services 20 1245509926 0 Physicians Optical Supplies 20 1245509926 0 Physicians Physician Services 00 1245511179 0 BADE AMENA 2016005 9999999 B 10 1245511179 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1245511179 0 Clinical Social Worker All Kids application agent 20 1245511179 0 Clinical Social Worker Social work service 00 1245513381 0 DEGROOTE DANIELLE L 2011274 9999999 B 10 1245513381 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1245513381 0 Nurse Practitioners Fluoride varnish 20 1245513381 0 Nurse Practitioners Healthy Kids Services 20 1245513381 0 Nurse Practitioners Nurse Practitioners Services 20 1245513381 0 Nurse Practitioners Physician Services 00 1245514397 0 JACKSON CHRISTINA J 2017317 9999999 B 10 1245514397 0 29373 NETWORK PL CHICAGO IL 606733039 20 1245514397 0 Nurse Practitioners Healthy Kids Services 20 1245514397 0 Nurse Practitioners Nurse Practitioners Services 20 1245514397 0 Nurse Practitioners Physician Services 00 1245515295 0 GIBBONS JESSE 2022341 9999999 B 10 1245515295 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1245515295 0 Physician Assistant Only Fluoride 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0 Physicians Anesthesia Services 20 1245519487 0 Physicians Fluoride varnish 20 1245519487 0 Physicians Healthy Kids Services 20 1245519487 0 Physicians Optical Supplies 20 1245519487 0 Physicians Physician Services 00 1245520246 0 STILES-SHIELDS ELIZABETH C 2019152 9999999 B 10 1245520246 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1245520246 0 Psychologist Psychologist service 00 1245520279 0 LINDHOLM ERIN 2022051 9999999 B 10 1245520279 0 246 OAKHURST CIR KISSIMMEE FL 347444752 20 1245520279 0 Physicians Anesthesia Services 20 1245520279 0 Physicians Fluoride varnish 20 1245520279 0 Physicians Healthy Kids Services 20 1245520279 0 Physicians Optical Supplies 20 1245520279 0 Physicians Physician Services 00 1245520410 0 HINZ ERICA 2017223 9999999 B 10 1245520410 0 17 N STATE ST STE 500 CHICAGO IL 606023384 20 1245520410 0 Physicians Anesthesia Services 20 1245520410 0 Physicians Family Planning Counseling 20 1245520410 0 Physicians Healthy Kids Services 20 1245520410 0 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1245521442 0 Physicians Physician Services 00 1245523216 0 CRAIG ELIZABETH V 2018134 9999999 B 10 1245523216 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1245523216 0 Physicians Anesthesia Services 20 1245523216 0 Physicians Healthy Kids Services 20 1245523216 0 Physicians Optical Supplies 20 1245523216 0 Physicians Physician Services 00 1245523380 0 NELSON RACHEL M 2024242 9999999 B 10 1245523380 0 PO BOX 857 FREEPORT IL 610320857 20 1245523380 0 Physicians Anesthesia Services 20 1245523380 0 Physicians Healthy Kids Services 20 1245523380 0 Physicians Optical Supplies 20 1245523380 0 Physicians Physician Services 00 1245523968 0 TORRES EUNICE 2018345 9999999 B 10 1245523968 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1245523968 0 Physicians Anesthesia Services 20 1245523968 0 Physicians Fluoride varnish 20 1245523968 0 Physicians Healthy Kids Services 20 1245523968 0 Physicians Optical Supplies 20 1245523968 0 Physicians Physician Services 00 1245524404 0 HAZEGHAZAM MARYAM HELEN 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2019189 9999999 B 10 1245525930 0 1 ILLINI DR PEORIA IL 616052576 20 1245525930 0 Physicians Anesthesia Services 20 1245525930 0 Physicians Healthy Kids Services 20 1245525930 0 Physicians Optical Supplies 20 1245525930 0 Physicians Physician Services 00 1245526250 0 CENEK PETER 2013335 9999999 B 10 1245526250 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1245526250 0 Nurse Practitioners Fluoride varnish 20 1245526250 0 Nurse Practitioners Healthy Kids Services 20 1245526250 0 Nurse Practitioners Nurse Practitioners Services 20 1245526250 0 Nurse Practitioners Physician Services 00 1245526268 0 DOMINGO CARMINA 2022145 9999999 B 10 1245526268 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1245526268 0 Physicians Anesthesia Services 20 1245526268 0 Physicians Healthy Kids Services 20 1245526268 0 Physicians Optical Supplies 20 1245526268 0 Physicians Physician Services 20 1245526268 0 Physicians Physicians Psychiatric Services 00 1245526334 0 LANG JOANNA 2021356 9999999 B 10 1245526334 0 335 E MAHN CT OAK CREEK WI 531542155 20 1245526334 0 Physician Assistant Only Fluoride varnish 20 1245526334 0 Physician Assistant Only Healthy Kids Services 20 1245526334 0 Physician Assistant Only Physician Services 00 1245526482 0 SHARMA SUNNY 2014244 9999999 B 10 1245526482 0 PO BOX 5588 BELFAST ME 049155500 20 1245526482 0 Physicians Anesthesia Services 20 1245526482 0 Physicians Fluoride varnish 20 1245526482 0 Physicians Healthy Kids Services 20 1245526482 0 Physicians Optical Supplies 20 1245526482 0 Physicians Physician Services 00 1245527142 0 DENTON COLE 2017152 9999999 B 10 1245527142 0 220 COMPASS POINT DR SAINT CHARLES MO 633014405 20 1245527142 0 Physicians Anesthesia Services 20 1245527142 0 Physicians Healthy Kids Services 20 1245527142 0 Physicians Optical Supplies 20 1245527142 0 Physicians Physician Services 00 1245527563 0 HILL-CIESIELSKI MEREDITH LYNNE 2015182 9999999 B 10 1245527563 0 1201 RICKER RD SALEM IL 628814263 20 1245527563 0 Physicians Anesthesia 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20 1245528058 0 Nurse Practitioners Healthy Kids Services 20 1245528058 0 Nurse Practitioners Midwife Services 20 1245528058 0 Nurse Practitioners Nurse Practitioners Services 20 1245528058 0 Nurse Practitioners Physician Services 00 1245528140 0 PATEL NIKULKUMAR 2014274 9999999 B 10 1245528140 0 329 W 18TH ST STE 311 CHICAGO IL 606165132 20 1245528140 0 Optometrists Optical Supplies 20 1245528140 0 Optometrists Optometric Services 20 1245528140 0 Optometrists Physician Services 00 1245528199 0 GARLAPATI SREE 2011182 9999999 B 10 1245528199 0 360 W CHRYSLER DR BELVIDERE IL 610086001 20 1245528199 0 Dentists Dental Services 20 1245528199 0 Dentists Physician Services 00 1245528777 0 SINGH HARKIRAT 2020057 9999999 B 10 1245528777 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1245528777 0 Physicians Anesthesia Services 20 1245528777 0 Physicians Fluoride varnish 20 1245528777 0 Physicians Healthy Kids Services 20 1245528777 0 Physicians Optical Supplies 20 1245528777 0 Physicians Physician 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Practitioners Nurse Practitioners Services 20 1245839323 0 Nurse Practitioners Physician Services 00 1245839364 0 LAWLOR CHRISTINE B 2020309 9999999 B 10 1245839364 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1245839364 0 Nurse Practitioners Healthy Kids Services 20 1245839364 0 Nurse Practitioners Nurse Practitioners Services 20 1245839364 0 Nurse Practitioners Physician Services 00 1245840636 0 EDWARDS BRANDON 2021111 9999999 B 10 1245840636 0 PO BOX 34266 BELFAST ME 049150620 20 1245840636 0 Nurse Practitioners Fluoride varnish 20 1245840636 0 Nurse Practitioners Healthy Kids Services 20 1245840636 0 Nurse Practitioners Nurse Practitioners Services 20 1245840636 0 Nurse Practitioners Physician Services 00 1245841238 0 MCMAKEN STEPHANIE 2021327 9999999 B 10 1245841238 0 124 SW ADAMS ST PEORIA IL 616021308 20 1245841238 0 Nurse Practitioners Fluoride varnish 20 1245841238 0 Nurse Practitioners Healthy Kids Services 20 1245841238 0 Nurse Practitioners Nurse Practitioners Services 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Practitioners Services 20 1245845114 0 Nurse Practitioners Physician Services 00 1245846211 0 ADAMS MORGAN 2024124 9999999 B 10 1245846211 0 5777 DEPT CAROL STREAM IL 601220021 20 1245846211 0 Nurse Practitioners Anesthesia Services 20 1245846211 0 Nurse Practitioners Nurse Practitioners Services 20 1245846211 0 Nurse Practitioners Physician Services 00 1245846989 0 CARL SUSAN M 2021230 9999999 B 10 1245846989 0 PO BOX 5022 PEORIA IL 616015022 20 1245846989 0 Nurse Practitioners Fluoride varnish 20 1245846989 0 Nurse Practitioners Healthy Kids Services 20 1245846989 0 Nurse Practitioners Nurse Practitioners Services 20 1245846989 0 Nurse Practitioners Physician Services 00 1245847276 0 NGUYEN MAI-LINH T 2021263 9999999 B 10 1245847276 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1245847276 0 Nurse Practitioners Fluoride varnish 20 1245847276 0 Nurse Practitioners Healthy Kids Services 20 1245847276 0 Nurse Practitioners Nurse Practitioners Services 20 1245847276 0 Nurse Practitioners Physician Services 00 1245847359 0 HASTINGS SHARIECE I 2021281 9999999 B 10 1245847359 0 904 E CINDY ST CARBONDALE IL 629013318 20 1245847359 0 Other behavior health professional LCPC/LMFT services 00 1245847656 0 GONZALEZ SUSIE A 2023009 9999999 B 10 1245847656 0 PO BOX 500 ELLICOTTVILLE NY 147310500 20 1245847656 0 Nurse Practitioners Fluoride varnish 20 1245847656 0 Nurse Practitioners Healthy Kids Services 20 1245847656 0 Nurse Practitioners Nurse Practitioners Services 20 1245847656 0 Nurse Practitioners Physician Services 00 1245847722 0 ANDERSON WENDEE 2024071 9999999 B 10 1245847722 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1245847722 0 Clinical Social Worker Social work service 00 1245850163 0 ROBINSON JULIEANN 2021088 9999999 B 10 1245850163 0 5230 S 6TH STREET RD BUSINESS OFFICE SPRINGFIELD IL 627035128 20 1245850163 0 Clinical Social Worker Social work service 00 1245850411 0 RIGSBY MORGAN D 2022195 9999999 B 10 1245850411 0 2050 E ALGONQUIN RD STE 610 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Therapists Medical Supplies 20 1245857333 0 Physical Therapists Medical equipment/prosthetic devices 20 1245857333 0 Physical Therapists Physical Therapy Services 00 1245857408 0 KNUPP JACOB 2024199 9999999 B 10 1245857408 0 3249 OAK PARK AVE BERWYN IL 604023429 20 1245857408 0 Physicians Anesthesia Services 20 1245857408 0 Physicians Fluoride varnish 20 1245857408 0 Physicians Healthy Kids Services 20 1245857408 0 Physicians Optical Supplies 20 1245857408 0 Physicians Physician Services 00 1245857762 0 FRISSORA KELLIE D 2020195 9999999 B 10 1245857762 0 2003 W FULTON ST STE 303 CHICAGO IL 606122345 20 1245857762 0 Nurse Practitioners Fluoride varnish 20 1245857762 0 Nurse Practitioners Healthy Kids Services 20 1245857762 0 Nurse Practitioners Nurse Practitioners Services 20 1245857762 0 Nurse Practitioners Physician Services 00 1245857796 0 FITCH HEATHER D 2020212 9999999 B 10 1245857796 0 PO BOX 778912 CHICAGO IL 606778912 20 1245857796 0 Nurse Practitioners Healthy Kids Services 20 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varnish 20 1245887728 0 Physicians Healthy Kids Services 20 1245887728 0 Physicians Optical Supplies 20 1245887728 0 Physicians Physician Services 00 1245889500 0 HALBROOKS LISA 2019267 9999999 B 10 1245889500 0 PO BOX 146 WATERLOO IL 622980146 20 1245889500 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1245890946 0 HANKINS ANNA 2023251 9999999 B 10 1245890946 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1245890946 0 Nurse Practitioners Healthy Kids Services 20 1245890946 0 Nurse Practitioners Midwife Services 20 1245890946 0 Nurse Practitioners Nurse Practitioners Services 20 1245890946 0 Nurse Practitioners Physician Services 00 1245891068 0 BAILEY JAMES R 2019196 9999999 B 10 1245891068 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1245891068 0 Physicians Anesthesia Services 20 1245891068 0 Physicians Healthy Kids Services 20 1245891068 0 Physicians Optical Supplies 20 1245891068 0 Physicians Physician Services 00 1245891613 0 ELUE JOHN 2020009 9999999 B 10 1245891613 0 5635 S ARCHER AVE CHICAGO IL 606381673 20 1245891613 0 Physicians Anesthesia Services 20 1245891613 0 Physicians Healthy Kids Services 20 1245891613 0 Physicians Optical Supplies 20 1245891613 0 Physicians Physician Services 00 1245891894 0 MUHAMAD ASEEL 2022266 9999999 B 10 1245891894 0 6024 RIDGE AVE STE 116-356 PHILADELPHIA PA 191281601 20 1245891894 0 Physician Assistant Only Fluoride varnish 20 1245891894 0 Physician Assistant Only Healthy Kids Services 20 1245891894 0 Physician Assistant Only Physician Services 00 1245892165 0 SYED YAHIYA 2022182 9999999 B 10 1245892165 0 5665 NEW NORTHSIDE DR STE 320 ATLANTA GA 303285834 20 1245892165 0 Physicians Anesthesia Services 20 1245892165 0 Physicians Fluoride varnish 20 1245892165 0 Physicians Healthy Kids Services 20 1245892165 0 Physicians Optical Supplies 20 1245892165 0 Physicians Physician Services 00 1245893049 0 TRINH SEAN QUOC RAO 2024155 9999999 B 10 1245893049 0 PO BOX 632281 CINCINNATI OH 452632281 20 1245893049 0 Physicians Anesthesia Services 20 1245893049 0 Physicians Fluoride varnish 20 1245893049 0 Physicians Healthy Kids Services 20 1245893049 0 Physicians Optical Supplies 20 1245893049 0 Physicians Physician Services 00 1245894054 0 LENO IRYNA 2019121 9999999 B 10 1245894054 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1245894054 0 Nurse Practitioners Healthy Kids Services 20 1245894054 0 Nurse Practitioners Nurse Practitioners Services 20 1245894054 0 Nurse Practitioners Physician Services 00 1245895325 0 BECKER JACOB 2019182 9999999 B 10 1245895325 0 515 22ND AVE MONROE WI 535661569 20 1245895325 0 Physicians Anesthesia Services 20 1245895325 0 Physicians Fluoride varnish 20 1245895325 0 Physicians Healthy Kids Services 20 1245895325 0 Physicians Optical Supplies 20 1245895325 0 Physicians Physician Services 00 1245895507 0 WALTON JOHN C 2021174 9999999 B 10 1245895507 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1245895507 0 Physicians Anesthesia Services 20 1245895507 0 Physicians Fluoride varnish 20 1245895507 0 Physicians Healthy Kids Services 20 1245895507 0 Physicians Optical Supplies 20 1245895507 0 Physicians Physician Services 00 1245896646 0 CUMMINGS HILLARY D 2019164 9999999 B 10 1245896646 0 5777 DEPT CAROL STREAM IL 601220021 20 1245896646 0 Physical Therapists Medical Supplies 20 1245896646 0 Physical Therapists Medical equipment/prosthetic devices 20 1245896646 0 Physical Therapists Physical Therapy Services 00 1245896893 0 SMITH KATINA 2023150 9999999 B 10 1245896893 0 1836 LACKLAND HILL PKWY SAINT LOUIS MO 631463572 20 1245896893 0 Nurse Practitioners Healthy Kids Services 20 1245896893 0 Nurse Practitioners Nurse Practitioners Services 20 1245896893 0 Nurse Practitioners Physician Services 00 1245897255 0 DAMHOFF HAYLIE A 2019026 9999999 B 10 1245897255 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1245897255 0 Nurse Practitioners Fluoride varnish 20 1245897255 0 Nurse Practitioners Healthy Kids Services 20 1245897255 0 Nurse Practitioners Nurse Practitioners Services 20 1245897255 0 Nurse Practitioners Physician Services 00 1245898311 0 ABELLANOSA ORVILLE 2019276 9999999 B 10 1245898311 0 101 E STATE ST KENNETT SQ PA 193483109 20 1245898311 0 Physical Therapists Medical Supplies 20 1245898311 0 Physical Therapists Medical equipment/prosthetic devices 20 1245898311 0 Physical Therapists Physical Therapy Services 00 1245899715 0 SHEN ISABEL 2019234 9999999 B 10 1245899715 0 5777 DEPT CAROL STREAM IL 601220021 20 1245899715 0 Physician Assistant Only Fluoride varnish 20 1245899715 0 Physician Assistant Only Healthy Kids Services 20 1245899715 0 Physician Assistant Only Physician Services 00 1245903467 0 DOUGLAS MEGAN 2021210 9999999 B 10 1245903467 0 6501 S PROMONTORY DR CHICAGO IL 606491003 20 1245903467 0 Physical Therapists Medical Supplies 20 1245903467 0 Physical Therapists Medical equipment/prosthetic devices 20 1245903467 0 Physical Therapists Physical Therapy Services 00 1245904135 0 ALEXANDRIA LEANN 2021313 9999999 H 10 1245904135 0 967 MCKNIGHT CIR APT 4 ROCKFORD IL 61107 20 1245904135 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1245904267 0 BALAGULSKA NATALIA 2022119 9999999 B 10 1245904267 0 715 LAKE ST STE 800 OAK PARK IL 603011417 20 1245904267 0 Other behavior health professional LCPC/LMFT services 20 1245904267 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1245904986 0 MIDDLETON ALEXIS 2021226 9999999 B 10 1245904986 0 201 W MULBERRY ST CHATHAM IL 626291329 20 1245904986 0 Speech Therapists Medical Supplies 20 1245904986 0 Speech Therapists Medical equipment/prosthetic devices 20 1245904986 0 Speech Therapists Speech Therapy/Pathology Services 00 1245905249 0 FOX RYAN 2021287 9999999 B 10 1245905249 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1245905249 0 Nurse Practitioners Anesthesia Services 20 1245905249 0 Nurse Practitioners Nurse Practitioners Services 20 1245905249 0 Nurse Practitioners Physician Services 00 1245905900 0 SCHICK PAUL 2021229 9999999 B 10 1245905900 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1245905900 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1245907906 0 GLAVAN KARA 2022326 9999999 B 10 1245907906 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1245907906 0 Physical Therapists Medical Supplies 20 1245907906 0 Physical Therapists Medical equipment/prosthetic devices 20 1245907906 0 Physical Therapists Physical Therapy Services 00 1245912385 0 TOZER ERICA JO 2023228 9999999 B 10 1245912385 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1245912385 0 Registered nurse Nursing service 20 1245912385 0 Registered nurse Waiver service 00 1245916329 0 POLECHONSKI NATALIE 2023193 9999999 B 10 1245916329 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1245916329 0 Physicians Anesthesia Services 20 1245916329 0 Physicians Healthy Kids Services 20 1245916329 0 Physicians Optical Supplies 20 1245916329 0 Physicians Physician Services 20 1245916329 0 Physicians Physicians Psychiatric Services 00 1245919257 0 MONTALTO NOAH 2024087 9999999 B 10 1245919257 0 9649 W 55TH ST COUNTRYSIDE IL 605253632 20 1245919257 0 Physical Therapists Medical Supplies 20 1245919257 0 Physical Therapists Medical equipment/prosthetic devices 20 1245919257 0 Physical Therapists Physical Therapy Services 00 1245921535 0 VISSCHER VICTORIA 2023156 9999999 B 10 1245921535 0 1701 E WOODFIELD RD STE 905 SCHAUMBURG IL 601735137 20 1245921535 0 Psychologist Psychologist service 00 1245924414 0 TATE-JULU NANCY 2023184 9999999 B 10 1245924414 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1245924414 0 Nurse Practitioners Healthy Kids Services 20 1245924414 0 Nurse Practitioners Nurse Practitioners Services 20 1245924414 0 Nurse Practitioners Physician Services 00 1245925049 0 BOZEK WEBBER VERONIKA A 2023297 9999999 B 10 1245925049 0 124 SW ADAMS ST PEORIA IL 616021308 20 1245925049 0 Physicians Anesthesia Services 20 1245925049 0 Physicians Healthy Kids Services 20 1245925049 0 Physicians Optical Supplies 20 1245925049 0 Physicians Physician Services 00 1245925429 0 GONZALEZ TAPIA EVELYN 2023256 9999999 B 10 1245925429 0 PO BOX 775253 CHICAGO IL 606775253 20 1245925429 0 Nurse Practitioners Fluoride varnish 20 1245925429 0 Nurse Practitioners Healthy Kids Services 20 1245925429 0 Nurse Practitioners Nurse Practitioners Services 20 1245925429 0 Nurse Practitioners Physician Services 00 1245926237 0 BOKHARI SYED A 2023263 9999999 B 10 1245926237 0 PO BOX 3039 OAK BROOK IL 605223039 20 1245926237 0 Physicians Anesthesia Services 20 1245926237 0 Physicians Fluoride varnish 20 1245926237 0 Physicians Healthy Kids Services 20 1245926237 0 Physicians Optical Supplies 20 1245926237 0 Physicians Physician Services 00 1245928126 0 ALVAREZ FLORIMON CARLOS 2023182 9999999 B 10 1245928126 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1245928126 0 Physicians Anesthesia Services 20 1245928126 0 Physicians Fluoride varnish 20 1245928126 0 Physicians Healthy Kids Services 20 1245928126 0 Physicians Optical Supplies 20 1245928126 0 Physicians Physician Services 00 1245928142 0 AL HAYALI ZUBAIDAH 2024134 9999999 B 10 1245928142 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1245928142 0 Physician Assistant Only Fluoride varnish 20 1245928142 0 Physician Assistant Only Healthy Kids Services 20 1245928142 0 Physician Assistant Only Physician Services 00 1245928589 0 SMITH CHANEL 2023283 9999999 B 10 1245928589 0 350 N WALL ST KANKAKEE IL 609012901 20 1245928589 0 Nurse Practitioners Fluoride varnish 20 1245928589 0 Nurse Practitioners Healthy Kids Services 20 1245928589 0 Nurse Practitioners Nurse Practitioners Services 20 1245928589 0 Nurse Practitioners Physician Services 00 1245928829 0 HARTER CAMERON A 2023137 9999999 B 10 1245928829 0 150 HARVESTER DR STE 300 BURR RIDGE IL 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0 Physicians Healthy Kids Services 20 1245932466 0 Physicians Optical Supplies 20 1245932466 0 Physicians Physician Services 00 1245933217 0 KIM JEANA 2023192 9999999 B 10 1245933217 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1245933217 0 Physicians Anesthesia Services 20 1245933217 0 Physicians Healthy Kids Services 20 1245933217 0 Physicians Optical Supplies 20 1245933217 0 Physicians Physician Services 00 1245936509 0 KRAMER ASHLEE 2023054 9999999 B 10 1245936509 0 4701 DEPT CAROL STREAM IL 601220021 20 1245936509 0 Nurse Practitioners Healthy Kids Services 20 1245936509 0 Nurse Practitioners Nurse Practitioners Services 20 1245936509 0 Nurse Practitioners Physician Services 00 1245937366 0 SUMAGUI ABEGAIL B 2023094 9999999 B 10 1245937366 0 120 S LA SALLE ST STE 1410 CHICAGO IL 606033579 20 1245937366 0 Physician Assistant Only Fluoride varnish 20 1245937366 0 Physician Assistant Only Healthy Kids Services 20 1245937366 0 Physician Assistant Only Physician Services 00 1245938125 0 TAYLOR JOSEPH 2023066 9999999 B 10 1245938125 0 1824 TOUBY PIKE STE B KOKOMO IN 469012573 20 1245938125 0 Other behavior health professional Adaptive behavior support technician services 20 1245938125 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1245938596 0 ZERTLER FAUSTINA MARGARET 2024005 9999999 B 10 1245938596 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1245938596 0 Physician Assistant Only Fluoride varnish 20 1245938596 0 Physician Assistant Only Healthy Kids Services 20 1245938596 0 Physician Assistant Only Physician Services 00 1245940170 0 KYLE LORI 2023011 9999999 B 10 1245940170 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1245940170 0 Clinical Social Worker Social work service 00 1245944198 0 LARA ERIC 2023346 9999999 B 10 1245944198 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1245944198 0 Nurse Practitioners Fluoride varnish 20 1245944198 0 Nurse Practitioners Healthy Kids 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CATALANO SONDRA 2023349 9999999 B 10 1245951227 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1245951227 0 Physician Assistant Only Fluoride varnish 20 1245951227 0 Physician Assistant Only Healthy Kids Services 20 1245951227 0 Physician Assistant Only Physician Services 00 1245952191 0 PAYNE SCOTT M 2022287 9999999 H 10 1245952191 0 111 BUCKLIN ST STE 1 LA SALLE IL 613012382 20 1245952191 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1245953223 0 TORRES JESUS 2022276 9999999 B 10 1245953223 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1245953223 0 Physical Therapists Medical Supplies 20 1245953223 0 Physical Therapists Medical equipment/prosthetic devices 20 1245953223 0 Physical Therapists Physical Therapy Services 00 1245953371 0 BROWN ADAM 2022284 9999999 B 10 1245953371 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1245953371 0 Nurse Practitioners Fluoride varnish 20 1245953371 0 Nurse Practitioners Healthy Kids 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20 1245953967 0 Physician Assistant Only Physician Services 00 1245954767 0 RAJU APOORVA 2022346 9999999 B 10 1245954767 0 611 W PARK ST URBANA IL 618012529 20 1245954767 0 Physicians Anesthesia Services 20 1245954767 0 Physicians Fluoride varnish 20 1245954767 0 Physicians Healthy Kids Services 20 1245954767 0 Physicians Optical Supplies 20 1245954767 0 Physicians Physician Services 00 1245954783 0 HUNZIKER BRIDGETT 2022272 9999999 B 10 1245954783 0 2043 W BELMONT AVE STE 1 CHICAGO IL 606186796 20 1245954783 0 Physical Therapists Medical Supplies 20 1245954783 0 Physical Therapists Medical equipment/prosthetic devices 20 1245954783 0 Physical Therapists Physical Therapy Services 00 1245957117 0 STEELE GINGER 2022297 9999999 B 10 1245957117 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1245957117 0 Occupational Therapists Medical Supplies 20 1245957117 0 Occupational Therapists Medical equipment/prosthetic devices 20 1245957117 0 Occupational Therapists Occupational Therapy Services 00 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1245959717 0 Nurse Practitioners Nurse Practitioners Services 20 1245959717 0 Nurse Practitioners Physician Services 00 1245959774 0 HASHI SAMIRA 2024306 9999999 B 10 1245959774 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1245959774 0 Nurse Practitioners Anesthesia Services 20 1245959774 0 Nurse Practitioners Nurse Practitioners Services 20 1245959774 0 Nurse Practitioners Physician Services 00 1245961176 0 KHAN FARYAL 2022236 9999999 B 10 1245961176 0 190 E DELAWARE PL CHICAGO IL 606111813 20 1245961176 0 Physicians Anesthesia Services 20 1245961176 0 Physicians Fluoride varnish 20 1245961176 0 Physicians Healthy Kids Services 20 1245961176 0 Physicians Optical Supplies 20 1245961176 0 Physicians Physician Services 00 1245961507 0 DUNDAR CABBAR 2022193 9999999 B 10 1245961507 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1245961507 0 Physicians Anesthesia Services 20 1245961507 0 Physicians Healthy Kids Services 20 1245961507 0 Physicians Optical Supplies 20 1245961507 0 Physicians Physician Services 20 1245961507 0 Physicians Physicians Psychiatric Services 00 1245961606 0 GENISIO ANTONIA J 2022237 9999999 B 10 1245961606 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1245961606 0 Other behavior health professional LCPC/LMFT services 20 1245961606 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1245962794 0 STURMWIND RONIT S 2022238 9999999 B 10 1245962794 0 29373 NETWORK PL CHICAGO IL 606733039 20 1245962794 0 Nurse Practitioners Fluoride varnish 20 1245962794 0 Nurse Practitioners Healthy Kids Services 20 1245962794 0 Nurse Practitioners Nurse Practitioners Services 20 1245962794 0 Nurse Practitioners Physician Services 00 1245963446 0 KRIPPINGER RACHEL 2022187 9999999 B 10 1245963446 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1245963446 0 Physical Therapists Medical Supplies 20 1245963446 0 Physical Therapists Medical equipment/prosthetic devices 20 1245963446 0 Physical Therapists Physical Therapy Services 00 1245963628 0 BOSNJAK EMRA 2022188 9999999 B 10 1245963628 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1245963628 0 Physicians Anesthesia Services 20 1245963628 0 Physicians Fluoride varnish 20 1245963628 0 Physicians Healthy Kids Services 20 1245963628 0 Physicians Optical Supplies 20 1245963628 0 Physicians Physician Services 00 1245968403 0 CROSS JAMES G 2023191 9999999 B 10 1245968403 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1245968403 0 Physicians Anesthesia Services 20 1245968403 0 Physicians Healthy Kids Services 20 1245968403 0 Physicians Optical Supplies 20 1245968403 0 Physicians Physician Services 20 1245968403 0 Physicians Physicians Psychiatric Services 00 1245969013 0 WELLER KATHERINE G 2022209 9999999 B 10 1245969013 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1245969013 0 Physicians Anesthesia Services 20 1245969013 0 Physicians Healthy Kids Services 20 1245969013 0 Physicians Optical Supplies 20 1245969013 0 Physicians Physician Services 00 1245970300 0 OMONI PETER 2023221 9999999 B 10 1245970300 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1245970300 0 Nurse Practitioners Anesthesia Services 20 1245970300 0 Nurse Practitioners Nurse Practitioners Services 20 1245970300 0 Nurse Practitioners Physician Services 00 1245970995 0 LE STEVEN 2023187 9999999 B 10 1245970995 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1245970995 0 Physicians Anesthesia Services 20 1245970995 0 Physicians Healthy Kids Services 20 1245970995 0 Physicians Optical Supplies 20 1245970995 0 Physicians Physician Services 00 1245971563 0 JARDALY ACHRAF H 2022173 9999999 B 10 1245971563 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1245971563 0 Physicians Anesthesia Services 20 1245971563 0 Physicians Healthy Kids Services 20 1245971563 0 Physicians Optical Supplies 20 1245971563 0 Physicians Physician Services 00 1245971654 0 XIE VICTORIA 2023197 9999999 B 10 1245971654 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1245971654 0 Physicians Anesthesia Services 20 1245971654 0 Physicians Healthy Kids Services 20 1245971654 0 Physicians Optical Supplies 20 1245971654 0 Physicians Physician Services 00 1245971993 0 OBASEKI EBUWA 2022242 9999999 B 10 1245971993 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1245971993 0 Physicians Anesthesia Services 20 1245971993 0 Physicians Fluoride varnish 20 1245971993 0 Physicians Healthy Kids Services 20 1245971993 0 Physicians Optical Supplies 20 1245971993 0 Physicians Physician Services 00 1245972645 0 GUSTAFSON LISA 2023075 9999999 B 10 1245972645 0 PO BOX 5588 BELFAST ME 049155500 20 1245972645 0 Physicians Anesthesia Services 20 1245972645 0 Physicians Healthy Kids Services 20 1245972645 0 Physicians Optical Supplies 20 1245972645 0 Physicians Physician Services 00 1245972843 0 ZAFRED MARCELINO ANTONIO 2022103 9999999 B 10 1245972843 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1245972843 0 Physicians Anesthesia Services 20 1245972843 0 Physicians Healthy Kids Services 20 1245972843 0 Physicians Optical Supplies 20 1245972843 0 Physicians Physician Services 00 1245974583 0 KURUPPATH MARIA J 2022140 9999999 B 10 1245974583 0 2601 NAVISTAR DR LISLE IL 605323661 20 1245974583 0 Physicians Anesthesia Services 20 1245974583 0 Physicians Fluoride varnish 20 1245974583 0 Physicians Healthy Kids Services 20 1245974583 0 Physicians Optical Supplies 20 1245974583 0 Physicians Physician Services 00 1245974955 0 DUPONT GABRIELLA 2022182 9999999 B 10 1245974955 0 PO BOX 809616 CHICAGO IL 606808802 20 1245974955 0 Physicians Anesthesia Services 20 1245974955 0 Physicians Healthy Kids Services 20 1245974955 0 Physicians Optical Supplies 20 1245974955 0 Physicians Physician Services 00 1245975267 0 OCHOA FABIOLA 2022306 9999999 B 10 1245975267 0 1400 W GREENLEAF AVE CHICAGO IL 606262805 20 1245975267 0 Clinical Social Worker Social work service 00 1245975333 0 WILSON JENNIFER 2022180 9999999 B 10 1245975333 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1245975333 0 Physicians Anesthesia Services 20 1245975333 0 Physicians Fluoride varnish 20 1245975333 0 Physicians Healthy Kids Services 20 1245975333 0 Physicians Optical Supplies 20 1245975333 0 Physicians Physician Services 00 1245975572 0 NWAUDO DARLINGTON 2022182 9999999 B 10 1245975572 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1245975572 0 Physicians Anesthesia Services 20 1245975572 0 Physicians Healthy Kids Services 20 1245975572 0 Physicians Optical Supplies 20 1245975572 0 Physicians Physician Services 00 1245975762 0 KIM SEOYEON 2022175 9999999 B 10 1245975762 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1245975762 0 Physicians Anesthesia Services 20 1245975762 0 Physicians Fluoride varnish 20 1245975762 0 Physicians Healthy Kids Services 20 1245975762 0 Physicians Optical Supplies 20 1245975762 0 Physicians Physician Services 00 1245975853 0 O'NEILL MICHAELA 2022175 9999999 B 10 1245975853 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1245975853 0 Physicians Anesthesia Services 20 1245975853 0 Physicians Fluoride varnish 20 1245975853 0 Physicians Healthy Kids Services 20 1245975853 0 Physicians Optical Supplies 20 1245975853 0 Physicians Physician Services 00 1245975994 0 TOMIC RENALDA 2022186 9999999 B 10 1245975994 0 PO BOX 775253 CHICAGO IL 606775253 20 1245975994 0 Nurse Practitioners Fluoride varnish 20 1245975994 0 Nurse Practitioners Healthy Kids Services 20 1245975994 0 Nurse Practitioners Nurse Practitioners Services 20 1245975994 0 Nurse Practitioners Physician Services 00 1245977040 0 WUELLNER HANNAH 2022228 9999999 B 10 1245977040 0 621 S NEW BALLAS RD STE 228A SAINT LOUIS MO 631418256 20 1245977040 0 Nurse Practitioners Healthy Kids Services 20 1245977040 0 Nurse Practitioners Nurse Practitioners Services 20 1245977040 0 Nurse Practitioners Physician Services 00 1245977461 0 HAMMERSTAD JASMINE 2022206 9999999 B 10 1245977461 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1245977461 0 Physician Assistant Only Fluoride varnish 20 1245977461 0 Physician Assistant Only Healthy Kids Services 20 1245977461 0 Physician Assistant Only Physician Services 00 1245978097 0 LAURASH EMMA P 2024030 9999999 B 10 1245978097 0 5777 DEPT CAROL STREAM IL 601220021 20 1245978097 0 Speech Therapists Medical Supplies 20 1245978097 0 Speech Therapists Medical equipment/prosthetic devices 20 1245978097 0 Speech Therapists Speech Therapy/Pathology Services 00 1245978915 0 MATUSIAK DIANA 2022255 9999999 B 10 1245978915 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1245978915 0 Nurse Practitioners Fluoride varnish 20 1245978915 0 Nurse Practitioners Healthy Kids Services 20 1245978915 0 Nurse Practitioners Nurse Practitioners Services 20 1245978915 0 Nurse Practitioners Physician Services 00 1245979673 0 SIEBERT TYLER 2022230 9999999 B 10 1245979673 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1245979673 0 Physical Therapists Medical Supplies 20 1245979673 0 Physical Therapists Medical equipment/prosthetic devices 20 1245979673 0 Physical Therapists Physical Therapy Services 00 1245979830 0 AHLUWALIA DAKSH 2022211 9999999 B 10 1245979830 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1245979830 0 Physicians Anesthesia Services 20 1245979830 0 Physicians Fluoride varnish 20 1245979830 0 Physicians Healthy Kids Services 20 1245979830 0 Physicians Optical Supplies 20 1245979830 0 Physicians Physician Services 00 1245980168 0 RAMOUTAR UMA 2022192 9999999 B 10 1245980168 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1245980168 0 Physicians Anesthesia Services 20 1245980168 0 Physicians Healthy Kids Services 20 1245980168 0 Physicians Optical Supplies 20 1245980168 0 Physicians Physician Services 00 1245980382 0 SCHEFFER DAVID R 2022171 9999999 B 10 1245980382 0 4698 DEPT CAROL STREAM IL 601220021 20 1245980382 0 Physicians Anesthesia Services 20 1245980382 0 Physicians Healthy Kids Services 20 1245980382 0 Physicians Optical Supplies 20 1245980382 0 Physicians Physician Services 00 1245980572 0 KASA REBECCA 2022177 9999999 B 10 1245980572 0 PO BOX 3039 OAK BROOK IL 605223039 20 1245980572 0 Physicians Anesthesia Services 20 1245980572 0 Physicians Fluoride varnish 20 1245980572 0 Physicians Healthy Kids Services 20 1245980572 0 Physicians Optical Supplies 20 1245980572 0 Physicians Physician Services 00 1245980663 0 NEWMAN JULIA D 2022223 9999999 B 10 1245980663 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1245980663 0 Physicians Anesthesia Services 20 1245980663 0 Physicians Fluoride varnish 20 1245980663 0 Physicians Healthy Kids Services 20 1245980663 0 Physicians Optical Supplies 20 1245980663 0 Physicians Physician Services 00 1245983113 0 DILL COLE J 2022039 9999999 B 10 1245983113 0 6742 N FROSTWOOD PKWY PEORIA IL 616152402 20 1245983113 0 Nurse Practitioners Anesthesia Services 20 1245983113 0 Nurse Practitioners Nurse Practitioners Services 20 1245983113 0 Nurse Practitioners Physician Services 00 1245984145 0 PUFF MICHAEL 2022308 9999999 B 10 1245984145 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1245984145 0 Nurse Practitioners Fluoride varnish 20 1245984145 0 Nurse Practitioners Healthy Kids Services 20 1245984145 0 Nurse Practitioners Nurse Practitioners Services 20 1245984145 0 Nurse Practitioners Physician Services 00 1245985241 0 MOORE VERA 2022062 9999999 B 10 1245985241 0 2211 N ELSTON AVE STE 301 CHICAGO IL 606149278 20 1245985241 0 Clinical Social Worker Social work service 00 1245986116 0 HOSTE BENJAMIN 2024183 9999999 B 10 1245986116 0 355 E ERIE ST CHICAGO IL 606113167 20 1245986116 0 Physicians Anesthesia Services 20 1245986116 0 Physicians Healthy Kids Services 20 1245986116 0 Physicians Optical Supplies 20 1245986116 0 Physicians Physician Services 00 1245986199 0 YEH GRACE 2022269 9999999 B 10 1245986199 0 29373 NETWORK PL CHICAGO IL 606733039 20 1245986199 0 Physician Assistant Only Fluoride varnish 20 1245986199 0 Physician Assistant Only Healthy Kids Services 20 1245986199 0 Physician Assistant Only Physician Services 00 1245986462 0 PITRE NATALIE 2022111 9999999 B 10 1245986462 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1245986462 0 Physician Assistant Only Fluoride varnish 20 1245986462 0 Physician Assistant Only Healthy Kids Services 20 1245986462 0 Physician Assistant Only Physician Services 00 1245988419 0 DZUL CATHERINE 2023117 9999999 B 10 1245988419 0 2547 PLAINFIELD NAPERVILLE RD NAPERVILLE IL 605648701 20 1245988419 0 Occupational Therapists Medical Supplies 20 1245988419 0 Occupational Therapists Medical equipment/prosthetic devices 20 1245988419 0 Occupational Therapists Occupational Therapy Services 00 1245989334 0 GADSON ANGELIQUE Q 2022264 9999999 B 10 1245989334 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1245989334 0 Physicians Anesthesia Services 20 1245989334 0 Physicians Fluoride varnish 20 1245989334 0 Physicians Healthy Kids Services 20 1245989334 0 Physicians Optical Supplies 20 1245989334 0 Physicians Physician Services 00 1245989367 0 LAVRENCIK JORDAN N 2022216 9999999 B 10 1245989367 0 29373 NETWORK PL CHICAGO IL 606733039 20 1245989367 0 Nurse Practitioners Fluoride varnish 20 1245989367 0 Nurse Practitioners Healthy Kids Services 20 1245989367 0 Nurse Practitioners Nurse Practitioners Services 20 1245989367 0 Nurse Practitioners Physician Services 00 1245989474 0 CHEN MICHAEL 2022176 9999999 B 10 1245989474 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1245989474 0 Physicians Anesthesia Services 20 1245989474 0 Physicians Fluoride varnish 20 1245989474 0 Physicians Healthy Kids Services 20 1245989474 0 Physicians Optical Supplies 20 1245989474 0 Physicians Physician Services 00 1245989797 0 HANNON RACHELLE 2023332 9999999 B 10 1245989797 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1245989797 0 Nurse Practitioners Fluoride varnish 20 1245989797 0 Nurse Practitioners Healthy Kids Services 20 1245989797 0 Nurse Practitioners Nurse Practitioners Services 20 1245989797 0 Nurse Practitioners Physician Services 00 1245990746 0 PATEL PUJA S 2022047 9999999 B 10 1245990746 0 # 8496 CHICAGO IL 606778004 20 1245990746 0 Physician Assistant Only Fluoride varnish 20 1245990746 0 Physician Assistant Only Healthy Kids Services 20 1245990746 0 Physician Assistant Only Physician Services 00 1245991108 0 WYNALDA BRIAN 2022287 9999999 B 10 1245991108 0 2525 KANEVILLE RD GENEVA IL 601342578 20 1245991108 0 Physician Assistant Only Fluoride varnish 20 1245991108 0 Physician Assistant Only Healthy Kids Services 20 1245991108 0 Physician Assistant Only Physician Services 00 1245991397 0 IJALE OLUWATOSIN 2023195 9999999 B 10 1245991397 0 222 MERCHANDISE MART PLZ STE 1 CHICAGO IL 606544342 20 1245991397 0 Nurse Practitioners Fluoride varnish 20 1245991397 0 Nurse Practitioners Healthy Kids Services 20 1245991397 0 Nurse Practitioners Nurse Practitioners Services 20 1245991397 0 Nurse Practitioners Physician Services 00 1245991801 0 STAUNTON ABIGAIL A 2023100 9999999 B 10 1245991801 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1245991801 0 Physician Assistant Only Fluoride varnish 20 1245991801 0 Physician Assistant Only Healthy Kids Services 20 1245991801 0 Physician Assistant Only Physician Services 00 1245991967 0 MANCERA MERCEDES 2022041 9999999 H 10 1245991967 0 512 3RD AVE STERLING IL 61081 20 1245991967 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1245996602 0 SPLAN MAKAYLA G 2024012 9999999 B 10 1245996602 0 PO BOX 28900 GREEN BAY WI 543240900 20 1245996602 0 Physician Assistant Only Fluoride varnish 20 1245996602 0 Physician Assistant Only Healthy Kids Services 20 1245996602 0 Physician Assistant Only Physician Services 00 1245997022 0 MCLAUGHLIN KELLY 2021349 9999999 B 10 1245997022 0 1979 N MILL ST STE 202 NAPERVILLE IL 605638472 20 1245997022 0 Clinical Social Worker Social work service 00 1245997857 0 RICHARDS NANETTE L 2024275 9999999 B 10 1245997857 0 7230 ARBUCKLE CMNS # 178 BROWNSBURG IN 461121791 20 1245997857 0 Nurse Practitioners Fluoride varnish 20 1245997857 0 Nurse Practitioners Healthy Kids Services 20 1245997857 0 Nurse Practitioners Nurse Practitioners Services 20 1245997857 0 Nurse Practitioners Physician Services 00 1245999747 0 RYBAK ANNA 2022026 9999999 B 10 1245999747 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1245999747 0 Clinical Social Worker Social work service 00 1255000659 0 SUPAN MEGAN E 2021263 9999999 B 10 1255000659 0 PO BOX 775253 CHICAGO IL 606775253 20 1255000659 0 Physician Assistant Only Fluoride varnish 20 1255000659 0 Physician Assistant Only Healthy Kids Services 20 1255000659 0 Physician Assistant Only Physician Services 00 1255001186 0 MATHIASEN MEGAN MICHELLE 2024356 9999999 B 10 1255001186 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1255001186 0 Speech Therapists Medical Supplies 20 1255001186 0 Speech Therapists Medical equipment/prosthetic devices 20 1255001186 0 Speech Therapists Speech Therapy/Pathology Services 00 1255001384 0 NANTAMBI SAUDAH 2021265 9999999 B 10 1255001384 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1255001384 0 Licensed Practical Nurses Nursing service 00 1255001863 0 STANLEY STEPHANIE 2021302 9999999 B 10 1255001863 0 909 RIDGEBROOK RD STE 300 SPARKS MD 211529477 20 1255001863 0 Nurse Practitioners Fluoride varnish 20 1255001863 0 Nurse Practitioners Healthy Kids Services 20 1255001863 0 Nurse Practitioners Nurse Practitioners Services 20 1255001863 0 Nurse Practitioners Physician Services 00 1255002036 0 GAUDETTE NICOLLE M 2021292 9999999 H 10 1255002036 0 2601 W MARQUETTE RD CHICAGO IL 606291817 20 1255002036 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1255003588 0 CRABTREE HANNAH 2024222 9999999 B 10 1255003588 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1255003588 0 Occupational Therapists Medical Supplies 20 1255003588 0 Occupational Therapists Medical equipment/prosthetic devices 20 1255003588 0 Occupational Therapists Occupational Therapy Services 00 1255004156 0 BRUCE DYAMOND 2021208 9999999 H 10 1255004156 0 721 N LA SALLE DR CHICAGO IL 606543503 20 1255004156 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1255005013 0 SCHOEPPNER PATRICK B 2021236 9999999 B 10 1255005013 0 1201 N SHERIDAN RD WAUKEGAN IL 600852081 20 1255005013 0 Speech Therapists Medical Supplies 20 1255005013 0 Speech Therapists Medical equipment/prosthetic devices 20 1255005013 0 Speech Therapists Speech Therapy/Pathology Services 00 1255005146 0 VOLPE LORELEI N 2021217 9999999 B 10 1255005146 0 1003 N CUMMINGS LN WASHINGTON IL 615719646 20 1255005146 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1255005211 0 KEMPKIEWICZ SAMANTHA 2022059 9999999 H 10 1255005211 0 1900 W POLK STE 220C CHICAGO IL 606123723 20 1255005211 0 Physician Assistant Only Fluoride varnish 20 1255005211 0 Physician Assistant Only Healthy Kids Services 20 1255005211 0 Physician Assistant Only Physician Services 00 1255005351 0 BHATT JENNA 2022145 9999999 B 10 1255005351 0 29373 NETWORK PL CHICAGO IL 606733039 20 1255005351 0 Physician Assistant Only Fluoride varnish 20 1255005351 0 Physician Assistant Only Healthy Kids Services 20 1255005351 0 Physician Assistant Only Physician Services 00 1255005443 0 NELSON LEAH M 2022166 9999999 B 10 1255005443 0 210 W WALNUT ST CANTON IL 615202444 20 1255005443 0 Nurse Practitioners Fluoride varnish 20 1255005443 0 Nurse Practitioners Healthy Kids Services 20 1255005443 0 Nurse Practitioners Nurse Practitioners Services 20 1255005443 0 Nurse Practitioners Physician Services 00 1255006128 0 SABAL CARISSA CAITLIN 2024058 9999999 B 10 1255006128 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1255006128 0 Other behavior 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devices 20 1255010781 0 Physical Therapists Physical Therapy Services 00 1255011235 0 BENNETT LATOI 2023249 9999999 B 10 1255011235 0 1850 W WINCHESTER RD STE 108 LIBERTYVILLE IL 600485355 20 1255011235 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1255011359 0 AGARWAL ANISHA 2023208 9999999 B 10 1255011359 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1255011359 0 Physicians Anesthesia Services 20 1255011359 0 Physicians Fluoride varnish 20 1255011359 0 Physicians Healthy Kids Services 20 1255011359 0 Physicians Optical Supplies 20 1255011359 0 Physicians Physician Services 00 1255013652 0 WIRE ASHLEY M 2023300 9999999 B 10 1255013652 0 351 EXECUTIVE PKWY ROCKFORD IL 611075339 20 1255013652 0 Nurse Practitioners Fluoride varnish 20 1255013652 0 Nurse Practitioners Healthy Kids Services 20 1255013652 0 Nurse Practitioners Nurse Practitioners Services 20 1255013652 0 Nurse Practitioners Physician Services 00 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Physician Services 20 1255016960 0 Physicians Physicians Psychiatric Services 00 1255017141 0 BLEWETT BRANDON 2023193 9999999 B 10 1255017141 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1255017141 0 Physicians Anesthesia Services 20 1255017141 0 Physicians Healthy Kids Services 20 1255017141 0 Physicians Optical Supplies 20 1255017141 0 Physicians Physician Services 20 1255017141 0 Physicians Physicians Psychiatric Services 00 1255017273 0 ADDISON SARAH 2024009 9999999 B 10 1255017273 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1255017273 0 Physicians Anesthesia Services 20 1255017273 0 Physicians Fluoride varnish 20 1255017273 0 Physicians Healthy Kids Services 20 1255017273 0 Physicians Optical Supplies 20 1255017273 0 Physicians Physician Services 00 1255018453 0 CAIN CARNEISHA S 2024292 9999999 B 10 1255018453 0 10759 WINTERSET DR ORLAND PARK IL 604671106 20 1255018453 0 Dentists Dental Services 20 1255018453 0 Dentists Physician Services 00 1255018826 0 SAMARDZICH SELENA 2023353 9999999 B 10 1255018826 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1255018826 0 Nurse Practitioners Fluoride varnish 20 1255018826 0 Nurse Practitioners Healthy Kids Services 20 1255018826 0 Nurse Practitioners Nurse Practitioners Services 20 1255018826 0 Nurse Practitioners Physician Services 00 1255019519 0 FLORES ESMERALDA 2023263 9999999 H 10 1255019519 0 2424 S PULASKI RD CHICAGO IL 606233718 20 1255019519 0 Clinical Social Worker Social work service 00 1255019774 0 KOKOSSIS DANAE 2023192 9999999 B 10 1255019774 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1255019774 0 Physicians Anesthesia Services 20 1255019774 0 Physicians Fluoride varnish 20 1255019774 0 Physicians Healthy Kids Services 20 1255019774 0 Physicians Optical Supplies 20 1255019774 0 Physicians Physician Services 00 1255020004 0 SALAS OSCAR M 2023147 9999999 B 10 1255020004 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1255020004 0 Physicians Anesthesia Services 20 1255020004 0 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Services 00 1255066262 0 GLINSKI JESSICA 2022237 9999999 B 10 1255066262 0 PO BOX 775342 CHICAGO IL 606775342 20 1255066262 0 Nurse Practitioners Fluoride varnish 20 1255066262 0 Nurse Practitioners Healthy Kids Services 20 1255066262 0 Nurse Practitioners Nurse Practitioners Services 20 1255066262 0 Nurse Practitioners Physician Services 00 1255067567 0 LEVEN JACOB 2023167 9999999 B 10 1255067567 0 PO BOX 3039 OAK BROOK IL 605223039 20 1255067567 0 Physicians Anesthesia Services 20 1255067567 0 Physicians Fluoride varnish 20 1255067567 0 Physicians Healthy Kids Services 20 1255067567 0 Physicians Optical Supplies 20 1255067567 0 Physicians Physician Services 00 1255067823 0 PEREZ STEPHANIE 2024028 9999999 B 10 1255067823 0 6000 N ALLEN RD PEORIA IL 616143294 20 1255067823 0 Physician Assistant Only Fluoride varnish 20 1255067823 0 Physician Assistant Only Healthy Kids Services 20 1255067823 0 Physician Assistant Only Physician Services 00 1255067922 0 BRENNER KATHRYN E 2022231 9999999 B 10 1255067922 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1255067922 0 Nurse Practitioners Healthy Kids Services 20 1255067922 0 Nurse Practitioners Nurse Practitioners Services 20 1255067922 0 Nurse Practitioners Physician Services 00 1255068011 0 FAULKNER CAROLINA 2023304 9999999 B 10 1255068011 0 10208 S INDIANAPOLIS AVE # 301 CHICAGO IL 606176033 20 1255068011 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1255070447 0 ARCHER LUKE W 2022161 9999999 B 10 1255070447 0 1 CHICAGO AVE OAK PARK IL 603022432 20 1255070447 0 Dentists Dental Services 20 1255070447 0 Dentists Physician Services 00 1255070645 0 SANDS DEREK 2022325 9999999 B 10 1255070645 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1255070645 0 Nurse Practitioners Healthy Kids Services 20 1255070645 0 Nurse Practitioners Nurse Practitioners Services 20 1255070645 0 Nurse Practitioners Physician Services 00 1255070884 0 SAINI AVIKAR S 2022189 9999999 B 10 1255070884 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1255070884 0 Physicians Anesthesia Services 20 1255070884 0 Physicians Fluoride varnish 20 1255070884 0 Physicians Healthy Kids Services 20 1255070884 0 Physicians Optical Supplies 20 1255070884 0 Physicians Physician Services 00 1255071221 0 PANKEY ASHLEY N 2022213 9999999 B 10 1255071221 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1255071221 0 Physicians Anesthesia Services 20 1255071221 0 Physicians Healthy Kids Services 20 1255071221 0 Physicians Optical Supplies 20 1255071221 0 Physicians Physician Services 00 1255071437 0 SANDHU KABIER SINGH 2022179 9999999 B 10 1255071437 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1255071437 0 Physicians Anesthesia Services 20 1255071437 0 Physicians Healthy Kids Services 20 1255071437 0 Physicians Optical Supplies 20 1255071437 0 Physicians Physician Services 00 1255072435 0 KARST DILLON B 2022178 9999999 B 10 1255072435 0 4698 DEPT CAROL STREAM IL 601224698 20 1255072435 0 Physicians Anesthesia Services 20 1255072435 0 Physicians Fluoride varnish 20 1255072435 0 Physicians Healthy Kids Services 20 1255072435 0 Physicians Optical Supplies 20 1255072435 0 Physicians Physician Services 00 1255072542 0 RUNNE JOHN W 2022176 9999999 B 10 1255072542 0 PO BOX 3039 OAK BROOK IL 605223039 20 1255072542 0 Physicians Anesthesia Services 20 1255072542 0 Physicians Healthy Kids Services 20 1255072542 0 Physicians Optical Supplies 20 1255072542 0 Physicians Physician Services 20 1255072542 0 Physicians Physicians Psychiatric Services 00 1255073169 0 WILLIAMS ZAINAB A 2022353 9999999 B 10 1255073169 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1255073169 0 Nurse Practitioners Fluoride varnish 20 1255073169 0 Nurse Practitioners Healthy Kids Services 20 1255073169 0 Nurse Practitioners Nurse Practitioners Services 20 1255073169 0 Nurse Practitioners Physician Services 00 1255073748 0 KONDAN CHRISTIAN M 2024353 9999999 B 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service 00 1255074407 0 SALETTA STEVEN 2022283 9999999 B 10 1255074407 0 4701 DEPT CAROL STREAM IL 601220021 20 1255074407 0 Physicians Anesthesia Services 20 1255074407 0 Physicians Fluoride varnish 20 1255074407 0 Physicians Healthy Kids Services 20 1255074407 0 Physicians Optical Supplies 20 1255074407 0 Physicians Physician Services 00 1255074977 0 SHANK-GUNTERMAN CHRISTENE 2022110 9999999 H 10 1255074977 0 PO BOX 1109 DEKALB IL 601157109 20 1255074977 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1255075495 0 JIA LENA S 2024314 9999999 B 10 1255075495 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1255075495 0 Physicians Anesthesia Services 20 1255075495 0 Physicians Healthy Kids Services 20 1255075495 0 Physicians Optical Supplies 20 1255075495 0 Physicians Physician Services 20 1255075495 0 Physicians Physicians Psychiatric Services 00 1255076071 0 ZHENG ERIKA W 2023212 9999999 B 10 1255076071 0 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1255076584 0 Physicians Anesthesia Services 20 1255076584 0 Physicians Healthy Kids Services 20 1255076584 0 Physicians Optical Supplies 20 1255076584 0 Physicians Physician Services 00 1255077665 0 SARNA ANDREA 2022273 9999999 B 10 1255077665 0 1243 RICKERT DR NAPERVILLE IL 605400954 20 1255077665 0 Nurse Practitioners Fluoride varnish 20 1255077665 0 Nurse Practitioners Healthy Kids Services 20 1255077665 0 Nurse Practitioners Nurse Practitioners Services 20 1255077665 0 Nurse Practitioners Physician Services 00 1255078309 0 LANDIN KIARA 2022167 9999999 B 10 1255078309 0 70 S RIVER ST AURORA IL 605065185 20 1255078309 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1255079737 0 WISE XIMENA 2025027 9999999 B 10 1255079737 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1255079737 0 Physicians Anesthesia Services 20 1255079737 0 Physicians Healthy Kids Services 20 1255079737 0 Physicians Optical Supplies 20 1255079737 0 Physicians Physician Services 00 1255080602 0 LEO ASHWIN J 2023250 9999999 B 10 1255080602 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1255080602 0 Physicians Anesthesia Services 20 1255080602 0 Physicians Healthy Kids Services 20 1255080602 0 Physicians Optical Supplies 20 1255080602 0 Physicians Physician Services 00 1255081006 0 ONYEUKWU OBINNA 2022182 9999999 B 10 1255081006 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1255081006 0 Physicians Anesthesia Services 20 1255081006 0 Physicians Healthy Kids Services 20 1255081006 0 Physicians Optical Supplies 20 1255081006 0 Physicians Physician Services 00 1255081113 0 HALLORAN DANIEL MICHAEL 2022178 9999999 B 10 1255081113 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1255081113 0 Physicians Anesthesia Services 20 1255081113 0 Physicians Fluoride varnish 20 1255081113 0 Physicians Healthy Kids Services 20 1255081113 0 Physicians Optical Supplies 20 1255081113 0 Physicians Physician Services 00 1255081170 0 CHOVANEC JACK 2022203 9999999 B 10 1255081170 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1255081170 0 Physicians Anesthesia Services 20 1255081170 0 Physicians Healthy Kids Services 20 1255081170 0 Physicians Optical Supplies 20 1255081170 0 Physicians Physician Services 20 1255081170 0 Physicians Physicians Psychiatric Services 00 1255081303 0 WINTER WILLIAM ALLEN 2022180 9999999 B 10 1255081303 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1255081303 0 Physicians Anesthesia Services 20 1255081303 0 Physicians Healthy Kids Services 20 1255081303 0 Physicians Optical Supplies 20 1255081303 0 Physicians Physician Services 00 1255081451 0 PEREZ BRANDON R 2022245 9999999 B 10 1255081451 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1255081451 0 Physicians Anesthesia Services 20 1255081451 0 Physicians Healthy Kids Services 20 1255081451 0 Physicians Optical Supplies 20 1255081451 0 Physicians Physician Services 00 1255081667 0 TEGERDINE MADELYN M 2022094 9999999 B 10 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varnish 20 1255339222 0 Physicians Healthy Kids Services 20 1255339222 0 Physicians Optical Supplies 20 1255339222 0 Physicians Physician Services 00 1255339503 0 BONTU UDAYA 1996333 9999999 B 10 1255339503 0 5777 DEPT CAROL STREAM IL 601228942 20 1255339503 0 Physicians Anesthesia Services 20 1255339503 0 Physicians Fluoride varnish 20 1255339503 0 Physicians Healthy Kids Services 20 1255339503 0 Physicians Optical Supplies 20 1255339503 0 Physicians Physician Services 00 1255339792 0 BERMAN DANIEL 2005298 9999999 B 10 1255339792 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1255339792 0 Physicians Anesthesia Services 20 1255339792 0 Physicians Fluoride varnish 20 1255339792 0 Physicians Healthy Kids Services 20 1255339792 0 Physicians Optical Supplies 20 1255339792 0 Physicians Physician Services 00 1255340139 0 GREENE MARIANNE E 2005274 9999999 B 10 1255340139 0 PO BOX 88493 CHICAGO IL 606801493 20 1255340139 0 Physicians Anesthesia Services 20 1255340139 0 Physicians Healthy Kids Services 20 1255340139 0 Physicians Optical Supplies 20 1255340139 0 Physicians Physician Services 00 1255340691 0 JEREMY WITTENBORN S 2016031 9999999 B 10 1255340691 0 1801 N SENATE BLVD STE 355 INDIANAPOLIS IN 462021252 20 1255340691 0 Physicians Anesthesia Services 20 1255340691 0 Physicians Fluoride varnish 20 1255340691 0 Physicians Healthy Kids Services 20 1255340691 0 Physicians Optical Supplies 20 1255340691 0 Physicians Physician Services 00 1255341681 0 WESSING MISTY M 2016254 9999999 B 10 1255341681 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1255341681 0 Physician Assistant Only Fluoride varnish 20 1255341681 0 Physician Assistant Only Healthy Kids Services 20 1255341681 0 Physician Assistant Only Physician Services 00 1255341970 0 ORKIN BRUCE 2013060 9999999 B 10 1255341970 0 611 W PARK ST URBANA IL 618012529 20 1255341970 0 Physicians Anesthesia Services 20 1255341970 0 Physicians Healthy Kids Services 20 1255341970 0 Physicians Optical Supplies 20 1255341970 0 Physicians Physician Services 00 1255342119 0 NESLER JAMES C 2023264 9999999 B 10 1255342119 0 1836 SOUTH AVE LA CROSSE WI 546015429 20 1255342119 0 Physicians Anesthesia Services 20 1255342119 0 Physicians Healthy Kids Services 20 1255342119 0 Physicians Optical Supplies 20 1255342119 0 Physicians Physician Services 00 1255342663 0 FEENEY TODD 2023080 9999999 B 10 1255342663 0 PO BOX 43230 PHOENIX AZ 850803230 20 1255342663 0 Physician Assistant Only Fluoride varnish 20 1255342663 0 Physician Assistant Only Healthy Kids Services 20 1255342663 0 Physician Assistant Only Physician Services 00 1255343026 0 MIESNER DAWN R 1997244 9999999 B 10 1255343026 0 313 N PLANKINTON AVE STE 211 MILWAUKEE WI 532033104 20 1255343026 0 Physicians Anesthesia Services 20 1255343026 0 Physicians Fluoride varnish 20 1255343026 0 Physicians Healthy Kids Services 20 1255343026 0 Physicians Optical Supplies 20 1255343026 0 Physicians Physician Services 00 1255343349 0 BALDWIN-DUFOUR TONI S 2023256 9999999 B 10 1255343349 0 PO BOX 500 ELLICOTTVILLE NY 147310500 20 1255343349 0 Nurse Practitioners Fluoride varnish 20 1255343349 0 Nurse Practitioners Healthy Kids Services 20 1255343349 0 Nurse Practitioners Nurse Practitioners Services 20 1255343349 0 Nurse Practitioners Physician Services 00 1255343364 0 CLAUDY FRANK 2009091 9999999 B 10 1255343364 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1255343364 0 Physicians Anesthesia Services 20 1255343364 0 Physicians Fluoride varnish 20 1255343364 0 Physicians Healthy Kids Services 20 1255343364 0 Physicians Optical Supplies 20 1255343364 0 Physicians Physician Services 00 1255343521 0 KLEINMAN MARLON B 1993179 9999999 B 10 1255343521 0 PO BOX 74008983 CHICAGO IL 606740001 20 1255343521 0 Physicians Anesthesia Services 20 1255343521 0 Physicians Fluoride varnish 20 1255343521 0 Physicians Healthy Kids Services 20 1255343521 0 Physicians Optical Supplies 20 1255343521 0 Physicians Physician Services 00 1255343596 0 PLISKIN NEIL 2015176 9999999 B 10 1255343596 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1255343596 0 Psychologist Psychologist service 00 1255343992 0 MICHALS EDWARD A 1993182 9999999 B 10 1255343992 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1255343992 0 Physicians Anesthesia Services 20 1255343992 0 Physicians Healthy Kids Services 20 1255343992 0 Physicians Optical Supplies 20 1255343992 0 Physicians Physician Services 00 1255344313 0 PORTER NORA 1995182 9999999 B 10 1255344313 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1255344313 0 Physicians Anesthesia Services 20 1255344313 0 Physicians Fluoride varnish 20 1255344313 0 Physicians Healthy Kids Services 20 1255344313 0 Physicians Optical Supplies 20 1255344313 0 Physicians Physician Services 00 1255344529 0 KAYDANOVA YEVGENYA 1997001 9999999 B 10 1255344529 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1255344529 0 Physicians Anesthesia Services 20 1255344529 0 Physicians Healthy Kids Services 20 1255344529 0 Physicians Optical Supplies 20 1255344529 0 Physicians Physician Services 20 1255344529 0 Physicians Physicians Psychiatric Services 00 1255344537 0 DINCER HUSEYIN 2021311 9999999 B 10 1255344537 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1255344537 0 Physicians Anesthesia Services 20 1255344537 0 Physicians Fluoride varnish 20 1255344537 0 Physicians Healthy Kids Services 20 1255344537 0 Physicians Optical Supplies 20 1255344537 0 Physicians Physician Services 00 1255344826 0 FLOCK SARAH E 2000230 9999999 B 10 1255344826 0 150 S WASHINGTON ST WHEATON IL 601875453 20 1255344826 0 Speech Therapists Medical Supplies 20 1255344826 0 Speech Therapists Medical equipment/prosthetic devices 20 1255344826 0 Speech Therapists Speech Therapy/Pathology Services 00 1255345708 0 BRODERICK PATRICK B 2023024 9999999 B 10 1255345708 0 5701 W TALAVI BLVD STE 120 GLENDALE AZ 853061888 20 1255345708 0 Physicians Anesthesia Services 20 1255345708 0 Physicians Healthy Kids Services 20 1255345708 0 Physicians Optical Supplies 20 1255345708 0 Physicians Physician Services 00 1255345823 0 WHITNAH JOSEPH RHETT 2006244 9999999 B 10 1255345823 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1255345823 0 Physicians Anesthesia Services 20 1255345823 0 Physicians Healthy Kids Services 20 1255345823 0 Physicians Optical Supplies 20 1255345823 0 Physicians Physician Services 00 1255347811 0 GOOMAR PRITH 1996275 9999999 B 10 1255347811 0 2843 S ARCHER AVE CHICAGO IL 606085655 20 1255347811 0 Physicians Anesthesia Services 20 1255347811 0 Physicians Fluoride varnish 20 1255347811 0 Physicians Healthy Kids Services 20 1255347811 0 Physicians Optical Supplies 20 1255347811 0 Physicians Physician Services 00 1255348371 0 DZERA OLEH 2017145 9999999 B 10 1255348371 0 18167 US HIGHWAY 19 N STE 650 CLEARWATER FL 337646576 20 1255348371 0 Physicians Anesthesia Services 20 1255348371 0 Physicians Healthy Kids Services 20 1255348371 0 Physicians Optical Supplies 20 1255348371 0 Physicians Physician Services 20 1255348371 0 Physicians Physicians Psychiatric Services 00 1255348546 0 BIERMANN ROBIN 1993182 9999999 B 10 1255348546 0 1000 N ALLEN ST ROBINSON IL 624541114 20 1255348546 0 Physicians Anesthesia Services 20 1255348546 0 Physicians Healthy Kids Services 20 1255348546 0 Physicians Optical Supplies 20 1255348546 0 Physicians Physician Services 00 1255348629 0 JOYCE JOHN 2014244 9999999 B 10 1255348629 0 9000 WAUKEGAN RD STE 240 MORTON GROVE IL 600532127 20 1255348629 0 Physicians Anesthesia Services 20 1255348629 0 Physicians Fluoride varnish 20 1255348629 0 Physicians Healthy Kids Services 20 1255348629 0 Physicians Optical Supplies 20 1255348629 0 Physicians Physician Services 00 1255348694 0 HAMPTON DAVID A 2017226 9999999 B 10 1255348694 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1255348694 0 Physicians Anesthesia Services 20 1255348694 0 Physicians Healthy Kids Services 20 1255348694 0 Physicians Optical Supplies 20 1255348694 0 Physicians Physician Services 00 1255348777 0 KOWAL JAMES 2020213 9999999 B 10 1255348777 0 1110 N WASHINGTON ST NAPERVILLE IL 605632767 20 1255348777 0 Other behavior health professional LCPC/LMFT services 00 1255349825 0 KING-CHEN ROSEMARY L 1985121 9999999 B 10 1255349825 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1255349825 0 Physicians Anesthesia Services 20 1255349825 0 Physicians Healthy Kids Services 20 1255349825 0 Physicians Optical Supplies 20 1255349825 0 Physicians Physician Services 00 1255350252 0 SUHRE CHRISTOPHER 2006184 9999999 B 10 1255350252 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1255350252 0 Physicians Anesthesia Services 20 1255350252 0 Physicians Fluoride varnish 20 1255350252 0 Physicians Healthy Kids Services 20 1255350252 0 Physicians Optical Supplies 20 1255350252 0 Physicians Physician Services 00 1255350641 0 WILLIAMS DANIEL H 2006244 9999999 B 10 1255350641 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1255350641 0 Physicians Anesthesia Services 20 1255350641 0 Physicians Healthy Kids Services 20 1255350641 0 Physicians Optical Supplies 20 1255350641 0 Physicians Physician Services 00 1255350849 0 HUANG MICHAEL Y 2006158 9999999 B 10 1255350849 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1255350849 0 Physicians Anesthesia Services 20 1255350849 0 Physicians Fluoride varnish 20 1255350849 0 Physicians Healthy Kids Services 20 1255350849 0 Physicians Optical Supplies 20 1255350849 0 Physicians Physician Services 00 1255351235 0 ARSLAN BULENT 2012027 9999999 B 10 1255351235 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1255351235 0 Physicians Anesthesia Services 20 1255351235 0 Physicians Healthy Kids Services 20 1255351235 0 Physicians Optical Supplies 20 1255351235 0 Physicians Physician Services 00 1255351581 0 HAHN SARAH 2011001 9999999 B 10 1255351581 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1255351581 0 Physicians All Kids application agent 20 1255351581 0 Physicians Anesthesia Services 20 1255351581 0 Physicians Fluoride varnish 20 1255351581 0 Physicians Healthy Kids Services 20 1255351581 0 Physicians Optical Supplies 20 1255351581 0 Physicians Physician Services 00 1255351938 0 GALIANO ROBERT D 2006182 9999999 B 10 1255351938 0 5777 DEPT CAROL STREAM IL 601220021 20 1255351938 0 Physicians Anesthesia Services 20 1255351938 0 Physicians Healthy Kids Services 20 1255351938 0 Physicians Optical Supplies 20 1255351938 0 Physicians Physician Services 00 1255353330 0 KARAM DEMORI MARIA 2008183 9999999 B 10 1255353330 0 STE 1159 1725 W HARRISON CHICAGO IL 606123883 20 1255353330 0 Physicians Anesthesia Services 20 1255353330 0 Physicians Healthy Kids Services 20 1255353330 0 Physicians Optical Supplies 20 1255353330 0 Physicians Physician Services 00 1255353579 0 GARCIA RENE 2018208 9999999 B 10 1255353579 0 PO BOX 28900 GREEN BAY WI 543240900 20 1255353579 0 Nurse Practitioners Anesthesia Services 20 1255353579 0 Nurse Practitioners Nurse Practitioners Services 20 1255353579 0 Nurse Practitioners Physician Services 00 1255353603 0 MARSHALL KIMBERLY 1995191 9999999 B 10 1255353603 0 306 SAINT JOSEPH DR BLOOMINGTON IL 617013506 20 1255353603 0 Physicians Anesthesia Services 20 1255353603 0 Physicians Fluoride varnish 20 1255353603 0 Physicians Healthy Kids Services 20 1255353603 0 Physicians Optical Supplies 20 1255353603 0 Physicians Physician Services 00 1255353660 0 HAUTER DRU 1991213 9999999 B 10 1255353660 0 29373 NETWORK PL CHICAGO IL 606733039 20 1255353660 0 Physicians Anesthesia Services 20 1255353660 0 Physicians Fluoride varnish 20 1255353660 0 Physicians Healthy Kids Services 20 1255353660 0 Physicians Optical Supplies 20 1255353660 0 Physicians Physician Services 00 1255353843 0 BERG KIMBERLY L 2016043 9999999 B 10 1255353843 0 5901 LINCOLN DR EDINA MN 554361611 20 1255353843 0 Nurse Practitioners Fluoride varnish 20 1255353843 0 Nurse Practitioners Healthy Kids Services 20 1255353843 0 Nurse Practitioners Nurse Practitioners Services 20 1255353843 0 Nurse Practitioners Physician Services 00 1255354262 0 YU GENE 2023152 9999999 B 10 1255354262 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1255354262 0 Physicians Anesthesia Services 20 1255354262 0 Physicians Healthy Kids Services 20 1255354262 0 Physicians Optical Supplies 20 1255354262 0 Physicians Physician Services 00 1255354460 0 DONAMARIA MARIA 2011202 9999999 B 10 1255354460 0 4740 N CLARK ST CHICAGO IL 606404689 20 1255354460 0 Other behavior health professional LCPC/LMFT services 00 1255354627 0 MAQBOOL ASIM 2022242 9999999 B 10 1255354627 0 100 E PENN SQ FL 9 PHILADELPHIA PA 191073377 20 1255354627 0 Physicians Anesthesia Services 20 1255354627 0 Physicians Fluoride varnish 20 1255354627 0 Physicians Healthy Kids Services 20 1255354627 0 Physicians Optical Supplies 20 1255354627 0 Physicians Physician Services 00 1255354908 0 KENNEDY WILLIAM A 2021240 9999999 B 10 1255354908 0 268 W HOSPITALITY LN STE 300 SAN BERNARDINO CA 924083234 20 1255354908 0 Physicians Anesthesia Services 20 1255354908 0 Physicians Fluoride varnish 20 1255354908 0 Physicians Healthy Kids Services 20 1255354908 0 Physicians Optical Supplies 20 1255354908 0 Physicians Physician Services 00 1255354973 0 LEE DOUGLAS 2021200 9999999 B 10 1255354973 0 PO BOX 43230 PHOENIX AZ 850803230 20 1255354973 0 Physicians Anesthesia Services 20 1255354973 0 Physicians Healthy Kids Services 20 1255354973 0 Physicians Optical Supplies 20 1255354973 0 Physicians Physician Services 00 1255355293 0 SHARMA ABHA 2001246 9999999 B 10 1255355293 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1255355293 0 Physicians Anesthesia Services 20 1255355293 0 Physicians Fluoride varnish 20 1255355293 0 Physicians Healthy Kids Services 20 1255355293 0 Physicians Optical Supplies 20 1255355293 0 Physicians Physician Services 00 1255356085 0 MISHRA VIVEK 2009274 9999999 B 10 1255356085 0 520 E 22ND ST LOMBARD IL 601486110 20 1255356085 0 Physicians Anesthesia Services 20 1255356085 0 Physicians Healthy Kids Services 20 1255356085 0 Physicians Optical Supplies 20 1255356085 0 Physicians Physician Services 00 1255356671 0 MILLER TIMOTHY 2007274 9999999 B 10 1255356671 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1255356671 0 Physicians Anesthesia Services 20 1255356671 0 Physicians Healthy Kids Services 20 1255356671 0 Physicians Optical Supplies 20 1255356671 0 Physicians Physician Services 20 1255356671 0 Physicians Physicians Psychiatric Services 00 1255356689 0 THOMAS ABRAHAM 2004174 9999999 B 10 1255356689 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1255356689 0 Physicians Anesthesia Services 20 1255356689 0 Physicians Fluoride varnish 20 1255356689 0 Physicians Healthy Kids Services 20 1255356689 0 Physicians Optical Supplies 20 1255356689 0 Physicians Physician Services 00 1255356762 0 MUNZIR SYED 2003213 9999999 B 10 1255356762 0 40 N AIRLITE ST STE 4 ELGIN IL 601234965 20 1255356762 0 Physicians Anesthesia Services 20 1255356762 0 Physicians Healthy Kids Services 20 1255356762 0 Physicians Optical Supplies 20 1255356762 0 Physicians Physician Services 20 1255356762 0 Physicians Physicians Psychiatric Services 00 1255357489 0 ZIPFEL GREGORY 2004214 9999999 B 10 1255357489 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1255357489 0 Physicians Anesthesia Services 20 1255357489 0 Physicians Healthy Kids Services 20 1255357489 0 Physicians Optical Supplies 20 1255357489 0 Physicians Physician Services 00 1255357562 0 GELTMAN EDWARD M 1981182 9999999 B 10 1255357562 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1255357562 0 Physicians Anesthesia Services 20 1255357562 0 Physicians Fluoride varnish 20 1255357562 0 Physicians Healthy Kids Services 20 1255357562 0 Physicians Optical Supplies 20 1255357562 0 Physicians Physician Services 00 1255357612 0 HAN PHYLLIS H 1997213 9999999 B 10 1255357612 0 44000 GARFIELD RD CLINTON TOWNSHI MI 480381125 20 1255357612 0 Physicians Anesthesia Services 20 1255357612 0 Physicians Healthy Kids Services 20 1255357612 0 Physicians Optical Supplies 20 1255357612 0 Physicians Physician Services 00 1255357778 0 MOOTH DAVID C 1996183 9999999 B 10 1255357778 0 929 STACEY BURK DR PO BOX 40 FLORA IL 628393241 20 1255357778 0 Physicians Anesthesia Services 20 1255357778 0 Physicians Healthy Kids Services 20 1255357778 0 Physicians Optical Supplies 20 1255357778 0 Physicians Physician Services 00 1255358776 0 SCHNEIDER STACY L 2006305 9999999 B 10 1255358776 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1255358776 0 Nurse Practitioners Healthy Kids Services 20 1255358776 0 Nurse Practitioners Nurse Practitioners Services 20 1255358776 0 Nurse Practitioners Physician Services 00 1255358883 0 ROSIER THOMAS A 1998244 9999999 B 10 1255358883 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1255358883 0 Physicians Anesthesia Services 20 1255358883 0 Physicians Healthy Kids Services 20 1255358883 0 Physicians Optical Supplies 20 1255358883 0 Physicians Physician Services 00 1255359543 0 PERKINS STEPHANIE MARBY 2012245 9999999 B 10 1255359543 0 PO BOX 7412011 CHICAGO IL 606742011 20 1255359543 0 Physicians Anesthesia Services 20 1255359543 0 Physicians Healthy Kids Services 20 1255359543 0 Physicians Optical Supplies 20 1255359543 0 Physicians Physician Services 00 1255359675 0 NEERHOF MARK GERALD 1991213 9999999 B 10 1255359675 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1255359675 0 Physicians Anesthesia Services 20 1255359675 0 Physicians Healthy Kids Services 20 1255359675 0 Physicians Optical Supplies 20 1255359675 0 Physicians Physician Services 00 1255359758 0 COON ANN G 2005233 9999999 B 10 1255359758 0 PO BOX 778912 CHICAGO IL 606778912 20 1255359758 0 Nurse Practitioners Fluoride varnish 20 1255359758 0 Nurse Practitioners Healthy Kids Services 20 1255359758 0 Nurse Practitioners Nurse Practitioners Services 20 1255359758 0 Nurse Practitioners Physician Services 00 1255359774 0 ROSS WILLIE R 1989213 9999999 B 10 1255359774 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1255359774 0 Physicians Anesthesia Services 20 1255359774 0 Physicians Fluoride varnish 20 1255359774 0 Physicians Healthy Kids Services 20 1255359774 0 Physicians Optical Supplies 20 1255359774 0 Physicians Physician Services 00 1255359899 0 BRANDES STEVEN 1998213 9999999 B 10 1255359899 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1255359899 0 Physicians Anesthesia Services 20 1255359899 0 Physicians Healthy Kids Services 20 1255359899 0 Physicians Optical Supplies 20 1255359899 0 Physicians Physician Services 00 1255359980 0 FREEMAN BRADLEY 1997182 9999999 B 10 1255359980 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1255359980 0 Physicians Anesthesia Services 20 1255359980 0 Physicians Healthy Kids Services 20 1255359980 0 Physicians Optical Supplies 20 1255359980 0 Physicians Physician Services 00 1255360715 0 HAFNER JOHN 1998182 9999999 B 10 1255360715 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1255360715 0 Physicians Anesthesia Services 20 1255360715 0 Physicians Healthy Kids Services 20 1255360715 0 Physicians Optical Supplies 20 1255360715 0 Physicians Physician Services 00 1255362000 0 KAISER ROBERT 1985182 9999999 B 10 1255362000 0 1880 W WINCHESTER RD STE 104 LIBERTYVILLE IL 600485321 20 1255362000 0 Physicians Anesthesia Services 20 1255362000 0 Physicians Fluoride varnish 20 1255362000 0 Physicians Healthy Kids Services 20 1255362000 0 Physicians Optical Supplies 20 1255362000 0 Physicians Physician Services 00 1255362265 0 DEBRAH CHARLES 2019070 9999999 B 10 1255362265 0 PO BOX 43230 PHOENIX AZ 850803230 20 1255362265 0 Physicians Anesthesia Services 20 1255362265 0 Physicians Healthy Kids Services 20 1255362265 0 Physicians Optical Supplies 20 1255362265 0 Physicians Physician Services 00 1255362430 0 LEIBOLD THOMAS M 2023307 9999999 B 10 1255362430 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1255362430 0 Physicians Anesthesia Services 20 1255362430 0 Physicians Healthy Kids Services 20 1255362430 0 Physicians Optical Supplies 20 1255362430 0 Physicians Physician Services 00 1255363305 0 BARINO MARIA NIDA V 1995205 9999999 B 10 1255363305 0 685 W BOUGHTON RD BOLINGBROOK IL 604401752 20 1255363305 0 Physicians Anesthesia Services 20 1255363305 0 Physicians Fluoride varnish 20 1255363305 0 Physicians Healthy Kids Services 20 1255363305 0 Physicians Optical Supplies 20 1255363305 0 Physicians Physician Services 00 1255363420 0 HOLLAND KRISTY L 2005091 9999999 B 10 1255363420 0 500 PORTER AVE AURORA MO 656052365 20 1255363420 0 Physicians Anesthesia Services 20 1255363420 0 Physicians Healthy Kids Services 20 1255363420 0 Physicians Optical Supplies 20 1255363420 0 Physicians Physician Services 00 1255363529 0 HOSKINS KENT F 1995191 9999999 B 10 1255363529 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1255363529 0 Physicians Anesthesia Services 20 1255363529 0 Physicians Fluoride varnish 20 1255363529 0 Physicians Healthy Kids Services 20 1255363529 0 Physicians Optical Supplies 20 1255363529 0 Physicians Physician Services 00 1255363651 0 CUNANAN ANTONIO 2022015 9999999 B 10 1255363651 0 PO BOX 43230 PHOENIX AZ 850803230 20 1255363651 0 Physicians Anesthesia Services 20 1255363651 0 Physicians Healthy Kids Services 20 1255363651 0 Physicians Optical Supplies 20 1255363651 0 Physicians Physician Services 00 1255364063 0 NIKOLICH SANJA 1995213 9999999 B 10 1255364063 0 8550 W BRYN MAWR AVE STE 800 CHICAGO IL 606313222 20 1255364063 0 Physicians Anesthesia Services 20 1255364063 0 Physicians Healthy Kids Services 20 1255364063 0 Physicians Optical Supplies 20 1255364063 0 Physicians Physician Services 00 1255366118 0 KEANE ROBERT A 2001216 9999999 B 10 1255366118 0 1200 E TREMONT ST HILLSBORO IL 620491912 20 1255366118 0 Physicians Anesthesia Services 20 1255366118 0 Physicians Fluoride varnish 20 1255366118 0 Physicians Healthy Kids Services 20 1255366118 0 Physicians Optical Supplies 20 1255366118 0 Physicians Physician Services 00 1255367603 0 HOLCOMB ROBERT 2022015 9999999 B 10 1255367603 0 PO BOX 412715 KANSAS CITY MO 641412715 20 1255367603 0 Physicians Anesthesia Services 20 1255367603 0 Physicians Fluoride varnish 20 1255367603 0 Physicians Healthy Kids Services 20 1255367603 0 Physicians Optical Supplies 20 1255367603 0 Physicians Physician Services 00 1255367868 0 SALSBERRY CINDY 2020335 9999999 B 10 1255367868 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1255367868 0 Nurse Practitioners Fluoride varnish 20 1255367868 0 Nurse Practitioners Healthy Kids Services 20 1255367868 0 Nurse Practitioners Nurse Practitioners Services 20 1255367868 0 Nurse Practitioners Physician Services 00 1255368353 0 MITCHELL RICHARD 2014001 9999999 B 10 1255368353 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1255368353 0 Physicians Anesthesia Services 20 1255368353 0 Physicians Healthy Kids Services 20 1255368353 0 Physicians Optical Supplies 20 1255368353 0 Physicians Physician Services 00 1255368395 0 MIKOLAJCZAK DAVID 1988162 9999999 B 10 1255368395 0 PO BOX 775231 CHICAGO IL 606775231 20 1255368395 0 Physicians Anesthesia Services 20 1255368395 0 Physicians Healthy Kids Services 20 1255368395 0 Physicians Optical Supplies 20 1255368395 0 Physicians Physician Services 00 1255368460 0 LEE JOSEPH R 2020298 9999999 B 10 1255368460 0 2695 ROCKY MOUNTAIN AVE STE 15 LOVELAND CO 805389071 20 1255368460 0 Physicians Anesthesia Services 20 1255368460 0 Physicians Fluoride varnish 20 1255368460 0 Physicians Healthy Kids Services 20 1255368460 0 Physicians Optical Supplies 20 1255368460 0 Physicians Physician Services 00 1255368890 0 HRYSZCZUK STEVEN W 2001213 9999999 B 10 1255368890 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1255368890 0 Physicians Anesthesia Services 20 1255368890 0 Physicians Healthy Kids Services 20 1255368890 0 Physicians Optical Supplies 20 1255368890 0 Physicians Physician Services 00 1255369534 0 LIGHT MICHAEL J 2024345 9999999 B 10 1255369534 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1255369534 0 Physicians Anesthesia Services 20 1255369534 0 Physicians Fluoride varnish 20 1255369534 0 Physicians Healthy Kids Services 20 1255369534 0 Physicians Optical Supplies 20 1255369534 0 Physicians Physician Services 00 1255369641 0 TJARKS MARY R 2000214 9999999 B 10 1255369641 0 600 JOHN DEERE RD STE 200 MOLINE IL 612656812 20 1255369641 0 Physicians Anesthesia Services 20 1255369641 0 Physicians Healthy Kids Services 20 1255369641 0 Physicians Optical Supplies 20 1255369641 0 Physicians Physician Services 00 1255370136 0 MARTINI MOHAMAD S 2000093 9999999 B 10 1255370136 0 PO BOX 781076 DETROIT MI 482781076 20 1255370136 0 Physicians Anesthesia Services 20 1255370136 0 Physicians Fluoride varnish 20 1255370136 0 Physicians Healthy Kids Services 20 1255370136 0 Physicians Optical Supplies 20 1255370136 0 Physicians Physician Services 00 1255370284 0 SZMYD TOMASZ 2006001 9999999 B 10 1255370284 0 5501 W BELMONT AVE CHICAGO IL 606414130 20 1255370284 0 Podiatrists Podiatric Services 00 1255370490 0 ROYSTON BETH A 2014226 9999999 B 10 1255370490 0 5777 DEPT CAROL STREAM IL 601220021 20 1255370490 0 Physicians Anesthesia Services 20 1255370490 0 Physicians Fluoride varnish 20 1255370490 0 Physicians Healthy Kids Services 20 1255370490 0 Physicians Optical Supplies 20 1255370490 0 Physicians Physician Services 00 1255370748 0 HARTMAN DAVID A 2021359 9999999 B 10 1255370748 0 301 JOHN ST # 42 KALAMAZOO MI 490075295 20 1255370748 0 Physicians Anesthesia Services 20 1255370748 0 Physicians Healthy Kids Services 20 1255370748 0 Physicians Optical Supplies 20 1255370748 0 Physicians Physician Services 00 1255370979 0 JIMENEZ YVONNE M 2004033 9999999 B 10 1255370979 0 35318 EAGLE WAY CHICAGO IL 606781353 20 1255370979 0 Physicians Anesthesia Services 20 1255370979 0 Physicians Fluoride varnish 20 1255370979 0 Physicians Healthy Kids Services 20 1255370979 0 Physicians Optical Supplies 20 1255370979 0 Physicians Physician Services 00 1255371415 0 PHILPOTT SHEILA 2020194 9999999 B 10 1255371415 0 PO BOX 43230 PHOENIX AZ 850803230 20 1255371415 0 Physicians Anesthesia Services 20 1255371415 0 Physicians Healthy Kids Services 20 1255371415 0 Physicians Optical Supplies 20 1255371415 0 Physicians Physician Services 00 1255371498 0 MOEED SYED 1996032 9999999 B 10 1255371498 0 3228 W 95TH ST EVERGREEN PARK IL 608052314 20 1255371498 0 Physicians Anesthesia Services 20 1255371498 0 Physicians Fluoride varnish 20 1255371498 0 Physicians Healthy Kids Services 20 1255371498 0 Physicians Optical Supplies 20 1255371498 0 Physicians Physician Services 00 1255371944 0 JOHNSON WILLIAM D 2020261 9999999 B 10 1255371944 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1255371944 0 Physicians Anesthesia Services 20 1255371944 0 Physicians Fluoride varnish 20 1255371944 0 Physicians Healthy Kids Services 20 1255371944 0 Physicians Optical Supplies 20 1255371944 0 Physicians Physician Services 00 1255372439 0 JENTILET DOUGLAS A 2018121 9999999 B 10 1255372439 0 29980 NETWORK PL CHICAGO IL 606734715 20 1255372439 0 Physicians Anesthesia Services 20 1255372439 0 Physicians Healthy Kids Services 20 1255372439 0 Physicians Optical Supplies 20 1255372439 0 Physicians Physician Services 00 1255373312 0 JIANG JINXING 2011213 9999999 B 10 1255373312 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1255373312 0 Physicians Anesthesia Services 20 1255373312 0 Physicians Healthy Kids Services 20 1255373312 0 Physicians Optical Supplies 20 1255373312 0 Physicians Physician Services 00 1255373395 0 DAVID AGARWAL 2000183 9999999 B 10 1255373395 0 250 N SHADELAND AVE STE 200 INDIANAPOLIS IN 462194959 20 1255373395 0 Physicians Anesthesia Services 20 1255373395 0 Physicians Healthy Kids Services 20 1255373395 0 Physicians Optical Supplies 20 1255373395 0 Physicians Physician Services 00 1255373759 0 GAGE DEBORAH 2022040 9999999 B 10 1255373759 0 246 OAKHURST CIR KISSIMMEE FL 347444752 20 1255373759 0 Physicians Anesthesia Services 20 1255373759 0 Physicians Fluoride varnish 20 1255373759 0 Physicians Healthy Kids Services 20 1255373759 0 Physicians Optical Supplies 20 1255373759 0 Physicians Physician Services 00 1255373866 0 NOWOBILSKA ANNA 1991001 9999999 B 10 1255373866 0 5257 S CICERO AVE CHICAGO IL 606324915 20 1255373866 0 Physicians Anesthesia Services 20 1255373866 0 Physicians Fluoride varnish 20 1255373866 0 Physicians Healthy Kids Services 20 1255373866 0 Physicians Optical Supplies 20 1255373866 0 Physicians Physician Services 00 1255374385 0 PATTERSON KATHERINE H 2008232 9999999 B 10 1255374385 0 250 N SHADELAND AVE STE 200 INDIANAPOLIS IN 462194959 20 1255374385 0 Physicians Anesthesia Services 20 1255374385 0 Physicians Healthy Kids Services 20 1255374385 0 Physicians Optical Supplies 20 1255374385 0 Physicians Physician Services 00 1255374708 0 LEE NITA KARNIK 2007244 9999999 B 10 1255374708 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1255374708 0 Physicians Anesthesia Services 20 1255374708 0 Physicians Healthy Kids Services 20 1255374708 0 Physicians Optical Supplies 20 1255374708 0 Physicians Physician Services 00 1255374781 0 LANGLEY JOHN 2021078 9999999 B 10 1255374781 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1255374781 0 Physicians Anesthesia Services 20 1255374781 0 Physicians Healthy Kids Services 20 1255374781 0 Physicians Optical Supplies 20 1255374781 0 Physicians Physician Services 00 1255375200 0 TREANOR MICHAEL 1989182 9999999 B 10 1255375200 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1255375200 0 Physicians Anesthesia Services 20 1255375200 0 Physicians Fluoride varnish 20 1255375200 0 Physicians Healthy Kids Services 20 1255375200 0 Physicians Optical Supplies 20 1255375200 0 Physicians Physician Services 00 1255375440 0 EGIEBOR OSBERT 1991203 9999999 B 10 1255375440 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1255375440 0 Physicians Anesthesia Services 20 1255375440 0 Physicians Healthy Kids Services 20 1255375440 0 Physicians Optical Supplies 20 1255375440 0 Physicians Physician Services 00 1255375515 0 MORTHLAND TIMOTHY E 2006182 9999999 B 10 1255375515 0 2250 N ILLINOIS AVE CARBONDALE IL 629015612 20 1255375515 0 Physicians Anesthesia Services 20 1255375515 0 Physicians Healthy Kids Services 20 1255375515 0 Physicians Optical Supplies 20 1255375515 0 Physicians Physician Services 00 1255375887 0 BARAKAT ROUBA 1998213 9999999 B 10 1255375887 0 7451 WOODWARD AVE STE 108 WOODRIDGE IL 605172665 20 1255375887 0 Physicians Anesthesia Services 20 1255375887 0 Physicians Fluoride varnish 20 1255375887 0 Physicians Healthy Kids Services 20 1255375887 0 Physicians Optical Supplies 20 1255375887 0 Physicians Physician Services 00 1255376026 0 PACHNER ROBERT W 1998039 9999999 B 10 1255376026 0 PO BOX 343918 MILWAUKEE WI 532343918 20 1255376026 0 Physicians Anesthesia Services 20 1255376026 0 Physicians Fluoride varnish 20 1255376026 0 Physicians Healthy Kids Services 20 1255376026 0 Physicians Optical Supplies 20 1255376026 0 Physicians Physician Services 00 1255376471 0 GO-LIM JOCELYN 1998222 9999999 B 10 1255376471 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1255376471 0 Physicians Anesthesia Services 20 1255376471 0 Physicians Fluoride varnish 20 1255376471 0 Physicians Healthy Kids Services 20 1255376471 0 Physicians Optical Supplies 20 1255376471 0 Physicians Physician Services 00 1255376885 0 LACROSSE MARILYN 2002335 9999999 B 10 1255376885 0 100 WITMER RD STE 220 SUITE 220 HORSHAM PA 190442279 20 1255376885 0 Physicians Anesthesia Services 20 1255376885 0 Physicians Fluoride varnish 20 1255376885 0 Physicians Healthy Kids Services 20 1255376885 0 Physicians Optical Supplies 20 1255376885 0 Physicians Physician Services 00 1255377321 0 GRIES AARON T 2003182 9999999 B 10 1255377321 0 PO BOX 3276 EVANSVILLE IN 477313276 20 1255377321 0 Physicians Anesthesia Services 20 1255377321 0 Physicians Healthy Kids Services 20 1255377321 0 Physicians Optical Supplies 20 1255377321 0 Physicians Physician Services 00 1255378832 0 GELMAN MIGUEL 2007001 9999999 B 10 1255378832 0 PO BOX 2153 DEPT 20002 BIRMINGHAM AL 352879216 20 1255378832 0 Physicians Anesthesia Services 20 1255378832 0 Physicians Healthy Kids Services 20 1255378832 0 Physicians Optical Supplies 20 1255378832 0 Physicians Physician Services 00 1255380325 0 CHOWDHURY PRITI 1995177 9999999 B 10 1255380325 0 8558 BROADWAY MERRILLVILLE IN 464107032 20 1255380325 0 Physicians Anesthesia Services 20 1255380325 0 Physicians Healthy Kids Services 20 1255380325 0 Physicians Optical Supplies 20 1255380325 0 Physicians Physician Services 00 1255380523 0 WINDSOR JIMMY J 2017108 9999999 B 10 1255380523 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1255380523 0 Physicians Anesthesia Services 20 1255380523 0 Physicians Healthy Kids Services 20 1255380523 0 Physicians Optical Supplies 20 1255380523 0 Physicians Physician Services 00 1255380689 0 SWIGONSKI NANCY L 1994105 9999999 B 10 1255380689 0 PO BOX 778912 CHICAGO IL 606778912 20 1255380689 0 Physicians Anesthesia Services 20 1255380689 0 Physicians Fluoride varnish 20 1255380689 0 Physicians Healthy Kids Services 20 1255380689 0 Physicians Optical Supplies 20 1255380689 0 Physicians Physician Services 00 1255380762 0 MOCK KRISTIN A 2000214 9999999 B 10 1255380762 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1255380762 0 Physicians Anesthesia Services 20 1255380762 0 Physicians Fluoride varnish 20 1255380762 0 Physicians Healthy Kids Services 20 1255380762 0 Physicians Optical Supplies 20 1255380762 0 Physicians Physician Services 00 1255381000 0 PURYEAR JEROME 2020343 9999999 B 10 1255381000 0 PO BOX 208807 DALLAS TX 753208807 20 1255381000 0 Physicians Anesthesia Services 20 1255381000 0 Physicians Healthy Kids Services 20 1255381000 0 Physicians Optical Supplies 20 1255381000 0 Physicians Physician Services 00 1255381877 0 MIKES PATRICIA S 1994045 9999999 B 10 1255381877 0 5777 DEPT CAROL STREAM IL 601228942 20 1255381877 0 Physicians Anesthesia Services 20 1255381877 0 Physicians Fluoride varnish 20 1255381877 0 Physicians Healthy Kids Services 20 1255381877 0 Physicians Optical Supplies 20 1255381877 0 Physicians Physician Services 00 1255381927 0 ONEILL IULIA 2003182 9999999 B 10 1255381927 0 PO BOX 713388 CHICAGO IL 606771525 20 1255381927 0 Physicians Anesthesia Services 20 1255381927 0 Physicians Fluoride varnish 20 1255381927 0 Physicians Healthy Kids Services 20 1255381927 0 Physicians Optical Supplies 20 1255381927 0 Physicians Physician Services 00 1255382099 0 KOCAK MEHMET 2009001 9999999 B 10 1255382099 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1255382099 0 Physicians Anesthesia Services 20 1255382099 0 Physicians Healthy Kids Services 20 1255382099 0 Physicians Optical Supplies 20 1255382099 0 Physicians Physician Services 00 1255382156 0 WILLIAMS ADRIENNE 2003307 9999999 B 10 1255382156 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1255382156 0 Physicians Anesthesia Services 20 1255382156 0 Physicians Healthy Kids Services 20 1255382156 0 Physicians Optical Supplies 20 1255382156 0 Physicians Physician Services 00 1255382529 0 LETZER DAVID M 1992183 9999999 B 10 1255382529 0 150 S SUNNY SLOPE RD STE 136 BROOKFIELD WI 530054858 20 1255382529 0 Physicians Anesthesia Services 20 1255382529 0 Physicians Fluoride varnish 20 1255382529 0 Physicians Healthy Kids Services 20 1255382529 0 Physicians Optical Supplies 20 1255382529 0 Physicians Physician Services 00 1255383220 0 OOSTENDORP KIM E 1993121 9999999 B 10 1255383220 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1255383220 0 Physical Therapists Medical Supplies 20 1255383220 0 Physical Therapists Medical equipment/prosthetic devices 20 1255383220 0 Physical Therapists Physical Therapy Services 00 1255383733 0 WIROSTKO WILLIAM 2002091 9999999 B 10 1255383733 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1255383733 0 Physicians Anesthesia Services 20 1255383733 0 Physicians Healthy Kids Services 20 1255383733 0 Physicians Optical Supplies 20 1255383733 0 Physicians Physician Services 00 1255383840 0 VETTER CAROLE 2001044 9999999 B 10 1255383840 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1255383840 0 Physicians Anesthesia Services 20 1255383840 0 Physicians Healthy Kids Services 20 1255383840 0 Physicians Optical Supplies 20 1255383840 0 Physicians Physician Services 00 1255384939 0 MULLIN KIMBERLY A 1990309 9999999 B 10 1255384939 0 5777 DEPT CAROL STREAM IL 601228942 20 1255384939 0 Physicians Anesthesia Services 20 1255384939 0 Physicians Healthy Kids Services 20 1255384939 0 Physicians Optical Supplies 20 1255384939 0 Physicians Physician Services 00 1255385258 0 TOMERA KEVIN M. 2017217 9999999 B 10 1255385258 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1255385258 0 Physicians Anesthesia Services 20 1255385258 0 Physicians Healthy Kids Services 20 1255385258 0 Physicians Optical Supplies 20 1255385258 0 Physicians Physician Services 00 1255385514 0 GURKA DAVID 1990274 9999999 B 10 1255385514 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1255385514 0 Physicians Anesthesia Services 20 1255385514 0 Physicians Fluoride varnish 20 1255385514 0 Physicians Healthy Kids Services 20 1255385514 0 Physicians Optical Supplies 20 1255385514 0 Physicians Physician Services 00 1255386785 0 PAVLATOS CHRIST 1990317 9999999 B 10 1255386785 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1255386785 0 Physicians Anesthesia Services 20 1255386785 0 Physicians Healthy Kids Services 20 1255386785 0 Physicians Optical Supplies 20 1255386785 0 Physicians Physician Services 00 1255387007 0 GOEL RAM L 1983052 9999999 B 10 1255387007 0 530 PARK AVE E STE 207 PRINCETON IL 613563902 20 1255387007 0 Physicians Anesthesia Services 20 1255387007 0 Physicians Fluoride varnish 20 1255387007 0 Physicians Healthy Kids Services 20 1255387007 0 Physicians Optical Supplies 20 1255387007 0 Physicians Physician Services 00 1255387437 0 KAISSAR GUY 2000082 9999999 B 10 1255387437 0 387 SHUMAN BLVD STE 240W NAPERVILLE IL 605638113 20 1255387437 0 Physicians Anesthesia Services 20 1255387437 0 Physicians Healthy Kids Services 20 1255387437 0 Physicians Optical Supplies 20 1255387437 0 Physicians Physician Services 00 1255387494 0 AL-JOUNDI TAMMAM 1996183 9999999 B 10 1255387494 0 400 MAPLE SUMMIT RD JERSEYVILLE IL 620522028 20 1255387494 0 Physicians Anesthesia Services 20 1255387494 0 Physicians Fluoride varnish 20 1255387494 0 Physicians Healthy Kids Services 20 1255387494 0 Physicians Optical Supplies 20 1255387494 0 Physicians Physician Services 00 1255387692 0 MUSSEMANN HELEN 2000245 9999999 B 10 1255387692 0 3230 VETERANS MEMORIAL DR MOUNT VERNON IL 628645950 20 1255387692 0 Physicians Anesthesia Services 20 1255387692 0 Physicians Healthy Kids Services 20 1255387692 0 Physicians Optical Supplies 20 1255387692 0 Physicians Physician Services 00 1255388286 0 AHDAB WADDAH 1996122 9999999 B 10 1255388286 0 9696 GORDON DR HIGHLAND IN 463222909 20 1255388286 0 Physicians Anesthesia Services 20 1255388286 0 Physicians Fluoride varnish 20 1255388286 0 Physicians HIV Counseling svcs 20 1255388286 0 Physicians Healthy Kids Services 20 1255388286 0 Physicians Optical Supplies 20 1255388286 0 Physicians Physician Services 00 1255388542 0 NAOM HASSAN F 1999244 9999999 B 10 1255388542 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1255388542 0 Physicians All Kids application agent 20 1255388542 0 Physicians Anesthesia Services 20 1255388542 0 Physicians Fluoride varnish 20 1255388542 0 Physicians Healthy Kids Services 20 1255388542 0 Physicians Optical Supplies 20 1255388542 0 Physicians Physician Services 00 1255388906 0 BOCHICCHIO GRANT V 2011182 9999999 B 10 1255388906 0 PO BOX 3988 CARBONDALE IL 629023988 20 1255388906 0 Physicians Anesthesia Services 20 1255388906 0 Physicians Healthy Kids Services 20 1255388906 0 Physicians Optical Supplies 20 1255388906 0 Physicians Physician Services 00 1255388955 0 STROTE JUSTIN 2019358 2028366 B 10 1255388955 0 2695 ROCKY MOUNTAIN AVE STE 15 LOVELAND CO 805389071 20 1255388955 0 Physicians Anesthesia Services 20 1255388955 0 Physicians Fluoride varnish 20 1255388955 0 Physicians Healthy Kids Services 20 1255388955 0 Physicians Optical Supplies 20 1255388955 0 Physicians Physician Services 00 1255389094 0 STAHLFELD KURT R 2023180 9999999 B 10 1255389094 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1255389094 0 Physicians Anesthesia Services 20 1255389094 0 Physicians Healthy Kids Services 20 1255389094 0 Physicians Optical Supplies 20 1255389094 0 Physicians Physician Services 00 1255390373 0 DESHAIES MARC R 1993182 9999999 B 10 1255390373 0 307 S EVERGREEN AVE WOODBURY NJ 080962739 20 1255390373 0 Physicians Anesthesia Services 20 1255390373 0 Physicians Healthy Kids Services 20 1255390373 0 Physicians Optical Supplies 20 1255390373 0 Physicians Physician Services 00 1255391116 0 WALCZYNSKI ANN 1981227 9999999 B 10 1255391116 0 7447 W TALCOTT AVE STE 225 CHICAGO IL 606313713 20 1255391116 0 Physicians Anesthesia Services 20 1255391116 0 Physicians Healthy Kids Services 20 1255391116 0 Physicians Optical Supplies 20 1255391116 0 Physicians Physician Services 20 1255391116 0 Physicians Physicians Psychiatric Services 00 1255392189 0 SCHNEIDER THOMAS A 2011351 9999999 B 10 1255392189 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1255392189 0 Physicians Anesthesia Services 20 1255392189 0 Physicians Healthy Kids Services 20 1255392189 0 Physicians Optical Supplies 20 1255392189 0 Physicians Physician Services 00 1255393476 0 KARMAN STEPHEN 2017001 9999999 B 10 1255393476 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1255393476 0 Physicians Anesthesia Services 20 1255393476 0 Physicians Fluoride varnish 20 1255393476 0 Physicians Healthy Kids Services 20 1255393476 0 Physicians Optical Supplies 20 1255393476 0 Physicians Physician Services 00 1255393716 0 PETZCHEN MARCELLA 2000092 9999999 B 10 1255393716 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1255393716 0 Nurse Practitioners Healthy Kids Services 20 1255393716 0 Nurse Practitioners Nurse Practitioners Services 20 1255393716 0 Nurse Practitioners Physician Services 00 1255393732 0 COSGROVE COUNTS KRISTEN 2007316 9999999 B 10 1255393732 0 28594 NETWORK PL CHICAGO IL 606731285 20 1255393732 0 Physicians Anesthesia Services 20 1255393732 0 Physicians Fluoride varnish 20 1255393732 0 Physicians Healthy Kids Services 20 1255393732 0 Physicians Optical Supplies 20 1255393732 0 Physicians Physician Services 00 1255393773 0 GANDHI MANISH RATI 1981227 9999999 B 10 1255393773 0 38865 DEQUINDRE RD STE 105 TROY MI 480836812 20 1255393773 0 Dentists Dental Services 20 1255393773 0 Dentists Physician Services 00 1255393997 0 RAMSEY LAURA J 2016118 9999999 B 10 1255393997 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1255393997 0 Nurse Practitioners Fluoride varnish 20 1255393997 0 Nurse Practitioners Healthy Kids Services 20 1255393997 0 Nurse Practitioners Nurse Practitioners Services 20 1255393997 0 Nurse Practitioners Physician Services 00 1255394722 0 MIGNOLI MICHAEL 2022313 9999999 B 10 1255394722 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1255394722 0 Physicians Anesthesia Services 20 1255394722 0 Physicians Fluoride varnish 20 1255394722 0 Physicians Healthy Kids Services 20 1255394722 0 Physicians Optical Supplies 20 1255394722 0 Physicians Physician Services 00 1255394797 0 FOLTZ TAMARA 2012012 9999999 B 10 1255394797 0 200 OCEANGATE STE 100 LONG BEACH CA 908024317 20 1255394797 0 Nurse Practitioners Fluoride varnish 20 1255394797 0 Nurse Practitioners Healthy Kids Services 20 1255394797 0 Nurse Practitioners Nurse Practitioners Services 20 1255394797 0 Nurse Practitioners Nursing service 20 1255394797 0 Nurse Practitioners Physician Services 20 1255394797 0 Nurse Practitioners Waiver service 00 1255395687 0 ELBENDARY ALAA A 1996214 9999999 B 10 1255395687 0 3015 N BALLAS RD SAINT LOUIS MO 631312329 20 1255395687 0 Physicians Anesthesia Services 20 1255395687 0 Physicians Healthy Kids Services 20 1255395687 0 Physicians Optical Supplies 20 1255395687 0 Physicians Physician Services 00 1255395976 0 ILLGEN RICHARD L 2000241 9999999 B 10 1255395976 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1255395976 0 Physicians Anesthesia Services 20 1255395976 0 Physicians Healthy Kids Services 20 1255395976 0 Physicians Optical Supplies 20 1255395976 0 Physicians Physician Services 00 1255396347 0 LADD PHILLIP 2015147 9999999 H 10 1255396347 0 3716 W BRIGHTON AVE PEORIA IL 616152938 20 1255396347 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1255396495 0 RHYNE STEVE A 2007092 9999999 B 10 1255396495 0 PO BOX 801143 KANSAS CITY MO 641801860 20 1255396495 0 Nurse Practitioners Anesthesia Services 20 1255396495 0 Nurse Practitioners Nurse Practitioners Services 20 1255396495 0 Nurse Practitioners Physician Services 00 1255396511 0 JONES CICILY 2000259 9999999 B 10 1255396511 0 620 N RIVER RD STE 102 STE. 102 NAPERVILLE IL 605638951 20 1255396511 0 Physicians Anesthesia Services 20 1255396511 0 Physicians Fluoride varnish 20 1255396511 0 Physicians Healthy Kids Services 20 1255396511 0 Physicians Optical Supplies 20 1255396511 0 Physicians Physician Services 00 1255396636 0 FORSEN JAMES W 2023058 9999999 B 10 1255396636 0 607 S NEW BALLAS RD STE 2300 SAINT LOUIS MO 631418234 20 1255396636 0 Physicians Anesthesia Services 20 1255396636 0 Physicians Healthy Kids Services 20 1255396636 0 Physicians Optical Supplies 20 1255396636 0 Physicians Physician Services 00 1255397519 0 RIEDER JEFFREY S 2018213 9999999 B 10 1255397519 0 1033 SAINT ANDREWS BLVD CHARLESTON SC 294077156 20 1255397519 0 Physicians Anesthesia Services 20 1255397519 0 Physicians Fluoride varnish 20 1255397519 0 Physicians Healthy Kids Services 20 1255397519 0 Physicians Optical Supplies 20 1255397519 0 Physicians Physician Services 00 1255398558 0 CONNOLLY LAURA L 2016238 9999999 B 10 1255398558 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1255398558 0 Physician Assistant Only Fluoride varnish 20 1255398558 0 Physician Assistant Only Healthy Kids Services 20 1255398558 0 Physician Assistant Only Physician Services 00 1255399028 0 ANDERSON STEPHEN H 2020328 9999999 B 10 1255399028 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1255399028 0 Physicians Anesthesia Services 20 1255399028 0 Physicians Healthy Kids Services 20 1255399028 0 Physicians Optical Supplies 20 1255399028 0 Physicians Physician Services 00 1255399242 0 PYATT STUART L 1994152 9999999 B 10 1255399242 0 1005 BROADWAY ST QUINCY IL 623012834 20 1255399242 0 Physicians Anesthesia Services 20 1255399242 0 Physicians Healthy Kids Services 20 1255399242 0 Physicians Optical Supplies 20 1255399242 0 Physicians Physician Services 00 1255399267 0 VENKAT ARUN 2010104 9999999 B 10 1255399267 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1255399267 0 Physicians Anesthesia Services 20 1255399267 0 Physicians Fluoride varnish 20 1255399267 0 Physicians Healthy Kids Services 20 1255399267 0 Physicians Optical Supplies 20 1255399267 0 Physicians Physician Services 00 1255399481 0 RAO ANUPAMA K 2017213 9999999 B 10 1255399481 0 75 REMITTANCE DR DEPT 1611 CHICAGO IL 606751611 20 1255399481 0 Physicians Anesthesia Services 20 1255399481 0 Physicians Fluoride varnish 20 1255399481 0 Physicians Healthy Kids Services 20 1255399481 0 Physicians Optical Supplies 20 1255399481 0 Physicians Physician Services 00 1255399739 0 GESSERT GLENN E 1990001 9999999 B 10 1255399739 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1255399739 0 Physicians Anesthesia Services 20 1255399739 0 Physicians Healthy Kids Services 20 1255399739 0 Physicians Optical Supplies 20 1255399739 0 Physicians Physician Services 00 1255401261 0 DECROES CARINA L 2006212 9999999 B 10 1255401261 0 5777 DEPT CAROL STREAM IL 601220021 20 1255401261 0 Nurse Practitioners Healthy Kids Services 20 1255401261 0 Nurse Practitioners Nurse Practitioners Services 20 1255401261 0 Nurse Practitioners Physician Services 00 1255401899 0 GRINTER JASON 2005192 9999999 B 10 1255401899 0 555 N COURT ST STE 100 ROCKFORD IL 611036898 20 1255401899 0 Dentists Dental Services 20 1255401899 0 Dentists Physician Services 00 1255401998 0 KURTZ CATHY 2006001 9999999 B 10 1255401998 0 611 W PARK ST URBANA IL 618012529 20 1255401998 0 Nurse Practitioners Fluoride varnish 20 1255401998 0 Nurse Practitioners Healthy Kids Services 20 1255401998 0 Nurse Practitioners Nurse Practitioners Services 20 1255401998 0 Nurse Practitioners Physician Services 00 1255402673 0 BISSONNETTE BRUCE 1984187 9999999 B 10 1255402673 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1255402673 0 Physicians Anesthesia Services 20 1255402673 0 Physicians Fluoride varnish 20 1255402673 0 Physicians Healthy Kids Services 20 1255402673 0 Physicians Optical Supplies 20 1255402673 0 Physicians Physician Services 00 1255403416 0 BUTLER ELIZABETH G 2008165 9999999 B 10 1255403416 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1255403416 0 Physicians Anesthesia Services 20 1255403416 0 Physicians Healthy Kids Services 20 1255403416 0 Physicians Optical Supplies 20 1255403416 0 Physicians Physician Services 00 1255405395 0 LUCAS RAYMOND 2020304 9999999 B 10 1255405395 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1255405395 0 Physicians Anesthesia Services 20 1255405395 0 Physicians Healthy Kids Services 20 1255405395 0 Physicians Optical Supplies 20 1255405395 0 Physicians Physician Services 00 1255405452 0 ALVA MANUEL E 1993182 9999999 B 10 1255405452 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1255405452 0 Physicians Anesthesia Services 20 1255405452 0 Physicians Healthy Kids Services 20 1255405452 0 Physicians Optical Supplies 20 1255405452 0 Physicians Physician Services 00 1255405627 0 PATEL ANNA 2014182 9999999 B 10 1255405627 0 20 TOWER CT STE F SUITE F GURNEE IL 600315711 20 1255405627 0 Physicians Anesthesia Services 20 1255405627 0 Physicians Fluoride varnish 20 1255405627 0 Physicians Healthy Kids Services 20 1255405627 0 Physicians Optical Supplies 20 1255405627 0 Physicians Physician Services 00 1255406518 0 YE ZHONG 1996061 9999999 B 10 1255406518 0 909 E GRANT ST MACOMB IL 614553371 20 1255406518 0 Physicians Anesthesia Services 20 1255406518 0 Physicians Healthy Kids Services 20 1255406518 0 Physicians Optical Supplies 20 1255406518 0 Physicians Physician Services 00 1255407755 0 PETERSON TIMOTHY 1992214 9999999 B 10 1255407755 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1255407755 0 Physicians Anesthesia Services 20 1255407755 0 Physicians Healthy Kids Services 20 1255407755 0 Physicians Optical Supplies 20 1255407755 0 Physicians Physician Services 00 1255408878 0 MCCLELLAN LESLIE 1998127 9999999 B 10 1255408878 0 3601 SW 160TH AVE STE 250 SUITE 250 MIRAMAR FL 330276314 20 1255408878 0 Physicians Anesthesia Services 20 1255408878 0 Physicians Healthy Kids Services 20 1255408878 0 Physicians Optical Supplies 20 1255408878 0 Physicians Physician Services 00 1255409017 0 VULETICH MARK 2011220 9999999 B 10 1255409017 0 PO BOX 80280 PHILADELPHIA PA 191011280 20 1255409017 0 Physicians Anesthesia Services 20 1255409017 0 Physicians Healthy Kids Services 20 1255409017 0 Physicians Optical Supplies 20 1255409017 0 Physicians Physician Services 00 1255410072 0 HARAZIN JAMES 1990058 9999999 B 10 1255410072 0 PO BOX 713388 CHICAGO IL 606771525 20 1255410072 0 Physicians Anesthesia Services 20 1255410072 0 Physicians Fluoride varnish 20 1255410072 0 Physicians Healthy Kids Services 20 1255410072 0 Physicians Optical Supplies 20 1255410072 0 Physicians Physician Services 00 1255410254 0 KING DANIEL 1993305 9999999 B 10 1255410254 0 5804 LAWN DR WESTERN SPRINGS IL 605582227 20 1255410254 0 Physical Therapists Medical Supplies 20 1255410254 0 Physical Therapists Medical equipment/prosthetic devices 20 1255410254 0 Physical Therapists Physical Therapy Services 00 1255412169 0 INTRIERI CORIN L 2009084 9999999 B 10 1255412169 0 2431 GLENMOUNT CT BELLEVILLE IL 622218803 20 1255412169 0 Occupational Therapists Medical Supplies 20 1255412169 0 Occupational Therapists Medical equipment/prosthetic devices 20 1255412169 0 Occupational Therapists Occupational Therapy Services 00 1255412193 0 TAKHTEHCHIAN DARIUSH S 2007227 9999999 B 10 1255412193 0 29373 NETWORK PL CHICAGO IL 606733039 20 1255412193 0 Physicians Anesthesia Services 20 1255412193 0 Physicians Fluoride varnish 20 1255412193 0 Physicians Healthy Kids Services 20 1255412193 0 Physicians Optical Supplies 20 1255412193 0 Physicians Physician Services 00 1255413225 0 LICHTENBERG VICTOR 1982182 9999999 B 10 1255413225 0 20 TOWER CT STE F SUITE F GURNEE IL 600315711 20 1255413225 0 Physicians Anesthesia Services 20 1255413225 0 Physicians Healthy Kids Services 20 1255413225 0 Physicians Optical Supplies 20 1255413225 0 Physicians Physician Services 00 1255413852 0 BULA MELANIA L 2008322 9999999 B 10 1255413852 0 29373 NETWORK PL CHICAGO IL 606733039 20 1255413852 0 Physicians Anesthesia Services 20 1255413852 0 Physicians Healthy Kids Services 20 1255413852 0 Physicians Optical Supplies 20 1255413852 0 Physicians Physician Services 00 1255413878 0 MICHALIK CYNTHIA 1984214 9999999 B 10 1255413878 0 PO BOX 250310 WEST BLOOMFIELD MI 483250310 20 1255413878 0 Dentists Dental Services 20 1255413878 0 Dentists Physician Services 00 1255414801 0 CRYSTAL DEBRA 2000001 9999999 B 10 1255414801 0 5777 DEPT CAROL STREAM IL 601220021 20 1255414801 0 Clinical Social Worker Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1255414801 0 Clinical Social Worker Social work service 00 1255417382 0 DAYHOFF CLYDE 1998182 9999999 B 10 1255417382 0 692 N MAPLE ST HERSCHER IL 609419785 20 1255417382 0 Physicians Anesthesia Services 20 1255417382 0 Physicians Fluoride varnish 20 1255417382 0 Physicians Healthy Kids Services 20 1255417382 0 Physicians Optical Supplies 20 1255417382 0 Physicians Physician Services 00 1255417754 0 POLITIS DEMETRIOS V 2023104 9999999 B 10 1255417754 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1255417754 0 Physicians Anesthesia Services 20 1255417754 0 Physicians Fluoride varnish 20 1255417754 0 Physicians Healthy Kids Services 20 1255417754 0 Physicians Optical Supplies 20 1255417754 0 Physicians Physician Services 00 1255418026 0 PATEL SONAL 2002280 9999999 B 10 1255418026 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1255418026 0 Physicians Anesthesia Services 20 1255418026 0 Physicians Fluoride varnish 20 1255418026 0 Physicians Healthy Kids Services 20 1255418026 0 Physicians Optical Supplies 20 1255418026 0 Physicians Physician Services 00 1255418299 0 NESTRUD MEGAN 2021091 9999999 B 10 1255418299 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1255418299 0 Nurse Practitioners Healthy Kids Services 20 1255418299 0 Nurse Practitioners Nurse Practitioners Services 20 1255418299 0 Nurse Practitioners Physician Services 00 1255418406 0 MCMAHON TIMOTHY 2000287 9999999 B 10 1255418406 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1255418406 0 Optometrists Optical Supplies 20 1255418406 0 Optometrists Optometric Services 20 1255418406 0 Optometrists Physician Services 00 1255418927 0 ZEE PHYLLIS C 1987182 9999999 B 10 1255418927 0 5777 DEPT CAROL STREAM IL 601220021 20 1255418927 0 Physicians Anesthesia Services 20 1255418927 0 Physicians Healthy Kids Services 20 1255418927 0 Physicians Optical Supplies 20 1255418927 0 Physicians Physician Services 20 1255418927 0 Physicians Physicians Psychiatric Services 00 1255418984 0 RODRIGUEZ MIGUEL 2023047 9999999 B 10 1255418984 0 4701 DEPT CAROL STREAM IL 601220021 20 1255418984 0 Physicians Anesthesia Services 20 1255418984 0 Physicians Healthy Kids Services 20 1255418984 0 Physicians Optical Supplies 20 1255418984 0 Physicians Physician Services 00 1255420030 0 VIDOVICH DANKO 2014168 9999999 B 10 1255420030 0 903 COMMERCE DR STE 333 SUITE 333 OAK BROOK IL 605238723 20 1255420030 0 Physicians Anesthesia Services 20 1255420030 0 Physicians Healthy Kids Services 20 1255420030 0 Physicians Optical Supplies 20 1255420030 0 Physicians Physician Services 00 1255420451 0 KOOP JAMES 1994213 9999999 B 10 1255420451 0 701 W NORTH AVE MELROSE PARK IL 601601612 20 1255420451 0 Physicians Anesthesia Services 20 1255420451 0 Physicians Fluoride varnish 20 1255420451 0 Physicians Healthy Kids Services 20 1255420451 0 Physicians Optical Supplies 20 1255420451 0 Physicians Physician Services 00 1255420881 0 ANDERSON JOSHUA 2012048 9999999 B 10 1255420881 0 4714 GETTYSBURG RD MECHANICSBURG PA 170554325 20 1255420881 0 Physical Therapists Medical Supplies 20 1255420881 0 Physical Therapists Medical equipment/prosthetic devices 20 1255420881 0 Physical Therapists Physical Therapy Services 00 1255421533 0 PRATT ELLEN L 2003174 9999999 B 10 1255421533 0 1025 MAINE ST QUINCY IL 623014038 20 1255421533 0 Physicians Anesthesia Services 20 1255421533 0 Physicians Fluoride varnish 20 1255421533 0 Physicians Healthy Kids Services 20 1255421533 0 Physicians Optical Supplies 20 1255421533 0 Physicians Physician Services 00 1255421558 0 MILLER MICHAEL 1998213 9999999 B 10 1255421558 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1255421558 0 Physicians Anesthesia Services 20 1255421558 0 Physicians Fluoride varnish 20 1255421558 0 Physicians Healthy Kids Services 20 1255421558 0 Physicians Optical Supplies 20 1255421558 0 Physicians Physician Services 00 1255422606 0 SONG HYUN M 2020252 9999999 B 10 1255422606 0 5400 KENNEDY AVE CINCINNATI OH 452132664 20 1255422606 0 Physicians Anesthesia Services 20 1255422606 0 Physicians Healthy Kids Services 20 1255422606 0 Physicians Optical Supplies 20 1255422606 0 Physicians Physician Services 00 1255423737 0 WESTERGAARD RYAN 2011182 9999999 B 10 1255423737 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1255423737 0 Physicians Anesthesia Services 20 1255423737 0 Physicians Fluoride varnish 20 1255423737 0 Physicians Healthy Kids Services 20 1255423737 0 Physicians Optical Supplies 20 1255423737 0 Physicians Physician Services 00 1255424750 0 HONAN MICHAEL P 2003182 9999999 B 10 1255424750 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1255424750 0 Physicians Anesthesia Services 20 1255424750 0 Physicians Fluoride varnish 20 1255424750 0 Physicians Healthy Kids Services 20 1255424750 0 Physicians Optical Supplies 20 1255424750 0 Physicians Physician Services 00 1255424792 0 PRUSS SHERESE 2014223 9999999 B 10 1255424792 0 725 SCHOOL ST STE A MORRIS IL 604501207 20 1255424792 0 Nurse Practitioners Fluoride varnish 20 1255424792 0 Nurse Practitioners Healthy Kids Services 20 1255424792 0 Nurse Practitioners Nurse Practitioners Services 20 1255424792 0 Nurse Practitioners Physician Services 00 1255426169 0 WILLIAMS STEVEN 1993235 9999999 B 10 1255426169 0 350 N WALL ST KANKAKEE IL 609012901 20 1255426169 0 Physicians Anesthesia Services 20 1255426169 0 Physicians Healthy Kids Services 20 1255426169 0 Physicians Optical Supplies 20 1255426169 0 Physicians Physician Services 00 1255426672 0 GOYAL MANU 2014152 9999999 B 10 1255426672 0 PO BOX 60352 SAINT LOUIS MO 631600352 20 1255426672 0 Physicians Anesthesia Services 20 1255426672 0 Physicians Healthy Kids Services 20 1255426672 0 Physicians Optical Supplies 20 1255426672 0 Physicians Physician Services 00 1255427779 0 CLEMENTS DEBORAH S 2014121 9999999 B 10 1255427779 0 5777 DEPT CAROL STREAM IL 601228942 20 1255427779 0 Physicians Anesthesia Services 20 1255427779 0 Physicians Fluoride varnish 20 1255427779 0 Physicians Healthy Kids Services 20 1255427779 0 Physicians Optical Supplies 20 1255427779 0 Physicians Physician Services 00 1255428157 0 ATTASSI KINAN 2007078 9999999 B 10 1255428157 0 9696 GORDON DR HIGHLAND IN 463222909 20 1255428157 0 Physicians Anesthesia Services 20 1255428157 0 Physicians Fluoride varnish 20 1255428157 0 Physicians Healthy Kids Services 20 1255428157 0 Physicians Optical Supplies 20 1255428157 0 Physicians Physician Services 00 1255428363 0 GORDEN DAVID LEE 2017110 9999999 B 10 1255428363 0 DEPT AT 40379 ATLANTA GA 311920379 20 1255428363 0 Physicians Anesthesia Services 20 1255428363 0 Physicians Healthy Kids Services 20 1255428363 0 Physicians Optical Supplies 20 1255428363 0 Physicians Physician Services 00 1255428538 0 AWAN MUHAMMAD S 1991354 9999999 B 10 1255428538 0 PO BOX 80309 PHILADELPHIA PA 191011309 20 1255428538 0 Physicians Anesthesia Services 20 1255428538 0 Physicians Fluoride varnish 20 1255428538 0 Physicians Healthy Kids Services 20 1255428538 0 Physicians Optical Supplies 20 1255428538 0 Physicians Physician Services 00 1255428769 0 MUNOZ MARIA M 1985116 9999999 B 10 1255428769 0 5318 W LAWRENCE AVE CHICAGO IL 606303618 20 1255428769 0 Physicians Anesthesia Services 20 1255428769 0 Physicians Healthy Kids Services 20 1255428769 0 Physicians Optical Supplies 20 1255428769 0 Physicians Physician Services 00 1255430039 0 AUGE VERNA L 2023061 9999999 B 10 1255430039 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1255430039 0 Nurse Practitioners Anesthesia Services 20 1255430039 0 Nurse Practitioners Nurse Practitioners Services 20 1255430039 0 Nurse Practitioners Physician Services 00 1255431128 0 LEE JOANNE M 2017326 9999999 B 10 1255431128 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1255431128 0 Physicians Anesthesia Services 20 1255431128 0 Physicians Healthy Kids Services 20 1255431128 0 Physicians Optical Supplies 20 1255431128 0 Physicians Physician Services 00 1255431524 0 HOLSINGER JILL R 2021073 9999999 B 10 1255431524 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1255431524 0 Physicians Anesthesia Services 20 1255431524 0 Physicians Healthy Kids Services 20 1255431524 0 Physicians Optical Supplies 20 1255431524 0 Physicians Physician Services 00 1255431870 0 WITKOWSKI LISA 2024221 9999999 B 10 1255431870 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1255431870 0 Physician Assistant Only Fluoride varnish 20 1255431870 0 Physician Assistant Only Healthy Kids Services 20 1255431870 0 Physician Assistant Only Physician Services 00 1255431912 0 MACZULSKI JO A 1997001 9999999 B 10 1255431912 0 18400 E BELVIDERE RD APT 314 GRAYSLAKE IL 600309207 20 1255431912 0 Occupational Therapists Medical Supplies 20 1255431912 0 Occupational Therapists Medical equipment/prosthetic devices 20 1255431912 0 Occupational Therapists Occupational Therapy Services 00 1255432134 0 KENZER STEVEN 2008214 9999999 B 10 1255432134 0 2900 W OKLAHOMA AVE MILWAUKEE WI 532154330 20 1255432134 0 Physicians Anesthesia Services 20 1255432134 0 Physicians Fluoride varnish 20 1255432134 0 Physicians Healthy Kids Services 20 1255432134 0 Physicians Optical Supplies 20 1255432134 0 Physicians Physician Services 00 1255433728 0 LEVY MARK 1993182 9999999 B 10 1255433728 0 4959 GOLF RD SKOKIE IL 600771537 20 1255433728 0 Physicians Anesthesia Services 20 1255433728 0 Physicians Fluoride varnish 20 1255433728 0 Physicians Healthy Kids Services 20 1255433728 0 Physicians Optical Supplies 20 1255433728 0 Physicians Physician Services 00 1255435285 0 SAWHNEY NIRAJ 2020163 9999999 B 10 1255435285 0 6308 8TH AVE KENOSHA WI 531435031 20 1255435285 0 Physicians Anesthesia Services 20 1255435285 0 Physicians Fluoride varnish 20 1255435285 0 Physicians Healthy Kids Services 20 1255435285 0 Physicians Optical Supplies 20 1255435285 0 Physicians Physician Services 00 1255435293 0 FOERST JASON 2020257 9999999 B 10 1255435293 0 PO BOX 43230 PHOENIX AZ 850803230 20 1255435293 0 Physicians Anesthesia Services 20 1255435293 0 Physicians Fluoride varnish 20 1255435293 0 Physicians Healthy Kids Services 20 1255435293 0 Physicians Optical Supplies 20 1255435293 0 Physicians Physician Services 00 1255436192 0 LEE MICHELLE 2007182 9999999 B 10 1255436192 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1255436192 0 Physicians Anesthesia Services 20 1255436192 0 Physicians Healthy Kids Services 20 1255436192 0 Physicians Optical Supplies 20 1255436192 0 Physicians Physician Services 00 1255437109 0 PETERSEND PAUL L 2023023 9999999 B 10 1255437109 0 PO BOX 41220 PHOENIX AZ 850801220 20 1255437109 0 Physicians Anesthesia Services 20 1255437109 0 Physicians Healthy Kids Services 20 1255437109 0 Physicians Optical Supplies 20 1255437109 0 Physicians Physician Services 00 1255437760 0 ROSENFELD ALAN 2013178 9999999 B 10 1255437760 0 7732 SOLUTION CENTER CHICAGO IL 606777007 20 1255437760 0 Dentists Dental Services 20 1255437760 0 Dentists Physician Services 00 1255438313 0 NELSON LORI J 2007011 9999999 B 10 1255438313 0 4215 NEWBURG RD ROCKFORD IL 611086479 20 1255438313 0 Nurse Practitioners Healthy Kids Services 20 1255438313 0 Nurse Practitioners Nurse Practitioners Services 20 1255438313 0 Nurse Practitioners Physician Services 00 1255438735 0 PIZINGER RYAN 2012240 9999999 B 10 1255438735 0 PO BOX 5009 BRENTWOOD TN 370245009 20 1255438735 0 Physicians Anesthesia Services 20 1255438735 0 Physicians Healthy Kids Services 20 1255438735 0 Physicians Optical Supplies 20 1255438735 0 Physicians Physician Services 00 1255439105 0 PENN MELISSA 2009305 9999999 B 10 1255439105 0 1005 BROADWAY ST QUINCY IL 623012834 20 1255439105 0 Clinical Social Worker Social work service 00 1255440954 0 CAMPAU STEVEN A 1996214 9999999 B 10 1255440954 0 900 W IL ROUTE 22 STE 100 LAKE ZURICH IL 600473416 20 1255440954 0 Physicians Anesthesia Services 20 1255440954 0 Physicians Fluoride varnish 20 1255440954 0 Physicians Healthy Kids Services 20 1255440954 0 Physicians Optical Supplies 20 1255440954 0 Physicians Physician Services 00 1255441275 0 BUCCIERO MICHELE A 2006121 9999999 B 10 1255441275 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1255441275 0 Physicians All Kids application agent 20 1255441275 0 Physicians Anesthesia Services 20 1255441275 0 Physicians Healthy Kids Services 20 1255441275 0 Physicians Optical Supplies 20 1255441275 0 Physicians Physician Services 00 1255442117 0 PATEL HINA H 2000245 9999999 B 10 1255442117 0 387 SHUMAN BLVD STE 240W NAPERVILLE IL 605638113 20 1255442117 0 Physicians Anesthesia Services 20 1255442117 0 Physicians Healthy Kids Services 20 1255442117 0 Physicians Optical Supplies 20 1255442117 0 Physicians Physician Services 00 1255443412 0 WAGNER STEPHEN P 2018102 9999999 B 10 1255443412 0 515 22ND AVE MONROE WI 535661569 20 1255443412 0 Physicians Anesthesia Services 20 1255443412 0 Physicians Healthy Kids Services 20 1255443412 0 Physicians Optical Supplies 20 1255443412 0 Physicians Physician Services 00 1255443537 0 GOLDRATH DAVID E 1990255 9999999 B 10 1255443537 0 22285 N PEPPER RD STE 201 LAKE BARRINGTON IL 600102540 20 1255443537 0 Physicians Anesthesia Services 20 1255443537 0 Physicians Healthy Kids Services 20 1255443537 0 Physicians Optical Supplies 20 1255443537 0 Physicians Physician Services 00 1255443594 0 SHEFTEL DAVID N 1983047 9999999 B 10 1255443594 0 29373 NETWORK PL CHICAGO IL 606733039 20 1255443594 0 Physicians Anesthesia Services 20 1255443594 0 Physicians Fluoride varnish 20 1255443594 0 Physicians Healthy Kids Services 20 1255443594 0 Physicians Optical Supplies 20 1255443594 0 Physicians Physician Services 00 1255444725 0 ERDOS BRANDON Z 2018283 9999999 B 10 1255444725 0 19990 GOVERNORS HWY OLYMPIA FIELDS IL 604611021 20 1255444725 0 Physicians Anesthesia Services 20 1255444725 0 Physicians Healthy Kids Services 20 1255444725 0 Physicians Optical Supplies 20 1255444725 0 Physicians Physician Services 20 1255444725 0 Physicians Physicians Psychiatric Services 00 1255444915 0 COLBERT CHRISTOPHER 2006241 9999999 B 10 1255444915 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1255444915 0 Physicians Anesthesia Services 20 1255444915 0 Physicians Healthy Kids Services 20 1255444915 0 Physicians Optical Supplies 20 1255444915 0 Physicians Physician Services 00 1255446100 0 TAGGE EDWARD P 2021269 9999999 B 10 1255446100 0 268 W HOSPITALITY LN STE 300 SAN BERNARDINO CA 924083234 20 1255446100 0 Physicians Anesthesia Services 20 1255446100 0 Physicians Healthy Kids Services 20 1255446100 0 Physicians Optical Supplies 20 1255446100 0 Physicians Physician Services 00 1255446423 0 DYKSTERHOUSE DWIGHT L 1998039 9999999 B 10 1255446423 0 2414 KOHLER MEMORIAL DR SHEBOYGAN WI 530813129 20 1255446423 0 Physicians Anesthesia Services 20 1255446423 0 Physicians Healthy Kids Services 20 1255446423 0 Physicians Optical Supplies 20 1255446423 0 Physicians Physician Services 00 1255446886 0 ERTHALL PHILLIP R 2016028 9999999 B 10 1255446886 0 PO BOX 889430 LOS ANGELES CA 900889430 20 1255446886 0 Physician Assistant Only Fluoride varnish 20 1255446886 0 Physician Assistant Only Healthy Kids Services 20 1255446886 0 Physician Assistant Only Physician Services 00 1255447728 0 GRAYBILL JAMES 2021215 9999999 B 10 1255447728 0 5121 MARYLAND WAY STE 300 BRENTWOOD TN 370277516 20 1255447728 0 Physicians Anesthesia Services 20 1255447728 0 Physicians Healthy Kids Services 20 1255447728 0 Physicians Optical Supplies 20 1255447728 0 Physicians Physician Services 00 1255448445 0 SHAH SONIYA G 2001213 9999999 B 10 1255448445 0 45 TOWER CT GURNEE IL 600313376 20 1255448445 0 Physicians Anesthesia Services 20 1255448445 0 Physicians Fluoride varnish 20 1255448445 0 Physicians Healthy Kids Services 20 1255448445 0 Physicians Optical Supplies 20 1255448445 0 Physicians Physician Services 00 1255448619 0 NIJHAWAN NIRAJ 2005182 9999999 B 10 1255448619 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1255448619 0 Physicians Anesthesia Services 20 1255448619 0 Physicians Healthy Kids Services 20 1255448619 0 Physicians Optical Supplies 20 1255448619 0 Physicians Physician Services 00 1255449393 0 RINKER JOHN 1987258 9999999 B 10 1255449393 0 600 E 1ST ST SPRING VALLEY IL 613621512 20 1255449393 0 Physicians Anesthesia Services 20 1255449393 0 Physicians Fluoride varnish 20 1255449393 0 Physicians Healthy Kids Services 20 1255449393 0 Physicians Optical Supplies 20 1255449393 0 Physicians Physician Services 00 1255450623 0 RANDOLPH JAMES 2019070 9999999 B 10 1255450623 0 5777 DEPT CAROL STREAM IL 601220021 20 1255450623 0 Physical Therapists Medical Supplies 20 1255450623 0 Physical Therapists Medical equipment/prosthetic devices 20 1255450623 0 Physical Therapists Physical Therapy Services 00 1255451803 0 CONKLIN DARREN 2007244 9999999 B 10 1255451803 0 221 NE GLEN OAK AVE PEORIA IL 616360002 20 1255451803 0 Physicians Anesthesia Services 20 1255451803 0 Physicians Fluoride varnish 20 1255451803 0 Physicians Healthy Kids Services 20 1255451803 0 Physicians Optical Supplies 20 1255451803 0 Physicians Physician Services 00 1255452959 0 KENDRICK LINDA 2012091 9999999 B 10 1255452959 0 1901 E VOORHEES ST MS 640 DANVILLE IL 618344509 20 1255452959 0 Nurse Practitioners Fluoride varnish 20 1255452959 0 Nurse Practitioners Healthy Kids Services 20 1255452959 0 Nurse Practitioners Nurse Practitioners Services 20 1255452959 0 Nurse Practitioners Physician Services 00 1255454518 0 HENRIKSEN BELINDA D 2019304 9999999 B 10 1255454518 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1255454518 0 Nurse Practitioners Healthy Kids Services 20 1255454518 0 Nurse Practitioners Nurse Practitioners Services 20 1255454518 0 Nurse Practitioners Physician Services 00 1255455606 0 HATTER ANNETTE 1999129 9999999 B 10 1255455606 0 145 S PROSPECT ST ROSELLE IL 601722263 20 1255455606 0 Occupational Therapists Medical Supplies 20 1255455606 0 Occupational Therapists Medical equipment/prosthetic devices 20 1255455606 0 Occupational Therapists Occupational Therapy Services 00 1255457164 0 ONDOY AREL 1997001 9999999 B 10 1255457164 0 8120 KATY LN ORLAND PARK IL 604626112 20 1255457164 0 Dentists Dental Services 20 1255457164 0 Dentists Physician Services 00 1255457271 0 ZHOU YIHUA 2010152 9999999 B 10 1255457271 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1255457271 0 Physicians Anesthesia Services 20 1255457271 0 Physicians Healthy Kids Services 20 1255457271 0 Physicians Optical Supplies 20 1255457271 0 Physicians Physician Services 00 1255457784 0 VESELY RICHARD 1986182 9999999 B 10 1255457784 0 PO BOX 778791 CHICAGO IL 606776473 20 1255457784 0 Physicians Anesthesia Services 20 1255457784 0 Physicians Healthy Kids Services 20 1255457784 0 Physicians Optical Supplies 20 1255457784 0 Physicians Physician Services 00 1255457941 0 FOWLER KATHRYN 2010152 9999999 B 10 1255457941 0 PO BOX 7412011 CHICAGO IL 606742011 20 1255457941 0 Physicians Anesthesia Services 20 1255457941 0 Physicians Healthy Kids Services 20 1255457941 0 Physicians Optical Supplies 20 1255457941 0 Physicians Physician Services 00 1255458055 0 LEVISAY JUSTIN P 2002182 9999999 B 10 1255458055 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1255458055 0 Physicians Anesthesia Services 20 1255458055 0 Physicians Fluoride varnish 20 1255458055 0 Physicians Healthy Kids Services 20 1255458055 0 Physicians Optical Supplies 20 1255458055 0 Physicians 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1255592655 0 AHMED SAUD S 2014335 9999999 B 10 1255592655 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1255592655 0 Physicians Anesthesia Services 20 1255592655 0 Physicians Healthy Kids Services 20 1255592655 0 Physicians Optical Supplies 20 1255592655 0 Physicians Physician Services 00 1255593034 0 HUTCHISON PAUL 2014182 9999999 B 10 1255593034 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1255593034 0 Physicians Anesthesia Services 20 1255593034 0 Physicians Fluoride varnish 20 1255593034 0 Physicians Healthy Kids Services 20 1255593034 0 Physicians Optical Supplies 20 1255593034 0 Physicians Physician Services 00 1255593919 0 REED ADRIAN 2011191 9999999 B 10 1255593919 0 PO BOX 3988 CARBONDALE IL 629023988 20 1255593919 0 Physicians Anesthesia Services 20 1255593919 0 Physicians Healthy Kids Services 20 1255593919 0 Physicians Optical Supplies 20 1255593919 0 Physicians Physician Services 00 1255593968 0 TSAI SALINA DORIS 2018109 9999999 B 10 1255593968 0 PO BOX 371863 PITTSBURGH PA 152507863 20 1255593968 0 Physicians Anesthesia Services 20 1255593968 0 Physicians Healthy Kids Services 20 1255593968 0 Physicians Optical Supplies 20 1255593968 0 Physicians Physician Services 00 1255594073 0 MEERAPATEL SHAKILABANU 2002274 9999999 B 10 1255594073 0 PO BOX 713388 CHICAGO IL 606771525 20 1255594073 0 Physicians Anesthesia Services 20 1255594073 0 Physicians Fluoride varnish 20 1255594073 0 Physicians Healthy Kids Services 20 1255594073 0 Physicians Optical Supplies 20 1255594073 0 Physicians Physician Services 00 1255594115 0 ZAHARIS CONSTANTINE 2021215 9999999 B 10 1255594115 0 1232 W STATE ROAD 2 LA PORTE IN 463505469 20 1255594115 0 Physicians Anesthesia Services 20 1255594115 0 Physicians Healthy Kids Services 20 1255594115 0 Physicians Optical Supplies 20 1255594115 0 Physicians Physician Services 00 1255594248 0 BHANDARI RAMANATH 2013266 9999999 B 10 1255594248 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1255594248 0 Physicians Anesthesia 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1255596144 0 Physicians Healthy Kids Services 20 1255596144 0 Physicians Optical Supplies 20 1255596144 0 Physicians Physician Services 00 1255596805 0 MOHAMMED REEMA 2013245 9999999 B 10 1255596805 0 41 W ROOSEVELT RD VILLA PARK IL 601813532 20 1255596805 0 Physicians Anesthesia Services 20 1255596805 0 Physicians Fluoride varnish 20 1255596805 0 Physicians Healthy Kids Services 20 1255596805 0 Physicians Optical Supplies 20 1255596805 0 Physicians Physician Services 00 1255597167 0 BHATE AMIT D 2010214 9999999 B 10 1255597167 0 5777 DEPT CAROL STREAM IL 601220021 20 1255597167 0 Physicians Anesthesia Services 20 1255597167 0 Physicians Healthy Kids Services 20 1255597167 0 Physicians Optical Supplies 20 1255597167 0 Physicians Physician Services 00 1255597175 0 HUNG YI-CHIEN 2016252 9999999 B 10 1255597175 0 309 W CLARK ST CHAMPAIGN IL 618204637 20 1255597175 0 Clinical Social Worker Social work service 00 1255597761 0 FEIFEL SHARI A 1998324 9999999 B 10 1255597761 0 2112 W GALENA 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IL 616151941 20 1255598512 0 Physicians Anesthesia Services 20 1255598512 0 Physicians Healthy Kids Services 20 1255598512 0 Physicians Optical Supplies 20 1255598512 0 Physicians Physician Services 20 1255598512 0 Physicians Physicians Psychiatric Services 00 1255598587 0 TABIT COREY E 2012245 9999999 B 10 1255598587 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1255598587 0 Physicians Anesthesia Services 20 1255598587 0 Physicians Fluoride varnish 20 1255598587 0 Physicians Healthy Kids Services 20 1255598587 0 Physicians Optical Supplies 20 1255598587 0 Physicians Physician Services 00 1255599452 0 PINE RYAN R 2012234 9999999 B 10 1255599452 0 1605 REYNOLDS DR CHARLESTON IL 619203152 20 1255599452 0 Physicians Anesthesia Services 20 1255599452 0 Physicians Healthy Kids Services 20 1255599452 0 Physicians Optical Supplies 20 1255599452 0 Physicians Physician Services 00 1255602033 0 MATTHEWS PAUL 2011286 9999999 B 10 1255602033 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1255602033 0 Clinical Social Worker All Kids application agent 20 1255602033 0 Clinical Social Worker Social work service 00 1255606125 0 LITTLE ANDREW 2021068 9999999 B 10 1255606125 0 PO BOX 43230 PHOENIX AZ 850803230 20 1255606125 0 Physicians Anesthesia Services 20 1255606125 0 Physicians Healthy Kids Services 20 1255606125 0 Physicians Optical Supplies 20 1255606125 0 Physicians Physician Services 00 1255606422 0 PAUL ROHAN S 2022301 9999999 B 10 1255606422 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1255606422 0 Physicians Anesthesia Services 20 1255606422 0 Physicians Fluoride varnish 20 1255606422 0 Physicians Healthy Kids Services 20 1255606422 0 Physicians Optical Supplies 20 1255606422 0 Physicians Physician Services 00 1255606430 0 FLEMING GARRETT W. 2017193 9999999 B 10 1255606430 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1255606430 0 Physicians Anesthesia Services 20 1255606430 0 Physicians Healthy Kids Services 20 1255606430 0 Physicians Optical 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KINZA 2014329 9999999 B 10 1255609541 0 1000 MEDICAL CENTER DR MONTICELLO IL 618562116 20 1255609541 0 Physicians Anesthesia Services 20 1255609541 0 Physicians Fluoride varnish 20 1255609541 0 Physicians Healthy Kids Services 20 1255609541 0 Physicians Optical Supplies 20 1255609541 0 Physicians Physician Services 00 1255610085 0 TESNOW DOUGLAS 2011270 9999999 B 10 1255610085 0 1925 N CLYBOURN AVE CHICAGO IL 606144946 20 1255610085 0 Other behavior health professional LCPC/LMFT services 00 1255612651 0 GALBRAITH BONNIE 2016076 9999999 B 10 1255612651 0 PO BOX 504469 SAINT LOUIS MO 631504469 20 1255612651 0 Speech Therapists Medical Supplies 20 1255612651 0 Speech Therapists Medical equipment/prosthetic devices 20 1255612651 0 Speech Therapists Speech Therapy/Pathology Services 00 1255613196 0 DADDONO JEANNETTE 2004122 9999999 B 10 1255613196 0 1414 MAIN ST MELROSE PARK IL 601603902 20 1255613196 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and 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GRAND AVE STE B CHICAGO IL 606121577 20 1255618633 0 Speech Therapists Medical Supplies 20 1255618633 0 Speech Therapists Medical equipment/prosthetic devices 20 1255618633 0 Speech Therapists Speech Therapy/Pathology Services 00 1255618773 0 WILKIE BRITTANY 2021214 9999999 B 10 1255618773 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1255618773 0 Clinical Social Worker Social work service 00 1255619177 0 CHAN HOLMAN 2017244 9999999 B 10 1255619177 0 7455 W WASHINGTON AVE STE 160 LAS VEGAS NV 891284356 20 1255619177 0 Physicians Anesthesia Services 20 1255619177 0 Physicians Healthy Kids Services 20 1255619177 0 Physicians Optical Supplies 20 1255619177 0 Physicians Physician Services 00 1255620076 0 LANGE ROSEMARY 2013352 9999999 B 10 1255620076 0 40B EDWARDSVILLE PROF PARK EDWARDSVILLE IL 620253602 20 1255620076 0 Other behavior health professional LCPC/LMFT services 00 1255620282 0 GOETZ CELINE 2017172 9999999 B 10 1255620282 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1255620282 0 Physicians Anesthesia Services 20 1255620282 0 Physicians Healthy Kids Services 20 1255620282 0 Physicians Optical Supplies 20 1255620282 0 Physicians Physician Services 00 1255621314 0 SULLIVAN MARICEL 2011255 9999999 B 10 1255621314 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1255621314 0 Nurse Practitioners Fluoride varnish 20 1255621314 0 Nurse Practitioners Healthy Kids Services 20 1255621314 0 Nurse Practitioners Nurse Practitioners Services 20 1255621314 0 Nurse Practitioners Physician Services 00 1255621496 0 LEVIN ANNA 2016158 9999999 B 10 1255621496 0 1025 MAINE ST QUINCY IL 623014038 20 1255621496 0 Physicians Anesthesia Services 20 1255621496 0 Physicians Healthy Kids Services 20 1255621496 0 Physicians Optical Supplies 20 1255621496 0 Physicians Physician Services 00 1255621512 0 SOULLI BETH 2020051 9999999 B 10 1255621512 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1255621512 0 Physicians Anesthesia Services 20 1255621512 0 Physicians Healthy Kids Services 20 1255621512 0 Physicians Optical Supplies 20 1255621512 0 Physicians Physician Services 00 1255622395 0 PITCHFORD LACHONE 1999340 9999999 B 10 1255622395 0 2109 E 87TH ST CHICAGO IL 606173012 20 1255622395 0 Speech Therapists Medical Supplies 20 1255622395 0 Speech Therapists Medical equipment/prosthetic devices 20 1255622395 0 Speech Therapists Speech Therapy/Pathology Services 00 1255623583 0 TENHARMSEL AARON 2023320 9999999 B 10 1255623583 0 500 ELDORADO BLVD STE 6250 BROOMFIELD CO 800213421 20 1255623583 0 Physicians Anesthesia Services 20 1255623583 0 Physicians Fluoride varnish 20 1255623583 0 Physicians Healthy Kids Services 20 1255623583 0 Physicians Optical Supplies 20 1255623583 0 Physicians Physician Services 00 1255623955 0 CHEN DERRICK J 2016124 9999999 B 10 1255623955 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1255623955 0 Physicians Anesthesia Services 20 1255623955 0 Physicians Healthy Kids Services 20 1255623955 0 Physicians Optical Supplies 20 1255623955 0 Physicians Physician Services 00 1255623997 0 MAJJIGA VENKATA 2011182 9999999 B 10 1255623997 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1255623997 0 Physicians Anesthesia Services 20 1255623997 0 Physicians Fluoride varnish 20 1255623997 0 Physicians Healthy Kids Services 20 1255623997 0 Physicians Optical Supplies 20 1255623997 0 Physicians Physician Services 00 1255625281 0 KRUSZEWSKI MARK K 2012170 9999999 B 10 1255625281 0 6501 N LINCOLN AVE LINCOLNWOOD IL 607123925 20 1255625281 0 Nurse Practitioners Fluoride varnish 20 1255625281 0 Nurse Practitioners Healthy Kids Services 20 1255625281 0 Nurse Practitioners Nurse Practitioners Services 20 1255625281 0 Nurse Practitioners Physician Services 00 1255625679 0 GROMSKI MARK 2021005 9999999 B 10 1255625679 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1255625679 0 Physicians Anesthesia Services 20 1255625679 0 Physicians Fluoride varnish 20 1255625679 0 Physicians Healthy Kids Services 20 1255625679 0 Physicians Optical Supplies 20 1255625679 0 Physicians Physician Services 00 1255625703 0 BEYENE ROBEL 2023291 9999999 B 10 1255625703 0 DEPT AT 40379 ATLANTA GA 311920001 20 1255625703 0 Physicians Anesthesia Services 20 1255625703 0 Physicians Healthy Kids Services 20 1255625703 0 Physicians Optical Supplies 20 1255625703 0 Physicians Physician Services 00 1255626685 0 OWEN SCOTT R 2017249 9999999 B 10 1255626685 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1255626685 0 Physicians Anesthesia Services 20 1255626685 0 Physicians Healthy Kids Services 20 1255626685 0 Physicians Optical Supplies 20 1255626685 0 Physicians Physician Services 00 1255628103 0 BROWNSWORTH CHRISTOPHER 2018091 9999999 B 10 1255628103 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1255628103 0 Physicians Anesthesia Services 20 1255628103 0 Physicians Fluoride varnish 20 1255628103 0 Physicians Healthy Kids Services 20 1255628103 0 Physicians Optical Supplies 20 1255628103 0 Physicians Physician Services 00 1255628616 0 BALDRIDGE DUSTIN M 2014335 9999999 B 10 1255628616 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1255628616 0 Physicians Anesthesia Services 20 1255628616 0 Physicians Fluoride varnish 20 1255628616 0 Physicians Healthy Kids Services 20 1255628616 0 Physicians Optical Supplies 20 1255628616 0 Physicians Physician Services 00 1255628723 0 BIRBAL JAIN ADITYA 2014188 9999999 B 10 1255628723 0 611 W PARK ST URBANA IL 618012529 20 1255628723 0 Physicians Anesthesia Services 20 1255628723 0 Physicians Fluoride varnish 20 1255628723 0 Physicians Healthy Kids Services 20 1255628723 0 Physicians Optical Supplies 20 1255628723 0 Physicians Physician Services 00 1255629192 0 KAPOOR RAGINI 2018347 9999999 B 10 1255629192 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1255629192 0 Physicians Anesthesia Services 20 1255629192 0 Physicians Fluoride varnish 20 1255629192 0 Physicians Healthy Kids Services 20 1255629192 0 Physicians Optical Supplies 20 1255629192 0 Physicians Physician Services 00 1255630406 0 RENO ELAINE M 2018001 9999999 B 10 1255630406 0 PO BOX 110429 AURORA CO 800420429 20 1255630406 0 Physicians Anesthesia Services 20 1255630406 0 Physicians Healthy Kids Services 20 1255630406 0 Physicians Optical Supplies 20 1255630406 0 Physicians Physician Services 00 1255630422 0 KOST ADAM 2015213 9999999 B 10 1255630422 0 PO BOX 775618 CHICAGO IL 606775618 20 1255630422 0 Physicians Anesthesia Services 20 1255630422 0 Physicians Fluoride varnish 20 1255630422 0 Physicians Healthy Kids Services 20 1255630422 0 Physicians Optical Supplies 20 1255630422 0 Physicians Physician Services 00 1255630646 0 KHAISER AFSHIN 2014244 9999999 B 10 1255630646 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1255630646 0 Physicians Anesthesia Services 20 1255630646 0 Physicians Fluoride varnish 20 1255630646 0 Physicians Healthy Kids Services 20 1255630646 0 Physicians Optical Supplies 20 1255630646 0 Physicians Physician Services 00 1255631099 0 NAQVI SYED 2020210 9999999 B 10 1255631099 0 7310 RITCHIE HWY STE 802 GLEN BURNIE MD 210613129 20 1255631099 0 Physicians Anesthesia Services 20 1255631099 0 Physicians Fluoride varnish 20 1255631099 0 Physicians Healthy Kids Services 20 1255631099 0 Physicians Optical Supplies 20 1255631099 0 Physicians Physician Services 00 1255631255 0 HEALY HANEY NANCY 2018281 9999999 B 10 1255631255 0 319 E MADISON ST STE 3B SPRINGFIELD IL 627013124 20 1255631255 0 Psychologist Psychologist service 00 1255632642 0 SHARP MICHAEL 2010327 9999999 B 10 1255632642 0 639 38TH ST ROCK ISLAND IL 612012210 20 1255632642 0 Audiologists Audiology Services 20 1255632642 0 Audiologists Medical Supplies 20 1255632642 0 Audiologists Medical equipment/prosthetic devices 00 1255633095 0 BROWN ELEANOR 2013075 9999999 B 10 1255633095 0 11365 DORSETT RD MARYLAND HTS MO 630433411 20 1255633095 0 Nurse Practitioners Fluoride varnish 20 1255633095 0 Nurse Practitioners Healthy Kids Services 20 1255633095 0 Nurse Practitioners Nurse Practitioners Services 20 1255633095 0 Nurse Practitioners Physician Services 00 1255633954 0 PIASECKI PATRICIA 2010335 9999999 B 10 1255633954 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1255633954 0 Nurse Practitioners Healthy Kids Services 20 1255633954 0 Nurse Practitioners Nurse Practitioners Services 20 1255633954 0 Nurse Practitioners Physician Services 00 1255634739 0 REINECKE ELIZABETH 2019182 9999999 B 10 1255634739 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1255634739 0 Clinical Social Worker Social work service 00 1255635835 0 VERDERAME DENA 2017094 9999999 B 10 1255635835 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1255635835 0 Clinical Social Worker Social work service 00 1255635991 0 COWAN COURTNEY 2011010 9999999 B 10 1255635991 0 2800 N SHERIDAN RD STE 502 SUITE 502 CHICAGO IL 606576183 20 1255635991 0 Nurse Practitioners Healthy Kids Services 20 1255635991 0 Nurse Practitioners Nurse Practitioners Services 20 1255635991 0 Nurse Practitioners Physician Services 00 1255637450 0 RAO SNEHA 2023349 9999999 B 10 1255637450 0 29373 NETWORK PL CHICAGO IL 606733039 20 1255637450 0 Physicians Anesthesia Services 20 1255637450 0 Physicians Healthy Kids Services 20 1255637450 0 Physicians Optical Supplies 20 1255637450 0 Physicians Physician Services 00 1255638193 0 SHANFELD TAYLOR L 2014121 9999999 B 10 1255638193 0 5777 DEPT CAROL STREAM IL 601220021 20 1255638193 0 Physical Therapists Medical Supplies 20 1255638193 0 Physical Therapists Medical equipment/prosthetic devices 20 1255638193 0 Physical Therapists Physical Therapy Services 00 1255639019 0 HUSTERMANN JUDITH 2024058 9999999 B 10 1255639019 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1255639019 0 Nurse Practitioners Fluoride varnish 20 1255639019 0 Nurse Practitioners Healthy Kids Services 20 1255639019 0 Nurse Practitioners Nurse Practitioners Services 20 1255639019 0 Nurse Practitioners Physician Services 00 1255639068 0 GRASSO FRANK 2011045 9999999 B 10 1255639068 0 PO BOX 235019 MONTGOMERY AL 361235019 20 1255639068 0 Nurse Practitioners Anesthesia Services 20 1255639068 0 Nurse Practitioners Nurse Practitioners Services 20 1255639068 0 Nurse Practitioners Physician Services 00 1255639563 0 BUNDY ANDREA C 2011206 9999999 B 10 1255639563 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1255639563 0 Nurse Practitioners Fluoride varnish 20 1255639563 0 Nurse Practitioners Healthy Kids Services 20 1255639563 0 Nurse Practitioners Nurse Practitioners Services 20 1255639563 0 Nurse Practitioners Physician Services 00 1255640058 0 KAURA TARUN 2019246 9999999 B 10 1255640058 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1255640058 0 Physicians Anesthesia Services 20 1255640058 0 Physicians Fluoride varnish 20 1255640058 0 Physicians Healthy Kids Services 20 1255640058 0 Physicians Optical Supplies 20 1255640058 0 Physicians Physician Services 00 1255640108 0 LANGLEY CYNTHIA 2014328 9999999 B 10 1255640108 0 5730 W ROOSEVELT RD CHICAGO IL 606441580 20 1255640108 0 Psychologist Psychologist service 00 1255641007 0 SHEEHAN KATHRYN 2000018 9999999 B 10 1255641007 0 4025 TAMPA RD STE 1106 OLDSMAR FL 346773213 20 1255641007 0 Physical Therapists Medical Supplies 20 1255641007 0 Physical Therapists Medical equipment/prosthetic devices 20 1255641007 0 Physical Therapists Physical Therapy Services 00 1255642047 0 RIAZ AHSUN 2016197 9999999 B 10 1255642047 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1255642047 0 Physicians Anesthesia Services 20 1255642047 0 Physicians Healthy Kids Services 20 1255642047 0 Physicians Optical Supplies 20 1255642047 0 Physicians Physician Services 00 1255642419 0 SONGER ADAM G 2025035 9999999 B 10 1255642419 0 800 W 9TH ST JASPER IN 475462514 20 1255642419 0 Physicians Anesthesia Services 20 1255642419 0 Physicians Fluoride varnish 20 1255642419 0 Physicians Healthy Kids Services 20 1255642419 0 Physicians Optical Supplies 20 1255642419 0 Physicians Physician Services 00 1255642484 0 KOBOLDT TIMOTHY 2023163 9999999 B 10 1255642484 0 1 HOSPITAL DR COLUMBIA MO 652120001 20 1255642484 0 Physicians Anesthesia Services 20 1255642484 0 Physicians Healthy Kids Services 20 1255642484 0 Physicians Optical Supplies 20 1255642484 0 Physicians Physician Services 00 1255643417 0 SUMMERS-FARLEY STACY L 2016041 9999999 B 10 1255643417 0 PO BOX 63814 PHOENIX AZ 850823814 20 1255643417 0 Physician Assistant Only Fluoride varnish 20 1255643417 0 Physician Assistant Only Healthy Kids Services 20 1255643417 0 Physician Assistant Only Physician Services 00 1255643987 0 OSADCHUK LILIANA 2013182 9999999 B 10 1255643987 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1255643987 0 Physicians Anesthesia Services 20 1255643987 0 Physicians Fluoride varnish 20 1255643987 0 Physicians Healthy Kids Services 20 1255643987 0 Physicians Optical Supplies 20 1255643987 0 Physicians Physician Services 00 1255644191 0 GHADBAN RUGHEED 2021203 9999999 B 10 1255644191 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1255644191 0 Physicians Anesthesia Services 20 1255644191 0 Physicians Fluoride varnish 20 1255644191 0 Physicians Healthy Kids Services 20 1255644191 0 Physicians Optical Supplies 20 1255644191 0 Physicians Physician Services 00 1255644555 0 PENESETTI SUNIL 2018113 9999999 B 10 1255644555 0 515 22ND AVE MONROE WI 535661569 20 1255644555 0 Physicians Anesthesia Services 20 1255644555 0 Physicians Fluoride varnish 20 1255644555 0 Physicians Healthy Kids Services 20 1255644555 0 Physicians Optical Supplies 20 1255644555 0 Physicians Physician Services 00 1255644621 0 ARENSDORFF MATTHEW 2010209 9999999 B 10 1255644621 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1255644621 0 Optometrists Optical Supplies 20 1255644621 0 Optometrists Optometric Services 20 1255644621 0 Optometrists Physician Services 00 1255644761 0 GEORGE IGE A 2015328 9999999 B 10 1255644761 0 PO BOX 60352 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2016289 9999999 B 10 1255650123 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1255650123 0 Physicians Anesthesia Services 20 1255650123 0 Physicians Healthy Kids Services 20 1255650123 0 Physicians Optical Supplies 20 1255650123 0 Physicians Physician Services 00 1255650313 0 DOWNES COURTNEY 2021232 9999999 B 10 1255650313 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1255650313 0 Physicians Anesthesia Services 20 1255650313 0 Physicians Healthy Kids Services 20 1255650313 0 Physicians Optical Supplies 20 1255650313 0 Physicians Physician Services 00 1255650354 0 SHLIMON ALAN 2010132 9999999 B 10 1255650354 0 5400 N MILWAUKEE AVE STE 3 CHICAGO IL 606301272 20 1255650354 0 Dentists Dental Services 20 1255650354 0 Dentists Physician Services 00 1255650503 0 HITT JAMIE L. 2016005 9999999 B 10 1255650503 0 PO BOX 5009 BRENTWOOD TN 370245009 20 1255650503 0 Nurse Practitioners Fluoride varnish 20 1255650503 0 Nurse Practitioners Healthy Kids Services 20 1255650503 0 Nurse Practitioners Nurse Practitioners Services 20 1255650503 0 Nurse Practitioners Physician Services 00 1255650834 0 BASTOS MARRERO JORGE 2021120 9999999 B 10 1255650834 0 PO BOX 43230 PHOENIX AZ 850803230 20 1255650834 0 Physicians Anesthesia Services 20 1255650834 0 Physicians Fluoride varnish 20 1255650834 0 Physicians Healthy Kids Services 20 1255650834 0 Physicians Optical Supplies 20 1255650834 0 Physicians Physician Services 00 1255651808 0 TUPAKULA RAMESH PRAVEEN 2016183 9999999 B 10 1255651808 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1255651808 0 Physicians Anesthesia Services 20 1255651808 0 Physicians Fluoride varnish 20 1255651808 0 Physicians Healthy Kids Services 20 1255651808 0 Physicians Optical Supplies 20 1255651808 0 Physicians Physician Services 00 1255652152 0 RUIZ MANUEL 2019169 9999999 B 10 1255652152 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1255652152 0 Physicians Anesthesia Services 20 1255652152 0 Physicians Healthy Kids Services 20 1255652152 0 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20 1255657540 0 Nurse Practitioners Anesthesia Services 20 1255657540 0 Nurse Practitioners Nurse Practitioners Services 20 1255657540 0 Nurse Practitioners Physician Services 00 1255658001 0 JAQUA MAUREEN K 2014363 9999999 B 10 1255658001 0 5901 LINCOLN DR EDINA MN 554361611 20 1255658001 0 Physicians Anesthesia Services 20 1255658001 0 Physicians Fluoride varnish 20 1255658001 0 Physicians Healthy Kids Services 20 1255658001 0 Physicians Optical Supplies 20 1255658001 0 Physicians Physician Services 00 1255658233 0 WILLOUGHBY KATHERINE E 2019331 9999999 B 10 1255658233 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1255658233 0 Physicians Anesthesia Services 20 1255658233 0 Physicians Fluoride varnish 20 1255658233 0 Physicians Healthy Kids Services 20 1255658233 0 Physicians Optical Supplies 20 1255658233 0 Physicians Physician Services 00 1255658274 0 MARETT CHRISTOPHER P 2023244 9999999 B 10 1255658274 0 PO BOX 43230 CINCINNATI OH 452430230 20 1255658274 0 Physicians Anesthesia Services 20 1255658274 0 Physicians Healthy Kids Services 20 1255658274 0 Physicians Optical Supplies 20 1255658274 0 Physicians Physician Services 20 1255658274 0 Physicians Physicians Psychiatric Services 00 1255658993 0 ARORA VINAY 2014281 9999999 B 10 1255658993 0 801 S WASHINGTON ST NAPERVILLE IL 605407430 20 1255658993 0 Physicians Anesthesia Services 20 1255658993 0 Physicians Fluoride varnish 20 1255658993 0 Physicians Healthy Kids Services 20 1255658993 0 Physicians Optical Supplies 20 1255658993 0 Physicians Physician Services 00 1255659587 0 RAJJOUB MOHANNAD 2012214 9999999 B 10 1255659587 0 200 E FAIRMAN AVE WATSEKA IL 609701644 20 1255659587 0 Physicians Anesthesia Services 20 1255659587 0 Physicians Healthy Kids Services 20 1255659587 0 Physicians Optical Supplies 20 1255659587 0 Physicians Physician Services 00 1255659686 0 HOLT LAURA 2013182 9999999 B 10 1255659686 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1255659686 0 Physicians Anesthesia Services 20 1255659686 0 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1994220 9999999 B 10 1255701090 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1255701090 0 Physicians Anesthesia Services 20 1255701090 0 Physicians Family Planning Counseling 20 1255701090 0 Physicians Fluoride varnish 20 1255701090 0 Physicians Healthy Kids Services 20 1255701090 0 Physicians Optical Supplies 20 1255701090 0 Physicians Physician Services 00 1255701538 0 HAWKINS NICOLE E 2016183 9999999 B 10 1255701538 0 PO BOX 775342 CHICAGO IL 606775342 20 1255701538 0 Nurse Practitioners Fluoride varnish 20 1255701538 0 Nurse Practitioners Healthy Kids Services 20 1255701538 0 Nurse Practitioners Nurse Practitioners Services 20 1255701538 0 Nurse Practitioners Physician Services 00 1255701660 0 KUSSATZ SHANNON M 2016341 9999999 B 10 1255701660 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1255701660 0 Nurse Practitioners Fluoride varnish 20 1255701660 0 Nurse Practitioners Healthy Kids Services 20 1255701660 0 Nurse Practitioners Nurse Practitioners Services 20 1255701660 0 Nurse 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CHICAGO IL 606123714 20 1255748075 0 Physicians Anesthesia Services 20 1255748075 0 Physicians Fluoride varnish 20 1255748075 0 Physicians Healthy Kids Services 20 1255748075 0 Physicians Optical Supplies 20 1255748075 0 Physicians Physician Services 00 1255748182 0 NOUHI ARBATANI MARYAM 2023310 9999999 B 10 1255748182 0 PO BOX 781076 DETROIT MI 482781076 20 1255748182 0 Physicians Anesthesia Services 20 1255748182 0 Physicians Healthy Kids Services 20 1255748182 0 Physicians Optical Supplies 20 1255748182 0 Physicians Physician Services 20 1255748182 0 Physicians Physicians Psychiatric Services 00 1255748380 0 BARTLETT COURTNEY 2024023 9999999 B 10 1255748380 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1255748380 0 Nurse Practitioners Healthy Kids Services 20 1255748380 0 Nurse Practitioners Nurse Practitioners Services 20 1255748380 0 Nurse Practitioners Physician Services 00 1255748950 0 HOFSTRA HEATHER 2024001 9999999 B 10 1255748950 0 55 E 86TH AVE MERRILLVILLE IN 464106382 20 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RD DES PLAINES IL 600164727 20 1255750576 0 Dentists Dental Services 20 1255750576 0 Dentists Physician Services 00 1255750980 0 MUDEGOWDRA NIVEDITHA S 2020014 9999999 B 10 1255750980 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1255750980 0 Physicians Anesthesia Services 20 1255750980 0 Physicians Fluoride varnish 20 1255750980 0 Physicians Healthy Kids Services 20 1255750980 0 Physicians Optical Supplies 20 1255750980 0 Physicians Physician Services 00 1255751087 0 HUANG KEVIN 2021274 9999999 B 10 1255751087 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1255751087 0 Physicians Anesthesia Services 20 1255751087 0 Physicians Healthy Kids Services 20 1255751087 0 Physicians Optical Supplies 20 1255751087 0 Physicians Physician Services 00 1255751095 0 WENDT ROBYN 2014182 9999999 B 10 1255751095 0 1003 MARTIN LUTHER KING DR BLOOMINGTON IL 617011429 20 1255751095 0 Nurse Practitioners All Kids application agent 20 1255751095 0 Nurse Practitioners Healthy Kids Services 20 1255751095 0 Nurse 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10 1255758363 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1255758363 0 Physicians Anesthesia Services 20 1255758363 0 Physicians Healthy Kids Services 20 1255758363 0 Physicians Optical Supplies 20 1255758363 0 Physicians Physician Services 00 1255758728 0 ELLIOTT MARY 2017182 9999999 B 10 1255758728 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1255758728 0 Physicians Anesthesia Services 20 1255758728 0 Physicians Healthy Kids Services 20 1255758728 0 Physicians Optical Supplies 20 1255758728 0 Physicians Physician Services 00 1255759056 0 FERRIS STEVEN 2024009 9999999 B 10 1255759056 0 28100 TORCH PKWY STE 600 WARRENVILLE IL 605554030 20 1255759056 0 Physical Therapists Medical Supplies 20 1255759056 0 Physical Therapists Medical equipment/prosthetic devices 20 1255759056 0 Physical Therapists Physical Therapy Services 00 1255759528 0 LAWTON CORT 2018251 9999999 B 10 1255759528 0 5875 E RIVERSIDE BLVD ROCKFORD IL 611144937 20 1255759528 0 Physicians Anesthesia Services 20 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1255825386 0 SHIRLENE OBUOBI 2018351 9999999 B 10 1255825386 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1255825386 0 Physicians Anesthesia Services 20 1255825386 0 Physicians Fluoride varnish 20 1255825386 0 Physicians Healthy Kids Services 20 1255825386 0 Physicians Optical Supplies 20 1255825386 0 Physicians Physician Services 00 1255825535 0 SCHINDLER BROC R 2023284 9999999 B 10 1255825535 0 8170 33RD AVE S MINNEAPOLIS MN 554254516 20 1255825535 0 Physicians Anesthesia Services 20 1255825535 0 Physicians Healthy Kids Services 20 1255825535 0 Physicians Optical Supplies 20 1255825535 0 Physicians Physician Services 00 1255825543 0 SUHAIL MOIZ 2021210 9999999 B 10 1255825543 0 PO BOX 73488 PUYALLUP WA 983730488 20 1255825543 0 Physicians Anesthesia Services 20 1255825543 0 Physicians Fluoride varnish 20 1255825543 0 Physicians Healthy Kids Services 20 1255825543 0 Physicians Optical Supplies 20 1255825543 0 Physicians Physician Services 00 1255825717 0 HASSABELNABY AHMED 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Practitioners Services 20 1255826814 0 Nurse Practitioners Physician Services 00 1255826954 0 OSOS JOANNA 2019161 9999999 B 10 1255826954 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1255826954 0 Speech Therapists Medical Supplies 20 1255826954 0 Speech Therapists Medical equipment/prosthetic devices 20 1255826954 0 Speech Therapists Speech Therapy/Pathology Services 00 1255827333 0 PAPILLON VALERIE 2024229 9999999 B 10 1255827333 0 PO BOX 21844 BELFAST ME 049154115 20 1255827333 0 Clinical Social Worker Social work service 00 1255828638 0 BEUSSINK ERIKA 2018091 9999999 B 10 1255828638 0 1701 LACEY ST CAPE GIRARDEAU MO 637015230 20 1255828638 0 Nurse Practitioners Anesthesia Services 20 1255828638 0 Nurse Practitioners Nurse Practitioners Services 20 1255828638 0 Nurse Practitioners Physician Services 00 1255829081 0 MITCHELL JOSEPH M 2024243 9999999 B 10 1255829081 0 1 ILLINI DR PEORIA IL 616052576 20 1255829081 0 Psychologist Psychologist service 00 1255830006 0 OAKLAND 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1255833695 0 Physician Assistant Only Healthy Kids Services 20 1255833695 0 Physician Assistant Only Physician Services 00 1255835070 0 WADSWORTH TRACY 2018291 9999999 B 10 1255835070 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1255835070 0 Physicians Anesthesia Services 20 1255835070 0 Physicians Healthy Kids Services 20 1255835070 0 Physicians Optical Supplies 20 1255835070 0 Physicians Physician Services 00 1255835237 0 LITTLE JASON M 2018152 9999999 B 10 1255835237 0 1005 BROADWAY ST QUINCY IL 623012834 20 1255835237 0 Nurse Practitioners Healthy Kids Services 20 1255835237 0 Nurse Practitioners Nurse Practitioners Services 20 1255835237 0 Nurse Practitioners Physician Services 00 1255835567 0 HANNEKEN ONTIS NICHOLE RAE 2018085 9999999 B 10 1255835567 0 401 CHAFFER AVE ROXANA IL 620841125 20 1255835567 0 Speech Therapists Medical Supplies 20 1255835567 0 Speech Therapists Medical equipment/prosthetic devices 20 1255835567 0 Speech Therapists Speech Therapy/Pathology Services 00 1255835757 0 HAN ALICE Q 2018199 9999999 B 10 1255835757 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1255835757 0 Physicians Anesthesia Services 20 1255835757 0 Physicians Fluoride varnish 20 1255835757 0 Physicians Healthy Kids Services 20 1255835757 0 Physicians Optical Supplies 20 1255835757 0 Physicians Physician Services 00 1255836136 0 RODRIGUEZ ANA L 2021217 9999999 B 10 1255836136 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1255836136 0 Physicians Anesthesia Services 20 1255836136 0 Physicians Fluoride varnish 20 1255836136 0 Physicians Healthy Kids Services 20 1255836136 0 Physicians Optical Supplies 20 1255836136 0 Physicians Physician Services 00 1255836144 0 LAGHI FRANCO A 2024183 9999999 B 10 1255836144 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1255836144 0 Physicians Anesthesia Services 20 1255836144 0 Physicians Fluoride varnish 20 1255836144 0 Physicians Healthy Kids Services 20 1255836144 0 Physicians Optical Supplies 20 1255836144 0 Physicians Physician Services 00 1255836326 0 BATES AMY 2018121 9999999 B 10 1255836326 0 1005 BROADWAY ST QUINCY IL 623012834 20 1255836326 0 Nurse Practitioners Healthy Kids Services 20 1255836326 0 Nurse Practitioners Nurse Practitioners Services 20 1255836326 0 Nurse Practitioners Physician Services 00 1255836631 0 KRISHNAN KAVITHA G 2020029 9999999 B 10 1255836631 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1255836631 0 Physicians Anesthesia Services 20 1255836631 0 Physicians Fluoride varnish 20 1255836631 0 Physicians Healthy Kids Services 20 1255836631 0 Physicians Optical Supplies 20 1255836631 0 Physicians Physician Services 00 1255836797 0 KRIDER SAMUEL 2023123 9999999 B 10 1255836797 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1255836797 0 Physicians Anesthesia Services 20 1255836797 0 Physicians Healthy Kids Services 20 1255836797 0 Physicians Optical Supplies 20 1255836797 0 Physicians Physician Services 00 1255836888 0 SANGANI DEEP BHUPAT 2022207 9999999 B 10 1255836888 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1255836888 0 Physicians Anesthesia Services 20 1255836888 0 Physicians Fluoride varnish 20 1255836888 0 Physicians Healthy Kids Services 20 1255836888 0 Physicians Optical Supplies 20 1255836888 0 Physicians Physician Services 00 1255837035 0 WILLIAMS CAMERONE 2022043 9999999 B 10 1255837035 0 5380 TECH DATA DR STE 101 CLEARWATER FL 337603122 20 1255837035 0 Physicians Anesthesia Services 20 1255837035 0 Physicians Healthy Kids Services 20 1255837035 0 Physicians Optical Supplies 20 1255837035 0 Physicians Physician Services 00 1255837050 0 MULVEY THOMAS R 2024231 9999999 B 10 1255837050 0 5901 LINCOLN DR EDINA MN 554361611 20 1255837050 0 Physicians Anesthesia Services 20 1255837050 0 Physicians Healthy Kids Services 20 1255837050 0 Physicians Optical Supplies 20 1255837050 0 Physicians Physician Services 00 1255837126 0 BREVIK CODY H 2023152 9999999 B 10 1255837126 0 12605 E 16TH AVE AURORA CO 800452545 20 1255837126 0 Physicians Anesthesia Services 20 1255837126 0 Physicians Healthy Kids Services 20 1255837126 0 Physicians Optical Supplies 20 1255837126 0 Physicians Physician Services 00 1255837381 0 STILGENBAUER HUTCH 2022306 9999999 B 10 1255837381 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1255837381 0 Physicians Anesthesia Services 20 1255837381 0 Physicians Healthy Kids Services 20 1255837381 0 Physicians Optical Supplies 20 1255837381 0 Physicians Physician Services 00 1255837993 0 TREMWELL MARTIN 2022206 9999999 B 10 1255837993 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1255837993 0 Physicians Anesthesia Services 20 1255837993 0 Physicians Healthy Kids Services 20 1255837993 0 Physicians Optical Supplies 20 1255837993 0 Physicians Physician Services 00 1255838272 0 GORSI ASHA A 2022077 9999999 B 10 1255838272 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1255838272 0 Physicians Anesthesia Services 20 1255838272 0 Physicians Fluoride varnish 20 1255838272 0 Physicians Healthy Kids Services 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Practitioners Nurse Practitioners Services 20 1255843660 0 Nurse Practitioners Physician Services 00 1255843835 0 SERRANO SONIA 2025009 9999999 B 10 1255843835 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1255843835 0 Clinical Social Worker Social work service 00 1255844189 0 CHRISTENSEN KEITH J 2019323 9999999 B 10 1255844189 0 124 SW ADAMS ST PEORIA IL 616021308 20 1255844189 0 Nurse Practitioners Fluoride varnish 20 1255844189 0 Nurse Practitioners Healthy Kids Services 20 1255844189 0 Nurse Practitioners Nurse Practitioners Services 20 1255844189 0 Nurse Practitioners Physician Services 00 1255844197 0 MARTIN PHILEASE 2020198 9999999 B 10 1255844197 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1255844197 0 Physician Assistant Only Fluoride varnish 20 1255844197 0 Physician Assistant Only Healthy Kids Services 20 1255844197 0 Physician Assistant Only Physician Services 00 1255844288 0 ABANCO FRANCISCO 2018066 9999999 B 10 1255844288 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1255844288 0 Nurse Practitioners Anesthesia Services 20 1255844288 0 Nurse Practitioners Nurse Practitioners Services 20 1255844288 0 Nurse Practitioners Physician Services 00 1255844296 0 MCKEE MANDY J 2019010 9999999 B 10 1255844296 0 330 S GIANT CITY RD CARBONDALE IL 629025042 20 1255844296 0 Clinical Social Worker Social work service 00 1255844692 0 DAVIS AUDREY R 2022136 9999999 B 10 1255844692 0 494 W BOUGHTON RD STE 4B BOLINGBROOK IL 604401881 20 1255844692 0 Clinical Social Worker Social work service 00 1255845210 0 GIAMMARINO BRITTANY 2018001 9999999 B 10 1255845210 0 164 EUCLID AVE BLOOMINGDALE IL 601081634 20 1255845210 0 Speech Therapists Medical Supplies 20 1255845210 0 Speech Therapists Medical equipment/prosthetic devices 20 1255845210 0 Speech Therapists Speech Therapy/Pathology Services 00 1255845244 0 COPUS KATELYN E 2017347 9999999 B 10 1255845244 0 501 E SOUTH ST FREEPORT IL 610329676 20 1255845244 0 Speech Therapists Medical Supplies 20 1255845244 0 Speech Therapists Medical equipment/prosthetic devices 20 1255845244 0 Speech Therapists Speech Therapy/Pathology Services 00 1255846069 0 NADER JULIA 2019345 9999999 B 10 1255846069 0 2900 OGDEN AVE LISLE IL 605321631 20 1255846069 0 Speech Therapists Medical Supplies 20 1255846069 0 Speech Therapists Medical equipment/prosthetic devices 20 1255846069 0 Speech Therapists Speech Therapy/Pathology Services 00 1255846622 0 BRIDGWATER JAMIE 2018009 9999999 B 10 1255846622 0 PO BOX 70 LAKE FOREST IL 600450070 20 1255846622 0 Nurse Practitioners Anesthesia Services 20 1255846622 0 Nurse Practitioners Nurse Practitioners Services 20 1255846622 0 Nurse Practitioners Physician Services 00 1255846697 0 CONLON KELLI A 2019063 9999999 B 10 1255846697 0 PO BOX 781076 DETROIT MI 482781076 20 1255846697 0 Clinical Social Worker Social work service 00 1255847422 0 DIAZ MICHELLE 2018200 9999999 H 10 1255847422 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1255847422 0 Other 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Practitioners Services 20 1255849030 0 Nurse Practitioners Physician Services 00 1255849626 0 WILSON JACOB 2022055 9999999 B 10 1255849626 0 100 W MAIN ST MOUNT STERLING IL 623531224 20 1255849626 0 Physical Therapists Medical Supplies 20 1255849626 0 Physical Therapists Medical equipment/prosthetic devices 20 1255849626 0 Physical Therapists Physical Therapy Services 00 1255851218 0 GULARI-JONES BRISA 2019267 9999999 B 10 1255851218 0 422 W WHITE ST CLINTON IL 617272272 20 1255851218 0 Physicians Anesthesia Services 20 1255851218 0 Physicians Fluoride varnish 20 1255851218 0 Physicians Healthy Kids Services 20 1255851218 0 Physicians Optical Supplies 20 1255851218 0 Physicians Physician Services 00 1255851796 0 CRAFT LINDA ANN 2019066 9999999 B 10 1255851796 0 611 W PARK ST URBANA IL 618012529 20 1255851796 0 Clinical Social Worker Social work service 00 1255852380 0 STEPHANY MATTHEW P 2024079 9999999 B 10 1255852380 0 988102 NEBRASKA MEDICAL CTR OMAHA NE 681988102 20 1255852380 0 Physicians Anesthesia Services 20 1255852380 0 Physicians Healthy Kids Services 20 1255852380 0 Physicians Optical Supplies 20 1255852380 0 Physicians Physician Services 00 1255852877 0 WOJNICKI BRITTANY N 2019283 9999999 B 10 1255852877 0 721 E COURT ST PARIS IL 619442460 20 1255852877 0 Podiatrists Podiatric Services 00 1255853081 0 HOPPER LAURIE M 2017265 9999999 B 10 1255853081 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1255853081 0 Nurse Practitioners Fluoride varnish 20 1255853081 0 Nurse Practitioners Healthy Kids Services 20 1255853081 0 Nurse Practitioners Nurse Practitioners Services 20 1255853081 0 Nurse Practitioners Physician Services 00 1255853347 0 BINION LEANNE M 2017261 9999999 B 10 1255853347 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1255853347 0 Nurse Practitioners Healthy Kids Services 20 1255853347 0 Nurse Practitioners Nurse Practitioners Services 20 1255853347 0 Nurse Practitioners Physician Services 00 1255853396 0 DACANAY ATHENA 2017244 9999999 B 10 1255853396 0 PO BOX 604 BLOOMINGTON IL 617020604 20 1255853396 0 Psychologist Psychologist service 00 1255853792 0 KUMAR VISHAL 2023264 9999999 B 10 1255853792 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1255853792 0 Physicians Anesthesia Services 20 1255853792 0 Physicians Healthy Kids Services 20 1255853792 0 Physicians Optical Supplies 20 1255853792 0 Physicians Physician Services 00 1255853859 0 DE OLIVEIRA SOARES RICARDO M 2019085 9999999 B 10 1255853859 0 5777 DEPT CAROL STREAM IL 601220021 20 1255853859 0 Physicians Anesthesia Services 20 1255853859 0 Physicians Healthy Kids Services 20 1255853859 0 Physicians Optical Supplies 20 1255853859 0 Physicians Physician Services 00 1255853933 0 CONNER ASHLEY E 2018232 9999999 B 10 1255853933 0 202 S PARK ST MADISON WI 537151507 20 1255853933 0 Nurse Practitioners Fluoride varnish 20 1255853933 0 Nurse Practitioners Healthy Kids Services 20 1255853933 0 Nurse Practitioners Nurse Practitioners Services 20 1255853933 0 Nurse Practitioners Physician Services 00 1255854204 0 RIES KAREN 2017215 9999999 B 10 1255854204 0 PO BOX 83242 CHICAGO IL 606910242 20 1255854204 0 Nurse Practitioners Fluoride varnish 20 1255854204 0 Nurse Practitioners Healthy Kids Services 20 1255854204 0 Nurse Practitioners Nurse Practitioners Services 20 1255854204 0 Nurse Practitioners Physician Services 00 1255856894 0 BURKE HEATHER ANN 2017240 9999999 B 10 1255856894 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1255856894 0 Nurse Practitioners Healthy Kids Services 20 1255856894 0 Nurse Practitioners Nurse Practitioners Services 20 1255856894 0 Nurse Practitioners Physician Services 00 1255856951 0 DAVIS ALEXANDRIA K 2020006 9999999 B 10 1255856951 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1255856951 0 Nurse Practitioners Healthy Kids Services 20 1255856951 0 Nurse Practitioners Nurse Practitioners Services 20 1255856951 0 Nurse Practitioners Physician Services 00 1255857207 0 EDLER CHRISTINA 2017272 9999999 B 10 1255857207 0 517 FREMONT ST LENA IL 610488610 20 1255857207 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1255858494 0 MALLARO HANNAH L 2021160 9999999 B 10 1255858494 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1255858494 0 Physicians Anesthesia Services 20 1255858494 0 Physicians Fluoride varnish 20 1255858494 0 Physicians Healthy Kids Services 20 1255858494 0 Physicians Optical Supplies 20 1255858494 0 Physicians Physician Services 00 1255858577 0 SHEKHRAJKA NITESH 2023186 9999999 B 10 1255858577 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1255858577 0 Physicians Anesthesia Services 20 1255858577 0 Physicians Healthy Kids Services 20 1255858577 0 Physicians Optical Supplies 20 1255858577 0 Physicians Physician Services 00 1255859260 0 TOBIAS KELSIE A 2017248 9999999 B 10 1255859260 0 600 N MAIN ST TAYLORVILLE IL 625681668 20 1255859260 0 Clinical Social Worker Social work service 00 1255859534 0 AMARO GABRIELA 2017282 9999999 B 10 1255859534 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1255859534 0 Nurse Practitioners Fluoride varnish 20 1255859534 0 Nurse Practitioners Healthy Kids Services 20 1255859534 0 Nurse Practitioners Nurse Practitioners Services 20 1255859534 0 Nurse Practitioners Physician Services 00 1255859575 0 TRILIKIS KAY L 2017250 9999999 B 10 1255859575 0 4812 PFEIFFER RD BARTONVILLE IL 616072647 20 1255859575 0 Speech Therapists Medical Supplies 20 1255859575 0 Speech Therapists Medical equipment/prosthetic devices 20 1255859575 0 Speech Therapists Speech Therapy/Pathology Services 00 1255860292 0 CHIPREAN KATHERINE 2024055 9999999 B 10 1255860292 0 6801 BRECKSVILLE RD INDEPENDENCE OH 441315032 20 1255860292 0 Physicians Anesthesia Services 20 1255860292 0 Physicians Healthy Kids Services 20 1255860292 0 Physicians Optical Supplies 20 1255860292 0 Physicians Physician Services 20 1255860292 0 Physicians Physicians Psychiatric Services 00 1255860870 0 ROLLYSON MIA K 2017292 9999999 B 10 1255860870 0 1001 E TOUHY AVE STE 170 DES PLAINES IL 600185800 20 1255860870 0 Registered nurse Nursing service 20 1255860870 0 Registered nurse Waiver service 00 1255861241 0 DOYLE MICHAEL 2021355 9999999 B 10 1255861241 0 301 JOHN ST # 42 KALAMAZOO MI 490075295 20 1255861241 0 Nurse Practitioners Anesthesia Services 20 1255861241 0 Nurse Practitioners Healthy Kids Services 20 1255861241 0 Nurse Practitioners Optical Supplies 20 1255861241 0 Nurse Practitioners Physician Services 00 1255861647 0 SEIPP JAMES B 2017215 9999999 B 10 1255861647 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1255861647 0 Physicians Anesthesia Services 20 1255861647 0 Physicians Fluoride varnish 20 1255861647 0 Physicians Healthy Kids Services 20 1255861647 0 Physicians Optical Supplies 20 1255861647 0 Physicians Physician Services 00 1255862157 0 GIBBERT WESLEY 2017081 9999999 B 10 1255862157 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1255862157 0 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1000 SUITE# 1000 CHICAGO IL 606118709 20 1255872644 0 Nurse Practitioners Healthy Kids Services 20 1255872644 0 Nurse Practitioners Nurse Practitioners Services 20 1255872644 0 Nurse Practitioners Physician Services 00 1255873089 0 KATZ TERESA 2016334 9999999 B 10 1255873089 0 2650 RIDGE AVE STE 1223 EVANSTON IL 602011718 20 1255873089 0 Nurse Practitioners Healthy Kids Services 20 1255873089 0 Nurse Practitioners Nurse Practitioners Services 20 1255873089 0 Nurse Practitioners Physician Services 00 1255873121 0 TOENNIES LESLEY A 2017121 9999999 B 10 1255873121 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1255873121 0 Nurse Practitioners Anesthesia Services 20 1255873121 0 Nurse Practitioners Nurse Practitioners Services 20 1255873121 0 Nurse Practitioners Physician Services 00 1255874335 0 DOYLE KRISTIN 2017032 9999999 B 10 1255874335 0 7270 W COLLEGE DR STE 102 PALOS HEIGHTS IL 604631287 20 1255874335 0 Nurse Practitioners Fluoride varnish 20 1255874335 0 Nurse 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3012 W FULLERTON AVE CHICAGO IL 606472940 20 1255902466 0 Dentists Dental Services 20 1255902466 0 Dentists Physician Services 00 1255902797 0 ASAD UZMA 2024199 9999999 B 10 1255902797 0 1200 W STATE ST ROCKFORD IL 611022112 20 1255902797 0 Physicians Anesthesia Services 20 1255902797 0 Physicians Fluoride varnish 20 1255902797 0 Physicians Healthy Kids Services 20 1255902797 0 Physicians Optical Supplies 20 1255902797 0 Physicians Physician Services 00 1255902870 0 SNYDER KRISTIN E 2021322 9999999 B 10 1255902870 0 PO BOX 778912 CHICAGO IL 606778912 20 1255902870 0 Nurse Practitioners Healthy Kids Services 20 1255902870 0 Nurse Practitioners Nurse Practitioners Services 20 1255902870 0 Nurse Practitioners Physician Services 00 1255904322 0 O'BRIEN ERIKA 2021308 9999999 B 10 1255904322 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1255904322 0 Nurse Practitioners Healthy Kids Services 20 1255904322 0 Nurse Practitioners Nurse Practitioners Services 20 1255904322 0 Nurse Practitioners 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1255905717 0 Physicians Fluoride varnish 20 1255905717 0 Physicians Healthy Kids Services 20 1255905717 0 Physicians Optical Supplies 20 1255905717 0 Physicians Physician Services 00 1255905782 0 SUN ERIC P 2023215 9999999 B 10 1255905782 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1255905782 0 Physicians Anesthesia Services 20 1255905782 0 Physicians Fluoride varnish 20 1255905782 0 Physicians Healthy Kids Services 20 1255905782 0 Physicians Optical Supplies 20 1255905782 0 Physicians Physician Services 00 1255905923 0 LISTER EMILY 2021201 9999999 B 10 1255905923 0 201 E MADISON ST STE 300 SPRINGFIELD IL 627025131 20 1255905923 0 Physicians Anesthesia Services 20 1255905923 0 Physicians Fluoride varnish 20 1255905923 0 Physicians Healthy Kids Services 20 1255905923 0 Physicians Optical Supplies 20 1255905923 0 Physicians Physician Services 00 1255906103 0 OSUJI NNEKA N 2021186 9999999 B 10 1255906103 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1255906103 0 Physicians Anesthesia Services 20 1255906103 0 Physicians Fluoride varnish 20 1255906103 0 Physicians Healthy Kids Services 20 1255906103 0 Physicians Optical Supplies 20 1255906103 0 Physicians Physician Services 00 1255906350 0 BAI PATRICIA 2022213 9999999 B 10 1255906350 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1255906350 0 Physicians Anesthesia Services 20 1255906350 0 Physicians Healthy Kids Services 20 1255906350 0 Physicians Optical Supplies 20 1255906350 0 Physicians Physician Services 00 1255907283 0 COLEMAN-BRADLEY BETTY 2021160 9999999 B 10 1255907283 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1255907283 0 Nurse Practitioners Fluoride varnish 20 1255907283 0 Nurse Practitioners Healthy Kids Services 20 1255907283 0 Nurse Practitioners Nurse Practitioners Services 20 1255907283 0 Nurse Practitioners Physician Services 00 1255907309 0 GREENBERG EMILY 2022156 9999999 B 10 1255907309 0 18160 W GAGES LAKE RD GAGES LAKE IL 600301819 20 1255907309 0 Speech Therapists Medical Supplies 20 1255907309 0 Speech Therapists Medical equipment/prosthetic devices 20 1255907309 0 Speech Therapists Speech Therapy/Pathology Services 00 1255907671 0 POWELL DJUAN 2021151 9999999 B 10 1255907671 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1255907671 0 Clinical Social Worker Social work service 00 1255909479 0 KUMAR SHALINI 2022178 9999999 B 10 1255909479 0 PO BOX 3039 OAK BROOK IL 605223039 20 1255909479 0 Physicians Anesthesia Services 20 1255909479 0 Physicians Fluoride varnish 20 1255909479 0 Physicians Healthy Kids Services 20 1255909479 0 Physicians Optical Supplies 20 1255909479 0 Physicians Physician Services 00 1255910006 0 AKYAR EDA 2024128 9999999 B 10 1255910006 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1255910006 0 Physicians Anesthesia Services 20 1255910006 0 Physicians Fluoride varnish 20 1255910006 0 Physicians Healthy Kids Services 20 1255910006 0 Physicians Optical Supplies 20 1255910006 0 Physicians Physician Services 00 1255910014 0 FANKAM STEVE 2021249 9999999 B 10 1255910014 0 PO BOX 5009 BRENTWOOD TN 370245009 20 1255910014 0 Nurse Practitioners Anesthesia Services 20 1255910014 0 Nurse Practitioners Nurse Practitioners Services 20 1255910014 0 Nurse Practitioners Physician Services 00 1255910204 0 PHILLIPS KATHRYN E 2024155 9999999 B 10 1255910204 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1255910204 0 Physicians Anesthesia Services 20 1255910204 0 Physicians Fluoride varnish 20 1255910204 0 Physicians Healthy Kids Services 20 1255910204 0 Physicians Optical Supplies 20 1255910204 0 Physicians Physician Services 00 1255910287 0 MELVILLE PATRICK 2021222 9999999 B 10 1255910287 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1255910287 0 Physicians Anesthesia Services 20 1255910287 0 Physicians Fluoride varnish 20 1255910287 0 Physicians Healthy Kids Services 20 1255910287 0 Physicians Optical Supplies 20 1255910287 0 Physicians Physician Services 00 1255910386 0 CLARK LEA L 2022201 9999999 B 10 1255910386 0 124 SW ADAMS ST PEORIA IL 616021308 20 1255910386 0 Nurse Practitioners Fluoride varnish 20 1255910386 0 Nurse Practitioners Healthy Kids Services 20 1255910386 0 Nurse Practitioners Nurse Practitioners Services 20 1255910386 0 Nurse Practitioners Physician Services 00 1255910402 0 FRIEDMAN ISAAC FOSTER 2023332 9999999 B 10 1255910402 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1255910402 0 Physician Assistant Only Fluoride varnish 20 1255910402 0 Physician Assistant Only Healthy Kids Services 20 1255910402 0 Physician Assistant Only Physician Services 00 1255910725 0 INDORATO DANIEL 2021194 9999999 B 10 1255910725 0 13450 S KEDZIE AVE ROBBINS IL 60472 20 1255910725 0 Physicians Anesthesia Services 20 1255910725 0 Physicians Healthy Kids Services 20 1255910725 0 Physicians Optical Supplies 20 1255910725 0 Physicians Physician Services 00 1255912218 0 STOTLAND AMY 2021168 9999999 B 10 1255912218 0 854 TECHNOLOGY WAY LIBERTYVILLE IL 600485350 20 1255912218 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1255912481 0 AHN YEO WON 2021180 9999999 B 10 1255912481 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1255912481 0 Physicians Anesthesia Services 20 1255912481 0 Physicians Fluoride varnish 20 1255912481 0 Physicians Healthy Kids Services 20 1255912481 0 Physicians Optical Supplies 20 1255912481 0 Physicians Physician Services 00 1255912507 0 PATEL JAY B 2021187 9999999 B 10 1255912507 0 5777 DEPT CAROL STREAM IL 601228942 20 1255912507 0 Physicians Anesthesia Services 20 1255912507 0 Physicians Fluoride varnish 20 1255912507 0 Physicians Healthy Kids Services 20 1255912507 0 Physicians Optical Supplies 20 1255912507 0 Physicians Physician Services 00 1255913273 0 LEE ALEX 2021204 9999999 B 10 1255913273 0 7039 ROOSEVELT RD BERWYN IL 604021059 20 1255913273 0 Dentists Dental Services 20 1255913273 0 Dentists Physician Services 00 1255913737 0 CHANG CHRISTOPHER 2022182 9999999 B 10 1255913737 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1255913737 0 Physicians Anesthesia Services 20 1255913737 0 Physicians Healthy Kids Services 20 1255913737 0 Physicians Optical Supplies 20 1255913737 0 Physicians Physician Services 00 1255913893 0 SAEZ JASON P 2024135 9999999 B 10 1255913893 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1255913893 0 Physicians Anesthesia Services 20 1255913893 0 Physicians Fluoride varnish 20 1255913893 0 Physicians Healthy Kids Services 20 1255913893 0 Physicians Optical Supplies 20 1255913893 0 Physicians Physician Services 00 1255914016 0 GRAS NICOLE 2021177 9999999 B 10 1255914016 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1255914016 0 Physicians Anesthesia Services 20 1255914016 0 Physicians Fluoride varnish 20 1255914016 0 Physicians Healthy Kids Services 20 1255914016 0 Physicians Optical Supplies 20 1255914016 0 Physicians Physician Services 00 1255914792 0 HAQ MOHAMMED A 2023331 9999999 B 10 1255914792 0 140 W ROOSEVELT RD VILLA PARK IL 601813504 20 1255914792 0 Dentists Dental Services 20 1255914792 0 Dentists Physician Services 00 1255915229 0 COUNSELL EVA 2023234 9999999 B 10 1255915229 0 502 SHAW AVE PARIS IL 619442352 20 1255915229 0 Dentists Dental Services 20 1255915229 0 Dentists Physician Services 00 1255916821 0 BAILEY TIFFANIE JO 2021159 9999999 B 10 1255916821 0 PO BOX 556 VINCENNES IN 475910556 20 1255916821 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1255916821 0 Other behavior health professional Social work service 00 1255917001 0 ANDEBRHAN SARAH 2021174 9999999 B 10 1255917001 0 4698 DEPT CAROL STREAM IL 601220021 20 1255917001 0 Physicians Anesthesia Services 20 1255917001 0 Physicians Healthy Kids Services 20 1255917001 0 Physicians Optical Supplies 20 1255917001 0 Physicians Physician Services 00 1255917290 0 DENNISON LENA F 2021174 9999999 B 10 1255917290 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1255917290 0 Physicians Anesthesia Services 20 1255917290 0 Physicians Fluoride varnish 20 1255917290 0 Physicians Healthy Kids Services 20 1255917290 0 Physicians Optical Supplies 20 1255917290 0 Physicians Physician Services 00 1255917712 0 LUO JESSICA 2021215 9999999 B 10 1255917712 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1255917712 0 Physicians Anesthesia Services 20 1255917712 0 Physicians Healthy Kids Services 20 1255917712 0 Physicians Optical Supplies 20 1255917712 0 Physicians Physician Services 00 1255917720 0 DITORO TAYLOR 2021223 9999999 B 10 1255917720 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1255917720 0 Physicians Anesthesia Services 20 1255917720 0 Physicians Healthy Kids Services 20 1255917720 0 Physicians Optical Supplies 20 1255917720 0 Physicians Physician Services 00 1255917761 0 ROPSKI PAMELA 2024158 9999999 B 10 1255917761 0 5777 DEPT CAROL STREAM IL 601220021 20 1255917761 0 Physicians Anesthesia Services 20 1255917761 0 Physicians Fluoride varnish 20 1255917761 0 Physicians Healthy Kids Services 20 1255917761 0 Physicians Optical Supplies 20 1255917761 0 Physicians Physician Services 00 1255917779 0 EING KATELIN 2021182 9999999 B 10 1255917779 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1255917779 0 Physicians Anesthesia Services 20 1255917779 0 Physicians Fluoride varnish 20 1255917779 0 Physicians Healthy Kids Services 20 1255917779 0 Physicians Optical Supplies 20 1255917779 0 Physicians Physician Services 00 1255917795 0 RODRIGUEZ ANA 2024177 9999999 B 10 1255917795 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1255917795 0 Physicians Anesthesia Services 20 1255917795 0 Physicians Healthy Kids Services 20 1255917795 0 Physicians Optical Supplies 20 1255917795 0 Physicians Physician Services 00 1255918629 0 THOMAS JOSHUA 2021225 9999999 B 10 1255918629 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1255918629 0 Physicians Anesthesia Services 20 1255918629 0 Physicians Fluoride varnish 20 1255918629 0 Physicians Healthy Kids Services 20 1255918629 0 Physicians Optical Supplies 20 1255918629 0 Physicians Physician Services 00 1255918793 0 BELNAVIS ZACHARY M 2021180 9999999 B 10 1255918793 0 29373 NETWORK PL CHICAGO IL 606733039 20 1255918793 0 Physicians Anesthesia Services 20 1255918793 0 Physicians Fluoride varnish 20 1255918793 0 Physicians Healthy Kids Services 20 1255918793 0 Physicians Optical Supplies 20 1255918793 0 Physicians Physician Services 00 1255919213 0 HENDERSON JEFFREY 2022250 9999999 B 10 1255919213 0 5501 W FULLERTON AVE PORTSMOUTH VA 237082111 20 1255919213 0 Nurse Practitioners Anesthesia Services 20 1255919213 0 Nurse Practitioners Nurse Practitioners Services 20 1255919213 0 Nurse Practitioners Physician Services 00 1255919338 0 RILEY AMY R 2021246 9999999 B 10 1255919338 0 727 E COURT ST PARIS IL 619442460 20 1255919338 0 Nurse Practitioners Fluoride varnish 20 1255919338 0 Nurse Practitioners Healthy Kids Services 20 1255919338 0 Nurse Practitioners Nurse Practitioners Services 20 1255919338 0 Nurse Practitioners Physician Services 00 1255919494 0 SINGH BAANI 2021182 9999999 B 10 1255919494 0 PO BOX 3039 OAK BROOK IL 605223039 20 1255919494 0 Physicians Anesthesia Services 20 1255919494 0 Physicians Fluoride varnish 20 1255919494 0 Physicians Healthy Kids Services 20 1255919494 0 Physicians Optical Supplies 20 1255919494 0 Physicians Physician Services 00 1255919916 0 PANTON CONSTANCE E 2023237 9999999 B 10 1255919916 0 PO BOX 3039 OAK BROOK IL 605223039 20 1255919916 0 Physicians Anesthesia Services 20 1255919916 0 Physicians Healthy Kids Services 20 1255919916 0 Physicians Optical Supplies 20 1255919916 0 Physicians Physician Services 00 1255920989 0 TUETKEN MEGAN 2022257 9999999 B 10 1255920989 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1255920989 0 Nurse Practitioners Healthy Kids Services 20 1255920989 0 Nurse Practitioners Nurse Practitioners Services 20 1255920989 0 Nurse Practitioners Physician Services 00 1255923371 0 COSTEA ANGELA 2021061 9999999 B 10 1255923371 0 75 REMITTANCE DR DEPT 1620 SUITE 1620 CHICAGO IL 606751620 20 1255923371 0 Nurse Practitioners Healthy Kids Services 20 1255923371 0 Nurse Practitioners Nurse Practitioners Services 20 1255923371 0 Nurse Practitioners Physician Services 00 1255925236 0 BEARNOD AIDA RUTH G 2021135 9999999 B 10 1255925236 0 5 TIMBERWOOD LN RIVERWOODS IL 600152463 20 1255925236 0 Registered nurse Fluoride varnish 20 1255925236 0 Registered nurse Healthy Kids Services 20 1255925236 0 Registered nurse Nurse Practitioners Services 20 1255925236 0 Registered nurse Nursing service 20 1255925236 0 Registered nurse Physician Services 20 1255925236 0 Registered nurse Waiver service 00 1255925392 0 HOAGUE FLETCHER 2021121 9999999 H 10 1255925392 0 621 S NEW BALLAS RD STE 5003B SAINT LOUIS MO 631418270 20 1255925392 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1255925764 0 ODELUGA NKIRUKA 2021190 9999999 B 10 1255925764 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1255925764 0 Physicians Anesthesia Services 20 1255925764 0 Physicians Healthy Kids Services 20 1255925764 0 Physicians Optical Supplies 20 1255925764 0 Physicians Physician Services 00 1255926291 0 FINN ALEXANDER 2021097 9999999 B 10 1255926291 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1255926291 0 Nurse Practitioners Healthy Kids Services 20 1255926291 0 Nurse Practitioners Nurse Practitioners Services 20 1255926291 0 Nurse Practitioners Physician Services 00 1255929733 0 BRECHBUHL BRITTANY A 2021197 9999999 B 10 1255929733 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1255929733 0 Nurse Practitioners Anesthesia Services 20 1255929733 0 Nurse Practitioners Nurse Practitioners Services 20 1255929733 0 Nurse Practitioners Physician Services 00 1255930434 0 JOSEPH JENNIFER 2021244 9999999 B 10 1255930434 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1255930434 0 Speech Therapists Medical Supplies 20 1255930434 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1255939500 0 VEALE ASHLEY 2023221 9999999 B 10 1255939500 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1255939500 0 Physician Assistant Only Fluoride varnish 20 1255939500 0 Physician Assistant Only Healthy Kids Services 20 1255939500 0 Physician Assistant Only Physician Services 00 1255940334 0 OXLEY RENEE 2020246 9999999 B 10 1255940334 0 1201 N SHERIDAN RD WAUKEGAN IL 600852081 20 1255940334 0 Speech Therapists Medical Supplies 20 1255940334 0 Speech Therapists Medical equipment/prosthetic devices 20 1255940334 0 Speech Therapists Speech Therapy/Pathology Services 00 1255941928 0 KORNHAUSER SAMANTHA 2020358 9999999 B 10 1255941928 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1255941928 0 Nurse Practitioners Healthy Kids Services 20 1255941928 0 Nurse Practitioners Nurse Practitioners Services 20 1255941928 0 Nurse Practitioners Physician Services 00 1255943999 0 HILL KRISTEN M 2021305 9999999 B 10 1255943999 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1255943999 0 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Supplies 20 1255969804 0 Physicians Physician Services 00 1255970141 0 REYES JOANN 2020189 9999999 B 10 1255970141 0 2835 N SHEFFIELD AVE STE 500 CHICAGO IL 606575084 20 1255970141 0 Nurse Practitioners Fluoride varnish 20 1255970141 0 Nurse Practitioners Healthy Kids Services 20 1255970141 0 Nurse Practitioners Nurse Practitioners Services 20 1255970141 0 Nurse Practitioners Physician Services 00 1255973830 0 MILLER AMY L 2023115 9999999 B 10 1255973830 0 PO BOX 3988 CARBONDALE IL 629023988 20 1255973830 0 Nurse Practitioners Healthy Kids Services 20 1255973830 0 Nurse Practitioners Nurse Practitioners Services 20 1255973830 0 Nurse Practitioners Physician Services 00 1255974705 0 REU MONICA 2020007 9999999 B 10 1255974705 0 74 ECLIPSE CTR BELOIT WI 535113550 20 1255974705 0 Clinical Social Worker Social work service 00 1255976528 0 BOU-SAAB RAMIE 2021176 9999999 B 10 1255976528 0 122 S MICHIGAN AVE STE 1441 CHICAGO IL 606036173 20 1255976528 0 Clinical Social Worker Social work 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Services 20 1255980025 0 Nurse Practitioners Physician Services 00 1255980991 0 FIGUEROA GUILLERMINA 2021257 9999999 B 10 1255980991 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1255980991 0 Other behavior health professional LCPC/LMFT services 20 1255980991 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1255981064 0 JENNINGS AMANDA 2020169 9999999 B 10 1255981064 0 1005 BROADWAY ST QUINCY IL 623012834 20 1255981064 0 Nurse Practitioners Fluoride varnish 20 1255981064 0 Nurse Practitioners Healthy Kids Services 20 1255981064 0 Nurse Practitioners Nurse Practitioners Services 20 1255981064 0 Nurse Practitioners Physician Services 00 1255981528 0 MARRIOTT STACY R 2019262 9999999 B 10 1255981528 0 3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047452 20 1255981528 0 Nurse Practitioners Fluoride varnish 20 1255981528 0 Nurse Practitioners Healthy Kids Services 20 1255981528 0 Nurse Practitioners Nurse 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Physician Services 00 1255985438 0 WIELAND STACY S 2019253 9999999 B 10 1255985438 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1255985438 0 Nurse Practitioners Fluoride varnish 20 1255985438 0 Nurse Practitioners Healthy Kids Services 20 1255985438 0 Nurse Practitioners Nurse Practitioners Services 20 1255985438 0 Nurse Practitioners Physician Services 00 1255986055 0 SANDHU GAGANDEEP S 2023100 9999999 B 10 1255986055 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1255986055 0 Podiatrists Podiatric Services 00 1255987418 0 SESTAK CLINT T 2019228 9999999 B 10 1255987418 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1255987418 0 Physical Therapists Medical Supplies 20 1255987418 0 Physical Therapists Medical equipment/prosthetic devices 20 1255987418 0 Physical Therapists Physical Therapy Services 00 1255987681 0 RYER JACQUELINE E 2019231 9999999 B 10 1255987681 0 1311 MAMARONECK AVE STE 140 WHITE PLAINS NY 106055224 20 1255987681 0 Speech Therapists Medical Supplies 20 1255987681 0 Speech Therapists Medical equipment/prosthetic devices 20 1255987681 0 Speech Therapists Speech Therapy/Pathology Services 00 1255987749 0 HULBERT MOLLY 2019224 9999999 B 10 1255987749 0 3649 N MARSHFIELD AVE APT 2 CHICAGO IL 606136959 20 1255987749 0 Speech Therapists Medical Supplies 20 1255987749 0 Speech Therapists Medical equipment/prosthetic devices 20 1255987749 0 Speech Therapists Speech Therapy/Pathology Services 00 1255988259 0 LI JONATHAN R 2020197 9999999 B 10 1255988259 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1255988259 0 Physician Assistant Only Fluoride varnish 20 1255988259 0 Physician Assistant Only Healthy Kids Services 20 1255988259 0 Physician Assistant Only Physician Services 00 1255988788 0 HARGAN AMANDA 2021075 9999999 B 10 1255988788 0 1525 LOCUST ST RED BUD IL 622781374 20 1255988788 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1255989919 0 REISMANN TAYLOR 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1255991907 0 Physicians Healthy Kids Services 20 1255991907 0 Physicians Optical Supplies 20 1255991907 0 Physicians Physician Services 00 1255992590 0 NICHOLSON KYRA 2020279 9999999 B 10 1255992590 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1255992590 0 Physicians Anesthesia Services 20 1255992590 0 Physicians Healthy Kids Services 20 1255992590 0 Physicians Optical Supplies 20 1255992590 0 Physicians Physician Services 00 1255992855 0 HALLMARK ANDREW 2023144 9999999 B 10 1255992855 0 4698 DEPT CAROL STREAM IL 601220021 20 1255992855 0 Physicians Anesthesia Services 20 1255992855 0 Physicians Healthy Kids Services 20 1255992855 0 Physicians Optical Supplies 20 1255992855 0 Physicians Physician Services 00 1255993309 0 HUSSAIN MUJTABA 2022242 9999999 B 10 1255993309 0 PO BOX 857 FREEPORT IL 610320857 20 1255993309 0 Physicians Anesthesia Services 20 1255993309 0 Physicians Fluoride varnish 20 1255993309 0 Physicians Healthy Kids Services 20 1255993309 0 Physicians Optical Supplies 20 1255993309 0 Physicians Physician Services 00 1255993564 0 ERNST SHAUN 2019231 9999999 B 10 1255993564 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1255993564 0 Physical Therapists Medical Supplies 20 1255993564 0 Physical Therapists Medical equipment/prosthetic devices 20 1255993564 0 Physical Therapists Physical Therapy Services 00 1255994448 0 BARNES ROBERT 2024165 9999999 B 10 1255994448 0 5777 DEPT CAROL STREAM IL 601220021 20 1255994448 0 Physicians Anesthesia Services 20 1255994448 0 Physicians Healthy Kids Services 20 1255994448 0 Physicians Optical Supplies 20 1255994448 0 Physicians Physician Services 00 1255994851 0 SPATA RACHEL 2019184 9999999 B 10 1255994851 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1255994851 0 Occupational Therapists Medical Supplies 20 1255994851 0 Occupational Therapists Medical equipment/prosthetic devices 20 1255994851 0 Occupational Therapists Occupational Therapy Services 00 1255995320 0 JANI AKASH 2020183 9999999 B 10 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606733039 20 1255998787 0 Physicians Anesthesia Services 20 1255998787 0 Physicians Fluoride varnish 20 1255998787 0 Physicians Healthy Kids Services 20 1255998787 0 Physicians Optical Supplies 20 1255998787 0 Physicians Physician Services 00 1265000335 0 SOGADE OMOLADE O 2021229 9999999 B 10 1265000335 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1265000335 0 Physicians Anesthesia Services 20 1265000335 0 Physicians Healthy Kids Services 20 1265000335 0 Physicians Optical Supplies 20 1265000335 0 Physicians Physician Services 00 1265000509 0 LOTHET EMILIE H 2021222 9999999 B 10 1265000509 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1265000509 0 Physicians Anesthesia Services 20 1265000509 0 Physicians Healthy Kids Services 20 1265000509 0 Physicians Optical Supplies 20 1265000509 0 Physicians Physician Services 00 1265000574 0 COX TIMOTHY W 2021222 9999999 B 10 1265000574 0 2605 KENTUCKY AVE STE 306 PADUCAH KY 420033802 20 1265000574 0 Physicians Anesthesia Services 20 1265000574 0 Physicians Fluoride varnish 20 1265000574 0 Physicians Healthy Kids Services 20 1265000574 0 Physicians Optical Supplies 20 1265000574 0 Physicians Physician Services 00 1265000814 0 TAUK HANNAH E 2021263 9999999 B 10 1265000814 0 3015 N BALLAS RD SAINT LOUIS MO 631312329 20 1265000814 0 Nurse Practitioners Anesthesia Services 20 1265000814 0 Nurse Practitioners Nurse Practitioners Services 20 1265000814 0 Nurse Practitioners Physician Services 00 1265001978 0 BEYER ISAAC 2021257 9999999 B 10 1265001978 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1265001978 0 Physical Therapists Medical Supplies 20 1265001978 0 Physical Therapists Medical equipment/prosthetic devices 20 1265001978 0 Physical Therapists Physical Therapy Services 00 1265002547 0 MARTINEZ MADELINE 2024078 9999999 B 10 1265002547 0 3600 W FULLERTON AVE ATTN: BILLING DEPARTMENT CHICAGO IL 606472319 20 1265002547 0 Clinical Social Worker Social work service 00 1265002992 0 VAN HANDEL ADAM 2021182 9999999 B 10 1265002992 0 5665 NEW NORTHSIDE DR STE 320 ATLANTA GA 303285834 20 1265002992 0 Physicians Anesthesia Services 20 1265002992 0 Physicians Healthy Kids Services 20 1265002992 0 Physicians Optical Supplies 20 1265002992 0 Physicians Physician Services 00 1265005102 0 DONNALS TOSHA NICOLE 2021285 9999999 B 10 1265005102 0 611 W PARK ST URBANA IL 618012529 20 1265005102 0 Nurse Practitioners Fluoride varnish 20 1265005102 0 Nurse Practitioners Healthy Kids Services 20 1265005102 0 Nurse Practitioners Nurse Practitioners Services 20 1265005102 0 Nurse Practitioners Physician Services 00 1265005276 0 SAMI FARIA L 2021245 9999999 B 10 1265005276 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1265005276 0 Physicians Anesthesia Services 20 1265005276 0 Physicians Fluoride varnish 20 1265005276 0 Physicians Healthy Kids Services 20 1265005276 0 Physicians Optical Supplies 20 1265005276 0 Physicians Physician Services 00 1265007116 0 SAHOTA KARANJOT 2024263 9999999 B 10 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1265009732 0 Physicians Fluoride varnish 20 1265009732 0 Physicians Healthy Kids Services 20 1265009732 0 Physicians Optical Supplies 20 1265009732 0 Physicians Physician Services 00 1265010045 0 DERVISHI AVNI Z 2021159 9999999 B 10 1265010045 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1265010045 0 Physicians Anesthesia Services 20 1265010045 0 Physicians Healthy Kids Services 20 1265010045 0 Physicians Optical Supplies 20 1265010045 0 Physicians Physician Services 00 1265010664 0 NDUKWE TOCHUKWU 2021176 9999999 B 10 1265010664 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1265010664 0 Physicians Anesthesia Services 20 1265010664 0 Physicians Healthy Kids Services 20 1265010664 0 Physicians Optical Supplies 20 1265010664 0 Physicians Physician Services 00 1265011209 0 WHITMEYER MAX 2022179 9999999 B 10 1265011209 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1265011209 0 Physicians Anesthesia Services 20 1265011209 0 Physicians Fluoride varnish 20 1265011209 0 Physicians Healthy Kids Services 20 1265011209 0 Physicians Optical Supplies 20 1265011209 0 Physicians Physician Services 00 1265011423 0 MANDALA RUPASHREE R 2021176 9999999 B 10 1265011423 0 PO BOX 3039 OAK BROOK IL 605223039 20 1265011423 0 Physicians Anesthesia Services 20 1265011423 0 Physicians Fluoride varnish 20 1265011423 0 Physicians Healthy Kids Services 20 1265011423 0 Physicians Optical Supplies 20 1265011423 0 Physicians Physician Services 00 1265011530 0 GUPTA NIHARIKA 2022171 9999999 B 10 1265011530 0 4698 DEPT CAROL STREAM IL 601220021 20 1265011530 0 Physicians Anesthesia Services 20 1265011530 0 Physicians Healthy Kids Services 20 1265011530 0 Physicians Optical Supplies 20 1265011530 0 Physicians Physician Services 00 1265011621 0 CHOWDHURY MUNTASIR H 2024218 9999999 B 10 1265011621 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1265011621 0 Physicians Anesthesia Services 20 1265011621 0 Physicians Fluoride varnish 20 1265011621 0 Physicians Healthy Kids Services 20 1265011621 0 Physicians Optical Supplies 20 1265011621 0 Physicians Physician Services 00 1265011878 0 WHITTINGTON JESSICA 2021173 9999999 B 10 1265011878 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1265011878 0 Nurse Practitioners Fluoride varnish 20 1265011878 0 Nurse Practitioners Healthy Kids Services 20 1265011878 0 Nurse Practitioners Nurse Practitioners Services 20 1265011878 0 Nurse Practitioners Physician Services 00 1265012322 0 RICHARDSON KEVIN R 2024206 9999999 B 10 1265012322 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1265012322 0 Physicians Anesthesia Services 20 1265012322 0 Physicians Healthy Kids Services 20 1265012322 0 Physicians Optical Supplies 20 1265012322 0 Physicians Physician Services 00 1265012553 0 RUDERMAN AARON 2021179 9999999 B 10 1265012553 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1265012553 0 Physicians Anesthesia Services 20 1265012553 0 Physicians Healthy Kids Services 20 1265012553 0 Physicians Optical Supplies 20 1265012553 0 Physicians Physician Services 20 1265012553 0 Physicians Physicians Psychiatric Services 00 1265013080 0 ANSARI AAMIR 2021247 9999999 B 10 1265013080 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1265013080 0 Physicians Anesthesia Services 20 1265013080 0 Physicians Fluoride varnish 20 1265013080 0 Physicians Healthy Kids Services 20 1265013080 0 Physicians Optical Supplies 20 1265013080 0 Physicians Physician Services 00 1265013601 0 ISAAC-COSS GIOVANNIE 2024205 9999999 B 10 1265013601 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1265013601 0 Physicians Anesthesia Services 20 1265013601 0 Physicians Fluoride varnish 20 1265013601 0 Physicians Healthy Kids Services 20 1265013601 0 Physicians Optical Supplies 20 1265013601 0 Physicians Physician Services 00 1265013619 0 WAHLSTROM DANIEL R 2021182 9999999 B 10 1265013619 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1265013619 0 Physicians Anesthesia Services 20 1265013619 0 Physicians Healthy Kids Services 20 1265013619 0 Physicians Optical Supplies 20 1265013619 0 Physicians Physician Services 20 1265013619 0 Physicians Physicians Psychiatric Services 00 1265013809 0 WEST ORTIZ WESLEY 2024193 9999999 B 10 1265013809 0 PO BOX 5081 JANESVILLE WI 535475081 20 1265013809 0 Physicians Anesthesia Services 20 1265013809 0 Physicians Fluoride varnish 20 1265013809 0 Physicians Healthy Kids Services 20 1265013809 0 Physicians Optical Supplies 20 1265013809 0 Physicians Physician Services 00 1265014005 0 VENZON ALLISON 2024241 9999999 B 10 1265014005 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1265014005 0 Physicians Anesthesia Services 20 1265014005 0 Physicians Fluoride varnish 20 1265014005 0 Physicians Healthy Kids Services 20 1265014005 0 Physicians Optical Supplies 20 1265014005 0 Physicians Physician Services 00 1265015226 0 NATION MARIA 2023141 9999999 B 10 1265015226 0 151 N MAIN ST DECATUR IL 625231206 20 1265015226 0 Clinical Social Worker Social work service 00 1265015515 0 LEONARD SKYLAR 2023175 9999999 B 10 1265015515 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1265015515 0 Physicians Anesthesia Services 20 1265015515 0 Physicians Healthy Kids Services 20 1265015515 0 Physicians Optical Supplies 20 1265015515 0 Physicians Physician Services 00 1265016513 0 TRAN KHANH H 2024158 9999999 B 10 1265016513 0 PO BOX 775253 CHICAGO IL 606775253 20 1265016513 0 Nurse Practitioners Fluoride varnish 20 1265016513 0 Nurse Practitioners Healthy Kids Services 20 1265016513 0 Nurse Practitioners Nurse Practitioners Services 20 1265016513 0 Nurse Practitioners Physician Services 00 1265016984 0 JENNINGS JAYLENE 2022276 9999999 B 10 1265016984 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1265016984 0 Physician Assistant Only Fluoride varnish 20 1265016984 0 Physician Assistant Only Healthy Kids Services 20 1265016984 0 Physician Assistant Only Physician Services 00 1265017149 0 BUSS MANDI L 2021106 9999999 B 10 1265017149 0 5777 DEPT CAROL STREAM IL 601220021 20 1265017149 0 Physician Assistant Only Social work service 00 1265017438 0 POQUETTE ALEJANDRA 2022089 9999999 B 10 1265017438 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1265017438 0 Physician Assistant Only Fluoride varnish 20 1265017438 0 Physician Assistant Only Healthy Kids Services 20 1265017438 0 Physician Assistant Only Physician Services 00 1265018055 0 CEISEL STEPHANIE 2021117 9999999 B 10 1265018055 0 370 SUMMIT ST # 1 ELGIN IL 601203843 20 1265018055 0 Clinical Social Worker Social work service 00 1265018253 0 PREMER-BARRAGAN COURTNEY H 2021174 9999999 B 10 1265018253 0 4698 DEPT CAROL STREAM IL 601220021 20 1265018253 0 Physicians Anesthesia Services 20 1265018253 0 Physicians Healthy Kids Services 20 1265018253 0 Physicians Optical Supplies 20 1265018253 0 Physicians Physician Services 00 1265018261 0 PRASAD MARK R 2024128 9999999 B 10 1265018261 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1265018261 0 Physicians Anesthesia Services 20 1265018261 0 Physicians Fluoride varnish 20 1265018261 0 Physicians Healthy Kids Services 20 1265018261 0 Physicians Optical Supplies 20 1265018261 0 Physicians Physician Services 00 1265018311 0 CRANE JILIAN 2022257 9999999 B 10 1265018311 0 109 CALIFORNIA ST PO BOX 577 CARTERVILLE IL 629181923 20 1265018311 0 Nurse Practitioners Healthy Kids Services 20 1265018311 0 Nurse Practitioners Nurse Practitioners Services 20 1265018311 0 Nurse Practitioners Physician Services 00 1265018378 0 CORN MOLLY E 2021092 9999999 B 10 1265018378 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1265018378 0 Nurse Practitioners Healthy Kids Services 20 1265018378 0 Nurse Practitioners Midwife Services 20 1265018378 0 Nurse Practitioners Nurse Practitioners Services 20 1265018378 0 Nurse Practitioners Physician Services 00 1265018907 0 JOHNSON SAMANTHA E 2021251 9999999 B 10 1265018907 0 387 SHUMAN BLVD STE 240W NAPERVILLE IL 605638113 20 1265018907 0 Nurse Practitioners Anesthesia Services 20 1265018907 0 Nurse Practitioners Nurse Practitioners Services 20 1265018907 0 Nurse Practitioners Physician Services 00 1265021257 0 CHIN BENETTA 2023226 9999999 B 10 1265021257 0 PO BOX 43230 PHOENIX AZ 850803230 20 1265021257 0 Physicians Anesthesia Services 20 1265021257 0 Physicians Fluoride varnish 20 1265021257 0 Physicians Healthy Kids Services 20 1265021257 0 Physicians Optical Supplies 20 1265021257 0 Physicians Physician Services 00 1265021919 0 KENT RYAN 2021116 9999999 B 10 1265021919 0 909 RIDGEBROOK RD STE 300 SPARKS MD 211529477 20 1265021919 0 Nurse Practitioners Fluoride varnish 20 1265021919 0 Nurse Practitioners Healthy Kids Services 20 1265021919 0 Nurse Practitioners Nurse Practitioners Services 20 1265021919 0 Nurse Practitioners Physician Services 00 1265021943 0 CURRY TOI 2022104 9999999 B 10 1265021943 0 6303 BLUE LAGOON DR STE 400 MIAMI FL 331266040 20 1265021943 0 Psychologist Psychologist service 00 1265022610 0 HIGGINS BRITTNEY N 2022005 9999999 B 10 1265022610 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1265022610 0 Occupational Therapists Medical Supplies 20 1265022610 0 Occupational Therapists Medical equipment/prosthetic devices 20 1265022610 0 Occupational Therapists Occupational Therapy Services 00 1265022693 0 ANASTOS CLAIRE K 2021270 9999999 B 10 1265022693 0 29373 NETWORK PL CHICAGO IL 606733039 20 1265022693 0 Nurse Practitioners Fluoride varnish 20 1265022693 0 Nurse Practitioners Healthy Kids Services 20 1265022693 0 Nurse Practitioners Nurse Practitioners Services 20 1265022693 0 Nurse Practitioners Physician Services 00 1265022735 0 KIHM SOPHIA 2022258 9999999 B 10 1265022735 0 1550 S INDIANA AVE STE 2NE CHICAGO IL 606052857 20 1265022735 0 Clinical Social Worker Social work service 00 1265023139 0 SCHULTZ LAUREN 2024095 9999999 B 10 1265023139 0 3832 N LINCOLN AVE CHICAGO IL 606133520 20 1265023139 0 Nurse Practitioners Healthy Kids Services 20 1265023139 0 Nurse Practitioners Midwife Services 20 1265023139 0 Nurse Practitioners Nurse Practitioners Services 20 1265023139 0 Nurse Practitioners Physician Services 00 1265023832 0 PATERSON HEATHER 2022025 9999999 B 10 1265023832 0 715 LAKE ST STE 800 OAK PARK IL 603011417 20 1265023832 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1265024582 0 BANO ANEM MUZAMMIL 2021083 9999999 B 10 1265024582 0 9701 W HIGGINS RD STE 270 STE 270 ROSEMONT IL 600184703 20 1265024582 0 Nurse Practitioners Fluoride varnish 20 1265024582 0 Nurse Practitioners Healthy Kids Services 20 1265024582 0 Nurse Practitioners Nurse Practitioners Services 20 1265024582 0 Nurse Practitioners Physician Services 00 1265024632 0 LEIDECKER MAUREEN Z 2022299 9999999 B 10 1265024632 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1265024632 0 Nurse Practitioners Anesthesia Services 20 1265024632 0 Nurse Practitioners Nurse Practitioners Services 20 1265024632 0 Nurse Practitioners Physician Services 00 1265026538 0 WEBER EMILY L 2021057 9999999 B 10 1265026538 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1265026538 0 Nurse Practitioners Healthy Kids Services 20 1265026538 0 Nurse Practitioners Nurse Practitioners Services 20 1265026538 0 Nurse Practitioners Physician Services 00 1265029011 0 PURSLEY MARY ELIZABETH 2021062 9999999 B 10 1265029011 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1265029011 0 Nurse Practitioners Fluoride varnish 20 1265029011 0 Nurse Practitioners Healthy Kids Services 20 1265029011 0 Nurse Practitioners Nurse Practitioners Services 20 1265029011 0 Nurse Practitioners Physician Services 00 1265030019 0 MCLEAN ANDREA A 2020288 9999999 B 10 1265030019 0 124 SW ADAMS ST FL 2 PEORIA IL 616021308 20 1265030019 0 Nurse Practitioners Fluoride varnish 20 1265030019 0 Nurse Practitioners Healthy Kids Services 20 1265030019 0 Nurse Practitioners Nurse Practitioners Services 20 1265030019 0 Nurse Practitioners Physician Services 00 1265030548 0 DAVID CHRISTINA L 2020345 9999999 B 10 1265030548 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1265030548 0 Nurse Practitioners Healthy Kids Services 20 1265030548 0 Nurse Practitioners Nurse Practitioners Services 20 1265030548 0 Nurse Practitioners Physician Services 00 1265030563 0 MONTGOMERY CHRISTIEJEAN 2023121 9999999 B 10 1265030563 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1265030563 0 Nurse Practitioners Fluoride varnish 20 1265030563 0 Nurse Practitioners Healthy Kids Services 20 1265030563 0 Nurse Practitioners Nurse Practitioners Services 20 1265030563 0 Nurse Practitioners Physician Services 00 1265032221 0 ROBERTS LINDSAY 2020351 9999999 B 10 1265032221 0 611 W PARK ST URBANA IL 618012529 20 1265032221 0 Nurse Practitioners Fluoride varnish 20 1265032221 0 Nurse Practitioners Healthy Kids Services 20 1265032221 0 Nurse Practitioners Nurse Practitioners Services 20 1265032221 0 Nurse Practitioners Physician Services 00 1265033385 0 DERRADJI CAROLLE 2021081 9999999 B 10 1265033385 0 124 N SANGAMON ST CHICAGO IL 606072202 20 1265033385 0 Nurse Practitioners Fluoride varnish 20 1265033385 0 Nurse Practitioners Healthy Kids Services 20 1265033385 0 Nurse Practitioners Nurse Practitioners Services 20 1265033385 0 Nurse Practitioners Physician Services 00 1265034078 0 GOMEZ FATIMA 2020323 9999999 B 10 1265034078 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1265034078 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1265034961 0 SMALLEY MACKENZIE LYNN 2020330 9999999 B 10 1265034961 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1265034961 0 Clinical Social Worker Social work service 00 1265035745 0 MCGRATH CALEEN K 2021043 9999999 B 10 1265035745 0 5777 DEPT CAROL STREAM IL 601220021 20 1265035745 0 Clinical Social Worker Social work service 00 1265035927 0 YAMAK SALAM 2022314 9999999 B 10 1265035927 0 PO BOX 500 ELLICOTTVILLE NY 147310500 20 1265035927 0 Physician Assistant Only Fluoride varnish 20 1265035927 0 Physician Assistant Only Healthy Kids Services 20 1265035927 0 Physician Assistant Only Physician Services 00 1265036164 0 CHAGOYA DEBBIE 2021189 9999999 B 10 1265036164 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1265036164 0 Nurse Practitioners Fluoride varnish 20 1265036164 0 Nurse Practitioners Healthy Kids Services 20 1265036164 0 Nurse Practitioners Nurse Practitioners Services 20 1265036164 0 Nurse Practitioners Physician Services 00 1265037428 0 TANKSLEY NEDRA L 2022340 9999999 B 10 1265037428 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1265037428 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1265037642 0 GUINAN DELANEY 2020343 9999999 H 10 1265037642 0 1120 RANDALL CT GENEVA IL 601343911 20 1265037642 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1265039143 0 FU FEI 2020259 9999999 B 10 1265039143 0 1 UNIVERSITY BLVD SAINT LOUIS MO 631214400 20 1265039143 0 Optometrists Optical Supplies 20 1265039143 0 Optometrists Optometric Services 20 1265039143 0 Optometrists Physician Services 00 1265039218 0 GUISSOU ADA PULCHERIE 2024330 9999999 B 10 1265039218 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1265039218 0 Physicians Anesthesia Services 20 1265039218 0 Physicians Healthy Kids Services 20 1265039218 0 Physicians Optical Supplies 20 1265039218 0 Physicians Physician Services 00 1265039812 0 BROWN SARA 2020281 9999999 B 10 1265039812 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1265039812 0 Nurse Practitioners Healthy Kids Services 20 1265039812 0 Nurse Practitioners Nurse Practitioners Services 20 1265039812 0 Nurse Practitioners Physician Services 00 1265041636 0 PARTIPILO ISABELLA A 2021021 9999999 B 10 1265041636 0 473 W ARMY TRAIL RD STE 107 BLOOMINGDALE IL 601082674 20 1265041636 0 Speech Therapists Medical Supplies 20 1265041636 0 Speech Therapists Medical equipment/prosthetic devices 20 1265041636 0 Speech 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PAUL 2020244 9999999 B 10 1265051254 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1265051254 0 Physicians Anesthesia Services 20 1265051254 0 Physicians Healthy Kids Services 20 1265051254 0 Physicians Optical Supplies 20 1265051254 0 Physicians Physician Services 00 1265051551 0 HASAN KAAZIM 2023285 9999999 B 10 1265051551 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1265051551 0 Physicians Anesthesia Services 20 1265051551 0 Physicians Healthy Kids Services 20 1265051551 0 Physicians Optical Supplies 20 1265051551 0 Physicians Physician Services 00 1265052294 0 URVEEL SHAH 2024169 9999999 B 10 1265052294 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1265052294 0 Physicians Anesthesia Services 20 1265052294 0 Physicians Fluoride varnish 20 1265052294 0 Physicians Healthy Kids Services 20 1265052294 0 Physicians Optical Supplies 20 1265052294 0 Physicians Physician Services 00 1265052302 0 POONAWALLA MARIA SHABBIR 2020178 9999999 B 10 1265052302 0 150 HARVESTER DR STE 300 BURR 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Physicians Anesthesia Services 20 1265053417 0 Physicians Fluoride varnish 20 1265053417 0 Physicians Healthy Kids Services 20 1265053417 0 Physicians Optical Supplies 20 1265053417 0 Physicians Physician Services 00 1265053433 0 NATIONS ADRIENNE M 2021029 9999999 B 10 1265053433 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1265053433 0 Nurse Practitioners Anesthesia Services 20 1265053433 0 Nurse Practitioners Nurse Practitioners Services 20 1265053433 0 Nurse Practitioners Physician Services 00 1265053631 0 NAMATH AMALIA G 2020191 9999999 B 10 1265053631 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1265053631 0 Physicians Anesthesia Services 20 1265053631 0 Physicians Healthy Kids Services 20 1265053631 0 Physicians Optical Supplies 20 1265053631 0 Physicians Physician Services 00 1265053771 0 SINGH RAVNEET 2022173 9999999 B 10 1265053771 0 2720 DUNDEE RD NORTHBROOK IL 600622609 20 1265053771 0 Physicians Anesthesia Services 20 1265053771 0 Physicians 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Physicians Optical Supplies 20 1265059935 0 Physicians Physician Services 00 1265060149 0 AN MICHAEL 2024220 9999999 B 10 1265060149 0 PO BOX 3988 CARBONDALE IL 629023988 20 1265060149 0 Podiatrists Podiatric Services 00 1265060396 0 FEATHERSTONE KAITLIN M 2021224 9999999 B 10 1265060396 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1265060396 0 Physician Assistant Only Fluoride varnish 20 1265060396 0 Physician Assistant Only Healthy Kids Services 20 1265060396 0 Physician Assistant Only Physician Services 00 1265060891 0 DI CHIARO BIANCA 2020266 9999999 B 10 1265060891 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1265060891 0 Physicians Anesthesia Services 20 1265060891 0 Physicians Healthy Kids Services 20 1265060891 0 Physicians Optical Supplies 20 1265060891 0 Physicians Physician Services 00 1265060917 0 FINE DAVID F 2024004 9999999 B 10 1265060917 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1265060917 0 Physicians Anesthesia Services 20 1265060917 0 Physicians Healthy Kids Services 20 1265060917 0 Physicians Optical Supplies 20 1265060917 0 Physicians Physician Services 00 1265060925 0 VEEDER AMANDA 2020119 9999999 B 10 1265060925 0 PO BOX 268 FREEPORT IL 610320268 20 1265060925 0 Nurse Practitioners Fluoride varnish 20 1265060925 0 Nurse Practitioners Healthy Kids Services 20 1265060925 0 Nurse Practitioners Nurse Practitioners Services 20 1265060925 0 Nurse Practitioners Physician Services 00 1265060990 0 FAIZAN FARAH 2022250 9999999 B 10 1265060990 0 2200 W HIGGINS RD STE 140 SUITE 140 HOFFMAN ESTATES IL 601692422 20 1265060990 0 Physicians Anesthesia Services 20 1265060990 0 Physicians Fluoride varnish 20 1265060990 0 Physicians Healthy Kids Services 20 1265060990 0 Physicians Optical Supplies 20 1265060990 0 Physicians Physician Services 00 1265061063 0 SIDDIKI MIKAIL 2021138 9999999 B 10 1265061063 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1265061063 0 Physicians Anesthesia Services 20 1265061063 0 Physicians Fluoride varnish 20 1265061063 0 Physicians Healthy Kids Services 20 1265061063 0 Physicians Optical Supplies 20 1265061063 0 Physicians Physician Services 00 1265061543 0 HUNTER EZRA L 2023250 9999999 B 10 1265061543 0 4730 N WINTHROP AVE CHICAGO IL 606405034 20 1265061543 0 Physician Assistant Only Fluoride varnish 20 1265061543 0 Physician Assistant Only Healthy Kids Services 20 1265061543 0 Physician Assistant Only Physician Services 00 1265061980 0 MOSSACK SPENCER M 2021182 9999999 B 10 1265061980 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1265061980 0 Physicians Anesthesia Services 20 1265061980 0 Physicians Healthy Kids Services 20 1265061980 0 Physicians Optical Supplies 20 1265061980 0 Physicians Physician Services 00 1265062178 0 BRUBAKER JON ELLIOTT D 2023250 9999999 B 10 1265062178 0 2041 GOOSE LAKE RD SAUGET IL 622062822 20 1265062178 0 Physicians Anesthesia Services 20 1265062178 0 Physicians Fluoride varnish 20 1265062178 0 Physicians Healthy Kids Services 20 1265062178 0 Physicians Optical Supplies 20 1265062178 0 Physicians Physician Services 00 1265062640 0 KEMEN JULIA D 2020050 9999999 B 10 1265062640 0 PO BOX 778912 CHICAGO IL 606778912 20 1265062640 0 Nurse Practitioners Fluoride varnish 20 1265062640 0 Nurse Practitioners Healthy Kids Services 20 1265062640 0 Nurse Practitioners Nurse Practitioners Services 20 1265062640 0 Nurse Practitioners Physician Services 00 1265063192 0 CLONINGER-HULTZ STEPHANNIE E 2020050 9999999 B 10 1265063192 0 400 MAPLE SUMMIT RD JERSEYVILLE IL 620522028 20 1265063192 0 Nurse Practitioners Fluoride varnish 20 1265063192 0 Nurse Practitioners Healthy Kids Services 20 1265063192 0 Nurse Practitioners Nurse Practitioners Services 20 1265063192 0 Nurse Practitioners Physician Services 00 1265063655 0 DAVID ALLISON J 2025021 9999999 B 10 1265063655 0 600 N COLLEGE AVE GENESEO IL 612541091 20 1265063655 0 Chiropractors Chiropractic Services 00 1265064380 0 WINKLER DEBRA J 2020209 9999999 B 10 1265064380 0 4199 GATEWAY BLVD STE 2400 NEWBURGH IN 476307972 20 1265064380 0 Nurse Practitioners Fluoride varnish 20 1265064380 0 Nurse Practitioners Healthy Kids Services 20 1265064380 0 Nurse Practitioners Nurse Practitioners Services 20 1265064380 0 Nurse Practitioners Physician Services 00 1265064612 0 LEYSAHT ROBERT E 2020077 9999999 B 10 1265064612 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1265064612 0 Nurse Practitioners Fluoride varnish 20 1265064612 0 Nurse Practitioners Healthy Kids Services 20 1265064612 0 Nurse Practitioners Nurse Practitioners Services 20 1265064612 0 Nurse Practitioners Physician Services 00 1265064703 0 GREUBEL KELSEY E 2020062 9999999 B 10 1265064703 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1265064703 0 Nurse Practitioners Healthy Kids Services 20 1265064703 0 Nurse Practitioners Nurse Practitioners Services 20 1265064703 0 Nurse Practitioners Physician Services 00 1265064927 0 LUNDBERG SHARON 2020058 9999999 B 10 1265064927 0 1020 E OGDEN 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0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1265066591 0 Physical Therapists Medical Supplies 20 1265066591 0 Physical Therapists Medical equipment/prosthetic devices 20 1265066591 0 Physical Therapists Physical Therapy Services 00 1265067003 0 PATEL PURVI 2020111 9999999 B 10 1265067003 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1265067003 0 Nurse Practitioners Fluoride varnish 20 1265067003 0 Nurse Practitioners Healthy Kids Services 20 1265067003 0 Nurse Practitioners Nurse Practitioners Services 20 1265067003 0 Nurse Practitioners Physician Services 00 1265067151 0 ROKNI ALEX M 2021176 9999999 B 10 1265067151 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1265067151 0 Physicians Anesthesia Services 20 1265067151 0 Physicians Healthy Kids Services 20 1265067151 0 Physicians Optical Supplies 20 1265067151 0 Physicians Physician Services 00 1265067391 0 SHAMAYEVA SABINA 2021222 9999999 B 10 1265067391 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1265067391 0 Physicians Anesthesia Services 20 1265067391 0 Physicians Fluoride varnish 20 1265067391 0 Physicians Healthy Kids Services 20 1265067391 0 Physicians Optical Supplies 20 1265067391 0 Physicians Physician Services 00 1265069157 0 HAYNES CAROLINE 2020227 9999999 B 10 1265069157 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1265069157 0 Physicians Anesthesia Services 20 1265069157 0 Physicians Healthy Kids Services 20 1265069157 0 Physicians Optical Supplies 20 1265069157 0 Physicians Physician Services 00 1265069207 0 MORRIS LISA M 2021221 9999999 B 10 1265069207 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1265069207 0 Physicians Anesthesia Services 20 1265069207 0 Physicians Healthy Kids Services 20 1265069207 0 Physicians Optical Supplies 20 1265069207 0 Physicians Physician Services 00 1265069306 0 KNIGHT CALEB 2024233 9999999 B 10 1265069306 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1265069306 0 Physicians Anesthesia Services 20 1265069306 0 Physicians Healthy Kids Services 20 1265069306 0 Physicians Optical Supplies 20 1265069306 0 Physicians Physician Services 00 1265069371 0 CRONIN KATHLEEN 2023075 9999999 B 10 1265069371 0 900 N KINGSBURY ST STE 130N CHICAGO IL 606107457 20 1265069371 0 Physicians Anesthesia Services 20 1265069371 0 Physicians Healthy Kids Services 20 1265069371 0 Physicians Optical Supplies 20 1265069371 0 Physicians Physician Services 00 1265070494 0 OWENS AARON M 2020042 9999999 B 10 1265070494 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1265070494 0 Nurse Practitioners Healthy Kids Services 20 1265070494 0 Nurse Practitioners Nurse Practitioners Services 20 1265070494 0 Nurse Practitioners Physician Services 00 1265071104 0 CARDELLA DIANA 2024039 9999999 B 10 1265071104 0 214 CENTERVIEW DR STE 250 BRENTWOOD TN 370273248 20 1265071104 0 Nurse Practitioners Fluoride varnish 20 1265071104 0 Nurse Practitioners Healthy Kids Services 20 1265071104 0 Nurse Practitioners Nurse Practitioners Services 20 1265071104 0 Nurse Practitioners Physician Services 00 1265075360 0 HICKSON ROBERT 2024165 9999999 B 10 1265075360 0 810 W DOWNER PL AURORA IL 605064904 20 1265075360 0 Other behavior health professional LCPC/LMFT services 00 1265075550 0 GRAY SARAH 2024144 9999999 B 10 1265075550 0 1951 NW 7TH AVE STE 300 MIAMI FL 331361112 20 1265075550 0 Other behavior health professional LCPC/LMFT services 00 1265077424 0 HARVEY VANESSA M 2019322 9999999 B 10 1265077424 0 29373 NETWORK PL CHICAGO IL 606733039 20 1265077424 0 Nurse Practitioners Fluoride varnish 20 1265077424 0 Nurse Practitioners Healthy Kids Services 20 1265077424 0 Nurse Practitioners Nurse Practitioners Services 20 1265077424 0 Nurse Practitioners Physician Services 00 1265078364 0 RHOTON TIMOTHY M 2023291 9999999 B 10 1265078364 0 1625 BETHANY RD SYCAMORE IL 601783124 20 1265078364 0 Nurse Practitioners Healthy Kids Services 20 1265078364 0 Nurse Practitioners Nurse Practitioners Services 20 1265078364 0 Nurse Practitioners Physician Services 00 1265080519 0 SMITH DANIELLE GRACE 2023164 9999999 B 10 1265080519 0 PO BOX 3039 OAK BROOK IL 605223039 20 1265080519 0 Physicians Anesthesia Services 20 1265080519 0 Physicians Fluoride varnish 20 1265080519 0 Physicians Healthy Kids Services 20 1265080519 0 Physicians Optical Supplies 20 1265080519 0 Physicians Physician Services 00 1265081681 0 CULLOR JUDY L 2019274 9999999 B 10 1265081681 0 PO BOX 857 FREEPORT IL 610320857 20 1265081681 0 Nurse Practitioners Fluoride varnish 20 1265081681 0 Nurse Practitioners Healthy Kids Services 20 1265081681 0 Nurse Practitioners Nurse Practitioners Services 20 1265081681 0 Nurse Practitioners Physician Services 00 1265083208 0 BLAKE RYAN P 2019357 9999999 B 10 1265083208 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1265083208 0 Nurse Practitioners Electronic Home Response/EHR Installation, MPE Certification 20 1265083208 0 Nurse Practitioners Fluoride varnish 20 1265083208 0 Nurse Practitioners Healthy Kids Services 20 1265083208 0 Nurse Practitioners Nurse Practitioners Services 20 1265083208 0 Nurse Practitioners Physician Services 00 1265084560 0 MARTINELLI SARA 2021356 9999999 B 10 1265084560 0 335 E MAHN CT OAK CREEK WI 531542155 20 1265084560 0 Physician Assistant Only Fluoride varnish 20 1265084560 0 Physician Assistant Only Healthy Kids Services 20 1265084560 0 Physician Assistant Only Physician Services 00 1265084842 0 ROE-FITZGERALD CARRIE J 2019248 9999999 B 10 1265084842 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1265084842 0 Nurse Practitioners Fluoride varnish 20 1265084842 0 Nurse Practitioners Healthy Kids Services 20 1265084842 0 Nurse Practitioners Nurse Practitioners Services 20 1265084842 0 Nurse Practitioners Physician Services 00 1265084859 0 MCCLURE SHAWN 2023076 9999999 B 10 1265084859 0 8400 LOUISIANA ST MERRILLVILLE IN 464106385 20 1265084859 0 Nurse Practitioners Healthy Kids Services 20 1265084859 0 Nurse Practitioners Nurse Practitioners Services 20 1265084859 0 Nurse Practitioners Physician Services 00 1265085807 0 MOORE MALLORY 2019224 9999999 B 10 1265085807 0 850 43RD AVE STE 100 MOLINE IL 612658401 20 1265085807 0 Physical Therapists Medical Supplies 20 1265085807 0 Physical Therapists Medical equipment/prosthetic devices 20 1265085807 0 Physical Therapists Physical Therapy Services 00 1265086086 0 BURNS SHELLEY 2019248 9999999 B 10 1265086086 0 414 PLAZA DR STE 301 WESTMONT IL 605595508 20 1265086086 0 Clinical Social Worker Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1265086086 0 Clinical Social Worker Social work service 00 1265090245 0 MILIAN ANDREW 2019183 9999999 B 10 1265090245 0 2305 GEORGIA ST LOUISIANA MO 633532559 20 1265090245 0 Physicians Anesthesia Services 20 1265090245 0 Physicians Fluoride varnish 20 1265090245 0 Physicians Healthy Kids Services 20 1265090245 0 Physicians Optical Supplies 20 1265090245 0 Physicians Physician Services 00 1265090856 0 COENEN KRISTINA 2024351 9999999 B 10 1265090856 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1265090856 0 Other behavior health professional LCPC/LMFT services 00 1265091128 0 OTHMAN HASAN F 2022126 9999999 B 10 1265091128 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1265091128 0 Physicians Anesthesia Services 20 1265091128 0 Physicians Fluoride varnish 20 1265091128 0 Physicians Healthy Kids Services 20 1265091128 0 Physicians Optical Supplies 20 1265091128 0 Physicians Physician Services 00 1265091334 0 EGANHOUSE MATTHEW M 2019327 9999999 B 10 1265091334 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1265091334 0 Physicians Anesthesia Services 20 1265091334 0 Physicians Fluoride varnish 20 1265091334 0 Physicians Healthy Kids Services 20 1265091334 0 Physicians Optical Supplies 20 1265091334 0 Physicians Physician Services 00 1265092670 0 DEKORVER NICHOLAS W 2020287 9999999 B 10 1265092670 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1265092670 0 Physicians Anesthesia Services 20 1265092670 0 Physicians Fluoride varnish 20 1265092670 0 Physicians Healthy Kids Services 20 1265092670 0 Physicians Optical Supplies 20 1265092670 0 Physicians Physician Services 00 1265092738 0 PEHLIVAN ESRA 2020287 9999999 B 10 1265092738 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1265092738 0 Physicians Anesthesia Services 20 1265092738 0 Physicians Fluoride varnish 20 1265092738 0 Physicians Healthy Kids Services 20 1265092738 0 Physicians Optical Supplies 20 1265092738 0 Physicians Physician Services 00 1265093033 0 ASIMAKOPOULOS ANGELA 2020010 9999999 B 10 1265093033 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1265093033 0 Nurse Practitioners Healthy Kids Services 20 1265093033 0 Nurse Practitioners Nurse Practitioners Services 20 1265093033 0 Nurse Practitioners Physician Services 00 1265093637 0 LITTELL LAUREN M 2021124 9999999 B 10 1265093637 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1265093637 0 Physicians Anesthesia Services 20 1265093637 0 Physicians Fluoride varnish 20 1265093637 0 Physicians Healthy Kids Services 20 1265093637 0 Physicians Optical Supplies 20 1265093637 0 Physicians Physician Services 00 1265094239 0 BERNARD SAMUEL R 2022335 9999999 B 10 1265094239 0 5139 MATTIS RD STE 102 SAINT LOUIS MO 631282250 20 1265094239 0 Podiatrists Podiatric Services 00 1265094254 0 CASHION CHRISTINE E 2022123 9999999 B 10 1265094254 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1265094254 0 Audiologists Audiology Services 20 1265094254 0 Audiologists Medical Supplies 20 1265094254 0 Audiologists Medical equipment/prosthetic devices 00 1265094510 0 CONCORS ERICA 2020274 9999999 B 10 1265094510 0 5777 DEPT CAROL STREAM IL 601220021 20 1265094510 0 Physicians Anesthesia Services 20 1265094510 0 Physicians Healthy Kids Services 20 1265094510 0 Physicians Optical Supplies 20 1265094510 0 Physicians Physician Services 00 1265095400 0 FLODEN SARAH 2023138 9999999 B 10 1265095400 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1265095400 0 Physicians Anesthesia Services 20 1265095400 0 Physicians Fluoride varnish 20 1265095400 0 Physicians Healthy Kids Services 20 1265095400 0 Physicians Optical Supplies 20 1265095400 0 Physicians Physician Services 00 1265096184 0 KHAN MUHAMMAD 2020213 9999999 B 10 1265096184 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1265096184 0 Physicians Anesthesia Services 20 1265096184 0 Physicians Healthy Kids Services 20 1265096184 0 Physicians Optical Supplies 20 1265096184 0 Physicians Physician Services 00 1265098206 0 GIBSON-O'GRADY EVAN JOSEPH 2022215 9999999 B 10 1265098206 0 7531 S STONY ISLAND AVE CHICAGO IL 606493954 20 1265098206 0 Physicians Anesthesia Services 20 1265098206 0 Physicians Healthy Kids Services 20 1265098206 0 Physicians Optical Supplies 20 1265098206 0 Physicians Physician Services 00 1265098255 0 MCCARTHY MORGAN 2019316 9999999 B 10 1265098255 0 1936 GREEN BAY RD HIGHLAND PARK IL 600353112 20 1265098255 0 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20 1265109045 0 Nurse Practitioners Nurse Practitioners Services 20 1265109045 0 Nurse Practitioners Physician Services 00 1265109409 0 DAVIS KELLY 2021287 9999999 B 10 1265109409 0 820 SPRINGER DR LOMBARD IL 601486413 20 1265109409 0 Nurse Practitioners Fluoride varnish 20 1265109409 0 Nurse Practitioners Healthy Kids Services 20 1265109409 0 Nurse Practitioners Nurse Practitioners Services 20 1265109409 0 Nurse Practitioners Physician Services 00 1265110258 0 HUNT CHARLEE G 2023226 9999999 B 10 1265110258 0 PO BOX 778912 CHICAGO IL 606778912 20 1265110258 0 Nurse Practitioners Healthy Kids Services 20 1265110258 0 Nurse Practitioners Nurse Practitioners Services 20 1265110258 0 Nurse Practitioners Physician Services 00 1265110290 0 MASLINE ALYSSA 2024218 9999999 B 10 1265110290 0 8 S MICHIGAN AVE FL 7 CHICAGO IL 606033357 20 1265110290 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1265110654 0 ALAMI WATEEN H 2023234 9999999 B 10 1265110654 0 3241 S MICHIGAN AVE CHICAGO IL 606164201 20 1265110654 0 Optometrists Optical Supplies 20 1265110654 0 Optometrists Optometric Services 20 1265110654 0 Optometrists Physician Services 00 1265111025 0 MCDONOUGH NICOLE E 2023341 9999999 B 10 1265111025 0 5777 DEPT CAROL STREAM IL 601220021 20 1265111025 0 Nurse Practitioners Anesthesia Services 20 1265111025 0 Nurse Practitioners Nurse Practitioners Services 20 1265111025 0 Nurse Practitioners Physician Services 00 1265111454 0 LOO YI-LING 2024208 9999999 B 10 1265111454 0 7732 SOLUTION CENTER CHICAGO IL 606777007 20 1265111454 0 Dentists Dental Services 20 1265111454 0 Dentists Physician Services 00 1265111579 0 SHARMA ISHAAN 2024323 9999999 B 10 1265111579 0 611 W PARK ST URBANA IL 618012529 20 1265111579 0 Physicians Anesthesia Services 20 1265111579 0 Physicians Fluoride varnish 20 1265111579 0 Physicians Healthy Kids Services 20 1265111579 0 Physicians Optical Supplies 20 1265111579 0 Physicians Physician Services 00 1265113179 0 CHAGOLLA MARGARITA 2024341 9999999 B 10 1265113179 0 10001 GRAND AVE ATTN: BILLING DEPARTMENT FRANKLIN PARK IL 601312563 20 1265113179 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1265113641 0 PURDY KELLY 2023289 9999999 B 10 1265113641 0 6404 N 70TH PLZ OMAHA NE 681041074 20 1265113641 0 Nurse Practitioners Fluoride varnish 20 1265113641 0 Nurse Practitioners Healthy Kids Services 20 1265113641 0 Nurse Practitioners Nurse Practitioners Services 20 1265113641 0 Nurse Practitioners Physician Services 00 1265113732 0 ELGAMAL AHMED 2024065 9999999 B 10 1265113732 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1265113732 0 Physicians Anesthesia Services 20 1265113732 0 Physicians Fluoride varnish 20 1265113732 0 Physicians Healthy Kids Services 20 1265113732 0 Physicians Optical Supplies 20 1265113732 0 Physicians Physician Services 00 1265114425 0 ROSADO BRUNO MONICA 2024180 9999999 B 10 1265114425 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1265114425 0 Physicians Anesthesia Services 20 1265114425 0 Physicians Healthy Kids Services 20 1265114425 0 Physicians Optical Supplies 20 1265114425 0 Physicians Physician Services 20 1265114425 0 Physicians Physicians Psychiatric Services 00 1265114888 0 SMITH MADELINE 2023257 9999999 B 10 1265114888 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1265114888 0 Nurse Practitioners Fluoride varnish 20 1265114888 0 Nurse Practitioners Healthy Kids Services 20 1265114888 0 Nurse Practitioners Nurse Practitioners Services 20 1265114888 0 Nurse Practitioners Physician Services 00 1265115893 0 BELL ALLISON 2023222 9999999 B 10 1265115893 0 15732 S HOWARD ST PLAINFIELD IL 605442399 20 1265115893 0 Speech Therapists Medical Supplies 20 1265115893 0 Speech Therapists Medical equipment/prosthetic devices 20 1265115893 0 Speech Therapists Speech Therapy/Pathology Services 00 1265116198 0 MESMIN MELSON 2023188 9999999 B 10 1265116198 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1265116198 0 Physicians Anesthesia Services 20 1265116198 0 Physicians Healthy Kids Services 20 1265116198 0 Physicians Optical Supplies 20 1265116198 0 Physicians Physician Services 00 1265116636 0 VENEZIA ERICA 2023354 9999999 B 10 1265116636 0 2348 POST RD STE 107 WARWICK RI 028862271 20 1265116636 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1265116735 0 MUHAMMED NASIRA 2023173 9999999 B 10 1265116735 0 14840 SHEPARD DR DOLTON IL 604192467 20 1265116735 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1265117204 0 GOROSPE DEAN M 2023221 9999999 B 10 1265117204 0 4 N DEER POINT RD STE 1002 HAINESVILLE IL 600303814 20 1265117204 0 Nurse Practitioners Fluoride varnish 20 1265117204 0 Nurse Practitioners Healthy Kids Services 20 1265117204 0 Nurse Practitioners Nurse Practitioners Services 20 1265117204 0 Nurse Practitioners Physician Services 00 1265117451 0 LATIF SURIYYA 2023199 9999999 B 10 1265117451 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1265117451 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1265117667 0 CLEMONS CHANEL A 2024318 9999999 B 10 1265117667 0 11940 S SPRINGFIELD AVE ALSIP IL 608031117 20 1265117667 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1265117956 0 MCKENZIE ANNA K 2023198 9999999 B 10 1265117956 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1265117956 0 Physicians Anesthesia Services 20 1265117956 0 Physicians Healthy Kids Services 20 1265117956 0 Physicians Optical Supplies 20 1265117956 0 Physicians Physician Services 20 1265117956 0 Physicians Physicians Psychiatric Services 00 1265117964 0 JOHNSON REBEKAH D 2023171 9999999 B 10 1265117964 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1265117964 0 Clinical Social Worker Social work service 00 1265117980 0 WAYNE JEREMIAH L 2023198 9999999 B 10 1265117980 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1265117980 0 Physicians Anesthesia Services 20 1265117980 0 Physicians Healthy Kids Services 20 1265117980 0 Physicians Optical Supplies 20 1265117980 0 Physicians Physician Services 20 1265117980 0 Physicians Physicians Psychiatric Services 00 1265119994 0 CROW MELANIE K 2023242 9999999 B 10 1265119994 0 PO BOX 3988 CARBONDALE IL 629023988 20 1265119994 0 Physician Assistant Only Fluoride varnish 20 1265119994 0 Physician Assistant Only Healthy Kids Services 20 1265119994 0 Physician Assistant Only Physician Services 00 1265120687 0 SUSTAITA KELLY 2023123 9999999 B 10 1265120687 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1265120687 0 Nurse Practitioners Healthy Kids Services 20 1265120687 0 Nurse Practitioners Nurse Practitioners Services 20 1265120687 0 Nurse Practitioners Physician Services 00 1265120786 0 BLASZCZYK JENNA 2023125 9999999 B 10 1265120786 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1265120786 0 Nurse Practitioners Healthy Kids Services 20 1265120786 0 Nurse Practitioners Nurse Practitioners Services 20 1265120786 0 Nurse Practitioners Physician Services 00 1265121131 0 NABUKEERA JACQUELINE 2024184 9999999 B 10 1265121131 0 2615 WASHINGTON ST WAUKEGAN IL 600854980 20 1265121131 0 Nurse Practitioners Healthy Kids Services 20 1265121131 0 Nurse Practitioners Nurse Practitioners Services 20 1265121131 0 Nurse Practitioners Physician Services 00 1265121255 0 PABON ANDREA 2023178 9999999 B 10 1265121255 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1265121255 0 Nurse Practitioners Healthy Kids Services 20 1265121255 0 Nurse Practitioners Nurse Practitioners Services 20 1265121255 0 Nurse Practitioners Physician Services 00 1265123806 0 RAVINDRAN SAHANA 2023192 9999999 B 10 1265123806 0 4701 DEPT CAROL STREAM IL 601220021 20 1265123806 0 Physicians Anesthesia Services 20 1265123806 0 Physicians Fluoride varnish 20 1265123806 0 Physicians Healthy Kids Services 20 1265123806 0 Physicians Optical Supplies 20 1265123806 0 Physicians Physician Services 00 1265125611 0 CZAJKOWSKI DANIELLE 2023157 9999999 B 10 1265125611 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1265125611 0 Clinical Social Worker Social work service 00 1265125710 0 MUNEER NIMRAH 2023202 9999999 B 10 1265125710 0 611 W PARK ST URBANA IL 618012529 20 1265125710 0 Physicians Anesthesia Services 20 1265125710 0 Physicians Fluoride varnish 20 1265125710 0 Physicians Healthy Kids Services 20 1265125710 0 Physicians Optical Supplies 20 1265125710 0 Physicians Physician Services 00 1265126403 0 SHIRZAI MANSOUR 2024362 9999999 B 10 1265126403 0 4701 DEPT CAROL STREAM IL 601220021 20 1265126403 0 Physicians Anesthesia Services 20 1265126403 0 Physicians Fluoride varnish 20 1265126403 0 Physicians Healthy Kids Services 20 1265126403 0 Physicians Optical Supplies 20 1265126403 0 Physicians Physician Services 00 1265126502 0 PRENGER HINDRIK L 2024171 9999999 B 10 1265126502 0 1301 W DEVON AVE CHICAGO IL 606601329 20 1265126502 0 Nurse Practitioners Fluoride varnish 20 1265126502 0 Nurse Practitioners Healthy Kids Services 20 1265126502 0 Nurse Practitioners Nurse Practitioners Services 20 1265126502 0 Nurse Practitioners Physician Services 00 1265126981 0 YERRA SRI LAKSHMI PRIYANKA 2024144 2026181 B 10 1265126981 0 6420 CLAYTON RD SAINT LOUIS MO 631171811 20 1265126981 0 Physicians Anesthesia Services 20 1265126981 0 Physicians Fluoride varnish 20 1265126981 0 Physicians Healthy Kids Services 20 1265126981 0 Physicians Optical Supplies 20 1265126981 0 Physicians Physician Services 00 1265127161 0 KUHN GABRIELLE 2023180 9999999 B 10 1265127161 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1265127161 0 Physicians Anesthesia Services 20 1265127161 0 Physicians Healthy Kids Services 20 1265127161 0 Physicians Optical Supplies 20 1265127161 0 Physicians Physician Services 00 1265128524 0 RYBKA ROBERT 2023122 9999999 B 10 1265128524 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1265128524 0 Physician Assistant Only Fluoride varnish 20 1265128524 0 Physician Assistant Only Healthy Kids Services 20 1265128524 0 Physician Assistant Only Physician Services 00 1265129167 0 LANTY JESSICA A 2023163 9999999 B 10 1265129167 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1265129167 0 Occupational Therapists Medical Supplies 20 1265129167 0 Occupational Therapists Medical equipment/prosthetic devices 20 1265129167 0 Occupational Therapists Occupational Therapy Services 00 1265130041 0 SITKI KATHRYN 2024184 9999999 B 10 1265130041 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1265130041 0 Nurse Practitioners Healthy Kids Services 20 1265130041 0 Nurse Practitioners Nurse Practitioners Services 20 1265130041 0 Nurse Practitioners Physician Services 00 1265131031 0 BENSON KOURTNEY 2025052 9999999 B 10 1265131031 0 1160 E SAINT CLAIR ST VINCENNES IN 475914853 20 1265131031 0 Nurse Practitioners Fluoride varnish 20 1265131031 0 Nurse Practitioners Healthy Kids Services 20 1265131031 0 Nurse Practitioners Nurse Practitioners Services 20 1265131031 0 Nurse Practitioners Physician Services 00 1265131635 0 SCHNEIDER NICOLE 2024037 9999999 B 10 1265131635 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1265131635 0 Physician Assistant Only Fluoride varnish 20 1265131635 0 Physician Assistant Only Healthy Kids Services 20 1265131635 0 Physician Assistant Only Physician Services 00 1265132807 0 LEE SAMANTHA 2023208 9999999 B 10 1265132807 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1265132807 0 Occupational Therapists Medical Supplies 20 1265132807 0 Occupational Therapists Medical equipment/prosthetic devices 20 1265132807 0 Occupational Therapists Occupational Therapy Services 00 1265134043 0 OKEKE BARBARA 2023201 9999999 B 10 1265134043 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1265134043 0 Physicians Anesthesia Services 20 1265134043 0 Physicians Fluoride varnish 20 1265134043 0 Physicians Healthy Kids Services 20 1265134043 0 Physicians Optical Supplies 20 1265134043 0 Physicians Physician Services 00 1265134845 0 XIN JASON 2024254 9999999 B 10 1265134845 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1265134845 0 Physicians Anesthesia Services 20 1265134845 0 Physicians Healthy Kids Services 20 1265134845 0 Physicians Optical Supplies 20 1265134845 0 Physicians Physician Services 00 1265134928 0 KUMAR ABHILASHA 2024185 9999999 B 10 1265134928 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1265134928 0 Physicians Anesthesia Services 20 1265134928 0 Physicians Fluoride varnish 20 1265134928 0 Physicians Healthy Kids Services 20 1265134928 0 Physicians Optical Supplies 20 1265134928 0 Physicians Physician Services 00 1265135396 0 IDRISS XAVIER 2023179 9999999 B 10 1265135396 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1265135396 0 Physicians Anesthesia Services 20 1265135396 0 Physicians Fluoride varnish 20 1265135396 0 Physicians Healthy Kids Services 20 1265135396 0 Physicians Optical Supplies 20 1265135396 0 Physicians Physician Services 00 1265135636 0 ATEM AUGUSTINE AYUK 2023268 9999999 B 10 1265135636 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1265135636 0 Nurse Practitioners Fluoride varnish 20 1265135636 0 Nurse Practitioners Healthy Kids Services 20 1265135636 0 Nurse Practitioners Nurse Practitioners Services 20 1265135636 0 Nurse Practitioners Physician Services 00 1265136071 0 MIDDLEBROOK CALEB N 2024173 9999999 B 10 1265136071 0 4698 DEPT CAROL STREAM IL 601220021 20 1265136071 0 Physicians Anesthesia Services 20 1265136071 0 Physicians Fluoride varnish 20 1265136071 0 Physicians Healthy Kids Services 20 1265136071 0 Physicians Optical Supplies 20 1265136071 0 Physicians Physician Services 00 1265136766 0 TSOUGRANIS GREGORY 2023300 9999999 B 10 1265136766 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1265136766 0 Physicians Anesthesia Services 20 1265136766 0 Physicians Healthy Kids Services 20 1265136766 0 Physicians Optical Supplies 20 1265136766 0 Physicians Physician Services 00 1265137350 0 BELL CHRISTOPHER RYAN 2023297 9999999 B 10 1265137350 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1265137350 0 Physicians Anesthesia Services 20 1265137350 0 Physicians Healthy Kids Services 20 1265137350 0 Physicians Optical Supplies 20 1265137350 0 Physicians Physician Services 00 1265138549 0 ALEXANDER JESSICA 2023046 9999999 B 10 1265138549 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1265138549 0 Physician Assistant Only Fluoride varnish 20 1265138549 0 Physician Assistant Only Healthy Kids Services 20 1265138549 0 Physician Assistant Only Physician Services 00 1265139810 0 LEE DARYL L 2023051 9999999 B 10 1265139810 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1265139810 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1265140420 0 KRUPINSKI CABRIA D 2022354 9999999 B 10 1265140420 0 29373 NETWORK PL CHICAGO IL 606733039 20 1265140420 0 Nurse Practitioners Fluoride varnish 20 1265140420 0 Nurse Practitioners Healthy Kids Services 20 1265140420 0 Nurse Practitioners Nurse Practitioners Services 20 1265140420 0 Nurse Practitioners Physician Services 00 1265141063 0 KOLODY MARIEL 2023100 9999999 B 10 1265141063 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1265141063 0 Physician Assistant Only Fluoride varnish 20 1265141063 0 Physician Assistant Only Healthy Kids Services 20 1265141063 0 Physician Assistant Only Physician Services 00 1265141568 0 KIRKWOOD FLORENCE 2022354 9999999 B 10 1265141568 0 3010 GRAND AVE WAUKEGAN IL 600852321 20 1265141568 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1265145965 0 DAKER ALYSON M 2022362 9999999 B 10 1265145965 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1265145965 0 Nurse Practitioners Healthy Kids Services 20 1265145965 0 Nurse Practitioners Nurse Practitioners Services 20 1265145965 0 Nurse Practitioners Physician Services 00 1265148969 0 HAN SANG 2023206 9999999 B 10 1265148969 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112386 20 1265148969 0 Dentists Dental Services 20 1265148969 0 Dentists Physician Services 00 1265149074 0 TILLHOF KATHERINE 2023004 9999999 B 10 1265149074 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1265149074 0 Nurse Practitioners Fluoride varnish 20 1265149074 0 Nurse Practitioners Healthy Kids Services 20 1265149074 0 Nurse Practitioners Nurse Practitioners Services 20 1265149074 0 Nurse Practitioners Physician Services 00 1265151419 0 ENRIQUEZ GILBERTO M 2024302 9999999 B 10 1265151419 0 PO BOX 5081 JANESVILLE WI 535475081 20 1265151419 0 Physicians Anesthesia Services 20 1265151419 0 Physicians Fluoride varnish 20 1265151419 0 Physicians Healthy Kids Services 20 1265151419 0 Physicians Optical Supplies 20 1265151419 0 Physicians Physician Services 00 1265151955 0 SETTLES JENNA E 2022335 9999999 B 10 1265151955 0 1025 MAINE ST QUINCY IL 623014038 20 1265151955 0 Nurse Practitioners Fluoride varnish 20 1265151955 0 Nurse Practitioners Healthy Kids Services 20 1265151955 0 Nurse Practitioners Nurse Practitioners Services 20 1265151955 0 Nurse Practitioners Physician Services 00 1265152839 0 SASSATELLI KYLE A 2022299 9999999 B 10 1265152839 0 5777 DEPT CAROL STREAM IL 601220021 20 1265152839 0 Nurse Practitioners Healthy Kids Services 20 1265152839 0 Nurse Practitioners Nurse Practitioners Services 20 1265152839 0 Nurse Practitioners Physician Services 00 1265154488 0 MARKER CHRISTINE 2022270 9999999 H 10 1265154488 0 3010 GRAND AVE WAUKEGAN IL 600852321 20 1265154488 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1265157903 0 POISSON JANAE E 2022304 9999999 B 10 1265157903 0 1325 SYCAMORE RD DEKALB IL 601152483 20 1265157903 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1265157952 0 STIVERS JESSICA 2024019 9999999 B 10 1265157952 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1265157952 0 Nurse Practitioners Anesthesia Services 20 1265157952 0 Nurse Practitioners Nurse Practitioners Services 20 1265157952 0 Nurse Practitioners Physician Services 00 1265158679 0 TIDD SUJATA 2022304 9999999 B 10 1265158679 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1265158679 0 Nurse Practitioners Fluoride varnish 20 1265158679 0 Nurse Practitioners Healthy Kids Services 20 1265158679 0 Nurse Practitioners Nurse Practitioners Services 20 1265158679 0 Nurse Practitioners Physician Services 00 1265158851 0 NICOLETTO TONI 2023289 9999999 B 10 1265158851 0 1101 W 40TH ST UNIT 2225 CHATTANOOGA TN 374091379 20 1265158851 0 Clinical Social Worker Social work service 00 1265159677 0 DALAL KHUSHBU S 2022304 9999999 H 10 1265159677 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1265159677 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1265160253 0 MUTHANNA BASSAM M 2022276 9999999 B 10 1265160253 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1265160253 0 Physicians Anesthesia Services 20 1265160253 0 Physicians Fluoride varnish 20 1265160253 0 Physicians Healthy Kids Services 20 1265160253 0 Physicians Optical Supplies 20 1265160253 0 Physicians Physician Services 00 1265160691 0 ZAVALA ALEJANDRO 2023003 9999999 B 10 1265160691 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1265160691 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1265160881 0 KOOP LISA 2024342 9999999 B 10 1265160881 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1265160881 0 Nurse Practitioners Anesthesia Services 20 1265160881 0 Nurse Practitioners Nurse Practitioners Services 20 1265160881 0 Nurse Practitioners Physician Services 00 1265161673 0 METKE PATRICK J 2024247 9999999 B 10 1265161673 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1265161673 0 Nurse Practitioners Anesthesia Services 20 1265161673 0 Nurse Practitioners Nurse Practitioners Services 20 1265161673 0 Nurse Practitioners Physician Services 00 1265162085 0 PATEL AKSHAR H 2022166 9999999 B 10 1265162085 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1265162085 0 Physicians Anesthesia Services 20 1265162085 0 Physicians Fluoride varnish 20 1265162085 0 Physicians Healthy Kids Services 20 1265162085 0 Physicians Optical Supplies 20 1265162085 0 Physicians Physician Services 00 1265162234 0 AMIN DANIYAL 2023249 9999999 B 10 1265162234 0 181 N HAMMES AVE STE 2 JOLIET IL 604356675 20 1265162234 0 Dentists Dental Services 20 1265162234 0 Dentists Physician Services 00 1265162879 0 KAUFMAN MARA I 2022199 9999999 B 10 1265162879 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1265162879 0 Physicians Anesthesia Services 20 1265162879 0 Physicians Healthy Kids Services 20 1265162879 0 Physicians Optical Supplies 20 1265162879 0 Physicians Physician Services 20 1265162879 0 Physicians Physicians Psychiatric Services 00 1265163554 0 HUSSAIN SHAHZMEEN 2022234 9999999 B 10 1265163554 0 4641 W FOSTER AVE CHICAGO IL 606301709 20 1265163554 0 Dentists Dental Services 20 1265163554 0 Dentists Physician Services 00 1265164297 0 CUTLER BRETT 2022278 9999999 B 10 1265164297 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1265164297 0 Physicians Anesthesia Services 20 1265164297 0 Physicians Healthy Kids Services 20 1265164297 0 Physicians Optical Supplies 20 1265164297 0 Physicians Physician Services 20 1265164297 0 Physicians Physicians Psychiatric Services 00 1265165229 0 GRAY KIMBERLY 2024206 9999999 B 10 1265165229 0 3600 N PROW RD BLOOMINGTON IN 474041616 20 1265165229 0 Nurse Practitioners Healthy Kids Services 20 1265165229 0 Nurse Practitioners Nurse Practitioners Services 20 1265165229 0 Nurse Practitioners Physician Services 00 1265165237 0 AMPAW NANA YAA A 2022210 9999999 B 10 1265165237 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1265165237 0 Physicians Anesthesia Services 20 1265165237 0 Physicians Fluoride varnish 20 1265165237 0 Physicians Healthy Kids Services 20 1265165237 0 Physicians Optical Supplies 20 1265165237 0 Physicians Physician Services 00 1265165492 0 RUFF KELLY 2022187 9999999 B 10 1265165492 0 611 W PARK ST BWPC URBANA IL 618012529 20 1265165492 0 Physical Therapists Medical Supplies 20 1265165492 0 Physical Therapists Medical equipment/prosthetic devices 20 1265165492 0 Physical Therapists Physical Therapy Services 00 1265165609 0 MARONG ISATOU 2024085 9999999 B 10 1265165609 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1265165609 0 Physician Assistant Only Fluoride varnish 20 1265165609 0 Physician Assistant Only Healthy Kids Services 20 1265165609 0 Physician Assistant Only Physician Services 00 1265166029 0 CATCHINGS NATHANIEL 2022199 9999999 B 10 1265166029 0 1414 MAIN ST MELROSE PARK IL 601603902 20 1265166029 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1265166821 0 YESPICA OTAOLA ENRIQUE A 2022193 9999999 B 10 1265166821 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1265166821 0 Physicians Anesthesia Services 20 1265166821 0 Physicians Fluoride varnish 20 1265166821 0 Physicians Healthy Kids Services 20 1265166821 0 Physicians Optical Supplies 20 1265166821 0 Physicians Physician Services 00 1265166904 0 BROWN PAUL DANIEL 2023108 9999999 B 10 1265166904 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1265166904 0 Nurse Practitioners Anesthesia Services 20 1265166904 0 Nurse Practitioners Nurse Practitioners Services 20 1265166904 0 Nurse Practitioners Physician Services 00 1265167050 0 BUSCHBACH JENNIFER L 2022257 9999999 B 10 1265167050 0 675 W NORTH AVE STE 107 MELROSE PARK IL 601601622 20 1265167050 0 Optometrists Optical Supplies 20 1265167050 0 Optometrists Optometric Services 20 1265167050 0 Optometrists Physician Services 00 1265169510 0 MCNALLY KATHRYN 2024149 9999999 B 10 1265169510 0 PO BOX 431 JANESVILLE WI 535470431 20 1265169510 0 Physician Assistant Only Fluoride varnish 20 1265169510 0 Physician Assistant Only Healthy Kids Services 20 1265169510 0 Physician Assistant Only Physician Services 00 1265171623 0 CAMARGO MELISSA 2023080 9999999 B 10 1265171623 0 2731 MANNHEIM RD FRANKLIN PARK IL 601312219 20 1265171623 0 Dentists Dental Services 20 1265171623 0 Dentists Physician Services 00 1265172753 0 SHUFORD DIWANTE 2022151 9999999 B 10 1265172753 0 PO BOX 3039 OAK BROOK IL 605223039 20 1265172753 0 Physicians Anesthesia Services 20 1265172753 0 Physicians Healthy Kids Services 20 1265172753 0 Physicians Optical Supplies 20 1265172753 0 Physicians Physician Services 00 1265172985 0 MAHMOOD SABAH 2022285 9999999 B 10 1265172985 0 4701 DEPT CAROL STREAM IL 601220021 20 1265172985 0 Physicians Anesthesia Services 20 1265172985 0 Physicians Fluoride varnish 20 1265172985 0 Physicians Healthy Kids Services 20 1265172985 0 Physicians Optical Supplies 20 1265172985 0 Physicians Physician Services 00 1265173645 0 LAAKER ANNALISE 2022239 9999999 B 10 1265173645 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1265173645 0 Physicians Anesthesia Services 20 1265173645 0 Physicians Healthy Kids Services 20 1265173645 0 Physicians Optical Supplies 20 1265173645 0 Physicians Physician Services 00 1265174031 0 ALSTON JAMESHA R 2024340 9999999 B 10 1265174031 0 8808 MOODY AVE OAK LAWN IL 604531149 20 1265174031 0 Other behavior health professional Adaptive behavior support technician services 20 1265174031 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1265174056 0 SNEAD KARLIE 2023075 2026181 B 10 1265174056 0 PO BOX 5588 BELFAST ME 049155500 20 1265174056 0 Physicians Anesthesia Services 20 1265174056 0 Physicians Healthy Kids Services 20 1265174056 0 Physicians Optical 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10 1265617658 0 540 SUPERIOR AVE CALUMET CITY IL 604093452 20 1265617658 0 Speech Therapists Medical Supplies 20 1265617658 0 Speech Therapists Medical equipment/prosthetic devices 20 1265617658 0 Speech Therapists Speech Therapy/Pathology Services 00 1265618870 0 SCHMITT VICTORIA 2008035 9999999 B 10 1265618870 0 1333 BURR RIDGE PKWY PARKWAY BURR RIDGE IL 605276423 20 1265618870 0 Nurse Practitioners Healthy Kids Services 20 1265618870 0 Nurse Practitioners Nurse Practitioners Services 20 1265618870 0 Nurse Practitioners Physician Services 00 1265620132 0 DAJUSTA DANIEL 2020070 9999999 B 10 1265620132 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1265620132 0 Physicians Anesthesia Services 20 1265620132 0 Physicians Healthy Kids Services 20 1265620132 0 Physicians Optical Supplies 20 1265620132 0 Physicians Physician Services 00 1265621916 0 STERN AMANDA 2007316 9999999 B 10 1265621916 0 24 KENMORE AVE DEERFIELD IL 600154748 20 1265621916 0 Occupational Therapists Medical Supplies 20 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1265624282 0 Physicians Physician Services 00 1265625354 0 KHATTAK FAUZIA 2007234 9999999 B 10 1265625354 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1265625354 0 Physicians Anesthesia Services 20 1265625354 0 Physicians Fluoride varnish 20 1265625354 0 Physicians Healthy Kids Services 20 1265625354 0 Physicians Optical Supplies 20 1265625354 0 Physicians Physician Services 00 1265627210 0 EHSAN MOHSIN 2013213 9999999 B 10 1265627210 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1265627210 0 Physicians Anesthesia Services 20 1265627210 0 Physicians Fluoride varnish 20 1265627210 0 Physicians Healthy Kids Services 20 1265627210 0 Physicians Optical Supplies 20 1265627210 0 Physicians Physician Services 00 1265627400 0 KHALEEL MOHEMAD R 2007276 9999999 B 10 1265627400 0 1600 167TH ST STE 250 SUITE 250 CALUMET CITY IL 604095484 20 1265627400 0 Physicians Anesthesia Services 20 1265627400 0 Physicians Fluoride varnish 20 1265627400 0 Physicians Healthy Kids Services 20 1265627400 0 Physicians Optical Supplies 20 1265627400 0 Physicians Physician Services 00 1265628762 0 AHMAD SALEEM 1993312 9999999 B 10 1265628762 0 175 E HOUSTON ST SAN ANTONIO TX 782052255 20 1265628762 0 Optometrists Optical Supplies 20 1265628762 0 Optometrists Optometric Services 20 1265628762 0 Optometrists Physician Services 00 1265629307 0 WAGNER KRISTIN 2023095 9999999 B 10 1265629307 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1265629307 0 Physical Therapists Medical Supplies 20 1265629307 0 Physical Therapists Medical equipment/prosthetic devices 20 1265629307 0 Physical Therapists Physical Therapy Services 00 1265629760 0 KENDHARI HARLEENA 2010196 9999999 B 10 1265629760 0 1 ILLINI DR PEORIA IL 616052576 20 1265629760 0 Physicians Anesthesia Services 20 1265629760 0 Physicians Fluoride varnish 20 1265629760 0 Physicians Healthy Kids Services 20 1265629760 0 Physicians Optical Supplies 20 1265629760 0 Physicians Physician Services 00 1265629786 0 WASIUDDIN ROOHI U 2008300 9999999 B 10 1265629786 0 PO BOX 21844 BELFAST ME 049154115 20 1265629786 0 Physicians Anesthesia Services 20 1265629786 0 Physicians Fluoride varnish 20 1265629786 0 Physicians Healthy Kids Services 20 1265629786 0 Physicians Optical Supplies 20 1265629786 0 Physicians Physician Services 00 1265630537 0 TINGLEY ELIZABETH 2017257 9999999 B 10 1265630537 0 611 W PARK ST URBANA IL 618012529 20 1265630537 0 Psychologist Psychologist service 00 1265630651 0 KIRKPATRICK EDWARD 2003182 9999999 B 10 1265630651 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1265630651 0 Physicians Anesthesia Services 20 1265630651 0 Physicians Fluoride varnish 20 1265630651 0 Physicians Healthy Kids Services 20 1265630651 0 Physicians Optical Supplies 20 1265630651 0 Physicians Physician Services 00 1265631691 0 ALEMAN ERIN P 2007213 9999999 B 10 1265631691 0 331 S MAIN ST VIRGINIA IL 626911571 20 1265631691 0 Dentists N/A 00 1265632459 0 LEWELING ELIZABETH M 2012198 9999999 B 10 1265632459 0 PO BOX 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1265633648 0 Physicians Healthy Kids Services 20 1265633648 0 Physicians Optical Supplies 20 1265633648 0 Physicians Physician Services 00 1265634307 0 ALBANESE GIUSTINO 2017243 9999999 B 10 1265634307 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1265634307 0 Physicians Anesthesia Services 20 1265634307 0 Physicians Healthy Kids Services 20 1265634307 0 Physicians Optical Supplies 20 1265634307 0 Physicians Physician Services 00 1265634513 0 VASUDEVAN VIJAYA 2023067 9999999 B 10 1265634513 0 5401 VETERANS MEMORIAL PKWY ST SAINT PETERS MO 633761687 20 1265634513 0 Physicians Anesthesia Services 20 1265634513 0 Physicians Fluoride varnish 20 1265634513 0 Physicians Healthy Kids Services 20 1265634513 0 Physicians Optical Supplies 20 1265634513 0 Physicians Physician Services 00 1265634810 0 HUSSAIN KAMRAN 2009349 9999999 B 10 1265634810 0 65 WAUKEGAN RD GLENVIEW IL 600255154 20 1265634810 0 Optometrists Optical Supplies 20 1265634810 0 Optometrists Optometric Services 20 1265634810 0 Optometrists Physician Services 00 1265635445 0 GARCHA SONNY 2021361 9999999 B 10 1265635445 0 4701 DEPT CAROL STREAM IL 601220021 20 1265635445 0 Physicians Anesthesia Services 20 1265635445 0 Physicians Healthy Kids Services 20 1265635445 0 Physicians Optical Supplies 20 1265635445 0 Physicians Physician Services 00 1265635957 0 SMITH TOMMIE S 2016074 9999999 B 10 1265635957 0 PO BOX 34266 BELFAST ME 049150620 20 1265635957 0 Physician Assistant Only Fluoride varnish 20 1265635957 0 Physician Assistant Only Healthy Kids Services 20 1265635957 0 Physician Assistant Only Physician Services 00 1265636211 0 ROWLAND TIM 2023225 9999999 B 10 1265636211 0 PO BOX 110429 AURORA CO 800420429 20 1265636211 0 Physicians Anesthesia Services 20 1265636211 0 Physicians Healthy Kids Services 20 1265636211 0 Physicians Optical Supplies 20 1265636211 0 Physicians Physician Services 00 1265637243 0 ANTHONY-PETTER JAMA 2020181 9999999 B 10 1265637243 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 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0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1265639652 0 Physicians Anesthesia Services 20 1265639652 0 Physicians Healthy Kids Services 20 1265639652 0 Physicians Optical Supplies 20 1265639652 0 Physicians Physician Services 00 1265641955 0 BOSACK LINDA 1995001 9999999 B 10 1265641955 0 16001 108TH AVE ORLAND PARK IL 604678788 20 1265641955 0 Audiologists Audiology Services 20 1265641955 0 Audiologists Medical Supplies 20 1265641955 0 Audiologists Medical equipment/prosthetic devices 00 1265642037 0 SCOTT EMILY K 2009182 9999999 B 10 1265642037 0 PO BOX 778912 CHICAGO IL 606778912 20 1265642037 0 Physicians Anesthesia Services 20 1265642037 0 Physicians Fluoride varnish 20 1265642037 0 Physicians Healthy Kids Services 20 1265642037 0 Physicians Optical Supplies 20 1265642037 0 Physicians Physician Services 00 1265642227 0 TRENT TOMMY A 2008188 9999999 B 10 1265642227 0 801 N LINCOLN AVE MONETT MO 657081641 20 1265642227 0 Physicians Anesthesia Services 20 1265642227 0 Physicians Healthy Kids Services 20 1265642227 0 Physicians Optical Supplies 20 1265642227 0 Physicians Physician Services 00 1265642276 0 ROGERS NICHOLAS ALAN 2018021 9999999 B 10 1265642276 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1265642276 0 Physicians Anesthesia Services 20 1265642276 0 Physicians Fluoride varnish 20 1265642276 0 Physicians Healthy Kids Services 20 1265642276 0 Physicians Optical Supplies 20 1265642276 0 Physicians Physician Services 00 1265643282 0 GARZON DAWN 2021174 9999999 B 10 1265643282 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1265643282 0 Nurse Practitioners Fluoride varnish 20 1265643282 0 Nurse Practitioners Healthy Kids Services 20 1265643282 0 Nurse Practitioners Nurse Practitioners Services 20 1265643282 0 Nurse Practitioners Physician Services 00 1265644371 0 SAGHA HAMID R 2013255 9999999 B 10 1265644371 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1265644371 0 Physicians Anesthesia Services 20 1265644371 0 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Kids Services 20 1265647069 0 Physicians Optical Supplies 20 1265647069 0 Physicians Physician Services 00 1265650527 0 NABHAN ZEINA M 2007244 9999999 B 10 1265650527 0 PO BOX 1510 EVANSVILLE IN 477061510 20 1265650527 0 Physicians Anesthesia Services 20 1265650527 0 Physicians Fluoride varnish 20 1265650527 0 Physicians Healthy Kids Services 20 1265650527 0 Physicians Optical Supplies 20 1265650527 0 Physicians Physician Services 00 1265650980 0 MCCOMB KATHRYN D 2022153 9999999 B 10 1265650980 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1265650980 0 Physician Assistant Only Fluoride varnish 20 1265650980 0 Physician Assistant Only Healthy Kids Services 20 1265650980 0 Physician Assistant Only Physician Services 00 1265651467 0 CHILES JONATHAN C 2007182 9999999 B 10 1265651467 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1265651467 0 Physicians Anesthesia Services 20 1265651467 0 Physicians Fluoride varnish 20 1265651467 0 Physicians Healthy Kids Services 20 1265651467 0 Physicians Optical Supplies 20 1265651467 0 Physicians Physician Services 00 1265651830 0 GHAFOOR SAAD 2013101 9999999 B 10 1265651830 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1265651830 0 Physicians Anesthesia Services 20 1265651830 0 Physicians Fluoride varnish 20 1265651830 0 Physicians Healthy Kids Services 20 1265651830 0 Physicians Optical Supplies 20 1265651830 0 Physicians Physician Services 00 1265652119 0 ZUREK SUSAN L 2001253 9999999 B 10 1265652119 0 130 W PARK AVE WHEATON IL 601896460 20 1265652119 0 Speech Therapists Medical Supplies 20 1265652119 0 Speech Therapists Medical equipment/prosthetic devices 20 1265652119 0 Speech Therapists Speech Therapy/Pathology Services 00 1265652242 0 PETROSYAN MIKAEL 2020295 9999999 B 10 1265652242 0 PO BOX 744785 ATLANTA GA 303744785 20 1265652242 0 Physicians Anesthesia Services 20 1265652242 0 Physicians Healthy Kids Services 20 1265652242 0 Physicians Optical Supplies 20 1265652242 0 Physicians Physician Services 00 1265652432 0 SHEARER 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Practitioners Nurse Practitioners Services 20 1265820021 0 Nurse Practitioners Physician Services 00 1265822928 0 SERRITELLA ANTHONY V 2018351 9999999 B 10 1265822928 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1265822928 0 Physicians Anesthesia Services 20 1265822928 0 Physicians Fluoride varnish 20 1265822928 0 Physicians Healthy Kids Services 20 1265822928 0 Physicians Optical Supplies 20 1265822928 0 Physicians Physician Services 00 1265823074 0 THANAVARO THEERARAT 2016336 9999999 B 10 1265823074 0 11125 DUNN RD STE 204 SAINT LOUIS MO 631366188 20 1265823074 0 Nurse Practitioners Healthy Kids Services 20 1265823074 0 Nurse Practitioners Nurse Practitioners Services 20 1265823074 0 Nurse Practitioners Physician Services 00 1265824551 0 SHETH REEMA 2022234 9999999 B 10 1265824551 0 13011 S 104TH AVE STE 100 SUITE 100 PALOS PARK IL 604641508 20 1265824551 0 Physicians Anesthesia Services 20 1265824551 0 Physicians Fluoride varnish 20 1265824551 0 Physicians Healthy Kids Services 20 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1275207409 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1275207409 0 Physician Assistant Only Fluoride varnish 20 1275207409 0 Physician Assistant Only Healthy Kids Services 20 1275207409 0 Physician Assistant Only Physician Services 00 1275208019 0 STEVENS MACY 2023074 9999999 B 10 1275208019 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1275208019 0 Physician Assistant Only Fluoride varnish 20 1275208019 0 Physician Assistant Only Healthy Kids Services 20 1275208019 0 Physician Assistant Only Physician Services 00 1275209298 0 ROEMER KRISTEN E 2021302 9999999 B 10 1275209298 0 5777 DEPT CAROL STREAM IL 601220021 20 1275209298 0 Nurse Practitioners Healthy Kids Services 20 1275209298 0 Nurse Practitioners Nurse Practitioners Services 20 1275209298 0 Nurse Practitioners Physician Services 00 1275209694 0 BIANCO NATALIE M 2024123 9999999 B 10 1275209694 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1275209694 0 Speech Therapists Medical Supplies 20 1275209694 0 Speech Therapists Medical equipment/prosthetic devices 20 1275209694 0 Speech Therapists Speech Therapy/Pathology Services 00 1275209785 0 THOMAS JENNIFER 2022250 9999999 B 10 1275209785 0 3353 S MORGAN ST UNIT 1 CHICAGO IL 606086885 20 1275209785 0 Other behavior health professional LCPC/LMFT services 20 1275209785 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1275210395 0 KANOR UNA 2023191 9999999 B 10 1275210395 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1275210395 0 Physicians Anesthesia Services 20 1275210395 0 Physicians Fluoride varnish 20 1275210395 0 Physicians Healthy Kids Services 20 1275210395 0 Physicians Optical Supplies 20 1275210395 0 Physicians Physician Services 00 1275211898 0 MIERS ZACHARY T 2023199 9999999 B 10 1275211898 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1275211898 0 Nurse Practitioners Healthy Kids Services 20 1275211898 0 Nurse Practitioners Nurse Practitioners Services 20 1275211898 0 Nurse Practitioners Physician Services 00 1275215279 0 BANGERT THOMAS M 2023283 9999999 B 10 1275215279 0 611 W PARK ST BWPC URBANA IL 618012529 20 1275215279 0 Physical Therapists Medical Supplies 20 1275215279 0 Physical Therapists Medical equipment/prosthetic devices 20 1275215279 0 Physical Therapists Physical Therapy Services 00 1275216319 0 SCHULTZ KAITLYN 2023307 9999999 B 10 1275216319 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1275216319 0 Occupational Therapists Medical Supplies 20 1275216319 0 Occupational Therapists Medical equipment/prosthetic devices 20 1275216319 0 Occupational Therapists Occupational Therapy Services 00 1275216392 0 EASTMAN ABRAHAM J 2023293 9999999 B 10 1275216392 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1275216392 0 Psychologist Psychologist service 00 1275216558 0 FEJZA SHASEME 2023258 9999999 B 10 1275216558 0 2215 SANDERS RD STE 105 SUITE 105 NORTHBROOK IL 600626194 20 1275216558 0 Nurse Practitioners Fluoride varnish 20 1275216558 0 Nurse Practitioners Healthy Kids Services 20 1275216558 0 Nurse Practitioners Nurse Practitioners Services 20 1275216558 0 Nurse Practitioners Physician Services 00 1275217556 0 DHAWAN SUNITA 2023170 9999999 B 10 1275217556 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1275217556 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1275217739 0 LOCKMAN CATHERINE MARIE 2023184 9999999 B 10 1275217739 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1275217739 0 Clinical Social Worker Social work service 00 1275217903 0 MUSLEH SEMAL 2023182 9999999 B 10 1275217903 0 1044 N FRANCISCO AVE CHICAGO IL 606222743 20 1275217903 0 Physicians Anesthesia Services 20 1275217903 0 Physicians Fluoride varnish 20 1275217903 0 Physicians Healthy Kids Services 20 1275217903 0 Physicians Optical Supplies 20 1275217903 0 Physicians Physician Services 00 1275218802 0 SHANKAR SURAJ 2023225 9999999 B 10 1275218802 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1275218802 0 Physicians Anesthesia Services 20 1275218802 0 Physicians Healthy Kids Services 20 1275218802 0 Physicians Optical Supplies 20 1275218802 0 Physicians Physician Services 20 1275218802 0 Physicians Physicians Psychiatric Services 00 1275220857 0 HIGGINBOTHAM HILLERY 2023297 9999999 B 10 1275220857 0 12151 REGENCY PKWY STE 12173 HUNTLEY IL 601427644 20 1275220857 0 Nurse Practitioners Fluoride varnish 20 1275220857 0 Nurse Practitioners Healthy Kids Services 20 1275220857 0 Nurse Practitioners Nurse Practitioners Services 20 1275220857 0 Nurse Practitioners Physician Services 00 1275221939 0 ALAIMO MICHELLE 2023240 9999999 B 10 1275221939 0 PO BOX 79591 BALTIMORE MD 212790591 20 1275221939 0 Optometrists Optical Supplies 20 1275221939 0 Optometrists Optometric Services 20 1275221939 0 Optometrists Physician Services 00 1275222085 0 FERGUSON MEGAN 2024129 9999999 B 10 1275222085 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1275222085 0 Nurse Practitioners Healthy Kids Services 20 1275222085 0 Nurse Practitioners Nurse Practitioners Services 20 1275222085 0 Nurse Practitioners Physician Services 00 1275227571 0 YUCKNUT ELIZABETH 2023180 9999999 B 10 1275227571 0 2020 OGDEN AVE STE 360 SUITE 360 AURORA IL 605046486 20 1275227571 0 Physicians Anesthesia Services 20 1275227571 0 Physicians Fluoride varnish 20 1275227571 0 Physicians Healthy Kids Services 20 1275227571 0 Physicians Optical Supplies 20 1275227571 0 Physicians Physician Services 00 1275228280 0 WALL CHACE 2024207 9999999 B 10 1275228280 0 8 S MICHIGAN AVE FL 7 CHICAGO IL 606033357 20 1275228280 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1275228322 0 MINAERT ANNALISA 2023116 9999999 B 10 1275228322 0 101 E STATE ST KENNETT SQ PA 193483109 20 1275228322 0 Occupational Therapists Medical Supplies 20 1275228322 0 Occupational Therapists Medical equipment/prosthetic devices 20 1275228322 0 Occupational Therapists Occupational Therapy Services 00 1275228439 0 MODI VAISHNAVI KALPESH 2023217 9999999 B 10 1275228439 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1275228439 0 Physicians Anesthesia Services 20 1275228439 0 Physicians Fluoride varnish 20 1275228439 0 Physicians Healthy Kids Services 20 1275228439 0 Physicians Optical Supplies 20 1275228439 0 Physicians Physician Services 00 1275233694 0 SAHAGUN LESLEY 2023067 9999999 B 10 1275233694 0 7421 MADISON ST FOREST PARK IL 601301575 20 1275233694 0 Occupational Therapists Medical Supplies 20 1275233694 0 Occupational Therapists Medical equipment/prosthetic devices 20 1275233694 0 Occupational Therapists Occupational Therapy Services 00 1275235335 0 KILBANE EMMA G 2023174 9999999 B 10 1275235335 0 4698 DEPT CAROL STREAM IL 601220021 20 1275235335 0 Physicians Anesthesia Services 20 1275235335 0 Physicians Healthy Kids Services 20 1275235335 0 Physicians Optical Supplies 20 1275235335 0 Physicians Physician Services 00 1275235632 0 RAUH AUDRA 2023306 9999999 B 10 1275235632 0 2050 E ALGONQUIN RD STE 610 SCHAUMBURG IL 601734166 20 1275235632 0 Dentists Dental Services 20 1275235632 0 Dentists Physician Services 00 1275235772 0 CORONA MIRANDA 2023199 9999999 B 10 1275235772 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1275235772 0 Physicians Anesthesia Services 20 1275235772 0 Physicians Healthy Kids Services 20 1275235772 0 Physicians Optical Supplies 20 1275235772 0 Physicians Physician Services 00 1275236077 0 ALUKO OYINDAMOLA 2023258 9999999 B 10 1275236077 0 2615 EDWARDS ST ALTON IL 620023915 20 1275236077 0 Nurse Practitioners Healthy Kids Services 20 1275236077 0 Nurse Practitioners Nurse Practitioners Services 20 1275236077 0 Nurse Practitioners Physician Services 00 1275236226 0 VALAIYADUPPU SUBAS SHARATHSHIV 2023249 9999999 B 10 1275236226 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1275236226 0 Physicians Anesthesia Services 20 1275236226 0 Physicians Fluoride varnish 20 1275236226 0 Physicians Healthy Kids Services 20 1275236226 0 Physicians Optical Supplies 20 1275236226 0 Physicians Physician Services 00 1275236648 0 WOODHOUSE KARIN LACHEY 2023094 9999999 B 10 1275236648 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1275236648 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1275236895 0 ANDERSON JOHN 2023299 9999999 B 10 1275236895 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1275236895 0 Physician Assistant Only Fluoride varnish 20 1275236895 0 Physician Assistant Only Healthy Kids Services 20 1275236895 0 Physician Assistant Only Physician Services 00 1275237091 0 RUMPLE CALEB 2023208 2029365 B 10 1275237091 0 221 NE GLEN OAK AVE PEORIA IL 616360002 20 1275237091 0 Physicians Anesthesia Services 20 1275237091 0 Physicians Healthy Kids Services 20 1275237091 0 Physicians Optical Supplies 20 1275237091 0 Physicians Physician Services 20 1275237091 0 Physicians Physicians Psychiatric Services 00 1275237257 0 JONES DEWITT 2023192 9999999 B 10 1275237257 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1275237257 0 Physicians Anesthesia Services 20 1275237257 0 Physicians Healthy Kids Services 20 1275237257 0 Physicians Optical Supplies 20 1275237257 0 Physicians Physician Services 20 1275237257 0 Physicians Physicians Psychiatric Services 00 1275237331 0 BUHLER HOLLY M 2023269 9999999 B 10 1275237331 0 6300 RIDGLEA PL STE 201 FORT WORTH TX 761165707 20 1275237331 0 Nurse Practitioners Healthy Kids Services 20 1275237331 0 Nurse Practitioners Nurse Practitioners Services 20 1275237331 0 Nurse Practitioners Physician Services 00 1275237745 0 WILD MEREDITH 2023114 9999999 B 10 1275237745 0 109 CALIFORNIA ST PO BOX 577 CARTERVILLE IL 629181923 20 1275237745 0 Clinical Social Worker Social work service 00 1275238321 0 SHABBIR ANAM 2024190 9999999 B 10 1275238321 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1275238321 0 Physicians Anesthesia Services 20 1275238321 0 Physicians Fluoride varnish 20 1275238321 0 Physicians Healthy Kids Services 20 1275238321 0 Physicians Optical Supplies 20 1275238321 0 Physicians Physician Services 00 1275238545 0 HABING MELISSA S 2023122 9999999 B 10 1275238545 0 PO BOX 607 TEUTOPOLIS IL 624670607 20 1275238545 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1275238669 0 LERER LILLIAN A 2023212 9999999 B 10 1275238669 0 355 E ERIE ST CHICAGO IL 606113167 20 1275238669 0 Physicians Anesthesia Services 20 1275238669 0 Physicians Healthy Kids Services 20 1275238669 0 Physicians Optical Supplies 20 1275238669 0 Physicians Physician Services 00 1275240152 0 SOUTHMAYD AUSTIN 2022318 9999999 B 10 1275240152 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1275240152 0 Physician Assistant Only Fluoride varnish 20 1275240152 0 Physician Assistant Only Healthy Kids Services 20 1275240152 0 Physician Assistant Only Physician Services 00 1275240392 0 MEAD HANNAH 2022311 9999999 B 10 1275240392 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1275240392 0 Physical Therapists Medical Supplies 20 1275240392 0 Physical Therapists Medical equipment/prosthetic devices 20 1275240392 0 Physical Therapists Physical Therapy Services 00 1275244741 0 HOWALD AUSTIN W 2022346 9999999 B 10 1275244741 0 1003 MARTIN LUTHER KING DR BLOOMINGTON IL 617011429 20 1275244741 0 Other behavior health professional Social work service 00 1275245300 0 BILDERBACK ABIGAIL R 2023240 9999999 B 10 1275245300 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1275245300 0 Psychologist Psychologist service 00 1275249237 0 JORDAN ANTIONETTE 2023055 9999999 B 10 1275249237 0 PO BOX 802841 KANSAS CITY MO 641802841 20 1275249237 0 Nurse Practitioners Healthy Kids Services 20 1275249237 0 Nurse Practitioners Nurse Practitioners Services 20 1275249237 0 Nurse Practitioners Physician Services 00 1275249427 0 TRAM JENNIFER 2024297 9999999 B 10 1275249427 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1275249427 0 Nurse Practitioners Healthy Kids Services 20 1275249427 0 Nurse Practitioners Nurse Practitioners Services 20 1275249427 0 Nurse Practitioners Physician Services 00 1275251878 0 PEARSON JILLIAN 2022272 9999999 B 10 1275251878 0 29373 NETWORK PL CHICAGO IL 606733039 20 1275251878 0 Nurse Practitioners Fluoride varnish 20 1275251878 0 Nurse Practitioners Healthy Kids Services 20 1275251878 0 Nurse Practitioners Nurse Practitioners Services 20 1275251878 0 Nurse Practitioners Physician Services 00 1275252827 0 SIEBER KYLE 2022287 9999999 B 10 1275252827 0 4712 LAUREL AVE GLENVIEW IL 600251419 20 1275252827 0 Nurse Practitioners Fluoride varnish 20 1275252827 0 Nurse Practitioners Healthy Kids Services 20 1275252827 0 Nurse Practitioners Nurse Practitioners Services 20 1275252827 0 Nurse Practitioners Physician Services 00 1275253866 0 TRUONG BAONGOC 2022277 9999999 B 10 1275253866 0 2003 W FULTON ST STE 303 CHICAGO IL 606122345 20 1275253866 0 Nurse Practitioners Fluoride varnish 20 1275253866 0 Nurse Practitioners Healthy Kids Services 20 1275253866 0 Nurse Practitioners Nurse Practitioners Services 20 1275253866 0 Nurse Practitioners Physician Services 00 1275255671 0 KEARNS JANA 2023056 9999999 B 10 1275255671 0 721 E COURT ST PARIS IL 619442460 20 1275255671 0 Nurse Practitioners Fluoride varnish 20 1275255671 0 Nurse Practitioners Healthy Kids Services 20 1275255671 0 Nurse Practitioners Nurse Practitioners Services 20 1275255671 0 Nurse Practitioners Physician Services 00 1275256695 0 MILEYKOVSKY ASHLEY 2022361 9999999 B 10 1275256695 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1275256695 0 Nurse Practitioners Healthy Kids Services 20 1275256695 0 Nurse Practitioners Nurse Practitioners Services 20 1275256695 0 Nurse Practitioners Physician Services 00 1275257115 0 RUDOLF CAROLYN 2022280 9999999 B 10 1275257115 0 1500 S SANGAMON ST CRETE IL 604172831 20 1275257115 0 Psychologist Provider is 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CALIFORNIA ST CARTERVILLE IL 629181923 20 1275265100 0 Clinical Social Worker Social work service 00 1275265423 0 BERMAN SCOTT 2022214 9999999 B 10 1275265423 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1275265423 0 Physicians Anesthesia Services 20 1275265423 0 Physicians Fluoride varnish 20 1275265423 0 Physicians Healthy Kids Services 20 1275265423 0 Physicians Optical Supplies 20 1275265423 0 Physicians Physician Services 00 1275265845 0 AMIN HAMNA 2022182 9999999 B 10 1275265845 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1275265845 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1275265928 0 LE TUAN THANH 2024040 9999999 B 10 1275265928 0 2050 E ALGONQUIN RD STE 610 SCHAUMBURG IL 601734166 20 1275265928 0 Dentists Dental Services 20 1275265928 0 Dentists Physician Services 00 1275265944 0 HUYNH KIEV 2023025 9999999 B 10 1275265944 0 1835 W HARRISON ST FL 6 C CHICAGO IL 60612 20 1275265944 0 Nurse Practitioners Fluoride varnish 20 1275265944 0 Nurse Practitioners Healthy Kids Services 20 1275265944 0 Nurse Practitioners Nurse Practitioners Services 20 1275265944 0 Nurse Practitioners Physician Services 00 1275266314 0 SCHEIN TABATHA 2023123 9999999 B 10 1275266314 0 1900 E GOLF RD STE 950 SCHAUMBURG IL 601735034 20 1275266314 0 Other behavior health professional Adaptive behavior support clinician services 20 1275266314 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1275267262 0 TERIET MARIAH 2022196 9999999 B 10 1275267262 0 PO BOX 3988 CARBONDALE IL 629023988 20 1275267262 0 Nurse Practitioners Healthy Kids Services 20 1275267262 0 Nurse Practitioners Nurse Practitioners Services 20 1275267262 0 Nurse Practitioners Physician Services 00 1275268369 0 KHAN AHMED A 2022208 9999999 B 10 1275268369 0 1220 S WOOD ST CHICAGO IL 606081202 20 1275268369 0 Physicians Anesthesia Services 20 1275268369 0 Physicians Fluoride varnish 20 1275268369 0 Physicians Healthy Kids Services 20 1275268369 0 Physicians Optical Supplies 20 1275268369 0 Physicians Physician Services 00 1275268427 0 SIARKIEWICZ SADIE 2022262 9999999 B 10 1275268427 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1275268427 0 Physician Assistant Only Fluoride varnish 20 1275268427 0 Physician Assistant Only Healthy Kids Services 20 1275268427 0 Physician Assistant Only Physician Services 00 1275268880 0 BECHERER TRACY 2024067 9999999 B 10 1275268880 0 2852 N HALSTED ST CHICAGO IL 606576531 20 1275268880 0 Optometrists Optical Supplies 20 1275268880 0 Optometrists Optometric Services 20 1275268880 0 Optometrists Physician Services 00 1275270670 0 DICKESON DOMIQUE 2024095 9999999 B 10 1275270670 0 975 W HAWTHORN DR ITASCA IL 601432056 20 1275270670 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1275272650 0 CORTEZ KATHLEEN 2024248 9999999 B 10 1275272650 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1275272650 0 Nurse Practitioners Anesthesia Services 20 1275272650 0 Nurse Practitioners Nurse Practitioners Services 20 1275272650 0 Nurse Practitioners Physician Services 00 1275272726 0 MARTINEZ MARIN DAVID 2022201 9999999 B 10 1275272726 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1275272726 0 Physicians Anesthesia Services 20 1275272726 0 Physicians Fluoride varnish 20 1275272726 0 Physicians Healthy Kids Services 20 1275272726 0 Physicians Optical Supplies 20 1275272726 0 Physicians Physician Services 00 1275272825 0 BUSH LAUREN A 2022199 9999999 B 10 1275272825 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1275272825 0 Psychologist Psychologist service 00 1275273393 0 EL-GABRI DEENA 2024277 9999999 B 10 1275273393 0 4698 DEPT CAROL STREAM IL 601220021 20 1275273393 0 Physicians Anesthesia Services 20 1275273393 0 Physicians Healthy Kids Services 20 1275273393 0 Physicians Optical Supplies 20 1275273393 0 Physicians Physician Services 00 1275274227 0 BETHEL JESSICA D 2022179 9999999 B 10 1275274227 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1275274227 0 Physicians Anesthesia Services 20 1275274227 0 Physicians Fluoride varnish 20 1275274227 0 Physicians Healthy Kids Services 20 1275274227 0 Physicians Optical Supplies 20 1275274227 0 Physicians Physician Services 00 1275274912 0 LEE-CAMPBELL KARIN 2023023 9999999 B 10 1275274912 0 100 CROSSING BLVD STE 300 FRAMINGHAM MA 017025555 20 1275274912 0 Nurse Practitioners Healthy Kids Services 20 1275274912 0 Nurse Practitioners Nurse Practitioners Services 20 1275274912 0 Nurse Practitioners Physician Services 00 1275276156 0 SHABA WINNIE 2024149 9999999 B 10 1275276156 0 6420 CLAYTON RD SAINT LOUIS MO 631171811 20 1275276156 0 Physicians Anesthesia Services 20 1275276156 0 Physicians Fluoride varnish 20 1275276156 0 Physicians Healthy Kids Services 20 1275276156 0 Physicians Optical Supplies 20 1275276156 0 Physicians Physician Services 00 1275277162 0 LIBBERT ABBY R 2022287 9999999 B 10 1275277162 0 4199 GATEWAY BLVD STE 2400 NEWBURGH IN 476307972 20 1275277162 0 Physician Assistant Only Fluoride varnish 20 1275277162 0 Physician Assistant Only Healthy Kids Services 20 1275277162 0 Physician Assistant Only Physician Services 00 1275277550 0 POLAMRAJU VINATHI 2023339 9999999 B 10 1275277550 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1275277550 0 Physicians Anesthesia Services 20 1275277550 0 Physicians Fluoride varnish 20 1275277550 0 Physicians Healthy Kids Services 20 1275277550 0 Physicians Optical Supplies 20 1275277550 0 Physicians Physician Services 00 1275277808 0 KLAUBER CARLY J 2023320 9999999 B 10 1275277808 0 120 E OGDEN AVE STE 101 HINSDALE IL 605213892 20 1275277808 0 Clinical Social Worker Social work service 00 1275278962 0 RAMOTOWSKI NICOLE B 2022206 9999999 B 10 1275278962 0 4714 GETTYSBURG RD MECHANICSBURG PA 170554325 20 1275278962 0 Occupational Therapists Medical Supplies 20 1275278962 0 Occupational Therapists Medical equipment/prosthetic devices 20 1275278962 0 Occupational Therapists Occupational Therapy Services 00 1275279366 0 KISSEBERTH KATHLEEN 2024185 9999999 B 10 1275279366 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1275279366 0 Physicians Anesthesia Services 20 1275279366 0 Physicians Healthy Kids Services 20 1275279366 0 Physicians Optical Supplies 20 1275279366 0 Physicians Physician Services 20 1275279366 0 Physicians Physicians Psychiatric Services 00 1275279747 0 WALKER JASMINE 2022363 9999999 B 10 1275279747 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1275279747 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1275280638 0 COOK MADELINE M 2023188 9999999 B 10 1275280638 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1275280638 0 Physicians Anesthesia Services 20 1275280638 0 Physicians Fluoride varnish 20 1275280638 0 Physicians Healthy Kids Services 20 1275280638 0 Physicians Optical Supplies 20 1275280638 0 Physicians Physician Services 00 1275280646 0 WALKOWIAK OLIVIA 2024209 9999999 B 10 1275280646 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1275280646 0 Physicians Anesthesia Services 20 1275280646 0 Physicians Healthy Kids Services 20 1275280646 0 Physicians Optical Supplies 20 1275280646 0 Physicians Physician Services 00 1275282618 0 WERNER STEPHANIE A 2022193 2025181 B 10 1275282618 0 1220 S WOOD ST CHICAGO IL 606081202 20 1275282618 0 Physicians Anesthesia Services 20 1275282618 0 Physicians Fluoride varnish 20 1275282618 0 Physicians Healthy Kids Services 20 1275282618 0 Physicians Optical Supplies 20 1275282618 0 Physicians Physician Services 00 1275283442 0 MEHTA MAITRI YAGNESH 2022187 9999999 B 10 1275283442 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1275283442 0 Physicians Anesthesia Services 20 1275283442 0 Physicians Healthy Kids Services 20 1275283442 0 Physicians Optical Supplies 20 1275283442 0 Physicians Physician Services 00 1275283699 0 JOHNSON MEGHAN A 2022126 9999999 B 10 1275283699 0 1311 MAMARONECK AVE STE 140 WHITE PLAINS NY 106055224 20 1275283699 0 Speech Therapists Medical Supplies 20 1275283699 0 Speech Therapists Medical equipment/prosthetic devices 20 1275283699 0 Speech Therapists Speech Therapy/Pathology Services 00 1275284002 0 HARVEY ANN J 2022061 9999999 H 10 1275284002 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1275284002 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1275284960 0 RUYLE BENJAMIN L 2022059 9999999 B 10 1275284960 0 15 E HAZEL DELL LN SPRINGFIELD IL 627124210 20 1275284960 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1275285652 0 JOHNSON BELINDA 2022290 9999999 B 10 1275285652 0 PO BOX 34266 BELFAST ME 049150620 20 1275285652 0 Nurse Practitioners Fluoride varnish 20 1275285652 0 Nurse Practitioners Healthy Kids Services 20 1275285652 0 Nurse Practitioners Nurse Practitioners Services 20 1275285652 0 Nurse Practitioners Physician Services 00 1275288243 0 HOWARD JOSIE 2022320 9999999 B 10 1275288243 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1275288243 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1275288755 0 RICHMOND KATHERINE 2023003 9999999 B 10 1275288755 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1275288755 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1275290264 0 CHUBINSKY KENNETH B 2021345 9999999 B 10 1275290264 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1275290264 0 Clinical Social Worker Social work service 00 1275290389 0 WINKLER ALLISON P 2022108 9999999 B 10 1275290389 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1275290389 0 Nurse Practitioners Healthy Kids Services 20 1275290389 0 Nurse Practitioners Nurse Practitioners Services 20 1275290389 0 Nurse Practitioners Physician Services 00 1275291015 0 ARRELLANO BIANCA 2022089 9999999 B 10 1275291015 0 2001 S CALIFORNIA AVE STE 100 CHICAGO IL 606082486 20 1275291015 0 Other behavior health professional LCPC/LMFT services 00 1275293524 0 PALISIN ABIGAIL 2022104 9999999 B 10 1275293524 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1275293524 0 Nurse Practitioners Fluoride varnish 20 1275293524 0 Nurse Practitioners Healthy Kids Services 20 1275293524 0 Nurse Practitioners Nurse Practitioners Services 20 1275293524 0 Nurse Practitioners Physician Services 00 1275293847 0 FOX KYNDALL 2022181 9999999 B 10 1275293847 0 250 W 96TH ST STE 520 INDIANAPOLIS IN 462601317 20 1275293847 0 Occupational Therapists Medical Supplies 20 1275293847 0 Occupational Therapists Medical equipment/prosthetic devices 20 1275293847 0 Occupational Therapists Occupational Therapy Services 00 1275294696 0 MAHER KATHERINE P 2023144 9999999 B 10 1275294696 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1275294696 0 Physician Assistant Only Fluoride varnish 20 1275294696 0 Physician Assistant Only Healthy Kids Services 20 1275294696 0 Physician Assistant Only Physician Services 00 1275294969 0 CASEY-BAGGETTE KAMELA 2022012 9999999 B 10 1275294969 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1275294969 0 Nurse Practitioners Healthy Kids Services 20 1275294969 0 Nurse Practitioners Nurse Practitioners Services 20 1275294969 0 Nurse Practitioners Physician Services 00 1275296105 0 SULLIVAN TAYLOR A 2021316 9999999 B 10 1275296105 0 5665 NEW NORTHSIDE DR STE 320 ATLANTA GA 303285834 20 1275296105 0 Nurse Practitioners Fluoride varnish 20 1275296105 0 Nurse Practitioners Healthy Kids Services 20 1275296105 0 Nurse Practitioners Nurse Practitioners Services 20 1275296105 0 Nurse Practitioners Physician Services 00 1275296261 0 PULLINS ERICA L 2025013 9999999 B 10 1275296261 0 501 7TH ST ROCKFORD IL 611041242 20 1275296261 0 Speech Therapists Medical Supplies 20 1275296261 0 Speech Therapists Medical equipment/prosthetic devices 20 1275296261 0 Speech Therapists Speech Therapy/Pathology Services 00 1275296972 0 PATHAK SHRADDHA 2021340 9999999 B 10 1275296972 0 29373 NETWORK PL CHICAGO IL 606733039 20 1275296972 0 Physician Assistant Only Fluoride varnish 20 1275296972 0 Physician Assistant Only Healthy Kids Services 20 1275296972 0 Physician Assistant Only Physician Services 00 1275297400 0 DAVENPORT KIERRA S 2024192 9999999 B 10 1275297400 0 1005 W END AVE CHICAGO HEIGHTS IL 604112742 20 1275297400 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1275299497 0 MCKINLEY ELIZABETH 2022080 9999999 B 10 1275299497 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1275299497 0 Physician Assistant Only Fluoride varnish 20 1275299497 0 Physician Assistant Only Healthy Kids Services 20 1275299497 0 Physician Assistant Only Physician Services 00 1275300022 0 VALLEY CRYSTAL 2024025 9999999 B 10 1275300022 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1275300022 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1275300675 0 PATEL ASHA 2025063 9999999 B 10 1275300675 0 7877 WILLOW CHASE BLVD HOUSTON TX 770705934 20 1275300675 0 Nurse Practitioners Healthy Kids Services 20 1275300675 0 Nurse Practitioners Nurse Practitioners Services 20 1275300675 0 Nurse Practitioners Physician Services 00 1275301509 0 SHAFER BRENDA 2024073 9999999 B 10 1275301509 0 1850 W WINCHESTER RD STE 108 LIBERTYVILLE IL 600485355 20 1275301509 0 Clinical Social Worker Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1275301772 0 MALCHOW MELINDA 2024023 9999999 B 10 1275301772 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1275301772 0 Nurse Practitioners Fluoride varnish 20 1275301772 0 Nurse Practitioners Healthy Kids Services 20 1275301772 0 Nurse Practitioners Nurse Practitioners Services 20 1275301772 0 Nurse Practitioners Physician Services 00 1275302986 0 ZIMMERMAN HEATHER M 2024003 9999999 B 10 1275302986 0 935 BRYANT ST LOUISVILLE IL 628581053 20 1275302986 0 Nurse Practitioners Fluoride varnish 20 1275302986 0 Nurse Practitioners Healthy Kids Services 20 1275302986 0 Nurse Practitioners Nurse Practitioners Services 20 1275302986 0 Nurse Practitioners Physician Services 00 1275306888 0 CONTRERAS GABRIELA 2024254 9999999 B 10 1275306888 0 PO BOX 10646 MERRILLVILLE IN 464110646 20 1275306888 0 Nurse Practitioners Fluoride varnish 20 1275306888 0 Nurse Practitioners Healthy Kids Services 20 1275306888 0 Nurse Practitioners Nurse Practitioners Services 20 1275306888 0 Nurse Practitioners Physician Services 00 1275308801 0 AKANDE OLUWASEUN 2024009 9999999 B 10 1275308801 0 9718 S HALSTED ST CHICAGO IL 606281007 20 1275308801 0 Nurse Practitioners Fluoride varnish 20 1275308801 0 Nurse Practitioners Healthy Kids Services 20 1275308801 0 Nurse Practitioners Nurse Practitioners Services 20 1275308801 0 Nurse Practitioners Physician Services 00 1275310146 0 BONIFACIO MICHAEL 2023348 9999999 B 10 1275310146 0 20855 S LAGRANGE RD STE 205 FRANKFORT IL 604232043 20 1275310146 0 Nurse Practitioners Healthy Kids Services 20 1275310146 0 Nurse Practitioners Nurse Practitioners Services 20 1275310146 0 Nurse Practitioners Physician Services 00 1275313074 0 WARDROP HAYLEY R 2023345 9999999 B 10 1275313074 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1275313074 0 Nurse Practitioners Anesthesia Services 20 1275313074 0 Nurse Practitioners Nurse Practitioners Services 20 1275313074 0 Nurse Practitioners Physician Services 00 1275317760 0 ZGORKA HEATHER 2023237 9999999 B 10 1275317760 0 370 SUMMIT ST # 1 ELGIN IL 601203843 20 1275317760 0 Nurse Practitioners Healthy Kids Services 20 1275317760 0 Nurse Practitioners Nurse Practitioners Services 20 1275317760 0 Nurse Practitioners Physician Services 00 1275339442 0 BAROT NIDHI 2025051 9999999 B 10 1275339442 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1275339442 0 Optometrists Optical Supplies 20 1275339442 0 Optometrists Optometric Services 20 1275339442 0 Optometrists Physician Services 00 1275345621 0 HETTINGER MATHEW R 2025058 9999999 B 10 1275345621 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1275345621 0 Nurse Practitioners Anesthesia Services 20 1275345621 0 Nurse Practitioners Nurse Practitioners Services 20 1275345621 0 Nurse Practitioners Physician Services 00 1275348161 0 BELL JASMAINE 2025041 9999999 B 10 1275348161 0 2038 221ST ST SAUK VILLAGE IL 604115064 20 1275348161 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1275359069 0 CLAEYS LACEY 2025006 9999999 B 10 1275359069 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1275359069 0 Nurse Practitioners Fluoride varnish 20 1275359069 0 Nurse Practitioners Healthy Kids Services 20 1275359069 0 Nurse Practitioners Nurse Practitioners Services 20 1275359069 0 Nurse Practitioners Physician Services 00 1275359606 0 BAILEY SHAUNTIA 2024346 9999999 B 10 1275359606 0 2112 W GALENA BLVD AURORA IL 605063255 20 1275359606 0 Occupational Therapists Medical Supplies 20 1275359606 0 Occupational Therapists Medical equipment/prosthetic devices 20 1275359606 0 Occupational Therapists Occupational Therapy Services 00 1275359887 0 RDZOK MELANIE J 2024340 9999999 B 10 1275359887 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1275359887 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1275363624 0 RYGIEWICZ SAVANNAH 2024273 9999999 B 10 1275363624 0 1200 W STATE ST ROCKFORD IL 611022112 20 1275363624 0 Physician Assistant Only Fluoride varnish 20 1275363624 0 Physician Assistant Only Healthy Kids Services 20 1275363624 0 Physician Assistant Only Physician Services 00 1275364366 0 AL MUGHRABI ANAS A 2024311 9999999 B 10 1275364366 0 9618 SOUTHWEST HWY OAK LAWN IL 604532862 20 1275364366 0 Dentists Dental Services 20 1275364366 0 Dentists Physician Services 00 1275366205 0 RADNEV GABRIELA 2024298 9999999 B 10 1275366205 0 PO BOX 5588 BELFAST ME 049155500 20 1275366205 0 Nurse Practitioners Fluoride varnish 20 1275366205 0 Nurse Practitioners Healthy Kids Services 20 1275366205 0 Nurse Practitioners Nurse Practitioners Services 20 1275366205 0 Nurse Practitioners Physician Services 00 1275368631 0 GREAVES LATONYA 2024249 9999999 B 10 1275368631 0 1414 MAIN ST MELROSE PARK IL 601603902 20 1275368631 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1275369241 0 ESQUIVEL URIEL 2024297 9999999 B 10 1275369241 0 415 W GOLF RD STE 52 ARLINGTON HEIGH IL 600053923 20 1275369241 0 Occupational Therapists Medical Supplies 20 1275369241 0 Occupational Therapists Medical equipment/prosthetic devices 20 1275369241 0 Occupational Therapists Occupational Therapy Services 00 1275369548 0 TAYLOR KESIA S 2024257 9999999 B 10 1275369548 0 540 SUPERIOR AVE CALUMET CITY IL 604093452 20 1275369548 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1275372005 0 ZALAVADIYA PRIYANSHI P 2024227 9999999 B 10 1275372005 0 5876 E STATE ST ROCKFORD IL 611082428 20 1275372005 0 Dentists Dental Services 20 1275372005 0 Dentists Physician Services 00 1275372468 0 PENA QUEVEDO JUDITH 2024250 9999999 B 10 1275372468 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1275372468 0 Nurse Practitioners Healthy Kids Services 20 1275372468 0 Nurse Practitioners Nurse Practitioners Services 20 1275372468 0 Nurse Practitioners Physician Services 00 1275373078 0 RODRIGUEZ ALEXIS G 2024220 9999999 B 10 1275373078 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1275373078 0 Clinical Social Worker Social work service 00 1275373680 0 NEYENS HALLE 2024215 9999999 B 10 1275373680 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1275373680 0 Optometrists Optical Supplies 20 1275373680 0 Optometrists Optometric Services 20 1275373680 0 Optometrists Physician Services 00 1275374704 0 GORSKI LISA 2024159 9999999 B 10 1275374704 0 2001 BUTTERFIELD RD STE 1600 DOWNERS GROVE IL 605151211 20 1275374704 0 Physical Therapists Medical Supplies 20 1275374704 0 Physical Therapists Medical equipment/prosthetic devices 20 1275374704 0 Physical Therapists Physical Therapy Services 00 1275374852 0 BURAGA JENNIFER 2024268 9999999 B 10 1275374852 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1275374852 0 Nurse Practitioners Fluoride varnish 20 1275374852 0 Nurse Practitioners Healthy Kids Services 20 1275374852 0 Nurse Practitioners Nurse Practitioners Services 20 1275374852 0 Nurse Practitioners Physician Services 00 1275375032 0 DORNON MARY 2024209 9999999 B 10 1275375032 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1275375032 0 Physicians Anesthesia Services 20 1275375032 0 Physicians Healthy Kids Services 20 1275375032 0 Physicians Optical Supplies 20 1275375032 0 Physicians Physician Services 00 1275375560 0 CARBAJAL STEPHANIE 2024176 9999999 B 10 1275375560 0 212 BARNEY DR JOLIET IL 604355271 20 1275375560 0 Occupational Therapists Medical Supplies 20 1275375560 0 Occupational Therapists Medical equipment/prosthetic devices 20 1275375560 0 Occupational Therapists Occupational Therapy Services 00 1275375644 0 GROSRENAUD JEAN-PATRICK 2024190 9999999 B 10 1275375644 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1275375644 0 Physicians Anesthesia Services 20 1275375644 0 Physicians Healthy Kids Services 20 1275375644 0 Physicians Optical Supplies 20 1275375644 0 Physicians Physician Services 20 1275375644 0 Physicians Physicians Psychiatric Services 00 1275376550 0 BUCHHOLZ ALAIRE 2024185 2028182 B 10 1275376550 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1275376550 0 Physicians Anesthesia Services 20 1275376550 0 Physicians Healthy Kids Services 20 1275376550 0 Physicians Optical Supplies 20 1275376550 0 Physicians Physician Services 00 1275376618 0 GBADEYAN RUTH 2025024 9999999 B 10 1275376618 0 1236 E RUSHOLME ST STE 300 DAVENPORT IA 528032473 20 1275376618 0 Nurse Practitioners Healthy Kids Services 20 1275376618 0 Nurse Practitioners Nurse Practitioners Services 20 1275376618 0 Nurse Practitioners Physician Services 00 1275380016 0 MERRILL LILIAN A 2024129 9999999 B 10 1275380016 0 1957 W DICKENS AVE UNIT 1 CHICAGO IL 606143934 20 1275380016 0 Speech Therapists Medical Supplies 20 1275380016 0 Speech Therapists Medical equipment/prosthetic devices 20 1275380016 0 Speech Therapists Speech Therapy/Pathology Services 00 1275380479 0 DOMKOWSKI JENNIFER 2024135 9999999 H 10 1275380479 0 3010 GRAND AVE WAUKEGAN IL 600852321 20 1275380479 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1275381378 0 HENAO JENAE A 2024135 9999999 B 10 1275381378 0 414 PLAZA DR STE 301 WESTMONT IL 605595508 20 1275381378 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1275381485 0 HUANG KEVIN 2024183 9999999 B 10 1275381485 0 26467 NETWORK PL CHICAGO IL 606731704 20 1275381485 0 Physicians Anesthesia Services 20 1275381485 0 Physicians Healthy Kids Services 20 1275381485 0 Physicians Optical Supplies 20 1275381485 0 Physicians Physician Services 00 1275381568 0 CONVERSE CHRISTY 2024323 9999999 B 10 1275381568 0 PO BOX 73488 PUYALLUP WA 983730488 20 1275381568 0 Nurse Practitioners Fluoride varnish 20 1275381568 0 Nurse Practitioners Healthy Kids Services 20 1275381568 0 Nurse Practitioners Nurse Practitioners Services 20 1275381568 0 Nurse Practitioners Physician Services 00 1275384125 0 ESHO YOUSIF 2024176 9999999 B 10 1275384125 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1275384125 0 Physicians Anesthesia Services 20 1275384125 0 Physicians Fluoride varnish 20 1275384125 0 Physicians Healthy Kids Services 20 1275384125 0 Physicians Optical Supplies 20 1275384125 0 Physicians Physician Services 00 1275385361 0 BALLARD ELISE 2024153 9999999 B 10 1275385361 0 120 W 22ND ST OAK BROOK IL 605231557 20 1275385361 0 Nurse Practitioners Fluoride varnish 20 1275385361 0 Nurse Practitioners Healthy Kids Services 20 1275385361 0 Nurse Practitioners Nurse Practitioners Services 20 1275385361 0 Nurse Practitioners Physician Services 00 1275385411 0 SHEPHERD MELISSA 2024194 9999999 B 10 1275385411 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1275385411 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1275388498 0 OKNER SARA 2024267 9999999 B 10 1275388498 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1275388498 0 Physician Assistant Only Fluoride varnish 20 1275388498 0 Physician Assistant Only Healthy Kids Services 20 1275388498 0 Physician Assistant Only Physician Services 00 1275391229 0 HANNAHS ALEXANDRA B 2024082 9999999 B 10 1275391229 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1275391229 0 Nurse Practitioners Fluoride varnish 20 1275391229 0 Nurse Practitioners Healthy Kids Services 20 1275391229 0 Nurse Practitioners Nurse Practitioners Services 20 1275391229 0 Nurse Practitioners Physician Services 00 1275391922 0 OLSHANNIKOV YURIY 2024197 9999999 B 10 1275391922 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1275391922 0 Nurse Practitioners Fluoride varnish 20 1275391922 0 Nurse Practitioners Healthy Kids Services 20 1275391922 0 Nurse Practitioners Nurse Practitioners Services 20 1275391922 0 Nurse Practitioners Physician Services 00 1275392417 0 SHAQILDI OWAYS 2024193 9999999 B 10 1275392417 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1275392417 0 Physicians Anesthesia Services 20 1275392417 0 Physicians Fluoride varnish 20 1275392417 0 Physicians Healthy Kids Services 20 1275392417 0 Physicians Optical Supplies 20 1275392417 0 Physicians Physician Services 00 1275392714 0 COWIE MICHAEL 2024233 9999999 B 10 1275392714 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1275392714 0 Physician Assistant Only Fluoride varnish 20 1275392714 0 Physician Assistant Only Healthy Kids Services 20 1275392714 0 Physician Assistant Only Physician Services 00 1275393209 0 PAUL KATLYNN 2024080 9999999 B 10 1275393209 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1275393209 0 Physician Assistant Only Fluoride varnish 20 1275393209 0 Physician Assistant Only Healthy Kids Services 20 1275393209 0 Physician Assistant Only Physician Services 00 1275393530 0 MAMIDI ANILA 2024326 9999999 B 10 1275393530 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1275393530 0 Physicians Anesthesia Services 20 1275393530 0 Physicians Fluoride varnish 20 1275393530 0 Physicians Healthy Kids Services 20 1275393530 0 Physicians Optical Supplies 20 1275393530 0 Physicians Physician Services 00 1275393944 0 KVASHA YULIANA 2024270 9999999 B 10 1275393944 0 4698 DEPT CAROL STREAM IL 601224698 20 1275393944 0 Physicians Anesthesia Services 20 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1275795569 0 Physicians Healthy Kids Services 20 1275795569 0 Physicians Optical Supplies 20 1275795569 0 Physicians Physician Services 00 1275795841 0 SANTIAGO IVAN 2009208 9999999 B 10 1275795841 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1275795841 0 Physicians Anesthesia Services 20 1275795841 0 Physicians Healthy Kids Services 20 1275795841 0 Physicians Optical Supplies 20 1275795841 0 Physicians Physician Services 00 1275795866 0 COFFEL MICHAEL 2008224 9999999 B 10 1275795866 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1275795866 0 Nurse Practitioners Fluoride varnish 20 1275795866 0 Nurse Practitioners Healthy Kids Services 20 1275795866 0 Nurse Practitioners Nurse Practitioners Services 20 1275795866 0 Nurse Practitioners Physician Services 00 1275795932 0 CHEEMA JASKIRAN 2013231 9999999 B 10 1275795932 0 28594 NETWORK PL CHICAGO IL 606731285 20 1275795932 0 Physicians Anesthesia Services 20 1275795932 0 Physicians Fluoride varnish 20 1275795932 0 Physicians Healthy Kids 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Physicians Optical Supplies 20 1275813206 0 Physicians Physician Services 00 1275814881 0 PETERSON RHONDA 2015141 9999999 B 10 1275814881 0 1236 E RUSHOLME ST STE 300 DAVENPORT IA 528032473 20 1275814881 0 Nurse Practitioners Healthy Kids Services 20 1275814881 0 Nurse Practitioners Nurse Practitioners Services 20 1275814881 0 Nurse Practitioners Physician Services 00 1275815508 0 VYAZOVSKY VERONICA 2015274 9999999 B 10 1275815508 0 8300 CALLIE AVE UNIT 405 MORTON GROVE IL 600533722 20 1275815508 0 Other behavior health professional LCPC/LMFT services 00 1275816167 0 KEATING KRISTIN LEE 2016068 9999999 B 10 1275816167 0 2010 N HARLEM AVE ELMWOOD PARK IL 607073119 20 1275816167 0 Physician Assistant Only Fluoride varnish 20 1275816167 0 Physician Assistant Only Healthy Kids Services 20 1275816167 0 Physician Assistant Only Physician Services 00 1275816654 0 KUMAR SUNEEL 2022272 9999999 B 10 1275816654 0 1000 MEDICAL CENTER DR MONTICELLO IL 618562116 20 1275816654 0 Physicians Anesthesia 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614622201 20 1275821027 0 Dentists Dental Services 20 1275821027 0 Dentists Physician Services 00 1275821225 0 SCHNEIDER SARAH E 2016028 9999999 B 10 1275821225 0 1120 N MELVIN ST GIBSON CITY IL 609361477 20 1275821225 0 Physician Assistant Only Fluoride varnish 20 1275821225 0 Physician Assistant Only Healthy Kids Services 20 1275821225 0 Physician Assistant Only Physician Services 00 1275821878 0 SUKHAL SHASHVAT 2017193 9999999 B 10 1275821878 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1275821878 0 Physicians Anesthesia Services 20 1275821878 0 Physicians Fluoride varnish 20 1275821878 0 Physicians Healthy Kids Services 20 1275821878 0 Physicians Optical Supplies 20 1275821878 0 Physicians Physician Services 00 1275822090 0 GRANT TERRANCE 2017182 9999999 B 10 1275822090 0 PO BOX 1790 BROOKFIELD WI 530081790 20 1275822090 0 Physicians Anesthesia Services 20 1275822090 0 Physicians Healthy Kids Services 20 1275822090 0 Physicians Optical Supplies 20 1275822090 0 Physicians Physician 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1275824484 0 1415 W 22ND ST OAK BROOK IL 605232074 20 1275824484 0 Nurse Practitioners Healthy Kids Services 20 1275824484 0 Nurse Practitioners Nurse Practitioners Services 20 1275824484 0 Nurse Practitioners Physician Services 00 1275824500 0 KNOUSE HENRY R 2014182 9999999 B 10 1275824500 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1275824500 0 Physicians Anesthesia Services 20 1275824500 0 Physicians Fluoride varnish 20 1275824500 0 Physicians Healthy Kids Services 20 1275824500 0 Physicians Optical Supplies 20 1275824500 0 Physicians Physician Services 00 1275824625 0 ROBERTS THOMAS W 2015001 9999999 B 10 1275824625 0 2215 SANDERS RD STE 105 SUITE 105 NORTHBROOK IL 600626194 20 1275824625 0 Physicians Anesthesia Services 20 1275824625 0 Physicians Fluoride varnish 20 1275824625 0 Physicians Healthy Kids Services 20 1275824625 0 Physicians Optical Supplies 20 1275824625 0 Physicians Physician Services 00 1275824930 0 PROKOP THOMAS 2019001 9999999 B 10 1275824930 0 8550 W BRYN MAWR AVE STE 800 STE 800 CHICAGO IL 606313222 20 1275824930 0 Physician Assistant Only Fluoride varnish 20 1275824930 0 Physician Assistant Only Healthy Kids Services 20 1275824930 0 Physician Assistant Only Physician Services 00 1275825978 0 ALI AHMER M 2017052 9999999 B 10 1275825978 0 29373 NETWORK PL CHICAGO IL 606733039 20 1275825978 0 Physicians Anesthesia Services 20 1275825978 0 Physicians Healthy Kids Services 20 1275825978 0 Physicians Optical Supplies 20 1275825978 0 Physicians Physician Services 20 1275825978 0 Physicians Physicians Psychiatric Services 00 1275826760 0 HUDAK KEVIN E 2018064 9999999 B 10 1275826760 0 2414 KOHLER MEMORIAL DR SHEBOYGAN WI 530813129 20 1275826760 0 Physicians Anesthesia Services 20 1275826760 0 Physicians Healthy Kids Services 20 1275826760 0 Physicians Optical Supplies 20 1275826760 0 Physicians Physician Services 00 1275826976 0 EYBERG RYAN T 2015283 9999999 B 10 1275826976 0 801 ILLINI DR SILVIS IL 612821804 20 1275826976 0 Nurse Practitioners Anesthesia Services 20 1275826976 0 Nurse Practitioners Nurse Practitioners Services 20 1275826976 0 Nurse Practitioners Physician Services 00 1275827917 0 WHITCHER CYNTHIA M 2011182 9999999 B 10 1275827917 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1275827917 0 Nurse Practitioners Healthy Kids Services 20 1275827917 0 Nurse Practitioners Nurse Practitioners Services 20 1275827917 0 Nurse Practitioners Physician Services 00 1275828063 0 SULIMAN ALI 2021094 9999999 B 10 1275828063 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1275828063 0 Physicians Anesthesia Services 20 1275828063 0 Physicians Fluoride varnish 20 1275828063 0 Physicians Healthy Kids Services 20 1275828063 0 Physicians Optical Supplies 20 1275828063 0 Physicians Physician Services 00 1275828394 0 BARRIOS CHRISTOPHER 2017182 9999999 B 10 1275828394 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1275828394 0 Physicians Anesthesia Services 20 1275828394 0 Physicians Fluoride varnish 20 1275828394 0 Physicians Healthy Kids Services 20 1275828394 0 Physicians Optical Supplies 20 1275828394 0 Physicians Physician Services 00 1275829046 0 SCHUSTER JOSEPH 2016092 9999999 B 10 1275829046 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1275829046 0 Physicians Anesthesia Services 20 1275829046 0 Physicians Healthy Kids Services 20 1275829046 0 Physicians Optical Supplies 20 1275829046 0 Physicians Physician Services 00 1275829095 0 GAVANESCU LAURA I 2016202 9999999 B 10 1275829095 0 1650 MOON LAKE BLVD HOFFMAN ESTATES IL 601691010 20 1275829095 0 Physicians Anesthesia Services 20 1275829095 0 Physicians Healthy Kids Services 20 1275829095 0 Physicians Optical Supplies 20 1275829095 0 Physicians Physician Services 20 1275829095 0 Physicians Physicians Psychiatric Services 00 1275829178 0 SCHULTHEIS MARTINE A 2014274 9999999 B 10 1275829178 0 124 SW ADAMS ST FL 2 PEORIA IL 616021308 20 1275829178 0 Physicians Anesthesia Services 20 1275829178 0 Physicians Fluoride varnish 20 1275829178 0 Physicians Healthy Kids Services 20 1275829178 0 Physicians Optical Supplies 20 1275829178 0 Physicians Physician Services 00 1275829277 0 ROMO ERNESTO JAVIER 2015351 9999999 B 10 1275829277 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1275829277 0 Physicians Anesthesia Services 20 1275829277 0 Physicians Fluoride varnish 20 1275829277 0 Physicians Healthy Kids Services 20 1275829277 0 Physicians Optical Supplies 20 1275829277 0 Physicians Physician Services 00 1275829723 0 WALIULLAH KHALID I 2016296 9999999 B 10 1275829723 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1275829723 0 Physicians Anesthesia Services 20 1275829723 0 Physicians Healthy Kids Services 20 1275829723 0 Physicians Optical Supplies 20 1275829723 0 Physicians Physician Services 00 1275829798 0 MIKOLAJCZYK ADAM 2014209 9999999 B 10 1275829798 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1275829798 0 Physicians Anesthesia Services 20 1275829798 0 Physicians Fluoride 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Physicians Anesthesia Services 20 1275831521 0 Physicians Fluoride varnish 20 1275831521 0 Physicians Healthy Kids Services 20 1275831521 0 Physicians Optical Supplies 20 1275831521 0 Physicians Physician Services 00 1275832024 0 DIETCH ZACHARY C 2020240 9999999 B 10 1275832024 0 5777 DEPT CAROL STREAM IL 601220021 20 1275832024 0 Physicians Anesthesia Services 20 1275832024 0 Physicians Healthy Kids Services 20 1275832024 0 Physicians Optical Supplies 20 1275832024 0 Physicians Physician Services 00 1275832396 0 ROSENBERG TANYA S 2011083 9999999 B 10 1275832396 0 5777 DEPT CAROL STREAM IL 601220021 20 1275832396 0 Nurse Practitioners Healthy Kids Services 20 1275832396 0 Nurse Practitioners Nurse Practitioners Services 20 1275832396 0 Nurse Practitioners Physician Services 00 1275832701 0 JAIN SACHIN 2015188 9999999 B 10 1275832701 0 5777 DEPT CAROL STREAM IL 601220021 20 1275832701 0 Physicians Anesthesia Services 20 1275832701 0 Physicians Healthy Kids Services 20 1275832701 0 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KEE LAFRANCE S 2022193 9999999 B 10 1275850992 0 600 HOLIDAY PLAZA DR STE 200 MATTESON IL 604432237 20 1275850992 0 Other behavior health professional LCPC/LMFT services 00 1275852642 0 MASON DANIEL 2022290 9999999 B 10 1275852642 0 8605 SANTA MONICA BLVD WEST HOLLYWOOD CA 900694109 20 1275852642 0 Speech Therapists Adaptive behavior support clinician services 20 1275852642 0 Speech Therapists Medical Supplies 20 1275852642 0 Speech Therapists Medical equipment/prosthetic devices 20 1275852642 0 Speech Therapists Speech Therapy/Pathology Services 00 1275853277 0 MCADAMS JILLIAN 2025013 9999999 B 10 1275853277 0 1 HOLLOW LN STE 301 NEW HYDE PARK NY 110421215 20 1275853277 0 Physicians Anesthesia Services 20 1275853277 0 Physicians Fluoride varnish 20 1275853277 0 Physicians Healthy Kids Services 20 1275853277 0 Physicians Optical Supplies 20 1275853277 0 Physicians Physician Services 00 1275853335 0 OGILVIE MICHAEL PATRICK 2017195 9999999 B 10 1275853335 0 29373 NETWORK PL CHICAGO IL 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Physicians Physician Services 00 1275923708 0 KAPALA MALWINA 2015349 9999999 B 10 1275923708 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1275923708 0 Other behavior health professional All Kids application agent 20 1275923708 0 Other behavior health professional LCPC/LMFT services 00 1275924813 0 MOREY DEBRA J 2018121 9999999 B 10 1275924813 0 PO BOX 5944 ROCKFORD IL 611250944 20 1275924813 0 Occupational Therapists Medical Supplies 20 1275924813 0 Occupational Therapists Medical equipment/prosthetic devices 20 1275924813 0 Occupational Therapists Occupational Therapy Services 00 1275926545 0 WHITE SARAH E 2016287 9999999 B 10 1275926545 0 1280 E TREMONT ST HILLSBORO IL 620491912 20 1275926545 0 Nurse Practitioners Fluoride varnish 20 1275926545 0 Nurse Practitioners Healthy Kids Services 20 1275926545 0 Nurse Practitioners Nurse Practitioners Services 20 1275926545 0 Nurse Practitioners Physician Services 00 1275926610 0 EFTINK JULIE 2017066 9999999 B 10 1275926610 0 1005 BROADWAY 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20 1275929101 0 Physicians Healthy Kids Services 20 1275929101 0 Physicians Optical Supplies 20 1275929101 0 Physicians Physician Services 00 1275929440 0 KASHANI SARA 2017164 9999999 B 10 1275929440 0 7825 SOLUTION CTR CHICAGO IL 606777007 20 1275929440 0 Physicians Anesthesia Services 20 1275929440 0 Physicians Healthy Kids Services 20 1275929440 0 Physicians Optical Supplies 20 1275929440 0 Physicians Physician Services 20 1275929440 0 Physicians Physicians Psychiatric Services 00 1275930299 0 DURMAN DRAGICA 2016258 9999999 B 10 1275930299 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1275930299 0 Nurse Practitioners Healthy Kids Services 20 1275930299 0 Nurse Practitioners Nurse Practitioners Services 20 1275930299 0 Nurse Practitioners Physician Services 00 1275930414 0 SILCROFT ALLISON C 2015182 9999999 B 10 1275930414 0 5777 DEPT CAROL STREAM IL 601220021 20 1275930414 0 Nurse Practitioners Healthy Kids Services 20 1275930414 0 Nurse Practitioners Nurse Practitioners Services 20 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1285075697 0 Nurse Practitioners Physician Services 00 1285075820 0 SHARAIN KOROSH 2021183 9999999 B 10 1285075820 0 5777 DEPT CAROL STREAM IL 601220021 20 1285075820 0 Physicians Anesthesia Services 20 1285075820 0 Physicians Fluoride varnish 20 1285075820 0 Physicians Healthy Kids Services 20 1285075820 0 Physicians Optical Supplies 20 1285075820 0 Physicians Physician Services 00 1285076760 0 MCDERMOTT AMY 2013252 9999999 B 10 1285076760 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1285076760 0 Nurse Practitioners Fluoride varnish 20 1285076760 0 Nurse Practitioners Healthy Kids Services 20 1285076760 0 Nurse Practitioners Nurse Practitioners Services 20 1285076760 0 Nurse Practitioners Physician Services 00 1285076794 0 MISCH LYNN 2014019 9999999 B 10 1285076794 0 2361 PAYSPHERE CIR CHICAGO IL 606740023 20 1285076794 0 Nurse Practitioners Fluoride varnish 20 1285076794 0 Nurse Practitioners Healthy Kids Services 20 1285076794 0 Nurse Practitioners Nurse Practitioners Services 20 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1285089664 0 Nurse Practitioners Healthy Kids Services 20 1285089664 0 Nurse Practitioners Nurse Practitioners Services 20 1285089664 0 Nurse Practitioners Physician Services 00 1285091751 0 MILLER LISA R 2016048 9999999 B 10 1285091751 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1285091751 0 Nurse Practitioners Healthy Kids Services 20 1285091751 0 Nurse Practitioners Nurse Practitioners Services 20 1285091751 0 Nurse Practitioners Physician Services 00 1285091934 0 ASCENCIO YANEZ DALIA 2015060 9999999 B 10 1285091934 0 29373 NETWORK PL CHICAGO IL 606733039 20 1285091934 0 Nurse Practitioners Fluoride varnish 20 1285091934 0 Nurse Practitioners Healthy Kids Services 20 1285091934 0 Nurse Practitioners Nurse Practitioners Services 20 1285091934 0 Nurse Practitioners Physician Services 00 1285092320 0 HASTINGS COREY 2020180 9999999 B 10 1285092320 0 90 CRESTMOOR ST COLLINSVILLE IL 622344951 20 1285092320 0 Dentists Dental Services 20 1285092320 0 Dentists Physician Services 00 1285093104 0 DUBOSE KYLE 2017218 9999999 B 10 1285093104 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1285093104 0 Physicians Anesthesia Services 20 1285093104 0 Physicians Fluoride varnish 20 1285093104 0 Physicians Healthy Kids Services 20 1285093104 0 Physicians Optical Supplies 20 1285093104 0 Physicians Physician Services 00 1285093351 0 PUTHIYOTTIL SAJA 2019309 9999999 B 10 1285093351 0 PO BOX 661495 BIRMINGHAM AL 352661495 20 1285093351 0 Nurse Practitioners Anesthesia Services 20 1285093351 0 Nurse Practitioners Nurse Practitioners Services 20 1285093351 0 Nurse Practitioners Nursing service 20 1285093351 0 Nurse Practitioners Physician Services 20 1285093351 0 Nurse Practitioners Waiver service 00 1285095190 0 CASSIDY MATT C 2023305 9999999 B 10 1285095190 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1285095190 0 Physical Therapists Medical Supplies 20 1285095190 0 Physical Therapists Medical equipment/prosthetic devices 20 1285095190 0 Physical Therapists Physical Therapy 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PAYSPHERE CIR CHICAGO IL 606740018 20 1285097352 0 Physicians Anesthesia Services 20 1285097352 0 Physicians Healthy Kids Services 20 1285097352 0 Physicians Optical Supplies 20 1285097352 0 Physicians Physician Services 00 1285097493 0 SAEEDI JOEL C 2019156 9999999 B 10 1285097493 0 29373 NETWORK PL CHICAGO IL 606733039 20 1285097493 0 Physicians Anesthesia Services 20 1285097493 0 Physicians Fluoride varnish 20 1285097493 0 Physicians Healthy Kids Services 20 1285097493 0 Physicians Optical Supplies 20 1285097493 0 Physicians Physician Services 00 1285098004 0 EMERY MATTHEW R 2022206 9999999 B 10 1285098004 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1285098004 0 Physicians Anesthesia Services 20 1285098004 0 Physicians Fluoride varnish 20 1285098004 0 Physicians Healthy Kids Services 20 1285098004 0 Physicians Optical Supplies 20 1285098004 0 Physicians Physician Services 00 1285098541 0 VAIDYA NEEL SUNIL 2020015 9999999 B 10 1285098541 0 1725 W HARRISON ST STE 906 CHICAGO IL 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1285099622 0 Nurse Practitioners Nurse Practitioners Services 20 1285099622 0 Nurse Practitioners Physician Services 00 1285101550 0 KUKULSKI LAURA 2018305 9999999 B 10 1285101550 0 8550 W BRYN MAWR AVE STE 800 SUITE 800 CHICAGO IL 606313222 20 1285101550 0 Nurse Practitioners Fluoride varnish 20 1285101550 0 Nurse Practitioners Healthy Kids Services 20 1285101550 0 Nurse Practitioners Nurse Practitioners Services 20 1285101550 0 Nurse Practitioners Physician Services 00 1285102004 0 WATSON TYNISA C 2018319 9999999 H 10 1285102004 0 1800 N HERMITAGE AVE ATTN: PAM DAVIS CHICAGO IL 606221161 20 1285102004 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1285102038 0 PREISSING MICHAEL 2023124 9999999 B 10 1285102038 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1285102038 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1285103002 0 LASK AMY 2018354 9999999 B 10 1285103002 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1285103002 0 Nurse Practitioners Fluoride varnish 20 1285103002 0 Nurse Practitioners Healthy Kids Services 20 1285103002 0 Nurse Practitioners Nurse Practitioners Services 20 1285103002 0 Nurse Practitioners Physician Services 00 1285103150 0 ROSSELL JOLENE 2018325 9999999 H 10 1285103150 0 2323 WINDISH DR GALESBURG IL 614019780 20 1285103150 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1285103853 0 KELLY DANIELLE 2023137 9999999 B 10 1285103853 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1285103853 0 Occupational Therapists Medical Supplies 20 1285103853 0 Occupational Therapists Medical equipment/prosthetic devices 20 1285103853 0 Occupational Therapists Occupational Therapy Services 00 1285107680 0 BLISS MARI 2019326 9999999 B 10 1285107680 0 2900 OGDEN AVE LISLE IL 605321631 20 1285107680 0 Speech Therapists Medical Supplies 20 1285107680 0 Speech Therapists Medical equipment/prosthetic devices 20 1285107680 0 Speech Therapists Speech Therapy/Pathology Services 00 1285109280 0 LEDBETTER KATHRYN 2020324 9999999 B 10 1285109280 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1285109280 0 Nurse Practitioners Healthy Kids Services 20 1285109280 0 Nurse Practitioners Nurse Practitioners Services 20 1285109280 0 Nurse Practitioners Physician Services 00 1285110213 0 CORCORAN NEVIN 2018225 9999999 B 10 1285110213 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1285110213 0 Nurse Practitioners Fluoride varnish 20 1285110213 0 Nurse Practitioners Healthy Kids Services 20 1285110213 0 Nurse Practitioners Nurse Practitioners Services 20 1285110213 0 Nurse Practitioners Physician Services 00 1285110593 0 GOLDSTEIN DAWN R 2023321 9999999 B 10 1285110593 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1285110593 0 Other behavior health professional LCPC/LMFT services 00 1285112276 0 ALBERS NICHOLE C 2021082 9999999 B 10 1285112276 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1285112276 0 Nurse Practitioners Fluoride varnish 20 1285112276 0 Nurse Practitioners Healthy Kids Services 20 1285112276 0 Nurse Practitioners Nurse Practitioners Services 20 1285112276 0 Nurse Practitioners Physician Services 00 1285112854 0 BATOOL SABA 2019365 9999999 B 10 1285112854 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1285112854 0 Physicians Anesthesia Services 20 1285112854 0 Physicians Fluoride varnish 20 1285112854 0 Physicians Healthy Kids Services 20 1285112854 0 Physicians Optical Supplies 20 1285112854 0 Physicians Physician Services 00 1285113779 0 ALTSCHAEFL MARGARET 2023066 9999999 B 10 1285113779 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1285113779 0 Psychologist Psychologist service 00 1285114181 0 REIMRINGER MADISON 2019280 9999999 B 10 1285114181 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1285114181 0 Physical Therapists Medical Supplies 20 1285114181 0 Physical Therapists Medical equipment/prosthetic devices 20 1285114181 0 Physical Therapists Physical Therapy Services 00 1285114959 0 ROSMAN SILVIA 2023082 9999999 B 10 1285114959 0 938 N CALIFORNIA AVE CHICAGO IL 606224462 20 1285114959 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1285115840 0 KRASSILNIK NINA 2022236 9999999 B 10 1285115840 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1285115840 0 Physicians Anesthesia Services 20 1285115840 0 Physicians Healthy Kids Services 20 1285115840 0 Physicians Optical Supplies 20 1285115840 0 Physicians Physician Services 00 1285116970 0 JONES MICHELLE A 2018260 9999999 B 10 1285116970 0 3010 GRAND AVE WAUKEGAN IL 600852321 20 1285116970 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1285117754 0 AULERT MICHAEL R 2018313 9999999 B 10 1285117754 0 5777 DEPT CAROL STREAM IL 601220021 20 1285117754 0 Nurse Practitioners Fluoride varnish 20 1285117754 0 Nurse Practitioners Healthy Kids Services 20 1285117754 0 Nurse Practitioners Nurse Practitioners Services 20 1285117754 0 Nurse Practitioners Physician Services 00 1285117820 0 HULSE LEAH 2018262 9999999 B 10 1285117820 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1285117820 0 Nurse Practitioners Fluoride varnish 20 1285117820 0 Nurse Practitioners Healthy Kids Services 20 1285117820 0 Nurse Practitioners Nurse Practitioners Services 20 1285117820 0 Nurse Practitioners Physician Services 00 1285118356 0 WATSON ANNA I 2018276 9999999 B 10 1285118356 0 29373 NETWORK PL CHICAGO IL 606733039 20 1285118356 0 Nurse Practitioners Healthy Kids Services 20 1285118356 0 Nurse Practitioners Nurse Practitioners Services 20 1285118356 0 Nurse Practitioners Nursing service 20 1285118356 0 Nurse Practitioners Physician Services 20 1285118356 0 Nurse Practitioners Waiver service 00 1285120600 0 RANA NATASHA 2019168 9999999 B 10 1285120600 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1285120600 0 Physicians Anesthesia Services 20 1285120600 0 Physicians Fluoride varnish 20 1285120600 0 Physicians Healthy Kids Services 20 1285120600 0 Physicians Optical Supplies 20 1285120600 0 Physicians Physician Services 00 1285120923 0 LEON SILVA ASTRID H 2018186 9999999 B 10 1285120923 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1285120923 0 Physicians All Kids application agent 20 1285120923 0 Physicians Anesthesia Services 20 1285120923 0 Physicians Fluoride varnish 20 1285120923 0 Physicians Healthy Kids Services 20 1285120923 0 Physicians Optical Supplies 20 1285120923 0 Physicians Physician Services 00 1285121228 0 FAROOQUI ANAM I 2021285 9999999 B 10 1285121228 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1285121228 0 Physicians Anesthesia Services 20 1285121228 0 Physicians Fluoride varnish 20 1285121228 0 Physicians Healthy Kids Services 20 1285121228 0 Physicians Optical Supplies 20 1285121228 0 Physicians Physician Services 00 1285121988 0 PETERSON JENNIFER 2021160 9999999 B 10 1285121988 0 903 COMMERCE DR STE 333 SUITE 333 OAK BROOK IL 605238723 20 1285121988 0 Nurse Practitioners Fluoride varnish 20 1285121988 0 Nurse Practitioners Healthy Kids Services 20 1285121988 0 Nurse Practitioners Nurse Practitioners Services 20 1285121988 0 Nurse Practitioners Physician Services 00 1285122374 0 SERRELL EMILY C 2023127 9999999 B 10 1285122374 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1285122374 0 Physicians Anesthesia Services 20 1285122374 0 Physicians Healthy Kids Services 20 1285122374 0 Physicians Optical Supplies 20 1285122374 0 Physicians Physician Services 00 1285124586 0 BROWN DYLAN J 2024044 9999999 B 10 1285124586 0 PO BOX 43230 PHOENIX AZ 850803230 20 1285124586 0 Physicians Anesthesia Services 20 1285124586 0 Physicians Healthy Kids Services 20 1285124586 0 Physicians Optical Supplies 20 1285124586 0 Physicians Physician Services 00 1285124792 0 ELNAGAR MOHAMMED 2019035 9999999 B 10 1285124792 0 7732 SOLUTION CENTER CHICAGO IL 606777007 20 1285124792 0 Dentists Dental Services 20 1285124792 0 Dentists Physician Services 00 1285125773 0 WELLS KRISTIE L 2018222 9999999 B 10 1285125773 0 PO BOX 778912 CHICAGO IL 606778912 20 1285125773 0 Nurse Practitioners Healthy Kids Services 20 1285125773 0 Nurse Practitioners Nurse Practitioners Services 20 1285125773 0 Nurse Practitioners Physician Services 00 1285125781 0 HALL MIENA M 2019262 9999999 B 10 1285125781 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1285125781 0 Physicians Anesthesia Services 20 1285125781 0 Physicians Fluoride varnish 20 1285125781 0 Physicians Healthy Kids Services 20 1285125781 0 Physicians Optical Supplies 20 1285125781 0 Physicians Physician Services 00 1285126086 0 ANSBRO DANIEL 2018177 9999999 B 10 1285126086 0 111 OAKWOOD RD EAST PEORIA IL 616111853 20 1285126086 0 Physicians Anesthesia Services 20 1285126086 0 Physicians Fluoride varnish 20 1285126086 0 Physicians Healthy Kids Services 20 1285126086 0 Physicians Optical Supplies 20 1285126086 0 Physicians Physician Services 00 1285126656 0 RIZVI ABBAS A 2021174 9999999 B 10 1285126656 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1285126656 0 Physicians Anesthesia Services 20 1285126656 0 Physicians Fluoride varnish 20 1285126656 0 Physicians Healthy Kids Services 20 1285126656 0 Physicians Optical Supplies 20 1285126656 0 Physicians Physician Services 00 1285127761 0 HASTINGS MYLES J 2018179 9999999 B 10 1285127761 0 PO BOX 174 SHELBYVILLE IL 625650174 20 1285127761 0 Dentists Dental Services 20 1285127761 0 Dentists Physician Services 00 1285127894 0 YOUNG SONDRA 2021158 9999999 B 10 1285127894 0 3700 S WALLACE ST CHICAGO IL 606091745 20 1285127894 0 Other behavior health professional LCPC/LMFT services 00 1285128033 0 MOHLING MELISSA D 2018276 9999999 B 10 1285128033 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1285128033 0 Nurse Practitioners Healthy Kids Services 20 1285128033 0 Nurse Practitioners Nurse Practitioners Services 20 1285128033 0 Nurse Practitioners Physician Services 00 1285128504 0 SMITH CHARELLE O 2018152 9999999 B 10 1285128504 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1285128504 0 Physicians Anesthesia Services 20 1285128504 0 Physicians Fluoride varnish 20 1285128504 0 Physicians Healthy Kids Services 20 1285128504 0 Physicians Optical Supplies 20 1285128504 0 Physicians Physician Services 00 1285128926 0 TWIEHAUS SARA 2019205 9999999 B 10 1285128926 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1285128926 0 Physicians Anesthesia Services 20 1285128926 0 Physicians Healthy Kids Services 20 1285128926 0 Physicians Optical Supplies 20 1285128926 0 Physicians Physician Services 00 1285128975 0 WARWICK REBECCA 2024240 9999999 B 10 1285128975 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1285128975 0 Physicians Anesthesia Services 20 1285128975 0 Physicians Fluoride varnish 20 1285128975 0 Physicians Healthy Kids Services 20 1285128975 0 Physicians Optical Supplies 20 1285128975 0 Physicians Physician Services 00 1285129387 0 PATEL TIRTH 2019163 9999999 B 10 1285129387 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1285129387 0 Physicians Anesthesia Services 20 1285129387 0 Physicians Healthy Kids Services 20 1285129387 0 Physicians Optical Supplies 20 1285129387 0 Physicians Physician Services 00 1285129502 0 PATEL SHIVANI T 2024169 9999999 B 10 1285129502 0 1301 S KOKE MILL RD SPRINGFIELD IL 627119252 20 1285129502 0 Physicians Anesthesia Services 20 1285129502 0 Physicians Healthy Kids Services 20 1285129502 0 Physicians Optical Supplies 20 1285129502 0 Physicians Physician Services 00 1285129643 0 BURKARD DAVID 2023226 9999999 B 10 1285129643 0 PO BOX 486 SAN JACINTO CA 925810486 20 1285129643 0 Physicians Anesthesia Services 20 1285129643 0 Physicians Healthy Kids Services 20 1285129643 0 Physicians Optical Supplies 20 1285129643 0 Physicians Physician Services 00 1285129650 0 AJEDE KEHINDE 2020009 9999999 B 10 1285129650 0 PO BOX 776473 CHICAGO IL 606776473 20 1285129650 0 Physicians Anesthesia Services 20 1285129650 0 Physicians Healthy Kids Services 20 1285129650 0 Physicians Optical Supplies 20 1285129650 0 Physicians Physician Services 00 1285129668 0 LIND WENDY M 2018232 9999999 B 10 1285129668 0 PO BOX 4028 ROCK ISLAND IL 612044028 20 1285129668 0 Nurse Practitioners Healthy Kids Services 20 1285129668 0 Nurse Practitioners Nurse Practitioners Services 20 1285129668 0 Nurse Practitioners Physician Services 00 1285130351 0 O'KEEFE HEATHER M 2018092 9999999 B 10 1285130351 0 11053 S MILLARD AVE CHICAGO IL 606553327 20 1285130351 0 Occupational Therapists Medical Supplies 20 1285130351 0 Occupational Therapists Medical equipment/prosthetic devices 20 1285130351 0 Occupational Therapists Occupational Therapy Services 00 1285130435 0 URBANIK JOSEPH 2020083 9999999 B 10 1285130435 0 29373 NETWORK PL CHICAGO IL 606733039 20 1285130435 0 Physicians Anesthesia Services 20 1285130435 0 Physicians Fluoride varnish 20 1285130435 0 Physicians Healthy Kids Services 20 1285130435 0 Physicians Optical Supplies 20 1285130435 0 Physicians Physician Services 00 1285130773 0 MALLARD JOCELYN 2018130 9999999 B 10 1285130773 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1285130773 0 Nurse Practitioners Fluoride varnish 20 1285130773 0 Nurse Practitioners Healthy Kids Services 20 1285130773 0 Nurse Practitioners Nurse Practitioners Services 20 1285130773 0 Nurse Practitioners Physician Services 00 1285130930 0 SHAW-REESE TRACY 2022277 9999999 B 10 1285130930 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1285130930 0 Nurse Practitioners Fluoride varnish 20 1285130930 0 Nurse Practitioners Healthy Kids Services 20 1285130930 0 Nurse Practitioners Nurse Practitioners Services 20 1285130930 0 Nurse Practitioners Physician Services 00 1285130963 0 WARD JORDAN L 2022305 9999999 B 10 1285130963 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1285130963 0 Physicians Anesthesia Services 20 1285130963 0 Physicians Healthy Kids Services 20 1285130963 0 Physicians Optical Supplies 20 1285130963 0 Physicians Physician Services 00 1285131946 0 HICKEY TEAL A 2018127 9999999 B 10 1285131946 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1285131946 0 Nurse Practitioners Anesthesia Services 20 1285131946 0 Nurse Practitioners Nurse Practitioners Services 20 1285131946 0 Nurse Practitioners Physician Services 00 1285134304 0 EVANS DEIDRE 2023055 9999999 B 10 1285134304 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1285134304 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1285136127 0 ARRIAGA JESSICA 2020171 9999999 B 10 1285136127 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1285136127 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1285137109 0 HARTNETT JOHN P 2018267 9999999 B 10 1285137109 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1285137109 0 Physicians Anesthesia Services 20 1285137109 0 Physicians Healthy Kids Services 20 1285137109 0 Physicians Optical Supplies 20 1285137109 0 Physicians Physician Services 00 1285137349 0 GALEMB JULIA M 2021316 9999999 B 10 1285137349 0 29373 NETWORK PL CHICAGO IL 606733039 20 1285137349 0 Occupational Therapists Medical Supplies 20 1285137349 0 Occupational Therapists Medical equipment/prosthetic devices 20 1285137349 0 Occupational Therapists Occupational Therapy Services 00 1285137653 0 KALE VALERIE T 2018087 9999999 B 10 1285137653 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1285137653 0 Physician Assistant Only Fluoride varnish 20 1285137653 0 Physician Assistant Only Healthy Kids Services 20 1285137653 0 Physician Assistant Only Physician Services 00 1285137752 0 MULESA PRISCILLA M 2020176 9999999 B 10 1285137752 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1285137752 0 Physical Therapists Medical Supplies 20 1285137752 0 Physical Therapists Medical equipment/prosthetic devices 20 1285137752 0 Physical Therapists Physical Therapy Services 00 1285138297 0 JIBAWI NIDAL 2020052 9999999 B 10 1285138297 0 PO BOX 1103 CROWN POINT IN 463081103 20 1285138297 0 Physicians Anesthesia Services 20 1285138297 0 Physicians Fluoride varnish 20 1285138297 0 Physicians Healthy Kids Services 20 1285138297 0 Physicians Optical Supplies 20 1285138297 0 Physicians Physician Services 00 1285138552 0 OLSEN JADE M 2018169 9999999 B 10 1285138552 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1285138552 0 Nurse Practitioners Healthy Kids Services 20 1285138552 0 Nurse Practitioners Nurse Practitioners Services 20 1285138552 0 Nurse Practitioners Physician Services 00 1285138594 0 KAADAN M IHSAN 2023354 9999999 B 10 1285138594 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1285138594 0 Physicians Anesthesia Services 20 1285138594 0 Physicians Fluoride varnish 20 1285138594 0 Physicians Healthy Kids Services 20 1285138594 0 Physicians Optical Supplies 20 1285138594 0 Physicians Physician Services 00 1285138883 0 LALEZARI RAMIN 2024239 9999999 B 10 1285138883 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1285138883 0 Physicians Anesthesia Services 20 1285138883 0 Physicians Healthy Kids Services 20 1285138883 0 Physicians Optical Supplies 20 1285138883 0 Physicians Physician Services 00 1285139162 0 KONG ANDREW P 2023123 9999999 B 10 1285139162 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1285139162 0 Physicians Anesthesia Services 20 1285139162 0 Physicians Healthy Kids Services 20 1285139162 0 Physicians Optical Supplies 20 1285139162 0 Physicians Physician Services 00 1285139311 0 COGGINS KATY 2022178 9999999 B 10 1285139311 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1285139311 0 Physicians Anesthesia Services 20 1285139311 0 Physicians Healthy Kids Services 20 1285139311 0 Physicians Optical Supplies 20 1285139311 0 Physicians Physician Services 00 1285141374 0 BIGGER MELISSA 2018010 9999999 B 10 1285141374 0 404 S 5TH ST # 409 SAINT JOSEPH IL 618739073 20 1285141374 0 Speech Therapists Medical Supplies 20 1285141374 0 Speech Therapists Medical equipment/prosthetic devices 20 1285141374 0 Speech Therapists Speech Therapy/Pathology Services 00 1285142281 0 CULP MATTHEW 2018018 9999999 B 10 1285142281 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1285142281 0 Nurse Practitioners Fluoride varnish 20 1285142281 0 Nurse Practitioners Healthy Kids Services 20 1285142281 0 Nurse Practitioners Nurse Practitioners Services 20 1285142281 0 Nurse Practitioners Physician Services 00 1285142828 0 MAYNARD-ROBBINS TAMARA J 2018001 9999999 B 10 1285142828 0 543 N WOOD DALE RD WOOD DALE IL 601911535 20 1285142828 0 Speech Therapists Medical Supplies 20 1285142828 0 Speech Therapists Medical equipment/prosthetic devices 20 1285142828 0 Speech Therapists Speech Therapy/Pathology Services 00 1285143107 0 SIEBERT TAMARA L 2017340 9999999 B 10 1285143107 0 716 W 6TH ST 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Practitioners Physician Services 00 1285160622 0 PARTIDA SARA T 2017244 9999999 B 10 1285160622 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1285160622 0 Nurse Practitioners Fluoride varnish 20 1285160622 0 Nurse Practitioners Healthy Kids Services 20 1285160622 0 Nurse Practitioners Nurse Practitioners Services 20 1285160622 0 Nurse Practitioners Physician Services 00 1285161075 0 GRANDISON KENISHA 2017159 9999999 B 10 1285161075 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1285161075 0 Nurse Practitioners Fluoride varnish 20 1285161075 0 Nurse Practitioners Healthy Kids Services 20 1285161075 0 Nurse Practitioners Nurse Practitioners Services 20 1285161075 0 Nurse Practitioners Physician Services 00 1285161562 0 ZINO KENNETH 2023182 9999999 B 10 1285161562 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1285161562 0 Nurse Practitioners Anesthesia Services 20 1285161562 0 Nurse Practitioners Nurse Practitioners Services 20 1285161562 0 Nurse Practitioners Physician 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Physicians Anesthesia Services 20 1285164319 0 Physicians Healthy Kids Services 20 1285164319 0 Physicians Optical Supplies 20 1285164319 0 Physicians Physician Services 00 1285164699 0 GUGLIELMI GINA N 2019274 9999999 B 10 1285164699 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1285164699 0 Physicians Anesthesia Services 20 1285164699 0 Physicians Healthy Kids Services 20 1285164699 0 Physicians Optical Supplies 20 1285164699 0 Physicians Physician Services 00 1285165548 0 WHERLEY JUDITH C 2017121 9999999 B 10 1285165548 0 320 W SAINT CHARLES RD VILLA PARK IL 601812403 20 1285165548 0 Clinical Social Worker Social work service 00 1285165696 0 WENDEL SARAH K 2021343 9999999 B 10 1285165696 0 PO BOX 110429 AURORA CO 800420429 20 1285165696 0 Physicians Anesthesia Services 20 1285165696 0 Physicians Healthy Kids Services 20 1285165696 0 Physicians Optical Supplies 20 1285165696 0 Physicians Physician Services 00 1285165795 0 MARCUS JILL K 2020024 9999999 B 10 1285165795 0 75 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1285297812 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1285297812 0 Physicians Anesthesia Services 20 1285297812 0 Physicians Healthy Kids Services 20 1285297812 0 Physicians Optical Supplies 20 1285297812 0 Physicians Physician Services 00 1285298257 0 WETJEN SEAN M 2023332 9999999 B 10 1285298257 0 PO BOX 43230 PHOENIX AZ 850803230 20 1285298257 0 Physicians Anesthesia Services 20 1285298257 0 Physicians Healthy Kids Services 20 1285298257 0 Physicians Optical Supplies 20 1285298257 0 Physicians Physician Services 00 1285298547 0 PANDE NISHA 2025043 9999999 B 10 1285298547 0 PO BOX 60352 SAINT LOUIS MO 631600352 20 1285298547 0 Physicians Anesthesia Services 20 1285298547 0 Physicians Healthy Kids Services 20 1285298547 0 Physicians Optical Supplies 20 1285298547 0 Physicians Physician Services 00 1285299271 0 MCNULTY AMANDA 2024361 9999999 B 10 1285299271 0 2901 FINLEY RD STE 102 DOWNERS GROVE IL 605151774 20 1285299271 0 Speech Therapists Medical Supplies 20 1285299271 0 Speech Therapists Medical equipment/prosthetic devices 20 1285299271 0 Speech Therapists Speech Therapy/Pathology Services 00 1285301143 0 TONG REBECCA 2023095 9999999 B 10 1285301143 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1285301143 0 Physician Assistant Only Fluoride varnish 20 1285301143 0 Physician Assistant Only Healthy Kids Services 20 1285301143 0 Physician Assistant Only Physician Services 00 1285301242 0 CLARKE ALISON C 2022109 9999999 B 10 1285301242 0 5777 DEPT CAROL STREAM IL 601220021 20 1285301242 0 Nurse Practitioners Fluoride varnish 20 1285301242 0 Nurse Practitioners Healthy Kids Services 20 1285301242 0 Nurse Practitioners Nurse Practitioners Services 20 1285301242 0 Nurse Practitioners Physician Services 00 1285303479 0 VACHIO MORGAN 2021253 9999999 B 10 1285303479 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1285303479 0 Speech Therapists Medical Supplies 20 1285303479 0 Speech Therapists Medical equipment/prosthetic devices 20 1285303479 0 Speech Therapists Speech Therapy/Pathology Services 00 1285304071 0 NADUPPARAMBIL MARIA 2024068 9999999 B 10 1285304071 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1285304071 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1285304105 0 DARKO AISHA 2022033 9999999 B 10 1285304105 0 1830 CARL DR ROUND LAKE BEAC IL 600731394 20 1285304105 0 Nurse Practitioners Fluoride varnish 20 1285304105 0 Nurse Practitioners Healthy Kids Services 20 1285304105 0 Nurse Practitioners Nurse Practitioners Services 20 1285304105 0 Nurse Practitioners Physician Services 00 1285304659 0 ALLEN DANIELLE 2021308 9999999 H 10 1285304659 0 70 S RIVER ST AURORA IL 605065185 20 1285304659 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1285306654 0 DEEB JENNIFER B 2022074 9999999 B 10 1285306654 0 221 NE GLEN OAK AVE PEORIA IL 616360002 20 1285306654 0 Nurse Practitioners Fluoride varnish 20 1285306654 0 Nurse Practitioners Healthy Kids Services 20 1285306654 0 Nurse Practitioners Nurse Practitioners Services 20 1285306654 0 Nurse Practitioners Physician Services 00 1285307041 0 KAMAL SYEDA ASHNA 2022220 9999999 B 10 1285307041 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1285307041 0 Physicians Anesthesia Services 20 1285307041 0 Physicians Fluoride varnish 20 1285307041 0 Physicians Healthy Kids Services 20 1285307041 0 Physicians Optical Supplies 20 1285307041 0 Physicians Physician Services 00 1285308171 0 KINDER BRETT A 2022025 9999999 B 10 1285308171 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1285308171 0 Nurse Practitioners Anesthesia Services 20 1285308171 0 Nurse Practitioners Nurse Practitioners Services 20 1285308171 0 Nurse Practitioners Physician Services 00 1285308320 0 TODT DANA ELIZABETH 2021274 9999999 B 10 1285308320 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1285308320 0 Nurse Practitioners Fluoride varnish 20 1285308320 0 Nurse Practitioners Healthy Kids Services 20 1285308320 0 Nurse Practitioners Nurse Practitioners Services 20 1285308320 0 Nurse Practitioners Physician Services 00 1285309484 0 HODGE DANIELLE 2022137 9999999 B 10 1285309484 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1285309484 0 Nurse Practitioners Fluoride varnish 20 1285309484 0 Nurse Practitioners Healthy Kids Services 20 1285309484 0 Nurse Practitioners Nurse Practitioners Services 20 1285309484 0 Nurse Practitioners Physician Services 00 1285309591 0 THOMASON ZACHARY 2021265 9999999 B 10 1285309591 0 102 N HEINLEIN DR SHELBYVILLE IL 625659050 20 1285309591 0 Optometrists Optical Supplies 20 1285309591 0 Optometrists Optometric Services 20 1285309591 0 Optometrists Physician Services 00 1285312017 0 CARFAGNINI CHRISTINA 2023298 9999999 B 10 1285312017 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1285312017 0 Physicians Anesthesia Services 20 1285312017 0 Physicians Fluoride varnish 20 1285312017 0 Physicians Healthy Kids Services 20 1285312017 0 Physicians Optical Supplies 20 1285312017 0 Physicians Physician Services 00 1285312934 0 RAI LAJPAT 2023214 9999999 B 10 1285312934 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1285312934 0 Physicians Anesthesia Services 20 1285312934 0 Physicians Fluoride varnish 20 1285312934 0 Physicians Healthy Kids Services 20 1285312934 0 Physicians Optical Supplies 20 1285312934 0 Physicians Physician Services 00 1285312967 0 LAGO EMILY G 2023243 9999999 B 10 1285312967 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1285312967 0 Nurse Practitioners Fluoride varnish 20 1285312967 0 Nurse Practitioners Healthy Kids Services 20 1285312967 0 Nurse Practitioners Nurse Practitioners Services 20 1285312967 0 Nurse Practitioners Physician Services 00 1285313072 0 SHIVANADA SUSHMA 2023363 9999999 B 10 1285313072 0 124 SW ADAMS ST PEORIA IL 616021308 20 1285313072 0 Physicians Anesthesia Services 20 1285313072 0 Physicians Fluoride varnish 20 1285313072 0 Physicians Healthy Kids Services 20 1285313072 0 Physicians Optical Supplies 20 1285313072 0 Physicians Physician Services 00 1285314468 0 YASMEEN JUVERIYA 2023206 9999999 B 10 1285314468 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1285314468 0 Physicians Anesthesia Services 20 1285314468 0 Physicians Fluoride varnish 20 1285314468 0 Physicians Healthy Kids Services 20 1285314468 0 Physicians Optical Supplies 20 1285314468 0 Physicians Physician Services 00 1285315382 0 GRAY JOCELYN 2024317 9999999 B 10 1285315382 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1285315382 0 Nurse Practitioners Anesthesia Services 20 1285315382 0 Nurse Practitioners Nurse Practitioners Services 20 1285315382 0 Nurse Practitioners Physician Services 00 1285317354 0 NEBUS WILLIAM H 2024005 9999999 B 10 1285317354 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1285317354 0 Nurse Practitioners Healthy Kids Services 20 1285317354 0 Nurse Practitioners Nurse Practitioners Services 20 1285317354 0 Nurse Practitioners Physician Services 00 1285317875 0 PICHE BROCK 2023222 9999999 B 10 1285317875 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1285317875 0 Nurse Practitioners Healthy Kids Services 20 1285317875 0 Nurse Practitioners Nurse Practitioners Services 20 1285317875 0 Nurse Practitioners Physician Services 00 1285318048 0 BINSKI BEATA BARBARA 2023223 9999999 B 10 1285318048 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1285318048 0 Nurse Practitioners Healthy Kids Services 20 1285318048 0 Nurse Practitioners Nurse Practitioners Services 20 1285318048 0 Nurse Practitioners Physician Services 00 1285318212 0 CHIN CHRISTINE S 2023188 9999999 B 10 1285318212 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1285318212 0 Physicians Anesthesia Services 20 1285318212 0 Physicians Healthy Kids Services 20 1285318212 0 Physicians Optical Supplies 20 1285318212 0 Physicians Physician Services 00 1285318345 0 CHAN HAYLEY 2023202 2026181 B 10 1285318345 0 611 W PARK ST URBANA IL 618012529 20 1285318345 0 Physicians Anesthesia Services 20 1285318345 0 Physicians Fluoride varnish 20 1285318345 0 Physicians Healthy Kids Services 20 1285318345 0 Physicians Optical Supplies 20 1285318345 0 Physicians Physician Services 00 1285319350 0 ALTIMARI MARC L 2023186 9999999 B 10 1285319350 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1285319350 0 Physicians Anesthesia Services 20 1285319350 0 Physicians Healthy Kids Services 20 1285319350 0 Physicians Optical Supplies 20 1285319350 0 Physicians Physician Services 00 1285319525 0 GEORGE TOM 2023192 9999999 B 10 1285319525 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1285319525 0 Physicians Anesthesia Services 20 1285319525 0 Physicians Fluoride varnish 20 1285319525 0 Physicians Healthy Kids Services 20 1285319525 0 Physicians Optical Supplies 20 1285319525 0 Physicians Physician Services 00 1285320291 0 AHMAD FAISAL SAIF 2024141 9999999 B 10 1285320291 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1285320291 0 Physicians Anesthesia Services 20 1285320291 0 Physicians Healthy Kids Services 20 1285320291 0 Physicians Optical Supplies 20 1285320291 0 Physicians Physician Services 00 1285321521 0 BAKSH MIZBA 2023201 9999999 B 10 1285321521 0 PO BOX 778791 CHICAGO IL 606776473 20 1285321521 0 Physicians Anesthesia Services 20 1285321521 0 Physicians Fluoride varnish 20 1285321521 0 Physicians Healthy Kids Services 20 1285321521 0 Physicians Optical Supplies 20 1285321521 0 Physicians Physician Services 00 1285322818 0 BORYS ADRIANNA A 2023297 9999999 B 10 1285322818 0 124 SW ADAMS ST PEORIA IL 616021308 20 1285322818 0 Physicians Anesthesia Services 20 1285322818 0 Physicians Fluoride varnish 20 1285322818 0 Physicians Healthy Kids Services 20 1285322818 0 Physicians Optical Supplies 20 1285322818 0 Physicians Physician Services 00 1285322883 0 KITE GRACE K 2023236 9999999 B 10 1285322883 0 7358 N LINCOLN AVE STE 170 LINCOLNWOOD IL 607121710 20 1285322883 0 Speech Therapists Medical Supplies 20 1285322883 0 Speech Therapists Medical equipment/prosthetic devices 20 1285322883 0 Speech Therapists Speech Therapy/Pathology Services 00 1285322891 0 NAIL NICOLE 2023159 9999999 B 10 1285322891 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1285322891 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1285323824 0 MATHEW DANICA 2023175 9999999 B 10 1285323824 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1285323824 0 Physicians Anesthesia Services 20 1285323824 0 Physicians Fluoride varnish 20 1285323824 0 Physicians Healthy Kids Services 20 1285323824 0 Physicians Optical Supplies 20 1285323824 0 Physicians Physician Services 00 1285324012 0 MADERA ESPERANCE M 2023191 9999999 B 10 1285324012 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1285324012 0 Physicians Anesthesia Services 20 1285324012 0 Physicians Fluoride varnish 20 1285324012 0 Physicians Healthy Kids Services 20 1285324012 0 Physicians Optical Supplies 20 1285324012 0 Physicians Physician Services 00 1285324632 0 HAN YUNAN 2023201 9999999 B 10 1285324632 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1285324632 0 Physicians Anesthesia Services 20 1285324632 0 Physicians Healthy Kids Services 20 1285324632 0 Physicians Optical Supplies 20 1285324632 0 Physicians Physician Services 00 1285324798 0 NGUYEN JIMMY 2023291 9999999 B 10 1285324798 0 2633 CHATHAM RD SPRINGFIELD IL 627044185 20 1285324798 0 Dentists Dental Services 20 1285324798 0 Dentists Physician Services 00 1285325266 0 STOUT AMY 2023242 9999999 B 10 1285325266 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1285325266 0 Registered nurse Nursing service 20 1285325266 0 Registered nurse Waiver service 00 1285325407 0 VALIANI HINA 2023166 9999999 B 10 1285325407 0 401 N MICHIGAN AVE STE 1200 CHICAGO IL 606114264 20 1285325407 0 Nurse Practitioners Healthy Kids Services 20 1285325407 0 Nurse Practitioners Nurse Practitioners Services 20 1285325407 0 Nurse Practitioners Physician Services 00 1285326025 0 KEEPES ASHLEY 2023324 9999999 B 10 1285326025 0 363 N WEST ST OLNEY IL 624501160 20 1285326025 0 Nurse Practitioners Healthy Kids Services 20 1285326025 0 Nurse Practitioners Nurse Practitioners Services 20 1285326025 0 Nurse Practitioners Physician Services 00 1285326777 0 PARK JUN HWAN 2023156 9999999 B 10 1285326777 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1285326777 0 Physicians Anesthesia Services 20 1285326777 0 Physicians Fluoride varnish 20 1285326777 0 Physicians Healthy Kids Services 20 1285326777 0 Physicians Optical Supplies 20 1285326777 0 Physicians Physician Services 00 1285330951 0 JACOBS EVE 2024256 9999999 B 10 1285330951 0 4251 FOREST PARK AVE SAINT LOUIS MO 631082810 20 1285330951 0 Nurse Practitioners Healthy Kids Services 20 1285330951 0 Nurse Practitioners Midwife Services 20 1285330951 0 Nurse Practitioners Nurse Practitioners Services 20 1285330951 0 Nurse Practitioners Physician Services 00 1285331058 0 REITZ NATALIE 2023123 9999999 B 10 1285331058 0 PO BOX 4028 ROCK ISLAND IL 612044028 20 1285331058 0 Nurse Practitioners Healthy Kids Services 20 1285331058 0 Nurse Practitioners Nurse Practitioners Services 20 1285331058 0 Nurse Practitioners Physician Services 00 1285331066 0 REBELSKY DAYLE 2024256 9999999 B 10 1285331066 0 151 N MAIN ST DECATUR IL 625231206 20 1285331066 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1285332072 0 RANDERSON BENJAMIN R 2024150 9999999 B 10 1285332072 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1285332072 0 Physician Assistant Only Fluoride varnish 20 1285332072 0 Physician Assistant Only Healthy Kids Services 20 1285332072 0 Physician Assistant Only Physician Services 00 1285334276 0 WILSON ETHAN 2024200 9999999 B 10 1285334276 0 3249 OAK PARK AVE BERWYN IL 604023429 20 1285334276 0 Physicians Anesthesia Services 20 1285334276 0 Physicians Fluoride varnish 20 1285334276 0 Physicians Healthy Kids Services 20 1285334276 0 Physicians Optical Supplies 20 1285334276 0 Physicians Physician Services 00 1285335406 0 VONDRAN AMARIA 2025050 9999999 B 10 1285335406 0 3621 MARION LN LAS CRUCES NM 880127579 20 1285335406 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1285336115 0 SHANA OLA 2023172 9999999 B 10 1285336115 0 4698 DEPT CAROL STREAM IL 601220021 20 1285336115 0 Physicians Anesthesia Services 20 1285336115 0 Physicians Healthy Kids Services 20 1285336115 0 Physicians Optical Supplies 20 1285336115 0 Physicians Physician Services 00 1285336891 0 DO MICHAEL T 2024183 9999999 B 10 1285336891 0 4698 DEPT CAROL STREAM IL 601220021 20 1285336891 0 Physicians Anesthesia Services 20 1285336891 0 Physicians Healthy Kids Services 20 1285336891 0 Physicians Optical Supplies 20 1285336891 0 Physicians Physician Services 00 1285337147 0 LI ROCKY K 2023187 9999999 B 10 1285337147 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1285337147 0 Physicians Anesthesia Services 20 1285337147 0 Physicians Fluoride varnish 20 1285337147 0 Physicians Healthy Kids Services 20 1285337147 0 Physicians Optical Supplies 20 1285337147 0 Physicians Physician Services 00 1285337816 0 ROBERTS CASSANDRA 2023192 9999999 B 10 1285337816 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1285337816 0 Physicians Anesthesia Services 20 1285337816 0 Physicians Fluoride varnish 20 1285337816 0 Physicians Healthy Kids Services 20 1285337816 0 Physicians Optical Supplies 20 1285337816 0 Physicians Physician Services 00 1285338012 0 ROA CHRISTIAN C 2023317 9999999 B 10 1285338012 0 PO BOX 3039 OAK BROOK IL 605223039 20 1285338012 0 Physicians Anesthesia Services 20 1285338012 0 Physicians Healthy Kids Services 20 1285338012 0 Physicians Optical Supplies 20 1285338012 0 Physicians Physician Services 00 1285338640 0 NDIKA ZELLE 2023286 9999999 B 10 1285338640 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1285338640 0 Physicians Anesthesia Services 20 1285338640 0 Physicians Healthy Kids Services 20 1285338640 0 Physicians Optical Supplies 20 1285338640 0 Physicians Physician Services 00 1285338707 0 ARONOWITZ ALEXANDRA 2024199 9999999 B 10 1285338707 0 3249 OAK PARK AVE BERWYN IL 604023429 20 1285338707 0 Physicians Anesthesia Services 20 1285338707 0 Physicians Healthy Kids Services 20 1285338707 0 Physicians Optical Supplies 20 1285338707 0 Physicians Physician Services 00 1285338830 0 DE BRITO B MONTEIRO JOANA 2024276 9999999 B 10 1285338830 0 4698 DEPT CAROL STREAM IL 601220021 20 1285338830 0 Physicians Anesthesia Services 20 1285338830 0 Physicians Healthy Kids Services 20 1285338830 0 Physicians Optical Supplies 20 1285338830 0 Physicians Physician Services 00 1285339390 0 KEBATO YUSUF HUSSEIN 2023207 9999999 B 10 1285339390 0 PO BOX 855671 MINNEAPOLIS MN 554851153 20 1285339390 0 Physicians Anesthesia Services 20 1285339390 0 Physicians Fluoride varnish 20 1285339390 0 Physicians Healthy Kids Services 20 1285339390 0 Physicians Optical Supplies 20 1285339390 0 Physicians Physician Services 00 1285339713 0 MCCARTNEY REBECCA 2024192 9999999 B 10 1285339713 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1285339713 0 Physicians Anesthesia Services 20 1285339713 0 Physicians Healthy Kids Services 20 1285339713 0 Physicians Optical Supplies 20 1285339713 0 Physicians Physician Services 20 1285339713 0 Physicians Physicians Psychiatric Services 00 1285339861 0 RAO MEGANA 2024192 9999999 B 10 1285339861 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1285339861 0 Physicians Anesthesia Services 20 1285339861 0 Physicians Healthy Kids Services 20 1285339861 0 Physicians Optical Supplies 20 1285339861 0 Physicians Physician Services 00 1285340984 0 PIOTROWSKI STEPHANIE 2023108 9999999 B 10 1285340984 0 29373 NETWORK PL CHICAGO IL 606733039 20 1285340984 0 Nurse Practitioners Fluoride varnish 20 1285340984 0 Nurse Practitioners Healthy Kids Services 20 1285340984 0 Nurse Practitioners Nurse Practitioners Services 20 1285340984 0 Nurse Practitioners Physician Services 00 1285342436 0 LUGBOSO SIMBIAT 2022313 9999999 B 10 1285342436 0 5220 EAST AVE COUNTRYSIDE IL 605253133 20 1285342436 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1285344358 0 ORDUNA SANTOS BRITTANY A 2022339 9999999 B 10 1285344358 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1285344358 0 Nurse Practitioners Healthy Kids Services 20 1285344358 0 Nurse Practitioners Nurse Practitioners Services 20 1285344358 0 Nurse Practitioners Physician Services 00 1285345462 0 BERTUCCI NIKOLAS 2024067 9999999 B 10 1285345462 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1285345462 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1285345660 0 MCWHIRTER WILLIAM SCOTT 2024176 9999999 B 10 1285345660 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1285345660 0 Nurse Practitioners Anesthesia Services 20 1285345660 0 Nurse Practitioners Nurse Practitioners Services 20 1285345660 0 Nurse Practitioners Physician Services 00 1285348136 0 CARUSO ANDREA 2023100 9999999 B 10 1285348136 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1285348136 0 Nurse Practitioners Healthy Kids Services 20 1285348136 0 Nurse Practitioners Nurse Practitioners Services 20 1285348136 0 Nurse Practitioners Physician Services 00 1285350348 0 JAMES KALI R 2023242 9999999 B 10 1285350348 0 4225 LINCOLNSHIRE DR STE B MOUNT VERNON IL 628642157 20 1285350348 0 Nurse Practitioners Fluoride varnish 20 1285350348 0 Nurse Practitioners Healthy Kids Services 20 1285350348 0 Nurse Practitioners Nurse Practitioners Services 20 1285350348 0 Nurse Practitioners Physician Services 00 1285350371 0 BRAZIL MICHELLE 2022299 9999999 B 10 1285350371 0 1414 MAIN ST MELROSE PARK IL 601603902 20 1285350371 0 Other behavior health professional LCPC/LMFT services 00 1285350892 0 BABIN DRAGANA 2024296 9999999 B 10 1285350892 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1285350892 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1285352096 0 LAJEUNESSE KAYLIE 2023151 9999999 B 10 1285352096 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1285352096 0 Nurse Practitioners Anesthesia Services 20 1285352096 0 Nurse Practitioners Nurse Practitioners Services 20 1285352096 0 Nurse Practitioners Physician Services 00 1285353086 0 SANCHEZ ANDREA 2022237 9999999 B 10 1285353086 0 70 S RIVER ST AURORA IL 605065185 20 1285353086 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1285354506 0 WITTING JAMIE 2022249 9999999 B 10 1285354506 0 PO BOX 775253 CHICAGO IL 606775253 20 1285354506 0 Nurse Practitioners Fluoride varnish 20 1285354506 0 Nurse Practitioners Healthy Kids Services 20 1285354506 0 Nurse Practitioners Nurse Practitioners Services 20 1285354506 0 Nurse Practitioners Physician Services 00 1285355354 0 PARKINSON CHELSEA 2023032 9999999 B 10 1285355354 0 PO BOX 748465 ATLANTA GA 303748465 20 1285355354 0 Other behavior health professional LCPC/LMFT services 00 1285359158 0 RILEY JESSICA R 2022313 9999999 B 10 1285359158 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1285359158 0 Nurse Practitioners Healthy Kids Services 20 1285359158 0 Nurse Practitioners Nurse Practitioners Services 20 1285359158 0 Nurse Practitioners Physician Services 00 1285360156 0 PARTAIN LAUREN 2022222 9999999 B 10 1285360156 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1285360156 0 Nurse Practitioners Fluoride varnish 20 1285360156 0 Nurse Practitioners Healthy Kids Services 20 1285360156 0 Nurse Practitioners Nurse Practitioners Services 20 1285360156 0 Nurse Practitioners Physician Services 00 1285361923 0 SMITH SABRINA 2024275 9999999 B 10 1285361923 0 3450 OAKTON 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Services 20 1285604926 0 Physicians Optical Supplies 20 1285604926 0 Physicians Physician Services 00 1285605402 0 HOLT DAVID R 1998213 9999999 B 10 1285605402 0 2800 W 95TH ST EVERGREEN PARK IL 608052701 20 1285605402 0 Physicians Anesthesia Services 20 1285605402 0 Physicians Healthy Kids Services 20 1285605402 0 Physicians Optical Supplies 20 1285605402 0 Physicians Physician Services 00 1285606590 0 NORTON OSCAR D 1999172 9999999 B 10 1285606590 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1285606590 0 Physicians Anesthesia Services 20 1285606590 0 Physicians Healthy Kids Services 20 1285606590 0 Physicians Optical Supplies 20 1285606590 0 Physicians Physician Services 00 1285606970 0 MARTIN LUCY 2002002 9999999 B 10 1285606970 0 4701 DEPT CAROL STREAM IL 601220021 20 1285606970 0 Nurse Practitioners All Kids application agent 20 1285606970 0 Nurse Practitioners Healthy Kids Services 20 1285606970 0 Nurse Practitioners Nurse Practitioners Services 20 1285606970 0 Nurse Practitioners Physician Services 00 1285607135 0 ALI MOHAMED A S 2005182 9999999 B 10 1285607135 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1285607135 0 Physicians Anesthesia Services 20 1285607135 0 Physicians Fluoride varnish 20 1285607135 0 Physicians Healthy Kids Services 20 1285607135 0 Physicians Optical Supplies 20 1285607135 0 Physicians Physician Services 00 1285607341 0 ISAKOW WARREN 2005125 9999999 B 10 1285607341 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1285607341 0 Physicians Anesthesia Services 20 1285607341 0 Physicians Fluoride varnish 20 1285607341 0 Physicians Healthy Kids Services 20 1285607341 0 Physicians Optical Supplies 20 1285607341 0 Physicians Physician Services 00 1285607986 0 FORTUNA RANDALL S 2002261 9999999 B 10 1285607986 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1285607986 0 Physicians Anesthesia Services 20 1285607986 0 Physicians Healthy Kids Services 20 1285607986 0 Physicians Optical Supplies 20 1285607986 0 Physicians Physician Services 00 1285608042 0 BIRD DAVID J 2001182 9999999 B 10 1285608042 0 5777 DEPT CAROL STREAM IL 601220021 20 1285608042 0 Physicians Anesthesia Services 20 1285608042 0 Physicians Healthy Kids Services 20 1285608042 0 Physicians Optical Supplies 20 1285608042 0 Physicians Physician Services 00 1285608158 0 DALLAL OUSAMA 2000153 9999999 B 10 1285608158 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1285608158 0 Physicians Anesthesia Services 20 1285608158 0 Physicians Fluoride varnish 20 1285608158 0 Physicians Healthy Kids Services 20 1285608158 0 Physicians Optical Supplies 20 1285608158 0 Physicians Physician Services 00 1285608315 0 SULO ROBERT M 1984184 9999999 B 10 1285608315 0 5777 DEPT CAROL STREAM IL 601228942 20 1285608315 0 Physicians Anesthesia Services 20 1285608315 0 Physicians Fluoride varnish 20 1285608315 0 Physicians Healthy Kids Services 20 1285608315 0 Physicians Optical Supplies 20 1285608315 0 Physicians Physician Services 00 1285608661 0 BRUCE TIMOTHY J. 2016230 9999999 B 10 1285608661 0 1 ILLINI DR PEORIA IL 616052576 20 1285608661 0 Psychologist Psychologist service 00 1285608976 0 KURIEN SHAUN 2011213 9999999 B 10 1285608976 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1285608976 0 Physicians Anesthesia Services 20 1285608976 0 Physicians Fluoride varnish 20 1285608976 0 Physicians Healthy Kids Services 20 1285608976 0 Physicians Optical Supplies 20 1285608976 0 Physicians Physician Services 00 1285609149 0 SCHULTZ PATRICIA 2013217 9999999 B 10 1285609149 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1285609149 0 Nurse Practitioners Healthy Kids Services 20 1285609149 0 Nurse Practitioners Nurse Practitioners Services 20 1285609149 0 Nurse Practitioners Physician Services 00 1285609321 0 VERMA AJAY 2004069 9999999 B 10 1285609321 0 2300 N EDWARD ST DECATUR IL 625264163 20 1285609321 0 Physicians Anesthesia Services 20 1285609321 0 Physicians Fluoride varnish 20 1285609321 0 Physicians 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1285612549 0 29373 NETWORK PL CHICAGO IL 606733039 20 1285612549 0 Physicians Anesthesia Services 20 1285612549 0 Physicians Fluoride varnish 20 1285612549 0 Physicians Healthy Kids Services 20 1285612549 0 Physicians Optical Supplies 20 1285612549 0 Physicians Physician Services 00 1285613059 0 WORELY JULIE 2016286 9999999 B 10 1285613059 0 127 S 1ST ST STE 205 GENEVA IL 601342644 20 1285613059 0 Nurse Practitioners Healthy Kids Services 20 1285613059 0 Nurse Practitioners Nurse Practitioners Services 20 1285613059 0 Nurse Practitioners Physician Services 00 1285613158 0 LANE RICHARD H 2001217 9999999 B 10 1285613158 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1285613158 0 Nurse Practitioners Anesthesia Services 20 1285613158 0 Nurse Practitioners Nurse Practitioners Services 20 1285613158 0 Nurse Practitioners Physician Services 00 1285613323 0 CONKLIN DONALD 2024158 9999999 B 10 1285613323 0 PO BOX 43230 PHOENIX AZ 850803230 20 1285613323 0 Physicians Anesthesia Services 20 1285613323 0 Physicians Fluoride varnish 20 1285613323 0 Physicians Healthy Kids Services 20 1285613323 0 Physicians Optical Supplies 20 1285613323 0 Physicians Physician Services 00 1285613463 0 BRATTAIN KEVIN 1983067 9999999 B 10 1285613463 0 124 SW ADAMS ST PEORIA IL 616021308 20 1285613463 0 Podiatrists Podiatric Services 00 1285613703 0 LELE PRITI S 1997091 9999999 B 10 1285613703 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1285613703 0 Physicians Anesthesia Services 20 1285613703 0 Physicians Healthy Kids Services 20 1285613703 0 Physicians Optical Supplies 20 1285613703 0 Physicians Physician Services 00 1285613901 0 REDDY SORAKAYALAPETA 1996214 9999999 B 10 1285613901 0 1518 MULBERRY AVE MUSCATINE IA 527613433 20 1285613901 0 Physicians Anesthesia Services 20 1285613901 0 Physicians Fluoride varnish 20 1285613901 0 Physicians Healthy Kids Services 20 1285613901 0 Physicians Optical Supplies 20 1285613901 0 Physicians Physician Services 00 1285614909 0 GARANT MARC 2022279 9999999 B 10 1285614909 0 1000 N ALLEN ST ROBINSON IL 624541114 20 1285614909 0 Physicians Anesthesia Services 20 1285614909 0 Physicians Healthy Kids Services 20 1285614909 0 Physicians Optical Supplies 20 1285614909 0 Physicians Physician Services 00 1285615609 0 SCHNITZER DAVID 1982296 9999999 B 10 1285615609 0 877 TIMBER HILL RD HIGHLAND PARK IL 600355150 20 1285615609 0 Dentists Dental Services 20 1285615609 0 Dentists Physician Services 00 1285615781 0 ROWELL SUSAN 2021061 9999999 B 10 1285615781 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1285615781 0 Physicians Anesthesia Services 20 1285615781 0 Physicians Healthy Kids Services 20 1285615781 0 Physicians Optical Supplies 20 1285615781 0 Physicians Physician Services 00 1285616193 0 BENSON AARON 2020073 9999999 B 10 1285616193 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1285616193 0 Physicians Anesthesia Services 20 1285616193 0 Physicians Healthy Kids Services 20 1285616193 0 Physicians Optical Supplies 20 1285616193 0 Physicians Physician Services 00 1285616300 0 MEREL NINA 2001182 9999999 B 10 1285616300 0 20 TOWER CT STE F SUITE F GURNEE IL 600315711 20 1285616300 0 Physicians Anesthesia Services 20 1285616300 0 Physicians Fluoride varnish 20 1285616300 0 Physicians Healthy Kids Services 20 1285616300 0 Physicians Optical Supplies 20 1285616300 0 Physicians Physician Services 00 1285616870 0 GOODWIN ANDREA 2023163 9999999 B 10 1285616870 0 317 6TH AVE STE 400 DES MOINES IA 503094108 20 1285616870 0 Physicians Anesthesia Services 20 1285616870 0 Physicians Fluoride varnish 20 1285616870 0 Physicians Healthy Kids Services 20 1285616870 0 Physicians Optical Supplies 20 1285616870 0 Physicians Physician Services 00 1285617456 0 MINER MICHELLE 2002182 9999999 B 10 1285617456 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1285617456 0 Physicians Anesthesia Services 20 1285617456 0 Physicians Fluoride varnish 20 1285617456 0 Physicians Healthy Kids Services 20 1285617456 0 Physicians Optical Supplies 20 1285617456 0 Physicians Physician Services 00 1285617803 0 ALAKHRAS MAZEN 2018071 9999999 B 10 1285617803 0 PO BOX 781076 DETROIT MI 482781076 20 1285617803 0 Physicians Anesthesia Services 20 1285617803 0 Physicians Fluoride varnish 20 1285617803 0 Physicians Healthy Kids Services 20 1285617803 0 Physicians Optical Supplies 20 1285617803 0 Physicians Physician Services 00 1285618280 0 COOPER AMY 2020265 9999999 B 10 1285618280 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1285618280 0 Physicians Anesthesia Services 20 1285618280 0 Physicians Fluoride varnish 20 1285618280 0 Physicians Healthy Kids Services 20 1285618280 0 Physicians Optical Supplies 20 1285618280 0 Physicians Physician Services 00 1285619056 0 NAHHAS TONY 1996061 9999999 B 10 1285619056 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1285619056 0 Physicians Anesthesia Services 20 1285619056 0 Physicians Fluoride varnish 20 1285619056 0 Physicians Healthy Kids Services 20 1285619056 0 Physicians Optical Supplies 20 1285619056 0 Physicians Physician Services 00 1285619726 0 LESTRUD STEVEN 1995182 9999999 B 10 1285619726 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1285619726 0 Physicians Anesthesia Services 20 1285619726 0 Physicians Fluoride varnish 20 1285619726 0 Physicians Healthy Kids Services 20 1285619726 0 Physicians Optical Supplies 20 1285619726 0 Physicians Physician Services 00 1285620484 0 KASKEL LARRY 1991182 9999999 B 10 1285620484 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1285620484 0 Physicians Anesthesia Services 20 1285620484 0 Physicians Fluoride varnish 20 1285620484 0 Physicians Healthy Kids Services 20 1285620484 0 Physicians Optical Supplies 20 1285620484 0 Physicians Physician Services 00 1285620492 0 HAIN TIMOTHY C 1990244 9999999 B 10 1285620492 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1285620492 0 Physicians Anesthesia Services 20 1285620492 0 Physicians Healthy Kids Services 20 1285620492 0 Physicians Optical Supplies 20 1285620492 0 Physicians Physician Services 20 1285620492 0 Physicians Physicians Psychiatric Services 00 1285620583 0 TANSEY MICHAEL J 2001100 9999999 B 10 1285620583 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1285620583 0 Physicians Anesthesia Services 20 1285620583 0 Physicians Fluoride varnish 20 1285620583 0 Physicians Healthy Kids Services 20 1285620583 0 Physicians Optical Supplies 20 1285620583 0 Physicians Physician Services 00 1285620617 0 SMITH MICHAEL C 1987213 9999999 B 10 1285620617 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1285620617 0 Physicians Anesthesia Services 20 1285620617 0 Physicians Healthy Kids Services 20 1285620617 0 Physicians Optical Supplies 20 1285620617 0 Physicians Physician Services 20 1285620617 0 Physicians Physicians Psychiatric Services 00 1285620815 0 MILLER DELWYN D 1991170 9999999 B 10 1285620815 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1285620815 0 Physicians Anesthesia Services 20 1285620815 0 Physicians Healthy Kids Services 20 1285620815 0 Physicians Optical Supplies 20 1285620815 0 Physicians Physician Services 20 1285620815 0 Physicians Physicians Psychiatric Services 00 1285620856 0 CASTELLS GRACE 1997060 9999999 B 10 1285620856 0 3241 S MICHIGAN AVE CHICAGO IL 606164201 20 1285620856 0 Optometrists Optical Supplies 20 1285620856 0 Optometrists Optometric Services 20 1285620856 0 Optometrists Physician Services 00 1285620898 0 HEALD LYNN 2005094 9999999 B 10 1285620898 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1285620898 0 Nurse Practitioners Healthy Kids Services 20 1285620898 0 Nurse Practitioners Nurse Practitioners Services 20 1285620898 0 Nurse Practitioners Physician Services 00 1285621151 0 BLAKEY BRADLEY 2002274 9999999 B 10 1285621151 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1285621151 0 Nurse Practitioners Anesthesia Services 20 1285621151 0 Nurse Practitioners Nurse Practitioners Services 20 1285621151 0 Nurse 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Anesthesia Services 20 1285621805 0 Physicians Healthy Kids Services 20 1285621805 0 Physicians Optical Supplies 20 1285621805 0 Physicians Physician Services 00 1285622340 0 DORAN EDWARD 1985115 9999999 B 10 1285622340 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1285622340 0 Physicians Anesthesia Services 20 1285622340 0 Physicians Fluoride varnish 20 1285622340 0 Physicians Healthy Kids Services 20 1285622340 0 Physicians Optical Supplies 20 1285622340 0 Physicians Physician Services 00 1285622621 0 BARIDI REFAT 1994093 9999999 B 10 1285622621 0 P O BOX 771858 CHICAGO IL 606770001 20 1285622621 0 Physicians Anesthesia Services 20 1285622621 0 Physicians Fluoride varnish 20 1285622621 0 Physicians Healthy Kids Services 20 1285622621 0 Physicians Optical Supplies 20 1285622621 0 Physicians Physician Services 00 1285622878 0 AREKAPUDI VIJAYALAKSHMI 1981227 9999999 B 10 1285622878 0 1044 N FRANCISCO AVE CHICAGO IL 606222743 20 1285622878 0 Physicians Anesthesia Services 20 1285622878 0 Physicians Fluoride varnish 20 1285622878 0 Physicians Healthy Kids Services 20 1285622878 0 Physicians Optical Supplies 20 1285622878 0 Physicians Physician Services 00 1285623470 0 KIM MAX 1992001 9999999 B 10 1285623470 0 8501 S CICERO AVE CHICAGO IL 606523504 20 1285623470 0 Dentists Dental Services 20 1285623470 0 Dentists Physician Services 00 1285623728 0 ST PIERRE-MACKOUL ANNETTE 2024289 9999999 B 10 1285623728 0 PO BOX 43230 PHOENIX AZ 850803230 20 1285623728 0 Physicians Anesthesia Services 20 1285623728 0 Physicians Fluoride varnish 20 1285623728 0 Physicians Healthy Kids Services 20 1285623728 0 Physicians Optical Supplies 20 1285623728 0 Physicians Physician Services 00 1285623785 0 PATRA KOUSIKI 2006244 9999999 B 10 1285623785 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1285623785 0 Physicians Anesthesia Services 20 1285623785 0 Physicians Fluoride varnish 20 1285623785 0 Physicians Healthy Kids Services 20 1285623785 0 Physicians Optical Supplies 20 1285623785 0 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522421009 20 1285626655 0 Physician Assistant Only Fluoride varnish 20 1285626655 0 Physician Assistant Only Healthy Kids Services 20 1285626655 0 Physician Assistant Only Physician Services 00 1285626747 0 WILLMS DAVID 1992001 9999999 B 10 1285626747 0 12230 WORLD TRADE DR STE 250 SAN DIEGO CA 921283799 20 1285626747 0 Physicians Anesthesia Services 20 1285626747 0 Physicians Fluoride varnish 20 1285626747 0 Physicians Healthy Kids Services 20 1285626747 0 Physicians Optical Supplies 20 1285626747 0 Physicians Physician Services 00 1285627166 0 ABI MANSOUR PIERROT 1986121 9999999 B 10 1285627166 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1285627166 0 Physicians Anesthesia Services 20 1285627166 0 Physicians Fluoride varnish 20 1285627166 0 Physicians Healthy Kids Services 20 1285627166 0 Physicians Optical Supplies 20 1285627166 0 Physicians Physician Services 00 1285627331 0 RADEL STEVEN M 2015324 9999999 B 10 1285627331 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 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1285628875 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1285628875 0 Physicians Anesthesia Services 20 1285628875 0 Physicians Fluoride varnish 20 1285628875 0 Physicians Healthy Kids Services 20 1285628875 0 Physicians Optical Supplies 20 1285628875 0 Physicians Physician Services 00 1285628982 0 JAFFE CHARLES E 2003182 9999999 B 10 1285628982 0 1870 W WINCHESTER RD STE 241 LIBERTYVILLE IL 600485360 20 1285628982 0 Physicians Anesthesia Services 20 1285628982 0 Physicians Fluoride varnish 20 1285628982 0 Physicians Healthy Kids Services 20 1285628982 0 Physicians Optical Supplies 20 1285628982 0 Physicians Physician Services 00 1285629063 0 WEINER MARTIN J 1989258 9999999 B 10 1285629063 0 3 S GREENLEAF ST STE A GURNEE IL 600313377 20 1285629063 0 Physicians Anesthesia Services 20 1285629063 0 Physicians Healthy Kids Services 20 1285629063 0 Physicians Optical Supplies 20 1285629063 0 Physicians Physician Services 00 1285629212 0 HSIEH JOWE Y 1981258 9999999 B 10 1285629212 0 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EDGEMERE CT ROSCOE IL 610738800 20 1285632620 0 Chiropractors Chiropractic Services 00 1285633420 0 NEWCOMER JOSEPH K 1998213 9999999 B 10 1285633420 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1285633420 0 Physicians Anesthesia Services 20 1285633420 0 Physicians Healthy Kids Services 20 1285633420 0 Physicians Optical Supplies 20 1285633420 0 Physicians Physician Services 00 1285633693 0 THOMAS TINA R 1997055 9999999 B 10 1285633693 0 8921 N WOOD SAGE RD PEORIA IL 616157822 20 1285633693 0 Optometrists Optical Supplies 20 1285633693 0 Optometrists Optometric Services 20 1285633693 0 Optometrists Physician Services 00 1285635367 0 DOWNER GREGORY 2022245 9999999 B 10 1285635367 0 PO BOX 486 SAN JACINTO CA 925810486 20 1285635367 0 Physicians Anesthesia Services 20 1285635367 0 Physicians Fluoride varnish 20 1285635367 0 Physicians Healthy Kids Services 20 1285635367 0 Physicians Optical Supplies 20 1285635367 0 Physicians Physician Services 00 1285635466 0 AHMADIAN JENNIFER 2003213 9999999 B 10 1285635466 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1285635466 0 Physicians Anesthesia Services 20 1285635466 0 Physicians Healthy Kids Services 20 1285635466 0 Physicians Optical Supplies 20 1285635466 0 Physicians Physician Services 20 1285635466 0 Physicians Physicians Psychiatric Services 00 1285635987 0 PORT JEFFREY 1982182 9999999 B 10 1285635987 0 1880 W WINCHESTER RD STE 104 LIBERTYVILLE IL 600485321 20 1285635987 0 Physicians Anesthesia Services 20 1285635987 0 Physicians Fluoride varnish 20 1285635987 0 Physicians Healthy Kids Services 20 1285635987 0 Physicians Optical Supplies 20 1285635987 0 Physicians Physician Services 00 1285635995 0 FONTANILLA RENATO 1998152 9999999 B 10 1285635995 0 PO BOX 5588 BELFAST ME 049155500 20 1285635995 0 Physicians Anesthesia Services 20 1285635995 0 Physicians Fluoride varnish 20 1285635995 0 Physicians Healthy Kids Services 20 1285635995 0 Physicians Optical Supplies 20 1285635995 0 Physicians Physician Services 20 1285635995 0 Physicians Physicians Psychiatric Services 00 1285636621 0 ALMANASEER IMAD 1993152 9999999 B 10 1285636621 0 PO BOX 578 PARK RIDGE IL 600680578 20 1285636621 0 Physicians Anesthesia Services 20 1285636621 0 Physicians Healthy Kids Services 20 1285636621 0 Physicians Optical Supplies 20 1285636621 0 Physicians Physician Services 00 1285637181 0 GREEN DANIEL 1992067 9999999 B 10 1285637181 0 48 S GREENLEAF ST GURNEE IL 600313300 20 1285637181 0 Physicians Anesthesia Services 20 1285637181 0 Physicians Healthy Kids Services 20 1285637181 0 Physicians Optical Supplies 20 1285637181 0 Physicians Physician Services 00 1285637298 0 KHAIRA DIVIS K 2023128 9999999 B 10 1285637298 0 621 S ILLINOIS AVE STE 103 MASON CITY IA 504015489 20 1285637298 0 Physicians Anesthesia Services 20 1285637298 0 Physicians Fluoride varnish 20 1285637298 0 Physicians Healthy Kids Services 20 1285637298 0 Physicians Optical Supplies 20 1285637298 0 Physicians Physician Services 00 1285637462 0 ELBAHLAWAN LAMA MA 2004092 9999999 B 10 1285637462 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1285637462 0 Physicians Anesthesia Services 20 1285637462 0 Physicians Fluoride varnish 20 1285637462 0 Physicians Healthy Kids Services 20 1285637462 0 Physicians Optical Supplies 20 1285637462 0 Physicians Physician Services 00 1285637801 0 SCHWARTZ PETERSON CHRISTINE 1994199 9999999 B 10 1285637801 0 PO BOX 17633 BELFAST ME 049154071 20 1285637801 0 Physicians Anesthesia Services 20 1285637801 0 Physicians Fluoride varnish 20 1285637801 0 Physicians Healthy Kids Services 20 1285637801 0 Physicians Optical Supplies 20 1285637801 0 Physicians Physician Services 00 1285638759 0 CURTIN JEFFREY 1994182 9999999 B 10 1285638759 0 901 MCCLINTOCK DR STE 202 SUITE 202 BURR RIDGE IL 605270872 20 1285638759 0 Physicians Anesthesia Services 20 1285638759 0 Physicians Healthy Kids Services 20 1285638759 0 Physicians Optical Supplies 20 1285638759 0 Physicians Physician Services 20 1285638759 0 Physicians Physicians Psychiatric Services 00 1285639237 0 WILLIAMS JASON R 2007244 9999999 B 10 1285639237 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1285639237 0 Nurse Practitioners Anesthesia Services 20 1285639237 0 Nurse Practitioners Nurse Practitioners Services 20 1285639237 0 Nurse Practitioners Physician Services 00 1285639559 0 KUMAR PRASANNA C 1981258 9999999 B 10 1285639559 0 3165 MYRTLE AVE GRANITE CITY IL 620405012 20 1285639559 0 Physicians Anesthesia Services 20 1285639559 0 Physicians Healthy Kids Services 20 1285639559 0 Physicians Optical Supplies 20 1285639559 0 Physicians Physician Services 00 1285640276 0 JOHNSON MICHAEL R 1994335 9999999 B 10 1285640276 0 6300 RIDGLEA PL STE 201 SUITE 201 FORT WORTH TX 761165707 20 1285640276 0 Physicians Anesthesia Services 20 1285640276 0 Physicians Healthy Kids Services 20 1285640276 0 Physicians Optical Supplies 20 1285640276 0 Physicians Physician Services 00 1285640458 0 HAHN EUGENIA L 2006274 9999999 B 10 1285640458 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1285640458 0 Physicians Anesthesia Services 20 1285640458 0 Physicians Fluoride varnish 20 1285640458 0 Physicians Healthy Kids Services 20 1285640458 0 Physicians Optical Supplies 20 1285640458 0 Physicians Physician Services 00 1285641530 0 ROGERS JARED C 1992202 9999999 B 10 1285641530 0 1003 MARTIN LUTHER KING DR BLOOMINGTON IL 617011429 20 1285641530 0 Physicians Anesthesia Services 20 1285641530 0 Physicians Fluoride varnish 20 1285641530 0 Physicians Healthy Kids Services 20 1285641530 0 Physicians Optical Supplies 20 1285641530 0 Physicians Physician Services 00 1285641571 0 SUFIT ROBERT L 1982182 9999999 B 10 1285641571 0 5777 DEPT CAROL STREAM IL 601220021 20 1285641571 0 Physicians Anesthesia Services 20 1285641571 0 Physicians Healthy Kids Services 20 1285641571 0 Physicians Optical Supplies 20 1285641571 0 Physicians Physician Services 20 1285641571 0 Physicians Physicians Psychiatric Services 00 1285642157 0 PURVIS DENISE 2017032 9999999 B 10 1285642157 0 5301 E STATE ST STE 202 ROCKFORD IL 611082392 20 1285642157 0 Other behavior health professional LCPC/LMFT services 00 1285642389 0 WARDZALA THOMAS J 2009278 9999999 B 10 1285642389 0 1219 W LAKEVIEW CT ROMEOVILLE IL 604466501 20 1285642389 0 Audiologists Audiology Services 20 1285642389 0 Audiologists Medical Supplies 20 1285642389 0 Audiologists Medical equipment/prosthetic devices 00 1285642439 0 PAUL SATNAM 2003274 9999999 B 10 1285642439 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1285642439 0 Physicians Anesthesia Services 20 1285642439 0 Physicians Healthy Kids Services 20 1285642439 0 Physicians Optical Supplies 20 1285642439 0 Physicians Physician Services 00 1285643163 0 SHANAWANI HASAN 2010060 9999999 B 10 1285643163 0 5410 MARYLAND WAY STE 300 BRENTWOOD TN 370275339 20 1285643163 0 Physicians Anesthesia Services 20 1285643163 0 Physicians Fluoride varnish 20 1285643163 0 Physicians Healthy Kids Services 20 1285643163 0 Physicians Optical Supplies 20 1285643163 0 Physicians Physician Services 00 1285643825 0 BOCK JAMES M 1990182 9999999 B 10 1285643825 0 2329 N DIRKSEN PKWY SPRINGFIELD IL 627021403 20 1285643825 0 Physicians Anesthesia Services 20 1285643825 0 Physicians Family Planning Counseling 20 1285643825 0 Physicians Fluoride varnish 20 1285643825 0 Physicians Healthy Kids Services 20 1285643825 0 Physicians Optical Supplies 20 1285643825 0 Physicians Physician Services 00 1285644393 0 KUCHINSKI MATTHEW S 2018001 9999999 B 10 1285644393 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1285644393 0 Physicians Anesthesia Services 20 1285644393 0 Physicians Healthy Kids Services 20 1285644393 0 Physicians Optical Supplies 20 1285644393 0 Physicians Physician Services 00 1285644740 0 HUMPHREY DEBORAH 2021189 9999999 B 10 1285644740 0 1232 W STATE ROAD 2 LA PORTE IN 463505469 20 1285644740 0 Physicians Anesthesia Services 20 1285644740 0 Physicians Fluoride varnish 20 1285644740 0 Physicians Healthy Kids Services 20 1285644740 0 Physicians Optical Supplies 20 1285644740 0 Physicians Physician Services 00 1285645549 0 BLAIR MICHAEL 2004188 9999999 B 10 1285645549 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1285645549 0 Physicians Anesthesia Services 20 1285645549 0 Physicians Healthy Kids Services 20 1285645549 0 Physicians Optical Supplies 20 1285645549 0 Physicians Physician Services 00 1285645804 0 DAMORE STEVEN 2016004 9999999 B 10 1285645804 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1285645804 0 Physicians Anesthesia Services 20 1285645804 0 Physicians Healthy Kids Services 20 1285645804 0 Physicians Optical Supplies 20 1285645804 0 Physicians Physician Services 00 1285646448 0 SIDRANSKY SHON 2023339 9999999 B 10 1285646448 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1285646448 0 Physicians Anesthesia Services 20 1285646448 0 Physicians Healthy Kids Services 20 1285646448 0 Physicians Optical Supplies 20 1285646448 0 Physicians Physician Services 00 1285646638 0 HUTCHINSON MARK 1993244 9999999 B 10 1285646638 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1285646638 0 Physicians Anesthesia Services 20 1285646638 0 Physicians Healthy Kids Services 20 1285646638 0 Physicians Optical Supplies 20 1285646638 0 Physicians Physician Services 00 1285646828 0 ZAKKAR MOHAMED 1996275 9999999 B 10 1285646828 0 6081 KELLER DR BURR RIDGE IL 605278124 20 1285646828 0 Physicians Anesthesia Services 20 1285646828 0 Physicians Fluoride varnish 20 1285646828 0 Physicians Healthy Kids Services 20 1285646828 0 Physicians Optical Supplies 20 1285646828 0 Physicians Physician Services 00 1285647065 0 GREER SOLOMON 1981227 9999999 B 10 1285647065 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1285647065 0 Physicians Anesthesia Services 20 1285647065 0 Physicians Healthy Kids Services 20 1285647065 0 Physicians Optical Supplies 20 1285647065 0 Physicians Physician Services 00 1285647115 0 GORSE GEOFFREY 1989182 9999999 B 10 1285647115 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1285647115 0 Physicians Anesthesia Services 20 1285647115 0 Physicians Fluoride varnish 20 1285647115 0 Physicians Healthy Kids Services 20 1285647115 0 Physicians Optical Supplies 20 1285647115 0 Physicians Physician Services 00 1285647313 0 COOPER HEATHER 2022117 9999999 B 10 1285647313 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1285647313 0 Nurse Practitioners Anesthesia Services 20 1285647313 0 Nurse Practitioners Nurse Practitioners Services 20 1285647313 0 Nurse Practitioners Physician Services 00 1285649012 0 OKAFOR LAWRENCE A 1990213 9999999 B 10 1285649012 0 29373 NETWORK PL CHICAGO IL 606733039 20 1285649012 0 Physicians Anesthesia Services 20 1285649012 0 Physicians Fluoride varnish 20 1285649012 0 Physicians Healthy Kids Services 20 1285649012 0 Physicians Optical Supplies 20 1285649012 0 Physicians Physician Services 00 1285649871 0 SIECZKOWSKI LISA 2021155 9999999 B 10 1285649871 0 PO BOX 43230 PHOENIX AZ 850803230 20 1285649871 0 Physicians Anesthesia Services 20 1285649871 0 Physicians Fluoride varnish 20 1285649871 0 Physicians Healthy Kids Services 20 1285649871 0 Physicians Optical Supplies 20 1285649871 0 Physicians Physician Services 00 1285650416 0 GILLEN DANIEL P. 1993182 9999999 B 10 1285650416 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1285650416 0 Physicians Anesthesia Services 20 1285650416 0 Physicians Healthy Kids Services 20 1285650416 0 Physicians Optical Supplies 20 1285650416 0 Physicians Physician Services 00 1285650507 0 ROTHSTEIN MARCOS 1986182 9999999 B 10 1285650507 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1285650507 0 Physicians Anesthesia Services 20 1285650507 0 Physicians Fluoride varnish 20 1285650507 0 Physicians Healthy Kids Services 20 1285650507 0 Physicians Optical Supplies 20 1285650507 0 Physicians Physician Services 00 1285650804 0 SAUNDERS MARY 2007214 9999999 B 10 1285650804 0 PO BOX 110429 AURORA CO 800420429 20 1285650804 0 Physicians Anesthesia Services 20 1285650804 0 Physicians Fluoride varnish 20 1285650804 0 Physicians Healthy Kids Services 20 1285650804 0 Physicians Optical Supplies 20 1285650804 0 Physicians Physician Services 00 1285651869 0 BUITEWEG JOHANNES J 2018182 9999999 B 10 1285651869 0 PO BOX 208807 DALLAS TX 753208807 20 1285651869 0 Physicians Anesthesia Services 20 1285651869 0 Physicians Healthy Kids Services 20 1285651869 0 Physicians Optical Supplies 20 1285651869 0 Physicians Physician Services 00 1285652099 0 STEPHAN STARK CHRISTINA L 2004019 9999999 B 10 1285652099 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1285652099 0 Nurse Practitioners Fluoride varnish 20 1285652099 0 Nurse Practitioners Healthy Kids Services 20 1285652099 0 Nurse Practitioners Nurse Practitioners Services 20 1285652099 0 Nurse Practitioners Physician Services 00 1285652636 0 MONTALBANO CATHERINE M 1998121 9999999 B 10 1285652636 0 44000 GARFIELD RD CLINTON TOWNSHI MI 480381125 20 1285652636 0 Physicians Anesthesia Services 20 1285652636 0 Physicians Fluoride varnish 20 1285652636 0 Physicians Healthy Kids Services 20 1285652636 0 Physicians Optical Supplies 20 1285652636 0 Physicians Physician Services 00 1285652743 0 MANARY MARK J. 2025141 9999999 B 10 1285652743 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1285652743 0 Physicians Anesthesia Services 20 1285652743 0 Physicians Fluoride varnish 20 1285652743 0 Physicians Healthy Kids Services 20 1285652743 0 Physicians Optical Supplies 20 1285652743 0 Physicians Physician Services 00 1285652792 0 THOMPSON ROBERT 1992183 9999999 B 10 1285652792 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1285652792 0 Physicians Anesthesia Services 20 1285652792 0 Physicians Healthy Kids Services 20 1285652792 0 Physicians Optical Supplies 20 1285652792 0 Physicians Physician Services 00 1285653717 0 BAILEY CHRISTOPHER 2004214 9999999 B 10 1285653717 0 13520 S ROUTE 59 STE 104 PLAINFIELD IL 605445546 20 1285653717 0 Podiatrists Podiatric Services 00 1285654889 0 RIEDL MARC A 2021299 9999999 B 10 1285654889 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1285654889 0 Physicians Anesthesia Services 20 1285654889 0 Physicians Healthy Kids Services 20 1285654889 0 Physicians Optical Supplies 20 1285654889 0 Physicians Physician Services 00 1285655662 0 WILSON CHRISTOPHER C 2002182 9999999 B 10 1285655662 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1285655662 0 Physicians Anesthesia Services 20 1285655662 0 Physicians Fluoride varnish 20 1285655662 0 Physicians Healthy Kids Services 20 1285655662 0 Physicians Optical Supplies 20 1285655662 0 Physicians Physician Services 00 1285656231 0 PODRAZA ADAMINA 1992055 9999999 B 10 1285656231 0 PO BOX 486 LAKE FOREST IL 600450486 20 1285656231 0 Physicians Anesthesia Services 20 1285656231 0 Physicians Healthy Kids Services 20 1285656231 0 Physicians Optical Supplies 20 1285656231 0 Physicians Physician Services 00 1285656512 0 MARCH KEITH W 2018308 9999999 B 10 1285656512 0 PO BOX 781076 DETROIT MI 482781076 20 1285656512 0 Physicians Anesthesia Services 20 1285656512 0 Physicians Fluoride varnish 20 1285656512 0 Physicians Healthy Kids Services 20 1285656512 0 Physicians Optical Supplies 20 1285656512 0 Physicians Physician Services 00 1285657684 0 VOLLMER LARA E 2007050 9999999 B 10 1285657684 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1285657684 0 Nurse Practitioners Fluoride varnish 20 1285657684 0 Nurse Practitioners Healthy Kids Services 20 1285657684 0 Nurse Practitioners Nurse Practitioners Services 20 1285657684 0 Nurse Practitioners Physician Services 00 1285659243 0 MCKENZIE MARK 2020305 9999999 B 10 1285659243 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1285659243 0 Physicians Anesthesia Services 20 1285659243 0 Physicians Fluoride varnish 20 1285659243 0 Physicians Healthy Kids Services 20 1285659243 0 Physicians Optical Supplies 20 1285659243 0 Physicians Physician Services 00 1285659771 0 BLOCK JOEL 1985164 9999999 B 10 1285659771 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1285659771 0 Physicians Anesthesia Services 20 1285659771 0 Physicians Fluoride varnish 20 1285659771 0 Physicians Healthy Kids Services 20 1285659771 0 Physicians Optical Supplies 20 1285659771 0 Physicians Physician Services 00 1285660175 0 LEE JULIANE 2005182 9999999 B 10 1285660175 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1285660175 0 Physicians Anesthesia Services 20 1285660175 0 Physicians Healthy Kids Services 20 1285660175 0 Physicians Optical Supplies 20 1285660175 0 Physicians Physician Services 00 1285660399 0 PAWLOWSKI THOMAS A 1999193 9999999 B 10 1285660399 0 150 HARVESTER DRIVE SUITE 300 BURR RIDGE IL 605275965 20 1285660399 0 Physicians Anesthesia Services 20 1285660399 0 Physicians Healthy Kids Services 20 1285660399 0 Physicians Optical Supplies 20 1285660399 0 Physicians Physician Services 00 1285660548 0 SWITZER KEVIN 2024108 9999999 B 10 1285660548 0 1406 6TH AVE N SAINT CLOUD MN 563031900 20 1285660548 0 Physicians Anesthesia Services 20 1285660548 0 Physicians Fluoride varnish 20 1285660548 0 Physicians Healthy Kids Services 20 1285660548 0 Physicians Optical Supplies 20 1285660548 0 Physicians Physician Services 00 1285660928 0 RAPATZ HARR STEPHEN 2020363 9999999 B 10 1285660928 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1285660928 0 Physician Assistant Only Fluoride varnish 20 1285660928 0 Physician Assistant Only Healthy Kids Services 20 1285660928 0 Physician Assistant Only Physician Services 00 1285662304 0 ROTSKOFF BRIAN 2001182 9999999 B 10 1285662304 0 4801 W PETERSON AVE STE 306 STE 306 CHICAGO IL 606465726 20 1285662304 0 Physicians Anesthesia Services 20 1285662304 0 Physicians Healthy Kids Services 20 1285662304 0 Physicians Optical Supplies 20 1285662304 0 Physicians Physician Services 00 1285662726 0 TAMBUNAN DANIEL 2024200 9999999 B 10 1285662726 0 PO BOX 43230 PHOENIX AZ 850803230 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Fluoride varnish 20 1285665596 0 Physicians Healthy Kids Services 20 1285665596 0 Physicians Optical Supplies 20 1285665596 0 Physicians Physician Services 00 1285665661 0 SHAFFER TROY 1996183 9999999 B 10 1285665661 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1285665661 0 Physicians All Kids application agent 20 1285665661 0 Physicians Anesthesia Services 20 1285665661 0 Physicians Healthy Kids Services 20 1285665661 0 Physicians Optical Supplies 20 1285665661 0 Physicians Physician Services 00 1285665729 0 SIMON ANDREW D 2004183 9999999 B 10 1285665729 0 29373 NETWORK PL CHICAGO IL 606733039 20 1285665729 0 Physicians Anesthesia Services 20 1285665729 0 Physicians Healthy Kids Services 20 1285665729 0 Physicians Optical Supplies 20 1285665729 0 Physicians Physician Services 00 1285668525 0 RUFFIN CRYSTAL D 2005244 9999999 B 10 1285668525 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1285668525 0 Physicians Anesthesia Services 20 1285668525 0 Physicians Healthy Kids 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varnish 20 1285670232 0 Physicians Healthy Kids Services 20 1285670232 0 Physicians Optical Supplies 20 1285670232 0 Physicians Physician Services 00 1285670273 0 CARLON MICHELE F 1995182 9999999 B 10 1285670273 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1285670273 0 Physicians Anesthesia Services 20 1285670273 0 Physicians Fluoride varnish 20 1285670273 0 Physicians Healthy Kids Services 20 1285670273 0 Physicians Optical Supplies 20 1285670273 0 Physicians Physician Services 00 1285670596 0 LAW DAVID 2012153 9999999 B 10 1285670596 0 1701 LACEY ST CAPE GIRARDEAU MO 637015230 20 1285670596 0 Physicians Anesthesia Services 20 1285670596 0 Physicians Fluoride varnish 20 1285670596 0 Physicians Healthy Kids Services 20 1285670596 0 Physicians Optical Supplies 20 1285670596 0 Physicians Physician Services 00 1285671917 0 WOODARD ERIC 2003001 9999999 B 10 1285671917 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1285671917 0 Physical Therapists Medical Supplies 20 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1285855403 0 Physicians Anesthesia Services 20 1285855403 0 Physicians Healthy Kids Services 20 1285855403 0 Physicians Optical Supplies 20 1285855403 0 Physicians Physician Services 00 1285856039 0 NEILL JULIE E 2015301 9999999 B 10 1285856039 0 2914 BLUE HERON RD NORMAL IL 617619545 20 1285856039 0 Occupational Therapists Medical Supplies 20 1285856039 0 Occupational Therapists Medical equipment/prosthetic devices 20 1285856039 0 Occupational Therapists Occupational Therapy Services 00 1285856278 0 BAIRSETTY ADARSH 2009261 9999999 B 10 1285856278 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1285856278 0 Physicians Anesthesia Services 20 1285856278 0 Physicians Fluoride varnish 20 1285856278 0 Physicians Healthy Kids Services 20 1285856278 0 Physicians Optical Supplies 20 1285856278 0 Physicians Physician Services 00 1285859132 0 SCHIFANO ANJA 2015351 9999999 B 10 1285859132 0 3230 VETERANS MEMORIAL DR MOUNT VERNON IL 628645950 20 1285859132 0 Nurse Practitioners Healthy Kids Services 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1285863860 0 Physicians Healthy Kids Services 20 1285863860 0 Physicians Optical Supplies 20 1285863860 0 Physicians Physician Services 00 1285864256 0 CREAN MARY B 2009244 9999999 B 10 1285864256 0 12251 S 80TH AVE STE 1630 PALOS HEIGHTS IL 604631256 20 1285864256 0 Nurse Practitioners Healthy Kids Services 20 1285864256 0 Nurse Practitioners Nurse Practitioners Services 20 1285864256 0 Nurse Practitioners Physician Services 00 1285865204 0 LERNER ANDRES 2019152 9999999 B 10 1285865204 0 3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047452 20 1285865204 0 Physicians Anesthesia Services 20 1285865204 0 Physicians Healthy Kids Services 20 1285865204 0 Physicians Optical Supplies 20 1285865204 0 Physicians Physician Services 00 1285865527 0 SHAKHSHEER BADDR A 2019244 9999999 B 10 1285865527 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1285865527 0 Physicians Anesthesia Services 20 1285865527 0 Physicians Healthy Kids Services 20 1285865527 0 Physicians Optical Supplies 20 1285865527 0 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Practitioners Physician Services 00 1285879494 0 NANNEGARI VEENA H 2014230 9999999 B 10 1285879494 0 7447 W TALCOTT AVE STE 209 CHICAGO IL 606313713 20 1285879494 0 Physicians Anesthesia Services 20 1285879494 0 Physicians Fluoride varnish 20 1285879494 0 Physicians Healthy Kids Services 20 1285879494 0 Physicians Optical Supplies 20 1285879494 0 Physicians Physician Services 00 1285879882 0 PRINGLE SARAH E 2011283 9999999 B 10 1285879882 0 2016 VADALABENE DR MARYVILLE IL 620626901 20 1285879882 0 Nurse Practitioners Healthy Kids Services 20 1285879882 0 Nurse Practitioners Midwife Services 20 1285879882 0 Nurse Practitioners Nurse Practitioners Services 20 1285879882 0 Nurse Practitioners Physician Services 00 1285880641 0 GAO JUEHUA 2012122 9999999 B 10 1285880641 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1285880641 0 Physicians Anesthesia Services 20 1285880641 0 Physicians Healthy Kids Services 20 1285880641 0 Physicians Optical Supplies 20 1285880641 0 Physicians Physician 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1285883314 0 KING KIARRA 2011227 9999999 B 10 1285883314 0 31 W 155TH ST HARVEY IL 604263556 20 1285883314 0 Physicians Anesthesia Services 20 1285883314 0 Physicians Healthy Kids Services 20 1285883314 0 Physicians Optical Supplies 20 1285883314 0 Physicians Physician Services 00 1285883991 0 MENICHELLA DANIELA 2011227 9999999 B 10 1285883991 0 5777 DEPT CAROL STREAM IL 601220021 20 1285883991 0 Physicians Anesthesia Services 20 1285883991 0 Physicians Healthy Kids Services 20 1285883991 0 Physicians Optical Supplies 20 1285883991 0 Physicians Physician Services 20 1285883991 0 Physicians Physicians Psychiatric Services 00 1285884403 0 MINHAS ALI 2011294 9999999 B 10 1285884403 0 114 N ORCHARD DR PARK FOREST IL 604661200 20 1285884403 0 Physicians Anesthesia Services 20 1285884403 0 Physicians Fluoride varnish 20 1285884403 0 Physicians Healthy Kids Services 20 1285884403 0 Physicians Optical Supplies 20 1285884403 0 Physicians Physician Services 00 1285884528 0 RENZ NICHOLAS ROBERT 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9999999 B 10 1285885145 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1285885145 0 Clinical Social Worker Social work service 00 1285886721 0 NEILSEN LAURA A 2016312 9999999 B 10 1285886721 0 28594 NETWORK PL CHICAGO IL 606731285 20 1285886721 0 Physician Assistant Only Fluoride varnish 20 1285886721 0 Physician Assistant Only Healthy Kids Services 20 1285886721 0 Physician Assistant Only Physician Services 00 1285890129 0 KASPER KATHERINE A 2011182 9999999 B 10 1285890129 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1285890129 0 Physicians Anesthesia Services 20 1285890129 0 Physicians Healthy Kids Services 20 1285890129 0 Physicians Optical Supplies 20 1285890129 0 Physicians Physician Services 00 1285890236 0 PATEL PARAV 2010214 9999999 B 10 1285890236 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1285890236 0 Physicians Anesthesia Services 20 1285890236 0 Physicians Fluoride varnish 20 1285890236 0 Physicians Healthy Kids Services 20 1285890236 0 Physicians Optical 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Physicians Healthy Kids Services 20 1285892455 0 Physicians Optical Supplies 20 1285892455 0 Physicians Physician Services 00 1285892844 0 BOUR ROBERT 2013182 9999999 B 10 1285892844 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1285892844 0 Physicians Anesthesia Services 20 1285892844 0 Physicians Healthy Kids Services 20 1285892844 0 Physicians Optical Supplies 20 1285892844 0 Physicians Physician Services 00 1285892877 0 CROSBY NICHOLAS 2022242 9999999 B 10 1285892877 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1285892877 0 Physicians Anesthesia Services 20 1285892877 0 Physicians Healthy Kids Services 20 1285892877 0 Physicians Optical Supplies 20 1285892877 0 Physicians Physician Services 00 1285892950 0 RAPP CATHERINE M 2020314 9999999 B 10 1285892950 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1285892950 0 Physicians Anesthesia Services 20 1285892950 0 Physicians Healthy Kids Services 20 1285892950 0 Physicians Optical Supplies 20 1285892950 0 Physicians 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RIDGE AVE # 1223 EVANSTON IL 602011700 20 1285895003 0 Physicians Anesthesia Services 20 1285895003 0 Physicians Healthy Kids Services 20 1285895003 0 Physicians Optical Supplies 20 1285895003 0 Physicians Physician Services 00 1285895037 0 ISAKSEN ANN 2016250 9999999 B 10 1285895037 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1285895037 0 Physicians Anesthesia Services 20 1285895037 0 Physicians Healthy Kids Services 20 1285895037 0 Physicians Optical Supplies 20 1285895037 0 Physicians Physician Services 00 1285895045 0 IVANOV ALEX 2024143 9999999 B 10 1285895045 0 4701 DEPT CAROL STREAM IL 601220021 20 1285895045 0 Physicians Anesthesia Services 20 1285895045 0 Physicians Healthy Kids Services 20 1285895045 0 Physicians Optical Supplies 20 1285895045 0 Physicians Physician Services 00 1285896753 0 HARRIS JOEL D 2012001 9999999 B 10 1285896753 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1285896753 0 Physicians Anesthesia Services 20 1285896753 0 Physicians Healthy Kids Services 20 1285896753 0 Physicians Optical Supplies 20 1285896753 0 Physicians Physician Services 00 1285896852 0 SHANNON CONNOR 2011206 9999999 B 10 1285896852 0 29373 NETWORK PL CHICAGO IL 606733039 20 1285896852 0 Physicians Anesthesia Services 20 1285896852 0 Physicians Healthy Kids Services 20 1285896852 0 Physicians Optical Supplies 20 1285896852 0 Physicians Physician Services 00 1285897397 0 FLORES REBECCA E 2004225 9999999 B 10 1285897397 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1285897397 0 Other behavior health professional LCPC/LMFT services 00 1285897728 0 LI NEWTON TAK YIP 2014243 9999999 B 10 1285897728 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1285897728 0 Physicians Anesthesia Services 20 1285897728 0 Physicians Healthy Kids Services 20 1285897728 0 Physicians Optical Supplies 20 1285897728 0 Physicians Physician Services 00 1285897967 0 GELLADA KAREN C 2011213 9999999 B 10 1285897967 0 29373 NETWORK PL CHICAGO IL 606733039 20 1285897967 0 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536 OLD HOWELL RD GREENVILLE SC 296151969 20 1285900894 0 Physical Therapists Medical Supplies 20 1285900894 0 Physical Therapists Medical equipment/prosthetic devices 20 1285900894 0 Physical Therapists Physical Therapy Services 00 1285901785 0 SIMNICK LAUREN 2013121 9999999 B 10 1285901785 0 3706 FLORIDA AVE GURNEE IL 600315527 20 1285901785 0 Speech Therapists Medical Supplies 20 1285901785 0 Speech Therapists Medical equipment/prosthetic devices 20 1285901785 0 Speech Therapists Speech Therapy/Pathology Services 00 1285903146 0 BURGESS BRIAN 2012183 9999999 B 10 1285903146 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1285903146 0 Podiatrists Podiatric Services 00 1285904805 0 YVES CHERY R 2023295 9999999 B 10 1285904805 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1285904805 0 Nurse Practitioners Healthy Kids Services 20 1285904805 0 Nurse Practitioners Nurse Practitioners Services 20 1285904805 0 Nurse Practitioners Physician Services 00 1285905158 0 OKE VIKRAM 2017039 9999999 B 10 1285905158 0 621 S NEW BALLAS RD STE 7020 SAINT LOUIS MO 631418232 20 1285905158 0 Physicians Anesthesia Services 20 1285905158 0 Physicians Fluoride varnish 20 1285905158 0 Physicians Healthy Kids Services 20 1285905158 0 Physicians Optical Supplies 20 1285905158 0 Physicians Physician Services 00 1285908509 0 EID ANAS 2022164 9999999 B 10 1285908509 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1285908509 0 Physicians Anesthesia Services 20 1285908509 0 Physicians Healthy Kids Services 20 1285908509 0 Physicians Optical Supplies 20 1285908509 0 Physicians Physician Services 00 1285909382 0 BAIG ABDUL R 2016049 9999999 B 10 1285909382 0 PO BOX 781076 DETROIT MI 482781076 20 1285909382 0 Physicians Anesthesia Services 20 1285909382 0 Physicians Fluoride varnish 20 1285909382 0 Physicians Healthy Kids Services 20 1285909382 0 Physicians Optical Supplies 20 1285909382 0 Physicians Physician Services 00 1285909481 0 SALAH AHMAD M 2017271 9999999 B 10 1285909481 0 7300 W COLLEGE DR PALOS HEIGHTS IL 604631152 20 1285909481 0 Physicians Anesthesia Services 20 1285909481 0 Physicians Fluoride varnish 20 1285909481 0 Physicians Healthy Kids Services 20 1285909481 0 Physicians Optical Supplies 20 1285909481 0 Physicians Physician Services 00 1285910059 0 MATHENIA JEREMY 2016015 9999999 B 10 1285910059 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1285910059 0 Physician Assistant Only Fluoride varnish 20 1285910059 0 Physician Assistant Only Healthy Kids Services 20 1285910059 0 Physician Assistant Only Physician Services 00 1285911149 0 CLARK SUSAN 2014176 9999999 B 10 1285911149 0 5777 DEPT CAROL STREAM IL 601228942 20 1285911149 0 Clinical Social Worker Social work service 00 1285912246 0 HISKEY MEGAN 2011065 9999999 B 10 1285912246 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1285912246 0 Nurse Practitioners Healthy Kids Services 20 1285912246 0 Nurse Practitioners Nurse Practitioners Services 20 1285912246 0 Nurse Practitioners Physician 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953586411 20 1285917542 0 Physician Assistant Only Fluoride varnish 20 1285917542 0 Physician Assistant Only Healthy Kids Services 20 1285917542 0 Physician Assistant Only Physician Services 00 1285917641 0 AQUILINE SONA 2013308 9999999 B 10 1285917641 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1285917641 0 Nurse Practitioners Anesthesia Services 20 1285917641 0 Nurse Practitioners Nurse Practitioners Services 20 1285917641 0 Nurse Practitioners Physician Services 00 1285920017 0 BILL JASON G 2014174 9999999 B 10 1285920017 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1285920017 0 Physicians Anesthesia Services 20 1285920017 0 Physicians Fluoride varnish 20 1285920017 0 Physicians Healthy Kids Services 20 1285920017 0 Physicians Optical Supplies 20 1285920017 0 Physicians Physician Services 00 1285920124 0 RINGHOUSE BRENDAN JEFFREY 2020015 9999999 B 10 1285920124 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1285920124 0 Physicians Anesthesia Services 20 1285920124 0 Physicians Healthy Kids Services 20 1285920124 0 Physicians Optical Supplies 20 1285920124 0 Physicians Physician Services 00 1285920637 0 AMIRHAMZEH DANIEL 2017335 9999999 B 10 1285920637 0 PO BOX 208807 DALLAS TX 753208807 20 1285920637 0 Physicians Anesthesia Services 20 1285920637 0 Physicians Healthy Kids Services 20 1285920637 0 Physicians Optical Supplies 20 1285920637 0 Physicians Physician Services 00 1285920694 0 YANG ZHINENG J 2022318 9999999 B 10 1285920694 0 210 W MCKINLEY AVE STE 1 DECATUR IL 625265858 20 1285920694 0 Physicians Anesthesia Services 20 1285920694 0 Physicians Fluoride varnish 20 1285920694 0 Physicians Healthy Kids Services 20 1285920694 0 Physicians Optical Supplies 20 1285920694 0 Physicians Physician Services 00 1285920835 0 COOK MITCHELL A 2014202 9999999 B 10 1285920835 0 PO BOX 34266 BELFAST ME 049150620 20 1285920835 0 Podiatrists Podiatric Services 00 1285921429 0 SAMEE IRFAN 2016263 9999999 B 10 1285921429 0 2502 E EMPIRE ST BLOOMINGTON IL 617043738 20 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1285922427 0 Physicians Healthy Kids Services 20 1285922427 0 Physicians Optical Supplies 20 1285922427 0 Physicians Physician Services 00 1285922575 0 RICHARDSON OCEAN 2024054 9999999 B 10 1285922575 0 2101 FOX DR STE 102 CHAMPAIGN IL 618208195 20 1285922575 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1285923078 0 KRIEGERMEIER ALYSSA A 2018182 9999999 B 10 1285923078 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1285923078 0 Physicians Anesthesia Services 20 1285923078 0 Physicians Fluoride varnish 20 1285923078 0 Physicians Healthy Kids Services 20 1285923078 0 Physicians Optical Supplies 20 1285923078 0 Physicians Physician Services 00 1285923524 0 SAEED SABA NAZ 2016275 9999999 B 10 1285923524 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1285923524 0 Physicians Anesthesia Services 20 1285923524 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1285923524 0 Physicians Healthy Kids Services 20 1285923524 0 Physicians Optical Supplies 20 1285923524 0 Physicians Physician Services 20 1285923524 0 Physicians Physicians Psychiatric Services 00 1285924811 0 LOOMBA ROHIT S 2018190 9999999 B 10 1285924811 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1285924811 0 Physicians Anesthesia Services 20 1285924811 0 Physicians Fluoride varnish 20 1285924811 0 Physicians Healthy Kids Services 20 1285924811 0 Physicians Optical Supplies 20 1285924811 0 Physicians Physician Services 00 1285925016 0 DAHER AHMAD 2022088 9999999 B 10 1285925016 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1285925016 0 Physicians Anesthesia Services 20 1285925016 0 Physicians Healthy Kids Services 20 1285925016 0 Physicians Optical Supplies 20 1285925016 0 Physicians Physician Services 20 1285925016 0 Physicians Physicians Psychiatric Services 00 1285926212 0 MILLER DANIEL J 2017258 9999999 B 10 1285926212 0 200 UNIVERSITY AVE E SAINT PAUL MN 551012507 20 1285926212 0 Physicians Anesthesia Services 20 1285926212 0 Physicians Fluoride varnish 20 1285926212 0 Physicians Healthy Kids Services 20 1285926212 0 Physicians Optical Supplies 20 1285926212 0 Physicians Physician Services 00 1285926238 0 BETTERS RICHARD Z 2023174 9999999 B 10 1285926238 0 PO BOX 43230 PHOENIX AZ 850803230 20 1285926238 0 Physicians Anesthesia Services 20 1285926238 0 Physicians Fluoride varnish 20 1285926238 0 Physicians Healthy Kids Services 20 1285926238 0 Physicians Optical Supplies 20 1285926238 0 Physicians Physician Services 00 1285926279 0 GABE MICHAEL 2022074 9999999 B 10 1285926279 0 111 OAKWOOD RD EAST PEORIA IL 616111853 20 1285926279 0 Physicians Anesthesia Services 20 1285926279 0 Physicians Healthy Kids Services 20 1285926279 0 Physicians Optical Supplies 20 1285926279 0 Physicians Physician Services 00 1285927277 0 TAWWAB FAISAL 2021221 9999999 B 10 1285927277 0 5121 MARYLAND WAY STE 300 BRENTWOOD TN 370277516 20 1285927277 0 Physicians Anesthesia Services 20 1285927277 0 Physicians Healthy Kids Services 20 1285927277 0 Physicians Optical Supplies 20 1285927277 0 Physicians Physician Services 00 1285927624 0 CRUMLEY SUZANNE 2024129 9999999 B 10 1285927624 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1285927624 0 Physicians Anesthesia Services 20 1285927624 0 Physicians Healthy Kids Services 20 1285927624 0 Physicians Optical Supplies 20 1285927624 0 Physicians Physician Services 00 1285928085 0 GORDON KATHRYN 2015297 9999999 B 10 1285928085 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1285928085 0 Physicians Anesthesia Services 20 1285928085 0 Physicians Healthy Kids Services 20 1285928085 0 Physicians Optical Supplies 20 1285928085 0 Physicians Physician Services 00 1285928416 0 AKHTAR LISA 2020035 9999999 B 10 1285928416 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1285928416 0 Physicians Anesthesia Services 20 1285928416 0 Physicians Fluoride varnish 20 1285928416 0 Physicians Healthy Kids Services 20 1285928416 0 Physicians Optical Supplies 20 1285928416 0 Physicians Physician Services 00 1285929059 0 RUDICEL JAMIE 2020045 9999999 B 10 1285929059 0 35318 EAGLE WAY CHICAGO IL 606781353 20 1285929059 0 Nurse Practitioners Healthy Kids Services 20 1285929059 0 Nurse Practitioners Nurse Practitioners Services 20 1285929059 0 Nurse Practitioners Physician Services 00 1285929414 0 KOWALCZYK JAMES 2015152 9999999 B 10 1285929414 0 PO BOX 38096 PHILADELPHIA PA 191011547 20 1285929414 0 Physicians Anesthesia Services 20 1285929414 0 Physicians Fluoride varnish 20 1285929414 0 Physicians Healthy Kids Services 20 1285929414 0 Physicians Optical Supplies 20 1285929414 0 Physicians Physician Services 00 1285929620 0 WILLIS SHIRLEY 2016267 9999999 B 10 1285929620 0 101 N WACKER DR STE 1700 CHICAGO IL 606067384 20 1285929620 0 Registered nurse Nursing service 20 1285929620 0 Registered nurse Waiver service 00 1285930883 0 BARNES EMILY 2017352 9999999 B 10 1285930883 0 524 E SCHAUMBURG RD SCHAUMBURG IL 601943510 20 1285930883 0 Speech Therapists Medical Supplies 20 1285930883 0 Speech Therapists Medical equipment/prosthetic devices 20 1285930883 0 Speech Therapists Speech Therapy/Pathology Services 00 1285931261 0 MERAJ SUMBUL 2012335 9999999 B 10 1285931261 0 PO BOX 776874 CHICAGO IL 606776874 20 1285931261 0 Physicians Anesthesia Services 20 1285931261 0 Physicians Fluoride varnish 20 1285931261 0 Physicians Healthy Kids Services 20 1285931261 0 Physicians Optical Supplies 20 1285931261 0 Physicians Physician Services 00 1285933549 0 ALFANO DANIELLE N 2017171 9999999 B 10 1285933549 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1285933549 0 Physicians Anesthesia Services 20 1285933549 0 Physicians Fluoride varnish 20 1285933549 0 Physicians Healthy Kids Services 20 1285933549 0 Physicians Optical Supplies 20 1285933549 0 Physicians Physician Services 00 1285934448 0 COSMOS JENNIFER 2011207 9999999 B 10 1285934448 0 1580 AIRPORT RD MORRIS IL 604508695 20 1285934448 0 Speech Therapists Medical 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EVANSVILLE IN 477333407 20 1285936377 0 Nurse Practitioners Fluoride varnish 20 1285936377 0 Nurse Practitioners Healthy Kids Services 20 1285936377 0 Nurse Practitioners Nurse Practitioners Services 20 1285936377 0 Nurse Practitioners Physician Services 00 1285936625 0 FAZ GABRIEL T 2025034 9999999 B 10 1285936625 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1285936625 0 Physicians Anesthesia Services 20 1285936625 0 Physicians Fluoride varnish 20 1285936625 0 Physicians Healthy Kids Services 20 1285936625 0 Physicians Optical Supplies 20 1285936625 0 Physicians Physician Services 00 1285939322 0 GRANGER LEKEBA 2012214 9999999 B 10 1285939322 0 1361 W FREMONT ST GALESBURG IL 614012436 20 1285939322 0 Dentists Dental Services 20 1285939322 0 Dentists Physician Services 00 1285940049 0 COHEN CASSIE N 2010266 9999999 B 10 1285940049 0 7355 LICK CREEK RD BUNCOMBE IL 629123016 20 1285940049 0 Speech Therapists Medical Supplies 20 1285940049 0 Speech Therapists Medical equipment/prosthetic devices 20 1285940049 0 Speech Therapists Speech Therapy/Pathology Services 00 1285940171 0 IBRAHIM ZEINA S 2017145 9999999 B 10 1285940171 0 9119 S EXCHANGE AVE CHICAGO IL 606174225 20 1285940171 0 Physicians Anesthesia Services 20 1285940171 0 Physicians Fluoride varnish 20 1285940171 0 Physicians Healthy Kids Services 20 1285940171 0 Physicians Optical Supplies 20 1285940171 0 Physicians Physician Services 00 1285940338 0 CHIRINOS LAZARTE JULIO 2021090 9999999 B 10 1285940338 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1285940338 0 Physicians Anesthesia Services 20 1285940338 0 Physicians Fluoride varnish 20 1285940338 0 Physicians Healthy Kids Services 20 1285940338 0 Physicians Optical Supplies 20 1285940338 0 Physicians Physician Services 00 1285940452 0 SHEIKH MOHAMMAD 2020264 9999999 B 10 1285940452 0 PO BOX 43230 PHOENIX AZ 850803230 20 1285940452 0 Physicians Anesthesia Services 20 1285940452 0 Physicians Fluoride varnish 20 1285940452 0 Physicians Healthy Kids Services 20 1285940452 0 Physicians Optical Supplies 20 1285940452 0 Physicians Physician Services 00 1285941153 0 ONYENWENYI CHIJOKE 2012272 9999999 B 10 1285941153 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1285941153 0 Physicians Anesthesia Services 20 1285941153 0 Physicians Fluoride varnish 20 1285941153 0 Physicians Healthy Kids Services 20 1285941153 0 Physicians Optical Supplies 20 1285941153 0 Physicians Physician Services 00 1285945436 0 NALL CANDACE 2013182 9999999 B 10 1285945436 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1285945436 0 Physicians Anesthesia Services 20 1285945436 0 Physicians Healthy Kids Services 20 1285945436 0 Physicians Optical Supplies 20 1285945436 0 Physicians Physician Services 00 1285945667 0 TABAKA COURTNEY A 2016207 9999999 B 10 1285945667 0 7447 W TALCOTT AVE STE 542 CHICAGO IL 606313716 20 1285945667 0 Physicians Anesthesia Services 20 1285945667 0 Physicians Fluoride varnish 20 1285945667 0 Physicians Healthy Kids Services 20 1285945667 0 Physicians Optical Supplies 20 1285945667 0 Physicians Physician Services 00 1285945691 0 SPENDLEY JAMES 2016315 9999999 B 10 1285945691 0 2925 CHICAGO AVE MINNEAPOLIS MN 554071321 20 1285945691 0 Physicians Anesthesia Services 20 1285945691 0 Physicians Healthy Kids Services 20 1285945691 0 Physicians Optical Supplies 20 1285945691 0 Physicians Physician Services 00 1285945832 0 BILGER WADE 2024075 9999999 B 10 1285945832 0 PO BOX 235019 MONTGOMERY AL 361235019 20 1285945832 0 Nurse Practitioners Anesthesia Services 20 1285945832 0 Nurse Practitioners Nurse Practitioners Services 20 1285945832 0 Nurse Practitioners Physician Services 00 1285945964 0 DUMPERT MICHAEL 2023082 9999999 B 10 1285945964 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1285945964 0 Nurse Practitioners Healthy Kids Services 20 1285945964 0 Nurse Practitioners Nurse Practitioners Services 20 1285945964 0 Nurse Practitioners Physician Services 00 1285946129 0 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20 1285950352 0 Physicians Physician Services 00 1285951723 0 LEWALLEN LAURA 2020216 9999999 B 10 1285951723 0 6501 S PROMONTORY DR CHICAGO IL 606491003 20 1285951723 0 Physicians Anesthesia Services 20 1285951723 0 Physicians Healthy Kids Services 20 1285951723 0 Physicians Optical Supplies 20 1285951723 0 Physicians Physician Services 00 1285952309 0 GARCIA WOJTCZAK JENNIFER 2010213 9999999 B 10 1285952309 0 5777 DEPT CAROL STREAM IL 601220021 20 1285952309 0 Physicians Anesthesia Services 20 1285952309 0 Physicians Healthy Kids Services 20 1285952309 0 Physicians Optical Supplies 20 1285952309 0 Physicians Physician Services 00 1285952572 0 TEMIYAKARN LOYRIRK 2016214 9999999 B 10 1285952572 0 8930 WAUKEGAN RD STE 130 SUITE 130 MORTON GROVE IL 600532132 20 1285952572 0 Physicians Anesthesia Services 20 1285952572 0 Physicians Healthy Kids Services 20 1285952572 0 Physicians Optical Supplies 20 1285952572 0 Physicians Physician Services 00 1285954206 0 SOMURI SASIDHAR 2010182 9999999 B 10 1285954206 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1285954206 0 Physicians Anesthesia Services 20 1285954206 0 Physicians Fluoride varnish 20 1285954206 0 Physicians Healthy Kids Services 20 1285954206 0 Physicians Optical Supplies 20 1285954206 0 Physicians Physician Services 00 1285954677 0 NEWHOOK ALEXANDRAE 2023174 9999999 B 10 1285954677 0 17500 W GRAND PKWY S SUGAR LAND TX 774792562 20 1285954677 0 Physicians Anesthesia Services 20 1285954677 0 Physicians Healthy Kids Services 20 1285954677 0 Physicians Optical Supplies 20 1285954677 0 Physicians Physician Services 00 1285954917 0 MCBRIDE ELIZABETH 2014060 9999999 B 10 1285954917 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1285954917 0 Physicians Anesthesia Services 20 1285954917 0 Physicians Fluoride varnish 20 1285954917 0 Physicians Healthy Kids Services 20 1285954917 0 Physicians Optical Supplies 20 1285954917 0 Physicians Physician Services 00 1285954933 0 BATDORF BJORN 2020329 9999999 B 10 1285954933 0 5700 SOUTHWYCK BLVD TOLEDO OH 436141509 20 1285954933 0 Physicians Anesthesia Services 20 1285954933 0 Physicians Healthy Kids Services 20 1285954933 0 Physicians Optical Supplies 20 1285954933 0 Physicians Physician Services 00 1285955476 0 FERRERA MARIA J 2013264 9999999 B 10 1285955476 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1285955476 0 Physicians Anesthesia Services 20 1285955476 0 Physicians Fluoride varnish 20 1285955476 0 Physicians Healthy Kids Services 20 1285955476 0 Physicians Optical Supplies 20 1285955476 0 Physicians Physician Services 00 1285955807 0 MUHA MELISSA 2023278 9999999 B 10 1285955807 0 800 W FULTON MARKET FL 12 CHICAGO IL 606071302 20 1285955807 0 Nurse Practitioners Fluoride varnish 20 1285955807 0 Nurse Practitioners Healthy Kids Services 20 1285955807 0 Nurse Practitioners Nurse Practitioners Services 20 1285955807 0 Nurse Practitioners Physician Services 00 1285958918 0 DICKINSON COLLEEN M 2010217 9999999 B 10 1285958918 0 15732 S HOWARD ST 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Physical Therapists Medical Supplies 20 1285966416 0 Physical Therapists Medical equipment/prosthetic devices 20 1285966416 0 Physical Therapists Physical Therapy Services 00 1285966465 0 BOES STEPHANIE M 2017074 9999999 B 10 1285966465 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1285966465 0 Nurse Practitioners Healthy Kids Services 20 1285966465 0 Nurse Practitioners Nurse Practitioners Services 20 1285966465 0 Nurse Practitioners Physician Services 00 1285966739 0 GILMORE COLLEEN 2021029 9999999 B 10 1285966739 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1285966739 0 Nurse Practitioners Healthy Kids Services 20 1285966739 0 Nurse Practitioners Nurse Practitioners Services 20 1285966739 0 Nurse Practitioners Physician Services 00 1285968149 0 DIPIRO CHRISTOPHER MICHAEL 2018017 9999999 B 10 1285968149 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1285968149 0 Physicians Anesthesia Services 20 1285968149 0 Physicians Fluoride varnish 20 1285968149 0 Physicians Healthy Kids Services 20 1285968149 0 Physicians Optical Supplies 20 1285968149 0 Physicians Physician Services 00 1285968263 0 LESTER MARK E 2015167 9999999 B 10 1285968263 0 PO BOX 1241 SOUTH BEND IN 466241241 20 1285968263 0 Physician Assistant Only Fluoride varnish 20 1285968263 0 Physician Assistant Only Healthy Kids Services 20 1285968263 0 Physician Assistant Only Physician Services 00 1285975680 0 QURESHI AMBER A 2016298 9999999 B 10 1285975680 0 28594 NETWORK PL CHICAGO IL 606731285 20 1285975680 0 Physicians Anesthesia Services 20 1285975680 0 Physicians Fluoride varnish 20 1285975680 0 Physicians Healthy Kids Services 20 1285975680 0 Physicians Optical Supplies 20 1285975680 0 Physicians Physician Services 00 1285976209 0 DREIFKE MICHAEL B 2022257 9999999 B 10 1285976209 0 801 YORK ST MANITOWOC WI 542204630 20 1285976209 0 Physicians Anesthesia Services 20 1285976209 0 Physicians Healthy Kids Services 20 1285976209 0 Physicians Optical Supplies 20 1285976209 0 Physicians Physician Services 00 1285976571 0 GRANDY BENJAMIN 2022087 9999999 B 10 1285976571 0 5121 MARYLAND WAY STE 300 BRENTWOOD TN 370277516 20 1285976571 0 Physicians Anesthesia Services 20 1285976571 0 Physicians Healthy Kids Services 20 1285976571 0 Physicians Optical Supplies 20 1285976571 0 Physicians Physician Services 00 1285977082 0 O'LEARY EDWARD 2021183 9999999 B 10 1285977082 0 300 LONGWOOD AVE BOSTON MA 021155724 20 1285977082 0 Physicians Anesthesia Services 20 1285977082 0 Physicians Fluoride varnish 20 1285977082 0 Physicians Healthy Kids Services 20 1285977082 0 Physicians Optical Supplies 20 1285977082 0 Physicians Physician Services 00 1285977314 0 PONTARELLI KRISTINA N 2017094 9999999 B 10 1285977314 0 1940 S WESTERN AVE STE 205 CHICAGO IL 606082503 20 1285977314 0 Physicians Anesthesia Services 20 1285977314 0 Physicians Healthy Kids Services 20 1285977314 0 Physicians Optical Supplies 20 1285977314 0 Physicians Physician Services 00 1285977397 0 QURAISHI NIDA 2021039 9999999 B 10 1285977397 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1285977397 0 Physicians Anesthesia Services 20 1285977397 0 Physicians Fluoride varnish 20 1285977397 0 Physicians Healthy Kids Services 20 1285977397 0 Physicians Optical Supplies 20 1285977397 0 Physicians Physician Services 00 1285977595 0 MATSON JENNIFER 2013091 9999999 B 10 1285977595 0 17 N STATE ST STE 500 CHICAGO IL 606023384 20 1285977595 0 Nurse Practitioners Family Planning Counseling 20 1285977595 0 Nurse Practitioners Healthy Kids Services 20 1285977595 0 Nurse Practitioners Nurse Practitioners Services 20 1285977595 0 Nurse Practitioners Physician Services 00 1285977769 0 APOSTOLOV YEVGENIY 2022220 9999999 B 10 1285977769 0 PO BOX 23410 LITTLE ROCK AR 722213410 20 1285977769 0 Physicians Anesthesia Services 20 1285977769 0 Physicians Fluoride varnish 20 1285977769 0 Physicians Healthy Kids Services 20 1285977769 0 Physicians Optical Supplies 20 1285977769 0 Physicians Physician Services 00 1285978718 0 MEIER-SHANNON STEPHANIE 2018064 9999999 B 10 1285978718 0 1 MEDICAL CENTER DR GALENA IL 610368118 20 1285978718 0 Nurse Practitioners Fluoride varnish 20 1285978718 0 Nurse Practitioners Healthy Kids Services 20 1285978718 0 Nurse Practitioners Nurse Practitioners Services 20 1285978718 0 Nurse Practitioners Physician Services 00 1285978940 0 CIRRINCIONE CLAUDIA J 2024164 9999999 B 10 1285978940 0 PO BOX 953 ADDISON IL 601010953 20 1285978940 0 Occupational Therapists Medical Supplies 20 1285978940 0 Occupational Therapists Medical equipment/prosthetic devices 20 1285978940 0 Occupational Therapists Occupational Therapy Services 00 1285979195 0 MUELLER MICHELE R 2013032 9999999 B 10 1285979195 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1285979195 0 Nurse Practitioners Fluoride varnish 20 1285979195 0 Nurse Practitioners Healthy Kids Services 20 1285979195 0 Nurse Practitioners Nurse Practitioners Services 20 1285979195 0 Nurse Practitioners Physician Services 00 1285979336 0 STOUT TERESA A 2018263 9999999 B 10 1285979336 0 303 N JACKSON ST MORRISON IL 612703042 20 1285979336 0 Nurse Practitioners Healthy Kids Services 20 1285979336 0 Nurse Practitioners Nurse Practitioners Services 20 1285979336 0 Nurse Practitioners Physician Services 00 1285980524 0 NATH RESHMI R 2022188 9999999 B 10 1285980524 0 PO BOX 43230 PHOENIX AZ 850803230 20 1285980524 0 Physicians Anesthesia Services 20 1285980524 0 Physicians Healthy Kids Services 20 1285980524 0 Physicians Optical Supplies 20 1285980524 0 Physicians Physician Services 00 1285982207 0 CHOUDHARY SONAL 2013001 9999999 B 10 1285982207 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1285982207 0 Physical Therapists Medical Supplies 20 1285982207 0 Physical Therapists Medical equipment/prosthetic devices 20 1285982207 0 Physical Therapists Physical Therapy Services 00 1285982330 0 TRACHTENBERG ALAN B 2015180 9999999 B 10 1285982330 0 800 E NORTHWEST HWY STE 106B MOUNT PROSPECT IL 600563457 20 1285982330 0 Clinical Social Worker Social work service 00 1285983437 0 SZYMANSKI MELANIE S 2012340 9999999 B 10 1285983437 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1285983437 0 Nurse Practitioners Anesthesia Services 20 1285983437 0 Nurse Practitioners Nurse Practitioners Services 20 1285983437 0 Nurse Practitioners Physician Services 00 1285985655 0 WILLIAMS LISA 2021070 9999999 B 10 1285985655 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1285985655 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1285985655 0 Other behavior health professional Social work service 00 1285986323 0 LEARY JENNIFER 2013075 9999999 B 10 1285986323 0 11365 DORSETT RD MARYLAND HEIGHT MO 630433411 20 1285986323 0 Nurse Practitioners Fluoride varnish 20 1285986323 0 Nurse Practitioners Healthy Kids Services 20 1285986323 0 Nurse Practitioners Nurse Practitioners Services 20 1285986323 0 Nurse Practitioners Physician Services 00 1285987511 0 PAPE GAYLE M 2019112 9999999 B 10 1285987511 0 400 N HIGHLAND AVE AURORA IL 605063814 20 1285987511 0 Clinical Social Worker Social work service 00 1285988105 0 BAUSER CHERYL 2019169 9999999 B 10 1285988105 0 121 E 2ND ST BEARDSTOWN IL 626181263 20 1285988105 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1285989269 0 ACKERMANN JOSHUA H 2019152 9999999 B 10 1285989269 0 250 W 96TH ST STE 520 INDIANAPOLIS IN 462601317 20 1285989269 0 Physician Assistant Only Fluoride varnish 20 1285989269 0 Physician Assistant Only Healthy Kids Services 20 1285989269 0 Physician Assistant Only Physician Services 00 1285990200 0 HASAN ALI A 2024137 9999999 B 10 1285990200 0 2990 TELESTAR CT FALLS CHURCH VA 220421207 20 1285990200 0 Physicians Anesthesia Services 20 1285990200 0 Physicians Healthy Kids Services 20 1285990200 0 Physicians Optical Supplies 20 1285990200 0 Physicians Physician Services 00 1285990564 0 AHMED FATMA 2019275 9999999 B 10 1285990564 0 9500 BRYN MAWR AVE STE 300 ROSEMONT IL 600185257 20 1285990564 0 Physicians Anesthesia Services 20 1285990564 0 Physicians Healthy Kids Services 20 1285990564 0 Physicians Optical Supplies 20 1285990564 0 Physicians Physician Services 00 1285990705 0 KALELKAR RAKHEE 2017061 9999999 B 10 1285990705 0 5777 DEPT CAROL STREAM IL 601228942 20 1285990705 0 Physicians Anesthesia Services 20 1285990705 0 Physicians Fluoride varnish 20 1285990705 0 Physicians Healthy Kids Services 20 1285990705 0 Physicians Optical Supplies 20 1285990705 0 Physicians Physician Services 00 1285990911 0 DAVIDSON BRIDGET R 2012122 9999999 B 10 1285990911 0 29373 NETWORK PL CHICAGO IL 606733039 20 1285990911 0 Nurse Practitioners Healthy Kids Services 20 1285990911 0 Nurse Practitioners Midwife Services 20 1285990911 0 Nurse Practitioners Nurse Practitioners Services 20 1285990911 0 Nurse Practitioners Physician Services 00 1285991117 0 MILLER LANE H 2024346 9999999 B 10 1285991117 0 5901 LINCOLN DR EDINA MN 554361611 20 1285991117 0 Physicians Anesthesia Services 20 1285991117 0 Physicians Fluoride varnish 20 1285991117 0 Physicians Healthy Kids Services 20 1285991117 0 Physicians Optical Supplies 20 1285991117 0 Physicians Physician Services 00 1285991299 0 CATT JERRY W 2016203 9999999 B 10 1285991299 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1285991299 0 Physicians Anesthesia Services 20 1285991299 0 Physicians Healthy Kids Services 20 1285991299 0 Physicians Optical Supplies 20 1285991299 0 Physicians Physician Services 00 1285991679 0 ADELEYE AMANDA J 2019253 9999999 B 10 1285991679 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1285991679 0 Physicians Anesthesia Services 20 1285991679 0 Physicians Healthy Kids Services 20 1285991679 0 Physicians Optical Supplies 20 1285991679 0 Physicians Physician Services 00 1285992297 0 SAMPLES DESIREE 2025059 9999999 B 10 1285992297 0 PO BOX 781076 DETROIT MI 482781076 20 1285992297 0 Nurse Practitioners Fluoride varnish 20 1285992297 0 Nurse Practitioners Healthy Kids Services 20 1285992297 0 Nurse Practitioners Nurse Practitioners Services 20 1285992297 0 Nurse Practitioners Physician Services 00 1285993014 0 JOHNS SARA A 2013315 9999999 B 10 1285993014 0 719 N MARION ST OAK PARK IL 603021530 20 1285993014 0 Physical Therapists Medical Supplies 20 1285993014 0 Physical Therapists Medical equipment/prosthetic devices 20 1285993014 0 Physical Therapists Physical Therapy Services 00 1285993576 0 CHITSAZ EHSAN 2024024 9999999 B 10 1285993576 0 29373 NETWORK PL CHICAGO IL 606733039 20 1285993576 0 Physicians Anesthesia Services 20 1285993576 0 Physicians Fluoride varnish 20 1285993576 0 Physicians Healthy Kids Services 20 1285993576 0 Physicians Optical Supplies 20 1285993576 0 Physicians Physician Services 00 1285993725 0 LARSON BRIDGET 2017251 9999999 B 10 1285993725 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1285993725 0 Physicians Anesthesia Services 20 1285993725 0 Physicians Healthy Kids Services 20 1285993725 0 Physicians Optical Supplies 20 1285993725 0 Physicians Physician Services 00 1285993782 0 FITZGERALD JOHN 2015012 9999999 B 10 1285993782 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1285993782 0 Nurse Practitioners Anesthesia Services 20 1285993782 0 Nurse Practitioners Nurse Practitioners Services 20 1285993782 0 Nurse Practitioners Physician Services 00 1285993972 0 SCHONAUER MARGARET 2016061 9999999 B 10 1285993972 0 60 S STATE ROUTE 157 STE 20 EDWARDSVILLE IL 620253899 20 1285993972 0 Speech Therapists Medical Supplies 20 1285993972 0 Speech Therapists Medical equipment/prosthetic devices 20 1285993972 0 Speech Therapists Speech Therapy/Pathology Services 00 1285995266 0 DUVALL ADAM S 2020202 9999999 B 10 1285995266 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1285995266 0 Physicians Anesthesia Services 20 1285995266 0 Physicians Fluoride varnish 20 1285995266 0 Physicians Healthy Kids Services 20 1285995266 0 Physicians Optical Supplies 20 1285995266 0 Physicians Physician Services 00 1285995480 0 SINGH NIKKI 2021154 9999999 B 10 1285995480 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1285995480 0 Physicians Anesthesia Services 20 1285995480 0 Physicians Fluoride varnish 20 1285995480 0 Physicians Healthy Kids Services 20 1285995480 0 Physicians Optical Supplies 20 1285995480 0 Physicians Physician Services 00 1285995779 0 VALENCIA VAL 2015250 9999999 B 10 1285995779 0 2250 N ILLINOIS AVE CARBONDALE IL 629015612 20 1285995779 0 Physicians Anesthesia Services 20 1285995779 0 Physicians Fluoride varnish 20 1285995779 0 Physicians Healthy Kids Services 20 1285995779 0 Physicians Optical Supplies 20 1285995779 0 Physicians Physician Services 00 1285996116 0 BADR ABDUL 2018184 9999999 B 10 1285996116 0 1418 COLLEGE DR MOUNT CARMEL IL 628632638 20 1285996116 0 Physicians Anesthesia Services 20 1285996116 0 Physicians Healthy Kids Services 20 1285996116 0 Physicians Optical Supplies 20 1285996116 0 Physicians Physician Services 00 1285997650 0 PREYSS BENJAMIN A 2015294 9999999 B 10 1285997650 0 2875 W 19TH ST CHICAGO IL 606233501 20 1285997650 0 Physicians All Kids application agent 20 1285997650 0 Physicians Anesthesia Services 20 1285997650 0 Physicians Fluoride varnish 20 1285997650 0 Physicians Healthy Kids Services 20 1285997650 0 Physicians Optical Supplies 20 1285997650 0 Physicians Physician Services 00 1285998088 0 SHIMAK MORTON CHRISTINA 2015213 9999999 B 10 1285998088 0 350 N GRANDVIEW AVE DUBUQUE IA 520016388 20 1285998088 0 Physicians Anesthesia Services 20 1285998088 0 Physicians Healthy Kids Services 20 1285998088 0 Physicians Optical Supplies 20 1285998088 0 Physicians Physician Services 00 1285998237 0 AFSHARI MITRA 2018213 9999999 B 10 1285998237 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1285998237 0 Physicians Anesthesia Services 20 1285998237 0 Physicians Healthy Kids Services 20 1285998237 0 Physicians Optical Supplies 20 1285998237 0 Physicians Physician Services 20 1285998237 0 Physicians Physicians Psychiatric Services 00 1285999334 0 GOTH STEPHEN 2017121 9999999 B 10 1285999334 0 111 OAKWOOD RD EAST PEORIA IL 616111853 20 1285999334 0 Physicians Anesthesia Services 20 1285999334 0 Physicians Healthy Kids Services 20 1285999334 0 Physicians Optical Supplies 20 1285999334 0 Physicians Physician Services 00 1285999508 0 VERTICCHIO JULIANA CARMI 2017318 9999999 B 10 1285999508 0 3015 N BALLAS RD ADMINISTRATION SAINT LOUIS MO 631312329 20 1285999508 0 Physicians Anesthesia Services 20 1285999508 0 Physicians Healthy Kids Services 20 1285999508 0 Physicians Optical Supplies 20 1285999508 0 Physicians Physician Services 00 1295000974 0 BROWN MIMI N 2012079 9999999 B 10 1295000974 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1295000974 0 Nurse Practitioners Anesthesia Services 20 1295000974 0 Nurse Practitioners Nurse Practitioners Services 20 1295000974 0 Nurse Practitioners Physician Services 00 1295001907 0 PARKER ELLEN 2017131 9999999 B 10 1295001907 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1295001907 0 Physicians Anesthesia Services 20 1295001907 0 Physicians Fluoride varnish 20 1295001907 0 Physicians Healthy Kids Services 20 1295001907 0 Physicians Optical Supplies 20 1295001907 0 Physicians Physician Services 00 1295002715 0 DIFFERDING CHRISTOPHER J 2016127 9999999 B 10 1295002715 0 600 E 1ST ST SPRING VALLEY IL 613621512 20 1295002715 0 Physician Assistant Only Fluoride varnish 20 1295002715 0 Physician Assistant Only Healthy Kids Services 20 1295002715 0 Physician Assistant Only Physician Services 00 1295003564 0 HETTIARACHCHI ERIWARAWE 2022275 9999999 B 10 1295003564 0 7624 WARREN PKWY FRISCO TX 750344158 20 1295003564 0 Physicians Anesthesia Services 20 1295003564 0 Physicians Fluoride varnish 20 1295003564 0 Physicians Healthy Kids Services 20 1295003564 0 Physicians Optical Supplies 20 1295003564 0 Physicians Physician Services 00 1295007334 0 TRICE SASHA 2018099 9999999 B 10 1295007334 0 4600 3RD ST MOLINE IL 612656106 20 1295007334 0 Other behavior health professional LCPC/LMFT services 00 1295007532 0 DIVEN SEAN 2016011 9999999 B 10 1295007532 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1295007532 0 Other behavior health professional All Kids application agent 20 1295007532 0 Other behavior health professional LCPC/LMFT services 00 1295010148 0 SHAW MCHAEL 2025013 9999999 B 10 1295010148 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1295010148 0 Physicians Anesthesia Services 20 1295010148 0 Physicians Fluoride varnish 20 1295010148 0 Physicians Healthy Kids Services 20 1295010148 0 Physicians Optical Supplies 20 1295010148 0 Physicians Physician Services 00 1295010635 0 WARD TRICIA H 2013046 9999999 B 10 1295010635 0 29373 NETWORK PL CHICAGO IL 606733039 20 1295010635 0 Nurse Practitioners Fluoride varnish 20 1295010635 0 Nurse Practitioners Healthy Kids Services 20 1295010635 0 Nurse Practitioners Nurse Practitioners Services 20 1295010635 0 Nurse Practitioners Physician Services 00 1295010825 0 CARDINAL COLLEEN D 2011289 9999999 B 10 1295010825 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1295010825 0 Nurse Practitioners Healthy Kids Services 20 1295010825 0 Nurse Practitioners Nurse Practitioners Services 20 1295010825 0 Nurse Practitioners Physician Services 00 1295011641 0 RAY STEPHEN 2020232 9999999 B 10 1295011641 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1295011641 0 Nurse Practitioners Healthy Kids Services 20 1295011641 0 Nurse Practitioners Nurse Practitioners Services 20 1295011641 0 Nurse Practitioners Physician Services 00 1295012912 0 MCKENNA EMILY 2022210 9999999 B 10 1295012912 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1295012912 0 Nurse Practitioners Fluoride varnish 20 1295012912 0 Nurse Practitioners Healthy Kids Services 20 1295012912 0 Nurse Practitioners Nurse Practitioners Services 20 1295012912 0 Nurse Practitioners Physician Services 00 1295013100 0 MITRIC SLADJANA 2017257 9999999 B 10 1295013100 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1295013100 0 Physicians Anesthesia Services 20 1295013100 0 Physicians Fluoride varnish 20 1295013100 0 Physicians Healthy Kids Services 20 1295013100 0 Physicians Optical Supplies 20 1295013100 0 Physicians Physician Services 00 1295013126 0 ALDERMAN RYAN 2015099 9999999 B 10 1295013126 0 5220 EAST AVE COUNTRYSIDE IL 605253133 20 1295013126 0 Other behavior health professional LCPC/LMFT services 00 1295013969 0 RADOVANOVIC DRAGANA 2014248 9999999 B 10 1295013969 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1295013969 0 Physicians Anesthesia Services 20 1295013969 0 Physicians Healthy Kids Services 20 1295013969 0 Physicians Optical Supplies 20 1295013969 0 Physicians Physician Services 00 1295014892 0 SALINGER KATHY J. 2015351 9999999 B 10 1295014892 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1295014892 0 Nurse Practitioners Healthy Kids Services 20 1295014892 0 Nurse Practitioners Nurse Practitioners Services 20 1295014892 0 Nurse Practitioners Physician Services 00 1295016210 0 KEY RANDI J 2016309 9999999 B 10 1295016210 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1295016210 0 Nurse Practitioners Healthy Kids Services 20 1295016210 0 Nurse Practitioners Nurse Practitioners Services 20 1295016210 0 Nurse Practitioners Physician Services 00 1295017408 0 SCHILLING ERIN 2011274 9999999 B 10 1295017408 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1295017408 0 Nurse Practitioners Healthy Kids Services 20 1295017408 0 Nurse Practitioners Nurse Practitioners Services 20 1295017408 0 Nurse Practitioners Physician Services 00 1295017663 0 TACDERAS DEANNA 2012079 9999999 B 10 1295017663 0 PO BOX 3988 CARBONDALE IL 629023988 20 1295017663 0 Nurse Practitioners Healthy Kids Services 20 1295017663 0 Nurse Practitioners Nurse Practitioners Services 20 1295017663 0 Nurse Practitioners Physician Services 00 1295017861 0 GUPTA SUKRITI 2012027 9999999 B 10 1295017861 0 8324 SKOKIE BLVD SKOKIE IL 600772545 20 1295017861 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1295018877 0 RASEKH FOAD 2012191 9999999 B 10 1295018877 0 341 E GENEVA RD CAROL STREAM IL 601882438 20 1295018877 0 Dentists Dental Services 20 1295018877 0 Dentists Physician Services 00 1295018935 0 LUNA RANDI 2011286 9999999 B 10 1295018935 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1295018935 0 Other behavior health professional All Kids application agent 20 1295018935 0 Other behavior health professional LCPC/LMFT services 00 1295019313 0 BYKERK RACHEL 2014288 9999999 B 10 1295019313 0 2875 W 19TH ST CHICAGO IL 606233501 20 1295019313 0 Physician Assistant Only All Kids application agent 20 1295019313 0 Physician Assistant Only Fluoride varnish 20 1295019313 0 Physician Assistant Only Healthy Kids Services 20 1295019313 0 Physician Assistant Only Physician Services 00 1295019941 0 EVERLEY CHELSA 2016084 9999999 B 10 1295019941 0 325 IL ROUTE 2 DIXON IL 610219118 20 1295019941 0 Nurse Practitioners Fluoride varnish 20 1295019941 0 Nurse Practitioners Healthy Kids Services 20 1295019941 0 Nurse Practitioners Nurse Practitioners Services 20 1295019941 0 Nurse Practitioners Physician Services 00 1295020113 0 JEELANI HUMA I 2013133 9999999 B 10 1295020113 0 175 E HOUSTON ST SAN ANTONIO TX 782052255 20 1295020113 0 Optometrists Optical Supplies 20 1295020113 0 Optometrists Optometric Services 20 1295020113 0 Optometrists Physician Services 00 1295020550 0 CHIARELLA SERGIO E 2017062 9999999 B 10 1295020550 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1295020550 0 Physicians Anesthesia Services 20 1295020550 0 Physicians Fluoride varnish 20 1295020550 0 Physicians Healthy Kids Services 20 1295020550 0 Physicians Optical Supplies 20 1295020550 0 Physicians Physician Services 00 1295020758 0 HO DAVID 2021258 9999999 B 10 1295020758 0 44000 GARFIELD RD CLINTON 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Healthy Kids Services 20 1295021079 0 Physicians Optical Supplies 20 1295021079 0 Physicians Physician Services 00 1295022002 0 BOU STEVEN 2016187 2099365 B 10 1295022002 0 PO BOX 684 BEDFORD PARK IL 604990684 20 1295022002 0 Physicians Anesthesia Services 20 1295022002 0 Physicians Healthy Kids Services 20 1295022002 0 Physicians Optical Supplies 20 1295022002 0 Physicians Physician Services 00 1295022218 0 KIDIWALA NILOFER 2016242 9999999 B 10 1295022218 0 29373 NETWORK PL CHICAGO IL 606733039 20 1295022218 0 Physicians Anesthesia Services 20 1295022218 0 Physicians Fluoride varnish 20 1295022218 0 Physicians Healthy Kids Services 20 1295022218 0 Physicians Optical Supplies 20 1295022218 0 Physicians Physician Services 00 1295022283 0 PUTMAN MARGARET 2014188 9999999 B 10 1295022283 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1295022283 0 Physicians Anesthesia Services 20 1295022283 0 Physicians Fluoride varnish 20 1295022283 0 Physicians Healthy Kids Services 20 1295022283 0 Physicians Optical Supplies 20 1295022283 0 Physicians Physician Services 00 1295022515 0 TOLAYMAT ABDULLAH 2016188 9999999 B 10 1295022515 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1295022515 0 Physicians Anesthesia Services 20 1295022515 0 Physicians Healthy Kids Services 20 1295022515 0 Physicians Optical Supplies 20 1295022515 0 Physicians Physician Services 20 1295022515 0 Physicians Physicians Psychiatric Services 00 1295022705 0 WILSON ANNIE J 2017131 9999999 B 10 1295022705 0 500 PORTER AVE AURORA MO 656052365 20 1295022705 0 Nurse Practitioners Healthy Kids Services 20 1295022705 0 Nurse Practitioners Nurse Practitioners Services 20 1295022705 0 Nurse Practitioners Physician Services 00 1295022739 0 EL TERS NATHALIE 2017170 9999999 B 10 1295022739 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1295022739 0 Physicians Anesthesia Services 20 1295022739 0 Physicians Fluoride varnish 20 1295022739 0 Physicians Healthy Kids Services 20 1295022739 0 Physicians Optical Supplies 20 1295022739 0 Physicians Physician Services 00 1295022945 0 WALCHUK STEPHAN V 2014202 9999999 B 10 1295022945 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1295022945 0 Physicians Anesthesia Services 20 1295022945 0 Physicians Healthy Kids Services 20 1295022945 0 Physicians Optical Supplies 20 1295022945 0 Physicians Physician Services 00 1295023604 0 SIDDIQI SAAMER M 2014258 9999999 B 10 1295023604 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1295023604 0 Physicians Anesthesia Services 20 1295023604 0 Physicians Fluoride varnish 20 1295023604 0 Physicians Healthy Kids Services 20 1295023604 0 Physicians Optical Supplies 20 1295023604 0 Physicians Physician Services 00 1295023836 0 BALDWIN MORGAN 2014078 9999999 B 10 1295023836 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1295023836 0 Nurse Practitioners Fluoride varnish 20 1295023836 0 Nurse Practitioners Healthy Kids Services 20 1295023836 0 Nurse Practitioners Nurse Practitioners Services 20 1295023836 0 Nurse Practitioners Physician Services 00 1295024453 0 DE BIASI ANDREAS 2020232 9999999 B 10 1295024453 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1295024453 0 Physicians Anesthesia Services 20 1295024453 0 Physicians Healthy Kids Services 20 1295024453 0 Physicians Optical Supplies 20 1295024453 0 Physicians Physician Services 00 1295024826 0 KORESSEL LINDSAY 2014070 9999999 B 10 1295024826 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1295024826 0 Physicians Anesthesia Services 20 1295024826 0 Physicians Fluoride varnish 20 1295024826 0 Physicians Healthy Kids Services 20 1295024826 0 Physicians Optical Supplies 20 1295024826 0 Physicians Physician Services 00 1295025245 0 RUBIN JONAH 2014182 9999999 B 10 1295025245 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1295025245 0 Physicians Anesthesia Services 20 1295025245 0 Physicians Fluoride varnish 20 1295025245 0 Physicians Healthy Kids Services 20 1295025245 0 Physicians Optical Supplies 20 1295025245 0 Physicians Physician Services 00 1295025393 0 GIESELMAN KATHRYN 2023365 9999999 B 10 1295025393 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1295025393 0 Physicians Anesthesia Services 20 1295025393 0 Physicians Fluoride varnish 20 1295025393 0 Physicians Healthy Kids Services 20 1295025393 0 Physicians Optical Supplies 20 1295025393 0 Physicians Physician Services 00 1295025534 0 CONE JENNIFER T 2017213 9999999 B 10 1295025534 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1295025534 0 Physicians Anesthesia Services 20 1295025534 0 Physicians Healthy Kids Services 20 1295025534 0 Physicians Optical Supplies 20 1295025534 0 Physicians Physician Services 00 1295026441 0 DELANEY KRISTIE S 2016337 9999999 B 10 1295026441 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1295026441 0 Physicians Anesthesia Services 20 1295026441 0 Physicians Fluoride varnish 20 1295026441 0 Physicians Healthy Kids Services 20 1295026441 0 Physicians Optical Supplies 20 1295026441 0 Physicians Physician Services 00 1295027498 0 CHAUDHARY HAROON 2015320 9999999 B 10 1295027498 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1295027498 0 Physicians Anesthesia Services 20 1295027498 0 Physicians Fluoride varnish 20 1295027498 0 Physicians Healthy Kids Services 20 1295027498 0 Physicians Optical Supplies 20 1295027498 0 Physicians Physician Services 00 1295027662 0 BETCHER HANNAH K 2018192 9999999 B 10 1295027662 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1295027662 0 Physicians Anesthesia Services 20 1295027662 0 Physicians Healthy Kids Services 20 1295027662 0 Physicians Optical Supplies 20 1295027662 0 Physicians Physician Services 20 1295027662 0 Physicians Physicians Psychiatric Services 00 1295027696 0 BYRNE MARGARET 2021137 9999999 B 10 1295027696 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1295027696 0 Physicians Anesthesia Services 20 1295027696 0 Physicians Fluoride varnish 20 1295027696 0 Physicians Healthy Kids Services 20 1295027696 0 Physicians Optical Supplies 20 1295027696 0 Physicians Physician Services 00 1295027704 0 KIRTANE NEHA NAVSARIA 2015182 9999999 B 10 1295027704 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1295027704 0 Psychologist Psychologist service 00 1295028256 0 MAYBERRY KOHL 2022316 9999999 B 10 1295028256 0 5777 DEPT CAROL STREAM IL 601228942 20 1295028256 0 Physicians Anesthesia Services 20 1295028256 0 Physicians Healthy Kids Services 20 1295028256 0 Physicians Optical Supplies 20 1295028256 0 Physicians Physician Services 20 1295028256 0 Physicians Physicians Psychiatric Services 00 1295028876 0 FLEMING ELIZABETH A 2022047 9999999 B 10 1295028876 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1295028876 0 Physicians Anesthesia Services 20 1295028876 0 Physicians Fluoride varnish 20 1295028876 0 Physicians Healthy Kids Services 20 1295028876 0 Physicians Optical Supplies 20 1295028876 0 Physicians Physician Services 00 1295029270 0 GHADIALI LARISSA 2017285 9999999 B 10 1295029270 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1295029270 0 Physicians Anesthesia Services 20 1295029270 0 Physicians Healthy Kids Services 20 1295029270 0 Physicians Optical Supplies 20 1295029270 0 Physicians Physician Services 00 1295029510 0 ROSSI NICHOLAS B 2019032 9999999 B 10 1295029510 0 107 TREMONT ST P O BOX 267 HOPEDALE IL 617477525 20 1295029510 0 Physicians Anesthesia Services 20 1295029510 0 Physicians Healthy Kids Services 20 1295029510 0 Physicians Optical Supplies 20 1295029510 0 Physicians Physician Services 00 1295029601 0 JOHNSON MERI M 2017058 9999999 B 10 1295029601 0 18167 US HIGHWAY 19 N STE 650 CLEARWATER FL 337646576 20 1295029601 0 Physicians Anesthesia Services 20 1295029601 0 Physicians Healthy Kids Services 20 1295029601 0 Physicians Optical Supplies 20 1295029601 0 Physicians Physician Services 00 1295031102 0 HIM MALI 2020205 9999999 B 10 1295031102 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1295031102 0 Physicians Anesthesia Services 20 1295031102 0 Physicians Fluoride varnish 20 1295031102 0 Physicians Healthy Kids Services 20 1295031102 0 Physicians Optical Supplies 20 1295031102 0 Physicians Physician Services 00 1295031128 0 POUNDERS MELISSA 2011059 9999999 B 10 1295031128 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1295031128 0 Nurse Practitioners Fluoride varnish 20 1295031128 0 Nurse Practitioners Healthy Kids Services 20 1295031128 0 Nurse Practitioners Nurse Practitioners Services 20 1295031128 0 Nurse Practitioners Physician Services 00 1295031342 0 GENUALDI LISA 2015032 9999999 B 10 1295031342 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1295031342 0 Nurse Practitioners Fluoride varnish 20 1295031342 0 Nurse Practitioners Healthy Kids Services 20 1295031342 0 Nurse Practitioners Nurse Practitioners Services 20 1295031342 0 Nurse Practitioners Physician Services 00 1295032555 0 MADUEKE-LAVEAUX OBIANUJU S 2017243 9999999 B 10 1295032555 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1295032555 0 Physicians Anesthesia Services 20 1295032555 0 Physicians Healthy Kids Services 20 1295032555 0 Physicians Optical Supplies 20 1295032555 0 Physicians Physician Services 00 1295034478 0 JAIN ROHAN K 2016202 9999999 B 10 1295034478 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1295034478 0 Physicians Anesthesia Services 20 1295034478 0 Physicians Healthy Kids Services 20 1295034478 0 Physicians Optical Supplies 20 1295034478 0 Physicians Physician Services 00 1295034569 0 LIU LUZHENG 2015223 9999999 B 10 1295034569 0 PO BOX 6685 CAROL STREAM IL 601976685 20 1295034569 0 Physicians Anesthesia Services 20 1295034569 0 Physicians Healthy Kids Services 20 1295034569 0 Physicians Optical Supplies 20 1295034569 0 Physicians Physician Services 00 1295034759 0 DAWOOD ALTAF 2018197 9999999 B 10 1295034759 0 PO BOX 4028 ROCK ISLAND IL 612044028 20 1295034759 0 Physicians Anesthesia Services 20 1295034759 0 Physicians Fluoride varnish 20 1295034759 0 Physicians Healthy Kids Services 20 1295034759 0 Physicians Optical Supplies 20 1295034759 0 Physicians Physician Services 00 1295034874 0 TARULLO DAVID M 2020297 9999999 B 10 1295034874 0 1233 E 2ND ST CASPER WY 826012926 20 1295034874 0 Physicians Anesthesia Services 20 1295034874 0 Physicians Healthy Kids Services 20 1295034874 0 Physicians Optical Supplies 20 1295034874 0 Physicians Physician Services 00 1295036457 0 SCHULTZ KATELYN J 2017307 9999999 B 10 1295036457 0 5777 DEPT CAROL STREAM IL 601220021 20 1295036457 0 Physician Assistant Only Fluoride varnish 20 1295036457 0 Physician Assistant Only Healthy Kids Services 20 1295036457 0 Physician Assistant Only Physician Services 00 1295036846 0 FRIEDMAN NANCY A 2017305 9999999 B 10 1295036846 0 1740 WAUKEGAN RD STE 10 GLENVIEW IL 600252157 20 1295036846 0 Other behavior health professional LCPC/LMFT services 00 1295036945 0 YOO MOONJA 2015300 9999999 B 10 1295036945 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1295036945 0 Nurse Practitioners Healthy Kids Services 20 1295036945 0 Nurse Practitioners Nurse Practitioners Services 20 1295036945 0 Nurse Practitioners Physician Services 00 1295039865 0 YAZICI CEMAL 2017095 9999999 B 10 1295039865 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1295039865 0 Physicians Anesthesia Services 20 1295039865 0 Physicians Fluoride varnish 20 1295039865 0 Physicians Healthy Kids Services 20 1295039865 0 Physicians Optical Supplies 20 1295039865 0 Physicians Physician Services 00 1295039873 0 WHEELER LYNN 2011001 9999999 B 10 1295039873 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1295039873 0 Nurse Practitioners Healthy Kids Services 20 1295039873 0 Nurse Practitioners Nurse Practitioners Services 20 1295039873 0 Nurse Practitioners Physician Services 00 1295042125 0 ANAENE MUTIMBWA J 2016214 9999999 B 10 1295042125 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1295042125 0 Physicians Anesthesia Services 20 1295042125 0 Physicians Fluoride varnish 20 1295042125 0 Physicians Healthy Kids Services 20 1295042125 0 Physicians Optical Supplies 20 1295042125 0 Physicians Physician Services 00 1295042422 0 WITT KRISTA N 2016228 9999999 B 10 1295042422 0 2111 OGDEN AVE AURORA IL 605047597 20 1295042422 0 Physician Assistant Only Fluoride varnish 20 1295042422 0 Physician Assistant Only Healthy Kids Services 20 1295042422 0 Physician Assistant Only Physician Services 00 1295042539 0 KALRA ANKUR 2023009 9999999 B 10 1295042539 0 PO BOX 781076 DETROIT MI 482781076 20 1295042539 0 Physicians Anesthesia Services 20 1295042539 0 Physicians Fluoride varnish 20 1295042539 0 Physicians Healthy Kids Services 20 1295042539 0 Physicians Optical Supplies 20 1295042539 0 Physicians Physician Services 00 1295044972 0 SELIGER JANE M 1995182 9999999 B 10 1295044972 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1295044972 0 Nurse Practitioners Healthy Kids Services 20 1295044972 0 Nurse Practitioners Nurse Practitioners Services 20 1295044972 0 Nurse Practitioners Physician Services 00 1295045425 0 WILSON MATTHEW 2013335 9999999 B 10 1295045425 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1295045425 0 Nurse Practitioners Fluoride varnish 20 1295045425 0 Nurse Practitioners Healthy Kids Services 20 1295045425 0 Nurse Practitioners Nurse Practitioners Services 20 1295045425 0 Nurse Practitioners Physician Services 00 1295046332 0 RUSINAK JACQUELINE THEODORA 2015268 9999999 B 10 1295046332 0 29373 NETWORK PL CHICAGO IL 606733039 20 1295046332 0 Physicians Anesthesia Services 20 1295046332 0 Physicians Healthy Kids Services 20 1295046332 0 Physicians Optical Supplies 20 1295046332 0 Physicians Physician Services 00 1295046795 0 MANLOVE ASHLEY 2016201 9999999 B 10 1295046795 0 611 W PARK ST URBANA IL 618012529 20 1295046795 0 Dentists Dental Services 20 1295046795 0 Dentists Physician Services 00 1295047306 0 SINGH GUNDEEP 2010309 9999999 B 10 1295047306 0 519 N CASS AVE STE 102 WESTMONT IL 605591589 20 1295047306 0 Dentists Dental Services 20 1295047306 0 Dentists Physician Services 00 1295047553 0 WEYER GEORGE W 2014182 9999999 B 10 1295047553 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1295047553 0 Physicians Anesthesia Services 20 1295047553 0 Physicians Fluoride varnish 20 1295047553 0 Physicians Healthy Kids Services 20 1295047553 0 Physicians Optical Supplies 20 1295047553 0 Physicians Physician Services 00 1295048031 0 COYNE CHARLES P 2019091 9999999 B 10 1295048031 0 16555 MANCHESTER RD STE 110 GROVER MO 630401220 20 1295048031 0 Physicians Anesthesia Services 20 1295048031 0 Physicians Fluoride varnish 20 1295048031 0 Physicians Healthy Kids Services 20 1295048031 0 Physicians Optical Supplies 20 1295048031 0 Physicians Physician Services 00 1295048411 0 TAHA AMJAD 2013182 9999999 B 10 1295048411 0 1701 LACEY ST CAPE GIRARDEAU MO 637015230 20 1295048411 0 Physicians Anesthesia Services 20 1295048411 0 Physicians Fluoride varnish 20 1295048411 0 Physicians Healthy Kids Services 20 1295048411 0 Physicians Optical Supplies 20 1295048411 0 Physicians Physician Services 00 1295049146 0 THAPA CHINIYA 2016242 9999999 B 10 1295049146 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1295049146 0 Physicians Anesthesia Services 20 1295049146 0 Physicians Fluoride varnish 20 1295049146 0 Physicians Healthy Kids Services 20 1295049146 0 Physicians Optical Supplies 20 1295049146 0 Physicians Physician Services 00 1295049260 0 EMAMI AMIR 2021222 9999999 B 10 1295049260 0 2250 N ILLINOIS AVE CARBONDALE IL 629015612 20 1295049260 0 Physicians Anesthesia Services 20 1295049260 0 Physicians Fluoride varnish 20 1295049260 0 Physicians Healthy Kids Services 20 1295049260 0 Physicians Optical Supplies 20 1295049260 0 Physicians Physician Services 00 1295049377 0 JAWAD AHMED 2017219 9999999 B 10 1295049377 0 1418 COLLEGE DR MOUNT CARMEL IL 628632638 20 1295049377 0 Physicians Anesthesia Services 20 1295049377 0 Physicians Fluoride varnish 20 1295049377 0 Physicians Healthy Kids Services 20 1295049377 0 Physicians Optical Supplies 20 1295049377 0 Physicians Physician Services 00 1295049732 0 RAHAL RIMA 2016153 9999999 B 10 1295049732 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1295049732 0 Physicians Anesthesia Services 20 1295049732 0 Physicians Healthy Kids Services 20 1295049732 0 Physicians Optical Supplies 20 1295049732 0 Physicians Physician Services 00 1295049849 0 CARINO JOSEPH L 2017027 9999999 B 10 1295049849 0 6801 BRECKSVILLE RD INDEPENDENCE OH 441315032 20 1295049849 0 Nurse Practitioners Healthy Kids Services 20 1295049849 0 Nurse Practitioners Nurse Practitioners Services 20 1295049849 0 Nurse Practitioners Physician Services 00 1295050763 0 PLANT ASHLEY S 2020111 9999999 B 10 1295050763 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1295050763 0 Physicians Anesthesia Services 20 1295050763 0 Physicians Fluoride varnish 20 1295050763 0 Physicians Healthy Kids Services 20 1295050763 0 Physicians Optical Supplies 20 1295050763 0 Physicians Physician Services 00 1295050946 0 MURPHY PAUL 2021338 9999999 B 10 1295050946 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1295050946 0 Physicians Anesthesia Services 20 1295050946 0 Physicians Healthy Kids Services 20 1295050946 0 Physicians Optical Supplies 20 1295050946 0 Physicians Physician Services 00 1295051548 0 GAO ENQUAN 2014230 9999999 B 10 1295051548 0 500 PORTER AVE AURORA MO 656052365 20 1295051548 0 Physicians Anesthesia Services 20 1295051548 0 Physicians Healthy Kids Services 20 1295051548 0 Physicians Optical Supplies 20 1295051548 0 Physicians Physician Services 20 1295051548 0 Physicians Physicians Psychiatric Services 00 1295051670 0 HORNYAK ALISON 2021300 9999999 B 10 1295051670 0 29373 NETWORK PL CHICAGO IL 606733039 20 1295051670 0 Physicians Anesthesia Services 20 1295051670 0 Physicians Fluoride varnish 20 1295051670 0 Physicians Healthy Kids Services 20 1295051670 0 Physicians Optical Supplies 20 1295051670 0 Physicians Physician Services 00 1295051860 0 BARRY SHEILA M 2016092 9999999 B 10 1295051860 0 901 MCCLINTOCK DR 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1295052389 0 Physical Therapists Medical Supplies 20 1295052389 0 Physical Therapists Medical equipment/prosthetic devices 20 1295052389 0 Physical Therapists Physical Therapy Services 00 1295052611 0 HYSINGER ERIK 2016336 9999999 B 10 1295052611 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1295052611 0 Physicians Anesthesia Services 20 1295052611 0 Physicians Fluoride varnish 20 1295052611 0 Physicians Healthy Kids Services 20 1295052611 0 Physicians Optical Supplies 20 1295052611 0 Physicians Physician Services 00 1295053106 0 TRIVEDI SETU D 2017133 9999999 B 10 1295053106 0 801 S WASHINGTON ST NAPERVILLE IL 605407430 20 1295053106 0 Physicians Anesthesia Services 20 1295053106 0 Physicians Fluoride varnish 20 1295053106 0 Physicians Healthy Kids Services 20 1295053106 0 Physicians Optical Supplies 20 1295053106 0 Physicians Physician Services 00 1295053395 0 GAUNTT JENNIFER M 2019063 9999999 B 10 1295053395 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1295053395 0 Physicians 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1295097103 0 2100 POWELL ST EMERYVILLE CA 946081826 20 1295097103 0 Physicians Anesthesia Services 20 1295097103 0 Physicians Healthy Kids Services 20 1295097103 0 Physicians Optical Supplies 20 1295097103 0 Physicians Physician Services 00 1295097822 0 WOLF MICHAEL 2023069 9999999 B 10 1295097822 0 DEPT AT 40379 ATLANTA GA 311920379 20 1295097822 0 Physicians Anesthesia Services 20 1295097822 0 Physicians Fluoride varnish 20 1295097822 0 Physicians Healthy Kids Services 20 1295097822 0 Physicians Optical Supplies 20 1295097822 0 Physicians Physician Services 00 1295098416 0 DICKEY TYLER 2023119 9999999 B 10 1295098416 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1295098416 0 Physicians Anesthesia Services 20 1295098416 0 Physicians Healthy Kids Services 20 1295098416 0 Physicians Optical Supplies 20 1295098416 0 Physicians Physician Services 00 1295098457 0 GREMIDA ANAS 2020183 9999999 B 10 1295098457 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 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1295112282 0 Physicians Optical Supplies 20 1295112282 0 Physicians Physician Services 00 1295113249 0 SCHNITKER CALLIE 2021302 9999999 B 10 1295113249 0 8170 33RD AVE S MINNEAPOLIS MN 554254516 20 1295113249 0 Physicians Anesthesia Services 20 1295113249 0 Physicians Healthy Kids Services 20 1295113249 0 Physicians Optical Supplies 20 1295113249 0 Physicians Physician Services 00 1295114668 0 NEUMAN ALEXANDER 2016004 9999999 B 10 1295114668 0 75 REMITTANCE DR DEPT 1620 SUITE 1620 CHICAGO IL 606751620 20 1295114668 0 Physicians Anesthesia Services 20 1295114668 0 Physicians Fluoride varnish 20 1295114668 0 Physicians Healthy Kids Services 20 1295114668 0 Physicians Optical Supplies 20 1295114668 0 Physicians Physician Services 00 1295114932 0 REDDY AMULYA R 2024235 9999999 B 10 1295114932 0 5777 DEPT CAROL STREAM IL 601220021 20 1295114932 0 Physicians Anesthesia Services 20 1295114932 0 Physicians Fluoride varnish 20 1295114932 0 Physicians Healthy Kids Services 20 1295114932 0 Physicians Optical Supplies 20 1295114932 0 Physicians Physician Services 00 1295115038 0 FLACK CHANDRA 2023307 9999999 B 10 1295115038 0 PO BOX 781076 DETROIT MI 482781076 20 1295115038 0 Physicians Anesthesia Services 20 1295115038 0 Physicians Healthy Kids Services 20 1295115038 0 Physicians Optical Supplies 20 1295115038 0 Physicians Physician Services 00 1295115079 0 FENTON GREGORY 2020009 9999999 B 10 1295115079 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1295115079 0 Physicians Anesthesia Services 20 1295115079 0 Physicians Healthy Kids Services 20 1295115079 0 Physicians Optical Supplies 20 1295115079 0 Physicians Physician Services 20 1295115079 0 Physicians Physicians Psychiatric Services 00 1295115236 0 CRASE DOUGLAS 2020291 9999999 B 10 1295115236 0 PO BOX 43230 PHOENIX AZ 850803230 20 1295115236 0 Physicians Anesthesia Services 20 1295115236 0 Physicians Fluoride varnish 20 1295115236 0 Physicians Healthy Kids Services 20 1295115236 0 Physicians Optical Supplies 20 1295115236 0 Physicians Physician Services 00 1295115913 0 PATEL NEIL B 2017069 9999999 B 10 1295115913 0 3601 SW 160TH AVE STE 250 SUITE 250 MIRAMAR FL 330276314 20 1295115913 0 Physicians Anesthesia Services 20 1295115913 0 Physicians Healthy Kids Services 20 1295115913 0 Physicians Optical Supplies 20 1295115913 0 Physicians Physician Services 00 1295116374 0 BRANHAM DAPHNE 2020289 9999999 B 10 1295116374 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1295116374 0 Physicians Anesthesia Services 20 1295116374 0 Physicians Fluoride varnish 20 1295116374 0 Physicians Healthy Kids Services 20 1295116374 0 Physicians Optical Supplies 20 1295116374 0 Physicians Physician Services 00 1295116879 0 HANSEN BRADFORD C 2020055 9999999 B 10 1295116879 0 PO BOX 43 MINNEAPOLIS MN 554400043 20 1295116879 0 Physicians Anesthesia Services 20 1295116879 0 Physicians Healthy Kids Services 20 1295116879 0 Physicians Optical Supplies 20 1295116879 0 Physicians Physician Services 00 1295118420 0 NAHHAS NOOR 2015295 9999999 B 10 1295118420 0 14130 S 88TH AVE ORLAND PARK IL 604624194 20 1295118420 0 Dentists Dental Services 20 1295118420 0 Dentists Physician Services 00 1295118610 0 ABBINANTE MARIE 2017067 9999999 B 10 1295118610 0 3 N MAIN ST MANTENO IL 609501534 20 1295118610 0 Nurse Practitioners Healthy Kids Services 20 1295118610 0 Nurse Practitioners Nurse Practitioners Services 20 1295118610 0 Nurse Practitioners Physician Services 00 1295118735 0 WAGNER AMALYA A 2019016 9999999 B 10 1295118735 0 164 S PROSPECT AVE PARK RIDGE IL 600684035 20 1295118735 0 Speech Therapists Medical Supplies 20 1295118735 0 Speech Therapists Medical equipment/prosthetic devices 20 1295118735 0 Speech Therapists Speech Therapy/Pathology Services 00 1295118792 0 ROCKETTE ALISHA 2025021 9999999 B 10 1295118792 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1295118792 0 Physicians Anesthesia Services 20 1295118792 0 Physicians Healthy Kids Services 20 1295118792 0 Physicians Optical Supplies 20 1295118792 0 Physicians Physician Services 00 1295119253 0 WILLIAMS DAWN 2018081 9999999 B 10 1295119253 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1295119253 0 Clinical Social Worker Social work service 00 1295120137 0 DOGGETTE ROBERT 2021154 9999999 B 10 1295120137 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1295120137 0 Physicians Anesthesia Services 20 1295120137 0 Physicians Healthy Kids Services 20 1295120137 0 Physicians Optical Supplies 20 1295120137 0 Physicians Physician Services 00 1295120517 0 PELEG YONATAN 2021187 9999999 B 10 1295120517 0 5777 DEPT CAROL STREAM IL 601220021 20 1295120517 0 Physicians Anesthesia Services 20 1295120517 0 Physicians Fluoride varnish 20 1295120517 0 Physicians Healthy Kids Services 20 1295120517 0 Physicians Optical Supplies 20 1295120517 0 Physicians Physician Services 00 1295120541 0 WEI PEI-KANG 2024122 9999999 B 10 1295120541 0 PO BOX 43230 PHOENIX AZ 850803230 20 1295120541 0 Physicians Anesthesia Services 20 1295120541 0 Physicians Healthy Kids Services 20 1295120541 0 Physicians Optical Supplies 20 1295120541 0 Physicians Physician Services 00 1295121127 0 KOHLI ANEM N 2019219 9999999 B 10 1295121127 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1295121127 0 Physicians Anesthesia Services 20 1295121127 0 Physicians Healthy Kids Services 20 1295121127 0 Physicians Optical Supplies 20 1295121127 0 Physicians Physician Services 20 1295121127 0 Physicians Physicians Psychiatric Services 00 1295121341 0 KHAN SHEBA 2017025 9999999 B 10 1295121341 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112323 20 1295121341 0 Dentists Dental Services 20 1295121341 0 Dentists Physician Services 00 1295121358 0 DYMALA ANNA M 2019091 9999999 B 10 1295121358 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1295121358 0 Physicians Anesthesia Services 20 1295121358 0 Physicians Fluoride varnish 20 1295121358 0 Physicians Healthy Kids Services 20 1295121358 0 Physicians Optical Supplies 20 1295121358 0 Physicians Physician Services 00 1295121960 0 BREDENBERG ERIN L 2020172 9999999 B 10 1295121960 0 PO BOX 110429 AURORA CO 800420429 20 1295121960 0 Physicians Anesthesia Services 20 1295121960 0 Physicians Fluoride varnish 20 1295121960 0 Physicians Healthy Kids Services 20 1295121960 0 Physicians Optical Supplies 20 1295121960 0 Physicians Physician Services 00 1295121986 0 WENTLAND ANDREW 2020153 9999999 B 10 1295121986 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1295121986 0 Physicians Anesthesia Services 20 1295121986 0 Physicians Healthy Kids Services 20 1295121986 0 Physicians Optical Supplies 20 1295121986 0 Physicians Physician Services 00 1295122182 0 STERKEN DAVID 2019244 9999999 B 10 1295122182 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1295122182 0 Physicians Anesthesia Services 20 1295122182 0 Physicians Healthy Kids Services 20 1295122182 0 Physicians Optical Supplies 20 1295122182 0 Physicians Physician Services 00 1295122299 0 DIONISIO CORISSA E 2021043 9999999 B 10 1295122299 0 PO BOX 778912 CHICAGO IL 606778912 20 1295122299 0 Physicians Anesthesia Services 20 1295122299 0 Physicians Healthy Kids Services 20 1295122299 0 Physicians Optical Supplies 20 1295122299 0 Physicians Physician Services 20 1295122299 0 Physicians Physicians Psychiatric Services 00 1295122745 0 IDREES THAER 2018348 9999999 B 10 1295122745 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1295122745 0 Physicians Anesthesia Services 20 1295122745 0 Physicians Fluoride varnish 20 1295122745 0 Physicians Healthy Kids Services 20 1295122745 0 Physicians Optical Supplies 20 1295122745 0 Physicians Physician Services 00 1295124766 0 KENTER MELISSA 2015057 9999999 B 10 1295124766 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1295124766 0 Nurse Practitioners All Kids application agent 20 1295124766 0 Nurse Practitioners Fluoride varnish 20 1295124766 0 Nurse Practitioners Healthy Kids Services 20 1295124766 0 Nurse Practitioners Nurse Practitioners Services 20 1295124766 0 Nurse Practitioners Physician Services 00 1295127470 0 DOBBINS SARAH J 2017163 9999999 B 10 1295127470 0 3600 W FULLERTON AVE ATTN: BILLING DEPARTMENT CHICAGO IL 606472319 20 1295127470 0 Nurse Practitioners Healthy Kids Services 20 1295127470 0 Nurse Practitioners Midwife Services 20 1295127470 0 Nurse Practitioners Nurse Practitioners Services 20 1295127470 0 Nurse Practitioners Physician Services 00 1295128049 0 ESPINOSA ANETA M 2019298 9999999 B 10 1295128049 0 4346 N WOLCOTT AVE CHICAGO IL 606131020 20 1295128049 0 Occupational Therapists Medical Supplies 20 1295128049 0 Occupational Therapists Medical equipment/prosthetic devices 20 1295128049 0 Occupational Therapists Occupational Therapy Services 00 1295128098 0 ROY ANNA 2018079 9999999 B 10 1295128098 0 850 W IRVING PARK RD CHICAGO IL 606133077 20 1295128098 0 Nurse Practitioners Healthy Kids Services 20 1295128098 0 Nurse Practitioners Nurse Practitioners Services 20 1295128098 0 Nurse Practitioners Physician Services 00 1295128148 0 FLUHLER BRITTANY N 2016343 9999999 B 10 1295128148 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1295128148 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1295129161 0 GOLDFARB BRITTNEY E 2015102 9999999 B 10 1295129161 0 5777 DEPT CAROL STREAM IL 601220021 20 1295129161 0 Nurse Practitioners Healthy Kids Services 20 1295129161 0 Nurse Practitioners Nurse Practitioners Services 20 1295129161 0 Nurse Practitioners Physician Services 00 1295129187 0 CAMPBELL COURTNEY M 2021167 9999999 B 10 1295129187 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1295129187 0 Physicians Anesthesia Services 20 1295129187 0 Physicians Fluoride varnish 20 1295129187 0 Physicians Healthy Kids Services 20 1295129187 0 Physicians Optical Supplies 20 1295129187 0 Physicians Physician Services 00 1295129310 0 BAUBLY KATHRYN 2018182 9999999 B 10 1295129310 0 103 N HAVEN RD FL 2 ELMHURST IL 601262973 20 1295129310 0 Physicians Anesthesia Services 20 1295129310 0 Physicians Fluoride varnish 20 1295129310 0 Physicians Healthy Kids Services 20 1295129310 0 Physicians Optical Supplies 20 1295129310 0 Physicians Physician Services 00 1295129732 0 PHAN DONNA T 2020147 9999999 B 10 1295129732 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1295129732 0 Nurse Practitioners Fluoride varnish 20 1295129732 0 Nurse Practitioners Healthy Kids Services 20 1295129732 0 Nurse Practitioners Nurse Practitioners Services 20 1295129732 0 Nurse Practitioners Physician Services 00 1295132074 0 NOWIK RENATA 2000333 9999999 B 10 1295132074 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1295132074 0 Physical Therapists Medical Supplies 20 1295132074 0 Physical Therapists Medical equipment/prosthetic devices 20 1295132074 0 Physical Therapists Physical Therapy Services 00 1295132199 0 BRITTON ALYSSA 2017096 9999999 B 10 1295132199 0 3471 EAGLE WAY CHICAGO IL 606781034 20 1295132199 0 Physician Assistant Only Fluoride varnish 20 1295132199 0 Physician Assistant Only Healthy Kids Services 20 1295132199 0 Physician Assistant Only Physician Services 00 1295133106 0 VOGT ELIZABETH 2015026 9999999 B 10 1295133106 0 201 W MULBERRY ST CHATHAM IL 626291329 20 1295133106 0 Speech Therapists Medical Supplies 20 1295133106 0 Speech Therapists Medical equipment/prosthetic devices 20 1295133106 0 Speech Therapists Speech Therapy/Pathology Services 00 1295134377 0 CHAUDHARY AMINAH A 2017109 9999999 B 10 1295134377 0 1467 N ELSTON AVE STE 103 CHICAGO IL 606422449 20 1295134377 0 Occupational Therapists Medical Supplies 20 1295134377 0 Occupational Therapists Medical equipment/prosthetic devices 20 1295134377 0 Occupational Therapists Occupational Therapy Services 00 1295134484 0 HIBINO NARUTOSHI 2019152 9999999 B 10 1295134484 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1295134484 0 Physicians Anesthesia Services 20 1295134484 0 Physicians Healthy Kids Services 20 1295134484 0 Physicians Optical Supplies 20 1295134484 0 Physicians Physician Services 00 1295135051 0 SAINT-CYR MARTINE 2021326 9999999 B 10 1295135051 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1295135051 0 Physicians Anesthesia Services 20 1295135051 0 Physicians Fluoride varnish 20 1295135051 0 Physicians Healthy Kids Services 20 1295135051 0 Physicians Optical Supplies 20 1295135051 0 Physicians Physician Services 00 1295135473 0 MILES BETH 2020099 9999999 B 10 1295135473 0 PO BOX 1510 EVANSVILLE IN 477061510 20 1295135473 0 Nurse Practitioners Fluoride varnish 20 1295135473 0 Nurse Practitioners Healthy Kids Services 20 1295135473 0 Nurse Practitioners Nurse Practitioners Services 20 1295135473 0 Nurse Practitioners Physician Services 00 1295137271 0 AUBREY MARY L 2020064 9999999 B 10 1295137271 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1295137271 0 Nurse Practitioners Fluoride varnish 20 1295137271 0 Nurse Practitioners Healthy Kids Services 20 1295137271 0 Nurse Practitioners Nurse Practitioners Services 20 1295137271 0 Nurse Practitioners Physician Services 00 1295137842 0 HUNTER SHERIVA 2014282 9999999 B 10 1295137842 0 PO BOX 73488 PUYALLUP WA 983730488 20 1295137842 0 Nurse Practitioners Fluoride varnish 20 1295137842 0 Nurse Practitioners Healthy Kids Services 20 1295137842 0 Nurse Practitioners Nurse Practitioners Services 20 1295137842 0 Nurse Practitioners Physician Services 00 1295138279 0 HANISCH KATELIN L 2015243 9999999 B 10 1295138279 0 1049 E WILSON ST STE 100 SUITE 100 BATAVIA IL 605102478 20 1295138279 0 Speech Therapists Medical Supplies 20 1295138279 0 Speech Therapists Medical equipment/prosthetic devices 20 1295138279 0 Speech Therapists Speech Therapy/Pathology Services 00 1295138782 0 CHARLES PATRICK 2025021 9999999 B 10 1295138782 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1295138782 0 Physicians Anesthesia Services 20 1295138782 0 Physicians Healthy Kids Services 20 1295138782 0 Physicians Optical Supplies 20 1295138782 0 Physicians Physician Services 00 1295140143 0 CHANDRA SIDHARTH 2017075 9999999 B 10 1295140143 0 4241 HIGHWAY 14 W PO BOX 155 CHRISTOPHER IL 628221037 20 1295140143 0 Physicians Anesthesia Services 20 1295140143 0 Physicians Fluoride varnish 20 1295140143 0 Physicians Healthy Kids Services 20 1295140143 0 Physicians Optical Supplies 20 1295140143 0 Physicians Physician Services 20 1295140143 0 Physicians Physicians Psychiatric Services 00 1295140291 0 GERAMINEGAD PARISA 2017194 9999999 B 10 1295140291 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1295140291 0 Physicians Anesthesia Services 20 1295140291 0 Physicians Fluoride varnish 20 1295140291 0 Physicians Healthy Kids Services 20 1295140291 0 Physicians Optical Supplies 20 1295140291 0 Physicians Physician Services 00 1295140309 0 PARK PAUL J 2018183 9999999 B 10 1295140309 0 7421 N MILWAUKEE AVE NILES IL 607143707 20 1295140309 0 Physicians Anesthesia Services 20 1295140309 0 Physicians Healthy Kids Services 20 1295140309 0 Physicians Optical Supplies 20 1295140309 0 Physicians Physician Services 00 1295140960 0 LAWLOR MEGAN 2018182 9999999 B 10 1295140960 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1295140960 0 Physicians Anesthesia Services 20 1295140960 0 Physicians Healthy Kids Services 20 1295140960 0 Physicians Optical Supplies 20 1295140960 0 Physicians Physician Services 00 1295141398 0 NORFOLK AMY 2020177 9999999 B 10 1295141398 0 8311 ROOSEVELT RD FOREST PARK IL 601302529 20 1295141398 0 Other behavior health professional LCPC/LMFT services 00 1295141471 0 MARINO KARA 2014223 9999999 B 10 1295141471 0 221 NE GLEN OAK AVE ATTN: STEPHEN CIRONE GOMP 100 PEORIA IL 616360001 20 1295141471 0 Nurse Practitioners Healthy Kids Services 20 1295141471 0 Nurse Practitioners Nurse Practitioners Services 20 1295141471 0 Nurse Practitioners Physician Services 00 1295141703 0 FOUST ALEXANDRA 2023140 9999999 B 10 1295141703 0 DEPT AT 40379 ATLANTA GA 311920379 20 1295141703 0 Physicians Anesthesia Services 20 1295141703 0 Physicians Fluoride varnish 20 1295141703 0 Physicians Healthy Kids Services 20 1295141703 0 Physicians Optical Supplies 20 1295141703 0 Physicians Physician Services 00 1295142131 0 MAKKI ISSA 2017163 9999999 B 10 1295142131 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1295142131 0 Physicians Anesthesia Services 20 1295142131 0 Physicians Fluoride varnish 20 1295142131 0 Physicians Healthy Kids Services 20 1295142131 0 Physicians Optical Supplies 20 1295142131 0 Physicians Physician Services 00 1295142891 0 SAFAVINEJAD SADAF 2014214 9999999 B 10 1295142891 0 370 SUMMIT ST # 1 ELGIN IL 601203843 20 1295142891 0 Dentists Dental Services 20 1295142891 0 Dentists Physician Services 00 1295143675 0 LEE YI-SHAN 2016183 9999999 B 10 1295143675 0 4320 FOREST PARK AVE STE 209 4320 FOREST PARK AVE SAINT LOUIS MO 631082979 20 1295143675 0 Physicians Anesthesia Services 20 1295143675 0 Physicians Healthy Kids Services 20 1295143675 0 Physicians Optical Supplies 20 1295143675 0 Physicians Physician Services 00 1295143725 0 HEGDE SHRUTI S 2020169 9999999 B 10 1295143725 0 201 E MADISON ST STE 300 SPRINGFIELD IL 627025131 20 1295143725 0 Physicians Anesthesia Services 20 1295143725 0 Physicians Fluoride varnish 20 1295143725 0 Physicians Healthy Kids Services 20 1295143725 0 Physicians Optical Supplies 20 1295143725 0 Physicians Physician Services 00 1295143915 0 PATEL AVANI 2016270 9999999 B 10 1295143915 0 1137 N EOLA RD STE 109 AURORA IL 605027097 20 1295143915 0 Dentists Dental Services 20 1295143915 0 Dentists Physician Services 00 1295145050 0 ZAMBRANO ANDREINA 2018192 9999999 B 10 1295145050 0 250 W 96TH ST STE 520 INDIANAPOLIS IN 462601317 20 1295145050 0 Physicians Anesthesia Services 20 1295145050 0 Physicians Healthy Kids Services 20 1295145050 0 Physicians Optical Supplies 20 1295145050 0 Physicians Physician Services 00 1295145167 0 ORGAN BROOKE E 2021251 9999999 B 10 1295145167 0 2041 GOOSE LAKE RD SAUGET IL 622062822 20 1295145167 0 Physicians Anesthesia Services 20 1295145167 0 Physicians Fluoride varnish 20 1295145167 0 Physicians Healthy Kids Services 20 1295145167 0 Physicians Optical Supplies 20 1295145167 0 Physicians Physician Services 00 1295146421 0 ALI ARFAA HADI 2017182 9999999 B 10 1295146421 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1295146421 0 Physicians Anesthesia Services 20 1295146421 0 Physicians Fluoride varnish 20 1295146421 0 Physicians Healthy Kids Services 20 1295146421 0 Physicians Optical Supplies 20 1295146421 0 Physicians Physician Services 00 1295146587 0 HENKLE SARAH 2019039 9999999 B 10 1295146587 0 1220 S WOOD ST CHICAGO IL 606081202 20 1295146587 0 Physicians Anesthesia Services 20 1295146587 0 Physicians Fluoride varnish 20 1295146587 0 Physicians Healthy Kids Services 20 1295146587 0 Physicians Optical Supplies 20 1295146587 0 Physicians Physician Services 00 1295147767 0 PIKE TALMAGE E 2014261 9999999 B 10 1295147767 0 PO BOX 776084 CHICAGO IL 606776084 20 1295147767 0 Nurse Practitioners Anesthesia Services 20 1295147767 0 Nurse Practitioners Nurse Practitioners Services 20 1295147767 0 Nurse Practitioners Physician Services 00 1295149284 0 FLETCHER MICHELLE L 2017194 9999999 B 10 1295149284 0 5777 DEPT CAROL STREAM IL 601220021 20 1295149284 0 Physicians Anesthesia Services 20 1295149284 0 Physicians Fluoride varnish 20 1295149284 0 Physicians Healthy Kids Services 20 1295149284 0 Physicians Optical Supplies 20 1295149284 0 Physicians Physician Services 00 1295149318 0 RODRIGUEZ ZICCARDI MARY CAROLI 2018182 9999999 B 10 1295149318 0 1919 W TAYLOR ST CHICAGO IL 606127246 20 1295149318 0 Physicians All Kids application agent 20 1295149318 0 Physicians Anesthesia Services 20 1295149318 0 Physicians Fluoride varnish 20 1295149318 0 Physicians Healthy Kids Services 20 1295149318 0 Physicians Optical Supplies 20 1295149318 0 Physicians Physician Services 00 1295149409 0 HAAMID AMEERA 2018001 9999999 B 10 1295149409 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1295149409 0 Physicians Anesthesia Services 20 1295149409 0 Physicians Healthy Kids Services 20 1295149409 0 Physicians Optical Supplies 20 1295149409 0 Physicians Physician Services 00 1295149797 0 GEORGE WILLIAM 2024255 9999999 B 10 1295149797 0 35318 EAGLE WAY CHICAGO IL 606781353 20 1295149797 0 Physicians Anesthesia Services 20 1295149797 0 Physicians Healthy Kids Services 20 1295149797 0 Physicians Optical Supplies 20 1295149797 0 Physicians Physician Services 20 1295149797 0 Physicians Physicians Psychiatric Services 00 1295149920 0 MUNMUN MUNJERINA 2022215 9999999 B 10 1295149920 0 1021 N MULFORD RD ROCKFORD IL 611073874 20 1295149920 0 Physicians Anesthesia Services 20 1295149920 0 Physicians Healthy Kids Services 20 1295149920 0 Physicians Optical Supplies 20 1295149920 0 Physicians Physician Services 20 1295149920 0 Physicians Physicians Psychiatric Services 00 1295151967 0 BROGAN JAMIE T 2014062 9999999 B 10 1295151967 0 5777 DEPT CAROL STREAM IL 601220021 20 1295151967 0 Nurse Practitioners Fluoride varnish 20 1295151967 0 Nurse Practitioners Healthy Kids Services 20 1295151967 0 Nurse Practitioners Nurse Practitioners Services 20 1295151967 0 Nurse Practitioners Physician Services 00 1295151983 0 LORIMER KATHERINE E 2014156 9999999 B 10 1295151983 0 2045 W GRAND AVE STE B CHICAGO IL 606121577 20 1295151983 0 Nurse Practitioners Fluoride varnish 20 1295151983 0 Nurse Practitioners Healthy Kids Services 20 1295151983 0 Nurse Practitioners Nurse Practitioners Services 20 1295151983 0 Nurse Practitioners Physician Services 00 1295152155 0 PATEL SAURABHKUMAR 2017171 9999999 B 10 1295152155 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1295152155 0 Physicians Anesthesia Services 20 1295152155 0 Physicians Fluoride varnish 20 1295152155 0 Physicians Healthy Kids Services 20 1295152155 0 Physicians Optical Supplies 20 1295152155 0 Physicians Physician Services 00 1295152205 0 HUANG EVELYN 2017184 9999999 B 10 1295152205 0 1000 MEDICAL CENTER DR MONTICELLO IL 618562116 20 1295152205 0 Physicians Anesthesia Services 20 1295152205 0 Physicians Fluoride varnish 20 1295152205 0 Physicians Healthy Kids Services 20 1295152205 0 Physicians Optical Supplies 20 1295152205 0 Physicians Physician Services 00 1295152494 0 SPRAGUE JENNIFER M 2018149 9999999 B 10 1295152494 0 29373 NETWORK PL CHICAGO IL 606733039 20 1295152494 0 Physicians Anesthesia Services 20 1295152494 0 Physicians Healthy Kids Services 20 1295152494 0 Physicians Optical Supplies 20 1295152494 0 Physicians Physician Services 20 1295152494 0 Physicians Physicians Psychiatric Services 00 1295153039 0 KIRKPATRICK DANIEL 2024032 9999999 B 10 1295153039 0 3621 S STATE ST ANN ARBOR MI 481081633 20 1295153039 0 Physicians Anesthesia Services 20 1295153039 0 Physicians Healthy Kids Services 20 1295153039 0 Physicians Optical Supplies 20 1295153039 0 Physicians Physician Services 00 1295153047 0 PRIGGE ANDREW 2019266 9999999 B 10 1295153047 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1295153047 0 Physicians Anesthesia Services 20 1295153047 0 Physicians Fluoride varnish 20 1295153047 0 Physicians Healthy Kids Services 20 1295153047 0 Physicians Optical Supplies 20 1295153047 0 Physicians Physician Services 00 1295153583 0 KLEINSCHMIDT PETER 2017136 9999999 B 10 1295153583 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1295153583 0 Physicians Anesthesia Services 20 1295153583 0 Physicians Fluoride varnish 20 1295153583 0 Physicians Healthy Kids Services 20 1295153583 0 Physicians Optical Supplies 20 1295153583 0 Physicians Physician Services 00 1295153922 0 ASHU MUNJUM RICHARD 2017210 9999999 B 10 1295153922 0 200 STAHLHUT DR LINCOLN IL 626565066 20 1295153922 0 Physicians Anesthesia Services 20 1295153922 0 Physicians Fluoride varnish 20 1295153922 0 Physicians Healthy Kids Services 20 1295153922 0 Physicians Optical Supplies 20 1295153922 0 Physicians Physician Services 00 1295154052 0 GOLDSTEIN JEFFERY A 2018113 9999999 B 10 1295154052 0 5777 DEPT CAROL STREAM IL 601220021 20 1295154052 0 Physicians Anesthesia Services 20 1295154052 0 Physicians Healthy Kids Services 20 1295154052 0 Physicians Optical Supplies 20 1295154052 0 Physicians Physician Services 00 1295154177 0 PORT ARIELLE N 2017205 9999999 B 10 1295154177 0 2333 W IRVING PARK RD CHICAGO IL 606183838 20 1295154177 0 Physicians Anesthesia Services 20 1295154177 0 Physicians Healthy Kids Services 20 1295154177 0 Physicians Optical Supplies 20 1295154177 0 Physicians Physician Services 00 1295154367 0 POWNELL BRANDY R 2019183 9999999 B 10 1295154367 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1295154367 0 Physicians Anesthesia Services 20 1295154367 0 Physicians Healthy Kids Services 20 1295154367 0 Physicians Optical Supplies 20 1295154367 0 Physicians Physician Services 00 1295155000 0 MATTHEWS GENEVIEVE CATHERINE 2018213 9999999 B 10 1295155000 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1295155000 0 Physicians Anesthesia Services 20 1295155000 0 Physicians Fluoride varnish 20 1295155000 0 Physicians Healthy Kids Services 20 1295155000 0 Physicians Optical Supplies 20 1295155000 0 Physicians Physician Services 00 1295155026 0 DELBECCARO MELANIE E 2017093 9999999 B 10 1295155026 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1295155026 0 Physicians Anesthesia Services 20 1295155026 0 Physicians Healthy Kids Services 20 1295155026 0 Physicians Optical Supplies 20 1295155026 0 Physicians Physician Services 00 1295155596 0 LEAF SAMUEL 2020284 9999999 B 10 1295155596 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1295155596 0 Physicians Anesthesia Services 20 1295155596 0 Physicians Healthy Kids Services 20 1295155596 0 Physicians Optical Supplies 20 1295155596 0 Physicians Physician Services 00 1295155646 0 CARABALLO CHRISTINA 2018187 9999999 B 10 1295155646 0 4400 W 95TH ST STE 308 OAK LAWN IL 604532660 20 1295155646 0 Physician Assistant Only Fluoride varnish 20 1295155646 0 Physician Assistant Only Healthy Kids Services 20 1295155646 0 Physician 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0 Nurse Practitioners Fluoride varnish 20 1295159846 0 Nurse Practitioners Healthy Kids Services 20 1295159846 0 Nurse Practitioners Nurse Practitioners Services 20 1295159846 0 Nurse Practitioners Physician Services 00 1295160364 0 POINDEXTER JON 2013239 9999999 B 10 1295160364 0 1925 N CLYBOURN AVE CHICAGO IL 606144946 20 1295160364 0 Other behavior health professional LCPC/LMFT services 00 1295162592 0 WEIS JAMIE K 2023251 9999999 B 10 1295162592 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1295162592 0 Nurse Practitioners Fluoride varnish 20 1295162592 0 Nurse Practitioners Healthy Kids Services 20 1295162592 0 Nurse Practitioners Nurse Practitioners Services 20 1295162592 0 Nurse Practitioners Physician Services 00 1295162840 0 SEMEYN MARTA Z 2014213 9999999 B 10 1295162840 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1295162840 0 Nurse Practitioners Healthy Kids Services 20 1295162840 0 Nurse Practitioners Nurse Practitioners Services 20 1295162840 0 Nurse Practitioners 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1295168896 0 Physicians Healthy Kids Services 20 1295168896 0 Physicians Optical Supplies 20 1295168896 0 Physicians Physician Services 00 1295169324 0 NORDSTROM ANNETTA M 2013284 9999999 B 10 1295169324 0 PO BOX 1455 DES MOINES IA 503061455 20 1295169324 0 Nurse Practitioners Fluoride varnish 20 1295169324 0 Nurse Practitioners Healthy Kids Services 20 1295169324 0 Nurse Practitioners Nurse Practitioners Services 20 1295169324 0 Nurse Practitioners Physician Services 00 1295171023 0 PAINTER KATHERINE C 2019074 9999999 B 10 1295171023 0 211 N BROADWAY GOREVILLE IL 629392323 20 1295171023 0 Physicians Anesthesia Services 20 1295171023 0 Physicians Family Planning Counseling 20 1295171023 0 Physicians Fluoride varnish 20 1295171023 0 Physicians Healthy Kids Services 20 1295171023 0 Physicians Optical Supplies 20 1295171023 0 Physicians Physician Services 00 1295171189 0 LAGER COREY 2018194 9999999 B 10 1295171189 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1295171189 0 Physicians 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00 1295173466 0 ELEZI ARLINDA 2013335 9999999 B 10 1295173466 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1295173466 0 Physicians Anesthesia Services 20 1295173466 0 Physicians Fluoride varnish 20 1295173466 0 Physicians Healthy Kids Services 20 1295173466 0 Physicians Optical Supplies 20 1295173466 0 Physicians Physician Services 00 1295173565 0 SEWARD SHERADEN 2022077 9999999 B 10 1295173565 0 PO BOX 1327 BROOKFIELD WI 530081327 20 1295173565 0 Physicians Anesthesia Services 20 1295173565 0 Physicians Fluoride varnish 20 1295173565 0 Physicians Healthy Kids Services 20 1295173565 0 Physicians Optical Supplies 20 1295173565 0 Physicians Physician Services 00 1295173730 0 BATTAGLIOLI NICOLE 2024061 9999999 B 10 1295173730 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1295173730 0 Physicians Anesthesia Services 20 1295173730 0 Physicians Healthy Kids Services 20 1295173730 0 Physicians Optical Supplies 20 1295173730 0 Physicians Physician Services 00 1295173821 0 SCALVA 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Practitioners Nurse Practitioners Services 20 1295379543 0 Nurse Practitioners Physician Services 00 1295380152 0 CANO CLAUDELIA 2019330 9999999 B 10 1295380152 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1295380152 0 Nurse Practitioners Family Planning Counseling 20 1295380152 0 Nurse Practitioners Fluoride varnish 20 1295380152 0 Nurse Practitioners Healthy Kids Services 20 1295380152 0 Nurse Practitioners Nurse Practitioners Services 20 1295380152 0 Nurse Practitioners Physician Services 00 1295380178 0 KUCHER WHITNEY A 2022147 9999999 B 10 1295380178 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1295380178 0 Physician Assistant Only Fluoride varnish 20 1295380178 0 Physician Assistant Only Healthy Kids Services 20 1295380178 0 Physician Assistant Only Physician Services 00 1295380277 0 KHALAF WASEEM 2020344 9999999 H 10 1295380277 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1295380277 0 Other behavior health professional Other Behavioral Health Services 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KRATSCHMER CHRISTINA 2019166 9999999 B 10 1295396224 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1295396224 0 Physicians Anesthesia Services 20 1295396224 0 Physicians Fluoride varnish 20 1295396224 0 Physicians Healthy Kids Services 20 1295396224 0 Physicians Optical Supplies 20 1295396224 0 Physicians Physician Services 00 1295396844 0 THOMPSON JEREMY M 2019177 9999999 B 10 1295396844 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1295396844 0 Physicians Anesthesia Services 20 1295396844 0 Physicians Healthy Kids Services 20 1295396844 0 Physicians Optical Supplies 20 1295396844 0 Physicians Physician Services 00 1295397388 0 LEE DAVID 2019002 9999999 B 10 1295397388 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1295397388 0 Physicians Anesthesia Services 20 1295397388 0 Physicians Healthy Kids Services 20 1295397388 0 Physicians Optical Supplies 20 1295397388 0 Physicians Physician Services 00 1295397446 0 OLLIE JOAN 2022090 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behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1295464543 0 KOCON PAULINA 2022193 9999999 B 10 1295464543 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1295464543 0 Audiologists Audiology Services 20 1295464543 0 Audiologists Medical Supplies 20 1295464543 0 Audiologists Medical equipment/prosthetic devices 00 1295465466 0 KUPSKY GENEVIEVE G 2022200 9999999 B 10 1295465466 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1295465466 0 Physicians Anesthesia Services 20 1295465466 0 Physicians Healthy Kids Services 20 1295465466 0 Physicians Optical Supplies 20 1295465466 0 Physicians Physician Services 20 1295465466 0 Physicians Physicians Psychiatric Services 00 1295465565 0 AREVALO HEINERY 2023103 9999999 B 10 1295465565 0 231 N BOLINGBROOK DR STE A BOLINGBROOK IL 604401960 20 1295465565 0 Dentists Dental Services 20 1295465565 0 Dentists Physician Services 00 1295466183 0 ANWAR MUHAMMAD TAYYAB 2022258 9999999 B 10 1295466183 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1295466183 0 Physicians Anesthesia Services 20 1295466183 0 Physicians Fluoride varnish 20 1295466183 0 Physicians Healthy Kids Services 20 1295466183 0 Physicians Optical Supplies 20 1295466183 0 Physicians Physician Services 00 1295466894 0 LAMOUR MARY JACQUES 2022187 2025181 B 10 1295466894 0 611 W PARK ST URBANA IL 618012529 20 1295466894 0 Physicians Anesthesia Services 20 1295466894 0 Physicians Fluoride varnish 20 1295466894 0 Physicians Healthy Kids Services 20 1295466894 0 Physicians Optical Supplies 20 1295466894 0 Physicians Physician Services 00 1295467603 0 GHOLSON ERIN 2022244 9999999 B 10 1295467603 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1295467603 0 Nurse Practitioners Healthy Kids Services 20 1295467603 0 Nurse Practitioners Nurse Practitioners Services 20 1295467603 0 Nurse Practitioners Physician Services 00 1295467652 0 DOUDNIKOFF ALEXANDER L 2024190 9999999 B 10 1295467652 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1295467652 0 Physicians Anesthesia Services 20 1295467652 0 Physicians Healthy Kids Services 20 1295467652 0 Physicians Optical Supplies 20 1295467652 0 Physicians Physician Services 00 1295468874 0 FAKHRAN NADINE S 2023208 9999999 B 10 1295468874 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1295468874 0 Physician Assistant Only Fluoride varnish 20 1295468874 0 Physician Assistant Only Healthy Kids Services 20 1295468874 0 Physician Assistant Only Physician Services 00 1295469138 0 EAGEN LAURA A 2022200 9999999 H 10 1295469138 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1295469138 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1295470763 0 NEHER FREDERICK J 2022203 9999999 B 10 1295470763 0 7600 W COLLEGE DR STE 9 PALOS HEIGHTS IL 604631039 20 1295470763 0 Optometrists Optical Supplies 20 1295470763 0 Optometrists Optometric Services 20 1295470763 0 Optometrists Physician Services 00 1295472900 0 BLACKWELL ANDREA C 2022255 9999999 B 10 1295472900 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1295472900 0 Nurse Practitioners Fluoride varnish 20 1295472900 0 Nurse Practitioners Healthy Kids Services 20 1295472900 0 Nurse Practitioners Nurse Practitioners Services 20 1295472900 0 Nurse Practitioners Physician Services 00 1295473122 0 SMITH TARVIES D 2022233 9999999 B 10 1295473122 0 11740 S WESTERN AVE CHICAGO IL 606434732 20 1295473122 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1295473239 0 CARTER KRISTA 2023189 9999999 B 10 1295473239 0 10208 S INDIANAPOLIS AVE # 301 CHICAGO IL 606176033 20 1295473239 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1295473296 0 VAN RYN MARYANN 2023318 9999999 B 10 1295473296 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1295473296 0 Nurse Practitioners Fluoride varnish 20 1295473296 0 Nurse Practitioners Healthy Kids Services 20 1295473296 0 Nurse Practitioners Nurse Practitioners Services 20 1295473296 0 Nurse Practitioners Physician Services 00 1295473551 0 THAKKAR SANJANA 2023114 9999999 B 10 1295473551 0 398 W ARMY TRAIL RD STE 118 BLOOMINGDALE IL 601082398 20 1295473551 0 Nurse Practitioners Fluoride varnish 20 1295473551 0 Nurse Practitioners Healthy Kids Services 20 1295473551 0 Nurse Practitioners Nurse Practitioners Services 20 1295473551 0 Nurse Practitioners Physician Services 00 1295475515 0 NWACHUKWU DEXTER E 2022199 9999999 B 10 1295475515 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1295475515 0 Physicians Anesthesia Services 20 1295475515 0 Physicians Fluoride varnish 20 1295475515 0 Physicians Healthy Kids Services 20 1295475515 0 Physicians Optical Supplies 20 1295475515 0 Physicians Physician Services 00 1295476224 0 BOROOSAN AVRAHAN T 2022208 9999999 B 10 1295476224 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1295476224 0 Physicians Anesthesia Services 20 1295476224 0 Physicians Healthy Kids Services 20 1295476224 0 Physicians Optical Supplies 20 1295476224 0 Physicians Physician Services 00 1295476513 0 KORTE ADAM GO 2022192 9999999 B 10 1295476513 0 PO BOX 3039 OAK BROOK IL 605223039 20 1295476513 0 Physicians Anesthesia Services 20 1295476513 0 Physicians Fluoride varnish 20 1295476513 0 Physicians Healthy Kids Services 20 1295476513 0 Physicians Optical Supplies 20 1295476513 0 Physicians Physician Services 00 1295477529 0 GHINAZZI MARGARET 2024012 9999999 B 10 1295477529 0 302 N JACKSON ST MILWAUKEE WI 532025904 20 1295477529 0 Nurse Practitioners Healthy Kids Services 20 1295477529 0 Nurse Practitioners Nurse Practitioners Services 20 1295477529 0 Nurse Practitioners Physician Services 00 1295477578 0 SIMSEK BERIN 2022181 9999999 B 10 1295477578 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1295477578 0 Physician Assistant Only Fluoride varnish 20 1295477578 0 Physician Assistant Only Healthy Kids Services 20 1295477578 0 Physician Assistant Only Physician Services 00 1295477784 0 DEMETRIOUS MATTHEW G 2023191 9999999 B 10 1295477784 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1295477784 0 Physicians Anesthesia Services 20 1295477784 0 Physicians Healthy Kids Services 20 1295477784 0 Physicians Optical Supplies 20 1295477784 0 Physicians Physician Services 00 1295478311 0 ATHAPPILLY JEAN G 2022192 9999999 B 10 1295478311 0 5250 OLD ORCHARD RD STE 300 SKOKIE IL 600774462 20 1295478311 0 Nurse Practitioners Healthy Kids Services 20 1295478311 0 Nurse Practitioners Nurse Practitioners Services 20 1295478311 0 Nurse Practitioners Physician Services 00 1295478535 0 BUI AN 2022205 9999999 B 10 1295478535 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1295478535 0 Physicians Anesthesia Services 20 1295478535 0 Physicians Healthy Kids Services 20 1295478535 0 Physicians Optical Supplies 20 1295478535 0 Physicians Physician Services 00 1295478550 0 GAJJAR ROHAN A 2022210 9999999 B 10 1295478550 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1295478550 0 Physicians Anesthesia Services 20 1295478550 0 Physicians Fluoride varnish 20 1295478550 0 Physicians Healthy Kids Services 20 1295478550 0 Physicians Optical Supplies 20 1295478550 0 Physicians Physician Services 00 1295479566 0 CLEAVENGER KYLIE A 2022226 9999999 B 10 1295479566 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1295479566 0 Physicians Anesthesia Services 20 1295479566 0 Physicians Fluoride varnish 20 1295479566 0 Physicians Healthy Kids Services 20 1295479566 0 Physicians Optical Supplies 20 1295479566 0 Physicians Physician Services 00 1295481471 0 PORER SUZANNE 2023131 9999999 B 10 1295481471 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1295481471 0 Nurse Practitioners Fluoride varnish 20 1295481471 0 Nurse Practitioners Healthy Kids Services 20 1295481471 0 Nurse Practitioners Nurse Practitioners Services 20 1295481471 0 Nurse Practitioners Physician Services 00 1295483485 0 SANTIAGO GAIA 2023175 9999999 B 10 1295483485 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1295483485 0 Physicians Anesthesia Services 20 1295483485 0 Physicians Healthy Kids Services 20 1295483485 0 Physicians Optical Supplies 20 1295483485 0 Physicians Physician Services 00 1295483865 0 KRISHNAN PRANAV 2023209 9999999 B 10 1295483865 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1295483865 0 Physicians Anesthesia Services 20 1295483865 0 Physicians Healthy Kids Services 20 1295483865 0 Physicians Optical Supplies 20 1295483865 0 Physicians Physician Services 00 1295484012 0 WHITEHEAD REBECKA 2022136 9999999 B 10 1295484012 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1295484012 0 Licensed Practical Nurses Nursing service 00 1295484186 0 WILSON OLIVIA A 2022172 9999999 B 10 1295484186 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1295484186 0 Physicians Anesthesia Services 20 1295484186 0 Physicians Healthy Kids Services 20 1295484186 0 Physicians Optical Supplies 20 1295484186 0 Physicians Physician Services 00 1295485647 0 CHANG JAIMIE 2022193 9999999 B 10 1295485647 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1295485647 0 Physicians Anesthesia Services 20 1295485647 0 Physicians Healthy Kids Services 20 1295485647 0 Physicians Optical Supplies 20 1295485647 0 Physicians Physician Services 00 1295485837 0 POSEN MATTHEW E 2022182 9999999 B 10 1295485837 0 PO BOX 3039 OAK BROOK IL 605223039 20 1295485837 0 Physicians Anesthesia Services 20 1295485837 0 Physicians Fluoride varnish 20 1295485837 0 Physicians Healthy Kids Services 20 1295485837 0 Physicians Optical Supplies 20 1295485837 0 Physicians Physician Services 00 1295485969 0 SANCHEZ-ATO LUIS ANDRES 2022179 9999999 B 10 1295485969 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1295485969 0 Physicians Anesthesia Services 20 1295485969 0 Physicians Fluoride varnish 20 1295485969 0 Physicians Healthy Kids Services 20 1295485969 0 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Physicians Optical Supplies 20 1295760593 0 Physicians Physician Services 00 1295760692 0 QIAN XIAOTAO 2003041 9999999 B 10 1295760692 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1295760692 0 Physicians Anesthesia Services 20 1295760692 0 Physicians Healthy Kids Services 20 1295760692 0 Physicians Optical Supplies 20 1295760692 0 Physicians Physician Services 00 1295761088 0 GONZALEZ DEL REY JAVIER 2010043 9999999 B 10 1295761088 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1295761088 0 Physicians Anesthesia Services 20 1295761088 0 Physicians Fluoride varnish 20 1295761088 0 Physicians Healthy Kids Services 20 1295761088 0 Physicians Optical Supplies 20 1295761088 0 Physicians Physician Services 00 1295761484 0 RIZWAN SHAFEEQUR 2016035 9999999 B 10 1295761484 0 1044 N FRANCISCO AVE CHICAGO IL 606222743 20 1295761484 0 Physicians Anesthesia Services 20 1295761484 0 Physicians Fluoride varnish 20 1295761484 0 Physicians Healthy Kids Services 20 1295761484 0 Physicians Optical Supplies 20 1295761484 0 Physicians Physician Services 00 1295761724 0 LENDERMAN MELISSA 2018226 9999999 B 10 1295761724 0 1025 MAINE ST QUINCY IL 623014038 20 1295761724 0 Physician Assistant Only Fluoride varnish 20 1295761724 0 Physician Assistant Only Healthy Kids Services 20 1295761724 0 Physician Assistant Only Physician Services 00 1295762045 0 JANECEK GWENDOLYN A 2005318 9999999 B 10 1295762045 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1295762045 0 Nurse Practitioners Anesthesia Services 20 1295762045 0 Nurse Practitioners Nurse Practitioners Services 20 1295762045 0 Nurse Practitioners Physician Services 00 1295762151 0 IRFAN TARIQ 2007151 9999999 B 10 1295762151 0 PO BOX 43230 PHOENIX AZ 850803230 20 1295762151 0 Physicians Anesthesia Services 20 1295762151 0 Physicians Healthy Kids Services 20 1295762151 0 Physicians Optical Supplies 20 1295762151 0 Physicians Physician Services 20 1295762151 0 Physicians Physicians Psychiatric Services 00 1295762649 0 DAGOSTINO ANTHONY M 1981227 9999999 B 10 1295762649 0 PO BOX 17632 BELFAST ME 049154071 20 1295762649 0 Physicians Anesthesia Services 20 1295762649 0 Physicians Healthy Kids Services 20 1295762649 0 Physicians Optical Supplies 20 1295762649 0 Physicians Physician Services 20 1295762649 0 Physicians Physicians Psychiatric Services 00 1295762797 0 THOMAS JOHN 2024061 9999999 B 10 1295762797 0 DEPT AT 40379 ATLANTA GA 311920379 20 1295762797 0 Physicians Anesthesia Services 20 1295762797 0 Physicians Healthy Kids Services 20 1295762797 0 Physicians Optical Supplies 20 1295762797 0 Physicians Physician Services 00 1295763704 0 DIXON KIMBERLY F 2008076 9999999 B 10 1295763704 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1295763704 0 Physicians Anesthesia Services 20 1295763704 0 Physicians Fluoride varnish 20 1295763704 0 Physicians Healthy Kids Services 20 1295763704 0 Physicians Optical Supplies 20 1295763704 0 Physicians Physician Services 00 1295763787 0 CRUZ MICHAEL A 1990182 9999999 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0 Physicians Anesthesia Services 20 1295777480 0 Physicians Healthy Kids Services 20 1295777480 0 Physicians Optical Supplies 20 1295777480 0 Physicians Physician Services 00 1295777563 0 LESKOSKY LOUIS A 2001292 9999999 B 10 1295777563 0 PO BOX 3272 INDIANAPOLIS IN 462063272 20 1295777563 0 Physicians Anesthesia Services 20 1295777563 0 Physicians Healthy Kids Services 20 1295777563 0 Physicians Optical Supplies 20 1295777563 0 Physicians Physician Services 00 1295778090 0 FERNANDEZ JORGE A 2022144 9999999 B 10 1295778090 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1295778090 0 Physicians Anesthesia Services 20 1295778090 0 Physicians Healthy Kids Services 20 1295778090 0 Physicians Optical Supplies 20 1295778090 0 Physicians Physician Services 00 1295778272 0 DIAZ JOSE 2005215 9999999 B 10 1295778272 0 PO BOX 43230 PHOENIX AZ 850803230 20 1295778272 0 Physicians Anesthesia Services 20 1295778272 0 Physicians Fluoride varnish 20 1295778272 0 Physicians Healthy Kids Services 20 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0 Physicians Optical Supplies 20 1295778801 0 Physicians Physician Services 00 1295779064 0 BRECKBILL DON 2023135 9999999 B 10 1295779064 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1295779064 0 Physicians Anesthesia Services 20 1295779064 0 Physicians Healthy Kids Services 20 1295779064 0 Physicians Optical Supplies 20 1295779064 0 Physicians Physician Services 00 1295779239 0 ISONIEMI MARK 2000262 9999999 B 10 1295779239 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1295779239 0 Physicians Anesthesia Services 20 1295779239 0 Physicians Fluoride varnish 20 1295779239 0 Physicians Healthy Kids Services 20 1295779239 0 Physicians Optical Supplies 20 1295779239 0 Physicians Physician Services 00 1295779627 0 NOSBISCH MICHAEL 2021034 9999999 B 10 1295779627 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1295779627 0 Nurse Practitioners Anesthesia Services 20 1295779627 0 Nurse Practitioners Nurse Practitioners Services 20 1295779627 0 Nurse Practitioners Physician Services 00 1295779775 0 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Physicians Anesthesia Services 20 1295785293 0 Physicians Fluoride varnish 20 1295785293 0 Physicians Healthy Kids Services 20 1295785293 0 Physicians Optical Supplies 20 1295785293 0 Physicians Physician Services 00 1295785400 0 SARNO RONALD A 2018176 9999999 B 10 1295785400 0 1431 CENTERPOINT BLVD STE 100 KNOXVILLE TN 379321983 20 1295785400 0 Physicians Anesthesia Services 20 1295785400 0 Physicians Healthy Kids Services 20 1295785400 0 Physicians Optical Supplies 20 1295785400 0 Physicians Physician Services 00 1295785723 0 BARBOI ALEXANDRU C 1997121 9999999 B 10 1295785723 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1295785723 0 Physicians Anesthesia Services 20 1295785723 0 Physicians Healthy Kids Services 20 1295785723 0 Physicians Optical Supplies 20 1295785723 0 Physicians Physician Services 20 1295785723 0 Physicians Physicians Psychiatric Services 00 1295785756 0 THOMAS CATHERINE S 1997121 9999999 B 10 1295785756 0 5777 DEPT CAROL STREAM IL 601228942 20 1295785756 0 Physicians Anesthesia Services 20 1295785756 0 Physicians Fluoride varnish 20 1295785756 0 Physicians Healthy Kids Services 20 1295785756 0 Physicians Optical Supplies 20 1295785756 0 Physicians Physician Services 00 1295786366 0 PAGE CYNTHIA A 1996214 9999999 B 10 1295786366 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1295786366 0 Physicians Anesthesia Services 20 1295786366 0 Physicians Healthy Kids Services 20 1295786366 0 Physicians Optical Supplies 20 1295786366 0 Physicians Physician Services 00 1295786952 0 REEDY JEREMIAH S 1997182 9999999 B 10 1295786952 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1295786952 0 Physicians Anesthesia Services 20 1295786952 0 Physicians Fluoride varnish 20 1295786952 0 Physicians Healthy Kids Services 20 1295786952 0 Physicians Optical Supplies 20 1295786952 0 Physicians Physician Services 00 1295786994 0 IRWIN TRACY 2006352 9999999 B 10 1295786994 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1295786994 0 Physicians Anesthesia Services 20 1295786994 0 Physicians Family Planning Counseling 20 1295786994 0 Physicians Healthy Kids Services 20 1295786994 0 Physicians Optical Supplies 20 1295786994 0 Physicians Physician Services 00 1295787299 0 BANERJEE DIPANJAN 2024061 9999999 B 10 1295787299 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1295787299 0 Physicians Anesthesia Services 20 1295787299 0 Physicians Fluoride varnish 20 1295787299 0 Physicians Healthy Kids Services 20 1295787299 0 Physicians Optical Supplies 20 1295787299 0 Physicians Physician Services 00 1295787422 0 AKHTER SYED 2006258 9999999 B 10 1295787422 0 205 W RANDOLPH ST STE 2222 CHICAGO IL 606061814 20 1295787422 0 Physicians Anesthesia Services 20 1295787422 0 Physicians Healthy Kids Services 20 1295787422 0 Physicians Optical Supplies 20 1295787422 0 Physicians Physician Services 00 1295788875 0 DANEK BEATA 1993001 9999999 B 10 1295788875 0 5545 N MILWAUKEE AVE CHICAGO IL 606301226 20 1295788875 0 Physicians All Kids application agent 20 1295788875 0 Physicians Anesthesia Services 20 1295788875 0 Physicians Fluoride varnish 20 1295788875 0 Physicians Healthy Kids Services 20 1295788875 0 Physicians Optical Supplies 20 1295788875 0 Physicians Physician Services 00 1295789410 0 JARA AUDREY 2022040 9999999 B 10 1295789410 0 246 OAKHURST CIR KISSIMMEE FL 347444752 20 1295789410 0 Physicians Anesthesia Services 20 1295789410 0 Physicians Fluoride varnish 20 1295789410 0 Physicians Healthy Kids Services 20 1295789410 0 Physicians Optical Supplies 20 1295789410 0 Physicians Physician Services 00 1295789576 0 DAVENPORT MICHAEL 2007092 9999999 B 10 1295789576 0 1201 PINE ST ELDORADO IL 629301634 20 1295789576 0 Nurse Practitioners Fluoride varnish 20 1295789576 0 Nurse Practitioners Healthy Kids Services 20 1295789576 0 Nurse Practitioners Nurse Practitioners Services 20 1295789576 0 Nurse Practitioners Physician Services 00 1295789618 0 JARA CESAR A 2023027 9999999 B 10 1295789618 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1295789618 0 Physicians Anesthesia Services 20 1295789618 0 Physicians Fluoride varnish 20 1295789618 0 Physicians Healthy Kids Services 20 1295789618 0 Physicians Optical Supplies 20 1295789618 0 Physicians Physician Services 00 1295789972 0 TSIMERINOV EVGENY 2016209 9999999 B 10 1295789972 0 10275 LITTLE PATUXENT PKWY STE COLUMBIA MD 210443445 20 1295789972 0 Physicians Anesthesia Services 20 1295789972 0 Physicians Healthy Kids Services 20 1295789972 0 Physicians Optical Supplies 20 1295789972 0 Physicians Physician Services 20 1295789972 0 Physicians Physicians Psychiatric Services 00 1295790525 0 AHMED AZAM 2012336 9999999 B 10 1295790525 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1295790525 0 Physicians Anesthesia Services 20 1295790525 0 Physicians Healthy Kids Services 20 1295790525 0 Physicians Optical Supplies 20 1295790525 0 Physicians Physician Services 00 1295790756 0 MCPHAIL PAULA K 2020035 9999999 B 10 1295790756 0 3200 E CAMELBACK RD STE 250 PHOENIX AZ 850182327 20 1295790756 0 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Services 20 1295940906 0 Nurse Practitioners Physician Services 00 1295942670 0 VORA AVNI 2015335 9999999 B 10 1295942670 0 5777 DEPT CAROL STREAM IL 601228942 20 1295942670 0 Physicians Anesthesia Services 20 1295942670 0 Physicians Fluoride varnish 20 1295942670 0 Physicians Healthy Kids Services 20 1295942670 0 Physicians Optical Supplies 20 1295942670 0 Physicians Physician Services 00 1295944163 0 KHAN ABDUL S 2007182 9999999 B 10 1295944163 0 6308 8TH AVE KENOSHA WI 531435031 20 1295944163 0 Physicians Anesthesia Services 20 1295944163 0 Physicians Fluoride varnish 20 1295944163 0 Physicians Healthy Kids Services 20 1295944163 0 Physicians Optical Supplies 20 1295944163 0 Physicians Physician Services 00 1295946218 0 LAUX DOUGLAS E 2014296 9999999 B 10 1295946218 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1295946218 0 Physicians Anesthesia Services 20 1295946218 0 Physicians Fluoride varnish 20 1295946218 0 Physicians Healthy Kids Services 20 1295946218 0 Physicians Optical 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522421009 20 1306040472 0 Physicians Anesthesia Services 20 1306040472 0 Physicians Fluoride varnish 20 1306040472 0 Physicians Healthy Kids Services 20 1306040472 0 Physicians Optical Supplies 20 1306040472 0 Physicians Physician Services 00 1306040498 0 DEKA VIKRAM J 2025027 9999999 B 10 1306040498 0 PO BOX 41220 PHOENIX AZ 850801220 20 1306040498 0 Physicians Anesthesia Services 20 1306040498 0 Physicians Healthy Kids Services 20 1306040498 0 Physicians Optical Supplies 20 1306040498 0 Physicians Physician Services 00 1306040985 0 NAGARAJ PANKAJ 2018199 9999999 B 10 1306040985 0 350 N GRANDVIEW AVE DUBUQUE IA 520016388 20 1306040985 0 Physicians Anesthesia Services 20 1306040985 0 Physicians Fluoride varnish 20 1306040985 0 Physicians Healthy Kids Services 20 1306040985 0 Physicians Optical Supplies 20 1306040985 0 Physicians Physician Services 00 1306041660 0 HANNA EYAD M 2003182 9999999 B 10 1306041660 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1306041660 0 Physicians Anesthesia 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BOX 776084 CHICAGO IL 606776084 20 1306050273 0 Physicians Anesthesia Services 20 1306050273 0 Physicians Fluoride varnish 20 1306050273 0 Physicians Healthy Kids Services 20 1306050273 0 Physicians Optical Supplies 20 1306050273 0 Physicians Physician Services 00 1306050877 0 OMOTOSHO PHILIP 2015152 9999999 B 10 1306050877 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1306050877 0 Physicians Anesthesia Services 20 1306050877 0 Physicians Healthy Kids Services 20 1306050877 0 Physicians Optical Supplies 20 1306050877 0 Physicians Physician Services 00 1306051552 0 WHITE CHRISTOPHER MICHAEL 2020133 9999999 B 10 1306051552 0 877 JEFFERSON AVE MEMPHIS TN 381032807 20 1306051552 0 Physicians Anesthesia Services 20 1306051552 0 Physicians Fluoride varnish 20 1306051552 0 Physicians Healthy Kids Services 20 1306051552 0 Physicians Optical Supplies 20 1306051552 0 Physicians Physician Services 00 1306052345 0 LATIF SHEIKH 2013002 9999999 B 10 1306052345 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1306052345 0 Physicians All Kids application agent 20 1306052345 0 Physicians Anesthesia Services 20 1306052345 0 Physicians Healthy Kids Services 20 1306052345 0 Physicians Optical Supplies 20 1306052345 0 Physicians Physician Services 20 1306052345 0 Physicians Physicians Psychiatric Services 00 1306053087 0 COLEMAN KIMBERLY A 2021288 9999999 B 10 1306053087 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1306053087 0 Nurse Practitioners Healthy Kids Services 20 1306053087 0 Nurse Practitioners Nurse Practitioners Services 20 1306053087 0 Nurse Practitioners Physician Services 00 1306054077 0 CHAPMAN CHRIS EDWARD 2007182 9999999 B 10 1306054077 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1306054077 0 Physicians Anesthesia Services 20 1306054077 0 Physicians Fluoride varnish 20 1306054077 0 Physicians Healthy Kids Services 20 1306054077 0 Physicians Optical Supplies 20 1306054077 0 Physicians Physician Services 00 1306054374 0 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CHICAGO IL 606740018 20 1306075106 0 Occupational Therapists Occupational Therapy Services 00 1306075635 0 KOZISEK JACOB 2022084 9999999 B 10 1306075635 0 PO BOX 28900 GREEN BAY WI 543240900 20 1306075635 0 Optometrists Anesthesia Services 20 1306075635 0 Optometrists Healthy Kids Services 20 1306075635 0 Optometrists Optical Supplies 20 1306075635 0 Optometrists Physician Services 00 1306076120 0 GARRI MIKAEL G 2012296 9999999 B 10 1306076120 0 9735 LANDMARK PARKWAY DR STE 2 SAINT LOUIS MO 631271666 20 1306076120 0 Physicians Anesthesia Services 20 1306076120 0 Physicians Fluoride varnish 20 1306076120 0 Physicians Healthy Kids Services 20 1306076120 0 Physicians Optical Supplies 20 1306076120 0 Physicians Physician Services 00 1306076518 0 ERNST DAVID D 2009182 9999999 B 10 1306076518 0 3990 N ILLINOIS ST SWANSEA IL 622261919 20 1306076518 0 Optometrists Optical Supplies 20 1306076518 0 Optometrists Optometric Services 20 1306076518 0 Optometrists Physician Services 00 1306076906 0 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EVANSTON IL 602011700 20 1306078498 0 Physicians Anesthesia Services 20 1306078498 0 Physicians Healthy Kids Services 20 1306078498 0 Physicians Optical Supplies 20 1306078498 0 Physicians Physician Services 00 1306078910 0 SHAH BHAVIN C 2015285 9999999 B 10 1306078910 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1306078910 0 Physicians Anesthesia Services 20 1306078910 0 Physicians Fluoride varnish 20 1306078910 0 Physicians Healthy Kids Services 20 1306078910 0 Physicians Optical Supplies 20 1306078910 0 Physicians Physician Services 00 1306079355 0 BODENSTINE ANNE L 2010347 9999999 B 10 1306079355 0 1523 WILLIAMS AVE ST CHARLES IL 601744626 20 1306079355 0 Physical Therapists Medical Supplies 20 1306079355 0 Physical Therapists Medical equipment/prosthetic devices 20 1306079355 0 Physical Therapists Physical Therapy Services 00 1306080957 0 FARGO JOHN 2023199 9999999 B 10 1306080957 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1306080957 0 Physicians Anesthesia Services 20 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Physicians Optical Supplies 20 1306091723 0 Physicians Physician Services 00 1306092135 0 MCCALL ANNA B 2024327 9999999 B 10 1306092135 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1306092135 0 Physicians Anesthesia Services 20 1306092135 0 Physicians Fluoride varnish 20 1306092135 0 Physicians Healthy Kids Services 20 1306092135 0 Physicians Optical Supplies 20 1306092135 0 Physicians Physician Services 00 1306092267 0 REID DAVID 2011213 9999999 B 10 1306092267 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1306092267 0 Physicians Anesthesia Services 20 1306092267 0 Physicians Healthy Kids Services 20 1306092267 0 Physicians Optical Supplies 20 1306092267 0 Physicians Physician Services 00 1306092283 0 JALEEL ATIF 2010200 9999999 B 10 1306092283 0 727 E COURT ST PARIS IL 619442460 20 1306092283 0 Physicians Anesthesia Services 20 1306092283 0 Physicians Healthy Kids Services 20 1306092283 0 Physicians Optical Supplies 20 1306092283 0 Physicians Physician Services 00 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298413862 20 1306096722 0 Physicians Anesthesia Services 20 1306096722 0 Physicians Healthy Kids Services 20 1306096722 0 Physicians Optical Supplies 20 1306096722 0 Physicians Physician Services 00 1306100516 0 KOSTANDY PETRO MA 2024119 9999999 B 10 1306100516 0 250 N SHADELAND AVE STE 200 INDIANAPOLIS IN 462194959 20 1306100516 0 Physicians Anesthesia Services 20 1306100516 0 Physicians Healthy Kids Services 20 1306100516 0 Physicians Optical Supplies 20 1306100516 0 Physicians Physician Services 00 1306101613 0 THOMAS LORI A 2012183 9999999 B 10 1306101613 0 1025 MAINE ST QUINCY IL 623014038 20 1306101613 0 Occupational Therapists Medical Supplies 20 1306101613 0 Occupational Therapists Medical equipment/prosthetic devices 20 1306101613 0 Occupational Therapists Occupational Therapy Services 00 1306102231 0 KOLB JOSHUA 2021238 9999999 B 10 1306102231 0 5665 NEW NORTHSIDE DR STE 320 ATLANTA GA 303285834 20 1306102231 0 Physicians Anesthesia Services 20 1306102231 0 Physicians Healthy 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1306102835 0 Physicians Optical Supplies 20 1306102835 0 Physicians Physician Services 00 1306102991 0 PLANCHARD JEFFREY ALAN 2019269 9999999 B 10 1306102991 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1306102991 0 Physicians Anesthesia Services 20 1306102991 0 Physicians Healthy Kids Services 20 1306102991 0 Physicians Optical Supplies 20 1306102991 0 Physicians Physician Services 00 1306103577 0 SEARS NATHANIEL C 2017226 9999999 B 10 1306103577 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1306103577 0 Physicians Anesthesia Services 20 1306103577 0 Physicians Healthy Kids Services 20 1306103577 0 Physicians Optical Supplies 20 1306103577 0 Physicians Physician Services 00 1306104385 0 SETHI POOJA 2017065 9999999 B 10 1306104385 0 877 JEFFERSON AVE MEMPHIS TN 381032807 20 1306104385 0 Physicians Anesthesia Services 20 1306104385 0 Physicians Fluoride varnish 20 1306104385 0 Physicians Healthy Kids Services 20 1306104385 0 Physicians Optical Supplies 20 1306104385 0 Physicians Physician Services 00 1306104633 0 NGUYEN PETER T 2022118 9999999 B 10 1306104633 0 PO BOX 857 FREEPORT IL 610320857 20 1306104633 0 Physicians Anesthesia Services 20 1306104633 0 Physicians Healthy Kids Services 20 1306104633 0 Physicians Optical Supplies 20 1306104633 0 Physicians Physician Services 20 1306104633 0 Physicians Physicians Psychiatric Services 00 1306105051 0 HENRICHS JACQUELINE 2019189 9999999 B 10 1306105051 0 611 W PARK ST URBANA IL 618012529 20 1306105051 0 Clinical Social Worker Social work service 00 1306105713 0 SALISBURY LISA 2012167 9999999 B 10 1306105713 0 124 SW ADAMS ST PEORIA IL 616021308 20 1306105713 0 Speech Therapists Medical Supplies 20 1306105713 0 Speech Therapists Medical equipment/prosthetic devices 20 1306105713 0 Speech Therapists Speech Therapy/Pathology Services 00 1306106158 0 FALLON KERRY 2023219 9999999 B 10 1306106158 0 1238 REGENT DR MUNDELEIN IL 600602062 20 1306106158 0 Occupational Therapists Medical Supplies 20 1306106158 0 Occupational Therapists Medical equipment/prosthetic devices 20 1306106158 0 Occupational Therapists Occupational Therapy Services 00 1306106455 0 PATEL AMI 2024184 9999999 B 10 1306106455 0 950 N MERIDIAN ST STE 500 INDIANAPOLIS IN 462043908 20 1306106455 0 Physicians Anesthesia Services 20 1306106455 0 Physicians Fluoride varnish 20 1306106455 0 Physicians Healthy Kids Services 20 1306106455 0 Physicians Optical Supplies 20 1306106455 0 Physicians Physician Services 00 1306106745 0 LIESE KYLEA L 2015335 9999999 B 10 1306106745 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1306106745 0 Nurse Practitioners Healthy Kids Services 20 1306106745 0 Nurse Practitioners Midwife Services 20 1306106745 0 Nurse Practitioners Nurse Practitioners Services 20 1306106745 0 Nurse Practitioners Physician Services 00 1306106927 0 PARILLA KATHLEEN 2016043 9999999 B 10 1306106927 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1306106927 0 Physician Assistant Only Fluoride varnish 20 1306106927 0 Physician Assistant Only Healthy Kids Services 20 1306106927 0 Physician Assistant Only Physician Services 00 1306107537 0 DREYER KATHLEEN 2020321 9999999 B 10 1306107537 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1306107537 0 Nurse Practitioners Fluoride varnish 20 1306107537 0 Nurse Practitioners Healthy Kids Services 20 1306107537 0 Nurse Practitioners Nurse Practitioners Services 20 1306107537 0 Nurse Practitioners Physician Services 00 1306108659 0 MURAKAMI NAOKA 2024243 9999999 B 10 1306108659 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1306108659 0 Physicians Anesthesia Services 20 1306108659 0 Physicians Fluoride varnish 20 1306108659 0 Physicians Healthy Kids Services 20 1306108659 0 Physicians Optical Supplies 20 1306108659 0 Physicians Physician Services 00 1306108824 0 NICHOLS KELLEY A 2018182 9999999 B 10 1306108824 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1306108824 0 Nurse Practitioners Anesthesia Services 20 1306108824 0 Nurse Practitioners Nurse Practitioners Services 20 1306108824 0 Nurse Practitioners Physician Services 00 1306109384 0 MICKEY WALTER L 2016289 9999999 B 10 1306109384 0 621 S NEW BALLAS RD STE 7020 SAINT LOUIS MO 631418232 20 1306109384 0 Physicians Anesthesia Services 20 1306109384 0 Physicians Fluoride varnish 20 1306109384 0 Physicians Healthy Kids Services 20 1306109384 0 Physicians Optical Supplies 20 1306109384 0 Physicians Physician Services 00 1306110457 0 DUNN BRITTANY 2013070 9999999 B 10 1306110457 0 455 BUTLER DR LAKE FOREST IL 600453013 20 1306110457 0 Speech Therapists Medical Supplies 20 1306110457 0 Speech Therapists Medical equipment/prosthetic devices 20 1306110457 0 Speech Therapists Speech Therapy/Pathology Services 00 1306110986 0 DUMAPLIN LORELEI SHERRY H 2022192 9999999 B 10 1306110986 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1306110986 0 Nurse Practitioners Healthy Kids Services 20 1306110986 0 Nurse Practitioners Nurse Practitioners Services 20 1306110986 0 Nurse Practitioners Physician Services 00 1306111463 0 SIRAJELDIN YASSIR 2020120 9999999 B 10 1306111463 0 120 W 22ND ST OAK BROOK IL 605231557 20 1306111463 0 Physicians Anesthesia Services 20 1306111463 0 Physicians Fluoride varnish 20 1306111463 0 Physicians Healthy Kids Services 20 1306111463 0 Physicians Optical Supplies 20 1306111463 0 Physicians Physician Services 00 1306111679 0 JOHNSON LAURA JANELLE 2015187 9999999 B 10 1306111679 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1306111679 0 Physicians Anesthesia Services 20 1306111679 0 Physicians Fluoride varnish 20 1306111679 0 Physicians Healthy Kids Services 20 1306111679 0 Physicians Optical Supplies 20 1306111679 0 Physicians Physician Services 00 1306111703 0 KAVANAGH KELLY 2012142 9999999 B 10 1306111703 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1306111703 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1306111703 0 Other behavior health professional Social work service 00 1306112172 0 HOWLETT BETHANY M 2015244 9999999 B 10 1306112172 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1306112172 0 Physicians Anesthesia Services 20 1306112172 0 Physicians Fluoride varnish 20 1306112172 0 Physicians Healthy Kids Services 20 1306112172 0 Physicians Optical Supplies 20 1306112172 0 Physicians Physician Services 00 1306112453 0 RO STEVE I 2016214 9999999 B 10 1306112453 0 387 SHUMAN BLVD STE 240W NAPERVILLE IL 605638113 20 1306112453 0 Physicians Anesthesia Services 20 1306112453 0 Physicians Healthy Kids Services 20 1306112453 0 Physicians Optical Supplies 20 1306112453 0 Physicians Physician Services 00 1306113303 0 BROWN BRADLEY D 2022032 9999999 B 10 1306113303 0 PO BOX 43230 PHOENIX AZ 850803230 20 1306113303 0 Physicians Anesthesia Services 20 1306113303 0 Physicians Fluoride varnish 20 1306113303 0 Physicians Healthy Kids Services 20 1306113303 0 Physicians Optical Supplies 20 1306113303 0 Physicians Physician Services 00 1306115514 0 BUGG JOHN 2016056 9999999 B 10 1306115514 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1306115514 0 Nurse Practitioners Anesthesia Services 20 1306115514 0 Nurse Practitioners Nurse Practitioners Services 20 1306115514 0 Nurse Practitioners Physician Services 00 1306117213 0 WAN REGINA M 2012092 9999999 B 10 1306117213 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1306117213 0 Nurse Practitioners Fluoride varnish 20 1306117213 0 Nurse Practitioners Healthy Kids Services 20 1306117213 0 Nurse Practitioners Nurse Practitioners Services 20 1306117213 0 Nurse Practitioners Physician Services 00 1306117361 0 KENDRICK KARIN 2024264 9999999 B 10 1306117361 0 1722 W FARRAGUT AVE UNIT 2 CHICAGO IL 606402012 20 1306117361 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1306117874 0 ANDRIOLA CHRISTINA 2022147 9999999 B 10 1306117874 0 29373 NETWORK PL CHICAGO IL 606733039 20 1306117874 0 Physical Therapists Medical Supplies 20 1306117874 0 Physical Therapists Medical equipment/prosthetic devices 20 1306117874 0 Physical Therapists Physical Therapy Services 00 1306118120 0 TAYLOR COLLENE ANN-MARIE 2012263 9999999 B 10 1306118120 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1306118120 0 Other behavior health professional LCPC/LMFT services 00 1306119557 0 JACOBSON BERNICE 2012142 9999999 B 10 1306119557 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1306119557 0 Clinical Social Worker Social work service 00 1306119847 0 BRAR RAMINDER K 2018032 9999999 B 10 1306119847 0 PO BOX 781076 DETROIT MI 482781076 20 1306119847 0 Psychologist Psychologist service 00 1306122163 0 EDWARDS PAUL 2012061 9999999 B 10 1306122163 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1306122163 0 Physicians Anesthesia Services 20 1306122163 0 Physicians Fluoride varnish 20 1306122163 0 Physicians Healthy Kids Services 20 1306122163 0 Physicians Optical Supplies 20 1306122163 0 Physicians Physician Services 00 1306123310 0 DEV VAISHALI S 2017207 9999999 B 10 1306123310 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1306123310 0 Physical Therapists Medical Supplies 20 1306123310 0 Physical Therapists Medical equipment/prosthetic devices 20 1306123310 0 Physical Therapists Physical Therapy Services 00 1306123757 0 CARLSON KATHERINE I 2016001 9999999 B 10 1306123757 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1306123757 0 Physician Assistant Only Fluoride varnish 20 1306123757 0 Physician Assistant Only Healthy Kids Services 20 1306123757 0 Physician Assistant Only Physician Services 00 1306124318 0 MORALES CARMEN N 2012027 9999999 B 10 1306124318 0 1414 MAIN ST MELROSE PARK IL 601603902 20 1306124318 0 Other behavior health professional LCPC/LMFT services 00 1306125166 0 HAVERA MARK 2011274 9999999 B 10 1306125166 0 40 E NORTH ST EUREKA MO 630251205 20 1306125166 0 Optometrists Optical Supplies 20 1306125166 0 Optometrists Optometric Services 20 1306125166 0 Optometrists Physician Services 00 1306127089 0 GRZYCH LAUREN 2011241 9999999 B 10 1306127089 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1306127089 0 Speech Therapists Medical Supplies 20 1306127089 0 Speech Therapists Medical equipment/prosthetic devices 20 1306127089 0 Speech Therapists Speech Therapy/Pathology Services 00 1306128285 0 DIXON SUSAN 2021160 9999999 B 10 1306128285 0 148 S BOLINGBROOK DR BOLINGBROOK IL 604402852 20 1306128285 0 Nurse Practitioners Fluoride varnish 20 1306128285 0 Nurse Practitioners Healthy Kids Services 20 1306128285 0 Nurse Practitioners Nurse Practitioners Services 20 1306128285 0 Nurse Practitioners Physician Services 00 1306129663 0 PRUEKSARITANOND SUARTCHA 2019213 9999999 B 10 1306129663 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1306129663 0 Physicians Anesthesia Services 20 1306129663 0 Physicians Fluoride varnish 20 1306129663 0 Physicians Healthy Kids Services 20 1306129663 0 Physicians Optical Supplies 20 1306129663 0 Physicians Physician Services 00 1306131255 0 PATEL RUPAL 2011157 9999999 B 10 1306131255 0 730 S WASHINGTON ST LOCKPORT IL 604413076 20 1306131255 0 Dentists Dental Services 20 1306131255 0 Dentists Physician Services 00 1306131313 0 BAKER CHRISTINE 2022313 9999999 B 10 1306131313 0 7421 MADISON ST FOREST PARK IL 601301575 20 1306131313 0 Speech Therapists Medical Supplies 20 1306131313 0 Speech Therapists Medical equipment/prosthetic devices 20 1306131313 0 Speech Therapists Speech Therapy/Pathology Services 00 1306131636 0 MISSION PAIGE 2018319 9999999 B 10 1306131636 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1306131636 0 Psychologist Psychologist service 00 1306131891 0 REDDY SATISH 2023026 9999999 B 10 1306131891 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1306131891 0 Physicians Anesthesia Services 20 1306131891 0 Physicians Healthy Kids Services 20 1306131891 0 Physicians Optical Supplies 20 1306131891 0 Physicians Physician Services 00 1306131974 0 KAO JEROME L 2017213 9999999 B 10 1306131974 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1306131974 0 Physicians Anesthesia Services 20 1306131974 0 Physicians Healthy Kids Services 20 1306131974 0 Physicians Optical Supplies 20 1306131974 0 Physicians Physician Services 00 1306132196 0 HAIDER IMRAN 2016131 9999999 B 10 1306132196 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1306132196 0 Physicians Anesthesia Services 20 1306132196 0 Physicians Fluoride varnish 20 1306132196 0 Physicians Healthy Kids Services 20 1306132196 0 Physicians Optical Supplies 20 1306132196 0 Physicians Physician Services 00 1306132345 0 BASIC MOLLIE 2023118 9999999 B 10 1306132345 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1306132345 0 Physical Therapists Medical Supplies 20 1306132345 0 Physical Therapists Medical equipment/prosthetic devices 20 1306132345 0 Physical Therapists Physical Therapy Services 00 1306133012 0 SOBERS KAREN 2015201 9999999 B 10 1306133012 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1306133012 0 Physicians Anesthesia Services 20 1306133012 0 Physicians Fluoride varnish 20 1306133012 0 Physicians Healthy Kids Services 20 1306133012 0 Physicians Optical Supplies 20 1306133012 0 Physicians Physician Services 00 1306133129 0 LAWRENCE ANDREW 2016279 9999999 B 10 1306133129 0 1701 LACEY ST CAPE GIRARDEAU MO 637015230 20 1306133129 0 Physicians Anesthesia Services 20 1306133129 0 Physicians Fluoride varnish 20 1306133129 0 Physicians Healthy Kids Services 20 1306133129 0 Physicians Optical Supplies 20 1306133129 0 Physicians Physician Services 00 1306133376 0 MEHTA AMEE 2021068 9999999 B 10 1306133376 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1306133376 0 Physicians Anesthesia Services 20 1306133376 0 Physicians Fluoride varnish 20 1306133376 0 Physicians Healthy Kids Services 20 1306133376 0 Physicians Optical Supplies 20 1306133376 0 Physicians Physician Services 00 1306133574 0 COPLEY CYNTHIA R 2017227 9999999 B 10 1306133574 0 3200 E CAMELBACK RD STE 250 PHOENIX AZ 850182327 20 1306133574 0 Physicians Anesthesia Services 20 1306133574 0 Physicians Fluoride varnish 20 1306133574 0 Physicians Healthy Kids Services 20 1306133574 0 Physicians Optical Supplies 20 1306133574 0 Physicians Physician Services 00 1306133640 0 WHITE JERMAINE K 2016006 9999999 B 10 1306133640 0 5645 W ADDISON ST CHICAGO IL 606344403 20 1306133640 0 Physicians Anesthesia Services 20 1306133640 0 Physicians Healthy Kids Services 20 1306133640 0 Physicians Optical Supplies 20 1306133640 0 Physicians Physician Services 00 1306133673 0 CHOWDHURY NAWEED 2014237 9999999 B 10 1306133673 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1306133673 0 Physicians Anesthesia Services 20 1306133673 0 Physicians Fluoride varnish 20 1306133673 0 Physicians Healthy Kids Services 20 1306133673 0 Physicians Optical Supplies 20 1306133673 0 Physicians Physician Services 00 1306134515 0 OBI ADITYA 2011196 9999999 B 10 1306134515 0 567 W 14TH ST CHICAGO HEIGHTS IL 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20 1306136346 0 Physicians Anesthesia Services 20 1306136346 0 Physicians Healthy Kids Services 20 1306136346 0 Physicians Optical Supplies 20 1306136346 0 Physicians Physician Services 00 1306136528 0 RAGHUPATRUNI PREETHI 2014202 9999999 B 10 1306136528 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1306136528 0 Physicians Anesthesia Services 20 1306136528 0 Physicians Family Planning Counseling 20 1306136528 0 Physicians Fluoride varnish 20 1306136528 0 Physicians Healthy Kids Services 20 1306136528 0 Physicians Optical Supplies 20 1306136528 0 Physicians Physician Services 00 1306136650 0 GALPERIN MIKHAIL M 2024228 9999999 B 10 1306136650 0 PO BOX 85079 CHICAGO IL 606895079 20 1306136650 0 Physicians Anesthesia Services 20 1306136650 0 Physicians Healthy Kids Services 20 1306136650 0 Physicians Optical Supplies 20 1306136650 0 Physicians Physician Services 00 1306136668 0 MAYEKAR EMILY MEREDITH 2017158 9999999 B 10 1306136668 0 29373 NETWORK PL CHICAGO IL 606733039 20 1306136668 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Services 20 1306138672 0 Physicians Optical Supplies 20 1306138672 0 Physicians Physician Services 00 1306139613 0 KENDRICK TREVOR 2020199 9999999 B 10 1306139613 0 1503 HALO DR MAHOMET IL 618537440 20 1306139613 0 Other behavior health professional LCPC/LMFT services 00 1306140538 0 OSAYI-ADAMS SUSAN 2024235 9999999 B 10 1306140538 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1306140538 0 Nurse Practitioners Fluoride varnish 20 1306140538 0 Nurse Practitioners Healthy Kids Services 20 1306140538 0 Nurse Practitioners Nurse Practitioners Services 20 1306140538 0 Nurse Practitioners Physician Services 00 1306141338 0 GROVER ANDREW R 2016245 9999999 B 10 1306141338 0 22285 N PEPPER RD STE 401 LAKE BARRINGTON IL 600102542 20 1306141338 0 Physician Assistant Only Fluoride varnish 20 1306141338 0 Physician Assistant Only Healthy Kids Services 20 1306141338 0 Physician Assistant Only Physician Services 00 1306143532 0 RICHARDSON RONALD 2011047 9999999 B 10 1306143532 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1306143532 0 Nurse Practitioners Anesthesia Services 20 1306143532 0 Nurse Practitioners Nurse Practitioners Services 20 1306143532 0 Nurse Practitioners Physician Services 00 1306144159 0 MILLS JULIE A 2018125 9999999 B 10 1306144159 0 200 UNIVERSITY AVE E SAINT PAUL MN 551012507 20 1306144159 0 Nurse Practitioners Fluoride varnish 20 1306144159 0 Nurse Practitioners Healthy Kids Services 20 1306144159 0 Nurse Practitioners Nurse Practitioners Services 20 1306144159 0 Nurse Practitioners Physician Services 00 1306144399 0 JIWANI ZAHRA 2014001 9999999 B 10 1306144399 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1306144399 0 Nurse Practitioners Fluoride varnish 20 1306144399 0 Nurse Practitioners Healthy Kids Services 20 1306144399 0 Nurse Practitioners Nurse Practitioners Services 20 1306144399 0 Nurse Practitioners Physician Services 00 1306145099 0 TRIPATHY SHREEPADA 2016162 9999999 B 10 1306145099 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 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Practitioners Nurse Practitioners Services 20 1306146972 0 Nurse Practitioners Physician Services 00 1306149497 0 WHITE JOHNNY 2000261 9999999 B 10 1306149497 0 3350 S KEDZIE AVE CHICAGO IL 606235114 20 1306149497 0 Clinical Social Worker Social work service 00 1306152129 0 BERGL PAUL 2013182 9999999 B 10 1306152129 0 180 N HARVESTER DR STE 110 BURR RIDGE IL 605277594 20 1306152129 0 Physicians Anesthesia Services 20 1306152129 0 Physicians Fluoride varnish 20 1306152129 0 Physicians Healthy Kids Services 20 1306152129 0 Physicians Optical Supplies 20 1306152129 0 Physicians Physician Services 00 1306152806 0 LODHI TANIA G 2015306 9999999 B 10 1306152806 0 10607 S HARLEM AVE UNIT 2 UNIT 2 WORTH IL 604821649 20 1306152806 0 Dentists Dental Services 20 1306152806 0 Dentists Physician Services 00 1306153002 0 DUPLANTIS MELISSA E 2015208 9999999 B 10 1306153002 0 9119 S EXCHANGE AVE CHICAGO IL 606174225 20 1306153002 0 Psychologist Psychologist service 00 1306154786 0 DONAHUE CHARITY 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1306155072 0 5777 DEPT CAROL STREAM IL 601220021 20 1306155072 0 Nurse Practitioners Fluoride varnish 20 1306155072 0 Nurse Practitioners Healthy Kids Services 20 1306155072 0 Nurse Practitioners Nurse Practitioners Services 20 1306155072 0 Nurse Practitioners Physician Services 00 1306156005 0 KRON MELISSA R 2018016 9999999 B 10 1306156005 0 524 E SCHAUMBURG RD SCHAUMBURG IL 601943510 20 1306156005 0 Speech Therapists Medical Supplies 20 1306156005 0 Speech Therapists Medical equipment/prosthetic devices 20 1306156005 0 Speech Therapists Speech Therapy/Pathology Services 00 1306156500 0 BENDER JESSICA L 2012214 9999999 B 10 1306156500 0 1801 W OLYMPIC BLVD PASADENA CA 911992636 20 1306156500 0 Physicians Anesthesia Services 20 1306156500 0 Physicians Healthy Kids Services 20 1306156500 0 Physicians Optical Supplies 20 1306156500 0 Physicians Physician Services 00 1306156856 0 CHINEME IKECHUKWU I 2012183 9999999 B 10 1306156856 0 5777 DEPT CAROL STREAM IL 601228942 20 1306156856 0 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Dentists Physician Services 00 1306264429 0 PINTO SONIYA 2022203 9999999 B 10 1306264429 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1306264429 0 Physicians Anesthesia Services 20 1306264429 0 Physicians Healthy Kids Services 20 1306264429 0 Physicians Optical Supplies 20 1306264429 0 Physicians Physician Services 00 1306264510 0 SCHLANGER RITA V 2022363 9999999 B 10 1306264510 0 PO BOX 43230 CINCINNATI OH 452430230 20 1306264510 0 Physicians Anesthesia Services 20 1306264510 0 Physicians Fluoride varnish 20 1306264510 0 Physicians Healthy Kids Services 20 1306264510 0 Physicians Optical Supplies 20 1306264510 0 Physicians Physician Services 00 1306265129 0 EIKHOFF NATHAN 2018165 9999999 B 10 1306265129 0 6801 BRECKSVILLE RD INDEPENDENCE OH 441315032 20 1306265129 0 Physicians Anesthesia Services 20 1306265129 0 Physicians Healthy Kids Services 20 1306265129 0 Physicians Optical Supplies 20 1306265129 0 Physicians Physician Services 00 1306265442 0 SHAHRRAVA ANAHITA 2023110 9999999 B 10 1306265442 0 5777 DEPT CAROL STREAM IL 601220021 20 1306265442 0 Physicians Anesthesia Services 20 1306265442 0 Physicians Fluoride varnish 20 1306265442 0 Physicians Healthy Kids Services 20 1306265442 0 Physicians Optical Supplies 20 1306265442 0 Physicians Physician Services 00 1306265988 0 SCHOENFELDT JOSEPH A 2018182 9999999 B 10 1306265988 0 5777 DEPT CAROL STREAM IL 601220021 20 1306265988 0 Physicians Anesthesia Services 20 1306265988 0 Physicians Healthy Kids Services 20 1306265988 0 Physicians Optical Supplies 20 1306265988 0 Physicians Physician Services 00 1306266093 0 STAIRS CHRISTINE 2024347 9999999 B 10 1306266093 0 800 W 9TH ST JASPER IN 475462514 20 1306266093 0 Physicians Anesthesia Services 20 1306266093 0 Physicians Healthy Kids Services 20 1306266093 0 Physicians Optical Supplies 20 1306266093 0 Physicians Physician Services 00 1306266341 0 SOONG LILLIAN K 2017145 9999999 B 10 1306266341 0 5777 DEPT CAROL STREAM IL 601220021 20 1306266341 0 Physicians Anesthesia 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520 E 22ND ST LOMBARD IL 601486110 20 1306270152 0 Physicians Anesthesia Services 20 1306270152 0 Physicians Healthy Kids Services 20 1306270152 0 Physicians Optical Supplies 20 1306270152 0 Physicians Physician Services 00 1306272489 0 MIDKIFF CORY 2017255 9999999 B 10 1306272489 0 510 LINCOLN DR HERRIN IL 629486334 20 1306272489 0 Physical Therapists Medical Supplies 20 1306272489 0 Physical Therapists Medical equipment/prosthetic devices 20 1306272489 0 Physical Therapists Physical Therapy Services 00 1306272588 0 DELLORSO MICHELLE R 2013266 9999999 B 10 1306272588 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1306272588 0 Nurse Practitioners Healthy Kids Services 20 1306272588 0 Nurse Practitioners Nurse Practitioners Services 20 1306272588 0 Nurse Practitioners Physician Services 00 1306273107 0 PECK MELISSA 2020021 9999999 B 10 1306273107 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1306273107 0 Nurse Practitioners Fluoride varnish 20 1306273107 0 Nurse Practitioners Healthy Kids Services 20 1306273107 0 Nurse Practitioners Nurse Practitioners Services 20 1306273107 0 Nurse Practitioners Physician Services 00 1306273685 0 MILLER HEATHER L 2013274 9999999 B 10 1306273685 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1306273685 0 Nurse Practitioners Healthy Kids Services 20 1306273685 0 Nurse Practitioners Midwife Services 20 1306273685 0 Nurse Practitioners Nurse Practitioners Services 20 1306273685 0 Nurse Practitioners Physician Services 00 1306274022 0 GORSON STACI L. 2015121 9999999 B 10 1306274022 0 5777 DEPT CAROL STREAM IL 601220021 20 1306274022 0 Nurse Practitioners Fluoride varnish 20 1306274022 0 Nurse Practitioners Healthy Kids Services 20 1306274022 0 Nurse Practitioners Nurse Practitioners Services 20 1306274022 0 Nurse Practitioners Physician Services 00 1306274246 0 LARK BETSY 2021120 9999999 B 10 1306274246 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1306274246 0 Physician Assistant Only Fluoride varnish 20 1306274246 0 Physician Assistant Only Healthy Kids Services 20 1306274246 0 Physician Assistant Only Physician Services 00 1306274535 0 MARUNA JILLIAN E 2014209 9999999 B 10 1306274535 0 5777 DEPT CAROL STREAM IL 601220021 20 1306274535 0 Nurse Practitioners Fluoride varnish 20 1306274535 0 Nurse Practitioners Healthy Kids Services 20 1306274535 0 Nurse Practitioners Nurse Practitioners Services 20 1306274535 0 Nurse Practitioners Physician Services 00 1306275888 0 SCHERGEN GINA 2013301 9999999 B 10 1306275888 0 100 W PLAINFIELD RD COUNTRYSIDE IL 605252869 20 1306275888 0 Occupational Therapists Medical Supplies 20 1306275888 0 Occupational Therapists Medical equipment/prosthetic devices 20 1306275888 0 Occupational Therapists Occupational Therapy Services 00 1306276761 0 BOHN MICHELLE L 2017180 9999999 B 10 1306276761 0 5777 DEPT CAROL STREAM IL 601220021 20 1306276761 0 Physician Assistant Only Fluoride varnish 20 1306276761 0 Physician Assistant Only Healthy Kids Services 20 1306276761 0 Physician Assistant Only Physician Services 00 1306278130 0 IGANA RAQUEL T 2013231 9999999 B 10 1306278130 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1306278130 0 Nurse Practitioners Fluoride varnish 20 1306278130 0 Nurse Practitioners Healthy Kids Services 20 1306278130 0 Nurse Practitioners Nurse Practitioners Services 20 1306278130 0 Nurse Practitioners Physician Services 00 1306278601 0 PHAN ALEXANDER 2022277 9999999 B 10 1306278601 0 2003 W FULTON ST STE 303 CHICAGO IL 606122345 20 1306278601 0 Physician Assistant Only Fluoride varnish 20 1306278601 0 Physician Assistant Only Healthy Kids Services 20 1306278601 0 Physician Assistant Only Physician Services 00 1306278833 0 TAYLOR ALANA 2025034 9999999 B 10 1306278833 0 3033 W PRESIDENT GEORGE BUSH H PLANO TX 750755885 20 1306278833 0 Nurse Practitioners Healthy Kids Services 20 1306278833 0 Nurse Practitioners Nurse Practitioners Services 20 1306278833 0 Nurse Practitioners Physician Services 00 1306280409 0 VASSALLI JEFFREY 2021130 9999999 B 10 1306280409 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1306280409 0 Physicians Anesthesia Services 20 1306280409 0 Physicians Fluoride varnish 20 1306280409 0 Physicians Healthy Kids Services 20 1306280409 0 Physicians Optical Supplies 20 1306280409 0 Physicians Physician Services 00 1306281167 0 KELLY ELIZABETH 2013182 9999999 B 10 1306281167 0 684 S BARRINGTON RD STE 112 STREAMWOOD IL 601071841 20 1306281167 0 Nurse Practitioners Fluoride varnish 20 1306281167 0 Nurse Practitioners Healthy Kids Services 20 1306281167 0 Nurse Practitioners Nurse Practitioners Services 20 1306281167 0 Nurse Practitioners Nursing service 20 1306281167 0 Nurse Practitioners Physician Services 20 1306281167 0 Nurse Practitioners Waiver service 00 1306281480 0 BEALLY MELISSA 2017237 9999999 B 10 1306281480 0 777 LOWNDES HILL RD BLDG 1 GREENVILLE SC 296072101 20 1306281480 0 Physicians Anesthesia Services 20 1306281480 0 Physicians Healthy Kids Services 20 1306281480 0 Physicians Optical Supplies 20 1306281480 0 Physicians Physician Services 00 1306282439 0 SHAH NIRAV N. 2018073 9999999 B 10 1306282439 0 21120 WASHINGTON PKWY FRANKFORT IL 604233112 20 1306282439 0 Physicians Anesthesia Services 20 1306282439 0 Physicians Healthy Kids Services 20 1306282439 0 Physicians Optical Supplies 20 1306282439 0 Physicians Physician Services 00 1306282504 0 BALTAZAR RUTH 2023282 9999999 B 10 1306282504 0 28100 TORCH PKWY STE 600 WARRENVILLE IL 605554030 20 1306282504 0 Physical Therapists Medical Supplies 20 1306282504 0 Physical Therapists Medical equipment/prosthetic devices 20 1306282504 0 Physical Therapists Physical Therapy Services 00 1306282561 0 HENSLEY LAUREN K 2017228 9999999 B 10 1306282561 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1306282561 0 Physicians Anesthesia Services 20 1306282561 0 Physicians Healthy Kids Services 20 1306282561 0 Physicians Optical Supplies 20 1306282561 0 Physicians Physician Services 00 1306284039 0 SCHMIDT CHRISTEN L 2020268 9999999 B 10 1306284039 0 2723 S 7TH ST STE A TERRE HAUTE IN 478023558 20 1306284039 0 Physician Assistant Only Fluoride varnish 20 1306284039 0 Physician Assistant Only Healthy Kids Services 20 1306284039 0 Physician Assistant Only Physician Services 00 1306284138 0 BRYAN DARREN S 2018348 9999999 B 10 1306284138 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1306284138 0 Physicians Anesthesia Services 20 1306284138 0 Physicians Healthy Kids Services 20 1306284138 0 Physicians Optical Supplies 20 1306284138 0 Physicians Physician Services 00 1306284161 0 BLEESS BRANDON B 2016092 9999999 B 10 1306284161 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1306284161 0 Physicians Anesthesia Services 20 1306284161 0 Physicians Healthy Kids Services 20 1306284161 0 Physicians Optical Supplies 20 1306284161 0 Physicians Physician Services 00 1306284765 0 COON SWATI 2021210 9999999 B 10 1306284765 0 350 N WALL ST KANKAKEE IL 609012901 20 1306284765 0 Physicians Anesthesia Services 20 1306284765 0 Physicians Healthy Kids Services 20 1306284765 0 Physicians Optical Supplies 20 1306284765 0 Physicians Physician Services 20 1306284765 0 Physicians Physicians Psychiatric Services 00 1306285051 0 HALABI SHADI 2017111 9999999 B 10 1306285051 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1306285051 0 Physicians Anesthesia Services 20 1306285051 0 Physicians Fluoride varnish 20 1306285051 0 Physicians Healthy Kids Services 20 1306285051 0 Physicians Optical Supplies 20 1306285051 0 Physicians Physician Services 00 1306285432 0 OHRI ABHINAV 2024180 9999999 B 10 1306285432 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1306285432 0 Physicians Anesthesia Services 20 1306285432 0 Physicians Healthy Kids Services 20 1306285432 0 Physicians Optical Supplies 20 1306285432 0 Physicians Physician Services 20 1306285432 0 Physicians Physicians Psychiatric Services 00 1306285556 0 STERLING FRANSETTA 2023152 9999999 B 10 1306285556 0 1051 SOUTHFIELD DR PLAINFIELD IN 461682955 20 1306285556 0 Physicians Anesthesia Services 20 1306285556 0 Physicians Healthy Kids Services 20 1306285556 0 Physicians Optical Supplies 20 1306285556 0 Physicians Physician Services 20 1306285556 0 Physicians Physicians Psychiatric Services 00 1306285986 0 HARRELL SAMARA D 2017233 9999999 B 10 1306285986 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1306285986 0 Nurse Practitioners Fluoride varnish 20 1306285986 0 Nurse Practitioners Healthy Kids Services 20 1306285986 0 Nurse Practitioners Nurse Practitioners Services 20 1306285986 0 Nurse Practitioners Physician Services 00 1306286216 0 KOWAL BRANDEN 2023045 9999999 B 10 1306286216 0 3300 OAKDALE AVE N ROBBINSDALE MN 554222926 20 1306286216 0 Physicians Anesthesia Services 20 1306286216 0 Physicians Healthy Kids Services 20 1306286216 0 Physicians Optical Supplies 20 1306286216 0 Physicians Physician Services 00 1306286463 0 KAZMI FARAZ 2024278 9999999 B 10 1306286463 0 4701 DEPT CAROL STREAM IL 601220021 20 1306286463 0 Physicians Anesthesia Services 20 1306286463 0 Physicians Fluoride varnish 20 1306286463 0 Physicians Healthy Kids Services 20 1306286463 0 Physicians Optical Supplies 20 1306286463 0 Physicians Physician Services 00 1306286703 0 REJOWSKI BENJAMIN 2017083 9999999 B 10 1306286703 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1306286703 0 Physicians Anesthesia Services 20 1306286703 0 Physicians Healthy Kids Services 20 1306286703 0 Physicians Optical Supplies 20 1306286703 0 Physicians Physician Services 00 1306286786 0 EDZARDS MICHAEL JOHN 2023334 9999999 B 10 1306286786 0 5901 LINCOLN DR EDINA MN 554361611 20 1306286786 0 Physicians Anesthesia Services 20 1306286786 0 Physicians Fluoride varnish 20 1306286786 0 Physicians Healthy Kids Services 20 1306286786 0 Physicians Optical Supplies 20 1306286786 0 Physicians Physician Services 00 1306286950 0 BLANFORD CHRISTOPHER T 2016214 9999999 B 10 1306286950 0 124 SW ADAMS ST PEORIA IL 616021308 20 1306286950 0 Physicians Anesthesia Services 20 1306286950 0 Physicians Fluoride varnish 20 1306286950 0 Physicians Healthy Kids Services 20 1306286950 0 Physicians Optical Supplies 20 1306286950 0 Physicians Physician Services 00 1306287214 0 SIDDIQUI OMAR 2016195 9999999 B 10 1306287214 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1306287214 0 Physicians Anesthesia Services 20 1306287214 0 Physicians Fluoride varnish 20 1306287214 0 Physicians Healthy Kids Services 20 1306287214 0 Physicians Optical Supplies 20 1306287214 0 Physicians Physician Services 00 1306287248 0 GUERRERO CHRISTOPHER 2017121 9999999 B 10 1306287248 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1306287248 0 Physicians Anesthesia Services 20 1306287248 0 Physicians Healthy Kids Services 20 1306287248 0 Physicians Optical Supplies 20 1306287248 0 Physicians Physician Services 20 1306287248 0 Physicians Physicians Psychiatric Services 00 1306287388 0 DWIGGINS MAGGIE L 2022332 9999999 B 10 1306287388 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1306287388 0 Physicians Anesthesia Services 20 1306287388 0 Physicians Healthy Kids Services 20 1306287388 0 Physicians Optical Supplies 20 1306287388 0 Physicians Physician Services 00 1306287396 0 SULEIMAN AYUB 2021132 9999999 B 10 1306287396 0 1005 BROADWAY ST QUINCY IL 623012834 20 1306287396 0 Physicians Anesthesia Services 20 1306287396 0 Physicians Healthy Kids Services 20 1306287396 0 Physicians Optical Supplies 20 1306287396 0 Physicians Physician Services 00 1306288022 0 LABUDA CARYN 2013210 9999999 B 10 1306288022 0 120 E COUNTRYSIDE PKWY YORKVILLE IL 605601877 20 1306288022 0 Optometrists Optical Supplies 20 1306288022 0 Optometrists Optometric Services 20 1306288022 0 Optometrists Physician Services 00 1306288840 0 HERRIG WHITNEY S 2017013 9999999 B 10 1306288840 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1306288840 0 Physician Assistant Only Fluoride varnish 20 1306288840 0 Physician Assistant Only Healthy Kids Services 20 1306288840 0 Physician Assistant Only Physician Services 00 1306289046 0 ZEAL CARLEY J 2019182 9999999 B 10 1306289046 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1306289046 0 Physicians Anesthesia Services 20 1306289046 0 Physicians Healthy Kids Services 20 1306289046 0 Physicians Optical Supplies 20 1306289046 0 Physicians Physician Services 00 1306289285 0 FARRELL PETER 2021197 9999999 B 10 1306289285 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1306289285 0 Physicians Anesthesia Services 20 1306289285 0 Physicians Fluoride varnish 20 1306289285 0 Physicians Healthy Kids Services 20 1306289285 0 Physicians Optical Supplies 20 1306289285 0 Physicians Physician Services 00 1306289509 0 KIM STACY J 2021049 9999999 B 10 1306289509 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1306289509 0 Physicians Anesthesia Services 20 1306289509 0 Physicians Healthy Kids Services 20 1306289509 0 Physicians Optical Supplies 20 1306289509 0 Physicians Physician Services 00 1306289533 0 ADEBAYO ALBERT 2013091 9999999 B 10 1306289533 0 3229 W 47TH PL CHICAGO IL 606323011 20 1306289533 0 Dentists Dental Services 20 1306289533 0 Dentists Physician Services 00 1306289640 0 REEVES JENNIFER 2021223 9999999 B 10 1306289640 0 1602 21ST ST GRANITE CITY IL 620405304 20 1306289640 0 Physicians Anesthesia Services 20 1306289640 0 Physicians Family Planning Counseling 20 1306289640 0 Physicians Healthy Kids Services 20 1306289640 0 Physicians Optical Supplies 20 1306289640 0 Physicians Physician Services 00 1306290044 0 CROOKS JAMES N 2019176 9999999 B 10 1306290044 0 1 ILLINI DR PEORIA IL 616052576 20 1306290044 0 Physicians Anesthesia Services 20 1306290044 0 Physicians Fluoride varnish 20 1306290044 0 Physicians Healthy Kids Services 20 1306290044 0 Physicians Optical Supplies 20 1306290044 0 Physicians Physician Services 00 1306290374 0 SIMON DAVID 2024108 9999999 B 10 1306290374 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1306290374 0 Physicians Anesthesia Services 20 1306290374 0 Physicians 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Physician Services 00 1306291976 0 QAMAR MUHAMMAD 2024046 9999999 B 10 1306291976 0 1400 US HIGHWAY 61 FESTUS MO 630284100 20 1306291976 0 Physicians Anesthesia Services 20 1306291976 0 Physicians Healthy Kids Services 20 1306291976 0 Physicians Optical Supplies 20 1306291976 0 Physicians Physician Services 00 1306292123 0 DOBRINICH LAURIE J 2016134 9999999 B 10 1306292123 0 1200 E TREMONT ST HILLSBORO IL 620491912 20 1306292123 0 Clinical Social Worker Social work service 00 1306292164 0 CZARKOWSKI BRIAN 2023160 9999999 B 10 1306292164 0 PO BOX 43230 PHOENIX AZ 850803230 20 1306292164 0 Physicians Anesthesia Services 20 1306292164 0 Physicians Healthy Kids Services 20 1306292164 0 Physicians Optical Supplies 20 1306292164 0 Physicians Physician Services 00 1306292271 0 LIN WINNIE 2016250 9999999 B 10 1306292271 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1306292271 0 Physicians All Kids application agent 20 1306292271 0 Physicians Anesthesia Services 20 1306292271 0 Physicians 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Physicians Physician Services 00 1306294988 0 PATEL VRUNDA 2024089 9999999 B 10 1306294988 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1306294988 0 Physicians Anesthesia Services 20 1306294988 0 Physicians Fluoride varnish 20 1306294988 0 Physicians Healthy Kids Services 20 1306294988 0 Physicians Optical Supplies 20 1306294988 0 Physicians Physician Services 00 1306295191 0 KONOPKA MEGAN 2019226 9999999 B 10 1306295191 0 75 REMITTANCE DR DEPT 1620 SUITE 1620 CHICAGO IL 606751620 20 1306295191 0 Physicians Anesthesia Services 20 1306295191 0 Physicians Fluoride varnish 20 1306295191 0 Physicians Healthy Kids Services 20 1306295191 0 Physicians Optical Supplies 20 1306295191 0 Physicians Physician Services 00 1306295308 0 FERANDO BLAKE A 2016167 9999999 B 10 1306295308 0 201 MCCAUSLAND ST CARLINVILLE IL 626269128 20 1306295308 0 Dentists Dental Services 20 1306295308 0 Dentists Physician Services 00 1306296074 0 GAZNABI SAFWAN 2020272 9999999 B 10 1306296074 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1306296074 0 Physicians Anesthesia Services 20 1306296074 0 Physicians Fluoride varnish 20 1306296074 0 Physicians Healthy Kids Services 20 1306296074 0 Physicians Optical Supplies 20 1306296074 0 Physicians Physician Services 00 1306296173 0 SCHNELL CLAIRE 2022278 9999999 B 10 1306296173 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1306296173 0 Physicians Anesthesia Services 20 1306296173 0 Physicians Fluoride varnish 20 1306296173 0 Physicians Healthy Kids Services 20 1306296173 0 Physicians Optical Supplies 20 1306296173 0 Physicians Physician Services 00 1306296363 0 DRNEK STEPHANIE L 2017082 9999999 B 10 1306296363 0 PO BOX 79591 BALTIMORE MD 212790591 20 1306296363 0 Optometrists Optical Supplies 20 1306296363 0 Optometrists Optometric Services 20 1306296363 0 Optometrists Physician Services 00 1306296678 0 NALIBOFF MELINDA 2025028 9999999 B 10 1306296678 0 PO BOX 43230 PHOENIX AZ 850803230 20 1306296678 0 Physicians Anesthesia Services 20 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Physical Therapy Services 00 1306364633 0 ROSENBERG JAMIE M 2017347 9999999 B 10 1306364633 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1306364633 0 Physician Assistant Only Fluoride varnish 20 1306364633 0 Physician Assistant Only Healthy Kids Services 20 1306364633 0 Physician Assistant Only Physician Services 00 1306364815 0 BERNDT MELISSA 2017068 9999999 B 10 1306364815 0 300 CEDAR ST PEKIN IL 615547009 20 1306364815 0 Speech Therapists Medical Supplies 20 1306364815 0 Speech Therapists Medical equipment/prosthetic devices 20 1306364815 0 Speech Therapists Speech Therapy/Pathology Services 00 1306365556 0 TROWER LEAH M 2017260 9999999 B 10 1306365556 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1306365556 0 Nurse Practitioners Healthy Kids Services 20 1306365556 0 Nurse Practitioners Nurse Practitioners Services 20 1306365556 0 Nurse Practitioners Physician Services 00 1306366158 0 ALUKO ATINUKE 2020274 9999999 B 10 1306366158 0 PO BOX 60352 660 SOUTH EUCLID 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1306371596 0 Nurse Practitioners Healthy Kids Services 20 1306371596 0 Nurse Practitioners Nurse Practitioners Services 20 1306371596 0 Nurse Practitioners Physician Services 00 1306372016 0 DEMARCO ERIN D 2017241 9999999 B 10 1306372016 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1306372016 0 Physical Therapists Medical Supplies 20 1306372016 0 Physical Therapists Medical equipment/prosthetic devices 20 1306372016 0 Physical Therapists Physical Therapy Services 00 1306372271 0 HAINES BRITTANY 2023311 9999999 B 10 1306372271 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1306372271 0 Physicians Anesthesia Services 20 1306372271 0 Physicians Fluoride varnish 20 1306372271 0 Physicians Healthy Kids Services 20 1306372271 0 Physicians Optical Supplies 20 1306372271 0 Physicians Physician Services 00 1306372735 0 OREKOYA ADEBOLA 2024191 9999999 B 10 1306372735 0 2300 N EDWARD ST DECATUR IL 625264163 20 1306372735 0 Physicians Anesthesia Services 20 1306372735 0 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Assistant Only Physician Services 00 1306374632 0 SHAMI SAQIB J 2018001 9999999 B 10 1306374632 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1306374632 0 Physicians Anesthesia Services 20 1306374632 0 Physicians Fluoride varnish 20 1306374632 0 Physicians Healthy Kids Services 20 1306374632 0 Physicians Optical Supplies 20 1306374632 0 Physicians Physician Services 00 1306374905 0 MCDONALD BENJAMIN D 2018353 9999999 B 10 1306374905 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1306374905 0 Physicians Anesthesia Services 20 1306374905 0 Physicians Fluoride varnish 20 1306374905 0 Physicians Healthy Kids Services 20 1306374905 0 Physicians Optical Supplies 20 1306374905 0 Physicians Physician Services 00 1306375514 0 GANDHI SHRIYA 2019144 9999999 B 10 1306375514 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1306375514 0 Physicians Anesthesia Services 20 1306375514 0 Physicians Fluoride varnish 20 1306375514 0 Physicians Healthy Kids Services 20 1306375514 0 Physicians Optical Supplies 20 1306375514 0 Physicians Physician Services 00 1306376496 0 NAUGHTON LAURA 2017179 9999999 B 10 1306376496 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1306376496 0 Physicians Anesthesia Services 20 1306376496 0 Physicians Healthy Kids Services 20 1306376496 0 Physicians Optical Supplies 20 1306376496 0 Physicians Physician Services 00 1306376595 0 JOHN JOEL ZACHARIAH 2023269 9999999 B 10 1306376595 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1306376595 0 Physicians Anesthesia Services 20 1306376595 0 Physicians Fluoride varnish 20 1306376595 0 Physicians Healthy Kids Services 20 1306376595 0 Physicians Optical Supplies 20 1306376595 0 Physicians Physician Services 00 1306376959 0 MONTESCO KLARIZZ BAJAR 2024234 9999999 B 10 1306376959 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1306376959 0 Physical Therapists Medical Supplies 20 1306376959 0 Physical Therapists Medical equipment/prosthetic devices 20 1306376959 0 Physical Therapists Physical Therapy Services 00 1306377023 0 GORDON ANDREA 2017196 9999999 B 10 1306377023 0 6308 8TH AVE KENOSHA WI 531435031 20 1306377023 0 Nurse Practitioners Fluoride varnish 20 1306377023 0 Nurse Practitioners Healthy Kids Services 20 1306377023 0 Nurse Practitioners Nurse Practitioners Services 20 1306377023 0 Nurse Practitioners Physician Services 00 1306377635 0 AGAPOVA SOPHIA EUGENIA 2020182 9999999 B 10 1306377635 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1306377635 0 Physicians Anesthesia Services 20 1306377635 0 Physicians Fluoride varnish 20 1306377635 0 Physicians Healthy Kids Services 20 1306377635 0 Physicians Optical Supplies 20 1306377635 0 Physicians Physician Services 00 1306378039 0 REZNICEK EMILY 2024100 9999999 B 10 1306378039 0 615 S NEW BALLAS RD STE 1200 SAINT LOUIS MO 631418221 20 1306378039 0 Physicians Anesthesia Services 20 1306378039 0 Physicians Fluoride varnish 20 1306378039 0 Physicians Healthy Kids Services 20 1306378039 0 Physicians Optical Supplies 20 1306378039 0 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1306466255 0 Physicians Healthy Kids Services 20 1306466255 0 Physicians Optical Supplies 20 1306466255 0 Physicians Physician Services 00 1306466925 0 WOLFE JAMES N 2023089 9999999 B 10 1306466925 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1306466925 0 Physicians Anesthesia Services 20 1306466925 0 Physicians Healthy Kids Services 20 1306466925 0 Physicians Optical Supplies 20 1306466925 0 Physicians Physician Services 00 1306467352 0 LEE CODY SHANE 2020197 9999999 B 10 1306467352 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1306467352 0 Physicians Anesthesia Services 20 1306467352 0 Physicians Healthy Kids Services 20 1306467352 0 Physicians Optical Supplies 20 1306467352 0 Physicians Physician Services 00 1306468640 0 PATEL AJAY S 2022206 9999999 B 10 1306468640 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1306468640 0 Physicians Anesthesia Services 20 1306468640 0 Physicians Fluoride varnish 20 1306468640 0 Physicians Healthy Kids Services 20 1306468640 0 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20 1306475629 0 Physicians Anesthesia Services 20 1306475629 0 Physicians Fluoride varnish 20 1306475629 0 Physicians Healthy Kids Services 20 1306475629 0 Physicians Optical Supplies 20 1306475629 0 Physicians Physician Services 00 1306475819 0 PATEL SEEMA 2022109 9999999 B 10 1306475819 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1306475819 0 Clinical Social Worker Social work service 00 1306475967 0 HUSSAINI SYED B 2024128 9999999 B 10 1306475967 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1306475967 0 Physicians Anesthesia Services 20 1306475967 0 Physicians Healthy Kids Services 20 1306475967 0 Physicians Optical Supplies 20 1306475967 0 Physicians Physician Services 20 1306475967 0 Physicians Physicians Psychiatric Services 00 1306476445 0 BROWN LAUREN E 2020071 9999999 B 10 1306476445 0 520 VALLEY VIEW DR MOLINE IL 612656152 20 1306476445 0 Physician Assistant Only Fluoride varnish 20 1306476445 0 Physician Assistant Only Healthy Kids Services 20 1306476445 0 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AVENUE SAINT LOUIS MO 631600352 20 1306481890 0 Physicians Anesthesia Services 20 1306481890 0 Physicians Healthy Kids Services 20 1306481890 0 Physicians Optical Supplies 20 1306481890 0 Physicians Physician Services 00 1306482187 0 OBRADOVIC NATASHA 2020014 9999999 B 10 1306482187 0 PO BOX 772 MC2295 WOONSOCKET RI 028950784 20 1306482187 0 Nurse Practitioners Fluoride varnish 20 1306482187 0 Nurse Practitioners Healthy Kids Services 20 1306482187 0 Nurse Practitioners Nurse Practitioners Services 20 1306482187 0 Nurse Practitioners Physician Services 00 1306482518 0 BUSTOS MARY 2020197 9999999 B 10 1306482518 0 PO BOX 775253 CHICAGO IL 606775253 20 1306482518 0 Nurse Practitioners Fluoride varnish 20 1306482518 0 Nurse Practitioners Healthy Kids Services 20 1306482518 0 Nurse Practitioners Nurse Practitioners Services 20 1306482518 0 Nurse Practitioners Physician Services 00 1306482617 0 O'SULLIVAN WHITNEY L 2020220 9999999 B 10 1306482617 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 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IL 601224698 20 1306536149 0 Physicians Anesthesia Services 20 1306536149 0 Physicians Fluoride varnish 20 1306536149 0 Physicians Healthy Kids Services 20 1306536149 0 Physicians Optical Supplies 20 1306536149 0 Physicians Physician Services 00 1306536339 0 HOLSTROM-MERCADER MARIA 2023143 9999999 B 10 1306536339 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1306536339 0 Physicians Anesthesia Services 20 1306536339 0 Physicians Healthy Kids Services 20 1306536339 0 Physicians Optical Supplies 20 1306536339 0 Physicians Physician Services 00 1306537212 0 CARR SHANE 2024183 9999999 B 10 1306537212 0 4698 DEPT CAROL STREAM IL 601220021 20 1306537212 0 Physicians Anesthesia Services 20 1306537212 0 Physicians Healthy Kids Services 20 1306537212 0 Physicians Optical Supplies 20 1306537212 0 Physicians Physician Services 00 1306537832 0 TAKAYA HIROKI 2024183 9999999 B 10 1306537832 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1306537832 0 Physicians Anesthesia Services 20 1306537832 0 Physicians Healthy Kids Services 20 1306537832 0 Physicians Optical Supplies 20 1306537832 0 Physicians Physician Services 00 1306538103 0 LAMPS KATELYN M 2023142 9999999 B 10 1306538103 0 1606 HUNT DR NORMAL IL 617612192 20 1306538103 0 Other behavior health professional Adaptive behavior support technician services 00 1306540455 0 ECK NICOLE 2023180 9999999 B 10 1306540455 0 PO BOX 3039 OAK BROOK IL 605223039 20 1306540455 0 Physicians Anesthesia Services 20 1306540455 0 Physicians Healthy Kids Services 20 1306540455 0 Physicians Optical Supplies 20 1306540455 0 Physicians Physician Services 00 1306543616 0 POKHVASHCHEV DMITRY 2023045 9999999 B 10 1306543616 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1306543616 0 Physicians Anesthesia Services 20 1306543616 0 Physicians Healthy Kids Services 20 1306543616 0 Physicians Optical Supplies 20 1306543616 0 Physicians Physician Services 00 1306543723 0 MUJAHID AMINAH H 2023069 9999999 B 10 1306543723 0 1325 SYCAMORE 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Therapists Medical equipment/prosthetic devices 20 1306545298 0 Occupational Therapists Occupational Therapy Services 00 1306545678 0 MAURER DANIEL L 2023240 9999999 B 10 1306545678 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1306545678 0 Nurse Practitioners Healthy Kids Services 20 1306545678 0 Nurse Practitioners Nurse Practitioners Services 20 1306545678 0 Nurse Practitioners Physician Services 00 1306546155 0 PETTIT ELIANETTE 2024243 9999999 B 10 1306546155 0 10208 S INDIANAPOLIS AVE # 301 CHICAGO IL 606176033 20 1306546155 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1306546262 0 JOHNSON LINDA 2023130 9999999 B 10 1306546262 0 2900 OGDEN AVE LISLE IL 605321676 20 1306546262 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1306547393 0 GHANI HAMZA 2024197 9999999 B 10 1306547393 0 4701 DEPT CAROL STREAM IL 601220021 20 1306547393 0 Physicians Anesthesia Services 20 1306547393 0 Physicians Fluoride varnish 20 1306547393 0 Physicians Healthy Kids Services 20 1306547393 0 Physicians Optical Supplies 20 1306547393 0 Physicians Physician Services 00 1306547872 0 KHAN AYAIMA 2023109 9999999 B 10 1306547872 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1306547872 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1306548417 0 LAMPSON MARY 2023083 9999999 B 10 1306548417 0 PO BOX 1109 DEKALB IL 601157109 20 1306548417 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1306548839 0 CARAVANA ELIZABETH 2023192 9999999 B 10 1306548839 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1306548839 0 Physicians Anesthesia Services 20 1306548839 0 Physicians Healthy Kids Services 20 1306548839 0 Physicians Optical Supplies 20 1306548839 0 Physicians Physician Services 00 1306549548 0 CRANE JODY SD 2023176 9999999 B 10 1306549548 0 PO BOX 3039 OAK BROOK IL 605223039 20 1306549548 0 Physicians Anesthesia Services 20 1306549548 0 Physicians Healthy Kids Services 20 1306549548 0 Physicians Optical Supplies 20 1306549548 0 Physicians Physician Services 20 1306549548 0 Physicians Physicians Psychiatric Services 00 1306549597 0 TAVERAS KENDYMILL 2023115 9999999 B 10 1306549597 0 PO BOX 3039 OAK BROOK IL 605223039 20 1306549597 0 Physicians Anesthesia Services 20 1306549597 0 Physicians Fluoride varnish 20 1306549597 0 Physicians Healthy Kids Services 20 1306549597 0 Physicians Optical Supplies 20 1306549597 0 Physicians Physician Services 00 1306551486 0 MACWAN JOLLY 2023270 9999999 B 10 1306551486 0 PO BOX 10417 HOLYOKE MA 010412017 20 1306551486 0 Nurse Practitioners Fluoride varnish 20 1306551486 0 Nurse Practitioners Healthy Kids Services 20 1306551486 0 Nurse Practitioners Nurse Practitioners Services 20 1306551486 0 Nurse Practitioners Physician Services 00 1306552872 0 MCCUE KRISTINA L 2024053 9999999 B 10 1306552872 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1306552872 0 Nurse Practitioners Healthy Kids Services 20 1306552872 0 Nurse Practitioners Nurse Practitioners Services 20 1306552872 0 Nurse Practitioners Physician Services 00 1306553359 0 LOWE DARONCIA M 2022350 9999999 B 10 1306553359 0 29373 NETWORK PL CHICAGO IL 606733039 20 1306553359 0 Clinical Social Worker Social work service 00 1306556519 0 STETSER KENNETH 2024080 9999999 B 10 1306556519 0 5777 DEPT CAROL STREAM IL 601220021 20 1306556519 0 Physician Assistant Only Fluoride varnish 20 1306556519 0 Physician Assistant Only Healthy Kids Services 20 1306556519 0 Physician Assistant Only Physician Services 00 1306557657 0 ATKINS MICHALLA J 2023016 9999999 B 10 1306557657 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1306557657 0 Nurse Practitioners Fluoride varnish 20 1306557657 0 Nurse Practitioners Healthy Kids Services 20 1306557657 0 Nurse Practitioners Nurse Practitioners Services 20 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Physician Services 00 1306563556 0 OCAMPO SANDY 2022301 9999999 B 10 1306563556 0 3010 GRAND AVE WAUKEGAN IL 600852321 20 1306563556 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1306563697 0 PERCH KATHERINE 2022322 9999999 B 10 1306563697 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1306563697 0 Nurse Practitioners Anesthesia Services 20 1306563697 0 Nurse Practitioners Nurse Practitioners Services 20 1306563697 0 Nurse Practitioners Physician Services 00 1306564521 0 WAYNE LINDSAY 2023017 9999999 B 10 1306564521 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1306564521 0 Nurse Practitioners Anesthesia Services 20 1306564521 0 Nurse Practitioners Nurse Practitioners Services 20 1306564521 0 Nurse Practitioners Physician Services 00 1306566369 0 SWITZER-POPLAR VERONICA N 2024190 9999999 B 10 1306566369 0 3520 W NORTH AVE STONE PARK IL 601651042 20 1306566369 0 Physician Assistant Only Fluoride varnish 20 1306566369 0 Physician Assistant Only Healthy Kids Services 20 1306566369 0 Physician Assistant Only Physician Services 00 1306569108 0 YOUNG MICHELLE 2022336 9999999 B 10 1306569108 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1306569108 0 Nurse Practitioners Fluoride varnish 20 1306569108 0 Nurse Practitioners Healthy Kids Services 20 1306569108 0 Nurse Practitioners Nurse Practitioners Services 20 1306569108 0 Nurse Practitioners Physician Services 00 1306570106 0 BIALORUCKI JOHN J 2024157 9999999 B 10 1306570106 0 4714 GETTYSBURG RD MECHANICSBURG PA 170554325 20 1306570106 0 Physical Therapists Medical Supplies 20 1306570106 0 Physical Therapists Medical equipment/prosthetic devices 20 1306570106 0 Physical Therapists Physical Therapy Services 00 1306572094 0 MASTERSON OLIVIA 2024120 9999999 B 10 1306572094 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1306572094 0 Physician Assistant Only Fluoride varnish 20 1306572094 0 Physician Assistant Only Healthy Kids Services 20 1306572094 0 Physician Assistant Only Physician Services 00 1306575055 0 SIEK NICOLE PAIGE 2024355 9999999 B 10 1306575055 0 PO BOX 953 ADDISON IL 601010953 20 1306575055 0 Occupational Therapists Medical Supplies 20 1306575055 0 Occupational Therapists Medical equipment/prosthetic devices 20 1306575055 0 Occupational Therapists Occupational Therapy Services 00 1306575576 0 TO JOSIAH 2022212 9999999 B 10 1306575576 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1306575576 0 Physicians Anesthesia Services 20 1306575576 0 Physicians Healthy Kids Services 20 1306575576 0 Physicians Optical Supplies 20 1306575576 0 Physicians Physician Services 00 1306575600 0 HOGAN DUSTIN T 2023165 9999999 B 10 1306575600 0 504 5TH ST CRETE IL 604172110 20 1306575600 0 Occupational Therapists Medical Supplies 20 1306575600 0 Occupational Therapists Medical equipment/prosthetic devices 20 1306575600 0 Occupational Therapists Occupational Therapy Services 00 1306575717 0 IMTIAZ SARA AHMAD 2022166 9999999 B 10 1306575717 0 3855 W NORTH AVE CHICAGO IL 606474640 20 1306575717 0 Dentists Dental Services 20 1306575717 0 Dentists Physician Services 00 1306575956 0 OLSON ELSA A 2022202 9999999 B 10 1306575956 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1306575956 0 Physicians Anesthesia Services 20 1306575956 0 Physicians Healthy Kids Services 20 1306575956 0 Physicians Optical Supplies 20 1306575956 0 Physicians Physician Services 00 1306579438 0 UNATIN KARA 2022210 9999999 B 10 1306579438 0 7421 MADISON ST FOREST PARK IL 601301575 20 1306579438 0 Speech Therapists Medical Supplies 20 1306579438 0 Speech Therapists Medical equipment/prosthetic devices 20 1306579438 0 Speech Therapists Speech Therapy/Pathology Services 00 1306579750 0 OANES JULIA 2023209 9999999 B 10 1306579750 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1306579750 0 Physician Assistant Only Fluoride varnish 20 1306579750 0 Physician Assistant Only Healthy Kids Services 20 1306579750 0 Physician Assistant Only Physician Services 00 1306579883 0 TAYLOR REBECCA 2023013 9999999 B 10 1306579883 0 7309 N KNOXVILLE AVE STE 300 PEORIA IL 616142085 20 1306579883 0 Nurse Practitioners Healthy Kids Services 20 1306579883 0 Nurse Practitioners Midwife Services 20 1306579883 0 Nurse Practitioners Nurse Practitioners Services 20 1306579883 0 Nurse Practitioners Physician Services 00 1306581376 0 BHARATHAN URMILA V 2022171 9999999 B 10 1306581376 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1306581376 0 Physicians Anesthesia Services 20 1306581376 0 Physicians Fluoride varnish 20 1306581376 0 Physicians Healthy Kids Services 20 1306581376 0 Physicians Optical Supplies 20 1306581376 0 Physicians Physician Services 00 1306581665 0 CHRISTENSEN ERIK 2022177 9999999 B 10 1306581665 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1306581665 0 Physicians Anesthesia Services 20 1306581665 0 Physicians Fluoride varnish 20 1306581665 0 Physicians Healthy Kids Services 20 1306581665 0 Physicians Optical Supplies 20 1306581665 0 Physicians Physician Services 00 1306581962 0 DEGONIA ADRIENNE M 2023191 9999999 B 10 1306581962 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1306581962 0 Physicians Anesthesia Services 20 1306581962 0 Physicians Fluoride varnish 20 1306581962 0 Physicians Healthy Kids Services 20 1306581962 0 Physicians Optical Supplies 20 1306581962 0 Physicians Physician Services 00 1306583760 0 GLASTETTER MICHAEL A 2022258 9999999 B 10 1306583760 0 PO BOX 790126 SAINT LOUIS MO 631790126 20 1306583760 0 Nurse Practitioners Anesthesia Services 20 1306583760 0 Nurse Practitioners Nurse Practitioners Services 20 1306583760 0 Nurse Practitioners Physician Services 00 1306583778 0 SUMIDA COURTNEY L 2024212 9999999 B 10 1306583778 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1306583778 0 Nurse Practitioners Healthy Kids Services 20 1306583778 0 Nurse Practitioners Nurse Practitioners Services 20 1306583778 0 Nurse Practitioners Physician Services 00 1306584347 0 HANKLE LUKE H 2022334 9999999 B 10 1306584347 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1306584347 0 Physician Assistant Only Fluoride varnish 20 1306584347 0 Physician Assistant Only Healthy Kids Services 20 1306584347 0 Physician Assistant Only Physician Services 00 1306584511 0 PLUARD ERIN 2022192 9999999 B 10 1306584511 0 PO BOX 781076 DETROIT MI 482781076 20 1306584511 0 Audiologists Audiology Services 20 1306584511 0 Audiologists Medical Supplies 20 1306584511 0 Audiologists Medical equipment/prosthetic devices 00 1306584917 0 KILLAM ZUZANA J 2022178 9999999 B 10 1306584917 0 205 OAKLAND AVE CARLINVILLE IL 626261921 20 1306584917 0 Nurse Practitioners Healthy Kids Services 20 1306584917 0 Nurse Practitioners Nurse Practitioners Services 20 1306584917 0 Nurse Practitioners Physician Services 00 1306585807 0 LI JOY 2024297 9999999 B 10 1306585807 0 5777 DEPT CAROL STREAM IL 601220021 20 1306585807 0 Physician Assistant Only Fluoride varnish 20 1306585807 0 Physician Assistant Only Healthy Kids Services 20 1306585807 0 Physician Assistant Only Physician Services 00 1306586003 0 WOODS ALEXANDER 2023285 9999999 B 10 1306586003 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1306586003 0 Physicians Anesthesia Services 20 1306586003 0 Physicians Healthy Kids Services 20 1306586003 0 Physicians Optical Supplies 20 1306586003 0 Physicians Physician Services 00 1306587217 0 WIERCK JADA 2024008 9999999 B 10 1306587217 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1306587217 0 Physician Assistant Only Fluoride varnish 20 1306587217 0 Physician Assistant Only Healthy Kids Services 20 1306587217 0 Physician Assistant Only Physician Services 00 1306587456 0 TORRES NICOLE 2024165 9999999 B 10 1306587456 0 810 W DOWNER PL AURORA IL 605064904 20 1306587456 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1306587605 0 MIRGATI SIDNEY 2022178 9999999 B 10 1306587605 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1306587605 0 Physicians Anesthesia Services 20 1306587605 0 Physicians Fluoride varnish 20 1306587605 0 Physicians Healthy Kids Services 20 1306587605 0 Physicians Optical Supplies 20 1306587605 0 Physicians Physician Services 00 1306588363 0 ZHANG XIN 2022180 9999999 B 10 1306588363 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1306588363 0 Physicians Anesthesia Services 20 1306588363 0 Physicians Fluoride varnish 20 1306588363 0 Physicians Healthy Kids Services 20 1306588363 0 Physicians Optical Supplies 20 1306588363 0 Physicians Physician Services 00 1306588983 0 WAGMEISTER SARAH N 2022187 9999999 B 10 1306588983 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1306588983 0 Physicians Anesthesia Services 20 1306588983 0 Physicians Fluoride varnish 20 1306588983 0 Physicians Healthy Kids Services 20 1306588983 0 Physicians Optical Supplies 20 1306588983 0 Physicians Physician Services 00 1306589163 0 ADDANKI TEJASWINI 2024151 9999999 B 10 1306589163 0 20201 CRAWFORD AVE 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FRANCO STEPHANIE M 2022182 9999999 B 10 1306595541 0 4698 DEPT CAROL STREAM IL 601220021 20 1306595541 0 Physicians Anesthesia Services 20 1306595541 0 Physicians Fluoride varnish 20 1306595541 0 Physicians Healthy Kids Services 20 1306595541 0 Physicians Optical Supplies 20 1306595541 0 Physicians Physician Services 00 1306595939 0 OSWALT ALEXANDRIA 2023143 9999999 B 10 1306595939 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1306595939 0 Physicians Anesthesia Services 20 1306595939 0 Physicians Healthy Kids Services 20 1306595939 0 Physicians Optical Supplies 20 1306595939 0 Physicians Physician Services 00 1306596416 0 COOTS KYLE SEAN 2022173 9999999 B 10 1306596416 0 5777 DEPT CAROL STREAM IL 601228942 20 1306596416 0 Physicians Anesthesia Services 20 1306596416 0 Physicians Fluoride varnish 20 1306596416 0 Physicians Healthy Kids Services 20 1306596416 0 Physicians Optical Supplies 20 1306596416 0 Physicians Physician Services 00 1306596671 0 KOON DEREK 2022241 9999999 B 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0 Physicians Physician Services 00 1306605738 0 ADOFO-ANSONG NANA SERWAH 2024194 9999999 B 10 1306605738 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1306605738 0 Physicians Anesthesia Services 20 1306605738 0 Physicians Fluoride varnish 20 1306605738 0 Physicians Healthy Kids Services 20 1306605738 0 Physicians Optical Supplies 20 1306605738 0 Physicians Physician Services 00 1306608898 0 AGUILAR ALICIA A 2024122 9999999 B 10 1306608898 0 PO BOX 4176 HOUMA LA 703614176 20 1306608898 0 Physician Assistant Only Fluoride varnish 20 1306608898 0 Physician Assistant Only Healthy Kids Services 20 1306608898 0 Physician Assistant Only Physician Services 00 1306611207 0 KIM DANIEL 2024131 9999999 B 10 1306611207 0 5777 DEPT CAROL STREAM IL 601220021 20 1306611207 0 Nurse Practitioners Fluoride varnish 20 1306611207 0 Nurse Practitioners Healthy Kids Services 20 1306611207 0 Nurse Practitioners Nurse Practitioners Services 20 1306611207 0 Nurse Practitioners Physician Services 00 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Physician Services 00 1306668629 0 REIDY KATARINA 2024339 9999999 B 10 1306668629 0 2720 DUNDEE RD NORTHBROOK IL 600622609 20 1306668629 0 Physician Assistant Only Fluoride varnish 20 1306668629 0 Physician Assistant Only Healthy Kids Services 20 1306668629 0 Physician Assistant Only Physician Services 00 1306670344 0 HENRY MONICA 2024311 9999999 B 10 1306670344 0 2801 W MAIN ST BELLEVILLE IL 622266646 20 1306670344 0 Nurse Practitioners Fluoride varnish 20 1306670344 0 Nurse Practitioners Healthy Kids Services 20 1306670344 0 Nurse Practitioners Nurse Practitioners Services 20 1306670344 0 Nurse Practitioners Physician Services 00 1306671490 0 LE MINH 2024253 9999999 B 10 1306671490 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1306671490 0 Physical Therapists Medical Supplies 20 1306671490 0 Physical Therapists Medical equipment/prosthetic devices 20 1306671490 0 Physical Therapists Physical Therapy Services 00 1306672811 0 MATUSIK SYDNEY L 2024348 9999999 B 10 1306672811 0 PO BOX 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1306815964 0 Physicians Optical Supplies 20 1306815964 0 Physicians Physician Services 00 1306816194 0 NUSE PATRICIA L 2025044 9999999 B 10 1306816194 0 29373 NETWORK PL CHICAGO IL 606733039 20 1306816194 0 Physicians Anesthesia Services 20 1306816194 0 Physicians Fluoride varnish 20 1306816194 0 Physicians Healthy Kids Services 20 1306816194 0 Physicians Optical Supplies 20 1306816194 0 Physicians Physician Services 00 1306816756 0 CHEKURI LAVANYA R 1997048 9999999 B 10 1306816756 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1306816756 0 Physicians Anesthesia Services 20 1306816756 0 Physicians Healthy Kids Services 20 1306816756 0 Physicians Optical Supplies 20 1306816756 0 Physicians Physician Services 00 1306817051 0 BHAMIDI ANURADHA 2024250 9999999 B 10 1306817051 0 PO BOX 43230 PHOENIX AZ 850803230 20 1306817051 0 Physicians Anesthesia Services 20 1306817051 0 Physicians Fluoride varnish 20 1306817051 0 Physicians Healthy Kids Services 20 1306817051 0 Physicians Optical Supplies 20 1306817051 0 Physicians Physician Services 00 1306818182 0 EPSTEIN HOWARD R 1995001 9999999 B 10 1306818182 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1306818182 0 Physicians Anesthesia Services 20 1306818182 0 Physicians Fluoride varnish 20 1306818182 0 Physicians Healthy Kids Services 20 1306818182 0 Physicians Optical Supplies 20 1306818182 0 Physicians Physician Services 00 1306819776 0 KYLE-WOLF LISA M 2017314 9999999 B 10 1306819776 0 7501 N UNIVERSITY ST STE 217B PEORIA IL 616141252 20 1306819776 0 Clinical Social Worker Social work service 00 1306820121 0 ADEYANJU MOSES 2001038 9999999 B 10 1306820121 0 PO BOX 365 CARBONDALE IL 629030365 20 1306820121 0 Physicians Anesthesia Services 20 1306820121 0 Physicians Healthy Kids Services 20 1306820121 0 Physicians Optical Supplies 20 1306820121 0 Physicians Physician Services 00 1306820139 0 GOLDIN NORMAN 2024281 9999999 B 10 1306820139 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1306820139 0 Physicians Anesthesia Services 20 1306820139 0 Physicians Fluoride varnish 20 1306820139 0 Physicians Healthy Kids Services 20 1306820139 0 Physicians Optical Supplies 20 1306820139 0 Physicians Physician Services 00 1306820527 0 RUSCH RICHARD 1987237 9999999 B 10 1306820527 0 225 S EXECUTIVE DR BROOKFIELD WI 530054257 20 1306820527 0 Physicians Anesthesia Services 20 1306820527 0 Physicians Healthy Kids Services 20 1306820527 0 Physicians Optical Supplies 20 1306820527 0 Physicians Physician Services 00 1306820717 0 AHUJA SANJAY P 2024289 9999999 B 10 1306820717 0 8326 NAAB RD INDIANAPOLIS IN 462601920 20 1306820717 0 Physicians Anesthesia Services 20 1306820717 0 Physicians Fluoride varnish 20 1306820717 0 Physicians Healthy Kids Services 20 1306820717 0 Physicians Optical Supplies 20 1306820717 0 Physicians Physician Services 00 1306821053 0 TALTY STEPHEN J 1992183 9999999 B 10 1306821053 0 909 E PALATINE RD PALATINE IL 600745551 20 1306821053 0 Physicians Anesthesia Services 20 1306821053 0 Physicians Healthy Kids Services 20 1306821053 0 Physicians Optical Supplies 20 1306821053 0 Physicians Physician Services 00 1306821707 0 CNOTA JAMES 2008126 9999999 B 10 1306821707 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1306821707 0 Physicians Anesthesia Services 20 1306821707 0 Physicians Fluoride varnish 20 1306821707 0 Physicians Healthy Kids Services 20 1306821707 0 Physicians Optical Supplies 20 1306821707 0 Physicians Physician Services 00 1306821756 0 GARDNER TRESSA 2022087 9999999 B 10 1306821756 0 5121 MARYLAND WAY STE 300 BRENTWOOD TN 370277516 20 1306821756 0 Physicians Anesthesia Services 20 1306821756 0 Physicians Healthy Kids Services 20 1306821756 0 Physicians Optical Supplies 20 1306821756 0 Physicians Physician Services 00 1306821905 0 BITTERMAN PINCAS 1999139 9999999 B 10 1306821905 0 105 N WATER ST MILWAUKEE WI 532026011 20 1306821905 0 Physicians Anesthesia Services 20 1306821905 0 Physicians Healthy Kids Services 20 1306821905 0 Physicians Optical Supplies 20 1306821905 0 Physicians Physician Services 00 1306822549 0 CETTA FRANK 1991182 9999999 B 10 1306822549 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1306822549 0 Physicians Anesthesia Services 20 1306822549 0 Physicians Fluoride varnish 20 1306822549 0 Physicians Healthy Kids Services 20 1306822549 0 Physicians Optical Supplies 20 1306822549 0 Physicians Physician Services 00 1306823208 0 HECHT DAVID 1988284 9999999 B 10 1306823208 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1306823208 0 Physicians Anesthesia Services 20 1306823208 0 Physicians Fluoride varnish 20 1306823208 0 Physicians Healthy Kids Services 20 1306823208 0 Physicians Optical Supplies 20 1306823208 0 Physicians Physician Services 00 1306823273 0 LOBATI FREDERICK N 2023072 9999999 B 10 1306823273 0 PO BOX 43230 PHOENIX AZ 850803230 20 1306823273 0 Physicians Anesthesia Services 20 1306823273 0 Physicians Fluoride varnish 20 1306823273 0 Physicians Healthy Kids Services 20 1306823273 0 Physicians Optical Supplies 20 1306823273 0 Physicians Physician Services 00 1306823570 0 KORACH JAY 1996245 9999999 B 10 1306823570 0 PO BOX 208807 DALLAS TX 753208807 20 1306823570 0 Physicians Anesthesia Services 20 1306823570 0 Physicians Healthy Kids Services 20 1306823570 0 Physicians Optical Supplies 20 1306823570 0 Physicians Physician Services 00 1306823679 0 BARTON KEVIN 1994182 9999999 B 10 1306823679 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1306823679 0 Physicians Anesthesia Services 20 1306823679 0 Physicians Fluoride varnish 20 1306823679 0 Physicians Healthy Kids Services 20 1306823679 0 Physicians Optical Supplies 20 1306823679 0 Physicians Physician Services 00 1306824727 0 POEPPING THOMAS 2010195 9999999 B 10 1306824727 0 1200 S YORK ST STE 4190 ELMHURST IL 601265640 20 1306824727 0 Physicians Anesthesia Services 20 1306824727 0 Physicians Healthy Kids Services 20 1306824727 0 Physicians Optical Supplies 20 1306824727 0 Physicians Physician Services 00 1306824735 0 BOLDREY ANDREW B 2005213 9999999 B 10 1306824735 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1306824735 0 Physicians Anesthesia Services 20 1306824735 0 Physicians Fluoride varnish 20 1306824735 0 Physicians Healthy Kids Services 20 1306824735 0 Physicians Optical Supplies 20 1306824735 0 Physicians Physician Services 00 1306825435 0 KOGAN MONICA 2006244 9999999 B 10 1306825435 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1306825435 0 Physicians Anesthesia Services 20 1306825435 0 Physicians Healthy Kids Services 20 1306825435 0 Physicians Optical Supplies 20 1306825435 0 Physicians Physician Services 00 1306825500 0 STATON THOMAS WALDON 1993200 9999999 B 10 1306825500 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1306825500 0 Physicians Anesthesia Services 20 1306825500 0 Physicians Fluoride varnish 20 1306825500 0 Physicians Healthy Kids Services 20 1306825500 0 Physicians Optical Supplies 20 1306825500 0 Physicians Physician Services 00 1306825740 0 TROY TARA N 2006182 9999999 B 10 1306825740 0 5777 DEPT CAROL STREAM IL 601220021 20 1306825740 0 Physicians Anesthesia Services 20 1306825740 0 Physicians Fluoride varnish 20 1306825740 0 Physicians Healthy Kids Services 20 1306825740 0 Physicians Optical Supplies 20 1306825740 0 Physicians Physician Services 00 1306825856 0 MIDKIFF CHRISTINA L 1998208 9999999 B 10 1306825856 0 2023 VADALABENE DR STE 200 MARYVILLE IL 620625636 20 1306825856 0 Physicians Anesthesia Services 20 1306825856 0 Physicians Healthy Kids Services 20 1306825856 0 Physicians Optical Supplies 20 1306825856 0 Physicians Physician Services 00 1306825930 0 VIERLING SUSAN 1995319 9999999 B 10 1306825930 0 130 S MAIN ST STE 303 LOMBARD IL 601482670 20 1306825930 0 Physicians Anesthesia Services 20 1306825930 0 Physicians Healthy Kids Services 20 1306825930 0 Physicians Optical Supplies 20 1306825930 0 Physicians Physician Services 00 1306826250 0 ALI MUHAMMAD A 1999301 9999999 B 10 1306826250 0 238 S CONGRESS ST RUSHVILLE IL 626811465 20 1306826250 0 Physicians Anesthesia Services 20 1306826250 0 Physicians Fluoride varnish 20 1306826250 0 Physicians Healthy Kids Services 20 1306826250 0 Physicians Optical Supplies 20 1306826250 0 Physicians Physician Services 00 1306826474 0 CABRERA JULIO 2002213 9999999 B 10 1306826474 0 PO BOX 578 PARK RIDGE IL 600680578 20 1306826474 0 Physicians Anesthesia Services 20 1306826474 0 Physicians Healthy Kids Services 20 1306826474 0 Physicians Optical Supplies 20 1306826474 0 Physicians Physician Services 00 1306827001 0 PYLE WILLIAM 1989182 9999999 B 10 1306827001 0 PO BOX 3988 CARBONDALE IL 629023988 20 1306827001 0 Physicians Anesthesia Services 20 1306827001 0 Physicians Healthy Kids Services 20 1306827001 0 Physicians Optical Supplies 20 1306827001 0 Physicians Physician Services 00 1306827159 0 YEMM-SHORES MARY E 2003192 9999999 B 10 1306827159 0 13545 BARRETT PARKWAY DR STE 1 BALLWIN MO 630213823 20 1306827159 0 Nurse Practitioners Anesthesia Services 20 1306827159 0 Nurse Practitioners Nurse Practitioners Services 20 1306827159 0 Nurse Practitioners Physician Services 00 1306827829 0 SCHROYER THOMAS 2004183 9999999 B 10 1306827829 0 12255 DE PAUL DR STE 737 BRIDGETON MO 630442530 20 1306827829 0 Physicians Anesthesia Services 20 1306827829 0 Physicians Healthy Kids Services 20 1306827829 0 Physicians Optical Supplies 20 1306827829 0 Physicians Physician Services 00 1306827910 0 NEWPORT ANDREA 2004113 9999999 B 10 1306827910 0 13545 BARRETT PARKWAY DR STE 1 BALLWIN MO 630213823 20 1306827910 0 Nurse Practitioners Anesthesia Services 20 1306827910 0 Nurse Practitioners Nurse Practitioners Services 20 1306827910 0 Nurse Practitioners Physician Services 00 1306828702 0 BEAMON RICHARD F 2016213 9999999 B 10 1306828702 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1306828702 0 Physicians Anesthesia Services 20 1306828702 0 Physicians Healthy Kids Services 20 1306828702 0 Physicians Optical Supplies 20 1306828702 0 Physicians Physician Services 00 1306828785 0 KAUFMAN LISA 2023081 9999999 B 10 1306828785 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1306828785 0 Physicians Anesthesia Services 20 1306828785 0 Physicians Fluoride varnish 20 1306828785 0 Physicians Healthy Kids Services 20 1306828785 0 Physicians Optical Supplies 20 1306828785 0 Physicians Physician Services 00 1306828975 0 WILSON MARY E 1986246 9999999 B 10 1306828975 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1306828975 0 Physicians Anesthesia Services 20 1306828975 0 Physicians Fluoride varnish 20 1306828975 0 Physicians Healthy Kids Services 20 1306828975 0 Physicians Optical Supplies 20 1306828975 0 Physicians Physician Services 00 1306829445 0 JOHNSON MICHAEL W 2016275 9999999 B 10 1306829445 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1306829445 0 Physicians Anesthesia Services 20 1306829445 0 Physicians Healthy Kids Services 20 1306829445 0 Physicians Optical Supplies 20 1306829445 0 Physicians Physician Services 00 1306829684 0 DYMEK MAKSYM 2021300 9999999 B 10 1306829684 0 PO BOX 208807 DALLAS TX 753208807 20 1306829684 0 Physicians Anesthesia Services 20 1306829684 0 Physicians Healthy Kids Services 20 1306829684 0 Physicians Optical Supplies 20 1306829684 0 Physicians Physician Services 00 1306829775 0 WACHTEL JESSICA 2017091 9999999 B 10 1306829775 0 PO BOX 34156 BELFAST ME 049150619 20 1306829775 0 Physician Assistant Only Fluoride varnish 20 1306829775 0 Physician Assistant Only Healthy Kids Services 20 1306829775 0 Physician Assistant Only Physician Services 00 1306831938 0 HOUSTON JOHN 1999244 9999999 B 10 1306831938 0 330 N CLINTON ST APT 304 CHICAGO IL 606611326 20 1306831938 0 Physicians Anesthesia Services 20 1306831938 0 Physicians Fluoride varnish 20 1306831938 0 Physicians Healthy Kids Services 20 1306831938 0 Physicians Optical Supplies 20 1306831938 0 Physicians Physician Services 00 1306832126 0 BUTZON STEVEN 1994222 9999999 B 10 1306832126 0 207 S ADDISON RD ADDISON IL 601013809 20 1306832126 0 Optometrists Optical Supplies 20 1306832126 0 Optometrists Optometric Services 20 1306832126 0 Optometrists Physician Services 00 1306832829 0 RAHMANI BAHRAM 2003182 9999999 B 10 1306832829 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1306832829 0 Physicians Anesthesia Services 20 1306832829 0 Physicians Fluoride varnish 20 1306832829 0 Physicians Healthy Kids Services 20 1306832829 0 Physicians Optical Supplies 20 1306832829 0 Physicians Physician Services 00 1306832860 0 BEEZHOLD DAVID 1994213 9999999 B 10 1306832860 0 901 MCCLINTOCK DR STE 202 SUITE 202 BURR RIDGE IL 605270872 20 1306832860 0 Physicians Anesthesia Services 20 1306832860 0 Physicians Fluoride varnish 20 1306832860 0 Physicians Healthy Kids Services 20 1306832860 0 Physicians Optical Supplies 20 1306832860 0 Physicians Physician Services 00 1306832910 0 PADGETT ROBERT 2001335 9999999 B 10 1306832910 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1306832910 0 Physicians Anesthesia Services 20 1306832910 0 Physicians Fluoride varnish 20 1306832910 0 Physicians Healthy Kids Services 20 1306832910 0 Physicians Optical Supplies 20 1306832910 0 Physicians Physician Services 00 1306833686 0 DURRANI ABDUL 2002359 9999999 B 10 1306833686 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1306833686 0 Physicians Anesthesia Services 20 1306833686 0 Physicians Fluoride varnish 20 1306833686 0 Physicians Healthy Kids Services 20 1306833686 0 Physicians Optical Supplies 20 1306833686 0 Physicians Physician Services 00 1306833843 0 ROBINSON ROBERT 2003177 9999999 B 10 1306833843 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1306833843 0 Physicians Anesthesia Services 20 1306833843 0 Physicians Fluoride varnish 20 1306833843 0 Physicians Healthy Kids Services 20 1306833843 0 Physicians Optical Supplies 20 1306833843 0 Physicians Physician Services 00 1306834882 0 OGRADY LISA 2020286 9999999 B 10 1306834882 0 PO BOX 43230 PHOENIX AZ 850803230 20 1306834882 0 Physicians Anesthesia Services 20 1306834882 0 Physicians Healthy Kids Services 20 1306834882 0 Physicians Optical Supplies 20 1306834882 0 Physicians Physician Services 00 1306835244 0 LEE EUGENE 1987110 9999999 B 10 1306835244 0 5777 DEPT CAROL STREAM IL 601228942 20 1306835244 0 Physicians Anesthesia Services 20 1306835244 0 Physicians Healthy Kids Services 20 1306835244 0 Physicians Optical Supplies 20 1306835244 0 Physicians Physician Services 00 1306835368 0 KEIPER MARK D 2020117 2099364 B 10 1306835368 0 988102 NEBRASKA MEDICAL CTR OMAHA NE 681988102 20 1306835368 0 Physicians Anesthesia Services 20 1306835368 0 Physicians Healthy Kids Services 20 1306835368 0 Physicians Optical Supplies 20 1306835368 0 Physicians Physician Services 00 1306835418 0 DALTON JERAD 2024192 9999999 B 10 1306835418 0 3600 N PROW RD BLOOMINGTON IN 474041616 20 1306835418 0 Physicians Anesthesia Services 20 1306835418 0 Physicians Healthy Kids Services 20 1306835418 0 Physicians Optical Supplies 20 1306835418 0 Physicians Physician Services 20 1306835418 0 Physicians Physicians Psychiatric Services 00 1306835517 0 AIVAZIAN ARAM 1999060 9999999 B 10 1306835517 0 1128 S ELMHURST RD MT PROSPECT IL 600564241 20 1306835517 0 Dentists Dental Services 20 1306835517 0 Dentists Physician Services 00 1306836549 0 TON ALEXANDER L 2021182 9999999 B 10 1306836549 0 4757 S 7TH ST TERRE HAUTE IN 478024559 20 1306836549 0 Physicians Anesthesia Services 20 1306836549 0 Physicians Fluoride varnish 20 1306836549 0 Physicians Healthy Kids Services 20 1306836549 0 Physicians Optical Supplies 20 1306836549 0 Physicians Physician Services 00 1306836739 0 FRANTA AMY K 2018091 9999999 B 10 1306836739 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1306836739 0 Physicians Anesthesia Services 20 1306836739 0 Physicians Healthy Kids Services 20 1306836739 0 Physicians Optical Supplies 20 1306836739 0 Physicians Physician Services 00 1306837075 0 RIDENOUR TODD 2009222 9999999 B 10 1306837075 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1306837075 0 Physicians Anesthesia Services 20 1306837075 0 Physicians Healthy Kids Services 20 1306837075 0 Physicians Optical Supplies 20 1306837075 0 Physicians Physician Services 00 1306837307 0 FITCH ROGER 1981258 9999999 B 10 1306837307 0 4727 N SHERIDAN RD PEORIA IL 616145925 20 1306837307 0 Optometrists Optical Supplies 20 1306837307 0 Optometrists Optometric Services 20 1306837307 0 Optometrists Physician Services 00 1306837349 0 AHMED AHSAN 2001335 9999999 B 10 1306837349 0 601 W ARMY TRAIL BLVD STE D ADDISON IL 601013299 20 1306837349 0 Dentists Dental Services 20 1306837349 0 Dentists Physician Services 00 1306837471 0 PATEL DHIRENDRA 1990141 9999999 B 10 1306837471 0 3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047452 20 1306837471 0 Physicians Anesthesia Services 20 1306837471 0 Physicians Fluoride varnish 20 1306837471 0 Physicians Healthy Kids Services 20 1306837471 0 Physicians Optical Supplies 20 1306837471 0 Physicians Physician Services 00 1306838255 0 GARRY JOSEPH P 2020003 9999999 B 10 1306838255 0 1220 S WOOD ST CHICAGO IL 606081202 20 1306838255 0 Physicians Anesthesia Services 20 1306838255 0 Physicians Fluoride varnish 20 1306838255 0 Physicians Healthy Kids Services 20 1306838255 0 Physicians Optical Supplies 20 1306838255 0 Physicians Physician Services 00 1306838503 0 ELRAKHAWY AHMED 2002329 9999999 B 10 1306838503 0 611 W PARK ST URBANA IL 618012529 20 1306838503 0 Physicians Anesthesia Services 20 1306838503 0 Physicians Fluoride varnish 20 1306838503 0 Physicians Healthy Kids Services 20 1306838503 0 Physicians Optical Supplies 20 1306838503 0 Physicians Physician Services 00 1306838644 0 KNOLL BARBARA 2003237 9999999 B 10 1306838644 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1306838644 0 Physicians Anesthesia Services 20 1306838644 0 Physicians Healthy Kids Services 20 1306838644 0 Physicians Optical Supplies 20 1306838644 0 Physicians Physician Services 00 1306838776 0 MERCER NANCI 2001152 9999999 B 10 1306838776 0 1005 BROADWAY ST QUINCY IL 623012834 20 1306838776 0 Physicians Anesthesia Services 20 1306838776 0 Physicians Healthy Kids Services 20 1306838776 0 Physicians Optical Supplies 20 1306838776 0 Physicians Physician Services 00 1306839055 0 SIKIC DANIEL 1997213 9999999 B 10 1306839055 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1306839055 0 Physicians Anesthesia Services 20 1306839055 0 Physicians Fluoride varnish 20 1306839055 0 Physicians Healthy Kids Services 20 1306839055 0 Physicians Optical Supplies 20 1306839055 0 Physicians Physician Services 00 1306839667 0 NICHOLSON MARY 1998182 9999999 B 10 1306839667 0 901 MACARTHUR BLVD MUNSTER IN 463212901 20 1306839667 0 Physicians Anesthesia Services 20 1306839667 0 Physicians Healthy Kids Services 20 1306839667 0 Physicians Optical Supplies 20 1306839667 0 Physicians Physician Services 00 1306840210 0 SESHADRI NIRANJAN 2017128 9999999 B 10 1306840210 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1306840210 0 Physicians Anesthesia Services 20 1306840210 0 Physicians Fluoride varnish 20 1306840210 0 Physicians Healthy Kids Services 20 1306840210 0 Physicians Optical Supplies 20 1306840210 0 Physicians Physician Services 00 1306843040 0 VENTURA SALVATORE 1993123 9999999 B 10 1306843040 0 120 W 22ND ST OAK BROOK IL 605231557 20 1306843040 0 Physicians Anesthesia Services 20 1306843040 0 Physicians Fluoride varnish 20 1306843040 0 Physicians Healthy Kids Services 20 1306843040 0 Physicians Optical Supplies 20 1306843040 0 Physicians Physician Services 00 1306843339 0 ALZUBI AYMAN S 2004336 9999999 B 10 1306843339 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1306843339 0 Physicians Anesthesia Services 20 1306843339 0 Physicians Fluoride varnish 20 1306843339 0 Physicians Healthy Kids Services 20 1306843339 0 Physicians Optical Supplies 20 1306843339 0 Physicians Physician Services 00 1306843446 0 STEVENS JEREMY 2012275 9999999 B 10 1306843446 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1306843446 0 Physicians Anesthesia Services 20 1306843446 0 Physicians Healthy Kids Services 20 1306843446 0 Physicians Optical Supplies 20 1306843446 0 Physicians Physician Services 00 1306844261 0 BERT MICHAEL 1996245 9999999 B 10 1306844261 0 175 E HOUSTON ST SAN ANTONIO TX 782052255 20 1306844261 0 Optometrists Optical Supplies 20 1306844261 0 Optometrists Optometric Services 20 1306844261 0 Optometrists Physician Services 00 1306844899 0 HERMAN MARTIN D 1995182 9999999 B 10 1306844899 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1306844899 0 Physicians Anesthesia Services 20 1306844899 0 Physicians Healthy Kids Services 20 1306844899 0 Physicians Optical Supplies 20 1306844899 0 Physicians Physician Services 00 1306844949 0 HOFMANN WILLIAM C. 2003213 9999999 B 10 1306844949 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1306844949 0 Physicians Anesthesia Services 20 1306844949 0 Physicians Healthy Kids Services 20 1306844949 0 Physicians Optical Supplies 20 1306844949 0 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1306845326 0 901 PATIENTS FIRST DR WASHINGTON MO 630904700 20 1306845326 0 Physicians Anesthesia Services 20 1306845326 0 Physicians Fluoride varnish 20 1306845326 0 Physicians Healthy Kids Services 20 1306845326 0 Physicians Optical Supplies 20 1306845326 0 Physicians Physician Services 00 1306846472 0 OKRENT DAVID H 1991212 9999999 B 10 1306846472 0 3249 OAK PARK AVE BERWYN IL 604023429 20 1306846472 0 Physicians Anesthesia Services 20 1306846472 0 Physicians Healthy Kids Services 20 1306846472 0 Physicians Optical Supplies 20 1306846472 0 Physicians Physician Services 00 1306846670 0 PATEL MANOJ R 2009305 9999999 B 10 1306846670 0 5777 DEPT CAROL STREAM IL 601220021 20 1306846670 0 Physicians Anesthesia Services 20 1306846670 0 Physicians Fluoride varnish 20 1306846670 0 Physicians Healthy Kids Services 20 1306846670 0 Physicians Optical Supplies 20 1306846670 0 Physicians Physician Services 00 1306847454 0 FINGERT JOHN H 2004183 9999999 B 10 1306847454 0 200 HAWKINS DR IOWA CITY IA 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1306887674 0 Physicians Fluoride varnish 20 1306887674 0 Physicians Healthy Kids Services 20 1306887674 0 Physicians Optical Supplies 20 1306887674 0 Physicians Physician Services 00 1306887807 0 CREMER EDUARDO 2003213 9999999 B 10 1306887807 0 210 S DESPLAINES ST CHICAGO IL 606615500 20 1306887807 0 Physicians Anesthesia Services 20 1306887807 0 Physicians Fluoride varnish 20 1306887807 0 Physicians Healthy Kids Services 20 1306887807 0 Physicians Optical Supplies 20 1306887807 0 Physicians Physician Services 00 1306888672 0 RIEGLE DARYLE S 1998001 9999999 B 10 1306888672 0 PO BOX 3276 EVANSVILLE IN 477313276 20 1306888672 0 Physicians Anesthesia Services 20 1306888672 0 Physicians Healthy Kids Services 20 1306888672 0 Physicians Optical Supplies 20 1306888672 0 Physicians Physician Services 00 1306889050 0 VANGALA PRADEEP 2019319 9999999 B 10 1306889050 0 PO BOX 43230 PHOENIX AZ 850803230 20 1306889050 0 Physicians Anesthesia Services 20 1306889050 0 Physicians Fluoride varnish 20 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varnish 20 1316252265 0 Physicians Healthy Kids Services 20 1316252265 0 Physicians Optical Supplies 20 1316252265 0 Physicians Physician Services 00 1316253305 0 GARCIA ROBYN 2024258 9999999 B 10 1316253305 0 921 GESSNER RD HOUSTON TX 770242501 20 1316253305 0 Physicians Anesthesia Services 20 1316253305 0 Physicians Healthy Kids Services 20 1316253305 0 Physicians Optical Supplies 20 1316253305 0 Physicians Physician Services 00 1316254139 0 BLACK ASHLEY 2013274 9999999 B 10 1316254139 0 7447 W TALCOTT AVE STE 542 CHICAGO IL 606313716 20 1316254139 0 Physicians Anesthesia Services 20 1316254139 0 Physicians Fluoride varnish 20 1316254139 0 Physicians Healthy Kids Services 20 1316254139 0 Physicians Optical Supplies 20 1316254139 0 Physicians Physician Services 00 1316254287 0 ROHER STACY A 2017188 9999999 B 10 1316254287 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1316254287 0 Nurse Practitioners Healthy Kids Services 20 1316254287 0 Nurse Practitioners Nurse Practitioners Services 20 1316254287 0 Nurse Practitioners Physician Services 00 1316255847 0 DUDANI PRIYANKA 2019354 9999999 B 10 1316255847 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1316255847 0 Physicians Anesthesia Services 20 1316255847 0 Physicians Fluoride varnish 20 1316255847 0 Physicians Healthy Kids Services 20 1316255847 0 Physicians Optical Supplies 20 1316255847 0 Physicians Physician Services 00 1316256688 0 DIAB SHERIF M 2015337 9999999 B 10 1316256688 0 1467 N ELSTON AVE STE 103 CHICAGO IL 606422449 20 1316256688 0 Physical Therapists Medical Supplies 20 1316256688 0 Physical Therapists Medical equipment/prosthetic devices 20 1316256688 0 Physical Therapists Physical Therapy Services 00 1316257645 0 KEMPF BROOKE 2016194 9999999 B 10 1316257645 0 1436 LOCUST ST TERRE HAUTE IN 478071648 20 1316257645 0 Nurse Practitioners Healthy Kids Services 20 1316257645 0 Nurse Practitioners Nurse Practitioners Services 20 1316257645 0 Nurse Practitioners Physician Services 00 1316258601 0 HANSEN PAUL 2016092 9999999 B 10 1316258601 0 2100 POWELL ST STE 900 EMERYVILLE CA 946081844 20 1316258601 0 Physicians Anesthesia Services 20 1316258601 0 Physicians Fluoride varnish 20 1316258601 0 Physicians Healthy Kids Services 20 1316258601 0 Physicians Optical Supplies 20 1316258601 0 Physicians Physician Services 00 1316258965 0 DAVIS RANDI L 2010235 9999999 B 10 1316258965 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1316258965 0 Nurse Practitioners Healthy Kids Services 20 1316258965 0 Nurse Practitioners Nurse Practitioners Services 20 1316258965 0 Nurse Practitioners Physician Services 00 1316259799 0 SINHA JYOTSANA 2017115 9999999 B 10 1316259799 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1316259799 0 Physicians Anesthesia Services 20 1316259799 0 Physicians Fluoride varnish 20 1316259799 0 Physicians Healthy Kids Services 20 1316259799 0 Physicians Optical Supplies 20 1316259799 0 Physicians Physician Services 00 1316259872 0 PATTANI ANAND 2013182 9999999 B 10 1316259872 0 29373 NETWORK PL 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1326067000 0 Physicians Physician Services 00 1326067042 0 JONES MARK A 2014244 9999999 B 10 1326067042 0 25 E SCHAUMBURG RD STE 110 SCHAUMBURG IL 601943548 20 1326067042 0 Podiatrists Podiatric Services 00 1326067117 0 ROCKWELL DAVID 2003119 9999999 B 10 1326067117 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1326067117 0 Physicians Anesthesia Services 20 1326067117 0 Physicians Healthy Kids Services 20 1326067117 0 Physicians Optical Supplies 20 1326067117 0 Physicians Physician Services 00 1326067711 0 SCHAECHER CAREN PAULINE 2019252 9999999 B 10 1326067711 0 3015 N BALLAS RD ADMINISTRATION SAINT LOUIS MO 631312329 20 1326067711 0 Physicians Anesthesia Services 20 1326067711 0 Physicians Healthy Kids Services 20 1326067711 0 Physicians Optical Supplies 20 1326067711 0 Physicians Physician Services 00 1326067950 0 PAVEL CARL 2016172 9999999 B 10 1326067950 0 101 E MILLER RD STERLING IL 610811252 20 1326067950 0 Physicians Anesthesia Services 20 1326067950 0 Physicians Fluoride varnish 20 1326067950 0 Physicians Healthy Kids Services 20 1326067950 0 Physicians Optical Supplies 20 1326067950 0 Physicians Physician Services 00 1326068016 0 SMITH DUSTIN D 2023261 9999999 B 10 1326068016 0 PO BOX 43230 PHOENIX AZ 850803230 20 1326068016 0 Physicians Anesthesia Services 20 1326068016 0 Physicians Healthy Kids Services 20 1326068016 0 Physicians Optical Supplies 20 1326068016 0 Physicians Physician Services 00 1326068149 0 HAESEMEYER SCOTT W 2025064 9999999 B 10 1326068149 0 70 DOCTORS PARK CAPE GIRARDEAU MO 637034928 20 1326068149 0 Physicians Anesthesia Services 20 1326068149 0 Physicians Healthy Kids Services 20 1326068149 0 Physicians Optical Supplies 20 1326068149 0 Physicians Physician Services 00 1326068347 0 REINOEHL JOEL 2012092 9999999 B 10 1326068347 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1326068347 0 Physicians Anesthesia Services 20 1326068347 0 Physicians Fluoride varnish 20 1326068347 0 Physicians Healthy Kids Services 20 1326068347 0 Physicians Optical Supplies 20 1326068347 0 Physicians Physician Services 00 1326068677 0 GELLER ROBERT 1981227 9999999 B 10 1326068677 0 PO BOX 7230 WESTCHESTER IL 601547230 20 1326068677 0 Physicians Anesthesia Services 20 1326068677 0 Physicians Healthy Kids Services 20 1326068677 0 Physicians Optical Supplies 20 1326068677 0 Physicians Physician Services 00 1326069683 0 KASDAN LISA N 2023017 9999999 B 10 1326069683 0 655 DEERFIELD RD STE 100-303 DEERFIELD IL 600153241 20 1326069683 0 Psychologist Psychologist service 00 1326069824 0 PULI SRINIVAS 2010244 9999999 B 10 1326069824 0 530 NE GLEN OAK AVE PEORIA IL 616370001 20 1326069824 0 Physicians Anesthesia Services 20 1326069824 0 Physicians Fluoride varnish 20 1326069824 0 Physicians Healthy Kids Services 20 1326069824 0 Physicians Optical Supplies 20 1326069824 0 Physicians Physician Services 00 1326070210 0 MALISCH TIMOTHY 1997213 9999999 B 10 1326070210 0 PO BOX 5588 BELFAST ME 049155500 20 1326070210 0 Physicians Anesthesia Services 20 1326070210 0 Physicians Fluoride varnish 20 1326070210 0 Physicians Healthy Kids Services 20 1326070210 0 Physicians Optical Supplies 20 1326070210 0 Physicians Physician Services 00 1326070269 0 CASALE LYNN 1993004 9999999 B 10 1326070269 0 PO BOX 411637 SAINT LOUIS MO 631411637 20 1326070269 0 Nurse Practitioners Anesthesia Services 20 1326070269 0 Nurse Practitioners Nurse Practitioners Services 20 1326070269 0 Nurse Practitioners Physician Services 00 1326070863 0 POP-VICAS AURORA 2017235 9999999 B 10 1326070863 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1326070863 0 Physicians Anesthesia Services 20 1326070863 0 Physicians Fluoride varnish 20 1326070863 0 Physicians Healthy Kids Services 20 1326070863 0 Physicians Optical Supplies 20 1326070863 0 Physicians Physician Services 00 1326071887 0 LORET DE MOLA JULIO 2007213 9999999 B 10 1326071887 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1326071887 0 Physicians Anesthesia Services 20 1326071887 0 Physicians Healthy Kids Services 20 1326071887 0 Physicians Optical Supplies 20 1326071887 0 Physicians Physician Services 00 1326071952 0 STOCKMAN REED 2024214 9999999 B 10 1326071952 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1326071952 0 Nurse Practitioners Anesthesia Services 20 1326071952 0 Nurse Practitioners Nurse Practitioners Services 20 1326071952 0 Nurse Practitioners Physician Services 00 1326072042 0 KHAN GHORI S 2002244 9999999 B 10 1326072042 0 5777 DEPT CAROL STREAM IL 601225777 20 1326072042 0 Physicians Anesthesia Services 20 1326072042 0 Physicians Fluoride varnish 20 1326072042 0 Physicians Healthy Kids Services 20 1326072042 0 Physicians Optical Supplies 20 1326072042 0 Physicians Physician Services 00 1326072463 0 FAREEDUDDIN AYESHA 2005122 9999999 B 10 1326072463 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1326072463 0 Physicians Anesthesia Services 20 1326072463 0 Physicians Fluoride varnish 20 1326072463 0 Physicians Healthy Kids Services 20 1326072463 0 Physicians Optical Supplies 20 1326072463 0 Physicians Physician Services 00 1326072760 0 STRICKER PAUL 2014043 9999999 B 10 1326072760 0 100 E PENN SQ PHILADELPHIA PA 191073323 20 1326072760 0 Physicians Anesthesia Services 20 1326072760 0 Physicians Healthy Kids Services 20 1326072760 0 Physicians Optical Supplies 20 1326072760 0 Physicians Physician Services 00 1326073073 0 HATLEY THOMAS 1996214 9999999 B 10 1326073073 0 20733 N BROAD ST CARLINVILLE IL 626263710 20 1326073073 0 Physicians Anesthesia Services 20 1326073073 0 Physicians Fluoride varnish 20 1326073073 0 Physicians Healthy Kids Services 20 1326073073 0 Physicians Optical Supplies 20 1326073073 0 Physicians Physician Services 00 1326073487 0 CLARK KARA G 2003001 9999999 B 10 1326073487 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1326073487 0 Nurse Practitioners Anesthesia Services 20 1326073487 0 Nurse Practitioners Nurse Practitioners Services 20 1326073487 0 Nurse Practitioners Physician Services 00 1326073750 0 WALTERS NIGEL 1995121 9999999 B 10 1326073750 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1326073750 0 Physicians Anesthesia Services 20 1326073750 0 Physicians Fluoride varnish 20 1326073750 0 Physicians Healthy Kids Services 20 1326073750 0 Physicians Optical Supplies 20 1326073750 0 Physicians Physician Services 00 1326074188 0 WASYLIW CHRISTOPHER W 2023077 9999999 B 10 1326074188 0 PO BOX 43230 PHOENIX AZ 850803230 20 1326074188 0 Physicians Anesthesia Services 20 1326074188 0 Physicians Healthy Kids Services 20 1326074188 0 Physicians Optical Supplies 20 1326074188 0 Physicians Physician Services 00 1326074303 0 RAY JOHN D 2007350 9999999 B 10 1326074303 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1326074303 0 Physicians Anesthesia Services 20 1326074303 0 Physicians Healthy Kids Services 20 1326074303 0 Physicians Optical Supplies 20 1326074303 0 Physicians Physician Services 00 1326074360 0 STANLAW KAREN A 2022335 9999999 B 10 1326074360 0 6308 8TH AVE KENOSHA WI 531435031 20 1326074360 0 Physicians Anesthesia Services 20 1326074360 0 Physicians Healthy Kids Services 20 1326074360 0 Physicians Optical Supplies 20 1326074360 0 Physicians Physician Services 00 1326074667 0 FLACH RYAN C 2020036 9999999 B 10 1326074667 0 500 PORTER AVE AURORA MO 656052365 20 1326074667 0 Physicians Anesthesia Services 20 1326074667 0 Physicians Healthy Kids Services 20 1326074667 0 Physicians Optical Supplies 20 1326074667 0 Physicians Physician Services 00 1326074907 0 KLABI LAURIE A 2021281 9999999 B 10 1326074907 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1326074907 0 Physicians Anesthesia Services 20 1326074907 0 Physicians Healthy Kids Services 20 1326074907 0 Physicians Optical Supplies 20 1326074907 0 Physicians Physician Services 00 1326076258 0 GAGE SCOTT W 2016092 9999999 B 10 1326076258 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1326076258 0 Physicians Anesthesia Services 20 1326076258 0 Physicians Healthy Kids Services 20 1326076258 0 Physicians Optical Supplies 20 1326076258 0 Physicians Physician Services 00 1326076654 0 GILL DAVID 1991213 9999999 B 10 1326076654 0 255 E 5TH ST STE 1050 CINCINNATI OH 452024121 20 1326076654 0 Physicians Anesthesia Services 20 1326076654 0 Physicians Healthy Kids Services 20 1326076654 0 Physicians Optical Supplies 20 1326076654 0 Physicians Physician Services 00 1326076845 0 KRYZA MICHAEL 1999328 9999999 B 10 1326076845 0 725 SCHOOL ST STE A MORRIS IL 604501207 20 1326076845 0 Physicians Anesthesia Services 20 1326076845 0 Physicians Healthy Kids Services 20 1326076845 0 Physicians Optical Supplies 20 1326076845 0 Physicians Physician Services 00 1326077165 0 KOLLEF MARIN H 1992183 9999999 B 10 1326077165 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1326077165 0 Physicians Anesthesia Services 20 1326077165 0 Physicians Fluoride varnish 20 1326077165 0 Physicians Healthy Kids Services 20 1326077165 0 Physicians Optical Supplies 20 1326077165 0 Physicians Physician Services 00 1326077579 0 KEE ROMINA 2000001 9999999 B 10 1326077579 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1326077579 0 Physicians Anesthesia Services 20 1326077579 0 Physicians Healthy Kids Services 20 1326077579 0 Physicians Optical Supplies 20 1326077579 0 Physicians Physician Services 00 1326077942 0 MCCUNE KEVIN C 1988214 9999999 B 10 1326077942 0 29373 NETWORK PL CHICAGO IL 606733039 20 1326077942 0 Physicians Anesthesia Services 20 1326077942 0 Physicians Fluoride varnish 20 1326077942 0 Physicians Healthy Kids Services 20 1326077942 0 Physicians Optical Supplies 20 1326077942 0 Physicians Physician Services 00 1326080037 0 MASEREJIAN JAMES P 2000017 9999999 B 10 1326080037 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1326080037 0 Physicians Anesthesia Services 20 1326080037 0 Physicians Fluoride varnish 20 1326080037 0 Physicians Healthy Kids Services 20 1326080037 0 Physicians Optical Supplies 20 1326080037 0 Physicians Physician Services 00 1326080144 0 WILLIAMS KENYA 2007225 9999999 B 10 1326080144 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1326080144 0 Physicians Anesthesia Services 20 1326080144 0 Physicians Healthy Kids Services 20 1326080144 0 Physicians Optical Supplies 20 1326080144 0 Physicians Physician Services 00 1326080177 0 BROOKS HARLEY 1999235 9999999 B 10 1326080177 0 PO BOX 87618 DEPT 10264 CHICAGO IL 606800618 20 1326080177 0 Physicians Anesthesia Services 20 1326080177 0 Physicians Fluoride varnish 20 1326080177 0 Physicians Healthy Kids Services 20 1326080177 0 Physicians Optical Supplies 20 1326080177 0 Physicians Physician Services 00 1326080409 0 OWENS JAMES 2023249 9999999 B 10 1326080409 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1326080409 0 Physicians Anesthesia Services 20 1326080409 0 Physicians Healthy Kids Services 20 1326080409 0 Physicians Optical Supplies 20 1326080409 0 Physicians Physician Services 20 1326080409 0 Physicians Physicians Psychiatric Services 00 1326080672 0 MCHUGH TIMOTHY R 2015143 9999999 B 10 1326080672 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1326080672 0 Physicians Anesthesia Services 20 1326080672 0 Physicians Healthy Kids Services 20 1326080672 0 Physicians Optical Supplies 20 1326080672 0 Physicians Physician Services 00 1326081316 0 JOHNSON THERESE A 2022066 9999999 B 10 1326081316 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1326081316 0 Physician Assistant Only Fluoride varnish 20 1326081316 0 Physician Assistant Only Healthy Kids Services 20 1326081316 0 Physician Assistant Only Physician Services 00 1326081407 0 MCDADE MARK 2020209 9999999 B 10 1326081407 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1326081407 0 Physicians Anesthesia Services 20 1326081407 0 Physicians Healthy Kids Services 20 1326081407 0 Physicians Optical Supplies 20 1326081407 0 Physicians Physician Services 00 1326081480 0 MCNELIS MARGARET 1995152 9999999 B 10 1326081480 0 2010 S ARLINGTON HEIGHTS RD ST ARLINGTON HEIGH IL 600054100 20 1326081480 0 Optometrists Optical Supplies 20 1326081480 0 Optometrists Optometric Services 20 1326081480 0 Optometrists Physician Services 00 1326081787 0 EUBANK LORI A 2017076 9999999 B 10 1326081787 0 5380 TECH DATA DR STE 101 CLEARWATER FL 337603122 20 1326081787 0 Physicians Anesthesia Services 20 1326081787 0 Physicians Healthy Kids Services 20 1326081787 0 Physicians Optical Supplies 20 1326081787 0 Physicians Physician Services 00 1326082140 0 ANGYALOSY ALINA S 2004308 9999999 B 10 1326082140 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1326082140 0 Nurse Practitioners Anesthesia Services 20 1326082140 0 Nurse Practitioners Nurse Practitioners Services 20 1326082140 0 Nurse Practitioners Physician Services 00 1326082462 0 LY BERNICE Q 2023166 9999999 B 10 1326082462 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1326082462 0 Physicians Anesthesia Services 20 1326082462 0 Physicians Family Planning Counseling 20 1326082462 0 Physicians Fluoride varnish 20 1326082462 0 Physicians Healthy 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1326094590 0 Physicians Fluoride varnish 20 1326094590 0 Physicians Healthy Kids Services 20 1326094590 0 Physicians Optical Supplies 20 1326094590 0 Physicians Physician Services 00 1326094699 0 SABALIAUSKAS GAILE 2003182 9999999 B 10 1326094699 0 29373 NETWORK PL CHICAGO IL 606733039 20 1326094699 0 Physicians Anesthesia Services 20 1326094699 0 Physicians Fluoride varnish 20 1326094699 0 Physicians Healthy Kids Services 20 1326094699 0 Physicians Optical Supplies 20 1326094699 0 Physicians Physician Services 00 1326095621 0 DARTT JAMES E 2022071 9999999 B 10 1326095621 0 301 JOHN ST # 42 KALAMAZOO MI 490075295 20 1326095621 0 Physicians Anesthesia Services 20 1326095621 0 Physicians Healthy Kids Services 20 1326095621 0 Physicians Optical Supplies 20 1326095621 0 Physicians Physician Services 00 1326095662 0 ASAD HATEM 2024201 9999999 B 10 1326095662 0 PO BOX 632122 CINCINNATI OH 452632122 20 1326095662 0 Physicians Anesthesia Services 20 1326095662 0 Physicians Fluoride varnish 20 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1326233081 0 Physicians Healthy Kids Services 20 1326233081 0 Physicians Optical Supplies 20 1326233081 0 Physicians Physician Services 00 1326233271 0 RISKIN BARRY 1993001 9999999 B 10 1326233271 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1326233271 0 Physicians Anesthesia Services 20 1326233271 0 Physicians Healthy Kids Services 20 1326233271 0 Physicians Optical Supplies 20 1326233271 0 Physicians Physician Services 20 1326233271 0 Physicians Physicians Psychiatric Services 00 1326235797 0 AYALEW GETINET D 2018161 9999999 B 10 1326235797 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1326235797 0 Physicians Anesthesia Services 20 1326235797 0 Physicians Fluoride varnish 20 1326235797 0 Physicians Healthy Kids Services 20 1326235797 0 Physicians Optical Supplies 20 1326235797 0 Physicians Physician Services 00 1326236563 0 CRUM CHRISTINA M 2015286 9999999 B 10 1326236563 0 1200 W STATE ST ROCKFORD IL 611022112 20 1326236563 0 Physician Assistant Only Electronic Home Response/EHR 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Physicians Anesthesia Services 20 1326249715 0 Physicians Healthy Kids Services 20 1326249715 0 Physicians Optical Supplies 20 1326249715 0 Physicians Physician Services 00 1326249947 0 ZELENA ROKSOLYANA 2016020 9999999 B 10 1326249947 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1326249947 0 Physician Assistant Only Fluoride varnish 20 1326249947 0 Physician Assistant Only Healthy Kids Services 20 1326249947 0 Physician Assistant Only Physician Services 00 1326250515 0 LONG ERIKA J 2007058 9999999 B 10 1326250515 0 6S272 SOMERSET CT NAPERVILLE IL 605403649 20 1326250515 0 Speech Therapists Medical Supplies 20 1326250515 0 Speech Therapists Medical equipment/prosthetic devices 20 1326250515 0 Speech Therapists Speech Therapy/Pathology Services 00 1326252545 0 BENNETT ASHLEY W 2021264 9999999 B 10 1326252545 0 621 S NEW BALLAS RD STE 560A SUITE 560A SAINT LOUIS MO 631418261 20 1326252545 0 Physicians Anesthesia Services 20 1326252545 0 Physicians Healthy Kids Services 20 1326252545 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Psychiatric Services 00 1326253998 0 KIMPLE RANDALL 2010277 9999999 B 10 1326253998 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1326253998 0 Physicians Anesthesia Services 20 1326253998 0 Physicians Healthy Kids Services 20 1326253998 0 Physicians Optical Supplies 20 1326253998 0 Physicians Physician Services 00 1326254921 0 BASSHAM BRIAN SCOTT 2021245 9999999 B 10 1326254921 0 2450 HOLCOMBE BLVD STE MN-34L HOUSTON TX 770212039 20 1326254921 0 Physicians Anesthesia Services 20 1326254921 0 Physicians Fluoride varnish 20 1326254921 0 Physicians Healthy Kids Services 20 1326254921 0 Physicians Optical Supplies 20 1326254921 0 Physicians Physician Services 00 1326255746 0 SMITH ALISON J 2016327 9999999 B 10 1326255746 0 PO BOX 1239 TROY MI 480991239 20 1326255746 0 Physicians Anesthesia Services 20 1326255746 0 Physicians Healthy Kids Services 20 1326255746 0 Physicians Optical Supplies 20 1326255746 0 Physicians Physician Services 00 1326255837 0 MCGUIRE CHRISTINE A 2016344 9999999 B 10 1326255837 0 2215 SANDERS RD STE 105 SUITE 105 NORTHBROOK IL 600626194 20 1326255837 0 Physicians Anesthesia Services 20 1326255837 0 Physicians Fluoride varnish 20 1326255837 0 Physicians Healthy Kids Services 20 1326255837 0 Physicians Optical Supplies 20 1326255837 0 Physicians Physician Services 00 1326257098 0 DELA CRUZ MARTHE 2009243 9999999 B 10 1326257098 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1326257098 0 Physicians Anesthesia Services 20 1326257098 0 Physicians Fluoride varnish 20 1326257098 0 Physicians Healthy Kids Services 20 1326257098 0 Physicians Optical Supplies 20 1326257098 0 Physicians Physician Services 00 1326257585 0 ARSHAVA EVGENY 2008184 9999999 B 10 1326257585 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1326257585 0 Physicians Anesthesia Services 20 1326257585 0 Physicians Healthy Kids Services 20 1326257585 0 Physicians Optical Supplies 20 1326257585 0 Physicians Physician Services 00 1326258401 0 DOWNEY KEISHA 2019023 9999999 B 10 1326258401 0 323 E WACKER DR UNIT 207 CHICAGO IL 606015282 20 1326258401 0 Other behavior health professional Psychologist service 00 1326258427 0 TASALI ESRA F 2005188 9999999 B 10 1326258427 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1326258427 0 Physicians Anesthesia Services 20 1326258427 0 Physicians Fluoride varnish 20 1326258427 0 Physicians Healthy Kids Services 20 1326258427 0 Physicians Optical Supplies 20 1326258427 0 Physicians Physician Services 00 1326258435 0 FINGERMAN MITCHELL E 2010193 9999999 B 10 1326258435 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1326258435 0 Physicians Anesthesia Services 20 1326258435 0 Physicians Healthy Kids Services 20 1326258435 0 Physicians Optical Supplies 20 1326258435 0 Physicians Physician Services 00 1326259433 0 ALLAREDDY VEERAJALANDHAR 2016168 9999999 B 10 1326259433 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1326259433 0 Physicians Anesthesia Services 20 1326259433 0 Physicians Fluoride varnish 20 1326259433 0 Physicians Healthy 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Physicians Healthy Kids Services 20 1326263260 0 Physicians Optical Supplies 20 1326263260 0 Physicians Physician Services 00 1326263682 0 WOLLASTON ANTONY S 2003032 9999999 B 10 1326263682 0 1005 BROADWAY ST QUINCY IL 623012834 20 1326263682 0 Physicians Anesthesia Services 20 1326263682 0 Physicians Healthy Kids Services 20 1326263682 0 Physicians Optical Supplies 20 1326263682 0 Physicians Physician Services 00 1326263831 0 HOUSTON NICHOL D 2005249 9999999 B 10 1326263831 0 1639 S CICERO AVE CICERO IL 608041520 20 1326263831 0 Dentists Dental Services 20 1326263831 0 Dentists Physician Services 00 1326264060 0 JOHNSON BENTON K 2014210 9999999 B 10 1326264060 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1326264060 0 Other behavior health professional Development Therapy, Orientation and Mobility Services 20 1326264060 0 Other behavior health professional Early Intervention Services 20 1326264060 0 Other behavior health professional LCPC/LMFT services 20 1326264060 0 Other behavior health professional Targeted case management service 00 1326264441 0 JACKLIN JENNIFER 2022137 9999999 B 10 1326264441 0 500 PORTER AVE AURORA MO 656052365 20 1326264441 0 Nurse Practitioners Fluoride varnish 20 1326264441 0 Nurse Practitioners Healthy Kids Services 20 1326264441 0 Nurse Practitioners Nurse Practitioners Services 20 1326264441 0 Nurse Practitioners Physician Services 00 1326266107 0 WOOD CATHERINE 2007274 9999999 B 10 1326266107 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1326266107 0 Physicians Anesthesia Services 20 1326266107 0 Physicians Fluoride varnish 20 1326266107 0 Physicians Healthy Kids Services 20 1326266107 0 Physicians Optical Supplies 20 1326266107 0 Physicians Physician Services 00 1326266784 0 SCHMIDT VALERIE 2012153 9999999 B 10 1326266784 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1326266784 0 Physicians Anesthesia Services 20 1326266784 0 Physicians Healthy Kids Services 20 1326266784 0 Physicians Optical Supplies 20 1326266784 0 Physicians Physician Services 00 1326269648 0 OAK JACK ROH 2015244 9999999 B 10 1326269648 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1326269648 0 Physicians Anesthesia Services 20 1326269648 0 Physicians Healthy Kids Services 20 1326269648 0 Physicians Optical Supplies 20 1326269648 0 Physicians Physician Services 00 1326270513 0 MARINCH CAROL A 1987258 9999999 B 10 1326270513 0 5777 DEPT CAROL STREAM IL 601220021 20 1326270513 0 Physicians Anesthesia Services 20 1326270513 0 Physicians Fluoride varnish 20 1326270513 0 Physicians Healthy Kids Services 20 1326270513 0 Physicians Optical Supplies 20 1326270513 0 Physicians Physician Services 00 1326271503 0 DEGARMO BETH 2023019 9999999 B 10 1326271503 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1326271503 0 Physician Assistant Only Fluoride varnish 20 1326271503 0 Physician Assistant Only Healthy Kids Services 20 1326271503 0 Physician Assistant Only Physician Services 00 1326271743 0 RIZVI SYED M 2017248 9999999 B 10 1326271743 0 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1326272162 0 COCKERHAM LESLIE 2017226 9999999 B 10 1326272162 0 PO BOX 18412 PALATINE IL 600558412 20 1326272162 0 Physicians Anesthesia Services 20 1326272162 0 Physicians Fluoride varnish 20 1326272162 0 Physicians Healthy Kids Services 20 1326272162 0 Physicians Optical Supplies 20 1326272162 0 Physicians Physician Services 00 1326272469 0 RAMPURWALA MURTUZA M 2015182 9999999 B 10 1326272469 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1326272469 0 Physicians Anesthesia Services 20 1326272469 0 Physicians Fluoride varnish 20 1326272469 0 Physicians Healthy Kids Services 20 1326272469 0 Physicians Optical Supplies 20 1326272469 0 Physicians Physician Services 00 1326273293 0 DAHLBERG ELIZABETH R 2014032 9999999 B 10 1326273293 0 201 S GRAND AVE E SPRINGFIELD IL 627631000 20 1326273293 0 Physicians Anesthesia Services 20 1326273293 0 Physicians Fluoride varnish 20 1326273293 0 Physicians Healthy Kids Services 20 1326273293 0 Physicians Optical Supplies 20 1326273293 0 Physicians Physician Services 00 1326274556 0 SARHAN MOHAMMAD 2015186 9999999 B 10 1326274556 0 PO BOX 84992 CHICAGO IL 606894992 20 1326274556 0 Physicians Anesthesia Services 20 1326274556 0 Physicians Healthy Kids Services 20 1326274556 0 Physicians Optical Supplies 20 1326274556 0 Physicians Physician Services 00 1326274812 0 GUTIERREZ ROBYN M 2014265 9999999 B 10 1326274812 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1326274812 0 Physicians Anesthesia Services 20 1326274812 0 Physicians Fluoride varnish 20 1326274812 0 Physicians Healthy Kids Services 20 1326274812 0 Physicians Optical Supplies 20 1326274812 0 Physicians Physician Services 00 1326275025 0 CARLSON SEAN W 2021226 9999999 B 10 1326275025 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1326275025 0 Physicians Anesthesia Services 20 1326275025 0 Physicians Healthy Kids Services 20 1326275025 0 Physicians Optical Supplies 20 1326275025 0 Physicians Physician Services 00 1326275215 0 STEWART CARLA 2012073 9999999 B 10 1326275215 0 19630 GOVERNORS HWY STE 5 FLOSSMOOR IL 604222079 20 1326275215 0 Other behavior health professional LCPC/LMFT services 00 1326275413 0 KARI MARUTI 2013001 9999999 B 10 1326275413 0 PO BOX 689 LAKE FOREST IL 600450689 20 1326275413 0 Physicians Anesthesia Services 20 1326275413 0 Physicians Healthy Kids Services 20 1326275413 0 Physicians Optical Supplies 20 1326275413 0 Physicians Physician Services 00 1326275520 0 ANNEN MICHAEL J 2023214 9999999 B 10 1326275520 0 PO BOX 41220 PHOENIX AZ 850801220 20 1326275520 0 Physicians Anesthesia Services 20 1326275520 0 Physicians Healthy Kids Services 20 1326275520 0 Physicians Optical Supplies 20 1326275520 0 Physicians Physician Services 00 1326276916 0 FRYE COURTNEY T 2016130 9999999 B 10 1326276916 0 PO BOX 778912 CHICAGO IL 606778912 20 1326276916 0 Physicians Anesthesia Services 20 1326276916 0 Physicians Fluoride varnish 20 1326276916 0 Physicians Healthy Kids Services 20 1326276916 0 Physicians Optical Supplies 20 1326276916 0 Physicians Physician Services 00 1326277435 0 LOZO SVJETLANA 2016181 9999999 B 10 1326277435 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1326277435 0 Physicians All Kids application agent 20 1326277435 0 Physicians Anesthesia Services 20 1326277435 0 Physicians Healthy Kids Services 20 1326277435 0 Physicians Optical Supplies 20 1326277435 0 Physicians Physician Services 00 1326277526 0 KEMP JOANNA 2017182 9999999 B 10 1326277526 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1326277526 0 Physicians Anesthesia Services 20 1326277526 0 Physicians Healthy Kids Services 20 1326277526 0 Physicians Optical Supplies 20 1326277526 0 Physicians Physician Services 00 1326277559 0 ROSS GREGORY 2009222 9999999 B 10 1326277559 0 13545 BARRETT PARKWAY DR STE 1 BALLWIN MO 630213823 20 1326277559 0 Physicians Anesthesia Services 20 1326277559 0 Physicians Healthy Kids Services 20 1326277559 0 Physicians Optical Supplies 20 1326277559 0 Physicians Physician Services 00 1326277989 0 MA CHANGQING 2021238 9999999 B 10 1326277989 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1326277989 0 Physicians Anesthesia Services 20 1326277989 0 Physicians Healthy Kids Services 20 1326277989 0 Physicians Optical Supplies 20 1326277989 0 Physicians Physician Services 00 1326278417 0 KHAN ALI A 2016046 9999999 B 10 1326278417 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1326278417 0 Physicians Anesthesia Services 20 1326278417 0 Physicians Fluoride varnish 20 1326278417 0 Physicians Healthy Kids Services 20 1326278417 0 Physicians Optical Supplies 20 1326278417 0 Physicians Physician Services 00 1326280264 0 SALEH RANIA 2012183 9999999 B 10 1326280264 0 901 MCCLINTOCK DR STE 202 SUITE 202 BURR RIDGE IL 605270872 20 1326280264 0 Physicians Anesthesia Services 20 1326280264 0 Physicians Fluoride varnish 20 1326280264 0 Physicians Healthy Kids Services 20 1326280264 0 Physicians Optical Supplies 20 1326280264 0 Physicians Physician Services 00 1326280611 0 POULSON-PORT ANDREA J 2024080 9999999 B 10 1326280611 0 PO BOX 343918 MILWAUKEE WI 532343918 20 1326280611 0 Physicians Anesthesia Services 20 1326280611 0 Physicians Fluoride varnish 20 1326280611 0 Physicians Healthy Kids Services 20 1326280611 0 Physicians Optical Supplies 20 1326280611 0 Physicians Physician Services 00 1326280868 0 AIKEN CORIE A 2012039 9999999 B 10 1326280868 0 PO BOX 1510 EVANSVILLE IN 477061510 20 1326280868 0 Nurse Practitioners Healthy Kids Services 20 1326280868 0 Nurse Practitioners Nurse Practitioners Services 20 1326280868 0 Nurse Practitioners Physician Services 00 1326281130 0 SHAMP WHITNEY N 2021336 9999999 B 10 1326281130 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1326281130 0 Physician Assistant Only Fluoride varnish 20 1326281130 0 Physician Assistant Only Healthy Kids Services 20 1326281130 0 Physician Assistant Only Physician Services 00 1326282153 0 CARRIGAN WARREN 2024263 9999999 B 10 1326282153 0 1160 E SAINT CLAIR ST VINCENNES IN 475914853 20 1326282153 0 Physicians Anesthesia Services 20 1326282153 0 Physicians Healthy Kids Services 20 1326282153 0 Physicians Optical Supplies 20 1326282153 0 Physicians Physician Services 20 1326282153 0 Physicians Physicians Psychiatric Services 00 1326282328 0 VANGALA NIVRUTHI 2019129 9999999 B 10 1326282328 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1326282328 0 Physicians Anesthesia Services 20 1326282328 0 Physicians Family Planning Counseling 20 1326282328 0 Physicians Fluoride varnish 20 1326282328 0 Physicians Healthy Kids Services 20 1326282328 0 Physicians Optical Supplies 20 1326282328 0 Physicians Physician Services 00 1326282526 0 YEAGER ANDREA 2004160 9999999 B 10 1326282526 0 1301 W COSSITT AVE LA GRANGE IL 605252145 20 1326282526 0 Speech Therapists Medical Supplies 20 1326282526 0 Speech Therapists Medical equipment/prosthetic devices 20 1326282526 0 Speech Therapists Speech Therapy/Pathology Services 00 1326283904 0 BALLARD JOHN 2017229 9999999 B 10 1326283904 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1326283904 0 Nurse Practitioners Anesthesia Services 20 1326283904 0 Nurse Practitioners Nurse Practitioners Services 20 1326283904 0 Nurse Practitioners Physician Services 00 1326286535 0 KROLCZYK ANITA 2011276 9999999 B 10 1326286535 0 405 LAKE ZURICH RD BARRINGTON IL 600103141 20 1326286535 0 Nurse Practitioners Fluoride varnish 20 1326286535 0 Nurse Practitioners Healthy Kids Services 20 1326286535 0 Nurse Practitioners Nurse Practitioners Services 20 1326286535 0 Nurse Practitioners Physician Services 00 1326287152 0 MEYERING PAULA 2008122 9999999 B 10 1326287152 0 3849 W 95TH ST EVERGREEN PARK IL 608052020 20 1326287152 0 Speech Therapists Speech Therapy/Pathology Services 00 1326287541 0 GIANFORTE ROSEMARIE 2021141 9999999 B 10 1326287541 0 708 CHURCH ST STE 217 EVANSTON IL 602013881 20 1326287541 0 Clinical Social Worker Social work service 00 1326288812 0 REATHERFORD BRADLEY 2009201 9999999 B 10 1326288812 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1326288812 0 Nurse Practitioners Anesthesia Services 20 1326288812 0 Nurse Practitioners Nurse Practitioners Services 20 1326288812 0 Nurse Practitioners Physician Services 00 1326291915 0 HUGHES BRIAN 2011186 9999999 B 10 1326291915 0 1700 E HIGGINS RD STE 600 DES PLAINES IL 600185621 20 1326291915 0 Physicians Anesthesia Services 20 1326291915 0 Physicians Healthy Kids Services 20 1326291915 0 Physicians Optical Supplies 20 1326291915 0 Physicians Physician Services 00 1326292079 0 OBRIEN SHERI 2014317 9999999 B 10 1326292079 0 1120 RANDALL CT GENEVA IL 601343911 20 1326292079 0 Other behavior health professional LCPC/LMFT services 00 1326292228 0 JAIN SACHIN 2012002 9999999 B 10 1326292228 0 5 TIMBERWOOD LN RIVERWOODS IL 600152463 20 1326292228 0 Physicians Anesthesia Services 20 1326292228 0 Physicians Fluoride varnish 20 1326292228 0 Physicians Healthy Kids Services 20 1326292228 0 Physicians Optical Supplies 20 1326292228 0 Physicians Physician Services 00 1326292962 0 HASSAN MUHAMMAD 2021335 9999999 B 10 1326292962 0 PO BOX 43230 PHOENIX AZ 850803230 20 1326292962 0 Physicians Anesthesia Services 20 1326292962 0 Physicians Fluoride varnish 20 1326292962 0 Physicians Healthy Kids Services 20 1326292962 0 Physicians Optical Supplies 20 1326292962 0 Physicians Physician Services 00 1326294935 0 WOLNIAK KRISTY L 2014182 9999999 B 10 1326294935 0 5777 DEPT CAROL STREAM IL 601220021 20 1326294935 0 Physicians Anesthesia Services 20 1326294935 0 Physicians Healthy Kids Services 20 1326294935 0 Physicians Optical Supplies 20 1326294935 0 Physicians Physician Services 00 1326294984 0 HERM-BARABASZ RITA M 2018346 9999999 B 10 1326294984 0 5777 DEPT CAROL STREAM IL 601220021 20 1326294984 0 Nurse Practitioners Healthy Kids Services 20 1326294984 0 Nurse Practitioners Nurse Practitioners Services 20 1326294984 0 Nurse Practitioners Physician Services 00 1326296732 0 BAKSHI AMIT 2009227 9999999 B 10 1326296732 0 PO BOX 120288 DALLAS TX 753120288 20 1326296732 0 Physicians Anesthesia Services 20 1326296732 0 Physicians Healthy Kids Services 20 1326296732 0 Physicians Optical Supplies 20 1326296732 0 Physicians Physician Services 00 1326297086 0 IBE JOYCE 2012122 9999999 B 10 1326297086 0 1S376 SUMMIT AVE OAKBROOK TERRAC IL 601813985 20 1326297086 0 Physicians Anesthesia Services 20 1326297086 0 Physicians Fluoride varnish 20 1326297086 0 Physicians Healthy Kids Services 20 1326297086 0 Physicians Optical Supplies 20 1326297086 0 Physicians Physician Services 00 1326297292 0 BISHOP KRISTEN H 2021355 9999999 B 10 1326297292 0 PO BOX 5588 BELFAST ME 049155500 20 1326297292 0 Physicians Anesthesia Services 20 1326297292 0 Physicians Fluoride varnish 20 1326297292 0 Physicians Healthy Kids Services 20 1326297292 0 Physicians Optical Supplies 20 1326297292 0 Physicians Physician Services 00 1326297359 0 PIES CARLA 2021005 9999999 B 10 1326297359 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1326297359 0 Nurse Practitioners Healthy Kids Services 20 1326297359 0 Nurse Practitioners Nurse Practitioners Services 20 1326297359 0 Nurse Practitioners Physician Services 00 1326298936 0 CARSON JOSHUA 2021272 9999999 B 10 1326298936 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1326298936 0 Physicians Anesthesia Services 20 1326298936 0 Physicians Healthy Kids Services 20 1326298936 0 Physicians Optical Supplies 20 1326298936 0 Physicians Physician Services 00 1326299199 0 WILSON STEPHANIE S 2023287 9999999 B 10 1326299199 0 500 ELDORADO BLVD STE 6250 BROOMFIELD CO 800213421 20 1326299199 0 Physicians Anesthesia Services 20 1326299199 0 Physicians Fluoride varnish 20 1326299199 0 Physicians Healthy Kids Services 20 1326299199 0 Physicians Optical Supplies 20 1326299199 0 Physicians Physician Services 00 1326299611 0 MAZHARI ALALEH 2009213 9999999 B 10 1326299611 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1326299611 0 Physicians Anesthesia Services 20 1326299611 0 Physicians Fluoride varnish 20 1326299611 0 Physicians Healthy Kids Services 20 1326299611 0 Physicians Optical Supplies 20 1326299611 0 Physicians Physician Services 00 1326299926 0 PORTER JASON 2020327 9999999 B 10 1326299926 0 PO BOX 43230 PHOENIX AZ 850803230 20 1326299926 0 Physicians Anesthesia Services 20 1326299926 0 Physicians Healthy Kids Services 20 1326299926 0 Physicians Optical Supplies 20 1326299926 0 Physicians Physician Services 00 1326300120 0 HUNG ADELINA 2018165 9999999 B 10 1326300120 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1326300120 0 Physicians Anesthesia Services 20 1326300120 0 Physicians Fluoride varnish 20 1326300120 0 Physicians Healthy Kids Services 20 1326300120 0 Physicians Optical Supplies 20 1326300120 0 Physicians Physician Services 00 1326300252 0 WILLIAMS LINDSEY 2025006 9999999 B 10 1326300252 0 PO BOX 3990 NAPERVILLE IL 605673990 20 1326300252 0 Speech Therapists Medical Supplies 20 1326300252 0 Speech Therapists Medical equipment/prosthetic devices 20 1326300252 0 Speech Therapists Speech Therapy/Pathology Services 00 1326300831 0 SHAH NIRAJ K 2015215 9999999 B 10 1326300831 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1326300831 0 Physicians Anesthesia Services 20 1326300831 0 Physicians Fluoride varnish 20 1326300831 0 Physicians Healthy Kids Services 20 1326300831 0 Physicians Optical Supplies 20 1326300831 0 Physicians Physician Services 00 1326302258 0 GILL RICK 2018198 9999999 B 10 1326302258 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1326302258 0 Physicians Anesthesia Services 20 1326302258 0 Physicians Healthy Kids Services 20 1326302258 0 Physicians Optical Supplies 20 1326302258 0 Physicians Physician Services 20 1326302258 0 Physicians Physicians Psychiatric Services 00 1326302761 0 POOWANAWITTAYAKOM NONGNOOCH 2020288 9999999 B 10 1326302761 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1326302761 0 Physicians Anesthesia Services 20 1326302761 0 Physicians Fluoride varnish 20 1326302761 0 Physicians Healthy Kids Services 20 1326302761 0 Physicians Optical Supplies 20 1326302761 0 Physicians Physician Services 00 1326302910 0 PATEL ANAND K 2015202 9999999 B 10 1326302910 0 303 N JACKSON ST MORRISON IL 612703042 20 1326302910 0 Physicians Anesthesia Services 20 1326302910 0 Physicians Fluoride varnish 20 1326302910 0 Physicians Healthy Kids Services 20 1326302910 0 Physicians Optical Supplies 20 1326302910 0 Physicians Physician Services 00 1326303520 0 DABROWSKI PAUL 2024081 9999999 B 10 1326303520 0 PO BOX 79591 BALTIMORE MD 212790591 20 1326303520 0 Optometrists Optical Supplies 20 1326303520 0 Optometrists Optometric Services 20 1326303520 0 Optometrists Physician Services 00 1326303736 0 EL GUINDY YEHIA 2024046 9999999 B 10 1326303736 0 2125 OAK GROVE RD STE 200 WALNUT CREEK CA 945982520 20 1326303736 0 Physicians Anesthesia Services 20 1326303736 0 Physicians Healthy Kids Services 20 1326303736 0 Physicians Optical Supplies 20 1326303736 0 Physicians Physician Services 00 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1326306309 0 Physicians Healthy Kids Services 20 1326306309 0 Physicians Optical Supplies 20 1326306309 0 Physicians Physician Services 00 1326306390 0 SCHWARTZ HENRY 2016093 9999999 B 10 1326306390 0 257 S MAIN ST BARTLETT IL 601034420 20 1326306390 0 Physicians Anesthesia Services 20 1326306390 0 Physicians Fluoride varnish 20 1326306390 0 Physicians Healthy Kids Services 20 1326306390 0 Physicians Optical Supplies 20 1326306390 0 Physicians Physician Services 00 1326306937 0 MATHUR ANU 2016214 9999999 B 10 1326306937 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1326306937 0 Physicians Anesthesia Services 20 1326306937 0 Physicians Healthy Kids Services 20 1326306937 0 Physicians Optical Supplies 20 1326306937 0 Physicians Physician Services 20 1326306937 0 Physicians Physicians Psychiatric Services 00 1326307299 0 O''BRIEN ELISE 1998110 9999999 B 10 1326307299 0 3600 W FULLERTON AVE CHICAGO IL 606472319 20 1326307299 0 Speech Therapists HIV Counseling svcs 20 1326307299 0 Speech 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BLUME KERRIE 2024262 9999999 B 10 1326310046 0 4300 WEAVER PKWY STE 100 WARRENVILLE IL 605553920 20 1326310046 0 Clinical Social Worker Social work service 00 1326310830 0 STEINMETZ JAMIE 2014182 9999999 B 10 1326310830 0 PO BOX 5981 CAROL STREAM IL 601975981 20 1326310830 0 Physicians Anesthesia Services 20 1326310830 0 Physicians Healthy Kids Services 20 1326310830 0 Physicians Optical Supplies 20 1326310830 0 Physicians Physician Services 00 1326312463 0 ANDERSON CARRI 2012062 9999999 B 10 1326312463 0 101 N 4TH ST STE A OREGON IL 610611430 20 1326312463 0 Chiropractors Chiropractic Services 00 1326313008 0 GRAVES KENYETTA D 2012032 9999999 B 10 1326313008 0 6742 N FROSTWOOD PKWY PEORIA IL 616152402 20 1326313008 0 Nurse Practitioners Anesthesia Services 20 1326313008 0 Nurse Practitioners Nurse Practitioners Services 20 1326313008 0 Nurse Practitioners Physician Services 00 1326313032 0 ZIEGLER MEGHAN 2014245 9999999 B 10 1326313032 0 3051 HOLLIS DR SPRINGFIELD IL 627047452 20 1326313032 0 Nurse Practitioners Fluoride varnish 20 1326313032 0 Nurse Practitioners Healthy Kids Services 20 1326313032 0 Nurse Practitioners Nurse Practitioners Services 20 1326313032 0 Nurse Practitioners Physician Services 00 1326313370 0 KOTSEVA MAGDALENA 2015182 9999999 B 10 1326313370 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1326313370 0 Physicians Anesthesia Services 20 1326313370 0 Physicians Fluoride varnish 20 1326313370 0 Physicians Healthy Kids Services 20 1326313370 0 Physicians Optical Supplies 20 1326313370 0 Physicians Physician Services 00 1326313768 0 BASKIN RACHEL 2016222 9999999 B 10 1326313768 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1326313768 0 Physicians Anesthesia Services 20 1326313768 0 Physicians Healthy Kids Services 20 1326313768 0 Physicians Optical Supplies 20 1326313768 0 Physicians Physician Services 00 1326314030 0 FOWLER KYLIE GLEN 2020153 9999999 B 10 1326314030 0 5901 LINCOLN DR EDINA MN 554361611 20 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1326319096 0 5121 MARYLAND WAY STE 300 BRENTWOOD TN 370277516 20 1326319096 0 Physicians Anesthesia Services 20 1326319096 0 Physicians Fluoride varnish 20 1326319096 0 Physicians Healthy Kids Services 20 1326319096 0 Physicians Optical Supplies 20 1326319096 0 Physicians Physician Services 00 1326319559 0 HAWKINS-FISHER LANITA L 2013324 9999999 B 10 1326319559 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1326319559 0 Nurse Practitioners Fluoride varnish 20 1326319559 0 Nurse Practitioners Healthy Kids Services 20 1326319559 0 Nurse Practitioners Nurse Practitioners Services 20 1326319559 0 Nurse Practitioners Physician Services 00 1326321084 0 WALL JILLIAN M 2017143 9999999 B 10 1326321084 0 3200 E CAMELBACK RD STE 250 PHOENIX AZ 850182327 20 1326321084 0 Physicians Anesthesia Services 20 1326321084 0 Physicians Fluoride varnish 20 1326321084 0 Physicians Healthy Kids Services 20 1326321084 0 Physicians Optical Supplies 20 1326321084 0 Physicians Physician Services 00 1326321233 0 SADDLETON ELISE 2017194 9999999 B 10 1326321233 0 PO BOX 713160 CHICAGO IL 606770360 20 1326321233 0 Physicians Anesthesia Services 20 1326321233 0 Physicians Healthy Kids Services 20 1326321233 0 Physicians Optical Supplies 20 1326321233 0 Physicians Physician Services 00 1326324260 0 DITTO LARINA J 2016336 9999999 B 10 1326324260 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1326324260 0 Clinical Social Worker Social work service 00 1326326315 0 ULUC KUTLUAY 2023152 9999999 B 10 1326326315 0 2200 E PARRISH AVE STE 100 BLDG D SUITE 100 OWENSBORO KY 423031449 20 1326326315 0 Physicians Anesthesia Services 20 1326326315 0 Physicians Healthy Kids Services 20 1326326315 0 Physicians Optical Supplies 20 1326326315 0 Physicians Physician Services 00 1326326539 0 POTOCKI KAREN 2011274 9999999 B 10 1326326539 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1326326539 0 Nurse Practitioners Healthy Kids Services 20 1326326539 0 Nurse Practitioners Nurse 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0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1326331893 0 Physicians Anesthesia Services 20 1326331893 0 Physicians Fluoride varnish 20 1326331893 0 Physicians Healthy Kids Services 20 1326331893 0 Physicians Optical Supplies 20 1326331893 0 Physicians Physician Services 00 1326332586 0 WESTMAN RYAN P 2022295 9999999 B 10 1326332586 0 6150 E BROAD ST COLUMBUS OH 432131574 20 1326332586 0 Physicians Anesthesia Services 20 1326332586 0 Physicians Fluoride varnish 20 1326332586 0 Physicians Healthy Kids Services 20 1326332586 0 Physicians Optical Supplies 20 1326332586 0 Physicians Physician Services 00 1326332776 0 ELLINGSON CLINTON 2018155 9999999 B 10 1326332776 0 6149 E COLUMBIA ST EVANSVILLE IN 477159134 20 1326332776 0 Physicians Anesthesia Services 20 1326332776 0 Physicians Healthy Kids Services 20 1326332776 0 Physicians Optical Supplies 20 1326332776 0 Physicians Physician Services 00 1326332818 0 JOHNSON KATHERINE 2015125 9999999 H 10 1326332818 0 1305 WILEY RD 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COLLEGE DR STE 1NW PALOS HEIGHTS IL 604631025 20 1326428103 0 Physicians Anesthesia Services 20 1326428103 0 Physicians Fluoride varnish 20 1326428103 0 Physicians Healthy Kids Services 20 1326428103 0 Physicians Optical Supplies 20 1326428103 0 Physicians Physician Services 00 1326428525 0 KITOWSKI STEVEN 2018047 9999999 B 10 1326428525 0 524 E SCHAUMBURG RD SCHAUMBURG IL 601943510 20 1326428525 0 Speech Therapists Medical Supplies 20 1326428525 0 Speech Therapists Medical equipment/prosthetic devices 20 1326428525 0 Speech Therapists Speech Therapy/Pathology Services 00 1326429242 0 MANSURI KAIF M 2017069 9999999 B 10 1326429242 0 109 CALIFORNIA ST CARTERVILLE IL 629181923 20 1326429242 0 Physicians Anesthesia Services 20 1326429242 0 Physicians Fluoride varnish 20 1326429242 0 Physicians Healthy Kids Services 20 1326429242 0 Physicians Optical Supplies 20 1326429242 0 Physicians Physician Services 00 1326429275 0 RINEHART KATHLEEN A 2015214 9999999 B 10 1326429275 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1326429275 0 Nurse Practitioners Nursing service 20 1326429275 0 Nurse Practitioners Waiver service 00 1326429333 0 PAMUDURTHY VIJETA REDDY 2021195 9999999 B 10 1326429333 0 29373 NETWORK PL CHICAGO IL 606733039 20 1326429333 0 Physicians Anesthesia Services 20 1326429333 0 Physicians Fluoride varnish 20 1326429333 0 Physicians Healthy Kids Services 20 1326429333 0 Physicians Optical Supplies 20 1326429333 0 Physicians Physician Services 00 1326429747 0 RAYA NISCHAL 2019155 9999999 B 10 1326429747 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1326429747 0 Physicians Anesthesia Services 20 1326429747 0 Physicians Fluoride varnish 20 1326429747 0 Physicians Healthy Kids Services 20 1326429747 0 Physicians Optical Supplies 20 1326429747 0 Physicians Physician Services 00 1326429937 0 POWERS SHANNON MARIE 2019197 9999999 B 10 1326429937 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1326429937 0 Physicians Anesthesia Services 20 1326429937 0 Physicians 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1326481219 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1326481219 0 Physicians Anesthesia Services 20 1326481219 0 Physicians Healthy Kids Services 20 1326481219 0 Physicians Optical Supplies 20 1326481219 0 Physicians Physician Services 00 1326481763 0 CALDWELL ALICIA 2020195 9999999 B 10 1326481763 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1326481763 0 Physicians Anesthesia Services 20 1326481763 0 Physicians Fluoride varnish 20 1326481763 0 Physicians Healthy Kids Services 20 1326481763 0 Physicians Optical Supplies 20 1326481763 0 Physicians Physician Services 00 1326482571 0 YUREVICH OLEG 2020225 9999999 B 10 1326482571 0 1005 BROADWAY ST QUINCY IL 623012834 20 1326482571 0 Physicians Anesthesia Services 20 1326482571 0 Physicians Fluoride varnish 20 1326482571 0 Physicians Healthy Kids Services 20 1326482571 0 Physicians Optical Supplies 20 1326482571 0 Physicians Physician Services 00 1326482688 0 TOLANI ANMOL N 2017318 9999999 B 10 1326482688 0 PO BOX 19639 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1326488651 0 Physicians Physician Services 00 1326488685 0 RYNERSON ZACHARY 2016214 9999999 B 10 1326488685 0 2100 POWELL ST STE 900 EMERYVILLE CA 946081844 20 1326488685 0 Physicians Anesthesia Services 20 1326488685 0 Physicians Healthy Kids Services 20 1326488685 0 Physicians Optical Supplies 20 1326488685 0 Physicians Physician Services 00 1326489196 0 SANGHANI RUSHI 2014062 9999999 B 10 1326489196 0 1155 N MAIN ST STE A GLENDALE HEIGHT IL 601393508 20 1326489196 0 Dentists Dental Services 20 1326489196 0 Dentists Physician Services 00 1326489436 0 VARMA SONAL 2020230 9999999 B 10 1326489436 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1326489436 0 Physicians Anesthesia Services 20 1326489436 0 Physicians Fluoride varnish 20 1326489436 0 Physicians Healthy Kids Services 20 1326489436 0 Physicians Optical Supplies 20 1326489436 0 Physicians Physician Services 00 1326490566 0 KHANAL AAYUSH 2017083 9999999 B 10 1326490566 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 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1326492018 0 ROACH JOSHUA 2020157 9999999 B 10 1326492018 0 4701 DEPT CAROL STREAM IL 601220021 20 1326492018 0 Physicians Anesthesia Services 20 1326492018 0 Physicians Healthy Kids Services 20 1326492018 0 Physicians Optical Supplies 20 1326492018 0 Physicians Physician Services 00 1326492117 0 DORNHECKER CODY A 2019351 9999999 B 10 1326492117 0 500 PORTER AVE AURORA MO 656052365 20 1326492117 0 Physicians Anesthesia Services 20 1326492117 0 Physicians Healthy Kids Services 20 1326492117 0 Physicians Optical Supplies 20 1326492117 0 Physicians Physician Services 00 1326492166 0 KLEIN STEPHANIE M 2023018 9999999 B 10 1326492166 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1326492166 0 Nurse Practitioners Healthy Kids Services 20 1326492166 0 Nurse Practitioners Nurse Practitioners Services 20 1326492166 0 Nurse Practitioners Physician Services 00 1326492323 0 SCHULTE SPENCER S 2024143 9999999 B 10 1326492323 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 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CAGLE JONATHAN S 2020035 9999999 B 10 1326538968 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1326538968 0 Physicians Anesthesia Services 20 1326538968 0 Physicians Healthy Kids Services 20 1326538968 0 Physicians Optical Supplies 20 1326538968 0 Physicians Physician Services 00 1326539859 0 ZELLER AMY 2021356 9999999 B 10 1326539859 0 PO BOX 34156 BELFAST ME 049150619 20 1326539859 0 Physician Assistant Only Fluoride varnish 20 1326539859 0 Physician Assistant Only Healthy Kids Services 20 1326539859 0 Physician Assistant Only Physician Services 00 1326540634 0 CIZINAUSKAS HOLLY 2024240 9999999 B 10 1326540634 0 106 W MAIN ST STE B WEST DUNDEE IL 601182017 20 1326540634 0 Other behavior health professional LCPC/LMFT services 00 1326540782 0 MCFARLAND CELESTE 2018274 9999999 B 10 1326540782 0 309 NEW INDIAN TRAIL CT AURORA IL 605062411 20 1326540782 0 Nurse Practitioners Fluoride varnish 20 1326540782 0 Nurse Practitioners Healthy Kids Services 20 1326540782 0 Nurse Practitioners 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Healthy Kids Services 20 1326616152 0 Physicians Optical Supplies 20 1326616152 0 Physicians Physician Services 00 1326616525 0 ASHTON CHRISTINE E 2022090 9999999 B 10 1326616525 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1326616525 0 Physicians Anesthesia Services 20 1326616525 0 Physicians Healthy Kids Services 20 1326616525 0 Physicians Optical Supplies 20 1326616525 0 Physicians Physician Services 20 1326616525 0 Physicians Physicians Psychiatric Services 00 1326617945 0 BRUINSMA RACHEL 2021222 9999999 B 10 1326617945 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1326617945 0 Optometrists Optical Supplies 20 1326617945 0 Optometrists Optometric Services 20 1326617945 0 Optometrists Physician Services 00 1326618315 0 CRITTENDEN TAYLOR L 2024030 9999999 B 10 1326618315 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1326618315 0 Nurse Practitioners Anesthesia Services 20 1326618315 0 Nurse Practitioners Nurse Practitioners Services 20 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1326625062 0 Physicians Healthy Kids Services 20 1326625062 0 Physicians Optical Supplies 20 1326625062 0 Physicians Physician Services 00 1326625070 0 MOTZKUS GREGORY 2021247 9999999 B 10 1326625070 0 124 SW ADAMS ST PEORIA IL 616021308 20 1326625070 0 Physicians Anesthesia Services 20 1326625070 0 Physicians Healthy Kids Services 20 1326625070 0 Physicians Optical Supplies 20 1326625070 0 Physicians Physician Services 00 1326625971 0 MULLER CARLY G 2024199 9999999 B 10 1326625971 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1326625971 0 Physicians Anesthesia Services 20 1326625971 0 Physicians Fluoride varnish 20 1326625971 0 Physicians Healthy Kids Services 20 1326625971 0 Physicians Optical Supplies 20 1326625971 0 Physicians Physician Services 00 1326626052 0 MILLER JOSEPH B 2021217 9999999 B 10 1326626052 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1326626052 0 Physicians Anesthesia Services 20 1326626052 0 Physicians Healthy Kids Services 20 1326626052 0 Physicians Optical Supplies 20 1326626052 0 Physicians Physician Services 00 1326626151 0 HAZIM KATRINA 2024157 9999999 B 10 1326626151 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1326626151 0 Physicians Anesthesia Services 20 1326626151 0 Physicians Healthy Kids Services 20 1326626151 0 Physicians Optical Supplies 20 1326626151 0 Physicians Physician Services 20 1326626151 0 Physicians Physicians Psychiatric Services 00 1326626185 0 KADAKIA ANAND D 2024206 9999999 B 10 1326626185 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1326626185 0 Physicians Anesthesia Services 20 1326626185 0 Physicians Fluoride varnish 20 1326626185 0 Physicians Healthy Kids Services 20 1326626185 0 Physicians Optical Supplies 20 1326626185 0 Physicians Physician Services 00 1326626235 0 ALBRECHT SARAH 2022068 9999999 B 10 1326626235 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1326626235 0 Physician Assistant Only Fluoride varnish 20 1326626235 0 Physician Assistant Only Healthy Kids Services 20 1326626235 0 Physician Assistant Only Physician Services 00 1326626391 0 LAURISCH ASHLEY N 2021182 9999999 B 10 1326626391 0 29373 NETWORK PL CHICAGO IL 606733039 20 1326626391 0 Physicians Anesthesia Services 20 1326626391 0 Physicians Fluoride varnish 20 1326626391 0 Physicians Healthy Kids Services 20 1326626391 0 Physicians Optical Supplies 20 1326626391 0 Physicians Physician Services 00 1326626987 0 UPPALAPATI SWETHA 2024191 9999999 B 10 1326626987 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1326626987 0 Physicians Anesthesia Services 20 1326626987 0 Physicians Healthy Kids Services 20 1326626987 0 Physicians Optical Supplies 20 1326626987 0 Physicians Physician Services 20 1326626987 0 Physicians Physicians Psychiatric Services 00 1326627084 0 HARRITY WILLIAM R 2023184 9999999 B 10 1326627084 0 PO BOX 3039 OAK BROOK IL 605223039 20 1326627084 0 Physicians Anesthesia Services 20 1326627084 0 Physicians Healthy Kids Services 20 1326627084 0 Physicians Optical Supplies 20 1326627084 0 Physicians Physician Services 00 1326628264 0 EKE-OKORO IKECHUKWU 2024183 9999999 B 10 1326628264 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1326628264 0 Physicians Anesthesia Services 20 1326628264 0 Physicians Healthy Kids Services 20 1326628264 0 Physicians Optical Supplies 20 1326628264 0 Physicians Physician Services 00 1326629007 0 ZANE KYLIE 2022266 9999999 B 10 1326629007 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1326629007 0 Physicians Anesthesia Services 20 1326629007 0 Physicians Healthy Kids Services 20 1326629007 0 Physicians Optical Supplies 20 1326629007 0 Physicians Physician Services 00 1326629056 0 SODERBERG SARAH 2024310 9999999 B 10 1326629056 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1326629056 0 Physicians Anesthesia Services 20 1326629056 0 Physicians Healthy Kids Services 20 1326629056 0 Physicians Optical Supplies 20 1326629056 0 Physicians Physician Services 00 1326629635 0 MIHAILESCU MARIA 2022205 9999999 B 10 1326629635 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1326629635 0 Physicians Anesthesia Services 20 1326629635 0 Physicians Healthy Kids Services 20 1326629635 0 Physicians Optical Supplies 20 1326629635 0 Physicians Physician Services 00 1326631052 0 FOSTER PAIGE 2022138 9999999 B 10 1326631052 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1326631052 0 Physician Assistant Only Fluoride varnish 20 1326631052 0 Physician Assistant Only Healthy Kids Services 20 1326631052 0 Physician Assistant Only Physician Services 00 1326631292 0 SIANEZ YESENIA 2025042 9999999 B 10 1326631292 0 8777 VELOCITY DR MACHESNEY PARK IL 611158002 20 1326631292 0 Nurse Practitioners Fluoride varnish 20 1326631292 0 Nurse Practitioners Healthy Kids Services 20 1326631292 0 Nurse Practitioners Nurse Practitioners Services 20 1326631292 0 Nurse Practitioners Physician Services 00 1326631433 0 CESHKER AMY JO 2021118 9999999 B 10 1326631433 0 2028 N SEMINARY AVE WOODSTOCK IL 600982626 20 1326631433 0 Clinical Social Worker Social work service 00 1326633652 0 RIVERS REID T 2021203 9999999 B 10 1326633652 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1326633652 0 Physicians Anesthesia Services 20 1326633652 0 Physicians Fluoride varnish 20 1326633652 0 Physicians Healthy Kids Services 20 1326633652 0 Physicians Optical Supplies 20 1326633652 0 Physicians Physician Services 00 1326633934 0 BHATTI NABEEL 2024127 9999999 B 10 1326633934 0 125 S BLOOMINGDALE RD STE 11 BLOOMINGDALE IL 601081216 20 1326633934 0 Physical Therapists Medical Supplies 20 1326633934 0 Physical Therapists Medical equipment/prosthetic devices 20 1326633934 0 Physical Therapists Physical Therapy Services 00 1326636689 0 TAYLOR MARIANA 2024284 9999999 B 10 1326636689 0 PO BOX 781076 DETROIT MI 482781076 20 1326636689 0 Nurse Practitioners Fluoride varnish 20 1326636689 0 Nurse Practitioners Healthy Kids Services 20 1326636689 0 Nurse Practitioners Nurse Practitioners Services 20 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FRANCO ROXANNA 2020344 9999999 H 10 1326644329 0 1414 MAIN ST MELROSE PARK IL 601603902 20 1326644329 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326644485 0 STEVENS REANNA 2021140 9999999 B 10 1326644485 0 11740 S WESTERN AVE CHICAGO IL 606434732 20 1326644485 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326645193 0 NASH COLLEEN 2020307 9999999 B 10 1326645193 0 5777 DEPT CAROL STREAM IL 601220021 20 1326645193 0 Nurse Practitioners Healthy Kids Services 20 1326645193 0 Nurse Practitioners Nurse Practitioners Services 20 1326645193 0 Nurse Practitioners Physician Services 00 1326648577 0 MUNDLE WILLIAM 2021314 9999999 B 10 1326648577 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1326648577 0 Physicians Anesthesia Services 20 1326648577 0 Physicians Healthy Kids Services 20 1326648577 0 Physicians Optical Supplies 20 1326648577 0 Physicians Physician Services 00 1326649856 0 LOSSIA AMANDA 2023255 9999999 B 10 1326649856 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1326649856 0 Psychologist Psychologist service 00 1326650250 0 SAPORITO MICHAEL L 2024192 9999999 B 10 1326650250 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1326650250 0 Physicians Anesthesia Services 20 1326650250 0 Physicians Fluoride varnish 20 1326650250 0 Physicians Healthy Kids Services 20 1326650250 0 Physicians Optical Supplies 20 1326650250 0 Physicians Physician Services 00 1326651407 0 NEIL NATALIE 2020247 9999999 B 10 1326651407 0 300 CEDAR ST PEKIN IL 615547009 20 1326651407 0 Speech Therapists Medical Supplies 20 1326651407 0 Speech Therapists Medical equipment/prosthetic devices 20 1326651407 0 Speech Therapists Speech Therapy/Pathology Services 00 1326652157 0 KOFFINKE LISA 2020248 9999999 B 10 1326652157 0 24014 W RENWICK RD PLAINFIELD IL 605448708 20 1326652157 0 Occupational Therapists Medical Supplies 20 1326652157 0 Occupational Therapists Medical equipment/prosthetic devices 20 1326652157 0 Occupational Therapists Occupational Therapy Services 00 1326654005 0 DIAMOND MATTHEW L 2024204 9999999 B 10 1326654005 0 2900 FOXFIELD RD STE 102 ST CHARLES IL 601745799 20 1326654005 0 Podiatrists Podiatric Services 00 1326656497 0 JACOBS RACHEL 2020197 9999999 B 10 1326656497 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1326656497 0 Other behavior health professional LCPC/LMFT services 00 1326656992 0 GUHA JESSICA 2020226 9999999 H 10 1326656992 0 333 N LA GRANGE RD STE 1 SUITE ONE LA GRANGE PARK IL 605265653 20 1326656992 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326660069 0 ANTONOPOULOS GEORGE J 2023025 9999999 B 10 1326660069 0 PO BOX 775253 CHICAGO IL 606775253 20 1326660069 0 Nurse Practitioners Fluoride varnish 20 1326660069 0 Nurse Practitioners Healthy Kids Services 20 1326660069 0 Nurse Practitioners Nurse Practitioners Services 20 1326660069 0 Nurse Practitioners Physician Services 00 1326660309 0 KELLER CHRISTOPHER 2023194 9999999 B 10 1326660309 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1326660309 0 Physicians Anesthesia Services 20 1326660309 0 Physicians Healthy Kids Services 20 1326660309 0 Physicians Optical Supplies 20 1326660309 0 Physicians Physician Services 00 1326660341 0 MARTIN DANIELLE 2021013 9999999 B 10 1326660341 0 1400 W GREENLEAF AVE CHICAGO IL 606262805 20 1326660341 0 Clinical Social Worker Social work service 00 1326660440 0 HOPP LEAH M 2020134 9999999 B 10 1326660440 0 5383 STATE ROUTE 154 PINCKNEYVILLE IL 622743342 20 1326660440 0 Nurse Practitioners Fluoride varnish 20 1326660440 0 Nurse Practitioners Healthy Kids Services 20 1326660440 0 Nurse Practitioners Nurse Practitioners Services 20 1326660440 0 Nurse Practitioners Physician Services 00 1326661166 0 HILDEBRAND JACQUELINE 2022059 9999999 B 10 1326661166 0 301 ALBERS ST GOLDEN IL 623391006 20 1326661166 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326661885 0 GOSS JENNIFER 2021356 9999999 B 10 1326661885 0 PO BOX 684 MUNDELEIN IL 600600684 20 1326661885 0 Other behavior health professional LCPC/LMFT services 00 1326662826 0 KALINSKI ARTHUR 2021274 9999999 B 10 1326662826 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1326662826 0 Physician Assistant Only Fluoride varnish 20 1326662826 0 Physician Assistant Only Healthy Kids Services 20 1326662826 0 Physician Assistant Only Physician Services 00 1326662974 0 CHIN NICOLE 2020181 9999999 B 10 1326662974 0 75 REMITTANCE DR DEPT 1296 CHICAGO IL 606751296 20 1326662974 0 Physicians Anesthesia Services 20 1326662974 0 Physicians Fluoride varnish 20 1326662974 0 Physicians Healthy Kids Services 20 1326662974 0 Physicians Optical Supplies 20 1326662974 0 Physicians Physician Services 00 1326663790 0 BENTZ AMBER 2023001 9999999 B 10 1326663790 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1326663790 0 Physician Assistant Only Fluoride varnish 20 1326663790 0 Physician Assistant Only Healthy Kids Services 20 1326663790 0 Physician Assistant Only Physician Services 00 1326663873 0 CHEBOLU SRUTHA KEERTHI 2020171 9999999 B 10 1326663873 0 2918 CROSSING CT STE A CHAMPAIGN IL 618226100 20 1326663873 0 Dentists Dental Services 20 1326663873 0 Dentists Physician Services 00 1326664111 0 PEDTKE NICOLE B 2021047 9999999 B 10 1326664111 0 PO BOX 955860 SAINT LOUIS MO 631955860 20 1326664111 0 Nurse Practitioners Fluoride varnish 20 1326664111 0 Nurse Practitioners Healthy Kids Services 20 1326664111 0 Nurse Practitioners Nurse Practitioners Services 20 1326664111 0 Nurse Practitioners Physician Services 00 1326664228 0 METZ RACHEL 2020213 9999999 B 10 1326664228 0 1418 COLLEGE DR MOUNT CARMEL IL 628632638 20 1326664228 0 Physician Assistant Only Fluoride varnish 20 1326664228 0 Physician Assistant Only Healthy Kids Services 20 1326664228 0 Physician Assistant Only Physician Services 00 1326664384 0 WONG DANIEL G 2022055 9999999 B 10 1326664384 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1326664384 0 Physicians Anesthesia Services 20 1326664384 0 Physicians Healthy Kids Services 20 1326664384 0 Physicians Optical Supplies 20 1326664384 0 Physicians Physician Services 00 1326664491 0 CALLOWAY CAMERON 2020190 9999999 B 10 1326664491 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1326664491 0 Physicians Anesthesia Services 20 1326664491 0 Physicians Healthy Kids Services 20 1326664491 0 Physicians Optical Supplies 20 1326664491 0 Physicians Physician Services 20 1326664491 0 Physicians Physicians Psychiatric Services 00 1326664608 0 SAFFARINI NOOR 2022292 9999999 B 10 1326664608 0 124 KRAML DR BURR RIDGE IL 605270303 20 1326664608 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326665043 0 SAN JUAN JEINETTE 2024319 9999999 B 10 1326665043 0 PO BOX 781076 DETROIT MI 482781076 20 1326665043 0 Nurse Practitioners Fluoride varnish 20 1326665043 0 Nurse Practitioners Healthy Kids Services 20 1326665043 0 Nurse Practitioners Nurse Practitioners Services 20 1326665043 0 Nurse Practitioners Physician Services 00 1326667304 0 KHAZOUM ELIAS 2020182 9999999 B 10 1326667304 0 35318 EAGLE WAY CHICAGO IL 606781353 20 1326667304 0 Physicians Anesthesia Services 20 1326667304 0 Physicians Fluoride varnish 20 1326667304 0 Physicians Healthy Kids Services 20 1326667304 0 Physicians Optical Supplies 20 1326667304 0 Physicians Physician Services 00 1326667619 0 KOZMINSKI ANDREW 2024222 9999999 B 10 1326667619 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1326667619 0 Physicians Anesthesia Services 20 1326667619 0 Physicians Healthy Kids Services 20 1326667619 0 Physicians Optical Supplies 20 1326667619 0 Physicians Physician Services 00 1326668047 0 RODMAN EMILY 2021076 9999999 B 10 1326668047 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1326668047 0 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Physician Assistant Only Healthy Kids Services 20 1326668492 0 Physician Assistant Only Physician Services 00 1326669516 0 BERGMANN KAYLA 2024100 9999999 B 10 1326669516 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1326669516 0 Physician Assistant Only Fluoride varnish 20 1326669516 0 Physician Assistant Only Healthy Kids Services 20 1326669516 0 Physician Assistant Only Physician Services 00 1326669581 0 TRAN QUOC 2024258 9999999 B 10 1326669581 0 PO BOX 43230 PHOENIX AZ 850803230 20 1326669581 0 Physicians Anesthesia Services 20 1326669581 0 Physicians Healthy Kids Services 20 1326669581 0 Physicians Optical Supplies 20 1326669581 0 Physicians Physician Services 00 1326670183 0 CHAMBERS JEFFERY R 2020085 9999999 B 10 1326670183 0 1301 S KOKE MILL RD SPRINGFIELD IL 627119252 20 1326670183 0 Nurse Practitioners Fluoride varnish 20 1326670183 0 Nurse Practitioners Healthy Kids Services 20 1326670183 0 Nurse Practitioners Nurse Practitioners Services 20 1326670183 0 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Nurse Practitioners Nurse Practitioners Services 20 1326673310 0 Nurse Practitioners Physician Services 00 1326675570 0 KIM SARAH 2020232 9999999 B 10 1326675570 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1326675570 0 Physicians Anesthesia Services 20 1326675570 0 Physicians Healthy Kids Services 20 1326675570 0 Physicians Optical Supplies 20 1326675570 0 Physicians Physician Services 00 1326675729 0 SCHAEFFER KAREN N 2024225 9999999 B 10 1326675729 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1326675729 0 Physicians Anesthesia Services 20 1326675729 0 Physicians Fluoride varnish 20 1326675729 0 Physicians Healthy Kids Services 20 1326675729 0 Physicians Optical Supplies 20 1326675729 0 Physicians Physician Services 00 1326675869 0 MOGALAPALLI NIKHIL 2020220 9999999 B 10 1326675869 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1326675869 0 Physicians Anesthesia Services 20 1326675869 0 Physicians Fluoride varnish 20 1326675869 0 Physicians Healthy Kids Services 20 1326675869 0 Physicians Optical Supplies 20 1326675869 0 Physicians Physician Services 00 1326676057 0 PATTON KATHRYN 2020260 9999999 B 10 1326676057 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1326676057 0 Physicians Anesthesia Services 20 1326676057 0 Physicians Healthy Kids Services 20 1326676057 0 Physicians Optical Supplies 20 1326676057 0 Physicians Physician Services 00 1326676305 0 LONG BRONWYN 2020261 9999999 B 10 1326676305 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1326676305 0 Physicians Anesthesia Services 20 1326676305 0 Physicians Healthy Kids Services 20 1326676305 0 Physicians Optical Supplies 20 1326676305 0 Physicians Physician Services 00 1326676339 0 SHAIKH SAIF 2022171 9999999 B 10 1326676339 0 PO BOX 3039 OAK BROOK IL 605223039 20 1326676339 0 Physicians Anesthesia Services 20 1326676339 0 Physicians Healthy Kids Services 20 1326676339 0 Physicians Optical Supplies 20 1326676339 0 Physicians Physician Services 00 1326676677 0 DESAI KRUPA 2020104 9999999 B 10 1326676677 0 1400 E IRVING PARK RD STREAMWOOD IL 601073201 20 1326676677 0 Other behavior health professional LCPC/LMFT services 00 1326676693 0 STATZER GABRIELLE 2020224 9999999 B 10 1326676693 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1326676693 0 Physicians Anesthesia Services 20 1326676693 0 Physicians Healthy Kids Services 20 1326676693 0 Physicians Optical Supplies 20 1326676693 0 Physicians Physician Services 00 1326677337 0 ADAH OSASU 2020247 9999999 B 10 1326677337 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1326677337 0 Physicians Anesthesia Services 20 1326677337 0 Physicians Healthy Kids Services 20 1326677337 0 Physicians Optical Supplies 20 1326677337 0 Physicians Physician Services 00 1326677451 0 FINNEGAN JACK A 2023032 9999999 B 10 1326677451 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1326677451 0 Physicians Anesthesia Services 20 1326677451 0 Physicians Healthy Kids Services 20 1326677451 0 Physicians Optical Supplies 20 1326677451 0 Physicians Physician Services 00 1326678327 0 SIEGEL JESSE 2021214 9999999 B 10 1326678327 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1326678327 0 Physicians Anesthesia Services 20 1326678327 0 Physicians Healthy Kids Services 20 1326678327 0 Physicians Optical Supplies 20 1326678327 0 Physicians Physician Services 00 1326678962 0 KODROS NINA 2020037 9999999 B 10 1326678962 0 PO BOX 781076 DETROIT MI 482781076 20 1326678962 0 Physician Assistant Only Fluoride varnish 20 1326678962 0 Physician Assistant Only Healthy Kids Services 20 1326678962 0 Physician Assistant Only Physician Services 00 1326679937 0 JUDGE ALLISON 2023046 9999999 B 10 1326679937 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1326679937 0 Nurse Practitioners Fluoride varnish 20 1326679937 0 Nurse Practitioners Healthy Kids Services 20 1326679937 0 Nurse Practitioners Nurse Practitioners Services 20 1326679937 0 Nurse Practitioners Physician Services 00 1326681388 0 CARAVELLO ROBYN 2023110 9999999 B 10 1326681388 0 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Services 20 1326683210 0 Nurse Practitioners Physician Services 00 1326683665 0 FOLLETT ELLEN M 2020080 9999999 B 10 1326683665 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1326683665 0 Nurse Practitioners Healthy Kids Services 20 1326683665 0 Nurse Practitioners Nurse Practitioners Services 20 1326683665 0 Nurse Practitioners Physician Services 00 1326685272 0 WEINGARDT SARAH 2024116 9999999 B 10 1326685272 0 PO BOX 781076 DETROIT MI 482781076 20 1326685272 0 Physician Assistant Only Fluoride varnish 20 1326685272 0 Physician Assistant Only Healthy Kids Services 20 1326685272 0 Physician Assistant Only Physician Services 00 1326685892 0 KIRWAN ALLISON 2020141 9999999 B 10 1326685892 0 4950 W 95TH ST OAK LAWN IL 604532504 20 1326685892 0 Nurse Practitioners Healthy Kids Services 20 1326685892 0 Nurse Practitioners Nurse Practitioners Services 20 1326685892 0 Nurse Practitioners Physician Services 00 1326686239 0 BRASHEAR CHARLINDA T 2020034 9999999 B 10 1326686239 0 5777 DEPT CAROL STREAM IL 601220021 20 1326686239 0 Clinical Social Worker Social work service 00 1326686577 0 MIARA CARISSA 2021039 9999999 B 10 1326686577 0 5777 DEPT CAROL STREAM IL 601220021 20 1326686577 0 Nurse Practitioners Anesthesia Services 20 1326686577 0 Nurse Practitioners Nurse Practitioners Services 20 1326686577 0 Nurse Practitioners Physician Services 00 1326686676 0 WALKER-LEWIS CLAUDIA 2023034 9999999 B 10 1326686676 0 99 HAWLEY LN STE 1102 STRATFORD CT 066141204 20 1326686676 0 Nurse Practitioners Healthy Kids Services 20 1326686676 0 Nurse Practitioners Nurse Practitioners Services 20 1326686676 0 Nurse Practitioners Physician Services 00 1326688532 0 KEENAN TAREN RAYME 2024151 9999999 B 10 1326688532 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1326688532 0 Clinical Social Worker Social work service 00 1326688714 0 WILLIAMS DANIELLE R 2020034 9999999 B 10 1326688714 0 PO BOX 5588 BELFAST ME 049155500 20 1326688714 0 Nurse Practitioners Fluoride varnish 20 1326688714 0 Nurse Practitioners Healthy Kids Services 20 1326688714 0 Nurse Practitioners Nurse Practitioners Services 20 1326688714 0 Nurse Practitioners Physician Services 00 1326688870 0 TROSPER SHANNON C 2020055 9999999 B 10 1326688870 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1326688870 0 Nurse Practitioners Healthy Kids Services 20 1326688870 0 Nurse Practitioners Nurse Practitioners Services 20 1326688870 0 Nurse Practitioners Physician Services 00 1326689126 0 STARK DANIELLE 2019311 9999999 B 10 1326689126 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1326689126 0 Physician Assistant Only Fluoride varnish 20 1326689126 0 Physician Assistant Only Healthy Kids Services 20 1326689126 0 Physician Assistant Only Physician Services 00 1326689696 0 MAAS LINDSAY 2020307 9999999 B 10 1326689696 0 5777 DEPT CAROL STREAM IL 601220021 20 1326689696 0 Physician Assistant Only Fluoride varnish 20 1326689696 0 Physician Assistant Only Healthy Kids Services 20 1326689696 0 Physician Assistant Only Physician Services 00 1326692328 0 RAMMOUNI LENA 2024176 9999999 B 10 1326692328 0 PO BOX 3039 OAK BROOK IL 605223039 20 1326692328 0 Physicians Anesthesia Services 20 1326692328 0 Physicians Fluoride varnish 20 1326692328 0 Physicians Healthy Kids Services 20 1326692328 0 Physicians Optical Supplies 20 1326692328 0 Physicians Physician Services 00 1326693342 0 MOORE SARA G 2019223 9999999 B 10 1326693342 0 621 S NEW BALLAS RD STE 228A SAINT LOUIS MO 631418256 20 1326693342 0 Nurse Practitioners Healthy Kids Services 20 1326693342 0 Nurse Practitioners Nurse Practitioners Services 20 1326693342 0 Nurse Practitioners Physician Services 00 1326694530 0 MATOVINA CHLOE N 2023174 9999999 B 10 1326694530 0 4698 DEPT CAROL STREAM IL 601220021 20 1326694530 0 Physicians Anesthesia Services 20 1326694530 0 Physicians Healthy Kids Services 20 1326694530 0 Physicians Optical Supplies 20 1326694530 0 Physicians Physician Services 00 1326696360 0 BUE AMY 2021363 9999999 B 10 1326696360 0 1601 OLD SOUTH RIVER RD SAINT CHARLES MO 633034120 20 1326696360 0 Nurse Practitioners Fluoride varnish 20 1326696360 0 Nurse Practitioners Healthy Kids Services 20 1326696360 0 Nurse Practitioners Nurse Practitioners Services 20 1326696360 0 Nurse Practitioners Physician Services 00 1326696766 0 OANES EMMA 2021028 9999999 B 10 1326696766 0 1901 W HARRISON CHICAGO IL 60612 20 1326696766 0 Nurse Practitioners Fluoride varnish 20 1326696766 0 Nurse Practitioners Healthy Kids Services 20 1326696766 0 Nurse Practitioners Nurse Practitioners Services 20 1326696766 0 Nurse Practitioners Physician Services 00 1326697376 0 HIBBELER KELSEY THERESE 2021266 9999999 B 10 1326697376 0 105 W A ST BELLEVILLE IL 622201326 20 1326697376 0 Occupational Therapists Medical Supplies 20 1326697376 0 Occupational Therapists Medical equipment/prosthetic devices 20 1326697376 0 Occupational Therapists Speech Therapy/Pathology Services 00 1326697798 0 KLENCHINA EKATERINA V 2022347 9999999 B 10 1326697798 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1326697798 0 Nurse Practitioners Healthy Kids Services 20 1326697798 0 Nurse Practitioners Nurse Practitioners Services 20 1326697798 0 Nurse Practitioners Physician Services 00 1326697830 0 KURZ ELISSA 2019273 9999999 B 10 1326697830 0 12300 GREENWOOD AVE BLUE ISLAND IL 604061558 20 1326697830 0 Speech Therapists Medical Supplies 20 1326697830 0 Speech Therapists Medical equipment/prosthetic devices 20 1326697830 0 Speech Therapists Speech Therapy/Pathology Services 00 1326701483 0 DUSSMAN MAURA E 2021343 9999999 B 10 1326701483 0 2500 W HIGGINS RD STE 670-680 HOFFMAN ESTATES IL 601697220 20 1326701483 0 Nurse Practitioners Fluoride varnish 20 1326701483 0 Nurse Practitioners Healthy Kids Services 20 1326701483 0 Nurse Practitioners Nurse Practitioners Services 20 1326701483 0 Nurse Practitioners Physician Services 00 1326702564 0 UREWICZ JESSICA 2022013 9999999 B 10 1326702564 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1326702564 0 Other behavior 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Therapists Speech Therapy/Pathology Services 00 1326705278 0 OCAMPO SAMANTHA N 2021363 9999999 B 10 1326705278 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1326705278 0 Nurse Practitioners Anesthesia Services 20 1326705278 0 Nurse Practitioners Nurse Practitioners Services 20 1326705278 0 Nurse Practitioners Physician Services 00 1326707878 0 RAYMOND ISABELLA 2021347 9999999 H 10 1326707878 0 14840 SHEPARD DR DOLTON IL 604192467 20 1326707878 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326709619 0 MONZYK EMILY D 2024191 9999999 B 10 1326709619 0 621 S NEW BALLAS RD STE 7020 SAINT LOUIS MO 631418232 20 1326709619 0 Physician Assistant Only Fluoride varnish 20 1326709619 0 Physician Assistant Only Healthy Kids Services 20 1326709619 0 Physician Assistant Only Physician Services 00 1326710096 0 SAMUTTHAI PAPHADA 2023088 9999999 B 10 1326710096 0 2900 OGDEN AVE LISLE IL 605321631 20 1326710096 0 Speech Therapists Medical Supplies 20 1326710096 0 Speech Therapists Medical equipment/prosthetic devices 20 1326710096 0 Speech Therapists Speech Therapy/Pathology Services 00 1326710666 0 GONZALEZ JAMIE L 2021314 9999999 B 10 1326710666 0 3030 NW EXPRESSWAY STE 1000 OKLAHOMA CITY OK 731125468 20 1326710666 0 Nurse Practitioners Fluoride varnish 20 1326710666 0 Nurse Practitioners Healthy Kids Services 20 1326710666 0 Nurse Practitioners Nurse Practitioners Services 20 1326710666 0 Nurse Practitioners Physician Services 00 1326711359 0 RIVERA FRANCES 2022202 9999999 B 10 1326711359 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1326711359 0 Nurse Practitioners Fluoride varnish 20 1326711359 0 Nurse Practitioners Healthy Kids Services 20 1326711359 0 Nurse Practitioners Nurse Practitioners Services 20 1326711359 0 Nurse Practitioners Physician Services 00 1326711623 0 ESPINOSA CYNTHIA 2022130 9999999 B 10 1326711623 0 212 BARNEY DR JOLIET IL 604355271 20 1326711623 0 Occupational Therapists Medical Supplies 20 1326711623 0 Occupational Therapists Medical equipment/prosthetic devices 20 1326711623 0 Occupational Therapists Occupational Therapy Services 00 1326712670 0 ALHALASEH SALEH YAZEED S 2024178 9999999 B 10 1326712670 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1326712670 0 Physicians Anesthesia Services 20 1326712670 0 Physicians Fluoride varnish 20 1326712670 0 Physicians Healthy Kids Services 20 1326712670 0 Physicians Optical Supplies 20 1326712670 0 Physicians Physician Services 00 1326712795 0 JOHNSON REBECCA A 2022199 9999999 B 10 1326712795 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1326712795 0 Speech Therapists Medical Supplies 20 1326712795 0 Speech Therapists Medical equipment/prosthetic devices 20 1326712795 0 Speech Therapists Speech Therapy/Pathology Services 00 1326714833 0 GORMAN MACKENZIE 2021329 9999999 H 10 1326714833 0 555 FAIRVIEW DR ROCHELLE IL 61068 20 1326714833 0 Other behavior health professional Other Behavioral 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117474300 20 1326717877 0 Nurse Practitioners Anesthesia Services 20 1326717877 0 Nurse Practitioners Nurse Practitioners Services 20 1326717877 0 Nurse Practitioners Physician Services 00 1326718644 0 ANDERSON CHRISTIAN 2021281 9999999 B 10 1326718644 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1326718644 0 Occupational Therapists Medical Supplies 20 1326718644 0 Occupational Therapists Medical equipment/prosthetic devices 20 1326718644 0 Occupational Therapists Occupational Therapy Services 00 1326718842 0 MORUA ANDREW 2024249 9999999 B 10 1326718842 0 1306 S HALSTED ST CHICAGO IL 606075022 20 1326718842 0 Optometrists Optical Supplies 20 1326718842 0 Optometrists Optometric Services 20 1326718842 0 Optometrists Physician Services 00 1326719261 0 COSGROVE REILLY 2022287 9999999 B 10 1326719261 0 8605 SANTA MONICA BLVD WEST HOLLYWOOD CA 900694109 20 1326719261 0 Occupational Therapists Adaptive behavior support clinician services 20 1326719261 0 Occupational Therapists 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professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326730375 0 HAQ ABDUL 2023202 9999999 B 10 1326730375 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1326730375 0 Physicians Anesthesia Services 20 1326730375 0 Physicians Fluoride varnish 20 1326730375 0 Physicians Healthy Kids Services 20 1326730375 0 Physicians Optical Supplies 20 1326730375 0 Physicians Physician Services 00 1326730862 0 COLEMAN DENALI 2023173 9999999 B 10 1326730862 0 14840 SHEPARD DR DOLTON IL 604192467 20 1326730862 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326731423 0 REYNOLDS DAVANNA J 2024033 9999999 B 10 1326731423 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1326731423 0 Clinical Social Worker Social work service 00 1326731993 0 DOLL BRITTANY M 2023191 9999999 B 10 1326731993 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1326731993 0 Physicians Anesthesia Services 20 1326731993 0 Physicians Fluoride varnish 20 1326731993 0 Physicians Healthy Kids Services 20 1326731993 0 Physicians Optical Supplies 20 1326731993 0 Physicians Physician Services 00 1326732074 0 CANNON HERSHEL W 2023275 9999999 B 10 1326732074 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1326732074 0 Physicians Anesthesia Services 20 1326732074 0 Physicians Healthy Kids Services 20 1326732074 0 Physicians Optical Supplies 20 1326732074 0 Physicians Physician Services 00 1326732371 0 NIKOLIC CANDIS 2023355 9999999 B 10 1326732371 0 2348 POST RD STE 107 WARWICK RI 028862271 20 1326732371 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326733593 0 LEWIS NICOLE T 2023291 9999999 B 10 1326733593 0 7300 W COLLEGE DR PALOS HEIGHTS IL 604631152 20 1326733593 0 Clinical Social Worker Social work service 00 1326733908 0 UPADHYAY DRASHTI 2023184 9999999 B 10 1326733908 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1326733908 0 Physicians Anesthesia Services 20 1326733908 0 Physicians Healthy Kids Services 20 1326733908 0 Physicians Optical Supplies 20 1326733908 0 Physicians Physician Services 00 1326734427 0 HIDES BRIAN 2024292 9999999 B 10 1326734427 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1326734427 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326735440 0 SANA MARYAM 2023316 9999999 B 10 1326735440 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1326735440 0 Physicians Anesthesia Services 20 1326735440 0 Physicians Fluoride varnish 20 1326735440 0 Physicians Healthy Kids Services 20 1326735440 0 Physicians Optical Supplies 20 1326735440 0 Physicians Physician Services 00 1326736760 0 KERR MATTHEW 2024183 9999999 B 10 1326736760 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1326736760 0 Physicians Anesthesia Services 20 1326736760 0 Physicians Healthy Kids Services 20 1326736760 0 Physicians Optical Supplies 20 1326736760 0 Physicians Physician Services 00 1326736943 0 BENET ANDREW 2023292 9999999 B 10 1326736943 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1326736943 0 Physicians Anesthesia Services 20 1326736943 0 Physicians Healthy Kids Services 20 1326736943 0 Physicians Optical Supplies 20 1326736943 0 Physicians Physician Services 00 1326737438 0 ARMS STEPHANIE J 2023124 9999999 B 10 1326737438 0 PO BOX 146 WATERLOO IL 622980146 20 1326737438 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326739020 0 WILKES LAUREN 2023222 9999999 B 10 1326739020 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1326739020 0 Physician Assistant Only Fluoride varnish 20 1326739020 0 Physician Assistant Only Healthy Kids Services 20 1326739020 0 Physician Assistant Only Physician Services 00 1326739343 0 LUNGAY MARA K 2024036 9999999 B 10 1326739343 0 PO BOX 28900 GREEN BAY WI 543240900 20 1326739343 0 Nurse Practitioners Anesthesia Services 20 1326739343 0 Nurse Practitioners Nurse Practitioners Services 20 1326739343 0 Nurse Practitioners Physician Services 00 1326739996 0 PIERRE-LOUIS YOURY S 2023192 9999999 B 10 1326739996 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1326739996 0 Physicians Anesthesia Services 20 1326739996 0 Physicians Healthy Kids Services 20 1326739996 0 Physicians Optical Supplies 20 1326739996 0 Physicians Physician Services 00 1326740002 0 DESAI NITIN 2023201 9999999 B 10 1326740002 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1326740002 0 Physicians Anesthesia Services 20 1326740002 0 Physicians Fluoride varnish 20 1326740002 0 Physicians Healthy Kids Services 20 1326740002 0 Physicians Optical Supplies 20 1326740002 0 Physicians Physician Services 00 1326740770 0 NEWLIN ADAM 2023200 9999999 B 10 1326740770 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1326740770 0 Physicians Anesthesia Services 20 1326740770 0 Physicians Healthy Kids Services 20 1326740770 0 Physicians Optical Supplies 20 1326740770 0 Physicians Physician Services 20 1326740770 0 Physicians Physicians Psychiatric Services 00 1326740861 0 GONTE MADELEINE 2023179 9999999 B 10 1326740861 0 4698 DEPT CAROL STREAM IL 601220021 20 1326740861 0 Physicians Anesthesia Services 20 1326740861 0 Physicians Healthy Kids Services 20 1326740861 0 Physicians Optical Supplies 20 1326740861 0 Physicians Physician Services 00 1326740911 0 KHOUNSOMBATH TIFFANY 2023193 9999999 B 10 1326740911 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1326740911 0 Physicians Anesthesia Services 20 1326740911 0 Physicians Fluoride varnish 20 1326740911 0 Physicians Healthy Kids Services 20 1326740911 0 Physicians Optical Supplies 20 1326740911 0 Physicians Physician Services 00 1326741422 0 CASALETTO EMILY A 2023195 9999999 B 10 1326741422 0 4698 DEPT CAROL STREAM IL 601220021 20 1326741422 0 Physicians Anesthesia Services 20 1326741422 0 Physicians Fluoride varnish 20 1326741422 0 Physicians Healthy Kids Services 20 1326741422 0 Physicians Optical Supplies 20 1326741422 0 Physicians Physician Services 00 1326741471 0 GOEL PRANSHUL 2023194 9999999 B 10 1326741471 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1326741471 0 Physicians Anesthesia Services 20 1326741471 0 Physicians Healthy Kids Services 20 1326741471 0 Physicians Optical Supplies 20 1326741471 0 Physicians Physician Services 00 1326742164 0 BROOKINS KRYSTAL 2024319 9999999 B 10 1326742164 0 657 E 83RD PL CHICAGO IL 606195805 20 1326742164 0 Other behavior health professional LCPC/LMFT services 00 1326742289 0 GIBSON LILIAN 2023240 9999999 B 10 1326742289 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1326742289 0 Physicians Anesthesia Services 20 1326742289 0 Physicians Fluoride varnish 20 1326742289 0 Physicians Healthy Kids Services 20 1326742289 0 Physicians Optical Supplies 20 1326742289 0 Physicians Physician Services 00 1326742800 0 LUSKEY NINA I 2023293 9999999 B 10 1326742800 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1326742800 0 Physicians Anesthesia Services 20 1326742800 0 Physicians Healthy Kids Services 20 1326742800 0 Physicians Optical Supplies 20 1326742800 0 Physicians Physician Services 00 1326743485 0 LIU MARGARET 2023269 9999999 B 10 1326743485 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1326743485 0 Physicians Anesthesia Services 20 1326743485 0 Physicians Fluoride varnish 20 1326743485 0 Physicians Healthy Kids Services 20 1326743485 0 Physicians Optical Supplies 20 1326743485 0 Physicians Physician Services 00 1326743964 0 OKOYA-THOMAS IVANNA 2025017 9999999 B 10 1326743964 0 2901 FINLEY RD STE 102 DOWNERS GROVE IL 605151774 20 1326743964 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326745829 0 LUJAN JOSHUA 2023193 9999999 B 10 1326745829 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1326745829 0 Physicians Anesthesia Services 20 1326745829 0 Physicians Fluoride varnish 20 1326745829 0 Physicians Healthy Kids Services 20 1326745829 0 Physicians Optical Supplies 20 1326745829 0 Physicians Physician Services 00 1326746736 0 BUTLER TUCKER 2024236 9999999 B 10 1326746736 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1326746736 0 Nurse Practitioners Healthy Kids Services 20 1326746736 0 Nurse Practitioners Nurse Practitioners Services 20 1326746736 0 Nurse Practitioners Physician Services 00 1326749185 0 MORADI HANNA 2024210 9999999 B 10 1326749185 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1326749185 0 Physicians Anesthesia Services 20 1326749185 0 Physicians Healthy Kids Services 20 1326749185 0 Physicians Optical Supplies 20 1326749185 0 Physicians Physician Services 00 1326749367 0 HRYNEWYCZ NADIA M 2024183 9999999 B 10 1326749367 0 4701 DEPT CAROL STREAM IL 601220021 20 1326749367 0 Physicians Anesthesia Services 20 1326749367 0 Physicians Fluoride varnish 20 1326749367 0 Physicians Healthy Kids Services 20 1326749367 0 Physicians Optical Supplies 20 1326749367 0 Physicians Physician Services 00 1326750399 0 CRICK JAMEE 2024283 9999999 B 10 1326750399 0 PO BOX 632122 CINCINNATI OH 452632122 20 1326750399 0 Nurse Practitioners Healthy Kids Services 20 1326750399 0 Nurse Practitioners Nurse Practitioners Services 20 1326750399 0 Nurse Practitioners Physician Services 00 1326755430 0 SMILEY SHELBY 2023095 9999999 B 10 1326755430 0 6810 STATE ROUTE 162 STE 215 MARYVILLE IL 620628566 20 1326755430 0 Nurse Practitioners Fluoride varnish 20 1326755430 0 Nurse Practitioners Healthy Kids Services 20 1326755430 0 Nurse Practitioners Nurse Practitioners Services 20 1326755430 0 Nurse Practitioners Physician Services 00 1326755505 0 BEDEL MELISSA A 2022341 9999999 B 10 1326755505 0 621 S NEW BALLAS RD STE 7020 SAINT LOUIS MO 631418232 20 1326755505 0 Nurse Practitioners Healthy Kids Services 20 1326755505 0 Nurse Practitioners Nurse Practitioners Services 20 1326755505 0 Nurse Practitioners Physician Services 00 1326756198 0 SIEGRIST ABBY N 2022314 9999999 B 10 1326756198 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1326756198 0 Nurse Practitioners Fluoride varnish 20 1326756198 0 Nurse Practitioners Healthy Kids Services 20 1326756198 0 Nurse Practitioners Nurse Practitioners Services 20 1326756198 0 Nurse Practitioners Physician Services 00 1326756578 0 MCCONVILLE CAITLIN H 2022335 9999999 B 10 1326756578 0 1700 E HIGGINS RD STE 600 DES PLAINES IL 600185621 20 1326756578 0 Nurse Practitioners Fluoride varnish 20 1326756578 0 Nurse Practitioners Healthy Kids Services 20 1326756578 0 Nurse Practitioners Nurse Practitioners Services 20 1326756578 0 Nurse Practitioners Physician Services 00 1326756719 0 BROCKWAY KRISTIE N 2023061 9999999 B 10 1326756719 0 355 E CHICAGO ST ELGIN IL 601206543 20 1326756719 0 Speech Therapists Speech Therapy/Pathology Services 00 1326757493 0 VATCHA DINA 2022321 9999999 B 10 1326757493 0 3320 LINCOLN ST FRANKLIN PARK IL 601311514 20 1326757493 0 Occupational Therapists Medical Supplies 20 1326757493 0 Occupational Therapists Medical equipment/prosthetic devices 20 1326757493 0 Occupational Therapists Occupational Therapy Services 00 1326758236 0 KAYTSNER NICOLLE 2023090 9999999 B 10 1326758236 0 28100 TORCH PKWY STE 600 WARRENVILLE IL 605554030 20 1326758236 0 Physical Therapists Medical Supplies 20 1326758236 0 Physical Therapists Medical equipment/prosthetic devices 20 1326758236 0 Physical Therapists Physical Therapy Services 00 1326761438 0 SMITH SHERRILYNN 2022325 9999999 B 10 1326761438 0 PO BOX 734352 CHICAGO IL 606734352 20 1326761438 0 Nurse Practitioners Healthy Kids Services 20 1326761438 0 Nurse Practitioners Nurse Practitioners Services 20 1326761438 0 Nurse Practitioners Physician Services 00 1326761529 0 VAZQUEZ ROBERT 2024057 9999999 B 10 1326761529 0 PO BOX 781076 DETROIT MI 482781076 20 1326761529 0 Physical Therapists Medical Supplies 20 1326761529 0 Physical Therapists Medical equipment/prosthetic devices 20 1326761529 0 Physical Therapists Physical Therapy Services 00 1326761750 0 EDMAN NATASHA I 2024173 9999999 B 10 1326761750 0 4698 DEPT CAROL STREAM IL 601220021 20 1326761750 0 Physicians Anesthesia Services 20 1326761750 0 Physicians Fluoride varnish 20 1326761750 0 Physicians Healthy Kids Services 20 1326761750 0 Physicians Optical Supplies 20 1326761750 0 Physicians Physician Services 00 1326762402 0 DELGADO MARIAELENA 2022304 9999999 B 10 1326762402 0 9119 S EXCHANGE AVE CHICAGO IL 606174225 20 1326762402 0 Nurse Practitioners Fluoride varnish 20 1326762402 0 Nurse Practitioners Healthy Kids Services 20 1326762402 0 Nurse Practitioners Nurse Practitioners Services 20 1326762402 0 Nurse Practitioners Physician Services 00 1326765298 0 SANQUIST HANNAH 2022321 9999999 B 10 1326765298 0 500 W RIVER DR DAVENPORT IA 528011014 20 1326765298 0 Nurse Practitioners Fluoride varnish 20 1326765298 0 Nurse Practitioners Healthy Kids Services 20 1326765298 0 Nurse Practitioners Nurse Practitioners Services 20 1326765298 0 Nurse Practitioners Physician Services 00 1326766510 0 TAYLOR SIDNEY R 2023360 9999999 B 10 1326766510 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1326766510 0 Physician Assistant Only Fluoride varnish 20 1326766510 0 Physician Assistant Only Healthy Kids Services 20 1326766510 0 Physician Assistant Only Physician Services 00 1326767690 0 TESTON MORGAN 2023249 9999999 B 10 1326767690 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1326767690 0 Nurse Practitioners Fluoride varnish 20 1326767690 0 Nurse Practitioners Healthy Kids Services 20 1326767690 0 Nurse Practitioners Nurse Practitioners Services 20 1326767690 0 Nurse Practitioners Physician Services 00 1326768227 0 STERNBERG ELIZABETH 2023018 9999999 B 10 1326768227 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1326768227 0 Physician Assistant Only Fluoride varnish 20 1326768227 0 Physician Assistant Only Healthy Kids Services 20 1326768227 0 Physician Assistant Only Physician Services 00 1326768599 0 VARGAS JOAN 2022269 9999999 H 10 1326768599 0 228 E LAKE ST ADDISON IL 601012889 20 1326768599 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326769290 0 PENNYPACKER KATHERINE 2024241 9999999 B 10 1326769290 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1326769290 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326769761 0 SERBU CRISTINA 2022293 9999999 H 10 1326769761 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1326769761 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326769985 0 SCHLANSKY ELANA 2023342 9999999 B 10 1326769985 0 29373 NETWORK PL CHICAGO IL 606733039 20 1326769985 0 Physician Assistant Only Fluoride varnish 20 1326769985 0 Physician Assistant Only Healthy Kids Services 20 1326769985 0 Physician Assistant Only Physician Services 00 1326770744 0 ANDERSEN ATALIE 2022210 9999999 B 10 1326770744 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1326770744 0 Nurse Practitioners Healthy Kids Services 20 1326770744 0 Nurse Practitioners Nurse Practitioners Services 20 1326770744 0 Nurse Practitioners Physician Services 00 1326770900 0 GONZALEZ LESLIE 2022271 9999999 B 10 1326770900 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1326770900 0 Physicians Anesthesia Services 20 1326770900 0 Physicians Fluoride varnish 20 1326770900 0 Physicians Healthy Kids Services 20 1326770900 0 Physicians Optical Supplies 20 1326770900 0 Physicians Physician Services 00 1326770934 0 PLUNKETT ELIZABETH 2022279 9999999 B 10 1326770934 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1326770934 0 Physicians Anesthesia Services 20 1326770934 0 Physicians Fluoride varnish 20 1326770934 0 Physicians Healthy Kids Services 20 1326770934 0 Physicians Optical Supplies 20 1326770934 0 Physicians Physician Services 00 1326771106 0 GONZALEZ JOCELYN Y 2022222 9999999 H 10 1326771106 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1326771106 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326772534 0 CVETKOVIC SAMUILO 2022214 9999999 B 10 1326772534 0 6258 S PULASKI RD CHICAGO IL 606294610 20 1326772534 0 Dentists Dental Services 20 1326772534 0 Dentists Physician Services 00 1326772609 0 WANG JUNWEN 2022276 9999999 B 10 1326772609 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1326772609 0 Physical Therapists Medical Supplies 20 1326772609 0 Physical Therapists Medical equipment/prosthetic devices 20 1326772609 0 Physical Therapists Physical Therapy Services 00 1326773698 0 YOUNG DRALISA V 2025024 9999999 B 10 1326773698 0 1021 N MULFORD RD ATTN: CONTRACTING DEPT. ROCKFORD IL 611073877 20 1326773698 0 Clinical Social Worker Social work service 00 1326773870 0 GILL ANISHA 2022223 9999999 B 10 1326773870 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1326773870 0 Nurse Practitioners Fluoride varnish 20 1326773870 0 Nurse Practitioners Healthy Kids Services 20 1326773870 0 Nurse Practitioners Nurse Practitioners Services 20 1326773870 0 Nurse Practitioners Physician Services 00 1326775289 0 CHEMELEWSKI KALI A 2022340 9999999 B 10 1326775289 0 5875 E RIVERSIDE BLVD ROCKFORD IL 611144937 20 1326775289 0 Physician Assistant Only Fluoride varnish 20 1326775289 0 Physician Assistant Only Healthy Kids Services 20 1326775289 0 Physician Assistant Only Physician Services 00 1326777137 0 COULTER DEAN 2022187 9999999 B 10 1326777137 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1326777137 0 Physical Therapists Medical Supplies 20 1326777137 0 Physical Therapists Medical equipment/prosthetic devices 20 1326777137 0 Physical Therapists Physical Therapy Services 00 1326777665 0 SHAIK IZAZ 2022161 9999999 B 10 1326777665 0 8777 PURDUE RD STE 115 INDIANAPOLIS IN 462683104 20 1326777665 0 Dentists Dental Services 20 1326777665 0 Dentists Physician Services 00 1326777954 0 CHAUDHRY SABRINA 2023220 9999999 B 10 1326777954 0 611 W PARK ST URBANA IL 618012529 20 1326777954 0 Physicians Anesthesia Services 20 1326777954 0 Physicians Healthy Kids Services 20 1326777954 0 Physicians Optical Supplies 20 1326777954 0 Physicians Physician Services 20 1326777954 0 Physicians Physicians Psychiatric Services 00 1326778713 0 EIG KARIN 2022229 9999999 B 10 1326778713 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1326778713 0 Speech Therapists Medical Supplies 20 1326778713 0 Speech Therapists Medical equipment/prosthetic devices 20 1326778713 0 Speech Therapists Speech Therapy/Pathology Services 00 1326779455 0 PATEL VAIRAGI 2022235 9999999 B 10 1326779455 0 PO BOX 79591 BALTIMORE MD 212790591 20 1326779455 0 Optometrists Optical Supplies 20 1326779455 0 Optometrists Optometric Services 20 1326779455 0 Optometrists Physician Services 00 1326779778 0 BENNETT BAILEY 2022236 9999999 B 10 1326779778 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1326779778 0 Speech Therapists Medical Supplies 20 1326779778 0 Speech Therapists Medical equipment/prosthetic devices 20 1326779778 0 Speech Therapists Speech Therapy/Pathology Services 00 1326779943 0 STAFFORD LAUREN 2024075 9999999 B 10 1326779943 0 555 BIESTERFIELD RD ELK GROVE VILLA IL 600073306 20 1326779943 0 Physician Assistant Only Fluoride varnish 20 1326779943 0 Physician Assistant Only Healthy Kids Services 20 1326779943 0 Physician Assistant Only Physician Services 00 1326780057 0 HART SHANNON 2023079 9999999 B 10 1326780057 0 2028 N SEMINARY AVE WOODSTOCK IL 600982626 20 1326780057 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326780826 0 MOREIRA BELLO RODRIGO 2022103 9999999 B 10 1326780826 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1326780826 0 Physicians Anesthesia Services 20 1326780826 0 Physicians Healthy Kids Services 20 1326780826 0 Physicians Optical Supplies 20 1326780826 0 Physicians Physician Services 00 1326780909 0 WILLIAMS CODY J 2022209 9999999 B 10 1326780909 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1326780909 0 Physicians Anesthesia Services 20 1326780909 0 Physicians Healthy Kids Services 20 1326780909 0 Physicians Optical Supplies 20 1326780909 0 Physicians Physician Services 00 1326781600 0 KUNKEN JESSICA T 2022130 9999999 B 10 1326781600 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1326781600 0 Nurse Practitioners Fluoride varnish 20 1326781600 0 Nurse Practitioners Healthy Kids Services 20 1326781600 0 Nurse Practitioners Nurse Practitioners Services 20 1326781600 0 Nurse Practitioners Physician Services 00 1326781824 0 CYBULSKI MALLORY 2023233 9999999 B 10 1326781824 0 75 REMITTANCE DR DEPT 1611 CHICAGO IL 606751611 20 1326781824 0 Clinical Social Worker Social work service 00 1326781865 0 MAKAR ANDREW E 2023241 9999999 B 10 1326781865 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1326781865 0 Physicians Anesthesia Services 20 1326781865 0 Physicians Fluoride varnish 20 1326781865 0 Physicians Healthy Kids Services 20 1326781865 0 Physicians Optical Supplies 20 1326781865 0 Physicians Physician Services 00 1326781972 0 BUNFILL MELISSA D 2023104 9999999 B 10 1326781972 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1326781972 0 Nurse Practitioners Fluoride varnish 20 1326781972 0 Nurse Practitioners Healthy Kids Services 20 1326781972 0 Nurse Practitioners Nurse Practitioners Services 20 1326781972 0 Nurse Practitioners Physician Services 00 1326782244 0 LUCE COURTNEY LYNN 2022206 9999999 B 10 1326782244 0 3241 S MICHIGAN AVE CHICAGO IL 606164201 20 1326782244 0 Optometrists Optical Supplies 20 1326782244 0 Optometrists Optometric Services 20 1326782244 0 Optometrists Physician Services 00 1326783200 0 SINGLETON JENNIFER 2022214 9999999 B 10 1326783200 0 902 W MAIN ST WEST FRANKFORT IL 628962210 20 1326783200 0 Nurse Practitioners Healthy Kids Services 20 1326783200 0 Nurse Practitioners Nurse Practitioners Services 20 1326783200 0 Nurse Practitioners Physician Services 00 1326783937 0 ZHENG CAIWEI 2022176 2026181 B 10 1326783937 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1326783937 0 Physicians Anesthesia Services 20 1326783937 0 Physicians Healthy Kids Services 20 1326783937 0 Physicians Optical Supplies 20 1326783937 0 Physicians Physician Services 00 1326784455 0 PADRON GOMEZ FRANCISCO 2024183 9999999 B 10 1326784455 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1326784455 0 Physicians Anesthesia Services 20 1326784455 0 Physicians Healthy Kids Services 20 1326784455 0 Physicians Optical Supplies 20 1326784455 0 Physicians Physician Services 00 1326785130 0 DESAI SANAM 2022182 9999999 B 10 1326785130 0 5145 N CALIFORNIA AVE CHICAGO IL 606253661 20 1326785130 0 Physicians Anesthesia Services 20 1326785130 0 Physicians Fluoride varnish 20 1326785130 0 Physicians Healthy Kids Services 20 1326785130 0 Physicians Optical Supplies 20 1326785130 0 Physicians Physician Services 00 1326785239 0 CRAIG MICHAEL 2022143 9999999 B 10 1326785239 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1326785239 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326786161 0 RAJU SILPA 2022346 2025181 B 10 1326786161 0 611 W PARK ST URBANA IL 618012529 20 1326786161 0 Physicians Anesthesia Services 20 1326786161 0 Physicians Fluoride varnish 20 1326786161 0 Physicians Healthy Kids Services 20 1326786161 0 Physicians Optical Supplies 20 1326786161 0 Physicians Physician Services 00 1326786518 0 AYLWARD STEPHANIE ANNE 2022354 9999999 B 10 1326786518 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1326786518 0 Psychologist Psychologist service 00 1326786559 0 FLETCHER JACKIE 2022202 9999999 B 10 1326786559 0 PO BOX 781076 DETROIT MI 482781076 20 1326786559 0 Audiologists Audiology Services 20 1326786559 0 Audiologists Medical Supplies 20 1326786559 0 Audiologists Medical equipment/prosthetic devices 00 1326787805 0 SHILBAYEH ABDUL-RAHIM 2022355 9999999 B 10 1326787805 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1326787805 0 Physicians Anesthesia Services 20 1326787805 0 Physicians Fluoride varnish 20 1326787805 0 Physicians Healthy Kids Services 20 1326787805 0 Physicians Optical Supplies 20 1326787805 0 Physicians Physician Services 00 1326788167 0 MOSES GEMEYEL A 2022236 9999999 B 10 1326788167 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1326788167 0 Physicians Anesthesia Services 20 1326788167 0 Physicians Fluoride varnish 20 1326788167 0 Physicians Healthy Kids Services 20 1326788167 0 Physicians Optical Supplies 20 1326788167 0 Physicians Physician Services 00 1326789223 0 APPOH ANITA E 2022145 9999999 B 10 1326789223 0 1665 LARKIN AVE ELGIN IL 601235977 20 1326789223 0 Nurse Practitioners Fluoride varnish 20 1326789223 0 Nurse Practitioners Healthy Kids Services 20 1326789223 0 Nurse Practitioners Nurse Practitioners Services 20 1326789223 0 Nurse Practitioners Physician Services 00 1326791914 0 WIERSUM VIOLET 2022122 9999999 B 10 1326791914 0 5777 DEPT CAROL STREAM IL 601220021 20 1326791914 0 Nurse Practitioners Healthy Kids Services 20 1326791914 0 Nurse Practitioners Nurse Practitioners Services 20 1326791914 0 Nurse Practitioners Physician Services 00 1326792029 0 MCLAURIN PERLA 2024218 9999999 B 10 1326792029 0 14421 S WALLIN DR PLAINFIELD IL 605442502 20 1326792029 0 Occupational Therapists Medical Supplies 20 1326792029 0 Occupational Therapists Medical equipment/prosthetic devices 20 1326792029 0 Occupational Therapists Occupational Therapy Services 00 1326796319 0 ALMANZA MARIA ISABEL 2022102 9999999 B 10 1326796319 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1326796319 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1326796319 0 Other behavior health professional Social work service 00 1326797150 0 LEE JOHN 2023115 9999999 B 10 1326797150 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1326797150 0 Physicians Anesthesia Services 20 1326797150 0 Physicians Fluoride varnish 20 1326797150 0 Physicians Healthy Kids Services 20 1326797150 0 Physicians Optical Supplies 20 1326797150 0 Physicians Physician Services 00 1326797267 0 MAURER NICHOLAS 2022174 9999999 B 10 1326797267 0 4698 DEPT CAROL STREAM IL 601220021 20 1326797267 0 Physicians Anesthesia Services 20 1326797267 0 Physicians Healthy Kids Services 20 1326797267 0 Physicians Optical Supplies 20 1326797267 0 Physicians Physician Services 00 1326797408 0 ECKERT NICHOLAS 2022213 9999999 B 10 1326797408 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1326797408 0 Physicians Anesthesia Services 20 1326797408 0 Physicians Fluoride varnish 20 1326797408 0 Physicians Healthy Kids Services 20 1326797408 0 Physicians Optical Supplies 20 1326797408 0 Physicians Physician Services 00 1326797499 0 RODRIGUEZ SARAH L 2022241 9999999 B 10 1326797499 0 4698 DEPT CAROL STREAM IL 601220021 20 1326797499 0 Physicians Anesthesia Services 20 1326797499 0 Physicians Healthy Kids Services 20 1326797499 0 Physicians Optical Supplies 20 1326797499 0 Physicians Physician Services 00 1326797838 0 VAN DOORN RACHEL 2023354 9999999 B 10 1326797838 0 4698 DEPT CAROL STREAM IL 601220021 20 1326797838 0 Physicians Anesthesia Services 20 1326797838 0 Physicians Healthy Kids Services 20 1326797838 0 Physicians Optical Supplies 20 1326797838 0 Physicians Physician Services 00 1326797838 0 VAN DOORN RACHEL 2023354 9999999 B 10 1326797838 0 4698 DEPT CAROL STREAM IL 601220021 20 1326797838 0 Physicians Anesthesia Services 20 1326797838 0 Physicians Healthy Kids Services 20 1326797838 0 Physicians Optical Supplies 20 1326797838 0 Physicians Physician Services 00 1326798737 0 SURJANCEV ALEKSANDAR 2022168 9999999 B 10 1326798737 0 PO BOX 3039 OAK BROOK IL 605223039 20 1326798737 0 Physicians Anesthesia Services 20 1326798737 0 Physicians Fluoride varnish 20 1326798737 0 Physicians Healthy Kids Services 20 1326798737 0 Physicians Optical Supplies 20 1326798737 0 Physicians Physician Services 00 1326798844 0 CANDELARIA PATRICK G 2023221 9999999 B 10 1326798844 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1326798844 0 Physicians Anesthesia Services 20 1326798844 0 Physicians Healthy Kids Services 20 1326798844 0 Physicians Optical Supplies 20 1326798844 0 Physicians Physician Services 00 1326800434 0 ADAMS ELIZABETH M 2024059 9999999 B 10 1326800434 0 PO BOX 778912 CHICAGO IL 606778912 20 1326800434 0 Nurse Practitioners Fluoride varnish 20 1326800434 0 Nurse Practitioners Healthy Kids Services 20 1326800434 0 Nurse Practitioners Nurse Practitioners Services 20 1326800434 0 Nurse Practitioners Physician Services 00 1326803511 0 MCLELLAN ALYSSA 2024124 9999999 B 10 1326803511 0 PO BOX 504604 SAINT LOUIS MO 631504604 20 1326803511 0 Nurse Practitioners Fluoride varnish 20 1326803511 0 Nurse Practitioners Healthy Kids Services 20 1326803511 0 Nurse Practitioners Nurse Practitioners Services 20 1326803511 0 Nurse Practitioners Physician Services 00 1326803909 0 JOLLY NAZREEBANU 2024324 9999999 B 10 1326803909 0 3024 E EMPIRE ST STE E&F BLOOMINGTON IL 617045402 20 1326803909 0 Physician Assistant Only Fluoride varnish 20 1326803909 0 Physician Assistant Only Healthy Kids Services 20 1326803909 0 Physician Assistant Only Physician Services 00 1326803990 0 DANKO BREANNA M 2024080 9999999 B 10 1326803990 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1326803990 0 Nurse Practitioners Fluoride varnish 20 1326803990 0 Nurse Practitioners Healthy Kids Services 20 1326803990 0 Nurse Practitioners Nurse Practitioners Services 20 1326803990 0 Nurse Practitioners Physician Services 00 1326804147 0 ISBEIH DEMA 2024219 9999999 B 10 1326804147 0 70 S RIVER ST AURORA IL 605065185 20 1326804147 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326810516 0 ROYSE ELIZABETH A 2024037 9999999 B 10 1326810516 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1326810516 0 Nurse Practitioners Anesthesia Services 20 1326810516 0 Nurse Practitioners Nurse Practitioners Services 20 1326810516 0 Nurse Practitioners Physician Services 00 1326810904 0 SHERRY SUSAN M 2023314 9999999 B 10 1326810904 0 400 N HIGHLAND AVE AURORA IL 605063814 20 1326810904 0 Nurse Practitioners Fluoride varnish 20 1326810904 0 Nurse Practitioners Healthy Kids Services 20 1326810904 0 Nurse Practitioners Nurse Practitioners Services 20 1326810904 0 Nurse Practitioners Physician Services 00 1326811894 0 THOMPSON SAMANTHA B 2023339 9999999 B 10 1326811894 0 863 CENTER CT UNIT D SHOREWOOD IL 604048512 20 1326811894 0 Occupational Therapists Medical Supplies 20 1326811894 0 Occupational Therapists Medical equipment/prosthetic devices 20 1326811894 0 Occupational Therapists Occupational Therapy Services 00 1326812215 0 MCGUIRE ERIN 2023332 9999999 B 10 1326812215 0 1601 OLD SOUTH RIVER RD SAINT CHARLES MO 633034120 20 1326812215 0 Nurse Practitioners Fluoride varnish 20 1326812215 0 Nurse Practitioners Healthy Kids Services 20 1326812215 0 Nurse Practitioners Nurse Practitioners Services 20 1326812215 0 Nurse Practitioners Physician Services 00 1326812942 0 AHMED ROMAYA 2023325 9999999 B 10 1326812942 0 709 S SEELEY ST CHICAGO IL 606125554 20 1326812942 0 Optometrists Optical Supplies 20 1326812942 0 Optometrists Optometric Services 20 1326812942 0 Optometrists Physician Services 00 1326813098 0 MONTELEONE JACLYN 2023345 9999999 B 10 1326813098 0 707 RIDGEVIEW DR MCHENRY IL 600507054 20 1326813098 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326816810 0 BILTEAN BEATRICE 2024135 9999999 B 10 1326816810 0 PO BOX 775253 CHICAGO IL 606775253 20 1326816810 0 Nurse Practitioners Healthy Kids Services 20 1326816810 0 Nurse Practitioners Nurse Practitioners Services 20 1326816810 0 Nurse Practitioners Physician Services 00 1326818303 0 WEST SARAH B 2024086 9999999 B 10 1326818303 0 PO BOX 155 CHRISTOPHER IL 628220155 20 1326818303 0 Nurse Practitioners Healthy Kids Services 20 1326818303 0 Nurse Practitioners Nurse Practitioners Services 20 1326818303 0 Nurse Practitioners Physician Services 00 1326819913 0 REAR JANELLE 2024018 9999999 B 10 1326819913 0 611 W PARK ST URBANA IL 618012529 20 1326819913 0 Nurse Practitioners Anesthesia Services 20 1326819913 0 Nurse Practitioners Nurse Practitioners Services 20 1326819913 0 Nurse Practitioners Physician Services 00 1326820218 0 IRVIN HEATHER L 2023307 9999999 B 10 1326820218 0 935 BRYANT ST LOUISVILLE IL 628581053 20 1326820218 0 Nurse Practitioners Fluoride varnish 20 1326820218 0 Nurse Practitioners Healthy Kids Services 20 1326820218 0 Nurse Practitioners Nurse Practitioners Services 20 1326820218 0 Nurse Practitioners Physician Services 00 1326821810 0 HOANG RACHEL 2023291 9999999 B 10 1326821810 0 40 SHUMAN BLVD STE 275 NAPERVILLE IL 605638669 20 1326821810 0 Nurse Practitioners Anesthesia Services 20 1326821810 0 Nurse Practitioners Nurse Practitioners Services 20 1326821810 0 Nurse Practitioners Physician Services 00 1326822164 0 BROEKEMA ASHLEIGH 2024306 9999999 B 10 1326822164 0 54 WHITE OAK DR MORRIS IL 604503614 20 1326822164 0 Speech Therapists Medical Supplies 20 1326822164 0 Speech Therapists Medical equipment/prosthetic devices 20 1326822164 0 Speech Therapists Speech Therapy/Pathology Services 00 1326823311 0 HERBOLSHEIMER CHARLOTTE G 2023241 9999999 B 10 1326823311 0 310 S MAIN ST STE D LOMBARD IL 601482692 20 1326823311 0 Speech Therapists Medical Supplies 20 1326823311 0 Speech Therapists Medical equipment/prosthetic devices 20 1326823311 0 Speech Therapists Speech Therapy/Pathology Services 00 1326824202 0 MOHAMED HAGIR 2024019 9999999 B 10 1326824202 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1326824202 0 Physicians Anesthesia Services 20 1326824202 0 Physicians Healthy Kids Services 20 1326824202 0 Physicians Optical Supplies 20 1326824202 0 Physicians Physician Services 00 1326850744 0 TOEPP SACHI L 2025034 9999999 B 10 1326850744 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1326850744 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326850900 0 RAINES PHYLLIS 2025028 9999999 B 10 1326850900 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1326850900 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326852997 0 BONNER PATRICE N 2025044 9999999 B 10 1326852997 0 1200 W STATE ST ROCKFORD IL 611022112 20 1326852997 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 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Physician Services 00 1326867193 0 CORNELIUS LESLEY C 2024348 9999999 B 10 1326867193 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1326867193 0 Nurse Practitioners Healthy Kids Services 20 1326867193 0 Nurse Practitioners Nurse Practitioners Services 20 1326867193 0 Nurse Practitioners Physician Services 00 1326869439 0 CLARKE RACHEL M 2025035 9999999 B 10 1326869439 0 27750 W HIGHWAY 22 STE 120 BARRINGTON IL 600102379 20 1326869439 0 Nurse Practitioners Healthy Kids Services 20 1326869439 0 Nurse Practitioners Nurse Practitioners Services 20 1326869439 0 Nurse Practitioners Physician Services 00 1326869819 0 VAZQUEZ VANESSA 2025029 9999999 B 10 1326869819 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1326869819 0 Physician Assistant Only Fluoride varnish 20 1326869819 0 Physician Assistant Only Healthy Kids Services 20 1326869819 0 Physician Assistant Only Physician Services 00 1326870098 0 ANWERI AISHWARYA V 2024249 9999999 B 10 1326870098 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1326870098 0 Physicians Anesthesia Services 20 1326870098 0 Physicians Fluoride varnish 20 1326870098 0 Physicians Healthy Kids Services 20 1326870098 0 Physicians Optical Supplies 20 1326870098 0 Physicians Physician Services 00 1326871021 0 HARRIS DUANE E 2024233 9999999 B 10 1326871021 0 1025 MAINE ST QUINCY IL 623014038 20 1326871021 0 Physical Therapists Medical Supplies 20 1326871021 0 Physical Therapists Medical equipment/prosthetic devices 20 1326871021 0 Physical Therapists Physical Therapy Services 00 1326871633 0 OTA MICHIKO 2024341 9999999 B 10 1326871633 0 5777 DEPT CAROL STREAM IL 601220021 20 1326871633 0 Physician Assistant Only Fluoride varnish 20 1326871633 0 Physician Assistant Only Healthy Kids Services 20 1326871633 0 Physician Assistant Only Physician Services 00 1326871898 0 CALDWELL BRANDON 2024330 9999999 B 10 1326871898 0 2025 WASHINGTON ST WAUKEGAN IL 600855131 20 1326871898 0 Other behavior health professional Other Behavioral 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Practitioners Physician Services 00 1326880139 0 KASI LAKSHMI S 2024191 9999999 B 10 1326880139 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1326880139 0 Physicians Anesthesia Services 20 1326880139 0 Physicians Healthy Kids Services 20 1326880139 0 Physicians Optical Supplies 20 1326880139 0 Physicians Physician Services 20 1326880139 0 Physicians Physicians Psychiatric Services 00 1326880402 0 POLANCO ANGIE 2024183 9999999 B 10 1326880402 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1326880402 0 Physicians Anesthesia Services 20 1326880402 0 Physicians Healthy Kids Services 20 1326880402 0 Physicians Optical Supplies 20 1326880402 0 Physicians Physician Services 00 1326881186 0 ZABILKA KELLI E 2024250 9999999 B 10 1326881186 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1326881186 0 Speech Therapists Medical Supplies 20 1326881186 0 Speech Therapists Medical equipment/prosthetic devices 20 1326881186 0 Speech Therapists Speech Therapy/Pathology Services 00 1326881715 0 SILBERSTEIN ALICE E 2024166 9999999 B 10 1326881715 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1326881715 0 Physicians Anesthesia Services 20 1326881715 0 Physicians Fluoride varnish 20 1326881715 0 Physicians Healthy Kids Services 20 1326881715 0 Physicians Optical Supplies 20 1326881715 0 Physicians Physician Services 00 1326881772 0 LEE CALEB I 2024172 9999999 B 10 1326881772 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1326881772 0 Physicians Anesthesia Services 20 1326881772 0 Physicians Fluoride varnish 20 1326881772 0 Physicians Healthy Kids Services 20 1326881772 0 Physicians Optical Supplies 20 1326881772 0 Physicians Physician Services 00 1326882986 0 HESSE JENNIFER 2024171 9999999 B 10 1326882986 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1326882986 0 Physicians Anesthesia Services 20 1326882986 0 Physicians Fluoride varnish 20 1326882986 0 Physicians Healthy Kids Services 20 1326882986 0 Physicians Optical Supplies 20 1326882986 0 Physicians Physician Services 00 1326883349 0 GAVANKAR SANAM 2024320 9999999 B 10 1326883349 0 3249 OAK PARK AVE BERWYN IL 604023429 20 1326883349 0 Physicians Anesthesia Services 20 1326883349 0 Physicians Fluoride varnish 20 1326883349 0 Physicians Healthy Kids Services 20 1326883349 0 Physicians Optical Supplies 20 1326883349 0 Physicians Physician Services 00 1326883596 0 BOZARTH MARISSA 2024192 9999999 B 10 1326883596 0 70 S RIVER ST AURORA IL 605065185 20 1326883596 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326883794 0 DUZAN HEATHER N 2024179 9999999 B 10 1326883794 0 5801 MOUNT PLEASANT LN BELLEVILLE IL 622233944 20 1326883794 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1326883893 0 NYONI SHARON-ROSE 2024191 9999999 B 10 1326883893 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1326883893 0 Physicians Anesthesia Services 20 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0 Physicians Physician Services 00 1326887258 0 LEE RENEE C 2024146 9999999 B 10 1326887258 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1326887258 0 Nurse Practitioners Healthy Kids Services 20 1326887258 0 Nurse Practitioners Nurse Practitioners Services 20 1326887258 0 Nurse Practitioners Physician Services 00 1326888231 0 KEYSER MORGAN L 2024238 9999999 B 10 1326888231 0 124 SW ADAMS ST PEORIA IL 616021308 20 1326888231 0 Physicians Anesthesia Services 20 1326888231 0 Physicians Healthy Kids Services 20 1326888231 0 Physicians Optical Supplies 20 1326888231 0 Physicians Physician Services 00 1326889874 0 TOLIVER BRANDON C 2024177 9999999 B 10 1326889874 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1326889874 0 Physicians Anesthesia Services 20 1326889874 0 Physicians Healthy Kids Services 20 1326889874 0 Physicians Optical Supplies 20 1326889874 0 Physicians Physician Services 00 1326890997 0 GROBELNY MEGAN 2024296 9999999 B 10 1326890997 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1326890997 0 Nurse Practitioners Fluoride varnish 20 1326890997 0 Nurse Practitioners Healthy Kids Services 20 1326890997 0 Nurse Practitioners Nurse Practitioners Services 20 1326890997 0 Nurse Practitioners Physician Services 00 1326891011 0 RIVERO SEAN 2024192 9999999 B 10 1326891011 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1326891011 0 Physicians Anesthesia Services 20 1326891011 0 Physicians Healthy Kids Services 20 1326891011 0 Physicians Optical Supplies 20 1326891011 0 Physicians Physician Services 00 1326892662 0 QADRI MAHEEN 2024191 9999999 B 10 1326892662 0 PO BOX 775248 CHICAGO IL 606775248 20 1326892662 0 Physicians Anesthesia Services 20 1326892662 0 Physicians Fluoride varnish 20 1326892662 0 Physicians Healthy Kids Services 20 1326892662 0 Physicians Optical Supplies 20 1326892662 0 Physicians Physician Services 00 1326893942 0 MENSAH DANIELLE 2024182 9999999 B 10 1326893942 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1326893942 0 Physicians Anesthesia Services 20 1326893942 0 Physicians Healthy Kids Services 20 1326893942 0 Physicians Optical Supplies 20 1326893942 0 Physicians Physician Services 20 1326893942 0 Physicians Physicians Psychiatric Services 00 1326894494 0 KIRKHAM BROOKE 2024183 9999999 B 10 1326894494 0 5145 N CALIFORNIA AVE CHICAGO IL 606253661 20 1326894494 0 Physicians Anesthesia Services 20 1326894494 0 Physicians Healthy Kids Services 20 1326894494 0 Physicians Optical Supplies 20 1326894494 0 Physicians Physician Services 00 1326895749 0 HARDEKOPF DOUGLAS 2024145 9999999 B 10 1326895749 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1326895749 0 Nurse Practitioners Anesthesia Services 20 1326895749 0 Nurse Practitioners Nurse Practitioners Services 20 1326895749 0 Nurse Practitioners Physician Services 00 1326896804 0 MELENDEZ LUIS 2024143 9999999 B 10 1326896804 0 70 S RIVER ST AURORA IL 605065185 20 1326896804 0 Other behavior health professional Other Behavioral Health Services (excludes 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KYLE 2004336 9999999 B 10 1336101682 0 78 REGENCY PKWY MANSFIELD TX 760637816 20 1336101682 0 Physicians Anesthesia Services 20 1336101682 0 Physicians Healthy Kids Services 20 1336101682 0 Physicians Optical Supplies 20 1336101682 0 Physicians Physician Services 00 1336102540 0 HERNANDEZ MANUEL 2005192 9999999 B 10 1336102540 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1336102540 0 Physicians Anesthesia Services 20 1336102540 0 Physicians Healthy Kids Services 20 1336102540 0 Physicians Optical Supplies 20 1336102540 0 Physicians Physician Services 00 1336102847 0 MA MARCUS 2009050 9999999 B 10 1336102847 0 PO BOX 8742 FORT WORTH TX 761240742 20 1336102847 0 Physicians Anesthesia Services 20 1336102847 0 Physicians Healthy Kids Services 20 1336102847 0 Physicians Optical Supplies 20 1336102847 0 Physicians Physician Services 00 1336104348 0 KLEIN GITELMAN MARISA 1994182 9999999 B 10 1336104348 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1336104348 0 Physicians 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Physicians Optical Supplies 20 1336106277 0 Physicians Physician Services 00 1336107465 0 TURKYILMAZ MUGE 2008001 9999999 B 10 1336107465 0 PO BOX 578 PARK RIDGE IL 600680578 20 1336107465 0 Physicians Anesthesia Services 20 1336107465 0 Physicians Healthy Kids Services 20 1336107465 0 Physicians Optical Supplies 20 1336107465 0 Physicians Physician Services 00 1336107937 0 CYBULSKI GEORGE R 1986182 9999999 B 10 1336107937 0 1044 N FRANCISCO AVE CHICAGO IL 606222743 20 1336107937 0 Physicians Anesthesia Services 20 1336107937 0 Physicians Healthy Kids Services 20 1336107937 0 Physicians Optical Supplies 20 1336107937 0 Physicians Physician Services 00 1336107986 0 BOKERMAN DAVID M 2022123 9999999 B 10 1336107986 0 6024 RIDGE AVE STE 116-356 PHILADELPHIA PA 191281601 20 1336107986 0 Physicians Anesthesia Services 20 1336107986 0 Physicians Healthy Kids Services 20 1336107986 0 Physicians Optical Supplies 20 1336107986 0 Physicians Physician Services 00 1336107994 0 PILLAI ARUN V 2024085 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Physicians Anesthesia Services 20 1336135961 0 Physicians Fluoride varnish 20 1336135961 0 Physicians Healthy Kids Services 20 1336135961 0 Physicians Optical Supplies 20 1336135961 0 Physicians Physician Services 00 1336136191 0 CARROLL RANDY 2019355 9999999 B 10 1336136191 0 PO BOX 43230 PHOENIX AZ 850803230 20 1336136191 0 Physician Assistant Only Fluoride varnish 20 1336136191 0 Physician Assistant Only Healthy Kids Services 20 1336136191 0 Physician Assistant Only Physician Services 00 1336136225 0 KRAMER DAVID 1991213 9999999 B 10 1336136225 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1336136225 0 Physicians Anesthesia Services 20 1336136225 0 Physicians Fluoride varnish 20 1336136225 0 Physicians Healthy Kids Services 20 1336136225 0 Physicians Optical Supplies 20 1336136225 0 Physicians Physician Services 00 1336136258 0 VASHI PANKAJ 1992066 9999999 B 10 1336136258 0 2361 PAYSPHERE CIR CHICAGO IL 606740023 20 1336136258 0 Physicians Anesthesia Services 20 1336136258 0 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9999999 B 10 1336156884 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1336156884 0 Physicians Anesthesia Services 20 1336156884 0 Physicians Fluoride varnish 20 1336156884 0 Physicians Healthy Kids Services 20 1336156884 0 Physicians Optical Supplies 20 1336156884 0 Physicians Physician Services 00 1336157023 0 STROHLDRIER JEANE L 2015261 9999999 B 10 1336157023 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1336157023 0 Physician Assistant Only Fluoride varnish 20 1336157023 0 Physician Assistant Only Healthy Kids Services 20 1336157023 0 Physician Assistant Only Physician Services 00 1336157171 0 ARORA ASHISH K 2006213 9999999 B 10 1336157171 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1336157171 0 Physicians Anesthesia Services 20 1336157171 0 Physicians Fluoride varnish 20 1336157171 0 Physicians Healthy Kids Services 20 1336157171 0 Physicians Optical Supplies 20 1336157171 0 Physicians Physician Services 00 1336157213 0 KEEGAN MARY 1997276 9999999 B 10 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0 Dentists Dental Services 20 1336221803 0 Dentists Physician Services 00 1336221852 0 MCCLOUD LINDA K 2000083 9999999 B 10 1336221852 0 4350 FOWLER ST STE 15 FORT MYERS FL 339012616 20 1336221852 0 Nurse Practitioners Fluoride varnish 20 1336221852 0 Nurse Practitioners Healthy Kids Services 20 1336221852 0 Nurse Practitioners Nurse Practitioners Services 20 1336221852 0 Nurse Practitioners Physician Services 00 1336222306 0 PORTER DAWN M 1995001 9999999 B 10 1336222306 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1336222306 0 Physicians Anesthesia Services 20 1336222306 0 Physicians Healthy Kids Services 20 1336222306 0 Physicians Optical Supplies 20 1336222306 0 Physicians Physician Services 20 1336222306 0 Physicians Physicians Psychiatric Services 00 1336222488 0 LEISCHNER JULIE A 2024121 9999999 B 10 1336222488 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1336222488 0 Physicians Anesthesia Services 20 1336222488 0 Physicians Fluoride varnish 20 1336222488 0 Physicians Healthy Kids Services 20 1336222488 0 Physicians Optical Supplies 20 1336222488 0 Physicians Physician Services 00 1336222983 0 PARR SHERRI 2015152 9999999 B 10 1336222983 0 PO BOX 34156 BELFAST ME 049150619 20 1336222983 0 Physician Assistant Only Fluoride varnish 20 1336222983 0 Physician Assistant Only Healthy Kids Services 20 1336222983 0 Physician Assistant Only Physician Services 00 1336223205 0 WAHIDI MOMEN 2006226 9999999 B 10 1336223205 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1336223205 0 Physicians Anesthesia Services 20 1336223205 0 Physicians Fluoride varnish 20 1336223205 0 Physicians Healthy Kids Services 20 1336223205 0 Physicians Optical Supplies 20 1336223205 0 Physicians Physician Services 00 1336224658 0 HANDELSMAN CAROL A 1994001 9999999 B 10 1336224658 0 2900 N LAKE SHORE DR CHICAGO IL 606575640 20 1336224658 0 Physicians Anesthesia Services 20 1336224658 0 Physicians Healthy Kids Services 20 1336224658 0 Physicians Optical Supplies 20 1336224658 0 Physicians Physician Services 00 1336225788 0 PORCHE JOAN 2014098 9999999 B 10 1336225788 0 20280 GOVERNORS HWY STE 207 OLYMPIA FIELDS IL 604611070 20 1336225788 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1336227503 0 GUREVICH TAMARA 2001171 9999999 B 10 1336227503 0 PO BOX 5979 BUFFALO GROVE IL 600895979 20 1336227503 0 Physicians Anesthesia Services 20 1336227503 0 Physicians Healthy Kids Services 20 1336227503 0 Physicians Optical Supplies 20 1336227503 0 Physicians Physician Services 00 1336227552 0 REHAK CHRISTOPHER 2021135 9999999 B 10 1336227552 0 PO BOX 10010 GLENDALE AZ 853180010 20 1336227552 0 Physicians Anesthesia Services 20 1336227552 0 Physicians Healthy Kids Services 20 1336227552 0 Physicians Optical Supplies 20 1336227552 0 Physicians Physician Services 00 1336230051 0 KROODSMA CHRISTOPHER T 2004183 9999999 B 10 1336230051 0 5401 N KNOXVILLE AVE STE 115 SUITE 115 PEORIA IL 616145068 20 1336230051 0 Physicians Anesthesia Services 20 1336230051 0 Physicians Healthy Kids Services 20 1336230051 0 Physicians Optical Supplies 20 1336230051 0 Physicians Physician Services 00 1336230499 0 HASLER TRACY 2010091 9999999 B 10 1336230499 0 PO BOX 34143 BELFAST ME 049150619 20 1336230499 0 Nurse Practitioners Healthy Kids Services 20 1336230499 0 Nurse Practitioners Nurse Practitioners Services 20 1336230499 0 Nurse Practitioners Physician Services 00 1336230580 0 WOLTER ELIZABETH A 2017335 9999999 B 10 1336230580 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1336230580 0 Physician Assistant Only Fluoride varnish 20 1336230580 0 Physician Assistant Only Healthy Kids Services 20 1336230580 0 Physician Assistant Only Physician Services 00 1336231547 0 BOYENS CARL 2014268 9999999 B 10 1336231547 0 2500 W HIGGINS RD STE 105 HOFFMAN ESTATES IL 601692040 20 1336231547 0 Other behavior health professional LCPC/LMFT services 00 1336231836 0 GINNETTI RICHARD A 1985213 9999999 B 10 1336231836 0 530 NE GLEN OAK AVE PEORIA IL 616370001 20 1336231836 0 Physicians Anesthesia Services 20 1336231836 0 Physicians Fluoride varnish 20 1336231836 0 Physicians Healthy Kids Services 20 1336231836 0 Physicians Optical Supplies 20 1336231836 0 Physicians Physician Services 00 1336232180 0 FELD JAMES 1983258 9999999 B 10 1336232180 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1336232180 0 Physicians Anesthesia Services 20 1336232180 0 Physicians Healthy Kids Services 20 1336232180 0 Physicians Optical Supplies 20 1336232180 0 Physicians Physician Services 00 1336235050 0 ANAND NITIN JAGDISH 2014330 9999999 B 10 1336235050 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1336235050 0 Physicians Anesthesia Services 20 1336235050 0 Physicians Fluoride varnish 20 1336235050 0 Physicians Healthy Kids Services 20 1336235050 0 Physicians Optical Supplies 20 1336235050 0 Physicians Physician Services 00 1336235522 0 PEDRIANA KATHRINE P 2022207 9999999 B 10 1336235522 0 6024 RIDGE 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IA 504015489 20 1336235738 0 Physicians Anesthesia Services 20 1336235738 0 Physicians Healthy Kids Services 20 1336235738 0 Physicians Optical Supplies 20 1336235738 0 Physicians Physician Services 00 1336235928 0 RICKARD JACQUELINE 2007211 9999999 B 10 1336235928 0 SUITE 327 340 W LINCOLN STREET BELLEVILLE IL 622201900 20 1336235928 0 Physicians Anesthesia Services 20 1336235928 0 Physicians Fluoride varnish 20 1336235928 0 Physicians Healthy Kids Services 20 1336235928 0 Physicians Optical Supplies 20 1336235928 0 Physicians Physician Services 00 1336235928 0 RICKARD JACQUELINE 2024214 9999999 B 10 1336235928 0 15740 S OUTER 40 RD CHESTERFIELD MO 630172004 20 1336235928 0 Physicians Anesthesia Services 20 1336235928 0 Physicians Fluoride varnish 20 1336235928 0 Physicians Healthy Kids Services 20 1336235928 0 Physicians Optical Supplies 20 1336235928 0 Physicians Physician Services 00 1336236132 0 BELL ANTHONY 2005001 9999999 B 10 1336236132 0 PO BOX 3487 BARRINGTON IL 600113487 20 1336236132 0 Physicians Anesthesia Services 20 1336236132 0 Physicians Fluoride varnish 20 1336236132 0 Physicians Healthy Kids Services 20 1336236132 0 Physicians Optical Supplies 20 1336236132 0 Physicians Physician Services 00 1336236157 0 ABREGO ANTONIO 1997135 9999999 B 10 1336236157 0 PO BOX 570 LAKE FOREST IL 600450570 20 1336236157 0 Physicians Anesthesia Services 20 1336236157 0 Physicians Healthy Kids Services 20 1336236157 0 Physicians Optical Supplies 20 1336236157 0 Physicians Physician Services 00 1336236959 0 JOHNSON BYRON W 1997182 9999999 B 10 1336236959 0 PO BOX 5588 BELFAST ME 049155500 20 1336236959 0 Physicians Anesthesia Services 20 1336236959 0 Physicians Healthy Kids Services 20 1336236959 0 Physicians Optical Supplies 20 1336236959 0 Physicians Physician Services 00 1336237833 0 GRAVES KAREN 2022052 9999999 B 10 1336237833 0 2521 E 15TH ST CASPER WY 826094126 20 1336237833 0 Nurse Practitioners Healthy Kids Services 20 1336237833 0 Nurse Practitioners Nurse Practitioners Services 20 1336237833 0 Nurse Practitioners Physician Services 00 1336239904 0 BRAHMBHATT TEJAS N 2023144 9999999 B 10 1336239904 0 1000 N OAK AVE MARSHFIELD WI 544495703 20 1336239904 0 Physicians Anesthesia Services 20 1336239904 0 Physicians Fluoride varnish 20 1336239904 0 Physicians Healthy Kids Services 20 1336239904 0 Physicians Optical Supplies 20 1336239904 0 Physicians Physician Services 00 1336240845 0 KUNJUMMEN BIJU 2020345 2026365 B 10 1336240845 0 44000 GARFIELD RD CLINTON TOWNSHI MI 480381125 20 1336240845 0 Physicians Anesthesia Services 20 1336240845 0 Physicians Healthy Kids Services 20 1336240845 0 Physicians Optical Supplies 20 1336240845 0 Physicians Physician Services 00 1336241256 0 LEE JEROME 1982213 9999999 B 10 1336241256 0 1286 N MILWAUKEE AVE CHICAGO IL 606229319 20 1336241256 0 Physicians Anesthesia Services 20 1336241256 0 Physicians Healthy Kids Services 20 1336241256 0 Physicians Optical Supplies 20 1336241256 0 Physicians Physician Services 00 1336242643 0 BRINT STEVEN 1988214 9999999 B 10 1336242643 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1336242643 0 Physicians Anesthesia Services 20 1336242643 0 Physicians Healthy Kids Services 20 1336242643 0 Physicians Optical Supplies 20 1336242643 0 Physicians Physician Services 20 1336242643 0 Physicians Physicians Psychiatric Services 00 1336243815 0 REDLICH KRISTI N 2008245 9999999 B 10 1336243815 0 5777 DEPT CAROL STREAM IL 601228942 20 1336243815 0 Physicians Anesthesia Services 20 1336243815 0 Physicians Fluoride varnish 20 1336243815 0 Physicians Healthy Kids Services 20 1336243815 0 Physicians Optical Supplies 20 1336243815 0 Physicians Physician Services 00 1336244854 0 JESSIE BROOKE M 2006236 9999999 B 10 1336244854 0 PO BOX 5081 JANESVILLE WI 535475081 20 1336244854 0 Physical Therapists Medical Supplies 20 1336244854 0 Physical Therapists Medical equipment/prosthetic devices 20 1336244854 0 Physical Therapists Physical Therapy Services 00 1336244870 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ST MADISON WI 537151507 20 1336245844 0 Physicians Anesthesia Services 20 1336245844 0 Physicians Fluoride varnish 20 1336245844 0 Physicians Healthy Kids Services 20 1336245844 0 Physicians Optical Supplies 20 1336245844 0 Physicians Physician Services 00 1336245968 0 SARNE DAVID H 1984208 9999999 B 10 1336245968 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1336245968 0 Physicians Anesthesia Services 20 1336245968 0 Physicians Fluoride varnish 20 1336245968 0 Physicians Healthy Kids Services 20 1336245968 0 Physicians Optical Supplies 20 1336245968 0 Physicians Physician Services 00 1336247519 0 VOGT JENNIFER 2001355 9999999 B 10 1336247519 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1336247519 0 Occupational Therapists Medical Supplies 20 1336247519 0 Occupational Therapists Medical equipment/prosthetic devices 20 1336247519 0 Occupational Therapists Occupational Therapy Services 00 1336247915 0 GAETA MATTHEW 2007213 9999999 B 10 1336247915 0 1900 STATE ST CHESTER 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Anesthesia Services 20 1336251719 0 Physicians Healthy Kids Services 20 1336251719 0 Physicians Optical Supplies 20 1336251719 0 Physicians Physician Services 00 1336251958 0 CASTRO SKOGLUND JENECSIS 1996214 9999999 B 10 1336251958 0 920 WEST ST STE 216-218 SUITE 216-218 PERU IL 613542763 20 1336251958 0 Physicians Anesthesia Services 20 1336251958 0 Physicians Fluoride varnish 20 1336251958 0 Physicians Healthy Kids Services 20 1336251958 0 Physicians Optical Supplies 20 1336251958 0 Physicians Physician Services 00 1336252204 0 AHMED TAUQIR 2008214 9999999 B 10 1336252204 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1336252204 0 Physicians Anesthesia Services 20 1336252204 0 Physicians Healthy Kids Services 20 1336252204 0 Physicians Optical Supplies 20 1336252204 0 Physicians Physician Services 00 1336252238 0 TIEMSTRA JEFFREY D 1987222 9999999 B 10 1336252238 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1336252238 0 Physicians Anesthesia Services 20 1336252238 0 Physicians Fluoride varnish 20 1336252238 0 Physicians Healthy Kids Services 20 1336252238 0 Physicians Optical Supplies 20 1336252238 0 Physicians Physician Services 00 1336252568 0 FLETCHER JEFFREY 2006213 9999999 B 10 1336252568 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1336252568 0 Physicians Anesthesia Services 20 1336252568 0 Physicians Healthy Kids Services 20 1336252568 0 Physicians Optical Supplies 20 1336252568 0 Physicians Physician Services 20 1336252568 0 Physicians Physicians Psychiatric Services 00 1336253822 0 NIEBLER ROBERT A 2008122 9999999 B 10 1336253822 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1336253822 0 Physicians Anesthesia Services 20 1336253822 0 Physicians Fluoride varnish 20 1336253822 0 Physicians Healthy Kids Services 20 1336253822 0 Physicians Optical Supplies 20 1336253822 0 Physicians Physician Services 00 1336255009 0 BOCHANTIN TRACY A 2001032 9999999 B 10 1336255009 0 5401 N KNOXVILLE AVE STE 308 PEORIA IL 616145099 20 1336255009 0 Physicians Anesthesia Services 20 1336255009 0 Physicians Healthy Kids Services 20 1336255009 0 Physicians Optical Supplies 20 1336255009 0 Physicians Physician Services 00 1336255611 0 DACCACHE ANTOINE 2006244 9999999 B 10 1336255611 0 530 NE GLEN OAK AVE PEORIA IL 616370001 20 1336255611 0 Physicians Anesthesia Services 20 1336255611 0 Physicians Fluoride varnish 20 1336255611 0 Physicians Healthy Kids Services 20 1336255611 0 Physicians Optical Supplies 20 1336255611 0 Physicians Physician Services 00 1336256148 0 GARDNER ROBERT W 2021175 9999999 B 10 1336256148 0 11995 SINGLETREE LN STE 500 SUITE 500 EDEN PRAIRIE MN 553445349 20 1336256148 0 Physicians Anesthesia Services 20 1336256148 0 Physicians Healthy Kids Services 20 1336256148 0 Physicians Optical Supplies 20 1336256148 0 Physicians Physician Services 00 1336256254 0 OXFORD THOMAS 2003319 9999999 B 10 1336256254 0 3 WINDSWEPT DR NASHVILLE IL 622635048 20 1336256254 0 Physical Therapists Medical Supplies 20 1336256254 0 Physical Therapists Medical equipment/prosthetic devices 20 1336256254 0 Physical Therapists Physical Therapy Services 00 1336256379 0 KYLE MAUNG 2023030 9999999 B 10 1336256379 0 1232 W STATE ROAD 2 LA PORTE IN 463505469 20 1336256379 0 Physicians Anesthesia Services 20 1336256379 0 Physicians Fluoride varnish 20 1336256379 0 Physicians Healthy Kids Services 20 1336256379 0 Physicians Optical Supplies 20 1336256379 0 Physicians Physician Services 00 1336256437 0 VENETOS TINA C 1997046 9999999 B 10 1336256437 0 925 SHERWOOD DR LAKE BLUFF IL 600442203 20 1336256437 0 Physicians Anesthesia Services 20 1336256437 0 Physicians Healthy Kids Services 20 1336256437 0 Physicians Optical Supplies 20 1336256437 0 Physicians Physician Services 00 1336257245 0 BUENGER WYNNDELL 1995182 9999999 B 10 1336257245 0 4121 VETERANS MEMORIAL DR MOUNT VERNON IL 628646262 20 1336257245 0 Physicians Anesthesia Services 20 1336257245 0 Physicians Healthy Kids Services 20 1336257245 0 Physicians Optical Supplies 20 1336257245 0 Physicians Physician Services 00 1336257567 0 PENG WENG 1989182 9999999 B 10 1336257567 0 3641 RIDGE RD STE 5 HIGHLAND IN 463222081 20 1336257567 0 Physicians Anesthesia Services 20 1336257567 0 Physicians Healthy Kids Services 20 1336257567 0 Physicians Optical Supplies 20 1336257567 0 Physicians Physician Services 00 1336258292 0 FOUCH ERIN M 2018214 9999999 B 10 1336258292 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1336258292 0 Physicians Anesthesia Services 20 1336258292 0 Physicians Fluoride varnish 20 1336258292 0 Physicians Healthy Kids Services 20 1336258292 0 Physicians Optical Supplies 20 1336258292 0 Physicians Physician Services 00 1336258698 0 ZIMMER DAWN M 1999182 9999999 B 10 1336258698 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1336258698 0 Physicians Anesthesia Services 20 1336258698 0 Physicians Healthy Kids Services 20 1336258698 0 Physicians Optical Supplies 20 1336258698 0 Physicians Physician Services 00 1336259068 0 RAFTIS THEMISTOCLES 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0 210 W MCKINLEY AVE STE 1 DECATUR IL 625265858 20 1336370915 0 Physicians Anesthesia Services 20 1336370915 0 Physicians Fluoride varnish 20 1336370915 0 Physicians Healthy Kids Services 20 1336370915 0 Physicians Optical Supplies 20 1336370915 0 Physicians Physician Services 00 1336371137 0 HADDAD WAJED H 2015182 9999999 B 10 1336371137 0 PO BOX 5588 BELFAST ME 049155500 20 1336371137 0 Physicians Anesthesia Services 20 1336371137 0 Physicians Fluoride varnish 20 1336371137 0 Physicians Healthy Kids Services 20 1336371137 0 Physicians Optical Supplies 20 1336371137 0 Physicians Physician Services 00 1336371269 0 CORNELL TERRAH L. 2013210 9999999 B 10 1336371269 0 114 S 4TH ST CUBA IL 614275062 20 1336371269 0 Nurse Practitioners Family Planning Counseling 20 1336371269 0 Nurse Practitioners Fluoride varnish 20 1336371269 0 Nurse Practitioners Healthy Kids Services 20 1336371269 0 Nurse Practitioners Nurse Practitioners Services 20 1336371269 0 Nurse Practitioners Physician Services 00 1336371590 0 MOREIRA JONATHAN 2012190 9999999 B 10 1336371590 0 5777 DEPT CAROL STREAM IL 601220021 20 1336371590 0 Physicians Anesthesia Services 20 1336371590 0 Physicians Fluoride varnish 20 1336371590 0 Physicians Healthy Kids Services 20 1336371590 0 Physicians Optical Supplies 20 1336371590 0 Physicians Physician Services 00 1336373364 0 MALIK MUHAMMAD F 2018349 9999999 B 10 1336373364 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1336373364 0 Physicians Anesthesia Services 20 1336373364 0 Physicians Fluoride varnish 20 1336373364 0 Physicians Healthy Kids Services 20 1336373364 0 Physicians Optical Supplies 20 1336373364 0 Physicians Physician Services 00 1336373406 0 SPIER ADDIE 2016214 9999999 B 10 1336373406 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1336373406 0 Physicians Anesthesia Services 20 1336373406 0 Physicians Fluoride varnish 20 1336373406 0 Physicians Healthy Kids Services 20 1336373406 0 Physicians Optical Supplies 20 1336373406 0 Physicians 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9999999 B 10 1336377001 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1336377001 0 Physicians Anesthesia Services 20 1336377001 0 Physicians Fluoride varnish 20 1336377001 0 Physicians Healthy Kids Services 20 1336377001 0 Physicians Optical Supplies 20 1336377001 0 Physicians Physician Services 20 1336377001 0 Physicians Physicians Psychiatric Services 00 1336377977 0 SHAREEF NAUSHIN 2017213 9999999 B 10 1336377977 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1336377977 0 Physicians Anesthesia Services 20 1336377977 0 Physicians Fluoride varnish 20 1336377977 0 Physicians Healthy Kids Services 20 1336377977 0 Physicians Optical Supplies 20 1336377977 0 Physicians Physician Services 00 1336378199 0 LACALLE EDUARDO J 2022299 9999999 B 10 1336378199 0 5701 W TALAVI BLVD STE 120 GLENDALE AZ 853061888 20 1336378199 0 Physicians Anesthesia Services 20 1336378199 0 Physicians Healthy Kids Services 20 1336378199 0 Physicians Optical Supplies 20 1336378199 0 Physicians Physician Services 00 1336378348 0 ACREE MARY ELLEN 2017179 9999999 B 10 1336378348 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1336378348 0 Physicians Anesthesia Services 20 1336378348 0 Physicians Fluoride varnish 20 1336378348 0 Physicians Healthy Kids Services 20 1336378348 0 Physicians Optical Supplies 20 1336378348 0 Physicians Physician Services 00 1336378934 0 CHODE SURESH 2019262 9999999 B 10 1336378934 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1336378934 0 Physicians Anesthesia Services 20 1336378934 0 Physicians Fluoride varnish 20 1336378934 0 Physicians Healthy Kids Services 20 1336378934 0 Physicians Optical Supplies 20 1336378934 0 Physicians Physician Services 00 1336379098 0 COCCO ROBAAB 2013224 9999999 B 10 1336379098 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1336379098 0 Physicians All Kids application agent 20 1336379098 0 Physicians Anesthesia Services 20 1336379098 0 Physicians Healthy Kids Services 20 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1336391929 0 Physicians Physician Services 00 1336394840 0 NYGAARD KIM 2018114 9999999 B 10 1336394840 0 145 S VIRGINIA ST CRYSTAL LAKE IL 600147226 20 1336394840 0 Other behavior health professional LCPC/LMFT services 00 1336395078 0 HERZAN-TAYLOR ELIZABETH 1997276 9999999 B 10 1336395078 0 2611 W CHICAGO AVE CHICAGO IL 606224519 20 1336395078 0 Nurse Practitioners Fluoride varnish 20 1336395078 0 Nurse Practitioners Healthy Kids Services 20 1336395078 0 Nurse Practitioners Nurse Practitioners Services 20 1336395078 0 Nurse Practitioners Physician Services 00 1336395490 0 SEO-LEE ALISA 2011213 9999999 B 10 1336395490 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1336395490 0 Physicians Anesthesia Services 20 1336395490 0 Physicians Fluoride varnish 20 1336395490 0 Physicians Healthy Kids Services 20 1336395490 0 Physicians Optical Supplies 20 1336395490 0 Physicians Physician Services 00 1336395524 0 LUNA CARLA J 2021048 9999999 B 10 1336395524 0 PO BOX 603725 CHARLOTTE NC 282603725 20 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1336544899 0 Nurse Practitioners Nurse Practitioners Services 20 1336544899 0 Nurse Practitioners Physician Services 00 1336545482 0 POLEK PAULINA 2015293 9999999 B 10 1336545482 0 400 S DRYDEN PL ARLINGTON HTS IL 600052136 20 1336545482 0 Speech Therapists Medical Supplies 20 1336545482 0 Speech Therapists Medical equipment/prosthetic devices 20 1336545482 0 Speech Therapists Speech Therapy/Pathology Services 00 1336545854 0 WAGGONER SCOTT A 2015026 9999999 B 10 1336545854 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1336545854 0 Nurse Practitioners Anesthesia Services 20 1336545854 0 Nurse Practitioners Nurse Practitioners Services 20 1336545854 0 Nurse Practitioners Physician Services 00 1336546969 0 NELSON JENNIFER A 2016187 9999999 B 10 1336546969 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1336546969 0 Nurse Practitioners Fluoride varnish 20 1336546969 0 Nurse Practitioners Healthy Kids Services 20 1336546969 0 Nurse Practitioners Nurse Practitioners Services 20 1336546969 0 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1336554799 0 Physicians Optical Supplies 20 1336554799 0 Physicians Physician Services 00 1336554898 0 KISZKA JESSICA 2014188 9999999 B 10 1336554898 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1336554898 0 Nurse Practitioners Healthy Kids Services 20 1336554898 0 Nurse Practitioners Nurse Practitioners Services 20 1336554898 0 Nurse Practitioners Physician Services 00 1336554963 0 POTHOUR ANNE 2016262 9999999 B 10 1336554963 0 8324 SKOKIE BLVD SKOKIE IL 600772545 20 1336554963 0 Clinical Social Worker Social work service 00 1336555150 0 BRYANT WILLIAM R 2014213 9999999 B 10 1336555150 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1336555150 0 Nurse Practitioners Fluoride varnish 20 1336555150 0 Nurse Practitioners Healthy Kids Services 20 1336555150 0 Nurse Practitioners Nurse Practitioners Services 20 1336555150 0 Nurse Practitioners Physician Services 00 1336555184 0 JEFFERSON NATALIE 2016326 9999999 B 10 1336555184 0 3471 EAGLE WAY CHICAGO IL 606781034 20 1336555184 0 Nurse 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9999999 B 10 1336556083 0 3500 W PETERSON AVE STE 401 CHICAGO IL 606593307 20 1336556083 0 Optometrists Optical Supplies 20 1336556083 0 Optometrists Optometric Services 20 1336556083 0 Optometrists Physician Services 00 1336556943 0 PURANIK SANDEEP 2017117 9999999 B 10 1336556943 0 PO BOX 778912 CHICAGO IL 606778912 20 1336556943 0 Physicians Anesthesia Services 20 1336556943 0 Physicians Fluoride varnish 20 1336556943 0 Physicians Healthy Kids Services 20 1336556943 0 Physicians Optical Supplies 20 1336556943 0 Physicians Physician Services 00 1336558543 0 DUPRE JACQUES 2023156 9999999 B 10 1336558543 0 7702 SOLUTION CENTER CHICAGO IL 606777007 20 1336558543 0 Dentists Dental Services 20 1336558543 0 Dentists Physician Services 00 1336559079 0 PATEL DEPEN 2024044 9999999 B 10 1336559079 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1336559079 0 Physicians Anesthesia Services 20 1336559079 0 Physicians Fluoride varnish 20 1336559079 0 Physicians Healthy Kids Services 20 1336559079 0 Physicians Optical Supplies 20 1336559079 0 Physicians Physician Services 00 1336559640 0 TAYLOR KRISTIN K 2019141 9999999 B 10 1336559640 0 12634 OLIVE BLVD SAINT LOUIS MO 631416337 20 1336559640 0 Nurse Practitioners Healthy Kids Services 20 1336559640 0 Nurse Practitioners Nurse Practitioners Services 20 1336559640 0 Nurse Practitioners Physician Services 00 1336561901 0 UNGER ROBERT C 2023003 9999999 B 10 1336561901 0 200 CLINT HILL BLVD PADUCAH KY 420016768 20 1336561901 0 Physician Assistant Only Fluoride varnish 20 1336561901 0 Physician Assistant Only Healthy Kids Services 20 1336561901 0 Physician Assistant Only Physician Services 00 1336563360 0 DIETZ ROBERT 2016062 9999999 B 10 1336563360 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1336563360 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1336564764 0 WEEDE NANCY 2017285 9999999 B 10 1336564764 0 PO BOX 3646 QUINCY IL 623053646 20 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0 STUTZ MATTHEW R 2018352 9999999 B 10 1336566819 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1336566819 0 Physicians Anesthesia Services 20 1336566819 0 Physicians Fluoride varnish 20 1336566819 0 Physicians Healthy Kids Services 20 1336566819 0 Physicians Optical Supplies 20 1336566819 0 Physicians Physician Services 00 1336566892 0 BANKS LAURA E 2017087 9999999 B 10 1336566892 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1336566892 0 Physicians Anesthesia Services 20 1336566892 0 Physicians Fluoride varnish 20 1336566892 0 Physicians Healthy Kids Services 20 1336566892 0 Physicians Optical Supplies 20 1336566892 0 Physicians Physician Services 00 1336567031 0 KALLINI JOSEPH 2023270 9999999 B 10 1336567031 0 19111 TOWN CENTER DR APPLE VALLEY CA 923088989 20 1336567031 0 Physicians Anesthesia Services 20 1336567031 0 Physicians Healthy Kids Services 20 1336567031 0 Physicians Optical Supplies 20 1336567031 0 Physicians Physician Services 00 1336567080 0 SAMRA SHEENA 2019174 9999999 B 10 1336567080 0 10001 W INNOVATION DR STE 200 WAUWATOSA WI 532264851 20 1336567080 0 Physicians Anesthesia Services 20 1336567080 0 Physicians Healthy Kids Services 20 1336567080 0 Physicians Optical Supplies 20 1336567080 0 Physicians Physician Services 00 1336567189 0 GARDNER KASEY S 2017191 9999999 B 10 1336567189 0 5777 DEPT CAROL STREAM IL 601220021 20 1336567189 0 Physicians Anesthesia Services 20 1336567189 0 Physicians Fluoride varnish 20 1336567189 0 Physicians Healthy Kids Services 20 1336567189 0 Physicians Optical Supplies 20 1336567189 0 Physicians Physician Services 00 1336567478 0 ROS SARA 2017121 9999999 B 10 1336567478 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1336567478 0 Physicians Anesthesia Services 20 1336567478 0 Physicians Fluoride varnish 20 1336567478 0 Physicians Healthy Kids Services 20 1336567478 0 Physicians Optical Supplies 20 1336567478 0 Physicians Physician Services 00 1336567536 0 MCKENZIE SHEENA 2019267 9999999 B 10 1336567536 0 29373 NETWORK PL CHICAGO IL 606733039 20 1336567536 0 Physicians Anesthesia Services 20 1336567536 0 Physicians Fluoride varnish 20 1336567536 0 Physicians Healthy Kids Services 20 1336567536 0 Physicians Optical Supplies 20 1336567536 0 Physicians Physician Services 00 1336567692 0 XU SHUAI 2018137 9999999 B 10 1336567692 0 5777 DEPT CAROL STREAM IL 601220021 20 1336567692 0 Physicians Anesthesia Services 20 1336567692 0 Physicians Healthy Kids Services 20 1336567692 0 Physicians Optical Supplies 20 1336567692 0 Physicians Physician Services 00 1336567833 0 CARRASCO MCCAUL MELISA 2021243 9999999 B 10 1336567833 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1336567833 0 Physicians Anesthesia Services 20 1336567833 0 Physicians Healthy Kids Services 20 1336567833 0 Physicians Optical Supplies 20 1336567833 0 Physicians Physician Services 20 1336567833 0 Physicians Physicians Psychiatric Services 00 1336568237 0 TARAZI CHRISTINA 2020195 9999999 B 10 1336568237 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1336568237 0 Physicians Anesthesia Services 20 1336568237 0 Physicians Fluoride varnish 20 1336568237 0 Physicians Healthy Kids Services 20 1336568237 0 Physicians Optical Supplies 20 1336568237 0 Physicians Physician Services 00 1336568278 0 BOKSA ANASTASIA 2014290 9999999 B 10 1336568278 0 6233 CERMAK RD BERWYN IL 604022317 20 1336568278 0 Optometrists Optical Supplies 20 1336568278 0 Optometrists Optometric Services 20 1336568278 0 Optometrists Physician Services 00 1336568450 0 EGGEMAN DANIEL R 2016347 9999999 B 10 1336568450 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1336568450 0 Physicians Anesthesia Services 20 1336568450 0 Physicians Healthy Kids Services 20 1336568450 0 Physicians Optical Supplies 20 1336568450 0 Physicians Physician Services 00 1336569169 0 MATTHEWS TALOR 2024235 9999999 B 10 1336569169 0 PO BOX 43230 PHOENIX AZ 850803230 20 1336569169 0 Physicians Anesthesia Services 20 1336569169 0 Physicians Healthy Kids Services 20 1336569169 0 Physicians Optical Supplies 20 1336569169 0 Physicians Physician Services 00 1336569557 0 ANDERSEN JENNIFER T 2019323 9999999 B 10 1336569557 0 29373 NETWORK PL CHICAGO IL 606733039 20 1336569557 0 Physicians Anesthesia Services 20 1336569557 0 Physicians Healthy Kids Services 20 1336569557 0 Physicians Optical Supplies 20 1336569557 0 Physicians Physician Services 00 1336572544 0 RAJU SIVASHANMUGAM 2018091 9999999 B 10 1336572544 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1336572544 0 Physicians Anesthesia Services 20 1336572544 0 Physicians Healthy Kids Services 20 1336572544 0 Physicians Optical Supplies 20 1336572544 0 Physicians Physician Services 00 1336572742 0 LICHTENFELD KIMBERLY 2016047 9999999 B 10 1336572742 0 PO BOX 781076 DETROIT MI 482781076 20 1336572742 0 Nurse Practitioners Fluoride varnish 20 1336572742 0 Nurse Practitioners Healthy Kids Services 20 1336572742 0 Nurse Practitioners Nurse Practitioners Services 20 1336572742 0 Nurse Practitioners Physician Services 00 1336573401 0 GRADY KAITLIN 2018340 9999999 B 10 1336573401 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1336573401 0 Physician Assistant Only Fluoride varnish 20 1336573401 0 Physician Assistant Only Healthy Kids Services 20 1336573401 0 Physician Assistant Only Physician Services 00 1336574383 0 THALHEIMER STEPHANIE C 2015320 9999999 B 10 1336574383 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1336574383 0 Physician Assistant Only Fluoride varnish 20 1336574383 0 Physician Assistant Only Healthy Kids Services 20 1336574383 0 Physician Assistant Only Physician Services 00 1336575562 0 ROY SHELLY A 2017172 9999999 B 10 1336575562 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1336575562 0 Clinical Social Worker Social work service 00 1336576495 0 DUNGEY EMILY L 2014269 9999999 B 10 1336576495 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1336576495 0 Other behavior health professional LCPC/LMFT services 00 1336576800 0 HEPPE MEGAN M 2017001 9999999 B 10 1336576800 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1336576800 0 Nurse Practitioners Fluoride varnish 20 1336576800 0 Nurse Practitioners Healthy Kids Services 20 1336576800 0 Nurse Practitioners Nurse Practitioners Services 20 1336576800 0 Nurse Practitioners Physician Services 00 1336576826 0 BLUME KOLLEEN A 2024254 9999999 B 10 1336576826 0 6301 N WESTERN AVE CHICAGO IL 606592009 20 1336576826 0 Clinical Social Worker LCPC/LMFT services 00 1336577741 0 LOPEZ JAMIE J 2018284 9999999 B 10 1336577741 0 8550 W BRYN MAWR AVE STE 800 SUITE 800 CHICAGO IL 606313222 20 1336577741 0 Nurse Practitioners Fluoride varnish 20 1336577741 0 Nurse Practitioners Healthy Kids Services 20 1336577741 0 Nurse Practitioners Nurse Practitioners Services 20 1336577741 0 Nurse Practitioners Physician Services 00 1336579416 0 HORGAN COLLEEN B 2016158 9999999 B 10 1336579416 0 800 E NORTHWEST HWY STE 106B MOUNT PROSPECT IL 600563457 20 1336579416 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1336579986 0 DRUMM ELIZABETH M 2014009 9999999 B 10 1336579986 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1336579986 0 Nurse Practitioners Fluoride varnish 20 1336579986 0 Nurse Practitioners Healthy Kids Services 20 1336579986 0 Nurse Practitioners Nurse Practitioners Services 20 1336579986 0 Nurse Practitioners Physician Services 00 1336580273 0 PATEL PREETI 2016225 9999999 B 10 1336580273 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1336580273 0 Physicians Anesthesia Services 20 1336580273 0 Physicians Fluoride varnish 20 1336580273 0 Physicians Healthy Kids Services 20 1336580273 0 Physicians Optical Supplies 20 1336580273 0 Physicians Physician Services 00 1336580760 0 LIN CHRISTINE 2020128 9999999 B 10 1336580760 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1336580760 0 Physicians Anesthesia Services 20 1336580760 0 Physicians Fluoride varnish 20 1336580760 0 Physicians Healthy Kids Services 20 1336580760 0 Physicians Optical Supplies 20 1336580760 0 Physicians Physician Services 00 1336581933 0 SEVERE JENNIFER 2020342 9999999 B 10 1336581933 0 3621 S STATE ST ANN ARBOR MI 481081633 20 1336581933 0 Physicians Anesthesia Services 20 1336581933 0 Physicians Healthy Kids Services 20 1336581933 0 Physicians Optical Supplies 20 1336581933 0 Physicians Physician Services 20 1336581933 0 Physicians Physicians Psychiatric Services 00 1336582485 0 BORODA KONSTANTIN 2020350 9999999 B 10 1336582485 0 3800 VENETIAN WAY NEWBURGH IN 476308257 20 1336582485 0 Physicians Anesthesia Services 20 1336582485 0 Physicians Fluoride varnish 20 1336582485 0 Physicians Healthy Kids Services 20 1336582485 0 Physicians Optical Supplies 20 1336582485 0 Physicians Physician Services 00 1336582592 0 JACKSON KARLA 2013266 9999999 B 10 1336582592 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1336582592 0 Speech Therapists Medical Supplies 20 1336582592 0 Speech Therapists Medical equipment/prosthetic devices 20 1336582592 0 Speech Therapists Speech Therapy/Pathology Services 00 1336582741 0 BROWN GINA 2018200 9999999 B 10 1336582741 0 3015 N BALLAS RD SAINT LOUIS MO 631312329 20 1336582741 0 Physicians Anesthesia Services 20 1336582741 0 Physicians Healthy Kids Services 20 1336582741 0 Physicians Optical Supplies 20 1336582741 0 Physicians Physician Services 00 1336582972 0 ZINAD SAAD M 2024242 9999999 B 10 1336582972 0 615 S NEW BALLAS RD STE 1200 SAINT LOUIS MO 631418221 20 1336582972 0 Physicians Anesthesia Services 20 1336582972 0 Physicians Fluoride varnish 20 1336582972 0 Physicians Healthy Kids Services 20 1336582972 0 Physicians Optical Supplies 20 1336582972 0 Physicians Physician Services 00 1336583079 0 MULYE ANITA D 2016245 9999999 B 10 1336583079 0 5777 DEPT CAROL STREAM IL 601220021 20 1336583079 0 Physicians Anesthesia Services 20 1336583079 0 Physicians Fluoride varnish 20 1336583079 0 Physicians Healthy Kids Services 20 1336583079 0 Physicians Optical Supplies 20 1336583079 0 Physicians Physician Services 00 1336585090 0 LOWE MICHAEL E 2019035 9999999 B 10 1336585090 0 339 CONSORT DR BALLWIN MO 630114439 20 1336585090 0 Physicians Anesthesia Services 20 1336585090 0 Physicians Healthy Kids Services 20 1336585090 0 Physicians Optical Supplies 20 1336585090 0 Physicians Physician Services 00 1336585132 0 XU LAI 2019244 9999999 B 10 1336585132 0 3701 ALGONQUIN RD STE 900 SUITE 900 ROLLING MEADOWS IL 600083193 20 1336585132 0 Physicians Anesthesia Services 20 1336585132 0 Physicians Fluoride varnish 20 1336585132 0 Physicians Healthy Kids Services 20 1336585132 0 Physicians Optical Supplies 20 1336585132 0 Physicians Physician Services 00 1336585140 0 ISHAQ MOHAMMAD A 2016194 9999999 B 10 1336585140 0 2361 PAYSPHERE CIR CHICAGO IL 606740023 20 1336585140 0 Physicians Anesthesia Services 20 1336585140 0 Physicians Healthy Kids Services 20 1336585140 0 Physicians Optical Supplies 20 1336585140 0 Physicians Physician Services 00 1336585728 0 APPLE ERYN 2016175 9999999 H 10 1336585728 0 721 N LA SALLE DR CHICAGO IL 606543503 20 1336585728 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1336585728 0 Other behavior health professional Social work service 00 1336585728 0 APPLE ERYN 2016175 9999999 B 10 1336585728 0 120 S MARION ST OAK PARK IL 603022809 20 1336585728 0 Clinical Social Worker Social work service 00 1336586734 0 SHETTY RAKSHIT 2018156 9999999 B 10 1336586734 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1336586734 0 Physicians Anesthesia Services 20 1336586734 0 Physicians Fluoride varnish 20 1336586734 0 Physicians Healthy Kids Services 20 1336586734 0 Physicians Optical Supplies 20 1336586734 0 Physicians Physician Services 00 1336586809 0 MASSA SEAN T 2018182 9999999 B 10 1336586809 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1336586809 0 Physicians Anesthesia Services 20 1336586809 0 Physicians Healthy Kids Services 20 1336586809 0 Physicians Optical Supplies 20 1336586809 0 Physicians Physician Services 00 1336587070 0 DANFORTH RACHEL 2022231 9999999 B 10 1336587070 0 545 BARNHILL DR # EH215 INDIANAPOLIS IN 462025112 20 1336587070 0 Physicians Anesthesia Services 20 1336587070 0 Physicians Healthy Kids Services 20 1336587070 0 Physicians Optical Supplies 20 1336587070 0 Physicians Physician Services 00 1336587377 0 QUINN JOSEPH W 2020160 9999999 B 10 1336587377 0 29373 NETWORK PL CHICAGO IL 606733039 20 1336587377 0 Physicians Anesthesia Services 20 1336587377 0 Physicians Fluoride varnish 20 1336587377 0 Physicians Healthy Kids Services 20 1336587377 0 Physicians Optical Supplies 20 1336587377 0 Physicians Physician Services 00 1336588342 0 DANIEL CALEB A 2016197 9999999 B 10 1336588342 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1336588342 0 Physicians Anesthesia Services 20 1336588342 0 Physicians Fluoride varnish 20 1336588342 0 Physicians Healthy Kids Services 20 1336588342 0 Physicians Optical Supplies 20 1336588342 0 Physicians Physician Services 00 1336588763 0 OESCH LINDSEY 2016308 9999999 B 10 1336588763 0 PO BOX 504469 SAINT LOUIS MO 631504469 20 1336588763 0 Physical Therapists Medical Supplies 20 1336588763 0 Physical Therapists Medical equipment/prosthetic devices 20 1336588763 0 Physical Therapists Physical Therapy Services 00 1336589118 0 ABRAHAM PRATIBHA M 2022305 9999999 B 10 1336589118 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1336589118 0 Physicians Anesthesia Services 20 1336589118 0 Physicians Fluoride varnish 20 1336589118 0 Physicians Healthy Kids Services 20 1336589118 0 Physicians Optical Supplies 20 1336589118 0 Physicians Physician Services 00 1336589225 0 THOMAS REI D 2024323 9999999 B 10 1336589225 0 1005 BROADWAY ST QUINCY IL 623012834 20 1336589225 0 Physicians Anesthesia Services 20 1336589225 0 Physicians Healthy Kids Services 20 1336589225 0 Physicians Optical Supplies 20 1336589225 0 Physicians Physician Services 00 1336589308 0 THOMPSON JON C 2022104 9999999 B 10 1336589308 0 1418 COLLEGE DR MOUNT CARMEL IL 628632638 20 1336589308 0 Physicians Anesthesia Services 20 1336589308 0 Physicians Healthy Kids Services 20 1336589308 0 Physicians Optical Supplies 20 1336589308 0 Physicians Physician Services 00 1336589480 0 TRILLO ALVAREZ LUDWIG 2017182 9999999 B 10 1336589480 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1336589480 0 Physicians Anesthesia Services 20 1336589480 0 Physicians Healthy Kids Services 20 1336589480 0 Physicians Optical Supplies 20 1336589480 0 Physicians Physician Services 20 1336589480 0 Physicians Physicians Psychiatric Services 00 1336589514 0 LEHN COLETTE A 2015237 9999999 B 10 1336589514 0 100 E LEFEVRE RD STERLING IL 610811278 20 1336589514 0 Nurse Practitioners Anesthesia Services 20 1336589514 0 Nurse Practitioners Nurse Practitioners Services 20 1336589514 0 Nurse Practitioners Physician Services 00 1336589878 0 FARRARI ANDREA B 2022009 9999999 B 10 1336589878 0 PO BOX 41220 PHOENIX AZ 850801220 20 1336589878 0 Physicians Anesthesia Services 20 1336589878 0 Physicians Healthy Kids Services 20 1336589878 0 Physicians Optical Supplies 20 1336589878 0 Physicians Physician Services 00 1336590140 0 LUDGATE MELISSA 2022052 9999999 B 10 1336590140 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1336590140 0 Physicians Anesthesia Services 20 1336590140 0 Physicians Healthy Kids Services 20 1336590140 0 Physicians Optical Supplies 20 1336590140 0 Physicians Physician Services 20 1336590140 0 Physicians Physicians Psychiatric Services 00 1336590249 0 BROWN JEFFREY 2018344 9999999 B 10 1336590249 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1336590249 0 Physicians Anesthesia Services 20 1336590249 0 Physicians Healthy Kids Services 20 1336590249 0 Physicians Optical Supplies 20 1336590249 0 Physicians Physician Services 00 1336591502 0 MRAZ CHRISTINA D 2018032 9999999 B 10 1336591502 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1336591502 0 Nurse Practitioners Healthy Kids Services 20 1336591502 0 Nurse Practitioners Nurse Practitioners Services 20 1336591502 0 Nurse Practitioners Physician Services 00 1336591759 0 SHAIKH HIRA 2022264 9999999 B 10 1336591759 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1336591759 0 Physicians Anesthesia Services 20 1336591759 0 Physicians Fluoride varnish 20 1336591759 0 Physicians Healthy Kids Services 20 1336591759 0 Physicians Optical Supplies 20 1336591759 0 Physicians Physician Services 00 1336593649 0 SALEM MOHAMMED N 2022314 9999999 B 10 1336593649 0 PO BOX 43230 PHOENIX AZ 850803230 20 1336593649 0 Physicians Anesthesia Services 20 1336593649 0 Physicians Fluoride varnish 20 1336593649 0 Physicians Healthy Kids Services 20 1336593649 0 Physicians Optical Supplies 20 1336593649 0 Physicians Physician Services 00 1336594209 0 MOELLER ASHLEY A 2021298 9999999 B 10 1336594209 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1336594209 0 Physicians Anesthesia Services 20 1336594209 0 Physicians Healthy Kids Services 20 1336594209 0 Physicians Optical Supplies 20 1336594209 0 Physicians Physician Services 20 1336594209 0 Physicians Physicians Psychiatric Services 00 1336594555 0 SARVER JANET 2017262 9999999 B 10 1336594555 0 PO BOX 504469 SAINT LOUIS MO 631504469 20 1336594555 0 Physical Therapists Medical Supplies 20 1336594555 0 Physical Therapists Medical equipment/prosthetic devices 20 1336594555 0 Physical Therapists Physical Therapy Services 00 1336594910 0 LELCHUK ALEXANDRA 2019227 9999999 B 10 1336594910 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1336594910 0 Physicians Anesthesia Services 20 1336594910 0 Physicians Healthy Kids Services 20 1336594910 0 Physicians Optical Supplies 20 1336594910 0 Physicians Physician Services 00 1336595123 0 YAN JERRY 2022256 9999999 B 10 1336595123 0 PO BOX 268 FREEPORT IL 610320268 20 1336595123 0 Physicians Anesthesia Services 20 1336595123 0 Physicians Fluoride varnish 20 1336595123 0 Physicians Healthy Kids Services 20 1336595123 0 Physicians Optical Supplies 20 1336595123 0 Physicians Physician Services 00 1336595974 0 ARWIKAR DEV 2025015 9999999 B 10 1336595974 0 PO BOX 208807 DALLAS TX 753208807 20 1336595974 0 Physicians Anesthesia Services 20 1336595974 0 Physicians Healthy Kids Services 20 1336595974 0 Physicians Optical Supplies 20 1336595974 0 Physicians Physician Services 00 1336596568 0 NAVID ARANDI 2023258 9999999 B 10 1336596568 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1336596568 0 Physicians Anesthesia Services 20 1336596568 0 Physicians Healthy Kids Services 20 1336596568 0 Physicians Optical Supplies 20 1336596568 0 Physicians Physician Services 00 1336597525 0 HOFFMAN AMANDA L 2019212 9999999 B 10 1336597525 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1336597525 0 Physicians Anesthesia Services 20 1336597525 0 Physicians Fluoride varnish 20 1336597525 0 Physicians Healthy Kids Services 20 1336597525 0 Physicians Optical Supplies 20 1336597525 0 Physicians Physician Services 00 1336597954 0 CHATTERTON ALICIA L 2016197 9999999 B 10 1336597954 0 671 S LEWIS AVE WAUKEGAN IL 600856101 20 1336597954 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1336598226 0 GREENBLATT ADAM S 2022181 9999999 B 10 1336598226 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1336598226 0 Physicians Anesthesia Services 20 1336598226 0 Physicians Healthy Kids Services 20 1336598226 0 Physicians Optical Supplies 20 1336598226 0 Physicians Physician Services 20 1336598226 0 Physicians Physicians Psychiatric Services 00 1336599240 0 FOSTER CATHERINE D 2019280 9999999 B 10 1336599240 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1336599240 0 Physicians Anesthesia Services 20 1336599240 0 Physicians Healthy Kids Services 20 1336599240 0 Physicians Optical Supplies 20 1336599240 0 Physicians Physician Services 00 1336599869 0 LEE JOHN L 2018162 9999999 B 10 1336599869 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1336599869 0 Physicians Anesthesia Services 20 1336599869 0 Physicians Fluoride varnish 20 1336599869 0 Physicians Healthy Kids Services 20 1336599869 0 Physicians Optical Supplies 20 1336599869 0 Physicians Physician Services 00 1336600238 0 KURAPEY ANNA 2020026 9999999 B 10 1336600238 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1336600238 0 Physicians Anesthesia Services 20 1336600238 0 Physicians Healthy Kids Services 20 1336600238 0 Physicians Optical Supplies 20 1336600238 0 Physicians Physician Services 20 1336600238 0 Physicians Physicians Psychiatric Services 00 1336600469 0 PATEL KEVAL A 2022213 9999999 B 10 1336600469 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1336600469 0 Physicians Anesthesia Services 20 1336600469 0 Physicians Fluoride varnish 20 1336600469 0 Physicians Healthy Kids Services 20 1336600469 0 Physicians Optical Supplies 20 1336600469 0 Physicians Physician Services 00 1336600972 0 DONG KEVIN 2020069 9999999 B 10 1336600972 0 29373 NETWORK PL CHICAGO IL 606733039 20 1336600972 0 Physicians Anesthesia Services 20 1336600972 0 Physicians Healthy Kids Services 20 1336600972 0 Physicians Optical Supplies 20 1336600972 0 Physicians Physician Services 00 1336601244 0 COSICO MAILA CHARINA D 2020043 9999999 B 10 1336601244 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1336601244 0 Nurse Practitioners Healthy Kids Services 20 1336601244 0 Nurse Practitioners Nurse Practitioners Services 20 1336601244 0 Nurse Practitioners Physician Services 00 1336601251 0 EJIOGU HELEN 2024229 9999999 B 10 1336601251 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1336601251 0 Physicians Anesthesia Services 20 1336601251 0 Physicians Healthy Kids Services 20 1336601251 0 Physicians Optical Supplies 20 1336601251 0 Physicians Physician Services 00 1336601525 0 WEITZNER SANDRA 2020029 9999999 B 10 1336601525 0 29373 NETWORK PL CHICAGO IL 606733039 20 1336601525 0 Physicians Anesthesia Services 20 1336601525 0 Physicians Fluoride varnish 20 1336601525 0 Physicians Healthy Kids Services 20 1336601525 0 Physicians Optical Supplies 20 1336601525 0 Physicians Physician Services 00 1336602267 0 MITCHELL CHRISTOPHER D 2019284 9999999 B 10 1336602267 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1336602267 0 Nurse Practitioners Anesthesia Services 20 1336602267 0 Nurse Practitioners Nurse Practitioners Services 20 1336602267 0 Nurse Practitioners Physician Services 00 1336602481 0 SUN TIANLIN 2019182 9999999 B 10 1336602481 0 5777 DEPT CAROL STREAM IL 601220021 20 1336602481 0 Physicians Anesthesia Services 20 1336602481 0 Physicians Fluoride varnish 20 1336602481 0 Physicians Healthy Kids Services 20 1336602481 0 Physicians Optical Supplies 20 1336602481 0 Physicians Physician Services 00 1336602705 0 VARMA AMRITA 2021068 9999999 B 10 1336602705 0 4101 MAIN ST SKOKIE IL 600762753 20 1336602705 0 Nurse Practitioners Healthy Kids Services 20 1336602705 0 Nurse Practitioners Nurse Practitioners Services 20 1336602705 0 Nurse Practitioners Physician Services 00 1336602994 0 SWEIS DEANNA 2019182 9999999 B 10 1336602994 0 4201 W 93RD ST OAK LAWN IL 604531998 20 1336602994 0 Speech Therapists Medical Supplies 20 1336602994 0 Speech Therapists Medical equipment/prosthetic devices 20 1336602994 0 Speech Therapists Speech Therapy/Pathology Services 00 1336603174 0 MURGLIN JESSICA 2019221 9999999 B 10 1336603174 0 29373 NETWORK PL CHICAGO IL 606733039 20 1336603174 0 Nurse Practitioners Fluoride varnish 20 1336603174 0 Nurse Practitioners Healthy Kids Services 20 1336603174 0 Nurse Practitioners Nurse Practitioners Services 20 1336603174 0 Nurse Practitioners Physician Services 00 1336604370 0 WILLIS MELODY K 2019136 9999999 B 10 1336604370 0 15740 S OUTER 40 RD CHESTERFIELD MO 630172004 20 1336604370 0 Nurse Practitioners Healthy Kids Services 20 1336604370 0 Nurse Practitioners Nurse Practitioners Services 20 1336604370 0 Nurse Practitioners Physician Services 00 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IL 606143033 20 1336605757 0 Audiologists Audiology Services 20 1336605757 0 Audiologists Medical Supplies 20 1336605757 0 Audiologists Medical equipment/prosthetic devices 00 1336605948 0 FRUSH BRITTANY R 2019121 9999999 B 10 1336605948 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1336605948 0 Physician Assistant Only Fluoride varnish 20 1336605948 0 Physician Assistant Only Healthy Kids Services 20 1336605948 0 Physician Assistant Only Physician Services 00 1336608165 0 USMAIEL IFREAH 2023348 9999999 B 10 1336608165 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1336608165 0 Physicians Anesthesia Services 20 1336608165 0 Physicians Fluoride varnish 20 1336608165 0 Physicians Healthy Kids Services 20 1336608165 0 Physicians Optical Supplies 20 1336608165 0 Physicians Physician Services 00 1336608322 0 BALUSU SREE 2019182 9999999 B 10 1336608322 0 PO BOX 957103 HOFFMAN ESTATES IL 601957103 20 1336608322 0 Physicians Anesthesia Services 20 1336608322 0 Physicians Fluoride varnish 20 1336608322 0 Physicians Healthy Kids Services 20 1336608322 0 Physicians Optical Supplies 20 1336608322 0 Physicians Physician Services 00 1336608884 0 SLACH NATALIE R 2019093 9999999 B 10 1336608884 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1336608884 0 Physician Assistant Only Fluoride varnish 20 1336608884 0 Physician Assistant Only Healthy Kids Services 20 1336608884 0 Physician Assistant Only Physician Services 00 1336609056 0 ROBINSON IYESHA R 2022192 9999999 B 10 1336609056 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1336609056 0 Physicians Anesthesia Services 20 1336609056 0 Physicians Fluoride varnish 20 1336609056 0 Physicians Healthy Kids Services 20 1336609056 0 Physicians Optical Supplies 20 1336609056 0 Physicians Physician Services 00 1336609494 0 BHARDWAJ NEHARIKA 2022208 9999999 B 10 1336609494 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1336609494 0 Physicians Anesthesia Services 20 1336609494 0 Physicians Fluoride varnish 20 1336609494 0 Physicians Healthy Kids Services 20 1336609494 0 Physicians Optical Supplies 20 1336609494 0 Physicians Physician Services 00 1336609890 0 SHAMS YARA E 2019261 9999999 B 10 1336609890 0 29373 NETWORK PL CHICAGO IL 606733039 20 1336609890 0 Physicians Anesthesia Services 20 1336609890 0 Physicians Fluoride varnish 20 1336609890 0 Physicians Healthy Kids Services 20 1336609890 0 Physicians Optical Supplies 20 1336609890 0 Physicians Physician Services 00 1336612449 0 FARES MALAK 2025056 9999999 B 10 1336612449 0 5741 W CERMAK RD CICERO IL 608042129 20 1336612449 0 Physician Assistant Only Fluoride varnish 20 1336612449 0 Physician Assistant Only Healthy Kids Services 20 1336612449 0 Physician Assistant Only Physician Services 00 1336612738 0 ADAMS BRIDGET F 2019094 9999999 B 10 1336612738 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1336612738 0 Physician Assistant Only Electronic Home Response/EHR Installation, MPE Certification 20 1336612738 0 Physician Assistant Only Fluoride varnish 20 1336612738 0 Physician Assistant Only Healthy Kids Services 20 1336612738 0 Physician Assistant Only Physician Services 00 1336614676 0 SAFRANSKI ARIKA C 2018285 9999999 B 10 1336614676 0 4909 N GLEN PARK PLACE RD PEORIA IL 616144676 20 1336614676 0 Nurse Practitioners Fluoride varnish 20 1336614676 0 Nurse Practitioners Healthy Kids Services 20 1336614676 0 Nurse Practitioners Nurse Practitioners Services 20 1336614676 0 Nurse Practitioners Physician Services 00 1336614882 0 MENICH ASHLEY M 2018347 9999999 B 10 1336614882 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1336614882 0 Physician Assistant Only Fluoride varnish 20 1336614882 0 Physician Assistant Only Healthy Kids Services 20 1336614882 0 Physician Assistant Only Physician Services 00 1336615186 0 SHAH NIKHAR 2019007 2099365 B 10 1336615186 0 510 AUBURN DR STE D ISLAND LAKE IL 600429105 20 1336615186 0 Dentists Dental Services 20 1336615186 0 Dentists Physician Services 00 1336617364 0 SCHMIDT NICOLE R 2023067 9999999 B 10 1336617364 0 203 E THROP ST TROY IL 622941231 20 1336617364 0 Speech Therapists Medical Supplies 20 1336617364 0 Speech Therapists Medical equipment/prosthetic devices 20 1336617364 0 Speech Therapists Speech Therapy/Pathology Services 00 1336618479 0 THOMAS CHRISTOPHER R 2018352 9999999 B 10 1336618479 0 PO BOX 3276 EVANSVILLE IN 477313276 20 1336618479 0 Nurse Practitioners Anesthesia Services 20 1336618479 0 Nurse Practitioners Nurse Practitioners Services 20 1336618479 0 Nurse Practitioners Physician Services 00 1336619188 0 GILES SUTARA M 2018365 9999999 B 10 1336619188 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1336619188 0 Registered nurse Nursing service 20 1336619188 0 Registered nurse Waiver service 00 1336619782 0 FARAONE MINDY MARIE 2019034 9999999 B 10 1336619782 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1336619782 0 Nurse Practitioners Fluoride varnish 20 1336619782 0 Nurse Practitioners Healthy Kids Services 20 1336619782 0 Nurse Practitioners Nurse Practitioners Services 20 1336619782 0 Nurse Practitioners Physician Services 00 1336620087 0 CARROLL ALYCIA 2018234 9999999 B 10 1336620087 0 275 S UNIVERSITY ST 211 RACHEL COOPER CAMPUS BOX 4 NORMAL IL 617904720 20 1336620087 0 Speech Therapists Medical Supplies 20 1336620087 0 Speech Therapists Medical equipment/prosthetic devices 20 1336620087 0 Speech Therapists Speech Therapy/Pathology Services 00 1336621028 0 NEBEL MICHELLE 2019158 9999999 B 10 1336621028 0 PO BOX 809094 CHICAGO IL 606809094 20 1336621028 0 Audiologists Audiology Services 20 1336621028 0 Audiologists Medical Supplies 20 1336621028 0 Audiologists Medical equipment/prosthetic devices 00 1336621713 0 STUMPP KARLA L 2022319 9999999 B 10 1336621713 0 1000 N OAK AVE MARSHFIELD WI 544495703 20 1336621713 0 Nurse Practitioners Fluoride varnish 20 1336621713 0 Nurse Practitioners Healthy Kids Services 20 1336621713 0 Nurse Practitioners Nurse Practitioners Services 20 1336621713 0 Nurse Practitioners Physician Services 00 1336622836 0 HAGERTY ASHLEY 2022027 9999999 B 10 1336622836 0 PO BOX 850 METROPOLIS IL 629600850 20 1336622836 0 Physician Assistant Only Fluoride varnish 20 1336622836 0 Physician Assistant Only Healthy Kids Services 20 1336622836 0 Physician Assistant Only Physician Services 00 1336623545 0 SINGLEY DAWN 2018257 9999999 B 10 1336623545 0 421 W EXCHANGE ST FREEPORT IL 610324008 20 1336623545 0 Registered nurse Nursing service 20 1336623545 0 Registered nurse Waiver service 00 1336623917 0 IBANEZ FAYE GANDEZA 2018334 9999999 B 10 1336623917 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1336623917 0 Nurse Practitioners Fluoride varnish 20 1336623917 0 Nurse Practitioners Healthy Kids Services 20 1336623917 0 Nurse Practitioners Nurse Practitioners Services 20 1336623917 0 Nurse Practitioners Physician Services 00 1336624196 0 BOWSER NICOLE M 2018305 9999999 B 10 1336624196 0 5665 NEW NORTHSIDE DR STE 320 ATLANTA GA 303285834 20 1336624196 0 Nurse Practitioners Fluoride varnish 20 1336624196 0 Nurse Practitioners Healthy Kids Services 20 1336624196 0 Nurse Practitioners Nurse Practitioners Services 20 1336624196 0 Nurse Practitioners Physician Services 00 1336624816 0 QUIGLEY REBECCA 2021260 9999999 B 10 1336624816 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1336624816 0 Speech Therapists Medical Supplies 20 1336624816 0 Speech Therapists Medical equipment/prosthetic devices 20 1336624816 0 Speech Therapists Speech Therapy/Pathology Services 00 1336625169 0 KAROVIC TATJANA 2019179 9999999 B 10 1336625169 0 409 W OGDEN AVE WESTMONT IL 605591421 20 1336625169 0 Optometrists Optical Supplies 20 1336625169 0 Optometrists Optometric Services 20 1336625169 0 Optometrists Physician Services 00 1336625383 0 CUMMINS HEIDI 2018208 9999999 B 10 1336625383 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1336625383 0 Physical Therapists Medical Supplies 20 1336625383 0 Physical Therapists Medical equipment/prosthetic devices 20 1336625383 0 Physical Therapists Physical Therapy Services 00 1336626274 0 SIDDIQUI MARYAM 2018205 9999999 B 10 1336626274 0 1642 E BARBERRY LN MOUNT PROSPECT IL 600561512 20 1336626274 0 Occupational Therapists Medical Supplies 20 1336626274 0 Occupational Therapists Medical equipment/prosthetic devices 20 1336626274 0 Occupational Therapists Occupational Therapy Services 00 1336626597 0 COFFEY MELISSA 2021307 9999999 B 10 1336626597 0 55 E JACKSON BLVD STE 1500 CHICAGO IL 606044184 20 1336626597 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1336626738 0 NEWBY JESSICA 2018305 9999999 B 10 1336626738 0 904 M L KING DR CENTRALIA IL 628013058 20 1336626738 0 Nurse Practitioners Fluoride varnish 20 1336626738 0 Nurse Practitioners Healthy Kids Services 20 1336626738 0 Nurse Practitioners Nurse Practitioners Services 20 1336626738 0 Nurse Practitioners Physician Services 00 1336626910 0 GUSS ADAM J 2020028 9999999 B 10 1336626910 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1336626910 0 Physician Assistant Only Fluoride varnish 20 1336626910 0 Physician Assistant Only Healthy Kids Services 20 1336626910 0 Physician Assistant Only Physician Services 00 1336627165 0 BRATKO LANA 2020181 9999999 B 10 1336627165 0 3880 SALEM LAKE DR STE F LONG GROVE IL 600475292 20 1336627165 0 Nurse Practitioners Healthy Kids Services 20 1336627165 0 Nurse Practitioners Nurse Practitioners Services 20 1336627165 0 Nurse Practitioners Physician Services 00 1336627348 0 STUMPF NICHOLE C 2018274 9999999 B 10 1336627348 0 1467 N ELSTON AVE STE 103 CHICAGO IL 606422449 20 1336627348 0 Speech Therapists Medical Supplies 20 1336627348 0 Speech Therapists Medical equipment/prosthetic devices 20 1336627348 0 Speech Therapists Speech Therapy/Pathology Services 00 1336628247 0 CRANK ELIZABETH N 2020273 9999999 B 10 1336628247 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1336628247 0 Nurse Practitioners Healthy Kids Services 20 1336628247 0 Nurse Practitioners Nurse Practitioners Services 20 1336628247 0 Nurse Practitioners Physician Services 00 1336631100 0 STREET JASMIN E 2018159 9999999 B 10 1336631100 0 6501 S PROMONTORY DR CHICAGO IL 606491003 20 1336631100 0 Nurse Practitioners Fluoride varnish 20 1336631100 0 Nurse Practitioners Healthy Kids Services 20 1336631100 0 Nurse Practitioners Nurse Practitioners Services 20 1336631100 0 Nurse Practitioners Physician Services 00 1336631803 0 CURTA ANA 2021224 9999999 B 10 1336631803 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1336631803 0 Physicians Anesthesia Services 20 1336631803 0 Physicians Healthy Kids Services 20 1336631803 0 Physicians Optical Supplies 20 1336631803 0 Physicians Physician Services 20 1336631803 0 Physicians Physicians Psychiatric Services 00 1336631910 0 BURNS LUKE P 2023151 9999999 B 10 1336631910 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1336631910 0 Physicians Anesthesia Services 20 1336631910 0 Physicians Healthy Kids Services 20 1336631910 0 Physicians Optical Supplies 20 1336631910 0 Physicians Physician Services 00 1336632934 0 SULTAN FARAZ A 2019111 9999999 B 10 1336632934 0 8311 ROOSEVELT RD FOREST PARK IL 601302529 20 1336632934 0 Physicians Anesthesia Services 20 1336632934 0 Physicians Healthy Kids Services 20 1336632934 0 Physicians Optical Supplies 20 1336632934 0 Physicians Physician Services 20 1336632934 0 Physicians Physicians Psychiatric Services 00 1336633197 0 GUESS SARAH 2024205 9999999 B 10 1336633197 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1336633197 0 Physicians Anesthesia Services 20 1336633197 0 Physicians Healthy Kids Services 20 1336633197 0 Physicians Optical Supplies 20 1336633197 0 Physicians Physician Services 00 1336633312 0 WHITE MEGAN 2019277 9999999 B 10 1336633312 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1336633312 0 Physicians Anesthesia Services 20 1336633312 0 Physicians Fluoride varnish 20 1336633312 0 Physicians Healthy Kids Services 20 1336633312 0 Physicians Optical Supplies 20 1336633312 0 Physicians Physician Services 00 1336633494 0 SCHKLAR ALLISON 2019305 9999999 B 10 1336633494 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1336633494 0 Audiologists Audiology Services 20 1336633494 0 Audiologists Medical Supplies 20 1336633494 0 Audiologists Medical equipment/prosthetic devices 00 1336633908 0 WRIGHT ALEC 2019303 9999999 B 10 1336633908 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1336633908 0 Physicians Anesthesia Services 20 1336633908 0 Physicians Healthy Kids Services 20 1336633908 0 Physicians Optical Supplies 20 1336633908 0 Physicians Physician Services 00 1336634179 0 GROSVENOR MOLLY 2018182 9999999 B 10 1336634179 0 5777 DEPT CAROL STREAM IL 601228942 20 1336634179 0 Nurse Practitioners Fluoride varnish 20 1336634179 0 Nurse Practitioners Healthy Kids Services 20 1336634179 0 Nurse Practitioners Nurse Practitioners Services 20 1336634179 0 Nurse Practitioners Physician Services 00 1336634237 0 WEBER NICHOLAS 2019262 9999999 B 10 1336634237 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1336634237 0 Physicians Anesthesia Services 20 1336634237 0 Physicians Fluoride varnish 20 1336634237 0 Physicians Healthy Kids Services 20 1336634237 0 Physicians Optical Supplies 20 1336634237 0 Physicians Physician Services 00 1336634500 0 MWANGI MARTIN K 2018182 9999999 B 10 1336634500 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1336634500 0 Physicians Anesthesia Services 20 1336634500 0 Physicians Fluoride varnish 20 1336634500 0 Physicians Healthy Kids Services 20 1336634500 0 Physicians Optical Supplies 20 1336634500 0 Physicians Physician Services 00 1336634591 0 MARTIS ANOKA S 2021200 9999999 B 10 1336634591 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1336634591 0 Physicians Anesthesia Services 20 1336634591 0 Physicians Fluoride varnish 20 1336634591 0 Physicians Healthy Kids Services 20 1336634591 0 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Physician Services 00 1336639723 0 RICHESON ABBEY 2020156 9999999 B 10 1336639723 0 42 W MADISON ST FL 2 CHICAGO IL 606024309 20 1336639723 0 Speech Therapists Medical Supplies 20 1336639723 0 Speech Therapists Medical equipment/prosthetic devices 20 1336639723 0 Speech Therapists Speech Therapy/Pathology Services 00 1336640036 0 CRUZ SUZANNE 1999315 9999999 B 10 1336640036 0 2115 CRYSTAL LAKE RD CARY IL 600131426 20 1336640036 0 Physical Therapists Medical Supplies 20 1336640036 0 Physical Therapists Medical equipment/prosthetic devices 20 1336640036 0 Physical Therapists Physical Therapy Services 00 1336640366 0 STUECK MACKENZIE 2021308 9999999 B 10 1336640366 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1336640366 0 Physician Assistant Only Fluoride varnish 20 1336640366 0 Physician Assistant Only Healthy Kids Services 20 1336640366 0 Physician Assistant Only Physician Services 00 1336640713 0 LIU CHRISTOPHER 2019351 9999999 B 10 1336640713 0 500 W RIVER DR DAVENPORT IA 528011014 20 1336640713 0 Dentists Dental Services 20 1336640713 0 Dentists Physician Services 00 1336641521 0 CONKLIN LUKE 2020213 9999999 B 10 1336641521 0 2041 GOOSE LAKE RD SAUGET IL 622062822 20 1336641521 0 Physicians Anesthesia Services 20 1336641521 0 Physicians Fluoride varnish 20 1336641521 0 Physicians Healthy Kids Services 20 1336641521 0 Physicians Optical Supplies 20 1336641521 0 Physicians Physician Services 00 1336642743 0 KUSS DEVAN G 2018087 9999999 B 10 1336642743 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1336642743 0 Occupational Therapists Medical Supplies 20 1336642743 0 Occupational Therapists Medical equipment/prosthetic devices 20 1336642743 0 Occupational Therapists Occupational Therapy Services 00 1336642867 0 ROVEY CHRISTINA 2018112 9999999 B 10 1336642867 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1336642867 0 Nurse Practitioners Fluoride varnish 20 1336642867 0 Nurse Practitioners Healthy Kids Services 20 1336642867 0 Nurse Practitioners Nurse Practitioners Services 20 1336642867 0 Nurse Practitioners Physician Services 00 1336643022 0 PARIKH RUPIN 2023184 9999999 B 10 1336643022 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1336643022 0 Physicians Anesthesia Services 20 1336643022 0 Physicians Healthy Kids Services 20 1336643022 0 Physicians Optical Supplies 20 1336643022 0 Physicians Physician Services 00 1336643329 0 PASARET ALEJANDRO 2018200 9999999 B 10 1336643329 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1336643329 0 Physicians Anesthesia Services 20 1336643329 0 Physicians Fluoride varnish 20 1336643329 0 Physicians Healthy Kids Services 20 1336643329 0 Physicians Optical Supplies 20 1336643329 0 Physicians Physician Services 00 1336644079 0 LEHMAN BRANDY S 2018152 9999999 B 10 1336644079 0 69 W BAILEY RD NAPERVILLE IL 605652346 20 1336644079 0 Nurse Practitioners Healthy Kids Services 20 1336644079 0 Nurse Practitioners Nurse Practitioners Services 20 1336644079 0 Nurse Practitioners Physician Services 00 1336644087 0 HOLVERSON AARON 2018085 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1336776103 0 Physicians Physician Services 00 1336776475 0 BLOOMBERG LAUREN 2020218 9999999 B 10 1336776475 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1336776475 0 Physicians Anesthesia Services 20 1336776475 0 Physicians Fluoride varnish 20 1336776475 0 Physicians Healthy Kids Services 20 1336776475 0 Physicians Optical Supplies 20 1336776475 0 Physicians Physician Services 00 1336776517 0 ANDERSON BRADEN 2021187 9999999 B 10 1336776517 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1336776517 0 Physicians Anesthesia Services 20 1336776517 0 Physicians Healthy Kids Services 20 1336776517 0 Physicians Optical Supplies 20 1336776517 0 Physicians Physician Services 00 1336776558 0 STELLA CHRISTINE 2020237 9999999 B 10 1336776558 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1336776558 0 Physicians Anesthesia Services 20 1336776558 0 Physicians Fluoride varnish 20 1336776558 0 Physicians Healthy Kids Services 20 1336776558 0 Physicians Optical Supplies 20 1336776558 0 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1336777325 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1336777325 0 Physicians Anesthesia Services 20 1336777325 0 Physicians Fluoride varnish 20 1336777325 0 Physicians Healthy Kids Services 20 1336777325 0 Physicians Optical Supplies 20 1336777325 0 Physicians Physician Services 00 1336777515 0 ROBERTS PAULA L 2020101 9999999 B 10 1336777515 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1336777515 0 Nurse Practitioners Fluoride varnish 20 1336777515 0 Nurse Practitioners Healthy Kids Services 20 1336777515 0 Nurse Practitioners Nurse Practitioners Services 20 1336777515 0 Nurse Practitioners Physician Services 00 1336777879 0 KHALYFA AHAMED 2020182 9999999 B 10 1336777879 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1336777879 0 Physicians Anesthesia Services 20 1336777879 0 Physicians Fluoride varnish 20 1336777879 0 Physicians Healthy Kids Services 20 1336777879 0 Physicians Optical Supplies 20 1336777879 0 Physicians Physician Services 00 1336778059 0 DIXON HARMONY B 2024018 9999999 B 10 1336778059 0 PO BOX 43230 PHOENIX AZ 850803230 20 1336778059 0 Physicians Anesthesia Services 20 1336778059 0 Physicians Fluoride varnish 20 1336778059 0 Physicians Healthy Kids Services 20 1336778059 0 Physicians Optical Supplies 20 1336778059 0 Physicians Physician Services 00 1336778273 0 DANIELS JEFFREY 2023277 9999999 B 10 1336778273 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1336778273 0 Physicians Anesthesia Services 20 1336778273 0 Physicians Fluoride varnish 20 1336778273 0 Physicians Healthy Kids Services 20 1336778273 0 Physicians Optical Supplies 20 1336778273 0 Physicians Physician Services 00 1336779487 0 SHAH KHUSHBOO M 2022361 9999999 B 10 1336779487 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1336779487 0 Physician Assistant Only Fluoride varnish 20 1336779487 0 Physician Assistant Only Healthy Kids Services 20 1336779487 0 Physician Assistant Only Physician Services 00 1336780121 0 BOE MEREDITH A 2019289 9999999 B 10 1336780121 0 225 E CHICAGO AVE 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Practitioners Physician Services 00 1336818145 0 OBETKOVSKA JULIJANA 2022251 9999999 B 10 1336818145 0 PO BOX 775342 CHICAGO IL 606775342 20 1336818145 0 Nurse Practitioners Fluoride varnish 20 1336818145 0 Nurse Practitioners Healthy Kids Services 20 1336818145 0 Nurse Practitioners Nurse Practitioners Services 20 1336818145 0 Nurse Practitioners Physician Services 00 1336818533 0 STIMMEL JACOB E 2022298 9999999 B 10 1336818533 0 1250 E US HIGHWAY 36 TUSCOLA IL 619538020 20 1336818533 0 Dentists Dental Services 20 1336818533 0 Dentists Physician Services 00 1336818665 0 IBRAHIM MOSTAFA A 2024213 9999999 B 10 1336818665 0 4953 W FULLERTON AVE CHICAGO IL 606392505 20 1336818665 0 Dentists Dental Services 20 1336818665 0 Dentists Physician Services 00 1336821537 0 MONAGHAN PATRICIA ANNE 2023265 9999999 B 10 1336821537 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1336821537 0 Nurse Practitioners Fluoride varnish 20 1336821537 0 Nurse Practitioners Healthy Kids Services 20 1336821537 0 Nurse Practitioners Nurse Practitioners Services 20 1336821537 0 Nurse Practitioners Physician Services 00 1336821818 0 BULGRIN BETHANY K 2023241 9999999 B 10 1336821818 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1336821818 0 Nurse Practitioners Healthy Kids Services 20 1336821818 0 Nurse Practitioners Nurse Practitioners Services 20 1336821818 0 Nurse Practitioners Physician Services 00 1336822733 0 OH YOUJIN 2023241 9999999 B 10 1336822733 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1336822733 0 Physicians Anesthesia Services 20 1336822733 0 Physicians Fluoride varnish 20 1336822733 0 Physicians Healthy Kids Services 20 1336822733 0 Physicians Optical Supplies 20 1336822733 0 Physicians Physician Services 00 1336823962 0 STERN LAUREN 2023193 9999999 B 10 1336823962 0 5730 W ROOSEVELT RD CHICAGO IL 606441580 20 1336823962 0 Clinical Social Worker Social work service 00 1336824028 0 AUSMUS ATROUS 2023304 9999999 B 10 1336824028 0 684 S BARRINGTON RD STE 112 STREAMWOOD IL 601071841 20 1336824028 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1336824481 0 WYNN RAINA 2023170 9999999 B 10 1336824481 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1336824481 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1336826486 0 STA MARIA JOSEPH JR 2024144 2026181 B 10 1336826486 0 6420 CLAYTON RD SAINT LOUIS MO 631171811 20 1336826486 0 Physicians Anesthesia Services 20 1336826486 0 Physicians Fluoride varnish 20 1336826486 0 Physicians Healthy Kids Services 20 1336826486 0 Physicians Optical Supplies 20 1336826486 0 Physicians Physician Services 00 1336827823 0 ALLEN LEAH 2023198 9999999 B 10 1336827823 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1336827823 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1336829035 0 MONTAGUE ANNA 2024295 9999999 B 10 1336829035 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1336829035 0 Nurse Practitioners Fluoride varnish 20 1336829035 0 Nurse Practitioners Healthy Kids Services 20 1336829035 0 Nurse Practitioners Nurse Practitioners Services 20 1336829035 0 Nurse Practitioners Physician Services 00 1336829431 0 LEE SUNYANG 2024215 9999999 B 10 1336829431 0 6742 N FROSTWOOD PKWY PEORIA IL 616152402 20 1336829431 0 Nurse Practitioners Anesthesia Services 20 1336829431 0 Nurse Practitioners Nurse Practitioners Services 20 1336829431 0 Nurse Practitioners Physician Services 00 1336830199 0 BRAVOS ANASTASIA R 2023138 9999999 B 10 1336830199 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1336830199 0 Physician Assistant Only Fluoride varnish 20 1336830199 0 Physician Assistant Only Healthy Kids Services 20 1336830199 0 Physician Assistant Only Physician Services 00 1336830272 0 FAROOQI MUSTAFA S 2023167 9999999 B 10 1336830272 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1336830272 0 Physicians Anesthesia Services 20 1336830272 0 Physicians Healthy Kids Services 20 1336830272 0 Physicians Optical Supplies 20 1336830272 0 Physicians Physician Services 00 1336830561 0 DARE VICTORIA 2023166 9999999 B 10 1336830561 0 PO BOX 428 HARRISBURG IL 629460428 20 1336830561 0 Nurse Practitioners Healthy Kids Services 20 1336830561 0 Nurse Practitioners Nurse Practitioners Services 20 1336830561 0 Nurse Practitioners Physician Services 00 1336830652 0 MAURER KAHLA 2023180 9999999 B 10 1336830652 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1336830652 0 Nurse Practitioners Fluoride varnish 20 1336830652 0 Nurse Practitioners Healthy Kids Services 20 1336830652 0 Nurse Practitioners Nurse Practitioners Services 20 1336830652 0 Nurse Practitioners Physician Services 00 1336830918 0 UTLEY JUSTIN E 2023307 9999999 B 10 1336830918 0 2202 HARLEM RD LOVES PARK IL 611112754 20 1336830918 0 Nurse Practitioners Anesthesia Services 20 1336830918 0 Nurse Practitioners Nurse Practitioners Services 20 1336830918 0 Nurse Practitioners Physician Services 00 1336831684 0 TOMPKIN EMILY L 2023163 9999999 B 10 1336831684 0 1101 31ST ST STE 110 DOWNERS GROVE IL 605155562 20 1336831684 0 Physical Therapists Medical Supplies 20 1336831684 0 Physical Therapists Medical equipment/prosthetic devices 20 1336831684 0 Physical Therapists Physical Therapy Services 00 1336832500 0 MAGEE DAISY 2023274 9999999 B 10 1336832500 0 2100 POWELL ST STE 400 EMERYVILLE CA 946081826 20 1336832500 0 Physician Assistant Only Fluoride varnish 20 1336832500 0 Physician Assistant Only Healthy Kids Services 20 1336832500 0 Physician Assistant Only Physician Services 00 1336832880 0 HEIMAN SHAELIN A 2024346 9999999 B 10 1336832880 0 PO BOX 328 EVANSVILLE IN 477020328 20 1336832880 0 Physician Assistant Only Fluoride varnish 20 1336832880 0 Physician Assistant Only Healthy Kids Services 20 1336832880 0 Physician Assistant Only Physician Services 00 1336834043 0 DUBOIS ASHLEY M 2023188 9999999 B 10 1336834043 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1336834043 0 Nurse Practitioners Anesthesia Services 20 1336834043 0 Nurse Practitioners Nurse Practitioners Services 20 1336834043 0 Nurse Practitioners Physician Services 00 1336834431 0 MCGUIRE ANTHONY 2023277 9999999 B 10 1336834431 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1336834431 0 Physicians Anesthesia Services 20 1336834431 0 Physicians Healthy Kids Services 20 1336834431 0 Physicians Optical Supplies 20 1336834431 0 Physicians Physician Services 00 1336834688 0 AMPATEY NICOLE 2023192 2027181 B 10 1336834688 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1336834688 0 Physicians Anesthesia Services 20 1336834688 0 Physicians Healthy Kids Services 20 1336834688 0 Physicians Optical Supplies 20 1336834688 0 Physicians Physician Services 00 1336835453 0 ALFARO SAMANTHA ATC 2024092 9999999 B 10 1336835453 0 1845 E RAND RD ARLINGTON HEIGH IL 600044356 20 1336835453 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1336835784 0 VIJ ADITYA 2023199 9999999 B 10 1336835784 0 2211 N ELSTON AVE STE 301 CHICAGO IL 606149278 20 1336835784 0 Physicians Anesthesia Services 20 1336835784 0 Physicians Fluoride varnish 20 1336835784 0 Physicians Healthy Kids Services 20 1336835784 0 Physicians Optical Supplies 20 1336835784 0 Physicians Physician Services 00 1336836907 0 APOSTOL BURROUGHS JOSEPH 2024348 9999999 B 10 1336836907 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1336836907 0 Nurse Practitioners Fluoride varnish 20 1336836907 0 Nurse Practitioners Healthy Kids Services 20 1336836907 0 Nurse Practitioners Nurse Practitioners Services 20 1336836907 0 Nurse Practitioners Physician Services 00 1336837020 0 BUSH BRIANNA 2024232 9999999 B 10 1336837020 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1336837020 0 Physician Assistant Only Fluoride varnish 20 1336837020 0 Physician Assistant Only Healthy Kids Services 20 1336837020 0 Physician Assistant Only Physician Services 00 1336838309 0 CHIJI-AGUMA JENNIFER C 2023205 9999999 B 10 1336838309 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1336838309 0 Physicians Anesthesia Services 20 1336838309 0 Physicians Fluoride varnish 20 1336838309 0 Physicians Healthy Kids Services 20 1336838309 0 Physicians Optical Supplies 20 1336838309 0 Physicians Physician Services 00 1336838374 0 ZAIDI SYED 2023229 9999999 B 10 1336838374 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112386 20 1336838374 0 Dentists Dental Services 20 1336838374 0 Dentists Physician Services 00 1336838762 0 HOWARD ERIC N 2023234 9999999 B 10 1336838762 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1336838762 0 Nurse Practitioners Healthy Kids Services 20 1336838762 0 Nurse Practitioners Nurse Practitioners Services 20 1336838762 0 Nurse Practitioners Physician Services 00 1336839109 0 DELGADO JESSICA 2024361 9999999 B 10 1336839109 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1336839109 0 Nurse Practitioners Healthy Kids Services 20 1336839109 0 Nurse Practitioners Nurse Practitioners Services 20 1336839109 0 Nurse Practitioners Physician Services 00 1336841014 0 RAY SPARSH PRATIK 2024183 9999999 B 10 1336841014 0 26W171 ROOSEVELT RD WHEATON IL 601876002 20 1336841014 0 Physicians Anesthesia Services 20 1336841014 0 Physicians Healthy Kids Services 20 1336841014 0 Physicians Optical Supplies 20 1336841014 0 Physicians Physician Services 00 1336841477 0 ISHA SHAHIN 2023206 9999999 B 10 1336841477 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1336841477 0 Physicians Anesthesia Services 20 1336841477 0 Physicians Fluoride varnish 20 1336841477 0 Physicians Healthy Kids Services 20 1336841477 0 Physicians Optical Supplies 20 1336841477 0 Physicians Physician Services 00 1336842152 0 PATEL JILL 2023192 9999999 B 10 1336842152 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1336842152 0 Podiatrists Podiatric Services 00 1336842251 0 KAKAR NANDITA 2023363 9999999 B 10 1336842251 0 124 SW ADAMS ST PEORIA IL 616021308 20 1336842251 0 Physicians Anesthesia Services 20 1336842251 0 Physicians Fluoride varnish 20 1336842251 0 Physicians Healthy Kids Services 20 1336842251 0 Physicians Optical Supplies 20 1336842251 0 Physicians Physician Services 00 1336842533 0 JOSHI VAIDEHI H 2023108 9999999 B 10 1336842533 0 PO BOX 3039 OAK BROOK IL 605223039 20 1336842533 0 Physicians Anesthesia Services 20 1336842533 0 Physicians Fluoride varnish 20 1336842533 0 Physicians Healthy Kids Services 20 1336842533 0 Physicians Optical Supplies 20 1336842533 0 Physicians Physician Services 00 1336842962 0 SCHULTZ RACHEL 2023192 9999999 B 10 1336842962 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1336842962 0 Physicians Anesthesia Services 20 1336842962 0 Physicians Fluoride varnish 20 1336842962 0 Physicians Healthy Kids Services 20 1336842962 0 Physicians Optical Supplies 20 1336842962 0 Physicians Physician Services 00 1336843424 0 PATEL KHUSHBU 2023171 9999999 B 10 1336843424 0 4701 DEPT CAROL STREAM IL 601220021 20 1336843424 0 Physicians Anesthesia Services 20 1336843424 0 Physicians Fluoride varnish 20 1336843424 0 Physicians Healthy Kids Services 20 1336843424 0 Physicians Optical Supplies 20 1336843424 0 Physicians Physician Services 00 1336844075 0 PEREZ JESUS 2023192 9999999 B 10 1336844075 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1336844075 0 Physicians Anesthesia Services 20 1336844075 0 Physicians Healthy Kids Services 20 1336844075 0 Physicians Optical Supplies 20 1336844075 0 Physicians Physician Services 00 1336844281 0 NUSBAUM ERIN 2023268 9999999 B 10 1336844281 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1336844281 0 Physicians Anesthesia Services 20 1336844281 0 Physicians Fluoride varnish 20 1336844281 0 Physicians Healthy Kids Services 20 1336844281 0 Physicians Optical Supplies 20 1336844281 0 Physicians Physician Services 00 1336844877 0 LEE JAY J 2023193 9999999 B 10 1336844877 0 7732 SOLUTION CENTER CHICAGO IL 606777007 20 1336844877 0 Dentists Dental Services 20 1336844877 0 Dentists Physician Services 00 1336844984 0 LUPIERI ANNIK 2023269 9999999 B 10 1336844984 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1336844984 0 Physicians Anesthesia Services 20 1336844984 0 Physicians Healthy Kids Services 20 1336844984 0 Physicians Optical Supplies 20 1336844984 0 Physicians Physician Services 00 1336846054 0 MCKENNA TESSA 2024229 9999999 B 10 1336846054 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1336846054 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1336847318 0 AQUINO LIZBETH 2023051 9999999 B 10 1336847318 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1336847318 0 Occupational Therapists Medical Supplies 20 1336847318 0 Occupational Therapists Medical equipment/prosthetic devices 20 1336847318 0 Occupational Therapists Occupational Therapy Services 00 1336847722 0 RUFFALO ANNA 2023261 9999999 B 10 1336847722 0 8201 CASS AVE DARIEN IL 605615314 20 1336847722 0 Other behavior health professional Adaptive behavior support technician services 00 1336848035 0 OBRIEN SAMANTHA 2023110 9999999 B 10 1336848035 0 510 HEMPSTEAD TPKE RM 203 WEST HEMPSTEAD NY 115521152 20 1336848035 0 Nurse Practitioners Healthy Kids Services 20 1336848035 0 Nurse Practitioners Nurse Practitioners Services 20 1336848035 0 Nurse Practitioners Physician Services 00 1336850775 0 ANDRADE HOLDEN 2023152 9999999 B 10 1336850775 0 PO BOX 3272 INDIANAPOLIS IN 462063272 20 1336850775 0 Nurse Practitioners Fluoride varnish 20 1336850775 0 Nurse Practitioners Healthy Kids Services 20 1336850775 0 Nurse Practitioners Nurse Practitioners Services 20 1336850775 0 Nurse Practitioners Physician Services 00 1336851294 0 CHEATHAM KATLIN 2023038 9999999 B 10 1336851294 0 PO BOX 5081 JANESVILLE WI 535475081 20 1336851294 0 Nurse Practitioners Fluoride varnish 20 1336851294 0 Nurse Practitioners Healthy Kids Services 20 1336851294 0 Nurse Practitioners Nurse Practitioners Services 20 1336851294 0 Nurse Practitioners Physician Services 00 1336851997 0 NOVAK TAMISHA A 2023055 9999999 B 10 1336851997 0 2201 MAIN ST EVANSTON IL 602021519 20 1336851997 0 Nurse Practitioners Fluoride varnish 20 1336851997 0 Nurse Practitioners Healthy Kids Services 20 1336851997 0 Nurse Practitioners Nurse Practitioners Services 20 1336851997 0 Nurse Practitioners Physician Services 00 1336852110 0 BURTON JAMES A 2023150 9999999 B 10 1336852110 0 5777 DEPT CAROL STREAM IL 601228942 20 1336852110 0 Nurse Practitioners Healthy Kids Services 20 1336852110 0 Nurse Practitioners Nurse Practitioners Services 20 1336852110 0 Nurse Practitioners Physician Services 00 1336853290 0 THOMPSON JAMES E 2023023 9999999 B 10 1336853290 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1336853290 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1336854074 0 SCHLEIER ZACHARY J 2024324 9999999 B 10 1336854074 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1336854074 0 Nurse Practitioners Fluoride varnish 20 1336854074 0 Nurse Practitioners Healthy Kids Services 20 1336854074 0 Nurse Practitioners Nurse Practitioners Services 20 1336854074 0 Nurse Practitioners Physician Services 00 1336856236 0 MUNOZ REGINA 2024184 9999999 B 10 1336856236 0 6821 S HALSTED ST CHICAGO IL 606211833 20 1336856236 0 Nurse Practitioners Fluoride varnish 20 1336856236 0 Nurse Practitioners Healthy Kids Services 20 1336856236 0 Nurse Practitioners Nurse Practitioners Services 20 1336856236 0 Nurse Practitioners Physician Services 00 1336857390 0 WILLIAMS SARA 2023011 9999999 B 10 1336857390 0 929 STACEY BURK DR PO BOX 40 FLORA IL 628393241 20 1336857390 0 Nurse Practitioners Healthy Kids Services 20 1336857390 0 Nurse Practitioners Nurse Practitioners Services 20 1336857390 0 Nurse Practitioners Physician Services 00 1336857531 0 THOMAS JEENA MARY 2023005 9999999 B 10 1336857531 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1336857531 0 Physician Assistant Only Fluoride varnish 20 1336857531 0 Physician Assistant Only Healthy Kids Services 20 1336857531 0 Physician Assistant Only Physician Services 00 1336859131 0 OKONKWO PHILOMENA C 2023025 9999999 B 10 1336859131 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1336859131 0 Nurse Practitioners Fluoride varnish 20 1336859131 0 Nurse Practitioners Healthy Kids Services 20 1336859131 0 Nurse Practitioners Nurse Practitioners Services 20 1336859131 0 Nurse Practitioners Physician Services 00 1336863034 0 ROSENFELD HANNAH 2022321 9999999 B 10 1336863034 0 5777 DEPT CAROL STREAM IL 601220021 20 1336863034 0 Clinical Social Worker Social work service 00 1336863166 0 RYBAK MADISON 2022270 9999999 B 10 1336863166 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1336863166 0 Physician Assistant Only Fluoride varnish 20 1336863166 0 Physician Assistant Only Healthy Kids Services 20 1336863166 0 Physician Assistant Only Physician Services 00 1336863505 0 LEVY CAROLINE 2023268 9999999 B 10 1336863505 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1336863505 0 Occupational Therapists Medical Supplies 20 1336863505 0 Occupational Therapists Medical equipment/prosthetic devices 20 1336863505 0 Occupational Therapists Occupational Therapy Services 00 1336864669 0 GUNDELACH ANDREA S 2023032 9999999 B 10 1336864669 0 PO BOX 28900 GREEN BAY WI 543240900 20 1336864669 0 Nurse Practitioners Anesthesia Services 20 1336864669 0 Nurse Practitioners Nurse Practitioners Services 20 1336864669 0 Nurse Practitioners Physician Services 00 1336865120 0 ALLEN NATASHA 2024053 9999999 B 10 1336865120 0 2045 W GRAND AVE STE B CHICAGO IL 606121577 20 1336865120 0 Other behavior health professional LCPC/LMFT services 00 1336866151 0 MICHELSEN SHANNON R 2023137 9999999 B 10 1336866151 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1336866151 0 Occupational Therapists Medical Supplies 20 1336866151 0 Occupational Therapists Medical equipment/prosthetic devices 20 1336866151 0 Occupational Therapists Occupational Therapy Services 00 1336866425 0 ARNOLD ABBEY L 2022276 9999999 B 10 1336866425 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1336866425 0 Nurse Practitioners Healthy Kids Services 20 1336866425 0 Nurse Practitioners Nurse Practitioners Services 20 1336866425 0 Nurse Practitioners Physician Services 00 1336866722 0 GREEN CENOA 2022301 9999999 H 10 1336866722 0 3010 GRAND AVE WAUKEGAN IL 60085 20 1336866722 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1336868819 0 SCHNEIDER MAGDALENA T 2023068 9999999 B 10 1336868819 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1336868819 0 Speech Therapists Medical Supplies 20 1336868819 0 Speech Therapists Medical equipment/prosthetic devices 20 1336868819 0 Speech Therapists Speech Therapy/Pathology Services 00 1336868876 0 TREVINO DAWN 2025028 9999999 B 10 1336868876 0 5801 MOUNT PLEASANT LN BELLEVILLE IL 622233944 20 1336868876 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1336870153 0 DADI YOGITHA 2022186 9999999 B 10 1336870153 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1336870153 0 Physicians Anesthesia Services 20 1336870153 0 Physicians Fluoride varnish 20 1336870153 0 Physicians Healthy Kids Services 20 1336870153 0 Physicians Optical Supplies 20 1336870153 0 Physicians Physician Services 00 1336870286 0 BHAVSAR MAURVI AMISH 2022193 9999999 B 10 1336870286 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1336870286 0 Physicians Anesthesia Services 20 1336870286 0 Physicians Fluoride varnish 20 1336870286 0 Physicians Healthy Kids Services 20 1336870286 0 Physicians Optical Supplies 20 1336870286 0 Physicians Physician Services 00 1336870401 0 SHAIKH NAZFA 2022314 9999999 B 10 1336870401 0 3425 S KING DR CHICAGO IL 606164108 20 1336870401 0 Dentists Dental Services 20 1336870401 0 Dentists Physician Services 00 1336870559 0 DEANE SAVANNAH J 2022249 9999999 B 10 1336870559 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1336870559 0 Nurse Practitioners Fluoride varnish 20 1336870559 0 Nurse Practitioners Healthy Kids Services 20 1336870559 0 Nurse Practitioners Nurse Practitioners Services 20 1336870559 0 Nurse Practitioners Physician Services 00 1336870831 0 STAMELOS GEORGE S 2022212 9999999 B 10 1336870831 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1336870831 0 Physicians Anesthesia Services 20 1336870831 0 Physicians Fluoride varnish 20 1336870831 0 Physicians Healthy Kids Services 20 1336870831 0 Physicians Optical Supplies 20 1336870831 0 Physicians Physician Services 00 1336871771 0 BROWN KAYDEAN 2022336 9999999 B 10 1336871771 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1336871771 0 Physicians Anesthesia Services 20 1336871771 0 Physicians Healthy Kids Services 20 1336871771 0 Physicians Optical Supplies 20 1336871771 0 Physicians Physician Services 00 1336872316 0 PFEIFFER MORGAN 2022215 9999999 B 10 1336872316 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1336872316 0 Physicians Anesthesia Services 20 1336872316 0 Physicians Fluoride varnish 20 1336872316 0 Physicians Healthy Kids Services 20 1336872316 0 Physicians Optical Supplies 20 1336872316 0 Physicians Physician Services 00 1336872845 0 BADE ALANNA J 2023254 9999999 B 10 1336872845 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1336872845 0 Physician Assistant Only Fluoride varnish 20 1336872845 0 Physician Assistant Only Healthy Kids Services 20 1336872845 0 Physician Assistant Only Physician Services 00 1336872951 0 ABDULLAH AAMIR 2022259 9999999 B 10 1336872951 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1336872951 0 Physicians Anesthesia Services 20 1336872951 0 Physicians Fluoride varnish 20 1336872951 0 Physicians Healthy Kids Services 20 1336872951 0 Physicians Optical Supplies 20 1336872951 0 Physicians Physician Services 00 1336873124 0 SALDANA CYNTHIA 2024262 9999999 B 10 1336873124 0 4300 WEAVER PKWY STE 100 WARRENVILLE IL 605553920 20 1336873124 0 Other behavior health professional LCPC/LMFT services 00 1336873132 0 MILAD ELLEN 2022238 9999999 B 10 1336873132 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1336873132 0 Nurse Practitioners Fluoride varnish 20 1336873132 0 Nurse Practitioners Healthy Kids Services 20 1336873132 0 Nurse Practitioners Nurse Practitioners Services 20 1336873132 0 Nurse Practitioners Physician Services 00 1336875848 0 HOOPER CARMEN 2022334 9999999 B 10 1336875848 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1336875848 0 Nurse Practitioners Fluoride varnish 20 1336875848 0 Nurse Practitioners Healthy Kids Services 20 1336875848 0 Nurse Practitioners Nurse Practitioners Services 20 1336875848 0 Nurse Practitioners Physician Services 00 1336875897 0 BRITZ JOSEPH 2023093 9999999 B 10 1336875897 0 5777 DEPT CAROL STREAM IL 601220021 20 1336875897 0 Nurse Practitioners Anesthesia Services 20 1336875897 0 Nurse Practitioners Nurse Practitioners Services 20 1336875897 0 Nurse Practitioners Physician Services 00 1336876721 0 WILLIAMS BRADEN T 2024016 9999999 B 10 1336876721 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1336876721 0 Physician Assistant Only Fluoride varnish 20 1336876721 0 Physician Assistant Only Healthy Kids Services 20 1336876721 0 Physician Assistant Only Physician Services 00 1336876770 0 MILLS HALEY 2022234 9999999 B 10 1336876770 0 PO BOX 5081 JANESVILLE WI 535475081 20 1336876770 0 Physician Assistant Only Fluoride varnish 20 1336876770 0 Physician Assistant Only Healthy Kids Services 20 1336876770 0 Physician Assistant Only Physician Services 00 1336877133 0 FREYER EDITH 2022278 9999999 B 10 1336877133 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1336877133 0 Nurse Practitioners Fluoride varnish 20 1336877133 0 Nurse Practitioners Healthy Kids Services 20 1336877133 0 Nurse Practitioners Nurse Practitioners Services 20 1336877133 0 Nurse Practitioners Physician Services 00 1336878214 0 SAROOP REANNA 2022239 9999999 B 10 1336878214 0 124 SW ADAMS ST PEORIA IL 616021308 20 1336878214 0 Physicians Anesthesia Services 20 1336878214 0 Physicians Fluoride varnish 20 1336878214 0 Physicians Healthy Kids Services 20 1336878214 0 Physicians Optical Supplies 20 1336878214 0 Physicians Physician Services 00 1336878669 0 PALAT SANJAY S 2024012 9999999 B 10 1336878669 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1336878669 0 Physicians Anesthesia Services 20 1336878669 0 Physicians Fluoride varnish 20 1336878669 0 Physicians Healthy Kids Services 20 1336878669 0 Physicians Optical Supplies 20 1336878669 0 Physicians Physician Services 00 1336878867 0 REVELT NICOLAS 2022192 9999999 B 10 1336878867 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1336878867 0 Physicians Anesthesia Services 20 1336878867 0 Physicians Healthy Kids Services 20 1336878867 0 Physicians Optical Supplies 20 1336878867 0 Physicians Physician Services 00 1336879170 0 HU RONG 2022199 9999999 B 10 1336879170 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1336879170 0 Physicians Anesthesia Services 20 1336879170 0 Physicians Fluoride varnish 20 1336879170 0 Physicians Healthy Kids Services 20 1336879170 0 Physicians Optical Supplies 20 1336879170 0 Physicians Physician Services 00 1336879832 0 CURE KATHRYN 2022193 9999999 B 10 1336879832 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1336879832 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1336879923 0 KLEIN AMANDA 2024008 9999999 B 10 1336879923 0 715 LAKE ST STE 800 OAK PARK IL 603011417 20 1336879923 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1336880129 0 TESHER BRIDGET 2022213 2099365 B 10 1336880129 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1336880129 0 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Physicians Optical Supplies 20 1336888403 0 Physicians Physician Services 00 1336889351 0 NAIDU VAMSIKRISHNA G 2022187 9999999 B 10 1336889351 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1336889351 0 Physicians Anesthesia Services 20 1336889351 0 Physicians Fluoride varnish 20 1336889351 0 Physicians Healthy Kids Services 20 1336889351 0 Physicians Optical Supplies 20 1336889351 0 Physicians Physician Services 00 1336889377 0 ROBERTS MORGAN A 2022117 9999999 B 10 1336889377 0 1467 N ELSTON AVE STE 103 CHICAGO IL 606422449 20 1336889377 0 Occupational Therapists Medical Supplies 20 1336889377 0 Occupational Therapists Medical equipment/prosthetic devices 20 1336889377 0 Occupational Therapists Occupational Therapy Services 00 1336889609 0 PFLEDERER TRAVIS 2022181 9999999 B 10 1336889609 0 PO BOX 3039 OAK BROOK IL 605223039 20 1336889609 0 Physicians Anesthesia Services 20 1336889609 0 Physicians Fluoride varnish 20 1336889609 0 Physicians Healthy Kids Services 20 1336889609 0 Physicians Optical Supplies 20 1336889609 0 Physicians Physician Services 00 1336889682 0 SAHNI ANKIT 2022186 9999999 B 10 1336889682 0 PO BOX 3039 OAK BROOK IL 605223039 20 1336889682 0 Physicians Anesthesia Services 20 1336889682 0 Physicians Fluoride varnish 20 1336889682 0 Physicians Healthy Kids Services 20 1336889682 0 Physicians Optical Supplies 20 1336889682 0 Physicians Physician Services 00 1336890672 0 WOLFF CATHERINE 2022018 9999999 B 10 1336890672 0 319 E MADISON ST STE 3B SPRINGFIELD IL 627013124 20 1336890672 0 Occupational Therapists Medical Supplies 20 1336890672 0 Occupational Therapists Medical equipment/prosthetic devices 20 1336890672 0 Occupational Therapists Occupational Therapy Services 00 1336895697 0 RATCLIFF JILL D 2024327 9999999 B 10 1336895697 0 777 S MAIN ST STE 100 CLINTON IN 478422493 20 1336895697 0 Clinical Social Worker Social work service 00 1336895705 0 PRASKOV SIYANA K 2022166 9999999 B 10 1336895705 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 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1336898592 0 Physicians Healthy Kids Services 20 1336898592 0 Physicians Optical Supplies 20 1336898592 0 Physicians Physician Services 00 1336899533 0 STELLA ALEXIS D 2023121 9999999 B 10 1336899533 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1336899533 0 Clinical Social Worker Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1336899533 0 STELLA ALEXIS D 2023121 9999999 B 10 1336899533 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1336899533 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1336899962 0 AUCOIN CLAIRE 2023201 9999999 B 10 1336899962 0 611 W PARK ST URBANA IL 618012529 20 1336899962 0 Physicians Anesthesia Services 20 1336899962 0 Physicians Healthy Kids Services 20 1336899962 0 Physicians Optical Supplies 20 1336899962 0 Physicians Physician Services 00 1336901347 0 COVERT TAYLOR 2024100 9999999 B 10 1336901347 0 212 BARNEY DR JOLIET IL 604355271 20 1336901347 0 Occupational Therapists Medical Supplies 20 1336901347 0 Occupational Therapists Medical equipment/prosthetic devices 20 1336901347 0 Occupational Therapists Occupational Therapy Services 00 1336903350 0 KRUTZ MARY 2024163 9999999 B 10 1336903350 0 5777 DEPT CAROL STREAM IL 601228942 20 1336903350 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1336905736 0 GROHLER SYDNEY E 2024087 9999999 B 10 1336905736 0 2300 N EDWARD ST DECATUR IL 625264163 20 1336905736 0 Nurse Practitioners Fluoride varnish 20 1336905736 0 Nurse Practitioners Healthy Kids Services 20 1336905736 0 Nurse Practitioners Nurse Practitioners Services 20 1336905736 0 Nurse Practitioners Physician Services 00 1336906247 0 GREIDER ABIGAIL 2024135 9999999 B 10 1336906247 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1336906247 0 Nurse Practitioners Fluoride varnish 20 1336906247 0 Nurse Practitioners Healthy Kids Services 20 1336906247 0 Nurse Practitioners 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MARTINEZ CARLA 2024011 9999999 B 10 1336919505 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1336919505 0 Nurse Practitioners Healthy Kids Services 20 1336919505 0 Nurse Practitioners Nurse Practitioners Services 20 1336919505 0 Nurse Practitioners Physician Services 00 1336921311 0 NORTHROP IVANKA 2023291 9999999 B 10 1336921311 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1336921311 0 Speech Therapists Medical Supplies 20 1336921311 0 Speech Therapists Medical equipment/prosthetic devices 20 1336921311 0 Speech Therapists Speech Therapy/Pathology Services 00 1336921790 0 BOLSKAR ERIN 2024061 9999999 B 10 1336921790 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1336921790 0 Physician Assistant Only Fluoride varnish 20 1336921790 0 Physician Assistant Only Healthy Kids Services 20 1336921790 0 Physician Assistant Only Physician Services 00 1336922517 0 CADA BRIANNA 2023244 9999999 B 10 1336922517 0 1325 SYCAMORE RD DEKALB IL 601152483 20 1336922517 0 Other behavior health 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Practitioners Healthy Kids Services 20 1336960772 0 Nurse Practitioners Nurse Practitioners Services 20 1336960772 0 Nurse Practitioners Physician Services 00 1336965607 0 ROLLINS LAEQUAH Z 2024345 9999999 B 10 1336965607 0 900 ROYAL HEIGHTS RD BELLEVILLE IL 622265457 20 1336965607 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1336966480 0 BAILEY MARGARET 2024285 9999999 B 10 1336966480 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1336966480 0 Occupational Therapists Medical Supplies 20 1336966480 0 Occupational Therapists Medical equipment/prosthetic devices 20 1336966480 0 Occupational Therapists Occupational Therapy Services 00 1336967231 0 MIDLASH NICHOLAS 2024339 9999999 B 10 1336967231 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1336967231 0 Physician Assistant Only Fluoride varnish 20 1336967231 0 Physician Assistant Only Healthy Kids Services 20 1336967231 0 Physician Assistant Only Physician 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0 BAROJA DANELLE 2023244 9999999 B 10 1346025624 0 5750 JOHNSTON ST STE 205 LAFAYETTE LA 705035334 20 1346025624 0 Nurse Practitioners Fluoride varnish 20 1346025624 0 Nurse Practitioners Healthy Kids Services 20 1346025624 0 Nurse Practitioners Nurse Practitioners Services 20 1346025624 0 Nurse Practitioners Physician Services 00 1346026424 0 YEAGER BROOKE 2024337 9999999 B 10 1346026424 0 2901 FINLEY RD STE 102 DOWNERS GROVE IL 605151774 20 1346026424 0 Other behavior health professional Adaptive behavior support clinician services 20 1346026424 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1346029220 0 FREEMAN MEREDITH 2023282 9999999 B 10 1346029220 0 PO BOX 775253 CHICAGO IL 606775253 20 1346029220 0 Nurse Practitioners Healthy Kids Services 20 1346029220 0 Nurse Practitioners Nurse Practitioners Services 20 1346029220 0 Nurse Practitioners Physician Services 00 1346050317 0 HARRINGTON MICHELLE 2025029 9999999 B 10 1346050317 0 7531 S STONY ISLAND AVE STE 16 CHICAGO IL 606493954 20 1346050317 0 Nurse Practitioners Fluoride varnish 20 1346050317 0 Nurse Practitioners Healthy Kids Services 20 1346050317 0 Nurse Practitioners Nurse Practitioners Services 20 1346050317 0 Nurse Practitioners Physician Services 00 1346053485 0 BARLOW DANYELLE 2025045 9999999 B 10 1346053485 0 5601 BROOKMERE ST EDWARDS IL 615289408 20 1346053485 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1346061223 0 ADAMS SALINNA L 2024325 9999999 B 10 1346061223 0 19990 GOVERNORS HWY OLYMPIA FIELDS IL 604611021 20 1346061223 0 Nurse Practitioners Fluoride varnish 20 1346061223 0 Nurse Practitioners Healthy Kids Services 20 1346061223 0 Nurse Practitioners Nurse Practitioners Services 20 1346061223 0 Nurse Practitioners Physician Services 00 1346064847 0 FRANTZEN KARI 2025045 9999999 B 10 1346064847 0 15450 STATE ROUTE 47 NEWARK IL 605419723 20 1346064847 0 Clinical Social Worker Social work service 00 1346066412 0 SANZ SERGIO 2024355 9999999 B 10 1346066412 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1346066412 0 Nurse Practitioners Anesthesia Services 20 1346066412 0 Nurse Practitioners Nurse Practitioners Services 20 1346066412 0 Nurse Practitioners Physician Services 00 1346067170 0 HUGHES SHELBY 2024275 9999999 B 10 1346067170 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1346067170 0 Nurse Practitioners Healthy Kids Services 20 1346067170 0 Nurse Practitioners Nurse Practitioners Services 20 1346067170 0 Nurse Practitioners Physician Services 00 1346071040 0 MAN XIAOYAN 2024226 9999999 B 10 1346071040 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1346071040 0 Physicians Anesthesia Services 20 1346071040 0 Physicians Healthy Kids Services 20 1346071040 0 Physicians Optical Supplies 20 1346071040 0 Physicians Physician Services 20 1346071040 0 Physicians Physicians Psychiatric Services 00 1346071867 0 SCHOONENBERG TARA 2024236 9999999 B 10 1346071867 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1346071867 0 Nurse Practitioners Healthy Kids Services 20 1346071867 0 Nurse Practitioners Nurse Practitioners Services 20 1346071867 0 Nurse Practitioners Physician Services 00 1346071883 0 MIZE NICOLE 2024295 9999999 B 10 1346071883 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1346071883 0 Nurse Practitioners Anesthesia Services 20 1346071883 0 Nurse Practitioners Nurse Practitioners Services 20 1346071883 0 Nurse Practitioners Physician Services 00 1346074002 0 PARK YUN JUN 2024240 9999999 B 10 1346074002 0 263 S BOLINGBROOK DR BOLINGBROOK IL 604402931 20 1346074002 0 Dentists Dental Services 20 1346074002 0 Dentists Physician Services 00 1346074036 0 MORA LESLIE 2025016 9999999 B 10 1346074036 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1346074036 0 Physician Assistant Only Fluoride varnish 20 1346074036 0 Physician Assistant Only Healthy Kids Services 20 1346074036 0 Physician Assistant Only Physician Services 00 1346076494 0 FILIPUT ALEXANDRA M 2024365 9999999 B 10 1346076494 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1346076494 0 Physician Assistant Only Fluoride varnish 20 1346076494 0 Physician Assistant Only Healthy Kids Services 20 1346076494 0 Physician Assistant Only Physician Services 00 1346080322 0 CONNER DREW 2024232 9999999 B 10 1346080322 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1346080322 0 Physicians Anesthesia Services 20 1346080322 0 Physicians Healthy Kids Services 20 1346080322 0 Physicians Optical Supplies 20 1346080322 0 Physicians Physician Services 00 1346081809 0 KANTHARIA RAJ SUNJAY 2024164 9999999 B 10 1346081809 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1346081809 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1346082153 0 ASHLEY JENNA N 2024264 9999999 B 10 1346082153 0 29373 NETWORK PL CHICAGO IL 606733039 20 1346082153 0 Physician Assistant Only Fluoride varnish 20 1346082153 0 Physician Assistant Only Healthy Kids Services 20 1346082153 0 Physician Assistant Only Physician Services 00 1346083094 0 CONSTANTINO MARCOS 2024176 9999999 B 10 1346083094 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1346083094 0 Clinical Social Worker Social work service 00 1346083557 0 CANAS DIAZ MELISSA 2024167 9999999 B 10 1346083557 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1346083557 0 Physicians Anesthesia Services 20 1346083557 0 Physicians Healthy Kids Services 20 1346083557 0 Physicians Optical Supplies 20 1346083557 0 Physicians Physician Services 00 1346084795 0 UN HALUK 2024211 9999999 B 10 1346084795 0 PO BOX 855795 MINNEAPOLIS MN 554851296 20 1346084795 0 Physicians Anesthesia Services 20 1346084795 0 Physicians Fluoride varnish 20 1346084795 0 Physicians Healthy Kids Services 20 1346084795 0 Physicians Optical Supplies 20 1346084795 0 Physicians Physician Services 00 1346085081 0 TRUONG THOA T 2024296 9999999 B 10 1346085081 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1346085081 0 Nurse Practitioners Healthy Kids Services 20 1346085081 0 Nurse Practitioners Nurse Practitioners Services 20 1346085081 0 Nurse Practitioners Physician Services 00 1346085149 0 DALLOW KARAM L 2024191 9999999 B 10 1346085149 0 201 E MADISON ST STE 300 SPRINGFIELD IL 627025131 20 1346085149 0 Physicians Anesthesia Services 20 1346085149 0 Physicians Fluoride varnish 20 1346085149 0 Physicians Healthy Kids Services 20 1346085149 0 Physicians Optical Supplies 20 1346085149 0 Physicians Physician Services 00 1346086014 0 SARACENO EDEN R 2024278 9999999 B 10 1346086014 0 7421 MADISON ST FOREST PARK IL 601301575 20 1346086014 0 Speech Therapists Medical Supplies 20 1346086014 0 Speech Therapists Medical equipment/prosthetic devices 20 1346086014 0 Speech Therapists Speech Therapy/Pathology Services 00 1346088481 0 HARRIS ANDREA 2024204 9999999 B 10 1346088481 0 2038 221ST ST SAUK 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1346092715 0 LIZON CHRISTOPHER 2024192 9999999 B 10 1346092715 0 PO BOX 3039 OAK BROOK IL 605223039 20 1346092715 0 Physicians Anesthesia Services 20 1346092715 0 Physicians Fluoride varnish 20 1346092715 0 Physicians Healthy Kids Services 20 1346092715 0 Physicians Optical Supplies 20 1346092715 0 Physicians Physician Services 00 1346093119 0 KHEDKAR SONAL 2024217 9999999 B 10 1346093119 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1346093119 0 Physicians Anesthesia Services 20 1346093119 0 Physicians Fluoride varnish 20 1346093119 0 Physicians Healthy Kids Services 20 1346093119 0 Physicians Optical Supplies 20 1346093119 0 Physicians Physician Services 00 1346097771 0 LACY DEVIN 2024129 9999999 B 10 1346097771 0 18154 MARTIN AVE STE 1 HOMEWOOD IL 604302155 20 1346097771 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1346097912 0 ADAMS EMYLEA 2024205 9999999 B 10 1346097912 0 2211 N ELSTON AVE STE 301 CHICAGO IL 606149278 20 1346097912 0 Physicians Anesthesia Services 20 1346097912 0 Physicians Fluoride varnish 20 1346097912 0 Physicians Healthy Kids Services 20 1346097912 0 Physicians Optical Supplies 20 1346097912 0 Physicians Physician Services 00 1346098746 0 BANNER HASSAN PRINCE ELI 2024199 9999999 B 10 1346098746 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1346098746 0 Physicians Anesthesia Services 20 1346098746 0 Physicians Fluoride varnish 20 1346098746 0 Physicians Healthy Kids Services 20 1346098746 0 Physicians Optical Supplies 20 1346098746 0 Physicians Physician Services 00 1346200078 0 MCGOWAN FRANCIS X. 2017321 9999999 B 10 1346200078 0 100 E PENN SQ PHILADELPHIA PA 191073323 20 1346200078 0 Physicians Anesthesia Services 20 1346200078 0 Physicians Healthy Kids Services 20 1346200078 0 Physicians Optical Supplies 20 1346200078 0 Physicians Physician Services 00 1346200573 0 MUDGE RANDY 2021207 9999999 B 10 1346200573 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1346200573 0 Physicians Anesthesia Services 20 1346200573 0 Physicians Healthy Kids Services 20 1346200573 0 Physicians Optical Supplies 20 1346200573 0 Physicians Physician Services 00 1346200805 0 HAMMONDS JENNIFER 2005004 9999999 B 10 1346200805 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1346200805 0 Clinical Social Worker Social work service 00 1346200938 0 SMITH JEFFREY 1995198 9999999 B 10 1346200938 0 4701 DEPT CAROL STREAM IL 601220021 20 1346200938 0 Physicians Anesthesia Services 20 1346200938 0 Physicians Fluoride varnish 20 1346200938 0 Physicians Healthy Kids Services 20 1346200938 0 Physicians Optical Supplies 20 1346200938 0 Physicians Physician Services 00 1346201241 0 JUOZEVICIUS JOHN L 2007001 9999999 B 10 1346201241 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1346201241 0 Physicians Anesthesia Services 20 1346201241 0 Physicians Fluoride varnish 20 1346201241 0 Physicians Healthy Kids Services 20 1346201241 0 Physicians Optical Supplies 20 1346201241 0 Physicians Physician Services 00 1346201761 0 SCHLAFMANN SUE 2020329 9999999 B 10 1346201761 0 5700 SOUTHWYCK BLVD TOLEDO OH 436141509 20 1346201761 0 Physicians Anesthesia Services 20 1346201761 0 Physicians Healthy Kids Services 20 1346201761 0 Physicians Optical Supplies 20 1346201761 0 Physicians Physician Services 00 1346201795 0 PFAU PATRICK 2001182 9999999 B 10 1346201795 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1346201795 0 Physicians Anesthesia Services 20 1346201795 0 Physicians Fluoride varnish 20 1346201795 0 Physicians Healthy Kids Services 20 1346201795 0 Physicians Optical Supplies 20 1346201795 0 Physicians Physician Services 00 1346202892 0 GLASGOW TARA 2004167 9999999 B 10 1346202892 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1346202892 0 Nurse Practitioners Anesthesia Services 20 1346202892 0 Nurse Practitioners Nurse Practitioners Services 20 1346202892 0 Nurse Practitioners Physician Services 00 1346203817 0 WINANS BRADFORD 2021145 9999999 B 10 1346203817 0 PO BOX 3272 INDIANAPOLIS IN 462063272 20 1346203817 0 Physicians Anesthesia Services 20 1346203817 0 Physicians Healthy Kids Services 20 1346203817 0 Physicians Optical Supplies 20 1346203817 0 Physicians Physician Services 00 1346204260 0 MANGLANO RAMON 1993182 9999999 B 10 1346204260 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1346204260 0 Physicians Anesthesia Services 20 1346204260 0 Physicians Healthy Kids Services 20 1346204260 0 Physicians Optical Supplies 20 1346204260 0 Physicians Physician Services 00 1346204401 0 DEWITT JOHN 2022207 9999999 B 10 1346204401 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1346204401 0 Physicians Anesthesia Services 20 1346204401 0 Physicians Healthy Kids Services 20 1346204401 0 Physicians Optical Supplies 20 1346204401 0 Physicians Physician Services 00 1346204518 0 KINDER CHARLES A 1995182 9999999 B 10 1346204518 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1346204518 0 Physicians Anesthesia Services 20 1346204518 0 Physicians Fluoride varnish 20 1346204518 0 Physicians Healthy Kids Services 20 1346204518 0 Physicians Optical Supplies 20 1346204518 0 Physicians Physician Services 00 1346204609 0 REID JANET 2001298 9999999 B 10 1346204609 0 3401 CIVIC CENTER BLVD # M975 PHILADELPHIA PA 191044319 20 1346204609 0 Physicians Anesthesia Services 20 1346204609 0 Physicians Healthy Kids Services 20 1346204609 0 Physicians Optical Supplies 20 1346204609 0 Physicians Physician Services 00 1346204989 0 DAILEY SETH H 2004306 9999999 B 10 1346204989 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1346204989 0 Physicians Anesthesia Services 20 1346204989 0 Physicians Healthy Kids Services 20 1346204989 0 Physicians Optical Supplies 20 1346204989 0 Physicians Physician Services 00 1346205036 0 HEISE CHARLES P 2002182 9999999 B 10 1346205036 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1346205036 0 Physicians Anesthesia Services 20 1346205036 0 Physicians Healthy Kids Services 20 1346205036 0 Physicians Optical Supplies 20 1346205036 0 Physicians Physician Services 00 1346206612 0 DAUD SHIRAZ AHMED 2006213 9999999 B 10 1346206612 0 21 EASTBROOK BND STE 218 PEACHTREE CITY GA 302691546 20 1346206612 0 Physicians Anesthesia Services 20 1346206612 0 Physicians Fluoride varnish 20 1346206612 0 Physicians Healthy Kids Services 20 1346206612 0 Physicians Optical Supplies 20 1346206612 0 Physicians Physician Services 00 1346206737 0 DEWEES AARON 2011182 9999999 B 10 1346206737 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1346206737 0 Physicians Anesthesia Services 20 1346206737 0 Physicians Fluoride varnish 20 1346206737 0 Physicians Healthy Kids Services 20 1346206737 0 Physicians Optical Supplies 20 1346206737 0 Physicians Physician Services 00 1346207719 0 ADAMS CHRISTOPHER M 2006230 9999999 B 10 1346207719 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1346207719 0 Physicians Anesthesia Services 20 1346207719 0 Physicians Fluoride varnish 20 1346207719 0 Physicians Healthy Kids Services 20 1346207719 0 Physicians Optical Supplies 20 1346207719 0 Physicians Physician Services 00 1346207958 0 HUYNH PHOUNG 2007091 9999999 B 10 1346207958 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1346207958 0 Physicians Anesthesia Services 20 1346207958 0 Physicians Healthy Kids Services 20 1346207958 0 Physicians Optical Supplies 20 1346207958 0 Physicians Physician Services 00 1346208253 0 BISESI MARK A 1995182 9999999 B 10 1346208253 0 525 E GRANT ST MACOMB IL 614553313 20 1346208253 0 Physicians Anesthesia Services 20 1346208253 0 Physicians Healthy Kids Services 20 1346208253 0 Physicians Optical Supplies 20 1346208253 0 Physicians Physician Services 00 1346208378 0 GELSTEIN LAURENCE 2020233 9999999 B 10 1346208378 0 607 S NEW BALLAS RD STE 3100 SAINT LOUIS MO 631418219 20 1346208378 0 Physicians Anesthesia Services 20 1346208378 0 Physicians Healthy Kids Services 20 1346208378 0 Physicians Optical Supplies 20 1346208378 0 Physicians Physician Services 00 1346208394 0 DUCHARME NICOLE M 2019310 9999999 B 10 1346208394 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1346208394 0 Physicians Anesthesia Services 20 1346208394 0 Physicians Fluoride varnish 20 1346208394 0 Physicians Healthy Kids Services 20 1346208394 0 Physicians Optical Supplies 20 1346208394 0 Physicians Physician Services 00 1346208519 0 WASSEF SAMIR Y 1994244 9999999 B 10 1346208519 0 415 E NORTH WATER ST APT 2005 SUITE 2005 CHICAGO IL 606115824 20 1346208519 0 Physicians Anesthesia Services 20 1346208519 0 Physicians Fluoride varnish 20 1346208519 0 Physicians Healthy Kids Services 20 1346208519 0 Physicians Optical Supplies 20 1346208519 0 Physicians Physician Services 00 1346208766 0 BOLEK BERQUIST JILAINE M 2007182 9999999 B 10 1346208766 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1346208766 0 Physicians Anesthesia Services 20 1346208766 0 Physicians Fluoride varnish 20 1346208766 0 Physicians Healthy Kids Services 20 1346208766 0 Physicians Optical Supplies 20 1346208766 0 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1346212693 0 Physicians Optical Supplies 20 1346212693 0 Physicians Physician Services 00 1346214319 0 TILLEMA MARY 1999152 9999999 B 10 1346214319 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1346214319 0 Physicians Anesthesia Services 20 1346214319 0 Physicians Fluoride varnish 20 1346214319 0 Physicians Healthy Kids Services 20 1346214319 0 Physicians Optical Supplies 20 1346214319 0 Physicians Physician Services 00 1346214483 0 SHUBER SUAD 1981227 9999999 B 10 1346214483 0 7237 W IRVING PARK RD CHICAGO IL 606343546 20 1346214483 0 Physicians Anesthesia Services 20 1346214483 0 Physicians Healthy Kids Services 20 1346214483 0 Physicians Optical Supplies 20 1346214483 0 Physicians Physician Services 00 1346214897 0 CHOLEWA RYSZARD 2003244 9999999 B 10 1346214897 0 PO BOX 343918 MILWAUKEE WI 532343918 20 1346214897 0 Physicians Anesthesia Services 20 1346214897 0 Physicians Fluoride varnish 20 1346214897 0 Physicians Healthy Kids Services 20 1346214897 0 Physicians 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0 GAMM DAVID M 2002182 9999999 B 10 1346216488 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1346216488 0 Physicians Anesthesia Services 20 1346216488 0 Physicians Healthy Kids Services 20 1346216488 0 Physicians Optical Supplies 20 1346216488 0 Physicians Physician Services 00 1346216595 0 KAGAN SCOTT M 2000213 9999999 B 10 1346216595 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1346216595 0 Physicians Anesthesia Services 20 1346216595 0 Physicians Healthy Kids Services 20 1346216595 0 Physicians Optical Supplies 20 1346216595 0 Physicians Physician Services 00 1346217023 0 NAYAR RAJEEV 2000152 9999999 B 10 1346217023 0 1044 N FRANCISCO AVE CHICAGO IL 606222743 20 1346217023 0 Physicians Anesthesia Services 20 1346217023 0 Physicians Fluoride varnish 20 1346217023 0 Physicians Healthy Kids Services 20 1346217023 0 Physicians Optical Supplies 20 1346217023 0 Physicians Physician Services 00 1346217056 0 MOLITOR CHRISTOPHER E 2012032 9999999 B 10 1346217056 0 1145 CORPORATE LAKE DR 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1346241866 0 Physical Therapists Medical Supplies 20 1346241866 0 Physical Therapists Medical equipment/prosthetic devices 20 1346241866 0 Physical Therapists Physical Therapy Services 00 1346241916 0 SINDT CHRISTINE W 1997182 9999999 B 10 1346241916 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1346241916 0 Optometrists Optical Supplies 20 1346241916 0 Optometrists Optometric Services 20 1346241916 0 Optometrists Physician Services 00 1346241999 0 PRYOR MICHAEL P 2005182 9999999 B 10 1346241999 0 2530 CHICAGO AVE STE 400 MINNEAPOLIS MN 554044387 20 1346241999 0 Physicians Anesthesia Services 20 1346241999 0 Physicians Fluoride varnish 20 1346241999 0 Physicians Healthy Kids Services 20 1346241999 0 Physicians Optical Supplies 20 1346241999 0 Physicians Physician Services 00 1346242559 0 DEBOER DAVID 1995182 9999999 B 10 1346242559 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1346242559 0 Physicians Anesthesia Services 20 1346242559 0 Physicians Healthy Kids Services 20 1346242559 0 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1346381837 0 Physicians Physician Services 00 1346382959 0 LO LESLI 2001067 9999999 B 10 1346382959 0 5777 DEPT CAROL STREAM IL 601220021 20 1346382959 0 Physical Therapists Medical Supplies 20 1346382959 0 Physical Therapists Medical equipment/prosthetic devices 20 1346382959 0 Physical Therapists Physical Therapy Services 00 1346384492 0 TASIOPOULOS JOHN 1996183 9999999 B 10 1346384492 0 1880 W WINCHESTER RD STE 104 LIBERTYVILLE IL 600485321 20 1346384492 0 Physicians Anesthesia Services 20 1346384492 0 Physicians Fluoride varnish 20 1346384492 0 Physicians Healthy Kids Services 20 1346384492 0 Physicians Optical Supplies 20 1346384492 0 Physicians Physician Services 00 1346384534 0 JACKSON KAREN ANN 2015060 9999999 B 10 1346384534 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1346384534 0 Physicians Anesthesia Services 20 1346384534 0 Physicians Healthy Kids Services 20 1346384534 0 Physicians Optical Supplies 20 1346384534 0 Physicians Physician Services 00 1346386984 0 KUS ROBERT T 1996001 9999999 B 10 1346386984 0 600 W FULTON ST STE 200 CHICAGO IL 606611262 20 1346386984 0 Physicians Anesthesia Services 20 1346386984 0 Physicians Family Planning Counseling 20 1346386984 0 Physicians Healthy Kids Services 20 1346386984 0 Physicians Optical Supplies 20 1346386984 0 Physicians Physician Services 00 1346388774 0 BECK MICHAEL E 2004001 9999999 B 10 1346388774 0 4938 W 95TH ST OAK LAWN IL 604532504 20 1346388774 0 Physicians Anesthesia Services 20 1346388774 0 Physicians Fluoride varnish 20 1346388774 0 Physicians Healthy Kids Services 20 1346388774 0 Physicians Optical Supplies 20 1346388774 0 Physicians Physician Services 00 1346390358 0 SKURKA PAULA A 2020149 9999999 B 10 1346390358 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1346390358 0 Physical Therapists Medical Supplies 20 1346390358 0 Physical Therapists Medical equipment/prosthetic devices 20 1346390358 0 Physical Therapists Physical Therapy Services 00 1346390382 0 CLARDY CHRISTOPHER 1990036 9999999 B 10 1346390382 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1346390382 0 Physicians Anesthesia Services 20 1346390382 0 Physicians Fluoride varnish 20 1346390382 0 Physicians Healthy Kids Services 20 1346390382 0 Physicians Optical Supplies 20 1346390382 0 Physicians Physician Services 00 1346391976 0 WILSON KEITH P 2000245 9999999 B 10 1346391976 0 19990 GOVERNORS HWY OLYMPIA FIELDS IL 604611021 20 1346391976 0 Dentists Dental Services 20 1346391976 0 Dentists Physician Services 00 1346392750 0 RUSSELL TERRI L 2008254 9999999 B 10 1346392750 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1346392750 0 Nurse Practitioners Healthy Kids Services 20 1346392750 0 Nurse Practitioners Nurse Practitioners Services 20 1346392750 0 Nurse Practitioners Physician Services 00 1346393428 0 CURTIN JOHN 1981227 9999999 B 10 1346393428 0 PO BOX 1033 YORKVILLE IL 605600896 20 1346393428 0 Physicians Anesthesia Services 20 1346393428 0 Physicians Fluoride varnish 20 1346393428 0 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1346397403 0 Physicians Healthy Kids Services 20 1346397403 0 Physicians Optical Supplies 20 1346397403 0 Physicians Physician Services 00 1346397619 0 SHARP LARISA 2024031 9999999 B 10 1346397619 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1346397619 0 Physicians Anesthesia Services 20 1346397619 0 Physicians Fluoride varnish 20 1346397619 0 Physicians Healthy Kids Services 20 1346397619 0 Physicians Optical Supplies 20 1346397619 0 Physicians Physician Services 00 1346399029 0 SAMSON SHERWIN G 2007002 9999999 B 10 1346399029 0 5777 DEPT CAROL STREAM IL 601220021 20 1346399029 0 Nurse Practitioners Anesthesia Services 20 1346399029 0 Nurse Practitioners Nurse Practitioners Services 20 1346399029 0 Nurse Practitioners Physician Services 00 1346399086 0 SHEADE MICHAEL 1981227 9999999 B 10 1346399086 0 1015 SUMMIT ST ELGIN IL 601204362 20 1346399086 0 Physicians All Kids application agent 20 1346399086 0 Physicians Anesthesia Services 20 1346399086 0 Physicians Family Planning Counseling 20 1346399086 0 Physicians Fluoride varnish 20 1346399086 0 Physicians Healthy Kids Services 20 1346399086 0 Physicians Optical Supplies 20 1346399086 0 Physicians Physician Services 00 1346400850 0 YOCKEY BRETT 2015104 9999999 B 10 1346400850 0 210 W WALNUT ST CANTON IL 615202444 20 1346400850 0 Physicians Anesthesia Services 20 1346400850 0 Physicians Healthy Kids Services 20 1346400850 0 Physicians Optical Supplies 20 1346400850 0 Physicians Physician Services 00 1346401288 0 KHAN MUHAMMAD A 2023205 9999999 B 10 1346401288 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1346401288 0 Physicians Anesthesia Services 20 1346401288 0 Physicians Fluoride varnish 20 1346401288 0 Physicians Healthy Kids Services 20 1346401288 0 Physicians Optical Supplies 20 1346401288 0 Physicians Physician Services 00 1346401379 0 LUKENS MELINDA K 2024004 9999999 B 10 1346401379 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1346401379 0 Physicians Anesthesia Services 20 1346401379 0 Physicians Healthy 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2011121 9999999 B 10 1346403060 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1346403060 0 Physicians Anesthesia Services 20 1346403060 0 Physicians Fluoride varnish 20 1346403060 0 Physicians Healthy Kids Services 20 1346403060 0 Physicians Optical Supplies 20 1346403060 0 Physicians Physician Services 00 1346403268 0 COOPER TRISTAN 2014060 9999999 B 10 1346403268 0 1800 W CHARLESTON BLVD LAS VEGAS NV 891022329 20 1346403268 0 Physicians Anesthesia Services 20 1346403268 0 Physicians Healthy Kids Services 20 1346403268 0 Physicians Optical Supplies 20 1346403268 0 Physicians Physician Services 00 1346403359 0 CATANZARO JOSEPHINE CHOU 2023250 9999999 B 10 1346403359 0 PO BOX 110429 AURORA CO 800420429 20 1346403359 0 Physicians Anesthesia Services 20 1346403359 0 Physicians Healthy Kids Services 20 1346403359 0 Physicians Optical Supplies 20 1346403359 0 Physicians Physician Services 00 1346403664 0 BRADFORD CARRIE 2010182 9999999 B 10 1346403664 0 PO BOX 5959 CAROL STREAM IL 601975959 20 1346403664 0 Physicians Anesthesia Services 20 1346403664 0 Physicians Healthy Kids Services 20 1346403664 0 Physicians Optical Supplies 20 1346403664 0 Physicians Physician Services 00 1346403821 0 DEJONG MEGAN J 2012219 9999999 B 10 1346403821 0 5777 DEPT CAROL STREAM IL 601228942 20 1346403821 0 Physicians Anesthesia Services 20 1346403821 0 Physicians Healthy Kids Services 20 1346403821 0 Physicians Optical Supplies 20 1346403821 0 Physicians Physician Services 00 1346403961 0 CHANG JONATHAN S 2016294 9999999 B 10 1346403961 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1346403961 0 Physicians Anesthesia Services 20 1346403961 0 Physicians Healthy Kids Services 20 1346403961 0 Physicians Optical Supplies 20 1346403961 0 Physicians Physician Services 00 1346404100 0 SWEENEY KATHERINE 2008293 9999999 B 10 1346404100 0 7108 S KANNER HWY STUART FL 349977462 20 1346404100 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 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Physicians Physician Services 00 1346405172 0 RIZWAN SABINA 2022014 9999999 B 10 1346405172 0 6201 W 95TH ST OAK LAWN IL 604532701 20 1346405172 0 Optometrists Optical Supplies 20 1346405172 0 Optometrists Optometric Services 20 1346405172 0 Optometrists Physician Services 00 1346405271 0 ADKINS JUSTIN 2023096 9999999 B 10 1346405271 0 PO BOX 43230 PHOENIX AZ 850803230 20 1346405271 0 Physicians Anesthesia Services 20 1346405271 0 Physicians Healthy Kids Services 20 1346405271 0 Physicians Optical Supplies 20 1346405271 0 Physicians Physician Services 00 1346406113 0 BURKE ALLISON 2020283 2099365 B 10 1346406113 0 119 S WESTERN AVE UNIT 1 CHICAGO IL 606124644 20 1346406113 0 Physicians Anesthesia Services 20 1346406113 0 Physicians Healthy Kids Services 20 1346406113 0 Physicians Optical Supplies 20 1346406113 0 Physicians Physician Services 00 1346406162 0 BUIER LINDA 2017279 9999999 B 10 1346406162 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1346406162 0 Nurse Practitioners 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Physicians Physician Services 00 1346410453 0 SIDDIQI AHEED J 2008183 9999999 B 10 1346410453 0 44000 GARFIELD RD CLINTON TOWNSHI MI 480381125 20 1346410453 0 Physicians Anesthesia Services 20 1346410453 0 Physicians Healthy Kids Services 20 1346410453 0 Physicians Optical Supplies 20 1346410453 0 Physicians Physician Services 00 1346411212 0 CHAMPION BARBARA 2008092 9999999 B 10 1346411212 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1346411212 0 Nurse Practitioners Fluoride varnish 20 1346411212 0 Nurse Practitioners Healthy Kids Services 20 1346411212 0 Nurse Practitioners Nurse Practitioners Services 20 1346411212 0 Nurse Practitioners Physician Services 00 1346411634 0 ADATIA SHAKUNTALA M 1981227 9999999 B 10 1346411634 0 359 N FARNSWORTH AVE AURORA IL 605053082 20 1346411634 0 Dentists Dental Services 20 1346411634 0 Dentists Physician Services 00 1346411980 0 KABRE RASHMI 2012245 9999999 B 10 1346411980 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1346411980 0 Physicians Anesthesia Services 20 1346411980 0 Physicians Healthy Kids Services 20 1346411980 0 Physicians Optical Supplies 20 1346411980 0 Physicians Physician Services 00 1346412319 0 HARGETT JAMES L 2012183 9999999 B 10 1346412319 0 PO BOX 3276 EVANSVILLE IN 477313276 20 1346412319 0 Physicians Anesthesia Services 20 1346412319 0 Physicians Healthy Kids Services 20 1346412319 0 Physicians Optical Supplies 20 1346412319 0 Physicians Physician Services 00 1346413234 0 SINTIM-DAMOA AKOSUA 2016037 9999999 B 10 1346413234 0 51 N DUNLAP ST # G145 MEMPHIS TN 381054625 20 1346413234 0 Physicians Anesthesia Services 20 1346413234 0 Physicians Healthy Kids Services 20 1346413234 0 Physicians Optical Supplies 20 1346413234 0 Physicians Physician Services 00 1346414091 0 HAMMOND JOJO 2021184 9999999 B 10 1346414091 0 PO BOX 10010 GLENDALE AZ 853180010 20 1346414091 0 Physicians Anesthesia Services 20 1346414091 0 Physicians Healthy Kids Services 20 1346414091 0 Physicians Optical 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HOLTZ LORI R 2009182 9999999 B 10 1346415700 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1346415700 0 Physicians Anesthesia Services 20 1346415700 0 Physicians Fluoride varnish 20 1346415700 0 Physicians Healthy Kids Services 20 1346415700 0 Physicians Optical Supplies 20 1346415700 0 Physicians Physician Services 00 1346415718 0 KELL TIMOTHY 2013255 9999999 B 10 1346415718 0 621 S NEW BALLAS RD SUITE 4006B SAINT LOUIS MO 631418268 20 1346415718 0 Nurse Practitioners Healthy Kids Services 20 1346415718 0 Nurse Practitioners Nurse Practitioners Services 20 1346415718 0 Nurse Practitioners Physician Services 00 1346415908 0 MEZO ISAAC R 2013182 9999999 B 10 1346415908 0 725 SCHOOL ST STE A MORRIS IL 604501207 20 1346415908 0 Physicians Anesthesia Services 20 1346415908 0 Physicians Healthy Kids Services 20 1346415908 0 Physicians Optical Supplies 20 1346415908 0 Physicians Physician Services 20 1346415908 0 Physicians Physicians Psychiatric Services 00 1346416369 0 GARY BRANDI 2024219 9999999 B 10 1346416369 0 2261 MARKET ST STE 10450 SAN FRANCISCO CA 941141612 20 1346416369 0 Physicians Anesthesia Services 20 1346416369 0 Physicians Healthy Kids Services 20 1346416369 0 Physicians Optical Supplies 20 1346416369 0 Physicians Physician Services 00 1346417086 0 BAUER MICHAEL JAMES 2022203 9999999 B 10 1346417086 0 5801 WASHINGTON AVE STE 203 MOUNT PLEASANT WI 534064057 20 1346417086 0 Physicians Anesthesia Services 20 1346417086 0 Physicians Healthy Kids Services 20 1346417086 0 Physicians Optical Supplies 20 1346417086 0 Physicians Physician Services 00 1346418605 0 KAPADIA FATEMA N 2008057 9999999 B 10 1346418605 0 1101 S CAPITAL OF TEXAS HWY ST WEST LAKE HILLS TX 787466445 20 1346418605 0 Physical Therapists Medical Supplies 20 1346418605 0 Physical Therapists Medical equipment/prosthetic devices 20 1346418605 0 Physical Therapists Physical Therapy Services 00 1346418902 0 ULLRICH ANGI 2022293 9999999 B 10 1346418902 0 1942 E CANTRELL ST DECATUR 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1346434446 0 Nurse Practitioners Healthy Kids Services 20 1346434446 0 Nurse Practitioners Nurse Practitioners Services 20 1346434446 0 Nurse Practitioners Physician Services 00 1346434578 0 FISHMAN ILYA 2007213 9999999 B 10 1346434578 0 800 BIESTERFIELD RD STE 3007 ELK GROVE VILLA IL 600073371 20 1346434578 0 Physicians Anesthesia Services 20 1346434578 0 Physicians Healthy Kids Services 20 1346434578 0 Physicians Optical Supplies 20 1346434578 0 Physicians Physician Services 00 1346434693 0 LEHNERT MATTHEW 2017001 9999999 B 10 1346434693 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1346434693 0 Physicians Anesthesia Services 20 1346434693 0 Physicians Fluoride varnish 20 1346434693 0 Physicians Healthy Kids Services 20 1346434693 0 Physicians Optical Supplies 20 1346434693 0 Physicians Physician Services 00 1346436516 0 FOGEL NAOMI 2011001 9999999 B 10 1346436516 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1346436516 0 Physicians Anesthesia Services 20 1346436516 0 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1346448867 0 Physicians Anesthesia Services 20 1346448867 0 Physicians Fluoride varnish 20 1346448867 0 Physicians Healthy Kids Services 20 1346448867 0 Physicians Optical Supplies 20 1346448867 0 Physicians Physician Services 00 1346448925 0 MILLER JOHN A 2016259 9999999 B 10 1346448925 0 PO BOX 2010 FARGO ND 581222484 20 1346448925 0 Physicians Anesthesia Services 20 1346448925 0 Physicians Healthy Kids Services 20 1346448925 0 Physicians Optical Supplies 20 1346448925 0 Physicians Physician Services 00 1346449188 0 MCCULLOUGH TANNA 2007227 9999999 B 10 1346449188 0 2200 STATE ST LAWRENCEVILLE IL 624391852 20 1346449188 0 Nurse Practitioners Fluoride varnish 20 1346449188 0 Nurse Practitioners Healthy Kids Services 20 1346449188 0 Nurse Practitioners Nurse Practitioners Services 20 1346449188 0 Nurse Practitioners Physician Services 00 1346449527 0 NODINE ELIZABETH 1999213 9999999 B 10 1346449527 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1346449527 0 Physicians Anesthesia 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1346451655 0 Physicians Optical Supplies 20 1346451655 0 Physicians Physician Services 00 1346452174 0 JOHN ASHISH 2009215 9999999 B 10 1346452174 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1346452174 0 Physicians Anesthesia Services 20 1346452174 0 Physicians Fluoride varnish 20 1346452174 0 Physicians Healthy Kids Services 20 1346452174 0 Physicians Optical Supplies 20 1346452174 0 Physicians Physician Services 00 1346452786 0 DHANARAJAN ASHA 2013274 9999999 B 10 1346452786 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1346452786 0 Physicians Anesthesia Services 20 1346452786 0 Physicians Fluoride varnish 20 1346452786 0 Physicians Healthy Kids Services 20 1346452786 0 Physicians Optical Supplies 20 1346452786 0 Physicians Physician Services 00 1346453412 0 LULLO ANTOINETTE 2007201 9999999 B 10 1346453412 0 PO BOX 775248 CHICAGO IL 606775248 20 1346453412 0 Physicians Anesthesia Services 20 1346453412 0 Physicians Fluoride varnish 20 1346453412 0 Physicians Healthy Kids Services 20 1346453412 0 Physicians Optical Supplies 20 1346453412 0 Physicians Physician Services 00 1346454634 0 STONE RYAN A 2016001 9999999 B 10 1346454634 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1346454634 0 Physicians Anesthesia Services 20 1346454634 0 Physicians Healthy Kids Services 20 1346454634 0 Physicians Optical Supplies 20 1346454634 0 Physicians Physician Services 00 1346455094 0 BUSSING DANA 2012214 9999999 B 10 1346455094 0 26895 NETWORK PL CHICAGO IL 606731268 20 1346455094 0 Physicians Anesthesia Services 20 1346455094 0 Physicians Healthy Kids Services 20 1346455094 0 Physicians Optical Supplies 20 1346455094 0 Physicians Physician Services 00 1346455110 0 WU BING 2024201 9999999 B 10 1346455110 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1346455110 0 Physicians Anesthesia Services 20 1346455110 0 Physicians Fluoride varnish 20 1346455110 0 Physicians Healthy Kids Services 20 1346455110 0 Physicians Optical Supplies 20 1346455110 0 Physicians Physician Services 00 1346455185 0 KOSURI RAJANI 2011182 9999999 B 10 1346455185 0 PO BOX 5391 WOODRIDGE IL 605170391 20 1346455185 0 Physicians Anesthesia Services 20 1346455185 0 Physicians Fluoride varnish 20 1346455185 0 Physicians Healthy Kids Services 20 1346455185 0 Physicians Optical Supplies 20 1346455185 0 Physicians Physician Services 00 1346456399 0 DOUGLAS GEOFFREY P 2015026 9999999 B 10 1346456399 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1346456399 0 Physicians Anesthesia Services 20 1346456399 0 Physicians Healthy Kids Services 20 1346456399 0 Physicians Optical Supplies 20 1346456399 0 Physicians Physician Services 00 1346458189 0 IQBAL NAVEED S 2018099 9999999 B 10 1346458189 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1346458189 0 Physicians Anesthesia Services 20 1346458189 0 Physicians Fluoride varnish 20 1346458189 0 Physicians Healthy Kids Services 20 1346458189 0 Physicians Optical Supplies 20 1346458189 0 Physicians Physician Services 00 1346458411 0 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1346506607 0 Physicians Physician Services 00 1346506839 0 AUBERT GREGORY 2016071 9999999 B 10 1346506839 0 221 NE GLEN OAK AVE ATTN: STEPHEN CIRONE GOMP 100 PEORIA IL 616360001 20 1346506839 0 Physicians Anesthesia Services 20 1346506839 0 Physicians Fluoride varnish 20 1346506839 0 Physicians Healthy Kids Services 20 1346506839 0 Physicians Optical Supplies 20 1346506839 0 Physicians Physician Services 00 1346506995 0 DATTA NEHA 2023195 9999999 B 10 1346506995 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1346506995 0 Physicians Anesthesia Services 20 1346506995 0 Physicians Healthy Kids Services 20 1346506995 0 Physicians Optical Supplies 20 1346506995 0 Physicians Physician Services 00 1346507001 0 AHAMED MOHAMED F 2015329 9999999 B 10 1346507001 0 3051 HOLLIS DR SPRINGFIELD IL 627047452 20 1346507001 0 Physicians Anesthesia Services 20 1346507001 0 Physicians Fluoride varnish 20 1346507001 0 Physicians Healthy Kids Services 20 1346507001 0 Physicians Optical Supplies 20 1346507001 0 Physicians Physician Services 00 1346507803 0 MIRICA ANA 2012107 9999999 B 10 1346507803 0 400 N HIGHLAND AVE AURORA IL 605063814 20 1346507803 0 Nurse Practitioners Healthy Kids Services 20 1346507803 0 Nurse Practitioners Nurse Practitioners Services 20 1346507803 0 Nurse Practitioners Physician Services 00 1346508280 0 GLESNE KURT 2012219 9999999 B 10 1346508280 0 600 S 13TH ST PEKIN IL 615544936 20 1346508280 0 Podiatrists Podiatric Services 00 1346508314 0 GARCIA-REYES LAWRENCE D 2017220 9999999 B 10 1346508314 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1346508314 0 Physicians Anesthesia Services 20 1346508314 0 Physicians Healthy Kids Services 20 1346508314 0 Physicians Optical Supplies 20 1346508314 0 Physicians Physician Services 00 1346509346 0 BRAVERMAN JAIME 2018201 9999999 B 10 1346509346 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1346509346 0 Physicians Anesthesia Services 20 1346509346 0 Physicians Fluoride varnish 20 1346509346 0 Physicians Healthy Kids Services 20 1346509346 0 Physicians Optical Supplies 20 1346509346 0 Physicians Physician Services 00 1346509510 0 SMITH JACQUELYN J 2024213 9999999 B 10 1346509510 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1346509510 0 Psychologist Psychologist service 00 1346509783 0 RAINEY SABRINA C 2017020 9999999 B 10 1346509783 0 8326 NAAB RD INDIANAPOLIS IN 462601920 20 1346509783 0 Physicians Anesthesia Services 20 1346509783 0 Physicians Fluoride varnish 20 1346509783 0 Physicians Healthy Kids Services 20 1346509783 0 Physicians Optical Supplies 20 1346509783 0 Physicians Physician Services 00 1346509874 0 NEWSON SHAD D 2021281 9999999 B 10 1346509874 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1346509874 0 Physicians Anesthesia Services 20 1346509874 0 Physicians Fluoride varnish 20 1346509874 0 Physicians Healthy Kids Services 20 1346509874 0 Physicians Optical Supplies 20 1346509874 0 Physicians Physician Services 00 1346510898 0 CARR BRITTANY M 2020016 9999999 B 10 1346510898 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1346510898 0 Physician Assistant Only Fluoride varnish 20 1346510898 0 Physician Assistant Only Healthy Kids Services 20 1346510898 0 Physician Assistant Only Physician Services 00 1346512274 0 CONNOR ERIN 2022081 9999999 B 10 1346512274 0 PO BOX 41220 PHOENIX AZ 850801220 20 1346512274 0 Physicians Anesthesia Services 20 1346512274 0 Physicians Healthy Kids Services 20 1346512274 0 Physicians Optical Supplies 20 1346512274 0 Physicians Physician Services 00 1346513231 0 HEFNI LAMIAA 2013152 9999999 B 10 1346513231 0 15 SPINNING WHEEL RD STE 24 HINSDALE IL 605212935 20 1346513231 0 Physical Therapists Medical Supplies 20 1346513231 0 Physical Therapists Medical equipment/prosthetic devices 20 1346513231 0 Physical Therapists Physical Therapy Services 00 1346514080 0 MAGEE KRISTEN B 2017339 9999999 B 10 1346514080 0 4016 N CALIFORNIA AVE APT 1 CHICAGO IL 606189084 20 1346514080 0 Occupational Therapists Medical 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Services 00 1346516655 0 HERMES NESREEN 2014234 9999999 B 10 1346516655 0 7047 NORTH AVE OAK PARK IL 603021015 20 1346516655 0 Physicians Anesthesia Services 20 1346516655 0 Physicians Fluoride varnish 20 1346516655 0 Physicians Healthy Kids Services 20 1346516655 0 Physicians Optical Supplies 20 1346516655 0 Physicians Physician Services 00 1346516689 0 FITZGERALD KELLY M 2015201 9999999 B 10 1346516689 0 5777 DEPT CAROL STREAM IL 601228942 20 1346516689 0 Physicians Anesthesia Services 20 1346516689 0 Physicians Fluoride varnish 20 1346516689 0 Physicians Healthy Kids Services 20 1346516689 0 Physicians Optical Supplies 20 1346516689 0 Physicians Physician Services 00 1346518594 0 AMARILLO LYZ KARENT 2016273 9999999 B 10 1346518594 0 911 WASHINGTON AVE STE 501 SAINT LOUIS MO 631011272 20 1346518594 0 Other behavior health professional LCPC/LMFT services 00 1346519568 0 KANN LEAH R 2024258 9999999 B 10 1346519568 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1346519568 0 Nurse 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varnish 20 1346525235 0 Physicians Healthy Kids Services 20 1346525235 0 Physicians Optical Supplies 20 1346525235 0 Physicians Physician Services 00 1346528569 0 HOPKINS BRYAN J 2013007 9999999 B 10 1346528569 0 PO BOX 207163 DALLAS TX 753207154 20 1346528569 0 Optometrists Optical Supplies 20 1346528569 0 Optometrists Optometric Services 20 1346528569 0 Optometrists Physician Services 00 1346528809 0 CARRIS ALISON B 2012026 9999999 B 10 1346528809 0 6106 IVY DR LISLE IL 605323225 20 1346528809 0 Other behavior health professional LCPC/LMFT services 20 1346528809 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1346528858 0 VAASSEN SAMANTHA 2012205 9999999 B 10 1346528858 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1346528858 0 Optometrists Optical Supplies 20 1346528858 0 Optometrists Optometric Services 20 1346528858 0 Optometrists Physician Services 00 1346529245 0 MCKINLEY DARA L 2024302 9999999 B 10 1346529245 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1346529245 0 Nurse Practitioners Healthy Kids Services 20 1346529245 0 Nurse Practitioners Nurse Practitioners Services 20 1346529245 0 Nurse Practitioners Physician Services 00 1346529443 0 MONAHAN ANN 2017311 9999999 B 10 1346529443 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1346529443 0 Physicians Anesthesia Services 20 1346529443 0 Physicians Healthy Kids Services 20 1346529443 0 Physicians Optical Supplies 20 1346529443 0 Physicians Physician Services 00 1346530979 0 GALE DANIEL S 2017076 9999999 B 10 1346530979 0 855 N WESTHAVEN DR OSHKOSH WI 549047668 20 1346530979 0 Physicians Anesthesia Services 20 1346530979 0 Physicians Healthy Kids Services 20 1346530979 0 Physicians Optical Supplies 20 1346530979 0 Physicians Physician Services 00 1346531464 0 SRIVILASA CHARLIE 2018246 9999999 B 10 1346531464 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1346531464 0 Physicians Anesthesia Services 20 1346531464 0 Physicians Healthy Kids Services 20 1346531464 0 Physicians Optical Supplies 20 1346531464 0 Physicians Physician Services 00 1346531787 0 SUNG CASSANDRA 2023024 9999999 B 10 1346531787 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1346531787 0 Physicians Anesthesia Services 20 1346531787 0 Physicians Fluoride varnish 20 1346531787 0 Physicians Healthy Kids Services 20 1346531787 0 Physicians Optical Supplies 20 1346531787 0 Physicians Physician Services 00 1346532124 0 TACKETT JOHN J 2023216 9999999 B 10 1346532124 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1346532124 0 Physicians Anesthesia Services 20 1346532124 0 Physicians Healthy Kids Services 20 1346532124 0 Physicians Optical Supplies 20 1346532124 0 Physicians Physician Services 00 1346532371 0 CHEON ERIC 2015295 2099365 B 10 1346532371 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1346532371 0 Physicians Anesthesia Services 20 1346532371 0 Physicians Healthy Kids Services 20 1346532371 0 Physicians Optical Supplies 20 1346532371 0 Physicians Physician Services 00 1346532777 0 ROMER AMY J 2022001 9999999 B 10 1346532777 0 100 E PENN SQ PHILADELPHIA PA 191073323 20 1346532777 0 Physicians Anesthesia Services 20 1346532777 0 Physicians Fluoride varnish 20 1346532777 0 Physicians Healthy Kids Services 20 1346532777 0 Physicians Optical Supplies 20 1346532777 0 Physicians Physician Services 00 1346532934 0 OLADAPO FOLASADE A 2014121 9999999 B 10 1346532934 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1346532934 0 Physicians Anesthesia Services 20 1346532934 0 Physicians Healthy Kids Services 20 1346532934 0 Physicians Optical Supplies 20 1346532934 0 Physicians Physician Services 00 1346533353 0 KUBASIAK JOHN 2020351 9999999 B 10 1346533353 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1346533353 0 Physicians Anesthesia Services 20 1346533353 0 Physicians Healthy Kids Services 20 1346533353 0 Physicians Optical Supplies 20 1346533353 0 Physicians Physician Services 00 1346533528 0 TRETO CABRERA AILEEN 2025003 9999999 B 10 1346533528 0 1002 N ALLEN ST STE B ROBINSON IL 624541167 20 1346533528 0 Physicians Anesthesia Services 20 1346533528 0 Physicians Fluoride varnish 20 1346533528 0 Physicians Healthy Kids Services 20 1346533528 0 Physicians Optical Supplies 20 1346533528 0 Physicians Physician Services 00 1346533866 0 LUTTIG CHRISTOPHER T 2016366 9999999 B 10 1346533866 0 PO BOX 1027 BEDFORD PARK IL 604991027 20 1346533866 0 Physicians Anesthesia Services 20 1346533866 0 Physicians Fluoride varnish 20 1346533866 0 Physicians Healthy Kids Services 20 1346533866 0 Physicians Optical Supplies 20 1346533866 0 Physicians Physician Services 00 1346534161 0 QAYYUM ZAINEB 2014230 9999999 B 10 1346534161 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1346534161 0 Physicians Anesthesia Services 20 1346534161 0 Physicians Fluoride varnish 20 1346534161 0 Physicians Healthy Kids Services 20 1346534161 0 Physicians Optical Supplies 20 1346534161 0 Physicians Physician Services 00 1346534351 0 FRANCIS KALI 2014182 9999999 B 10 1346534351 0 PO BOX 776084 CHICAGO IL 606776084 20 1346534351 0 Physicians Anesthesia Services 20 1346534351 0 Physicians Fluoride varnish 20 1346534351 0 Physicians Healthy Kids Services 20 1346534351 0 Physicians Optical Supplies 20 1346534351 0 Physicians Physician Services 00 1346534724 0 COLEN ADAM E 2015215 9999999 B 10 1346534724 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1346534724 0 Physicians Anesthesia Services 20 1346534724 0 Physicians Fluoride varnish 20 1346534724 0 Physicians Healthy Kids Services 20 1346534724 0 Physicians Optical Supplies 20 1346534724 0 Physicians Physician Services 00 1346535770 0 HERBERT AUDREY G 2018311 9999999 B 10 1346535770 0 PO BOX 43230 PHOENIX AZ 850803230 20 1346535770 0 Physicians Anesthesia Services 20 1346535770 0 Physicians Healthy Kids Services 20 1346535770 0 Physicians Optical Supplies 20 1346535770 0 Physicians Physician Services 00 1346536315 0 TULL CAMERON A 2022067 9999999 B 10 1346536315 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1346536315 0 Physician Assistant Only Fluoride varnish 20 1346536315 0 Physician Assistant Only Healthy Kids Services 20 1346536315 0 Physician Assistant Only Physician Services 00 1346536620 0 PATEL SHILPAN 2015285 9999999 B 10 1346536620 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1346536620 0 Physicians Anesthesia Services 20 1346536620 0 Physicians Fluoride varnish 20 1346536620 0 Physicians Healthy Kids Services 20 1346536620 0 Physicians Optical Supplies 20 1346536620 0 Physicians Physician Services 00 1346536638 0 ALEKSANDROVA IRYNA 2014182 9999999 B 10 1346536638 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1346536638 0 Physicians Anesthesia Services 20 1346536638 0 Physicians Fluoride varnish 20 1346536638 0 Physicians Healthy Kids Services 20 1346536638 0 Physicians Optical Supplies 20 1346536638 0 Physicians Physician Services 00 1346537131 0 YANG MONA 2015310 9999999 B 10 1346537131 0 4849 N MILWAUKEE AVE STE 403 CHICAGO IL 606302169 20 1346537131 0 Dentists Dental Services 20 1346537131 0 Dentists Physician Services 00 1346537222 0 STETZ MICHAEL 2016153 9999999 B 10 1346537222 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1346537222 0 Physicians Anesthesia Services 20 1346537222 0 Physicians Healthy Kids Services 20 1346537222 0 Physicians Optical Supplies 20 1346537222 0 Physicians Physician Services 00 1346537404 0 ORLOWSKI HILARY L 2016275 9999999 B 10 1346537404 0 510 S KINGSHIGHWAY BLVD SAINT LOUIS MO 631101016 20 1346537404 0 Physicians Anesthesia Services 20 1346537404 0 Physicians Healthy Kids Services 20 1346537404 0 Physicians Optical Supplies 20 1346537404 0 Physicians Physician Services 00 1346538154 0 DUNN JASON A 2013115 9999999 B 10 1346538154 0 1107 AIRPORT RD BLOOMINGTON IL 617042544 20 1346538154 0 Optometrists Optical Supplies 20 1346538154 0 Optometrists Optometric Services 20 1346538154 0 Optometrists Physician Services 00 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2024282 9999999 B 10 1346603545 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1346603545 0 Physicians Anesthesia Services 20 1346603545 0 Physicians Healthy Kids Services 20 1346603545 0 Physicians Optical Supplies 20 1346603545 0 Physicians Physician Services 00 1346603875 0 MEYERSON CHERISE 2021137 9999999 B 10 1346603875 0 5777 DEPT CAROL STREAM IL 601220021 20 1346603875 0 Physicians Anesthesia Services 20 1346603875 0 Physicians Healthy Kids Services 20 1346603875 0 Physicians Optical Supplies 20 1346603875 0 Physicians Physician Services 00 1346604097 0 WESSELS STEPHANIE 2016182 9999999 B 10 1346604097 0 721 N LA SALLE DR CHICAGO IL 606543503 20 1346604097 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1346604139 0 MATALKA LEEN 2022009 9999999 B 10 1346604139 0 PO BOX 43230 PHOENIX AZ 850803230 20 1346604139 0 Physicians Anesthesia Services 20 1346604139 0 Physicians Fluoride varnish 20 1346604139 0 Physicians 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ALICIA T 2019284 9999999 B 10 1346609914 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1346609914 0 Nurse Practitioners Healthy Kids Services 20 1346609914 0 Nurse Practitioners Nurse Practitioners Services 20 1346609914 0 Nurse Practitioners Physician Services 00 1346611365 0 SMITH JAMIE N 2018003 9999999 B 10 1346611365 0 PO BOX 604 BLOOMINGTON IL 617020604 20 1346611365 0 Clinical Social Worker Social work service 00 1346611670 0 HOWE SARAH M 2017095 9999999 B 10 1346611670 0 PO BOX 5588 BELFAST ME 049155500 20 1346611670 0 Nurse Practitioners Healthy Kids Services 20 1346611670 0 Nurse Practitioners Nurse Practitioners Services 20 1346611670 0 Nurse Practitioners Physician Services 00 1346612140 0 BALABAN MALGORZATA 2016005 9999999 B 10 1346612140 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1346612140 0 Nurse Practitioners Healthy Kids Services 20 1346612140 0 Nurse Practitioners Nurse Practitioners Services 20 1346612140 0 Nurse Practitioners Physician Services 00 1346612561 0 QADRI SUBUHI 2016343 9999999 B 10 1346612561 0 1812 BROADWAY ST MELROSE PARK IL 601602039 20 1346612561 0 Dentists Dental Services 20 1346612561 0 Dentists Physician Services 00 1346613718 0 GALLOWAY CHRISTOPHER 2017182 9999999 B 10 1346613718 0 20660 CATON FARM RD UNIT F CREST HILL IL 604031201 20 1346613718 0 Nurse Practitioners Fluoride varnish 20 1346613718 0 Nurse Practitioners Healthy Kids Services 20 1346613718 0 Nurse Practitioners Nurse Practitioners Services 20 1346613718 0 Nurse Practitioners Physician Services 00 1346614161 0 ZAKARI NOURA 2016100 9999999 B 10 1346614161 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1346614161 0 Nurse Practitioners Healthy Kids Services 20 1346614161 0 Nurse Practitioners Nurse Practitioners Services 20 1346614161 0 Nurse Practitioners Physician Services 00 1346614435 0 SHORES-GASTON RENITA 2016090 9999999 B 10 1346614435 0 5844 ELAINE DR STE 101 ROCKFORD IL 611082494 20 1346614435 0 Clinical Social Worker Social work service 00 1346614864 0 SANTANA ANGELA P 2017079 9999999 B 10 1346614864 0 31 SHORE DR PORTAGE IN 463681008 20 1346614864 0 Speech Therapists Medical Supplies 20 1346614864 0 Speech Therapists Medical equipment/prosthetic devices 20 1346614864 0 Speech Therapists Speech Therapy/Pathology Services 00 1346615663 0 ERNZEN JOHN 2019182 9999999 B 10 1346615663 0 4720 N CLARENDON AVE CHICAGO IL 606405122 20 1346615663 0 Physicians Anesthesia Services 20 1346615663 0 Physicians Healthy Kids Services 20 1346615663 0 Physicians Optical Supplies 20 1346615663 0 Physicians Physician Services 20 1346615663 0 Physicians Physicians Psychiatric Services 00 1346616133 0 ROSKA ED ALLEN E 2015314 9999999 B 10 1346616133 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1346616133 0 Nurse Practitioners Anesthesia Services 20 1346616133 0 Nurse Practitioners Nurse Practitioners Services 20 1346616133 0 Nurse Practitioners Physician Services 00 1346616372 0 MULLER JAMIE L 2016076 9999999 B 10 1346616372 0 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Supplies 20 1346617628 0 Physical Therapists Medical equipment/prosthetic devices 20 1346617628 0 Physical Therapists Physical Therapy Services 00 1346618121 0 GESTES LAUREN 2018220 9999999 H 10 1346618121 0 333 N LA GRANGE RD STE 1 SUITE ONE LA GRANGE PARK IL 605265653 20 1346618121 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1346619095 0 WALK JENNIFER 2015285 9999999 B 10 1346619095 0 500 PORTER AVE AURORA MO 656052365 20 1346619095 0 Nurse Practitioners Fluoride varnish 20 1346619095 0 Nurse Practitioners Healthy Kids Services 20 1346619095 0 Nurse Practitioners Nurse Practitioners Services 20 1346619095 0 Nurse Practitioners Physician Services 00 1346620366 0 HUNDAL RAJBIR 2020170 9999999 B 10 1346620366 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1346620366 0 Physicians Anesthesia Services 20 1346620366 0 Physicians Healthy Kids Services 20 1346620366 0 Physicians Optical Supplies 20 1346620366 0 Physicians Physician Services 00 1346620838 0 BHARDWAJ RICHA 2022158 9999999 B 10 1346620838 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1346620838 0 Physicians Anesthesia Services 20 1346620838 0 Physicians Fluoride varnish 20 1346620838 0 Physicians Healthy Kids Services 20 1346620838 0 Physicians Optical Supplies 20 1346620838 0 Physicians Physician Services 00 1346621042 0 SALFITY NINA 2021201 9999999 B 10 1346621042 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1346621042 0 Physicians Anesthesia Services 20 1346621042 0 Physicians Fluoride varnish 20 1346621042 0 Physicians Healthy Kids Services 20 1346621042 0 Physicians Optical Supplies 20 1346621042 0 Physicians Physician Services 00 1346621083 0 NGUYEN PHUONG T 2023011 9999999 B 10 1346621083 0 PO BOX 43230 PHOENIX AZ 850803230 20 1346621083 0 Physicians Anesthesia Services 20 1346621083 0 Physicians Fluoride varnish 20 1346621083 0 Physicians Healthy Kids Services 20 1346621083 0 Physicians Optical Supplies 20 1346621083 0 Physicians Physician Services 00 1346621257 0 PEDDY RYAN R 2018270 9999999 B 10 1346621257 0 611 W PARK ST URBANA IL 618012529 20 1346621257 0 Physicians Anesthesia Services 20 1346621257 0 Physicians Fluoride varnish 20 1346621257 0 Physicians Healthy Kids Services 20 1346621257 0 Physicians Optical Supplies 20 1346621257 0 Physicians Physician Services 00 1346621505 0 LORTS STEPHANIE N 2018131 9999999 B 10 1346621505 0 4804 S STATE ROUTE 159 GLEN CARBON IL 620341904 20 1346621505 0 Physicians Anesthesia Services 20 1346621505 0 Physicians Fluoride varnish 20 1346621505 0 Physicians Healthy Kids Services 20 1346621505 0 Physicians Optical Supplies 20 1346621505 0 Physicians Physician Services 00 1346622628 0 MC DERMOTT SARAH E 2022362 9999999 B 10 1346622628 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1346622628 0 Physicians Anesthesia Services 20 1346622628 0 Physicians Fluoride varnish 20 1346622628 0 Physicians Healthy Kids Services 20 1346622628 0 Physicians Optical Supplies 20 1346622628 0 Physicians Physician Services 00 1346623055 0 SAMBHARIA MEENAKSHI 2020183 9999999 B 10 1346623055 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1346623055 0 Physicians Anesthesia Services 20 1346623055 0 Physicians Fluoride varnish 20 1346623055 0 Physicians Healthy Kids Services 20 1346623055 0 Physicians Optical Supplies 20 1346623055 0 Physicians Physician Services 00 1346623832 0 GREYSON MARGARET A 2015266 9999999 B 10 1346623832 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1346623832 0 Physical Therapists Medical Supplies 20 1346623832 0 Physical Therapists Medical equipment/prosthetic devices 20 1346623832 0 Physical Therapists Physical Therapy Services 00 1346624020 0 SASS LAURA 2015208 9999999 B 10 1346624020 0 500 W RIVER DR DAVENPORT IA 528011014 20 1346624020 0 Dentists Dental Services 20 1346624020 0 Dentists Physician Services 00 1346624293 0 WALSH KAREN A 2018345 9999999 B 10 1346624293 0 5777 DEPT CAROL STREAM IL 601220021 20 1346624293 0 Nurse Practitioners Healthy Kids Services 20 1346624293 0 Nurse Practitioners Nurse Practitioners Services 20 1346624293 0 Nurse Practitioners Physician Services 00 1346626280 0 ADLER JENNA M 2023240 9999999 B 10 1346626280 0 4840 W BYRON ST CHICAGO IL 606412712 20 1346626280 0 Clinical Social Worker Social work service 00 1346626389 0 GINDER KELSEY L 2019021 9999999 B 10 1346626389 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1346626389 0 Clinical Social Worker Social work service 00 1346626702 0 LAWRENCE ALESANDRA 2017018 9999999 B 10 1346626702 0 245 W EXCHANGE ST SYCAMORE IL 601781495 20 1346626702 0 Audiologists Audiology Services 20 1346626702 0 Audiologists Medical Supplies 20 1346626702 0 Audiologists Medical equipment/prosthetic devices 00 1346627536 0 SPRAGUE LISA K 2015121 9999999 B 10 1346627536 0 1025 MAINE ST QUINCY IL 623014038 20 1346627536 0 Nurse Practitioners Healthy Kids Services 20 1346627536 0 Nurse Practitioners Nurse Practitioners Services 20 1346627536 0 Nurse Practitioners Physician Services 00 1346628054 0 HOVORKA BRIAN 2017032 9999999 B 10 1346628054 0 100 W PLAINFIELD RD COUNTRYSIDE IL 605252869 20 1346628054 0 Occupational Therapists Medical Supplies 20 1346628054 0 Occupational Therapists Medical equipment/prosthetic devices 20 1346628054 0 Occupational Therapists Occupational Therapy Services 00 1346628351 0 PETERSON GINETTE 2019152 9999999 B 10 1346628351 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1346628351 0 Nurse Practitioners Anesthesia Services 20 1346628351 0 Nurse Practitioners Nurse Practitioners Services 20 1346628351 0 Nurse Practitioners Physician Services 00 1346628617 0 SHOPP LAURA M 2021251 9999999 B 10 1346628617 0 PO BOX 1510 EVANSVILLE IN 477061510 20 1346628617 0 Physicians Anesthesia Services 20 1346628617 0 Physicians Fluoride varnish 20 1346628617 0 Physicians Healthy Kids Services 20 1346628617 0 Physicians Optical Supplies 20 1346628617 0 Physicians Physician Services 00 1346628997 0 PEZZINO RACHEL L 2021195 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1346631009 0 Physicians Anesthesia Services 20 1346631009 0 Physicians Fluoride varnish 20 1346631009 0 Physicians Healthy Kids Services 20 1346631009 0 Physicians Optical Supplies 20 1346631009 0 Physicians Physician Services 00 1346632502 0 PELLICER DANIEL 2025063 9999999 B 10 1346632502 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1346632502 0 Physicians Anesthesia Services 20 1346632502 0 Physicians Healthy Kids Services 20 1346632502 0 Physicians Optical Supplies 20 1346632502 0 Physicians Physician Services 00 1346633872 0 MCCORMACK MARIBETH J 2015001 9999999 B 10 1346633872 0 3015 N BALLAS RD SAINT LOUIS MO 631312329 20 1346633872 0 Nurse Practitioners Anesthesia Services 20 1346633872 0 Nurse Practitioners Nurse Practitioners Services 20 1346633872 0 Nurse Practitioners Physician Services 00 1346634011 0 BLYLY LAUREN M 2022201 9999999 B 10 1346634011 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1346634011 0 Physician Assistant Only Fluoride varnish 20 1346634011 0 Physician Assistant Only Healthy Kids Services 20 1346634011 0 Physician Assistant Only Physician Services 00 1346634193 0 SARTIPI SHAYAN 2015201 9999999 B 10 1346634193 0 PO BOX 17633 BELFAST ME 049154071 20 1346634193 0 Physicians Anesthesia Services 20 1346634193 0 Physicians Fluoride varnish 20 1346634193 0 Physicians Healthy Kids Services 20 1346634193 0 Physicians Optical Supplies 20 1346634193 0 Physicians Physician Services 00 1346635331 0 GERMAN OLGA 2019175 9999999 B 10 1346635331 0 1000 RANDALL RD STE 100 GENEVA IL 601342591 20 1346635331 0 Physicians Anesthesia Services 20 1346635331 0 Physicians Healthy Kids Services 20 1346635331 0 Physicians Optical Supplies 20 1346635331 0 Physicians Physician Services 00 1346635380 0 PEET BRADLEY T 2023158 9999999 B 10 1346635380 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1346635380 0 Physicians Anesthesia Services 20 1346635380 0 Physicians Healthy Kids Services 20 1346635380 0 Physicians Optical Supplies 20 1346635380 0 Physicians Physician Services 20 1346635380 0 Physicians Physicians Psychiatric Services 00 1346635497 0 ARINZE NKIRUKA 2024222 9999999 B 10 1346635497 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1346635497 0 Physicians Anesthesia Services 20 1346635497 0 Physicians Healthy Kids Services 20 1346635497 0 Physicians Optical Supplies 20 1346635497 0 Physicians Physician Services 00 1346636156 0 SHETTY NEIL K 2019063 9999999 B 10 1346636156 0 5777 DEPT CAROL STREAM IL 601220021 20 1346636156 0 Physicians Anesthesia Services 20 1346636156 0 Physicians Healthy Kids Services 20 1346636156 0 Physicians Optical Supplies 20 1346636156 0 Physicians Physician Services 20 1346636156 0 Physicians Physicians Psychiatric Services 00 1346636479 0 SUAREZ DANIEL P 2021209 9999999 B 10 1346636479 0 800 E LOCUST ST OLNEY IL 624502553 20 1346636479 0 Physicians Anesthesia Services 20 1346636479 0 Physicians Fluoride varnish 20 1346636479 0 Physicians Healthy Kids Services 20 1346636479 0 Physicians Optical Supplies 20 1346636479 0 Physicians Physician Services 00 1346637170 0 RODRIGUEZ SOLARES ADIB F 2021181 9999999 B 10 1346637170 0 1800 W CHARLESTON BLVD LAS VEGAS NV 891022329 20 1346637170 0 Physicians Anesthesia Services 20 1346637170 0 Physicians Fluoride varnish 20 1346637170 0 Physicians Healthy Kids Services 20 1346637170 0 Physicians Optical Supplies 20 1346637170 0 Physicians Physician Services 00 1346637485 0 ZHANG HAO 2021133 9999999 B 10 1346637485 0 5777 DEPT CAROL STREAM IL 601220021 20 1346637485 0 Physicians Anesthesia Services 20 1346637485 0 Physicians Fluoride varnish 20 1346637485 0 Physicians Healthy Kids Services 20 1346637485 0 Physicians Optical Supplies 20 1346637485 0 Physicians Physician Services 00 1346637626 0 BUNGCAYAO RICHELLE M 2023264 9999999 B 10 1346637626 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1346637626 0 Occupational Therapists Medical Supplies 20 1346637626 0 Occupational Therapists Medical equipment/prosthetic devices 20 1346637626 0 Occupational Therapists Occupational Therapy Services 00 1346638806 0 EBERT ASHLEY 2015278 9999999 B 10 1346638806 0 600 N COLLEGE AVE GENESEO IL 612541091 20 1346638806 0 Nurse Practitioners Healthy Kids Services 20 1346638806 0 Nurse Practitioners Nurse Practitioners Services 20 1346638806 0 Nurse Practitioners Physician Services 00 1346638947 0 KNEIP MELISSA J 2015233 9999999 B 10 1346638947 0 PO BOX 713388 CHICAGO IL 606771525 20 1346638947 0 Nurse Practitioners Fluoride varnish 20 1346638947 0 Nurse Practitioners Healthy Kids Services 20 1346638947 0 Nurse Practitioners Nurse Practitioners Services 20 1346638947 0 Nurse Practitioners Physician Services 00 1346640828 0 MAY ELLEN 2014244 9999999 B 10 1346640828 0 PO BOX 809094 CHICAGO IL 606809094 20 1346640828 0 Audiologists Audiology Services 20 1346640828 0 Audiologists Medical Supplies 20 1346640828 0 Audiologists Medical equipment/prosthetic devices 00 1346641115 0 WADLOW TARA R 2016160 9999999 B 10 1346641115 0 1101 W LIBERTY ST ADMINISTRATION FARMINGTON MO 636401921 20 1346641115 0 Nurse Practitioners Fluoride varnish 20 1346641115 0 Nurse Practitioners Healthy Kids Services 20 1346641115 0 Nurse Practitioners Nurse Practitioners Services 20 1346641115 0 Nurse Practitioners Physician Services 00 1346641487 0 DESAI PINAL K 2017100 9999999 B 10 1346641487 0 1660 FEEHANVILLE DR STE 200 MOUNT PROSPECT IL 600566036 20 1346641487 0 Physician Assistant Only Fluoride varnish 20 1346641487 0 Physician Assistant Only Healthy Kids Services 20 1346641487 0 Physician Assistant Only Physician Services 00 1346641560 0 CRAZYTHUNDER JENIFER 2016348 9999999 B 10 1346641560 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1346641560 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1346643293 0 COBERT ROBERT 2015141 9999999 B 10 1346643293 0 1236 E RUSHOLME ST STE 300 DAVENPORT IA 528032473 20 1346643293 0 Nurse Practitioners Fluoride varnish 20 1346643293 0 Nurse Practitioners Healthy Kids Services 20 1346643293 0 Nurse Practitioners Nurse Practitioners Services 20 1346643293 0 Nurse Practitioners Physician Services 00 1346645918 0 DENTON TAMARA 2015126 9999999 H 10 1346645918 0 15127 S 73RD AVE STE C SUITE C ORLAND PARK IL 604623463 20 1346645918 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1346645991 0 DEISS KYRA A 2016097 9999999 B 10 1346645991 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1346645991 0 Physician Assistant Only Fluoride varnish 20 1346645991 0 Physician Assistant Only Healthy Kids Services 20 1346645991 0 Physician Assistant Only Physician Services 00 1346646213 0 WALSH DEBORAH 2015019 9999999 B 10 1346646213 0 611 W PARK ST URBANA IL 618012529 20 1346646213 0 Nurse Practitioners Fluoride varnish 20 1346646213 0 Nurse Practitioners Healthy Kids Services 20 1346646213 0 Nurse Practitioners Nurse Practitioners Services 20 1346646213 0 Nurse Practitioners Physician Services 00 1346646429 0 SCHUSTER MICHELE 2015050 9999999 H 10 1346646429 0 3033 W JEFFERSON SUITE 107 JOLIET IL 604355298 20 1346646429 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1346648185 0 NYSTROM LINDA 2015005 9999999 B 10 1346648185 0 400 N HIGHLAND AVE AURORA IL 605063814 20 1346648185 0 Nurse Practitioners Fluoride varnish 20 1346648185 0 Nurse Practitioners Healthy Kids Services 20 1346648185 0 Nurse Practitioners Nurse Practitioners Services 20 1346648185 0 Nurse Practitioners Physician Services 00 1346648573 0 PETTIT LINDA 2015350 9999999 B 10 1346648573 0 PO BOX 772 MC2295 WOONSOCKET RI 028950784 20 1346648573 0 Nurse Practitioners Fluoride varnish 20 1346648573 0 Nurse Practitioners Healthy Kids Services 20 1346648573 0 Nurse Practitioners Nurse Practitioners Services 20 1346648573 0 Nurse Practitioners Physician Services 00 1346648755 0 LOWERY KATHLEEN 2014293 9999999 B 10 1346648755 0 PO BOX 80309 PHILADELPHIA PA 191011309 20 1346648755 0 Nurse Practitioners Healthy Kids Services 20 1346648755 0 Nurse Practitioners Nurse Practitioners Services 20 1346648755 0 Nurse Practitioners Physician Services 00 1346649209 0 POWELL APRIL 2014242 9999999 B 10 1346649209 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1346649209 0 Nurse Practitioners Fluoride varnish 20 1346649209 0 Nurse Practitioners Healthy Kids Services 20 1346649209 0 Nurse Practitioners Nurse Practitioners Services 20 1346649209 0 Nurse Practitioners Physician Services 00 1346649282 0 AKKINENI KANTHI 2016105 9999999 B 10 1346649282 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1346649282 0 Physician Assistant Only Fluoride varnish 20 1346649282 0 Physician Assistant Only Healthy Kids Services 20 1346649282 0 Physician Assistant Only Physician Services 00 1346650249 0 OLEAR OSEZUA JOHN 2019197 9999999 B 10 1346650249 0 1395 NW 167TH ST MIAMI FL 331695710 20 1346650249 0 Physicians Anesthesia Services 20 1346650249 0 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CYDNEY C 2024185 9999999 B 10 1346746716 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1346746716 0 Physicians Anesthesia Services 20 1346746716 0 Physicians Fluoride varnish 20 1346746716 0 Physicians Healthy Kids Services 20 1346746716 0 Physicians Optical Supplies 20 1346746716 0 Physicians Physician Services 00 1346746864 0 HWANG JENNIFER H 2022164 9999999 B 10 1346746864 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1346746864 0 Physicians Anesthesia Services 20 1346746864 0 Physicians Fluoride varnish 20 1346746864 0 Physicians Healthy Kids Services 20 1346746864 0 Physicians Optical Supplies 20 1346746864 0 Physicians Physician Services 00 1346747292 0 FONSECA-PARICIO MARIO J 2021170 9999999 B 10 1346747292 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1346747292 0 Physicians Anesthesia Services 20 1346747292 0 Physicians Fluoride varnish 20 1346747292 0 Physicians Healthy Kids Services 20 1346747292 0 Physicians Optical Supplies 20 1346747292 0 Physicians Physician Services 00 1346747342 0 CAPELOUTO SARAH M 2022144 9999999 B 10 1346747342 0 5777 DEPT CAROL STREAM IL 601220021 20 1346747342 0 Physicians Anesthesia Services 20 1346747342 0 Physicians Healthy Kids Services 20 1346747342 0 Physicians Optical Supplies 20 1346747342 0 Physicians Physician Services 00 1346747771 0 OKENDO JOYCE A 2022181 9999999 B 10 1346747771 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1346747771 0 Physicians Anesthesia Services 20 1346747771 0 Physicians Healthy Kids Services 20 1346747771 0 Physicians Optical Supplies 20 1346747771 0 Physicians Physician Services 20 1346747771 0 Physicians Physicians Psychiatric Services 00 1346747888 0 GIUROVICI MICHELE 2021124 9999999 B 10 1346747888 0 412 W 31ST ST CHICAGO IL 606163116 20 1346747888 0 Physical Therapists Medical Supplies 20 1346747888 0 Physical Therapists Medical equipment/prosthetic devices 20 1346747888 0 Physical Therapists Physical Therapy Services 00 1346749389 0 EARHART 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0 Speech Therapists Medical equipment/prosthetic devices 20 1346752201 0 Speech Therapists Speech Therapy/Pathology Services 00 1346752557 0 FOGLE JENNIFER 2017282 9999999 B 10 1346752557 0 320 E CENTRAL AVE DECATUR IL 625214665 20 1346752557 0 Nurse Practitioners Fluoride varnish 20 1346752557 0 Nurse Practitioners Healthy Kids Services 20 1346752557 0 Nurse Practitioners Nurse Practitioners Services 20 1346752557 0 Nurse Practitioners Physician Services 00 1346752581 0 MANKARIOUS MARY 2023283 9999999 B 10 1346752581 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1346752581 0 Physical Therapists Medical Supplies 20 1346752581 0 Physical Therapists Medical equipment/prosthetic devices 20 1346752581 0 Physical Therapists Physical Therapy Services 00 1346753738 0 GRAVEN ALEXIS R 2017318 9999999 B 10 1346753738 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1346753738 0 Nurse Practitioners Healthy Kids Services 20 1346753738 0 Nurse Practitioners Nurse Practitioners Services 20 1346753738 0 Nurse Practitioners Physician Services 00 1346754835 0 ARMSTRONG DETONYA 2018001 9999999 B 10 1346754835 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1346754835 0 Nurse Practitioners Fluoride varnish 20 1346754835 0 Nurse Practitioners Healthy Kids Services 20 1346754835 0 Nurse Practitioners Nurse Practitioners Services 20 1346754835 0 Nurse Practitioners Physician Services 00 1346755477 0 HOLMBERG CHRISTINE 2017354 9999999 B 10 1346755477 0 524 E SCHAUMBURG RD SCHAUMBURG IL 601943510 20 1346755477 0 Speech Therapists Medical Supplies 20 1346755477 0 Speech Therapists Medical equipment/prosthetic devices 20 1346755477 0 Speech Therapists Speech Therapy/Pathology Services 00 1346756954 0 LARSEN REBECCA 2017353 9999999 B 10 1346756954 0 15732 S HOWARD ST PLAINFIELD IL 605442399 20 1346756954 0 Speech Therapists Medical Supplies 20 1346756954 0 Speech Therapists Medical equipment/prosthetic devices 20 1346756954 0 Speech Therapists Speech Therapy/Pathology Services 00 1346757374 0 OTOOLE-GRANBERRY CYNTHIA 2018005 9999999 B 10 1346757374 0 501 7TH ST ROCKFORD IL 611041242 20 1346757374 0 Speech Therapists Medical Supplies 20 1346757374 0 Speech Therapists Medical equipment/prosthetic devices 20 1346757374 0 Speech Therapists Speech Therapy/Pathology Services 00 1346759461 0 MESERVE ALISHA M 2022020 9999999 B 10 1346759461 0 PO BOX 110429 AURORA CO 800420429 20 1346759461 0 Physician Assistant Only Fluoride varnish 20 1346759461 0 Physician Assistant Only Healthy Kids Services 20 1346759461 0 Physician Assistant Only Physician Services 00 1346760105 0 HARDING BRETTE C 2023205 9999999 B 10 1346760105 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1346760105 0 Physicians Anesthesia Services 20 1346760105 0 Physicians Healthy Kids Services 20 1346760105 0 Physicians Optical Supplies 20 1346760105 0 Physicians Physician Services 00 1346760253 0 DEVLIN ELIZABETH 2017198 9999999 B 10 1346760253 0 902 N HERSHEY RD BLOOMINGTON IL 617043730 20 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601603902 20 1346764552 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1346764834 0 FINN MARGARET 2023004 9999999 B 10 1346764834 0 5777 DEPT CAROL STREAM IL 601220021 20 1346764834 0 Physical Therapists Medical Supplies 20 1346764834 0 Physical Therapists Medical equipment/prosthetic devices 20 1346764834 0 Physical Therapists Physical Therapy Services 00 1346765211 0 SCHEITZ LUCAS 2024325 9999999 B 10 1346765211 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1346765211 0 Physician Assistant Only Fluoride varnish 20 1346765211 0 Physician Assistant Only Healthy Kids Services 20 1346765211 0 Physician Assistant Only Physician Services 00 1346766011 0 VENHAUS ALEXANDRIA N 2021196 9999999 B 10 1346766011 0 1441 W BROADWAY CENTRALIA IL 628015613 20 1346766011 0 Physical Therapists Medical Supplies 20 1346766011 0 Physical Therapists Medical equipment/prosthetic devices 20 1346766011 0 Physical Therapists Physical Therapy Services 00 1346767027 0 AMORUSO SCOTT 2018241 9999999 B 10 1346767027 0 PO BOX 79591 BALTIMORE MD 212790591 20 1346767027 0 Optometrists Optical Supplies 20 1346767027 0 Optometrists Optometric Services 20 1346767027 0 Optometrists Physician Services 00 1346767449 0 KIENZLE STEPHAN 2021176 9999999 B 10 1346767449 0 4698 DEPT CAROL STREAM IL 601220021 20 1346767449 0 Physicians Anesthesia Services 20 1346767449 0 Physicians Healthy Kids Services 20 1346767449 0 Physicians Optical Supplies 20 1346767449 0 Physicians Physician Services 00 1346768058 0 MATHEW JENNY 2017262 9999999 B 10 1346768058 0 370 SUMMIT ST # 1 ELGIN IL 601203843 20 1346768058 0 Nurse Practitioners Healthy Kids Services 20 1346768058 0 Nurse Practitioners Nurse Practitioners Services 20 1346768058 0 Nurse Practitioners Physician Services 00 1346768199 0 DELGADO FLOR 2017254 9999999 B 10 1346768199 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1346768199 0 Physical Therapists Medical Supplies 20 1346768199 0 Physical Therapists Medical equipment/prosthetic devices 20 1346768199 0 Physical Therapists Physical Therapy Services 00 1346768306 0 GIPSON KESHIA 2017263 9999999 H 10 1346768306 0 1200 S DUNTON AVE ARLINGTON HEIGH IL 600053111 20 1346768306 0 Other behavior health professional Development Therapy, Orientation and Mobility Services 20 1346768306 0 Other behavior health professional Early Intervention Services 20 1346768306 0 Other behavior health professional Targeted case management service 00 1346768660 0 WIEWEL BRENDA 2017250 9999999 B 10 1346768660 0 4812 PFEIFFER RD BARTONVILLE IL 616072647 20 1346768660 0 Speech Therapists Medical Supplies 20 1346768660 0 Speech Therapists Medical equipment/prosthetic devices 20 1346768660 0 Speech Therapists Speech Therapy/Pathology Services 00 1346768751 0 LOWRY SHAE N 2017249 9999999 B 10 1346768751 0 634 N MAIN ST STE 3 O FALLON IL 622693746 20 1346768751 0 Speech Therapists Medical Supplies 20 1346768751 0 Speech Therapists Medical equipment/prosthetic devices 20 1346768751 0 Speech Therapists Speech Therapy/Pathology Services 00 1346768769 0 MCLEOD TANYA 2023223 9999999 B 10 1346768769 0 7373 N LINCOLN AVE LINCOLNWOOD IL 607121715 20 1346768769 0 Clinical Social Worker Social work service 00 1346769171 0 MARSH SARAH E 2017257 9999999 B 10 1346769171 0 515 22ND AVE MONROE WI 535661569 20 1346769171 0 Nurse Practitioners Fluoride varnish 20 1346769171 0 Nurse Practitioners Healthy Kids Services 20 1346769171 0 Nurse Practitioners Nurse Practitioners Services 20 1346769171 0 Nurse Practitioners Physician Services 00 1346769338 0 BALDWIN RACHEL M 2018236 9999999 B 10 1346769338 0 1640 N WELLS ST UNIT 103 CHICAGO IL 606146006 20 1346769338 0 Speech Therapists Medical Supplies 20 1346769338 0 Speech Therapists Medical equipment/prosthetic devices 20 1346769338 0 Speech Therapists Speech Therapy/Pathology Services 00 1346770047 0 ALADI STANLEY 2021165 9999999 B 10 1346770047 0 4698 DEPT CAROL STREAM IL 601220021 20 1346770047 0 Physicians Anesthesia Services 20 1346770047 0 Physicians Fluoride varnish 20 1346770047 0 Physicians Healthy Kids Services 20 1346770047 0 Physicians Optical Supplies 20 1346770047 0 Physicians Physician Services 00 1346770377 0 LEUNG HERMAN 2017237 9999999 B 10 1346770377 0 1005 BROADWAY ST QUINCY IL 623012834 20 1346770377 0 Physicians Anesthesia Services 20 1346770377 0 Physicians Fluoride varnish 20 1346770377 0 Physicians Healthy Kids Services 20 1346770377 0 Physicians Optical Supplies 20 1346770377 0 Physicians Physician Services 00 1346770492 0 TAVAREZ ANA M 2017248 9999999 B 10 1346770492 0 355 E ERIE ST CHICAGO IL 606113167 20 1346770492 0 Nurse Practitioners Healthy Kids Services 20 1346770492 0 Nurse Practitioners Nurse Practitioners Services 20 1346770492 0 Nurse Practitioners Physician Services 00 1346770708 0 PETH MARA L 2017214 9999999 B 10 1346770708 0 621 S ILLINOIS AVE STE 103 MASON CITY IA 504015489 20 1346770708 0 Physician Assistant Only Fluoride varnish 20 1346770708 0 Physician Assistant Only Healthy Kids Services 20 1346770708 0 Physician Assistant Only Physician Services 00 1346770914 0 GUIAB MARK P 2017237 9999999 B 10 1346770914 0 2210 MIDWEST RD STE 102A OAK BROOK IL 605231280 20 1346770914 0 Nurse Practitioners Fluoride varnish 20 1346770914 0 Nurse Practitioners Healthy Kids Services 20 1346770914 0 Nurse Practitioners Nurse Practitioners Services 20 1346770914 0 Nurse Practitioners Physician Services 00 1346771201 0 PAN JOSHUA C 2022227 9999999 B 10 1346771201 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1346771201 0 Physicians Anesthesia Services 20 1346771201 0 Physicians Healthy Kids Services 20 1346771201 0 Physicians Optical Supplies 20 1346771201 0 Physicians Physician Services 00 1346771482 0 WANG SIEW MAY 2022191 9999999 B 10 1346771482 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1346771482 0 Physicians Anesthesia Services 20 1346771482 0 Physicians Healthy Kids Services 20 1346771482 0 Physicians Optical Supplies 20 1346771482 0 Physicians Physician Services 00 1346771615 0 NORRIS VAN EATON MOLLY KATHLEE 2018274 9999999 B 10 1346771615 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1346771615 0 Audiologists Audiology Services 20 1346771615 0 Audiologists Medical Supplies 20 1346771615 0 Audiologists Medical equipment/prosthetic devices 00 1346771698 0 WEISS JENNIFER 2020233 9999999 B 10 1346771698 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1346771698 0 Physicians Anesthesia Services 20 1346771698 0 Physicians Fluoride varnish 20 1346771698 0 Physicians Healthy Kids Services 20 1346771698 0 Physicians Optical Supplies 20 1346771698 0 Physicians Physician Services 00 1346771839 0 SEWELL CRAIG D 2022200 9999999 B 10 1346771839 0 PO BOX 778912 CHICAGO IL 606778912 20 1346771839 0 Physicians Anesthesia Services 20 1346771839 0 Physicians Fluoride varnish 20 1346771839 0 Physicians Healthy Kids Services 20 1346771839 0 Physicians Optical Supplies 20 1346771839 0 Physicians Physician Services 00 1346771862 0 KABAT BROCK E 2021175 9999999 B 10 1346771862 0 29373 NETWORK PL CHICAGO IL 606733039 20 1346771862 0 Physicians Anesthesia Services 20 1346771862 0 Physicians Fluoride varnish 20 1346771862 0 Physicians Healthy Kids Services 20 1346771862 0 Physicians Optical Supplies 20 1346771862 0 Physicians Physician Services 00 1346771979 0 PATEL PURVA UMESH 2022165 9999999 B 10 1346771979 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1346771979 0 Physicians Anesthesia Services 20 1346771979 0 Physicians Fluoride varnish 20 1346771979 0 Physicians Healthy Kids Services 20 1346771979 0 Physicians Optical Supplies 20 1346771979 0 Physicians Physician Services 00 1346772225 0 DUONG VI 2024235 9999999 B 10 1346772225 0 5777 DEPT CAROL STREAM IL 601220021 20 1346772225 0 Physicians Anesthesia Services 20 1346772225 0 Physicians Healthy Kids Services 20 1346772225 0 Physicians Optical Supplies 20 1346772225 0 Physicians Physician Services 00 1346772761 0 STONE ELIZABETH 2017317 9999999 B 10 1346772761 0 4230 11TH ST ROCK ISLAND IL 612016746 20 1346772761 0 Other behavior health professional Social work service 00 1346772795 0 PINTO ASHLEY 2020210 9999999 B 10 1346772795 0 1601 BOND ST STE 302 NAPERVILLE IL 605630116 20 1346772795 0 Other behavior health professional LCPC/LMFT services 00 1346772886 0 MALONE MEGAN M 2017121 9999999 B 10 1346772886 0 29373 NETWORK PL CHICAGO IL 606733039 20 1346772886 0 Occupational Therapists Medical Supplies 20 1346772886 0 Occupational Therapists Medical equipment/prosthetic devices 20 1346772886 0 Occupational Therapists Occupational Therapy Services 00 1346773116 0 WALSH AARON 2023315 9999999 B 10 1346773116 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1346773116 0 Physicians Anesthesia Services 20 1346773116 0 Physicians Fluoride varnish 20 1346773116 0 Physicians Healthy Kids Services 20 1346773116 0 Physicians Optical Supplies 20 1346773116 0 Physicians Physician Services 00 1346773694 0 KURLAND KATHERINE D 2024001 9999999 B 10 1346773694 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1346773694 0 Physicians Anesthesia Services 20 1346773694 0 Physicians Fluoride varnish 20 1346773694 0 Physicians Healthy Kids Services 20 1346773694 0 Physicians Optical Supplies 20 1346773694 0 Physicians Physician Services 00 1346773777 0 AHMAD FARHAN 2025064 9999999 B 10 1346773777 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1346773777 0 Physicians Anesthesia Services 20 1346773777 0 Physicians Healthy Kids Services 20 1346773777 0 Physicians Optical Supplies 20 1346773777 0 Physicians Physician Services 00 1346774353 0 AULD ELIZABETH 2023196 9999999 B 10 1346774353 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1346774353 0 Physicians Anesthesia Services 20 1346774353 0 Physicians Healthy Kids Services 20 1346774353 0 Physicians Optical Supplies 20 1346774353 0 Physicians Physician Services 00 1346774452 0 HAWKINS BRIAN 2022348 9999999 B 10 1346774452 0 PO BOX 301208 DALLAS TX 753031501 20 1346774452 0 Physicians Anesthesia Services 20 1346774452 0 Physicians Healthy Kids Services 20 1346774452 0 Physicians Optical Supplies 20 1346774452 0 Physicians Physician Services 00 1346774536 0 KHAN AYSHA N 2019182 9999999 B 10 1346774536 0 PO BOX 708760 SANDY UT 840708760 20 1346774536 0 Physicians Anesthesia Services 20 1346774536 0 Physicians Fluoride varnish 20 1346774536 0 Physicians Healthy Kids Services 20 1346774536 0 Physicians Optical Supplies 20 1346774536 0 Physicians Physician Services 00 1346775574 0 HATFIELD ANDREW 2019338 9999999 B 10 1346775574 0 PO BOX 5602 CAROL STREAM IL 601975602 20 1346775574 0 Nurse Practitioners Healthy Kids Services 20 1346775574 0 Nurse Practitioners Nurse Practitioners Services 20 1346775574 0 Nurse Practitioners Physician Services 00 1346775921 0 SCHLOTTERBACK MARK WILLIAM 2020006 9999999 B 10 1346775921 0 221 NE GLEN OAK AVE ATTN: STEPHEN CIRONE GOMP100 PEORIA IL 616360002 20 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Healthy Kids Services 20 1346778297 0 Physicians Optical Supplies 20 1346778297 0 Physicians Physician Services 00 1346779022 0 MCENERY CHRISTINA 2017121 9999999 B 10 1346779022 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1346779022 0 Nurse Practitioners Healthy Kids Services 20 1346779022 0 Nurse Practitioners Nurse Practitioners Services 20 1346779022 0 Nurse Practitioners Physician Services 00 1346779063 0 LONG JESSICA R 2018352 9999999 B 10 1346779063 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1346779063 0 Physicians Anesthesia Services 20 1346779063 0 Physicians Healthy Kids Services 20 1346779063 0 Physicians Optical Supplies 20 1346779063 0 Physicians Physician Services 00 1346779147 0 NAQVI AMBER F 2021118 9999999 B 10 1346779147 0 PO BOX 5944 ROCKFORD IL 611250944 20 1346779147 0 Optometrists Optical Supplies 20 1346779147 0 Optometrists Optometric Services 20 1346779147 0 Optometrists Physician Services 00 1346779196 0 ELSER TAYLOR 2024222 9999999 B 10 1346779196 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1346779196 0 Physicians Anesthesia Services 20 1346779196 0 Physicians Healthy Kids Services 20 1346779196 0 Physicians Optical Supplies 20 1346779196 0 Physicians Physician Services 00 1346779261 0 JOHNSTON KATHLEEN R 2017170 9999999 B 10 1346779261 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1346779261 0 Occupational Therapists Medical Supplies 20 1346779261 0 Occupational Therapists Medical equipment/prosthetic devices 20 1346779261 0 Occupational Therapists Occupational Therapy Services 00 1346779345 0 DAINTON-HOWARD HELEN L 2023153 9999999 B 10 1346779345 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1346779345 0 Physicians Anesthesia Services 20 1346779345 0 Physicians Healthy Kids Services 20 1346779345 0 Physicians Optical Supplies 20 1346779345 0 Physicians Physician Services 20 1346779345 0 Physicians Physicians Psychiatric Services 00 1346779386 0 BAMPOE AUDREY N 2019137 9999999 B 10 1346779386 0 5777 DEPT CAROL STREAM IL 601220021 20 1346779386 0 Physicians Anesthesia Services 20 1346779386 0 Physicians Fluoride varnish 20 1346779386 0 Physicians Healthy Kids Services 20 1346779386 0 Physicians Optical Supplies 20 1346779386 0 Physicians Physician Services 00 1346780244 0 JOHNSON JINTU 2017075 9999999 B 10 1346780244 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1346780244 0 Nurse Practitioners Fluoride varnish 20 1346780244 0 Nurse Practitioners Healthy Kids Services 20 1346780244 0 Nurse Practitioners Nurse Practitioners Services 20 1346780244 0 Nurse Practitioners Physician Services 00 1346780756 0 THOMAS CARLA 2017065 9999999 B 10 1346780756 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1346780756 0 Nurse Practitioners Healthy Kids Services 20 1346780756 0 Nurse Practitioners Nurse Practitioners Services 20 1346780756 0 Nurse Practitioners Physician Services 00 1346781077 0 CASE EMILY R 2017075 9999999 B 10 1346781077 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 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1346781630 0 Physicians Healthy Kids Services 20 1346781630 0 Physicians Optical Supplies 20 1346781630 0 Physicians Physician Services 00 1346781655 0 STRAJACK SABRINA 2017081 9999999 B 10 1346781655 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1346781655 0 Nurse Practitioners Anesthesia Services 20 1346781655 0 Nurse Practitioners Nurse Practitioners Services 20 1346781655 0 Nurse Practitioners Physician Services 00 1346781879 0 VAIDYA KELLIE 2017060 9999999 B 10 1346781879 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1346781879 0 Nurse Practitioners Healthy Kids Services 20 1346781879 0 Nurse Practitioners Nurse Practitioners Services 20 1346781879 0 Nurse Practitioners Physician Services 00 1346782877 0 ROGOZ DEBORAH A 2016337 9999999 B 10 1346782877 0 PO BOX 88667 CHICAGO IL 606801667 20 1346782877 0 Nurse Practitioners Healthy Kids Services 20 1346782877 0 Nurse Practitioners Nurse Practitioners Services 20 1346782877 0 Nurse Practitioners 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SPRINGFIELD IL 627621000 20 1346797396 0 Physical Therapists Medical Supplies 20 1346797396 0 Physical Therapists Medical equipment/prosthetic devices 20 1346797396 0 Physical Therapists Physical Therapy Services 00 1346798220 0 KON AUDREY 2019311 9999999 B 10 1346798220 0 5777 DEPT CAROL STREAM IL 601220021 20 1346798220 0 Nurse Practitioners Anesthesia Services 20 1346798220 0 Nurse Practitioners Nurse Practitioners Services 20 1346798220 0 Nurse Practitioners Physician Services 00 1346801099 0 PLOG BENJAMIN 2019179 9999999 B 10 1346801099 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1346801099 0 Physicians Anesthesia Services 20 1346801099 0 Physicians Healthy Kids Services 20 1346801099 0 Physicians Optical Supplies 20 1346801099 0 Physicians Physician Services 00 1346801891 0 TANDON DAMINI 2019304 9999999 B 10 1346801891 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1346801891 0 Physicians Anesthesia Services 20 1346801891 0 Physicians Healthy Kids Services 20 1346801891 0 Physicians Optical Supplies 20 1346801891 0 Physicians Physician Services 00 1346802923 0 DING DING 2023094 9999999 B 10 1346802923 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1346802923 0 Physicians Anesthesia Services 20 1346802923 0 Physicians Healthy Kids Services 20 1346802923 0 Physicians Optical Supplies 20 1346802923 0 Physicians Physician Services 00 1346803012 0 CURTIS KYLE L 2024164 9999999 B 10 1346803012 0 5777 DEPT CAROL STREAM IL 601220021 20 1346803012 0 Physicians Anesthesia Services 20 1346803012 0 Physicians Healthy Kids Services 20 1346803012 0 Physicians Optical Supplies 20 1346803012 0 Physicians Physician Services 00 1346803384 0 TAORMINA HALEY 2024036 9999999 B 10 1346803384 0 8170 33RD AVE S MINNEAPOLIS MN 554254516 20 1346803384 0 Physicians Anesthesia Services 20 1346803384 0 Physicians Healthy Kids Services 20 1346803384 0 Physicians Optical Supplies 20 1346803384 0 Physicians Physician Services 00 1346806296 0 MARTINO ANNA LISA 2022362 9999999 B 10 1346806296 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1346806296 0 Physicians Anesthesia Services 20 1346806296 0 Physicians Fluoride varnish 20 1346806296 0 Physicians Healthy Kids Services 20 1346806296 0 Physicians Optical Supplies 20 1346806296 0 Physicians Physician Services 00 1346806874 0 GOINES LAVANDY 2019150 9999999 B 10 1346806874 0 3015 HAROLDS CRES FLOSSMOOR IL 604222009 20 1346806874 0 Registered nurse Nursing service 20 1346806874 0 Registered nurse Waiver service 00 1346807781 0 SHAIK IRFAN 2023324 9999999 B 10 1346807781 0 4370 E NEW YORK ST AURORA IL 605044121 20 1346807781 0 Dentists Dental Services 20 1346807781 0 Dentists Physician Services 00 1346807872 0 LAHOOD VANESSA 2022220 9999999 B 10 1346807872 0 611 W PARK ST URBANA IL 618012529 20 1346807872 0 Physicians Anesthesia Services 20 1346807872 0 Physicians Fluoride varnish 20 1346807872 0 Physicians Healthy Kids Services 20 1346807872 0 Physicians Optical Supplies 20 1346807872 0 Physicians Physician Services 00 1346808912 0 SUNVOLD MARY S 2019156 9999999 B 10 1346808912 0 830 S ADDISON AVE VILLA PARK IL 601812877 20 1346808912 0 Speech Therapists Medical Supplies 20 1346808912 0 Speech Therapists Medical equipment/prosthetic devices 20 1346808912 0 Speech Therapists Speech Therapy/Pathology Services 00 1346809381 0 DISILVIO FRANK A 2020300 9999999 B 10 1346809381 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1346809381 0 Physicians Anesthesia Services 20 1346809381 0 Physicians Healthy Kids Services 20 1346809381 0 Physicians Optical Supplies 20 1346809381 0 Physicians Physician Services 00 1346810108 0 SHUAIPAJ NAIM 2023341 9999999 B 10 1346810108 0 11739 SOUTHWEST HWY PALOS HEIGHTS IL 604631897 20 1346810108 0 Dentists Dental Services 20 1346810108 0 Dentists Physician Services 00 1346810488 0 ZUPANSIC JILL C 2021271 9999999 B 10 1346810488 0 500 PARK AVE LAKE VILLA IL 600466556 20 1346810488 0 Nurse Practitioners Fluoride varnish 20 1346810488 0 Nurse Practitioners Healthy Kids Services 20 1346810488 0 Nurse Practitioners Nurse Practitioners Services 20 1346810488 0 Nurse Practitioners Physician Services 00 1346810660 0 OKOH NELSON 2024137 9999999 B 10 1346810660 0 13000 DEERFIELD PKWY STE 100 ALPHARETTA GA 300046118 20 1346810660 0 Physicians Anesthesia Services 20 1346810660 0 Physicians Fluoride varnish 20 1346810660 0 Physicians Healthy Kids Services 20 1346810660 0 Physicians Optical Supplies 20 1346810660 0 Physicians Physician Services 00 1346811957 0 SHARIF AFTAB 2024212 9999999 B 10 1346811957 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1346811957 0 Physicians Anesthesia Services 20 1346811957 0 Physicians Fluoride varnish 20 1346811957 0 Physicians Healthy Kids Services 20 1346811957 0 Physicians Optical Supplies 20 1346811957 0 Physicians Physician Services 00 1346813334 0 TOTTEN ALLISON 2021263 9999999 B 10 1346813334 0 PO BOX 631767 CINCINNATI OH 452631767 20 1346813334 0 Physician Assistant Only Fluoride varnish 20 1346813334 0 Physician Assistant Only Healthy Kids Services 20 1346813334 0 Physician Assistant Only Physician Services 00 1346813508 0 MOSS EMILY R 2021207 9999999 B 10 1346813508 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1346813508 0 Occupational Therapists Medical Supplies 20 1346813508 0 Occupational Therapists Medical equipment/prosthetic devices 20 1346813508 0 Occupational Therapists Occupational Therapy Services 00 1346813557 0 POTTENGER SEAN V 2024037 9999999 B 10 1346813557 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1346813557 0 Nurse Practitioners Anesthesia Services 20 1346813557 0 Nurse Practitioners Nurse Practitioners Services 20 1346813557 0 Nurse Practitioners Physician Services 00 1346814779 0 ADAM ANECE 2021242 9999999 B 10 1346814779 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1346814779 0 Nurse Practitioners Healthy Kids Services 20 1346814779 0 Nurse Practitioners Nurse Practitioners Services 20 1346814779 0 Nurse Practitioners Physician Services 00 1346815925 0 VEGA KEVIN 2021234 9999999 B 10 1346815925 0 120 S MARION ST OAK PARK IL 603022809 20 1346815925 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1346816766 0 BARTON HANNAH C 2022169 9999999 B 10 1346816766 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1346816766 0 Speech Therapists Medical Supplies 20 1346816766 0 Speech Therapists Medical equipment/prosthetic devices 20 1346816766 0 Speech Therapists Speech Therapy/Pathology Services 00 1346816824 0 VALENTINE ARIELLE 2021161 9999999 B 10 1346816824 0 4698 DEPT CAROL STREAM IL 601220021 20 1346816824 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1346816881 0 SIEGEL LINDSEY 2021158 9999999 B 10 1346816881 0 4714 GETTYSBURG RD MECHANICSBURG PA 170554325 20 1346816881 0 Physical Therapists Medical Supplies 20 1346816881 0 Physical Therapists Medical equipment/prosthetic devices 20 1346816881 0 Physical Therapists Physical Therapy Services 00 1346817566 0 PLANTHOLT RACHAEL 2024243 9999999 B 10 1346817566 0 611 W PARK ST URBANA IL 618012529 20 1346817566 0 Physicians Anesthesia Services 20 1346817566 0 Physicians Fluoride varnish 20 1346817566 0 Physicians Healthy Kids Services 20 1346817566 0 Physicians Optical Supplies 20 1346817566 0 Physicians Physician Services 00 1346818077 0 MIFFLIN JOSHUA 2024209 9999999 B 10 1346818077 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1346818077 0 Physicians Anesthesia Services 20 1346818077 0 Physicians Fluoride varnish 20 1346818077 0 Physicians Healthy Kids Services 20 1346818077 0 Physicians Optical Supplies 20 1346818077 0 Physicians Physician Services 00 1346818564 0 LYNN MITCHELL A 2021231 9999999 B 10 1346818564 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1346818564 0 Physicians Anesthesia Services 20 1346818564 0 Physicians Fluoride varnish 20 1346818564 0 Physicians Healthy Kids Services 20 1346818564 0 Physicians Optical Supplies 20 1346818564 0 Physicians Physician Services 00 1346818655 0 PINTER AHLYSSA A 2023283 9999999 B 10 1346818655 0 124 SW ADAMS ST FL 2 PEORIA IL 616021308 20 1346818655 0 Clinical Social Worker Social work service 00 1346819216 0 LASSISE HANNAH 2022256 9999999 B 10 1346819216 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1346819216 0 Nurse Practitioners Anesthesia Services 20 1346819216 0 Nurse Practitioners Nurse Practitioners Services 20 1346819216 0 Nurse Practitioners Physician Services 00 1346819968 0 PORTWINE MIRANDA 2023164 9999999 B 10 1346819968 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1346819968 0 Nurse Practitioners Anesthesia Services 20 1346819968 0 Nurse Practitioners Nurse Practitioners Services 20 1346819968 0 Nurse Practitioners Physician Services 00 1346821162 0 GARCIA-URIBE JUNE G 2021105 9999999 B 10 1346821162 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1346821162 0 Nurse Practitioners Healthy Kids Services 20 1346821162 0 Nurse Practitioners Nurse Practitioners Services 20 1346821162 0 Nurse Practitioners Physician Services 00 1346821345 0 KAUR RAMANDEEP 2021175 9999999 B 10 1346821345 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1346821345 0 Physicians Anesthesia Services 20 1346821345 0 Physicians Fluoride varnish 20 1346821345 0 Physicians Healthy Kids Services 20 1346821345 0 Physicians Optical Supplies 20 1346821345 0 Physicians Physician Services 00 1346821527 0 BROWN KAITLYN 2021247 9999999 B 10 1346821527 0 124 SW ADAMS ST PEORIA IL 616021308 20 1346821527 0 Physicians Anesthesia Services 20 1346821527 0 Physicians Fluoride varnish 20 1346821527 0 Physicians Healthy Kids Services 20 1346821527 0 Physicians Optical Supplies 20 1346821527 0 Physicians Physician Services 00 1346822525 0 GOR JUHI 2024208 9999999 B 10 1346822525 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1346822525 0 Physicians Anesthesia Services 20 1346822525 0 Physicians Fluoride varnish 20 1346822525 0 Physicians Healthy Kids Services 20 1346822525 0 Physicians Optical Supplies 20 1346822525 0 Physicians Physician Services 00 1346823275 0 STAATS KRISTIN L 2021217 9999999 B 10 1346823275 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1346823275 0 Nurse Practitioners Fluoride varnish 20 1346823275 0 Nurse Practitioners Healthy Kids Services 20 1346823275 0 Nurse Practitioners Nurse Practitioners Services 20 1346823275 0 Nurse Practitioners Physician Services 00 1346823895 0 ZAFAR SHOZAB 2021124 9999999 B 10 1346823895 0 524 E SCHAUMBURG RD SCHAUMBURG IL 601943510 20 1346823895 0 Speech Therapists Medical Supplies 20 1346823895 0 Speech Therapists Medical equipment/prosthetic devices 20 1346823895 0 Speech Therapists Speech Therapy/Pathology Services 00 1346823911 0 KREMER AMIE 2024332 9999999 B 10 1346823911 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1346823911 0 Nurse Practitioners Healthy Kids Services 20 1346823911 0 Nurse Practitioners Nurse Practitioners Services 20 1346823911 0 Nurse Practitioners Physician Services 00 1346824265 0 BRODETTE HALEY 2024254 9999999 B 10 1346824265 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1346824265 0 Physicians Anesthesia Services 20 1346824265 0 Physicians Fluoride varnish 20 1346824265 0 Physicians Healthy Kids Services 20 1346824265 0 Physicians Optical Supplies 20 1346824265 0 Physicians Physician Services 00 1346824620 0 AZIZ SMITH RAHMANA H 2021232 9999999 B 10 1346824620 0 1643 NW 136TH AVE STE 100 SUNRISE FL 333232857 20 1346824620 0 Nurse Practitioners Healthy Kids Services 20 1346824620 0 Nurse Practitioners Nurse Practitioners Services 20 1346824620 0 Nurse Practitioners Physician Services 00 1346825031 0 BLUMENTHAL RACHEL 2021155 9999999 B 10 1346825031 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1346825031 0 Nurse Practitioners Healthy Kids Services 20 1346825031 0 Nurse Practitioners Nurse Practitioners Services 20 1346825031 0 Nurse Practitioners Physician Services 00 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Physician Services 00 1346827086 0 MU BRIAN H 2021176 9999999 B 10 1346827086 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1346827086 0 Physicians Anesthesia Services 20 1346827086 0 Physicians Fluoride varnish 20 1346827086 0 Physicians Healthy Kids Services 20 1346827086 0 Physicians Optical Supplies 20 1346827086 0 Physicians Physician Services 00 1346827151 0 FRUGOLI CHRISTINA M 2021123 9999999 B 10 1346827151 0 PO BOX 775253 CHICAGO IL 606775253 20 1346827151 0 Nurse Practitioners Fluoride varnish 20 1346827151 0 Nurse Practitioners Healthy Kids Services 20 1346827151 0 Nurse Practitioners Nurse Practitioners Services 20 1346827151 0 Nurse Practitioners Physician Services 00 1346827490 0 ZIMO JESSICA E 2024080 9999999 B 10 1346827490 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1346827490 0 Physicians Anesthesia Services 20 1346827490 0 Physicians Fluoride varnish 20 1346827490 0 Physicians Healthy Kids Services 20 1346827490 0 Physicians Optical 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varnish 20 1346892346 0 Physician Assistant Only Healthy Kids Services 20 1346892346 0 Physician Assistant Only Physician Services 00 1346894144 0 HANG PHAN T 2019339 9999999 B 10 1346894144 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1346894144 0 Nurse Practitioners Healthy Kids Services 20 1346894144 0 Nurse Practitioners Nurse Practitioners Services 20 1346894144 0 Nurse Practitioners Physician Services 00 1346894755 0 KELLEY KIMBERLY A 2020317 9999999 B 10 1346894755 0 PO BOX 840532 DALLAS TX 752840532 20 1346894755 0 Nurse Practitioners Healthy Kids Services 20 1346894755 0 Nurse Practitioners Nurse Practitioners Services 20 1346894755 0 Nurse Practitioners Physician Services 00 1346895182 0 KIM KEUN YOUNG 2019365 9999999 B 10 1346895182 0 5777 DEPT CAROL STREAM IL 601220021 20 1346895182 0 Physicians Anesthesia Services 20 1346895182 0 Physicians Fluoride varnish 20 1346895182 0 Physicians Healthy Kids Services 20 1346895182 0 Physicians Optical Supplies 20 1346895182 0 Physicians Physician Services 00 1346895372 0 NIEWIARA JOANNA 2019287 9999999 B 10 1346895372 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1346895372 0 Nurse Practitioners Anesthesia Services 20 1346895372 0 Nurse Practitioners Nurse Practitioners Services 20 1346895372 0 Nurse Practitioners Physician Services 00 1346895430 0 BRODERICK ELYSE 2019246 9999999 B 10 1346895430 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1346895430 0 Physical Therapists Medical Supplies 20 1346895430 0 Physical Therapists Medical equipment/prosthetic devices 20 1346895430 0 Physical Therapists Physical Therapy Services 00 1346897972 0 DUNNING RACHEL 2019260 9999999 B 10 1346897972 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1346897972 0 Other behavior health professional Social work service 00 1346898103 0 SMITH GEORGE E 2023290 9999999 B 10 1346898103 0 200 CLINT HILL BLVD PADUCAH KY 420016768 20 1346898103 0 Physical Therapists Medical Supplies 20 1346898103 0 Physical Therapists Medical equipment/prosthetic devices 20 1346898103 0 Physical Therapists Physical Therapy Services 00 1346898210 0 PIHL CASANDRA KAY 2019259 9999999 B 10 1346898210 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1346898210 0 Nurse Practitioners Fluoride varnish 20 1346898210 0 Nurse Practitioners Healthy Kids Services 20 1346898210 0 Nurse Practitioners Nurse Practitioners Services 20 1346898210 0 Nurse Practitioners Physician Services 00 1346898616 0 BOFFA DANIEL 2020161 9999999 B 10 1346898616 0 PO BOX 2477 SHELTON CT 064841477 20 1346898616 0 Nurse Practitioners Healthy Kids Services 20 1346898616 0 Nurse Practitioners Nurse Practitioners Services 20 1346898616 0 Nurse Practitioners Physician Services 00 1346898921 0 SIMOENS KELSEY A 2019322 9999999 B 10 1346898921 0 5777 DEPT CAROL STREAM IL 601220021 20 1346898921 0 Nurse Practitioners Anesthesia Services 20 1346898921 0 Nurse Practitioners Nurse Practitioners Services 20 1346898921 0 Nurse Practitioners Physician Services 00 1346900479 0 HALL TIFFANY 2022007 9999999 H 10 1346900479 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1346900479 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1346900578 0 VINCENT SOPHIE 2023025 9999999 B 10 1346900578 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1346900578 0 Nurse Practitioners Fluoride varnish 20 1346900578 0 Nurse Practitioners Healthy Kids Services 20 1346900578 0 Nurse Practitioners Nurse Practitioners Services 20 1346900578 0 Nurse Practitioners Physician Services 00 1346902053 0 ANTONOV EVGENII 2022125 9999999 B 10 1346902053 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1346902053 0 Physicians Anesthesia Services 20 1346902053 0 Physicians Fluoride varnish 20 1346902053 0 Physicians Healthy Kids Services 20 1346902053 0 Physicians Optical Supplies 20 1346902053 0 Physicians Physician Services 00 1346902269 0 RIEGLER DANIELLE C 2022236 9999999 B 10 1346902269 0 2900 OGDEN AVE LISLE IL 605321631 20 1346902269 0 Speech Therapists Medical Supplies 20 1346902269 0 Speech Therapists Medical equipment/prosthetic devices 20 1346902269 0 Speech Therapists Speech Therapy/Pathology Services 00 1346902459 0 MADRIGAL-LEON SUSI 2022181 9999999 B 10 1346902459 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1346902459 0 Nurse Practitioners Fluoride varnish 20 1346902459 0 Nurse Practitioners Healthy Kids Services 20 1346902459 0 Nurse Practitioners Nurse Practitioners Services 20 1346902459 0 Nurse Practitioners Physician Services 00 1346902483 0 CORBITT DELANEY B 2022207 9999999 B 10 1346902483 0 3030 W SALT CREEK LN STE 200 ARLINGTON HEIGH IL 600055002 20 1346902483 0 Physician Assistant Only Fluoride varnish 20 1346902483 0 Physician Assistant Only Healthy Kids Services 20 1346902483 0 Physician Assistant Only Physician Services 00 1346903010 0 TIJERINA GABRIEL 2021293 9999999 H 10 1346903010 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1346903010 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1346903994 0 NICOLOSI JOSEPH 1990052 9999999 B 10 1346903994 0 5030 N MARINE DR APT 406 CHICAGO IL 606406310 20 1346903994 0 Dentists Dental Services 20 1346903994 0 Dentists Physician Services 00 1346905197 0 COMERFORD JENNIFER M 2021320 9999999 B 10 1346905197 0 124 SW ADAMS ST PEORIA IL 616021308 20 1346905197 0 Nurse Practitioners Fluoride varnish 20 1346905197 0 Nurse Practitioners Healthy Kids Services 20 1346905197 0 Nurse Practitioners Nurse Practitioners Services 20 1346905197 0 Nurse Practitioners Physician Services 00 1346907144 0 KOSO MICHELLE D 2021333 9999999 H 10 1346907144 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1346907144 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1346910502 0 BURTON MARY 2022061 9999999 B 10 1346910502 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1346910502 0 Nurse Practitioners Healthy Kids Services 20 1346910502 0 Nurse Practitioners Nurse Practitioners Services 20 1346910502 0 Nurse Practitioners Physician Services 00 1346912128 0 SUSZKO JENNIFER 2021291 9999999 B 10 1346912128 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1346912128 0 Nurse Practitioners Healthy Kids Services 20 1346912128 0 Nurse Practitioners Nurse Practitioners Services 20 1346912128 0 Nurse Practitioners Physician Services 00 1346912292 0 DUNCAN KAITLYN N 2021287 9999999 B 10 1346912292 0 1401 EASTLAND DR BLOOMINGTON IL 617013552 20 1346912292 0 Nurse Practitioners Fluoride varnish 20 1346912292 0 Nurse Practitioners Healthy Kids Services 20 1346912292 0 Nurse Practitioners Nurse Practitioners Services 20 1346912292 0 Nurse Practitioners Physician Services 00 1346912631 0 TORGERSON KIMBERLY 2021347 9999999 B 10 1346912631 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1346912631 0 Nurse Practitioners Fluoride varnish 20 1346912631 0 Nurse Practitioners Healthy Kids Services 20 1346912631 0 Nurse Practitioners Nurse Practitioners Services 20 1346912631 0 Nurse Practitioners Physician Services 00 1346913134 0 KUKIRATIRAT TANATCHA 2021257 9999999 B 10 1346913134 0 323 E CASS ST JOLIET IL 604322814 20 1346913134 0 Dentists Dental Services 20 1346913134 0 Dentists Physician Services 00 1346914488 0 RADWAN JANEEN R 2021239 9999999 B 10 1346914488 0 2906 HIGHWAY AVE HIGHLAND IN 463221631 20 1346914488 0 Speech Therapists Medical Supplies 20 1346914488 0 Speech Therapists Medical equipment/prosthetic devices 20 1346914488 0 Speech Therapists Speech Therapy/Pathology Services 00 1346914884 0 WRIGHT ERIN 2022012 9999999 B 10 1346914884 0 9445 INDIANAPOLIS BLVD # HIGHL HIGHLAND IN 463222648 20 1346914884 0 Nurse Practitioners Fluoride varnish 20 1346914884 0 Nurse Practitioners Healthy Kids Services 20 1346914884 0 Nurse Practitioners Nurse Practitioners Services 20 1346914884 0 Nurse Practitioners Physician Services 00 1346915964 0 LOPEZ CANO MELISSA 2021286 9999999 B 10 1346915964 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1346915964 0 Nurse Practitioners Fluoride varnish 20 1346915964 0 Nurse Practitioners Healthy Kids Services 20 1346915964 0 Nurse Practitioners Nurse Practitioners Services 20 1346915964 0 Nurse Practitioners Physician Services 00 1346916103 0 SCHELLER MEGAN 2021274 9999999 B 10 1346916103 0 PO BOX 1510 EVANSVILLE IN 477061510 20 1346916103 0 Nurse Practitioners Healthy Kids Services 20 1346916103 0 Nurse Practitioners Nurse Practitioners Services 20 1346916103 0 Nurse Practitioners Physician Services 00 1346916491 0 YEOM SOOYOUNG 2022300 9999999 B 10 1346916491 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1346916491 0 Nurse Practitioners Electronic Home Response/EHR Installation, MPE Certification 20 1346916491 0 Nurse Practitioners Fluoride varnish 20 1346916491 0 Nurse Practitioners Healthy Kids Services 20 1346916491 0 Nurse Practitioners Nurse Practitioners Services 20 1346916491 0 Nurse Practitioners Physician Services 00 1346917408 0 LUMPA KATIE 2023071 9999999 B 10 1346917408 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1346917408 0 Physician Assistant Only Fluoride varnish 20 1346917408 0 Physician Assistant Only Healthy Kids Services 20 1346917408 0 Physician Assistant Only Physician Services 00 1346919123 0 PAINE REBECCA 2023016 9999999 B 10 1346919123 0 16220 N SCOTTSDALE RD STE 600 SCOTTSDALE AZ 852541804 20 1346919123 0 Physician Assistant Only Fluoride varnish 20 1346919123 0 Physician Assistant Only Healthy Kids Services 20 1346919123 0 Physician Assistant Only Physician Services 00 1346920006 0 OTT HAYLEY C 2024156 9999999 B 10 1346920006 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1346920006 0 Nurse Practitioners Fluoride varnish 20 1346920006 0 Nurse Practitioners Healthy Kids Services 20 1346920006 0 Nurse Practitioners Nurse Practitioners Services 20 1346920006 0 Nurse Practitioners Physician Services 00 1346923034 0 MARINO MICHAEL 2023314 9999999 B 10 1346923034 0 929 W HIGGINS RD SCHAUMBURG IL 601953203 20 1346923034 0 Physician Assistant Only Fluoride varnish 20 1346923034 0 Physician Assistant Only Healthy Kids Services 20 1346923034 0 Physician Assistant Only Physician Services 00 1346926003 0 GORRIS NICOLE K 2023248 9999999 B 10 1346926003 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1346926003 0 Nurse Practitioners Anesthesia Services 20 1346926003 0 Nurse Practitioners Nurse Practitioners Services 20 1346926003 0 Nurse Practitioners Physician Services 00 1346927225 0 SHAH ASHKA 2024339 9999999 B 10 1346927225 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1346927225 0 Dentists Dental Services 20 1346927225 0 Dentists Physician Services 00 1346927274 0 SNEH RINAT 2024144 9999999 B 10 1346927274 0 6420 CLAYTON RD SAINT LOUIS MO 631171811 20 1346927274 0 Physicians Anesthesia Services 20 1346927274 0 Physicians Fluoride varnish 20 1346927274 0 Physicians Healthy Kids Services 20 1346927274 0 Physicians Optical Supplies 20 1346927274 0 Physicians Physician Services 00 1346928652 0 LAU ASHLEY J 2023201 9999999 B 10 1346928652 0 611 W PARK ST URBANA IL 618012529 20 1346928652 0 Dentists Dental Services 20 1346928652 0 Dentists Physician Services 00 1346929593 0 NEHRU NAROIS 2023233 9999999 B 10 1346929593 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1346929593 0 Physicians Anesthesia Services 20 1346929593 0 Physicians Fluoride varnish 20 1346929593 0 Physicians Healthy Kids Services 20 1346929593 0 Physicians Optical Supplies 20 1346929593 0 Physicians Physician Services 00 1346929601 0 PARK LILLY 2023278 9999999 B 10 1346929601 0 62647 COLLECTION CENTER DR CHICAGO IL 606930626 20 1346929601 0 Nurse Practitioners Fluoride varnish 20 1346929601 0 Nurse Practitioners Healthy Kids Services 20 1346929601 0 Nurse Practitioners Nurse Practitioners Services 20 1346929601 0 Nurse Practitioners Physician Services 00 1346930484 0 LONG ALEXIS 2025024 9999999 B 10 1346930484 0 2900 OGDEN AVE LISLE IL 605321631 20 1346930484 0 Speech Therapists Medical Supplies 20 1346930484 0 Speech Therapists Medical equipment/prosthetic devices 20 1346930484 0 Speech Therapists Speech Therapy/Pathology Services 00 1346931292 0 SHAH NEAL 2023142 9999999 B 10 1346931292 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1346931292 0 Physicians Anesthesia Services 20 1346931292 0 Physicians Fluoride varnish 20 1346931292 0 Physicians Healthy Kids Services 20 1346931292 0 Physicians Optical Supplies 20 1346931292 0 Physicians Physician Services 00 1346932399 0 PAIK JUSTIN 2024223 9999999 B 10 1346932399 0 229 W GRAND AVE STE W BENSENVILLE IL 601063365 20 1346932399 0 Dentists Dental Services 20 1346932399 0 Dentists Physician Services 00 1346936556 0 BALAJI AAKASH 2023265 2026181 B 10 1346936556 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1346936556 0 Physicians Anesthesia Services 20 1346936556 0 Physicians Fluoride varnish 20 1346936556 0 Physicians Healthy Kids Services 20 1346936556 0 Physicians Optical Supplies 20 1346936556 0 Physicians Physician Services 00 1346936614 0 HINGL GRETTA 2023142 9999999 B 10 1346936614 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1346936614 0 Physician Assistant Only Fluoride varnish 20 1346936614 0 Physician Assistant Only Healthy Kids Services 20 1346936614 0 Physician Assistant Only Physician Services 00 1346936879 0 VENVERTLOH MAXWELL T 2023297 9999999 B 10 1346936879 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1346936879 0 Physicians Anesthesia Services 20 1346936879 0 Physicians Healthy Kids Services 20 1346936879 0 Physicians Optical Supplies 20 1346936879 0 Physicians Physician Services 00 1346937273 0 KERLEY JANE M 2023125 9999999 B 10 1346937273 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1346937273 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1346938081 0 WYNCOTT AARON A 2023121 9999999 B 10 1346938081 0 70 S RIVER ST AURORA IL 605065185 20 1346938081 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1346938362 0 MARKOVA IRENA 2024095 9999999 B 10 1346938362 0 7101 N CICERO AVE STE 202 LINCOLNWOOD IL 607122143 20 1346938362 0 Nurse Practitioners Healthy Kids Services 20 1346938362 0 Nurse Practitioners Nurse Practitioners Services 20 1346938362 0 Nurse Practitioners Physician Services 00 1346939154 0 VANN BRITNYE 2023130 9999999 B 10 1346939154 0 1414 MAIN ST MELROSE PARK IL 601603902 20 1346939154 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1346939659 0 SHAH SAMARTH 2023127 9999999 B 10 1346939659 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1346939659 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1346942190 0 YAMADA JESSICA M 2024185 9999999 B 10 1346942190 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1346942190 0 Physicians Anesthesia Services 20 1346942190 0 Physicians Fluoride varnish 20 1346942190 0 Physicians Healthy Kids Services 20 1346942190 0 Physicians Optical Supplies 20 1346942190 0 Physicians Physician Services 00 1346942711 0 DYBALA MICHAEL 2023172 9999999 B 10 1346942711 0 4698 DEPT CAROL STREAM IL 601220021 20 1346942711 0 Physicians Anesthesia Services 20 1346942711 0 Physicians Fluoride varnish 20 1346942711 0 Physicians Healthy Kids Services 20 1346942711 0 Physicians Optical Supplies 20 1346942711 0 Physicians Physician Services 00 1346943636 0 ANDERSON KYRIE 2023178 9999999 B 10 1346943636 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1346943636 0 Physicians Anesthesia Services 20 1346943636 0 Physicians Fluoride varnish 20 1346943636 0 Physicians Healthy Kids Services 20 1346943636 0 Physicians Optical Supplies 20 1346943636 0 Physicians Physician Services 00 1346943859 0 DE FILIPPIS FALCON ALEJANDRO 2024188 9999999 B 10 1346943859 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1346943859 0 Physicians Anesthesia Services 20 1346943859 0 Physicians Healthy Kids Services 20 1346943859 0 Physicians Optical Supplies 20 1346943859 0 Physicians Physician Services 00 1346944329 0 KHAN ZOYA 2023177 9999999 B 10 1346944329 0 PO BOX 3039 OAK BROOK IL 605223039 20 1346944329 0 Physicians Anesthesia Services 20 1346944329 0 Physicians Fluoride varnish 20 1346944329 0 Physicians Healthy Kids Services 20 1346944329 0 Physicians Optical Supplies 20 1346944329 0 Physicians Physician Services 00 1346944873 0 DAI MICHELLE 2024183 9999999 B 10 1346944873 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1346944873 0 Physicians Anesthesia Services 20 1346944873 0 Physicians Fluoride varnish 20 1346944873 0 Physicians Healthy Kids Services 20 1346944873 0 Physicians Optical Supplies 20 1346944873 0 Physicians Physician Services 00 1346944980 0 GILDEA GREGORY 2023249 9999999 B 10 1346944980 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1346944980 0 Physicians Anesthesia Services 20 1346944980 0 Physicians Fluoride varnish 20 1346944980 0 Physicians Healthy Kids Services 20 1346944980 0 Physicians Optical Supplies 20 1346944980 0 Physicians Physician Services 00 1346947256 0 GILMAN CELINA 2023052 9999999 B 10 1346947256 0 17 N STATE ST STE 500 CHICAGO IL 606023384 20 1346947256 0 Nurse Practitioners Family Planning Counseling 20 1346947256 0 Nurse Practitioners Fluoride varnish 20 1346947256 0 Nurse Practitioners Healthy Kids Services 20 1346947256 0 Nurse Practitioners Nurse Practitioners Services 20 1346947256 0 Nurse Practitioners Physician Services 00 1346949278 0 NAKAYENZE MAUREEN 2023144 9999999 B 10 1346949278 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1346949278 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1346950862 0 WILLIAMS RACHAEL L 2023137 9999999 B 10 1346950862 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1346950862 0 Nurse Practitioners Healthy Kids Services 20 1346950862 0 Nurse Practitioners Nurse Practitioners Services 20 1346950862 0 Nurse Practitioners Physician Services 00 1346951316 0 SHAH NISHA 2023017 9999999 B 10 1346951316 0 2245 ENTERPRISE DR STE 4506 WESTCHESTER IL 601545803 20 1346951316 0 Physician Assistant Only Fluoride varnish 20 1346951316 0 Physician Assistant Only Healthy Kids Services 20 1346951316 0 Physician Assistant Only Physician Services 00 1346952728 0 ELWOOD JANALYN L 2023184 9999999 B 10 1346952728 0 PO BOX 3988 CARBONDALE IL 629023988 20 1346952728 0 Nurse Practitioners Healthy Kids Services 20 1346952728 0 Nurse Practitioners Nurse Practitioners Services 20 1346952728 0 Nurse Practitioners Physician Services 00 1346954526 0 PATTON RACHAEL 2025034 9999999 B 10 1346954526 0 1201 PINE ST ELDORADO IL 629301634 20 1346954526 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1346955341 0 VELEZ TERESA 2023081 9999999 B 10 1346955341 0 PO BOX 684 BEDFORD PARK IL 604990684 20 1346955341 0 Nurse Practitioners Healthy Kids Services 20 1346955341 0 Nurse Practitioners Nurse Practitioners Services 20 1346955341 0 Nurse Practitioners Physician Services 00 1346956828 0 FISCHER ALEXIS 2023089 9999999 B 10 1346956828 0 PO BOX 34266 BELFAST ME 049150620 20 1346956828 0 Nurse Practitioners Fluoride varnish 20 1346956828 0 Nurse Practitioners Healthy Kids Services 20 1346956828 0 Nurse Practitioners Nurse Practitioners Services 20 1346956828 0 Nurse Practitioners Physician Services 00 1346961224 0 BURGOS KAYLA 2022252 9999999 B 10 1346961224 0 7101 N CICERO AVE STE 202 LINCOLNWOOD IL 607122143 20 1346961224 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1346961927 0 BADAHMAN MOHAMMED 2023080 9999999 B 10 1346961927 0 2633 CHATHAM RD SPRINGFIELD IL 627044185 20 1346961927 0 Dentists Dental Services 20 1346961927 0 Dentists Physician Services 00 1346964574 0 DASAL TARAK TENZIN 2022335 9999999 B 10 1346964574 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1346964574 0 Audiologists Audiology Services 20 1346964574 0 Audiologists Medical Supplies 20 1346964574 0 Audiologists Medical equipment/prosthetic devices 00 1346964640 0 TEJAN ALEXANDRA C 2022350 9999999 B 10 1346964640 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1346964640 0 Nurse Practitioners Anesthesia Services 20 1346964640 0 Nurse Practitioners Nurse Practitioners Services 20 1346964640 0 Nurse Practitioners Physician Services 00 1346966801 0 HURTLEY ANNA 2022291 9999999 B 10 1346966801 0 PO BOX 5081 JANESVILLE WI 535475081 20 1346966801 0 Physical Therapists Medical Supplies 20 1346966801 0 Physical Therapists Medical equipment/prosthetic devices 20 1346966801 0 Physical Therapists Physical Therapy Services 00 1346968914 0 LENICH JONATHAN M 2022340 9999999 B 10 1346968914 0 5875 E RIVERSIDE BLVD ROCKFORD IL 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equipment/prosthetic devices 20 1346972668 0 Occupational Therapists Occupational Therapy Services 00 1346972973 0 HERNTON SHERITA 2024283 9999999 B 10 1346972973 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1346972973 0 Physician Assistant Only Fluoride varnish 20 1346972973 0 Physician Assistant Only Healthy Kids Services 20 1346972973 0 Physician Assistant Only Physician Services 00 1346973385 0 KAMEL ALEXIA 2022194 9999999 B 10 1346973385 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1346973385 0 Physicians Anesthesia Services 20 1346973385 0 Physicians Family Planning Counseling 20 1346973385 0 Physicians Fluoride varnish 20 1346973385 0 Physicians Healthy Kids Services 20 1346973385 0 Physicians Optical Supplies 20 1346973385 0 Physicians Physician Services 00 1346973559 0 KAMINENI MALINI 2022188 9999999 B 10 1346973559 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1346973559 0 Physicians Anesthesia Services 20 1346973559 0 Physicians Fluoride varnish 20 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JENNAFER 2016001 9999999 B 10 1356753016 0 5777 DEPT CAROL STREAM IL 601220021 20 1356753016 0 Physician Assistant Only Fluoride varnish 20 1356753016 0 Physician Assistant Only Healthy Kids Services 20 1356753016 0 Physician Assistant Only Physician Services 00 1356753560 0 PRATER MARLENA 2017060 9999999 B 10 1356753560 0 1525 E 53RD ST STE 425 CHICAGO IL 606154545 20 1356753560 0 Other behavior health professional LCPC/LMFT services 00 1356753776 0 DURATINSKY JOSEPH 2020133 9999999 B 10 1356753776 0 387 SHUMAN BLVD STE 275 NAPERVILLE IL 605638450 20 1356753776 0 Physicians Anesthesia Services 20 1356753776 0 Physicians Healthy Kids Services 20 1356753776 0 Physicians Optical Supplies 20 1356753776 0 Physicians Physician Services 00 1356753859 0 LUTZ KATIE L 2019248 9999999 B 10 1356753859 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1356753859 0 Physicians Anesthesia Services 20 1356753859 0 Physicians Healthy Kids Services 20 1356753859 0 Physicians Optical Supplies 20 1356753859 0 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Physicians Optical Supplies 20 1356755201 0 Physicians Physician Services 00 1356755722 0 ADDANTE AMY 2018130 9999999 B 10 1356755722 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1356755722 0 Physicians Anesthesia Services 20 1356755722 0 Physicians Family Planning Counseling 20 1356755722 0 Physicians Healthy Kids Services 20 1356755722 0 Physicians Optical Supplies 20 1356755722 0 Physicians Physician Services 00 1356756282 0 MOHINDROO RAUBY 2017244 9999999 B 10 1356756282 0 210 N HAMMES AVE STE 103 JOLIET IL 604356688 20 1356756282 0 Podiatrists Podiatric Services 00 1356756605 0 MASSEY ALLISON 2023012 9999999 B 10 1356756605 0 PO BOX 781076 DETROIT MI 482781076 20 1356756605 0 Physician Assistant Only Fluoride varnish 20 1356756605 0 Physician Assistant Only Healthy Kids Services 20 1356756605 0 Physician Assistant Only Physician Services 00 1356756985 0 BABIONE LILY 2019183 9999999 B 10 1356756985 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1356756985 0 Physicians Anesthesia Services 20 1356756985 0 Physicians Healthy Kids Services 20 1356756985 0 Physicians Optical Supplies 20 1356756985 0 Physicians Physician Services 00 1356756993 0 IRELAND DANIELLE M 2016154 9999999 B 10 1356756993 0 721 E COURT ST PARIS IL 619442460 20 1356756993 0 Nurse Practitioners Fluoride varnish 20 1356756993 0 Nurse Practitioners Healthy Kids Services 20 1356756993 0 Nurse Practitioners Nurse Practitioners Services 20 1356756993 0 Nurse Practitioners Physician Services 00 1356757652 0 RIDLEY RIDONNA G 2007088 9999999 B 10 1356757652 0 3901 21ST ST ZION IL 600991476 20 1356757652 0 Speech Therapists Medical Supplies 20 1356757652 0 Speech Therapists Medical equipment/prosthetic devices 20 1356757652 0 Speech Therapists Speech Therapy/Pathology Services 00 1356757660 0 SUTTON DANIELLE B 2023181 9999999 B 10 1356757660 0 PO BOX 32861 CHARLOTTE NC 282322861 20 1356757660 0 Physicians Anesthesia Services 20 1356757660 0 Physicians Fluoride varnish 20 1356757660 0 Physicians Healthy Kids Services 20 1356757660 0 Physicians Optical Supplies 20 1356757660 0 Physicians Physician Services 00 1356757736 0 PATEL DILAN A 2021349 9999999 B 10 1356757736 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1356757736 0 Physicians Anesthesia Services 20 1356757736 0 Physicians Fluoride varnish 20 1356757736 0 Physicians Healthy Kids Services 20 1356757736 0 Physicians Optical Supplies 20 1356757736 0 Physicians Physician Services 00 1356759237 0 GHANTASALA PARITHARSH 2021157 9999999 B 10 1356759237 0 PO BOX 43230 PHOENIX AZ 850803230 20 1356759237 0 Physicians Anesthesia Services 20 1356759237 0 Physicians Fluoride varnish 20 1356759237 0 Physicians Healthy Kids Services 20 1356759237 0 Physicians Optical Supplies 20 1356759237 0 Physicians Physician Services 00 1356759401 0 TARIQ ALI 2020177 9999999 B 10 1356759401 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1356759401 0 Physicians Anesthesia Services 20 1356759401 0 Physicians Healthy Kids Services 20 1356759401 0 Physicians Optical Supplies 20 1356759401 0 Physicians Physician Services 00 1356760011 0 ELLIOTT CHARISSA 2016158 9999999 B 10 1356760011 0 1706 W AGENCY RD WEST BURLINGTON IA 526551667 20 1356760011 0 Nurse Practitioners Fluoride varnish 20 1356760011 0 Nurse Practitioners Healthy Kids Services 20 1356760011 0 Nurse Practitioners Nurse Practitioners Services 20 1356760011 0 Nurse Practitioners Physician Services 00 1356760276 0 BISSET LOGAN 2024254 9999999 B 10 1356760276 0 1025 MAINE ST QUINCY IL 623014038 20 1356760276 0 Physicians Anesthesia Services 20 1356760276 0 Physicians Healthy Kids Services 20 1356760276 0 Physicians Optical Supplies 20 1356760276 0 Physicians Physician Services 00 1356760995 0 AKHTER TALAL 2020189 9999999 B 10 1356760995 0 4062 DEPARTMENT CAROL STREAM IL 601224062 20 1356760995 0 Physicians Anesthesia Services 20 1356760995 0 Physicians Healthy Kids Services 20 1356760995 0 Physicians Optical Supplies 20 1356760995 0 Physicians Physician Services 00 1356762397 0 ANDERSON LIANNE 2014146 9999999 B 10 1356762397 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1356762397 0 Nurse Practitioners Healthy Kids Services 20 1356762397 0 Nurse Practitioners Nurse Practitioners Services 20 1356762397 0 Nurse Practitioners Physician Services 00 1356762702 0 KRUMWIEDE MELANIE J 2020196 9999999 B 10 1356762702 0 333 N SUMMIT ST FL 7 TOLEDO OH 436041531 20 1356762702 0 Nurse Practitioners Fluoride varnish 20 1356762702 0 Nurse Practitioners Healthy Kids Services 20 1356762702 0 Nurse Practitioners Nurse Practitioners Services 20 1356762702 0 Nurse Practitioners Physician Services 00 1356763213 0 MISZCZYSZYN BOGUSIA E 2014001 9999999 B 10 1356763213 0 PO BOX 411637 SAINT LOUIS MO 631411637 20 1356763213 0 Nurse Practitioners Anesthesia Services 20 1356763213 0 Nurse Practitioners Nurse Practitioners Services 20 1356763213 0 Nurse Practitioners Physician Services 00 1356764948 0 COOK CINDY 2016230 9999999 B 10 1356764948 0 70 S RIVER ST AURORA IL 605065185 20 1356764948 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1356765085 0 PIPIK MELINDA 2014307 9999999 B 10 1356765085 0 1029 E 130TH ST CHICAGO IL 606286908 20 1356765085 0 Nurse Practitioners Family Planning Counseling 20 1356765085 0 Nurse Practitioners Fluoride varnish 20 1356765085 0 Nurse Practitioners Healthy Kids Services 20 1356765085 0 Nurse Practitioners Nurse Practitioners Services 20 1356765085 0 Nurse Practitioners Physician Services 00 1356768030 0 PINCUS ESTHER 2018182 9999999 B 10 1356768030 0 1812 N 19TH AVE MELROSE PARK IL 601602039 20 1356768030 0 Dentists Dental Services 20 1356768030 0 Dentists Physician Services 00 1356768220 0 CAPEL KELLY W 2018173 9999999 B 10 1356768220 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1356768220 0 Physicians Anesthesia Services 20 1356768220 0 Physicians Healthy Kids Services 20 1356768220 0 Physicians Optical Supplies 20 1356768220 0 Physicians Physician Services 00 1356768253 0 ALEXANDER MICHAEL JASON 2019290 9999999 B 10 1356768253 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1356768253 0 Physicians Anesthesia Services 20 1356768253 0 Physicians Fluoride varnish 20 1356768253 0 Physicians Healthy Kids Services 20 1356768253 0 Physicians Optical Supplies 20 1356768253 0 Physicians Physician Services 00 1356768295 0 HARIHARAN MINI V 2018073 9999999 B 10 1356768295 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1356768295 0 Physicians Anesthesia Services 20 1356768295 0 Physicians Fluoride varnish 20 1356768295 0 Physicians Healthy Kids Services 20 1356768295 0 Physicians Optical Supplies 20 1356768295 0 Physicians Physician Services 00 1356768683 0 LONGFELLOW RYAN 2022292 9999999 B 10 1356768683 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1356768683 0 Physicians Anesthesia Services 20 1356768683 0 Physicians Healthy Kids Services 20 1356768683 0 Physicians Optical Supplies 20 1356768683 0 Physicians Physician Services 00 1356769020 0 METWALLY SHERIF 2022185 9999999 B 10 1356769020 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1356769020 0 Physicians Anesthesia Services 20 1356769020 0 Physicians Fluoride varnish 20 1356769020 0 Physicians Healthy Kids Services 20 1356769020 0 Physicians Optical Supplies 20 1356769020 0 Physicians Physician Services 00 1356769210 0 VERRE MICHAEL 2017142 9999999 B 10 1356769210 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1356769210 0 Physicians Anesthesia Services 20 1356769210 0 Physicians Fluoride varnish 20 1356769210 0 Physicians Healthy Kids Services 20 1356769210 0 Physicians Optical Supplies 20 1356769210 0 Physicians Physician Services 00 1356769236 0 FULLENKAMP DOMINIC E 2018296 9999999 B 10 1356769236 0 5777 DEPT CAROL STREAM IL 601220021 20 1356769236 0 Physicians Anesthesia Services 20 1356769236 0 Physicians Fluoride varnish 20 1356769236 0 Physicians Healthy Kids Services 20 1356769236 0 Physicians Optical Supplies 20 1356769236 0 Physicians Physician Services 00 1356769673 0 KLUEMPER CHASE 2023052 9999999 B 10 1356769673 0 PO BOX 43230 PHOENIX AZ 850803230 20 1356769673 0 Physicians Anesthesia Services 20 1356769673 0 Physicians Healthy Kids Services 20 1356769673 0 Physicians Optical Supplies 20 1356769673 0 Physicians Physician Services 00 1356769996 0 AVENDANO CARMEN 2023306 9999999 B 10 1356769996 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1356769996 0 Physicians Anesthesia Services 20 1356769996 0 Physicians Fluoride varnish 20 1356769996 0 Physicians Healthy Kids Services 20 1356769996 0 Physicians Optical Supplies 20 1356769996 0 Physicians Physician Services 00 1356770077 0 RUHF ADRIENNE 2025015 9999999 B 10 1356770077 0 1449 S MICHIGAN AVE STE 13006 CHICAGO IL 606052810 20 1356770077 0 Nurse Practitioners Healthy Kids Services 20 1356770077 0 Nurse Practitioners Midwife Services 20 1356770077 0 Nurse Practitioners Nurse Practitioners Services 20 1356770077 0 Nurse Practitioners Physician Services 00 1356771901 0 GAHLMAN TERRA 2021244 9999999 B 10 1356771901 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1356771901 0 Physician Assistant Only Fluoride varnish 20 1356771901 0 Physician Assistant Only Healthy Kids Services 20 1356771901 0 Physician Assistant Only Physician Services 00 1356772636 0 UMBRIACO FRANCESCO J 2014121 9999999 B 10 1356772636 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1356772636 0 Nurse Practitioners Healthy Kids Services 20 1356772636 0 Nurse Practitioners Nurse Practitioners Services 20 1356772636 0 Nurse Practitioners Physician Services 00 1356772743 0 UTOMI HELEN N 2014028 9999999 B 10 1356772743 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1356772743 0 Nurse Practitioners Healthy Kids Services 20 1356772743 0 Nurse Practitioners Nurse Practitioners Services 20 1356772743 0 Nurse Practitioners Physician Services 00 1356773485 0 RAMAYAPALLY AKHILA 2018244 9999999 B 10 1356773485 0 PO BOX 955860 SAINT LOUIS MO 631955860 20 1356773485 0 Physicians Anesthesia Services 20 1356773485 0 Physicians Fluoride varnish 20 1356773485 0 Physicians Healthy Kids Services 20 1356773485 0 Physicians Optical Supplies 20 1356773485 0 Physicians Physician Services 00 1356773717 0 FAWLEY KIMBERLY A 2017352 9999999 B 10 1356773717 0 3248 VANDEVER AVE PEKIN IL 615546257 20 1356773717 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1356775324 0 ALBERS ALLISON 2014223 9999999 B 10 1356775324 0 2339 N CALIFORNIA AVE UNIT 479 CHICAGO IL 606470360 20 1356775324 0 Speech Therapists Medical Supplies 20 1356775324 0 Speech Therapists Medical equipment/prosthetic devices 20 1356775324 0 Speech Therapists Speech Therapy/Pathology Services 00 1356775720 0 KVITLE JASON 2013238 9999999 B 10 1356775720 0 1107 COLLEGE AVE QUINCY IL 623012600 20 1356775720 0 Optometrists Optical Supplies 20 1356775720 0 Optometrists Optometric Services 20 1356775720 0 Optometrists Physician Services 00 1356776272 0 DANIELSON EMILY 2018022 9999999 B 10 1356776272 0 1095 HIGHWAY 15 S HUTCHINSON MN 553505000 20 1356776272 0 Physician Assistant Only Fluoride varnish 20 1356776272 0 Physician Assistant Only Healthy Kids Services 20 1356776272 0 Physician Assistant Only Physician Services 00 1356779318 0 GREGGAIN JENNIFER A 2013315 9999999 B 10 1356779318 0 725 SCHOOL ST STE A MORRIS IL 604501207 20 1356779318 0 Nurse Practitioners Fluoride varnish 20 1356779318 0 Nurse Practitioners Healthy Kids Services 20 1356779318 0 Nurse Practitioners Nurse Practitioners Services 20 1356779318 0 Nurse Practitioners Physician Services 00 1356779722 0 LEINS MARY 2020302 9999999 B 10 1356779722 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1356779722 0 Psychologist Psychologist service 00 1356779961 0 MAYO ANNA 2014015 9999999 B 10 1356779961 0 792 GLENBARD RD GLEN ELLYN IL 601376363 20 1356779961 0 Physical Therapists Medical Supplies 20 1356779961 0 Physical Therapists Medical equipment/prosthetic devices 20 1356779961 0 Physical Therapists Physical Therapy Services 00 1356780449 0 BEDAIR BAHAA A 2016155 9999999 B 10 1356780449 0 3015 N BALLAS RD ADMINISTRATION SAINT LOUIS MO 631312329 20 1356780449 0 Physicians Anesthesia Services 20 1356780449 0 Physicians Fluoride varnish 20 1356780449 0 Physicians Healthy Kids Services 20 1356780449 0 Physicians Optical Supplies 20 1356780449 0 Physicians Physician Services 00 1356780514 0 KHAN MURTAZA SARDAR 2022011 9999999 B 10 1356780514 0 29373 NETWORK PL CHICAGO IL 606733039 20 1356780514 0 Physicians Anesthesia Services 20 1356780514 0 Physicians Healthy Kids Services 20 1356780514 0 Physicians Optical Supplies 20 1356780514 0 Physicians Physician Services 20 1356780514 0 Physicians Physicians Psychiatric Services 00 1356781314 0 NALAWADI SHANTESH 2018023 9999999 B 10 1356781314 0 29373 NETWORK PL CHICAGO IL 606733039 20 1356781314 0 Physicians Anesthesia Services 20 1356781314 0 Physicians Fluoride varnish 20 1356781314 0 Physicians Healthy Kids Services 20 1356781314 0 Physicians Optical Supplies 20 1356781314 0 Physicians Physician Services 00 1356781348 0 MALIK ANEEQA A 2013189 9999999 B 10 1356781348 0 1812 N 19TH AVE MELROSE PARK IL 601602039 20 1356781348 0 Dentists Dental Services 20 1356781348 0 Dentists Physician Services 00 1356781363 0 AZIZ HASSAN 2022243 9999999 B 10 1356781363 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1356781363 0 Physicians Anesthesia Services 20 1356781363 0 Physicians Healthy Kids Services 20 1356781363 0 Physicians Optical Supplies 20 1356781363 0 Physicians Physician Services 00 1356781421 0 LOCH ARCHIBALD J 2016193 9999999 B 10 1356781421 0 PO BOX 5081 JANESVILLE WI 535475081 20 1356781421 0 Podiatrists Podiatric Services 00 1356782759 0 BRIGGS DAVID 2014301 9999999 H 10 1356782759 0 6645 N OLIPHANT AVE SUITE F CHICAGO IL 606311585 20 1356782759 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and 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1356786255 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1356786255 0 Physicians Anesthesia Services 20 1356786255 0 Physicians Healthy Kids Services 20 1356786255 0 Physicians Optical Supplies 20 1356786255 0 Physicians Physician Services 00 1356787048 0 RIZVI ASAD 2016335 9999999 B 10 1356787048 0 3040 W SALT CREEK LN ARLINGTON HEIGH IL 600051069 20 1356787048 0 Physicians Anesthesia Services 20 1356787048 0 Physicians Fluoride varnish 20 1356787048 0 Physicians Healthy Kids Services 20 1356787048 0 Physicians Optical Supplies 20 1356787048 0 Physicians Physician Services 00 1356787873 0 JOHNSON KATHRYN 2022066 9999999 B 10 1356787873 0 801 ADLAI STEVENSON DR SPRINGFIELD IL 627034261 20 1356787873 0 Physicians Anesthesia Services 20 1356787873 0 Physicians Healthy Kids Services 20 1356787873 0 Physicians Optical Supplies 20 1356787873 0 Physicians Physician Services 20 1356787873 0 Physicians Physicians Psychiatric Services 00 1356787972 0 DELGADO VERONICA 2013126 9999999 B 10 1356787972 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1356787972 0 Nurse Practitioners Fluoride varnish 20 1356787972 0 Nurse Practitioners Healthy Kids Services 20 1356787972 0 Nurse Practitioners Nurse Practitioners Services 20 1356787972 0 Nurse Practitioners Physician Services 00 1356788079 0 TZONKOV ANNA 2017240 9999999 B 10 1356788079 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1356788079 0 Physicians Anesthesia Services 20 1356788079 0 Physicians Healthy Kids Services 20 1356788079 0 Physicians Optical Supplies 20 1356788079 0 Physicians Physician Services 00 1356788202 0 HANNEMAN PHILIP 2023025 9999999 B 10 1356788202 0 1160 E SAINT CLAIR ST VINCENNES IN 475914853 20 1356788202 0 Physicians Anesthesia Services 20 1356788202 0 Physicians Fluoride varnish 20 1356788202 0 Physicians Healthy Kids Services 20 1356788202 0 Physicians Optical Supplies 20 1356788202 0 Physicians Physician Services 00 1356788285 0 DOBITSCH DENNIS M 2016301 9999999 B 10 1356788285 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1356788285 0 Physicians Anesthesia Services 20 1356788285 0 Physicians Fluoride varnish 20 1356788285 0 Physicians Healthy Kids Services 20 1356788285 0 Physicians Optical Supplies 20 1356788285 0 Physicians Physician Services 00 1356788467 0 ASLAM ANUM 2022361 9999999 B 10 1356788467 0 3621 S STATE ST ANN ARBOR MI 481081633 20 1356788467 0 Physicians Anesthesia Services 20 1356788467 0 Physicians Healthy Kids Services 20 1356788467 0 Physicians Optical Supplies 20 1356788467 0 Physicians Physician Services 00 1356788590 0 PATEL NAYAN R 2013259 9999999 B 10 1356788590 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1356788590 0 Optometrists Optical Supplies 20 1356788590 0 Optometrists Optometric Services 20 1356788590 0 Optometrists Physician Services 00 1356789176 0 STEIMAN CHERYL A 2019239 9999999 B 10 1356789176 0 5777 DEPT CAROL STREAM IL 601220021 20 1356789176 0 Physicians Anesthesia Services 20 1356789176 0 Physicians Fluoride varnish 20 1356789176 0 Physicians Healthy Kids Services 20 1356789176 0 Physicians Optical Supplies 20 1356789176 0 Physicians Physician Services 00 1356789622 0 REYES ROBERT 2023139 9999999 B 10 1356789622 0 1005 BROADWAY ST QUINCY IL 623012834 20 1356789622 0 Physicians Anesthesia Services 20 1356789622 0 Physicians Healthy Kids Services 20 1356789622 0 Physicians Optical Supplies 20 1356789622 0 Physicians Physician Services 00 1356789754 0 HUBBARD ALLISON R 2015314 9999999 H 10 1356789754 0 210 N HAMMES AVE STE 205 JOLIET IL 604358139 20 1356789754 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1356789887 0 KYDES ASHLEY 2023254 9999999 B 10 1356789887 0 PO BOX 411637 SAINT LOUIS MO 631411637 20 1356789887 0 Physicians Anesthesia Services 20 1356789887 0 Physicians Healthy Kids Services 20 1356789887 0 Physicians Optical Supplies 20 1356789887 0 Physicians Physician Services 00 1356790141 0 MULROW JAMIE 2016139 9999999 B 10 1356790141 0 901 MCCLINTOCK DR STE 202 SUITE 202 BURR RIDGE IL 605270872 20 1356790141 0 Physician Assistant Only Fluoride varnish 20 1356790141 0 Physician Assistant Only Healthy Kids Services 20 1356790141 0 Physician Assistant Only Physician Services 00 1356790372 0 DICIANNI ANTHONY 2020115 9999999 B 10 1356790372 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1356790372 0 Physicians Anesthesia Services 20 1356790372 0 Physicians Healthy Kids Services 20 1356790372 0 Physicians Optical Supplies 20 1356790372 0 Physicians Physician Services 00 1356790653 0 EETTICKAL SHEENA 2017080 9999999 B 10 1356790653 0 200 N GARY AVE CAROL STREAM IL 601881834 20 1356790653 0 Physicians Anesthesia Services 20 1356790653 0 Physicians Fluoride varnish 20 1356790653 0 Physicians Healthy Kids Services 20 1356790653 0 Physicians Optical Supplies 20 1356790653 0 Physicians Physician Services 00 1356790851 0 MAXWELL JODAN 2023173 9999999 B 10 1356790851 0 6150 PARKLAND BLVD STE 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Services 20 1356792055 0 Nurse Practitioners Nurse Practitioners Services 20 1356792055 0 Nurse Practitioners Physician Services 00 1356792063 0 CURTIS KATELYN 2023067 9999999 B 10 1356792063 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1356792063 0 Physician Assistant Only Fluoride varnish 20 1356792063 0 Physician Assistant Only Healthy Kids Services 20 1356792063 0 Physician Assistant Only Physician Services 00 1356792196 0 HO DUONG 2018210 9999999 B 10 1356792196 0 PO BOX 776874 CHICAGO IL 606776874 20 1356792196 0 Nurse Practitioners Fluoride varnish 20 1356792196 0 Nurse Practitioners Healthy Kids Services 20 1356792196 0 Nurse Practitioners Nurse Practitioners Services 20 1356792196 0 Nurse Practitioners Physician Services 00 1356792956 0 GAMBLIN JESSICA 2016257 9999999 B 10 1356792956 0 8940 N WOOD SAGE RD PEORIA IL 616157822 20 1356792956 0 Nurse Practitioners Healthy Kids Services 20 1356792956 0 Nurse Practitioners Nurse Practitioners Services 20 1356792956 0 Nurse 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Healthy Kids Services 20 1366558769 0 Physicians Optical Supplies 20 1366558769 0 Physicians Physician Services 00 1366559072 0 BUTTERLY MARK 2005032 9999999 B 10 1366559072 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1366559072 0 Physicians Anesthesia Services 20 1366559072 0 Physicians Fluoride varnish 20 1366559072 0 Physicians Healthy Kids Services 20 1366559072 0 Physicians Optical Supplies 20 1366559072 0 Physicians Physician Services 00 1366560898 0 ALVAREZ ELIZABETH 2006068 9999999 B 10 1366560898 0 544 NUNDA TRL CRYSTAL LAKE IL 600123795 20 1366560898 0 Speech Therapists Medical Supplies 20 1366560898 0 Speech Therapists Medical equipment/prosthetic devices 20 1366560898 0 Speech Therapists Speech Therapy/Pathology Services 00 1366561458 0 NGUYEN DUYHUU 2009244 9999999 B 10 1366561458 0 29373 NETWORK PL CHICAGO IL 606733039 20 1366561458 0 Physicians Anesthesia Services 20 1366561458 0 Physicians Fluoride varnish 20 1366561458 0 Physicians Healthy Kids Services 20 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1366671463 0 Physicians Anesthesia Services 20 1366671463 0 Physicians Family Planning Counseling 20 1366671463 0 Physicians Fluoride varnish 20 1366671463 0 Physicians Healthy Kids Services 20 1366671463 0 Physicians Optical Supplies 20 1366671463 0 Physicians Physician Services 00 1366671489 0 LEONARD DANIEL 2012323 9999999 B 10 1366671489 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1366671489 0 Physicians All Kids application agent 20 1366671489 0 Physicians Anesthesia Services 20 1366671489 0 Physicians Fluoride varnish 20 1366671489 0 Physicians Healthy Kids Services 20 1366671489 0 Physicians Optical Supplies 20 1366671489 0 Physicians Physician Services 00 1366671802 0 BROWN DERRICK M 2017011 9999999 B 10 1366671802 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1366671802 0 Physician Assistant Only Fluoride varnish 20 1366671802 0 Physician Assistant Only Healthy Kids Services 20 1366671802 0 Physician Assistant Only Physician Services 00 1366672644 0 ASCHER JENNIFER D 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1366675332 0 Physicians Physician Services 00 1366675480 0 OFORI-GYEBI FELIX 2024230 9999999 B 10 1366675480 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1366675480 0 Physicians Anesthesia Services 20 1366675480 0 Physicians Healthy Kids Services 20 1366675480 0 Physicians Optical Supplies 20 1366675480 0 Physicians Physician Services 00 1366676801 0 CLEMENS REGINA A 2017001 9999999 B 10 1366676801 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1366676801 0 Physicians Anesthesia Services 20 1366676801 0 Physicians Fluoride varnish 20 1366676801 0 Physicians Healthy Kids Services 20 1366676801 0 Physicians Optical Supplies 20 1366676801 0 Physicians Physician Services 00 1366676835 0 EDEN BRENDA 2009145 9999999 B 10 1366676835 0 619 E MASON ST STE 4P57 SPRINGFIELD IL 627011034 20 1366676835 0 Nurse Practitioners Healthy Kids Services 20 1366676835 0 Nurse Practitioners Nurse Practitioners Services 20 1366676835 0 Nurse Practitioners Physician Services 00 1366677007 0 MICHELOTTI BRETT F 2016214 9999999 B 10 1366677007 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1366677007 0 Physicians Anesthesia Services 20 1366677007 0 Physicians Healthy Kids Services 20 1366677007 0 Physicians Optical Supplies 20 1366677007 0 Physicians Physician Services 00 1366677320 0 ZARSE CHAD A 2016189 9999999 B 10 1366677320 0 1801 N SENATE BLVD STE 355 INDIANAPOLIS IN 462021252 20 1366677320 0 Physicians Anesthesia Services 20 1366677320 0 Physicians Fluoride varnish 20 1366677320 0 Physicians Healthy Kids Services 20 1366677320 0 Physicians Optical Supplies 20 1366677320 0 Physicians Physician Services 00 1366678088 0 DAMITZ EMILY 2024023 9999999 B 10 1366678088 0 PO BOX 781076 DETROIT MI 482781076 20 1366678088 0 Physician Assistant Only Fluoride varnish 20 1366678088 0 Physician Assistant Only Healthy Kids Services 20 1366678088 0 Physician Assistant Only Physician Services 00 1366678096 0 LEWIS JAIME 2013231 9999999 B 10 1366678096 0 2 WESTBROOK CORP CTR STE 600 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1366686966 0 TOROK KATHRYN 2021218 9999999 B 10 1366686966 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1366686966 0 Physicians Anesthesia Services 20 1366686966 0 Physicians Fluoride varnish 20 1366686966 0 Physicians Healthy Kids Services 20 1366686966 0 Physicians Optical Supplies 20 1366686966 0 Physicians Physician Services 00 1366687303 0 WALDMAN BABS 1981227 9999999 B 10 1366687303 0 2611 W CHICAGO AVE CHICAGO IL 606224519 20 1366687303 0 Physicians Anesthesia Services 20 1366687303 0 Physicians Fluoride varnish 20 1366687303 0 Physicians Healthy Kids Services 20 1366687303 0 Physicians Optical Supplies 20 1366687303 0 Physicians Physician Services 00 1366688632 0 CARTOLANO THOMAS J 2015215 9999999 B 10 1366688632 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1366688632 0 Physicians Anesthesia Services 20 1366688632 0 Physicians Healthy Kids Services 20 1366688632 0 Physicians Optical Supplies 20 1366688632 0 Physicians Physician Services 00 1366689911 0 DORMAN HALINA B 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1366839151 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1366839151 0 Registered nurse Nursing service 20 1366839151 0 Registered nurse Waiver service 00 1366839581 0 MADUEKE IKENNA 2017160 9999999 B 10 1366839581 0 7732 SOLUTION CTR MC 776 CHICAGO IL 606777007 20 1366839581 0 Physicians Anesthesia Services 20 1366839581 0 Physicians Healthy Kids Services 20 1366839581 0 Physicians Optical Supplies 20 1366839581 0 Physicians Physician Services 00 1366840407 0 WENDELL BEVERLY 2014335 9999999 B 10 1366840407 0 3471 EAGLE WAY CHICAGO IL 606781034 20 1366840407 0 Nurse Practitioners Healthy Kids Services 20 1366840407 0 Nurse Practitioners Nurse Practitioners Services 20 1366840407 0 Nurse Practitioners Physician Services 00 1366841389 0 DUARTEBEZERRADIBEGON MERCIA J 2018364 9999999 B 10 1366841389 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1366841389 0 Physicians Anesthesia Services 20 1366841389 0 Physicians Healthy Kids Services 20 1366841389 0 Physicians Optical Supplies 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1366858797 0 Physicians Healthy Kids Services 20 1366858797 0 Physicians Optical Supplies 20 1366858797 0 Physicians Physician Services 00 1366858805 0 BENDIX SARAH 2016252 9999999 B 10 1366858805 0 5777 DEPT CAROL STREAM IL 601220021 20 1366858805 0 Clinical Social Worker Social work service 00 1366858987 0 MOHANDAS ARAVIND 2022266 9999999 B 10 1366858987 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1366858987 0 Physicians Anesthesia Services 20 1366858987 0 Physicians Healthy Kids Services 20 1366858987 0 Physicians Optical Supplies 20 1366858987 0 Physicians Physician Services 00 1366859142 0 DUDIKI NATASHA 2023069 9999999 B 10 1366859142 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1366859142 0 Physicians Anesthesia Services 20 1366859142 0 Physicians Fluoride varnish 20 1366859142 0 Physicians Healthy Kids Services 20 1366859142 0 Physicians Optical Supplies 20 1366859142 0 Physicians Physician Services 00 1366860215 0 CUEVA SHIRLEY 2017093 9999999 B 10 1366860215 0 777 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Physicians Optical Supplies 20 1376029447 0 Physicians Physician Services 20 1376029447 0 Physicians Physicians Psychiatric Services 00 1376029603 0 RESTAINO CRISTINA A 2018219 9999999 B 10 1376029603 0 654 HICKORY DR ITASCA IL 601431655 20 1376029603 0 Speech Therapists Medical Supplies 20 1376029603 0 Speech Therapists Medical equipment/prosthetic devices 20 1376029603 0 Speech Therapists Speech Therapy/Pathology Services 00 1376029959 0 BEYER BRIANA M 2018309 9999999 B 10 1376029959 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1376029959 0 Physician Assistant Only Fluoride varnish 20 1376029959 0 Physician Assistant Only Healthy Kids Services 20 1376029959 0 Physician Assistant Only Physician Services 00 1376030239 0 RUBEN RACHEL 2018099 9999999 B 10 1376030239 0 828 N CASS AVE STE 1B WESTMONT IL 605591368 20 1376030239 0 Optometrists Optical Supplies 20 1376030239 0 Optometrists Optometric Services 20 1376030239 0 Optometrists Physician Services 00 1376030528 0 PATEL RUSHIL 2021174 9999999 B 10 1376030528 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1376030528 0 Physicians Anesthesia Services 20 1376030528 0 Physicians Fluoride varnish 20 1376030528 0 Physicians Healthy Kids Services 20 1376030528 0 Physicians Optical Supplies 20 1376030528 0 Physicians Physician Services 00 1376030551 0 VALERA REYES ADRIANA C 2024262 9999999 B 10 1376030551 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1376030551 0 Physicians Anesthesia Services 20 1376030551 0 Physicians Healthy Kids Services 20 1376030551 0 Physicians Optical Supplies 20 1376030551 0 Physicians Physician Services 00 1376030627 0 MARTINEZ ARAUJO WENDY R 2021121 9999999 B 10 1376030627 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1376030627 0 Physicians Anesthesia Services 20 1376030627 0 Physicians Fluoride varnish 20 1376030627 0 Physicians Healthy Kids Services 20 1376030627 0 Physicians Optical Supplies 20 1376030627 0 Physicians Physician Services 00 1376031625 0 PAVER DONNA M 2018347 9999999 B 10 1376031625 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1376031625 0 Nurse Practitioners Fluoride varnish 20 1376031625 0 Nurse Practitioners Healthy Kids Services 20 1376031625 0 Nurse Practitioners Nurse Practitioners Services 20 1376031625 0 Nurse Practitioners Physician Services 00 1376031831 0 MAU KRISTEN M 2019091 9999999 B 10 1376031831 0 PO BOX 772 MC2295 WOONSOCKET RI 028950784 20 1376031831 0 Nurse Practitioners Fluoride varnish 20 1376031831 0 Nurse Practitioners Healthy Kids Services 20 1376031831 0 Nurse Practitioners Nurse Practitioners Services 20 1376031831 0 Nurse Practitioners Physician Services 00 1376032136 0 PIRROTTA ANNUNZIATO 2020274 9999999 B 10 1376032136 0 29373 NETWORK PL CHICAGO IL 606733039 20 1376032136 0 Physicians Anesthesia Services 20 1376032136 0 Physicians Healthy Kids Services 20 1376032136 0 Physicians Optical Supplies 20 1376032136 0 Physicians Physician Services 00 1376032250 0 DAM ANGELLIE 2018182 9999999 B 10 1376032250 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1376032250 0 Nurse Practitioners Healthy Kids Services 20 1376032250 0 Nurse Practitioners Nurse Practitioners Services 20 1376032250 0 Nurse Practitioners Physician Services 00 1376033241 0 RIM MARIA K 2018199 9999999 B 10 1376033241 0 1151 N STATE ST ELGIN IL 601231404 20 1376033241 0 Clinical Social Worker Social work service 00 1376033415 0 SANTEE KYLE 2022244 9999999 B 10 1376033415 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1376033415 0 Physicians Anesthesia Services 20 1376033415 0 Physicians Healthy Kids Services 20 1376033415 0 Physicians Optical Supplies 20 1376033415 0 Physicians Physician Services 00 1376034439 0 BELL ELIZABETH F 2019137 9999999 B 10 1376034439 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1376034439 0 Physicians Anesthesia Services 20 1376034439 0 Physicians Fluoride varnish 20 1376034439 0 Physicians Healthy Kids Services 20 1376034439 0 Physicians Optical Supplies 20 1376034439 0 Physicians Physician Services 00 1376034991 0 BRADLEY KAREN 2018152 9999999 B 10 1376034991 0 312 N MAY ST CHICAGO IL 606071200 20 1376034991 0 Nurse Practitioners Fluoride varnish 20 1376034991 0 Nurse Practitioners Healthy Kids Services 20 1376034991 0 Nurse Practitioners Nurse Practitioners Services 20 1376034991 0 Nurse Practitioners Physician Services 00 1376035105 0 ARORA SHANNON 2022130 9999999 B 10 1376035105 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1376035105 0 Physicians Anesthesia Services 20 1376035105 0 Physicians Fluoride varnish 20 1376035105 0 Physicians Healthy Kids Services 20 1376035105 0 Physicians Optical Supplies 20 1376035105 0 Physicians Physician Services 00 1376035295 0 TIMM FLOYD 2021305 9999999 B 10 1376035295 0 PO BOX 1412 SOUTH BEND IN 466241412 20 1376035295 0 Physicians Anesthesia Services 20 1376035295 0 Physicians Healthy Kids Services 20 1376035295 0 Physicians Optical Supplies 20 1376035295 0 Physicians Physician Services 00 1376035857 0 MORREALE TERESA 2018127 9999999 B 10 1376035857 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1376035857 0 Occupational Therapists Medical Supplies 20 1376035857 0 Occupational Therapists Medical equipment/prosthetic devices 20 1376035857 0 Occupational Therapists Occupational Therapy Services 00 1376035931 0 JACOBS MAURA 2018182 9999999 B 10 1376035931 0 5777 DEPT CAROL STREAM IL 601220021 20 1376035931 0 Physicians Anesthesia Services 20 1376035931 0 Physicians Fluoride varnish 20 1376035931 0 Physicians Healthy Kids Services 20 1376035931 0 Physicians Optical Supplies 20 1376035931 0 Physicians Physician Services 00 1376036418 0 KIM SO LIM 2018351 9999999 B 10 1376036418 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1376036418 0 Physicians Anesthesia Services 20 1376036418 0 Physicians Fluoride varnish 20 1376036418 0 Physicians Healthy Kids Services 20 1376036418 0 Physicians Optical Supplies 20 1376036418 0 Physicians Physician Services 00 1376037010 0 ACAR OMER 2018318 9999999 B 10 1376037010 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1376037010 0 Physicians Anesthesia Services 20 1376037010 0 Physicians Healthy Kids Services 20 1376037010 0 Physicians Optical Supplies 20 1376037010 0 Physicians Physician Services 00 1376037168 0 RITTER STEPHANIE M 2018255 9999999 B 10 1376037168 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1376037168 0 Registered nurse Nursing service 20 1376037168 0 Registered nurse Waiver service 00 1376037713 0 SALAS FAYLENE 2018169 9999999 B 10 1376037713 0 966 W 21ST ST CHICAGO IL 606084511 20 1376037713 0 Nurse Practitioners Fluoride varnish 20 1376037713 0 Nurse Practitioners Healthy Kids Services 20 1376037713 0 Nurse Practitioners Nurse Practitioners Services 20 1376037713 0 Nurse Practitioners Physician Services 00 1376038166 0 WIENKES BRITTANY L 2018200 9999999 B 10 1376038166 0 PO BOX 101625 FORT WORTH TX 761851625 20 1376038166 0 Nurse Practitioners Healthy Kids Services 20 1376038166 0 Nurse Practitioners Nurse Practitioners Services 20 1376038166 0 Nurse Practitioners Physician Services 00 1376038273 0 PRUETT KAILEY 2019323 9999999 B 10 1376038273 0 634 N MAIN ST STE 3 O FALLON IL 622693746 20 1376038273 0 Physical Therapists Medical Supplies 20 1376038273 0 Physical Therapists Medical equipment/prosthetic devices 20 1376038273 0 Physical Therapists Physical Therapy Services 00 1376039669 0 NARAYANASAMY SABARISH 2022213 9999999 B 10 1376039669 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1376039669 0 Physicians Anesthesia Services 20 1376039669 0 Physicians Healthy Kids Services 20 1376039669 0 Physicians Optical Supplies 20 1376039669 0 Physicians Physician Services 00 1376039859 0 DUMMER JAMIE 2018197 9999999 H 10 1376039859 0 4600 3RD ST MOLINE IL 612656106 20 1376039859 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1376040014 0 WONG JODY 2022192 9999999 B 10 1376040014 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1376040014 0 Physicians Anesthesia Services 20 1376040014 0 Physicians Healthy Kids Services 20 1376040014 0 Physicians Optical Supplies 20 1376040014 0 Physicians Physician Services 20 1376040014 0 Physicians Physicians Psychiatric Services 00 1376040089 0 BLOCK ALLISON N 2022181 9999999 B 10 1376040089 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1376040089 0 Physicians Anesthesia Services 20 1376040089 0 Physicians Healthy Kids Services 20 1376040089 0 Physicians Optical Supplies 20 1376040089 0 Physicians Physician Services 20 1376040089 0 Physicians Physicians Psychiatric Services 00 1376040402 0 PACKETT ASHLEY 2024354 9999999 B 10 1376040402 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1376040402 0 Physicians Anesthesia Services 20 1376040402 0 Physicians Fluoride varnish 20 1376040402 0 Physicians Healthy Kids Services 20 1376040402 0 Physicians Optical Supplies 20 1376040402 0 Physicians Physician Services 00 1376040477 0 HEINZMANN CHARLES 2019265 9999999 B 10 1376040477 0 1000 W HARLEM AVE MONMOUTH IL 614621007 20 1376040477 0 Physicians Anesthesia Services 20 1376040477 0 Physicians Healthy Kids Services 20 1376040477 0 Physicians Optical Supplies 20 1376040477 0 Physicians Physician Services 00 1376040774 0 BEAMSLEY CHRISTOPHER 2018110 9999999 H 10 1376040774 0 70 S RIVER ST AURORA IL 605065185 20 1376040774 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1376042580 0 SCHILLMOELLER SUSAN 2017279 9999999 B 10 1376042580 0 17 N STATE ST STE 500 CHICAGO IL 606023384 20 1376042580 0 Clinical Social Worker Social work service 00 1376043737 0 DENIS LIZ M 2019182 9999999 B 10 1376043737 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1376043737 0 Physician Assistant Only Fluoride varnish 20 1376043737 0 Physician Assistant Only Healthy Kids Services 20 1376043737 0 Physician Assistant Only Physician Services 00 1376044693 0 WIENKE ALYSSA B 2020153 9999999 B 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Physicians Anesthesia Services 20 1376047506 0 Physicians Fluoride varnish 20 1376047506 0 Physicians Healthy Kids Services 20 1376047506 0 Physicians Optical Supplies 20 1376047506 0 Physicians Physician Services 00 1376047589 0 SALAZAR ALAN G 2021174 9999999 B 10 1376047589 0 901 MCCLINTOCK DR STE 202 SUITE 202 BURR RIDGE IL 605270872 20 1376047589 0 Physicians Anesthesia Services 20 1376047589 0 Physicians Fluoride varnish 20 1376047589 0 Physicians Healthy Kids Services 20 1376047589 0 Physicians Optical Supplies 20 1376047589 0 Physicians Physician Services 00 1376047647 0 ALAM MOHAMMAD 2022031 9999999 B 10 1376047647 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1376047647 0 Nurse Practitioners Anesthesia Services 20 1376047647 0 Nurse Practitioners Fluoride varnish 20 1376047647 0 Nurse Practitioners Healthy Kids Services 20 1376047647 0 Nurse Practitioners Optical Supplies 20 1376047647 0 Nurse Practitioners Physician Services 00 1376047704 0 SCODARY KATHERINE E 2019018 9999999 B 10 1376047704 0 PO BOX 955860 SAINT LOUIS MO 631955860 20 1376047704 0 Nurse Practitioners Healthy Kids Services 20 1376047704 0 Nurse Practitioners Nurse Practitioners Services 20 1376047704 0 Nurse Practitioners Physician Services 00 1376047886 0 PARUCHURI THARUN 2024319 9999999 B 10 1376047886 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1376047886 0 Physicians Anesthesia Services 20 1376047886 0 Physicians Fluoride varnish 20 1376047886 0 Physicians Healthy Kids Services 20 1376047886 0 Physicians Optical Supplies 20 1376047886 0 Physicians Physician Services 00 1376048041 0 PATULLO LEAH V 2023011 9999999 B 10 1376048041 0 PO BOX 10010 GLENDALE AZ 853180010 20 1376048041 0 Physicians Anesthesia Services 20 1376048041 0 Physicians Healthy Kids Services 20 1376048041 0 Physicians Optical Supplies 20 1376048041 0 Physicians Physician Services 00 1376049072 0 OKANU NGOZI 2024213 9999999 B 10 1376049072 0 2361 PAYSPHERE CIR CHICAGO IL 606740023 20 1376049072 0 Physicians Anesthesia Services 20 1376049072 0 Physicians Fluoride varnish 20 1376049072 0 Physicians Healthy Kids Services 20 1376049072 0 Physicians Optical Supplies 20 1376049072 0 Physicians Physician Services 00 1376049676 0 WATSON ROBERT C 2023018 9999999 B 10 1376049676 0 340 MIDLAND RD STE 120 JANESVILLE WI 535462339 20 1376049676 0 Physicians Anesthesia Services 20 1376049676 0 Physicians Healthy Kids Services 20 1376049676 0 Physicians Optical Supplies 20 1376049676 0 Physicians Physician Services 00 1376050112 0 RICHTER DEANNE L 2018001 9999999 B 10 1376050112 0 15732 S HOWARD ST PLAINFIELD IL 605442399 20 1376050112 0 Speech Therapists Medical Supplies 20 1376050112 0 Speech Therapists Medical equipment/prosthetic devices 20 1376050112 0 Speech Therapists Speech Therapy/Pathology Services 00 1376051292 0 DETERS KAYLA R 2018002 9999999 B 10 1376051292 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1376051292 0 Nurse Practitioners Fluoride varnish 20 1376051292 0 Nurse Practitioners Healthy Kids Services 20 1376051292 0 Nurse Practitioners Nurse Practitioners Services 20 1376051292 0 Nurse Practitioners Physician Services 00 1376051789 0 GREGORY CLAYTON T 2018043 9999999 B 10 1376051789 0 238 S CONGRESS ST RUSHVILLE IL 626811465 20 1376051789 0 Nurse Practitioners Anesthesia Services 20 1376051789 0 Nurse Practitioners Nurse Practitioners Services 20 1376051789 0 Nurse Practitioners Physician Services 00 1376052365 0 ALLEN ROBIN 2020157 9999999 B 10 1376052365 0 100 MEDICAL DR HANNIBAL MO 634016877 20 1376052365 0 Nurse Practitioners Fluoride varnish 20 1376052365 0 Nurse Practitioners Healthy Kids Services 20 1376052365 0 Nurse Practitioners Nurse Practitioners Services 20 1376052365 0 Nurse Practitioners Physician Services 00 1376052423 0 PENTEK DEIDRE A 2017352 9999999 B 10 1376052423 0 6020 151ST ST OAK FOREST IL 604521841 20 1376052423 0 Speech Therapists Medical Supplies 20 1376052423 0 Speech Therapists Medical equipment/prosthetic devices 20 1376052423 0 Speech Therapists Speech Therapy/Pathology Services 00 1376053140 0 LITTIG ANNA M 2017319 9999999 B 10 1376053140 0 4239 W 95TH ST OAK LAWN IL 604532623 20 1376053140 0 Nurse Practitioners Fluoride varnish 20 1376053140 0 Nurse Practitioners Healthy Kids Services 20 1376053140 0 Nurse Practitioners Nurse Practitioners Services 20 1376053140 0 Nurse Practitioners Physician Services 00 1376053652 0 WILLIAMS LINDSEY 2020218 9999999 B 10 1376053652 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1376053652 0 Nurse Practitioners Healthy Kids Services 20 1376053652 0 Nurse Practitioners Nurse Practitioners Services 20 1376053652 0 Nurse Practitioners Physician Services 00 1376056309 0 GUTIERREZ NICOLE E 2017335 9999999 B 10 1376056309 0 PO BOX 3990 NAPERVILLE IL 605673990 20 1376056309 0 Speech Therapists Medical Supplies 20 1376056309 0 Speech Therapists Medical equipment/prosthetic devices 20 1376056309 0 Speech Therapists Speech Therapy/Pathology Services 00 1376058230 0 KANSLER COURTNEY 2017347 9999999 B 10 1376058230 0 601 WILLOW ST FRANKFORT IL 604231140 20 1376058230 0 Speech Therapists Medical Supplies 20 1376058230 0 Speech Therapists Medical equipment/prosthetic devices 20 1376058230 0 Speech Therapists Speech Therapy/Pathology Services 00 1376058305 0 ANDERSON REBECCA 2018032 9999999 B 10 1376058305 0 1016 S MADISON ST STE A DU QUOIN IL 628322442 20 1376058305 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1376059014 0 VARGAS ANGELO GREGORY 2018337 9999999 B 10 1376059014 0 24014 W RENWICK RD PLAINFIELD IL 605448708 20 1376059014 0 Physical Therapists Medical Supplies 20 1376059014 0 Physical Therapists Medical equipment/prosthetic devices 20 1376059014 0 Physical Therapists Physical Therapy Services 00 1376059477 0 RANSFORD STACEY 2018003 9999999 B 10 1376059477 0 2202 HARLEM RD LOVES PARK IL 611112754 20 1376059477 0 Nurse Practitioners Anesthesia Services 20 1376059477 0 Nurse Practitioners Nurse Practitioners Services 20 1376059477 0 Nurse Practitioners Physician Services 00 1376060012 0 FISK NANCY A 2017269 9999999 B 10 1376060012 0 PO BOX 2048 CARBONDALE IL 629022048 20 1376060012 0 Speech Therapists Medical Supplies 20 1376060012 0 Speech Therapists Medical equipment/prosthetic devices 20 1376060012 0 Speech Therapists Speech Therapy/Pathology Services 00 1376060418 0 OTTO-MEYER SEBASTIAN 2021125 9999999 B 10 1376060418 0 PO BOX 8500 LOCKBOX 7642 PHILADELPHIA PA 191787642 20 1376060418 0 Physicians Anesthesia Services 20 1376060418 0 Physicians Fluoride varnish 20 1376060418 0 Physicians Healthy Kids Services 20 1376060418 0 Physicians Optical Supplies 20 1376060418 0 Physicians Physician Services 00 1376062570 0 O'CONNOR SUSAN M 2017255 9999999 H 10 1376062570 0 1003 ML KING DR BLOOMINGTON IL 617011429 20 1376062570 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1376062729 0 SILDIRYAN 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B 10 1376125088 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1376125088 0 Nurse Practitioners Healthy Kids Services 20 1376125088 0 Nurse Practitioners Nurse Practitioners Services 20 1376125088 0 Nurse Practitioners Physician Services 00 1376125104 0 KHAN AMIR A 2024270 9999999 B 10 1376125104 0 1701 LACEY ST CAPE GIRARDEAU MO 637015230 20 1376125104 0 Physicians Anesthesia Services 20 1376125104 0 Physicians Healthy Kids Services 20 1376125104 0 Physicians Optical Supplies 20 1376125104 0 Physicians Physician Services 00 1376125609 0 KHAN AAHAD N 2024232 9999999 B 10 1376125609 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1376125609 0 Physicians Anesthesia Services 20 1376125609 0 Physicians Healthy Kids Services 20 1376125609 0 Physicians Optical Supplies 20 1376125609 0 Physicians Physician Services 00 1376125690 0 GUPTA RACHIT 2023004 9999999 B 10 1376125690 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1376125690 0 Physicians Anesthesia Services 20 1376125690 0 Physicians Healthy Kids Services 20 1376125690 0 Physicians Optical Supplies 20 1376125690 0 Physicians Physician Services 00 1376126136 0 SAHAR FARAH 2021189 9999999 B 10 1376126136 0 800 E LOCUST ST OLNEY IL 624502553 20 1376126136 0 Physicians Anesthesia Services 20 1376126136 0 Physicians Fluoride varnish 20 1376126136 0 Physicians Healthy Kids Services 20 1376126136 0 Physicians Optical Supplies 20 1376126136 0 Physicians Physician Services 00 1376126425 0 CROFTON CHARIS N 2023191 9999999 B 10 1376126425 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1376126425 0 Physicians Anesthesia Services 20 1376126425 0 Physicians Healthy Kids Services 20 1376126425 0 Physicians Optical Supplies 20 1376126425 0 Physicians Physician Services 00 1376127050 0 NNONYELU CHIBUEZE 2024255 9999999 B 10 1376127050 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1376127050 0 Physicians Anesthesia Services 20 1376127050 0 Physicians Fluoride varnish 20 1376127050 0 Physicians Healthy Kids 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9999999 B 10 1376128439 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1376128439 0 Nurse Practitioners Fluoride varnish 20 1376128439 0 Nurse Practitioners Healthy Kids Services 20 1376128439 0 Nurse Practitioners Nurse Practitioners Services 20 1376128439 0 Nurse Practitioners Physician Services 00 1376129247 0 TOPALIS THOMAS S 2021316 9999999 B 10 1376129247 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1376129247 0 Physicians Anesthesia Services 20 1376129247 0 Physicians Healthy Kids Services 20 1376129247 0 Physicians Optical Supplies 20 1376129247 0 Physicians Physician Services 00 1376129411 0 BONNERUP SPENCER 2024166 9999999 B 10 1376129411 0 PO BOX 708760 SANDY UT 840708760 20 1376129411 0 Physicians Anesthesia Services 20 1376129411 0 Physicians Fluoride varnish 20 1376129411 0 Physicians Healthy Kids Services 20 1376129411 0 Physicians Optical Supplies 20 1376129411 0 Physicians Physician Services 00 1376129460 0 SADA KAHMALIA-KALEE C 2024193 9999999 B 10 1376129460 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1376129460 0 Physicians Anesthesia Services 20 1376129460 0 Physicians Fluoride varnish 20 1376129460 0 Physicians Healthy Kids Services 20 1376129460 0 Physicians Optical Supplies 20 1376129460 0 Physicians Physician Services 00 1376129783 0 TIANGSON GLENNALYN G 2024206 9999999 B 10 1376129783 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1376129783 0 Physicians Anesthesia Services 20 1376129783 0 Physicians Fluoride varnish 20 1376129783 0 Physicians Healthy Kids Services 20 1376129783 0 Physicians Optical Supplies 20 1376129783 0 Physicians Physician Services 00 1376129874 0 YASSA GIZEM 2021208 9999999 B 10 1376129874 0 5777 DEPT CAROL STREAM IL 601220021 20 1376129874 0 Physicians Anesthesia Services 20 1376129874 0 Physicians Fluoride varnish 20 1376129874 0 Physicians Healthy Kids Services 20 1376129874 0 Physicians Optical Supplies 20 1376129874 0 Physicians Physician Services 00 1376131870 0 KLOEPPINGER LAUREN M 2022192 9999999 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TAYLOR JULIA M 2021021 9999999 B 10 1376133637 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1376133637 0 Nurse Practitioners Healthy Kids Services 20 1376133637 0 Nurse Practitioners Nurse Practitioners Services 20 1376133637 0 Nurse Practitioners Physician Services 00 1376133918 0 CHASE EMILY 2022007 9999999 B 10 1376133918 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1376133918 0 Physical Therapists Medical Supplies 20 1376133918 0 Physical Therapists Medical equipment/prosthetic devices 20 1376133918 0 Physical Therapists Physical Therapy Services 00 1376134148 0 BECHTOLD JENNIFER 2022235 9999999 B 10 1376134148 0 PO BOX 3990 NAPERVILLE IL 605673990 20 1376134148 0 Speech Therapists Medical Supplies 20 1376134148 0 Speech Therapists Medical equipment/prosthetic devices 20 1376134148 0 Speech Therapists Speech Therapy/Pathology Services 00 1376135996 0 MACEK JANICE A 2021046 9999999 B 10 1376135996 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1376135996 0 Other behavior health 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1376153825 0 Nurse Practitioners Fluoride varnish 20 1376153825 0 Nurse Practitioners Healthy Kids Services 20 1376153825 0 Nurse Practitioners Nurse Practitioners Services 20 1376153825 0 Nurse Practitioners Physician Services 00 1376154419 0 HOLM ANDREA 2024232 9999999 B 10 1376154419 0 25435 W ROUTE 30 PLAINFIELD IL 605859781 20 1376154419 0 Other behavior health professional LCPC/LMFT services 00 1376155358 0 LINDENBERG HEATHER 2021119 9999999 B 10 1376155358 0 6020 151ST ST OAK FOREST IL 604521841 20 1376155358 0 Speech Therapists Medical Supplies 20 1376155358 0 Speech Therapists Medical equipment/prosthetic devices 20 1376155358 0 Speech Therapists Speech Therapy/Pathology Services 00 1376155473 0 SCHNEIDER AVERY 2022124 9999999 B 10 1376155473 0 1400 W GREENLEAF AVE CHICAGO IL 606262805 20 1376155473 0 Occupational Therapists Medical Supplies 20 1376155473 0 Occupational Therapists Medical equipment/prosthetic devices 20 1376155473 0 Occupational Therapists Occupational Therapy 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0 ABOUZEID BASSEL 2020300 9999999 B 10 1376160846 0 221 NE GLEN OAK AVE PEORIA IL 616360002 20 1376160846 0 Physicians Anesthesia Services 20 1376160846 0 Physicians Healthy Kids Services 20 1376160846 0 Physicians Optical Supplies 20 1376160846 0 Physicians Physician Services 00 1376162545 0 KENNEDY OLIVIA A 2024234 9999999 B 10 1376162545 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1376162545 0 Physicians Anesthesia Services 20 1376162545 0 Physicians Healthy Kids Services 20 1376162545 0 Physicians Optical Supplies 20 1376162545 0 Physicians Physician Services 00 1376162578 0 OWEN CHELSEA 2022264 9999999 B 10 1376162578 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1376162578 0 Nurse Practitioners Anesthesia Services 20 1376162578 0 Nurse Practitioners Nurse Practitioners Services 20 1376162578 0 Nurse Practitioners Physician Services 00 1376163121 0 MEHTA VIVEK 2024172 9999999 B 10 1376163121 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1376163121 0 Physicians Anesthesia Services 20 1376163121 0 Physicians Healthy Kids Services 20 1376163121 0 Physicians Optical Supplies 20 1376163121 0 Physicians Physician Services 20 1376163121 0 Physicians Physicians Psychiatric Services 00 1376163139 0 BRITTON ANDREA 2020120 9999999 B 10 1376163139 0 611 W PARK ST URBANA IL 618012529 20 1376163139 0 Physical Therapists Medical Supplies 20 1376163139 0 Physical Therapists Medical equipment/prosthetic devices 20 1376163139 0 Physical Therapists Physical Therapy Services 00 1376163261 0 ALI MD SHAHIN 2023244 9999999 B 10 1376163261 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1376163261 0 Physicians Anesthesia Services 20 1376163261 0 Physicians Fluoride varnish 20 1376163261 0 Physicians Healthy Kids Services 20 1376163261 0 Physicians Optical Supplies 20 1376163261 0 Physicians Physician Services 00 1376163295 0 GARG PARAS 2024121 9999999 B 10 1376163295 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1376163295 0 Physicians 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1376235861 0 Physicians Physician Services 00 1376236273 0 PURKS JULIA 2023175 9999999 B 10 1376236273 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1376236273 0 Physicians Anesthesia Services 20 1376236273 0 Physicians Healthy Kids Services 20 1376236273 0 Physicians Optical Supplies 20 1376236273 0 Physicians Physician Services 20 1376236273 0 Physicians Physicians Psychiatric Services 00 1376236471 0 SYE CASSIDY 2024200 9999999 B 10 1376236471 0 8777 PURDUE RD STE 115 INDIANAPOLIS IN 462683104 20 1376236471 0 Dentists Dental Services 20 1376236471 0 Dentists Physician Services 00 1376236869 0 FATIMA SAFOORA 2023195 9999999 B 10 1376236869 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1376236869 0 Physicians Anesthesia Services 20 1376236869 0 Physicians Healthy Kids Services 20 1376236869 0 Physicians Optical Supplies 20 1376236869 0 Physicians Physician Services 20 1376236869 0 Physicians Physicians Psychiatric Services 00 1376237313 0 NAIR POOJA 2023173 9999999 B 10 1376237313 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1376237313 0 Physicians Anesthesia Services 20 1376237313 0 Physicians Fluoride varnish 20 1376237313 0 Physicians Healthy Kids Services 20 1376237313 0 Physicians Optical Supplies 20 1376237313 0 Physicians Physician Services 00 1376237453 0 WILSON STEVEN A 2023177 9999999 B 10 1376237453 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1376237453 0 Physicians Anesthesia Services 20 1376237453 0 Physicians Fluoride varnish 20 1376237453 0 Physicians Healthy Kids Services 20 1376237453 0 Physicians Optical Supplies 20 1376237453 0 Physicians Physician Services 00 1376237479 0 LUBEGA NASSER 2023195 9999999 B 10 1376237479 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1376237479 0 Physicians Anesthesia Services 20 1376237479 0 Physicians Healthy Kids Services 20 1376237479 0 Physicians Optical Supplies 20 1376237479 0 Physicians Physician Services 00 1376238089 0 EILAND RASHEEDA 2023206 9999999 B 10 1376238089 0 400 N HIGHLAND AVE AURORA IL 605063814 20 1376238089 0 Nurse Practitioners Fluoride varnish 20 1376238089 0 Nurse Practitioners Healthy Kids Services 20 1376238089 0 Nurse Practitioners Nurse Practitioners Services 20 1376238089 0 Nurse Practitioners Physician Services 00 1376238303 0 DYBAS MARRISSA M 2023298 9999999 B 10 1376238303 0 124 SW ADAMS ST PEORIA IL 616021308 20 1376238303 0 Physicians Anesthesia Services 20 1376238303 0 Physicians Healthy Kids Services 20 1376238303 0 Physicians Optical Supplies 20 1376238303 0 Physicians Physician Services 00 1376238691 0 SWEIS NADIA 2023227 9999999 B 10 1376238691 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1376238691 0 Physicians Anesthesia Services 20 1376238691 0 Physicians Fluoride varnish 20 1376238691 0 Physicians Healthy Kids Services 20 1376238691 0 Physicians Optical Supplies 20 1376238691 0 Physicians Physician Services 00 1376238725 0 BEASLEY JASMINE T 2023187 9999999 B 10 1376238725 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1376238725 0 Physicians Anesthesia Services 20 1376238725 0 Physicians Healthy Kids Services 20 1376238725 0 Physicians Optical Supplies 20 1376238725 0 Physicians Physician Services 00 1376239483 0 PETROCHENKOV EGOR 2023277 9999999 B 10 1376239483 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1376239483 0 Physicians Anesthesia Services 20 1376239483 0 Physicians Healthy Kids Services 20 1376239483 0 Physicians Optical Supplies 20 1376239483 0 Physicians Physician Services 00 1376242321 0 LEWIS KATELYN WHITNEY 2023059 9999999 B 10 1376242321 0 42 W MADISON ST FL 2 CHICAGO IL 606024309 20 1376242321 0 Speech Therapists Medical Supplies 20 1376242321 0 Speech Therapists Medical equipment/prosthetic devices 20 1376242321 0 Speech Therapists Speech Therapy/Pathology Services 00 1376242677 0 CRAWFORD CARMELLA 2025013 9999999 B 10 1376242677 0 10205 W LINCOLN HWY FRANKFORT IL 604231279 20 1376242677 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1376245035 0 SCHOENTHAL FREDRICK 2023207 9999999 B 10 1376245035 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1376245035 0 Dentists Dental Services 20 1376245035 0 Dentists Physician Services 00 1376245084 0 VARDANYAN ANNA 2024248 9999999 B 10 1376245084 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1376245084 0 Physicians Anesthesia Services 20 1376245084 0 Physicians Healthy Kids Services 20 1376245084 0 Physicians Optical Supplies 20 1376245084 0 Physicians Physician Services 00 1376245175 0 CARROLL WENDY J 2024145 9999999 B 10 1376245175 0 1270 NORTHLAND DR STE 250 MENDOTA HEIGHTS MN 551201156 20 1376245175 0 Nurse Practitioners Healthy Kids Services 20 1376245175 0 Nurse Practitioners Nurse Practitioners Services 20 1376245175 0 Nurse Practitioners Physician Services 00 1376245589 0 DINKEL ANTHONY R 2023169 9999999 B 10 1376245589 0 4698 DEPT CAROL STREAM IL 601220021 20 1376245589 0 Physicians Anesthesia Services 20 1376245589 0 Physicians Healthy Kids Services 20 1376245589 0 Physicians Optical Supplies 20 1376245589 0 Physicians Physician Services 00 1376245852 0 LI ZIRUI 2023192 9999999 B 10 1376245852 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1376245852 0 Physicians Anesthesia Services 20 1376245852 0 Physicians Healthy Kids Services 20 1376245852 0 Physicians Optical Supplies 20 1376245852 0 Physicians Physician Services 20 1376245852 0 Physicians Physicians Psychiatric Services 00 1376246025 0 LAW JENNIFER 2023174 9999999 B 10 1376246025 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1376246025 0 Physicians Anesthesia Services 20 1376246025 0 Physicians Healthy Kids Services 20 1376246025 0 Physicians Optical Supplies 20 1376246025 0 Physicians Physician Services 00 1376246504 0 COLE CONNOR 2023181 9999999 B 10 1376246504 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1376246504 0 Physicians Anesthesia Services 20 1376246504 0 Physicians Fluoride varnish 20 1376246504 0 Physicians Healthy Kids Services 20 1376246504 0 Physicians Optical Supplies 20 1376246504 0 Physicians Physician Services 00 1376246538 0 ROTH ANDREW M 2023182 9999999 B 10 1376246538 0 PO BOX 3039 OAK BROOK IL 605223039 20 1376246538 0 Physicians Anesthesia Services 20 1376246538 0 Physicians Fluoride varnish 20 1376246538 0 Physicians Healthy Kids Services 20 1376246538 0 Physicians Optical Supplies 20 1376246538 0 Physicians Physician Services 00 1376246546 0 NEBECK SHANE 2024208 9999999 B 10 1376246546 0 515 22ND AVE MONROE WI 535661569 20 1376246546 0 Physicians Anesthesia Services 20 1376246546 0 Physicians Fluoride varnish 20 1376246546 0 Physicians Healthy Kids Services 20 1376246546 0 Physicians Optical Supplies 20 1376246546 0 Physicians Physician Services 00 1376247213 0 PEREZ GABRIELLE M 2023192 9999999 B 10 1376247213 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1376247213 0 Physicians Anesthesia Services 20 1376247213 0 Physicians Healthy Kids Services 20 1376247213 0 Physicians Optical Supplies 20 1376247213 0 Physicians Physician Services 20 1376247213 0 Physicians Physicians Psychiatric Services 00 1376247551 0 ZAMORA-PINEDA JESUS B 2024176 9999999 B 10 1376247551 0 4698 DEPT CAROL STREAM IL 601220021 20 1376247551 0 Physicians Anesthesia Services 20 1376247551 0 Physicians Fluoride varnish 20 1376247551 0 Physicians Healthy Kids Services 20 1376247551 0 Physicians Optical Supplies 20 1376247551 0 Physicians Physician Services 00 1376247668 0 KONS KELLY 2023249 9999999 B 10 1376247668 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1376247668 0 Physicians Anesthesia Services 20 1376247668 0 Physicians Healthy Kids Services 20 1376247668 0 Physicians Optical Supplies 20 1376247668 0 Physicians Physician Services 00 1376247767 0 RURA JOSEPH 2023292 9999999 B 10 1376247767 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1376247767 0 Physician Assistant Only Fluoride varnish 20 1376247767 0 Physician Assistant Only Healthy Kids Services 20 1376247767 0 Physician Assistant Only Physician Services 00 1376248310 0 OTUSILE IBIRONKE 2023207 9999999 B 10 1376248310 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1376248310 0 Physicians Anesthesia Services 20 1376248310 0 Physicians Fluoride varnish 20 1376248310 0 Physicians Healthy Kids Services 20 1376248310 0 Physicians Optical Supplies 20 1376248310 0 Physicians Physician Services 00 1376248351 0 XIAO KANGNI 2024209 9999999 B 10 1376248351 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1376248351 0 Physicians Anesthesia Services 20 1376248351 0 Physicians Healthy Kids Services 20 1376248351 0 Physicians Optical Supplies 20 1376248351 0 Physicians Physician Services 20 1376248351 0 Physicians Physicians Psychiatric Services 00 1376248724 0 SUN MICHAEL 2023286 9999999 B 10 1376248724 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1376248724 0 Physicians Anesthesia Services 20 1376248724 0 Physicians Healthy Kids Services 20 1376248724 0 Physicians Optical Supplies 20 1376248724 0 Physicians Physician Services 00 1376249052 0 FORZLEY ANNE 2023076 9999999 B 10 1376249052 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1376249052 0 Nurse Practitioners Anesthesia Services 20 1376249052 0 Nurse Practitioners Nurse Practitioners Services 20 1376249052 0 Nurse Practitioners Physician Services 00 1376249995 0 LOOS JULIE 2023069 9999999 B 10 1376249995 0 50 S MAIN ST STE 200 NAPERVILLE IL 605405485 20 1376249995 0 Physical Therapists Medical Supplies 20 1376249995 0 Physical Therapists Medical equipment/prosthetic devices 20 1376249995 0 Physical Therapists Physical Therapy Services 00 1376251561 0 ALBRECHT AMANDA 2023286 9999999 B 10 1376251561 0 2073 N CLYBOURN AVE CHICAGO IL 606144003 20 1376251561 0 Physician Assistant Only Fluoride varnish 20 1376251561 0 Physician Assistant Only Healthy Kids Services 20 1376251561 0 Physician Assistant Only Physician Services 00 1376253823 0 ARCEO JENNILYN 2022340 9999999 B 10 1376253823 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1376253823 0 Registered nurse Nursing service 20 1376253823 0 Registered nurse Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1376253823 0 Registered nurse Waiver service 00 1376254433 0 MARRO KELSEY R 2024023 9999999 B 10 1376254433 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1376254433 0 Nurse Practitioners Healthy Kids Services 20 1376254433 0 Nurse Practitioners Nurse Practitioners Services 20 1376254433 0 Nurse Practitioners Physician Services 00 1376258186 0 KINSINGER MIRANDA 2023220 9999999 B 10 1376258186 0 1 TRANSAM PLAZA DR STE 100 OAKBROOK TERRAC IL 601814286 20 1376258186 0 Nurse Practitioners Fluoride varnish 20 1376258186 0 Nurse Practitioners Healthy Kids Services 20 1376258186 0 Nurse Practitioners Nurse Practitioners Services 20 1376258186 0 Nurse Practitioners Physician Services 00 1376258905 0 ADANK MADISON 2023039 9999999 B 10 1376258905 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1376258905 0 Nurse Practitioners Fluoride varnish 20 1376258905 0 Nurse Practitioners Healthy Kids Services 20 1376258905 0 Nurse Practitioners Nurse Practitioners Services 20 1376258905 0 Nurse Practitioners Physician Services 00 1376259630 0 TRUSSLER ZACHARY R 2023136 9999999 B 10 1376259630 0 2044 MADISON AVE STE 15 GRANITE CITY IL 620404641 20 1376259630 0 Physician Assistant Only Fluoride varnish 20 1376259630 0 Physician Assistant Only Healthy Kids Services 20 1376259630 0 Physician Assistant Only Physician Services 00 1376259820 0 HABLISTON MICHAEL 2023037 9999999 B 10 1376259820 0 2361 PAYSPHERE CIR CHICAGO IL 606740023 20 1376259820 0 Physician Assistant Only Fluoride varnish 20 1376259820 0 Physician Assistant Only Healthy Kids Services 20 1376259820 0 Physician Assistant Only Physician Services 00 1376260182 0 LAMARCA VIANCA 2023032 9999999 B 10 1376260182 0 400 N HIGHLAND AVE AURORA IL 605063814 20 1376260182 0 Nurse Practitioners Fluoride varnish 20 1376260182 0 Nurse Practitioners Healthy Kids Services 20 1376260182 0 Nurse Practitioners Nurse Practitioners Services 20 1376260182 0 Nurse Practitioners Physician Services 00 1376260398 0 PADILLA KENNETH 2022311 9999999 B 10 1376260398 0 929 W HIGGINS RD SCHAUMBURG IL 601953203 20 1376260398 0 Physician Assistant Only Fluoride varnish 20 1376260398 0 Physician Assistant Only Healthy Kids Services 20 1376260398 0 Physician Assistant Only Physician Services 00 1376260414 0 JOHANNSEN STEPHANIE K 2023303 9999999 B 10 1376260414 0 PO BOX 43230 PHOENIX AZ 850803230 20 1376260414 0 Nurse Practitioners Fluoride varnish 20 1376260414 0 Nurse Practitioners Healthy Kids Services 20 1376260414 0 Nurse Practitioners Nurse Practitioners Services 20 1376260414 0 Nurse Practitioners Physician Services 00 1376261081 0 KOVALEVA ANNA 2022279 9999999 B 10 1376261081 0 3471 GREEN BAY RD NORTH CHICAGO IL 600643090 20 1376261081 0 Other behavior health professional LCPC/LMFT services 00 1376263996 0 PATEL JANU 2022332 9999999 B 10 1376263996 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1376263996 0 Physician Assistant Only Fluoride varnish 20 1376263996 0 Physician Assistant Only Healthy Kids Services 20 1376263996 0 Physician Assistant Only Physician Services 00 1376264069 0 RITCHIE LAURA 2022299 9999999 B 10 1376264069 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1376264069 0 Nurse Practitioners Healthy Kids Services 20 1376264069 0 Nurse Practitioners Nurse Practitioners Services 20 1376264069 0 Nurse Practitioners Physician Services 00 1376264952 0 CHIRI CAITLIN B 2022320 9999999 B 10 1376264952 0 901 BIESTERFIELD RD STE 110 ELK GROVE VILLA IL 600073393 20 1376264952 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1376267666 0 JUILFS KAITLYN M 2022315 9999999 B 10 1376267666 0 2100 MADISON AVE STE 301 GRANITE CITY IL 620404713 20 1376267666 0 Nurse Practitioners Fluoride varnish 20 1376267666 0 Nurse Practitioners Healthy Kids Services 20 1376267666 0 Nurse Practitioners Nurse Practitioners Services 20 1376267666 0 Nurse Practitioners Physician Services 00 1376272070 0 GILLETTE DORCIE ANN P 2022179 9999999 B 10 1376272070 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1376272070 0 Physicians Anesthesia Services 20 1376272070 0 Physicians Healthy Kids Services 20 1376272070 0 Physicians Optical Supplies 20 1376272070 0 Physicians Physician Services 00 1376272435 0 EWALDT JESSE 2022193 9999999 B 10 1376272435 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1376272435 0 Physicians Anesthesia Services 20 1376272435 0 Physicians Healthy Kids Services 20 1376272435 0 Physicians Optical Supplies 20 1376272435 0 Physicians Physician Services 00 1376272963 0 HERNANDEZ LARTIGUE NAMYR 2024222 9999999 B 10 1376272963 0 3600 W FULLERTON AVE ATTN: BILLING DEPARTMENT CHICAGO IL 606472319 20 1376272963 0 Physician Assistant Only Fluoride varnish 20 1376272963 0 Physician Assistant Only Healthy Kids Services 20 1376272963 0 Physician Assistant Only Physician Services 00 1376273573 0 SKONDRAS ANTONIOS 2022207 9999999 B 10 1376273573 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1376273573 0 Physicians Anesthesia Services 20 1376273573 0 Physicians Fluoride varnish 20 1376273573 0 Physicians Healthy Kids Services 20 1376273573 0 Physicians Optical Supplies 20 1376273573 0 Physicians Physician Services 00 1376275594 0 HEFFERNAN JANICE E 2022270 9999999 B 10 1376275594 0 5777 DEPT CAROL STREAM IL 601220021 20 1376275594 0 Nurse Practitioners Fluoride varnish 20 1376275594 0 Nurse Practitioners Healthy Kids Services 20 1376275594 0 Nurse Practitioners Nurse Practitioners Services 20 1376275594 0 Nurse Practitioners Physician Services 00 1376275719 0 MASTER FAIZAN ASHARAF BHAI 2022273 9999999 B 10 1376275719 0 190 E DELAWARE PL CHICAGO IL 606111813 20 1376275719 0 Physicians Anesthesia Services 20 1376275719 0 Physicians Fluoride varnish 20 1376275719 0 Physicians Healthy Kids Services 20 1376275719 0 Physicians Optical Supplies 20 1376275719 0 Physicians Physician Services 00 1376276022 0 ANDAYA VINA 2022210 9999999 B 10 1376276022 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1376276022 0 Nurse Practitioners Healthy Kids Services 20 1376276022 0 Nurse Practitioners Nurse Practitioners Services 20 1376276022 0 Nurse Practitioners Physician Services 00 1376276378 0 ESPINOZA MERCADO GUSTAVO 2022194 9999999 B 10 1376276378 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1376276378 0 Physicians Anesthesia Services 20 1376276378 0 Physicians Fluoride varnish 20 1376276378 0 Physicians Healthy Kids Services 20 1376276378 0 Physicians Optical Supplies 20 1376276378 0 Physicians Physician Services 00 1376279893 0 HICKS MICHELLE A 2024361 9999999 B 10 1376279893 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1376279893 0 Nurse Practitioners Healthy Kids Services 20 1376279893 0 Nurse Practitioners Nurse Practitioners Services 20 1376279893 0 Nurse Practitioners Physician Services 00 1376280255 0 ELSHARNOBY HADEER RAFAT 2022214 2025181 B 10 1376280255 0 611 W PARK ST URBANA IL 618012529 20 1376280255 0 Physicians Anesthesia Services 20 1376280255 0 Physicians Fluoride varnish 20 1376280255 0 Physicians Healthy Kids Services 20 1376280255 0 Physicians Optical Supplies 20 1376280255 0 Physicians Physician Services 00 1376280693 0 BECKER MATTHEW 2022213 9999999 B 10 1376280693 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1376280693 0 Physicians Anesthesia Services 20 1376280693 0 Physicians Fluoride varnish 20 1376280693 0 Physicians Healthy Kids Services 20 1376280693 0 Physicians Optical Supplies 20 1376280693 0 Physicians Physician Services 00 1376280883 0 BRINK KATE M 2022273 9999999 B 10 1376280883 0 2350 ROYAL BLVD STE 300 ELGIN IL 601234718 20 1376280883 0 Nurse Practitioners Fluoride varnish 20 1376280883 0 Nurse Practitioners Healthy Kids Services 20 1376280883 0 Nurse Practitioners Nurse Practitioners Services 20 1376280883 0 Nurse Practitioners Physician Services 00 1376281154 0 KEMP ADAM 2022179 2027181 B 10 1376281154 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1376281154 0 Physicians Anesthesia Services 20 1376281154 0 Physicians Healthy Kids Services 20 1376281154 0 Physicians Optical Supplies 20 1376281154 0 Physicians Physician Services 00 1376281733 0 KRONE KATHERINE 2022347 9999999 B 10 1376281733 0 4600 3RD ST MOLINE IL 612656106 20 1376281733 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1376282467 0 FAN JAMES 2022180 9999999 B 10 1376282467 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1376282467 0 Physicians Anesthesia Services 20 1376282467 0 Physicians Fluoride varnish 20 1376282467 0 Physicians Healthy Kids Services 20 1376282467 0 Physicians Optical Supplies 20 1376282467 0 Physicians Physician Services 00 1376282814 0 SHARMA PRABHAT 2022251 9999999 B 10 1376282814 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1376282814 0 Physicians Anesthesia Services 20 1376282814 0 Physicians Fluoride varnish 20 1376282814 0 Physicians Healthy Kids Services 20 1376282814 0 Physicians Optical Supplies 20 1376282814 0 Physicians Physician Services 00 1376283549 0 GUI HOLLY 2022192 9999999 B 10 1376283549 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1376283549 0 Physicians Anesthesia Services 20 1376283549 0 Physicians Healthy Kids Services 20 1376283549 0 Physicians Optical Supplies 20 1376283549 0 Physicians Physician Services 00 1376283945 0 MANTICAS NICHOLAS 2022353 9999999 B 10 1376283945 0 4698 DEPT CAROL STREAM IL 601224698 20 1376283945 0 Physicians Anesthesia Services 20 1376283945 0 Physicians Fluoride varnish 20 1376283945 0 Physicians Healthy Kids Services 20 1376283945 0 Physicians Optical Supplies 20 1376283945 0 Physicians Physician Services 00 1376284091 0 GAZDZIK NICOLE K 2022364 9999999 B 10 1376284091 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1376284091 0 Nurse Practitioners Fluoride varnish 20 1376284091 0 Nurse Practitioners Healthy Kids Services 20 1376284091 0 Nurse Practitioners Nurse Practitioners Services 20 1376284091 0 Nurse Practitioners Physician Services 00 1376284653 0 CLEMENS JULIA 2022179 9999999 B 10 1376284653 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1376284653 0 Physicians Anesthesia Services 20 1376284653 0 Physicians Fluoride varnish 20 1376284653 0 Physicians Healthy Kids Services 20 1376284653 0 Physicians Optical Supplies 20 1376284653 0 Physicians Physician Services 00 1376285551 0 BEG USMAN 2024157 9999999 B 10 1376285551 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1376285551 0 Physicians Anesthesia Services 20 1376285551 0 Physicians Healthy Kids Services 20 1376285551 0 Physicians Optical Supplies 20 1376285551 0 Physicians Physician Services 00 1376286344 0 TIEMENS ERICK 2024231 9999999 B 10 1376286344 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1376286344 0 Physicians Anesthesia Services 20 1376286344 0 Physicians Healthy Kids Services 20 1376286344 0 Physicians Optical Supplies 20 1376286344 0 Physicians Physician Services 00 1376287615 0 PATEL AASHAY V 2022248 9999999 B 10 1376287615 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1376287615 0 Physicians Anesthesia Services 20 1376287615 0 Physicians Healthy Kids Services 20 1376287615 0 Physicians Optical Supplies 20 1376287615 0 Physicians Physician Services 00 1376287680 0 OLOKUN WUNMI 2023179 9999999 B 10 1376287680 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1376287680 0 Nurse Practitioners Fluoride varnish 20 1376287680 0 Nurse Practitioners Healthy Kids Services 20 1376287680 0 Nurse Practitioners Nurse Practitioners Services 20 1376287680 0 Nurse Practitioners Physician Services 00 1376287946 0 VELASQUEZ WILLIAM H 2022182 9999999 B 10 1376287946 0 PO BOX 857 FREEPORT IL 610320857 20 1376287946 0 Physicians Anesthesia Services 20 1376287946 0 Physicians Fluoride varnish 20 1376287946 0 Physicians Healthy Kids Services 20 1376287946 0 Physicians Optical Supplies 20 1376287946 0 Physicians Physician Services 00 1376288951 0 GHIMIRE PRABINA 2022214 2025181 B 10 1376288951 0 611 W PARK ST URBANA IL 618012529 20 1376288951 0 Physicians Anesthesia Services 20 1376288951 0 Physicians Fluoride varnish 20 1376288951 0 Physicians Healthy Kids Services 20 1376288951 0 Physicians Optical Supplies 20 1376288951 0 Physicians Physician Services 00 1376291757 0 HEALY SHAUNNA 2024277 9999999 B 10 1376291757 0 1757 N KIMBALL AVE STE 202 CHICAGO IL 606474805 20 1376291757 0 Other behavior health professional Social work service 00 1376291823 0 HAYNE LAURA 2022363 9999999 B 10 1376291823 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1376291823 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1376292227 0 PLUNKETT RYAN D 2022196 9999999 B 10 1376292227 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1376292227 0 Physicians Anesthesia Services 20 1376292227 0 Physicians Fluoride varnish 20 1376292227 0 Physicians Healthy Kids Services 20 1376292227 0 Physicians Optical Supplies 20 1376292227 0 Physicians Physician Services 00 1376293225 0 SILVA-NASH JENNIFER 2022181 9999999 B 10 1376293225 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1376293225 0 Physicians Anesthesia Services 20 1376293225 0 Physicians Healthy Kids Services 20 1376293225 0 Physicians Optical Supplies 20 1376293225 0 Physicians Physician Services 00 1376293266 0 ZEB SALMA 2023206 9999999 B 10 1376293266 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1376293266 0 Physicians Anesthesia Services 20 1376293266 0 Physicians Fluoride varnish 20 1376293266 0 Physicians Healthy Kids Services 20 1376293266 0 Physicians Optical Supplies 20 1376293266 0 Physicians Physician Services 00 1376293548 0 SAMAD SYED A 2023203 9999999 B 10 1376293548 0 PO BOX 778791 CHICAGO IL 606776473 20 1376293548 0 Physicians Anesthesia Services 20 1376293548 0 Physicians Fluoride varnish 20 1376293548 0 Physicians Healthy Kids Services 20 1376293548 0 Physicians Optical Supplies 20 1376293548 0 Physicians Physician Services 00 1376293894 0 QAQISH HANAN 2024158 9999999 B 10 1376293894 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1376293894 0 Physicians Anesthesia Services 20 1376293894 0 Physicians Healthy Kids Services 20 1376293894 0 Physicians Optical Supplies 20 1376293894 0 Physicians Physician Services 20 1376293894 0 Physicians Physicians Psychiatric Services 00 1376295360 0 WALASZEK DANIEL C 2022067 9999999 B 10 1376295360 0 13550 S ROUTE 30 STE 100 PLAINFIELD IL 605445686 20 1376295360 0 Nurse Practitioners Fluoride varnish 20 1376295360 0 Nurse Practitioners Healthy Kids Services 20 1376295360 0 Nurse Practitioners Nurse Practitioners Services 20 1376295360 0 Nurse Practitioners Physician Services 00 1376295428 0 BANKS AYANNA 2023335 9999999 B 10 1376295428 0 PO BOX 775618 CHICAGO IL 606775618 20 1376295428 0 Physician Assistant Only Fluoride varnish 20 1376295428 0 Physician Assistant Only Healthy Kids Services 20 1376295428 0 Physician Assistant Only Physician Services 00 1376297002 0 MANN TRICIA 2022054 9999999 B 10 1376297002 0 PO BOX 775253 CHICAGO IL 606775253 20 1376297002 0 Nurse Practitioners Fluoride varnish 20 1376297002 0 Nurse Practitioners Healthy Kids Services 20 1376297002 0 Nurse Practitioners Nurse Practitioners Services 20 1376297002 0 Nurse Practitioners Physician Services 00 1376297093 0 SEMBATYA RASHIDAH 2022244 9999999 B 10 1376297093 0 303 E ARMY TRAIL RD STE 111 BLOOMINGDALE IL 601082140 20 1376297093 0 Nurse Practitioners Fluoride varnish 20 1376297093 0 Nurse Practitioners Healthy Kids Services 20 1376297093 0 Nurse Practitioners Nurse Practitioners Services 20 1376297093 0 Nurse Practitioners Physician Services 00 1376297564 0 KELLEHER CARLY 2023251 9999999 B 10 1376297564 0 801 YORK ST MANITOWOC WI 542204630 20 1376297564 0 Physician Assistant Only Fluoride varnish 20 1376297564 0 Physician Assistant Only Healthy Kids Services 20 1376297564 0 Physician Assistant Only Physician Services 00 1376297937 0 COLEMAN BRANDY J 2022271 9999999 B 10 1376297937 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1376297937 0 Nurse Practitioners Fluoride varnish 20 1376297937 0 Nurse Practitioners Healthy Kids Services 20 1376297937 0 Nurse Practitioners Nurse Practitioners Services 20 1376297937 0 Nurse Practitioners Physician Services 00 1376298596 0 DUE RICHARD J 2023276 9999999 B 10 1376298596 0 5777 DEPT CAROL STREAM IL 601220021 20 1376298596 0 Physician Assistant Only Fluoride varnish 20 1376298596 0 Physician Assistant Only Healthy Kids Services 20 1376298596 0 Physician Assistant Only Physician Services 00 1376298919 0 MOOMAW JADEN 2023268 9999999 B 10 1376298919 0 800 E LOCUST ST OLNEY IL 624502553 20 1376298919 0 Nurse Practitioners Healthy Kids Services 20 1376298919 0 Nurse Practitioners Nurse Practitioners Services 20 1376298919 0 Nurse Practitioners Physician Services 00 1376299446 0 CURRAN PATRICK 2024143 9999999 B 10 1376299446 0 611 W PARK ST URBANA IL 618012529 20 1376299446 0 Nurse Practitioners Anesthesia Services 20 1376299446 0 Nurse Practitioners Nurse Practitioners Services 20 1376299446 0 Nurse Practitioners Physician Services 00 1376299818 0 PHILIP SAJAN 2022109 9999999 B 10 1376299818 0 2720 S RIVER RD STE 128 DES PLAINES IL 600184110 20 1376299818 0 Physician Assistant Only Fluoride varnish 20 1376299818 0 Physician Assistant Only Healthy Kids Services 20 1376299818 0 Physician Assistant Only Physician Services 00 1376299925 0 GHANT ALEAHA A 2022073 9999999 B 10 1376299925 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1376299925 0 Nurse Practitioners Healthy Kids Services 20 1376299925 0 Nurse Practitioners Nurse Practitioners Services 20 1376299925 0 Nurse Practitioners Physician Services 00 1376299933 0 OFORI DANSO EMMANUEL 2023283 9999999 B 10 1376299933 0 1643 NW 136TH AVE STE 100 SUNRISE FL 333232857 20 1376299933 0 Nurse Practitioners Healthy Kids 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Fluoride varnish 20 1376303370 0 Physicians Healthy Kids Services 20 1376303370 0 Physicians Optical Supplies 20 1376303370 0 Physicians Physician Services 00 1376303719 0 O'MEARA MAXIMILIAN 2024165 9999999 B 10 1376303719 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1376303719 0 Physicians Anesthesia Services 20 1376303719 0 Physicians Healthy Kids Services 20 1376303719 0 Physicians Optical Supplies 20 1376303719 0 Physicians Physician Services 00 1376310151 0 OWUSU DANSO STANLEY 2025042 9999999 B 10 1376310151 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1376310151 0 Nurse Practitioners Anesthesia Services 20 1376310151 0 Nurse Practitioners Nurse Practitioners Services 20 1376310151 0 Nurse Practitioners Physician Services 00 1376311175 0 HOFFEDITZ GRETCHEN 2024025 9999999 B 10 1376311175 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1376311175 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1376312561 0 PASSARELLI ARIEL 2024131 9999999 B 10 1376312561 0 PO BOX 713388 CHICAGO IL 606771525 20 1376312561 0 Nurse Practitioners Healthy Kids Services 20 1376312561 0 Nurse Practitioners Midwife Services 20 1376312561 0 Nurse Practitioners Nurse Practitioners Services 20 1376312561 0 Nurse Practitioners Physician Services 00 1376312629 0 GARCIA ELISA P 2024011 9999999 B 10 1376312629 0 1500 E LINCOLN HWY STE 1 DEKALB IL 601153990 20 1376312629 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1376314682 0 WALQUIST STACIE A 2024029 9999999 B 10 1376314682 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1376314682 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1376316463 0 MILLER BAILEY 2024114 9999999 B 10 1376316463 0 818 5TH AVE STE 200 DES MOINES IA 503091307 20 1376316463 0 Nurse Practitioners Fluoride varnish 20 1376316463 0 Nurse Practitioners Healthy Kids Services 20 1376316463 0 Nurse Practitioners Nurse Practitioners Services 20 1376316463 0 Nurse Practitioners Physician Services 00 1376316604 0 ROWLAND CAROLINE A 2024089 9999999 B 10 1376316604 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1376316604 0 Nurse Practitioners Healthy Kids Services 20 1376316604 0 Nurse Practitioners Nurse Practitioners Services 20 1376316604 0 Nurse Practitioners Physician Services 00 1376316968 0 WESTERBERG KATRINA 2025004 9999999 B 10 1376316968 0 5229 W 105TH PL STE 150 OAK LAWN IL 604535145 20 1376316968 0 Nurse Practitioners Fluoride varnish 20 1376316968 0 Nurse Practitioners Healthy Kids Services 20 1376316968 0 Nurse Practitioners Nurse Practitioners Services 20 1376316968 0 Nurse Practitioners Physician Services 00 1376317891 0 CONNOR SHANNON 2024305 9999999 B 10 1376317891 0 2025 WASHINGTON ST WAUKEGAN IL 600855131 20 1376317891 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1376320465 0 BLACKAMORE BRITTNEY 2024016 9999999 B 10 1376320465 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1376320465 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1376320499 0 ADAMS AYLA 2023269 9999999 B 10 1376320499 0 221 NE GLEN OAK AVE ATTN: STEPHEN CIRONE GOMP 100 PEORIA IL 616360001 20 1376320499 0 Physician Assistant Only Fluoride varnish 20 1376320499 0 Physician Assistant Only Healthy Kids Services 20 1376320499 0 Physician Assistant Only Physician Services 00 1376323576 0 MASIHI JULIA 2023279 9999999 B 10 1376323576 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1376323576 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1376325597 0 VENUTO ALEXANDRA 2024031 9999999 B 10 1376325597 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1376325597 0 Nurse Practitioners Healthy Kids Services 20 1376325597 0 Nurse Practitioners Nurse Practitioners Services 20 1376325597 0 Nurse Practitioners Physician Services 00 1376326116 0 BIERMAN CAROLINE 2023249 9999999 B 10 1376326116 0 PO BOX 372 MATTOON IL 619380372 20 1376326116 0 Nurse Practitioners Fluoride varnish 20 1376326116 0 Nurse Practitioners Healthy Kids Services 20 1376326116 0 Nurse Practitioners Nurse Practitioners Services 20 1376326116 0 Nurse Practitioners Physician Services 00 1376326124 0 HULL MADISON 2023292 9999999 B 10 1376326124 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1376326124 0 Physician Assistant Only Fluoride varnish 20 1376326124 0 Physician Assistant Only Healthy Kids Services 20 1376326124 0 Physician Assistant Only Physician Services 00 1376326546 0 KNUDSEN ANDREW 2023291 9999999 B 10 1376326546 0 520 VALLEY VIEW DR MOLINE IL 612656152 20 1376326546 0 Physician Assistant Only Fluoride varnish 20 1376326546 0 Physician Assistant Only Healthy Kids Services 20 1376326546 0 Physician Assistant Only Physician Services 00 1376327114 0 BORKHOVIK SIMONA 2024230 9999999 B 10 1376327114 0 1049 E WILSON ST STE 100 SUITE 100 BATAVIA IL 605102478 20 1376327114 0 Speech Therapists Medical Supplies 20 1376327114 0 Speech Therapists Medical equipment/prosthetic devices 20 1376327114 0 Speech Therapists Speech Therapy/Pathology Services 00 1376327544 0 HOFFMAN ADRIENNE 2023262 9999999 B 10 1376327544 0 1812 N 19TH AVE MELROSE PARK IL 601602039 20 1376327544 0 Dentists Dental Services 20 1376327544 0 Dentists Physician Services 00 1376328666 0 ELBELLA AHMAD A 2023295 9999999 B 10 1376328666 0 PO BOX 3039 OAK BROOK IL 605223039 20 1376328666 0 Physicians Anesthesia Services 20 1376328666 0 Physicians Fluoride varnish 20 1376328666 0 Physicians Healthy Kids Services 20 1376328666 0 Physicians Optical Supplies 20 1376328666 0 Physicians Physician Services 00 1376329748 0 TERRADO MARIA S 2024012 9999999 B 10 1376329748 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1376329748 0 Nurse Practitioners Fluoride varnish 20 1376329748 0 Nurse Practitioners Healthy Kids Services 20 1376329748 0 Nurse Practitioners Nurse Practitioners Services 20 1376329748 0 Nurse Practitioners Physician Services 00 1376329789 0 RENAUD MEGAN 2023284 9999999 B 10 1376329789 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1376329789 0 Nurse Practitioners Healthy Kids Services 20 1376329789 0 Nurse Practitioners Nurse Practitioners Services 20 1376329789 0 Nurse Practitioners Physician Services 00 1376350108 0 STOCKTON KARI 2025013 9999999 B 10 1376350108 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1376350108 0 Registered nurse Nursing service 20 1376350108 0 Registered nurse Waiver service 00 1376351189 0 BUENING PENNY E 2025020 9999999 B 10 1376351189 0 1005 BROADWAY ST QUINCY IL 623012834 20 1376351189 0 Nurse Practitioners Fluoride varnish 20 1376351189 0 Nurse Practitioners Healthy Kids Services 20 1376351189 0 Nurse Practitioners Nurse Practitioners Services 20 1376351189 0 Nurse Practitioners Physician Services 00 1376351254 0 PANAMA CAYLA M 2024362 9999999 B 10 1376351254 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1376351254 0 Registered nurse Nursing service 20 1376351254 0 Registered nurse Waiver service 00 1376351767 0 QUAD NADIA S 2025006 9999999 B 10 1376351767 0 8808 MOODY AVE OAK LAWN IL 604531149 20 1376351767 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1376352823 0 PATRICK REBECCA J 2025058 9999999 B 10 1376352823 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1376352823 0 Nurse Practitioners Anesthesia Services 20 1376352823 0 Nurse Practitioners Nurse Practitioners Services 20 1376352823 0 Nurse Practitioners Physician Services 00 1376355776 0 FRAMKE COURTNEY 2025037 9999999 B 10 1376355776 0 2001 BUTTERFIELD RD STE 1600 DOWNERS GROVE IL 605151211 20 1376355776 0 Occupational Therapists Medical Supplies 20 1376355776 0 Occupational Therapists Medical equipment/prosthetic devices 20 1376355776 0 Occupational Therapists Occupational Therapy Services 00 1376357160 0 HOLLY LEANNE 2025035 9999999 B 10 1376357160 0 1400 W GREENLEAF AVE CHICAGO IL 606262805 20 1376357160 0 Other behavior health professional Social work service 00 1376359760 0 ELGOGARI ZANE A 2025042 9999999 B 10 1376359760 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1376359760 0 Physician Assistant Only Fluoride varnish 20 1376359760 0 Physician Assistant Only Healthy Kids Services 20 1376359760 0 Physician Assistant Only Physician Services 00 1376359786 0 SCHUESSLER EDWARD S 2025014 9999999 B 10 1376359786 0 900 ROYAL HEIGHTS RD BELLEVILLE IL 622265457 20 1376359786 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1376360057 0 GIL JANET 2024362 9999999 B 10 1376360057 0 2850 W 95TH ST STE 400 EVERGREEN PARK IL 608052755 20 1376360057 0 Nurse Practitioners Fluoride varnish 20 1376360057 0 Nurse Practitioners Healthy Kids Services 20 1376360057 0 Nurse Practitioners Nurse Practitioners Services 20 1376360057 0 Nurse Practitioners Physician Services 00 1376360404 0 GOPANI PARVA U 2024276 9999999 B 10 1376360404 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1376360404 0 Physicians Anesthesia Services 20 1376360404 0 Physicians Fluoride varnish 20 1376360404 0 Physicians Healthy Kids Services 20 1376360404 0 Physicians Optical Supplies 20 1376360404 0 Physicians Physician Services 00 1376362749 0 CEGLINSKI KATARZYNA 2024327 9999999 B 10 1376362749 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1376362749 0 Nurse Practitioners Fluoride varnish 20 1376362749 0 Nurse Practitioners Healthy Kids Services 20 1376362749 0 Nurse Practitioners Nurse Practitioners Services 20 1376362749 0 Nurse Practitioners Physician Services 00 1376363176 0 GOLUB ELENA 2024316 9999999 B 10 1376363176 0 1345 WILEY RD STE 111 SCHAUMBURG IL 601734356 20 1376363176 0 Nurse Practitioners Fluoride varnish 20 1376363176 0 Nurse Practitioners Healthy Kids Services 20 1376363176 0 Nurse Practitioners Nurse Practitioners Services 20 1376363176 0 Nurse Practitioners Physician Services 00 1376364695 0 SHAH MEGHA A 2024352 9999999 B 10 1376364695 0 5777 DEPT CAROL STREAM IL 601220021 20 1376364695 0 Nurse Practitioners Fluoride varnish 20 1376364695 0 Nurse Practitioners Healthy Kids Services 20 1376364695 0 Nurse Practitioners Nurse Practitioners Services 20 1376364695 0 Nurse Practitioners Physician Services 00 1376364752 0 NORTON BRITTANY E 2024298 9999999 B 10 1376364752 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1376364752 0 Physician Assistant Only Fluoride varnish 20 1376364752 0 Physician Assistant Only Healthy Kids Services 20 1376364752 0 Physician Assistant Only Physician Services 00 1376366989 0 SHORT ANDREA E 2025062 9999999 B 10 1376366989 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1376366989 0 Nurse Practitioners Healthy Kids Services 20 1376366989 0 Nurse Practitioners Nurse Practitioners Services 20 1376366989 0 Nurse Practitioners Physician Services 00 1376371765 0 KENNEBECK AUSTIN 2024274 9999999 B 10 1376371765 0 5665 NEW NORTHSIDE DR STE 320 ATLANTA GA 303285834 20 1376371765 0 Physician Assistant Only Fluoride varnish 20 1376371765 0 Physician Assistant Only Healthy Kids Services 20 1376371765 0 Physician Assistant Only Physician Services 00 1376375105 0 MARTIN CAILYNN L 2024254 9999999 B 10 1376375105 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1376375105 0 Speech Therapists Medical Supplies 20 1376375105 0 Speech Therapists Medical equipment/prosthetic devices 20 1376375105 0 Speech Therapists Speech Therapy/Pathology Services 00 1376379156 0 RONGALI DINESH A 2024271 9999999 B 10 1376379156 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1376379156 0 Physicians Anesthesia Services 20 1376379156 0 Physicians Healthy Kids Services 20 1376379156 0 Physicians Optical Supplies 20 1376379156 0 Physicians Physician Services 00 1376382945 0 HERNANDEZ NOAMI 2024162 9999999 B 10 1376382945 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1376382945 0 Other behavior health professional Social work service 00 1376383216 0 HAYES ANNA 2024260 9999999 B 10 1376383216 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1376383216 0 Physician Assistant Only Fluoride varnish 20 1376383216 0 Physician Assistant Only Healthy Kids Services 20 1376383216 0 Physician Assistant Only Physician Services 00 1376387480 0 LI XIN RAN 2024176 9999999 B 10 1376387480 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1376387480 0 Physicians Anesthesia Services 20 1376387480 0 Physicians Healthy Kids Services 20 1376387480 0 Physicians Optical Supplies 20 1376387480 0 Physicians Physician Services 00 1376387548 0 CHANDI PARAS SINGH 2024213 9999999 B 10 1376387548 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1376387548 0 Physicians Anesthesia Services 20 1376387548 0 Physicians Fluoride varnish 20 1376387548 0 Physicians Healthy Kids Services 20 1376387548 0 Physicians Optical Supplies 20 1376387548 0 Physicians Physician Services 00 1376387647 0 MURDENT AMANDA 2024198 9999999 B 10 1376387647 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1376387647 0 Registered nurse Nursing service 20 1376387647 0 Registered nurse Waiver service 00 1376388975 0 KLIEBHAN MARGARET P 2024191 9999999 B 10 1376388975 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1376388975 0 Physicians Anesthesia Services 20 1376388975 0 Physicians Fluoride varnish 20 1376388975 0 Physicians Healthy Kids Services 20 1376388975 0 Physicians Optical Supplies 20 1376388975 0 Physicians Physician Services 00 1376389809 0 GOEL KESHAV 2024190 9999999 B 10 1376389809 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1376389809 0 Physicians Anesthesia Services 20 1376389809 0 Physicians Healthy Kids Services 20 1376389809 0 Physicians Optical Supplies 20 1376389809 0 Physicians Physician Services 00 1376389874 0 MCCLARY MATTHEW 2024254 9999999 B 10 1376389874 0 PO BOX 775253 CHICAGO IL 606775253 20 1376389874 0 Nurse Practitioners Healthy Kids Services 20 1376389874 0 Nurse Practitioners Nurse Practitioners Services 20 1376389874 0 Nurse Practitioners Physician Services 00 1376393256 0 PULISETTY TANAYA 2024183 9999999 B 10 1376393256 0 PO BOX 3039 OAK BROOK IL 605223039 20 1376393256 0 Physicians Anesthesia Services 20 1376393256 0 Physicians Healthy Kids Services 20 1376393256 0 Physicians Optical Supplies 20 1376393256 0 Physicians Physician Services 00 1376393470 0 YANCHEVA JANETA 2024205 9999999 B 10 1376393470 0 PO BOX 3039 OAK BROOK IL 605223039 20 1376393470 0 Physicians Anesthesia Services 20 1376393470 0 Physicians Healthy Kids Services 20 1376393470 0 Physicians Optical Supplies 20 1376393470 0 Physicians Physician Services 00 1376393496 0 HAMMOCK COLIN 2024176 9999999 B 10 1376393496 0 4698 DEPT CAROL STREAM IL 601220021 20 1376393496 0 Physicians Anesthesia Services 20 1376393496 0 Physicians Healthy Kids Services 20 1376393496 0 Physicians Optical Supplies 20 1376393496 0 Physicians Physician Services 20 1376393496 0 Physicians Physicians Psychiatric Services 00 1376395152 0 ELMES MEGAN 2024183 9999999 B 10 1376395152 0 PO BOX 3039 OAK BROOK IL 605223039 20 1376395152 0 Physicians Anesthesia Services 20 1376395152 0 Physicians Fluoride varnish 20 1376395152 0 Physicians Healthy Kids Services 20 1376395152 0 Physicians Optical Supplies 20 1376395152 0 Physicians Physician Services 00 1376500918 0 ULBRIGHT THOMAS 2021198 9999999 B 10 1376500918 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1376500918 0 Physicians Anesthesia Services 20 1376500918 0 Physicians Healthy Kids Services 20 1376500918 0 Physicians Optical Supplies 20 1376500918 0 Physicians Physician Services 00 1376501130 0 PARENS KARL 2024094 9999999 B 10 1376501130 0 PO BOX 1437 COLUMBUS GA 319021437 20 1376501130 0 Physicians Anesthesia Services 20 1376501130 0 Physicians Fluoride varnish 20 1376501130 0 Physicians Healthy Kids Services 20 1376501130 0 Physicians Optical Supplies 20 1376501130 0 Physicians Physician Services 00 1376501304 0 THOMPSON ROHAN A 2016079 9999999 B 10 1376501304 0 PO BOX 778912 CHICAGO IL 606778912 20 1376501304 0 Physicians Anesthesia Services 20 1376501304 0 Physicians Fluoride varnish 20 1376501304 0 Physicians Healthy Kids Services 20 1376501304 0 Physicians Optical Supplies 20 1376501304 0 Physicians Physician Services 00 1376501395 0 KELLEY TIMOTHY 2023311 9999999 B 10 1376501395 0 PO BOX 776084 CHICAGO IL 606776084 20 1376501395 0 Nurse Practitioners Anesthesia Services 20 1376501395 0 Nurse Practitioners Nurse Practitioners Services 20 1376501395 0 Nurse Practitioners Physician Services 00 1376501429 0 LIVERMORE URSULA C 2001305 9999999 B 10 1376501429 0 1690 ELM ST STE 300 DUBUQUE IA 520013686 20 1376501429 0 Physicians Anesthesia Services 20 1376501429 0 Physicians Fluoride varnish 20 1376501429 0 Physicians Healthy Kids Services 20 1376501429 0 Physicians Optical Supplies 20 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CHICAGO IL 606115935 20 1376503557 0 Physicians Anesthesia Services 20 1376503557 0 Physicians Healthy Kids Services 20 1376503557 0 Physicians Optical Supplies 20 1376503557 0 Physicians Physician Services 00 1376503771 0 PATRAS THEODOSIOS 1991152 9999999 B 10 1376503771 0 5777 DEPT CAROL STREAM IL 601220021 20 1376503771 0 Physicians Anesthesia Services 20 1376503771 0 Physicians Healthy Kids Services 20 1376503771 0 Physicians Optical Supplies 20 1376503771 0 Physicians Physician Services 00 1376503987 0 UNG FEODOR 2004243 9999999 B 10 1376503987 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1376503987 0 Physicians Anesthesia Services 20 1376503987 0 Physicians Healthy Kids Services 20 1376503987 0 Physicians Optical Supplies 20 1376503987 0 Physicians Physician Services 00 1376504183 0 CARR JAMES 2001135 9999999 B 10 1376504183 0 5777 DEPT CAROL STREAM IL 601220021 20 1376504183 0 Physicians Anesthesia Services 20 1376504183 0 Physicians Healthy Kids Services 20 1376504183 0 Physicians Optical Supplies 20 1376504183 0 Physicians Physician Services 00 1376504365 0 STRAYER SUE A 1992214 9999999 B 10 1376504365 0 1120 N MELVIN ST GIBSON CITY IL 609361477 20 1376504365 0 Physicians Anesthesia Services 20 1376504365 0 Physicians Healthy Kids Services 20 1376504365 0 Physicians Optical Supplies 20 1376504365 0 Physicians Physician Services 00 1376505412 0 VARGA JEFFREY M 2019284 9999999 B 10 1376505412 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1376505412 0 Physicians Anesthesia Services 20 1376505412 0 Physicians Healthy Kids Services 20 1376505412 0 Physicians Optical Supplies 20 1376505412 0 Physicians Physician Services 00 1376505420 0 MIRANDA MARIO D 1998091 9999999 B 10 1376505420 0 221 NE GLEN OAK AVE PEORIA IL 616360002 20 1376505420 0 Physicians Anesthesia Services 20 1376505420 0 Physicians Fluoride varnish 20 1376505420 0 Physicians Healthy Kids Services 20 1376505420 0 Physicians Optical Supplies 20 1376505420 0 Physicians Physician Services 00 1376505479 0 BOCKWOLDT DENISE 2006016 9999999 B 10 1376505479 0 PO BOX 73488 PUYALLUP WA 983730488 20 1376505479 0 Nurse Practitioners All Kids application agent 20 1376505479 0 Nurse Practitioners Fluoride varnish 20 1376505479 0 Nurse Practitioners Healthy Kids Services 20 1376505479 0 Nurse Practitioners Nurse Practitioners Services 20 1376505479 0 Nurse Practitioners Physician Services 00 1376506287 0 HIROSE KEIKO 2008032 9999999 B 10 1376506287 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1376506287 0 Physicians Anesthesia Services 20 1376506287 0 Physicians Healthy Kids Services 20 1376506287 0 Physicians Optical Supplies 20 1376506287 0 Physicians Physician Services 00 1376507103 0 LANE FREDERICK 2024298 9999999 B 10 1376507103 0 PO BOX 781076 DETROIT MI 482781076 20 1376507103 0 Physicians Anesthesia Services 20 1376507103 0 Physicians Healthy Kids Services 20 1376507103 0 Physicians Optical Supplies 20 1376507103 0 Physicians Physician Services 00 1376507137 0 WEIGEL THOMAS J 1992084 9999999 B 10 1376507137 0 2923 N CALIFORNIA AVE STE 230 CHICAGO IL 606184677 20 1376507137 0 Physicians Anesthesia Services 20 1376507137 0 Physicians Fluoride varnish 20 1376507137 0 Physicians Healthy Kids Services 20 1376507137 0 Physicians Optical Supplies 20 1376507137 0 Physicians Physician Services 00 1376508481 0 BROWN RANDALL T 2020073 9999999 B 10 1376508481 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1376508481 0 Physicians Anesthesia Services 20 1376508481 0 Physicians Fluoride varnish 20 1376508481 0 Physicians Healthy Kids Services 20 1376508481 0 Physicians Optical Supplies 20 1376508481 0 Physicians Physician Services 00 1376508861 0 EAST MARK D 1992363 9999999 B 10 1376508861 0 PO BOX 689022 FRANKLIN TN 370689022 20 1376508861 0 Physicians Anesthesia Services 20 1376508861 0 Physicians Fluoride varnish 20 1376508861 0 Physicians Healthy Kids Services 20 1376508861 0 Physicians Optical Supplies 20 1376508861 0 Physicians Physician Services 00 1376508895 0 ORTEGON NINA 2006091 9999999 B 10 1376508895 0 29373 NETWORK PL CHICAGO IL 606733039 20 1376508895 0 Nurse Practitioners Fluoride varnish 20 1376508895 0 Nurse Practitioners Healthy Kids Services 20 1376508895 0 Nurse Practitioners Nurse Practitioners Services 20 1376508895 0 Nurse Practitioners Physician Services 00 1376510453 0 YOSOWITZ THEA L 1998182 9999999 B 10 1376510453 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1376510453 0 Physicians Anesthesia Services 20 1376510453 0 Physicians Fluoride varnish 20 1376510453 0 Physicians Healthy Kids Services 20 1376510453 0 Physicians Optical Supplies 20 1376510453 0 Physicians Physician Services 00 1376511287 0 THIMESCH TEGAN A 1987335 9999999 B 10 1376511287 0 4040 W PETERSON AVE CHICAGO IL 606466019 20 1376511287 0 Podiatrists Podiatric Services 00 1376511337 0 PISCHKE MARK 2006213 9999999 B 10 1376511337 0 520 VALLEY VIEW DR MOLINE IL 612656152 20 1376511337 0 Occupational Therapists Medical Supplies 20 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20 1376515379 0 Nurse Practitioners Healthy Kids Services 20 1376515379 0 Nurse Practitioners Nurse Practitioners Services 20 1376515379 0 Nurse Practitioners Physician Services 00 1376515841 0 RIZOS STEPHANOS 2018360 9999999 B 10 1376515841 0 PO BOX 781076 DETROIT MI 482781076 20 1376515841 0 Physicians Anesthesia Services 20 1376515841 0 Physicians Healthy Kids Services 20 1376515841 0 Physicians Optical Supplies 20 1376515841 0 Physicians Physician Services 00 1376516021 0 DESAI MUNEER J 2024108 9999999 B 10 1376516021 0 1120 N MELVIN ST GIBSON CITY IL 609361477 20 1376516021 0 Physicians Anesthesia Services 20 1376516021 0 Physicians Healthy Kids Services 20 1376516021 0 Physicians Optical Supplies 20 1376516021 0 Physicians Physician Services 00 1376516302 0 JALADI RADHIKA 2005060 9999999 B 10 1376516302 0 21 EASTBROOK BND STE 218 PEACHTREE CITY GA 302691546 20 1376516302 0 Physicians Anesthesia Services 20 1376516302 0 Physicians Fluoride varnish 20 1376516302 0 Physicians 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Physician Services 00 1376522870 0 TWEEDY PHILIP D 2003195 9999999 B 10 1376522870 0 1005 BROADWAY ST QUINCY IL 623012834 20 1376522870 0 Physicians Anesthesia Services 20 1376522870 0 Physicians Fluoride varnish 20 1376522870 0 Physicians Healthy Kids Services 20 1376522870 0 Physicians Optical Supplies 20 1376522870 0 Physicians Physician Services 00 1376523589 0 SHLIMOVITZ CARY 2004194 9999999 B 10 1376523589 0 340 MIDLAND RD STE 120 JANESVILLE WI 535462339 20 1376523589 0 Physicians Anesthesia Services 20 1376523589 0 Physicians Healthy Kids Services 20 1376523589 0 Physicians Optical Supplies 20 1376523589 0 Physicians Physician Services 00 1376523647 0 SOUNDARARAJAN RAMESH 2004245 9999999 B 10 1376523647 0 PO BOX 776473 CHICAGO IL 606776473 20 1376523647 0 Physicians Anesthesia Services 20 1376523647 0 Physicians Fluoride varnish 20 1376523647 0 Physicians Healthy Kids Services 20 1376523647 0 Physicians Optical Supplies 20 1376523647 0 Physicians Physician Services 00 1376524470 0 SIPES MARY 2012001 9999999 B 10 1376524470 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1376524470 0 Podiatrists Podiatric Services 00 1376524983 0 TAN FRANKLIN C 2002090 9999999 B 10 1376524983 0 PO BOX 999 EVANSVILLE IN 477060999 20 1376524983 0 Physicians Anesthesia Services 20 1376524983 0 Physicians Healthy Kids Services 20 1376524983 0 Physicians Optical Supplies 20 1376524983 0 Physicians Physician Services 00 1376525550 0 LOBE THOM 1990137 9999999 B 10 1376525550 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1376525550 0 Physicians Anesthesia Services 20 1376525550 0 Physicians Healthy Kids Services 20 1376525550 0 Physicians Optical Supplies 20 1376525550 0 Physicians Physician Services 00 1376525592 0 MAHONEY LYNETTE M 2000245 9999999 B 10 1376525592 0 929 W HIGGINS RD SCHAUMBURG IL 601953203 20 1376525592 0 Podiatrists Podiatric Services 00 1376526095 0 HANSON ERIC 2015315 9999999 B 10 1376526095 0 801 YORK ST MANITOWOC WI 542204630 20 1376526095 0 Physicians 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AVE WOODBURY NJ 080962739 20 1376538694 0 Physicians Anesthesia Services 20 1376538694 0 Physicians Healthy Kids Services 20 1376538694 0 Physicians Optical Supplies 20 1376538694 0 Physicians Physician Services 00 1376539163 0 BUECHE MATTHEW 1990213 9999999 B 10 1376539163 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1376539163 0 Physicians Anesthesia Services 20 1376539163 0 Physicians Healthy Kids Services 20 1376539163 0 Physicians Optical Supplies 20 1376539163 0 Physicians Physician Services 00 1376539221 0 YIGAZU SOLOMON 2006032 9999999 B 10 1376539221 0 800 AUSTIN ST STE 269 EVANSTON IL 602023453 20 1376539221 0 Physicians Anesthesia Services 20 1376539221 0 Physicians Fluoride varnish 20 1376539221 0 Physicians Healthy Kids Services 20 1376539221 0 Physicians Optical Supplies 20 1376539221 0 Physicians Physician Services 00 1376539668 0 DEMIDOVICH TATYANA 2004201 9999999 B 10 1376539668 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1376539668 0 Physicians Anesthesia Services 20 1376539668 0 Physicians Healthy Kids Services 20 1376539668 0 Physicians Optical Supplies 20 1376539668 0 Physicians Physician Services 00 1376539692 0 PETRAK RUSSELL 1983147 9999999 B 10 1376539692 0 901 MCCLINTOCK DR STE 202 SUITE 202 BURR RIDGE IL 605270872 20 1376539692 0 Physicians Anesthesia Services 20 1376539692 0 Physicians Fluoride varnish 20 1376539692 0 Physicians Healthy Kids Services 20 1376539692 0 Physicians Optical Supplies 20 1376539692 0 Physicians Physician Services 00 1376539700 0 ISRAEL STEPHEN F 2004201 9999999 B 10 1376539700 0 238 S CONGRESS ST RUSHVILLE IL 626811465 20 1376539700 0 Physicians Anesthesia Services 20 1376539700 0 Physicians Fluoride varnish 20 1376539700 0 Physicians Healthy Kids Services 20 1376539700 0 Physicians Optical Supplies 20 1376539700 0 Physicians Physician Services 00 1376539718 0 MCLAIN MONIKA 1994060 9999999 B 10 1376539718 0 5777 DEPT CAROL STREAM IL 601220021 20 1376539718 0 Physicians Anesthesia Services 20 1376539718 0 Physicians Fluoride varnish 20 1376539718 0 Physicians Healthy Kids Services 20 1376539718 0 Physicians Optical Supplies 20 1376539718 0 Physicians Physician Services 00 1376539726 0 CONNIFF CORY L 2004197 9999999 B 10 1376539726 0 80 W HILLCREST BLVD SCHAUMBURG IL 601953106 20 1376539726 0 Physicians Anesthesia Services 20 1376539726 0 Physicians Fluoride varnish 20 1376539726 0 Physicians Healthy Kids Services 20 1376539726 0 Physicians Optical Supplies 20 1376539726 0 Physicians Physician Services 00 1376540930 0 HAGEMAN MATTHEW DEAN 1999244 9999999 B 10 1376540930 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1376540930 0 Physicians Anesthesia Services 20 1376540930 0 Physicians Fluoride varnish 20 1376540930 0 Physicians Healthy Kids Services 20 1376540930 0 Physicians Optical Supplies 20 1376540930 0 Physicians Physician Services 00 1376541763 0 CHUDIK BRIAN 2002066 9999999 B 10 1376541763 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1376541763 0 Physicians Anesthesia Services 20 1376541763 0 Physicians Fluoride varnish 20 1376541763 0 Physicians Healthy Kids Services 20 1376541763 0 Physicians Optical Supplies 20 1376541763 0 Physicians Physician Services 00 1376541920 0 KUMBAR DEEPA H 2003274 9999999 B 10 1376541920 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1376541920 0 Physicians Anesthesia Services 20 1376541920 0 Physicians Fluoride varnish 20 1376541920 0 Physicians Healthy Kids Services 20 1376541920 0 Physicians Optical Supplies 20 1376541920 0 Physicians Physician Services 00 1376543025 0 LUBIENSKI MARK 1992001 9999999 B 10 1376543025 0 5250 OLD ORCHARD RD UNIT 300S SKOKIE IL 600774460 20 1376543025 0 Physicians Anesthesia Services 20 1376543025 0 Physicians Healthy Kids Services 20 1376543025 0 Physicians Optical Supplies 20 1376543025 0 Physicians Physician Services 00 1376543041 0 WARREN MITCHELL L 1999056 9999999 B 10 1376543041 0 3471 GREEN BAY RD NORTH CHICAGO IL 600643090 20 1376543041 0 Physicians Anesthesia Services 20 1376543041 0 Physicians Healthy Kids Services 20 1376543041 0 Physicians Optical Supplies 20 1376543041 0 Physicians Physician Services 00 1376543199 0 PAR MIDORI TAKEYASU 1998052 9999999 B 10 1376543199 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1376543199 0 Physicians Anesthesia Services 20 1376543199 0 Physicians Healthy Kids Services 20 1376543199 0 Physicians Optical Supplies 20 1376543199 0 Physicians Physician Services 00 1376543421 0 ZUN LESLIE S 1984104 9999999 B 10 1376543421 0 5777 DEPT CAROL STREAM IL 601220021 20 1376543421 0 Physicians Anesthesia Services 20 1376543421 0 Physicians Healthy Kids Services 20 1376543421 0 Physicians Optical Supplies 20 1376543421 0 Physicians Physician Services 00 1376543488 0 BAQAI SERENA 2004320 9999999 B 10 1376543488 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1376543488 0 Physicians Anesthesia Services 20 1376543488 0 Physicians Healthy Kids Services 20 1376543488 0 Physicians Optical Supplies 20 1376543488 0 Physicians Physician Services 00 1376543629 0 HENDRIX ALAN H 1998001 9999999 B 10 1376543629 0 1160 E SAINT CLAIR ST VINCENNES IN 475914853 20 1376543629 0 Physicians Anesthesia Services 20 1376543629 0 Physicians Healthy Kids Services 20 1376543629 0 Physicians Optical Supplies 20 1376543629 0 Physicians Physician Services 00 1376543702 0 CHATTO ELADIO 1991270 9999999 B 10 1376543702 0 6 FERRELL RD ROSICLARE IL 629821052 20 1376543702 0 Physicians Anesthesia Services 20 1376543702 0 Physicians Fluoride varnish 20 1376543702 0 Physicians Healthy Kids Services 20 1376543702 0 Physicians Optical Supplies 20 1376543702 0 Physicians Physician Services 00 1376544312 0 KHOSLA SANDEEP 1990001 9999999 B 10 1376544312 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1376544312 0 Physicians Anesthesia Services 20 1376544312 0 Physicians Fluoride varnish 20 1376544312 0 Physicians Healthy Kids Services 20 1376544312 0 Physicians Optical Supplies 20 1376544312 0 Physicians Physician Services 00 1376544585 0 SHORE BRIAN 2018236 9999999 B 10 1376544585 0 1505 EASTLAND DR STE 220 BLOOMINGTON IL 617017906 20 1376544585 0 Nurse Practitioners Fluoride varnish 20 1376544585 0 Nurse Practitioners Healthy Kids Services 20 1376544585 0 Nurse Practitioners Physician Services 00 1376545160 0 METCALF JERRY THOMAS 1997001 9999999 B 10 1376545160 0 1 KISH HOSPITAL DR DEKALB IL 601159602 20 1376545160 0 Nurse Practitioners Anesthesia Services 20 1376545160 0 Nurse Practitioners Nurse Practitioners Services 20 1376545160 0 Nurse Practitioners Physician Services 00 1376545939 0 KINSEY WILLIAM J 2020059 9999999 B 10 1376545939 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1376545939 0 Physicians Anesthesia Services 20 1376545939 0 Physicians Fluoride varnish 20 1376545939 0 Physicians Healthy Kids Services 20 1376545939 0 Physicians Optical Supplies 20 1376545939 0 Physicians Physician Services 00 1376546770 0 HOLLAR MARGARET 2008223 9999999 B 10 1376546770 0 250 N SHADELAND AVE STE 200 INDIANAPOLIS IN 462194959 20 1376546770 0 Physicians Anesthesia Services 20 1376546770 0 Physicians Healthy Kids Services 20 1376546770 0 Physicians Optical Supplies 20 1376546770 0 Physicians Physician Services 00 1376546804 0 AHMED NADEEM 1996092 9999999 B 10 1376546804 0 400 MAPLE SUMMIT RD JERSEYVILLE IL 620522028 20 1376546804 0 Physicians Anesthesia Services 20 1376546804 0 Physicians Fluoride varnish 20 1376546804 0 Physicians Healthy Kids Services 20 1376546804 0 Physicians Optical Supplies 20 1376546804 0 Physicians Physician Services 00 1376547802 0 PROPHETE ROBERT Y 1987274 9999999 B 10 1376547802 0 PO BOX 843033 KANSAS CITY MO 641842326 20 1376547802 0 Physicians Anesthesia Services 20 1376547802 0 Physicians Healthy Kids Services 20 1376547802 0 Physicians Optical Supplies 20 1376547802 0 Physicians Physician Services 00 1376547927 0 SCHLARB CHRISTOPHER A 2023208 9999999 B 10 1376547927 0 16220 N SCOTTSDALE RD STE 600 SCOTTSDALE AZ 852541804 20 1376547927 0 Physicians Anesthesia Services 20 1376547927 0 Physicians Healthy Kids Services 20 1376547927 0 Physicians Optical Supplies 20 1376547927 0 Physicians Physician Services 00 1376548289 0 LIPMAN MICHELLE M 2005220 9999999 B 10 1376548289 0 PO BOX 713388 CHICAGO IL 606771525 20 1376548289 0 Physicians Anesthesia Services 20 1376548289 0 Physicians Fluoride varnish 20 1376548289 0 Physicians Healthy Kids Services 20 1376548289 0 Physicians Optical Supplies 20 1376548289 0 Physicians Physician Services 00 1376548768 0 TOMLIN JAMES L 2023355 9999999 B 10 1376548768 0 1910 SOUTH AVE LA CROSSE WI 546015467 20 1376548768 0 Physician Assistant Only Fluoride varnish 20 1376548768 0 Physician Assistant Only Healthy Kids Services 20 1376548768 0 Physician Assistant Only Physician Services 00 1376549139 0 RAWDON DAVID P 1998182 9999999 B 10 1376549139 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1376549139 0 Physicians Anesthesia Services 20 1376549139 0 Physicians Fluoride varnish 20 1376549139 0 Physicians Healthy Kids Services 20 1376549139 0 Physicians Optical Supplies 20 1376549139 0 Physicians Physician Services 00 1376549394 0 BACALAR CAREY 1988053 9999999 B 10 1376549394 0 PO BOX 5588 BELFAST ME 049155500 20 1376549394 0 Physicians Anesthesia Services 20 1376549394 0 Physicians Healthy Kids Services 20 1376549394 0 Physicians Optical Supplies 20 1376549394 0 Physicians Physician Services 00 1376549964 0 HERING LEONARD G 1992205 9999999 B 10 1376549964 0 5777 DEPT CAROL STREAM IL 601228942 20 1376549964 0 Physicians Anesthesia Services 20 1376549964 0 Physicians Healthy Kids Services 20 1376549964 0 Physicians Optical Supplies 20 1376549964 0 Physicians Physician Services 00 1376550335 0 LU STEPHEN 2005227 9999999 B 10 1376550335 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1376550335 0 Physicians Anesthesia Services 20 1376550335 0 Physicians Healthy Kids Services 20 1376550335 0 Physicians Optical Supplies 20 1376550335 0 Physicians Physician Services 00 1376550806 0 QADRI SYED 2014217 9999999 B 10 1376550806 0 2701 17TH ST ROCK ISLAND IL 612015351 20 1376550806 0 Physicians Anesthesia Services 20 1376550806 0 Physicians Healthy Kids Services 20 1376550806 0 Physicians Optical Supplies 20 1376550806 0 Physicians Physician Services 00 1376551671 0 THOMAS KEVIN 2000207 9999999 B 10 1376551671 0 PO BOX 3717 SPRINGFIELD IL 627083717 20 1376551671 0 Physicians Anesthesia Services 20 1376551671 0 Physicians Healthy Kids Services 20 1376551671 0 Physicians Optical Supplies 20 1376551671 0 Physicians Physician Services 00 1376551960 0 PLONKA CATHERINE 1998087 9999999 B 10 1376551960 0 29373 NETWORK PL CHICAGO IL 606733039 20 1376551960 0 Physicians Anesthesia Services 20 1376551960 0 Physicians Fluoride varnish 20 1376551960 0 Physicians Healthy Kids Services 20 1376551960 0 Physicians Optical Supplies 20 1376551960 0 Physicians Physician Services 00 1376553040 0 HAMON BETA 2024170 9999999 B 10 1376553040 0 2000 S MAIN ST FAIRFIELD IA 525569572 20 1376553040 0 Physicians Anesthesia Services 20 1376553040 0 Physicians Fluoride varnish 20 1376553040 0 Physicians Healthy Kids Services 20 1376553040 0 Physicians Optical Supplies 20 1376553040 0 Physicians Physician Services 00 1376553487 0 SILVERA DWIGHT 2006186 9999999 B 10 1376553487 0 6149 E COLUMBIA ST EVANSVILLE IN 477159134 20 1376553487 0 Physicians Anesthesia Services 20 1376553487 0 Physicians Healthy Kids Services 20 1376553487 0 Physicians Optical Supplies 20 1376553487 0 Physicians Physician Services 00 1376553875 0 ROBERTSON SCOTT 1997213 9999999 B 10 1376553875 0 5201 WILLOW SPRINGS RD STE 300 LA GRANGE HIGHL IL 605256539 20 1376553875 0 Physicians Anesthesia Services 20 1376553875 0 Physicians Fluoride varnish 20 1376553875 0 Physicians Healthy Kids Services 20 1376553875 0 Physicians Optical Supplies 20 1376553875 0 Physicians Physician Services 00 1376554667 0 KENNEY SHANNON C 2006182 9999999 B 10 1376554667 0 7974 UW HEALTH 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1376559161 0 Physicians Healthy Kids Services 20 1376559161 0 Physicians Optical Supplies 20 1376559161 0 Physicians Physician Services 00 1376560102 0 BECERRA ELIZABETH 1998152 9999999 B 10 1376560102 0 2223 OAK PARK AVE BERWYN IL 604024670 20 1376560102 0 Physicians Anesthesia Services 20 1376560102 0 Physicians Healthy Kids Services 20 1376560102 0 Physicians Optical Supplies 20 1376560102 0 Physicians Physician Services 00 1376560805 0 PARK TAE 1990002 9999999 B 10 1376560805 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1376560805 0 Physicians Anesthesia Services 20 1376560805 0 Physicians Healthy Kids Services 20 1376560805 0 Physicians Optical Supplies 20 1376560805 0 Physicians Physician Services 00 1376560821 0 GERAGHTY PATRICK 2000183 9999999 B 10 1376560821 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1376560821 0 Physicians Anesthesia Services 20 1376560821 0 Physicians Healthy Kids Services 20 1376560821 0 Physicians Optical 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1376563023 0 Physicians Optical Supplies 20 1376563023 0 Physicians Physician Services 00 1376563742 0 GLOVER JENNIFER R 2004183 9999999 B 10 1376563742 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1376563742 0 Physicians Anesthesia Services 20 1376563742 0 Physicians Healthy Kids Services 20 1376563742 0 Physicians Optical Supplies 20 1376563742 0 Physicians Physician Services 00 1376563916 0 MANJARRES RODRIGO A 2011350 9999999 B 10 1376563916 0 163 N GREENLEAF ST STE 2 GURNEE IL 600313344 20 1376563916 0 Other behavior health professional LCPC/LMFT services 00 1376564724 0 BERTONI GAIL 2007044 9999999 B 10 1376564724 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1376564724 0 Nurse Practitioners Healthy Kids Services 20 1376564724 0 Nurse Practitioners Nurse Practitioners Services 20 1376564724 0 Nurse Practitioners Physician Services 00 1376564815 0 ALI MADAD 2016153 9999999 B 10 1376564815 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1376564815 0 Physicians Anesthesia Services 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Practitioners Physician Services 00 1376677559 0 TAKAOKA LISA 1997006 9999999 B 10 1376677559 0 615 SYCAMORE ST VERNON HILLS IL 600611085 20 1376677559 0 Speech Therapists Medical Supplies 20 1376677559 0 Speech Therapists Medical equipment/prosthetic devices 20 1376677559 0 Speech Therapists Speech Therapy/Pathology Services 00 1376679811 0 MUSTAFA RAABIA 2005262 9999999 B 10 1376679811 0 6341 N SPRINGFIELD AVE CHICAGO IL 606591017 20 1376679811 0 Speech Therapists Medical Supplies 20 1376679811 0 Speech Therapists Medical equipment/prosthetic devices 20 1376679811 0 Speech Therapists Speech Therapy/Pathology Services 00 1376680223 0 TRAFTON JULIE 2000084 9999999 B 10 1376680223 0 115 W NEBRASKA ST FRANKFORT IL 604231419 20 1376680223 0 Speech Therapists Medical Supplies 20 1376680223 0 Speech Therapists Medical equipment/prosthetic devices 20 1376680223 0 Speech Therapists Speech Therapy/Pathology Services 00 1376680462 0 MARTIN GABRIEL A 2016165 9999999 B 10 1376680462 0 PO BOX 3988 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1376691147 0 WIGGINS SHAWN M 2024283 9999999 B 10 1376691147 0 5701 W TALAVI BLVD GLENDALE AZ 853061886 20 1376691147 0 Physicians Anesthesia Services 20 1376691147 0 Physicians Healthy Kids Services 20 1376691147 0 Physicians Optical Supplies 20 1376691147 0 Physicians Physician Services 00 1376692319 0 MCALLISTER POONAM 1998104 9999999 B 10 1376692319 0 211 LANDMARK DR STE E3 NORMAL IL 617616165 20 1376692319 0 Physical Therapists Medical Supplies 20 1376692319 0 Physical Therapists Medical equipment/prosthetic devices 20 1376692319 0 Physical Therapists Physical Therapy Services 00 1376693754 0 GALATI VINCENZO 2009229 9999999 B 10 1376693754 0 3 DOCTORS PARK CAPE GIRARDEAU MO 637034927 20 1376693754 0 Physicians Anesthesia Services 20 1376693754 0 Physicians Healthy Kids Services 20 1376693754 0 Physicians Optical Supplies 20 1376693754 0 Physicians Physician Services 00 1376694356 0 REZANIA KOUROSH 2001182 9999999 B 10 1376694356 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 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Physicians Physician Services 00 1376725424 0 TRAHANAS CHRISTINA 2010188 9999999 B 10 1376725424 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1376725424 0 Physical Therapists Medical Supplies 20 1376725424 0 Physical Therapists Medical equipment/prosthetic devices 20 1376725424 0 Physical Therapists Physical Therapy Services 00 1376725457 0 PETEREIN JUDY L 2009274 9999999 B 10 1376725457 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1376725457 0 Audiologists Audiology Services 20 1376725457 0 Audiologists Medical Supplies 20 1376725457 0 Audiologists Medical equipment/prosthetic devices 00 1376726455 0 LANGHEIM FREDERICK 2015274 9999999 B 10 1376726455 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1376726455 0 Physicians Anesthesia Services 20 1376726455 0 Physicians Healthy Kids Services 20 1376726455 0 Physicians Optical Supplies 20 1376726455 0 Physicians Physician Services 20 1376726455 0 Physicians Physicians Psychiatric Services 00 1376727552 0 GOPINATH ANIL 2023360 9999999 B 10 1376727552 0 PO BOX 43230 PHOENIX AZ 850803230 20 1376727552 0 Physicians Anesthesia Services 20 1376727552 0 Physicians Fluoride varnish 20 1376727552 0 Physicians Healthy Kids Services 20 1376727552 0 Physicians Optical Supplies 20 1376727552 0 Physicians Physician Services 00 1376728113 0 BEHARA VENKATA 2005182 9999999 B 10 1376728113 0 120 W 22ND ST OAK BROOK IL 605231557 20 1376728113 0 Physicians Anesthesia Services 20 1376728113 0 Physicians Fluoride varnish 20 1376728113 0 Physicians Healthy Kids Services 20 1376728113 0 Physicians Optical Supplies 20 1376728113 0 Physicians Physician Services 00 1376728196 0 PATEL ALKESH P 2008176 9999999 B 10 1376728196 0 PO BOX 5588 BELFAST ME 049155500 20 1376728196 0 Physicians Anesthesia Services 20 1376728196 0 Physicians Healthy Kids Services 20 1376728196 0 Physicians Optical Supplies 20 1376728196 0 Physicians Physician Services 20 1376728196 0 Physicians Physicians Psychiatric Services 00 1376730366 0 PAYOT 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20 1376752634 0 Physicians Healthy Kids Services 20 1376752634 0 Physicians Optical Supplies 20 1376752634 0 Physicians Physician Services 00 1376753319 0 O''KEEFE MELISSA A 2016181 9999999 B 10 1376753319 0 PO BOX 80309 PHILADELPHIA PA 191011309 20 1376753319 0 Physician Assistant Only Fluoride varnish 20 1376753319 0 Physician Assistant Only Healthy Kids Services 20 1376753319 0 Physician Assistant Only Physician Services 00 1376753731 0 AUSTIN NED A 2023195 9999999 B 10 1376753731 0 7083 GRAND NATIONAL DR STE 102 ORLANDO FL 328198942 20 1376753731 0 Physicians Anesthesia Services 20 1376753731 0 Physicians Healthy Kids Services 20 1376753731 0 Physicians Optical Supplies 20 1376753731 0 Physicians Physician Services 00 1376754135 0 MARLEGA MARIA 2002044 9999999 B 10 1376754135 0 1467 N ELSTON AVE STE 103 CHICAGO IL 606422449 20 1376754135 0 Occupational Therapists Medical Supplies 20 1376754135 0 Occupational Therapists Medical equipment/prosthetic devices 20 1376754135 0 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Physician Services 00 1376839241 0 PEACOCK AMANDA L 2011201 9999999 B 10 1376839241 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1376839241 0 Speech Therapists Medical Supplies 20 1376839241 0 Speech Therapists Medical equipment/prosthetic devices 20 1376839241 0 Speech Therapists Speech Therapy/Pathology Services 00 1376839852 0 KELKER HEATHER P 2022006 9999999 B 10 1376839852 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1376839852 0 Physicians Anesthesia Services 20 1376839852 0 Physicians Fluoride varnish 20 1376839852 0 Physicians Healthy Kids Services 20 1376839852 0 Physicians Optical Supplies 20 1376839852 0 Physicians Physician Services 00 1376839969 0 BACHIER-RODRIGUEZ MARIELENA 2020279 9999999 B 10 1376839969 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1376839969 0 Physicians Anesthesia Services 20 1376839969 0 Physicians Healthy Kids Services 20 1376839969 0 Physicians Optical Supplies 20 1376839969 0 Physicians Physician Services 00 1376840025 0 CASTLE GAIL 2015126 9999999 H 10 1376840025 0 2500 W HIGGINS ROAD SUITE 105 HOFFMAN ESTATES IL 601692040 20 1376840025 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1376840041 0 SAMALA ANUVESHA 2012245 9999999 B 10 1376840041 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1376840041 0 Physicians Anesthesia Services 20 1376840041 0 Physicians Fluoride varnish 20 1376840041 0 Physicians Healthy Kids Services 20 1376840041 0 Physicians Optical Supplies 20 1376840041 0 Physicians Physician Services 00 1376841072 0 STEVERSON SARAH 2013254 9999999 B 10 1376841072 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1376841072 0 Occupational Therapists Medical Supplies 20 1376841072 0 Occupational Therapists Medical equipment/prosthetic devices 20 1376841072 0 Occupational Therapists Occupational Therapy Services 00 1376841155 0 NGUYEN BRITTANY 2010302 9999999 B 10 1376841155 0 8780 W GOLF RD STE 200 SUITE 200 NILES IL 607145611 20 1376841155 0 Audiologists Audiology Services 20 1376841155 0 Audiologists Medical Supplies 20 1376841155 0 Audiologists Medical equipment/prosthetic devices 00 1376841429 0 GRIFFEY MEGAN 2016214 9999999 B 10 1376841429 0 PO BOX 4698 CAROL STREAM IL 601224698 20 1376841429 0 Occupational Therapists Medical Supplies 20 1376841429 0 Occupational Therapists Medical equipment/prosthetic devices 20 1376841429 0 Occupational Therapists Occupational Therapy Services 00 1376842682 0 PLATT JENNIFER A 2020162 9999999 B 10 1376842682 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1376842682 0 Physicians Anesthesia Services 20 1376842682 0 Physicians Fluoride varnish 20 1376842682 0 Physicians Healthy Kids Services 20 1376842682 0 Physicians Optical Supplies 20 1376842682 0 Physicians Physician Services 00 1376843284 0 EISELE HEATHER 2016030 9999999 B 10 1376843284 0 7732 SOLUTION CENTER CHICAGO IL 606770001 20 1376843284 0 Psychologist Psychologist service 00 1376846220 0 HENDEE RACHEL E 2017205 9999999 B 10 1376846220 0 5777 DEPT CAROL STREAM IL 601220021 20 1376846220 0 Physician Assistant Only Fluoride varnish 20 1376846220 0 Physician Assistant Only Healthy Kids Services 20 1376846220 0 Physician Assistant Only Physician Services 00 1376847301 0 ARNOLD LISA E 2013287 9999999 B 10 1376847301 0 PO BOX 3988 CARBONDALE IL 629023988 20 1376847301 0 Nurse Practitioners Healthy Kids Services 20 1376847301 0 Nurse Practitioners Nurse Practitioners Services 20 1376847301 0 Nurse Practitioners Physician Services 00 1376847533 0 MIKAL MEGGAN A 2016182 9999999 B 10 1376847533 0 250 WATER STONE CIR JOLIET IL 604318313 20 1376847533 0 Nurse Practitioners Healthy Kids Services 20 1376847533 0 Nurse Practitioners Nurse Practitioners Services 20 1376847533 0 Nurse Practitioners Physician Services 00 1376847707 0 TWARDOWSKI MARY EILEEN 2011112 9999999 B 10 1376847707 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1376847707 0 Nurse Practitioners Healthy Kids Services 20 1376847707 0 Nurse Practitioners Nurse Practitioners Services 20 1376847707 0 Nurse Practitioners Physician Services 00 1376848028 0 HALL BRIAN M 2016287 9999999 B 10 1376848028 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1376848028 0 Nurse Practitioners Anesthesia Services 20 1376848028 0 Nurse Practitioners Nurse Practitioners Services 20 1376848028 0 Nurse Practitioners Physician Services 00 1376849109 0 HALL EMILY 2015196 9999999 B 10 1376849109 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1376849109 0 Physicians Anesthesia Services 20 1376849109 0 Physicians Fluoride varnish 20 1376849109 0 Physicians Healthy Kids Services 20 1376849109 0 Physicians Optical Supplies 20 1376849109 0 Physicians Physician Services 00 1376851329 0 SWINT BRITTANY 2024340 9999999 B 10 1376851329 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1376851329 0 Physical Therapists Medical Supplies 20 1376851329 0 Physical Therapists Medical equipment/prosthetic devices 20 1376851329 0 Physical Therapists Physical Therapy Services 00 1376851410 0 FULLER CHERYL 2010267 9999999 B 10 1376851410 0 PO BOX 277 DONGOLA IL 629260277 20 1376851410 0 Nurse Practitioners All Kids application agent 20 1376851410 0 Nurse Practitioners Family Planning Counseling 20 1376851410 0 Nurse Practitioners Fluoride varnish 20 1376851410 0 Nurse Practitioners Healthy Kids Services 20 1376851410 0 Nurse Practitioners Nurse Practitioners Services 20 1376851410 0 Nurse Practitioners Physician Services 00 1376852087 0 STRATTON MICHAEL S 2022116 9999999 B 10 1376852087 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1376852087 0 Physicians Anesthesia Services 20 1376852087 0 Physicians Fluoride varnish 20 1376852087 0 Physicians Healthy Kids Services 20 1376852087 0 Physicians Optical Supplies 20 1376852087 0 Physicians Physician Services 00 1376853671 0 URSPRUNG JESSICA A 2017088 9999999 B 10 1376853671 0 PO BOX 28900 GREEN BAY WI 543240900 20 1376853671 0 Physician Assistant Only Fluoride varnish 20 1376853671 0 Physician Assistant Only Healthy Kids Services 20 1376853671 0 Physician Assistant Only Physician Services 00 1376854166 0 HO-LEON RYAN K 2019045 9999999 B 10 1376854166 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1376854166 0 Physician Assistant Only Fluoride varnish 20 1376854166 0 Physician Assistant Only Healthy Kids Services 20 1376854166 0 Physician Assistant Only Physician Services 00 1376854257 0 LAUGHLIN HEATH 2015166 9999999 B 10 1376854257 0 1000 N ALLEN ST ROBINSON IL 624541114 20 1376854257 0 Physicians Anesthesia Services 20 1376854257 0 Physicians Healthy Kids Services 20 1376854257 0 Physicians Optical Supplies 20 1376854257 0 Physicians Physician Services 00 1376855288 0 HUFFMAN LAURA B 2014182 9999999 B 10 1376855288 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1376855288 0 Physicians Anesthesia Services 20 1376855288 0 Physicians Fluoride varnish 20 1376855288 0 Physicians Healthy Kids Services 20 1376855288 0 Physicians Optical Supplies 20 1376855288 0 Physicians Physician Services 00 1376855601 0 SHELTON MEGAN 2015168 9999999 B 10 1376855601 0 1 CHILDRENS PL STE 3N-14 SAINT LOUIS MO 631101002 20 1376855601 0 Psychologist Psychologist service 00 1376856039 0 OKOTIE FIDELIS 2025045 9999999 B 10 1376856039 0 PO BOX 736230 DALLAS TX 753736230 20 1376856039 0 Physicians Anesthesia Services 20 1376856039 0 Physicians Fluoride varnish 20 1376856039 0 Physicians Healthy Kids Services 20 1376856039 0 Physicians Optical Supplies 20 1376856039 0 Physicians Physician Services 00 1376856187 0 KHAN SABA 2019297 9999999 B 10 1376856187 0 2400 N ASHLAND AVE CHICAGO IL 606142021 20 1376856187 0 Physician Assistant Only Fluoride varnish 20 1376856187 0 Physician Assistant Only Healthy Kids Services 20 1376856187 0 Physician Assistant Only Physician Services 00 1376856195 0 DONAHUE LAURENCE 2017335 9999999 B 10 1376856195 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1376856195 0 Physicians Anesthesia Services 20 1376856195 0 Physicians Healthy Kids Services 20 1376856195 0 Physicians Optical Supplies 20 1376856195 0 Physicians Physician Services 00 1376856559 0 LIDVALL JOHN 2013213 9999999 B 10 1376856559 0 221 NE GLEN OAK AVE ATTN: STEPHEN CIRONE GOMP 100 PEORIA IL 616360001 20 1376856559 0 Physicians Anesthesia Services 20 1376856559 0 Physicians Fluoride varnish 20 1376856559 0 Physicians Healthy Kids Services 20 1376856559 0 Physicians Optical Supplies 20 1376856559 0 Physicians Physician Services 00 1376859140 0 HUIZAR FATIMA 2011224 9999999 B 10 1376859140 0 2901 FINLEY RD STE 102 DOWNERS GROVE IL 605151774 20 1376859140 0 Speech Therapists Medical Supplies 20 1376859140 0 Speech Therapists Medical equipment/prosthetic devices 20 1376859140 0 Speech Therapists Speech Therapy/Pathology Services 00 1376859215 0 GONZALEZ JESUS 2017001 9999999 B 10 1376859215 0 3223 W 63RD ST CHICAGO IL 606293333 20 1376859215 0 Other behavior health professional LCPC/LMFT services 00 1376859454 0 RIDER MICHAEL J 2010274 9999999 B 10 1376859454 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1376859454 0 Nurse Practitioners Anesthesia Services 20 1376859454 0 Nurse Practitioners Nurse Practitioners Services 20 1376859454 0 Nurse Practitioners Physician Services 00 1376859884 0 CHENNAMANENI VENU 2016203 9999999 B 10 1376859884 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1376859884 0 Physicians Anesthesia Services 20 1376859884 0 Physicians Fluoride varnish 20 1376859884 0 Physicians Healthy Kids Services 20 1376859884 0 Physicians Optical Supplies 20 1376859884 0 Physicians Physician Services 00 1376860338 0 JAIN SONALI 2014262 9999999 B 10 1376860338 0 13000 DEERFIELD PKWY STE 100 ALPHARETTA GA 300046118 20 1376860338 0 Physicians Anesthesia Services 20 1376860338 0 Physicians Fluoride varnish 20 1376860338 0 Physicians Healthy Kids Services 20 1376860338 0 Physicians Optical Supplies 20 1376860338 0 Physicians Physician Services 00 1376860429 0 RIVERA CARMEN MARIA 2014182 9999999 B 10 1376860429 0 1 KISH HOSPITAL DR DEKALB IL 601159602 20 1376860429 0 Physicians Anesthesia Services 20 1376860429 0 Physicians Healthy Kids Services 20 1376860429 0 Physicians Optical Supplies 20 1376860429 0 Physicians Physician Services 00 1376860544 0 KATZ DAVID B 2023102 9999999 B 10 1376860544 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1376860544 0 Occupational Therapists Medical Supplies 20 1376860544 0 Occupational Therapists Medical equipment/prosthetic devices 20 1376860544 0 Occupational Therapists Occupational Therapy Services 00 1376860668 0 BELL JAMES 2023136 9999999 B 10 1376860668 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1376860668 0 Physicians Anesthesia Services 20 1376860668 0 Physicians Healthy Kids Services 20 1376860668 0 Physicians Optical Supplies 20 1376860668 0 Physicians Physician Services 00 1376860775 0 REDDY TARA 2013213 9999999 B 10 1376860775 0 5777 DEPT CAROL STREAM IL 601220021 20 1376860775 0 Physicians Anesthesia Services 20 1376860775 0 Physicians Fluoride varnish 20 1376860775 0 Physicians Healthy Kids Services 20 1376860775 0 Physicians Optical Supplies 20 1376860775 0 Physicians Physician Services 00 1376862540 0 BAESHU ASHRAF 2016183 9999999 B 10 1376862540 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1376862540 0 Physicians Anesthesia Services 20 1376862540 0 Physicians Fluoride varnish 20 1376862540 0 Physicians Healthy Kids Services 20 1376862540 0 Physicians Optical Supplies 20 1376862540 0 Physicians Physician Services 00 1376862706 0 SAMUELS KERBY 2013001 9999999 B 10 1376862706 0 6501 S PROMONTORY DR CHICAGO IL 606491003 20 1376862706 0 Physicians Anesthesia Services 20 1376862706 0 Physicians Fluoride varnish 20 1376862706 0 Physicians Healthy Kids Services 20 1376862706 0 Physicians Optical Supplies 20 1376862706 0 Physicians Physician Services 00 1376863050 0 SCHREIBER ANN MARIE 2024215 9999999 B 10 1376863050 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1376863050 0 Physicians Anesthesia Services 20 1376863050 0 Physicians Fluoride varnish 20 1376863050 0 Physicians Healthy Kids Services 20 1376863050 0 Physicians Optical Supplies 20 1376863050 0 Physicians Physician Services 00 1376863720 0 ROBLES LILIANA 2018346 9999999 B 10 1376863720 0 10275 LITTLE PATUXENT PKWY STE COLUMBIA MD 210443445 20 1376863720 0 Physicians Anesthesia Services 20 1376863720 0 Physicians Healthy Kids Services 20 1376863720 0 Physicians Optical Supplies 20 1376863720 0 Physicians Physician Services 20 1376863720 0 Physicians Physicians Psychiatric Services 00 1376863779 0 HIDALGO ARMIDA 2014020 9999999 B 10 1376863779 0 PO BOX 5009 BRENTWOOD TN 370245009 20 1376863779 0 Physicians Anesthesia Services 20 1376863779 0 Physicians Fluoride varnish 20 1376863779 0 Physicians Healthy Kids Services 20 1376863779 0 Physicians Optical Supplies 20 1376863779 0 Physicians Physician Services 00 1376863936 0 GEORGE PREETA 2015182 9999999 B 10 1376863936 0 PO BOX 8500 LOCKBOX #7642 PHILADELPHIA PA 191787642 20 1376863936 0 Physicians Anesthesia Services 20 1376863936 0 Physicians Healthy Kids Services 20 1376863936 0 Physicians Optical Supplies 20 1376863936 0 Physicians Physician Services 00 1376864777 0 LINTNER MICHAEL D 2016233 9999999 B 10 1376864777 0 PO BOX 778912 CHICAGO IL 606778912 20 1376864777 0 Physicians Anesthesia Services 20 1376864777 0 Physicians Fluoride varnish 20 1376864777 0 Physicians Healthy Kids Services 20 1376864777 0 Physicians Optical Supplies 20 1376864777 0 Physicians Physician Services 00 1376864959 0 OLIVER ROXIE N 2015033 9999999 B 10 1376864959 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1376864959 0 Physicians Anesthesia Services 20 1376864959 0 Physicians Fluoride varnish 20 1376864959 0 Physicians Healthy Kids Services 20 1376864959 0 Physicians Optical Supplies 20 1376864959 0 Physicians Physician Services 00 1376866285 0 BECK COURTNEY B 2012122 9999999 B 10 1376866285 0 387 SHUMAN BLVD STE 240W NAPERVILLE IL 605638113 20 1376866285 0 Nurse Practitioners Anesthesia Services 20 1376866285 0 Nurse Practitioners Nurse Practitioners Services 20 1376866285 0 Nurse Practitioners Physician Services 00 1376866913 0 DI SABATO DIEGO 2013182 9999999 B 10 1376866913 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1376866913 0 Physicians Anesthesia Services 20 1376866913 0 Physicians Healthy Kids Services 20 1376866913 0 Physicians Optical Supplies 20 1376866913 0 Physicians Physician Services 00 1376868208 0 ADAMS KENNETH 2017281 9999999 B 10 1376868208 0 1409 E LAKE MEAD BLVD NORTH LAS VEGAS NV 890307120 20 1376868208 0 Physicians Anesthesia Services 20 1376868208 0 Physicians Healthy Kids Services 20 1376868208 0 Physicians Optical Supplies 20 1376868208 0 Physicians Physician Services 00 1376868661 0 SMILEY JEREMY 2014026 9999999 B 10 1376868661 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1376868661 0 Physicians Anesthesia Services 20 1376868661 0 Physicians Healthy Kids Services 20 1376868661 0 Physicians Optical Supplies 20 1376868661 0 Physicians Physician Services 00 1376868687 0 KIM DAVID U 2015182 9999999 B 10 1376868687 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1376868687 0 Physicians Anesthesia Services 20 1376868687 0 Physicians Healthy Kids Services 20 1376868687 0 Physicians Optical Supplies 20 1376868687 0 Physicians Physician Services 00 1376868828 0 BURRIS NICHOLAS 2024351 9999999 B 10 1376868828 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1376868828 0 Physicians Anesthesia Services 20 1376868828 0 Physicians Healthy Kids Services 20 1376868828 0 Physicians Optical Supplies 20 1376868828 0 Physicians Physician Services 00 1376869347 0 OSMANOVIC SENAD 2016153 9999999 B 10 1376869347 0 1220 W HIGGINS RD STE 102 HOFFMAN ESTATES IL 601694033 20 1376869347 0 Physicians Anesthesia Services 20 1376869347 0 Physicians Healthy Kids Services 20 1376869347 0 Physicians Optical Supplies 20 1376869347 0 Physicians Physician Services 00 1376869396 0 PARKS BRIAN 2016347 9999999 B 10 1376869396 0 PO BOX 790126 SAINT LOUIS MO 631790126 20 1376869396 0 Physicians Anesthesia Services 20 1376869396 0 Physicians Healthy Kids Services 20 1376869396 0 Physicians Optical Supplies 20 1376869396 0 Physicians Physician Services 00 1376869891 0 WESTLEY RENEE ELIZABETH 2013182 9999999 B 10 1376869891 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1376869891 0 Physicians Anesthesia Services 20 1376869891 0 Physicians Fluoride varnish 20 1376869891 0 Physicians Healthy Kids Services 20 1376869891 0 Physicians Optical Supplies 20 1376869891 0 Physicians Physician Services 00 1376870311 0 JOHN JOBIN 2017052 9999999 B 10 1376870311 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1376870311 0 Physicians All Kids application agent 20 1376870311 0 Physicians Anesthesia Services 20 1376870311 0 Physicians Fluoride varnish 20 1376870311 0 Physicians Healthy Kids Services 20 1376870311 0 Physicians Optical Supplies 20 1376870311 0 Physicians Physician Services 00 1376871897 0 DUNHAM NEUBERT AUTUMN 2018068 9999999 B 10 1376871897 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1376871897 0 Clinical Social Worker Social work service 00 1376872721 0 HAWTHORNE STEPHEN E 1988257 9999999 B 10 1376872721 0 1111 SUPERIOR ST STE 207 SUITE 207 MELROSE PARK IL 601604156 20 1376872721 0 Physicians Anesthesia Services 20 1376872721 0 Physicians Fluoride varnish 20 1376872721 0 Physicians Healthy Kids Services 20 1376872721 0 Physicians Optical Supplies 20 1376872721 0 Physicians Physician Services 00 1376874651 0 WAITES JULIE 2011111 9999999 B 10 1376874651 0 3471 GREEN BAY RD NORTH CHICAGO IL 600643090 20 1376874651 0 Psychologist Psychologist service 00 1376879122 0 BAKER RICHARD 2009327 9999999 B 10 1376879122 0 PO BOX 693 MAHOMET IL 618530693 20 1376879122 0 Nurse Practitioners Anesthesia Services 20 1376879122 0 Nurse Practitioners Nurse Practitioners Services 20 1376879122 0 Nurse Practitioners Physician Services 00 1376879940 0 SOHAIL UMAIR 2020059 9999999 B 10 1376879940 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1376879940 0 Physicians Anesthesia Services 20 1376879940 0 Physicians Fluoride varnish 20 1376879940 0 Physicians Healthy Kids Services 20 1376879940 0 Physicians Optical Supplies 20 1376879940 0 Physicians Physician Services 00 1376881136 0 GAZDA DODIE 2014182 9999999 B 10 1376881136 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1376881136 0 Nurse Practitioners Healthy Kids Services 20 1376881136 0 Nurse Practitioners Nurse Practitioners Services 20 1376881136 0 Nurse Practitioners Physician Services 00 1376881185 0 MURPHY CHRISTOPHER 2013032 9999999 B 10 1376881185 0 850 43RD AVE STE 100 MOLINE IL 612658401 20 1376881185 0 Physical Therapists Medical Supplies 20 1376881185 0 Physical Therapists Medical equipment/prosthetic devices 20 1376881185 0 Physical Therapists Physical Therapy Services 00 1376882647 0 WITGES SHANNA M 2013217 9999999 B 10 1376882647 0 PO BOX 34156 BELFAST ME 049150619 20 1376882647 0 Nurse Practitioners 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1376887299 0 Nurse Practitioners Physician Services 00 1376889071 0 RALSTON ANASTASIA 2013022 9999999 B 10 1376889071 0 1160 E SAINT CLAIR ST VINCENNES IN 475914853 20 1376889071 0 Nurse Practitioners Fluoride varnish 20 1376889071 0 Nurse Practitioners Healthy Kids Services 20 1376889071 0 Nurse Practitioners Nurse Practitioners Services 20 1376889071 0 Nurse Practitioners Physician Services 00 1376890376 0 PARKER AMANDA 2016258 9999999 B 10 1376890376 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1376890376 0 Physician Assistant Only Fluoride varnish 20 1376890376 0 Physician Assistant Only Healthy Kids Services 20 1376890376 0 Physician Assistant Only Physician Services 00 1376890889 0 KRAUSE MICHELLE 2012229 9999999 B 10 1376890889 0 370 SUMMIT ST # 1 ELGIN IL 601203843 20 1376890889 0 Nurse Practitioners Healthy Kids Services 20 1376890889 0 Nurse Practitioners Nurse Practitioners Services 20 1376890889 0 Nurse Practitioners Physician Services 00 1376891028 0 CHAUDHURI RISHI 2018121 9999999 B 10 1376891028 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1376891028 0 Physicians Anesthesia Services 20 1376891028 0 Physicians Healthy Kids Services 20 1376891028 0 Physicians Optical Supplies 20 1376891028 0 Physicians Physician Services 00 1376892117 0 DURSKI AGNIESZKA 2014062 9999999 B 10 1376892117 0 29373 NETWORK PL CHICAGO IL 606733039 20 1376892117 0 Nurse Practitioners Fluoride varnish 20 1376892117 0 Nurse Practitioners Healthy Kids Services 20 1376892117 0 Nurse Practitioners Nurse Practitioners Services 20 1376892117 0 Nurse Practitioners Physician Services 00 1376892398 0 DOLE JENNIFER L 2013322 9999999 B 10 1376892398 0 4400 W 95TH ST STE 308 OAK LAWN IL 604532660 20 1376892398 0 Nurse Practitioners Healthy Kids Services 20 1376892398 0 Nurse Practitioners Nurse Practitioners Services 20 1376892398 0 Nurse Practitioners Physician Services 00 1376897074 0 THROM LYNDA 2017109 9999999 B 10 1376897074 0 2504 WASHINGTON ST STE 403 WAUKEGAN IL 600854960 20 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Services 00 1376961680 0 MAMIC MARKO 2019290 9999999 B 10 1376961680 0 40 SHUMAN BLVD STE 275 SUITE 275 NAPERVILLE IL 605638669 20 1376961680 0 Physicians Anesthesia Services 20 1376961680 0 Physicians Healthy Kids Services 20 1376961680 0 Physicians Optical Supplies 20 1376961680 0 Physicians Physician Services 00 1376961730 0 ROSS ANTHONY J 2021104 9999999 B 10 1376961730 0 PO BOX 778912 CHICAGO IL 606778912 20 1376961730 0 Physicians Anesthesia Services 20 1376961730 0 Physicians Fluoride varnish 20 1376961730 0 Physicians Healthy Kids Services 20 1376961730 0 Physicians Optical Supplies 20 1376961730 0 Physicians Physician Services 00 1376961748 0 VALENTE MATTHEW E 2019185 9999999 B 10 1376961748 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1376961748 0 Physicians Anesthesia Services 20 1376961748 0 Physicians Fluoride varnish 20 1376961748 0 Physicians Healthy Kids Services 20 1376961748 0 Physicians Optical Supplies 20 1376961748 0 Physicians Physician Services 00 1376961870 0 QUINN BRIAN 2017141 9999999 B 10 1376961870 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1376961870 0 Physicians Anesthesia Services 20 1376961870 0 Physicians Fluoride varnish 20 1376961870 0 Physicians Healthy Kids Services 20 1376961870 0 Physicians Optical Supplies 20 1376961870 0 Physicians Physician Services 00 1376962076 0 VOLK RICHELLE E 2014090 9999999 B 10 1376962076 0 1106 N MERCHANT ST PO BOX 665 EFFINGHAM IL 624012128 20 1376962076 0 Nurse Practitioners Healthy Kids Services 20 1376962076 0 Nurse Practitioners Nurse Practitioners Services 20 1376962076 0 Nurse Practitioners Physician Services 00 1376962142 0 GRAWEY THOMAS 2017121 9999999 B 10 1376962142 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1376962142 0 Physicians Anesthesia Services 20 1376962142 0 Physicians Healthy Kids Services 20 1376962142 0 Physicians Optical Supplies 20 1376962142 0 Physicians Physician Services 00 1376962894 0 SUTHERLAND MONIQUE 2018183 9999999 B 10 1376962894 0 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1376968842 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1376968842 0 Nurse Practitioners Healthy Kids Services 20 1376968842 0 Nurse Practitioners Nurse Practitioners Services 20 1376968842 0 Nurse Practitioners Physician Services 00 1376968974 0 BOYER KRISTEN 2018297 9999999 B 10 1376968974 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1376968974 0 Physical Therapists Medical Supplies 20 1376968974 0 Physical Therapists Medical equipment/prosthetic devices 20 1376968974 0 Physical Therapists Physical Therapy Services 00 1376969436 0 ASAFU-ADJEI DENISE A 2021190 9999999 B 10 1376969436 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1376969436 0 Physicians Anesthesia Services 20 1376969436 0 Physicians Healthy Kids Services 20 1376969436 0 Physicians Optical Supplies 20 1376969436 0 Physicians Physician Services 00 1376969634 0 HUTNICK AMELIA L 2014167 9999999 B 10 1376969634 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1376969634 0 Occupational Therapists Medical 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616021308 20 1376978601 0 Nurse Practitioners Healthy Kids Services 20 1376978601 0 Nurse Practitioners Nurse Practitioners Services 20 1376978601 0 Nurse Practitioners Physician Services 00 1376979815 0 ROUNDS LISA 2014105 9999999 B 10 1376979815 0 611 W PARK ST URBANA IL 618012529 20 1376979815 0 Nurse Practitioners Fluoride varnish 20 1376979815 0 Nurse Practitioners Healthy Kids Services 20 1376979815 0 Nurse Practitioners Nurse Practitioners Services 20 1376979815 0 Nurse Practitioners Physician Services 00 1376980524 0 MANCUSO ABIGAIL 2020183 9999999 B 10 1376980524 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1376980524 0 Physicians Anesthesia Services 20 1376980524 0 Physicians Healthy Kids Services 20 1376980524 0 Physicians Optical Supplies 20 1376980524 0 Physicians Physician Services 00 1376980599 0 SKINNER JESSICA 2014306 9999999 B 10 1376980599 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1376980599 0 Nurse Practitioners Fluoride varnish 20 1376980599 0 Nurse Practitioners 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PEORIA IL 616021308 20 1376982082 0 Physicians Anesthesia Services 20 1376982082 0 Physicians Fluoride varnish 20 1376982082 0 Physicians Healthy Kids Services 20 1376982082 0 Physicians Optical Supplies 20 1376982082 0 Physicians Physician Services 00 1376982306 0 TANN CHRISTOPHER 2020297 9999999 B 10 1376982306 0 PO BOX 43230 PHOENIX AZ 850803230 20 1376982306 0 Physicians Anesthesia Services 20 1376982306 0 Physicians Healthy Kids Services 20 1376982306 0 Physicians Optical Supplies 20 1376982306 0 Physicians Physician Services 00 1376982371 0 ADAMS PHILLIP M 2016134 9999999 B 10 1376982371 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1376982371 0 Physicians Anesthesia Services 20 1376982371 0 Physicians Fluoride varnish 20 1376982371 0 Physicians Healthy Kids Services 20 1376982371 0 Physicians Optical Supplies 20 1376982371 0 Physicians Physician Services 00 1376983205 0 HANZAKER CHRISTOPHER 2020302 9999999 B 10 1376983205 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1376983205 0 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Physical Therapists Physical Therapy Services 00 1376992818 0 WEBBER MILLER TERRI A 2022200 9999999 B 10 1376992818 0 820 SPRINGER DR LOMBARD IL 601486413 20 1376992818 0 Nurse Practitioners Healthy Kids Services 20 1376992818 0 Nurse Practitioners Nurse Practitioners Services 20 1376992818 0 Nurse Practitioners Physician Services 00 1376993139 0 MOORE REILIN J 2021266 9999999 B 10 1376993139 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1376993139 0 Physicians Anesthesia Services 20 1376993139 0 Physicians Healthy Kids Services 20 1376993139 0 Physicians Optical Supplies 20 1376993139 0 Physicians Physician Services 00 1376993709 0 ELLSWORTH STEPHANIE A 2016221 9999999 B 10 1376993709 0 PO BOX 4827 DES MOINES IA 503054827 20 1376993709 0 Nurse Practitioners Fluoride varnish 20 1376993709 0 Nurse Practitioners Healthy Kids Services 20 1376993709 0 Nurse Practitioners Nurse Practitioners Services 20 1376993709 0 Nurse Practitioners Physician Services 00 1376993899 0 REES MATTHEW 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Physicians Optical Supplies 20 1386051142 0 Physicians Physician Services 20 1386051142 0 Physicians Physicians Psychiatric Services 00 1386052470 0 WEPFER VICTORIA A 2014274 9999999 B 10 1386052470 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1386052470 0 Nurse Practitioners Healthy Kids Services 20 1386052470 0 Nurse Practitioners Nurse Practitioners Services 20 1386052470 0 Nurse Practitioners Physician Services 00 1386053346 0 STRASSMAN ANITA M 2017325 9999999 B 10 1386053346 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1386053346 0 Speech Therapists Medical Supplies 20 1386053346 0 Speech Therapists Medical equipment/prosthetic devices 20 1386053346 0 Speech Therapists Speech Therapy/Pathology Services 00 1386053825 0 GORASIYA MANISHKUMAR 2015001 9999999 B 10 1386053825 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1386053825 0 Physicians Anesthesia Services 20 1386053825 0 Physicians Fluoride varnish 20 1386053825 0 Physicians Healthy Kids Services 20 1386053825 0 Physicians Optical Supplies 20 1386053825 0 Physicians Physician Services 00 1386053882 0 LAVIN ERIKA 2022124 9999999 H 10 1386053882 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1386053882 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1386054583 0 HART ALYSHA S 2016221 9999999 B 10 1386054583 0 333 COMMERCE ST STE 700 NASHVILLE TN 372011835 20 1386054583 0 Nurse Practitioners Healthy Kids Services 20 1386054583 0 Nurse Practitioners Nurse Practitioners Services 20 1386054583 0 Nurse Practitioners Physician Services 00 1386055531 0 COSTANTINI HOLLY B 2015050 9999999 B 10 1386055531 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1386055531 0 Nurse Practitioners Healthy Kids Services 20 1386055531 0 Nurse Practitioners Nurse Practitioners Services 20 1386055531 0 Nurse Practitioners Physician Services 00 1386055622 0 AHMAD DANIEL 2022189 9999999 B 10 1386055622 0 5777 DEPT CAROL STREAM 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1386058733 0 Physicians Healthy Kids Services 20 1386058733 0 Physicians Optical Supplies 20 1386058733 0 Physicians Physician Services 00 1386059277 0 COOPER MICHAEL P 2019001 9999999 B 10 1386059277 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1386059277 0 Physicians Anesthesia Services 20 1386059277 0 Physicians Healthy Kids Services 20 1386059277 0 Physicians Optical Supplies 20 1386059277 0 Physicians Physician Services 20 1386059277 0 Physicians Physicians Psychiatric Services 00 1386059400 0 RYAN DANIEL M 2021140 9999999 B 10 1386059400 0 PO BOX 843033 KANSAS CITY MO 641843033 20 1386059400 0 Physicians Anesthesia Services 20 1386059400 0 Physicians Healthy Kids Services 20 1386059400 0 Physicians Optical Supplies 20 1386059400 0 Physicians Physician Services 00 1386059624 0 AVILA CARLOS 2016259 9999999 B 10 1386059624 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1386059624 0 Physicians Anesthesia Services 20 1386059624 0 Physicians Fluoride varnish 20 1386059624 0 Physicians 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Healthy Kids Services 20 1386061232 0 Physicians Optical Supplies 20 1386061232 0 Physicians Physician Services 00 1386061380 0 BHAT ADITHYA DEVADAS 2019085 9999999 B 10 1386061380 0 5777 DEPT CAROL STREAM IL 601220021 20 1386061380 0 Physicians Anesthesia Services 20 1386061380 0 Physicians Healthy Kids Services 20 1386061380 0 Physicians Optical Supplies 20 1386061380 0 Physicians Physician Services 00 1386061679 0 PATTISAPU PRASANTH 2020301 9999999 B 10 1386061679 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1386061679 0 Physicians Anesthesia Services 20 1386061679 0 Physicians Healthy Kids Services 20 1386061679 0 Physicians Optical Supplies 20 1386061679 0 Physicians Physician Services 00 1386061729 0 SIDDIQUI WAQAS J 2022257 9999999 B 10 1386061729 0 5777 DEPT CAROL STREAM IL 601220021 20 1386061729 0 Physicians Anesthesia Services 20 1386061729 0 Physicians Fluoride varnish 20 1386061729 0 Physicians Healthy Kids Services 20 1386061729 0 Physicians Optical Supplies 20 1386061729 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Anesthesia Services 20 1386063931 0 Physicians Healthy Kids Services 20 1386063931 0 Physicians Optical Supplies 20 1386063931 0 Physicians Physician Services 00 1386064269 0 NGUYEN CHEW JENNIFER 2025063 9999999 B 10 1386064269 0 8300 ESTERS BLVD STE 900 IRVING TX 750632233 20 1386064269 0 Physicians Anesthesia Services 20 1386064269 0 Physicians Fluoride varnish 20 1386064269 0 Physicians Healthy Kids Services 20 1386064269 0 Physicians Optical Supplies 20 1386064269 0 Physicians Physician Services 00 1386064566 0 YOUNG KRISTA 2020183 9999999 B 10 1386064566 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1386064566 0 Physicians Anesthesia Services 20 1386064566 0 Physicians Fluoride varnish 20 1386064566 0 Physicians Healthy Kids Services 20 1386064566 0 Physicians Optical Supplies 20 1386064566 0 Physicians Physician Services 00 1386064897 0 CROSS LORI A 2014322 9999999 B 10 1386064897 0 611 W PARK ST URBANA IL 618012529 20 1386064897 0 Nurse Practitioners Healthy Kids Services 20 1386064897 0 Nurse Practitioners Nurse Practitioners Services 20 1386064897 0 Nurse Practitioners Physician Services 00 1386064996 0 WILKE HOLLY A 2014170 9999999 B 10 1386064996 0 PO BOX 297 SPARTA IL 622860297 20 1386064996 0 Nurse Practitioners Anesthesia Services 20 1386064996 0 Nurse Practitioners Nurse Practitioners Services 20 1386064996 0 Nurse Practitioners Physician Services 00 1386065894 0 CARLSON AMY 2014116 9999999 B 10 1386065894 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1386065894 0 Nurse Practitioners Fluoride varnish 20 1386065894 0 Nurse Practitioners Healthy Kids Services 20 1386065894 0 Nurse Practitioners Nurse Practitioners Services 20 1386065894 0 Nurse Practitioners Physician Services 00 1386066173 0 USHER MICHAEL 2025037 9999999 B 10 1386066173 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1386066173 0 Physicians Anesthesia Services 20 1386066173 0 Physicians Fluoride varnish 20 1386066173 0 Physicians Healthy Kids Services 20 1386066173 0 Physicians Optical Supplies 20 1386066173 0 Physicians Physician Services 00 1386067767 0 MELINDA DUNN 2021202 9999999 B 10 1386067767 0 101 E STATE ST KENNETT SQ PA 193483109 20 1386067767 0 Speech Therapists Medical Supplies 20 1386067767 0 Speech Therapists Medical equipment/prosthetic devices 20 1386067767 0 Speech Therapists Speech Therapy/Pathology Services 00 1386068260 0 EASON DANNY J 2024298 9999999 B 10 1386068260 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1386068260 0 Nurse Practitioners Anesthesia Services 20 1386068260 0 Nurse Practitioners Nurse Practitioners Services 20 1386068260 0 Nurse Practitioners Physician Services 00 1386068427 0 NASSER NORA 2016183 9999999 H 10 1386068427 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1386068427 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1386068955 0 LUCCA ANTHONY 2017194 9999999 B 10 1386068955 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1386068955 0 Physician Assistant Only Fluoride varnish 20 1386068955 0 Physician Assistant Only Healthy Kids Services 20 1386068955 0 Physician Assistant Only Physician Services 00 1386069250 0 WEBER TANIA M 2014120 9999999 B 10 1386069250 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1386069250 0 Nurse Practitioners Healthy Kids Services 20 1386069250 0 Nurse Practitioners Nurse Practitioners Services 20 1386069250 0 Nurse Practitioners Physician Services 00 1386069490 0 HICKS CATRESA M 2020265 9999999 B 10 1386069490 0 700 N SACRAMENTO BLVD STE 201 CHICAGO IL 606121058 20 1386069490 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1386069607 0 ESSLING CARA B 2016252 9999999 B 10 1386069607 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1386069607 0 Physician Assistant Only Fluoride varnish 20 1386069607 0 Physician Assistant Only Healthy Kids Services 20 1386069607 0 Physician Assistant Only Physician Services 00 1386070480 0 BROCK THEODORE 2013272 9999999 B 10 1386070480 0 5777 DEPT CAROL STREAM IL 601220021 20 1386070480 0 Nurse Practitioners Healthy Kids Services 20 1386070480 0 Nurse Practitioners Nurse Practitioners Services 20 1386070480 0 Nurse Practitioners Physician Services 00 1386072452 0 MEAD JESSICA 2018171 9999999 B 10 1386072452 0 721 N LA SALLE DR CHICAGO IL 606543503 20 1386072452 0 Clinical Social Worker Social work service 00 1386072783 0 KELLY MAURA 2013343 9999999 B 10 1386072783 0 122 TUTTLE AVE CLARENDON HILLS IL 605141156 20 1386072783 0 Physical Therapists Medical Supplies 20 1386072783 0 Physical Therapists Medical equipment/prosthetic devices 20 1386072783 0 Physical Therapists Physical Therapy Services 00 1386074037 0 KATSAROS ANTONIA 2016290 9999999 H 10 1386074037 0 2500 W HIGGINS RD STE 105 HOFFMAN ESTATES IL 601692040 20 1386074037 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1386074847 0 FARR DREWW T 2017325 9999999 B 10 1386074847 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1386074847 0 Clinical Social Worker Social work service 00 1386076024 0 RINALDI MARCUS 2022346 9999999 B 10 1386076024 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1386076024 0 Physical Therapists Medical Supplies 20 1386076024 0 Physical Therapists Medical equipment/prosthetic devices 20 1386076024 0 Physical Therapists Physical Therapy Services 00 1386077279 0 LE TRUNG B 2023082 9999999 B 10 1386077279 0 PO BOX 43230 PHOENIX AZ 850803230 20 1386077279 0 Physicians Anesthesia Services 20 1386077279 0 Physicians Healthy Kids Services 20 1386077279 0 Physicians Optical Supplies 20 1386077279 0 Physicians Physician Services 00 1386077683 0 CHEN KAIYUN 2013261 9999999 B 10 1386077683 0 555 N WASHINGTON ST NAPERVILLE IL 605633162 20 1386077683 0 Dentists Dental Services 20 1386077683 0 Dentists Physician Services 00 1386080463 0 WILDE MEGAN M 2021166 9999999 B 10 1386080463 0 PO BOX 778912 CHICAGO IL 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1386080943 0 Physicians Fluoride varnish 20 1386080943 0 Physicians Healthy Kids Services 20 1386080943 0 Physicians Optical Supplies 20 1386080943 0 Physicians Physician Services 00 1386081123 0 O''DONOGHUE SARAH 2016183 9999999 B 10 1386081123 0 PO BOX 8742 FORT WORTH TX 761240742 20 1386081123 0 Physicians Anesthesia Services 20 1386081123 0 Physicians Healthy Kids Services 20 1386081123 0 Physicians Optical Supplies 20 1386081123 0 Physicians Physician Services 00 1386081800 0 ALREFAI ALI 2017264 9999999 B 10 1386081800 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1386081800 0 Physicians Anesthesia Services 20 1386081800 0 Physicians Healthy Kids Services 20 1386081800 0 Physicians Optical Supplies 20 1386081800 0 Physicians Physician Services 20 1386081800 0 Physicians Physicians Psychiatric Services 00 1386082824 0 BAUMGARTNER ELIZABETH 2021332 9999999 B 10 1386082824 0 525 PARK ST STE 300 SUITE 300 SAINT PAUL MN 551032197 20 1386082824 0 Physician Assistant Only Fluoride varnish 20 1386082824 0 Physician Assistant Only Healthy Kids Services 20 1386082824 0 Physician Assistant Only Physician Services 00 1386083194 0 FROLOVA ANTONINA I 2019280 9999999 B 10 1386083194 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1386083194 0 Physicians Anesthesia Services 20 1386083194 0 Physicians Healthy Kids Services 20 1386083194 0 Physicians Optical Supplies 20 1386083194 0 Physicians Physician Services 00 1386083335 0 TIMPE JOSHUA 2016153 9999999 B 10 1386083335 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1386083335 0 Physicians Anesthesia Services 20 1386083335 0 Physicians Healthy Kids Services 20 1386083335 0 Physicians Optical Supplies 20 1386083335 0 Physicians Physician Services 00 1386083665 0 BANNER OTHELLO 2016243 9999999 B 10 1386083665 0 333 S STATE ST STE 200 CHICAGO IL 606043946 20 1386083665 0 Other behavior health professional LCPC/LMFT services 00 1386084044 0 PATEL JAYMON 2016179 9999999 B 10 1386084044 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1386084044 0 Physicians Anesthesia Services 20 1386084044 0 Physicians Fluoride varnish 20 1386084044 0 Physicians Healthy Kids Services 20 1386084044 0 Physicians Optical Supplies 20 1386084044 0 Physicians Physician Services 00 1386084101 0 PALMER JAIME 2021025 9999999 B 10 1386084101 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1386084101 0 Physicians Anesthesia Services 20 1386084101 0 Physicians Fluoride varnish 20 1386084101 0 Physicians Healthy Kids Services 20 1386084101 0 Physicians Optical Supplies 20 1386084101 0 Physicians Physician Services 00 1386084259 0 KIMBELL JOSEPH C 2016315 9999999 B 10 1386084259 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1386084259 0 Physicians Anesthesia Services 20 1386084259 0 Physicians Fluoride varnish 20 1386084259 0 Physicians Healthy Kids Services 20 1386084259 0 Physicians Optical Supplies 20 1386084259 0 Physicians Physician Services 00 1386084739 0 PEREZ EMERALD J 2023177 9999999 B 10 1386084739 0 850 W IRVING PARK RD CHICAGO IL 606133077 20 1386084739 0 Physical Therapists Medical Supplies 20 1386084739 0 Physical Therapists Medical equipment/prosthetic devices 20 1386084739 0 Physical Therapists Physical Therapy Services 00 1386085942 0 HASHMI AFREEDA 2022236 9999999 B 10 1386085942 0 5777 DEPT CAROL STREAM IL 601220021 20 1386085942 0 Physicians Anesthesia Services 20 1386085942 0 Physicians Fluoride varnish 20 1386085942 0 Physicians Healthy Kids Services 20 1386085942 0 Physicians Optical Supplies 20 1386085942 0 Physicians Physician Services 00 1386085967 0 AYRES CATHERINE M 2015097 9999999 B 10 1386085967 0 1025 MAINE ST QUINCY IL 623014038 20 1386085967 0 Nurse Practitioners Fluoride varnish 20 1386085967 0 Nurse Practitioners Healthy Kids Services 20 1386085967 0 Nurse Practitioners Nurse Practitioners Services 20 1386085967 0 Nurse Practitioners Physician Services 00 1386086791 0 ALI-BURFORD ZARINAH 2013244 9999999 B 10 1386086791 0 PO BOX 548 INDIANAPOLIS IN 462060548 20 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Supplies 20 1386089324 0 Physicians Physician Services 00 1386089746 0 CHEN RONG 2017234 9999999 B 10 1386089746 0 611 W PARK ST URBANA IL 618012529 20 1386089746 0 Physicians Anesthesia Services 20 1386089746 0 Physicians Healthy Kids Services 20 1386089746 0 Physicians Optical Supplies 20 1386089746 0 Physicians Physician Services 00 1386089803 0 REED LOREN K 2016183 9999999 B 10 1386089803 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1386089803 0 Physicians Anesthesia Services 20 1386089803 0 Physicians Healthy Kids Services 20 1386089803 0 Physicians Optical Supplies 20 1386089803 0 Physicians Physician Services 00 1386089860 0 SALVATO GENEVIEVE V 2016214 9999999 B 10 1386089860 0 1616 CEDAR ST MUSCATINE IA 527613453 20 1386089860 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1386090009 0 HUSSAIN IRFAN 2021210 9999999 B 10 1386090009 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1386090009 0 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Services 20 1386131720 0 Physicians Fluoride varnish 20 1386131720 0 Physicians Healthy Kids Services 20 1386131720 0 Physicians Optical Supplies 20 1386131720 0 Physicians Physician Services 00 1386131878 0 HELLING NICHOLAS 2018137 9999999 B 10 1386131878 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1386131878 0 Physical Therapists Medical Supplies 20 1386131878 0 Physical Therapists Medical equipment/prosthetic devices 20 1386131878 0 Physical Therapists Physical Therapy Services 00 1386134641 0 SWOFFORD DEVON P 2021160 9999999 B 10 1386134641 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1386134641 0 Physicians Anesthesia Services 20 1386134641 0 Physicians Fluoride varnish 20 1386134641 0 Physicians Healthy Kids Services 20 1386134641 0 Physicians Optical Supplies 20 1386134641 0 Physicians Physician Services 00 1386135424 0 MUNAGALA ANISH RAO 2021243 9999999 B 10 1386135424 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1386135424 0 Physicians Anesthesia Services 20 1386135424 0 Physicians Healthy Kids Services 20 1386135424 0 Physicians Optical Supplies 20 1386135424 0 Physicians Physician Services 00 1386135804 0 ACEVEDO ISABEL 2018213 9999999 B 10 1386135804 0 370 SUMMIT ST # 1 ELGIN IL 601203843 20 1386135804 0 Other behavior health professional LCPC/LMFT services 00 1386137693 0 GINN JASMINE 2018351 9999999 B 10 1386137693 0 800 E LOCUST ST OLNEY IL 624502553 20 1386137693 0 Physicians Anesthesia Services 20 1386137693 0 Physicians Healthy Kids Services 20 1386137693 0 Physicians Optical Supplies 20 1386137693 0 Physicians Physician Services 00 1386137990 0 TERHUNE ELIZABETH B 2019203 9999999 B 10 1386137990 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1386137990 0 Physicians Anesthesia Services 20 1386137990 0 Physicians Healthy Kids Services 20 1386137990 0 Physicians Optical Supplies 20 1386137990 0 Physicians Physician Services 00 1386138352 0 SALEH ALA 2022250 9999999 B 10 1386138352 0 7430 161ST PL TINLEY PARK IL 604771535 20 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Healthy Kids Services 20 1386140366 0 Physicians Optical Supplies 20 1386140366 0 Physicians Physician Services 00 1386140457 0 KIRK REBECCA K 2020028 9999999 B 10 1386140457 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1386140457 0 Physicians Anesthesia Services 20 1386140457 0 Physicians Fluoride varnish 20 1386140457 0 Physicians Healthy Kids Services 20 1386140457 0 Physicians Optical Supplies 20 1386140457 0 Physicians Physician Services 00 1386140481 0 AZHER TAYABA N 2023033 9999999 B 10 1386140481 0 1880 W WINCHESTER RD STE 105 LIBERTYVILLE IL 600485321 20 1386140481 0 Physicians Anesthesia Services 20 1386140481 0 Physicians Healthy Kids Services 20 1386140481 0 Physicians Optical Supplies 20 1386140481 0 Physicians Physician Services 00 1386141125 0 NGUYEN DAVID 2020045 9999999 B 10 1386141125 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1386141125 0 Physicians Anesthesia Services 20 1386141125 0 Physicians Healthy Kids Services 20 1386141125 0 Physicians 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1386145258 0 Nurse Practitioners Healthy Kids Services 20 1386145258 0 Nurse Practitioners Nurse Practitioners Services 20 1386145258 0 Nurse Practitioners Physician Services 00 1386145530 0 HARRISON BROOKE A 2018122 9999999 B 10 1386145530 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1386145530 0 Nurse Practitioners Fluoride varnish 20 1386145530 0 Nurse Practitioners Healthy Kids Services 20 1386145530 0 Nurse Practitioners Nurse Practitioners Services 20 1386145530 0 Nurse Practitioners Physician Services 00 1386146207 0 VARGAS-VERA SARAI L 2023305 9999999 B 10 1386146207 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1386146207 0 Physician Assistant Only Fluoride varnish 20 1386146207 0 Physician Assistant Only Healthy Kids Services 20 1386146207 0 Physician Assistant Only Physician Services 00 1386146728 0 MANN ALLISON 2022033 9999999 B 10 1386146728 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1386146728 0 Physician Assistant Only Fluoride varnish 20 1386146728 0 Physician Assistant Only Healthy Kids Services 20 1386146728 0 Physician Assistant Only Physician Services 00 1386147163 0 AMENGUAL TRAVIS MARK 2018234 9999999 B 10 1386147163 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1386147163 0 Physicians Anesthesia Services 20 1386147163 0 Physicians Healthy Kids Services 20 1386147163 0 Physicians Optical Supplies 20 1386147163 0 Physicians Physician Services 20 1386147163 0 Physicians Physicians Psychiatric Services 00 1386147866 0 BERRY NICHOLAS W 2022048 9999999 B 10 1386147866 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1386147866 0 Physicians Anesthesia Services 20 1386147866 0 Physicians Fluoride varnish 20 1386147866 0 Physicians Healthy Kids Services 20 1386147866 0 Physicians Optical Supplies 20 1386147866 0 Physicians Physician Services 00 1386148070 0 KAPLITA JILLIAN 2018187 9999999 B 10 1386148070 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1386148070 0 Physicians Anesthesia Services 20 1386148070 0 Physicians Fluoride varnish 20 1386148070 0 Physicians Healthy Kids Services 20 1386148070 0 Physicians Optical Supplies 20 1386148070 0 Physicians Physician Services 00 1386148393 0 JOSTS DIONYSIAN A 2023067 9999999 B 10 1386148393 0 7421 MADISON ST FOREST PARK IL 601301575 20 1386148393 0 Occupational Therapists Medical Supplies 20 1386148393 0 Occupational Therapists Medical equipment/prosthetic devices 20 1386148393 0 Occupational Therapists Occupational Therapy Services 00 1386148427 0 ALIHODZIC EDIN 2021162 9999999 B 10 1386148427 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1386148427 0 Physicians Anesthesia Services 20 1386148427 0 Physicians Fluoride varnish 20 1386148427 0 Physicians Healthy Kids Services 20 1386148427 0 Physicians Optical Supplies 20 1386148427 0 Physicians Physician Services 00 1386148799 0 WEINHAMMER ANNIKA P 2023201 9999999 B 10 1386148799 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1386148799 0 Physicians Anesthesia Services 20 1386148799 0 Physicians Healthy Kids Services 20 1386148799 0 Physicians Optical Supplies 20 1386148799 0 Physicians Physician Services 00 1386148872 0 KRUSE BRANDON C 2023018 9999999 B 10 1386148872 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1386148872 0 Physicians Anesthesia Services 20 1386148872 0 Physicians Fluoride varnish 20 1386148872 0 Physicians Healthy Kids Services 20 1386148872 0 Physicians Optical Supplies 20 1386148872 0 Physicians Physician Services 00 1386149763 0 THOMAS JENNA 2023065 9999999 B 10 1386149763 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1386149763 0 Physicians Anesthesia Services 20 1386149763 0 Physicians Healthy Kids Services 20 1386149763 0 Physicians Optical Supplies 20 1386149763 0 Physicians Physician Services 00 1386151116 0 CAVENEY JULIA M 2018016 9999999 B 10 1386151116 0 3320 LINCOLN ST FRANKLIN PARK IL 601311514 20 1386151116 0 Speech Therapists Medical Supplies 20 1386151116 0 Speech Therapists Medical equipment/prosthetic devices 20 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MCCONNELL BRIDGET 2024274 9999999 B 10 1386154789 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1386154789 0 Nurse Practitioners Fluoride varnish 20 1386154789 0 Nurse Practitioners Healthy Kids Services 20 1386154789 0 Nurse Practitioners Nurse Practitioners Services 20 1386154789 0 Nurse Practitioners Physician Services 00 1386154870 0 HARRIS REBECCA L 2017317 9999999 B 10 1386154870 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1386154870 0 Nurse Practitioners Fluoride varnish 20 1386154870 0 Nurse Practitioners Healthy Kids Services 20 1386154870 0 Nurse Practitioners Nurse Practitioners Services 20 1386154870 0 Nurse Practitioners Physician Services 00 1386154938 0 WELIN ELLEN 2018015 9999999 B 10 1386154938 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1386154938 0 Speech Therapists Medical Supplies 20 1386154938 0 Speech Therapists Medical equipment/prosthetic devices 20 1386154938 0 Speech Therapists Speech Therapy/Pathology Services 00 1386156040 0 RODRIGUEZ ROMO MARIA X 2017306 9999999 B 10 1386156040 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1386156040 0 Speech Therapists Medical Supplies 20 1386156040 0 Speech Therapists Medical equipment/prosthetic devices 20 1386156040 0 Speech Therapists Speech Therapy/Pathology Services 00 1386156339 0 DOYLE EVA 2018145 9999999 B 10 1386156339 0 9701 W HIGGINS RD STE 270 ROSEMONT IL 600184703 20 1386156339 0 Physician Assistant Only Fluoride varnish 20 1386156339 0 Physician Assistant Only Healthy Kids Services 20 1386156339 0 Physician Assistant Only Physician Services 00 1386156917 0 RYAN KELLY 2018003 9999999 B 10 1386156917 0 28594 NETWORK PL CHICAGO IL 606731285 20 1386156917 0 Nurse Practitioners Healthy Kids Services 20 1386156917 0 Nurse Practitioners Nurse Practitioners Services 20 1386156917 0 Nurse Practitioners Physician Services 00 1386156933 0 AUSTIN ANN 2017307 9999999 B 10 1386156933 0 501 7TH ST ROCKFORD IL 611041242 20 1386156933 0 Speech Therapists Medical Supplies 20 1386156933 0 Speech Therapists Medical equipment/prosthetic devices 20 1386156933 0 Speech Therapists Speech Therapy/Pathology Services 00 1386157105 0 HACKETT HEIDI M 2022070 9999999 B 10 1386157105 0 125 W ELLSWORTH ST WESTVILLE IL 618831233 20 1386157105 0 Speech Therapists Speech Therapy/Pathology Services 00 1386158822 0 MALONEY KERRY 2019100 9999999 B 10 1386158822 0 801 W BIG BEAVER RD STE 300 TROY MI 480844725 20 1386158822 0 Nurse Practitioners Fluoride varnish 20 1386158822 0 Nurse Practitioners Healthy Kids Services 20 1386158822 0 Nurse Practitioners Nurse Practitioners Services 20 1386158822 0 Nurse Practitioners Physician Services 00 1386158921 0 WALTERS KRISTEN 2018001 9999999 B 10 1386158921 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1386158921 0 Nurse Practitioners Healthy Kids Services 20 1386158921 0 Nurse Practitioners Nurse Practitioners Services 20 1386158921 0 Nurse Practitioners Physician Services 00 1386159028 0 RICCIARDI ASHLEY 2017341 9999999 B 10 1386159028 0 611 W PARK 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Physicians Physician Services 00 1386171155 0 LEVINSON POLLY 2017182 9999999 B 10 1386171155 0 PO BOX 856 ANTIOCH IL 600020856 20 1386171155 0 Clinical Social Worker Social work service 00 1386171163 0 POLLACK ELLEN 2017213 9999999 B 10 1386171163 0 901 MCCLINTOCK DR STE 202 SUITE 202 BURR RIDGE IL 605270872 20 1386171163 0 Physician Assistant Only Fluoride varnish 20 1386171163 0 Physician Assistant Only Healthy Kids Services 20 1386171163 0 Physician Assistant Only Physician Services 00 1386171346 0 MUJADAD HUMA 2022283 9999999 B 10 1386171346 0 5777 DEPT CAROL STREAM IL 601228942 20 1386171346 0 Physicians Anesthesia Services 20 1386171346 0 Physicians Healthy Kids Services 20 1386171346 0 Physicians Optical Supplies 20 1386171346 0 Physicians Physician Services 00 1386171809 0 DIVELY CASEY 2017187 9999999 B 10 1386171809 0 3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047452 20 1386171809 0 Nurse Practitioners Fluoride varnish 20 1386171809 0 Nurse Practitioners Healthy Kids Services 20 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Practitioners Nurse Practitioners Services 20 1386264034 0 Nurse Practitioners Physician Services 00 1386264166 0 DONALDSON HALSIE 2020232 9999999 B 10 1386264166 0 7732 SOLUTION CTR MC 776 CHICAGO IL 606777007 20 1386264166 0 Physicians Anesthesia Services 20 1386264166 0 Physicians Healthy Kids Services 20 1386264166 0 Physicians Optical Supplies 20 1386264166 0 Physicians Physician Services 00 1386264653 0 HUANG SOPHIE 2020218 9999999 B 10 1386264653 0 543 ORCHARD ST ANTIOCH IL 600023107 20 1386264653 0 Physicians Anesthesia Services 20 1386264653 0 Physicians Fluoride varnish 20 1386264653 0 Physicians Healthy Kids Services 20 1386264653 0 Physicians Optical Supplies 20 1386264653 0 Physicians Physician Services 00 1386264943 0 ZASADA ANDREW ROBERT 2020181 9999999 B 10 1386264943 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1386264943 0 Physicians Anesthesia Services 20 1386264943 0 Physicians Fluoride varnish 20 1386264943 0 Physicians Healthy Kids Services 20 1386264943 0 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1386272060 0 Physician Assistant Only Healthy Kids Services 20 1386272060 0 Physician Assistant Only Physician Services 00 1386272086 0 BIALEK JANE 2020276 9999999 B 10 1386272086 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1386272086 0 Physicians Anesthesia Services 20 1386272086 0 Physicians Fluoride varnish 20 1386272086 0 Physicians Healthy Kids Services 20 1386272086 0 Physicians Optical Supplies 20 1386272086 0 Physicians Physician Services 00 1386272169 0 UZODI NNENNA L 2021082 9999999 B 10 1386272169 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1386272169 0 Physicians Anesthesia Services 20 1386272169 0 Physicians Fluoride varnish 20 1386272169 0 Physicians Healthy Kids Services 20 1386272169 0 Physicians Optical Supplies 20 1386272169 0 Physicians Physician Services 00 1386272383 0 TAK MIHIR 2023206 9999999 B 10 1386272383 0 PO BOX 43230 PHOENIX AZ 850803230 20 1386272383 0 Physicians Anesthesia Services 20 1386272383 0 Physicians Healthy Kids Services 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1386273621 0 Physicians Fluoride varnish 20 1386273621 0 Physicians Healthy Kids Services 20 1386273621 0 Physicians Optical Supplies 20 1386273621 0 Physicians Physician Services 00 1386273654 0 AJIBOYE FOLARANMI O 2023123 9999999 B 10 1386273654 0 PO BOX 632122 CINCINNATI OH 452632122 20 1386273654 0 Physicians Anesthesia Services 20 1386273654 0 Physicians Healthy Kids Services 20 1386273654 0 Physicians Optical Supplies 20 1386273654 0 Physicians Physician Services 00 1386273662 0 HANG ANTHONY 2020227 9999999 B 10 1386273662 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1386273662 0 Physicians Anesthesia Services 20 1386273662 0 Physicians Fluoride varnish 20 1386273662 0 Physicians Healthy Kids Services 20 1386273662 0 Physicians Optical Supplies 20 1386273662 0 Physicians Physician Services 00 1386273696 0 WACLAWSKI PAUL 2022005 9999999 B 10 1386273696 0 PO BOX 3039 OAK BROOK IL 605223039 20 1386273696 0 Physicians Anesthesia Services 20 1386273696 0 Physicians Fluoride varnish 20 1386273696 0 Physicians Healthy Kids Services 20 1386273696 0 Physicians Optical Supplies 20 1386273696 0 Physicians Physician Services 00 1386273936 0 SHAH HARSH 2022181 9999999 B 10 1386273936 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1386273936 0 Physicians Anesthesia Services 20 1386273936 0 Physicians Healthy Kids Services 20 1386273936 0 Physicians Optical Supplies 20 1386273936 0 Physicians Physician Services 00 1386273951 0 ALLEN KIMBERLY 2020219 9999999 B 10 1386273951 0 8558 BROADWAY MERRILLVILLE IN 464107032 20 1386273951 0 Physicians Anesthesia Services 20 1386273951 0 Physicians Healthy Kids Services 20 1386273951 0 Physicians Optical Supplies 20 1386273951 0 Physicians Physician Services 00 1386274017 0 NATARUS DANIELLE F 2020101 9999999 B 10 1386274017 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1386274017 0 Nurse Practitioners Fluoride varnish 20 1386274017 0 Nurse Practitioners Healthy Kids Services 20 1386274017 0 Nurse Practitioners Nurse Practitioners Services 20 1386274017 0 Nurse Practitioners Physician Services 00 1386274843 0 ORTON LISA M 2020049 9999999 B 10 1386274843 0 1102 N COUNTY ROAD 700 WARSAW IL 623793011 20 1386274843 0 Nurse Practitioners Fluoride varnish 20 1386274843 0 Nurse Practitioners Healthy Kids Services 20 1386274843 0 Nurse Practitioners Nurse Practitioners Services 20 1386274843 0 Nurse Practitioners Physician Services 00 1386276392 0 ORTIZ-RIVERA MIGUEL 2022195 9999999 B 10 1386276392 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1386276392 0 Physicians Anesthesia Services 20 1386276392 0 Physicians Healthy Kids Services 20 1386276392 0 Physicians Optical Supplies 20 1386276392 0 Physicians Physician Services 00 1386278430 0 SIMONELLI ADARA 2020239 9999999 B 10 1386278430 0 PO BOX 781076 DETROIT MI 482781076 20 1386278430 0 Physician Assistant Only Fluoride varnish 20 1386278430 0 Physician Assistant Only Healthy Kids Services 20 1386278430 0 Physician Assistant Only Physician Services 00 1386278687 0 WRIGHT JENNIFER L 2020356 9999999 B 10 1386278687 0 5777 DEPT CAROL STREAM IL 601228942 20 1386278687 0 Nurse Practitioners Healthy Kids Services 20 1386278687 0 Nurse Practitioners Nurse Practitioners Services 20 1386278687 0 Nurse Practitioners Physician Services 00 1386279677 0 YANG JENNIFER 2020108 9999999 B 10 1386279677 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1386279677 0 Physician Assistant Only Fluoride varnish 20 1386279677 0 Physician Assistant Only Healthy Kids Services 20 1386279677 0 Physician Assistant Only Physician Services 00 1386280105 0 BREWER STACI 2024095 9999999 B 10 1386280105 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1386280105 0 Nurse Practitioners Healthy Kids Services 20 1386280105 0 Nurse Practitioners Nurse Practitioners Services 20 1386280105 0 Nurse Practitioners Physician Services 00 1386280253 0 WADE GREGORY 2021218 9999999 B 10 1386280253 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1386280253 0 Nurse Practitioners Healthy Kids 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Physicians Physician Services 00 1386287597 0 SAFAEIAN NILA G 2020052 9999999 B 10 1386287597 0 5777 DEPT CAROL STREAM IL 601220021 20 1386287597 0 Nurse Practitioners Fluoride varnish 20 1386287597 0 Nurse Practitioners Healthy Kids Services 20 1386287597 0 Nurse Practitioners Nurse Practitioners Services 20 1386287597 0 Nurse Practitioners Physician Services 00 1386288660 0 TONE ERIKA 2019317 9999999 B 10 1386288660 0 29373 NETWORK PL CHICAGO IL 606733039 20 1386288660 0 Physician Assistant Only Fluoride varnish 20 1386288660 0 Physician Assistant Only Healthy Kids Services 20 1386288660 0 Physician Assistant Only Physician Services 00 1386293678 0 GRANT ERICA L 2021153 9999999 B 10 1386293678 0 5777 DEPT CAROL STREAM IL 601220021 20 1386293678 0 Nurse Practitioners Fluoride varnish 20 1386293678 0 Nurse Practitioners Healthy Kids Services 20 1386293678 0 Nurse Practitioners Nurse Practitioners Services 20 1386293678 0 Nurse Practitioners Physician Services 00 1386294197 0 SNOWDEN MADALYN M 2019256 9999999 B 10 1386294197 0 2816 BROOK CT JOLIET IL 604319227 20 1386294197 0 Occupational Therapists Medical Supplies 20 1386294197 0 Occupational Therapists Medical equipment/prosthetic devices 20 1386294197 0 Occupational Therapists Occupational Therapy Services 00 1386294262 0 BAZZI AMELIA 2022343 9999999 B 10 1386294262 0 PO BOX 772 MC2295 WOONSOCKET RI 028950784 20 1386294262 0 Nurse Practitioners Fluoride varnish 20 1386294262 0 Nurse Practitioners Healthy Kids Services 20 1386294262 0 Nurse Practitioners Nurse Practitioners Services 20 1386294262 0 Nurse Practitioners Physician Services 00 1386294817 0 BOLLIGER JOSHUA T 2019281 9999999 B 10 1386294817 0 6742 N FROSTWOOD PKWY PEORIA IL 616152402 20 1386294817 0 Nurse Practitioners Anesthesia Services 20 1386294817 0 Nurse Practitioners Nurse Practitioners Services 20 1386294817 0 Nurse Practitioners Physician Services 00 1386296606 0 NALLAPARAJU HARITHA 2019213 9999999 B 10 1386296606 0 1905 W SPRINGFIELD AVE 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Practitioners Healthy Kids Services 20 1386303139 0 Nurse Practitioners Nurse Practitioners Services 20 1386303139 0 Nurse Practitioners Physician Services 00 1386303295 0 YOUKHANA MIRIANA E 2022052 9999999 B 10 1386303295 0 3445 N CENTRAL AVE UNIT C CHICAGO IL 606344420 20 1386303295 0 Nurse Practitioners Fluoride varnish 20 1386303295 0 Nurse Practitioners Healthy Kids Services 20 1386303295 0 Nurse Practitioners Nurse Practitioners Services 20 1386303295 0 Nurse Practitioners Physician Services 00 1386304764 0 CARTER KELSEY 2022203 9999999 B 10 1386304764 0 1307 E MCCORD ST CENTRALIA IL 628013610 20 1386304764 0 Nurse Practitioners Fluoride varnish 20 1386304764 0 Nurse Practitioners Healthy Kids Services 20 1386304764 0 Nurse Practitioners Nurse Practitioners Services 20 1386304764 0 Nurse Practitioners Physician Services 00 1386305191 0 ZITO CHLOE 2023249 9999999 B 10 1386305191 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1386305191 0 Physician Assistant Only Fluoride varnish 20 1386305191 0 Physician Assistant Only Healthy Kids Services 20 1386305191 0 Physician Assistant Only Physician Services 00 1386305795 0 SCHIEK CAITLYN M 2022081 9999999 B 10 1386305795 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1386305795 0 Nurse Practitioners Healthy Kids Services 20 1386305795 0 Nurse Practitioners Nurse Practitioners Services 20 1386305795 0 Nurse Practitioners Physician Services 00 1386308534 0 PABST MARY 2024143 9999999 B 10 1386308534 0 3545 W 95TH ST EVERGREEN PARK IL 608052135 20 1386308534 0 Nurse Practitioners Healthy Kids Services 20 1386308534 0 Nurse Practitioners Nurse Practitioners Services 20 1386308534 0 Nurse Practitioners Physician Services 00 1386309912 0 SINGH KIRAN JASMINE 2024165 9999999 B 10 1386309912 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1386309912 0 Physician Assistant Only Fluoride varnish 20 1386309912 0 Physician Assistant Only Healthy Kids Services 20 1386309912 0 Physician Assistant Only Physician Services 00 1386310357 0 LANGE JENNY 2021232 9999999 H 10 1386310357 0 1721 BOUL AVE SWANSEA IL 622264254 20 1386310357 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1386310605 0 GAZDZIAK LISA 2021305 9999999 B 10 1386310605 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1386310605 0 Nurse Practitioners Fluoride varnish 20 1386310605 0 Nurse Practitioners Healthy Kids Services 20 1386310605 0 Nurse Practitioners Nurse Practitioners Services 20 1386310605 0 Nurse Practitioners Physician Services 00 1386311165 0 HEIDTMANN ASHLEY 2022042 9999999 B 10 1386311165 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1386311165 0 Speech Therapists Medical Supplies 20 1386311165 0 Speech Therapists Medical equipment/prosthetic devices 20 1386311165 0 Speech Therapists Speech Therapy/Pathology Services 00 1386311371 0 MERCADO EDGAR A 2021267 9999999 B 10 1386311371 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 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IMPACT specialties) 00 1386316164 0 SEBREE REBECCA 2025042 9999999 B 10 1386316164 0 5777 DEPT CAROL STREAM IL 601220021 20 1386316164 0 Clinical Social Worker Social work service 00 1386316206 0 ENDERLE KRISTEN M 2021294 9999999 B 10 1386316206 0 611 W PARK ST URBANA IL 618012529 20 1386316206 0 Nurse Practitioners Fluoride varnish 20 1386316206 0 Nurse Practitioners Healthy Kids Services 20 1386316206 0 Nurse Practitioners Nurse Practitioners Services 20 1386316206 0 Nurse Practitioners Physician Services 00 1386317253 0 DAILY SAMANTHA D 2025052 9999999 B 10 1386317253 0 5139 MATTIS RD STE 102 SAINT LOUIS MO 631282250 20 1386317253 0 Nurse Practitioners Fluoride varnish 20 1386317253 0 Nurse Practitioners Healthy Kids Services 20 1386317253 0 Nurse Practitioners Nurse Practitioners Services 20 1386317253 0 Nurse Practitioners Physician Services 00 1386318137 0 ABRAHAM JUSTIN 2024044 9999999 B 10 1386318137 0 111 E 4TH ST STE 440 ALTON IL 620026206 20 1386318137 0 Optometrists Optical Supplies 20 1386318137 0 Optometrists Optometric Services 20 1386318137 0 Optometrists Physician Services 00 1386318798 0 DOUGLAS KERRI 2021246 9999999 B 10 1386318798 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1386318798 0 Nurse Practitioners Healthy Kids Services 20 1386318798 0 Nurse Practitioners Nurse Practitioners Services 20 1386318798 0 Nurse Practitioners Physician Services 00 1386318947 0 KELLER JORDAN 2021301 9999999 B 10 1386318947 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1386318947 0 Nurse Practitioners Fluoride varnish 20 1386318947 0 Nurse Practitioners Healthy Kids Services 20 1386318947 0 Nurse Practitioners Nurse Practitioners Services 20 1386318947 0 Nurse Practitioners Physician Services 00 1386321438 0 CALLAHAN CAITLIN 2023187 9999999 B 10 1386321438 0 PO BOX 1109 DEKALB IL 601157109 20 1386321438 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1386322014 0 CAMACHO VANESSA 2024072 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1386323558 0 HORNE DARNISE 2024002 9999999 B 10 1386323558 0 715 LAKE ST STE 800 OAK PARK IL 603011417 20 1386323558 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1386324143 0 PATEL NISHA 2023258 9999999 B 10 1386324143 0 2235 SYCAMORE RD DEKALB IL 601152046 20 1386324143 0 Dentists Dental Services 20 1386324143 0 Dentists Physician Services 00 1386324853 0 SIDHWA ZARIR S 2024130 9999999 B 10 1386324853 0 1235 N RAND RD ARLINGTON HEIGH IL 600044314 20 1386324853 0 Dentists Dental Services 20 1386324853 0 Dentists Physician Services 00 1386326718 0 PARRISH AMANDA J 2024200 9999999 B 10 1386326718 0 1120 N MELVIN ST GIBSON CITY IL 609361477 20 1386326718 0 Nurse Practitioners Healthy Kids Services 20 1386326718 0 Nurse Practitioners Nurse Practitioners Services 20 1386326718 0 Nurse Practitioners Physician Services 00 1386328508 0 SATHYA DEBBIE A 2023202 9999999 B 10 1386328508 0 611 W PARK ST URBANA IL 618012529 20 1386328508 0 Physicians Anesthesia Services 20 1386328508 0 Physicians Fluoride varnish 20 1386328508 0 Physicians Healthy Kids Services 20 1386328508 0 Physicians Optical Supplies 20 1386328508 0 Physicians Physician Services 00 1386328524 0 AJAKAIYE GANIU J 2023269 9999999 B 10 1386328524 0 331 W SURF ST STE 708 CHICAGO IL 606577227 20 1386328524 0 Nurse Practitioners Healthy Kids Services 20 1386328524 0 Nurse Practitioners Nurse Practitioners Services 20 1386328524 0 Nurse Practitioners Physician Services 00 1386330280 0 YODER SARAH 2024249 9999999 B 10 1386330280 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1386330280 0 Nurse Practitioners Healthy Kids Services 20 1386330280 0 Nurse Practitioners Nurse Practitioners Services 20 1386330280 0 Nurse Practitioners Physician Services 00 1386330793 0 CHOL NYADOW 2023199 9999999 B 10 1386330793 0 2211 N ELSTON AVE STE 301 CHICAGO IL 606149278 20 1386330793 0 Physicians Anesthesia Services 20 1386330793 0 Physicians Fluoride varnish 20 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Physicians Anesthesia Services 20 1386334258 0 Physicians Fluoride varnish 20 1386334258 0 Physicians Healthy Kids Services 20 1386334258 0 Physicians Optical Supplies 20 1386334258 0 Physicians Physician Services 00 1386335453 0 JOHNSON JOSICA 2023276 9999999 B 10 1386335453 0 211 E LAKE ST STE 1B ADDISON IL 601012877 20 1386335453 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1386336790 0 BALTHAZORE RACHAEL 2023214 9999999 B 10 1386336790 0 5777 DEPT CAROL STREAM IL 601220021 20 1386336790 0 Nurse Practitioners Healthy Kids Services 20 1386336790 0 Nurse Practitioners Nurse Practitioners Services 20 1386336790 0 Nurse Practitioners Physician Services 00 1386337061 0 KING DANIELLE 2023208 9999999 B 10 1386337061 0 611 W PARK ST URBANA IL 618012529 20 1386337061 0 Physicians Anesthesia Services 20 1386337061 0 Physicians Healthy Kids Services 20 1386337061 0 Physicians Optical Supplies 20 1386337061 0 Physicians Physician Services 20 1386337061 0 Physicians Physicians Psychiatric Services 00 1386337418 0 MIERS COURTNEY L 2023167 9999999 B 10 1386337418 0 1200 W STATE ST ROCKFORD IL 611022112 20 1386337418 0 Dentists Dental Services 20 1386337418 0 Dentists Physician Services 00 1386339059 0 SAINT-VICTOR EUNICE 2023277 9999999 B 10 1386339059 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1386339059 0 Physicians Anesthesia Services 20 1386339059 0 Physicians Fluoride varnish 20 1386339059 0 Physicians Healthy Kids Services 20 1386339059 0 Physicians Optical Supplies 20 1386339059 0 Physicians Physician Services 00 1386340784 0 AGUIRRE-RUVALCABA ANA 2024239 9999999 B 10 1386340784 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1386340784 0 Nurse Practitioners Fluoride varnish 20 1386340784 0 Nurse Practitioners Healthy Kids Services 20 1386340784 0 Nurse Practitioners Nurse Practitioners Services 20 1386340784 0 Nurse Practitioners Physician Services 00 1386342962 0 HOU JIA 2023096 9999999 B 10 1386342962 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1386342962 0 Physicians Anesthesia Services 20 1386342962 0 Physicians Healthy Kids Services 20 1386342962 0 Physicians Optical Supplies 20 1386342962 0 Physicians Physician Services 00 1386343051 0 MAZZOLI AMANDA C 2024201 9999999 B 10 1386343051 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1386343051 0 Physicians Anesthesia Services 20 1386343051 0 Physicians Fluoride varnish 20 1386343051 0 Physicians Healthy Kids Services 20 1386343051 0 Physicians Optical Supplies 20 1386343051 0 Physicians Physician Services 00 1386346799 0 MITCHELL CRAIG 2023200 9999999 B 10 1386346799 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1386346799 0 Physicians Anesthesia Services 20 1386346799 0 Physicians Healthy Kids Services 20 1386346799 0 Physicians Optical Supplies 20 1386346799 0 Physicians Physician Services 00 1386348472 0 BHARDWAJ HIRAL 2024019 9999999 B 10 1386348472 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1386348472 0 Physicians Anesthesia Services 20 1386348472 0 Physicians Fluoride varnish 20 1386348472 0 Physicians Healthy Kids Services 20 1386348472 0 Physicians Optical Supplies 20 1386348472 0 Physicians Physician Services 00 1386349694 0 DALEY MARGARET 2023095 9999999 B 10 1386349694 0 42 W MADISON ST FL 2 CHICAGO IL 606024309 20 1386349694 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1386349884 0 ZHITNITSKY MICHAEL 2023282 9999999 B 10 1386349884 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1386349884 0 Physicians Anesthesia Services 20 1386349884 0 Physicians Healthy Kids Services 20 1386349884 0 Physicians Optical Supplies 20 1386349884 0 Physicians Physician Services 00 1386349900 0 SHARMA ARUNIMA 2023182 9999999 B 10 1386349900 0 PO BOX 3039 OAK BROOK IL 605223039 20 1386349900 0 Physicians Anesthesia Services 20 1386349900 0 Physicians Fluoride varnish 20 1386349900 0 Physicians Healthy Kids 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Physicians Anesthesia Services 20 1386489946 0 Physicians Healthy Kids Services 20 1386489946 0 Physicians Optical Supplies 20 1386489946 0 Physicians Physician Services 00 1386490597 0 GREEN DANIEL L 2024183 9999999 B 10 1386490597 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1386490597 0 Physicians Anesthesia Services 20 1386490597 0 Physicians Fluoride varnish 20 1386490597 0 Physicians Healthy Kids Services 20 1386490597 0 Physicians Optical Supplies 20 1386490597 0 Physicians Physician Services 00 1386491132 0 CORTES JOAQUIN F 2024169 9999999 B 10 1386491132 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1386491132 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1386493187 0 STALEVA PETKANA K 2024211 9999999 B 10 1386493187 0 3241 S MICHIGAN AVE CHICAGO IL 606164201 20 1386493187 0 Optometrists Optical Supplies 20 1386493187 0 Optometrists Optometric Services 20 1386493187 0 Optometrists Physician Services 00 1386493690 0 MIRANDA KRISTIN 2024296 9999999 B 10 1386493690 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1386493690 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1386493989 0 KRIKORIAN ELLA 2024281 9999999 B 10 1386493989 0 4714 GETTYSBURG RD MECHANICSBURG PA 170554325 20 1386493989 0 Speech Therapists Medical Supplies 20 1386493989 0 Speech Therapists Medical equipment/prosthetic devices 20 1386493989 0 Speech Therapists Speech Therapy/Pathology Services 00 1386494151 0 MAYER MEGAN 2024191 9999999 B 10 1386494151 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1386494151 0 Physicians Anesthesia Services 20 1386494151 0 Physicians Fluoride varnish 20 1386494151 0 Physicians Healthy Kids Services 20 1386494151 0 Physicians Optical Supplies 20 1386494151 0 Physicians Physician Services 00 1386494474 0 MASALHA AHMAD 2024164 9999999 B 10 1386494474 0 PO BOX 3039 OAK BROOK IL 605223039 20 1386494474 0 Physicians Anesthesia Services 20 1386494474 0 Physicians Healthy Kids Services 20 1386494474 0 Physicians Optical Supplies 20 1386494474 0 Physicians Physician Services 00 1386494896 0 MCPHERSON HOLLY 2024163 9999999 B 10 1386494896 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1386494896 0 Nurse Practitioners Fluoride varnish 20 1386494896 0 Nurse Practitioners Healthy Kids Services 20 1386494896 0 Nurse Practitioners Nurse Practitioners Services 20 1386494896 0 Nurse Practitioners Physician Services 00 1386494920 0 VARGHESE MEGHA M 2024179 9999999 B 10 1386494920 0 PO BOX 3039 OAK BROOK IL 605223039 20 1386494920 0 Physicians Anesthesia Services 20 1386494920 0 Physicians Fluoride varnish 20 1386494920 0 Physicians Healthy Kids Services 20 1386494920 0 Physicians Optical Supplies 20 1386494920 0 Physicians Physician Services 00 1386495695 0 CHO TIMOTHY 2024183 9999999 B 10 1386495695 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1386495695 0 Physicians Anesthesia Services 20 1386495695 0 Physicians Healthy Kids Services 20 1386495695 0 Physicians Optical Supplies 20 1386495695 0 Physicians Physician Services 00 1386495984 0 AMARQUAYE AUDREY 2024177 9999999 B 10 1386495984 0 PO BOX 3039 OAK BROOK IL 605223039 20 1386495984 0 Physicians Anesthesia Services 20 1386495984 0 Physicians Fluoride varnish 20 1386495984 0 Physicians Healthy Kids Services 20 1386495984 0 Physicians Optical Supplies 20 1386495984 0 Physicians Physician Services 00 1386498327 0 KOTHARI KRSNA 2024199 9999999 B 10 1386498327 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1386498327 0 Physicians Anesthesia Services 20 1386498327 0 Physicians Fluoride varnish 20 1386498327 0 Physicians Healthy Kids Services 20 1386498327 0 Physicians Optical Supplies 20 1386498327 0 Physicians Physician Services 00 1386499606 0 BUI TIFFANY L 2024123 9999999 B 10 1386499606 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1386499606 0 Nurse Practitioners Healthy Kids Services 20 1386499606 0 Nurse Practitioners Nurse Practitioners Services 20 1386499606 0 Nurse Practitioners Physician Services 00 1386600625 0 REDDY SUJATHA 2024211 9999999 B 10 1386600625 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1386600625 0 Physicians Anesthesia Services 20 1386600625 0 Physicians Fluoride varnish 20 1386600625 0 Physicians Healthy Kids Services 20 1386600625 0 Physicians Optical Supplies 20 1386600625 0 Physicians Physician Services 00 1386600864 0 FLECKENSTEIN JAQUELYN F 1999258 9999999 B 10 1386600864 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1386600864 0 Physicians Anesthesia Services 20 1386600864 0 Physicians Fluoride varnish 20 1386600864 0 Physicians Healthy Kids Services 20 1386600864 0 Physicians Optical Supplies 20 1386600864 0 Physicians Physician Services 00 1386601185 0 CABELIN MARK A 2016319 9999999 B 10 1386601185 0 PO BOX 889430 LOS ANGELES CA 900889430 20 1386601185 0 Physicians Anesthesia Services 20 1386601185 0 Physicians Healthy Kids Services 20 1386601185 0 Physicians Optical Supplies 20 1386601185 0 Physicians Physician Services 00 1386601508 0 BALDWIN DAVID 1986182 9999999 B 10 1386601508 0 PO BOX 781076 DETROIT MI 482781076 20 1386601508 0 Physicians Anesthesia Services 20 1386601508 0 Physicians Fluoride varnish 20 1386601508 0 Physicians Healthy Kids Services 20 1386601508 0 Physicians Optical Supplies 20 1386601508 0 Physicians Physician Services 00 1386601888 0 SALMAN NAJMUL 2021060 9999999 B 10 1386601888 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1386601888 0 Physicians Anesthesia Services 20 1386601888 0 Physicians Fluoride varnish 20 1386601888 0 Physicians Healthy Kids Services 20 1386601888 0 Physicians Optical Supplies 20 1386601888 0 Physicians Physician Services 00 1386602001 0 SIEBERG MELANIE 2020170 9999999 H 10 1386602001 0 623 E ADAMS ST SPRINGFIELD IL 627011614 20 1386602001 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1386602134 0 TAYLOR NANCY J 2016288 9999999 B 10 1386602134 0 9447 HOLY CROSS LN BREESE IL 622303510 20 1386602134 0 Nurse Practitioners Healthy Kids Services 20 1386602134 0 Nurse Practitioners Nurse Practitioners Services 20 1386602134 0 Nurse Practitioners Physician Services 00 1386602407 0 LYTOLLIS WILLIAM 2017297 9999999 B 10 1386602407 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1386602407 0 Physicians Anesthesia Services 20 1386602407 0 Physicians Fluoride varnish 20 1386602407 0 Physicians Healthy Kids Services 20 1386602407 0 Physicians Optical Supplies 20 1386602407 0 Physicians Physician Services 00 1386602431 0 QURESHI MOHAMMED 1996182 9999999 B 10 1386602431 0 1730 PARK ST STE 101 SUITE 101 NAPERVILLE IL 605631290 20 1386602431 0 Physicians Anesthesia Services 20 1386602431 0 Physicians Fluoride varnish 20 1386602431 0 Physicians Healthy Kids Services 20 1386602431 0 Physicians Optical Supplies 20 1386602431 0 Physicians Physician Services 00 1386604460 0 GREGORY MELISSA 2024317 9999999 B 10 1386604460 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1386604460 0 Physicians Anesthesia Services 20 1386604460 0 Physicians Fluoride varnish 20 1386604460 0 Physicians Healthy Kids Services 20 1386604460 0 Physicians Optical Supplies 20 1386604460 0 Physicians Physician Services 00 1386605061 0 IYENGAR NEHA 2004183 9999999 B 10 1386605061 0 126 W FIRST ST HINSDALE IL 605214013 20 1386605061 0 Physicians Anesthesia Services 20 1386605061 0 Physicians Healthy Kids Services 20 1386605061 0 Physicians Optical Supplies 20 1386605061 0 Physicians Physician Services 00 1386605525 0 KUMAR SUNITA 2003213 9999999 B 10 1386605525 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1386605525 0 Physicians Anesthesia Services 20 1386605525 0 Physicians Fluoride varnish 20 1386605525 0 Physicians Healthy Kids Services 20 1386605525 0 Physicians Optical Supplies 20 1386605525 0 Physicians Physician Services 00 1386605756 0 NEWCOMER PETER 2000106 9999999 B 10 1386605756 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1386605756 0 Physicians Anesthesia Services 20 1386605756 0 Physicians Fluoride varnish 20 1386605756 0 Physicians Healthy Kids Services 20 1386605756 0 Physicians Optical Supplies 20 1386605756 0 Physicians Physician Services 00 1386606671 0 ENGEL MICHAEL 2021274 9999999 B 10 1386606671 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1386606671 0 Physicians Anesthesia Services 20 1386606671 0 Physicians Healthy Kids Services 20 1386606671 0 Physicians Optical Supplies 20 1386606671 0 Physicians Physician Services 00 1386606689 0 SAUSKER DAVID 2017058 9999999 B 10 1386606689 0 2925 CHICAGO AVE MINNEAPOLIS MN 554071321 20 1386606689 0 Physicians Anesthesia Services 20 1386606689 0 Physicians Fluoride varnish 20 1386606689 0 Physicians Healthy Kids Services 20 1386606689 0 Physicians Optical Supplies 20 1386606689 0 Physicians Physician Services 00 1386607471 0 ROTH GARY SCOTT 1999349 9999999 B 10 1386607471 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1386607471 0 Nurse Practitioners Anesthesia Services 20 1386607471 0 Nurse Practitioners Nurse Practitioners Services 20 1386607471 0 Nurse Practitioners Physician Services 00 1386608008 0 MCINTYRE SAMUEL B 2016231 9999999 B 10 1386608008 0 1 ILLINI DR PEORIA IL 616052576 20 1386608008 0 Psychologist Psychologist service 00 1386608677 0 FEUERBACH STEPHEN P 2020030 9999999 B 10 1386608677 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1386608677 0 Physicians Anesthesia Services 20 1386608677 0 Physicians Fluoride varnish 20 1386608677 0 Physicians Healthy Kids Services 20 1386608677 0 Physicians Optical Supplies 20 1386608677 0 Physicians Physician Services 00 1386608909 0 EBERT JEROME C 1999182 9999999 B 10 1386608909 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1386608909 0 Physicians Anesthesia Services 20 1386608909 0 Physicians Healthy Kids Services 20 1386608909 0 Physicians Optical Supplies 20 1386608909 0 Physicians Physician Services 00 1386608925 0 FRIERDICH SHARON 2003091 9999999 B 10 1386608925 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1386608925 0 Nurse Practitioners Fluoride varnish 20 1386608925 0 Nurse Practitioners Healthy Kids Services 20 1386608925 0 Nurse Practitioners Nurse Practitioners Services 20 1386608925 0 Nurse Practitioners Physician Services 00 1386608966 0 HARTIG GREGORY K 1994213 9999999 B 10 1386608966 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1386608966 0 Physicians Anesthesia Services 20 1386608966 0 Physicians Healthy Kids Services 20 1386608966 0 Physicians Optical Supplies 20 1386608966 0 Physicians Physician Services 00 1386609808 0 JACKSON STEPHEN 2020357 9999999 B 10 1386609808 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1386609808 0 Physicians Anesthesia Services 20 1386609808 0 Physicians Healthy Kids Services 20 1386609808 0 Physicians Optical Supplies 20 1386609808 0 Physicians Physician Services 00 1386610087 0 GREEN BART 1996183 9999999 B 10 1386610087 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1386610087 0 Physicians Anesthesia Services 20 1386610087 0 Physicians Healthy Kids Services 20 1386610087 0 Physicians Optical Supplies 20 1386610087 0 Physicians Physician Services 00 1386610764 0 YOUNES WASSIM 2022341 9999999 B 10 1386610764 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1386610764 0 Physicians Anesthesia Services 20 1386610764 0 Physicians Fluoride varnish 20 1386610764 0 Physicians Healthy Kids Services 20 1386610764 0 Physicians Optical Supplies 20 1386610764 0 Physicians Physician Services 00 1386610871 0 BURKAT CATHY N 2003182 9999999 B 10 1386610871 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1386610871 0 Physicians Anesthesia Services 20 1386610871 0 Physicians Healthy Kids Services 20 1386610871 0 Physicians Optical Supplies 20 1386610871 0 Physicians Physician Services 00 1386611432 0 HOLMES JAY C 2024093 9999999 B 10 1386611432 0 5701 W TALAVI BLVD GLENDALE AZ 853061886 20 1386611432 0 Physicians Anesthesia Services 20 1386611432 0 Physicians Healthy Kids Services 20 1386611432 0 Physicians Optical Supplies 20 1386611432 0 Physicians Physician Services 00 1386611861 0 DAVIDSON SCOTT C 2022322 9999999 B 10 1386611861 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1386611861 0 Physicians Anesthesia Services 20 1386611861 0 Physicians Fluoride varnish 20 1386611861 0 Physicians Healthy Kids Services 20 1386611861 0 Physicians Optical Supplies 20 1386611861 0 Physicians Physician Services 00 1386612000 0 CHANG BARRY 2019175 9999999 B 10 1386612000 0 611 W PARK ST URBANA IL 618012529 20 1386612000 0 Physicians Anesthesia Services 20 1386612000 0 Physicians Healthy Kids Services 20 1386612000 0 Physicians Optical Supplies 20 1386612000 0 Physicians Physician Services 00 1386612133 0 TIEMAN BARBARA 2006053 9999999 B 10 1386612133 0 101 E MILLER RD STERLING IL 610811252 20 1386612133 0 Nurse Practitioners Fluoride varnish 20 1386612133 0 Nurse Practitioners Healthy Kids Services 20 1386612133 0 Nurse Practitioners Nurse Practitioners Services 20 1386612133 0 Nurse Practitioners Physician Services 00 1386612679 0 TYLER JEFFRY A 1992001 9999999 B 10 1386612679 0 PO BOX 14054 SAINT LOUIS MO 631784054 20 1386612679 0 Physicians Anesthesia Services 20 1386612679 0 Physicians Healthy Kids Services 20 1386612679 0 Physicians Optical Supplies 20 1386612679 0 Physicians Physician Services 00 1386612901 0 MAIERS TIMOTHY J 2005182 9999999 B 10 1386612901 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1386612901 0 Physicians Anesthesia Services 20 1386612901 0 Physicians Healthy Kids Services 20 1386612901 0 Physicians Optical Supplies 20 1386612901 0 Physicians Physician Services 00 1386613149 0 AUTERI JOSEPH 2023215 9999999 B 10 1386613149 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1386613149 0 Physicians Anesthesia Services 20 1386613149 0 Physicians Healthy Kids Services 20 1386613149 0 Physicians Optical Supplies 20 1386613149 0 Physicians Physician Services 00 1386614170 0 VANDENBERG BYRON F 1985343 9999999 B 10 1386614170 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1386614170 0 Physicians Anesthesia Services 20 1386614170 0 Physicians Fluoride varnish 20 1386614170 0 Physicians Healthy Kids Services 20 1386614170 0 Physicians Optical Supplies 20 1386614170 0 Physicians Physician Services 00 1386615607 0 MOHAMMED YOUSUF 2004183 9999999 B 10 1386615607 0 1801 W OLYMPIC BLVD PASADENA CA 911992636 20 1386615607 0 Physicians Anesthesia Services 20 1386615607 0 Physicians Fluoride varnish 20 1386615607 0 Physicians Healthy Kids Services 20 1386615607 0 Physicians Optical Supplies 20 1386615607 0 Physicians Physician Services 00 1386615664 0 BROWN IRWIN 1992336 9999999 B 10 1386615664 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1386615664 0 Physicians Anesthesia Services 20 1386615664 0 Physicians Healthy Kids Services 20 1386615664 0 Physicians Optical Supplies 20 1386615664 0 Physicians Physician Services 00 1386615904 0 AMANI EBRAHIM 1997245 9999999 B 10 1386615904 0 5777 DEPT CAROL STREAM IL 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Anesthesia Services 20 1386617223 0 Physicians Healthy Kids Services 20 1386617223 0 Physicians Optical Supplies 20 1386617223 0 Physicians Physician Services 00 1386617694 0 GOYAL SUBHASH 1985132 9999999 B 10 1386617694 0 1634 W POLK ST CHICAGO IL 606124352 20 1386617694 0 Physicians Anesthesia Services 20 1386617694 0 Physicians Healthy Kids Services 20 1386617694 0 Physicians Optical Supplies 20 1386617694 0 Physicians Physician Services 20 1386617694 0 Physicians Physicians Psychiatric Services 00 1386618429 0 BOBLICK JAMES 1988032 9999999 B 10 1386618429 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1386618429 0 Physicians Anesthesia Services 20 1386618429 0 Physicians Fluoride varnish 20 1386618429 0 Physicians Healthy Kids Services 20 1386618429 0 Physicians Optical Supplies 20 1386618429 0 Physicians Physician Services 00 1386618478 0 WESTER DAVID 2016011 9999999 B 10 1386618478 0 5777 DEPT CAROL STREAM IL 601225777 20 1386618478 0 Physician Assistant Only Fluoride 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Anesthesia Services 20 1386626844 0 Physicians Healthy Kids Services 20 1386626844 0 Physicians Optical Supplies 20 1386626844 0 Physicians Physician Services 00 1386626935 0 SAEED MOAZZAM 1996275 9999999 B 10 1386626935 0 215 REMINGTON BLVD STE B BOLINGBROOK IL 604403658 20 1386626935 0 Physicians Anesthesia Services 20 1386626935 0 Physicians Fluoride varnish 20 1386626935 0 Physicians Healthy Kids Services 20 1386626935 0 Physicians Optical Supplies 20 1386626935 0 Physicians Physician Services 00 1386627404 0 REBBE NEIL F 2016153 9999999 B 10 1386627404 0 PO BOX 503900 SAINT LOUIS MO 631503900 20 1386627404 0 Physicians Anesthesia Services 20 1386627404 0 Physicians Fluoride varnish 20 1386627404 0 Physicians Healthy Kids Services 20 1386627404 0 Physicians Optical Supplies 20 1386627404 0 Physicians Physician Services 00 1386627974 0 GUINN DEBRA 1995198 9999999 B 10 1386627974 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1386627974 0 Physicians Anesthesia Services 20 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Physician Services 00 1386634384 0 KYOBE MOSES 2018121 9999999 B 10 1386634384 0 PO BOX 268 FREEPORT IL 610320268 20 1386634384 0 Physicians Anesthesia Services 20 1386634384 0 Physicians Fluoride varnish 20 1386634384 0 Physicians Healthy Kids Services 20 1386634384 0 Physicians Optical Supplies 20 1386634384 0 Physicians Physician Services 00 1386635381 0 HAMILTON BRANDON 2022015 9999999 B 10 1386635381 0 PO BOX 43230 PHOENIX AZ 850803230 20 1386635381 0 Physicians Anesthesia Services 20 1386635381 0 Physicians Healthy Kids Services 20 1386635381 0 Physicians Optical Supplies 20 1386635381 0 Physicians Physician Services 00 1386635662 0 HENRICHS BERNADETTE M 1996066 9999999 B 10 1386635662 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1386635662 0 Nurse Practitioners Anesthesia Services 20 1386635662 0 Nurse Practitioners Nurse Practitioners Services 20 1386635662 0 Nurse Practitioners Physician Services 00 1386636009 0 MCDONALD KIM 2023341 9999999 B 10 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Services 00 1386638310 0 NORMAN JACKSON T 2001060 9999999 B 10 1386638310 0 5777 DEPT CAROL STREAM IL 601220021 20 1386638310 0 Physicians Anesthesia Services 20 1386638310 0 Physicians Healthy Kids Services 20 1386638310 0 Physicians Optical Supplies 20 1386638310 0 Physicians Physician Services 00 1386638823 0 GIRBES MINA 2004245 9999999 B 10 1386638823 0 29373 NETWORK PL CHICAGO IL 606733039 20 1386638823 0 Physicians Anesthesia Services 20 1386638823 0 Physicians Healthy Kids Services 20 1386638823 0 Physicians Optical Supplies 20 1386638823 0 Physicians Physician Services 00 1386638997 0 WEAVER CURTIS 2017002 9999999 B 10 1386638997 0 187 W IRVING PARK RD ROSELLE IL 601721119 20 1386638997 0 Optometrists Optical Supplies 20 1386638997 0 Optometrists Optometric Services 20 1386638997 0 Optometrists Physician Services 00 1386639227 0 COLAIZY TARAH 2005001 9999999 B 10 1386639227 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1386639227 0 Physicians Anesthesia Services 20 1386639227 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Physician Services 00 1386723781 0 SU GRANT 2007218 9999999 B 10 1386723781 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1386723781 0 Physicians Anesthesia Services 20 1386723781 0 Physicians Healthy Kids Services 20 1386723781 0 Physicians Optical Supplies 20 1386723781 0 Physicians Physician Services 00 1386724219 0 MCCONNELL JOHN 1988183 9999999 B 10 1386724219 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1386724219 0 Physicians Anesthesia Services 20 1386724219 0 Physicians Healthy Kids Services 20 1386724219 0 Physicians Optical Supplies 20 1386724219 0 Physicians Physician Services 00 1386724235 0 WADE JOSHUA 2016242 9999999 B 10 1386724235 0 101 E MILLER RD STERLING IL 610811252 20 1386724235 0 Physician Assistant Only Fluoride varnish 20 1386724235 0 Physician Assistant Only Healthy Kids Services 20 1386724235 0 Physician Assistant Only Physician Services 00 1386724417 0 EARLEY MARIA E 2021084 9999999 B 10 1386724417 0 1418 COLLEGE DR MOUNT CARMEL IL 628632638 20 1386724417 0 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0 Physicians Healthy Kids Services 20 1386748903 0 Physicians Optical Supplies 20 1386748903 0 Physicians Physician Services 00 1386750008 0 HILDEBRANDT JAMES 1992321 9999999 B 10 1386750008 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1386750008 0 Physicians All Kids application agent 20 1386750008 0 Physicians Anesthesia Services 20 1386750008 0 Physicians Fluoride varnish 20 1386750008 0 Physicians Healthy Kids Services 20 1386750008 0 Physicians Optical Supplies 20 1386750008 0 Physicians Physician Services 00 1386750032 0 LEAKE LEANNA 2013247 9999999 B 10 1386750032 0 100 MEDICAL DR HANNIBAL MO 634016877 20 1386750032 0 Nurse Practitioners Fluoride varnish 20 1386750032 0 Nurse Practitioners Healthy Kids Services 20 1386750032 0 Nurse Practitioners Nurse Practitioners Services 20 1386750032 0 Nurse Practitioners Physician Services 00 1386750404 0 DEATON ROBERT W 2007182 9999999 B 10 1386750404 0 510 LINCOLN DR HERRIN IL 629486334 20 1386750404 0 Nurse Practitioners Healthy Kids 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43230 PHOENIX AZ 850803230 20 1386752962 0 Physicians Anesthesia Services 20 1386752962 0 Physicians Fluoride varnish 20 1386752962 0 Physicians Healthy Kids Services 20 1386752962 0 Physicians Optical Supplies 20 1386752962 0 Physicians Physician Services 00 1386753226 0 VASILEVICH DIANE 2000220 9999999 B 10 1386753226 0 6036 N OLYMPIA AVE CHICAGO IL 606313847 20 1386753226 0 Speech Therapists Medical Supplies 20 1386753226 0 Speech Therapists Medical equipment/prosthetic devices 20 1386753226 0 Speech Therapists Speech Therapy/Pathology Services 00 1386755197 0 LEVI MICHAEL S 1990001 9999999 B 10 1386755197 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1386755197 0 Physicians Anesthesia Services 20 1386755197 0 Physicians Fluoride varnish 20 1386755197 0 Physicians Healthy Kids Services 20 1386755197 0 Physicians Optical Supplies 20 1386755197 0 Physicians Physician Services 00 1386755486 0 NORDLI DOUGLAS 2001035 9999999 B 10 1386755486 0 150 HARVESTER DR STE 300 BURR RIDGE IL 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1386755973 0 1900 STATE ST CHESTER IL 622331116 20 1386755973 0 Physicians Anesthesia Services 20 1386755973 0 Physicians Fluoride varnish 20 1386755973 0 Physicians Healthy Kids Services 20 1386755973 0 Physicians Optical Supplies 20 1386755973 0 Physicians Physician Services 00 1386757565 0 TAX AMY 2002121 9999999 B 10 1386757565 0 5777 DEPT CAROL STREAM IL 601220021 20 1386757565 0 Nurse Practitioners Anesthesia Services 20 1386757565 0 Nurse Practitioners Nurse Practitioners Services 20 1386757565 0 Nurse Practitioners Physician Services 00 1386757581 0 MALKO MAREK 2002194 9999999 B 10 1386757581 0 5600 W ADDISON ST LOWR 1LL SUITE LL001 CHICAGO IL 606344444 20 1386757581 0 Physicians Anesthesia Services 20 1386757581 0 Physicians Fluoride varnish 20 1386757581 0 Physicians Healthy Kids Services 20 1386757581 0 Physicians Optical Supplies 20 1386757581 0 Physicians Physician Services 00 1386758266 0 SACHS DAVID 2016081 9999999 B 10 1386758266 0 1050 COUNTRY CLUB RD UNIT 386 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Supplies 20 1386800688 0 Physicians Physician Services 00 1386800746 0 CHIMINO JOSEPH M 2010182 9999999 B 10 1386800746 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1386800746 0 Physicians Anesthesia Services 20 1386800746 0 Physicians Fluoride varnish 20 1386800746 0 Physicians Healthy Kids Services 20 1386800746 0 Physicians Optical Supplies 20 1386800746 0 Physicians Physician Services 00 1386800902 0 PARRELLA NAOMI I 2010244 9999999 B 10 1386800902 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1386800902 0 Physicians Anesthesia Services 20 1386800902 0 Physicians Fluoride varnish 20 1386800902 0 Physicians Healthy Kids Services 20 1386800902 0 Physicians Optical Supplies 20 1386800902 0 Physicians Physician Services 00 1386800985 0 DAVIS CHRISTOPHER 2016183 9999999 B 10 1386800985 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1386800985 0 Physicians Anesthesia Services 20 1386800985 0 Physicians Healthy Kids Services 20 1386800985 0 Physicians Optical Supplies 20 1386800985 0 Physicians Physician Services 00 1386801199 0 RAJZER-WAKEHAM KARI 2020183 9999999 B 10 1386801199 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1386801199 0 Nurse Practitioners Fluoride varnish 20 1386801199 0 Nurse Practitioners Healthy Kids Services 20 1386801199 0 Nurse Practitioners Nurse Practitioners Services 20 1386801199 0 Nurse Practitioners Physician Services 00 1386801488 0 NARLA VENKATA 2021221 9999999 B 10 1386801488 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1386801488 0 Physicians Anesthesia Services 20 1386801488 0 Physicians Fluoride varnish 20 1386801488 0 Physicians Healthy Kids Services 20 1386801488 0 Physicians Optical Supplies 20 1386801488 0 Physicians Physician Services 00 1386801504 0 RILEY STEPHANIE L 2017001 9999999 B 10 1386801504 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1386801504 0 Physicians Anesthesia Services 20 1386801504 0 Physicians Healthy Kids Services 20 1386801504 0 Physicians Optical Supplies 20 1386801504 0 Physicians Physician Services 00 1386801751 0 DIVAKARUNI NAVEEN 2013224 9999999 B 10 1386801751 0 28594 NETWORK PL CHICAGO IL 606731285 20 1386801751 0 Physicians Anesthesia Services 20 1386801751 0 Physicians Healthy Kids Services 20 1386801751 0 Physicians Optical Supplies 20 1386801751 0 Physicians Physician Services 00 1386802312 0 PUNCH GREGORY E 2021132 9999999 B 10 1386802312 0 210 W WALNUT ST CANTON IL 615202444 20 1386802312 0 Physicians Anesthesia Services 20 1386802312 0 Physicians Healthy Kids Services 20 1386802312 0 Physicians Optical Supplies 20 1386802312 0 Physicians Physician Services 00 1386802387 0 FULKERSON DANIEL 2010182 9999999 B 10 1386802387 0 702 BARNHILL DR SUITE 1134 INDIANAPOLIS IN 462025128 20 1386802387 0 Physicians Anesthesia Services 20 1386802387 0 Physicians Healthy Kids Services 20 1386802387 0 Physicians Optical Supplies 20 1386802387 0 Physicians Physician Services 00 1386803187 0 MOKADEM MOHAMAD A 2014218 9999999 B 10 1386803187 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1386803187 0 Physicians Anesthesia Services 20 1386803187 0 Physicians Healthy Kids Services 20 1386803187 0 Physicians Optical Supplies 20 1386803187 0 Physicians Physician Services 00 1386804987 0 BERTRAND TODD 2017060 9999999 B 10 1386804987 0 550 UNIVERSITY BLVD INDIANAPOLIS IN 462025149 20 1386804987 0 Physicians Anesthesia Services 20 1386804987 0 Physicians Healthy Kids Services 20 1386804987 0 Physicians Optical Supplies 20 1386804987 0 Physicians Physician Services 00 1386805240 0 SILVIERA MATTHEW 2013182 9999999 B 10 1386805240 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1386805240 0 Physicians Anesthesia Services 20 1386805240 0 Physicians Healthy Kids Services 20 1386805240 0 Physicians Optical Supplies 20 1386805240 0 Physicians Physician Services 00 1386805307 0 COOK VIVIAN C 2009313 9999999 B 10 1386805307 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1386805307 0 Physicians Anesthesia Services 20 1386805307 0 Physicians Fluoride varnish 20 1386805307 0 Physicians Healthy Kids Services 20 1386805307 0 Physicians Optical Supplies 20 1386805307 0 Physicians Physician Services 00 1386805612 0 VELLANKI KAVITHA 2009196 9999999 B 10 1386805612 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1386805612 0 Physicians Anesthesia Services 20 1386805612 0 Physicians Fluoride varnish 20 1386805612 0 Physicians Healthy Kids Services 20 1386805612 0 Physicians Optical Supplies 20 1386805612 0 Physicians Physician Services 00 1386806115 0 AGRAWAL DIVYA 2017166 9999999 B 10 1386806115 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1386806115 0 Physicians Anesthesia Services 20 1386806115 0 Physicians Healthy Kids Services 20 1386806115 0 Physicians Optical Supplies 20 1386806115 0 Physicians Physician Services 00 1386806222 0 CHOW CHIEN HSIANG 2023261 9999999 B 10 1386806222 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1386806222 0 Physicians Anesthesia Services 20 1386806222 0 Physicians Healthy Kids Services 20 1386806222 0 Physicians Optical Supplies 20 1386806222 0 Physicians Physician Services 00 1386806354 0 GATLIN JULIANNE J 2011213 9999999 B 10 1386806354 0 PO BOX 713388 CHICAGO IL 606771525 20 1386806354 0 Physicians Anesthesia Services 20 1386806354 0 Physicians Fluoride varnish 20 1386806354 0 Physicians Healthy Kids Services 20 1386806354 0 Physicians Optical Supplies 20 1386806354 0 Physicians Physician Services 00 1386806453 0 ONWUAMEZE OBIORA 2012184 9999999 B 10 1386806453 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1386806453 0 Physicians Anesthesia Services 20 1386806453 0 Physicians Healthy Kids Services 20 1386806453 0 Physicians Optical Supplies 20 1386806453 0 Physicians Physician Services 20 1386806453 0 Physicians Physicians Psychiatric Services 00 1386807691 0 DUX KATHERINE 2010182 9999999 B 10 1386807691 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1386807691 0 Podiatrists Podiatric Services 00 1386807816 0 SAWLANI SARENA 2015001 9999999 B 10 1386807816 0 7447 W TALCOTT AVE STE 308 CHICAGO IL 606313714 20 1386807816 0 Physicians Anesthesia Services 20 1386807816 0 Physicians Healthy Kids Services 20 1386807816 0 Physicians Optical Supplies 20 1386807816 0 Physicians Physician Services 00 1386808731 0 HAWKINS DEANA L 2008253 9999999 B 10 1386808731 0 1118 COUNTY ROAD 2100 E FAIRFIELD IL 628373124 20 1386808731 0 Occupational Therapists Medical Supplies 20 1386808731 0 Occupational Therapists Medical equipment/prosthetic devices 20 1386808731 0 Occupational Therapists Occupational Therapy Services 00 1386808798 0 ALUR RAM S 2023191 9999999 B 10 1386808798 0 1400 US HIGHWAY 61 FESTUS MO 630284100 20 1386808798 0 Physicians Anesthesia Services 20 1386808798 0 Physicians Fluoride varnish 20 1386808798 0 Physicians Healthy Kids Services 20 1386808798 0 Physicians Optical Supplies 20 1386808798 0 Physicians Physician Services 00 1386808913 0 GRZELAK MICHAEL E 2010244 9999999 B 10 1386808913 0 5777 DEPT CAROL STREAM IL 601228942 20 1386808913 0 Physicians Anesthesia Services 20 1386808913 0 Physicians Fluoride varnish 20 1386808913 0 Physicians Healthy Kids Services 20 1386808913 0 Physicians Optical Supplies 20 1386808913 0 Physicians Physician Services 00 1386809200 0 PELES SHACHAR 2011182 9999999 B 10 1386809200 0 202 S PARK ST MADISON WI 537151507 20 1386809200 0 Physicians Anesthesia Services 20 1386809200 0 Physicians Fluoride varnish 20 1386809200 0 Physicians Healthy Kids Services 20 1386809200 0 Physicians Optical Supplies 20 1386809200 0 Physicians Physician Services 00 1386809374 0 KOWALSKI HEATHER R 2014274 9999999 B 10 1386809374 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1386809374 0 Physicians Anesthesia Services 20 1386809374 0 Physicians Healthy Kids Services 20 1386809374 0 Physicians Optical Supplies 20 1386809374 0 Physicians Physician Services 00 1386809440 0 MULICK MICHAEL 2025055 9999999 B 10 1386809440 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1386809440 0 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2005335 9999999 B 10 1386814440 0 609 S ROUTE 59 AURORA IL 605048169 20 1386814440 0 Dentists Dental Services 20 1386814440 0 Dentists Physician Services 00 1386815504 0 SCHRIEDEL ADAM 2008189 9999999 B 10 1386815504 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1386815504 0 Physicians Anesthesia Services 20 1386815504 0 Physicians Fluoride varnish 20 1386815504 0 Physicians Healthy Kids Services 20 1386815504 0 Physicians Optical Supplies 20 1386815504 0 Physicians Physician Services 00 1386816130 0 BRICKLER JENNIFER L 2012153 9999999 B 10 1386816130 0 10176 CORPORATE SQUARE DR STE SAINT LOUIS MO 631322924 20 1386816130 0 Nurse Practitioners Healthy Kids Services 20 1386816130 0 Nurse Practitioners Nurse Practitioners Services 20 1386816130 0 Nurse Practitioners Physician Services 00 1386817468 0 BROWN MICHAEL C 2024100 9999999 B 10 1386817468 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1386817468 0 Physicians Anesthesia Services 20 1386817468 0 Physicians Fluoride 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1386830156 0 SCHWAB LISA M 2015001 9999999 B 10 1386830156 0 4211 N PROSPECT RD PEORIA HEIGHTS IL 616167754 20 1386830156 0 Other behavior health professional LCPC/LMFT services 00 1386830222 0 TYE GRACE A 2016204 9999999 B 10 1386830222 0 3249 OAK PARK AVE BERWYN IL 604023429 20 1386830222 0 Physicians Anesthesia Services 20 1386830222 0 Physicians Healthy Kids Services 20 1386830222 0 Physicians Optical Supplies 20 1386830222 0 Physicians Physician Services 00 1386831212 0 RANGEL YADIRA 2007227 9999999 B 10 1386831212 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1386831212 0 Nurse Practitioners Healthy Kids Services 20 1386831212 0 Nurse Practitioners Nurse Practitioners Services 20 1386831212 0 Nurse Practitioners Physician Services 00 1386831527 0 TOWER RICHARD T 2007274 9999999 B 10 1386831527 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1386831527 0 Physicians Anesthesia Services 20 1386831527 0 Physicians Fluoride varnish 20 1386831527 0 Physicians Healthy Kids 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Physicians Physician Services 00 1386834901 0 NAVA BAHENA RUBEN G 2018130 9999999 B 10 1386834901 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1386834901 0 Physicians Anesthesia Services 20 1386834901 0 Physicians Healthy Kids Services 20 1386834901 0 Physicians Optical Supplies 20 1386834901 0 Physicians Physician Services 00 1386834927 0 DOBRINICK AMY 2007221 9999999 B 10 1386834927 0 PO BOX 557 DECATUR IL 625250557 20 1386834927 0 Nurse Practitioners Anesthesia Services 20 1386834927 0 Nurse Practitioners Nurse Practitioners Services 20 1386834927 0 Nurse Practitioners Physician Services 00 1386835528 0 DADOURIAN VAROUJAN 1985060 9999999 B 10 1386835528 0 1103 CENTRAL AVE WILMETTE IL 600912611 20 1386835528 0 Dentists Dental Services 20 1386835528 0 Dentists Physician Services 00 1386835585 0 FOWLER JUSTIN 2022013 9999999 B 10 1386835585 0 PO BOX 889430 LOS ANGELES CA 900889430 20 1386835585 0 Physicians Anesthesia Services 20 1386835585 0 Physicians Healthy Kids Services 20 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1386838399 0 621 S ILLINOIS AVE STE 103 MASON CITY IA 504015489 20 1386838399 0 Physicians Anesthesia Services 20 1386838399 0 Physicians Fluoride varnish 20 1386838399 0 Physicians Healthy Kids Services 20 1386838399 0 Physicians Optical Supplies 20 1386838399 0 Physicians Physician Services 00 1386838506 0 BEIERMANN GREGORY J 2007091 9999999 B 10 1386838506 0 PO BOX 570 LAKE FOREST IL 600450570 20 1386838506 0 Nurse Practitioners Anesthesia Services 20 1386838506 0 Nurse Practitioners Nurse Practitioners Services 20 1386838506 0 Nurse Practitioners Physician Services 00 1386839389 0 VANDELOO CATRINA 2011021 9999999 B 10 1386839389 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1386839389 0 Nurse Practitioners Fluoride varnish 20 1386839389 0 Nurse Practitioners Healthy Kids Services 20 1386839389 0 Nurse Practitioners Nurse Practitioners Services 20 1386839389 0 Nurse Practitioners Physician Services 00 1386840148 0 KHEDKAR RAO SHEETAL 2010182 9999999 B 10 1386840148 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1386840148 0 Physicians Anesthesia Services 20 1386840148 0 Physicians Fluoride varnish 20 1386840148 0 Physicians Healthy Kids Services 20 1386840148 0 Physicians Optical Supplies 20 1386840148 0 Physicians Physician Services 00 1386840304 0 KERR SCOTT M 2010182 9999999 B 10 1386840304 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1386840304 0 Physicians Anesthesia Services 20 1386840304 0 Physicians Healthy Kids Services 20 1386840304 0 Physicians Optical Supplies 20 1386840304 0 Physicians Physician Services 00 1386840395 0 ZAVELSKY OLGA 2007121 9999999 B 10 1386840395 0 307 S EVERGREEN AVE WOODBURY NJ 080962739 20 1386840395 0 Physicians Anesthesia Services 20 1386840395 0 Physicians Healthy Kids Services 20 1386840395 0 Physicians Optical Supplies 20 1386840395 0 Physicians Physician Services 00 1386840585 0 METZLOFF KIMBERLEY 2007149 9999999 B 10 1386840585 0 124 SW ADAMS ST PEORIA IL 616021308 20 1386840585 0 Physical Therapists 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1386841211 0 Physicians Healthy Kids Services 20 1386841211 0 Physicians Optical Supplies 20 1386841211 0 Physicians Physician Services 00 1386841260 0 CHOI JANET RHIM 2012240 9999999 B 10 1386841260 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1386841260 0 Physicians Anesthesia Services 20 1386841260 0 Physicians Healthy Kids Services 20 1386841260 0 Physicians Optical Supplies 20 1386841260 0 Physicians Physician Services 20 1386841260 0 Physicians Physicians Psychiatric Services 00 1386841757 0 KAHLE EDEN 2022062 9999999 B 10 1386841757 0 100 E PENN SQ FL 9 PHILADELPHIA PA 191073377 20 1386841757 0 Physicians Anesthesia Services 20 1386841757 0 Physicians Fluoride varnish 20 1386841757 0 Physicians Healthy Kids Services 20 1386841757 0 Physicians Optical Supplies 20 1386841757 0 Physicians Physician Services 00 1386841799 0 RAGHUVIR RASHMI 2007253 9999999 B 10 1386841799 0 28592 NETWORK PL CHICAGO IL 606731285 20 1386841799 0 Physicians Anesthesia Services 20 1386841799 0 Physicians Fluoride varnish 20 1386841799 0 Physicians Healthy Kids Services 20 1386841799 0 Physicians Optical Supplies 20 1386841799 0 Physicians Physician Services 00 1386842557 0 CHIANG LO-KU 2007213 9999999 B 10 1386842557 0 2500 W HIGGINS RD STE 505 HOFFMAN ESTATES IL 601692045 20 1386842557 0 Physicians Anesthesia Services 20 1386842557 0 Physicians Fluoride varnish 20 1386842557 0 Physicians Healthy Kids Services 20 1386842557 0 Physicians Optical Supplies 20 1386842557 0 Physicians Physician Services 00 1386842706 0 FUNARI BRYAN 2022153 9999999 B 10 1386842706 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1386842706 0 Physicians Anesthesia Services 20 1386842706 0 Physicians Fluoride varnish 20 1386842706 0 Physicians Healthy Kids Services 20 1386842706 0 Physicians Optical Supplies 20 1386842706 0 Physicians Physician Services 00 1386843191 0 DAVIS SLATE MOLLY A 2021298 9999999 B 10 1386843191 0 PO BOX 110429 AURORA CO 800420429 20 1386843191 0 Physicians Anesthesia Services 20 1386843191 0 Physicians Fluoride varnish 20 1386843191 0 Physicians Healthy Kids Services 20 1386843191 0 Physicians Optical Supplies 20 1386843191 0 Physicians Physician Services 00 1386843332 0 PARCHURI HIMA 2024198 9999999 B 10 1386843332 0 119 S WESTERN AVE UNIT 1 CHICAGO IL 606124644 20 1386843332 0 Physicians Anesthesia Services 20 1386843332 0 Physicians Fluoride varnish 20 1386843332 0 Physicians Healthy Kids Services 20 1386843332 0 Physicians Optical Supplies 20 1386843332 0 Physicians Physician Services 00 1386845246 0 SILVELA BACALING BRIDGID 2007111 9999999 B 10 1386845246 0 5777 DEPT CAROL STREAM IL 601220021 20 1386845246 0 Nurse Practitioners Healthy Kids Services 20 1386845246 0 Nurse Practitioners Nurse Practitioners Services 20 1386845246 0 Nurse Practitioners Physician Services 00 1386845808 0 ZAPATA SUSANNE G 2021219 9999999 B 10 1386845808 0 250 W 96TH ST STE 520 INDIANAPOLIS IN 462601317 20 1386845808 0 Physical Therapists Medical Supplies 20 1386845808 0 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SHIN THOMAS 2008183 9999999 B 10 1386852010 0 901 MACARTHUR BLVD MUNSTER IN 463212901 20 1386852010 0 Physicians Anesthesia Services 20 1386852010 0 Physicians Healthy Kids Services 20 1386852010 0 Physicians Optical Supplies 20 1386852010 0 Physicians Physician Services 00 1386852077 0 FERN STEPHEN E 2010121 9999999 B 10 1386852077 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1386852077 0 Physicians Anesthesia Services 20 1386852077 0 Physicians Healthy Kids Services 20 1386852077 0 Physicians Optical Supplies 20 1386852077 0 Physicians Physician Services 00 1386853471 0 WOJNARSKI AGNES 2009229 9999999 B 10 1386853471 0 5140 N CALIFORNIA AVE STE 575 CHICAGO IL 606257065 20 1386853471 0 Physicians Anesthesia Services 20 1386853471 0 Physicians Fluoride varnish 20 1386853471 0 Physicians Healthy Kids Services 20 1386853471 0 Physicians Optical Supplies 20 1386853471 0 Physicians Physician Services 00 1386856490 0 ROGERS EMILY L 2008308 9999999 B 10 1386856490 0 2550 CHARLES ST ROCKFORD IL 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2007182 9999999 B 10 1386862639 0 75 REMITTANCE DR DEPT 1620 SUITE 1620 CHICAGO IL 606751620 20 1386862639 0 Physicians Anesthesia Services 20 1386862639 0 Physicians Healthy Kids Services 20 1386862639 0 Physicians Optical Supplies 20 1386862639 0 Physicians Physician Services 00 1386865046 0 BUCKALEW ANGELA J 2013136 9999999 B 10 1386865046 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1386865046 0 Nurse Practitioners Anesthesia Services 20 1386865046 0 Nurse Practitioners Nurse Practitioners Services 20 1386865046 0 Nurse Practitioners Physician Services 00 1386865244 0 KHOKHAR OMAR 2010291 9999999 B 10 1386865244 0 221 NE GLEN OAK AVE PEORIA IL 616360002 20 1386865244 0 Physicians Anesthesia Services 20 1386865244 0 Physicians Fluoride varnish 20 1386865244 0 Physicians Healthy Kids Services 20 1386865244 0 Physicians Optical Supplies 20 1386865244 0 Physicians Physician Services 00 1386865426 0 STRENGE BRANDON 2010007 9999999 B 10 1386865426 0 200 CLINT HILL BLVD PADUCAH KY 420016768 20 1386865426 0 Physicians Anesthesia Services 20 1386865426 0 Physicians Healthy Kids Services 20 1386865426 0 Physicians Optical Supplies 20 1386865426 0 Physicians Physician Services 00 1386865822 0 ISHIYAMA TAKAAKI 2008246 9999999 B 10 1386865822 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1386865822 0 Physicians Anesthesia Services 20 1386865822 0 Physicians Fluoride varnish 20 1386865822 0 Physicians Healthy Kids Services 20 1386865822 0 Physicians Optical Supplies 20 1386865822 0 Physicians Physician Services 00 1386866333 0 MILLER CHAD 2015183 9999999 B 10 1386866333 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1386866333 0 Physicians Anesthesia Services 20 1386866333 0 Physicians Fluoride varnish 20 1386866333 0 Physicians Healthy Kids Services 20 1386866333 0 Physicians Optical Supplies 20 1386866333 0 Physicians Physician Services 00 1386866853 0 KUMAR RAMAN 2019116 9999999 B 10 1386866853 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1386866853 0 Physicians Anesthesia Services 20 1386866853 0 Physicians Healthy Kids Services 20 1386866853 0 Physicians Optical Supplies 20 1386866853 0 Physicians Physician Services 00 1386867208 0 LIMOSNERO TEOFILO N 1992336 9999999 B 10 1386867208 0 4025 N SHERIDAN RD CHICAGO IL 606132010 20 1386867208 0 Dentists Dental Services 20 1386867208 0 Dentists Physician Services 00 1386867232 0 ZBYTEK BLAZEJ 2020321 9999999 B 10 1386867232 0 3495 HACKS CROSS RD MEMPHIS TN 381258803 20 1386867232 0 Physicians Anesthesia Services 20 1386867232 0 Physicians Healthy Kids Services 20 1386867232 0 Physicians Optical Supplies 20 1386867232 0 Physicians Physician Services 00 1386868826 0 REYES HERNAN S 2007227 9999999 B 10 1386868826 0 5610 W CERMAK RD UNIT 2 CICERO IL 608042219 20 1386868826 0 Physicians Anesthesia Services 20 1386868826 0 Physicians Fluoride varnish 20 1386868826 0 Physicians Healthy Kids Services 20 1386868826 0 Physicians Optical Supplies 20 1386868826 0 Physicians Physician Services 00 1386869287 0 MORAN DANIEL 1981258 9999999 B 10 1386869287 0 300 S MCLEAN BLVD STE M ELGIN IL 601231023 20 1386869287 0 Dentists Dental Services 20 1386869287 0 Dentists Physician Services 00 1386870046 0 SPERRY CHRISTOPHER LYNN 2017250 9999999 B 10 1386870046 0 2200 JEFFERSON AVE TOLEDO OH 436047101 20 1386870046 0 Physicians Anesthesia Services 20 1386870046 0 Physicians Fluoride varnish 20 1386870046 0 Physicians Healthy Kids Services 20 1386870046 0 Physicians Optical Supplies 20 1386870046 0 Physicians Physician Services 00 1386870483 0 CRAMER ELIZABETH 2012233 9999999 B 10 1386870483 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1386870483 0 Physicians Anesthesia Services 20 1386870483 0 Physicians Healthy Kids Services 20 1386870483 0 Physicians Optical Supplies 20 1386870483 0 Physicians Physician Services 00 1386871069 0 SAINT LINDSEY LEIGH 2018211 9999999 B 10 1386871069 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1386871069 0 Physicians Anesthesia Services 20 1386871069 0 Physicians Healthy Kids Services 20 1386871069 0 Physicians Optical Supplies 20 1386871069 0 Physicians Physician Services 00 1386871325 0 POULOS ELIJAH M 2020275 9999999 B 10 1386871325 0 PO BOX 967 FLAGSTAFF AZ 860020967 20 1386871325 0 Physicians Anesthesia Services 20 1386871325 0 Physicians Fluoride varnish 20 1386871325 0 Physicians Healthy Kids Services 20 1386871325 0 Physicians Optical Supplies 20 1386871325 0 Physicians Physician Services 00 1386871473 0 GELLER DREW 2014307 9999999 B 10 1386871473 0 515 22ND AVE MONROE WI 535661569 20 1386871473 0 Physicians Anesthesia Services 20 1386871473 0 Physicians Fluoride varnish 20 1386871473 0 Physicians Healthy Kids Services 20 1386871473 0 Physicians Optical Supplies 20 1386871473 0 Physicians Physician Services 00 1386871689 0 MARCUS JENNA Z 2021286 9999999 B 10 1386871689 0 5777 DEPT CAROL STREAM IL 601220021 20 1386871689 0 Physicians Anesthesia Services 20 1386871689 0 Physicians Healthy Kids Services 20 1386871689 0 Physicians Optical Supplies 20 1386871689 0 Physicians Physician Services 00 1386871721 0 STEELE MARISSA 2016332 9999999 B 10 1386871721 0 440 STEVENS AVE STE 150 SOLANA BEACH CA 920752058 20 1386871721 0 Physicians Anesthesia Services 20 1386871721 0 Physicians Fluoride varnish 20 1386871721 0 Physicians Healthy Kids Services 20 1386871721 0 Physicians Optical Supplies 20 1386871721 0 Physicians Physician Services 00 1386872166 0 POPP NIKI L 2014297 9999999 B 10 1386872166 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1386872166 0 Physicians Anesthesia Services 20 1386872166 0 Physicians Healthy Kids Services 20 1386872166 0 Physicians Optical Supplies 20 1386872166 0 Physicians Physician Services 00 1386872307 0 THOMAS MICHAEL 2016200 9999999 B 10 1386872307 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1386872307 0 Physicians Anesthesia Services 20 1386872307 0 Physicians Healthy Kids Services 20 1386872307 0 Physicians Optical Supplies 20 1386872307 0 Physicians Physician Services 00 1386873248 0 SHEA JORI L 2000365 9999999 B 10 1386873248 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1386873248 0 Physical Therapists Medical Supplies 20 1386873248 0 Physical Therapists Medical equipment/prosthetic devices 20 1386873248 0 Physical Therapists Physical Therapy Services 00 1386873537 0 SARRAFF LILLIANE M 2017335 9999999 B 10 1386873537 0 PO BOX 110429 AURORA CO 800420429 20 1386873537 0 Physicians Anesthesia Services 20 1386873537 0 Physicians Healthy Kids Services 20 1386873537 0 Physicians Optical Supplies 20 1386873537 0 Physicians Physician Services 00 1386873883 0 ARUCHAMY SENTHIL K 2020219 9999999 B 10 1386873883 0 15740 S OUTER 40 RD CHESTERFIELD MO 630172004 20 1386873883 0 Physicians Anesthesia Services 20 1386873883 0 Physicians Fluoride varnish 20 1386873883 0 Physicians Healthy Kids Services 20 1386873883 0 Physicians Optical Supplies 20 1386873883 0 Physicians Physician Services 00 1386874022 0 MCALLISTER MICHAEL J 2017139 9999999 B 10 1386874022 0 29980 NETWORK PL CHICAGO IL 606731299 20 1386874022 0 Physicians Anesthesia Services 20 1386874022 0 Physicians Healthy Kids Services 20 1386874022 0 Physicians Optical Supplies 20 1386874022 0 Physicians Physician Services 00 1386874501 0 LHOTAK MARY 2017213 9999999 B 10 1386874501 0 2835 N SHEFFIELD AVE STE 401 SUITE 401 CHICAGO IL 606575084 20 1386874501 0 Physical Therapists Medical Supplies 20 1386874501 0 Physical Therapists Medical equipment/prosthetic devices 20 1386874501 0 Physical Therapists Physical Therapy Services 00 1386875375 0 RAFI RENE 2009243 9999999 B 10 1386875375 0 29373 NETWORK PL CHICAGO IL 606733039 20 1386875375 0 Nurse Practitioners Anesthesia Services 20 1386875375 0 Nurse Practitioners Nurse Practitioners Services 20 1386875375 0 Nurse Practitioners Physician Services 00 1386875680 0 HAYDEN LAURA A 2016022 9999999 B 10 1386875680 0 611 W PARK ST URBANA IL 618012529 20 1386875680 0 Physician Assistant Only Fluoride varnish 20 1386875680 0 Physician Assistant Only Healthy Kids Services 20 1386875680 0 Physician Assistant Only Physician Services 00 1386877504 0 CHABEZ STEPHANIE 2009244 9999999 B 10 1386877504 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1386877504 0 Audiologists Audiology Services 20 1386877504 0 Audiologists Medical Supplies 20 1386877504 0 Audiologists Medical equipment/prosthetic devices 00 1386878742 0 DROBISH JULIE K 2016214 9999999 B 10 1386878742 0 PO BOX 8500 LOCKBOX #7642 PHILADELPHIA PA 191787642 20 1386878742 0 Physicians Anesthesia Services 20 1386878742 0 Physicians Healthy Kids Services 20 1386878742 0 Physicians Optical Supplies 20 1386878742 0 Physicians Physician Services 00 1386881688 0 ALSHOBAKI MANSOUR 2011213 9999999 B 10 1386881688 0 11 SORRENTO DR PALOS HEIGHTS IL 604631752 20 1386881688 0 Physicians Anesthesia Services 20 1386881688 0 Physicians Fluoride varnish 20 1386881688 0 Physicians Healthy Kids Services 20 1386881688 0 Physicians Optical Supplies 20 1386881688 0 Physicians Physician Services 00 1386881902 0 PHEREZ FRANCISCO M 2020245 9999999 B 10 1386881902 0 10004 KENNERLY RD STE 392B SAINT LOUIS MO 631282190 20 1386881902 0 Physicians Anesthesia Services 20 1386881902 0 Physicians Fluoride varnish 20 1386881902 0 Physicians Healthy Kids Services 20 1386881902 0 Physicians Optical Supplies 20 1386881902 0 Physicians Physician Services 00 1386883130 0 BAYNES NUTASHIA SLANCIE 2016262 9999999 B 10 1386883130 0 850 E HIGGINS RD STE 125E SCHAUMBURG IL 601734788 20 1386883130 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1386883593 0 DIETZ GREGORY M 2009041 9999999 B 10 1386883593 0 314 SUSAN DR NORMAL IL 617616206 20 1386883593 0 Dentists Dental Services 20 1386883593 0 Dentists Physician Services 00 1386884302 0 WEIHE ELIZABETH K 2015354 9999999 B 10 1386884302 0 FILE 57326 LOS ANGELES CA 900740001 20 1386884302 0 Physicians Anesthesia Services 20 1386884302 0 Physicians Healthy Kids Services 20 1386884302 0 Physicians Optical Supplies 20 1386884302 0 Physicians Physician Services 00 1386885317 0 VULJAJ NIKOLA 2022309 9999999 B 10 1386885317 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1386885317 0 Physicians Anesthesia Services 20 1386885317 0 Physicians Healthy Kids Services 20 1386885317 0 Physicians Optical Supplies 20 1386885317 0 Physicians Physician Services 00 1386886778 0 BEGLEY HEATHER 2012198 9999999 B 10 1386886778 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1386886778 0 Physicians Anesthesia Services 20 1386886778 0 Physicians Fluoride varnish 20 1386886778 0 Physicians Healthy Kids Services 20 1386886778 0 Physicians Optical Supplies 20 1386886778 0 Physicians Physician Services 00 1386887701 0 WANG MIN 2013152 9999999 B 10 1386887701 0 PO BOX 22718 BEACHWOOD OH 441220718 20 1386887701 0 Physicians Anesthesia Services 20 1386887701 0 Physicians Fluoride varnish 20 1386887701 0 Physicians Healthy Kids Services 20 1386887701 0 Physicians Optical Supplies 20 1386887701 0 Physicians Physician Services 20 1386887701 0 Physicians Physicians Psychiatric Services 00 1386888469 0 PATEL SUCHIT A 2016126 9999999 B 10 1386888469 0 11475 OLDE CABIN RD STE 200 SAINT LOUIS MO 631417129 20 1386888469 0 Physicians Anesthesia Services 20 1386888469 0 Physicians Healthy Kids Services 20 1386888469 0 Physicians Optical Supplies 20 1386888469 0 Physicians Physician Services 00 1386888527 0 BAKER MATTHEW C 2016251 9999999 B 10 1386888527 0 1701 LACEY ST CAPE GIRARDEAU MO 637015230 20 1386888527 0 Physicians Anesthesia Services 20 1386888527 0 Physicians Healthy Kids Services 20 1386888527 0 Physicians Optical Supplies 20 1386888527 0 Physicians Physician Services 00 1386890077 0 FARLOW ERIN 2014203 9999999 B 10 1386890077 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1386890077 0 Physicians Anesthesia Services 20 1386890077 0 Physicians Healthy Kids Services 20 1386890077 0 Physicians Optical Supplies 20 1386890077 0 Physicians Physician Services 00 1386890150 0 JOHNSON ANDREW K 2017104 9999999 B 10 1386890150 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1386890150 0 Physicians Anesthesia Services 20 1386890150 0 Physicians Healthy Kids Services 20 1386890150 0 Physicians Optical Supplies 20 1386890150 0 Physicians Physician Services 00 1386890416 0 WIEMER SARA A 2010213 9999999 B 10 1386890416 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1386890416 0 Physicians Anesthesia Services 20 1386890416 0 Physicians Fluoride varnish 20 1386890416 0 Physicians Healthy Kids Services 20 1386890416 0 Physicians Optical Supplies 20 1386890416 0 Physicians Physician Services 00 1386890754 0 YOUNG SONA Y 2014244 9999999 B 10 1386890754 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1386890754 0 Physicians Anesthesia Services 20 1386890754 0 Physicians Fluoride varnish 20 1386890754 0 Physicians Healthy Kids Services 20 1386890754 0 Physicians Optical Supplies 20 1386890754 0 Physicians Physician Services 00 1386890978 0 KENKRE VAISHALEE P 2010182 9999999 B 10 1386890978 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1386890978 0 Physicians Anesthesia Services 20 1386890978 0 Physicians Fluoride varnish 20 1386890978 0 Physicians Healthy Kids Services 20 1386890978 0 Physicians Optical Supplies 20 1386890978 0 Physicians Physician Services 00 1386891679 0 RII JOYCE 2011152 9999999 B 10 1386891679 0 901 MCCLINTOCK DR STE 202 SUITE 202 BURR RIDGE IL 605270872 20 1386891679 0 Physicians Anesthesia Services 20 1386891679 0 Physicians Fluoride varnish 20 1386891679 0 Physicians Healthy Kids Services 20 1386891679 0 Physicians Optical Supplies 20 1386891679 0 Physicians Physician Services 00 1386891760 0 JOHNSON BELINDA 2023182 9999999 B 10 1386891760 0 PO BOX 43230 PHOENIX AZ 850803230 20 1386891760 0 Physicians Anesthesia Services 20 1386891760 0 Physicians Fluoride varnish 20 1386891760 0 Physicians Healthy Kids Services 20 1386891760 0 Physicians Optical Supplies 20 1386891760 0 Physicians Physician Services 00 1386892172 0 SCHINKEL MARY LOUISE 2014307 9999999 B 10 1386892172 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1386892172 0 Physicians Anesthesia Services 20 1386892172 0 Physicians Healthy Kids Services 20 1386892172 0 Physicians Optical Supplies 20 1386892172 0 Physicians Physician Services 00 1386896314 0 GOUDSCHAAL ANGELA 2014161 9999999 B 10 1386896314 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1386896314 0 Occupational Therapists Adaptive behavior support clinician services 20 1386896314 0 Occupational Therapists Medical Supplies 20 1386896314 0 Occupational Therapists Medical equipment/prosthetic devices 20 1386896314 0 Occupational Therapists Occupational Therapy Services 00 1386897700 0 ALVAREZ SUSANA 2009176 9999999 B 10 1386897700 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1386897700 0 Physicians Anesthesia Services 20 1386897700 0 Physicians Fluoride varnish 20 1386897700 0 Physicians Healthy Kids Services 20 1386897700 0 Physicians Optical Supplies 20 1386897700 0 Physicians Physician Services 00 1386899193 0 DEARMONT RACHEL KATHLEEN 2016032 9999999 B 10 1386899193 0 3015 N BALLAS RD ADMINISTRATION SAINT LOUIS MO 631312329 20 1386899193 0 Physician Assistant Only Fluoride varnish 20 1386899193 0 Physician Assistant Only Healthy Kids Services 20 1386899193 0 Physician Assistant Only Physician Services 00 1386899458 0 BAUM STACY 2018109 9999999 B 10 1386899458 0 5777 DEPT CAROL STREAM IL 601228942 20 1386899458 0 Physician Assistant Only Fluoride varnish 20 1386899458 0 Physician Assistant Only Healthy Kids Services 20 1386899458 0 Physician Assistant Only Physician Services 00 1386899482 0 OLDROYD JULIE H 2023094 9999999 B 10 1386899482 0 PO BOX 5081 JANESVILLE WI 535475081 20 1386899482 0 Physicians Anesthesia Services 20 1386899482 0 Physicians Healthy Kids Services 20 1386899482 0 Physicians Optical Supplies 20 1386899482 0 Physicians Physician Services 20 1386899482 0 Physicians Physicians Psychiatric Services 00 1386900694 0 ADAMS KATHRYN H 2018200 9999999 B 10 1386900694 0 PO BOX 778912 CHICAGO IL 606778912 20 1386900694 0 Physicians Anesthesia Services 20 1386900694 0 Physicians Fluoride varnish 20 1386900694 0 Physicians Healthy Kids Services 20 1386900694 0 Physicians Optical Supplies 20 1386900694 0 Physicians Physician Services 00 1386900835 0 BERRY ADAM 2012092 9999999 B 10 1386900835 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1386900835 0 Physicians Anesthesia Services 20 1386900835 0 Physicians Fluoride varnish 20 1386900835 0 Physicians Healthy Kids Services 20 1386900835 0 Physicians Optical Supplies 20 1386900835 0 Physicians Physician Services 00 1386900892 0 TSAO MICHELLE 2017121 9999999 B 10 1386900892 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1386900892 0 Physicians Anesthesia Services 20 1386900892 0 Physicians Healthy Kids Services 20 1386900892 0 Physicians Optical Supplies 20 1386900892 0 Physicians Physician Services 00 1386901098 0 GUADARRAMA CHRISTOPHER 2021299 9999999 B 10 1386901098 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1386901098 0 Physicians Anesthesia Services 20 1386901098 0 Physicians Healthy Kids Services 20 1386901098 0 Physicians Optical Supplies 20 1386901098 0 Physicians Physician Services 00 1386901106 0 STEED MAURA 2016183 9999999 B 10 1386901106 0 6501 S PROMONTORY DR CHICAGO IL 606491003 20 1386901106 0 Physicians Anesthesia Services 20 1386901106 0 Physicians Fluoride varnish 20 1386901106 0 Physicians Healthy Kids Services 20 1386901106 0 Physicians Optical Supplies 20 1386901106 0 Physicians Physician Services 00 1386901353 0 MAJUMDER PRATYAYA 2015152 9999999 B 10 1386901353 0 PO BOX 17633 BELFAST ME 049154071 20 1386901353 0 Physicians Anesthesia Services 20 1386901353 0 Physicians Fluoride varnish 20 1386901353 0 Physicians Healthy Kids Services 20 1386901353 0 Physicians Optical Supplies 20 1386901353 0 Physicians Physician Services 00 1386901817 0 VILLACRESES RADA RAUL A 2015182 9999999 B 10 1386901817 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1386901817 0 Physicians Anesthesia Services 20 1386901817 0 Physicians Fluoride varnish 20 1386901817 0 Physicians Healthy Kids Services 20 1386901817 0 Physicians Optical Supplies 20 1386901817 0 Physicians Physician Services 00 1386902260 0 KHAN BILAL 2024267 9999999 B 10 1386902260 0 221 NE GLEN OAK AVE PEORIA IL 616360002 20 1386902260 0 Physicians Anesthesia Services 20 1386902260 0 Physicians Fluoride varnish 20 1386902260 0 Physicians Healthy Kids Services 20 1386902260 0 Physicians Optical Supplies 20 1386902260 0 Physicians Physician Services 00 1386902682 0 WILLIS MELISSA S 2016301 9999999 B 10 1386902682 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1386902682 0 Physicians Anesthesia Services 20 1386902682 0 Physicians Healthy Kids Services 20 1386902682 0 Physicians Optical Supplies 20 1386902682 0 Physicians Physician Services 00 1386903060 0 WIRTHLIN JAMES D 2021169 9999999 B 10 1386903060 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1386903060 0 Physicians Anesthesia Services 20 1386903060 0 Physicians Healthy Kids Services 20 1386903060 0 Physicians Optical Supplies 20 1386903060 0 Physicians Physician Services 00 1386905669 0 EAPPEN SETH A 2015336 9999999 B 10 1386905669 0 600 ENTERPRISE DR STE 220 OAK BROOK IL 605234202 20 1386905669 0 Physicians Anesthesia Services 20 1386905669 0 Physicians Healthy Kids Services 20 1386905669 0 Physicians Optical Supplies 20 1386905669 0 Physicians Physician Services 20 1386905669 0 Physicians Physicians Psychiatric Services 00 1386906030 0 WHITE REBECCA L 2012156 9999999 B 10 1386906030 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1386906030 0 Physical Therapists Medical Supplies 20 1386906030 0 Physical Therapists Medical equipment/prosthetic devices 20 1386906030 0 Physical Therapists Physical Therapy Services 00 1386906089 0 SMITH EMILY 2017182 9999999 B 10 1386906089 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1386906089 0 Physicians Anesthesia Services 20 1386906089 0 Physicians Fluoride varnish 20 1386906089 0 Physicians Healthy Kids Services 20 1386906089 0 Physicians Optical Supplies 20 1386906089 0 Physicians Physician Services 00 1386907160 0 ATASSI MANAR 2013305 9999999 B 10 1386907160 0 5821 W 87TH ST OAK LAWN IL 604531295 20 1386907160 0 Dentists Dental Services 20 1386907160 0 Dentists Physician Services 00 1386907640 0 REICHERT KAREN 2023103 9999999 B 10 1386907640 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1386907640 0 Occupational Therapists Medical Supplies 20 1386907640 0 Occupational Therapists Medical equipment/prosthetic devices 20 1386907640 0 Occupational Therapists Occupational Therapy Services 00 1386907772 0 GAYESKI MEGAN A 2016336 9999999 B 10 1386907772 0 75 REMITTANCE DR DEPT 1620 SUITE 1620 CHICAGO IL 606751620 20 1386907772 0 Physicians Anesthesia Services 20 1386907772 0 Physicians Fluoride varnish 20 1386907772 0 Physicians Healthy Kids Services 20 1386907772 0 Physicians Optical Supplies 20 1386907772 0 Physicians Physician Services 00 1386908002 0 SYED NOSHEEN 2015257 9999999 B 10 1386908002 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1386908002 0 Physicians Anesthesia Services 20 1386908002 0 Physicians Fluoride varnish 20 1386908002 0 Physicians Healthy Kids Services 20 1386908002 0 Physicians Optical Supplies 20 1386908002 0 Physicians Physician Services 00 1386908218 0 VATTEROTT PHILIP C 2017121 9999999 B 10 1386908218 0 PO BOX 110429 AURORA CO 800420429 20 1386908218 0 Physicians Anesthesia Services 20 1386908218 0 Physicians Fluoride varnish 20 1386908218 0 Physicians Healthy Kids Services 20 1386908218 0 Physicians Optical Supplies 20 1386908218 0 Physicians Physician Services 00 1386909125 0 ANDREW EMILY K 2015320 9999999 B 10 1386909125 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1386909125 0 Physicians Anesthesia Services 20 1386909125 0 Physicians Fluoride varnish 20 1386909125 0 Physicians Healthy Kids Services 20 1386909125 0 Physicians Optical Supplies 20 1386909125 0 Physicians Physician Services 00 1386909737 0 OMER WALID 2018200 9999999 B 10 1386909737 0 4701 DEPT CAROL STREAM IL 601220021 20 1386909737 0 Physicians All Kids application agent 20 1386909737 0 Physicians Anesthesia Services 20 1386909737 0 Physicians Fluoride varnish 20 1386909737 0 Physicians Healthy Kids Services 20 1386909737 0 Physicians Optical Supplies 20 1386909737 0 Physicians Physician Services 00 1386910610 0 VAREEDAYAH ASHLEY A 2023219 9999999 B 10 1386910610 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1386910610 0 Physicians Anesthesia Services 20 1386910610 0 Physicians Fluoride varnish 20 1386910610 0 Physicians Healthy Kids Services 20 1386910610 0 Physicians Optical Supplies 20 1386910610 0 Physicians Physician Services 00 1386911469 0 BARTELMENT AMY 2011363 9999999 B 10 1386911469 0 18428 GOVERNORS HWY HOMEWOOD IL 604302911 20 1386911469 0 Speech Therapists Medical Supplies 20 1386911469 0 Speech Therapists Medical equipment/prosthetic devices 20 1386911469 0 Speech Therapists Speech Therapy/Pathology Services 00 1386914075 0 SULEJMANI IBADETE 2017158 9999999 B 10 1386914075 0 5777 DEPT CAROL STREAM IL 601220021 20 1386914075 0 Physician Assistant Only Fluoride varnish 20 1386914075 0 Physician Assistant Only Healthy Kids Services 20 1386914075 0 Physician Assistant Only Physician Services 00 1386914265 0 SEKAR RAJESH 2023006 9999999 B 10 1386914265 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1386914265 0 Physicians Anesthesia Services 20 1386914265 0 Physicians Fluoride varnish 20 1386914265 0 Physicians Healthy Kids Services 20 1386914265 0 Physicians Optical Supplies 20 1386914265 0 Physicians Physician Services 00 1386914653 0 MITCHELL TERESA 2012003 9999999 B 10 1386914653 0 5777 DEPT CAROL STREAM IL 601220021 20 1386914653 0 Nurse Practitioners Anesthesia Services 20 1386914653 0 Nurse Practitioners Nurse Practitioners Services 20 1386914653 0 Nurse Practitioners Physician Services 00 1386916195 0 BYRNE DAWN ELISABETH 2021049 9999999 B 10 1386916195 0 70 S RIVER ST AURORA IL 605065185 20 1386916195 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1386917268 0 ZIRK AARON F 2015001 9999999 B 10 1386917268 0 1431 CENTERPOINT BLVD STE 100 KNOXVILLE TN 379321983 20 1386917268 0 Physicians Anesthesia Services 20 1386917268 0 Physicians Healthy Kids Services 20 1386917268 0 Physicians Optical Supplies 20 1386917268 0 Physicians Physician Services 00 1386918597 0 LOPEZ GEORGINA G 2013032 9999999 B 10 1386918597 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1386918597 0 Nurse Practitioners Fluoride varnish 20 1386918597 0 Nurse Practitioners Healthy Kids Services 20 1386918597 0 Nurse Practitioners Nurse Practitioners Services 20 1386918597 0 Nurse Practitioners Physician Services 00 1386919041 0 CHESTEK DAVID W 2014296 9999999 B 10 1386919041 0 307 S EVERGREEN AVE WOODBURY NJ 080962739 20 1386919041 0 Physicians Anesthesia Services 20 1386919041 0 Physicians Fluoride varnish 20 1386919041 0 Physicians Healthy Kids Services 20 1386919041 0 Physicians Optical Supplies 20 1386919041 0 Physicians Physician Services 00 1386919488 0 NIZIOLEK PAUL 2020252 9999999 B 10 1386919488 0 250 N SHADELAND AVE STE 200 INDIANAPOLIS IN 462194959 20 1386919488 0 Physicians Anesthesia Services 20 1386919488 0 Physicians Healthy Kids Services 20 1386919488 0 Physicians Optical Supplies 20 1386919488 0 Physicians Physician Services 00 1386919728 0 OSMANOVIC DIANA 2014216 9999999 B 10 1386919728 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1386919728 0 Physicians Anesthesia Services 20 1386919728 0 Physicians Healthy Kids Services 20 1386919728 0 Physicians Optical Supplies 20 1386919728 0 Physicians Physician Services 00 1386919785 0 ROSENFELD BENJAMIN I 2015182 9999999 B 10 1386919785 0 5777 DEPT CAROL STREAM IL 601220021 20 1386919785 0 Physicians Anesthesia Services 20 1386919785 0 Physicians Fluoride varnish 20 1386919785 0 Physicians Healthy Kids Services 20 1386919785 0 Physicians Optical Supplies 20 1386919785 0 Physicians Physician Services 00 1386920510 0 SULLIVAN CARLA A 2017202 9999999 B 10 1386920510 0 1000 BRADY ST DAVENPORT IA 528035214 20 1386920510 0 Chiropractors Chiropractic Services 00 1386920551 0 FOUTS JESSICA L 2011306 9999999 B 10 1386920551 0 PO BOX 632111 CINCINNATI OH 452632111 20 1386920551 0 Nurse Practitioners Healthy Kids Services 20 1386920551 0 Nurse Practitioners Nurse Practitioners Services 20 1386920551 0 Nurse Practitioners Physician Services 00 1386920924 0 HURT GAIL 2015274 9999999 B 10 1386920924 0 621 S NEW BALLAS RD STE 6017B SAINT LOUIS MO 631418274 20 1386920924 0 Nurse Practitioners Healthy Kids Services 20 1386920924 0 Nurse Practitioners Nurse Practitioners Services 20 1386920924 0 Nurse Practitioners Physician Services 00 1386922466 0 ORTEZA RHEA DIVINA 2025027 9999999 B 10 1386922466 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1386922466 0 Physical Therapists Medical Supplies 20 1386922466 0 Physical Therapists Medical equipment/prosthetic devices 20 1386922466 0 Physical Therapists Physical Therapy Services 00 1386922706 0 PATEL SANDIPKUMAR 2014244 9999999 B 10 1386922706 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1386922706 0 Physicians Anesthesia Services 20 1386922706 0 Physicians Fluoride varnish 20 1386922706 0 Physicians Healthy Kids Services 20 1386922706 0 Physicians Optical Supplies 20 1386922706 0 Physicians Physician Services 00 1386923118 0 GRIPPI AMANDA L 2016238 9999999 B 10 1386923118 0 278 ANDES DR GLEN CARBON IL 620341318 20 1386923118 0 Other behavior health professional Adaptive behavior support clinician services 20 1386923118 0 Other behavior health professional LCPC/LMFT services 00 1386923167 0 BUCHANAN CRAIG 2014227 9999999 B 10 1386923167 0 1701 LACEY ST CAPE GIRARDEAU MO 637015230 20 1386923167 0 Physicians Anesthesia Services 20 1386923167 0 Physicians Fluoride varnish 20 1386923167 0 Physicians Healthy Kids Services 20 1386923167 0 Physicians Optical Supplies 20 1386923167 0 Physicians Physician Services 00 1386924272 0 RILEY KATHRYN F 2022115 9999999 B 10 1386924272 0 8201 W FULLERTON AVE ELMWOOD PARK IL 607072449 20 1386924272 0 Speech Therapists Medical Supplies 20 1386924272 0 Speech Therapists Medical equipment/prosthetic devices 20 1386924272 0 Speech Therapists Speech Therapy/Pathology Services 00 1386926525 0 LUSTFELDT LINDSEY J 2019303 9999999 B 10 1386926525 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1386926525 0 Clinical Social Worker Social work service 00 1386927192 0 MATTEI TOBIAS 2018135 9999999 B 10 1386927192 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1386927192 0 Physicians Anesthesia Services 20 1386927192 0 Physicians Healthy Kids Services 20 1386927192 0 Physicians Optical Supplies 20 1386927192 0 Physicians Physician Services 00 1386929206 0 BROWN-DANZEISEN KRISTIN A 2011311 9999999 B 10 1386929206 0 6300 RIDGLEA PL STE 201 SUITE 201 FORT WORTH TX 761165707 20 1386929206 0 Nurse Practitioners Healthy Kids Services 20 1386929206 0 Nurse Practitioners Nurse Practitioners Services 20 1386929206 0 Nurse Practitioners Physician Services 00 1386930238 0 HART STEPHEN A 2019005 9999999 B 10 1386930238 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1386930238 0 Physicians Anesthesia Services 20 1386930238 0 Physicians Fluoride varnish 20 1386930238 0 Physicians Healthy Kids Services 20 1386930238 0 Physicians Optical Supplies 20 1386930238 0 Physicians Physician Services 00 1386930428 0 MALLICK NADIR 2014349 9999999 B 10 1386930428 0 PO BOX 920128 DALLAS TX 753920128 20 1386930428 0 Physicians Anesthesia Services 20 1386930428 0 Physicians Fluoride varnish 20 1386930428 0 Physicians Healthy Kids Services 20 1386930428 0 Physicians Optical Supplies 20 1386930428 0 Physicians Physician Services 00 1386930675 0 NAJAM SAIMA 2014213 9999999 B 10 1386930675 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1386930675 0 Physicians Anesthesia Services 20 1386930675 0 Physicians Fluoride varnish 20 1386930675 0 Physicians Healthy Kids Services 20 1386930675 0 Physicians Optical Supplies 20 1386930675 0 Physicians Physician Services 00 1386931590 0 HOFFMAN MEGAN M 2011227 9999999 B 10 1386931590 0 PO BOX 3988 CARBONDALE IL 629023988 20 1386931590 0 Nurse Practitioners Fluoride varnish 20 1386931590 0 Nurse Practitioners Healthy Kids Services 20 1386931590 0 Nurse Practitioners Nurse Practitioners Services 20 1386931590 0 Nurse Practitioners Physician Services 00 1386931921 0 OBRIEN ERIC 2012171 9999999 B 10 1386931921 0 PO BOX 465 MACOMB IL 614550465 20 1386931921 0 Optometrists Optical Supplies 20 1386931921 0 Optometrists Optometric Services 20 1386931921 0 Optometrists Physician Services 00 1386932028 0 WHITAKER KELLY 2011221 9999999 B 10 1386932028 0 PO BOX 303 MASCOUTAH IL 622580303 20 1386932028 0 Nurse Practitioners Healthy Kids Services 20 1386932028 0 Nurse Practitioners Nurse Practitioners Services 20 1386932028 0 Nurse Practitioners Physician Services 00 1386933075 0 MILLER KARISSA R 2018001 9999999 B 10 1386933075 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1386933075 0 Physicians Anesthesia Services 20 1386933075 0 Physicians Healthy Kids Services 20 1386933075 0 Physicians Optical Supplies 20 1386933075 0 Physicians Physician Services 00 1386933091 0 KEATING JULIE K 2018267 9999999 B 10 1386933091 0 7733 FORSYTH BLVD STE 1700 SAINT LOUIS MO 631051801 20 1386933091 0 Occupational Therapists Medical Supplies 20 1386933091 0 Occupational Therapists Medical equipment/prosthetic devices 20 1386933091 0 Occupational Therapists Occupational Therapy Services 00 1386933133 0 MINNEMAN SAMANTHA M 2020061 9999999 B 10 1386933133 0 PO BOX 110429 AURORA CO 800420429 20 1386933133 0 Physicians Anesthesia Services 20 1386933133 0 Physicians Fluoride varnish 20 1386933133 0 Physicians Healthy Kids Services 20 1386933133 0 Physicians Optical Supplies 20 1386933133 0 Physicians Physician Services 00 1386933497 0 OK MICHALE S 2018239 9999999 B 10 1386933497 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1386933497 0 Physicians Anesthesia Services 20 1386933497 0 Physicians Healthy Kids Services 20 1386933497 0 Physicians Optical Supplies 20 1386933497 0 Physicians Physician Services 00 1386933877 0 CAGA-ANAN REXANNE 2014230 9999999 B 10 1386933877 0 201 E MADISON ST STE 328 SPRINGFIELD IL 627025131 20 1386933877 0 Physicians Anesthesia Services 20 1386933877 0 Physicians Fluoride varnish 20 1386933877 0 Physicians Healthy Kids Services 20 1386933877 0 Physicians Optical Supplies 20 1386933877 0 Physicians Physician Services 00 1386934008 0 MONTOYA ERIKA 2014202 9999999 B 10 1386934008 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1386934008 0 Physicians Anesthesia Services 20 1386934008 0 Physicians Fluoride varnish 20 1386934008 0 Physicians Healthy Kids Services 20 1386934008 0 Physicians Optical Supplies 20 1386934008 0 Physicians Physician Services 00 1386934073 0 STANLEY MARION V. 2014213 9999999 B 10 1386934073 0 5777 DEPT CAROL STREAM IL 601220021 20 1386934073 0 Physicians Anesthesia Services 20 1386934073 0 Physicians Fluoride varnish 20 1386934073 0 Physicians Healthy Kids Services 20 1386934073 0 Physicians Optical Supplies 20 1386934073 0 Physicians Physician Services 00 1386934370 0 SHERIDAN NATH ALISON S 2022017 9999999 B 10 1386934370 0 PO BOX 110429 AURORA CO 800420429 20 1386934370 0 Physicians Anesthesia Services 20 1386934370 0 Physicians Healthy Kids Services 20 1386934370 0 Physicians Optical Supplies 20 1386934370 0 Physicians Physician Services 00 1386934487 0 GHUMAN HARPREET K 2014182 9999999 B 10 1386934487 0 7725 W RENO AVE STE 330 OKLAHOMA CITY OK 731279742 20 1386934487 0 Physicians Anesthesia Services 20 1386934487 0 Physicians Healthy Kids Services 20 1386934487 0 Physicians Optical Supplies 20 1386934487 0 Physicians Physician Services 00 1386934768 0 DUMONTIER ERIN MICHELE 2015276 9999999 B 10 1386934768 0 3015 N BALLAS RD ADMINISTRATION SAINT LOUIS MO 631312329 20 1386934768 0 Physicians Anesthesia Services 20 1386934768 0 Physicians Healthy Kids Services 20 1386934768 0 Physicians Optical Supplies 20 1386934768 0 Physicians Physician Services 00 1386935013 0 HEIDRICH BRYAN 2020117 9999999 B 10 1386935013 0 PO BOX 43230 PHOENIX AZ 850803230 20 1386935013 0 Physicians Anesthesia Services 20 1386935013 0 Physicians Healthy Kids Services 20 1386935013 0 Physicians Optical Supplies 20 1386935013 0 Physicians Physician Services 00 1386935344 0 BENDINGER KRISTEN 2023266 9999999 B 10 1386935344 0 PO BOX 43230 PHOENIX AZ 850803230 20 1386935344 0 Physicians Anesthesia Services 20 1386935344 0 Physicians Fluoride varnish 20 1386935344 0 Physicians Healthy Kids Services 20 1386935344 0 Physicians Optical Supplies 20 1386935344 0 Physicians Physician Services 00 1386936870 0 HAYES LAURA 2011122 9999999 B 10 1386936870 0 3241 S MICHIGAN AVE CHICAGO IL 606164201 20 1386936870 0 Occupational Therapists Medical Supplies 20 1386936870 0 Occupational Therapists Medical equipment/prosthetic devices 20 1386936870 0 Occupational Therapists Occupational Therapy Services 00 1386937167 0 MAEZA ALAEDDIN A 2019231 9999999 B 10 1386937167 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1386937167 0 Physicians Anesthesia Services 20 1386937167 0 Physicians Fluoride varnish 20 1386937167 0 Physicians Healthy Kids Services 20 1386937167 0 Physicians Optical Supplies 20 1386937167 0 Physicians Physician Services 00 1386937803 0 LIN TIFFANY 2016190 9999999 B 10 1386937803 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1386937803 0 Physicians Anesthesia Services 20 1386937803 0 Physicians Fluoride varnish 20 1386937803 0 Physicians Healthy Kids Services 20 1386937803 0 Physicians Optical Supplies 20 1386937803 0 Physicians Physician Services 00 1386937944 0 QUADE ROBERT 2020209 9999999 B 10 1386937944 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1386937944 0 Physicians Anesthesia Services 20 1386937944 0 Physicians Fluoride varnish 20 1386937944 0 Physicians Healthy Kids Services 20 1386937944 0 Physicians Optical Supplies 20 1386937944 0 Physicians Physician Services 00 1386938157 0 KADOW BRIAN 2019197 9999999 B 10 1386938157 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1386938157 0 Physicians Anesthesia Services 20 1386938157 0 Physicians Healthy Kids Services 20 1386938157 0 Physicians Optical Supplies 20 1386938157 0 Physicians Physician Services 00 1386938272 0 LYNN BRYCE 2020207 9999999 B 10 1386938272 0 250 W 96TH ST STE 520 INDIANAPOLIS IN 462601317 20 1386938272 0 Physicians Anesthesia Services 20 1386938272 0 Physicians Fluoride varnish 20 1386938272 0 Physicians Healthy Kids Services 20 1386938272 0 Physicians Optical Supplies 20 1386938272 0 Physicians Physician Services 00 1386938322 0 BOZIEL ELIZABETH E 2022063 9999999 B 10 1386938322 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1386938322 0 Physician Assistant Only Fluoride varnish 20 1386938322 0 Physician Assistant Only Healthy Kids Services 20 1386938322 0 Physician Assistant Only Physician Services 00 1386938447 0 CZECH THERESA M 2014108 9999999 B 10 1386938447 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1386938447 0 Physicians Anesthesia Services 20 1386938447 0 Physicians Healthy Kids Services 20 1386938447 0 Physicians Optical Supplies 20 1386938447 0 Physicians Physician Services 20 1386938447 0 Physicians Physicians Psychiatric Services 00 1386938686 0 BROWN JENNIFER GENEVA 2022091 9999999 B 10 1386938686 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1386938686 0 Physicians Anesthesia Services 20 1386938686 0 Physicians Fluoride varnish 20 1386938686 0 Physicians Healthy Kids Services 20 1386938686 0 Physicians Optical Supplies 20 1386938686 0 Physicians Physician Services 00 1386938702 0 HEIDI ALVEY 2024003 9999999 B 10 1386938702 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1386938702 0 Physicians Anesthesia Services 20 1386938702 0 Physicians Healthy Kids Services 20 1386938702 0 Physicians Optical Supplies 20 1386938702 0 Physicians Physician Services 00 1386940781 0 DOUGLAS ZAKIYA 2021356 9999999 B 10 1386940781 0 1160 E SAINT CLAIR ST VINCENNES IN 475914853 20 1386940781 0 Physicians Anesthesia Services 20 1386940781 0 Physicians Fluoride varnish 20 1386940781 0 Physicians Healthy Kids Services 20 1386940781 0 Physicians Optical Supplies 20 1386940781 0 Physicians Physician Services 00 1386941482 0 SALIEVSKA AFRODITA 2014001 9999999 B 10 1386941482 0 PO BOX 772 MC2295 WOONSOCKET RI 028950784 20 1386941482 0 Nurse Practitioners Fluoride varnish 20 1386941482 0 Nurse Practitioners Healthy Kids Services 20 1386941482 0 Nurse Practitioners Nurse Practitioners Services 20 1386941482 0 Nurse Practitioners Physician Services 00 1386941508 0 BRUME EDIRI J 2016328 9999999 B 10 1386941508 0 4701 DEPT CAROL STREAM IL 601220021 20 1386941508 0 Physicians Anesthesia Services 20 1386941508 0 Physicians Fluoride varnish 20 1386941508 0 Physicians Healthy Kids Services 20 1386941508 0 Physicians Optical Supplies 20 1386941508 0 Physicians Physician Services 00 1386942985 0 SMOLTER PATRICIA 2020236 9999999 B 10 1386942985 0 PO BOX 43230 PHOENIX AZ 850803230 20 1386942985 0 Physicians Anesthesia Services 20 1386942985 0 Physicians Healthy Kids Services 20 1386942985 0 Physicians Optical Supplies 20 1386942985 0 Physicians Physician Services 00 1386947026 0 SCHIESTEL RHONDA C 2013231 9999999 B 10 1386947026 0 1256 WATERFORD DR STE 230 AURORA IL 605044511 20 1386947026 0 Nurse Practitioners Fluoride varnish 20 1386947026 0 Nurse Practitioners Healthy Kids Services 20 1386947026 0 Nurse Practitioners Nurse Practitioners Services 20 1386947026 0 Nurse Practitioners Physician Services 00 1386949816 0 WALLER WILLIAM N 2017079 9999999 B 10 1386949816 0 5777 DEPT CAROL STREAM IL 601220021 20 1386949816 0 Speech Therapists Medical Supplies 20 1386949816 0 Speech Therapists Medical equipment/prosthetic devices 20 1386949816 0 Speech Therapists Speech Therapy/Pathology Services 00 1386950319 0 BRANDIS OLESYA 2011182 9999999 B 10 1386950319 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1386950319 0 Physicians Anesthesia Services 20 1386950319 0 Physicians Healthy Kids Services 20 1386950319 0 Physicians Optical Supplies 20 1386950319 0 Physicians Physician Services 00 1386950533 0 FREY CHARITY A 2010335 9999999 B 10 1386950533 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1386950533 0 Nurse Practitioners Healthy Kids Services 20 1386950533 0 Nurse Practitioners Nurse Practitioners Services 20 1386950533 0 Nurse Practitioners Physician Services 00 1386952117 0 PERRON-BURDICK MISA 2023143 9999999 B 10 1386952117 0 190 E BANNOCK ST BOISE ID 837126241 20 1386952117 0 Physicians Anesthesia Services 20 1386952117 0 Physicians Healthy Kids Services 20 1386952117 0 Physicians Optical Supplies 20 1386952117 0 Physicians Physician Services 00 1386952299 0 MCKENZIE JAMES B 2019268 9999999 B 10 1386952299 0 625 MASSACHUSETTS AVE FL 2 CAMBRIDGE MA 021393357 20 1386952299 0 Physicians Anesthesia Services 20 1386952299 0 Physicians Fluoride varnish 20 1386952299 0 Physicians Healthy Kids Services 20 1386952299 0 Physicians Optical Supplies 20 1386952299 0 Physicians Physician Services 00 1386953172 0 ANDERSON OLSON LEAH C 2017011 9999999 B 10 1386953172 0 5777 DEPT CAROL STREAM IL 601220021 20 1386953172 0 Physician Assistant Only Fluoride varnish 20 1386953172 0 Physician Assistant Only Healthy Kids Services 20 1386953172 0 Physician Assistant Only Physician Services 00 1386953602 0 LALIWALA MOHSINA T 2013196 9999999 B 10 1386953602 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1386953602 0 Physicians Anesthesia Services 20 1386953602 0 Physicians Fluoride varnish 20 1386953602 0 Physicians Healthy Kids Services 20 1386953602 0 Physicians Optical Supplies 20 1386953602 0 Physicians Physician Services 00 1386953800 0 BLEUER JEREMY 2016333 9999999 B 10 1386953800 0 325 IL ROUTE 2 DIXON IL 610219118 20 1386953800 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1386954436 0 TAHERKHANI SARA 2019017 9999999 B 10 1386954436 0 1 ILLINI DR PEORIA IL 616052576 20 1386954436 0 Physicians All Kids application agent 20 1386954436 0 Physicians Anesthesia Services 20 1386954436 0 Physicians Fluoride varnish 20 1386954436 0 Physicians Healthy Kids Services 20 1386954436 0 Physicians Optical Supplies 20 1386954436 0 Physicians Physician Services 00 1386954923 0 SHUMS MONA 2024267 9999999 B 10 1386954923 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1386954923 0 Physician Assistant Only Fluoride varnish 20 1386954923 0 Physician Assistant Only Healthy Kids Services 20 1386954923 0 Physician Assistant Only Physician Services 00 1386955417 0 COWAN ALISON 2024071 9999999 B 10 1386955417 0 515 22ND AVE MONROE WI 535661569 20 1386955417 0 Physicians Anesthesia Services 20 1386955417 0 Physicians Healthy Kids Services 20 1386955417 0 Physicians Optical Supplies 20 1386955417 0 Physicians Physician Services 00 1386955623 0 LISA GRAHAM 2020339 9999999 B 10 1386955623 0 PO BOX 967 FLAGSTAFF AZ 860020967 20 1386955623 0 Physicians Anesthesia Services 20 1386955623 0 Physicians Fluoride varnish 20 1386955623 0 Physicians Healthy Kids Services 20 1386955623 0 Physicians Optical Supplies 20 1386955623 0 Physicians Physician Services 00 1386957884 0 LEE JANE K 2010048 9999999 B 10 1386957884 0 29373 NETWORK PL CHICAGO IL 606733039 20 1386957884 0 Physicians Anesthesia Services 20 1386957884 0 Physicians Healthy Kids Services 20 1386957884 0 Physicians Optical Supplies 20 1386957884 0 Physicians Physician Services 00 1386958064 0 FENZL CARLTON R 2015215 9999999 B 10 1386958064 0 777 TANGLEFOOT LN BETTENDORF IA 527221650 20 1386958064 0 Physicians Anesthesia Services 20 1386958064 0 Physicians Healthy Kids Services 20 1386958064 0 Physicians Optical Supplies 20 1386958064 0 Physicians Physician Services 00 1386958122 0 SYSE KENDALL 2020142 9999999 B 10 1386958122 0 515 22ND AVE MONROE WI 535661569 20 1386958122 0 Physical Therapists Medical Supplies 20 1386958122 0 Physical Therapists Medical equipment/prosthetic devices 20 1386958122 0 Physical Therapists Physical Therapy Services 00 1386959302 0 GOPAL ARAVIND 2013199 9999999 B 10 1386959302 0 35318 EAGLE WAY CHICAGO IL 606781353 20 1386959302 0 Physicians Anesthesia Services 20 1386959302 0 Physicians Fluoride varnish 20 1386959302 0 Physicians Healthy Kids Services 20 1386959302 0 Physicians Optical Supplies 20 1386959302 0 Physicians Physician Services 00 1386959443 0 RICE MARY E 2011045 9999999 B 10 1386959443 0 825 S TAYLOR AVE SAINT LOUIS MO 631101567 20 1386959443 0 Audiologists Audiology Services 20 1386959443 0 Audiologists Medical Supplies 20 1386959443 0 Audiologists Medical equipment/prosthetic devices 00 1386959732 0 BRIMEYER ELIZABETH J 2017348 9999999 B 10 1386959732 0 350 N GRANDVIEW AVE DUBUQUE IA 520016388 20 1386959732 0 Nurse Practitioners Fluoride varnish 20 1386959732 0 Nurse Practitioners Healthy Kids Services 20 1386959732 0 Nurse Practitioners Nurse Practitioners Services 20 1386959732 0 Nurse Practitioners Physician Services 00 1386960144 0 HERSEY BENJAMIN 2016183 9999999 B 10 1386960144 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1386960144 0 Physicians Anesthesia Services 20 1386960144 0 Physicians Healthy Kids Services 20 1386960144 0 Physicians Optical Supplies 20 1386960144 0 Physicians Physician Services 20 1386960144 0 Physicians Physicians Psychiatric Services 00 1386960151 0 CHAPMAN MARY L 2010091 9999999 B 10 1386960151 0 PO BOX 3988 CARBONDALE IL 629023988 20 1386960151 0 Nurse Practitioners Healthy Kids Services 20 1386960151 0 Nurse Practitioners Nurse Practitioners Services 20 1386960151 0 Nurse Practitioners Physician Services 00 1386960359 0 ROWLAND MICHELLE 2021146 9999999 B 10 1386960359 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1386960359 0 Physicians Anesthesia Services 20 1386960359 0 Physicians Healthy Kids Services 20 1386960359 0 Physicians Optical Supplies 20 1386960359 0 Physicians Physician Services 00 1386960367 0 SENESCU CARLY 2013225 9999999 B 10 1386960367 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1386960367 0 Physicians Anesthesia Services 20 1386960367 0 Physicians Fluoride varnish 20 1386960367 0 Physicians Healthy Kids Services 20 1386960367 0 Physicians Optical Supplies 20 1386960367 0 Physicians Physician Services 00 1386960375 0 ZAHN RACHEL 2011292 9999999 B 10 1386960375 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1386960375 0 Psychologist All Kids application agent 20 1386960375 0 Psychologist Psychologist service 00 1386960573 0 WINIKOFF WALLIS JACLYN P 2013001 9999999 B 10 1386960573 0 1460 N HALSTED ST STE 402 CHICAGO IL 606422607 20 1386960573 0 Physicians Anesthesia Services 20 1386960573 0 Physicians Fluoride varnish 20 1386960573 0 Physicians Healthy Kids Services 20 1386960573 0 Physicians Optical Supplies 20 1386960573 0 Physicians Physician Services 00 1386961357 0 BANECK TRISHA C 2012317 9999999 B 10 1386961357 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1386961357 0 Nurse Practitioners Healthy Kids Services 20 1386961357 0 Nurse Practitioners Nurse Practitioners Services 20 1386961357 0 Nurse Practitioners Physician Services 00 1386961662 0 LUNA SERGIO ERNESTO 2013238 9999999 B 10 1386961662 0 4712 LAUREL AVE GLENVIEW IL 600251419 20 1386961662 0 Physicians Anesthesia Services 20 1386961662 0 Physicians Fluoride varnish 20 1386961662 0 Physicians Healthy Kids Services 20 1386961662 0 Physicians Optical Supplies 20 1386961662 0 Physicians Physician Services 00 1386962207 0 GANTT GERALD A 2018213 9999999 B 10 1386962207 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1386962207 0 Physicians Anesthesia Services 20 1386962207 0 Physicians Healthy Kids Services 20 1386962207 0 Physicians Optical Supplies 20 1386962207 0 Physicians Physician Services 00 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Physicians Anesthesia Services 20 1396000337 0 Physicians Fluoride varnish 20 1396000337 0 Physicians Healthy Kids Services 20 1396000337 0 Physicians Optical Supplies 20 1396000337 0 Physicians Physician Services 00 1396000352 0 ULLMANN SCOTT 2012201 9999999 B 10 1396000352 0 6233 CERMAK RD BERWYN IL 604022317 20 1396000352 0 Optometrists Optical Supplies 20 1396000352 0 Optometrists Optometric Services 20 1396000352 0 Optometrists Physician Services 00 1396000360 0 SCHWENN MARY 2012212 9999999 B 10 1396000360 0 520 VALLEY VIEW DR MOLINE IL 612656152 20 1396000360 0 Nurse Practitioners Fluoride varnish 20 1396000360 0 Nurse Practitioners Healthy Kids Services 20 1396000360 0 Nurse Practitioners Nurse Practitioners Services 20 1396000360 0 Nurse Practitioners Physician Services 00 1396000378 0 LIU JASON 2016180 9999999 B 10 1396000378 0 611 W PARK ST URBANA IL 618012529 20 1396000378 0 Physicians Anesthesia Services 20 1396000378 0 Physicians Healthy Kids Services 20 1396000378 0 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2018244 9999999 B 10 1396011847 0 13545 BARRETT PARKWAY DR STE 1 BALLWIN MO 630213823 20 1396011847 0 Nurse Practitioners Anesthesia Services 20 1396011847 0 Nurse Practitioners Nurse Practitioners Services 20 1396011847 0 Nurse Practitioners Physician Services 00 1396014650 0 EVANS RENEE S 2012263 9999999 B 10 1396014650 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1396014650 0 Nurse Practitioners Healthy Kids Services 20 1396014650 0 Nurse Practitioners Nurse Practitioners Services 20 1396014650 0 Nurse Practitioners Physician Services 00 1396017877 0 CURTIS BENJAMIN 2015304 9999999 B 10 1396017877 0 2200 STATE ST LAWRENCEVILLE IL 624391852 20 1396017877 0 Nurse Practitioners Anesthesia Services 20 1396017877 0 Nurse Practitioners Nurse Practitioners Services 20 1396017877 0 Nurse Practitioners Physician Services 00 1396017992 0 DESJARLAIS LUKE V 2022212 9999999 B 10 1396017992 0 6024 RIDGE AVE STE 116-356 PHILADELPHIA PA 191281601 20 1396017992 0 Physician 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20 1396028296 0 Physician Assistant Only Fluoride varnish 20 1396028296 0 Physician Assistant Only Healthy Kids Services 20 1396028296 0 Physician Assistant Only Physician Services 00 1396029013 0 UZOKA CHUKWUEMEKA C 2014118 9999999 B 10 1396029013 0 PO BOX 15250 CHICAGO IL 606155143 20 1396029013 0 Physicians Anesthesia Services 20 1396029013 0 Physicians Fluoride varnish 20 1396029013 0 Physicians Healthy Kids Services 20 1396029013 0 Physicians Optical Supplies 20 1396029013 0 Physicians Physician Services 00 1396029187 0 BLACKMAN ANGELA 2020099 9999999 B 10 1396029187 0 865 LINCOLN RD STE L10 BETTENDORF IA 527224159 20 1396029187 0 Nurse Practitioners Healthy Kids Services 20 1396029187 0 Nurse Practitioners Nurse Practitioners Services 20 1396029187 0 Nurse Practitioners Physician Services 00 1396029450 0 DEMERS MICHAEL 2013075 9999999 B 10 1396029450 0 1439 W 103RD ST STE 3 CHICAGO IL 606432900 20 1396029450 0 Optometrists Optical Supplies 20 1396029450 0 Optometrists Optometric 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1396033825 0 Physicians Fluoride varnish 20 1396033825 0 Physicians Healthy Kids Services 20 1396033825 0 Physicians Optical Supplies 20 1396033825 0 Physicians Physician Services 00 1396034161 0 SILVER JEREMY M 2021214 9999999 B 10 1396034161 0 5777 DEPT CAROL STREAM IL 601220021 20 1396034161 0 Physicians Anesthesia Services 20 1396034161 0 Physicians Healthy Kids Services 20 1396034161 0 Physicians Optical Supplies 20 1396034161 0 Physicians Physician Services 00 1396034484 0 KANSAL NIDHI 2014244 9999999 B 10 1396034484 0 5777 DEPT CAROL STREAM IL 601220021 20 1396034484 0 Physicians Anesthesia Services 20 1396034484 0 Physicians Fluoride varnish 20 1396034484 0 Physicians Healthy Kids Services 20 1396034484 0 Physicians Optical Supplies 20 1396034484 0 Physicians Physician Services 00 1396035465 0 MOREIRA RIDSDALE DANIEL 2024258 9999999 B 10 1396035465 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1396035465 0 Physicians Anesthesia Services 20 1396035465 0 Physicians Fluoride 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Nurse Practitioners Optical Supplies 20 1396047668 0 Nurse Practitioners Physician Services 00 1396048666 0 NIAZI SULTAN 2011182 9999999 B 10 1396048666 0 119 S WESTERN AVE UNIT 1 CHICAGO IL 606124644 20 1396048666 0 Physicians Anesthesia Services 20 1396048666 0 Physicians Fluoride varnish 20 1396048666 0 Physicians Healthy Kids Services 20 1396048666 0 Physicians Optical Supplies 20 1396048666 0 Physicians Physician Services 00 1396048898 0 DRAKE ROBIN 2013032 9999999 B 10 1396048898 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1396048898 0 Physicians Anesthesia Services 20 1396048898 0 Physicians Healthy Kids Services 20 1396048898 0 Physicians Optical Supplies 20 1396048898 0 Physicians Physician Services 00 1396050043 0 HARPER SARA 2010274 9999999 B 10 1396050043 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1396050043 0 Nurse Practitioners Anesthesia Services 20 1396050043 0 Nurse Practitioners Nurse Practitioners Services 20 1396050043 0 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Services 20 1396057972 0 Physicians Optical Supplies 20 1396057972 0 Physicians Physician Services 00 1396058194 0 STURGILL SARAH C 2014209 9999999 B 10 1396058194 0 1008 N MAIN ST BLOOMINGTON IL 617011784 20 1396058194 0 Optometrists Optical Supplies 20 1396058194 0 Optometrists Optometric Services 20 1396058194 0 Optometrists Physician Services 00 1396058871 0 SOBRINO JUSTIN A 2022080 9999999 B 10 1396058871 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1396058871 0 Physicians Anesthesia Services 20 1396058871 0 Physicians Fluoride varnish 20 1396058871 0 Physicians Healthy Kids Services 20 1396058871 0 Physicians Optical Supplies 20 1396058871 0 Physicians Physician Services 00 1396059325 0 RAKERS COLEEN K 2012042 9999999 B 10 1396059325 0 101 E 9TH ST PANA IL 625571716 20 1396059325 0 Nurse Practitioners Healthy Kids Services 20 1396059325 0 Nurse Practitioners Nurse Practitioners Services 20 1396059325 0 Nurse Practitioners Physician Services 00 1396059606 0 ANDEREGG KIMBERLY 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E 2018234 9999999 B 10 1396061024 0 5777 DEPT CAROL STREAM IL 601220021 20 1396061024 0 Physicians Anesthesia Services 20 1396061024 0 Physicians Healthy Kids Services 20 1396061024 0 Physicians Optical Supplies 20 1396061024 0 Physicians Physician Services 00 1396061339 0 RALEIGH TODD M 2022271 9999999 B 10 1396061339 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1396061339 0 Physicians Anesthesia Services 20 1396061339 0 Physicians Healthy Kids Services 20 1396061339 0 Physicians Optical Supplies 20 1396061339 0 Physicians Physician Services 20 1396061339 0 Physicians Physicians Psychiatric Services 00 1396061818 0 BRODNICK ERIN 1999088 9999999 B 10 1396061818 0 2501 COTTONTAIL LN SOMERSET NJ 088735125 20 1396061818 0 Audiologists Audiology Services 20 1396061818 0 Audiologists Medical Supplies 20 1396061818 0 Audiologists Medical equipment/prosthetic devices 00 1396061925 0 WINDELS DANIEL C 2025063 9999999 B 10 1396061925 0 8300 W 38TH AVE WHEAT RIDGE CO 800336005 20 1396061925 0 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20 1396062782 0 Physicians Optical Supplies 20 1396062782 0 Physicians Physician Services 00 1396063921 0 PALMER JEREMIAH 2016181 9999999 B 10 1396063921 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1396063921 0 Physicians Anesthesia Services 20 1396063921 0 Physicians Healthy Kids Services 20 1396063921 0 Physicians Optical Supplies 20 1396063921 0 Physicians Physician Services 00 1396064176 0 OLORUNNISOMO VINCENT 2022312 9999999 B 10 1396064176 0 1541 RIVERBOAT CENTER DR JOLIET IL 604319341 20 1396064176 0 Physicians Anesthesia Services 20 1396064176 0 Physicians Healthy Kids Services 20 1396064176 0 Physicians Optical Supplies 20 1396064176 0 Physicians Physician Services 00 1396064499 0 HERINGHAUS ADAM 2020340 9999999 B 10 1396064499 0 PO BOX 43230 PHOENIX AZ 850803230 20 1396064499 0 Physicians Anesthesia Services 20 1396064499 0 Physicians Healthy Kids Services 20 1396064499 0 Physicians Optical Supplies 20 1396064499 0 Physicians Physician Services 00 1396064549 0 TORGESON JENNA N 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1396125662 0 Physicians Optical Supplies 20 1396125662 0 Physicians Physician Services 00 1396125720 0 CROSH CLARE C 2018117 9999999 B 10 1396125720 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1396125720 0 Physicians Anesthesia Services 20 1396125720 0 Physicians Fluoride varnish 20 1396125720 0 Physicians Healthy Kids Services 20 1396125720 0 Physicians Optical Supplies 20 1396125720 0 Physicians Physician Services 00 1396126124 0 JOHNSON LISA 2015286 9999999 H 10 1396126124 0 339 ALANA DR NEW LENOX IL 604511766 20 1396126124 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1396126553 0 CHI STEPHEN W 2018176 9999999 B 10 1396126553 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1396126553 0 Physicians Anesthesia Services 20 1396126553 0 Physicians Fluoride varnish 20 1396126553 0 Physicians Healthy Kids Services 20 1396126553 0 Physicians Optical Supplies 20 1396126553 0 Physicians 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Physician Services 00 1396127841 0 LEQUIA VERONICA A 2016084 9999999 B 10 1396127841 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1396127841 0 Physician Assistant Only Fluoride varnish 20 1396127841 0 Physician Assistant Only Healthy Kids Services 20 1396127841 0 Physician Assistant Only Physician Services 00 1396127866 0 GIBSON EMMALEEN 2021272 9999999 B 10 1396127866 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1396127866 0 Nurse Practitioners Healthy Kids Services 20 1396127866 0 Nurse Practitioners Nurse Practitioners Services 20 1396127866 0 Nurse Practitioners Physician Services 00 1396127890 0 KUPRIEN POLINA 2015159 9999999 B 10 1396127890 0 29373 NETWORK PL CHICAGO IL 606733039 20 1396127890 0 Physicians Anesthesia Services 20 1396127890 0 Physicians Fluoride varnish 20 1396127890 0 Physicians Healthy Kids Services 20 1396127890 0 Physicians Optical Supplies 20 1396127890 0 Physicians Physician Services 00 1396128393 0 LESS AUDREY A 2015244 9999999 B 10 1396128393 0 150 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TIMOTHY L 2020026 9999999 B 10 1396205530 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1396205530 0 Physicians Anesthesia Services 20 1396205530 0 Physicians Healthy Kids Services 20 1396205530 0 Physicians Optical Supplies 20 1396205530 0 Physicians Physician Services 00 1396205993 0 LEO PAUL 2019182 9999999 B 10 1396205993 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1396205993 0 Physicians Anesthesia Services 20 1396205993 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1396205993 0 Physicians Fluoride varnish 20 1396205993 0 Physicians Healthy Kids Services 20 1396205993 0 Physicians Optical Supplies 20 1396205993 0 Physicians Physician Services 00 1396206405 0 MAURER PAIGE K 2019217 9999999 B 10 1396206405 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1396206405 0 Physicians Anesthesia Services 20 1396206405 0 Physicians Healthy Kids Services 20 1396206405 0 Physicians Optical Supplies 20 1396206405 0 Physicians Physician Services 00 1396206611 0 CORNAGHIE MARY MARGARET 2024208 9999999 B 10 1396206611 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1396206611 0 Physicians Anesthesia Services 20 1396206611 0 Physicians Healthy Kids Services 20 1396206611 0 Physicians Optical Supplies 20 1396206611 0 Physicians Physician Services 00 1396206785 0 SWEENEY ERIC 2019194 9999999 B 10 1396206785 0 387 SHUMAN BLVD STE 275 NAPERVILLE IL 605638450 20 1396206785 0 Physicians Anesthesia Services 20 1396206785 0 Physicians Healthy Kids Services 20 1396206785 0 Physicians Optical Supplies 20 1396206785 0 Physicians Physician Services 00 1396206827 0 GASTON GINA 2021159 9999999 B 10 1396206827 0 145 S VIRGINIA ST STE C CRYSTAL LAKE IL 600147226 20 1396206827 0 Clinical Social Worker Social work service 00 1396206967 0 BROWN ELIZABETH E 2020172 9999999 B 10 1396206967 0 355 E ERIE ST CHICAGO IL 606113167 20 1396206967 0 Physicians Anesthesia Services 20 1396206967 0 Physicians Healthy Kids Services 20 1396206967 0 Physicians Optical Supplies 20 1396206967 0 Physicians Physician Services 00 1396207338 0 HARRIES MICHAEL D 2019175 9999999 B 10 1396207338 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1396207338 0 Physicians Anesthesia Services 20 1396207338 0 Physicians Fluoride varnish 20 1396207338 0 Physicians Healthy Kids Services 20 1396207338 0 Physicians Optical Supplies 20 1396207338 0 Physicians Physician Services 00 1396207395 0 RUBIN JACOB P 2024128 9999999 B 10 1396207395 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1396207395 0 Physicians Anesthesia Services 20 1396207395 0 Physicians Healthy Kids Services 20 1396207395 0 Physicians Optical Supplies 20 1396207395 0 Physicians Physician Services 00 1396207783 0 SPITZ HUNTER 2024220 9999999 B 10 1396207783 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1396207783 0 Physicians Anesthesia Services 20 1396207783 0 Physicians Healthy Kids Services 20 1396207783 0 Physicians Optical Supplies 20 1396207783 0 Physicians Physician Services 00 1396208294 0 REDONDO MICHAEL 2019182 9999999 B 10 1396208294 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1396208294 0 Physicians Anesthesia Services 20 1396208294 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1396208294 0 Physicians Healthy Kids Services 20 1396208294 0 Physicians Optical Supplies 20 1396208294 0 Physicians Physician Services 00 1396210647 0 WEBSTER SUZANNE 2024009 9999999 B 10 1396210647 0 28100 TORCH PKWY STE 600 WARRENVILLE IL 605554030 20 1396210647 0 Physical Therapists Medical Supplies 20 1396210647 0 Physical Therapists Medical equipment/prosthetic devices 20 1396210647 0 Physical Therapists Physical Therapy Services 00 1396210829 0 GETTY KRISTINA 2018284 9999999 B 10 1396210829 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1396210829 0 Occupational Therapists Medical Supplies 20 1396210829 0 Occupational Therapists Medical equipment/prosthetic devices 20 1396210829 0 Occupational Therapists Occupational Therapy Services 00 1396211066 0 KIM JENNIFER 2018361 9999999 B 10 1396211066 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1396211066 0 Registered nurse Nursing service 20 1396211066 0 Registered nurse Waiver service 00 1396211769 0 HAYNES CAMILLE 2018355 9999999 B 10 1396211769 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1396211769 0 Registered nurse Nursing service 20 1396211769 0 Registered nurse Waiver service 00 1396214425 0 SALEM MUSERRAH 2020223 9999999 B 10 1396214425 0 830 W DIVERSEY PKWY FL 2 CHICAGO IL 606141454 20 1396214425 0 Dentists Dental Services 20 1396214425 0 Dentists Physician Services 00 1396216354 0 MILEON-ETUK OLYNDA B 2019014 9999999 B 10 1396216354 0 800 W FULTON MARKET FL 12 CHICAGO IL 606071302 20 1396216354 0 Physician Assistant Only Electronic Home Response/EHR Installation, MPE Certification 20 1396216354 0 Physician Assistant Only Fluoride varnish 20 1396216354 0 Physician Assistant Only Healthy Kids Services 20 1396216354 0 Physician Assistant Only Physician Services 00 1396216990 0 LINDQUIST CARLY 2019001 9999999 B 10 1396216990 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1396216990 0 Nurse Practitioners Fluoride varnish 20 1396216990 0 Nurse Practitioners Healthy Kids Services 20 1396216990 0 Nurse Practitioners Nurse Practitioners Services 20 1396216990 0 Nurse Practitioners Physician Services 00 1396217048 0 VANTILBURG WENDY 2018354 9999999 B 10 1396217048 0 201 E JEFFERSON ST JOLIET IL 604322841 20 1396217048 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1396218202 0 DEMSAR JENNIFER A 2019007 9999999 B 10 1396218202 0 PO BOX 378 SPARTA IL 622860378 20 1396218202 0 Nurse Practitioners Fluoride varnish 20 1396218202 0 Nurse Practitioners Healthy Kids Services 20 1396218202 0 Nurse Practitioners Nurse Practitioners Services 20 1396218202 0 Nurse Practitioners Physician Services 00 1396219176 0 DEEN MOHAMMAD J 2019060 9999999 B 10 1396219176 0 120 W 22ND ST OAK BROOK IL 605231557 20 1396219176 0 Nurse Practitioners Anesthesia Services 20 1396219176 0 Nurse Practitioners Nurse Practitioners Services 20 1396219176 0 Nurse Practitioners Physician Services 00 1396219705 0 OTTO SARA 2021168 9999999 B 10 1396219705 0 1900 E GOLF RD STE 950 SCHAUMBURG IL 601735034 20 1396219705 0 Other behavior health professional Adaptive behavior support clinician services 00 1396221057 0 RAPOSO MORALES EVA 2022172 9999999 B 10 1396221057 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112323 20 1396221057 0 Dentists Dental Services 20 1396221057 0 Dentists Physician Services 00 1396222048 0 GUDENKAUF KATIE 2019149 9999999 B 10 1396222048 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1396222048 0 Nurse Practitioners Fluoride varnish 20 1396222048 0 Nurse Practitioners Healthy Kids Services 20 1396222048 0 Nurse Practitioners Nurse Practitioners Services 20 1396222048 0 Nurse Practitioners Physician Services 00 1396222675 0 MILLER CORY P 2018365 9999999 B 10 1396222675 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1396222675 0 Physicians Anesthesia Services 20 1396222675 0 Physicians Fluoride varnish 20 1396222675 0 Physicians Healthy Kids Services 20 1396222675 0 Physicians Optical Supplies 20 1396222675 0 Physicians Physician Services 00 1396223095 0 PECHACEK JAIME E 2018239 9999999 B 10 1396223095 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1396223095 0 Physician Assistant Only Fluoride varnish 20 1396223095 0 Physician Assistant Only Healthy Kids Services 20 1396223095 0 Physician Assistant Only Physician Services 00 1396223467 0 KEPPY TAYLOR 2018214 9999999 B 10 1396223467 0 850 43RD AVE STE 100 MOLINE IL 612658401 20 1396223467 0 Physical Therapists Medical Supplies 20 1396223467 0 Physical Therapists Medical equipment/prosthetic devices 20 1396223467 0 Physical Therapists Physical Therapy Services 00 1396225041 0 ROTTINGHAUS GINA 2020141 9999999 B 10 1396225041 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1396225041 0 Nurse Practitioners Healthy Kids Services 20 1396225041 0 Nurse Practitioners Nurse Practitioners Services 20 1396225041 0 Nurse Practitioners Physician Services 00 1396225199 0 HAMMEL KRISTEN C 2018276 9999999 B 10 1396225199 0 7757 US ROUTE 136 POTOMAC IL 618653047 20 1396225199 0 Other behavior health professional LCPC/LMFT services 00 1396225280 0 FRANCIS STEFFANIE 2018347 9999999 B 10 1396225280 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1396225280 0 Physician Assistant Only Fluoride varnish 20 1396225280 0 Physician Assistant Only Healthy Kids Services 20 1396225280 0 Physician Assistant Only Physician Services 00 1396225942 0 SMITH OLIVIA 2018226 9999999 B 10 1396225942 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1396225942 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1396226908 0 GIL VALENTINA 2018250 9999999 B 10 1396226908 0 42 W MADISON ST FL 2 CHICAGO IL 606024309 20 1396226908 0 Speech Therapists Medical Supplies 20 1396226908 0 Speech Therapists Medical equipment/prosthetic devices 20 1396226908 0 Speech Therapists Speech Therapy/Pathology Services 00 1396228607 0 TREXLER MIKAELA B 2019289 9999999 B 10 1396228607 0 4033 S ILLINOIS AVE CARBONDALE IL 629038375 20 1396228607 0 Speech Therapists Speech Therapy/Pathology Services 00 1396228631 0 THAMMARATH NIRANDONE 2018256 9999999 B 10 1396228631 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1396228631 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1396229043 0 TRAVERSO SARAH 2018345 9999999 B 10 1396229043 0 5777 DEPT CAROL STREAM IL 601220021 20 1396229043 0 Physician Assistant Only Fluoride varnish 20 1396229043 0 Physician Assistant Only Healthy Kids Services 20 1396229043 0 Physician Assistant Only Physician Services 00 1396229522 0 GERRINGER ALISON J 2018320 9999999 B 10 1396229522 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1396229522 0 Nurse Practitioners Fluoride varnish 20 1396229522 0 Nurse Practitioners Healthy Kids Services 20 1396229522 0 Nurse Practitioners Nurse Practitioners Services 20 1396229522 0 Nurse Practitioners Physician Services 00 1396230009 0 JOSHI RESHMA 2023206 9999999 B 10 1396230009 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1396230009 0 Physicians Anesthesia Services 20 1396230009 0 Physicians Fluoride varnish 20 1396230009 0 Physicians Healthy Kids Services 20 1396230009 0 Physicians Optical Supplies 20 1396230009 0 Physicians Physician Services 00 1396230025 0 BARD AMBER J 2019001 9999999 B 10 1396230025 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1396230025 0 Physicians Anesthesia Services 20 1396230025 0 Physicians Healthy Kids Services 20 1396230025 0 Physicians Optical Supplies 20 1396230025 0 Physicians Physician Services 20 1396230025 0 Physicians Physicians Psychiatric Services 00 1396230462 0 MCCARTY OMAR 2019303 9999999 B 10 1396230462 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1396230462 0 Physicians Anesthesia Services 20 1396230462 0 Physicians Healthy Kids Services 20 1396230462 0 Physicians Optical Supplies 20 1396230462 0 Physicians Physician Services 00 1396231056 0 MARTINEZ EMANUEL 2021148 9999999 B 10 1396231056 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1396231056 0 Physicians Anesthesia Services 20 1396231056 0 Physicians Healthy Kids Services 20 1396231056 0 Physicians Optical Supplies 20 1396231056 0 Physicians Physician Services 20 1396231056 0 Physicians Physicians Psychiatric Services 00 1396231379 0 JAMIL SAAD 2018257 9999999 B 10 1396231379 0 5777 DEPT CAROL STREAM IL 601228942 20 1396231379 0 Physicians Anesthesia Services 20 1396231379 0 Physicians Fluoride varnish 20 1396231379 0 Physicians Healthy Kids Services 20 1396231379 0 Physicians Optical Supplies 20 1396231379 0 Physicians Physician Services 00 1396231676 0 JANI SHRUTVA 2018194 9999999 B 10 1396231676 0 1739 N ELSTON AVE CHICAGO IL 606421544 20 1396231676 0 Occupational Therapists Medical Supplies 20 1396231676 0 Occupational Therapists Medical equipment/prosthetic devices 20 1396231676 0 Occupational Therapists Occupational Therapy Services 00 1396231767 0 WRIGHT LAUREN 2018281 9999999 B 10 1396231767 0 1120 N MELVIN ST GIBSON CITY IL 609361477 20 1396231767 0 Nurse Practitioners Fluoride varnish 20 1396231767 0 Nurse Practitioners Healthy Kids Services 20 1396231767 0 Nurse Practitioners Nurse Practitioners Services 20 1396231767 0 Nurse Practitioners Physician Services 00 1396233136 0 QURAISHI SARAH 2022012 9999999 B 10 1396233136 0 5777 DEPT CAROL STREAM IL 601220021 20 1396233136 0 Physicians Anesthesia Services 20 1396233136 0 Physicians Fluoride varnish 20 1396233136 0 Physicians Healthy Kids Services 20 1396233136 0 Physicians Optical Supplies 20 1396233136 0 Physicians Physician Services 00 1396233433 0 RAND CAREY 2018131 9999999 B 10 1396233433 0 707 LAKE COOK RD STE 105 DEERFIELD IL 600154909 20 1396233433 0 Clinical Social Worker Social work service 00 1396234571 0 HAMMOUR RASHAD 2020022 9999999 B 10 1396234571 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1396234571 0 Physicians Anesthesia Services 20 1396234571 0 Physicians Fluoride varnish 20 1396234571 0 Physicians Healthy Kids Services 20 1396234571 0 Physicians Optical Supplies 20 1396234571 0 Physicians Physician Services 00 1396235180 0 BELITZ BRIAN A 2018274 9999999 B 10 1396235180 0 1518 MULBERRY AVE MUSCATINE IA 527613433 20 1396235180 0 Nurse Practitioners Fluoride varnish 20 1396235180 0 Nurse Practitioners Healthy Kids Services 20 1396235180 0 Nurse Practitioners Nurse Practitioners Services 20 1396235180 0 Nurse Practitioners Physician Services 00 1396235461 0 HUMBLE STEPHEN 2023056 9999999 B 10 1396235461 0 PO BOX 1437 COLUMBUS GA 319021437 20 1396235461 0 Physicians Anesthesia Services 20 1396235461 0 Physicians Healthy Kids Services 20 1396235461 0 Physicians Optical Supplies 20 1396235461 0 Physicians Physician Services 00 1396235792 0 MEGALLY AMALIA M 2018227 9999999 B 10 1396235792 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1396235792 0 Physician Assistant Only Fluoride varnish 20 1396235792 0 Physician Assistant Only Healthy Kids Services 20 1396235792 0 Physician Assistant Only Physician Services 00 1396235800 0 MARACHI AYA 2021210 9999999 B 10 1396235800 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1396235800 0 Physicians Anesthesia Services 20 1396235800 0 Physicians Healthy Kids Services 20 1396235800 0 Physicians Optical Supplies 20 1396235800 0 Physicians Physician Services 00 1396235933 0 SCHOLLENBERGER AMY 2018138 9999999 B 10 1396235933 0 PO BOX 790126 SAINT LOUIS MO 631790126 20 1396235933 0 Nurse Practitioners Anesthesia Services 20 1396235933 0 Nurse Practitioners Nurse Practitioners Services 20 1396235933 0 Nurse Practitioners Physician Services 00 1396236220 0 FROMAL OLLYA 2024191 9999999 B 10 1396236220 0 PO BOX 60394 SAINT LOUIS MO 631600394 20 1396236220 0 Physicians Anesthesia Services 20 1396236220 0 Physicians Healthy Kids Services 20 1396236220 0 Physicians Optical Supplies 20 1396236220 0 Physicians Physician Services 00 1396236287 0 TALLMAN BRANDON 2019268 9999999 B 10 1396236287 0 124 SW ADAMS ST PEORIA IL 616021308 20 1396236287 0 Physicians Anesthesia Services 20 1396236287 0 Physicians Fluoride varnish 20 1396236287 0 Physicians Healthy Kids Services 20 1396236287 0 Physicians Optical Supplies 20 1396236287 0 Physicians Physician Services 00 1396236402 0 FRICK WILLIAM 2021234 9999999 B 10 1396236402 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1396236402 0 Physicians Anesthesia Services 20 1396236402 0 Physicians Fluoride varnish 20 1396236402 0 Physicians Healthy Kids Services 20 1396236402 0 Physicians Optical Supplies 20 1396236402 0 Physicians Physician Services 00 1396237095 0 TRACE ELIAS D 2018255 9999999 B 10 1396237095 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1396237095 0 Physicians Anesthesia Services 20 1396237095 0 Physicians Healthy Kids Services 20 1396237095 0 Physicians Optical Supplies 20 1396237095 0 Physicians Physician Services 00 1396237376 0 JOHNSON JENNIFER L 2018255 9999999 B 10 1396237376 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1396237376 0 Nurse Practitioners Nursing service 20 1396237376 0 Nurse Practitioners Waiver service 00 1396237459 0 SABBAR ALI 2018159 9999999 B 10 1396237459 0 1753 W ALGONQUIN RD MOUNT PROSPECT IL 600565401 20 1396237459 0 Dentists Dental Services 20 1396237459 0 Dentists Physician Services 00 1396238192 0 MEHROTRA MAYANK 2023262 9999999 B 10 1396238192 0 4701 DEPT CAROL STREAM IL 601220021 20 1396238192 0 Physicians Anesthesia Services 20 1396238192 0 Physicians Healthy Kids Services 20 1396238192 0 Physicians Optical Supplies 20 1396238192 0 Physicians Physician Services 00 1396239125 0 GLENN GEORGE 2023347 9999999 B 10 1396239125 0 111 OAKWOOD RD EAST PEORIA IL 616111853 20 1396239125 0 Physicians Anesthesia Services 20 1396239125 0 Physicians Healthy Kids Services 20 1396239125 0 Physicians Optical Supplies 20 1396239125 0 Physicians Physician Services 00 1396239273 0 ABUGHNAIM TAMATHOR 2020029 9999999 B 10 1396239273 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1396239273 0 Physicians Anesthesia Services 20 1396239273 0 Physicians Healthy Kids Services 20 1396239273 0 Physicians Optical Supplies 20 1396239273 0 Physicians Physician Services 00 1396239372 0 BOCO ULYSSES 2024235 9999999 B 10 1396239372 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1396239372 0 Physicians Anesthesia Services 20 1396239372 0 Physicians Fluoride varnish 20 1396239372 0 Physicians Healthy Kids Services 20 1396239372 0 Physicians Optical Supplies 20 1396239372 0 Physicians Physician Services 00 1396239596 0 URIBE LISA N 2018182 9999999 B 10 1396239596 0 14620 S LA GRANGE RD STE 2 ORLAND PARK IL 604622581 20 1396239596 0 Nurse Practitioners Fluoride varnish 20 1396239596 0 Nurse Practitioners Healthy Kids Services 20 1396239596 0 Nurse Practitioners Nurse Practitioners Services 20 1396239596 0 Nurse Practitioners Physician Services 00 1396240180 0 SIBLEY ROBERT R 2020075 9999999 B 10 1396240180 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1396240180 0 Physicians Anesthesia Services 20 1396240180 0 Physicians Healthy Kids Services 20 1396240180 0 Physicians Optical Supplies 20 1396240180 0 Physicians Physician Services 00 1396240214 0 ABROL SRISHTI 2023184 9999999 B 10 1396240214 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1396240214 0 Physicians Anesthesia Services 20 1396240214 0 Physicians Healthy Kids Services 20 1396240214 0 Physicians Optical Supplies 20 1396240214 0 Physicians Physician Services 00 1396240461 0 SINGAPORI MANSI 2024215 9999999 B 10 1396240461 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1396240461 0 Physicians Anesthesia Services 20 1396240461 0 Physicians Fluoride varnish 20 1396240461 0 Physicians Healthy Kids Services 20 1396240461 0 Physicians Optical Supplies 20 1396240461 0 Physicians Physician Services 00 1396240669 0 MORIMOTO JUDY A 2018128 9999999 B 10 1396240669 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1396240669 0 Nurse Practitioners Healthy Kids Services 20 1396240669 0 Nurse Practitioners Nurse Practitioners Services 20 1396240669 0 Nurse Practitioners Physician Services 00 1396241204 0 ALWINE ANNICA LEIGH 2024359 9999999 B 10 1396241204 0 5901 LINCOLN DR EDINA MN 554361611 20 1396241204 0 Physicians Anesthesia Services 20 1396241204 0 Physicians Fluoride varnish 20 1396241204 0 Physicians Healthy Kids Services 20 1396241204 0 Physicians Optical Supplies 20 1396241204 0 Physicians Physician Services 00 1396241311 0 PHAN NOEL 2024038 9999999 B 10 1396241311 0 PO BOX 3988 CARBONDALE IL 629023988 20 1396241311 0 Physicians Anesthesia Services 20 1396241311 0 Physicians Healthy Kids Services 20 1396241311 0 Physicians Optical Supplies 20 1396241311 0 Physicians Physician Services 00 1396242053 0 WILLIAMS KATHERINE M 2022290 9999999 B 10 1396242053 0 2801 LAKESIDE DR STE 209 BANNOCKBURN IL 600151271 20 1396242053 0 Physicians Anesthesia Services 20 1396242053 0 Physicians Healthy Kids Services 20 1396242053 0 Physicians Optical Supplies 20 1396242053 0 Physicians Physician Services 00 1396242954 0 NANDAMURU PRAVEEN 2018182 9999999 B 10 1396242954 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1396242954 0 Physicians Anesthesia Services 20 1396242954 0 Physicians Fluoride varnish 20 1396242954 0 Physicians Healthy Kids Services 20 1396242954 0 Physicians Optical Supplies 20 1396242954 0 Physicians Physician Services 00 1396243515 0 ZAYAT RACHEL 2018043 9999999 B 10 1396243515 0 2900 FOXFIELD RD STE 102 ST CHARLES IL 601745799 20 1396243515 0 Physician Assistant Only Fluoride varnish 20 1396243515 0 Physician Assistant Only Healthy Kids Services 20 1396243515 0 Physician Assistant Only Physician Services 00 1396243978 0 GARDNER AMBER 2022095 9999999 B 10 1396243978 0 9944 S ROBERTS RD STE 202 PALOS HILLS IL 604651558 20 1396243978 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1396244208 0 KIPP STEPHANIE 2018058 9999999 B 10 1396244208 0 5730 W ROOSEVELT RD CHICAGO IL 606441580 20 1396244208 0 Other behavior health professional LCPC/LMFT services 00 1396246211 0 BARTEL ELIANA 2017238 9999999 B 10 1396246211 0 422 N NORTHWEST HWY STE 210 PARK RIDGE IL 600683261 20 1396246211 0 Physical Therapists Medical Supplies 20 1396246211 0 Physical Therapists Medical equipment/prosthetic devices 20 1396246211 0 Physical Therapists Occupational Therapy Services 00 1396246401 0 MALE SHANNON K 2018058 9999999 B 10 1396246401 0 350 N WALL ST KANKAKEE IL 609012901 20 1396246401 0 Nurse Practitioners Fluoride varnish 20 1396246401 0 Nurse Practitioners Healthy Kids Services 20 1396246401 0 Nurse Practitioners Nurse Practitioners Services 20 1396246401 0 Nurse Practitioners Physician Services 00 1396246450 0 PARTYKA JESSICA 2018058 9999999 B 10 1396246450 0 731 S IL ROUTE 21 STE 120 UNIT 120 GURNEE IL 600313803 20 1396246450 0 Nurse Practitioners Fluoride varnish 20 1396246450 0 Nurse Practitioners Healthy Kids Services 20 1396246450 0 Nurse Practitioners Nurse Practitioners Services 20 1396246450 0 Nurse Practitioners Physician Services 00 1396246815 0 PRANGE HANNAH 2022327 9999999 B 10 1396246815 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1396246815 0 Nurse Practitioners Fluoride varnish 20 1396246815 0 Nurse Practitioners Healthy Kids Services 20 1396246815 0 Nurse Practitioners Nurse Practitioners Services 20 1396246815 0 Nurse Practitioners Physician Services 00 1396248464 0 JONES AMBER K 2018074 9999999 B 10 1396248464 0 1404 EASTLAND DR STE 103 BLOOMINGTON IL 617017904 20 1396248464 0 Nurse Practitioners Fluoride varnish 20 1396248464 0 Nurse Practitioners Healthy Kids Services 20 1396248464 0 Nurse Practitioners Nurse Practitioners Services 20 1396248464 0 Nurse Practitioners Physician Services 00 1396249009 0 NAKHAIMA SELASI M 2019304 9999999 B 10 1396249009 0 11475 OLDE CABIN RD STE 200 SAINT LOUIS MO 631417129 20 1396249009 0 Physicians Anesthesia Services 20 1396249009 0 Physicians Healthy Kids Services 20 1396249009 0 Physicians Optical Supplies 20 1396249009 0 Physicians Physician Services 00 1396249553 0 GELARDEN IAN 2023179 9999999 B 10 1396249553 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1396249553 0 Physicians Anesthesia Services 20 1396249553 0 Physicians Healthy Kids Services 20 1396249553 0 Physicians Optical Supplies 20 1396249553 0 Physicians Physician Services 00 1396249561 0 KHAIRALLAH JASSER 2018159 9999999 B 10 1396249561 0 4698 DEPT CAROL STREAM IL 601220021 20 1396249561 0 Physicians Anesthesia Services 20 1396249561 0 Physicians Fluoride varnish 20 1396249561 0 Physicians Healthy Kids Services 20 1396249561 0 Physicians Optical Supplies 20 1396249561 0 Physicians Physician Services 00 1396249694 0 SIRAFI RASHAD 2022147 9999999 B 10 1396249694 0 PO BOX 43230 PHOENIX AZ 850803230 20 1396249694 0 Physicians Anesthesia Services 20 1396249694 0 Physicians Healthy Kids Services 20 1396249694 0 Physicians Optical Supplies 20 1396249694 0 Physicians Physician Services 00 1396249751 0 KWON CHRISTINE 2018182 9999999 B 10 1396249751 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1396249751 0 Physicians All Kids application agent 20 1396249751 0 Physicians Anesthesia Services 20 1396249751 0 Physicians Healthy Kids Services 20 1396249751 0 Physicians Optical Supplies 20 1396249751 0 Physicians Physician Services 00 1396249850 0 PHAM KATHLEEN 2018159 9999999 B 10 1396249850 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1396249850 0 Physicians Anesthesia Services 20 1396249850 0 Physicians Fluoride varnish 20 1396249850 0 Physicians Healthy Kids Services 20 1396249850 0 Physicians Optical Supplies 20 1396249850 0 Physicians Physician Services 00 1396249967 0 MARTI AMARISTA CRISTINA 2023194 9999999 B 10 1396249967 0 1395 NW 167TH ST MIAMI 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Physicians Fluoride varnish 20 1396740395 0 Physicians Healthy Kids Services 20 1396740395 0 Physicians Optical Supplies 20 1396740395 0 Physicians Physician Services 00 1396740981 0 ARIANO MOIRA 1985125 9999999 B 10 1396740981 0 820 SPRINGER DR LOMBARD IL 601486413 20 1396740981 0 Physicians Anesthesia Services 20 1396740981 0 Physicians Healthy Kids Services 20 1396740981 0 Physicians Optical Supplies 20 1396740981 0 Physicians Physician Services 00 1396741666 0 SCHAEFER ROBERT 2015337 9999999 B 10 1396741666 0 339 CONSORT DR BALLWIN MO 630114439 20 1396741666 0 Physicians Anesthesia Services 20 1396741666 0 Physicians Healthy Kids Services 20 1396741666 0 Physicians Optical Supplies 20 1396741666 0 Physicians Physician Services 00 1396742060 0 HARRIS CHRISTOPHER E C 1986202 9999999 B 10 1396742060 0 303 E PARK AVE LIBERTYVILLE IL 600482872 20 1396742060 0 Physicians Anesthesia Services 20 1396742060 0 Physicians Fluoride varnish 20 1396742060 0 Physicians Healthy Kids Services 20 1396742060 0 Physicians Optical Supplies 20 1396742060 0 Physicians Physician Services 00 1396742748 0 BRIGNOL YVES 1994244 9999999 B 10 1396742748 0 120 W 22ND ST OAK BROOK IL 605231557 20 1396742748 0 Physicians Anesthesia Services 20 1396742748 0 Physicians Fluoride varnish 20 1396742748 0 Physicians Healthy Kids Services 20 1396742748 0 Physicians Optical Supplies 20 1396742748 0 Physicians Physician Services 00 1396743647 0 SADOWSKI DAWN 1998293 9999999 B 10 1396743647 0 1630 W CENTRAL RD ARLINGTON HEIGH IL 600052407 20 1396743647 0 Physicians Anesthesia Services 20 1396743647 0 Physicians Healthy Kids Services 20 1396743647 0 Physicians Optical Supplies 20 1396743647 0 Physicians Physician Services 00 1396743928 0 LEE JUNG H 2016281 9999999 B 10 1396743928 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1396743928 0 Physicians Anesthesia Services 20 1396743928 0 Physicians Fluoride varnish 20 1396743928 0 Physicians Healthy Kids Services 20 1396743928 0 Physicians Optical 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1396744934 0 Physicians Physicians Psychiatric Services 00 1396745717 0 GOLDBERG GREGG 1986365 9999999 B 10 1396745717 0 PO BOX 85442 CHICAGO IL 606895442 20 1396745717 0 Physicians Anesthesia Services 20 1396745717 0 Physicians Healthy Kids Services 20 1396745717 0 Physicians Optical Supplies 20 1396745717 0 Physicians Physician Services 00 1396746616 0 CULLEN JOSEPH J 1993167 9999999 B 10 1396746616 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1396746616 0 Physicians Anesthesia Services 20 1396746616 0 Physicians Healthy Kids Services 20 1396746616 0 Physicians Optical Supplies 20 1396746616 0 Physicians Physician Services 00 1396746822 0 GHABRA MOHAMMED 1998244 9999999 B 10 1396746822 0 3012 OAK BROOK DR OAK BROOK IL 605231628 20 1396746822 0 Physicians Anesthesia Services 20 1396746822 0 Physicians Healthy Kids Services 20 1396746822 0 Physicians Optical Supplies 20 1396746822 0 Physicians Physician Services 20 1396746822 0 Physicians Physicians Psychiatric Services 00 1396747374 0 MIGA ANDRZEJ 2004197 9999999 B 10 1396747374 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1396747374 0 Physicians Anesthesia Services 20 1396747374 0 Physicians Healthy Kids Services 20 1396747374 0 Physicians Optical Supplies 20 1396747374 0 Physicians Physician Services 00 1396748992 0 ACKLEY SCOTT 1994335 9999999 B 10 1396748992 0 6100 W 96TH ST STE 125 INDIANAPOLIS IN 462786006 20 1396748992 0 Physicians Anesthesia Services 20 1396748992 0 Physicians Healthy Kids Services 20 1396748992 0 Physicians Optical Supplies 20 1396748992 0 Physicians Physician Services 00 1396749628 0 JANUSZ ALEX 2022077 9999999 B 10 1396749628 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1396749628 0 Physicians Anesthesia Services 20 1396749628 0 Physicians Healthy Kids Services 20 1396749628 0 Physicians Optical Supplies 20 1396749628 0 Physicians Physician Services 20 1396749628 0 Physicians Physicians Psychiatric Services 00 1396749867 0 CAMBRON KATHRYN 2024253 9999999 B 10 1396749867 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1396749867 0 Physicians Anesthesia Services 20 1396749867 0 Physicians Healthy Kids Services 20 1396749867 0 Physicians Optical Supplies 20 1396749867 0 Physicians Physician Services 00 1396750600 0 FITZGERALD COLLEEN 2000032 9999999 B 10 1396750600 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1396750600 0 Physicians Anesthesia Services 20 1396750600 0 Physicians Healthy Kids Services 20 1396750600 0 Physicians Optical Supplies 20 1396750600 0 Physicians Physician Services 00 1396751350 0 KEESHIN SUSAN 1995182 9999999 B 10 1396751350 0 355 E ERIE ST CHICAGO IL 606113167 20 1396751350 0 Physicians Anesthesia Services 20 1396751350 0 Physicians Healthy Kids Services 20 1396751350 0 Physicians Optical Supplies 20 1396751350 0 Physicians Physician Services 00 1396752218 0 BOYER MARY 2021078 9999999 B 10 1396752218 0 PO BOX 486 SAN JACINTO CA 925810486 20 1396752218 0 Physicians Anesthesia Services 20 1396752218 0 Physicians Healthy Kids 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Physicians Healthy Kids Services 20 1396753018 0 Physicians Optical Supplies 20 1396753018 0 Physicians Physician Services 00 1396753059 0 EDWARDS ROBERT 1982138 9999999 B 10 1396753059 0 3055 WABASH AVE SPRINGFIELD IL 627046414 20 1396753059 0 Optometrists Optical Supplies 20 1396753059 0 Optometrists Optometric Services 20 1396753059 0 Optometrists Physician Services 00 1396753083 0 SHEIKH SALMAN Q 2003288 9999999 B 10 1396753083 0 2000 OGDEN AVE AURORA IL 605047222 20 1396753083 0 Physicians Anesthesia Services 20 1396753083 0 Physicians Fluoride varnish 20 1396753083 0 Physicians Healthy Kids Services 20 1396753083 0 Physicians Optical Supplies 20 1396753083 0 Physicians Physician Services 00 1396753406 0 GARSON JENNIFER 2016001 9999999 B 10 1396753406 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1396753406 0 Physician Assistant Only Fluoride varnish 20 1396753406 0 Physician Assistant Only Healthy Kids Services 20 1396753406 0 Physician Assistant Only Physician 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1396755740 0 NORDICK GARY 2018296 9999999 B 10 1396755740 0 2100 52ND AVE MOLINE IL 612656366 20 1396755740 0 Psychologist Psychologist service 00 1396755856 0 WYATT AMY 2006226 9999999 B 10 1396755856 0 7562 OLD ROUTE 13 MARION IL 629597776 20 1396755856 0 Dentists Dental Services 20 1396755856 0 Dentists Physician Services 00 1396755914 0 KRISHNARAO TANGELLA 2003112 9999999 B 10 1396755914 0 PO BOX 6146 CHAMPAIGN IL 618266146 20 1396755914 0 Physicians Anesthesia Services 20 1396755914 0 Physicians Healthy Kids Services 20 1396755914 0 Physicians Optical Supplies 20 1396755914 0 Physicians Physician Services 00 1396756748 0 BARBER ANGELA 1992216 9999999 B 10 1396756748 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1396756748 0 Physicians Anesthesia Services 20 1396756748 0 Physicians Healthy Kids Services 20 1396756748 0 Physicians Optical Supplies 20 1396756748 0 Physicians Physician Services 00 1396757050 0 KANUMURY RATNA 2015350 9999999 B 10 1396757050 0 1901 W HARRISON ST 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1396773842 0 PO BOX 208807 DALLAS TX 753208807 20 1396773842 0 Physicians Anesthesia Services 20 1396773842 0 Physicians Healthy Kids Services 20 1396773842 0 Physicians Optical Supplies 20 1396773842 0 Physicians Physician Services 00 1396774055 0 ZINANNI JANIS 2009001 9999999 B 10 1396774055 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1396774055 0 Nurse Practitioners Healthy Kids Services 20 1396774055 0 Nurse Practitioners Nurse Practitioners Services 20 1396774055 0 Nurse Practitioners Physician Services 00 1396774485 0 GIROUX JOHN 1988214 9999999 B 10 1396774485 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1396774485 0 Physicians Anesthesia Services 20 1396774485 0 Physicians Fluoride varnish 20 1396774485 0 Physicians Healthy Kids Services 20 1396774485 0 Physicians Optical Supplies 20 1396774485 0 Physicians Physician Services 00 1396775185 0 BODINE CHRISTOPHER 1995212 9999999 B 10 1396775185 0 800 E LOCUST ST OLNEY IL 624502553 20 1396775185 0 Physicians 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6308 8TH AVE KENOSHA WI 531435031 20 1396779989 0 Physicians Anesthesia Services 20 1396779989 0 Physicians Fluoride varnish 20 1396779989 0 Physicians Healthy Kids Services 20 1396779989 0 Physicians Optical Supplies 20 1396779989 0 Physicians Physician Services 00 1396780102 0 AMUH SHELLEY 1999091 9999999 B 10 1396780102 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1396780102 0 Physicians Anesthesia Services 20 1396780102 0 Physicians Healthy Kids Services 20 1396780102 0 Physicians Optical Supplies 20 1396780102 0 Physicians Physician Services 00 1396780862 0 TREPASHKO DONALD W 1990078 9999999 B 10 1396780862 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1396780862 0 Physicians Anesthesia Services 20 1396780862 0 Physicians Healthy Kids Services 20 1396780862 0 Physicians Optical Supplies 20 1396780862 0 Physicians Physician Services 00 1396781654 0 KULSTAD ROGER 2007135 9999999 B 10 1396781654 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1396781654 0 Physicians Anesthesia 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1407259559 0 Nurse Practitioners Nurse Practitioners Services 20 1407259559 0 Nurse Practitioners Physician Services 00 1407260110 0 PATEL ANJU 2017226 9999999 B 10 1407260110 0 1401 E 12TH ST MENDOTA IL 613429216 20 1407260110 0 Physicians Anesthesia Services 20 1407260110 0 Physicians Fluoride varnish 20 1407260110 0 Physicians Healthy Kids Services 20 1407260110 0 Physicians Optical Supplies 20 1407260110 0 Physicians Physician Services 00 1407260227 0 GIDAY GENET F 2017215 9999999 B 10 1407260227 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1407260227 0 Physicians Anesthesia Services 20 1407260227 0 Physicians Fluoride varnish 20 1407260227 0 Physicians Healthy Kids Services 20 1407260227 0 Physicians Optical Supplies 20 1407260227 0 Physicians Physician Services 00 1407260755 0 CHUN LAURA 2018117 9999999 B 10 1407260755 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1407260755 0 Physicians Anesthesia Services 20 1407260755 0 Physicians Healthy Kids Services 20 1407260755 0 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Services 20 1407264187 0 Nurse Practitioners Physician Services 00 1407264203 0 WAHIDI NASRATULLAH N 2021188 9999999 B 10 1407264203 0 3051 HOLLIS DR SPRINGFIELD IL 627047452 20 1407264203 0 Physicians Anesthesia Services 20 1407264203 0 Physicians Healthy Kids Services 20 1407264203 0 Physicians Optical Supplies 20 1407264203 0 Physicians Physician Services 20 1407264203 0 Physicians Physicians Psychiatric Services 00 1407264385 0 MCBURNEY ELIZABETH 2017262 9999999 B 10 1407264385 0 PO BOX 504469 SAINT LOUIS MO 631504469 20 1407264385 0 Speech Therapists Medical Supplies 20 1407264385 0 Speech Therapists Medical equipment/prosthetic devices 20 1407264385 0 Speech Therapists Speech Therapy/Pathology Services 00 1407264716 0 PATEL JIGNESH 2014206 9999999 B 10 1407264716 0 1120 N MAIN ST STE 2 GLENDALE HEIGHT IL 601393511 20 1407264716 0 Dentists Dental Services 20 1407264716 0 Dentists Physician Services 00 1407265432 0 CURRY MELISSA 2014230 9999999 B 10 1407265432 0 908 N RIDGEWAY AVE 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Services 00 1407433055 0 BRENNAN MEGAN 2021129 9999999 B 10 1407433055 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1407433055 0 Physicians Anesthesia Services 20 1407433055 0 Physicians Fluoride varnish 20 1407433055 0 Physicians Healthy Kids Services 20 1407433055 0 Physicians Optical Supplies 20 1407433055 0 Physicians Physician Services 00 1407433477 0 BENSON CHARLES E 2021186 9999999 B 10 1407433477 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1407433477 0 Physicians Anesthesia Services 20 1407433477 0 Physicians Fluoride varnish 20 1407433477 0 Physicians Healthy Kids Services 20 1407433477 0 Physicians Optical Supplies 20 1407433477 0 Physicians Physician Services 00 1407433634 0 DEHGHAN YALDA 2021160 9999999 B 10 1407433634 0 541 N FAIRBANKS CT PFS 25TH FLOOR CHICAGO IL 606113319 20 1407433634 0 Physicians Anesthesia Services 20 1407433634 0 Physicians Fluoride varnish 20 1407433634 0 Physicians Healthy Kids Services 20 1407433634 0 Physicians Optical Supplies 20 1407433634 0 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Practitioners Services 20 1407476096 0 Nurse Practitioners Physician Services 00 1407476153 0 HILD KAITLYN 2024219 9999999 B 10 1407476153 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1407476153 0 Physician Assistant Only Fluoride varnish 20 1407476153 0 Physician Assistant Only Healthy Kids Services 20 1407476153 0 Physician Assistant Only Physician Services 00 1407476237 0 SMITH SERENA 2023298 9999999 B 10 1407476237 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1407476237 0 Physicians Anesthesia Services 20 1407476237 0 Physicians Healthy Kids Services 20 1407476237 0 Physicians Optical Supplies 20 1407476237 0 Physicians Physician Services 00 1407476492 0 FIRMAN TIMOTHY 2020265 9999999 B 10 1407476492 0 2100 POWELL ST EMERYVILLE CA 946081826 20 1407476492 0 Physicians Anesthesia Services 20 1407476492 0 Physicians Healthy Kids Services 20 1407476492 0 Physicians Optical Supplies 20 1407476492 0 Physicians Physician Services 00 1407477284 0 SADAUSKAS ALEX 2020197 9999999 B 10 1407477284 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1407477284 0 Physicians Anesthesia Services 20 1407477284 0 Physicians Healthy Kids Services 20 1407477284 0 Physicians Optical Supplies 20 1407477284 0 Physicians Physician Services 00 1407478134 0 CRILLY COLIN 2023153 9999999 B 10 1407478134 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1407478134 0 Physicians Anesthesia Services 20 1407478134 0 Physicians Fluoride varnish 20 1407478134 0 Physicians Healthy Kids Services 20 1407478134 0 Physicians Optical Supplies 20 1407478134 0 Physicians Physician Services 00 1407478431 0 SWIED AMAN 2020218 9999999 B 10 1407478431 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1407478431 0 Physicians Anesthesia Services 20 1407478431 0 Physicians Fluoride varnish 20 1407478431 0 Physicians Healthy Kids Services 20 1407478431 0 Physicians Optical Supplies 20 1407478431 0 Physicians Physician Services 00 1407479116 0 NODA JUAN 2021182 9999999 B 10 1407479116 0 4698 DEPT CAROL 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601854819 20 1407480262 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1407481898 0 FUNKHOUSER COLTON 2022357 9999999 B 10 1407481898 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1407481898 0 Physicians Anesthesia Services 20 1407481898 0 Physicians Healthy Kids Services 20 1407481898 0 Physicians Optical Supplies 20 1407481898 0 Physicians Physician Services 00 1407482300 0 WOLGEMUTH TIERNEY E 2020175 9999999 B 10 1407482300 0 4698 DEPT CAROL STREAM IL 601220021 20 1407482300 0 Physicians Anesthesia Services 20 1407482300 0 Physicians Healthy Kids Services 20 1407482300 0 Physicians Optical Supplies 20 1407482300 0 Physicians Physician Services 00 1407482573 0 STARZEC ANNMARIE J 2021008 9999999 B 10 1407482573 0 29373 NETWORK PL CHICAGO IL 606733039 20 1407482573 0 Physician Assistant Only Fluoride varnish 20 1407482573 0 Physician Assistant Only Healthy Kids Services 20 1407482573 0 Physician Assistant Only Physician Services 00 1407482615 0 ROSINSKI RACHEL 2024302 9999999 B 10 1407482615 0 5777 DEPT CAROL STREAM IL 601220021 20 1407482615 0 Physician Assistant Only Fluoride varnish 20 1407482615 0 Physician Assistant Only Healthy Kids Services 20 1407482615 0 Physician Assistant Only Physician Services 00 1407483365 0 THOMPSEN KRISTINA E 2020133 9999999 B 10 1407483365 0 4698 DEPT CAROL STREAM IL 601220021 20 1407483365 0 Physicians Anesthesia Services 20 1407483365 0 Physicians Fluoride varnish 20 1407483365 0 Physicians Healthy Kids Services 20 1407483365 0 Physicians Optical Supplies 20 1407483365 0 Physicians Physician Services 00 1407483720 0 ALLEN AUSTIN HUNTER 2024342 9999999 B 10 1407483720 0 PO BOX 632122 CINCINNATI OH 452632122 20 1407483720 0 Physicians Anesthesia Services 20 1407483720 0 Physicians Healthy Kids Services 20 1407483720 0 Physicians Optical Supplies 20 1407483720 0 Physicians Physician Services 00 1407484207 0 PATEL ANJALI 2020223 9999999 B 10 1407484207 0 5777 DEPT CAROL STREAM IL 601220021 20 1407484207 0 Physicians Anesthesia Services 20 1407484207 0 Physicians Healthy Kids Services 20 1407484207 0 Physicians Optical Supplies 20 1407484207 0 Physicians Physician Services 00 1407484587 0 COBB EMAREE C 2023241 9999999 B 10 1407484587 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1407484587 0 Physicians Anesthesia Services 20 1407484587 0 Physicians Fluoride varnish 20 1407484587 0 Physicians Healthy Kids Services 20 1407484587 0 Physicians Optical Supplies 20 1407484587 0 Physicians Physician Services 00 1407485709 0 ILYAS MUHAMMAD 2020213 9999999 B 10 1407485709 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1407485709 0 Physicians Anesthesia Services 20 1407485709 0 Physicians Healthy Kids Services 20 1407485709 0 Physicians Optical Supplies 20 1407485709 0 Physicians Physician Services 00 1407485923 0 GREENBERG DANIEL R 2020174 9999999 B 10 1407485923 0 4698 DEPT CAROL STREAM IL 601220021 20 1407485923 0 Physicians Anesthesia Services 20 1407485923 0 Physicians Healthy Kids Services 20 1407485923 0 Physicians Optical Supplies 20 1407485923 0 Physicians Physician Services 00 1407485964 0 REICH KIRA L 2024281 9999999 B 10 1407485964 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1407485964 0 Physicians Anesthesia Services 20 1407485964 0 Physicians Fluoride varnish 20 1407485964 0 Physicians Healthy Kids Services 20 1407485964 0 Physicians Optical Supplies 20 1407485964 0 Physicians Physician Services 00 1407489685 0 YAMNITZ BENJAMIN L 2020051 9999999 B 10 1407489685 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1407489685 0 Clinical Social Worker Social work service 00 1407490477 0 GREENE EBONE 2023034 9999999 B 10 1407490477 0 1835 W CENTRAL RD ARLINGTON HEIGH IL 600052410 20 1407490477 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1407490543 0 OLUWAFEMI TAMARA M 2021056 9999999 B 10 1407490543 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1407490543 0 Nurse Practitioners Fluoride varnish 20 1407490543 0 Nurse Practitioners Healthy Kids Services 20 1407490543 0 Nurse Practitioners Nurse Practitioners Services 20 1407490543 0 Nurse Practitioners Physician Services 00 1407490584 0 KELLEY MICHELLE 2024138 9999999 B 10 1407490584 0 PO BOX 632122 CINCINNATI OH 452632122 20 1407490584 0 Nurse Practitioners Fluoride varnish 20 1407490584 0 Nurse Practitioners Healthy Kids Services 20 1407490584 0 Nurse Practitioners Nurse Practitioners Services 20 1407490584 0 Nurse Practitioners Physician Services 00 1407492325 0 ROBERTSON COURTNEY 2019361 9999999 B 10 1407492325 0 303 NW 11TH ST FAIRFIELD IL 628371203 20 1407492325 0 Nurse Practitioners Fluoride varnish 20 1407492325 0 Nurse Practitioners Healthy Kids Services 20 1407492325 0 Nurse Practitioners Nurse Practitioners Services 20 1407492325 0 Nurse Practitioners Physician Services 00 1407495807 0 JONES JENNIFER L 2020055 9999999 B 10 1407495807 0 7974 UW HEALTH CT 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2023054 9999999 B 10 1407501471 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1407501471 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1407501513 0 KENNEY AMANDA K 2022118 9999999 B 10 1407501513 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1407501513 0 Nurse Practitioners Fluoride varnish 20 1407501513 0 Nurse Practitioners Healthy Kids Services 20 1407501513 0 Nurse Practitioners Nurse Practitioners Services 20 1407501513 0 Nurse Practitioners Physician Services 00 1407504194 0 SANTIAGO CHIARA 2023300 9999999 B 10 1407504194 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1407504194 0 Physicians Anesthesia Services 20 1407504194 0 Physicians Healthy Kids Services 20 1407504194 0 Physicians Optical Supplies 20 1407504194 0 Physicians Physician Services 00 1407504327 0 CHANG ELIZABETH 2024199 9999999 B 10 1407504327 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1407504327 0 Physicians Anesthesia Services 20 1407504327 0 Physicians Healthy Kids Services 20 1407504327 0 Physicians Optical Supplies 20 1407504327 0 Physicians Physician Services 00 1407505175 0 REARDON ALEXANDER 2022174 9999999 B 10 1407505175 0 4698 DEPT CAROL STREAM IL 601220021 20 1407505175 0 Physicians Anesthesia Services 20 1407505175 0 Physicians Healthy Kids Services 20 1407505175 0 Physicians Optical Supplies 20 1407505175 0 Physicians Physician Services 00 1407505399 0 JOHN MIHIR S 2022158 9999999 B 10 1407505399 0 4698 DEPT CAROL STREAM IL 601220021 20 1407505399 0 Physicians Anesthesia Services 20 1407505399 0 Physicians Fluoride varnish 20 1407505399 0 Physicians Healthy Kids Services 20 1407505399 0 Physicians Optical Supplies 20 1407505399 0 Physicians Physician Services 00 1407506223 0 SCHULZ CONNOR 2023001 9999999 B 10 1407506223 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1407506223 0 Physician Assistant Only Fluoride varnish 20 1407506223 0 Physician Assistant Only Healthy Kids Services 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Services 20 1407508807 0 Nurse Practitioners Physician Services 00 1407509516 0 LARA ALEJANDRA 2022048 9999999 B 10 1407509516 0 355 RIDGE AVE EVANSTON IL 602023328 20 1407509516 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1407510886 0 ANDREWS ALLEGRA 2023352 9999999 B 10 1407510886 0 5547 N RAVENSWOOD AVE STE 103 CHICAGO IL 606401125 20 1407510886 0 Clinical Social Worker Social work service 00 1407511793 0 MURRAY DEVIN 2023251 9999999 B 10 1407511793 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1407511793 0 Nurse Practitioners Fluoride varnish 20 1407511793 0 Nurse Practitioners Healthy Kids Services 20 1407511793 0 Nurse Practitioners Nurse Practitioners Services 20 1407511793 0 Nurse Practitioners Physician Services 00 1407512056 0 WIDDIS KEVIN 2022018 9999999 B 10 1407512056 0 PO BOX 1109 CROWN POINT IN 463081109 20 1407512056 0 Physician Assistant Only Fluoride varnish 20 1407512056 0 Physician Assistant Only Healthy Kids Services 20 1407512056 0 Physician Assistant Only Physician Services 00 1407513294 0 TRULOVE SAMANTHA C 2025035 9999999 B 10 1407513294 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1407513294 0 Nurse Practitioners Anesthesia Services 20 1407513294 0 Nurse Practitioners Nurse Practitioners Services 20 1407513294 0 Nurse Practitioners Physician Services 00 1407517204 0 RICHARDS MEREDITH 2023208 9999999 B 10 1407517204 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1407517204 0 Physician Assistant Only Fluoride varnish 20 1407517204 0 Physician Assistant Only Healthy Kids Services 20 1407517204 0 Physician Assistant Only Physician Services 00 1407517238 0 SCHMUTZLER KRISTEN 2023135 9999999 B 10 1407517238 0 5875 E RIVERSIDE BLVD ROCKFORD IL 611144937 20 1407517238 0 Physician Assistant Only Fluoride varnish 20 1407517238 0 Physician Assistant Only Healthy Kids Services 20 1407517238 0 Physician Assistant Only Physician Services 00 1407517394 0 COYER BEN C 2022103 9999999 B 10 1407517394 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1407517394 0 Nurse Practitioners Healthy Kids Services 20 1407517394 0 Nurse Practitioners Nurse Practitioners Services 20 1407517394 0 Nurse Practitioners Physician Services 00 1407517758 0 SALIHEFENDIC SELMA 2022070 9999999 B 10 1407517758 0 1200 W STATE ST ROCKFORD IL 611022112 20 1407517758 0 Nurse Practitioners Fluoride varnish 20 1407517758 0 Nurse Practitioners Healthy Kids Services 20 1407517758 0 Nurse Practitioners Nurse Practitioners Services 20 1407517758 0 Nurse Practitioners Physician Services 00 1407517923 0 WHITE CIARA J 2022095 9999999 B 10 1407517923 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1407517923 0 Nurse Practitioners Fluoride varnish 20 1407517923 0 Nurse Practitioners Healthy Kids Services 20 1407517923 0 Nurse Practitioners Nurse Practitioners Services 20 1407517923 0 Nurse Practitioners Physician Services 00 1407519960 0 REGAN JENNIFER B 2021299 9999999 B 10 1407519960 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1407519960 0 Nurse Practitioners Healthy Kids Services 20 1407519960 0 Nurse Practitioners Nurse Practitioners Services 20 1407519960 0 Nurse Practitioners Physician Services 00 1407523624 0 DOBLE ASIA 2021292 9999999 H 10 1407523624 0 1120 RANDALL CT GENEVA IL 601343911 20 1407523624 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1407525702 0 CARON NATHAN L 2021252 9999999 B 10 1407525702 0 PO BOX 146 WATERLOO IL 622980146 20 1407525702 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1407528987 0 ALTIDOR AMBER M 2021300 9999999 B 10 1407528987 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1407528987 0 Nurse Practitioners Healthy Kids Services 20 1407528987 0 Nurse Practitioners Nurse Practitioners Services 20 1407528987 0 Nurse Practitioners Physician Services 00 1407529498 0 CARMAN TARA A 2021288 9999999 B 10 1407529498 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1407529498 0 Audiologists Audiology Services 20 1407529498 0 Audiologists Medical Supplies 20 1407529498 0 Audiologists Medical equipment/prosthetic devices 00 1407529563 0 STEIN NICOLE 2024346 9999999 B 10 1407529563 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1407529563 0 Nurse Practitioners Fluoride varnish 20 1407529563 0 Nurse Practitioners Healthy Kids Services 20 1407529563 0 Nurse Practitioners Nurse Practitioners Services 20 1407529563 0 Nurse Practitioners Physician Services 00 1407530033 0 SLIBI TAREK 2023202 2026181 B 10 1407530033 0 PO BOX 778791 CHICAGO IL 606776473 20 1407530033 0 Physicians Anesthesia Services 20 1407530033 0 Physicians Fluoride varnish 20 1407530033 0 Physicians Healthy Kids Services 20 1407530033 0 Physicians Optical Supplies 20 1407530033 0 Physicians Physician Services 00 1407531494 0 SACHDEV GANDE KAJAL K 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Practitioners Nurse Practitioners Services 20 1407534563 0 Nurse Practitioners Physician Services 00 1407535735 0 TAGAR KANWAL 2023237 9999999 B 10 1407535735 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1407535735 0 Physicians Anesthesia Services 20 1407535735 0 Physicians Fluoride varnish 20 1407535735 0 Physicians Healthy Kids Services 20 1407535735 0 Physicians Optical Supplies 20 1407535735 0 Physicians Physician Services 00 1407535826 0 JACOB SHEBY 2023285 9999999 B 10 1407535826 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1407535826 0 Nurse Practitioners Fluoride varnish 20 1407535826 0 Nurse Practitioners Healthy Kids Services 20 1407535826 0 Nurse Practitioners Nurse Practitioners Services 20 1407535826 0 Nurse Practitioners Physician Services 00 1407537905 0 CASCIOTTI OLIVA 2023291 9999999 B 10 1407537905 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1407537905 0 Nurse Practitioners Anesthesia Services 20 1407537905 0 Nurse Practitioners Nurse Practitioners Services 20 1407537905 0 Nurse Practitioners Physician Services 00 1407538960 0 FECHNER CHELSEA AFTON 2023277 9999999 B 10 1407538960 0 211 E LAKE ST STE 1A ADDISON IL 601012877 20 1407538960 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1407539182 0 KAUFFMAN KAYLA SUE 2024267 9999999 B 10 1407539182 0 1120 E MAIN ST ST CHARLES IL 601742287 20 1407539182 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1407541121 0 ANDREWS MYRA 2023114 9999999 B 10 1407541121 0 400 N HIGHLAND AVE AURORA IL 605063814 20 1407541121 0 Nurse Practitioners Fluoride varnish 20 1407541121 0 Nurse Practitioners Healthy Kids Services 20 1407541121 0 Nurse Practitioners Nurse Practitioners Services 20 1407541121 0 Nurse Practitioners Physician Services 00 1407543838 0 WALDER OLIVIA 2024002 9999999 B 10 1407543838 0 1120 N MELVIN ST GIBSON CITY IL 609361477 20 1407543838 0 Nurse Practitioners Fluoride varnish 20 1407543838 0 Nurse Practitioners Healthy Kids Services 20 1407543838 0 Nurse Practitioners Nurse Practitioners Services 20 1407543838 0 Nurse Practitioners Physician Services 00 1407543903 0 USMANI SADIA S 2023201 9999999 B 10 1407543903 0 PO BOX 778791 CHICAGO IL 606776473 20 1407543903 0 Physicians Anesthesia Services 20 1407543903 0 Physicians Fluoride varnish 20 1407543903 0 Physicians Healthy Kids Services 20 1407543903 0 Physicians Optical Supplies 20 1407543903 0 Physicians Physician Services 00 1407543978 0 NARSING TYLER 2023292 9999999 B 10 1407543978 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1407543978 0 Physicians Anesthesia Services 20 1407543978 0 Physicians Healthy Kids Services 20 1407543978 0 Physicians Optical Supplies 20 1407543978 0 Physicians Physician Services 00 1407544992 0 GRAHAM ABIGAIL F 2023270 9999999 B 10 1407544992 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1407544992 0 Nurse Practitioners Fluoride varnish 20 1407544992 0 Nurse Practitioners Healthy Kids Services 20 1407544992 0 Nurse Practitioners Nurse Practitioners Services 20 1407544992 0 Nurse Practitioners Physician Services 00 1407545007 0 VALDERRAMA JAMES 2023177 9999999 B 10 1407545007 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1407545007 0 Physicians Anesthesia Services 20 1407545007 0 Physicians Fluoride varnish 20 1407545007 0 Physicians Healthy Kids Services 20 1407545007 0 Physicians Optical Supplies 20 1407545007 0 Physicians Physician Services 00 1407545767 0 SONE JE YEONG 2023210 9999999 B 10 1407545767 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1407545767 0 Physicians Anesthesia Services 20 1407545767 0 Physicians Healthy Kids Services 20 1407545767 0 Physicians Optical Supplies 20 1407545767 0 Physicians Physician Services 00 1407546138 0 YANG RYAN R 2023191 9999999 B 10 1407546138 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1407546138 0 Physicians Anesthesia Services 20 1407546138 0 Physicians Fluoride varnish 20 1407546138 0 Physicians Healthy Kids Services 20 1407546138 0 Physicians Optical Supplies 20 1407546138 0 Physicians Physician Services 00 1407546153 0 ZUREK ERIN 2023187 9999999 B 10 1407546153 0 2906 HIGHWAY AVE HIGHLAND IN 463221631 20 1407546153 0 Speech Therapists Medical Supplies 20 1407546153 0 Speech Therapists Medical equipment/prosthetic devices 20 1407546153 0 Speech Therapists Speech Therapy/Pathology Services 00 1407546419 0 ABIUSI FRANCESCA 2023157 9999999 B 10 1407546419 0 5777 DEPT CAROL STREAM IL 601220021 20 1407546419 0 Physical Therapists Medical Supplies 20 1407546419 0 Physical Therapists Medical equipment/prosthetic devices 20 1407546419 0 Physical Therapists Physical Therapy Services 00 1407546823 0 SMITH JOANN 2023130 9999999 B 10 1407546823 0 303 NW 11TH ST FAIRFIELD IL 628371203 20 1407546823 0 Nurse Practitioners Healthy Kids Services 20 1407546823 0 Nurse Practitioners Nurse Practitioners Services 20 1407546823 0 Nurse Practitioners Physician Services 00 1407548076 0 SALAMAH RIBHI 2023209 9999999 B 10 1407548076 0 2122 N MILWAUKEE AVE CHICAGO IL 606474067 20 1407548076 0 Dentists Dental Services 20 1407548076 0 Dentists Physician Services 00 1407548472 0 CROSS NAJAFI ARTHUR 2023191 9999999 B 10 1407548472 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1407548472 0 Physicians Anesthesia Services 20 1407548472 0 Physicians Healthy Kids Services 20 1407548472 0 Physicians Optical Supplies 20 1407548472 0 Physicians Physician Services 00 1407549421 0 MCCOACH RENEE A 2023202 9999999 B 10 1407549421 0 1029 E 130TH ST CHICAGO IL 606286908 20 1407549421 0 Nurse Practitioners Fluoride varnish 20 1407549421 0 Nurse Practitioners Healthy Kids Services 20 1407549421 0 Nurse Practitioners Nurse Practitioners Services 20 1407549421 0 Nurse Practitioners Physician Services 00 1407549553 0 MURPHY LINDSEY J 2023241 9999999 B 10 1407549553 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1407549553 0 Nurse Practitioners Fluoride varnish 20 1407549553 0 Nurse Practitioners Healthy Kids Services 20 1407549553 0 Nurse Practitioners Nurse Practitioners Services 20 1407549553 0 Nurse Practitioners Physician Services 00 1407550189 0 SHEFFIELD CEDRIC 2024004 9999999 B 10 1407550189 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1407550189 0 Physicians Anesthesia Services 20 1407550189 0 Physicians Healthy Kids Services 20 1407550189 0 Physicians Optical Supplies 20 1407550189 0 Physicians Physician Services 00 1407550320 0 SOIK SAVANNAH D 2023185 9999999 B 10 1407550320 0 PO BOX 3039 OAK BROOK IL 605223039 20 1407550320 0 Physicians Anesthesia Services 20 1407550320 0 Physicians Fluoride varnish 20 1407550320 0 Physicians Healthy Kids Services 20 1407550320 0 Physicians Optical Supplies 20 1407550320 0 Physicians Physician Services 00 1407551153 0 CURTIS TOREE 2023145 9999999 B 10 1407551153 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1407551153 0 Physician Assistant Only Family Planning Counseling 20 1407551153 0 Physician Assistant Only Fluoride varnish 20 1407551153 0 Physician Assistant Only Healthy Kids Services 20 1407551153 0 Physician Assistant Only Physician Services 00 1407553019 0 BLACKWELL MICHAELA R 2024317 9999999 B 10 1407553019 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1407553019 0 Physician Assistant Only Fluoride varnish 20 1407553019 0 Physician Assistant Only Healthy Kids Services 20 1407553019 0 Physician Assistant Only Physician Services 00 1407553340 0 SMITH CAMILLE 2023152 9999999 B 10 1407553340 0 5777 DEPT CAROL STREAM IL 601220021 20 1407553340 0 Nurse Practitioners Healthy Kids Services 20 1407553340 0 Nurse Practitioners Nurse Practitioners Services 20 1407553340 0 Nurse Practitioners Physician Services 00 1407556863 0 LEE JONATHAN S 2024191 9999999 B 10 1407556863 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1407556863 0 Physicians Anesthesia Services 20 1407556863 0 Physicians Fluoride varnish 20 1407556863 0 Physicians Healthy Kids Services 20 1407556863 0 Physicians Optical Supplies 20 1407556863 0 Physicians Physician Services 00 1407557655 0 SLUSKY SAMUEL R 2024175 9999999 B 10 1407557655 0 4698 DEPT CAROL STREAM IL 601220021 20 1407557655 0 Physicians Anesthesia Services 20 1407557655 0 Physicians Healthy Kids Services 20 1407557655 0 Physicians Optical Supplies 20 1407557655 0 Physicians Physician Services 00 1407558190 0 PATIL RICA 2023201 9999999 B 10 1407558190 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1407558190 0 Physicians Anesthesia Services 20 1407558190 0 Physicians Fluoride varnish 20 1407558190 0 Physicians Healthy Kids Services 20 1407558190 0 Physicians Optical Supplies 20 1407558190 0 Physicians Physician Services 00 1407558224 0 KHAN ASHER 2023193 9999999 B 10 1407558224 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1407558224 0 Physicians Anesthesia Services 20 1407558224 0 Physicians Healthy Kids Services 20 1407558224 0 Physicians Optical Supplies 20 1407558224 0 Physicians Physician Services 00 1407558356 0 ROCK NICOLE 2024192 9999999 B 10 1407558356 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1407558356 0 Physicians Anesthesia Services 20 1407558356 0 Physicians Fluoride varnish 20 1407558356 0 Physicians Healthy Kids Services 20 1407558356 0 Physicians Optical Supplies 20 1407558356 0 Physicians Physician Services 00 1407558380 0 RAY KAHINA 2023104 9999999 B 10 1407558380 0 7101 N CICERO AVE STE 202 LINCOLNWOOD IL 607122143 20 1407558380 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1407558877 0 NATHAN HORVAT 2023202 9999999 B 10 1407558877 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1407558877 0 Physicians Anesthesia Services 20 1407558877 0 Physicians Fluoride varnish 20 1407558877 0 Physicians Healthy Kids Services 20 1407558877 0 Physicians Optical Supplies 20 1407558877 0 Physicians Physician Services 00 1407559453 0 MALHIS ZENA 2023269 9999999 B 10 1407559453 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1407559453 0 Physicians Anesthesia Services 20 1407559453 0 Physicians Fluoride varnish 20 1407559453 0 Physicians Healthy Kids Services 20 1407559453 0 Physicians Optical Supplies 20 1407559453 0 Physicians Physician Services 00 1407559487 0 JABER DIMA T 2023268 9999999 B 10 1407559487 0 PO BOX 3039 OAK BROOK IL 605223039 20 1407559487 0 Physicians Anesthesia Services 20 1407559487 0 Physicians Healthy Kids Services 20 1407559487 0 Physicians Optical Supplies 20 1407559487 0 Physicians Physician Services 00 1407559537 0 KAKADIA ROOTUL 2023182 9999999 B 10 1407559537 0 4701 DEPT CAROL STREAM IL 601220021 20 1407559537 0 Physicians Anesthesia Services 20 1407559537 0 Physicians Fluoride varnish 20 1407559537 0 Physicians Healthy Kids Services 20 1407559537 0 Physicians Optical Supplies 20 1407559537 0 Physicians Physician Services 00 1407559602 0 YARBROUGH ELIZABETH R 2023164 9999999 B 10 1407559602 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1407559602 0 Nurse Practitioners Fluoride varnish 20 1407559602 0 Nurse Practitioners Healthy Kids Services 20 1407559602 0 Nurse Practitioners Nurse Practitioners Services 20 1407559602 0 Nurse Practitioners Physician Services 00 1407560204 0 BRISENO JESSENIA 2023039 9999999 B 10 1407560204 0 1940 S WESTERN AVE STE 205 CHICAGO IL 606082503 20 1407560204 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1407560287 0 MEDINA RON KYLE 2023032 9999999 B 10 1407560287 0 PO BOX 516 OREGON IL 610610516 20 1407560287 0 Nurse Practitioners Healthy Kids Services 20 1407560287 0 Nurse Practitioners Nurse Practitioners Services 20 1407560287 0 Nurse Practitioners Physician Services 00 1407561228 0 AUDU OLUKEMI 2023086 9999999 B 10 1407561228 0 101 E STATE ST KENNETT SQ PA 193483109 20 1407561228 0 Physical Therapists Medical Supplies 20 1407561228 0 Physical Therapists Medical equipment/prosthetic devices 20 1407561228 0 Physical Therapists Physical Therapy Services 00 1407562325 0 ZAMFIR ECATERINA 2025009 9999999 B 10 1407562325 0 1 ERIE CT STE 3000 OAK PARK IL 603022611 20 1407562325 0 Nurse Practitioners Healthy Kids Services 20 1407562325 0 Nurse Practitioners Nurse Practitioners Services 20 1407562325 0 Nurse Practitioners Physician Services 00 1407562804 0 HUSSAIN ASMA 2023228 9999999 B 10 1407562804 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1407562804 0 Physician Assistant Only Fluoride varnish 20 1407562804 0 Physician Assistant Only Healthy Kids Services 20 1407562804 0 Physician Assistant Only Physician Services 00 1407564537 0 PEARSON MALLORY K 2024044 9999999 B 10 1407564537 0 PO BOX 778912 CHICAGO IL 606778912 20 1407564537 0 Physician Assistant Only Fluoride varnish 20 1407564537 0 Physician Assistant Only Healthy Kids Services 20 1407564537 0 Physician Assistant Only Physician Services 00 1407565021 0 SALGADO GABRIELA 2022348 9999999 B 10 1407565021 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1407565021 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1407565831 0 ANDERSON MARY 2024179 9999999 B 10 1407565831 0 108 E DEYOUNG ST MARION IL 629592958 20 1407565831 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1407566011 0 LOCKENVITZ MICHAEL 2023005 9999999 B 10 1407566011 0 1350 GRAND AVE BEARDSTOWN IL 626188092 20 1407566011 0 Physical Therapists Medical Supplies 20 1407566011 0 Physical Therapists Medical equipment/prosthetic devices 20 1407566011 0 Physical Therapists Physical Therapy Services 00 1407566524 0 FINLEY JOHN 2023307 9999999 B 10 1407566524 0 850 43RD AVE STE 100 MOLINE IL 612658401 20 1407566524 0 Physical Therapists Medical Supplies 20 1407566524 0 Physical Therapists Medical equipment/prosthetic devices 20 1407566524 0 Physical Therapists Physical Therapy Services 00 1407569312 0 DELEON CAMERON 2023018 9999999 B 10 1407569312 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1407569312 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1407569320 0 HEMZACEK MELISSA L 2024218 9999999 B 10 1407569320 0 135 TROUTMAN DR BARTLETT IL 601031312 20 1407569320 0 Clinical Social Worker Social work service 00 1407569445 0 MAGEE MARY 2024218 9999999 B 10 1407569445 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1407569445 0 Physician Assistant Only Fluoride varnish 20 1407569445 0 Physician Assistant Only Healthy Kids Services 20 1407569445 0 Physician Assistant Only Physician Services 00 1407569452 0 MCCOMB ARIELLE 2023059 9999999 B 10 1407569452 0 370 SUMMIT ST # 1 ELGIN IL 601203843 20 1407569452 0 Nurse Practitioners Healthy Kids Services 20 1407569452 0 Nurse Practitioners Nurse Practitioners Services 20 1407569452 0 Nurse Practitioners Physician Services 00 1407569627 0 PINNEY MELISSA 2023005 9999999 B 10 1407569627 0 PO BOX 6037 WAUCONDA IL 600846037 20 1407569627 0 Nurse Practitioners Fluoride varnish 20 1407569627 0 Nurse Practitioners Healthy Kids Services 20 1407569627 0 Nurse Practitioners Nurse Practitioners Services 20 1407569627 0 Nurse Practitioners Physician Services 00 1407569866 0 PEARSON TASIA 2023201 9999999 B 10 1407569866 0 2875 W 19TH ST CHICAGO IL 606233501 20 1407569866 0 Nurse Practitioners Fluoride varnish 20 1407569866 0 Nurse Practitioners Healthy Kids Services 20 1407569866 0 Nurse Practitioners Nurse Practitioners Services 20 1407569866 0 Nurse Practitioners Physician Services 00 1407572167 0 KUNYSZ BRYAN 2022319 9999999 B 10 1407572167 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1407572167 0 Nurse Practitioners Anesthesia Services 20 1407572167 0 Nurse Practitioners Nurse Practitioners Services 20 1407572167 0 Nurse Practitioners Physician Services 00 1407575590 0 OAKLEY KAYLEE N 2023132 9999999 B 10 1407575590 0 411 S COURT ST MARION IL 629592711 20 1407575590 0 Speech Therapists Medical Supplies 20 1407575590 0 Speech Therapists Medical equipment/prosthetic devices 20 1407575590 0 Speech Therapists Speech Therapy/Pathology Services 00 1407578222 0 DORAN JENNIFER ANN 2024225 9999999 B 10 1407578222 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1407578222 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1407579147 0 MCCHRISTEN FAITH 2022279 9999999 B 10 1407579147 0 101 E STATE ST KENNETT SQUARE PA 193483109 20 1407579147 0 Occupational Therapists Medical Supplies 20 1407579147 0 Occupational Therapists Medical equipment/prosthetic devices 20 1407579147 0 Occupational Therapists Occupational Therapy Services 00 1407580020 0 DUDZIK ELIZABETH C 2022222 9999999 B 10 1407580020 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1407580020 0 Speech Therapists Medical Supplies 20 1407580020 0 Speech Therapists Medical equipment/prosthetic devices 20 1407580020 0 Speech Therapists Speech Therapy/Pathology Services 00 1407580228 0 CHELBERG MICHAEL J 2024334 9999999 B 10 1407580228 0 1005 BROADWAY ST QUINCY IL 623012834 20 1407580228 0 Nurse Practitioners Anesthesia Services 20 1407580228 0 Nurse Practitioners Nurse Practitioners Services 20 1407580228 0 Nurse Practitioners Physician Services 00 1407581986 0 TAMAYO LUCIANO A 2025036 9999999 B 10 1407581986 0 645 S CENTRAL AVE CHICAGO IL 606445059 20 1407581986 0 Physicians Anesthesia Services 20 1407581986 0 Physicians Healthy Kids Services 20 1407581986 0 Physicians Optical Supplies 20 1407581986 0 Physicians Physician Services 20 1407581986 0 Physicians Physicians Psychiatric Services 00 1407583412 0 HINTZMAN LAUREN J 2022273 9999999 B 10 1407583412 0 27555 DIEHL RD WARRENVILLE IL 605553849 20 1407583412 0 Occupational Therapists Medical Supplies 20 1407583412 0 Occupational Therapists Medical equipment/prosthetic devices 20 1407583412 0 Occupational Therapists Occupational Therapy Services 00 1407583768 0 KLAY LILLIANA 2024067 9999999 B 10 1407583768 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1407583768 0 Clinical Social Worker Social work service 00 1407583966 0 CHATTIC MARIA 2022227 9999999 B 10 1407583966 0 101 E MILLER RD STERLING IL 610811252 20 1407583966 0 Nurse Practitioners Fluoride varnish 20 1407583966 0 Nurse Practitioners Healthy Kids Services 20 1407583966 0 Nurse Practitioners Nurse Practitioners Services 20 1407583966 0 Nurse Practitioners Physician Services 00 1407584220 0 GOMEZ MARIELA 2022257 9999999 B 10 1407584220 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1407584220 0 Nurse Practitioners Anesthesia Services 20 1407584220 0 Nurse Practitioners Nurse Practitioners Services 20 1407584220 0 Nurse Practitioners Physician Services 00 1407585144 0 AKINTOLA MUINAT 2023352 9999999 B 10 1407585144 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1407585144 0 Nurse Practitioners Fluoride varnish 20 1407585144 0 Nurse Practitioners Healthy Kids Services 20 1407585144 0 Nurse Practitioners Nurse Practitioners Services 20 1407585144 0 Nurse Practitioners Physician Services 00 1407585268 0 WRIGHT MARTICE 2023201 9999999 B 10 1407585268 0 2025 WASHINGTON ST WAUKEGAN IL 600855131 20 1407585268 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1407585508 0 BENSON RACHAEL 2022158 9999999 B 10 1407585508 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1407585508 0 Physician Assistant Only Fluoride varnish 20 1407585508 0 Physician Assistant Only Healthy Kids Services 20 1407585508 0 Physician Assistant Only Physician Services 00 1407585813 0 BUGNO SIERRA 2024050 9999999 B 10 1407585813 0 29373 NETWORK PL CHICAGO IL 606733039 20 1407585813 0 Physical Therapists Medical Supplies 20 1407585813 0 Physical Therapists Medical equipment/prosthetic devices 20 1407585813 0 Physical Therapists Physical Therapy Services 00 1407588080 0 JALLOH DARRIN 2022189 9999999 B 10 1407588080 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1407588080 0 Physicians Anesthesia Services 20 1407588080 0 Physicians Fluoride varnish 20 1407588080 0 Physicians Healthy Kids Services 20 1407588080 0 Physicians Optical Supplies 20 1407588080 0 Physicians Physician Services 00 1407588783 0 ZIFFRA ROBERT A 2022209 9999999 B 10 1407588783 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1407588783 0 Podiatrists Podiatric Services 00 1407589021 0 TOPOLNITSKA ILONA 2023249 9999999 B 10 1407589021 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1407589021 0 Physician Assistant Only Fluoride varnish 20 1407589021 0 Physician Assistant Only Healthy Kids Services 20 1407589021 0 Physician Assistant Only Physician Services 00 1407589286 0 WHITE MATTHEW G 2024183 9999999 B 10 1407589286 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1407589286 0 Physicians Anesthesia Services 20 1407589286 0 Physicians Healthy Kids Services 20 1407589286 0 Physicians Optical Supplies 20 1407589286 0 Physicians Physician Services 00 1407589781 0 KUMAR ASHOK 2022258 9999999 B 10 1407589781 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1407589781 0 Physicians Anesthesia Services 20 1407589781 0 Physicians Fluoride varnish 20 1407589781 0 Physicians Healthy Kids Services 20 1407589781 0 Physicians Optical Supplies 20 1407589781 0 Physicians Physician Services 00 1407589815 0 EICH KATHLEEN 2023209 9999999 B 10 1407589815 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1407589815 0 Physician Assistant Only Fluoride varnish 20 1407589815 0 Physician Assistant Only Healthy Kids Services 20 1407589815 0 Physician Assistant Only Physician Services 00 1407591225 0 ONICA ELLEN 2022249 9999999 B 10 1407591225 0 9835 MANCHESTER RD SAINT LOUIS MO 631191243 20 1407591225 0 Audiologists Audiology Services 20 1407591225 0 Audiologists Medical Supplies 20 1407591225 0 Audiologists Medical equipment/prosthetic devices 00 1407591498 0 NOVAK REBECCA 2025048 9999999 B 10 1407591498 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1407591498 0 Physician Assistant Only Fluoride varnish 20 1407591498 0 Physician Assistant Only Healthy Kids Services 20 1407591498 0 Physician Assistant Only Physician Services 00 1407591761 0 GINTER GEOFFREY 2024035 9999999 B 10 1407591761 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1407591761 0 Physicians Anesthesia Services 20 1407591761 0 Physicians Fluoride varnish 20 1407591761 0 Physicians Healthy Kids Services 20 1407591761 0 Physicians Optical Supplies 20 1407591761 0 Physicians Physician Services 00 1407591779 0 GOLDBERG LEAH A 2022179 9999999 B 10 1407591779 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1407591779 0 Physicians Anesthesia Services 20 1407591779 0 Physicians Healthy Kids Services 20 1407591779 0 Physicians Optical Supplies 20 1407591779 0 Physicians Physician Services 00 1407595192 0 PINEDA MAURICIO O 2022230 9999999 B 10 1407595192 0 3040 W SALT CREEK LN ARLINGTON HEIGH IL 600051069 20 1407595192 0 Nurse Practitioners Fluoride varnish 20 1407595192 0 Nurse Practitioners Healthy Kids Services 20 1407595192 0 Nurse Practitioners Nurse Practitioners Services 20 1407595192 0 Nurse Practitioners Physician Services 00 1407595796 0 KEHL ELIZABETH 2022251 9999999 B 10 1407595796 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1407595796 0 Physicians Anesthesia Services 20 1407595796 0 Physicians Fluoride varnish 20 1407595796 0 Physicians Healthy Kids Services 20 1407595796 0 Physicians Optical Supplies 20 1407595796 0 Physicians Physician Services 00 1407596141 0 NWACHUKWU MICHELLE 2022187 9999999 B 10 1407596141 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1407596141 0 Physicians Anesthesia Services 20 1407596141 0 Physicians Fluoride varnish 20 1407596141 0 Physicians Healthy Kids Services 20 1407596141 0 Physicians Optical Supplies 20 1407596141 0 Physicians Physician Services 00 1407596265 0 MUNOZ MARIBEL 2023167 9999999 B 10 1407596265 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1407596265 0 Physicians Anesthesia Services 20 1407596265 0 Physicians Fluoride varnish 20 1407596265 0 Physicians Healthy Kids Services 20 1407596265 0 Physicians Optical Supplies 20 1407596265 0 Physicians Physician Services 00 1407598089 0 HASS ADAM YUSIM 2023177 9999999 B 10 1407598089 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1407598089 0 Physicians Anesthesia Services 20 1407598089 0 Physicians Healthy Kids Services 20 1407598089 0 Physicians Optical Supplies 20 1407598089 0 Physicians Physician Services 00 1407598204 0 WILSON CHERYL 2024365 9999999 B 10 1407598204 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1407598204 0 Nurse Practitioners Fluoride varnish 20 1407598204 0 Nurse Practitioners Healthy Kids Services 20 1407598204 0 Nurse Practitioners Nurse Practitioners Services 20 1407598204 0 Nurse Practitioners Physician Services 00 1407598584 0 BLAKEMORE CARLEE A 2022181 9999999 B 10 1407598584 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1407598584 0 Physicians Anesthesia Services 20 1407598584 0 Physicians Fluoride varnish 20 1407598584 0 Physicians Healthy Kids Services 20 1407598584 0 Physicians Optical Supplies 20 1407598584 0 Physicians Physician Services 00 1407598717 0 CONDIT KEVIN 2022186 9999999 B 10 1407598717 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1407598717 0 Physicians Anesthesia Services 20 1407598717 0 Physicians Healthy Kids Services 20 1407598717 0 Physicians Optical Supplies 20 1407598717 0 Physicians Physician Services 00 1407598881 0 KERDJOUDJ MOURAD M 2024183 9999999 B 10 1407598881 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1407598881 0 Physicians Anesthesia Services 20 1407598881 0 Physicians Healthy Kids Services 20 1407598881 0 Physicians Optical Supplies 20 1407598881 0 Physicians Physician Services 00 1407603517 0 ABDELMALAK MARY 2024192 9999999 B 10 1407603517 0 1220 S WOOD ST CHICAGO IL 606081202 20 1407603517 0 Physicians Anesthesia Services 20 1407603517 0 Physicians Fluoride varnish 20 1407603517 0 Physicians Healthy Kids Services 20 1407603517 0 Physicians Optical Supplies 20 1407603517 0 Physicians Physician Services 00 1407604150 0 SEVERINO MARIA 2024263 9999999 B 10 1407604150 0 1120 RANDALL CT GENEVA IL 601343911 20 1407604150 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1407605942 0 QUINN ERIKA 2024359 9999999 B 10 1407605942 0 411 E PARK ST STE 106 CHAMPAIGN IL 618203862 20 1407605942 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1407606023 0 SAWIN NICHOLAS M 2024243 9999999 B 10 1407606023 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1407606023 0 Physicians Anesthesia Services 20 1407606023 0 Physicians Healthy Kids Services 20 1407606023 0 Physicians Optical Supplies 20 1407606023 0 Physicians Physician Services 00 1407606056 0 CASE LIA BARKMEIER 2024206 9999999 B 10 1407606056 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1407606056 0 Physicians Anesthesia Services 20 1407606056 0 Physicians Healthy Kids Services 20 1407606056 0 Physicians Optical Supplies 20 1407606056 0 Physicians Physician Services 00 1407606346 0 KHAN NAZISH 2024163 9999999 B 10 1407606346 0 PO BOX 920128 DALLAS TX 753920128 20 1407606346 0 Physician Assistant Only Fluoride varnish 20 1407606346 0 Physician Assistant Only Healthy Kids Services 20 1407606346 0 Physician Assistant Only Physician Services 00 1407606411 0 ABOU CHAKRA MOHAMAD 2024214 9999999 B 10 1407606411 0 7732 SOLUTION CTR MC 776 CHICAGO IL 606777007 20 1407606411 0 Physicians Anesthesia Services 20 1407606411 0 Physicians Healthy Kids Services 20 1407606411 0 Physicians Optical Supplies 20 1407606411 0 Physicians Physician Services 00 1407606429 0 HAMAD EYAD 2024199 9999999 B 10 1407606429 0 3249 OAK PARK AVE BERWYN IL 604023429 20 1407606429 0 Physicians Anesthesia Services 20 1407606429 0 Physicians Fluoride varnish 20 1407606429 0 Physicians Healthy Kids Services 20 1407606429 0 Physicians Optical Supplies 20 1407606429 0 Physicians Physician Services 00 1407606833 0 PROCH RACHEL L 2024128 9999999 B 10 1407606833 0 1301 W DEVON AVE CHICAGO IL 606601329 20 1407606833 0 Nurse Practitioners Healthy Kids Services 20 1407606833 0 Nurse Practitioners Midwife Services 20 1407606833 0 Nurse Practitioners Nurse Practitioners Services 20 1407606833 0 Nurse Practitioners Physician Services 00 1407606916 0 MASCO BILLY R 2024238 9999999 B 10 1407606916 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1407606916 0 Physicians Anesthesia Services 20 1407606916 0 Physicians Healthy Kids Services 20 1407606916 0 Physicians Optical Supplies 20 1407606916 0 Physicians Physician Services 00 1407607179 0 KHOMENKO ANNA 2024214 9999999 B 10 1407607179 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1407607179 0 Physicians Anesthesia Services 20 1407607179 0 Physicians Healthy Kids Services 20 1407607179 0 Physicians Optical Supplies 20 1407607179 0 Physicians Physician Services 00 1407608086 0 ANGUIANO MUNOZ LAZARO 2025010 9999999 B 10 1407608086 0 700 E OGDEN AVE STE 202 WESTMONT IL 605591296 20 1407608086 0 Nurse Practitioners Fluoride varnish 20 1407608086 0 Nurse Practitioners Healthy Kids Services 20 1407608086 0 Nurse Practitioners Nurse Practitioners Services 20 1407608086 0 Nurse Practitioners Physician Services 00 1407609183 0 POON HEVIN 2024183 9999999 B 10 1407609183 0 221 NE GLEN OAK AVE ATTN: STEPHEN CIRONE GOMP100 PEORIA IL 616360002 20 1407609183 0 Physicians Anesthesia Services 20 1407609183 0 Physicians Fluoride varnish 20 1407609183 0 Physicians Healthy Kids Services 20 1407609183 0 Physicians Optical Supplies 20 1407609183 0 Physicians Physician Services 00 1407614548 0 JONES EMMA L 2024185 9999999 B 10 1407614548 0 621 S NEW BALLAS RD STE 7020 SAINT LOUIS MO 631418232 20 1407614548 0 Nurse Practitioners Healthy Kids Services 20 1407614548 0 Nurse Practitioners Nurse Practitioners Services 20 1407614548 0 Nurse Practitioners 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300 MILWAUKEE WI 532264837 20 1407930332 0 Physicians Anesthesia Services 20 1407930332 0 Physicians Fluoride varnish 20 1407930332 0 Physicians Healthy Kids Services 20 1407930332 0 Physicians Optical Supplies 20 1407930332 0 Physicians Physician Services 00 1407931140 0 PORTER TODD R 2021231 9999999 B 10 1407931140 0 1025 MAINE ST QUINCY IL 623014038 20 1407931140 0 Physicians Anesthesia Services 20 1407931140 0 Physicians Fluoride varnish 20 1407931140 0 Physicians Healthy Kids Services 20 1407931140 0 Physicians Optical Supplies 20 1407931140 0 Physicians Physician Services 00 1407932031 0 HENRY TEKESHA 2022276 9999999 B 10 1407932031 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1407932031 0 Physicians Anesthesia Services 20 1407932031 0 Physicians Healthy Kids Services 20 1407932031 0 Physicians Optical Supplies 20 1407932031 0 Physicians Physician Services 00 1407932114 0 STOWE CATHERINE 2016140 9999999 B 10 1407932114 0 300 N OTTAWA ST JOLIET IL 604324009 20 1407932114 0 Nurse 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1407936040 0 Nurse Practitioners Physician Services 00 1407936974 0 HUSSAIN AHMED 1998182 9999999 B 10 1407936974 0 PO BOX 775231 CHICAGO IL 606775231 20 1407936974 0 Physicians Anesthesia Services 20 1407936974 0 Physicians Fluoride varnish 20 1407936974 0 Physicians Healthy Kids Services 20 1407936974 0 Physicians Optical Supplies 20 1407936974 0 Physicians Physician Services 00 1407937733 0 MILES JAMES 2021339 9999999 B 10 1407937733 0 PO BOX 10010 GLENDALE AZ 853180010 20 1407937733 0 Physicians Anesthesia Services 20 1407937733 0 Physicians Healthy Kids Services 20 1407937733 0 Physicians Optical Supplies 20 1407937733 0 Physicians Physician Services 00 1407938186 0 LEAGUE ALAN 2006227 9999999 B 10 1407938186 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1407938186 0 Physicians Anesthesia Services 20 1407938186 0 Physicians Healthy Kids Services 20 1407938186 0 Physicians Optical Supplies 20 1407938186 0 Physicians Physician Services 00 1407939630 0 JESPERSEN ROBERT 1985060 9999999 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Physicians Psychiatric Services 00 1407940463 0 LEE DORIS M 1993181 9999999 A 10 1407940463 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1407940463 0 Physicians Anesthesia Services 20 1407940463 0 Physicians Healthy Kids Services 20 1407940463 0 Physicians Optical Supplies 20 1407940463 0 Physicians Physician Services 00 1407940513 0 THAKKAR HEMALINI 1999244 9999999 B 10 1407940513 0 5777 DEPT CAROL STREAM IL 601228942 20 1407940513 0 Physicians Anesthesia Services 20 1407940513 0 Physicians Fluoride varnish 20 1407940513 0 Physicians Healthy Kids Services 20 1407940513 0 Physicians Optical Supplies 20 1407940513 0 Physicians Physician Services 00 1407940794 0 MANRING MONICA A 2009033 9999999 B 10 1407940794 0 4701 DEPT CAROL STREAM IL 601220021 20 1407940794 0 Physical Therapists Medical Supplies 20 1407940794 0 Physical Therapists Medical equipment/prosthetic devices 20 1407940794 0 Physical Therapists Physical Therapy Services 00 1407941230 0 SNYDER KIMBERLY 2016242 9999999 B 10 1407941230 0 PO BOX 637273 CINCINNATI OH 452637273 20 1407941230 0 Physical Therapists Medical Supplies 20 1407941230 0 Physical Therapists Medical equipment/prosthetic devices 20 1407941230 0 Physical Therapists Physical Therapy Services 00 1407941255 0 BORTNICK CARY J 1985067 9999999 B 10 1407941255 0 303 E ARMY TRAIL RD STE 100 BLOOMINGDALE IL 601082140 20 1407941255 0 Physicians Anesthesia Services 20 1407941255 0 Physicians Healthy Kids Services 20 1407941255 0 Physicians Optical Supplies 20 1407941255 0 Physicians Physician Services 00 1407942352 0 ALBRIGHT EMILY 2011244 9999999 B 10 1407942352 0 1420 W PIONEER PKWY STE 205 PEORIA IL 616151941 20 1407942352 0 Physicians Anesthesia Services 20 1407942352 0 Physicians Healthy Kids Services 20 1407942352 0 Physicians Optical Supplies 20 1407942352 0 Physicians Physician Services 00 1407942717 0 HOSTETLER JOSEPH 2020361 9999999 B 10 1407942717 0 250 N SHADELAND AVE STE 200 INDIANAPOLIS IN 462194959 20 1407942717 0 Physician Assistant 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Physicians Optical Supplies 20 1407944309 0 Physicians Physician Services 00 1407944317 0 EGELSEER JENNIFER 2018338 9999999 B 10 1407944317 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1407944317 0 Physicians Anesthesia Services 20 1407944317 0 Physicians Fluoride varnish 20 1407944317 0 Physicians Healthy Kids Services 20 1407944317 0 Physicians Optical Supplies 20 1407944317 0 Physicians Physician Services 00 1407944531 0 SEARS ROBERT C 2018029 9999999 B 10 1407944531 0 2200 JEFFERSON AVE TOLEDO OH 436047101 20 1407944531 0 Physicians Anesthesia Services 20 1407944531 0 Physicians Healthy Kids Services 20 1407944531 0 Physicians Optical Supplies 20 1407944531 0 Physicians Physician Services 20 1407944531 0 Physicians Physicians Psychiatric Services 00 1407945553 0 CASTILLO GONZALO D 1996151 9999999 B 10 1407945553 0 5777 DEPT CAROL STREAM IL 601220021 20 1407945553 0 Physicians Anesthesia Services 20 1407945553 0 Physicians Healthy Kids Services 20 1407945553 0 Physicians Optical 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Physicians Fluoride varnish 20 1407955214 0 Physicians Healthy Kids Services 20 1407955214 0 Physicians Optical Supplies 20 1407955214 0 Physicians Physician Services 00 1407955248 0 BOYD MICHAEL A 2011213 9999999 A 10 1407955248 0 2200 STATE ST LAWRENCEVILLE IL 624391852 20 1407955248 0 Physicians Anesthesia Services 20 1407955248 0 Physicians Healthy Kids Services 20 1407955248 0 Physicians Optical Supplies 20 1407955248 0 Physicians Physician Services 00 1407955487 0 KETNER LARRY 1990183 9999999 B 10 1407955487 0 PO BOX 772294 DETROIT MI 482772294 20 1407955487 0 Podiatrists Podiatric Services 00 1407956170 0 MORTON SCOTT 1986152 9999999 B 10 1407956170 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1407956170 0 Physicians Anesthesia Services 20 1407956170 0 Physicians Fluoride varnish 20 1407956170 0 Physicians Healthy Kids Services 20 1407956170 0 Physicians Optical Supplies 20 1407956170 0 Physicians Physician Services 00 1407956758 0 SHANNON TIMOTHY 2014176 9999999 B 10 1407956758 0 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1417007402 0 DUMBA JOSEPH S 2012001 9999999 B 10 1417007402 0 6404 N 70TH PLZ OMAHA NE 681041074 20 1417007402 0 Physicians Anesthesia Services 20 1417007402 0 Physicians Fluoride varnish 20 1417007402 0 Physicians Healthy Kids Services 20 1417007402 0 Physicians Optical Supplies 20 1417007402 0 Physicians Physician Services 00 1417007428 0 VETTRAINO IVANA M 1992136 9999999 B 10 1417007428 0 PO BOX 840532 DALLAS TX 752840532 20 1417007428 0 Physicians Anesthesia Services 20 1417007428 0 Physicians Healthy Kids Services 20 1417007428 0 Physicians Optical Supplies 20 1417007428 0 Physicians Physician Services 00 1417008475 0 SHANKS RAINA 2023255 9999999 B 10 1417008475 0 PO BOX 776084 CHICAGO IL 606776084 20 1417008475 0 Physicians Anesthesia Services 20 1417008475 0 Physicians Healthy Kids Services 20 1417008475 0 Physicians Optical Supplies 20 1417008475 0 Physicians Physician Services 00 1417008483 0 HENTATI AFIF 2001305 9999999 B 10 1417008483 0 2650 RIDGE AVE # 1223 EVANSTON IL 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Physician Services 00 1417105149 0 MCCARTHY DANIEL P 2017244 9999999 B 10 1417105149 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1417105149 0 Physicians Anesthesia Services 20 1417105149 0 Physicians Healthy Kids Services 20 1417105149 0 Physicians Optical Supplies 20 1417105149 0 Physicians Physician Services 00 1417106105 0 EPURE MIHAIL C 2009213 9999999 B 10 1417106105 0 29373 NETWORK PL CHICAGO IL 606733039 20 1417106105 0 Physicians Anesthesia Services 20 1417106105 0 Physicians Healthy Kids Services 20 1417106105 0 Physicians Optical Supplies 20 1417106105 0 Physicians Physician Services 00 1417106519 0 MEERSMAN MICHELENE 2016032 9999999 B 10 1417106519 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1417106519 0 Physician Assistant Only Fluoride varnish 20 1417106519 0 Physician Assistant Only Healthy Kids Services 20 1417106519 0 Physician Assistant Only Physician Services 00 1417107087 0 WALSH ANUJA THAKKAR 2017001 9999999 B 10 1417107087 0 5777 DEPT CAROL STREAM IL 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GOVERNORS HWY OLYMPIA FIELDS IL 604611021 20 1417110826 0 Physicians Anesthesia Services 20 1417110826 0 Physicians Healthy Kids Services 20 1417110826 0 Physicians Optical Supplies 20 1417110826 0 Physicians Physician Services 00 1417111311 0 OLUTADE TOYOSI T 2011220 2099365 B 10 1417111311 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1417111311 0 Physicians Anesthesia Services 20 1417111311 0 Physicians Fluoride varnish 20 1417111311 0 Physicians Healthy Kids Services 20 1417111311 0 Physicians Optical Supplies 20 1417111311 0 Physicians Physician Services 00 1417111477 0 RIAD SHAREEF M 2021195 9999999 B 10 1417111477 0 PO BOX 1790 BROOKFIELD WI 530081790 20 1417111477 0 Physicians Anesthesia Services 20 1417111477 0 Physicians Healthy Kids Services 20 1417111477 0 Physicians Optical Supplies 20 1417111477 0 Physicians Physician Services 00 1417111584 0 AJMERE RESHMA 2008231 9999999 B 10 1417111584 0 3900 GABRIELLE LN UNIT 9130 AURORA IL 605984335 20 1417111584 0 Physicians Anesthesia 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1417117219 0 PELZEL KELLY E 2018184 9999999 B 10 1417117219 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1417117219 0 Psychologist Psychologist service 00 1417117854 0 DOELLMAN MARY S 2024172 9999999 B 10 1417117854 0 1025 MAINE ST QUINCY IL 623014038 20 1417117854 0 Physicians Anesthesia Services 20 1417117854 0 Physicians Healthy Kids Services 20 1417117854 0 Physicians Optical Supplies 20 1417117854 0 Physicians Physician Services 00 1417118613 0 HENDEL EMILY 2022256 9999999 B 10 1417118613 0 2611 W CHICAGO AVE CHICAGO IL 606224519 20 1417118613 0 Nurse Practitioners Fluoride varnish 20 1417118613 0 Nurse Practitioners Healthy Kids Services 20 1417118613 0 Nurse Practitioners Nurse Practitioners Services 20 1417118613 0 Nurse Practitioners Physician Services 00 1417118647 0 BOZADA KATRINA A 2021036 9999999 B 10 1417118647 0 3621 S STATE ST ANN ARBOR MI 481081633 20 1417118647 0 Physicians Anesthesia Services 20 1417118647 0 Physicians Healthy Kids Services 20 1417118647 0 Physicians 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Physicians Healthy Kids Services 20 1417127457 0 Physicians Optical Supplies 20 1417127457 0 Physicians Physician Services 00 1417128083 0 ETHERIDGE MEREDITH J 2017181 9999999 B 10 1417128083 0 2200 JEFFERSON AVE TOLEDO OH 436047101 20 1417128083 0 Nurse Practitioners Fluoride varnish 20 1417128083 0 Nurse Practitioners Healthy Kids Services 20 1417128083 0 Nurse Practitioners Nurse Practitioners Services 20 1417128083 0 Nurse Practitioners Physician Services 00 1417129693 0 WINCE REGINALD 2010310 9999999 B 10 1417129693 0 PO BOX 843033 KANSAS CITY MO 641843033 20 1417129693 0 Nurse Practitioners Healthy Kids Services 20 1417129693 0 Nurse Practitioners Nurse Practitioners Services 20 1417129693 0 Nurse Practitioners Physician Services 00 1417131772 0 WAHEED SALMAN 2019001 9999999 B 10 1417131772 0 124 SW ADAMS ST PEORIA IL 616021308 20 1417131772 0 Physicians Anesthesia Services 20 1417131772 0 Physicians Fluoride varnish 20 1417131772 0 Physicians Healthy Kids Services 20 1417131772 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Physicians Healthy Kids Services 20 1417133463 0 Physicians Optical Supplies 20 1417133463 0 Physicians Physician Services 00 1417134305 0 HERRICK JESICA 2012306 9999999 B 10 1417134305 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1417134305 0 Physicians Anesthesia Services 20 1417134305 0 Physicians Fluoride varnish 20 1417134305 0 Physicians Healthy Kids Services 20 1417134305 0 Physicians Optical Supplies 20 1417134305 0 Physicians Physician Services 00 1417134883 0 HAMMOND KENDRA 2008245 9999999 B 10 1417134883 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1417134883 0 Physicians Anesthesia Services 20 1417134883 0 Physicians Fluoride varnish 20 1417134883 0 Physicians Healthy Kids Services 20 1417134883 0 Physicians Optical Supplies 20 1417134883 0 Physicians Physician Services 00 1417137092 0 DAVEY TERRY K 2004226 9999999 B 10 1417137092 0 744 SNUG HARBOR TRL ELIZABETH AR 725317015 20 1417137092 0 Speech Therapists Medical Supplies 20 1417137092 0 Speech Therapists Medical equipment/prosthetic devices 20 1417137092 0 Speech Therapists Speech Therapy/Pathology Services 00 1417138546 0 KITCHIN DOUGLAS 2012061 9999999 B 10 1417138546 0 340 MIDLAND RD STE 120 JANESVILLE WI 535462339 20 1417138546 0 Physicians Anesthesia Services 20 1417138546 0 Physicians Healthy Kids Services 20 1417138546 0 Physicians Optical Supplies 20 1417138546 0 Physicians Physician Services 00 1417139452 0 KAUFMAN KENDRA 2011202 9999999 B 10 1417139452 0 5750 JOHNSTON ST STE 205 LAFAYETTE LA 705035334 20 1417139452 0 Physician Assistant Only Fluoride varnish 20 1417139452 0 Physician Assistant Only Healthy Kids Services 20 1417139452 0 Physician Assistant Only Physician Services 00 1417140591 0 SOLINI ROBIN L 2018346 9999999 B 10 1417140591 0 5777 DEPT CAROL STREAM IL 601220021 20 1417140591 0 Physician Assistant Only Fluoride varnish 20 1417140591 0 Physician Assistant Only Healthy Kids Services 20 1417140591 0 Physician Assistant Only Physician Services 00 1417140757 0 MITCHELL 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9999999 B 10 1417197690 0 210 N HAMMES AVE STE 205 SUITE 205 JOLIET IL 604358139 20 1417197690 0 Nurse Practitioners Healthy Kids Services 20 1417197690 0 Nurse Practitioners Nurse Practitioners Services 20 1417197690 0 Nurse Practitioners Physician Services 00 1417198011 0 AHMED KHAN MOHAMMED ILYAS 2014198 9999999 B 10 1417198011 0 PO BOX 17633 BELFAST ME 049154071 20 1417198011 0 Physicians Anesthesia Services 20 1417198011 0 Physicians Fluoride varnish 20 1417198011 0 Physicians Healthy Kids Services 20 1417198011 0 Physicians Optical Supplies 20 1417198011 0 Physicians Physician Services 00 1417199670 0 DAMMRICH DANIEL 2018128 9999999 B 10 1417199670 0 5777 DEPT CAROL STREAM IL 601220021 20 1417199670 0 Physicians Anesthesia Services 20 1417199670 0 Physicians Fluoride varnish 20 1417199670 0 Physicians Healthy Kids Services 20 1417199670 0 Physicians Optical Supplies 20 1417199670 0 Physicians Physician Services 00 1417202128 0 MASTRANGELO AIMEE 2016123 9999999 B 10 1417202128 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1417202128 0 Physician Assistant Only Fluoride varnish 20 1417202128 0 Physician Assistant Only Healthy Kids Services 20 1417202128 0 Physician Assistant Only Physician Services 00 1417202235 0 EL KASSIS YVONNE 2023181 9999999 B 10 1417202235 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1417202235 0 Physicians Anesthesia Services 20 1417202235 0 Physicians Fluoride varnish 20 1417202235 0 Physicians Healthy Kids Services 20 1417202235 0 Physicians Optical Supplies 20 1417202235 0 Physicians Physician Services 00 1417202623 0 KANTOR OLGA 2018352 9999999 B 10 1417202623 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1417202623 0 Physicians Anesthesia Services 20 1417202623 0 Physicians Healthy Kids Services 20 1417202623 0 Physicians Optical Supplies 20 1417202623 0 Physicians Physician Services 00 1417203050 0 KHURSHID JAHANZEB 2019288 9999999 B 10 1417203050 0 500 PORTER AVE AURORA MO 656052365 20 1417203050 0 Physicians 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Practitioners Healthy Kids Services 20 1417206616 0 Nurse Practitioners Nurse Practitioners Services 20 1417206616 0 Nurse Practitioners Physician Services 00 1417207689 0 CRIEL COURTNEY J 2021047 9999999 B 10 1417207689 0 2300 N EDWARD ST DECATUR IL 625264163 20 1417207689 0 Nurse Practitioners Healthy Kids Services 20 1417207689 0 Nurse Practitioners Nurse Practitioners Services 20 1417207689 0 Nurse Practitioners Physician Services 00 1417208299 0 ROSS HILLARY A 2015097 9999999 B 10 1417208299 0 5901 LINCOLN DR EDINA MN 554361611 20 1417208299 0 Nurse Practitioners Fluoride varnish 20 1417208299 0 Nurse Practitioners Healthy Kids Services 20 1417208299 0 Nurse Practitioners Nurse Practitioners Services 20 1417208299 0 Nurse Practitioners Physician Services 00 1417208505 0 TELLER COURTNEY 2012236 9999999 B 10 1417208505 0 309 S GALENA AVE STE 100 SUITE 100 DIXON IL 610213090 20 1417208505 0 Physician Assistant Only Family Planning Counseling 20 1417208505 0 Physician Assistant Only 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20 1417211756 0 Physicians Physician Services 00 1417211780 0 DERANI LENA 2016230 9999999 B 10 1417211780 0 29373 NETWORK PL CHICAGO IL 606733039 20 1417211780 0 Physicians Anesthesia Services 20 1417211780 0 Physicians Healthy Kids Services 20 1417211780 0 Physicians Optical Supplies 20 1417211780 0 Physicians Physician Services 20 1417211780 0 Physicians Physicians Psychiatric Services 00 1417211830 0 COTLER KAREN 2019042 9999999 B 10 1417211830 0 7732 SOLUTIOIN CENTER CHICAGO IL 606770001 20 1417211830 0 Nurse Practitioners All Kids application agent 20 1417211830 0 Nurse Practitioners Fluoride varnish 20 1417211830 0 Nurse Practitioners Healthy Kids Services 20 1417211830 0 Nurse Practitioners Nurse Practitioners Services 20 1417211830 0 Nurse Practitioners Physician Services 00 1417212119 0 JABBOUR BASSEL 2022221 9999999 B 10 1417212119 0 PO BOX 5045 SIOUX FALLS SD 571175045 20 1417212119 0 Physicians Anesthesia Services 20 1417212119 0 Physicians Healthy Kids Services 20 1417212119 0 Physicians Optical Supplies 20 1417212119 0 Physicians Physician Services 00 1417212150 0 MCDONALD TRACY J 2012214 9999999 A 10 1417212150 0 5777 DEPT CAROL STREAM IL 601228942 20 1417212150 0 Nurse Practitioners Healthy Kids Services 20 1417212150 0 Nurse Practitioners Nurse Practitioners Services 20 1417212150 0 Nurse Practitioners Physician Services 00 1417213190 0 GLADWIN OMAR 2024092 9999999 B 10 1417213190 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1417213190 0 Physicians Anesthesia Services 20 1417213190 0 Physicians Healthy Kids Services 20 1417213190 0 Physicians Optical Supplies 20 1417213190 0 Physicians Physician Services 20 1417213190 0 Physicians Physicians Psychiatric Services 00 1417213869 0 DOMANSKI KRISTINA H 2023119 9999999 B 10 1417213869 0 1800 W CHARLESTON BLVD LAS VEGAS NV 891022329 20 1417213869 0 Physicians Anesthesia Services 20 1417213869 0 Physicians Healthy Kids Services 20 1417213869 0 Physicians Optical Supplies 20 1417213869 0 Physicians Physician Services 00 1417214156 0 HOLERS ADAM 2024162 9999999 B 10 1417214156 0 PO BOX 43230 PHOENIX AZ 850803230 20 1417214156 0 Physicians Anesthesia Services 20 1417214156 0 Physicians Fluoride varnish 20 1417214156 0 Physicians Healthy Kids Services 20 1417214156 0 Physicians Optical Supplies 20 1417214156 0 Physicians Physician Services 00 1417214222 0 WELLS KALANI R 2012153 9999999 B 10 1417214222 0 28592 NETWORK PL CHICAGO IL 606731285 20 1417214222 0 Nurse Practitioners Fluoride varnish 20 1417214222 0 Nurse Practitioners Healthy Kids Services 20 1417214222 0 Nurse Practitioners Nurse Practitioners Services 20 1417214222 0 Nurse Practitioners Physician Services 00 1417214404 0 KUMAR RAKESH 2024164 9999999 B 10 1417214404 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1417214404 0 Physicians Anesthesia Services 20 1417214404 0 Physicians Healthy Kids Services 20 1417214404 0 Physicians Optical Supplies 20 1417214404 0 Physicians Physician Services 00 1417214479 0 EISENMENGER LAURA 2018352 9999999 B 10 1417214479 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1417214479 0 Physicians Anesthesia Services 20 1417214479 0 Physicians Healthy Kids Services 20 1417214479 0 Physicians Optical Supplies 20 1417214479 0 Physicians Physician Services 00 1417215427 0 YEMANE RUTH EH 2018255 9999999 B 10 1417215427 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1417215427 0 Physicians Anesthesia Services 20 1417215427 0 Physicians Healthy Kids Services 20 1417215427 0 Physicians Optical Supplies 20 1417215427 0 Physicians Physician Services 00 1417215435 0 MUNJAL NEIL K 2022206 9999999 B 10 1417215435 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1417215435 0 Physicians Anesthesia Services 20 1417215435 0 Physicians Fluoride varnish 20 1417215435 0 Physicians Healthy Kids Services 20 1417215435 0 Physicians Optical Supplies 20 1417215435 0 Physicians Physician Services 00 1417215492 0 REYNOLDS DANIELLE 2017102 9999999 B 10 1417215492 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1417215492 0 Nurse Practitioners Fluoride varnish 20 1417215492 0 Nurse Practitioners Healthy Kids Services 20 1417215492 0 Nurse Practitioners Nurse Practitioners Services 20 1417215492 0 Nurse Practitioners Physician Services 00 1417215658 0 KULDANEK SUSAN A 2024001 9999999 B 10 1417215658 0 5901 LINCOLN DR EDINA MN 554361611 20 1417215658 0 Physicians Anesthesia Services 20 1417215658 0 Physicians Fluoride varnish 20 1417215658 0 Physicians Healthy Kids Services 20 1417215658 0 Physicians Optical Supplies 20 1417215658 0 Physicians Physician Services 00 1417215807 0 TESTIN ALYSSA M 2017340 9999999 B 10 1417215807 0 320 W MAIN ST OTTAWA IL 613502825 20 1417215807 0 Speech Therapists Medical Supplies 20 1417215807 0 Speech Therapists Medical equipment/prosthetic devices 20 1417215807 0 Speech Therapists Speech Therapy/Pathology Services 00 1417216052 0 TOCCO MARY W 2023023 9999999 B 10 1417216052 0 921 GESSNER RD HOUSTON TX 770242501 20 1417216052 0 Physicians 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1417217084 0 Physicians Fluoride varnish 20 1417217084 0 Physicians Healthy Kids Services 20 1417217084 0 Physicians Optical Supplies 20 1417217084 0 Physicians Physician Services 00 1417217415 0 STRANGE JEHU E 2017353 9999999 B 10 1417217415 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1417217415 0 Physicians Anesthesia Services 20 1417217415 0 Physicians Fluoride varnish 20 1417217415 0 Physicians Healthy Kids Services 20 1417217415 0 Physicians Optical Supplies 20 1417217415 0 Physicians Physician Services 00 1417217530 0 BEATTIE MEAGHAN J 2024250 9999999 B 10 1417217530 0 500 PASTEUR DR PALO ALTO CA 943041048 20 1417217530 0 Physicians Anesthesia Services 20 1417217530 0 Physicians Fluoride varnish 20 1417217530 0 Physicians Healthy Kids Services 20 1417217530 0 Physicians Optical Supplies 20 1417217530 0 Physicians Physician Services 00 1417217829 0 LALEKER ASHLEY 2022322 9999999 B 10 1417217829 0 901 MCCLINTOCK DR STE 202 SUITE 202 BURR RIDGE IL 605270872 20 1417217829 0 Physicians Anesthesia Services 20 1417217829 0 Physicians Fluoride varnish 20 1417217829 0 Physicians Healthy Kids Services 20 1417217829 0 Physicians Optical Supplies 20 1417217829 0 Physicians Physician Services 00 1417218405 0 KAR AROOP 2018182 9999999 B 10 1417218405 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1417218405 0 Physicians Anesthesia Services 20 1417218405 0 Physicians Fluoride varnish 20 1417218405 0 Physicians Healthy Kids Services 20 1417218405 0 Physicians Optical Supplies 20 1417218405 0 Physicians Physician Services 00 1417218462 0 KENNY JOHN PATRICK 2017201 9999999 B 10 1417218462 0 PO BOX 70 LAKE FOREST IL 600450070 20 1417218462 0 Physicians Anesthesia Services 20 1417218462 0 Physicians Healthy Kids Services 20 1417218462 0 Physicians Optical Supplies 20 1417218462 0 Physicians Physician Services 00 1417218751 0 SLABAUGH GREGORY J 2019055 9999999 B 10 1417218751 0 PO BOX 781076 DETROIT MI 482781076 20 1417218751 0 Physicians Anesthesia 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Physicians Optical Supplies 20 1417219437 0 Physicians Physician Services 00 1417220252 0 NICHOLSON ELIZABETH 2012046 9999999 B 10 1417220252 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1417220252 0 Nurse Practitioners Anesthesia Services 20 1417220252 0 Nurse Practitioners Nurse Practitioners Services 20 1417220252 0 Nurse Practitioners Physician Services 00 1417220336 0 CAPUTA TINA 2012142 9999999 H 10 1417220336 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1417220336 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1417220807 0 WALKER LAUREN 2021314 9999999 H 10 1417220807 0 18698 W PETERSON RD LIBERTYVILLE IL 60048 20 1417220807 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1417221524 0 NASR ALI S 2015090 9999999 B 10 1417221524 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1417221524 0 Physicians Anesthesia 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Healthy Kids Services 20 1417222779 0 Physicians Optical Supplies 20 1417222779 0 Physicians Physician Services 00 1417223157 0 SPAIN ADAM 2022149 9999999 B 10 1417223157 0 PO BOX 486 SAN JACINTO CA 925810486 20 1417223157 0 Physicians Anesthesia Services 20 1417223157 0 Physicians Fluoride varnish 20 1417223157 0 Physicians Healthy Kids Services 20 1417223157 0 Physicians Optical Supplies 20 1417223157 0 Physicians Physician Services 00 1417223447 0 SHPIGEL ADAM A 2020280 9999999 B 10 1417223447 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1417223447 0 Physicians Anesthesia Services 20 1417223447 0 Physicians Fluoride varnish 20 1417223447 0 Physicians Healthy Kids Services 20 1417223447 0 Physicians Optical Supplies 20 1417223447 0 Physicians Physician Services 00 1417224098 0 PATEL MILAP 2017202 9999999 B 10 1417224098 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1417224098 0 Physicians Anesthesia Services 20 1417224098 0 Physicians Healthy Kids Services 20 1417224098 0 Physicians Optical Supplies 20 1417224098 0 Physicians Physician Services 00 1417225210 0 BERRY KRYSTYNA 2025007 9999999 B 10 1417225210 0 5159 W FULLERTON AVE CHICAGO IL 606392403 20 1417225210 0 Physicians Anesthesia Services 20 1417225210 0 Physicians Healthy Kids Services 20 1417225210 0 Physicians Optical Supplies 20 1417225210 0 Physicians Physician Services 00 1417226986 0 LORENZIN CHERYL 2011332 9999999 B 10 1417226986 0 3471 EAGLE WAY CHICAGO IL 606781034 20 1417226986 0 Nurse Practitioners Healthy Kids Services 20 1417226986 0 Nurse Practitioners Nurse Practitioners Services 20 1417226986 0 Nurse Practitioners Physician Services 00 1417228222 0 YUNG FLORENCE Y 2011103 9999999 H 10 1417228222 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1417228222 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1417228537 0 YOST LAURA D 2006166 9999999 B 10 1417228537 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1417228537 0 Speech Therapists Medical Supplies 20 1417228537 0 Speech Therapists Medical equipment/prosthetic devices 20 1417228537 0 Speech Therapists Speech Therapy/Pathology Services 00 1417228560 0 LANIER TRACY 2020155 9999999 B 10 1417228560 0 1901 W HARRISON ST CHICAGO IL 60612 20 1417228560 0 Clinical Social Worker Social work service 00 1417230426 0 BRIER STEFANIE R 2022363 9999999 B 10 1417230426 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1417230426 0 Physician Assistant Only Fluoride varnish 20 1417230426 0 Physician Assistant Only Healthy Kids Services 20 1417230426 0 Physician Assistant Only Physician Services 00 1417231515 0 PAGANO JAMIE L 2015034 9999999 B 10 1417231515 0 631 E PENNSYLVANIA CT ARLINGTON HEIGH IL 600054281 20 1417231515 0 Speech Therapists Medical Supplies 20 1417231515 0 Speech Therapists Medical equipment/prosthetic devices 20 1417231515 0 Speech Therapists Speech Therapy/Pathology Services 00 1417232059 0 KELLER LACEE A 2015348 9999999 B 10 1417232059 0 PO BOX 336 ALGONQUIN IL 601020336 20 1417232059 0 Physician Assistant Only Fluoride varnish 20 1417232059 0 Physician Assistant Only Healthy Kids Services 20 1417232059 0 Physician Assistant Only Physician Services 00 1417232125 0 FRIEDMAN EMILY B 2022241 9999999 B 10 1417232125 0 5777 DEPT CAROL STREAM IL 601220021 20 1417232125 0 Physician Assistant Only Fluoride varnish 20 1417232125 0 Physician Assistant Only Healthy Kids Services 20 1417232125 0 Physician Assistant Only Physician Services 00 1417232794 0 LAFFEY MARY 2012197 9999999 B 10 1417232794 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1417232794 0 Nurse Practitioners Fluoride varnish 20 1417232794 0 Nurse Practitioners Healthy Kids Services 20 1417232794 0 Nurse Practitioners Nurse Practitioners Services 20 1417232794 0 Nurse Practitioners Physician Services 00 1417235185 0 JONES JORDAN K 2013213 9999999 B 10 1417235185 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1417235185 0 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2017121 9999999 B 10 1417239583 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1417239583 0 Physicians Anesthesia Services 20 1417239583 0 Physicians Fluoride varnish 20 1417239583 0 Physicians Healthy Kids Services 20 1417239583 0 Physicians Optical Supplies 20 1417239583 0 Physicians Physician Services 00 1417240102 0 HANIF SAMEUL O 2017166 9999999 B 10 1417240102 0 3435 W VAN BUREN ST CHICAGO IL 606243312 20 1417240102 0 Physicians Anesthesia Services 20 1417240102 0 Physicians Healthy Kids Services 20 1417240102 0 Physicians Optical Supplies 20 1417240102 0 Physicians Physician Services 00 1417241050 0 STAHLSCHMIDT MARK 2015032 9999999 B 10 1417241050 0 500 PORTER AVE AURORA MO 656052365 20 1417241050 0 Physicians Anesthesia Services 20 1417241050 0 Physicians Healthy Kids Services 20 1417241050 0 Physicians Optical Supplies 20 1417241050 0 Physicians Physician Services 00 1417241944 0 GENTILE NICOLE MARIE 2017180 9999999 B 10 1417241944 0 1880 W WINCHESTER RD STE 104 LIBERTYVILLE IL 600485321 20 1417241944 0 Physicians Anesthesia Services 20 1417241944 0 Physicians Fluoride varnish 20 1417241944 0 Physicians Healthy Kids Services 20 1417241944 0 Physicians Optical Supplies 20 1417241944 0 Physicians Physician Services 00 1417242314 0 KING MICHAEL R 2016001 9999999 B 10 1417242314 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1417242314 0 Physicians Anesthesia Services 20 1417242314 0 Physicians Healthy Kids Services 20 1417242314 0 Physicians Optical Supplies 20 1417242314 0 Physicians Physician Services 00 1417243098 0 THOMAS ANDREW 2022293 9999999 B 10 1417243098 0 1232 W STATE ROAD 2 LA PORTE IN 463505469 20 1417243098 0 Physicians Anesthesia Services 20 1417243098 0 Physicians Healthy Kids Services 20 1417243098 0 Physicians Optical Supplies 20 1417243098 0 Physicians Physician Services 00 1417243189 0 SHAIKH KASHIF 2022297 9999999 B 10 1417243189 0 PO BOX 781076 DETROIT MI 482781076 20 1417243189 0 Physicians Anesthesia Services 20 1417243189 0 Physicians Healthy Kids Services 20 1417243189 0 Physicians Optical Supplies 20 1417243189 0 Physicians Physician Services 00 1417243296 0 ALSAKKA MOHAMMED A 2014259 9999999 B 10 1417243296 0 2250 N ILLINOIS AVE CARBONDALE IL 629015612 20 1417243296 0 Physicians Anesthesia Services 20 1417243296 0 Physicians Fluoride varnish 20 1417243296 0 Physicians Healthy Kids Services 20 1417243296 0 Physicians Optical Supplies 20 1417243296 0 Physicians Physician Services 00 1417243445 0 ELLIOTT MICHAEL 2024038 9999999 B 10 1417243445 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1417243445 0 Physician Assistant Only Fluoride varnish 20 1417243445 0 Physician Assistant Only Healthy Kids Services 20 1417243445 0 Physician Assistant Only Physician Services 00 1417243866 0 LASTE ZACHARY R 2016153 9999999 B 10 1417243866 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1417243866 0 Physicians Anesthesia Services 20 1417243866 0 Physicians Healthy Kids Services 20 1417243866 0 Physicians 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1417259805 0 9735 LANDMARK PARKWAY DR STE 2 SAINT LOUIS MO 631271666 20 1417259805 0 Physicians Anesthesia Services 20 1417259805 0 Physicians Fluoride varnish 20 1417259805 0 Physicians Healthy Kids Services 20 1417259805 0 Physicians Optical Supplies 20 1417259805 0 Physicians Physician Services 00 1417260548 0 NARANG AKHIL 2013182 9999999 B 10 1417260548 0 5777 DEPT CAROL STREAM IL 601220021 20 1417260548 0 Physicians Anesthesia Services 20 1417260548 0 Physicians Fluoride varnish 20 1417260548 0 Physicians Healthy Kids Services 20 1417260548 0 Physicians Optical Supplies 20 1417260548 0 Physicians Physician Services 00 1417261041 0 BUCKLEY ERIN K 2013246 9999999 B 10 1417261041 0 300 WINDING WOODS DR STE 200 O FALLON MO 633665081 20 1417261041 0 Physicians Anesthesia Services 20 1417261041 0 Physicians Healthy Kids Services 20 1417261041 0 Physicians Optical Supplies 20 1417261041 0 Physicians Physician Services 00 1417261363 0 SOLTYS DOUGLAS F 2017117 9999999 B 10 1417261363 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1417261363 0 Physicians Anesthesia Services 20 1417261363 0 Physicians Healthy Kids Services 20 1417261363 0 Physicians Optical Supplies 20 1417261363 0 Physicians Physician Services 00 1417261611 0 MOUAWAD AYHAM 2023213 9999999 B 10 1417261611 0 PO BOX 43230 PHOENIX AZ 850803230 20 1417261611 0 Physicians Anesthesia Services 20 1417261611 0 Physicians Fluoride varnish 20 1417261611 0 Physicians Healthy Kids Services 20 1417261611 0 Physicians Optical Supplies 20 1417261611 0 Physicians Physician Services 00 1417261967 0 COPPER TARA C 2014001 9999999 B 10 1417261967 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1417261967 0 Physicians Anesthesia Services 20 1417261967 0 Physicians Fluoride varnish 20 1417261967 0 Physicians Healthy Kids Services 20 1417261967 0 Physicians Optical Supplies 20 1417261967 0 Physicians Physician Services 00 1417262031 0 PHILIP-KULI JULIA M 2013294 9999999 B 10 1417262031 0 150 HARVESTER DR STE 300 BURR RIDGE IL 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WHITMAN RD STE 300 MELVILLE NY 117474300 20 1417268392 0 Physicians Anesthesia Services 20 1417268392 0 Physicians Healthy Kids Services 20 1417268392 0 Physicians Optical Supplies 20 1417268392 0 Physicians Physician Services 00 1417268475 0 KROMREY LORYN KING 2015244 9999999 B 10 1417268475 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1417268475 0 Physicians Anesthesia Services 20 1417268475 0 Physicians Healthy Kids Services 20 1417268475 0 Physicians Optical Supplies 20 1417268475 0 Physicians Physician Services 00 1417269077 0 BRIEGEL MARY C 2024123 9999999 B 10 1417269077 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1417269077 0 Clinical Social Worker Social work service 00 1417269424 0 SYMANSKI MARGARET 2015327 9999999 B 10 1417269424 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1417269424 0 Physician Assistant Only Fluoride varnish 20 1417269424 0 Physician Assistant Only Healthy Kids Services 20 1417269424 0 Physician Assistant Only Physician Services 00 1417272212 0 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9999999 B 10 1417442351 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1417442351 0 Physicians Anesthesia Services 20 1417442351 0 Physicians Fluoride varnish 20 1417442351 0 Physicians Healthy Kids Services 20 1417442351 0 Physicians Optical Supplies 20 1417442351 0 Physicians Physician Services 00 1417442823 0 PATEL NEIL 2019213 9999999 B 10 1417442823 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1417442823 0 Physicians Anesthesia Services 20 1417442823 0 Physicians Fluoride varnish 20 1417442823 0 Physicians Healthy Kids Services 20 1417442823 0 Physicians Optical Supplies 20 1417442823 0 Physicians Physician Services 00 1417442971 0 SUBOC GESSA T 2018353 9999999 B 10 1417442971 0 29373 NETWORK PL CHICAGO IL 606733039 20 1417442971 0 Physicians Anesthesia Services 20 1417442971 0 Physicians Fluoride varnish 20 1417442971 0 Physicians Healthy Kids Services 20 1417442971 0 Physicians Optical Supplies 20 1417442971 0 Physicians Physician Services 00 1417443284 0 MAUTE TUCKER D 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1417451022 0 Physicians Optical Supplies 20 1417451022 0 Physicians Physician Services 00 1417451147 0 AINLEY HOLLIE E 2018218 9999999 B 10 1417451147 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1417451147 0 Nurse Practitioners Healthy Kids Services 20 1417451147 0 Nurse Practitioners Nurse Practitioners Services 20 1417451147 0 Nurse Practitioners Physician Services 00 1417451345 0 HALLORAN BETHANY 2022251 9999999 B 10 1417451345 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1417451345 0 Physicians Anesthesia Services 20 1417451345 0 Physicians Healthy Kids Services 20 1417451345 0 Physicians Optical Supplies 20 1417451345 0 Physicians Physician Services 00 1417451451 0 MAYBERRY TIFFANY 2018082 9999999 B 10 1417451451 0 300 CEDAR ST PEKIN IL 615547009 20 1417451451 0 Speech Therapists Medical Supplies 20 1417451451 0 Speech Therapists Medical equipment/prosthetic devices 20 1417451451 0 Speech Therapists Speech Therapy/Pathology Services 00 1417451501 0 SHAH SALONI 2021090 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Services 20 1417460502 0 Nurse Practitioners Physician Services 00 1417460833 0 CIULLA WANDA 2023131 9999999 B 10 1417460833 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1417460833 0 Physician Assistant Only Fluoride varnish 20 1417460833 0 Physician Assistant Only Healthy Kids Services 20 1417460833 0 Physician Assistant Only Physician Services 00 1417460932 0 PATEL RUTU 2023062 9999999 B 10 1417460932 0 2001 S CALIFORNIA AVE CHICAGO IL 606082486 20 1417460932 0 Dentists Dental Services 20 1417460932 0 Dentists Physician Services 00 1417461260 0 DUDLEY MICHELE D 2018012 9999999 B 10 1417461260 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1417461260 0 Nurse Practitioners Fluoride varnish 20 1417461260 0 Nurse Practitioners Healthy Kids Services 20 1417461260 0 Nurse Practitioners Nurse Practitioners Services 20 1417461260 0 Nurse Practitioners Physician Services 00 1417462573 0 CICHELLA MEGAN 2017353 9999999 B 10 1417462573 0 524 E SCHAUMBURG RD SCHAUMBURG IL 601943510 20 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Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1417521618 0 DIDIER BRIAN J 2021208 9999999 B 10 1417521618 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1417521618 0 Physicians Anesthesia Services 20 1417521618 0 Physicians Fluoride varnish 20 1417521618 0 Physicians Healthy Kids Services 20 1417521618 0 Physicians Optical Supplies 20 1417521618 0 Physicians Physician Services 00 1417522418 0 MENDONCA JOSEPH 2025016 9999999 B 10 1417522418 0 2001 BUTTERFIELD RD STE 1600 DOWNERS GROVE IL 605151211 20 1417522418 0 Physical Therapists Medical Supplies 20 1417522418 0 Physical Therapists Medical equipment/prosthetic devices 20 1417522418 0 Physical Therapists Physical Therapy Services 00 1417522699 0 KURZROCK PATRICIA M 2021141 9999999 H 10 1417522699 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1417522699 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1417522780 0 ANTON ANGELA 2023012 9999999 B 10 1417522780 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1417522780 0 Nurse Practitioners Healthy Kids Services 20 1417522780 0 Nurse Practitioners Nurse Practitioners Services 20 1417522780 0 Nurse Practitioners Physician Services 00 1417524703 0 ISINA AINURA S 2021188 9999999 B 10 1417524703 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1417524703 0 Physicians Anesthesia Services 20 1417524703 0 Physicians Healthy Kids Services 20 1417524703 0 Physicians Optical Supplies 20 1417524703 0 Physicians Physician Services 00 1417526310 0 WINKELER ANNA 2021249 9999999 B 10 1417526310 0 118 E WASHINGTON ST O FALLON IL 622691419 20 1417526310 0 Speech Therapists Medical Supplies 20 1417526310 0 Speech Therapists Medical equipment/prosthetic devices 20 1417526310 0 Speech Therapists Speech Therapy/Pathology Services 00 1417528951 0 GRIFFITH KYLE B 2024199 9999999 B 10 1417528951 0 1200 W STATE ST ROCKFORD IL 611022112 20 1417528951 0 Physicians Anesthesia Services 20 1417528951 0 Physicians Fluoride varnish 20 1417528951 0 Physicians Healthy Kids Services 20 1417528951 0 Physicians Optical Supplies 20 1417528951 0 Physicians Physician Services 00 1417529892 0 STEWART ALLISON 2022004 9999999 H 10 1417529892 0 555 FAIRVIEW DR ROCHELLE IL 61068 20 1417529892 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1417530478 0 WILLIAMS AEQULIA 2021120 9999999 B 10 1417530478 0 18154 MARTIN AVE STE 1 HOMEWOOD IL 604302155 20 1417530478 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1417530643 0 SCHWARTZ NATHANIEL 2023227 9999999 B 10 1417530643 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1417530643 0 Physicians Anesthesia Services 20 1417530643 0 Physicians Fluoride varnish 20 1417530643 0 Physicians Healthy Kids Services 20 1417530643 0 Physicians Optical Supplies 20 1417530643 0 Physicians Physician Services 00 1417530916 0 MARKEE PETER C 2024212 9999999 B 10 1417530916 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1417530916 0 Physicians Anesthesia Services 20 1417530916 0 Physicians Healthy Kids Services 20 1417530916 0 Physicians Optical Supplies 20 1417530916 0 Physicians Physician Services 00 1417531930 0 VERSLUYS ASHLEY D 2021200 9999999 B 10 1417531930 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1417531930 0 Nurse Practitioners Healthy Kids Services 20 1417531930 0 Nurse Practitioners Nurse Practitioners Services 20 1417531930 0 Nurse Practitioners Physician Services 00 1417532839 0 PERRY DANA M 2021081 9999999 B 10 1417532839 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1417532839 0 Nurse Practitioners Fluoride varnish 20 1417532839 0 Nurse Practitioners Healthy Kids Services 20 1417532839 0 Nurse Practitioners Nurse Practitioners Services 20 1417532839 0 Nurse Practitioners Physician Services 00 1417533043 0 LEE DAVID M 2021216 9999999 B 10 1417533043 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1417533043 0 Physicians Anesthesia Services 20 1417533043 0 Physicians Fluoride varnish 20 1417533043 0 Physicians Healthy Kids Services 20 1417533043 0 Physicians Optical Supplies 20 1417533043 0 Physicians Physician Services 00 1417533340 0 BRZYCKI ELIZABETH 2021104 9999999 B 10 1417533340 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1417533340 0 Nurse Practitioners Healthy Kids Services 20 1417533340 0 Nurse Practitioners Nurse Practitioners Services 20 1417533340 0 Nurse Practitioners Physician Services 00 1417533514 0 PANKO AUDREY J 2021174 9999999 B 10 1417533514 0 4698 DEPT CAROL STREAM IL 601220021 20 1417533514 0 Physicians Anesthesia Services 20 1417533514 0 Physicians Healthy Kids Services 20 1417533514 0 Physicians Optical Supplies 20 1417533514 0 Physicians Physician Services 00 1417534876 0 ABOELNASR AMR A 2024204 9999999 B 10 1417534876 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1417534876 0 Physicians Anesthesia Services 20 1417534876 0 Physicians Fluoride varnish 20 1417534876 0 Physicians Healthy Kids Services 20 1417534876 0 Physicians Optical Supplies 20 1417534876 0 Physicians Physician Services 00 1417535212 0 PENCE KELSEY 2021193 9999999 B 10 1417535212 0 250 W 96TH ST STE 520 INDIANAPOLIS IN 462601317 20 1417535212 0 Occupational Therapists Medical Supplies 20 1417535212 0 Occupational Therapists Medical equipment/prosthetic devices 20 1417535212 0 Occupational Therapists Occupational Therapy Services 00 1417535238 0 BELILOS ELEANOR A 2022192 9999999 B 10 1417535238 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1417535238 0 Physicians Anesthesia Services 20 1417535238 0 Physicians Fluoride varnish 20 1417535238 0 Physicians Healthy Kids Services 20 1417535238 0 Physicians Optical Supplies 20 1417535238 0 Physicians Physician Services 00 1417535469 0 FERNANDEZ MORALES LAURA I 2022236 9999999 B 10 1417535469 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1417535469 0 Physicians Anesthesia Services 20 1417535469 0 Physicians Fluoride varnish 20 1417535469 0 Physicians Healthy Kids Services 20 1417535469 0 Physicians Optical Supplies 20 1417535469 0 Physicians Physician Services 00 1417536152 0 MARTINEZ JENNIFER 2024143 9999999 B 10 1417536152 0 70 S RIVER ST AURORA IL 605065185 20 1417536152 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1417537051 0 O'SULLIVAN CHRISTOPHER 2023208 9999999 B 10 1417537051 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1417537051 0 Physicians Anesthesia Services 20 1417537051 0 Physicians Healthy Kids Services 20 1417537051 0 Physicians Optical Supplies 20 1417537051 0 Physicians Physician Services 00 1417537242 0 MAHONEY LINDSEY 2023191 9999999 B 10 1417537242 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1417537242 0 Physicians Anesthesia Services 20 1417537242 0 Physicians Healthy Kids Services 20 1417537242 0 Physicians Optical Supplies 20 1417537242 0 Physicians Physician Services 00 1417537531 0 EPSTEN MADELINE J 2022193 9999999 B 10 1417537531 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1417537531 0 Physicians Anesthesia Services 20 1417537531 0 Physicians Healthy Kids Services 20 1417537531 0 Physicians Optical Supplies 20 1417537531 0 Physicians Physician Services 00 1417537945 0 CRUZ NELSY 2021104 9999999 B 10 1417537945 0 1414 MAIN ST MELROSE PARK IL 601603902 20 1417537945 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1417539180 0 YOUNG ABIGAIL 2021238 9999999 B 10 1417539180 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1417539180 0 Nurse Practitioners Fluoride varnish 20 1417539180 0 Nurse Practitioners Healthy Kids Services 20 1417539180 0 Nurse Practitioners Nurse Practitioners Services 20 1417539180 0 Nurse Practitioners Physician Services 00 1417540527 0 VILLEGAS EMILY L 2021062 9999999 B 10 1417540527 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1417540527 0 Nurse Practitioners Healthy Kids Services 20 1417540527 0 Nurse Practitioners Nurse Practitioners Services 20 1417540527 0 Nurse Practitioners Physician Services 00 1417541186 0 SCANLON EMILY 2023138 9999999 B 10 1417541186 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1417541186 0 Speech Therapists Medical Supplies 20 1417541186 0 Speech Therapists Medical equipment/prosthetic devices 20 1417541186 0 Speech Therapists Speech Therapy/Pathology Services 00 1417544305 0 KITZMANN NATHANIEL G 2022327 9999999 B 10 1417544305 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1417544305 0 Physician Assistant Only Fluoride varnish 20 1417544305 0 Physician Assistant Only Healthy Kids Services 20 1417544305 0 Physician Assistant Only Physician Services 00 1417546193 0 SHRUM MICHEAL 2022251 9999999 B 10 1417546193 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1417546193 0 Physician Assistant Only Fluoride varnish 20 1417546193 0 Physician Assistant Only Healthy Kids Services 20 1417546193 0 Physician Assistant Only Physician Services 00 1417546268 0 PANG SARAH 2024113 9999999 B 10 1417546268 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1417546268 0 Physician Assistant Only Fluoride varnish 20 1417546268 0 Physician Assistant Only Healthy Kids Services 20 1417546268 0 Physician Assistant Only Physician Services 00 1417546441 0 GRIESBAUM MARY M 2021075 9999999 B 10 1417546441 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1417546441 0 Nurse Practitioners Healthy Kids Services 20 1417546441 0 Nurse Practitioners Nurse Practitioners Services 20 1417546441 0 Nurse Practitioners Physician Services 00 1417546607 0 ENGLISH MATTHEW E 2021103 9999999 B 10 1417546607 0 2211 N ELSTON AVE STE 301 CHICAGO IL 606149278 20 1417546607 0 Clinical Social Worker Social work service 00 1417549882 0 KAMAR VANSA 2022145 9999999 B 10 1417549882 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1417549882 0 Nurse Practitioners Anesthesia Services 20 1417549882 0 Nurse Practitioners Nurse Practitioners Services 20 1417549882 0 Nurse Practitioners Physician Services 00 1417551276 0 SAAVEDRA ANA L 2021050 9999999 B 10 1417551276 0 2001 S CALIFORNIA AVE # 100 CHICAGO IL 606082486 20 1417551276 0 Nurse Practitioners Fluoride varnish 20 1417551276 0 Nurse Practitioners Healthy Kids Services 20 1417551276 0 Nurse Practitioners Nurse Practitioners Services 20 1417551276 0 Nurse Practitioners Physician Services 00 1417552092 0 BUSKOHL MISTY 2020338 9999999 B 10 1417552092 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1417552092 0 Nurse Practitioners Fluoride varnish 20 1417552092 0 Nurse Practitioners Healthy Kids Services 20 1417552092 0 Nurse Practitioners Nurse Practitioners Services 20 1417552092 0 Nurse Practitioners Physician Services 00 1417553694 0 BRASHARES RAEANNA 2023303 9999999 B 10 1417553694 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1417553694 0 Speech Therapists Medical Supplies 20 1417553694 0 Speech Therapists Medical equipment/prosthetic devices 20 1417553694 0 Speech Therapists Speech Therapy/Pathology Services 00 1417554130 0 GERBERDING STEPHANIE R 2020297 9999999 B 10 1417554130 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1417554130 0 Clinical Social Worker Social work service 00 1417554940 0 SKURTU THOMAS 2022300 9999999 B 10 1417554940 0 1009 WINDCROSS CT STE 101 FRANKLIN TN 370672678 20 1417554940 0 Nurse Practitioners Healthy Kids Services 20 1417554940 0 Nurse Practitioners Nurse Practitioners Services 20 1417554940 0 Nurse Practitioners Physician Services 00 1417555897 0 ROGERS CARLA R 2020335 9999999 B 10 1417555897 0 PO BOX 34266 BELFAST ME 049150620 20 1417555897 0 Nurse Practitioners Fluoride varnish 20 1417555897 0 Nurse Practitioners Healthy Kids Services 20 1417555897 0 Nurse Practitioners Nurse Practitioners Services 20 1417555897 0 Nurse Practitioners Physician Services 00 1417556812 0 FIGUEROA MONICA 2020336 9999999 B 10 1417556812 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1417556812 0 Nurse Practitioners Healthy Kids Services 20 1417556812 0 Nurse Practitioners Nurse Practitioners Services 20 1417556812 0 Nurse Practitioners Physician Services 00 1417559402 0 SNEEK JESSICA 2020321 9999999 H 10 1417559402 0 421 W EXCHANGE ST FREEPORT IL 610324008 20 1417559402 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1417560517 0 NORKIEWICZ MADELYN L 2020243 9999999 B 10 1417560517 0 310 S MAIN ST STE D LOMBARD IL 601482692 20 1417560517 0 Speech Therapists Medical Supplies 20 1417560517 0 Speech Therapists Medical equipment/prosthetic devices 20 1417560517 0 Speech Therapists Speech Therapy/Pathology Services 00 1417561770 0 WRIGHT DAVID C 2020239 9999999 B 10 1417561770 0 PO BOX 88848 CAROL STREAM IL 601880848 20 1417561770 0 Nurse Practitioners Anesthesia Services 20 1417561770 0 Nurse Practitioners Nurse Practitioners Services 20 1417561770 0 Nurse Practitioners Physician Services 00 1417563404 0 KHAN HUNNAAN M 2024108 9999999 B 10 1417563404 0 800 W FULTON MARKET FL 12 CHICAGO IL 606071302 20 1417563404 0 Physician Assistant Only Fluoride varnish 20 1417563404 0 Physician Assistant Only Healthy Kids Services 20 1417563404 0 Physician Assistant Only Physician Services 00 1417564188 0 LIM SANG IN 2020319 9999999 B 10 1417564188 0 1102 4TH AVE MOLINE IL 612651231 20 1417564188 0 Dentists Dental Services 20 1417564188 0 Dentists Physician Services 00 1417567546 0 RUSNAK CYNTHIA L 2020290 9999999 B 10 1417567546 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1417567546 0 Nurse Practitioners Healthy Kids Services 20 1417567546 0 Nurse Practitioners Nurse Practitioners Services 20 1417567546 0 Nurse Practitioners Physician Services 00 1417568759 0 RAUNIYAR ROHIT 2024219 9999999 B 10 1417568759 0 PO BOX 43230 PHOENIX AZ 850803230 20 1417568759 0 Physicians Anesthesia Services 20 1417568759 0 Physicians Fluoride varnish 20 1417568759 0 Physicians Healthy Kids Services 20 1417568759 0 Physicians Optical Supplies 20 1417568759 0 Physicians Physician Services 00 1417569641 0 ELDIFRAWI ASHRAF A 1998274 9999999 B 10 1417569641 0 564 N ELM ST HINSDALE IL 605213502 20 1417569641 0 Psychologist Psychologist service 00 1417570268 0 HUSSAINI SYED I 2020260 9999999 B 10 1417570268 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1417570268 0 Physicians Anesthesia Services 20 1417570268 0 Physicians Fluoride varnish 20 1417570268 0 Physicians Healthy Kids Services 20 1417570268 0 Physicians Optical Supplies 20 1417570268 0 Physicians Physician Services 00 1417570482 0 PIGGOT KAITLIN M 2021018 9999999 B 10 1417570482 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1417570482 0 Nurse Practitioners Healthy Kids Services 20 1417570482 0 Nurse Practitioners Nurse Practitioners Services 20 1417570482 0 Nurse Practitioners Physician Services 00 1417570490 0 RAJU RUBY 2020183 9999999 B 10 1417570490 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1417570490 0 Physicians Anesthesia Services 20 1417570490 0 Physicians Fluoride varnish 20 1417570490 0 Physicians Healthy Kids Services 20 1417570490 0 Physicians Optical Supplies 20 1417570490 0 Physicians Physician Services 00 1417571001 0 SARKAR SAMIHA 2020182 9999999 B 10 1417571001 0 221 NE GLEN OAK AVE ATTN: STEPHEN CIRONE GOMP 100 PEORIA IL 616360001 20 1417571001 0 Physicians Anesthesia Services 20 1417571001 0 Physicians Fluoride varnish 20 1417571001 0 Physicians Healthy Kids Services 20 1417571001 0 Physicians Optical Supplies 20 1417571001 0 Physicians Physician Services 00 1417571233 0 STOWELL AMY M 2021051 9999999 B 10 1417571233 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1417571233 0 Nurse Practitioners Fluoride varnish 20 1417571233 0 Nurse Practitioners Healthy Kids Services 20 1417571233 0 Nurse Practitioners Nurse Practitioners Services 20 1417571233 0 Nurse Practitioners Physician Services 00 1417571449 0 PANOS ARIELLA 2023018 9999999 B 10 1417571449 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1417571449 0 Physician Assistant Only Fluoride varnish 20 1417571449 0 Physician Assistant Only Healthy Kids Services 20 1417571449 0 Physician Assistant Only Physician Services 00 1417571761 0 SUHAIL SAM K 2024058 9999999 B 10 1417571761 0 1811 W NORTH AVE STE 201 CHICAGO IL 606221488 20 1417571761 0 Physicians Anesthesia Services 20 1417571761 0 Physicians Healthy Kids Services 20 1417571761 0 Physicians Optical Supplies 20 1417571761 0 Physicians Physician Services 20 1417571761 0 Physicians Physicians Psychiatric Services 00 1417572058 0 HILL SPENCER L 2021175 9999999 B 10 1417572058 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1417572058 0 Physicians Anesthesia Services 20 1417572058 0 Physicians Fluoride varnish 20 1417572058 0 Physicians Healthy Kids Services 20 1417572058 0 Physicians Optical Supplies 20 1417572058 0 Physicians Physician Services 00 1417572603 0 LOPEZ-CORBIN MIXI J 2020203 9999999 B 10 1417572603 0 6501 S PROMONTORY DR CHICAGO IL 606491003 20 1417572603 0 Clinical Social Worker Social work service 00 1417572652 0 CHONG DANIEL HYUN 2024356 9999999 B 10 1417572652 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1417572652 0 Occupational Therapists Medical Supplies 20 1417572652 0 Occupational Therapists Medical equipment/prosthetic devices 20 1417572652 0 Occupational Therapists Occupational Therapy Services 00 1417573734 0 MEDINA SCHERRIE 2020227 9999999 B 10 1417573734 0 4119 S WATER TOWER PL STE A MOUNT VERNON IL 628646293 20 1417573734 0 Nurse Practitioners Healthy Kids Services 20 1417573734 0 Nurse Practitioners Nurse Practitioners Services 20 1417573734 0 Nurse Practitioners Physician Services 00 1417573932 0 EKESA EVALYNE N 2022322 9999999 B 10 1417573932 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1417573932 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1417574054 0 CLEMANS KATHRYN 2020198 9999999 B 10 1417574054 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1417574054 0 Nurse Practitioners Anesthesia Services 20 1417574054 0 Nurse Practitioners Nurse Practitioners Services 20 1417574054 0 Nurse Practitioners Physician Services 00 1417574575 0 DENMAN NICOLE 2024296 9999999 B 10 1417574575 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1417574575 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1417575226 0 JOSEPH SHARON 2021173 9999999 B 10 1417575226 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1417575226 0 Physicians Anesthesia Services 20 1417575226 0 Physicians Healthy Kids Services 20 1417575226 0 Physicians Optical Supplies 20 1417575226 0 Physicians Physician Services 00 1417575630 0 RHEINTGEN CHRISTINE 2020212 9999999 B 10 1417575630 0 1414 MAIN ST MELROSE PARK IL 601603902 20 1417575630 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1417575853 0 BABIONE JOSEPH M 2020266 9999999 B 10 1417575853 0 221 NE GLEN OAK AVE ATTN: STEPHEN CIRONE GOMP 100 PEORIA IL 616360001 20 1417575853 0 Psychologist Psychologist service 00 1417576984 0 AHMAD MUHADDIS 2023268 9999999 B 10 1417576984 0 9735 LANDMARK PARKWAY DR STE 2 SAINT LOUIS MO 631271666 20 1417576984 0 Physicians Anesthesia Services 20 1417576984 0 Physicians Fluoride varnish 20 1417576984 0 Physicians Healthy Kids Services 20 1417576984 0 Physicians Optical Supplies 20 1417576984 0 Physicians Physician Services 00 1417577057 0 IBARRA LOPEZ JOSE S 2024044 9999999 B 10 1417577057 0 14050 NW 14TH ST STE 190 SUNRISE FL 333232851 20 1417577057 0 Physicians Anesthesia Services 20 1417577057 0 Physicians Fluoride varnish 20 1417577057 0 Physicians Healthy Kids Services 20 1417577057 0 Physicians Optical Supplies 20 1417577057 0 Physicians Physician Services 00 1417577263 0 CONWAY SAMANTHA D 2024066 9999999 B 10 1417577263 0 5777 DEPT CAROL STREAM IL 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20 1417578527 0 Physicians Physician Services 00 1417578618 0 BRAUNEIS CAITLIN 2024113 9999999 B 10 1417578618 0 5777 DEPT CAROL STREAM IL 601220021 20 1417578618 0 Physician Assistant Only Fluoride varnish 20 1417578618 0 Physician Assistant Only Healthy Kids Services 20 1417578618 0 Physician Assistant Only Physician Services 00 1417578626 0 MOODY ALISSA A 2023278 9999999 B 10 1417578626 0 6300 RIDGLEA PL STE 201 FORT WORTH TX 761165707 20 1417578626 0 Physicians Anesthesia Services 20 1417578626 0 Physicians Healthy Kids Services 20 1417578626 0 Physicians Optical Supplies 20 1417578626 0 Physicians Physician Services 00 1417578873 0 CHASKELSON SASKIA N 2020332 9999999 B 10 1417578873 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1417578873 0 Nurse Practitioners Healthy Kids Services 20 1417578873 0 Nurse Practitioners Nurse Practitioners Services 20 1417578873 0 Nurse Practitioners Physician Services 00 1417578980 0 HEISE RACHEL N 2020192 9999999 B 10 1417578980 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1417578980 0 Nurse Practitioners Anesthesia Services 20 1417578980 0 Nurse Practitioners Nurse Practitioners Services 20 1417578980 0 Nurse Practitioners Physician Services 00 1417579426 0 HANSON BRETT 2021316 9999999 B 10 1417579426 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1417579426 0 Physicians Anesthesia Services 20 1417579426 0 Physicians Healthy Kids Services 20 1417579426 0 Physicians Optical Supplies 20 1417579426 0 Physicians Physician Services 00 1417579541 0 PITTMAN KELYN 2020244 9999999 B 10 1417579541 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1417579541 0 Physicians Anesthesia Services 20 1417579541 0 Physicians Healthy Kids Services 20 1417579541 0 Physicians Optical Supplies 20 1417579541 0 Physicians Physician Services 00 1417580622 0 DEE TARYN 2020218 9999999 B 10 1417580622 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1417580622 0 Physicians Anesthesia Services 20 1417580622 0 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1417607888 0 Physicians Anesthesia Services 20 1417607888 0 Physicians Healthy Kids Services 20 1417607888 0 Physicians Optical Supplies 20 1417607888 0 Physicians Physician Services 00 1417609884 0 WINTERS TONYA 2022073 9999999 B 10 1417609884 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1417609884 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1417610239 0 MARTINSON BRIAN 2022018 9999999 B 10 1417610239 0 PO BOX 431 JANESVILLE WI 535470431 20 1417610239 0 Physician Assistant Only Fluoride varnish 20 1417610239 0 Physician Assistant Only Healthy Kids Services 20 1417610239 0 Physician Assistant Only Physician Services 00 1417610510 0 KOVALEVSKY NICOLE 2022182 9999999 B 10 1417610510 0 1901 RAYMOND DR STE 14 NORTHBROOK IL 600626739 20 1417610510 0 Occupational Therapists Medical Supplies 20 1417610510 0 Occupational Therapists Medical equipment/prosthetic devices 20 1417610510 0 Occupational 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Nurse Practitioners Healthy Kids Services 20 1417648148 0 Nurse Practitioners Nurse Practitioners Services 20 1417648148 0 Nurse Practitioners Physician Services 00 1417648312 0 KYEREMATEN VICTORIA 2023194 9999999 B 10 1417648312 0 5145 N CALIFORNIA AVE CHICAGO IL 606253661 20 1417648312 0 Physicians Anesthesia Services 20 1417648312 0 Physicians Fluoride varnish 20 1417648312 0 Physicians Healthy Kids Services 20 1417648312 0 Physicians Optical Supplies 20 1417648312 0 Physicians Physician Services 00 1417648338 0 WOOD ALEKSANDAR R 2023261 9999999 B 10 1417648338 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1417648338 0 Physicians Anesthesia Services 20 1417648338 0 Physicians Healthy Kids Services 20 1417648338 0 Physicians Optical Supplies 20 1417648338 0 Physicians Physician Services 00 1417648437 0 QUAN MEIYAN 2023172 9999999 B 10 1417648437 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1417648437 0 Physicians Anesthesia Services 20 1417648437 0 Physicians Fluoride varnish 20 1417648437 0 Physicians Healthy Kids Services 20 1417648437 0 Physicians Optical Supplies 20 1417648437 0 Physicians Physician Services 00 1417648825 0 WILLIAMS DENA L 2023142 9999999 B 10 1417648825 0 1 MEMORIAL DR ALTON IL 620026722 20 1417648825 0 Nurse Practitioners Fluoride varnish 20 1417648825 0 Nurse Practitioners Healthy Kids Services 20 1417648825 0 Nurse Practitioners Nurse Practitioners Services 20 1417648825 0 Nurse Practitioners Physician Services 00 1417648866 0 FREEMAN JOSHUA 2023187 9999999 B 10 1417648866 0 5145 N CALIFORNIA AVE CHICAGO IL 606253661 20 1417648866 0 Physicians Anesthesia Services 20 1417648866 0 Physicians Fluoride varnish 20 1417648866 0 Physicians Healthy Kids Services 20 1417648866 0 Physicians Optical Supplies 20 1417648866 0 Physicians Physician Services 00 1417649385 0 HORTON THEMBISILE 2023228 9999999 B 10 1417649385 0 29373 NETWORK PL CHICAGO IL 606733039 20 1417649385 0 Nurse Practitioners Fluoride varnish 20 1417649385 0 Nurse Practitioners Healthy Kids Services 20 1417649385 0 Nurse Practitioners Nurse Practitioners Services 20 1417649385 0 Nurse Practitioners Physician Services 00 1417649922 0 NEWMAN KARA 2023304 9999999 B 10 1417649922 0 1418 COLLEGE DR MOUNT CARMEL IL 628632638 20 1417649922 0 Physician Assistant Only Fluoride varnish 20 1417649922 0 Physician Assistant Only Healthy Kids Services 20 1417649922 0 Physician Assistant Only Physician Services 00 1417651134 0 ZENKIN SERAFETTIN 2024142 9999999 B 10 1417651134 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1417651134 0 Physicians Anesthesia Services 20 1417651134 0 Physicians Healthy Kids Services 20 1417651134 0 Physicians Optical Supplies 20 1417651134 0 Physicians Physician Services 00 1417651282 0 CARRANO ANDREW 2023144 9999999 B 10 1417651282 0 5777 DEPT CAROL STREAM IL 601220021 20 1417651282 0 Nurse Practitioners Fluoride varnish 20 1417651282 0 Nurse Practitioners Healthy Kids Services 20 1417651282 0 Nurse Practitioners Nurse Practitioners Services 20 1417651282 0 Nurse Practitioners Physician Services 00 1417652249 0 OBEGOLU ARINZECHUKWU M 2023150 9999999 B 10 1417652249 0 PO BOX 3039 OAK BROOK IL 605223039 20 1417652249 0 Physicians Anesthesia Services 20 1417652249 0 Physicians Fluoride varnish 20 1417652249 0 Physicians Healthy Kids Services 20 1417652249 0 Physicians Optical Supplies 20 1417652249 0 Physicians Physician Services 00 1417652363 0 SIMON BRIAN 2023217 9999999 B 10 1417652363 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1417652363 0 Physicians Anesthesia Services 20 1417652363 0 Physicians Fluoride varnish 20 1417652363 0 Physicians Healthy Kids Services 20 1417652363 0 Physicians Optical Supplies 20 1417652363 0 Physicians Physician Services 00 1417654914 0 GUTHRIE TIFFANY 2024257 9999999 B 10 1417654914 0 PO BOX 2477 SHELTON CT 064841477 20 1417654914 0 Nurse Practitioners Healthy Kids Services 20 1417654914 0 Nurse Practitioners Nurse Practitioners Services 20 1417654914 0 Nurse 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1417657875 0 Nurse Practitioners Healthy Kids Services 20 1417657875 0 Nurse Practitioners Nurse Practitioners Services 20 1417657875 0 Nurse Practitioners Physician Services 00 1417663345 0 AKINWOLE TAIWO 2023166 9999999 B 10 1417663345 0 1051 SOUTHFIELD DR PLAINFIELD IN 461682955 20 1417663345 0 Nurse Practitioners Fluoride varnish 20 1417663345 0 Nurse Practitioners Healthy Kids Services 20 1417663345 0 Nurse Practitioners Nurse Practitioners Services 20 1417663345 0 Nurse Practitioners Physician Services 00 1417663485 0 BOLTON JESSICA L 2024080 9999999 B 10 1417663485 0 1 ILLINI DR PEORIA IL 616052576 20 1417663485 0 Nurse Practitioners Fluoride varnish 20 1417663485 0 Nurse Practitioners Healthy Kids Services 20 1417663485 0 Nurse Practitioners Nurse Practitioners Services 20 1417663485 0 Nurse Practitioners Physician Services 00 1417664558 0 JONES LEAH 2022314 9999999 B 10 1417664558 0 PO BOX 856 ANTIOCH IL 600020856 20 1417664558 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1417664707 0 SALAZAR SALLY 2023150 9999999 B 10 1417664707 0 7300 W COLLEGE DR PALOS HEIGHTS IL 604631152 20 1417664707 0 Nurse Practitioners Healthy Kids Services 20 1417664707 0 Nurse Practitioners Nurse Practitioners Services 20 1417664707 0 Nurse Practitioners Physician Services 00 1417665951 0 HICKEY MEGAN M 2023026 9999999 B 10 1417665951 0 28594 NETWORK PL CHICAGO IL 606731285 20 1417665951 0 Physician Assistant Only Fluoride varnish 20 1417665951 0 Physician Assistant Only Healthy Kids Services 20 1417665951 0 Physician Assistant Only Physician Services 00 1417667296 0 SCHWARZROCK MEAGAN 2023032 9999999 B 10 1417667296 0 5777 DEPT CAROL STREAM IL 601220021 20 1417667296 0 Physical Therapists Medical Supplies 20 1417667296 0 Physical Therapists Medical equipment/prosthetic devices 20 1417667296 0 Physical Therapists Physical Therapy Services 00 1417670449 0 MARTIN MARIA 2023026 9999999 B 10 1417670449 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1417670449 0 Nurse Practitioners Healthy Kids Services 20 1417670449 0 Nurse Practitioners Nurse Practitioners Services 20 1417670449 0 Nurse Practitioners Physician Services 00 1417670589 0 FLEISCHMAN BRYAN 2024048 9999999 B 10 1417670589 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1417670589 0 Physician Assistant Only Fluoride varnish 20 1417670589 0 Physician Assistant Only HIV Counseling svcs 20 1417670589 0 Physician Assistant Only Healthy Kids Services 20 1417670589 0 Physician Assistant Only Physician Services 00 1417671223 0 COLLIER CHRISTINA M 2024023 9999999 B 10 1417671223 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1417671223 0 Nurse Practitioners Fluoride varnish 20 1417671223 0 Nurse Practitioners Healthy Kids Services 20 1417671223 0 Nurse Practitioners Nurse Practitioners Services 20 1417671223 0 Nurse Practitioners Physician Services 00 1417671553 0 MCCURRY CLAIRE C 2022311 9999999 B 10 1417671553 0 PO BOX 778912 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GABRIELLE 2022227 9999999 H 10 1417681388 0 721 N LA SALLE DR CHICAGO IL 606543503 20 1417681388 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1417681891 0 ANDEWAY RYAN GARRETT 2024255 9999999 B 10 1417681891 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1417681891 0 Physician Assistant Only Fluoride varnish 20 1417681891 0 Physician Assistant Only Healthy Kids Services 20 1417681891 0 Physician Assistant Only Physician Services 00 1417682303 0 ROWE KATHERINE 2022255 9999999 B 10 1417682303 0 1518 MULBERRY AVE MUSCATINE IA 527613433 20 1417682303 0 Nurse Practitioners Fluoride varnish 20 1417682303 0 Nurse Practitioners Healthy Kids Services 20 1417682303 0 Nurse Practitioners Nurse Practitioners Services 20 1417682303 0 Nurse Practitioners Physician Services 00 1417682436 0 VAUGHN LINDSEY L 2022265 9999999 B 10 1417682436 0 801 ILLINI DR SILVIS IL 612821804 20 1417682436 0 Nurse Practitioners Fluoride varnish 20 1417682436 0 Nurse Practitioners Healthy Kids Services 20 1417682436 0 Nurse Practitioners Nurse Practitioners Services 20 1417682436 0 Nurse Practitioners Physician Services 00 1417683400 0 KIM LEENA 2024029 9999999 B 10 1417683400 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1417683400 0 Speech Therapists Medical Supplies 20 1417683400 0 Speech Therapists Medical equipment/prosthetic devices 20 1417683400 0 Speech Therapists Speech Therapy/Pathology Services 00 1417683962 0 PANCHOLIA SMITA 2023237 9999999 B 10 1417683962 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1417683962 0 Physicians Anesthesia Services 20 1417683962 0 Physicians Healthy Kids Services 20 1417683962 0 Physicians Optical Supplies 20 1417683962 0 Physicians Physician Services 00 1417684382 0 MURPHY NORA E 2024241 9999999 B 10 1417684382 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1417684382 0 Physician Assistant Only Fluoride varnish 20 1417684382 0 Physician Assistant Only Healthy Kids Services 20 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DEPT CAROL STREAM IL 601220021 20 1417690827 0 Physicians Anesthesia Services 20 1417690827 0 Physicians Fluoride varnish 20 1417690827 0 Physicians Healthy Kids Services 20 1417690827 0 Physicians Optical Supplies 20 1417690827 0 Physicians Physician Services 00 1417690876 0 BISWAS SUDAKSHINA 2022192 9999999 B 10 1417690876 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1417690876 0 Nurse Practitioners Fluoride varnish 20 1417690876 0 Nurse Practitioners Healthy Kids Services 20 1417690876 0 Nurse Practitioners Nurse Practitioners Services 20 1417690876 0 Nurse Practitioners Physician Services 00 1417691627 0 PRITCHARD RACHAEL R 2022199 9999999 B 10 1417691627 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1417691627 0 Nurse Practitioners Fluoride varnish 20 1417691627 0 Nurse Practitioners Healthy Kids Services 20 1417691627 0 Nurse Practitioners Nurse Practitioners Services 20 1417691627 0 Nurse Practitioners Physician Services 00 1417692641 0 WESTER RENEE D 2022144 9999999 B 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1417694639 0 Physicians Optical Supplies 20 1417694639 0 Physicians Physician Services 00 1417695560 0 HUMENIK MICAELA 2023297 9999999 B 10 1417695560 0 9611 165TH ST STE 16 ORLAND PARK IL 604675685 20 1417695560 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1417695735 0 SAGALOV ANDREW 2022186 9999999 B 10 1417695735 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1417695735 0 Physicians Anesthesia Services 20 1417695735 0 Physicians Fluoride varnish 20 1417695735 0 Physicians Healthy Kids Services 20 1417695735 0 Physicians Optical Supplies 20 1417695735 0 Physicians Physician Services 00 1417695826 0 WIATR LAUREN A 2022192 9999999 B 10 1417695826 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1417695826 0 Nurse Practitioners Healthy Kids Services 20 1417695826 0 Nurse Practitioners Nurse Practitioners Services 20 1417695826 0 Nurse Practitioners Physician Services 00 1417695982 0 NG JOANIE 2023113 9999999 B 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Physician Assistant Only Fluoride varnish 20 1417699802 0 Physician Assistant Only Healthy Kids Services 20 1417699802 0 Physician Assistant Only Physician Services 00 1417700287 0 PORTIELES PENA ROMY 2024178 9999999 B 10 1417700287 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1417700287 0 Physicians Anesthesia Services 20 1417700287 0 Physicians Fluoride varnish 20 1417700287 0 Physicians Healthy Kids Services 20 1417700287 0 Physicians Optical Supplies 20 1417700287 0 Physicians Physician Services 00 1417700303 0 PAVON-CARDENAS YVETTE C 2024102 9999999 B 10 1417700303 0 1200 W STATE ST ROCKFORD IL 611022112 20 1417700303 0 Nurse Practitioners Fluoride varnish 20 1417700303 0 Nurse Practitioners Healthy Kids Services 20 1417700303 0 Nurse Practitioners Nurse Practitioners Services 20 1417700303 0 Nurse Practitioners Physician Services 00 1417700469 0 YEAKLE MADELEINE 2024193 9999999 B 10 1417700469 0 221 NE GLEN OAK AVE PEORIA IL 616360002 20 1417700469 0 Physicians Anesthesia Services 20 1417700469 0 Physicians Healthy Kids Services 20 1417700469 0 Physicians Optical Supplies 20 1417700469 0 Physicians Physician Services 20 1417700469 0 Physicians Physicians Psychiatric Services 00 1417700618 0 MUNSON HANNAH 2024209 9999999 B 10 1417700618 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1417700618 0 Physicians Anesthesia Services 20 1417700618 0 Physicians Healthy Kids Services 20 1417700618 0 Physicians Optical Supplies 20 1417700618 0 Physicians Physician Services 20 1417700618 0 Physicians Physicians Psychiatric Services 00 1417700691 0 CORRAL ALEJANDRA 2024185 9999999 B 10 1417700691 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1417700691 0 Physicians Anesthesia Services 20 1417700691 0 Physicians Fluoride varnish 20 1417700691 0 Physicians Healthy Kids Services 20 1417700691 0 Physicians Optical Supplies 20 1417700691 0 Physicians Physician Services 00 1417700782 0 CANDIA ALONDRA 2024103 9999999 B 10 1417700782 0 3621 MARION LN LAS CRUCES NM 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Physician Services 00 1417707852 0 BROWN CHRISTIAN 2024197 9999999 B 10 1417707852 0 7825 SOLUTION CTR CHICAGO IL 606777007 20 1417707852 0 Physicians Anesthesia Services 20 1417707852 0 Physicians Healthy Kids Services 20 1417707852 0 Physicians Optical Supplies 20 1417707852 0 Physicians Physician Services 20 1417707852 0 Physicians Physicians Psychiatric Services 00 1417708256 0 HOTWAGNER TIFFANI R 2024313 9999999 B 10 1417708256 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1417708256 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1417708710 0 DONKOR LINDA A 2024275 9999999 B 10 1417708710 0 10205 W LINCOLN HWY FRANKFORT IL 604231279 20 1417708710 0 Nurse Practitioners Healthy Kids Services 20 1417708710 0 Nurse Practitioners Nurse Practitioners Services 20 1417708710 0 Nurse Practitioners Physician Services 00 1417708975 0 YAMAKAWA SHOHEI 2024200 9999999 B 10 1417708975 0 3249 OAK PARK AVE BERWYN IL 604023429 20 1417708975 0 Physicians Anesthesia Services 20 1417708975 0 Physicians Fluoride varnish 20 1417708975 0 Physicians Healthy Kids Services 20 1417708975 0 Physicians Optical Supplies 20 1417708975 0 Physicians Physician Services 00 1417709213 0 AHMED AHMED K 2024209 9999999 B 10 1417709213 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1417709213 0 Physicians Anesthesia Services 20 1417709213 0 Physicians Fluoride varnish 20 1417709213 0 Physicians Healthy Kids Services 20 1417709213 0 Physicians Optical Supplies 20 1417709213 0 Physicians Physician Services 00 1417709320 0 IVERSON ANN M 2024168 9999999 B 10 1417709320 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1417709320 0 Physicians Anesthesia Services 20 1417709320 0 Physicians Fluoride varnish 20 1417709320 0 Physicians Healthy Kids Services 20 1417709320 0 Physicians Optical Supplies 20 1417709320 0 Physicians Physician Services 00 1417709817 0 CHOUDHARY AKRITI 2024214 9999999 B 10 1417709817 0 7732 SOLUTION CTR CHICAGO IL 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9999999 B 10 1427009265 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1427009265 0 Physicians Anesthesia Services 20 1427009265 0 Physicians Fluoride varnish 20 1427009265 0 Physicians Healthy Kids Services 20 1427009265 0 Physicians Optical Supplies 20 1427009265 0 Physicians Physician Services 00 1427009273 0 MAAS DIANA 1992001 9999999 B 10 1427009273 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1427009273 0 Physicians Anesthesia Services 20 1427009273 0 Physicians Fluoride varnish 20 1427009273 0 Physicians Healthy Kids Services 20 1427009273 0 Physicians Optical Supplies 20 1427009273 0 Physicians Physician Services 00 1427009778 0 COLLINS JANIS 2016195 9999999 B 10 1427009778 0 1285 FRANCISCAN DR LITCHFIELD IL 620561778 20 1427009778 0 Nurse Practitioners Fluoride varnish 20 1427009778 0 Nurse Practitioners Healthy Kids Services 20 1427009778 0 Nurse Practitioners Nurse Practitioners Services 20 1427009778 0 Nurse Practitioners Physician Services 00 1427010743 0 KIN-KARTSIMAS YULIYA 2004349 9999999 B 10 1427010743 0 29373 NETWORK PL CHICAGO IL 606733039 20 1427010743 0 Physicians Anesthesia Services 20 1427010743 0 Physicians Healthy Kids Services 20 1427010743 0 Physicians Optical Supplies 20 1427010743 0 Physicians Physician Services 00 1427011170 0 PUGA WILLIAM 1987196 9999999 B 10 1427011170 0 1400 E IRVING PARK RD STREAMWOOD IL 601073201 20 1427011170 0 Physicians Anesthesia Services 20 1427011170 0 Physicians Healthy Kids Services 20 1427011170 0 Physicians Optical Supplies 20 1427011170 0 Physicians Physician Services 20 1427011170 0 Physicians Physicians Psychiatric Services 00 1427012004 0 VELEZ JO ESTRELLITA TAN 2002060 9999999 B 10 1427012004 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1427012004 0 Physicians Anesthesia Services 20 1427012004 0 Physicians Fluoride varnish 20 1427012004 0 Physicians Healthy Kids Services 20 1427012004 0 Physicians Optical Supplies 20 1427012004 0 Physicians Physician Services 00 1427013499 0 MOHIUDDIN SYED G 2021287 9999999 B 10 1427013499 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1427013499 0 Physicians Anesthesia Services 20 1427013499 0 Physicians Fluoride varnish 20 1427013499 0 Physicians Healthy Kids Services 20 1427013499 0 Physicians Optical Supplies 20 1427013499 0 Physicians Physician Services 00 1427013648 0 WEBSTER METODIA J 1996190 9999999 B 10 1427013648 0 400 MAPLE SUMMIT RD JERSEYVILLE IL 620522028 20 1427013648 0 Physicians Anesthesia Services 20 1427013648 0 Physicians Healthy Kids Services 20 1427013648 0 Physicians Optical Supplies 20 1427013648 0 Physicians Physician Services 20 1427013648 0 Physicians Physicians Psychiatric Services 00 1427013689 0 SARMIENTO RODOLFO 1983298 9999999 B 10 1427013689 0 29373 NETWORK PL CHICAGO IL 606733039 20 1427013689 0 Physicians Anesthesia Services 20 1427013689 0 Physicians Fluoride varnish 20 1427013689 0 Physicians Healthy Kids Services 20 1427013689 0 Physicians Optical Supplies 20 1427013689 0 Physicians Physician Services 00 1427013820 0 TOPEL CYNTHIA 1992307 9999999 B 10 1427013820 0 PO BOX 70 LAKE FOREST IL 600450070 20 1427013820 0 Nurse Practitioners Anesthesia Services 20 1427013820 0 Nurse Practitioners Nurse Practitioners Services 20 1427013820 0 Nurse Practitioners Physician Services 00 1427014018 0 LIBRANDI GEORGE PATRICK 1993244 9999999 B 10 1427014018 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1427014018 0 Physicians Anesthesia Services 20 1427014018 0 Physicians Healthy Kids Services 20 1427014018 0 Physicians Optical Supplies 20 1427014018 0 Physicians Physician Services 00 1427014331 0 PRESTON STEPHANIE L 2017326 9999999 B 10 1427014331 0 5777 DEPT CAROL STREAM IL 601220021 20 1427014331 0 Nurse Practitioners Anesthesia Services 20 1427014331 0 Nurse Practitioners Nurse Practitioners Services 20 1427014331 0 Nurse Practitioners Physician Services 00 1427014976 0 SCHREIBER KEVIN 2020300 9999999 B 10 1427014976 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1427014976 0 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CHICAGO IL 606132010 20 1427298116 0 Physicians Anesthesia Services 20 1427298116 0 Physicians Fluoride varnish 20 1427298116 0 Physicians Healthy Kids Services 20 1427298116 0 Physicians Optical Supplies 20 1427298116 0 Physicians Physician Services 00 1427299692 0 BROWN KAMEKA L 2018338 9999999 B 10 1427299692 0 1520 N KOSTNER AVE CHICAGO IL 606511610 20 1427299692 0 Nurse Practitioners Fluoride varnish 20 1427299692 0 Nurse Practitioners Healthy Kids Services 20 1427299692 0 Nurse Practitioners Nurse Practitioners Services 20 1427299692 0 Nurse Practitioners Physician Services 00 1427300581 0 ENDRES ERIN L 2013091 9999999 B 10 1427300581 0 317 SALEM PL FAIRVIEW HEIGHT IL 622081367 20 1427300581 0 Nurse Practitioners Anesthesia Services 20 1427300581 0 Nurse Practitioners Nurse Practitioners Services 20 1427300581 0 Nurse Practitioners Physician Services 00 1427300656 0 RIVERA SHARITZA 2017110 9999999 B 10 1427300656 0 715 LAKE ST STE 800 OAK PARK IL 603011417 20 1427300656 0 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2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1427303635 0 Physicians Anesthesia Services 20 1427303635 0 Physicians Healthy Kids Services 20 1427303635 0 Physicians Optical Supplies 20 1427303635 0 Physicians Physician Services 00 1427304666 0 SERIEUX RENA 2021245 9999999 B 10 1427304666 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1427304666 0 Physicians Anesthesia Services 20 1427304666 0 Physicians Fluoride varnish 20 1427304666 0 Physicians Healthy Kids Services 20 1427304666 0 Physicians Optical Supplies 20 1427304666 0 Physicians Physician Services 00 1427306182 0 DRATNOL RACHEL A 2020086 9999999 B 10 1427306182 0 29373 NETWORK PL CHICAGO IL 606733039 20 1427306182 0 Occupational Therapists Medical Supplies 20 1427306182 0 Occupational Therapists Medical equipment/prosthetic devices 20 1427306182 0 Occupational Therapists Occupational Therapy Services 00 1427306786 0 JAGER JASON 2015001 9999999 B 10 1427306786 0 1520 FRINGETREE LN WOODRIDGE IL 605174653 20 1427306786 0 Optometrists Optical Supplies 20 1427306786 0 Optometrists Optometric Services 20 1427306786 0 Optometrists Physician Services 00 1427306935 0 BELLO KAYODE J 2018276 9999999 B 10 1427306935 0 29980 NETWORK PL CHICAGO IL 606730968 20 1427306935 0 Physicians Anesthesia Services 20 1427306935 0 Physicians Fluoride varnish 20 1427306935 0 Physicians Healthy Kids Services 20 1427306935 0 Physicians Optical Supplies 20 1427306935 0 Physicians Physician Services 00 1427307305 0 CANNON JENNIFER 2012268 9999999 B 10 1427307305 0 355 E ERIE ST CHICAGO IL 606113167 20 1427307305 0 Nurse Practitioners Healthy Kids Services 20 1427307305 0 Nurse Practitioners Nurse Practitioners Services 20 1427307305 0 Nurse Practitioners Physician Services 00 1427308030 0 EILERS LINDSEY 2019121 9999999 B 10 1427308030 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1427308030 0 Clinical Social Worker Social work service 00 1427310481 0 XIONG XINGYING 2012172 9999999 B 10 1427310481 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1427310481 0 Nurse Practitioners Anesthesia Services 20 1427310481 0 Nurse Practitioners Nurse Practitioners Services 20 1427310481 0 Nurse Practitioners Physician Services 00 1427311646 0 MIKHAEIL DEMO YARA 2018260 9999999 B 10 1427311646 0 2875 W 19TH ST CHICAGO IL 606233501 20 1427311646 0 Physicians Anesthesia Services 20 1427311646 0 Physicians Healthy Kids Services 20 1427311646 0 Physicians Optical Supplies 20 1427311646 0 Physicians Physician Services 20 1427311646 0 Physicians Physicians Psychiatric Services 00 1427311877 0 GASHOUTA MOHAMED A 2019354 9999999 B 10 1427311877 0 PO BOX 4028 ROCK ISLAND IL 612044028 20 1427311877 0 Physicians Anesthesia Services 20 1427311877 0 Physicians Fluoride varnish 20 1427311877 0 Physicians Healthy Kids Services 20 1427311877 0 Physicians Optical Supplies 20 1427311877 0 Physicians Physician Services 00 1427312453 0 SAYERS THOMAS 2016266 9999999 B 10 1427312453 0 1506 E ROOSEVELT RD WHEATON IL 601876806 20 1427312453 0 Other behavior health professional LCPC/LMFT services 20 1427312453 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1427312727 0 SHAH SWETA K 2017121 2026365 B 10 1427312727 0 5777 DEPT CAROL STREAM IL 601220021 20 1427312727 0 Physicians Anesthesia Services 20 1427312727 0 Physicians Healthy Kids Services 20 1427312727 0 Physicians Optical Supplies 20 1427312727 0 Physicians Physician Services 00 1427312875 0 ELMAGBARI AMIRA M 2023201 9999999 B 10 1427312875 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1427312875 0 Physicians Anesthesia Services 20 1427312875 0 Physicians Fluoride varnish 20 1427312875 0 Physicians Healthy Kids Services 20 1427312875 0 Physicians Optical Supplies 20 1427312875 0 Physicians Physician Services 00 1427313790 0 YOUNG DEBORAH 2015247 9999999 H 10 1427313790 0 9449 S KEDZIE AVE # 142 EVERGREEN PARK IL 608052325 20 1427313790 0 Other behavior health professional Social work service 00 1427314095 0 NIZIOLEK KYLE C 2023124 9999999 B 10 1427314095 0 4240 DUNCAN AVE STE 301 SAINT LOUIS MO 631101123 20 1427314095 0 Physicians Anesthesia Services 20 1427314095 0 Physicians Healthy Kids Services 20 1427314095 0 Physicians Optical Supplies 20 1427314095 0 Physicians Physician Services 00 1427314376 0 NORMAN CORY 2020297 9999999 B 10 1427314376 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1427314376 0 Physicians Anesthesia Services 20 1427314376 0 Physicians Healthy Kids Services 20 1427314376 0 Physicians Optical Supplies 20 1427314376 0 Physicians Physician Services 00 1427314624 0 BERNSTEIN JOANNE 2015343 9999999 B 10 1427314624 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1427314624 0 Physicians Anesthesia Services 20 1427314624 0 Physicians Fluoride varnish 20 1427314624 0 Physicians Healthy Kids Services 20 1427314624 0 Physicians Optical Supplies 20 1427314624 0 Physicians Physician Services 00 1427315423 0 LARSEN PAUL 2018347 9999999 B 10 1427315423 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1427315423 0 Physicians Anesthesia Services 20 1427315423 0 Physicians Fluoride varnish 20 1427315423 0 Physicians Healthy Kids Services 20 1427315423 0 Physicians Optical Supplies 20 1427315423 0 Physicians Physician Services 00 1427316942 0 PERRY ALVIN P 2020105 9999999 B 10 1427316942 0 PO BOX 3988 CARBONDALE IL 629023988 20 1427316942 0 Physicians Anesthesia Services 20 1427316942 0 Physicians Healthy Kids Services 20 1427316942 0 Physicians Optical Supplies 20 1427316942 0 Physicians Physician Services 00 1427316983 0 ZANBRAKJI MOHAMAD 2024092 9999999 B 10 1427316983 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1427316983 0 Physicians Anesthesia Services 20 1427316983 0 Physicians Healthy Kids Services 20 1427316983 0 Physicians Optical Supplies 20 1427316983 0 Physicians Physician Services 00 1427317254 0 SIMONS ALLISON 2018199 9999999 B 10 1427317254 0 PO BOX 631771 CINCINNATI OH 452630139 20 1427317254 0 Physicians Anesthesia Services 20 1427317254 0 Physicians Healthy Kids Services 20 1427317254 0 Physicians Optical Supplies 20 1427317254 0 Physicians Physician Services 00 1427317668 0 VALASSIS MEGAN ELIZABETH GUETZ 2016225 9999999 B 10 1427317668 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1427317668 0 Physicians Anesthesia Services 20 1427317668 0 Physicians Healthy Kids Services 20 1427317668 0 Physicians Optical Supplies 20 1427317668 0 Physicians Physician Services 00 1427318310 0 ECKERSLEY DAVID J 2015182 9999999 B 10 1427318310 0 1005 BROADWAY ST QUINCY IL 623012834 20 1427318310 0 Physicians Anesthesia Services 20 1427318310 0 Physicians Healthy Kids Services 20 1427318310 0 Physicians Optical Supplies 20 1427318310 0 Physicians Physician Services 00 1427318666 0 VANDERJACK STACI LYNN 2015212 9999999 B 10 1427318666 0 29373 NETWORK PL CHICAGO IL 606733039 20 1427318666 0 Physicians Anesthesia Services 20 1427318666 0 Physicians Fluoride varnish 20 1427318666 0 Physicians Healthy Kids Services 20 1427318666 0 Physicians Optical Supplies 20 1427318666 0 Physicians Physician Services 00 1427320340 0 DENNIS HEATHER 2018077 9999999 B 10 1427320340 0 600 E 1ST ST SPRING VALLEY IL 613621512 20 1427320340 0 Nurse Practitioners Fluoride varnish 20 1427320340 0 Nurse Practitioners Healthy Kids Services 20 1427320340 0 Nurse Practitioners Nurse Practitioners Services 20 1427320340 0 Nurse Practitioners Physician Services 00 1427322122 0 FINN BONNIE 2012142 9999999 B 10 1427322122 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1427322122 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1427322130 0 JEDIOLA KASSANDRA 2014301 9999999 B 10 1427322130 0 PO BOX 1109 DEKALB IL 601157109 20 1427322130 0 Clinical Social Worker Social work service 00 1427323203 0 OVERTON CRYSTAL M 2018083 9999999 B 10 1427323203 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1427323203 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1427323864 0 VETRI FRANCESCO 2017163 9999999 B 10 1427323864 0 600 S 13TH ST PEKIN IL 615544936 20 1427323864 0 Physicians Anesthesia Services 20 1427323864 0 Physicians Healthy Kids Services 20 1427323864 0 Physicians Optical Supplies 20 1427323864 0 Physicians Physician Services 00 1427324334 0 LEE STEPHANIE S 2018344 9999999 B 10 1427324334 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1427324334 0 Physicians Anesthesia Services 20 1427324334 0 Physicians Fluoride varnish 20 1427324334 0 Physicians Healthy Kids Services 20 1427324334 0 Physicians Optical Supplies 20 1427324334 0 Physicians Physician Services 00 1427324425 0 WABICH JAMIE B 2018123 9999999 B 10 1427324425 0 5777 DEPT CAROL STREAM IL 601220021 20 1427324425 0 Physicians Anesthesia Services 20 1427324425 0 Physicians Fluoride varnish 20 1427324425 0 Physicians Healthy Kids Services 20 1427324425 0 Physicians Optical Supplies 20 1427324425 0 Physicians Physician Services 00 1427324441 0 IBRAHIM KHALIL 2020219 9999999 B 10 1427324441 0 1220 S WOOD ST CHICAGO IL 606081202 20 1427324441 0 Physicians Anesthesia Services 20 1427324441 0 Physicians Fluoride varnish 20 1427324441 0 Physicians Healthy Kids Services 20 1427324441 0 Physicians Optical Supplies 20 1427324441 0 Physicians Physician Services 00 1427324623 0 SWARTZ SHEILA 2018228 9999999 B 10 1427324623 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1427324623 0 Physicians Anesthesia Services 20 1427324623 0 Physicians Healthy Kids Services 20 1427324623 0 Physicians Optical Supplies 20 1427324623 0 Physicians Physician Services 00 1427325034 0 ACEVEDO JOSUE 2019246 9999999 B 10 1427325034 0 1005 BROADWAY ST QUINCY IL 623012834 20 1427325034 0 Physicians Anesthesia Services 20 1427325034 0 Physicians Healthy Kids Services 20 1427325034 0 Physicians Optical Supplies 20 1427325034 0 Physicians Physician Services 00 1427325208 0 CASEY SHARON A 2012001 9999999 B 10 1427325208 0 29373 NETWORK PL CHICAGO IL 606733039 20 1427325208 0 Nurse Practitioners Healthy Kids Services 20 1427325208 0 Nurse Practitioners Nurse Practitioners Services 20 1427325208 0 Nurse Practitioners Physician Services 00 1427325711 0 FEARON LORRAINE 2011274 9999999 B 10 1427325711 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1427325711 0 Nurse Practitioners Fluoride varnish 20 1427325711 0 Nurse Practitioners Healthy Kids Services 20 1427325711 0 Nurse Practitioners Nurse Practitioners Services 20 1427325711 0 Nurse Practitioners Physician Services 00 1427327766 0 ASSADI KHATEREH 2012001 9999999 B 10 1427327766 0 800 E 55TH ST CHICAGO IL 606154906 20 1427327766 0 Physicians Anesthesia Services 20 1427327766 0 Physicians Fluoride varnish 20 1427327766 0 Physicians Healthy Kids Services 20 1427327766 0 Physicians Optical Supplies 20 1427327766 0 Physicians Physician Services 00 1427328251 0 SEVERINE MARIANNE 2017156 9999999 B 10 1427328251 0 PO BOX 504469 SAINT LOUIS MO 631504469 20 1427328251 0 Physical Therapists Medical Supplies 20 1427328251 0 Physical Therapists Medical equipment/prosthetic devices 20 1427328251 0 Physical Therapists Physical Therapy Services 00 1427328798 0 LESLEY GLENN MEGAN C 2016001 9999999 B 10 1427328798 0 3024 E EMPIRE ST STE E&F BLOOMINGTON IL 617045402 20 1427328798 0 Physician Assistant Only Fluoride varnish 20 1427328798 0 Physician Assistant Only Healthy Kids Services 20 1427328798 0 Physician Assistant Only Physician Services 00 1427329051 0 TEMESVARI RAQUEL 2012217 9999999 B 10 1427329051 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1427329051 0 Nurse Practitioners Fluoride varnish 20 1427329051 0 Nurse Practitioners Healthy Kids Services 20 1427329051 0 Nurse Practitioners Nurse Practitioners Services 20 1427329051 0 Nurse Practitioners Physician Services 00 1427330083 0 FERRO JOSEPH 2023345 9999999 B 10 1427330083 0 813 CUMBERLAND CT NAPERVILLE IL 605653416 20 1427330083 0 Speech Therapists Medical Supplies 20 1427330083 0 Speech Therapists Medical equipment/prosthetic devices 20 1427330083 0 Speech Therapists Speech Therapy/Pathology Services 00 1427331347 0 KALK JASON 2014305 9999999 B 10 1427331347 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1427331347 0 Podiatrists Podiatric Services 00 1427331404 0 WOOLLEY BRITTANY S 2020211 9999999 B 10 1427331404 0 1 ILLINI DR PEORIA IL 616052576 20 1427331404 0 Nurse Practitioners Healthy Kids Services 20 1427331404 0 Nurse Practitioners Nurse Practitioners Services 20 1427331404 0 Nurse Practitioners Physician Services 00 1427332253 0 NOVOF JOSEPH 2014182 9999999 B 10 1427332253 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1427332253 0 Physicians Anesthesia Services 20 1427332253 0 Physicians Healthy Kids Services 20 1427332253 0 Physicians Optical Supplies 20 1427332253 0 Physicians Physician Services 00 1427332956 0 ODEMERHO BENEDICTA I 2013148 9999999 B 10 1427332956 0 3307 BROADWAY ST STE 140 STE 140 MOUNT VERNON IL 628642387 20 1427332956 0 Nurse Practitioners Fluoride varnish 20 1427332956 0 Nurse Practitioners Healthy Kids Services 20 1427332956 0 Nurse Practitioners Nurse Practitioners Services 20 1427332956 0 Nurse Practitioners Physician Services 00 1427334473 0 VIRNIG KATHERINE 2021062 9999999 B 10 1427334473 0 2525 KANEVILLE RD GENEVA IL 601342578 20 1427334473 0 Physician Assistant Only Fluoride varnish 20 1427334473 0 Physician Assistant Only Healthy Kids Services 20 1427334473 0 Physician Assistant Only Physician Services 00 1427334515 0 DESAI PARIN 2007274 9999999 B 10 1427334515 0 860 SUMMIT ST STE 111 ELGIN IL 601204350 20 1427334515 0 Dentists Dental Services 20 1427334515 0 Dentists Physician Services 00 1427336262 0 CHEN YUN CHU 2017001 9999999 B 10 1427336262 0 715 LAKE ST STE 800 OAK PARK IL 603011417 20 1427336262 0 Other behavior health professional LCPC/LMFT services 00 1427337195 0 JIMENEZ PAULA 2021127 9999999 B 10 1427337195 0 3600 W FULLERTON AVE ATTN: BILLING DEPARTMENT CHICAGO IL 606472319 20 1427337195 0 Other behavior health professional LCPC/LMFT services 00 1427337906 0 RAED MONA A 2018311 9999999 B 10 1427337906 0 PO BOX 778912 CHICAGO IL 606778912 20 1427337906 0 Physicians Anesthesia Services 20 1427337906 0 Physicians Fluoride varnish 20 1427337906 0 Physicians Healthy Kids Services 20 1427337906 0 Physicians Optical Supplies 20 1427337906 0 Physicians Physician Services 00 1427338409 0 GORSI SHAMAILA B 2016275 9999999 B 10 1427338409 0 124 SW ADAMS ST PEORIA IL 616021308 20 1427338409 0 Physicians Anesthesia Services 20 1427338409 0 Physicians Fluoride varnish 20 1427338409 0 Physicians Healthy Kids Services 20 1427338409 0 Physicians Optical Supplies 20 1427338409 0 Physicians Physician Services 00 1427339803 0 MATIASEK MEGAN 2017060 9999999 B 10 1427339803 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1427339803 0 Nurse Practitioners Fluoride varnish 20 1427339803 0 Nurse Practitioners Healthy Kids Services 20 1427339803 0 Nurse Practitioners Nurse Practitioners Services 20 1427339803 0 Nurse Practitioners Physician Services 00 1427339928 0 JAVED ASAD 2020214 9999999 B 10 1427339928 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1427339928 0 Physicians Anesthesia Services 20 1427339928 0 Physicians Fluoride varnish 20 1427339928 0 Physicians Healthy Kids Services 20 1427339928 0 Physicians Optical Supplies 20 1427339928 0 Physicians Physician Services 00 1427342211 0 WALDROP MEGAN A 2020224 9999999 B 10 1427342211 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1427342211 0 Physicians Anesthesia Services 20 1427342211 0 Physicians Healthy Kids Services 20 1427342211 0 Physicians Optical Supplies 20 1427342211 0 Physicians Physician Services 20 1427342211 0 Physicians Physicians Psychiatric Services 00 1427343458 0 HULIYAR VINAY 2014230 9999999 B 10 1427343458 0 700 E OGDEN AVE STE 202 WESTMONT IL 605591296 20 1427343458 0 Physicians Anesthesia Services 20 1427343458 0 Physicians Fluoride varnish 20 1427343458 0 Physicians Healthy Kids Services 20 1427343458 0 Physicians Optical Supplies 20 1427343458 0 Physicians Physician Services 00 1427343730 0 SHEATSLEY JARROD THOMAS 2017158 9999999 B 10 1427343730 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1427343730 0 Physicians Anesthesia Services 20 1427343730 0 Physicians Fluoride varnish 20 1427343730 0 Physicians Healthy Kids Services 20 1427343730 0 Physicians Optical Supplies 20 1427343730 0 Physicians Physician Services 00 1427343938 0 NASIR SAIFULLAH 2015030 9999999 B 10 1427343938 0 PO BOX 776473 CHICAGO IL 606776473 20 1427343938 0 Physicians Anesthesia Services 20 1427343938 0 Physicians Fluoride varnish 20 1427343938 0 Physicians Healthy Kids Services 20 1427343938 0 Physicians Optical Supplies 20 1427343938 0 Physicians Physician Services 00 1427344100 0 PARIKH NEIL 2011182 9999999 B 10 1427344100 0 1812 N 19TH AVE MELROSE PARK IL 601602039 20 1427344100 0 Dentists Dental Services 20 1427344100 0 Dentists Physician Services 00 1427344258 0 VAN BEEK DARREN B 2017130 9999999 B 10 1427344258 0 645 S CENTRAL AVE CHICAGO IL 606445059 20 1427344258 0 Physicians Anesthesia Services 20 1427344258 0 Physicians Healthy Kids Services 20 1427344258 0 Physicians Optical Supplies 20 1427344258 0 Physicians Physician Services 00 1427344761 0 IFTIKHAR ASMA 2023361 9999999 B 10 1427344761 0 PO BOX 708760 SANDY UT 840708760 20 1427344761 0 Physicians Anesthesia Services 20 1427344761 0 Physicians Fluoride varnish 20 1427344761 0 Physicians Healthy Kids Services 20 1427344761 0 Physicians Optical Supplies 20 1427344761 0 Physicians Physician Services 00 1427345263 0 BALL ALISON J 2018184 9999999 B 10 1427345263 0 300 WINDING WOODS DR STE 200 O FALLON MO 633665081 20 1427345263 0 Physicians Anesthesia Services 20 1427345263 0 Physicians Fluoride varnish 20 1427345263 0 Physicians Healthy Kids Services 20 1427345263 0 Physicians Optical Supplies 20 1427345263 0 Physicians Physician Services 00 1427345438 0 KALINOWSKA EWA 2014028 9999999 B 10 1427345438 0 525 E GRANT ST MACOMB IL 614553313 20 1427345438 0 Physicians Anesthesia Services 20 1427345438 0 Physicians Fluoride varnish 20 1427345438 0 Physicians Healthy Kids Services 20 1427345438 0 Physicians Optical Supplies 20 1427345438 0 Physicians Physician Services 00 1427346188 0 BOBINSKI MICHELLE A 2011171 9999999 B 10 1427346188 0 611 W PARK ST URBANA IL 618012529 20 1427346188 0 Nurse Practitioners Family Planning Counseling 20 1427346188 0 Nurse Practitioners Healthy Kids Services 20 1427346188 0 Nurse Practitioners Nurse Practitioners Services 20 1427346188 0 Nurse Practitioners Physician Services 00 1427346444 0 ABUALSUOD AMJAD M 2021195 9999999 B 10 1427346444 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1427346444 0 Physicians Anesthesia Services 20 1427346444 0 Physicians Fluoride varnish 20 1427346444 0 Physicians Healthy Kids Services 20 1427346444 0 Physicians Optical Supplies 20 1427346444 0 Physicians Physician Services 00 1427346501 0 KANBOUR MAJD 2020175 9999999 B 10 1427346501 0 55 E 86TH AVE MERRILLVILLE IN 464106382 20 1427346501 0 Physicians Anesthesia Services 20 1427346501 0 Physicians Fluoride varnish 20 1427346501 0 Physicians Healthy Kids Services 20 1427346501 0 Physicians Optical Supplies 20 1427346501 0 Physicians Physician Services 00 1427348143 0 CHRISTIAN SCOTT 2016086 9999999 B 10 1427348143 0 5352 N LINCOLN AVE CHICAGO IL 606252316 20 1427348143 0 Dentists Dental Services 20 1427348143 0 Dentists Physician Services 00 1427348291 0 MARTIN DAVID T 2021358 9999999 B 10 1427348291 0 3300 OAKDALE AVE N ROBBINSDALE MN 554222926 20 1427348291 0 Physicians Anesthesia Services 20 1427348291 0 Physicians Healthy Kids Services 20 1427348291 0 Physicians Optical Supplies 20 1427348291 0 Physicians Physician Services 00 1427348333 0 BERENZ ANDREW J 2017244 9999999 B 10 1427348333 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1427348333 0 Physicians Anesthesia 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equipment/prosthetic devices 20 1427406537 0 Physical Therapists Physical Therapy Services 00 1427407105 0 PATEL ARTI 2016223 9999999 B 10 1427407105 0 PO BOX 772 MC2295 WOONSOCKET RI 028950784 20 1427407105 0 Nurse Practitioners Fluoride varnish 20 1427407105 0 Nurse Practitioners Healthy Kids Services 20 1427407105 0 Nurse Practitioners Nurse Practitioners Services 20 1427407105 0 Nurse Practitioners Physician Services 00 1427407568 0 BAROT KHUSHBU R 2017122 9999999 B 10 1427407568 0 2235 SYCAMORE RD DEKALB IL 601152046 20 1427407568 0 Dentists Dental Services 20 1427407568 0 Dentists Physician Services 00 1427407782 0 FRIEDMAN ZACHARY 2016162 9999999 B 10 1427407782 0 5777 DEPT CAROL STREAM IL 601220021 20 1427407782 0 Physician Assistant Only Fluoride varnish 20 1427407782 0 Physician Assistant Only Healthy Kids Services 20 1427407782 0 Physician Assistant Only Physician Services 00 1427407980 0 NICOLAY DANIEL 2017256 9999999 B 10 1427407980 0 1021 N MULFORD RD ROCKFORD IL 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033017559 20 1427411164 0 Physicians Anesthesia Services 20 1427411164 0 Physicians Fluoride varnish 20 1427411164 0 Physicians Healthy Kids Services 20 1427411164 0 Physicians Optical Supplies 20 1427411164 0 Physicians Physician Services 00 1427411404 0 HOPWOOD SHANI N 2018068 9999999 B 10 1427411404 0 1395 NW 167TH ST MIAMI FL 331695710 20 1427411404 0 Physicians Anesthesia Services 20 1427411404 0 Physicians Fluoride varnish 20 1427411404 0 Physicians Healthy Kids Services 20 1427411404 0 Physicians Optical Supplies 20 1427411404 0 Physicians Physician Services 00 1427412014 0 RAJDEV MAHARSHI A 2024170 9999999 B 10 1427412014 0 4646 N MARINE DR CHICAGO IL 606405759 20 1427412014 0 Physicians Anesthesia Services 20 1427412014 0 Physicians Healthy Kids Services 20 1427412014 0 Physicians Optical Supplies 20 1427412014 0 Physicians Physician Services 00 1427412022 0 ULRICH CHAD L 2023184 9999999 B 10 1427412022 0 5090 S FORT APACHE RD LAS VEGAS NV 891481714 20 1427412022 0 Physicians Anesthesia Services 20 1427412022 0 Physicians Healthy Kids Services 20 1427412022 0 Physicians Optical Supplies 20 1427412022 0 Physicians Physician Services 00 1427412261 0 SALMAN JACOB G 2019227 9999999 B 10 1427412261 0 29373 NETWORK PL CHICAGO IL 606733039 20 1427412261 0 Physicians Anesthesia Services 20 1427412261 0 Physicians Fluoride varnish 20 1427412261 0 Physicians Healthy Kids Services 20 1427412261 0 Physicians Optical Supplies 20 1427412261 0 Physicians Physician Services 00 1427412444 0 SCOVILLE JONATHAN P 2023157 9999999 B 10 1427412444 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1427412444 0 Physicians Anesthesia Services 20 1427412444 0 Physicians Healthy Kids Services 20 1427412444 0 Physicians Optical Supplies 20 1427412444 0 Physicians Physician Services 00 1427413913 0 RUSOFF JASON 2016061 9999999 B 10 1427413913 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1427413913 0 Nurse Practitioners Fluoride varnish 20 1427413913 0 Nurse Practitioners Healthy Kids Services 20 1427413913 0 Nurse Practitioners Nurse Practitioners Services 20 1427413913 0 Nurse Practitioners Physician Services 00 1427414119 0 SIEGEL MAYA E 2022245 9999999 B 10 1427414119 0 6201 ROOSEVELT RD BERWYN IL 604021108 20 1427414119 0 Physicians Anesthesia Services 20 1427414119 0 Physicians Fluoride varnish 20 1427414119 0 Physicians Healthy Kids Services 20 1427414119 0 Physicians Optical Supplies 20 1427414119 0 Physicians Physician Services 00 1427414754 0 HOYT KATERINA R 2022222 9999999 B 10 1427414754 0 5777 DEPT CAROL STREAM IL 601220021 20 1427414754 0 Physicians Anesthesia Services 20 1427414754 0 Physicians Healthy Kids Services 20 1427414754 0 Physicians Optical Supplies 20 1427414754 0 Physicians Physician Services 00 1427415207 0 ADEKUNLE IDAYAT A 2017231 9999999 B 10 1427415207 0 10909 COOK AVE OAK LAWN IL 604536332 20 1427415207 0 Nurse Practitioners Fluoride varnish 20 1427415207 0 Nurse Practitioners Healthy Kids Services 20 1427415207 0 Nurse Practitioners Nurse Practitioners Services 20 1427415207 0 Nurse Practitioners Physician Services 00 1427418607 0 NAY CHESTER B 2016081 9999999 B 10 1427418607 0 2041 GOOSE LAKE RD SAUGET IL 622062822 20 1427418607 0 Physician Assistant Only Fluoride varnish 20 1427418607 0 Physician Assistant Only Healthy Kids Services 20 1427418607 0 Physician Assistant Only Physician Services 00 1427418656 0 LATHAM YOLANDA 2023003 9999999 B 10 1427418656 0 9725 NW 117TH AVE STE 200 MEDLEY FL 331781260 20 1427418656 0 Nurse Practitioners Fluoride varnish 20 1427418656 0 Nurse Practitioners Healthy Kids Services 20 1427418656 0 Nurse Practitioners Nurse Practitioners Services 20 1427418656 0 Nurse Practitioners Physician Services 00 1427419233 0 DE ALWIS AULBREY E 2016107 9999999 B 10 1427419233 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1427419233 0 Nurse Practitioners Fluoride varnish 20 1427419233 0 Nurse Practitioners Healthy Kids Services 20 1427419233 0 Nurse Practitioners Nurse Practitioners Services 20 1427419233 0 Nurse Practitioners Physician Services 00 1427420066 0 MONK MADISON M 2021039 9999999 B 10 1427420066 0 1051 W RAND RD STE 101 ARLINGTON HEIGH IL 600042315 20 1427420066 0 Physician Assistant Only Fluoride varnish 20 1427420066 0 Physician Assistant Only Healthy Kids Services 20 1427420066 0 Physician Assistant Only Physician Services 00 1427420397 0 STOTT AMY S 2018242 9999999 B 10 1427420397 0 PO BOX 631767 CINCINNATI OH 452631767 20 1427420397 0 Nurse Practitioners Fluoride varnish 20 1427420397 0 Nurse Practitioners Healthy Kids Services 20 1427420397 0 Nurse Practitioners Nurse Practitioners Services 20 1427420397 0 Nurse Practitioners Physician Services 00 1427420579 0 PLAGGE KELSEY 2021036 9999999 B 10 1427420579 0 2361 PAYSPHERE CIR CHICAGO IL 606740023 20 1427420579 0 Physician Assistant Only Fluoride varnish 20 1427420579 0 Physician Assistant Only Healthy Kids Services 20 1427420579 0 Physician Assistant Only Physician Services 00 1427420900 0 TOTH MARK A 2015343 9999999 B 10 1427420900 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1427420900 0 Nurse Practitioners Anesthesia Services 20 1427420900 0 Nurse Practitioners Nurse Practitioners Services 20 1427420900 0 Nurse Practitioners Physician Services 00 1427421346 0 MASON DONALD 2020232 9999999 B 10 1427421346 0 4025 N SHERIDAN RD CHICAGO IL 606132010 20 1427421346 0 Chiropractors Chiropractic Services 00 1427421833 0 MOUNTSIER AMY S 2016365 9999999 B 10 1427421833 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1427421833 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1427422864 0 TOBER GINA M 2015348 9999999 B 10 1427422864 0 1113 S MILWAUKEE AVE STE 104 LIBERTYVILLE IL 600483759 20 1427422864 0 Other behavior health professional LCPC/LMFT services 00 1427423367 0 WARREN ANDREA L 2016040 9999999 B 10 1427423367 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1427423367 0 Nurse Practitioners Healthy Kids 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1427426931 0 Physicians Optical Supplies 20 1427426931 0 Physicians Physician Services 00 1427427418 0 HOLMBERG KATHRINE L 2015217 9999999 B 10 1427427418 0 366 DIXIE HWY CHICAGO HEIGHTS IL 604111758 20 1427427418 0 Optometrists Optical Supplies 20 1427427418 0 Optometrists Optometric Services 20 1427427418 0 Optometrists Physician Services 00 1427427731 0 BESKAR JENNIFER 2021302 9999999 B 10 1427427731 0 525 PARK ST STE 300 SUITE 300 SAINT PAUL MN 551032197 20 1427427731 0 Physician Assistant Only Fluoride varnish 20 1427427731 0 Physician Assistant Only Healthy Kids Services 20 1427427731 0 Physician Assistant Only Physician Services 00 1427429240 0 PATZ AMANDA 2015335 9999999 B 10 1427429240 0 4701 DEPT CAROL STREAM IL 601220021 20 1427429240 0 Nurse Practitioners Anesthesia Services 20 1427429240 0 Nurse Practitioners Nurse Practitioners Services 20 1427429240 0 Nurse Practitioners Physician Services 00 1427429976 0 CHEYNEY MARIAH N 2015274 9999999 B 10 1427429976 0 100 S GRAND AVE 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0 Physicians Anesthesia Services 20 1427430446 0 Physicians Healthy Kids Services 20 1427430446 0 Physicians Optical Supplies 20 1427430446 0 Physicians Physician Services 00 1427433283 0 WOOD TASHINA 2017084 9999999 B 10 1427433283 0 2200A ILLINOIS AVE ELDORADO IL 629301851 20 1427433283 0 Speech Therapists Medical Supplies 20 1427433283 0 Speech Therapists Medical equipment/prosthetic devices 20 1427433283 0 Speech Therapists Speech Therapy/Pathology Services 00 1427433416 0 SAMPATHGIRI KRUTHIKA 2020034 9999999 B 10 1427433416 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1427433416 0 Physicians Anesthesia Services 20 1427433416 0 Physicians Healthy Kids Services 20 1427433416 0 Physicians Optical Supplies 20 1427433416 0 Physicians Physician Services 20 1427433416 0 Physicians Physicians Psychiatric Services 00 1427434323 0 SNYDER STEPHANIE A 2015364 9999999 B 10 1427434323 0 611 W PARK ST URBANA IL 618012529 20 1427434323 0 Nurse Practitioners Fluoride varnish 20 1427434323 0 Nurse Practitioners Healthy Kids Services 20 1427434323 0 Nurse Practitioners Nurse Practitioners Services 20 1427434323 0 Nurse Practitioners Physician Services 00 1427434596 0 DAHMER CAITLIN M 2015209 9999999 B 10 1427434596 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1427434596 0 Nurse Practitioners All Kids application agent 20 1427434596 0 Nurse Practitioners Healthy Kids Services 20 1427434596 0 Nurse Practitioners Midwife Services 20 1427434596 0 Nurse Practitioners Nurse Practitioners Services 20 1427434596 0 Nurse Practitioners Nursing service 20 1427434596 0 Nurse Practitioners Physician Services 20 1427434596 0 Nurse Practitioners Waiver service 00 1427435221 0 MAPES NICKOLE L 2021112 9999999 B 10 1427435221 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1427435221 0 Nurse Practitioners Fluoride varnish 20 1427435221 0 Nurse Practitioners Healthy Kids Services 20 1427435221 0 Nurse Practitioners Nurse Practitioners Services 20 1427435221 0 Nurse Practitioners Physician Services 00 1427437342 0 ELLIOTT ELIZABETH 2020015 9999999 B 10 1427437342 0 3701 ALGONQUIN RD STE 900 SUITE 900 ROLLING MEADOWS IL 600083193 20 1427437342 0 Physicians Anesthesia Services 20 1427437342 0 Physicians Fluoride varnish 20 1427437342 0 Physicians Healthy Kids Services 20 1427437342 0 Physicians Optical Supplies 20 1427437342 0 Physicians Physician Services 00 1427437482 0 VALINETZ ETHAN D 2025058 9999999 B 10 1427437482 0 PO BOX 631767 CINCINNATI OH 452631767 20 1427437482 0 Physicians Anesthesia Services 20 1427437482 0 Physicians Fluoride varnish 20 1427437482 0 Physicians Healthy Kids Services 20 1427437482 0 Physicians Optical Supplies 20 1427437482 0 Physicians Physician Services 00 1427437706 0 HRAD VALERY 2021244 9999999 B 10 1427437706 0 515 22ND AVE MONROE WI 535661569 20 1427437706 0 Physicians Anesthesia Services 20 1427437706 0 Physicians Fluoride varnish 20 1427437706 0 Physicians Healthy Kids Services 20 1427437706 0 Physicians Optical 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1427439363 0 Physicians Optical Supplies 20 1427439363 0 Physicians Physician Services 00 1427439462 0 KEAG HELENA 2018274 9999999 B 10 1427439462 0 PO BOX 713388 CHICAGO IL 606771525 20 1427439462 0 Physicians Anesthesia Services 20 1427439462 0 Physicians Fluoride varnish 20 1427439462 0 Physicians Healthy Kids Services 20 1427439462 0 Physicians Optical Supplies 20 1427439462 0 Physicians Physician Services 00 1427439603 0 SOLINSKY BRADLEY J 2015316 9999999 B 10 1427439603 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1427439603 0 Nurse Practitioners Anesthesia Services 20 1427439603 0 Nurse Practitioners Nurse Practitioners Services 20 1427439603 0 Nurse Practitioners Physician Services 00 1427439645 0 YANIZ RALPH 2017291 9999999 B 10 1427439645 0 800 E NORTHWEST HWY STE 106 MOUNT PROSPECT IL 600563457 20 1427439645 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1427439934 0 SAMORE WESLY 2020244 9999999 B 10 1427439934 0 PO BOX 578 PARK RIDGE IL 600680578 20 1427439934 0 Physicians Anesthesia Services 20 1427439934 0 Physicians Healthy Kids Services 20 1427439934 0 Physicians Optical Supplies 20 1427439934 0 Physicians Physician Services 00 1427440577 0 FALLON ALEXANDRA G 2022335 9999999 B 10 1427440577 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1427440577 0 Physicians Anesthesia Services 20 1427440577 0 Physicians Healthy Kids Services 20 1427440577 0 Physicians Optical Supplies 20 1427440577 0 Physicians Physician Services 00 1427441583 0 MARKLEY VALERIE 2023335 9999999 B 10 1427441583 0 3600 N PROW RD BLOOMINGTON IN 474041616 20 1427441583 0 Nurse Practitioners Healthy Kids Services 20 1427441583 0 Nurse Practitioners Nurse Practitioners Services 20 1427441583 0 Nurse Practitioners Physician Services 00 1427441815 0 KING BRITTANY N 2015071 9999999 B 10 1427441815 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1427441815 0 Nurse Practitioners Healthy Kids Services 20 1427441815 0 Nurse Practitioners Nurse Practitioners Services 20 1427441815 0 Nurse Practitioners Physician Services 00 1427441856 0 GONZALEZ STEPHANIE K 2023324 9999999 B 10 1427441856 0 1700 E HIGGINS RD STE 600 DES PLAINES IL 600185621 20 1427441856 0 Nurse Practitioners Fluoride varnish 20 1427441856 0 Nurse Practitioners Healthy Kids Services 20 1427441856 0 Nurse Practitioners Nurse Practitioners Services 20 1427441856 0 Nurse Practitioners Physician Services 00 1427442292 0 PATEL GINA 2017046 9999999 B 10 1427442292 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1427442292 0 Physical Therapists Medical Supplies 20 1427442292 0 Physical Therapists Medical equipment/prosthetic devices 20 1427442292 0 Physical Therapists Physical Therapy Services 00 1427442698 0 FUSSNER STEVEN L 2020311 9999999 B 10 1427442698 0 336 22ND AVE N NASHVILLE TN 372031844 20 1427442698 0 Physicians Anesthesia Services 20 1427442698 0 Physicians Healthy Kids Services 20 1427442698 0 Physicians Optical Supplies 20 1427442698 0 Physicians Physician Services 20 1427442698 0 Physicians Physicians Psychiatric Services 00 1427442821 0 MEREDYTH NICOLE A 2023240 9999999 B 10 1427442821 0 5777 DEPT CAROL STREAM IL 601220021 20 1427442821 0 Physicians Anesthesia Services 20 1427442821 0 Physicians Healthy Kids Services 20 1427442821 0 Physicians Optical Supplies 20 1427442821 0 Physicians Physician Services 00 1427443712 0 KHAMBHATI JAY 2024214 9999999 B 10 1427443712 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1427443712 0 Physicians Anesthesia Services 20 1427443712 0 Physicians Fluoride varnish 20 1427443712 0 Physicians Healthy Kids Services 20 1427443712 0 Physicians Optical Supplies 20 1427443712 0 Physicians Physician Services 00 1427443753 0 LEDFORD DYLAN 2023164 9999999 B 10 1427443753 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1427443753 0 Physicians Anesthesia Services 20 1427443753 0 Physicians Fluoride varnish 20 1427443753 0 Physicians Healthy Kids Services 20 1427443753 0 Physicians 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0 1051 ESSINGTON RD STE 210 JOLIET IL 604352812 20 1427444967 0 Physicians Anesthesia Services 20 1427444967 0 Physicians Fluoride varnish 20 1427444967 0 Physicians Healthy Kids Services 20 1427444967 0 Physicians Optical Supplies 20 1427444967 0 Physicians Physician Services 00 1427447036 0 CHEEMA BALJASH SINGH 2018129 9999999 B 10 1427447036 0 5777 DEPT CAROL STREAM IL 601220021 20 1427447036 0 Physicians Anesthesia Services 20 1427447036 0 Physicians Fluoride varnish 20 1427447036 0 Physicians Healthy Kids Services 20 1427447036 0 Physicians Optical Supplies 20 1427447036 0 Physicians Physician Services 00 1427447861 0 ANDERSON BERNADETTE 1999346 9999999 B 10 1427447861 0 3330 S INDIANA AVE APT 2N CHICAGO IL 606164942 20 1427447861 0 Speech Therapists Medical Supplies 20 1427447861 0 Speech Therapists Medical equipment/prosthetic devices 20 1427447861 0 Speech Therapists Speech Therapy/Pathology Services 00 1427448240 0 RUBIN ABIGAIL 2016113 9999999 B 10 1427448240 0 1509 W ROSCOE ST CHICAGO IL 606571311 20 1427448240 0 Speech Therapists Medical Supplies 20 1427448240 0 Speech Therapists Medical equipment/prosthetic devices 20 1427448240 0 Speech Therapists Speech Therapy/Pathology Services 00 1427449297 0 MIRABBASI SEYED 2023341 9999999 B 10 1427449297 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1427449297 0 Physicians Anesthesia Services 20 1427449297 0 Physicians Fluoride varnish 20 1427449297 0 Physicians Healthy Kids Services 20 1427449297 0 Physicians Optical Supplies 20 1427449297 0 Physicians Physician Services 00 1427450378 0 BRADLEY AMY 2022079 9999999 B 10 1427450378 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1427450378 0 Nurse Practitioners Healthy Kids Services 20 1427450378 0 Nurse Practitioners Nurse Practitioners Services 20 1427450378 0 Nurse Practitioners Physician Services 00 1427451525 0 CAREY KATHRYN A 2015088 9999999 B 10 1427451525 0 5777 DEPT CAROL STREAM IL 601220021 20 1427451525 0 Nurse Practitioners Healthy Kids Services 20 1427451525 0 Nurse Practitioners Nurse Practitioners Services 20 1427451525 0 Nurse Practitioners Physician Services 00 1427451624 0 PHILLIPS NOHL APRIL 2014305 9999999 B 10 1427451624 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1427451624 0 Nurse Practitioners Healthy Kids Services 20 1427451624 0 Nurse Practitioners Nurse Practitioners Services 20 1427451624 0 Nurse Practitioners Physician Services 00 1427452051 0 HULTS JENNIFER D 2015047 9999999 B 10 1427452051 0 339 CONSORT DR BALLWIN MO 630114439 20 1427452051 0 Nurse Practitioners Anesthesia Services 20 1427452051 0 Nurse Practitioners Nurse Practitioners Services 20 1427452051 0 Nurse Practitioners Physician Services 00 1427452119 0 CLICK KIMBRA 2014286 9999999 B 10 1427452119 0 PO BOX 88848 CAROL STREAM IL 601880848 20 1427452119 0 Nurse Practitioners Anesthesia Services 20 1427452119 0 Nurse Practitioners Nurse Practitioners Services 20 1427452119 0 Nurse Practitioners Physician Services 00 1427452499 0 MARSHALL MARY K 2017111 9999999 B 10 1427452499 0 12609 S MELVINA AVE PALOS HEIGHTS IL 604631800 20 1427452499 0 Occupational Therapists Medical Supplies 20 1427452499 0 Occupational Therapists Medical equipment/prosthetic devices 20 1427452499 0 Occupational Therapists Occupational Therapy Services 00 1427452762 0 SPELL DAWN 2015075 9999999 B 10 1427452762 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1427452762 0 Nurse Practitioners Healthy Kids Services 20 1427452762 0 Nurse Practitioners Nurse Practitioners Services 20 1427452762 0 Nurse Practitioners Physician Services 00 1427453539 0 HARNISH JESSICA 2017048 9999999 B 10 1427453539 0 1243 RICKERT DR NAPERVILLE IL 605400954 20 1427453539 0 Nurse Practitioners Healthy Kids Services 20 1427453539 0 Nurse Practitioners Nurse Practitioners Services 20 1427453539 0 Nurse Practitioners Physician Services 00 1427453760 0 RANDICH THERESA 2016056 9999999 B 10 1427453760 0 28W671 GARYS MILL RD WINFIELD IL 601901564 20 1427453760 0 Other behavior health professional All Kids application agent 20 1427453760 0 Other behavior health professional LCPC/LMFT services 20 1427453760 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1427454602 0 HOLLAND BARBARA 2023179 9999999 B 10 1427454602 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1427454602 0 Nurse Practitioners Healthy Kids Services 20 1427454602 0 Nurse Practitioners Nurse Practitioners Services 20 1427454602 0 Nurse Practitioners Physician Services 00 1427456318 0 MEYER SHARON A 2015222 9999999 B 10 1427456318 0 1400 S MICHIGAN AVE APT 1203 CHICAGO IL 606053720 20 1427456318 0 Nurse Practitioners Healthy Kids Services 20 1427456318 0 Nurse Practitioners Nurse Practitioners Services 20 1427456318 0 Nurse Practitioners Physician Services 00 1427456961 0 DEARMOND ALISA D 2015005 9999999 B 10 1427456961 0 PO BOX 378 SPARTA IL 622860378 20 1427456961 0 Nurse Practitioners Family Planning Counseling 20 1427456961 0 Nurse Practitioners Fluoride varnish 20 1427456961 0 Nurse Practitioners Healthy Kids Services 20 1427456961 0 Nurse Practitioners Nurse Practitioners Services 20 1427456961 0 Nurse Practitioners Physician Services 00 1427457415 0 HEXAMER LAURA 2022108 9999999 B 10 1427457415 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1427457415 0 Occupational Therapists Medical Supplies 20 1427457415 0 Occupational Therapists Medical equipment/prosthetic devices 20 1427457415 0 Occupational Therapists Occupational Therapy Services 00 1427459007 0 HALL ASHLEY 2014266 9999999 B 10 1427459007 0 2202 HARLEM RD LOVES PARK IL 611112754 20 1427459007 0 Nurse Practitioners Anesthesia Services 20 1427459007 0 Nurse Practitioners Nurse Practitioners Services 20 1427459007 0 Nurse Practitioners Physician Services 00 1427459957 0 MILLER PETER 2017075 9999999 B 10 1427459957 0 3051 HOLLIS DR SPRINGFIELD IL 627047452 20 1427459957 0 Physicians Anesthesia Services 20 1427459957 0 Physicians Fluoride varnish 20 1427459957 0 Physicians Healthy Kids Services 20 1427459957 0 Physicians Optical Supplies 20 1427459957 0 Physicians Physician Services 00 1427460567 0 REGGI JOHNNA 2015222 9999999 B 10 1427460567 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1427460567 0 Nurse Practitioners Healthy Kids Services 20 1427460567 0 Nurse Practitioners Midwife Services 20 1427460567 0 Nurse Practitioners Nurse Practitioners Services 20 1427460567 0 Nurse Practitioners Physician Services 00 1427461540 0 MOSTAD LORRI J 2014248 9999999 B 10 1427461540 0 100 E LEFEVRE RD STERLING IL 610811278 20 1427461540 0 Nurse Practitioners Healthy Kids Services 20 1427461540 0 Nurse Practitioners Nurse Practitioners Services 20 1427461540 0 Nurse Practitioners Nursing service 20 1427461540 0 Nurse Practitioners Physician Services 20 1427461540 0 Nurse Practitioners Waiver service 00 1427461581 0 MEYER CORTNEY D 2018309 9999999 B 10 1427461581 0 PO BOX 3988 CARBONDALE IL 629023988 20 1427461581 0 Clinical Social Worker Social work service 00 1427461920 0 DETELICH DANIELLE 2024278 9999999 B 10 1427461920 0 PO BOX 43230 PHOENIX AZ 850803230 20 1427461920 0 Physicians Anesthesia Services 20 1427461920 0 Physicians Healthy Kids Services 20 1427461920 0 Physicians Optical Supplies 20 1427461920 0 Physicians Physician Services 00 1427462282 0 PATEL GOPI R 2019346 9999999 B 10 1427462282 0 29373 NETWORK PL CHICAGO IL 606733039 20 1427462282 0 Physicians Anesthesia Services 20 1427462282 0 Physicians Healthy Kids Services 20 1427462282 0 Physicians Optical Supplies 20 1427462282 0 Physicians Physician Services 00 1427462324 0 BAMBERGER BRIAN C 2018215 9999999 B 10 1427462324 0 1 ILLINI DR PEORIA IL 616052576 20 1427462324 0 Physicians Anesthesia Services 20 1427462324 0 Physicians Fluoride varnish 20 1427462324 0 Physicians Healthy Kids Services 20 1427462324 0 Physicians Optical Supplies 20 1427462324 0 Physicians Physician Services 00 1427462456 0 SCHULTE JEFREE 2018353 9999999 B 10 1427462456 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1427462456 0 Physicians Anesthesia Services 20 1427462456 0 Physicians Healthy Kids Services 20 1427462456 0 Physicians Optical Supplies 20 1427462456 0 Physicians Physician Services 00 1427462910 0 GODWIN AMY M 2022077 9999999 B 10 1427462910 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1427462910 0 Nurse Practitioners Anesthesia Services 20 1427462910 0 Nurse Practitioners Nurse Practitioners Services 20 1427462910 0 Nurse Practitioners Physician Services 00 1427463074 0 SAMANT MAANASI 2019165 9999999 B 10 1427463074 0 5777 DEPT CAROL STREAM IL 601220021 20 1427463074 0 Physicians Anesthesia Services 20 1427463074 0 Physicians Fluoride varnish 20 1427463074 0 Physicians Healthy Kids Services 20 1427463074 0 Physicians Optical Supplies 20 1427463074 0 Physicians Physician Services 00 1427463322 0 JERKOVICH ADRIA 2018060 9999999 B 10 1427463322 0 2100 POWELL ST STE 900 EMERYVILLE CA 946081844 20 1427463322 0 Physicians Anesthesia Services 20 1427463322 0 Physicians Fluoride varnish 20 1427463322 0 Physicians Healthy Kids Services 20 1427463322 0 Physicians Optical Supplies 20 1427463322 0 Physicians Physician Services 00 1427463454 0 CHAPPELL BRANDON A 2020314 9999999 B 10 1427463454 0 PO BOX 638704 CINCINNATI OH 452638704 20 1427463454 0 Physicians Anesthesia Services 20 1427463454 0 Physicians Fluoride varnish 20 1427463454 0 Physicians Healthy Kids Services 20 1427463454 0 Physicians Optical Supplies 20 1427463454 0 Physicians Physician Services 00 1427463801 0 MORAN LAUREN R 2017177 9999999 B 10 1427463801 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1427463801 0 Physicians Anesthesia Services 20 1427463801 0 Physicians Fluoride varnish 20 1427463801 0 Physicians Healthy Kids Services 20 1427463801 0 Physicians Optical Supplies 20 1427463801 0 Physicians Physician Services 00 1427464304 0 CASEY MONET 2021312 9999999 B 10 1427464304 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1427464304 0 Physicians Anesthesia Services 20 1427464304 0 Physicians Fluoride varnish 20 1427464304 0 Physicians Healthy Kids Services 20 1427464304 0 Physicians Optical Supplies 20 1427464304 0 Physicians Physician Services 00 1427464379 0 RAMAKRISHNA AKHILA 2020238 9999999 B 10 1427464379 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1427464379 0 Physicians Anesthesia Services 20 1427464379 0 Physicians Fluoride varnish 20 1427464379 0 Physicians Healthy Kids Services 20 1427464379 0 Physicians Optical Supplies 20 1427464379 0 Physicians Physician Services 00 1427464817 0 FIELDS CASEY L 2018218 9999999 B 10 1427464817 0 PO BOX 4028 ROCK ISLAND IL 612044028 20 1427464817 0 Psychologist Psychologist service 00 1427465095 0 COFFEY ASHLEY 2022335 9999999 B 10 1427465095 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1427465095 0 Clinical Social Worker Social work service 00 1427466655 0 BISTA AMIR 2022084 9999999 B 10 1427466655 0 2845 GREENBRIER RD GREEN BAY WI 543116519 20 1427466655 0 Physicians Anesthesia Services 20 1427466655 0 Physicians Fluoride varnish 20 1427466655 0 Physicians Healthy Kids Services 20 1427466655 0 Physicians Optical Supplies 20 1427466655 0 Physicians Physician Services 00 1427467703 0 KHAN SAMEER 2018335 9999999 B 10 1427467703 0 PO BOX 402308 MIAMI BEACH FL 331400308 20 1427467703 0 Podiatrists Podiatric Services 00 1427468438 0 MAIKRANZ MONICA J 2015182 9999999 B 10 1427468438 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1427468438 0 Nurse Practitioners Healthy Kids Services 20 1427468438 0 Nurse Practitioners Nurse Practitioners Services 20 1427468438 0 Nurse Practitioners Physician Services 00 1427468818 0 ASGHARI HOSSEIN 2020306 9999999 B 10 1427468818 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1427468818 0 Physicians Anesthesia Services 20 1427468818 0 Physicians Healthy Kids Services 20 1427468818 0 Physicians Optical Supplies 20 1427468818 0 Physicians Physician Services 00 1427469345 0 DOWZICKY PHILLIP M 2023275 9999999 B 10 1427469345 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1427469345 0 Physicians Anesthesia Services 20 1427469345 0 Physicians Healthy Kids Services 20 1427469345 0 Physicians Optical Supplies 20 1427469345 0 Physicians Physician Services 00 1427469923 0 NADAR ALI A 2022116 9999999 B 10 1427469923 0 3300 OAKDALE AVE N ROBBINSDALE MN 554222926 20 1427469923 0 Physicians Anesthesia Services 20 1427469923 0 Physicians Fluoride varnish 20 1427469923 0 Physicians Healthy Kids Services 20 1427469923 0 Physicians Optical Supplies 20 1427469923 0 Physicians Physician Services 00 1427471333 0 SOLOMONOV REBECCA A 2020051 9999999 B 10 1427471333 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1427471333 0 Nurse Practitioners Fluoride varnish 20 1427471333 0 Nurse Practitioners Healthy Kids Services 20 1427471333 0 Nurse Practitioners Nurse Practitioners Services 20 1427471333 0 Nurse Practitioners Physician Services 00 1427471713 0 MALENA ERICA 2014357 9999999 B 10 1427471713 0 20280 GOVERNORS HWY STE 207 OLYMPIA FIELDS IL 604611028 20 1427471713 0 Clinical Social Worker Social work service 00 1427473693 0 WELDING MARCUS 2014034 9999999 B 10 1427473693 0 850 43RD AVE STE 100 MOLINE IL 612658401 20 1427473693 0 Physical Therapists Medical Supplies 20 1427473693 0 Physical Therapists Medical equipment/prosthetic devices 20 1427473693 0 Physical Therapists Physical Therapy Services 00 1427474402 0 ASHLEY MELISSA L 2014182 9999999 B 10 1427474402 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1427474402 0 Nurse Practitioners Healthy Kids Services 20 1427474402 0 Nurse Practitioners Nurse Practitioners Services 20 1427474402 0 Nurse Practitioners Physician Services 00 1427475599 0 RUIZ RAYMOND 2020349 9999999 B 10 1427475599 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1427475599 0 Physicians Anesthesia Services 20 1427475599 0 Physicians Healthy Kids Services 20 1427475599 0 Physicians Optical Supplies 20 1427475599 0 Physicians Physician Services 00 1427475623 0 TIPPETT LENAE 2024032 9999999 B 10 1427475623 0 118 N 2ND ST STE 200 SAINT CHARLES MO 633012894 20 1427475623 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1427475987 0 EDER LAURA 2017121 9999999 B 10 1427475987 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1427475987 0 Physicians Anesthesia Services 20 1427475987 0 Physicians Fluoride varnish 20 1427475987 0 Physicians Healthy Kids Services 20 1427475987 0 Physicians Optical Supplies 20 1427475987 0 Physicians Physician Services 00 1427476100 0 SHOUP JOHN PAUL 2020143 9999999 B 10 1427476100 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1427476100 0 Physicians Anesthesia Services 20 1427476100 0 Physicians Fluoride varnish 20 1427476100 0 Physicians Healthy Kids Services 20 1427476100 0 Physicians Optical Supplies 20 1427476100 0 Physicians Physician Services 00 1427476654 0 ZAGHI JUSTIN 2022026 9999999 B 10 1427476654 0 528 PALISADES DR UNIT 176 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631600352 20 1427477843 0 Physicians Anesthesia Services 20 1427477843 0 Physicians Healthy Kids Services 20 1427477843 0 Physicians Optical Supplies 20 1427477843 0 Physicians Physician Services 00 1427477926 0 GEORGES ALAN 2019197 9999999 B 10 1427477926 0 5777 DEPT CAROL STREAM IL 601220021 20 1427477926 0 Physicians Anesthesia Services 20 1427477926 0 Physicians Healthy Kids Services 20 1427477926 0 Physicians Optical Supplies 20 1427477926 0 Physicians Physician Services 20 1427477926 0 Physicians Physicians Psychiatric Services 00 1427478635 0 SCHUESSLER MARTHA 2025008 9999999 B 10 1427478635 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1427478635 0 Physicians Anesthesia Services 20 1427478635 0 Physicians Healthy Kids Services 20 1427478635 0 Physicians Optical Supplies 20 1427478635 0 Physicians Physician Services 00 1427478726 0 ODEH ADEEB 2023114 9999999 B 10 1427478726 0 29373 NETWORK PL CHICAGO IL 606733039 20 1427478726 0 Other behavior health professional LCPC/LMFT services 00 1427478817 0 TAYLOR CHRISTINE 2014132 9999999 B 10 1427478817 0 3471 EAGLE WAY CHICAGO IL 606781034 20 1427478817 0 Nurse Practitioners Healthy Kids Services 20 1427478817 0 Nurse Practitioners Nurse Practitioners Services 20 1427478817 0 Nurse Practitioners Physician Services 00 1427481472 0 KHAN MUHAMMAD 2016183 9999999 B 10 1427481472 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1427481472 0 Physicians Anesthesia Services 20 1427481472 0 Physicians Fluoride varnish 20 1427481472 0 Physicians Healthy Kids Services 20 1427481472 0 Physicians Optical Supplies 20 1427481472 0 Physicians Physician Services 00 1427481548 0 OCEGUEDA HECTOR 2015293 9999999 B 10 1427481548 0 3600 W FULLERTON AVE CHICAGO IL 606472319 20 1427481548 0 Clinical Social Worker Social work service 00 1427482157 0 SHINE KATHERINE M 2018213 9999999 B 10 1427482157 0 12655 OLIVE BLVD FL 4 SAINT LOUIS MO 631416362 20 1427482157 0 Nurse Practitioners Fluoride varnish 20 1427482157 0 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Physicians Healthy Kids Services 20 1427484682 0 Physicians Optical Supplies 20 1427484682 0 Physicians Physician Services 00 1427489079 0 RANDALL KARA 2015272 9999999 B 10 1427489079 0 15505 E 127TH ST LEMONT IL 604394433 20 1427489079 0 Nurse Practitioners Fluoride varnish 20 1427489079 0 Nurse Practitioners Healthy Kids Services 20 1427489079 0 Nurse Practitioners Nurse Practitioners Services 20 1427489079 0 Nurse Practitioners Physician Services 00 1427489970 0 JOSEPH NEETHU 2016011 9999999 B 10 1427489970 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1427489970 0 Physician Assistant Only Fluoride varnish 20 1427489970 0 Physician Assistant Only Healthy Kids Services 20 1427489970 0 Physician Assistant Only Physician Services 00 1427489996 0 EHLERS KRISTINE 2014048 9999999 B 10 1427489996 0 611 W PARK ST URBANA IL 618012529 20 1427489996 0 Nurse Practitioners Fluoride varnish 20 1427489996 0 Nurse Practitioners Healthy Kids Services 20 1427489996 0 Nurse Practitioners Nurse Practitioners Services 20 1427489996 0 Nurse Practitioners Physician Services 00 1427490325 0 DORIA LORNA 1994182 9999999 B 10 1427490325 0 PO BOX 775161 CHICAGO IL 606775161 20 1427490325 0 Physicians Anesthesia Services 20 1427490325 0 Physicians Healthy Kids Services 20 1427490325 0 Physicians Optical Supplies 20 1427490325 0 Physicians Physician Services 00 1427490614 0 MENIS KATHY 1996122 9999999 B 10 1427490614 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1427490614 0 Occupational Therapists Medical Supplies 20 1427490614 0 Occupational Therapists Medical equipment/prosthetic devices 20 1427490614 0 Occupational Therapists Occupational Therapy Services 00 1427491711 0 REID PANKTI D 2018285 9999999 B 10 1427491711 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1427491711 0 Physicians Anesthesia Services 20 1427491711 0 Physicians Fluoride varnish 20 1427491711 0 Physicians Healthy Kids Services 20 1427491711 0 Physicians Optical Supplies 20 1427491711 0 Physicians 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Services 00 1427493022 0 PERKINS KIARA 2014247 9999999 B 10 1427493022 0 1507 E 53RD ST CHICAGO IL 606154573 20 1427493022 0 Speech Therapists Medical Supplies 20 1427493022 0 Speech Therapists Medical equipment/prosthetic devices 20 1427493022 0 Speech Therapists Speech Therapy/Pathology Services 00 1427493485 0 SCHROEDER RONALD J 2022223 9999999 B 10 1427493485 0 10001 W INNOVATION DR STE 200 WAUWATOSA WI 532264851 20 1427493485 0 Physicians Anesthesia Services 20 1427493485 0 Physicians Healthy Kids Services 20 1427493485 0 Physicians Optical Supplies 20 1427493485 0 Physicians Physician Services 00 1427493576 0 GALLI SARA 2024131 9999999 B 10 1427493576 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1427493576 0 Physicians Anesthesia Services 20 1427493576 0 Physicians Healthy Kids Services 20 1427493576 0 Physicians Optical Supplies 20 1427493576 0 Physicians Physician Services 00 1427493972 0 RATHI SHAMA 2023292 9999999 B 10 1427493972 0 200 2ND AVE S STE 356 SAINT PETERSBUR FL 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Healthy Kids Services 20 1427573518 0 Physicians Optical Supplies 20 1427573518 0 Physicians Physician Services 00 1427573633 0 HEISLER ELIZABETH S. 2017263 9999999 B 10 1427573633 0 1318 W 6TH ST KEWANEE IL 614431261 20 1427573633 0 Speech Therapists Medical Supplies 20 1427573633 0 Speech Therapists Medical equipment/prosthetic devices 20 1427573633 0 Speech Therapists Speech Therapy/Pathology Services 00 1427573773 0 LYSAGHT ANDREA M 2017226 9999999 B 10 1427573773 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1427573773 0 Nurse Practitioners Healthy Kids Services 20 1427573773 0 Nurse Practitioners Nurse Practitioners Services 20 1427573773 0 Nurse Practitioners Physician Services 00 1427574714 0 WOODCOX BOLDEN NICOLE 2020135 9999999 B 10 1427574714 0 10 N MARTINGALE RD STE 400 SCHAUMBURG IL 601732411 20 1427574714 0 Clinical Social Worker Social work service 00 1427574961 0 SCHRYVER ALLISON 2024344 9999999 B 10 1427574961 0 119 S WESTERN AVE UNIT 1 CHICAGO IL 606124644 20 1427574961 0 Nurse Practitioners Fluoride varnish 20 1427574961 0 Nurse Practitioners Healthy Kids Services 20 1427574961 0 Nurse Practitioners Nurse Practitioners Services 20 1427574961 0 Nurse Practitioners Physician Services 00 1427575190 0 MILLER TERRYA V 2018169 9999999 B 10 1427575190 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1427575190 0 Nurse Practitioners Fluoride varnish 20 1427575190 0 Nurse Practitioners Healthy Kids Services 20 1427575190 0 Nurse Practitioners Nurse Practitioners Services 20 1427575190 0 Nurse Practitioners Physician Services 00 1427575513 0 KRIFKA MEREDITH A 2020200 9999999 B 10 1427575513 0 855 SPRINGDALE DR STE 200 EXTON PA 193412852 20 1427575513 0 Physical Therapists Medical Supplies 20 1427575513 0 Physical Therapists Medical equipment/prosthetic devices 20 1427575513 0 Physical Therapists Physical Therapy Services 00 1427575612 0 SIES BETH 2017313 9999999 B 10 1427575612 0 510 W ELM ST GILLESPIE IL 620331167 20 1427575612 0 Speech Therapists Medical Supplies 20 1427575612 0 Speech Therapists Medical equipment/prosthetic devices 20 1427575612 0 Speech Therapists Speech Therapy/Pathology Services 00 1427576180 0 WILSON AMELIE H 2017244 9999999 B 10 1427576180 0 510 LINCOLN DR HERRIN IL 629486334 20 1427576180 0 Physical Therapists Medical Supplies 20 1427576180 0 Physical Therapists Medical equipment/prosthetic devices 20 1427576180 0 Physical Therapists Physical Therapy Services 00 1427576495 0 CLINE HAYLEY R 2017310 9999999 B 10 1427576495 0 300 CEDAR ST PEKIN IL 615547009 20 1427576495 0 Speech Therapists Medical Supplies 20 1427576495 0 Speech Therapists Medical equipment/prosthetic devices 20 1427576495 0 Speech Therapists Speech Therapy/Pathology Services 00 1427577949 0 GARCIA FRANCISCO J 2025062 9999999 B 10 1427577949 0 5777 DEPT CAROL STREAM IL 601228942 20 1427577949 0 Physician Assistant Only Fluoride varnish 20 1427577949 0 Physician Assistant Only Healthy Kids Services 20 1427577949 0 Physician Assistant Only Physician Services 00 1427578319 0 UZELAC LYNN 2017193 9999999 B 10 1427578319 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1427578319 0 Nurse Practitioners Fluoride varnish 20 1427578319 0 Nurse Practitioners Healthy Kids Services 20 1427578319 0 Nurse Practitioners Nurse Practitioners Services 20 1427578319 0 Nurse Practitioners Physician Services 00 1427578681 0 FRUIN DOUGLASS 2021361 9999999 B 10 1427578681 0 3500 W PETERSON AVE STE 401 CHICAGO IL 606593307 20 1427578681 0 Optometrists Optical Supplies 20 1427578681 0 Optometrists Optometric Services 20 1427578681 0 Optometrists Physician Services 00 1427579432 0 ANSARI MUJIBA 2022004 9999999 B 10 1427579432 0 4701 DEPT CAROL STREAM IL 601220021 20 1427579432 0 Physician Assistant Only Fluoride varnish 20 1427579432 0 Physician Assistant Only Healthy Kids Services 20 1427579432 0 Physician Assistant Only Physician Services 00 1427579853 0 ST-PIERRE FREDERIQUE 2020200 9999999 B 10 1427579853 0 2704 NE INDEPENDENCE AVE 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Only Fluoride varnish 20 1427605435 0 Physician Assistant Only Healthy Kids Services 20 1427605435 0 Physician Assistant Only Physician Services 00 1427606060 0 DUARTE SAMANTHA E 2023218 9999999 B 10 1427606060 0 4698 DEPT CAROL STREAM IL 601220021 20 1427606060 0 Physicians Anesthesia Services 20 1427606060 0 Physicians Fluoride varnish 20 1427606060 0 Physicians Healthy Kids Services 20 1427606060 0 Physicians Optical Supplies 20 1427606060 0 Physicians Physician Services 00 1427606250 0 NAHLIK ERIN K 2019305 9999999 B 10 1427606250 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1427606250 0 Nurse Practitioners Healthy Kids Services 20 1427606250 0 Nurse Practitioners Nurse Practitioners Services 20 1427606250 0 Nurse Practitioners Physician Services 00 1427606458 0 RYAN LENGACHER TYBYTHA D 2021272 9999999 B 10 1427606458 0 PO BOX 778912 CHICAGO IL 606778912 20 1427606458 0 Psychologist Psychologist service 00 1427606805 0 HUMES HALEY 2020153 9999999 B 10 1427606805 0 921 CREAMERY HILL RD DALLAS CITY IL 623301216 20 1427606805 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1427606920 0 DANNELLS DESTINY R 2019329 9999999 B 10 1427606920 0 929 STACEY BURK DR PO BOX 40 FLORA IL 628393241 20 1427606920 0 Nurse Practitioners Fluoride varnish 20 1427606920 0 Nurse Practitioners Healthy Kids Services 20 1427606920 0 Nurse Practitioners Nurse Practitioners Services 20 1427606920 0 Nurse Practitioners Physician Services 00 1427607860 0 MURRAY EMILY S 2019267 9999999 B 10 1427607860 0 1311 MAMARONECK AVE STE 140 WHITE PLAINS NY 106055224 20 1427607860 0 Occupational Therapists Medical Supplies 20 1427607860 0 Occupational Therapists Medical equipment/prosthetic devices 20 1427607860 0 Occupational Therapists Occupational Therapy Services 00 1427608082 0 QUAID EMILY M 2019260 9999999 B 10 1427608082 0 1120 N MELVIN ST GIBSON CITY IL 609361477 20 1427608082 0 Physician Assistant Only Fluoride varnish 20 1427608082 0 Physician Assistant Only Healthy Kids Services 20 1427608082 0 Physician Assistant Only Physician Services 00 1427608090 0 BELCINA JENNELYN M 2020205 9999999 B 10 1427608090 0 800 W FULTON MARKET FL 12 CHICAGO IL 606071302 20 1427608090 0 Nurse Practitioners Fluoride varnish 20 1427608090 0 Nurse Practitioners Healthy Kids Services 20 1427608090 0 Nurse Practitioners Nurse Practitioners Services 20 1427608090 0 Nurse Practitioners Physician Services 00 1427608140 0 BENEMATTI DANIELLE 2020035 9999999 B 10 1427608140 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1427608140 0 Nurse Practitioners Anesthesia Services 20 1427608140 0 Nurse Practitioners Nurse Practitioners Services 20 1427608140 0 Nurse Practitioners Physician Services 00 1427609775 0 ANDERSON BRANDI L 2019276 9999999 B 10 1427609775 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1427609775 0 Nurse Practitioners Healthy Kids Services 20 1427609775 0 Nurse Practitioners Nurse Practitioners Services 20 1427609775 0 Nurse Practitioners Physician Services 00 1427610617 0 ALPOGIANIS KATHERINE 2020225 9999999 B 10 1427610617 0 PO BOX 110429 AURORA CO 800420429 20 1427610617 0 Physician Assistant Only Fluoride varnish 20 1427610617 0 Physician Assistant Only Healthy Kids Services 20 1427610617 0 Physician Assistant Only Physician Services 00 1427611441 0 KALHAN VARUN 2020139 9999999 B 10 1427611441 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1427611441 0 Physicians Anesthesia Services 20 1427611441 0 Physicians Fluoride varnish 20 1427611441 0 Physicians Healthy Kids Services 20 1427611441 0 Physicians Optical Supplies 20 1427611441 0 Physicians Physician Services 00 1427611565 0 SOUNDARARAJAN VINAYA 2019182 9999999 B 10 1427611565 0 903 COMMERCE DR STE 333 OAK BROOK IL 605238723 20 1427611565 0 Physicians Anesthesia Services 20 1427611565 0 Physicians Fluoride varnish 20 1427611565 0 Physicians Healthy Kids Services 20 1427611565 0 Physicians Optical Supplies 20 1427611565 0 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1427613694 0 Physicians Optical Supplies 20 1427613694 0 Physicians Physician Services 00 1427613793 0 FASS LUCAS 2025016 9999999 B 10 1427613793 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1427613793 0 Physicians Anesthesia Services 20 1427613793 0 Physicians Fluoride varnish 20 1427613793 0 Physicians Healthy Kids Services 20 1427613793 0 Physicians Optical Supplies 20 1427613793 0 Physicians Physician Services 00 1427614908 0 ARTZ HANNAH K 2023103 9999999 B 10 1427614908 0 988102 NEBRASKA MEDICAL CTR OMAHA NE 681988102 20 1427614908 0 Physicians Anesthesia Services 20 1427614908 0 Physicians Fluoride varnish 20 1427614908 0 Physicians Healthy Kids Services 20 1427614908 0 Physicians Optical Supplies 20 1427614908 0 Physicians Physician Services 00 1427615178 0 MARIANO NICOLE 2023052 9999999 B 10 1427615178 0 3401 GUNDERSON AVE BERWYN IL 604023771 20 1427615178 0 Speech Therapists Medical Supplies 20 1427615178 0 Speech Therapists Medical equipment/prosthetic devices 20 1427615178 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Practitioners Healthy Kids Services 20 1427621705 0 Nurse Practitioners Nurse Practitioners Services 20 1427621705 0 Nurse Practitioners Physician Services 00 1427622232 0 ADEYEMI ISAAC O 2021185 9999999 B 10 1427622232 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1427622232 0 Nurse Practitioners Fluoride varnish 20 1427622232 0 Nurse Practitioners Healthy Kids Services 20 1427622232 0 Nurse Practitioners Nurse Practitioners Services 20 1427622232 0 Nurse Practitioners Physician Services 00 1427623503 0 DUVVADA SURESH 2022196 9999999 B 10 1427623503 0 700 E OGDEN AVE STE 202 WESTMONT IL 605591296 20 1427623503 0 Physicians Anesthesia Services 20 1427623503 0 Physicians Fluoride varnish 20 1427623503 0 Physicians Healthy Kids Services 20 1427623503 0 Physicians Optical Supplies 20 1427623503 0 Physicians Physician Services 00 1427624345 0 MCGHEE MYLES 2021259 9999999 H 10 1427624345 0 PO BOX 1109 DEKALB IL 601157109 20 1427624345 0 Other behavior health professional Other 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PHILIP G 2024227 9999999 B 10 1427631845 0 4698 DEPT CAROL STREAM IL 601220021 20 1427631845 0 Physicians Anesthesia Services 20 1427631845 0 Physicians Healthy Kids Services 20 1427631845 0 Physicians Optical Supplies 20 1427631845 0 Physicians Physician Services 00 1427631936 0 PETERSEN ANNA 2023182 9999999 B 10 1427631936 0 PO BOX 855795 MINNEAPOLIS MN 554851296 20 1427631936 0 Physicians Anesthesia Services 20 1427631936 0 Physicians Fluoride varnish 20 1427631936 0 Physicians Healthy Kids Services 20 1427631936 0 Physicians Optical Supplies 20 1427631936 0 Physicians Physician Services 00 1427632280 0 ADESANYA DAMILOLA 2024206 9999999 B 10 1427632280 0 1044 N FRANCISCO AVE CHICAGO IL 606222743 20 1427632280 0 Physicians Anesthesia Services 20 1427632280 0 Physicians Fluoride varnish 20 1427632280 0 Physicians Healthy Kids Services 20 1427632280 0 Physicians Optical Supplies 20 1427632280 0 Physicians Physician Services 00 1427632959 0 MICHAEL NICOLE 2022211 9999999 B 10 1427632959 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1427632959 0 Physicians Anesthesia Services 20 1427632959 0 Physicians Healthy Kids Services 20 1427632959 0 Physicians Optical Supplies 20 1427632959 0 Physicians Physician Services 00 1427635713 0 MCCRARY MYAH 2021182 9999999 B 10 1427635713 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1427635713 0 Physicians Anesthesia Services 20 1427635713 0 Physicians Fluoride varnish 20 1427635713 0 Physicians Healthy Kids Services 20 1427635713 0 Physicians Optical Supplies 20 1427635713 0 Physicians Physician Services 00 1427636570 0 ZHANG QIAN S 2022182 9999999 B 10 1427636570 0 4698 DEPT CAROL STREAM IL 601220021 20 1427636570 0 Physicians Anesthesia Services 20 1427636570 0 Physicians Healthy Kids Services 20 1427636570 0 Physicians Optical Supplies 20 1427636570 0 Physicians Physician Services 00 1427636703 0 HANSEN KAREN S 2021109 9999999 B 10 1427636703 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1427636703 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1427636992 0 HILL COURTNEY 2024214 9999999 B 10 1427636992 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1427636992 0 Physicians Anesthesia Services 20 1427636992 0 Physicians Healthy Kids Services 20 1427636992 0 Physicians Optical Supplies 20 1427636992 0 Physicians Physician Services 00 1427637040 0 MARDINI DUNIA 2021174 9999999 B 10 1427637040 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1427637040 0 Physicians Anesthesia Services 20 1427637040 0 Physicians Fluoride varnish 20 1427637040 0 Physicians Healthy Kids Services 20 1427637040 0 Physicians Optical Supplies 20 1427637040 0 Physicians Physician Services 00 1427637305 0 MANNING CASIANNE 2022213 9999999 B 10 1427637305 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1427637305 0 Physicians Anesthesia Services 20 1427637305 0 Physicians Fluoride varnish 20 1427637305 0 Physicians Healthy Kids Services 20 1427637305 0 Physicians Optical Supplies 20 1427637305 0 Physicians Physician Services 00 1427637412 0 COHEN JEREMY S 2021182 9999999 B 10 1427637412 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1427637412 0 Physicians Anesthesia Services 20 1427637412 0 Physicians Fluoride varnish 20 1427637412 0 Physicians Healthy Kids Services 20 1427637412 0 Physicians Optical Supplies 20 1427637412 0 Physicians Physician Services 00 1427638485 0 SUCHY ERIN E 2022024 9999999 B 10 1427638485 0 1436 W RANDOLPH ST STE 204 CHICAGO IL 606071415 20 1427638485 0 Occupational Therapists Medical Supplies 20 1427638485 0 Occupational Therapists Medical equipment/prosthetic devices 20 1427638485 0 Occupational Therapists Occupational Therapy Services 00 1427640051 0 STOEFEN JESSICA 2024137 9999999 B 10 1427640051 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1427640051 0 Nurse Practitioners Fluoride varnish 20 1427640051 0 Nurse Practitioners Healthy Kids Services 20 1427640051 0 Nurse Practitioners Nurse Practitioners Services 20 1427640051 0 Nurse Practitioners Physician Services 00 1427640382 0 ROSENFIELD JONATHAN 2023082 9999999 B 10 1427640382 0 938 N CALIFORNIA AVE CHICAGO IL 606224462 20 1427640382 0 Other behavior health professional LCPC/LMFT services 00 1427644145 0 PEROZZI MARIA 2024199 9999999 B 10 1427644145 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1427644145 0 Physician Assistant Only Fluoride varnish 20 1427644145 0 Physician Assistant Only Healthy Kids Services 20 1427644145 0 Physician Assistant Only Physician Services 00 1427644210 0 O''HANLON VICTORIA A 2021098 9999999 B 10 1427644210 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1427644210 0 Nurse Practitioners Fluoride varnish 20 1427644210 0 Nurse Practitioners Healthy Kids Services 20 1427644210 0 Nurse Practitioners Nurse Practitioners Services 20 1427644210 0 Nurse Practitioners Physician Services 00 1427646496 0 GIBSON JOSHUA L 2021147 9999999 B 10 1427646496 0 2100 MADISON AVE STE 301 GRANITE CITY IL 620404713 20 1427646496 0 Nurse Practitioners Fluoride varnish 20 1427646496 0 Nurse Practitioners Healthy Kids Services 20 1427646496 0 Nurse Practitioners Nurse Practitioners Services 20 1427646496 0 Nurse Practitioners Physician Services 00 1427647130 0 CASEY NATHAN 2024004 9999999 B 10 1427647130 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1427647130 0 Nurse Practitioners Anesthesia Services 20 1427647130 0 Nurse Practitioners Nurse Practitioners Services 20 1427647130 0 Nurse Practitioners Physician Services 00 1427647726 0 TORRES KELLI 2021036 9999999 B 10 1427647726 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1427647726 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1427648203 0 HUETTE PAIGE E 2021130 9999999 B 10 1427648203 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1427648203 0 Nurse Practitioners Fluoride varnish 20 1427648203 0 Nurse Practitioners Healthy Kids Services 20 1427648203 0 Nurse Practitioners Nurse Practitioners Services 20 1427648203 0 Nurse Practitioners Physician Services 00 1427648807 0 SCHLUPP BRIANNA M 2021063 9999999 B 10 1427648807 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1427648807 0 Nurse Practitioners Fluoride varnish 20 1427648807 0 Nurse Practitioners Healthy Kids Services 20 1427648807 0 Nurse Practitioners Nurse Practitioners Services 20 1427648807 0 Nurse Practitioners Physician Services 00 1427649185 0 WINCHESTER TIFFANY L 2021069 9999999 B 10 1427649185 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1427649185 0 Nurse Practitioners Fluoride varnish 20 1427649185 0 Nurse Practitioners Healthy Kids Services 20 1427649185 0 Nurse Practitioners Nurse Practitioners Services 20 1427649185 0 Nurse Practitioners Physician Services 00 1427649300 0 POWERS DANIEL J 2021120 9999999 B 10 1427649300 0 42 W MADISON ST FL 2 CHICAGO IL 606024309 20 1427649300 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1427649532 0 BRENNAN ELIZABETH 2022013 9999999 B 10 1427649532 0 422 N NORTHWEST HWY STE 210 PARK RIDGE IL 600683261 20 1427649532 0 Speech Therapists Medical Supplies 20 1427649532 0 Speech Therapists Medical equipment/prosthetic devices 20 1427649532 0 Speech Therapists Speech Therapy/Pathology Services 00 1427650076 0 KORAH AMANDA 2023137 9999999 B 10 1427650076 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1427650076 0 Speech Therapists Medical Supplies 20 1427650076 0 Speech Therapists Medical equipment/prosthetic devices 20 1427650076 0 Speech Therapists Speech Therapy/Pathology Services 00 1427650464 0 REIDER CRISTAL 2020356 9999999 B 10 1427650464 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1427650464 0 Nurse Practitioners Fluoride varnish 20 1427650464 0 Nurse Practitioners Healthy Kids Services 20 1427650464 0 Nurse Practitioners Nurse Practitioners Services 20 1427650464 0 Nurse Practitioners Physician Services 00 1427652668 0 POWELL SARAH B 2021007 9999999 B 10 1427652668 0 PO BOX 632281 CINCINNATI OH 452632281 20 1427652668 0 Nurse Practitioners Fluoride varnish 20 1427652668 0 Nurse Practitioners Healthy Kids Services 20 1427652668 0 Nurse Practitioners Nurse Practitioners Services 20 1427652668 0 Nurse Practitioners Physician Services 00 1427656859 0 COLEMAN MICA 2021028 9999999 H 10 1427656859 0 1642 E 56TH ST STE 110 CHICAGO IL 606375049 20 1427656859 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1427657634 0 GREGG ASHLEY 2020322 9999999 B 10 1427657634 0 585 TOLLGATE RD ELGIN IL 601239323 20 1427657634 0 Nurse Practitioners Fluoride varnish 20 1427657634 0 Nurse Practitioners Healthy Kids Services 20 1427657634 0 Nurse Practitioners Nurse Practitioners Services 20 1427657634 0 Nurse Practitioners Physician Services 00 1427658301 0 WHITE JULIA S 2021340 9999999 B 10 1427658301 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1427658301 0 Nurse Practitioners Anesthesia Services 20 1427658301 0 Nurse Practitioners Nurse Practitioners Services 20 1427658301 0 Nurse Practitioners Physician Services 00 1427660257 0 JOHNSON GINA M 2024176 9999999 B 10 1427660257 0 4698 DEPT CAROL STREAM IL 601220021 20 1427660257 0 Physicians Anesthesia Services 20 1427660257 0 Physicians Healthy Kids Services 20 1427660257 0 Physicians Optical Supplies 20 1427660257 0 Physicians Physician Services 00 1427660505 0 STROUP FONDA 2021313 9999999 H 10 1427660505 0 3511 HARBOR DR ROCK FALLS IL 61071 20 1427660505 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1427660869 0 ADAMS KAYLA R 2020307 9999999 H 10 1427660869 0 900 ROYAL HEIGHTS RD STE 1150 BELLEVILLE IL 622265457 20 1427660869 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1427661552 0 PRZYGODA GLORIA 2020287 9999999 B 10 1427661552 0 5383 STATE ROUTE 154 PINCKNEYVILLE IL 622743342 20 1427661552 0 Nurse Practitioners Fluoride varnish 20 1427661552 0 Nurse Practitioners Healthy Kids Services 20 1427661552 0 Nurse Practitioners Nurse Practitioners Services 20 1427661552 0 Nurse Practitioners Physician Services 00 1427662519 0 SEVGI MERT 2024048 9999999 B 10 1427662519 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1427662519 0 Physicians Anesthesia Services 20 1427662519 0 Physicians Fluoride varnish 20 1427662519 0 Physicians Healthy Kids Services 20 1427662519 0 Physicians Optical Supplies 20 1427662519 0 Physicians Physician Services 00 1427664812 0 DOUGHTY ALESANDRA 2020268 9999999 B 10 1427664812 0 422 N NORTHWEST HWY STE 210 PARK RIDGE IL 600683261 20 1427664812 0 Physical Therapists Medical Supplies 20 1427664812 0 Physical Therapists Medical equipment/prosthetic devices 20 1427664812 0 Physical Therapists Physical Therapy Services 00 1427666304 0 TAN MARION R 2023037 9999999 B 10 1427666304 0 3880 SALEM LAKE DR STE F LONG GROVE IL 600475292 20 1427666304 0 Nurse Practitioners Healthy Kids Services 20 1427666304 0 Nurse Practitioners Nurse Practitioners Services 20 1427666304 0 Nurse Practitioners Physician Services 00 1427668151 0 HOLMES DOMINIQUE 2022178 9999999 B 10 1427668151 0 684 S BARRINGTON RD STE 112 STREAMWOOD IL 601071841 20 1427668151 0 Nurse Practitioners Healthy Kids Services 20 1427668151 0 Nurse Practitioners Nurse Practitioners Services 20 1427668151 0 Nurse Practitioners Physician Services 00 1427672245 0 ISHAQ HASSAN 2023300 9999999 B 10 1427672245 0 PO BOX 708760 SANDY UT 840708760 20 1427672245 0 Physicians Anesthesia Services 20 1427672245 0 Physicians Fluoride varnish 20 1427672245 0 Physicians Healthy Kids Services 20 1427672245 0 Physicians Optical Supplies 20 1427672245 0 Physicians Physician Services 00 1427672732 0 BARBER COLLIN 2024078 9999999 B 10 1427672732 0 29373 NETWORK PL CHICAGO IL 606733039 20 1427672732 0 Physical Therapists Medical Supplies 20 1427672732 0 Physical Therapists Medical equipment/prosthetic devices 20 1427672732 0 Physical Therapists Physical Therapy Services 00 1427673029 0 SHAMSHUDDIN NABILA H 2021227 9999999 B 10 1427673029 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1427673029 0 Physicians Anesthesia Services 20 1427673029 0 Physicians Healthy Kids Services 20 1427673029 0 Physicians Optical Supplies 20 1427673029 0 Physicians Physician Services 00 1427673045 0 MORAN MARY 2024297 9999999 B 10 1427673045 0 PO BOX 352 MERCER ISLAND WA 980400352 20 1427673045 0 Clinical Social Worker Social work service 00 1427673219 0 BROWNING DAVID K 2024261 9999999 B 10 1427673219 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1427673219 0 Physician Assistant Only Fluoride varnish 20 1427673219 0 Physician Assistant Only Healthy Kids Services 20 1427673219 0 Physician Assistant Only Physician Services 00 1427673342 0 JACKOWICZ CHRISTA M 2021327 9999999 B 10 1427673342 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1427673342 0 Physician Assistant Only Fluoride varnish 20 1427673342 0 Physician Assistant Only Healthy Kids Services 20 1427673342 0 Physician Assistant Only Physician Services 00 1427673730 0 FREUND KRISTINA 2023296 9999999 B 10 1427673730 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1427673730 0 Physicians Anesthesia Services 20 1427673730 0 Physicians Fluoride varnish 20 1427673730 0 Physicians Healthy Kids Services 20 1427673730 0 Physicians Optical Supplies 20 1427673730 0 Physicians Physician Services 00 1427673821 0 HORN MILLICENT L 2023152 9999999 B 10 1427673821 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1427673821 0 Physicians Anesthesia Services 20 1427673821 0 Physicians Fluoride varnish 20 1427673821 0 Physicians Healthy Kids Services 20 1427673821 0 Physicians Optical Supplies 20 1427673821 0 Physicians Physician Services 00 1427674316 0 GIGUERE PATRICK T 2024274 9999999 B 10 1427674316 0 4698 DEPT CAROL STREAM IL 601220021 20 1427674316 0 Physicians Anesthesia Services 20 1427674316 0 Physicians Healthy Kids Services 20 1427674316 0 Physicians Optical Supplies 20 1427674316 0 Physicians Physician Services 00 1427675495 0 ALSAHOURY JERIES J 2020197 9999999 B 10 1427675495 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1427675495 0 Physicians Anesthesia Services 20 1427675495 0 Physicians Fluoride varnish 20 1427675495 0 Physicians Healthy Kids Services 20 1427675495 0 Physicians Optical Supplies 20 1427675495 0 Physicians Physician Services 00 1427675800 0 SMITH LAUREN E 2021333 9999999 B 10 1427675800 0 607 S NEW BALLAS RD STE 3300 SAINT LOUIS MO 631418219 20 1427675800 0 Nurse Practitioners Healthy Kids Services 20 1427675800 0 Nurse Practitioners Nurse Practitioners Services 20 1427675800 0 Nurse Practitioners Physician Services 00 1427676113 0 EDWARDS WALLIS O 2023156 9999999 B 10 1427676113 0 PO BOX 5009 BRENTWOOD TN 370245009 20 1427676113 0 Physicians Anesthesia Services 20 1427676113 0 Physicians Fluoride varnish 20 1427676113 0 Physicians Healthy Kids Services 20 1427676113 0 Physicians Optical Supplies 20 1427676113 0 Physicians Physician Services 00 1427676212 0 MOSHOGINIS JESSICA 2020238 9999999 B 10 1427676212 0 1640 N WELLS ST UNIT 103 CHICAGO IL 606146006 20 1427676212 0 Physical Therapists Medical Supplies 20 1427676212 0 Physical Therapists Medical equipment/prosthetic devices 20 1427676212 0 Physical Therapists Physical Therapy Services 00 1427676899 0 BLACKWELL BRITTNEY 2024290 9999999 B 10 1427676899 0 1039 BROOK FOREST AVE SHOREWOOD IL 604048849 20 1427676899 0 Nurse Practitioners Healthy Kids Services 20 1427676899 0 Nurse Practitioners Nurse Practitioners Services 20 1427676899 0 Nurse Practitioners Physician Services 00 1427678325 0 DREWRY DANIEL 2023193 9999999 B 10 1427678325 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1427678325 0 Physicians Anesthesia Services 20 1427678325 0 Physicians Healthy Kids Services 20 1427678325 0 Physicians Optical Supplies 20 1427678325 0 Physicians Physician Services 00 1427679851 0 BROWN ALEXANDRIA D 2023289 9999999 B 10 1427679851 0 515 VALLEY ST STE 203 MAPLEWOOD NJ 070404300 20 1427679851 0 Physician Assistant Only Fluoride varnish 20 1427679851 0 Physician Assistant Only Healthy Kids Services 20 1427679851 0 Physician Assistant Only Physician Services 00 1427680248 0 VAGADIA NEHA P 2021271 9999999 B 10 1427680248 0 1700 E HIGGINS RD STE 600 DES PLAINES IL 600185621 20 1427680248 0 Physician Assistant Only Fluoride varnish 20 1427680248 0 Physician Assistant Only Healthy Kids Services 20 1427680248 0 Physician Assistant Only Physician Services 00 1427680727 0 MITCHELL JOSHUA 2022279 9999999 B 10 1427680727 0 520 VALLEY VIEW DR MOLINE IL 612656152 20 1427680727 0 Physical Therapists Medical Supplies 20 1427680727 0 Physical Therapists Medical equipment/prosthetic devices 20 1427680727 0 Physical Therapists Physical Therapy Services 00 1427683903 0 HOFFMAN MADELINE 2020065 9999999 B 10 1427683903 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1427683903 0 Nurse Practitioners Healthy Kids Services 20 1427683903 0 Nurse Practitioners Nurse Practitioners Services 20 1427683903 0 Nurse Practitioners Physician Services 00 1427684281 0 SMRECZAK CHRISTOPHER 2020092 9999999 B 10 1427684281 0 1365 WILEY RD STE 153 SUITE 153 SCHAUMBURG IL 601734357 20 1427684281 0 Physician Assistant Only Fluoride varnish 20 1427684281 0 Physician Assistant Only Healthy Kids Services 20 1427684281 0 Physician Assistant Only Physician Services 00 1427684547 0 CARSON MICHAEL 2023220 9999999 B 10 1427684547 0 PO BOX 708760 SANDY UT 840708760 20 1427684547 0 Physicians Anesthesia Services 20 1427684547 0 Physicians Fluoride varnish 20 1427684547 0 Physicians Healthy Kids Services 20 1427684547 0 Physicians Optical Supplies 20 1427684547 0 Physicians Physician Services 00 1427684687 0 EGART JESSICA M 2020344 9999999 B 10 1427684687 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1427684687 0 Nurse Practitioners Fluoride varnish 20 1427684687 0 Nurse Practitioners Healthy Kids Services 20 1427684687 0 Nurse Practitioners Nurse Practitioners Services 20 1427684687 0 Nurse Practitioners Physician Services 00 1427684745 0 ZAPATA MELISSA E 2021128 9999999 B 10 1427684745 0 4440 W 95TH ST OAK LAWN IL 604532600 20 1427684745 0 Physicians Anesthesia Services 20 1427684745 0 Physicians Fluoride varnish 20 1427684745 0 Physicians Healthy Kids Services 20 1427684745 0 Physicians Optical Supplies 20 1427684745 0 Physicians Physician Services 00 1427685049 0 WATSON CHRISTOPHER 2021300 9999999 B 10 1427685049 0 5665 NEW NORTHSIDE DR ATLANTA GA 303285831 20 1427685049 0 Physician Assistant Only Fluoride varnish 20 1427685049 0 Physician Assistant Only Healthy Kids Services 20 1427685049 0 Physician Assistant Only Physician Services 00 1427685114 0 HUNTER TIMOTHY 2020234 9999999 B 10 1427685114 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1427685114 0 Physicians Anesthesia Services 20 1427685114 0 Physicians Healthy Kids Services 20 1427685114 0 Physicians Optical Supplies 20 1427685114 0 Physicians Physician Services 00 1427685510 0 KOCOJ DAVID 2021088 9999999 B 10 1427685510 0 2361 PAYSPHERE CIR CHICAGO IL 606740023 20 1427685510 0 Physicians Anesthesia Services 20 1427685510 0 Physicians Healthy Kids Services 20 1427685510 0 Physicians Optical Supplies 20 1427685510 0 Physicians Physician Services 00 1427685825 0 BHANSALI PAIGE 2024312 9999999 B 10 1427685825 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1427685825 0 Physicians Anesthesia Services 20 1427685825 0 Physicians Fluoride varnish 20 1427685825 0 Physicians Healthy Kids Services 20 1427685825 0 Physicians Optical Supplies 20 1427685825 0 Physicians Physician Services 00 1427686609 0 SEVENICH MARTHA 2024277 9999999 B 10 1427686609 0 4698 DEPT CAROL STREAM IL 601220021 20 1427686609 0 Physicians Anesthesia Services 20 1427686609 0 Physicians Healthy Kids Services 20 1427686609 0 Physicians Optical Supplies 20 1427686609 0 Physicians Physician Services 00 1427686963 0 BOETTGE KATHERINA 2020194 9999999 B 10 1427686963 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1427686963 0 Physicians Anesthesia Services 20 1427686963 0 Physicians Healthy Kids Services 20 1427686963 0 Physicians Optical Supplies 20 1427686963 0 Physicians Physician Services 00 1427687524 0 MARTINEZ PATRICIA J 2020115 9999999 B 10 1427687524 0 244 E ROOSEVELT RD LOMBARD IL 601484647 20 1427687524 0 Nurse Practitioners Fluoride varnish 20 1427687524 0 Nurse Practitioners Healthy Kids Services 20 1427687524 0 Nurse Practitioners Nurse Practitioners Services 20 1427687524 0 Nurse Practitioners Physician Services 00 1427687557 0 CANIFF ALISON 2023193 9999999 B 10 1427687557 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1427687557 0 Physicians Anesthesia Services 20 1427687557 0 Physicians Fluoride varnish 20 1427687557 0 Physicians Healthy Kids Services 20 1427687557 0 Physicians Optical Supplies 20 1427687557 0 Physicians Physician Services 00 1427687615 0 VEMULA SAI 2024240 9999999 B 10 1427687615 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1427687615 0 Physicians Anesthesia Services 20 1427687615 0 Physicians Healthy Kids Services 20 1427687615 0 Physicians Optical Supplies 20 1427687615 0 Physicians Physician Services 00 1427687755 0 MAGEN MOLLY V 2024243 9999999 B 10 1427687755 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1427687755 0 Physicians Anesthesia Services 20 1427687755 0 Physicians Fluoride varnish 20 1427687755 0 Physicians Healthy Kids Services 20 1427687755 0 Physicians Optical Supplies 20 1427687755 0 Physicians Physician Services 00 1427692771 0 HAIFA ATEF 2024193 9999999 B 10 1427692771 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1427692771 0 Physicians Anesthesia Services 20 1427692771 0 Physicians Healthy Kids Services 20 1427692771 0 Physicians Optical Supplies 20 1427692771 0 Physicians Physician Services 00 1427694124 0 KOSS ADAM 2020090 9999999 B 10 1427694124 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1427694124 0 Physician Assistant Only Fluoride varnish 20 1427694124 0 Physician Assistant Only Healthy Kids Services 20 1427694124 0 Physician Assistant Only Physician Services 00 1427694462 0 SCHULTZ TESSA 2020020 9999999 B 10 1427694462 0 5730 W ROOSEVELT RD BUSINESS OFFICE CHICAGO IL 606441580 20 1427694462 0 Nurse Practitioners Healthy Kids Services 20 1427694462 0 Nurse Practitioners Nurse Practitioners Services 20 1427694462 0 Nurse Practitioners Physician Services 00 1427696855 0 DIDIER ANNE 2019357 9999999 B 10 1427696855 0 5440 CORPORATE DR STE 400 TROY MI 480982645 20 1427696855 0 Nurse Practitioners Healthy Kids Services 20 1427696855 0 Nurse Practitioners Nurse Practitioners Services 20 1427696855 0 Nurse Practitioners Physician Services 00 1427700558 0 DOERR HANNA 2022195 9999999 B 10 1427700558 0 PO BOX 5081 JANESVILLE WI 535475081 20 1427700558 0 Physician Assistant Only Fluoride varnish 20 1427700558 0 Physician Assistant Only Healthy Kids Services 20 1427700558 0 Physician Assistant Only Physician Services 00 1427702018 0 FIELDS AMANDA R 2022073 9999999 B 10 1427702018 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1427702018 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1427703172 0 DERKS JESSICA L 2022090 9999999 B 10 1427703172 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1427703172 0 Nurse Practitioners Fluoride varnish 20 1427703172 0 Nurse Practitioners Healthy Kids Services 20 1427703172 0 Nurse Practitioners Nurse Practitioners Services 20 1427703172 0 Nurse Practitioners Physician Services 00 1427704063 0 JESKE MICHAEL J 2024136 9999999 B 10 1427704063 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1427704063 0 Clinical Social Worker Social work service 00 1427704329 0 LEWIS EMILY 2022062 9999999 B 10 1427704329 0 721 N LA SALLE DR CHICAGO IL 606543503 20 1427704329 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1427704386 0 HOOPER MADELINE J 2023184 9999999 B 10 1427704386 0 4698 DEPT CAROL STREAM IL 601220021 20 1427704386 0 Physicians Anesthesia Services 20 1427704386 0 Physicians Fluoride varnish 20 1427704386 0 Physicians Healthy Kids Services 20 1427704386 0 Physicians Optical Supplies 20 1427704386 0 Physicians Physician Services 00 1427704436 0 KORST CHLOE M 2022061 9999999 B 10 1427704436 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1427704436 0 Occupational Therapists Medical Supplies 20 1427704436 0 Occupational Therapists Medical equipment/prosthetic devices 20 1427704436 0 Occupational Therapists Occupational Therapy Services 00 1427707215 0 ZAHED TARA 2022174 9999999 B 10 1427707215 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1427707215 0 Physicians Anesthesia Services 20 1427707215 0 Physicians Healthy Kids Services 20 1427707215 0 Physicians Optical Supplies 20 1427707215 0 Physicians Physician Services 20 1427707215 0 Physicians Physicians Psychiatric Services 00 1427707223 0 PROSPERO FRANCESCA T 2022143 9999999 B 10 1427707223 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1427707223 0 Physicians Anesthesia Services 20 1427707223 0 Physicians Fluoride varnish 20 1427707223 0 Physicians Healthy Kids Services 20 1427707223 0 Physicians Optical Supplies 20 1427707223 0 Physicians Physician Services 00 1427707835 0 UPPUGUNDURI JITI M 2022199 9999999 B 10 1427707835 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1427707835 0 Physicians Anesthesia Services 20 1427707835 0 Physicians Fluoride varnish 20 1427707835 0 Physicians Healthy Kids Services 20 1427707835 0 Physicians Optical Supplies 20 1427707835 0 Physicians Physician Services 00 1427709112 0 BUTTON SHELBY MICHELLE 2022059 9999999 B 10 1427709112 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1427709112 0 Other behavior health professional Other Behavioral Health 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Assistant Only Fluoride varnish 20 1427784115 0 Physician Assistant Only Healthy Kids Services 20 1427784115 0 Physician Assistant Only Physician Services 00 1427786706 0 LOPEZ JULIO 2022319 9999999 B 10 1427786706 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1427786706 0 Clinical Social Worker Social work service 00 1427787456 0 KADARMANDALGI ANKITA 2022199 9999999 B 10 1427787456 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1427787456 0 Physicians Anesthesia Services 20 1427787456 0 Physicians Healthy Kids Services 20 1427787456 0 Physicians Optical Supplies 20 1427787456 0 Physicians Physician Services 00 1427789783 0 KISCELLUS MAYRA 2022262 9999999 B 10 1427789783 0 2201 MAIN ST EVANSTON IL 602021519 20 1427789783 0 Nurse Practitioners Fluoride varnish 20 1427789783 0 Nurse Practitioners Healthy Kids Services 20 1427789783 0 Nurse Practitioners Nurse Practitioners Services 20 1427789783 0 Nurse Practitioners Physician Services 00 1427789817 0 NARVAEZ JEMINA SAMANTHA 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SAINT LOUIS MO 631101003 20 1427792316 0 Physicians Anesthesia Services 20 1427792316 0 Physicians Fluoride varnish 20 1427792316 0 Physicians Healthy Kids Services 20 1427792316 0 Physicians Optical Supplies 20 1427792316 0 Physicians Physician Services 00 1427793710 0 MENDENHALL SETH 2022335 9999999 B 10 1427793710 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1427793710 0 Nurse Practitioners Healthy Kids Services 20 1427793710 0 Nurse Practitioners Nurse Practitioners Services 20 1427793710 0 Nurse Practitioners Physician Services 00 1427794080 0 CHEVERE SUZETTE 2022182 9999999 B 10 1427794080 0 7101 N CICERO AVE STE 202 LINCOLNWOOD IL 607122143 20 1427794080 0 Nurse Practitioners Fluoride varnish 20 1427794080 0 Nurse Practitioners Healthy Kids Services 20 1427794080 0 Nurse Practitioners Nurse Practitioners Services 20 1427794080 0 Nurse Practitioners Physician Services 00 1427794700 0 ROTH ROBERT K 2024200 9999999 B 10 1427794700 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1427794700 0 Physicians Anesthesia Services 20 1427794700 0 Physicians Healthy Kids Services 20 1427794700 0 Physicians Optical Supplies 20 1427794700 0 Physicians Physician Services 00 1427795194 0 PRITCHARD JENNIFER 2022137 9999999 B 10 1427795194 0 9855 W ROOSEVELT RD WESTCHESTER IL 601542758 20 1427795194 0 Clinical Social Worker Social work service 00 1427795228 0 FULLER ANNETTE M 2024288 9999999 B 10 1427795228 0 1004 PAWLAK PKWY NEW LENOX IL 604519401 20 1427795228 0 Nurse Practitioners Healthy Kids Services 20 1427795228 0 Nurse Practitioners Nurse Practitioners Services 20 1427795228 0 Nurse Practitioners Physician Services 00 1427795343 0 MARSEE JUSTIN 2024036 9999999 B 10 1427795343 0 742 MARBLE CT BOCA RATON FL 334323018 20 1427795343 0 Registered nurse Nursing service 20 1427795343 0 Registered nurse Waiver service 00 1427795376 0 MADAN KAJAL 2022201 9999999 B 10 1427795376 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1427795376 0 Physicians Anesthesia Services 20 1427795376 0 Physicians Fluoride varnish 20 1427795376 0 Physicians Healthy Kids Services 20 1427795376 0 Physicians Optical Supplies 20 1427795376 0 Physicians Physician Services 00 1427795574 0 DILLE ALLISON M 2022167 9999999 B 10 1427795574 0 70 S RIVER ST AURORA IL 605065185 20 1427795574 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1427796143 0 MARRERO-RIVERA LADISLAO 2024197 9999999 B 10 1427796143 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1427796143 0 Physicians Anesthesia Services 20 1427796143 0 Physicians Fluoride varnish 20 1427796143 0 Physicians Healthy Kids Services 20 1427796143 0 Physicians Optical Supplies 20 1427796143 0 Physicians Physician Services 00 1427797075 0 STAFFORD ANNE 2024326 9999999 B 10 1427797075 0 PO BOX 959794 SAINT LOUIS MO 631959794 20 1427797075 0 Nurse Practitioners Fluoride varnish 20 1427797075 0 Nurse Practitioners Healthy Kids Services 20 1427797075 0 Nurse Practitioners Nurse Practitioners Services 20 1427797075 0 Nurse Practitioners Physician Services 00 1427797356 0 GRAY BRADIE S 2022157 9999999 H 10 1427797356 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1427797356 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1427798370 0 PINARDO HEINRICH 2023363 9999999 B 10 1427798370 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1427798370 0 Physicians Anesthesia Services 20 1427798370 0 Physicians Healthy Kids Services 20 1427798370 0 Physicians Optical Supplies 20 1427798370 0 Physicians Physician Services 00 1427798396 0 SHAJU RAHUL 2022115 9999999 B 10 1427798396 0 PO BOX 3039 OAK BROOK IL 605223039 20 1427798396 0 Physicians Anesthesia Services 20 1427798396 0 Physicians Fluoride varnish 20 1427798396 0 Physicians Healthy Kids Services 20 1427798396 0 Physicians Optical Supplies 20 1427798396 0 Physicians Physician Services 00 1427798586 0 DAVIS BRIANA 2022363 9999999 B 10 1427798586 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1427798586 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1427798883 0 MADJER NIKOLINA A 2022176 9999999 B 10 1427798883 0 PO BOX 3039 OAK BROOK IL 605223039 20 1427798883 0 Physicians Anesthesia Services 20 1427798883 0 Physicians Fluoride varnish 20 1427798883 0 Physicians Healthy Kids Services 20 1427798883 0 Physicians Optical Supplies 20 1427798883 0 Physicians Physician Services 00 1427799501 0 TRUDEAU EMILY M 2023318 9999999 B 10 1427799501 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1427799501 0 Physicians Anesthesia Services 20 1427799501 0 Physicians Healthy Kids Services 20 1427799501 0 Physicians Optical Supplies 20 1427799501 0 Physicians Physician Services 00 1427801679 0 CHRISTENSEN MATHIAS A 2024250 9999999 B 10 1427801679 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1427801679 0 Physicians Anesthesia Services 20 1427801679 0 Physicians Healthy Kids Services 20 1427801679 0 Physicians Optical Supplies 20 1427801679 0 Physicians Physician Services 00 1427804277 0 STEPHENSON HALEY C 2024192 9999999 B 10 1427804277 0 PO BOX 3988 CARBONDALE IL 629023988 20 1427804277 0 Nurse Practitioners Healthy Kids Services 20 1427804277 0 Nurse Practitioners Nurse Practitioners Services 20 1427804277 0 Nurse Practitioners Physician Services 00 1427805258 0 SHOLL SPENCER P 2025003 9999999 B 10 1427805258 0 3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047452 20 1427805258 0 Physician Assistant Only Fluoride varnish 20 1427805258 0 Physician Assistant Only Healthy Kids Services 20 1427805258 0 Physician Assistant Only Physician Services 00 1427805647 0 DINOFFIA ALEXANDRIA 2024179 9999999 B 10 1427805647 0 PO BOX 1027 BEDFORD PARK IL 604991027 20 1427805647 0 Nurse Practitioners Fluoride varnish 20 1427805647 0 Nurse Practitioners Healthy Kids Services 20 1427805647 0 Nurse Practitioners Nurse Practitioners Services 20 1427805647 0 Nurse Practitioners Physician Services 00 1427805910 0 WANG AMY M 2024183 9999999 B 10 1427805910 0 2020 OGDEN AVE STE 360 SUITE 360 AURORA IL 605046486 20 1427805910 0 Physicians Anesthesia Services 20 1427805910 0 Physicians Fluoride varnish 20 1427805910 0 Physicians Healthy Kids Services 20 1427805910 0 Physicians Optical Supplies 20 1427805910 0 Physicians Physician Services 00 1427806140 0 WEBER HANNA 2024232 9999999 B 10 1427806140 0 5777 DEPT CAROL STREAM IL 601228942 20 1427806140 0 Nurse Practitioners Healthy Kids Services 20 1427806140 0 Nurse Practitioners Nurse Practitioners Services 20 1427806140 0 Nurse Practitioners Physician Services 00 1427806884 0 BALGEMANN MI 2024171 9999999 B 10 1427806884 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1427806884 0 Nurse Practitioners Anesthesia Services 20 1427806884 0 Nurse Practitioners Nurse Practitioners Services 20 1427806884 0 Nurse Practitioners Physician Services 00 1427808229 0 WHITE KAITLYN M 2024240 9999999 B 10 1427808229 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1427808229 0 Physical Therapists Medical Supplies 20 1427808229 0 Physical Therapists Medical equipment/prosthetic devices 20 1427808229 0 Physical Therapists Physical Therapy Services 00 1427808245 0 YONG ZACHARY 2024190 9999999 B 10 1427808245 0 PO BOX 3039 OAK BROOK IL 605223039 20 1427808245 0 Physicians Anesthesia Services 20 1427808245 0 Physicians Fluoride varnish 20 1427808245 0 Physicians Healthy Kids Services 20 1427808245 0 Physicians Optical Supplies 20 1427808245 0 Physicians Physician Services 00 1427808278 0 GOKHALE HANNAH M 2024175 2099365 B 10 1427808278 0 PO BOX 3039 OAK BROOK IL 605223039 20 1427808278 0 Physicians Anesthesia Services 20 1427808278 0 Physicians Healthy Kids Services 20 1427808278 0 Physicians Optical Supplies 20 1427808278 0 Physicians Physician Services 00 1427808492 0 GORDON NOAH B 2024182 9999999 B 10 1427808492 0 PO BOX 3039 OAK BROOK IL 605223039 20 1427808492 0 Physicians Anesthesia Services 20 1427808492 0 Physicians Fluoride varnish 20 1427808492 0 Physicians Healthy Kids Services 20 1427808492 0 Physicians Optical Supplies 20 1427808492 0 Physicians Physician Services 00 1427809045 0 WALTERS MALIK 2024241 9999999 B 10 1427809045 0 7732 SOLUTION CENTER CHICAGO IL 606777007 20 1427809045 0 Dentists Dental Services 20 1427809045 0 Dentists Physician Services 00 1427809862 0 LINDSTROM ANNE E 2024101 9999999 B 10 1427809862 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1427809862 0 Nurse Practitioners Healthy Kids Services 20 1427809862 0 Nurse Practitioners Midwife Services 20 1427809862 0 Nurse Practitioners Nurse Practitioners Services 20 1427809862 0 Nurse Practitioners Physician Services 00 1427810019 0 LAMB HANNAH 2024225 9999999 B 10 1427810019 0 151 N MAIN ST DECATUR IL 625231206 20 1427810019 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1427810472 0 REINIG HEATHER C 2024149 9999999 B 10 1427810472 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1427810472 0 Nurse Practitioners Anesthesia Services 20 1427810472 0 Nurse Practitioners Nurse Practitioners Services 20 1427810472 0 Nurse Practitioners Physician Services 00 1427812965 0 LIS CATHERINE L 2024080 9999999 B 10 1427812965 0 611 W PARK ST URBANA IL 618012529 20 1427812965 0 Physician Assistant Only Fluoride varnish 20 1427812965 0 Physician Assistant Only Healthy Kids Services 20 1427812965 0 Physician Assistant Only Physician Services 00 1427813799 0 RAMIREZ JUAN P 2024194 9999999 B 10 1427813799 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1427813799 0 Physicians Anesthesia Services 20 1427813799 0 Physicians Healthy Kids Services 20 1427813799 0 Physicians Optical Supplies 20 1427813799 0 Physicians Physician Services 00 1427816131 0 TABAKA COLLEEN M 2024150 9999999 B 10 1427816131 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1427816131 0 Nurse Practitioners Fluoride varnish 20 1427816131 0 Nurse Practitioners Healthy Kids Services 20 1427816131 0 Nurse Practitioners Nurse Practitioners Services 20 1427816131 0 Nurse Practitioners Physician Services 00 1427818574 0 MCDONALD NICOLAS 2024192 9999999 B 10 1427818574 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1427818574 0 Physicians Anesthesia Services 20 1427818574 0 Physicians Fluoride varnish 20 1427818574 0 Physicians Healthy Kids Services 20 1427818574 0 Physicians Optical Supplies 20 1427818574 0 Physicians Physician Services 00 1427819747 0 CATO KATHRYN 2024130 9999999 B 10 1427819747 0 PO BOX 775253 CHICAGO IL 606775253 20 1427819747 0 Nurse Practitioners Healthy Kids Services 20 1427819747 0 Nurse Practitioners Nurse Practitioners Services 20 1427819747 0 Nurse Practitioners Physician Services 00 1427820224 0 WATSON ALETHEA LOUISE 2023298 9999999 B 10 1427820224 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1427820224 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1427822147 0 PARK JUN HWAN 2023321 9999999 B 10 1427822147 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112386 20 1427822147 0 Dentists Dental Services 20 1427822147 0 Dentists Physician Services 00 1427822188 0 SKROBOT PEIGHTON 2024044 9999999 B 10 1427822188 0 25 N RIVER LN STE 2109 GENEVA IL 601342003 20 1427822188 0 Other behavior health professional Adaptive behavior support technician services 00 1427828524 0 MAGDALENO JOANNA 2024130 9999999 B 10 1427828524 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1427828524 0 Speech Therapists Medical Supplies 20 1427828524 0 Speech Therapists Medical equipment/prosthetic devices 20 1427828524 0 Speech Therapists Speech Therapy/Pathology Services 00 1427830884 0 CROZIER MICHAIAH 2023299 9999999 B 10 1427830884 0 611 W PARK ST BWPC URBANA IL 618012529 20 1427830884 0 Physical Therapists Medical Supplies 20 1427830884 0 Physical Therapists Medical equipment/prosthetic devices 20 1427830884 0 Physical Therapists Physical Therapy Services 00 1427831585 0 FULK EMILY 2023242 9999999 B 10 1427831585 0 6308 8TH AVE KENOSHA WI 531435031 20 1427831585 0 Physician Assistant Only Fluoride varnish 20 1427831585 0 Physician Assistant Only Healthy Kids Services 20 1427831585 0 Physician Assistant Only Physician Services 00 1427832062 0 FAZZIO ANN 2024109 9999999 B 10 1427832062 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1427832062 0 Nurse Practitioners Fluoride varnish 20 1427832062 0 Nurse Practitioners Healthy Kids Services 20 1427832062 0 Nurse Practitioners Nurse Practitioners Services 20 1427832062 0 Nurse Practitioners Physician Services 00 1427833003 0 WALDROP DEEDRIA 2023335 9999999 B 10 1427833003 0 3621 MARION LN LAS CRUCES NM 880127579 20 1427833003 0 Other behavior health professional Adaptive behavior support technician services 00 1427835230 0 REVIS MOLLY 2023312 9999999 B 10 1427835230 0 PO BOX 713388 CHICAGO IL 606771525 20 1427835230 0 Physician Assistant Only Fluoride varnish 20 1427835230 0 Physician Assistant Only Healthy Kids Services 20 1427835230 0 Physician Assistant Only Physician Services 00 1427838192 0 KOPF ERICA D 2024243 9999999 B 10 1427838192 0 5777 DEPT CAROL STREAM IL 601220021 20 1427838192 0 Nurse Practitioners Healthy Kids Services 20 1427838192 0 Nurse Practitioners Nurse Practitioners Services 20 1427838192 0 Nurse Practitioners Physician Services 00 1427861327 0 JIMENEZ PAOLO FRANCISCO 2025028 9999999 B 10 1427861327 0 2001 BUTTERFIELD RD STE 1600 DOWNERS GROVE IL 605151211 20 1427861327 0 Physical Therapists Medical Supplies 20 1427861327 0 Physical Therapists Medical equipment/prosthetic devices 20 1427861327 0 Physical Therapists Physical Therapy Services 00 1427861772 0 MARANGELLI NICOLAS 2025030 9999999 B 10 1427861772 0 120 S MARION ST OAK PARK IL 603022809 20 1427861772 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1427864818 0 HASSA MORGAN 2025056 9999999 B 10 1427864818 0 2901 FINLEY RD STE 102 DOWNERS GROVE IL 605151774 20 1427864818 0 Occupational Therapists Medical Supplies 20 1427864818 0 Occupational Therapists Medical equipment/prosthetic devices 20 1427864818 0 Occupational Therapists Occupational Therapy Services 00 1427868728 0 ALBATTIKHI ANAS BASSAM MOHD KH 2025048 9999999 B 10 1427868728 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1427868728 0 Physicians Anesthesia Services 20 1427868728 0 Physicians Healthy Kids Services 20 1427868728 0 Physicians Optical Supplies 20 1427868728 0 Physicians Physician Services 00 1427873009 0 ALOBAIDI SAMEER 2024331 9999999 B 10 1427873009 0 1235 N RAND RD ARLINGTON HEIGH IL 600044314 20 1427873009 0 Dentists Dental Services 20 1427873009 0 Dentists Physician Services 00 1427873462 0 FORREST MORGAN 2024330 9999999 B 10 1427873462 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1427873462 0 Nurse Practitioners Fluoride varnish 20 1427873462 0 Nurse Practitioners Healthy Kids Services 20 1427873462 0 Nurse Practitioners Nurse Practitioners Services 20 1427873462 0 Nurse Practitioners Physician Services 00 1427875426 0 PHELPS KIMBERLY 2024268 9999999 B 10 1427875426 0 6106 IVY DR LISLE IL 605323225 20 1427875426 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1427875921 0 BLATT SARAH R 2024288 9999999 B 10 1427875921 0 524 E SCHAUMBURG RD SCHAUMBURG IL 601943510 20 1427875921 0 Speech Therapists Medical Supplies 20 1427875921 0 Speech Therapists Medical equipment/prosthetic devices 20 1427875921 0 Speech Therapists Speech Therapy/Pathology Services 00 1427876192 0 STEPHENSON CAMRYN 2024302 9999999 B 10 1427876192 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1427876192 0 Physician Assistant Only Fluoride varnish 20 1427876192 0 Physician Assistant Only Healthy Kids Services 20 1427876192 0 Physician Assistant Only Physician Services 00 1427881739 0 KERST RHYLEE 2024264 9999999 B 10 1427881739 0 611 W PARK ST BWPC URBANA IL 618012529 20 1427881739 0 Physical Therapists Medical Supplies 20 1427881739 0 Physical Therapists Medical equipment/prosthetic devices 20 1427881739 0 Physical Therapists Physical Therapy Services 00 1427882273 0 VERNIER KAITLIN E 2024252 9999999 B 10 1427882273 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1427882273 0 Nurse Practitioners Fluoride varnish 20 1427882273 0 Nurse Practitioners Healthy Kids Services 20 1427882273 0 Nurse Practitioners Nurse Practitioners Services 20 1427882273 0 Nurse Practitioners Physician Services 00 1427882570 0 KAHLFELDT JESSICA L 2024285 9999999 B 10 1427882570 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1427882570 0 Nurse Practitioners Healthy Kids Services 20 1427882570 0 Nurse Practitioners Nurse Practitioners Services 20 1427882570 0 Nurse Practitioners Physician Services 00 1427882943 0 ALEXANDER KYLE 2024257 9999999 B 10 1427882943 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1427882943 0 Nurse Practitioners Fluoride varnish 20 1427882943 0 Nurse Practitioners Healthy Kids Services 20 1427882943 0 Nurse Practitioners Nurse Practitioners Services 20 1427882943 0 Nurse Practitioners Physician Services 00 1427885961 0 SAJEEV ANN 2025014 9999999 B 10 1427885961 0 10209 W LINCOLN HWY FRANKFORT IL 604231279 20 1427885961 0 Nurse Practitioners Healthy Kids Services 20 1427885961 0 Nurse Practitioners Nurse Practitioners Services 20 1427885961 0 Nurse Practitioners Physician Services 00 1427888361 0 ROWE KATHERINE M 2024254 9999999 B 10 1427888361 0 5758 ELAINE DR STE 206 ROCKFORD IL 611083102 20 1427888361 0 Clinical Social Worker Social work service 00 1427889856 0 SUVAGIA MIRA 2024341 9999999 B 10 1427889856 0 1010 S ARLINGTON HEIGHTS RD ARLINGTON HEIGH IL 600053168 20 1427889856 0 Dentists Dental Services 20 1427889856 0 Dentists Physician Services 00 1427890110 0 TUCKER MATTHEW K 2024172 9999999 B 10 1427890110 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1427890110 0 Physical Therapists Medical Supplies 20 1427890110 0 Physical Therapists Medical equipment/prosthetic devices 20 1427890110 0 Physical Therapists Physical Therapy Services 00 1427890342 0 RINK DEREK R 2024200 9999999 B 10 1427890342 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1427890342 0 Physicians Anesthesia Services 20 1427890342 0 Physicians Healthy Kids Services 20 1427890342 0 Physicians Optical Supplies 20 1427890342 0 Physicians Physician Services 00 1427890441 0 NADEEM HIBA 2024192 9999999 B 10 1427890441 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1427890441 0 Physicians Anesthesia Services 20 1427890441 0 Physicians Healthy Kids Services 20 1427890441 0 Physicians Optical Supplies 20 1427890441 0 Physicians Physician Services 00 1427893346 0 SAAB ANGELA A 2024256 9999999 B 10 1427893346 0 PO BOX 855671 MINNEAPOLIS MN 554851153 20 1427893346 0 Physicians Anesthesia Services 20 1427893346 0 Physicians Fluoride varnish 20 1427893346 0 Physicians Healthy Kids Services 20 1427893346 0 Physicians Optical Supplies 20 1427893346 0 Physicians Physician Services 00 1427893833 0 HERNANDEZ FERNANDO 2024205 9999999 B 10 1427893833 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1427893833 0 Physicians Anesthesia Services 20 1427893833 0 Physicians Fluoride varnish 20 1427893833 0 Physicians Healthy Kids Services 20 1427893833 0 Physicians Optical Supplies 20 1427893833 0 Physicians Physician Services 00 1427894757 0 DIAZ YVONNE 2024187 9999999 B 10 1427894757 0 2038 221ST ST SAUK VILLAGE IL 604115064 20 1427894757 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1427898642 0 KROEGER JAZZ 2024193 9999999 B 10 1427898642 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1427898642 0 Physicians Anesthesia Services 20 1427898642 0 Physicians Healthy Kids Services 20 1427898642 0 Physicians Optical Supplies 20 1427898642 0 Physicians Physician Services 00 1427898964 0 RICKETTS RAMON 2024193 9999999 B 10 1427898964 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1427898964 0 Physicians Anesthesia Services 20 1427898964 0 Physicians Fluoride varnish 20 1427898964 0 Physicians Healthy Kids Services 20 1427898964 0 Physicians Optical Supplies 20 1427898964 0 Physicians Physician Services 00 1427899228 0 BLEVINS VICTORIA 2024159 9999999 B 10 1427899228 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1427899228 0 Physical Therapists Medical Supplies 20 1427899228 0 Physical Therapists Medical equipment/prosthetic devices 20 1427899228 0 Physical Therapists Physical Therapy Services 00 1437100815 0 MONG DAVID A 2005182 9999999 B 10 1437100815 0 PO BOX 110429 AURORA CO 800420429 20 1437100815 0 Physicians Anesthesia Services 20 1437100815 0 Physicians Healthy Kids Services 20 1437100815 0 Physicians Optical Supplies 20 1437100815 0 Physicians Physician Services 00 1437100856 0 MILORO MICHAEL 2003305 9999999 B 10 1437100856 0 7732 SOLUTION CENTER CHICAGO IL 606777007 20 1437100856 0 Dentists Anesthesia Services 20 1437100856 0 Dentists Dental Services 20 1437100856 0 Dentists Physician Services 00 1437101094 0 GILL KULJEET 2007213 9999999 B 10 1437101094 0 5777 DEPT CAROL STREAM IL 601228942 20 1437101094 0 Physicians Anesthesia Services 20 1437101094 0 Physicians Healthy Kids Services 20 1437101094 0 Physicians Optical Supplies 20 1437101094 0 Physicians Physician Services 20 1437101094 0 Physicians Physicians Psychiatric Services 00 1437101128 0 HENDRIX CHARLES 1984025 9999999 B 10 1437101128 0 PO BOX 708760 SANDY UT 840708760 20 1437101128 0 Physicians Anesthesia Services 20 1437101128 0 Physicians Fluoride varnish 20 1437101128 0 Physicians Healthy Kids Services 20 1437101128 0 Physicians Optical Supplies 20 1437101128 0 Physicians Physician Services 00 1437101409 0 SHASTRI PRIYA M 2006152 9999999 B 10 1437101409 0 17901 GOVERNORS HWY STE 100 HOMEWOOD IL 604301145 20 1437101409 0 Physicians Anesthesia Services 20 1437101409 0 Physicians Fluoride varnish 20 1437101409 0 Physicians Healthy Kids Services 20 1437101409 0 Physicians Optical Supplies 20 1437101409 0 Physicians Physician Services 00 1437101615 0 MCGRAW MARTHA 2008245 9999999 B 10 1437101615 0 5777 DEPT CAROL STREAM IL 601220021 20 1437101615 0 Physicians Anesthesia Services 20 1437101615 0 Physicians Healthy Kids Services 20 1437101615 0 Physicians Optical Supplies 20 1437101615 0 Physicians Physician Services 20 1437101615 0 Physicians Physicians Psychiatric Services 00 1437101714 0 LEVY DAVID 1990182 9999999 B 10 1437101714 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1437101714 0 Physicians Anesthesia Services 20 1437101714 0 Physicians Fluoride varnish 20 1437101714 0 Physicians Healthy Kids Services 20 1437101714 0 Physicians Optical Supplies 20 1437101714 0 Physicians Physician Services 00 1437102175 0 RILLING WILLIAM 1997001 9999999 B 10 1437102175 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1437102175 0 Physicians Anesthesia Services 20 1437102175 0 Physicians Healthy Kids Services 20 1437102175 0 Physicians Optical Supplies 20 1437102175 0 Physicians Physician Services 00 1437102886 0 GLAVIN MICHAEL J. 1984237 9999999 B 10 1437102886 0 426 SHERWOOD RD LA GRANGE PARK IL 605261968 20 1437102886 0 Physicians Anesthesia Services 20 1437102886 0 Physicians Healthy Kids Services 20 1437102886 0 Physicians Optical Supplies 20 1437102886 0 Physicians Physician Services 00 1437103280 0 SOBEL DORE H 1995213 9999999 B 10 1437103280 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1437103280 0 Physicians Anesthesia Services 20 1437103280 0 Physicians Fluoride varnish 20 1437103280 0 Physicians Healthy Kids Services 20 1437103280 0 Physicians Optical Supplies 20 1437103280 0 Physicians Physician Services 00 1437103314 0 JAIN RAJEEV K 2007213 9999999 B 10 1437103314 0 403 E 1ST ST DIXON IL 610213116 20 1437103314 0 Physicians Anesthesia Services 20 1437103314 0 Physicians Healthy Kids Services 20 1437103314 0 Physicians Optical Supplies 20 1437103314 0 Physicians Physician Services 00 1437103348 0 VAN WHY SCOTT 2001001 9999999 B 10 1437103348 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1437103348 0 Physicians Anesthesia Services 20 1437103348 0 Physicians Fluoride varnish 20 1437103348 0 Physicians Healthy Kids Services 20 1437103348 0 Physicians Optical Supplies 20 1437103348 0 Physicians Physician Services 00 1437103736 0 RICKERL SAMUEL J 1996197 9999999 B 10 1437103736 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1437103736 0 Physicians Anesthesia Services 20 1437103736 0 Physicians Healthy Kids Services 20 1437103736 0 Physicians Optical Supplies 20 1437103736 0 Physicians Physician Services 00 1437104528 0 JOSHI SUREKHA 1984207 9999999 B 10 1437104528 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1437104528 0 Physicians Anesthesia Services 20 1437104528 0 Physicians Healthy Kids Services 20 1437104528 0 Physicians Optical Supplies 20 1437104528 0 Physicians Physician Services 00 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1437176443 0 Physician Assistant Only Fluoride varnish 20 1437176443 0 Physician Assistant Only Healthy Kids Services 20 1437176443 0 Physician Assistant Only Physician Services 00 1437176997 0 DUNCAN JAMES 2002182 9999999 B 10 1437176997 0 510 S KINGSHIGHWAY BLVD SAINT LOUIS MO 631101016 20 1437176997 0 Physicians Anesthesia Services 20 1437176997 0 Physicians Healthy Kids Services 20 1437176997 0 Physicians Optical Supplies 20 1437176997 0 Physicians Physician Services 00 1437177078 0 MATHUR AMIT 1998188 9999999 B 10 1437177078 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1437177078 0 Physicians Anesthesia Services 20 1437177078 0 Physicians Fluoride varnish 20 1437177078 0 Physicians Healthy Kids Services 20 1437177078 0 Physicians Optical Supplies 20 1437177078 0 Physicians Physician Services 00 1437177953 0 ESKER DEBORAH A 2016307 9999999 B 10 1437177953 0 300 WINDING WOODS DR STE 200 O FALLON MO 633665081 20 1437177953 0 Nurse Practitioners Healthy Kids Services 20 1437177953 0 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631600352 20 1437184819 0 Physicians Anesthesia Services 20 1437184819 0 Physicians Fluoride varnish 20 1437184819 0 Physicians Healthy Kids Services 20 1437184819 0 Physicians Optical Supplies 20 1437184819 0 Physicians Physician Services 00 1437185253 0 KUEKER JULIE 2007251 9999999 B 10 1437185253 0 435 S BUCHANAN ST STE B EDWARDSVILLE IL 620252091 20 1437185253 0 Optometrists Optical Supplies 20 1437185253 0 Optometrists Optometric Services 20 1437185253 0 Optometrists Physician Services 00 1437185360 0 CERONE DAVID 2023240 9999999 B 10 1437185360 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1437185360 0 Physicians Anesthesia Services 20 1437185360 0 Physicians Healthy Kids Services 20 1437185360 0 Physicians Optical Supplies 20 1437185360 0 Physicians Physician Services 00 1437186095 0 VARGAS SERGIO 2011213 9999999 B 10 1437186095 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1437186095 0 Physicians Anesthesia Services 20 1437186095 0 Physicians Electronic Home Response/EHR 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843033 KANSAS CITY MO 641843033 20 1437262540 0 Physicians Anesthesia Services 20 1437262540 0 Physicians Healthy Kids Services 20 1437262540 0 Physicians Optical Supplies 20 1437262540 0 Physicians Physician Services 00 1437262557 0 CAMPAGNA DANIEL P 2001032 9999999 B 10 1437262557 0 5777 DEPT CAROL STREAM IL 601220021 20 1437262557 0 Physicians Anesthesia Services 20 1437262557 0 Physicians Healthy Kids Services 20 1437262557 0 Physicians Optical Supplies 20 1437262557 0 Physicians Physician Services 00 1437262631 0 MUTHEKEPALLI SUDHA 2002246 9999999 B 10 1437262631 0 611 W PARK ST URBANA IL 618012529 20 1437262631 0 Physicians Anesthesia Services 20 1437262631 0 Physicians Fluoride varnish 20 1437262631 0 Physicians Healthy Kids Services 20 1437262631 0 Physicians Optical Supplies 20 1437262631 0 Physicians Physician Services 00 1437263076 0 WYGODNY JEFFREY 1996001 9999999 B 10 1437263076 0 18221 TORRENCE AVE STE 1B LANSING IL 604382870 20 1437263076 0 Physicians Anesthesia Services 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1437304722 0 Physicians Anesthesia Services 20 1437304722 0 Physicians Healthy Kids Services 20 1437304722 0 Physicians Optical Supplies 20 1437304722 0 Physicians Physician Services 00 1437304888 0 YOUSSEF NANCY 2016246 9999999 B 10 1437304888 0 9830 RIDGELAND AVE STE 9A CHICAGO RIDGE IL 604152668 20 1437304888 0 Physicians Anesthesia Services 20 1437304888 0 Physicians Fluoride varnish 20 1437304888 0 Physicians Healthy Kids Services 20 1437304888 0 Physicians Optical Supplies 20 1437304888 0 Physicians Physician Services 00 1437304904 0 THORNTON JOHN B 2020201 9999999 B 10 1437304904 0 988102 NEBRASKA MEDICAL CTR OMAHA NE 681988102 20 1437304904 0 Nurse Practitioners Fluoride varnish 20 1437304904 0 Nurse Practitioners Healthy Kids Services 20 1437304904 0 Nurse Practitioners Nurse Practitioners Services 20 1437304904 0 Nurse Practitioners Physician Services 00 1437305190 0 CARPENTER KRISTOPHER K 2010182 9999999 B 10 1437305190 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 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1437308194 0 Physicians Anesthesia Services 20 1437308194 0 Physicians Fluoride varnish 20 1437308194 0 Physicians Healthy Kids Services 20 1437308194 0 Physicians Optical Supplies 20 1437308194 0 Physicians Physician Services 00 1437308707 0 MCELDERRY JOSHUA 2021089 9999999 B 10 1437308707 0 PO BOX 43230 PHOENIX AZ 850803230 20 1437308707 0 Physicians Anesthesia Services 20 1437308707 0 Physicians Healthy Kids Services 20 1437308707 0 Physicians Optical Supplies 20 1437308707 0 Physicians Physician Services 00 1437309234 0 CHARLES BERNARD R 2009187 9999999 B 10 1437309234 0 PO BOX 53 WHEATON IL 601870053 20 1437309234 0 Physicians Anesthesia Services 20 1437309234 0 Physicians Healthy Kids Services 20 1437309234 0 Physicians Optical Supplies 20 1437309234 0 Physicians Physician Services 00 1437310034 0 WANTUCH ELIZABETH 2010182 9999999 B 10 1437310034 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1437310034 0 Physicians Anesthesia Services 20 1437310034 0 Physicians 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10 1437416518 0 PO BOX 301208 DALLAS TX 753031208 20 1437416518 0 Physicians Anesthesia Services 20 1437416518 0 Physicians Healthy Kids Services 20 1437416518 0 Physicians Optical Supplies 20 1437416518 0 Physicians Physician Services 00 1437417623 0 RIOS ELIZABETH 2012122 9999999 B 10 1437417623 0 205 W RANDOLPH ST STE 2222 CHICAGO IL 606061814 20 1437417623 0 Nurse Practitioners Healthy Kids Services 20 1437417623 0 Nurse Practitioners Nurse Practitioners Services 20 1437417623 0 Nurse Practitioners Physician Services 00 1437418050 0 DEVINE CONOR M 2021097 9999999 B 10 1437418050 0 3401 CIVIC CENTER BLVD PHILADELPHIA PA 191044319 20 1437418050 0 Physicians Anesthesia Services 20 1437418050 0 Physicians Healthy Kids Services 20 1437418050 0 Physicians Optical Supplies 20 1437418050 0 Physicians Physician Services 00 1437419058 0 SILVERMAN DANIEL 2015230 9999999 B 10 1437419058 0 5777 DEPT CAROL STREAM IL 601220021 20 1437419058 0 Physicians Anesthesia Services 20 1437419058 0 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SUMMIT MO 640642323 20 1437420072 0 Physicians Anesthesia Services 20 1437420072 0 Physicians Fluoride varnish 20 1437420072 0 Physicians Healthy Kids Services 20 1437420072 0 Physicians Optical Supplies 20 1437420072 0 Physicians Physician Services 00 1437420916 0 HENDRIX ANNA 2016244 9999999 B 10 1437420916 0 325 IL ROUTE 2 DIXON IL 610219118 20 1437420916 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1437421047 0 STOUT SABRINA 2012052 9999999 B 10 1437421047 0 PO BOX 429 MC LEANSBORO IL 628590429 20 1437421047 0 Nurse Practitioners Fluoride varnish 20 1437421047 0 Nurse Practitioners Healthy Kids Services 20 1437421047 0 Nurse Practitioners Nurse Practitioners Services 20 1437421047 0 Nurse Practitioners Physician Services 00 1437422136 0 MUHAMMAD NINA A 2012159 9999999 B 10 1437422136 0 8100 W 119TH ST PALOS PARK IL 604643041 20 1437422136 0 Physicians Anesthesia Services 20 1437422136 0 Physicians Fluoride varnish 20 1437422136 0 Physicians Healthy Kids Services 20 1437422136 0 Physicians Optical Supplies 20 1437422136 0 Physicians Physician Services 00 1437422300 0 GUSTIN LESLIE 2016063 9999999 B 10 1437422300 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1437422300 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1437422375 0 WALLECK JULIE 2015350 9999999 B 10 1437422375 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1437422375 0 Registered nurse Nursing service 20 1437422375 0 Registered nurse Waiver service 00 1437422920 0 DREW JOSEPH M 2023361 9999999 B 10 1437422920 0 710 N 8TH ST SPRINGFIELD IL 627026324 20 1437422920 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1437423480 0 KOHUT TONYA C 2019275 9999999 B 10 1437423480 0 242 S ORCHARD DR PARK FOREST IL 604662041 20 1437423480 0 Speech Therapists Medical Supplies 20 1437423480 0 Speech Therapists Medical equipment/prosthetic devices 20 1437423480 0 Speech Therapists Speech Therapy/Pathology Services 00 1437423613 0 TRICKEY BROOKE Y 2017200 9999999 B 10 1437423613 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1437423613 0 Nurse Practitioners Fluoride varnish 20 1437423613 0 Nurse Practitioners Healthy Kids Services 20 1437423613 0 Nurse Practitioners Nurse Practitioners Services 20 1437423613 0 Nurse Practitioners Physician Services 00 1437423662 0 STORM AMY C 2012142 9999999 H 10 1437423662 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1437423662 0 Clinical Social Worker Social work service 00 1437424462 0 MUSSMAN LISA J 2015341 9999999 B 10 1437424462 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1437424462 0 Physicians Anesthesia Services 20 1437424462 0 Physicians Healthy Kids Services 20 1437424462 0 Physicians Optical Supplies 20 1437424462 0 Physicians Physician Services 00 1437424835 0 MEDURI VENKATA 2012183 9999999 B 10 1437424835 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1437424835 0 Physicians Anesthesia Services 20 1437424835 0 Physicians Healthy Kids Services 20 1437424835 0 Physicians Optical Supplies 20 1437424835 0 Physicians Physician Services 00 1437425436 0 LEOPOLD SCOTT M 2022203 2025181 B 10 1437425436 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1437425436 0 Physicians Anesthesia Services 20 1437425436 0 Physicians Fluoride varnish 20 1437425436 0 Physicians Healthy Kids Services 20 1437425436 0 Physicians Optical Supplies 20 1437425436 0 Physicians Physician Services 00 1437425675 0 QUASEM OSAMA K 2015215 9999999 B 10 1437425675 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1437425675 0 Physicians Anesthesia Services 20 1437425675 0 Physicians Fluoride varnish 20 1437425675 0 Physicians Healthy Kids Services 20 1437425675 0 Physicians Optical Supplies 20 1437425675 0 Physicians Physician Services 00 1437425857 0 ASIF ASMA 2018233 9999999 B 10 1437425857 0 29373 NETWORK PL CHICAGO IL 606733039 20 1437425857 0 Physicians Anesthesia Services 20 1437425857 0 Physicians Healthy Kids Services 20 1437425857 0 Physicians Optical Supplies 20 1437425857 0 Physicians Physician Services 00 1437426046 0 DEJULIA LAURA N 2015060 9999999 B 10 1437426046 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1437426046 0 Audiologists Audiology Services 20 1437426046 0 Audiologists Medical Supplies 20 1437426046 0 Audiologists Medical equipment/prosthetic devices 00 1437427317 0 GOLDENSTEIN RYAN 2020205 9999999 B 10 1437427317 0 7272 WURZBACH RD STE 601 SAN ANTONIO TX 782404803 20 1437427317 0 Psychologist Psychologist service 00 1437428786 0 STOLSPART MARK 2015253 9999999 B 10 1437428786 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1437428786 0 Nurse Practitioners All Kids application agent 20 1437428786 0 Nurse Practitioners Fluoride varnish 20 1437428786 0 Nurse Practitioners Healthy Kids Services 20 1437428786 0 Nurse Practitioners Nurse Practitioners Services 20 1437428786 0 Nurse Practitioners Physician Services 00 1437430030 0 FEE KATHERINE 2011292 9999999 B 10 1437430030 0 44 N VIRGINIA ST STE 3B CRYSTAL LAKE IL 600144154 20 1437430030 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1437431368 0 GARWOOD AMBER 2011262 9999999 B 10 1437431368 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1437431368 0 Nurse Practitioners Fluoride varnish 20 1437431368 0 Nurse Practitioners Healthy Kids Services 20 1437431368 0 Nurse Practitioners Nurse Practitioners Services 20 1437431368 0 Nurse Practitioners Physician Services 00 1437434289 0 LUECKE JAMIE 2011290 9999999 B 10 1437434289 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1437434289 0 Nurse Practitioners Healthy Kids Services 20 1437434289 0 Nurse Practitioners Nurse Practitioners Services 20 1437434289 0 Nurse Practitioners Physician Services 00 1437434693 0 AGUILA JENNIFER 2021362 9999999 B 10 1437434693 0 PO BOX 15490 SCOTTSDALE AZ 852675490 20 1437434693 0 Nurse Practitioners Fluoride varnish 20 1437434693 0 Nurse Practitioners Healthy Kids Services 20 1437434693 0 Nurse Practitioners Nurse Practitioners Services 20 1437434693 0 Nurse Practitioners Physician Services 00 1437434982 0 CARR ABBI D 2016001 9999999 B 10 1437434982 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1437434982 0 Nurse Practitioners Fluoride varnish 20 1437434982 0 Nurse Practitioners Healthy Kids Services 20 1437434982 0 Nurse Practitioners Nurse Practitioners Services 20 1437434982 0 Nurse Practitioners Physician Services 00 1437435997 0 MAY CARRIE 2016256 9999999 B 10 1437435997 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1437435997 0 Nurse Practitioners Healthy Kids Services 20 1437435997 0 Nurse Practitioners Nurse Practitioners Services 20 1437435997 0 Nurse Practitioners Physician Services 00 1437437449 0 HADDAD MAJD 2022335 9999999 B 10 1437437449 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1437437449 0 Dentists Dental Services 20 1437437449 0 Dentists Physician Services 00 1437438249 0 AEDMA KAPIL K 2019182 9999999 B 10 1437438249 0 221 NE GLEN OAK AVE PEORIA IL 616360002 20 1437438249 0 Physicians Anesthesia Services 20 1437438249 0 Physicians Healthy Kids Services 20 1437438249 0 Physicians Optical Supplies 20 1437438249 0 Physicians Physician Services 20 1437438249 0 Physicians Physicians Psychiatric Services 00 1437438280 0 LAMB DANIEL P 2021270 9999999 B 10 1437438280 0 268 W HOSPITALITY LN STE 300 SAN BERNARDINO CA 924083234 20 1437438280 0 Physicians Anesthesia Services 20 1437438280 0 Physicians Fluoride varnish 20 1437438280 0 Physicians Healthy Kids Services 20 1437438280 0 Physicians Optical Supplies 20 1437438280 0 Physicians Physician Services 00 1437438660 0 BAVANI NAZLI 2014182 9999999 B 10 1437438660 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1437438660 0 Physicians Anesthesia Services 20 1437438660 0 Physicians Fluoride varnish 20 1437438660 0 Physicians Healthy Kids Services 20 1437438660 0 Physicians Optical Supplies 20 1437438660 0 Physicians Physician Services 00 1437439973 0 GOROKHOVSKY JOCELYN 2023135 9999999 B 10 1437439973 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1437439973 0 Clinical Social Worker Social work service 00 1437440609 0 WRIGHT BECKER CAROL LEA 2021228 9999999 B 10 1437440609 0 PO BOX 1649 CHEYENNE WY 820031649 20 1437440609 0 Physicians Anesthesia Services 20 1437440609 0 Physicians Fluoride varnish 20 1437440609 0 Physicians Healthy Kids Services 20 1437440609 0 Physicians Optical Supplies 20 1437440609 0 Physicians Physician Services 00 1437440633 0 CAMACHO-SOTO ALEJANDRA 2015251 9999999 B 10 1437440633 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1437440633 0 Physicians Anesthesia Services 20 1437440633 0 Physicians Healthy Kids Services 20 1437440633 0 Physicians Optical Supplies 20 1437440633 0 Physicians Physician Services 00 1437441672 0 AVVARI SUNIL 2016257 9999999 B 10 1437441672 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1437441672 0 Physicians Anesthesia Services 20 1437441672 0 Physicians Fluoride varnish 20 1437441672 0 Physicians Healthy Kids Services 20 1437441672 0 Physicians Optical Supplies 20 1437441672 0 Physicians Physician Services 00 1437443629 0 PATEL AMISHA 2024194 9999999 B 10 1437443629 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1437443629 0 Physicians Anesthesia Services 20 1437443629 0 Physicians Healthy Kids Services 20 1437443629 0 Physicians Optical Supplies 20 1437443629 0 Physicians Physician Services 20 1437443629 0 Physicians Physicians Psychiatric Services 00 1437443637 0 MOHAMED AMBREEN J 2024303 9999999 B 10 1437443637 0 16220 N SCOTTSDALE RD STE 600 SCOTTSDALE AZ 852541804 20 1437443637 0 Physicians Anesthesia Services 20 1437443637 0 Physicians Healthy Kids Services 20 1437443637 0 Physicians Optical Supplies 20 1437443637 0 Physicians Physician Services 00 1437443777 0 LAU VIVIAN 2014060 9999999 B 10 1437443777 0 530 NE GLEN OAK AVE PEORIA IL 616370001 20 1437443777 0 Physicians Anesthesia Services 20 1437443777 0 Physicians Healthy Kids Services 20 1437443777 0 Physicians Optical Supplies 20 1437443777 0 Physicians Physician Services 00 1437443884 0 CONWAY JASON A 2016139 9999999 B 10 1437443884 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1437443884 0 Physicians Anesthesia Services 20 1437443884 0 Physicians Healthy Kids Services 20 1437443884 0 Physicians Optical Supplies 20 1437443884 0 Physicians Physician Services 00 1437444163 0 SHAW EVERETT L 2017118 9999999 B 10 1437444163 0 2300 N EDWARD ST DECATUR IL 625264163 20 1437444163 0 Physician Assistant Only Fluoride varnish 20 1437444163 0 Physician Assistant Only Healthy Kids Services 20 1437444163 0 Physician Assistant Only Physician Services 00 1437445087 0 PARISER JOSEPH J 2018249 9999999 B 10 1437445087 0 200 UNIVERSITY AVE E SAINT PAUL MN 551012507 20 1437445087 0 Physicians Anesthesia Services 20 1437445087 0 Physicians Healthy Kids Services 20 1437445087 0 Physicians Optical Supplies 20 1437445087 0 Physicians Physician Services 00 1437445202 0 KHAN TAARIQ 2014213 9999999 B 10 1437445202 0 124 SW ADAMS ST FL 2 PEORIA IL 616021308 20 1437445202 0 Physicians Anesthesia Services 20 1437445202 0 Physicians Fluoride varnish 20 1437445202 0 Physicians Healthy Kids Services 20 1437445202 0 Physicians Optical Supplies 20 1437445202 0 Physicians Physician Services 00 1437445277 0 PATEL AJANTA 2017263 9999999 B 10 1437445277 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1437445277 0 Physicians Anesthesia Services 20 1437445277 0 Physicians Fluoride varnish 20 1437445277 0 Physicians Healthy Kids Services 20 1437445277 0 Physicians Optical Supplies 20 1437445277 0 Physicians Physician Services 00 1437445467 0 BUTOS JOHN 2014182 9999999 B 10 1437445467 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1437445467 0 Physicians Anesthesia Services 20 1437445467 0 Physicians Fluoride varnish 20 1437445467 0 Physicians Healthy Kids Services 20 1437445467 0 Physicians Optical Supplies 20 1437445467 0 Physicians Physician Services 00 1437446234 0 DEPALMA DOMINIKA V 2024313 9999999 B 10 1437446234 0 515 VALLEY ST STE 203 MAPLEWOOD NJ 070404300 20 1437446234 0 Physician Assistant Only Fluoride varnish 20 1437446234 0 Physician Assistant Only Healthy Kids Services 20 1437446234 0 Physician Assistant Only Physician Services 00 1437446333 0 BHAKHRI RAMAN 2011182 9999999 B 10 1437446333 0 3241 S MICHIGAN AVE CHICAGO IL 606164201 20 1437446333 0 Optometrists Optical Supplies 20 1437446333 0 Optometrists Optometric Services 20 1437446333 0 Optometrists Physician Services 00 1437447091 0 PENNIX CHARLES E 2015244 9999999 B 10 1437447091 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1437447091 0 Physicians Anesthesia Services 20 1437447091 0 Physicians Healthy Kids Services 20 1437447091 0 Physicians Optical Supplies 20 1437447091 0 Physicians Physician Services 00 1437447679 0 HUGHES KYLIE A 2021029 9999999 B 10 1437447679 0 29373 NETWORK PL CHICAGO IL 606733039 20 1437447679 0 Nurse Practitioners Healthy Kids Services 20 1437447679 0 Nurse Practitioners Nurse Practitioners Services 20 1437447679 0 Nurse Practitioners Physician Services 00 1437447802 0 ANDERSON LINDSAY R 2015344 9999999 B 10 1437447802 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1437447802 0 Physician Assistant Only Fluoride varnish 20 1437447802 0 Physician Assistant Only Healthy Kids Services 20 1437447802 0 Physician Assistant Only Physician Services 00 1437448180 0 HINTZKE MARIA 2019023 9999999 B 10 1437448180 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1437448180 0 Physicians Anesthesia Services 20 1437448180 0 Physicians Healthy Kids Services 20 1437448180 0 Physicians Optical Supplies 20 1437448180 0 Physicians Physician Services 00 1437448503 0 LUETTINGER MAIRA 2018256 9999999 B 10 1437448503 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1437448503 0 Nurse Practitioners Healthy Kids Services 20 1437448503 0 Nurse Practitioners Nurse Practitioners Services 20 1437448503 0 Nurse Practitioners Physician Services 00 1437448602 0 KING JUDITH 1991182 9999999 B 10 1437448602 0 945 W GEORGE ST STE 218 CHICAGO IL 606575876 20 1437448602 0 Physicians Anesthesia Services 20 1437448602 0 Physicians Healthy Kids Services 20 1437448602 0 Physicians Optical Supplies 20 1437448602 0 Physicians Physician Services 00 1437448867 0 SAVU CRISTINA E 2023054 9999999 B 10 1437448867 0 PO BOX 43230 PHOENIX AZ 850803230 20 1437448867 0 Physicians Anesthesia Services 20 1437448867 0 Physicians Fluoride varnish 20 1437448867 0 Physicians Healthy Kids Services 20 1437448867 0 Physicians Optical Supplies 20 1437448867 0 Physicians Physician Services 00 1437449238 0 FATIMA NAZNEEN 2015338 9999999 B 10 1437449238 0 8594 SOLUTIONS CTR PATHOLOGY DEPT. CHICAGO IL 606778005 20 1437449238 0 Physicians Anesthesia Services 20 1437449238 0 Physicians Healthy Kids Services 20 1437449238 0 Physicians Optical Supplies 20 1437449238 0 Physicians Physician Services 00 1437449527 0 LANDIS KEITH 1994243 9999999 B 10 1437449527 0 415 W GOLF RD STE 52 ARLINGTON HEIGH IL 600053923 20 1437449527 0 Speech Therapists Medical Supplies 20 1437449527 0 Speech Therapists Medical equipment/prosthetic devices 20 1437449527 0 Speech Therapists Speech Therapy/Pathology Services 00 1437449725 0 KENNEDY ELAINE 2012003 9999999 B 10 1437449725 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1437449725 0 Nurse Practitioners Healthy Kids Services 20 1437449725 0 Nurse Practitioners Nurse Practitioners Services 20 1437449725 0 Nurse Practitioners Physician Services 00 1437449980 0 OKPALA CHUKWUDI 2016159 9999999 B 10 1437449980 0 PO BOX 443 BEDFORD PARK IL 604990443 20 1437449980 0 Physicians Anesthesia Services 20 1437449980 0 Physicians Healthy 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2015001 9999999 B 10 1437461084 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1437461084 0 Physicians Anesthesia Services 20 1437461084 0 Physicians Fluoride varnish 20 1437461084 0 Physicians Healthy Kids Services 20 1437461084 0 Physicians Optical Supplies 20 1437461084 0 Physicians Physician Services 00 1437461191 0 CLARK AMY 2017298 9999999 B 10 1437461191 0 2806 E 600 NORTH RD STRASBURG IL 624654102 20 1437461191 0 Speech Therapists Medical Supplies 20 1437461191 0 Speech Therapists Medical equipment/prosthetic devices 20 1437461191 0 Speech Therapists Speech Therapy/Pathology Services 00 1437461852 0 MANLEY GEORGENE A 2015137 9999999 B 10 1437461852 0 5435 BULL VALLEY RD STE 230 MCHENRY IL 600507435 20 1437461852 0 Other behavior health professional LCPC/LMFT services 00 1437462546 0 ERNST DEBRA 2021293 9999999 B 10 1437462546 0 1120 E MAIN ST ST CHARLES IL 601742287 20 1437462546 0 Other behavior health professional LCPC/LMFT services 00 1437462918 0 QURESHI AMNA 2015305 9999999 B 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1437475225 0 Physicians Optical Supplies 20 1437475225 0 Physicians Physician Services 00 1437476520 0 WANG YI CHU 2016301 9999999 B 10 1437476520 0 318 MAXWELL RD STE 500 ALPHARETTA GA 300092064 20 1437476520 0 Physicians Anesthesia Services 20 1437476520 0 Physicians Fluoride varnish 20 1437476520 0 Physicians Healthy Kids Services 20 1437476520 0 Physicians Optical Supplies 20 1437476520 0 Physicians Physician Services 00 1437478245 0 KHAN ROOZEHRA A 2022129 9999999 B 10 1437478245 0 5410 MARYLAND WAY STE 300 BRENTWOOD TN 370275339 20 1437478245 0 Physicians Anesthesia Services 20 1437478245 0 Physicians Fluoride varnish 20 1437478245 0 Physicians Healthy Kids Services 20 1437478245 0 Physicians Optical Supplies 20 1437478245 0 Physicians Physician Services 00 1437478294 0 ALI ARSHIA 2018201 9999999 B 10 1437478294 0 2830 VICTORY PKWY STE 119 CINCINNATI OH 452061785 20 1437478294 0 Physicians Anesthesia Services 20 1437478294 0 Physicians Fluoride varnish 20 1437478294 0 Physicians 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1437481355 0 Physicians Optical Supplies 20 1437481355 0 Physicians Physician Services 20 1437481355 0 Physicians Physicians Psychiatric Services 00 1437481397 0 SAID OMAR 2014216 9999999 B 10 1437481397 0 5777 DEPT CAROL STREAM IL 601220021 20 1437481397 0 Physicians Anesthesia Services 20 1437481397 0 Physicians Healthy Kids Services 20 1437481397 0 Physicians Optical Supplies 20 1437481397 0 Physicians Physician Services 00 1437481595 0 CLAUSSEN MALINI R 2023107 9999999 B 10 1437481595 0 2601 NETWORK BLVD STE 102 FRISCO TX 750349092 20 1437481595 0 Speech Therapists Medical Supplies 20 1437481595 0 Speech Therapists Medical equipment/prosthetic devices 20 1437481595 0 Speech Therapists Speech Therapy/Pathology Services 00 1437481843 0 TUSKENIS ELENA V 2017166 9999999 B 10 1437481843 0 12251 S 80TH AVE STE 1630 PALOS HEIGHTS IL 604631256 20 1437481843 0 Physicians Anesthesia Services 20 1437481843 0 Physicians Healthy Kids Services 20 1437481843 0 Physicians Optical Supplies 20 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Services 20 1437499803 0 Nurse Practitioners Nurse Practitioners Services 20 1437499803 0 Nurse Practitioners Physician Services 00 1437500402 0 NAWAZ SARIYA 2022075 9999999 B 10 1437500402 0 7522 N HARLEM AVE CHICAGO IL 606314400 20 1437500402 0 Physicians Anesthesia Services 20 1437500402 0 Physicians Fluoride varnish 20 1437500402 0 Physicians Healthy Kids Services 20 1437500402 0 Physicians Optical Supplies 20 1437500402 0 Physicians Physician Services 00 1437500410 0 CONTRERAS MAYRA 2016252 9999999 B 10 1437500410 0 70 S RIVER ST AURORA IL 605065185 20 1437500410 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1437501202 0 AMIN SAAD MUHAMMAD 2024213 9999999 B 10 1437501202 0 PO BOX 632281 CINCINNATI OH 452632281 20 1437501202 0 Physicians Anesthesia Services 20 1437501202 0 Physicians Fluoride varnish 20 1437501202 0 Physicians Healthy Kids Services 20 1437501202 0 Physicians Optical Supplies 20 1437501202 0 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Nurse Practitioners Healthy Kids Services 20 1437656527 0 Nurse Practitioners Nurse Practitioners Services 20 1437656527 0 Nurse Practitioners Physician Services 00 1437656550 0 COLLOPY CATHRYN M 2018182 9999999 B 10 1437656550 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1437656550 0 Audiologists Audiology Services 20 1437656550 0 Audiologists Medical Supplies 20 1437656550 0 Audiologists Medical equipment/prosthetic devices 00 1437656683 0 UNGCHUSRI ETHAN N 2019182 9999999 B 10 1437656683 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1437656683 0 Physicians Anesthesia Services 20 1437656683 0 Physicians Healthy Kids Services 20 1437656683 0 Physicians Optical Supplies 20 1437656683 0 Physicians Physician Services 00 1437656691 0 KHAWAJA SALEEM 2023091 9999999 B 10 1437656691 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1437656691 0 Physicians Anesthesia Services 20 1437656691 0 Physicians Fluoride varnish 20 1437656691 0 Physicians Healthy 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Nurse Practitioners Fluoride varnish 20 1437661980 0 Nurse Practitioners Healthy Kids Services 20 1437661980 0 Nurse Practitioners Nurse Practitioners Services 20 1437661980 0 Nurse Practitioners Physician Services 00 1437662046 0 GOODSON KIMBERLY 2017312 9999999 B 10 1437662046 0 105 W A ST BELLEVILLE IL 622201326 20 1437662046 0 Registered nurse Nursing service 20 1437662046 0 Registered nurse Waiver service 00 1437662103 0 BENSON DEBRA J 2017334 9999999 B 10 1437662103 0 501 E SOUTH ST FREEPORT IL 610329676 20 1437662103 0 Speech Therapists Medical Supplies 20 1437662103 0 Speech Therapists Medical equipment/prosthetic devices 20 1437662103 0 Speech Therapists Speech Therapy/Pathology Services 00 1437662244 0 PEDERSEN JANE L 2017213 9999999 B 10 1437662244 0 1050 IVY HALL LN BUFFALO GROVE IL 600891333 20 1437662244 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1437662483 0 BITZ SEAN K 2017326 9999999 B 10 1437662483 0 PO BOX 824246 PHILADELPHIA PA 191824246 20 1437662483 0 Nurse Practitioners Anesthesia Services 20 1437662483 0 Nurse Practitioners Nurse Practitioners Services 20 1437662483 0 Nurse Practitioners Physician Services 00 1437662574 0 OSBORNE DAYNA C 2019109 9999999 B 10 1437662574 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1437662574 0 Nurse Practitioners Healthy Kids Services 20 1437662574 0 Nurse Practitioners Nurse Practitioners Services 20 1437662574 0 Nurse Practitioners Physician Services 00 1437662723 0 SMITH DEBORAH LEE 2017213 9999999 B 10 1437662723 0 3706 FLORIDA AVE GURNEE IL 600315527 20 1437662723 0 Speech Therapists Medical Supplies 20 1437662723 0 Speech Therapists Medical equipment/prosthetic devices 20 1437662723 0 Speech Therapists Speech Therapy/Pathology Services 00 1437663382 0 CABA MARY 2017340 9999999 B 10 1437663382 0 1009 BOYCE MEMORIAL DR OTTAWA IL 613502500 20 1437663382 0 Speech Therapists Medical Supplies 20 1437663382 0 Speech 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Psychiatric Services 00 1437678943 0 O'DONOGHUE CARISSA J 2017264 9999999 B 10 1437678943 0 1000 PRIMM RD LINCOLN IL 626563180 20 1437678943 0 Speech Therapists Medical Supplies 20 1437678943 0 Speech Therapists Medical equipment/prosthetic devices 20 1437678943 0 Speech Therapists Speech Therapy/Pathology Services 00 1437678992 0 KOULARMANIS MARIA 2017355 9999999 B 10 1437678992 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1437678992 0 Physician Assistant Only Fluoride varnish 20 1437678992 0 Physician Assistant Only Healthy Kids Services 20 1437678992 0 Physician Assistant Only Physician Services 00 1437679115 0 CHO BRIAN 2017192 2099365 B 10 1437679115 0 11 W DOWNER PL AURORA IL 605065134 20 1437679115 0 Dentists Dental Services 20 1437679115 0 Dentists Physician Services 00 1437679586 0 RODRIGUEZ RESTREPO ANDREA 2023115 9999999 B 10 1437679586 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1437679586 0 Physicians Anesthesia Services 20 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9999999 B 10 1437684321 0 3200 E CAMELBACK RD STE 250 PHOENIX AZ 850182327 20 1437684321 0 Physicians Anesthesia Services 20 1437684321 0 Physicians Fluoride varnish 20 1437684321 0 Physicians Healthy Kids Services 20 1437684321 0 Physicians Optical Supplies 20 1437684321 0 Physicians Physician Services 00 1437684693 0 ORTEGA DAYRON 2023012 9999999 B 10 1437684693 0 PO BOX 43230 PHOENIX AZ 850803230 20 1437684693 0 Physicians Anesthesia Services 20 1437684693 0 Physicians Fluoride varnish 20 1437684693 0 Physicians Healthy Kids Services 20 1437684693 0 Physicians Optical Supplies 20 1437684693 0 Physicians Physician Services 00 1437685237 0 REHMAN FAISAL 2022177 9999999 B 10 1437685237 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1437685237 0 Physicians Anesthesia Services 20 1437685237 0 Physicians Healthy Kids Services 20 1437685237 0 Physicians Optical Supplies 20 1437685237 0 Physicians Physician Services 00 1437685500 0 HASSUMANI DANIEL 2023221 9999999 B 10 1437685500 0 9000 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Physicians Fluoride varnish 20 1437688579 0 Physicians Healthy Kids Services 20 1437688579 0 Physicians Optical Supplies 20 1437688579 0 Physicians Physician Services 00 1437689072 0 HILL CHRISTOPHER 2023356 9999999 B 10 1437689072 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1437689072 0 Physicians Anesthesia Services 20 1437689072 0 Physicians Healthy Kids Services 20 1437689072 0 Physicians Optical Supplies 20 1437689072 0 Physicians Physician Services 20 1437689072 0 Physicians Physicians Psychiatric Services 00 1437689437 0 NOURELDIN MOHAMED 2023213 9999999 B 10 1437689437 0 PO BOX 43230 PHOENIX AZ 850803230 20 1437689437 0 Physicians Anesthesia Services 20 1437689437 0 Physicians Fluoride varnish 20 1437689437 0 Physicians Healthy Kids Services 20 1437689437 0 Physicians Optical Supplies 20 1437689437 0 Physicians Physician Services 00 1437690542 0 DUNKELBERGER ALAINA C 2020153 9999999 B 10 1437690542 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1437690542 0 Nurse Practitioners Anesthesia Services 20 1437690542 0 Nurse Practitioners Nurse Practitioners Services 20 1437690542 0 Nurse Practitioners Physician Services 00 1437690575 0 GOLDING RAYON 2020051 9999999 B 10 1437690575 0 PO BOX 781076 DETROIT MI 482781076 20 1437690575 0 Physicians Anesthesia Services 20 1437690575 0 Physicians Fluoride varnish 20 1437690575 0 Physicians Healthy Kids Services 20 1437690575 0 Physicians Optical Supplies 20 1437690575 0 Physicians Physician Services 00 1437690724 0 XIAO QI 2022111 9999999 B 10 1437690724 0 1000 MEDICAL CENTER DR MONTICELLO IL 618562116 20 1437690724 0 Physicians Anesthesia Services 20 1437690724 0 Physicians Healthy Kids Services 20 1437690724 0 Physicians Optical Supplies 20 1437690724 0 Physicians Physician Services 00 1437691540 0 WILLEY DANIELLE A 2018060 9999999 B 10 1437691540 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1437691540 0 Physician Assistant Only Fluoride varnish 20 1437691540 0 Physician Assistant Only 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1437696663 0 Physicians Anesthesia Services 20 1437696663 0 Physicians Fluoride varnish 20 1437696663 0 Physicians Healthy Kids Services 20 1437696663 0 Physicians Optical Supplies 20 1437696663 0 Physicians Physician Services 00 1437696812 0 BARON MARINA 2018008 9999999 B 10 1437696812 0 PO BOX 953 ADDISON IL 601010953 20 1437696812 0 Speech Therapists Medical Supplies 20 1437696812 0 Speech Therapists Medical equipment/prosthetic devices 20 1437696812 0 Speech Therapists Speech Therapy/Pathology Services 00 1437697620 0 SCHRECK JENNIFER L 2017092 9999999 B 10 1437697620 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1437697620 0 Nurse Practitioners Fluoride varnish 20 1437697620 0 Nurse Practitioners Healthy Kids Services 20 1437697620 0 Nurse Practitioners Nurse Practitioners Services 20 1437697620 0 Nurse Practitioners Physician Services 00 1437698511 0 REICHENBERGER CHRISTINA 2021084 9999999 B 10 1437698511 0 2954 W PRATT BLVD CHICAGO IL 606454219 20 1437698511 0 Other 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9999999 B 10 1437706744 0 1500 E LINCOLN HWY STE 1 DEKALB IL 601153990 20 1437706744 0 Other behavior health professional LCPC/LMFT services 00 1437706876 0 JEPSON KELLI 2019248 9999999 B 10 1437706876 0 101 E MILLER RD STERLING IL 610811252 20 1437706876 0 Nurse Practitioners Healthy Kids Services 20 1437706876 0 Nurse Practitioners Nurse Practitioners Services 20 1437706876 0 Nurse Practitioners Physician Services 00 1437707247 0 SCHICHT ARYELLE L 2019274 9999999 B 10 1437707247 0 5777 DEPT CAROL STREAM IL 601220021 20 1437707247 0 Nurse Practitioners Healthy Kids Services 20 1437707247 0 Nurse Practitioners Nurse Practitioners Services 20 1437707247 0 Nurse Practitioners Physician Services 00 1437707528 0 SPRINGER KATHERINE 2021081 9999999 B 10 1437707528 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1437707528 0 Speech Therapists Medical Supplies 20 1437707528 0 Speech Therapists Medical equipment/prosthetic devices 20 1437707528 0 Speech Therapists Speech Therapy/Pathology Services 00 1437709763 0 BOYLER ANNE M 2021126 9999999 B 10 1437709763 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1437709763 0 Physician Assistant Only Fluoride varnish 20 1437709763 0 Physician Assistant Only Healthy Kids Services 20 1437709763 0 Physician Assistant Only Physician Services 00 1437710571 0 COOKE ALEXANDRA D 2019326 9999999 B 10 1437710571 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1437710571 0 Physicians Anesthesia Services 20 1437710571 0 Physicians Healthy Kids Services 20 1437710571 0 Physicians Optical Supplies 20 1437710571 0 Physicians Physician Services 00 1437710761 0 HANAK MARK F 2019179 9999999 B 10 1437710761 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1437710761 0 Physicians Anesthesia Services 20 1437710761 0 Physicians Healthy Kids Services 20 1437710761 0 Physicians Optical Supplies 20 1437710761 0 Physicians Physician Services 00 1437711975 0 BANU MADEEHA 2024298 9999999 B 10 1437711975 0 PO BOX 5081 JANESVILLE WI 535475081 20 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Only Fluoride varnish 20 1437713930 0 Physician Assistant Only Healthy Kids Services 20 1437713930 0 Physician Assistant Only Physician Services 00 1437714375 0 DAVIS JUSTIN 2021181 9999999 B 10 1437714375 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1437714375 0 Physicians Anesthesia Services 20 1437714375 0 Physicians Healthy Kids Services 20 1437714375 0 Physicians Optical Supplies 20 1437714375 0 Physicians Physician Services 00 1437714938 0 FEHR RILEY 2024183 9999999 B 10 1437714938 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1437714938 0 Physicians Anesthesia Services 20 1437714938 0 Physicians Healthy Kids Services 20 1437714938 0 Physicians Optical Supplies 20 1437714938 0 Physicians Physician Services 00 1437715380 0 KIM JEREMY S 2019182 9999999 B 10 1437715380 0 515 22ND AVE MONROE WI 535661569 20 1437715380 0 Physicians Anesthesia Services 20 1437715380 0 Physicians Fluoride varnish 20 1437715380 0 Physicians Healthy Kids Services 20 1437715380 0 Physicians Optical Supplies 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1437717816 0 HITCHCOCK EDIE 2019304 9999999 B 10 1437717816 0 1305 S MICHIGAN AVE APT 602 CHICAGO IL 606053398 20 1437717816 0 Other behavior health professional LCPC/LMFT services 00 1437717832 0 GOODFELLOW MADISON R 2019182 9999999 B 10 1437717832 0 3241 S MICHIGAN AVE CHICAGO IL 606164201 20 1437717832 0 Optometrists Optical Supplies 20 1437717832 0 Optometrists Optometric Services 20 1437717832 0 Optometrists Physician Services 00 1437717923 0 BENBERRY MIA 2024125 9999999 B 10 1437717923 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1437717923 0 Other behavior health professional LCPC/LMFT services 00 1437718335 0 VELLOOKUNNEL SHILPA 2019260 9999999 B 10 1437718335 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1437718335 0 Physician Assistant Only Fluoride varnish 20 1437718335 0 Physician Assistant Only Healthy Kids Services 20 1437718335 0 Physician Assistant Only Physician Services 00 1437718384 0 HATLEY HA T 2022116 9999999 B 10 1437718384 0 6300 RIDGLEA PL STE 201 FORT WORTH TX 761165707 20 1437718384 0 Physicians Anesthesia Services 20 1437718384 0 Physicians Fluoride varnish 20 1437718384 0 Physicians Healthy Kids Services 20 1437718384 0 Physicians Optical Supplies 20 1437718384 0 Physicians Physician Services 00 1437718442 0 BALTAG ELENA 2020076 9999999 B 10 1437718442 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1437718442 0 Physicians Anesthesia Services 20 1437718442 0 Physicians Fluoride varnish 20 1437718442 0 Physicians Healthy Kids Services 20 1437718442 0 Physicians Optical Supplies 20 1437718442 0 Physicians Physician Services 00 1437719093 0 COMPTON VINCENT C 2019189 9999999 B 10 1437719093 0 PO BOX 280 911 STACY BURK DR FLORA IL 628390280 20 1437719093 0 Nurse Practitioners Anesthesia Services 20 1437719093 0 Nurse Practitioners Nurse Practitioners Services 20 1437719093 0 Nurse Practitioners Physician Services 00 1437719291 0 FELCKOWSKI DAKOTA L 2019210 9999999 B 10 1437719291 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1437719291 0 Nurse Practitioners Fluoride varnish 20 1437719291 0 Nurse Practitioners Healthy Kids Services 20 1437719291 0 Nurse Practitioners Nurse Practitioners Services 20 1437719291 0 Nurse Practitioners Physician Services 00 1437720695 0 DEFRIES SARAH 2021204 9999999 B 10 1437720695 0 1812 N 19TH AVE MELROSE PARK IL 601602039 20 1437720695 0 Dentists Dental Services 20 1437720695 0 Dentists Physician Services 00 1437721727 0 PIANTEDOSI JANA M 2024277 9999999 B 10 1437721727 0 777 S MAIN ST STE 100 CLINTON IN 478422493 20 1437721727 0 Clinical Social Worker Social work service 00 1437722394 0 WOOD JOSHUA 2024075 9999999 B 10 1437722394 0 5250 OLD ORCHARD RD STE 300 SKOKIE IL 600774462 20 1437722394 0 Nurse Practitioners Fluoride varnish 20 1437722394 0 Nurse Practitioners Healthy Kids Services 20 1437722394 0 Nurse Practitioners Nurse Practitioners Services 20 1437722394 0 Nurse Practitioners Physician Services 00 1437722493 0 ANDRADE MICAH 2024236 9999999 B 10 1437722493 0 1 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1437729118 0 1385 STATE ROUTE 35 STE 284 MIDDLETOWN NJ 077482012 20 1437729118 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1437729621 0 KIM PAUL 2021309 9999999 B 10 1437729621 0 618 S ROUTE 59 STE 122 NAPERVILLE IL 605406100 20 1437729621 0 Dentists Dental Services 20 1437729621 0 Dentists Physician Services 00 1437729639 0 HOFFART AUDREY E 2022146 9999999 B 10 1437729639 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1437729639 0 Occupational Therapists Medical Supplies 20 1437729639 0 Occupational Therapists Medical equipment/prosthetic devices 20 1437729639 0 Occupational Therapists Occupational Therapy Services 00 1437729753 0 KRONK JENNIFER 2021300 9999999 B 10 1437729753 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1437729753 0 Other behavior health professional LCPC/LMFT services 00 1437730587 0 RATHORE GURSHER 2024248 9999999 B 10 1437730587 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1437730587 0 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DIXON IL 610210737 20 1437880804 0 Audiologists Audiology Services 20 1437880804 0 Audiologists Medical Supplies 20 1437880804 0 Audiologists Medical equipment/prosthetic devices 00 1437881349 0 SMITH HUANG OLIVIA 2022306 9999999 B 10 1437881349 0 122 S MICHIGAN AVE STE 1441 CHICAGO IL 606036173 20 1437881349 0 Clinical Social Worker Social work service 00 1437881448 0 ALDUJAIL RAWAA 2023087 9999999 B 10 1437881448 0 2050 E ALGONQUIN RD STE 610 SCHAUMBURG IL 601734166 20 1437881448 0 Dentists Dental Services 20 1437881448 0 Dentists Physician Services 00 1437882032 0 CATTERALL LAUREN 2022199 9999999 B 10 1437882032 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1437882032 0 Physicians Anesthesia Services 20 1437882032 0 Physicians Healthy Kids Services 20 1437882032 0 Physicians Optical Supplies 20 1437882032 0 Physicians Physician Services 00 1437882644 0 BANKS KENDALL 2022187 9999999 B 10 1437882644 0 70 S RIVER ST AURORA IL 605065185 20 1437882644 0 Other behavior health professional 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Social work service 00 1437885209 0 PANCHAPAKESAN KAILASH 2023202 9999999 B 10 1437885209 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1437885209 0 Physicians Anesthesia Services 20 1437885209 0 Physicians Healthy Kids Services 20 1437885209 0 Physicians Optical Supplies 20 1437885209 0 Physicians Physician Services 00 1437885225 0 CARLETTI ALEXIE 2024176 9999999 B 10 1437885225 0 4698 DEPT CAROL STREAM IL 601220021 20 1437885225 0 Physicians Anesthesia Services 20 1437885225 0 Physicians Fluoride varnish 20 1437885225 0 Physicians Healthy Kids Services 20 1437885225 0 Physicians Optical Supplies 20 1437885225 0 Physicians Physician Services 00 1437885415 0 MALIVERT KATELYNN 2024198 9999999 B 10 1437885415 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1437885415 0 Nurse Practitioners Anesthesia Services 20 1437885415 0 Nurse Practitioners Nurse Practitioners Services 20 1437885415 0 Nurse Practitioners Physician Services 00 1437887866 0 SONNEFELDT NICOLE 2023352 9999999 B 10 1437887866 0 6713 KINGERY HWY WILLOWBROOK IL 605275142 20 1437887866 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1437888674 0 SANDILANDS MEGAN 2022187 9999999 B 10 1437888674 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1437888674 0 Physical Therapists Medical Supplies 20 1437888674 0 Physical Therapists Medical equipment/prosthetic devices 20 1437888674 0 Physical Therapists Physical Therapy Services 00 1437889565 0 RICHARDS DOMINICK C 2022207 9999999 B 10 1437889565 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1437889565 0 Physicians Anesthesia Services 20 1437889565 0 Physicians Healthy Kids Services 20 1437889565 0 Physicians Optical Supplies 20 1437889565 0 Physicians Physician Services 00 1437890464 0 WING SAMUEL 2024295 9999999 B 10 1437890464 0 PO BOX 431 JANESVILLE WI 535470431 20 1437890464 0 Physicians Anesthesia Services 20 1437890464 0 Physicians Healthy Kids Services 20 1437890464 0 Physicians Optical Supplies 20 1437890464 0 Physicians Physician Services 00 1437890522 0 LOCKART KYLE J 2022214 9999999 B 10 1437890522 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1437890522 0 Physicians Anesthesia Services 20 1437890522 0 Physicians Healthy Kids Services 20 1437890522 0 Physicians Optical Supplies 20 1437890522 0 Physicians Physician Services 00 1437890597 0 AGYAPONG YVONNE O 2022214 9999999 B 10 1437890597 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1437890597 0 Physicians Anesthesia Services 20 1437890597 0 Physicians Healthy Kids Services 20 1437890597 0 Physicians Optical Supplies 20 1437890597 0 Physicians Physician Services 00 1437890738 0 LAUER KATE V 2022175 9999999 B 10 1437890738 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1437890738 0 Physicians Anesthesia Services 20 1437890738 0 Physicians Healthy Kids Services 20 1437890738 0 Physicians Optical Supplies 20 1437890738 0 Physicians Physician Services 00 1437891314 0 WATTS AMBER 2023136 9999999 B 10 1437891314 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1437891314 0 Occupational Therapists Medical Supplies 20 1437891314 0 Occupational Therapists Medical equipment/prosthetic devices 20 1437891314 0 Occupational Therapists Occupational Therapy Services 00 1437892866 0 WILLIAMS CONRAD 2023174 9999999 B 10 1437892866 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1437892866 0 Physicians Anesthesia Services 20 1437892866 0 Physicians Healthy Kids Services 20 1437892866 0 Physicians Optical Supplies 20 1437892866 0 Physicians Physician Services 00 1437893229 0 DIMASI TIANA 2024180 9999999 B 10 1437893229 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1437893229 0 Physicians Anesthesia Services 20 1437893229 0 Physicians Healthy Kids Services 20 1437893229 0 Physicians Optical Supplies 20 1437893229 0 Physicians Physician Services 20 1437893229 0 Physicians Physicians Psychiatric Services 00 1437893500 0 INGRAM TINA M 2022229 9999999 B 10 1437893500 0 631 N LONGWOOD ST STE 103 ROCKFORD IL 611074263 20 1437893500 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1437893765 0 HUANG ANTHONY 2022192 9999999 B 10 1437893765 0 28592 NETWORK PL CHICAGO IL 606731285 20 1437893765 0 Nurse Practitioners Healthy Kids Services 20 1437893765 0 Nurse Practitioners Nurse Practitioners Services 20 1437893765 0 Nurse Practitioners Physician Services 00 1437894458 0 TROUE CATHY 2023199 9999999 B 10 1437894458 0 3412 OFFICE PARK DR MARION IL 629596477 20 1437894458 0 Nurse Practitioners Healthy Kids Services 20 1437894458 0 Nurse Practitioners Nurse Practitioners Services 20 1437894458 0 Nurse Practitioners Physician Services 00 1437896487 0 MOHARRAM-ZADEH SANAZ 2025024 9999999 B 10 1437896487 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1437896487 0 Physicians Anesthesia Services 20 1437896487 0 Physicians Fluoride varnish 20 1437896487 0 Physicians Healthy Kids Services 20 1437896487 0 Physicians Optical Supplies 20 1437896487 0 Physicians Physician Services 00 1437896594 0 CREAGER JALEN 2023256 9999999 B 10 1437896594 0 6303 BLUE LAGOON DR STE 400 MIAMI FL 331266040 20 1437896594 0 Other behavior health professional Adaptive behavior support technician services 00 1437896974 0 BRUSLIK NATALIYA 2023009 9999999 B 10 1437896974 0 3015 N BALLAS RD ADMINISTRATION SAINT LOUIS MO 631312329 20 1437896974 0 Nurse Practitioners Healthy Kids Services 20 1437896974 0 Nurse Practitioners Nurse Practitioners Services 20 1437896974 0 Nurse Practitioners Physician Services 00 1437897923 0 MONTGOMERY COLLIN B 2022180 9999999 B 10 1437897923 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1437897923 0 Physicians Anesthesia Services 20 1437897923 0 Physicians Healthy Kids Services 20 1437897923 0 Physicians Optical Supplies 20 1437897923 0 Physicians Physician Services 00 1437898111 0 MORENO DANIEL A 2022202 9999999 B 10 1437898111 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1437898111 0 Physicians Anesthesia Services 20 1437898111 0 Physicians Fluoride varnish 20 1437898111 0 Physicians Healthy Kids Services 20 1437898111 0 Physicians Optical Supplies 20 1437898111 0 Physicians Physician Services 00 1437898368 0 FANCHER ABBY 2022160 9999999 B 10 1437898368 0 110 CARVER LN EAST PEORIA IL 616113052 20 1437898368 0 Speech Therapists Medical Supplies 20 1437898368 0 Speech Therapists Medical equipment/prosthetic devices 20 1437898368 0 Speech Therapists Speech Therapy/Pathology Services 00 1437899119 0 PENN MAUREEN 2022174 9999999 B 10 1437899119 0 4698 DEPT CAROL STREAM IL 601224698 20 1437899119 0 Physicians Anesthesia Services 20 1437899119 0 Physicians Fluoride varnish 20 1437899119 0 Physicians Healthy Kids Services 20 1437899119 0 Physicians Optical Supplies 20 1437899119 0 Physicians Physician Services 00 1437899689 0 OLOMUKORO OGHENERO 2022256 9999999 B 10 1437899689 0 505 S 8TH ST EAST SAINT LOUI IL 622012919 20 1437899689 0 Nurse Practitioners Healthy Kids Services 20 1437899689 0 Nurse Practitioners Nurse Practitioners Services 20 1437899689 0 Nurse Practitioners Physician Services 00 1437902335 0 HENDERSON MICHALA 2024163 9999999 B 10 1437902335 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1437902335 0 Physicians Anesthesia Services 20 1437902335 0 Physicians Fluoride varnish 20 1437902335 0 Physicians Healthy Kids Services 20 1437902335 0 Physicians Optical Supplies 20 1437902335 0 Physicians Physician Services 00 1437902582 0 BRETT EMMA I 2024197 9999999 B 10 1437902582 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1437902582 0 Psychologist Psychologist service 00 1437902699 0 JOSHEE SHREEYA 2024189 9999999 B 10 1437902699 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1437902699 0 Physicians Anesthesia Services 20 1437902699 0 Physicians Fluoride varnish 20 1437902699 0 Physicians Healthy Kids Services 20 1437902699 0 Physicians Optical Supplies 20 1437902699 0 Physicians Physician Services 00 1437902756 0 LI DAVID S 2024238 9999999 B 10 1437902756 0 124 SW ADAMS ST PEORIA IL 616021308 20 1437902756 0 Physicians Anesthesia Services 20 1437902756 0 Physicians Fluoride varnish 20 1437902756 0 Physicians Healthy Kids Services 20 1437902756 0 Physicians Optical Supplies 20 1437902756 0 Physicians Physician Services 00 1437903606 0 ESCOBAR KARINA 2024201 9999999 B 10 1437903606 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1437903606 0 Nurse Practitioners Fluoride varnish 20 1437903606 0 Nurse Practitioners Healthy Kids Services 20 1437903606 0 Nurse Practitioners Nurse Practitioners Services 20 1437903606 0 Nurse Practitioners Physician Services 00 1437908134 0 ROTH NICOLAS 2024178 9999999 B 10 1437908134 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1437908134 0 Physicians Anesthesia Services 20 1437908134 0 Physicians Healthy Kids Services 20 1437908134 0 Physicians Optical Supplies 20 1437908134 0 Physicians Physician Services 00 1437908183 0 FEDDERSEN SAMANTHA 2024353 9999999 B 10 1437908183 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1437908183 0 Nurse Practitioners Healthy Kids Services 20 1437908183 0 Nurse Practitioners Nurse Practitioners Services 20 1437908183 0 Nurse Practitioners Physician Services 00 1437909199 0 LYTTLE MORGAN 2024185 9999999 B 10 1437909199 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1437909199 0 Physicians Anesthesia Services 20 1437909199 0 Physicians Fluoride varnish 20 1437909199 0 Physicians Healthy Kids Services 20 1437909199 0 Physicians Optical Supplies 20 1437909199 0 Physicians Physician Services 00 1437909207 0 MORGAN KIPP 2024175 9999999 B 10 1437909207 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1437909207 0 Physicians Anesthesia Services 20 1437909207 0 Physicians Fluoride varnish 20 1437909207 0 Physicians Healthy Kids Services 20 1437909207 0 Physicians Optical Supplies 20 1437909207 0 Physicians Physician Services 00 1437910957 0 BHAKTA SHIV 2024278 9999999 B 10 1437910957 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1437910957 0 Physical Therapists Medical Supplies 20 1437910957 0 Physical Therapists Medical equipment/prosthetic devices 20 1437910957 0 Physical Therapists Physical Therapy Services 00 1437911039 0 SCHELLER HALEY 2024100 9999999 B 10 1437911039 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1437911039 0 Physician Assistant Only Fluoride varnish 20 1437911039 0 Physician Assistant Only Healthy Kids Services 20 1437911039 0 Physician Assistant Only Physician Services 00 1437911310 0 GOOD JESSICA 2024099 9999999 B 10 1437911310 0 2744 W 63RD ST CHICAGO IL 606292343 20 1437911310 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1437913308 0 SANDERS JAIME N 2024157 9999999 B 10 1437913308 0 1701 LACEY ST CAPE GIRARDEAU MO 637015230 20 1437913308 0 Nurse Practitioners Fluoride varnish 20 1437913308 0 Nurse Practitioners Healthy Kids Services 20 1437913308 0 Nurse Practitioners Nurse Practitioners Services 20 1437913308 0 Nurse Practitioners Physician Services 00 1437913555 0 SEDLOCK REBECCA L 2024054 9999999 B 10 1437913555 0 124 SW ADAMS ST PEORIA IL 616021320 20 1437913555 0 Nurse Practitioners Fluoride varnish 20 1437913555 0 Nurse Practitioners Healthy Kids Services 20 1437913555 0 Nurse Practitioners Nurse Practitioners Services 20 1437913555 0 Nurse Practitioners Physician Services 00 1437915816 0 LUBELCHECK ALISON R 2024057 9999999 B 10 1437915816 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1437915816 0 Nurse Practitioners Fluoride varnish 20 1437915816 0 Nurse Practitioners Healthy Kids Services 20 1437915816 0 Nurse Practitioners Nurse Practitioners Services 20 1437915816 0 Nurse Practitioners Physician Services 00 1437917085 0 MYERS DESSIE 2024136 9999999 B 10 1437917085 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1437917085 0 Nurse Practitioners Healthy Kids Services 20 1437917085 0 Nurse Practitioners Nurse Practitioners Services 20 1437917085 0 Nurse Practitioners Physician Services 00 1437917705 0 FRAZIER ALEXIS L 2024071 9999999 B 10 1437917705 0 9649 W 55TH ST COUNTRYSIDE IL 605253632 20 1437917705 0 Occupational Therapists Medical Supplies 20 1437917705 0 Occupational Therapists Medical equipment/prosthetic devices 20 1437917705 0 Occupational Therapists Occupational Therapy Services 00 1437917929 0 NAYLOR MEGAN N 2024134 9999999 B 10 1437917929 0 4400 W 95TH ST STE 308 OAK LAWN IL 604532660 20 1437917929 0 Nurse Practitioners Healthy Kids Services 20 1437917929 0 Nurse Practitioners Nurse Practitioners Services 20 1437917929 0 Nurse Practitioners Physician Services 00 1437918646 0 AYESH YUSOUF 2024179 9999999 B 10 1437918646 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1437918646 0 Podiatrists Podiatric Services 00 1437918927 0 OROZCO RODRIGUEZ EDUARDO 2024149 9999999 B 10 1437918927 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1437918927 0 Physicians Anesthesia Services 20 1437918927 0 Physicians Fluoride varnish 20 1437918927 0 Physicians Healthy Kids Services 20 1437918927 0 Physicians Optical Supplies 20 1437918927 0 Physicians Physician Services 00 1437919750 0 GADHOKE NEEL 2024180 9999999 B 10 1437919750 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1437919750 0 Physicians Anesthesia Services 20 1437919750 0 Physicians Fluoride varnish 20 1437919750 0 Physicians Healthy Kids Services 20 1437919750 0 Physicians Optical Supplies 20 1437919750 0 Physicians Physician Services 00 1437919834 0 MASSIE CYNTHIA 2024136 9999999 B 10 1437919834 0 70 S RIVER ST AURORA IL 605065185 20 1437919834 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1437924305 0 CLEMEN LINDA J 2024023 9999999 B 10 1437924305 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1437924305 0 Nurse Practitioners Healthy Kids Services 20 1437924305 0 Nurse Practitioners Nurse Practitioners Services 20 1437924305 0 Nurse Practitioners Physician Services 00 1437927399 0 FLOWERS SHATARA 2024025 9999999 B 10 1437927399 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1437927399 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1437928538 0 BALLARD RANDI JANAE 2024200 9999999 B 10 1437928538 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1437928538 0 Nurse Practitioners Fluoride varnish 20 1437928538 0 Nurse Practitioners Healthy Kids Services 20 1437928538 0 Nurse Practitioners Nurse Practitioners Services 20 1437928538 0 Nurse Practitioners Physician Services 00 1437929247 0 JAFFERY SYED 2025021 9999999 B 10 1437929247 0 111 E 4TH ST STE 440 ALTON IL 620026206 20 1437929247 0 Optometrists Optical Supplies 20 1437929247 0 Optometrists Optometric Services 20 1437929247 0 Optometrists Physician Services 00 1437930302 0 BAZIZ NADIR 2023299 9999999 B 10 1437930302 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1437930302 0 Nurse Practitioners Fluoride varnish 20 1437930302 0 Nurse Practitioners HIV Counseling svcs 20 1437930302 0 Nurse Practitioners Healthy Kids Services 20 1437930302 0 Nurse Practitioners Nurse Practitioners Services 20 1437930302 0 Nurse Practitioners Physician Services 00 1437930377 0 EZEOKONKWO UZOMA 2024117 9999999 B 10 1437930377 0 PO BOX 775253 CHICAGO IL 606775253 20 1437930377 0 Nurse Practitioners Healthy Kids Services 20 1437930377 0 Nurse Practitioners Nurse Practitioners Services 20 1437930377 0 Nurse Practitioners Physician Services 00 1437930435 0 WEDDLE STEPHANIE 2024129 9999999 B 10 1437930435 0 3809 S GREYSTONE CT STE B SPRINGFIELD MO 658046561 20 1437930435 0 Nurse Practitioners Fluoride varnish 20 1437930435 0 Nurse Practitioners Healthy Kids Services 20 1437930435 0 Nurse Practitioners Nurse Practitioners Services 20 1437930435 0 Nurse Practitioners Physician Services 00 1437933223 0 SOMMA LUCAS 2023268 9999999 B 10 1437933223 0 122 S MICHIGAN AVE STE 1441 CHICAGO IL 606036173 20 1437933223 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1437933504 0 PAREDES SOSA JOSE LUIS 2023275 9999999 B 10 1437933504 0 PO BOX 3039 OAK BROOK IL 605223039 20 1437933504 0 Physicians Anesthesia Services 20 1437933504 0 Physicians Fluoride varnish 20 1437933504 0 Physicians Healthy Kids Services 20 1437933504 0 Physicians Optical Supplies 20 1437933504 0 Physicians Physician Services 00 1437934288 0 CULBERTSON NICOLE 2023333 9999999 B 10 1437934288 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1437934288 0 Registered nurse Nursing service 20 1437934288 0 Registered nurse Waiver service 00 1437934908 0 RAMIREZ GRECIA 2023250 9999999 B 10 1437934908 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1437934908 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1437935202 0 DEGENHARDT CAITLIN 2023360 9999999 B 10 1437935202 0 29373 NETWORK PL CHICAGO IL 606733039 20 1437935202 0 Nurse Practitioners Healthy Kids Services 20 1437935202 0 Nurse Practitioners Nurse Practitioners Services 20 1437935202 0 Nurse Practitioners Physician Services 00 1437935400 0 HAAKE ELYSE 2023249 9999999 B 10 1437935400 0 224 S LOCUST ST CENTRALIA IL 628013509 20 1437935400 0 Speech Therapists Speech Therapy/Pathology Services 00 1437935699 0 KISSAMIS STACY 2023283 9999999 B 10 1437935699 0 2045 W GRAND AVE STE B CHICAGO IL 606121577 20 1437935699 0 Clinical Social Worker Social work service 00 1437935830 0 CAPERS PATRICIA 2024248 9999999 B 10 1437935830 0 684 S BARRINGTON RD STE 112 STREAMWOOD IL 601071841 20 1437935830 0 Nurse Practitioners Fluoride varnish 20 1437935830 0 Nurse Practitioners Healthy Kids Services 20 1437935830 0 Nurse Practitioners Nurse Practitioners Services 20 1437935830 0 Nurse Practitioners Physician Services 00 1437936036 0 WOOD DAYNA M 2023271 9999999 B 10 1437936036 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1437936036 0 Nurse Practitioners Fluoride varnish 20 1437936036 0 Nurse Practitioners Healthy Kids Services 20 1437936036 0 Nurse Practitioners Nurse Practitioners Services 20 1437936036 0 Nurse Practitioners Physician Services 00 1437936549 0 JOHNSON STEPHANIE 2023263 9999999 B 10 1437936549 0 20613 N BROAD ST STE B CARLINVILLE IL 626263717 20 1437936549 0 Nurse Practitioners Fluoride varnish 20 1437936549 0 Nurse Practitioners Healthy Kids Services 20 1437936549 0 Nurse Practitioners Nurse Practitioners Services 20 1437936549 0 Nurse Practitioners Physician Services 00 1437937216 0 HANNEBAUER KRISTIN 2023313 9999999 B 10 1437937216 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1437937216 0 Nurse Practitioners Healthy Kids Services 20 1437937216 0 Nurse Practitioners Nurse Practitioners Services 20 1437937216 0 Nurse Practitioners Physician Services 00 1437937398 0 JOHNSON LORRAINE 2024065 9999999 B 10 1437937398 0 120 N SANGAMON ST CHICAGO IL 606072202 20 1437937398 0 Registered nurse Nursing service 20 1437937398 0 Registered nurse Waiver service 00 1437938156 0 KACENA ALEXANDRA 2024009 9999999 B 10 1437938156 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1437938156 0 Nurse Practitioners Fluoride varnish 20 1437938156 0 Nurse Practitioners Healthy Kids Services 20 1437938156 0 Nurse Practitioners Nurse Practitioners Services 20 1437938156 0 Nurse Practitioners Physician Services 00 1437938834 0 MANTEY CLAIRE 2023271 9999999 B 10 1437938834 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1437938834 0 Physical Therapists Medical Supplies 20 1437938834 0 Physical Therapists Medical equipment/prosthetic devices 20 1437938834 0 Physical Therapists Physical Therapy Services 00 1437963584 0 BERNABE TERESITA 2025055 9999999 B 10 1437963584 0 101 MADISON ST STE 300 OAK PARK IL 603024210 20 1437963584 0 Nurse Practitioners Healthy Kids Services 20 1437963584 0 Nurse Practitioners Nurse Practitioners Services 20 1437963584 0 Nurse Practitioners Physician Services 00 1437965829 0 HICKS HAILEY 2025014 9999999 B 10 1437965829 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1437965829 0 Nurse Practitioners Healthy Kids Services 20 1437965829 0 Nurse Practitioners Nurse Practitioners Services 20 1437965829 0 Nurse Practitioners Physician Services 00 1437967601 0 KOESTER SHANNON 2025017 9999999 B 10 1437967601 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1437967601 0 Clinical Social Worker Social work service 00 1437967692 0 HEINDEL CORINNA J 2024359 9999999 B 10 1437967692 0 625 MASSACHUSETTS AVE FL 2 CAMBRIDGE MA 021393357 20 1437967692 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1437968559 0 PONNLE ARAMIDE 2025010 9999999 B 10 1437968559 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1437968559 0 Physical Therapists Medical Supplies 20 1437968559 0 Physical Therapists Medical equipment/prosthetic devices 20 1437968559 0 Physical Therapists Physical Therapy Services 00 1437970563 0 CHRISTOFOROU ANDRIANI 2024296 9999999 B 10 1437970563 0 8701 MENARD AVE MORTON GROVE IL 600533052 20 1437970563 0 Speech Therapists Medical Supplies 20 1437970563 0 Speech Therapists Medical equipment/prosthetic devices 20 1437970563 0 Speech Therapists Speech Therapy/Pathology Services 00 1437972254 0 SULLIVAN BRIDGET K 2025017 9999999 B 10 1437972254 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1437972254 0 Nurse Practitioners Anesthesia Services 20 1437972254 0 Nurse Practitioners Nurse Practitioners Services 20 1437972254 0 Nurse Practitioners Physician Services 00 1437972270 0 DOTY ANNA 2024305 9999999 B 10 1437972270 0 310 S MAIN ST STE D LOMBARD IL 601482692 20 1437972270 0 Speech Therapists Medical Supplies 20 1437972270 0 Speech Therapists Medical equipment/prosthetic devices 20 1437972270 0 Speech Therapists Speech Therapy/Pathology Services 00 1437975893 0 VOOS HALLE C 2024348 9999999 B 10 1437975893 0 123 WASHINGTON CIR LAKE FOREST IL 600452455 20 1437975893 0 Speech Therapists Medical Supplies 20 1437975893 0 Speech Therapists Medical equipment/prosthetic devices 20 1437975893 0 Speech Therapists Speech Therapy/Pathology Services 00 1437977261 0 SICAIROS GARCIA PABLA 2024283 9999999 B 10 1437977261 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1437977261 0 Physical Therapists Medical Supplies 20 1437977261 0 Physical Therapists Medical equipment/prosthetic devices 20 1437977261 0 Physical Therapists Physical Therapy Services 00 1437978863 0 MORRISSETTE MEGHAN C 2024365 9999999 B 10 1437978863 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1437978863 0 Physician Assistant Only Fluoride varnish 20 1437978863 0 Physician Assistant Only Healthy Kids Services 20 1437978863 0 Physician Assistant Only Physician Services 00 1437983699 0 MENTZER AARON 2024312 9999999 B 10 1437983699 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1437983699 0 Physician Assistant Only Fluoride varnish 20 1437983699 0 Physician Assistant Only Healthy Kids Services 20 1437983699 0 Physician Assistant Only Physician Services 00 1437984275 0 KIANDER HAYLEY 2024346 9999999 B 10 1437984275 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1437984275 0 Nurse Practitioners Healthy Kids Services 20 1437984275 0 Nurse Practitioners Nurse Practitioners Services 20 1437984275 0 Nurse Practitioners Physician Services 00 1437984689 0 LINDSEY JENAY 2025045 9999999 B 10 1437984689 0 PO BOX 4028 ROCK ISLAND IL 612044028 20 1437984689 0 Nurse Practitioners Healthy Kids Services 20 1437984689 0 Nurse Practitioners Nurse Practitioners Services 20 1437984689 0 Nurse Practitioners Physician Services 00 1437985611 0 EADES VICTORIA 2024285 9999999 B 10 1437985611 0 2201 MAIN ST EVANSTON IL 602021519 20 1437985611 0 Nurse Practitioners Fluoride varnish 20 1437985611 0 Nurse Practitioners Healthy Kids Services 20 1437985611 0 Nurse Practitioners Nurse Practitioners Services 20 1437985611 0 Nurse Practitioners Physician Services 00 1437986932 0 DEE ELLEN 2024267 9999999 B 10 1437986932 0 120 BRENTWOOD COMMONS 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0 Physicians Fluoride varnish 20 1447204136 0 Physicians Healthy Kids Services 20 1447204136 0 Physicians Optical Supplies 20 1447204136 0 Physicians Physician Services 00 1447205497 0 ASTRAUSKAS ASTA 1999274 9999999 B 10 1447205497 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1447205497 0 Physicians Anesthesia Services 20 1447205497 0 Physicians Fluoride varnish 20 1447205497 0 Physicians Healthy Kids Services 20 1447205497 0 Physicians Optical Supplies 20 1447205497 0 Physicians Physician Services 00 1447205869 0 FLERSHEM DIANE M 1998164 9999999 B 10 1447205869 0 1S376 SUMMIT AVE STE 4C OAKBROOK TERRAC IL 601813966 20 1447205869 0 Physicians Anesthesia Services 20 1447205869 0 Physicians Fluoride varnish 20 1447205869 0 Physicians Healthy Kids Services 20 1447205869 0 Physicians Optical Supplies 20 1447205869 0 Physicians Physician Services 00 1447206289 0 VONHARZ SARAH A 2014060 9999999 B 10 1447206289 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1447206289 0 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1447210075 0 Physicians Fluoride varnish 20 1447210075 0 Physicians Healthy Kids Services 20 1447210075 0 Physicians Optical Supplies 20 1447210075 0 Physicians Physician Services 00 1447210315 0 GOREE JEFFREY C 2000045 9999999 B 10 1447210315 0 1970 E 53RD ST DAVENPORT IA 528072710 20 1447210315 0 Physicians Anesthesia Services 20 1447210315 0 Physicians Healthy Kids Services 20 1447210315 0 Physicians Optical Supplies 20 1447210315 0 Physicians Physician Services 00 1447210562 0 SCOTT KAREN 2007253 9999999 B 10 1447210562 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1447210562 0 Physicians Anesthesia Services 20 1447210562 0 Physicians Fluoride varnish 20 1447210562 0 Physicians Healthy Kids Services 20 1447210562 0 Physicians Optical Supplies 20 1447210562 0 Physicians Physician Services 00 1447210638 0 SY MARIO B 2003169 9999999 B 10 1447210638 0 621 S ILLINOIS AVE STE 103 MASON CITY IA 504015489 20 1447210638 0 Physicians Anesthesia Services 20 1447210638 0 Physicians Fluoride varnish 20 1447210638 0 Physicians Healthy Kids Services 20 1447210638 0 Physicians Optical Supplies 20 1447210638 0 Physicians Physician Services 00 1447211222 0 PEPPER STEVEN S 2010213 9999999 B 10 1447211222 0 500 MEDICAL DR WENTZVILLE MO 633853421 20 1447211222 0 Physicians Anesthesia Services 20 1447211222 0 Physicians Fluoride varnish 20 1447211222 0 Physicians Healthy Kids Services 20 1447211222 0 Physicians Optical Supplies 20 1447211222 0 Physicians Physician Services 00 1447211404 0 JOHNSON DALE A 2020245 9999999 B 10 1447211404 0 N17W24100 RIVERWOOD DR WAUKESHA WI 531881127 20 1447211404 0 Physicians Anesthesia Services 20 1447211404 0 Physicians Fluoride varnish 20 1447211404 0 Physicians Healthy Kids Services 20 1447211404 0 Physicians Optical Supplies 20 1447211404 0 Physicians Physician Services 00 1447211776 0 HARRE RAYMOND G 1988139 9999999 B 10 1447211776 0 1970 E 53RD ST DAVENPORT IA 528072710 20 1447211776 0 Physicians Anesthesia Services 20 1447211776 0 Physicians 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0 Physicians Physician Services 00 1447214002 0 SAHLOUL MOHAMMED 1997001 9999999 B 10 1447214002 0 29777 NETWORK PL CHICAGO IL 606731297 20 1447214002 0 Physicians Anesthesia Services 20 1447214002 0 Physicians Fluoride varnish 20 1447214002 0 Physicians Healthy Kids Services 20 1447214002 0 Physicians Optical Supplies 20 1447214002 0 Physicians Physician Services 00 1447214093 0 POSICK LYNN 2016123 9999999 B 10 1447214093 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1447214093 0 Nurse Practitioners Healthy Kids Services 20 1447214093 0 Nurse Practitioners Nurse Practitioners Services 20 1447214093 0 Nurse Practitioners Physician Services 00 1447214317 0 COX JESSE T 2017139 9999999 B 10 1447214317 0 1300 SAWGRS CORP PKWY STE 200 SUNRISE FL 333232823 20 1447214317 0 Physicians Anesthesia Services 20 1447214317 0 Physicians Fluoride varnish 20 1447214317 0 Physicians Healthy Kids Services 20 1447214317 0 Physicians Optical Supplies 20 1447214317 0 Physicians Physician Services 00 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1447222146 0 HARRIS ANDREW T 1997010 9999999 B 10 1447222146 0 6300 RIDGLEA PL STE 201 FORT WORTH TX 761165707 20 1447222146 0 Physicians Anesthesia Services 20 1447222146 0 Physicians Healthy Kids Services 20 1447222146 0 Physicians Optical Supplies 20 1447222146 0 Physicians Physician Services 00 1447222419 0 MERRELL JANET R 2009244 9999999 B 10 1447222419 0 PO BOX 955860 SAINT LOUIS MO 631955860 20 1447222419 0 Nurse Practitioners Healthy Kids Services 20 1447222419 0 Nurse Practitioners Nurse Practitioners Services 20 1447222419 0 Nurse Practitioners Physician Services 00 1447222781 0 YAZDANI AIJAZ A 2021159 9999999 B 10 1447222781 0 1160 E SAINT CLAIR ST VINCENNES IN 475914853 20 1447222781 0 Physicians Anesthesia Services 20 1447222781 0 Physicians Fluoride varnish 20 1447222781 0 Physicians Healthy Kids Services 20 1447222781 0 Physicians Optical Supplies 20 1447222781 0 Physicians Physician Services 00 1447223367 0 MALNAR GERARD J 1991182 9999999 B 10 1447223367 0 2 PROGRESS 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BERMAN ANDREW A 1986274 9999999 B 10 1447240270 0 9630 KENTON AVE SKOKIE IL 600761216 20 1447240270 0 Physicians Anesthesia Services 20 1447240270 0 Physicians Healthy Kids Services 20 1447240270 0 Physicians Optical Supplies 20 1447240270 0 Physicians Physician Services 00 1447240544 0 BURK JANE M 2008275 9999999 B 10 1447240544 0 5400 KENNEDY AVE CINCINNATI OH 452132664 20 1447240544 0 Physicians Anesthesia Services 20 1447240544 0 Physicians Healthy Kids Services 20 1447240544 0 Physicians Optical Supplies 20 1447240544 0 Physicians Physician Services 00 1447240874 0 MILLER MICHAEL P 1996305 9999999 B 10 1447240874 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1447240874 0 Physicians Anesthesia Services 20 1447240874 0 Physicians Fluoride varnish 20 1447240874 0 Physicians Healthy Kids Services 20 1447240874 0 Physicians Optical Supplies 20 1447240874 0 Physicians Physician Services 00 1447242441 0 ZAHNLE MARICHRIS 2024123 9999999 B 10 1447242441 0 PO BOX 4028 ROCK ISLAND IL 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Physicians Anesthesia Services 20 1447243100 0 Physicians Fluoride varnish 20 1447243100 0 Physicians Healthy Kids Services 20 1447243100 0 Physicians Optical Supplies 20 1447243100 0 Physicians Physician Services 00 1447243209 0 HUEBNER JEFFREY 2016306 9999999 B 10 1447243209 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1447243209 0 Physicians Anesthesia Services 20 1447243209 0 Physicians Fluoride varnish 20 1447243209 0 Physicians Healthy Kids Services 20 1447243209 0 Physicians Optical Supplies 20 1447243209 0 Physicians Physician Services 00 1447243241 0 GARTEL MEDEIA 2001182 9999999 B 10 1447243241 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1447243241 0 Physicians Anesthesia Services 20 1447243241 0 Physicians Healthy Kids Services 20 1447243241 0 Physicians Optical Supplies 20 1447243241 0 Physicians Physician Services 20 1447243241 0 Physicians Physicians Psychiatric Services 00 1447243258 0 DUGGAL MANOJ 1996214 9999999 B 10 1447243258 0 PO BOX 781076 DETROIT MI 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1447244603 0 Physicians Physician Services 00 1447244702 0 FISK ELSA 1986113 9999999 B 10 1447244702 0 PO BOX 78838 DETROIT MI 482780838 20 1447244702 0 Physicians Anesthesia Services 20 1447244702 0 Physicians Healthy Kids Services 20 1447244702 0 Physicians Optical Supplies 20 1447244702 0 Physicians Physician Services 00 1447245048 0 MASON CHARLES A 2024274 9999999 B 10 1447245048 0 29373 NETWORK PL CHICAGO IL 606733039 20 1447245048 0 Physicians Anesthesia Services 20 1447245048 0 Physicians Healthy Kids Services 20 1447245048 0 Physicians Optical Supplies 20 1447245048 0 Physicians Physician Services 00 1447245071 0 PUNDALEEKA SARODE K 1981258 9999999 B 10 1447245071 0 2614 W JEFFERSON ST JOLIET IL 604356433 20 1447245071 0 Physicians Anesthesia Services 20 1447245071 0 Physicians Healthy Kids Services 20 1447245071 0 Physicians Optical Supplies 20 1447245071 0 Physicians Physician Services 00 1447245493 0 LUNDBERG JERILYN S 2014321 9999999 B 10 1447245493 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1447245493 0 Physicians Anesthesia Services 20 1447245493 0 Physicians Fluoride varnish 20 1447245493 0 Physicians Healthy Kids Services 20 1447245493 0 Physicians Optical Supplies 20 1447245493 0 Physicians Physician Services 00 1447245816 0 MASSEY COREY P 2017178 9999999 B 10 1447245816 0 PO BOX 28900 GREEN BAY WI 543240900 20 1447245816 0 Physicians Anesthesia Services 20 1447245816 0 Physicians Healthy Kids Services 20 1447245816 0 Physicians Optical Supplies 20 1447245816 0 Physicians Physician Services 00 1447246111 0 GOLDMAN CYNTHIA A 2004215 9999999 B 10 1447246111 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1447246111 0 Physicians Anesthesia Services 20 1447246111 0 Physicians Fluoride varnish 20 1447246111 0 Physicians Healthy Kids Services 20 1447246111 0 Physicians Optical Supplies 20 1447246111 0 Physicians Physician Services 00 1447246392 0 NISSIM KENNETH 2024240 9999999 B 10 1447246392 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1447246392 0 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1447247572 0 Physicians Healthy Kids Services 20 1447247572 0 Physicians Optical Supplies 20 1447247572 0 Physicians Physician Services 00 1447247671 0 SAN PEDRO RICARDO A 2021256 9999999 B 10 1447247671 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1447247671 0 Nurse Practitioners Anesthesia Services 20 1447247671 0 Nurse Practitioners Nurse Practitioners Services 20 1447247671 0 Nurse Practitioners Physician Services 00 1447247747 0 PENNELL RICHARD 2005121 9999999 B 10 1447247747 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1447247747 0 Physicians Anesthesia Services 20 1447247747 0 Physicians Healthy Kids Services 20 1447247747 0 Physicians Optical Supplies 20 1447247747 0 Physicians Physician Services 00 1447249479 0 AYNGORN ALEXANDER 1993305 9999999 B 10 1447249479 0 4433 W TOUHY AVE STE 360 LINCOLNWOOD IL 607121832 20 1447249479 0 Dentists Dental Services 20 1447249479 0 Dentists Physician Services 00 1447249875 0 THOMAS CYNTHIA 1994199 9999999 B 10 1447249875 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1447249875 0 Physicians Anesthesia Services 20 1447249875 0 Physicians Fluoride varnish 20 1447249875 0 Physicians Healthy Kids Services 20 1447249875 0 Physicians Optical Supplies 20 1447249875 0 Physicians Physician Services 00 1447249990 0 NG CHUN 2021198 9999999 B 10 1447249990 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1447249990 0 Physicians Anesthesia Services 20 1447249990 0 Physicians Fluoride varnish 20 1447249990 0 Physicians Healthy Kids Services 20 1447249990 0 Physicians Optical Supplies 20 1447249990 0 Physicians Physician Services 00 1447250543 0 BUNNEY EDWARD 1992061 9999999 B 10 1447250543 0 5665 NEW NORTHSIDE DR ATLANTA GA 303285831 20 1447250543 0 Physicians Anesthesia Services 20 1447250543 0 Physicians Healthy Kids Services 20 1447250543 0 Physicians Optical Supplies 20 1447250543 0 Physicians Physician Services 00 1447250949 0 MAY RONALD C 1981258 9999999 B 10 1447250949 0 740 WAUKEGAN RD STE 360 DEERFIELD IL 600154472 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1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1447304282 0 Physicians Anesthesia Services 20 1447304282 0 Physicians Fluoride varnish 20 1447304282 0 Physicians Healthy Kids Services 20 1447304282 0 Physicians Optical Supplies 20 1447304282 0 Physicians Physician Services 00 1447304431 0 HUANG DORIS SHUWEN 2004054 9999999 B 10 1447304431 0 3753 S COTTAGE GROVE AVE STE 1 CHICAGO IL 606531662 20 1447304431 0 Nurse Practitioners Fluoride varnish 20 1447304431 0 Nurse Practitioners Healthy Kids Services 20 1447304431 0 Nurse Practitioners Nurse Practitioners Services 20 1447304431 0 Nurse Practitioners Physician Services 00 1447307269 0 HARRIS ELIZABETH 2019309 9999999 B 10 1447307269 0 401 COMMERCE ST STE 600 NASHVILLE TN 372192518 20 1447307269 0 Physicians Anesthesia Services 20 1447307269 0 Physicians Healthy Kids Services 20 1447307269 0 Physicians Optical Supplies 20 1447307269 0 Physicians Physician Services 00 1447307897 0 DEMUTH ROBERT W 2021126 9999999 B 10 1447307897 0 PO BOX 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1447315189 0 Physicians Healthy Kids Services 20 1447315189 0 Physicians Optical Supplies 20 1447315189 0 Physicians Physician Services 00 1447315270 0 MILLIS JAMES M 1994189 9999999 B 10 1447315270 0 PO BOX 713384 CHICAGO IL 606771521 20 1447315270 0 Physicians Anesthesia Services 20 1447315270 0 Physicians Healthy Kids Services 20 1447315270 0 Physicians Optical Supplies 20 1447315270 0 Physicians Physician Services 00 1447315783 0 GORSKI KATHERINE O 2000284 9999999 B 10 1447315783 0 1222 DROVER DR LEMONT IL 604397348 20 1447315783 0 Physical Therapists Medical Supplies 20 1447315783 0 Physical Therapists Medical equipment/prosthetic devices 20 1447315783 0 Physical Therapists Physical Therapy Services 00 1447319983 0 HALPERN HOWARD J 1985182 9999999 B 10 1447319983 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1447319983 0 Physicians Anesthesia Services 20 1447319983 0 Physicians Healthy Kids Services 20 1447319983 0 Physicians Optical Supplies 20 1447319983 0 Physicians Physician Services 00 1447320577 0 MELTON PAULA 2008001 9999999 B 10 1447320577 0 PO BOX 736230 DALLAS TX 753736230 20 1447320577 0 Nurse Practitioners Healthy Kids Services 20 1447320577 0 Nurse Practitioners Nurse Practitioners Services 20 1447320577 0 Nurse Practitioners Physician Services 00 1447321849 0 WILLIAMS DONNA C 2006317 9999999 B 10 1447321849 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1447321849 0 Physicians Anesthesia Services 20 1447321849 0 Physicians Fluoride varnish 20 1447321849 0 Physicians Healthy Kids Services 20 1447321849 0 Physicians Optical Supplies 20 1447321849 0 Physicians Physician Services 00 1447322813 0 MACKICHAN CHERYL 2004215 9999999 B 10 1447322813 0 611 W PARK ST URBANA IL 618012529 20 1447322813 0 Nurse Practitioners Anesthesia Services 20 1447322813 0 Nurse Practitioners Nurse Practitioners Services 20 1447322813 0 Nurse Practitioners Physician Services 00 1447324702 0 DUMRAUF JENNIFER E 2007280 9999999 B 10 1447324702 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1447324702 0 Nurse Practitioners Healthy Kids Services 20 1447324702 0 Nurse Practitioners Nurse Practitioners Services 20 1447324702 0 Nurse Practitioners Physician Services 00 1447326905 0 WOO SANG U 1988001 9999999 B 10 1447326905 0 3403 W LAWRENCE AVE CHICAGO IL 606255165 20 1447326905 0 Dentists Dental Services 20 1447326905 0 Dentists Physician Services 00 1447327036 0 ZEMAN DAVID 1982227 9999999 B 10 1447327036 0 611 W PARK ST URBANA IL 618012529 20 1447327036 0 Physicians Anesthesia Services 20 1447327036 0 Physicians Healthy Kids Services 20 1447327036 0 Physicians Optical Supplies 20 1447327036 0 Physicians Physician Services 00 1447327192 0 BARRERA ERMILO 1986202 9999999 B 10 1447327192 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1447327192 0 Physicians Anesthesia Services 20 1447327192 0 Physicians Healthy Kids Services 20 1447327192 0 Physicians Optical Supplies 20 1447327192 0 Physicians Physician Services 00 1447327531 0 FINK ROBERT J 1984224 9999999 B 10 1447327531 0 7200 N WESTERN AVE FL 2 CHICAGO IL 606451812 20 1447327531 0 Physicians Anesthesia Services 20 1447327531 0 Physicians Healthy Kids Services 20 1447327531 0 Physicians Optical Supplies 20 1447327531 0 Physicians Physician Services 00 1447327606 0 KHAN SHIRIN 1996061 9999999 B 10 1447327606 0 PO BOX 527 PALOS PARK IL 604640527 20 1447327606 0 Physicians Anesthesia Services 20 1447327606 0 Physicians Fluoride varnish 20 1447327606 0 Physicians Healthy Kids Services 20 1447327606 0 Physicians Optical Supplies 20 1447327606 0 Physicians Physician Services 00 1447329107 0 MCCUE BENAY A 2007036 9999999 B 10 1447329107 0 8 HERITAGE DR BOURBONNAIS IL 609142514 20 1447329107 0 Other behavior health professional LCPC/LMFT services 00 1447329354 0 HANSEN THOMAS N 2009194 9999999 B 10 1447329354 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1447329354 0 Physicians Anesthesia Services 20 1447329354 0 Physicians Healthy Kids Services 20 1447329354 0 Physicians Optical Supplies 20 1447329354 0 Physicians Physician Services 00 1447329537 0 WEN STEPHEN 2004054 9999999 B 10 1447329537 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1447329537 0 Physicians Anesthesia Services 20 1447329537 0 Physicians Fluoride varnish 20 1447329537 0 Physicians Healthy Kids Services 20 1447329537 0 Physicians Optical Supplies 20 1447329537 0 Physicians Physician Services 00 1447329669 0 LUKANCIC STEVEN 1994182 9999999 B 10 1447329669 0 111 OAKWOOD RD EAST PEORIA IL 616111853 20 1447329669 0 Physicians Anesthesia Services 20 1447329669 0 Physicians Healthy Kids Services 20 1447329669 0 Physicians Optical Supplies 20 1447329669 0 Physicians Physician Services 00 1447329933 0 MONTPETIT MICHELLE C 2004214 9999999 B 10 1447329933 0 5777 DEPT CAROL STREAM IL 601220021 20 1447329933 0 Physicians Anesthesia Services 20 1447329933 0 Physicians Fluoride varnish 20 1447329933 0 Physicians Healthy Kids Services 20 1447329933 0 Physicians Optical Supplies 20 1447329933 0 Physicians Physician Services 00 1447330584 0 CHAMPAGNE CATHERINE M 2022221 9999999 B 10 1447330584 0 PO BOX 43230 PHOENIX AZ 850803230 20 1447330584 0 Physicians Anesthesia Services 20 1447330584 0 Physicians Healthy Kids Services 20 1447330584 0 Physicians Optical Supplies 20 1447330584 0 Physicians Physician Services 00 1447331889 0 PETTY ELIZABETH M 2015244 9999999 B 10 1447331889 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1447331889 0 Physicians Anesthesia Services 20 1447331889 0 Physicians Fluoride varnish 20 1447331889 0 Physicians Healthy Kids Services 20 1447331889 0 Physicians Optical Supplies 20 1447331889 0 Physicians Physician Services 00 1447331897 0 GOLEMBESKI CHRISTOPHER P 2015210 9999999 B 10 1447331897 0 3495 HACKS CROSS RD MEMPHIS TN 381258803 20 1447331897 0 Physicians Anesthesia Services 20 1447331897 0 Physicians Healthy Kids Services 20 1447331897 0 Physicians Optical Supplies 20 1447331897 0 Physicians Physician Services 00 1447332416 0 ROSEN DAVID 1996183 9999999 B 10 1447332416 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1447332416 0 Physicians Anesthesia Services 20 1447332416 0 Physicians Healthy Kids Services 20 1447332416 0 Physicians Optical Supplies 20 1447332416 0 Physicians Physician Services 00 1447332424 0 SHANE STEPHAN W 1999182 9999999 B 10 1447332424 0 530 NE GLEN OAK AVE PEORIA IL 616370001 20 1447332424 0 Physicians Anesthesia Services 20 1447332424 0 Physicians Fluoride varnish 20 1447332424 0 Physicians Healthy Kids Services 20 1447332424 0 Physicians Optical Supplies 20 1447332424 0 Physicians Physician Services 00 1447332705 0 HUSSAIN OMAR S 2007182 9999999 B 10 1447332705 0 29373 NETWORK PL CHICAGO IL 606733039 20 1447332705 0 Physicians Anesthesia Services 20 1447332705 0 Physicians Fluoride varnish 20 1447332705 0 Physicians Healthy Kids Services 20 1447332705 0 Physicians Optical Supplies 20 1447332705 0 Physicians Physician Services 00 1447333554 0 OSOFISAN OLANIYI 1994185 9999999 B 10 1447333554 0 221 NE GLEN OAK AVE PEORIA IL 616360002 20 1447333554 0 Physicians Anesthesia Services 20 1447333554 0 Physicians Fluoride varnish 20 1447333554 0 Physicians Healthy Kids Services 20 1447333554 0 Physicians Optical Supplies 20 1447333554 0 Physicians Physician Services 00 1447336136 0 BHOJWANI ARUN A 1997286 9999999 B 10 1447336136 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1447336136 0 Physicians Anesthesia Services 20 1447336136 0 Physicians Fluoride varnish 20 1447336136 0 Physicians Healthy Kids Services 20 1447336136 0 Physicians Optical Supplies 20 1447336136 0 Physicians Physician Services 00 1447336706 0 VERMA DHARMVIR 1986188 9999999 B 10 1447336706 0 616 S IL ROUTE 31 STE B MCHENRY IL 600508269 20 1447336706 0 Physicians Anesthesia Services 20 1447336706 0 Physicians Healthy Kids Services 20 1447336706 0 Physicians Optical Supplies 20 1447336706 0 Physicians Physician Services 00 1447337340 0 GEDYE JONATHAN 2023345 9999999 B 10 1447337340 0 PO BOX 628215 MIDDLETON WI 535628215 20 1447337340 0 Physicians Anesthesia Services 20 1447337340 0 Physicians Healthy Kids Services 20 1447337340 0 Physicians Optical Supplies 20 1447337340 0 Physicians Physician Services 00 1447337704 0 SHIVALINGAPPA PRABHU 1997032 9999999 B 10 1447337704 0 534 CHESTNUT ST STE 210 HINSDALE IL 605213175 20 1447337704 0 Physicians Anesthesia Services 20 1447337704 0 Physicians Fluoride varnish 20 1447337704 0 Physicians Healthy Kids Services 20 1447337704 0 Physicians Optical Supplies 20 1447337704 0 Physicians Physician Services 00 1447339809 0 SCHROEDER JEFFREY D 2020024 9999999 B 10 1447339809 0 PO BOX 28900 GREEN BAY WI 543240900 20 1447339809 0 Physicians Anesthesia Services 20 1447339809 0 Physicians Healthy Kids Services 20 1447339809 0 Physicians Optical Supplies 20 1447339809 0 Physicians Physician Services 00 1447340120 0 CAMPBELL THOMAS B 2020221 9999999 B 10 1447340120 0 PO BOX 110429 AURORA CO 800420429 20 1447340120 0 Physicians Anesthesia Services 20 1447340120 0 Physicians Fluoride varnish 20 1447340120 0 Physicians Healthy Kids Services 20 1447340120 0 Physicians Optical Supplies 20 1447340120 0 Physicians Physician Services 00 1447341458 0 GRABER DIANNA 2016032 9999999 B 10 1447341458 0 1900 STATE ST CHESTER IL 622331116 20 1447341458 0 Nurse Practitioners Anesthesia Services 20 1447341458 0 Nurse Practitioners Nurse Practitioners Services 20 1447341458 0 Nurse Practitioners Physician Services 00 1447342878 0 VAUGHAN DOUGLAS E 2019007 9999999 B 10 1447342878 0 5777 DEPT CAROL STREAM IL 601220021 20 1447342878 0 Physicians Anesthesia Services 20 1447342878 0 Physicians Fluoride varnish 20 1447342878 0 Physicians Healthy Kids Services 20 1447342878 0 Physicians Optical Supplies 20 1447342878 0 Physicians Physician Services 00 1447343470 0 DEGEUS JENNIFER 2006213 9999999 B 10 1447343470 0 917 SHERWOOD DR LAKE BLUFF IL 600442203 20 1447343470 0 Physicians Anesthesia Services 20 1447343470 0 Physicians Fluoride varnish 20 1447343470 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9999999 B 10 1447346317 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1447346317 0 Physicians Anesthesia Services 20 1447346317 0 Physicians Healthy Kids Services 20 1447346317 0 Physicians Optical Supplies 20 1447346317 0 Physicians Physician Services 00 1447346630 0 GRAY TODD W 2016197 9999999 B 10 1447346630 0 801 ILLINI DR SILVIS IL 612821804 20 1447346630 0 Physicians Anesthesia Services 20 1447346630 0 Physicians Fluoride varnish 20 1447346630 0 Physicians Healthy Kids Services 20 1447346630 0 Physicians Optical Supplies 20 1447346630 0 Physicians Physician Services 00 1447347802 0 VILLA EDUARDO J 1991212 9999999 B 10 1447347802 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1447347802 0 Physicians Anesthesia Services 20 1447347802 0 Physicians Fluoride varnish 20 1447347802 0 Physicians Healthy Kids Services 20 1447347802 0 Physicians Optical Supplies 20 1447347802 0 Physicians Physician Services 00 1447348040 0 TRITES PAUL N. 2005125 9999999 B 10 1447348040 0 1118 11TH ST DE 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Physician Services 00 1447350442 0 KOUSOUBRIS PHILIP D 2022024 9999999 B 10 1447350442 0 PO BOX 3272 INDIANAPOLIS IN 462063272 20 1447350442 0 Physicians Anesthesia Services 20 1447350442 0 Physicians Healthy Kids Services 20 1447350442 0 Physicians Optical Supplies 20 1447350442 0 Physicians Physician Services 00 1447350830 0 ATCHA ISMAIL E 1981227 9999999 B 10 1447350830 0 5420 CLOVERDALE RD STE 101 HANOVER PARK IL 601333649 20 1447350830 0 Physicians Anesthesia Services 20 1447350830 0 Physicians Fluoride varnish 20 1447350830 0 Physicians Healthy Kids Services 20 1447350830 0 Physicians Optical Supplies 20 1447350830 0 Physicians Physician Services 00 1447351077 0 VOLMAR FRITZ HENRY 2010214 9999999 B 10 1447351077 0 530 NE GLEN OAK AVE PEORIA IL 616370001 20 1447351077 0 Physicians Anesthesia Services 20 1447351077 0 Physicians Fluoride varnish 20 1447351077 0 Physicians Healthy Kids Services 20 1447351077 0 Physicians Optical Supplies 20 1447351077 0 Physicians Physician Services 00 1447351192 0 SRIVASTAVA RICHA 2003244 9999999 B 10 1447351192 0 PO BOX 59612 SCHAUMBURG IL 601590612 20 1447351192 0 Physicians Anesthesia Services 20 1447351192 0 Physicians Fluoride varnish 20 1447351192 0 Physicians Healthy Kids Services 20 1447351192 0 Physicians Optical Supplies 20 1447351192 0 Physicians Physician Services 00 1447351648 0 LEAVELL MICHAEL 1987190 9999999 B 10 1447351648 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1447351648 0 Physicians Anesthesia Services 20 1447351648 0 Physicians Healthy Kids Services 20 1447351648 0 Physicians Optical Supplies 20 1447351648 0 Physicians Physician Services 00 1447351655 0 NUNN ANDRE 2023306 9999999 B 10 1447351655 0 PO BOX 34266 BELFAST ME 049150620 20 1447351655 0 Physicians Anesthesia Services 20 1447351655 0 Physicians Healthy Kids Services 20 1447351655 0 Physicians Optical Supplies 20 1447351655 0 Physicians Physician Services 00 1447352620 0 BULGER JOHN J 2005159 9999999 B 10 1447352620 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1447352620 0 Physicians Anesthesia Services 20 1447352620 0 Physicians Healthy Kids Services 20 1447352620 0 Physicians Optical Supplies 20 1447352620 0 Physicians Physician Services 00 1447352711 0 WALSH LORI A 1995032 9999999 B 10 1447352711 0 29373 NETWORK PL CHICAGO IL 606733039 20 1447352711 0 Physicians Anesthesia Services 20 1447352711 0 Physicians Fluoride varnish 20 1447352711 0 Physicians Healthy Kids Services 20 1447352711 0 Physicians Optical Supplies 20 1447352711 0 Physicians Physician Services 00 1447353768 0 ALLIGOOD DAVID 2020085 9999999 B 10 1447353768 0 PO BOX 43230 PHOENIX AZ 850803230 20 1447353768 0 Physicians Anesthesia Services 20 1447353768 0 Physicians Healthy Kids Services 20 1447353768 0 Physicians Optical Supplies 20 1447353768 0 Physicians Physician Services 00 1447354709 0 MATHEW MATHEW C 1981258 9999999 B 10 1447354709 0 303 N JACKSON ST MORRISON IL 612703042 20 1447354709 0 Physicians Anesthesia Services 20 1447354709 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1447632369 0 Physicians Optical Supplies 20 1447632369 0 Physicians Physician Services 20 1447632369 0 Physicians Physicians Psychiatric Services 00 1447632807 0 GARG NITIN 2020118 9999999 B 10 1447632807 0 318 MAXWELL RD STE 500 ALPHARETTA GA 300092064 20 1447632807 0 Physicians Anesthesia Services 20 1447632807 0 Physicians Fluoride varnish 20 1447632807 0 Physicians Healthy Kids Services 20 1447632807 0 Physicians Optical Supplies 20 1447632807 0 Physicians Physician Services 00 1447632815 0 JINA NIMIRA 2022059 9999999 B 10 1447632815 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1447632815 0 Physicians Anesthesia Services 20 1447632815 0 Physicians Healthy Kids Services 20 1447632815 0 Physicians Optical Supplies 20 1447632815 0 Physicians Physician Services 00 1447633128 0 HELMKAMP KIMBERLY E 2019126 9999999 B 10 1447633128 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1447633128 0 Physicians Anesthesia Services 20 1447633128 0 Physicians Fluoride varnish 20 1447633128 0 Physicians 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Physician Assistant Only Fluoride varnish 20 1447640057 0 Physician Assistant Only Healthy Kids Services 20 1447640057 0 Physician Assistant Only Physician Services 00 1447641253 0 SUBHEDAR ADWAITA 2016182 9999999 B 10 1447641253 0 28100 TORCH PKWY STE 600 WARRENVILLE IL 605554030 20 1447641253 0 Physical Therapists Medical Supplies 20 1447641253 0 Physical Therapists Medical equipment/prosthetic devices 20 1447641253 0 Physical Therapists Physical Therapy Services 00 1447641725 0 PETERS JESSICA E 2024219 9999999 B 10 1447641725 0 PO BOX 28900 GREEN BAY WI 543240900 20 1447641725 0 Nurse Practitioners Anesthesia Services 20 1447641725 0 Nurse Practitioners Nurse Practitioners Services 20 1447641725 0 Nurse Practitioners Physician Services 00 1447643341 0 LIPE COREY L 2016287 9999999 B 10 1447643341 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1447643341 0 Nurse Practitioners Fluoride varnish 20 1447643341 0 Nurse Practitioners Healthy Kids Services 20 1447643341 0 Nurse Practitioners 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631952334 20 1447650171 0 Physicians Anesthesia Services 20 1447650171 0 Physicians Healthy Kids Services 20 1447650171 0 Physicians Optical Supplies 20 1447650171 0 Physicians Physician Services 00 1447651708 0 GROSCH DANA MARIE 2014244 9999999 B 10 1447651708 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1447651708 0 Nurse Practitioners Healthy Kids Services 20 1447651708 0 Nurse Practitioners Nurse Practitioners Services 20 1447651708 0 Nurse Practitioners Physician Services 00 1447652078 0 FERRARA MULLIN LENA 2018352 9999999 B 10 1447652078 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1447652078 0 Occupational Therapists Medical Supplies 20 1447652078 0 Occupational Therapists Medical equipment/prosthetic devices 20 1447652078 0 Occupational Therapists Occupational Therapy Services 00 1447654827 0 JOHNSON TANJA M 2015152 9999999 B 10 1447654827 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1447654827 0 Registered nurse Fluoride varnish 20 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00 1447707880 0 BETANCOURT ISABEL 2017053 9999999 B 10 1447707880 0 2245 ENTERPRISE DR STE 4506 WESTCHESTER IL 601545803 20 1447707880 0 Nurse Practitioners Healthy Kids Services 20 1447707880 0 Nurse Practitioners Nurse Practitioners Services 20 1447707880 0 Nurse Practitioners Nursing service 20 1447707880 0 Nurse Practitioners Physician Services 00 1447708300 0 POPP REBEKAH 2023282 9999999 B 10 1447708300 0 302 N JACKSON ST MILWAUKEE WI 532025904 20 1447708300 0 Nurse Practitioners Healthy Kids Services 20 1447708300 0 Nurse Practitioners Midwife Services 20 1447708300 0 Nurse Practitioners Nurse Practitioners Services 20 1447708300 0 Nurse Practitioners Physician Services 00 1447709100 0 HERKERT KATHERINE E 2016267 9999999 B 10 1447709100 0 PO BOX 781076 DETROIT MI 482781076 20 1447709100 0 Physical Therapists Medical Supplies 20 1447709100 0 Physical Therapists Medical equipment/prosthetic devices 20 1447709100 0 Physical Therapists Physical Therapy Services 00 1447709159 0 NICHOLS KELLY A 2016291 9999999 B 10 1447709159 0 2605 KENTUCKY AVE STE 306 PADUCAH KY 420033802 20 1447709159 0 Nurse Practitioners Healthy Kids Services 20 1447709159 0 Nurse Practitioners Nurse Practitioners Services 20 1447709159 0 Nurse Practitioners Physician Services 00 1447709365 0 ABARICIA SARAH N 2017136 9999999 B 10 1447709365 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1447709365 0 Nurse Practitioners Fluoride varnish 20 1447709365 0 Nurse Practitioners Healthy Kids Services 20 1447709365 0 Nurse Practitioners Nurse Practitioners Services 20 1447709365 0 Nurse Practitioners Physician Services 00 1447710967 0 MARCUS KARA 2022242 9999999 B 10 1447710967 0 20100 S SPRUCE DR FRANKFORT IL 604237099 20 1447710967 0 Speech Therapists Medical Supplies 20 1447710967 0 Speech Therapists Medical equipment/prosthetic devices 20 1447710967 0 Speech Therapists Speech Therapy/Pathology Services 00 1447711031 0 DWYER EMMA P 2019175 9999999 B 10 1447711031 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1447711031 0 Physicians Anesthesia Services 20 1447711031 0 Physicians Healthy Kids Services 20 1447711031 0 Physicians Optical Supplies 20 1447711031 0 Physicians Physician Services 00 1447711171 0 GRAY JENNIFER M 2022259 9999999 B 10 1447711171 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1447711171 0 Physicians Anesthesia Services 20 1447711171 0 Physicians Fluoride varnish 20 1447711171 0 Physicians Healthy Kids Services 20 1447711171 0 Physicians Optical Supplies 20 1447711171 0 Physicians Physician Services 00 1447711395 0 BALAGANI AMULYA 2022144 9999999 B 10 1447711395 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1447711395 0 Physicians Anesthesia Services 20 1447711395 0 Physicians Fluoride varnish 20 1447711395 0 Physicians Healthy Kids Services 20 1447711395 0 Physicians Optical Supplies 20 1447711395 0 Physicians Physician Services 00 1447711734 0 LAM NHI 2022143 9999999 B 10 1447711734 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1447711734 0 Physicians Anesthesia Services 20 1447711734 0 Physicians Fluoride varnish 20 1447711734 0 Physicians Healthy Kids Services 20 1447711734 0 Physicians Optical Supplies 20 1447711734 0 Physicians Physician Services 00 1447711742 0 MOHILE NEIL V 2024143 9999999 B 10 1447711742 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1447711742 0 Physicians Anesthesia Services 20 1447711742 0 Physicians Healthy Kids Services 20 1447711742 0 Physicians Optical Supplies 20 1447711742 0 Physicians Physician Services 00 1447711866 0 DONNELL DREW MICHAEL S 2023180 9999999 B 10 1447711866 0 4698 DEPT CAROL STREAM IL 601220021 20 1447711866 0 Physicians Anesthesia Services 20 1447711866 0 Physicians Healthy Kids Services 20 1447711866 0 Physicians Optical Supplies 20 1447711866 0 Physicians Physician Services 00 1447712138 0 ZINTSMASTER KATHLEEN 2023234 9999999 B 10 1447712138 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1447712138 0 Occupational Therapists Medical Supplies 20 1447712138 0 Occupational Therapists Medical equipment/prosthetic devices 20 1447712138 0 Occupational Therapists Occupational Therapy Services 00 1447712161 0 BUTLER KELCI B 2020038 9999999 B 10 1447712161 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1447712161 0 Physicians Anesthesia Services 20 1447712161 0 Physicians Fluoride varnish 20 1447712161 0 Physicians Healthy Kids Services 20 1447712161 0 Physicians Optical Supplies 20 1447712161 0 Physicians Physician Services 00 1447712278 0 HESSINGER JUSTIN 2023362 9999999 B 10 1447712278 0 124 SW ADAMS ST PEORIA IL 616021308 20 1447712278 0 Physicians Anesthesia Services 20 1447712278 0 Physicians Fluoride varnish 20 1447712278 0 Physicians Healthy Kids Services 20 1447712278 0 Physicians Optical Supplies 20 1447712278 0 Physicians Physician Services 00 1447712302 0 LY ANDREW J 2020006 9999999 B 10 1447712302 0 5777 DEPT CAROL STREAM IL 601228942 20 1447712302 0 Physicians Anesthesia Services 20 1447712302 0 Physicians Fluoride varnish 20 1447712302 0 Physicians Healthy Kids Services 20 1447712302 0 Physicians Optical Supplies 20 1447712302 0 Physicians Physician Services 00 1447712328 0 WANG KATHY K 2020031 9999999 B 10 1447712328 0 PO BOX 3039 OAK BROOK IL 605223039 20 1447712328 0 Physicians Anesthesia Services 20 1447712328 0 Physicians Healthy Kids Services 20 1447712328 0 Physicians Optical Supplies 20 1447712328 0 Physicians Physician Services 00 1447713409 0 SCHENCK JEFFREY 2019289 9999999 B 10 1447713409 0 3051 HOLLIS DR SPRINGFIELD IL 627047452 20 1447713409 0 Physicians Anesthesia Services 20 1447713409 0 Physicians Fluoride varnish 20 1447713409 0 Physicians Healthy Kids Services 20 1447713409 0 Physicians Optical Supplies 20 1447713409 0 Physicians Physician Services 00 1447714704 0 BENEFIEL ERIN K 2024289 9999999 B 10 1447714704 0 5777 DEPT CAROL STREAM IL 601220021 20 1447714704 0 Physician Assistant Only Fluoride varnish 20 1447714704 0 Physician Assistant Only Healthy Kids Services 20 1447714704 0 Physician Assistant Only Physician Services 00 1447714712 0 HERNANDEZ RODRIGUEZ REY LUIS 2022182 9999999 B 10 1447714712 0 4698 DEPT CAROL STREAM IL 601220021 20 1447714712 0 Physicians Anesthesia Services 20 1447714712 0 Physicians Healthy Kids Services 20 1447714712 0 Physicians Optical Supplies 20 1447714712 0 Physicians Physician Services 00 1447715420 0 PYTEL TETYANA 2019074 9999999 B 10 1447715420 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1447715420 0 Nurse Practitioners Fluoride varnish 20 1447715420 0 Nurse Practitioners Healthy Kids Services 20 1447715420 0 Nurse Practitioners Nurse Practitioners Services 20 1447715420 0 Nurse Practitioners Physician Services 00 1447716501 0 JONES JOSEPH M 2020061 9999999 B 10 1447716501 0 29373 NETWORK PL CHICAGO IL 606733039 20 1447716501 0 Nurse Practitioners Healthy Kids Services 20 1447716501 0 Nurse Practitioners Nurse Practitioners Services 20 1447716501 0 Nurse Practitioners Physician Services 00 1447717111 0 CLARK KRISTEN M 2019182 9999999 B 10 1447717111 0 600 ENTERPRISE DR STE 220 OAK BROOK IL 605234202 20 1447717111 0 Nurse Practitioners Fluoride varnish 20 1447717111 0 Nurse Practitioners Healthy Kids Services 20 1447717111 0 Nurse Practitioners Nurse Practitioners Services 20 1447717111 0 Nurse Practitioners Physician Services 00 1447717525 0 ABRAMS KELLY J 2019106 9999999 B 10 1447717525 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1447717525 0 Nurse Practitioners Fluoride varnish 20 1447717525 0 Nurse Practitioners Healthy Kids Services 20 1447717525 0 Nurse Practitioners Nurse Practitioners Services 20 1447717525 0 Nurse Practitioners Physician Services 00 1447718820 0 DUNNE THERESE E 2019329 9999999 B 10 1447718820 0 29373 NETWORK PL CHICAGO IL 606733039 20 1447718820 0 Physicians Anesthesia Services 20 1447718820 0 Physicians Fluoride varnish 20 1447718820 0 Physicians Healthy Kids Services 20 1447718820 0 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MULFORD RD ROCKFORD IL 611073877 20 1447724844 0 Registered nurse Nursing service 20 1447724844 0 Registered nurse Waiver service 00 1447725411 0 DAUPHIN CHRISTELLE 2018244 9999999 B 10 1447725411 0 17746 OAK PARK AVE TINLEY PARK IL 604773936 20 1447725411 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1447726161 0 DISANTI DANIELLE 2020021 9999999 B 10 1447726161 0 5777 DEPT CAROL STREAM IL 601220021 20 1447726161 0 Physician Assistant Only Fluoride varnish 20 1447726161 0 Physician Assistant Only Healthy Kids Services 20 1447726161 0 Physician Assistant Only Physician Services 00 1447727847 0 SYEDA SARAH 2023186 9999999 B 10 1447727847 0 11516 183RD PL STE SW ORLAND PARK IL 604679471 20 1447727847 0 Physicians Anesthesia Services 20 1447727847 0 Physicians Healthy Kids Services 20 1447727847 0 Physicians Optical Supplies 20 1447727847 0 Physicians Physician Services 00 1447728019 0 RAHALEY CASEY A 2024207 9999999 B 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1447936000 0 AHMAD FAYEK 2023298 9999999 B 10 1447936000 0 2937 N STATE ROUTE 178 UNIT 2 UTICA IL 613739708 20 1447936000 0 Dentists Dental Services 20 1447936000 0 Dentists Physician Services 00 1447936935 0 MOONEY JOSEPH 2024194 9999999 B 10 1447936935 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1447936935 0 Physicians Anesthesia Services 20 1447936935 0 Physicians Fluoride varnish 20 1447936935 0 Physicians Healthy Kids Services 20 1447936935 0 Physicians Optical Supplies 20 1447936935 0 Physicians Physician Services 00 1447936984 0 VILLALON MARY ANN LONGALONG 2023268 9999999 B 10 1447936984 0 7800 N MILWAUKEE AVE NILES IL 607143124 20 1447936984 0 Nurse Practitioners Healthy Kids Services 20 1447936984 0 Nurse Practitioners Nurse Practitioners Services 20 1447936984 0 Nurse Practitioners Physician Services 00 1447938220 0 DUARTE KRISTINA IZABEL 2023236 9999999 B 10 1447938220 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1447938220 0 Registered nurse Nursing service 20 1447938220 0 Registered nurse Waiver service 00 1447939822 0 TARVAINIS ALEXANDRIA 2023223 9999999 B 10 1447939822 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1447939822 0 Nurse Practitioners Healthy Kids Services 20 1447939822 0 Nurse Practitioners Nurse Practitioners Services 20 1447939822 0 Nurse Practitioners Physician Services 00 1447941745 0 WILEY BENJAMIN 2024303 9999999 B 10 1447941745 0 PO BOX 314 VALPARAISO IN 463840314 20 1447941745 0 Physical Therapists Medical Supplies 20 1447941745 0 Physical Therapists Medical equipment/prosthetic devices 20 1447941745 0 Physical Therapists Physical Therapy Services 00 1447943154 0 OLUSOLA THERESA 2023271 9999999 B 10 1447943154 0 331 W SURF ST STE 708 CHICAGO IL 606577227 20 1447943154 0 Nurse Practitioners Healthy Kids Services 20 1447943154 0 Nurse Practitioners Nurse Practitioners Services 20 1447943154 0 Nurse Practitioners Physician Services 00 1447943808 0 ADAMS KAYLA 2023200 9999999 B 10 1447943808 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1447943808 0 Physicians Anesthesia Services 20 1447943808 0 Physicians Fluoride varnish 20 1447943808 0 Physicians Healthy Kids Services 20 1447943808 0 Physicians Optical Supplies 20 1447943808 0 Physicians Physician Services 00 1447944202 0 PUTHUMANA JOE 2023167 9999999 B 10 1447944202 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1447944202 0 Physicians Anesthesia Services 20 1447944202 0 Physicians Healthy Kids Services 20 1447944202 0 Physicians Optical Supplies 20 1447944202 0 Physicians Physician Services 00 1447944996 0 WIEGAND RYAN 2023202 9999999 B 10 1447944996 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1447944996 0 Physicians Anesthesia Services 20 1447944996 0 Physicians Fluoride varnish 20 1447944996 0 Physicians Healthy Kids Services 20 1447944996 0 Physicians Optical Supplies 20 1447944996 0 Physicians Physician Services 00 1447945472 0 HAMPEL MACKENZIE L 2023128 9999999 B 10 1447945472 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1447945472 0 Clinical Social Worker Social work service 00 1447946066 0 MCDANIEL KENDALL 2024194 9999999 B 10 1447946066 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1447946066 0 Physicians Anesthesia Services 20 1447946066 0 Physicians Healthy Kids Services 20 1447946066 0 Physicians Optical Supplies 20 1447946066 0 Physicians Physician Services 00 1447947452 0 TRUONG ROKY 2024068 9999999 B 10 1447947452 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1447947452 0 Physician Assistant Only Fluoride varnish 20 1447947452 0 Physician Assistant Only Healthy Kids Services 20 1447947452 0 Physician Assistant Only Physician Services 00 1447948021 0 PUNTASECCA CHRISTOPHER J 2023175 9999999 B 10 1447948021 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1447948021 0 Physicians Anesthesia Services 20 1447948021 0 Physicians Healthy Kids Services 20 1447948021 0 Physicians Optical Supplies 20 1447948021 0 Physicians Physician Services 00 1447948088 0 LIANG EDWARD D 2023179 9999999 B 10 1447948088 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1447948088 0 Physicians Anesthesia Services 20 1447948088 0 Physicians Healthy Kids Services 20 1447948088 0 Physicians Optical Supplies 20 1447948088 0 Physicians Physician Services 20 1447948088 0 Physicians Physicians Psychiatric Services 00 1447949730 0 KLEINJAN MATTHEW L 2023201 9999999 B 10 1447949730 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1447949730 0 Physicians Anesthesia Services 20 1447949730 0 Physicians Healthy Kids Services 20 1447949730 0 Physicians Optical Supplies 20 1447949730 0 Physicians Physician Services 00 1447949854 0 OKOROIGWE ASHLEY 2023195 9999999 B 10 1447949854 0 2201 MAIN ST EVANSTON IL 602021519 20 1447949854 0 Nurse Practitioners Fluoride varnish 20 1447949854 0 Nurse Practitioners Healthy Kids Services 20 1447949854 0 Nurse Practitioners Nurse Practitioners Services 20 1447949854 0 Nurse Practitioners Physician Services 00 1447952015 0 OVROM ERIK A 2024184 9999999 B 10 1447952015 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1447952015 0 Physicians Anesthesia Services 20 1447952015 0 Physicians Healthy Kids Services 20 1447952015 0 Physicians Optical Supplies 20 1447952015 0 Physicians Physician Services 00 1447952114 0 INIGUEZ RENIELL X 2024025 9999999 B 10 1447952114 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1447952114 0 Physicians Anesthesia Services 20 1447952114 0 Physicians Fluoride varnish 20 1447952114 0 Physicians Healthy Kids Services 20 1447952114 0 Physicians Optical Supplies 20 1447952114 0 Physicians Physician Services 00 1447952478 0 KISTNER ISABELLA MARY 2023188 9999999 B 10 1447952478 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1447952478 0 Physician Assistant Only Fluoride varnish 20 1447952478 0 Physician Assistant Only Healthy Kids Services 20 1447952478 0 Physician Assistant Only Physician Services 00 1447952577 0 FLAGE MARK 2024183 9999999 B 10 1447952577 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1447952577 0 Physicians Anesthesia Services 20 1447952577 0 Physicians Healthy Kids Services 20 1447952577 0 Physicians Optical Supplies 20 1447952577 0 Physicians Physician Services 00 1447954623 0 ADELOWO BUNMI 2023190 9999999 B 10 1447954623 0 1443 JACKSON AVE RIVER FOREST IL 603051111 20 1447954623 0 Physicians Anesthesia Services 20 1447954623 0 Physicians Fluoride varnish 20 1447954623 0 Physicians Healthy Kids Services 20 1447954623 0 Physicians Optical Supplies 20 1447954623 0 Physicians Physician Services 00 1447954920 0 NIZAMANI KIRAN 2023163 9999999 B 10 1447954920 0 PO BOX 3039 OAK BROOK IL 605223039 20 1447954920 0 Physicians Anesthesia Services 20 1447954920 0 Physicians Fluoride varnish 20 1447954920 0 Physicians Healthy Kids Services 20 1447954920 0 Physicians Optical Supplies 20 1447954920 0 Physicians Physician Services 00 1447955208 0 WANG CATHERINE 2024004 9999999 B 10 1447955208 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1447955208 0 Physicians Anesthesia Services 20 1447955208 0 Physicians Healthy Kids Services 20 1447955208 0 Physicians Optical Supplies 20 1447955208 0 Physicians Physician Services 00 1447955315 0 ZEBOLD MICHAEL R 2023178 9999999 B 10 1447955315 0 PO BOX 3039 OAK BROOK IL 605223039 20 1447955315 0 Physicians Anesthesia Services 20 1447955315 0 Physicians Healthy Kids Services 20 1447955315 0 Physicians Optical Supplies 20 1447955315 0 Physicians Physician Services 00 1447956297 0 SHIN SALLY 2023079 9999999 B 10 1447956297 0 29373 NETWORK PL CHICAGO IL 606733039 20 1447956297 0 Nurse Practitioners Fluoride varnish 20 1447956297 0 Nurse Practitioners Healthy Kids Services 20 1447956297 0 Nurse Practitioners Nurse Practitioners Services 20 1447956297 0 Nurse Practitioners Physician Services 00 1447956669 0 KASUNIC PAUL 2023258 9999999 B 10 1447956669 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1447956669 0 Physicians Anesthesia Services 20 1447956669 0 Physicians Fluoride varnish 20 1447956669 0 Physicians Healthy Kids Services 20 1447956669 0 Physicians Optical Supplies 20 1447956669 0 Physicians Physician Services 00 1447956693 0 HOUSTON INUMIDUM KAFISANWO 2023058 9999999 B 10 1447956693 0 804 E WOODFIELD RD STE 300 SCHAUMBURG IL 601734776 20 1447956693 0 Nurse Practitioners Healthy Kids Services 20 1447956693 0 Nurse Practitioners Nurse Practitioners Services 20 1447956693 0 Nurse Practitioners Physician Services 00 1447956776 0 ROGERS LASHANTI 2023044 9999999 B 10 1447956776 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1447956776 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1447962378 0 KING KELLY M 2023171 9999999 B 10 1447962378 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1447962378 0 Nurse Practitioners Fluoride varnish 20 1447962378 0 Nurse Practitioners Healthy Kids Services 20 1447962378 0 Nurse Practitioners Nurse Practitioners Services 20 1447962378 0 Nurse Practitioners Physician Services 00 1447962568 0 BECZKIEWICZ JEFFREY 2024226 9999999 B 10 1447962568 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1447962568 0 Physician Assistant Only Fluoride varnish 20 1447962568 0 Physician Assistant Only Healthy Kids Services 20 1447962568 0 Physician Assistant Only Physician Services 00 1447963905 0 HAWKINS BREANA M 2024278 9999999 B 10 1447963905 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1447963905 0 Nurse Practitioners Fluoride varnish 20 1447963905 0 Nurse Practitioners Healthy Kids Services 20 1447963905 0 Nurse Practitioners Nurse Practitioners Services 20 1447963905 0 Nurse Practitioners Physician Services 00 1447965538 0 CARRASQUILLA KRISTEN 2023034 9999999 B 10 1447965538 0 2001 BUTTERFIELD RD STE 1600 DOWNERS GROVE IL 605151211 20 1447965538 0 Physical Therapists Medical Supplies 20 1447965538 0 Physical Therapists Medical equipment/prosthetic devices 20 1447965538 0 Physical Therapists Physical Therapy Services 00 1447967393 0 EGSTAD ABBY C 2025023 9999999 B 10 1447967393 0 4714 GETTYSBURG RD MECHANICSBURG PA 170554325 20 1447967393 0 Speech Therapists Medical Supplies 20 1447967393 0 Speech Therapists Medical equipment/prosthetic devices 20 1447967393 0 Speech Therapists Speech Therapy/Pathology Services 00 1447968789 0 LEONIDA FLORDELUZ M 2024023 9999999 B 10 1447968789 0 1S450 SUMMIT AVE STE 270 OAKBROOK TERRAC IL 601813959 20 1447968789 0 Nurse Practitioners Healthy Kids Services 20 1447968789 0 Nurse Practitioners Nurse Practitioners Services 20 1447968789 0 Nurse Practitioners Physician Services 00 1447970108 0 POLASCIK BREANNA 2023174 9999999 B 10 1447970108 0 4698 DEPT CAROL STREAM IL 601220021 20 1447970108 0 Physicians Anesthesia Services 20 1447970108 0 Physicians Healthy Kids Services 20 1447970108 0 Physicians Optical Supplies 20 1447970108 0 Physicians Physician Services 00 1447974514 0 BUTLER SARAH E 2023173 9999999 B 10 1447974514 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1447974514 0 Nurse Practitioners Anesthesia Services 20 1447974514 0 Nurse Practitioners Nurse Practitioners Services 20 1447974514 0 Nurse Practitioners Physician Services 00 1447974753 0 COLLIER CASSIDY D 2024010 9999999 B 10 1447974753 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1447974753 0 Speech Therapists Medical Supplies 20 1447974753 0 Speech Therapists Medical equipment/prosthetic devices 20 1447974753 0 Speech Therapists Speech Therapy/Pathology Services 00 1447976394 0 JOHNSTON BRENNAN F 2022312 9999999 B 10 1447976394 0 122 S MICHIGAN AVE STE 1441 CHICAGO IL 606036173 20 1447976394 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1447977137 0 HANNA NICOLE 2023027 9999999 B 10 1447977137 0 725 S 14TH ST PEKIN IL 615545073 20 1447977137 0 Optometrists Optical Supplies 20 1447977137 0 Optometrists Optometric Services 20 1447977137 0 Optometrists Physician Services 00 1447977509 0 TINNIN TARA 2022322 9999999 B 10 1447977509 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1447977509 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1447978200 0 O'MEARA ASHLEY A 2023017 9999999 B 10 1447978200 0 300 W VAN BUREN ST WYOMING IL 614911172 20 1447978200 0 Speech Therapists Medical Supplies 20 1447978200 0 Speech Therapists Medical equipment/prosthetic devices 20 1447978200 0 Speech Therapists Speech Therapy/Pathology Services 00 1447978697 0 LYONS CAITLYN M 2022231 9999999 B 10 1447978697 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1447978697 0 Nurse Practitioners Healthy Kids Services 20 1447978697 0 Nurse Practitioners Nurse Practitioners Services 20 1447978697 0 Nurse Practitioners Physician Services 00 1447978887 0 GARKOVA MIGLENA 2022235 9999999 B 10 1447978887 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1447978887 0 Nurse Practitioners Fluoride varnish 20 1447978887 0 Nurse Practitioners Healthy Kids Services 20 1447978887 0 Nurse Practitioners Nurse Practitioners Services 20 1447978887 0 Nurse Practitioners Physician Services 00 1447979711 0 ORCHOLSKI COURTNEY 2022236 9999999 B 10 1447979711 0 10150 DEE RD DES PLAINES IL 600161512 20 1447979711 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1447980842 0 BINKLEY TAYLOR 2025030 9999999 B 10 1447980842 0 3033 W PRESIDENT GEORGE BUSH H PLANO TX 750755885 20 1447980842 0 Nurse Practitioners Fluoride varnish 20 1447980842 0 Nurse Practitioners Healthy Kids Services 20 1447980842 0 Nurse Practitioners Nurse Practitioners Services 20 1447980842 0 Nurse Practitioners Physician Services 00 1447981329 0 MEDINA CARBONELL VICTORIA M 2022174 9999999 B 10 1447981329 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1447981329 0 Physicians Anesthesia Services 20 1447981329 0 Physicians Fluoride varnish 20 1447981329 0 Physicians Healthy Kids Services 20 1447981329 0 Physicians Optical Supplies 20 1447981329 0 Physicians Physician Services 00 1447982590 0 KIM JUNGLEE 2022271 2025182 B 10 1447982590 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1447982590 0 Physicians Anesthesia Services 20 1447982590 0 Physicians Fluoride varnish 20 1447982590 0 Physicians Healthy Kids Services 20 1447982590 0 Physicians Optical Supplies 20 1447982590 0 Physicians Physician Services 00 1447984430 0 STALLARD YVONNE G 2022298 9999999 B 10 1447984430 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1447984430 0 Nurse Practitioners Healthy Kids Services 20 1447984430 0 Nurse Practitioners Nurse Practitioners Services 20 1447984430 0 Nurse Practitioners Physician Services 00 1447985668 0 SAJJAD FATIMAH 2023357 9999999 B 10 1447985668 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1447985668 0 Physicians Anesthesia Services 20 1447985668 0 Physicians Fluoride varnish 20 1447985668 0 Physicians Healthy Kids Services 20 1447985668 0 Physicians Optical Supplies 20 1447985668 0 Physicians Physician Services 00 1447985775 0 MUGHAL MOHAMMED Z 2022202 9999999 B 10 1447985775 0 201 E MADISON ST STE 300 SPRINGFIELD IL 627025131 20 1447985775 0 Physicians Anesthesia Services 20 1447985775 0 Physicians Fluoride varnish 20 1447985775 0 Physicians Healthy Kids Services 20 1447985775 0 Physicians Optical Supplies 20 1447985775 0 Physicians Physician Services 00 1447986575 0 JODAT JACOB 2023068 9999999 B 10 1447986575 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1447986575 0 Physician Assistant Only Fluoride varnish 20 1447986575 0 Physician Assistant Only Healthy Kids Services 20 1447986575 0 Physician Assistant Only Physician Services 00 1447987524 0 ATALLAH FEROSS W 2022353 9999999 B 10 1447987524 0 1600 E 93RD ST CHICAGO IL 606173607 20 1447987524 0 Dentists Dental Services 20 1447987524 0 Dentists Physician Services 00 1447987557 0 JAEGGI JANELLE 2023040 9999999 B 10 1447987557 0 515 22ND AVE MONROE WI 535661569 20 1447987557 0 Nurse Practitioners Healthy Kids Services 20 1447987557 0 Nurse Practitioners Nurse Practitioners Services 20 1447987557 0 Nurse Practitioners Physician Services 00 1447988571 0 LUCAS SANJAY R 2022292 9999999 B 10 1447988571 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1447988571 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1447988597 0 WARD MEGAN 2023335 9999999 B 10 1447988597 0 1301 W COSSITT AVE LA GRANGE IL 605252145 20 1447988597 0 Speech Therapists Medical Supplies 20 1447988597 0 Speech Therapists Medical equipment/prosthetic devices 20 1447988597 0 Speech Therapists Speech Therapy/Pathology Services 00 1447988852 0 HARTE HALEY 2023003 9999999 B 10 1447988852 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1447988852 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1447989538 0 TYTUS KARLA 2022168 9999999 B 10 1447989538 0 PO BOX 855795 MINNEAPOLIS MN 554851296 20 1447989538 0 Physicians Anesthesia Services 20 1447989538 0 Physicians Fluoride varnish 20 1447989538 0 Physicians Healthy Kids Services 20 1447989538 0 Physicians Optical Supplies 20 1447989538 0 Physicians Physician Services 00 1447990510 0 LEE JANET D 2023176 9999999 B 10 1447990510 0 PO BOX 3039 OAK BROOK IL 605223039 20 1447990510 0 Physicians Anesthesia Services 20 1447990510 0 Physicians Healthy Kids Services 20 1447990510 0 Physicians Optical Supplies 20 1447990510 0 Physicians Physician Services 00 1447990833 0 QURESHI HASSAN AHMED 2022180 9999999 B 10 1447990833 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1447990833 0 Physicians Anesthesia Services 20 1447990833 0 Physicians Healthy Kids Services 20 1447990833 0 Physicians Optical Supplies 20 1447990833 0 Physicians Physician Services 00 1447990882 0 ZAYED NAJLA 2022178 9999999 B 10 1447990882 0 PO BOX 3039 OAK BROOK IL 605223039 20 1447990882 0 Physicians Anesthesia Services 20 1447990882 0 Physicians Fluoride varnish 20 1447990882 0 Physicians Healthy Kids Services 20 1447990882 0 Physicians Optical Supplies 20 1447990882 0 Physicians Physician Services 00 1447991062 0 RAMIREZ XIOMARA 2025014 9999999 B 10 1447991062 0 207 THUNDER RDG LAKE IN THE HIL IL 601564829 20 1447991062 0 Clinical Social Worker Social work service 00 1447991187 0 BOCHENEK ALEXANDRA N 2022200 9999999 B 10 1447991187 0 PO BOX 3039 OAK BROOK IL 605223039 20 1447991187 0 Physicians Anesthesia Services 20 1447991187 0 Physicians Fluoride varnish 20 1447991187 0 Physicians Healthy Kids Services 20 1447991187 0 Physicians Optical Supplies 20 1447991187 0 Physicians Physician Services 00 1447991401 0 SHARP DILLON W 2022235 9999999 B 10 1447991401 0 7825 SOLUTION CTR CHICAGO IL 606777007 20 1447991401 0 Physicians Anesthesia Services 20 1447991401 0 Physicians Healthy Kids Services 20 1447991401 0 Physicians Optical Supplies 20 1447991401 0 Physicians Physician Services 20 1447991401 0 Physicians Physicians Psychiatric Services 00 1447991898 0 BADARUDDIN MOHAMMED 2022208 9999999 B 10 1447991898 0 PO BOX 3039 OAK BROOK IL 605223039 20 1447991898 0 Physicians Anesthesia Services 20 1447991898 0 Physicians Fluoride varnish 20 1447991898 0 Physicians Healthy Kids Services 20 1447991898 0 Physicians Optical Supplies 20 1447991898 0 Physicians Physician Services 00 1447991930 0 LEE JUWON 2022153 9999999 B 10 1447991930 0 PO BOX 3039 OAK BROOK IL 605223039 20 1447991930 0 Physicians Anesthesia Services 20 1447991930 0 Physicians Fluoride varnish 20 1447991930 0 Physicians Healthy Kids Services 20 1447991930 0 Physicians Optical Supplies 20 1447991930 0 Physicians Physician Services 00 1447992896 0 CHALLA NAYANIKA 2022213 9999999 B 10 1447992896 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1447992896 0 Physicians Anesthesia Services 20 1447992896 0 Physicians Healthy Kids Services 20 1447992896 0 Physicians Optical Supplies 20 1447992896 0 Physicians Physician Services 00 1447993811 0 ZHAO MICHAEL 2023201 9999999 B 10 1447993811 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1447993811 0 Physicians Anesthesia Services 20 1447993811 0 Physicians Healthy Kids Services 20 1447993811 0 Physicians Optical Supplies 20 1447993811 0 Physicians Physician Services 00 1447994942 0 MATE-KOLE NENEYO E 2023187 9999999 B 10 1447994942 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1447994942 0 Physicians Anesthesia Services 20 1447994942 0 Physicians Healthy Kids Services 20 1447994942 0 Physicians Optical Supplies 20 1447994942 0 Physicians Physician Services 00 1447995352 0 POULOS DANIELLE P 2023258 9999999 B 10 1447995352 0 13011 S 104TH AVE STE 100 SUITE 100 PALOS PARK IL 604641508 20 1447995352 0 Nurse Practitioners Fluoride varnish 20 1447995352 0 Nurse Practitioners Healthy Kids Services 20 1447995352 0 Nurse Practitioners Nurse Practitioners Services 20 1447995352 0 Nurse Practitioners Physician Services 00 1447995816 0 MARTINEZ JAVIER 2024183 9999999 B 10 1447995816 0 2001 S CALIFORNIA AVE STE 100 CHICAGO IL 606082486 20 1447995816 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1447997382 0 KUM DENNIS 2023138 9999999 B 10 1447997382 0 PO BOX 3039 OAK BROOK IL 605223039 20 1447997382 0 Physicians Anesthesia Services 20 1447997382 0 Physicians Healthy Kids Services 20 1447997382 0 Physicians Optical Supplies 20 1447997382 0 Physicians Physician Services 00 1447997952 0 MARABLE MARCUS 2022172 9999999 B 10 1447997952 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1447997952 0 Physicians Anesthesia Services 20 1447997952 0 Physicians Fluoride varnish 20 1447997952 0 Physicians Healthy Kids Services 20 1447997952 0 Physicians Optical Supplies 20 1447997952 0 Physicians Physician Services 00 1447998166 0 JOHNSON SHANICE 2022339 9999999 B 10 1447998166 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1447998166 0 Nurse Practitioners Healthy Kids Services 20 1447998166 0 Nurse Practitioners Nurse Practitioners Services 20 1447998166 0 Nurse Practitioners Physician Services 00 1447998364 0 GITTEMEIER KATHLEEN 2022187 9999999 B 10 1447998364 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1447998364 0 Nurse Practitioners Healthy Kids Services 20 1447998364 0 Nurse Practitioners Nurse Practitioners Services 20 1447998364 0 Nurse Practitioners Physician Services 00 1447998984 0 NEWELL MAKYRA 2022145 9999999 B 10 1447998984 0 110 CARVER LN EAST PEORIA IL 616113052 20 1447998984 0 Speech Therapists Medical Supplies 20 1447998984 0 Speech Therapists Medical equipment/prosthetic devices 20 1447998984 0 Speech Therapists Speech Therapy/Pathology Services 00 1447999297 0 AYNGORN ISABELLE 2022197 9999999 B 10 1447999297 0 4433 W TOUHY AVE STE 360 LINCOLNWOOD IL 607121832 20 1447999297 0 Dentists Dental Services 20 1447999297 0 Dentists Physician Services 00 1447999305 0 RADZIN ALEXANDRA 2022178 9999999 B 10 1447999305 0 150 HARVESTER DR STE 300 BURR RIDGE IL 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Only Fluoride varnish 20 1457024754 0 Physician Assistant Only Healthy Kids Services 20 1457024754 0 Physician Assistant Only Physician Services 00 1457025355 0 FORSYTHE MARIKA 2021221 9999999 B 10 1457025355 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1457025355 0 Physicians Anesthesia Services 20 1457025355 0 Physicians Healthy Kids Services 20 1457025355 0 Physicians Optical Supplies 20 1457025355 0 Physicians Physician Services 00 1457025983 0 SAHAGUN JOSEPH 2022241 9999999 B 10 1457025983 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1457025983 0 Physicians Anesthesia Services 20 1457025983 0 Physicians Healthy Kids Services 20 1457025983 0 Physicians Optical Supplies 20 1457025983 0 Physicians Physician Services 00 1457026254 0 CORIROSSI KAYLA B 2021242 9999999 B 10 1457026254 0 1414 MAIN ST MELROSE PARK IL 601603902 20 1457026254 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1457026320 0 GOERGEN 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Physicians Fluoride varnish 20 1457038366 0 Physicians Healthy Kids Services 20 1457038366 0 Physicians Optical Supplies 20 1457038366 0 Physicians Physician Services 00 1457038507 0 AGWUEDU ALEXANDRA 2023192 9999999 B 10 1457038507 0 PO BOX 1109 DEKALB IL 601157109 20 1457038507 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1457038978 0 LEE JENNIFER 2023199 9999999 B 10 1457038978 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1457038978 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1457040537 0 GUNCHENKO MELISSA T 2023192 9999999 B 10 1457040537 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1457040537 0 Physicians Anesthesia Services 20 1457040537 0 Physicians Fluoride varnish 20 1457040537 0 Physicians Healthy Kids Services 20 1457040537 0 Physicians Optical Supplies 20 1457040537 0 Physicians Physician Services 00 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0 1952 MC DOWELL RD STE 305 NAPERVILLE IL 605636507 20 1457068405 0 Physician Assistant Only Fluoride varnish 20 1457068405 0 Physician Assistant Only Healthy Kids Services 20 1457068405 0 Physician Assistant Only Physician Services 00 1457070351 0 ANDERSON JULIA 2022311 9999999 B 10 1457070351 0 29373 NETWORK PL CHICAGO IL 606733039 20 1457070351 0 Physician Assistant Only Fluoride varnish 20 1457070351 0 Physician Assistant Only Healthy Kids Services 20 1457070351 0 Physician Assistant Only Physician Services 00 1457070864 0 MCGEE DANIEL J 2024324 9999999 B 10 1457070864 0 339 CONSORT DR BALLWIN MO 630114439 20 1457070864 0 Nurse Practitioners Anesthesia Services 20 1457070864 0 Nurse Practitioners Nurse Practitioners Services 20 1457070864 0 Nurse Practitioners Physician Services 00 1457070880 0 BURNS MICHELLE 2024110 9999999 B 10 1457070880 0 PO BOX 775253 CHICAGO IL 606775253 20 1457070880 0 Nurse Practitioners Healthy Kids Services 20 1457070880 0 Nurse Practitioners Nurse 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Only Healthy Kids Services 20 1457073876 0 Physician Assistant Only Physician Services 00 1457075103 0 JESBERGER MOLLIE 2024296 9999999 B 10 1457075103 0 PO BOX 431 JANESVILLE WI 535470431 20 1457075103 0 Nurse Practitioners Healthy Kids Services 20 1457075103 0 Nurse Practitioners Nurse Practitioners Services 20 1457075103 0 Nurse Practitioners Physician Services 00 1457075152 0 RINEHART MELISSA 2022362 9999999 B 10 1457075152 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1457075152 0 Nurse Practitioners Healthy Kids Services 20 1457075152 0 Nurse Practitioners Nurse Practitioners Services 20 1457075152 0 Nurse Practitioners Physician Services 00 1457079006 0 CLOW RACHEL 2022279 9999999 B 10 1457079006 0 800 E LOCUST ST OLNEY IL 624502553 20 1457079006 0 Nurse Practitioners Fluoride varnish 20 1457079006 0 Nurse Practitioners Healthy Kids Services 20 1457079006 0 Nurse Practitioners Nurse Practitioners Services 20 1457079006 0 Nurse Practitioners Physician Services 00 1457080293 0 GARCIA JENNIFER 2022306 9999999 B 10 1457080293 0 5220 EAST AVE COUNTRYSIDE IL 605253133 20 1457080293 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1457081531 0 RASOOL FAIZAN 2022228 9999999 B 10 1457081531 0 2653 W OGDEN AVE CHICAGO IL 60608 20 1457081531 0 Physicians Anesthesia Services 20 1457081531 0 Physicians Fluoride varnish 20 1457081531 0 Physicians Healthy Kids Services 20 1457081531 0 Physicians Optical Supplies 20 1457081531 0 Physicians Physician Services 00 1457083545 0 BARTI LATIFA 2022194 9999999 B 10 1457083545 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1457083545 0 Physicians Anesthesia Services 20 1457083545 0 Physicians Fluoride varnish 20 1457083545 0 Physicians Healthy Kids Services 20 1457083545 0 Physicians Optical Supplies 20 1457083545 0 Physicians Physician Services 00 1457083677 0 SHAH KHUSBU 2022202 9999999 B 10 1457083677 0 370 SUMMIT ST # 1 ELGIN IL 601203843 20 1457083677 0 Physician Assistant Only Fluoride varnish 20 1457083677 0 Physician Assistant Only Healthy Kids Services 20 1457083677 0 Physician Assistant Only Physician Services 00 1457084915 0 ROSARIO LORA DAURIS 2022207 9999999 B 10 1457084915 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1457084915 0 Physicians Anesthesia Services 20 1457084915 0 Physicians Fluoride varnish 20 1457084915 0 Physicians Healthy Kids Services 20 1457084915 0 Physicians Optical Supplies 20 1457084915 0 Physicians Physician Services 00 1457085789 0 BRONES ANGELA 2023283 9999999 B 10 1457085789 0 4600 3RD ST MOLINE IL 612656106 20 1457085789 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1457085946 0 ASHTON JENNIFER 2022262 9999999 B 10 1457085946 0 5921 MERIDIAN WOODS GLEN CARBON IL 620341545 20 1457085946 0 Nurse Practitioners Anesthesia Services 20 1457085946 0 Nurse Practitioners Nurse Practitioners Services 20 1457085946 0 Nurse Practitioners Physician Services 00 1457086076 0 AUBRY DEANNA 2022277 9999999 B 10 1457086076 0 10001 W INNOVATION DR STE 200 WAUWATOSA WI 532264851 20 1457086076 0 Nurse Practitioners Healthy Kids Services 20 1457086076 0 Nurse Practitioners Nurse Practitioners Services 20 1457086076 0 Nurse Practitioners Physician Services 00 1457086407 0 BARRY SHANNON 2023335 9999999 B 10 1457086407 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1457086407 0 Audiologists Audiology Services 20 1457086407 0 Audiologists Medical Supplies 20 1457086407 0 Audiologists Medical equipment/prosthetic devices 00 1457086696 0 BERNAT MELISSA 2022299 9999999 B 10 1457086696 0 1009 WINDCROSS CT STE 101 FRANKLIN TN 370672678 20 1457086696 0 Nurse Practitioners Healthy Kids Services 20 1457086696 0 Nurse Practitioners Nurse Practitioners Services 20 1457086696 0 Nurse Practitioners Physician Services 00 1457086886 0 RAMESH KEERTHIVASAN 2022221 9999999 B 10 1457086886 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1457086886 0 Physicians Anesthesia Services 20 1457086886 0 Physicians Healthy Kids Services 20 1457086886 0 Physicians Optical Supplies 20 1457086886 0 Physicians Physician Services 20 1457086886 0 Physicians Physicians Psychiatric Services 00 1457087900 0 KEIGLEY BENJAMIN J 2022265 9999999 B 10 1457087900 0 29373 NETWORK PL CHICAGO IL 606733039 20 1457087900 0 Nurse Practitioners Healthy Kids Services 20 1457087900 0 Nurse Practitioners Nurse Practitioners Services 20 1457087900 0 Nurse Practitioners Physician Services 00 1457089609 0 SIGDEL SURENDRA 2022313 9999999 B 10 1457089609 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1457089609 0 Physicians Anesthesia Services 20 1457089609 0 Physicians Fluoride varnish 20 1457089609 0 Physicians Healthy Kids Services 20 1457089609 0 Physicians Optical Supplies 20 1457089609 0 Physicians Physician Services 00 1457089674 0 TSO ANGELA 2022263 9999999 B 10 1457089674 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1457089674 0 Physician Assistant Only Fluoride varnish 20 1457089674 0 Physician Assistant Only Healthy Kids Services 20 1457089674 0 Physician Assistant Only Physician Services 00 1457090078 0 FLYNN TAYLOR 2022224 9999999 B 10 1457090078 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1457090078 0 Audiologists Audiology Services 20 1457090078 0 Audiologists Medical Supplies 20 1457090078 0 Audiologists Medical equipment/prosthetic devices 00 1457090441 0 MACDADE ERIN S 2022236 9999999 B 10 1457090441 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1457090441 0 Nurse Practitioners Healthy Kids Services 20 1457090441 0 Nurse Practitioners Nurse Practitioners Services 20 1457090441 0 Nurse Practitioners Physician Services 00 1457090789 0 KALLAN ABUBAKER 2022186 9999999 B 10 1457090789 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1457090789 0 Physicians Anesthesia Services 20 1457090789 0 Physicians Fluoride varnish 20 1457090789 0 Physicians Healthy Kids Services 20 1457090789 0 Physicians Optical Supplies 20 1457090789 0 Physicians Physician Services 00 1457091142 0 JOHN PAUL 2022175 9999999 B 10 1457091142 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1457091142 0 Physicians Anesthesia Services 20 1457091142 0 Physicians Fluoride varnish 20 1457091142 0 Physicians Healthy Kids Services 20 1457091142 0 Physicians Optical Supplies 20 1457091142 0 Physicians Physician Services 00 1457091456 0 BAKARE MARYAM 2022180 9999999 B 10 1457091456 0 PO BOX 3039 OAK BROOK IL 605223039 20 1457091456 0 Physicians Anesthesia Services 20 1457091456 0 Physicians Healthy Kids Services 20 1457091456 0 Physicians Optical Supplies 20 1457091456 0 Physicians Physician Services 00 1457091886 0 APPALANENI VINEELA 2022173 9999999 B 10 1457091886 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1457091886 0 Physicians Anesthesia Services 20 1457091886 0 Physicians Fluoride varnish 20 1457091886 0 Physicians Healthy Kids Services 20 1457091886 0 Physicians Optical Supplies 20 1457091886 0 Physicians Physician Services 00 1457092561 0 PRICE SARAH E 2022179 9999999 B 10 1457092561 0 8940 N WOOD SAGE RD PEORIA IL 616157822 20 1457092561 0 Nurse Practitioners Fluoride varnish 20 1457092561 0 Nurse Practitioners Healthy Kids Services 20 1457092561 0 Nurse Practitioners Nurse Practitioners Services 20 1457092561 0 Nurse Practitioners Physician Services 00 1457092694 0 SKELTON PAUL B 2022199 9999999 B 10 1457092694 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1457092694 0 Physicians Anesthesia Services 20 1457092694 0 Physicians Fluoride varnish 20 1457092694 0 Physicians Healthy Kids Services 20 1457092694 0 Physicians Optical Supplies 20 1457092694 0 Physicians Physician Services 00 1457092769 0 NANGUNURI BHAVANA 2023207 9999999 B 10 1457092769 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1457092769 0 Physicians Anesthesia Services 20 1457092769 0 Physicians Healthy Kids Services 20 1457092769 0 Physicians Optical Supplies 20 1457092769 0 Physicians Physician Services 00 1457092868 0 MARTINEZ JACQUELINE 2022104 9999999 B 10 1457092868 0 2875 W 19TH ST CHICAGO IL 606233501 20 1457092868 0 Nurse Practitioners Fluoride varnish 20 1457092868 0 Nurse Practitioners Healthy Kids Services 20 1457092868 0 Nurse Practitioners Nurse Practitioners Services 20 1457092868 0 Nurse Practitioners Physician Services 00 1457093213 0 AMIR UROOSA 2022180 9999999 B 10 1457093213 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1457093213 0 Physicians Anesthesia Services 20 1457093213 0 Physicians Fluoride varnish 20 1457093213 0 Physicians Healthy Kids Services 20 1457093213 0 Physicians Optical Supplies 20 1457093213 0 Physicians Physician Services 00 1457093726 0 CASEY LAUREN E 2022239 9999999 B 10 1457093726 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1457093726 0 Physicians Anesthesia Services 20 1457093726 0 Physicians Healthy Kids Services 20 1457093726 0 Physicians Optical Supplies 20 1457093726 0 Physicians Physician Services 00 1457093809 0 ALI PAULA 2022112 9999999 H 10 1457093809 0 3010 GRAND AVE WAUKEGAN IL 60085 20 1457093809 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1457093999 0 KOZAK KYLE J 2022213 9999999 B 10 1457093999 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1457093999 0 Physicians Anesthesia Services 20 1457093999 0 Physicians Healthy Kids Services 20 1457093999 0 Physicians Optical Supplies 20 1457093999 0 Physicians Physician Services 00 1457094385 0 RICHEY ALLISON 2024192 9999999 B 10 1457094385 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1457094385 0 Physicians Anesthesia Services 20 1457094385 0 Physicians Fluoride varnish 20 1457094385 0 Physicians Healthy Kids Services 20 1457094385 0 Physicians Optical Supplies 20 1457094385 0 Physicians Physician Services 00 1457094492 0 ALASHOOR MARAM 2022224 9999999 B 10 1457094492 0 4698 DEPT CAROL STREAM IL 601224698 20 1457094492 0 Physicians Anesthesia Services 20 1457094492 0 Physicians Fluoride varnish 20 1457094492 0 Physicians Healthy Kids Services 20 1457094492 0 Physicians Optical Supplies 20 1457094492 0 Physicians Physician Services 00 1457094609 0 COOK CONNOR J 2022181 9999999 B 10 1457094609 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1457094609 0 Physicians Anesthesia Services 20 1457094609 0 Physicians Fluoride varnish 20 1457094609 0 Physicians Healthy Kids Services 20 1457094609 0 Physicians Optical Supplies 20 1457094609 0 Physicians Physician Services 00 1457095820 0 PALCHEFF NICHOLAS 2022213 9999999 B 10 1457095820 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1457095820 0 Physicians Anesthesia Services 20 1457095820 0 Physicians Fluoride varnish 20 1457095820 0 Physicians Healthy Kids Services 20 1457095820 0 Physicians Optical Supplies 20 1457095820 0 Physicians Physician Services 00 1457096497 0 KLAPHOLZ NATALIE K 2022177 9999999 B 10 1457096497 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1457096497 0 Physicians Anesthesia Services 20 1457096497 0 Physicians Fluoride varnish 20 1457096497 0 Physicians Healthy Kids Services 20 1457096497 0 Physicians Optical Supplies 20 1457096497 0 Physicians Physician Services 00 1457096935 0 MARKULIN JAMIE M 2022147 9999999 B 10 1457096935 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1457096935 0 Nurse Practitioners Healthy Kids Services 20 1457096935 0 Nurse Practitioners Nurse Practitioners Services 20 1457096935 0 Nurse Practitioners Physician Services 00 1457096968 0 MCCANN JESSICA P 2022177 9999999 B 10 1457096968 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1457096968 0 Physicians Anesthesia Services 20 1457096968 0 Physicians Healthy Kids Services 20 1457096968 0 Physicians Optical Supplies 20 1457096968 0 Physicians Physician Services 00 1457097693 0 WAHEED HIBA 2022144 9999999 H 10 1457097693 0 1013 CLUB LAKE DR ANTIOCH IL 60002 20 1457097693 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1457098410 0 CZOPEK COREY J 2022322 9999999 B 10 1457098410 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1457098410 0 Physician Assistant Only Fluoride varnish 20 1457098410 0 Physician Assistant Only Healthy Kids Services 20 1457098410 0 Physician Assistant Only Physician Services 00 1457099277 0 TAMIZUDDIN SALLY-ANN 2022250 9999999 B 10 1457099277 0 55 E JACKSON BLVD STE 1500 CHICAGO IL 606044184 20 1457099277 0 Nurse Practitioners Healthy Kids Services 20 1457099277 0 Nurse Practitioners Nurse Practitioners Services 20 1457099277 0 Nurse Practitioners Physician Services 00 1457101040 0 WILNER JOSEPH 2024198 9999999 B 10 1457101040 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1457101040 0 Physicians Anesthesia Services 20 1457101040 0 Physicians Fluoride varnish 20 1457101040 0 Physicians Healthy Kids Services 20 1457101040 0 Physicians Optical Supplies 20 1457101040 0 Physicians Physician Services 00 1457101362 0 CARLSON RACHEL J 2024176 9999999 B 10 1457101362 0 4698 DEPT CAROL STREAM IL 601224698 20 1457101362 0 Physicians Anesthesia Services 20 1457101362 0 Physicians Fluoride varnish 20 1457101362 0 Physicians Healthy Kids Services 20 1457101362 0 Physicians Optical Supplies 20 1457101362 0 Physicians Physician Services 00 1457101545 0 SHIRAZI SAJJAD 2024157 9999999 B 10 1457101545 0 PO BOX 3039 OAK BROOK IL 605223039 20 1457101545 0 Dentists Dental Services 20 1457101545 0 Dentists Physician Services 00 1457101685 0 MALONE REISE 2024176 9999999 B 10 1457101685 0 4698 DEPT CAROL STREAM IL 601224698 20 1457101685 0 Physicians Anesthesia Services 20 1457101685 0 Physicians Fluoride varnish 20 1457101685 0 Physicians Healthy Kids Services 20 1457101685 0 Physicians Optical Supplies 20 1457101685 0 Physicians Physician Services 00 1457102600 0 GREY-THERIOT FRANCINE 2024184 9999999 B 10 1457102600 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1457102600 0 Physicians Anesthesia Services 20 1457102600 0 Physicians Fluoride varnish 20 1457102600 0 Physicians Healthy Kids Services 20 1457102600 0 Physicians Optical Supplies 20 1457102600 0 Physicians Physician Services 00 1457103459 0 GARG VIKRANT 2024173 9999999 B 10 1457103459 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1457103459 0 Physicians Anesthesia Services 20 1457103459 0 Physicians Fluoride varnish 20 1457103459 0 Physicians Healthy Kids Services 20 1457103459 0 Physicians Optical Supplies 20 1457103459 0 Physicians Physician Services 00 1457103509 0 KHAN MUHAMMAD ASAD 2024179 9999999 B 10 1457103509 0 1044 N FRANCISCO AVE CHICAGO IL 606222743 20 1457103509 0 Physicians Anesthesia Services 20 1457103509 0 Physicians Fluoride varnish 20 1457103509 0 Physicians Healthy Kids Services 20 1457103509 0 Physicians Optical Supplies 20 1457103509 0 Physicians Physician Services 00 1457103632 0 IZAT LICEOGLU AYLIN 2024185 9999999 B 10 1457103632 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1457103632 0 Physicians Anesthesia Services 20 1457103632 0 Physicians Fluoride varnish 20 1457103632 0 Physicians Healthy Kids Services 20 1457103632 0 Physicians Optical Supplies 20 1457103632 0 Physicians Physician Services 00 1457103806 0 JUERGENS TAMMY 2024161 9999999 B 10 1457103806 0 901 E 5TH ST WASHINGTON MO 630903127 20 1457103806 0 Nurse Practitioners Fluoride varnish 20 1457103806 0 Nurse Practitioners Healthy Kids Services 20 1457103806 0 Nurse Practitioners Nurse Practitioners Services 20 1457103806 0 Nurse Practitioners Physician Services 00 1457104465 0 GRISEL BRAYLEE 2024180 9999999 B 10 1457104465 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1457104465 0 Physicians Anesthesia Services 20 1457104465 0 Physicians Healthy Kids Services 20 1457104465 0 Physicians Optical Supplies 20 1457104465 0 Physicians Physician Services 00 1457105389 0 BANKS CHRISTINE 2025007 9999999 B 10 1457105389 0 3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047452 20 1457105389 0 Nurse Practitioners Fluoride varnish 20 1457105389 0 Nurse Practitioners Healthy Kids Services 20 1457105389 0 Nurse Practitioners Nurse Practitioners Services 20 1457105389 0 Nurse Practitioners Physician Services 00 1457108235 0 SAGHIR ZERNAB 2024262 2099365 B 10 1457108235 0 1220 S WOOD ST CHICAGO IL 606081202 20 1457108235 0 Physicians Anesthesia Services 20 1457108235 0 Physicians Fluoride varnish 20 1457108235 0 Physicians Healthy Kids Services 20 1457108235 0 Physicians Optical Supplies 20 1457108235 0 Physicians Physician Services 00 1457109928 0 COYNE SAMANTHA E 2024158 9999999 B 10 1457109928 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1457109928 0 Nurse Practitioners Fluoride varnish 20 1457109928 0 Nurse Practitioners Healthy Kids Services 20 1457109928 0 Nurse Practitioners Nurse Practitioners Services 20 1457109928 0 Nurse Practitioners Physician Services 00 1457110769 0 PONT ABIGAIL 2024192 9999999 B 10 1457110769 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1457110769 0 Physicians Anesthesia Services 20 1457110769 0 Physicians Fluoride varnish 20 1457110769 0 Physicians Healthy Kids Services 20 1457110769 0 Physicians Optical Supplies 20 1457110769 0 Physicians Physician Services 00 1457111411 0 SILVERGLATE BRET 2024193 9999999 B 10 1457111411 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1457111411 0 Physicians Anesthesia Services 20 1457111411 0 Physicians Healthy Kids Services 20 1457111411 0 Physicians Optical Supplies 20 1457111411 0 Physicians Physician Services 20 1457111411 0 Physicians Physicians Psychiatric Services 00 1457111734 0 REXROTH JONATHAN 2024192 9999999 B 10 1457111734 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1457111734 0 Physicians Anesthesia Services 20 1457111734 0 Physicians Fluoride varnish 20 1457111734 0 Physicians Healthy Kids Services 20 1457111734 0 Physicians Optical Supplies 20 1457111734 0 Physicians Physician Services 00 1457116246 0 ANDERSON COURTNEY 2024064 9999999 B 10 1457116246 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1457116246 0 Nurse Practitioners Fluoride varnish 20 1457116246 0 Nurse Practitioners Healthy Kids Services 20 1457116246 0 Nurse Practitioners Nurse Practitioners Services 20 1457116246 0 Nurse Practitioners Physician Services 00 1457121063 0 STATZ ALYSHA 2024060 9999999 B 10 1457121063 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1457121063 0 Physician Assistant Only Fluoride varnish 20 1457121063 0 Physician Assistant Only Healthy Kids Services 20 1457121063 0 Physician Assistant Only Physician Services 00 1457121246 0 ADELEYE BABAJIDE 2024284 9999999 B 10 1457121246 0 PO BOX 345 SUMMIT ARGO IL 605010345 20 1457121246 0 Nurse Practitioners Healthy Kids Services 20 1457121246 0 Nurse Practitioners Nurse Practitioners Services 20 1457121246 0 Nurse Practitioners Physician Services 00 1457121345 0 AMBROSY COURTNEY N 2024022 9999999 B 10 1457121345 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1457121345 0 Physician Assistant Only Fluoride varnish 20 1457121345 0 Physician Assistant Only Healthy Kids Services 20 1457121345 0 Physician Assistant Only Physician Services 00 1457123226 0 KELSO LAURA M 2023362 9999999 B 10 1457123226 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1457123226 0 Nurse Practitioners Healthy Kids Services 20 1457123226 0 Nurse Practitioners Nurse Practitioners Services 20 1457123226 0 Nurse Practitioners Physician Services 00 1457125643 0 VOGT CLAYTON R 2023353 9999999 B 10 1457125643 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1457125643 0 Physician Assistant Only Fluoride varnish 20 1457125643 0 Physician Assistant Only Healthy Kids Services 20 1457125643 0 Physician Assistant Only Physician Services 00 1457129272 0 OKAGBUE NNEKA 2024236 9999999 B 10 1457129272 0 5736 W NORTH AVE CHICAGO IL 606394152 20 1457129272 0 Nurse Practitioners Fluoride varnish 20 1457129272 0 Nurse Practitioners Healthy Kids Services 20 1457129272 0 Nurse Practitioners Nurse Practitioners Services 20 1457129272 0 Nurse Practitioners Physician Services 00 1457130247 0 ELLIOTT JORDAN E 2023282 9999999 B 10 1457130247 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1457130247 0 Nurse Practitioners Healthy Kids Services 20 1457130247 0 Nurse Practitioners Nurse Practitioners Services 20 1457130247 0 Nurse Practitioners Physician Services 00 1457133431 0 TRAVIS ASHLEY L 2023289 9999999 B 10 1457133431 0 7358 N LINCOLN AVE STE 170 LINCOLNWOOD IL 607121710 20 1457133431 0 Occupational Therapists Medical Supplies 20 1457133431 0 Occupational Therapists Medical equipment/prosthetic devices 20 1457133431 0 Occupational Therapists Occupational Therapy Services 00 1457133787 0 WILLIAMS TAWANA M 2024044 9999999 B 10 1457133787 0 2081 CALISTOGA DR STE 2 NEW LENOX IL 604514831 20 1457133787 0 Nurse Practitioners Healthy Kids Services 20 1457133787 0 Nurse Practitioners Nurse Practitioners Services 20 1457133787 0 Nurse Practitioners Physician Services 00 1457134751 0 SEEHOFNEROVA ANNA 2024236 9999999 B 10 1457134751 0 500 PASTEUR DR PALO ALTO CA 943041048 20 1457134751 0 Physicians Anesthesia Services 20 1457134751 0 Physicians Healthy Kids Services 20 1457134751 0 Physicians Optical Supplies 20 1457134751 0 Physicians Physician Services 00 1457134926 0 FLAHERTY OLIVIA 2023335 9999999 B 10 1457134926 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1457134926 0 Nurse Practitioners Fluoride varnish 20 1457134926 0 Nurse Practitioners Healthy Kids Services 20 1457134926 0 Nurse Practitioners Nurse Practitioners Services 20 1457134926 0 Nurse Practitioners Physician Services 00 1457137143 0 SANTIAGO-ROQUE JOSE J 2024005 9999999 B 10 1457137143 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1457137143 0 Physician Assistant Only Fluoride varnish 20 1457137143 0 Physician Assistant Only Healthy Kids Services 20 1457137143 0 Physician Assistant Only Physician Services 00 1457137770 0 TREMBLAY SAMANTHA 2023257 9999999 B 10 1457137770 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1457137770 0 Occupational Therapists Medical Supplies 20 1457137770 0 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00 1457190399 0 LOWERY MARTINA 2024186 9999999 B 10 1457190399 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1457190399 0 Clinical Social Worker Social work service 00 1457191041 0 CRESSELL DALLAS 2024156 9999999 B 10 1457191041 0 2885 W BATTLEFIELD ST SPRINGFIELD MO 658073952 20 1457191041 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1457191181 0 WILLINGHAM DELANEY 2024158 9999999 B 10 1457191181 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1457191181 0 Physical Therapists Medical Supplies 20 1457191181 0 Physical Therapists Medical equipment/prosthetic devices 20 1457191181 0 Physical Therapists Physical Therapy Services 00 1457191751 0 GELERI DUYGU B 2024180 9999999 B 10 1457191751 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1457191751 0 Physicians Anesthesia Services 20 1457191751 0 Physicians Healthy Kids Services 20 1457191751 0 Physicians Optical Supplies 20 1457191751 0 Physicians Physician Services 00 1457191983 0 SIMON MICHAELA 2024290 9999999 B 10 1457191983 0 1757 N KIMBALL AVE STE 202 CHICAGO IL 606474805 20 1457191983 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1457192205 0 IVORY CHRISTY 2024194 9999999 B 10 1457192205 0 15740 S OUTER 40 RD CHESTERFIELD MO 630172004 20 1457192205 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1457192338 0 FUENTES JANAY 2024340 9999999 B 10 1457192338 0 118 APPLEBEE ST BARRINGTON IL 600103035 20 1457192338 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1457192379 0 SANDERS SAMARIA 2024158 9999999 B 10 1457192379 0 PO BOX 1109 DEKALB IL 601157109 20 1457192379 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1457194052 0 TURKIN MARISSA K 2024199 9999999 B 10 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Physician Assistant Only Fluoride varnish 20 1457198160 0 Physician Assistant Only Healthy Kids Services 20 1457198160 0 Physician Assistant Only Physician Services 00 1457199671 0 PEDERSEN PRECIOUS 2024205 9999999 B 10 1457199671 0 201 E MADISON ST STE 300 SPRINGFIELD IL 627025131 20 1457199671 0 Physicians Anesthesia Services 20 1457199671 0 Physicians Fluoride varnish 20 1457199671 0 Physicians Healthy Kids Services 20 1457199671 0 Physicians Optical Supplies 20 1457199671 0 Physicians Physician Services 00 1457300857 0 AL-MASSALKHI MOHAMAD 1996270 9999999 B 10 1457300857 0 29373 NETWORK PL CHICAGO IL 606733039 20 1457300857 0 Physicians Anesthesia Services 20 1457300857 0 Physicians Fluoride varnish 20 1457300857 0 Physicians Healthy Kids Services 20 1457300857 0 Physicians Optical Supplies 20 1457300857 0 Physicians Physician Services 00 1457301368 0 BOTTS ERIC K 2005284 9999999 B 10 1457301368 0 PO BOX 465 MACOMB IL 614550465 20 1457301368 0 Optometrists Optical Supplies 20 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Supplies 20 1457302564 0 Physicians Physician Services 00 1457302986 0 CHIOROS PETER G 1989084 9999999 B 10 1457302986 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1457302986 0 Podiatrists Podiatric Services 00 1457303943 0 EWELL KIMBALL 1995032 9999999 B 10 1457303943 0 1239 E MAIN ST CARBONDALE IL 629013175 20 1457303943 0 Physicians Anesthesia Services 20 1457303943 0 Physicians Fluoride varnish 20 1457303943 0 Physicians Healthy Kids Services 20 1457303943 0 Physicians Optical Supplies 20 1457303943 0 Physicians Physician Services 00 1457303968 0 MOHAN GLEN A 2016130 9999999 B 10 1457303968 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1457303968 0 Nurse Practitioners Fluoride varnish 20 1457303968 0 Nurse Practitioners Healthy Kids Services 20 1457303968 0 Nurse Practitioners Nurse Practitioners Services 20 1457303968 0 Nurse Practitioners Physician Services 00 1457304156 0 WARGO MARK A 1999187 9999999 B 10 1457304156 0 124 SW ADAMS ST PEORIA IL 616021320 20 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9999999 B 10 1457324311 0 7331 N LINCOLN AVE STE 15 LINCOLNWOOD IL 607121766 20 1457324311 0 Nurse Practitioners Healthy Kids Services 20 1457324311 0 Nurse Practitioners Nurse Practitioners Services 20 1457324311 0 Nurse Practitioners Physician Services 00 1457325037 0 BATLLE DANIEL 1981227 9999999 B 10 1457325037 0 5777 DEPT CAROL STREAM IL 601220021 20 1457325037 0 Physicians Anesthesia Services 20 1457325037 0 Physicians Fluoride varnish 20 1457325037 0 Physicians Healthy Kids Services 20 1457325037 0 Physicians Optical Supplies 20 1457325037 0 Physicians Physician Services 00 1457325334 0 VILLARROEL FERNANDEZ OMAR M 2007311 9999999 B 10 1457325334 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1457325334 0 Physicians Anesthesia Services 20 1457325334 0 Physicians Fluoride varnish 20 1457325334 0 Physicians Healthy Kids Services 20 1457325334 0 Physicians Optical Supplies 20 1457325334 0 Physicians Physician Services 00 1457325433 0 QUEK MARCUS 2005213 9999999 B 10 1457325433 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1457325433 0 Physicians Anesthesia Services 20 1457325433 0 Physicians Healthy Kids Services 20 1457325433 0 Physicians Optical Supplies 20 1457325433 0 Physicians Physician Services 00 1457325987 0 OREILLY DANIEL 1981227 9999999 B 10 1457325987 0 20 TOWER CT STE F SUITE F GURNEE IL 600315711 20 1457325987 0 Physicians Anesthesia Services 20 1457325987 0 Physicians Healthy Kids Services 20 1457325987 0 Physicians Optical Supplies 20 1457325987 0 Physicians Physician Services 00 1457326332 0 YANG LEE ANN 1995292 9999999 B 10 1457326332 0 5777 DEPT CAROL STREAM IL 601220021 20 1457326332 0 Physicians Anesthesia Services 20 1457326332 0 Physicians Fluoride varnish 20 1457326332 0 Physicians Healthy Kids Services 20 1457326332 0 Physicians Optical Supplies 20 1457326332 0 Physicians Physician Services 00 1457326944 0 HICOK WILLIAM 1992214 9999999 B 10 1457326944 0 221 NE GLEN OAK AVE PEORIA IL 616360002 20 1457326944 0 Physicians Anesthesia Services 20 1457326944 0 Physicians Fluoride varnish 20 1457326944 0 Physicians Healthy Kids Services 20 1457326944 0 Physicians Optical Supplies 20 1457326944 0 Physicians Physician Services 00 1457327199 0 HIBINO SEIKEI 2021039 9999999 B 10 1457327199 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1457327199 0 Physicians Anesthesia Services 20 1457327199 0 Physicians Fluoride varnish 20 1457327199 0 Physicians Healthy Kids Services 20 1457327199 0 Physicians Optical Supplies 20 1457327199 0 Physicians Physician Services 00 1457327496 0 HOFFMAN ROBERT 2005152 9999999 B 10 1457327496 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1457327496 0 Physicians Anesthesia Services 20 1457327496 0 Physicians Healthy Kids Services 20 1457327496 0 Physicians Optical Supplies 20 1457327496 0 Physicians Physician Services 00 1457328148 0 CATTAPAN STEVEN E 2005001 9999999 B 10 1457328148 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1457328148 0 Physicians Anesthesia Services 20 1457328148 0 Physicians Fluoride varnish 20 1457328148 0 Physicians Healthy Kids Services 20 1457328148 0 Physicians Optical Supplies 20 1457328148 0 Physicians Physician Services 00 1457328411 0 RADEMAKER DENNIS E 1984158 9999999 B 10 1457328411 0 PO BOX 781076 DETROIT MI 482781076 20 1457328411 0 Physicians Anesthesia Services 20 1457328411 0 Physicians Fluoride varnish 20 1457328411 0 Physicians Healthy Kids Services 20 1457328411 0 Physicians Optical Supplies 20 1457328411 0 Physicians Physician Services 00 1457328502 0 OLSON WILLIAM 2005213 9999999 B 10 1457328502 0 3400 DEXTER CT STE 118 SUITE 118 DAVENPORT IA 528073419 20 1457328502 0 Physicians Anesthesia Services 20 1457328502 0 Physicians Healthy Kids Services 20 1457328502 0 Physicians Optical Supplies 20 1457328502 0 Physicians Physician Services 00 1457328536 0 CHUNG YOUNGRAN 1990289 9999999 B 10 1457328536 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1457328536 0 Physicians Anesthesia Services 20 1457328536 0 Physicians Fluoride varnish 20 1457328536 0 Physicians Healthy Kids Services 20 1457328536 0 Physicians Optical Supplies 20 1457328536 0 Physicians Physician Services 00 1457328874 0 MUZYKANSKY EUGENE A 2001121 9999999 B 10 1457328874 0 215 REMINGTON BLVD STE I BOLINGBROOK IL 604403665 20 1457328874 0 Physicians Anesthesia Services 20 1457328874 0 Physicians Healthy Kids Services 20 1457328874 0 Physicians Optical Supplies 20 1457328874 0 Physicians Physician Services 00 1457329526 0 BRANTMEIER SCOTT 2024030 9999999 B 10 1457329526 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1457329526 0 Physicians Anesthesia Services 20 1457329526 0 Physicians Fluoride varnish 20 1457329526 0 Physicians Healthy Kids Services 20 1457329526 0 Physicians Optical Supplies 20 1457329526 0 Physicians Physician Services 00 1457329682 0 LOPUKHIN SERGUEI 2001192 9999999 B 10 1457329682 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1457329682 0 Physicians Anesthesia Services 20 1457329682 0 Physicians Healthy Kids Services 20 1457329682 0 Physicians Optical Supplies 20 1457329682 0 Physicians Physician Services 00 1457329708 0 PETENZI DENISE 2004097 9999999 B 10 1457329708 0 3758 W CHICAGO AVE CHICAGO IL 606513823 20 1457329708 0 Podiatrists Podiatric Services 00 1457329724 0 KARTEL JULI 2018365 9999999 B 10 1457329724 0 1801 FOX DR CHAMPAIGN IL 618207236 20 1457329724 0 Other behavior health professional LCPC/LMFT services 00 1457330128 0 BENNETT JOHN R 2000227 9999999 B 10 1457330128 0 100 MEDICAL DR HANNIBAL MO 634016877 20 1457330128 0 Physicians Anesthesia Services 20 1457330128 0 Physicians Healthy Kids Services 20 1457330128 0 Physicians Optical Supplies 20 1457330128 0 Physicians Physician Services 00 1457330367 0 MCELVAIN MOLLY B 2003090 9999999 B 10 1457330367 0 PO BOX 3988 CARBONDALE IL 629023988 20 1457330367 0 Other behavior health professional LCPC/LMFT services 00 1457330425 0 SHAPIRO RICKY D 2015174 9999999 B 10 1457330425 0 PO BOX 603725 CHARLOTTE NC 282603725 20 1457330425 0 Physician Assistant Only Fluoride varnish 20 1457330425 0 Physician Assistant Only Healthy Kids Services 20 1457330425 0 Physician Assistant Only Physician Services 00 1457331647 0 HANSON ADAM C 2002335 9999999 B 10 1457331647 0 PO BOX 628156 MIDDLETON WI 535628156 20 1457331647 0 Physicians Anesthesia Services 20 1457331647 0 Physicians Healthy Kids Services 20 1457331647 0 Physicians Optical Supplies 20 1457331647 0 Physicians Physician Services 00 1457332066 0 KEITH STEPHEN P 2024051 9999999 B 10 1457332066 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1457332066 0 Physicians Anesthesia Services 20 1457332066 0 Physicians Fluoride varnish 20 1457332066 0 Physicians Healthy Kids Services 20 1457332066 0 Physicians Optical Supplies 20 1457332066 0 Physicians Physician Services 00 1457332207 0 ALPERT ALISON 1993182 9999999 B 10 1457332207 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1457332207 0 Physicians Anesthesia Services 20 1457332207 0 Physicians Healthy Kids Services 20 1457332207 0 Physicians Optical Supplies 20 1457332207 0 Physicians Physician Services 00 1457334468 0 O'CONNOR ANGELA MW 2022108 9999999 B 10 1457334468 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1457334468 0 Physicians Anesthesia Services 20 1457334468 0 Physicians Fluoride varnish 20 1457334468 0 Physicians Healthy Kids Services 20 1457334468 0 Physicians Optical Supplies 20 1457334468 0 Physicians Physician Services 00 1457334542 0 PETTKER CHRISTIAN 2024236 9999999 B 10 1457334542 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1457334542 0 Physicians Anesthesia Services 20 1457334542 0 Physicians Healthy Kids Services 20 1457334542 0 Physicians Optical Supplies 20 1457334542 0 Physicians Physician Services 00 1457334591 0 MCKENNEY EDWARD F F 1981258 9999999 B 10 1457334591 0 1471 KEOKUK ST HAMILTON IL 623411135 20 1457334591 0 Physicians Anesthesia Services 20 1457334591 0 Physicians Fluoride varnish 20 1457334591 0 Physicians Healthy Kids Services 20 1457334591 0 Physicians Optical Supplies 20 1457334591 0 Physicians Physician Services 00 1457334617 0 HABEEB BAHER N 2018180 9999999 B 10 1457334617 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1457334617 0 Physicians Anesthesia Services 20 1457334617 0 Physicians Fluoride varnish 20 1457334617 0 Physicians Healthy Kids Services 20 1457334617 0 Physicians Optical Supplies 20 1457334617 0 Physicians Physician Services 00 1457334971 0 FLAGG TALISYN 2023124 9999999 B 10 1457334971 0 818 5TH AVE STE 200 DES MOINES IA 503091307 20 1457334971 0 Nurse Practitioners Healthy Kids Services 20 1457334971 0 Nurse Practitioners Nurse Practitioners Services 20 1457334971 0 Nurse Practitioners Physician Services 00 1457335523 0 STAACKE TIMOTHY S 2010001 9999999 B 10 1457335523 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1457335523 0 Physicians Anesthesia Services 20 1457335523 0 Physicians Healthy Kids Services 20 1457335523 0 Physicians Optical Supplies 20 1457335523 0 Physicians Physician Services 00 1457335614 0 LYON ROBERT D 2023118 9999999 B 10 1457335614 0 PO BOX 713160 CHICAGO IL 606770360 20 1457335614 0 Physicians Anesthesia Services 20 1457335614 0 Physicians Healthy Kids Services 20 1457335614 0 Physicians Optical Supplies 20 1457335614 0 Physicians Physician Services 00 1457335648 0 HOLLAND REUBEN W 2023331 9999999 B 10 1457335648 0 PO BOX 43230 PHOENIX AZ 850803230 20 1457335648 0 Physicians Anesthesia Services 20 1457335648 0 Physicians Healthy Kids Services 20 1457335648 0 Physicians Optical Supplies 20 1457335648 0 Physicians Physician Services 00 1457335762 0 KATSIKAS DEMETRIOS A 2001001 9999999 B 10 1457335762 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1457335762 0 Physicians Anesthesia Services 20 1457335762 0 Physicians Healthy Kids Services 20 1457335762 0 Physicians Optical Supplies 20 1457335762 0 Physicians Physician Services 00 1457336679 0 SATOOR SUMALATHA 2024170 9999999 B 10 1457336679 0 PO BOX 632122 CINCINNATI OH 452632122 20 1457336679 0 Physicians Anesthesia Services 20 1457336679 0 Physicians Fluoride varnish 20 1457336679 0 Physicians Healthy Kids Services 20 1457336679 0 Physicians Optical Supplies 20 1457336679 0 Physicians Physician Services 00 1457337099 0 CASEY LUKE 2016242 9999999 B 10 1457337099 0 350 N GRANDVIEW AVE DUBUQUE IA 520016388 20 1457337099 0 Physician Assistant Only Fluoride varnish 20 1457337099 0 Physician Assistant Only Healthy Kids Services 20 1457337099 0 Physician Assistant Only Physician Services 00 1457337453 0 EHLE JOSEPH 2009138 9999999 B 10 1457337453 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1457337453 0 Physicians Anesthesia Services 20 1457337453 0 Physicians Healthy Kids Services 20 1457337453 0 Physicians Optical Supplies 20 1457337453 0 Physicians Physician Services 00 1457337735 0 CASTEEL SHEILA 2014083 9999999 B 10 1457337735 0 920 N YORK RD STE 200 HINSDALE IL 605218626 20 1457337735 0 Nurse Practitioners Healthy Kids Services 20 1457337735 0 Nurse Practitioners Nurse Practitioners Services 20 1457337735 0 Nurse Practitioners Physician Services 00 1457338626 0 JAGIELO PAUL J 1993167 9999999 B 10 1457338626 0 700 E OGDEN AVE STE 202 WESTMONT IL 605591296 20 1457338626 0 Physicians Anesthesia Services 20 1457338626 0 Physicians Fluoride varnish 20 1457338626 0 Physicians Healthy Kids Services 20 1457338626 0 Physicians Optical Supplies 20 1457338626 0 Physicians Physician Services 00 1457338907 0 MALDE BAIJU 2005250 9999999 B 10 1457338907 0 5777 DEPT CAROL STREAM IL 601220021 20 1457338907 0 Physicians Anesthesia Services 20 1457338907 0 Physicians Fluoride varnish 20 1457338907 0 Physicians Healthy Kids Services 20 1457338907 0 Physicians Optical Supplies 20 1457338907 0 Physicians Physician Services 00 1457339608 0 ALBRIGHT AMANDA M 2006228 9999999 B 10 1457339608 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1457339608 0 Speech Therapists Medical Supplies 20 1457339608 0 Speech Therapists Medical equipment/prosthetic devices 20 1457339608 0 Speech Therapists Speech Therapy/Pathology Services 00 1457339616 0 BELL JEREMY M 2025001 9999999 B 10 1457339616 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1457339616 0 Physicians Anesthesia Services 20 1457339616 0 Physicians Healthy Kids Services 20 1457339616 0 Physicians Optical Supplies 20 1457339616 0 Physicians Physician Services 00 1457340002 0 KAMAL SHWETA 2004043 9999999 B 10 1457340002 0 11 W DOWNER PL AURORA IL 605065134 20 1457340002 0 Dentists Dental Services 20 1457340002 0 Dentists Physician Services 00 1457340267 0 WONAIS CONSTANTINE 1983062 9999999 B 10 1457340267 0 PO BOX 776926 CHICAGO IL 606776926 20 1457340267 0 Physicians Anesthesia Services 20 1457340267 0 Physicians Healthy Kids Services 20 1457340267 0 Physicians Optical Supplies 20 1457340267 0 Physicians Physician Services 00 1457340622 0 PAFFORD CARL 2021093 9999999 B 10 1457340622 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1457340622 0 Physicians Anesthesia Services 20 1457340622 0 Physicians Fluoride varnish 20 1457340622 0 Physicians Healthy Kids Services 20 1457340622 0 Physicians Optical Supplies 20 1457340622 0 Physicians Physician Services 00 1457341406 0 MOCHEL DAVID 1993213 9999999 B 10 1457341406 0 5777 DEPT CAROL STREAM IL 601228942 20 1457341406 0 Physicians Anesthesia Services 20 1457341406 0 Physicians Healthy Kids Services 20 1457341406 0 Physicians Optical Supplies 20 1457341406 0 Physicians Physician Services 00 1457342610 0 RADZIENDA MICHAEL 1999182 9999999 B 10 1457342610 0 1395 NW 167TH ST MIAMI FL 331695710 20 1457342610 0 Physicians Anesthesia Services 20 1457342610 0 Physicians Fluoride varnish 20 1457342610 0 Physicians Healthy Kids Services 20 1457342610 0 Physicians Optical Supplies 20 1457342610 0 Physicians Physician Services 00 1457342685 0 EIDEN STEVEN B 1986144 9999999 B 10 1457342685 0 111 E 4TH ST STE 440 ALTON IL 620026206 20 1457342685 0 Optometrists Optical Supplies 20 1457342685 0 Optometrists Optometric Services 20 1457342685 0 Optometrists Physician Services 00 1457343931 0 HAMILTON JOHN 1996001 9999999 B 10 1457343931 0 PO BOX 578 PARK RIDGE IL 600680578 20 1457343931 0 Physicians Anesthesia Services 20 1457343931 0 Physicians Healthy Kids Services 20 1457343931 0 Physicians Optical Supplies 20 1457343931 0 Physicians Physician Services 00 1457344194 0 CUADROS HUGO F 1981227 9999999 B 10 1457344194 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1457344194 0 Physicians Anesthesia Services 20 1457344194 0 Physicians Fluoride varnish 20 1457344194 0 Physicians Healthy Kids Services 20 1457344194 0 Physicians Optical Supplies 20 1457344194 0 Physicians Physician Services 00 1457344582 0 CLARK CHARLES R 1981258 9999999 B 10 1457344582 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1457344582 0 Physicians Anesthesia Services 20 1457344582 0 Physicians Healthy Kids Services 20 1457344582 0 Physicians Optical Supplies 20 1457344582 0 Physicians Physician Services 00 1457344947 0 BOYCE PAMELA 1993272 9999999 B 10 1457344947 0 3241 S MICHIGAN AVE CHICAGO IL 606164201 20 1457344947 0 Optometrists Optical Supplies 20 1457344947 0 Optometrists Optometric Services 20 1457344947 0 Optometrists Physician Services 00 1457345258 0 KAPERICK VIRGINIA A 2000001 9999999 B 10 1457345258 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1457345258 0 Physicians Anesthesia Services 20 1457345258 0 Physicians Fluoride varnish 20 1457345258 0 Physicians Healthy Kids Services 20 1457345258 0 Physicians Optical Supplies 20 1457345258 0 Physicians Physician Services 00 1457345381 0 PAPIERSKI PAUL 1997335 9999999 B 10 1457345381 0 1110 W SCHICK RD BARTLETT IL 601033007 20 1457345381 0 Physicians Anesthesia Services 20 1457345381 0 Physicians Healthy Kids Services 20 1457345381 0 Physicians Optical Supplies 20 1457345381 0 Physicians Physician Services 00 1457346074 0 PATEL DEEPAK 2008214 9999999 B 10 1457346074 0 2000 OGDEN AVE AURORA IL 605047222 20 1457346074 0 Physicians Anesthesia Services 20 1457346074 0 Physicians Fluoride varnish 20 1457346074 0 Physicians Healthy Kids Services 20 1457346074 0 Physicians Optical Supplies 20 1457346074 0 Physicians Physician Services 00 1457346082 0 RUOCCO ERIC M 1995182 9999999 B 10 1457346082 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1457346082 0 Physicians Anesthesia Services 20 1457346082 0 Physicians Healthy Kids Services 20 1457346082 0 Physicians Optical Supplies 20 1457346082 0 Physicians Physician Services 00 1457346231 0 EBACH DAWN R 2005182 9999999 B 10 1457346231 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1457346231 0 Physicians Anesthesia Services 20 1457346231 0 Physicians Fluoride varnish 20 1457346231 0 Physicians Healthy Kids Services 20 1457346231 0 Physicians Optical Supplies 20 1457346231 0 Physicians Physician Services 00 1457346272 0 PERKINSON WILLIAM 2004183 9999999 B 10 1457346272 0 1812 N 19TH AVE MELROSE PARK IL 601602039 20 1457346272 0 Dentists Dental Services 20 1457346272 0 Dentists Physician Services 00 1457346280 0 CHIMATA MURTHY 2007001 9999999 B 10 1457346280 0 55 E 86TH AVE MERRILLVILLE IN 464106382 20 1457346280 0 Physicians Anesthesia Services 20 1457346280 0 Physicians Healthy Kids Services 20 1457346280 0 Physicians Optical Supplies 20 1457346280 0 Physicians Physician Services 00 1457346322 0 TAIBERG LEO 2004245 9999999 B 10 1457346322 0 5410 MARYLAND WAY STE 300 BRENTWOOD TN 370275339 20 1457346322 0 Physicians Anesthesia Services 20 1457346322 0 Physicians Fluoride varnish 20 1457346322 0 Physicians Healthy Kids Services 20 1457346322 0 Physicians Optical Supplies 20 1457346322 0 Physicians Physician Services 00 1457346355 0 CUEVA JOHN PAUL 1993274 9999999 B 10 1457346355 0 2601 LINCOLN HWY STE 105 105 OLYMPIA FIELDS IL 604611845 20 1457346355 0 Physicians Anesthesia Services 20 1457346355 0 Physicians Fluoride varnish 20 1457346355 0 Physicians Healthy Kids Services 20 1457346355 0 Physicians Optical Supplies 20 1457346355 0 Physicians Physician Services 00 1457347049 0 FICK DANIEL S 1993167 9999999 B 10 1457347049 0 5820 WESTOWN PKWY WEST DES MOINES IA 502668223 20 1457347049 0 Physicians Anesthesia Services 20 1457347049 0 Physicians Fluoride varnish 20 1457347049 0 Physicians Healthy Kids Services 20 1457347049 0 Physicians Optical Supplies 20 1457347049 0 Physicians Physician Services 00 1457347163 0 RAJAGOPAL SRINIVASAN 2005047 9999999 B 10 1457347163 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1457347163 0 Physicians Anesthesia Services 20 1457347163 0 Physicians Healthy Kids Services 20 1457347163 0 Physicians Optical Supplies 20 1457347163 0 Physicians Physician Services 00 1457348187 0 PHADKE ASHOK 1997016 9999999 B 10 1457348187 0 2031 E GRAND AVE STE 200 LINDENHURST IL 600469094 20 1457348187 0 Physicians Anesthesia Services 20 1457348187 0 Physicians Fluoride varnish 20 1457348187 0 Physicians Healthy Kids Services 20 1457348187 0 Physicians Optical Supplies 20 1457348187 0 Physicians Physician Services 00 1457348401 0 RAKINIC JAN 2001274 9999999 B 10 1457348401 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1457348401 0 Physicians Anesthesia Services 20 1457348401 0 Physicians Healthy Kids Services 20 1457348401 0 Physicians Optical Supplies 20 1457348401 0 Physicians Physician Services 00 1457348484 0 EHRLER CHRISTOPHER 2018121 9999999 B 10 1457348484 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1457348484 0 Nurse Practitioners Anesthesia Services 20 1457348484 0 Nurse Practitioners Nurse Practitioners Services 20 1457348484 0 Nurse Practitioners Physician Services 00 1457348815 0 ALKADRY SUHA 2023019 9999999 B 10 1457348815 0 PO BOX 43230 PHOENIX AZ 850803230 20 1457348815 0 Physicians Anesthesia Services 20 1457348815 0 Physicians Fluoride varnish 20 1457348815 0 Physicians Healthy Kids Services 20 1457348815 0 Physicians Optical Supplies 20 1457348815 0 Physicians Physician Services 00 1457350118 0 CRYSTAL NURIT 2006107 9999999 B 10 1457350118 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1457350118 0 Physicians Anesthesia Services 20 1457350118 0 Physicians Fluoride varnish 20 1457350118 0 Physicians Healthy Kids Services 20 1457350118 0 Physicians Optical Supplies 20 1457350118 0 Physicians Physician Services 00 1457351041 0 JOHN THOMAS 1987182 9999999 B 10 1457351041 0 3900 GABRIELLE LN UNIT 9130 AURORA IL 605984335 20 1457351041 0 Physicians Anesthesia Services 20 1457351041 0 Physicians Healthy Kids Services 20 1457351041 0 Physicians Optical Supplies 20 1457351041 0 Physicians Physician Services 00 1457351165 0 SLOAS HAROLD A 2017108 9999999 B 10 1457351165 0 5380 TECH DATA DR STE 101 CLEARWATER FL 337603122 20 1457351165 0 Physicians Anesthesia Services 20 1457351165 0 Physicians Healthy Kids Services 20 1457351165 0 Physicians Optical Supplies 20 1457351165 0 Physicians Physician Services 00 1457351876 0 BROCK PAUL W 2023214 9999999 B 10 1457351876 0 PO BOX 4803 HOUSTON TX 772104803 20 1457351876 0 Physicians Anesthesia Services 20 1457351876 0 Physicians Healthy Kids Services 20 1457351876 0 Physicians Optical Supplies 20 1457351876 0 Physicians Physician Services 00 1457352049 0 TRIMBLE NANCY 2020309 9999999 B 10 1457352049 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1457352049 0 Physician Assistant Only Fluoride varnish 20 1457352049 0 Physician Assistant Only Healthy Kids Services 20 1457352049 0 Physician Assistant Only Physician Services 00 1457352064 0 OZOLINS ANDREW L 1991219 9999999 B 10 1457352064 0 2530 CHICAGO AVE STE 400 MINNEAPOLIS MN 554044387 20 1457352064 0 Physicians Anesthesia Services 20 1457352064 0 Physicians Fluoride varnish 20 1457352064 0 Physicians Healthy Kids Services 20 1457352064 0 Physicians Optical Supplies 20 1457352064 0 Physicians Physician Services 00 1457354276 0 PRELUTSKY DAVID J 1988306 9999999 B 10 1457354276 0 2340 HAMPTON AVE SAINT LOUIS MO 631392935 20 1457354276 0 Physicians Anesthesia Services 20 1457354276 0 Physicians Fluoride varnish 20 1457354276 0 Physicians Healthy Kids Services 20 1457354276 0 Physicians Optical Supplies 20 1457354276 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1457386351 0 Physicians Physician Services 00 1457386922 0 BRAHMAMDAM JAGANNADHARAO 1983167 9999999 B 10 1457386922 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1457386922 0 Physicians Anesthesia Services 20 1457386922 0 Physicians Healthy Kids Services 20 1457386922 0 Physicians Optical Supplies 20 1457386922 0 Physicians Physician Services 00 1457387334 0 DSIDA RICHARD M 1988336 9999999 B 10 1457387334 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1457387334 0 Physicians Anesthesia Services 20 1457387334 0 Physicians Healthy Kids Services 20 1457387334 0 Physicians Optical Supplies 20 1457387334 0 Physicians Physician Services 00 1457387987 0 MUELLEMAN ROBERT L 2017290 9999999 B 10 1457387987 0 988102 NEBRASKA MEDICAL CTR OMAHA NE 681988102 20 1457387987 0 Physicians Anesthesia Services 20 1457387987 0 Physicians Healthy Kids Services 20 1457387987 0 Physicians Optical Supplies 20 1457387987 0 Physicians Physician Services 00 1457388217 0 STEELE JEFFREY S 1991217 9999999 B 10 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00 1457388928 0 PARKER FRANK H 1988245 9999999 B 10 1457388928 0 2122 W HOWLAND AVE CHICAGO IL 606435930 20 1457388928 0 Physicians Anesthesia Services 20 1457388928 0 Physicians Healthy Kids Services 20 1457388928 0 Physicians Optical Supplies 20 1457388928 0 Physicians Physician Services 00 1457389116 0 HOSKINS MARC E 2016113 9999999 B 10 1457389116 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1457389116 0 Physician Assistant Only Fluoride varnish 20 1457389116 0 Physician Assistant Only Healthy Kids Services 20 1457389116 0 Physician Assistant Only Physician Services 00 1457389371 0 MELNICK MICHAEL 1990290 9999999 B 10 1457389371 0 29373 NETWORK PL CHICAGO IL 606733039 20 1457389371 0 Physicians Anesthesia Services 20 1457389371 0 Physicians Fluoride varnish 20 1457389371 0 Physicians Healthy Kids Services 20 1457389371 0 Physicians Optical Supplies 20 1457389371 0 Physicians Physician Services 00 1457390577 0 BRAUNLIN JAMES 2022161 9999999 B 10 1457390577 0 920 WEST ST BLDG B 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Services 00 1457395931 0 RICHARDS NORMAN R 1996255 9999999 B 10 1457395931 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1457395931 0 Physicians Anesthesia Services 20 1457395931 0 Physicians Healthy Kids Services 20 1457395931 0 Physicians Optical Supplies 20 1457395931 0 Physicians Physician Services 00 1457396566 0 SARNOV OLGA 2005244 9999999 B 10 1457396566 0 7725 W RENO AVE STE 330 OKLAHOMA CITY OK 731279742 20 1457396566 0 Physicians Anesthesia Services 20 1457396566 0 Physicians Healthy Kids Services 20 1457396566 0 Physicians Optical Supplies 20 1457396566 0 Physicians Physician Services 00 1457397119 0 NAVARRO JOSELITO S 1996061 9999999 B 10 1457397119 0 PO BOX 781076 DETROIT MI 482781076 20 1457397119 0 Physicians Anesthesia Services 20 1457397119 0 Physicians Fluoride varnish 20 1457397119 0 Physicians Healthy Kids Services 20 1457397119 0 Physicians Optical Supplies 20 1457397119 0 Physicians Physician Services 00 1457397341 0 NALEWAY KAREN M 2006128 9999999 B 10 1457397341 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Physical Therapists Medical equipment/prosthetic devices 20 1457407553 0 Physical Therapists Physical Therapy Services 00 1457407819 0 SANDAGE SCOTT J 1983220 9999999 B 10 1457407819 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1457407819 0 Physicians Anesthesia Services 20 1457407819 0 Physicians Healthy Kids Services 20 1457407819 0 Physicians Optical Supplies 20 1457407819 0 Physicians Physician Services 20 1457407819 0 Physicians Physicians Psychiatric Services 00 1457408262 0 JOGGERST STEVEN 2014196 9999999 B 10 1457408262 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1457408262 0 Physicians Anesthesia Services 20 1457408262 0 Physicians Fluoride varnish 20 1457408262 0 Physicians Healthy Kids Services 20 1457408262 0 Physicians Optical Supplies 20 1457408262 0 Physicians Physician Services 00 1457408338 0 STEVENSON CHARLES 2016312 9999999 B 10 1457408338 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1457408338 0 Physicians Anesthesia Services 20 1457408338 0 Physicians 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Physicians Physician Services 00 1457410417 0 BICOS ANGELA A 2000214 9999999 B 10 1457410417 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1457410417 0 Physicians Anesthesia Services 20 1457410417 0 Physicians Fluoride varnish 20 1457410417 0 Physicians Healthy Kids Services 20 1457410417 0 Physicians Optical Supplies 20 1457410417 0 Physicians Physician Services 00 1457411340 0 KERNS KAREN 2016266 9999999 B 10 1457411340 0 1005 BROADWAY ST QUINCY IL 623012834 20 1457411340 0 Speech Therapists Medical Supplies 20 1457411340 0 Speech Therapists Medical equipment/prosthetic devices 20 1457411340 0 Speech Therapists Speech Therapy/Pathology Services 00 1457412124 0 PIRAINO JANE A 2006039 9999999 B 10 1457412124 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1457412124 0 Nurse Practitioners Healthy Kids Services 20 1457412124 0 Nurse Practitioners Nurse Practitioners Services 20 1457412124 0 Nurse Practitioners Physician Services 00 1457412280 0 JOHNSON KRISTA M 1998182 9999999 B 10 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1457416752 0 Nurse Practitioners All Kids application agent 20 1457416752 0 Nurse Practitioners Healthy Kids Services 20 1457416752 0 Nurse Practitioners Nurse Practitioners Services 20 1457416752 0 Nurse Practitioners Physician Services 00 1457416844 0 ARNOLD EVE N 2016265 9999999 B 10 1457416844 0 35 SKOKIE BLVD NORTHBROOK IL 600621607 20 1457416844 0 Optometrists Optical Supplies 20 1457416844 0 Optometrists Optometric Services 20 1457416844 0 Optometrists Physician Services 00 1457417750 0 HAYES TRACY 2000110 9999999 B 10 1457417750 0 41 CLAYMONT CT SPRINGFIELD IL 627041207 20 1457417750 0 Speech Therapists Medical Supplies 20 1457417750 0 Speech Therapists Medical equipment/prosthetic devices 20 1457417750 0 Speech Therapists Speech Therapy/Pathology Services 00 1457418154 0 IANITELLI ANGELA 2021312 9999999 B 10 1457418154 0 PO BOX 500 ELLICOTTVILLE NY 147310500 20 1457418154 0 Physician Assistant Only Fluoride varnish 20 1457418154 0 Physician Assistant Only Healthy Kids Services 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Physicians Healthy Kids Services 20 1457420408 0 Physicians Optical Supplies 20 1457420408 0 Physicians Physician Services 00 1457421117 0 RAZMA KRISTINA 1996183 9999999 B 10 1457421117 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1457421117 0 Occupational Therapists Medical Supplies 20 1457421117 0 Occupational Therapists Medical equipment/prosthetic devices 20 1457421117 0 Occupational Therapists Occupational Therapy Services 00 1457422230 0 MESKIN JOSHUA 2010001 9999999 B 10 1457422230 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1457422230 0 Physicians Anesthesia Services 20 1457422230 0 Physicians Fluoride varnish 20 1457422230 0 Physicians Healthy Kids Services 20 1457422230 0 Physicians Optical Supplies 20 1457422230 0 Physicians Physician Services 00 1457424301 0 SALWAN MANAV 2006358 9999999 B 10 1457424301 0 2540 HAUSER ROSS DR STE 275 SYCAMORE IL 601783178 20 1457424301 0 Physicians Anesthesia Services 20 1457424301 0 Physicians Fluoride varnish 20 1457424301 0 Physicians Healthy Kids Services 20 1457424301 0 Physicians Optical Supplies 20 1457424301 0 Physicians Physician Services 00 1457428542 0 MLSNA ROSS R 2003121 9999999 B 10 1457428542 0 120 E COUNTRYSIDE PKWY YORKVILLE IL 605601877 20 1457428542 0 Optometrists Optical Supplies 20 1457428542 0 Optometrists Optometric Services 20 1457428542 0 Optometrists Physician Services 00 1457429235 0 SHELLMER DIANA A 2020147 9999999 B 10 1457429235 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1457429235 0 Psychologist Psychologist service 00 1457429359 0 PAVATE RITA 1998032 9999999 B 10 1457429359 0 100 E JEFFERY ST KANKAKEE IL 609015018 20 1457429359 0 Physicians Anesthesia Services 20 1457429359 0 Physicians Fluoride varnish 20 1457429359 0 Physicians Healthy Kids Services 20 1457429359 0 Physicians Optical Supplies 20 1457429359 0 Physicians Physician Services 00 1457430027 0 VILLANUEVA MARIE ELIZABETH N 2017202 9999999 B 10 1457430027 0 5777 DEPT CAROL STREAM IL 601220021 20 1457430027 0 Nurse Practitioners Healthy Kids Services 20 1457430027 0 Nurse Practitioners Nurse Practitioners Services 20 1457430027 0 Nurse Practitioners Physician Services 00 1457430175 0 SIDDIQUI MOHAMMED W 1991077 9999999 B 10 1457430175 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1457430175 0 Physicians Anesthesia Services 20 1457430175 0 Physicians Fluoride varnish 20 1457430175 0 Physicians Healthy Kids Services 20 1457430175 0 Physicians Optical Supplies 20 1457430175 0 Physicians Physician Services 00 1457430852 0 ROY ESTEFAN G 1987274 9999999 B 10 1457430852 0 5600 W ADDISON ST STE 201 CHICAGO IL 606344469 20 1457430852 0 Physicians Anesthesia Services 20 1457430852 0 Physicians Healthy Kids Services 20 1457430852 0 Physicians Optical Supplies 20 1457430852 0 Physicians Physician Services 00 1457430910 0 ENCINAS EDUARDO 1983182 9999999 B 10 1457430910 0 PO BOX 1805 SKOKIE IL 600768805 20 1457430910 0 Physicians Anesthesia Services 20 1457430910 0 Physicians Healthy Kids Services 20 1457430910 0 Physicians Optical Supplies 20 1457430910 0 Physicians Physician Services 00 1457430969 0 COLN CHARLES E 2005222 9999999 B 10 1457430969 0 621 S NEW BALLAS RD STE 483A SAINT LOUIS MO 631418259 20 1457430969 0 Physicians Anesthesia Services 20 1457430969 0 Physicians Healthy Kids Services 20 1457430969 0 Physicians Optical Supplies 20 1457430969 0 Physicians Physician Services 00 1457432015 0 CULLINANE NATALIE 2017255 9999999 B 10 1457432015 0 541 OTIS BOWEN DR MUNSTER IN 463214158 20 1457432015 0 Physicians Anesthesia Services 20 1457432015 0 Physicians Healthy Kids Services 20 1457432015 0 Physicians Optical Supplies 20 1457432015 0 Physicians Physician Services 00 1457432742 0 PONAKALA B NARAYAN 1997287 9999999 B 10 1457432742 0 645 S CENTRAL AVE CHICAGO IL 606445059 20 1457432742 0 Physicians Anesthesia Services 20 1457432742 0 Physicians Healthy Kids Services 20 1457432742 0 Physicians Optical Supplies 20 1457432742 0 Physicians Physician Services 00 1457433039 0 BARRON CHARLES 1998244 9999999 B 10 1457433039 0 19990 GOVERNORS HWY OLYMPIA FIELDS IL 604611021 20 1457433039 0 Physicians All Kids application agent 20 1457433039 0 Physicians Anesthesia Services 20 1457433039 0 Physicians Fluoride varnish 20 1457433039 0 Physicians Healthy Kids Services 20 1457433039 0 Physicians Optical Supplies 20 1457433039 0 Physicians Physician Services 00 1457433179 0 HERBERGER GARY R 1981258 9999999 B 10 1457433179 0 80 LONGWOOD DR CANTON IL 615201203 20 1457433179 0 Dentists Dental Services 20 1457433179 0 Dentists Physician Services 00 1457433955 0 NAIK AMAR S 2015001 9999999 B 10 1457433955 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1457433955 0 Physicians Anesthesia Services 20 1457433955 0 Physicians Fluoride varnish 20 1457433955 0 Physicians Healthy Kids Services 20 1457433955 0 Physicians Optical Supplies 20 1457433955 0 Physicians Physician Services 00 1457434235 0 AKHTER JAVEED 1981227 9999999 B 10 1457434235 0 29373 NETWORK PL CHICAGO IL 606733039 20 1457434235 0 Physicians Anesthesia Services 20 1457434235 0 Physicians Fluoride varnish 20 1457434235 0 Physicians Healthy Kids Services 20 1457434235 0 Physicians Optical Supplies 20 1457434235 0 Physicians Physician Services 00 1457434383 0 ORAL ELIF 2022238 9999999 B 10 1457434383 0 3621 S STATE ST ANN ARBOR MI 481081633 20 1457434383 0 Physicians Anesthesia Services 20 1457434383 0 Physicians Fluoride varnish 20 1457434383 0 Physicians Healthy Kids Services 20 1457434383 0 Physicians Optical Supplies 20 1457434383 0 Physicians Physician Services 00 1457434466 0 BRINEY LYNSE 2006209 9999999 B 10 1457434466 0 28 MADISON ST OAK PARK IL 603024230 20 1457434466 0 Dentists Dental Services 20 1457434466 0 Dentists Physician Services 00 1457434623 0 DEL CASTILLO JORGE 1982001 9999999 B 10 1457434623 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1457434623 0 Physicians Anesthesia Services 20 1457434623 0 Physicians Healthy Kids Services 20 1457434623 0 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1457507378 0 Physicians Optical Supplies 20 1457507378 0 Physicians Physician Services 00 1457507535 0 CASEY ANJALI RISHI 2009182 9999999 B 10 1457507535 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1457507535 0 Physicians Anesthesia Services 20 1457507535 0 Physicians Fluoride varnish 20 1457507535 0 Physicians Healthy Kids Services 20 1457507535 0 Physicians Optical Supplies 20 1457507535 0 Physicians Physician Services 00 1457507568 0 CHAUDHRY SADAF 2017342 9999999 B 10 1457507568 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1457507568 0 Physicians Anesthesia Services 20 1457507568 0 Physicians Healthy Kids Services 20 1457507568 0 Physicians Optical Supplies 20 1457507568 0 Physicians Physician Services 00 1457509150 0 HERMAN LUKE D 2010262 9999999 B 10 1457509150 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1457509150 0 Physicians All Kids application agent 20 1457509150 0 Physicians Anesthesia Services 20 1457509150 0 Physicians Family 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1457510323 0 Physicians Optical Supplies 20 1457510323 0 Physicians Physician Services 00 1457511966 0 ZAIDI NAUSHEEN I 2011276 9999999 B 10 1457511966 0 29373 NETWORK PL CHICAGO IL 606733039 20 1457511966 0 Physicians Anesthesia Services 20 1457511966 0 Physicians Healthy Kids Services 20 1457511966 0 Physicians Optical Supplies 20 1457511966 0 Physicians Physician Services 00 1457512089 0 VIEHMANN JULIE 2013135 9999999 B 10 1457512089 0 100 MEDICAL DR HANNIBAL MO 634016877 20 1457512089 0 Physicians Anesthesia Services 20 1457512089 0 Physicians Healthy Kids Services 20 1457512089 0 Physicians Optical Supplies 20 1457512089 0 Physicians Physician Services 00 1457512436 0 STEVENS TRACEY W 2013182 9999999 B 10 1457512436 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1457512436 0 Physicians Anesthesia Services 20 1457512436 0 Physicians Healthy Kids Services 20 1457512436 0 Physicians Optical Supplies 20 1457512436 0 Physicians Physician Services 00 1457512816 0 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10 1457667057 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1457667057 0 Occupational Therapists Medical Supplies 20 1457667057 0 Occupational Therapists Medical equipment/prosthetic devices 20 1457667057 0 Occupational Therapists Occupational Therapy Services 00 1457667677 0 JHA KAMLESH K 2014343 9999999 B 10 1457667677 0 2875 W 19TH ST CHICAGO IL 606233501 20 1457667677 0 Physicians Anesthesia Services 20 1457667677 0 Physicians Fluoride varnish 20 1457667677 0 Physicians Healthy Kids Services 20 1457667677 0 Physicians Optical Supplies 20 1457667677 0 Physicians Physician Services 00 1457667776 0 MARSHALL JESSICA 2017305 9999999 B 10 1457667776 0 373 S SCHMALE RD STE 102 CAROL STREAM IL 601882771 20 1457667776 0 Psychologist Psychologist service 00 1457667891 0 WILLIAMSON STACEY A 2021194 9999999 B 10 1457667891 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1457667891 0 Physician Assistant Only Fluoride varnish 20 1457667891 0 Physician Assistant Only Healthy 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83475 WOBURN MA 018133475 20 1457672792 0 Physicians Anesthesia Services 20 1457672792 0 Physicians Fluoride varnish 20 1457672792 0 Physicians Healthy Kids Services 20 1457672792 0 Physicians Optical Supplies 20 1457672792 0 Physicians Physician Services 00 1457674582 0 ALI VAN H 2020009 9999999 B 10 1457674582 0 5777 DEPT CAROL STREAM IL 601220021 20 1457674582 0 Physicians Anesthesia Services 20 1457674582 0 Physicians Healthy Kids Services 20 1457674582 0 Physicians Optical Supplies 20 1457674582 0 Physicians Physician Services 00 1457675233 0 GONG EDWARD 2011211 9999999 B 10 1457675233 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1457675233 0 Physicians Anesthesia Services 20 1457675233 0 Physicians Healthy Kids Services 20 1457675233 0 Physicians Optical Supplies 20 1457675233 0 Physicians Physician Services 00 1457676520 0 RIVENBURG COURTNEY 2012058 9999999 B 10 1457676520 0 736 N YORK RD HINSDALE IL 605213535 20 1457676520 0 Clinical Social Worker Social work service 00 1457677007 0 ACORD MICHAEL 2023206 9999999 B 10 1457677007 0 3401 CIVIC CENTER BLVD # M975 PHILADELPHIA PA 191044319 20 1457677007 0 Physicians Anesthesia Services 20 1457677007 0 Physicians Healthy Kids Services 20 1457677007 0 Physicians Optical Supplies 20 1457677007 0 Physicians Physician Services 00 1457677114 0 COORDS MICHAEL 2021321 9999999 B 10 1457677114 0 16220 N SCOTTSDALE RD STE 600 SCOTTSDALE AZ 852541804 20 1457677114 0 Physicians Anesthesia Services 20 1457677114 0 Physicians Healthy Kids Services 20 1457677114 0 Physicians Optical Supplies 20 1457677114 0 Physicians Physician Services 00 1457677536 0 BENOIT STEFANIE 2022122 9999999 B 10 1457677536 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1457677536 0 Physicians Anesthesia Services 20 1457677536 0 Physicians Fluoride varnish 20 1457677536 0 Physicians Healthy Kids Services 20 1457677536 0 Physicians Optical Supplies 20 1457677536 0 Physicians Physician Services 00 1457677619 0 WOLSKI CHRISTINE 2020197 9999999 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STREAM IL 601220021 20 1457679961 0 Nurse Practitioners Healthy Kids Services 20 1457679961 0 Nurse Practitioners Midwife Services 20 1457679961 0 Nurse Practitioners Nurse Practitioners Services 20 1457679961 0 Nurse Practitioners Physician Services 00 1457680662 0 URANI LIU MARIA 2024361 9999999 B 10 1457680662 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1457680662 0 Psychologist Psychologist service 00 1457680985 0 FEFFER YVONNE 2018263 9999999 B 10 1457680985 0 10455 RIVERSIDE DR PALM BEACH GARD FL 334104237 20 1457680985 0 Audiologists Audiology Services 20 1457680985 0 Audiologists Medical Supplies 20 1457680985 0 Audiologists Medical equipment/prosthetic devices 00 1457681645 0 LARDARO THOMAS A 2023343 9999999 B 10 1457681645 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1457681645 0 Physicians Anesthesia Services 20 1457681645 0 Physicians Healthy Kids Services 20 1457681645 0 Physicians Optical Supplies 20 1457681645 0 Physicians Physician Services 00 1457682700 0 BECK KRISTEN 2010032 9999999 B 10 1457682700 0 660 WHITNEY DR PADUCAH KY 420015394 20 1457682700 0 Nurse Practitioners Anesthesia Services 20 1457682700 0 Nurse Practitioners Nurse Practitioners Services 20 1457682700 0 Nurse Practitioners Physician Services 00 1457684144 0 DWORKIN-CANTOR LISA N 2024330 9999999 B 10 1457684144 0 3327 N ASHLAND AVE CHICAGO IL 606572127 20 1457684144 0 Psychologist Psychologist service 00 1457686271 0 WARREN SHEILA 2009338 9999999 B 10 1457686271 0 5777 DEPT CAROL STREAM IL 601220021 20 1457686271 0 Nurse Practitioners Anesthesia Services 20 1457686271 0 Nurse Practitioners Nurse Practitioners Services 20 1457686271 0 Nurse Practitioners Physician Services 00 1457686297 0 SCOTT YVONDIA 2020356 9999999 B 10 1457686297 0 326 W 64TH ST CHICAGO IL 606213114 20 1457686297 0 Dentists Dental Services 20 1457686297 0 Dentists Physician Services 00 1457687832 0 GLATZ ROBERT P 2021232 9999999 B 10 1457687832 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1457687832 0 Clinical Social Worker Social work service 00 1457691040 0 CORRIGAN MELISSA 2017319 9999999 B 10 1457691040 0 16931 GRISSOM DR TINLEY PARK IL 604772318 20 1457691040 0 Speech Therapists Medical Supplies 20 1457691040 0 Speech Therapists Medical equipment/prosthetic devices 20 1457691040 0 Speech Therapists Speech Therapy/Pathology Services 00 1457692857 0 DEVILLE RICKY J 2018071 9999999 B 10 1457692857 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1457692857 0 Nurse Practitioners Anesthesia Services 20 1457692857 0 Nurse Practitioners Nurse Practitioners Services 20 1457692857 0 Nurse Practitioners Physician Services 00 1457692931 0 CLARKSON SARA N 2013077 9999999 B 10 1457692931 0 PO BOX 8500 LOCKBOX #7642 PHILADELPHIA PA 191787642 20 1457692931 0 Nurse Practitioners Anesthesia Services 20 1457692931 0 Nurse Practitioners Nurse Practitioners Services 20 1457692931 0 Nurse Practitioners Physician Services 00 1457693079 0 XANTHOPOULOS ERIC P 2018113 9999999 B 10 1457693079 0 1969 W HART RD BELOIT WI 535112230 20 1457693079 0 Physicians Anesthesia Services 20 1457693079 0 Physicians Healthy Kids Services 20 1457693079 0 Physicians Optical Supplies 20 1457693079 0 Physicians Physician Services 00 1457693160 0 RODRIGUEZ SOPHIA M 2017186 9999999 B 10 1457693160 0 29373 NETWORK PL CHICAGO IL 606733039 20 1457693160 0 Physicians Anesthesia Services 20 1457693160 0 Physicians Healthy Kids Services 20 1457693160 0 Physicians Optical Supplies 20 1457693160 0 Physicians Physician Services 00 1457693665 0 DAGNEW YIMENU 2018244 9999999 B 10 1457693665 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1457693665 0 Physicians Anesthesia Services 20 1457693665 0 Physicians Fluoride varnish 20 1457693665 0 Physicians Healthy Kids Services 20 1457693665 0 Physicians Optical Supplies 20 1457693665 0 Physicians Physician Services 00 1457693764 0 EVANS MICHAEL 2018121 9999999 B 10 1457693764 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1457693764 0 Physicians Anesthesia Services 20 1457693764 0 Physicians Healthy Kids Services 20 1457693764 0 Physicians Optical Supplies 20 1457693764 0 Physicians Physician Services 00 1457694481 0 JACOBY CORY 2016235 9999999 B 10 1457694481 0 750 FLETCHER DR STE 300 ELGIN IL 601234703 20 1457694481 0 Podiatrists Podiatric Services 00 1457694887 0 LEE CHAD A 2023001 9999999 B 10 1457694887 0 2041 W DIVISION ST CHICAGO IL 606228521 20 1457694887 0 Physicians Anesthesia Services 20 1457694887 0 Physicians Healthy Kids Services 20 1457694887 0 Physicians Optical Supplies 20 1457694887 0 Physicians Physician Services 00 1457695272 0 BELLISARIO ANGELICA M 2015288 9999999 B 10 1457695272 0 5777 DEPT CAROL STREAM IL 601220021 20 1457695272 0 Nurse Practitioners Fluoride varnish 20 1457695272 0 Nurse Practitioners Healthy Kids Services 20 1457695272 0 Nurse Practitioners Nurse Practitioners Services 20 1457695272 0 Nurse Practitioners Physician Services 00 1457696007 0 GODDARD REBECCA J 2017298 9999999 B 10 1457696007 0 540 SUPERIOR AVE CALUMET CITY IL 604093452 20 1457696007 0 Speech Therapists Medical Supplies 20 1457696007 0 Speech Therapists Medical equipment/prosthetic devices 20 1457696007 0 Speech Therapists Speech Therapy/Pathology Services 00 1457696379 0 WELLS MEGHAN 2019361 9999999 B 10 1457696379 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1457696379 0 Physician Assistant Only Fluoride varnish 20 1457696379 0 Physician Assistant Only Healthy Kids Services 20 1457696379 0 Physician Assistant Only Physician Services 00 1457697898 0 JOHNSON-WILLIAMS LEAH 2023016 9999999 B 10 1457697898 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1457697898 0 Nurse Practitioners Fluoride varnish 20 1457697898 0 Nurse Practitioners Healthy Kids Services 20 1457697898 0 Nurse Practitioners Nurse Practitioners Services 20 1457697898 0 Nurse Practitioners Physician Services 00 1457698169 0 ATA MOHAMAD 2018078 9999999 B 10 1457698169 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1457698169 0 Nurse Practitioners Healthy Kids Services 20 1457698169 0 Nurse Practitioners Nurse Practitioners Services 20 1457698169 0 Nurse Practitioners Physician Services 00 1457698607 0 ALCAZAR ERIN 2016096 9999999 B 10 1457698607 0 6810 STATE ROUTE 162 STE 215 MARYVILLE IL 620628566 20 1457698607 0 Nurse Practitioners Fluoride varnish 20 1457698607 0 Nurse Practitioners Healthy Kids Services 20 1457698607 0 Nurse Practitioners Nurse Practitioners Services 20 1457698607 0 Nurse Practitioners Nursing service 20 1457698607 0 Nurse Practitioners Physician Services 00 1457698912 0 CISCO WASHINGTON 2015161 9999999 B 10 1457698912 0 PO BOX 190 PO BOX 190 IRVING IL 620510190 20 1457698912 0 Clinical Social Worker Social work service 00 1457698961 0 BARA JESSICA 2013019 9999999 B 10 1457698961 0 PO BOX 775253 CHICAGO IL 606775253 20 1457698961 0 Nurse Practitioners Fluoride varnish 20 1457698961 0 Nurse Practitioners Healthy Kids Services 20 1457698961 0 Nurse Practitioners Nurse Practitioners Services 20 1457698961 0 Nurse Practitioners Physician Services 00 1457701104 0 JAMAL NIDA 2018034 9999999 B 10 1457701104 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1457701104 0 Physicians Anesthesia Services 20 1457701104 0 Physicians Healthy Kids Services 20 1457701104 0 Physicians Optical Supplies 20 1457701104 0 Physicians Physician Services 20 1457701104 0 Physicians Physicians Psychiatric Services 00 1457701120 0 GADDI KIRAN LAIQUE 2019193 9999999 B 10 1457701120 0 29373 NETWORK PL CHICAGO IL 606733039 20 1457701120 0 Physicians Anesthesia Services 20 1457701120 0 Physicians Healthy Kids Services 20 1457701120 0 Physicians Optical Supplies 20 1457701120 0 Physicians Physician Services 00 1457701633 0 KANE AMANDA K 2021180 9999999 B 10 1457701633 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1457701633 0 Nurse Practitioners Fluoride varnish 20 1457701633 0 Nurse Practitioners Healthy Kids Services 20 1457701633 0 Nurse Practitioners Nurse Practitioners Services 20 1457701633 0 Nurse Practitioners Physician Services 00 1457701674 0 MACGREGOR ROBERT M 2019295 9999999 B 10 1457701674 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1457701674 0 Physicians Anesthesia Services 20 1457701674 0 Physicians Healthy Kids Services 20 1457701674 0 Physicians Optical Supplies 20 1457701674 0 Physicians Physician Services 00 1457702078 0 SHAVER MARY CAROLINE 2022343 9999999 B 10 1457702078 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1457702078 0 Clinical Social Worker Social work service 00 1457702094 0 WILLIAMS HOPE ELIZABETH 2017080 9999999 B 10 1457702094 0 3323 W DIVERSEY AVE STE 7 CHICAGO IL 606478582 20 1457702094 0 Clinical Social Worker Social work service 00 1457702318 0 AHMED OMAR F 2017182 9999999 B 10 1457702318 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1457702318 0 Physicians All Kids application agent 20 1457702318 0 Physicians Anesthesia Services 20 1457702318 0 Physicians Fluoride varnish 20 1457702318 0 Physicians Healthy Kids Services 20 1457702318 0 Physicians Optical Supplies 20 1457702318 0 Physicians Physician Services 00 1457702953 0 CASTRO BRANDYN A 2018348 9999999 B 10 1457702953 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1457702953 0 Physicians Anesthesia Services 20 1457702953 0 Physicians Healthy Kids Services 20 1457702953 0 Physicians Optical Supplies 20 1457702953 0 Physicians Physician Services 00 1457703282 0 MARTIS TREVISSA 2024240 9999999 B 10 1457703282 0 28100 TORCH PKWY STE 600 WARRENVILLE IL 605554030 20 1457703282 0 Physical Therapists Medical Supplies 20 1457703282 0 Physical Therapists Medical equipment/prosthetic devices 20 1457703282 0 Physical Therapists Physical Therapy Services 00 1457704025 0 STARK KATHY 2016258 9999999 B 10 1457704025 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1457704025 0 Nurse Practitioners Healthy Kids Services 20 1457704025 0 Nurse Practitioners Nurse Practitioners Services 20 1457704025 0 Nurse Practitioners Physician Services 00 1457704512 0 SEMAR MEGHAN K 2017034 9999999 B 10 1457704512 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1457704512 0 Nurse Practitioners Anesthesia Services 20 1457704512 0 Nurse Practitioners Nurse Practitioners Services 20 1457704512 0 Nurse Practitioners Physician Services 00 1457706624 0 HUBLER AIMEE 2016196 9999999 B 10 1457706624 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1457706624 0 Nurse Practitioners Fluoride varnish 20 1457706624 0 Nurse Practitioners Healthy Kids Services 20 1457706624 0 Nurse Practitioners Nurse Practitioners Services 20 1457706624 0 Nurse Practitioners Physician Services 00 1457706772 0 MCGUIRE BRIAN 2018353 9999999 B 10 1457706772 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1457706772 0 Physicians Anesthesia Services 20 1457706772 0 Physicians Healthy Kids Services 20 1457706772 0 Physicians Optical Supplies 20 1457706772 0 Physicians Physician Services 00 1457707010 0 ADE JUSTINE 2021363 9999999 B 10 1457707010 0 611 W PARK ST URBANA IL 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Practitioners Fluoride varnish 20 1457707572 0 Nurse Practitioners Healthy Kids Services 20 1457707572 0 Nurse Practitioners Nurse Practitioners Services 20 1457707572 0 Nurse Practitioners Physician Services 00 1457707705 0 MCDONALD RENEE 2021160 9999999 B 10 1457707705 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1457707705 0 Nurse Practitioners Fluoride varnish 20 1457707705 0 Nurse Practitioners Healthy Kids Services 20 1457707705 0 Nurse Practitioners Nurse Practitioners Services 20 1457707705 0 Nurse Practitioners Physician Services 00 1457708521 0 RIFFLE RIANA M 2019351 9999999 B 10 1457708521 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1457708521 0 Physicians Anesthesia Services 20 1457708521 0 Physicians Fluoride varnish 20 1457708521 0 Physicians Healthy Kids Services 20 1457708521 0 Physicians Optical Supplies 20 1457708521 0 Physicians Physician Services 00 1457709065 0 COPELAND TAMARA 2021260 9999999 B 10 1457709065 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1457709065 0 Physicians Anesthesia Services 20 1457709065 0 Physicians Fluoride varnish 20 1457709065 0 Physicians Healthy Kids Services 20 1457709065 0 Physicians Optical Supplies 20 1457709065 0 Physicians Physician Services 00 1457709172 0 REHMAN JAMAAL A 2018353 9999999 B 10 1457709172 0 820 E TERRA COTTA AVE STE 216 CRYSTAL LAKE IL 600143646 20 1457709172 0 Physicians Anesthesia Services 20 1457709172 0 Physicians Healthy Kids Services 20 1457709172 0 Physicians Optical Supplies 20 1457709172 0 Physicians Physician Services 00 1457709404 0 KOTHARI SHAWN 2018351 9999999 B 10 1457709404 0 5777 DEPT CAROL STREAM IL 601220021 20 1457709404 0 Physicians Anesthesia Services 20 1457709404 0 Physicians Fluoride varnish 20 1457709404 0 Physicians Healthy Kids Services 20 1457709404 0 Physicians Optical Supplies 20 1457709404 0 Physicians Physician Services 00 1457709453 0 CAUDILLO CLEO 2016158 9999999 B 10 1457709453 0 PO BOX 1109 DEKALB IL 601157109 20 1457709453 0 Other behavior health professional 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Healthy Kids Services 20 1457713646 0 Physicians Optical Supplies 20 1457713646 0 Physicians Physician Services 00 1457713901 0 ZAMUDIO ALEJANDRO 2020290 9999999 B 10 1457713901 0 PO BOX 781076 DETROIT MI 482781076 20 1457713901 0 Physicians Anesthesia Services 20 1457713901 0 Physicians Fluoride varnish 20 1457713901 0 Physicians Healthy Kids Services 20 1457713901 0 Physicians Optical Supplies 20 1457713901 0 Physicians Physician Services 00 1457714479 0 ISRAEL SAMANTHA C 2016147 9999999 B 10 1457714479 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1457714479 0 Nurse Practitioners Fluoride varnish 20 1457714479 0 Nurse Practitioners Healthy Kids Services 20 1457714479 0 Nurse Practitioners Nurse Practitioners Services 20 1457714479 0 Nurse Practitioners Physician Services 00 1457714487 0 MCGINNIS CAROLYN 2016144 9999999 B 10 1457714487 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1457714487 0 Nurse Practitioners Healthy Kids Services 20 1457714487 0 Nurse Practitioners 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1457719023 0 LANGENOHL ROBERT 2024261 9999999 B 10 1457719023 0 4701 DEPT CAROL STREAM IL 601220021 20 1457719023 0 Physicians Anesthesia Services 20 1457719023 0 Physicians Healthy Kids Services 20 1457719023 0 Physicians Optical Supplies 20 1457719023 0 Physicians Physician Services 00 1457720682 0 BARKEI KATHERINE L 2018169 9999999 B 10 1457720682 0 10205 W LINCOLN HWY FRANKFORT IL 604231279 20 1457720682 0 Nurse Practitioners Fluoride varnish 20 1457720682 0 Nurse Practitioners Healthy Kids Services 20 1457720682 0 Nurse Practitioners Nurse Practitioners Services 20 1457720682 0 Nurse Practitioners Physician Services 00 1457721037 0 KOTECHA RISHA 2016057 9999999 B 10 1457721037 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1457721037 0 Physical Therapists Medical Supplies 20 1457721037 0 Physical Therapists Medical equipment/prosthetic devices 20 1457721037 0 Physical Therapists Physical Therapy Services 00 1457721227 0 SINGH SANMINDER 2022193 2099365 B 10 1457721227 0 900 N WESTMORELAND RD STE 222 LAKE FOREST IL 600451694 20 1457721227 0 Physicians Anesthesia Services 20 1457721227 0 Physicians Healthy Kids Services 20 1457721227 0 Physicians Optical Supplies 20 1457721227 0 Physicians Physician Services 00 1457721532 0 KOSTECKI HALEY D 2016162 9999999 B 10 1457721532 0 513 N MAIN ST ANNA IL 629061668 20 1457721532 0 Physician Assistant Only All Kids application agent 20 1457721532 0 Physician Assistant Only Family Planning Counseling 20 1457721532 0 Physician Assistant Only Fluoride varnish 20 1457721532 0 Physician Assistant Only Healthy Kids Services 20 1457721532 0 Physician Assistant Only Physician Services 00 1457721946 0 DORAN LESLIE D 2017001 9999999 B 10 1457721946 0 2225 CRANSTON RD STE 103 BELOIT WI 535113187 20 1457721946 0 Nurse Practitioners Fluoride varnish 20 1457721946 0 Nurse Practitioners Healthy Kids Services 20 1457721946 0 Nurse Practitioners Nurse Practitioners Services 20 1457721946 0 Nurse Practitioners Physician Services 00 1457722506 0 SIMMONS ELIZABETH 2017001 9999999 B 10 1457722506 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1457722506 0 Psychologist Psychologist service 00 1457722910 0 WESHINSKEY ETHAN 2015274 9999999 B 10 1457722910 0 109 CALIFORNIA ST CARTERVILLE IL 629181923 20 1457722910 0 Physician Assistant Only Fluoride varnish 20 1457722910 0 Physician Assistant Only Healthy Kids Services 20 1457722910 0 Physician Assistant Only Physician Services 00 1457723454 0 NOFSINGER ANDREA 2015182 9999999 B 10 1457723454 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1457723454 0 Nurse Practitioners Anesthesia Services 20 1457723454 0 Nurse Practitioners Nurse Practitioners Services 20 1457723454 0 Nurse Practitioners Physician Services 00 1457725459 0 DUFF VALERIE 2015335 9999999 B 10 1457725459 0 5010 ROSE LN COULTERVILLE IL 622372746 20 1457725459 0 Other behavior health professional Social work service 00 1457727646 0 HOYE SCOTT 2023133 9999999 B 10 1457727646 0 917 W WASHINGTON BLVD CHICAGO IL 606072203 20 1457727646 0 Psychologist Psychologist service 00 1457727695 0 ORTON KADIE A 2016214 9999999 B 10 1457727695 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1457727695 0 Nurse Practitioners Healthy Kids Services 20 1457727695 0 Nurse Practitioners Nurse Practitioners Services 20 1457727695 0 Nurse Practitioners Physician Services 00 1457727836 0 KATSIGIANNIS ATHANASIA 2015229 9999999 B 10 1457727836 0 9649 W 55TH ST COUNTRYSIDE IL 605253632 20 1457727836 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1457729915 0 AMOS JOSEPH C 2016161 9999999 B 10 1457729915 0 250 W 96TH ST STE 520 INDIANAPOLIS IN 462601317 20 1457729915 0 Licensed Practical Nurses Fluoride varnish 20 1457729915 0 Licensed Practical Nurses Healthy Kids Services 20 1457729915 0 Licensed Practical Nurses Nurse Practitioners Services 20 1457729915 0 Licensed Practical Nurses Nursing service 20 1457729915 0 Licensed Practical Nurses Physician Services 00 1457730038 0 DOUTHIT MELISSA A 2018199 9999999 B 10 1457730038 0 PO BOX 1412 SOUTH BEND IN 466241412 20 1457730038 0 Nurse Practitioners Healthy Kids Services 20 1457730038 0 Nurse Practitioners Nurse Practitioners Services 20 1457730038 0 Nurse Practitioners Physician Services 00 1457730046 0 WILMERT DOREEN 2015138 9999999 B 10 1457730046 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1457730046 0 Nurse Practitioners Fluoride varnish 20 1457730046 0 Nurse Practitioners Healthy Kids Services 20 1457730046 0 Nurse Practitioners Nurse Practitioners Services 20 1457730046 0 Nurse Practitioners Physician Services 00 1457730996 0 FORSHAW ADAM 2022228 9999999 B 10 1457730996 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1457730996 0 Physicians Anesthesia Services 20 1457730996 0 Physicians Healthy Kids Services 20 1457730996 0 Physicians Optical Supplies 20 1457730996 0 Physicians Physician Services 00 1457731127 0 ELLISON AMY M 2015278 9999999 B 10 1457731127 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1457731127 0 Nurse Practitioners Fluoride varnish 20 1457731127 0 Nurse Practitioners Healthy Kids Services 20 1457731127 0 Nurse Practitioners Nurse Practitioners Services 20 1457731127 0 Nurse Practitioners Physician Services 00 1457731291 0 SIDDIQUI MARYAM 2018299 9999999 B 10 1457731291 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1457731291 0 Physicians Anesthesia Services 20 1457731291 0 Physicians Fluoride varnish 20 1457731291 0 Physicians Healthy Kids Services 20 1457731291 0 Physicians Optical Supplies 20 1457731291 0 Physicians Physician Services 20 1457731291 0 Physicians Physicians Psychiatric Services 00 1457731861 0 ADHIKARI SUBODH 2020230 9999999 B 10 1457731861 0 PO BOX 15722 HATTIESBURG MS 394045722 20 1457731861 0 Physicians Anesthesia Services 20 1457731861 0 Physicians Healthy Kids Services 20 1457731861 0 Physicians Optical Supplies 20 1457731861 0 Physicians Physician Services 00 1457732125 0 YALCIN NILUFER 2019329 9999999 B 10 1457732125 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1457732125 0 Physicians Anesthesia Services 20 1457732125 0 Physicians Healthy Kids Services 20 1457732125 0 Physicians Optical Supplies 20 1457732125 0 Physicians Physician Services 20 1457732125 0 Physicians Physicians Psychiatric Services 00 1457732455 0 MORGAN ZACHARY A 2018220 9999999 B 10 1457732455 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1457732455 0 Physicians Anesthesia Services 20 1457732455 0 Physicians Fluoride varnish 20 1457732455 0 Physicians Healthy Kids Services 20 1457732455 0 Physicians Optical Supplies 20 1457732455 0 Physicians Physician Services 00 1457732620 0 KOPYDLOWSKI AMANDA A 2018149 9999999 B 10 1457732620 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1457732620 0 Physicians Anesthesia Services 20 1457732620 0 Physicians Fluoride varnish 20 1457732620 0 Physicians Healthy Kids Services 20 1457732620 0 Physicians Optical Supplies 20 1457732620 0 Physicians Physician Services 00 1457732745 0 RAWNSLEY DAVID 2019302 9999999 B 10 1457732745 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1457732745 0 Physicians Anesthesia Services 20 1457732745 0 Physicians Fluoride varnish 20 1457732745 0 Physicians Healthy Kids Services 20 1457732745 0 Physicians Optical Supplies 20 1457732745 0 Physicians Physician Services 00 1457732869 0 CARLSON ERIN 2016252 9999999 B 10 1457732869 0 70 S RIVER ST AURORA IL 605065185 20 1457732869 0 Other behavior health professional LCPC/LMFT services 20 1457732869 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1457733156 0 ARDILA SILVIA M 2021263 9999999 B 10 1457733156 0 29373 NETWORK PL CHICAGO IL 606733039 20 1457733156 0 Physicians Anesthesia Services 20 1457733156 0 Physicians Fluoride varnish 20 1457733156 0 Physicians Healthy Kids Services 20 1457733156 0 Physicians Optical Supplies 20 1457733156 0 Physicians Physician Services 00 1457733305 0 SETSER JESSICA 2024100 9999999 B 10 1457733305 0 PO BOX 43230 PHOENIX AZ 850803230 20 1457733305 0 Physicians Anesthesia Services 20 1457733305 0 Physicians Fluoride varnish 20 1457733305 0 Physicians Healthy Kids Services 20 1457733305 0 Physicians Optical Supplies 20 1457733305 0 Physicians Physician Services 00 1457733354 0 TISH JACQUELINE 2017304 9999999 B 10 1457733354 0 620 E GARFIELD AVE DECATUR IL 625264550 20 1457733354 0 Speech Therapists Medical Supplies 20 1457733354 0 Speech Therapists Medical equipment/prosthetic devices 20 1457733354 0 Speech Therapists Speech Therapy/Pathology Services 00 1457733396 0 JAMI ASMA 2020303 9999999 B 10 1457733396 0 400 N HIGHLAND AVE AURORA IL 605063814 20 1457733396 0 Physicians Anesthesia Services 20 1457733396 0 Physicians Healthy Kids Services 20 1457733396 0 Physicians Optical Supplies 20 1457733396 0 Physicians Physician Services 20 1457733396 0 Physicians Physicians Psychiatric Services 00 1457733438 0 WILSON CRAIG J 2017082 9999999 B 10 1457733438 0 124 SW ADAMS ST PEORIA IL 616021308 20 1457733438 0 Physicians Anesthesia Services 20 1457733438 0 Physicians Healthy Kids Services 20 1457733438 0 Physicians Optical Supplies 20 1457733438 0 Physicians Physician Services 00 1457733883 0 WYCOFF JAMES W 2022235 9999999 B 10 1457733883 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1457733883 0 Physicians Anesthesia Services 20 1457733883 0 Physicians Healthy Kids Services 20 1457733883 0 Physicians Optical Supplies 20 1457733883 0 Physicians Physician Services 00 1457734808 0 JOSEPH THOMAS 2018121 9999999 B 10 1457734808 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1457734808 0 Physicians Anesthesia Services 20 1457734808 0 Physicians Fluoride varnish 20 1457734808 0 Physicians Healthy Kids Services 20 1457734808 0 Physicians Optical Supplies 20 1457734808 0 Physicians Physician Services 00 1457735342 0 GUZMAN JASMIN 2015165 9999999 B 10 1457735342 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1457735342 0 Dentists All Kids application agent 20 1457735342 0 Dentists Dental Services 20 1457735342 0 Dentists Physician Services 00 1457736712 0 PETIT COLETTE 2016013 9999999 B 10 1457736712 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1457736712 0 Registered nurse All Kids application agent 20 1457736712 0 Registered nurse Nursing service 20 1457736712 0 Registered nurse Waiver service 00 1457737975 0 HUNT ERICA 2016133 9999999 B 10 1457737975 0 1436 LOCUST ST TERRE HAUTE IN 478071648 20 1457737975 0 Dentists Dental Services 20 1457737975 0 Dentists Physician Services 00 1457738635 0 LAMBERT MATTHEW C 2021154 9999999 B 10 1457738635 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1457738635 0 Physicians Anesthesia Services 20 1457738635 0 Physicians Fluoride varnish 20 1457738635 0 Physicians Healthy Kids Services 20 1457738635 0 Physicians Optical Supplies 20 1457738635 0 Physicians Physician Services 00 1457739229 0 JENDUSA MICHAEL F 2017132 9999999 B 10 1457739229 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1457739229 0 Physicians All Kids application agent 20 1457739229 0 Physicians Anesthesia Services 20 1457739229 0 Physicians Fluoride varnish 20 1457739229 0 Physicians Healthy Kids Services 20 1457739229 0 Physicians Optical Supplies 20 1457739229 0 Physicians Physician Services 00 1457741548 0 SAINI RAVINDER K 2015140 9999999 B 10 1457741548 0 405 LAKE ZURICH RD BARRINGTON IL 600103141 20 1457741548 0 Nurse Practitioners Healthy Kids Services 20 1457741548 0 Nurse Practitioners Nurse Practitioners Services 20 1457741548 0 Nurse Practitioners Physician Services 00 1457742546 0 ADEWALE ADEDOTUN O 2018348 9999999 B 10 1457742546 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1457742546 0 Physicians Anesthesia Services 20 1457742546 0 Physicians Fluoride varnish 20 1457742546 0 Physicians Healthy Kids Services 20 1457742546 0 Physicians Optical Supplies 20 1457742546 0 Physicians Physician Services 00 1457743106 0 JANETOS TIMOTHY M 2019285 9999999 B 10 1457743106 0 5777 DEPT CAROL STREAM IL 601220021 20 1457743106 0 Physicians Anesthesia Services 20 1457743106 0 Physicians Healthy Kids Services 20 1457743106 0 Physicians Optical Supplies 20 1457743106 0 Physicians Physician Services 00 1457743189 0 BUGAY BRIAN 2020289 9999999 B 10 1457743189 0 6801 BRECKSVILLE RD INDEPENDENCE OH 441315032 20 1457743189 0 Physicians Anesthesia Services 20 1457743189 0 Physicians Healthy Kids Services 20 1457743189 0 Physicians Optical Supplies 20 1457743189 0 Physicians Physician Services 00 1457743312 0 HUGHES-STRANGE ABIGAIL C 2015119 9999999 B 10 1457743312 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1457743312 0 Nurse Practitioners Anesthesia Services 20 1457743312 0 Nurse Practitioners Nurse Practitioners Services 20 1457743312 0 Nurse Practitioners Physician Services 00 1457743338 0 ROEDL KATIE J 2015089 9999999 B 10 1457743338 0 1106 N MERCHANT ST PO BOX 665 EFFINGHAM IL 624012128 20 1457743338 0 Nurse Practitioners Fluoride varnish 20 1457743338 0 Nurse Practitioners Healthy Kids Services 20 1457743338 0 Nurse Practitioners Nurse Practitioners Services 20 1457743338 0 Nurse Practitioners Physician Services 00 1457744278 0 CARNEVALE MEAGHAN C 2021323 9999999 B 10 1457744278 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1457744278 0 Nurse Practitioners Healthy Kids Services 20 1457744278 0 Nurse Practitioners Nurse Practitioners Services 20 1457744278 0 Nurse Practitioners Physician Services 00 1457745358 0 CHRISTOPHER SAMANTHA J 2017251 9999999 B 10 1457745358 0 PO BOX 3988 CARBONDALE IL 629023988 20 1457745358 0 Nurse Practitioners Fluoride varnish 20 1457745358 0 Nurse Practitioners Healthy Kids Services 20 1457745358 0 Nurse Practitioners Nurse Practitioners Services 20 1457745358 0 Nurse Practitioners Physician Services 00 1457745432 0 ROWAN KATHRYN ANNE 2017179 9999999 B 10 1457745432 0 29373 NETWORK PL CHICAGO IL 606733039 20 1457745432 0 Physicians Anesthesia Services 20 1457745432 0 Physicians Healthy Kids Services 20 1457745432 0 Physicians Optical Supplies 20 1457745432 0 Physicians Physician Services 00 1457745887 0 ZEHRER TARA 2023001 9999999 B 10 1457745887 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1457745887 0 Physicians Anesthesia Services 20 1457745887 0 Physicians Fluoride varnish 20 1457745887 0 Physicians Healthy Kids Services 20 1457745887 0 Physicians Optical Supplies 20 1457745887 0 Physicians Physician Services 00 1457745911 0 MCCRORY EMERY H 2019088 9999999 B 10 1457745911 0 5777 DEPT CAROL STREAM IL 601220021 20 1457745911 0 Physicians Anesthesia Services 20 1457745911 0 Physicians Healthy Kids Services 20 1457745911 0 Physicians Optical Supplies 20 1457745911 0 Physicians Physician Services 00 1457745937 0 EL SAYED AMER 2015090 9999999 B 10 1457745937 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1457745937 0 Physicians Anesthesia Services 20 1457745937 0 Physicians Fluoride varnish 20 1457745937 0 Physicians Healthy Kids Services 20 1457745937 0 Physicians Optical Supplies 20 1457745937 0 Physicians Physician Services 00 1457746117 0 BANALA MOUNICA 2024150 9999999 B 10 1457746117 0 PO BOX 43230 PHOENIX AZ 850803230 20 1457746117 0 Physicians Anesthesia Services 20 1457746117 0 Physicians Fluoride varnish 20 1457746117 0 Physicians Healthy Kids Services 20 1457746117 0 Physicians Optical Supplies 20 1457746117 0 Physicians Physician Services 00 1457746240 0 STASKIEWICZ CHRISTINA 2018156 9999999 B 10 1457746240 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1457746240 0 Podiatrists Podiatric Services 00 1457746752 0 OLSON ERIKA N 2023306 9999999 B 10 1457746752 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1457746752 0 Physicians Anesthesia Services 20 1457746752 0 Physicians Healthy Kids Services 20 1457746752 0 Physicians Optical Supplies 20 1457746752 0 Physicians Physician Services 20 1457746752 0 Physicians Physicians Psychiatric Services 00 1457747032 0 ROSE RACHAEL 2021320 9999999 B 10 1457747032 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1457747032 0 Physicians Anesthesia Services 20 1457747032 0 Physicians Fluoride varnish 20 1457747032 0 Physicians Healthy Kids Services 20 1457747032 0 Physicians Optical Supplies 20 1457747032 0 Physicians Physician Services 00 1457747479 0 METZLER ROBERT T 2019163 9999999 B 10 1457747479 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1457747479 0 Physicians Anesthesia Services 20 1457747479 0 Physicians Healthy Kids Services 20 1457747479 0 Physicians Optical Supplies 20 1457747479 0 Physicians Physician Services 00 1457747677 0 WORKMAN CAYCE SPENCER 2023205 9999999 B 10 1457747677 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1457747677 0 Physicians Anesthesia Services 20 1457747677 0 Physicians Healthy Kids Services 20 1457747677 0 Physicians Optical Supplies 20 1457747677 0 Physicians Physician Services 00 1457747859 0 CHHAPARIA ANUJ 2018206 9999999 B 10 1457747859 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1457747859 0 Physicians Anesthesia Services 20 1457747859 0 Physicians Fluoride varnish 20 1457747859 0 Physicians Healthy Kids Services 20 1457747859 0 Physicians Optical Supplies 20 1457747859 0 Physicians Physician Services 00 1457748394 0 RITTER DAVID 2020245 9999999 B 10 1457748394 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1457748394 0 Physicians Anesthesia Services 20 1457748394 0 Physicians Healthy Kids Services 20 1457748394 0 Physicians Optical Supplies 20 1457748394 0 Physicians Physician Services 20 1457748394 0 Physicians Physicians Psychiatric Services 00 1457748907 0 SWANSON KURTIS J 2020140 9999999 B 10 1457748907 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1457748907 0 Physicians Anesthesia Services 20 1457748907 0 Physicians Fluoride varnish 20 1457748907 0 Physicians Healthy Kids Services 20 1457748907 0 Physicians Optical Supplies 20 1457748907 0 Physicians Physician Services 00 1457749079 0 MERCADO LLOYD 2016004 9999999 B 10 1457749079 0 2720 W DIVISION ST CHICAGO IL 606222853 20 1457749079 0 Nurse Practitioners Healthy Kids Services 20 1457749079 0 Nurse Practitioners Nurse Practitioners Services 20 1457749079 0 Nurse Practitioners Physician Services 00 1457750085 0 BEARD STEPHANIE A 2018060 9999999 B 10 1457750085 0 214 S GARRARD ST RANTOUL IL 618662317 20 1457750085 0 Other behavior health professional LCPC/LMFT services 00 1457750895 0 RUSSELL THERESA 2015104 9999999 B 10 1457750895 0 1005 BROADWAY ST QUINCY IL 623012834 20 1457750895 0 Other behavior health professional LCPC/LMFT services 00 1457751125 0 ROSATO NATHAN 2022027 9999999 B 10 1457751125 0 1400 W GREENLEAF AVE CHICAGO IL 606262805 20 1457751125 0 Clinical Social Worker Social work service 00 1457751281 0 COTTRELL THOMAS E 2014274 9999999 B 10 1457751281 0 5777 DEPT CAROL STREAM IL 601220021 20 1457751281 0 Nurse Practitioners Healthy Kids Services 20 1457751281 0 Nurse Practitioners Nurse Practitioners Services 20 1457751281 0 Nurse Practitioners Physician Services 00 1457751851 0 THOMPSON BRANDI M 2016224 9999999 B 10 1457751851 0 1005 BROADWAY ST QUINCY IL 623012834 20 1457751851 0 Nurse Practitioners Fluoride varnish 20 1457751851 0 Nurse Practitioners Healthy Kids Services 20 1457751851 0 Nurse Practitioners Nurse Practitioners Services 20 1457751851 0 Nurse Practitioners Physician Services 00 1457752230 0 SZAFRANSKI JACOB M 2015262 9999999 B 10 1457752230 0 1315 N HIGHLAND AVE STE 203 AURORA IL 605061460 20 1457752230 0 Nurse Practitioners Anesthesia Services 20 1457752230 0 Nurse Practitioners Nurse Practitioners Services 20 1457752230 0 Nurse Practitioners Physician Services 00 1457752719 0 KOVACEVIC MERDIJANA 2021343 9999999 B 10 1457752719 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1457752719 0 Psychologist Psychologist service 00 1457752743 0 MOY ANNIE 2014194 9999999 B 10 1457752743 0 1 CVS DR # MC2295 WOONSOCKET RI 028956146 20 1457752743 0 Nurse Practitioners Fluoride varnish 20 1457752743 0 Nurse Practitioners Healthy Kids Services 20 1457752743 0 Nurse Practitioners Nurse Practitioners Services 20 1457752743 0 Nurse Practitioners Physician Services 00 1457752826 0 MALONE PITTS VALERIE 2014301 9999999 B 10 1457752826 0 8051 186TH ST TINLEY PARK IL 604879341 20 1457752826 0 Clinical Social Worker Social work service 00 1457755019 0 DIGIACOMO JENNIFER A 2017138 9999999 B 10 1457755019 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1457755019 0 Nurse Practitioners Healthy Kids Services 20 1457755019 0 Nurse Practitioners Nurse Practitioners Services 20 1457755019 0 Nurse Practitioners Physician Services 00 1457756199 0 HUHNSTOCK JEFFREY 2023066 9999999 B 10 1457756199 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1457756199 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1457756272 0 OTTOMANELLI GRACE-MARIE M 2018182 9999999 B 10 1457756272 0 5777 DEPT CAROL STREAM IL 601228942 20 1457756272 0 Physician Assistant Only Fluoride varnish 20 1457756272 0 Physician Assistant Only Healthy Kids Services 20 1457756272 0 Physician Assistant Only Physician Services 00 1457756611 0 KAVANAUGH MOLLY E 2014335 9999999 B 10 1457756611 0 29373 NETWORK PL CHICAGO IL 606733039 20 1457756611 0 Nurse Practitioners Healthy Kids Services 20 1457756611 0 Nurse Practitioners Midwife Services 20 1457756611 0 Nurse Practitioners Nurse Practitioners Services 20 1457756611 0 Nurse Practitioners Physician Services 00 1457757247 0 QUIRK SARAH 2014335 9999999 B 10 1457757247 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1457757247 0 Nurse Practitioners All Kids application agent 20 1457757247 0 Nurse Practitioners Family Planning Counseling 20 1457757247 0 Nurse Practitioners Healthy Kids Services 20 1457757247 0 Nurse Practitioners Midwife Services 20 1457757247 0 Nurse Practitioners Nurse Practitioners Services 20 1457757247 0 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LINCOLN AVE MILWAUKEE WI 532272409 20 1457761108 0 Physicians Anesthesia Services 20 1457761108 0 Physicians Healthy Kids Services 20 1457761108 0 Physicians Optical Supplies 20 1457761108 0 Physicians Physician Services 00 1457762395 0 MAGEE ANDREA LYNN 2018353 9999999 B 10 1457762395 0 9500 BRYN MAWR AVE STE 300 ROSEMONT IL 600185257 20 1457762395 0 Physicians Anesthesia Services 20 1457762395 0 Physicians Healthy Kids Services 20 1457762395 0 Physicians Optical Supplies 20 1457762395 0 Physicians Physician Services 00 1457762445 0 DETERS HENRY 2014240 9999999 B 10 1457762445 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1457762445 0 Physical Therapists Medical Supplies 20 1457762445 0 Physical Therapists Medical equipment/prosthetic devices 20 1457762445 0 Physical Therapists Physical Therapy Services 00 1457762841 0 ORF LAUREN 2020268 9999999 B 10 1457762841 0 1430 N ARLINGTON HEIGHTS RD ST ARLINGTON HEIGH IL 600044823 20 1457762841 0 Nurse Practitioners Fluoride 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600508377 20 1457859555 0 Other behavior health professional Social work service 00 1457860009 0 BLACKBURN PATRICE R 2017305 9999999 B 10 1457860009 0 8940 W 24TH ST N RIVERSIDE IL 605461158 20 1457860009 0 Speech Therapists Medical Supplies 20 1457860009 0 Speech Therapists Medical equipment/prosthetic devices 20 1457860009 0 Speech Therapists Speech Therapy/Pathology Services 00 1457861049 0 DESMITH LAUREN E 2017297 9999999 B 10 1457861049 0 1301 W COSSITT AVE LA GRANGE IL 605252145 20 1457861049 0 Speech Therapists Medical Supplies 20 1457861049 0 Speech Therapists Medical equipment/prosthetic devices 20 1457861049 0 Speech Therapists Speech Therapy/Pathology Services 00 1457862187 0 ARNOLD DANA L 2020128 9999999 B 10 1457862187 0 411 S COURT ST MARION IL 629592711 20 1457862187 0 Speech Therapists Medical Supplies 20 1457862187 0 Speech Therapists Medical equipment/prosthetic devices 20 1457862187 0 Speech Therapists Speech Therapy/Pathology Services 00 1457862997 0 LOPEZ ANGELICA 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Practitioners Nurse Practitioners Services 20 1457868689 0 Nurse Practitioners Physician Services 00 1457869232 0 DEVRIES MARY ELIZABETH 2018011 9999999 B 10 1457869232 0 604 N BROAD ST CARLINVILLE IL 626261021 20 1457869232 0 Nurse Practitioners Fluoride varnish 20 1457869232 0 Nurse Practitioners Healthy Kids Services 20 1457869232 0 Nurse Practitioners Nurse Practitioners Services 20 1457869232 0 Nurse Practitioners Physician Services 00 1457869380 0 SUTTON JOCELYN 2022299 9999999 B 10 1457869380 0 101 E STATE ST KENNETT SQ PA 193483109 20 1457869380 0 Occupational Therapists Medical Supplies 20 1457869380 0 Occupational Therapists Medical equipment/prosthetic devices 20 1457869380 0 Occupational Therapists Occupational Therapy Services 00 1457870131 0 FAZIL TAYLER R 2018197 9999999 B 10 1457870131 0 6800 STATE ROUTE 162 MARYVILLE IL 620628500 20 1457870131 0 Audiologists Audiology Services 20 1457870131 0 Audiologists Medical Supplies 20 1457870131 0 Audiologists Medical equipment/prosthetic devices 00 1457870230 0 SNEED JESSICA 2017285 9999999 B 10 1457870230 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1457870230 0 Occupational Therapists Medical Supplies 20 1457870230 0 Occupational Therapists Medical equipment/prosthetic devices 20 1457870230 0 Occupational Therapists Occupational Therapy Services 00 1457870412 0 KINNEY KARA 2017228 9999999 B 10 1457870412 0 1008 N HENA ST GREENVILLE IL 622461378 20 1457870412 0 Speech Therapists Medical Supplies 20 1457870412 0 Speech Therapists Medical equipment/prosthetic devices 20 1457870412 0 Speech Therapists Speech Therapy/Pathology Services 00 1457870917 0 WINDERS SARA 2017345 9999999 B 10 1457870917 0 3451 MORTON DR EAST MOLINE IL 612441921 20 1457870917 0 Speech Therapists Medical Supplies 20 1457870917 0 Speech Therapists Medical equipment/prosthetic devices 20 1457870917 0 Speech Therapists Speech Therapy/Pathology Services 00 1457871394 0 HENDERSON MIQUIA S 2019001 9999999 B 10 1457871394 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1457871394 0 Physicians Anesthesia Services 20 1457871394 0 Physicians Fluoride varnish 20 1457871394 0 Physicians Healthy Kids Services 20 1457871394 0 Physicians Optical Supplies 20 1457871394 0 Physicians Physician Services 00 1457871402 0 BAKHSH SAAQUIB R 2023200 9999999 B 10 1457871402 0 2015 N MAIN ST WHEATON IL 601873152 20 1457871402 0 Physicians Anesthesia Services 20 1457871402 0 Physicians Healthy Kids Services 20 1457871402 0 Physicians Optical Supplies 20 1457871402 0 Physicians Physician Services 00 1457872400 0 GOSTOMSKI APRILEE DV 2021189 9999999 B 10 1457872400 0 5777 DEPT CAROL STREAM IL 601228942 20 1457872400 0 Physicians Anesthesia Services 20 1457872400 0 Physicians Healthy Kids Services 20 1457872400 0 Physicians Optical Supplies 20 1457872400 0 Physicians Physician Services 00 1457873036 0 MCCUTCHEN WILLIAMS MELISSA A 2017221 9999999 B 10 1457873036 0 800 E NORTHWEST HWY STE 106B MOUNT PROSPECT IL 600563457 20 1457873036 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1457876658 0 Nurse Practitioners Nurse Practitioners Services 20 1457876658 0 Nurse Practitioners Physician Services 00 1457877508 0 BRANDONISIO DANIELLE M 2017258 9999999 B 10 1457877508 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1457877508 0 Nurse Practitioners Fluoride varnish 20 1457877508 0 Nurse Practitioners Healthy Kids Services 20 1457877508 0 Nurse Practitioners Nurse Practitioners Services 20 1457877508 0 Nurse Practitioners Physician Services 00 1457877839 0 ROSALES KAITLYN R 2017310 9999999 B 10 1457877839 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1457877839 0 Nurse Practitioners Healthy Kids Services 20 1457877839 0 Nurse Practitioners Nurse Practitioners Services 20 1457877839 0 Nurse Practitioners Physician Services 00 1457877979 0 NORMAN MEREDITH A 2020034 9999999 B 10 1457877979 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1457877979 0 Nurse Practitioners Fluoride varnish 20 1457877979 0 Nurse Practitioners Healthy Kids Services 20 1457877979 0 Nurse Practitioners Nurse Practitioners Services 20 1457877979 0 Nurse Practitioners Physician Services 00 1457878225 0 WAITZMAN SAMANTHA B. 2018132 9999999 B 10 1457878225 0 820 SPRINGER DR LOMBARD IL 601486413 20 1457878225 0 Physician Assistant Only Fluoride varnish 20 1457878225 0 Physician Assistant Only Healthy Kids Services 20 1457878225 0 Physician Assistant Only Physician Services 00 1457878506 0 HOFMANN ERIC 2017274 9999999 B 10 1457878506 0 PO BOX 75081 CHICAGO IL 606755081 20 1457878506 0 Nurse Practitioners Anesthesia Services 20 1457878506 0 Nurse Practitioners Nurse Practitioners Services 20 1457878506 0 Nurse Practitioners Physician Services 00 1457878837 0 SAEY TAYLOR 2020238 9999999 B 10 1457878837 0 1002 SW 6TH ST ALEDO IL 612312100 20 1457878837 0 Speech Therapists Speech Therapy/Pathology Services 00 1457879330 0 WITCHER ALEX M 2017289 9999999 B 10 1457879330 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1457879330 0 Nurse Practitioners Anesthesia Services 20 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0 Physicians Optical Supplies 20 1457880007 0 Physicians Physician Services 00 1457880080 0 PRADES CARLO 2019168 9999999 B 10 1457880080 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1457880080 0 Physicians Anesthesia Services 20 1457880080 0 Physicians Fluoride varnish 20 1457880080 0 Physicians Healthy Kids Services 20 1457880080 0 Physicians Optical Supplies 20 1457880080 0 Physicians Physician Services 00 1457880171 0 WARREN ALEXIS 2021188 9999999 B 10 1457880171 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1457880171 0 Physicians Anesthesia Services 20 1457880171 0 Physicians Healthy Kids Services 20 1457880171 0 Physicians Optical Supplies 20 1457880171 0 Physicians Physician Services 00 1457880262 0 SCUORZO JOSEPH 2023291 9999999 B 10 1457880262 0 2100 POWELL ST STE 400 EMERYVILLE CA 946081872 20 1457880262 0 Physicians Anesthesia Services 20 1457880262 0 Physicians Healthy Kids Services 20 1457880262 0 Physicians Optical Supplies 20 1457880262 0 Physicians Physician 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0 29373 NETWORK PL CHICAGO IL 606733039 20 1457881682 0 Nurse Practitioners Fluoride varnish 20 1457881682 0 Nurse Practitioners Healthy Kids Services 20 1457881682 0 Nurse Practitioners Nurse Practitioners Services 20 1457881682 0 Nurse Practitioners Physician Services 00 1457881765 0 VU JOHN 2017237 9999999 B 10 1457881765 0 1005 BROADWAY ST QUINCY IL 623012834 20 1457881765 0 Physicians Anesthesia Services 20 1457881765 0 Physicians Fluoride varnish 20 1457881765 0 Physicians Healthy Kids Services 20 1457881765 0 Physicians Optical Supplies 20 1457881765 0 Physicians Physician Services 00 1457882417 0 ALTMAN ASHLEY N 2017182 9999999 B 10 1457882417 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1457882417 0 Nurse Practitioners Fluoride varnish 20 1457882417 0 Nurse Practitioners Healthy Kids Services 20 1457882417 0 Nurse Practitioners Nurse Practitioners Services 20 1457882417 0 Nurse Practitioners Physician Services 00 1457882474 0 DELGADO AARON E 2019266 9999999 B 10 1457882474 0 1 ILLINI DR PEORIA IL 616052576 20 1457882474 0 Physicians Anesthesia Services 20 1457882474 0 Physicians Fluoride varnish 20 1457882474 0 Physicians Healthy Kids Services 20 1457882474 0 Physicians Optical Supplies 20 1457882474 0 Physicians Physician Services 00 1457882813 0 BERNHARDSON NOAH 2020204 9999999 B 10 1457882813 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1457882813 0 Physicians Anesthesia Services 20 1457882813 0 Physicians Fluoride varnish 20 1457882813 0 Physicians Healthy Kids Services 20 1457882813 0 Physicians Optical Supplies 20 1457882813 0 Physicians Physician Services 00 1457882946 0 TARBUTTON MORGAN 2018059 9999999 B 10 1457882946 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1457882946 0 Physicians Anesthesia Services 20 1457882946 0 Physicians Fluoride varnish 20 1457882946 0 Physicians Healthy Kids Services 20 1457882946 0 Physicians Optical Supplies 20 1457882946 0 Physicians Physician Services 00 1457883449 0 BURGUNDER LAUREN 2023254 9999999 B 10 1457883449 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1457883449 0 Physicians Anesthesia Services 20 1457883449 0 Physicians Fluoride varnish 20 1457883449 0 Physicians Healthy Kids Services 20 1457883449 0 Physicians Optical Supplies 20 1457883449 0 Physicians Physician Services 00 1457883472 0 SUN PHILIP 2024144 9999999 B 10 1457883472 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1457883472 0 Physicians Anesthesia Services 20 1457883472 0 Physicians Healthy Kids Services 20 1457883472 0 Physicians Optical Supplies 20 1457883472 0 Physicians Physician Services 20 1457883472 0 Physicians Physicians Psychiatric Services 00 1457883985 0 GARRITY MATTHEW R 2024281 9999999 B 10 1457883985 0 9735 LANDMARK PARKWAY DR STE 2 SAINT LOUIS MO 631271666 20 1457883985 0 Physicians Anesthesia Services 20 1457883985 0 Physicians Fluoride varnish 20 1457883985 0 Physicians Healthy Kids Services 20 1457883985 0 Physicians Optical Supplies 20 1457883985 0 Physicians Physician 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1467080325 0 Physicians Fluoride varnish 20 1467080325 0 Physicians Healthy Kids Services 20 1467080325 0 Physicians Optical Supplies 20 1467080325 0 Physicians Physician Services 00 1467080820 0 THAKER PARTH 2024121 9999999 B 10 1467080820 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1467080820 0 Physicians Anesthesia Services 20 1467080820 0 Physicians Fluoride varnish 20 1467080820 0 Physicians Healthy Kids Services 20 1467080820 0 Physicians Optical Supplies 20 1467080820 0 Physicians Physician Services 00 1467080994 0 MACMILLAN JUSTIN J 2020177 9999999 B 10 1467080994 0 29373 NETWORK PL CHICAGO IL 606733039 20 1467080994 0 Physicians Anesthesia Services 20 1467080994 0 Physicians Fluoride varnish 20 1467080994 0 Physicians Healthy Kids Services 20 1467080994 0 Physicians Optical Supplies 20 1467080994 0 Physicians Physician Services 00 1467081257 0 BLAZEL MARK 2020216 9999999 B 10 1467081257 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1467081257 0 Physicians Anesthesia 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Practitioners Nurse Practitioners Services 20 1467092783 0 Nurse Practitioners Physician Services 00 1467093088 0 MINIET ASHLEY 2020014 9999999 B 10 1467093088 0 PO BOX 775231 CHICAGO IL 606775231 20 1467093088 0 Nurse Practitioners Fluoride varnish 20 1467093088 0 Nurse Practitioners Healthy Kids Services 20 1467093088 0 Nurse Practitioners Nurse Practitioners Services 20 1467093088 0 Nurse Practitioners Physician Services 00 1467093286 0 WALKER AMANDA J 2019336 9999999 B 10 1467093286 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1467093286 0 Clinical Social Worker Social work service 00 1467094839 0 MOORE BRITTNEY 2022215 9999999 B 10 1467094839 0 1005 BROADWAY ST QUINCY IL 623012834 20 1467094839 0 Psychologist Psychologist service 00 1467096339 0 MATTESON MATTHEW 2023255 9999999 B 10 1467096339 0 1236 N WABASH AVE KOKOMO IN 469012604 20 1467096339 0 Clinical Social Worker Social work service 00 1467096958 0 CRAIN ERIN 2019309 9999999 B 10 1467096958 0 1860 PAYSPHERE CIR 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Practitioners Physician Services 00 1467100248 0 KRIVENKO GABRIEL 2023179 9999999 B 10 1467100248 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1467100248 0 Nurse Practitioners Anesthesia Services 20 1467100248 0 Nurse Practitioners Fluoride varnish 20 1467100248 0 Nurse Practitioners Healthy Kids Services 20 1467100248 0 Nurse Practitioners Optical Supplies 20 1467100248 0 Nurse Practitioners Physician Services 00 1467101378 0 DEVLIN BRIDGET 2022173 9999999 B 10 1467101378 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1467101378 0 Physicians Anesthesia Services 20 1467101378 0 Physicians Healthy Kids Services 20 1467101378 0 Physicians Optical Supplies 20 1467101378 0 Physicians Physician Services 00 1467101535 0 DUBNER RACHEL 2022171 9999999 B 10 1467101535 0 4698 DEPT CAROL STREAM IL 601220021 20 1467101535 0 Physicians Anesthesia Services 20 1467101535 0 Physicians Fluoride varnish 20 1467101535 0 Physicians Healthy Kids Services 20 1467101535 0 Physicians Optical 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Physician Services 00 1467102996 0 KOMRO KATHRYN A 2023198 9999999 B 10 1467102996 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1467102996 0 Physicians Anesthesia Services 20 1467102996 0 Physicians Fluoride varnish 20 1467102996 0 Physicians Healthy Kids Services 20 1467102996 0 Physicians Optical Supplies 20 1467102996 0 Physicians Physician Services 00 1467103192 0 CZAPIGA ASHLYN 2024071 9999999 B 10 1467103192 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1467103192 0 Physician Assistant Only Fluoride varnish 20 1467103192 0 Physician Assistant Only Healthy Kids Services 20 1467103192 0 Physician Assistant Only Physician Services 00 1467106401 0 ALTENBERND ALAINA 2024275 9999999 B 10 1467106401 0 3500 W PETERSON AVE STE 401 CHICAGO IL 606593307 20 1467106401 0 Optometrists Optical Supplies 20 1467106401 0 Optometrists Optometric Services 20 1467106401 0 Optometrists Physician Services 00 1467107953 0 TAPIA EDUARDO 2022048 9999999 B 10 1467107953 0 3010 GRAND AVE ATTN: 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2023200 9999999 B 10 1467145466 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1467145466 0 Physical Therapists Medical Supplies 20 1467145466 0 Physical Therapists Medical equipment/prosthetic devices 20 1467145466 0 Physical Therapists Physical Therapy Services 00 1467145664 0 MAATOUK CHRISTOPHER M 2023170 9999999 B 10 1467145664 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1467145664 0 Physicians Anesthesia Services 20 1467145664 0 Physicians Fluoride varnish 20 1467145664 0 Physicians Healthy Kids Services 20 1467145664 0 Physicians Optical Supplies 20 1467145664 0 Physicians Physician Services 00 1467146233 0 LAGUNAS LIZETTE 2023263 9999999 B 10 1467146233 0 1940 S WESTERN AVE STE 205 CHICAGO IL 606082503 20 1467146233 0 Nurse Practitioners Healthy Kids Services 20 1467146233 0 Nurse Practitioners Nurse Practitioners Services 20 1467146233 0 Nurse Practitioners Physician Services 00 1467146498 0 ULLMAN ABIGAIL 2024022 9999999 B 10 1467146498 0 10000 W INNOVATION DR 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COURTNEY 2023072 9999999 B 10 1467152439 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1467152439 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1467153148 0 BUTLER BLAKE A 2023325 9999999 B 10 1467153148 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1467153148 0 Nurse Practitioners Anesthesia Services 20 1467153148 0 Nurse Practitioners Nurse Practitioners Services 20 1467153148 0 Nurse Practitioners Physician Services 00 1467153544 0 HIGGINS FINNBAR 2023094 9999999 B 10 1467153544 0 244 E ROOSEVELT RD LOMBARD IL 601484647 20 1467153544 0 Nurse Practitioners Fluoride varnish 20 1467153544 0 Nurse Practitioners Healthy Kids Services 20 1467153544 0 Nurse Practitioners Nurse Practitioners Services 20 1467153544 0 Nurse Practitioners Physician Services 00 1467154146 0 GAGEN ASHLEY 2023201 9999999 B 10 1467154146 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1467154146 0 Physicians Anesthesia Services 20 1467154146 0 Physicians Fluoride varnish 20 1467154146 0 Physicians Healthy Kids Services 20 1467154146 0 Physicians Optical Supplies 20 1467154146 0 Physicians Physician Services 00 1467155614 0 CABREJAS JACOB M 2023194 9999999 B 10 1467155614 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1467155614 0 Physicians Anesthesia Services 20 1467155614 0 Physicians Healthy Kids Services 20 1467155614 0 Physicians Optical Supplies 20 1467155614 0 Physicians Physician Services 00 1467156018 0 PECHTL KENNETH 2024183 9999999 B 10 1467156018 0 26W171 ROOSEVELT RD WHEATON IL 601876002 20 1467156018 0 Physicians Anesthesia Services 20 1467156018 0 Physicians Healthy Kids Services 20 1467156018 0 Physicians Optical Supplies 20 1467156018 0 Physicians Physician Services 00 1467156026 0 SENLIK RANA 2023228 9999999 B 10 1467156026 0 PO BOX 3039 OAK BROOK IL 605223039 20 1467156026 0 Physicians Anesthesia Services 20 1467156026 0 Physicians Fluoride varnish 20 1467156026 0 Physicians Healthy Kids Services 20 1467156026 0 Physicians Optical Supplies 20 1467156026 0 Physicians Physician Services 00 1467156570 0 GUPTA JUHI C 2023198 9999999 B 10 1467156570 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1467156570 0 Physicians Anesthesia Services 20 1467156570 0 Physicians Healthy Kids Services 20 1467156570 0 Physicians Optical Supplies 20 1467156570 0 Physicians Physician Services 20 1467156570 0 Physicians Physicians Psychiatric Services 00 1467156893 0 FLOSI EMMA 2023183 9999999 B 10 1467156893 0 PO BOX 3039 OAK BROOK IL 605223039 20 1467156893 0 Physicians Anesthesia Services 20 1467156893 0 Physicians Fluoride varnish 20 1467156893 0 Physicians Healthy Kids Services 20 1467156893 0 Physicians Optical Supplies 20 1467156893 0 Physicians Physician Services 00 1467157867 0 PATEL VARSHA B 2023254 9999999 B 10 1467157867 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1467157867 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1467157941 0 PACHECO JULIAN 2023277 9999999 B 10 1467157941 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1467157941 0 Physicians Anesthesia Services 20 1467157941 0 Physicians Healthy Kids Services 20 1467157941 0 Physicians Optical Supplies 20 1467157941 0 Physicians Physician Services 00 1467158667 0 HOLMES PAULETTE 2023036 9999999 B 10 1467158667 0 42 W MADISON ST FL 2 CHICAGO IL 606024309 20 1467158667 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1467164129 0 SHAY SAMANTHA A 2023144 9999999 B 10 1467164129 0 3 ERIE CT STE 1300 OAK PARK IL 603022519 20 1467164129 0 Clinical Social Worker Social work service 00 1467164939 0 WARD FRANCES E 2023090 9999999 B 10 1467164939 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1467164939 0 Nurse Practitioners Healthy Kids Services 20 1467164939 0 Nurse Practitioners Nurse Practitioners Services 20 1467164939 0 Nurse Practitioners Physician Services 00 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(excludes LCPC and LMFT IMPACT specialties) 00 1467172387 0 MARSH MISTI D 2022285 9999999 B 10 1467172387 0 PO BOX 1510 EVANSVILLE IN 477061510 20 1467172387 0 Nurse Practitioners Healthy Kids Services 20 1467172387 0 Nurse Practitioners Nurse Practitioners Services 20 1467172387 0 Nurse Practitioners Physician Services 00 1467173617 0 SCHLECHTER BRANDON M 2022255 9999999 B 10 1467173617 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1467173617 0 Nurse Practitioners Healthy Kids Services 20 1467173617 0 Nurse Practitioners Nurse Practitioners Services 20 1467173617 0 Nurse Practitioners Physician Services 00 1467174433 0 BLETHEN KATRINA E 2023215 9999999 B 10 1467174433 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1467174433 0 Nurse Practitioners Healthy Kids Services 20 1467174433 0 Nurse Practitioners Nurse Practitioners Services 20 1467174433 0 Nurse Practitioners Physician Services 00 1467175646 0 SCHROEDER COURTNEY 2024365 9999999 B 10 1467175646 0 911 N ELM ST STE 128 STE 128 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Medical equipment/prosthetic devices 20 1467177709 0 Occupational Therapists Occupational Therapy Services 00 1467178418 0 CONE ROBERT P 2024142 9999999 B 10 1467178418 0 4645 VILLAGE SQUARE DR STE C PADUCAH KY 420017448 20 1467178418 0 Nurse Practitioners Fluoride varnish 20 1467178418 0 Nurse Practitioners Healthy Kids Services 20 1467178418 0 Nurse Practitioners Nurse Practitioners Services 20 1467178418 0 Nurse Practitioners Physician Services 00 1467179085 0 KHAN SIDRAH 2023213 9999999 B 10 1467179085 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1467179085 0 Physicians Anesthesia Services 20 1467179085 0 Physicians Healthy Kids Services 20 1467179085 0 Physicians Optical Supplies 20 1467179085 0 Physicians Physician Services 00 1467179242 0 GINDVILLE LEA 2022335 9999999 B 10 1467179242 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1467179242 0 Physician Assistant Only Fluoride varnish 20 1467179242 0 Physician Assistant Only Healthy Kids Services 20 1467179242 0 Physician Assistant Only Physician Services 00 1467179986 0 LAMBDIN ELIZABETH 2022315 9999999 B 10 1467179986 0 1192 E PERSHING RD DECATUR IL 625264753 20 1467179986 0 Nurse Practitioners Fluoride varnish 20 1467179986 0 Nurse Practitioners Healthy Kids Services 20 1467179986 0 Nurse Practitioners Nurse Practitioners Services 20 1467179986 0 Nurse Practitioners Physician Services 00 1467180125 0 SADEK NADA 2024230 9999999 B 10 1467180125 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1467180125 0 Physicians Anesthesia Services 20 1467180125 0 Physicians Healthy Kids Services 20 1467180125 0 Physicians Optical Supplies 20 1467180125 0 Physicians Physician Services 00 1467181529 0 PEARSON MATTHEW C 2022206 9999999 B 10 1467181529 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1467181529 0 Physicians Anesthesia Services 20 1467181529 0 Physicians Healthy Kids Services 20 1467181529 0 Physicians Optical Supplies 20 1467181529 0 Physicians Physician Services 00 1467181685 0 HAJAR ALMA 2022182 9999999 B 10 1467181685 0 PO BOX 855795 MINNEAPOLIS MN 554851296 20 1467181685 0 Physicians Anesthesia Services 20 1467181685 0 Physicians Fluoride varnish 20 1467181685 0 Physicians Healthy Kids Services 20 1467181685 0 Physicians Optical Supplies 20 1467181685 0 Physicians Physician Services 00 1467181818 0 PARIKH NISHI 2022239 9999999 B 10 1467181818 0 124 SW ADAMS ST PEORIA IL 616021308 20 1467181818 0 Physicians Anesthesia Services 20 1467181818 0 Physicians Fluoride varnish 20 1467181818 0 Physicians Healthy Kids Services 20 1467181818 0 Physicians Optical Supplies 20 1467181818 0 Physicians Physician Services 00 1467181875 0 FARMER DONTANE 2022294 9999999 B 10 1467181875 0 47 W POLK ST STE 250 CHICAGO IL 606052765 20 1467181875 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1467182832 0 DUONG SOPHIE 2022189 9999999 B 10 1467182832 0 2211 N ELSTON AVE STE 301 CHICAGO IL 606149278 20 1467182832 0 Physicians Anesthesia Services 20 1467182832 0 Physicians Fluoride varnish 20 1467182832 0 Physicians Healthy Kids Services 20 1467182832 0 Physicians Optical Supplies 20 1467182832 0 Physicians Physician Services 00 1467183236 0 HAZELRIGG MATT S 2022238 9999999 B 10 1467183236 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1467183236 0 Physicians Anesthesia Services 20 1467183236 0 Physicians Healthy Kids Services 20 1467183236 0 Physicians Optical Supplies 20 1467183236 0 Physicians Physician Services 00 1467183830 0 OLAITAN ANIKE 2022188 9999999 B 10 1467183830 0 414 PLAZA DR STE 301 WESTMONT IL 605595508 20 1467183830 0 Other behavior health professional Development Therapy, Orientation and Mobility Services 20 1467183830 0 Other behavior health professional Early Intervention Services 20 1467183830 0 Other behavior health professional Targeted case management service 00 1467184622 0 MEHTA KARAN 2022193 9999999 B 10 1467184622 0 201 E MADISON ST STE 300 SPRINGFIELD IL 627025131 20 1467184622 0 Physicians Anesthesia Services 20 1467184622 0 Physicians Fluoride varnish 20 1467184622 0 Physicians Healthy Kids Services 20 1467184622 0 Physicians Optical Supplies 20 1467184622 0 Physicians Physician Services 00 1467185520 0 WHITE OLIVIA M 2022202 9999999 H 10 1467185520 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1467185520 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1467186908 0 KHTAB KHLWD 2023068 9999999 B 10 1467186908 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1467186908 0 Physicians Anesthesia Services 20 1467186908 0 Physicians Fluoride varnish 20 1467186908 0 Physicians Healthy Kids Services 20 1467186908 0 Physicians Optical Supplies 20 1467186908 0 Physicians Physician Services 00 1467188425 0 SABILLO MARGARET K 2024291 9999999 B 10 1467188425 0 1101 W 40TH ST UNIT 2225 CHATTANOOGA TN 374091379 20 1467188425 0 Other behavior health professional LCPC/LMFT services 00 1467188698 0 ALLINGER MELISSA 2022257 9999999 B 10 1467188698 0 201 W SPRINGFIELD AVE STE 1005 CHAMPAIGN IL 618204968 20 1467188698 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1467189407 0 ESPEJO JHERUM B 2023268 9999999 B 10 1467189407 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1467189407 0 Physical Therapists Medical Supplies 20 1467189407 0 Physical Therapists Medical equipment/prosthetic devices 20 1467189407 0 Physical Therapists Physical Therapy Services 00 1467190660 0 KORRELL HANNAH L 2022178 9999999 B 10 1467190660 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1467190660 0 Physicians Anesthesia Services 20 1467190660 0 Physicians Healthy Kids Services 20 1467190660 0 Physicians Optical Supplies 20 1467190660 0 Physicians Physician Services 00 1467190819 0 TOPPS MAYA E 2022159 9999999 B 10 1467190819 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1467190819 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1467191452 0 MOY MICHELLE 2023328 9999999 B 10 1467191452 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1467191452 0 Occupational Therapists Medical Supplies 20 1467191452 0 Occupational Therapists Medical equipment/prosthetic devices 20 1467191452 0 Occupational Therapists Occupational Therapy Services 00 1467192344 0 RAZA HASAN S 2022199 9999999 B 10 1467192344 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1467192344 0 Physicians Anesthesia Services 20 1467192344 0 Physicians Fluoride varnish 20 1467192344 0 Physicians Healthy Kids Services 20 1467192344 0 Physicians Optical Supplies 20 1467192344 0 Physicians Physician Services 00 1467192435 0 YAZDANPANAH GHASEM 2022234 9999999 B 10 1467192435 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1467192435 0 Physicians Anesthesia Services 20 1467192435 0 Physicians Healthy Kids Services 20 1467192435 0 Physicians Optical Supplies 20 1467192435 0 Physicians Physician Services 00 1467192989 0 MODI ZEEL N 2022262 9999999 B 10 1467192989 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1467192989 0 Physicians Anesthesia Services 20 1467192989 0 Physicians Fluoride varnish 20 1467192989 0 Physicians Healthy Kids Services 20 1467192989 0 Physicians Optical Supplies 20 1467192989 0 Physicians Physician Services 00 1467193326 0 TOUGAS KATHERINE J 2022151 9999999 B 10 1467193326 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1467193326 0 Physicians Anesthesia Services 20 1467193326 0 Physicians Healthy Kids Services 20 1467193326 0 Physicians Optical Supplies 20 1467193326 0 Physicians Physician Services 00 1467193656 0 BELL ALYSSA 2024240 9999999 B 10 1467193656 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1467193656 0 Physician Assistant Only Fluoride varnish 20 1467193656 0 Physician Assistant Only Healthy Kids Services 20 1467193656 0 Physician Assistant Only Physician Services 00 1467193888 0 PARK YOONHO 2022182 9999999 B 10 1467193888 0 PO BOX 3039 OAK BROOK IL 605223039 20 1467193888 0 Physicians Anesthesia Services 20 1467193888 0 Physicians Fluoride varnish 20 1467193888 0 Physicians Healthy Kids Services 20 1467193888 0 Physicians Optical Supplies 20 1467193888 0 Physicians Physician Services 00 1467195222 0 GANT JAMISE 2022229 9999999 B 10 1467195222 0 3330 SKOKIE VALLEY RD STE 200 HIGHLAND PARK IL 600351041 20 1467195222 0 Nurse Practitioners Fluoride varnish 20 1467195222 0 Nurse Practitioners Healthy Kids Services 20 1467195222 0 Nurse Practitioners Nurse Practitioners Services 20 1467195222 0 Nurse Practitioners Physician Services 00 1467196485 0 CHADWICK LEXIA 2022208 9999999 B 10 1467196485 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1467196485 0 Physicians Anesthesia Services 20 1467196485 0 Physicians Healthy Kids Services 20 1467196485 0 Physicians Optical Supplies 20 1467196485 0 Physicians Physician Services 00 1467196535 0 RUBEIZ MICHAEL 2022353 9999999 B 10 1467196535 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1467196535 0 Physicians Anesthesia Services 20 1467196535 0 Physicians Fluoride varnish 20 1467196535 0 Physicians Healthy Kids Services 20 1467196535 0 Physicians Optical Supplies 20 1467196535 0 Physicians Physician Services 00 1467197053 0 HARIDASA NAEHA P 2022179 9999999 B 10 1467197053 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1467197053 0 Physicians Anesthesia Services 20 1467197053 0 Physicians Healthy Kids Services 20 1467197053 0 Physicians Optical Supplies 20 1467197053 0 Physicians Physician Services 00 1467197129 0 COLEMAN GINA 2012053 9999999 B 10 1467197129 0 19990 GOVERNORS HWY OLYMPIA FIELDS IL 604611021 20 1467197129 0 Other behavior health professional LCPC/LMFT services 00 1467197293 0 SAGIREDDY SRAVANI 2022178 9999999 B 10 1467197293 0 PO BOX 775248 CHICAGO IL 606775248 20 1467197293 0 Physicians Anesthesia Services 20 1467197293 0 Physicians Fluoride varnish 20 1467197293 0 Physicians Healthy Kids Services 20 1467197293 0 Physicians Optical Supplies 20 1467197293 0 Physicians Physician Services 00 1467199208 0 ROSS ABEGAIL 2022188 9999999 B 10 1467199208 0 2211 N ELSTON AVE STE 301 CHICAGO IL 606149278 20 1467199208 0 Physicians Anesthesia Services 20 1467199208 0 Physicians Fluoride varnish 20 1467199208 0 Physicians Healthy Kids Services 20 1467199208 0 Physicians Optical Supplies 20 1467199208 0 Physicians Physician Services 00 1467199729 0 ZURLIENE KELLI D 2022217 9999999 B 10 1467199729 0 7951 E MAPLEWOOD AVE STE 118 GREENWOOD VILLA CO 801114724 20 1467199729 0 Clinical Social Worker Social work service 00 1467201061 0 BOUTSIKAKIS ALEXANDRA 2024270 9999999 B 10 1467201061 0 29373 NETWORK PL CHICAGO IL 606733039 20 1467201061 0 Physical Therapists Medical Supplies 20 1467201061 0 Physical Therapists Medical equipment/prosthetic devices 20 1467201061 0 Physical Therapists Physical Therapy Services 00 1467202556 0 ABDULLA AHMAD M 2024170 9999999 B 10 1467202556 0 PO BOX 3039 OAK BROOK IL 605223039 20 1467202556 0 Physicians Anesthesia Services 20 1467202556 0 Physicians Healthy Kids Services 20 1467202556 0 Physicians Optical Supplies 20 1467202556 0 Physicians Physician Services 00 1467210930 0 GERSTENKORN BRITTANY 2024277 9999999 B 10 1467210930 0 PO BOX 840532 DALLAS TX 752840532 20 1467210930 0 Nurse Practitioners Fluoride varnish 20 1467210930 0 Nurse Practitioners Healthy Kids Services 20 1467210930 0 Nurse Practitioners Nurse Practitioners Services 20 1467210930 0 Nurse Practitioners Physician Services 00 1467211078 0 PIASECKI SARA E 2024179 9999999 B 10 1467211078 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1467211078 0 Nurse Practitioners Healthy Kids Services 20 1467211078 0 Nurse Practitioners Nurse Practitioners Services 20 1467211078 0 Nurse Practitioners Physician Services 00 1467211524 0 JAMIL LIANA 2024197 9999999 B 10 1467211524 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1467211524 0 Physicians Anesthesia Services 20 1467211524 0 Physicians Healthy Kids Services 20 1467211524 0 Physicians Optical Supplies 20 1467211524 0 Physicians Physician Services 20 1467211524 0 Physicians Physicians Psychiatric Services 00 1467211581 0 EVANS VIRGINIA PEYTON 2024358 9999999 B 10 1467211581 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1467211581 0 Physicians Anesthesia Services 20 1467211581 0 Physicians Fluoride varnish 20 1467211581 0 Physicians Healthy Kids Services 20 1467211581 0 Physicians Optical Supplies 20 1467211581 0 Physicians Physician Services 00 1467212159 0 MCFARLAND PARIS 2024096 9999999 B 10 1467212159 0 975 W HAWTHORN DR ITASCA IL 601432056 20 1467212159 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1467212670 0 BICKNELL HEATHER 2024093 9999999 B 10 1467212670 0 7373 N LINCOLN AVE LINCOLNWOOD IL 607121715 20 1467212670 0 Clinical Social Worker Social work service 00 1467213868 0 DARDEN ELARNTA 2024327 9999999 B 10 1467213868 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1467213868 0 Nurse Practitioners Fluoride varnish 20 1467213868 0 Nurse Practitioners Healthy Kids Services 20 1467213868 0 Nurse Practitioners Nurse Practitioners Services 20 1467213868 0 Nurse Practitioners Physician Services 00 1467214726 0 GUZMAN ANDREA ALEXIS 2024086 9999999 B 10 1467214726 0 5777 DEPT CAROL STREAM IL 601228942 20 1467214726 0 Physician Assistant Only Fluoride varnish 20 1467214726 0 Physician Assistant Only Healthy Kids Services 20 1467214726 0 Physician Assistant Only Physician Services 00 1467217943 0 EID KEVIN T 2024195 9999999 B 10 1467217943 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1467217943 0 Physicians Anesthesia Services 20 1467217943 0 Physicians Healthy Kids Services 20 1467217943 0 Physicians Optical Supplies 20 1467217943 0 Physicians Physician Services 00 1467218321 0 BOYLE ADDISON M 2024326 9999999 B 10 1467218321 0 PO BOX 1230 EVANSVILLE IN 477061230 20 1467218321 0 Physician Assistant Only Fluoride varnish 20 1467218321 0 Physician Assistant Only Healthy Kids Services 20 1467218321 0 Physician Assistant Only Physician Services 00 1467218479 0 HOLCOMBE ALYSSA 2024102 9999999 B 10 1467218479 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1467218479 0 Nurse Practitioners Healthy Kids Services 20 1467218479 0 Nurse Practitioners Nurse Practitioners Services 20 1467218479 0 Nurse Practitioners Physician Services 00 1467219824 0 FAKHOURY JULIA 2024071 9999999 B 10 1467219824 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1467219824 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1467220525 0 CLUFF ZEBEDEE D 2024078 9999999 B 10 1467220525 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1467220525 0 Physician Assistant Only Fluoride varnish 20 1467220525 0 Physician Assistant Only Healthy Kids Services 20 1467220525 0 Physician Assistant Only Physician Services 00 1467222331 0 GENGNAGEL HEATHER 2024276 9999999 B 10 1467222331 0 PO BOX 781076 DETROIT MI 482781076 20 1467222331 0 Nurse Practitioners Fluoride varnish 20 1467222331 0 Nurse Practitioners Healthy Kids Services 20 1467222331 0 Nurse Practitioners Nurse Practitioners Services 20 1467222331 0 Nurse Practitioners Physician Services 00 1467222521 0 SAMMARCO JOANNA 2024031 9999999 B 10 1467222521 0 800 BIESTERFIELD RD STE G01 ELK GROVE VILLA IL 600073372 20 1467222521 0 Nurse Practitioners Fluoride varnish 20 1467222521 0 Nurse Practitioners Healthy Kids Services 20 1467222521 0 Nurse Practitioners Nurse Practitioners Services 20 1467222521 0 Nurse Practitioners Physician Services 00 1467224113 0 NEMETH MANDIE L 2023319 9999999 B 10 1467224113 0 8940 N WOOD SAGE RD PEORIA IL 616157822 20 1467224113 0 Nurse Practitioners Healthy Kids Services 20 1467224113 0 Nurse Practitioners Nurse Practitioners Services 20 1467224113 0 Nurse Practitioners Physician Services 00 1467225680 0 MICHELS KATE M 2023335 9999999 B 10 1467225680 0 1500 E LINCOLN HWY STE 1 DEKALB IL 601153990 20 1467225680 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1467226621 0 ZADOROZNY JESSICA M 2023333 9999999 B 10 1467226621 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1467226621 0 Occupational Therapists Medical Supplies 20 1467226621 0 Occupational Therapists Medical equipment/prosthetic devices 20 1467226621 0 Occupational Therapists Occupational Therapy Services 00 1467228049 0 BOYLE TERESA E 2023348 9999999 B 10 1467228049 0 800 E LOCUST ST OLNEY IL 624502553 20 1467228049 0 Nurse Practitioners Fluoride varnish 20 1467228049 0 Nurse Practitioners Healthy Kids Services 20 1467228049 0 Nurse Practitioners Nurse Practitioners Services 20 1467228049 0 Nurse Practitioners Physician Services 00 1467230904 0 MITCHELL CYNTHIA M 2023319 9999999 B 10 1467230904 0 1720 S MICHIGAN AVE APT 2909 CHICAGO IL 606164861 20 1467230904 0 Nurse Practitioners Fluoride varnish 20 1467230904 0 Nurse Practitioners Healthy Kids Services 20 1467230904 0 Nurse Practitioners Nurse Practitioners Services 20 1467230904 0 Nurse Practitioners Physician Services 00 1467231779 0 ENDEBROCK LISA 2023290 9999999 B 10 1467231779 0 7 S EWING ST ALTAMONT IL 624111265 20 1467231779 0 Registered nurse Nursing service 20 1467231779 0 Registered nurse Waiver service 00 1467235051 0 GUINNEE KATHLEEN A 2023249 9999999 B 10 1467235051 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1467235051 0 Nurse Practitioners Healthy Kids Services 20 1467235051 0 Nurse Practitioners Nurse Practitioners Services 20 1467235051 0 Nurse Practitioners Physician Services 00 1467236729 0 GORE NICHOLAS 2024004 9999999 B 10 1467236729 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1467236729 0 Physician Assistant Only Fluoride varnish 20 1467236729 0 Physician Assistant Only Healthy Kids Services 20 1467236729 0 Physician Assistant Only Physician Services 00 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Practitioners Services 20 1467273144 0 Nurse Practitioners Physician Services 00 1467275487 0 PHELAN CHARLES M 2025015 9999999 B 10 1467275487 0 9735 LANDMARK PARKWAY DR STE 2 SAINT LOUIS MO 631271666 20 1467275487 0 Nurse Practitioners Healthy Kids Services 20 1467275487 0 Nurse Practitioners Nurse Practitioners Services 20 1467275487 0 Nurse Practitioners Physician Services 00 1467279638 0 DEEN SURRIN S 2024271 9999999 B 10 1467279638 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1467279638 0 Physicians Anesthesia Services 20 1467279638 0 Physicians Healthy Kids Services 20 1467279638 0 Physicians Optical Supplies 20 1467279638 0 Physicians Physician Services 00 1467279786 0 ROBINSON KARLI 2025023 9999999 B 10 1467279786 0 11191 ILLINOIS ROUTE 185 HILLSBORO IL 620492664 20 1467279786 0 Nurse Practitioners Healthy Kids Services 20 1467279786 0 Nurse Practitioners Nurse Practitioners Services 20 1467279786 0 Nurse Practitioners Physician Services 00 1467281709 0 PROSSER 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Physician Assistant Only Fluoride varnish 20 1467287623 0 Physician Assistant Only Healthy Kids Services 20 1467287623 0 Physician Assistant Only Physician Services 00 1467290205 0 CARRION JULIANA CARMIN 2024227 9999999 B 10 1467290205 0 211 E LAKE ST STE 1B ADDISON IL 601012877 20 1467290205 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1467290478 0 MAKI MARGARET A 2024274 9999999 B 10 1467290478 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1467290478 0 Physician Assistant Only Fluoride varnish 20 1467290478 0 Physician Assistant Only Healthy Kids Services 20 1467290478 0 Physician Assistant Only Physician Services 00 1467290544 0 GALINDEZ RODRIGUEZ NICHOLE ENI 2024271 9999999 B 10 1467290544 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1467290544 0 Nurse Practitioners Healthy Kids Services 20 1467290544 0 Nurse Practitioners Nurse Practitioners Services 20 1467290544 0 Nurse Practitioners Physician Services 00 1467291120 0 BLACK JAMES 2024194 9999999 B 10 1467291120 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1467291120 0 Physicians Anesthesia Services 20 1467291120 0 Physicians Healthy Kids Services 20 1467291120 0 Physicians Optical Supplies 20 1467291120 0 Physicians Physician Services 00 1467292011 0 VAILLANCOURT OLIVIER 2024267 9999999 B 10 1467292011 0 5777 DEPT CAROL STREAM IL 601220021 20 1467292011 0 Physicians Anesthesia Services 20 1467292011 0 Physicians Healthy Kids Services 20 1467292011 0 Physicians Optical Supplies 20 1467292011 0 Physicians Physician Services 00 1467292185 0 BERG DEIDRA 2024267 9999999 B 10 1467292185 0 2605 KENTUCKY AVE STE 306 PADUCAH KY 420033802 20 1467292185 0 Nurse Practitioners Fluoride varnish 20 1467292185 0 Nurse Practitioners Healthy Kids Services 20 1467292185 0 Nurse Practitioners Nurse Practitioners Services 20 1467292185 0 Nurse Practitioners Physician Services 00 1467292482 0 JORDAN HEFLIN SHELLY 2024317 9999999 B 10 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Fluoride varnish 20 1467296574 0 Physicians Healthy Kids Services 20 1467296574 0 Physicians Optical Supplies 20 1467296574 0 Physicians Physician Services 00 1467298257 0 CLARK BENJAMIN G 2024206 9999999 B 10 1467298257 0 20855 S LAGRANGE RD STE 205 FRANKFORT IL 604232043 20 1467298257 0 Nurse Practitioners Healthy Kids Services 20 1467298257 0 Nurse Practitioners Nurse Practitioners Services 20 1467298257 0 Nurse Practitioners Physician Services 00 1467298307 0 MINAS ZAKI 2025094 9999999 B 10 1467298307 0 7562 OLD ROUTE 13 MARION IL 629597776 20 1467298307 0 Dentists Dental Services 20 1467298307 0 Dentists Physician Services 00 1467298638 0 WRIGHT ROXANNE 2024214 9999999 B 10 1467298638 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1467298638 0 Nurse Practitioners Healthy Kids Services 20 1467298638 0 Nurse Practitioners Midwife Services 20 1467298638 0 Nurse Practitioners Nurse Practitioners Services 20 1467298638 0 Nurse Practitioners Physician Services 00 1467400390 0 GARVEY 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HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1467617662 0 Physicians Anesthesia Services 20 1467617662 0 Physicians Healthy Kids Services 20 1467617662 0 Physicians Optical Supplies 20 1467617662 0 Physicians Physician Services 00 1467617845 0 DESAI BINA 2010200 9999999 B 10 1467617845 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1467617845 0 Physicians Anesthesia Services 20 1467617845 0 Physicians Fluoride varnish 20 1467617845 0 Physicians Healthy Kids Services 20 1467617845 0 Physicians Optical Supplies 20 1467617845 0 Physicians Physician Services 00 1467617894 0 LENTZ TAMMY C 2008245 9999999 B 10 1467617894 0 PO BOX 840532 DALLAS TX 752840532 20 1467617894 0 Nurse Practitioners Healthy Kids Services 20 1467617894 0 Nurse Practitioners Nurse Practitioners Services 20 1467617894 0 Nurse Practitioners Physician Services 00 1467617902 0 GAURAV KUMAR 2021291 9999999 B 10 1467617902 0 PO BOX 5009 BRENTWOOD TN 370245009 20 1467617902 0 Physicians Anesthesia Services 20 1467617902 0 Physicians Fluoride varnish 20 1467617902 0 Physicians Healthy Kids Services 20 1467617902 0 Physicians Optical Supplies 20 1467617902 0 Physicians Physician Services 00 1467618116 0 WANGARD REBECCA 2008232 9999999 B 10 1467618116 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1467618116 0 Nurse Practitioners Fluoride varnish 20 1467618116 0 Nurse Practitioners Healthy Kids Services 20 1467618116 0 Nurse Practitioners Nurse Practitioners Services 20 1467618116 0 Nurse Practitioners Physician Services 00 1467618553 0 MA TEHUI 2012244 9999999 B 10 1467618553 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1467618553 0 Physicians Anesthesia Services 20 1467618553 0 Physicians Fluoride varnish 20 1467618553 0 Physicians Healthy Kids Services 20 1467618553 0 Physicians Optical Supplies 20 1467618553 0 Physicians Physician Services 00 1467618561 0 OMIYI DIDI E 2014274 9999999 B 10 1467618561 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1467618561 0 Physicians Anesthesia Services 20 1467618561 0 Physicians Healthy Kids Services 20 1467618561 0 Physicians Optical Supplies 20 1467618561 0 Physicians Physician Services 00 1467618736 0 PATSAVAS KRISTIA 2009229 9999999 B 10 1467618736 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1467618736 0 Physicians Anesthesia Services 20 1467618736 0 Physicians Healthy Kids Services 20 1467618736 0 Physicians Optical Supplies 20 1467618736 0 Physicians Physician Services 00 1467621110 0 CHOUDHURI INDRAJIT 2009182 9999999 B 10 1467621110 0 6308 8TH AVE KENOSHA WI 531435031 20 1467621110 0 Physicians Anesthesia Services 20 1467621110 0 Physicians Fluoride varnish 20 1467621110 0 Physicians Healthy Kids Services 20 1467621110 0 Physicians Optical Supplies 20 1467621110 0 Physicians Physician Services 00 1467621987 0 BHARAMANA GOUDRA BASAVANA 2024023 9999999 B 10 1467621987 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1467621987 0 Physicians Anesthesia Services 20 1467621987 0 Physicians Healthy Kids Services 20 1467621987 0 Physicians Optical Supplies 20 1467621987 0 Physicians Physician Services 00 1467622373 0 BOORMAN CAROLINE 2011015 9999999 B 10 1467622373 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1467622373 0 Physicians Anesthesia Services 20 1467622373 0 Physicians Fluoride varnish 20 1467622373 0 Physicians Healthy Kids Services 20 1467622373 0 Physicians Optical Supplies 20 1467622373 0 Physicians Physician Services 00 1467623173 0 FORD JOHNSON ARIN 2008183 9999999 B 10 1467623173 0 1256 WATERFORD DR STE 230 AURORA IL 605044511 20 1467623173 0 Physicians Anesthesia Services 20 1467623173 0 Physicians Healthy Kids Services 20 1467623173 0 Physicians Optical Supplies 20 1467623173 0 Physicians Physician Services 00 1467624528 0 HENSLEY JENNIFER 2019086 9999999 B 10 1467624528 0 PO BOX 6685 CAROL STREAM IL 601976685 20 1467624528 0 Physicians Anesthesia Services 20 1467624528 0 Physicians Healthy Kids Services 20 1467624528 0 Physicians Optical Supplies 20 1467624528 0 Physicians Physician Services 00 1467624775 0 LEWIS LAUREEN 2007148 9999999 B 10 1467624775 0 1512 ARTAIUS PKWY STE 200 LIBERTYVILLE IL 600485231 20 1467624775 0 Nurse Practitioners Healthy Kids Services 20 1467624775 0 Nurse Practitioners Nurse Practitioners Services 20 1467624775 0 Nurse Practitioners Physician Services 00 1467626051 0 KUMMET GARY J 2017052 9999999 B 10 1467626051 0 1000 HADDONFIELD BERLIN RD STE VOORHEES NJ 080433520 20 1467626051 0 Physicians Anesthesia Services 20 1467626051 0 Physicians Fluoride varnish 20 1467626051 0 Physicians Healthy Kids Services 20 1467626051 0 Physicians Optical Supplies 20 1467626051 0 Physicians Physician Services 00 1467626176 0 CARMEAN AMANDA C 2020061 9999999 B 10 1467626176 0 PO BOX 110429 AURORA CO 800420429 20 1467626176 0 Physicians Anesthesia Services 20 1467626176 0 Physicians Fluoride varnish 20 1467626176 0 Physicians Healthy Kids Services 20 1467626176 0 Physicians Optical Supplies 20 1467626176 0 Physicians Physician Services 00 1467626184 0 KOO NATHANIEL 2017182 9999999 B 10 1467626184 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1467626184 0 Physicians Anesthesia Services 20 1467626184 0 Physicians Healthy Kids Services 20 1467626184 0 Physicians Optical Supplies 20 1467626184 0 Physicians Physician Services 00 1467626705 0 CAMODECA SILVIO 1981227 9999999 B 10 1467626705 0 3223 N HARLEM AVE CHICAGO IL 606344502 20 1467626705 0 Dentists Dental Services 20 1467626705 0 Dentists Physician Services 00 1467627935 0 DAMIAN DANIELA 2009089 9999999 B 10 1467627935 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1467627935 0 Physicians Anesthesia Services 20 1467627935 0 Physicians Healthy Kids Services 20 1467627935 0 Physicians Optical Supplies 20 1467627935 0 Physicians Physician Services 00 1467628180 0 TWEED MEGAN M 2013032 9999999 B 10 1467628180 0 0N668 BOWDISH DR GENEVA IL 601343560 20 1467628180 0 Optometrists Optical Supplies 20 1467628180 0 Optometrists Optometric Services 20 1467628180 0 Optometrists Physician Services 00 1467629733 0 ALLEN ANN 2010214 9999999 B 10 1467629733 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1467629733 0 Physicians Anesthesia Services 20 1467629733 0 Physicians Fluoride varnish 20 1467629733 0 Physicians Healthy Kids Services 20 1467629733 0 Physicians Optical Supplies 20 1467629733 0 Physicians Physician Services 00 1467631978 0 CORRAL MARIBEL 2015281 9999999 B 10 1467631978 0 800 E 55TH ST CHICAGO IL 606154906 20 1467631978 0 Physician Assistant Only All Kids application agent 20 1467631978 0 Physician Assistant Only Fluoride varnish 20 1467631978 0 Physician Assistant Only Healthy Kids Services 20 1467631978 0 Physician Assistant Only Physician Services 00 1467633115 0 GUR SUJATA S 2007305 9999999 B 10 1467633115 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1467633115 0 Nurse Practitioners Healthy Kids Services 20 1467633115 0 Nurse Practitioners Nurse Practitioners Services 20 1467633115 0 Nurse Practitioners Physician Services 00 1467633750 0 RAJAMONEY HEATHER 2001309 9999999 B 10 1467633750 0 12640 S ROUTE 59 UNIT 110 PLAINFIELD IL 605855408 20 1467633750 0 Physical Therapists Medical Supplies 20 1467633750 0 Physical Therapists Medical equipment/prosthetic devices 20 1467633750 0 Physical Therapists Physical Therapy Services 00 1467633974 0 NORGROVE ROBERT 2023038 9999999 B 10 1467633974 0 9701 W HIGGINS RD STE 270 STE 270 ROSEMONT IL 600184703 20 1467633974 0 Physician Assistant Only Fluoride varnish 20 1467633974 0 Physician Assistant Only Healthy Kids Services 20 1467633974 0 Physician Assistant Only Physician Services 00 1467634048 0 SCHUBBE AUNDREA K 2020346 9999999 B 10 1467634048 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1467634048 0 Nurse Practitioners Fluoride varnish 20 1467634048 0 Nurse Practitioners Healthy Kids Services 20 1467634048 0 Nurse Practitioners Nurse Practitioners Services 20 1467634048 0 Nurse Practitioners Physician Services 00 1467635409 0 WELCH TIMOTHY P 2013182 9999999 B 10 1467635409 0 PO BOX 8500 LOCKBOX #7642 PHILADELPHIA PA 191787642 20 1467635409 0 Physicians Anesthesia Services 20 1467635409 0 Physicians Healthy Kids Services 20 1467635409 0 Physicians Optical Supplies 20 1467635409 0 Physicians Physician Services 00 1467635524 0 BOTTROS JOHN J 2011213 9999999 B 10 1467635524 0 5666 E STATE ST ROCKFORD IL 611082425 20 1467635524 0 Physicians Anesthesia Services 20 1467635524 0 Physicians Healthy Kids Services 20 1467635524 0 Physicians Optical Supplies 20 1467635524 0 Physicians Physician Services 00 1467636142 0 CIRINCIONE-ULEZI NASIAH 2002219 9999999 B 10 1467636142 0 162 CHRISTINE WAY BOLINGBROOK IL 604406137 20 1467636142 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1467636563 0 KANE TIMOTHY 2008111 9999999 B 10 1467636563 0 PO BOX 7411347 CHICAGO IL 606743347 20 1467636563 0 Nurse Practitioners Anesthesia Services 20 1467636563 0 Nurse Practitioners Nurse Practitioners Services 20 1467636563 0 Nurse Practitioners Physician Services 00 1467637090 0 VANSCOYOC JENNIFER L 2008154 9999999 B 10 1467637090 0 1018 HAYES AVE OAK PARK IL 603021414 20 1467637090 0 Physical Therapists Medical Supplies 20 1467637090 0 Physical Therapists Medical equipment/prosthetic devices 20 1467637090 0 Physical Therapists Physical Therapy Services 00 1467638932 0 WAHEED KHALID 2009060 9999999 B 10 1467638932 0 1025 MAINE ST QUINCY IL 623014038 20 1467638932 0 Physicians Anesthesia Services 20 1467638932 0 Physicians Fluoride varnish 20 1467638932 0 Physicians Healthy Kids Services 20 1467638932 0 Physicians Optical Supplies 20 1467638932 0 Physicians Physician Services 00 1467639229 0 WILHELMI AMY 2024290 9999999 B 10 1467639229 0 1757 N KIMBALL AVE STE 202 CHICAGO IL 606474805 20 1467639229 0 Other behavior health professional LCPC/LMFT services 00 1467639781 0 ARONIN DANA J 2013261 9999999 B 10 1467639781 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1467639781 0 Nurse Practitioners Fluoride varnish 20 1467639781 0 Nurse Practitioners Healthy Kids Services 20 1467639781 0 Nurse Practitioners Nurse Practitioners Services 20 1467639781 0 Nurse Practitioners Physician Services 00 1467640292 0 GALE CAROLYN J 2016229 9999999 B 10 1467640292 0 124 SW ADAMS ST FL 2 PEORIA IL 616021308 20 1467640292 0 Physician Assistant Only Fluoride varnish 20 1467640292 0 Physician Assistant Only Healthy Kids Services 20 1467640292 0 Physician Assistant Only Physician Services 00 1467641191 0 SCHERMERHORN CHRISTA 2011116 9999999 B 10 1467641191 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1467641191 0 Occupational Therapists Medical Supplies 20 1467641191 0 Occupational Therapists Medical equipment/prosthetic devices 20 1467641191 0 Occupational Therapists Occupational Therapy Services 00 1467641613 0 OCONNOR ANNEMARIE 2007295 9999999 B 10 1467641613 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1467641613 0 Nurse Practitioners 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631600352 20 1467643528 0 Physicians Anesthesia Services 20 1467643528 0 Physicians Healthy Kids Services 20 1467643528 0 Physicians Optical Supplies 20 1467643528 0 Physicians Physician Services 20 1467643528 0 Physicians Physicians Psychiatric Services 00 1467645390 0 ZLOWODZKI MICHAEL 2016183 9999999 B 10 1467645390 0 PO BOX 268 FREEPORT IL 610320268 20 1467645390 0 Physicians All Kids application agent 20 1467645390 0 Physicians Anesthesia Services 20 1467645390 0 Physicians Healthy Kids Services 20 1467645390 0 Physicians Optical Supplies 20 1467645390 0 Physicians Physician Services 00 1467645473 0 BUMA KERI L 2013163 9999999 B 10 1467645473 0 4714 GETTYSBURG RD MECHANICSBURG PA 170554325 20 1467645473 0 Speech Therapists Medical Supplies 20 1467645473 0 Speech Therapists Medical equipment/prosthetic devices 20 1467645473 0 Speech Therapists Speech Therapy/Pathology Services 00 1467646141 0 GUNDALA SRILATA 2010071 9999999 B 10 1467646141 0 PO BOX 4535 OAK BROOK IL 605224535 20 1467646141 0 Physicians Anesthesia Services 20 1467646141 0 Physicians Fluoride varnish 20 1467646141 0 Physicians Healthy Kids Services 20 1467646141 0 Physicians Optical Supplies 20 1467646141 0 Physicians Physician Services 00 1467646752 0 DENO-BUECHLEIN TRACY J 2009121 9999999 B 10 1467646752 0 PO BOX 638704 CINCINNATI OH 452638704 20 1467646752 0 Nurse Practitioners Healthy Kids Services 20 1467646752 0 Nurse Practitioners Nurse Practitioners Services 20 1467646752 0 Nurse Practitioners Physician Services 00 1467647859 0 HEERALALL RAMANAND 2007244 9999999 B 10 1467647859 0 250 W 96TH ST STE 520 INDIANAPOLIS IN 462601317 20 1467647859 0 Physicians Anesthesia Services 20 1467647859 0 Physicians Fluoride varnish 20 1467647859 0 Physicians Healthy Kids Services 20 1467647859 0 Physicians Optical Supplies 20 1467647859 0 Physicians Physician Services 00 1467648683 0 SPRINGER KATIE 2018158 9999999 B 10 1467648683 0 5777 DEPT CAROL STREAM IL 601220021 20 1467648683 0 Physician Assistant Only Fluoride varnish 20 1467648683 0 Physician Assistant Only Healthy Kids Services 20 1467648683 0 Physician Assistant Only Physician Services 00 1467649855 0 ORIA VALENTE 1984214 9999999 B 10 1467649855 0 430 DIXIE HWY STE 101 CHICAGO HEIGHTS IL 604111990 20 1467649855 0 Dentists Dental Services 20 1467649855 0 Dentists Physician Services 00 1467650473 0 KOH STEVE H 2021181 9999999 B 10 1467650473 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1467650473 0 Physicians Anesthesia Services 20 1467650473 0 Physicians Healthy Kids Services 20 1467650473 0 Physicians Optical Supplies 20 1467650473 0 Physicians Physician Services 20 1467650473 0 Physicians Physicians Psychiatric Services 00 1467650929 0 SUGAR HUGH 2018240 9999999 B 10 1467650929 0 515 22ND AVE MONROE WI 535661569 20 1467650929 0 Physician Assistant Only Fluoride varnish 20 1467650929 0 Physician Assistant Only Healthy Kids Services 20 1467650929 0 Physician Assistant Only Physician Services 00 1467651570 0 KOZENIEWSKI 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3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1467653279 0 Physicians Anesthesia Services 20 1467653279 0 Physicians Fluoride varnish 20 1467653279 0 Physicians Healthy Kids Services 20 1467653279 0 Physicians Optical Supplies 20 1467653279 0 Physicians Physician Services 00 1467653402 0 BHATIA VISHAL 2015001 9999999 B 10 1467653402 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1467653402 0 Physicians Anesthesia Services 20 1467653402 0 Physicians Fluoride varnish 20 1467653402 0 Physicians Healthy Kids Services 20 1467653402 0 Physicians Optical Supplies 20 1467653402 0 Physicians Physician Services 00 1467653782 0 CHRISTIAN ROSALES ELIZABETH 2007128 9999999 B 10 1467653782 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1467653782 0 Audiologists Audiology Services 20 1467653782 0 Audiologists Medical Supplies 20 1467653782 0 Audiologists Medical equipment/prosthetic devices 00 1467653790 0 PULLIAM JESSICA 2024150 9999999 B 10 1467653790 0 495 FLATBUSH AVE # C5 BROOKLYN NY 112253706 20 1467653790 0 Physician Assistant Only Physician Services 00 1467654533 0 CARROLL BRENT 2024218 9999999 B 10 1467654533 0 PO BOX 43230 CINCINNATI OH 452430230 20 1467654533 0 Physicians Anesthesia Services 20 1467654533 0 Physicians Healthy Kids Services 20 1467654533 0 Physicians Optical Supplies 20 1467654533 0 Physicians Physician Services 00 1467654566 0 MOHR NICHOLAS M 2009213 9999999 B 10 1467654566 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1467654566 0 Physicians Anesthesia Services 20 1467654566 0 Physicians Healthy Kids Services 20 1467654566 0 Physicians Optical Supplies 20 1467654566 0 Physicians Physician Services 00 1467656041 0 POPURI DEEPA 2013001 9999999 B 10 1467656041 0 5777 DEPT CAROL STREAM IL 601220021 20 1467656041 0 Physicians Anesthesia Services 20 1467656041 0 Physicians Healthy Kids Services 20 1467656041 0 Physicians Optical Supplies 20 1467656041 0 Physicians Physician Services 00 1467656272 0 FOREMAN MARK 2022166 9999999 B 10 1467656272 0 PO BOX 486 SAN JACINTO CA 925810486 20 1467656272 0 Physicians Anesthesia Services 20 1467656272 0 Physicians Fluoride varnish 20 1467656272 0 Physicians Healthy Kids Services 20 1467656272 0 Physicians Optical Supplies 20 1467656272 0 Physicians Physician Services 00 1467656926 0 GUDJONSSON ULFUR T 2018136 9999999 B 10 1467656926 0 1701 LACEY ST CAPE GIRARDEAU MO 637015230 20 1467656926 0 Physicians Anesthesia Services 20 1467656926 0 Physicians Healthy Kids Services 20 1467656926 0 Physicians Optical Supplies 20 1467656926 0 Physicians Physician Services 00 1467658195 0 SOLOLA MARIE C 2021357 9999999 B 10 1467658195 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1467658195 0 Physician Assistant Only Fluoride varnish 20 1467658195 0 Physician Assistant Only Healthy Kids Services 20 1467658195 0 Physician Assistant Only Physician Services 00 1467658583 0 DAMM MARY BETH E 2007088 9999999 B 10 1467658583 0 7825 W 103RD ST PALOS HILLS IL 604651676 20 1467658583 0 Speech Therapists Medical Supplies 20 1467658583 0 Speech Therapists Medical equipment/prosthetic devices 20 1467658583 0 Speech Therapists Speech Therapy/Pathology Services 00 1467658716 0 BRODERICK ERIN 2020137 9999999 B 10 1467658716 0 6801 BRECKSVILLE RD INDEPENDENCE OH 441315032 20 1467658716 0 Physicians Anesthesia Services 20 1467658716 0 Physicians Healthy Kids Services 20 1467658716 0 Physicians Optical Supplies 20 1467658716 0 Physicians Physician Services 00 1467658989 0 MIKKELSEN ERIK J 2016153 9999999 B 10 1467658989 0 200 UNIVERSITY AVE E SAINT PAUL MN 551012507 20 1467658989 0 Physicians Anesthesia Services 20 1467658989 0 Physicians Fluoride varnish 20 1467658989 0 Physicians Healthy Kids Services 20 1467658989 0 Physicians Optical Supplies 20 1467658989 0 Physicians Physician Services 00 1467659318 0 HARTING REKHA 2003182 9999999 B 10 1467659318 0 PO BOX 713388 CHICAGO IL 606771525 20 1467659318 0 Physicians Anesthesia Services 20 1467659318 0 Physicians Fluoride varnish 20 1467659318 0 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varnish 20 1467661124 0 Physicians Healthy Kids Services 20 1467661124 0 Physicians Optical Supplies 20 1467661124 0 Physicians Physician Services 00 1467661199 0 MOORE PAULA 2017236 9999999 B 10 1467661199 0 801 W NORMANTOWN RD ROMEOVILLE IL 604464330 20 1467661199 0 Speech Therapists Medical Supplies 20 1467661199 0 Speech Therapists Medical equipment/prosthetic devices 20 1467661199 0 Speech Therapists Speech Therapy/Pathology Services 00 1467661678 0 RATTAN GINGER 2013160 9999999 B 10 1467661678 0 1945 CEI DR BLUE ASH OH 452425664 20 1467661678 0 Physicians Anesthesia Services 20 1467661678 0 Physicians Healthy Kids Services 20 1467661678 0 Physicians Optical Supplies 20 1467661678 0 Physicians Physician Services 00 1467661801 0 JERATH MAYA R 2017305 9999999 B 10 1467661801 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1467661801 0 Physicians Anesthesia Services 20 1467661801 0 Physicians Fluoride varnish 20 1467661801 0 Physicians Healthy Kids Services 20 1467661801 0 Physicians Optical Supplies 20 1467661801 0 Physicians Physician Services 00 1467662973 0 TORRES MATILDE 2020230 9999999 H 10 1467662973 0 1901 W HARRISON ST CHICAGO IL 60612 20 1467662973 0 Clinical Social Worker Social work service 00 1467663757 0 DEPOWELL JOHN J 2023097 9999999 B 10 1467663757 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1467663757 0 Physicians Anesthesia Services 20 1467663757 0 Physicians Healthy Kids Services 20 1467663757 0 Physicians Optical Supplies 20 1467663757 0 Physicians Physician Services 00 1467663856 0 NARAYAN AJITA 2023025 9999999 B 10 1467663856 0 PO BOX 781076 DETROIT MI 482781076 20 1467663856 0 Physicians Anesthesia Services 20 1467663856 0 Physicians Fluoride varnish 20 1467663856 0 Physicians Healthy Kids Services 20 1467663856 0 Physicians Optical Supplies 20 1467663856 0 Physicians Physician Services 00 1467664946 0 SOYEMI KENNETH 1996275 9999999 B 10 1467664946 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1467664946 0 Physicians Anesthesia Services 20 1467664946 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1467664946 0 Physicians Fluoride varnish 20 1467664946 0 Physicians Healthy Kids Services 20 1467664946 0 Physicians Optical Supplies 20 1467664946 0 Physicians Physician Services 00 1467665604 0 KLUG BRENDA C 2008245 9999999 B 10 1467665604 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1467665604 0 Nurse Practitioners Healthy Kids Services 20 1467665604 0 Nurse Practitioners Nurse Practitioners Services 20 1467665604 0 Nurse Practitioners Physician Services 00 1467665703 0 BREUER TUVIA T 2021068 9999999 B 10 1467665703 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1467665703 0 Physicians Anesthesia Services 20 1467665703 0 Physicians Healthy Kids Services 20 1467665703 0 Physicians Optical Supplies 20 1467665703 0 Physicians Physician Services 20 1467665703 0 Physicians Physicians Psychiatric Services 00 1467666081 0 ROSSINI CONNIE J 2015182 9999999 B 10 1467666081 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1467666081 0 Physicians Anesthesia Services 20 1467666081 0 Physicians Healthy Kids Services 20 1467666081 0 Physicians Optical Supplies 20 1467666081 0 Physicians Physician Services 00 1467666370 0 PATEL YOGIN 2023180 9999999 B 10 1467666370 0 5665 NEW NORTHSIDE DR STE 320 ATLANTA GA 303285834 20 1467666370 0 Physicians Anesthesia Services 20 1467666370 0 Physicians Healthy Kids Services 20 1467666370 0 Physicians Optical Supplies 20 1467666370 0 Physicians Physician Services 00 1467666453 0 SINATRA SHELLY 2012170 9999999 B 10 1467666453 0 28594 NETWORK PL CHICAGO IL 606731285 20 1467666453 0 Nurse Practitioners Healthy Kids Services 20 1467666453 0 Nurse Practitioners Nurse Practitioners Services 20 1467666453 0 Nurse Practitioners Physician Services 00 1467667360 0 SEDER CHRISTOPHER 2013213 9999999 B 10 1467667360 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1467667360 0 Physicians Anesthesia Services 20 1467667360 0 Physicians Healthy Kids Services 20 1467667360 0 Physicians Optical Supplies 20 1467667360 0 Physicians Physician Services 00 1467668111 0 KWAK MELISSA 2008210 9999999 B 10 1467668111 0 PO BOX 776926 CHICAGO IL 606776926 20 1467668111 0 Physicians Anesthesia Services 20 1467668111 0 Physicians Healthy Kids Services 20 1467668111 0 Physicians Optical Supplies 20 1467668111 0 Physicians Physician Services 00 1467668285 0 HEENAN THERESE 2009060 9999999 B 10 1467668285 0 350 N WALL ST KANKAKEE IL 609012901 20 1467668285 0 Physicians Anesthesia Services 20 1467668285 0 Physicians Fluoride varnish 20 1467668285 0 Physicians Healthy Kids Services 20 1467668285 0 Physicians Optical Supplies 20 1467668285 0 Physicians Physician Services 00 1467669259 0 GAO ZHENQIANG 2007182 9999999 B 10 1467669259 0 PO BOX 5987 CAROL STREAM IL 601975987 20 1467669259 0 Physicians Anesthesia Services 20 1467669259 0 Physicians Healthy Kids Services 20 1467669259 0 Physicians Optical Supplies 20 1467669259 0 Physicians Physician Services 00 1467670059 0 MANCHA NICOLE 2010182 9999999 B 10 1467670059 0 1518 MULBERRY AVE MUSCATINE IA 527613433 20 1467670059 0 Physicians Anesthesia Services 20 1467670059 0 Physicians Healthy Kids Services 20 1467670059 0 Physicians Optical Supplies 20 1467670059 0 Physicians Physician Services 00 1467670521 0 WOLF JILL M 2015189 9999999 B 10 1467670521 0 1548 W SHERWIN AVE APT 1N 1N CHICAGO IL 606262143 20 1467670521 0 Clinical Social Worker Social work service 00 1467670778 0 POMA TAMMY A 2009070 9999999 B 10 1467670778 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1467670778 0 Nurse Practitioners Healthy Kids Services 20 1467670778 0 Nurse Practitioners Nurse Practitioners Services 20 1467670778 0 Nurse Practitioners Physician Services 00 1467670901 0 HOLROYD THEODORE 2020234 9999999 B 10 1467670901 0 543 ORCHARD ST ANTIOCH IL 600023107 20 1467670901 0 Physician Assistant Only Fluoride varnish 20 1467670901 0 Physician Assistant Only 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3880 SALEM LAKE DR STE F LONG GROVE IL 600475292 20 1467674754 0 Physicians Anesthesia Services 20 1467674754 0 Physicians Fluoride varnish 20 1467674754 0 Physicians Healthy Kids Services 20 1467674754 0 Physicians Optical Supplies 20 1467674754 0 Physicians Physician Services 00 1467676627 0 SINGLA SANDEEP 2020156 9999999 B 10 1467676627 0 101 E MILLER RD STERLING IL 610811252 20 1467676627 0 Physicians Anesthesia Services 20 1467676627 0 Physicians Fluoride varnish 20 1467676627 0 Physicians Healthy Kids Services 20 1467676627 0 Physicians Optical Supplies 20 1467676627 0 Physicians Physician Services 00 1467678896 0 VERNIK JANE 2008001 9999999 B 10 1467678896 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1467678896 0 Physicians Anesthesia Services 20 1467678896 0 Physicians Fluoride varnish 20 1467678896 0 Physicians Healthy Kids Services 20 1467678896 0 Physicians Optical Supplies 20 1467678896 0 Physicians Physician Services 00 1467680223 0 BULLOCK GRANT 2023059 9999999 B 10 1467680223 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1467680223 0 Physicians Anesthesia Services 20 1467680223 0 Physicians Healthy Kids Services 20 1467680223 0 Physicians Optical Supplies 20 1467680223 0 Physicians Physician Services 00 1467680504 0 MOLAVI SASAN 2009166 9999999 B 10 1467680504 0 231 N BOLINGBROOK DR STE A BOLINGBROOK IL 604401960 20 1467680504 0 Dentists Dental Services 20 1467680504 0 Dentists Physician Services 00 1467680942 0 AJAM SAMER 2020161 9999999 B 10 1467680942 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1467680942 0 Physicians Anesthesia Services 20 1467680942 0 Physicians Fluoride varnish 20 1467680942 0 Physicians Healthy Kids Services 20 1467680942 0 Physicians Optical Supplies 20 1467680942 0 Physicians Physician Services 00 1467681999 0 CHO NARI 2009191 9999999 B 10 1467681999 0 178 E GOLF RD SCHAUMBURG IL 601733726 20 1467681999 0 Dentists Dental Services 20 1467681999 0 Dentists Physician Services 00 1467682229 0 MISSOI ALLEN K 2020302 9999999 B 10 1467682229 0 1005 BROADWAY ST QUINCY IL 623012834 20 1467682229 0 Physicians Anesthesia Services 20 1467682229 0 Physicians Healthy Kids Services 20 1467682229 0 Physicians Optical Supplies 20 1467682229 0 Physicians Physician Services 00 1467682690 0 ROQUE DARIO R 2020176 9999999 B 10 1467682690 0 5777 DEPT CAROL STREAM IL 601220021 20 1467682690 0 Physicians Anesthesia Services 20 1467682690 0 Physicians Healthy Kids Services 20 1467682690 0 Physicians Optical Supplies 20 1467682690 0 Physicians Physician Services 00 1467683094 0 GLAZIK ELIZABETH 2011230 9999999 B 10 1467683094 0 2112 W GALENA BLVD AURORA IL 605063255 20 1467683094 0 Speech Therapists Medical Supplies 20 1467683094 0 Speech Therapists Medical equipment/prosthetic devices 20 1467683094 0 Speech Therapists Speech Therapy/Pathology Services 00 1467684126 0 SCHNACK KELSI J 2020300 9999999 B 10 1467684126 0 1002 SW 6TH ST ALEDO IL 612312100 20 1467684126 0 Speech Therapists Speech Therapy/Pathology Services 00 1467684183 0 KUNNASSERY LIYA M 2009227 9999999 B 10 1467684183 0 601 W CENTRAL RD STE 3 MOUNT PROSPECT IL 600562379 20 1467684183 0 Dentists Dental Services 20 1467684183 0 Dentists Physician Services 00 1467684332 0 ENEOGWE GRACE 2014244 9999999 B 10 1467684332 0 6033 N SHERIDAN RD STE N6 SUITE N6 CHICAGO IL 606603013 20 1467684332 0 Nurse Practitioners Electronic Home Response/EHR Installation, MPE Certification 20 1467684332 0 Nurse Practitioners Fluoride varnish 20 1467684332 0 Nurse Practitioners Healthy Kids Services 20 1467684332 0 Nurse Practitioners Nurse Practitioners Services 20 1467684332 0 Nurse Practitioners Physician Services 00 1467684613 0 WOLFF MARIA JOY F 2009239 9999999 B 10 1467684613 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1467684613 0 Physical Therapists Medical Supplies 20 1467684613 0 Physical Therapists Medical equipment/prosthetic devices 20 1467684613 0 Physical Therapists Physical Therapy Services 00 1467685214 0 TEME TONYE 2017312 9999999 B 10 1467685214 0 5777 DEPT CAROL STREAM IL 601220021 20 1467685214 0 Physicians Anesthesia Services 20 1467685214 0 Physicians Fluoride varnish 20 1467685214 0 Physicians Healthy Kids Services 20 1467685214 0 Physicians Optical Supplies 20 1467685214 0 Physicians Physician Services 00 1467687657 0 HUANG ANDREA S 2014182 9999999 B 10 1467687657 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1467687657 0 Physicians Anesthesia Services 20 1467687657 0 Physicians Healthy Kids Services 20 1467687657 0 Physicians Optical Supplies 20 1467687657 0 Physicians Physician Services 00 1467687723 0 ARENS ANN 2018213 9999999 B 10 1467687723 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1467687723 0 Physicians Anesthesia Services 20 1467687723 0 Physicians Fluoride varnish 20 1467687723 0 Physicians Healthy Kids Services 20 1467687723 0 Physicians Optical Supplies 20 1467687723 0 Physicians Physician Services 00 1467687921 0 BOWDEN OGBONNA 2010202 9999999 B 10 1467687921 0 605 E 170TH ST SOUTH HOLLAND IL 604733408 20 1467687921 0 Dentists Dental Services 20 1467687921 0 Dentists Physician Services 00 1467688044 0 NAIK RONAK J 2013140 9999999 B 10 1467688044 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1467688044 0 Physicians Anesthesia Services 20 1467688044 0 Physicians Fluoride varnish 20 1467688044 0 Physicians Healthy Kids Services 20 1467688044 0 Physicians Optical Supplies 20 1467688044 0 Physicians Physician Services 00 1467688804 0 ASGHAR JAVARIAH 2020255 9999999 B 10 1467688804 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1467688804 0 Physicians Anesthesia Services 20 1467688804 0 Physicians Healthy Kids Services 20 1467688804 0 Physicians Optical Supplies 20 1467688804 0 Physicians Physician Services 00 1467688879 0 GONZALEZ-RENDON CARLOS R 2014209 9999999 B 10 1467688879 0 62311 COLLECTION CENTER DR CHICAGO IL 606930001 20 1467688879 0 Physicians Anesthesia Services 20 1467688879 0 Physicians Healthy Kids Services 20 1467688879 0 Physicians Optical Supplies 20 1467688879 0 Physicians Physician Services 00 1467689281 0 TOTONCHI SAMER 2017010 9999999 B 10 1467689281 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1467689281 0 Physicians Anesthesia Services 20 1467689281 0 Physicians Healthy Kids Services 20 1467689281 0 Physicians Optical Supplies 20 1467689281 0 Physicians Physician Services 00 1467689349 0 SIMPSON BLAIR 2022214 9999999 B 10 1467689349 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1467689349 0 Physicians Anesthesia Services 20 1467689349 0 Physicians Fluoride varnish 20 1467689349 0 Physicians Healthy Kids Services 20 1467689349 0 Physicians Optical Supplies 20 1467689349 0 Physicians Physician Services 00 1467689695 0 CHEESMAN MICHAEL 2017274 9999999 B 10 1467689695 0 1418 COLLEGE DR MOUNT CARMEL IL 628632638 20 1467689695 0 Physician Assistant Only Fluoride varnish 20 1467689695 0 Physician Assistant Only Healthy Kids Services 20 1467689695 0 Physician Assistant Only Physician Services 00 1467689729 0 KNIGHT MEGAN M 2019148 9999999 B 10 1467689729 0 5777 DEPT CAROL STREAM IL 601220021 20 1467689729 0 Physician Assistant Only Fluoride varnish 20 1467689729 0 Physician Assistant Only Healthy Kids Services 20 1467689729 0 Physician Assistant Only Physician Services 00 1467689794 0 LIU CATHERINE C 2012197 9999999 B 10 1467689794 0 106 W CALENDAR AVE # 172 LA GRANGE IL 605252325 20 1467689794 0 Physicians All Kids application agent 20 1467689794 0 Physicians Anesthesia Services 20 1467689794 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1467689794 0 Physicians Family Planning Counseling 20 1467689794 0 Physicians Healthy Kids Services 20 1467689794 0 Physicians Optical Supplies 20 1467689794 0 Physicians Physician Services 00 1467689844 0 BICKING GRIFFIN K 2012214 9999999 B 10 1467689844 0 2605 KENTUCKY AVE STE 306 PADUCAH KY 420033802 20 1467689844 0 Physicians Anesthesia Services 20 1467689844 0 Physicians Healthy Kids Services 20 1467689844 0 Physicians 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Practitioners Healthy Kids Services 20 1467694034 0 Nurse Practitioners Nurse Practitioners Services 20 1467694034 0 Nurse Practitioners Physician Services 00 1467694489 0 BAILEY ANGELA N 2016282 9999999 B 10 1467694489 0 5380 TECH DATA DR STE 101 CLEARWATER FL 337603122 20 1467694489 0 Physicians Anesthesia Services 20 1467694489 0 Physicians Healthy Kids Services 20 1467694489 0 Physicians Optical Supplies 20 1467694489 0 Physicians Physician Services 00 1467695361 0 PATIL KAUSTUBHA D 2019198 9999999 B 10 1467695361 0 5777 DEPT CAROL STREAM IL 601220021 20 1467695361 0 Physicians Anesthesia Services 20 1467695361 0 Physicians Fluoride varnish 20 1467695361 0 Physicians Healthy Kids Services 20 1467695361 0 Physicians Optical Supplies 20 1467695361 0 Physicians Physician Services 00 1467695536 0 CHOI HUMBERTO 2018182 9999999 B 10 1467695536 0 6801 BRECKSVILLE RD INDEPENDENCE OH 441315032 20 1467695536 0 Physicians Anesthesia Services 20 1467695536 0 Physicians Fluoride varnish 20 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00 1467707125 0 BLUEMLEIN MATTHEW R 2022012 9999999 B 10 1467707125 0 111 E 4TH ST STE 440 ALTON IL 620026206 20 1467707125 0 Optometrists Optical Supplies 20 1467707125 0 Optometrists Optometric Services 20 1467707125 0 Optometrists Physician Services 00 1467707182 0 SINGH SMITA 2015213 9999999 B 10 1467707182 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1467707182 0 Physicians Anesthesia Services 20 1467707182 0 Physicians Fluoride varnish 20 1467707182 0 Physicians Healthy Kids Services 20 1467707182 0 Physicians Optical Supplies 20 1467707182 0 Physicians Physician Services 00 1467707539 0 FINNO LAUREN 2017228 9999999 B 10 1467707539 0 801 W NORMANTOWN RD ROMEOVILLE IL 604464330 20 1467707539 0 Speech Therapists Medical Supplies 20 1467707539 0 Speech Therapists Medical equipment/prosthetic devices 20 1467707539 0 Speech Therapists Speech Therapy/Pathology Services 00 1467707596 0 NUZZO GINA 2021072 9999999 B 10 1467707596 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1467707596 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JESSICA W 2015236 9999999 B 10 1467741355 0 1005 BROADWAY ST QUINCY IL 623012834 20 1467741355 0 Physicians All Kids application agent 20 1467741355 0 Physicians Anesthesia Services 20 1467741355 0 Physicians Healthy Kids Services 20 1467741355 0 Physicians Optical Supplies 20 1467741355 0 Physicians Physician Services 00 1467743039 0 RAMAVARAM SAMYUKTHA 2017244 9999999 B 10 1467743039 0 801 ILLINI DR SILVIS IL 612821804 20 1467743039 0 Physicians Anesthesia Services 20 1467743039 0 Physicians Fluoride varnish 20 1467743039 0 Physicians Healthy Kids Services 20 1467743039 0 Physicians Optical Supplies 20 1467743039 0 Physicians Physician Services 00 1467743302 0 PANDE ANUPAM S 2016165 9999999 B 10 1467743302 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1467743302 0 Physicians Anesthesia Services 20 1467743302 0 Physicians Fluoride varnish 20 1467743302 0 Physicians Healthy Kids Services 20 1467743302 0 Physicians Optical Supplies 20 1467743302 0 Physicians 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1467785352 0 Physicians Optical Supplies 20 1467785352 0 Physicians Physician Services 00 1467786046 0 CHUGHTAI HAROON L 2013182 9999999 B 10 1467786046 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1467786046 0 Physicians Anesthesia Services 20 1467786046 0 Physicians Healthy Kids Services 20 1467786046 0 Physicians Optical Supplies 20 1467786046 0 Physicians Physician Services 00 1467786673 0 TURNBOUGH CHRISTOPHER J 2023062 9999999 B 10 1467786673 0 339 CONSORT DR BALLWIN MO 630114439 20 1467786673 0 Physician Assistant Only Fluoride varnish 20 1467786673 0 Physician Assistant Only Healthy Kids Services 20 1467786673 0 Physician Assistant Only Physician Services 00 1467786988 0 KNAB LAWRENCE 2018242 9999999 B 10 1467786988 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1467786988 0 Physicians Anesthesia Services 20 1467786988 0 Physicians Healthy Kids Services 20 1467786988 0 Physicians Optical Supplies 20 1467786988 0 Physicians Physician Services 00 1467789511 0 TUTTLE 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STREAM IL 601220021 20 1467794248 0 Physicians Anesthesia Services 20 1467794248 0 Physicians Healthy Kids Services 20 1467794248 0 Physicians Optical Supplies 20 1467794248 0 Physicians Physician Services 00 1467794271 0 CONTE WILLIAM 2018341 9999999 B 10 1467794271 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1467794271 0 Physicians Anesthesia Services 20 1467794271 0 Physicians Healthy Kids Services 20 1467794271 0 Physicians Optical Supplies 20 1467794271 0 Physicians Physician Services 20 1467794271 0 Physicians Physicians Psychiatric Services 00 1467794636 0 O'MALLEY JOSEPH 2020210 9999999 B 10 1467794636 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1467794636 0 Physicians Anesthesia Services 20 1467794636 0 Physicians Healthy Kids Services 20 1467794636 0 Physicians Optical Supplies 20 1467794636 0 Physicians Physician Services 00 1467794883 0 BIELSKI RAGINI 2017277 9999999 B 10 1467794883 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1467794883 0 Physicians 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Physicians Physician Services 00 1467800565 0 SAHAI ADITYA 2024207 9999999 B 10 1467800565 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1467800565 0 Physicians Anesthesia Services 20 1467800565 0 Physicians Fluoride varnish 20 1467800565 0 Physicians Healthy Kids Services 20 1467800565 0 Physicians Optical Supplies 20 1467800565 0 Physicians Physician Services 00 1467800961 0 HABIB ISHTIAQ 2019189 9999999 B 10 1467800961 0 725 SCHOOL ST STE A MORRIS IL 604501207 20 1467800961 0 Physicians Anesthesia Services 20 1467800961 0 Physicians Fluoride varnish 20 1467800961 0 Physicians Healthy Kids Services 20 1467800961 0 Physicians Optical Supplies 20 1467800961 0 Physicians Physician Services 00 1467802033 0 STORY SARAH 2016179 9999999 B 10 1467802033 0 4100 VETERANS PKWY MCHENRY IL 600508350 20 1467802033 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1467802090 0 MORRISON JENNIFER M 2017174 9999999 B 10 1467802090 0 3716 W BRIGHTON AVE PEORIA IL 616152938 20 1467802090 0 Psychologist Psychologist service 00 1467802124 0 THOMAS JESSICA 2023023 9999999 B 10 1467802124 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1467802124 0 Nurse Practitioners Healthy Kids Services 20 1467802124 0 Nurse Practitioners Nurse Practitioners Services 20 1467802124 0 Nurse Practitioners Physician Services 00 1467802199 0 TAX KATHRYN 2023095 9999999 B 10 1467802199 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1467802199 0 Physical Therapists Medical Supplies 20 1467802199 0 Physical Therapists Medical equipment/prosthetic devices 20 1467802199 0 Physical Therapists Physical Therapy Services 00 1467802371 0 CHAN ERNEST G 2024218 9999999 B 10 1467802371 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1467802371 0 Physicians Anesthesia Services 20 1467802371 0 Physicians Healthy Kids Services 20 1467802371 0 Physicians Optical Supplies 20 1467802371 0 Physicians Physician Services 00 1467802595 0 WOLFE JESSE 2024008 9999999 B 10 1467802595 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1467802595 0 Podiatrists Podiatric Services 00 1467802736 0 GRATHWOL CORY A 2022077 9999999 B 10 1467802736 0 28 MADISON ST OAK PARK IL 603024230 20 1467802736 0 Dentists Dental Services 20 1467802736 0 Dentists Physician Services 00 1467803049 0 BUTLER MALLORY A 2016251 9999999 B 10 1467803049 0 3033 W PRESIDENT GEORGE BUSH H PLANO TX 750755885 20 1467803049 0 Nurse Practitioners Fluoride varnish 20 1467803049 0 Nurse Practitioners Healthy Kids Services 20 1467803049 0 Nurse Practitioners Nurse Practitioners Services 20 1467803049 0 Nurse Practitioners Physician Services 00 1467803098 0 HULYALKAR MANASI 2019312 9999999 B 10 1467803098 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1467803098 0 Physicians Anesthesia Services 20 1467803098 0 Physicians Fluoride varnish 20 1467803098 0 Physicians Healthy Kids Services 20 1467803098 0 Physicians Optical Supplies 20 1467803098 0 Physicians Physician Services 00 1467803122 0 SIDDIQUI OMAR 2017083 9999999 B 10 1467803122 0 35318 EAGLE WAY CHICAGO IL 606781353 20 1467803122 0 Physicians Anesthesia Services 20 1467803122 0 Physicians Fluoride varnish 20 1467803122 0 Physicians Healthy Kids Services 20 1467803122 0 Physicians Optical Supplies 20 1467803122 0 Physicians Physician Services 00 1467803452 0 ATKINSON ADRIENNE RENEE 2020031 9999999 B 10 1467803452 0 PO BOX 7412011 CHICAGO IL 606742011 20 1467803452 0 Nurse Practitioners Healthy Kids Services 20 1467803452 0 Nurse Practitioners Nurse Practitioners Services 20 1467803452 0 Nurse Practitioners Physician Services 00 1467803718 0 KUCEROVA YEKATERINA 2020015 9999999 B 10 1467803718 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1467803718 0 Physicians Anesthesia Services 20 1467803718 0 Physicians Healthy Kids Services 20 1467803718 0 Physicians Optical Supplies 20 1467803718 0 Physicians Physician Services 00 1467804427 0 SLEZAK TREVOR 2018363 9999999 B 10 1467804427 0 265 BROOKVIEW CENTRE WAY 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1467808089 0 Nurse Practitioners Fluoride varnish 20 1467808089 0 Nurse Practitioners Healthy Kids Services 20 1467808089 0 Nurse Practitioners Nurse Practitioners Services 20 1467808089 0 Nurse Practitioners Physician Services 00 1467808162 0 FERNANDES CHRISTOPHER RAHUL 2018351 9999999 B 10 1467808162 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1467808162 0 Physicians Anesthesia Services 20 1467808162 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1467808162 0 Physicians Fluoride varnish 20 1467808162 0 Physicians Healthy Kids Services 20 1467808162 0 Physicians Optical Supplies 20 1467808162 0 Physicians Physician Services 00 1467808584 0 FOX TASHIA I 2017032 9999999 B 10 1467808584 0 PO BOX 428 HARRISBURG IL 629460428 20 1467808584 0 Nurse Practitioners Fluoride varnish 20 1467808584 0 Nurse Practitioners Healthy Kids Services 20 1467808584 0 Nurse Practitioners Nurse Practitioners Services 20 1467808584 0 Nurse Practitioners Physician Services 00 1467808956 0 BLAIR SAMARA L 2019234 9999999 B 10 1467808956 0 40 SHUMAN BLVD STE 275 NAPERVILLE IL 605638669 20 1467808956 0 Nurse Practitioners Anesthesia Services 20 1467808956 0 Nurse Practitioners Nurse Practitioners Services 20 1467808956 0 Nurse Practitioners Physician Services 00 1467809293 0 BONGERS KALE 2025011 9999999 B 10 1467809293 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1467809293 0 Physicians Anesthesia Services 20 1467809293 0 Physicians Fluoride varnish 20 1467809293 0 Physicians Healthy Kids Services 20 1467809293 0 Physicians Optical Supplies 20 1467809293 0 Physicians Physician Services 00 1467814145 0 ZELEKE BETHLEHEM G 2020187 9999999 B 10 1467814145 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1467814145 0 Physicians Anesthesia Services 20 1467814145 0 Physicians Fluoride varnish 20 1467814145 0 Physicians Healthy Kids Services 20 1467814145 0 Physicians Optical Supplies 20 1467814145 0 Physicians Physician Services 00 1467815068 0 POSTON PATRICK 2020201 9999999 B 10 1467815068 0 500 PORTER AVE AURORA MO 656052365 20 1467815068 0 Physicians Anesthesia Services 20 1467815068 0 Physicians Healthy Kids Services 20 1467815068 0 Physicians Optical Supplies 20 1467815068 0 Physicians Physician Services 00 1467815209 0 DESAI POOJA S 2019228 9999999 B 10 1467815209 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1467815209 0 Physicians Anesthesia Services 20 1467815209 0 Physicians Healthy Kids Services 20 1467815209 0 Physicians Optical Supplies 20 1467815209 0 Physicians Physician Services 00 1467815506 0 SETH ARJUN 2021183 9999999 B 10 1467815506 0 5777 DEPT CAROL STREAM IL 601220021 20 1467815506 0 Physicians Anesthesia Services 20 1467815506 0 Physicians Healthy Kids Services 20 1467815506 0 Physicians Optical Supplies 20 1467815506 0 Physicians Physician Services 20 1467815506 0 Physicians Physicians Psychiatric Services 00 1467815654 0 ELKINS KATHRYN 2023123 9999999 B 10 1467815654 0 7344 SOLUTIONS CTR CHICAGO IL 606777003 20 1467815654 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1467816561 0 Physicians Anesthesia Services 20 1467816561 0 Physicians Fluoride varnish 20 1467816561 0 Physicians Healthy Kids Services 20 1467816561 0 Physicians Optical Supplies 20 1467816561 0 Physicians Physician Services 00 1467816652 0 ALLRED JONATHAN JACOB 2020361 9999999 B 10 1467816652 0 1005 BROADWAY ST QUINCY IL 623012834 20 1467816652 0 Physicians Anesthesia Services 20 1467816652 0 Physicians Healthy Kids Services 20 1467816652 0 Physicians Optical Supplies 20 1467816652 0 Physicians Physician Services 00 1467818393 0 BIRDOES JENNIFER 2016190 9999999 B 10 1467818393 0 6501 N SHERIDAN RD PEORIA IL 616142932 20 1467818393 0 Speech Therapists Medical Supplies 20 1467818393 0 Speech Therapists Medical equipment/prosthetic devices 20 1467818393 0 Speech Therapists Speech Therapy/Pathology Services 00 1467820035 0 O'DONNELL RACHEL 2025015 9999999 B 10 1467820035 0 29373 NETWORK PL CHICAGO IL 606733039 20 1467820035 0 Physical Therapists Medical Supplies 20 1467820035 0 Physical 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Physician Services 00 1467827907 0 MARCINEK ELIZABETH 2015350 9999999 B 10 1467827907 0 5777 DEPT CAROL STREAM IL 601220021 20 1467827907 0 Nurse Practitioners Fluoride varnish 20 1467827907 0 Nurse Practitioners Healthy Kids Services 20 1467827907 0 Nurse Practitioners Nurse Practitioners Services 20 1467827907 0 Nurse Practitioners Physician Services 00 1467830018 0 GRIFFIN JULIE E 2021196 9999999 B 10 1467830018 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1467830018 0 Nurse Practitioners Healthy Kids Services 20 1467830018 0 Nurse Practitioners Nurse Practitioners Services 20 1467830018 0 Nurse Practitioners Physician Services 00 1467830695 0 STUEVE PETER A 2023010 9999999 B 10 1467830695 0 PO BOX 41220 PHOENIX AZ 850801220 20 1467830695 0 Physicians Anesthesia Services 20 1467830695 0 Physicians Healthy Kids Services 20 1467830695 0 Physicians Optical Supplies 20 1467830695 0 Physicians Physician Services 00 1467831305 0 SAPP ALEXANDER 2024264 9999999 B 10 1467831305 0 2605 KENTUCKY AVE STE 306 PADUCAH KY 420033802 20 1467831305 0 Physicians Anesthesia Services 20 1467831305 0 Physicians Healthy Kids Services 20 1467831305 0 Physicians Optical Supplies 20 1467831305 0 Physicians Physician Services 00 1467831446 0 LUCCHETTI AMANDA R 2020058 9999999 B 10 1467831446 0 5777 DEPT CAROL STREAM IL 601228942 20 1467831446 0 Psychologist Psychologist service 00 1467831552 0 YARLAGADDA SUDHA R 2023206 9999999 B 10 1467831552 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1467831552 0 Physicians Anesthesia Services 20 1467831552 0 Physicians Fluoride varnish 20 1467831552 0 Physicians Healthy Kids Services 20 1467831552 0 Physicians Optical Supplies 20 1467831552 0 Physicians Physician Services 00 1467831768 0 BURIC DANICA 2023136 9999999 B 10 1467831768 0 1800 DEWES ST STE B GLENVIEW IL 600254377 20 1467831768 0 Physical Therapists Medical Supplies 20 1467831768 0 Physical Therapists Medical equipment/prosthetic devices 20 1467831768 0 Physical Therapists Physical Therapy Services 00 1467831867 0 CRIHFIELD ANASTASIA M 2016010 9999999 B 10 1467831867 0 5359 W FULLERTON AVE CHICAGO IL 606391450 20 1467831867 0 Physicians Anesthesia Services 20 1467831867 0 Physicians Fluoride varnish 20 1467831867 0 Physicians Healthy Kids Services 20 1467831867 0 Physicians Optical Supplies 20 1467831867 0 Physicians Physician Services 00 1467832238 0 TANN VICTORIA TANN 2019273 9999999 B 10 1467832238 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1467832238 0 Physicians Anesthesia Services 20 1467832238 0 Physicians Fluoride varnish 20 1467832238 0 Physicians Healthy Kids Services 20 1467832238 0 Physicians Optical Supplies 20 1467832238 0 Physicians Physician Services 20 1467832238 0 Physicians Physicians Psychiatric Services 00 1467832428 0 SANCHEZ ROBERT 2018345 9999999 B 10 1467832428 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1467832428 0 Physicians Anesthesia Services 20 1467832428 0 Physicians Fluoride varnish 20 1467832428 0 Physicians Healthy Kids Services 20 1467832428 0 Physicians Optical Supplies 20 1467832428 0 Physicians Physician Services 00 1467832436 0 RUDNICK ASHLEY 2022290 9999999 B 10 1467832436 0 5777 DEPT CAROL STREAM IL 601228942 20 1467832436 0 Psychologist Psychologist service 00 1467832691 0 AHMAD MUHAMMAD 2019128 9999999 B 10 1467832691 0 7447 W TALCOTT AVE STE 216 SUITE 216 CHICAGO IL 606313713 20 1467832691 0 Physicians Anesthesia Services 20 1467832691 0 Physicians Fluoride varnish 20 1467832691 0 Physicians Healthy Kids Services 20 1467832691 0 Physicians Optical Supplies 20 1467832691 0 Physicians Physician Services 00 1467833301 0 WALKER TED 2019176 9999999 B 10 1467833301 0 615 S NEW BALLAS RD STE 1200 SAINT LOUIS MO 631418221 20 1467833301 0 Physicians Anesthesia Services 20 1467833301 0 Physicians Fluoride varnish 20 1467833301 0 Physicians Healthy Kids Services 20 1467833301 0 Physicians Optical Supplies 20 1467833301 0 Physicians Physician Services 00 1467834200 0 MOSIER 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1467858308 0 GUZLAS KELLY 2015146 9999999 B 10 1467858308 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1467858308 0 Nurse Practitioners Healthy Kids Services 20 1467858308 0 Nurse Practitioners Nurse Practitioners Services 20 1467858308 0 Nurse Practitioners Physician Services 00 1467858514 0 RIMAR JENNIFER 2016217 9999999 B 10 1467858514 0 201 E MADISON ST STE 328 SPRINGFIELD IL 627025131 20 1467858514 0 Nurse Practitioners Fluoride varnish 20 1467858514 0 Nurse Practitioners Healthy Kids Services 20 1467858514 0 Nurse Practitioners Nurse Practitioners Services 20 1467858514 0 Nurse Practitioners Physician Services 00 1467858712 0 SMITH GRETA L 2014321 9999999 B 10 1467858712 0 PO BOX 155 CHRISTOPHER IL 628220155 20 1467858712 0 Nurse Practitioners Fluoride varnish 20 1467858712 0 Nurse Practitioners Healthy Kids Services 20 1467858712 0 Nurse Practitioners Nurse Practitioners Services 20 1467858712 0 Nurse Practitioners Physician Services 00 1467859454 0 BENJAMIN AMANDA R 2016026 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10 1467860445 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1467860445 0 Nurse Practitioners Healthy Kids Services 20 1467860445 0 Nurse Practitioners Nurse Practitioners Services 20 1467860445 0 Nurse Practitioners Physician Services 00 1467861005 0 GILMAN ANDREA P 2016154 9999999 B 10 1467861005 0 PO BOX 953 ADDISON IL 601010953 20 1467861005 0 Occupational Therapists Medical Supplies 20 1467861005 0 Occupational Therapists Medical equipment/prosthetic devices 20 1467861005 0 Occupational Therapists Occupational Therapy Services 00 1467861864 0 YOUNG JEFFREY C 2018106 9999999 B 10 1467861864 0 PO BOX 79591 BALTIMORE MD 212790591 20 1467861864 0 Optometrists Optical Supplies 20 1467861864 0 Optometrists Optometric Services 20 1467861864 0 Optometrists Physician Services 00 1467862144 0 MARCOUX STEPHEN V 2022135 9999999 B 10 1467862144 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1467862144 0 Physicians Anesthesia Services 20 1467862144 0 Physicians Healthy Kids Services 20 1467862144 0 Physicians Optical Supplies 20 1467862144 0 Physicians Physician Services 20 1467862144 0 Physicians Physicians Psychiatric Services 00 1467862672 0 TRAN VU 2023124 9999999 B 10 1467862672 0 PO BOX 713160 CHICAGO IL 606770360 20 1467862672 0 Physicians Anesthesia Services 20 1467862672 0 Physicians Healthy Kids Services 20 1467862672 0 Physicians Optical Supplies 20 1467862672 0 Physicians Physician Services 00 1467862995 0 KAUR NAVNEET 2017229 9999999 B 10 1467862995 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1467862995 0 Physicians Anesthesia Services 20 1467862995 0 Physicians Fluoride varnish 20 1467862995 0 Physicians Healthy Kids Services 20 1467862995 0 Physicians Optical Supplies 20 1467862995 0 Physicians Physician Services 00 1467863043 0 PETERSON WILLIAM 2023326 9999999 B 10 1467863043 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1467863043 0 Physicians Anesthesia Services 20 1467863043 0 Physicians Healthy Kids Services 20 1467863043 0 Physicians Optical Supplies 20 1467863043 0 Physicians Physician Services 00 1467863282 0 CLIFFORD ALISON I 2014191 9999999 B 10 1467863282 0 2215 W 110TH PL CHICAGO IL 606433919 20 1467863282 0 Occupational Therapists Medical Supplies 20 1467863282 0 Occupational Therapists Medical equipment/prosthetic devices 20 1467863282 0 Occupational Therapists Occupational Therapy Services 00 1467863589 0 MUSA MINHAJ 2016214 9999999 B 10 1467863589 0 29373 NETWORK PL CHICAGO IL 606733039 20 1467863589 0 Physicians Anesthesia Services 20 1467863589 0 Physicians Fluoride varnish 20 1467863589 0 Physicians Healthy Kids Services 20 1467863589 0 Physicians Optical Supplies 20 1467863589 0 Physicians Physician Services 00 1467863878 0 BRUKETTA BROOKE 2018253 9999999 B 10 1467863878 0 101 E MILLER RD STERLING IL 610811252 20 1467863878 0 Clinical Social Worker Social work service 00 1467863985 0 BEBIC ZVONIMIR 2021304 9999999 B 10 1467863985 0 PO BOX 110429 AURORA CO 800420429 20 1467863985 0 Physicians Anesthesia Services 20 1467863985 0 Physicians Healthy Kids Services 20 1467863985 0 Physicians Optical Supplies 20 1467863985 0 Physicians Physician Services 00 1467864389 0 GUPTA SHIVANI 2022206 9999999 B 10 1467864389 0 29373 NETWORK PL CHICAGO IL 606733039 20 1467864389 0 Physicians Anesthesia Services 20 1467864389 0 Physicians Healthy Kids Services 20 1467864389 0 Physicians Optical Supplies 20 1467864389 0 Physicians Physician Services 00 1467864520 0 WARD JOANNA 2018263 9999999 B 10 1467864520 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1467864520 0 Physician Assistant Only Fluoride varnish 20 1467864520 0 Physician Assistant Only Healthy Kids Services 20 1467864520 0 Physician Assistant Only Physician Services 00 1467865311 0 PILEWICZ KATARZYNA B 2020169 9999999 B 10 1467865311 0 405 LAKE COOK RD STE 203 DEERFIELD IL 600154993 20 1467865311 0 Other behavior health professional LCPC/LMFT services 20 1467865311 0 Other behavior health professional Other 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F. 2017160 9999999 B 10 1467865808 0 PO BOX 778912 CHICAGO IL 606778912 20 1467865808 0 Physicians Anesthesia Services 20 1467865808 0 Physicians Fluoride varnish 20 1467865808 0 Physicians Healthy Kids Services 20 1467865808 0 Physicians Optical Supplies 20 1467865808 0 Physicians Physician Services 00 1467865824 0 JUN EMILY 2023279 9999999 B 10 1467865824 0 111 OAKWOOD RD EAST PEORIA IL 616111853 20 1467865824 0 Physicians Anesthesia Services 20 1467865824 0 Physicians Healthy Kids Services 20 1467865824 0 Physicians Optical Supplies 20 1467865824 0 Physicians Physician Services 00 1467865873 0 BOJEDLA KIRAN 2015149 9999999 B 10 1467865873 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1467865873 0 Physicians Anesthesia Services 20 1467865873 0 Physicians Fluoride varnish 20 1467865873 0 Physicians Healthy Kids Services 20 1467865873 0 Physicians Optical Supplies 20 1467865873 0 Physicians Physician Services 00 1467866418 0 DESAI HELI A 2017209 9999999 B 10 1467866418 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1467866418 0 Physicians Anesthesia Services 20 1467866418 0 Physicians Fluoride varnish 20 1467866418 0 Physicians Healthy Kids Services 20 1467866418 0 Physicians Optical Supplies 20 1467866418 0 Physicians Physician Services 00 1467866475 0 DESAI NIMIT 2017027 9999999 B 10 1467866475 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1467866475 0 Physicians Anesthesia Services 20 1467866475 0 Physicians Fluoride varnish 20 1467866475 0 Physicians Healthy Kids Services 20 1467866475 0 Physicians Optical Supplies 20 1467866475 0 Physicians Physician Services 00 1467866673 0 RALPH HAYLEY A 2018167 9999999 B 10 1467866673 0 124 SW ADAMS ST PEORIA IL 616021308 20 1467866673 0 Physicians Anesthesia Services 20 1467866673 0 Physicians Fluoride varnish 20 1467866673 0 Physicians Healthy Kids Services 20 1467866673 0 Physicians Optical Supplies 20 1467866673 0 Physicians Physician Services 00 1467866723 0 MILLER KRISTIN L 2019196 9999999 B 10 1467866723 0 5777 DEPT CAROL STREAM IL 601220021 20 1467866723 0 Physicians Anesthesia Services 20 1467866723 0 Physicians Healthy Kids Services 20 1467866723 0 Physicians Optical Supplies 20 1467866723 0 Physicians Physician Services 20 1467866723 0 Physicians Physicians Psychiatric Services 00 1467867176 0 CORDRAY ADAM 2022278 9999999 B 10 1467867176 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1467867176 0 Physicians Anesthesia Services 20 1467867176 0 Physicians Fluoride varnish 20 1467867176 0 Physicians Healthy Kids Services 20 1467867176 0 Physicians Optical Supplies 20 1467867176 0 Physicians Physician Services 00 1467867358 0 LITTLEFIELD JOHN P 2016260 9999999 B 10 1467867358 0 800 W FULTON MARKET FL 12 CHICAGO IL 606071302 20 1467867358 0 Physician Assistant Only Fluoride varnish 20 1467867358 0 Physician Assistant Only Healthy Kids Services 20 1467867358 0 Physician Assistant Only Physician Services 00 1467867382 0 PODOBINSKI TOMASZ 2021075 9999999 B 10 1467867382 0 675 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Services 20 1467870204 0 Physicians Fluoride varnish 20 1467870204 0 Physicians Healthy Kids Services 20 1467870204 0 Physicians Optical Supplies 20 1467870204 0 Physicians Physician Services 00 1467870261 0 WALTER JESSICA R 2018102 9999999 B 10 1467870261 0 5777 DEPT CAROL STREAM IL 601220021 20 1467870261 0 Physicians Anesthesia Services 20 1467870261 0 Physicians Healthy Kids Services 20 1467870261 0 Physicians Optical Supplies 20 1467870261 0 Physicians Physician Services 00 1467870337 0 APPLEGATE DANIEL E 2015104 9999999 B 10 1467870337 0 819 BLOOMINGTON RD CHAMPAIGN IL 618202101 20 1467870337 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1467870519 0 OUIMET GINA 2016342 9999999 B 10 1467870519 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1467870519 0 Other behavior health professional LCPC/LMFT services 00 1467870964 0 KARAS ANATOLI F 2020255 9999999 B 10 1467870964 0 2000 OGDEN AVE AURORA IL 605047222 20 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00 1467958520 0 HILL CHARLES L 2023067 9999999 B 10 1467958520 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1467958520 0 Physicians Anesthesia Services 20 1467958520 0 Physicians Fluoride varnish 20 1467958520 0 Physicians Healthy Kids Services 20 1467958520 0 Physicians Optical Supplies 20 1467958520 0 Physicians Physician Services 00 1467958561 0 OWEN AARON L 2022213 9999999 B 10 1467958561 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1467958561 0 Physicians Anesthesia Services 20 1467958561 0 Physicians Healthy Kids Services 20 1467958561 0 Physicians Optical Supplies 20 1467958561 0 Physicians Physician Services 20 1467958561 0 Physicians Physicians Psychiatric Services 00 1467959031 0 ALFAHEL WASEEM 2019191 9999999 B 10 1467959031 0 387 SHUMAN BLVD STE 275 NAPERVILLE IL 605638450 20 1467959031 0 Physicians Anesthesia Services 20 1467959031 0 Physicians Healthy Kids Services 20 1467959031 0 Physicians Optical Supplies 20 1467959031 0 Physicians Physician Services 00 1467959171 0 PETERSON CHELSEY 2020212 9999999 B 10 1467959171 0 3654 N LAKEWOOD AVE CHICAGO IL 606133725 20 1467959171 0 Speech Therapists Medical Supplies 20 1467959171 0 Speech Therapists Medical equipment/prosthetic devices 20 1467959171 0 Speech Therapists Speech Therapy/Pathology Services 00 1467959510 0 MAINI KUNAL 2021189 9999999 B 10 1467959510 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1467959510 0 Physicians Anesthesia Services 20 1467959510 0 Physicians Healthy Kids Services 20 1467959510 0 Physicians Optical Supplies 20 1467959510 0 Physicians Physician Services 20 1467959510 0 Physicians Physicians Psychiatric Services 00 1467960104 0 FRAZIER DAVID M. 2018012 9999999 B 10 1467960104 0 611 W PARK ST BWPC URBANA IL 618012529 20 1467960104 0 Nurse Practitioners Anesthesia Services 20 1467960104 0 Nurse Practitioners Nurse Practitioners Services 20 1467960104 0 Nurse Practitioners Physician Services 00 1467960906 0 STREICHER VICKIE 2018040 9999999 B 10 1467960906 0 4230 11TH 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1467973396 0 3450 LACEY RD DOWNERS GROVE IL 605155430 20 1467973396 0 Optometrists Optical Supplies 20 1467973396 0 Optometrists Optometric Services 20 1467973396 0 Optometrists Physician Services 00 1467974196 0 MCLEOD ELIZABETH A 2017213 9999999 B 10 1467974196 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1467974196 0 Nurse Practitioners Fluoride varnish 20 1467974196 0 Nurse Practitioners Healthy Kids Services 20 1467974196 0 Nurse Practitioners Nurse Practitioners Services 20 1467974196 0 Nurse Practitioners Physician Services 00 1467974402 0 DMYTRUK KAYLA J 2020017 9999999 B 10 1467974402 0 29373 NETWORK PL CHICAGO IL 606733039 20 1467974402 0 Physicians Anesthesia Services 20 1467974402 0 Physicians Healthy Kids Services 20 1467974402 0 Physicians Optical Supplies 20 1467974402 0 Physicians Physician Services 00 1467975052 0 DUKANWALA SUHEL 2017211 9999999 B 10 1467975052 0 2319 S CICERO AVE CICERO IL 608042451 20 1467975052 0 Dentists Dental Services 20 1467975052 0 Dentists Physician Services 00 1467975243 0 IBRAHIM MAGDI T 2018001 9999999 B 10 1467975243 0 8729 S HARLEM AVE BRIDGEVIEW IL 604551905 20 1467975243 0 Dentists Dental Services 20 1467975243 0 Dentists Physician Services 00 1467976696 0 CLARK HEATHER 2024017 9999999 B 10 1467976696 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1467976696 0 Physician Assistant Only Fluoride varnish 20 1467976696 0 Physician Assistant Only Healthy Kids Services 20 1467976696 0 Physician Assistant Only Physician Services 00 1467977652 0 BROWN BRITTANY 2021363 9999999 B 10 1467977652 0 9701 W HIGGINS RD STE 270 STE 270 ROSEMONT IL 600184703 20 1467977652 0 Physician Assistant Only Fluoride varnish 20 1467977652 0 Physician Assistant Only Healthy Kids Services 20 1467977652 0 Physician Assistant Only Physician Services 00 1467977678 0 CARPER KRISTEN PAIGE 2017230 9999999 B 10 1467977678 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1467977678 0 Nurse Practitioners Anesthesia Services 20 1467977678 0 Nurse 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Speech Therapy/Pathology Services 00 1467978882 0 CREDILLE JAMIESON T 2017111 9999999 B 10 1467978882 0 1952 ABERDEEN CT SYCAMORE IL 601783175 20 1467978882 0 Physical Therapists Medical Supplies 20 1467978882 0 Physical Therapists Medical equipment/prosthetic devices 20 1467978882 0 Physical Therapists Physical Therapy Services 00 1467979252 0 WALKER STEPHANIE D 2017248 9999999 B 10 1467979252 0 1200 S DUNTON AVE ARLINGTON HEIGH IL 600053111 20 1467979252 0 Speech Therapists Medical Supplies 20 1467979252 0 Speech Therapists Medical equipment/prosthetic devices 20 1467979252 0 Speech Therapists Speech Therapy/Pathology Services 00 1467979260 0 MAINOR JENNIFER D 2017240 9999999 B 10 1467979260 0 PO BOX 775253 CHICAGO IL 606775253 20 1467979260 0 Nurse Practitioners Fluoride varnish 20 1467979260 0 Nurse Practitioners Healthy Kids Services 20 1467979260 0 Nurse Practitioners Nurse Practitioners Services 20 1467979260 0 Nurse Practitioners Physician Services 00 1467979401 0 MONTI DENISE 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2020352 9999999 B 10 1467981852 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1467981852 0 Psychologist Psychologist service 00 1467982108 0 EASSA JOSHUA 2022261 9999999 B 10 1467982108 0 9725 NW 117TH AVE STE 200 MEDLEY FL 331781260 20 1467982108 0 Physicians Anesthesia Services 20 1467982108 0 Physicians Fluoride varnish 20 1467982108 0 Physicians Healthy Kids Services 20 1467982108 0 Physicians Optical Supplies 20 1467982108 0 Physicians Physician Services 00 1467982181 0 MAZZONE STEVEN 2018353 9999999 B 10 1467982181 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1467982181 0 Physicians Anesthesia Services 20 1467982181 0 Physicians Fluoride varnish 20 1467982181 0 Physicians Healthy Kids Services 20 1467982181 0 Physicians Optical Supplies 20 1467982181 0 Physicians Physician Services 00 1467983163 0 TIMOTHY THEODORE A 2021181 9999999 B 10 1467983163 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1467983163 0 Physicians Anesthesia Services 20 1467983163 0 Physicians Healthy Kids Services 20 1467983163 0 Physicians Optical Supplies 20 1467983163 0 Physicians Physician Services 00 1467983395 0 THANGADA NEELA D 2023136 9999999 B 10 1467983395 0 5777 DEPT CAROL STREAM IL 601220021 20 1467983395 0 Physicians Anesthesia Services 20 1467983395 0 Physicians Fluoride varnish 20 1467983395 0 Physicians Healthy Kids Services 20 1467983395 0 Physicians Optical Supplies 20 1467983395 0 Physicians Physician Services 00 1467983486 0 ODOM APRIL 2017142 9999999 B 10 1467983486 0 19740 GOVERNORS HWY STE 116 FLOSSMOOR IL 604222085 20 1467983486 0 Nurse Practitioners Fluoride varnish 20 1467983486 0 Nurse Practitioners Healthy Kids Services 20 1467983486 0 Nurse Practitioners Nurse Practitioners Services 20 1467983486 0 Nurse Practitioners Physician Services 00 1467983544 0 MORGAN JESSICA C 2017289 9999999 B 10 1467983544 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1467983544 0 Physicians Anesthesia Services 20 1467983544 0 Physicians Healthy Kids Services 20 1467983544 0 Physicians Optical Supplies 20 1467983544 0 Physicians Physician Services 00 1467983767 0 CALCANO ISRAEL I 2024289 9999999 B 10 1467983767 0 580 WATERS EDGE STE 100 LOMBARD IL 601486431 20 1467983767 0 Physicians Anesthesia Services 20 1467983767 0 Physicians Fluoride varnish 20 1467983767 0 Physicians Healthy Kids Services 20 1467983767 0 Physicians Optical Supplies 20 1467983767 0 Physicians Physician Services 00 1467983908 0 WITHERS BRADLEY R 2023360 9999999 B 10 1467983908 0 PO BOX 43230 PHOENIX AZ 850803230 20 1467983908 0 Physicians Anesthesia Services 20 1467983908 0 Physicians Healthy Kids Services 20 1467983908 0 Physicians Optical Supplies 20 1467983908 0 Physicians Physician Services 00 1467983965 0 LAPINS ALLISON E 2018352 9999999 B 10 1467983965 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1467983965 0 Physicians Anesthesia Services 20 1467983965 0 Physicians Healthy Kids Services 20 1467983965 0 Physicians Optical Supplies 20 1467983965 0 Physicians Physician Services 20 1467983965 0 Physicians Physicians Psychiatric Services 00 1467984823 0 KONSUR EVELYN 2020190 9999999 B 10 1467984823 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1467984823 0 Physicians Anesthesia Services 20 1467984823 0 Physicians Fluoride varnish 20 1467984823 0 Physicians Healthy Kids Services 20 1467984823 0 Physicians Optical Supplies 20 1467984823 0 Physicians Physician Services 00 1467985051 0 PATEL JAY 2020255 9999999 B 10 1467985051 0 PO BOX 708760 SANDY UT 840708760 20 1467985051 0 Physicians Anesthesia Services 20 1467985051 0 Physicians Fluoride varnish 20 1467985051 0 Physicians Healthy Kids Services 20 1467985051 0 Physicians Optical Supplies 20 1467985051 0 Physicians Physician Services 00 1467985853 0 CRAWFORD PATRICIA 2017150 9999999 B 10 1467985853 0 3436 N KENNICOTT AVE STE 114 STE 114 ARLINGTON HEIGH IL 600047814 20 1467985853 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and 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COLLEEN M 2017203 9999999 B 10 1477005304 0 912 NORTHWEST HWY STE 206 FOX RIVER GROVE IL 600211925 20 1477005304 0 Nurse Practitioners Healthy Kids Services 20 1477005304 0 Nurse Practitioners Nurse Practitioners Services 20 1477005304 0 Nurse Practitioners Physician Services 00 1477005734 0 POOR LAUREN 2018248 9999999 B 10 1477005734 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1477005734 0 Nurse Practitioners Healthy Kids Services 20 1477005734 0 Nurse Practitioners Nurse Practitioners Services 20 1477005734 0 Nurse Practitioners Physician Services 00 1477006294 0 KLOCH JANELLE 2016222 9999999 B 10 1477006294 0 1643 NW 136TH AVE STE 100 SUNRISE FL 333232857 20 1477006294 0 Nurse Practitioners Healthy Kids Services 20 1477006294 0 Nurse Practitioners Nurse Practitioners Services 20 1477006294 0 Nurse Practitioners Physician Services 00 1477006351 0 ALM CARL J 2016278 9999999 B 10 1477006351 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1477006351 0 Nurse 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Physicians Physician Services 00 1477013407 0 SUPAN EDWARD J 2019151 9999999 B 10 1477013407 0 5777 DEPT CAROL STREAM IL 601220021 20 1477013407 0 Physician Assistant Only Fluoride varnish 20 1477013407 0 Physician Assistant Only Healthy Kids Services 20 1477013407 0 Physician Assistant Only Physician Services 00 1477013506 0 TURK OMAR 2022199 9999999 B 10 1477013506 0 29373 NETWORK PL CHICAGO IL 606733039 20 1477013506 0 Physicians Anesthesia Services 20 1477013506 0 Physicians Fluoride varnish 20 1477013506 0 Physicians Healthy Kids Services 20 1477013506 0 Physicians Optical Supplies 20 1477013506 0 Physicians Physician Services 00 1477013902 0 HONSBERGER STEVEN S 2022192 9999999 B 10 1477013902 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1477013902 0 Physicians Anesthesia Services 20 1477013902 0 Physicians Fluoride varnish 20 1477013902 0 Physicians Healthy Kids Services 20 1477013902 0 Physicians Optical Supplies 20 1477013902 0 Physicians Physician Services 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Services 20 1477070407 0 Nurse Practitioners Physician Services 00 1477070456 0 GARCIA PAMELA J 2017263 9999999 B 10 1477070456 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1477070456 0 Nurse Practitioners Fluoride varnish 20 1477070456 0 Nurse Practitioners Healthy Kids Services 20 1477070456 0 Nurse Practitioners Nurse Practitioners Services 20 1477070456 0 Nurse Practitioners Physician Services 00 1477070795 0 BLAIR TAYLOR E 2017263 9999999 B 10 1477070795 0 5601 BROOKMERE ST EDWARDS IL 615289408 20 1477070795 0 Speech Therapists Medical Supplies 20 1477070795 0 Speech Therapists Medical equipment/prosthetic devices 20 1477070795 0 Speech Therapists Speech Therapy/Pathology Services 00 1477071074 0 LIN KEVIN H 2021173 9999999 B 10 1477071074 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1477071074 0 Physicians Anesthesia Services 20 1477071074 0 Physicians Fluoride varnish 20 1477071074 0 Physicians Healthy Kids Services 20 1477071074 0 Physicians Optical 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2020016 9999999 B 10 1477074722 0 1042 MAPLE AVE STE 335 SUITE 335 LISLE IL 605322329 20 1477074722 0 Physicians Anesthesia Services 20 1477074722 0 Physicians Fluoride varnish 20 1477074722 0 Physicians Healthy Kids Services 20 1477074722 0 Physicians Optical Supplies 20 1477074722 0 Physicians Physician Services 00 1477074789 0 SRINIVASAMURTHY RUTHVIK 2020141 9999999 B 10 1477074789 0 PO BOX 632122 CINCINNATI OH 452632122 20 1477074789 0 Physicians Anesthesia Services 20 1477074789 0 Physicians Fluoride varnish 20 1477074789 0 Physicians Healthy Kids Services 20 1477074789 0 Physicians Optical Supplies 20 1477074789 0 Physicians Physician Services 00 1477075943 0 WAQAR ANEEQ 2020016 9999999 B 10 1477075943 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1477075943 0 Physicians Anesthesia Services 20 1477075943 0 Physicians Fluoride varnish 20 1477075943 0 Physicians Healthy Kids Services 20 1477075943 0 Physicians Optical Supplies 20 1477075943 0 Physicians Physician Services 00 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CHICAGO IL 606543503 20 1477078921 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477079523 0 ASCENCIO DIANA 2017248 9999999 B 10 1477079523 0 70 S RIVER ST AURORA IL 605065185 20 1477079523 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477080984 0 RADA CAROLINA 2017152 9999999 B 10 1477080984 0 5341 W CERMAK RD CICERO IL 608042817 20 1477080984 0 Other behavior health professional LCPC/LMFT services 00 1477081032 0 ZELICHOWSKI KATARZYNA 2020090 9999999 B 10 1477081032 0 7300 N WESTERN AVE STE J CHICAGO IL 606451833 20 1477081032 0 Dentists Dental Services 20 1477081032 0 Dentists Physician Services 00 1477081420 0 GURALA DHINESHREDDY 2024221 9999999 B 10 1477081420 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1477081420 0 Physicians Anesthesia Services 20 1477081420 0 Physicians Fluoride varnish 20 1477081420 0 Physicians Healthy Kids Services 20 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660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1477086510 0 Physicians Anesthesia Services 20 1477086510 0 Physicians Fluoride varnish 20 1477086510 0 Physicians Healthy Kids Services 20 1477086510 0 Physicians Optical Supplies 20 1477086510 0 Physicians Physician Services 00 1477086619 0 DE ANDRADE PEREIRA RACHEL 2024199 9999999 B 10 1477086619 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1477086619 0 Physicians Anesthesia Services 20 1477086619 0 Physicians Healthy Kids Services 20 1477086619 0 Physicians Optical Supplies 20 1477086619 0 Physicians Physician Services 00 1477086874 0 KRAMER OWEN 2018205 9999999 B 10 1477086874 0 820 SPRINGER DR LOMBARD IL 601486413 20 1477086874 0 Physicians Anesthesia Services 20 1477086874 0 Physicians Healthy Kids Services 20 1477086874 0 Physicians Optical Supplies 20 1477086874 0 Physicians Physician Services 00 1477087369 0 AL-AZZAM BAHAA 2019304 9999999 B 10 1477087369 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1477087369 0 Physicians 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IKENS TONI L 2017053 9999999 B 10 1477091726 0 101 E MILLER RD STERLING IL 610811252 20 1477091726 0 Nurse Practitioners Fluoride varnish 20 1477091726 0 Nurse Practitioners Healthy Kids Services 20 1477091726 0 Nurse Practitioners Nurse Practitioners Services 20 1477091726 0 Nurse Practitioners Physician Services 00 1477092328 0 SHEPARD DEBBIE 2017075 9999999 B 10 1477092328 0 1301 W 22ND ST STE 500 OAK BROOK IL 605232014 20 1477092328 0 Clinical Social Worker Social work service 00 1477092427 0 SAGEZ ALLISON N 2017055 9999999 B 10 1477092427 0 400 MAPLE SUMMIT RD JERSEYVILLE IL 620522028 20 1477092427 0 Nurse Practitioners Fluoride varnish 20 1477092427 0 Nurse Practitioners Healthy Kids Services 20 1477092427 0 Nurse Practitioners Nurse Practitioners Services 20 1477092427 0 Nurse Practitioners Physician Services 00 1477092468 0 NAGY SKYLAR 2017057 9999999 B 10 1477092468 0 319 E MADISON ST STE 3B SPRINGFIELD IL 627013124 20 1477092468 0 Other behavior health professional LCPC/LMFT 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Services 00 1477095321 0 POINDEXTER KRYSTAL M 2017121 9999999 B 10 1477095321 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1477095321 0 Nurse Practitioners Healthy Kids Services 20 1477095321 0 Nurse Practitioners Nurse Practitioners Services 20 1477095321 0 Nurse Practitioners Physician Services 00 1477097962 0 JEREMIAH IBI J 2018001 9999999 B 10 1477097962 0 730 S CLARK ST APT 1403 CHICAGO IL 606051750 20 1477097962 0 Clinical Social Worker Social work service 00 1477099935 0 RUDER STANLEY A 2017059 9999999 B 10 1477099935 0 2600 WYNNCREST DR LONG GROVE IL 600475033 20 1477099935 0 Nurse Practitioners Healthy Kids Services 20 1477099935 0 Nurse Practitioners Nurse Practitioners Services 20 1477099935 0 Nurse Practitioners Physician Services 00 1477103653 0 STONE GABRIELLA 2019269 9999999 H 10 1477103653 0 333 N LA GRANGE RD STE 1 SUITE ONE LA GRANGE PARK IL 605265653 20 1477103653 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT 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1477113181 0 Nurse Practitioners Nurse Practitioners Services 20 1477113181 0 Nurse Practitioners Physician Services 00 1477113348 0 FRECKLETON ABBY G 2019192 9999999 B 10 1477113348 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1477113348 0 Nurse Practitioners Healthy Kids Services 20 1477113348 0 Nurse Practitioners Nurse Practitioners Services 20 1477113348 0 Nurse Practitioners Physician Services 00 1477114064 0 JAIN DEEPANJALI 2022227 9999999 B 10 1477114064 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1477114064 0 Physicians Anesthesia Services 20 1477114064 0 Physicians Fluoride varnish 20 1477114064 0 Physicians Healthy Kids Services 20 1477114064 0 Physicians Optical Supplies 20 1477114064 0 Physicians Physician Services 00 1477114064 0 JAIN DEEPANJALI 2022227 9999999 B 10 1477114064 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1477114064 0 Physicians Anesthesia Services 20 1477114064 0 Physicians Fluoride varnish 20 1477114064 0 Physicians Healthy Kids 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1477116317 0 Physicians Physician Services 00 1477116507 0 MONTESANO MICHAEL J 2020362 9999999 B 10 1477116507 0 1643 NW 136TH AVE STE 100 SUNRISE FL 333232857 20 1477116507 0 Physicians Anesthesia Services 20 1477116507 0 Physicians Fluoride varnish 20 1477116507 0 Physicians Healthy Kids Services 20 1477116507 0 Physicians Optical Supplies 20 1477116507 0 Physicians Physician Services 00 1477117117 0 FREYMILLER CASEY 2023192 9999999 B 10 1477117117 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1477117117 0 Physicians Anesthesia Services 20 1477117117 0 Physicians Fluoride varnish 20 1477117117 0 Physicians Healthy Kids Services 20 1477117117 0 Physicians Optical Supplies 20 1477117117 0 Physicians Physician Services 00 1477117539 0 MATHUR ANKUR 2021208 9999999 B 10 1477117539 0 4698 DEPT CAROL STREAM IL 601220021 20 1477117539 0 Physicians Anesthesia Services 20 1477117539 0 Physicians Healthy Kids Services 20 1477117539 0 Physicians Optical Supplies 20 1477117539 0 Physicians Physician Services 00 1477118164 0 HANNEMANN MEGAN 2022207 9999999 B 10 1477118164 0 1969 W HART RD BELOIT WI 535112230 20 1477118164 0 Physicians Anesthesia Services 20 1477118164 0 Physicians Healthy Kids Services 20 1477118164 0 Physicians Optical Supplies 20 1477118164 0 Physicians Physician Services 00 1477118289 0 DORE HEIDI 2019135 9999999 B 10 1477118289 0 1301 W COSSITT AVE LA GRANGE IL 605252145 20 1477118289 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1477118362 0 GIOVANNINI PAUL 2022274 9999999 B 10 1477118362 0 1518 MULBERRY AVE MUSCATINE IA 527613433 20 1477118362 0 Nurse Practitioners Anesthesia Services 20 1477118362 0 Nurse Practitioners Nurse Practitioners Services 20 1477118362 0 Nurse Practitioners Physician Services 00 1477118552 0 FAHEY CHRISTINA M 2022262 9999999 B 10 1477118552 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1477118552 0 Physicians Anesthesia Services 20 1477118552 0 Physicians Fluoride varnish 20 1477118552 0 Physicians Healthy Kids Services 20 1477118552 0 Physicians Optical Supplies 20 1477118552 0 Physicians Physician Services 00 1477118883 0 SUNG AUDREY 2021147 9999999 B 10 1477118883 0 75 REMITTANCE DR DEPT 1296 CHICAGO IL 606751296 20 1477118883 0 Physicians Anesthesia Services 20 1477118883 0 Physicians Fluoride varnish 20 1477118883 0 Physicians Healthy Kids Services 20 1477118883 0 Physicians Optical Supplies 20 1477118883 0 Physicians Physician Services 00 1477119006 0 SIMONAITIS KATHLEEN A 2019141 9999999 B 10 1477119006 0 1 CVS DR # MC2295 WOONSOCKET RI 028956146 20 1477119006 0 Nurse Practitioners Fluoride varnish 20 1477119006 0 Nurse Practitioners Healthy Kids Services 20 1477119006 0 Nurse Practitioners Nurse Practitioners Services 20 1477119006 0 Nurse Practitioners Physician Services 00 1477119014 0 RAMIREZ MILKA 2019151 9999999 H 10 1477119014 0 PO BOX 967 TINLEY PARK IL 604770967 20 1477119014 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477119576 0 FASSHAUER KRISTIN C 2019141 9999999 B 10 1477119576 0 10001 GRAND AVE ATTN: BILLING DEPARTMENT FRANKLIN PARK IL 601312563 20 1477119576 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477120897 0 GORHAM JANE 2024141 9999999 B 10 1477120897 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1477120897 0 Physicians Anesthesia Services 20 1477120897 0 Physicians Fluoride varnish 20 1477120897 0 Physicians Healthy Kids Services 20 1477120897 0 Physicians Optical Supplies 20 1477120897 0 Physicians Physician Services 00 1477121176 0 NEILSON NATHAN A 2021215 9999999 B 10 1477121176 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1477121176 0 Physicians Anesthesia Services 20 1477121176 0 Physicians Fluoride varnish 20 1477121176 0 Physicians Healthy Kids Services 20 1477121176 0 Physicians Optical Supplies 20 1477121176 0 Physicians Physician Services 00 1477121325 0 WHEATLEY ALICIA 2021266 9999999 B 10 1477121325 0 PO BOX 1230 EVANSVILLE IN 477061230 20 1477121325 0 Nurse Practitioners Fluoride varnish 20 1477121325 0 Nurse Practitioners Healthy Kids Services 20 1477121325 0 Nurse Practitioners Nurse Practitioners Services 20 1477121325 0 Nurse Practitioners Physician Services 00 1477121440 0 ZIVANOV CATHERINE N 2021229 9999999 B 10 1477121440 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1477121440 0 Physicians Anesthesia Services 20 1477121440 0 Physicians Healthy Kids Services 20 1477121440 0 Physicians Optical Supplies 20 1477121440 0 Physicians Physician Services 00 1477121663 0 GRANDHI NIKHIL R 2021207 9999999 B 10 1477121663 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1477121663 0 Physicians Anesthesia Services 20 1477121663 0 Physicians Fluoride varnish 20 1477121663 0 Physicians Healthy Kids Services 20 1477121663 0 Physicians Optical Supplies 20 1477121663 0 Physicians Physician Services 00 1477122000 0 WORKMAN LANCE A 2024318 9999999 B 10 1477122000 0 1106 N MERCHANT ST PO BOX 665 EFFINGHAM IL 624012128 20 1477122000 0 Physicians Anesthesia Services 20 1477122000 0 Physicians Fluoride varnish 20 1477122000 0 Physicians Healthy Kids Services 20 1477122000 0 Physicians Optical Supplies 20 1477122000 0 Physicians Physician Services 00 1477122489 0 VILCHIS NORMA 2021181 9999999 B 10 1477122489 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1477122489 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477122661 0 LEUBKA KYLE J 2024143 9999999 B 10 1477122661 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1477122661 0 Physicians Anesthesia Services 20 1477122661 0 Physicians Fluoride varnish 20 1477122661 0 Physicians Healthy Kids Services 20 1477122661 0 Physicians Optical Supplies 20 1477122661 0 Physicians Physician Services 00 1477122919 0 SHAH DHARA 2023228 9999999 B 10 1477122919 0 201 E MADISON ST STE 300 SPRINGFIELD IL 627025131 20 1477122919 0 Dentists Dental Services 20 1477122919 0 Dentists Physician Services 00 1477122968 0 ESTRADA JASMINE A 2021172 9999999 B 10 1477122968 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1477122968 0 Physicians Anesthesia Services 20 1477122968 0 Physicians Healthy Kids Services 20 1477122968 0 Physicians Optical Supplies 20 1477122968 0 Physicians Physician Services 00 1477123198 0 PATEL DILLAN 2025037 9999999 B 10 1477123198 0 PO BOX 60394 SAINT LOUIS MO 631600394 20 1477123198 0 Physicians Anesthesia Services 20 1477123198 0 Physicians Healthy Kids Services 20 1477123198 0 Physicians Optical Supplies 20 1477123198 0 Physicians Physician Services 00 1477123727 0 KURCZAB ELLEN H 2021197 9999999 H 10 1477123727 0 721 N LA SALLE DR CHICAGO IL 606543503 20 1477123727 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477124238 0 ROSS MARY K 2022228 9999999 B 10 1477124238 0 1104 W PARK AVE CHAMPAIGN IL 618213245 20 1477124238 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477124329 0 ABNEY KYLIE T 2021308 9999999 B 10 1477124329 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1477124329 0 Nurse Practitioners Healthy Kids Services 20 1477124329 0 Nurse Practitioners Nurse Practitioners Services 20 1477124329 0 Nurse Practitioners Physician Services 00 1477125060 0 MAREMMA NATASHA 2021250 9999999 B 10 1477125060 0 530 NE GLEN OAK AVE PEORIA IL 616370001 20 1477125060 0 Physicians Anesthesia Services 20 1477125060 0 Physicians Fluoride varnish 20 1477125060 0 Physicians Healthy Kids Services 20 1477125060 0 Physicians Optical Supplies 20 1477125060 0 Physicians Physician Services 00 1477125136 0 RICE MATTHEW DAVID 2021308 9999999 B 10 1477125136 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1477125136 0 Physician Assistant Only Fluoride varnish 20 1477125136 0 Physician Assistant Only Healthy Kids Services 20 1477125136 0 Physician Assistant Only Physician Services 00 1477125870 0 IRACI NINA 2024149 9999999 B 10 1477125870 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1477125870 0 Speech Therapists Medical Supplies 20 1477125870 0 Speech Therapists Medical equipment/prosthetic devices 20 1477125870 0 Speech Therapists Speech Therapy/Pathology Services 00 1477127520 0 TAYLOR TAMRA 2021139 9999999 B 10 1477127520 0 205 OAKLAND AVE CARLINVILLE IL 626261921 20 1477127520 0 Other behavior health professional LCPC/LMFT services 00 1477129419 0 WOOLDRIDGE DANIEL 2021189 9999999 B 10 1477129419 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1477129419 0 Physicians Anesthesia Services 20 1477129419 0 Physicians Fluoride varnish 20 1477129419 0 Physicians Healthy Kids Services 20 1477129419 0 Physicians Optical Supplies 20 1477129419 0 Physicians Physician Services 00 1477129542 0 NORRIS LUKE 2021181 9999999 B 10 1477129542 0 PO BOX 20556 SPRINGFIELD IL 627080556 20 1477129542 0 Physicians Anesthesia Services 20 1477129542 0 Physicians Healthy Kids Services 20 1477129542 0 Physicians Optical Supplies 20 1477129542 0 Physicians Physician Services 00 1477130599 0 CURRY ELORA L 2021095 9999999 B 10 1477130599 0 29373 NETWORK PL CHICAGO IL 606733039 20 1477130599 0 Nurse Practitioners Fluoride varnish 20 1477130599 0 Nurse Practitioners Healthy Kids Services 20 1477130599 0 Nurse Practitioners Nurse Practitioners Services 20 1477130599 0 Nurse Practitioners Physician Services 00 1477132066 0 GARBER REBECCA 2021175 9999999 B 10 1477132066 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1477132066 0 Physicians Anesthesia Services 20 1477132066 0 Physicians Fluoride varnish 20 1477132066 0 Physicians Healthy Kids Services 20 1477132066 0 Physicians Optical Supplies 20 1477132066 0 Physicians Physician Services 00 1477132132 0 WILLIAMS EMMA C 2023331 9999999 B 10 1477132132 0 29373 NETWORK PL CHICAGO IL 606733039 20 1477132132 0 Physicians Anesthesia Services 20 1477132132 0 Physicians Fluoride varnish 20 1477132132 0 Physicians Healthy Kids Services 20 1477132132 0 Physicians Optical Supplies 20 1477132132 0 Physicians Physician Services 00 1477132363 0 WOO FRANK W 2021214 9999999 B 10 1477132363 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1477132363 0 Physicians Anesthesia Services 20 1477132363 0 Physicians Fluoride varnish 20 1477132363 0 Physicians Healthy Kids Services 20 1477132363 0 Physicians Optical Supplies 20 1477132363 0 Physicians Physician Services 00 1477132421 0 ABBOTT MARIN ANN R 2024268 9999999 B 10 1477132421 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1477132421 0 Physicians Anesthesia Services 20 1477132421 0 Physicians Fluoride varnish 20 1477132421 0 Physicians Healthy Kids Services 20 1477132421 0 Physicians Optical Supplies 20 1477132421 0 Physicians Physician Services 00 1477132520 0 GARZA ASHLEY N 2021179 9999999 B 10 1477132520 0 29373 NETWORK PL CHICAGO IL 606733039 20 1477132520 0 Physicians Anesthesia Services 20 1477132520 0 Physicians Fluoride varnish 20 1477132520 0 Physicians Healthy Kids Services 20 1477132520 0 Physicians Optical Supplies 20 1477132520 0 Physicians Physician Services 00 1477132728 0 TREIBER KATARINA 2022224 9999999 B 10 1477132728 0 PO BOX 6037 WAUCONDA IL 600846037 20 1477132728 0 Nurse Practitioners Fluoride varnish 20 1477132728 0 Nurse Practitioners Healthy Kids Services 20 1477132728 0 Nurse Practitioners Nurse Practitioners Services 20 1477132728 0 Nurse Practitioners Physician Services 00 1477133346 0 WEGLARZ PIOTR 2021182 2099365 B 10 1477133346 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1477133346 0 Physicians Anesthesia Services 20 1477133346 0 Physicians Fluoride varnish 20 1477133346 0 Physicians Healthy Kids Services 20 1477133346 0 Physicians Optical Supplies 20 1477133346 0 Physicians Physician Services 00 1477133387 0 LOPSHIRE AUBREY 2022266 9999999 B 10 1477133387 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1477133387 0 Physicians Anesthesia Services 20 1477133387 0 Physicians Fluoride varnish 20 1477133387 0 Physicians Healthy Kids Services 20 1477133387 0 Physicians Optical Supplies 20 1477133387 0 Physicians Physician Services 00 1477134039 0 QIAO JAMES 2022182 9999999 B 10 1477134039 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1477134039 0 Physicians Anesthesia Services 20 1477134039 0 Physicians Fluoride varnish 20 1477134039 0 Physicians Healthy Kids Services 20 1477134039 0 Physicians Optical Supplies 20 1477134039 0 Physicians Physician Services 00 1477134872 0 HEMMRICH MAXIMILIAN 2021197 9999999 B 10 1477134872 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1477134872 0 Physicians Anesthesia Services 20 1477134872 0 Physicians Healthy Kids Services 20 1477134872 0 Physicians Optical Supplies 20 1477134872 0 Physicians Physician Services 00 1477134922 0 KONTOGHIORGHES CHRISTOPHER P 2024164 9999999 B 10 1477134922 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1477134922 0 Physicians Anesthesia Services 20 1477134922 0 Physicians Fluoride varnish 20 1477134922 0 Physicians Healthy Kids Services 20 1477134922 0 Physicians Optical Supplies 20 1477134922 0 Physicians Physician Services 00 1477135143 0 KHAN HIBA A 2022186 9999999 B 10 1477135143 0 PO BOX 3039 OAK BROOK IL 605223039 20 1477135143 0 Physicians Anesthesia Services 20 1477135143 0 Physicians Fluoride varnish 20 1477135143 0 Physicians Healthy Kids Services 20 1477135143 0 Physicians Optical Supplies 20 1477135143 0 Physicians Physician Services 00 1477135259 0 KNIGHT MARGOT P 2021195 9999999 B 10 1477135259 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1477135259 0 Physicians Anesthesia Services 20 1477135259 0 Physicians Healthy Kids Services 20 1477135259 0 Physicians Optical Supplies 20 1477135259 0 Physicians Physician Services 00 1477135374 0 JONES MICHELLE S 2022277 9999999 B 10 1477135374 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1477135374 0 Nurse Practitioners Healthy Kids Services 20 1477135374 0 Nurse Practitioners Nurse Practitioners Services 20 1477135374 0 Nurse Practitioners Physician Services 00 1477136034 0 LAMONICA-WEIER AMANDA 2022011 9999999 B 10 1477136034 0 4730 N WINTHROP AVE CHICAGO IL 606405034 20 1477136034 0 Nurse Practitioners Fluoride varnish 20 1477136034 0 Nurse Practitioners Healthy Kids Services 20 1477136034 0 Nurse Practitioners Nurse Practitioners Services 20 1477136034 0 Nurse Practitioners Physician Services 00 1477136281 0 CIMAROLI WIMANN SAWYER 2023183 9999999 B 10 1477136281 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1477136281 0 Physicians Anesthesia Services 20 1477136281 0 Physicians Healthy Kids Services 20 1477136281 0 Physicians Optical Supplies 20 1477136281 0 Physicians Physician Services 00 1477136638 0 LYNNE SARAH J 2021356 9999999 B 10 1477136638 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 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equipment/prosthetic devices 20 1477137370 0 Speech Therapists Speech Therapy/Pathology Services 00 1477137693 0 PENN EBONY 2021208 9999999 B 10 1477137693 0 200 OCEANGATE STE 100 LONG BEACH CA 908024317 20 1477137693 0 Nurse Practitioners Fluoride varnish 20 1477137693 0 Nurse Practitioners Healthy Kids Services 20 1477137693 0 Nurse Practitioners Nurse Practitioners Services 20 1477137693 0 Nurse Practitioners Physician Services 00 1477138170 0 CHAUHAN NIYATI 2021141 9999999 B 10 1477138170 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1477138170 0 Physical Therapists Medical Supplies 20 1477138170 0 Physical Therapists Medical equipment/prosthetic devices 20 1477138170 0 Physical Therapists Physical Therapy Services 00 1477139202 0 CLIMACO GREGORIO C 2021204 9999999 B 10 1477139202 0 3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047452 20 1477139202 0 Physicians Anesthesia Services 20 1477139202 0 Physicians Fluoride varnish 20 1477139202 0 Physicians Healthy Kids Services 20 1477139202 0 Physicians Optical Supplies 20 1477139202 0 Physicians Physician Services 00 1477139822 0 ZHANG JEREMY S 2024164 9999999 B 10 1477139822 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1477139822 0 Physicians Anesthesia Services 20 1477139822 0 Physicians Fluoride varnish 20 1477139822 0 Physicians Healthy Kids Services 20 1477139822 0 Physicians Optical Supplies 20 1477139822 0 Physicians Physician Services 00 1477141729 0 SAJN MARY E 2021090 9999999 B 10 1477141729 0 1730 45TH ST MUNSTER IN 463213915 20 1477141729 0 Nurse Practitioners Healthy Kids Services 20 1477141729 0 Nurse Practitioners Nurse Practitioners Services 20 1477141729 0 Nurse Practitioners Physician Services 00 1477143618 0 WINGERTER KRISTY 2021281 9999999 B 10 1477143618 0 114 BARNEY DR JOLIET IL 604356404 20 1477143618 0 Nurse Practitioners Fluoride varnish 20 1477143618 0 Nurse Practitioners Healthy Kids Services 20 1477143618 0 Nurse Practitioners Nurse Practitioners Services 20 1477143618 0 Nurse Practitioners Physician Services 00 1477147668 0 HILT ASHLYN 2024256 9999999 B 10 1477147668 0 317 SALEM PL FAIRVIEW HEIGHT IL 622081367 20 1477147668 0 Nurse Practitioners Healthy Kids Services 20 1477147668 0 Nurse Practitioners Nurse Practitioners Services 20 1477147668 0 Nurse Practitioners Physician Services 00 1477148443 0 HUBER JOSEPH 2021089 9999999 B 10 1477148443 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1477148443 0 Nurse Practitioners Healthy Kids Services 20 1477148443 0 Nurse Practitioners Nurse Practitioners Services 20 1477148443 0 Nurse Practitioners Physician Services 00 1477149698 0 COMTE CASEY J 2022347 9999999 B 10 1477149698 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1477149698 0 Nurse Practitioners Fluoride varnish 20 1477149698 0 Nurse Practitioners Healthy Kids Services 20 1477149698 0 Nurse Practitioners Nurse Practitioners Services 20 1477149698 0 Nurse Practitioners Physician Services 00 1477150415 0 ORZECHOWSKA IZABELA 2023137 9999999 B 10 1477150415 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1477150415 0 Physical Therapists Medical Supplies 20 1477150415 0 Physical Therapists Medical equipment/prosthetic devices 20 1477150415 0 Physical Therapists Physical Therapy Services 00 1477150936 0 PRESTON DEBARA 2020363 9999999 B 10 1477150936 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1477150936 0 Nurse Practitioners Fluoride varnish 20 1477150936 0 Nurse Practitioners Healthy Kids Services 20 1477150936 0 Nurse Practitioners Nurse Practitioners Services 20 1477150936 0 Nurse Practitioners Physician Services 00 1477151272 0 BRADFORD YOLANDA 2022081 9999999 B 10 1477151272 0 101 MADISON ST STE 300 OAK PARK IL 603024210 20 1477151272 0 Nurse Practitioners Fluoride varnish 20 1477151272 0 Nurse Practitioners Healthy Kids Services 20 1477151272 0 Nurse Practitioners Nurse Practitioners Services 20 1477151272 0 Nurse Practitioners Physician Services 00 1477155760 0 ZIMMERMAN DIANE 2022042 9999999 B 10 1477155760 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1477155760 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477155810 0 MONICAL KRISTIN L 2022202 9999999 B 10 1477155810 0 7421 MADISON ST FOREST PARK IL 601301575 20 1477155810 0 Occupational Therapists Medical Supplies 20 1477155810 0 Occupational Therapists Medical equipment/prosthetic devices 20 1477155810 0 Occupational Therapists Occupational Therapy Services 00 1477157410 0 WRIGLEY ASHLEY L 2020337 9999999 B 10 1477157410 0 2300 N EDWARD ST DECATUR IL 625264163 20 1477157410 0 Nurse Practitioners Healthy Kids Services 20 1477157410 0 Nurse Practitioners Nurse Practitioners Services 20 1477157410 0 Nurse Practitioners Physician Services 00 1477158434 0 SMAZIL JENNIFER 2021130 9999999 B 10 1477158434 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1477158434 0 Nurse Practitioners Fluoride varnish 20 1477158434 0 Nurse Practitioners Healthy Kids Services 20 1477158434 0 Nurse Practitioners Nurse Practitioners Services 20 1477158434 0 Nurse Practitioners Physician Services 00 1477159028 0 HIGGINS KATHRYN 2020353 9999999 B 10 1477159028 0 811 W JOHN ST YORKVILLE IL 605609249 20 1477159028 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477160158 0 HUSSEIN MOHAMMED Z 2023249 9999999 B 10 1477160158 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1477160158 0 Physicians Anesthesia Services 20 1477160158 0 Physicians Healthy Kids Services 20 1477160158 0 Physicians Optical Supplies 20 1477160158 0 Physicians Physician Services 00 1477160331 0 MOSOOF SAMER 2020279 9999999 B 10 1477160331 0 1812 N 19TH AVE MELROSE PARK IL 601602039 20 1477160331 0 Dentists Dental Services 20 1477160331 0 Dentists Physician Services 00 1477161420 0 STARK VALDEZ ALEX 2021098 9999999 B 10 1477161420 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1477161420 0 Nurse Practitioners Fluoride varnish 20 1477161420 0 Nurse Practitioners Healthy Kids Services 20 1477161420 0 Nurse Practitioners Nurse Practitioners Services 20 1477161420 0 Nurse Practitioners Physician Services 00 1477162089 0 REINEKE LAUREN 2020252 9999999 B 10 1477162089 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1477162089 0 Physician Assistant Only Fluoride varnish 20 1477162089 0 Physician Assistant Only Healthy Kids Services 20 1477162089 0 Physician Assistant Only Physician Services 00 1477162535 0 WIDDOWS SAMANTHA 2022354 9999999 B 10 1477162535 0 231 E INDIAN TRL AURORA IL 605051732 20 1477162535 0 Psychologist Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477162808 0 LAMOTTE JULIA E 2020282 9999999 B 10 1477162808 0 PO BOX 778912 CHICAGO IL 606778912 20 1477162808 0 Psychologist Psychologist service 00 1477163137 0 KHALEELULLAH UROOBA M 2020220 9999999 B 10 1477163137 0 2500 W BRADLEY PL STE 109 CHICAGO IL 606184716 20 1477163137 0 Occupational Therapists Medical Supplies 20 1477163137 0 Occupational Therapists Medical equipment/prosthetic devices 20 1477163137 0 Occupational Therapists Occupational Therapy Services 00 1477164077 0 MERCHO PATRICK 2024206 9999999 B 10 1477164077 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1477164077 0 Physicians Anesthesia Services 20 1477164077 0 Physicians Healthy Kids Services 20 1477164077 0 Physicians Optical Supplies 20 1477164077 0 Physicians Physician Services 20 1477164077 0 Physicians Physicians Psychiatric Services 00 1477165124 0 VOLPE LENA J 2024176 9999999 B 10 1477165124 0 4698 DEPT CAROL STREAM IL 601220021 20 1477165124 0 Physicians Anesthesia Services 20 1477165124 0 Physicians Healthy Kids Services 20 1477165124 0 Physicians Optical Supplies 20 1477165124 0 Physicians Physician Services 00 1477165371 0 KANG ANTHONY J 2024176 9999999 B 10 1477165371 0 4698 DEPT CAROL STREAM IL 601220021 20 1477165371 0 Physicians Anesthesia Services 20 1477165371 0 Physicians Fluoride varnish 20 1477165371 0 Physicians Healthy Kids Services 20 1477165371 0 Physicians Optical Supplies 20 1477165371 0 Physicians Physician Services 00 1477165488 0 RINGHAUSEN MEREDITH 2020297 9999999 B 10 1477165488 0 3621 MARION LN LAS CRUCES NM 880127579 20 1477165488 0 Other behavior health professional Adaptive behavior support clinician services 20 1477165488 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477167146 0 STORHOFF BRITTANY J 2020247 9999999 B 10 1477167146 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1477167146 0 Nurse Practitioners Fluoride varnish 20 1477167146 0 Nurse Practitioners Healthy Kids Services 20 1477167146 0 Nurse Practitioners Nurse Practitioners Services 20 1477167146 0 Nurse Practitioners Physician Services 00 1477167880 0 MALABANAN RENZI 2020274 9999999 B 10 1477167880 0 450 E 22ND ST STE 217 LOMBARD IL 601486176 20 1477167880 0 Registered nurse Nursing service 20 1477167880 0 Registered nurse Waiver service 00 1477168326 0 MCPHEETERS JACLYN M 2024317 9999999 B 10 1477168326 0 13305 S RIDGELAND AVE UNIT A PALOS HEIGHTS IL 604631814 20 1477168326 0 Nurse Practitioners Healthy Kids Services 20 1477168326 0 Nurse Practitioners Nurse Practitioners Services 20 1477168326 0 Nurse Practitioners Nursing service 20 1477168326 0 Nurse Practitioners Physician Services 20 1477168326 0 Nurse Practitioners Waiver service 00 1477169654 0 O'CONNELL KRISTEN A 2022215 9999999 B 10 1477169654 0 741 S MCHENRY AVE CRYSTAL LAKE IL 600147445 20 1477169654 0 Physician Assistant Only Fluoride varnish 20 1477169654 0 Physician Assistant Only Healthy Kids Services 20 1477169654 0 Physician Assistant Only Physician Services 00 1477170090 0 MENDOZA TORRES JHOANA 2025043 9999999 B 10 1477170090 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1477170090 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477170199 0 ACKERMAN KYLE 2020198 9999999 B 10 1477170199 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1477170199 0 Physicians Anesthesia Services 20 1477170199 0 Physicians Healthy Kids Services 20 1477170199 0 Physicians Optical Supplies 20 1477170199 0 Physicians Physician Services 00 1477171536 0 LAM AUDREY 2020225 9999999 B 10 1477171536 0 611 W PARK ST URBANA IL 618012529 20 1477171536 0 Physicians Anesthesia Services 20 1477171536 0 Physicians Fluoride varnish 20 1477171536 0 Physicians Healthy Kids Services 20 1477171536 0 Physicians Optical Supplies 20 1477171536 0 Physicians Physician Services 00 1477172005 0 BRZUSZKIEWICZ KELSEY 2020260 9999999 B 10 1477172005 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1477172005 0 Nurse Practitioners Fluoride varnish 20 1477172005 0 Nurse Practitioners Healthy Kids Services 20 1477172005 0 Nurse Practitioners Nurse Practitioners Services 20 1477172005 0 Nurse Practitioners Physician Services 00 1477172237 0 MCNIELL ALLISON 2021097 9999999 B 10 1477172237 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1477172237 0 Physician Assistant Only Fluoride varnish 20 1477172237 0 Physician Assistant Only Healthy Kids Services 20 1477172237 0 Physician Assistant Only Physician Services 00 1477172369 0 DAVILA ANDRES 2023213 9999999 B 10 1477172369 0 2800 COLLEGE AVE ALTON IL 620024742 20 1477172369 0 Dentists Dental Services 20 1477172369 0 Dentists Physician Services 00 1477172823 0 NECESARIO SMITH LAUREN A 2021104 9999999 B 10 1477172823 0 727 E COURT ST PARIS IL 619442460 20 1477172823 0 Psychologist Psychologist service 00 1477172914 0 RANDOLPH RICHARD 2021280 9999999 B 10 1477172914 0 11740 S WESTERN AVE CHICAGO IL 606434732 20 1477172914 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477173177 0 BERTSCH-GOUT MARCEL 2020276 9999999 B 10 1477173177 0 684 S BARRINGTON RD STE 112 STREAMWOOD IL 601071841 20 1477173177 0 Physicians Anesthesia Services 20 1477173177 0 Physicians Healthy Kids Services 20 1477173177 0 Physicians Optical Supplies 20 1477173177 0 Physicians Physician Services 20 1477173177 0 Physicians Physicians Psychiatric Services 00 1477173185 0 KRAMER LEAH M 2020307 9999999 B 10 1477173185 0 611 W PARK ST URBANA IL 618012529 20 1477173185 0 Physician Assistant Only Fluoride varnish 20 1477173185 0 Physician Assistant Only Healthy Kids Services 20 1477173185 0 Physician Assistant Only Physician Services 00 1477173540 0 NUSBAUM DAVID JACOB 2020182 9999999 B 10 1477173540 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1477173540 0 Physicians Anesthesia Services 20 1477173540 0 Physicians Healthy Kids Services 20 1477173540 0 Physicians Optical Supplies 20 1477173540 0 Physicians Physician Services 00 1477173664 0 FASSL MICHAEL R 2023209 9999999 B 10 1477173664 0 29373 NETWORK PL CHICAGO IL 606733039 20 1477173664 0 Physicians Anesthesia Services 20 1477173664 0 Physicians Fluoride varnish 20 1477173664 0 Physicians Healthy Kids Services 20 1477173664 0 Physicians Optical Supplies 20 1477173664 0 Physicians Physician Services 00 1477175081 0 KABAT GREGORY 2021027 9999999 B 10 1477175081 0 1400 E IRVING PARK RD STREAMWOOD IL 601073201 20 1477175081 0 Other behavior health professional LCPC/LMFT services 00 1477175446 0 HARZAN MIMI 2021343 9999999 B 10 1477175446 0 PO BOX 3988 CARBONDALE IL 629023988 20 1477175446 0 Physician Assistant Only Fluoride varnish 20 1477175446 0 Physician Assistant Only Healthy Kids Services 20 1477175446 0 Physician Assistant Only Physician Services 00 1477175552 0 RUBLE MARGARET G 2020184 9999999 B 10 1477175552 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1477175552 0 Clinical Social Worker Social work service 00 1477175578 0 BARTELSMEYER CAROLINE 2022115 9999999 B 10 1477175578 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1477175578 0 Physician Assistant Only Fluoride varnish 20 1477175578 0 Physician Assistant Only Healthy Kids Services 20 1477175578 0 Physician Assistant Only Physician Services 00 1477175982 0 HANSON JILLIAN 2020188 9999999 B 10 1477175982 0 1003 MARTIN LUTHER KING DR BLOOMINGTON IL 617011429 20 1477175982 0 Physicians Anesthesia Services 20 1477175982 0 Physicians Fluoride varnish 20 1477175982 0 Physicians Healthy Kids Services 20 1477175982 0 Physicians Optical Supplies 20 1477175982 0 Physicians Physician Services 00 1477176113 0 STRAIN TYLER 2023213 9999999 B 10 1477176113 0 2100 POWELL ST STE 400 EMERYVILLE CA 946081826 20 1477176113 0 Physicians Anesthesia Services 20 1477176113 0 Physicians Healthy Kids Services 20 1477176113 0 Physicians Optical Supplies 20 1477176113 0 Physicians Physician Services 00 1477177376 0 TAYLOR EMILY M 2020212 9999999 B 10 1477177376 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1477177376 0 Speech Therapists Medical Supplies 20 1477177376 0 Speech Therapists Medical equipment/prosthetic devices 20 1477177376 0 Speech Therapists Speech Therapy/Pathology Services 00 1477177947 0 KON RYBECCA 2021116 9999999 B 10 1477177947 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1477177947 0 Physician Assistant Only Fluoride varnish 20 1477177947 0 Physician Assistant Only Healthy Kids Services 20 1477177947 0 Physician Assistant Only Physician Services 00 1477179927 0 BRENNEISEN REBECCA 2021250 9999999 B 10 1477179927 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1477179927 0 Nurse Practitioners Fluoride varnish 20 1477179927 0 Nurse Practitioners Healthy Kids Services 20 1477179927 0 Nurse Practitioners Nurse Practitioners Services 20 1477179927 0 Nurse Practitioners Physician Services 00 1477180115 0 MARQUARDT CHARLES 2020216 9999999 B 10 1477180115 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1477180115 0 Physicians Anesthesia Services 20 1477180115 0 Physicians Healthy Kids Services 20 1477180115 0 Physicians Optical Supplies 20 1477180115 0 Physicians Physician Services 00 1477180149 0 INDELLI MICHELLE A 2020119 9999999 B 10 1477180149 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1477180149 0 Nurse Practitioners Fluoride varnish 20 1477180149 0 Nurse Practitioners Healthy Kids Services 20 1477180149 0 Nurse Practitioners Nurse Practitioners Services 20 1477180149 0 Nurse Practitioners Physician Services 00 1477180198 0 SINGLETON VICTORIA 2021259 9999999 B 10 1477180198 0 250 W 96TH ST STE 520 INDIANAPOLIS IN 462601317 20 1477180198 0 Physician Assistant Only Fluoride varnish 20 1477180198 0 Physician Assistant Only Healthy Kids Services 20 1477180198 0 Physician Assistant Only Physician Services 00 1477180537 0 HALILI KIMVERLI ASHLY ADAMOS 2020087 9999999 B 10 1477180537 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1477180537 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477180651 0 PIERCE CHARLES 2020234 9999999 B 10 1477180651 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1477180651 0 Physicians Anesthesia Services 20 1477180651 0 Physicians Fluoride varnish 20 1477180651 0 Physicians Healthy Kids Services 20 1477180651 0 Physicians Optical Supplies 20 1477180651 0 Physicians Physician Services 00 1477180669 0 WANG JESSIE 2021184 9999999 B 10 1477180669 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1477180669 0 Physicians Anesthesia Services 20 1477180669 0 Physicians Healthy Kids Services 20 1477180669 0 Physicians Optical Supplies 20 1477180669 0 Physicians Physician Services 00 1477180743 0 SLEDZ ELISABETH M 2020217 9999999 B 10 1477180743 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1477180743 0 Optometrists Optical Supplies 20 1477180743 0 Optometrists Optometric Services 20 1477180743 0 Optometrists Physician Services 00 1477180792 0 PADMANABHAN MANOJ 2020234 9999999 B 10 1477180792 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1477180792 0 Physicians Anesthesia Services 20 1477180792 0 Physicians Healthy Kids Services 20 1477180792 0 Physicians Optical Supplies 20 1477180792 0 Physicians Physician Services 20 1477180792 0 Physicians Physicians Psychiatric Services 00 1477181071 0 VARGHESE KEVIN 2020210 9999999 B 10 1477181071 0 350 N WALL ST KANKAKEE IL 609012901 20 1477181071 0 Physicians Anesthesia Services 20 1477181071 0 Physicians Healthy Kids Services 20 1477181071 0 Physicians Optical Supplies 20 1477181071 0 Physicians Physician Services 20 1477181071 0 Physicians Physicians Psychiatric Services 00 1477181147 0 SAELENS PAIGE A 2022189 9999999 B 10 1477181147 0 2835 N SHEFFIELD AVE STE 303 CHICAGO IL 606575084 20 1477181147 0 Physician Assistant Only Fluoride varnish 20 1477181147 0 Physician Assistant Only Healthy Kids Services 20 1477181147 0 Physician Assistant Only Physician Services 00 1477181204 0 STIEGAL DIANA 2020166 9999999 B 10 1477181204 0 5777 DEPT CAROL STREAM IL 601228942 20 1477181204 0 Physicians Anesthesia Services 20 1477181204 0 Physicians Fluoride varnish 20 1477181204 0 Physicians Healthy Kids Services 20 1477181204 0 Physicians Optical Supplies 20 1477181204 0 Physicians Physician Services 00 1477181352 0 AL-DAIRI AMMER 2023236 9999999 B 10 1477181352 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1477181352 0 Physicians Anesthesia Services 20 1477181352 0 Physicians Fluoride varnish 20 1477181352 0 Physicians Healthy Kids Services 20 1477181352 0 Physicians Optical Supplies 20 1477181352 0 Physicians Physician Services 00 1477181477 0 LE DILLON 2024198 9999999 B 10 1477181477 0 PO BOX 801106 KANSAS CITY MO 641802203 20 1477181477 0 Physicians Anesthesia Services 20 1477181477 0 Physicians Fluoride varnish 20 1477181477 0 Physicians Healthy Kids Services 20 1477181477 0 Physicians Optical Supplies 20 1477181477 0 Physicians Physician Services 00 1477181485 0 HUH NOAH 2020232 9999999 B 10 1477181485 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1477181485 0 Physicians Anesthesia Services 20 1477181485 0 Physicians Healthy Kids Services 20 1477181485 0 Physicians Optical Supplies 20 1477181485 0 Physicians Physician Services 00 1477181501 0 REYES KIRSTEN G 2021351 9999999 B 10 1477181501 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1477181501 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477181980 0 HURTH CHARLES 2020234 9999999 B 10 1477181980 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1477181980 0 Physicians Anesthesia Services 20 1477181980 0 Physicians Fluoride varnish 20 1477181980 0 Physicians Healthy Kids Services 20 1477181980 0 Physicians Optical Supplies 20 1477181980 0 Physicians Physician Services 00 1477182095 0 SLESNICK LARA 2020233 9999999 B 10 1477182095 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1477182095 0 Physicians Anesthesia Services 20 1477182095 0 Physicians Healthy Kids Services 20 1477182095 0 Physicians Optical Supplies 20 1477182095 0 Physicians Physician Services 00 1477182459 0 STORCK EMILY 2023230 9999999 B 10 1477182459 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1477182459 0 Physicians Anesthesia Services 20 1477182459 0 Physicians Fluoride varnish 20 1477182459 0 Physicians Healthy Kids Services 20 1477182459 0 Physicians Optical Supplies 20 1477182459 0 Physicians Physician Services 00 1477182699 0 VALASAREDDY SANHITHA 2023195 9999999 B 10 1477182699 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1477182699 0 Physicians Anesthesia Services 20 1477182699 0 Physicians Fluoride varnish 20 1477182699 0 Physicians Healthy Kids Services 20 1477182699 0 Physicians Optical Supplies 20 1477182699 0 Physicians Physician Services 00 1477182897 0 SLACK ERICA 2024340 9999999 B 10 1477182897 0 29373 NETWORK PL CHICAGO IL 606733039 20 1477182897 0 Nurse Practitioners Fluoride varnish 20 1477182897 0 Nurse Practitioners Healthy Kids Services 20 1477182897 0 Nurse Practitioners Nurse Practitioners Services 20 1477182897 0 Nurse Practitioners Physician Services 00 1477184281 0 FERGUSON JULIA M 2020083 9999999 B 10 1477184281 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1477184281 0 Occupational Therapists Medical Supplies 20 1477184281 0 Occupational Therapists Medical equipment/prosthetic devices 20 1477184281 0 Occupational Therapists Occupational Therapy Services 00 1477186203 0 KIM JIN HEE 2020077 9999999 B 10 1477186203 0 120 W 22ND ST OAK BROOK IL 605231557 20 1477186203 0 Nurse Practitioners Fluoride varnish 20 1477186203 0 Nurse Practitioners Healthy Kids Services 20 1477186203 0 Nurse Practitioners Nurse Practitioners Services 20 1477186203 0 Nurse Practitioners Physician Services 00 1477186385 0 GOMEZ HIDAKA AMIKO 2022263 9999999 B 10 1477186385 0 1220 S WOOD ST CHICAGO IL 606081202 20 1477186385 0 Physician Assistant Only Fluoride varnish 20 1477186385 0 Physician Assistant Only Healthy Kids Services 20 1477186385 0 Physician Assistant Only Physician Services 00 1477187359 0 SULLIVAN SAMANTHA M 2022194 9999999 B 10 1477187359 0 1500 S DOUGLAS RD STE 230 CORAL GABLES FL 331344108 20 1477187359 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477187383 0 WAGNER ROY M 2020241 9999999 B 10 1477187383 0 2041 GOOSE LAKE RD SAUGET IL 622062822 20 1477187383 0 Physicians Anesthesia Services 20 1477187383 0 Physicians Fluoride varnish 20 1477187383 0 Physicians Healthy Kids Services 20 1477187383 0 Physicians Optical Supplies 20 1477187383 0 Physicians Physician Services 00 1477187946 0 FELTS JOSHUA M 2020056 9999999 B 10 1477187946 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1477187946 0 Nurse Practitioners Healthy Kids Services 20 1477187946 0 Nurse Practitioners Nurse Practitioners Services 20 1477187946 0 Nurse Practitioners Physician Services 00 1477189025 0 PLUMER CLAUDIA A 2020214 9999999 B 10 1477189025 0 1 ILLINI DR PEORIA IL 616052576 20 1477189025 0 Nurse Practitioners Fluoride varnish 20 1477189025 0 Nurse Practitioners Healthy Kids Services 20 1477189025 0 Nurse Practitioners Nurse Practitioners Services 20 1477189025 0 Nurse Practitioners Physician Services 00 1477190411 0 BONDE SIMONE 2020029 9999999 B 10 1477190411 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1477190411 0 Nurse Practitioners Family Planning Counseling 20 1477190411 0 Nurse Practitioners Healthy Kids Services 20 1477190411 0 Nurse Practitioners Midwife Services 20 1477190411 0 Nurse Practitioners Nurse Practitioners Services 20 1477190411 0 Nurse Practitioners Physician Services 00 1477191336 0 SULLIVAN LEAH 2021200 9999999 B 10 1477191336 0 PO BOX 1109 CROWN POINT IN 463081109 20 1477191336 0 Nurse Practitioners Fluoride varnish 20 1477191336 0 Nurse Practitioners Healthy Kids Services 20 1477191336 0 Nurse Practitioners Nurse Practitioners Services 20 1477191336 0 Nurse Practitioners Physician Services 00 1477192839 0 JONES EBONY O 2020265 9999999 B 10 1477192839 0 1039 BROOK FOREST AVE SHOREWOOD IL 604048849 20 1477192839 0 Nurse Practitioners Fluoride varnish 20 1477192839 0 Nurse Practitioners Healthy Kids Services 20 1477192839 0 Nurse Practitioners Nurse Practitioners Services 20 1477192839 0 Nurse Practitioners Physician Services 00 1477192938 0 OBERT CONNOR 2020045 9999999 B 10 1477192938 0 850 43RD AVE STE 100 MOLINE IL 612658401 20 1477192938 0 Physical Therapists Medical Supplies 20 1477192938 0 Physical Therapists Medical equipment/prosthetic devices 20 1477192938 0 Physical Therapists Physical Therapy Services 00 1477193258 0 FOWLER ERIN 2020023 9999999 H 10 1477193258 0 145 S VIRGINIA ST CRYSTAL LAKE IL 600147226 20 1477193258 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477194447 0 SZTUKOWSKI RUSSELL 2019361 9999999 B 10 1477194447 0 621 S NEW BALLAS RD STE 560A SUITE 560A SAINT LOUIS MO 631418261 20 1477194447 0 Physician Assistant Only Fluoride varnish 20 1477194447 0 Physician Assistant Only Healthy Kids Services 20 1477194447 0 Physician Assistant Only Physician Services 00 1477196533 0 COREY SAMANTHA M 2019315 9999999 B 10 1477196533 0 7600 W COLLEGE DR PALOS HEIGHTS IL 604631001 20 1477196533 0 Physician Assistant Only Fluoride varnish 20 1477196533 0 Physician Assistant Only Healthy Kids Services 20 1477196533 0 Physician Assistant Only Physician Services 00 1477196723 0 SAUNDERS DANELLE 2020010 9999999 B 10 1477196723 0 101 E MILLER RD STERLING IL 610811252 20 1477196723 0 Nurse Practitioners Healthy Kids Services 20 1477196723 0 Nurse Practitioners Nurse Practitioners Services 20 1477196723 0 Nurse Practitioners Physician Services 00 1477196962 0 EVERHART MEREDITH K 2019318 9999999 B 10 1477196962 0 5777 DEPT CAROL STREAM IL 601220021 20 1477196962 0 Clinical Social Worker Social work service 00 1477198026 0 MALLOY JULIA M 2022070 9999999 B 10 1477198026 0 5777 DEPT CAROL STREAM IL 601220021 20 1477198026 0 Nurse Practitioners Healthy Kids Services 20 1477198026 0 Nurse Practitioners Nurse Practitioners Services 20 1477198026 0 Nurse Practitioners Physician Services 00 1477198596 0 SCHMITT DARCEE B 2019329 9999999 B 10 1477198596 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1477198596 0 Nurse Practitioners Healthy Kids Services 20 1477198596 0 Nurse Practitioners Nurse Practitioners Services 20 1477198596 0 Nurse Practitioners Physician Services 00 1477199271 0 ESLINGER JAYNE 2021201 9999999 B 10 1477199271 0 29373 NETWORK PL CHICAGO IL 606733039 20 1477199271 0 Physician Assistant Only Fluoride varnish 20 1477199271 0 Physician Assistant Only Healthy Kids Services 20 1477199271 0 Physician Assistant Only Physician Services 00 1477199560 0 BELLAGAMBA JANELLE 2023278 9999999 B 10 1477199560 0 PO BOX 500 ELLICOTTVILLE NY 147310500 20 1477199560 0 Nurse Practitioners Fluoride varnish 20 1477199560 0 Nurse Practitioners Healthy Kids Services 20 1477199560 0 Nurse Practitioners Nurse Practitioners Services 20 1477199560 0 Nurse Practitioners Physician Services 00 1477200152 0 RYOU CHRISTINA S 2022266 9999999 B 10 1477200152 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1477200152 0 Physician Assistant Only Fluoride varnish 20 1477200152 0 Physician Assistant Only Healthy Kids Services 20 1477200152 0 Physician Assistant Only Physician Services 00 1477201770 0 HORTON STEPHANIE L 2022095 9999999 B 10 1477201770 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1477201770 0 Nurse Practitioners Healthy Kids Services 20 1477201770 0 Nurse Practitioners Nurse Practitioners Services 20 1477201770 0 Nurse Practitioners Physician Services 00 1477202083 0 BLACKSHARE ANNA C 2022195 9999999 B 10 1477202083 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1477202083 0 Physicians Anesthesia Services 20 1477202083 0 Physicians Healthy Kids Services 20 1477202083 0 Physicians Optical Supplies 20 1477202083 0 Physicians Physician Services 00 1477202307 0 PANWAR SAPNA 2022171 9999999 B 10 1477202307 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112323 20 1477202307 0 Dentists Dental Services 20 1477202307 0 Dentists Physician Services 00 1477202620 0 SIRAW BEKURE B 2022259 2025365 B 10 1477202620 0 221 NE GLEN OAK AVE PEORIA IL 616360002 20 1477202620 0 Physicians Anesthesia Services 20 1477202620 0 Physicians Fluoride varnish 20 1477202620 0 Physicians Healthy Kids Services 20 1477202620 0 Physicians Optical Supplies 20 1477202620 0 Physicians Physician Services 00 1477202695 0 MUNSON KATHERINE 2023249 9999999 B 10 1477202695 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1477202695 0 Physicians Anesthesia Services 20 1477202695 0 Physicians Healthy Kids Services 20 1477202695 0 Physicians Optical Supplies 20 1477202695 0 Physicians Physician Services 00 1477202802 0 LAI LINHCHI 2022207 9999999 B 10 1477202802 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1477202802 0 Physicians Anesthesia Services 20 1477202802 0 Physicians Fluoride varnish 20 1477202802 0 Physicians Healthy Kids Services 20 1477202802 0 Physicians Optical Supplies 20 1477202802 0 Physicians Physician Services 00 1477202869 0 IBIZUGBE UWAGBAE M 2023208 9999999 B 10 1477202869 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1477202869 0 Physicians Anesthesia Services 20 1477202869 0 Physicians Healthy Kids Services 20 1477202869 0 Physicians Optical Supplies 20 1477202869 0 Physicians Physician Services 00 1477202943 0 COZZI PHILLIP 2022215 9999999 B 10 1477202943 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1477202943 0 Physicians Anesthesia Services 20 1477202943 0 Physicians Fluoride varnish 20 1477202943 0 Physicians Healthy Kids Services 20 1477202943 0 Physicians Optical Supplies 20 1477202943 0 Physicians Physician Services 00 1477203057 0 MICHEL AMAURY I 2022174 9999999 B 10 1477203057 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1477203057 0 Physicians Anesthesia Services 20 1477203057 0 Physicians Fluoride varnish 20 1477203057 0 Physicians Healthy Kids Services 20 1477203057 0 Physicians Optical Supplies 20 1477203057 0 Physicians Physician Services 00 1477203974 0 YANAMADALA VIVEK 2022235 9999999 B 10 1477203974 0 3023 N CLARK ST STE 593 CHICAGO IL 606575200 20 1477203974 0 Physicians Anesthesia Services 20 1477203974 0 Physicians Healthy Kids Services 20 1477203974 0 Physicians Optical Supplies 20 1477203974 0 Physicians Physician Services 20 1477203974 0 Physicians Physicians Psychiatric Services 00 1477204352 0 BISHOP DAWN 2022061 9999999 B 10 1477204352 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1477204352 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477206308 0 GRAY JENNIFER K 2022294 9999999 B 10 1477206308 0 3023 N CLARK ST STE 593 CHICAGO IL 606575200 20 1477206308 0 Nurse Practitioners Healthy Kids Services 20 1477206308 0 Nurse Practitioners Nurse Practitioners Services 20 1477206308 0 Nurse Practitioners Physician Services 00 1477212744 0 WILKINSON REBECCA 2024149 9999999 B 10 1477212744 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1477212744 0 Clinical Social Worker Social work service 00 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Services 20 1477244457 0 Physicians Fluoride varnish 20 1477244457 0 Physicians Healthy Kids Services 20 1477244457 0 Physicians Optical Supplies 20 1477244457 0 Physicians Physician Services 20 1477244457 0 Physicians Physicians Psychiatric Services 00 1477245074 0 ALRASHID OMAR A 2023167 9999999 B 10 1477245074 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1477245074 0 Physicians Anesthesia Services 20 1477245074 0 Physicians Healthy Kids Services 20 1477245074 0 Physicians Optical Supplies 20 1477245074 0 Physicians Physician Services 00 1477245272 0 SHAH AASHAKA C 2023207 9999999 B 10 1477245272 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1477245272 0 Physicians Anesthesia Services 20 1477245272 0 Physicians Healthy Kids Services 20 1477245272 0 Physicians Optical Supplies 20 1477245272 0 Physicians Physician Services 00 1477246148 0 VANGEMERT SCOTT 2023195 9999999 B 10 1477246148 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1477246148 0 Physicians Anesthesia Services 20 1477246148 0 Physicians Fluoride varnish 20 1477246148 0 Physicians Healthy Kids Services 20 1477246148 0 Physicians Optical Supplies 20 1477246148 0 Physicians Physician Services 00 1477246395 0 LESSARD SAVANNAH 2025049 9999999 B 10 1477246395 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1477246395 0 Speech Therapists Medical Supplies 20 1477246395 0 Speech Therapists Medical equipment/prosthetic devices 20 1477246395 0 Speech Therapists Speech Therapy/Pathology Services 00 1477247336 0 ABDULBASEER UMMESALMAH 2023186 9999999 B 10 1477247336 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1477247336 0 Physicians Anesthesia Services 20 1477247336 0 Physicians Fluoride varnish 20 1477247336 0 Physicians Healthy Kids Services 20 1477247336 0 Physicians Optical Supplies 20 1477247336 0 Physicians Physician Services 00 1477248623 0 PRATAPA NAGA 2023179 9999999 B 10 1477248623 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1477248623 0 Physicians Anesthesia Services 20 1477248623 0 Physicians Fluoride varnish 20 1477248623 0 Physicians Healthy Kids Services 20 1477248623 0 Physicians Optical Supplies 20 1477248623 0 Physicians Physician Services 00 1477248862 0 PARK JUNO 2023194 9999999 B 10 1477248862 0 7732 SOLUTION CENTER CHICAGO IL 606777007 20 1477248862 0 Dentists Dental Services 20 1477248862 0 Dentists Physician Services 00 1477248961 0 CAREY ASIA M 2023102 9999999 B 10 1477248961 0 16200 COLLECTION CENTER DR CHICAGO IL 606930125 20 1477248961 0 Occupational Therapists Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477251007 0 ROWLAND ANDREW 2023082 9999999 B 10 1477251007 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1477251007 0 Nurse Practitioners Fluoride varnish 20 1477251007 0 Nurse Practitioners Healthy Kids Services 20 1477251007 0 Nurse Practitioners Nurse Practitioners Services 20 1477251007 0 Nurse Practitioners Physician Services 00 1477251882 0 TSIAO RYAN 2023156 9999999 B 10 1477251882 0 29373 NETWORK PL CHICAGO IL 606733039 20 1477251882 0 Physician Assistant Only Fluoride varnish 20 1477251882 0 Physician Assistant Only Healthy Kids Services 20 1477251882 0 Physician Assistant Only Physician Services 00 1477252948 0 ALBERS KALEIGH M 2023055 9999999 B 10 1477252948 0 2020 W ILES AVE SPRINGFIELD IL 627047015 20 1477252948 0 Optometrists Optical Supplies 20 1477252948 0 Optometrists Optometric Services 20 1477252948 0 Optometrists Physician Services 00 1477253540 0 BAMIDELE ADEGBOYEGA 2024017 9999999 B 10 1477253540 0 188 W INDUSTRIAL DR STE 110 ELMHURST IL 601261608 20 1477253540 0 Physical Therapists Medical Supplies 20 1477253540 0 Physical Therapists Medical equipment/prosthetic devices 20 1477253540 0 Physical Therapists Physical Therapy Services 00 1477254712 0 PATEL RAJAVI 2024176 9999999 B 10 1477254712 0 4698 DEPT CAROL STREAM IL 601224698 20 1477254712 0 Physicians Anesthesia Services 20 1477254712 0 Physicians Fluoride varnish 20 1477254712 0 Physicians Healthy Kids Services 20 1477254712 0 Physicians Optical Supplies 20 1477254712 0 Physicians Physician Services 00 1477255065 0 VEST LUKE 2023201 9999999 B 10 1477255065 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1477255065 0 Physicians Anesthesia Services 20 1477255065 0 Physicians Fluoride varnish 20 1477255065 0 Physicians Healthy Kids Services 20 1477255065 0 Physicians Optical Supplies 20 1477255065 0 Physicians Physician Services 00 1477255164 0 YATZKAN GRANT D 2024174 9999999 B 10 1477255164 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1477255164 0 Physicians Anesthesia Services 20 1477255164 0 Physicians Healthy Kids Services 20 1477255164 0 Physicians Optical Supplies 20 1477255164 0 Physicians Physician Services 00 1477255412 0 BOSTANCHE BRIENNA MARIE 2023191 9999999 B 10 1477255412 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1477255412 0 Podiatrists Podiatric Services 00 1477255800 0 GOYAL RAASHIKA 2024190 9999999 B 10 1477255800 0 1700 W VAN 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1477257574 0 Physicians Optical Supplies 20 1477257574 0 Physicians Physician Services 00 1477257582 0 BIESER STEVEN 2023172 9999999 B 10 1477257582 0 4698 DEPT CAROL STREAM IL 601220021 20 1477257582 0 Physicians Anesthesia Services 20 1477257582 0 Physicians Fluoride varnish 20 1477257582 0 Physicians Healthy Kids Services 20 1477257582 0 Physicians Optical Supplies 20 1477257582 0 Physicians Physician Services 00 1477258861 0 MCMILLER ZACHARY J 2023175 9999999 B 10 1477258861 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1477258861 0 Physicians Anesthesia Services 20 1477258861 0 Physicians Fluoride varnish 20 1477258861 0 Physicians Healthy Kids Services 20 1477258861 0 Physicians Optical Supplies 20 1477258861 0 Physicians Physician Services 00 1477259448 0 BORGMAN ASHLEY 2023198 9999999 B 10 1477259448 0 PO BOX 8209 VIENNA VA 221832058 20 1477259448 0 Nurse Practitioners Healthy Kids Services 20 1477259448 0 Nurse Practitioners Midwife Services 20 1477259448 0 Nurse Practitioners 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TAHJI 2024213 9999999 B 10 1477272904 0 PO BOX 235019 MONTGOMERY AL 361235019 20 1477272904 0 Nurse Practitioners Anesthesia Services 20 1477272904 0 Nurse Practitioners Nurse Practitioners Services 20 1477272904 0 Nurse Practitioners Physician Services 00 1477273449 0 RODRIGUEZ MARIA 2023244 9999999 B 10 1477273449 0 10883 CONCORD LN HUNTLEY IL 601424041 20 1477273449 0 Optometrists Optical Supplies 20 1477273449 0 Optometrists Optometric Services 20 1477273449 0 Optometrists Physician Services 00 1477274355 0 DALTON KATIE B 2022319 9999999 B 10 1477274355 0 5777 DEPT CAROL STREAM IL 601220021 20 1477274355 0 Nurse Practitioners Anesthesia Services 20 1477274355 0 Nurse Practitioners Nurse Practitioners Services 20 1477274355 0 Nurse Practitioners Physician Services 00 1477274538 0 SINGH AMRIT 2022258 9999999 B 10 1477274538 0 228 E LAKE ST ADDISON IL 601012889 20 1477274538 0 Other behavior health professional Social work service 00 1477274827 0 KRUSE MEGAN 2023352 9999999 B 10 1477274827 0 1601 OLD SOUTH RIVER RD SAINT CHARLES MO 633034120 20 1477274827 0 Nurse Practitioners Fluoride varnish 20 1477274827 0 Nurse Practitioners Healthy Kids Services 20 1477274827 0 Nurse Practitioners Nurse Practitioners Services 20 1477274827 0 Nurse Practitioners Physician Services 00 1477275634 0 FORD COURTNEY 2025020 9999999 B 10 1477275634 0 211 E LAKE ST STE 1B ADDISON IL 601012877 20 1477275634 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477276400 0 ALEXANDER CALEB S 2024177 9999999 B 10 1477276400 0 PO BOX 3039 OAK BROOK IL 605223039 20 1477276400 0 Physicians Anesthesia Services 20 1477276400 0 Physicians Fluoride varnish 20 1477276400 0 Physicians Healthy Kids Services 20 1477276400 0 Physicians Optical Supplies 20 1477276400 0 Physicians Physician Services 00 1477276913 0 BRADBURY LOGAN L 2022332 9999999 B 10 1477276913 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1477276913 0 Nurse Practitioners Healthy Kids Services 20 1477276913 0 Nurse Practitioners Nurse Practitioners Services 20 1477276913 0 Nurse Practitioners Physician Services 00 1477277622 0 VELAZQUEZ DE ANDA KARINA 2024240 9999999 B 10 1477277622 0 1951 NW 7TH AVE STE 300 MIAMI FL 331361112 20 1477277622 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477279701 0 WALSH TRACY L 2022300 9999999 B 10 1477279701 0 5777 DEPT CAROL STREAM IL 601220021 20 1477279701 0 Clinical Social Worker Social work service 00 1477282564 0 MACHAIN JOCELYN 2024150 9999999 B 10 1477282564 0 1951 NW 7TH AVE STE 300 MIAMI FL 331361112 20 1477282564 0 Clinical Social Worker Social work service 00 1477283240 0 WILDER BART A 2022209 9999999 B 10 1477283240 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1477283240 0 Physicians Anesthesia Services 20 1477283240 0 Physicians Fluoride varnish 20 1477283240 0 Physicians Healthy Kids Services 20 1477283240 0 Physicians Optical Supplies 20 1477283240 0 Physicians Physician Services 00 1477283505 0 PATEL ANISHI S 2022171 9999999 B 10 1477283505 0 1 CHICAGO AVE OAK PARK IL 603022432 20 1477283505 0 Dentists Dental Services 20 1477283505 0 Dentists Physician Services 00 1477283604 0 CASPER CARRIE 2024009 9999999 B 10 1477283604 0 28100 TORCH PKWY STE 600 WARRENVILLE IL 605554030 20 1477283604 0 Speech Therapists Medical Supplies 20 1477283604 0 Speech Therapists Medical equipment/prosthetic devices 20 1477283604 0 Speech Therapists Speech Therapy/Pathology Services 00 1477283760 0 BURRIS JAMES J 2022164 9999999 B 10 1477283760 0 PO BOX 155 CHRISTOPHER IL 628220155 20 1477283760 0 Dentists Dental Services 20 1477283760 0 Dentists Physician Services 00 1477283968 0 VASIL HANNAH 2024044 9999999 B 10 1477283968 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1477283968 0 Physical Therapists Medical Supplies 20 1477283968 0 Physical Therapists Medical equipment/prosthetic devices 20 1477283968 0 Physical Therapists Physical Therapy Services 00 1477284446 0 RIFAI ZEYAD 2022186 9999999 B 10 1477284446 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1477284446 0 Physicians Anesthesia Services 20 1477284446 0 Physicians Fluoride varnish 20 1477284446 0 Physicians Healthy Kids Services 20 1477284446 0 Physicians Optical Supplies 20 1477284446 0 Physicians Physician Services 00 1477284917 0 UKLEIKINS STANISLAVS 2022211 9999999 B 10 1477284917 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1477284917 0 Physicians Anesthesia Services 20 1477284917 0 Physicians Healthy Kids Services 20 1477284917 0 Physicians Optical Supplies 20 1477284917 0 Physicians Physician Services 00 1477284925 0 RUTHER HENRY D 2022231 9999999 B 10 1477284925 0 3012 W FULLERTON AVE CHICAGO IL 606472940 20 1477284925 0 Dentists Dental Services 20 1477284925 0 Dentists Physician Services 00 1477285179 0 MAKWANA NEIL 2024183 9999999 B 10 1477285179 0 26W171 ROOSEVELT RD WHEATON IL 601876002 20 1477285179 0 Physicians Anesthesia Services 20 1477285179 0 Physicians Healthy Kids Services 20 1477285179 0 Physicians Optical Supplies 20 1477285179 0 Physicians Physician Services 00 1477285658 0 BACZYNSKI ALEXANDRA E 2023152 9999999 B 10 1477285658 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1477285658 0 Physicians Anesthesia Services 20 1477285658 0 Physicians Fluoride varnish 20 1477285658 0 Physicians Healthy Kids Services 20 1477285658 0 Physicians Optical Supplies 20 1477285658 0 Physicians Physician Services 00 1477286607 0 VANDERKOLK SARA 2024025 9999999 B 10 1477286607 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1477286607 0 Physician Assistant Only Fluoride varnish 20 1477286607 0 Physician Assistant Only Healthy Kids Services 20 1477286607 0 Physician Assistant Only Physician Services 00 1477286615 0 MADDOX AMANDA 2022263 9999999 B 10 1477286615 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1477286615 0 Nurse Practitioners Fluoride varnish 20 1477286615 0 Nurse Practitioners Healthy Kids Services 20 1477286615 0 Nurse Practitioners Nurse Practitioners Services 20 1477286615 0 Nurse Practitioners Physician Services 00 1477286714 0 SOMAGUTTA MANOJ KUMAR REDDY 2022189 9999999 B 10 1477286714 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1477286714 0 Physicians Anesthesia Services 20 1477286714 0 Physicians Fluoride varnish 20 1477286714 0 Physicians Healthy Kids Services 20 1477286714 0 Physicians Optical Supplies 20 1477286714 0 Physicians Physician Services 00 1477287183 0 SAVAGE LARISA M 2022220 9999999 B 10 1477287183 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1477287183 0 Nurse Practitioners Healthy Kids Services 20 1477287183 0 Nurse Practitioners Midwife Services 20 1477287183 0 Nurse Practitioners Nurse Practitioners Services 20 1477287183 0 Nurse Practitioners Physician Services 00 1477287431 0 BELFORD LAUREN M 2022297 9999999 B 10 1477287431 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1477287431 0 Nurse Practitioners Fluoride varnish 20 1477287431 0 Nurse Practitioners Healthy Kids Services 20 1477287431 0 Nurse Practitioners Nurse Practitioners Services 20 1477287431 0 Nurse Practitioners Physician Services 00 1477288090 0 DUDENHOEFFER MICHAELLA L 2022213 9999999 B 10 1477288090 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1477288090 0 Nurse Practitioners Healthy Kids Services 20 1477288090 0 Nurse Practitioners Nurse Practitioners Services 20 1477288090 0 Nurse Practitioners Physician Services 00 1477288694 0 MARTINEZ LINDA 2023123 9999999 B 10 1477288694 0 1528 UNION RD GASTONIA NC 280542200 20 1477288694 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477290799 0 LYONS CORI 2022200 9999999 B 10 1477290799 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1477290799 0 Nurse Practitioners Healthy Kids Services 20 1477290799 0 Nurse Practitioners Nurse Practitioners Services 20 1477290799 0 Nurse Practitioners Physician Services 00 1477290849 0 FRANKO SYDNEY 2022235 9999999 B 10 1477290849 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1477290849 0 Physician Assistant Only Fluoride varnish 20 1477290849 0 Physician Assistant Only Healthy Kids Services 20 1477290849 0 Physician Assistant Only Physician Services 00 1477291177 0 MARTINEZ TREVINO ENRIQUE F 2022282 9999999 B 10 1477291177 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1477291177 0 Physicians Anesthesia Services 20 1477291177 0 Physicians Fluoride varnish 20 1477291177 0 Physicians Healthy Kids Services 20 1477291177 0 Physicians Optical Supplies 20 1477291177 0 Physicians Physician Services 00 1477291334 0 CHANG ANDREW 2022214 9999999 B 10 1477291334 0 611 W PARK ST URBANA IL 618012529 20 1477291334 0 Physicians Anesthesia Services 20 1477291334 0 Physicians Fluoride varnish 20 1477291334 0 Physicians Healthy Kids Services 20 1477291334 0 Physicians Optical Supplies 20 1477291334 0 Physicians Physician Services 00 1477292084 0 EVERSGERD MARY K 2022202 9999999 B 10 1477292084 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1477292084 0 Nurse Practitioners Fluoride varnish 20 1477292084 0 Nurse Practitioners Healthy Kids Services 20 1477292084 0 Nurse Practitioners Nurse Practitioners Services 20 1477292084 0 Nurse Practitioners Physician Services 00 1477292456 0 DELGADO CHRISTIAN 2023250 9999999 B 10 1477292456 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1477292456 0 Physicians Anesthesia Services 20 1477292456 0 Physicians Healthy Kids Services 20 1477292456 0 Physicians Optical Supplies 20 1477292456 0 Physicians Physician Services 00 1477292654 0 HOLADAY MATTHEW 2023220 9999999 B 10 1477292654 0 611 W PARK ST URBANA IL 618012529 20 1477292654 0 Physicians Anesthesia Services 20 1477292654 0 Physicians Healthy Kids Services 20 1477292654 0 Physicians Optical Supplies 20 1477292654 0 Physicians Physician Services 20 1477292654 0 Physicians Physicians Psychiatric Services 00 1477292738 0 RACOVITA ALEXEI 2022203 9999999 B 10 1477292738 0 PO BOX 855671 MINNEAPOLIS MN 554851153 20 1477292738 0 Physicians Anesthesia Services 20 1477292738 0 Physicians Fluoride varnish 20 1477292738 0 Physicians Healthy Kids Services 20 1477292738 0 Physicians Optical Supplies 20 1477292738 0 Physicians Physician Services 00 1477292779 0 EDWARDS MALLORY L 2025041 9999999 B 10 1477292779 0 793 SUNSET BLVD BELLEVILLE IL 622691960 20 1477292779 0 Nurse Practitioners Fluoride varnish 20 1477292779 0 Nurse Practitioners Healthy Kids Services 20 1477292779 0 Nurse Practitioners Nurse Practitioners Services 20 1477292779 0 Nurse Practitioners Physician Services 00 1477293967 0 HARKINS MELISSA 2022131 9999999 B 10 1477293967 0 5501 DELMAR BLVD STE B560 SAINT LOUIS MO 631123084 20 1477293967 0 Nurse Practitioners Fluoride varnish 20 1477293967 0 Nurse Practitioners Healthy Kids Services 20 1477293967 0 Nurse Practitioners Nurse Practitioners Services 20 1477293967 0 Nurse Practitioners Physician Services 00 1477294106 0 SABATINO KRISTIN 2022125 9999999 B 10 1477294106 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1477294106 0 Clinical Social Worker Social work service 00 1477294122 0 TODD MATTHEW W 2022184 9999999 B 10 1477294122 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1477294122 0 Physicians Anesthesia Services 20 1477294122 0 Physicians Healthy Kids Services 20 1477294122 0 Physicians Optical Supplies 20 1477294122 0 Physicians Physician Services 00 1477294130 0 JUNOD COLTON 2024270 9999999 B 10 1477294130 0 PO BOX 1085 EVANSVILLE IN 477061085 20 1477294130 0 Physicians Anesthesia Services 20 1477294130 0 Physicians Healthy Kids Services 20 1477294130 0 Physicians Optical Supplies 20 1477294130 0 Physicians Physician Services 00 1477294353 0 DE BRUYN ELISE A 2024325 9999999 B 10 1477294353 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1477294353 0 Physicians Anesthesia Services 20 1477294353 0 Physicians Healthy Kids Services 20 1477294353 0 Physicians Optical Supplies 20 1477294353 0 Physicians Physician Services 00 1477294619 0 SYED NEHA 2022151 9999999 B 10 1477294619 0 PO BOX 3039 OAK BROOK IL 605223039 20 1477294619 0 Physicians Anesthesia Services 20 1477294619 0 Physicians Fluoride varnish 20 1477294619 0 Physicians Healthy Kids Services 20 1477294619 0 Physicians Optical Supplies 20 1477294619 0 Physicians Physician Services 00 1477294809 0 KACHAPPILLY ANNMARY 2022117 9999999 B 10 1477294809 0 303 E ARMY TRAIL RD STE 111 BLOOMINGDALE IL 601082140 20 1477294809 0 Nurse Practitioners Fluoride varnish 20 1477294809 0 Nurse Practitioners Healthy Kids Services 20 1477294809 0 Nurse Practitioners Nurse Practitioners Services 20 1477294809 0 Nurse Practitioners Physician Services 00 1477295111 0 ECKBURG ALEXANDRA R 2023234 9999999 B 10 1477295111 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1477295111 0 Physicians Anesthesia Services 20 1477295111 0 Physicians Healthy Kids Services 20 1477295111 0 Physicians Optical Supplies 20 1477295111 0 Physicians Physician Services 00 1477296408 0 FAEHLING SHANNON D 2024346 9999999 B 10 1477296408 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1477296408 0 Physicians Anesthesia Services 20 1477296408 0 Physicians Healthy Kids Services 20 1477296408 0 Physicians Optical Supplies 20 1477296408 0 Physicians Physician Services 00 1477296556 0 MATTER PAUL 2022196 9999999 B 10 1477296556 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1477296556 0 Nurse Practitioners Anesthesia Services 20 1477296556 0 Nurse Practitioners Nurse Practitioners Services 20 1477296556 0 Nurse Practitioners Physician Services 00 1477297315 0 WOODLEY ELIZABETH 2022208 9999999 B 10 1477297315 0 1952 EVERGREEN AVE CHICAGO IL 606221932 20 1477297315 0 Physician Assistant Only Electronic Home Response/EHR Installation, MPE Certification 20 1477297315 0 Physician Assistant Only Healthy Kids Services 20 1477297315 0 Physician Assistant Only Physician Services 00 1477299972 0 HARPER FAITH 2022277 9999999 B 10 1477299972 0 28100 TORCH PKWY STE 600 WARRENVILLE IL 605554030 20 1477299972 0 Occupational Therapists Medical Supplies 20 1477299972 0 Occupational Therapists Medical equipment/prosthetic devices 20 1477299972 0 Occupational Therapists Occupational Therapy Services 00 1477299980 0 BHAVSAR KRUPA D 2022187 9999999 B 10 1477299980 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1477299980 0 Physicians Anesthesia Services 20 1477299980 0 Physicians Fluoride varnish 20 1477299980 0 Physicians Healthy Kids Services 20 1477299980 0 Physicians Optical Supplies 20 1477299980 0 Physicians Physician Services 00 1477301083 0 GABEL MELVIN 2024164 9999999 B 10 1477301083 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1477301083 0 Nurse Practitioners Anesthesia Services 20 1477301083 0 Nurse Practitioners Nurse Practitioners Services 20 1477301083 0 Nurse Practitioners Physician Services 00 1477303410 0 KOTHANDARAMAN VENKATRAMAN 2024191 9999999 B 10 1477303410 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1477303410 0 Physicians Anesthesia Services 20 1477303410 0 Physicians Fluoride varnish 20 1477303410 0 Physicians Healthy Kids Services 20 1477303410 0 Physicians Optical Supplies 20 1477303410 0 Physicians Physician Services 00 1477303972 0 AVERY KRISTA S 2024137 9999999 B 10 1477303972 0 2003 W FULTON ST STE 303 CHICAGO IL 606122345 20 1477303972 0 Physician Assistant Only Fluoride varnish 20 1477303972 0 Physician Assistant Only Healthy Kids Services 20 1477303972 0 Physician Assistant Only Physician Services 00 1477304517 0 HOOPER ALANNA 2024183 9999999 B 10 1477304517 0 PO BOX 3039 OAK BROOK IL 605223039 20 1477304517 0 Physicians Anesthesia Services 20 1477304517 0 Physicians Fluoride varnish 20 1477304517 0 Physicians Healthy Kids Services 20 1477304517 0 Physicians Optical Supplies 20 1477304517 0 Physicians Physician Services 00 1477304996 0 AGWUNCHA CHINELO 2024179 9999999 B 10 1477304996 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1477304996 0 Physicians Anesthesia Services 20 1477304996 0 Physicians Healthy Kids Services 20 1477304996 0 Physicians Optical Supplies 20 1477304996 0 Physicians Physician Services 00 1477306108 0 KADAH ALEXANDER 2024187 9999999 B 10 1477306108 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1477306108 0 Physicians Anesthesia Services 20 1477306108 0 Physicians Fluoride varnish 20 1477306108 0 Physicians Healthy Kids Services 20 1477306108 0 Physicians Optical Supplies 20 1477306108 0 Physicians Physician Services 00 1477306157 0 WASSERMAN-BRUCK TOVA 2024241 9999999 B 10 1477306157 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1477306157 0 Physicians Anesthesia Services 20 1477306157 0 Physicians Fluoride varnish 20 1477306157 0 Physicians Healthy Kids Services 20 1477306157 0 Physicians Optical Supplies 20 1477306157 0 Physicians Physician Services 00 1477306751 0 FRIEDMAN JANE F 2024241 9999999 B 10 1477306751 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1477306751 0 Physicians Anesthesia Services 20 1477306751 0 Physicians Healthy Kids Services 20 1477306751 0 Physicians Optical Supplies 20 1477306751 0 Physicians Physician Services 00 1477309755 0 CULLINGS MORGAN 2024121 9999999 B 10 1477309755 0 PO BOX 734352 CHICAGO IL 606734352 20 1477309755 0 Nurse Practitioners Healthy Kids Services 20 1477309755 0 Nurse Practitioners Nurse Practitioners Services 20 1477309755 0 Nurse Practitioners Physician Services 00 1477310001 0 HECKLE MATT 2024089 9999999 B 10 1477310001 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1477310001 0 Nurse Practitioners Healthy Kids Services 20 1477310001 0 Nurse Practitioners Nurse Practitioners Services 20 1477310001 0 Nurse Practitioners Physician Services 00 1477311561 0 KEYS TAYLOR L 2024169 9999999 B 10 1477311561 0 1701 LACEY ST CAPE GIRARDEAU MO 637015230 20 1477311561 0 Nurse Practitioners Fluoride varnish 20 1477311561 0 Nurse Practitioners Healthy Kids Services 20 1477311561 0 Nurse Practitioners Nurse Practitioners Services 20 1477311561 0 Nurse Practitioners Physician Services 00 1477311645 0 WALTERS ARIELLE ROSE 2024072 9999999 B 10 1477311645 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1477311645 0 Physician Assistant Only Fluoride varnish 20 1477311645 0 Physician Assistant Only Healthy Kids Services 20 1477311645 0 Physician Assistant Only Physician Services 00 1477312718 0 HUSTEDDE MARISSA 2024197 9999999 B 10 1477312718 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1477312718 0 Physicians Anesthesia Services 20 1477312718 0 Physicians Fluoride varnish 20 1477312718 0 Physicians Healthy Kids Services 20 1477312718 0 Physicians Optical Supplies 20 1477312718 0 Physicians Physician Services 00 1477312833 0 ASAD MUHAMMAD 2024197 9999999 B 10 1477312833 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1477312833 0 Physicians Anesthesia Services 20 1477312833 0 Physicians Fluoride varnish 20 1477312833 0 Physicians Healthy Kids Services 20 1477312833 0 Physicians Optical Supplies 20 1477312833 0 Physicians Physician Services 00 1477313112 0 SAAK CECE 2024095 9999999 B 10 1477313112 0 975 W HAWTHORN DR ITASCA IL 601432056 20 1477313112 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477314318 0 KAPST JULIE A 2024050 9999999 B 10 1477314318 0 5777 DEPT CAROL STREAM IL 601220021 20 1477314318 0 Nurse Practitioners Fluoride varnish 20 1477314318 0 Nurse Practitioners Healthy Kids Services 20 1477314318 0 Nurse Practitioners Nurse Practitioners Services 20 1477314318 0 Nurse Practitioners Physician Services 00 1477315273 0 UPTON WILLIAM J 2024101 9999999 B 10 1477315273 0 5777 DEPT CAROL STREAM IL 601220021 20 1477315273 0 Nurse Practitioners Fluoride varnish 20 1477315273 0 Nurse Practitioners Healthy Kids Services 20 1477315273 0 Nurse Practitioners Nurse Practitioners Services 20 1477315273 0 Nurse Practitioners Physician Services 00 1477315687 0 ATADE-NANGUIT PAMELA 2024176 9999999 B 10 1477315687 0 29373 NETWORK PL CHICAGO IL 606733039 20 1477315687 0 Physician Assistant Only Fluoride varnish 20 1477315687 0 Physician Assistant Only Healthy Kids Services 20 1477315687 0 Physician Assistant Only Physician Services 00 1477316255 0 AGORIS MARIA 2024155 9999999 B 10 1477316255 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1477316255 0 Physician Assistant Only Fluoride varnish 20 1477316255 0 Physician Assistant Only Healthy Kids Services 20 1477316255 0 Physician Assistant Only Physician Services 00 1477317121 0 PRGAM MERNA 2024171 9999999 B 10 1477317121 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1477317121 0 Nurse Practitioners Healthy Kids Services 20 1477317121 0 Nurse Practitioners Nurse Practitioners Services 20 1477317121 0 Nurse Practitioners Physician Services 00 1477320828 0 COTTRELL CHAD O 2024116 9999999 B 10 1477320828 0 809 W CHURCH ST CHAMPAIGN IL 618203320 20 1477320828 0 Nurse Practitioners Healthy Kids Services 20 1477320828 0 Nurse Practitioners Nurse Practitioners Services 20 1477320828 0 Nurse Practitioners Physician Services 00 1477321339 0 BOCIO RICHARDSON SELIN BENJAMI 2024084 9999999 B 10 1477321339 0 2424 N 8TH ST PEKIN IL 615541547 20 1477321339 0 Dentists Dental Services 20 1477321339 0 Dentists Physician Services 00 1477324564 0 GRADY JOHANNA O 2024274 9999999 B 10 1477324564 0 1900 W LE FEVRE RD STE A STERLING IL 610819202 20 1477324564 0 Speech Therapists Speech Therapy/Pathology Services 00 1477324630 0 ROBERTS ANTANET 2024165 9999999 B 10 1477324630 0 1400 W GREENLEAF AVE CHICAGO IL 606262805 20 1477324630 0 Clinical Social Worker Social work service 00 1477324655 0 STOIA GABRIELA 2024087 9999999 B 10 1477324655 0 PO BOX 684 BEDFORD PARK IL 604990684 20 1477324655 0 Nurse Practitioners Fluoride varnish 20 1477324655 0 Nurse Practitioners Healthy Kids Services 20 1477324655 0 Nurse Practitioners Nurse Practitioners Services 20 1477324655 0 Nurse Practitioners Physician Services 00 1477324754 0 CRUZ MOYA LUIS E 2025003 9999999 B 10 1477324754 0 3030 W SALT CREEK LN STE 200 ARLINGTON HEIGH IL 600055002 20 1477324754 0 Physician Assistant Only Fluoride varnish 20 1477324754 0 Physician Assistant Only Healthy Kids Services 20 1477324754 0 Physician Assistant Only Physician Services 00 1477326536 0 GERENA KELSEY R 2023342 9999999 B 10 1477326536 0 PO BOX 735044 CHICAGO IL 606735044 20 1477326536 0 Nurse Practitioners Fluoride varnish 20 1477326536 0 Nurse Practitioners Healthy Kids Services 20 1477326536 0 Nurse Practitioners Nurse Practitioners Services 20 1477326536 0 Nurse Practitioners Physician Services 00 1477327682 0 PLOWMAN ASHLEIGH D 2024026 9999999 B 10 1477327682 0 201 W MULBERRY ST CHATHAM IL 626291329 20 1477327682 0 Speech Therapists Medical Supplies 20 1477327682 0 Speech Therapists Medical equipment/prosthetic devices 20 1477327682 0 Speech Therapists Speech Therapy/Pathology Services 00 1477329100 0 NEMENZO LEONID R 2024004 9999999 B 10 1477329100 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1477329100 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Kids Services 20 1477578664 0 Physicians Optical Supplies 20 1477578664 0 Physicians Physician Services 00 1477578896 0 LOTHARIUS EDYTHE T 2002344 9999999 B 10 1477578896 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1477578896 0 Physicians Anesthesia Services 20 1477578896 0 Physicians Fluoride varnish 20 1477578896 0 Physicians Healthy Kids Services 20 1477578896 0 Physicians Optical Supplies 20 1477578896 0 Physicians Physician Services 00 1477578920 0 HANNA NAGUI 1989002 9999999 B 10 1477578920 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1477578920 0 Physicians Anesthesia Services 20 1477578920 0 Physicians Healthy Kids Services 20 1477578920 0 Physicians Optical Supplies 20 1477578920 0 Physicians Physician Services 00 1477579563 0 FINNEGAN DAVID C 2016001 9999999 B 10 1477579563 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1477579563 0 Physician Assistant Only Fluoride varnish 20 1477579563 0 Physician Assistant Only Healthy Kids Services 20 1477579563 0 Physician Assistant 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1477739472 0 Physicians Fluoride varnish 20 1477739472 0 Physicians Healthy Kids Services 20 1477739472 0 Physicians Optical Supplies 20 1477739472 0 Physicians Physician Services 00 1477740074 0 HANNA BERGEN LAURA 2023204 9999999 B 10 1477740074 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1477740074 0 Nurse Practitioners Healthy Kids Services 20 1477740074 0 Nurse Practitioners Nurse Practitioners Services 20 1477740074 0 Nurse Practitioners Physician Services 00 1477741007 0 BEILFUSS DENIELLE M 2015238 9999999 B 10 1477741007 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1477741007 0 Nurse Practitioners Healthy Kids Services 20 1477741007 0 Nurse Practitioners Nurse Practitioners Services 20 1477741007 0 Nurse Practitioners Physician Services 00 1477741189 0 KIRSCHEN MATTHEW P 2022001 9999999 B 10 1477741189 0 100 E PENN SQ PHILADELPHIA PA 191073323 20 1477741189 0 Physicians Anesthesia Services 20 1477741189 0 Physicians Fluoride varnish 20 1477741189 0 Physicians Healthy Kids 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2016162 9999999 B 10 1477981421 0 803 N 1ST ST VIENNA IL 629951544 20 1477981421 0 Physician Assistant Only All Kids application agent 20 1477981421 0 Physician Assistant Only Fluoride varnish 20 1477981421 0 Physician Assistant Only Healthy Kids Services 20 1477981421 0 Physician Assistant Only Physician Services 00 1477981454 0 EDDINGTON KATHLEEN 2017122 9999999 B 10 1477981454 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1477981454 0 Nurse Practitioners Healthy Kids Services 20 1477981454 0 Nurse Practitioners Nurse Practitioners Services 20 1477981454 0 Nurse Practitioners Physician Services 00 1477981710 0 UHLIR ELLEN E 2015015 9999999 B 10 1477981710 0 2900 OGDEN AVE LISLE IL 605321631 20 1477981710 0 Speech Therapists Medical Supplies 20 1477981710 0 Speech Therapists Medical equipment/prosthetic devices 20 1477981710 0 Speech Therapists Speech Therapy/Pathology Services 00 1477982270 0 MATHEWS REGINA 2014001 9999999 B 10 1477982270 0 PO BOX 83287 CHICAGO IL 606910287 20 1477982270 0 Nurse Practitioners Fluoride varnish 20 1477982270 0 Nurse Practitioners Healthy Kids Services 20 1477982270 0 Nurse Practitioners Nurse Practitioners Services 20 1477982270 0 Nurse Practitioners Physician Services 00 1477983773 0 LENOBLE JENNIFER 2021036 9999999 B 10 1477983773 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1477983773 0 Psychologist Psychologist service 00 1477983914 0 KHAN MOHAMMAD HASSAN 2023221 9999999 B 10 1477983914 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1477983914 0 Nurse Practitioners Fluoride varnish 20 1477983914 0 Nurse Practitioners Healthy Kids Services 20 1477983914 0 Nurse Practitioners Nurse Practitioners Services 20 1477983914 0 Nurse Practitioners Physician Services 00 1477984631 0 UDEVBULU EHIZODE 2021144 9999999 B 10 1477984631 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1477984631 0 Physicians Anesthesia Services 20 1477984631 0 Physicians Fluoride varnish 20 1477984631 0 Physicians Healthy Kids Services 20 1477984631 0 Physicians Optical Supplies 20 1477984631 0 Physicians Physician Services 00 1477984656 0 DUST THOMAS 2016307 9999999 B 10 1477984656 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1477984656 0 Physician Assistant Only Fluoride varnish 20 1477984656 0 Physician Assistant Only Healthy Kids Services 20 1477984656 0 Physician Assistant Only Physician Services 00 1477985141 0 POLITSCH ANDREA V 2020126 9999999 B 10 1477985141 0 755 BENNETT AVE OGLESBY IL 613481067 20 1477985141 0 Speech Therapists Medical Supplies 20 1477985141 0 Speech Therapists Medical equipment/prosthetic devices 20 1477985141 0 Speech Therapists Speech Therapy/Pathology Services 00 1477985547 0 FLINN LAURA E 2016035 9999999 B 10 1477985547 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1477985547 0 Nurse Practitioners Fluoride varnish 20 1477985547 0 Nurse Practitioners Healthy Kids Services 20 1477985547 0 Nurse Practitioners Nurse Practitioners Services 20 1477985547 0 Nurse Practitioners Physician Services 00 1477985828 0 AHANIHU CHIOMA E 2017361 9999999 B 10 1477985828 0 721 N LA SALLE DR CHICAGO IL 606543503 20 1477985828 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477986081 0 SKURTU TIFFANY 2013244 9999999 B 10 1477986081 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1477986081 0 Nurse Practitioners Healthy Kids Services 20 1477986081 0 Nurse Practitioners Nurse Practitioners Services 20 1477986081 0 Nurse Practitioners Physician Services 00 1477986479 0 FLESHMAN PILAR 2020028 9999999 B 10 1477986479 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1477986479 0 Nurse Practitioners Healthy Kids Services 20 1477986479 0 Nurse Practitioners Nurse Practitioners Services 20 1477986479 0 Nurse Practitioners Physician Services 00 1477986826 0 ALAM YASHAM 2014041 9999999 B 10 1477986826 0 502 WAVERLY DR ELGIN IL 601204082 20 1477986826 0 Optometrists Optical Supplies 20 1477986826 0 Optometrists 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Nurse Practitioners Services 20 1477988087 0 Nurse Practitioners Physician Services 00 1477988624 0 ASARE YAA 2022137 9999999 B 10 1477988624 0 PO BOX 60352 SAINT LOUIS MO 631600352 20 1477988624 0 Physicians Anesthesia Services 20 1477988624 0 Physicians Healthy Kids Services 20 1477988624 0 Physicians Optical Supplies 20 1477988624 0 Physicians Physician Services 00 1477990497 0 COPELAND SARAH L. 2016034 9999999 B 10 1477990497 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1477990497 0 Physician Assistant Only Fluoride varnish 20 1477990497 0 Physician Assistant Only Healthy Kids Services 20 1477990497 0 Physician Assistant Only Physician Services 00 1477990521 0 HERMANN MATTHEW 2021335 9999999 B 10 1477990521 0 PO BOX 778791 CHICAGO IL 606776473 20 1477990521 0 Physicians Anesthesia Services 20 1477990521 0 Physicians Healthy Kids Services 20 1477990521 0 Physicians Optical Supplies 20 1477990521 0 Physicians Physician Services 00 1477991297 0 COZACOV YANIV 2018129 9999999 B 10 1477991297 0 721 E COURT ST PARIS IL 619442460 20 1477991297 0 Physicians Anesthesia Services 20 1477991297 0 Physicians Healthy Kids Services 20 1477991297 0 Physicians Optical Supplies 20 1477991297 0 Physicians Physician Services 00 1477991602 0 GILLING NATHAN C 2017230 9999999 B 10 1477991602 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1477991602 0 Physicians Anesthesia Services 20 1477991602 0 Physicians Fluoride varnish 20 1477991602 0 Physicians Healthy Kids Services 20 1477991602 0 Physicians Optical Supplies 20 1477991602 0 Physicians Physician Services 00 1477992022 0 JOHNSON DANIEL N 2019001 9999999 B 10 1477992022 0 PO BOX 5981 CAROL STREAM IL 601975981 20 1477992022 0 Physicians Anesthesia Services 20 1477992022 0 Physicians Healthy Kids Services 20 1477992022 0 Physicians Optical Supplies 20 1477992022 0 Physicians Physician Services 00 1477992899 0 BHAYANA MAYANK 2016126 9999999 B 10 1477992899 0 700 E OGDEN AVE STE 202 WESTMONT IL 605591296 20 1477992899 0 Physicians Anesthesia Services 20 1477992899 0 Physicians Fluoride varnish 20 1477992899 0 Physicians Healthy Kids Services 20 1477992899 0 Physicians Optical Supplies 20 1477992899 0 Physicians Physician Services 00 1477993053 0 ARNOLD NICOLE L 2017017 9999999 B 10 1477993053 0 611 W PARK ST URBANA IL 618012529 20 1477993053 0 Physicians Anesthesia Services 20 1477993053 0 Physicians Fluoride varnish 20 1477993053 0 Physicians Healthy Kids Services 20 1477993053 0 Physicians Optical Supplies 20 1477993053 0 Physicians Physician Services 00 1477993137 0 NEUMANN TONYA R 2017250 9999999 B 10 1477993137 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1477993137 0 Physicians Anesthesia Services 20 1477993137 0 Physicians Healthy Kids Services 20 1477993137 0 Physicians Optical Supplies 20 1477993137 0 Physicians Physician Services 00 1477993715 0 VARGHESE JIMMY J 2018094 9999999 B 10 1477993715 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1477993715 0 Physicians Anesthesia Services 20 1477993715 0 Physicians Fluoride varnish 20 1477993715 0 Physicians Healthy Kids Services 20 1477993715 0 Physicians Optical Supplies 20 1477993715 0 Physicians Physician Services 00 1477993772 0 BULLOCK VERONICA 2014182 9999999 B 10 1477993772 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1477993772 0 Speech Therapists Medical Supplies 20 1477993772 0 Speech Therapists Medical equipment/prosthetic devices 20 1477993772 0 Speech Therapists Speech Therapy/Pathology Services 00 1477993830 0 ANNAM KIRAN 2014091 9999999 B 10 1477993830 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1477993830 0 Nurse Practitioners Fluoride varnish 20 1477993830 0 Nurse Practitioners Healthy Kids Services 20 1477993830 0 Nurse Practitioners Nurse Practitioners Services 20 1477993830 0 Nurse Practitioners Physician Services 00 1477994523 0 KIMMIG NORMA C 2017136 9999999 B 10 1477994523 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1477994523 0 Physicians Anesthesia Services 20 1477994523 0 Physicians Fluoride varnish 20 1477994523 0 Physicians Healthy Kids Services 20 1477994523 0 Physicians Optical Supplies 20 1477994523 0 Physicians Physician Services 00 1477995611 0 DAMBACHER MARY T 2014121 9999999 B 10 1477995611 0 2239 E COOK ST SPRINGFIELD IL 627031944 20 1477995611 0 Nurse Practitioners Fluoride varnish 20 1477995611 0 Nurse Practitioners Healthy Kids Services 20 1477995611 0 Nurse Practitioners Nurse Practitioners Services 20 1477995611 0 Nurse Practitioners Physician Services 00 1477996015 0 ABELLERA MARGARET 2014001 9999999 B 10 1477996015 0 100 CROSSING BLVD STE 300 FRAMINGHAM MA 017025555 20 1477996015 0 Nurse Practitioners Fluoride varnish 20 1477996015 0 Nurse Practitioners Healthy Kids Services 20 1477996015 0 Nurse Practitioners Nurse Practitioners Services 20 1477996015 0 Nurse Practitioners Physician Services 00 1477996346 0 MITCHELL PHILLIP 2024023 9999999 B 10 1477996346 0 DEPT AT 40379 ATLANTA GA 311920001 20 1477996346 0 Physicians Anesthesia Services 20 1477996346 0 Physicians Healthy Kids Services 20 1477996346 0 Physicians Optical Supplies 20 1477996346 0 Physicians Physician Services 00 1477996585 0 ADAMU DESMOND Y 2021232 9999999 B 10 1477996585 0 611 W PARK ST URBANA IL 618012529 20 1477996585 0 Physicians Anesthesia Services 20 1477996585 0 Physicians Healthy Kids Services 20 1477996585 0 Physicians Optical Supplies 20 1477996585 0 Physicians Physician Services 00 1477996627 0 RAOL KRISHNA M 2020042 9999999 B 10 1477996627 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1477996627 0 Physicians Anesthesia Services 20 1477996627 0 Physicians Healthy Kids Services 20 1477996627 0 Physicians Optical Supplies 20 1477996627 0 Physicians Physician Services 00 1477997369 0 HOLADAY CLINTON 2018213 9999999 B 10 1477997369 0 1701 LACEY ST CAPE GIRARDEAU MO 637015230 20 1477997369 0 Physicians Anesthesia Services 20 1477997369 0 Physicians Healthy Kids Services 20 1477997369 0 Physicians Optical Supplies 20 1477997369 0 Physicians Physician Services 00 1477997674 0 KOZLOVA OLGA 2014274 9999999 B 10 1477997674 0 5318 W DEVON AVE CHICAGO IL 606464108 20 1477997674 0 Physicians Anesthesia Services 20 1477997674 0 Physicians Healthy Kids Services 20 1477997674 0 Physicians Optical Supplies 20 1477997674 0 Physicians Physician Services 20 1477997674 0 Physicians Physicians Psychiatric Services 00 1477997849 0 CONNOLLY GILLIAN 2013091 9999999 B 10 1477997849 0 1940 S WESTERN AVE STE 205 CHICAGO IL 606082503 20 1477997849 0 Nurse Practitioners All Kids application agent 20 1477997849 0 Nurse Practitioners Fluoride varnish 20 1477997849 0 Nurse Practitioners Healthy Kids Services 20 1477997849 0 Nurse Practitioners Nurse Practitioners Services 20 1477997849 0 Nurse Practitioners Physician Services 00 1477998185 0 MACCABEE-RYABOY NADIA 2019260 9999999 B 10 1477998185 0 5901 LINCOLN DR EDINA MN 554361611 20 1477998185 0 Physicians Anesthesia Services 20 1477998185 0 Physicians Fluoride varnish 20 1477998185 0 Physicians Healthy Kids Services 20 1477998185 0 Physicians Optical Supplies 20 1477998185 0 Physicians Physician Services 00 1477998334 0 TALMAGE ALINE 2016163 9999999 B 10 1477998334 0 6201 ROOSEVELT RD BERWYN IL 604021108 20 1477998334 0 Clinical Social Worker Social work service 00 1477998433 0 DILLARD JAZMINE 2013346 9999999 B 10 1477998433 0 2050 E ALGONQUIN RD STE 610 SCHAUMBURG IL 601734166 20 1477998433 0 Dentists Dental Services 20 1477998433 0 Dentists Physician Services 00 1477998714 0 FAIN CORY LYN 2021046 9999999 B 10 1477998714 0 4100 VETERANS PKWY MCHENRY IL 600508350 20 1477998714 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1477998730 0 HASAN SARA 2022062 9999999 B 10 1477998730 0 100 E PENN SQ FL 9 PHILADELPHIA PA 191073377 20 1477998730 0 Physicians Anesthesia Services 20 1477998730 0 Physicians Fluoride varnish 20 1477998730 0 Physicians Healthy Kids Services 20 1477998730 0 Physicians Optical Supplies 20 1477998730 0 Physicians Physician Services 00 1477999167 0 SHELLEY ERIC J 2016214 9999999 B 10 1477999167 0 1400 US HIGHWAY 61 FESTUS MO 630284100 20 1477999167 0 Physicians Anesthesia Services 20 1477999167 0 Physicians Fluoride varnish 20 1477999167 0 Physicians Healthy Kids Services 20 1477999167 0 Physicians Optical Supplies 20 1477999167 0 Physicians Physician Services 00 1477999258 0 DELGADO RICHARD 2016245 9999999 B 10 1477999258 0 100 WITMER RD STE 220 HORSHAM PA 190442279 20 1477999258 0 Physicians Anesthesia Services 20 1477999258 0 Physicians Healthy Kids Services 20 1477999258 0 Physicians Optical Supplies 20 1477999258 0 Physicians Physician Services 00 1487000964 0 AGUBE WERUCHE 2016222 9999999 B 10 1487000964 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1487000964 0 Nurse Practitioners Healthy Kids Services 20 1487000964 0 Nurse Practitioners Nurse Practitioners Services 20 1487000964 0 Nurse Practitioners Physician Services 00 1487001368 0 HUSSAIN ASAD 2024185 9999999 B 10 1487001368 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1487001368 0 Physicians Anesthesia Services 20 1487001368 0 Physicians Healthy Kids Services 20 1487001368 0 Physicians Optical Supplies 20 1487001368 0 Physicians Physician Services 00 1487001467 0 CURTIS MOLLY G 2025048 9999999 B 10 1487001467 0 5901 LINCOLN DR EDINA MN 554361611 20 1487001467 0 Physicians Anesthesia Services 20 1487001467 0 Physicians Healthy Kids Services 20 1487001467 0 Physicians Optical Supplies 20 1487001467 0 Physicians Physician Services 00 1487001624 0 BARFIELD ASHLEY 2022236 9999999 B 10 1487001624 0 PO BOX 4028 ROCK ISLAND IL 612044028 20 1487001624 0 Physicians Anesthesia Services 20 1487001624 0 Physicians Healthy Kids Services 20 1487001624 0 Physicians Optical Supplies 20 1487001624 0 Physicians Physician Services 00 1487001657 0 FERNANDEZ SONJA 2016267 9999999 B 10 1487001657 0 504 MICAH DR DRAWER M OLNEY IL 624504720 20 1487001657 0 Other behavior health professional 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Physicians Anesthesia Services 20 1487003323 0 Physicians Healthy Kids Services 20 1487003323 0 Physicians Optical Supplies 20 1487003323 0 Physicians Physician Services 00 1487003679 0 BARCLAY JOSHUA 2025003 9999999 B 10 1487003679 0 3600 W ROOSEVELT RD CHICAGO IL 606244225 20 1487003679 0 Dentists Dental Services 20 1487003679 0 Dentists Physician Services 00 1487004537 0 MARTIN BRENDA L 2016155 9999999 B 10 1487004537 0 201 E STRONG ST STE 4 WHEELING IL 600902979 20 1487004537 0 Dentists Dental Services 20 1487004537 0 Dentists Physician Services 00 1487004917 0 MALDONADO JONATHAN 2024173 9999999 B 10 1487004917 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1487004917 0 Physicians Anesthesia Services 20 1487004917 0 Physicians Healthy Kids Services 20 1487004917 0 Physicians Optical Supplies 20 1487004917 0 Physicians Physician Services 00 1487005393 0 MOORE JUSTIN A 2018275 9999999 B 10 1487005393 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1487005393 0 Psychologist Psychologist service 00 1487006052 0 KESKINEN ERIK 2021157 9999999 B 10 1487006052 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1487006052 0 Physicians Anesthesia Services 20 1487006052 0 Physicians Fluoride varnish 20 1487006052 0 Physicians Healthy Kids Services 20 1487006052 0 Physicians Optical Supplies 20 1487006052 0 Physicians Physician Services 00 1487007696 0 GOLDBERG DAVID B 2017184 9999999 B 10 1487007696 0 3021 W ARMITAGE AVE CHICAGO IL 606476569 20 1487007696 0 Dentists Dental Services 20 1487007696 0 Dentists Physician Services 00 1487007985 0 KOLLIPARA VIJAYA 2024017 9999999 B 10 1487007985 0 PO BOX 1649 CHEYENNE WY 820031649 20 1487007985 0 Physicians Anesthesia Services 20 1487007985 0 Physicians Fluoride varnish 20 1487007985 0 Physicians Healthy Kids Services 20 1487007985 0 Physicians Optical Supplies 20 1487007985 0 Physicians Physician Services 00 1487008389 0 DISSEN MOSHE 2016183 9999999 B 10 1487008389 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1487008389 0 Physicians Anesthesia Services 20 1487008389 0 Physicians Fluoride varnish 20 1487008389 0 Physicians Healthy Kids Services 20 1487008389 0 Physicians Optical Supplies 20 1487008389 0 Physicians Physician Services 00 1487008645 0 WEHLE SHAUN 2020183 9999999 B 10 1487008645 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1487008645 0 Psychologist Psychologist service 00 1487008694 0 FENTON REBEKAH 2019263 9999999 B 10 1487008694 0 966 W 21ST ST CHICAGO IL 606084511 20 1487008694 0 Physicians Anesthesia Services 20 1487008694 0 Physicians Fluoride varnish 20 1487008694 0 Physicians Healthy Kids Services 20 1487008694 0 Physicians Optical Supplies 20 1487008694 0 Physicians Physician Services 00 1487009510 0 URSETTO VERONICA 2016322 9999999 B 10 1487009510 0 1301 W DEVON AVE CHICAGO IL 606601329 20 1487009510 0 Other behavior health professional LCPC/LMFT services 00 1487010534 0 HOMECGOY IMELDA 2017003 9999999 B 10 1487010534 0 PO BOX 772 MC2295 WOONSOCKET RI 028950784 20 1487010534 0 Nurse Practitioners Fluoride varnish 20 1487010534 0 Nurse Practitioners Healthy Kids Services 20 1487010534 0 Nurse Practitioners Nurse Practitioners Services 20 1487010534 0 Nurse Practitioners Physician Services 00 1487010807 0 PFOFF DARBY 2017025 9999999 B 10 1487010807 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1487010807 0 Nurse Practitioners Fluoride varnish 20 1487010807 0 Nurse Practitioners Healthy Kids Services 20 1487010807 0 Nurse Practitioners Nurse Practitioners Services 20 1487010807 0 Nurse Practitioners Physician Services 00 1487011144 0 VOGLER SHAUNA B 2016011 9999999 B 10 1487011144 0 619 E MASON ST STE 4P57 SPRINGFIELD IL 627011034 20 1487011144 0 Nurse Practitioners Fluoride varnish 20 1487011144 0 Nurse Practitioners Healthy Kids Services 20 1487011144 0 Nurse Practitioners Nurse Practitioners Services 20 1487011144 0 Nurse Practitioners Physician Services 00 1487011334 0 SUNG SARAH E 2025125 9999999 B 10 1487011334 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1487011334 0 Speech Therapists Medical Supplies 20 1487011334 0 Speech Therapists Medical equipment/prosthetic devices 20 1487011334 0 Speech Therapists Speech Therapy/Pathology Services 00 1487012860 0 YOUSUF SAMINA 2016144 9999999 B 10 1487012860 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1487012860 0 Physicians Anesthesia Services 20 1487012860 0 Physicians Fluoride varnish 20 1487012860 0 Physicians Healthy Kids Services 20 1487012860 0 Physicians Optical Supplies 20 1487012860 0 Physicians Physician Services 00 1487013652 0 SVINKUNAS AGNES 2020085 9999999 B 10 1487013652 0 3166 N LINCOLN AVE STE 401 CHICAGO IL 606573181 20 1487013652 0 Other behavior health professional LCPC/LMFT services 00 1487014411 0 SULTAN-LUNDEEN KIERAN A 2017153 9999999 B 10 1487014411 0 8901 W LINCOLN AVE MILWAUKEE WI 532272409 20 1487014411 0 Physicians Anesthesia Services 20 1487014411 0 Physicians Healthy Kids Services 20 1487014411 0 Physicians Optical Supplies 20 1487014411 0 Physicians Physician Services 00 1487014627 0 SWAYZE ROBERT M 2015297 9999999 B 10 1487014627 0 1307 E MCCORD ST CENTRALIA IL 628013610 20 1487014627 0 Nurse Practitioners Healthy Kids Services 20 1487014627 0 Nurse Practitioners Nurse Practitioners Services 20 1487014627 0 Nurse Practitioners Physician Services 00 1487016010 0 STAMBAUGH LAYNE D 2016137 9999999 B 10 1487016010 0 706 N MAIN ST ROCKFORD IL 611036904 20 1487016010 0 Nurse Practitioners Healthy Kids Services 20 1487016010 0 Nurse Practitioners Nurse Practitioners Services 20 1487016010 0 Nurse Practitioners Physician Services 00 1487016390 0 AVILA GUERRA MAURICIO 2023143 9999999 B 10 1487016390 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1487016390 0 Physicians Anesthesia Services 20 1487016390 0 Physicians Healthy Kids Services 20 1487016390 0 Physicians Optical Supplies 20 1487016390 0 Physicians Physician Services 00 1487016564 0 PIERCE JOHN E 2023177 9999999 B 10 1487016564 0 PO BOX 736216 DALLAS TX 753736216 20 1487016564 0 Physicians Anesthesia Services 20 1487016564 0 Physicians Healthy Kids Services 20 1487016564 0 Physicians Optical Supplies 20 1487016564 0 Physicians Physician Services 00 1487017661 0 IRMEN STEFANIE 2017006 9999999 B 10 1487017661 0 2339 N CALIFORNIA AVE UNIT 479 CHICAGO IL 606470360 20 1487017661 0 Occupational Therapists Medical Supplies 20 1487017661 0 Occupational Therapists Medical equipment/prosthetic devices 20 1487017661 0 Occupational Therapists Occupational Therapy Services 00 1487017802 0 NAZERI ARASH 2019302 9999999 B 10 1487017802 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1487017802 0 Physicians Anesthesia Services 20 1487017802 0 Physicians Healthy Kids Services 20 1487017802 0 Physicians Optical Supplies 20 1487017802 0 Physicians Physician Services 00 1487017836 0 WEINLANDER ERIC J 2022074 9999999 B 10 1487017836 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1487017836 0 Physicians Anesthesia Services 20 1487017836 0 Physicians Healthy Kids Services 20 1487017836 0 Physicians Optical Supplies 20 1487017836 0 Physicians Physician Services 00 1487018081 0 ADEYANJU OLUWEMIMO 2019266 9999999 B 10 1487018081 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1487018081 0 Physicians Anesthesia Services 20 1487018081 0 Physicians Healthy Kids Services 20 1487018081 0 Physicians Optical Supplies 20 1487018081 0 Physicians Physician Services 20 1487018081 0 Physicians Physicians Psychiatric Services 00 1487018255 0 HUSSAIN MOHAMMED S 2022133 9999999 B 10 1487018255 0 520 VALLEY VIEW DR MOLINE IL 612656152 20 1487018255 0 Physicians Anesthesia Services 20 1487018255 0 Physicians Healthy Kids Services 20 1487018255 0 Physicians Optical Supplies 20 1487018255 0 Physicians Physician Services 00 1487018529 0 WEBER ALLISON C 2023032 9999999 B 10 1487018529 0 1650 LYNDON FARM CT STE 300 LOUISVILLE KY 402235005 20 1487018529 0 Physical Therapists Medical Supplies 20 1487018529 0 Physical Therapists Medical equipment/prosthetic devices 20 1487018529 0 Physical Therapists Physical Therapy Services 00 1487018867 0 WOGE MATTHEW 2021180 9999999 B 10 1487018867 0 8901 W LINCOLN AVE MILWAUKEE WI 532272409 20 1487018867 0 Physicians Anesthesia Services 20 1487018867 0 Physicians Healthy Kids Services 20 1487018867 0 Physicians Optical Supplies 20 1487018867 0 Physicians Physician Services 00 1487018883 0 MASTERS HANNAH 2024230 9999999 B 10 1487018883 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1487018883 0 Physicians Anesthesia Services 20 1487018883 0 Physicians Healthy Kids Services 20 1487018883 0 Physicians Optical Supplies 20 1487018883 0 Physicians Physician Services 00 1487018925 0 CHAMERNIK BRETT B 2022271 9999999 B 10 1487018925 0 1585 N BARRINGTON RD STE 101 HOFFMAN ESTATES IL 601695019 20 1487018925 0 Physicians Anesthesia Services 20 1487018925 0 Physicians Healthy Kids Services 20 1487018925 0 Physicians Optical Supplies 20 1487018925 0 Physicians Physician Services 00 1487019485 0 RAJU PRIANKA 2020239 9999999 B 10 1487019485 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1487019485 0 Physicians Anesthesia Services 20 1487019485 0 Physicians Fluoride varnish 20 1487019485 0 Physicians Healthy Kids Services 20 1487019485 0 Physicians Optical Supplies 20 1487019485 0 Physicians Physician Services 00 1487021119 0 OSTROV RACHEL P 2017191 9999999 B 10 1487021119 0 5777 DEPT CAROL STREAM IL 601220021 20 1487021119 0 Clinical Social Worker Social work service 00 1487023057 0 SYN WING-KIN 2021348 9999999 B 10 1487023057 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1487023057 0 Physicians Anesthesia Services 20 1487023057 0 Physicians Fluoride varnish 20 1487023057 0 Physicians Healthy Kids Services 20 1487023057 0 Physicians Optical Supplies 20 1487023057 0 Physicians Physician Services 00 1487023198 0 MCCARVILLE MEGHAN 2020199 9999999 B 10 1487023198 0 8 S MICHIGAN AVE STE 2300 CHICAGO IL 606033357 20 1487023198 0 Other behavior health professional 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Physicians Physician Services 00 1487114831 0 SNYDER THEODORE 2019301 9999999 B 10 1487114831 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1487114831 0 Physicians Anesthesia Services 20 1487114831 0 Physicians Fluoride varnish 20 1487114831 0 Physicians Healthy Kids Services 20 1487114831 0 Physicians Optical Supplies 20 1487114831 0 Physicians Physician Services 00 1487115259 0 WHITTAKER ARRIANNE M 2023031 9999999 B 10 1487115259 0 727 N LINCOLN RD ROCKVILLE IN 478721117 20 1487115259 0 Physicians Anesthesia Services 20 1487115259 0 Physicians Fluoride varnish 20 1487115259 0 Physicians Healthy Kids Services 20 1487115259 0 Physicians Optical Supplies 20 1487115259 0 Physicians Physician Services 00 1487115408 0 WILLE AARON 2023223 9999999 B 10 1487115408 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1487115408 0 Physicians Anesthesia Services 20 1487115408 0 Physicians Healthy Kids Services 20 1487115408 0 Physicians Optical Supplies 20 1487115408 0 Physicians Physician Services 00 1487115424 0 WILSON MARCUS 2023153 9999999 B 10 1487115424 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1487115424 0 Physicians Anesthesia Services 20 1487115424 0 Physicians Healthy Kids Services 20 1487115424 0 Physicians Optical Supplies 20 1487115424 0 Physicians Physician Services 00 1487115440 0 SKODA LUCAS L 2024124 9999999 B 10 1487115440 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1487115440 0 Physicians Anesthesia Services 20 1487115440 0 Physicians Healthy Kids Services 20 1487115440 0 Physicians Optical Supplies 20 1487115440 0 Physicians Physician Services 00 1487115499 0 ELTORAI ADAM 2024037 9999999 B 10 1487115499 0 PO BOX 713160 CHICAGO IL 606770360 20 1487115499 0 Physicians Anesthesia Services 20 1487115499 0 Physicians Healthy Kids Services 20 1487115499 0 Physicians Optical Supplies 20 1487115499 0 Physicians Physician Services 00 1487115523 0 ZEGAR AYAH 2023143 9999999 B 10 1487115523 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1487115523 0 Physicians Anesthesia Services 20 1487115523 0 Physicians Healthy Kids Services 20 1487115523 0 Physicians Optical Supplies 20 1487115523 0 Physicians Physician Services 00 1487115648 0 CHRISTIAN DAVID R 2019174 9999999 B 10 1487115648 0 5875 E RIVERSIDE BLVD ROCKFORD IL 611144937 20 1487115648 0 Physicians Anesthesia Services 20 1487115648 0 Physicians Healthy Kids Services 20 1487115648 0 Physicians Optical Supplies 20 1487115648 0 Physicians Physician Services 00 1487116877 0 WILKINSON KRISTEN 2023335 9999999 B 10 1487116877 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1487116877 0 Psychologist Psychologist service 00 1487117123 0 WISE JESSICA 2022207 9999999 B 10 1487117123 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1487117123 0 Physicians Anesthesia Services 20 1487117123 0 Physicians Healthy Kids Services 20 1487117123 0 Physicians Optical Supplies 20 1487117123 0 Physicians Physician Services 00 1487117206 0 WELLS FORREST C 2023303 9999999 B 10 1487117206 0 8300 W 38TH 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varnish 20 1487118212 0 Physician Assistant Only Healthy Kids Services 20 1487118212 0 Physician Assistant Only Physician Services 00 1487118550 0 CHINAVONG NAOMI 2019022 9999999 B 10 1487118550 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1487118550 0 Nurse Practitioners Fluoride varnish 20 1487118550 0 Nurse Practitioners Healthy Kids Services 20 1487118550 0 Nurse Practitioners Nurse Practitioners Services 20 1487118550 0 Nurse Practitioners Physician Services 00 1487118709 0 MARR KATHERINE M 2021050 9999999 B 10 1487118709 0 4714 GETTYSBURG RD MECHANICSBURG PA 170554325 20 1487118709 0 Speech Therapists Medical Supplies 20 1487118709 0 Speech Therapists Medical equipment/prosthetic devices 20 1487118709 0 Speech Therapists Speech Therapy/Pathology Services 00 1487121349 0 PFEIFFER KIMBERLEY S 2019032 9999999 B 10 1487121349 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1487121349 0 Nurse Practitioners Fluoride varnish 20 1487121349 0 Nurse Practitioners Healthy Kids Services 20 1487121349 0 Nurse Practitioners Nurse Practitioners Services 20 1487121349 0 Nurse Practitioners Physician Services 00 1487122784 0 KELLY MELISSA A 2023093 9999999 B 10 1487122784 0 15740 S OUTER 40 RD CHESTERFIELD MO 630172004 20 1487122784 0 Nurse Practitioners Fluoride varnish 20 1487122784 0 Nurse Practitioners Healthy Kids Services 20 1487122784 0 Nurse Practitioners Nurse Practitioners Services 20 1487122784 0 Nurse Practitioners Physician Services 00 1487123345 0 SHEPARD SHERILEE 2018145 9999999 H 10 1487123345 0 2323 WINDISH DR GALESBURG IL 614019780 20 1487123345 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487123790 0 BARRETT-HURH ALEXANDRIA L 2020317 9999999 B 10 1487123790 0 29373 NETWORK PL CHICAGO IL 606733039 20 1487123790 0 Nurse Practitioners Fluoride varnish 20 1487123790 0 Nurse Practitioners Healthy Kids Services 20 1487123790 0 Nurse Practitioners Nurse Practitioners Services 20 1487123790 0 Nurse Practitioners Physician Services 00 1487123832 0 CHRIST ANDREW M 2019346 9999999 B 10 1487123832 0 PO BOX 70 LAKE FOREST IL 600450070 20 1487123832 0 Nurse Practitioners Anesthesia Services 20 1487123832 0 Nurse Practitioners Nurse Practitioners Services 20 1487123832 0 Nurse Practitioners Physician Services 00 1487123956 0 RICHARDS SYDNEY 2024087 9999999 B 10 1487123956 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1487123956 0 Physician Assistant Only Fluoride varnish 20 1487123956 0 Physician Assistant Only Healthy Kids Services 20 1487123956 0 Physician Assistant Only Physician Services 00 1487124335 0 RUIZ ALBEZA V 2018361 9999999 B 10 1487124335 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1487124335 0 Nurse Practitioners Nursing service 20 1487124335 0 Nurse Practitioners Waiver service 00 1487124574 0 NUGENT NICOLE C 2019100 9999999 B 10 1487124574 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1487124574 0 Occupational Therapists Medical Supplies 20 1487124574 0 Occupational Therapists Medical equipment/prosthetic devices 20 1487124574 0 Occupational Therapists Occupational Therapy Services 00 1487125704 0 MENDEZ JESSICA 2019150 9999999 B 10 1487125704 0 50 S MILWAUKEE AVE STE 103 LAKE VILLA IL 600469407 20 1487125704 0 Nurse Practitioners Fluoride varnish 20 1487125704 0 Nurse Practitioners Healthy Kids Services 20 1487125704 0 Nurse Practitioners Nurse Practitioners Services 20 1487125704 0 Nurse Practitioners Physician Services 00 1487127734 0 BECKSTROM STEPHANIE S 2019016 9999999 B 10 1487127734 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1487127734 0 Nurse Practitioners Healthy Kids Services 20 1487127734 0 Nurse Practitioners Nurse Practitioners Services 20 1487127734 0 Nurse Practitioners Physician Services 00 1487128468 0 WHITE LAURA J 2019042 9999999 B 10 1487128468 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1487128468 0 Nurse Practitioners Fluoride varnish 20 1487128468 0 Nurse Practitioners Healthy Kids Services 20 1487128468 0 Nurse Practitioners Nurse Practitioners Services 20 1487128468 0 Nurse Practitioners Physician Services 00 1487129318 0 JAEGLE KATE E 2018281 9999999 B 10 1487129318 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1487129318 0 Nurse Practitioners Fluoride varnish 20 1487129318 0 Nurse Practitioners Healthy Kids Services 20 1487129318 0 Nurse Practitioners Nurse Practitioners Services 20 1487129318 0 Nurse Practitioners Physician Services 00 1487130274 0 MACAGBA GREGORY 2018213 9999999 B 10 1487130274 0 501 S LOCUST ST MANTENO IL 609501654 20 1487130274 0 Optometrists Optical Supplies 20 1487130274 0 Optometrists Optometric Services 20 1487130274 0 Optometrists Physician Services 00 1487130464 0 QUISTAD ANNA 2024050 9999999 B 10 1487130464 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1487130464 0 Psychologist Psychologist service 00 1487130746 0 WIESE JONATHAN RICHARD 2024171 9999999 B 10 1487130746 0 PO BOX 60352 660 SOUTH EUCLID 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ND??YE F 2021237 9999999 B 10 1487134680 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1487134680 0 Physicians Anesthesia Services 20 1487134680 0 Physicians Healthy Kids Services 20 1487134680 0 Physicians Optical Supplies 20 1487134680 0 Physicians Physician Services 00 1487134979 0 HUMMEL ALEXANDRIA 2022354 9999999 B 10 1487134979 0 451 COVENTRY LN STE 101 CRYSTAL LAKE IL 600147569 20 1487134979 0 Clinical Social Worker Social work service 00 1487135034 0 SWARDSON BARRY AMIE 2018234 9999999 B 10 1487135034 0 PO BOX 1203 BEDFORD PARK IL 604991203 20 1487135034 0 Nurse Practitioners Fluoride varnish 20 1487135034 0 Nurse Practitioners Healthy Kids Services 20 1487135034 0 Nurse Practitioners Nurse Practitioners Services 20 1487135034 0 Nurse Practitioners Physician Services 00 1487135208 0 HILSON DIANNA 2019141 9999999 B 10 1487135208 0 8 OAK PARK DR BEDFORD MA 017301414 20 1487135208 0 Nurse Practitioners Fluoride varnish 20 1487135208 0 Nurse Practitioners Healthy Kids 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Services 20 1487140596 0 Optometrists Physician Services 00 1487141057 0 OLIVER-LINEN ERICKA N 2021182 9999999 B 10 1487141057 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1487141057 0 Physicians Anesthesia Services 20 1487141057 0 Physicians Fluoride varnish 20 1487141057 0 Physicians Healthy Kids Services 20 1487141057 0 Physicians Optical Supplies 20 1487141057 0 Physicians Physician Services 00 1487141180 0 MESSERSCHMIDT STEPHANIE 2018152 9999999 B 10 1487141180 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1487141180 0 Nurse Practitioners Fluoride varnish 20 1487141180 0 Nurse Practitioners Healthy Kids Services 20 1487141180 0 Nurse Practitioners Nurse Practitioners Services 20 1487141180 0 Nurse Practitioners Physician Services 00 1487141214 0 WELZENBACH LYNN 2018150 9999999 B 10 1487141214 0 5132 N ELSTON AVE CHICAGO IL 606302429 20 1487141214 0 Nurse Practitioners Healthy Kids Services 20 1487141214 0 Nurse Practitioners Nurse Practitioners Services 20 1487141214 0 Nurse Practitioners Physician Services 00 1487141446 0 FOX CAITLYN 2018158 9999999 B 10 1487141446 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1487141446 0 Nurse Practitioners Healthy Kids Services 20 1487141446 0 Nurse Practitioners Nurse Practitioners Services 20 1487141446 0 Nurse Practitioners Physician Services 00 1487141545 0 SAHU KIRTI 2023244 9999999 B 10 1487141545 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1487141545 0 Nurse Practitioners Anesthesia Services 20 1487141545 0 Nurse Practitioners Healthy Kids Services 20 1487141545 0 Nurse Practitioners Optical Supplies 20 1487141545 0 Nurse Practitioners Physician Services 00 1487141735 0 BECKER LAUREN 2024174 9999999 B 10 1487141735 0 29373 NETWORK PL CHICAGO IL 606733039 20 1487141735 0 Physicians Anesthesia Services 20 1487141735 0 Physicians Fluoride varnish 20 1487141735 0 Physicians Healthy Kids Services 20 1487141735 0 Physicians Optical Supplies 20 1487141735 0 Physicians Physician Services 00 1487142345 0 ROBINSON DIANE 2025107 9999999 B 10 1487142345 0 55 E JACKSON BLVD STE 1500 CHICAGO IL 606044184 20 1487142345 0 Clinical Social Worker Social work service 00 1487145124 0 WILL RASHANDA 2019195 9999999 B 10 1487145124 0 1903 LOOMIS ST ROCKFORD IL 611022665 20 1487145124 0 Other behavior health professional LCPC/LMFT services 00 1487145215 0 PITTMAN LUCAS 2023277 9999999 B 10 1487145215 0 PO BOX 556 VINCENNES IN 475910556 20 1487145215 0 Nurse Practitioners Healthy Kids Services 20 1487145215 0 Nurse Practitioners Nurse Practitioners Services 20 1487145215 0 Nurse Practitioners Physician Services 00 1487145264 0 BAXTER CHASE A 2024208 9999999 B 10 1487145264 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1487145264 0 Physicians Anesthesia Services 20 1487145264 0 Physicians Fluoride varnish 20 1487145264 0 Physicians Healthy Kids Services 20 1487145264 0 Physicians Optical Supplies 20 1487145264 0 Physicians Physician Services 00 1487145470 0 BARKER CARA A 2018001 9999999 B 10 1487145470 0 PO BOX 250 EDWARDSVILLE IL 620250250 20 1487145470 0 Speech Therapists Medical Supplies 20 1487145470 0 Speech Therapists Medical equipment/prosthetic devices 20 1487145470 0 Speech Therapists Speech Therapy/Pathology Services 00 1487145629 0 HOVLAND MARK G 2021165 9999999 B 10 1487145629 0 515 22ND AVE MONROE WI 535661569 20 1487145629 0 Physicians Anesthesia Services 20 1487145629 0 Physicians Healthy Kids Services 20 1487145629 0 Physicians Optical Supplies 20 1487145629 0 Physicians Physician Services 00 1487146486 0 WEISS MATTHEW 2019213 9999999 B 10 1487146486 0 5777 DEPT CAROL STREAM IL 601228942 20 1487146486 0 Physicians Anesthesia Services 20 1487146486 0 Physicians Fluoride varnish 20 1487146486 0 Physicians Healthy Kids Services 20 1487146486 0 Physicians Optical Supplies 20 1487146486 0 Physicians Physician Services 00 1487147393 0 REED KRISTEN L 2018222 9999999 B 10 1487147393 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1487147393 0 Physician Assistant Only Fluoride varnish 20 1487147393 0 Physician Assistant Only Healthy Kids Services 20 1487147393 0 Physician Assistant Only Physician Services 00 1487147948 0 HUYSMAN BRIDGET C 2018233 9999999 B 10 1487147948 0 1602 21ST ST GRANITE CITY IL 620405304 20 1487147948 0 Physicians Anesthesia Services 20 1487147948 0 Physicians Healthy Kids Services 20 1487147948 0 Physicians Optical Supplies 20 1487147948 0 Physicians Physician Services 00 1487147971 0 ATALLAH ISSAM 2022208 9999999 B 10 1487147971 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1487147971 0 Physicians Anesthesia Services 20 1487147971 0 Physicians Fluoride varnish 20 1487147971 0 Physicians Healthy Kids Services 20 1487147971 0 Physicians Optical Supplies 20 1487147971 0 Physicians Physician Services 00 1487148136 0 ELAHI AMNA 2021161 9999999 B 10 1487148136 0 5777 DEPT CAROL STREAM IL 601228942 20 1487148136 0 Physicians Anesthesia Services 20 1487148136 0 Physicians Fluoride varnish 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1487149365 0 HONG DONALD 2018358 9999999 B 10 1487149365 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1487149365 0 Physicians Anesthesia Services 20 1487149365 0 Physicians Fluoride varnish 20 1487149365 0 Physicians Healthy Kids Services 20 1487149365 0 Physicians Optical Supplies 20 1487149365 0 Physicians Physician Services 00 1487150025 0 PATEL RUSHI 2023237 9999999 B 10 1487150025 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1487150025 0 Physicians Anesthesia Services 20 1487150025 0 Physicians Healthy Kids Services 20 1487150025 0 Physicians Optical Supplies 20 1487150025 0 Physicians Physician Services 00 1487150306 0 ELHARRIF KHALID 2022187 9999999 B 10 1487150306 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1487150306 0 Physicians Anesthesia Services 20 1487150306 0 Physicians Fluoride varnish 20 1487150306 0 Physicians Healthy Kids Services 20 1487150306 0 Physicians Optical Supplies 20 1487150306 0 Physicians Physician Services 00 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Practitioners Services 20 1487199386 0 Nurse Practitioners Physician Services 00 1487199980 0 CRAIG SAMANTHA 2021286 9999999 B 10 1487199980 0 6742 N FROSTWOOD PKWY PEORIA IL 616152402 20 1487199980 0 Nurse Practitioners Anesthesia Services 20 1487199980 0 Nurse Practitioners Nurse Practitioners Services 20 1487199980 0 Nurse Practitioners Physician Services 00 1487200630 0 DICARA MIA 2023179 9999999 B 10 1487200630 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1487200630 0 Physicians Anesthesia Services 20 1487200630 0 Physicians Fluoride varnish 20 1487200630 0 Physicians Healthy Kids Services 20 1487200630 0 Physicians Optical Supplies 20 1487200630 0 Physicians Physician Services 00 1487200697 0 LETTENBERGER LAURA P 2023174 9999999 B 10 1487200697 0 4698 DEPT CAROL STREAM IL 601220021 20 1487200697 0 Physicians Anesthesia Services 20 1487200697 0 Physicians Fluoride varnish 20 1487200697 0 Physicians Healthy Kids Services 20 1487200697 0 Physicians Optical Supplies 20 1487200697 0 Physicians Physician Services 00 1487201414 0 SADAUSKAS NORA 2024214 9999999 B 10 1487201414 0 5777 DEPT CAROL STREAM IL 601220021 20 1487201414 0 Physical Therapists Medical Supplies 20 1487201414 0 Physical Therapists Medical equipment/prosthetic devices 20 1487201414 0 Physical Therapists Physical Therapy Services 00 1487202479 0 PLUMMER TARYN 2020076 9999999 B 10 1487202479 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1487202479 0 Nurse Practitioners Healthy Kids Services 20 1487202479 0 Nurse Practitioners Nurse Practitioners Services 20 1487202479 0 Nurse Practitioners Physician Services 00 1487203659 0 PATEL CHAULA 2021032 9999999 B 10 1487203659 0 1301 W DEVON AVE CHICAGO IL 606601329 20 1487203659 0 Nurse Practitioners Fluoride varnish 20 1487203659 0 Nurse Practitioners Healthy Kids Services 20 1487203659 0 Nurse Practitioners Nurse Practitioners Services 20 1487203659 0 Nurse Practitioners Physician Services 00 1487204319 0 BORST JESSICA 2019273 9999999 B 10 1487204319 0 5777 DEPT CAROL STREAM IL 601220021 20 1487204319 0 Nurse Practitioners Fluoride varnish 20 1487204319 0 Nurse Practitioners Healthy Kids Services 20 1487204319 0 Nurse Practitioners Nurse Practitioners Services 20 1487204319 0 Nurse Practitioners Physician Services 00 1487206306 0 DAVENPORT ANDREA L 2019213 9999999 B 10 1487206306 0 777 S MAIN ST STE 100 CLINTON IN 478422493 20 1487206306 0 Nurse Practitioners Fluoride varnish 20 1487206306 0 Nurse Practitioners Healthy Kids Services 20 1487206306 0 Nurse Practitioners Nurse Practitioners Services 20 1487206306 0 Nurse Practitioners Physician Services 00 1487208104 0 ANDERSON FARAH 2023199 9999999 B 10 1487208104 0 723 15TH AVE EAST MOLINE IL 612442133 20 1487208104 0 Other behavior health professional LCPC/LMFT services 00 1487208369 0 KENDALL SAMANTHA M 2020107 9999999 B 10 1487208369 0 5 VETERANS PKWY COLUMBIA IL 622361147 20 1487208369 0 Speech Therapists Medical Supplies 20 1487208369 0 Speech Therapists Medical 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Physicians Physician Services 00 1487210837 0 SINGH SHARONPEET 2025063 9999999 B 10 1487210837 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1487210837 0 Physicians Anesthesia Services 20 1487210837 0 Physicians Fluoride varnish 20 1487210837 0 Physicians Healthy Kids Services 20 1487210837 0 Physicians Optical Supplies 20 1487210837 0 Physicians Physician Services 00 1487211298 0 LAMPINEN KARA 2020143 9999999 B 10 1487211298 0 6809 MCCULLOM LAKE RD WONDER LAKE IL 600979546 20 1487211298 0 Speech Therapists Speech Therapy/Pathology Services 00 1487211470 0 CHEN HUIYI 2023039 9999999 B 10 1487211470 0 1106 MIDWEST CLUB PKWY OAK BROOK IL 605232535 20 1487211470 0 Other behavior health professional LCPC/LMFT services 00 1487211694 0 HEGAZY AHMED M 2019150 9999999 B 10 1487211694 0 640 OGDEN AVE STE E DOWNERS GROVE IL 605152940 20 1487211694 0 Dentists Dental Services 20 1487211694 0 Dentists Physician Services 00 1487211702 0 FUENTES VANESSA G 2020329 9999999 B 10 1487211702 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1487211702 0 Physicians Anesthesia Services 20 1487211702 0 Physicians Healthy Kids Services 20 1487211702 0 Physicians Optical Supplies 20 1487211702 0 Physicians Physician Services 00 1487211793 0 OZEN GULSEN 2024236 9999999 B 10 1487211793 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1487211793 0 Physicians Anesthesia Services 20 1487211793 0 Physicians Fluoride varnish 20 1487211793 0 Physicians Healthy Kids Services 20 1487211793 0 Physicians Optical Supplies 20 1487211793 0 Physicians Physician Services 00 1487212452 0 RYTLEWSKI KACIE 2022221 9999999 B 10 1487212452 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1487212452 0 Physicians Anesthesia Services 20 1487212452 0 Physicians Fluoride varnish 20 1487212452 0 Physicians Healthy Kids Services 20 1487212452 0 Physicians Optical Supplies 20 1487212452 0 Physicians Physician Services 00 1487213146 0 ONDERKO KAYLEE 2022063 9999999 B 10 1487213146 0 2045 W GRAND AVE STE B CHICAGO IL 606121577 20 1487213146 0 Speech Therapists Medical Supplies 20 1487213146 0 Speech Therapists Medical equipment/prosthetic devices 20 1487213146 0 Speech Therapists Speech Therapy/Pathology Services 00 1487213484 0 MARTENS SPENCER 2020276 9999999 B 10 1487213484 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1487213484 0 Physicians Anesthesia Services 20 1487213484 0 Physicians Healthy Kids Services 20 1487213484 0 Physicians Optical Supplies 20 1487213484 0 Physicians Physician Services 00 1487213864 0 VANDERMIERDEN JAMIE 2019198 9999999 B 10 1487213864 0 1701 LACEY ST CAPE GIRARDEAU MO 637015230 20 1487213864 0 Nurse Practitioners Healthy Kids Services 20 1487213864 0 Nurse Practitioners Nurse Practitioners Services 20 1487213864 0 Nurse Practitioners Physician Services 00 1487214029 0 RAVELLA BALAKRISHNA 2022188 9999999 B 10 1487214029 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1487214029 0 Physicians Anesthesia Services 20 1487214029 0 Physicians Fluoride varnish 20 1487214029 0 Physicians Healthy Kids Services 20 1487214029 0 Physicians Optical Supplies 20 1487214029 0 Physicians Physician Services 00 1487215638 0 MEDAVARAM ATUL 2023167 9999999 B 10 1487215638 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1487215638 0 Physicians Anesthesia Services 20 1487215638 0 Physicians Fluoride varnish 20 1487215638 0 Physicians Healthy Kids Services 20 1487215638 0 Physicians Optical Supplies 20 1487215638 0 Physicians Physician Services 00 1487217642 0 DORDEK TARA E 2019141 9999999 B 10 1487217642 0 5777 DEPT CAROL STREAM IL 601220021 20 1487217642 0 Physician Assistant Only Fluoride varnish 20 1487217642 0 Physician Assistant Only Healthy Kids Services 20 1487217642 0 Physician Assistant Only Physician Services 00 1487218103 0 FRIEDMAN LINDSAY R 2021161 9999999 B 10 1487218103 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1487218103 0 Physicians Anesthesia Services 20 1487218103 0 Physicians Healthy Kids Services 20 1487218103 0 Physicians Optical Supplies 20 1487218103 0 Physicians Physician Services 00 1487218772 0 AVERY JADE 2024158 9999999 B 10 1487218772 0 5777 DEPT CAROL STREAM IL 601220021 20 1487218772 0 Physicians Anesthesia Services 20 1487218772 0 Physicians Healthy Kids Services 20 1487218772 0 Physicians Optical Supplies 20 1487218772 0 Physicians Physician Services 20 1487218772 0 Physicians Physicians Psychiatric Services 00 1487218921 0 ISUFI MARVINA M 2019140 9999999 B 10 1487218921 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1487218921 0 Nurse Practitioners Fluoride varnish 20 1487218921 0 Nurse Practitioners Healthy Kids Services 20 1487218921 0 Nurse Practitioners Nurse Practitioners Services 20 1487218921 0 Nurse Practitioners Physician Services 00 1487220109 0 GOLDEN KIMBERLY 2021182 9999999 B 10 1487220109 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1487220109 0 Physicians Anesthesia Services 20 1487220109 0 Physicians Fluoride varnish 20 1487220109 0 Physicians Healthy Kids Services 20 1487220109 0 Physicians Optical Supplies 20 1487220109 0 Physicians Physician Services 00 1487220422 0 HUERTA EDUARDO 2021153 9999999 H 10 1487220422 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1487220422 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487221750 0 ZENGER BRIAN 2023309 9999999 B 10 1487221750 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1487221750 0 Physicians Anesthesia Services 20 1487221750 0 Physicians Fluoride varnish 20 1487221750 0 Physicians Healthy Kids Services 20 1487221750 0 Physicians Optical Supplies 20 1487221750 0 Physicians Physician Services 00 1487222303 0 KAMRAN MOOSA 2021194 9999999 B 10 1487222303 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1487222303 0 Physicians Anesthesia Services 20 1487222303 0 Physicians Fluoride varnish 20 1487222303 0 Physicians Healthy Kids Services 20 1487222303 0 Physicians Optical Supplies 20 1487222303 0 Physicians Physician Services 00 1487222410 0 WAQAR SAMAR 2024192 9999999 B 10 1487222410 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1487222410 0 Physicians Anesthesia Services 20 1487222410 0 Physicians Fluoride varnish 20 1487222410 0 Physicians Healthy Kids Services 20 1487222410 0 Physicians Optical Supplies 20 1487222410 0 Physicians Physician Services 00 1487223061 0 RYAN SYDNEY 2022300 9999999 B 10 1487223061 0 715 LAKE ST STE 800 OAK PARK IL 603011417 20 1487223061 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487223384 0 SON TIFFANY J 2021242 9999999 B 10 1487223384 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1487223384 0 Physicians Anesthesia Services 20 1487223384 0 Physicians Healthy Kids Services 20 1487223384 0 Physicians Optical Supplies 20 1487223384 0 Physicians Physician Services 20 1487223384 0 Physicians Physicians Psychiatric Services 00 1487225025 0 DUONG PRISCILLA 2021202 9999999 B 10 1487225025 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1487225025 0 Physicians Anesthesia Services 20 1487225025 0 Physicians Healthy Kids Services 20 1487225025 0 Physicians Optical Supplies 20 1487225025 0 Physicians Physician Services 20 1487225025 0 Physicians Physicians Psychiatric Services 00 1487225389 0 GONZALEZ DAVILA MARTHA CITLALY 2021251 9999999 B 10 1487225389 0 830 S ADDISON AVE VILLA PARK IL 601812877 20 1487225389 0 Psychologist Psychologist service 00 1487226999 0 MAJACHANI NICOLE N 2024197 9999999 B 10 1487226999 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1487226999 0 Physicians Anesthesia Services 20 1487226999 0 Physicians Fluoride varnish 20 1487226999 0 Physicians Healthy Kids Services 20 1487226999 0 Physicians Optical Supplies 20 1487226999 0 Physicians Physician Services 00 1487227419 0 MENDOZA ARACELI 2025014 9999999 B 10 1487227419 0 501 7TH ST ROCKFORD IL 611041242 20 1487227419 0 Speech Therapists Medical Supplies 20 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Optical Supplies 20 1487229795 0 Physicians Physician Services 00 1487230041 0 PAMULAPATI SAAGAR V 2021203 9999999 B 10 1487230041 0 PO BOX 3039 OAK BROOK IL 605223039 20 1487230041 0 Physicians Anesthesia Services 20 1487230041 0 Physicians Fluoride varnish 20 1487230041 0 Physicians Healthy Kids Services 20 1487230041 0 Physicians Optical Supplies 20 1487230041 0 Physicians Physician Services 00 1487230215 0 APPUKUTTY ABHINAV J 2021325 9999999 B 10 1487230215 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1487230215 0 Physicians Anesthesia Services 20 1487230215 0 Physicians Fluoride varnish 20 1487230215 0 Physicians Healthy Kids Services 20 1487230215 0 Physicians Optical Supplies 20 1487230215 0 Physicians Physician Services 00 1487230884 0 AKULA VENKATA S 2021225 9999999 B 10 1487230884 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1487230884 0 Physicians Anesthesia Services 20 1487230884 0 Physicians Fluoride varnish 20 1487230884 0 Physicians Healthy Kids Services 20 1487230884 0 Physicians Optical Supplies 20 1487230884 0 Physicians Physician Services 00 1487230900 0 FUCHS JOSEPH 2021173 9999999 B 10 1487230900 0 4698 DEPT CAROL STREAM IL 601220021 20 1487230900 0 Physicians Anesthesia Services 20 1487230900 0 Physicians Fluoride varnish 20 1487230900 0 Physicians Healthy Kids Services 20 1487230900 0 Physicians Optical Supplies 20 1487230900 0 Physicians Physician Services 00 1487230926 0 RAO AMITH 2021160 9999999 B 10 1487230926 0 4698 DEPT CAROL STREAM IL 601220021 20 1487230926 0 Physicians Anesthesia Services 20 1487230926 0 Physicians Healthy Kids Services 20 1487230926 0 Physicians Optical Supplies 20 1487230926 0 Physicians Physician Services 00 1487231122 0 ACHEAMPONG NASRAH S 2021182 9999999 B 10 1487231122 0 PO BOX 3039 OAK BROOK IL 605223039 20 1487231122 0 Physicians Anesthesia Services 20 1487231122 0 Physicians Healthy Kids Services 20 1487231122 0 Physicians Optical Supplies 20 1487231122 0 Physicians Physician Services 00 1487231155 0 TRINIDAD IVANA L 2021176 9999999 B 10 1487231155 0 PO BOX 3039 OAK BROOK IL 605223039 20 1487231155 0 Physicians Anesthesia Services 20 1487231155 0 Physicians Healthy Kids Services 20 1487231155 0 Physicians Optical Supplies 20 1487231155 0 Physicians Physician Services 00 1487231478 0 RUSTOM HANI 2021182 9999999 B 10 1487231478 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1487231478 0 Physicians Anesthesia Services 20 1487231478 0 Physicians Fluoride varnish 20 1487231478 0 Physicians Healthy Kids Services 20 1487231478 0 Physicians Optical Supplies 20 1487231478 0 Physicians Physician Services 00 1487232609 0 RARICK KELSI R 2021092 9999999 B 10 1487232609 0 3350 W SALT CREEK LN STE 115 ARLINGTON HEIGH IL 600051089 20 1487232609 0 Speech Therapists Medical Supplies 20 1487232609 0 Speech Therapists Medical equipment/prosthetic devices 20 1487232609 0 Speech Therapists Speech Therapy/Pathology Services 00 1487234100 0 THOLANY JOHN 2024205 9999999 B 10 1487234100 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KRISHNA S 2024275 9999999 B 10 1487234985 0 PO BOX 5009 BRENTWOOD TN 370245009 20 1487234985 0 Physicians Anesthesia Services 20 1487234985 0 Physicians Fluoride varnish 20 1487234985 0 Physicians Healthy Kids Services 20 1487234985 0 Physicians Optical Supplies 20 1487234985 0 Physicians Physician Services 00 1487235180 0 CHEAV SOVANNDY B 2023182 9999999 B 10 1487235180 0 4698 DEPT CAROL STREAM IL 601220021 20 1487235180 0 Physicians Anesthesia Services 20 1487235180 0 Physicians Healthy Kids Services 20 1487235180 0 Physicians Optical Supplies 20 1487235180 0 Physicians Physician Services 00 1487235321 0 BARRETT KATIE L 2021292 9999999 B 10 1487235321 0 1600 W WALNUT ST JACKSONVILLE IL 626501136 20 1487235321 0 Nurse Practitioners Anesthesia Services 20 1487235321 0 Nurse Practitioners Nurse Practitioners Services 20 1487235321 0 Nurse Practitioners Physician Services 00 1487235396 0 LIN JASON 2021223 9999999 B 10 1487235396 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1487235396 0 Physicians Anesthesia Services 20 1487235396 0 Physicians Healthy Kids Services 20 1487235396 0 Physicians Optical Supplies 20 1487235396 0 Physicians Physician Services 00 1487235701 0 FONEY NIA D 2021198 9999999 B 10 1487235701 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1487235701 0 Physicians Anesthesia Services 20 1487235701 0 Physicians Fluoride varnish 20 1487235701 0 Physicians Healthy Kids Services 20 1487235701 0 Physicians Optical Supplies 20 1487235701 0 Physicians Physician Services 00 1487235826 0 PITNEY RYAN 2024235 9999999 B 10 1487235826 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1487235826 0 Physicians Anesthesia Services 20 1487235826 0 Physicians Healthy Kids Services 20 1487235826 0 Physicians Optical Supplies 20 1487235826 0 Physicians Physician Services 00 1487236105 0 SEROTTE JORDAN C 2021183 9999999 B 10 1487236105 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1487236105 0 Physicians Anesthesia Services 20 1487236105 0 Physicians Healthy Kids Services 20 1487236105 0 Physicians Optical Supplies 20 1487236105 0 Physicians Physician Services 00 1487236204 0 ZAMAN AZKAA R 2021191 9999999 B 10 1487236204 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1487236204 0 Physicians Anesthesia Services 20 1487236204 0 Physicians Fluoride varnish 20 1487236204 0 Physicians Healthy Kids Services 20 1487236204 0 Physicians Optical Supplies 20 1487236204 0 Physicians Physician Services 00 1487236923 0 GILLEN SARAH 2024233 9999999 B 10 1487236923 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1487236923 0 Physicians Anesthesia Services 20 1487236923 0 Physicians Healthy Kids Services 20 1487236923 0 Physicians Optical Supplies 20 1487236923 0 Physicians Physician Services 00 1487237061 0 LIPPMAN JEREMY D 2024030 9999999 B 10 1487237061 0 24014 W RENWICK RD PLAINFIELD IL 605448708 20 1487237061 0 Physical Therapists Medical Supplies 20 1487237061 0 Physical Therapists Medical equipment/prosthetic devices 20 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20 1487314316 0 Nurse Practitioners Healthy Kids Services 20 1487314316 0 Nurse Practitioners Nurse Practitioners Services 20 1487314316 0 Nurse Practitioners Physician Services 00 1487315511 0 MUNOZ MARITZA 2022014 9999999 B 10 1487315511 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1487315511 0 Nurse Practitioners Fluoride varnish 20 1487315511 0 Nurse Practitioners Healthy Kids Services 20 1487315511 0 Nurse Practitioners Nurse Practitioners Services 20 1487315511 0 Nurse Practitioners Physician Services 00 1487316113 0 BECKER VALERIE R 2022308 9999999 B 10 1487316113 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1487316113 0 Nurse Practitioners Healthy Kids Services 20 1487316113 0 Nurse Practitioners Nurse Practitioners Services 20 1487316113 0 Nurse Practitioners Physician Services 00 1487316444 0 FRITZ SADE 2024172 9999999 B 10 1487316444 0 PO BOX 146 WATERLOO IL 622980146 20 1487316444 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and 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TATE-LEE TAMIRA 2021266 9999999 B 10 1487323325 0 8 S MICHIGAN AVE STE 1700 CHICAGO IL 606033353 20 1487323325 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487324455 0 TONGSON ISABELLE 2022090 9999999 B 10 1487324455 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1487324455 0 Nurse Practitioners Fluoride varnish 20 1487324455 0 Nurse Practitioners Healthy Kids Services 20 1487324455 0 Nurse Practitioners Nurse Practitioners Services 20 1487324455 0 Nurse Practitioners Physician Services 00 1487324919 0 FANKAM FRANK E 2023135 9999999 B 10 1487324919 0 PO BOX 235019 MONTGOMERY AL 361235019 20 1487324919 0 Nurse Practitioners Anesthesia Services 20 1487324919 0 Nurse Practitioners Nurse Practitioners Services 20 1487324919 0 Nurse Practitioners Physician Services 00 1487327532 0 MAHARJAN SUMAN 2022055 9999999 B 10 1487327532 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1487327532 0 Physicians Anesthesia Services 20 1487327532 0 Physicians Fluoride varnish 20 1487327532 0 Physicians Healthy Kids Services 20 1487327532 0 Physicians Optical Supplies 20 1487327532 0 Physicians Physician Services 00 1487327797 0 KNECHT HAILEY 2024232 9999999 B 10 1487327797 0 PO BOX 781076 DETROIT MI 482781076 20 1487327797 0 Physician Assistant Only Fluoride varnish 20 1487327797 0 Physician Assistant Only Healthy Kids Services 20 1487327797 0 Physician Assistant Only Physician Services 00 1487328134 0 BLANK JESSICA 2021305 9999999 B 10 1487328134 0 PO BOX 734477 CHICAGO IL 606734477 20 1487328134 0 Nurse Practitioners Healthy Kids Services 20 1487328134 0 Nurse Practitioners Nurse Practitioners Services 20 1487328134 0 Nurse Practitioners Physician Services 00 1487328316 0 TRINIDAD MATTHEW 2023143 9999999 B 10 1487328316 0 PO BOX 1430 PORTAGE IN 463689230 20 1487328316 0 Chiropractors Chiropractic Services 00 1487328506 0 FOSTER ANNE O 2021246 9999999 B 10 1487328506 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1487328506 0 Nurse Practitioners Fluoride varnish 20 1487328506 0 Nurse Practitioners Healthy Kids Services 20 1487328506 0 Nurse Practitioners Nurse Practitioners Services 20 1487328506 0 Nurse Practitioners Physician Services 00 1487328621 0 SELZER ERIKA J 2021237 9999999 B 10 1487328621 0 310 S MAIN ST STE D LOMBARD IL 601482692 20 1487328621 0 Speech Therapists Medical Supplies 20 1487328621 0 Speech Therapists Medical equipment/prosthetic devices 20 1487328621 0 Speech Therapists Speech Therapy/Pathology Services 00 1487329439 0 GENRE JENNA 2021258 9999999 B 10 1487329439 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1487329439 0 Nurse Practitioners Healthy Kids Services 20 1487329439 0 Nurse Practitioners Midwife Services 20 1487329439 0 Nurse Practitioners Nurse Practitioners Services 20 1487329439 0 Nurse Practitioners Physician Services 00 1487331450 0 ADHIKARI SANTOSH 2023240 9999999 B 10 1487331450 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1487331450 0 Physicians Anesthesia Services 20 1487331450 0 Physicians Fluoride varnish 20 1487331450 0 Physicians Healthy Kids Services 20 1487331450 0 Physicians Optical Supplies 20 1487331450 0 Physicians Physician Services 00 1487331823 0 ASHLEY MARY 2023310 9999999 B 10 1487331823 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1487331823 0 Physician Assistant Only Fluoride varnish 20 1487331823 0 Physician Assistant Only Healthy Kids Services 20 1487331823 0 Physician Assistant Only Physician Services 00 1487332292 0 SIKORA JESSICA 2023193 9999999 B 10 1487332292 0 PO BOX 5081 JANESVILLE WI 535475081 20 1487332292 0 Speech Therapists Medical Supplies 20 1487332292 0 Speech Therapists Medical equipment/prosthetic devices 20 1487332292 0 Speech Therapists Speech Therapy/Pathology Services 00 1487333159 0 CHAPON LISA R 2023193 9999999 B 10 1487333159 0 1475 MAPLE AVE NORTHBROOK IL 600625418 20 1487333159 0 Speech Therapists Medical Supplies 20 1487333159 0 Speech Therapists Medical equipment/prosthetic devices 20 1487333159 0 Speech Therapists Speech Therapy/Pathology Services 00 1487334835 0 SALEHBEIKI ALIREZA 2023208 9999999 B 10 1487334835 0 PO BOX 855671 MINNEAPOLIS MN 554851153 20 1487334835 0 Physicians Anesthesia Services 20 1487334835 0 Physicians Fluoride varnish 20 1487334835 0 Physicians Healthy Kids Services 20 1487334835 0 Physicians Optical Supplies 20 1487334835 0 Physicians Physician Services 00 1487336400 0 BARRON MARY ELIZABETH 2023219 9999999 B 10 1487336400 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1487336400 0 Registered nurse Nursing service 20 1487336400 0 Registered nurse Waiver service 00 1487338463 0 HUMPHRIES JOSEPH 2024268 9999999 B 10 1487338463 0 8777 PURDUE RD STE 115 INDIANAPOLIS IN 462683104 20 1487338463 0 Dentists Dental Services 20 1487338463 0 Dentists Physician Services 00 1487339446 0 O'DELL RACHEL A 2023196 9999999 B 10 1487339446 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1487339446 0 Physicians Anesthesia Services 20 1487339446 0 Physicians Healthy Kids Services 20 1487339446 0 Physicians Optical Supplies 20 1487339446 0 Physicians Physician Services 00 1487339453 0 ARMAN GENAN 2023195 9999999 B 10 1487339453 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1487339453 0 Physicians Anesthesia Services 20 1487339453 0 Physicians Fluoride varnish 20 1487339453 0 Physicians Healthy Kids Services 20 1487339453 0 Physicians Optical Supplies 20 1487339453 0 Physicians Physician Services 00 1487339479 0 WRIGHT ALEXANDER Y 2023191 9999999 B 10 1487339479 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1487339479 0 Physicians Anesthesia Services 20 1487339479 0 Physicians Fluoride varnish 20 1487339479 0 Physicians Healthy Kids Services 20 1487339479 0 Physicians Optical Supplies 20 1487339479 0 Physicians Physician Services 00 1487340006 0 THRELKELD EDIE 2024169 9999999 B 10 1487340006 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1487340006 0 Physicians Anesthesia Services 20 1487340006 0 Physicians Healthy Kids Services 20 1487340006 0 Physicians Optical Supplies 20 1487340006 0 Physicians Physician Services 00 1487340469 0 URSO CARMEN 2024208 9999999 B 10 1487340469 0 515 22ND AVE MONROE WI 535661569 20 1487340469 0 Physicians Anesthesia Services 20 1487340469 0 Physicians Fluoride varnish 20 1487340469 0 Physicians Healthy Kids Services 20 1487340469 0 Physicians Optical Supplies 20 1487340469 0 Physicians Physician Services 00 1487341400 0 GARCIA ANGELA 2023118 9999999 B 10 1487341400 0 414 PLAZA DR STE 301 WESTMONT IL 605595508 20 1487341400 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487341525 0 WAIL DANA 2023129 9999999 B 10 1487341525 0 5635 S ARCHER AVE CHICAGO IL 606381673 20 1487341525 0 Other behavior health professional LCPC/LMFT services 00 1487341756 0 ROMANOS SHARBEL 2024175 9999999 B 10 1487341756 0 4698 DEPT CAROL STREAM IL 601220021 20 1487341756 0 Physicians Anesthesia Services 20 1487341756 0 Physicians Healthy Kids Services 20 1487341756 0 Physicians Optical Supplies 20 1487341756 0 Physicians Physician Services 00 1487341863 0 FRIEDMAN REBECCA 2024240 9999999 B 10 1487341863 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1487341863 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487343729 0 DINELLI JESSIE L 2024204 9999999 B 10 1487343729 0 1425 N HUNT CLUB RD STE 100 GURNEE IL 600312632 20 1487343729 0 Nurse Practitioners Fluoride varnish 20 1487343729 0 Nurse Practitioners Healthy Kids Services 20 1487343729 0 Nurse Practitioners Nurse Practitioners Services 20 1487343729 0 Nurse Practitioners Physician Services 00 1487345070 0 RAPOLTI DIANA IOANA 2023195 9999999 B 10 1487345070 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1487345070 0 Physicians Anesthesia Services 20 1487345070 0 Physicians Healthy Kids Services 20 1487345070 0 Physicians Optical Supplies 20 1487345070 0 Physicians Physician Services 00 1487347159 0 DRAKE ASHLEY 2024228 9999999 B 10 1487347159 0 1095 PINGREE RD STE 108 CRYSTAL LAKE IL 600141726 20 1487347159 0 Nurse Practitioners Fluoride varnish 20 1487347159 0 Nurse Practitioners Healthy Kids Services 20 1487347159 0 Nurse Practitioners Nurse Practitioners Services 20 1487347159 0 Nurse Practitioners Physician Services 00 1487347746 0 DUNLEAVY TIM 2024248 9999999 B 10 1487347746 0 412 W 31ST ST CHICAGO IL 606163116 20 1487347746 0 Physical Therapists Medical Supplies 20 1487347746 0 Physical Therapists Medical equipment/prosthetic devices 20 1487347746 0 Physical Therapists Physical Therapy Services 00 1487348355 0 PETRUS NICHOLAS 2023202 9999999 B 10 1487348355 0 212 BARNEY DR JOLIET IL 604355271 20 1487348355 0 Speech Therapists Medical Supplies 20 1487348355 0 Speech Therapists Medical equipment/prosthetic devices 20 1487348355 0 Speech Therapists Speech Therapy/Pathology Services 00 1487349239 0 RACHFORD CONNOR 2023363 9999999 B 10 1487349239 0 124 SW ADAMS ST PEORIA IL 616021308 20 1487349239 0 Physicians Anesthesia Services 20 1487349239 0 Physicians Fluoride varnish 20 1487349239 0 Physicians Healthy Kids Services 20 1487349239 0 Physicians Optical Supplies 20 1487349239 0 Physicians Physician Services 00 1487349635 0 KHOURI CHRISTINA 2023212 9999999 B 10 1487349635 0 PO BOX 3039 OAK BROOK IL 605223039 20 1487349635 0 Physicians Anesthesia Services 20 1487349635 0 Physicians Fluoride varnish 20 1487349635 0 Physicians Healthy Kids Services 20 1487349635 0 Physicians Optical Supplies 20 1487349635 0 Physicians Physician Services 00 1487351623 0 TANSEY AMBER 2024059 9999999 B 10 1487351623 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1487351623 0 Nurse Practitioners Healthy Kids Services 20 1487351623 0 Nurse Practitioners Nurse Practitioners Services 20 1487351623 0 Nurse Practitioners Physician Services 00 1487352464 0 VISTELLE CHRISTOPHE 2024005 9999999 B 10 1487352464 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1487352464 0 Physician Assistant Only Fluoride varnish 20 1487352464 0 Physician Assistant Only Healthy Kids Services 20 1487352464 0 Physician Assistant Only Physician Services 00 1487353660 0 PONCE FIDEL 2023058 9999999 B 10 1487353660 0 PO BOX 1109 DEKALB IL 601157109 20 1487353660 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487354064 0 CHRISTIAN STEPHANIE 2024281 9999999 B 10 1487354064 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1487354064 0 Nurse Practitioners Fluoride varnish 20 1487354064 0 Nurse Practitioners Healthy Kids Services 20 1487354064 0 Nurse Practitioners Nurse Practitioners Services 20 1487354064 0 Nurse Practitioners Physician Services 00 1487354353 0 GIST RYAN 2024253 9999999 B 10 1487354353 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1487354353 0 Physician Assistant Only Fluoride varnish 20 1487354353 0 Physician Assistant Only Healthy Kids Services 20 1487354353 0 Physician Assistant Only Physician Services 00 1487355038 0 FATIMA MAH E NOOR 2023314 9999999 B 10 1487355038 0 1812 N 19TH AVE MELROSE PARK IL 601602039 20 1487355038 0 Dentists Dental Services 20 1487355038 0 Dentists Physician Services 00 1487355368 0 KEARNS JENNIFER 2024037 9999999 B 10 1487355368 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1487355368 0 Nurse Practitioners Healthy Kids Services 20 1487355368 0 Nurse Practitioners Nurse Practitioners Services 20 1487355368 0 Nurse Practitioners Physician Services 00 1487355384 0 CASINELLI ERIC J 2024192 9999999 B 10 1487355384 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1487355384 0 Physicians Anesthesia Services 20 1487355384 0 Physicians Fluoride varnish 20 1487355384 0 Physicians Healthy Kids Services 20 1487355384 0 Physicians Optical Supplies 20 1487355384 0 Physicians Physician Services 00 1487356333 0 DASS MADHUR 2023094 9999999 B 10 1487356333 0 PO BOX 7951 BELFAST ME 049157900 20 1487356333 0 Nurse Practitioners Fluoride varnish 20 1487356333 0 Nurse Practitioners Healthy Kids Services 20 1487356333 0 Nurse Practitioners Nurse Practitioners Services 20 1487356333 0 Nurse Practitioners Physician Services 00 1487356556 0 ENSIGN BRYSON 2023212 9999999 B 10 1487356556 0 221 NE GLEN OAK AVE PEORIA IL 616360002 20 1487356556 0 Physicians Anesthesia Services 20 1487356556 0 Physicians Healthy Kids Services 20 1487356556 0 Physicians Optical Supplies 20 1487356556 0 Physicians Physician Services 20 1487356556 0 Physicians Physicians Psychiatric Services 00 1487356804 0 CHARLETON MARY 2024208 9999999 B 10 1487356804 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1487356804 0 Physicians Anesthesia Services 20 1487356804 0 Physicians Healthy Kids Services 20 1487356804 0 Physicians Optical Supplies 20 1487356804 0 Physicians Physician Services 00 1487356994 0 PRASANNA ANAGHA 2023174 9999999 B 10 1487356994 0 4698 DEPT CAROL STREAM IL 601220021 20 1487356994 0 Physicians Anesthesia Services 20 1487356994 0 Physicians Healthy Kids Services 20 1487356994 0 Physicians Optical Supplies 20 1487356994 0 Physicians Physician Services 00 1487357695 0 TADALAN MELANIE 2023187 9999999 B 10 1487357695 0 214 CENTERVIEW DR STE 250 BRENTWOOD TN 370273248 20 1487357695 0 Nurse Practitioners Fluoride varnish 20 1487357695 0 Nurse Practitioners Healthy Kids Services 20 1487357695 0 Nurse Practitioners Nurse Practitioners Services 20 1487357695 0 Nurse Practitioners Physician Services 00 1487357778 0 RUELLE MARIANNE 2023182 9999999 B 10 1487357778 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1487357778 0 Physicians Anesthesia Services 20 1487357778 0 Physicians Healthy Kids Services 20 1487357778 0 Physicians Optical Supplies 20 1487357778 0 Physicians Physician Services 00 1487358396 0 VELIS YESENIA 2023227 2026181 B 10 1487358396 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1487358396 0 Physicians Anesthesia Services 20 1487358396 0 Physicians Fluoride varnish 20 1487358396 0 Physicians Healthy Kids Services 20 1487358396 0 Physicians Optical Supplies 20 1487358396 0 Physicians Physician Services 00 1487358776 0 WHITE WANDA 2023094 9999999 B 10 1487358776 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1487358776 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487359394 0 TRIPP KNICHOLE 2023132 9999999 B 10 1487359394 0 211 N BROADWAY GOREVILLE IL 629392323 20 1487359394 0 Nurse Practitioners Family Planning Counseling 20 1487359394 0 Nurse Practitioners Fluoride varnish 20 1487359394 0 Nurse Practitioners Healthy Kids Services 20 1487359394 0 Nurse Practitioners Nurse Practitioners Services 20 1487359394 0 Nurse Practitioners Physician Services 00 1487359410 0 FATUNMBI OLUWAFUNMBI 2024002 9999999 B 10 1487359410 0 4698 DEPT CAROL STREAM IL 601224698 20 1487359410 0 Physicians Anesthesia Services 20 1487359410 0 Physicians Fluoride varnish 20 1487359410 0 Physicians Healthy Kids Services 20 1487359410 0 Physicians Optical Supplies 20 1487359410 0 Physicians Physician Services 00 1487359964 0 SIDDIQUI HAREEM 2024078 2026181 B 10 1487359964 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1487359964 0 Physicians Anesthesia Services 20 1487359964 0 Physicians Healthy Kids Services 20 1487359964 0 Physicians Optical Supplies 20 1487359964 0 Physicians Physician Services 00 1487363552 0 CHAPPLE MIA M 2022357 9999999 B 10 1487363552 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1487363552 0 Nurse Practitioners Healthy Kids Services 20 1487363552 0 Nurse Practitioners Nurse Practitioners Services 20 1487363552 0 Nurse Practitioners Physician Services 00 1487364816 0 CATIZONE-DIEGUEZ JOY M 2022340 9999999 B 10 1487364816 0 17 N STATE ST STE 500 CHICAGO IL 606023384 20 1487364816 0 Nurse Practitioners Family Planning Counseling 20 1487364816 0 Nurse Practitioners Healthy Kids Services 20 1487364816 0 Nurse Practitioners Nurse Practitioners Services 20 1487364816 0 Nurse Practitioners Physician Services 00 1487365219 0 FRANK GINA A 2023193 9999999 B 10 1487365219 0 PO BOX 120288 DALLAS TX 753120288 20 1487365219 0 Nurse Practitioners Fluoride varnish 20 1487365219 0 Nurse Practitioners Healthy Kids Services 20 1487365219 0 Nurse Practitioners Nurse Practitioners Services 20 1487365219 0 Nurse Practitioners Physician Services 00 1487366035 0 WILDERMAN ALYSSA 2024134 9999999 B 10 1487366035 0 1804 N NAPER BLVD STE 250 NAPERVILLE IL 605638830 20 1487366035 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487366811 0 FORST KATHRYN 2022350 9999999 B 10 1487366811 0 PO BOX 1109 DEKALB IL 601157109 20 1487366811 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487369054 0 O'NEIL ANNABELLE M 2023025 9999999 B 10 1487369054 0 10001 GRAND AVE ATTN: BILLING DEPARTMENT FRANKLIN PARK IL 601312563 20 1487369054 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487370029 0 HAWLEY ABIGAIL 2023041 9999999 B 10 1487370029 0 107 S MCLEAN BLVD STE B SOUTH ELGIN IL 601771822 20 1487370029 0 Nurse Practitioners Fluoride varnish 20 1487370029 0 Nurse Practitioners Healthy Kids Services 20 1487370029 0 Nurse Practitioners Nurse Practitioners Services 20 1487370029 0 Nurse Practitioners Physician Services 00 1487370250 0 HOLLEY CHARLOTTE 2022286 9999999 B 10 1487370250 0 120 S MARION ST OAK PARK IL 603022809 20 1487370250 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487371712 0 DHILLON AMRJIT 2023017 9999999 B 10 1487371712 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1487371712 0 Nurse Practitioners Healthy Kids Services 20 1487371712 0 Nurse Practitioners Nurse Practitioners Services 20 1487371712 0 Nurse Practitioners Physician Services 00 1487373775 0 SIDDIQUI AMIR 2023174 9999999 B 10 1487373775 0 PO BOX 3039 OAK BROOK IL 605223039 20 1487373775 0 Physicians Anesthesia Services 20 1487373775 0 Physicians Healthy Kids Services 20 1487373775 0 Physicians Optical Supplies 20 1487373775 0 Physicians Physician Services 00 1487373809 0 PAX CASSANDRA 2024085 9999999 B 10 1487373809 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1487373809 0 Other behavior health professional LCPC/LMFT services 00 1487373916 0 O''BRIEN KELSEY 2024192 9999999 B 10 1487373916 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1487373916 0 Nurse Practitioners Anesthesia Services 20 1487373916 0 Nurse Practitioners Nurse Practitioners Services 20 1487373916 0 Nurse Practitioners Physician Services 00 1487374260 0 BROTTMAN FRANCINE 2022298 9999999 H 10 1487374260 0 1120 RANDALL CT GENEVA IL 601343911 20 1487374260 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487374518 0 LEE ASHTON E 2022251 9999999 B 10 1487374518 0 PO BOX 3988 CARBONDALE IL 629023988 20 1487374518 0 Physician Assistant Only Fluoride varnish 20 1487374518 0 Physician Assistant Only Healthy Kids Services 20 1487374518 0 Physician Assistant Only Physician Services 00 1487374682 0 CHASE ELIZABETH 2022258 9999999 B 10 1487374682 0 350 N WALL ST KANKAKEE IL 609012901 20 1487374682 0 Nurse Practitioners Fluoride varnish 20 1487374682 0 Nurse Practitioners Healthy Kids Services 20 1487374682 0 Nurse Practitioners Nurse Practitioners Services 20 1487374682 0 Nurse Practitioners Physician Services 00 1487376984 0 ISER-SCHNEIDER JULIE S 2024352 9999999 B 10 1487376984 0 1440 RENAISSANCE DR STE 320 PARK RIDGE IL 600681471 20 1487376984 0 Clinical Social Worker Social work service 00 1487379244 0 YECKE ANGELA 2022348 9999999 B 10 1487379244 0 4025 N SHERIDAN RD CHICAGO IL 606132010 20 1487379244 0 Nurse Practitioners Fluoride varnish 20 1487379244 0 Nurse Practitioners Healthy Kids Services 20 1487379244 0 Nurse Practitioners Nurse Practitioners Services 20 1487379244 0 Nurse Practitioners Physician Services 00 1487380184 0 RITZ AUTUMN M 2022297 9999999 B 10 1487380184 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1487380184 0 Nurse Practitioners Fluoride varnish 20 1487380184 0 Nurse Practitioners Healthy Kids Services 20 1487380184 0 Nurse Practitioners Nurse Practitioners Services 20 1487380184 0 Nurse Practitioners Physician Services 00 1487381125 0 SOBENES ELIZABETH 2022335 9999999 B 10 1487381125 0 8300 CALLIE AVE UNIT 405 MORTON GROVE IL 600533722 20 1487381125 0 Other behavior health professional LCPC/LMFT services 00 1487382156 0 GOLLIHER ALYSSA V 2022270 9999999 B 10 1487382156 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1487382156 0 Physician Assistant Only Fluoride varnish 20 1487382156 0 Physician Assistant Only Healthy Kids Services 20 1487382156 0 Physician Assistant Only Physician Services 00 1487382313 0 SARSABA RODERICK H 2023047 9999999 B 10 1487382313 0 PO BOX 83242 CHICAGO IL 606910242 20 1487382313 0 Nurse Practitioners Healthy Kids Services 20 1487382313 0 Nurse Practitioners Nurse Practitioners Services 20 1487382313 0 Nurse Practitioners Physician Services 00 1487382339 0 WONG MICHELLE 2023217 9999999 B 10 1487382339 0 715 LAKE ST STE 800 OAK PARK IL 603011417 20 1487382339 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487382685 0 CELIK BURAK 2025018 9999999 B 10 1487382685 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1487382685 0 Physicians Anesthesia Services 20 1487382685 0 Physicians Fluoride varnish 20 1487382685 0 Physicians Healthy Kids Services 20 1487382685 0 Physicians Optical Supplies 20 1487382685 0 Physicians Physician Services 00 1487383550 0 OMAR HASAAN 2023195 9999999 B 10 1487383550 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1487383550 0 Physicians Anesthesia Services 20 1487383550 0 Physicians Healthy Kids Services 20 1487383550 0 Physicians Optical Supplies 20 1487383550 0 Physicians Physician Services 00 1487383774 0 TRUJILLO MONICA M 2024228 9999999 B 10 1487383774 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1487383774 0 Nurse Practitioners Healthy Kids Services 20 1487383774 0 Nurse Practitioners Nurse Practitioners Services 20 1487383774 0 Nurse Practitioners Physician Services 00 1487386769 0 NUCCIO LISA 2022228 9999999 B 10 1487386769 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1487386769 0 Nurse Practitioners Fluoride varnish 20 1487386769 0 Nurse Practitioners Healthy Kids Services 20 1487386769 0 Nurse Practitioners Nurse Practitioners Services 20 1487386769 0 Nurse Practitioners Physician Services 00 1487386827 0 ZGHAYER ASEEL 2022209 9999999 B 10 1487386827 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1487386827 0 Physicians Anesthesia Services 20 1487386827 0 Physicians Fluoride varnish 20 1487386827 0 Physicians Healthy Kids Services 20 1487386827 0 Physicians Optical Supplies 20 1487386827 0 Physicians Physician Services 00 1487387221 0 AL-KASSEM ADAM 2022203 9999999 B 10 1487387221 0 2843 W IRVING PARK RD CHICAGO IL 606183624 20 1487387221 0 Dentists Dental Services 20 1487387221 0 Dentists Physician Services 00 1487387601 0 BARIMAYENA JUSTN K 2022194 9999999 B 10 1487387601 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1487387601 0 Physicians Anesthesia Services 20 1487387601 0 Physicians Fluoride varnish 20 1487387601 0 Physicians Healthy Kids Services 20 1487387601 0 Physicians Optical Supplies 20 1487387601 0 Physicians Physician Services 00 1487388013 0 MEI XUEYAN 2023229 9999999 B 10 1487388013 0 4714 GETTYSBURG RD MECHANICSBURG PA 170554325 20 1487388013 0 Physical Therapists Medical Supplies 20 1487388013 0 Physical Therapists Medical equipment/prosthetic devices 20 1487388013 0 Physical Therapists Physical Therapy Services 00 1487388179 0 KNOLL MARGARET 2022207 9999999 B 10 1487388179 0 4714 GETTYSBURG RD MECHANICSBURG PA 170554325 20 1487388179 0 Physical Therapists Medical Supplies 20 1487388179 0 Physical Therapists Medical equipment/prosthetic devices 20 1487388179 0 Physical Therapists Physical Therapy Services 00 1487388534 0 NGUYEN HONG THOAI 2022232 9999999 B 10 1487388534 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1487388534 0 Physicians Anesthesia Services 20 1487388534 0 Physicians Fluoride varnish 20 1487388534 0 Physicians Healthy Kids Services 20 1487388534 0 Physicians Optical Supplies 20 1487388534 0 Physicians Physician Services 00 1487389649 0 GARCIA ERICKA 2023320 9999999 B 10 1487389649 0 352 BROWN BLVD BOURBONNAIS IL 609142458 20 1487389649 0 Optometrists Optical Supplies 20 1487389649 0 Optometrists Optometric Services 20 1487389649 0 Optometrists Physician Services 00 1487390795 0 HIRSLEY BETH A 2022241 9999999 B 10 1487390795 0 6501 S PROMONTORY DR CHICAGO IL 606491003 20 1487390795 0 Nurse Practitioners Fluoride varnish 20 1487390795 0 Nurse Practitioners Healthy Kids Services 20 1487390795 0 Nurse Practitioners Nurse Practitioners Services 20 1487390795 0 Nurse Practitioners Physician Services 00 1487391496 0 BAER THERESA 2022165 9999999 B 10 1487391496 0 70 S RIVER ST AURORA IL 605065185 20 1487391496 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487392031 0 ROBINSON MICHELLE 2022169 9999999 B 10 1487392031 0 15 SPINNING WHEEL RD STE 30 HINSDALE IL 605217651 20 1487392031 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487392528 0 ARIANAS DEMETRA 2022354 9999999 B 10 1487392528 0 PO BOX 79591 BALTIMORE MD 212790591 20 1487392528 0 Optometrists Optical Supplies 20 1487392528 0 Optometrists Optometric Services 20 1487392528 0 Optometrists Physician Services 00 1487394078 0 SOBCZAK JANE M 2022171 9999999 B 10 1487394078 0 PO BOX 3039 OAK BROOK IL 605223039 20 1487394078 0 Dentists Dental Services 20 1487394078 0 Dentists Physician Services 00 1487395166 0 LANG MARGARET G 2022172 9999999 B 10 1487395166 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1487395166 0 Physicians Anesthesia Services 20 1487395166 0 Physicians Fluoride varnish 20 1487395166 0 Physicians Healthy Kids Services 20 1487395166 0 Physicians Optical Supplies 20 1487395166 0 Physicians Physician Services 00 1487395315 0 CHOE SHAWN 2023213 9999999 B 10 1487395315 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1487395315 0 Physicians Anesthesia Services 20 1487395315 0 Physicians Healthy Kids Services 20 1487395315 0 Physicians Optical Supplies 20 1487395315 0 Physicians Physician Services 00 1487396487 0 BEHRENS IMANI J 2022264 9999999 B 10 1487396487 0 7732 SOLUTION CENTER CHICAGO IL 606777007 20 1487396487 0 Dentists Dental Services 20 1487396487 0 Dentists Physician Services 00 1487397154 0 HUSSAIN ZAID A 2022182 9999999 B 10 1487397154 0 2020 OGDEN AVE STE 360 SUITE 360 AURORA IL 605046486 20 1487397154 0 Physicians Anesthesia Services 20 1487397154 0 Physicians Fluoride varnish 20 1487397154 0 Physicians Healthy Kids Services 20 1487397154 0 Physicians Optical Supplies 20 1487397154 0 Physicians Physician Services 00 1487398095 0 MUHAMMAD RAZA A 2023209 9999999 B 10 1487398095 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1487398095 0 Physicians Anesthesia Services 20 1487398095 0 Physicians Fluoride varnish 20 1487398095 0 Physicians Healthy Kids Services 20 1487398095 0 Physicians Optical Supplies 20 1487398095 0 Physicians Physician Services 00 1487398772 0 MAROLT CLAYTON 2022234 9999999 B 10 1487398772 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1487398772 0 Physicians Anesthesia Services 20 1487398772 0 Physicians Healthy Kids Services 20 1487398772 0 Physicians Optical Supplies 20 1487398772 0 Physicians Physician Services 00 1487398855 0 SWIFT DANIEL 2022112 9999999 B 10 1487398855 0 9845 W ROOSEVELT RD WESTCHESTER IL 601542758 20 1487398855 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487400420 0 GILLUND SUZANN 2024288 9999999 B 10 1487400420 0 2601 NETWORK BLVD STE 102 FRISCO TX 750349092 20 1487400420 0 Physical Therapists Medical Supplies 20 1487400420 0 Physical Therapists Medical equipment/prosthetic devices 20 1487400420 0 Physical Therapists Physical Therapy Services 00 1487402889 0 TODD KELAIAH 2024135 9999999 B 10 1487402889 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1487402889 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487404067 0 MANGAT ANUREET 2024185 9999999 B 10 1487404067 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1487404067 0 Physicians Anesthesia Services 20 1487404067 0 Physicians Healthy Kids Services 20 1487404067 0 Physicians Optical Supplies 20 1487404067 0 Physicians Physician Services 20 1487404067 0 Physicians Physicians Psychiatric Services 00 1487404463 0 HANSEN GRACE 2024191 9999999 B 10 1487404463 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1487404463 0 Physicians Anesthesia Services 20 1487404463 0 Physicians Fluoride varnish 20 1487404463 0 Physicians Healthy Kids Services 20 1487404463 0 Physicians Optical Supplies 20 1487404463 0 Physicians Physician Services 00 1487404547 0 SAVANI SUNNA 2024199 9999999 B 10 1487404547 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1487404547 0 Physicians Anesthesia Services 20 1487404547 0 Physicians Fluoride varnish 20 1487404547 0 Physicians Healthy Kids Services 20 1487404547 0 Physicians Optical Supplies 20 1487404547 0 Physicians Physician Services 00 1487406039 0 LEHACHI MOHAMED AMINE 2024180 9999999 B 10 1487406039 0 4701 DEPT CAROL STREAM IL 601220021 20 1487406039 0 Physicians Anesthesia Services 20 1487406039 0 Physicians Fluoride varnish 20 1487406039 0 Physicians Healthy Kids Services 20 1487406039 0 Physicians Optical Supplies 20 1487406039 0 Physicians Physician Services 00 1487406393 0 GRAHAM KATHERINE J 2024359 9999999 B 10 1487406393 0 2028 N SEMINARY AVE WOODSTOCK IL 600982626 20 1487406393 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487409397 0 MOCK ROBERT 2024297 9999999 B 10 1487409397 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1487409397 0 Clinical Social Worker Social work service 00 1487409835 0 ROE CAILEY C 2024157 9999999 B 10 1487409835 0 10759 WINTERSET DR ORLAND PARK IL 604671106 20 1487409835 0 Dentists Dental Services 20 1487409835 0 Dentists Physician Services 00 1487411385 0 MAGEE BRITTNEY 2024263 9999999 B 10 1487411385 0 211 E LAKE ST STE 1A ADDISON IL 601012877 20 1487411385 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487413613 0 JONES CAMERAN 2024185 9999999 B 10 1487413613 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1487413613 0 Physicians Anesthesia Services 20 1487413613 0 Physicians Fluoride varnish 20 1487413613 0 Physicians Healthy Kids Services 20 1487413613 0 Physicians Optical Supplies 20 1487413613 0 Physicians Physician Services 00 1487414470 0 RAMIREZ-ALLEN VANESSA 2024176 9999999 B 10 1487414470 0 4698 DEPT CAROL STREAM IL 601220021 20 1487414470 0 Physicians Anesthesia Services 20 1487414470 0 Physicians Healthy Kids Services 20 1487414470 0 Physicians Optical Supplies 20 1487414470 0 Physicians Physician Services 00 1487421301 0 BOATMAN ANDREA 2021134 9999999 B 10 1487421301 0 515 22ND AVE MONROE WI 535661569 20 1487421301 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487421392 0 CONGORAN MICHAEL 2024043 9999999 B 10 1487421392 0 4701 DEPT CAROL STREAM IL 601220021 20 1487421392 0 Speech Therapists Medical Supplies 20 1487421392 0 Speech Therapists Medical equipment/prosthetic devices 20 1487421392 0 Speech Therapists Speech Therapy/Pathology Services 00 1487422093 0 FIGUEROA FRANCISO 2023348 9999999 B 10 1487422093 0 1414 MAIN ST MELROSE PARK IL 601603902 20 1487422093 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487423281 0 AGUILAR DOS SANTOS MILTON 2024002 9999999 B 10 1487423281 0 4025 N SHERIDAN RD CHICAGO IL 606132010 20 1487423281 0 Nurse Practitioners Healthy Kids Services 20 1487423281 0 Nurse Practitioners Nurse Practitioners Services 20 1487423281 0 Nurse Practitioners Physician Services 00 1487425013 0 GARGANO SHAUNA R 2024134 9999999 B 10 1487425013 0 29373 NETWORK PL CHICAGO IL 606733039 20 1487425013 0 Nurse Practitioners Healthy Kids Services 20 1487425013 0 Nurse Practitioners Nurse Practitioners Services 20 1487425013 0 Nurse Practitioners Physician Services 00 1487425633 0 PAVEY HANNAH 2024032 9999999 B 10 1487425633 0 1120 RANDALL CT GENEVA IL 601343911 20 1487425633 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487427787 0 DELLAMORTE SHARLINE 2023339 9999999 B 10 1487427787 0 PO BOX 775253 CHICAGO IL 606775253 20 1487427787 0 Nurse Practitioners Healthy Kids Services 20 1487427787 0 Nurse Practitioners Nurse Practitioners Services 20 1487427787 0 Nurse Practitioners Physician Services 00 1487427860 0 FRANCO SALVADOR 2023313 9999999 B 10 1487427860 0 7108 S KANNER HWY STUART FL 349977462 20 1487427860 0 Other behavior health professional Adaptive behavior support technician services 20 1487427860 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487428066 0 SHORT JENNIFER L 2023356 9999999 B 10 1487428066 0 448 WYLIE DR NORMAL IL 617615405 20 1487428066 0 Nurse Practitioners Fluoride varnish 20 1487428066 0 Nurse Practitioners Healthy Kids Services 20 1487428066 0 Nurse Practitioners Nurse Practitioners Services 20 1487428066 0 Nurse Practitioners Physician Services 00 1487428330 0 GARDNER MICHELLE 2024239 9999999 B 10 1487428330 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1487428330 0 Nurse Practitioners Fluoride varnish 20 1487428330 0 Nurse Practitioners Healthy Kids Services 20 1487428330 0 Nurse Practitioners Nurse Practitioners Services 20 1487428330 0 Nurse Practitioners Physician Services 00 1487431086 0 RUFF EVAN 2023269 9999999 B 10 1487431086 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1487431086 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487431706 0 CORDES JEFFREY ALLEN 2023255 9999999 B 10 1487431706 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1487431706 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487432480 0 RICHART JASON M 2023335 9999999 B 10 1487432480 0 1002 N ALLEN ST STE B SUITE B ROBINSON IL 624541167 20 1487432480 0 Nurse Practitioners Healthy Kids Services 20 1487432480 0 Nurse Practitioners Nurse Practitioners Services 20 1487432480 0 Nurse Practitioners Physician Services 00 1487433157 0 SAVALICK JENNIFER 2024192 9999999 B 10 1487433157 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1487433157 0 Nurse Practitioners Fluoride varnish 20 1487433157 0 Nurse Practitioners Healthy Kids Services 20 1487433157 0 Nurse Practitioners Nurse Practitioners Services 20 1487433157 0 Nurse Practitioners Physician Services 00 1487433918 0 ROZNOWSKI ALLSION 2024305 9999999 B 10 1487433918 0 302 N JACKSON ST MILWAUKEE WI 532025904 20 1487433918 0 Nurse Practitioners Healthy Kids Services 20 1487433918 0 Nurse Practitioners Nurse Practitioners Services 20 1487433918 0 Nurse Practitioners Physician Services 00 1487460952 0 MOSQUERA MICHAEL 2025010 9999999 B 10 1487460952 0 PO BOX 6037 WAUCONDA IL 600846037 20 1487460952 0 Nurse Practitioners Fluoride varnish 20 1487460952 0 Nurse Practitioners Healthy Kids Services 20 1487460952 0 Nurse Practitioners Nurse Practitioners Services 20 1487460952 0 Nurse Practitioners Physician Services 00 1487462644 0 SARKA RYAN 2025031 9999999 B 10 1487462644 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1487462644 0 Physician Assistant Only Fluoride varnish 20 1487462644 0 Physician Assistant Only Healthy Kids Services 20 1487462644 0 Physician Assistant Only Physician Services 00 1487463568 0 LOGSDON SUSANNE 2025014 9999999 B 10 1487463568 0 5844 ELAINE DR STE 103 ROCKFORD IL 611082494 20 1487463568 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487465621 0 TOMCHEK BENJAMIN F 2025017 9999999 B 10 1487465621 0 2901 FINLEY RD STE 102 DOWNERS GROVE IL 605151774 20 1487465621 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487467270 0 CIRAK LINDSEY L 2025043 9999999 B 10 1487467270 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1487467270 0 Nurse Practitioners Fluoride varnish 20 1487467270 0 Nurse Practitioners Healthy Kids Services 20 1487467270 0 Nurse Practitioners Nurse Practitioners Services 20 1487467270 0 Nurse Practitioners Physician Services 00 1487472643 0 RUTKOWSKI ANETA 2024288 9999999 B 10 1487472643 0 PO BOX 775253 CHICAGO IL 606775253 20 1487472643 0 Nurse Practitioners Fluoride varnish 20 1487472643 0 Nurse Practitioners Healthy Kids Services 20 1487472643 0 Nurse Practitioners Nurse Practitioners Services 20 1487472643 0 Nurse Practitioners Physician Services 00 1487472940 0 MELENDEZ VALERIE 2024324 9999999 B 10 1487472940 0 PO BOX 322 323 WEST MULBERRY ST WATSEKA IL 609700322 20 1487472940 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487474326 0 JONES DANIELLE 2024303 9999999 B 10 1487474326 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1487474326 0 Nurse Practitioners Fluoride varnish 20 1487474326 0 Nurse Practitioners Healthy Kids Services 20 1487474326 0 Nurse Practitioners Nurse Practitioners Services 20 1487474326 0 Nurse Practitioners Physician Services 00 1487477121 0 SCURR ERINN 2024318 9999999 B 10 1487477121 0 4670 11TH ST EAST MOLINE IL 612444428 20 1487477121 0 Speech Therapists Medical Supplies 20 1487477121 0 Speech Therapists Medical equipment/prosthetic devices 20 1487477121 0 Speech Therapists Speech Therapy/Pathology Services 00 1487481677 0 THOMPSON CELESTE 2024270 9999999 B 10 1487481677 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1487481677 0 Physical Therapists Medical Supplies 20 1487481677 0 Physical Therapists Medical equipment/prosthetic devices 20 1487481677 0 Physical Therapists Physical Therapy Services 00 1487482022 0 MINTURN MARISSA R 2024227 9999999 B 10 1487482022 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1487482022 0 Occupational Therapists Medical Supplies 20 1487482022 0 Occupational Therapists Medical equipment/prosthetic devices 20 1487482022 0 Occupational Therapists Occupational Therapy Services 00 1487482162 0 OLSON CASSANDRA 2024319 9999999 B 10 1487482162 0 600 N COLLEGE AVE GENESEO IL 612541091 20 1487482162 0 Nurse Practitioners Fluoride varnish 20 1487482162 0 Nurse Practitioners Healthy Kids Services 20 1487482162 0 Nurse Practitioners Nurse Practitioners Services 20 1487482162 0 Nurse Practitioners Physician Services 00 1487483228 0 CHAVEZ ALISON 2024270 9999999 B 10 1487483228 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1487483228 0 Psychologist Psychologist service 00 1487483871 0 ORONI JOSEPH G 2024358 9999999 B 10 1487483871 0 6024 RIDGE AVE STE 116-356 PHILADELPHIA PA 191281601 20 1487483871 0 Physician Assistant Only Fluoride varnish 20 1487483871 0 Physician Assistant Only Healthy Kids Services 20 1487483871 0 Physician Assistant Only Physician Services 00 1487484176 0 HUNT MELICIA QUEEN 2024241 9999999 B 10 1487484176 0 PO BOX 866 EDWARDSVILLE IL 620250866 20 1487484176 0 Nurse Practitioners Fluoride varnish 20 1487484176 0 Nurse Practitioners Healthy Kids Services 20 1487484176 0 Nurse Practitioners Nurse Practitioners Services 20 1487484176 0 Nurse Practitioners Physician Services 00 1487484283 0 RINEHART KIMBERLY 2024311 9999999 B 10 1487484283 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1487484283 0 Nurse Practitioners Healthy Kids Services 20 1487484283 0 Nurse Practitioners Nurse Practitioners Services 20 1487484283 0 Nurse Practitioners Physician Services 00 1487484390 0 GURROLA LUCIA 2024239 9999999 B 10 1487484390 0 PO BOX 21844 BELFAST ME 049154115 20 1487484390 0 Physician Assistant Only Fluoride varnish 20 1487484390 0 Physician Assistant Only Healthy Kids Services 20 1487484390 0 Physician Assistant Only Physician Services 00 1487485280 0 OLADELE LAWUNMI 2024225 9999999 B 10 1487485280 0 10653 W 154TH ST ORLAND PARK IL 604626036 20 1487485280 0 Licensed Practical Nurses Nursing service 00 1487485538 0 KREINDEL TAMARA G 2024229 9999999 B 10 1487485538 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1487485538 0 Physicians Anesthesia Services 20 1487485538 0 Physicians Healthy Kids Services 20 1487485538 0 Physicians Optical Supplies 20 1487485538 0 Physicians Physician Services 00 1487487419 0 CONRAD JESSICA 2024303 9999999 B 10 1487487419 0 501 S MCKINLEY ST HAVANA IL 626441867 20 1487487419 0 Speech Therapists Medical Supplies 20 1487487419 0 Speech Therapists Medical equipment/prosthetic devices 20 1487487419 0 Speech Therapists Speech Therapy/Pathology Services 00 1487487781 0 MARDEN CANDICE S 2025034 9999999 B 10 1487487781 0 PO BOX 322 323 WEST MULBERRY ST WATSEKA IL 609700322 20 1487487781 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487490389 0 IKORO CHIMAMAKA CAMELA 2024196 9999999 B 10 1487490389 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1487490389 0 Physicians Anesthesia Services 20 1487490389 0 Physicians Fluoride varnish 20 1487490389 0 Physicians Healthy Kids Services 20 1487490389 0 Physicians Optical Supplies 20 1487490389 0 Physicians Physician Services 00 1487492609 0 FICO DANIELLE 2024261 9999999 B 10 1487492609 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1487492609 0 Physician Assistant Only Fluoride varnish 20 1487492609 0 Physician Assistant Only Healthy Kids Services 20 1487492609 0 Physician Assistant Only Physician Services 00 1487492708 0 MROZ KATRINA A 2024241 9999999 B 10 1487492708 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1487492708 0 Nurse Practitioners Healthy Kids Services 20 1487492708 0 Nurse Practitioners Nurse Practitioners Services 20 1487492708 0 Nurse Practitioners Physician Services 00 1487493045 0 LYON ABIGAIL 2024331 9999999 B 10 1487493045 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1487493045 0 Physician Assistant Only Fluoride varnish 20 1487493045 0 Physician Assistant Only Healthy Kids Services 20 1487493045 0 Physician Assistant Only Physician Services 00 1487494910 0 VALLE CRISTINA 2024291 9999999 B 10 1487494910 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1487494910 0 Other behavior health professional LCPC/LMFT services 00 1487495883 0 ABDEL-GHANI MAHMOUD 2024191 9999999 B 10 1487495883 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1487495883 0 Physicians Anesthesia Services 20 1487495883 0 Physicians Fluoride varnish 20 1487495883 0 Physicians Healthy Kids Services 20 1487495883 0 Physicians Optical Supplies 20 1487495883 0 Physicians Physician Services 00 1487496477 0 GKEKAS PAIGE 2024233 9999999 B 10 1487496477 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1487496477 0 Physician Assistant Only Fluoride varnish 20 1487496477 0 Physician Assistant Only Healthy Kids Services 20 1487496477 0 Physician Assistant Only Physician Services 00 1487497251 0 JOHNSON MACKENZIE 2024172 9999999 B 10 1487497251 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1487497251 0 Physicians Anesthesia Services 20 1487497251 0 Physicians Healthy Kids Services 20 1487497251 0 Physicians Optical Supplies 20 1487497251 0 Physicians Physician Services 00 1487497491 0 OBI CHINEDUM BYRON 2024212 9999999 B 10 1487497491 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1487497491 0 Physicians Anesthesia Services 20 1487497491 0 Physicians Fluoride varnish 20 1487497491 0 Physicians Healthy Kids Services 20 1487497491 0 Physicians Optical Supplies 20 1487497491 0 Physicians Physician Services 00 1487497509 0 EGHTESADI NICOLE 2024200 9999999 B 10 1487497509 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1487497509 0 Physicians Anesthesia Services 20 1487497509 0 Physicians Healthy Kids Services 20 1487497509 0 Physicians Optical Supplies 20 1487497509 0 Physicians Physician Services 00 1487497657 0 RODRIGUEZ MARIA G 2024210 9999999 B 10 1487497657 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1487497657 0 Physicians Anesthesia Services 20 1487497657 0 Physicians Fluoride varnish 20 1487497657 0 Physicians Healthy Kids Services 20 1487497657 0 Physicians Optical Supplies 20 1487497657 0 Physicians Physician Services 00 1487497889 0 TAMADONFAR KEVIN O 2024168 9999999 B 10 1487497889 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1487497889 0 Physicians Anesthesia Services 20 1487497889 0 Physicians Fluoride varnish 20 1487497889 0 Physicians Healthy Kids Services 20 1487497889 0 Physicians Optical Supplies 20 1487497889 0 Physicians Physician Services 00 1487497996 0 KINARD ASHLYN E 2024166 9999999 B 10 1487497996 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1487497996 0 Physicians Anesthesia Services 20 1487497996 0 Physicians Healthy Kids Services 20 1487497996 0 Physicians Optical Supplies 20 1487497996 0 Physicians Physician Services 00 1487498077 0 TRAN ANDY 2024177 9999999 B 10 1487498077 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1487498077 0 Physicians Anesthesia Services 20 1487498077 0 Physicians Healthy Kids Services 20 1487498077 0 Physicians Optical Supplies 20 1487498077 0 Physicians Physician Services 00 1487498838 0 DRAGNA FRANCIS J 2025016 9999999 B 10 1487498838 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1487498838 0 Psychologist Psychologist service 00 1487499109 0 HARDT VERONICA 2024229 9999999 B 10 1487499109 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1487499109 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487499612 0 GILLETT RACHEL M 2024185 9999999 B 10 1487499612 0 30 W CHICAGO AVE CHICAGO IL 606543231 20 1487499612 0 Nurse Practitioners Healthy Kids Services 20 1487499612 0 Nurse Practitioners Nurse Practitioners Services 20 1487499612 0 Nurse Practitioners Physician Services 00 1487499737 0 BUTT ELAINA F 2024198 9999999 B 10 1487499737 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1487499737 0 Physicians Anesthesia Services 20 1487499737 0 Physicians Fluoride varnish 20 1487499737 0 Physicians Healthy Kids Services 20 1487499737 0 Physicians Optical Supplies 20 1487499737 0 Physicians Physician Services 00 1487601258 0 SANTOS EVELYN G 1989263 9999999 B 10 1487601258 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1487601258 0 Physicians Anesthesia Services 20 1487601258 0 Physicians Healthy Kids Services 20 1487601258 0 Physicians Optical Supplies 20 1487601258 0 Physicians Physician Services 00 1487601761 0 HAMMONS JOHN B 1998182 9999999 B 10 1487601761 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1487601761 0 Physicians Anesthesia Services 20 1487601761 0 Physicians Healthy Kids Services 20 1487601761 0 Physicians Optical Supplies 20 1487601761 0 Physicians Physician Services 00 1487601936 0 COTTONE KYLE 2006152 9999999 B 10 1487601936 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1487601936 0 Physical Therapists Medical Supplies 20 1487601936 0 Physical Therapists Medical equipment/prosthetic devices 20 1487601936 0 Physical Therapists Physical Therapy Services 00 1487601985 0 DIMATTEO THOMAS L 2001092 9999999 B 10 1487601985 0 1819 BAY SCOTT CIR STE 109 NAPERVILLE IL 605401130 20 1487601985 0 Physicians Anesthesia Services 20 1487601985 0 Physicians Healthy Kids Services 20 1487601985 0 Physicians Optical Supplies 20 1487601985 0 Physicians Physician Services 20 1487601985 0 Physicians Physicians Psychiatric Services 00 1487602553 0 ANSARI ANIS 1993274 9999999 B 10 1487602553 0 621 S ILLINOIS AVE STE 103 MASON CITY IA 504015489 20 1487602553 0 Physicians Anesthesia Services 20 1487602553 0 Physicians Fluoride varnish 20 1487602553 0 Physicians Healthy Kids Services 20 1487602553 0 Physicians Optical Supplies 20 1487602553 0 Physicians Physician Services 00 1487602637 0 BASIT ABDUL 2024261 9999999 B 10 1487602637 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1487602637 0 Physicians Anesthesia Services 20 1487602637 0 Physicians Fluoride varnish 20 1487602637 0 Physicians Healthy Kids Services 20 1487602637 0 Physicians Optical Supplies 20 1487602637 0 Physicians Physician Services 00 1487603114 0 PATEL SUBHASH 1986263 9999999 B 10 1487603114 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1487603114 0 Physicians Anesthesia Services 20 1487603114 0 Physicians Healthy Kids Services 20 1487603114 0 Physicians Optical Supplies 20 1487603114 0 Physicians Physician Services 00 1487603239 0 KHADRA SUHAIL 1989186 9999999 B 10 1487603239 0 10010 DON S POWERS DR MUNSTER IN 463214054 20 1487603239 0 Physicians Anesthesia Services 20 1487603239 0 Physicians Fluoride varnish 20 1487603239 0 Physicians Healthy Kids Services 20 1487603239 0 Physicians Optical Supplies 20 1487603239 0 Physicians Physician Services 00 1487604161 0 QURESHI IMRAN I 2005213 9999999 B 10 1487604161 0 2875 W 19TH ST CHICAGO IL 606233501 20 1487604161 0 Physicians Anesthesia Services 20 1487604161 0 Physicians Healthy Kids Services 20 1487604161 0 Physicians Optical Supplies 20 1487604161 0 Physicians Physician Services 00 1487604625 0 PETREE TRAVIS J 2025045 9999999 B 10 1487604625 0 3871 N PERRYVILLE RD ROCKFORD IL 611148080 20 1487604625 0 Physicians Anesthesia Services 20 1487604625 0 Physicians Healthy Kids Services 20 1487604625 0 Physicians Optical Supplies 20 1487604625 0 Physicians Physician Services 00 1487604906 0 BALCOM ANTHONY H 1992214 9999999 B 10 1487604906 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1487604906 0 Physicians Anesthesia Services 20 1487604906 0 Physicians Healthy Kids Services 20 1487604906 0 Physicians Optical Supplies 20 1487604906 0 Physicians Physician Services 00 1487605143 0 LOWELL GINA 2005182 9999999 B 10 1487605143 0 75 REMITTANCE DR DEPT 1611 CHICAGO IL 606751611 20 1487605143 0 Physicians Anesthesia Services 20 1487605143 0 Physicians Fluoride varnish 20 1487605143 0 Physicians Healthy Kids Services 20 1487605143 0 Physicians Optical Supplies 20 1487605143 0 Physicians Physician Services 00 1487605291 0 CRABTREE DAVID C 1991250 9999999 B 10 1487605291 0 2010 JACOBSSEN DR NORMAL IL 617616280 20 1487605291 0 Physicians Anesthesia Services 20 1487605291 0 Physicians Fluoride varnish 20 1487605291 0 Physicians Healthy Kids Services 20 1487605291 0 Physicians Optical Supplies 20 1487605291 0 Physicians Physician Services 00 1487605457 0 CLETO-QUIAOIT MARIA C 1999349 9999999 B 10 1487605457 0 PO BOX 88493 CHICAGO IL 606801493 20 1487605457 0 Physicians Anesthesia Services 20 1487605457 0 Physicians Healthy Kids Services 20 1487605457 0 Physicians Optical Supplies 20 1487605457 0 Physicians Physician Services 00 1487605556 0 MATUSIAK DAVID M 1990150 9999999 B 10 1487605556 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1487605556 0 Physicians Anesthesia Services 20 1487605556 0 Physicians Fluoride varnish 20 1487605556 0 Physicians Healthy Kids Services 20 1487605556 0 Physicians Optical Supplies 20 1487605556 0 Physicians Physician Services 00 1487605606 0 LEWIS STEVENS TASHA J 2020034 9999999 B 10 1487605606 0 777 S MAIN ST STE 100 CLINTON IN 478422493 20 1487605606 0 Nurse Practitioners Healthy Kids Services 20 1487605606 0 Nurse Practitioners Nurse Practitioners Services 20 1487605606 0 Nurse Practitioners Physician Services 00 1487605861 0 LEE PETER J 2001182 9999999 B 10 1487605861 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1487605861 0 Physicians Anesthesia Services 20 1487605861 0 Physicians Fluoride varnish 20 1487605861 0 Physicians Healthy Kids Services 20 1487605861 0 Physicians Optical Supplies 20 1487605861 0 Physicians Physician Services 00 1487606208 0 MELDE NANCY C 2010244 9999999 B 10 1487606208 0 P O BOX 771858 CHICAGO IL 606770001 20 1487606208 0 Nurse Practitioners Healthy Kids Services 20 1487606208 0 Nurse Practitioners Nurse Practitioners Services 20 1487606208 0 Nurse Practitioners Nursing service 20 1487606208 0 Nurse Practitioners Physician Services 20 1487606208 0 Nurse Practitioners Waiver service 00 1487606216 0 HOR KAN N 2007292 9999999 B 10 1487606216 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1487606216 0 Physicians Anesthesia Services 20 1487606216 0 Physicians Fluoride varnish 20 1487606216 0 Physicians Healthy Kids Services 20 1487606216 0 Physicians Optical Supplies 20 1487606216 0 Physicians Physician Services 00 1487606299 0 GRABLER PAULA 1998219 9999999 B 10 1487606299 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1487606299 0 Physicians Anesthesia Services 20 1487606299 0 Physicians Healthy Kids Services 20 1487606299 0 Physicians Optical Supplies 20 1487606299 0 Physicians Physician Services 00 1487606810 0 BICALHO PAULO 2001121 9999999 B 10 1487606810 0 6810 STATE ROUTE 162 STE 215 MARYVILLE IL 620628566 20 1487606810 0 Physicians Anesthesia Services 20 1487606810 0 Physicians Healthy Kids Services 20 1487606810 0 Physicians Optical Supplies 20 1487606810 0 Physicians Physician Services 00 1487606984 0 DUNCAN VERNON 2006182 9999999 B 10 1487606984 0 PO BOX 631771 CINCINNATI OH 452630139 20 1487606984 0 Physicians Anesthesia Services 20 1487606984 0 Physicians Healthy Kids Services 20 1487606984 0 Physicians Optical Supplies 20 1487606984 0 Physicians Physician Services 00 1487607370 0 PIGMAN EDWIN C 2022360 9999999 B 10 1487607370 0 4200 SUN N LAKE BLVD PO BOX 4200 SEBRING FL 338721986 20 1487607370 0 Physicians Anesthesia Services 20 1487607370 0 Physicians Healthy Kids Services 20 1487607370 0 Physicians Optical Supplies 20 1487607370 0 Physicians Physician Services 00 1487607412 0 GERANIOS GEORGE A 2002213 9999999 B 10 1487607412 0 1418 COLLEGE DR MOUNT CARMEL IL 628632638 20 1487607412 0 Physicians Anesthesia Services 20 1487607412 0 Physicians Fluoride varnish 20 1487607412 0 Physicians Healthy Kids Services 20 1487607412 0 Physicians Optical Supplies 20 1487607412 0 Physicians Physician Services 00 1487607610 0 CHAPMAN DARREN 2025029 9999999 B 10 1487607610 0 PO BOX 632122 CINCINNATI OH 452632122 20 1487607610 0 Physicians Anesthesia Services 20 1487607610 0 Physicians Healthy Kids Services 20 1487607610 0 Physicians Optical Supplies 20 1487607610 0 Physicians Physician Services 00 1487607891 0 ROBIN BEVERLEY 2003213 9999999 B 10 1487607891 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1487607891 0 Physicians Anesthesia Services 20 1487607891 0 Physicians Fluoride varnish 20 1487607891 0 Physicians Healthy Kids Services 20 1487607891 0 Physicians Optical Supplies 20 1487607891 0 Physicians Physician Services 00 1487609327 0 SAPOVADIA PARIMAL G 2024310 9999999 B 10 1487609327 0 519 N CASS AVE STE 102 WESTMONT IL 605591589 20 1487609327 0 Dentists Dental Services 20 1487609327 0 Dentists Physician Services 00 1487609343 0 GERBER BRIAN 1998182 9999999 B 10 1487609343 0 750 FLETCHER DR ELGIN IL 601234703 20 1487609343 0 Physicians Anesthesia Services 20 1487609343 0 Physicians Healthy Kids Services 20 1487609343 0 Physicians Optical Supplies 20 1487609343 0 Physicians Physician Services 00 1487609616 0 ALLISON ARDIS K 2011274 9999999 B 10 1487609616 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1487609616 0 Physicians Anesthesia Services 20 1487609616 0 Physicians Fluoride varnish 20 1487609616 0 Physicians Healthy Kids Services 20 1487609616 0 Physicians Optical Supplies 20 1487609616 0 Physicians Physician Services 00 1487609772 0 BENIG VINCENT R 2019031 9999999 B 10 1487609772 0 725 SCHOOL ST STE A MORRIS IL 604501207 20 1487609772 0 Physicians Anesthesia Services 20 1487609772 0 Physicians Fluoride varnish 20 1487609772 0 Physicians Healthy Kids Services 20 1487609772 0 Physicians Optical Supplies 20 1487609772 0 Physicians Physician Services 00 1487609822 0 YOUSUF NAVEED 1999200 9999999 B 10 1487609822 0 PO BOX 20356 SPRINGFIELD IL 627080356 20 1487609822 0 Physicians Anesthesia Services 20 1487609822 0 Physicians Healthy Kids Services 20 1487609822 0 Physicians Optical Supplies 20 1487609822 0 Physicians Physician Services 00 1487609954 0 KAZLAUSKAITE RASA 2009005 9999999 B 10 1487609954 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1487609954 0 Physicians Anesthesia Services 20 1487609954 0 Physicians Fluoride varnish 20 1487609954 0 Physicians Healthy Kids Services 20 1487609954 0 Physicians Optical 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1487612297 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1487612297 0 Physicians Anesthesia Services 20 1487612297 0 Physicians Healthy Kids Services 20 1487612297 0 Physicians Optical Supplies 20 1487612297 0 Physicians Physician Services 00 1487612370 0 OGBEVOEN JUSTIN O 1996085 9999999 B 10 1487612370 0 6 LONDON PARK EDWARDSVILLE IL 620253879 20 1487612370 0 Physicians Anesthesia Services 20 1487612370 0 Physicians Fluoride varnish 20 1487612370 0 Physicians Healthy Kids Services 20 1487612370 0 Physicians Optical Supplies 20 1487612370 0 Physicians Physician Services 00 1487612586 0 ARONSON LORI 2005108 9999999 B 10 1487612586 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1487612586 0 Physicians Anesthesia Services 20 1487612586 0 Physicians Healthy Kids Services 20 1487612586 0 Physicians Optical Supplies 20 1487612586 0 Physicians Physician Services 00 1487612735 0 GOSCH CARRIE 1997212 9999999 B 10 1487612735 0 2900 N ASHLAND AVE CHICAGO IL 606574004 20 1487612735 0 Physicians Anesthesia Services 20 1487612735 0 Physicians Fluoride varnish 20 1487612735 0 Physicians Healthy Kids Services 20 1487612735 0 Physicians Optical Supplies 20 1487612735 0 Physicians Physician Services 00 1487613816 0 JOHNSON TESSA J 2004208 9999999 B 10 1487613816 0 671 WABASH AVE CARTHAGE IL 623211443 20 1487613816 0 Dentists Dental Services 20 1487613816 0 Dentists Physician Services 00 1487614210 0 ARNDT THOMAS R 1987002 9999999 B 10 1487614210 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1487614210 0 Physicians Anesthesia Services 20 1487614210 0 Physicians Fluoride varnish 20 1487614210 0 Physicians Healthy Kids Services 20 1487614210 0 Physicians Optical Supplies 20 1487614210 0 Physicians Physician Services 00 1487614939 0 RAYHILL DONALD 2024046 9999999 B 10 1487614939 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1487614939 0 Occupational Therapists Medical Supplies 20 1487614939 0 Occupational Therapists Medical equipment/prosthetic devices 20 1487614939 0 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1487632527 0 Physicians Anesthesia Services 20 1487632527 0 Physicians Healthy Kids Services 20 1487632527 0 Physicians Optical Supplies 20 1487632527 0 Physicians Physician Services 00 1487632782 0 MCCARTHY TIMOTHY 2002152 9999999 B 10 1487632782 0 7055 NORTH AVE OAK PARK IL 603021015 20 1487632782 0 Physicians Anesthesia Services 20 1487632782 0 Physicians Healthy Kids Services 20 1487632782 0 Physicians Optical Supplies 20 1487632782 0 Physicians Physician Services 00 1487633251 0 MACVICAR GARY R 2005199 9999999 B 10 1487633251 0 8940 N WOOD SAGE RD PEORIA IL 616157822 20 1487633251 0 Physicians Anesthesia Services 20 1487633251 0 Physicians Fluoride varnish 20 1487633251 0 Physicians Healthy Kids Services 20 1487633251 0 Physicians Optical Supplies 20 1487633251 0 Physicians Physician Services 00 1487633566 0 NWACHUKWU DENNIS 2000214 9999999 B 10 1487633566 0 15255 S 94TH AVE STE 500 ORLAND PARK IL 604623895 20 1487633566 0 Physicians Anesthesia Services 20 1487633566 0 Physicians 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20 1487637294 0 Physicians Healthy Kids Services 20 1487637294 0 Physicians Optical Supplies 20 1487637294 0 Physicians Physician Services 00 1487637567 0 AGUILAR FRANCISCO G 2010213 9999999 B 10 1487637567 0 PO BOX 775280 CHICAGO IL 606775280 20 1487637567 0 Physicians Anesthesia Services 20 1487637567 0 Physicians Fluoride varnish 20 1487637567 0 Physicians Healthy Kids Services 20 1487637567 0 Physicians Optical Supplies 20 1487637567 0 Physicians Physician Services 00 1487638763 0 EUBANKS KATHRYN L 2010244 9999999 B 10 1487638763 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1487638763 0 Physicians Anesthesia Services 20 1487638763 0 Physicians Fluoride varnish 20 1487638763 0 Physicians Healthy Kids Services 20 1487638763 0 Physicians Optical Supplies 20 1487638763 0 Physicians Physician Services 00 1487638805 0 BLANCO ROBERT 1989186 9999999 B 10 1487638805 0 9401 S PULASKI RD EVERGREEN PARK IL 608051924 20 1487638805 0 Physicians Anesthesia Services 20 1487638805 0 Physicians 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Services 20 1487639514 0 Physicians Healthy Kids Services 20 1487639514 0 Physicians Optical Supplies 20 1487639514 0 Physicians Physician Services 00 1487640033 0 WALKER WILLIAM 2024163 9999999 B 10 1487640033 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1487640033 0 Nurse Practitioners Fluoride varnish 20 1487640033 0 Nurse Practitioners Healthy Kids Services 20 1487640033 0 Nurse Practitioners Nurse Practitioners Services 20 1487640033 0 Nurse Practitioners Physician Services 00 1487640660 0 PEDDINGHAUS WOLF DIETRICH 1984108 9999999 B 10 1487640660 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1487640660 0 Physicians Anesthesia Services 20 1487640660 0 Physicians Fluoride varnish 20 1487640660 0 Physicians Healthy Kids Services 20 1487640660 0 Physicians Optical Supplies 20 1487640660 0 Physicians Physician Services 00 1487641247 0 BENDER DAVID P 2000182 9999999 B 10 1487641247 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1487641247 0 Physicians Anesthesia Services 20 1487641247 0 Physicians Healthy Kids Services 20 1487641247 0 Physicians Optical Supplies 20 1487641247 0 Physicians Physician Services 00 1487642013 0 CHASE JOHN S 1997155 9999999 B 10 1487642013 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1487642013 0 Physicians Anesthesia Services 20 1487642013 0 Physicians Fluoride varnish 20 1487642013 0 Physicians Healthy Kids Services 20 1487642013 0 Physicians Optical Supplies 20 1487642013 0 Physicians Physician Services 00 1487642039 0 ALAPATI SUBBA 2024170 9999999 B 10 1487642039 0 2000 S MAIN ST FAIRFIELD IA 525569572 20 1487642039 0 Physicians Anesthesia Services 20 1487642039 0 Physicians Healthy Kids Services 20 1487642039 0 Physicians Optical Supplies 20 1487642039 0 Physicians Physician Services 00 1487642179 0 LEMKE DAVID B 1999340 9999999 B 10 1487642179 0 PO BOX 781076 DETROIT MI 482781076 20 1487642179 0 Physicians Anesthesia Services 20 1487642179 0 Physicians Fluoride varnish 20 1487642179 0 Physicians Healthy Kids Services 20 1487642179 0 Physicians Optical Supplies 20 1487642179 0 Physicians Physician Services 00 1487642302 0 AGARWAL DEEPAK 2005167 9999999 B 10 1487642302 0 1163 E OGDEN AVE STE 403 NAPERVILLE IL 605638532 20 1487642302 0 Dentists Dental Services 20 1487642302 0 Dentists Physician Services 00 1487642419 0 HAISLER ROSE M 2004019 9999999 B 10 1487642419 0 6300 RIDGLEA PL STE 201 FORT WORTH TX 761165707 20 1487642419 0 Physicians Anesthesia Services 20 1487642419 0 Physicians Healthy Kids Services 20 1487642419 0 Physicians Optical Supplies 20 1487642419 0 Physicians Physician Services 00 1487642567 0 ROBINSON PATRICIA A 2006335 9999999 B 10 1487642567 0 5777 DEPT CAROL STREAM IL 601220021 20 1487642567 0 Physicians Anesthesia Services 20 1487642567 0 Physicians Fluoride varnish 20 1487642567 0 Physicians Healthy Kids Services 20 1487642567 0 Physicians Optical Supplies 20 1487642567 0 Physicians Physician Services 00 1487642823 0 VELANO LAWRENCE 2003239 9999999 B 10 1487642823 0 4049 W 26TH 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20 1487645776 0 Physicians Healthy Kids Services 20 1487645776 0 Physicians Optical Supplies 20 1487645776 0 Physicians Physician Services 20 1487645776 0 Physicians Physicians Psychiatric Services 00 1487646477 0 WARREN PAUL 1997274 9999999 B 10 1487646477 0 335 E MAHN CT OAK CREEK WI 531542155 20 1487646477 0 Physicians Anesthesia Services 20 1487646477 0 Physicians Fluoride varnish 20 1487646477 0 Physicians Healthy Kids Services 20 1487646477 0 Physicians Optical Supplies 20 1487646477 0 Physicians Physician Services 00 1487646972 0 PARHAM WALTER 2004183 9999999 B 10 1487646972 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1487646972 0 Physicians Anesthesia Services 20 1487646972 0 Physicians Fluoride varnish 20 1487646972 0 Physicians Healthy Kids Services 20 1487646972 0 Physicians Optical Supplies 20 1487646972 0 Physicians Physician Services 00 1487647517 0 TRAYNELIS VINCENT 1989172 9999999 B 10 1487647517 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1487647517 0 Physicians Anesthesia Services 20 1487647517 0 Physicians Healthy Kids Services 20 1487647517 0 Physicians Optical Supplies 20 1487647517 0 Physicians Physician Services 00 1487647715 0 KOLLER TERRENCE 2023108 9999999 B 10 1487647715 0 1740 RIDGE AVE STE 200C EVANSTON IL 602015918 20 1487647715 0 Psychologist Psychologist service 00 1487648887 0 MCCOY KAREN S 2016056 9999999 B 10 1487648887 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1487648887 0 Physicians Anesthesia Services 20 1487648887 0 Physicians Fluoride varnish 20 1487648887 0 Physicians Healthy Kids Services 20 1487648887 0 Physicians Optical Supplies 20 1487648887 0 Physicians Physician Services 00 1487649067 0 SENSINTAFFAR LOWELL G 2002157 9999999 B 10 1487649067 0 3051 HOLLIS DR SPRINGFIELD IL 627047452 20 1487649067 0 Physicians Anesthesia Services 20 1487649067 0 Physicians Fluoride varnish 20 1487649067 0 Physicians Healthy Kids Services 20 1487649067 0 Physicians Optical Supplies 20 1487649067 0 Physicians Physician 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BROOK IL 605231557 20 1487652186 0 Physicians Anesthesia Services 20 1487652186 0 Physicians Fluoride varnish 20 1487652186 0 Physicians Healthy Kids Services 20 1487652186 0 Physicians Optical Supplies 20 1487652186 0 Physicians Physician Services 00 1487652517 0 BIEDERMANN CHRISTINE L 1993235 9999999 B 10 1487652517 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1487652517 0 Physicians Anesthesia Services 20 1487652517 0 Physicians Healthy Kids Services 20 1487652517 0 Physicians Optical Supplies 20 1487652517 0 Physicians Physician Services 00 1487653275 0 MCDERMOTT RAYMOND GUY G 1998152 9999999 B 10 1487653275 0 PO BOX 7784 CAROL STREAM IL 601977784 20 1487653275 0 Physicians Anesthesia Services 20 1487653275 0 Physicians Healthy Kids Services 20 1487653275 0 Physicians Optical Supplies 20 1487653275 0 Physicians Physician Services 00 1487653515 0 KORNILOW JAN 2022252 9999999 B 10 1487653515 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1487653515 0 Physicians Anesthesia Services 20 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1487667614 0 Physicians Anesthesia Services 20 1487667614 0 Physicians Fluoride varnish 20 1487667614 0 Physicians Healthy Kids Services 20 1487667614 0 Physicians Optical Supplies 20 1487667614 0 Physicians Physician Services 00 1487668224 0 VARGA PETER 1988008 9999999 B 10 1487668224 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1487668224 0 Physicians All Kids application agent 20 1487668224 0 Physicians Anesthesia Services 20 1487668224 0 Physicians Family Planning Counseling 20 1487668224 0 Physicians Fluoride varnish 20 1487668224 0 Physicians Healthy Kids Services 20 1487668224 0 Physicians Optical Supplies 20 1487668224 0 Physicians Physician Services 00 1487669735 0 MOAZZAM FARNAZ 2003195 9999999 B 10 1487669735 0 PO BOX 530 HAVANA IL 626440530 20 1487669735 0 Physicians Anesthesia Services 20 1487669735 0 Physicians Healthy Kids Services 20 1487669735 0 Physicians Optical Supplies 20 1487669735 0 Physicians Physician Services 00 1487670063 0 POHLMAN TIMOTHY H 2007166 9999999 B 10 1487670063 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1487670063 0 Physicians Anesthesia Services 20 1487670063 0 Physicians Healthy Kids Services 20 1487670063 0 Physicians Optical Supplies 20 1487670063 0 Physicians Physician Services 00 1487670188 0 DOYLE JANELLE 2022200 9999999 B 10 1487670188 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1487670188 0 Physicians Anesthesia Services 20 1487670188 0 Physicians Healthy Kids Services 20 1487670188 0 Physicians Optical Supplies 20 1487670188 0 Physicians Physician Services 00 1487670600 0 NUSSENBAUM BRIAN 2002196 9999999 B 10 1487670600 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1487670600 0 Physicians Anesthesia Services 20 1487670600 0 Physicians Healthy Kids Services 20 1487670600 0 Physicians Optical Supplies 20 1487670600 0 Physicians Physician Services 00 1487670618 0 MORRISON AUBREY R 1981182 9999999 B 10 1487670618 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 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1487671830 0 Physicians Healthy Kids Services 20 1487671830 0 Physicians Optical Supplies 20 1487671830 0 Physicians Physician Services 00 1487671947 0 AVERY JAMES G 1993182 9999999 B 10 1487671947 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1487671947 0 Physicians Anesthesia Services 20 1487671947 0 Physicians Fluoride varnish 20 1487671947 0 Physicians Healthy Kids Services 20 1487671947 0 Physicians Optical Supplies 20 1487671947 0 Physicians Physician Services 00 1487672747 0 SEWALL LUKE 1999032 9999999 B 10 1487672747 0 2245 ENTERPRISE DR STE 4506 WESTCHESTER IL 601545803 20 1487672747 0 Physicians Anesthesia Services 20 1487672747 0 Physicians Healthy Kids Services 20 1487672747 0 Physicians Optical Supplies 20 1487672747 0 Physicians Physician Services 00 1487672804 0 FARBER NURI B 1993182 9999999 B 10 1487672804 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1487672804 0 Physicians Anesthesia Services 20 1487672804 0 Physicians Healthy 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0 Physicians Healthy Kids Services 20 1487675633 0 Physicians Optical Supplies 20 1487675633 0 Physicians Physician Services 00 1487676664 0 DREVLOW BARBARA E 1990152 9999999 B 10 1487676664 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1487676664 0 Physicians Anesthesia Services 20 1487676664 0 Physicians Fluoride varnish 20 1487676664 0 Physicians Healthy Kids Services 20 1487676664 0 Physicians Optical Supplies 20 1487676664 0 Physicians Physician Services 00 1487677076 0 HONG DAVID 1992113 9999999 B 10 1487677076 0 180 W WASHINGTON ST STE 930 CHICAGO IL 606023580 20 1487677076 0 Podiatrists Podiatric Services 00 1487677100 0 CHASE CARMEN D 2004245 9999999 B 10 1487677100 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1487677100 0 Physicians Anesthesia Services 20 1487677100 0 Physicians Healthy Kids Services 20 1487677100 0 Physicians Optical Supplies 20 1487677100 0 Physicians Physician Services 20 1487677100 0 Physicians Physicians Psychiatric Services 00 1487677316 0 LOPEZ JOHN M 2018015 9999999 B 10 1487677316 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1487677316 0 Physicians Anesthesia Services 20 1487677316 0 Physicians Fluoride varnish 20 1487677316 0 Physicians Healthy Kids Services 20 1487677316 0 Physicians Optical Supplies 20 1487677316 0 Physicians Physician Services 00 1487677597 0 LEVY RICHARD J 1986202 9999999 B 10 1487677597 0 3040 W SALT CREEK LN ARLINGTON HEIGH IL 600051069 20 1487677597 0 Physicians Anesthesia Services 20 1487677597 0 Physicians Healthy Kids Services 20 1487677597 0 Physicians Optical Supplies 20 1487677597 0 Physicians Physician Services 00 1487677787 0 MOSS LORI 1993037 9999999 B 10 1487677787 0 3471 GREEN BAY RD NORTH CHICAGO IL 600643090 20 1487677787 0 Physicians Anesthesia Services 20 1487677787 0 Physicians Healthy Kids Services 20 1487677787 0 Physicians Optical Supplies 20 1487677787 0 Physicians Physician Services 20 1487677787 0 Physicians Physicians Psychiatric Services 00 1487678454 0 DESAI DINA 1993213 9999999 B 10 1487678454 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1487678454 0 Physicians Anesthesia Services 20 1487678454 0 Physicians Fluoride varnish 20 1487678454 0 Physicians Healthy Kids Services 20 1487678454 0 Physicians Optical Supplies 20 1487678454 0 Physicians Physician Services 00 1487679205 0 HARYANI VIJAY M 1986130 9999999 B 10 1487679205 0 350 N WALL ST KANKAKEE IL 609012901 20 1487679205 0 Physicians Anesthesia Services 20 1487679205 0 Physicians Fluoride varnish 20 1487679205 0 Physicians Healthy Kids Services 20 1487679205 0 Physicians Optical Supplies 20 1487679205 0 Physicians Physician Services 00 1487680005 0 RATHOD HARISHCHANDRA 2008206 9999999 B 10 1487680005 0 119 S WESTERN AVE UNIT 1 CHICAGO IL 606124644 20 1487680005 0 Physicians Anesthesia Services 20 1487680005 0 Physicians Fluoride varnish 20 1487680005 0 Physicians Healthy Kids Services 20 1487680005 0 Physicians Optical Supplies 20 1487680005 0 Physicians Physician Services 00 1487680278 0 GEIS GARY 2010021 9999999 B 10 1487680278 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1487680278 0 Physicians Anesthesia Services 20 1487680278 0 Physicians Fluoride varnish 20 1487680278 0 Physicians Healthy Kids Services 20 1487680278 0 Physicians Optical Supplies 20 1487680278 0 Physicians Physician Services 00 1487680377 0 NORFLEET TRACY W 2015323 9999999 B 10 1487680377 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1487680377 0 Physicians Anesthesia Services 20 1487680377 0 Physicians Fluoride varnish 20 1487680377 0 Physicians Healthy Kids Services 20 1487680377 0 Physicians Optical Supplies 20 1487680377 0 Physicians Physician Services 00 1487680468 0 SCHMID BENJAMIN D 1981258 9999999 B 10 1487680468 0 PO BOX 781076 DETROIT MI 482781076 20 1487680468 0 Physicians Anesthesia Services 20 1487680468 0 Physicians Fluoride varnish 20 1487680468 0 Physicians Healthy Kids Services 20 1487680468 0 Physicians Optical Supplies 20 1487680468 0 Physicians Physician Services 00 1487681235 0 ROSENBLUM JASON 2003202 9999999 B 10 1487681235 0 PO BOX 781076 DETROIT MI 482781076 20 1487681235 0 Podiatrists Podiatric Services 00 1487682514 0 CRUZ ARNOLD S 2000183 9999999 B 10 1487682514 0 5777 DEPT CAROL STREAM IL 601220021 20 1487682514 0 Physicians Anesthesia Services 20 1487682514 0 Physicians Healthy Kids Services 20 1487682514 0 Physicians Optical Supplies 20 1487682514 0 Physicians Physician Services 00 1487682977 0 ROSS JOSEPH E 1981258 9999999 B 10 1487682977 0 1220 S WOOD ST CHICAGO IL 606081202 20 1487682977 0 Physicians Anesthesia Services 20 1487682977 0 Physicians Family Planning Counseling 20 1487682977 0 Physicians Fluoride varnish 20 1487682977 0 Physicians Healthy Kids Services 20 1487682977 0 Physicians Optical Supplies 20 1487682977 0 Physicians Physician Services 00 1487683793 0 ANTONIOU NIKOLAS J 2000129 9999999 B 10 1487683793 0 7900 ROLLINS RD STE 1100 GURNEE IL 600311512 20 1487683793 0 Physicians Anesthesia Services 20 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1487688925 0 HUSSAIN TAYEB S 1997244 9999999 B 10 1487688925 0 4646 N MARINE DR CHICAGO IL 606405759 20 1487688925 0 Podiatrists Podiatric Services 00 1487688974 0 BANE ROBERT 2004082 9999999 B 10 1487688974 0 611 W PARK ST URBANA IL 618012529 20 1487688974 0 Physicians Anesthesia Services 20 1487688974 0 Physicians Healthy Kids Services 20 1487688974 0 Physicians Optical Supplies 20 1487688974 0 Physicians Physician Services 00 1487689014 0 DOTSON CLIFFORD L 2004183 9999999 B 10 1487689014 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1487689014 0 Physicians Anesthesia Services 20 1487689014 0 Physicians Fluoride varnish 20 1487689014 0 Physicians Healthy Kids Services 20 1487689014 0 Physicians Optical Supplies 20 1487689014 0 Physicians Physician Services 00 1487689451 0 GODFREY GERALD C 2017151 9999999 B 10 1487689451 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1487689451 0 Physicians Anesthesia Services 20 1487689451 0 Physicians Healthy Kids Services 20 1487689451 0 Physicians 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INDIANAPOLIS IN 462194959 20 1487692901 0 Physicians Anesthesia Services 20 1487692901 0 Physicians Healthy Kids Services 20 1487692901 0 Physicians Optical Supplies 20 1487692901 0 Physicians Physician Services 00 1487693131 0 JESKE JOHN 2017171 9999999 B 10 1487693131 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1487693131 0 Physician Assistant Only Fluoride varnish 20 1487693131 0 Physician Assistant Only Healthy Kids Services 20 1487693131 0 Physician Assistant Only Physician Services 00 1487693248 0 COHEN MITCHELL JAY 2024249 9999999 B 10 1487693248 0 PO BOX 110429 AURORA CO 800420429 20 1487693248 0 Physicians Anesthesia Services 20 1487693248 0 Physicians Healthy Kids Services 20 1487693248 0 Physicians Optical Supplies 20 1487693248 0 Physicians Physician Services 00 1487693511 0 JAIN LATA 2002244 9999999 B 10 1487693511 0 10455 RIVERSIDE DR PALM BEACH GARD FL 334104237 20 1487693511 0 Audiologists Audiology Services 20 1487693511 0 Audiologists Medical Supplies 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9999999 B 10 1487941092 0 PO BOX 843033 KANSAS CITY MO 641843033 20 1487941092 0 Physicians Anesthesia Services 20 1487941092 0 Physicians Healthy Kids Services 20 1487941092 0 Physicians Optical Supplies 20 1487941092 0 Physicians Physician Services 00 1487941241 0 MATHIAS EMILY J 2022185 9999999 B 10 1487941241 0 700 KMS PL ANN ARBOR MI 481081652 20 1487941241 0 Physicians Anesthesia Services 20 1487941241 0 Physicians Healthy Kids Services 20 1487941241 0 Physicians Optical Supplies 20 1487941241 0 Physicians Physician Services 00 1487941456 0 KEMAL MARIAM 2018235 9999999 B 10 1487941456 0 901 E 5TH ST WASHINGTON MO 630903127 20 1487941456 0 Physicians Anesthesia Services 20 1487941456 0 Physicians Fluoride varnish 20 1487941456 0 Physicians Healthy Kids Services 20 1487941456 0 Physicians Optical Supplies 20 1487941456 0 Physicians Physician Services 00 1487941472 0 DOUGHERTY CHRISTOPHER 2020125 9999999 B 10 1487941472 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1487941472 0 Physicians Anesthesia Services 20 1487941472 0 Physicians Fluoride varnish 20 1487941472 0 Physicians Healthy Kids Services 20 1487941472 0 Physicians Optical Supplies 20 1487941472 0 Physicians Physician Services 00 1487941738 0 CHIERO KAITLYN M 2015351 9999999 B 10 1487941738 0 5665 NEW NORTHSIDE DR STE 320 ATLANTA GA 303285834 20 1487941738 0 Physician Assistant Only Fluoride varnish 20 1487941738 0 Physician Assistant Only Healthy Kids Services 20 1487941738 0 Physician Assistant Only Physician Services 00 1487941969 0 ABBASI WALEED 2014261 9999999 B 10 1487941969 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1487941969 0 Physicians Anesthesia Services 20 1487941969 0 Physicians Fluoride varnish 20 1487941969 0 Physicians Healthy Kids Services 20 1487941969 0 Physicians Optical Supplies 20 1487941969 0 Physicians Physician Services 00 1487942033 0 POWELL SASHA 2017025 9999999 B 10 1487942033 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1487942033 0 Nurse 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Physicians Physician Services 20 1487944450 0 Physicians Physicians Psychiatric Services 00 1487944849 0 HUGHES CHARLES T 2019246 9999999 B 10 1487944849 0 850 W IRVING PARK RD CHICAGO IL 606133077 20 1487944849 0 Physicians Anesthesia Services 20 1487944849 0 Physicians Healthy Kids Services 20 1487944849 0 Physicians Optical Supplies 20 1487944849 0 Physicians Physician Services 00 1487947958 0 LINDO JOHN D 2016211 9999999 B 10 1487947958 0 4740 N CLARK ST CHICAGO IL 606404689 20 1487947958 0 Physicians Anesthesia Services 20 1487947958 0 Physicians Healthy Kids Services 20 1487947958 0 Physicians Optical Supplies 20 1487947958 0 Physicians Physician Services 20 1487947958 0 Physicians Physicians Psychiatric Services 00 1487948303 0 MORRISEY JODI 2011228 9999999 B 10 1487948303 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1487948303 0 Nurse Practitioners Fluoride varnish 20 1487948303 0 Nurse Practitioners Healthy Kids Services 20 1487948303 0 Nurse Practitioners Nurse 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Supplies 20 1487950010 0 Physicians Physician Services 00 1487950671 0 HERZIG MICHAEL J 2013232 9999999 B 10 1487950671 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1487950671 0 Nurse Practitioners Anesthesia Services 20 1487950671 0 Nurse Practitioners Nurse Practitioners Services 20 1487950671 0 Nurse Practitioners Physician Services 00 1487953659 0 SHAPIRO SARAH 2014244 9999999 B 10 1487953659 0 29373 NETWORK PL CHICAGO IL 606733039 20 1487953659 0 Physicians Anesthesia Services 20 1487953659 0 Physicians Fluoride varnish 20 1487953659 0 Physicians Healthy Kids Services 20 1487953659 0 Physicians Optical Supplies 20 1487953659 0 Physicians Physician Services 00 1487954038 0 BARNETT BRITTANY L 2019032 9999999 B 10 1487954038 0 545 BARNHILL DR # EH215 INDIANAPOLIS IN 462025112 20 1487954038 0 Physician Assistant Only Fluoride varnish 20 1487954038 0 Physician Assistant Only Healthy Kids Services 20 1487954038 0 Physician Assistant Only Physician Services 00 1487954707 0 MORRIS KRISTEN A 2018333 9999999 B 10 1487954707 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1487954707 0 Nurse Practitioners Fluoride varnish 20 1487954707 0 Nurse Practitioners Healthy Kids Services 20 1487954707 0 Nurse Practitioners Nurse Practitioners Services 20 1487954707 0 Nurse Practitioners Physician Services 00 1487957957 0 KARP CAROLYN D 2020288 9999999 B 10 1487957957 0 19990 GOVERNORS HWY OLYMPIA FIELDS IL 604611021 20 1487957957 0 Other behavior health professional LCPC/LMFT services 00 1487958377 0 PEARCE MERCY 2021182 9999999 B 10 1487958377 0 255 N 30TH ST LARAMIE WY 820725140 20 1487958377 0 Physician Assistant Only Fluoride varnish 20 1487958377 0 Physician Assistant Only Healthy Kids Services 20 1487958377 0 Physician Assistant Only Physician Services 00 1487959300 0 O'GRADY LORI 2021134 9999999 B 10 1487959300 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1487959300 0 Nurse Practitioners Healthy Kids Services 20 1487959300 0 Nurse Practitioners Nurse Practitioners Services 20 1487959300 0 Nurse Practitioners Physician Services 00 1487959847 0 KELLEY STARLENE 2011018 9999999 B 10 1487959847 0 1819 BAY SCOTT CIR STE 109 NAPERVILLE IL 605401130 20 1487959847 0 Clinical Social Worker Social work service 00 1487960019 0 RUTKOWSKI MAGDALENA M 2018106 9999999 B 10 1487960019 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1487960019 0 Physicians Anesthesia Services 20 1487960019 0 Physicians Fluoride varnish 20 1487960019 0 Physicians Healthy Kids Services 20 1487960019 0 Physicians Optical Supplies 20 1487960019 0 Physicians Physician Services 00 1487960589 0 BECERRA SANDRA 2016140 9999999 B 10 1487960589 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1487960589 0 Other behavior health professional All Kids application agent 20 1487960589 0 Other behavior health professional Family Planning Counseling 20 1487960589 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1487960951 0 JANI JAI SAILESH 2015213 9999999 B 10 1487960951 0 2740 W FOSTER AVE LL7 CHICAGO IL 606253500 20 1487960951 0 Physicians Anesthesia Services 20 1487960951 0 Physicians Healthy Kids Services 20 1487960951 0 Physicians Optical Supplies 20 1487960951 0 Physicians Physician Services 00 1487962445 0 CASABIANCA LEIGH C 2025013 9999999 B 10 1487962445 0 515 VALLEY ST STE 203 MAPLEWOOD NJ 070404300 20 1487962445 0 Physician Assistant Only Fluoride varnish 20 1487962445 0 Physician Assistant Only Healthy Kids Services 20 1487962445 0 Physician Assistant Only Physician Services 00 1487962494 0 MARAPAREDDIGARI PARTHASARATHI 2024128 9999999 B 10 1487962494 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1487962494 0 Physicians Anesthesia Services 20 1487962494 0 Physicians Fluoride varnish 20 1487962494 0 Physicians Healthy Kids Services 20 1487962494 0 Physicians Optical Supplies 20 1487962494 0 Physicians Physician Services 00 1487963450 0 RAMOS TIRADO JOEL 2020348 9999999 B 10 1487963450 0 PO BOX 43230 PHOENIX AZ 850803230 20 1487963450 0 Physicians Anesthesia Services 20 1487963450 0 Physicians Fluoride varnish 20 1487963450 0 Physicians Healthy Kids Services 20 1487963450 0 Physicians Optical Supplies 20 1487963450 0 Physicians Physician Services 00 1487963708 0 SANDERSON JULIE 2022244 9999999 B 10 1487963708 0 1S450 SUMMIT AVE STE 270 OAKBROOK TERRAC IL 601813959 20 1487963708 0 Clinical Social Worker Social work service 00 1487963724 0 MEREDITH CARLY J 2015245 9999999 B 10 1487963724 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1487963724 0 Nurse Practitioners Fluoride varnish 20 1487963724 0 Nurse Practitioners Healthy Kids Services 20 1487963724 0 Nurse Practitioners Nurse Practitioners Services 20 1487963724 0 Nurse Practitioners Physician Services 00 1487965356 0 GONCZY CHAD 2018221 9999999 B 10 1487965356 0 3051 HOLLIS DR SPRINGFIELD IL 627047452 20 1487965356 0 Physicians Anesthesia Services 20 1487965356 0 Physicians Healthy Kids Services 20 1487965356 0 Physicians Optical Supplies 20 1487965356 0 Physicians Physician Services 00 1487965679 0 BHATT SIMA T 2013189 9999999 B 10 1487965679 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1487965679 0 Physicians Anesthesia Services 20 1487965679 0 Physicians Fluoride varnish 20 1487965679 0 Physicians Healthy Kids Services 20 1487965679 0 Physicians Optical Supplies 20 1487965679 0 Physicians Physician Services 00 1487966818 0 SCHNEIDER WILLIAM RICHARD 2021228 9999999 B 10 1487966818 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1487966818 0 Physicians Anesthesia Services 20 1487966818 0 Physicians Healthy Kids Services 20 1487966818 0 Physicians Optical Supplies 20 1487966818 0 Physicians Physician Services 00 1487967352 0 NELSON REBECCA 2022283 9999999 B 10 1487967352 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1487967352 0 Physician Assistant Only Fluoride varnish 20 1487967352 0 Physician Assistant Only Healthy Kids Services 20 1487967352 0 Physician Assistant Only Physician Services 00 1487968665 0 MOLINA HEATHER A 2017236 9999999 B 10 1487968665 0 5777 DEPT CAROL STREAM IL 601220021 20 1487968665 0 Physician Assistant Only Fluoride varnish 20 1487968665 0 Physician Assistant Only Healthy Kids Services 20 1487968665 0 Physician Assistant Only Physician Services 00 1487968962 0 SICKS LINDSAY 2013213 9999999 B 10 1487968962 0 7600 W COLLEGE DR STE 9 PALOS HEIGHTS IL 604631039 20 1487968962 0 Optometrists Optical Supplies 20 1487968962 0 Optometrists Optometric Services 20 1487968962 0 Optometrists Physician Services 00 1487970471 0 DELGADO GABRIELA 2014202 9999999 B 10 1487970471 0 5777 DEPT CAROL STREAM IL 601228942 20 1487970471 0 Physicians Anesthesia Services 20 1487970471 0 Physicians Fluoride varnish 20 1487970471 0 Physicians Healthy Kids Services 20 1487970471 0 Physicians Optical Supplies 20 1487970471 0 Physicians Physician Services 00 1487971537 0 SEIFFERT LORRAINE 2010179 9999999 B 10 1487971537 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1487971537 0 Nurse Practitioners Healthy Kids Services 20 1487971537 0 Nurse Practitioners Nurse Practitioners Services 20 1487971537 0 Nurse Practitioners Physician Services 00 1487972451 0 MERRYMAN ABBEY S 2014251 9999999 B 10 1487972451 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1487972451 0 Physicians Anesthesia Services 20 1487972451 0 Physicians Healthy Kids Services 20 1487972451 0 Physicians Optical Supplies 20 1487972451 0 Physicians Physician Services 00 1487973491 0 BETANCOURT JAVIER 2024082 9999999 B 10 1487973491 0 9 EXECUTIVE CAMPUS CHERRY HILL NJ 080024502 20 1487973491 0 Physicians Anesthesia Services 20 1487973491 0 Physicians Healthy Kids Services 20 1487973491 0 Physicians Optical Supplies 20 1487973491 0 Physicians Physician Services 00 1487974119 0 TRENDELMAN SHERI G 2021308 9999999 H 10 1487974119 0 777 S MAIN ST STE 100 CLINTON IN 478422493 20 1487974119 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT 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843151 KANSAS CITY MO 641843151 20 1487975066 0 Physicians Anesthesia Services 20 1487975066 0 Physicians Fluoride varnish 20 1487975066 0 Physicians Healthy Kids Services 20 1487975066 0 Physicians Optical Supplies 20 1487975066 0 Physicians Physician Services 00 1487975181 0 MATTSON LESLIE 2013210 9999999 B 10 1487975181 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1487975181 0 Physicians Anesthesia Services 20 1487975181 0 Physicians Fluoride varnish 20 1487975181 0 Physicians Healthy Kids Services 20 1487975181 0 Physicians Optical Supplies 20 1487975181 0 Physicians Physician Services 00 1487975918 0 KOWALSKI JOSEPH T 2017270 9999999 B 10 1487975918 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1487975918 0 Nurse Practitioners Anesthesia Services 20 1487975918 0 Nurse Practitioners Healthy Kids Services 20 1487975918 0 Nurse Practitioners Optical Supplies 20 1487975918 0 Nurse Practitioners Physician Services 00 1487977427 0 BURNHAM LEONA 2010060 9999999 B 10 1487977427 0 PO BOX 3428 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service 00 1487984589 0 HILL EMILY K 2015246 9999999 B 10 1487984589 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1487984589 0 Physicians Anesthesia Services 20 1487984589 0 Physicians Healthy Kids Services 20 1487984589 0 Physicians Optical Supplies 20 1487984589 0 Physicians Physician Services 00 1487984605 0 KANESHIRO MELANIE M 2022350 9999999 B 10 1487984605 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1487984605 0 Speech Therapists Medical Supplies 20 1487984605 0 Speech Therapists Medical equipment/prosthetic devices 20 1487984605 0 Speech Therapists Speech Therapy/Pathology Services 00 1487984613 0 SCHARER BRANDON M 2023237 9999999 B 10 1487984613 0 PO BOX 28900 GREEN BAY WI 543240900 20 1487984613 0 Physicians Anesthesia Services 20 1487984613 0 Physicians Healthy Kids Services 20 1487984613 0 Physicians Optical Supplies 20 1487984613 0 Physicians Physician Services 00 1487985883 0 SHARMA PARIKSHIT S. 2016228 9999999 B 10 1487985883 0 75 REMITTANCE DR DEPT 1611 CHICAGO IL 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OUTER 40 RD CHESTERFIELD MO 630172004 20 1487988093 0 Physicians Anesthesia Services 20 1487988093 0 Physicians Fluoride varnish 20 1487988093 0 Physicians Healthy Kids Services 20 1487988093 0 Physicians Optical Supplies 20 1487988093 0 Physicians Physician Services 00 1487989083 0 AJIDE JULIUS C 2009305 9999999 B 10 1487989083 0 20 TOWER CT STE F SUITE F GURNEE IL 600315711 20 1487989083 0 Nurse Practitioners Anesthesia Services 20 1487989083 0 Nurse Practitioners Nurse Practitioners Services 20 1487989083 0 Nurse Practitioners Physician Services 00 1487989091 0 SPENCER VANESIA 2023103 9999999 B 10 1487989091 0 2001 BUTTERFIELD RD STE 1600 DOWNERS GROVE IL 605151211 20 1487989091 0 Physical Therapists Medical Supplies 20 1487989091 0 Physical Therapists Medical equipment/prosthetic devices 20 1487989091 0 Physical Therapists Physical Therapy Services 00 1487989513 0 COX SHAUN 2024053 9999999 B 10 1487989513 0 800 E LOCUST ST OLNEY IL 624502553 20 1487989513 0 Nurse Practitioners 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2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1497015242 0 Psychologist Psychologist service 00 1497018469 0 OLORTEGUI KINGA S 2018352 9999999 B 10 1497018469 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1497018469 0 Physicians Anesthesia Services 20 1497018469 0 Physicians Healthy Kids Services 20 1497018469 0 Physicians Optical Supplies 20 1497018469 0 Physicians Physician Services 00 1497018477 0 HATHAWAY SAMANTHA 2016182 9999999 B 10 1497018477 0 PO BOX 775618 CHICAGO IL 606775618 20 1497018477 0 Physicians Anesthesia Services 20 1497018477 0 Physicians Fluoride varnish 20 1497018477 0 Physicians Healthy Kids Services 20 1497018477 0 Physicians Optical Supplies 20 1497018477 0 Physicians Physician Services 00 1497018774 0 CHEN DAVID Y 2016162 9999999 B 10 1497018774 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1497018774 0 Physicians Anesthesia Services 20 1497018774 0 Physicians Fluoride varnish 20 1497018774 0 Physicians Healthy Kids Services 20 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Physicians Fluoride varnish 20 1497046452 0 Physicians Healthy Kids Services 20 1497046452 0 Physicians Optical Supplies 20 1497046452 0 Physicians Physician Services 00 1497046619 0 AHMED FATIMA 2017331 9999999 B 10 1497046619 0 611 W PARK ST URBANA IL 618012529 20 1497046619 0 Physicians Anesthesia Services 20 1497046619 0 Physicians Healthy Kids Services 20 1497046619 0 Physicians Optical Supplies 20 1497046619 0 Physicians Physician Services 00 1497047096 0 WILLARD SCOTT D 2024183 9999999 B 10 1497047096 0 3200 E CAMELBACK RD STE 250 PHOENIX AZ 850182327 20 1497047096 0 Physicians Anesthesia Services 20 1497047096 0 Physicians Healthy Kids Services 20 1497047096 0 Physicians Optical Supplies 20 1497047096 0 Physicians Physician Services 00 1497047567 0 WAGNER BENJAMIN J 2016181 9999999 B 10 1497047567 0 PO BOX 3988 CARBONDALE IL 629023988 20 1497047567 0 Physicians Anesthesia Services 20 1497047567 0 Physicians Healthy Kids Services 20 1497047567 0 Physicians Optical Supplies 20 1497047567 0 Physicians Physician Services 00 1497049373 0 CUNNINGHAM BRYCE A 2020354 9999999 B 10 1497049373 0 1501 RIVERSIDE DR STE 105 CHATTANOOGA TN 374064332 20 1497049373 0 Physicians Anesthesia Services 20 1497049373 0 Physicians Healthy Kids Services 20 1497049373 0 Physicians Optical Supplies 20 1497049373 0 Physicians Physician Services 00 1497051213 0 HARRIS SANDRA 2011094 9999999 B 10 1497051213 0 17746 OAK PARK AVE TINLEY PARK IL 604773936 20 1497051213 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1497051239 0 SOROKIN YEVGENIYA 2012214 9999999 B 10 1497051239 0 PO BOX 5588 BELFAST ME 049155500 20 1497051239 0 Physicians All Kids application agent 20 1497051239 0 Physicians Anesthesia Services 20 1497051239 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1497051239 0 Physicians Healthy Kids Services 20 1497051239 0 Physicians Optical Supplies 20 1497051239 0 Physicians Physician Services 00 1497052021 0 HARMELINK MATTHEW 2016336 9999999 B 10 1497052021 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1497052021 0 Physicians Anesthesia Services 20 1497052021 0 Physicians Fluoride varnish 20 1497052021 0 Physicians Healthy Kids Services 20 1497052021 0 Physicians Optical Supplies 20 1497052021 0 Physicians Physician Services 20 1497052021 0 Physicians Physicians Psychiatric Services 00 1497052336 0 KURTH KATHRYN H 2015167 9999999 B 10 1497052336 0 PO BOX 778912 CHICAGO IL 606778912 20 1497052336 0 Nurse Practitioners Fluoride varnish 20 1497052336 0 Nurse Practitioners Healthy Kids Services 20 1497052336 0 Nurse Practitioners Nurse Practitioners Services 20 1497052336 0 Nurse Practitioners Physician Services 00 1497053607 0 WHITMAN STEVEN E 2011073 9999999 B 10 1497053607 0 225 MEDICAL CENTER DR STE 405 PADUCAH KY 420037914 20 1497053607 0 Nurse Practitioners Anesthesia Services 20 1497053607 0 Nurse Practitioners Nurse Practitioners Services 20 1497053607 0 Nurse Practitioners Physician Services 00 1497054944 0 RODRIGUEZ SARAH H 2016245 9999999 B 10 1497054944 0 6501 S PROMONTORY DR CHICAGO IL 606491003 20 1497054944 0 Physicians Anesthesia Services 20 1497054944 0 Physicians Healthy Kids Services 20 1497054944 0 Physicians Optical Supplies 20 1497054944 0 Physicians Physician Services 00 1497055909 0 BEEL BRETT L 2019334 9999999 B 10 1497055909 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1497055909 0 Physicians Anesthesia Services 20 1497055909 0 Physicians Healthy Kids Services 20 1497055909 0 Physicians Optical Supplies 20 1497055909 0 Physicians Physician Services 00 1497057905 0 LOKARE SHRIRAM 2015306 9999999 B 10 1497057905 0 600 S 13TH ST PEKIN IL 615544936 20 1497057905 0 Physicians Anesthesia Services 20 1497057905 0 Physicians Fluoride varnish 20 1497057905 0 Physicians Healthy Kids Services 20 1497057905 0 Physicians Optical Supplies 20 1497057905 0 Physicians Physician Services 00 1497060982 0 SIGLIN SCOTT J 2016214 9999999 B 10 1497060982 0 29373 NETWORK PL CHICAGO IL 606733039 20 1497060982 0 Physicians Anesthesia Services 20 1497060982 0 Physicians Fluoride varnish 20 1497060982 0 Physicians Healthy Kids Services 20 1497060982 0 Physicians Optical Supplies 20 1497060982 0 Physicians Physician Services 00 1497062103 0 ELSKAMP KIMBERLY A 2010270 9999999 B 10 1497062103 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1497062103 0 Nurse Practitioners Anesthesia Services 20 1497062103 0 Nurse Practitioners Nurse Practitioners Services 20 1497062103 0 Nurse Practitioners Physician Services 00 1497063044 0 RICE ALISON 2025139 9999999 B 10 1497063044 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1497063044 0 Nurse Practitioners Fluoride varnish 20 1497063044 0 Nurse Practitioners Healthy Kids Services 20 1497063044 0 Nurse Practitioners Nurse Practitioners Services 20 1497063044 0 Nurse Practitioners Physician Services 00 1497065189 0 ISRAILOVA MALIKA 2021216 9999999 B 10 1497065189 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1497065189 0 Physicians Anesthesia Services 20 1497065189 0 Physicians Fluoride varnish 20 1497065189 0 Physicians Healthy Kids Services 20 1497065189 0 Physicians Optical Supplies 20 1497065189 0 Physicians Physician Services 00 1497065312 0 BURKE MARY C 2010274 9999999 B 10 1497065312 0 16325 HARLEM AVE TINLEY PARK IL 604772509 20 1497065312 0 Nurse Practitioners Healthy Kids Services 20 1497065312 0 Nurse Practitioners Midwife Services 20 1497065312 0 Nurse Practitioners Nurse Practitioners Services 20 1497065312 0 Nurse Practitioners Physician Services 00 1497065452 0 ODOM DEVIN C 2013182 9999999 B 10 1497065452 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1497065452 0 Physicians Anesthesia Services 20 1497065452 0 Physicians Fluoride varnish 20 1497065452 0 Physicians Healthy Kids Services 20 1497065452 0 Physicians Optical Supplies 20 1497065452 0 Physicians Physician Services 00 1497066732 0 STAUFFER MATTHEW 2013214 9999999 B 10 1497066732 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1497066732 0 Physicians Anesthesia Services 20 1497066732 0 Physicians Healthy Kids Services 20 1497066732 0 Physicians Optical Supplies 20 1497066732 0 Physicians Physician Services 00 1497066740 0 BRANDT KIMBERLY 2022220 9999999 B 10 1497066740 0 10018 KENNERLY RD SAINT LOUIS MO 631282106 20 1497066740 0 Physicians Anesthesia Services 20 1497066740 0 Physicians Healthy Kids Services 20 1497066740 0 Physicians Optical Supplies 20 1497066740 0 Physicians Physician Services 20 1497066740 0 Physicians Physicians Psychiatric Services 00 1497067318 0 HAJIAN NISHA R 2014120 9999999 B 10 1497067318 0 5777 DEPT CAROL STREAM IL 601220021 20 1497067318 0 Nurse Practitioners Healthy Kids Services 20 1497067318 0 Nurse Practitioners Nurse Practitioners Services 20 1497067318 0 Nurse Practitioners Physician Services 00 1497067409 0 BAROUNIS DAVID 2012336 9999999 B 10 1497067409 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1497067409 0 Physicians Anesthesia Services 20 1497067409 0 Physicians Healthy Kids Services 20 1497067409 0 Physicians Optical Supplies 20 1497067409 0 Physicians Physician Services 00 1497067615 0 ALIA YAZAN M 2016214 9999999 B 10 1497067615 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1497067615 0 Physicians Anesthesia Services 20 1497067615 0 Physicians Fluoride varnish 20 1497067615 0 Physicians Healthy Kids Services 20 1497067615 0 Physicians Optical Supplies 20 1497067615 0 Physicians Physician Services 00 1497068316 0 NARANG SHWETA 2015001 9999999 B 10 1497068316 0 PO BOX 790126 SAINT LOUIS MO 631790126 20 1497068316 0 Physicians Anesthesia Services 20 1497068316 0 Physicians Healthy Kids Services 20 1497068316 0 Physicians Optical Supplies 20 1497068316 0 Physicians Physician Services 00 1497068415 0 HEGDE SHILPA V 2023316 9999999 B 10 1497068415 0 5901 LINCOLN DR EDINA MN 554361611 20 1497068415 0 Physicians Anesthesia Services 20 1497068415 0 Physicians Healthy Kids Services 20 1497068415 0 Physicians Optical Supplies 20 1497068415 0 Physicians Physician Services 00 1497068795 0 CRANFORD DANIEL J 2022005 9999999 B 10 1497068795 0 70 DOCTORS PARK CAPE GIRARDEAU MO 637034928 20 1497068795 0 Physicians Anesthesia Services 20 1497068795 0 Physicians Healthy Kids Services 20 1497068795 0 Physicians Optical Supplies 20 1497068795 0 Physicians Physician Services 00 1497069231 0 REJON VERONICA 2011343 9999999 B 10 1497069231 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1497069231 0 Physicians Anesthesia Services 20 1497069231 0 Physicians Fluoride varnish 20 1497069231 0 Physicians Healthy Kids Services 20 1497069231 0 Physicians Optical Supplies 20 1497069231 0 Physicians Physician Services 00 1497069306 0 CHOW JARVA 2016214 9999999 B 10 1497069306 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1497069306 0 Physicians Anesthesia Services 20 1497069306 0 Physicians Healthy Kids Services 20 1497069306 0 Physicians Optical Supplies 20 1497069306 0 Physicians Physician Services 00 1497069926 0 CANE ELVIRA 2013182 9999999 B 10 1497069926 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1497069926 0 Physicians Anesthesia Services 20 1497069926 0 Physicians Fluoride varnish 20 1497069926 0 Physicians Healthy Kids Services 20 1497069926 0 Physicians Optical Supplies 20 1497069926 0 Physicians Physician Services 00 1497070361 0 WHEELER NATALIE C 2016139 9999999 B 10 1497070361 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1497070361 0 Physicians Anesthesia Services 20 1497070361 0 Physicians Healthy Kids Services 20 1497070361 0 Physicians Optical Supplies 20 1497070361 0 Physicians Physician Services 20 1497070361 0 Physicians Physicians Psychiatric Services 00 1497070601 0 FERGUSON SANCIA 2020029 9999999 B 10 1497070601 0 202 S PARK ST MADISON WI 537151507 20 1497070601 0 Physicians Anesthesia Services 20 1497070601 0 Physicians Fluoride varnish 20 1497070601 0 Physicians Healthy Kids Services 20 1497070601 0 Physicians Optical Supplies 20 1497070601 0 Physicians Physician Services 00 1497070940 0 BADAL EDWARD B 2013244 9999999 B 10 1497070940 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1497070940 0 Physicians Anesthesia Services 20 1497070940 0 Physicians Fluoride varnish 20 1497070940 0 Physicians Healthy Kids Services 20 1497070940 0 Physicians Optical Supplies 20 1497070940 0 Physicians Physician Services 00 1497071039 0 JOSEPH NATALIE M 2015005 9999999 B 10 1497071039 0 29373 NETWORK PL CHICAGO IL 606733039 20 1497071039 0 Physicians Anesthesia Services 20 1497071039 0 Physicians Fluoride varnish 20 1497071039 0 Physicians Healthy Kids Services 20 1497071039 0 Physicians Optical Supplies 20 1497071039 0 Physicians Physician Services 00 1497071146 0 BEEBE MICHAEL 2023160 9999999 B 10 1497071146 0 PO BOX 43230 PHOENIX AZ 850803230 20 1497071146 0 Physicians Anesthesia Services 20 1497071146 0 Physicians Healthy Kids Services 20 1497071146 0 Physicians Optical Supplies 20 1497071146 0 Physicians Physician Services 00 1497071674 0 BROWN JORDAN 2014168 9999999 B 10 1497071674 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1497071674 0 Physicians Anesthesia Services 20 1497071674 0 Physicians Healthy Kids Services 20 1497071674 0 Physicians Optical Supplies 20 1497071674 0 Physicians Physician Services 00 1497071872 0 LEMOINE BENJAMIN D 2018339 9999999 B 10 1497071872 0 111 OAKWOOD RD EAST PEORIA IL 616111853 20 1497071872 0 Physicians All Kids application agent 20 1497071872 0 Physicians Anesthesia Services 20 1497071872 0 Physicians Healthy Kids Services 20 1497071872 0 Physicians Optical Supplies 20 1497071872 0 Physicians Physician Services 00 1497071898 0 RATTAN HOLLIE 2021197 9999999 B 10 1497071898 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1497071898 0 Physicians Anesthesia Services 20 1497071898 0 Physicians Healthy Kids Services 20 1497071898 0 Physicians Optical Supplies 20 1497071898 0 Physicians Physician Services 00 1497071971 0 STRASSER KRISTEN M 2022200 9999999 B 10 1497071971 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1497071971 0 Physicians Anesthesia Services 20 1497071971 0 Physicians Fluoride varnish 20 1497071971 0 Physicians Healthy Kids Services 20 1497071971 0 Physicians Optical Supplies 20 1497071971 0 Physicians Physician Services 00 1497072078 0 BAESEL CHRISTEN A 2018289 9999999 B 10 1497072078 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1497072078 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1497072425 0 LI ANDREA 2020286 9999999 B 10 1497072425 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1497072425 0 Physicians Anesthesia Services 20 1497072425 0 Physicians Healthy Kids Services 20 1497072425 0 Physicians Optical Supplies 20 1497072425 0 Physicians Physician Services 00 1497072854 0 OCHIENG'' FREDERICK O 2020213 9999999 B 10 1497072854 0 3051 HOLLIS DR SPRINGFIELD IL 627047452 20 1497072854 0 Physicians Anesthesia Services 20 1497072854 0 Physicians Fluoride varnish 20 1497072854 0 Physicians Healthy Kids Services 20 1497072854 0 Physicians Optical Supplies 20 1497072854 0 Physicians Physician Services 00 1497072953 0 REIF AMY L 2016267 9999999 B 10 1497072953 0 PO BOX 736033 DALLAS TX 753736033 20 1497072953 0 Physicians Anesthesia Services 20 1497072953 0 Physicians Fluoride varnish 20 1497072953 0 Physicians Healthy Kids Services 20 1497072953 0 Physicians Optical Supplies 20 1497072953 0 Physicians Physician Services 00 1497072987 0 ARENDT ADAM J 2015329 9999999 B 10 1497072987 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1497072987 0 Podiatrists Podiatric Services 00 1497074991 0 BHATIA SHAUN 2024231 9999999 B 10 1497074991 0 921 GESSNER RD HOUSTON TX 770242501 20 1497074991 0 Physicians Anesthesia Services 20 1497074991 0 Physicians Healthy Kids Services 20 1497074991 0 Physicians Optical Supplies 20 1497074991 0 Physicians Physician Services 00 1497075196 0 MEAGHER ASHLEY 2021151 9999999 B 10 1497075196 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1497075196 0 Physicians Anesthesia Services 20 1497075196 0 Physicians Healthy Kids Services 20 1497075196 0 Physicians Optical Supplies 20 1497075196 0 Physicians Physician Services 00 1497075600 0 STEFKO MAURA 2014300 9999999 B 10 1497075600 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1497075600 0 Physicians All Kids application agent 20 1497075600 0 Physicians Anesthesia Services 20 1497075600 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1497075600 0 Physicians Family Planning Counseling 20 1497075600 0 Physicians Fluoride varnish 20 1497075600 0 Physicians Healthy Kids Services 20 1497075600 0 Physicians Optical Supplies 20 1497075600 0 Physicians Physician Services 00 1497076236 0 ALBERT LAURA 2017334 9999999 B 10 1497076236 0 777 BANNOCK ST DENVER CO 802044507 20 1497076236 0 Psychologist Psychologist service 00 1497076582 0 RAINES REBEKAH 2024106 9999999 B 10 1497076582 0 PO BOX 500720 SAINT LOUIS MO 631500720 20 1497076582 0 Physicians Anesthesia Services 20 1497076582 0 Physicians Healthy Kids Services 20 1497076582 0 Physicians Optical Supplies 20 1497076582 0 Physicians Physician Services 00 1497076798 0 MUELLER KRISTEN 2014037 9999999 B 10 1497076798 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1497076798 0 Physicians Anesthesia Services 20 1497076798 0 Physicians Healthy Kids Services 20 1497076798 0 Physicians Optical Supplies 20 1497076798 0 Physicians Physician Services 00 1497078190 0 BELOW JAIME L 2018001 9999999 B 10 1497078190 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1497078190 0 Psychologist Psychologist service 00 1497079099 0 VILLEGAS RICHARD F 2022202 9999999 B 10 1497079099 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1497079099 0 Physicians Anesthesia Services 20 1497079099 0 Physicians Healthy Kids Services 20 1497079099 0 Physicians Optical Supplies 20 1497079099 0 Physicians Physician Services 00 1497080584 0 HOMAN ELIZABETH M 2018361 9999999 B 10 1497080584 0 29373 NETWORK PL CHICAGO IL 606733039 20 1497080584 0 Physicians Anesthesia Services 20 1497080584 0 Physicians Healthy Kids Services 20 1497080584 0 Physicians Optical Supplies 20 1497080584 0 Physicians Physician Services 20 1497080584 0 Physicians Physicians Psychiatric Services 00 1497080709 0 KASULA SRIKANTH 2016214 9999999 B 10 1497080709 0 621 S ILLINOIS AVE STE 103 MASON CITY IA 504015489 20 1497080709 0 Physicians Anesthesia Services 20 1497080709 0 Physicians Fluoride varnish 20 1497080709 0 Physicians Healthy Kids Services 20 1497080709 0 Physicians Optical Supplies 20 1497080709 0 Physicians Physician Services 00 1497080808 0 SCHWARTZ KRISTY L 2017033 9999999 B 10 1497080808 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1497080808 0 Physicians Anesthesia Services 20 1497080808 0 Physicians Healthy Kids Services 20 1497080808 0 Physicians Optical Supplies 20 1497080808 0 Physicians Physician Services 00 1497080865 0 NADOLSKI STEVEN J 2009244 9999999 B 10 1497080865 0 40 SHUMAN BLVD STE 275 NAPERVILLE IL 605638669 20 1497080865 0 Nurse Practitioners Anesthesia Services 20 1497080865 0 Nurse Practitioners Nurse Practitioners Services 00 1497081145 0 JOHNSON MARGARET J 2015247 9999999 B 10 1497081145 0 611 W PARK ST URBANA IL 618012529 20 1497081145 0 Clinical Social Worker Social work service 00 1497081830 0 SIRACUSA CHRISTOPHER 2017182 9999999 B 10 1497081830 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1497081830 0 Physicians Anesthesia Services 20 1497081830 0 Physicians Fluoride varnish 20 1497081830 0 Physicians Healthy Kids Services 20 1497081830 0 Physicians Optical Supplies 20 1497081830 0 Physicians Physician Services 00 1497082218 0 ANJUM SAQUIB 2022349 9999999 B 10 1497082218 0 5750 JOHNSTON ST STE 205 LAFAYETTE LA 705035334 20 1497082218 0 Physicians Anesthesia Services 20 1497082218 0 Physicians Fluoride varnish 20 1497082218 0 Physicians Healthy Kids Services 20 1497082218 0 Physicians 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Services 00 1497085609 0 TOPKARA VELI 2024193 9999999 B 10 1497085609 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1497085609 0 Physicians Anesthesia Services 20 1497085609 0 Physicians Fluoride varnish 20 1497085609 0 Physicians Healthy Kids Services 20 1497085609 0 Physicians Optical Supplies 20 1497085609 0 Physicians Physician Services 00 1497086722 0 COLLINS JOHN M 2012322 9999999 B 10 1497086722 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1497086722 0 Physicians Anesthesia Services 20 1497086722 0 Physicians Healthy Kids Services 20 1497086722 0 Physicians Optical Supplies 20 1497086722 0 Physicians Physician Services 00 1497088322 0 COLLANDER BRETT 2015182 9999999 B 10 1497088322 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1497088322 0 Physicians Anesthesia Services 20 1497088322 0 Physicians Fluoride varnish 20 1497088322 0 Physicians Healthy Kids Services 20 1497088322 0 Physicians Optical Supplies 20 1497088322 0 Physicians Physician Services 00 1497089825 0 RUSSELL HORTENSE P 2022335 9999999 B 10 1497089825 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1497089825 0 Physicians Anesthesia Services 20 1497089825 0 Physicians Fluoride varnish 20 1497089825 0 Physicians Healthy Kids Services 20 1497089825 0 Physicians Optical Supplies 20 1497089825 0 Physicians Physician Services 00 1497091219 0 RHODES CALEB W 2024354 9999999 B 10 1497091219 0 PO BOX 219 BROOKPORT IL 629100219 20 1497091219 0 Audiologists Audiology Services 20 1497091219 0 Audiologists Medical Supplies 20 1497091219 0 Audiologists Medical equipment/prosthetic devices 00 1497093033 0 ALGARRA ESTHER 1999315 9999999 B 10 1497093033 0 1101 S CAPITAL OF TEXAS HWY ST WEST LAKE HILLS TX 787466445 20 1497093033 0 Occupational Therapists Medical Supplies 20 1497093033 0 Occupational Therapists Medical equipment/prosthetic devices 20 1497093033 0 Occupational Therapists Occupational Therapy Services 00 1497093264 0 KNOWSKI PEGGY L 2013032 9999999 B 10 1497093264 0 PO BOX 3428 SPRINGFIELD 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MORENO KATIE 2014305 9999999 B 10 1497149173 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1497149173 0 Nurse Practitioners Anesthesia Services 20 1497149173 0 Nurse Practitioners Nurse Practitioners Services 20 1497149173 0 Nurse Practitioners Physician Services 00 1497149629 0 SHAHARYAR SAMEER 2023354 9999999 B 10 1497149629 0 PO BOX 43230 PHOENIX AZ 850803230 20 1497149629 0 Physicians Anesthesia Services 20 1497149629 0 Physicians Healthy Kids Services 20 1497149629 0 Physicians Optical Supplies 20 1497149629 0 Physicians Physician Services 00 1497149694 0 BAHRANI NEDA O 2016096 9999999 B 10 1497149694 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1497149694 0 Physicians Anesthesia Services 20 1497149694 0 Physicians Fluoride varnish 20 1497149694 0 Physicians Healthy Kids Services 20 1497149694 0 Physicians Optical Supplies 20 1497149694 0 Physicians Physician Services 00 1497150106 0 OWEN PAIGE M 2016095 9999999 B 10 1497150106 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1497150106 0 Nurse Practitioners Fluoride varnish 20 1497150106 0 Nurse Practitioners Healthy Kids Services 20 1497150106 0 Nurse Practitioners Nurse Practitioners Services 20 1497150106 0 Nurse Practitioners Physician Services 00 1497150221 0 MINASSIAN TIERENY N 2015265 9999999 B 10 1497150221 0 909 RIDGEBROOK RD STE 300 SPARKS MD 211529477 20 1497150221 0 Nurse Practitioners Fluoride varnish 20 1497150221 0 Nurse Practitioners Healthy Kids Services 20 1497150221 0 Nurse Practitioners Nurse Practitioners Services 20 1497150221 0 Nurse Practitioners Physician Services 00 1497150486 0 LESS DIANE M 2016140 9999999 B 10 1497150486 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1497150486 0 Physician Assistant Only Fluoride varnish 20 1497150486 0 Physician Assistant Only Healthy Kids Services 20 1497150486 0 Physician Assistant Only Physician Services 00 1497150908 0 VILLALOBOS ANGELE 2016244 9999999 B 10 1497150908 0 1500 E LINCOLN HWY STE A DEKALB IL 601153990 20 1497150908 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1497150908 0 Other behavior health professional Social work service 00 1497151542 0 SMITH CHARITA 2014328 9999999 B 10 1497151542 0 8500 W 110TH ST STE 450 OVERLAND PARK KS 662104029 20 1497151542 0 Optometrists Optical Supplies 20 1497151542 0 Optometrists Optometric Services 20 1497151542 0 Optometrists Physician Services 00 1497151617 0 GUENTHER SUSAN B 2017365 9999999 B 10 1497151617 0 2530 CRAWFORD AVE STE 308 EVANSTON IL 602014972 20 1497151617 0 Other behavior health professional LCPC/LMFT services 00 1497155295 0 SKRZYPCHAK DALE P 2025064 9999999 B 10 1497155295 0 5777 DEPT CAROL STREAM IL 601220021 20 1497155295 0 Physical Therapists Medical Supplies 20 1497155295 0 Physical Therapists Medical equipment/prosthetic devices 20 1497155295 0 Physical Therapists Physical Therapy Services 00 1497155790 0 PARENTI BRITTANY 2018277 9999999 B 10 1497155790 0 5220 EAST AVE COUNTRYSIDE IL 605253133 20 1497155790 0 Clinical Social Worker Social work service 00 1497155998 0 TAYLOR ANEESHA 2014274 9999999 B 10 1497155998 0 2201 MAIN ST EVANSTON IL 602021519 20 1497155998 0 Nurse Practitioners Fluoride varnish 20 1497155998 0 Nurse Practitioners Healthy Kids Services 20 1497155998 0 Nurse Practitioners Nurse Practitioners Services 20 1497155998 0 Nurse Practitioners Physician Services 00 1497156731 0 THEOBALD TIMOTHY 2015321 9999999 B 10 1497156731 0 2127 GREEN BAY RD NORTH CHICAGO IL 600642801 20 1497156731 0 Dentists Dental Services 20 1497156731 0 Dentists Physician Services 00 1497157275 0 IBRAHIM-JOUDEH HEBA 2021110 9999999 B 10 1497157275 0 7667 W 95TH ST STE 209 HICKORY HILLS IL 604572281 20 1497157275 0 Other behavior health professional LCPC/LMFT services 00 1497159206 0 MILAM ZACHERY M 2021308 9999999 H 10 1497159206 0 777 S MAIN ST STE 100 CLINTON IN 478422493 20 1497159206 0 Other behavior health professional Other Behavioral Health 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Services 00 1497160584 0 WANG AMY Y 2018352 9999999 B 10 1497160584 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1497160584 0 Physicians Anesthesia Services 20 1497160584 0 Physicians Fluoride varnish 20 1497160584 0 Physicians Healthy Kids Services 20 1497160584 0 Physicians Optical Supplies 20 1497160584 0 Physicians Physician Services 00 1497160691 0 NAZIR MUHAMMAD R 2024184 9999999 B 10 1497160691 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1497160691 0 Physicians Anesthesia Services 20 1497160691 0 Physicians Fluoride varnish 20 1497160691 0 Physicians Healthy Kids Services 20 1497160691 0 Physicians Optical Supplies 20 1497160691 0 Physicians Physician Services 00 1497160725 0 PATEL GOPI 2019256 9999999 B 10 1497160725 0 PO BOX 5588 BELFAST ME 049155500 20 1497160725 0 Physicians Anesthesia Services 20 1497160725 0 Physicians Healthy Kids Services 20 1497160725 0 Physicians Optical Supplies 20 1497160725 0 Physicians Physician Services 20 1497160725 0 Physicians 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1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1497161814 0 Nurse Practitioners Healthy Kids Services 20 1497161814 0 Nurse Practitioners Nurse Practitioners Services 20 1497161814 0 Nurse Practitioners Nursing service 20 1497161814 0 Nurse Practitioners Physician Services 20 1497161814 0 Nurse Practitioners Waiver service 00 1497164974 0 GOLDENBERG ZENA FRAN 2024123 9999999 B 10 1497164974 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1497164974 0 Clinical Social Worker Social work service 00 1497165146 0 SONG WOOJIN 2015176 9999999 B 10 1497165146 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1497165146 0 Psychologist Psychologist service 00 1497166680 0 HUSSAIN-WEERES ROSINA MARIE 2022276 9999999 B 10 1497166680 0 5901 LINCOLN DR EDINA MN 554361611 20 1497166680 0 Physicians Anesthesia Services 20 1497166680 0 Physicians Fluoride varnish 20 1497166680 0 Physicians Healthy Kids Services 20 1497166680 0 Physicians Optical Supplies 20 1497166680 0 Physicians Physician Services 00 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MAINE ST QUINCY IL 623014038 20 1497285977 0 Nurse Practitioners Fluoride varnish 20 1497285977 0 Nurse Practitioners Healthy Kids Services 20 1497285977 0 Nurse Practitioners Nurse Practitioners Services 20 1497285977 0 Nurse Practitioners Physician Services 00 1497286470 0 DINH VY T 2021007 9999999 B 10 1497286470 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1497286470 0 Physicians Anesthesia Services 20 1497286470 0 Physicians Fluoride varnish 20 1497286470 0 Physicians Healthy Kids Services 20 1497286470 0 Physicians Optical Supplies 20 1497286470 0 Physicians Physician Services 00 1497286587 0 PARK DAVID J 2020016 9999999 B 10 1497286587 0 5777 DEPT CAROL STREAM IL 601220021 20 1497286587 0 Physicians Anesthesia Services 20 1497286587 0 Physicians Fluoride varnish 20 1497286587 0 Physicians Healthy Kids Services 20 1497286587 0 Physicians Optical Supplies 20 1497286587 0 Physicians Physician Services 00 1497286645 0 SEPLAK NINA R 2017131 9999999 B 10 1497286645 0 150 W HIGH 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Physician Assistant Only Fluoride varnish 20 1497295125 0 Physician Assistant Only Healthy Kids Services 20 1497295125 0 Physician Assistant Only Physician Services 00 1497295992 0 ZAPKE ANDREW 2021062 9999999 B 10 1497295992 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1497295992 0 Clinical Social Worker Social work service 00 1497296099 0 HURDLE SHARON 2017279 9999999 B 10 1497296099 0 17746 OAK PARK AVE TINLEY PARK IL 604773936 20 1497296099 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1497296255 0 STRALKA MEGAN 2017028 9999999 B 10 1497296255 0 4230 11TH ST ROCK ISLAND IL 612016746 20 1497296255 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1497296800 0 FRIEDMAN JACOB 2019143 9999999 B 10 1497296800 0 PO BOX 809094 CHICAGO IL 606809094 20 1497296800 0 Physicians Anesthesia Services 20 1497296800 0 Physicians Healthy Kids Services 20 1497296800 0 Physicians Optical Supplies 20 1497296800 0 Physicians Physician Services 00 1497296818 0 HEELEIN TRACY 2017107 9999999 B 10 1497296818 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1497296818 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1497297667 0 DERRIG KATELYN M 2017018 9999999 B 10 1497297667 0 5 S BUSSE RD MOUNT PROSPECT IL 600562901 20 1497297667 0 Occupational Therapists Medical Supplies 20 1497297667 0 Occupational Therapists Medical equipment/prosthetic devices 20 1497297667 0 Occupational Therapists Occupational Therapy Services 00 1497298996 0 SIDBERRY REBECCA L 2016347 9999999 B 10 1497298996 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1497298996 0 Nurse Practitioners Fluoride varnish 20 1497298996 0 Nurse Practitioners Healthy Kids Services 20 1497298996 0 Nurse Practitioners Nurse Practitioners Services 20 1497298996 0 Nurse Practitioners Physician Services 00 1497299465 0 KASSEL ARYN K 2017032 9999999 B 10 1497299465 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1497299465 0 Nurse Practitioners Healthy Kids Services 20 1497299465 0 Nurse Practitioners Nurse Practitioners Services 20 1497299465 0 Nurse Practitioners Physician Services 00 1497299689 0 CHAN SUZANNE 2017040 9999999 B 10 1497299689 0 850 W IRVING PARK RD CHICAGO IL 606133077 20 1497299689 0 Nurse Practitioners Fluoride varnish 20 1497299689 0 Nurse Practitioners Healthy Kids Services 20 1497299689 0 Nurse Practitioners Nurse Practitioners Services 20 1497299689 0 Nurse Practitioners Physician Services 00 1497300206 0 HUDSON JUSTI M 2019224 9999999 B 10 1497300206 0 1120 N MELVIN ST GIBSON CITY IL 609361477 20 1497300206 0 Nurse Practitioners Fluoride varnish 20 1497300206 0 Nurse Practitioners Healthy Kids Services 20 1497300206 0 Nurse Practitioners Nurse Practitioners Services 20 1497300206 0 Nurse Practitioners Physician Services 00 1497301311 0 STANCROFF JENNIFER 2020315 9999999 B 10 1497301311 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1497301311 0 Physician Assistant Only Fluoride varnish 20 1497301311 0 Physician Assistant Only Healthy Kids Services 20 1497301311 0 Physician Assistant Only Physician Services 00 1497301832 0 FATIMA JABEEN 2024275 9999999 B 10 1497301832 0 1634 S ARDMORE AVE VILLA PARK IL 601813742 20 1497301832 0 Physicians Anesthesia Services 20 1497301832 0 Physicians Healthy Kids Services 20 1497301832 0 Physicians Optical Supplies 20 1497301832 0 Physicians Physician Services 00 1497302657 0 ZDANY KRISTEN 2023013 9999999 B 10 1497302657 0 29373 NETWORK PL CHICAGO IL 606733039 20 1497302657 0 Nurse Practitioners Healthy Kids Services 20 1497302657 0 Nurse Practitioners Nurse Practitioners Services 20 1497302657 0 Nurse Practitioners Physician Services 00 1497303556 0 SURESH NILA 2023198 9999999 B 10 1497303556 0 7825 SOLUTION CTR CHICAGO IL 606777007 20 1497303556 0 Physicians Anesthesia Services 20 1497303556 0 Physicians 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20 1497307342 0 Physicians Healthy Kids Services 20 1497307342 0 Physicians Optical Supplies 20 1497307342 0 Physicians Physician Services 00 1497309629 0 HAYES JERICA 2022306 9999999 B 10 1497309629 0 1400 W GREENLEAF AVE CHICAGO IL 606262805 20 1497309629 0 Other behavior health professional LCPC/LMFT services 00 1497310049 0 POWELL NATHAN 2022188 9999999 B 10 1497310049 0 7108 S KANNER HWY STUART FL 349977462 20 1497310049 0 Other behavior health professional Adaptive behavior support clinician services 20 1497310049 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1497310056 0 SPOONER MELISSA 2021103 9999999 B 10 1497310056 0 2361 PAYSPHERE CIR CHICAGO IL 606740023 20 1497310056 0 Physician Assistant Only Fluoride varnish 20 1497310056 0 Physician Assistant Only Healthy Kids Services 20 1497310056 0 Physician Assistant Only Physician Services 00 1497310064 0 HUGHES JOSHUA 2024046 9999999 B 10 1497310064 0 510 S 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1497314702 0 Physicians Anesthesia Services 20 1497314702 0 Physicians Fluoride varnish 20 1497314702 0 Physicians Healthy Kids Services 20 1497314702 0 Physicians Optical Supplies 20 1497314702 0 Physicians Physician Services 00 1497315873 0 POOLE SHAWN 2019177 9999999 B 10 1497315873 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1497315873 0 Physicians Anesthesia Services 20 1497315873 0 Physicians Healthy Kids Services 20 1497315873 0 Physicians Optical Supplies 20 1497315873 0 Physicians Physician Services 00 1497316236 0 PATEL KIERAN 2019175 9999999 B 10 1497316236 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1497316236 0 Physicians Anesthesia Services 20 1497316236 0 Physicians Fluoride varnish 20 1497316236 0 Physicians Healthy Kids Services 20 1497316236 0 Physicians Optical Supplies 20 1497316236 0 Physicians Physician Services 00 1497316384 0 SVED DAVID H 2023243 9999999 B 10 1497316384 0 4701 DEPT CAROL STREAM IL 601220021 20 1497316384 0 Podiatrists 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1497374417 0 KOCHAT SUJITH 2020183 9999999 B 10 1497374417 0 29373 NETWORK PL CHICAGO IL 606733039 20 1497374417 0 Physicians Anesthesia Services 20 1497374417 0 Physicians Fluoride varnish 20 1497374417 0 Physicians Healthy Kids Services 20 1497374417 0 Physicians Optical Supplies 20 1497374417 0 Physicians Physician Services 00 1497374599 0 KOESTER ELIZABETH 2024131 9999999 B 10 1497374599 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1497374599 0 Physicians Anesthesia Services 20 1497374599 0 Physicians Fluoride varnish 20 1497374599 0 Physicians Healthy Kids Services 20 1497374599 0 Physicians Optical Supplies 20 1497374599 0 Physicians Physician Services 00 1497375190 0 ISAACS MEGAN 2020136 9999999 B 10 1497375190 0 611 W PARK ST BWPC URBANA IL 618012529 20 1497375190 0 Physical Therapists Medical Supplies 20 1497375190 0 Physical Therapists Medical equipment/prosthetic devices 20 1497375190 0 Physical Therapists Physical Therapy Services 00 1497375307 0 MITCHELL KATHERINE KEARNEY 2021035 9999999 B 10 1497375307 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1497375307 0 Physician Assistant Only Fluoride varnish 20 1497375307 0 Physician Assistant Only Healthy Kids Services 20 1497375307 0 Physician Assistant Only Physician Services 00 1497375349 0 LEAVITT MOLLY 2020274 9999999 B 10 1497375349 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1497375349 0 Physicians Anesthesia Services 20 1497375349 0 Physicians Fluoride varnish 20 1497375349 0 Physicians Healthy Kids Services 20 1497375349 0 Physicians Optical Supplies 20 1497375349 0 Physicians Physician Services 00 1497375554 0 MARCHIAFAVA DOMINIC 2021354 9999999 B 10 1497375554 0 PO BOX 500 ELLICOTTVILLE NY 147310500 20 1497375554 0 Physician Assistant Only Fluoride varnish 20 1497375554 0 Physician Assistant Only Healthy Kids Services 20 1497375554 0 Physician Assistant Only Physician Services 00 1497375687 0 PATEL VIVEK B 2025010 9999999 B 10 1497375687 0 611 W PARK ST URBANA IL 618012529 20 1497375687 0 Physicians Anesthesia Services 20 1497375687 0 Physicians Fluoride varnish 20 1497375687 0 Physicians Healthy Kids Services 20 1497375687 0 Physicians Optical Supplies 20 1497375687 0 Physicians Physician Services 00 1497375943 0 MATSELA JACQUELINE 2020125 9999999 B 10 1497375943 0 611 W PARK ST URBANA IL 618012529 20 1497375943 0 Occupational Therapists Medical Supplies 20 1497375943 0 Occupational Therapists Medical equipment/prosthetic devices 20 1497375943 0 Occupational Therapists Occupational Therapy Services 00 1497376487 0 SPRING JESSICA ALLISON 2020143 9999999 B 10 1497376487 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1497376487 0 Nurse Practitioners Fluoride varnish 20 1497376487 0 Nurse Practitioners Healthy Kids Services 20 1497376487 0 Nurse Practitioners Nurse Practitioners Services 20 1497376487 0 Nurse Practitioners Physician Services 00 1497376883 0 JIN JEFFREY CHIANGPEI 2020181 9999999 B 10 1497376883 0 5777 DEPT CAROL STREAM IL 601228942 20 1497376883 0 Physicians Anesthesia Services 20 1497376883 0 Physicians Fluoride varnish 20 1497376883 0 Physicians Healthy Kids Services 20 1497376883 0 Physicians Optical Supplies 20 1497376883 0 Physicians Physician Services 00 1497377121 0 DILO MARINELA 2020160 9999999 B 10 1497377121 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112386 20 1497377121 0 Dentists Dental Services 20 1497377121 0 Dentists Physician Services 00 1497377154 0 KHORSANDI MICHAEL 2024142 9999999 B 10 1497377154 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1497377154 0 Physicians Anesthesia Services 20 1497377154 0 Physicians Fluoride varnish 20 1497377154 0 Physicians Healthy Kids Services 20 1497377154 0 Physicians Optical Supplies 20 1497377154 0 Physicians Physician Services 00 1497377881 0 AVERY LEE 2020142 9999999 B 10 1497377881 0 1815 S WOLF RD HILLSIDE IL 601622110 20 1497377881 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1497378244 0 PATEL SHREY Y 2021243 9999999 B 10 1497378244 0 6233 CERMAK RD BERWYN IL 604022317 20 1497378244 0 Optometrists Optical Supplies 20 1497378244 0 Optometrists Optometric Services 20 1497378244 0 Optometrists Physician Services 00 1497378749 0 CHRISTENSEN NATHANAEL 2024185 9999999 B 10 1497378749 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1497378749 0 Physicians Anesthesia Services 20 1497378749 0 Physicians Healthy Kids Services 20 1497378749 0 Physicians Optical Supplies 20 1497378749 0 Physicians Physician Services 00 1497378897 0 STEWART-HESTER THEODORE W 2020197 9999999 B 10 1497378897 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1497378897 0 Physicians Anesthesia Services 20 1497378897 0 Physicians Healthy Kids Services 20 1497378897 0 Physicians Optical Supplies 20 1497378897 0 Physicians Physician Services 00 1497378939 0 JOHNSON REED 2023184 9999999 B 10 1497378939 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1497378939 0 Physicians Anesthesia Services 20 1497378939 0 Physicians Fluoride varnish 20 1497378939 0 Physicians Healthy Kids Services 20 1497378939 0 Physicians Optical Supplies 20 1497378939 0 Physicians Physician Services 00 1497379424 0 GARCIA ROSALIA 2022235 9999999 B 10 1497379424 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1497379424 0 Physician Assistant Only Fluoride varnish 20 1497379424 0 Physician Assistant Only Healthy Kids Services 20 1497379424 0 Physician Assistant Only Physician Services 00 1497379432 0 COOK VANESSA 2021258 9999999 B 10 1497379432 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1497379432 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1497379572 0 BRANDON MARGARET E 2020183 9999999 B 10 1497379572 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1497379572 0 Physicians Anesthesia Services 20 1497379572 0 Physicians Fluoride varnish 20 1497379572 0 Physicians Healthy Kids Services 20 1497379572 0 Physicians Optical Supplies 20 1497379572 0 Physicians Physician Services 00 1497379861 0 SIELSCHOTT ALEXIS N 2021085 9999999 B 10 1497379861 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1497379861 0 Physician Assistant Only Fluoride varnish 20 1497379861 0 Physician Assistant Only Healthy Kids Services 20 1497379861 0 Physician Assistant Only Physician Services 00 1497380224 0 MAGNUSON MICHAEL 2022300 9999999 B 10 1497380224 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1497380224 0 Physicians Anesthesia Services 20 1497380224 0 Physicians Fluoride varnish 20 1497380224 0 Physicians Healthy Kids Services 20 1497380224 0 Physicians Optical Supplies 20 1497380224 0 Physicians Physician Services 00 1497380547 0 CURTIS LISA 2020079 9999999 B 10 1497380547 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1497380547 0 Nurse Practitioners Fluoride varnish 20 1497380547 0 Nurse Practitioners Healthy Kids Services 20 1497380547 0 Nurse Practitioners Nurse Practitioners Services 20 1497380547 0 Nurse Practitioners Physician Services 00 1497381040 0 KEARES PETER 2020241 9999999 B 10 1497381040 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1497381040 0 Physicians Anesthesia Services 20 1497381040 0 Physicians Fluoride varnish 20 1497381040 0 Physicians Healthy Kids Services 20 1497381040 0 Physicians Optical Supplies 20 1497381040 0 Physicians Physician Services 00 1497381230 0 PAULSON HAILEY M 2022244 9999999 B 10 1497381230 0 545 BARNHILL DR # EH215 INDIANAPOLIS IN 462025112 20 1497381230 0 Nurse Practitioners Healthy Kids Services 20 1497381230 0 Nurse Practitioners Nurse Practitioners Services 20 1497381230 0 Nurse Practitioners Physician Services 00 1497381412 0 CARNEY JOHN J 2020175 9999999 B 10 1497381412 0 4698 DEPT CAROL STREAM IL 601220021 20 1497381412 0 Physicians Anesthesia Services 20 1497381412 0 Physicians Healthy Kids Services 20 1497381412 0 Physicians Optical Supplies 20 1497381412 0 Physicians Physician Services 00 1497381438 0 NDEDI BERNARD 2020183 9999999 B 10 1497381438 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1497381438 0 Physicians Anesthesia Services 20 1497381438 0 Physicians Healthy Kids Services 20 1497381438 0 Physicians Optical Supplies 20 1497381438 0 Physicians Physician Services 00 1497381941 0 OMAR MAZOUZAH 2020135 9999999 B 10 1497381941 0 2025 S CHICAGO ST STE 1 JOLIET IL 604363173 20 1497381941 0 Nurse Practitioners Healthy Kids Services 20 1497381941 0 Nurse Practitioners Nurse Practitioners Services 20 1497381941 0 Nurse Practitioners Physician Services 00 1497382030 0 WOODS TOYA 2021336 9999999 B 10 1497382030 0 PO BOX 734179 CHICAGO IL 606734179 20 1497382030 0 Nurse Practitioners Fluoride varnish 20 1497382030 0 Nurse Practitioners Healthy Kids Services 20 1497382030 0 Nurse Practitioners Nurse Practitioners Services 20 1497382030 0 Nurse Practitioners Physician Services 00 1497382196 0 CHOI JUSTIN 2023160 9999999 B 10 1497382196 0 29373 NETWORK PL CHICAGO IL 606733039 20 1497382196 0 Physicians Anesthesia Services 20 1497382196 0 Physicians Fluoride varnish 20 1497382196 0 Physicians Healthy Kids Services 20 1497382196 0 Physicians Optical Supplies 20 1497382196 0 Physicians Physician Services 00 1497382402 0 BUSHUE ZAKARY T 2022244 9999999 B 10 1497382402 0 777 S MAIN ST STE 100 CLINTON IN 478422493 20 1497382402 0 Clinical Social Worker Social work service 00 1497382709 0 SWANTEK COURTNEY 2020231 9999999 B 10 1497382709 0 124 SW ADAMS ST PEORIA IL 616021308 20 1497382709 0 Physicians Anesthesia Services 20 1497382709 0 Physicians Fluoride varnish 20 1497382709 0 Physicians Healthy Kids Services 20 1497382709 0 Physicians Optical Supplies 20 1497382709 0 Physicians Physician Services 00 1497382758 0 MEANEY JENA 2020153 9999999 B 10 1497382758 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1497382758 0 Nurse Practitioners Anesthesia Services 20 1497382758 0 Nurse Practitioners Nurse Practitioners Services 20 1497382758 0 Nurse Practitioners Physician Services 00 1497382790 0 PASTRANA FRANCESCA 2020244 9999999 B 10 1497382790 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1497382790 0 Physicians Anesthesia Services 20 1497382790 0 Physicians Healthy Kids Services 20 1497382790 0 Physicians Optical Supplies 20 1497382790 0 Physicians Physician Services 20 1497382790 0 Physicians Physicians Psychiatric Services 00 1497382931 0 MITCHELL LAUREN M 2023208 9999999 B 10 1497382931 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1497382931 0 Physicians Anesthesia Services 20 1497382931 0 Physicians Fluoride varnish 20 1497382931 0 Physicians Healthy Kids Services 20 1497382931 0 Physicians Optical Supplies 20 1497382931 0 Physicians Physician Services 00 1497383061 0 GAIER KRISTOPHER 2020179 9999999 B 10 1497383061 0 29373 NETWORK PL CHICAGO IL 606733039 20 1497383061 0 Physicians Anesthesia Services 20 1497383061 0 Physicians Healthy Kids Services 20 1497383061 0 Physicians Optical Supplies 20 1497383061 0 Physicians Physician Services 00 1497383301 0 TUBRIDY SEAN E 2023045 9999999 B 10 1497383301 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1497383301 0 Physicians Anesthesia Services 20 1497383301 0 Physicians Healthy Kids Services 20 1497383301 0 Physicians Optical Supplies 20 1497383301 0 Physicians Physician Services 00 1497383434 0 HUGHES KATHRYN L 2021182 9999999 B 10 1497383434 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1497383434 0 Physicians Anesthesia Services 20 1497383434 0 Physicians Healthy Kids Services 20 1497383434 0 Physicians Optical Supplies 20 1497383434 0 Physicians Physician Services 00 1497383707 0 OZINGA JOHN R 2024227 9999999 B 10 1497383707 0 5777 DEPT CAROL STREAM IL 601220021 20 1497383707 0 Physicians Anesthesia Services 20 1497383707 0 Physicians Healthy Kids Services 20 1497383707 0 Physicians Optical Supplies 20 1497383707 0 Physicians Physician Services 00 1497383806 0 BRIDER JAMARCUS T 2020182 9999999 B 10 1497383806 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1497383806 0 Physicians Anesthesia Services 20 1497383806 0 Physicians Fluoride varnish 20 1497383806 0 Physicians Healthy Kids Services 20 1497383806 0 Physicians Optical Supplies 20 1497383806 0 Physicians Physician Services 00 1497383814 0 ADETUNJI ADEOLA 2020227 9999999 B 10 1497383814 0 29373 NETWORK PL CHICAGO IL 606733039 20 1497383814 0 Physicians Anesthesia Services 20 1497383814 0 Physicians Fluoride varnish 20 1497383814 0 Physicians Healthy Kids Services 20 1497383814 0 Physicians Optical Supplies 20 1497383814 0 Physicians Physician Services 00 1497384010 0 MASOOD MAHVISH F 2024192 9999999 B 10 1497384010 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1497384010 0 Physicians Anesthesia Services 20 1497384010 0 Physicians Fluoride varnish 20 1497384010 0 Physicians Healthy Kids Services 20 1497384010 0 Physicians Optical Supplies 20 1497384010 0 Physicians Physician Services 00 1497384861 0 BREWER OWEN R 2020251 9999999 B 10 1497384861 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1497384861 0 Physicians Anesthesia Services 20 1497384861 0 Physicians Healthy Kids Services 20 1497384861 0 Physicians Optical Supplies 20 1497384861 0 Physicians Physician Services 00 1497384903 0 RIKABI SARAH 2023200 9999999 B 10 1497384903 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1497384903 0 Physicians Anesthesia Services 20 1497384903 0 Physicians Fluoride varnish 20 1497384903 0 Physicians Healthy Kids Services 20 1497384903 0 Physicians Optical Supplies 20 1497384903 0 Physicians Physician Services 00 1497385082 0 JASTILLANO SEAN 2021068 9999999 B 10 1497385082 0 155 E BRUSH HILL RD ELMHURST IL 601265658 20 1497385082 0 Nurse Practitioners Anesthesia Services 20 1497385082 0 Nurse Practitioners Nurse Practitioners Services 20 1497385082 0 Nurse Practitioners Physician Services 00 1497385249 0 MULLIN REBECCA 2022355 9999999 B 10 1497385249 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1497385249 0 Nurse Practitioners Healthy Kids Services 20 1497385249 0 Nurse Practitioners Nurse Practitioners Services 20 1497385249 0 Nurse Practitioners Physician Services 00 1497385264 0 GHERMAN MAYA O 2020044 9999999 B 10 1497385264 0 3880 SALEM LAKE DR STE F STE F LONG GROVE IL 600475292 20 1497385264 0 Nurse Practitioners Fluoride varnish 20 1497385264 0 Nurse Practitioners Healthy Kids Services 20 1497385264 0 Nurse Practitioners Nurse Practitioners Services 20 1497385264 0 Nurse Practitioners Physician Services 00 1497386486 0 GUTIERREZ MAGDALENO A 2023160 9999999 B 10 1497386486 0 4698 DEPT CAROL STREAM IL 601224698 20 1497386486 0 Physicians Anesthesia Services 20 1497386486 0 Physicians Fluoride varnish 20 1497386486 0 Physicians Healthy Kids Services 20 1497386486 0 Physicians Optical Supplies 20 1497386486 0 Physicians Physician Services 00 1497387807 0 GIESE DOMINIQUE S 2023032 9999999 B 10 1497387807 0 232 N BRUNS LN SPRINGFIELD IL 627024613 20 1497387807 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT 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605151211 20 1497394720 0 Physical Therapists Medical Supplies 20 1497394720 0 Physical Therapists Medical equipment/prosthetic devices 20 1497394720 0 Physical Therapists Physical Therapy Services 00 1497395172 0 AL ABBADI ELIZABETH 2024004 9999999 B 10 1497395172 0 2111 OGDEN AVE AURORA IL 605047597 20 1497395172 0 Physician Assistant Only Fluoride varnish 20 1497395172 0 Physician Assistant Only Healthy Kids Services 20 1497395172 0 Physician Assistant Only Physician Services 00 1497395347 0 BRIGGS FAITH 2023089 9999999 B 10 1497395347 0 8400 LOUISIANA ST MERRILLVILLE IN 464106385 20 1497395347 0 Other behavior health professional LCPC/LMFT services 00 1497395578 0 SELVIDGE COLTON L 2021270 9999999 B 10 1497395578 0 PO BOX 22407 SAINT LOUIS MO 631260407 20 1497395578 0 Nurse Practitioners Anesthesia Services 20 1497395578 0 Nurse Practitioners Nurse Practitioners Services 20 1497395578 0 Nurse Practitioners Physician Services 00 1497395594 0 MAXEY AMETHYST R 2020022 9999999 B 10 1497395594 0 4920 N KENMORE AVE CHICAGO IL 606403710 20 1497395594 0 Nurse Practitioners Fluoride varnish 20 1497395594 0 Nurse Practitioners Healthy Kids Services 20 1497395594 0 Nurse Practitioners Nurse Practitioners Services 20 1497395594 0 Nurse Practitioners Physician Services 00 1497397707 0 LOPEZ MELISSA C 2019283 9999999 B 10 1497397707 0 PO BOX 772290 DETROIT MI 482772290 20 1497397707 0 Nurse Practitioners Fluoride varnish 20 1497397707 0 Nurse Practitioners Healthy Kids Services 20 1497397707 0 Nurse Practitioners Nurse Practitioners Services 20 1497397707 0 Nurse Practitioners Physician Services 00 1497398309 0 WERDERITCH JORDYN 2021152 9999999 B 10 1497398309 0 1236 E RUSHOLME ST STE 300 DAVENPORT IA 528032473 20 1497398309 0 Nurse Practitioners Healthy Kids Services 20 1497398309 0 Nurse Practitioners Nurse Practitioners Services 20 1497398309 0 Nurse Practitioners Physician Services 00 1497399901 0 KAPER ALLISON J 2019365 9999999 B 10 1497399901 0 1120 N MELVIN ST GIBSON CITY IL 609361477 20 1497399901 0 Physician Assistant Only Fluoride varnish 20 1497399901 0 Physician Assistant Only Healthy Kids Services 20 1497399901 0 Physician Assistant Only Physician Services 00 1497400477 0 WISEMAN BREANNA 2022363 9999999 B 10 1497400477 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1497400477 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1497400584 0 GRUNENWALD KATHRYN 2024281 9999999 B 10 1497400584 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1497400584 0 Dentists Dental Services 20 1497400584 0 Dentists Physician Services 00 1497401665 0 PRADER LAUREN 2023030 9999999 B 10 1497401665 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1497401665 0 Physician Assistant Only Fluoride varnish 20 1497401665 0 Physician Assistant Only Healthy Kids Services 20 1497401665 0 Physician Assistant Only Physician Services 00 1497401822 0 MILLER SARAH 2023108 9999999 B 10 1497401822 0 5801 MOUNT PLEASANT LN BELLEVILLE IL 622233944 20 1497401822 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1497402853 0 LANNON DYLAN 2024068 9999999 B 10 1497402853 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1497402853 0 Physical Therapists Medical Supplies 20 1497402853 0 Physical Therapists Medical equipment/prosthetic devices 20 1497402853 0 Physical Therapists Physical Therapy Services 00 1497403117 0 CAMERON LASHONDA P 2024123 9999999 B 10 1497403117 0 2201 MAIN ST EVANSTON IL 602021519 20 1497403117 0 Clinical Social Worker Social work service 00 1497403315 0 VEAL RHEA 2023012 9999999 B 10 1497403315 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1497403315 0 Nurse Practitioners Fluoride varnish 20 1497403315 0 Nurse Practitioners Healthy Kids Services 20 1497403315 0 Nurse Practitioners Nurse Practitioners Services 20 1497403315 0 Nurse Practitioners Physician Services 00 1497403448 0 WEILER MITCHEL 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Nurse Practitioners Services 20 1497475594 0 Nurse Practitioners Physician Services 00 1497476394 0 IOAN SARAH 2022252 9999999 B 10 1497476394 0 7101 N CICERO AVE STE 202 LINCOLNWOOD IL 607122143 20 1497476394 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1497476717 0 BYERS SAMANTHA M 2022258 9999999 B 10 1497476717 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1497476717 0 Nurse Practitioners Anesthesia Services 20 1497476717 0 Nurse Practitioners Nurse Practitioners Services 20 1497476717 0 Nurse Practitioners Physician Services 00 1497477004 0 KIKKERT KRISTIN 2022327 9999999 B 10 1497477004 0 PO BOX 775342 CHICAGO IL 606775342 20 1497477004 0 Physician Assistant Only Fluoride varnish 20 1497477004 0 Physician Assistant Only Healthy Kids Services 20 1497477004 0 Physician Assistant Only Physician Services 00 1497478234 0 GRADY IFAH S 2024359 9999999 B 10 1497478234 0 15826 S LA GRANGE RD STE 135 ORLAND PARK IL 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Therapists Medical equipment/prosthetic devices 20 1497480438 0 Speech Therapists Speech Therapy/Pathology Services 00 1497482889 0 BEIRAM SHABAN A 2022284 9999999 B 10 1497482889 0 10417 S ROBERTS RD PALOS HILLS IL 604651931 20 1497482889 0 Physical Therapists Medical Supplies 20 1497482889 0 Physical Therapists Medical equipment/prosthetic devices 20 1497482889 0 Physical Therapists Physical Therapy Services 00 1497484182 0 SACKEY ANDY 2022193 9999999 B 10 1497484182 0 201 E MADISON ST STE 300 SPRINGFIELD IL 627025131 20 1497484182 0 Physicians Anesthesia Services 20 1497484182 0 Physicians Fluoride varnish 20 1497484182 0 Physicians Healthy Kids Services 20 1497484182 0 Physicians Optical Supplies 20 1497484182 0 Physicians Physician Services 00 1497484489 0 KALIA TANYA 2022270 9999999 B 10 1497484489 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112386 20 1497484489 0 Dentists Dental Services 20 1497484489 0 Dentists Physician Services 00 1497484547 0 CARLSON SAMUEL F 2022180 9999999 B 10 1497484547 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1497484547 0 Physicians Anesthesia Services 20 1497484547 0 Physicians Healthy Kids Services 20 1497484547 0 Physicians Optical Supplies 20 1497484547 0 Physicians Physician Services 00 1497485445 0 MCCAFFREY CASEY C 2022202 9999999 B 10 1497485445 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1497485445 0 Physicians Anesthesia Services 20 1497485445 0 Physicians Fluoride varnish 20 1497485445 0 Physicians Healthy Kids Services 20 1497485445 0 Physicians Optical Supplies 20 1497485445 0 Physicians Physician Services 00 1497486039 0 SKYLAR KAREN 2023262 9999999 B 10 1497486039 0 2500 W BRADLEY PL STE 109 CHICAGO IL 606184716 20 1497486039 0 Speech Therapists Medical Supplies 20 1497486039 0 Speech Therapists Medical equipment/prosthetic devices 20 1497486039 0 Speech Therapists Speech Therapy/Pathology Services 00 1497486716 0 CHUNG JOYCE J 2022200 9999999 B 10 1497486716 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1497486716 0 Physicians Anesthesia Services 20 1497486716 0 Physicians Fluoride varnish 20 1497486716 0 Physicians Healthy Kids Services 20 1497486716 0 Physicians Optical Supplies 20 1497486716 0 Physicians Physician Services 00 1497487003 0 KARPENKO CORRINNA 2022206 9999999 B 10 1497487003 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1497487003 0 Physicians Anesthesia Services 20 1497487003 0 Physicians Fluoride varnish 20 1497487003 0 Physicians Healthy Kids Services 20 1497487003 0 Physicians Optical Supplies 20 1497487003 0 Physicians Physician Services 00 1497487227 0 MALONGA BRYAN 2023065 9999999 B 10 1497487227 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1497487227 0 Physicians Anesthesia Services 20 1497487227 0 Physicians Fluoride varnish 20 1497487227 0 Physicians Healthy Kids Services 20 1497487227 0 Physicians Optical Supplies 20 1497487227 0 Physicians Physician Services 00 1497487532 0 ZAWOJSKI OLIVIA M 2023355 9999999 B 10 1497487532 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1497487532 0 Physician Assistant Only Fluoride varnish 20 1497487532 0 Physician Assistant Only Healthy Kids Services 20 1497487532 0 Physician Assistant Only Physician Services 00 1497487573 0 SHAW JOSHUA A 2022189 9999999 B 10 1497487573 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1497487573 0 Physicians Anesthesia Services 20 1497487573 0 Physicians Fluoride varnish 20 1497487573 0 Physicians Healthy Kids Services 20 1497487573 0 Physicians Optical Supplies 20 1497487573 0 Physicians Physician Services 00 1497487870 0 BITTAR CARLINI GIANFRANCO 2022257 9999999 B 10 1497487870 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1497487870 0 Physicians Anesthesia Services 20 1497487870 0 Physicians Fluoride varnish 20 1497487870 0 Physicians Healthy Kids Services 20 1497487870 0 Physicians Optical Supplies 20 1497487870 0 Physicians Physician Services 00 1497487920 0 SOBARNIA ANDREW 2023138 9999999 B 10 1497487920 0 5820 W IRVING PARK RD CHICAGO IL 606342616 20 1497487920 0 Physical Therapists Medical Supplies 20 1497487920 0 Physical Therapists Medical equipment/prosthetic devices 20 1497487920 0 Physical Therapists Physical Therapy Services 00 1497488365 0 RAMIREZ SAUL 2022209 9999999 B 10 1497488365 0 4148 S ARCHER AVE CHICAGO IL 606321825 20 1497488365 0 Dentists Dental Services 20 1497488365 0 Dentists Physician Services 00 1497488522 0 THIMS JOEY L 2022220 9999999 B 10 1497488522 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1497488522 0 Nurse Practitioners Healthy Kids Services 20 1497488522 0 Nurse Practitioners Nurse Practitioners Services 20 1497488522 0 Nurse Practitioners Physician Services 00 1497488761 0 MOSES DEJA 2024330 9999999 B 10 1497488761 0 2025 WASHINGTON ST WAUKEGAN IL 600855131 20 1497488761 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1497488993 0 PIERWOLA NATALIA M 2023137 9999999 B 10 1497488993 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1497488993 0 Speech Therapists Medical Supplies 20 1497488993 0 Speech Therapists Medical equipment/prosthetic devices 20 1497488993 0 Speech Therapists Speech Therapy/Pathology Services 00 1497489520 0 GREENE AMY M 2022272 9999999 B 10 1497489520 0 5777 DEPT CAROL STREAM IL 601220021 20 1497489520 0 Clinical Social Worker Social work service 00 1497489546 0 RILEY MADELINE C 2024330 9999999 B 10 1497489546 0 777 S MAIN ST STE 100 CLINTON IN 478422493 20 1497489546 0 Physician Assistant Only Fluoride varnish 20 1497489546 0 Physician Assistant Only Healthy Kids Services 20 1497489546 0 Physician Assistant Only Physician Services 00 1497490031 0 KAPADIA ANJANI D 2022185 9999999 B 10 1497490031 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1497490031 0 Physicians Anesthesia Services 20 1497490031 0 Physicians Fluoride varnish 20 1497490031 0 Physicians Healthy Kids Services 20 1497490031 0 Physicians Optical Supplies 20 1497490031 0 Physicians Physician Services 00 1497490908 0 BATTAGLIA MURIEL R 2022175 9999999 B 10 1497490908 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1497490908 0 Physicians Anesthesia Services 20 1497490908 0 Physicians Fluoride varnish 20 1497490908 0 Physicians Healthy Kids Services 20 1497490908 0 Physicians Optical Supplies 20 1497490908 0 Physicians Physician Services 00 1497491005 0 MERCER JILLANNA 2024064 9999999 B 10 1497491005 0 1503 HALO DR MAHOMET IL 618537440 20 1497491005 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1497492334 0 LEW ROBERT M 2022136 9999999 B 10 1497492334 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1497492334 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1497493431 0 PETERSON ALEXANDRIA 2023223 9999999 B 10 1497493431 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1497493431 0 Physician Assistant Only Fluoride varnish 20 1497493431 0 Physician Assistant Only Healthy Kids Services 20 1497493431 0 Physician Assistant Only Physician Services 00 1497493605 0 RISINGER DARRELL 2022159 9999999 B 10 1497493605 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1497493605 0 Nurse Practitioners Anesthesia Services 20 1497493605 0 Nurse Practitioners Nurse Practitioners Services 20 1497493605 0 Nurse Practitioners Physician Services 00 1497493746 0 NWANKWO CHINEZE 2022203 9999999 B 10 1497493746 0 PO BOX 855671 MINNEAPOLIS MN 554851153 20 1497493746 0 Physicians Anesthesia Services 20 1497493746 0 Physicians Fluoride varnish 20 1497493746 0 Physicians Healthy Kids Services 20 1497493746 0 Physicians Optical Supplies 20 1497493746 0 Physicians Physician Services 00 1497493928 0 SAEED MOSSAB Y 2023175 9999999 B 10 1497493928 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1497493928 0 Physicians Anesthesia Services 20 1497493928 0 Physicians Healthy Kids Services 20 1497493928 0 Physicians Optical Supplies 20 1497493928 0 Physicians Physician Services 00 1497494157 0 POMMERT KATHLEEN 2022206 9999999 B 10 1497494157 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1497494157 0 Physicians Anesthesia Services 20 1497494157 0 Physicians Fluoride varnish 20 1497494157 0 Physicians Healthy Kids Services 20 1497494157 0 Physicians Optical Supplies 20 1497494157 0 Physicians Physician Services 00 1497494793 0 THOMPSON KATHERINE T 2022207 9999999 B 10 1497494793 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1497494793 0 Physicians Anesthesia Services 20 1497494793 0 Physicians Healthy Kids Services 20 1497494793 0 Physicians Optical Supplies 20 1497494793 0 Physicians Physician Services 00 1497495378 0 THAI ASHLEY H 2022199 9999999 B 10 1497495378 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1497495378 0 Physician Assistant Only Fluoride varnish 20 1497495378 0 Physician Assistant Only Healthy Kids Services 20 1497495378 0 Physician Assistant Only Physician Services 00 1497496517 0 HULIN BLAISE 2022179 9999999 B 10 1497496517 0 PO BOX 3039 OAK BROOK IL 605223039 20 1497496517 0 Physicians Anesthesia Services 20 1497496517 0 Physicians Healthy Kids Services 20 1497496517 0 Physicians Optical Supplies 20 1497496517 0 Physicians Physician Services 00 1497497473 0 SARVARI FAHAD 2022297 9999999 B 10 1497497473 0 4701 DEPT CAROL STREAM IL 601220021 20 1497497473 0 Physicians Anesthesia Services 20 1497497473 0 Physicians Fluoride varnish 20 1497497473 0 Physicians Healthy Kids Services 20 1497497473 0 Physicians Optical Supplies 20 1497497473 0 Physicians Physician Services 00 1497497721 0 BEILFUSS MATTHEW A 2022181 9999999 B 10 1497497721 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1497497721 0 Physicians Anesthesia Services 20 1497497721 0 Physicians Healthy Kids Services 20 1497497721 0 Physicians Optical Supplies 20 1497497721 0 Physicians Physician Services 00 1497497747 0 SCHROEDER CLARISSA N 2024144 9999999 B 10 1497497747 0 5775 WAYZATA BLVD STE 400 SAINT LOUIS PAR MN 554161271 20 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1497499719 0 Physicians Healthy Kids Services 20 1497499719 0 Physicians Optical Supplies 20 1497499719 0 Physicians Physician Services 00 1497500045 0 GHALI MIRIYAM 2024302 9999999 B 10 1497500045 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1497500045 0 Physicians Anesthesia Services 20 1497500045 0 Physicians Healthy Kids Services 20 1497500045 0 Physicians Optical Supplies 20 1497500045 0 Physicians Physician Services 00 1497500557 0 REHMANN CHRISTOPHER 2024311 9999999 B 10 1497500557 0 510 YOSEMITE TRL ROSELLE IL 601721215 20 1497500557 0 Other behavior health professional LCPC/LMFT services 00 1497500862 0 TORRES SARA E 2024213 9999999 B 10 1497500862 0 725 SCHOOL ST MORRIS IL 604501218 20 1497500862 0 Speech Therapists Speech Therapy/Pathology Services 00 1497501480 0 DOWELL KATHERINE 2024213 9999999 B 10 1497501480 0 3024 E EMPIRE ST STE E&F BLOOMINGTON IL 617045402 20 1497501480 0 Physician Assistant Only Fluoride varnish 20 1497501480 0 Physician Assistant Only Healthy Kids Services 20 1497501480 0 Physician Assistant Only Physician Services 00 1497503833 0 ADUGBA JOY 2024235 9999999 B 10 1497503833 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1497503833 0 Nurse Practitioners Healthy Kids Services 20 1497503833 0 Nurse Practitioners Nurse Practitioners Services 20 1497503833 0 Nurse Practitioners Physician Services 00 1497504575 0 VILLAGOMEZ GUADALUPE 2024135 9999999 B 10 1497504575 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1497504575 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1497505234 0 ORTINAU KELSEY A 2024113 9999999 B 10 1497505234 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1497505234 0 Physical Therapists Medical Supplies 20 1497505234 0 Physical Therapists Medical equipment/prosthetic devices 20 1497505234 0 Physical Therapists Physical Therapy Services 00 1497505507 0 BAIG NAZNEEN 2024168 9999999 B 10 1497505507 0 PO BOX 3039 OAK BROOK IL 605223039 20 1497505507 0 Dentists Dental Services 20 1497505507 0 Dentists Physician Services 00 1497506034 0 HOUSTON SAMANTHA 2024184 9999999 B 10 1497506034 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1497506034 0 Physicians Anesthesia Services 20 1497506034 0 Physicians Fluoride varnish 20 1497506034 0 Physicians Healthy Kids Services 20 1497506034 0 Physicians Optical Supplies 20 1497506034 0 Physicians Physician Services 00 1497506893 0 WAZIR AZRA 2024198 9999999 B 10 1497506893 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1497506893 0 Physicians Anesthesia Services 20 1497506893 0 Physicians Healthy Kids Services 20 1497506893 0 Physicians Optical Supplies 20 1497506893 0 Physicians Physician Services 00 1497508600 0 SNEIDER ABIGAIL P 2024179 9999999 B 10 1497508600 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1497508600 0 Physicians Anesthesia Services 20 1497508600 0 Physicians Fluoride varnish 20 1497508600 0 Physicians Healthy Kids Services 20 1497508600 0 Physicians Optical Supplies 20 1497508600 0 Physicians Physician Services 00 1497509244 0 OGBENNA UGONNA K 2024193 9999999 B 10 1497509244 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1497509244 0 Physicians Anesthesia Services 20 1497509244 0 Physicians Fluoride varnish 20 1497509244 0 Physicians Healthy Kids Services 20 1497509244 0 Physicians Optical Supplies 20 1497509244 0 Physicians Physician Services 00 1497510416 0 DIEP JANET 2024053 9999999 B 10 1497510416 0 5844 ELAINE DR STE 103 ROCKFORD IL 611082494 20 1497510416 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1497510689 0 DYKSTRA KATELYN N 2024121 9999999 B 10 1497510689 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1497510689 0 Nurse Practitioners Healthy Kids Services 20 1497510689 0 Nurse Practitioners Nurse Practitioners Services 20 1497510689 0 Nurse Practitioners Physician Services 00 1497511752 0 ALMIERI FAITH 2024059 9999999 B 10 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Anesthesia Services 20 1497515902 0 Physicians Healthy Kids Services 20 1497515902 0 Physicians Optical Supplies 20 1497515902 0 Physicians Physician Services 00 1497516280 0 STAROSTOVIC ANNA M 2024141 9999999 B 10 1497516280 0 29373 NETWORK PL CHICAGO IL 606733039 20 1497516280 0 Nurse Practitioners Healthy Kids Services 20 1497516280 0 Nurse Practitioners Nurse Practitioners Services 20 1497516280 0 Nurse Practitioners Physician Services 00 1497516397 0 FISHER KRISTEN 2024163 9999999 B 10 1497516397 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1497516397 0 Nurse Practitioners Healthy Kids Services 20 1497516397 0 Nurse Practitioners Nurse Practitioners Services 20 1497516397 0 Nurse Practitioners Physician Services 00 1497518633 0 ONYEMEZIEM JOSEPHINE 2024038 9999999 B 10 1497518633 0 PO BOX 775253 CHICAGO IL 606775253 20 1497518633 0 Nurse Practitioners Healthy Kids Services 20 1497518633 0 Nurse Practitioners Nurse Practitioners Services 20 1497518633 0 Nurse Practitioners Physician Services 00 1497519045 0 BASLER DANE 2024089 9999999 B 10 1497519045 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1497519045 0 Physician Assistant Only Fluoride varnish 20 1497519045 0 Physician Assistant Only Healthy Kids Services 20 1497519045 0 Physician Assistant Only Physician Services 00 1497520621 0 LEPARD BRITTANY 2024016 9999999 B 10 1497520621 0 PO BOX 781076 DETROIT MI 482781076 20 1497520621 0 Nurse Practitioners Healthy Kids Services 20 1497520621 0 Nurse Practitioners Nurse Practitioners Services 20 1497520621 0 Nurse Practitioners Physician Services 00 1497523484 0 TINEH AMAN 2024004 9999999 B 10 1497523484 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1497523484 0 Physician Assistant Only Fluoride varnish 20 1497523484 0 Physician Assistant Only Healthy Kids Services 20 1497523484 0 Physician Assistant Only Physician Services 00 1497524151 0 BURTON BROOKE A 2024204 9999999 B 10 1497524151 0 2038 221ST ST SAUK VILLAGE IL 604115064 20 1497524151 0 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Practitioners Nurse Practitioners Services 20 1497527790 0 Nurse Practitioners Physician Services 00 1497530935 0 FELLOWS ROBERT 2023269 9999999 B 10 1497530935 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1497530935 0 Psychologist Psychologist service 00 1497531800 0 ALDAG ALISON 2023255 9999999 B 10 1497531800 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1497531800 0 Nurse Practitioners Healthy Kids Services 20 1497531800 0 Nurse Practitioners Nurse Practitioners Services 20 1497531800 0 Nurse Practitioners Physician Services 00 1497531891 0 WRIGHT THEONITA 2024338 9999999 B 10 1497531891 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1497531891 0 Clinical Social Worker Social work service 00 1497534747 0 WRIGHT ARIEL M 2023324 9999999 B 10 1497534747 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1497534747 0 Nurse Practitioners Fluoride varnish 20 1497534747 0 Nurse Practitioners Healthy Kids Services 20 1497534747 0 Nurse Practitioners Nurse Practitioners Services 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1497701809 0 Physicians Anesthesia Services 20 1497701809 0 Physicians Fluoride varnish 20 1497701809 0 Physicians Healthy Kids Services 20 1497701809 0 Physicians Optical Supplies 20 1497701809 0 Physicians Physician Services 00 1497702542 0 ABDALLA ADEL A 2024255 9999999 B 10 1497702542 0 19111 TOWN CENTER DR APPLE VALLEY CA 923088989 20 1497702542 0 Physicians Anesthesia Services 20 1497702542 0 Physicians Healthy Kids Services 20 1497702542 0 Physicians Optical Supplies 20 1497702542 0 Physicians Physician Services 00 1497703367 0 MURPHY PATRICK B 1990152 9999999 B 10 1497703367 0 3051 HOLLIS DR SPRINGFIELD IL 627047452 20 1497703367 0 Physicians Anesthesia Services 20 1497703367 0 Physicians Healthy Kids Services 20 1497703367 0 Physicians Optical Supplies 20 1497703367 0 Physicians Physician Services 00 1497703458 0 HARRIS MATTHEW 2004214 9999999 B 10 1497703458 0 903 COMMERCE DR STE 333 OAK BROOK IL 605238723 20 1497703458 0 Physicians Anesthesia Services 20 1497703458 0 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9999999 B 10 1497748438 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1497748438 0 Physicians Anesthesia Services 20 1497748438 0 Physicians Healthy Kids Services 20 1497748438 0 Physicians Optical Supplies 20 1497748438 0 Physicians Physician Services 00 1497748727 0 JEHA MIKHAIL 2003274 9999999 B 10 1497748727 0 901 MACARTHUR BLVD MUNSTER IN 463212901 20 1497748727 0 Physicians Anesthesia Services 20 1497748727 0 Physicians Healthy Kids Services 20 1497748727 0 Physicians Optical Supplies 20 1497748727 0 Physicians Physician Services 00 1497749931 0 JOHNSON VINCENT 1997305 9999999 B 10 1497749931 0 5777 DEPT CAROL STREAM IL 601228942 20 1497749931 0 Physicians Anesthesia Services 20 1497749931 0 Physicians Fluoride varnish 20 1497749931 0 Physicians Healthy Kids Services 20 1497749931 0 Physicians Optical Supplies 20 1497749931 0 Physicians Physician Services 00 1497750749 0 RYAN PAUL 1997182 9999999 B 10 1497750749 0 PO BOX 775248 CHICAGO IL 606775248 20 1497750749 0 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1497752562 0 Physicians Fluoride varnish 20 1497752562 0 Physicians Healthy Kids Services 20 1497752562 0 Physicians Optical Supplies 20 1497752562 0 Physicians Physician Services 00 1497752570 0 ZAWILENSKI MATTHEW 1997223 9999999 B 10 1497752570 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1497752570 0 Physicians Anesthesia Services 20 1497752570 0 Physicians Fluoride varnish 20 1497752570 0 Physicians Healthy Kids Services 20 1497752570 0 Physicians Optical Supplies 20 1497752570 0 Physicians Physician Services 00 1497752703 0 MANAM SATYA PRABHA 1996001 9999999 B 10 1497752703 0 2202 HARLEM RD LOVES PARK IL 611112754 20 1497752703 0 Physicians Anesthesia Services 20 1497752703 0 Physicians Healthy Kids Services 20 1497752703 0 Physicians Optical Supplies 20 1497752703 0 Physicians Physician Services 00 1497752893 0 CHEN ALICE 1993244 9999999 B 10 1497752893 0 4711 GOLF RD STE 808 SKOKIE IL 600761246 20 1497752893 0 Physicians Anesthesia Services 20 1497752893 0 Physicians Healthy 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1497754287 0 Physicians Physician Services 00 1497754634 0 RIEPSHOFF REBECCA 2019330 9999999 B 10 1497754634 0 3051 HOLLIS DR SPRINGFIELD IL 627047452 20 1497754634 0 Physician Assistant Only Fluoride varnish 20 1497754634 0 Physician Assistant Only Healthy Kids Services 20 1497754634 0 Physician Assistant Only Physician Services 00 1497755375 0 KRENGEL SAMUEL 1994258 9999999 B 10 1497755375 0 950 N YORK RD STE 208 HINSDALE IL 605218609 20 1497755375 0 Physicians Anesthesia Services 20 1497755375 0 Physicians Healthy Kids Services 20 1497755375 0 Physicians Optical Supplies 20 1497755375 0 Physicians Physician Services 00 1497755565 0 BENYA ELLEN 1995198 9999999 B 10 1497755565 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1497755565 0 Physicians Anesthesia Services 20 1497755565 0 Physicians Healthy Kids Services 20 1497755565 0 Physicians Optical Supplies 20 1497755565 0 Physicians Physician Services 00 1497755573 0 JONES SCOTT 1997001 9999999 B 10 1497755573 0 PO BOX 4912 WHEATON IL 601894912 20 1497755573 0 Physical Therapists Medical Supplies 20 1497755573 0 Physical Therapists Medical equipment/prosthetic devices 20 1497755573 0 Physical Therapists Physical Therapy Services 00 1497756563 0 ROOKSTOOL DOUGLAS W 2005145 9999999 B 10 1497756563 0 PO BOX 781076 DETROIT MI 482781076 20 1497756563 0 Physicians Anesthesia Services 20 1497756563 0 Physicians Fluoride varnish 20 1497756563 0 Physicians Healthy Kids Services 20 1497756563 0 Physicians Optical Supplies 20 1497756563 0 Physicians Physician Services 00 1497756605 0 JUTOVSKY MICHAEL H 1992179 9999999 B 10 1497756605 0 PO BOX 21 WAUCONDA IL 600840021 20 1497756605 0 Physicians Anesthesia Services 20 1497756605 0 Physicians Fluoride varnish 20 1497756605 0 Physicians Healthy Kids Services 20 1497756605 0 Physicians Optical Supplies 20 1497756605 0 Physicians Physician Services 00 1497756720 0 ALNAHASS MAHMOOD 2024008 9999999 B 10 1497756720 0 PO BOX 781076 DETROIT MI 482781076 20 1497756720 0 Physicians Anesthesia Services 20 1497756720 0 Physicians Healthy Kids Services 20 1497756720 0 Physicians Optical Supplies 20 1497756720 0 Physicians Physician Services 20 1497756720 0 Physicians Physicians Psychiatric Services 00 1497757306 0 MOK CHUNG Z 1981227 2099196 B 10 1497757306 0 3535 W LAWRENCE AVE CHICAGO IL 606255627 20 1497757306 0 Physicians Anesthesia Services 20 1497757306 0 Physicians Family Planning Counseling 20 1497757306 0 Physicians Fluoride varnish 20 1497757306 0 Physicians Healthy Kids Services 20 1497757306 0 Physicians Optical Supplies 20 1497757306 0 Physicians Physician Services 00 1497757595 0 JANI SIDDHARTH B 1984004 9999999 B 10 1497757595 0 1418 COLLEGE DR MOUNT CARMEL IL 628632638 20 1497757595 0 Physicians Anesthesia Services 20 1497757595 0 Physicians Fluoride varnish 20 1497757595 0 Physicians Healthy Kids Services 20 1497757595 0 Physicians Optical Supplies 20 1497757595 0 Physicians Physician Services 00 1497759062 0 BRUNK SCOTT 2000121 9999999 B 10 1497759062 0 1910 SOUTH AVE LA CROSSE WI 546015467 20 1497759062 0 Physicians Anesthesia Services 20 1497759062 0 Physicians Healthy Kids Services 20 1497759062 0 Physicians Optical Supplies 20 1497759062 0 Physicians Physician Services 00 1497759898 0 RICKMAN CHRISTOPHER E 1992327 9999999 B 10 1497759898 0 1000 N ALLEN ST ROBINSON IL 624541114 20 1497759898 0 Physicians Anesthesia Services 20 1497759898 0 Physicians Healthy Kids Services 20 1497759898 0 Physicians Optical Supplies 20 1497759898 0 Physicians Physician Services 00 1497761100 0 CARMICHAEL CRAIG W 2000214 9999999 B 10 1497761100 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1497761100 0 Physicians Anesthesia Services 20 1497761100 0 Physicians Healthy Kids Services 20 1497761100 0 Physicians Optical Supplies 20 1497761100 0 Physicians Physician Services 00 1497761134 0 JOHNSON SCOTT R 2024111 9999999 B 10 1497761134 0 1423 7TH ST AURORA NE 688181141 20 1497761134 0 Physicians Anesthesia Services 20 1497761134 0 Physicians Fluoride varnish 20 1497761134 0 Physicians Healthy Kids Services 20 1497761134 0 Physicians Optical Supplies 20 1497761134 0 Physicians Physician Services 00 1497761316 0 PALMER SHARI L 1989352 9999999 B 10 1497761316 0 29373 NETWORK PL CHICAGO IL 606733039 20 1497761316 0 Physicians Anesthesia Services 20 1497761316 0 Physicians Fluoride varnish 20 1497761316 0 Physicians Healthy Kids Services 20 1497761316 0 Physicians Optical Supplies 20 1497761316 0 Physicians Physician Services 00 1497761597 0 MARKARIAN RANDALL C 1994305 9999999 B 10 1497761597 0 10 PARK PL SWANSEA IL 622262967 20 1497761597 0 Dentists Dental Services 20 1497761597 0 Dentists Physician Services 00 1497761654 0 DEMPSEY AMANDA F 2016091 9999999 B 10 1497761654 0 PO BOX 110429 AURORA CO 800420429 20 1497761654 0 Physicians Anesthesia Services 20 1497761654 0 Physicians Fluoride varnish 20 1497761654 0 Physicians Healthy Kids Services 20 1497761654 0 Physicians Optical Supplies 20 1497761654 0 Physicians Physician Services 00 1497761811 0 LEE CHOONGKOON 2025122 9999999 B 10 1497761811 0 219 BEDFORD RD MORRIS IL 604501442 20 1497761811 0 Physicians Anesthesia Services 20 1497761811 0 Physicians Healthy Kids Services 20 1497761811 0 Physicians Optical Supplies 20 1497761811 0 Physicians Physician Services 00 1497762868 0 CARLSON CHERYL 2002152 9999999 B 10 1497762868 0 305 MOORE AVE LE ROY IL 617521580 20 1497762868 0 Speech Therapists Medical Supplies 20 1497762868 0 Speech Therapists Medical equipment/prosthetic devices 20 1497762868 0 Speech Therapists Speech Therapy/Pathology Services 00 1497762892 0 FELLOWS JAMES 2023114 9999999 B 10 1497762892 0 4225 LINCOLNSHIRE DR STE B MOUNT VERNON IL 628642157 20 1497762892 0 Physicians Anesthesia Services 20 1497762892 0 Physicians Healthy Kids Services 20 1497762892 0 Physicians Optical Supplies 20 1497762892 0 Physicians Physician Services 00 1497762959 0 BROWDER VICKI 2000153 9999999 B 10 1497762959 0 2300 N EDWARD ST DECATUR IL 625264163 20 1497762959 0 Physicians Anesthesia Services 20 1497762959 0 Physicians Fluoride varnish 20 1497762959 0 Physicians Healthy Kids Services 20 1497762959 0 Physicians Optical Supplies 20 1497762959 0 Physicians Physician Services 00 1497763130 0 KOMOROWSKI MONICA 2006213 9999999 B 10 1497763130 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1497763130 0 Physicians Anesthesia Services 20 1497763130 0 Physicians Fluoride varnish 20 1497763130 0 Physicians Healthy Kids Services 20 1497763130 0 Physicians Optical Supplies 20 1497763130 0 Physicians Physician Services 00 1497763882 0 CARLSON RACHEL J 2006182 9999999 B 10 1497763882 0 1039 BROOK FOREST AVE SHOREWOOD IL 604048849 20 1497763882 0 Nurse Practitioners Healthy Kids Services 20 1497763882 0 Nurse Practitioners Nurse Practitioners Services 20 1497763882 0 Nurse Practitioners Physician Services 00 1497764518 0 FORTSAS MICHAEL N 1996001 9999999 B 10 1497764518 0 29373 NETWORK PL CHICAGO IL 606733039 20 1497764518 0 Physicians Anesthesia Services 20 1497764518 0 Physicians Fluoride varnish 20 1497764518 0 Physicians Healthy Kids Services 20 1497764518 0 Physicians Optical Supplies 20 1497764518 0 Physicians Physician Services 00 1497765663 0 BETTLACH LAURIE L 2017188 9999999 B 10 1497765663 0 510 S KINGSHIGHWAY BLVD SAINT LOUIS MO 631101016 20 1497765663 0 Physician Assistant Only Fluoride varnish 20 1497765663 0 Physician Assistant Only Healthy Kids Services 20 1497765663 0 Physician Assistant Only Physician Services 00 1497766596 0 HORNING SANDRA 2022190 9999999 B 10 1497766596 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1497766596 0 Physicians Anesthesia Services 20 1497766596 0 Physicians Healthy Kids Services 20 1497766596 0 Physicians Optical Supplies 20 1497766596 0 Physicians Physician Services 00 1497766810 0 HANSEN JOHN 2023182 9999999 B 10 1497766810 0 PO BOX 43230 PHOENIX AZ 850803230 20 1497766810 0 Physicians Anesthesia Services 20 1497766810 0 Physicians Healthy 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1497768972 0 1000 REMINGTON BLVD STE 200 BOLINGBROOK IL 604405125 20 1497768972 0 Physicians Anesthesia Services 20 1497768972 0 Physicians Healthy Kids Services 20 1497768972 0 Physicians Optical Supplies 20 1497768972 0 Physicians Physician Services 00 1497769095 0 CHEN DAVID 1991182 9999999 B 10 1497769095 0 355 E ERIE ST CHICAGO IL 606113167 20 1497769095 0 Physicians Anesthesia Services 20 1497769095 0 Physicians Healthy Kids Services 20 1497769095 0 Physicians Optical Supplies 20 1497769095 0 Physicians Physician Services 00 1497770416 0 AHN JOSEPH 2024201 9999999 B 10 1497770416 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1497770416 0 Physicians Anesthesia Services 20 1497770416 0 Physicians Fluoride varnish 20 1497770416 0 Physicians Healthy Kids Services 20 1497770416 0 Physicians Optical Supplies 20 1497770416 0 Physicians Physician Services 00 1497770762 0 SILVERBERG ROBERT 1996001 9999999 B 10 1497770762 0 5777 DEPT CAROL STREAM IL 601220021 20 1497770762 0 Physicians Anesthesia Services 20 1497770762 0 Physicians Fluoride varnish 20 1497770762 0 Physicians Healthy Kids Services 20 1497770762 0 Physicians Optical Supplies 20 1497770762 0 Physicians Physician Services 00 1497771356 0 CONWAY CHARLES R 1999227 9999999 B 10 1497771356 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1497771356 0 Physicians Anesthesia Services 20 1497771356 0 Physicians Healthy Kids Services 20 1497771356 0 Physicians Optical Supplies 20 1497771356 0 Physicians Physician Services 20 1497771356 0 Physicians Physicians Psychiatric Services 00 1497771570 0 DONNAL TERRANCE 2020227 9999999 B 10 1497771570 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1497771570 0 Physicians Anesthesia Services 20 1497771570 0 Physicians Fluoride varnish 20 1497771570 0 Physicians Healthy Kids Services 20 1497771570 0 Physicians Optical Supplies 20 1497771570 0 Physicians Physician Services 00 1497771612 0 DESPOTIS GEORGE J 1989193 9999999 B 10 1497771612 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1497771612 0 Physicians Anesthesia Services 20 1497771612 0 Physicians Healthy Kids Services 20 1497771612 0 Physicians Optical Supplies 20 1497771612 0 Physicians Physician Services 00 1497771638 0 KERTZ LILA C 2005062 9999999 B 10 1497771638 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1497771638 0 Nurse Practitioners Fluoride varnish 20 1497771638 0 Nurse Practitioners Healthy Kids Services 20 1497771638 0 Nurse Practitioners Nurse Practitioners Services 20 1497771638 0 Nurse Practitioners Physician Services 00 1497771786 0 IRFANULLAH ASAD 2016153 9999999 B 10 1497771786 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1497771786 0 Physicians Anesthesia Services 20 1497771786 0 Physicians Healthy Kids Services 20 1497771786 0 Physicians Optical Supplies 20 1497771786 0 Physicians Physician Services 00 1497771851 0 SKOPEC KATHRYN 2024031 9999999 B 10 1497771851 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1497771851 0 Physicians Anesthesia Services 20 1497771851 0 Physicians Fluoride varnish 20 1497771851 0 Physicians Healthy Kids Services 20 1497771851 0 Physicians Optical Supplies 20 1497771851 0 Physicians Physician Services 00 1497772362 0 GRINTON PATRICIA W 2024338 9999999 B 10 1497772362 0 29373 NETWORK PL CHICAGO IL 606733039 20 1497772362 0 Physicians Anesthesia Services 20 1497772362 0 Physicians Fluoride varnish 20 1497772362 0 Physicians Healthy Kids Services 20 1497772362 0 Physicians Optical Supplies 20 1497772362 0 Physicians Physician Services 00 1497772388 0 SCHIEL KIMBERLY 1999211 9999999 B 10 1497772388 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1497772388 0 Physicians Anesthesia Services 20 1497772388 0 Physicians Fluoride varnish 20 1497772388 0 Physicians Healthy Kids Services 20 1497772388 0 Physicians Optical Supplies 20 1497772388 0 Physicians Physician Services 00 1497772404 0 NAQVI SAYED Z 2022152 9999999 B 10 1497772404 0 PO BOX 43230 PHOENIX AZ 850803230 20 1497772404 0 Physicians Anesthesia Services 20 1497772404 0 Physicians Healthy Kids Services 20 1497772404 0 Physicians Optical Supplies 20 1497772404 0 Physicians Physician Services 20 1497772404 0 Physicians Physicians Psychiatric Services 00 1497772941 0 MOORE DAVID 1999305 9999999 B 10 1497772941 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1497772941 0 Physicians Anesthesia Services 20 1497772941 0 Physicians Healthy Kids Services 20 1497772941 0 Physicians Optical Supplies 20 1497772941 0 Physicians Physician Services 00 1497773956 0 IFUNE CATHERINE KEI 2001305 9999999 B 10 1497773956 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1497773956 0 Physicians Anesthesia Services 20 1497773956 0 Physicians Healthy Kids Services 20 1497773956 0 Physicians Optical Supplies 20 1497773956 0 Physicians Physician Services 00 1497774285 0 BANDY MARIA V 2017269 9999999 B 10 1497774285 0 545 BARNHILL DR # EH215 INDIANAPOLIS IN 462025112 20 1497774285 0 Physician Assistant Only Fluoride varnish 20 1497774285 0 Physician Assistant Only Healthy Kids Services 20 1497774285 0 Physician Assistant Only Physician Services 00 1497774459 0 LUM BENNETT 2000245 9999999 B 10 1497774459 0 111 OAKWOOD RD EAST PEORIA IL 616111853 20 1497774459 0 Physicians Anesthesia Services 20 1497774459 0 Physicians Healthy Kids Services 20 1497774459 0 Physicians Optical Supplies 20 1497774459 0 Physicians Physician Services 00 1497775068 0 CAYEA PAUL D 2020257 9999999 B 10 1497775068 0 11995 SINGLETREE LN STE 500 SUITE 500 EDEN PRAIRIE MN 553445349 20 1497775068 0 Physicians Anesthesia Services 20 1497775068 0 Physicians Healthy Kids Services 20 1497775068 0 Physicians Optical Supplies 20 1497775068 0 Physicians Physician Services 00 1497775233 0 SAMBARE VARSHA 2004245 9999999 B 10 1497775233 0 730 S WEBER RD BOLINGBROOK IL 604905472 20 1497775233 0 Physicians Anesthesia Services 20 1497775233 0 Physicians Fluoride varnish 20 1497775233 0 Physicians Healthy Kids Services 20 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00 1497778419 0 CISLO GEOFFREY 1999152 9999999 B 10 1497778419 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1497778419 0 Physicians Anesthesia Services 20 1497778419 0 Physicians Fluoride varnish 20 1497778419 0 Physicians Healthy Kids Services 20 1497778419 0 Physicians Optical Supplies 20 1497778419 0 Physicians Physician Services 00 1497779078 0 SPANN ANANYA 1996204 9999999 B 10 1497779078 0 16660 107TH ST ORLAND PARK IL 604678898 20 1497779078 0 Physicians Anesthesia Services 20 1497779078 0 Physicians Healthy Kids Services 20 1497779078 0 Physicians Optical Supplies 20 1497779078 0 Physicians Physician Services 00 1497780381 0 MILLER FRANK 1994182 9999999 B 10 1497780381 0 5777 DEPT CAROL STREAM IL 601220021 20 1497780381 0 Physicians Anesthesia Services 20 1497780381 0 Physicians Healthy Kids Services 20 1497780381 0 Physicians Optical Supplies 20 1497780381 0 Physicians Physician Services 00 1497781389 0 HOLLENBECK JED 2023051 9999999 B 10 1497781389 0 PO BOX 43230 PHOENIX AZ 850803230 20 1497781389 0 Physician Assistant Only Fluoride varnish 20 1497781389 0 Physician Assistant Only Healthy Kids Services 20 1497781389 0 Physician Assistant Only Physician Services 00 1497781488 0 CHANG RANDOLPH Y. 1995182 9999999 B 10 1497781488 0 2450 WOLF RD STE D STE. D WESTCHESTER IL 601545643 20 1497781488 0 Physicians Anesthesia Services 20 1497781488 0 Physicians Healthy Kids Services 20 1497781488 0 Physicians Optical Supplies 20 1497781488 0 Physicians Physician Services 00 1497782247 0 CLINE CHARLES D 2022182 9999999 B 10 1497782247 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1497782247 0 Physician Assistant Only Fluoride varnish 20 1497782247 0 Physician Assistant Only Healthy Kids Services 20 1497782247 0 Physician Assistant Only Physician Services 00 1497782718 0 WEBER ELIZABETH W 2016049 9999999 B 10 1497782718 0 5901 LINCOLN DR EDINA MN 554361611 20 1497782718 0 Physicians Anesthesia Services 20 1497782718 0 Physicians Healthy Kids Services 20 1497782718 0 Physicians Optical Supplies 20 1497782718 0 Physicians Physician Services 00 1497783179 0 CHAAR BASSEM 2015272 9999999 B 10 1497783179 0 29373 NETWORK PL CHICAGO IL 606733039 20 1497783179 0 Physicians Anesthesia Services 20 1497783179 0 Physicians Fluoride varnish 20 1497783179 0 Physicians Healthy Kids Services 20 1497783179 0 Physicians Optical Supplies 20 1497783179 0 Physicians Physician Services 00 1497783567 0 DONINGTON JESSICA S 2018215 9999999 B 10 1497783567 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1497783567 0 Physicians Anesthesia Services 20 1497783567 0 Physicians Healthy Kids Services 20 1497783567 0 Physicians Optical Supplies 20 1497783567 0 Physicians Physician Services 00 1497783641 0 BJORAKER ROBERT W 2016302 9999999 B 10 1497783641 0 PO BOX 28900 GREEN BAY WI 543240900 20 1497783641 0 Physicians Anesthesia Services 20 1497783641 0 Physicians Healthy Kids Services 20 1497783641 0 Physicians Optical Supplies 20 1497783641 0 Physicians Physician Services 00 1497783997 0 GREEN BARBARA J 2005069 9999999 B 10 1497783997 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1497783997 0 Physicians Anesthesia Services 20 1497783997 0 Physicians Healthy Kids Services 20 1497783997 0 Physicians Optical Supplies 20 1497783997 0 Physicians Physician Services 20 1497783997 0 Physicians Physicians Psychiatric Services 00 1497784003 0 FLORES WILLIAM 2018058 9999999 B 10 1497784003 0 5665 NEW NORTHSIDE DR STE 320 ATLANTA GA 303285834 20 1497784003 0 Physician Assistant Only Fluoride varnish 20 1497784003 0 Physician Assistant Only Healthy Kids Services 20 1497784003 0 Physician Assistant Only Physician Services 00 1497784813 0 HOLLY THOMAS 1996183 9999999 B 10 1497784813 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1497784813 0 Physicians Anesthesia Services 20 1497784813 0 Physicians Fluoride varnish 20 1497784813 0 Physicians Healthy Kids Services 20 1497784813 0 Physicians Optical Supplies 20 1497784813 0 Physicians Physician Services 00 1497784821 0 FOLTZ PHOEBE A 2014242 9999999 B 10 1497784821 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1497784821 0 Physician Assistant Only All Kids application agent 20 1497784821 0 Physician Assistant Only Fluoride varnish 20 1497784821 0 Physician Assistant Only Healthy Kids Services 20 1497784821 0 Physician Assistant Only Physician Services 00 1497784862 0 KRUEGER RICHARD C 1997001 9999999 B 10 1497784862 0 1000 HADDONFIELD BERLIN RD STE VOORHEES NJ 080433520 20 1497784862 0 Physicians Anesthesia Services 20 1497784862 0 Physicians Fluoride varnish 20 1497784862 0 Physicians Healthy Kids Services 20 1497784862 0 Physicians Optical Supplies 20 1497784862 0 Physicians Physician Services 00 1497785257 0 GREENWOOD JODIE 2000122 9999999 B 10 1497785257 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1497785257 0 Physicians Anesthesia Services 20 1497785257 0 Physicians Healthy Kids Services 20 1497785257 0 Physicians Optical Supplies 20 1497785257 0 Physicians Physician Services 00 1497785323 0 MILES DAVID A 2003091 9999999 B 10 1497785323 0 PO BOX 88848 CAROL STREAM IL 601880848 20 1497785323 0 Nurse Practitioners Anesthesia Services 20 1497785323 0 Nurse Practitioners Nurse Practitioners Services 20 1497785323 0 Nurse Practitioners Physician Services 00 1497785497 0 BRICKNER RICHARD L 1993001 9999999 B 10 1497785497 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1497785497 0 Physicians Anesthesia Services 20 1497785497 0 Physicians Healthy Kids Services 20 1497785497 0 Physicians Optical Supplies 20 1497785497 0 Physicians Physician Services 00 1497785828 0 ZHANG HUAYAN 2018114 9999999 B 10 1497785828 0 100 E PENN SQ FL 9 PHILADELPHIA PA 191073377 20 1497785828 0 Physicians Anesthesia Services 20 1497785828 0 Physicians Fluoride varnish 20 1497785828 0 Physicians Healthy Kids Services 20 1497785828 0 Physicians Optical Supplies 20 1497785828 0 Physicians Physician Services 00 1497787238 0 RINELLA MARY E 2002213 9999999 B 10 1497787238 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1497787238 0 Physicians Anesthesia Services 20 1497787238 0 Physicians Fluoride varnish 20 1497787238 0 Physicians Healthy Kids Services 20 1497787238 0 Physicians Optical Supplies 20 1497787238 0 Physicians Physician Services 00 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0 Physicians Healthy Kids Services 20 1497869622 0 Physicians Optical Supplies 20 1497869622 0 Physicians Physician Services 00 1497870117 0 SAROLI TANIA 2009001 9999999 B 10 1497870117 0 29373 NETWORK PL CHICAGO IL 606733039 20 1497870117 0 Physicians Anesthesia Services 20 1497870117 0 Physicians Fluoride varnish 20 1497870117 0 Physicians Healthy Kids Services 20 1497870117 0 Physicians Optical Supplies 20 1497870117 0 Physicians Physician Services 00 1497870315 0 SITJAR GUADALUPE 1981258 9999999 A 10 1497870315 0 2210 MIDWEST RD STE 102A OAK BROOK IL 605231280 20 1497870315 0 Physicians Anesthesia Services 20 1497870315 0 Physicians Fluoride varnish 20 1497870315 0 Physicians Healthy Kids Services 20 1497870315 0 Physicians Optical Supplies 20 1497870315 0 Physicians Physician Services 00 1497870554 0 ALRAYYES SAHAR 1999060 9999999 B 10 1497870554 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1497870554 0 Dentists Dental Services 20 1497870554 0 Dentists Physician Services 00 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Supplies 20 1497962096 0 Physicians Physician Services 00 1497963011 0 SHAH DISHANT G 2023164 9999999 B 10 1497963011 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1497963011 0 Physicians Anesthesia Services 20 1497963011 0 Physicians Healthy Kids Services 20 1497963011 0 Physicians Optical Supplies 20 1497963011 0 Physicians Physician Services 00 1497965172 0 LAGERLUND ANN 2013231 9999999 B 10 1497965172 0 PO BOX 735041 CHICAGO IL 606731828 20 1497965172 0 Physicians Anesthesia Services 20 1497965172 0 Physicians Healthy Kids Services 20 1497965172 0 Physicians Optical Supplies 20 1497965172 0 Physicians Physician Services 00 1497965214 0 MANIAR HERSH 2009305 9999999 B 10 1497965214 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1497965214 0 Physicians Anesthesia Services 20 1497965214 0 Physicians Healthy Kids Services 20 1497965214 0 Physicians Optical Supplies 20 1497965214 0 Physicians Physician Services 00 1497965487 0 HANNON TERRI 2001060 9999999 B 10 1497965487 0 2712 FORGUE DR STE 100 NAPERVILLE IL 605644230 20 1497965487 0 Nurse Practitioners Fluoride varnish 20 1497965487 0 Nurse Practitioners Healthy Kids Services 20 1497965487 0 Nurse Practitioners Nurse Practitioners Services 20 1497965487 0 Nurse Practitioners Physician Services 00 1497965990 0 RUDOMIOTOV OLGA 2008183 9999999 B 10 1497965990 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1497965990 0 Physicians Anesthesia Services 20 1497965990 0 Physicians Fluoride varnish 20 1497965990 0 Physicians Healthy Kids Services 20 1497965990 0 Physicians Optical Supplies 20 1497965990 0 Physicians Physician Services 00 1497966584 0 SWIBEL ROSENTHAL LAURA 2010228 9999999 B 10 1497966584 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1497966584 0 Physicians Anesthesia Services 20 1497966584 0 Physicians Healthy Kids Services 20 1497966584 0 Physicians Optical Supplies 20 1497966584 0 Physicians Physician Services 00 1497966709 0 MILLIKAN TIMOTHY 2004001 9999999 B 10 1497966709 0 100 S 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Anesthesia Services 20 1497971931 0 Physicians Healthy Kids Services 20 1497971931 0 Physicians Optical Supplies 20 1497971931 0 Physicians Physician Services 00 1497972640 0 DEWAN SHERI 2012245 9999999 B 10 1497972640 0 5777 DEPT CAROL STREAM IL 601220021 20 1497972640 0 Physicians Anesthesia Services 20 1497972640 0 Physicians Healthy Kids Services 20 1497972640 0 Physicians Optical Supplies 20 1497972640 0 Physicians Physician Services 00 1497974356 0 CRUZ MARTHA 2018104 9999999 B 10 1497974356 0 5220 EAST AVE COUNTRYSIDE IL 605253133 20 1497974356 0 Clinical Social Worker Social work service 00 1497975502 0 HA KENNETH C 2006182 9999999 B 10 1497975502 0 5777 DEPT CAROL STREAM IL 601228942 20 1497975502 0 Physicians Anesthesia Services 20 1497975502 0 Physicians Fluoride varnish 20 1497975502 0 Physicians Healthy Kids Services 20 1497975502 0 Physicians Optical Supplies 20 1497975502 0 Physicians Physician Services 00 1497976286 0 PUGH JENNIFER 2007213 9999999 B 10 1497976286 0 339 CONSORT DR BALLWIN MO 630114439 20 1497976286 0 Physicians Anesthesia Services 20 1497976286 0 Physicians Healthy Kids Services 20 1497976286 0 Physicians Optical Supplies 20 1497976286 0 Physicians Physician Services 00 1497977888 0 WIETFELDT JOEL 2012245 9999999 B 10 1497977888 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1497977888 0 Physicians Anesthesia Services 20 1497977888 0 Physicians Healthy Kids Services 20 1497977888 0 Physicians Optical Supplies 20 1497977888 0 Physicians Physician Services 00 1497978035 0 DEL MUNDO MELANIE 2011111 9999999 B 10 1497978035 0 319 E MADISON ST STE 3B SPRINGFIELD IL 627013124 20 1497978035 0 Other behavior health professional LCPC/LMFT services 00 1497978407 0 WINDEKNECHT JOAN 2012001 9999999 B 10 1497978407 0 1701 LACEY ST CAPE GIRARDEAU MO 637015230 20 1497978407 0 Nurse Practitioners Anesthesia Services 20 1497978407 0 Nurse Practitioners Nurse Practitioners Services 20 1497978407 0 Nurse Practitioners Physician Services 00 1497978472 0 SCALA CHRISTINE 2001128 9999999 B 10 1497978472 0 1439 CRAIN ST PARK RIDGE IL 600681211 20 1497978472 0 Speech Therapists Medical Supplies 20 1497978472 0 Speech Therapists Medical equipment/prosthetic devices 20 1497978472 0 Speech Therapists Speech Therapy/Pathology Services 00 1497978621 0 HOLZ JILL A 2021078 9999999 B 10 1497978621 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1497978621 0 Physicians Anesthesia Services 20 1497978621 0 Physicians Fluoride varnish 20 1497978621 0 Physicians Healthy Kids Services 20 1497978621 0 Physicians Optical Supplies 20 1497978621 0 Physicians Physician Services 00 1497980387 0 WALSH COLLEEN A 2020176 9999999 B 10 1497980387 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1497980387 0 Nurse Practitioners Fluoride varnish 20 1497980387 0 Nurse Practitioners Healthy Kids Services 20 1497980387 0 Nurse Practitioners Nurse Practitioners Services 20 1497980387 0 Nurse Practitioners Physician Services 00 1497980452 0 PATRICK JILMA L 2014182 9999999 B 10 1497980452 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1497980452 0 Physicians Anesthesia Services 20 1497980452 0 Physicians Healthy Kids Services 20 1497980452 0 Physicians Optical Supplies 20 1497980452 0 Physicians Physician Services 00 1497980973 0 GURSKY CATHERINE T 2013189 9999999 B 10 1497980973 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1497980973 0 Physicians Anesthesia Services 20 1497980973 0 Physicians Fluoride varnish 20 1497980973 0 Physicians Healthy Kids Services 20 1497980973 0 Physicians Optical Supplies 20 1497980973 0 Physicians Physician Services 00 1497981351 0 GIBSON ANGELA L 2015244 9999999 B 10 1497981351 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1497981351 0 Physicians Anesthesia Services 20 1497981351 0 Physicians Healthy Kids Services 20 1497981351 0 Physicians Optical Supplies 20 1497981351 0 Physicians Physician Services 00 1497981781 0 SENH ALAN C 2011335 9999999 B 10 1497981781 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1497981781 0 Physicians Anesthesia Services 20 1497981781 0 Physicians Healthy Kids Services 20 1497981781 0 Physicians Optical Supplies 20 1497981781 0 Physicians Physician Services 00 1497981971 0 NAYAK SUJATHA 2009243 9999999 B 10 1497981971 0 29373 NETWORK PL CHICAGO IL 606733039 20 1497981971 0 Physicians Anesthesia Services 20 1497981971 0 Physicians Fluoride varnish 20 1497981971 0 Physicians Healthy Kids Services 20 1497981971 0 Physicians Optical Supplies 20 1497981971 0 Physicians Physician Services 00 1497982151 0 NELSON JONATHAN S 2019204 9999999 B 10 1497982151 0 6066 STRATHMOOR DR # C2 ROCKFORD IL 611076633 20 1497982151 0 Other behavior health professional LCPC/LMFT services 00 1497982227 0 LENZEN CHRISTIANE 2022264 9999999 B 10 1497982227 0 3020 CHILDRENS WAY SAN DIEGO CA 921234223 20 1497982227 0 Physicians Anesthesia Services 20 1497982227 0 Physicians Fluoride varnish 20 1497982227 0 Physicians Healthy Kids Services 20 1497982227 0 Physicians Optical Supplies 20 1497982227 0 Physicians Physician Services 00 1497982334 0 FOLEY RYAN T 2015182 9999999 B 10 1497982334 0 9500 BRYN MAWR AVE STE 300 ROSEMONT IL 600185257 20 1497982334 0 Physicians Anesthesia Services 20 1497982334 0 Physicians Healthy Kids Services 20 1497982334 0 Physicians Optical Supplies 20 1497982334 0 Physicians Physician Services 00 1497982771 0 VREELAND TIMOTHY 2020351 9999999 B 10 1497982771 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1497982771 0 Physicians Anesthesia Services 20 1497982771 0 Physicians Healthy Kids Services 20 1497982771 0 Physicians Optical Supplies 20 1497982771 0 Physicians Physician Services 00 1497982813 0 TRAVERSO VINCENT J 2016252 9999999 B 10 1497982813 0 10 E 22ND ST STE 205 LOMBARD IL 601486108 20 1497982813 0 Podiatrists Podiatric Services 00 1497982847 0 BUCKMAN DONALD M 2016222 9999999 B 10 1497982847 0 1200 LOCUST ST ELDORADO IL 629301723 20 1497982847 0 Psychologist Psychologist service 00 1497983266 0 DAHL ERIC 2021310 9999999 B 10 1497983266 0 8170 33RD AVE S MINNEAPOLIS MN 554254516 20 1497983266 0 Physicians Anesthesia Services 20 1497983266 0 Physicians Healthy Kids Services 20 1497983266 0 Physicians Optical Supplies 20 1497983266 0 Physicians Physician Services 00 1497983613 0 MANGOLD JENNA 2016243 9999999 B 10 1497983613 0 2103 E WASHINGTON ST STE 2G BLOOMINGTON IL 617014365 20 1497983613 0 Clinical Social Worker Social work service 00 1497983704 0 HAJJIRI ZAHRAA 2015182 9999999 B 10 1497983704 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1497983704 0 Physicians Anesthesia Services 20 1497983704 0 Physicians Fluoride varnish 20 1497983704 0 Physicians Healthy Kids Services 20 1497983704 0 Physicians Optical Supplies 20 1497983704 0 Physicians Physician Services 00 1497983787 0 DURBIN JOHN P 2016184 9999999 B 10 1497983787 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1497983787 0 Physicians Anesthesia Services 20 1497983787 0 Physicians Fluoride varnish 20 1497983787 0 Physicians Healthy Kids Services 20 1497983787 0 Physicians Optical Supplies 20 1497983787 0 Physicians Physician Services 00 1497984157 0 VERMA SACHIN 2009182 9999999 B 10 1497984157 0 205 W RANDOLPH ST STE 2222 CHICAGO IL 606061814 20 1497984157 0 Dentists Dental Services 20 1497984157 0 Dentists Physician Services 00 1497984983 0 VOGEL MARK 2015187 9999999 B 10 1497984983 0 901 PATIENTS FIRST DR WASHINGTON MO 630904700 20 1497984983 0 Physicians Anesthesia Services 20 1497984983 0 Physicians Fluoride varnish 20 1497984983 0 Physicians Healthy Kids Services 20 1497984983 0 Physicians Optical Supplies 20 1497984983 0 Physicians Physician Services 00 1497985980 0 AHMED SANA S 2018039 9999999 B 10 1497985980 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1497985980 0 Physicians Anesthesia Services 20 1497985980 0 Physicians Fluoride varnish 20 1497985980 0 Physicians Healthy Kids Services 20 1497985980 0 Physicians Optical Supplies 20 1497985980 0 Physicians Physician Services 00 1497986087 0 PANDO WHITNEY 2010274 9999999 B 10 1497986087 0 1754 LOUISVILLE LN CRYSTAL LAKE IL 600142921 20 1497986087 0 Speech Therapists Medical Supplies 20 1497986087 0 Speech Therapists Medical equipment/prosthetic devices 20 1497986087 0 Speech Therapists Speech Therapy/Pathology Services 00 1497989644 0 THOMAS BRENDAN 2012261 9999999 B 10 1497989644 0 28594 NETWORK PL CHICAGO IL 606731285 20 1497989644 0 Physicians Anesthesia Services 20 1497989644 0 Physicians Healthy Kids Services 20 1497989644 0 Physicians Optical Supplies 20 1497989644 0 Physicians Physician Services 00 1497989784 0 RADKE STEPHANIE M 2016251 9999999 B 10 1497989784 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1497989784 0 Physicians Anesthesia Services 20 1497989784 0 Physicians Healthy Kids Services 20 1497989784 0 Physicians Optical Supplies 20 1497989784 0 Physicians Physician Services 00 1497990667 0 TERRONEZ JARED A 2018335 9999999 B 10 1497990667 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1497990667 0 Physicians Anesthesia Services 20 1497990667 0 Physicians Fluoride varnish 20 1497990667 0 Physicians Healthy Kids Services 20 1497990667 0 Physicians Optical Supplies 20 1497990667 0 Physicians Physician Services 00 1497991012 0 EGGERS NITA 2014245 9999999 B 10 1497991012 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1497991012 0 Nurse Practitioners Healthy Kids Services 20 1497991012 0 Nurse Practitioners Nurse Practitioners Services 20 1497991012 0 Nurse Practitioners Physician Services 00 1497991251 0 GRUNDHOEFER DAVA L 2022024 9999999 B 10 1497991251 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1497991251 0 Physicians Anesthesia Services 20 1497991251 0 Physicians Healthy Kids Services 20 1497991251 0 Physicians Optical Supplies 20 1497991251 0 Physicians Physician Services 00 1497991509 0 SYED ALMAS 2012214 9999999 B 10 1497991509 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1497991509 0 Physicians Anesthesia Services 20 1497991509 0 Physicians Fluoride varnish 20 1497991509 0 Physicians Healthy Kids Services 20 1497991509 0 Physicians Optical Supplies 20 1497991509 0 Physicians Physician Services 00 1497992101 0 SCHMITT MEREDITH L 2020094 9999999 B 10 1497992101 0 PO BOX 638704 CINCINNATI OH 452638704 20 1497992101 0 Nurse Practitioners Anesthesia Services 20 1497992101 0 Nurse Practitioners Nurse Practitioners Services 20 1497992101 0 Nurse Practitioners Physician Services 00 1497993158 0 GAFFORD SARAH 2017047 9999999 B 10 1497993158 0 1976 MAPLELEAF DR COLLINSVILLE IL 622345265 20 1497993158 0 Clinical Social Worker Social work service 00 1497993380 0 GERZ CHARLES C 2021063 9999999 B 10 1497993380 0 PO BOX 3988 CARBONDALE IL 629023988 20 1497993380 0 Nurse Practitioners Healthy Kids Services 20 1497993380 0 Nurse Practitioners Nurse Practitioners Services 20 1497993380 0 Nurse Practitioners Physician Services 00 1497994784 0 RUSSELL HYDE M 2010182 9999999 B 10 1497994784 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 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20 1497997787 0 Physician Assistant Only Physician Services 00 1497998868 0 TRUXAL KRISTEN V 2016307 9999999 B 10 1497998868 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1497998868 0 Physicians Anesthesia Services 20 1497998868 0 Physicians Healthy Kids Services 20 1497998868 0 Physicians Optical Supplies 20 1497998868 0 Physicians Physician Services 00 1497998991 0 DUGAL BRIAN M 2012183 9999999 B 10 1497998991 0 75 REMITTANCE DR DEPT 1620 SUITE 1620 CHICAGO IL 606751620 20 1497998991 0 Physicians Anesthesia Services 20 1497998991 0 Physicians Healthy Kids Services 20 1497998991 0 Physicians Optical Supplies 20 1497998991 0 Physicians Physician Services 00 1497999627 0 FAMUYIDE VICTORIA O 2015327 9999999 B 10 1497999627 0 800 E LOCUST ST OLNEY IL 624502553 20 1497999627 0 Physicians Anesthesia Services 20 1497999627 0 Physicians Fluoride varnish 20 1497999627 0 Physicians Healthy Kids Services 20 1497999627 0 Physicians Optical Supplies 20 1497999627 0 Physicians Physician Services 00 1508000977 0 SANGAL NEHA 2014213 9999999 B 10 1508000977 0 2640 183RD ST HOMEWOOD IL 604302914 20 1508000977 0 Physicians Anesthesia Services 20 1508000977 0 Physicians Healthy Kids Services 20 1508000977 0 Physicians Optical Supplies 20 1508000977 0 Physicians Physician Services 00 1508002064 0 BAXTER SARAH JANE 2018016 9999999 B 10 1508002064 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1508002064 0 Physical Therapists Medical Supplies 20 1508002064 0 Physical Therapists Medical equipment/prosthetic devices 20 1508002064 0 Physical Therapists Physical Therapy Services 00 1508003526 0 REYNOLDS MINDY R 2009049 9999999 B 10 1508003526 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1508003526 0 Nurse Practitioners Anesthesia Services 20 1508003526 0 Nurse Practitioners Nurse Practitioners Services 20 1508003526 0 Nurse Practitioners Physician Services 00 1508003849 0 MOORE MELINDA B 2009244 9999999 B 10 1508003849 0 201 BAILEY LN BENTON IL 628121969 20 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Physicians Physician Services 00 1508005125 0 RAINS BRONWYN E 2022221 9999999 B 10 1508005125 0 710 N 8TH ST SPRINGFIELD IL 627026324 20 1508005125 0 Other behavior health professional LCPC/LMFT services 00 1508005380 0 KIM SUK CHUL 2012287 9999999 B 10 1508005380 0 PO BOX 781076 DETROIT MI 482781076 20 1508005380 0 Physicians Anesthesia Services 20 1508005380 0 Physicians Fluoride varnish 20 1508005380 0 Physicians Healthy Kids Services 20 1508005380 0 Physicians Optical Supplies 20 1508005380 0 Physicians Physician Services 00 1508006768 0 MOUNTFORD STEPHANIE A 2018165 9999999 B 10 1508006768 0 1612 BAYOU PATH DR NAPERVILLE IL 605631718 20 1508006768 0 Physical Therapists Medical Supplies 20 1508006768 0 Physical Therapists Medical equipment/prosthetic devices 20 1508006768 0 Physical Therapists Physical Therapy Services 00 1508007584 0 BUZHARDT MATTHEW 2020177 9999999 B 10 1508007584 0 PO BOX 43230 PHOENIX AZ 850803230 20 1508007584 0 Physicians Anesthesia Services 20 1508007584 0 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1508009473 0 2547 PLAINFIELD NAPERVILLE RD NAPERVILLE IL 605648701 20 1508009473 0 Physical Therapists Physical Therapy Services 00 1508010042 0 SMOLNICKY JOHN 2023090 9999999 B 10 1508010042 0 8400 LOUISIANA ST MERRILLVILLE IN 464106385 20 1508010042 0 Dentists Dental Services 20 1508010042 0 Dentists Physician Services 00 1508011040 0 HUANG HENRY D 2015182 9999999 B 10 1508011040 0 75 REMITTANCE DR DEPT 1611 CHICAGO IL 606751611 20 1508011040 0 Physicians Anesthesia Services 20 1508011040 0 Physicians Fluoride varnish 20 1508011040 0 Physicians Healthy Kids Services 20 1508011040 0 Physicians Optical Supplies 20 1508011040 0 Physicians Physician Services 00 1508012352 0 PARKS DEIDRA D 1999258 9999999 B 10 1508012352 0 16721 E KENDALL RD MOUNT VERNON IL 628642077 20 1508012352 0 Speech Therapists Medical Supplies 20 1508012352 0 Speech Therapists Medical equipment/prosthetic devices 20 1508012352 0 Speech Therapists Speech Therapy/Pathology Services 00 1508012485 0 THARP RASA 2009210 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1508015181 0 Physicians Optical Supplies 20 1508015181 0 Physicians Physician Services 00 1508015207 0 SHAHEEN FAWAD AHMED 2012183 9999999 B 10 1508015207 0 611 W PARK ST URBANA IL 618012529 20 1508015207 0 Physicians All Kids application agent 20 1508015207 0 Physicians Anesthesia Services 20 1508015207 0 Physicians Healthy Kids Services 20 1508015207 0 Physicians Optical Supplies 20 1508015207 0 Physicians Physician Services 00 1508015587 0 PUGH DAVID 2015091 9999999 B 10 1508015587 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1508015587 0 Physicians Anesthesia Services 20 1508015587 0 Physicians Healthy Kids Services 20 1508015587 0 Physicians Optical Supplies 20 1508015587 0 Physicians Physician Services 00 1508016817 0 BESAW ANGELA M 2021039 9999999 B 10 1508016817 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1508016817 0 Nurse Practitioners Healthy Kids Services 20 1508016817 0 Nurse Practitioners Nurse Practitioners Services 20 1508016817 0 Nurse Practitioners 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1508061409 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1508061409 0 Physician Assistant Only Fluoride varnish 20 1508061409 0 Physician Assistant Only Healthy Kids Services 20 1508061409 0 Physician Assistant Only Physician Services 00 1508062043 0 RENNICK NEIL J 1990060 9999999 B 10 1508062043 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1508062043 0 Physicians Anesthesia Services 20 1508062043 0 Physicians Fluoride varnish 20 1508062043 0 Physicians Healthy Kids Services 20 1508062043 0 Physicians Optical Supplies 20 1508062043 0 Physicians Physician Services 00 1508062159 0 HAMDAN JOEHAR 2010182 9999999 B 10 1508062159 0 350 N WALL ST KANKAKEE IL 609012901 20 1508062159 0 Physicians Anesthesia Services 20 1508062159 0 Physicians Fluoride varnish 20 1508062159 0 Physicians Healthy Kids Services 20 1508062159 0 Physicians Optical Supplies 20 1508062159 0 Physicians Physician Services 00 1508062837 0 DEBRUIN DAVID 2013213 9999999 B 10 1508062837 0 645 S CENTRAL AVE CHICAGO 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Services 20 1508064932 0 Physicians Fluoride varnish 20 1508064932 0 Physicians Healthy Kids Services 20 1508064932 0 Physicians Optical Supplies 20 1508064932 0 Physicians Physician Services 00 1508065558 0 KLEMENS JAMES 2008001 9999999 B 10 1508065558 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1508065558 0 Physicians Anesthesia Services 20 1508065558 0 Physicians Healthy Kids Services 20 1508065558 0 Physicians Optical Supplies 20 1508065558 0 Physicians Physician Services 00 1508066192 0 BAQAI ATIF 2017274 9999999 B 10 1508066192 0 PO BOX 5588 BELFAST ME 049155500 20 1508066192 0 Physicians Anesthesia Services 20 1508066192 0 Physicians Healthy Kids Services 20 1508066192 0 Physicians Optical Supplies 20 1508066192 0 Physicians Physician Services 00 1508067158 0 DUNLAP CHRISTINE M 2018043 9999999 B 10 1508067158 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1508067158 0 Other behavior health professional Development Therapy, Orientation and Mobility Services 20 1508067158 0 Other behavior health professional Early Intervention Services 20 1508067158 0 Other behavior health professional Targeted case management service 00 1508067596 0 DOTHAGER CHRISTINA 2010207 9999999 B 10 1508067596 0 787 SUNSET BLVD STE 200 O FALLON IL 622691960 20 1508067596 0 Physicians Anesthesia Services 20 1508067596 0 Physicians Healthy Kids Services 20 1508067596 0 Physicians Optical Supplies 20 1508067596 0 Physicians Physician Services 00 1508069212 0 HYDER FATIMA 2012275 9999999 B 10 1508069212 0 PO BOX 775253 CHICAGO IL 606775253 20 1508069212 0 Physicians Anesthesia Services 20 1508069212 0 Physicians Fluoride varnish 20 1508069212 0 Physicians Healthy Kids Services 20 1508069212 0 Physicians Optical Supplies 20 1508069212 0 Physicians Physician Services 00 1508069279 0 SABENS CHERYL 2020205 9999999 B 10 1508069279 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1508069279 0 Nurse Practitioners Healthy Kids Services 20 1508069279 0 Nurse Practitioners Nurse Practitioners Services 20 1508069279 0 Nurse Practitioners Physician Services 00 1508070442 0 ROYCE MARY 2008245 9999999 B 10 1508070442 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1508070442 0 Nurse Practitioners Healthy Kids Services 20 1508070442 0 Nurse Practitioners Nurse Practitioners Services 20 1508070442 0 Nurse Practitioners Physician Services 00 1508071309 0 MUHAMMEDKARIM FOUZIA 2011164 9999999 B 10 1508071309 0 535 FAIRWAY DR STE 107 NAPERVILLE IL 605633940 20 1508071309 0 Physicians Anesthesia Services 20 1508071309 0 Physicians Fluoride varnish 20 1508071309 0 Physicians Healthy Kids Services 20 1508071309 0 Physicians Optical Supplies 20 1508071309 0 Physicians Physician Services 00 1508072190 0 LEHMANN RYAN 2017235 9999999 B 10 1508072190 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1508072190 0 Physicians Anesthesia Services 20 1508072190 0 Physicians Healthy Kids Services 20 1508072190 0 Physicians Optical Supplies 20 1508072190 0 Physicians Physician Services 00 1508074618 0 KENNEDY TABASSUM 2009182 9999999 B 10 1508074618 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1508074618 0 Physicians Anesthesia Services 20 1508074618 0 Physicians Healthy Kids Services 20 1508074618 0 Physicians Optical Supplies 20 1508074618 0 Physicians Physician Services 00 1508074915 0 DOYLE MICHAEL 2024050 9999999 B 10 1508074915 0 500 W RIVER DR DAVENPORT IA 528011014 20 1508074915 0 Dentists Dental Services 20 1508074915 0 Dentists Physician Services 00 1508075102 0 BUDZIAKOWSKI ROBERT S 2008054 9999999 B 10 1508075102 0 5725 S ARCHER AVE CHICAGO IL 606381617 20 1508075102 0 Physicians Anesthesia Services 20 1508075102 0 Physicians Fluoride varnish 20 1508075102 0 Physicians Healthy Kids Services 20 1508075102 0 Physicians Optical Supplies 20 1508075102 0 Physicians Physician Services 00 1508076126 0 KAO PATRICIA F 2016306 9999999 B 10 1508076126 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1508076126 0 Physicians Anesthesia Services 20 1508076126 0 Physicians Fluoride varnish 20 1508076126 0 Physicians Healthy Kids Services 20 1508076126 0 Physicians Optical Supplies 20 1508076126 0 Physicians Physician Services 00 1508076522 0 MARTINI JOHN 2007152 9999999 B 10 1508076522 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1508076522 0 Physicians Anesthesia Services 20 1508076522 0 Physicians Healthy Kids Services 20 1508076522 0 Physicians Optical Supplies 20 1508076522 0 Physicians Physician Services 00 1508078379 0 WILKINS JOHN T 2007175 9999999 B 10 1508078379 0 5777 DEPT CAROL STREAM IL 601220021 20 1508078379 0 Physicians Anesthesia Services 20 1508078379 0 Physicians Fluoride varnish 20 1508078379 0 Physicians Healthy Kids Services 20 1508078379 0 Physicians Optical Supplies 20 1508078379 0 Physicians Physician Services 00 1508078643 0 SO JASON S 2008061 9999999 B 10 1508078643 0 500 W CENTRAL RD STE 204 MT PROSPECT IL 600562381 20 1508078643 0 Physicians Anesthesia Services 20 1508078643 0 Physicians Fluoride varnish 20 1508078643 0 Physicians Healthy Kids Services 20 1508078643 0 Physicians Optical Supplies 20 1508078643 0 Physicians Physician Services 00 1508080870 0 PARKER SHARON L 2014091 9999999 B 10 1508080870 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1508080870 0 Nurse Practitioners Fluoride varnish 20 1508080870 0 Nurse Practitioners Healthy Kids Services 20 1508080870 0 Nurse Practitioners Nurse Practitioners Services 20 1508080870 0 Nurse Practitioners Physician Services 00 1508081589 0 BEDI ASHEESH 2017271 9999999 B 10 1508081589 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1508081589 0 Physicians Anesthesia Services 20 1508081589 0 Physicians Healthy Kids Services 20 1508081589 0 Physicians Optical Supplies 20 1508081589 0 Physicians Physician Services 00 1508081688 0 APOSTOL MARC 2010182 9999999 B 10 1508081688 0 1000 N ALLEN ST ROBINSON IL 624541114 20 1508081688 0 Physicians Anesthesia Services 20 1508081688 0 Physicians Healthy Kids Services 20 1508081688 0 Physicians Optical Supplies 20 1508081688 0 Physicians Physician Services 00 1508083692 0 GOSSMAN DAVID G 2021019 9999999 B 10 1508083692 0 PO BOX 28900 GREEN BAY WI 543240900 20 1508083692 0 Physicians Anesthesia Services 20 1508083692 0 Physicians Healthy Kids Services 20 1508083692 0 Physicians Optical Supplies 20 1508083692 0 Physicians Physician Services 00 1508085184 0 VERMA ANITA 2007335 9999999 B 10 1508085184 0 3253 S HARLEM AVE STE 1C BERWYN IL 604022996 20 1508085184 0 Dentists Dental Services 20 1508085184 0 Dentists Physician Services 00 1508086943 0 VERSLUIS CHAD J 2008043 9999999 B 10 1508086943 0 1830 6TH AVE MOLINE IL 612652105 20 1508086943 0 Dentists Dental Services 20 1508086943 0 Dentists Physician Services 00 1508088485 0 VARGHESE SHINEY 2014001 9999999 B 10 1508088485 0 PO BOX 772 MC2295 WOONSOCKET RI 028950784 20 1508088485 0 Nurse Practitioners Fluoride varnish 20 1508088485 0 Nurse Practitioners Healthy Kids Services 20 1508088485 0 Nurse Practitioners Nurse Practitioners Services 20 1508088485 0 Nurse Practitioners Physician Services 00 1508088741 0 SHAFFER CASEY A 2018184 9999999 B 10 1508088741 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1508088741 0 Physicians Anesthesia Services 20 1508088741 0 Physicians Healthy Kids Services 20 1508088741 0 Physicians Optical Supplies 20 1508088741 0 Physicians Physician Services 00 1508089442 0 EDWARDS SAMUEL 2012046 9999999 B 10 1508089442 0 PO BOX 110429 AURORA CO 800420429 20 1508089442 0 Physicians Anesthesia Services 20 1508089442 0 Physicians Healthy Kids Services 20 1508089442 0 Physicians Optical Supplies 20 1508089442 0 Physicians Physician Services 00 1508089608 0 SOCO CHERYL 2007001 9999999 B 10 1508089608 0 5777 DEPT CAROL STREAM IL 601220021 20 1508089608 0 Nurse Practitioners Healthy Kids Services 20 1508089608 0 Nurse Practitioners Nurse Practitioners Services 20 1508089608 0 Nurse Practitioners Physician Services 00 1508090234 0 DESAI CHAITANYA R 2012245 9999999 B 10 1508090234 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1508090234 0 Physicians Anesthesia Services 20 1508090234 0 Physicians Fluoride varnish 20 1508090234 0 Physicians Healthy Kids Services 20 1508090234 0 Physicians Optical Supplies 20 1508090234 0 Physicians Physician Services 00 1508090481 0 AABY KELLI A 2023220 9999999 B 10 1508090481 0 3957 N MULFORD RD STE A SUITE A ROCKFORD IL 611148004 20 1508090481 0 Dentists Dental Services 20 1508090481 0 Dentists Physician Services 00 1508091976 0 WOELTZ TIFFANY A 2015152 9999999 B 10 1508091976 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1508091976 0 Nurse Practitioners Fluoride varnish 20 1508091976 0 Nurse Practitioners Healthy Kids Services 20 1508091976 0 Nurse Practitioners Nurse Practitioners Services 20 1508091976 0 Nurse Practitioners Physician Services 00 1508093196 0 MAREK ASHLEY 2016183 9999999 B 10 1508093196 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1508093196 0 Physicians Anesthesia Services 20 1508093196 0 Physicians Healthy Kids Services 20 1508093196 0 Physicians Optical Supplies 20 1508093196 0 Physicians Physician Services 00 1508093246 0 DAHILL AMY E 2024099 9999999 B 10 1508093246 0 2201 MAIN ST EVANSTON IL 602021519 20 1508093246 0 Other behavior health professional LCPC/LMFT services 00 1508093501 0 CASSARA CHRISTOPHER 2017145 9999999 B 10 1508093501 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1508093501 0 Physicians Anesthesia Services 20 1508093501 0 Physicians Healthy Kids Services 20 1508093501 0 Physicians Optical Supplies 20 1508093501 0 Physicians Physician Services 00 1508093527 0 KALU UWA 2011301 9999999 B 10 1508093527 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1508093527 0 Physicians Anesthesia Services 20 1508093527 0 Physicians Fluoride varnish 20 1508093527 0 Physicians Healthy Kids Services 20 1508093527 0 Physicians Optical Supplies 20 1508093527 0 Physicians Physician Services 00 1508094210 0 QAQI OSAMA M 2024191 9999999 B 10 1508094210 0 PO BOX 4176 HOUMA LA 703614176 20 1508094210 0 Physicians Anesthesia Services 20 1508094210 0 Physicians Fluoride varnish 20 1508094210 0 Physicians Healthy Kids Services 20 1508094210 0 Physicians Optical Supplies 20 1508094210 0 Physicians Physician Services 00 1508094756 0 TUMU ANIL Y 2015187 9999999 B 10 1508094756 0 PO BOX 735044 CHICAGO IL 606735044 20 1508094756 0 Physicians Anesthesia Services 20 1508094756 0 Physicians Healthy Kids Services 20 1508094756 0 Physicians Optical Supplies 20 1508094756 0 Physicians Physician Services 00 1508095209 0 COORG ROHINI K 2013182 9999999 B 10 1508095209 0 2450 HOLCOMBE BLVD STE MN-34L HOUSTON TX 770212039 20 1508095209 0 Physicians Anesthesia Services 20 1508095209 0 Physicians Fluoride varnish 20 1508095209 0 Physicians Healthy Kids Services 20 1508095209 0 Physicians Optical Supplies 20 1508095209 0 Physicians Physician Services 00 1508095605 0 ZAIDI FARHAN 2015306 9999999 B 10 1508095605 0 1S450 SUMMIT AVE STE 270 OAKBROOK TERRAC IL 601813959 20 1508095605 0 Physicians Anesthesia Services 20 1508095605 0 Physicians Fluoride varnish 20 1508095605 0 Physicians Healthy Kids Services 20 1508095605 0 Physicians Optical Supplies 20 1508095605 0 Physicians Physician Services 00 1508096041 0 LACHCIK KAREN 2020183 9999999 B 10 1508096041 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1508096041 0 Occupational Therapists Medical Supplies 20 1508096041 0 Occupational Therapists Medical equipment/prosthetic devices 20 1508096041 0 Occupational Therapists Occupational Therapy Services 00 1508096256 0 FITZGERALD THERESA M 2024327 9999999 B 10 1508096256 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1508096256 0 Physicians Anesthesia Services 20 1508096256 0 Physicians Fluoride varnish 20 1508096256 0 Physicians Healthy Kids Services 20 1508096256 0 Physicians Optical Supplies 20 1508096256 0 Physicians Physician Services 00 1508096819 0 MAY MOLLIE C 2020335 9999999 B 10 1508096819 0 29373 NETWORK PL CHICAGO IL 606733039 20 1508096819 0 Nurse Practitioners Healthy Kids Services 20 1508096819 0 Nurse Practitioners Nurse Practitioners Services 20 1508096819 0 Nurse Practitioners Physician Services 00 1508096892 0 STRIBLING ANDREA 2009222 9999999 B 10 1508096892 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1508096892 0 Nurse Practitioners Fluoride varnish 20 1508096892 0 Nurse Practitioners Healthy Kids Services 20 1508096892 0 Nurse Practitioners Nurse Practitioners Services 20 1508096892 0 Nurse Practitioners Physician Services 00 1508098476 0 COLMAN KATHRYN 2014244 9999999 B 10 1508098476 0 PO BOX 8500 LOCKBOX 7642 PHILADELPHIA PA 191787642 20 1508098476 0 Physicians Anesthesia Services 20 1508098476 0 Physicians Healthy Kids Services 20 1508098476 0 Physicians Optical Supplies 20 1508098476 0 Physicians Physician Services 00 1508098799 0 BETANCOURT SANTIAGO 2022210 9999999 B 10 1508098799 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1508098799 0 Nurse Practitioners Anesthesia Services 20 1508098799 0 Nurse Practitioners Nurse Practitioners Services 20 1508098799 0 Nurse Practitioners Physician Services 00 1508103094 0 BIJANA ALLEN 2015126 9999999 H 10 1508103094 0 2500 W HIGGINS ROAD SUITE 105 HOFFMAN ESTATES IL 601692040 20 1508103094 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1508103144 0 AGUERO CHRISTINA 2024145 9999999 B 10 1508103144 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1508103144 0 Nurse Practitioners Anesthesia Services 20 1508103144 0 Nurse Practitioners Nurse Practitioners Services 20 1508103144 0 Nurse Practitioners Physician Services 00 1508106410 0 GREER SARA K 2017177 9999999 B 10 1508106410 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1508106410 0 Physicians Anesthesia Services 20 1508106410 0 Physicians Fluoride varnish 20 1508106410 0 Physicians Healthy Kids Services 20 1508106410 0 Physicians Optical Supplies 20 1508106410 0 Physicians Physician Services 00 1508107772 0 ROKE SARAH 2013152 9999999 B 10 1508107772 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1508107772 0 Nurse Practitioners Anesthesia Services 20 1508107772 0 Nurse Practitioners Nurse Practitioners Services 20 1508107772 0 Nurse Practitioners Physician Services 00 1508108036 0 CREWS CAROL 2020069 9999999 B 10 1508108036 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1508108036 0 Clinical Social Worker Social work service 00 1508108226 0 MAGNETTA MICHAEL J 2019162 9999999 B 10 1508108226 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1508108226 0 Physicians Anesthesia Services 20 1508108226 0 Physicians Healthy Kids Services 20 1508108226 0 Physicians Optical Supplies 20 1508108226 0 Physicians Physician Services 00 1508108531 0 VERA DANER DENNYS 2016057 9999999 B 10 1508108531 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1508108531 0 Physicians Anesthesia Services 20 1508108531 0 Physicians Fluoride varnish 20 1508108531 0 Physicians Healthy Kids Services 20 1508108531 0 Physicians Optical Supplies 20 1508108531 0 Physicians Physician Services 00 1508108689 0 SHAH-BECKER SHIVANI 2024003 9999999 B 10 1508108689 0 700 KMS PL ANN ARBOR MI 481081652 20 1508108689 0 Physicians Anesthesia Services 20 1508108689 0 Physicians Healthy Kids Services 20 1508108689 0 Physicians Optical Supplies 20 1508108689 0 Physicians Physician Services 00 1508108846 0 HARRIS ANDREW W 2021028 9999999 B 10 1508108846 0 700 KMS PL ANN ARBOR MI 481081652 20 1508108846 0 Physicians Anesthesia Services 20 1508108846 0 Physicians Fluoride varnish 20 1508108846 0 Physicians Healthy Kids Services 20 1508108846 0 Physicians Optical Supplies 20 1508108846 0 Physicians Physician Services 00 1508109505 0 BURKE ELIZABETH ANNE 2020198 9999999 B 10 1508109505 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1508109505 0 Physicians Anesthesia Services 20 1508109505 0 Physicians Healthy Kids Services 20 1508109505 0 Physicians Optical Supplies 20 1508109505 0 Physicians Physician Services 00 1508110198 0 ANEWENAH LESLIE 2019182 9999999 B 10 1508110198 0 101 E 9TH ST PANA IL 625571716 20 1508110198 0 Physicians Anesthesia Services 20 1508110198 0 Physicians Healthy Kids Services 20 1508110198 0 Physicians Optical Supplies 20 1508110198 0 Physicians Physician Services 00 1508110776 0 JACOBS BETH A 2016085 9999999 B 10 1508110776 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1508110776 0 Nurse Practitioners Healthy Kids Services 20 1508110776 0 Nurse Practitioners Nurse Practitioners Services 20 1508110776 0 Nurse Practitioners Physician Services 00 1508111402 0 SHEFF DAVID 2024031 9999999 B 10 1508111402 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1508111402 0 Physicians Anesthesia Services 20 1508111402 0 Physicians Fluoride varnish 20 1508111402 0 Physicians Healthy Kids Services 20 1508111402 0 Physicians Optical Supplies 20 1508111402 0 Physicians Physician Services 00 1508113515 0 RAMIREDDY SRINIVAS 2025036 9999999 B 10 1508113515 0 5777 DEPT CAROL STREAM IL 601220021 20 1508113515 0 Physicians Anesthesia Services 20 1508113515 0 Physicians Fluoride varnish 20 1508113515 0 Physicians Healthy Kids Services 20 1508113515 0 Physicians Optical Supplies 20 1508113515 0 Physicians Physician Services 00 1508114620 0 BLECHLE VALERIE 2014197 9999999 B 10 1508114620 0 1900 STATE ST CHESTER IL 622331116 20 1508114620 0 Nurse Practitioners Fluoride varnish 20 1508114620 0 Nurse Practitioners Healthy Kids Services 20 1508114620 0 Nurse Practitioners Nurse Practitioners Services 20 1508114620 0 Nurse Practitioners Physician Services 00 1508114828 0 DAGEL BRIAN E 2012214 9999999 B 10 1508114828 0 29373 NETWORK PL CHICAGO IL 606733039 20 1508114828 0 Nurse Practitioners Anesthesia Services 20 1508114828 0 Nurse Practitioners Nurse Practitioners Services 20 1508114828 0 Nurse Practitioners Physician Services 00 1508115437 0 FROHNING JONATHAN R 2022031 9999999 B 10 1508115437 0 1650 LYNDON FARM CT STE 300 LOUISVILLE KY 402235005 20 1508115437 0 Physical 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DAISY-SCARLETT 2023040 9999999 B 10 1508120924 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1508120924 0 Physicians Anesthesia Services 20 1508120924 0 Physicians Fluoride varnish 20 1508120924 0 Physicians Healthy Kids Services 20 1508120924 0 Physicians Optical Supplies 20 1508120924 0 Physicians Physician Services 00 1508120981 0 ARREDONDO RUPP MELISSA M 2016193 9999999 B 10 1508120981 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1508120981 0 Physicians Anesthesia Services 20 1508120981 0 Physicians Fluoride varnish 20 1508120981 0 Physicians Healthy Kids Services 20 1508120981 0 Physicians Optical Supplies 20 1508120981 0 Physicians Physician Services 00 1508121344 0 THORPE KLINSKY CLAIRE M 2016277 9999999 B 10 1508121344 0 201 W SAINT LOUIS ST LEBANON IL 622541515 20 1508121344 0 Optometrists Optical Supplies 20 1508121344 0 Optometrists Optometric Services 20 1508121344 0 Optometrists Physician Services 00 1508121518 0 FLEMING MATTHEW 2018105 9999999 B 10 1508121518 0 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20 1508122185 0 Physicians Fluoride varnish 20 1508122185 0 Physicians Healthy Kids Services 20 1508122185 0 Physicians Optical Supplies 20 1508122185 0 Physicians Physician Services 00 1508122607 0 NUBANI REEM Y 2018019 9999999 B 10 1508122607 0 400 E RANDOLPH ST APT 3730 CHICAGO IL 606015065 20 1508122607 0 Physicians Anesthesia Services 20 1508122607 0 Physicians Fluoride varnish 20 1508122607 0 Physicians Healthy Kids Services 20 1508122607 0 Physicians Optical Supplies 20 1508122607 0 Physicians Physician Services 00 1508122656 0 RIYAT NAYNA 2020252 9999999 B 10 1508122656 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1508122656 0 Physicians Anesthesia Services 20 1508122656 0 Physicians Fluoride varnish 20 1508122656 0 Physicians Healthy Kids Services 20 1508122656 0 Physicians Optical Supplies 20 1508122656 0 Physicians Physician Services 00 1508123787 0 TAZEH NGII N 2017187 9999999 B 10 1508123787 0 515 22ND AVE MONROE WI 535661569 20 1508123787 0 Physicians Anesthesia Services 20 1508123787 0 Physicians Healthy Kids Services 20 1508123787 0 Physicians Optical Supplies 20 1508123787 0 Physicians Physician Services 00 1508124785 0 FIGUEROA AARON DANIEL 2020065 9999999 B 10 1508124785 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1508124785 0 Optometrists Dental Services 20 1508124785 0 Optometrists Physician Services 00 1508125295 0 HARTMAN NEAL R 2016323 9999999 B 10 1508125295 0 3200 E CAMELBACK RD STE 250 PHOENIX AZ 850182327 20 1508125295 0 Physicians Anesthesia Services 20 1508125295 0 Physicians Fluoride varnish 20 1508125295 0 Physicians Healthy Kids Services 20 1508125295 0 Physicians Optical Supplies 20 1508125295 0 Physicians Physician Services 00 1508125774 0 LOGAN LORRETTA G 2012292 9999999 B 10 1508125774 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1508125774 0 Nurse Practitioners Healthy Kids Services 20 1508125774 0 Nurse Practitioners Nurse Practitioners Services 20 1508125774 0 Nurse Practitioners Physician Services 00 1508126699 0 ABRAHAM 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1508202045 0 Nurse Practitioners Physician Services 00 1508203514 0 LIAO MARK Y 2022022 9999999 B 10 1508203514 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1508203514 0 Physicians Anesthesia Services 20 1508203514 0 Physicians Healthy Kids Services 20 1508203514 0 Physicians Optical Supplies 20 1508203514 0 Physicians Physician Services 00 1508203597 0 CARRICO KIERSTEN 2022010 9999999 B 10 1508203597 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1508203597 0 Physician Assistant Only Fluoride varnish 20 1508203597 0 Physician Assistant Only Healthy Kids Services 20 1508203597 0 Physician Assistant Only Physician Services 00 1508203829 0 BAALMANN DAMIAN V 2016204 9999999 B 10 1508203829 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1508203829 0 Physicians Anesthesia Services 20 1508203829 0 Physicians Healthy Kids Services 20 1508203829 0 Physicians Optical Supplies 20 1508203829 0 Physicians Physician Services 00 1508203928 0 SALAS DAVID M 2016281 9999999 B 10 1508203928 0 54 N WOLF 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Services 20 1508278896 0 Nurse Practitioners Physician Services 00 1508279456 0 DYME NICOLE 2015334 9999999 B 10 1508279456 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1508279456 0 Dentists All Kids application agent 20 1508279456 0 Dentists Dental Services 20 1508279456 0 Dentists Physician Services 00 1508279522 0 REYES GENERE JUAN P 2020183 9999999 B 10 1508279522 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1508279522 0 Physicians Anesthesia Services 20 1508279522 0 Physicians Fluoride varnish 20 1508279522 0 Physicians Healthy Kids Services 20 1508279522 0 Physicians Optical Supplies 20 1508279522 0 Physicians Physician Services 00 1508279795 0 DURANTE RICHARD 2017081 9999999 B 10 1508279795 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1508279795 0 Physicians Anesthesia Services 20 1508279795 0 Physicians Fluoride varnish 20 1508279795 0 Physicians Healthy Kids Services 20 1508279795 0 Physicians Optical Supplies 20 1508279795 0 Physicians Physician 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2022239 9999999 B 10 1508500570 0 124 SW ADAMS ST PEORIA IL 616021308 20 1508500570 0 Physicians Anesthesia Services 20 1508500570 0 Physicians Fluoride varnish 20 1508500570 0 Physicians Healthy Kids Services 20 1508500570 0 Physicians Optical Supplies 20 1508500570 0 Physicians Physician Services 00 1508500919 0 GRIFFITH JHAZMIN 2023134 9999999 B 10 1508500919 0 PO BOX 3039 OAK BROOK IL 605223039 20 1508500919 0 Physicians Anesthesia Services 20 1508500919 0 Physicians Healthy Kids Services 20 1508500919 0 Physicians Optical Supplies 20 1508500919 0 Physicians Physician Services 00 1508501263 0 ABUALI NEVEEN 2022165 9999999 B 10 1508501263 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1508501263 0 Podiatrists Podiatric Services 00 1508501487 0 ACUNA ALEXANDER J 2022189 9999999 B 10 1508501487 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1508501487 0 Physicians Anesthesia Services 20 1508501487 0 Physicians Healthy Kids Services 20 1508501487 0 Physicians Optical Supplies 20 1508501487 0 Physicians Physician Services 00 1508502980 0 BABY NIMMY 2022144 9999999 B 10 1508502980 0 PO BOX 775253 CHICAGO IL 606775253 20 1508502980 0 Nurse Practitioners Fluoride varnish 20 1508502980 0 Nurse Practitioners Healthy Kids Services 20 1508502980 0 Nurse Practitioners Nurse Practitioners Services 20 1508502980 0 Nurse Practitioners Physician Services 00 1508504341 0 FOUST ZACHARY L 2022195 9999999 B 10 1508504341 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1508504341 0 Physicians Anesthesia Services 20 1508504341 0 Physicians Healthy Kids Services 20 1508504341 0 Physicians Optical Supplies 20 1508504341 0 Physicians Physician Services 00 1508504747 0 SCRENCHUK ANDREW 2023313 9999999 B 10 1508504747 0 3015 N BALLAS RD SAINT LOUIS MO 631312329 20 1508504747 0 Nurse Practitioners Anesthesia Services 20 1508504747 0 Nurse Practitioners Nurse Practitioners Services 20 1508504747 0 Nurse Practitioners Physician Services 00 1508505215 0 LOHMAN IRWIN EMILIE 2022193 9999999 B 10 1508505215 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1508505215 0 Physicians Anesthesia Services 20 1508505215 0 Physicians Healthy Kids Services 20 1508505215 0 Physicians Optical Supplies 20 1508505215 0 Physicians Physician Services 00 1508506148 0 TESHOME BEZAYE T 2023086 9999999 B 10 1508506148 0 4698 DEPT CAROL STREAM IL 601220021 20 1508506148 0 Physicians Anesthesia Services 20 1508506148 0 Physicians Healthy Kids Services 20 1508506148 0 Physicians Optical Supplies 20 1508506148 0 Physicians Physician Services 00 1508506668 0 DANG CHAU 2022159 9999999 B 10 1508506668 0 PO BOX 781076 DETROIT MI 482781076 20 1508506668 0 Nurse Practitioners Fluoride varnish 20 1508506668 0 Nurse Practitioners Healthy Kids Services 20 1508506668 0 Nurse Practitioners Nurse Practitioners Services 20 1508506668 0 Nurse Practitioners Physician Services 00 1508508748 0 BRANHAM CASEY L 2022224 9999999 B 10 1508508748 0 520 MARY ST STE 520 EVANSVILLE IN 477101682 20 1508508748 0 Physician Assistant Only Fluoride varnish 20 1508508748 0 Physician Assistant Only Healthy Kids Services 20 1508508748 0 Physician Assistant Only Physician Services 00 1508509837 0 CONSOL DUSTIN C 2022311 9999999 B 10 1508509837 0 28592 NETWORK PL CHICAGO IL 606731285 20 1508509837 0 Physician Assistant Only Fluoride varnish 20 1508509837 0 Physician Assistant Only Healthy Kids Services 20 1508509837 0 Physician Assistant Only Physician Services 00 1508509969 0 DAHODWALA MOHSIN 2022187 9999999 B 10 1508509969 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1508509969 0 Physicians Anesthesia Services 20 1508509969 0 Physicians Fluoride varnish 20 1508509969 0 Physicians Healthy Kids Services 20 1508509969 0 Physicians Optical Supplies 20 1508509969 0 Physicians Physician Services 00 1508512666 0 HITCHENS LACIE M 2022095 9999999 B 10 1508512666 0 PO BOX 3988 CARBONDALE IL 629023988 20 1508512666 0 Nurse Practitioners Fluoride varnish 20 1508512666 0 Nurse Practitioners Healthy Kids Services 20 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Supplies 20 1508514183 0 Physicians Physician Services 00 1508515024 0 VERMA DIYA 2024249 9999999 B 10 1508515024 0 4714 GETTYSBURG RD MECHANICSBURG PA 170554325 20 1508515024 0 Physical Therapists Medical Supplies 20 1508515024 0 Physical Therapists Medical equipment/prosthetic devices 20 1508515024 0 Physical Therapists Physical Therapy Services 00 1508515198 0 KWON DANNY KANG HYUK 2022178 9999999 B 10 1508515198 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1508515198 0 Physicians Anesthesia Services 20 1508515198 0 Physicians Fluoride varnish 20 1508515198 0 Physicians Healthy Kids Services 20 1508515198 0 Physicians Optical Supplies 20 1508515198 0 Physicians Physician Services 00 1508515362 0 BELKNAP VANESSA N 2022342 9999999 B 10 1508515362 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1508515362 0 Physicians Anesthesia Services 20 1508515362 0 Physicians Healthy Kids Services 20 1508515362 0 Physicians Optical Supplies 20 1508515362 0 Physicians Physician Services 00 1508515693 0 LEE VICTORIA 2023027 9999999 B 10 1508515693 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1508515693 0 Physicians Anesthesia Services 20 1508515693 0 Physicians Healthy Kids Services 20 1508515693 0 Physicians Optical Supplies 20 1508515693 0 Physicians Physician Services 00 1508515792 0 EISCHEN EMILY M 2022196 9999999 B 10 1508515792 0 4698 DEPT CAROL STREAM IL 601220021 20 1508515792 0 Physicians Anesthesia Services 20 1508515792 0 Physicians Fluoride varnish 20 1508515792 0 Physicians Healthy Kids Services 20 1508515792 0 Physicians Optical Supplies 20 1508515792 0 Physicians Physician Services 00 1508516139 0 HERNANDEZ JAVIER 2022239 9999999 B 10 1508516139 0 124 SW ADAMS ST PEORIA IL 616021308 20 1508516139 0 Physicians Anesthesia Services 20 1508516139 0 Physicians Fluoride varnish 20 1508516139 0 Physicians Healthy Kids Services 20 1508516139 0 Physicians Optical Supplies 20 1508516139 0 Physicians Physician Services 00 1508516188 0 DEVEAUX HILLARY K 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DAYTON ST MCHENRY IL 600508377 20 1508517749 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1508518218 0 QUIRK KARLEY H 2023193 9999999 B 10 1508518218 0 5220 6TH STREET FRONTAGE RD E SPRINGFIELD IL 627035771 20 1508518218 0 Other behavior health professional Adaptive behavior support technician services 00 1508518317 0 LUPO ASHLEY E 2022081 9999999 B 10 1508518317 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1508518317 0 Nurse Practitioners Fluoride varnish 20 1508518317 0 Nurse Practitioners Healthy Kids Services 20 1508518317 0 Nurse Practitioners Nurse Practitioners Services 20 1508518317 0 Nurse Practitioners Physician Services 00 1508519281 0 ALSHAIR ALAA 2022145 9999999 B 10 1508519281 0 211 N BROADWAY GOREVILLE IL 629392323 20 1508519281 0 Dentists Dental Services 20 1508519281 0 Dentists Physician Services 00 1508520123 0 BIXBY LAURA 2023199 9999999 B 10 1508520123 0 260 26TH ST PRAIRIE DU SAC WI 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Practitioners Services 20 1508535063 0 Nurse Practitioners Physician Services 00 1508535352 0 WRIGHT AMANDA 2024117 9999999 B 10 1508535352 0 800 E LOCUST ST OLNEY IL 624502553 20 1508535352 0 Nurse Practitioners Healthy Kids Services 20 1508535352 0 Nurse Practitioners Nurse Practitioners Services 20 1508535352 0 Nurse Practitioners Physician Services 00 1508538091 0 BATES NATASHA A 2025022 9999999 B 10 1508538091 0 PO BOX 155 CHRISTOPHER IL 628220155 20 1508538091 0 Nurse Practitioners Healthy Kids Services 20 1508538091 0 Nurse Practitioners Nurse Practitioners Services 20 1508538091 0 Nurse Practitioners Physician Services 00 1508539289 0 OBEIDAT KHALDUN 2021231 9999999 B 10 1508539289 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1508539289 0 Physicians Anesthesia Services 20 1508539289 0 Physicians Fluoride varnish 20 1508539289 0 Physicians Healthy Kids Services 20 1508539289 0 Physicians Optical Supplies 20 1508539289 0 Physicians Physician Services 00 1508539768 0 FICHTEL AMY T 2021216 9999999 B 10 1508539768 0 5669 N NORTHWEST HWY CHICAGO IL 606466153 20 1508539768 0 Physical Therapists Medical Supplies 20 1508539768 0 Physical Therapists Medical equipment/prosthetic devices 20 1508539768 0 Physical Therapists Physical Therapy Services 00 1508539891 0 SHREDL BAILEY 2022049 9999999 B 10 1508539891 0 607 S NEW BALLAS RD STE 3300 SAINT LOUIS MO 631418219 20 1508539891 0 Nurse Practitioners Healthy Kids Services 20 1508539891 0 Nurse Practitioners Nurse Practitioners Services 20 1508539891 0 Nurse Practitioners Physician Services 00 1508541020 0 NICHOLSON MACKENZIE A 2023321 9999999 B 10 1508541020 0 414 PLAZA DR STE 301 WESTMONT IL 605595508 20 1508541020 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1508541426 0 LOUGHMAN BLAISE J 2023214 9999999 B 10 1508541426 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1508541426 0 Physicians Anesthesia Services 20 1508541426 0 Physicians Healthy Kids Services 20 1508541426 0 Physicians Optical Supplies 20 1508541426 0 Physicians Physician Services 00 1508542010 0 ADEAGBO AYOBAMI 2024151 9999999 B 10 1508542010 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1508542010 0 Physicians Anesthesia Services 20 1508542010 0 Physicians Healthy Kids Services 20 1508542010 0 Physicians Optical Supplies 20 1508542010 0 Physicians Physician Services 00 1508544206 0 GHERLE EMILY N 2023248 9999999 B 10 1508544206 0 PO BOX 22407 SAINT LOUIS MO 631260407 20 1508544206 0 Nurse Practitioners Fluoride varnish 20 1508544206 0 Nurse Practitioners Healthy Kids Services 20 1508544206 0 Nurse Practitioners Nurse Practitioners Services 20 1508544206 0 Nurse Practitioners Physician Services 00 1508544230 0 PORTER SHARINA 2023339 9999999 B 10 1508544230 0 6713 KINGERY HWY WILLOWBROOK IL 605275142 20 1508544230 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1508544420 0 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JOHNSTON ST STE 205 LAFAYETTE LA 705035334 20 1508549742 0 Nurse Practitioners Fluoride varnish 20 1508549742 0 Nurse Practitioners Healthy Kids Services 20 1508549742 0 Nurse Practitioners Nurse Practitioners Services 20 1508549742 0 Nurse Practitioners Physician Services 00 1508550559 0 SINN AUSTIN 2023188 9999999 B 10 1508550559 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1508550559 0 Physicians Anesthesia Services 20 1508550559 0 Physicians Healthy Kids Services 20 1508550559 0 Physicians Optical Supplies 20 1508550559 0 Physicians Physician Services 00 1508550716 0 KOLADE TEMPITOPE 2023186 9999999 B 10 1508550716 0 1900 W POLK ST STE 220C CHICAGO IL 60612 20 1508550716 0 Physicians Anesthesia Services 20 1508550716 0 Physicians Fluoride varnish 20 1508550716 0 Physicians Healthy Kids Services 20 1508550716 0 Physicians Optical Supplies 20 1508550716 0 Physicians Physician Services 00 1508550823 0 BLOCHWITZ JORDAN 2023285 9999999 B 10 1508550823 0 1560 CARLEMONT DR CRYSTAL LAKE IL 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1508817040 0 Physicians Optical Supplies 20 1508817040 0 Physicians Physician Services 00 1508817461 0 FROMMELT PETER 1991244 9999999 B 10 1508817461 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1508817461 0 Physicians Anesthesia Services 20 1508817461 0 Physicians Fluoride varnish 20 1508817461 0 Physicians Healthy Kids Services 20 1508817461 0 Physicians Optical Supplies 20 1508817461 0 Physicians Physician Services 00 1508817750 0 DUPONT MICHAEL 1993285 9999999 B 10 1508817750 0 5201 WILLOW SPRINGS RD STE 300 LA GRANGE HIGHL IL 605256539 20 1508817750 0 Physicians Anesthesia Services 20 1508817750 0 Physicians Fluoride varnish 20 1508817750 0 Physicians Healthy Kids Services 20 1508817750 0 Physicians Optical Supplies 20 1508817750 0 Physicians Physician Services 00 1508817941 0 BALABANOV ROUMEN 2005088 9999999 B 10 1508817941 0 5777 DEPT CAROL STREAM IL 601220021 20 1508817941 0 Physicians Anesthesia Services 20 1508817941 0 Physicians Healthy Kids Services 20 1508817941 0 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1508858226 0 Physicians Fluoride varnish 20 1508858226 0 Physicians Healthy Kids Services 20 1508858226 0 Physicians Optical Supplies 20 1508858226 0 Physicians Physician Services 00 1508858424 0 MAJID ABDUL 1998166 9999999 B 10 1508858424 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1508858424 0 Physicians Anesthesia Services 20 1508858424 0 Physicians Healthy Kids Services 20 1508858424 0 Physicians Optical Supplies 20 1508858424 0 Physicians Physician Services 00 1508858713 0 MORRISON SCOTT 2003213 9999999 B 10 1508858713 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1508858713 0 Physicians Anesthesia Services 20 1508858713 0 Physicians Fluoride varnish 20 1508858713 0 Physicians Healthy Kids Services 20 1508858713 0 Physicians Optical Supplies 20 1508858713 0 Physicians Physician Services 00 1508859059 0 MILLER STEVEN 2000249 9999999 B 10 1508859059 0 9933 LAWLER AVE STE 315 SKOKIE IL 600773706 20 1508859059 0 Podiatrists Podiatric Services 00 1508859265 0 ARBET TIMOTHY P 1984310 9999999 B 10 1508859265 0 2501 24TH ST ROCK ISLAND IL 612015300 20 1508859265 0 Optometrists Optical Supplies 20 1508859265 0 Optometrists Optometric Services 20 1508859265 0 Optometrists Physician Services 00 1508859521 0 ROSTAFINSKI THOMAS 2016245 9999999 B 10 1508859521 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1508859521 0 Psychologist Psychologist service 00 1508862368 0 ROSENBAUM ALLEN J 2017111 9999999 B 10 1508862368 0 3340 OAK PARK AVE STE 304 BERWYN IL 604023483 20 1508862368 0 Physicians Anesthesia Services 20 1508862368 0 Physicians Fluoride varnish 20 1508862368 0 Physicians Healthy Kids Services 20 1508862368 0 Physicians Optical Supplies 20 1508862368 0 Physicians Physician Services 00 1508863176 0 CHESSER ROBERT 1988183 9999999 B 10 1508863176 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1508863176 0 Physicians Anesthesia Services 20 1508863176 0 Physicians Healthy Kids Services 20 1508863176 0 Physicians Optical Supplies 20 1508863176 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1508866856 0 GINDER CHRISTINA 1999253 9999999 B 10 1508866856 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1508866856 0 Nurse Practitioners Anesthesia Services 20 1508866856 0 Nurse Practitioners Nurse Practitioners Services 20 1508866856 0 Nurse Practitioners Physician Services 00 1508866922 0 SALAMIN MAHER 2017001 9999999 B 10 1508866922 0 318 MAXWELL RD STE 500 ALPHARETTA GA 300092064 20 1508866922 0 Physicians Anesthesia Services 20 1508866922 0 Physicians Fluoride varnish 20 1508866922 0 Physicians Healthy Kids Services 20 1508866922 0 Physicians Optical Supplies 20 1508866922 0 Physicians Physician Services 00 1508867078 0 ILAHI SHAHID 1994244 9999999 B 10 1508867078 0 22285 N PEPPER RD STE 303 LAKE BARRINGTON IL 600102541 20 1508867078 0 Physicians Anesthesia Services 20 1508867078 0 Physicians Fluoride varnish 20 1508867078 0 Physicians Healthy Kids Services 20 1508867078 0 Physicians Optical Supplies 20 1508867078 0 Physicians Physician Services 00 1508867300 0 SYED SHAH 1999182 9999999 B 10 1508867300 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1508867300 0 Physicians Anesthesia Services 20 1508867300 0 Physicians Healthy Kids Services 20 1508867300 0 Physicians Optical Supplies 20 1508867300 0 Physicians Physician Services 20 1508867300 0 Physicians Physicians Psychiatric Services 00 1508867318 0 ROTHMAN RICHARD J 1991310 9999999 B 10 1508867318 0 2201 S BRENTWOOD BLVD SAINT LOUIS MO 631441815 20 1508867318 0 Physicians Anesthesia Services 20 1508867318 0 Physicians Healthy Kids Services 20 1508867318 0 Physicians Optical Supplies 20 1508867318 0 Physicians Physician Services 00 1508869744 0 RICHTER STASIA E 1988193 9999999 B 10 1508869744 0 PO BOX 775618 CHICAGO IL 606775618 20 1508869744 0 Physicians Anesthesia Services 20 1508869744 0 Physicians Fluoride varnish 20 1508869744 0 Physicians Healthy Kids Services 20 1508869744 0 Physicians Optical Supplies 20 1508869744 0 Physicians Physician Services 00 1508869793 0 DAVIDOFF ANDREW 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00 1508872755 0 CHARPIE JOHN 2003361 9999999 B 10 1508872755 0 PO BOX 223064 PITTSBURGH PA 152512064 20 1508872755 0 Physicians Anesthesia Services 20 1508872755 0 Physicians Fluoride varnish 20 1508872755 0 Physicians Healthy Kids Services 20 1508872755 0 Physicians Optical Supplies 20 1508872755 0 Physicians Physician Services 00 1508874744 0 BOENTE HULCHER LEAH 2003057 9999999 B 10 1508874744 0 2921 GREENBRIAR DR STE B2 SPRINGFIELD IL 627046440 20 1508874744 0 Physical Therapists Medical Supplies 20 1508874744 0 Physical Therapists Medical equipment/prosthetic devices 20 1508874744 0 Physical Therapists Physical Therapy Services 00 1508874827 0 SCOTT JONATHAN 1995121 9999999 B 10 1508874827 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1508874827 0 Psychologist Psychologist service 00 1508878364 0 GRIESS MICHAEL D 2015020 9999999 B 10 1508878364 0 28594 NETWORK PL CHICAGO IL 606731285 20 1508878364 0 Physicians Anesthesia Services 20 1508878364 0 Physicians Healthy Kids 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1508944778 0 Physicians Optical Supplies 20 1508944778 0 Physicians Physician Services 00 1508946864 0 KERTESZ NAOMI J 2016046 9999999 B 10 1508946864 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1508946864 0 Physicians Anesthesia Services 20 1508946864 0 Physicians Fluoride varnish 20 1508946864 0 Physicians Healthy Kids Services 20 1508946864 0 Physicians Optical Supplies 20 1508946864 0 Physicians Physician Services 00 1508947383 0 ADAJAR MARC 2006182 9999999 B 10 1508947383 0 1S376 SUMMIT AVE STE 4C OAKBROOK TERRAC IL 601813966 20 1508947383 0 Physicians Anesthesia Services 20 1508947383 0 Physicians Healthy Kids Services 20 1508947383 0 Physicians Optical Supplies 20 1508947383 0 Physicians Physician Services 00 1508948530 0 ROCHA SINGH KRISHNA 1993001 9999999 B 10 1508948530 0 1200 E TREMONT ST HILLSBORO IL 620491912 20 1508948530 0 Physicians Anesthesia Services 20 1508948530 0 Physicians Fluoride varnish 20 1508948530 0 Physicians Healthy Kids Services 20 1508948530 0 Physicians 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KHALIFA NOHA 2015135 9999999 B 10 1518350073 0 800 E NORTHWEST HWY STE 106 MOUNT PROSPECT IL 600563457 20 1518350073 0 Other behavior health professional LCPC/LMFT services 00 1518351188 0 SELLEY ASHLEY K 2018152 9999999 B 10 1518351188 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1518351188 0 Physicians Anesthesia Services 20 1518351188 0 Physicians Fluoride varnish 20 1518351188 0 Physicians Healthy Kids Services 20 1518351188 0 Physicians Optical Supplies 20 1518351188 0 Physicians Physician Services 00 1518351758 0 LEUNG VANIA 2017143 9999999 B 10 1518351758 0 2600 S MICHIGAN AVE STE 408 CHICAGO IL 606162696 20 1518351758 0 Physicians Anesthesia Services 20 1518351758 0 Physicians Fluoride varnish 20 1518351758 0 Physicians Healthy Kids Services 20 1518351758 0 Physicians Optical Supplies 20 1518351758 0 Physicians Physician Services 00 1518352012 0 MAUTER MARIE 2018002 9999999 B 10 1518352012 0 5816 S MULLIGAN AVE CHICAGO IL 606383431 20 1518352012 0 Clinical Social Worker Social work service 00 1518352152 0 HANSEN MICHAEL 2020190 9999999 B 10 1518352152 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1518352152 0 Physicians Anesthesia Services 20 1518352152 0 Physicians Healthy Kids Services 20 1518352152 0 Physicians Optical Supplies 20 1518352152 0 Physicians Physician Services 20 1518352152 0 Physicians Physicians Psychiatric Services 00 1518352400 0 TABOR AARON V 2018191 9999999 B 10 1518352400 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1518352400 0 Physicians Anesthesia Services 20 1518352400 0 Physicians Healthy Kids Services 20 1518352400 0 Physicians Optical Supplies 20 1518352400 0 Physicians Physician Services 00 1518352574 0 UDOKO MFONOBONG 2023182 9999999 B 10 1518352574 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1518352574 0 Physicians Anesthesia Services 20 1518352574 0 Physicians Fluoride varnish 20 1518352574 0 Physicians Healthy Kids Services 20 1518352574 0 Physicians Optical Supplies 20 1518352574 0 Physicians Physician Services 00 1518352772 0 LUEKING RYAN E 2016060 9999999 B 10 1518352772 0 PO BOX 60352 SAINT LOUIS MO 631600352 20 1518352772 0 Physician Assistant Only Fluoride varnish 20 1518352772 0 Physician Assistant Only Healthy Kids Services 20 1518352772 0 Physician Assistant Only Physician Services 00 1518354414 0 SEICEAN ANDREEA 2017165 9999999 B 10 1518354414 0 7825 SOLUTION CTR CHICAGO IL 606777007 20 1518354414 0 Physicians Anesthesia Services 20 1518354414 0 Physicians Healthy Kids Services 20 1518354414 0 Physicians Optical Supplies 20 1518354414 0 Physicians Physician Services 20 1518354414 0 Physicians Physicians Psychiatric Services 00 1518356294 0 KESTER KRISTEN 2020170 9999999 B 10 1518356294 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1518356294 0 Physicians Anesthesia Services 20 1518356294 0 Physicians Fluoride varnish 20 1518356294 0 Physicians Healthy Kids Services 20 1518356294 0 Physicians Optical Supplies 20 1518356294 0 Physicians Physician Services 00 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1518463330 0 5777 DEPT CAROL STREAM IL 601220021 20 1518463330 0 Physician Assistant Only Fluoride varnish 20 1518463330 0 Physician Assistant Only Healthy Kids Services 20 1518463330 0 Physician Assistant Only Physician Services 00 1518463447 0 MICHAEL ALEXANDER 2019274 9999999 B 10 1518463447 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1518463447 0 Physicians Anesthesia Services 20 1518463447 0 Physicians Healthy Kids Services 20 1518463447 0 Physicians Optical Supplies 20 1518463447 0 Physicians Physician Services 00 1518463504 0 HANEY KRISTEN A 2020027 9999999 B 10 1518463504 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1518463504 0 Physicians Anesthesia Services 20 1518463504 0 Physicians Fluoride varnish 20 1518463504 0 Physicians Healthy Kids Services 20 1518463504 0 Physicians Optical Supplies 20 1518463504 0 Physicians Physician Services 00 1518464155 0 BIRO MARK 2024247 9999999 B 10 1518464155 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1518464155 0 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3619 RICHARDSON SQUARE DR STE ARNOLD MO 630106021 20 1518465707 0 Nurse Practitioners Healthy Kids Services 20 1518465707 0 Nurse Practitioners Nurse Practitioners Services 20 1518465707 0 Nurse Practitioners Physician Services 00 1518466077 0 SHAW ANGELA M 2018182 9999999 B 10 1518466077 0 901 MCCLINTOCK DR STE 202 SUITE 202 BURR RIDGE IL 605270872 20 1518466077 0 Physician Assistant Only Fluoride varnish 20 1518466077 0 Physician Assistant Only Healthy Kids Services 20 1518466077 0 Physician Assistant Only Physician Services 00 1518466408 0 VANDEN HOEK BETH A 2018091 9999999 B 10 1518466408 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1518466408 0 Nurse Practitioners Healthy Kids Services 20 1518466408 0 Nurse Practitioners Nurse Practitioners Services 20 1518466408 0 Nurse Practitioners Physician Services 00 1518466895 0 TURNER ABBEY G 2020245 9999999 B 10 1518466895 0 15127 S 73RD AVE STE C ORLAND PARK IL 604623463 20 1518466895 0 Other behavior health professional Other 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Speech Therapists Speech Therapy/Pathology Services 00 1518472463 0 HARTY REBECCA L 2018033 9999999 B 10 1518472463 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1518472463 0 Nurse Practitioners Fluoride varnish 20 1518472463 0 Nurse Practitioners Healthy Kids Services 20 1518472463 0 Nurse Practitioners Nurse Practitioners Services 20 1518472463 0 Nurse Practitioners Physician Services 00 1518473883 0 JANSEN ALLYSON 2017356 9999999 B 10 1518473883 0 1201 5TH AVE BELVIDERE IL 610085125 20 1518473883 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1518474709 0 LABELLA RENEE 2018008 9999999 B 10 1518474709 0 501 7TH ST ROCKFORD IL 611041242 20 1518474709 0 Speech Therapists Medical Supplies 20 1518474709 0 Speech Therapists Medical equipment/prosthetic devices 20 1518474709 0 Speech Therapists Speech Therapy/Pathology Services 00 1518475615 0 MUSSER KYLA L 2019266 9999999 B 10 1518475615 0 800 BIESTERFIELD RD STE G01 ELK GROVE VILLA IL 600073372 20 1518475615 0 Nurse Practitioners Healthy Kids Services 20 1518475615 0 Nurse Practitioners Nurse Practitioners Services 20 1518475615 0 Nurse Practitioners Physician Services 00 1518475904 0 SONG ESTHER 2023011 9999999 B 10 1518475904 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1518475904 0 Nurse Practitioners Healthy Kids Services 20 1518475904 0 Nurse Practitioners Nurse Practitioners Services 20 1518475904 0 Nurse Practitioners Physician Services 00 1518476191 0 MEWES SHERRY L 2018361 9999999 B 10 1518476191 0 213 NW 10TH ST STE A FAIRFIELD IL 628371219 20 1518476191 0 Nurse Practitioners Fluoride varnish 20 1518476191 0 Nurse Practitioners Healthy Kids Services 20 1518476191 0 Nurse Practitioners Nurse Practitioners Services 20 1518476191 0 Nurse Practitioners Physician Services 00 1518476688 0 WILLIS-JACKSON INDIA 2017254 9999999 B 10 1518476688 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1518476688 0 Nurse Practitioners Fluoride varnish 20 1518476688 0 Nurse Practitioners Healthy Kids Services 20 1518476688 0 Nurse Practitioners Nurse Practitioners Services 20 1518476688 0 Nurse Practitioners Physician Services 00 1518476936 0 KAWALEK LAUREN 2017338 9999999 B 10 1518476936 0 PO BOX 3990 NAPERVILLE IL 605673990 20 1518476936 0 Speech Therapists Medical Supplies 20 1518476936 0 Speech Therapists Medical equipment/prosthetic devices 20 1518476936 0 Speech Therapists Speech Therapy/Pathology Services 00 1518476969 0 KONING ABIGAIL LEE 2018240 9999999 B 10 1518476969 0 411 CHICAGO AVE OAK PARK IL 603022233 20 1518476969 0 Occupational Therapists Medical Supplies 20 1518476969 0 Occupational Therapists Medical equipment/prosthetic devices 20 1518476969 0 Occupational Therapists Occupational Therapy Services 00 1518477363 0 LARGE MALLORY 2018068 9999999 B 10 1518477363 0 11053 S MILLARD AVE CHICAGO IL 606553327 20 1518477363 0 Speech Therapists Medical Supplies 20 1518477363 0 Speech Therapists Medical equipment/prosthetic devices 20 1518477363 0 Speech Therapists Speech Therapy/Pathology Services 00 1518478577 0 GOMEZ GRISELDA M 2017310 9999999 B 10 1518478577 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1518478577 0 Speech Therapists Medical Supplies 20 1518478577 0 Speech Therapists Medical equipment/prosthetic devices 20 1518478577 0 Speech Therapists Speech Therapy/Pathology Services 00 1518478635 0 SAJUAN STEPHANIE N 2020029 9999999 B 10 1518478635 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1518478635 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1518480599 0 MEHTA NISHIT K 2017212 9999999 B 10 1518480599 0 1260 MILTON AVE STE 140 JANESVILLE WI 535451890 20 1518480599 0 Dentists Dental Services 20 1518480599 0 Dentists Physician Services 00 1518481654 0 MUJER MARK 2021204 9999999 B 10 1518481654 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1518481654 0 Physicians Anesthesia Services 20 1518481654 0 Physicians Fluoride varnish 20 1518481654 0 Physicians Healthy Kids Services 20 1518481654 0 Physicians Optical Supplies 20 1518481654 0 Physicians Physician Services 00 1518481845 0 PATEL POOJA 2024096 9999999 B 10 1518481845 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1518481845 0 Nurse Practitioners Fluoride varnish 20 1518481845 0 Nurse Practitioners Healthy Kids Services 20 1518481845 0 Nurse Practitioners Nurse Practitioners Services 20 1518481845 0 Nurse Practitioners Physician Services 00 1518482074 0 ANTHONY AMY 2017237 9999999 B 10 1518482074 0 7101 N CICERO AVE STE 202 LINCOLNWOOD IL 607122143 20 1518482074 0 Clinical Social Worker Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1518482074 0 Clinical Social Worker Social work service 00 1518482298 0 MUDD MOLLY L 2020288 9999999 B 10 1518482298 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1518482298 0 Nurse Practitioners Fluoride varnish 20 1518482298 0 Nurse Practitioners Healthy Kids Services 20 1518482298 0 Nurse Practitioners Nurse Practitioners Services 20 1518482298 0 Nurse Practitioners Physician Services 00 1518482983 0 BARNES ALICIA 2018360 9999999 B 10 1518482983 0 PO BOX 1790 BROOKFIELD WI 530081790 20 1518482983 0 Nurse Practitioners Fluoride varnish 20 1518482983 0 Nurse Practitioners Healthy Kids Services 20 1518482983 0 Nurse Practitioners Nurse Practitioners Services 20 1518482983 0 Nurse Practitioners Physician Services 00 1518483114 0 MONCADA WENDY P 2019122 9999999 H 10 1518483114 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1518483114 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1518484716 0 MILLER DANA L 2017297 9999999 B 10 1518484716 0 611 W PARK ST URBANA IL 618012529 20 1518484716 0 Nurse Practitioners Fluoride varnish 20 1518484716 0 Nurse Practitioners Healthy Kids Services 20 1518484716 0 Nurse Practitioners Nurse Practitioners Services 20 1518484716 0 Nurse Practitioners Physician Services 00 1518484971 0 WILSON ALEXANDRIA 2022283 9999999 B 10 1518484971 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1518484971 0 Physical Therapists Medical Supplies 20 1518484971 0 Physical Therapists Medical equipment/prosthetic devices 20 1518484971 0 Physical Therapists Physical Therapy Services 00 1518485432 0 LUNIEWICZ MADELINE 2017233 9999999 B 10 1518485432 0 325 IL ROUTE 2 DIXON IL 610219118 20 1518485432 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1518485580 0 MEEKER KELSI N 2021028 9999999 B 10 1518485580 0 300 CEDAR ST PEKIN IL 615547009 20 1518485580 0 Speech Therapists Medical Supplies 20 1518485580 0 Speech Therapists Medical equipment/prosthetic devices 20 1518485580 0 Speech Therapists Speech Therapy/Pathology Services 00 1518485879 0 OSTERMAN CHRISTINE 2017250 9999999 B 10 1518485879 0 2900 OGDEN AVE LISLE IL 605321631 20 1518485879 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1518485978 0 SANDERS AMY 2017249 9999999 B 10 1518485978 0 4812 PFEIFFER RD BARTONVILLE IL 616072647 20 1518485978 0 Speech Therapists Medical Supplies 20 1518485978 0 Speech Therapists Medical equipment/prosthetic devices 20 1518485978 0 Speech Therapists Speech Therapy/Pathology Services 00 1518486067 0 HOOVER LAURA D 2017277 9999999 B 10 1518486067 0 1619 11TH AVE MOLINE IL 612653143 20 1518486067 0 Speech Therapists Medical Supplies 20 1518486067 0 Speech Therapists Medical equipment/prosthetic devices 20 1518486067 0 Speech Therapists Speech Therapy/Pathology Services 00 1518486398 0 MORRIS JORDYN R 2018031 9999999 B 10 1518486398 0 4060 MCFARLAND RD LOVES PARK IL 611114402 20 1518486398 0 Speech Therapists Medical Supplies 20 1518486398 0 Speech Therapists Medical equipment/prosthetic devices 20 1518486398 0 Speech Therapists Speech Therapy/Pathology Services 00 1518487503 0 DUCKWORTH LAURA A 2018351 9999999 B 10 1518487503 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1518487503 0 Physicians Anesthesia Services 20 1518487503 0 Physicians Fluoride varnish 20 1518487503 0 Physicians Healthy Kids Services 20 1518487503 0 Physicians Optical Supplies 20 1518487503 0 Physicians Physician Services 00 1518487925 0 STEELE GABRIELLE L 2017274 9999999 B 10 1518487925 0 PO BOX 638704 CINCINNATI OH 452638704 20 1518487925 0 Physician Assistant Only Fluoride varnish 20 1518487925 0 Physician Assistant Only Healthy Kids Services 20 1518487925 0 Physician Assistant Only Physician Services 00 1518488931 0 LOYA AMBER 2024012 9999999 B 10 1518488931 0 213 NW 10TH ST STE A FAIRFIELD IL 628371219 20 1518488931 0 Nurse Practitioners Fluoride varnish 20 1518488931 0 Nurse Practitioners Healthy Kids Services 20 1518488931 0 Nurse Practitioners Nurse Practitioners Services 20 1518488931 0 Nurse Practitioners Physician Services 00 1518489590 0 VEGTER NATHAN 2018288 9999999 H 10 1518489590 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1518489590 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1518489889 0 ASAMOAH DENNIS 2018072 9999999 B 10 1518489889 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1518489889 0 Physicians Anesthesia Services 20 1518489889 0 Physicians Healthy Kids Services 20 1518489889 0 Physicians Optical Supplies 20 1518489889 0 Physicians Physician Services 00 1518489897 0 VALERO HERNANDEZ FREDY DAVID 2020057 9999999 B 10 1518489897 0 800 E 55TH ST CHICAGO IL 606154906 20 1518489897 0 Physicians Anesthesia Services 20 1518489897 0 Physicians Fluoride varnish 20 1518489897 0 Physicians Healthy Kids Services 20 1518489897 0 Physicians Optical Supplies 20 1518489897 0 Physicians Physician Services 00 1518490135 0 VELASQUEZ CHRISTOPHER W 2023335 9999999 B 10 1518490135 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1518490135 0 Physicians Anesthesia Services 20 1518490135 0 Physicians 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1518493105 0 11516 N PORT WASHINGTON RD STE MEQUON WI 530923441 20 1518493105 0 Physicians Anesthesia Services 20 1518493105 0 Physicians Healthy Kids Services 20 1518493105 0 Physicians Optical Supplies 20 1518493105 0 Physicians Physician Services 00 1518493527 0 IRVING CAYLEE 2020220 9999999 B 10 1518493527 0 21600 OXNARD ST STE 1800 WOODLAND HILLS CA 913677807 20 1518493527 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1518493782 0 FILIP PETER 2022188 9999999 B 10 1518493782 0 PO BOX 3988 CARBONDALE IL 629023988 20 1518493782 0 Physicians Anesthesia Services 20 1518493782 0 Physicians Healthy Kids Services 20 1518493782 0 Physicians Optical Supplies 20 1518493782 0 Physicians Physician Services 00 1518493840 0 MULLINS SEAN C 2022067 9999999 B 10 1518493840 0 5121 MARYLAND WAY STE 300 BRENTWOOD TN 370277516 20 1518493840 0 Physicians Anesthesia Services 20 1518493840 0 Physicians Fluoride varnish 20 1518493840 0 Physicians Healthy Kids Services 20 1518493840 0 Physicians Optical Supplies 20 1518493840 0 Physicians Physician Services 00 1518494467 0 VAN ETTEN MATTHEW BERNARD 2017091 9999999 B 10 1518494467 0 1301 W DEVON AVE CHICAGO IL 606601329 20 1518494467 0 Other behavior health professional LCPC/LMFT services 00 1518494640 0 ARON HANNAH 2020183 9999999 B 10 1518494640 0 2858 W DIVERSEY AVE CHICAGO IL 606471871 20 1518494640 0 Other behavior health professional LCPC/LMFT services 00 1518494731 0 KNIPPENBERG PAIGE A 2021327 9999999 B 10 1518494731 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1518494731 0 Physician Assistant Only Fluoride varnish 20 1518494731 0 Physician Assistant Only Healthy Kids Services 20 1518494731 0 Physician Assistant Only Physician Services 00 1518494764 0 HASAN SUHAIR 2017150 9999999 B 10 1518494764 0 5917 S PULASKI RD CHICAGO IL 606294515 20 1518494764 0 Dentists Dental Services 20 1518494764 0 Dentists Physician Services 00 1518495092 0 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1518498625 0 Physicians Anesthesia Services 20 1518498625 0 Physicians Healthy Kids Services 20 1518498625 0 Physicians Optical Supplies 20 1518498625 0 Physicians Physician Services 00 1518498971 0 GOODWIN RAYMOND J 2017117 9999999 B 10 1518498971 0 5777 DEPT CAROL STREAM IL 601228942 20 1518498971 0 Nurse Practitioners Fluoride varnish 20 1518498971 0 Nurse Practitioners Healthy Kids Services 20 1518498971 0 Nurse Practitioners Nurse Practitioners Services 20 1518498971 0 Nurse Practitioners Physician Services 00 1518499409 0 MANDELL MATTHEW J 2020030 9999999 B 10 1518499409 0 5777 DEPT CAROL STREAM IL 601220021 20 1518499409 0 Physicians Anesthesia Services 20 1518499409 0 Physicians Fluoride varnish 20 1518499409 0 Physicians Healthy Kids Services 20 1518499409 0 Physicians Optical Supplies 20 1518499409 0 Physicians Physician Services 00 1518499557 0 WENDEL MICHAEL 2024185 9999999 B 10 1518499557 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1518499557 0 Physicians 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W HARRISON ST CHICAGO IL 606123714 20 1518532399 0 Physicians Anesthesia Services 20 1518532399 0 Physicians Fluoride varnish 20 1518532399 0 Physicians Healthy Kids Services 20 1518532399 0 Physicians Optical Supplies 20 1518532399 0 Physicians Physician Services 00 1518532605 0 AYUB TOOBA 2021222 9999999 B 10 1518532605 0 3249 OAK PARK AVE BERWYN IL 604023429 20 1518532605 0 Physicians Anesthesia Services 20 1518532605 0 Physicians Fluoride varnish 20 1518532605 0 Physicians Healthy Kids Services 20 1518532605 0 Physicians Optical Supplies 20 1518532605 0 Physicians Physician Services 00 1518532977 0 MIX KELSEY 2023045 9999999 B 10 1518532977 0 2140 LAKE COOK RD ALGONQUIN IL 601025447 20 1518532977 0 Physical Therapists Medical Supplies 20 1518532977 0 Physical Therapists Medical equipment/prosthetic devices 20 1518532977 0 Physical Therapists Physical Therapy Services 00 1518533439 0 KHAZANEWALA IKROOP 2024257 9999999 B 10 1518533439 0 28W671 GARYS MILL RD WINFIELD IL 601901564 20 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GLENVIEW IL 600250049 20 1518651462 0 Dentists Dental Services 20 1518651462 0 Dentists Physician Services 00 1518651827 0 MESQUITA VERA B 2023159 9999999 B 10 1518651827 0 70 S RIVER ST AURORA IL 605065185 20 1518651827 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1518651983 0 IBARRA JOSHUA 2023188 9999999 B 10 1518651983 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1518651983 0 Physicians Anesthesia Services 20 1518651983 0 Physicians Fluoride varnish 20 1518651983 0 Physicians Healthy Kids Services 20 1518651983 0 Physicians Optical Supplies 20 1518651983 0 Physicians Physician Services 00 1518653674 0 WIRKUS BRITTANY M 2023195 9999999 B 10 1518653674 0 4400 W 95TH ST STE 308 OAK LAWN IL 604532660 20 1518653674 0 Nurse Practitioners Healthy Kids Services 20 1518653674 0 Nurse Practitioners Nurse Practitioners Services 20 1518653674 0 Nurse Practitioners Physician Services 00 1518655018 0 MARCUCCI MICHAEL 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MARCELLA V 2023215 9999999 B 10 1518655737 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1518655737 0 Physicians Anesthesia Services 20 1518655737 0 Physicians Fluoride varnish 20 1518655737 0 Physicians Healthy Kids Services 20 1518655737 0 Physicians Optical Supplies 20 1518655737 0 Physicians Physician Services 00 1518656024 0 THEURER NATALIE M 2023187 9999999 B 10 1518656024 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1518656024 0 Occupational Therapists Medical Supplies 20 1518656024 0 Occupational Therapists Medical equipment/prosthetic devices 20 1518656024 0 Occupational Therapists Occupational Therapy Services 00 1518657170 0 URBAN MELISSA M 2023129 9999999 B 10 1518657170 0 PO BOX 1541 NORTHBROOK IL 600651541 20 1518657170 0 Nurse Practitioners Healthy Kids Services 20 1518657170 0 Nurse Practitioners Nurse Practitioners Services 20 1518657170 0 Nurse Practitioners Physician Services 00 1518658277 0 WEBB-HARPER KIMBERLY RENEE 2023324 9999999 B 10 1518658277 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1518658277 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1518660166 0 WOOTEN STEPHANIE 2023200 9999999 B 10 1518660166 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1518660166 0 Physicians Anesthesia Services 20 1518660166 0 Physicians Fluoride varnish 20 1518660166 0 Physicians Healthy Kids Services 20 1518660166 0 Physicians Optical Supplies 20 1518660166 0 Physicians Physician Services 00 1518661172 0 IMMEN DAVID M 2023150 9999999 B 10 1518661172 0 4698 DEPT CAROL STREAM IL 601220021 20 1518661172 0 Physicians Anesthesia Services 20 1518661172 0 Physicians Healthy Kids Services 20 1518661172 0 Physicians Optical Supplies 20 1518661172 0 Physicians Physician Services 00 1518661313 0 PERERA AVNI 2024130 9999999 B 10 1518661313 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1518661313 0 Physicians Anesthesia Services 20 1518661313 0 Physicians Healthy Kids Services 20 1518661313 0 Physicians Optical Supplies 20 1518661313 0 Physicians Physician Services 00 1518661586 0 ZHANG JESSICA 2023170 9999999 B 10 1518661586 0 4698 DEPT CAROL STREAM IL 601220021 20 1518661586 0 Physicians Anesthesia Services 20 1518661586 0 Physicians Fluoride varnish 20 1518661586 0 Physicians Healthy Kids Services 20 1518661586 0 Physicians Optical Supplies 20 1518661586 0 Physicians Physician Services 00 1518661826 0 RAND DAYTON 2024200 9999999 B 10 1518661826 0 4698 DEPT CAROL STREAM IL 601220021 20 1518661826 0 Physicians Anesthesia Services 20 1518661826 0 Physicians Healthy Kids Services 20 1518661826 0 Physicians Optical Supplies 20 1518661826 0 Physicians Physician Services 00 1518661909 0 YATES AMANDA J 2023088 9999999 B 10 1518661909 0 1200 W STATE ST ROCKFORD IL 611022112 20 1518661909 0 Nurse Practitioners Fluoride varnish 20 1518661909 0 Nurse Practitioners Healthy Kids Services 20 1518661909 0 Nurse Practitioners Nurse Practitioners Services 20 1518661909 0 Nurse Practitioners Physician Services 00 1518662063 0 PARVEZ SIDRAH 2023191 9999999 B 10 1518662063 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1518662063 0 Physicians Anesthesia Services 20 1518662063 0 Physicians Fluoride varnish 20 1518662063 0 Physicians Healthy Kids Services 20 1518662063 0 Physicians Optical Supplies 20 1518662063 0 Physicians Physician Services 00 1518662709 0 CHATRATH SHEENA 2024183 9999999 B 10 1518662709 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1518662709 0 Physicians Anesthesia Services 20 1518662709 0 Physicians Healthy Kids Services 20 1518662709 0 Physicians Optical Supplies 20 1518662709 0 Physicians Physician Services 00 1518663459 0 SIERRA ADY M 2023033 9999999 B 10 1518663459 0 42 W MADISON ST FL 2 CHICAGO IL 606024309 20 1518663459 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1518664176 0 ABERBOOK JEANINE 2023118 9999999 B 10 1518664176 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO 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1518666379 0 Physicians Healthy Kids Services 20 1518666379 0 Physicians Optical Supplies 20 1518666379 0 Physicians Physician Services 00 1518666452 0 NG AMANDA 2023062 9999999 B 10 1518666452 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1518666452 0 Physical Therapists Medical Supplies 20 1518666452 0 Physical Therapists Medical equipment/prosthetic devices 20 1518666452 0 Physical Therapists Physical Therapy Services 00 1518667195 0 GONZALEZ MELISSA M 2023109 9999999 B 10 1518667195 0 PO BOX 772 MC2295 WOONSOCKET RI 028950784 20 1518667195 0 Nurse Practitioners Fluoride varnish 20 1518667195 0 Nurse Practitioners Healthy Kids Services 20 1518667195 0 Nurse Practitioners Nurse Practitioners Services 20 1518667195 0 Nurse Practitioners Physician Services 00 1518668037 0 HUSSAIN KUMAIL 2024183 9999999 B 10 1518668037 0 2020 OGDEN AVE STE 360 SUITE 360 AURORA IL 605046486 20 1518668037 0 Physicians Anesthesia Services 20 1518668037 0 Physicians Fluoride varnish 20 1518668037 0 Physicians Healthy Kids Services 20 1518668037 0 Physicians Optical Supplies 20 1518668037 0 Physicians Physician Services 00 1518668524 0 DIULUS SAMANTHA 2024240 9999999 B 10 1518668524 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1518668524 0 Physicians Anesthesia Services 20 1518668524 0 Physicians Healthy Kids Services 20 1518668524 0 Physicians Optical Supplies 20 1518668524 0 Physicians Physician Services 00 1518669001 0 SPIHLMAN ALLISON 2023145 9999999 B 10 1518669001 0 4698 DEPT CAROL STREAM IL 601220021 20 1518669001 0 Physicians Anesthesia Services 20 1518669001 0 Physicians Fluoride varnish 20 1518669001 0 Physicians Healthy Kids Services 20 1518669001 0 Physicians Optical Supplies 20 1518669001 0 Physicians Physician Services 00 1518669886 0 PATEL VEDANG 2023202 9999999 B 10 1518669886 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1518669886 0 Physicians Anesthesia Services 20 1518669886 0 Physicians Fluoride varnish 20 1518669886 0 Physicians Healthy Kids Services 20 1518669886 0 Physicians Optical Supplies 20 1518669886 0 Physicians Physician Services 00 1518670496 0 PEREZ SHELBY 2023023 9999999 B 10 1518670496 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1518670496 0 Nurse Practitioners Healthy Kids Services 20 1518670496 0 Nurse Practitioners Nurse Practitioners Services 20 1518670496 0 Nurse Practitioners Physician Services 00 1518672245 0 SMITH ALEXANDRA M 2023100 9999999 B 10 1518672245 0 2100 POWELL ST STE 400 EMERYVILLE CA 946081826 20 1518672245 0 Physician Assistant Only Fluoride varnish 20 1518672245 0 Physician Assistant Only Healthy Kids Services 20 1518672245 0 Physician Assistant Only Physician Services 00 1518676071 0 IMAM SYEDA 2022354 9999999 B 10 1518676071 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1518676071 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1518676360 0 PATEL DARSHNA 2022327 9999999 B 10 1518676360 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1518676360 0 Nurse Practitioners Fluoride varnish 20 1518676360 0 Nurse Practitioners Healthy Kids Services 20 1518676360 0 Nurse Practitioners Nurse Practitioners Services 20 1518676360 0 Nurse Practitioners Physician Services 00 1518676816 0 MOESNER JUSTINE M 2023060 9999999 B 10 1518676816 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1518676816 0 Nurse Practitioners Fluoride varnish 20 1518676816 0 Nurse Practitioners Healthy Kids Services 20 1518676816 0 Nurse Practitioners Nurse Practitioners Services 20 1518676816 0 Nurse Practitioners Physician Services 00 1518678382 0 NEKY SARAH 2024022 9999999 B 10 1518678382 0 PO BOX 781076 DETROIT MI 482781076 20 1518678382 0 Physician Assistant Only Fluoride varnish 20 1518678382 0 Physician Assistant Only Healthy Kids Services 20 1518678382 0 Physician Assistant Only Physician Services 00 1518679125 0 MILLER SCOTT E 2023110 9999999 B 10 1518679125 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1518679125 0 Nurse Practitioners Healthy Kids Services 20 1518679125 0 Nurse Practitioners Nurse Practitioners Services 20 1518679125 0 Nurse Practitioners Physician Services 00 1518679976 0 JANSEN KELSIE 2023111 9999999 B 10 1518679976 0 1701 LACEY ST CAPE GIRARDEAU MO 637015230 20 1518679976 0 Nurse Practitioners Fluoride varnish 20 1518679976 0 Nurse Practitioners Healthy Kids Services 20 1518679976 0 Nurse Practitioners Nurse Practitioners Services 20 1518679976 0 Nurse Practitioners Physician Services 00 1518681824 0 MANES SCOTTI 2022291 9999999 B 10 1518681824 0 621 S NEW BALLAS RD STE 537A SAINT LOUIS MO 631418261 20 1518681824 0 Nurse Practitioners Fluoride varnish 20 1518681824 0 Nurse Practitioners Healthy Kids Services 20 1518681824 0 Nurse Practitioners Nurse Practitioners Services 20 1518681824 0 Nurse Practitioners Physician Services 00 1518683143 0 LIGGETT ALANA R 2022318 9999999 B 10 1518683143 0 122 S MICHIGAN AVE STE 1441 CHICAGO IL 606036173 20 1518683143 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1518684489 0 BIGOS ISABELLA 2024221 9999999 B 10 1518684489 0 1343 E 7TH ST LOCKPORT IL 604413823 20 1518684489 0 Speech Therapists Medical Supplies 20 1518684489 0 Speech Therapists Medical equipment/prosthetic devices 20 1518684489 0 Speech Therapists Speech Therapy/Pathology Services 00 1518684711 0 WEILBRENNER ELLIE 2022337 9999999 B 10 1518684711 0 1701 LACEY ST CAPE GIRARDEAU MO 637015230 20 1518684711 0 Nurse Practitioners Fluoride varnish 20 1518684711 0 Nurse Practitioners Healthy Kids Services 20 1518684711 0 Nurse Practitioners Nurse Practitioners Services 20 1518684711 0 Nurse Practitioners Physician Services 00 1518686047 0 MACCRACKEN JOY 2024236 9999999 B 10 1518686047 0 PO BOX 548 INDIANAPOLIS IN 462060548 20 1518686047 0 Nurse Practitioners Anesthesia Services 20 1518686047 0 Nurse Practitioners Nurse Practitioners Services 20 1518686047 0 Nurse Practitioners Physician Services 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1518697093 0 PO BOX 634483 CINCINNATI OH 452634483 20 1518697093 0 Nurse Practitioners Anesthesia Services 20 1518697093 0 Nurse Practitioners Nurse Practitioners Services 20 1518697093 0 Nurse Practitioners Physician Services 00 1518697101 0 RABIN SYDNEY E 2022206 9999999 B 10 1518697101 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1518697101 0 Physicians Anesthesia Services 20 1518697101 0 Physicians Fluoride varnish 20 1518697101 0 Physicians Healthy Kids Services 20 1518697101 0 Physicians Optical Supplies 20 1518697101 0 Physicians Physician Services 00 1518697606 0 ADAMS MADISON M 2024354 9999999 B 10 1518697606 0 625 MASSACHUSETTS AVE FL 2 CAMBRIDGE MA 021393357 20 1518697606 0 Clinical Social Worker Social work service 00 1518698893 0 PROSKURIAKOVA EKATERINA 2022189 9999999 B 10 1518698893 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1518698893 0 Physicians Anesthesia Services 20 1518698893 0 Physicians Fluoride varnish 20 1518698893 0 Physicians Healthy 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Physicians Anesthesia Services 20 1518701812 0 Physicians Fluoride varnish 20 1518701812 0 Physicians Healthy Kids Services 20 1518701812 0 Physicians Optical Supplies 20 1518701812 0 Physicians Physician Services 00 1518702521 0 NWABUEZE CHERECHI O 2024192 9999999 B 10 1518702521 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1518702521 0 Physicians Anesthesia Services 20 1518702521 0 Physicians Fluoride varnish 20 1518702521 0 Physicians Healthy Kids Services 20 1518702521 0 Physicians Optical Supplies 20 1518702521 0 Physicians Physician Services 00 1518705862 0 VASQUEZ PORTILLO CLAUDIA 2024212 9999999 B 10 1518705862 0 2211 N ELSTON AVE STE 301 CHICAGO IL 606149278 20 1518705862 0 Physicians Anesthesia Services 20 1518705862 0 Physicians Fluoride varnish 20 1518705862 0 Physicians Healthy Kids Services 20 1518705862 0 Physicians Optical Supplies 20 1518705862 0 Physicians Physician Services 00 1518708783 0 ALBANO MARWEN FAYE Y 2024232 9999999 B 10 1518708783 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1518708783 0 Physicians Anesthesia Services 20 1518708783 0 Physicians Fluoride varnish 20 1518708783 0 Physicians Healthy Kids Services 20 1518708783 0 Physicians Optical Supplies 20 1518708783 0 Physicians Physician Services 00 1518709450 0 STERN KELLY C 2024165 9999999 B 10 1518709450 0 PO BOX 5081 JANESVILLE WI 535475081 20 1518709450 0 Physical Therapists Medical Supplies 20 1518709450 0 Physical Therapists Medical equipment/prosthetic devices 20 1518709450 0 Physical Therapists Physical Therapy Services 00 1518709526 0 CHU KATHERINE A 2024261 9999999 B 10 1518709526 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1518709526 0 Physical Therapists Medical Supplies 20 1518709526 0 Physical Therapists Medical equipment/prosthetic devices 20 1518709526 0 Physical Therapists Physical Therapy Services 00 1518709732 0 LOZANO JAMILA 2024172 9999999 B 10 1518709732 0 PO BOX 775342 CHICAGO IL 606775342 20 1518709732 0 Nurse Practitioners Healthy Kids Services 20 1518709732 0 Nurse Practitioners Nurse Practitioners Services 20 1518709732 0 Nurse Practitioners Physician Services 00 1518710359 0 CASSIMATIS ANDREA 2024142 9999999 B 10 1518710359 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1518710359 0 Nurse Practitioners Fluoride varnish 20 1518710359 0 Nurse Practitioners Healthy Kids Services 20 1518710359 0 Nurse Practitioners Nurse Practitioners Services 20 1518710359 0 Nurse Practitioners Physician Services 00 1518710433 0 SMITH RYAN 2024194 9999999 B 10 1518710433 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1518710433 0 Physicians Anesthesia Services 20 1518710433 0 Physicians Healthy Kids Services 20 1518710433 0 Physicians Optical Supplies 20 1518710433 0 Physicians Physician Services 00 1518710722 0 GORDON SHANNON 2024182 9999999 B 10 1518710722 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1518710722 0 Physicians Anesthesia Services 20 1518710722 0 Physicians Fluoride varnish 20 1518710722 0 Physicians Healthy 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RIDGE AVE # 1223 EVANSTON IL 602011700 20 1518725993 0 Physician Assistant Only Fluoride varnish 20 1518725993 0 Physician Assistant Only Healthy Kids Services 20 1518725993 0 Physician Assistant Only Physician Services 00 1518726082 0 GARCIA EMMANUEL JOSHUA MAGCALA 2024176 9999999 B 10 1518726082 0 4698 DEPT CAROL STREAM IL 601220021 20 1518726082 0 Physicians Anesthesia Services 20 1518726082 0 Physicians Healthy Kids Services 20 1518726082 0 Physicians Optical Supplies 20 1518726082 0 Physicians Physician Services 00 1518726801 0 ALATTAR SARA 2024183 9999999 B 10 1518726801 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1518726801 0 Physicians Anesthesia Services 20 1518726801 0 Physicians Healthy Kids Services 20 1518726801 0 Physicians Optical Supplies 20 1518726801 0 Physicians Physician Services 20 1518726801 0 Physicians Physicians Psychiatric Services 00 1518727593 0 TOOR MANVINDER 2024184 9999999 B 10 1518727593 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1518727593 0 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Healthy Kids Services 20 1518773076 0 Nurse Practitioners Nurse Practitioners Services 20 1518773076 0 Nurse Practitioners Physician Services 00 1518775691 0 RILEY ELIZABETH O 2025051 9999999 B 10 1518775691 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1518775691 0 Nurse Practitioners Healthy Kids Services 20 1518775691 0 Nurse Practitioners Nurse Practitioners Services 20 1518775691 0 Nurse Practitioners Physician Services 00 1518777820 0 HARPOLE ALICIA 2025027 9999999 B 10 1518777820 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1518777820 0 Speech Therapists Medical Supplies 20 1518777820 0 Speech Therapists Medical equipment/prosthetic devices 20 1518777820 0 Speech Therapists Speech Therapy/Pathology Services 00 1518780204 0 BUTLER BEUNKA 2025047 9999999 B 10 1518780204 0 613 E 50TH ST APT 2C CHICAGO IL 606152597 20 1518780204 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1518781046 0 OCON MELISSA 2024319 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Practitioners Nurse Practitioners Services 20 1518788900 0 Nurse Practitioners Physician Services 00 1518797562 0 LEVY HANNAH MARIE 2024280 9999999 B 10 1518797562 0 1200 W STATE ST ROCKFORD IL 611022112 20 1518797562 0 Physician Assistant Only Fluoride varnish 20 1518797562 0 Physician Assistant Only Healthy Kids Services 20 1518797562 0 Physician Assistant Only Physician Services 00 1518799063 0 WISNIEWSKI LISA J 2024341 9999999 B 10 1518799063 0 1400 S MICHIGAN AVE APT 1203 CHICAGO IL 606053720 20 1518799063 0 Nurse Practitioners Fluoride varnish 20 1518799063 0 Nurse Practitioners Healthy Kids Services 20 1518799063 0 Nurse Practitioners Nurse Practitioners Services 20 1518799063 0 Nurse Practitioners Physician Services 00 1518799105 0 WYLER HANNAH 2024249 9999999 B 10 1518799105 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1518799105 0 Nurse Practitioners Fluoride varnish 20 1518799105 0 Nurse Practitioners Healthy Kids Services 20 1518799105 0 Nurse Practitioners Nurse Practitioners Services 20 1518799105 0 Nurse Practitioners Physician Services 00 1518900034 0 GREENFIELD DAVID 2020342 9999999 B 10 1518900034 0 11705 MERCY BLVD SAVANNAH GA 314191711 20 1518900034 0 Physicians Anesthesia Services 20 1518900034 0 Physicians Healthy Kids Services 20 1518900034 0 Physicians Optical Supplies 20 1518900034 0 Physicians Physician Services 00 1518901545 0 SIEGEL ROBERT D 2022307 9999999 B 10 1518901545 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1518901545 0 Physicians Anesthesia Services 20 1518901545 0 Physicians Fluoride varnish 20 1518901545 0 Physicians Healthy Kids Services 20 1518901545 0 Physicians Optical Supplies 20 1518901545 0 Physicians Physician Services 00 1518901677 0 URBAN AMY 2021124 9999999 B 10 1518901677 0 1800 W CHARLESTON BLVD LAS VEGAS NV 891022329 20 1518901677 0 Physicians Anesthesia Services 20 1518901677 0 Physicians Healthy Kids Services 20 1518901677 0 Physicians Optical Supplies 20 1518901677 0 Physicians Physician Services 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Physicians Healthy Kids Services 20 1518903483 0 Physicians Optical Supplies 20 1518903483 0 Physicians Physician Services 00 1518903509 0 OHL MICHAEL E 2009182 9999999 B 10 1518903509 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1518903509 0 Physicians Anesthesia Services 20 1518903509 0 Physicians Fluoride varnish 20 1518903509 0 Physicians Healthy Kids Services 20 1518903509 0 Physicians Optical Supplies 20 1518903509 0 Physicians Physician Services 00 1518903632 0 BRAMLETT CHARLES 2019309 9999999 B 10 1518903632 0 401 COMMERCE ST STE 600 NASHVILLE TN 372192518 20 1518903632 0 Physicians Anesthesia Services 20 1518903632 0 Physicians Healthy Kids Services 20 1518903632 0 Physicians Optical Supplies 20 1518903632 0 Physicians Physician Services 00 1518903731 0 WHITE KATHERINE 2012248 9999999 B 10 1518903731 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1518903731 0 Physicians Anesthesia Services 20 1518903731 0 Physicians Fluoride varnish 20 1518903731 0 Physicians Healthy Kids Services 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622691960 20 1528602331 0 Nurse Practitioners Fluoride varnish 20 1528602331 0 Nurse Practitioners Healthy Kids Services 20 1528602331 0 Nurse Practitioners Nurse Practitioners Services 20 1528602331 0 Nurse Practitioners Physician Services 00 1528602513 0 JORDAN KATHERINE 2019312 9999999 B 10 1528602513 0 1800 W ROSCOE ST APT 206 CHICAGO IL 606571073 20 1528602513 0 Occupational Therapists Medical Supplies 20 1528602513 0 Occupational Therapists Medical equipment/prosthetic devices 20 1528602513 0 Occupational Therapists Occupational Therapy Services 00 1528602646 0 GEORGE ROBERTO G 2021250 9999999 B 10 1528602646 0 2001 S CALIFORNIA AVE STE 100 CHICAGO IL 606082486 20 1528602646 0 Nurse Practitioners Fluoride varnish 20 1528602646 0 Nurse Practitioners Healthy Kids Services 20 1528602646 0 Nurse Practitioners Nurse Practitioners Services 20 1528602646 0 Nurse Practitioners Physician Services 00 1528603057 0 VIPOND TAYLOR A 2020015 9999999 B 10 1528603057 0 1401 E 12TH ST MENDOTA IL 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EVANSTON IL 602011700 20 1528613841 0 Nurse Practitioners Anesthesia Services 20 1528613841 0 Nurse Practitioners Nurse Practitioners Services 20 1528613841 0 Nurse Practitioners Physician Services 00 1528614583 0 ARTEAGA MARIBEL 2021237 9999999 B 10 1528614583 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1528614583 0 Physical Therapists Medical Supplies 20 1528614583 0 Physical Therapists Medical equipment/prosthetic devices 20 1528614583 0 Physical Therapists Physical Therapy Services 00 1528615010 0 DELAHERA ALEXANDRA 2020002 9999999 B 10 1528615010 0 5777 DEPT CAROL STREAM IL 601220021 20 1528615010 0 Physician Assistant Only Fluoride varnish 20 1528615010 0 Physician Assistant Only Healthy Kids Services 20 1528615010 0 Physician Assistant Only Physician Services 00 1528615101 0 LA MICHAEL 2021168 9999999 B 10 1528615101 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1528615101 0 Physician Assistant Only Fluoride varnish 20 1528615101 0 Physician Assistant Only Healthy Kids 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Anesthesia Services 20 1528760311 0 Physicians Healthy Kids Services 20 1528760311 0 Physicians Optical Supplies 20 1528760311 0 Physicians Physician Services 00 1528761061 0 PEREZ RAMONCITO 2023094 9999999 B 10 1528761061 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1528761061 0 Nurse Practitioners Anesthesia Services 20 1528761061 0 Nurse Practitioners Nurse Practitioners Services 20 1528761061 0 Nurse Practitioners Physician Services 00 1528761277 0 OVROM LAUREL B 2023240 9999999 B 10 1528761277 0 4698 DEPT CAROL STREAM IL 601220021 20 1528761277 0 Physicians Anesthesia Services 20 1528761277 0 Physicians Fluoride varnish 20 1528761277 0 Physicians Healthy Kids Services 20 1528761277 0 Physicians Optical Supplies 20 1528761277 0 Physicians Physician Services 00 1528761715 0 PLUCINSKI EMILY ANNE 2023136 9999999 B 10 1528761715 0 PO BOX 3039 OAK BROOK IL 605223039 20 1528761715 0 Physicians Anesthesia Services 20 1528761715 0 Physicians Fluoride varnish 20 1528761715 0 Physicians Healthy Kids Services 20 1528761715 0 Physicians Optical Supplies 20 1528761715 0 Physicians Physician Services 00 1528761756 0 POCHA SUNEHA 2023171 9999999 B 10 1528761756 0 4701 DEPT CAROL STREAM IL 601220021 20 1528761756 0 Physicians Anesthesia Services 20 1528761756 0 Physicians Fluoride varnish 20 1528761756 0 Physicians Healthy Kids Services 20 1528761756 0 Physicians Optical Supplies 20 1528761756 0 Physicians Physician Services 00 1528762333 0 XU CHANG 2023286 9999999 B 10 1528762333 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1528762333 0 Physicians Anesthesia Services 20 1528762333 0 Physicians Fluoride varnish 20 1528762333 0 Physicians Healthy Kids Services 20 1528762333 0 Physicians Optical Supplies 20 1528762333 0 Physicians Physician Services 00 1528762838 0 FONTHEIM ARIELLE 2023135 9999999 B 10 1528762838 0 PO BOX 3039 OAK BROOK IL 605223039 20 1528762838 0 Physicians Anesthesia Services 20 1528762838 0 Physicians Fluoride varnish 20 1528762838 0 Physicians Healthy Kids Services 20 1528762838 0 Physicians Optical Supplies 20 1528762838 0 Physicians Physician Services 00 1528764107 0 BROOK ROBERT A 2024066 9999999 B 10 1528764107 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1528764107 0 Physician Assistant Only Fluoride varnish 20 1528764107 0 Physician Assistant Only Healthy Kids Services 20 1528764107 0 Physician Assistant Only Physician Services 00 1528764701 0 CRAIG CAROLINE 2023031 9999999 B 10 1528764701 0 42 W MADISON ST FL 2 CHICAGO IL 606024309 20 1528764701 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1528764925 0 TORRES REBECCA 2023086 9999999 B 10 1528764925 0 29373 NETWORK PL CHICAGO IL 606733039 20 1528764925 0 Physician Assistant Only Fluoride varnish 20 1528764925 0 Physician Assistant Only Healthy Kids Services 20 1528764925 0 Physician Assistant Only Physician Services 00 1528767530 0 TAYLOR SHEKELIA 2023292 9999999 B 10 1528767530 0 1215 E 165TH PL SOUTH HOLLAND IL 604732528 20 1528767530 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1528767985 0 MORALES HASMIK 2023102 9999999 B 10 1528767985 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1528767985 0 Nurse Practitioners Healthy Kids Services 20 1528767985 0 Nurse Practitioners Nurse Practitioners Services 20 1528767985 0 Nurse Practitioners Physician Services 00 1528769130 0 WOLF DERRICK J 2023361 9999999 B 10 1528769130 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1528769130 0 Nurse Practitioners Fluoride varnish 20 1528769130 0 Nurse Practitioners Healthy Kids Services 20 1528769130 0 Nurse Practitioners Nurse Practitioners Services 20 1528769130 0 Nurse Practitioners Physician Services 00 1528769171 0 LOZANO CYNTHIA 2023072 9999999 B 10 1528769171 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1528769171 0 Registered nurse Nursing service 20 1528769171 0 Registered nurse Waiver service 00 1528770484 0 WYNN CHANTEL H 2023234 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Practitioners Nurse Practitioners Services 20 1528776168 0 Nurse Practitioners Physician Services 00 1528776614 0 VANVLEET PHUONG 2022349 9999999 B 10 1528776614 0 PO BOX 631767 CINCINNATI OH 452631767 20 1528776614 0 Nurse Practitioners Healthy Kids Services 20 1528776614 0 Nurse Practitioners Nurse Practitioners Services 20 1528776614 0 Nurse Practitioners Physician Services 00 1528778974 0 CALABRIA MEGAN A 2022341 9999999 B 10 1528778974 0 6742 N FROSTWOOD PKWY PEORIA IL 616152402 20 1528778974 0 Nurse Practitioners Anesthesia Services 20 1528778974 0 Nurse Practitioners Nurse Practitioners Services 20 1528778974 0 Nurse Practitioners Physician Services 00 1528780392 0 DAVIS CRYSTAL 2022356 9999999 B 10 1528780392 0 801 N WALNUT ST CHAMPAIGN IL 618203055 20 1528780392 0 Nurse Practitioners Healthy Kids Services 20 1528780392 0 Nurse Practitioners Nurse Practitioners Services 20 1528780392 0 Nurse Practitioners Physician Services 00 1528782612 0 YOUNGER BETH 2022294 9999999 B 10 1528782612 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1528782612 0 Nurse Practitioners Healthy Kids Services 20 1528782612 0 Nurse Practitioners Nurse Practitioners Services 20 1528782612 0 Nurse Practitioners Physician Services 00 1528786357 0 CAMERON RAQUEL N 2022325 9999999 B 10 1528786357 0 1701 E WOODFIELD RD STE 435 SCHAUMBURG IL 601735129 20 1528786357 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1528787330 0 VAZQUEZ KRYSTAL 2024239 9999999 B 10 1528787330 0 6127 S UNIVERSITY AVE STE 109 CHICAGO IL 606375894 20 1528787330 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1528787744 0 WALLACE DANE C 2022257 9999999 B 10 1528787744 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1528787744 0 Nurse Practitioners Fluoride varnish 20 1528787744 0 Nurse Practitioners Healthy Kids Services 20 1528787744 0 Nurse Practitioners Nurse Practitioners Services 20 1528787744 0 Nurse Practitioners Physician Services 00 1528788379 0 CRUZ JESSICA C 2022244 9999999 B 10 1528788379 0 4501 HILL RD HIGHLAND IL 622493519 20 1528788379 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1528790086 0 TOMEY ANDREA 2023182 9999999 B 10 1528790086 0 PO BOX 556 VINCENNES IN 475910556 20 1528790086 0 Nurse Practitioners Healthy Kids Services 20 1528790086 0 Nurse Practitioners Nurse Practitioners Services 20 1528790086 0 Nurse Practitioners Physician Services 00 1528790417 0 TOPAKTAS EYLEM 2022259 9999999 B 10 1528790417 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1528790417 0 Physicians Anesthesia Services 20 1528790417 0 Physicians Fluoride varnish 20 1528790417 0 Physicians Healthy Kids Services 20 1528790417 0 Physicians Optical Supplies 20 1528790417 0 Physicians Physician Services 00 1528790649 0 NAJDAWI FARIS 2022194 9999999 B 10 1528790649 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1528790649 0 Physicians Anesthesia Services 20 1528790649 0 Physicians Healthy Kids Services 20 1528790649 0 Physicians Optical Supplies 20 1528790649 0 Physicians Physician Services 00 1528790656 0 CAIN BLAKE W 2022189 9999999 B 10 1528790656 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1528790656 0 Physicians Anesthesia Services 20 1528790656 0 Physicians Fluoride varnish 20 1528790656 0 Physicians Healthy Kids Services 20 1528790656 0 Physicians Optical Supplies 20 1528790656 0 Physicians Physician Services 00 1528790920 0 ACOSTA BOWEN DANIEL E 2022194 9999999 B 10 1528790920 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1528790920 0 Physicians Anesthesia Services 20 1528790920 0 Physicians Fluoride varnish 20 1528790920 0 Physicians Healthy Kids Services 20 1528790920 0 Physicians Optical Supplies 20 1528790920 0 Physicians Physician Services 00 1528791027 0 SWARNA SIRI CHANDANA 2022210 9999999 B 10 1528791027 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1528791027 0 Physicians Anesthesia Services 20 1528791027 0 Physicians Fluoride varnish 20 1528791027 0 Physicians Healthy Kids Services 20 1528791027 0 Physicians Optical Supplies 20 1528791027 0 Physicians Physician Services 00 1528793148 0 MAY KELLI J 2022283 9999999 B 10 1528793148 0 PO BOX 378 SPARTA IL 622860378 20 1528793148 0 Nurse Practitioners Healthy Kids Services 20 1528793148 0 Nurse Practitioners Nurse Practitioners Services 20 1528793148 0 Nurse Practitioners Physician Services 00 1528793288 0 HICKS BRITTANY 2022270 9999999 B 10 1528793288 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1528793288 0 Nurse Practitioners Fluoride varnish 20 1528793288 0 Nurse Practitioners Healthy Kids Services 20 1528793288 0 Nurse Practitioners Nurse Practitioners Services 20 1528793288 0 Nurse Practitioners Physician Services 00 1528793320 0 THERRIAULT SARAH M 2022200 9999999 H 10 1528793320 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1528793320 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1528794328 0 OVERMANN MORGAN S 2022231 9999999 B 10 1528794328 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1528794328 0 Nurse Practitioners Healthy Kids Services 20 1528794328 0 Nurse Practitioners Nurse Practitioners Services 20 1528794328 0 Nurse Practitioners Physician Services 00 1528794492 0 BLAKE COURTNEY L 2022321 9999999 B 10 1528794492 0 520 MARY ST STE 520 EVANSVILLE IN 477101682 20 1528794492 0 Nurse Practitioners Fluoride varnish 20 1528794492 0 Nurse Practitioners Healthy Kids Services 20 1528794492 0 Nurse Practitioners Nurse Practitioners Services 20 1528794492 0 Nurse Practitioners Physician Services 00 1528795085 0 SANTIAGO KEVIN 2023094 9999999 B 10 1528795085 0 2050 E ALGONQUIN RD STE 610 SCHAUMBURG IL 601734166 20 1528795085 0 Dentists Dental Services 20 1528795085 0 Dentists Physician Services 00 1528796067 0 JINDAL RISHABH 2023286 9999999 B 10 1528796067 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1528796067 0 Physicians Anesthesia Services 20 1528796067 0 Physicians Healthy Kids Services 20 1528796067 0 Physicians Optical Supplies 20 1528796067 0 Physicians Physician Services 00 1528796703 0 SALANS EMILY 2022266 9999999 B 10 1528796703 0 75 REMITTANCE DR DEPT 1611 CHICAGO IL 606751611 20 1528796703 0 Nurse Practitioners Fluoride varnish 20 1528796703 0 Nurse Practitioners Healthy Kids Services 20 1528796703 0 Nurse Practitioners Nurse Practitioners Services 20 1528796703 0 Nurse Practitioners Physician Services 00 1528797164 0 GILANI SAMIE 2022186 9999999 B 10 1528797164 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1528797164 0 Physicians Anesthesia Services 20 1528797164 0 Physicians Fluoride varnish 20 1528797164 0 Physicians Healthy Kids Services 20 1528797164 0 Physicians Optical Supplies 20 1528797164 0 Physicians Physician Services 00 1528798006 0 HORTON JANTELLE R 2022321 9999999 B 10 1528798006 0 42 W MADISON ST FL 2 CHICAGO IL 606024309 20 1528798006 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1528799483 0 ATKINSON JODIE 2022220 9999999 B 10 1528799483 0 621 S ILLINOIS AVE STE 103 MASON CITY IA 504015489 20 1528799483 0 Nurse Practitioners Fluoride varnish 20 1528799483 0 Nurse Practitioners Healthy Kids Services 20 1528799483 0 Nurse Practitioners Nurse Practitioners Services 20 1528799483 0 Nurse Practitioners Physician Services 00 1528799525 0 LOOSE CAMERON 2023165 9999999 B 10 1528799525 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1528799525 0 Physical Therapists Medical Supplies 20 1528799525 0 Physical Therapists Medical equipment/prosthetic devices 20 1528799525 0 Physical Therapists Physical Therapy Services 00 1528801149 0 CHRISWELL MEAGAN ELIZABETH 2024165 9999999 B 10 1528801149 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1528801149 0 Physicians Anesthesia Services 20 1528801149 0 Physicians Fluoride varnish 20 1528801149 0 Physicians Healthy Kids Services 20 1528801149 0 Physicians Optical Supplies 20 1528801149 0 Physicians Physician Services 00 1528801222 0 HIGGINS BROOKE V 2024173 9999999 B 10 1528801222 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1528801222 0 Physicians Anesthesia Services 20 1528801222 0 Physicians Healthy Kids Services 20 1528801222 0 Physicians Optical Supplies 20 1528801222 0 Physicians Physician Services 00 1528801610 0 LOPEZ DINORA 2024169 9999999 B 10 1528801610 0 1414 MAIN ST MELROSE PARK IL 601603902 20 1528801610 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1528801776 0 HABIB ANDY M 2025014 9999999 B 10 1528801776 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1528801776 0 Physicians Anesthesia Services 20 1528801776 0 Physicians Healthy Kids Services 20 1528801776 0 Physicians Optical Supplies 20 1528801776 0 Physicians Physician Services 00 1528802006 0 QADIR QURATULAIN 2024227 9999999 B 10 1528802006 0 2239 E COOK ST SPRINGFIELD IL 627031944 20 1528802006 0 Dentists Dental Services 20 1528802006 0 Dentists Physician Services 00 1528802709 0 SHAMS ZOYA 2024199 9999999 B 10 1528802709 0 PO BOX 49 GLENVIEW IL 600250049 20 1528802709 0 Dentists Dental Services 20 1528802709 0 Dentists Physician Services 00 1528803483 0 WEEMS ALANNA 2024190 9999999 B 10 1528803483 0 PO BOX 1109 DEKALB IL 601157109 20 1528803483 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1528804887 0 QI JIANSHU 2024256 9999999 B 10 1528804887 0 PO BOX 855671 MINNEAPOLIS MN 554851153 20 1528804887 0 Physicians Anesthesia Services 20 1528804887 0 Physicians Fluoride varnish 20 1528804887 0 Physicians Healthy Kids Services 20 1528804887 0 Physicians Optical Supplies 20 1528804887 0 Physicians Physician Services 00 1528805751 0 HILL KATELYN L 2024339 9999999 B 10 1528805751 0 39465 W 14 MILE RD NOVI MI 483771600 20 1528805751 0 Clinical Social Worker Social work service 00 1528807906 0 GROSS JULIANN 2024281 9999999 B 10 1528807906 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1528807906 0 Clinical Social Worker Social work service 00 1528808896 0 FAHSAL EMAAN 2024323 9999999 B 10 1528808896 0 17W679 ROOSEVELT RD OAKBROOK TERRAC IL 601813545 20 1528808896 0 Dentists Dental Services 20 1528808896 0 Dentists Physician Services 00 1528809456 0 HECKE RACHEL 2024172 9999999 B 10 1528809456 0 PO BOX 1109 DEKALB IL 601157109 20 1528809456 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1528811304 0 NIGEDA BELAINESH 2024200 9999999 B 10 1528811304 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1528811304 0 Physicians Anesthesia Services 20 1528811304 0 Physicians Fluoride varnish 20 1528811304 0 Physicians Healthy Kids Services 20 1528811304 0 Physicians Optical Supplies 20 1528811304 0 Physicians Physician Services 00 1528811965 0 DIAMANTOPOULOS NICHOLAS 2024250 2027174 B 10 1528811965 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1528811965 0 Physicians Anesthesia Services 20 1528811965 0 Physicians Healthy Kids Services 20 1528811965 0 Physicians Optical Supplies 20 1528811965 0 Physicians Physician Services 00 1528813789 0 PALADI-NOEL IRIS 2024193 9999999 B 10 1528813789 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1528813789 0 Physicians Anesthesia Services 20 1528813789 0 Physicians Fluoride varnish 20 1528813789 0 Physicians Healthy Kids Services 20 1528813789 0 Physicians Optical Supplies 20 1528813789 0 Physicians Physician Services 00 1528815958 0 BLACKWELL DANIELLE C 2024283 9999999 B 10 1528815958 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1528815958 0 Nurse Practitioners Healthy Kids Services 20 1528815958 0 Nurse Practitioners Nurse Practitioners Services 20 1528815958 0 Nurse Practitioners Physician Services 00 1528818069 0 CLARKE EMMA 2024144 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1538105093 0 Physicians Anesthesia Services 20 1538105093 0 Physicians Fluoride varnish 20 1538105093 0 Physicians Healthy Kids Services 20 1538105093 0 Physicians Optical Supplies 20 1538105093 0 Physicians Physician Services 00 1538105184 0 BORKOWSKY SHANE 2011213 9999999 B 10 1538105184 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1538105184 0 Physicians Anesthesia Services 20 1538105184 0 Physicians Fluoride varnish 20 1538105184 0 Physicians Healthy Kids Services 20 1538105184 0 Physicians Optical Supplies 20 1538105184 0 Physicians Physician Services 00 1538105721 0 PASSINI JENNIFER 2009229 9999999 B 10 1538105721 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1538105721 0 Physicians Anesthesia Services 20 1538105721 0 Physicians Fluoride varnish 20 1538105721 0 Physicians Healthy Kids Services 20 1538105721 0 Physicians Optical Supplies 20 1538105721 0 Physicians Physician Services 00 1538105911 0 KHUDEIRA ABDULKAREEM 1995001 9999999 B 10 1538105911 0 9405 S OKETO AVE 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PO BOX 954467 SAINT LOUIS MO 631952334 20 1538109467 0 Physicians Anesthesia Services 20 1538109467 0 Physicians Healthy Kids Services 20 1538109467 0 Physicians Optical Supplies 20 1538109467 0 Physicians Physician Services 00 1538109947 0 BEST MELISSA 2016282 9999999 B 10 1538109947 0 PO BOX 776926 CHICAGO IL 606776926 20 1538109947 0 Physician Assistant Only Fluoride varnish 20 1538109947 0 Physician Assistant Only Healthy Kids Services 20 1538109947 0 Physician Assistant Only Physician Services 00 1538110077 0 HORSFIELD MICHAEL 2001213 9999999 B 10 1538110077 0 850 43RD AVE STE 100 MOLINE IL 612658401 20 1538110077 0 Physical Therapists Medical Supplies 20 1538110077 0 Physical Therapists Medical equipment/prosthetic devices 20 1538110077 0 Physical Therapists Physical Therapy Services 00 1538110085 0 BARCLAY BRIANA 2009189 9999999 B 10 1538110085 0 5350 EASTERN AVE DAVENPORT IA 528070008 20 1538110085 0 Physicians Anesthesia Services 20 1538110085 0 Physicians Healthy Kids 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IL 600855744 20 1538268230 0 Physicians Anesthesia Services 20 1538268230 0 Physicians Fluoride varnish 20 1538268230 0 Physicians Healthy Kids Services 20 1538268230 0 Physicians Optical Supplies 20 1538268230 0 Physicians Physician Services 00 1538268628 0 KHUSRO QAZI 1993182 9999999 B 10 1538268628 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1538268628 0 Physicians Anesthesia Services 20 1538268628 0 Physicians Fluoride varnish 20 1538268628 0 Physicians Healthy Kids Services 20 1538268628 0 Physicians Optical Supplies 20 1538268628 0 Physicians Physician Services 00 1538268966 0 MELTZER HERBERT Y 2012001 9999999 B 10 1538268966 0 5777 DEPT CAROL STREAM IL 601220021 20 1538268966 0 Physicians Anesthesia Services 20 1538268966 0 Physicians Healthy Kids Services 20 1538268966 0 Physicians Optical Supplies 20 1538268966 0 Physicians Physician Services 20 1538268966 0 Physicians Physicians Psychiatric Services 00 1538270178 0 MILLER GREG 2022349 9999999 B 10 1538270178 0 PO BOX 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9999999 B 10 1538512280 0 PO BOX 21844 BELFAST ME 049154115 20 1538512280 0 Physicians All Kids application agent 20 1538512280 0 Physicians Anesthesia Services 20 1538512280 0 Physicians Fluoride varnish 20 1538512280 0 Physicians Healthy Kids Services 20 1538512280 0 Physicians Optical Supplies 20 1538512280 0 Physicians Physician Services 00 1538512629 0 ANSARI TAHA 2022115 9999999 B 10 1538512629 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1538512629 0 Physicians Anesthesia Services 20 1538512629 0 Physicians Healthy Kids Services 20 1538512629 0 Physicians Optical Supplies 20 1538512629 0 Physicians Physician Services 20 1538512629 0 Physicians Physicians Psychiatric Services 00 1538512934 0 ZIMA ANETA 2016266 9999999 B 10 1538512934 0 657 E GOLF RD STE 309 ARLINGTON HEIGH IL 600054071 20 1538512934 0 Nurse Practitioners Fluoride varnish 20 1538512934 0 Nurse Practitioners Healthy Kids Services 20 1538512934 0 Nurse Practitioners Nurse Practitioners Services 20 1538512934 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Nurse Practitioners Healthy Kids Services 20 1538628250 0 Nurse Practitioners Nurse Practitioners Services 20 1538628250 0 Nurse Practitioners Physician Services 00 1538628508 0 WONAIS MATT 2025134 9999999 B 10 1538628508 0 2111 OGDEN AVE AURORA IL 605047597 20 1538628508 0 Physicians All Kids application agent 20 1538628508 0 Physicians Anesthesia Services 20 1538628508 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1538628508 0 Physicians Healthy Kids Services 20 1538628508 0 Physicians Optical Supplies 20 1538628508 0 Physicians Physician Services 00 1538628698 0 GUO JENNY N 2019141 9999999 B 10 1538628698 0 4698 DEPT CAROL STREAM IL 601220021 20 1538628698 0 Physicians Anesthesia Services 20 1538628698 0 Physicians Healthy Kids Services 20 1538628698 0 Physicians Optical Supplies 20 1538628698 0 Physicians Physician Services 00 1538629241 0 CHU YAN 2019182 9999999 B 10 1538629241 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1538629241 0 Physicians Anesthesia Services 20 1538629241 0 Physicians Fluoride varnish 20 1538629241 0 Physicians Healthy Kids Services 20 1538629241 0 Physicians Optical Supplies 20 1538629241 0 Physicians Physician Services 00 1538629266 0 BAYATI JULIAN 2022332 9999999 B 10 1538629266 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1538629266 0 Physicians Anesthesia Services 20 1538629266 0 Physicians Fluoride varnish 20 1538629266 0 Physicians Healthy Kids Services 20 1538629266 0 Physicians Optical Supplies 20 1538629266 0 Physicians Physician Services 00 1538629449 0 VAHIDSAFA ALEXANDER NAVEED 2023160 9999999 B 10 1538629449 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1538629449 0 Physicians Anesthesia Services 20 1538629449 0 Physicians Healthy Kids Services 20 1538629449 0 Physicians Optical Supplies 20 1538629449 0 Physicians Physician Services 00 1538629514 0 FESTOK AHMER 2022262 9999999 B 10 1538629514 0 PO BOX 781076 DETROIT MI 482781076 20 1538629514 0 Physicians Anesthesia Services 20 1538629514 0 Physicians Healthy Kids Services 20 1538629514 0 Physicians Optical Supplies 20 1538629514 0 Physicians Physician Services 00 1538629746 0 MURPHY MICHAEL PATRICK 2020013 9999999 B 10 1538629746 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1538629746 0 Physicians Anesthesia Services 20 1538629746 0 Physicians Healthy Kids Services 20 1538629746 0 Physicians Optical Supplies 20 1538629746 0 Physicians Physician Services 00 1538629860 0 ZHEUTLIN ALEXANDER 2023143 9999999 B 10 1538629860 0 4698 DEPT CAROL STREAM IL 601220021 20 1538629860 0 Physicians Anesthesia Services 20 1538629860 0 Physicians Fluoride varnish 20 1538629860 0 Physicians Healthy Kids Services 20 1538629860 0 Physicians Optical Supplies 20 1538629860 0 Physicians Physician Services 00 1538630231 0 EWING FELICIA K 2024142 9999999 B 10 1538630231 0 4509 N ILLINOIS ST STE 5 SWANSEA IL 622261524 20 1538630231 0 Other behavior health professional LCPC/LMFT services 00 1538631114 0 WAGNER SAMANTHA E 2019009 9999999 B 10 1538631114 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1538631114 0 Nurse Practitioners Healthy Kids Services 20 1538631114 0 Nurse Practitioners Nurse Practitioners Services 20 1538631114 0 Nurse Practitioners Physician Services 00 1538633938 0 BROWN KAITLYN D 2023318 9999999 B 10 1538633938 0 339 CONSORT DR BALLWIN MO 630114439 20 1538633938 0 Nurse Practitioners Anesthesia Services 20 1538633938 0 Nurse Practitioners Nurse Practitioners Services 20 1538633938 0 Nurse Practitioners Physician Services 00 1538635487 0 SKIRVIN STACY 2018298 9999999 H 10 1538635487 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1538635487 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1538635818 0 SERRANO ERIN E 2018353 9999999 B 10 1538635818 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1538635818 0 Clinical Social Worker Social work service 00 1538639406 0 REDMOND TIRANEY 2018360 9999999 B 10 1538639406 0 2003 W FULTON 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Physician Assistant Only Physician Services 00 1538649967 0 TRAME DANA L 2018245 9999999 B 10 1538649967 0 PO BOX 955860 SAINT LOUIS MO 631955860 20 1538649967 0 Nurse Practitioners Healthy Kids Services 20 1538649967 0 Nurse Practitioners Nurse Practitioners Services 20 1538649967 0 Nurse Practitioners Physician Services 00 1538650056 0 HADLEY JANELLE K 2020035 9999999 B 10 1538650056 0 29373 NETWORK PL CHICAGO IL 606733039 20 1538650056 0 Physicians Anesthesia Services 20 1538650056 0 Physicians Fluoride varnish 20 1538650056 0 Physicians Healthy Kids Services 20 1538650056 0 Physicians Optical Supplies 20 1538650056 0 Physicians Physician Services 00 1538651666 0 SAMSON SHIREEN 2018320 9999999 B 10 1538651666 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1538651666 0 Physicians Anesthesia Services 20 1538651666 0 Physicians Healthy Kids Services 20 1538651666 0 Physicians Optical Supplies 20 1538651666 0 Physicians Physician Services 20 1538651666 0 Physicians Physicians Psychiatric Services 00 1538651799 0 KUCERA MOLLY M 2021166 9999999 B 10 1538651799 0 29373 NETWORK PL CHICAGO IL 606733039 20 1538651799 0 Physicians Anesthesia Services 20 1538651799 0 Physicians Fluoride varnish 20 1538651799 0 Physicians Healthy Kids Services 20 1538651799 0 Physicians Optical Supplies 20 1538651799 0 Physicians Physician Services 00 1538652664 0 QATU MOSSUB M 2024127 9999999 B 10 1538652664 0 5777 DEPT CAROL STREAM IL 601220021 20 1538652664 0 Physicians Anesthesia Services 20 1538652664 0 Physicians Healthy Kids Services 20 1538652664 0 Physicians Optical Supplies 20 1538652664 0 Physicians Physician Services 00 1538652920 0 ALBERSON KURT E 2018351 9999999 B 10 1538652920 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1538652920 0 Physicians Anesthesia Services 20 1538652920 0 Physicians Fluoride varnish 20 1538652920 0 Physicians Healthy Kids Services 20 1538652920 0 Physicians Optical Supplies 20 1538652920 0 Physicians Physician Services 00 1538652961 0 BRUNE KATHERINE E 2024212 9999999 B 10 1538652961 0 5665 NEW NORTHSIDE DR ATLANTA GA 303285831 20 1538652961 0 Physician Assistant Only Fluoride varnish 20 1538652961 0 Physician Assistant Only Healthy Kids Services 20 1538652961 0 Physician Assistant Only Physician Services 00 1538653084 0 BLOCK ARON J 2021124 9999999 B 10 1538653084 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1538653084 0 Podiatrists Podiatric Services 00 1538653233 0 CORSIATTI NICOLE A 2018218 9999999 B 10 1538653233 0 179 N CHICAGO ST JOLIET IL 604324126 20 1538653233 0 Optometrists Optical Supplies 20 1538653233 0 Optometrists Optometric Services 20 1538653233 0 Optometrists Physician Services 00 1538653399 0 TULMAN MICHAEL 2023157 9999999 B 10 1538653399 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1538653399 0 Physical Therapists Medical Supplies 20 1538653399 0 Physical Therapists Medical equipment/prosthetic devices 20 1538653399 0 Physical Therapists Physical Therapy Services 00 1538653761 0 RASCHE DAVID P 2021139 9999999 B 10 1538653761 0 PO BOX 22407 SAINT LOUIS MO 631260407 20 1538653761 0 Physicians Anesthesia Services 20 1538653761 0 Physicians Healthy Kids Services 20 1538653761 0 Physicians Optical Supplies 20 1538653761 0 Physicians Physician Services 00 1538653894 0 PALKA NATALIE A 2018183 9999999 B 10 1538653894 0 350 N WALL ST KANKAKEE IL 609012901 20 1538653894 0 Nurse Practitioners Fluoride varnish 20 1538653894 0 Nurse Practitioners Healthy Kids Services 20 1538653894 0 Nurse Practitioners Nurse Practitioners Services 20 1538653894 0 Nurse Practitioners Physician Services 00 1538654256 0 DERBY KATHERINE D 2019142 9999999 B 10 1538654256 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1538654256 0 Physicians Anesthesia Services 20 1538654256 0 Physicians Healthy Kids Services 20 1538654256 0 Physicians Optical Supplies 20 1538654256 0 Physicians Physician Services 00 1538654371 0 ENNEKING BRETT A 2018228 9999999 B 10 1538654371 0 PO BOX 778912 CHICAGO IL 606778912 20 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WINKLE RACHEL 2018200 9999999 B 10 1538655865 0 5777 DEPT CAROL STREAM IL 601220021 20 1538655865 0 Physician Assistant Only Fluoride varnish 20 1538655865 0 Physician Assistant Only Healthy Kids Services 20 1538655865 0 Physician Assistant Only Physician Services 00 1538656145 0 TODD KELLY C 2018222 9999999 B 10 1538656145 0 130 N DUNCAN ST MARINE IL 620611052 20 1538656145 0 Nurse Practitioners Fluoride varnish 20 1538656145 0 Nurse Practitioners Healthy Kids Services 20 1538656145 0 Nurse Practitioners Nurse Practitioners Services 20 1538656145 0 Nurse Practitioners Physician Services 00 1538656723 0 NOWAK MARIA 2025035 9999999 B 10 1538656723 0 1801 WOODFIELD DR SAVOY IL 618749505 20 1538656723 0 Clinical Social Worker Social work service 00 1538658729 0 ABDUR-RAHMAN SYED 2020019 9999999 B 10 1538658729 0 5777 DEPT CAROL STREAM IL 601228942 20 1538658729 0 Physicians Anesthesia Services 20 1538658729 0 Physicians Fluoride varnish 20 1538658729 0 Physicians Healthy Kids Services 20 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7974 UW HEALTH CT MIDDLETON WI 535625531 20 1538664891 0 Physicians Anesthesia Services 20 1538664891 0 Physicians Fluoride varnish 20 1538664891 0 Physicians Healthy Kids Services 20 1538664891 0 Physicians Optical Supplies 20 1538664891 0 Physicians Physician Services 00 1538664941 0 DYER ALEXANDRA JULIAN 2018175 9999999 B 10 1538664941 0 7825 SOLUTION CTR CHICAGO IL 606777007 20 1538664941 0 Physicians Anesthesia Services 20 1538664941 0 Physicians Healthy Kids Services 20 1538664941 0 Physicians Optical Supplies 20 1538664941 0 Physicians Physician Services 20 1538664941 0 Physicians Physicians Psychiatric Services 00 1538665005 0 HOFFMAN ADA 2024342 9999999 B 10 1538665005 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1538665005 0 Physicians Anesthesia Services 20 1538665005 0 Physicians Healthy Kids Services 20 1538665005 0 Physicians Optical Supplies 20 1538665005 0 Physicians Physician Services 00 1538665146 0 DONOVAN MEGHAN E 2018212 9999999 B 10 1538665146 0 100 S GRAND AVE E FL 1 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Speech Therapists Speech Therapy/Pathology Services 00 1538672183 0 TUCKER ARLISA 2017310 9999999 B 10 1538672183 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1538672183 0 Nurse Practitioners Fluoride varnish 20 1538672183 0 Nurse Practitioners Healthy Kids Services 20 1538672183 0 Nurse Practitioners Nurse Practitioners Services 20 1538672183 0 Nurse Practitioners Physician Services 00 1538672225 0 ARENAS ELIZABETH M 2017320 9999999 B 10 1538672225 0 3401 GUNDERSON AVE BERWYN IL 604023771 20 1538672225 0 Speech Therapists Medical Supplies 20 1538672225 0 Speech Therapists Medical equipment/prosthetic devices 20 1538672225 0 Speech Therapists Speech Therapy/Pathology Services 00 1538672977 0 WILKINS BRITTANY E 2018253 9999999 B 10 1538672977 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1538672977 0 Physician Assistant Only Fluoride varnish 20 1538672977 0 Physician Assistant Only Healthy Kids Services 20 1538672977 0 Physician Assistant Only Physician Services 00 1538673108 0 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COURT ST PARIS IL 619442460 20 1538835350 0 Nurse Practitioners Fluoride varnish 20 1538835350 0 Nurse Practitioners Healthy Kids Services 20 1538835350 0 Nurse Practitioners Nurse Practitioners Services 20 1538835350 0 Nurse Practitioners Physician Services 00 1538835962 0 SCHNEPP AMBER L 2021229 9999999 B 10 1538835962 0 400 N PINE ST MOMENCE IL 609541158 20 1538835962 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1538836200 0 AGRAWAL KARTIKI 2021250 9999999 B 10 1538836200 0 2937 N STATE ROUTE 178 UNIT 2 UTICA IL 613739708 20 1538836200 0 Dentists Dental Services 20 1538836200 0 Dentists Physician Services 00 1538836846 0 COSTILOW CAROLYN 2024029 9999999 B 10 1538836846 0 PO BOX 3276 EVANSVILLE IN 477313276 20 1538836846 0 Nurse Practitioners Anesthesia Services 20 1538836846 0 Nurse Practitioners Nurse Practitioners Services 20 1538836846 0 Nurse Practitioners Physician Services 00 1538837190 0 MOURISSE RITA E 2021243 9999999 B 10 1538837190 0 300 CEDAR ST PEKIN IL 615547009 20 1538837190 0 Speech Therapists Medical Supplies 20 1538837190 0 Speech Therapists Medical equipment/prosthetic devices 20 1538837190 0 Speech Therapists Speech Therapy/Pathology Services 00 1538840715 0 ZAPARANIUK KALYNA V 2024366 9999999 B 10 1538840715 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1538840715 0 Nurse Practitioners Anesthesia Services 20 1538840715 0 Nurse Practitioners Nurse Practitioners Services 20 1538840715 0 Nurse Practitioners Physician Services 00 1538841721 0 WHITAKER ELIZABETH 2024055 9999999 B 10 1538841721 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1538841721 0 Nurse Practitioners Healthy Kids Services 20 1538841721 0 Nurse Practitioners Nurse Practitioners Services 20 1538841721 0 Nurse Practitioners Physician Services 00 1538842117 0 GOTHARD AUDREY 2024200 9999999 B 10 1538842117 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1538842117 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1538842943 0 ROSINSKI ANGELICA 2023268 9999999 B 10 1538842943 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1538842943 0 Nurse Practitioners Healthy Kids Services 20 1538842943 0 Nurse Practitioners Nurse Practitioners Services 20 1538842943 0 Nurse Practitioners Physician Services 00 1538844071 0 QUIRARTE ALAN D 2023202 9999999 B 10 1538844071 0 4830 N PULASKI RD STE 108 CHICAGO IL 606302847 20 1538844071 0 Dentists Anesthesia Services 20 1538844071 0 Dentists Dental Services 20 1538844071 0 Dentists Physician Services 00 1538844386 0 YABROUDI DANA F 2024001 9999999 B 10 1538844386 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1538844386 0 Physicians Anesthesia Services 20 1538844386 0 Physicians Fluoride varnish 20 1538844386 0 Physicians Healthy Kids Services 20 1538844386 0 Physicians Optical Supplies 20 1538844386 0 Physicians Physician Services 00 1538844626 0 CADET JAMIE 2023187 9999999 B 10 1538844626 0 800 BIESTERFIELD RD STE G01 ELK GROVE VILLA IL 600073372 20 1538844626 0 Nurse Practitioners Fluoride varnish 20 1538844626 0 Nurse Practitioners Healthy Kids Services 20 1538844626 0 Nurse Practitioners Nurse Practitioners Services 20 1538844626 0 Nurse Practitioners Physician Services 00 1538844741 0 MARTIN ALEXANDRA 2023198 9999999 B 10 1538844741 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1538844741 0 Nurse Practitioners Fluoride varnish 20 1538844741 0 Nurse Practitioners Healthy Kids Services 20 1538844741 0 Nurse Practitioners Nurse Practitioners Services 20 1538844741 0 Nurse Practitioners Physician Services 00 1538846407 0 ANOSIKE NNENNAOYIN 2023194 9999999 B 10 1538846407 0 5145 N CALIFORNIA AVE CHICAGO IL 606253661 20 1538846407 0 Physicians Anesthesia Services 20 1538846407 0 Physicians Fluoride varnish 20 1538846407 0 Physicians Healthy Kids Services 20 1538846407 0 Physicians Optical Supplies 20 1538846407 0 Physicians Physician Services 00 1538848015 0 ROMAN ROMAN 2023207 9999999 B 10 1538848015 0 PO BOX 855671 MINNEAPOLIS MN 554851153 20 1538848015 0 Physicians Anesthesia Services 20 1538848015 0 Physicians Fluoride varnish 20 1538848015 0 Physicians Healthy Kids Services 20 1538848015 0 Physicians Optical Supplies 20 1538848015 0 Physicians Physician Services 00 1538849534 0 BAUMANN MEGAN E 2024218 9999999 B 10 1538849534 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1538849534 0 Speech Therapists Medical Supplies 20 1538849534 0 Speech Therapists Medical equipment/prosthetic devices 20 1538849534 0 Speech Therapists Speech Therapy/Pathology Services 00 1538850946 0 BHATTARAI TRINA 2023199 9999999 B 10 1538850946 0 5145 N CALIFORNIA AVE CHICAGO IL 606253661 20 1538850946 0 Physicians Anesthesia Services 20 1538850946 0 Physicians Fluoride varnish 20 1538850946 0 Physicians Healthy Kids Services 20 1538850946 0 Physicians Optical Supplies 20 1538850946 0 Physicians Physician Services 00 1538851274 0 RAYMOND CASSANDRA 2023199 9999999 B 10 1538851274 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1538851274 0 Nurse Practitioners Fluoride varnish 20 1538851274 0 Nurse Practitioners Healthy Kids Services 20 1538851274 0 Nurse Practitioners Nurse Practitioners Services 20 1538851274 0 Nurse Practitioners Physician Services 00 1538851795 0 KHAN HASEEB 2023202 9999999 B 10 1538851795 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1538851795 0 Physicians Anesthesia Services 20 1538851795 0 Physicians Fluoride varnish 20 1538851795 0 Physicians Healthy Kids Services 20 1538851795 0 Physicians Optical Supplies 20 1538851795 0 Physicians Physician Services 00 1538853056 0 SWAIN KYLA E 2023326 9999999 B 10 1538853056 0 1 MEMORIAL DR ALTON IL 620026722 20 1538853056 0 Physicians Anesthesia Services 20 1538853056 0 Physicians Fluoride varnish 20 1538853056 0 Physicians Healthy Kids Services 20 1538853056 0 Physicians Optical Supplies 20 1538853056 0 Physicians Physician Services 00 1538854062 0 BAGLEY CARTER 2023196 9999999 B 10 1538854062 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1538854062 0 Physicians Anesthesia Services 20 1538854062 0 Physicians Healthy Kids Services 20 1538854062 0 Physicians Optical Supplies 20 1538854062 0 Physicians Physician Services 00 1538854716 0 STAFFORD TARA R 2023121 9999999 B 10 1538854716 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1538854716 0 Physician Assistant Only Fluoride varnish 20 1538854716 0 Physician Assistant Only Healthy Kids Services 20 1538854716 0 Physician Assistant Only Physician Services 00 1538858576 0 OPALIKHIN ANNE M 2023182 9999999 B 10 1538858576 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1538858576 0 Physicians Anesthesia Services 20 1538858576 0 Physicians Healthy Kids Services 20 1538858576 0 Physicians Optical Supplies 20 1538858576 0 Physicians Physician Services 00 1538859053 0 OTSKEY THOMAS 2025037 9999999 B 10 1538859053 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1538859053 0 Physician Assistant Only Fluoride varnish 20 1538859053 0 Physician Assistant Only Healthy Kids Services 20 1538859053 0 Physician Assistant Only Physician Services 00 1538859103 0 FRIEDERICH ASHLEY R 2023130 9999999 B 10 1538859103 0 705 S GRAND ST NASHVILLE IL 622631534 20 1538859103 0 Nurse Practitioners Fluoride varnish 20 1538859103 0 Nurse Practitioners Healthy Kids Services 20 1538859103 0 Nurse Practitioners Nurse Practitioners Services 20 1538859103 0 Nurse Practitioners Physician Services 00 1538859152 0 BELBINA SAFIYA-HANA 2023175 9999999 B 10 1538859152 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1538859152 0 Physicians Anesthesia Services 20 1538859152 0 Physicians Healthy Kids Services 20 1538859152 0 Physicians Optical Supplies 20 1538859152 0 Physicians Physician Services 00 1538859582 0 KAZMI ALVINA 2023202 9999999 B 10 1538859582 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1538859582 0 Physicians Anesthesia Services 20 1538859582 0 Physicians Fluoride varnish 20 1538859582 0 Physicians Healthy Kids Services 20 1538859582 0 Physicians Optical Supplies 20 1538859582 0 Physicians Physician Services 00 1538859780 0 ZIECINA ALICJA 2023329 9999999 B 10 1538859780 0 914 S OWEN ST MOUNT PROSPECT IL 600564342 20 1538859780 0 Speech Therapists Medical Supplies 20 1538859780 0 Speech Therapists Medical equipment/prosthetic devices 20 1538859780 0 Speech Therapists Speech Therapy/Pathology Services 00 1538859822 0 CHAPMAN MARIE-LISETTE DIMITREW 2023159 9999999 B 10 1538859822 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1538859822 0 Nurse Practitioners Healthy Kids Services 20 1538859822 0 Nurse Practitioners Nurse Practitioners Services 20 1538859822 0 Nurse Practitioners Physician Services 00 1538860572 0 WECHT SOPHIE 2024174 9999999 B 10 1538860572 0 1900 W POLD ST STE220C CHICAGO IL 60612 20 1538860572 0 Physicians Anesthesia Services 20 1538860572 0 Physicians Healthy Kids Services 20 1538860572 0 Physicians Optical Supplies 20 1538860572 0 Physicians Physician Services 00 1538860580 0 BENSON AUSTIN 2025009 9999999 B 10 1538860580 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1538860580 0 Physician Assistant Only Fluoride varnish 20 1538860580 0 Physician Assistant Only Healthy Kids Services 20 1538860580 0 Physician Assistant Only Physician Services 00 1538861612 0 ABDALLA AMIRA 2023284 9999999 B 10 1538861612 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1538861612 0 Physicians Anesthesia Services 20 1538861612 0 Physicians Fluoride varnish 20 1538861612 0 Physicians Healthy Kids Services 20 1538861612 0 Physicians Optical Supplies 20 1538861612 0 Physicians Physician Services 00 1538861901 0 LUSTEK ANGELA 2023170 9999999 B 10 1538861901 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1538861901 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1538862206 0 THOMPSON LENA 2023179 9999999 B 10 1538862206 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1538862206 0 Physicians Anesthesia Services 20 1538862206 0 Physicians Fluoride varnish 20 1538862206 0 Physicians Healthy Kids Services 20 1538862206 0 Physicians Optical Supplies 20 1538862206 0 Physicians Physician Services 00 1538862479 0 BENIGNI SAMANTHA 2023217 9999999 B 10 1538862479 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1538862479 0 Physicians Anesthesia Services 20 1538862479 0 Physicians Fluoride varnish 20 1538862479 0 Physicians Healthy Kids Services 20 1538862479 0 Physicians Optical Supplies 20 1538862479 0 Physicians Physician Services 00 1538862503 0 NARVAEZ PEREYRA MARIA J 2023205 9999999 B 10 1538862503 0 4698 DEPT CAROL STREAM IL 601220021 20 1538862503 0 Physicians Anesthesia Services 20 1538862503 0 Physicians Healthy Kids Services 20 1538862503 0 Physicians Optical Supplies 20 1538862503 0 Physicians Physician Services 00 1538862586 0 COMUZZIE BRENDAN 2023293 9999999 B 10 1538862586 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1538862586 0 Physicians Anesthesia Services 20 1538862586 0 Physicians Fluoride varnish 20 1538862586 0 Physicians Healthy Kids Services 20 1538862586 0 Physicians Optical Supplies 20 1538862586 0 Physicians Physician Services 00 1538862727 0 LEEF MAE A 2023276 9999999 B 10 1538862727 0 PO BOX 3039 OAK BROOK IL 605223039 20 1538862727 0 Physicians Anesthesia Services 20 1538862727 0 Physicians Fluoride varnish 20 1538862727 0 Physicians Healthy Kids Services 20 1538862727 0 Physicians Optical Supplies 20 1538862727 0 Physicians Physician Services 00 1538863469 0 KROPF QUINN C 2024142 9999999 B 10 1538863469 0 PO BOX 3039 OAK BROOK IL 605223039 20 1538863469 0 Dentists Dental Services 20 1538863469 0 Dentists Physician Services 00 1538863790 0 LAFAZANOS YANNIS S 2023182 9999999 B 10 1538863790 0 PO BOX 3039 OAK BROOK IL 605223039 20 1538863790 0 Physicians Anesthesia Services 20 1538863790 0 Physicians Fluoride varnish 20 1538863790 0 Physicians Healthy Kids Services 20 1538863790 0 Physicians Optical Supplies 20 1538863790 0 Physicians Physician Services 00 1538863808 0 BRITTON NELLIE H 2023102 9999999 B 10 1538863808 0 6810 STATE ROUTE 162 STE 215 MARYVILLE IL 620628566 20 1538863808 0 Nurse Practitioners Fluoride varnish 20 1538863808 0 Nurse Practitioners Healthy Kids Services 20 1538863808 0 Nurse Practitioners Nurse Practitioners Services 20 1538863808 0 Nurse Practitioners Physician Services 00 1538864459 0 PINKNEY BRITTANY 2024030 9999999 B 10 1538864459 0 255 E 5TH ST STE 1050 CINCINNATI OH 452024121 20 1538864459 0 Nurse Practitioners Fluoride varnish 20 1538864459 0 Nurse Practitioners Healthy Kids Services 20 1538864459 0 Nurse Practitioners Nurse Practitioners Services 20 1538864459 0 Nurse Practitioners Physician Services 00 1538864509 0 KROL PATRICK 2023181 9999999 B 10 1538864509 0 PO BOX 3039 OAK BROOK IL 605223039 20 1538864509 0 Physicians Anesthesia Services 20 1538864509 0 Physicians Fluoride varnish 20 1538864509 0 Physicians Healthy Kids Services 20 1538864509 0 Physicians Optical Supplies 20 1538864509 0 Physicians Physician Services 00 1538865456 0 ORTMANN KARLI 2024235 9999999 B 10 1538865456 0 3809 MAGNOLIA DR SPRING GROVE IL 600818631 20 1538865456 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1538866199 0 HUDSON COLLEEN E 2023131 9999999 B 10 1538866199 0 5777 DEPT CAROL STREAM IL 601220021 20 1538866199 0 Nurse Practitioners Healthy Kids Services 20 1538866199 0 Nurse Practitioners Nurse Practitioners Services 20 1538866199 0 Nurse Practitioners Physician Services 00 1538869664 0 YOUNG SARA M 2023114 9999999 B 10 1538869664 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1538869664 0 Nurse Practitioners Healthy Kids Services 20 1538869664 0 Nurse Practitioners Nurse Practitioners Services 20 1538869664 0 Nurse Practitioners Physician Services 00 1538870431 0 HUSSAINI ILHAM 2024002 9999999 B 10 1538870431 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1538870431 0 Physician Assistant Only Fluoride varnish 20 1538870431 0 Physician Assistant Only Healthy Kids Services 20 1538870431 0 Physician Assistant Only Physician Services 00 1538870670 0 MATOVU MARK T 2023012 9999999 B 10 1538870670 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1538870670 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1538870787 0 NGUYEN PHUONG-THAO 2024261 9999999 B 10 1538870787 0 6881 SEPTEMBER BLVD LONG GROVE IL 600475117 20 1538870787 0 Nurse Practitioners Healthy Kids Services 20 1538870787 0 Nurse Practitioners Nurse Practitioners Services 20 1538870787 0 Nurse Practitioners Physician Services 00 1538872726 0 ROSEBROUGH MADELINE 2024134 9999999 B 10 1538872726 0 6810 STATE ROUTE 162 STE 215 MARYVILLE IL 620628566 20 1538872726 0 Physician Assistant Only Fluoride varnish 20 1538872726 0 Physician Assistant Only Healthy Kids Services 20 1538872726 0 Physician Assistant Only Physician Services 00 1538873633 0 PUCKETT SARAH 2024103 9999999 B 10 1538873633 0 1285 FRANCISCAN DR LITCHFIELD IL 620561778 20 1538873633 0 Nurse Practitioners Fluoride varnish 20 1538873633 0 Nurse Practitioners Healthy Kids Services 20 1538873633 0 Nurse Practitioners Nurse Practitioners Services 20 1538873633 0 Nurse Practitioners Physician Services 00 1538873864 0 MCLUCKIE MEGAN 2024072 9999999 B 10 1538873864 0 820 SPRINGER DR LOMBARD IL 601486413 20 1538873864 0 Nurse Practitioners Fluoride varnish 20 1538873864 0 Nurse Practitioners Healthy Kids Services 20 1538873864 0 Nurse Practitioners Nurse Practitioners Services 20 1538873864 0 Nurse Practitioners Physician Services 00 1538874938 0 SMITH GINA 2024050 9999999 B 10 1538874938 0 5730 W ROOSEVELT RD CHICAGO IL 606441580 20 1538874938 0 Clinical Social Worker Social work service 00 1538877154 0 GARCIA YADIRA 2022316 9999999 B 10 1538877154 0 10208 S INDIANAPOLIS AVE # 301 CHICAGO IL 606176033 20 1538877154 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1538878558 0 DYER CHEYENNE 2022327 9999999 B 10 1538878558 0 2348 POST RD STE 107 WARWICK RI 028862271 20 1538878558 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1538882006 0 JANIEC COURTNEY 2023033 9999999 B 10 1538882006 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1538882006 0 Nurse Practitioners Anesthesia Services 20 1538882006 0 Nurse Practitioners Nurse Practitioners Services 20 1538882006 0 Nurse Practitioners Physician Services 00 1538882329 0 YOAKUM RACHEL 2022332 9999999 B 10 1538882329 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1538882329 0 Physician Assistant Only Fluoride varnish 20 1538882329 0 Physician Assistant Only Healthy Kids Services 20 1538882329 0 Physician Assistant Only Physician Services 00 1538885157 0 KEITH LESILE 2022312 9999999 B 10 1538885157 0 122 S MICHIGAN AVE STE 1441 CHICAGO IL 606036173 20 1538885157 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1538885520 0 HANLON NATALIE 2022285 9999999 B 10 1538885520 0 5220 EAST AVE COUNTRYSIDE IL 605253133 20 1538885520 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1538885793 0 LUNA MARLENE 2022322 9999999 B 10 1538885793 0 10001 GRAND AVE FRANKLIN PARK IL 601312563 20 1538885793 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1538886460 0 SCHICK LAUREN 2022306 9999999 B 10 1538886460 0 PO BOX 776084 CHICAGO IL 606776084 20 1538886460 0 Nurse Practitioners Anesthesia Services 20 1538886460 0 Nurse Practitioners Nurse Practitioners Services 20 1538886460 0 Nurse Practitioners Physician Services 00 1538887195 0 KESSLER JULIANNA 2024039 9999999 B 10 1538887195 0 201 W MULBERRY ST CHATHAM IL 626291329 20 1538887195 0 Speech Therapists Medical Supplies 20 1538887195 0 Speech Therapists Medical equipment/prosthetic devices 20 1538887195 0 Speech Therapists Speech Therapy/Pathology Services 00 1538889092 0 THOMAS MIESHA 2022320 9999999 B 10 1538889092 0 9701 W HIGGINS RD STE 270 STE 270 ROSEMONT IL 600184703 20 1538889092 0 Nurse Practitioners Fluoride varnish 20 1538889092 0 Nurse Practitioners Healthy Kids Services 20 1538889092 0 Nurse Practitioners Nurse Practitioners Services 20 1538889092 0 Nurse Practitioners Physician Services 00 1538889886 0 PAULSON HELENE M 2022241 9999999 B 10 1538889886 0 310 S MAIN ST STE D LOMBARD IL 601482692 20 1538889886 0 Speech Therapists Medical Supplies 20 1538889886 0 Speech Therapists Medical equipment/prosthetic devices 20 1538889886 0 Speech Therapists Speech Therapy/Pathology Services 00 1538890777 0 HODGES WESLEY 2023195 9999999 B 10 1538890777 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1538890777 0 Physicians Anesthesia Services 20 1538890777 0 Physicians Healthy Kids Services 20 1538890777 0 Physicians Optical Supplies 20 1538890777 0 Physicians Physician Services 00 1538890843 0 FRANKLIN TAYLOR 2023180 9999999 B 10 1538890843 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1538890843 0 Physicians Anesthesia Services 20 1538890843 0 Physicians Healthy Kids Services 20 1538890843 0 Physicians Optical Supplies 20 1538890843 0 Physicians Physician Services 00 1538890926 0 GAS CATHERINE 2022252 9999999 B 10 1538890926 0 29373 NETWORK PL CHICAGO IL 606733039 20 1538890926 0 Nurse Practitioners Fluoride varnish 20 1538890926 0 Nurse Practitioners Healthy Kids Services 20 1538890926 0 Nurse Practitioners Nurse Practitioners Services 20 1538890926 0 Nurse Practitioners Physician Services 00 1538891825 0 SCHRIEVER MORGAN 2022181 9999999 B 10 1538891825 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1538891825 0 Physicians Anesthesia Services 20 1538891825 0 Physicians Healthy Kids Services 20 1538891825 0 Physicians Optical Supplies 20 1538891825 0 Physicians Physician Services 00 1538895297 0 BRENGMAN RACHAEL 2024114 9999999 B 10 1538895297 0 520 VALLEY VIEW DR MOLINE IL 612656152 20 1538895297 0 Physician Assistant Only Fluoride varnish 20 1538895297 0 Physician Assistant Only Healthy Kids Services 20 1538895297 0 Physician Assistant Only Physician Services 00 1538896667 0 PASHA UMAR AHMAD 2022226 9999999 B 10 1538896667 0 502 RIVERSIDE DR EAST PEORIA IL 616112068 20 1538896667 0 Dentists Dental Services 20 1538896667 0 Dentists Physician Services 00 1538896907 0 YEH SHENGEN A 2023082 9999999 B 10 1538896907 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1538896907 0 Nurse Practitioners Fluoride varnish 20 1538896907 0 Nurse Practitioners Healthy Kids Services 20 1538896907 0 Nurse Practitioners Nurse Practitioners Services 20 1538896907 0 Nurse Practitioners Physician Services 00 1538897392 0 GLEAVES SHANE M 2022278 9999999 B 10 1538897392 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1538897392 0 Physician Assistant Only Fluoride varnish 20 1538897392 0 Physician Assistant Only Healthy Kids Services 20 1538897392 0 Physician Assistant Only Physician Services 00 1538898200 0 MEHDI BATOOL 2022188 9999999 B 10 1538898200 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1538898200 0 Physicians Anesthesia Services 20 1538898200 0 Physicians Fluoride varnish 20 1538898200 0 Physicians Healthy Kids Services 20 1538898200 0 Physicians Optical Supplies 20 1538898200 0 Physicians Physician Services 00 1538898655 0 DILLER EANN J 2022157 9999999 B 10 1538898655 0 1025 MAINE ST QUINCY IL 623014038 20 1538898655 0 Physical Therapists Medical Supplies 20 1538898655 0 Physical Therapists Medical equipment/prosthetic devices 20 1538898655 0 Physical Therapists Physical Therapy Services 00 1538900378 0 SEERING THERESA 2024337 9999999 B 10 1538900378 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1538900378 0 Physician Assistant Only Fluoride varnish 20 1538900378 0 Physician Assistant Only Healthy Kids Services 20 1538900378 0 Physician Assistant Only Physician Services 00 1538901954 0 ALI FURKHAN 2024192 9999999 B 10 1538901954 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1538901954 0 Physicians Anesthesia Services 20 1538901954 0 Physicians Fluoride varnish 20 1538901954 0 Physicians Healthy Kids Services 20 1538901954 0 Physicians Optical Supplies 20 1538901954 0 Physicians Physician Services 00 1538902390 0 NANDI LIA 2024191 9999999 B 10 1538902390 0 PO BOX 775257 CHICAGO IL 606775257 20 1538902390 0 Physicians Anesthesia Services 20 1538902390 0 Physicians Fluoride varnish 20 1538902390 0 Physicians Healthy Kids Services 20 1538902390 0 Physicians Optical Supplies 20 1538902390 0 Physicians Physician Services 00 1538902812 0 LEWIS APRIL Y 2024169 9999999 B 10 1538902812 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1538902812 0 Physicians Anesthesia Services 20 1538902812 0 Physicians Healthy Kids Services 20 1538902812 0 Physicians Optical Supplies 20 1538902812 0 Physicians Physician Services 00 1538902937 0 HER MAI 2024299 9999999 B 10 1538902937 0 302 N JACKSON ST MILWAUKEE WI 532025904 20 1538902937 0 Nurse Practitioners Fluoride varnish 20 1538902937 0 Nurse Practitioners Healthy Kids Services 20 1538902937 0 Nurse Practitioners Nurse Practitioners Services 20 1538902937 0 Nurse Practitioners Physician Services 00 1538904263 0 HOFF AMANDA L 2024213 9999999 B 10 1538904263 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1538904263 0 Nurse Practitioners Healthy Kids Services 20 1538904263 0 Nurse Practitioners Nurse Practitioners Services 20 1538904263 0 Nurse Practitioners Physician Services 00 1538904883 0 CERVANTES DIAZ FRIDA N 2024211 9999999 B 10 1538904883 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1538904883 0 Physicians Anesthesia Services 20 1538904883 0 Physicians Fluoride varnish 20 1538904883 0 Physicians Healthy Kids Services 20 1538904883 0 Physicians Optical 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Optometrists Optometric Services 20 1538918420 0 Optometrists Physician Services 00 1538919485 0 HAQ MAHAM 2024182 9999999 B 10 1538919485 0 PO BOX 3039 OAK BROOK IL 605223039 20 1538919485 0 Physicians Anesthesia Services 20 1538919485 0 Physicians Fluoride varnish 20 1538919485 0 Physicians Healthy Kids Services 20 1538919485 0 Physicians Optical Supplies 20 1538919485 0 Physicians Physician Services 00 1538919550 0 RAMCHANDRAN SHWETHA 2024192 9999999 B 10 1538919550 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1538919550 0 Physicians Anesthesia Services 20 1538919550 0 Physicians Healthy Kids Services 20 1538919550 0 Physicians Optical Supplies 20 1538919550 0 Physicians Physician Services 20 1538919550 0 Physicians Physicians Psychiatric Services 00 1538919576 0 KOTHA PRASANTH S 2024176 9999999 B 10 1538919576 0 4698 DEPT CAROL STREAM IL 601220021 20 1538919576 0 Physicians Anesthesia Services 20 1538919576 0 Physicians Fluoride varnish 20 1538919576 0 Physicians Healthy Kids Services 20 1538919576 0 Physicians Optical Supplies 20 1538919576 0 Physicians Physician Services 00 1538920756 0 PETR GRACE 2024095 9999999 B 10 1538920756 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1538920756 0 Physician Assistant Only Fluoride varnish 20 1538920756 0 Physician Assistant Only Healthy Kids Services 20 1538920756 0 Physician Assistant Only Physician Services 00 1538922323 0 DERRICKSON JENNIFER L 2024233 9999999 B 10 1538922323 0 611 W PARK ST URBANA IL 618012529 20 1538922323 0 Nurse Practitioners Fluoride varnish 20 1538922323 0 Nurse Practitioners Healthy Kids Services 20 1538922323 0 Nurse Practitioners Nurse Practitioners Services 20 1538922323 0 Nurse Practitioners Physician Services 00 1538923693 0 WATKINS BROOKLYNNE 2024060 9999999 B 10 1538923693 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1538923693 0 Physician Assistant Only Fluoride varnish 20 1538923693 0 Physician Assistant Only Healthy Kids Services 20 1538923693 0 Physician Assistant Only 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Physicians Physician Services 00 1538929070 0 BLASIUS LABORDE TAYLOR 2024209 9999999 B 10 1538929070 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1538929070 0 Physicians Anesthesia Services 20 1538929070 0 Physicians Fluoride varnish 20 1538929070 0 Physicians Healthy Kids Services 20 1538929070 0 Physicians Optical Supplies 20 1538929070 0 Physicians Physician Services 00 1538929583 0 CAVENDER ADRIAN A 2024239 9999999 B 10 1538929583 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1538929583 0 Physicians Anesthesia Services 20 1538929583 0 Physicians Fluoride varnish 20 1538929583 0 Physicians Healthy Kids Services 20 1538929583 0 Physicians Optical Supplies 20 1538929583 0 Physicians Physician Services 00 1538930946 0 JIWANI SEHRISH 2024144 9999999 B 10 1538930946 0 PO BOX 5588 BELFAST ME 049155500 20 1538930946 0 Nurse Practitioners Fluoride varnish 20 1538930946 0 Nurse Practitioners Healthy Kids Services 20 1538930946 0 Nurse Practitioners Nurse Practitioners Services 20 1538930946 0 Nurse Practitioners Physician Services 00 1538933148 0 VARDY SAHAR 2023319 9999999 B 10 1538933148 0 5777 DEPT CAROL STREAM IL 601220021 20 1538933148 0 Nurse Practitioners Fluoride varnish 20 1538933148 0 Nurse Practitioners Healthy Kids Services 20 1538933148 0 Nurse Practitioners Nurse Practitioners Services 20 1538933148 0 Nurse Practitioners Physician Services 00 1538933254 0 ELKHATIB MICHELLE A 2024079 9999999 B 10 1538933254 0 29373 NETWORK PL CHICAGO IL 606733039 20 1538933254 0 Nurse Practitioners Fluoride varnish 20 1538933254 0 Nurse Practitioners Healthy Kids Services 20 1538933254 0 Nurse Practitioners Nurse Practitioners Services 20 1538933254 0 Nurse Practitioners Physician Services 00 1538933445 0 RIVERA RAVEN 2024009 9999999 B 10 1538933445 0 1951 NW 7TH AVE STE 300 MIAMI FL 331361112 20 1538933445 0 Clinical Social Worker Social work service 00 1538935507 0 LEE RONALD JORDAN 2024047 9999999 B 10 1538935507 0 310 S GREENLEAF ST STE 212 SUITE 212 GURNEE IL 600315708 20 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1548569767 0 Physicians Anesthesia Services 20 1548569767 0 Physicians Healthy Kids Services 20 1548569767 0 Physicians Optical Supplies 20 1548569767 0 Physicians Physician Services 00 1548569858 0 KHOURY CHARBEL C 2018182 9999999 B 10 1548569858 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1548569858 0 Physicians Anesthesia Services 20 1548569858 0 Physicians Fluoride varnish 20 1548569858 0 Physicians Healthy Kids Services 20 1548569858 0 Physicians Optical Supplies 20 1548569858 0 Physicians Physician Services 00 1548569890 0 KERSTEN TARA A 2022192 9999999 B 10 1548569890 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1548569890 0 Physicians Anesthesia Services 20 1548569890 0 Physicians Healthy Kids Services 20 1548569890 0 Physicians Optical Supplies 20 1548569890 0 Physicians Physician Services 00 1548571888 0 MKPOLULU CHIEDOZIE 2023292 9999999 B 10 1548571888 0 28594 NETWORK PL CHICAGO IL 606731081 20 1548571888 0 Physicians Anesthesia Services 20 1548571888 0 Physicians Healthy Kids Services 20 1548571888 0 Physicians Optical Supplies 20 1548571888 0 Physicians Physician Services 00 1548571953 0 KAUFMAN ROBERT 2015224 9999999 B 10 1548571953 0 1 ZOTEC WAY CARMEL IN 460320052 20 1548571953 0 Physicians Anesthesia Services 20 1548571953 0 Physicians Healthy Kids Services 20 1548571953 0 Physicians Optical Supplies 20 1548571953 0 Physicians Physician Services 00 1548572670 0 PATEL PAYAL 2016159 9999999 B 10 1548572670 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1548572670 0 Physicians Anesthesia Services 20 1548572670 0 Physicians Fluoride varnish 20 1548572670 0 Physicians Healthy Kids Services 20 1548572670 0 Physicians Optical Supplies 20 1548572670 0 Physicians Physician Services 00 1548575384 0 RIVERA SARAH J 2011262 9999999 B 10 1548575384 0 PO BOX 781076 DETROIT MI 482781076 20 1548575384 0 Nurse Practitioners Healthy Kids Services 20 1548575384 0 Nurse Practitioners Nurse Practitioners Services 20 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MEMPHIS TN 381032807 20 1548581085 0 Physicians Anesthesia Services 20 1548581085 0 Physicians Healthy Kids Services 20 1548581085 0 Physicians Optical Supplies 20 1548581085 0 Physicians Physician Services 00 1548581226 0 DICKERSON DAVID M 2013231 9999999 B 10 1548581226 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1548581226 0 Physicians Anesthesia Services 20 1548581226 0 Physicians Healthy Kids Services 20 1548581226 0 Physicians Optical Supplies 20 1548581226 0 Physicians Physician Services 00 1548581275 0 SHARON RONI 2022123 9999999 B 10 1548581275 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1548581275 0 Physicians Anesthesia Services 20 1548581275 0 Physicians Healthy Kids Services 20 1548581275 0 Physicians Optical Supplies 20 1548581275 0 Physicians Physician Services 20 1548581275 0 Physicians Physicians Psychiatric Services 00 1548581408 0 OSBORNE ZACHARY 2017257 9999999 B 10 1548581408 0 221 NE GLEN OAK AVE PEORIA IL 616360002 20 1548581408 0 Physicians Anesthesia Services 20 1548581408 0 Physicians Healthy Kids Services 20 1548581408 0 Physicians Optical Supplies 20 1548581408 0 Physicians Physician Services 00 1548581713 0 GESCHEIDLER JENNIFER 2023089 9999999 B 10 1548581713 0 8400 LOUISIANA ST MERRILLVILLE IN 464106385 20 1548581713 0 Other behavior health professional LCPC/LMFT services 00 1548585128 0 GRAF STACI L 2017076 9999999 B 10 1548585128 0 PO BOX 3988 CARBONDALE IL 629023988 20 1548585128 0 Physicians Anesthesia Services 20 1548585128 0 Physicians Healthy Kids Services 20 1548585128 0 Physicians Optical Supplies 20 1548585128 0 Physicians Physician Services 20 1548585128 0 Physicians Physicians Psychiatric Services 00 1548585193 0 CHEUNG AMANDA C 2014182 9999999 A 10 1548585193 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1548585193 0 Physicians Anesthesia Services 20 1548585193 0 Physicians Healthy Kids Services 20 1548585193 0 Physicians Optical Supplies 20 1548585193 0 Physicians Physician Services 00 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Assistant Only Healthy Kids Services 20 1548779887 0 Physician Assistant Only Physician Services 00 1548780117 0 CASS DARYN 2024193 9999999 B 10 1548780117 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1548780117 0 Physicians Anesthesia Services 20 1548780117 0 Physicians Healthy Kids Services 20 1548780117 0 Physicians Optical Supplies 20 1548780117 0 Physicians Physician Services 00 1548780166 0 MOORE KATHRYN 2022242 9999999 B 10 1548780166 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1548780166 0 Physician Assistant Only Fluoride varnish 20 1548780166 0 Physician Assistant Only Healthy Kids Services 20 1548780166 0 Physician Assistant Only Physician Services 00 1548780315 0 HABITEMICHAEL DEREJE 2025030 9999999 B 10 1548780315 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1548780315 0 Physicians Anesthesia Services 20 1548780315 0 Physicians Fluoride varnish 20 1548780315 0 Physicians Healthy Kids Services 20 1548780315 0 Physicians Optical Supplies 20 1548780315 0 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1548885791 0 Physicians Anesthesia Services 20 1548885791 0 Physicians Healthy Kids Services 20 1548885791 0 Physicians Optical Supplies 20 1548885791 0 Physicians Physician Services 20 1548885791 0 Physicians Physicians Psychiatric Services 00 1548886542 0 GRAMAN DIANE 2020253 9999999 B 10 1548886542 0 300 N OTTAWA ST JOLIET IL 604324009 20 1548886542 0 Nurse Practitioners Fluoride varnish 20 1548886542 0 Nurse Practitioners Healthy Kids Services 20 1548886542 0 Nurse Practitioners Nurse Practitioners Services 20 1548886542 0 Nurse Practitioners Physician Services 00 1548887003 0 HOMAN VILIJA 2020188 9999999 B 10 1548887003 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1548887003 0 Speech Therapists Medical Supplies 20 1548887003 0 Speech Therapists Medical equipment/prosthetic devices 20 1548887003 0 Speech Therapists Speech Therapy/Pathology Services 00 1548887276 0 LEHOCKY ALINA 2020248 9999999 B 10 1548887276 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1548887276 0 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Physician Assistant Only Physician Services 00 1548889710 0 GREGORY ANASTACIA D 2020232 9999999 B 10 1548889710 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1548889710 0 Nurse Practitioners Anesthesia Services 20 1548889710 0 Nurse Practitioners Nurse Practitioners Services 20 1548889710 0 Nurse Practitioners Physician Services 00 1548889942 0 HARRINGTON AMANDA 2020211 9999999 B 10 1548889942 0 1002 N ALLEN ST STE B SUITE B ROBINSON IL 624541167 20 1548889942 0 Nurse Practitioners Fluoride varnish 20 1548889942 0 Nurse Practitioners Healthy Kids Services 20 1548889942 0 Nurse Practitioners Nurse Practitioners Services 20 1548889942 0 Nurse Practitioners Physician Services 00 1548890775 0 ANGELE MEREDITH M 2021271 9999999 B 10 1548890775 0 29373 NETWORK PL CHICAGO IL 606733039 20 1548890775 0 Physician Assistant Only Fluoride varnish 20 1548890775 0 Physician Assistant Only Healthy Kids Services 20 1548890775 0 Physician Assistant Only Physician Services 00 1548891880 0 WHALIN NICOLE L 2022063 9999999 B 10 1548891880 0 PO BOX 372 MATTOON IL 619380372 20 1548891880 0 Nurse Practitioners Healthy Kids Services 20 1548891880 0 Nurse Practitioners Nurse Practitioners Services 20 1548891880 0 Nurse Practitioners Physician Services 00 1548892417 0 YATES AKILAH 2020059 9999999 B 10 1548892417 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1548892417 0 Other behavior health professional LCPC/LMFT services 00 1548892888 0 DAVILA MORALES ANA MARIA 2022193 9999999 B 10 1548892888 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1548892888 0 Physicians Anesthesia Services 20 1548892888 0 Physicians Fluoride varnish 20 1548892888 0 Physicians Healthy Kids Services 20 1548892888 0 Physicians Optical Supplies 20 1548892888 0 Physicians Physician Services 00 1548893084 0 NEIL LISA 2023025 9999999 B 10 1548893084 0 PO BOX 775342 CHICAGO IL 606775342 20 1548893084 0 Nurse Practitioners Fluoride varnish 20 1548893084 0 Nurse Practitioners Healthy 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1548900517 0 Physicians Optical Supplies 20 1548900517 0 Physicians Physician Services 00 1548900947 0 SHAREEF SARAH 2022182 9999999 B 10 1548900947 0 5145 N CALIFORNIA AVE CHICAGO IL 606253661 20 1548900947 0 Physicians Anesthesia Services 20 1548900947 0 Physicians Fluoride varnish 20 1548900947 0 Physicians Healthy Kids Services 20 1548900947 0 Physicians Optical Supplies 20 1548900947 0 Physicians Physician Services 00 1548901127 0 JOHNSON SHELBY 2023353 9999999 B 10 1548901127 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1548901127 0 Physicians Anesthesia Services 20 1548901127 0 Physicians Healthy Kids Services 20 1548901127 0 Physicians Optical Supplies 20 1548901127 0 Physicians Physician Services 00 1548901846 0 GRUNVALD WARREN 2023242 9999999 B 10 1548901846 0 PO BOX 3039 OAK BROOK IL 605223039 20 1548901846 0 Physicians Anesthesia Services 20 1548901846 0 Physicians Healthy Kids Services 20 1548901846 0 Physicians Optical Supplies 20 1548901846 0 Physicians Physician 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Assistant Only Healthy Kids Services 20 1558056796 0 Physician Assistant Only Physician Services 00 1558057422 0 GILL MATTHEW T 2023163 9999999 B 10 1558057422 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1558057422 0 Nurse Practitioners Anesthesia Services 20 1558057422 0 Nurse Practitioners Nurse Practitioners Services 20 1558057422 0 Nurse Practitioners Physician Services 00 1558057521 0 PIELER KAITLYN 2023117 9999999 B 10 1558057521 0 212 BARNEY DR JOLIET IL 604355271 20 1558057521 0 Occupational Therapists Medical Supplies 20 1558057521 0 Occupational Therapists Medical equipment/prosthetic devices 20 1558057521 0 Occupational Therapists Occupational Therapy Services 00 1558057554 0 BZDULA MAXIMILLIAN 2023190 9999999 B 10 1558057554 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1558057554 0 Physicians Anesthesia Services 20 1558057554 0 Physicians Fluoride varnish 20 1558057554 0 Physicians Healthy Kids Services 20 1558057554 0 Physicians Optical Supplies 20 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SUMMERS KATHERINE A 2023137 9999999 B 10 1558059923 0 PO BOX 5629 EVANSVILLE IN 477165629 20 1558059923 0 Physical Therapists Medical Supplies 20 1558059923 0 Physical Therapists Medical equipment/prosthetic devices 20 1558059923 0 Physical Therapists Physical Therapy Services 00 1558060541 0 MARTIN ANNA L 2023065 9999999 B 10 1558060541 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1558060541 0 Nurse Practitioners Healthy Kids Services 20 1558060541 0 Nurse Practitioners Nurse Practitioners Services 20 1558060541 0 Nurse Practitioners Physician Services 00 1558061564 0 PAOLETTI BRIDGET 2023135 9999999 B 10 1558061564 0 5730 W ROOSEVELT RD BUSINESS OFFICE CHICAGO IL 606441580 20 1558061564 0 Clinical Social Worker Social work service 00 1558063909 0 AMIR MALIK 2023206 9999999 B 10 1558063909 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1558063909 0 Physicians Anesthesia Services 20 1558063909 0 Physicians Healthy Kids Services 20 1558063909 0 Physicians Optical Supplies 20 1558063909 0 Physicians Physician Services 00 1558066258 0 KRAFT KARI A 2024248 9999999 B 10 1558066258 0 9007 SAFE HAVEN PL SPRING HILL TN 371746420 20 1558066258 0 Clinical Social Worker Social work service 00 1558066738 0 DAVIS SARAH 2023095 9999999 B 10 1558066738 0 710 N 8TH ST SPRINGFIELD IL 627026324 20 1558066738 0 Other behavior health professional LCPC/LMFT services 00 1558068635 0 GARCIA CRISTIAN 2024240 9999999 B 10 1558068635 0 1951 NW 7TH AVE STE 300 MIAMI FL 331361112 20 1558068635 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1558069542 0 MOORE TANISHA 2024179 9999999 H 10 1558069542 0 1901 W HARRISON ST CHICAGO IL 60612 20 1558069542 0 Physician Assistant Only Fluoride varnish 20 1558069542 0 Physician Assistant Only Healthy Kids Services 20 1558069542 0 Physician Assistant Only Physician Services 00 1558070722 0 KELLOGG NICOLE 2023179 9999999 B 10 1558070722 0 PO BOX 661495 BIRMINGHAM AL 352661495 20 1558070722 0 Nurse Practitioners Anesthesia Services 20 1558070722 0 Nurse Practitioners Nurse Practitioners Services 20 1558070722 0 Nurse Practitioners Physician Services 00 1558073387 0 CUELLAR DEBORAH M 2023223 9999999 B 10 1558073387 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1558073387 0 Nurse Practitioners Healthy Kids Services 20 1558073387 0 Nurse Practitioners Nurse Practitioners Services 20 1558073387 0 Nurse Practitioners Physician Services 00 1558074864 0 PERKINS IZABELLA L 2024044 9999999 B 10 1558074864 0 6300 RIDGLEA PL STE 201 FORT WORTH TX 761165707 20 1558074864 0 Physician Assistant Only Fluoride varnish 20 1558074864 0 Physician Assistant Only Healthy Kids Services 20 1558074864 0 Physician Assistant Only Physician Services 00 1558077453 0 VILLAREAL STEPHANIE 2023166 9999999 B 10 1558077453 0 715 LAKE ST STE 800 OAK PARK IL 603011417 20 1558077453 0 Clinical Social Worker Social work service 00 1558077487 0 POTTER MARISA 2023313 9999999 B 10 1558077487 0 1101 31ST ST STE 110 DOWNERS GROVE IL 605155562 20 1558077487 0 Speech Therapists Medical Supplies 20 1558077487 0 Speech Therapists Medical equipment/prosthetic devices 20 1558077487 0 Speech Therapists Speech Therapy/Pathology Services 00 1558077602 0 SCOTT JENNIFER 2024204 9999999 B 10 1558077602 0 200 STAHLHUT DR LINCOLN IL 626565066 20 1558077602 0 Nurse Practitioners Healthy Kids Services 20 1558077602 0 Nurse Practitioners Nurse Practitioners Services 20 1558077602 0 Nurse Practitioners Physician Services 00 1558079186 0 SPRUELL TAYLOR B 2023012 9999999 B 10 1558079186 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1558079186 0 Physician Assistant Only Fluoride varnish 20 1558079186 0 Physician Assistant Only Healthy Kids Services 20 1558079186 0 Physician Assistant Only Physician Services 00 1558080747 0 POHLMAN ASHLEY 2024206 9999999 B 10 1558080747 0 PO BOX 5081 JANESVILLE WI 535475081 20 1558080747 0 Physicians Anesthesia Services 20 1558080747 0 Physicians Fluoride varnish 20 1558080747 0 Physicians Healthy Kids Services 20 1558080747 0 Physicians Optical Supplies 20 1558080747 0 Physicians Physician Services 00 1558082529 0 THOMAS TIFFANY 2022277 9999999 B 10 1558082529 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1558082529 0 Physical Therapists Medical Supplies 20 1558082529 0 Physical Therapists Medical equipment/prosthetic devices 20 1558082529 0 Physical Therapists Physical Therapy Services 00 1558083600 0 HOLMAN IRIS 2024079 9999999 H 10 1558083600 0 3250 N ARLINGTON HEIGH ARLINGTON HEIGH IL 60004 20 1558083600 0 Physician Assistant Only Fluoride varnish 20 1558083600 0 Physician Assistant Only Healthy Kids Services 20 1558083600 0 Physician Assistant Only Physician Services 00 1558085852 0 HERTZOG ELIZABETH 2022284 9999999 B 10 1558085852 0 8182 W GREENDALE AVE NILES IL 607142738 20 1558085852 0 Speech Therapists Medical Supplies 20 1558085852 0 Speech Therapists Medical equipment/prosthetic devices 20 1558085852 0 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SZCZEPANIK MONIQUE L 2023214 9999999 B 10 1558088427 0 1634 S ARDMORE AVE VILLA PARK IL 601813742 20 1558088427 0 Nurse Practitioners Fluoride varnish 20 1558088427 0 Nurse Practitioners Healthy Kids Services 20 1558088427 0 Nurse Practitioners Nurse Practitioners Services 20 1558088427 0 Nurse Practitioners Physician Services 00 1558090167 0 GOLUBYANTS KARINA 2022181 9999999 B 10 1558090167 0 712 LEE ST DES PLAINES IL 600164584 20 1558090167 0 Dentists Dental Services 20 1558090167 0 Dentists Physician Services 00 1558090357 0 KOCAK BRIAN R 2023362 9999999 B 10 1558090357 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1558090357 0 Physicians Anesthesia Services 20 1558090357 0 Physicians Fluoride varnish 20 1558090357 0 Physicians Healthy Kids Services 20 1558090357 0 Physicians Optical Supplies 20 1558090357 0 Physicians Physician Services 00 1558090779 0 STOESZ KATIE 2024008 9999999 B 10 1558090779 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1558090779 0 Physician Assistant Only Fluoride varnish 20 1558090779 0 Physician Assistant Only Healthy Kids Services 20 1558090779 0 Physician Assistant Only Physician Services 00 1558090886 0 GRAHAM COBB ASHLEY 2022363 9999999 B 10 1558090886 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1558090886 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1558090936 0 PITZAFERRO ALEXANDRA L 2022262 9999999 B 10 1558090936 0 5777 DEPT CAROL STREAM IL 601220021 20 1558090936 0 Nurse Practitioners Healthy Kids Services 20 1558090936 0 Nurse Practitioners Nurse Practitioners Services 20 1558090936 0 Nurse Practitioners Physician Services 00 1558091918 0 RADWANSKI ZACHARY R 2022207 9999999 B 10 1558091918 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1558091918 0 Physicians Anesthesia Services 20 1558091918 0 Physicians Healthy Kids Services 20 1558091918 0 Physicians Optical Supplies 20 1558091918 0 Physicians Physician Services 00 1558092098 0 STANHOPE CLARISSA 2022223 9999999 B 10 1558092098 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1558092098 0 Occupational Therapists Medical Supplies 20 1558092098 0 Occupational Therapists Medical equipment/prosthetic devices 20 1558092098 0 Occupational Therapists Occupational Therapy Services 00 1558092536 0 IFFRIG LEIGH E 2022210 9999999 B 10 1558092536 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1558092536 0 Nurse Practitioners Fluoride varnish 20 1558092536 0 Nurse Practitioners Healthy Kids Services 20 1558092536 0 Nurse Practitioners Nurse Practitioners Services 20 1558092536 0 Nurse Practitioners Physician Services 00 1558092924 0 GRUBB LOGAN R 2022189 9999999 B 10 1558092924 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1558092924 0 Physicians Anesthesia Services 20 1558092924 0 Physicians Fluoride varnish 20 1558092924 0 Physicians Healthy Kids Services 20 1558092924 0 Physicians Optical Supplies 20 1558092924 0 Physicians Physician Services 00 1558093179 0 LUCAS CRYSTAL 2022207 9999999 B 10 1558093179 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1558093179 0 Nurse Practitioners Fluoride varnish 20 1558093179 0 Nurse Practitioners Healthy Kids Services 20 1558093179 0 Nurse Practitioners Nurse Practitioners Services 20 1558093179 0 Nurse Practitioners Physician Services 00 1558094094 0 WAQAR DANISH 2023005 9999999 B 10 1558094094 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1558094094 0 Physicians Anesthesia Services 20 1558094094 0 Physicians Fluoride varnish 20 1558094094 0 Physicians Healthy Kids Services 20 1558094094 0 Physicians Optical Supplies 20 1558094094 0 Physicians Physician Services 00 1558094235 0 TOBERNA CAROLINE P 2022277 9999999 B 10 1558094235 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1558094235 0 Physician Assistant Only Fluoride varnish 20 1558094235 0 Physician Assistant Only Healthy Kids Services 20 1558094235 0 Physician Assistant Only Physician Services 00 1558095323 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Physicians Healthy Kids Services 20 1558103465 0 Physicians Optical Supplies 20 1558103465 0 Physicians Physician Services 00 1558103770 0 ALKHASSIB SAMAA 2024191 9999999 B 10 1558103770 0 800 KIRTS BLVD STE 650 TROY MI 480844878 20 1558103770 0 Dentists Dental Services 20 1558103770 0 Dentists Physician Services 00 1558104141 0 ERLAND MIA 2024170 9999999 B 10 1558104141 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1558104141 0 Clinical Social Worker Social work service 00 1558105130 0 SKALLERUD WILLIAM 2024190 9999999 B 10 1558105130 0 PO BOX 855795 MINNEAPOLIS MN 554851296 20 1558105130 0 Physicians Anesthesia Services 20 1558105130 0 Physicians Fluoride varnish 20 1558105130 0 Physicians Healthy Kids Services 20 1558105130 0 Physicians Optical Supplies 20 1558105130 0 Physicians Physician Services 00 1558105700 0 SANII RYAN 2024232 9999999 B 10 1558105700 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1558105700 0 Physicians Anesthesia Services 20 1558105700 0 Physicians Healthy Kids Services 20 1558105700 0 Physicians Optical Supplies 20 1558105700 0 Physicians Physician Services 00 1558106831 0 TUBBS ANDREW S 2024179 9999999 B 10 1558106831 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1558106831 0 Physicians Anesthesia Services 20 1558106831 0 Physicians Healthy Kids Services 20 1558106831 0 Physicians Optical Supplies 20 1558106831 0 Physicians Physician Services 20 1558106831 0 Physicians Physicians Psychiatric Services 00 1558111047 0 CASOS KRISTINA 2024209 9999999 B 10 1558111047 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1558111047 0 Physicians Anesthesia Services 20 1558111047 0 Physicians Healthy Kids Services 20 1558111047 0 Physicians Optical Supplies 20 1558111047 0 Physicians Physician Services 00 1558111351 0 MARTINEZ RUBEN 2024171 9999999 B 10 1558111351 0 PO BOX 3039 OAK BROOK IL 605223039 20 1558111351 0 Physicians Anesthesia Services 20 1558111351 0 Physicians Fluoride varnish 20 1558111351 0 Physicians Healthy Kids Services 20 1558111351 0 Physicians Optical Supplies 20 1558111351 0 Physicians Physician Services 00 1558112730 0 TREMBLEY KEVIN 2024184 9999999 B 10 1558112730 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1558112730 0 Physicians Anesthesia Services 20 1558112730 0 Physicians Healthy Kids Services 20 1558112730 0 Physicians Optical Supplies 20 1558112730 0 Physicians Physician Services 00 1558113639 0 PEREZ NEGRIN MARLA 2024161 9999999 B 10 1558113639 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1558113639 0 Physicians Anesthesia Services 20 1558113639 0 Physicians Fluoride varnish 20 1558113639 0 Physicians Healthy Kids Services 20 1558113639 0 Physicians Optical Supplies 20 1558113639 0 Physicians Physician Services 00 1558114272 0 EVANS CHRISTY J 2024178 9999999 B 10 1558114272 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1558114272 0 Physicians Anesthesia Services 20 1558114272 0 Physicians Healthy Kids Services 20 1558114272 0 Physicians Optical Supplies 20 1558114272 0 Physicians Physician Services 00 1558114504 0 GUPTA DEVEN 2024179 9999999 B 10 1558114504 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1558114504 0 Physicians Anesthesia Services 20 1558114504 0 Physicians Healthy Kids Services 20 1558114504 0 Physicians Optical Supplies 20 1558114504 0 Physicians Physician Services 00 1558115592 0 BYRNE WILLIAM 2024129 9999999 B 10 1558115592 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1558115592 0 Nurse Practitioners Healthy Kids Services 20 1558115592 0 Nurse Practitioners Nurse Practitioners Services 20 1558115592 0 Nurse Practitioners Physician Services 00 1558115923 0 DHUNGANA SHRESTHA ISHA 2024157 9999999 B 10 1558115923 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1558115923 0 Physicians Anesthesia Services 20 1558115923 0 Physicians Healthy Kids Services 20 1558115923 0 Physicians Optical Supplies 20 1558115923 0 Physicians Physician Services 20 1558115923 0 Physicians Physicians Psychiatric Services 00 1558117515 0 HEREDIA ABBEY M 2024298 9999999 B 10 1558117515 0 4701 N OAK ST CRYSTAL LAKE IL 600123309 20 1558117515 0 Occupational Therapists Medical Supplies 20 1558117515 0 Occupational Therapists Medical equipment/prosthetic devices 20 1558117515 0 Occupational Therapists Occupational Therapy Services 00 1558118158 0 JAFARZADEH SHEIKH EBRAHIM 2024205 9999999 B 10 1558118158 0 2211 N ELSTON AVE STE 301 CHICAGO IL 606149278 20 1558118158 0 Physicians Anesthesia Services 20 1558118158 0 Physicians Fluoride varnish 20 1558118158 0 Physicians Healthy Kids Services 20 1558118158 0 Physicians Optical Supplies 20 1558118158 0 Physicians Physician Services 00 1558119784 0 REDENIUS LAURA 2024206 9999999 B 10 1558119784 0 350 N WALL ST KANKAKEE IL 609012901 20 1558119784 0 Nurse Practitioners Fluoride varnish 20 1558119784 0 Nurse Practitioners Healthy Kids Services 20 1558119784 0 Nurse Practitioners Nurse Practitioners Services 20 1558119784 0 Nurse Practitioners Physician Services 00 1558120071 0 DEFILIPPO CHRISTINE G 2024176 9999999 B 10 1558120071 0 4698 DEPT CAROL STREAM IL 601220021 20 1558120071 0 Physicians Anesthesia Services 20 1558120071 0 Physicians Healthy Kids Services 20 1558120071 0 Physicians Optical Supplies 20 1558120071 0 Physicians Physician Services 00 1558120923 0 JOHNSON CHRISTOPHER 2024193 9999999 B 10 1558120923 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1558120923 0 Physicians Anesthesia Services 20 1558120923 0 Physicians Healthy Kids Services 20 1558120923 0 Physicians Optical Supplies 20 1558120923 0 Physicians Physician Services 00 1558121087 0 WHITTEN JOHN P 2024238 9999999 B 10 1558121087 0 124 SW ADAMS ST PEORIA IL 616021308 20 1558121087 0 Physicians Anesthesia Services 20 1558121087 0 Physicians Healthy Kids Services 20 1558121087 0 Physicians Optical Supplies 20 1558121087 0 Physicians Physician Services 00 1558121830 0 LIU IAN 2024214 9999999 B 10 1558121830 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1558121830 0 Physicians 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Services 20 1558127134 0 Nurse Practitioners Physician Services 00 1558132266 0 GOSSETT KELSEY P 2024019 9999999 B 10 1558132266 0 PO BOX 778912 CHICAGO IL 606778912 20 1558132266 0 Clinical Social Worker Social work service 00 1558132522 0 YOON YUNJI 2024019 9999999 B 10 1558132522 0 407 WILLOUGHBY AVE BROOKLYN NY 112054590 20 1558132522 0 Nurse Practitioners Fluoride varnish 20 1558132522 0 Nurse Practitioners Healthy Kids Services 20 1558132522 0 Nurse Practitioners Nurse Practitioners Services 20 1558132522 0 Nurse Practitioners Nursing service 20 1558132522 0 Nurse Practitioners Physician Services 20 1558132522 0 Nurse Practitioners Waiver service 00 1558133116 0 RHOADS SARAH P 2023352 9999999 B 10 1558133116 0 2431 GLENMOUNT CT BELLEVILLE IL 622218803 20 1558133116 0 Occupational Therapists Medical Supplies 20 1558133116 0 Occupational Therapists Medical equipment/prosthetic devices 20 1558133116 0 Occupational Therapists Occupational Therapy Services 00 1558133728 0 SINGH MICKEY 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Anesthesia Services 20 1558326363 0 Physicians Healthy Kids Services 20 1558326363 0 Physicians Optical Supplies 20 1558326363 0 Physicians Physician Services 00 1558326439 0 BAKER HOWARD R 1994175 9999999 B 10 1558326439 0 5777 DEPT CAROL STREAM IL 601220021 20 1558326439 0 Physicians Anesthesia Services 20 1558326439 0 Physicians Fluoride varnish 20 1558326439 0 Physicians Healthy Kids Services 20 1558326439 0 Physicians Optical Supplies 20 1558326439 0 Physicians Physician Services 00 1558326629 0 AOKI ANDY 2021225 9999999 B 10 1558326629 0 PO BOX 778791 CHICAGO IL 606776473 20 1558326629 0 Physicians Anesthesia Services 20 1558326629 0 Physicians Healthy Kids Services 20 1558326629 0 Physicians Optical Supplies 20 1558326629 0 Physicians Physician Services 00 1558326710 0 MEZRICH JOSHUA D 2005182 9999999 B 10 1558326710 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1558326710 0 Physicians Anesthesia Services 20 1558326710 0 Physicians Healthy Kids Services 20 1558326710 0 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1558327486 0 Physicians Physician Services 00 1558327890 0 GOLDBERGER DAVID B 2022241 9999999 B 10 1558327890 0 5701 W TALAVI BLVD STE 120 GLENDALE AZ 853061888 20 1558327890 0 Physicians Anesthesia Services 20 1558327890 0 Physicians Fluoride varnish 20 1558327890 0 Physicians Healthy Kids Services 20 1558327890 0 Physicians Optical Supplies 20 1558327890 0 Physicians Physician Services 00 1558328377 0 CODY DOUGLAS THANE 1996183 9999999 B 10 1558328377 0 303 N JACKSON ST MORRISON IL 612703042 20 1558328377 0 Physicians Anesthesia Services 20 1558328377 0 Physicians Healthy Kids Services 20 1558328377 0 Physicians Optical Supplies 20 1558328377 0 Physicians Physician Services 00 1558328633 0 LOVINGGOOD JAMES P 2012335 9999999 B 10 1558328633 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1558328633 0 Physicians Anesthesia Services 20 1558328633 0 Physicians Healthy Kids Services 20 1558328633 0 Physicians Optical Supplies 20 1558328633 0 Physicians Physician Services 00 1558328831 0 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1558337089 0 Physicians Anesthesia Services 20 1558337089 0 Physicians Healthy Kids Services 20 1558337089 0 Physicians Optical Supplies 20 1558337089 0 Physicians Physician Services 00 1558337295 0 MITTAL BHARAT 1985108 9999999 B 10 1558337295 0 5777 DEPT CAROL STREAM IL 601220021 20 1558337295 0 Physicians Anesthesia Services 20 1558337295 0 Physicians Healthy Kids Services 20 1558337295 0 Physicians Optical Supplies 20 1558337295 0 Physicians Physician Services 00 1558337519 0 MERRITT ELIZABETH E 2003001 9999999 B 10 1558337519 0 7344 SOLUTIONS CTR CHICAGO IL 606777003 20 1558337519 0 Nurse Practitioners Fluoride varnish 20 1558337519 0 Nurse Practitioners Healthy Kids Services 20 1558337519 0 Nurse Practitioners Nurse Practitioners Services 20 1558337519 0 Nurse Practitioners Physician Services 00 1558337840 0 OZARK GREGORY 1998213 9999999 B 10 1558337840 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1558337840 0 Physicians Anesthesia Services 20 1558337840 0 Physicians Fluoride varnish 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1558389361 0 Nurse Practitioners Fluoride varnish 20 1558389361 0 Nurse Practitioners Healthy Kids Services 20 1558389361 0 Nurse Practitioners Nurse Practitioners Services 20 1558389361 0 Nurse Practitioners Physician Services 00 1558389866 0 BOSCHERT MARK T 2013032 9999999 B 10 1558389866 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1558389866 0 Physicians Anesthesia Services 20 1558389866 0 Physicians Healthy Kids Services 20 1558389866 0 Physicians Optical Supplies 20 1558389866 0 Physicians Physician Services 00 1558390211 0 LOPP BRIAN ROBERT 2006205 9999999 B 10 1558390211 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1558390211 0 Physicians Anesthesia Services 20 1558390211 0 Physicians Healthy Kids Services 20 1558390211 0 Physicians Optical Supplies 20 1558390211 0 Physicians Physician Services 00 1558390948 0 KARDOS KATRINA 2024207 9999999 B 10 1558390948 0 PO BOX 43230 PHOENIX AZ 850803230 20 1558390948 0 Physicians Anesthesia Services 20 1558390948 0 Physicians Healthy 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Services 00 1558394569 0 HEINISCH EDWARD J 1993305 9999999 B 10 1558394569 0 28594 NETWORK PL CHICAGO IL 606731285 20 1558394569 0 Optometrists Optical Supplies 20 1558394569 0 Optometrists Optometric Services 20 1558394569 0 Optometrists Physician Services 00 1558394841 0 HOLTON KEVIN S 2022003 9999999 B 10 1558394841 0 1406 6TH AVE N SAINT CLOUD MN 563031900 20 1558394841 0 Podiatrists Podiatric Services 00 1558396085 0 STRACZYNSKI EDYTA 2006227 9999999 B 10 1558396085 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1558396085 0 Physicians Anesthesia Services 20 1558396085 0 Physicians Fluoride varnish 20 1558396085 0 Physicians Healthy Kids Services 20 1558396085 0 Physicians Optical Supplies 20 1558396085 0 Physicians Physician Services 00 1558396606 0 COLEMAN DAVID B 2024010 9999999 B 10 1558396606 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1558396606 0 Physicians Anesthesia Services 20 1558396606 0 Physicians Healthy Kids Services 20 1558396606 0 Physicians 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Physicians Physician Services 00 1558398008 0 GANSCHOW PAMELA 1998335 9999999 B 10 1558398008 0 1220 S WOOD ST CHICAGO IL 606081202 20 1558398008 0 Physicians Anesthesia Services 20 1558398008 0 Physicians Family Planning Counseling 20 1558398008 0 Physicians Fluoride varnish 20 1558398008 0 Physicians Healthy Kids Services 20 1558398008 0 Physicians Optical Supplies 20 1558398008 0 Physicians Physician Services 00 1558398263 0 MURRAY GINA M 2007244 9999999 B 10 1558398263 0 5777 DEPT CAROL STREAM IL 601220021 20 1558398263 0 Physicians Anesthesia Services 20 1558398263 0 Physicians Healthy Kids Services 20 1558398263 0 Physicians Optical Supplies 20 1558398263 0 Physicians Physician Services 00 1558398388 0 MIZUNO ERIC 1992183 9999999 B 10 1558398388 0 850 W IRVING PARK RD CHICAGO IL 606133077 20 1558398388 0 Physicians Anesthesia Services 20 1558398388 0 Physicians Fluoride varnish 20 1558398388 0 Physicians Healthy Kids Services 20 1558398388 0 Physicians Optical Supplies 20 1558398388 0 Physicians Physician Services 00 1558398685 0 NARRA VAMSIDHAR 2002182 9999999 B 10 1558398685 0 PO BOX 60352 SAINT LOUIS MO 631600352 20 1558398685 0 Physicians Anesthesia Services 20 1558398685 0 Physicians Healthy Kids Services 20 1558398685 0 Physicians Optical Supplies 20 1558398685 0 Physicians Physician Services 00 1558399279 0 LEACH WILLIAM C 2019326 9999999 B 10 1558399279 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1558399279 0 Physicians Anesthesia Services 20 1558399279 0 Physicians Healthy Kids Services 20 1558399279 0 Physicians Optical Supplies 20 1558399279 0 Physicians Physician Services 00 1558399949 0 BURANOSKY MARK P 1996158 9999999 B 10 1558399949 0 5600 W ADDISON ST STE 102 CHICAGO IL 606344401 20 1558399949 0 Physicians Anesthesia Services 20 1558399949 0 Physicians Healthy Kids Services 20 1558399949 0 Physicians Optical Supplies 20 1558399949 0 Physicians Physician Services 00 1558400358 0 BEKKER SIMON 2009182 9999999 B 10 1558400358 0 PO BOX 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920 E NORTHWEST HWY MOUNT PROSPECT IL 600563444 20 1558411561 0 Physical Therapists Physical Therapy Services 00 1558411645 0 FROWNFELTER DEBORAH J 2004183 9999999 B 10 1558411645 0 611 W PARK ST URBANA IL 618012529 20 1558411645 0 Nurse Practitioners Fluoride varnish 20 1558411645 0 Nurse Practitioners Healthy Kids Services 20 1558411645 0 Nurse Practitioners Nurse Practitioners Services 20 1558411645 0 Nurse Practitioners Physician Services 00 1558412106 0 ASFOUR SAWSAN 1996278 9999999 B 10 1558412106 0 10607 S HARLEM AVE UNIT 2 UNIT 2 WORTH IL 604821649 20 1558412106 0 Dentists Dental Services 20 1558412106 0 Dentists Physician Services 00 1558412130 0 WOODBURY BRENT 2021304 9999999 B 10 1558412130 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1558412130 0 Physicians Anesthesia Services 20 1558412130 0 Physicians Healthy Kids Services 20 1558412130 0 Physicians Optical Supplies 20 1558412130 0 Physicians Physician Services 00 1558413054 0 PIECZYNSKI KIMBERLY 2010152 9999999 B 10 1558413054 0 2500 W HIGGINS RD STE 440 HOFFMAN ESTATES IL 601692044 20 1558413054 0 Nurse Practitioners Fluoride varnish 20 1558413054 0 Nurse Practitioners Healthy Kids Services 20 1558413054 0 Nurse Practitioners Nurse Practitioners Services 20 1558413054 0 Nurse Practitioners Physician Services 00 1558413294 0 RUBENSTEIN JONATHAN B 1986272 9999999 B 10 1558413294 0 1725 W HARRISON ST STE 906 CHICAGO IL 606123848 20 1558413294 0 Physicians Anesthesia Services 20 1558413294 0 Physicians Healthy Kids Services 20 1558413294 0 Physicians Optical Supplies 20 1558413294 0 Physicians Physician Services 00 1558413302 0 GUPTA RUCHI 2018207 9999999 B 10 1558413302 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1558413302 0 Physicians Anesthesia Services 20 1558413302 0 Physicians Fluoride varnish 20 1558413302 0 Physicians Healthy Kids Services 20 1558413302 0 Physicians Optical Supplies 20 1558413302 0 Physicians Physician Services 00 1558414243 0 GORDON CHRISTAL A 1990203 9999999 B 10 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1558417881 0 Physicians Healthy Kids Services 20 1558417881 0 Physicians Optical Supplies 20 1558417881 0 Physicians Physician Services 00 1558418343 0 KILKELLY JILL 2021238 9999999 B 10 1558418343 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1558418343 0 Physicians Anesthesia Services 20 1558418343 0 Physicians Healthy Kids Services 20 1558418343 0 Physicians Optical Supplies 20 1558418343 0 Physicians Physician Services 00 1558418590 0 EGAN JOHN C 2017181 9999999 B 10 1558418590 0 3200 E CAMELBACK RD STE 250 PHOENIX AZ 850182327 20 1558418590 0 Physicians Anesthesia Services 20 1558418590 0 Physicians Healthy Kids Services 20 1558418590 0 Physicians Optical Supplies 20 1558418590 0 Physicians Physician Services 00 1558419325 0 SMITH ROBERT 2007152 9999999 B 10 1558419325 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1558419325 0 Optometrists Optical Supplies 20 1558419325 0 Optometrists Optometric Services 20 1558419325 0 Optometrists Physician Services 00 1558421727 0 BHURGRI ABDUL 1996214 9999999 B 10 1558421727 0 966 W 21ST ST CHICAGO IL 606084511 20 1558421727 0 Physicians Anesthesia Services 20 1558421727 0 Physicians Fluoride varnish 20 1558421727 0 Physicians Healthy Kids Services 20 1558421727 0 Physicians Optical Supplies 20 1558421727 0 Physicians Physician Services 00 1558421875 0 HAWKINS JAMES N 1998216 9999999 B 10 1558421875 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1558421875 0 Physicians Anesthesia Services 20 1558421875 0 Physicians Healthy Kids Services 20 1558421875 0 Physicians Optical Supplies 20 1558421875 0 Physicians Physician Services 00 1558422543 0 KARIUS EDWARD 1998057 9999999 B 10 1558422543 0 1467 N ELSTON AVE STE 103 CHICAGO IL 606422449 20 1558422543 0 Physical Therapists Medical Supplies 20 1558422543 0 Physical Therapists Medical equipment/prosthetic devices 20 1558422543 0 Physical Therapists Physical Therapy Services 00 1558423004 0 PANNAIN SILVANA 2004183 9999999 B 10 1558423004 0 150 HARVESTER DR STE 300 BURR RIDGE IL 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1558458554 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1558458554 0 Physicians Anesthesia Services 20 1558458554 0 Physicians Fluoride varnish 20 1558458554 0 Physicians Healthy Kids Services 20 1558458554 0 Physicians Optical Supplies 20 1558458554 0 Physicians Physician Services 00 1558459099 0 STAKENAS STEVEN 2008021 9999999 B 10 1558459099 0 5777 DEPT CAROL STREAM IL 601220021 20 1558459099 0 Nurse Practitioners Fluoride varnish 20 1558459099 0 Nurse Practitioners Healthy Kids Services 20 1558459099 0 Nurse Practitioners Nurse Practitioners Services 20 1558459099 0 Nurse Practitioners Physician Services 00 1558459560 0 HASSAN RANDA M 2009306 9999999 B 10 1558459560 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1558459560 0 Physicians Anesthesia Services 20 1558459560 0 Physicians Healthy Kids Services 20 1558459560 0 Physicians Optical Supplies 20 1558459560 0 Physicians Physician Services 00 1558460022 0 SASSO BRIAN 2005213 9999999 B 10 1558460022 0 1615 N CONVENT ST STE 1 STE 1 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1558789826 0 Physicians Healthy Kids Services 20 1558789826 0 Physicians Optical Supplies 20 1558789826 0 Physicians Physician Services 00 1558789891 0 MOLL WILLIAM 2016004 9999999 B 10 1558789891 0 7732 SOLUTION CENTER CHICAGO IL 606777007 20 1558789891 0 Dentists Dental Services 20 1558789891 0 Dentists Physician Services 00 1558791350 0 POINDEXTER AMANDA 2013335 9999999 B 10 1558791350 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1558791350 0 Nurse Practitioners Fluoride varnish 20 1558791350 0 Nurse Practitioners Healthy Kids Services 20 1558791350 0 Nurse Practitioners Nurse Practitioners Services 20 1558791350 0 Nurse Practitioners Physician Services 00 1558791459 0 MULDER BRIAN T 2013298 9999999 B 10 1558791459 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1558791459 0 Nurse Practitioners Fluoride varnish 20 1558791459 0 Nurse Practitioners Healthy Kids Services 20 1558791459 0 Nurse Practitioners Nurse Practitioners Services 20 1558791459 0 Nurse Practitioners 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1558803247 0 Physicians Anesthesia Services 20 1558803247 0 Physicians Fluoride varnish 20 1558803247 0 Physicians Healthy Kids Services 20 1558803247 0 Physicians Optical Supplies 20 1558803247 0 Physicians Physician Services 00 1558803791 0 SAENGMANY JACQUELYN V 2017001 9999999 B 10 1558803791 0 PO BOX 5081 JANESVILLE WI 535475081 20 1558803791 0 Nurse Practitioners Healthy Kids Services 20 1558803791 0 Nurse Practitioners Nurse Practitioners Services 20 1558803791 0 Nurse Practitioners Physician Services 00 1558805705 0 WOLF CRYSTAL 2017062 9999999 B 10 1558805705 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1558805705 0 Physician Assistant Only Fluoride varnish 20 1558805705 0 Physician Assistant Only Healthy Kids Services 20 1558805705 0 Physician Assistant Only Physician Services 00 1558806224 0 OKOLO CINDY A 2018032 9999999 B 10 1558806224 0 PO BOX 708760 SANDY UT 840708760 20 1558806224 0 Nurse Practitioners Fluoride varnish 20 1558806224 0 Nurse 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JASON 2017227 9999999 B 10 1558874453 0 411 S COURT ST MARION IL 629592711 20 1558874453 0 Speech Therapists Medical Supplies 20 1558874453 0 Speech Therapists Medical equipment/prosthetic devices 20 1558874453 0 Speech Therapists Speech Therapy/Pathology Services 00 1558874891 0 COYNE CLAIRE 2018045 9999999 B 10 1558874891 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1558874891 0 Psychologist Psychologist service 00 1558875500 0 HAVEL BRITTANY R 2021260 9999999 B 10 1558875500 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1558875500 0 Nurse Practitioners Fluoride varnish 20 1558875500 0 Nurse Practitioners Healthy Kids Services 20 1558875500 0 Nurse Practitioners Nurse Practitioners Services 20 1558875500 0 Nurse Practitioners Physician Services 00 1558875732 0 HUTCHINGS ELIZA 2019025 9999999 B 10 1558875732 0 224 S LOCUST ST CENTRALIA IL 628013509 20 1558875732 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 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MAIN ST WEST SALEM IL 624761202 20 1558880872 0 Physician Assistant Only Fluoride varnish 20 1558880872 0 Physician Assistant Only Healthy Kids Services 20 1558880872 0 Physician Assistant Only Physician Services 00 1558881052 0 OWENS AMBER M 2021061 9999999 B 10 1558881052 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1558881052 0 Nurse Practitioners Healthy Kids Services 20 1558881052 0 Nurse Practitioners Nurse Practitioners Services 20 1558881052 0 Nurse Practitioners Physician Services 00 1558881110 0 WENGERSKI PAULA P 2017244 9999999 B 10 1558881110 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1558881110 0 Physician Assistant Only Fluoride varnish 20 1558881110 0 Physician Assistant Only Healthy Kids Services 20 1558881110 0 Physician Assistant Only Physician Services 00 1558881409 0 KIDD ALLIE E 2019288 9999999 B 10 1558881409 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1558881409 0 Physicians Anesthesia Services 20 1558881409 0 Physicians Healthy Kids Services 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1558990598 0 Nurse Practitioners Healthy Kids Services 20 1558990598 0 Nurse Practitioners Nurse Practitioners Services 20 1558990598 0 Nurse Practitioners Physician Services 00 1558990960 0 GREGORY LAUREN 2020317 9999999 B 10 1558990960 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1558990960 0 Nurse Practitioners Fluoride varnish 20 1558990960 0 Nurse Practitioners Healthy Kids Services 20 1558990960 0 Nurse Practitioners Nurse Practitioners Services 20 1558990960 0 Nurse Practitioners Physician Services 00 1558994343 0 CHARTRAND MEGAN 2020113 9999999 B 10 1558994343 0 400 N HIGHLAND AVE AURORA IL 605063814 20 1558994343 0 Nurse Practitioners Healthy Kids Services 20 1558994343 0 Nurse Practitioners Nurse Practitioners Services 20 1558994343 0 Nurse Practitioners Physician Services 00 1558996942 0 KOUGBANI-SEBOU MARCELINE 2020225 9999999 B 10 1558996942 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1558996942 0 Nurse Practitioners Fluoride varnish 20 1558996942 0 Nurse 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1558997908 0 Physicians Healthy Kids Services 20 1558997908 0 Physicians Optical Supplies 20 1558997908 0 Physicians Physician Services 00 1558998898 0 SORENSON JOSHUA A 2022149 9999999 B 10 1558998898 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1558998898 0 Physicians Anesthesia Services 20 1558998898 0 Physicians Healthy Kids Services 20 1558998898 0 Physicians Optical Supplies 20 1558998898 0 Physicians Physician Services 00 1558999458 0 VAZQUEZ PHILIP 2023212 9999999 B 10 1558999458 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1558999458 0 Physicians Anesthesia Services 20 1558999458 0 Physicians Healthy Kids Services 20 1558999458 0 Physicians Optical Supplies 20 1558999458 0 Physicians Physician Services 00 1568001105 0 STOCCHERO MAXIMILLIAN E 2020191 9999999 B 10 1568001105 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1568001105 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1568001337 0 NAVARRO ERICA 2020016 9999999 B 10 1568001337 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1568001337 0 Clinical Social Worker Social work service 00 1568002491 0 LUSH ROSE 2024130 9999999 B 10 1568002491 0 1902 FOX DR STE B CHAMPAIGN IL 618207378 20 1568002491 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1568002673 0 GARDNER MEGAN 2020043 9999999 B 10 1568002673 0 611 W PARK ST URBANA IL 618012529 20 1568002673 0 Nurse Practitioners Fluoride varnish 20 1568002673 0 Nurse Practitioners Healthy Kids Services 20 1568002673 0 Nurse Practitioners Nurse Practitioners Services 20 1568002673 0 Nurse Practitioners Physician Services 00 1568003622 0 DODGE AARON N 2020216 9999999 B 10 1568003622 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1568003622 0 Physician Assistant Only Fluoride varnish 20 1568003622 0 Physician Assistant Only Healthy Kids Services 20 1568003622 0 Physician Assistant Only Physician Services 00 1568004463 0 WINSTON MEGHAN 2020003 9999999 B 10 1568004463 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1568004463 0 Physician Assistant Only Fluoride varnish 20 1568004463 0 Physician Assistant Only Healthy Kids Services 20 1568004463 0 Physician Assistant Only Physician Services 00 1568004620 0 HAWKINS JACQUES 2019304 9999999 B 10 1568004620 0 410 157TH ST CALUMET CITY IL 604094704 20 1568004620 0 Speech Therapists Medical Supplies 20 1568004620 0 Speech Therapists Medical equipment/prosthetic devices 20 1568004620 0 Speech Therapists Speech Therapy/Pathology Services 00 1568004968 0 WEST KYLE R 2022041 9999999 B 10 1568004968 0 PO BOX 776084 CHICAGO IL 606776084 20 1568004968 0 Nurse Practitioners Anesthesia Services 20 1568004968 0 Nurse Practitioners Nurse Practitioners Services 20 1568004968 0 Nurse Practitioners Physician Services 00 1568006096 0 MCKNIGHT BRIDGET 2023059 9999999 B 10 1568006096 0 5906 ELAINE DR STE 103 ROCKFORD IL 611082467 20 1568006096 0 Clinical Social Worker Social work service 00 1568006195 0 OKAFO CORDELIA C 2021224 9999999 B 10 1568006195 0 4001 W DEVON AVE CHICAGO IL 606464523 20 1568006195 0 Nurse Practitioners Fluoride varnish 20 1568006195 0 Nurse Practitioners Healthy Kids Services 20 1568006195 0 Nurse Practitioners Nurse Practitioners Services 20 1568006195 0 Nurse Practitioners Physician Services 00 1568007102 0 MORGAN KARYN 2019326 9999999 B 10 1568007102 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1568007102 0 Nurse Practitioners Fluoride varnish 20 1568007102 0 Nurse Practitioners Healthy Kids Services 20 1568007102 0 Nurse Practitioners Nurse Practitioners Services 20 1568007102 0 Nurse Practitioners Physician Services 00 1568007433 0 JOLY CHRISTINA 2019318 9999999 B 10 1568007433 0 PO BOX 18440 PALATINE IL 600551405 20 1568007433 0 Other behavior health professional Electronic Home Response/EHR Installation, MPE Certification 20 1568007433 0 Other behavior health professional Family Planning Counseling 20 1568007433 0 Other behavior health professional LCPC/LMFT services 00 1568007508 0 USMAN MUHAMMAD U 2019334 9999999 B 10 1568007508 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1568007508 0 Physicians Anesthesia Services 20 1568007508 0 Physicians Fluoride varnish 20 1568007508 0 Physicians Healthy Kids Services 20 1568007508 0 Physicians Optical Supplies 20 1568007508 0 Physicians Physician Services 00 1568010601 0 MCCUTCHEON MELANIE 2023024 9999999 B 10 1568010601 0 25440 S GOUGAR RD MANHATTAN IL 604429511 20 1568010601 0 Speech Therapists Medical Supplies 20 1568010601 0 Speech Therapists Medical equipment/prosthetic devices 20 1568010601 0 Speech Therapists Speech Therapy/Pathology Services 00 1568011518 0 REINGLASS KAYLIE A 2021022 9999999 B 10 1568011518 0 1509 W ROSCOE ST CHICAGO IL 606571311 20 1568011518 0 Speech Therapists Medical Supplies 20 1568011518 0 Speech Therapists Medical equipment/prosthetic devices 20 1568011518 0 Speech Therapists Speech Therapy/Pathology Services 00 1568012292 0 GONZALEZ MARTA N 2020143 9999999 B 10 1568012292 0 PO BOX 38096 PHILADELPHIA PA 191011547 20 1568012292 0 Nurse Practitioners Fluoride varnish 20 1568012292 0 Nurse Practitioners Healthy Kids Services 20 1568012292 0 Nurse Practitioners Nurse Practitioners Services 20 1568012292 0 Nurse Practitioners Physician Services 00 1568012409 0 IRWIN LAURA 2022235 9999999 B 10 1568012409 0 520 VALLEY VIEW DR MOLINE IL 612656152 20 1568012409 0 Physical Therapists Medical Supplies 20 1568012409 0 Physical Therapists Medical equipment/prosthetic devices 20 1568012409 0 Physical Therapists Physical Therapy Services 00 1568012706 0 MOSS HALEIGH N 2019266 9999999 B 10 1568012706 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1568012706 0 Nurse Practitioners Fluoride varnish 20 1568012706 0 Nurse Practitioners Healthy Kids Services 20 1568012706 0 Nurse Practitioners Nurse Practitioners Services 20 1568012706 0 Nurse Practitioners Physician Services 00 1568013183 0 RODRIGUEZ GABRIELA 2019298 9999999 B 10 1568013183 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1568013183 0 Nurse Practitioners Healthy Kids Services 20 1568013183 0 Nurse Practitioners Nurse Practitioners Services 20 1568013183 0 Nurse Practitioners Physician Services 00 1568013498 0 WALTER KATHERINE M 2019315 9999999 B 10 1568013498 0 5777 DEPT CAROL STREAM IL 601220021 20 1568013498 0 Physician Assistant Only Fluoride varnish 20 1568013498 0 Physician Assistant Only Healthy Kids Services 20 1568013498 0 Physician Assistant Only Physician Services 00 1568013951 0 OROS TRACY 2024239 9999999 B 10 1568013951 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1568013951 0 Nurse Practitioners Fluoride varnish 20 1568013951 0 Nurse Practitioners Healthy Kids Services 20 1568013951 0 Nurse Practitioners Nurse Practitioners Services 20 1568013951 0 Nurse Practitioners Physician Services 00 1568014843 0 LOFTUS TIA 2019274 9999999 B 10 1568014843 0 1419 W LAKE ST STE A MELROSE PARK IL 601603930 20 1568014843 0 Nurse Practitioners Healthy Kids Services 20 1568014843 0 Nurse Practitioners Nurse Practitioners Services 20 1568014843 0 Nurse Practitioners Physician Services 00 1568015568 0 MAHDI MOHAMMED 2020265 9999999 B 10 1568015568 0 640 OGDEN AVE STE E DOWNERS GROVE IL 605152940 20 1568015568 0 Dentists Dental Services 20 1568015568 0 Dentists Physician Services 00 1568015592 0 KLISURICH KARI A 2020217 9999999 B 10 1568015592 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1568015592 0 Nurse Practitioners Fluoride varnish 20 1568015592 0 Nurse Practitioners Healthy Kids Services 20 1568015592 0 Nurse Practitioners Nurse Practitioners Services 20 1568015592 0 Nurse Practitioners Physician Services 00 1568016335 0 RIVERS ANDI 2019234 9999999 B 10 1568016335 0 PO BOX 66973 SLOT 303125 CHICAGO IL 606660973 20 1568016335 0 Nurse Practitioners Fluoride varnish 20 1568016335 0 Nurse Practitioners Healthy Kids Services 20 1568016335 0 Nurse Practitioners Nurse Practitioners Services 20 1568016335 0 Nurse 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Physicians Anesthesia Services 20 1568022820 0 Physicians Fluoride varnish 20 1568022820 0 Physicians Healthy Kids Services 20 1568022820 0 Physicians Optical Supplies 20 1568022820 0 Physicians Physician Services 00 1568023158 0 DWYER ALEX J 2023151 9999999 B 10 1568023158 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1568023158 0 Physicians Anesthesia Services 20 1568023158 0 Physicians Healthy Kids Services 20 1568023158 0 Physicians Optical Supplies 20 1568023158 0 Physicians Physician Services 00 1568023281 0 HENIGMAN EMILY 2024317 9999999 B 10 1568023281 0 2201 MAIN ST EVANSTON IL 602021519 20 1568023281 0 Nurse Practitioners Fluoride varnish 20 1568023281 0 Nurse Practitioners Healthy Kids Services 20 1568023281 0 Nurse Practitioners Nurse Practitioners Services 20 1568023281 0 Nurse Practitioners Physician Services 00 1568023307 0 MANN IMANI 2019206 9999999 H 10 1568023307 0 1801 FOX DR CHAMPAIGN IL 618207236 20 1568023307 0 Other behavior health professional Other Behavioral 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Physicians Psychiatric Services 00 1568029593 0 RIVERA SAMANTHA 2022217 9999999 B 10 1568029593 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1568029593 0 Physicians Anesthesia Services 20 1568029593 0 Physicians Fluoride varnish 20 1568029593 0 Physicians Healthy Kids Services 20 1568029593 0 Physicians Optical Supplies 20 1568029593 0 Physicians Physician Services 00 1568030385 0 PASTAPUR AISHWARYA E 2024170 9999999 B 10 1568030385 0 4698 DEPT CAROL STREAM IL 601220021 20 1568030385 0 Physicians Anesthesia Services 20 1568030385 0 Physicians Fluoride varnish 20 1568030385 0 Physicians Healthy Kids Services 20 1568030385 0 Physicians Optical Supplies 20 1568030385 0 Physicians Physician Services 00 1568032365 0 SALEEM ASHLEY ABBAS 2022179 9999999 B 10 1568032365 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1568032365 0 Physicians Anesthesia Services 20 1568032365 0 Physicians Fluoride varnish 20 1568032365 0 Physicians Healthy Kids Services 20 1568032365 0 Physicians Optical Supplies 20 1568032365 0 Physicians Physician Services 00 1568032936 0 CHANG ANNIE 2021242 9999999 B 10 1568032936 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1568032936 0 Physicians Anesthesia Services 20 1568032936 0 Physicians Healthy Kids Services 20 1568032936 0 Physicians Optical Supplies 20 1568032936 0 Physicians Physician Services 20 1568032936 0 Physicians Physicians Psychiatric Services 00 1568033652 0 PYLE JENNIFER 2023291 9999999 B 10 1568033652 0 2640 183RD ST HOMEWOOD IL 604302914 20 1568033652 0 Optometrists Optical Supplies 20 1568033652 0 Optometrists Optometric Services 20 1568033652 0 Optometrists Physician Services 00 1568033660 0 MANCZKO SARAH 2023062 9999999 B 10 1568033660 0 5777 DEPT CAROL STREAM IL 601220021 20 1568033660 0 Physician Assistant Only Fluoride varnish 20 1568033660 0 Physician Assistant Only Healthy Kids Services 20 1568033660 0 Physician Assistant Only Physician Services 00 1568035376 0 SCHMIDT JESSE M L 2021202 9999999 B 10 1568035376 0 201 E MADISON ST STE 300 SPRINGFIELD IL 627025131 20 1568035376 0 Physicians Anesthesia Services 20 1568035376 0 Physicians Fluoride varnish 20 1568035376 0 Physicians Healthy Kids Services 20 1568035376 0 Physicians Optical Supplies 20 1568035376 0 Physicians Physician Services 00 1568036648 0 YOUSSEF MOUSTAFA ROSHDI 2021152 9999999 B 10 1568036648 0 3855 W NORTH AVE CHICAGO IL 606474640 20 1568036648 0 Dentists Dental Services 20 1568036648 0 Dentists Physician Services 00 1568036689 0 KEATING LAYNE M 2021176 9999999 B 10 1568036689 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1568036689 0 Physicians Anesthesia Services 20 1568036689 0 Physicians Fluoride varnish 20 1568036689 0 Physicians Healthy Kids Services 20 1568036689 0 Physicians Optical Supplies 20 1568036689 0 Physicians Physician Services 00 1568037695 0 ALIER FRANKLIN 2021184 9999999 B 10 1568037695 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1568037695 0 Physicians Anesthesia Services 20 1568037695 0 Physicians Healthy Kids Services 20 1568037695 0 Physicians Optical Supplies 20 1568037695 0 Physicians Physician Services 20 1568037695 0 Physicians Physicians Psychiatric Services 00 1568039576 0 BAHR AMY M 2022187 9999999 B 10 1568039576 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1568039576 0 Speech Therapists Medical Supplies 20 1568039576 0 Speech Therapists Medical equipment/prosthetic devices 20 1568039576 0 Speech Therapists Speech Therapy/Pathology Services 00 1568040160 0 GILLANI SHEENA HUSSAIN 2021182 9999999 B 10 1568040160 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1568040160 0 Physicians Anesthesia Services 20 1568040160 0 Physicians Fluoride varnish 20 1568040160 0 Physicians Healthy Kids Services 20 1568040160 0 Physicians Optical Supplies 20 1568040160 0 Physicians Physician Services 00 1568040178 0 TURSKI CHRISTOPHER 2025041 9999999 B 10 1568040178 0 1008 N MAIN ST BLOOMINGTON IL 617011784 20 1568040178 0 Physicians 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Physicians Fluoride varnish 20 1568040780 0 Physicians Healthy Kids Services 20 1568040780 0 Physicians Optical Supplies 20 1568040780 0 Physicians Physician Services 00 1568040830 0 PATEL KESHAV R 2021176 9999999 B 10 1568040830 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1568040830 0 Physicians Anesthesia Services 20 1568040830 0 Physicians Fluoride varnish 20 1568040830 0 Physicians Healthy Kids Services 20 1568040830 0 Physicians Optical Supplies 20 1568040830 0 Physicians Physician Services 00 1568040889 0 HALE COOPER W 2021176 9999999 B 10 1568040889 0 4698 DEPT CAROL STREAM IL 601220021 20 1568040889 0 Physicians Anesthesia Services 20 1568040889 0 Physicians Healthy Kids Services 20 1568040889 0 Physicians Optical Supplies 20 1568040889 0 Physicians Physician Services 00 1568041978 0 PATEL PUJA 2022243 9999999 B 10 1568041978 0 4663 W 95TH ST OAK LAWN IL 604532540 20 1568041978 0 Optometrists Optical Supplies 20 1568041978 0 Optometrists Optometric Services 20 1568041978 0 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1568047983 0 Nurse Practitioners Physician Services 00 1568048015 0 ZACK ADAM 2021316 9999999 B 10 1568048015 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1568048015 0 Physicians Anesthesia Services 20 1568048015 0 Physicians Healthy Kids Services 20 1568048015 0 Physicians Optical Supplies 20 1568048015 0 Physicians Physician Services 00 1568048239 0 DUBEY SAGEL K 2024183 9999999 B 10 1568048239 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1568048239 0 Physicians Anesthesia Services 20 1568048239 0 Physicians Fluoride varnish 20 1568048239 0 Physicians Healthy Kids Services 20 1568048239 0 Physicians Optical Supplies 20 1568048239 0 Physicians Physician Services 00 1568048940 0 MOTHERAMGARI SRAVYA 2021231 9999999 B 10 1568048940 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1568048940 0 Physicians Anesthesia Services 20 1568048940 0 Physicians Fluoride varnish 20 1568048940 0 Physicians Healthy Kids Services 20 1568048940 0 Physicians Optical Supplies 20 1568048940 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1568083053 0 Nurse Practitioners Healthy Kids Services 20 1568083053 0 Nurse Practitioners Nurse Practitioners Services 20 1568083053 0 Nurse Practitioners Physician Services 00 1568083442 0 LYMAN MARION 2023137 9999999 B 10 1568083442 0 PO BOX 411637 SAINT LOUIS MO 631411637 20 1568083442 0 Nurse Practitioners Anesthesia Services 20 1568083442 0 Nurse Practitioners Nurse Practitioners Services 20 1568083442 0 Nurse Practitioners Physician Services 00 1568084523 0 ZYKA ALKETA 2023128 9999999 B 10 1568084523 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1568084523 0 Physicians Anesthesia Services 20 1568084523 0 Physicians Fluoride varnish 20 1568084523 0 Physicians Healthy Kids Services 20 1568084523 0 Physicians Optical Supplies 20 1568084523 0 Physicians Physician Services 00 1568084689 0 ALEXIS JANEAH 2023227 9999999 B 10 1568084689 0 PO BOX 43230 PHOENIX AZ 850803230 20 1568084689 0 Physicians Anesthesia Services 20 1568084689 0 Physicians Healthy Kids Services 20 1568084689 0 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1568086668 0 Physicians Healthy Kids Services 20 1568086668 0 Physicians Optical Supplies 20 1568086668 0 Physicians Physician Services 00 1568086676 0 QUIDORT MICHAEL D 2020351 9999999 B 10 1568086676 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1568086676 0 Nurse Practitioners Anesthesia Services 20 1568086676 0 Nurse Practitioners Nurse Practitioners Services 20 1568086676 0 Nurse Practitioners Physician Services 00 1568088359 0 YOUSSEF STEPHANIE 2020310 9999999 B 10 1568088359 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1568088359 0 Physicians Anesthesia Services 20 1568088359 0 Physicians Healthy Kids Services 20 1568088359 0 Physicians Optical Supplies 20 1568088359 0 Physicians Physician Services 00 1568088649 0 GILL MALIKA H 2023171 9999999 B 10 1568088649 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1568088649 0 Physicians Anesthesia Services 20 1568088649 0 Physicians Fluoride varnish 20 1568088649 0 Physicians Healthy Kids Services 20 1568088649 0 Physicians Optical Supplies 20 1568088649 0 Physicians Physician Services 00 1568089589 0 ANDREWS CRESTIN 2024211 9999999 B 10 1568089589 0 PO BOX 4028 ROCK ISLAND IL 612044028 20 1568089589 0 Physicians Anesthesia Services 20 1568089589 0 Physicians Healthy Kids Services 20 1568089589 0 Physicians Optical Supplies 20 1568089589 0 Physicians Physician Services 20 1568089589 0 Physicians Physicians Psychiatric Services 00 1568089621 0 VILLAVICENCIOJIMENEZ MARIA 2025031 9999999 B 10 1568089621 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1568089621 0 Physicians Anesthesia Services 20 1568089621 0 Physicians Fluoride varnish 20 1568089621 0 Physicians Healthy Kids Services 20 1568089621 0 Physicians Optical Supplies 20 1568089621 0 Physicians Physician Services 00 1568090249 0 LIN KAIQING 2023195 9999999 B 10 1568090249 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1568090249 0 Physicians Anesthesia Services 20 1568090249 0 Physicians Fluoride varnish 20 1568090249 0 Physicians Healthy Kids Services 20 1568090249 0 Physicians Optical Supplies 20 1568090249 0 Physicians Physician Services 00 1568090389 0 SCARPATO TATUM S 2020175 9999999 B 10 1568090389 0 5777 DEPT CAROL STREAM IL 601228942 20 1568090389 0 Physicians Anesthesia Services 20 1568090389 0 Physicians Fluoride varnish 20 1568090389 0 Physicians Healthy Kids Services 20 1568090389 0 Physicians Optical Supplies 20 1568090389 0 Physicians Physician Services 00 1568090769 0 SCHNEIDER REBECCA 2021019 9999999 B 10 1568090769 0 PO BOX 650 EDWARDSVILLE IL 620250650 20 1568090769 0 Physician Assistant Only Fluoride varnish 20 1568090769 0 Physician Assistant Only Healthy Kids Services 20 1568090769 0 Physician Assistant Only Physician Services 00 1568090884 0 MONTEVERDE JACLYN R 2021101 9999999 B 10 1568090884 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1568090884 0 Physician Assistant Only Fluoride varnish 20 1568090884 0 Physician Assistant Only Healthy Kids Services 20 1568090884 0 Physician Assistant Only Physician Services 00 1568090918 0 CIVERA EMILY 2023004 9999999 B 10 1568090918 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1568090918 0 Physician Assistant Only Fluoride varnish 20 1568090918 0 Physician Assistant Only Healthy Kids Services 20 1568090918 0 Physician Assistant Only Physician Services 00 1568091270 0 GORDON-BAILEY TONI S 2023172 9999999 B 10 1568091270 0 PO BOX 736216 DALLAS TX 753736216 20 1568091270 0 Nurse Practitioners Healthy Kids Services 20 1568091270 0 Nurse Practitioners Nurse Practitioners Services 20 1568091270 0 Nurse Practitioners Physician Services 00 1568091924 0 DE VENECIA BRYCE T 2023191 9999999 B 10 1568091924 0 75 REMITTANCE DR DEPT 1620 SUITE 1620 CHICAGO IL 606751620 20 1568091924 0 Physicians Anesthesia Services 20 1568091924 0 Physicians Healthy Kids Services 20 1568091924 0 Physicians Optical Supplies 20 1568091924 0 Physicians Physician Services 20 1568091924 0 Physicians Physicians Psychiatric Services 00 1568092021 0 CHAVAN HARSHALA 2020027 9999999 B 10 1568092021 0 1 CHICAGO AVE OAK PARK IL 603022432 20 1568092021 0 Dentists Dental Services 20 1568092021 0 Dentists Physician Services 00 1568092203 0 RICHARDSON NICOLE 2020345 9999999 B 10 1568092203 0 110 CARVER LN EAST PEORIA IL 616113052 20 1568092203 0 Occupational Therapists Medical Supplies 20 1568092203 0 Occupational Therapists Medical equipment/prosthetic devices 20 1568092203 0 Occupational Therapists Occupational Therapy Services 00 1568094803 0 GWOZDZ KLAUDIA M 2020063 9999999 B 10 1568094803 0 PO BOX 38096 PHILADELPHIA PA 191011547 20 1568094803 0 Nurse Practitioners Fluoride varnish 20 1568094803 0 Nurse Practitioners Healthy Kids Services 20 1568094803 0 Nurse Practitioners Nurse Practitioners Services 20 1568094803 0 Nurse Practitioners Physician Services 00 1568096147 0 AFOLABI NURUDEEN 2020297 9999999 B 10 1568096147 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1568096147 0 Nurse Practitioners Fluoride varnish 20 1568096147 0 Nurse Practitioners Healthy Kids Services 20 1568096147 0 Nurse Practitioners Nurse Practitioners Services 20 1568096147 0 Nurse Practitioners Physician Services 00 1568097244 0 DASSOW ELIZABETH D 2020234 9999999 B 10 1568097244 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1568097244 0 Physician Assistant Only Fluoride varnish 20 1568097244 0 Physician Assistant Only Healthy Kids Services 20 1568097244 0 Physician Assistant Only Physician Services 00 1568097541 0 HALICI ALTAN 2020210 9999999 B 10 1568097541 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1568097541 0 Nurse Practitioners Anesthesia Services 20 1568097541 0 Nurse Practitioners Nurse Practitioners Services 20 1568097541 0 Nurse Practitioners Physician Services 00 1568097889 0 SMITH STELLA 2020294 9999999 B 10 1568097889 0 PO BOX 684 MUNDELEIN IL 600600684 20 1568097889 0 Other behavior health professional LCPC/LMFT services 00 1568098283 0 MILLER KAYLA 2020078 9999999 B 10 1568098283 0 727 E COURT ST PARIS IL 619442460 20 1568098283 0 Nurse Practitioners Fluoride varnish 20 1568098283 0 Nurse Practitioners Healthy Kids Services 20 1568098283 0 Nurse Practitioners Nurse Practitioners Services 20 1568098283 0 Nurse Practitioners Physician Services 00 1568098366 0 HOLLENBECK-PRINGLE DANIELLE 2021179 9999999 B 10 1568098366 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1568098366 0 Physicians Anesthesia Services 20 1568098366 0 Physicians Family Planning Counseling 20 1568098366 0 Physicians Healthy Kids Services 20 1568098366 0 Physicians Optical Supplies 20 1568098366 0 Physicians Physician Services 00 1568098457 0 BUCKLEY ELIZABETH S 2021236 9999999 B 10 1568098457 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1568098457 0 Physicians Anesthesia Services 20 1568098457 0 Physicians Healthy Kids Services 20 1568098457 0 Physicians Optical Supplies 20 1568098457 0 Physicians Physician Services 00 1568098572 0 NG THOMAS J 2020175 9999999 B 10 1568098572 0 4698 DEPT CAROL STREAM IL 601220021 20 1568098572 0 Physicians Anesthesia Services 20 1568098572 0 Physicians Healthy Kids Services 20 1568098572 0 Physicians Optical Supplies 20 1568098572 0 Physicians Physician Services 00 1568098622 0 WHITE JENNA M 2022199 9999999 B 10 1568098622 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1568098622 0 Nurse Practitioners Anesthesia Services 20 1568098622 0 Nurse Practitioners Nurse Practitioners Services 20 1568098622 0 Nurse Practitioners Physician Services 00 1568099117 0 BOGE MOLLY E 2021305 9999999 B 10 1568099117 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1568099117 0 Physician Assistant Only Fluoride varnish 20 1568099117 0 Physician Assistant Only Healthy Kids Services 20 1568099117 0 Physician Assistant Only Physician Services 00 1568099356 0 DOMASK ELLIOT 2020230 9999999 B 10 1568099356 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1568099356 0 Physicians Anesthesia Services 20 1568099356 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1568099356 0 Physicians Healthy Kids Services 20 1568099356 0 Physicians Optical Supplies 20 1568099356 0 Physicians Physician Services 00 1568099380 0 JENKINS BIANCA 2020178 9999999 B 10 1568099380 0 4025 N SHERIDAN RD CHICAGO IL 606132010 20 1568099380 0 Physicians Anesthesia Services 20 1568099380 0 Physicians Fluoride varnish 20 1568099380 0 Physicians Healthy Kids Services 20 1568099380 0 Physicians Optical Supplies 20 1568099380 0 Physicians Physician Services 00 1568099646 0 KIM DANIEL R 2023214 9999999 B 10 1568099646 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1568099646 0 Physicians Anesthesia Services 20 1568099646 0 Physicians Fluoride varnish 20 1568099646 0 Physicians Healthy Kids Services 20 1568099646 0 Physicians Optical Supplies 20 1568099646 0 Physicians Physician Services 00 1568099745 0 BLOMQUIST KATHERINE 2023329 9999999 B 10 1568099745 0 PO BOX 1437 COLUMBUS GA 319021437 20 1568099745 0 Physicians Anesthesia Services 20 1568099745 0 Physicians Fluoride varnish 20 1568099745 0 Physicians Healthy Kids Services 20 1568099745 0 Physicians Optical Supplies 20 1568099745 0 Physicians Physician Services 00 1568099844 0 MILLER ROY D 2023303 9999999 B 10 1568099844 0 PO BOX 43230 PHOENIX AZ 850803230 20 1568099844 0 Physicians Anesthesia Services 20 1568099844 0 Physicians Fluoride varnish 20 1568099844 0 Physicians Healthy Kids Services 20 1568099844 0 Physicians Optical Supplies 20 1568099844 0 Physicians Physician Services 00 1568099885 0 GUSTAFSON ANDREW A 2023114 9999999 B 10 1568099885 0 4698 DEPT CAROL STREAM IL 601220021 20 1568099885 0 Physicians Anesthesia Services 20 1568099885 0 Physicians Fluoride varnish 20 1568099885 0 Physicians Healthy Kids Services 20 1568099885 0 Physicians Optical Supplies 20 1568099885 0 Physicians Physician Services 00 1568100055 0 LI YARU 2022182 9999999 B 10 1568100055 0 5145 N CALIFORNIA AVE CHICAGO IL 606253661 20 1568100055 0 Physicians Anesthesia Services 20 1568100055 0 Physicians Fluoride varnish 20 1568100055 0 Physicians Healthy Kids Services 20 1568100055 0 Physicians Optical Supplies 20 1568100055 0 Physicians Physician Services 00 1568100287 0 HUYNH JOANNA 2022188 9999999 B 10 1568100287 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1568100287 0 Physicians Anesthesia Services 20 1568100287 0 Physicians Fluoride varnish 20 1568100287 0 Physicians Healthy Kids Services 20 1568100287 0 Physicians Optical Supplies 20 1568100287 0 Physicians Physician Services 00 1568100360 0 DIKE-UDENSI EMMANUEL 2022195 9999999 B 10 1568100360 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1568100360 0 Physicians Anesthesia Services 20 1568100360 0 Physicians Fluoride varnish 20 1568100360 0 Physicians Healthy Kids Services 20 1568100360 0 Physicians Optical Supplies 20 1568100360 0 Physicians Physician Services 00 1568101061 0 CAI SYLVIA 2025006 9999999 B 10 1568101061 0 5777 DEPT CAROL STREAM IL 601220021 20 1568101061 0 Physician Assistant Only Fluoride varnish 20 1568101061 0 Physician Assistant Only Healthy Kids Services 20 1568101061 0 Physician Assistant Only Physician Services 00 1568101228 0 STANULIS SCOT 2022180 9999999 B 10 1568101228 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1568101228 0 Physicians Anesthesia Services 20 1568101228 0 Physicians Healthy Kids Services 20 1568101228 0 Physicians Optical Supplies 20 1568101228 0 Physicians Physician Services 00 1568101715 0 GUERRERO MAYELA 2025024 9999999 B 10 1568101715 0 2906 HIGHWAY AVE HIGHLAND IN 463221631 20 1568101715 0 Speech Therapists Medical Supplies 20 1568101715 0 Speech Therapists Medical equipment/prosthetic devices 20 1568101715 0 Speech Therapists Speech Therapy/Pathology Services 00 1568101996 0 BREWSTER DANA N 2023180 9999999 B 10 1568101996 0 1418 COLLEGE DR MOUNT CARMEL IL 628632638 20 1568101996 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1568101996 0 Other behavior health professional Social work service 00 1568103075 0 TUDOR ISAAC E 2022239 9999999 B 10 1568103075 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1568103075 0 Physicians Anesthesia Services 20 1568103075 0 Physicians Healthy Kids Services 20 1568103075 0 Physicians Optical Supplies 20 1568103075 0 Physicians Physician Services 00 1568104487 0 BARAKAT ELHAM 2022273 9999999 B 10 1568104487 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1568104487 0 Nurse Practitioners Fluoride varnish 20 1568104487 0 Nurse Practitioners Healthy Kids Services 20 1568104487 0 Nurse Practitioners Nurse Practitioners Services 20 1568104487 0 Nurse Practitioners Physician Services 00 1568105948 0 CORTEZ VANESSA 2022108 9999999 B 10 1568105948 0 10001 GRAND AVE FRANKLIN PARK IL 601312563 20 1568105948 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1568106474 0 LYONS EMILY 2024233 9999999 B 10 1568106474 0 2100 POWELL ST STE 400 EMERYVILLE CA 946081826 20 1568106474 0 Physicians Anesthesia Services 20 1568106474 0 Physicians Healthy Kids Services 20 1568106474 0 Physicians Optical Supplies 20 1568106474 0 Physicians Physician Services 00 1568106649 0 ARNEAUD JORDAN 2022174 9999999 B 10 1568106649 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1568106649 0 Nurse Practitioners Healthy Kids Services 20 1568106649 0 Nurse Practitioners Nurse Practitioners Services 20 1568106649 0 Nurse Practitioners Physician Services 00 1568108553 0 HAU JENNY 2022178 9999999 B 10 1568108553 0 PO BOX 775248 CHICAGO IL 606775248 20 1568108553 0 Physicians Anesthesia Services 20 1568108553 0 Physicians Fluoride varnish 20 1568108553 0 Physicians Healthy Kids Services 20 1568108553 0 Physicians Optical Supplies 20 1568108553 0 Physicians Physician Services 00 1568108934 0 XIA ERIC T 2022205 9999999 B 10 1568108934 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1568108934 0 Physicians Anesthesia Services 20 1568108934 0 Physicians Fluoride varnish 20 1568108934 0 Physicians Healthy Kids Services 20 1568108934 0 Physicians Optical Supplies 20 1568108934 0 Physicians Physician Services 00 1568109585 0 UNNI SUSMITA 2023285 9999999 B 10 1568109585 0 1044 N FRANCISCO AVE CHICAGO IL 606222743 20 1568109585 0 Physicians Anesthesia Services 20 1568109585 0 Physicians Fluoride varnish 20 1568109585 0 Physicians Healthy Kids Services 20 1568109585 0 Physicians Optical Supplies 20 1568109585 0 Physicians Physician Services 00 1568110237 0 POLANCICH MARISSA 2023174 9999999 B 10 1568110237 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1568110237 0 Physicians Anesthesia Services 20 1568110237 0 Physicians Healthy Kids Services 20 1568110237 0 Physicians Optical Supplies 20 1568110237 0 Physicians Physician Services 00 1568111417 0 IRVING RICHARD M 2023179 9999999 B 10 1568111417 0 PO BOX 3039 OAK BROOK IL 605223039 20 1568111417 0 Physicians Anesthesia Services 20 1568111417 0 Physicians Fluoride varnish 20 1568111417 0 Physicians Healthy Kids Services 20 1568111417 0 Physicians Optical Supplies 20 1568111417 0 Physicians Physician Services 00 1568111573 0 VAJDA JORDAN 2022174 9999999 B 10 1568111573 0 4698 DEPT CAROL STREAM IL 601220021 20 1568111573 0 Physicians Anesthesia Services 20 1568111573 0 Physicians Healthy Kids Services 20 1568111573 0 Physicians Optical Supplies 20 1568111573 0 Physicians Physician Services 20 1568111573 0 Physicians Physicians Psychiatric Services 00 1568112019 0 WALKER JANIECE 2022234 9999999 B 10 1568112019 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1568112019 0 Physicians Anesthesia Services 20 1568112019 0 Physicians Fluoride varnish 20 1568112019 0 Physicians Healthy Kids Services 20 1568112019 0 Physicians Optical Supplies 20 1568112019 0 Physicians Physician Services 00 1568112134 0 AEGERTER PAULINE 2023155 2029182 B 10 1568112134 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1568112134 0 Physicians Anesthesia Services 20 1568112134 0 Physicians Healthy Kids Services 20 1568112134 0 Physicians Optical Supplies 20 1568112134 0 Physicians Physician Services 00 1568112456 0 OJO AYOTOMIWA 2022193 9999999 B 10 1568112456 0 4698 DEPT CAROL STREAM IL 601220021 20 1568112456 0 Physicians Anesthesia Services 20 1568112456 0 Physicians Healthy Kids Services 20 1568112456 0 Physicians Optical Supplies 20 1568112456 0 Physicians Physician Services 00 1568112589 0 TANQUILUT ROSEANN 2022115 9999999 B 10 1568112589 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1568112589 0 Nurse Practitioners Fluoride varnish 20 1568112589 0 Nurse Practitioners Healthy Kids Services 20 1568112589 0 Nurse Practitioners Nurse Practitioners Services 20 1568112589 0 Nurse Practitioners Physician Services 00 1568115376 0 BIGGS HANNAH 2022157 9999999 B 10 1568115376 0 PO BOX 1109 DEKALB IL 601157109 20 1568115376 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1568116374 0 TAYLOR KATHERINE B 2023118 9999999 B 10 1568116374 0 5777 DEPT CAROL STREAM IL 601228942 20 1568116374 0 Nurse Practitioners Fluoride varnish 20 1568116374 0 Nurse Practitioners Healthy Kids Services 20 1568116374 0 Nurse Practitioners Nurse Practitioners Services 20 1568116374 0 Nurse Practitioners Physician Services 00 1568116762 0 SVYMBERSKY LAUREN 2022080 9999999 B 10 1568116762 0 8605 SANTA MONICA BLVD # PMB90 WEST HOLLYWOOD CA 900694109 20 1568116762 0 Speech Therapists Adaptive behavior support clinician services 20 1568116762 0 Speech Therapists Medical Supplies 20 1568116762 0 Speech Therapists Medical equipment/prosthetic devices 20 1568116762 0 Speech Therapists Speech Therapy/Pathology Services 00 1568116820 0 BARNHOLTZ RACHEL 2022039 9999999 B 10 1568116820 0 621 S NEW BALLAS RD STE 5003B SAINT LOUIS MO 631418270 20 1568116820 0 Clinical Social Worker Social work service 00 1568117968 0 NELMS ALETHA 2022098 9999999 B 10 1568117968 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1568117968 0 Nurse Practitioners Fluoride varnish 20 1568117968 0 Nurse Practitioners Healthy Kids Services 20 1568117968 0 Nurse Practitioners Nurse Practitioners Services 20 1568117968 0 Nurse Practitioners Physician Services 00 1568117992 0 ZERFAS ANN 2022340 9999999 B 10 1568117992 0 4714 GETTYSBURG RD MECHANICSBURG PA 170554325 20 1568117992 0 Physical Therapists Medical Supplies 20 1568117992 0 Physical Therapists Medical equipment/prosthetic devices 20 1568117992 0 Physical Therapists Physical Therapy Services 00 1568118255 0 JEONG RACHEL 2022258 9999999 B 10 1568118255 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1568118255 0 Physician Assistant Only Fluoride varnish 20 1568118255 0 Physician Assistant Only Healthy Kids Services 20 1568118255 0 Physician Assistant Only Physician Services 00 1568119246 0 HOLCOMB MELISSA 2022313 9999999 B 10 1568119246 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1568119246 0 Physician Assistant Only Fluoride varnish 20 1568119246 0 Physician Assistant Only Healthy Kids Services 20 1568119246 0 Physician Assistant Only Physician Services 00 1568120103 0 LOMELI BRENDA 2021343 9999999 B 10 1568120103 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1568120103 0 Occupational Therapists Medical Supplies 20 1568120103 0 Occupational Therapists Medical equipment/prosthetic devices 20 1568120103 0 Occupational Therapists Occupational Therapy Services 00 1568122091 0 DEBROSSE ADRIENNE C 2024182 9999999 B 10 1568122091 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1568122091 0 Physicians Anesthesia Services 20 1568122091 0 Physicians Healthy Kids Services 20 1568122091 0 Physicians Optical Supplies 20 1568122091 0 Physicians Physician Services 20 1568122091 0 Physicians Physicians Psychiatric Services 00 1568122299 0 HOFFMAN SARAH P 2022202 9999999 B 10 1568122299 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1568122299 0 Registered nurse Anesthesia Services 20 1568122299 0 Registered nurse Nurse Practitioners Services 20 1568122299 0 Registered nurse Physician Services 00 1568123362 0 SUMMERS STACIE L 2025045 9999999 B 10 1568123362 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1568123362 0 Nurse Practitioners Anesthesia Services 20 1568123362 0 Nurse Practitioners Nurse Practitioners Services 20 1568123362 0 Nurse Practitioners Physician Services 00 1568124154 0 COMPOSTO RENELL F 2021319 9999999 B 10 1568124154 0 306 SAINT JOSEPH DR BLOOMINGTON IL 617013506 20 1568124154 0 Nurse Practitioners Fluoride varnish 20 1568124154 0 Nurse Practitioners Healthy Kids Services 20 1568124154 0 Nurse Practitioners Nurse Practitioners Services 20 1568124154 0 Nurse Practitioners Physician Services 00 1568124659 0 STEWART YASMINE 2022117 9999999 B 10 1568124659 0 2025 WASHINGTON ST WAUKEGAN IL 600855131 20 1568124659 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1568125078 0 SMILEY CASSANDRA 2022032 9999999 B 10 1568125078 0 325 IL ROUTE 2 DIXON IL 610219118 20 1568125078 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1568126936 0 ENGBERG MONIQUE 2021341 9999999 H 10 1568126936 0 555 FAIRVIEW DR ROCHELLE IL 61068 20 1568126936 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1568127629 0 MARSHALL MARY-KATHERINE 2022049 9999999 B 10 1568127629 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1568127629 0 Nurse Practitioners Fluoride varnish 20 1568127629 0 Nurse Practitioners Healthy Kids Services 20 1568127629 0 Nurse Practitioners Nurse Practitioners Services 20 1568127629 0 Nurse Practitioners Physician Services 00 1568128486 0 WESTER ELEANORA 2021326 9999999 H 10 1568128486 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1568128486 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1568129146 0 AHLERS MICHELLE A 2024236 9999999 B 10 1568129146 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1568129146 0 Physician Assistant Only Fluoride varnish 20 1568129146 0 Physician Assistant Only Healthy Kids Services 20 1568129146 0 Physician Assistant Only Physician Services 00 1568129427 0 O'CONNOR EILEEN 2024113 9999999 B 10 1568129427 0 5901 N CICERO AVE STE 606 CHICAGO IL 606465721 20 1568129427 0 Other behavior health professional Adaptive behavior support clinician services 20 1568129427 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1568129799 0 MABREY JAMIE 2021351 9999999 B 10 1568129799 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1568129799 0 Nurse Practitioners Healthy Kids Services 20 1568129799 0 Nurse Practitioners Nurse Practitioners Services 20 1568129799 0 Nurse Practitioners Physician Services 00 1568130003 0 NEWARK ALEXANDRA E 2021244 9999999 B 10 1568130003 0 1905 E HUEBBE PKWY 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WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1578094033 0 Physicians Anesthesia Services 20 1578094033 0 Physicians Fluoride varnish 20 1578094033 0 Physicians Healthy Kids Services 20 1578094033 0 Physicians Optical Supplies 20 1578094033 0 Physicians Physician Services 00 1578094090 0 FISHER MARYANN C 2020329 9999999 B 10 1578094090 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1578094090 0 Physicians Anesthesia Services 20 1578094090 0 Physicians Fluoride varnish 20 1578094090 0 Physicians Healthy Kids Services 20 1578094090 0 Physicians Optical Supplies 20 1578094090 0 Physicians Physician Services 00 1578094108 0 SIEGEL LEON 2023271 9999999 B 10 1578094108 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1578094108 0 Physicians Anesthesia Services 20 1578094108 0 Physicians Healthy Kids Services 20 1578094108 0 Physicians Optical Supplies 20 1578094108 0 Physicians Physician Services 00 1578094231 0 MAENG JOOYOUNG 2022165 9999999 B 10 1578094231 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1578094231 0 Physicians Anesthesia Services 20 1578094231 0 Physicians Healthy Kids Services 20 1578094231 0 Physicians Optical Supplies 20 1578094231 0 Physicians Physician Services 00 1578094272 0 MALIK MOHAMMAD S 2018277 9999999 B 10 1578094272 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1578094272 0 Physicians Anesthesia Services 20 1578094272 0 Physicians Healthy Kids Services 20 1578094272 0 Physicians Optical Supplies 20 1578094272 0 Physicians Physician Services 00 1578094710 0 CHAN LUCAS 2020016 9999999 B 10 1578094710 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1578094710 0 Physicians Anesthesia Services 20 1578094710 0 Physicians Fluoride varnish 20 1578094710 0 Physicians Healthy Kids Services 20 1578094710 0 Physicians Optical Supplies 20 1578094710 0 Physicians Physician Services 00 1578094819 0 MALONE FIONA 2023177 9999999 B 10 1578094819 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1578094819 0 Physicians Anesthesia Services 20 1578094819 0 Physicians Healthy Kids Services 20 1578094819 0 Physicians Optical Supplies 20 1578094819 0 Physicians Physician Services 00 1578094918 0 XIA JONATHAN YU 2019182 9999999 B 10 1578094918 0 4698 DEPT CAROL STREAM IL 601220021 20 1578094918 0 Physicians Anesthesia Services 20 1578094918 0 Physicians Fluoride varnish 20 1578094918 0 Physicians Healthy Kids Services 20 1578094918 0 Physicians Optical Supplies 20 1578094918 0 Physicians Physician Services 00 1578095055 0 CHEN TSUNGYEN 2020357 9999999 B 10 1578095055 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1578095055 0 Physicians Anesthesia Services 20 1578095055 0 Physicians Fluoride varnish 20 1578095055 0 Physicians Healthy Kids Services 20 1578095055 0 Physicians Optical Supplies 20 1578095055 0 Physicians Physician Services 00 1578095147 0 SCHRAM NICOLE 2017163 9999999 B 10 1578095147 0 PO BOX 80309 PHILADELPHIA PA 191011309 20 1578095147 0 Nurse Practitioners Fluoride varnish 20 1578095147 0 Nurse Practitioners Healthy Kids 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20 1578096350 0 Physicians Optical Supplies 20 1578096350 0 Physicians Physician Services 00 1578096418 0 JOHNSON ELIZABETH M 2017227 9999999 B 10 1578096418 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1578096418 0 Occupational Therapists Medical Supplies 20 1578096418 0 Occupational Therapists Medical equipment/prosthetic devices 20 1578096418 0 Occupational Therapists Occupational Therapy Services 00 1578096806 0 AMPADU CLARA M 2017135 9999999 B 10 1578096806 0 15 PARK PL SWANSEA IL 622262918 20 1578096806 0 Nurse Practitioners Fluoride varnish 20 1578096806 0 Nurse Practitioners Healthy Kids Services 20 1578096806 0 Nurse Practitioners Nurse Practitioners Services 20 1578096806 0 Nurse Practitioners Physician Services 00 1578097473 0 KUHN ANDREW 2022233 9999999 B 10 1578097473 0 PO BOX 208807 DALLAS TX 753208807 20 1578097473 0 Physicians Anesthesia Services 20 1578097473 0 Physicians Healthy Kids Services 20 1578097473 0 Physicians Optical Supplies 20 1578097473 0 Physicians Physician Services 00 1578097630 0 HUFFMAN REBEKAH A 2021180 9999999 B 10 1578097630 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1578097630 0 Physicians Anesthesia Services 20 1578097630 0 Physicians Healthy Kids Services 20 1578097630 0 Physicians Optical Supplies 20 1578097630 0 Physicians Physician Services 00 1578097846 0 LOMBARDI CHRISTOPHER 2021251 9999999 B 10 1578097846 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1578097846 0 Physicians Anesthesia Services 20 1578097846 0 Physicians Healthy Kids Services 20 1578097846 0 Physicians Optical Supplies 20 1578097846 0 Physicians Physician Services 20 1578097846 0 Physicians Physicians Psychiatric Services 00 1578097952 0 HAMANN HAROLD CHRISTOPHER 2022136 9999999 B 10 1578097952 0 1000 N ALLEN ST ROBINSON IL 624541114 20 1578097952 0 Physicians Anesthesia Services 20 1578097952 0 Physicians Healthy Kids Services 20 1578097952 0 Physicians Optical Supplies 20 1578097952 0 Physicians Physician Services 00 1578098265 0 STANLEY MELISSI L 2019030 9999999 B 10 1578098265 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1578098265 0 Nurse Practitioners Healthy Kids Services 20 1578098265 0 Nurse Practitioners Nurse Practitioners Services 20 1578098265 0 Nurse Practitioners Physician Services 00 1578098513 0 ASHAI ALI A 2024340 9999999 B 10 1578098513 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1578098513 0 Physicians Anesthesia Services 20 1578098513 0 Physicians Healthy Kids Services 20 1578098513 0 Physicians Optical Supplies 20 1578098513 0 Physicians Physician Services 20 1578098513 0 Physicians Physicians Psychiatric Services 00 1578099347 0 PANAGAKIS DIMITRA T. 2017223 9999999 B 10 1578099347 0 29373 NETWORK PL CHICAGO IL 606733039 20 1578099347 0 Nurse Practitioners Fluoride varnish 20 1578099347 0 Nurse Practitioners Healthy Kids Services 20 1578099347 0 Nurse Practitioners Nurse Practitioners Services 20 1578099347 0 Nurse Practitioners Physician Services 00 1578099578 0 MCMILLAN ROSS H 2021181 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10 1578112983 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1578112983 0 Podiatrists Podiatric Services 00 1578113759 0 BOOZER JESSICA N 2019330 9999999 B 10 1578113759 0 1025 MAINE ST QUINCY IL 623014038 20 1578113759 0 Nurse Practitioners Fluoride varnish 20 1578113759 0 Nurse Practitioners Healthy Kids Services 20 1578113759 0 Nurse Practitioners Nurse Practitioners Services 20 1578113759 0 Nurse Practitioners Physician Services 00 1578117339 0 DANIEL ALEX 2019246 9999999 B 10 1578117339 0 1730 PARK ST STE 106 NAPERVILLE IL 605632609 20 1578117339 0 Dentists Dental Services 20 1578117339 0 Dentists Physician Services 00 1578117529 0 LEEVER MEGAN A 2022234 9999999 B 10 1578117529 0 6800 STATE ROUTE 162 MARYVILLE IL 620628500 20 1578117529 0 Speech Therapists Medical Supplies 20 1578117529 0 Speech Therapists Medical equipment/prosthetic devices 20 1578117529 0 Speech Therapists Speech Therapy/Pathology Services 00 1578117578 0 CHAKOUR SARA 2019255 9999999 B 10 1578117578 0 5777 DEPT CAROL STREAM IL 601220021 20 1578117578 0 Nurse Practitioners Fluoride varnish 20 1578117578 0 Nurse Practitioners Healthy Kids Services 20 1578117578 0 Nurse Practitioners Nurse Practitioners Services 20 1578117578 0 Nurse Practitioners Physician Services 00 1578119467 0 RIMSNIDER SHAWNAE 1998334 9999999 B 10 1578119467 0 15733 S BELL RD LOCKPORT IL 604918404 20 1578119467 0 Speech Therapists Medical Supplies 20 1578119467 0 Speech Therapists Medical equipment/prosthetic devices 20 1578119467 0 Speech Therapists Speech Therapy/Pathology Services 00 1578120077 0 LUSBY CHRISTINE 2020028 9999999 B 10 1578120077 0 611 W PARK ST URBANA IL 618012529 20 1578120077 0 Physicians Anesthesia Services 20 1578120077 0 Physicians Healthy Kids Services 20 1578120077 0 Physicians Optical Supplies 20 1578120077 0 Physicians Physician Services 00 1578120770 0 TRASK JOANNA 2019161 9999999 B 10 1578120770 0 2001 S CALIFORNIA AVE # 100 CHICAGO IL 606082486 20 1578120770 0 Other behavior health 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Healthy Kids Services 20 1578127684 0 Nurse Practitioners Nurse Practitioners Services 20 1578127684 0 Nurse Practitioners Physician Services 00 1578128732 0 RAMBO CARLY A 2019182 9999999 B 10 1578128732 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1578128732 0 Nurse Practitioners Anesthesia Services 20 1578128732 0 Nurse Practitioners Nurse Practitioners Services 20 1578128732 0 Nurse Practitioners Physician Services 00 1578129987 0 PALMER TRACY A 2019136 9999999 B 10 1578129987 0 124 SW ADAMS ST FL 2 PEORIA IL 616021308 20 1578129987 0 Nurse Practitioners Fluoride varnish 20 1578129987 0 Nurse Practitioners Healthy Kids Services 20 1578129987 0 Nurse Practitioners Nurse Practitioners Services 20 1578129987 0 Nurse Practitioners Physician Services 00 1578130605 0 PAYNE JENNIFER 2024337 9999999 B 10 1578130605 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1578130605 0 Clinical Social Worker Social work service 00 1578130985 0 YU TONG 2024178 9999999 B 10 1578130985 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1578130985 0 Physicians Anesthesia Services 20 1578130985 0 Physicians Fluoride varnish 20 1578130985 0 Physicians Healthy Kids Services 20 1578130985 0 Physicians Optical Supplies 20 1578130985 0 Physicians Physician Services 00 1578131017 0 TAVERAS GENESIS 2022362 9999999 B 10 1578131017 0 1809 SHERIDAN RD NORTH CHICAGO IL 600642235 20 1578131017 0 Physician Assistant Only Fluoride varnish 20 1578131017 0 Physician Assistant Only Healthy Kids Services 20 1578131017 0 Physician Assistant Only Physician Services 00 1578131819 0 MATLOCK MATTHEW K 2021222 9999999 B 10 1578131819 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1578131819 0 Physicians Anesthesia Services 20 1578131819 0 Physicians Healthy Kids Services 20 1578131819 0 Physicians Optical Supplies 20 1578131819 0 Physicians Physician Services 00 1578131967 0 CHON MINJI 2021174 9999999 B 10 1578131967 0 2020 N CALIFORNIA AVE STE 5 CHICAGO 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Physician Services 00 1578136362 0 BECK JARED T 2024015 9999999 B 10 1578136362 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1578136362 0 Occupational Therapists Medical Supplies 20 1578136362 0 Occupational Therapists Medical equipment/prosthetic devices 20 1578136362 0 Occupational Therapists Occupational Therapy Services 00 1578136610 0 SANERT MEGAN M 2021214 9999999 B 10 1578136610 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1578136610 0 Nurse Practitioners Healthy Kids Services 20 1578136610 0 Nurse Practitioners Nurse Practitioners Services 20 1578136610 0 Nurse Practitioners Physician Services 00 1578136925 0 NYEMBO PHILIPPE F 2024191 9999999 B 10 1578136925 0 1005 BROADWAY ST QUINCY IL 623012834 20 1578136925 0 Physicians Anesthesia Services 20 1578136925 0 Physicians Fluoride varnish 20 1578136925 0 Physicians Healthy Kids Services 20 1578136925 0 Physicians Optical Supplies 20 1578136925 0 Physicians Physician Services 00 1578137899 0 HOOD ALEXIS B 2022224 9999999 B 10 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Physicians Healthy Kids Services 20 1578138426 0 Physicians Optical Supplies 20 1578138426 0 Physicians Physician Services 00 1578139598 0 AMRA ALI H 2024271 2027244 B 10 1578139598 0 3939 W FULLERTON AVE CHICAGO IL 606472243 20 1578139598 0 Dentists Dental Services 20 1578139598 0 Dentists Physician Services 00 1578140489 0 HOPKINS AMANDA 2021218 9999999 B 10 1578140489 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1578140489 0 Physicians Anesthesia Services 20 1578140489 0 Physicians Fluoride varnish 20 1578140489 0 Physicians Healthy Kids Services 20 1578140489 0 Physicians Optical Supplies 20 1578140489 0 Physicians Physician Services 00 1578140927 0 PHUNG ANNIE 2021174 9999999 B 10 1578140927 0 4698 DEPT CAROL STREAM IL 601224698 20 1578140927 0 Physicians Anesthesia Services 20 1578140927 0 Physicians Fluoride varnish 20 1578140927 0 Physicians Healthy Kids Services 20 1578140927 0 Physicians Optical Supplies 20 1578140927 0 Physicians Physician Services 00 1578141073 0 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EUCLID AVENUE SAINT LOUIS MO 631600352 20 1578739124 0 Nurse Practitioners Fluoride varnish 20 1578739124 0 Nurse Practitioners Healthy Kids Services 20 1578739124 0 Nurse Practitioners Nurse Practitioners Services 20 1578739124 0 Nurse Practitioners Physician Services 00 1578739710 0 CIMBALUK DAVID 2008183 9999999 B 10 1578739710 0 5700 SOUTHWYCK BLVD TOLEDO OH 436141509 20 1578739710 0 Physicians Anesthesia Services 20 1578739710 0 Physicians Healthy Kids Services 20 1578739710 0 Physicians Optical Supplies 20 1578739710 0 Physicians Physician Services 00 1578741922 0 BINALSHEIKH IBRAHIM M 2018199 9999999 B 10 1578741922 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1578741922 0 Physicians Anesthesia Services 20 1578741922 0 Physicians Healthy Kids Services 20 1578741922 0 Physicians Optical Supplies 20 1578741922 0 Physicians Physician Services 20 1578741922 0 Physicians Physicians Psychiatric Services 00 1578742268 0 RAO MADHAV 2008183 9999999 B 10 1578742268 0 210 S DESPLAINES ST 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1578765251 0 Physicians Healthy Kids Services 20 1578765251 0 Physicians Optical Supplies 20 1578765251 0 Physicians Physician Services 00 1578766796 0 VAKKALANKA BHANU 2010274 9999999 B 10 1578766796 0 PO BOX 3988 CARBONDALE IL 629023988 20 1578766796 0 Physicians Anesthesia Services 20 1578766796 0 Physicians Fluoride varnish 20 1578766796 0 Physicians Healthy Kids Services 20 1578766796 0 Physicians Optical Supplies 20 1578766796 0 Physicians Physician Services 00 1578767265 0 MILLER REBECCA L 2007169 9999999 B 10 1578767265 0 720 W MAIN ST SHELBYVILLE IL 625651334 20 1578767265 0 Speech Therapists Medical Supplies 20 1578767265 0 Speech Therapists Medical equipment/prosthetic devices 20 1578767265 0 Speech Therapists Speech Therapy/Pathology Services 00 1578768321 0 HUESER CHRISTOPHER 2009274 9999999 B 10 1578768321 0 607 S NEW BALLAS RD STE 3300 SAINT LOUIS MO 631418219 20 1578768321 0 Physicians Anesthesia Services 20 1578768321 0 Physicians Fluoride varnish 20 1578768321 0 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Physicians Optical Supplies 20 1578922902 0 Physicians Physician Services 00 1578923561 0 CHYBOWSKA KINGA 2019060 9999999 B 10 1578923561 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1578923561 0 Nurse Practitioners Fluoride varnish 20 1578923561 0 Nurse Practitioners Healthy Kids Services 20 1578923561 0 Nurse Practitioners Nurse Practitioners Services 20 1578923561 0 Nurse Practitioners Physician Services 00 1578923579 0 MAKER CAROLYN 2017061 9999999 B 10 1578923579 0 737 N MICHIGAN AVE STE 2040 CHICAGO IL 606116649 20 1578923579 0 Clinical Social Worker Social work service 00 1578923660 0 PALMER KAILY M 2017346 9999999 B 10 1578923660 0 510 LINCOLN DR HERRIN IL 629486334 20 1578923660 0 Physical Therapists Medical Supplies 20 1578923660 0 Physical Therapists Medical equipment/prosthetic devices 20 1578923660 0 Physical Therapists Physical Therapy Services 00 1578924247 0 BROWN NADINE 2016208 9999999 B 10 1578924247 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 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Supplies 20 1578925202 0 Physicians Physician Services 00 1578925657 0 BRAJCICH BRIAN C 2019009 9999999 B 10 1578925657 0 5777 DEPT CAROL STREAM IL 601220021 20 1578925657 0 Physicians Anesthesia Services 20 1578925657 0 Physicians Healthy Kids Services 20 1578925657 0 Physicians Optical Supplies 20 1578925657 0 Physicians Physician Services 00 1578925988 0 BAKER MARIA D 2022223 9999999 B 10 1578925988 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1578925988 0 Speech Therapists Medical Supplies 20 1578925988 0 Speech Therapists Medical equipment/prosthetic devices 20 1578925988 0 Speech Therapists Speech Therapy/Pathology Services 00 1578926143 0 ALIA LENA K 2019246 9999999 B 10 1578926143 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1578926143 0 Physicians Anesthesia Services 20 1578926143 0 Physicians Healthy Kids Services 20 1578926143 0 Physicians Optical Supplies 20 1578926143 0 Physicians Physician Services 00 1578926481 0 BURNS URSULA A 2000129 9999999 B 10 1578926481 0 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varnish 20 1578928719 0 Physicians Healthy Kids Services 20 1578928719 0 Physicians Optical Supplies 20 1578928719 0 Physicians Physician Services 00 1578930418 0 DEDECKER KEITH R 2017208 9999999 B 10 1578930418 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1578930418 0 Physical Therapists Medical Supplies 20 1578930418 0 Physical Therapists Medical equipment/prosthetic devices 20 1578930418 0 Physical Therapists Physical Therapy Services 00 1578932620 0 KEITHLEY KATRINA MARGARET 2017338 9999999 B 10 1578932620 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1578932620 0 Physician Assistant Only Fluoride varnish 20 1578932620 0 Physician Assistant Only Healthy Kids Services 20 1578932620 0 Physician Assistant Only Physician Services 00 1578934477 0 SANTA MARIA MICHAEL P 2018219 9999999 B 10 1578934477 0 20 1578934477 0 Physical Therapists Medical Supplies 20 1578934477 0 Physical Therapists Medical equipment/prosthetic devices 20 1578934477 0 Physical Therapists Physical Therapy Services 00 1578935698 0 WING HOWE GRETCHEN 2016244 9999999 B 10 1578935698 0 325 IL ROUTE 2 DIXON IL 610219118 20 1578935698 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1578935896 0 BROPHY JENNY 2018113 9999999 B 10 1578935896 0 750 W LAKE COOK RD STE 270 BUFFALO GROVE IL 600892069 20 1578935896 0 Physician Assistant Only Fluoride varnish 20 1578935896 0 Physician Assistant Only Healthy Kids Services 20 1578935896 0 Physician Assistant Only Physician Services 00 1578936076 0 LINDSEY IAN J 2018267 9999999 B 10 1578936076 0 PO BOX 7428 CAROL STREAM IL 601977428 20 1578936076 0 Nurse Practitioners Anesthesia Services 20 1578936076 0 Nurse Practitioners Nurse Practitioners Services 20 1578936076 0 Nurse Practitioners Physician Services 00 1578936522 0 MILLER-ATTANG MEGAN 2021054 9999999 B 10 1578936522 0 1400 W GREENLEAF AVE CHICAGO IL 606262805 20 1578936522 0 Clinical Social Worker Social work service 00 1578937991 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Healthy Kids Services 20 1578941407 0 Nurse Practitioners Nurse Practitioners Services 20 1578941407 0 Nurse Practitioners Physician Services 00 1578941753 0 HORNIK JONATAN 2019182 9999999 B 10 1578941753 0 PO BOX 3988 CARBONDALE IL 629023988 20 1578941753 0 Physicians Anesthesia Services 20 1578941753 0 Physicians Healthy Kids Services 20 1578941753 0 Physicians Optical Supplies 20 1578941753 0 Physicians Physician Services 20 1578941753 0 Physicians Physicians Psychiatric Services 00 1578942686 0 WEED AMANDA L 2016001 9999999 B 10 1578942686 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1578942686 0 Nurse Practitioners Fluoride varnish 20 1578942686 0 Nurse Practitioners Healthy Kids Services 20 1578942686 0 Nurse Practitioners Nurse Practitioners Services 20 1578942686 0 Nurse Practitioners Physician Services 00 1578943569 0 WONG ANDREW 2021208 9999999 B 10 1578943569 0 5775 WAYZATA BLVD STE 400 SAINT LOUIS PAR MN 554161271 20 1578943569 0 Physicians Anesthesia Services 20 1578943569 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CHICAGO IL 606778912 20 1578946463 0 Nurse Practitioners Healthy Kids Services 20 1578946463 0 Nurse Practitioners Nurse Practitioners Services 20 1578946463 0 Nurse Practitioners Physician Services 00 1578946489 0 BLANCHARD LEANNA 2023255 9999999 B 10 1578946489 0 24014 W RENWICK RD PLAINFIELD IL 605448708 20 1578946489 0 Physical Therapists Medical Supplies 20 1578946489 0 Physical Therapists Medical equipment/prosthetic devices 20 1578946489 0 Physical Therapists Physical Therapy Services 00 1578947354 0 YADAVALLI VENKATA RAMA NIHARIK 2018187 9999999 B 10 1578947354 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1578947354 0 Physicians Anesthesia Services 20 1578947354 0 Physicians Fluoride varnish 20 1578947354 0 Physicians Healthy Kids Services 20 1578947354 0 Physicians Optical Supplies 20 1578947354 0 Physicians Physician Services 00 1578948188 0 EUGENE RESHMA 2018263 9999999 B 10 1578948188 0 1101 W LIBERTY ST ADMINISTRATION FARMINGTON MO 636401921 20 1578948188 0 Physicians Anesthesia Services 20 1578948188 0 Physicians Fluoride varnish 20 1578948188 0 Physicians Healthy Kids Services 20 1578948188 0 Physicians Optical Supplies 20 1578948188 0 Physicians Physician Services 00 1578950101 0 CASWELL KAYLIE 2015153 9999999 B 10 1578950101 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1578950101 0 Nurse Practitioners Healthy Kids Services 20 1578950101 0 Nurse Practitioners Nurse Practitioners Services 20 1578950101 0 Nurse Practitioners Physician Services 00 1578950234 0 KNOEDLER MARGARET A 2020153 9999999 B 10 1578950234 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1578950234 0 Physicians Anesthesia Services 20 1578950234 0 Physicians Healthy Kids Services 20 1578950234 0 Physicians Optical Supplies 20 1578950234 0 Physicians Physician Services 00 1578950424 0 AVINA KATHRYN 2017331 9999999 B 10 1578950424 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1578950424 0 Physician Assistant Only Fluoride varnish 20 1578950424 0 Physician Assistant Only 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LESLIE 2015121 9999999 B 10 1578960084 0 401 N MICHIGAN AVE STE 1200 CHICAGO IL 606114264 20 1578960084 0 Nurse Practitioners Healthy Kids Services 20 1578960084 0 Nurse Practitioners Nurse Practitioners Services 20 1578960084 0 Nurse Practitioners Physician Services 00 1578960969 0 WILLIAMS NASTASSJA 2014342 9999999 B 10 1578960969 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1578960969 0 Nurse Practitioners Fluoride varnish 20 1578960969 0 Nurse Practitioners Healthy Kids Services 20 1578960969 0 Nurse Practitioners Nurse Practitioners Services 20 1578960969 0 Nurse Practitioners Physician Services 00 1578962189 0 ABOUL HOSN MAEN S 2017358 9999999 B 10 1578962189 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1578962189 0 Physicians Anesthesia Services 20 1578962189 0 Physicians Healthy Kids Services 20 1578962189 0 Physicians Optical Supplies 20 1578962189 0 Physicians Physician Services 00 1578964151 0 VOLZ LISA 2016092 9999999 B 10 1578964151 0 1431 CENTERPOINT 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1578967907 0 Physicians Healthy Kids Services 20 1578967907 0 Physicians Optical Supplies 20 1578967907 0 Physicians Physician Services 00 1578968202 0 SILVER MILLICENT A 2016182 9999999 B 10 1578968202 0 1025 MAINE ST QUINCY IL 623014038 20 1578968202 0 Clinical Social Worker Social work service 00 1578968244 0 SPECK CASSIE N 2023032 9999999 B 10 1578968244 0 1001 CONNECTICUT AVE NW STE 80 WASHINGTON DC 200365536 20 1578968244 0 Nurse Practitioners Healthy Kids Services 20 1578968244 0 Nurse Practitioners Nurse Practitioners Services 20 1578968244 0 Nurse Practitioners Physician Services 00 1578969259 0 HUCKSTEP JENNIFER 2014356 9999999 B 10 1578969259 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1578969259 0 Nurse Practitioners Healthy Kids Services 20 1578969259 0 Nurse Practitioners Nurse Practitioners Services 20 1578969259 0 Nurse Practitioners Physician Services 00 1578969929 0 ANDERSON RYAN 2017354 9999999 B 10 1578969929 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1578969929 0 Physician Assistant Only Fluoride varnish 20 1578969929 0 Physician Assistant Only Healthy Kids Services 20 1578969929 0 Physician Assistant Only Physician Services 00 1578970851 0 RADISH AARON C 2016273 9999999 B 10 1578970851 0 800 E LOCUST ST OLNEY IL 624502553 20 1578970851 0 Physicians Anesthesia Services 20 1578970851 0 Physicians Fluoride varnish 20 1578970851 0 Physicians Healthy Kids Services 20 1578970851 0 Physicians Optical Supplies 20 1578970851 0 Physicians Physician Services 00 1578972303 0 AMARANTE ANDRE 2014213 9999999 B 10 1578972303 0 3020 S CICERO AVE CICERO IL 608043638 20 1578972303 0 Dentists Dental Services 20 1578972303 0 Dentists Physician Services 00 1578974069 0 DEVANABANDA ARVIND REDDY 2022178 9999999 B 10 1578974069 0 611 W PARK ST URBANA IL 618012529 20 1578974069 0 Physicians Anesthesia Services 20 1578974069 0 Physicians Fluoride varnish 20 1578974069 0 Physicians Healthy Kids Services 20 1578974069 0 Physicians Optical Supplies 20 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1578976205 0 Physicians Fluoride varnish 20 1578976205 0 Physicians Healthy Kids Services 20 1578976205 0 Physicians Optical Supplies 20 1578976205 0 Physicians Physician Services 00 1578976254 0 KRAMER TREVOR 2021049 9999999 B 10 1578976254 0 PO BOX 1109 DEKALB IL 601157109 20 1578976254 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1578976270 0 NYOTOWIDJOJO IWAN S 2023262 9999999 B 10 1578976270 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1578976270 0 Physicians Anesthesia Services 20 1578976270 0 Physicians Fluoride varnish 20 1578976270 0 Physicians Healthy Kids Services 20 1578976270 0 Physicians Optical Supplies 20 1578976270 0 Physicians Physician Services 00 1578976635 0 MITCHELL SARAH 2018001 9999999 B 10 1578976635 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1578976635 0 Physicians Anesthesia Services 20 1578976635 0 Physicians Fluoride varnish 20 1578976635 0 Physicians 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varnish 20 1578991881 0 Physician Assistant Only Healthy Kids Services 20 1578991881 0 Physician Assistant Only Physician Services 00 1578992384 0 WEISS REED 2016051 9999999 B 10 1578992384 0 PO BOX 110429 AURORA CO 800420429 20 1578992384 0 Nurse Practitioners Healthy Kids Services 20 1578992384 0 Nurse Practitioners Nurse Practitioners Services 20 1578992384 0 Nurse Practitioners Physician Services 00 1578992905 0 JOHNSON KATHERINE M 2017348 9999999 B 10 1578992905 0 3248 VANDEVER AVE PEKIN IL 615546257 20 1578992905 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1578992939 0 WARNER AMY J 2023100 9999999 B 10 1578992939 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1578992939 0 Nurse Practitioners Healthy Kids Services 20 1578992939 0 Nurse Practitioners Nurse Practitioners Services 20 1578992939 0 Nurse Practitioners Physician Services 00 1578994976 0 LEROY HATHEWAY MICHELLE A 2023216 9999999 B 10 1578994976 0 7974 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JURAJ 2017291 9999999 B 10 1588001754 0 2900 FOXFIELD RD STE 102 ST CHARLES IL 601745799 20 1588001754 0 Physicians Anesthesia Services 20 1588001754 0 Physicians Fluoride varnish 20 1588001754 0 Physicians Healthy Kids Services 20 1588001754 0 Physicians Optical Supplies 20 1588001754 0 Physicians Physician Services 00 1588002364 0 VENTURINI JOSEPH M 2018351 9999999 B 10 1588002364 0 29373 NETWORK PL CHICAGO IL 606733039 20 1588002364 0 Physicians Anesthesia Services 20 1588002364 0 Physicians Fluoride varnish 20 1588002364 0 Physicians Healthy Kids Services 20 1588002364 0 Physicians Optical Supplies 20 1588002364 0 Physicians Physician Services 00 1588002398 0 CLERC PHILIP G 2023219 9999999 B 10 1588002398 0 621 S NEW BALLAS RD STE 460A SAINT LOUIS MO 631418259 20 1588002398 0 Physicians Anesthesia Services 20 1588002398 0 Physicians Fluoride varnish 20 1588002398 0 Physicians Healthy Kids Services 20 1588002398 0 Physicians Optical Supplies 20 1588002398 0 Physicians Physician Services 00 1588003289 0 FLETCHER RACHEL 2023241 9999999 B 10 1588003289 0 PO BOX 824246 PHILADELPHIA PA 191824246 20 1588003289 0 Nurse Practitioners Anesthesia Services 20 1588003289 0 Nurse Practitioners Nurse Practitioners Services 20 1588003289 0 Nurse Practitioners Physician Services 00 1588003354 0 PORTER JESSEE 2018253 9999999 B 10 1588003354 0 6308 8TH AVE KENOSHA WI 531435031 20 1588003354 0 Physician Assistant Only Fluoride varnish 20 1588003354 0 Physician Assistant Only Healthy Kids Services 20 1588003354 0 Physician Assistant Only Physician Services 00 1588003750 0 MCCOY WILLIAM H 2017182 9999999 B 10 1588003750 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1588003750 0 Physicians Anesthesia Services 20 1588003750 0 Physicians Fluoride varnish 20 1588003750 0 Physicians Healthy Kids Services 20 1588003750 0 Physicians Optical Supplies 20 1588003750 0 Physicians Physician Services 00 1588003867 0 WEBB THOMAS J 2021242 9999999 B 10 1588003867 0 1220 S WOOD ST CHICAGO IL 606081202 20 1588003867 0 Physicians Anesthesia Services 20 1588003867 0 Physicians Fluoride varnish 20 1588003867 0 Physicians Healthy Kids Services 20 1588003867 0 Physicians Optical Supplies 20 1588003867 0 Physicians Physician Services 00 1588004162 0 BROSSIER NICOLE M 2018353 9999999 B 10 1588004162 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1588004162 0 Physicians Anesthesia Services 20 1588004162 0 Physicians Fluoride varnish 20 1588004162 0 Physicians Healthy Kids Services 20 1588004162 0 Physicians Optical Supplies 20 1588004162 0 Physicians Physician Services 00 1588004246 0 GOLAM ISRAA 2016279 9999999 B 10 1588004246 0 5 N ROOT ST STE 105 AURORA IL 605053435 20 1588004246 0 Dentists Dental Services 20 1588004246 0 Dentists Physician Services 00 1588004329 0 HEBERER BRIAN J 2019361 9999999 B 10 1588004329 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1588004329 0 Physicians Anesthesia Services 20 1588004329 0 Physicians Healthy 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0 Physicians Physician Services 00 1588007330 0 GANSKE PAIGE 2023352 9999999 B 10 1588007330 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1588007330 0 Physicians Anesthesia Services 20 1588007330 0 Physicians Healthy Kids Services 20 1588007330 0 Physicians Optical Supplies 20 1588007330 0 Physicians Physician Services 00 1588007744 0 CRAIG LAURA 2017209 9999999 B 10 1588007744 0 4025 N SHERIDAN RD CHICAGO IL 606132010 20 1588007744 0 Physicians Anesthesia Services 20 1588007744 0 Physicians Healthy Kids Services 20 1588007744 0 Physicians Optical Supplies 20 1588007744 0 Physicians Physician Services 20 1588007744 0 Physicians Physicians Psychiatric Services 00 1588007751 0 DINNEL KINSEY I 2017274 9999999 B 10 1588007751 0 1701 LACEY ST CAPE GIRARDEAU MO 637015230 20 1588007751 0 Physicians Anesthesia Services 20 1588007751 0 Physicians Healthy Kids Services 20 1588007751 0 Physicians Optical Supplies 20 1588007751 0 Physicians Physician Services 00 1588008122 0 CARROLL MICHELE M 2018003 9999999 B 10 1588008122 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1588008122 0 Clinical Social Worker Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1588008569 0 TREMBLY VICTORIA 2018001 9999999 B 10 1588008569 0 1019 VALMEYER RD COLUMBIA IL 622364123 20 1588008569 0 Physician Assistant Only Fluoride varnish 20 1588008569 0 Physician Assistant Only Healthy Kids Services 20 1588008569 0 Physician Assistant Only Physician Services 00 1588008809 0 ALHASAN ROBA 2022284 9999999 B 10 1588008809 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1588008809 0 Physicians Anesthesia Services 20 1588008809 0 Physicians Fluoride varnish 20 1588008809 0 Physicians Healthy Kids Services 20 1588008809 0 Physicians Optical Supplies 20 1588008809 0 Physicians Physician Services 00 1588009229 0 OLIVIERI PATRICK 2021115 9999999 B 10 1588009229 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1588009229 0 Physicians Anesthesia Services 20 1588009229 0 Physicians Healthy Kids Services 20 1588009229 0 Physicians Optical Supplies 20 1588009229 0 Physicians Physician Services 00 1588010177 0 LIEN MING 2024347 9999999 B 10 1588010177 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1588010177 0 Physicians Anesthesia Services 20 1588010177 0 Physicians Healthy Kids Services 20 1588010177 0 Physicians Optical Supplies 20 1588010177 0 Physicians Physician Services 20 1588010177 0 Physicians Physicians Psychiatric Services 00 1588010607 0 FARLOW JANICE 2023343 9999999 B 10 1588010607 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1588010607 0 Physicians Anesthesia Services 20 1588010607 0 Physicians Healthy Kids Services 20 1588010607 0 Physicians Optical Supplies 20 1588010607 0 Physicians Physician Services 00 1588011605 0 SYED TALAT 2020195 9999999 B 10 1588011605 0 500 PORTER AVE AURORA MO 656052365 20 1588011605 0 Physicians Anesthesia Services 20 1588011605 0 Physicians Fluoride varnish 20 1588011605 0 Physicians Healthy 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Supplies 20 1588012041 0 Physicians Physician Services 00 1588012256 0 HOLTHAUS EMILY 2020199 9999999 B 10 1588012256 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1588012256 0 Physicians Anesthesia Services 20 1588012256 0 Physicians Healthy Kids Services 20 1588012256 0 Physicians Optical Supplies 20 1588012256 0 Physicians Physician Services 00 1588013726 0 DECUFFA MATTHEW RAYMOND 2019310 9999999 B 10 1588013726 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1588013726 0 Physicians Anesthesia Services 20 1588013726 0 Physicians Fluoride varnish 20 1588013726 0 Physicians Healthy Kids Services 20 1588013726 0 Physicians Optical Supplies 20 1588013726 0 Physicians Physician Services 00 1588013783 0 GUNTHER KRYSTYN M 2016239 9999999 B 10 1588013783 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1588013783 0 Clinical Social Worker Social work service 00 1588014336 0 LARSON BRANDI 2016222 9999999 B 10 1588014336 0 727 E COURT ST PARIS IL 619442460 20 1588014336 0 Nurse Practitioners Fluoride varnish 20 1588014336 0 Nurse Practitioners Healthy Kids Services 20 1588014336 0 Nurse Practitioners Nurse Practitioners Services 20 1588014336 0 Nurse Practitioners Physician Services 00 1588014716 0 FERNANDEZ DANIEL 2019300 9999999 B 10 1588014716 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1588014716 0 Physicians Anesthesia Services 20 1588014716 0 Physicians Healthy Kids Services 20 1588014716 0 Physicians Optical Supplies 20 1588014716 0 Physicians Physician Services 00 1588014757 0 WEGLEITNER ELIZABETH 2020214 9999999 B 10 1588014757 0 300 WINDING WOODS DR STE 200 O FALLON MO 633665081 20 1588014757 0 Physicians Anesthesia Services 20 1588014757 0 Physicians Healthy Kids Services 20 1588014757 0 Physicians Optical Supplies 20 1588014757 0 Physicians Physician Services 00 1588015143 0 ELDOMERY MOHAMMAD 2021307 9999999 B 10 1588015143 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1588015143 0 Physicians Anesthesia Services 20 1588015143 0 Physicians Healthy Kids Services 20 1588015143 0 Physicians Optical Supplies 20 1588015143 0 Physicians Physician Services 00 1588015184 0 DE DEBALINA 2018060 9999999 B 10 1588015184 0 5777 DEPT CAROL STREAM IL 601220021 20 1588015184 0 Physicians Anesthesia Services 20 1588015184 0 Physicians Fluoride varnish 20 1588015184 0 Physicians Healthy Kids Services 20 1588015184 0 Physicians Optical Supplies 20 1588015184 0 Physicians Physician Services 00 1588015416 0 THEKKEKARA JAISON 2019204 9999999 B 10 1588015416 0 PO BOX 548 INDIANAPOLIS IN 462060548 20 1588015416 0 Physicians Anesthesia Services 20 1588015416 0 Physicians Healthy Kids Services 20 1588015416 0 Physicians Optical Supplies 20 1588015416 0 Physicians Physician Services 00 1588015697 0 DELEONGUERRERO AARON 2024234 9999999 B 10 1588015697 0 PO BOX 43230 PHOENIX AZ 850803230 20 1588015697 0 Physicians Anesthesia Services 20 1588015697 0 Physicians Healthy Kids Services 20 1588015697 0 Physicians Optical Supplies 20 1588015697 0 Physicians Physician Services 00 1588015762 0 TANEEM SULTANA FNU 2023362 9999999 B 10 1588015762 0 400 N HIGHLAND AVE AURORA IL 605063814 20 1588015762 0 Physicians Anesthesia Services 20 1588015762 0 Physicians Fluoride varnish 20 1588015762 0 Physicians Healthy Kids Services 20 1588015762 0 Physicians Optical Supplies 20 1588015762 0 Physicians Physician Services 00 1588015788 0 PERELMAN ELIZABETH ANN 2019235 9999999 B 10 1588015788 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1588015788 0 Physicians Anesthesia Services 20 1588015788 0 Physicians Healthy Kids Services 20 1588015788 0 Physicians Optical Supplies 20 1588015788 0 Physicians Physician Services 00 1588016091 0 MILLER JENNIFER R 2016221 9999999 B 10 1588016091 0 29373 NETWORK PL CHICAGO IL 606733039 20 1588016091 0 Psychologist Psychologist service 00 1588016257 0 NEWCOMER SALLY 2016188 9999999 B 10 1588016257 0 110 CARVER LN EAST PEORIA IL 616113052 20 1588016257 0 Speech Therapists 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Practitioners Services 20 1588018311 0 Nurse Practitioners Physician Services 00 1588018337 0 GHOUS FARAH 2021033 9999999 B 10 1588018337 0 1395 NW 167TH ST MIAMI FL 331695710 20 1588018337 0 Physicians Anesthesia Services 20 1588018337 0 Physicians Fluoride varnish 20 1588018337 0 Physicians Healthy Kids Services 20 1588018337 0 Physicians Optical Supplies 20 1588018337 0 Physicians Physician Services 00 1588018865 0 CEDENO ANDREA E 2020273 9999999 B 10 1588018865 0 5777 DEPT CAROL STREAM IL 601220021 20 1588018865 0 Physicians Anesthesia Services 20 1588018865 0 Physicians Fluoride varnish 20 1588018865 0 Physicians Healthy Kids Services 20 1588018865 0 Physicians Optical Supplies 20 1588018865 0 Physicians Physician Services 00 1588019293 0 BALUZY MATTHEW 2020106 9999999 B 10 1588019293 0 5635 S ARCHER AVE CHICAGO IL 606381673 20 1588019293 0 Physicians Anesthesia Services 20 1588019293 0 Physicians Healthy Kids Services 20 1588019293 0 Physicians Optical Supplies 20 1588019293 0 Physicians Physician Services 00 1588019558 0 AU EDMUND W 2017087 9999999 B 10 1588019558 0 55 E JACKSON BLVD STE 1500 CHICAGO IL 606044184 20 1588019558 0 Other behavior health professional LCPC/LMFT services 00 1588019715 0 DOSER ERIN M 2023346 9999999 B 10 1588019715 0 12855 N 40 DR STE 375 SAINT LOUIS MO 631418657 20 1588019715 0 Nurse Practitioners Healthy Kids Services 20 1588019715 0 Nurse Practitioners Nurse Practitioners Services 20 1588019715 0 Nurse Practitioners Physician Services 00 1588021307 0 GONZALEZ DAVID A 2021356 9999999 B 10 1588021307 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1588021307 0 Psychologist Psychologist service 00 1588022198 0 LAURIA JENNA R 2024017 9999999 B 10 1588022198 0 515 VALLEY ST STE 203 MAPLEWOOD NJ 070404300 20 1588022198 0 Physician Assistant Only Fluoride varnish 20 1588022198 0 Physician Assistant Only Healthy Kids Services 20 1588022198 0 Physician Assistant Only Physician Services 00 1588025084 0 MIETUS ADAM 2017335 9999999 B 10 1588025084 0 6701 W 95TH ST OAK LAWN IL 604532105 20 1588025084 0 Physician Assistant Only Fluoride varnish 20 1588025084 0 Physician Assistant Only Healthy Kids Services 20 1588025084 0 Physician Assistant Only Physician Services 00 1588025662 0 STURM SEAN MICHAEL 2024220 9999999 B 10 1588025662 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1588025662 0 Physicians Anesthesia Services 20 1588025662 0 Physicians Healthy Kids Services 20 1588025662 0 Physicians Optical Supplies 20 1588025662 0 Physicians Physician Services 00 1588026025 0 GREENFIELD KATHARINE 2019244 9999999 B 10 1588026025 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1588026025 0 Physicians Anesthesia Services 20 1588026025 0 Physicians Fluoride varnish 20 1588026025 0 Physicians Healthy Kids Services 20 1588026025 0 Physicians Optical Supplies 20 1588026025 0 Physicians Physician Services 00 1588026348 0 EMUCHAY NGOZI 2019255 9999999 B 10 1588026348 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1588026348 0 Physicians Anesthesia Services 20 1588026348 0 Physicians Fluoride varnish 20 1588026348 0 Physicians Healthy Kids Services 20 1588026348 0 Physicians Optical Supplies 20 1588026348 0 Physicians Physician Services 00 1588026538 0 PRILUTSKIY ANDREY 2021166 9999999 B 10 1588026538 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1588026538 0 Physicians Anesthesia Services 20 1588026538 0 Physicians Healthy Kids Services 20 1588026538 0 Physicians Optical Supplies 20 1588026538 0 Physicians Physician Services 00 1588026579 0 CONNELL ADAM 2020223 9999999 B 10 1588026579 0 PO BOX 850 METROPOLIS IL 629600850 20 1588026579 0 Physicians Anesthesia Services 20 1588026579 0 Physicians Fluoride varnish 20 1588026579 0 Physicians Healthy Kids Services 20 1588026579 0 Physicians Optical Supplies 20 1588026579 0 Physicians Physician Services 20 1588026579 0 Physicians Physicians Psychiatric Services 00 1588026603 0 TADROS KATHERINE M 2020027 9999999 B 10 1588026603 0 29373 NETWORK PL CHICAGO IL 606733039 20 1588026603 0 Physicians Anesthesia Services 20 1588026603 0 Physicians Healthy Kids Services 20 1588026603 0 Physicians Optical Supplies 20 1588026603 0 Physicians Physician Services 00 1588026637 0 GANDHI SAGAR 2023303 9999999 B 10 1588026637 0 5777 DEPT CAROL STREAM IL 601228942 20 1588026637 0 Physicians Anesthesia Services 20 1588026637 0 Physicians Healthy Kids Services 20 1588026637 0 Physicians Optical Supplies 20 1588026637 0 Physicians Physician Services 00 1588026835 0 MILBROOK NACOLE 2019094 9999999 B 10 1588026835 0 PO BOX 967 TINLEY PARK IL 604770967 20 1588026835 0 Other behavior health professional LCPC/LMFT services 00 1588026991 0 PIPONOV HRISTO IVANOV 2017136 9999999 B 10 1588026991 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1588026991 0 Physicians Anesthesia Services 20 1588026991 0 Physicians Healthy Kids Services 20 1588026991 0 Physicians Optical Supplies 20 1588026991 0 Physicians Physician Services 00 1588027528 0 DILLON TARA M 2017171 9999999 B 10 1588027528 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1588027528 0 Nurse Practitioners Healthy Kids Services 20 1588027528 0 Nurse Practitioners Nurse Practitioners Services 20 1588027528 0 Nurse Practitioners Physician Services 00 1588027924 0 VERMA GEETA 2020016 9999999 B 10 1588027924 0 5777 DEPT CAROL STREAM IL 601220021 20 1588027924 0 Physicians Anesthesia Services 20 1588027924 0 Physicians Healthy Kids Services 20 1588027924 0 Physicians Optical Supplies 20 1588027924 0 Physicians Physician Services 20 1588027924 0 Physicians Physicians Psychiatric Services 00 1588028633 0 CASMARTINO EKATERINA F 2021208 9999999 B 10 1588028633 0 PO BOX 43230 PHOENIX AZ 850803230 20 1588028633 0 Physicians Anesthesia Services 20 1588028633 0 Physicians Fluoride varnish 20 1588028633 0 Physicians Healthy Kids Services 20 1588028633 0 Physicians Optical Supplies 20 1588028633 0 Physicians Physician Services 00 1588028773 0 HU TIFFANY 2024226 9999999 B 10 1588028773 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1588028773 0 Physicians Anesthesia Services 20 1588028773 0 Physicians Fluoride varnish 20 1588028773 0 Physicians Healthy Kids Services 20 1588028773 0 Physicians Optical Supplies 20 1588028773 0 Physicians Physician Services 00 1588030373 0 GONZALES GREZELRO R 2015231 9999999 B 10 1588030373 0 7156 W 127TH ST UNIT 300 PALOS HEIGHTS IL 604631560 20 1588030373 0 Nurse Practitioners Fluoride varnish 20 1588030373 0 Nurse Practitioners Healthy Kids Services 20 1588030373 0 Nurse Practitioners Nurse Practitioners Services 20 1588030373 0 Nurse Practitioners Physician Services 00 1588031934 0 PLASKEY TRACY 2018001 9999999 B 10 1588031934 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1588031934 0 Nurse Practitioners Fluoride varnish 20 1588031934 0 Nurse Practitioners Healthy Kids Services 20 1588031934 0 Nurse Practitioners Nurse Practitioners Services 20 1588031934 0 Nurse Practitioners Physician Services 00 1588034201 0 FLOWERS ANDREW 2019217 9999999 B 10 1588034201 0 3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047452 20 1588034201 0 Nurse Practitioners Anesthesia Services 20 1588034201 0 Nurse Practitioners Nurse Practitioners Services 20 1588034201 0 Nurse Practitioners Physician Services 00 1588034292 0 CANNATARO NICHOLAS 2022131 9999999 B 10 1588034292 0 2390 W STATION ST KANKAKEE IL 609013000 20 1588034292 0 Physician Assistant Only Fluoride varnish 20 1588034292 0 Physician Assistant Only Healthy Kids Services 20 1588034292 0 Physician Assistant Only Physician Services 00 1588034839 0 BYARS AMELIA J 2016161 9999999 B 10 1588034839 0 1101 S CAPITAL OF TEXAS HWY ST WEST LAKE HILLS TX 787466445 20 1588034839 0 Speech Therapists Medical Supplies 20 1588034839 0 Speech Therapists Medical equipment/prosthetic devices 20 1588034839 0 Speech Therapists Speech Therapy/Pathology Services 00 1588037378 0 BLEW ROBIN E 2015307 9999999 B 10 1588037378 0 611 W PARK ST URBANA IL 618012529 20 1588037378 0 Nurse Practitioners Fluoride varnish 20 1588037378 0 Nurse Practitioners Healthy Kids Services 20 1588037378 0 Nurse Practitioners Nurse Practitioners Services 20 1588037378 0 Nurse Practitioners Physician Services 00 1588037915 0 MCCLAIN HEIDI R 2017199 9999999 B 10 1588037915 0 5665 NEW NORTHSIDE DR STE 320 ATLANTA GA 303285834 20 1588037915 0 Nurse Practitioners Fluoride varnish 20 1588037915 0 Nurse Practitioners Healthy Kids Services 20 1588037915 0 Nurse Practitioners Nurse Practitioners Services 20 1588037915 0 Nurse Practitioners Physician Services 00 1588039218 0 BURNS CLIFTON G 2020025 9999999 B 10 1588039218 0 3333 WARRENVILLE RD LISLE IL 605321157 20 1588039218 0 Other behavior health professional LCPC/LMFT services 00 1588039432 0 SCHLESSINGER DANIEL I 2020216 9999999 B 10 1588039432 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1588039432 0 Physicians Anesthesia Services 20 1588039432 0 Physicians Healthy Kids Services 20 1588039432 0 Physicians Optical Supplies 20 1588039432 0 Physicians Physician Services 00 1588040422 0 KARLEN CLAIRE 2022012 9999999 B 10 1588040422 0 11365 DORSETT RD MARYLAND HEIGHT MO 630433411 20 1588040422 0 Psychologist Psychologist service 00 1588040976 0 PHOENIX SHIMA 2018190 9999999 B 10 1588040976 0 802 N 9TH ST SPRINGFIELD IL 627026309 20 1588040976 0 Dentists Dental Services 20 1588040976 0 Dentists Physician Services 00 1588041164 0 RAINEY SHANE C 2018024 9999999 B 10 1588041164 0 1518 MULBERRY AVE MUSCATINE IA 527613433 20 1588041164 0 Physicians Anesthesia Services 20 1588041164 0 Physicians Fluoride varnish 20 1588041164 0 Physicians Healthy Kids Services 20 1588041164 0 Physicians Optical Supplies 20 1588041164 0 Physicians Physician Services 00 1588041206 0 TURNER AMY L 2023109 9999999 B 10 1588041206 0 6820 MADRONE DR ROCKFORD MI 493419578 20 1588041206 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1588041313 0 SADEDDIN MOHAMMAD 2022341 9999999 B 10 1588041313 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1588041313 0 Physicians Anesthesia Services 20 1588041313 0 Physicians Fluoride varnish 20 1588041313 0 Physicians Healthy Kids Services 20 1588041313 0 Physicians Optical Supplies 20 1588041313 0 Physicians Physician Services 00 1588041362 0 BONSU ELIZABETH 2019043 9999999 B 10 1588041362 0 800 E LOCUST ST OLNEY IL 624502553 20 1588041362 0 Physicians Anesthesia Services 20 1588041362 0 Physicians Fluoride varnish 20 1588041362 0 Physicians Healthy Kids Services 20 1588041362 0 Physicians Optical Supplies 20 1588041362 0 Physicians Physician Services 00 1588041404 0 GRANT TIFFANI M 2018151 9999999 B 10 1588041404 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1588041404 0 Occupational Therapists Medical Supplies 20 1588041404 0 Occupational Therapists Medical equipment/prosthetic devices 20 1588041404 0 Occupational Therapists Occupational Therapy Services 00 1588041891 0 SWIERAD MELISSA M 2017214 9999999 B 10 1588041891 0 5777 DEPT CAROL STREAM IL 601220021 20 1588041891 0 Nurse Practitioners Healthy Kids Services 20 1588041891 0 Nurse Practitioners Nurse Practitioners Services 20 1588041891 0 Nurse Practitioners Physician Services 00 1588042709 0 STUNKEL MARIA 2018033 9999999 B 10 1588042709 0 621 S NEW BALLAS RD STE 585A SAINT LOUIS MO 631418261 20 1588042709 0 Physicians Anesthesia Services 20 1588042709 0 Physicians Healthy Kids Services 20 1588042709 0 Physicians Optical Supplies 20 1588042709 0 Physicians Physician Services 00 1588043046 0 CHECCHI KYLE D 2024275 9999999 B 10 1588043046 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1588043046 0 Physicians Anesthesia Services 20 1588043046 0 Physicians Healthy Kids Services 20 1588043046 0 Physicians Optical Supplies 20 1588043046 0 Physicians Physician Services 00 1588043285 0 VELEDNITSKY EUGENE 2025041 9999999 B 10 1588043285 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1588043285 0 Physician Assistant Only Fluoride varnish 20 1588043285 0 Physician Assistant Only Healthy Kids Services 20 1588043285 0 Physician Assistant Only Physician Services 00 1588043772 0 MERAM MARY KATHERINE 2020217 9999999 B 10 1588043772 0 29373 NETWORK PL CHICAGO IL 606733039 20 1588043772 0 Physicians Anesthesia Services 20 1588043772 0 Physicians Healthy Kids Services 20 1588043772 0 Physicians Optical Supplies 20 1588043772 0 Physicians Physician Services 00 1588044127 0 DELI CHRISTINA 2017306 9999999 B 10 1588044127 0 373 S SCHMALE RD STE 102 CAROL STREAM IL 601882771 20 1588044127 0 Other behavior health professional LCPC/LMFT services 00 1588044275 0 BONTRAGER KATHRYN 2016246 9999999 B 10 1588044275 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1588044275 0 Physician Assistant Only Fluoride varnish 20 1588044275 0 Physician Assistant Only Healthy Kids Services 20 1588044275 0 Physician Assistant Only Physician Services 00 1588045017 0 MITCHELL CALEB J 2018197 9999999 B 10 1588045017 0 1201 PINE ST ELDORADO IL 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MAYWOOD IL 601533328 20 1588049100 0 Physician Assistant Only Fluoride varnish 20 1588049100 0 Physician Assistant Only Healthy Kids Services 20 1588049100 0 Physician Assistant Only Physician Services 00 1588049571 0 FRANSON MONICA T 2015271 9999999 B 10 1588049571 0 10150 DEE RD DES PLAINES IL 600161512 20 1588049571 0 Speech Therapists Medical Supplies 20 1588049571 0 Speech Therapists Medical equipment/prosthetic devices 20 1588049571 0 Speech Therapists Speech Therapy/Pathology Services 00 1588049712 0 ATTILI ABDELRAHMAN 2022225 9999999 B 10 1588049712 0 PO BOX 23410 LITTLE ROCK AR 722213410 20 1588049712 0 Physicians Anesthesia Services 20 1588049712 0 Physicians Healthy Kids Services 20 1588049712 0 Physicians Optical Supplies 20 1588049712 0 Physicians Physician Services 00 1588049928 0 OSHINSKI ASHLEN 2017267 9999999 B 10 1588049928 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1588049928 0 Occupational Therapists Medical Supplies 20 1588049928 0 Occupational Therapists 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Physician Services 00 1588059356 0 AJAM TAREK 2023128 9999999 B 10 1588059356 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1588059356 0 Physicians Anesthesia Services 20 1588059356 0 Physicians Fluoride varnish 20 1588059356 0 Physicians Healthy Kids Services 20 1588059356 0 Physicians Optical Supplies 20 1588059356 0 Physicians Physician Services 00 1588059570 0 CHERAYIL NEENA 2020197 9999999 B 10 1588059570 0 5777 DEPT CAROL STREAM IL 601220021 20 1588059570 0 Physicians Anesthesia Services 20 1588059570 0 Physicians Healthy Kids Services 20 1588059570 0 Physicians Optical Supplies 20 1588059570 0 Physicians Physician Services 20 1588059570 0 Physicians Physicians Psychiatric Services 00 1588059679 0 WASZ MEGAN A 2018270 9999999 B 10 1588059679 0 29373 NETWORK PL CHICAGO IL 606733039 20 1588059679 0 Physicians Anesthesia Services 20 1588059679 0 Physicians Fluoride varnish 20 1588059679 0 Physicians Healthy Kids Services 20 1588059679 0 Physicians Optical Supplies 20 1588059679 0 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Practitioners Healthy Kids Services 20 1588063390 0 Nurse Practitioners Nurse Practitioners Services 20 1588063390 0 Nurse Practitioners Physician Services 00 1588063408 0 WECKBACH MICHELLE 2015239 9999999 B 10 1588063408 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1588063408 0 Speech Therapists Medical Supplies 20 1588063408 0 Speech Therapists Medical equipment/prosthetic devices 20 1588063408 0 Speech Therapists Speech Therapy/Pathology Services 00 1588063994 0 CASSIDY GWEN M 2014244 9999999 B 10 1588063994 0 PO BOX 2477 SHELTON CT 064841477 20 1588063994 0 Nurse Practitioners Healthy Kids Services 20 1588063994 0 Nurse Practitioners Nurse Practitioners Services 20 1588063994 0 Nurse Practitioners Physician Services 00 1588065270 0 SMITH RYLEY 2014162 9999999 B 10 1588065270 0 1025 MAINE ST QUINCY IL 623014038 20 1588065270 0 Physical Therapists Medical Supplies 20 1588065270 0 Physical Therapists Medical equipment/prosthetic devices 20 1588065270 0 Physical Therapists Physical Therapy Services 00 1588065353 0 BEHLING ANDREA 2015050 9999999 B 10 1588065353 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1588065353 0 Nurse Practitioners Healthy Kids Services 20 1588065353 0 Nurse Practitioners Nurse Practitioners Services 20 1588065353 0 Nurse Practitioners Physician Services 00 1588066427 0 CHAN TAMRA 2014349 9999999 B 10 1588066427 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1588066427 0 Nurse Practitioners Fluoride varnish 20 1588066427 0 Nurse Practitioners Healthy Kids Services 20 1588066427 0 Nurse Practitioners Nurse Practitioners Services 20 1588066427 0 Nurse Practitioners Physician Services 00 1588067557 0 DUPONT AMY 2023343 9999999 B 10 1588067557 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1588067557 0 Physician Assistant Only Fluoride varnish 20 1588067557 0 Physician Assistant Only Healthy Kids Services 20 1588067557 0 Physician Assistant Only Physician Services 00 1588068464 0 MERCHIORI REBECCA J 2014305 9999999 B 10 1588068464 0 PO BOX 843033 KANSAS CITY MO 641843033 20 1588068464 0 Nurse Practitioners Healthy Kids Services 20 1588068464 0 Nurse Practitioners Nurse Practitioners Services 20 1588068464 0 Nurse Practitioners Physician Services 00 1588068597 0 CHILKULWAR ABHISHEK R 2018204 9999999 B 10 1588068597 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1588068597 0 Physicians Anesthesia Services 20 1588068597 0 Physicians Fluoride varnish 20 1588068597 0 Physicians Healthy Kids Services 20 1588068597 0 Physicians Optical Supplies 20 1588068597 0 Physicians Physician Services 00 1588068894 0 COSTELLOE LINA 2014305 9999999 B 10 1588068894 0 2824 ORCHARD LN WILMETTE IL 600912144 20 1588068894 0 Clinical Social Worker Social work service 00 1588069728 0 SCHINDLER CLAUDIA 2014349 9999999 B 10 1588069728 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1588069728 0 Nurse Practitioners Fluoride varnish 20 1588069728 0 Nurse Practitioners Healthy Kids Services 20 1588069728 0 Nurse Practitioners Nurse Practitioners Services 20 1588069728 0 Nurse Practitioners Physician Services 00 1588070965 0 EVANS JAMI 2023356 9999999 B 10 1588070965 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1588070965 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1588071294 0 JAROSZEWSKA ANNA 2017182 9999999 B 10 1588071294 0 2211 N ELSTON AVE STE 301 CHICAGO IL 606149278 20 1588071294 0 Physicians All Kids application agent 20 1588071294 0 Physicians Anesthesia Services 20 1588071294 0 Physicians Fluoride varnish 20 1588071294 0 Physicians Healthy Kids Services 20 1588071294 0 Physicians Optical Supplies 20 1588071294 0 Physicians Physician Services 00 1588073555 0 REDIG LAUREN N 2018270 9999999 B 10 1588073555 0 1765 N ELSTON AVE STE 206 CHICAGO IL 606421501 20 1588073555 0 Physical Therapists Medical Supplies 20 1588073555 0 Physical Therapists Medical equipment/prosthetic devices 20 1588073555 0 Physical Therapists Physical Therapy Services 00 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0 1044 N FRANCISCO AVE CHICAGO IL 606222743 20 1588075576 0 Physicians Anesthesia Services 20 1588075576 0 Physicians Fluoride varnish 20 1588075576 0 Physicians Healthy Kids Services 20 1588075576 0 Physicians Optical Supplies 20 1588075576 0 Physicians Physician Services 00 1588075584 0 MIRKOVIC DIJANA 2017160 9999999 B 10 1588075584 0 3260 W 111TH ST CHICAGO IL 606552729 20 1588075584 0 Podiatrists Podiatric Services 00 1588076285 0 RAMIREZ GOMEZ JOSE M 2021209 9999999 B 10 1588076285 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1588076285 0 Physicians Anesthesia Services 20 1588076285 0 Physicians Healthy Kids Services 20 1588076285 0 Physicians Optical Supplies 20 1588076285 0 Physicians Physician Services 00 1588076624 0 LEE ZIHO 2021251 9999999 B 10 1588076624 0 5777 DEPT CAROL STREAM IL 601220021 20 1588076624 0 Physicians Anesthesia Services 20 1588076624 0 Physicians Healthy Kids Services 20 1588076624 0 Physicians Optical Supplies 20 1588076624 0 Physicians Physician Services 00 1588077887 0 WALSH KATE LYN 2023283 9999999 B 10 1588077887 0 PO BOX 778912 CHICAGO IL 606778912 20 1588077887 0 Psychologist Psychologist service 00 1588079107 0 STUNKEL LEANNE D 2019244 9999999 B 10 1588079107 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1588079107 0 Physicians Anesthesia Services 20 1588079107 0 Physicians Healthy Kids Services 20 1588079107 0 Physicians Optical Supplies 20 1588079107 0 Physicians Physician Services 00 1588079479 0 LEIKIN SCOTT M 2017182 9999999 B 10 1588079479 0 2315 ENTERPRISE DR STE 110 SUITE 110 WESTCHESTER IL 601545809 20 1588079479 0 Physicians Anesthesia Services 20 1588079479 0 Physicians Fluoride varnish 20 1588079479 0 Physicians Healthy Kids Services 20 1588079479 0 Physicians Optical Supplies 20 1588079479 0 Physicians Physician Services 00 1588079644 0 KELEHER KRISTEN 2018174 9999999 B 10 1588079644 0 120 S MARION ST OAK PARK IL 603022809 20 1588079644 0 Other behavior health professional LCPC/LMFT services 00 1588079966 0 KENNEDY MICHAEL R 2017135 9999999 B 10 1588079966 0 28592 NETWORK PL CHICAGO IL 606731285 20 1588079966 0 Physicians Anesthesia Services 20 1588079966 0 Physicians Healthy Kids Services 20 1588079966 0 Physicians Optical Supplies 20 1588079966 0 Physicians Physician Services 00 1588082507 0 COBB REBECCA L 2017180 9999999 B 10 1588082507 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1588082507 0 Physicians Anesthesia Services 20 1588082507 0 Physicians Fluoride varnish 20 1588082507 0 Physicians Healthy Kids Services 20 1588082507 0 Physicians Optical Supplies 20 1588082507 0 Physicians Physician Services 00 1588083232 0 GHANAYEM-BOUIKIDIS SAMANTHA J 2017226 9999999 B 10 1588083232 0 PO BOX 343918 MILWAUKEE WI 532343918 20 1588083232 0 Physicians Anesthesia Services 20 1588083232 0 Physicians Fluoride varnish 20 1588083232 0 Physicians Healthy Kids Services 20 1588083232 0 Physicians Optical Supplies 20 1588083232 0 Physicians Physician Services 00 1588083257 0 SHANKAR SHILPA 2017230 9999999 B 10 1588083257 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1588083257 0 Physicians Anesthesia Services 20 1588083257 0 Physicians Fluoride varnish 20 1588083257 0 Physicians Healthy Kids Services 20 1588083257 0 Physicians Optical Supplies 20 1588083257 0 Physicians Physician Services 00 1588083430 0 LADD JENNIFER M 2024115 9999999 B 10 1588083430 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1588083430 0 Physicians Anesthesia Services 20 1588083430 0 Physicians Fluoride varnish 20 1588083430 0 Physicians Healthy Kids Services 20 1588083430 0 Physicians Optical Supplies 20 1588083430 0 Physicians Physician Services 00 1588083844 0 SPEZIA AMANDA 2014271 9999999 B 10 1588083844 0 610 N GILBERT ST STE A610N DANVILLE IL 618323940 20 1588083844 0 Nurse Practitioners Fluoride varnish 20 1588083844 0 Nurse Practitioners Healthy Kids Services 20 1588083844 0 Nurse Practitioners Nurse Practitioners Services 20 1588083844 0 Nurse Practitioners 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KRYSTAL 2024303 9999999 B 10 1588352074 0 200 OCEANGATE STE 100 LONG BEACH CA 908024317 20 1588352074 0 Nurse Practitioners Fluoride varnish 20 1588352074 0 Nurse Practitioners Healthy Kids Services 20 1588352074 0 Nurse Practitioners Nurse Practitioners Services 20 1588352074 0 Nurse Practitioners Physician Services 00 1588352405 0 PRIDE CEYMONE L 2025045 9999999 B 10 1588352405 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1588352405 0 Physician Assistant Only Fluoride varnish 20 1588352405 0 Physician Assistant Only Healthy Kids Services 20 1588352405 0 Physician Assistant Only Physician Services 00 1588354823 0 MANN JULIE 2024271 9999999 B 10 1588354823 0 211 E LAKE ST STE 1A ADDISON IL 601012877 20 1588354823 0 Psychologist Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1588355176 0 NAWAZ SHAIZORE 2023199 9999999 B 10 1588355176 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1588355176 0 Physicians Anesthesia Services 20 1588355176 0 Physicians 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Anesthesia Services 20 1588616585 0 Physicians Fluoride varnish 20 1588616585 0 Physicians Healthy Kids Services 20 1588616585 0 Physicians Optical Supplies 20 1588616585 0 Physicians Physician Services 00 1588616601 0 DON IRL J 1993274 9999999 B 10 1588616601 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1588616601 0 Physicians Anesthesia Services 20 1588616601 0 Physicians Fluoride varnish 20 1588616601 0 Physicians Healthy Kids Services 20 1588616601 0 Physicians Optical Supplies 20 1588616601 0 Physicians Physician Services 00 1588616627 0 NEVEL ETTA 2020323 9999999 B 10 1588616627 0 621 S ILLINOIS AVE STE 103 MASON CITY IA 504015489 20 1588616627 0 Physicians Anesthesia Services 20 1588616627 0 Physicians Healthy Kids Services 20 1588616627 0 Physicians Optical Supplies 20 1588616627 0 Physicians Physician Services 00 1588616783 0 KIRBY AMY B 2025017 9999999 B 10 1588616783 0 PO BOX 776473 CHICAGO IL 606776473 20 1588616783 0 Physicians Anesthesia Services 20 1588616783 0 Physicians Healthy Kids Services 20 1588616783 0 Physicians Optical Supplies 20 1588616783 0 Physicians Physician Services 00 1588616981 0 FALCO WILLIAM D 1996245 9999999 B 10 1588616981 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1588616981 0 Physicians Anesthesia Services 20 1588616981 0 Physicians Healthy Kids Services 20 1588616981 0 Physicians Optical Supplies 20 1588616981 0 Physicians Physician Services 00 1588617757 0 VLAHOS ATHANASIOS 2005206 9999999 B 10 1588617757 0 2875 W 19TH ST CHICAGO IL 606233501 20 1588617757 0 Physicians Anesthesia Services 20 1588617757 0 Physicians Healthy Kids Services 20 1588617757 0 Physicians Optical Supplies 20 1588617757 0 Physicians Physician Services 00 1588617831 0 TOLLEY JAMES A 1999182 9999999 B 10 1588617831 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1588617831 0 Physicians Anesthesia Services 20 1588617831 0 Physicians Healthy Kids Services 20 1588617831 0 Physicians Optical Supplies 20 1588617831 0 Physicians Physician Services 00 1588617856 0 IACOB MIRCEA TUDOR 2006182 9999999 B 10 1588617856 0 5777 DEPT CAROL STREAM IL 601220021 20 1588617856 0 Physicians Anesthesia Services 20 1588617856 0 Physicians Healthy Kids Services 20 1588617856 0 Physicians Optical Supplies 20 1588617856 0 Physicians Physician Services 20 1588617856 0 Physicians Physicians Psychiatric Services 00 1588618474 0 INGRAM CHARLES 2000061 9999999 B 10 1588618474 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1588618474 0 Physicians Anesthesia Services 20 1588618474 0 Physicians Healthy Kids Services 20 1588618474 0 Physicians Optical Supplies 20 1588618474 0 Physicians Physician Services 00 1588618482 0 QURESHI NAEEM A 2000082 9999999 B 10 1588618482 0 PO BOX 3988 CARBONDALE IL 629023988 20 1588618482 0 Physicians All Kids application agent 20 1588618482 0 Physicians Anesthesia Services 20 1588618482 0 Physicians Healthy Kids Services 20 1588618482 0 Physicians Optical Supplies 20 1588618482 0 Physicians Physician Services 20 1588618482 0 Physicians Physicians Psychiatric Services 00 1588618516 0 PHILLIPS CRAIG S 2000183 9999999 B 10 1588618516 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1588618516 0 Physicians Anesthesia Services 20 1588618516 0 Physicians Healthy Kids Services 20 1588618516 0 Physicians Optical Supplies 20 1588618516 0 Physicians Physician Services 00 1588620249 0 SEBRANEK JOSHUA J 2006182 9999999 B 10 1588620249 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1588620249 0 Physicians Anesthesia Services 20 1588620249 0 Physicians Healthy Kids Services 20 1588620249 0 Physicians Optical Supplies 20 1588620249 0 Physicians Physician Services 00 1588620603 0 RUSSELL KAREN 1987182 9999999 B 10 1588620603 0 PO BOX 120288 DALLAS TX 753120288 20 1588620603 0 Physicians Anesthesia Services 20 1588620603 0 Physicians Healthy Kids Services 20 1588620603 0 Physicians Optical Supplies 20 1588620603 0 Physicians Physician Services 00 1588620686 0 KULKARNI KEDAR 2020083 9999999 B 10 1588620686 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1588620686 0 Physicians Anesthesia Services 20 1588620686 0 Physicians Healthy Kids Services 20 1588620686 0 Physicians Optical Supplies 20 1588620686 0 Physicians Physician Services 00 1588620819 0 TOBIAS JOSEPH D 1995244 9999999 B 10 1588620819 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1588620819 0 Physicians Anesthesia Services 20 1588620819 0 Physicians Healthy Kids Services 20 1588620819 0 Physicians Optical Supplies 20 1588620819 0 Physicians Physician Services 00 1588620959 0 ARNO JANET N 1989322 9999999 B 10 1588620959 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1588620959 0 Physicians Anesthesia Services 20 1588620959 0 Physicians Fluoride varnish 20 1588620959 0 Physicians Healthy Kids Services 20 1588620959 0 Physicians Optical Supplies 20 1588620959 0 Physicians Physician Services 00 1588621205 0 MILLER TIMOTHY ALLEN 1996197 9999999 B 10 1588621205 0 5160 HICKORY POINT FRONTAGE RD DECATUR IL 625269778 20 1588621205 0 Physicians Anesthesia Services 20 1588621205 0 Physicians Fluoride varnish 20 1588621205 0 Physicians Healthy Kids Services 20 1588621205 0 Physicians Optical Supplies 20 1588621205 0 Physicians Physician Services 00 1588621601 0 MARIN THELMA 2000214 9999999 B 10 1588621601 0 3900 GABRIELLE LN UNIT 9130 AURORA IL 605984335 20 1588621601 0 Physicians Anesthesia Services 20 1588621601 0 Physicians Fluoride varnish 20 1588621601 0 Physicians Healthy Kids Services 20 1588621601 0 Physicians Optical Supplies 20 1588621601 0 Physicians Physician Services 00 1588621783 0 DITTMER STACY 2010091 9999999 B 10 1588621783 0 939 W NORTH AVE CHICAGO IL 606427138 20 1588621783 0 Physical Therapists Physical Therapy Services 00 1588622682 0 BRAUN RYAN M 2006150 9999999 B 10 1588622682 0 44000 GARFIELD RD CLINTON TOWNSHI MI 480381125 20 1588622682 0 Physicians Anesthesia Services 20 1588622682 0 Physicians Healthy Kids Services 20 1588622682 0 Physicians Optical 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BOGAERDE JAMES M 2023226 9999999 B 10 1588624522 0 1450 N COUNTY ROAD 2050 E CARTHAGE IL 623213551 20 1588624522 0 Physicians Anesthesia Services 20 1588624522 0 Physicians Healthy Kids Services 20 1588624522 0 Physicians Optical Supplies 20 1588624522 0 Physicians Physician Services 00 1588625149 0 SCHLEETER THOMAS P 2003213 9999999 B 10 1588625149 0 250 W 96TH ST STE 520 INDIANAPOLIS IN 462601317 20 1588625149 0 Physicians Anesthesia Services 20 1588625149 0 Physicians Fluoride varnish 20 1588625149 0 Physicians Healthy Kids Services 20 1588625149 0 Physicians Optical Supplies 20 1588625149 0 Physicians Physician Services 00 1588625677 0 HOANG VU 2013032 9999999 B 10 1588625677 0 PO BOX 781076 DETROIT MI 482781076 20 1588625677 0 Physicians Anesthesia Services 20 1588625677 0 Physicians Healthy Kids Services 20 1588625677 0 Physicians Optical Supplies 20 1588625677 0 Physicians Physician Services 00 1588625875 0 PRIEST EDWIN 1988113 9999999 B 10 1588625875 0 3701 ALGONQUIN RD STE 900 SUITE 900 ROLLING MEADOWS IL 600083193 20 1588625875 0 Physicians Anesthesia Services 20 1588625875 0 Physicians Fluoride varnish 20 1588625875 0 Physicians Healthy Kids Services 20 1588625875 0 Physicians Optical Supplies 20 1588625875 0 Physicians Physician Services 00 1588626576 0 REED CRYSTAL D 1994166 9999999 B 10 1588626576 0 124 SW ADAMS ST PEORIA IL 616021320 20 1588626576 0 Physicians Anesthesia Services 20 1588626576 0 Physicians Healthy Kids Services 20 1588626576 0 Physicians Optical Supplies 20 1588626576 0 Physicians Physician Services 00 1588627251 0 WELLINGTON JOSHUA R 2005019 9999999 B 10 1588627251 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1588627251 0 Physicians Anesthesia Services 20 1588627251 0 Physicians Healthy Kids Services 20 1588627251 0 Physicians Optical Supplies 20 1588627251 0 Physicians Physician Services 00 1588627558 0 KNUCKEY JANICE C 2006001 9999999 B 10 1588627558 0 5777 DEPT CAROL STREAM IL 601220021 20 1588627558 0 Nurse Practitioners Healthy Kids Services 20 1588627558 0 Nurse Practitioners Nurse Practitioners Services 20 1588627558 0 Nurse Practitioners Physician Services 00 1588628002 0 CHALASANI NAGA 2005233 9999999 B 10 1588628002 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1588628002 0 Physicians Anesthesia Services 20 1588628002 0 Physicians Fluoride varnish 20 1588628002 0 Physicians Healthy Kids Services 20 1588628002 0 Physicians Optical Supplies 20 1588628002 0 Physicians Physician Services 00 1588628168 0 TRIBUS CLIFFORD B 1993227 9999999 B 10 1588628168 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1588628168 0 Physicians Anesthesia Services 20 1588628168 0 Physicians Healthy Kids Services 20 1588628168 0 Physicians Optical Supplies 20 1588628168 0 Physicians Physician Services 00 1588629026 0 MARKUS ROBERT S 1991182 9999999 B 10 1588629026 0 P O BOX 771858 CHICAGO IL 606770001 20 1588629026 0 Physicians Anesthesia Services 20 1588629026 0 Physicians Healthy Kids Services 20 1588629026 0 Physicians Optical Supplies 20 1588629026 0 Physicians Physician Services 00 1588629455 0 ROSS BRADLEY 1988284 9999999 B 10 1588629455 0 PO BOX 772294 DETROIT MI 482772294 20 1588629455 0 Podiatrists Podiatric Services 00 1588630446 0 HUIE MICHAEL 2005274 9999999 B 10 1588630446 0 515 22ND AVE MONROE WI 535661569 20 1588630446 0 Physicians Anesthesia Services 20 1588630446 0 Physicians Fluoride varnish 20 1588630446 0 Physicians Healthy Kids Services 20 1588630446 0 Physicians Optical Supplies 20 1588630446 0 Physicians Physician Services 00 1588630495 0 KORCEK ANDREW 2004183 9999999 B 10 1588630495 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1588630495 0 Physicians Anesthesia Services 20 1588630495 0 Physicians Fluoride varnish 20 1588630495 0 Physicians Healthy Kids Services 20 1588630495 0 Physicians Optical Supplies 20 1588630495 0 Physicians Physician Services 00 1588630529 0 ANDREWS STEVE 1992275 9999999 B 10 1588630529 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1588630529 0 Physicians Anesthesia Services 20 1588630529 0 Physicians Fluoride varnish 20 1588630529 0 Physicians Healthy Kids Services 20 1588630529 0 Physicians Optical Supplies 20 1588630529 0 Physicians Physician Services 00 1588630610 0 KRANNER PAUL W 1992183 9999999 B 10 1588630610 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1588630610 0 Physicians Anesthesia Services 20 1588630610 0 Physicians Healthy Kids Services 20 1588630610 0 Physicians Optical Supplies 20 1588630610 0 Physicians Physician Services 00 1588630644 0 HEGEMAN ROBERT 2005182 9999999 B 10 1588630644 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1588630644 0 Physicians Anesthesia Services 20 1588630644 0 Physicians Fluoride varnish 20 1588630644 0 Physicians Healthy Kids Services 20 1588630644 0 Physicians Optical Supplies 20 1588630644 0 Physicians Physician Services 00 1588630669 0 KLUGMAN ADAM 1992183 9999999 B 10 1588630669 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1588630669 0 Physicians Anesthesia Services 20 1588630669 0 Physicians Fluoride varnish 20 1588630669 0 Physicians Healthy Kids Services 20 1588630669 0 Physicians Optical Supplies 20 1588630669 0 Physicians Physician Services 00 1588630719 0 DANG DUC VUONG ANH 2003034 9999999 B 10 1588630719 0 5665 NEW NORTHSIDE DR STE 320 ATLANTA GA 303285834 20 1588630719 0 Physicians Anesthesia Services 20 1588630719 0 Physicians Fluoride varnish 20 1588630719 0 Physicians Healthy Kids Services 20 1588630719 0 Physicians Optical Supplies 20 1588630719 0 Physicians Physician Services 00 1588630727 0 BOPPANA PRASHANTHI 2000183 9999999 B 10 1588630727 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1588630727 0 Physicians Anesthesia Services 20 1588630727 0 Physicians Healthy Kids Services 20 1588630727 0 Physicians Optical Supplies 20 1588630727 0 Physicians Physician Services 20 1588630727 0 Physicians Physicians Psychiatric Services 00 1588630743 0 CLAYTON GALETA C 2002182 9999999 B 10 1588630743 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1588630743 0 Physicians Anesthesia Services 20 1588630743 0 Physicians Healthy Kids Services 20 1588630743 0 Physicians Optical Supplies 20 1588630743 0 Physicians Physician Services 00 1588631212 0 HARJAI KISHORE J 2021127 9999999 B 10 1588631212 0 1 SAINT ANTHONYS WAY ALTON IL 620024568 20 1588631212 0 Physicians Anesthesia Services 20 1588631212 0 Physicians Fluoride varnish 20 1588631212 0 Physicians Healthy Kids Services 20 1588631212 0 Physicians Optical Supplies 20 1588631212 0 Physicians Physician Services 00 1588631329 0 SHARPE ROBERT 1988001 9999999 B 10 1588631329 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1588631329 0 Physicians Anesthesia Services 20 1588631329 0 Physicians Healthy Kids Services 20 1588631329 0 Physicians Optical Supplies 20 1588631329 0 Physicians Physician Services 20 1588631329 0 Physicians Physicians Psychiatric Services 00 1588631378 0 SHAH ASAD 2001182 9999999 B 10 1588631378 0 1750 N RANDALL RD STE 110 SUITE 110 ELGIN IL 601237900 20 1588631378 0 Physicians Anesthesia Services 20 1588631378 0 Physicians Fluoride varnish 20 1588631378 0 Physicians Healthy Kids Services 20 1588631378 0 Physicians Optical Supplies 20 1588631378 0 Physicians Physician Services 00 1588632244 0 MARX PHYLLIS D 1984228 9999999 B 10 1588632244 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1588632244 0 Physicians Anesthesia Services 20 1588632244 0 Physicians Healthy Kids Services 20 1588632244 0 Physicians Optical Supplies 20 1588632244 0 Physicians Physician Services 00 1588632681 0 SHUSHUNOV SERGEY 1996153 9999999 B 10 1588632681 0 6825 HOBSON VALLEY DR WOODRIDGE IL 605171453 20 1588632681 0 Physicians Anesthesia Services 20 1588632681 0 Physicians Fluoride varnish 20 1588632681 0 Physicians Healthy Kids Services 20 1588632681 0 Physicians Optical Supplies 20 1588632681 0 Physicians Physician Services 00 1588632913 0 MEHL DAVID J 1993187 9999999 B 10 1588632913 0 35318 EAGLE WAY CHICAGO IL 606781353 20 1588632913 0 Physicians Anesthesia Services 20 1588632913 0 Physicians Healthy Kids Services 20 1588632913 0 Physicians Optical Supplies 20 1588632913 0 Physicians Physician Services 00 1588633564 0 NWANERI MATTHEW 2016230 9999999 B 10 1588633564 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1588633564 0 Physicians Anesthesia Services 20 1588633564 0 Physicians Fluoride varnish 20 1588633564 0 Physicians Healthy Kids Services 20 1588633564 0 Physicians Optical Supplies 20 1588633564 0 Physicians Physician Services 00 1588633820 0 VOIGT ELIZABETH 2018159 9999999 B 10 1588633820 0 5777 DEPT CAROL STREAM IL 601228942 20 1588633820 0 Physician Assistant Only Fluoride varnish 20 1588633820 0 Physician Assistant Only Healthy Kids Services 20 1588633820 0 Physician Assistant Only Physician Services 00 1588633853 0 MORGAN MATTHEW 2023250 9999999 B 10 1588633853 0 8170 33RD AVE S MINNEAPOLIS MN 554254516 20 1588633853 0 Physicians Anesthesia Services 20 1588633853 0 Physicians Healthy Kids Services 20 1588633853 0 Physicians Optical Supplies 20 1588633853 0 Physicians Physician Services 00 1588634414 0 HENRICH DOUGLAS 2002252 9999999 B 10 1588634414 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1588634414 0 Physicians Anesthesia Services 20 1588634414 0 Physicians Healthy Kids Services 20 1588634414 0 Physicians Optical Supplies 20 1588634414 0 Physicians Physician Services 00 1588634786 0 BINNS TURNER PAMELA 2023324 9999999 B 10 1588634786 0 PO BOX 3276 EVANSVILLE IN 477313276 20 1588634786 0 Nurse Practitioners Anesthesia Services 20 1588634786 0 Nurse Practitioners Nurse Practitioners Services 20 1588634786 0 Nurse Practitioners Physician Services 00 1588635411 0 PAISNER MARTIN 1988042 9999999 B 10 1588635411 0 917 W FULLERTON AVE CHICAGO IL 606142406 20 1588635411 0 Physicians Anesthesia Services 20 1588635411 0 Physicians Healthy Kids Services 20 1588635411 0 Physicians Optical Supplies 20 1588635411 0 Physicians Physician Services 20 1588635411 0 Physicians Physicians Psychiatric Services 00 1588635940 0 MUN JOSEPH H 2000236 9999999 B 10 1588635940 0 1445 N HUNT CLUB RD STE 102 GURNEE IL 600312603 20 1588635940 0 Physicians Anesthesia Services 20 1588635940 0 Physicians Fluoride varnish 20 1588635940 0 Physicians Healthy Kids Services 20 1588635940 0 Physicians Optical Supplies 20 1588635940 0 Physicians Physician Services 00 1588636286 0 GO STANLEY 2020250 9999999 B 10 1588636286 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1588636286 0 Physicians Anesthesia Services 20 1588636286 0 Physicians Fluoride varnish 20 1588636286 0 Physicians Healthy Kids Services 20 1588636286 0 Physicians Optical Supplies 20 1588636286 0 Physicians Physician Services 00 1588636435 0 HABIB ISAM H 2024219 9999999 B 10 1588636435 0 PO BOX 3988 CARBONDALE IL 629023988 20 1588636435 0 Physicians Anesthesia Services 20 1588636435 0 Physicians Fluoride varnish 20 1588636435 0 Physicians Healthy Kids Services 20 1588636435 0 Physicians Optical 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1588638639 0 Physicians Physician Services 00 1588638811 0 DESTEFANI THOMAS B 1984214 9999999 B 10 1588638811 0 5777 DEPT CAROL STREAM IL 601228942 20 1588638811 0 Physicians Anesthesia Services 20 1588638811 0 Physicians Fluoride varnish 20 1588638811 0 Physicians Healthy Kids Services 20 1588638811 0 Physicians Optical Supplies 20 1588638811 0 Physicians Physician Services 00 1588638928 0 PITTMAN ISAIAH 2007227 9999999 B 10 1588638928 0 3560 S 4TH ST TERRE HAUTE IN 478025540 20 1588638928 0 Physicians Anesthesia Services 20 1588638928 0 Physicians Fluoride varnish 20 1588638928 0 Physicians Healthy Kids Services 20 1588638928 0 Physicians Optical Supplies 20 1588638928 0 Physicians Physician Services 00 1588638993 0 DAWKINS ADAM S 2025055 9999999 B 10 1588638993 0 800 W 9TH ST JASPER IN 475462514 20 1588638993 0 Physicians Anesthesia Services 20 1588638993 0 Physicians Fluoride varnish 20 1588638993 0 Physicians Healthy Kids Services 20 1588638993 0 Physicians Optical Supplies 20 1588638993 0 Physicians Physician Services 00 1588639520 0 JOHNSON MARK 2024187 9999999 B 10 1588639520 0 PO BOX 43230 PHOENIX AZ 850803230 20 1588639520 0 Physicians Anesthesia Services 20 1588639520 0 Physicians Healthy Kids Services 20 1588639520 0 Physicians Optical Supplies 20 1588639520 0 Physicians Physician Services 00 1588639926 0 BARR MICHAEL 2003060 9999999 B 10 1588639926 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1588639926 0 Physicians Anesthesia Services 20 1588639926 0 Physicians Healthy Kids Services 20 1588639926 0 Physicians Optical Supplies 20 1588639926 0 Physicians Physician Services 00 1588640049 0 TOULEIMAT BSHER ABDUL ILAH 2003152 9999999 B 10 1588640049 0 10660 W 143RD ST STE B ORLAND PARK IL 604621989 20 1588640049 0 Physicians Anesthesia Services 20 1588640049 0 Physicians Fluoride varnish 20 1588640049 0 Physicians Healthy Kids Services 20 1588640049 0 Physicians Optical Supplies 20 1588640049 0 Physicians Physician Services 00 1588640650 0 CLARK JAMES 1995182 9999999 B 10 1588640650 0 1880 W WINCHESTER RD STE 104 LIBERTYVILLE IL 600485321 20 1588640650 0 Physicians Anesthesia Services 20 1588640650 0 Physicians Fluoride varnish 20 1588640650 0 Physicians Healthy Kids Services 20 1588640650 0 Physicians Optical Supplies 20 1588640650 0 Physicians Physician Services 00 1588640940 0 COMELLA CYNTHIA 1984171 9999999 B 10 1588640940 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1588640940 0 Physicians Anesthesia Services 20 1588640940 0 Physicians Healthy Kids Services 20 1588640940 0 Physicians Optical Supplies 20 1588640940 0 Physicians Physician Services 20 1588640940 0 Physicians Physicians Psychiatric Services 00 1588641104 0 CHOH JEFFERY 1997182 9999999 B 10 1588641104 0 2361 PAYSPHERE CIR CHICAGO IL 606740023 20 1588641104 0 Physicians Anesthesia Services 20 1588641104 0 Physicians Healthy Kids Services 20 1588641104 0 Physicians Optical Supplies 20 1588641104 0 Physicians Physician Services 00 1588641450 0 EMAMI BAHMAN 1981182 9999999 B 10 1588641450 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1588641450 0 Physicians Anesthesia Services 20 1588641450 0 Physicians Healthy Kids Services 20 1588641450 0 Physicians Optical Supplies 20 1588641450 0 Physicians Physician Services 00 1588642136 0 MARTINI FRANK G. 1987213 9999999 B 10 1588642136 0 5777 DEPT CAROL STREAM IL 601220021 20 1588642136 0 Physicians Anesthesia Services 20 1588642136 0 Physicians Fluoride varnish 20 1588642136 0 Physicians Healthy Kids Services 20 1588642136 0 Physicians Optical Supplies 20 1588642136 0 Physicians Physician Services 00 1588642482 0 SHUJA ATTIA 2005269 9999999 B 10 1588642482 0 PO BOX 486 LAKE FOREST IL 600450486 20 1588642482 0 Physicians Anesthesia Services 20 1588642482 0 Physicians Healthy Kids Services 20 1588642482 0 Physicians Optical Supplies 20 1588642482 0 Physicians Physician Services 00 1588643639 0 PURIGHALLA SRINIVASAN S 2004114 9999999 B 10 1588643639 0 616 35TH AVE STE 1 MOLINE IL 612656158 20 1588643639 0 Physicians Anesthesia Services 20 1588643639 0 Physicians Healthy Kids Services 20 1588643639 0 Physicians Optical Supplies 20 1588643639 0 Physicians Physician Services 00 1588643670 0 MROZOWICZ PICKEN MARIA 1988246 9999999 B 10 1588643670 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1588643670 0 Physicians Anesthesia Services 20 1588643670 0 Physicians Healthy Kids Services 20 1588643670 0 Physicians Optical Supplies 20 1588643670 0 Physicians Physician Services 00 1588643811 0 FULLER LORI A 2021310 9999999 B 10 1588643811 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1588643811 0 Physician Assistant Only Fluoride varnish 20 1588643811 0 Physician Assistant Only Healthy Kids Services 20 1588643811 0 Physician Assistant Only Physician Services 00 1588644207 0 GERKE HENNING 2004214 9999999 B 10 1588644207 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1588644207 0 Physicians Anesthesia Services 20 1588644207 0 Physicians Fluoride varnish 20 1588644207 0 Physicians Healthy Kids Services 20 1588644207 0 Physicians Optical Supplies 20 1588644207 0 Physicians Physician Services 00 1588644215 0 RICH MARK 1999001 9999999 B 10 1588644215 0 340 MIDLAND RD STE 120 JANESVILLE WI 535462339 20 1588644215 0 Physicians Anesthesia Services 20 1588644215 0 Physicians Healthy Kids Services 20 1588644215 0 Physicians Optical Supplies 20 1588644215 0 Physicians Physician Services 00 1588644330 0 REED TRENT 2005182 9999999 B 10 1588644330 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1588644330 0 Physicians Anesthesia Services 20 1588644330 0 Physicians Healthy Kids Services 20 1588644330 0 Physicians Optical Supplies 20 1588644330 0 Physicians Physician Services 00 1588644637 0 RUMJAHN HOWARD A 2010274 9999999 B 10 1588644637 0 PO BOX 3276 EVANSVILLE IN 477313276 20 1588644637 0 Physicians Anesthesia Services 20 1588644637 0 Physicians Healthy Kids Services 20 1588644637 0 Physicians Optical Supplies 20 1588644637 0 Physicians Physician Services 00 1588644835 0 HOLLAND SHERI C 2003213 9999999 B 10 1588644835 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1588644835 0 Physicians Anesthesia Services 20 1588644835 0 Physicians Healthy Kids Services 20 1588644835 0 Physicians Optical Supplies 20 1588644835 0 Physicians Physician Services 00 1588644983 0 BINGHAM HEATHER L 2008275 9999999 B 10 1588644983 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1588644983 0 Physicians Anesthesia Services 20 1588644983 0 Physicians Healthy Kids Services 20 1588644983 0 Physicians Optical Supplies 20 1588644983 0 Physicians Physician Services 00 1588645345 0 MORCOS EHAB S 2006166 9999999 B 10 1588645345 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1588645345 0 Physicians Anesthesia Services 20 1588645345 0 Physicians Healthy Kids Services 20 1588645345 0 Physicians Optical Supplies 20 1588645345 0 Physicians Physician Services 00 1588645527 0 GOERS KERRI 2020178 9999999 B 10 1588645527 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1588645527 0 Nurse Practitioners Healthy Kids Services 20 1588645527 0 Nurse Practitioners Nurse Practitioners Services 20 1588645527 0 Nurse Practitioners Physician Services 00 1588645741 0 BERKSON MICHAEL 1994335 9999999 B 10 1588645741 0 801 YORK ST MANITOWOC WI 542204630 20 1588645741 0 Physicians Anesthesia Services 20 1588645741 0 Physicians Healthy Kids Services 20 1588645741 0 Physicians Optical Supplies 20 1588645741 0 Physicians Physician Services 00 1588646756 0 SWEET FREDERICK 2000214 9999999 B 10 1588646756 0 2902 MCFARLAND RD STE 300 SUITE 300 ROCKFORD IL 611076801 20 1588646756 0 Physicians Anesthesia Services 20 1588646756 0 Physicians Healthy Kids Services 20 1588646756 0 Physicians Optical Supplies 20 1588646756 0 Physicians Physician Services 00 1588647523 0 MALONE LISA 1996032 9999999 B 10 1588647523 0 777 LOWNDES HILL RD BLDG 1 GREENVILLE SC 296072101 20 1588647523 0 Physicians Anesthesia Services 20 1588647523 0 Physicians Healthy Kids Services 20 1588647523 0 Physicians Optical Supplies 20 1588647523 0 Physicians Physician Services 00 1588647655 0 BUHIMSCHI CATALIN 2019032 9999999 B 10 1588647655 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1588647655 0 Physicians Anesthesia Services 20 1588647655 0 Physicians Healthy Kids Services 20 1588647655 0 Physicians Optical Supplies 20 1588647655 0 Physicians Physician Services 00 1588648414 0 PAREKH PARAS 2002152 9999999 B 10 1588648414 0 2320 N DAMEN AVE STE 1F CHICAGO IL 606473367 20 1588648414 0 Podiatrists Podiatric Services 00 1588649321 0 AJAYI FUNMINIYI ANNE 2015005 9999999 B 10 1588649321 0 4701 DEPT CAROL STREAM IL 601220021 20 1588649321 0 Physicians Anesthesia Services 20 1588649321 0 Physicians Healthy Kids Services 20 1588649321 0 Physicians Optical Supplies 20 1588649321 0 Physicians Physician Services 00 1588649545 0 ROPACKI JAMIE 2021050 9999999 B 10 1588649545 0 PO BOX 43230 PHOENIX AZ 850803230 20 1588649545 0 Physicians Anesthesia Services 20 1588649545 0 Physicians 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0 Physicians Fluoride varnish 20 1588652580 0 Physicians Healthy Kids Services 20 1588652580 0 Physicians Optical Supplies 20 1588652580 0 Physicians Physician Services 00 1588653075 0 REED JONATHAN G 2020188 9999999 B 10 1588653075 0 PO BOX 857 FREEPORT IL 610320857 20 1588653075 0 Physicians Anesthesia Services 20 1588653075 0 Physicians Healthy Kids Services 20 1588653075 0 Physicians Optical Supplies 20 1588653075 0 Physicians Physician Services 00 1588653125 0 SPENCE ROBERT 2006244 9999999 B 10 1588653125 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1588653125 0 Physicians Anesthesia Services 20 1588653125 0 Physicians Healthy Kids Services 20 1588653125 0 Physicians Optical Supplies 20 1588653125 0 Physicians Physician Services 00 1588653935 0 ALWAN PERCELL RENEE 2016204 9999999 B 10 1588653935 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1588653935 0 Physician Assistant Only Fluoride varnish 20 1588653935 0 Physician Assistant Only Healthy Kids Services 20 1588653935 0 Physician Assistant Only Physician Services 00 1588654032 0 KRAINC DIMITRI W 2014335 9999999 B 10 1588654032 0 5777 DEPT CAROL STREAM IL 601220021 20 1588654032 0 Physicians Anesthesia Services 20 1588654032 0 Physicians Healthy Kids Services 20 1588654032 0 Physicians Optical Supplies 20 1588654032 0 Physicians Physician Services 20 1588654032 0 Physicians Physicians Psychiatric Services 00 1588654057 0 KUNZELMAN JOSEPH L 2002035 9999999 B 10 1588654057 0 1002 N ALLEN ST STE B ROBINSON IL 624541167 20 1588654057 0 Physicians Anesthesia Services 20 1588654057 0 Physicians Healthy Kids Services 20 1588654057 0 Physicians Optical Supplies 20 1588654057 0 Physicians Physician Services 00 1588655781 0 DE MOYA MARC A 2017186 9999999 B 10 1588655781 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1588655781 0 Physicians Anesthesia Services 20 1588655781 0 Physicians Healthy Kids Services 20 1588655781 0 Physicians Optical Supplies 20 1588655781 0 Physicians Physician Services 00 1588656573 0 MAJEED LUBNA 2008001 9999999 B 10 1588656573 0 335 E MAHN CT OAK CREEK WI 531542155 20 1588656573 0 Physicians Anesthesia Services 20 1588656573 0 Physicians Fluoride varnish 20 1588656573 0 Physicians Healthy Kids Services 20 1588656573 0 Physicians Optical Supplies 20 1588656573 0 Physicians Physician Services 00 1588656995 0 LIBIRAN MATTHEW 2020043 9999999 B 10 1588656995 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1588656995 0 Physicians Anesthesia Services 20 1588656995 0 Physicians Fluoride varnish 20 1588656995 0 Physicians Healthy Kids Services 20 1588656995 0 Physicians Optical Supplies 20 1588656995 0 Physicians Physician Services 00 1588657316 0 O'KLOCK ANN K. 2016221 9999999 H 10 1588657316 0 PO BOX 4028 ROCK ISLAND IL 612044028 20 1588657316 0 Other behavior health professional Social work service 00 1588657514 0 URBAN MICHAEL 2016221 9999999 B 10 1588657514 0 4757 S 7TH ST TERRE HAUTE IN 478024559 20 1588657514 0 Psychologist Psychologist service 00 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Services 00 1588659304 0 NAGARAJA TAMBARAHALLI 1983199 9999999 B 10 1588659304 0 55 E 86TH AVE MERRILLVILLE IN 464106382 20 1588659304 0 Physicians Anesthesia Services 20 1588659304 0 Physicians Healthy Kids Services 20 1588659304 0 Physicians Optical Supplies 20 1588659304 0 Physicians Physician Services 00 1588659486 0 LYNCH LORI 2002274 9999999 B 10 1588659486 0 PO BOX 3186 EVANSVILLE IN 477313186 20 1588659486 0 Physicians Anesthesia Services 20 1588659486 0 Physicians Healthy Kids Services 20 1588659486 0 Physicians Optical Supplies 20 1588659486 0 Physicians Physician Services 00 1588660062 0 GANGASINGH DENISH 1996183 9999999 B 10 1588660062 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1588660062 0 Physicians Anesthesia Services 20 1588660062 0 Physicians Healthy Kids Services 20 1588660062 0 Physicians Optical Supplies 20 1588660062 0 Physicians Physician Services 00 1588660633 0 BOWEN BRYAN 2005034 9999999 B 10 1588660633 0 PO BOX 1178 MARION IL 629597678 20 1588660633 0 Optometrists Optical Supplies 20 1588660633 0 Optometrists Optometric Services 20 1588660633 0 Optometrists Physician Services 00 1588661110 0 RAHIMI FRED 1985233 9999999 B 10 1588661110 0 4650 SOUTHWEST HWY OAK LAWN IL 604531836 20 1588661110 0 Podiatrists Podiatric Services 00 1588661185 0 BLAKE WAYNE 1996242 9999999 B 10 1588661185 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1588661185 0 Physicians Anesthesia Services 20 1588661185 0 Physicians Fluoride varnish 20 1588661185 0 Physicians Healthy Kids Services 20 1588661185 0 Physicians Optical Supplies 20 1588661185 0 Physicians Physician Services 00 1588661607 0 CONOVER CRAIG S 1997216 9999999 B 10 1588661607 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1588661607 0 Physicians Anesthesia Services 20 1588661607 0 Physicians Fluoride varnish 20 1588661607 0 Physicians Healthy Kids Services 20 1588661607 0 Physicians Optical Supplies 20 1588661607 0 Physicians Physician Services 00 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1588665244 0 Physicians Physician Services 00 1588665517 0 GULECYUZ MEHMET 1996214 9999999 B 10 1588665517 0 801 S WASHINGTON ST NAPERVILLE IL 605407430 20 1588665517 0 Physicians Anesthesia Services 20 1588665517 0 Physicians Fluoride varnish 20 1588665517 0 Physicians Healthy Kids Services 20 1588665517 0 Physicians Optical Supplies 20 1588665517 0 Physicians Physician Services 00 1588665640 0 GOINS KENNETH M 1992196 9999999 B 10 1588665640 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1588665640 0 Physicians Anesthesia Services 20 1588665640 0 Physicians Healthy Kids Services 20 1588665640 0 Physicians Optical Supplies 20 1588665640 0 Physicians Physician Services 00 1588667315 0 LEAVITT BARRY M 2000001 9999999 B 10 1588667315 0 1500 SKOKIE BLVD STE 315 NORTHBROOK IL 600624145 20 1588667315 0 Psychologist Psychologist service 00 1588667968 0 NEFF WARD M 1987180 9999999 B 10 1588667968 0 PO BOX 1510 EVANSVILLE IN 477061510 20 1588667968 0 Physicians Anesthesia Services 20 1588667968 0 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1588854848 0 Physicians Optical Supplies 20 1588854848 0 Physicians Physician Services 00 1588855498 0 BARILYAK OKSANA 2008238 9999999 B 10 1588855498 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1588855498 0 Physicians Anesthesia Services 20 1588855498 0 Physicians Fluoride varnish 20 1588855498 0 Physicians Healthy Kids Services 20 1588855498 0 Physicians Optical Supplies 20 1588855498 0 Physicians Physician Services 00 1588855746 0 FAUBEL CHRISTOPHER L 2013222 9999999 B 10 1588855746 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1588855746 0 Physicians Anesthesia Services 20 1588855746 0 Physicians Healthy Kids Services 20 1588855746 0 Physicians Optical Supplies 20 1588855746 0 Physicians Physician Services 00 1588856116 0 VAN ETTEN LARS K 2023083 9999999 B 10 1588856116 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1588856116 0 Physicians Anesthesia Services 20 1588856116 0 Physicians Healthy Kids Services 20 1588856116 0 Physicians Optical Supplies 20 1588856116 0 Physicians 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ZACHARY C 2018345 9999999 B 10 1598113458 0 100 W CHICAGO AVE STE F EAST CHICAGO IN 463123261 20 1598113458 0 Physicians Anesthesia Services 20 1598113458 0 Physicians Healthy Kids Services 20 1598113458 0 Physicians Optical Supplies 20 1598113458 0 Physicians Physician Services 00 1598114621 0 ROEMER KRISTIN 2017102 9999999 B 10 1598114621 0 830 S ADDISON AVE VILLA PARK IL 601812877 20 1598114621 0 Occupational Therapists Medical Supplies 20 1598114621 0 Occupational Therapists Medical equipment/prosthetic devices 20 1598114621 0 Occupational Therapists Occupational Therapy Services 00 1598115255 0 UNNITHAN RACHNA 2022146 9999999 B 10 1598115255 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1598115255 0 Physicians Anesthesia Services 20 1598115255 0 Physicians Fluoride varnish 20 1598115255 0 Physicians Healthy Kids Services 20 1598115255 0 Physicians Optical Supplies 20 1598115255 0 Physicians Physician Services 00 1598115727 0 VIEHL LUKE T 2018338 9999999 B 10 1598115727 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1598115727 0 Physicians Anesthesia Services 20 1598115727 0 Physicians Fluoride varnish 20 1598115727 0 Physicians Healthy Kids Services 20 1598115727 0 Physicians Optical Supplies 20 1598115727 0 Physicians Physician Services 00 1598116360 0 HARMS TAYLOR 2022257 9999999 B 10 1598116360 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1598116360 0 Physicians Anesthesia Services 20 1598116360 0 Physicians Healthy Kids Services 20 1598116360 0 Physicians Optical Supplies 20 1598116360 0 Physicians Physician Services 00 1598116618 0 DE GUZMAN CHARLES 2025045 9999999 B 10 1598116618 0 1440 RENAISSANCE DR STE 320 PARK RIDGE IL 600681471 20 1598116618 0 Other behavior health professional LCPC/LMFT services 00 1598117301 0 VOREL ALYSSA J 2016289 9999999 B 10 1598117301 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1598117301 0 Physician Assistant Only Fluoride varnish 20 1598117301 0 Physician Assistant Only Healthy Kids Services 20 1598117301 0 Physician Assistant Only Physician Services 00 1598118218 0 ANDERSON KELSEY L 2018361 9999999 B 10 1598118218 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1598118218 0 Physicians Anesthesia Services 20 1598118218 0 Physicians Healthy Kids Services 20 1598118218 0 Physicians Optical Supplies 20 1598118218 0 Physicians Physician Services 00 1598118895 0 GHANIM MOSTAFA 2023138 9999999 B 10 1598118895 0 725 SCHOOL ST STE A MORRIS IL 604501207 20 1598118895 0 Physicians Anesthesia Services 20 1598118895 0 Physicians Fluoride varnish 20 1598118895 0 Physicians Healthy Kids Services 20 1598118895 0 Physicians Optical Supplies 20 1598118895 0 Physicians Physician Services 00 1598119216 0 ALHARASH JIHAD 2021182 9999999 B 10 1598119216 0 1901 W HARRISON ST CHICAGO IL 60612 20 1598119216 0 Physicians Anesthesia Services 20 1598119216 0 Physicians Healthy Kids Services 20 1598119216 0 Physicians Optical Supplies 20 1598119216 0 Physicians Physician Services 00 1598119539 0 LIONBERG ALEXANDER 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Physician Services 00 1598130064 0 LOPEZ HEATHER E 2024159 9999999 B 10 1598130064 0 PO BOX 73488 PUYALLUP WA 983730488 20 1598130064 0 Clinical Social Worker Social work service 00 1598130379 0 DUFFY LAURA 2017067 9999999 B 10 1598130379 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1598130379 0 Nurse Practitioners Fluoride varnish 20 1598130379 0 Nurse Practitioners Healthy Kids Services 20 1598130379 0 Nurse Practitioners Nurse Practitioners Services 20 1598130379 0 Nurse Practitioners Physician Services 00 1598131559 0 DIAMOND KEVIN S 2015213 9999999 B 10 1598131559 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1598131559 0 Nurse Practitioners Anesthesia Services 20 1598131559 0 Nurse Practitioners Nurse Practitioners Services 20 1598131559 0 Nurse Practitioners Physician Services 00 1598131856 0 LEVING ELLEN 2022026 9999999 B 10 1598131856 0 2374 SHERMER RD NORTHBROOK IL 600626729 20 1598131856 0 Speech Therapists Medical Supplies 20 1598131856 0 Speech Therapists Medical 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9999999 B 10 1598137390 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1598137390 0 Nurse Practitioners Fluoride varnish 20 1598137390 0 Nurse Practitioners Healthy Kids Services 20 1598137390 0 Nurse Practitioners Nurse Practitioners Services 20 1598137390 0 Nurse Practitioners Physician Services 00 1598140071 0 MCCONNEHEY KELLI J 2015349 9999999 B 10 1598140071 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1598140071 0 Physician Assistant Only Fluoride varnish 20 1598140071 0 Physician Assistant Only Healthy Kids Services 20 1598140071 0 Physician Assistant Only Physician Services 00 1598140105 0 AHMEDTAHA OSMAN 2022152 9999999 B 10 1598140105 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1598140105 0 Physicians Anesthesia Services 20 1598140105 0 Physicians Healthy Kids Services 20 1598140105 0 Physicians Optical Supplies 20 1598140105 0 Physicians Physician Services 00 1598140311 0 ELDER CHAD 2023268 9999999 B 10 1598140311 0 PO BOX 43230 PHOENIX AZ 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Services 00 1598255937 0 HASENSTAB CARRIE 2018172 9999999 B 10 1598255937 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1598255937 0 Nurse Practitioners Anesthesia Services 20 1598255937 0 Nurse Practitioners Nurse Practitioners Services 20 1598255937 0 Nurse Practitioners Physician Services 00 1598256265 0 HAMMOND NICOLE 2024249 9999999 B 10 1598256265 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1598256265 0 Physicians Anesthesia Services 20 1598256265 0 Physicians Healthy Kids Services 20 1598256265 0 Physicians Optical Supplies 20 1598256265 0 Physicians Physician Services 00 1598256497 0 VALMONT CANDICE 2023331 9999999 B 10 1598256497 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1598256497 0 Physicians Anesthesia Services 20 1598256497 0 Physicians Fluoride varnish 20 1598256497 0 Physicians Healthy Kids Services 20 1598256497 0 Physicians Optical Supplies 20 1598256497 0 Physicians Physician Services 00 1598257545 0 MEI JENNY X 2018208 9999999 B 10 1598257545 0 355 E ERIE ST CHICAGO IL 606113167 20 1598257545 0 Nurse Practitioners Fluoride varnish 20 1598257545 0 Nurse Practitioners Healthy Kids Services 20 1598257545 0 Nurse Practitioners Nurse Practitioners Services 20 1598257545 0 Nurse Practitioners Physician Services 00 1598257628 0 ECLOV JULIE 2023038 9999999 B 10 1598257628 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1598257628 0 Physicians Anesthesia Services 20 1598257628 0 Physicians Healthy Kids Services 20 1598257628 0 Physicians Optical Supplies 20 1598257628 0 Physicians Physician Services 00 1598258089 0 ABDELAZIZ SARA 2023276 9999999 B 10 1598258089 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1598258089 0 Physicians Anesthesia Services 20 1598258089 0 Physicians Fluoride varnish 20 1598258089 0 Physicians Healthy Kids Services 20 1598258089 0 Physicians Optical Supplies 20 1598258089 0 Physicians Physician Services 00 1598258196 0 SURYK STEPHANIE 2018162 9999999 B 10 1598258196 0 PO BOX 604 BLOOMINGTON IL 617020604 20 1598258196 0 Other behavior health professional LCPC/LMFT services 00 1598259202 0 CORDOVA ALEJANDRA 2018037 9999999 B 10 1598259202 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1598259202 0 Physicians Anesthesia Services 20 1598259202 0 Physicians Fluoride varnish 20 1598259202 0 Physicians Healthy Kids Services 20 1598259202 0 Physicians Optical Supplies 20 1598259202 0 Physicians Physician Services 00 1598259244 0 MERICAL BRANDON 2024143 9999999 B 10 1598259244 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1598259244 0 Physicians Anesthesia Services 20 1598259244 0 Physicians Healthy Kids Services 20 1598259244 0 Physicians Optical Supplies 20 1598259244 0 Physicians Physician Services 20 1598259244 0 Physicians Physicians Psychiatric Services 00 1598259319 0 THOMPSON WILLIAM C 2021121 9999999 B 10 1598259319 0 PO BOX 1085 EVANSVILLE IN 477061085 20 1598259319 0 Physicians Anesthesia Services 20 1598259319 0 Physicians Fluoride varnish 20 1598259319 0 Physicians Healthy Kids Services 20 1598259319 0 Physicians Optical Supplies 20 1598259319 0 Physicians Physician Services 00 1598259566 0 BUSHROE KYLIE M 2018338 9999999 B 10 1598259566 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1598259566 0 Physicians Anesthesia Services 20 1598259566 0 Physicians Fluoride varnish 20 1598259566 0 Physicians Healthy Kids Services 20 1598259566 0 Physicians Optical Supplies 20 1598259566 0 Physicians Physician Services 00 1598259590 0 BAIG AMER 2021070 9999999 B 10 1598259590 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1598259590 0 Physicians Anesthesia Services 20 1598259590 0 Physicians Fluoride varnish 20 1598259590 0 Physicians Healthy Kids Services 20 1598259590 0 Physicians Optical Supplies 20 1598259590 0 Physicians Physician Services 00 1598260390 0 ESTEVA SANDERS ALISON 2019276 9999999 B 10 1598260390 0 5777 DEPT CAROL STREAM IL 601220021 20 1598260390 0 Physicians Anesthesia Services 20 1598260390 0 Physicians Healthy Kids Services 20 1598260390 0 Physicians Optical Supplies 20 1598260390 0 Physicians Physician Services 00 1598260424 0 TAYA MICHIO D 2024274 9999999 B 10 1598260424 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1598260424 0 Physicians Anesthesia Services 20 1598260424 0 Physicians Healthy Kids Services 20 1598260424 0 Physicians Optical Supplies 20 1598260424 0 Physicians Physician Services 00 1598260911 0 WINTER ALLYSON 2023234 9999999 B 10 1598260911 0 PO BOX 4028 ROCK ISLAND IL 612044028 20 1598260911 0 Physicians Anesthesia Services 20 1598260911 0 Physicians Healthy Kids Services 20 1598260911 0 Physicians Optical Supplies 20 1598260911 0 Physicians Physician Services 00 1598260929 0 KHAN SAAD 2019226 9999999 B 10 1598260929 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1598260929 0 Physicians All Kids application agent 20 1598260929 0 Physicians Anesthesia Services 20 1598260929 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1598260929 0 Physicians Healthy 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Practitioners Services 20 1598267866 0 Nurse Practitioners Physician Services 00 1598267981 0 WACHTER DANIEL 2018135 9999999 B 10 1598267981 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1598267981 0 Nurse Practitioners Healthy Kids Services 20 1598267981 0 Nurse Practitioners Nurse Practitioners Services 20 1598267981 0 Nurse Practitioners Physician Services 00 1598270035 0 WADE THOMAS JOHN 2018008 9999999 B 10 1598270035 0 800 S HALE ST PLANO IL 605452000 20 1598270035 0 Speech Therapists Medical Supplies 20 1598270035 0 Speech Therapists Medical equipment/prosthetic devices 20 1598270035 0 Speech Therapists Speech Therapy/Pathology Services 00 1598270290 0 ROGERS-O'BRIEN HANNAH 2024115 9999999 B 10 1598270290 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1598270290 0 Other behavior health professional LCPC/LMFT services 00 1598270563 0 GERECKE CYNTHIA J 2018001 9999999 B 10 1598270563 0 41 E ELMWOOD DR CHICAGO HEIGHTS IL 604111104 20 1598270563 0 Speech Therapists Medical Supplies 20 1598270563 0 Speech Therapists Medical equipment/prosthetic devices 20 1598270563 0 Speech Therapists Speech Therapy/Pathology Services 00 1598270753 0 SHEPARD JENNIFER 2017354 9999999 B 10 1598270753 0 524 E SCHAUMBURG RD SCHAUMBURG IL 601943510 20 1598270753 0 Speech Therapists Medical Supplies 20 1598270753 0 Speech Therapists Medical equipment/prosthetic devices 20 1598270753 0 Speech Therapists Speech Therapy/Pathology Services 00 1598271058 0 YUHAS MARY E 2019140 9999999 B 10 1598271058 0 124 SW ADAMS ST PEORIA IL 616021320 20 1598271058 0 Speech Therapists Medical Supplies 20 1598271058 0 Speech Therapists Medical equipment/prosthetic devices 20 1598271058 0 Speech Therapists Speech Therapy/Pathology Services 00 1598271777 0 BROWN DOKOTA L 2021264 9999999 B 10 1598271777 0 6615 GRAND AVE STE 1090 GURNEE IL 600314591 20 1598271777 0 Nurse Practitioners Healthy Kids Services 20 1598271777 0 Nurse Practitioners Nurse Practitioners Services 20 1598271777 0 Nurse Practitioners Physician Services 00 1598272023 0 NUNEZ SILVIA 2018099 9999999 B 10 1598272023 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1598272023 0 Nurse Practitioners Fluoride varnish 20 1598272023 0 Nurse Practitioners Healthy Kids Services 20 1598272023 0 Nurse Practitioners Nurse Practitioners Services 20 1598272023 0 Nurse Practitioners Physician Services 00 1598272882 0 HAIL LAMONT 2018155 9999999 B 10 1598272882 0 515 22ND AVE MONROE WI 535661569 20 1598272882 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1598273096 0 WEINBRENNER LAURA K 2022130 9999999 B 10 1598273096 0 2900 OGDEN AVE LISLE IL 605321631 20 1598273096 0 Speech Therapists Medical Supplies 20 1598273096 0 Speech Therapists Medical equipment/prosthetic devices 20 1598273096 0 Speech Therapists Speech Therapy/Pathology Services 00 1598273120 0 HULSER BRITNI E 2021095 9999999 B 10 1598273120 0 7272 WURZBACH RD STE 601 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service 00 1598281438 0 LEVI SAMUEL 2017250 9999999 B 10 1598281438 0 9855 W ROOSEVELT RD WESTCHESTER IL 601542758 20 1598281438 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1598281487 0 SALMAN NADINE 2021266 9999999 B 10 1598281487 0 901 MCCLINTOCK DR STE 202 SUITE 202 BURR RIDGE IL 605270872 20 1598281487 0 Nurse Practitioners Fluoride varnish 20 1598281487 0 Nurse Practitioners Healthy Kids Services 20 1598281487 0 Nurse Practitioners Nurse Practitioners Services 20 1598281487 0 Nurse Practitioners Physician Services 00 1598281743 0 LOPEZ BEATRIZ 2018100 9999999 B 10 1598281743 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1598281743 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1598282329 0 SKALAK DAMIAN J 2017248 9999999 B 10 1598282329 0 5820 W IRVING PARK RD CHICAGO IL 606342616 20 1598282329 0 Physical Therapists Medical Supplies 20 1598282329 0 Physical Therapists Medical equipment/prosthetic devices 20 1598282329 0 Physical Therapists Physical Therapy Services 00 1598282352 0 DIETEL KEITH 2017244 9999999 B 10 1598282352 0 545 BARNHILL DR # EH215 INDIANAPOLIS IN 462025112 20 1598282352 0 Physician Assistant Only Fluoride varnish 20 1598282352 0 Physician Assistant Only Healthy Kids Services 20 1598282352 0 Physician Assistant Only Physician Services 00 1598282659 0 WALSH KATHRYN 2017268 9999999 B 10 1598282659 0 465 E 170TH ST SOUTH HOLLAND IL 604733400 20 1598282659 0 Speech Therapists Medical Supplies 20 1598282659 0 Speech Therapists Medical equipment/prosthetic devices 20 1598282659 0 Speech Therapists Speech Therapy/Pathology Services 00 1598282766 0 BURMAHL LISA M 2020337 9999999 B 10 1598282766 0 3451 MORTON DR EAST MOLINE IL 612441921 20 1598282766 0 Speech Therapists Medical Supplies 20 1598282766 0 Speech Therapists Medical equipment/prosthetic devices 20 1598282766 0 Speech Therapists Speech Therapy/Pathology Services 00 1598283327 0 ZIJLSTRA PETER S 2023113 9999999 B 10 1598283327 0 PO BOX 43230 PHOENIX AZ 850803230 20 1598283327 0 Physicians Anesthesia Services 20 1598283327 0 Physicians Healthy Kids Services 20 1598283327 0 Physicians Optical Supplies 20 1598283327 0 Physicians Physician Services 00 1598283509 0 ROBERTSON JULIE 2017257 9999999 B 10 1598283509 0 300 CEDAR ST PEKIN IL 615547009 20 1598283509 0 Speech Therapists Medical Supplies 20 1598283509 0 Speech Therapists Medical equipment/prosthetic devices 20 1598283509 0 Speech Therapists Speech Therapy/Pathology Services 00 1598283913 0 TURNER ALLIE J 2017249 9999999 B 10 1598283913 0 224 S LOCUST ST CENTRALIA IL 628013509 20 1598283913 0 Speech Therapists Medical Supplies 20 1598283913 0 Speech Therapists Medical equipment/prosthetic devices 20 1598283913 0 Speech Therapists Speech Therapy/Pathology Services 00 1598284291 0 CARCELLAR LESLIEANN 2018191 9999999 B 10 1598284291 0 100 CROSSING BLVD STE 300 FRAMINGHAM MA 017025555 20 1598284291 0 Nurse Practitioners Fluoride varnish 20 1598284291 0 Nurse Practitioners Healthy Kids Services 20 1598284291 0 Nurse Practitioners Nurse Practitioners Services 20 1598284291 0 Nurse Practitioners Physician Services 00 1598284994 0 VILLARREAL EMILY K 2017304 9999999 B 10 1598284994 0 620 E GARFIELD AVE DECATUR IL 625264550 20 1598284994 0 Speech Therapists Medical Supplies 20 1598284994 0 Speech Therapists Medical equipment/prosthetic devices 20 1598284994 0 Speech Therapists Speech Therapy/Pathology Services 00 1598285165 0 TICA STEFANI S 2018362 9999999 B 10 1598285165 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1598285165 0 Physicians Anesthesia Services 20 1598285165 0 Physicians Fluoride varnish 20 1598285165 0 Physicians Healthy Kids Services 20 1598285165 0 Physicians Optical Supplies 20 1598285165 0 Physicians Physician Services 00 1598285421 0 BISHOP CALLIE L 2019182 9999999 B 10 1598285421 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1598285421 0 Physicians Anesthesia Services 20 1598285421 0 Physicians Healthy Kids Services 20 1598285421 0 Physicians Optical Supplies 20 1598285421 0 Physicians Physician Services 20 1598285421 0 Physicians Physicians Psychiatric Services 00 1598285959 0 LE TRUNG Q 2021021 9999999 B 10 1598285959 0 3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047452 20 1598285959 0 Physicians Anesthesia Services 20 1598285959 0 Physicians Healthy Kids Services 20 1598285959 0 Physicians Optical Supplies 20 1598285959 0 Physicians Physician Services 00 1598286163 0 SANCHEZ VENTURA LUISANNA M 2023222 9999999 B 10 1598286163 0 8326 NAAB RD INDIANAPOLIS IN 462601920 20 1598286163 0 Physicians Anesthesia Services 20 1598286163 0 Physicians Fluoride varnish 20 1598286163 0 Physicians Healthy Kids Services 20 1598286163 0 Physicians Optical Supplies 20 1598286163 0 Physicians Physician Services 00 1598286353 0 IAKYMENKO OLEKSII 2023208 9999999 B 10 1598286353 0 PO BOX 3988 CARBONDALE IL 629023988 20 1598286353 0 Physicians Anesthesia Services 20 1598286353 0 Physicians Healthy Kids Services 20 1598286353 0 Physicians Optical Supplies 20 1598286353 0 Physicians Physician Services 00 1598286692 0 KRIZ LAURA 2018220 9999999 B 10 1598286692 0 15732 S HOWARD ST PLAINFIELD IL 605442399 20 1598286692 0 Speech Therapists Medical Supplies 20 1598286692 0 Speech Therapists Medical equipment/prosthetic devices 20 1598286692 0 Speech Therapists Speech Therapy/Pathology Services 00 1598290082 0 NASSIF ABUDINEN SAMIH 2022322 9999999 B 10 1598290082 0 PO BOX 43230 PHOENIX AZ 850803230 20 1598290082 0 Physicians Anesthesia Services 20 1598290082 0 Physicians Healthy Kids Services 20 1598290082 0 Physicians Optical Supplies 20 1598290082 0 Physicians Physician Services 00 1598290272 0 MAUCH SCOTT C 2021165 9999999 B 10 1598290272 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1598290272 0 Physicians Anesthesia Services 20 1598290272 0 Physicians Healthy Kids Services 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601157109 20 1598351660 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1598352122 0 CALMA MIRIAM 2021061 9999999 B 10 1598352122 0 101 E STATE ST KENNETT SQ PA 193483109 20 1598352122 0 Physical Therapists Medical Supplies 20 1598352122 0 Physical Therapists Medical equipment/prosthetic devices 20 1598352122 0 Physical Therapists Physical Therapy Services 00 1598353377 0 ZIEGLER LAURA R 2021008 9999999 B 10 1598353377 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1598353377 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1598353377 0 Other behavior health professional Social work service 00 1598354912 0 DAIL LINDSAY 2021084 9999999 B 10 1598354912 0 4909 N GLEN PARK PLACE RD PEORIA IL 616144676 20 1598354912 0 Nurse Practitioners Fluoride varnish 20 1598354912 0 Nurse Practitioners Healthy Kids Services 20 1598354912 0 Nurse Practitioners Nurse 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B 10 1598359580 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1598359580 0 Nurse Practitioners Anesthesia Services 20 1598359580 0 Nurse Practitioners Nurse Practitioners Services 20 1598359580 0 Nurse Practitioners Physician Services 00 1598362865 0 MAROTTE ELIZA 2022285 9999999 B 10 1598362865 0 1125 W LUNT AVE APT 301 CHICAGO IL 606263531 20 1598362865 0 Other behavior health professional LCPC/LMFT services 00 1598362980 0 KLEIN COURTNEY 2020310 9999999 B 10 1598362980 0 124 SW ADAMS ST FL 2 PEORIA IL 616021308 20 1598362980 0 Nurse Practitioners Fluoride varnish 20 1598362980 0 Nurse Practitioners Healthy Kids Services 20 1598362980 0 Nurse Practitioners Nurse Practitioners Services 20 1598362980 0 Nurse Practitioners Physician Services 00 1598363368 0 CEPEK MEGHAN 2022238 9999999 B 10 1598363368 0 900 OGDEN AVE # 112 DOWNERS GROVE IL 605152829 20 1598363368 0 Other behavior health professional LCPC/LMFT services 00 1598365140 0 WINDSOR CAITLYN 2023261 9999999 B 10 1598365140 0 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Physicians Anesthesia Services 20 1598373615 0 Physicians Fluoride varnish 20 1598373615 0 Physicians Healthy Kids Services 20 1598373615 0 Physicians Optical Supplies 20 1598373615 0 Physicians Physician Services 00 1598373714 0 KOSCIELNIAK KATARZYNA R 2021025 9999999 B 10 1598373714 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1598373714 0 Nurse Practitioners Fluoride varnish 20 1598373714 0 Nurse Practitioners Healthy Kids Services 20 1598373714 0 Nurse Practitioners Nurse Practitioners Services 20 1598373714 0 Nurse Practitioners Physician Services 00 1598375073 0 VANDYKE CALEB 2022182 9999999 B 10 1598375073 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1598375073 0 Physicians Anesthesia Services 20 1598375073 0 Physicians Healthy Kids Services 20 1598375073 0 Physicians Optical Supplies 20 1598375073 0 Physicians Physician Services 00 1598375552 0 SMITH KRISTY 2022224 9999999 B 10 1598375552 0 684 S BARRINGTON RD STE 112 STREAMWOOD IL 601071841 20 1598375552 0 Other 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Services 20 1598378457 0 Physicians Optical Supplies 20 1598378457 0 Physicians Physician Services 00 1598379430 0 NWOKOCHA CHIDINMA 2021194 9999999 B 10 1598379430 0 600 HOLIDAY PLAZA DR STE 200 MATTESON IL 604432237 20 1598379430 0 Nurse Practitioners Fluoride varnish 20 1598379430 0 Nurse Practitioners Healthy Kids Services 20 1598379430 0 Nurse Practitioners Nurse Practitioners Services 20 1598379430 0 Nurse Practitioners Physician Services 00 1598380867 0 THOMPSON EMILY 2023267 9999999 B 10 1598380867 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1598380867 0 Physicians Anesthesia Services 20 1598380867 0 Physicians Healthy Kids Services 20 1598380867 0 Physicians Optical Supplies 20 1598380867 0 Physicians Physician Services 00 1598380875 0 MORRIS AIMEE E 2020287 9999999 B 10 1598380875 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1598380875 0 Physicians Anesthesia Services 20 1598380875 0 Physicians Fluoride varnish 20 1598380875 0 Physicians Healthy Kids Services 20 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1598392169 0 Physicians Healthy Kids Services 20 1598392169 0 Physicians Optical Supplies 20 1598392169 0 Physicians Physician Services 00 1598392342 0 JESSE JACQUELYN 2020091 9999999 B 10 1598392342 0 5220 EAST AVE COUNTRYSIDE IL 605253133 20 1598392342 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1598392789 0 OSWALD DEREK 2024219 9999999 B 10 1598392789 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1598392789 0 Physicians Anesthesia Services 20 1598392789 0 Physicians Healthy Kids Services 20 1598392789 0 Physicians Optical Supplies 20 1598392789 0 Physicians Physician Services 00 1598393043 0 SYED MONIS 2020177 9999999 B 10 1598393043 0 PO BOX 3039 OAK BROOK IL 605223039 20 1598393043 0 Physicians Anesthesia Services 20 1598393043 0 Physicians Fluoride varnish 20 1598393043 0 Physicians Healthy Kids Services 20 1598393043 0 Physicians Optical Supplies 20 1598393043 0 Physicians Physician Services 00 1598393266 0 BRETT RACHEL 2020230 9999999 B 10 1598393266 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1598393266 0 Physicians Anesthesia Services 20 1598393266 0 Physicians Fluoride varnish 20 1598393266 0 Physicians Healthy Kids Services 20 1598393266 0 Physicians Optical Supplies 20 1598393266 0 Physicians Physician Services 00 1598394017 0 PARTYKA KATHERINE 2024192 9999999 B 10 1598394017 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1598394017 0 Physicians Anesthesia Services 20 1598394017 0 Physicians Fluoride varnish 20 1598394017 0 Physicians Healthy Kids Services 20 1598394017 0 Physicians Optical Supplies 20 1598394017 0 Physicians Physician Services 00 1598394454 0 KAML ALYSE M 2020177 9999999 B 10 1598394454 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1598394454 0 Physicians Anesthesia Services 20 1598394454 0 Physicians Fluoride varnish 20 1598394454 0 Physicians Healthy Kids Services 20 1598394454 0 Physicians Optical Supplies 20 1598394454 0 Physicians Physician Services 00 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Services 20 1598401994 0 Physicians Optical Supplies 20 1598401994 0 Physicians Physician Services 00 1598402471 0 PRICE ELIZABETH 2023173 9999999 B 10 1598402471 0 PO BOX 3039 OAK BROOK IL 605223039 20 1598402471 0 Physicians Anesthesia Services 20 1598402471 0 Physicians Fluoride varnish 20 1598402471 0 Physicians Healthy Kids Services 20 1598402471 0 Physicians Optical Supplies 20 1598402471 0 Physicians Physician Services 00 1598403891 0 HALL CHRISTINA 2023179 9999999 B 10 1598403891 0 7108 S KANNER HWY STUART FL 349977462 20 1598403891 0 Other behavior health professional Adaptive behavior support technician services 00 1598403917 0 SCHULTZ YITZCHAK 2022207 9999999 B 10 1598403917 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1598403917 0 Physicians Anesthesia Services 20 1598403917 0 Physicians Healthy Kids Services 20 1598403917 0 Physicians Optical Supplies 20 1598403917 0 Physicians Physician Services 00 1598404766 0 CHUNG MICHAEL ELIAS ROMERO 2022200 9999999 B 10 1598404766 0 1940 S WESTERN AVE STE 205 CHICAGO IL 606082503 20 1598404766 0 Physicians Anesthesia Services 20 1598404766 0 Physicians Fluoride varnish 20 1598404766 0 Physicians Healthy Kids Services 20 1598404766 0 Physicians Optical Supplies 20 1598404766 0 Physicians Physician Services 00 1598405722 0 RILEY TARICA R 2025016 9999999 B 10 1598405722 0 1215 BURTON ST ROCKFORD IL 611034607 20 1598405722 0 Other behavior health professional Social work service 00 1598406811 0 BURUTOLU TONYE BEATRICE 2022175 9999999 B 10 1598406811 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1598406811 0 Physicians Anesthesia Services 20 1598406811 0 Physicians Fluoride varnish 20 1598406811 0 Physicians Healthy Kids Services 20 1598406811 0 Physicians Optical Supplies 20 1598406811 0 Physicians Physician Services 00 1598407520 0 AWOYEMI TOLUWALASE 2024277 9999999 B 10 1598407520 0 4698 DEPT CAROL STREAM IL 601220021 20 1598407520 0 Physicians Anesthesia Services 20 1598407520 0 Physicians Fluoride 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Occupational Therapists Medical Supplies 20 1598414088 0 Occupational Therapists Medical equipment/prosthetic devices 20 1598414088 0 Occupational Therapists Occupational Therapy Services 00 1598414484 0 ARCHER GAYANE N 2022174 9999999 B 10 1598414484 0 4698 DEPT CAROL STREAM IL 601220021 20 1598414484 0 Physicians Anesthesia Services 20 1598414484 0 Physicians Healthy Kids Services 20 1598414484 0 Physicians Optical Supplies 20 1598414484 0 Physicians Physician Services 20 1598414484 0 Physicians Physicians Psychiatric Services 00 1598414708 0 GOHL TREVOR 2022176 9999999 B 10 1598414708 0 4698 DEPT CAROL STREAM IL 601224698 20 1598414708 0 Physicians Anesthesia Services 20 1598414708 0 Physicians Fluoride varnish 20 1598414708 0 Physicians Healthy Kids Services 20 1598414708 0 Physicians Optical Supplies 20 1598414708 0 Physicians Physician Services 00 1598415622 0 PEZZINO ELENA 2024007 9999999 B 10 1598415622 0 4698 DEPT CAROL STREAM IL 601220021 20 1598415622 0 Physicians Anesthesia Services 20 1598415622 0 Physicians Fluoride varnish 20 1598415622 0 Physicians Healthy Kids Services 20 1598415622 0 Physicians Optical Supplies 20 1598415622 0 Physicians Physician Services 00 1598415770 0 SKABELUND ZACHARY T 2022096 9999999 B 10 1598415770 0 1812 N 19TH AVE MELROSE PARK IL 601602039 20 1598415770 0 Dentists Dental Services 20 1598415770 0 Dentists Physician Services 00 1598415986 0 TSU SOPHIA 2022215 9999999 B 10 1598415986 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1598415986 0 Physicians Anesthesia Services 20 1598415986 0 Physicians Healthy Kids Services 20 1598415986 0 Physicians Optical Supplies 20 1598415986 0 Physicians Physician Services 20 1598415986 0 Physicians Physicians Psychiatric Services 00 1598416976 0 NAMBO ALEJANDRO 2022019 9999999 B 10 1598416976 0 370 SUMMIT ST # 1 ELGIN IL 601203843 20 1598416976 0 Physician Assistant Only Fluoride varnish 20 1598416976 0 Physician Assistant Only Healthy Kids Services 20 1598416976 0 Physician Assistant Only Physician Services 00 1598418386 0 PLINE ANNALISE 2023286 9999999 B 10 1598418386 0 PO BOX 486 SAN JACINTO CA 925810486 20 1598418386 0 Physician Assistant Only Fluoride varnish 20 1598418386 0 Physician Assistant Only Healthy Kids Services 20 1598418386 0 Physician Assistant Only Physician Services 00 1598419160 0 GALEWSKI BRITTANY 2024310 9999999 B 10 1598419160 0 335 E MAHN CT OAK CREEK WI 531542155 20 1598419160 0 Nurse Practitioners Healthy Kids Services 20 1598419160 0 Nurse Practitioners Nurse Practitioners Services 20 1598419160 0 Nurse Practitioners Physician Services 00 1598420051 0 APATA TEMITOPE 2023061 9999999 B 10 1598420051 0 PO BOX 2477 SHELTON CT 064841477 20 1598420051 0 Nurse Practitioners Healthy Kids Services 20 1598420051 0 Nurse Practitioners Nurse Practitioners Services 20 1598420051 0 Nurse Practitioners Physician Services 00 1598420358 0 ZIEGLER NICOLE D 2021322 9999999 B 10 1598420358 0 1919 CATON FARM RD CREST HILL IL 604031700 20 1598420358 0 Speech Therapists Medical Supplies 20 1598420358 0 Speech Therapists Medical equipment/prosthetic devices 20 1598420358 0 Speech Therapists Speech Therapy/Pathology Services 00 1598423006 0 NOSA TAMARA 2022129 9999999 B 10 1598423006 0 387 SHUMAN BLVD STE 203W NAPERVILLE IL 605638644 20 1598423006 0 Nurse Practitioners Fluoride varnish 20 1598423006 0 Nurse Practitioners Healthy Kids Services 20 1598423006 0 Nurse Practitioners Nurse Practitioners Services 20 1598423006 0 Nurse Practitioners Physician Services 00 1598424541 0 MOORE PATRICIA A 2022046 9999999 B 10 1598424541 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1598424541 0 Nurse Practitioners Healthy Kids Services 20 1598424541 0 Nurse Practitioners Nurse Practitioners Services 20 1598424541 0 Nurse Practitioners Physician Services 00 1598425084 0 VIOLA VICTORIA 2024330 9999999 B 10 1598425084 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1598425084 0 Occupational Therapists Medical Supplies 20 1598425084 0 Occupational 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varnish 20 1598878373 0 Physicians Healthy Kids Services 20 1598878373 0 Physicians Optical Supplies 20 1598878373 0 Physicians Physician Services 00 1598878464 0 HARTMAN HEATHER 2010182 9999999 B 10 1598878464 0 5979 NEBESHONE LN ROCKFORD IL 611038926 20 1598878464 0 Nurse Practitioners Healthy Kids Services 20 1598878464 0 Nurse Practitioners Nurse Practitioners Services 20 1598878464 0 Nurse Practitioners Physician Services 00 1598879223 0 BALDINGER MICHAEL 1981227 9999999 B 10 1598879223 0 5517 N KENMORE AVE CHICAGO IL 606401515 20 1598879223 0 Physicians Anesthesia Services 20 1598879223 0 Physicians Healthy Kids Services 20 1598879223 0 Physicians Optical Supplies 20 1598879223 0 Physicians Physician Services 00 1598879884 0 WILLIS MICHELLE 2016001 9999999 B 10 1598879884 0 PO BOX 500 ELLICOTTVILLE NY 147310500 20 1598879884 0 Physician Assistant Only Fluoride varnish 20 1598879884 0 Physician Assistant Only Healthy Kids Services 20 1598879884 0 Physician Assistant Only Physician Services 00 1598880601 0 TOMCZAK MELISSA 2004286 9999999 B 10 1598880601 0 9575 KELLEY LN HUNTLEY IL 601420057 20 1598880601 0 Speech Therapists Medical Supplies 20 1598880601 0 Speech Therapists Medical equipment/prosthetic devices 20 1598880601 0 Speech Therapists Speech Therapy/Pathology Services 00 1598881591 0 MEYER NOELLE 2005227 9999999 B 10 1598881591 0 611 W PARK ST BWPC URBANA IL 618012529 20 1598881591 0 Physical Therapists Medical Supplies 20 1598881591 0 Physical Therapists Medical equipment/prosthetic devices 20 1598881591 0 Physical Therapists Physical Therapy Services 00 1598883993 0 WOLOWICK MARK J 2009152 9999999 B 10 1598883993 0 5777 DEPT CAROL STREAM IL 601220021 20 1598883993 0 Physicians Anesthesia Services 20 1598883993 0 Physicians Healthy Kids Services 20 1598883993 0 Physicians Optical Supplies 20 1598883993 0 Physicians Physician Services 00 1598886004 0 GREEN THOMAS J 2013253 9999999 B 10 1598886004 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1598886004 0 Physicians Anesthesia Services 20 1598886004 0 Physicians Healthy Kids Services 20 1598886004 0 Physicians Optical Supplies 20 1598886004 0 Physicians Physician Services 00 1598886368 0 TAFUR ALFONSO J 2015121 9999999 B 10 1598886368 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1598886368 0 Physicians Anesthesia Services 20 1598886368 0 Physicians Fluoride varnish 20 1598886368 0 Physicians Healthy Kids Services 20 1598886368 0 Physicians Optical Supplies 20 1598886368 0 Physicians Physician Services 00 1598886723 0 BACK NICOLE E 2018150 9999999 B 10 1598886723 0 5777 DEPT CAROL STREAM IL 601220021 20 1598886723 0 Physician Assistant Only Fluoride varnish 20 1598886723 0 Physician Assistant Only Healthy Kids Services 20 1598886723 0 Physician Assistant Only Physician Services 00 1598889370 0 ALLEN ANNE C 2019003 9999999 B 10 1598889370 0 120 W 22ND ST OAK BROOK IL 605231557 20 1598889370 0 Physician Assistant Only Fluoride varnish 20 1598889370 0 Physician Assistant Only Healthy Kids Services 20 1598889370 0 Physician Assistant Only Physician Services 00 1598891939 0 MARTINEZ ANJALI G 2022194 9999999 B 10 1598891939 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1598891939 0 Physicians Anesthesia Services 20 1598891939 0 Physicians Healthy Kids Services 20 1598891939 0 Physicians Optical Supplies 20 1598891939 0 Physicians Physician Services 00 1598892150 0 ODONNELL LISA 2006101 9999999 B 10 1598892150 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1598892150 0 Speech Therapists Medical Supplies 20 1598892150 0 Speech Therapists Medical equipment/prosthetic devices 20 1598892150 0 Speech Therapists Speech Therapy/Pathology Services 00 1598894891 0 KIM EUGENE P 2007157 9999999 B 10 1598894891 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1598894891 0 Physicians Anesthesia Services 20 1598894891 0 Physicians Fluoride varnish 20 1598894891 0 Physicians Healthy Kids Services 20 1598894891 0 Physicians Optical Supplies 20 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Physician Assistant Only Healthy Kids Services 20 1598899700 0 Physician Assistant Only Physician Services 00 1598901423 0 AGARWAL DEEPTI 2012245 9999999 B 10 1598901423 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1598901423 0 Physicians Anesthesia Services 20 1598901423 0 Physicians Healthy Kids Services 20 1598901423 0 Physicians Optical Supplies 20 1598901423 0 Physicians Physician Services 00 1598901894 0 MARKS RICHARD 2021106 9999999 B 10 1598901894 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1598901894 0 Physicians Anesthesia Services 20 1598901894 0 Physicians Healthy Kids Services 20 1598901894 0 Physicians Optical Supplies 20 1598901894 0 Physicians Physician Services 00 1598902272 0 BARNES DENISE 2011335 9999999 B 10 1598902272 0 PO BOX 5588 BELFAST ME 049155500 20 1598902272 0 Nurse Practitioners Healthy Kids Services 20 1598902272 0 Nurse Practitioners Nurse Practitioners Services 20 1598902272 0 Nurse Practitioners Physician Services 00 1598904906 0 JEFFRIES MIRANDA 2023123 9999999 B 10 1598904906 0 727 E COURT ST PARIS IL 619442460 20 1598904906 0 Other behavior health professional LCPC/LMFT services 00 1598905028 0 PARBO OLIVER T 2023137 9999999 B 10 1598905028 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1598905028 0 Physical Therapists Medical Supplies 20 1598905028 0 Physical Therapists Medical equipment/prosthetic devices 20 1598905028 0 Physical Therapists Physical Therapy Services 00 1598905887 0 GUFFEY RYAN C 2013182 9999999 B 10 1598905887 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1598905887 0 Physicians Anesthesia Services 20 1598905887 0 Physicians Healthy Kids Services 20 1598905887 0 Physicians Optical Supplies 20 1598905887 0 Physicians Physician Services 00 1598906059 0 BIERBAUM ELIZABETH 2017255 9999999 B 10 1598906059 0 PO BOX 504469 SAINT LOUIS MO 631504469 20 1598906059 0 Speech Therapists Medical Supplies 20 1598906059 0 Speech Therapists Medical equipment/prosthetic devices 20 1598906059 0 Speech Therapists Speech Therapy/Pathology Services 00 1598908022 0 MARTIN PATRICK S 2016288 2099365 B 10 1598908022 0 727 E COURT ST PARIS IL 619442460 20 1598908022 0 Physicians Anesthesia Services 20 1598908022 0 Physicians Healthy Kids Services 20 1598908022 0 Physicians Optical Supplies 20 1598908022 0 Physicians Physician Services 00 1598908592 0 NIEHOFF LAURA 2009133 9999999 B 10 1598908592 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1598908592 0 Nurse Practitioners Anesthesia Services 20 1598908592 0 Nurse Practitioners Nurse Practitioners Services 20 1598908592 0 Nurse Practitioners Physician Services 00 1598908758 0 CHIGANOS TERRY 2012183 9999999 B 10 1598908758 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1598908758 0 Physicians Anesthesia Services 20 1598908758 0 Physicians Healthy Kids Services 20 1598908758 0 Physicians Optical Supplies 20 1598908758 0 Physicians Physician Services 00 1598909202 0 KHUON DALIYA 2021270 9999999 B 10 1598909202 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1598909202 0 Physicians Anesthesia Services 20 1598909202 0 Physicians Fluoride varnish 20 1598909202 0 Physicians Healthy Kids Services 20 1598909202 0 Physicians Optical Supplies 20 1598909202 0 Physicians Physician Services 00 1598909244 0 MCHUGH MEGAN 2017260 9999999 B 10 1598909244 0 6308 8TH AVE KENOSHA WI 531435031 20 1598909244 0 Nurse Practitioners Healthy Kids Services 20 1598909244 0 Nurse Practitioners Nurse Practitioners Services 20 1598909244 0 Nurse Practitioners Physician Services 00 1598910192 0 HAMPER STEPHANIE 2008275 9999999 B 10 1598910192 0 PO BOX 674 TOLUCA IL 613690674 20 1598910192 0 Dentists Dental Services 20 1598910192 0 Dentists Physician Services 00 1598910218 0 HAIDO ASHOR 1999060 9999999 B 10 1598910218 0 4420 N MILWAUKEE AVE CHICAGO IL 606303710 20 1598910218 0 Dentists Dental Services 20 1598910218 0 Dentists Physician Services 00 1598911059 0 SPEAR GEORGIA G 2010262 9999999 B 10 1598911059 0 5777 DEPT CAROL STREAM IL 601220021 20 1598911059 0 Physicians Anesthesia Services 20 1598911059 0 Physicians Healthy Kids Services 20 1598911059 0 Physicians Optical Supplies 20 1598911059 0 Physicians Physician Services 00 1598911372 0 MICHEHL JAMES 2019051 9999999 B 10 1598911372 0 1850 W WINCHESTER RD STE 108 LIBERTYVILLE IL 600485355 20 1598911372 0 Other behavior health professional LCPC/LMFT services 00 1598911505 0 VERCILLO MICHAEL S 2015306 9999999 B 10 1598911505 0 5777 DEPT CAROL STREAM IL 601220021 20 1598911505 0 Physicians Anesthesia Services 20 1598911505 0 Physicians Healthy Kids Services 20 1598911505 0 Physicians Optical Supplies 20 1598911505 0 Physicians Physician Services 00 1598911562 0 OSUCH MARISOL 2014218 9999999 B 10 1598911562 0 5341 W CERMAK RD CICERO IL 608042817 20 1598911562 0 Other behavior health professional LCPC/LMFT services 00 1598912644 0 AVEYARD CAITLIN E 2008252 9999999 B 10 1598912644 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1598912644 0 Physicians Anesthesia Services 20 1598912644 0 Physicians Healthy Kids Services 20 1598912644 0 Physicians Optical Supplies 20 1598912644 0 Physicians Physician Services 00 1598912651 0 HAINES ERICA 2023268 9999999 B 10 1598912651 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1598912651 0 Speech Therapists Medical Supplies 20 1598912651 0 Speech Therapists Medical equipment/prosthetic devices 20 1598912651 0 Speech Therapists Speech Therapy/Pathology Services 00 1598912966 0 HUDSON ROBIN E 2020038 9999999 B 10 1598912966 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1598912966 0 Audiologists Audiology Services 20 1598912966 0 Audiologists Medical Supplies 20 1598912966 0 Audiologists Medical equipment/prosthetic devices 00 1598914657 0 BRYANT ELIZABETH ANNE 2018001 9999999 B 10 1598914657 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1598914657 0 Physicians Anesthesia Services 20 1598914657 0 Physicians Healthy Kids Services 20 1598914657 0 Physicians 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Practitioners Nurse Practitioners Services 20 1598917452 0 Nurse Practitioners Physician Services 00 1598917965 0 BRAND JASON 2009032 9999999 B 10 1598917965 0 1794 S ARLINGTON HEIGHTS RD ARLINGTON HEIGH IL 600053727 20 1598917965 0 Optometrists Optical Supplies 20 1598917965 0 Optometrists Optometric Services 20 1598917965 0 Optometrists Physician Services 00 1598918583 0 GIACALONE DEANA MARIE 2008323 9999999 B 10 1598918583 0 PO BOX 7411347 CHICAGO IL 606743347 20 1598918583 0 Nurse Practitioners Anesthesia Services 20 1598918583 0 Nurse Practitioners Nurse Practitioners Services 20 1598918583 0 Nurse Practitioners Physician Services 00 1598919078 0 BUSHBACHER VANESSA ANNE 2024312 9999999 B 10 1598919078 0 799 W KENSINGTON RD MT PROSPECT IL 600561111 20 1598919078 0 Speech Therapists Medical Supplies 20 1598919078 0 Speech Therapists Medical equipment/prosthetic devices 20 1598919078 0 Speech Therapists Speech Therapy/Pathology Services 00 1598920274 0 GULATI DHIRAJ 2017164 9999999 B 10 1598920274 0 5777 DEPT CAROL STREAM IL 601220021 20 1598920274 0 Physicians Anesthesia Services 20 1598920274 0 Physicians Fluoride varnish 20 1598920274 0 Physicians Healthy Kids Services 20 1598920274 0 Physicians Optical Supplies 20 1598920274 0 Physicians Physician Services 00 1598920308 0 SHAH PURVI K 2009244 9999999 B 10 1598920308 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1598920308 0 Physicians Anesthesia Services 20 1598920308 0 Physicians Fluoride varnish 20 1598920308 0 Physicians Healthy Kids Services 20 1598920308 0 Physicians Optical Supplies 20 1598920308 0 Physicians Physician Services 00 1598920647 0 PIEPER MATTHEW 2010182 9999999 B 10 1598920647 0 615 S NEW BALLAS RD STE 1200 SAINT LOUIS MO 631418221 20 1598920647 0 Physicians Anesthesia Services 20 1598920647 0 Physicians Healthy Kids Services 20 1598920647 0 Physicians Optical Supplies 20 1598920647 0 Physicians Physician Services 00 1598920860 0 SACHWANI-DASWANI GUL R 2024004 9999999 B 10 1598920860 0 5701 W TALAVI BLVD GLENDALE AZ 853061886 20 1598920860 0 Physicians Anesthesia Services 20 1598920860 0 Physicians Healthy Kids Services 20 1598920860 0 Physicians Optical Supplies 20 1598920860 0 Physicians Physician Services 00 1598921249 0 CAMPBELL TRACY 2015001 9999999 B 10 1598921249 0 PO BOX 6685 CAROL STREAM IL 601976685 20 1598921249 0 Physicians Anesthesia Services 20 1598921249 0 Physicians Healthy Kids Services 20 1598921249 0 Physicians Optical Supplies 20 1598921249 0 Physicians Physician Services 00 1598921959 0 YEAGER ROBERT 2009196 9999999 B 10 1598921959 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1598921959 0 Physicians Anesthesia Services 20 1598921959 0 Physicians Healthy Kids Services 20 1598921959 0 Physicians Optical Supplies 20 1598921959 0 Physicians Physician Services 00 1598922957 0 RAO KALYAN 2013196 9999999 B 10 1598922957 0 1220 S WOOD ST CHICAGO IL 606081202 20 1598922957 0 Physicians Anesthesia Services 20 1598922957 0 Physicians Healthy Kids Services 20 1598922957 0 Physicians Optical Supplies 20 1598922957 0 Physicians Physician Services 20 1598922957 0 Physicians Physicians Psychiatric Services 00 1598923005 0 KIM GENE 2008183 9999999 B 10 1598923005 0 PO BOX 713388 CHICAGO IL 606771525 20 1598923005 0 Physicians Anesthesia Services 20 1598923005 0 Physicians Fluoride varnish 20 1598923005 0 Physicians Healthy Kids Services 20 1598923005 0 Physicians Optical Supplies 20 1598923005 0 Physicians Physician Services 00 1598923047 0 UJIKI MICHAEL B 2008228 9999999 B 10 1598923047 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1598923047 0 Physicians Anesthesia Services 20 1598923047 0 Physicians Healthy Kids Services 20 1598923047 0 Physicians Optical Supplies 20 1598923047 0 Physicians Physician Services 00 1598924987 0 CATAPANO ANTHONY A 2024046 9999999 B 10 1598924987 0 PO BOX 41220 PHOENIX AZ 850801220 20 1598924987 0 Physicians Anesthesia Services 20 1598924987 0 Physicians Healthy Kids Services 20 1598924987 0 Physicians Optical Supplies 20 1598924987 0 Physicians Physician Services 00 1598925455 0 RICKARD JENNIFER 2022167 9999999 B 10 1598925455 0 3300 OAKDALE AVE N ROBBINSDALE MN 554222926 20 1598925455 0 Physicians Anesthesia Services 20 1598925455 0 Physicians Healthy Kids Services 20 1598925455 0 Physicians Optical Supplies 20 1598925455 0 Physicians Physician Services 00 1598925778 0 WILSON JEANNE B 2008196 9999999 B 10 1598925778 0 PO BOX 1109 CROWN POINT IN 463081109 20 1598925778 0 Physicians Anesthesia Services 20 1598925778 0 Physicians Healthy Kids Services 20 1598925778 0 Physicians Optical Supplies 20 1598925778 0 Physicians Physician Services 00 1598926107 0 CHAE YOUNG KWANG 2014195 9999999 B 10 1598926107 0 5777 DEPT CAROL STREAM IL 601220021 20 1598926107 0 Physicians Anesthesia Services 20 1598926107 0 Physicians Fluoride varnish 20 1598926107 0 Physicians Healthy Kids Services 20 1598926107 0 Physicians Optical Supplies 20 1598926107 0 Physicians Physician Services 00 1598926198 0 GYEBI KOFI 2024079 9999999 B 10 1598926198 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1598926198 0 Physicians Anesthesia Services 20 1598926198 0 Physicians Healthy Kids Services 20 1598926198 0 Physicians Optical Supplies 20 1598926198 0 Physicians Physician Services 00 1598926289 0 GRIEDER RACHEL 2008219 9999999 B 10 1598926289 0 221 NE GLEN OAK AVE PEORIA IL 616360002 20 1598926289 0 Podiatrists Podiatric Services 00 1598926297 0 MOSS KRISTIE 2024139 9999999 B 10 1598926297 0 PO BOX 43230 PHOENIX AZ 850803230 20 1598926297 0 Physicians Anesthesia Services 20 1598926297 0 Physicians Healthy Kids Services 20 1598926297 0 Physicians Optical Supplies 20 1598926297 0 Physicians Physician Services 00 1598926339 0 JOSHI NEHA 2019288 9999999 B 10 1598926339 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1598926339 0 Physicians Anesthesia Services 20 1598926339 0 Physicians Fluoride varnish 20 1598926339 0 Physicians Healthy Kids Services 20 1598926339 0 Physicians 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Practitioners Services 20 1598927246 0 Nurse Practitioners Physician Services 00 1598929853 0 GOVINDARAJAN HEMAMAHESWARI 2008183 9999999 B 10 1598929853 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1598929853 0 Physicians Anesthesia Services 20 1598929853 0 Physicians Fluoride varnish 20 1598929853 0 Physicians Healthy Kids Services 20 1598929853 0 Physicians Optical Supplies 20 1598929853 0 Physicians Physician Services 00 1598930257 0 JENIGIRI SREEDEVI 2024048 9999999 B 10 1598930257 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1598930257 0 Physicians Anesthesia Services 20 1598930257 0 Physicians Fluoride varnish 20 1598930257 0 Physicians Healthy Kids Services 20 1598930257 0 Physicians Optical Supplies 20 1598930257 0 Physicians Physician Services 00 1598930331 0 PEGLOW SARAH 2020305 9999999 B 10 1598930331 0 PO BOX 1309 MAIL STOP 21110Q MINNEAPOLIS MN 554401309 20 1598930331 0 Physicians Anesthesia Services 20 1598930331 0 Physicians Fluoride varnish 20 1598930331 0 Physicians Healthy Kids Services 20 1598930331 0 Physicians Optical Supplies 20 1598930331 0 Physicians Physician Services 00 1598930406 0 HOOKER RYAN 2013001 9999999 B 10 1598930406 0 6501 N SHERIDAN RD PEORIA IL 616142932 20 1598930406 0 Physical Therapists Physical Therapy Services 00 1598930760 0 SPILLER STACEY 2013001 9999999 B 10 1598930760 0 6501 N SHERIDAN RD PEORIA IL 616142932 20 1598930760 0 Physical Therapists Medical Supplies 20 1598930760 0 Physical Therapists Medical equipment/prosthetic devices 20 1598930760 0 Physical Therapists Physical Therapy Services 00 1598930935 0 SHER CARRYL 1998231 9999999 B 10 1598930935 0 919 N WOLCOTT AVE APT 201 CHICAGO IL 606227229 20 1598930935 0 Speech Therapists Medical Supplies 20 1598930935 0 Speech Therapists Medical equipment/prosthetic devices 20 1598930935 0 Speech Therapists Speech Therapy/Pathology Services 00 1598930950 0 LIAO STEVE MING-CHE 2009182 9999999 B 10 1598930950 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1598930950 0 Physicians Anesthesia Services 20 1598930950 0 Physicians Fluoride varnish 20 1598930950 0 Physicians Healthy Kids Services 20 1598930950 0 Physicians Optical Supplies 20 1598930950 0 Physicians Physician Services 00 1598931339 0 AMATYA BIRENDRA 2020034 9999999 B 10 1598931339 0 PO BOX 43230 PHOENIX AZ 850803230 20 1598931339 0 Physicians Anesthesia Services 20 1598931339 0 Physicians Healthy Kids Services 20 1598931339 0 Physicians Optical Supplies 20 1598931339 0 Physicians Physician Services 00 1598931719 0 COLAVINCENZO MARIA 2009213 9999999 B 10 1598931719 0 5777 DEPT CAROL STREAM IL 601220021 20 1598931719 0 Physicians Anesthesia Services 20 1598931719 0 Physicians Healthy Kids Services 20 1598931719 0 Physicians Optical Supplies 20 1598931719 0 Physicians Physician Services 00 1598931867 0 PANOZZO LISA A 2024129 9999999 B 10 1598931867 0 16614 W 159TH ST STE 302 LOCKPORT IL 604418009 20 1598931867 0 Clinical Social Worker Social work service 00 1598932097 0 TANG MICHAEL 2024071 9999999 B 10 1598932097 0 495 FLATBUSH AVE # C5 BROOKLYN NY 112253706 20 1598932097 0 Physicians Anesthesia Services 20 1598932097 0 Physicians Healthy Kids Services 20 1598932097 0 Physicians Optical Supplies 20 1598932097 0 Physicians Physician Services 20 1598932097 0 Physicians Physicians Psychiatric Services 00 1598932550 0 BECKER MATTHEW C 2022224 9999999 B 10 1598932550 0 2300 N EDWARD ST DECATUR IL 625264163 20 1598932550 0 Physicians Anesthesia Services 20 1598932550 0 Physicians Fluoride varnish 20 1598932550 0 Physicians Healthy Kids Services 20 1598932550 0 Physicians Optical Supplies 20 1598932550 0 Physicians Physician Services 00 1598932741 0 JAIN BHANDARI NEHA 2016005 9999999 B 10 1598932741 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1598932741 0 Physicians Anesthesia Services 20 1598932741 0 Physicians Fluoride varnish 20 1598932741 0 Physicians Healthy Kids Services 20 1598932741 0 Physicians Optical Supplies 20 1598932741 0 Physicians Physician Services 00 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1598934689 0 Nurse Practitioners Nurse Practitioners Services 20 1598934689 0 Nurse Practitioners Physician Services 00 1598936999 0 WISSEN ALISON 2009037 9999999 B 10 1598936999 0 1520 N BLOOMINGTON ST STREATOR IL 613641312 20 1598936999 0 Speech Therapists Medical Supplies 20 1598936999 0 Speech Therapists Medical equipment/prosthetic devices 20 1598936999 0 Speech Therapists Speech Therapy/Pathology Services 00 1598938540 0 VALLALA NIRUPAMA 2023072 9999999 B 10 1598938540 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1598938540 0 Physicians Anesthesia Services 20 1598938540 0 Physicians Fluoride varnish 20 1598938540 0 Physicians Healthy Kids Services 20 1598938540 0 Physicians Optical Supplies 20 1598938540 0 Physicians Physician Services 00 1598938672 0 DING DAVID D 2013182 9999999 B 10 1598938672 0 5777 DEPT CAROL STREAM IL 601228942 20 1598938672 0 Physicians Anesthesia Services 20 1598938672 0 Physicians Healthy Kids Services 20 1598938672 0 Physicians Optical Supplies 20 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1598973018 0 Nurse Practitioners Healthy Kids Services 20 1598973018 0 Nurse Practitioners Nurse Practitioners Services 20 1598973018 0 Nurse Practitioners Physician Services 00 1598973042 0 NIZNIK CHARLOTTE 2008275 9999999 B 10 1598973042 0 5777 DEPT CAROL STREAM IL 601220021 20 1598973042 0 Nurse Practitioners Healthy Kids Services 20 1598973042 0 Nurse Practitioners Nurse Practitioners Services 20 1598973042 0 Nurse Practitioners Physician Services 00 1598974149 0 ALSHARIF HANI 2011182 9999999 B 10 1598974149 0 1395 NW 167TH ST MIAMI FL 331695710 20 1598974149 0 Physicians Anesthesia Services 20 1598974149 0 Physicians Fluoride varnish 20 1598974149 0 Physicians Healthy Kids Services 20 1598974149 0 Physicians Optical Supplies 20 1598974149 0 Physicians Physician Services 00 1598975260 0 WILHITE KYLE 2008183 9999999 B 10 1598975260 0 2202 HARLEM RD LOVES PARK IL 611112754 20 1598975260 0 Physicians All Kids application agent 20 1598975260 0 Physicians Anesthesia Services 20 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20 1598987083 0 Physicians Physician Services 00 1598987711 0 STEINBERG SARAH 2020234 9999999 B 10 1598987711 0 3109 W NORTH SHORE AVE CHICAGO IL 606454002 20 1598987711 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1598987836 0 JOURNAGAN SUSAN 2007213 9999999 B 10 1598987836 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1598987836 0 Physicians Anesthesia Services 20 1598987836 0 Physicians Healthy Kids Services 20 1598987836 0 Physicians Optical Supplies 20 1598987836 0 Physicians Physician Services 00 1598988438 0 FIGUEREDO YVONNE 1999069 9999999 B 10 1598988438 0 8909 MCCONNELL RD WOODSTOCK IL 600987459 20 1598988438 0 Speech Therapists Medical Supplies 20 1598988438 0 Speech Therapists Medical equipment/prosthetic devices 20 1598988438 0 Speech Therapists Speech Therapy/Pathology Services 00 1598988727 0 LIBSON ELIZABETH 2007030 9999999 B 10 1598988727 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 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1598994493 0 Physicians Physician Services 00 1598995748 0 WOODS RYAN 2014182 9999999 B 10 1598995748 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1598995748 0 Physicians Anesthesia Services 20 1598995748 0 Physicians Healthy Kids Services 20 1598995748 0 Physicians Optical Supplies 20 1598995748 0 Physicians Physician Services 00 1598995995 0 SHAIKH SUMAIRA T 2014223 9999999 B 10 1598995995 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1598995995 0 Physicians Anesthesia Services 20 1598995995 0 Physicians Fluoride varnish 20 1598995995 0 Physicians Healthy Kids Services 20 1598995995 0 Physicians Optical Supplies 20 1598995995 0 Physicians Physician Services 00 1598997348 0 DHAKAL LAXMI 2023005 9999999 B 10 1598997348 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1598997348 0 Physicians Anesthesia Services 20 1598997348 0 Physicians Healthy Kids Services 20 1598997348 0 Physicians Optical Supplies 20 1598997348 0 Physicians Physician Services 20 1598997348 0 Physicians Physicians 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20 1609072818 0 Physicians Healthy Kids Services 20 1609072818 0 Physicians Optical Supplies 20 1609072818 0 Physicians Physician Services 20 1609072818 0 Physicians Physicians Psychiatric Services 00 1609072883 0 MEERSMAN THOMAS M 2016001 9999999 B 10 1609072883 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1609072883 0 Physician Assistant Only Fluoride varnish 20 1609072883 0 Physician Assistant Only Healthy Kids Services 20 1609072883 0 Physician Assistant Only Physician Services 00 1609072933 0 WAHL MELANIE J 2009180 9999999 B 10 1609072933 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1609072933 0 Physicians Anesthesia Services 20 1609072933 0 Physicians Fluoride varnish 20 1609072933 0 Physicians Healthy Kids Services 20 1609072933 0 Physicians Optical Supplies 20 1609072933 0 Physicians Physician Services 00 1609073030 0 PATEL NEESHA 2011152 9999999 B 10 1609073030 0 2100 POWELL ST STE 900 EMERYVILLE CA 946081844 20 1609073030 0 Physicians Anesthesia Services 20 1609073030 0 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1609075787 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1609075787 0 Physicians Anesthesia Services 20 1609075787 0 Physicians Fluoride varnish 20 1609075787 0 Physicians Healthy Kids Services 20 1609075787 0 Physicians Optical Supplies 20 1609075787 0 Physicians Physician Services 00 1609075944 0 CROCKER ERIN 2011250 9999999 B 10 1609075944 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1609075944 0 Physicians Anesthesia Services 20 1609075944 0 Physicians Healthy Kids Services 20 1609075944 0 Physicians Optical Supplies 20 1609075944 0 Physicians Physician Services 20 1609075944 0 Physicians Physicians Psychiatric Services 00 1609077619 0 LAPEROUSE LAMBERT 2022331 9999999 B 10 1609077619 0 PO BOX 43230 PHOENIX AZ 850803230 20 1609077619 0 Physicians Anesthesia Services 20 1609077619 0 Physicians Healthy Kids Services 20 1609077619 0 Physicians Optical Supplies 20 1609077619 0 Physicians Physician Services 00 1609077866 0 SAXENA NUPUR 2008214 9999999 B 10 1609077866 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1609077866 0 Physicians Anesthesia Services 20 1609077866 0 Physicians Healthy Kids Services 20 1609077866 0 Physicians Optical Supplies 20 1609077866 0 Physicians Physician Services 00 1609078443 0 KHALID AKBAR 2012275 9999999 B 10 1609078443 0 PO BOX 80309 PHILADELPHIA PA 191011309 20 1609078443 0 Physicians Anesthesia Services 20 1609078443 0 Physicians Healthy Kids Services 20 1609078443 0 Physicians Optical Supplies 20 1609078443 0 Physicians Physician Services 00 1609079003 0 FUSCO MATTHEW 2023321 9999999 B 10 1609079003 0 DEPT AT 40379 ATLANTA GA 311920001 20 1609079003 0 Physicians Anesthesia Services 20 1609079003 0 Physicians Healthy Kids Services 20 1609079003 0 Physicians Optical Supplies 20 1609079003 0 Physicians Physician Services 00 1609079219 0 NAIR ANJANA 2016004 9999999 B 10 1609079219 0 12251 S 80TH AVE STE 1630 PALOS HEIGHTS IL 604631256 20 1609079219 0 Physicians Anesthesia Services 20 1609079219 0 Physicians Healthy 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Physicians Fluoride varnish 20 1609085273 0 Physicians Healthy Kids Services 20 1609085273 0 Physicians Optical Supplies 20 1609085273 0 Physicians Physician Services 00 1609085356 0 GHOBADI ARMIN 2013335 9999999 B 10 1609085356 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1609085356 0 Physicians Anesthesia Services 20 1609085356 0 Physicians Fluoride varnish 20 1609085356 0 Physicians Healthy Kids Services 20 1609085356 0 Physicians Optical Supplies 20 1609085356 0 Physicians Physician Services 00 1609086180 0 SHEIKH AHMAD Z 2008182 9999999 B 10 1609086180 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1609086180 0 Physicians Anesthesia Services 20 1609086180 0 Physicians Fluoride varnish 20 1609086180 0 Physicians Healthy Kids Services 20 1609086180 0 Physicians Optical Supplies 20 1609086180 0 Physicians Physician Services 00 1609087915 0 HEITSCH LAURA 2011213 9999999 B 10 1609087915 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1609087915 0 Physicians Anesthesia Services 20 1609087915 0 Physicians Healthy Kids Services 20 1609087915 0 Physicians Optical Supplies 20 1609087915 0 Physicians Physician Services 00 1609088384 0 SARBESCU IOANA 2024257 9999999 B 10 1609088384 0 519 N CASS AVE STE 102 WESTMONT IL 605591589 20 1609088384 0 Dentists Dental Services 20 1609088384 0 Dentists Physician Services 00 1609090026 0 ANDERSON DONALD R 2007001 9999999 B 10 1609090026 0 111 OAKWOOD RD EAST PEORIA IL 616111853 20 1609090026 0 Physicians Anesthesia Services 20 1609090026 0 Physicians Healthy Kids Services 20 1609090026 0 Physicians Optical Supplies 20 1609090026 0 Physicians Physician Services 00 1609090208 0 ZOPEL MATTHEW 2007196 9999999 B 10 1609090208 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1609090208 0 Physicians Anesthesia Services 20 1609090208 0 Physicians Healthy Kids Services 20 1609090208 0 Physicians Optical Supplies 20 1609090208 0 Physicians Physician Services 00 1609090943 0 MEADOWS LISA A 2021070 9999999 B 10 1609090943 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1609090943 0 Nurse Practitioners Fluoride varnish 20 1609090943 0 Nurse Practitioners Healthy Kids Services 20 1609090943 0 Nurse Practitioners Nurse Practitioners Services 20 1609090943 0 Nurse Practitioners Physician Services 00 1609093517 0 LIPPINCOTT AMY M 2006188 9999999 B 10 1609093517 0 309 WALNUT ST ENERGY IL 629333549 20 1609093517 0 Speech Therapists Medical Supplies 20 1609093517 0 Speech Therapists Medical equipment/prosthetic devices 20 1609093517 0 Speech Therapists Speech Therapy/Pathology Services 00 1609093632 0 YOUNG MICHAEL 2017032 9999999 B 10 1609093632 0 PO BOX 1790 BROOKFIELD WI 530081790 20 1609093632 0 Physicians Anesthesia Services 20 1609093632 0 Physicians Healthy Kids Services 20 1609093632 0 Physicians Optical Supplies 20 1609093632 0 Physicians Physician Services 00 1609094044 0 DAS SANJNA 2018136 9999999 B 10 1609094044 0 2515 W LAWRENCE AVE CHICAGO IL 606252929 20 1609094044 0 Clinical 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LOUIS MO 631101123 20 1609104603 0 Nurse Practitioners Healthy Kids Services 20 1609104603 0 Nurse Practitioners Nurse Practitioners Services 20 1609104603 0 Nurse Practitioners Physician Services 00 1609105527 0 LLOYD MARY M 2010011 9999999 B 10 1609105527 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1609105527 0 Nurse Practitioners Fluoride varnish 20 1609105527 0 Nurse Practitioners Healthy Kids Services 20 1609105527 0 Nurse Practitioners Nurse Practitioners Services 20 1609105527 0 Nurse Practitioners Physician Services 00 1609105899 0 FURGASON TARA A 2010140 9999999 B 10 1609105899 0 4600 3RD ST MOLINE IL 612656106 20 1609105899 0 Other behavior health professional LCPC/LMFT services 00 1609106137 0 ABRAMSON SIMON G 2016203 9999999 B 10 1609106137 0 3249 OAK PARK AVE BERWYN IL 604023429 20 1609106137 0 Physicians Anesthesia Services 20 1609106137 0 Physicians Healthy Kids Services 20 1609106137 0 Physicians Optical Supplies 20 1609106137 0 Physicians Physician Services 00 1609107952 0 PRABHAKAR DEEPA 2015194 9999999 B 10 1609107952 0 611 W PARK ST URBANA IL 618012529 20 1609107952 0 Physicians Anesthesia Services 20 1609107952 0 Physicians Fluoride varnish 20 1609107952 0 Physicians Healthy Kids Services 20 1609107952 0 Physicians Optical Supplies 20 1609107952 0 Physicians Physician Services 00 1609108422 0 FERIZI NICOLE 2010116 9999999 B 10 1609108422 0 406 FAYETTE DR OSWEGO IL 605437724 20 1609108422 0 Speech Therapists Medical Supplies 20 1609108422 0 Speech Therapists Medical equipment/prosthetic devices 20 1609108422 0 Speech Therapists Speech Therapy/Pathology Services 00 1609109883 0 ZABAD MOHAMMAD NOUR 2020013 9999999 B 10 1609109883 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1609109883 0 Physicians Anesthesia Services 20 1609109883 0 Physicians Fluoride varnish 20 1609109883 0 Physicians Healthy Kids Services 20 1609109883 0 Physicians Optical Supplies 20 1609109883 0 Physicians Physician Services 00 1609110469 0 DANIHER KATHERINE 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1609134782 0 Physicians Optical Supplies 20 1609134782 0 Physicians Physician Services 20 1609134782 0 Physicians Physicians Psychiatric Services 00 1609135383 0 PATADIA NEELAM 2015252 9999999 B 10 1609135383 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1609135383 0 Optometrists Optical Supplies 20 1609135383 0 Optometrists Optometric Services 20 1609135383 0 Optometrists Physician Services 00 1609135615 0 WHITE JONATHON W 2013292 9999999 B 10 1609135615 0 2250 N ILLINOIS AVE CARBONDALE IL 629015612 20 1609135615 0 Physicians Anesthesia Services 20 1609135615 0 Physicians Fluoride varnish 20 1609135615 0 Physicians Healthy Kids Services 20 1609135615 0 Physicians Optical Supplies 20 1609135615 0 Physicians Physician Services 00 1609135938 0 LIMAYE KAUSTUBH 2017211 9999999 B 10 1609135938 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1609135938 0 Physicians Anesthesia Services 20 1609135938 0 Physicians Healthy Kids Services 20 1609135938 0 Physicians Optical Supplies 20 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1609440148 0 Physicians Anesthesia Services 20 1609440148 0 Physicians Fluoride varnish 20 1609440148 0 Physicians Healthy Kids Services 20 1609440148 0 Physicians Optical Supplies 20 1609440148 0 Physicians Physician Services 00 1609440684 0 WAGNER MITCHEL 2024037 9999999 B 10 1609440684 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1609440684 0 Physicians Anesthesia Services 20 1609440684 0 Physicians Healthy Kids Services 20 1609440684 0 Physicians Optical Supplies 20 1609440684 0 Physicians Physician Services 00 1609441500 0 NESTLER ANTHONY J 2021181 9999999 B 10 1609441500 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1609441500 0 Physicians Anesthesia Services 20 1609441500 0 Physicians Healthy Kids Services 20 1609441500 0 Physicians Optical Supplies 20 1609441500 0 Physicians Physician Services 00 1609442813 0 VALADEZ JOSEPH 2023103 9999999 B 10 1609442813 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1609442813 0 Physical Therapists Medical Supplies 20 1609442813 0 Physical 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1609444843 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1609444843 0 Physicians Anesthesia Services 20 1609444843 0 Physicians Healthy Kids Services 20 1609444843 0 Physicians Optical Supplies 20 1609444843 0 Physicians Physician Services 00 1609444967 0 EDMISSON JACOB S 2021207 9999999 B 10 1609444967 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1609444967 0 Physicians Anesthesia Services 20 1609444967 0 Physicians Fluoride varnish 20 1609444967 0 Physicians Healthy Kids Services 20 1609444967 0 Physicians Optical Supplies 20 1609444967 0 Physicians Physician Services 00 1609445360 0 YOSEF NATALIE 2021210 9999999 B 10 1609445360 0 1949 W LELAND AVE APT 1 CHICAGO IL 606407559 20 1609445360 0 Occupational Therapists Medical Supplies 20 1609445360 0 Occupational Therapists Medical equipment/prosthetic devices 20 1609445360 0 Occupational Therapists Occupational Therapy Services 00 1609445733 0 HOUGHTON MICHELLE 2022335 9999999 B 10 1609445733 0 2704 NE 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20 1609858034 0 Physicians Healthy Kids Services 20 1609858034 0 Physicians Optical Supplies 20 1609858034 0 Physicians Physician Services 00 1609858067 0 YU RICHARD 2000358 9999999 B 10 1609858067 0 55 E 86TH AVE MERRILLVILLE IN 464106382 20 1609858067 0 Physicians Anesthesia Services 20 1609858067 0 Physicians Healthy Kids Services 20 1609858067 0 Physicians Optical Supplies 20 1609858067 0 Physicians Physician Services 00 1609858471 0 OLSON SHERRI L 2016360 9999999 B 10 1609858471 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1609858471 0 Physician Assistant Only Fluoride varnish 20 1609858471 0 Physician Assistant Only Healthy Kids Services 20 1609858471 0 Physician Assistant Only Physician Services 00 1609858547 0 CO DANIEL 1997182 9999999 B 10 1609858547 0 300 READ ST LOCKPORT IL 604413265 20 1609858547 0 Physicians Anesthesia Services 20 1609858547 0 Physicians Healthy Kids Services 20 1609858547 0 Physicians Optical Supplies 20 1609858547 0 Physicians Physician Services 00 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B 10 1609874684 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1609874684 0 Physicians Anesthesia Services 20 1609874684 0 Physicians Healthy Kids Services 20 1609874684 0 Physicians Optical Supplies 20 1609874684 0 Physicians Physician Services 00 1609875699 0 KARDESCH DAVID J 2020052 9999999 B 10 1609875699 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1609875699 0 Physicians Anesthesia Services 20 1609875699 0 Physicians Fluoride varnish 20 1609875699 0 Physicians Healthy Kids Services 20 1609875699 0 Physicians Optical Supplies 20 1609875699 0 Physicians Physician Services 00 1609875798 0 RHODA KIMBERLY A 2005182 9999999 B 10 1609875798 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1609875798 0 Occupational Therapists Medical Supplies 20 1609875798 0 Occupational Therapists Medical equipment/prosthetic devices 20 1609875798 0 Occupational Therapists Occupational Therapy Services 00 1609876028 0 LOFCHY NEAL 1995091 9999999 B 10 1609876028 0 3800 HIGHLAND AVE STE 105 DOWNERS GROVE IL 605151558 20 1609876028 0 Physicians Anesthesia Services 20 1609876028 0 Physicians Healthy Kids Services 20 1609876028 0 Physicians Optical Supplies 20 1609876028 0 Physicians Physician Services 00 1609876077 0 GREEN PAULA 2001182 9999999 B 10 1609876077 0 7725 W RENO AVE STE 330 OKLAHOMA CITY OK 731279742 20 1609876077 0 Physicians Anesthesia Services 20 1609876077 0 Physicians Healthy Kids Services 20 1609876077 0 Physicians Optical Supplies 20 1609876077 0 Physicians Physician Services 00 1609876424 0 SYED ZAINULABUDDIN 1996153 9999999 B 10 1609876424 0 4121 FAIRVIEW AVE STE L1 DOWNERS GROVE IL 605152265 20 1609876424 0 Physicians Anesthesia Services 20 1609876424 0 Physicians Fluoride varnish 20 1609876424 0 Physicians Healthy Kids Services 20 1609876424 0 Physicians Optical Supplies 20 1609876424 0 Physicians Physician Services 00 1609877265 0 SWANSON JOHN R 2004183 9999999 B 10 1609877265 0 PO BOX 3272 INDIANAPOLIS IN 462063272 20 1609877265 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PL MEMPHIS TN 381053678 20 1609879865 0 Physicians Anesthesia Services 20 1609879865 0 Physicians Fluoride varnish 20 1609879865 0 Physicians Healthy Kids Services 20 1609879865 0 Physicians Optical Supplies 20 1609879865 0 Physicians Physician Services 00 1609880939 0 ALWARD WILLIAM T 1991182 9999999 B 10 1609880939 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1609880939 0 Physicians Anesthesia Services 20 1609880939 0 Physicians Fluoride varnish 20 1609880939 0 Physicians Healthy Kids Services 20 1609880939 0 Physicians Optical Supplies 20 1609880939 0 Physicians Physician Services 00 1609882703 0 GAEBLER-SPIRA DEBORAH J 1987244 9999999 B 10 1609882703 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1609882703 0 Physicians Anesthesia Services 20 1609882703 0 Physicians Healthy Kids Services 20 1609882703 0 Physicians Optical Supplies 20 1609882703 0 Physicians Physician Services 00 1609882935 0 PAREKH DEVEN 2017228 9999999 B 10 1609882935 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 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0 CORNELIUS VICTORIA 1995339 9999999 B 10 1609885607 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1609885607 0 Physicians Anesthesia Services 20 1609885607 0 Physicians Fluoride varnish 20 1609885607 0 Physicians Healthy Kids Services 20 1609885607 0 Physicians Optical Supplies 20 1609885607 0 Physicians Physician Services 00 1609886183 0 PARK C LUCY 1984254 9999999 B 10 1609886183 0 3030 W SALT CREEK LN STE 200 ARLINGTON HEIGH IL 600055002 20 1609886183 0 Physicians Anesthesia Services 20 1609886183 0 Physicians Healthy Kids Services 20 1609886183 0 Physicians Optical Supplies 20 1609886183 0 Physicians Physician Services 00 1609886324 0 IYER PALLAVI 2022215 9999999 B 10 1609886324 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1609886324 0 Physicians Anesthesia Services 20 1609886324 0 Physicians Fluoride varnish 20 1609886324 0 Physicians Healthy Kids Services 20 1609886324 0 Physicians Optical Supplies 20 1609886324 0 Physicians Physician Services 00 1609886332 0 CAMPANELLA FRANCO MICHAEL 2000333 9999999 B 10 1609886332 0 3040 W SALT CREEK LN ARLINGTON HEIGH IL 600051069 20 1609886332 0 Physicians Anesthesia Services 20 1609886332 0 Physicians Healthy Kids Services 20 1609886332 0 Physicians Optical Supplies 20 1609886332 0 Physicians Physician Services 20 1609886332 0 Physicians Physicians Psychiatric Services 00 1609887983 0 BECKER BRADLEY 1994227 9999999 B 10 1609887983 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1609887983 0 Physicians Anesthesia Services 20 1609887983 0 Physicians Fluoride varnish 20 1609887983 0 Physicians Healthy Kids Services 20 1609887983 0 Physicians Optical Supplies 20 1609887983 0 Physicians Physician Services 00 1609888320 0 SCHELL NANCY 1999274 9999999 B 10 1609888320 0 2361 PAYSPHERE CIR CHICAGO IL 606740023 20 1609888320 0 Physicians Anesthesia Services 20 1609888320 0 Physicians Healthy Kids Services 20 1609888320 0 Physicians Optical Supplies 20 1609888320 0 Physicians Physician Services 20 1609888320 0 Physicians Physicians Psychiatric Services 00 1609888361 0 LYONS MICHELLE L 2017088 9999999 B 10 1609888361 0 PO BOX 28900 GREEN BAY WI 543240900 20 1609888361 0 Nurse Practitioners Anesthesia Services 20 1609888361 0 Nurse Practitioners Nurse Practitioners Services 20 1609888361 0 Nurse Practitioners Physician Services 00 1609889203 0 CASS ALLAN W 2024113 9999999 B 10 1609889203 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1609889203 0 Physicians Anesthesia Services 20 1609889203 0 Physicians Healthy Kids Services 20 1609889203 0 Physicians Optical Supplies 20 1609889203 0 Physicians Physician Services 00 1609889450 0 MUSIAL CORA E 1998194 9999999 B 10 1609889450 0 PO BOX 3988 CARBONDALE IL 629023988 20 1609889450 0 Physicians Anesthesia Services 20 1609889450 0 Physicians Fluoride varnish 20 1609889450 0 Physicians Healthy Kids Services 20 1609889450 0 Physicians Optical Supplies 20 1609889450 0 Physicians Physician Services 00 1609889690 0 WILSBACHER LISA D 2015070 9999999 B 10 1609889690 0 5777 DEPT CAROL STREAM IL 601220021 20 1609889690 0 Physicians Anesthesia Services 20 1609889690 0 Physicians Fluoride varnish 20 1609889690 0 Physicians Healthy Kids Services 20 1609889690 0 Physicians Optical Supplies 20 1609889690 0 Physicians Physician Services 00 1609889831 0 GLAUBER JAMES 1987182 9999999 B 10 1609889831 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1609889831 0 Physicians Anesthesia Services 20 1609889831 0 Physicians Fluoride varnish 20 1609889831 0 Physicians Healthy Kids Services 20 1609889831 0 Physicians Optical Supplies 20 1609889831 0 Physicians Physician Services 00 1609890540 0 CUMMINGS CATHERINE 2023059 9999999 B 10 1609890540 0 2 S MAIN ST MILFORD MA 017573771 20 1609890540 0 Physicians Anesthesia Services 20 1609890540 0 Physicians Healthy Kids Services 20 1609890540 0 Physicians Optical Supplies 20 1609890540 0 Physicians Physician Services 00 1609890581 0 DRUECK CHARLES 1981227 9999999 B 10 1609890581 0 111 YALE COURT GLENVIEW IL 600265916 20 1609890581 0 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varnish 20 1609895192 0 Physicians Healthy Kids Services 20 1609895192 0 Physicians Optical Supplies 20 1609895192 0 Physicians Physician Services 00 1609895473 0 SMITH PAMELA D 1996275 9999999 B 10 1609895473 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1609895473 0 Physicians Anesthesia Services 20 1609895473 0 Physicians Fluoride varnish 20 1609895473 0 Physicians Healthy Kids Services 20 1609895473 0 Physicians Optical Supplies 20 1609895473 0 Physicians Physician Services 00 1609895499 0 FRANZEN THOMAS 1996306 9999999 B 10 1609895499 0 611 W PARK ST URBANA IL 618012529 20 1609895499 0 Physicians Anesthesia Services 20 1609895499 0 Physicians Fluoride varnish 20 1609895499 0 Physicians Healthy Kids Services 20 1609895499 0 Physicians Optical Supplies 20 1609895499 0 Physicians Physician Services 00 1609895515 0 REDDY DARAM D 1985252 9999999 B 10 1609895515 0 3010 GRAND AVE WAUKEGAN IL 600852321 20 1609895515 0 Physicians Anesthesia Services 20 1609895515 0 Physicians Healthy Kids 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9999999 B 10 1609897552 0 317 MARTIN LUTHER KING JR WAY TACOMA WA 984054234 20 1609897552 0 Physicians Anesthesia Services 20 1609897552 0 Physicians Fluoride varnish 20 1609897552 0 Physicians Healthy Kids Services 20 1609897552 0 Physicians Optical Supplies 20 1609897552 0 Physicians Physician Services 00 1609897644 0 CRANE JULAN 2001169 9999999 B 10 1609897644 0 515 22ND AVE MONROE WI 535661569 20 1609897644 0 Physicians Anesthesia Services 20 1609897644 0 Physicians Fluoride varnish 20 1609897644 0 Physicians Healthy Kids Services 20 1609897644 0 Physicians Optical Supplies 20 1609897644 0 Physicians Physician Services 00 1609899913 0 HUNT KEVIN E 1984122 9999999 B 10 1609899913 0 5777 DEPT CAROL STREAM IL 601220021 20 1609899913 0 Physicians Anesthesia Services 20 1609899913 0 Physicians Fluoride varnish 20 1609899913 0 Physicians Healthy Kids Services 20 1609899913 0 Physicians Optical Supplies 20 1609899913 0 Physicians Physician Services 00 1609901396 0 BAIRD BARBARA A 1987219 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Services 00 1609907195 0 HORINEK ANTHONY 2005182 9999999 B 10 1609907195 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1609907195 0 Physicians Anesthesia Services 20 1609907195 0 Physicians Fluoride varnish 20 1609907195 0 Physicians Healthy Kids Services 20 1609907195 0 Physicians Optical Supplies 20 1609907195 0 Physicians Physician Services 00 1609909217 0 PELLO NATASHA 2013152 9999999 B 10 1609909217 0 PO BOX 88493 CHICAGO IL 606801493 20 1609909217 0 Physicians Anesthesia Services 20 1609909217 0 Physicians Healthy Kids Services 20 1609909217 0 Physicians Optical Supplies 20 1609909217 0 Physicians Physician Services 00 1609912161 0 RADAK RICHARD 1997001 9999999 B 10 1609912161 0 PO BOX 431 JANESVILLE WI 535470431 20 1609912161 0 Physicians Anesthesia Services 20 1609912161 0 Physicians Healthy Kids Services 20 1609912161 0 Physicians Optical Supplies 20 1609912161 0 Physicians Physician Services 00 1609913169 0 RIESBERG JEFFREY 1987132 9999999 B 10 1609913169 0 1722 1ST ST 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1619103280 0 Physicians Optical Supplies 20 1619103280 0 Physicians Physician Services 00 1619103306 0 GARCIA CHRISTOPHER 2023262 9999999 B 10 1619103306 0 2330 UTAH AVE STE 200 EL SEGUNDO CA 902454817 20 1619103306 0 Physicians Anesthesia Services 20 1619103306 0 Physicians Healthy Kids Services 20 1619103306 0 Physicians Optical Supplies 20 1619103306 0 Physicians Physician Services 00 1619104148 0 BEGA DANNY G 2014182 9999999 B 10 1619104148 0 5777 DEPT CAROL STREAM IL 601220021 20 1619104148 0 Physicians Anesthesia Services 20 1619104148 0 Physicians Healthy Kids Services 20 1619104148 0 Physicians Optical Supplies 20 1619104148 0 Physicians Physician Services 20 1619104148 0 Physicians Physicians Psychiatric Services 00 1619104262 0 PANJWANI ANJANA 2014182 9999999 B 10 1619104262 0 387 SHUMAN BLVD STE 240W NAPERVILLE IL 605638113 20 1619104262 0 Physicians Anesthesia Services 20 1619104262 0 Physicians Healthy Kids Services 20 1619104262 0 Physicians Optical Supplies 20 1619104262 0 Physicians Physician Services 00 1619104445 0 LAES JOAN 2017110 9999999 B 10 1619104445 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1619104445 0 Physicians Anesthesia Services 20 1619104445 0 Physicians Fluoride varnish 20 1619104445 0 Physicians Healthy Kids Services 20 1619104445 0 Physicians Optical Supplies 20 1619104445 0 Physicians Physician Services 00 1619104478 0 HARLOW PATRICIA A 2020062 9999999 B 10 1619104478 0 PO BOX 781076 DETROIT MI 482781076 20 1619104478 0 Nurse Practitioners Fluoride varnish 20 1619104478 0 Nurse Practitioners Healthy Kids Services 20 1619104478 0 Nurse Practitioners Nurse Practitioners Services 20 1619104478 0 Nurse Practitioners Physician Services 00 1619105202 0 KUROKI LINDSAY MIDORI 2016074 9999999 B 10 1619105202 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1619105202 0 Physicians Anesthesia Services 20 1619105202 0 Physicians Healthy Kids Services 20 1619105202 0 Physicians Optical Supplies 20 1619105202 0 Physicians Physician Services 00 1619105293 0 SHERWOOD KARNA D 2013213 9999999 B 10 1619105293 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1619105293 0 Physicians Anesthesia Services 20 1619105293 0 Physicians Healthy Kids Services 20 1619105293 0 Physicians Optical Supplies 20 1619105293 0 Physicians Physician Services 20 1619105293 0 Physicians Physicians Psychiatric Services 00 1619105491 0 KINSEY SARAH N 2014010 9999999 B 10 1619105491 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1619105491 0 Physicians Anesthesia Services 20 1619105491 0 Physicians Fluoride varnish 20 1619105491 0 Physicians Healthy Kids Services 20 1619105491 0 Physicians Optical Supplies 20 1619105491 0 Physicians Physician Services 00 1619105897 0 BARRETT HEATHER L 2014230 9999999 B 10 1619105897 0 PO BOX 3988 CARBONDALE IL 629023988 20 1619105897 0 Physicians Anesthesia Services 20 1619105897 0 Physicians Healthy Kids Services 20 1619105897 0 Physicians Optical Supplies 20 1619105897 0 Physicians Physician Services 00 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640642323 20 1619107034 0 Physicians Anesthesia Services 20 1619107034 0 Physicians Healthy Kids Services 20 1619107034 0 Physicians Optical Supplies 20 1619107034 0 Physicians Physician Services 00 1619107216 0 DRAGILA FLAVIUS 2021346 9999999 B 10 1619107216 0 PO BOX 43230 PHOENIX AZ 850803230 20 1619107216 0 Physicians Anesthesia Services 20 1619107216 0 Physicians Fluoride varnish 20 1619107216 0 Physicians Healthy Kids Services 20 1619107216 0 Physicians Optical Supplies 20 1619107216 0 Physicians Physician Services 00 1619107554 0 PATEL TEJAS 2019126 9999999 B 10 1619107554 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1619107554 0 Physicians Anesthesia Services 20 1619107554 0 Physicians Healthy Kids Services 20 1619107554 0 Physicians Optical Supplies 20 1619107554 0 Physicians Physician Services 00 1619107885 0 NANDYALA SATISH 2012183 9999999 B 10 1619107885 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1619107885 0 Physicians Anesthesia Services 20 1619107885 0 Physicians Fluoride varnish 20 1619107885 0 Physicians Healthy Kids Services 20 1619107885 0 Physicians Optical Supplies 20 1619107885 0 Physicians Physician Services 00 1619107968 0 AHUJA RENO 2014032 9999999 B 10 1619107968 0 902 W MAIN ST WEST FRANKFORT IL 628962210 20 1619107968 0 Physicians Anesthesia Services 20 1619107968 0 Physicians Healthy Kids Services 20 1619107968 0 Physicians Optical Supplies 20 1619107968 0 Physicians Physician Services 20 1619107968 0 Physicians Physicians Psychiatric Services 00 1619108842 0 PADDOLKAR VINODKUMAR 2018263 9999999 B 10 1619108842 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1619108842 0 Physicians Anesthesia Services 20 1619108842 0 Physicians Healthy Kids Services 20 1619108842 0 Physicians Optical Supplies 20 1619108842 0 Physicians Physician Services 20 1619108842 0 Physicians Physicians Psychiatric Services 00 1619109329 0 KWAN KATHERINE T. 2009257 9999999 B 10 1619109329 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1619109329 0 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Services 20 1619121639 0 Physicians Fluoride varnish 20 1619121639 0 Physicians Healthy Kids Services 20 1619121639 0 Physicians Optical Supplies 20 1619121639 0 Physicians Physician Services 00 1619123031 0 FINN TIMOTHY P 2013274 9999999 B 10 1619123031 0 29373 NETWORK PL CHICAGO IL 606733039 20 1619123031 0 Nurse Practitioners Anesthesia Services 20 1619123031 0 Nurse Practitioners Nurse Practitioners Services 20 1619123031 0 Nurse Practitioners Physician Services 00 1619123114 0 MICHELSON MARGARET G 2013032 9999999 B 10 1619123114 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1619123114 0 Physicians Anesthesia Services 20 1619123114 0 Physicians Healthy Kids Services 20 1619123114 0 Physicians Optical Supplies 20 1619123114 0 Physicians Physician Services 20 1619123114 0 Physicians Physicians Psychiatric Services 00 1619123171 0 BORISOVSKY OLGA 2016001 9999999 B 10 1619123171 0 5251 GALITZ ST APT 304 SKOKIE IL 600773661 20 1619123171 0 Physician Assistant Only Fluoride varnish 20 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Physician Services 00 1619727997 0 JANG GYU BIN 2024184 9999999 B 10 1619727997 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1619727997 0 Physicians Anesthesia Services 20 1619727997 0 Physicians Healthy Kids Services 20 1619727997 0 Physicians Optical Supplies 20 1619727997 0 Physicians Physician Services 00 1619732427 0 SHRESTHA PRABIN 2024052 9999999 B 10 1619732427 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1619732427 0 Physicians Anesthesia Services 20 1619732427 0 Physicians Healthy Kids Services 20 1619732427 0 Physicians Optical Supplies 20 1619732427 0 Physicians Physician Services 00 1619732633 0 RUSSELL KATELYN 2024312 9999999 B 10 1619732633 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1619732633 0 Nurse Practitioners Healthy Kids Services 20 1619732633 0 Nurse Practitioners Nurse Practitioners Services 20 1619732633 0 Nurse Practitioners Physician Services 00 1619735164 0 SINHA RAVI 2024071 9999999 B 10 1619735164 0 414 PLAZA DR STE 301 WESTMONT IL 605595508 20 1619735164 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Physicians Healthy Kids Services 20 1619737558 0 Physicians Optical Supplies 20 1619737558 0 Physicians Physician Services 00 1619737756 0 INCE MARY A 2024109 9999999 B 10 1619737756 0 PO BOX 535 PRINCETON IL 613560535 20 1619737756 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1619739448 0 STUDER STEPHANIE 2024158 9999999 B 10 1619739448 0 29373 NETWORK PL CHICAGO IL 606733039 20 1619739448 0 Nurse Practitioners Healthy Kids Services 20 1619739448 0 Nurse Practitioners Nurse Practitioners Services 20 1619739448 0 Nurse Practitioners Physician Services 00 1619740529 0 HYLAND BILLI A 2024190 9999999 B 10 1619740529 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1619740529 0 Audiologists Audiology Services 20 1619740529 0 Audiologists Medical Supplies 20 1619740529 0 Audiologists Medical equipment/prosthetic devices 00 1619740925 0 ZACHARA IDALIA 2023355 9999999 B 10 1619740925 0 5875 E RIVERSIDE BLVD ROCKFORD IL 611144937 20 1619740925 0 Physician Assistant Only Fluoride varnish 20 1619740925 0 Physician Assistant Only Healthy Kids Services 20 1619740925 0 Physician Assistant Only Physician Services 00 1619741790 0 YOUNG MEGAN 2023334 9999999 B 10 1619741790 0 3051 HOLLIS DR SPRINGFIELD IL 627047452 20 1619741790 0 Nurse Practitioners Healthy Kids Services 20 1619741790 0 Nurse Practitioners Nurse Practitioners Services 20 1619741790 0 Nurse Practitioners Physician Services 00 1619747219 0 OGUNSANWO BOLATITO O 2024122 9999999 B 10 1619747219 0 5777 DEPT CAROL STREAM IL 601228942 20 1619747219 0 Nurse Practitioners Healthy Kids Services 20 1619747219 0 Nurse Practitioners Nurse Practitioners Services 20 1619747219 0 Nurse Practitioners Physician Services 00 1619750106 0 JOHNSON STEPHANIE 2024210 9999999 B 10 1619750106 0 PO BOX 3990 NAPERVILLE IL 605673990 20 1619750106 0 Speech Therapists Medical Supplies 20 1619750106 0 Speech Therapists Medical equipment/prosthetic devices 20 1619750106 0 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Physicians Fluoride varnish 20 1619908191 0 Physicians Healthy Kids Services 20 1619908191 0 Physicians Optical Supplies 20 1619908191 0 Physicians Physician Services 00 1619908662 0 HENRICHS CHRISTINE E 2004215 9999999 B 10 1619908662 0 611 W PARK ST URBANA IL 618012529 20 1619908662 0 Physicians Anesthesia Services 20 1619908662 0 Physicians Fluoride varnish 20 1619908662 0 Physicians Healthy Kids Services 20 1619908662 0 Physicians Optical Supplies 20 1619908662 0 Physicians Physician Services 00 1619910635 0 ROYCE JEFFREY S 1988183 9999999 B 10 1619910635 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1619910635 0 Physicians Anesthesia Services 20 1619910635 0 Physicians Fluoride varnish 20 1619910635 0 Physicians Healthy Kids Services 20 1619910635 0 Physicians Optical Supplies 20 1619910635 0 Physicians Physician Services 00 1619911211 0 SAMBARE DATTATREYA 1997335 9999999 B 10 1619911211 0 730 S WEBER RD BOLINGBROOK IL 604905472 20 1619911211 0 Physicians Anesthesia Services 20 1619911211 0 Physicians Fluoride varnish 20 1619911211 0 Physicians Healthy Kids Services 20 1619911211 0 Physicians Optical Supplies 20 1619911211 0 Physicians Physician Services 00 1619912664 0 PATEL ANUP D 2008209 9999999 B 10 1619912664 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1619912664 0 Physicians Anesthesia Services 20 1619912664 0 Physicians Healthy Kids Services 20 1619912664 0 Physicians Optical Supplies 20 1619912664 0 Physicians Physician Services 20 1619912664 0 Physicians Physicians Psychiatric Services 00 1619912979 0 COPLEY PATRICIA D 2016214 9999999 B 10 1619912979 0 14050 NW 14TH ST STE 190 SUNRISE FL 333232851 20 1619912979 0 Physicians Anesthesia Services 20 1619912979 0 Physicians Fluoride varnish 20 1619912979 0 Physicians Healthy Kids Services 20 1619912979 0 Physicians Optical Supplies 20 1619912979 0 Physicians Physician Services 00 1619913001 0 ELKINS DEVONNE A 2006182 9999999 B 10 1619913001 0 PO BOX 778912 CHICAGO IL 606778912 20 1619913001 0 Physicians Anesthesia Services 20 1619913001 0 Physicians Fluoride varnish 20 1619913001 0 Physicians Healthy Kids Services 20 1619913001 0 Physicians Optical Supplies 20 1619913001 0 Physicians Physician Services 00 1619913639 0 CHATTERJEE ANISH 2000183 9999999 B 10 1619913639 0 PO BOX 776473 CHICAGO IL 606776473 20 1619913639 0 Physicians Anesthesia Services 20 1619913639 0 Physicians Healthy Kids Services 20 1619913639 0 Physicians Optical Supplies 20 1619913639 0 Physicians Physician Services 00 1619913761 0 EVANS WILLIAM 2023020 9999999 B 10 1619913761 0 2101 HIGHWAY 90 GAUTIER MS 395535340 20 1619913761 0 Physicians Anesthesia Services 20 1619913761 0 Physicians Healthy Kids Services 20 1619913761 0 Physicians Optical Supplies 20 1619913761 0 Physicians Physician Services 20 1619913761 0 Physicians Physicians Psychiatric Services 00 1619913811 0 REHM JENNIFER L 2012183 9999999 B 10 1619913811 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1619913811 0 Physicians Anesthesia Services 20 1619913811 0 Physicians Fluoride varnish 20 1619913811 0 Physicians Healthy Kids Services 20 1619913811 0 Physicians Optical Supplies 20 1619913811 0 Physicians Physician Services 00 1619914264 0 DEBOER SHARILYNN R 2020167 9999999 B 10 1619914264 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1619914264 0 Physical Therapists Medical Supplies 20 1619914264 0 Physical Therapists Medical equipment/prosthetic devices 20 1619914264 0 Physical Therapists Physical Therapy Services 00 1619914496 0 NAZIR SAIF A 1988165 9999999 B 10 1619914496 0 PO BOX 38096 PHILADELPHIA PA 191011547 20 1619914496 0 Physicians Anesthesia Services 20 1619914496 0 Physicians Healthy Kids Services 20 1619914496 0 Physicians Optical Supplies 20 1619914496 0 Physicians Physician Services 00 1619914884 0 SEALS HEIDI E 2017319 9999999 B 10 1619914884 0 515 22ND AVE MONROE WI 535661569 20 1619914884 0 Other behavior health professional LCPC/LMFT services 00 1619915105 0 MINTCHELL PAULA 2001182 9999999 B 10 1619915105 0 1995 SPRINGBROOK SQUARE DR STE NAPERVILLE IL 605645952 20 1619915105 0 Optometrists Optical Supplies 20 1619915105 0 Optometrists Optometric Services 20 1619915105 0 Optometrists Physician Services 00 1619915147 0 PASHA AZEEM S 2002121 9999999 B 10 1619915147 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1619915147 0 Physicians Anesthesia Services 20 1619915147 0 Physicians Healthy Kids Services 20 1619915147 0 Physicians Optical Supplies 20 1619915147 0 Physicians Physician Services 00 1619915246 0 DHARNIDHARKA VIKAS R 2012183 9999999 B 10 1619915246 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1619915246 0 Physicians Anesthesia Services 20 1619915246 0 Physicians Fluoride varnish 20 1619915246 0 Physicians Healthy Kids Services 20 1619915246 0 Physicians Optical Supplies 20 1619915246 0 Physicians Physician Services 00 1619915295 0 DSOUZA GODWIN HERMAN 1996183 9999999 B 10 1619915295 0 5600 W ADDISON ST LOWR 1LL CHICAGO IL 606344444 20 1619915295 0 Physicians Anesthesia Services 20 1619915295 0 Physicians Fluoride varnish 20 1619915295 0 Physicians Healthy Kids Services 20 1619915295 0 Physicians Optical Supplies 20 1619915295 0 Physicians Physician Services 00 1619915337 0 KHAN NEELOFAR 2022336 9999999 B 10 1619915337 0 4 FOSTER PLZ PITTSBURGH PA 152202749 20 1619915337 0 Physicians Anesthesia Services 20 1619915337 0 Physicians Healthy Kids Services 20 1619915337 0 Physicians Optical Supplies 20 1619915337 0 Physicians Physician Services 20 1619915337 0 Physicians Physicians Psychiatric Services 00 1619915873 0 LYNCH MICHAEL J 1982187 9999999 B 10 1619915873 0 5777 DEPT CAROL STREAM IL 601228942 20 1619915873 0 Physicians Anesthesia Services 20 1619915873 0 Physicians Fluoride varnish 20 1619915873 0 Physicians Healthy Kids Services 20 1619915873 0 Physicians Optical Supplies 20 1619915873 0 Physicians Physician Services 00 1619917101 0 GARCIA-FERRER EDUARDO 1991003 9999999 B 10 1619917101 0 500 PORTER AVE AURORA MO 656052365 20 1619917101 0 Physicians Anesthesia Services 20 1619917101 0 Physicians Healthy Kids Services 20 1619917101 0 Physicians Optical Supplies 20 1619917101 0 Physicians Physician Services 20 1619917101 0 Physicians Physicians Psychiatric Services 00 1619917523 0 AHMED KHURSHEED 1992350 9999999 B 10 1619917523 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1619917523 0 Physicians Anesthesia Services 20 1619917523 0 Physicians Fluoride varnish 20 1619917523 0 Physicians Healthy Kids Services 20 1619917523 0 Physicians Optical Supplies 20 1619917523 0 Physicians Physician Services 00 1619917713 0 KHAN KALEEM 1999193 9999999 B 10 1619917713 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1619917713 0 Physicians Anesthesia Services 20 1619917713 0 Physicians Fluoride varnish 20 1619917713 0 Physicians Healthy Kids Services 20 1619917713 0 Physicians Optical Supplies 20 1619917713 0 Physicians Physician Services 00 1619917812 0 KAUFMAN CATHERINE 2010152 9999999 B 10 1619917812 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1619917812 0 Nurse Practitioners Fluoride varnish 20 1619917812 0 Nurse Practitioners Healthy Kids Services 20 1619917812 0 Nurse Practitioners Nurse Practitioners Services 20 1619917812 0 Nurse Practitioners Physician Services 00 1619919164 0 HARATAU IOANA C 2011213 9999999 B 10 1619919164 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1619919164 0 Physicians Anesthesia Services 20 1619919164 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1619919164 0 Physicians Fluoride varnish 20 1619919164 0 Physicians Healthy Kids Services 20 1619919164 0 Physicians Optical Supplies 20 1619919164 0 Physicians Physician Services 00 1619919537 0 LOW WANG CECILIA C 2017062 9999999 B 10 1619919537 0 PO BOX 110429 AURORA CO 800420429 20 1619919537 0 Physicians Anesthesia Services 20 1619919537 0 Physicians Fluoride varnish 20 1619919537 0 Physicians Healthy Kids Services 20 1619919537 0 Physicians Optical Supplies 20 1619919537 0 Physicians Physician Services 00 1619919735 0 D'AGOSTINO JOSEPH C 2024323 9999999 B 10 1619919735 0 PO BOX 776084 CHICAGO IL 606776084 20 1619919735 0 Physicians Anesthesia Services 20 1619919735 0 Physicians Healthy Kids Services 20 1619919735 0 Physicians Optical Supplies 20 1619919735 0 Physicians Physician Services 00 1619919750 0 JAIN SANJAY R 2025049 9999999 B 10 1619919750 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1619919750 0 Physicians Anesthesia Services 20 1619919750 0 Physicians Fluoride varnish 20 1619919750 0 Physicians Healthy Kids Services 20 1619919750 0 Physicians Optical Supplies 20 1619919750 0 Physicians Physician Services 00 1619920618 0 YERRAPRAGADA RAJASHEKAR 2003274 9999999 B 10 1619920618 0 4225 LINCOLNSHIRE DR STE B MOUNT VERNON IL 628642157 20 1619920618 0 Physicians Anesthesia Services 20 1619920618 0 Physicians Healthy Kids Services 20 1619920618 0 Physicians Optical Supplies 20 1619920618 0 Physicians Physician Services 00 1619920634 0 BDEIR RABEI 2023088 9999999 B 10 1619920634 0 32743 23 MILE RD STE 210 CHESTERFIELD MI 480472176 20 1619920634 0 Physicians Anesthesia Services 20 1619920634 0 Physicians Healthy Kids Services 20 1619920634 0 Physicians Optical Supplies 20 1619920634 0 Physicians Physician Services 00 1619921228 0 BATTS MARK 2001060 9999999 B 10 1619921228 0 801 S WASHINGTON ST NAPERVILLE IL 605407430 20 1619921228 0 Physicians Anesthesia Services 20 1619921228 0 Physicians Healthy Kids Services 20 1619921228 0 Physicians Optical Supplies 20 1619921228 0 Physicians Physician Services 00 1619921541 0 BURFORD FOGGS ADRIENNE 1987182 9999999 B 10 1619921541 0 207 E OHIO ST # 172 CHICAGO IL 606114092 20 1619921541 0 Physicians Anesthesia Services 20 1619921541 0 Physicians Fluoride varnish 20 1619921541 0 Physicians Healthy Kids Services 20 1619921541 0 Physicians Optical Supplies 20 1619921541 0 Physicians Physician Services 00 1619921574 0 WEISMAN STUART M 2025045 9999999 B 10 1619921574 0 3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047452 20 1619921574 0 Physicians Anesthesia Services 20 1619921574 0 Physicians Fluoride varnish 20 1619921574 0 Physicians Healthy Kids Services 20 1619921574 0 Physicians Optical Supplies 20 1619921574 0 Physicians Physician Services 00 1619921806 0 AKRAM MOHAMMED SAMI 2017081 9999999 B 10 1619921806 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1619921806 0 Physicians Anesthesia Services 20 1619921806 0 Physicians Fluoride varnish 20 1619921806 0 Physicians Healthy Kids Services 20 1619921806 0 Physicians Optical Supplies 20 1619921806 0 Physicians Physician Services 00 1619922135 0 PODOLSKIY ALEKSANDR 2004252 9999999 B 10 1619922135 0 PO BOX 5979 BUFFALO GROVE IL 600895979 20 1619922135 0 Physicians Anesthesia Services 20 1619922135 0 Physicians Fluoride varnish 20 1619922135 0 Physicians Healthy Kids Services 20 1619922135 0 Physicians Optical Supplies 20 1619922135 0 Physicians Physician Services 00 1619922325 0 SNYDER SUZANNE 2012097 9999999 B 10 1619922325 0 600 W FULTON ST STE 200 CHICAGO 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0 Physicians Healthy Kids Services 20 1629085022 0 Physicians Optical Supplies 20 1629085022 0 Physicians Physician Services 00 1629085071 0 KOENIGSBERG LISA A 1994244 9999999 B 10 1629085071 0 3537 N RETA AVE APT 1 UNIT 1 CHICAGO IL 606579252 20 1629085071 0 Speech Therapists Medical Supplies 20 1629085071 0 Speech Therapists Medical equipment/prosthetic devices 20 1629085071 0 Speech Therapists Speech Therapy/Pathology Services 00 1629085089 0 IRWIN GEORGE S 1983097 9999999 B 10 1629085089 0 2406 E EMPIRE ST BLOOMINGTON IL 617043630 20 1629085089 0 Physicians Anesthesia Services 20 1629085089 0 Physicians Healthy Kids Services 20 1629085089 0 Physicians Optical Supplies 20 1629085089 0 Physicians Physician Services 00 1629085212 0 NUGENT CLAUDIA 1989153 9999999 B 10 1629085212 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1629085212 0 Physicians Anesthesia Services 20 1629085212 0 Physicians Fluoride varnish 20 1629085212 0 Physicians Healthy Kids Services 20 1629085212 0 Physicians Optical Supplies 20 1629085212 0 Physicians Physician Services 00 1629085444 0 CHORZEMPA-SCHAINIS LISA 1997305 9999999 B 10 1629085444 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1629085444 0 Physicians Anesthesia Services 20 1629085444 0 Physicians Healthy Kids Services 20 1629085444 0 Physicians Optical Supplies 20 1629085444 0 Physicians Physician Services 00 1629085816 0 RAIKER SMITA K 2020181 9999999 B 10 1629085816 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1629085816 0 Physicians Anesthesia Services 20 1629085816 0 Physicians Fluoride varnish 20 1629085816 0 Physicians Healthy Kids Services 20 1629085816 0 Physicians Optical Supplies 20 1629085816 0 Physicians Physician Services 00 1629085857 0 MARTINEZ FIDEL 1998274 9999999 B 10 1629085857 0 PO BOX 781076 DETROIT MI 482781076 20 1629085857 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1629085915 0 NELSON KAREN R 2003307 9999999 B 10 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Physicians Optical Supplies 20 1629193750 0 Physicians Physician Services 00 1629194089 0 WILLIAMS LASHUNDA JEAN 2014307 9999999 B 10 1629194089 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1629194089 0 Physicians Anesthesia Services 20 1629194089 0 Physicians Fluoride varnish 20 1629194089 0 Physicians Healthy Kids Services 20 1629194089 0 Physicians Optical Supplies 20 1629194089 0 Physicians Physician Services 00 1629194543 0 HASHMI NASHIB 2004183 9999999 B 10 1629194543 0 375 N WALL ST STE P610 KANKAKEE IL 609013494 20 1629194543 0 Physicians Anesthesia Services 20 1629194543 0 Physicians Fluoride varnish 20 1629194543 0 Physicians Healthy Kids Services 20 1629194543 0 Physicians Optical Supplies 20 1629194543 0 Physicians Physician Services 00 1629195581 0 STUART JULIE E 2019324 9999999 B 10 1629195581 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1629195581 0 Physicians Anesthesia Services 20 1629195581 0 Physicians Fluoride varnish 20 1629195581 0 Physicians Healthy Kids 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Supplies 20 1629199419 0 Physicians Physician Services 00 1629200688 0 GRIFFIN TERRY 2010121 9999999 B 10 1629200688 0 PO BOX 5588 BELFAST ME 049155500 20 1629200688 0 Nurse Practitioners Healthy Kids Services 20 1629200688 0 Nurse Practitioners Nurse Practitioners Services 20 1629200688 0 Nurse Practitioners Physician Services 00 1629200753 0 NULLMEYER CATHERINE B 2012245 9999999 B 10 1629200753 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1629200753 0 Physicians Anesthesia Services 20 1629200753 0 Physicians Fluoride varnish 20 1629200753 0 Physicians Healthy Kids Services 20 1629200753 0 Physicians Optical Supplies 20 1629200753 0 Physicians Physician Services 00 1629201512 0 CAMACHO DAGOBERTO 2012177 9999999 B 10 1629201512 0 1044 N FRANCISCO AVE CHICAGO IL 606222743 20 1629201512 0 Physicians Anesthesia Services 20 1629201512 0 Physicians Fluoride varnish 20 1629201512 0 Physicians Healthy Kids Services 20 1629201512 0 Physicians Optical Supplies 20 1629201512 0 Physicians Physician Services 00 1629202114 0 WINTER LISA C 2016109 9999999 B 10 1629202114 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1629202114 0 Nurse Practitioners Healthy Kids Services 20 1629202114 0 Nurse Practitioners Nurse Practitioners Services 20 1629202114 0 Nurse Practitioners Physician Services 00 1629202270 0 FATHIAN ASAL 2018218 9999999 B 10 1629202270 0 621 S NEW BALLAS RD STE 2007B SAINT LOUIS MO 631418265 20 1629202270 0 Physicians Anesthesia Services 20 1629202270 0 Physicians Healthy Kids Services 20 1629202270 0 Physicians Optical Supplies 20 1629202270 0 Physicians Physician Services 00 1629203328 0 VANHAERENTS STEPHEN A 2014227 9999999 B 10 1629203328 0 2875 W 19TH ST CHICAGO IL 606233501 20 1629203328 0 Physicians Anesthesia Services 20 1629203328 0 Physicians Healthy Kids Services 20 1629203328 0 Physicians Optical Supplies 20 1629203328 0 Physicians Physician Services 20 1629203328 0 Physicians Physicians Psychiatric Services 00 1629203708 0 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1629206164 0 Physicians Optical Supplies 20 1629206164 0 Physicians Physician Services 00 1629206511 0 JORGE JUAQUITO M 2018270 9999999 B 10 1629206511 0 1950 N HARLEM AVE ELMWOOD PARK IL 607073717 20 1629206511 0 Physicians Anesthesia Services 20 1629206511 0 Physicians Healthy Kids Services 20 1629206511 0 Physicians Optical Supplies 20 1629206511 0 Physicians Physician Services 00 1629206628 0 MANASTERSKY NATALKA 2009182 9999999 B 10 1629206628 0 1700 E WEST RD CALUMET CITY IL 604095415 20 1629206628 0 Optometrists Optical Supplies 20 1629206628 0 Optometrists Optometric Services 20 1629206628 0 Optometrists Physician Services 00 1629206644 0 JANSEN ELIZABETH A 2014321 9999999 B 10 1629206644 0 PO BOX 486 LAKE FOREST IL 600450486 20 1629206644 0 Physicians Anesthesia Services 20 1629206644 0 Physicians Healthy Kids Services 20 1629206644 0 Physicians Optical Supplies 20 1629206644 0 Physicians Physician Services 00 1629206891 0 LAGOUROS EVAN 2014251 9999999 B 10 1629206891 0 8921 N WOOD SAGE RD PEORIA IL 616157822 20 1629206891 0 Physicians Anesthesia Services 20 1629206891 0 Physicians Healthy Kids Services 20 1629206891 0 Physicians Optical Supplies 20 1629206891 0 Physicians Physician Services 00 1629207253 0 TUCKER MATTHEW A 2015213 9999999 B 10 1629207253 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1629207253 0 Physicians Anesthesia Services 20 1629207253 0 Physicians Fluoride varnish 20 1629207253 0 Physicians Healthy Kids Services 20 1629207253 0 Physicians Optical Supplies 20 1629207253 0 Physicians Physician Services 00 1629207477 0 ABO-SALEM ELSAYED 2016214 9999999 B 10 1629207477 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1629207477 0 Physicians Anesthesia Services 20 1629207477 0 Physicians Fluoride varnish 20 1629207477 0 Physicians Healthy Kids Services 20 1629207477 0 Physicians Optical Supplies 20 1629207477 0 Physicians Physician Services 00 1629207519 0 WOODS ROBERT J 2020356 9999999 B 10 1629207519 0 3621 S STATE ST ANN ARBOR MI 481081633 20 1629207519 0 Physicians Anesthesia Services 20 1629207519 0 Physicians Fluoride varnish 20 1629207519 0 Physicians Healthy Kids Services 20 1629207519 0 Physicians Optical Supplies 20 1629207519 0 Physicians Physician Services 00 1629207840 0 MCMURRAY DIRK 2023120 9999999 B 10 1629207840 0 PO BOX 962 BRANSON MO 656150962 20 1629207840 0 Physicians Anesthesia Services 20 1629207840 0 Physicians Healthy Kids Services 20 1629207840 0 Physicians Optical Supplies 20 1629207840 0 Physicians Physician Services 00 1629208483 0 BRADFORD ANJU 2012235 9999999 B 10 1629208483 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1629208483 0 Physicians Anesthesia Services 20 1629208483 0 Physicians Fluoride varnish 20 1629208483 0 Physicians Healthy Kids Services 20 1629208483 0 Physicians Optical Supplies 20 1629208483 0 Physicians Physician Services 00 1629208822 0 WEILAND KATHRYN 2019177 9999999 H 10 1629208822 0 306 N KENSINGTON AVE LA GRANGE PARK IL 605261870 20 1629208822 0 Other behavior health 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20 1629211776 0 Physicians Physician Services 00 1629211875 0 CHEN STUART 2015231 9999999 B 10 1629211875 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1629211875 0 Physicians Anesthesia Services 20 1629211875 0 Physicians Fluoride varnish 20 1629211875 0 Physicians Healthy Kids Services 20 1629211875 0 Physicians Optical Supplies 20 1629211875 0 Physicians Physician Services 00 1629212725 0 WIGGINS ANDREW C 2017058 9999999 B 10 1629212725 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1629212725 0 Physicians Anesthesia Services 20 1629212725 0 Physicians Healthy Kids Services 20 1629212725 0 Physicians Optical Supplies 20 1629212725 0 Physicians Physician Services 00 1629212782 0 SHAH UMANG 2016306 9999999 B 10 1629212782 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1629212782 0 Physicians Anesthesia Services 20 1629212782 0 Physicians Healthy Kids Services 20 1629212782 0 Physicians Optical Supplies 20 1629212782 0 Physicians Physician Services 20 1629212782 0 Physicians Physicians Psychiatric Services 00 1629213210 0 MEYER JACOB 2014237 9999999 B 10 1629213210 0 2875 W 19TH ST CHICAGO IL 606233501 20 1629213210 0 Physicians All Kids application agent 20 1629213210 0 Physicians Anesthesia Services 20 1629213210 0 Physicians Family Planning Counseling 20 1629213210 0 Physicians Healthy Kids Services 20 1629213210 0 Physicians Optical Supplies 20 1629213210 0 Physicians Physician Services 00 1629213509 0 DEVINE TERI A 2016130 9999999 B 10 1629213509 0 PO BOX 4028 ROCK ISLAND IL 612044028 20 1629213509 0 Nurse Practitioners Healthy Kids Services 20 1629213509 0 Nurse Practitioners Nurse Practitioners Services 20 1629213509 0 Nurse Practitioners Physician Services 00 1629213624 0 LONGTIN KARRIANN 2011259 9999999 B 10 1629213624 0 400 S KENNEDY DR STE 900 BRADLEY IL 609152683 20 1629213624 0 Nurse Practitioners Fluoride varnish 20 1629213624 0 Nurse Practitioners Healthy Kids Services 20 1629213624 0 Nurse Practitioners Nurse Practitioners Services 20 1629213624 0 Nurse Practitioners Physician Services 00 1629213871 0 WINTER ZIER MONICA 2022126 9999999 B 10 1629213871 0 5121 MARYLAND WAY STE 300 BRENTWOOD TN 370277516 20 1629213871 0 Physician Assistant Only Fluoride varnish 20 1629213871 0 Physician Assistant Only Healthy Kids Services 20 1629213871 0 Physician Assistant Only Physician Services 00 1629215322 0 SALADAR TRACY 2009035 9999999 B 10 1629215322 0 74 ECLIPSE CTR BELOIT WI 535113550 20 1629215322 0 Nurse Practitioners Fluoride varnish 20 1629215322 0 Nurse Practitioners Healthy Kids Services 20 1629215322 0 Nurse Practitioners Nurse Practitioners Services 20 1629215322 0 Nurse Practitioners Physician Services 00 1629216627 0 MIRAVALLE AUGUSTO 2023209 9999999 B 10 1629216627 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1629216627 0 Physicians Anesthesia Services 20 1629216627 0 Physicians Healthy Kids Services 20 1629216627 0 Physicians Optical Supplies 20 1629216627 0 Physicians Physician Services 20 1629216627 0 Physicians Physicians Psychiatric Services 00 1629217153 0 MORETTA-VASQUEZ MIGDIEL 2012275 9999999 B 10 1629217153 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1629217153 0 Nurse Practitioners Anesthesia Services 20 1629217153 0 Nurse Practitioners Nurse Practitioners Services 20 1629217153 0 Nurse Practitioners Physician Services 00 1629218235 0 RIVERA ANGEL 2016280 9999999 B 10 1629218235 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1629218235 0 Physicians Anesthesia Services 20 1629218235 0 Physicians Fluoride varnish 20 1629218235 0 Physicians Healthy Kids Services 20 1629218235 0 Physicians Optical Supplies 20 1629218235 0 Physicians Physician Services 00 1629222054 0 DECUBELLIS MIKE 2017276 9999999 B 10 1629222054 0 5157 MAIN ST STE 200 DOWNERS GROVE IL 605154862 20 1629222054 0 Chiropractors Chiropractic Services 00 1629222450 0 MALEC LYNN 2019052 9999999 B 10 1629222450 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1629222450 0 Physicians Anesthesia Services 20 1629222450 0 Physicians Fluoride varnish 20 1629222450 0 Physicians Healthy Kids Services 20 1629222450 0 Physicians Optical Supplies 20 1629222450 0 Physicians Physician Services 00 1629222971 0 SINGH RAVNEET 2010274 9999999 B 10 1629222971 0 2001 S CALIFORNIA AVE CHICAGO IL 606082486 20 1629222971 0 Dentists Dental Services 20 1629222971 0 Dentists Physician Services 00 1629223318 0 STREETER MICHAEL A 2010201 9999999 B 10 1629223318 0 PO BOX 96208 OKLAHOMA CITY OK 731436208 20 1629223318 0 Physicians Anesthesia Services 20 1629223318 0 Physicians Healthy Kids Services 20 1629223318 0 Physicians Optical Supplies 20 1629223318 0 Physicians Physician Services 00 1629224399 0 LAFEVER MARGARET 2011221 9999999 B 10 1629224399 0 325 IL RT 2 DIXON IL 610219118 20 1629224399 0 Clinical Social Worker Social work service 00 1629224399 0 LAFEVER MARGARET 2023345 9999999 B 10 1629224399 0 325 IL ROUTE 2 DIXON IL 610219118 20 1629224399 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1629224399 0 Other behavior health professional Social work service 00 1629226998 0 WILLBEE ROBERT 2022361 9999999 B 10 1629226998 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1629226998 0 Psychologist Psychologist service 00 1629228713 0 SAWARDEKAR UMAYAL 2011244 9999999 B 10 1629228713 0 645 S CENTRAL AVE CHICAGO IL 606445059 20 1629228713 0 Physicians Anesthesia Services 20 1629228713 0 Physicians Healthy Kids Services 20 1629228713 0 Physicians Optical Supplies 20 1629228713 0 Physicians Physician Services 00 1629229794 0 LOSCHEN REBECCA 2017001 9999999 B 10 1629229794 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1629229794 0 Clinical Social Worker Social work service 00 1629229836 0 SIDELL DOUGLAS R 2021177 9999999 B 10 1629229836 0 500 PASTEUR DR PALO ALTO CA 943041048 20 1629229836 0 Physicians Anesthesia Services 20 1629229836 0 Physicians Healthy Kids Services 20 1629229836 0 Physicians Optical Supplies 20 1629229836 0 Physicians Physician Services 00 1629230628 0 PITTMAN AMY 2013238 9999999 B 10 1629230628 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1629230628 0 Physicians Anesthesia Services 20 1629230628 0 Physicians Healthy Kids Services 20 1629230628 0 Physicians Optical Supplies 20 1629230628 0 Physicians Physician Services 00 1629230768 0 LUCKEY JOHN 2009213 9999999 B 10 1629230768 0 101 E MILLER RD STERLING IL 610811252 20 1629230768 0 Physicians Anesthesia Services 20 1629230768 0 Physicians Fluoride varnish 20 1629230768 0 Physicians Healthy Kids Services 20 1629230768 0 Physicians Optical Supplies 20 1629230768 0 Physicians Physician Services 00 1629230834 0 LIBERMAN COLIN W 2009194 9999999 B 10 1629230834 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1629230834 0 Physicians Anesthesia Services 20 1629230834 0 Physicians Healthy Kids Services 20 1629230834 0 Physicians Optical Supplies 20 1629230834 0 Physicians Physician Services 00 1629231139 0 RAUCH VASILIKE 2013058 9999999 B 10 1629231139 0 1000 REMINGTON BLVD STE 200 BOLINGBROOK IL 604405125 20 1629231139 0 Audiologists Audiology Services 20 1629231139 0 Audiologists Medical Supplies 20 1629231139 0 Audiologists Medical equipment/prosthetic devices 00 1629231212 0 GERHART CALEB C 2024019 9999999 B 10 1629231212 0 PO BOX 32861 CHARLOTTE NC 282322861 20 1629231212 0 Physicians Anesthesia Services 20 1629231212 0 Physicians Healthy Kids Services 20 1629231212 0 Physicians Optical Supplies 20 1629231212 0 Physicians Physician Services 00 1629232087 0 DELACRUZ MICHAEL 2017257 9999999 B 10 1629232087 0 1201 RICKER RD SALEM IL 628814263 20 1629232087 0 Physicians Anesthesia Services 20 1629232087 0 Physicians Fluoride varnish 20 1629232087 0 Physicians Healthy Kids Services 20 1629232087 0 Physicians Optical Supplies 20 1629232087 0 Physicians Physician Services 00 1629232491 0 DEETZ CARL 2016109 9999999 B 10 1629232491 0 PO BOX 144333 ORLANDO FL 328144333 20 1629232491 0 Physicians Anesthesia Services 20 1629232491 0 Physicians Healthy Kids Services 20 1629232491 0 Physicians Optical Supplies 20 1629232491 0 Physicians Physician Services 00 1629232699 0 SINGH STEVEN T 2013274 9999999 B 10 1629232699 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1629232699 0 Physicians Anesthesia Services 20 1629232699 0 Physicians Healthy Kids Services 20 1629232699 0 Physicians Optical Supplies 20 1629232699 0 Physicians Physician Services 00 1629232780 0 MAZALEWSKI ASHLEY E 2020253 9999999 B 10 1629232780 0 PO BOX 500 ELLICOTTVILLE NY 147310500 20 1629232780 0 Physician Assistant Only Fluoride varnish 20 1629232780 0 Physician Assistant Only Healthy Kids Services 20 1629232780 0 Physician Assistant Only Physician Services 00 1629233408 0 SUZUE KIMIKO 2008151 9999999 B 10 1629233408 0 28100 N ASHLEY CIR STE 106 LIBERTYVILLE IL 600489478 20 1629233408 0 Physicians Anesthesia Services 20 1629233408 0 Physicians Healthy Kids Services 20 1629233408 0 Physicians Optical Supplies 20 1629233408 0 Physicians Physician Services 00 1629233580 0 TSENG ERIC 2009169 9999999 B 10 1629233580 0 9928 S WESTERN AVE CHICAGO IL 606431831 20 1629233580 0 Optometrists Optical Supplies 20 1629233580 0 Optometrists Optometric Services 20 1629233580 0 Optometrists Physician Services 00 1629234240 0 GARDON STEPHANIE N 2013244 9999999 B 10 1629234240 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1629234240 0 Physicians Anesthesia Services 20 1629234240 0 Physicians Healthy Kids Services 20 1629234240 0 Physicians Optical Supplies 20 1629234240 0 Physicians Physician Services 20 1629234240 0 Physicians Physicians Psychiatric Services 00 1629234323 0 NIELSEN MICAH K 2021092 9999999 B 10 1629234323 0 5110 E CLINTON WAY FRESNO CA 937272040 20 1629234323 0 Physicians Anesthesia Services 20 1629234323 0 Physicians Healthy Kids Services 20 1629234323 0 Physicians Optical Supplies 20 1629234323 0 Physicians Physician Services 00 1629234851 0 VARGAS VINCENT 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1629236203 0 1000 HADDONFIELD BERLIN RD STE VOORHEES NJ 080433520 20 1629236203 0 Physicians Anesthesia Services 20 1629236203 0 Physicians Fluoride varnish 20 1629236203 0 Physicians Healthy Kids Services 20 1629236203 0 Physicians Optical Supplies 20 1629236203 0 Physicians Physician Services 00 1629236757 0 SANOW KRISTINE 2022002 9999999 B 10 1629236757 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1629236757 0 Physicians Anesthesia Services 20 1629236757 0 Physicians Healthy Kids Services 20 1629236757 0 Physicians Optical Supplies 20 1629236757 0 Physicians Physician Services 00 1629236815 0 PAIK CHARLES 2009213 9999999 B 10 1629236815 0 PO BOX 713388 CHICAGO IL 606771525 20 1629236815 0 Physicians Anesthesia Services 20 1629236815 0 Physicians Healthy Kids Services 20 1629236815 0 Physicians Optical Supplies 20 1629236815 0 Physicians Physician Services 00 1629237078 0 KHADILKAR NITIN A 2014223 9999999 B 10 1629237078 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1629237078 0 Physicians Anesthesia Services 20 1629237078 0 Physicians Healthy Kids Services 20 1629237078 0 Physicians Optical Supplies 20 1629237078 0 Physicians Physician Services 20 1629237078 0 Physicians Physicians Psychiatric Services 00 1629237227 0 ABOOD GERARD 2012214 9999999 B 10 1629237227 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1629237227 0 Physicians Anesthesia Services 20 1629237227 0 Physicians Healthy Kids Services 20 1629237227 0 Physicians Optical Supplies 20 1629237227 0 Physicians Physician Services 00 1629237326 0 KANG EVAN A 2008272 9999999 B 10 1629237326 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1629237326 0 Physicians Anesthesia Services 20 1629237326 0 Physicians Fluoride varnish 20 1629237326 0 Physicians Healthy Kids Services 20 1629237326 0 Physicians Optical Supplies 20 1629237326 0 Physicians Physician Services 00 1629237409 0 FERRARO DANIEL J 2015240 9999999 B 10 1629237409 0 1025 MAINE ST QUINCY IL 623014038 20 1629237409 0 Physicians Anesthesia Services 20 1629237409 0 Physicians Healthy Kids Services 20 1629237409 0 Physicians Optical Supplies 20 1629237409 0 Physicians Physician Services 00 1629238498 0 OYEDELE TEMITOPE O 2012183 9999999 B 10 1629238498 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1629238498 0 Physicians Anesthesia Services 20 1629238498 0 Physicians Fluoride varnish 20 1629238498 0 Physicians Healthy Kids Services 20 1629238498 0 Physicians Optical Supplies 20 1629238498 0 Physicians Physician Services 00 1629239082 0 FRIED EMILY 2021079 9999999 B 10 1629239082 0 777 LOWNDES HILL RD BLDG 1 GREENVILLE SC 296072101 20 1629239082 0 Physicians Anesthesia Services 20 1629239082 0 Physicians Healthy Kids Services 20 1629239082 0 Physicians Optical Supplies 20 1629239082 0 Physicians Physician Services 00 1629239314 0 LAWRENCE ASHLEY R 2020240 9999999 B 10 1629239314 0 545 BARNHILL DR # EH215 INDIANAPOLIS IN 462025112 20 1629239314 0 Nurse Practitioners Fluoride varnish 20 1629239314 0 Nurse Practitioners Healthy Kids Services 20 1629239314 0 Nurse Practitioners Nurse Practitioners Services 20 1629239314 0 Nurse Practitioners Physician Services 00 1629239629 0 CHASSON GREGORY S 2022244 9999999 B 10 1629239629 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1629239629 0 Psychologist Psychologist service 00 1629240007 0 ALAMAR SCOTT A 2018130 9999999 B 10 1629240007 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1629240007 0 Nurse Practitioners Fluoride varnish 20 1629240007 0 Nurse Practitioners Healthy Kids Services 20 1629240007 0 Nurse Practitioners Nurse Practitioners Services 20 1629240007 0 Nurse Practitioners Physician Services 00 1629240197 0 SHIFFMAN ROBERT 2024105 9999999 B 10 1629240197 0 1029 HOWARD ST EVANSTON IL 602023877 20 1629240197 0 Dentists Dental Services 20 1629240197 0 Dentists Physician Services 00 1629241849 0 BEE KRISTA 2008070 9999999 B 10 1629241849 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1629241849 0 Nurse Practitioners Anesthesia Services 20 1629241849 0 Nurse Practitioners Nurse Practitioners Services 20 1629241849 0 Nurse Practitioners Physician Services 00 1629242094 0 CZAJKOWSKA JADWIGA B 2012214 9999999 B 10 1629242094 0 800 BIESTERFIELD RD STE 4003 ELK GROVE VILLA IL 600073371 20 1629242094 0 Physicians Anesthesia Services 20 1629242094 0 Physicians Fluoride varnish 20 1629242094 0 Physicians Healthy Kids Services 20 1629242094 0 Physicians Optical Supplies 20 1629242094 0 Physicians Physician Services 00 1629242524 0 SUBIETA-BENITO GUNAR G 2008001 9999999 B 10 1629242524 0 2525 S MICHIGAN AVE CHICAGO IL 606162315 20 1629242524 0 Physicians Anesthesia Services 20 1629242524 0 Physicians Healthy Kids Services 20 1629242524 0 Physicians Optical Supplies 20 1629242524 0 Physicians Physician Services 00 1629243886 0 DAVIS-JACKSON JAMI 2009005 9999999 B 10 1629243886 0 2100 POWELL ST STE 900 EMERYVILLE CA 946081844 20 1629243886 0 Nurse Practitioners Healthy Kids Services 20 1629243886 0 Nurse Practitioners Nurse Practitioners Services 20 1629243886 0 Nurse Practitioners Physician Services 00 1629244322 0 UHRING GREEN JULIA E 2019346 9999999 B 10 1629244322 0 141 MARKET PL STE 100 FAIRVIEW HEIGHT IL 622082089 20 1629244322 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1629245048 0 PARDO JACQUELINE D 1993244 9999999 B 10 1629245048 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1629245048 0 Physicians Anesthesia Services 20 1629245048 0 Physicians Healthy Kids Services 20 1629245048 0 Physicians Optical Supplies 20 1629245048 0 Physicians Physician Services 20 1629245048 0 Physicians Physicians Psychiatric Services 00 1629245709 0 ANDREATTA BROCK 2011213 9999999 A 10 1629245709 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1629245709 0 Physicians Anesthesia Services 20 1629245709 0 Physicians Healthy Kids Services 20 1629245709 0 Physicians Optical Supplies 20 1629245709 0 Physicians Physician Services 00 1629247465 0 SHETTY ANISHA 2012240 9999999 B 10 1629247465 0 28594 NETWORK PL CHICAGO IL 606731285 20 1629247465 0 Physicians Anesthesia Services 20 1629247465 0 Physicians Fluoride varnish 20 1629247465 0 Physicians Healthy Kids Services 20 1629247465 0 Physicians Optical Supplies 20 1629247465 0 Physicians Physician Services 00 1629247572 0 AZAB EMAD E 1994213 9999999 B 10 1629247572 0 8441 W LAWRENCE AVE CHICAGO IL 606562953 20 1629247572 0 Dentists Dental Services 20 1629247572 0 Dentists Physician Services 00 1629247713 0 ERDELAC TAMMIE 2020311 9999999 B 10 1629247713 0 55 E 86TH AVE MERRILLVILLE IN 464106382 20 1629247713 0 Nurse Practitioners Fluoride varnish 20 1629247713 0 Nurse Practitioners Healthy Kids Services 20 1629247713 0 Nurse Practitioners Nurse Practitioners Services 20 1629247713 0 Nurse Practitioners Physician Services 00 1629248877 0 BOWERSOX SANDY A 2018098 9999999 B 10 1629248877 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1629248877 0 Psychologist Psychologist service 00 1629248992 0 KURSEL ELLEN 2023192 9999999 B 10 1629248992 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1629248992 0 Occupational Therapists Medical Supplies 20 1629248992 0 Occupational Therapists Medical equipment/prosthetic devices 20 1629248992 0 Occupational Therapists Occupational Therapy Services 00 1629249453 0 CASTILLO DANIEL J 2008183 9999999 B 10 1629249453 0 5777 DEPT CAROL STREAM IL 601220021 20 1629249453 0 Physicians Anesthesia Services 20 1629249453 0 Physicians Healthy Kids Services 20 1629249453 0 Physicians Optical Supplies 20 1629249453 0 Physicians Physician Services 00 1629249867 0 PILATI STAMATOULA 2018066 9999999 B 10 1629249867 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1629249867 0 Physicians Anesthesia Services 20 1629249867 0 Physicians Fluoride varnish 20 1629249867 0 Physicians Healthy Kids Services 20 1629249867 0 Physicians Optical Supplies 20 1629249867 0 Physicians Physician Services 00 1629250501 0 SHARABASH NOURA M 2008183 9999999 B 10 1629250501 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1629250501 0 Physicians Anesthesia Services 20 1629250501 0 Physicians Fluoride varnish 20 1629250501 0 Physicians Healthy Kids Services 20 1629250501 0 Physicians Optical Supplies 20 1629250501 0 Physicians Physician Services 00 1629251145 0 DALLMIER J MICHELE 2001001 9999999 B 10 1629251145 0 300 N MAPLE ST EFFINGHAM IL 624012003 20 1629251145 0 Nurse Practitioners Healthy Kids Services 20 1629251145 0 Nurse Practitioners Nurse Practitioners Services 20 1629251145 0 Nurse Practitioners Physician Services 00 1629252465 0 DAVIS ANTHONY K 2016173 9999999 B 10 1629252465 0 2605 KENTUCKY AVE STE 306 PADUCAH KY 420033802 20 1629252465 0 Physicians Anesthesia Services 20 1629252465 0 Physicians Healthy Kids Services 20 1629252465 0 Physicians Optical Supplies 20 1629252465 0 Physicians Physician Services 00 1629252754 0 PEDDINTI RADHIKA R 2011326 9999999 B 10 1629252754 0 2875 W 19TH ST CHICAGO IL 606233501 20 1629252754 0 Physicians Anesthesia Services 20 1629252754 0 Physicians Fluoride varnish 20 1629252754 0 Physicians Healthy Kids Services 20 1629252754 0 Physicians Optical Supplies 20 1629252754 0 Physicians Physician Services 00 1629254750 0 KILKELLY MICHAEL 2014274 9999999 B 10 1629254750 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1629254750 0 Physicians Anesthesia Services 20 1629254750 0 Physicians Healthy Kids Services 20 1629254750 0 Physicians Optical Supplies 20 1629254750 0 Physicians Physician Services 00 1629256391 0 BORGES MANUEL T 2012112 9999999 B 10 1629256391 0 PO BOX 110429 AURORA CO 800420429 20 1629256391 0 Physicians Anesthesia Services 20 1629256391 0 Physicians Healthy Kids Services 20 1629256391 0 Physicians Optical Supplies 20 1629256391 0 Physicians Physician Services 00 1629257514 0 GUANZON RICARDO A 2016314 9999999 B 10 1629257514 0 PO BOX 2010 FARGO ND 581222484 20 1629257514 0 Physicians Anesthesia Services 20 1629257514 0 Physicians Fluoride varnish 20 1629257514 0 Physicians Healthy Kids Services 20 1629257514 0 Physicians Optical Supplies 20 1629257514 0 Physicians Physician Services 00 1629259890 0 AZIZ SAAD 2008028 9999999 B 10 1629259890 0 1S280 SUMMIT AVE STE A1 OAKBROOK TERRAC IL 601813936 20 1629259890 0 Physicians Anesthesia Services 20 1629259890 0 Physicians Fluoride varnish 20 1629259890 0 Physicians Healthy Kids Services 20 1629259890 0 Physicians Optical Supplies 20 1629259890 0 Physicians Physician Services 00 1629260567 0 HASSAN BONNIE 2016099 9999999 B 10 1629260567 0 301 VETERANS PKWY NEW LENOX IL 604512899 20 1629260567 0 Other behavior health professional LCPC/LMFT services 00 1629260716 0 ANTLE LISA 2017186 9999999 B 10 1629260716 0 4215 NEWBURG RD ROCKFORD IL 611086479 20 1629260716 0 Nurse Practitioners Healthy Kids Services 20 1629260716 0 Nurse Practitioners Nurse Practitioners Services 20 1629260716 0 Nurse Practitioners Physician Services 00 1629260724 0 DIGLORIA DONNA 2016209 9999999 B 10 1629260724 0 3880 SALEM LAKE DR STE F STE F LONG GROVE IL 600475292 20 1629260724 0 Nurse Practitioners Healthy Kids Services 20 1629260724 0 Nurse Practitioners Nurse Practitioners Services 20 1629260724 0 Nurse Practitioners Physician Services 00 1629261391 0 SHELTON-ESPINOSA JACQUELINE M 2011123 9999999 B 10 1629261391 0 10001 GRAND AVE FRANKLIN PARK IL 601312563 20 1629261391 0 Clinical Social Worker Social work service 00 1629262738 0 MATEJA CANDICE 2021241 9999999 B 10 1629262738 0 1232 W STATE ROAD 2 LA PORTE IN 463505469 20 1629262738 0 Physicians Anesthesia Services 20 1629262738 0 Physicians Fluoride varnish 20 1629262738 0 Physicians Healthy Kids Services 20 1629262738 0 Physicians Optical Supplies 20 1629262738 0 Physicians Physician Services 00 1629263793 0 SCHREY DONITA S 2007254 9999999 B 10 1629263793 0 3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047452 20 1629263793 0 Nurse Practitioners Healthy Kids Services 20 1629263793 0 Nurse Practitioners Nurse Practitioners Services 20 1629263793 0 Nurse Practitioners Physician Services 00 1629263843 0 HARDMAN LORRAINE L 2017207 9999999 B 10 1629263843 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1629263843 0 Physical Therapists Medical Supplies 20 1629263843 0 Physical Therapists Medical equipment/prosthetic devices 20 1629263843 0 Physical Therapists Physical Therapy Services 00 1629266341 0 PURI MOHAMMAD 2016001 9999999 B 10 1629266341 0 35318 EAGLE WAY CHICAGO IL 606781353 20 1629266341 0 Physicians Anesthesia Services 20 1629266341 0 Physicians Fluoride varnish 20 1629266341 0 Physicians Healthy Kids Services 20 1629266341 0 Physicians Optical Supplies 20 1629266341 0 Physicians Physician Services 00 1629266770 0 BLATNIK JEFFREY A 2025086 9999999 B 10 1629266770 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1629266770 0 Physicians Anesthesia Services 20 1629266770 0 Physicians Healthy Kids Services 20 1629266770 0 Physicians Optical Supplies 20 1629266770 0 Physicians Physician Services 00 1629266945 0 MARQUEZ GABRIELA I 2007213 9999999 B 10 1629266945 0 416 S GROVE AVE OAK PARK IL 603023802 20 1629266945 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1629267612 0 JOHN RAHEL 2012275 9999999 B 10 1629267612 0 PO BOX 578 PARK RIDGE IL 600680578 20 1629267612 0 Physicians Anesthesia Services 20 1629267612 0 Physicians Healthy Kids Services 20 1629267612 0 Physicians Optical Supplies 20 1629267612 0 Physicians Physician Services 00 1629268412 0 LUCAS RACHEL L 2022189 9999999 B 10 1629268412 0 PO BOX 735041 CHICAGO IL 606735041 20 1629268412 0 Physicians Anesthesia Services 20 1629268412 0 Physicians Healthy Kids Services 20 1629268412 0 Physicians Optical Supplies 20 1629268412 0 Physicians Physician Services 00 1629268669 0 DIEMER LISA 2007221 9999999 B 10 1629268669 0 611 W PARK ST URBANA IL 618012529 20 1629268669 0 Nurse Practitioners Anesthesia Services 20 1629268669 0 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Physicians Physician Services 00 1629273131 0 HAMILTON EMILY L 2013182 9999999 B 10 1629273131 0 1300 SAWGRS CORP PKWY STE 200 SUNRISE FL 333232823 20 1629273131 0 Physicians Anesthesia Services 20 1629273131 0 Physicians Fluoride varnish 20 1629273131 0 Physicians Healthy Kids Services 20 1629273131 0 Physicians Optical Supplies 20 1629273131 0 Physicians Physician Services 00 1629273669 0 LUDWIG NICHOLAS S 2016083 9999999 B 10 1629273669 0 PO BOX 3272 INDIANAPOLIS IN 462063272 20 1629273669 0 Physicians Anesthesia Services 20 1629273669 0 Physicians Healthy Kids Services 20 1629273669 0 Physicians Optical Supplies 20 1629273669 0 Physicians Physician Services 00 1629274303 0 ABBOTT SUSAN 2021005 9999999 B 10 1629274303 0 PO BOX 790 THERMOPOLIS WY 824430790 20 1629274303 0 Physical Therapists Medical Supplies 20 1629274303 0 Physical Therapists Medical equipment/prosthetic devices 20 1629274303 0 Physical Therapists Physical Therapy Services 00 1629275623 0 MITTENTHAL SCOTT A 2011215 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1629402003 0 Physicians Fluoride varnish 20 1629402003 0 Physicians Healthy Kids Services 20 1629402003 0 Physicians Optical Supplies 20 1629402003 0 Physicians Physician Services 00 1629402300 0 ORANU OMOTAYO R 2013252 9999999 B 10 1629402300 0 5777 DEPT CAROL STREAM IL 601220021 20 1629402300 0 Nurse Practitioners Anesthesia Services 20 1629402300 0 Nurse Practitioners Nurse Practitioners Services 20 1629402300 0 Nurse Practitioners Physician Services 00 1629402482 0 HOFSTETTER CAMERON 2022277 9999999 B 10 1629402482 0 3825 N LAFAYETTE ST DENVER CO 802053316 20 1629402482 0 Nurse Practitioners Fluoride varnish 20 1629402482 0 Nurse Practitioners Healthy Kids Services 20 1629402482 0 Nurse Practitioners Nurse Practitioners Services 20 1629402482 0 Nurse Practitioners Physician Services 00 1629403019 0 NONNIE CHRISTOPHER 2021349 9999999 B 10 1629403019 0 9845 W ROOSEVELT RD WESTCHESTER IL 601542758 20 1629403019 0 Other behavior health professional LCPC/LMFT services 00 1629404298 0 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SANA 2019302 9999999 B 10 1629431747 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1629431747 0 Physicians Anesthesia Services 20 1629431747 0 Physicians Fluoride varnish 20 1629431747 0 Physicians Healthy Kids Services 20 1629431747 0 Physicians Optical Supplies 20 1629431747 0 Physicians Physician Services 00 1629432091 0 GROSS NICHOLAS 2019060 9999999 B 10 1629432091 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1629432091 0 Physicians Anesthesia Services 20 1629432091 0 Physicians Healthy Kids Services 20 1629432091 0 Physicians Optical Supplies 20 1629432091 0 Physicians Physician Services 00 1629432299 0 KARLOV DARA M 2016122 9999999 B 10 1629432299 0 2570 FOXFIELD RD STE 101 SAINT CHARLES IL 601741406 20 1629432299 0 Nurse Practitioners Fluoride varnish 20 1629432299 0 Nurse Practitioners Healthy Kids Services 20 1629432299 0 Nurse Practitioners Nurse Practitioners Services 20 1629432299 0 Nurse Practitioners Physician Services 00 1629432679 0 MOTINO ORESTES 2019182 9999999 B 10 1629432679 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1629432679 0 Physicians Anesthesia Services 20 1629432679 0 Physicians Healthy Kids Services 20 1629432679 0 Physicians Optical Supplies 20 1629432679 0 Physicians Physician Services 00 1629434741 0 OKAMGBA VICTOR C 2016032 9999999 B 10 1629434741 0 600 HOLIDAY PLAZA DR STE 200 MATTESON IL 604432237 20 1629434741 0 Nurse Practitioners Fluoride varnish 20 1629434741 0 Nurse Practitioners Healthy Kids Services 20 1629434741 0 Nurse Practitioners Nurse Practitioners Services 20 1629434741 0 Nurse Practitioners Physician Services 00 1629435102 0 GLON RAYMOND R 2016032 9999999 B 10 1629435102 0 29373 NETWORK PL CHICAGO IL 606733039 20 1629435102 0 Nurse Practitioners Fluoride varnish 20 1629435102 0 Nurse Practitioners Healthy Kids Services 20 1629435102 0 Nurse Practitioners Nurse Practitioners Services 20 1629435102 0 Nurse Practitioners Physician Services 00 1629435987 0 RAI ROOPLEEN 2016049 9999999 B 10 1629435987 0 2901 FINLEY 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2016208 9999999 B 10 1629452958 0 715 LAKE ST STE 800 OAK PARK IL 603011417 20 1629452958 0 Other behavior health professional LCPC/LMFT services 00 1629454087 0 ALI HASSAN 2024298 9999999 B 10 1629454087 0 PO BOX 1257 HANNIBAL MO 634011257 20 1629454087 0 Physicians Anesthesia Services 20 1629454087 0 Physicians Healthy Kids Services 20 1629454087 0 Physicians Optical Supplies 20 1629454087 0 Physicians Physician Services 00 1629454145 0 WALSH DAYLE 2016032 9999999 B 10 1629454145 0 250 W 96TH ST STE 520 INDIANAPOLIS IN 462601317 20 1629454145 0 Nurse Practitioners Fluoride varnish 20 1629454145 0 Nurse Practitioners Healthy Kids Services 20 1629454145 0 Nurse Practitioners Nurse Practitioners Services 20 1629454145 0 Nurse Practitioners Physician Services 00 1629454293 0 SCHIMP BRIANNA M 2018002 9999999 B 10 1629454293 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1629454293 0 Nurse Practitioners Healthy Kids Services 20 1629454293 0 Nurse Practitioners Nurse Practitioners Services 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RONAK V 2023187 9999999 B 10 1629509476 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1629509476 0 Physicians Anesthesia Services 20 1629509476 0 Physicians Fluoride varnish 20 1629509476 0 Physicians Healthy Kids Services 20 1629509476 0 Physicians Optical Supplies 20 1629509476 0 Physicians Physician Services 00 1629509963 0 KRAFT KATHRYN 2023168 9999999 B 10 1629509963 0 DEPT AT 40379 ATLANTA GA 311920001 20 1629509963 0 Physicians Anesthesia Services 20 1629509963 0 Physicians Healthy Kids Services 20 1629509963 0 Physicians Optical Supplies 20 1629509963 0 Physicians Physician Services 00 1629509997 0 GANDHI RHYTHM 2018024 9999999 B 10 1629509997 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1629509997 0 Physicians Anesthesia Services 20 1629509997 0 Physicians Fluoride varnish 20 1629509997 0 Physicians Healthy Kids Services 20 1629509997 0 Physicians Optical Supplies 20 1629509997 0 Physicians Physician Services 00 1629510532 0 MANNING SHANA A 2016312 9999999 B 10 1629510532 0 2906 HIGHWAY AVE HIGHLAND IN 463221631 20 1629510532 0 Physical Therapists Medical Supplies 20 1629510532 0 Physical Therapists Medical equipment/prosthetic devices 20 1629510532 0 Physical Therapists Physical Therapy Services 00 1629510581 0 THOMPSON HEIDI 2016343 9999999 B 10 1629510581 0 PO BOX 955860 SAINT LOUIS MO 631955860 20 1629510581 0 Nurse Practitioners Fluoride varnish 20 1629510581 0 Nurse Practitioners Healthy Kids Services 20 1629510581 0 Nurse Practitioners Nurse Practitioners Services 20 1629510581 0 Nurse Practitioners Physician Services 00 1629511019 0 VARGA KRISTINA 2016336 9999999 B 10 1629511019 0 201 E STRONG ST STE 4 WHEELING IL 600902979 20 1629511019 0 Dentists Dental Services 20 1629511019 0 Dentists Physician Services 00 1629511225 0 HERZOG BRITTNEY N 2021056 9999999 B 10 1629511225 0 PO BOX 3276 EVANSVILLE IN 477313276 20 1629511225 0 Nurse Practitioners Anesthesia Services 20 1629511225 0 Nurse Practitioners Nurse Practitioners Services 20 1629511225 0 Nurse Practitioners Physician Services 00 1629512850 0 REBOLLEDO CATHERINE AN 2017104 9999999 B 10 1629512850 0 17 N STATE ST STE 500 CHICAGO IL 606023384 20 1629512850 0 Nurse Practitioners Family Planning Counseling 20 1629512850 0 Nurse Practitioners Healthy Kids Services 20 1629512850 0 Nurse Practitioners Nurse Practitioners Services 20 1629512850 0 Nurse Practitioners Nursing service 20 1629512850 0 Nurse Practitioners Physician Services 20 1629512850 0 Nurse Practitioners Waiver service 00 1629513270 0 HELLING EMILY 2023274 9999999 B 10 1629513270 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1629513270 0 Physician Assistant Only Fluoride varnish 20 1629513270 0 Physician Assistant Only Healthy Kids Services 20 1629513270 0 Physician Assistant Only Physician Services 00 1629513965 0 HILL AMY J 2017123 9999999 B 10 1629513965 0 6 WESTPORT CT BLOOMINGTON IL 617048233 20 1629513965 0 Nurse Practitioners Healthy Kids Services 20 1629513965 0 Nurse Practitioners Midwife Services 20 1629513965 0 Nurse Practitioners Nurse Practitioners Services 20 1629513965 0 Nurse Practitioners Physician Services 00 1629514096 0 FOREMAN ANTHONY D 2017010 9999999 B 10 1629514096 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1629514096 0 Nurse Practitioners Anesthesia Services 20 1629514096 0 Nurse Practitioners Nurse Practitioners Services 20 1629514096 0 Nurse Practitioners Physician Services 00 1629515259 0 STEVENSON BRITTANY K 2017034 9999999 B 10 1629515259 0 3350 S KEDZIE AVE CHICAGO IL 606235114 20 1629515259 0 Other behavior health professional LCPC/LMFT services 00 1629515606 0 MILLER KIRK W 2019085 9999999 B 10 1629515606 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1629515606 0 Physician Assistant Only Fluoride varnish 20 1629515606 0 Physician Assistant Only Healthy Kids Services 20 1629515606 0 Physician Assistant Only Physician Services 00 1629516455 0 GALLOWAY TARA N 2017127 9999999 B 10 1629516455 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1629516455 0 Nurse Practitioners Healthy Kids Services 20 1629516455 0 Nurse Practitioners Nurse Practitioners Services 20 1629516455 0 Nurse Practitioners Physician Services 00 1629517875 0 CREWS AMY 2017129 9999999 B 10 1629517875 0 1243 RICKERT DR NAPERVILLE IL 605400954 20 1629517875 0 Nurse Practitioners Healthy Kids Services 20 1629517875 0 Nurse Practitioners Nurse Practitioners Services 20 1629517875 0 Nurse Practitioners Physician Services 00 1629519061 0 PEIGH GRAHAM SPENCER 2018295 9999999 B 10 1629519061 0 4698 DEPT CAROL STREAM IL 601220021 20 1629519061 0 Physicians Anesthesia Services 20 1629519061 0 Physicians Fluoride varnish 20 1629519061 0 Physicians Healthy Kids Services 20 1629519061 0 Physicians Optical Supplies 20 1629519061 0 Physicians Physician Services 00 1629521109 0 PARKER LYNN A 2016227 9999999 B 10 1629521109 0 2861 MADISON AVE GRANITE CITY IL 620403614 20 1629521109 0 Nurse Practitioners Fluoride varnish 20 1629521109 0 Nurse Practitioners Healthy Kids Services 20 1629521109 0 Nurse Practitioners Nurse Practitioners Services 20 1629521109 0 Nurse Practitioners Physician Services 00 1629522123 0 ROARK KIMBERLY 2016163 9999999 B 10 1629522123 0 4230 11TH ST ROCK ISLAND IL 612016746 20 1629522123 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1629522180 0 HILDRETH KORI 2016098 9999999 B 10 1629522180 0 4230 11TH ST ROCK ISLAND IL 612016746 20 1629522180 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1629524251 0 COLLINS STEVEN M 2016321 9999999 B 10 1629524251 0 4400 W 95TH ST STE 308 OAK LAWN IL 604532660 20 1629524251 0 Physician Assistant Only Fluoride varnish 20 1629524251 0 Physician Assistant Only Healthy Kids Services 20 1629524251 0 Physician Assistant Only Physician Services 00 1629525522 0 PARKER WENDY 2016244 9999999 B 10 1629525522 0 325 IL ROUTE 2 DIXON IL 610219118 20 1629525522 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1629525613 0 SIMONS KATHERINE 2021173 9999999 B 10 1629525613 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1629525613 0 Nurse Practitioners Healthy Kids Services 20 1629525613 0 Nurse Practitioners Nurse Practitioners Services 20 1629525613 0 Nurse Practitioners Physician Services 00 1629527155 0 DE LA CRUZ ARRIOLA BEVERLY 2024331 9999999 B 10 1629527155 0 2171 W EXECUTIVE DR STE 500 ADDISON IL 601015626 20 1629527155 0 Physical Therapists Medical Supplies 20 1629527155 0 Physical Therapists Medical equipment/prosthetic devices 20 1629527155 0 Physical Therapists Physical Therapy Services 00 1629527379 0 HAMMERMAN LAUREN M 2016320 9999999 B 10 1629527379 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1629527379 0 Nurse Practitioners Healthy Kids Services 20 1629527379 0 Nurse Practitioners Nurse Practitioners Services 20 1629527379 0 Nurse Practitioners Physician Services 00 1629527635 0 BOGGIO MELISSA 2023001 9999999 B 10 1629527635 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1629527635 0 Nurse Practitioners Fluoride varnish 20 1629527635 0 Nurse Practitioners Healthy Kids Services 20 1629527635 0 Nurse Practitioners Nurse Practitioners Services 20 1629527635 0 Nurse Practitioners Physician Services 00 1629527759 0 WARKENTIEN AMY 2016274 9999999 B 10 1629527759 0 7421 MADISON ST FOREST PARK IL 601301575 20 1629527759 0 Occupational Therapists Medical Supplies 20 1629527759 0 Occupational Therapists Medical equipment/prosthetic devices 20 1629527759 0 Occupational Therapists Occupational Therapy Services 00 1629528443 0 PATEL SEJALBEN 2016350 9999999 B 10 1629528443 0 1831 BAY SCOTT CIR STE 109 NAPERVILLE IL 605401115 20 1629528443 0 Nurse Practitioners Fluoride varnish 20 1629528443 0 Nurse Practitioners Healthy Kids Services 20 1629528443 0 Nurse Practitioners Nurse Practitioners Services 20 1629528443 0 Nurse Practitioners Physician Services 00 1629529334 0 KERZAN TRACY L 2016292 9999999 B 10 1629529334 0 1160 E SAINT CLAIR ST VINCENNES IN 475914853 20 1629529334 0 Nurse Practitioners Fluoride varnish 20 1629529334 0 Nurse Practitioners Healthy Kids Services 20 1629529334 0 Nurse Practitioners Nurse Practitioners Services 20 1629529334 0 Nurse Practitioners Physician Services 00 1629530019 0 CRONE ALLISON 2024143 9999999 B 10 1629530019 0 5777 DEPT CAROL STREAM IL 601220021 20 1629530019 0 Physicians Anesthesia Services 20 1629530019 0 Physicians Healthy Kids Services 20 1629530019 0 Physicians Optical Supplies 20 1629530019 0 Physicians Physician Services 00 1629530043 0 PRANTNER ALISA 2019150 9999999 B 10 1629530043 0 PO BOX 17632 BELFAST ME 049154071 20 1629530043 0 Nurse Practitioners Healthy Kids Services 20 1629530043 0 Nurse Practitioners Nurse Practitioners Services 20 1629530043 0 Nurse Practitioners Physician Services 00 1629530399 0 SULLIVAN MICHELLE D 2019271 9999999 B 10 1629530399 0 1225 S GEAR AVE STE 153 SUITE 153 WEST BURLINGTON IA 526551686 20 1629530399 0 Nurse Practitioners Fluoride varnish 20 1629530399 0 Nurse Practitioners Healthy Kids Services 20 1629530399 0 Nurse Practitioners Nurse Practitioners Services 20 1629530399 0 Nurse Practitioners Physician Services 00 1629530654 0 STEED JOHN 2024326 9999999 B 10 1629530654 0 PO BOX 959794 SAINT LOUIS MO 631959794 20 1629530654 0 Physicians Anesthesia Services 20 1629530654 0 Physicians Fluoride varnish 20 1629530654 0 Physicians Healthy Kids Services 20 1629530654 0 Physicians Optical Supplies 20 1629530654 0 Physicians Physician Services 00 1629531124 0 CHAMBERS MEGAN M 2019121 9999999 B 10 1629531124 0 3015 N BALLAS RD SAINT LOUIS MO 631312329 20 1629531124 0 Nurse Practitioners Anesthesia Services 20 1629531124 0 Nurse Practitioners Nurse Practitioners Services 20 1629531124 0 Nurse Practitioners Physician Services 00 1629534169 0 PHELPS AMY 2019107 9999999 B 10 1629534169 0 PO BOX 1230 EVANSVILLE IN 477061230 20 1629534169 0 Nurse Practitioners Healthy Kids Services 20 1629534169 0 Nurse Practitioners Nurse Practitioners Services 20 1629534169 0 Nurse Practitioners Physician Services 00 1629534227 0 BEHRENS SONIA 2020336 9999999 B 10 1629534227 0 1005 BROADWAY ST QUINCY IL 623012834 20 1629534227 0 Nurse Practitioners Fluoride varnish 20 1629534227 0 Nurse Practitioners Healthy Kids Services 20 1629534227 0 Nurse Practitioners Nurse Practitioners Services 20 1629534227 0 Nurse Practitioners Physician Services 00 1629535158 0 AL-SAFFAR MAYS 2024150 9999999 B 10 1629535158 0 3855 W NORTH AVE CHICAGO IL 606474640 20 1629535158 0 Dentists Dental Services 20 1629535158 0 Dentists Physician Services 00 1629536099 0 SULEIMAN TALAT 2019182 9999999 B 10 1629536099 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1629536099 0 Physicians Anesthesia Services 20 1629536099 0 Physicians Fluoride varnish 20 1629536099 0 Physicians Healthy Kids Services 20 1629536099 0 Physicians Optical Supplies 20 1629536099 0 Physicians Physician Services 00 1629537576 0 EVANS JORDAN B 2023208 9999999 B 10 1629537576 0 4909 N GLEN PARK PLACE RD PEORIA IL 616144676 20 1629537576 0 Physicians Anesthesia Services 20 1629537576 0 Physicians Healthy Kids Services 20 1629537576 0 Physicians Optical Supplies 20 1629537576 0 Physicians Physician Services 00 1629537824 0 JONES CAMERON S 2019182 9999999 B 10 1629537824 0 5777 DEPT CAROL STREAM IL 601220021 20 1629537824 0 Physicians Anesthesia Services 20 1629537824 0 Physicians Healthy Kids Services 20 1629537824 0 Physicians Optical Supplies 20 1629537824 0 Physicians Physician Services 00 1629537873 0 EBANKS ANDREW 2023286 9999999 B 10 1629537873 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1629537873 0 Physicians Anesthesia Services 20 1629537873 0 Physicians Fluoride varnish 20 1629537873 0 Physicians Healthy Kids Services 20 1629537873 0 Physicians Optical Supplies 20 1629537873 0 Physicians Physician Services 00 1629538863 0 PAGE NIEL 2019324 9999999 B 10 1629538863 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1629538863 0 Physicians Anesthesia Services 20 1629538863 0 Physicians Healthy Kids Services 20 1629538863 0 Physicians Optical Supplies 20 1629538863 0 Physicians Physician Services 00 1629539150 0 MULK NUHA 2019218 9999999 B 10 1629539150 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1629539150 0 Physicians Anesthesia Services 20 1629539150 0 Physicians Fluoride varnish 20 1629539150 0 Physicians Healthy Kids Services 20 1629539150 0 Physicians Optical Supplies 20 1629539150 0 Physicians Physician Services 00 1629539176 0 DUNCAN COURTNEY S 2022182 9999999 B 10 1629539176 0 PO BOX 3039 OAK BROOK IL 605223039 20 1629539176 0 Physicians Anesthesia Services 20 1629539176 0 Physicians Fluoride varnish 20 1629539176 0 Physicians Healthy Kids Services 20 1629539176 0 Physicians Optical Supplies 20 1629539176 0 Physicians Physician Services 00 1629539614 0 HANSON AMY E 2023186 9999999 B 10 1629539614 0 PO BOX 778912 CHICAGO IL 606778912 20 1629539614 0 Physicians Anesthesia Services 20 1629539614 0 Physicians Fluoride varnish 20 1629539614 0 Physicians Healthy Kids Services 20 1629539614 0 Physicians Optical Supplies 20 1629539614 0 Physicians Physician Services 00 1629539655 0 WEGNER ELLEN 2022215 9999999 B 10 1629539655 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1629539655 0 Physicians Anesthesia Services 20 1629539655 0 Physicians Fluoride varnish 20 1629539655 0 Physicians Healthy Kids Services 20 1629539655 0 Physicians Optical Supplies 20 1629539655 0 Physicians Physician Services 00 1629539663 0 GARTMOND TORI 2019234 9999999 B 10 1629539663 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1629539663 0 Physicians Anesthesia Services 20 1629539663 0 Physicians Fluoride varnish 20 1629539663 0 Physicians Healthy Kids Services 20 1629539663 0 Physicians Optical Supplies 20 1629539663 0 Physicians Physician Services 00 1629539994 0 HANLEY THOMAS E 2019175 9999999 B 10 1629539994 0 111 OAKWOOD RD EAST PEORIA IL 616111853 20 1629539994 0 Physicians Anesthesia Services 20 1629539994 0 Physicians Fluoride varnish 20 1629539994 0 Physicians Healthy Kids Services 20 1629539994 0 Physicians Optical Supplies 20 1629539994 0 Physicians Physician Services 00 1629540331 0 SANCHEZ JAVIER 2022006 9999999 B 10 1629540331 0 5206 N LIND AVE CHICAGO IL 606301436 20 1629540331 0 Clinical Social Worker Social work service 00 1629542857 0 LEWIS MIKALA M 2020262 9999999 B 10 1629542857 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1629542857 0 Nurse Practitioners Healthy Kids Services 20 1629542857 0 Nurse Practitioners Nurse Practitioners Services 20 1629542857 0 Nurse Practitioners Physician Services 00 1629543764 0 DEWAN COLLEEN M 2023065 9999999 B 10 1629543764 0 2900 OGDEN AVE LISLE IL 605321676 20 1629543764 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1629544150 0 DOLLIGER KILEY 2022245 9999999 B 10 1629544150 0 25440 S GOUGAR RD MANHATTAN IL 604429511 20 1629544150 0 Speech Therapists Medical Supplies 20 1629544150 0 Speech Therapists Medical equipment/prosthetic devices 20 1629544150 0 Speech Therapists Speech Therapy/Pathology Services 00 1629544234 0 DEVALON DOROTY 2022132 9999999 B 10 1629544234 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1629544234 0 Physician Assistant Only Fluoride varnish 20 1629544234 0 Physician Assistant Only Healthy Kids Services 20 1629544234 0 Physician Assistant Only Physician Services 00 1629545595 0 LAWRENCE EMILY 2019315 9999999 B 10 1629545595 0 2003 W FULTON ST STE 303 CHICAGO IL 606122345 20 1629545595 0 Nurse Practitioners Fluoride varnish 20 1629545595 0 Nurse Practitioners Healthy Kids Services 20 1629545595 0 Nurse Practitioners Nurse Practitioners Services 20 1629545595 0 Nurse Practitioners Physician Services 00 1629545892 0 SHEEHY MARY E 2018302 9999999 B 10 1629545892 0 29373 NETWORK PL CHICAGO IL 606733039 20 1629545892 0 Nurse Practitioners Healthy Kids Services 20 1629545892 0 Nurse Practitioners Nurse Practitioners Services 20 1629545892 0 Nurse Practitioners Physician Services 00 1629546411 0 SUWANAWONGSE LISA 2018319 9999999 B 10 1629546411 0 1239 E MAIN ST CARBONDALE IL 629013175 20 1629546411 0 Nurse Practitioners Fluoride varnish 20 1629546411 0 Nurse Practitioners Healthy Kids Services 20 1629546411 0 Nurse Practitioners Nurse Practitioners Services 20 1629546411 0 Nurse Practitioners Physician Services 00 1629547807 0 SHORI AKHIL 2024225 9999999 B 10 1629547807 0 350 N WALL ST KANKAKEE IL 609012901 20 1629547807 0 Physicians Anesthesia Services 20 1629547807 0 Physicians Healthy Kids Services 20 1629547807 0 Physicians Optical Supplies 20 1629547807 0 Physicians Physician Services 00 1629548185 0 KEARNEY ANNA 2021137 9999999 B 10 1629548185 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1629548185 0 Physician Assistant Only Fluoride varnish 20 1629548185 0 Physician Assistant Only Healthy Kids Services 20 1629548185 0 Physician Assistant Only Physician Services 00 1629550108 0 ANDERSON STEPHANIE 2018232 9999999 B 10 1629550108 0 15100 S 94TH AVE ORLAND PARK IL 604623291 20 1629550108 0 Speech Therapists Medical Supplies 20 1629550108 0 Speech Therapists Medical equipment/prosthetic devices 20 1629550108 0 Speech Therapists Speech Therapy/Pathology Services 00 1629550165 0 FREDERICK JAMIE 2022027 9999999 B 10 1629550165 0 PO BOX 556 VINCENNES IN 475910556 20 1629550165 0 Nurse Practitioners Fluoride varnish 20 1629550165 0 Nurse Practitioners Healthy Kids Services 20 1629550165 0 Nurse Practitioners Nurse Practitioners Services 20 1629550165 0 Nurse Practitioners Physician Services 00 1629550231 0 KAPOLNEK LAUREN 2025013 9999999 B 10 1629550231 0 830 S ADDISON AVE VILLA PARK IL 601812877 20 1629550231 0 Occupational Therapists Medical Supplies 20 1629550231 0 Occupational Therapists Medical equipment/prosthetic devices 20 1629550231 0 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Services 20 1629553888 0 Nurse Practitioners Physician Services 00 1629554498 0 BRAR JASMEET 2018298 9999999 B 10 1629554498 0 5501 W 79TH ST STE 201 BURBANK IL 604591796 20 1629554498 0 Dentists Dental Services 20 1629554498 0 Dentists Physician Services 00 1629558226 0 RODGERS CASEY D 2020174 9999999 B 10 1629558226 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1629558226 0 Speech Therapists Medical Supplies 20 1629558226 0 Speech Therapists Medical equipment/prosthetic devices 20 1629558226 0 Speech Therapists Occupational Therapy Services 00 1629559455 0 PATLA MONICA M 1996176 9999999 B 10 1629559455 0 1323 E 7TH ST LOCKPORT IL 604413823 20 1629559455 0 Speech Therapists Speech Therapy/Pathology Services 00 1629559497 0 HAMMUCK JORDAN M 2018290 9999999 B 10 1629559497 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1629559497 0 Occupational Therapists Medical Supplies 20 1629559497 0 Occupational Therapists Medical equipment/prosthetic devices 20 1629559497 0 Occupational Therapists Occupational Therapy Services 00 1629560297 0 SING MIA R 2022005 9999999 B 10 1629560297 0 11125 DUNN RD STE 411 SAINT LOUIS MO 631366132 20 1629560297 0 Nurse Practitioners Fluoride varnish 20 1629560297 0 Nurse Practitioners Healthy Kids Services 20 1629560297 0 Nurse Practitioners Nurse Practitioners Services 20 1629560297 0 Nurse Practitioners Physician Services 00 1629560339 0 MANISH PANDYA 2020078 9999999 B 10 1629560339 0 75 REMITTANCE DR DEPT 1153 CHICAGO IL 606751153 20 1629560339 0 Podiatrists Podiatric Services 00 1629561220 0 BACKIEV LINDSAY 2018225 9999999 B 10 1629561220 0 1 WESTBROOK CORPORATE CTR STE 240 WESTCHESTER IL 601545745 20 1629561220 0 Physical Therapists Medical Supplies 20 1629561220 0 Physical Therapists Medical equipment/prosthetic devices 20 1629561220 0 Physical Therapists Physical Therapy Services 00 1629562178 0 SINGH RACHITA 2022309 9999999 B 10 1629562178 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1629562178 0 Physician Assistant Only Fluoride varnish 20 1629562178 0 Physician Assistant Only Healthy Kids Services 20 1629562178 0 Physician Assistant Only Physician Services 00 1629562459 0 LEWANDOWSKI ANDRZEJ 2019187 9999999 B 10 1629562459 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1629562459 0 Speech Therapists Medical Supplies 20 1629562459 0 Speech Therapists Medical equipment/prosthetic devices 20 1629562459 0 Speech Therapists Speech Therapy/Pathology Services 00 1629562608 0 MCCARTIN MICHAEL P 2018347 9999999 B 10 1629562608 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1629562608 0 Physicians Anesthesia Services 20 1629562608 0 Physicians Healthy Kids Services 20 1629562608 0 Physicians Optical Supplies 20 1629562608 0 Physicians Physician Services 00 1629562657 0 HA YOUNA 2019182 9999999 B 10 1629562657 0 318 MAXWELL RD STE 500 ALPHARETTA GA 300092064 20 1629562657 0 Physicians Anesthesia Services 20 1629562657 0 Physicians Fluoride varnish 20 1629562657 0 Physicians Healthy Kids Services 20 1629562657 0 Physicians Optical Supplies 20 1629562657 0 Physicians Physician Services 00 1629562715 0 GILANYI EMILY M 2022063 9999999 B 10 1629562715 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1629562715 0 Physician Assistant Only Fluoride varnish 20 1629562715 0 Physician Assistant Only Healthy Kids Services 20 1629562715 0 Physician Assistant Only Physician Services 00 1629562939 0 SINGH PREET M 2018213 9999999 B 10 1629562939 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1629562939 0 Physicians Anesthesia Services 20 1629562939 0 Physicians Healthy Kids Services 20 1629562939 0 Physicians Optical Supplies 20 1629562939 0 Physicians Physician Services 00 1629563093 0 NEWCOMER KENNETH F 2018364 9999999 B 10 1629563093 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1629563093 0 Physicians Anesthesia Services 20 1629563093 0 Physicians Healthy Kids Services 20 1629563093 0 Physicians Optical Supplies 20 1629563093 0 Physicians Physician Services 00 1629564331 0 CHOUDHARY PREETI 2018190 9999999 B 10 1629564331 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1629564331 0 Nurse Practitioners Nursing service 20 1629564331 0 Nurse Practitioners Waiver service 00 1629565007 0 GIDDENS MAGGIE 2018144 9999999 B 10 1629565007 0 1480 MOMENTUM PL CHICAGO IL 606895314 20 1629565007 0 Nurse Practitioners Fluoride varnish 20 1629565007 0 Nurse Practitioners Healthy Kids Services 20 1629565007 0 Nurse Practitioners Nurse Practitioners Services 20 1629565007 0 Nurse Practitioners Physician Services 00 1629565106 0 ROSS PATRICIA 2018131 9999999 B 10 1629565106 0 PO BOX 856 ANTIOCH IL 600020856 20 1629565106 0 Clinical Social Worker Social work service 00 1629565213 0 CALA MARY T 2018115 9999999 B 10 1629565213 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1629565213 0 Nurse Practitioners Fluoride varnish 20 1629565213 0 Nurse Practitioners Healthy Kids Services 20 1629565213 0 Nurse Practitioners Nurse Practitioners Services 20 1629565213 0 Nurse Practitioners Physician Services 00 1629565973 0 MOELLERING MARY 2023240 9999999 B 10 1629565973 0 29373 NETWORK PL CHICAGO IL 606733039 20 1629565973 0 Physicians Anesthesia Services 20 1629565973 0 Physicians Healthy Kids Services 20 1629565973 0 Physicians Optical Supplies 20 1629565973 0 Physicians Physician Services 20 1629565973 0 Physicians Physicians Psychiatric Services 00 1629566278 0 GUESS RACHEL L 2022269 9999999 B 10 1629566278 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1629566278 0 Physicians Anesthesia Services 20 1629566278 0 Physicians Fluoride varnish 20 1629566278 0 Physicians Healthy Kids Services 20 1629566278 0 Physicians Optical Supplies 20 1629566278 0 Physicians Physician Services 00 1629567185 0 LEM STEFANIE A 2020107 9999999 B 10 1629567185 0 350 N WALL ST KANKAKEE IL 609012901 20 1629567185 0 Psychologist Psychologist service 00 1629567425 0 SHRESTHA AYUSH B 2023182 9999999 B 10 1629567425 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1629567425 0 Physicians Anesthesia Services 20 1629567425 0 Physicians Fluoride varnish 20 1629567425 0 Physicians Healthy Kids Services 20 1629567425 0 Physicians Optical Supplies 20 1629567425 0 Physicians Physician Services 00 1629569082 0 WILLIAMS MASON 2020155 9999999 B 10 1629569082 0 2929 MCFARLAND RD ROCKFORD IL 611076809 20 1629569082 0 Optometrists Optical Supplies 20 1629569082 0 Optometrists Optometric Services 20 1629569082 0 Optometrists Physician Services 00 1629569140 0 PERCIFIELD CHAD R 2023234 9999999 B 10 1629569140 0 3600 N PROW RD BLOOMINGTON IN 474041616 20 1629569140 0 Physicians Anesthesia Services 20 1629569140 0 Physicians Healthy Kids Services 20 1629569140 0 Physicians Optical Supplies 20 1629569140 0 Physicians Physician Services 20 1629569140 0 Physicians Physicians Psychiatric Services 00 1629569546 0 ATA RONNIE A 2018296 9999999 B 10 1629569546 0 12601 WESTERN AVE STE B BLUE ISLAND IL 604061777 20 1629569546 0 Dentists Dental Services 20 1629569546 0 Dentists Physician Services 00 1629569843 0 NISSEN NICOLE 2018341 9999999 B 10 1629569843 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1629569843 0 Nurse Practitioners Fluoride varnish 20 1629569843 0 Nurse Practitioners Healthy Kids Services 20 1629569843 0 Nurse Practitioners Nurse Practitioners Services 20 1629569843 0 Nurse Practitioners Physician Services 00 1629570536 0 ELLIS DANIELLE 2017296 9999999 B 10 1629570536 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1629570536 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1629572177 0 HUKKU ARUSHI 2020015 9999999 B 10 1629572177 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1629572177 0 Physicians Anesthesia Services 20 1629572177 0 Physicians Fluoride varnish 20 1629572177 0 Physicians Healthy Kids Services 20 1629572177 0 Physicians Optical Supplies 20 1629572177 0 Physicians Physician Services 00 1629572193 0 PHILIBERT JOHN C 2020036 9999999 B 10 1629572193 0 3015 N BALLAS RD SAINT LOUIS MO 631312329 20 1629572193 0 Physicians Anesthesia Services 20 1629572193 0 Physicians Healthy Kids Services 20 1629572193 0 Physicians Optical Supplies 20 1629572193 0 Physicians Physician Services 00 1629572490 0 PATEL KUNAL PARITOSH 2018164 9999999 B 10 1629572490 0 PO BOX 120288 DALLAS TX 753120288 20 1629572490 0 Physicians Anesthesia Services 20 1629572490 0 Physicians Healthy Kids Services 20 1629572490 0 Physicians Optical Supplies 20 1629572490 0 Physicians Physician Services 00 1629572649 0 SCHULTZ MICHELLE L 2018354 9999999 B 10 1629572649 0 PO BOX 62946 BALTIMORE MD 212642946 20 1629572649 0 Nurse Practitioners Fluoride varnish 20 1629572649 0 Nurse Practitioners Healthy Kids Services 20 1629572649 0 Nurse Practitioners Nurse Practitioners Services 20 1629572649 0 Nurse Practitioners Physician Services 00 1629572789 0 GILBERT ELAINE A 2018255 9999999 B 10 1629572789 0 PO BOX 778912 CHICAGO IL 606778912 20 1629572789 0 Psychologist Psychologist service 00 1629572862 0 DANG ELIZABETH 2022094 9999999 B 10 1629572862 0 3990 N ILLINOIS ST SWANSEA IL 622261919 20 1629572862 0 Optometrists Optical Supplies 20 1629572862 0 Optometrists Optometric Services 20 1629572862 0 Optometrists Physician Services 00 1629573142 0 AHMAD AYAZ 2021243 9999999 B 10 1629573142 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1629573142 0 Physicians Anesthesia Services 20 1629573142 0 Physicians Fluoride varnish 20 1629573142 0 Physicians Healthy Kids Services 20 1629573142 0 Physicians Optical Supplies 20 1629573142 0 Physicians Physician Services 00 1629573761 0 AGTARAP PAUL 2022347 9999999 B 10 1629573761 0 PO BOX 43230 PHOENIX AZ 850803230 20 1629573761 0 Physicians Anesthesia Services 20 1629573761 0 Physicians Fluoride varnish 20 1629573761 0 Physicians Healthy Kids Services 20 1629573761 0 Physicians Optical Supplies 20 1629573761 0 Physicians Physician Services 00 1629573837 0 CONTRERAS CHAVEZ PAMELA 2024141 9999999 B 10 1629573837 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1629573837 0 Physicians Anesthesia Services 20 1629573837 0 Physicians Fluoride varnish 20 1629573837 0 Physicians Healthy Kids Services 20 1629573837 0 Physicians Optical Supplies 20 1629573837 0 Physicians Physician Services 00 1629573878 0 SIMMONS BRITTANY S 2018200 9999999 B 10 1629573878 0 124 SW ADAMS ST PEORIA IL 616021308 20 1629573878 0 Physician Assistant Only Fluoride varnish 20 1629573878 0 Physician Assistant Only Healthy Kids Services 20 1629573878 0 Physician Assistant Only Physician Services 00 1629574009 0 MACNEILLE RHETT A 2024085 9999999 B 10 1629574009 0 510 LINCOLN DR HERRIN IL 629486334 20 1629574009 0 Physicians Anesthesia Services 20 1629574009 0 Physicians Healthy Kids Services 20 1629574009 0 Physicians Optical Supplies 20 1629574009 0 Physicians Physician Services 00 1629574561 0 TAMASFI TIFFANY E 2018152 9999999 B 10 1629574561 0 1203 POPLAR AVE MEMPHIS TN 381047241 20 1629574561 0 Nurse Practitioners Fluoride varnish 20 1629574561 0 Nurse Practitioners Healthy Kids Services 20 1629574561 0 Nurse Practitioners Nurse Practitioners Services 20 1629574561 0 Nurse Practitioners Physician Services 00 1629574926 0 GARHAN MEGAN E 2018102 9999999 B 10 1629574926 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1629574926 0 Physical Therapists Medical Supplies 20 1629574926 0 Physical Therapists Medical equipment/prosthetic devices 20 1629574926 0 Physical Therapists Physical Therapy Services 00 1629575238 0 MARTIN LINDSEY E 2018060 9999999 B 10 1629575238 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1629575238 0 Clinical Social Worker All Kids application agent 20 1629575238 0 Clinical Social Worker Social work service 00 1629575360 0 COOK DANIEL 2024178 9999999 B 10 1629575360 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1629575360 0 Physicians Anesthesia Services 20 1629575360 0 Physicians Fluoride varnish 20 1629575360 0 Physicians Healthy Kids Services 20 1629575360 0 Physicians Optical Supplies 20 1629575360 0 Physicians Physician Services 00 1629575691 0 GULIZIA DUSTIN 2019148 9999999 B 10 1629575691 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1629575691 0 Physicians Anesthesia Services 20 1629575691 0 Physicians Healthy Kids Services 20 1629575691 0 Physicians Optical Supplies 20 1629575691 0 Physicians Physician Services 00 1629576368 0 TILLMAN LAUREN 2018346 9999999 B 10 1629576368 0 PO BOX 631767 CINCINNATI OH 452631767 20 1629576368 0 Nurse Practitioners Healthy Kids Services 20 1629576368 0 Nurse Practitioners Nurse Practitioners Services 20 1629576368 0 Nurse Practitioners Physician Services 00 1629577572 0 OROURKE DIANA 2018008 9999999 B 10 1629577572 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1629577572 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1629577689 0 SIMMONS ABIGALE A 2018107 9999999 B 10 1629577689 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1629577689 0 Physician Assistant Only Fluoride varnish 20 1629577689 0 Physician Assistant Only Healthy Kids Services 20 1629577689 0 Physician Assistant Only Physician Services 00 1629578075 0 GOMEZ MARIA 2025021 9999999 B 10 1629578075 0 4600 3RD ST MOLINE IL 612656106 20 1629578075 0 Other behavior health professional LCPC/LMFT services 00 1629579271 0 SANDERS RENITA C 2018274 9999999 B 10 1629579271 0 600 HOLIDAY PLAZA DR STE 200 MATTESON IL 604432237 20 1629579271 0 Physician Assistant Only Fluoride varnish 20 1629579271 0 Physician Assistant Only Healthy Kids Services 20 1629579271 0 Physician Assistant Only Nurse Practitioners Services 20 1629579271 0 Physician Assistant Only Physician Services 00 1629579446 0 MORSE COURTNEY 2018059 9999999 B 10 1629579446 0 300 CEDAR ST PEKIN IL 615547009 20 1629579446 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1629579446 0 Other behavior health professional Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1629579446 0 MORSE COURTNEY 2018059 9999999 B 10 1629579446 0 300 CEDAR ST PEKIN IL 615547009 20 1629579446 0 Psychologist Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1629579446 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1629579479 0 LEE SE RIN 2018228 9999999 B 10 1629579479 0 7732 SOLUTION CENTER CHICAGO IL 606777007 20 1629579479 0 Dentists Dental Services 20 1629579479 0 Dentists Electronic Home Response/EHR Installation, MPE Certification 20 1629579479 0 Dentists Physician Services 00 1629581152 0 DEEPANKAR SHARA 2022041 9999999 B 10 1629581152 0 6303 BLUE LAGOON DR STE 400 MIAMI FL 331266040 20 1629581152 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1629581160 0 FULKERSON BRACI L 2019266 9999999 B 10 1629581160 0 800 S DIVISION ST NORRIS CITY IL 628691634 20 1629581160 0 Speech Therapists Medical Supplies 20 1629581160 0 Speech Therapists Medical equipment/prosthetic devices 20 1629581160 0 Speech Therapists Speech Therapy/Pathology Services 00 1629581855 0 JOHNSON RACHAEL V 2021084 9999999 B 10 1629581855 0 PO BOX 8500 LOCKBOX 7642 PHILADELPHIA PA 191787642 20 1629581855 0 Physician Assistant Only Fluoride varnish 20 1629581855 0 Physician Assistant Only Healthy Kids Services 20 1629581855 0 Physician Assistant Only Physician Services 00 1629581897 0 THORNTON RASHONDA 2017352 9999999 H 10 1629581897 0 10176 CORPORATE SQUARE DR STE SAINT LOUIS MO 631322924 20 1629581897 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1629582689 0 RICHARDS JULIA R 2017346 9999999 B 10 1629582689 0 320 W MAIN ST OTTAWA IL 613502825 20 1629582689 0 Speech Therapists 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Services 00 1629586946 0 FERGUSON ASHLEY 2018024 9999999 B 10 1629586946 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1629586946 0 Nurse Practitioners Healthy Kids Services 20 1629586946 0 Nurse Practitioners Nurse Practitioners Services 20 1629586946 0 Nurse Practitioners Physician Services 00 1629588660 0 PAWLOWSKI MARGARET A 2017296 9999999 B 10 1629588660 0 PO BOX 5081 JANESVILLE WI 535475081 20 1629588660 0 Speech Therapists Medical Supplies 20 1629588660 0 Speech Therapists Medical equipment/prosthetic devices 20 1629588660 0 Speech Therapists Speech Therapy/Pathology Services 00 1629589460 0 SEEMANN THERESA 2017213 9999999 B 10 1629589460 0 11900 S KOSTNER AVE ALSIP IL 608032307 20 1629589460 0 Speech Therapists Medical Supplies 20 1629589460 0 Speech Therapists Medical equipment/prosthetic devices 20 1629589460 0 Speech Therapists Speech Therapy/Pathology Services 00 1629591854 0 TADAKAMALLA PRAMOD 2017213 9999999 B 10 1629591854 0 3510 N UNIVERSITY ST STE A PEORIA IL 616041346 20 1629591854 0 Dentists Dental Services 20 1629591854 0 Dentists Physician Services 00 1629592258 0 COLLINS SANDRA B 2020022 9999999 B 10 1629592258 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1629592258 0 Nurse Practitioners Fluoride varnish 20 1629592258 0 Nurse Practitioners Healthy Kids Services 20 1629592258 0 Nurse Practitioners Nurse Practitioners Services 20 1629592258 0 Nurse Practitioners Physician Services 00 1629592639 0 MIMA MAHMOUD 2017233 9999999 B 10 1629592639 0 PO BOX 83287 CHICAGO IL 606910287 20 1629592639 0 Physicians Anesthesia Services 20 1629592639 0 Physicians Healthy Kids Services 20 1629592639 0 Physicians Optical Supplies 20 1629592639 0 Physicians Physician Services 00 1629593231 0 LOBANOVA ANNA 2020049 9999999 B 10 1629593231 0 8311 ROOSEVELT RD FOREST PARK IL 601302529 20 1629593231 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1629594825 0 CARVER ADAM T 2017226 9999999 B 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1629683289 0 Nurse Practitioners Healthy Kids Services 20 1629683289 0 Nurse Practitioners Nurse Practitioners Services 20 1629683289 0 Nurse Practitioners Physician Services 00 1629683453 0 KYLES MONIQUE 2021060 9999999 B 10 1629683453 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1629683453 0 Nurse Practitioners Fluoride varnish 20 1629683453 0 Nurse Practitioners Healthy Kids Services 20 1629683453 0 Nurse Practitioners Nurse Practitioners Services 20 1629683453 0 Nurse Practitioners Physician Services 00 1629683784 0 SAD ALDEEN ZIAD 2020266 9999999 B 10 1629683784 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1629683784 0 Physicians Anesthesia Services 20 1629683784 0 Physicians Fluoride varnish 20 1629683784 0 Physicians Healthy Kids Services 20 1629683784 0 Physicians Optical Supplies 20 1629683784 0 Physicians Physician Services 00 1629684220 0 JOHNSON ERIK 2020265 9999999 B 10 1629684220 0 501 7TH ST ROCKFORD IL 611041242 20 1629684220 0 Speech Therapists Medical Supplies 20 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Practitioners Nurse Practitioners Services 20 1629687041 0 Nurse Practitioners Physician Services 00 1629687231 0 RESENDEZ KARINA 2020218 9999999 B 10 1629687231 0 70 S RIVER ST AURORA IL 605065185 20 1629687231 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1629689096 0 MEEHAN SARAH 2020329 9999999 B 10 1629689096 0 520 MARY ST STE 520 EVANSVILLE IN 477101682 20 1629689096 0 Nurse Practitioners Fluoride varnish 20 1629689096 0 Nurse Practitioners Healthy Kids Services 20 1629689096 0 Nurse Practitioners Nurse Practitioners Services 20 1629689096 0 Nurse Practitioners Physician Services 00 1629690649 0 AUGUSTINE ELIZABETH 2022201 9999999 B 10 1629690649 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1629690649 0 Physicians Anesthesia Services 20 1629690649 0 Physicians Healthy Kids Services 20 1629690649 0 Physicians Optical Supplies 20 1629690649 0 Physicians Physician Services 20 1629690649 0 Physicians Physicians Psychiatric Services 00 1629691605 0 SPORYSHEVA ANNA 2020238 9999999 B 10 1629691605 0 8780 W GOLF RD STE 304 STE 304 NILES IL 607145611 20 1629691605 0 Physicians Anesthesia Services 20 1629691605 0 Physicians Healthy Kids Services 20 1629691605 0 Physicians Optical Supplies 20 1629691605 0 Physicians Physician Services 00 1629692553 0 WHITE RONALD 2022291 9999999 B 10 1629692553 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1629692553 0 Physicians Anesthesia Services 20 1629692553 0 Physicians Fluoride varnish 20 1629692553 0 Physicians Healthy Kids Services 20 1629692553 0 Physicians Optical Supplies 20 1629692553 0 Physicians Physician Services 00 1629692835 0 SCHWARTZ JESSICA 2020183 9999999 B 10 1629692835 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1629692835 0 Physicians Anesthesia Services 20 1629692835 0 Physicians Fluoride varnish 20 1629692835 0 Physicians Healthy Kids Services 20 1629692835 0 Physicians Optical Supplies 20 1629692835 0 Physicians Physician Services 00 1629693726 0 TULLEY STEPHEN 2023200 9999999 B 10 1629693726 0 700 E OGDEN AVE STE 202 WESTMONT IL 605591296 20 1629693726 0 Physicians Anesthesia Services 20 1629693726 0 Physicians Fluoride varnish 20 1629693726 0 Physicians Healthy Kids Services 20 1629693726 0 Physicians Optical Supplies 20 1629693726 0 Physicians Physician Services 00 1629694500 0 TROIA CLAIRE 2023195 9999999 B 10 1629694500 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1629694500 0 Physicians Anesthesia Services 20 1629694500 0 Physicians Fluoride varnish 20 1629694500 0 Physicians Healthy Kids Services 20 1629694500 0 Physicians Optical Supplies 20 1629694500 0 Physicians Physician Services 00 1629694542 0 GALLAGHER MEGHAN E 2021159 9999999 B 10 1629694542 0 16650 HARLEM AVE TINLEY PARK IL 604771847 20 1629694542 0 Physician Assistant Only Fluoride varnish 20 1629694542 0 Physician Assistant Only Healthy Kids Services 20 1629694542 0 Physician Assistant Only Physician Services 00 1629694930 0 BERKEL TIFFANI D 2020303 9999999 B 10 1629694930 0 1400 US HIGHWAY 61 FESTUS MO 630284100 20 1629694930 0 Physicians Anesthesia Services 20 1629694930 0 Physicians Healthy Kids Services 20 1629694930 0 Physicians Optical Supplies 20 1629694930 0 Physicians Physician Services 20 1629694930 0 Physicians Physicians Psychiatric Services 00 1629695333 0 CHEMMACHEL ALLI J 2021280 9999999 B 10 1629695333 0 29373 NETWORK PL CHICAGO IL 606733039 20 1629695333 0 Physician Assistant Only Fluoride varnish 20 1629695333 0 Physician Assistant Only Healthy Kids Services 20 1629695333 0 Physician Assistant Only Physician Services 00 1629695390 0 DVORAK KARIANNE D 2020195 9999999 B 10 1629695390 0 11053 S MILLARD AVE CHICAGO IL 606553327 20 1629695390 0 Occupational Therapists Medical Supplies 20 1629695390 0 Occupational Therapists Medical equipment/prosthetic devices 20 1629695390 0 Occupational Therapists Occupational Therapy Services 00 1629697180 0 BRUBAKER MARGARET R 2024206 9999999 B 10 1629697180 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1629697180 0 Physicians Anesthesia Services 20 1629697180 0 Physicians Fluoride varnish 20 1629697180 0 Physicians Healthy Kids Services 20 1629697180 0 Physicians Optical Supplies 20 1629697180 0 Physicians Physician Services 00 1629697222 0 STAFFETTI JOSEPH 2024183 9999999 B 10 1629697222 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1629697222 0 Physicians Anesthesia Services 20 1629697222 0 Physicians Healthy Kids Services 20 1629697222 0 Physicians Optical Supplies 20 1629697222 0 Physicians Physician Services 20 1629697222 0 Physicians Physicians Psychiatric Services 00 1629697297 0 JOHNSON LYNDSEY 2022319 9999999 B 10 1629697297 0 244 E ROOSEVELT RD LOMBARD IL 601484647 20 1629697297 0 Nurse Practitioners Fluoride varnish 20 1629697297 0 Nurse Practitioners Healthy Kids Services 20 1629697297 0 Nurse Practitioners Nurse Practitioners Services 20 1629697297 0 Nurse Practitioners Physician Services 00 1629698709 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1629699616 0 SAYANI TIFFANY A 2020205 9999999 B 10 1629699616 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1629699616 0 Nurse Practitioners Healthy Kids Services 20 1629699616 0 Nurse Practitioners Nurse Practitioners Services 20 1629699616 0 Nurse Practitioners Physician Services 00 1629699715 0 YOUSEF JARDIN 2023093 9999999 B 10 1629699715 0 PO BOX 49 GLENVIEW IL 600250049 20 1629699715 0 Dentists Dental Services 20 1629699715 0 Dentists Physician Services 00 1629699780 0 REED NINA 2020259 9999999 B 10 1629699780 0 3410 W ROOSEVELT RD CHICAGO IL 606244343 20 1629699780 0 Clinical Social Worker Social work service 00 1629700794 0 DOLAN COLIN C 2022188 9999999 B 10 1629700794 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1629700794 0 Physicians Anesthesia Services 20 1629700794 0 Physicians Fluoride varnish 20 1629700794 0 Physicians Healthy Kids Services 20 1629700794 0 Physicians Optical Supplies 20 1629700794 0 Physicians Physician Services 00 1629701081 0 MANCE STEPHAN 2024214 9999999 B 10 1629701081 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1629701081 0 Physician Assistant Only Fluoride varnish 20 1629701081 0 Physician Assistant Only Healthy Kids Services 20 1629701081 0 Physician Assistant Only Physician Services 00 1629701412 0 PAWELSKI ALEXANDRA 2024296 9999999 B 10 1629701412 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1629701412 0 Speech Therapists Medical Supplies 20 1629701412 0 Speech Therapists Medical equipment/prosthetic devices 20 1629701412 0 Speech Therapists Speech Therapy/Pathology Services 00 1629701677 0 BOSNOYAN KEVIN 2022284 9999999 B 10 1629701677 0 326 W 64TH ST CHICAGO IL 606213114 20 1629701677 0 Physicians Anesthesia Services 20 1629701677 0 Physicians Healthy Kids Services 20 1629701677 0 Physicians Optical Supplies 20 1629701677 0 Physicians Physician Services 00 1629701784 0 PEREZ ARNOLD LAURA M 2022188 9999999 B 10 1629701784 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1629701784 0 Physicians Anesthesia Services 20 1629701784 0 Physicians Fluoride varnish 20 1629701784 0 Physicians Healthy Kids Services 20 1629701784 0 Physicians Optical Supplies 20 1629701784 0 Physicians Physician Services 00 1629702766 0 PALISCH COURTNEY L 2022215 9999999 B 10 1629702766 0 60 DOCTORS PARK CAPE GIRARDEAU MO 637034928 20 1629702766 0 Nurse Practitioners Fluoride varnish 20 1629702766 0 Nurse Practitioners Healthy Kids Services 20 1629702766 0 Nurse Practitioners Nurse Practitioners Services 20 1629702766 0 Nurse Practitioners Physician Services 00 1629702998 0 PAYNE RACHEL L 2022195 9999999 B 10 1629702998 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1629702998 0 Physician Assistant Only Fluoride varnish 20 1629702998 0 Physician Assistant Only Healthy Kids Services 20 1629702998 0 Physician Assistant Only Physician Services 00 1629703079 0 SNOW EMILY K 2022301 9999999 B 10 1629703079 0 124 SW ADAMS ST PEORIA IL 616021320 20 1629703079 0 Nurse Practitioners Fluoride varnish 20 1629703079 0 Nurse Practitioners Healthy Kids Services 20 1629703079 0 Nurse Practitioners Nurse Practitioners Services 20 1629703079 0 Nurse Practitioners Physician Services 00 1629704929 0 ONTIS MARISSA A 2022258 9999999 B 10 1629704929 0 5220 BELFORT RD STE 130 JACKSONVILLE FL 322566018 20 1629704929 0 Nurse Practitioners Fluoride varnish 20 1629704929 0 Nurse Practitioners Healthy Kids Services 20 1629704929 0 Nurse Practitioners Nurse Practitioners Services 20 1629704929 0 Nurse Practitioners Physician Services 00 1629705256 0 HERRERA ANGELINA 2025016 9999999 B 10 1629705256 0 PO BOX 10417 HOLYOKE MA 010412017 20 1629705256 0 Physician Assistant Only Fluoride varnish 20 1629705256 0 Physician Assistant Only Healthy Kids Services 20 1629705256 0 Physician Assistant Only Physician Services 00 1629705363 0 LOCKRIDGE MEGLAN JOAN M 2024093 9999999 B 10 1629705363 0 13400 S ROUTE 59 STE 116-326 PLAINFIELD IL 605855826 20 1629705363 0 Other behavior health professional Other 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1629716774 0 Nurse Practitioners Nurse Practitioners Services 20 1629716774 0 Nurse Practitioners Physician Services 00 1629717129 0 PHILLIPS RACHEL C 2024311 9999999 B 10 1629717129 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1629717129 0 Physician Assistant Only Fluoride varnish 20 1629717129 0 Physician Assistant Only Healthy Kids Services 20 1629717129 0 Physician Assistant Only Physician Services 00 1629717293 0 CHAN MICHELLE 2022219 9999999 B 10 1629717293 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1629717293 0 Physicians Anesthesia Services 20 1629717293 0 Physicians Fluoride varnish 20 1629717293 0 Physicians Healthy Kids Services 20 1629717293 0 Physicians Optical Supplies 20 1629717293 0 Physicians Physician Services 00 1629717517 0 WELLS LAUREN M 2022164 9999999 B 10 1629717517 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1629717517 0 Physicians Anesthesia Services 20 1629717517 0 Physicians Healthy Kids Services 20 1629717517 0 Physicians Optical Supplies 20 1629717517 0 Physicians Physician Services 00 1629718002 0 FERNANDEZ-MIRO VANESS M 2022201 9999999 B 10 1629718002 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1629718002 0 Physicians Anesthesia Services 20 1629718002 0 Physicians Fluoride varnish 20 1629718002 0 Physicians Healthy Kids Services 20 1629718002 0 Physicians Optical Supplies 20 1629718002 0 Physicians Physician Services 00 1629718259 0 TALATI SHEEBANI 2022176 9999999 B 10 1629718259 0 PO BOX 3039 OAK BROOK IL 605223039 20 1629718259 0 Physicians Anesthesia Services 20 1629718259 0 Physicians Fluoride varnish 20 1629718259 0 Physicians Healthy Kids Services 20 1629718259 0 Physicians Optical Supplies 20 1629718259 0 Physicians Physician Services 00 1629718572 0 ZUBEK SYLWIA M 2022182 9999999 B 10 1629718572 0 PO BOX 70508 CHICAGO IL 606730508 20 1629718572 0 Physicians Anesthesia Services 20 1629718572 0 Physicians Fluoride varnish 20 1629718572 0 Physicians Healthy Kids Services 20 1629718572 0 Physicians Optical Supplies 20 1629718572 0 Physicians Physician Services 00 1629718879 0 SCHAEFER THOMAS L 2022157 9999999 B 10 1629718879 0 PO BOX 5009 BRENTWOOD TN 370245009 20 1629718879 0 Nurse Practitioners Healthy Kids Services 20 1629718879 0 Nurse Practitioners Nurse Practitioners Services 20 1629718879 0 Nurse Practitioners Physician Services 00 1629719158 0 LARSON LEAH E 2022212 9999999 B 10 1629719158 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1629719158 0 Physicians Anesthesia Services 20 1629719158 0 Physicians Healthy Kids Services 20 1629719158 0 Physicians Optical Supplies 20 1629719158 0 Physicians Physician Services 00 1629719224 0 BAHROLOOMI SHEENA M 2022208 9999999 B 10 1629719224 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1629719224 0 Physicians Anesthesia Services 20 1629719224 0 Physicians Healthy Kids Services 20 1629719224 0 Physicians Optical Supplies 20 1629719224 0 Physicians Physician Services 00 1629719265 0 PATEL NEIL 2022193 9999999 B 10 1629719265 0 1220 S WOOD ST CHICAGO IL 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Practitioners Anesthesia Services 20 1629720248 0 Nurse Practitioners Nurse Practitioners Services 20 1629720248 0 Nurse Practitioners Physician Services 00 1629720891 0 JARAMILLO YOELY 2022070 9999999 B 10 1629720891 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1629720891 0 Nurse Practitioners Fluoride varnish 20 1629720891 0 Nurse Practitioners Healthy Kids Services 20 1629720891 0 Nurse Practitioners Nurse Practitioners Services 20 1629720891 0 Nurse Practitioners Physician Services 00 1629721808 0 PATEL SHIVANI 2022054 9999999 B 10 1629721808 0 125 S BLOOMINGDALE RD STE 11 BLOOMINGDALE IL 601081216 20 1629721808 0 Occupational Therapists Medical Supplies 20 1629721808 0 Occupational Therapists Medical equipment/prosthetic devices 20 1629721808 0 Occupational Therapists Occupational Therapy Services 00 1629722715 0 ASTRAUSKAS KIMBERLY 2024304 9999999 B 10 1629722715 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1629722715 0 Nurse Practitioners Healthy Kids Services 20 1629722715 0 Nurse Practitioners Nurse Practitioners Services 20 1629722715 0 Nurse Practitioners Physician Services 00 1629723101 0 AKIMPAYE LILIANE 2022160 9999999 B 10 1629723101 0 200 OCEANGATE STE 100 LONG BEACH CA 908024317 20 1629723101 0 Nurse Practitioners Fluoride varnish 20 1629723101 0 Nurse Practitioners Healthy Kids Services 20 1629723101 0 Nurse Practitioners Nurse Practitioners Services 20 1629723101 0 Nurse Practitioners Physician Services 00 1629723309 0 MURRAY JOANNE M 2022090 9999999 B 10 1629723309 0 7272 WURZBACH RD STE 601 SAN ANTONIO TX 782404803 20 1629723309 0 Clinical Social Worker Social work service 00 1629724901 0 MILLER MELANIE A 2022062 9999999 B 10 1629724901 0 PO BOX 530 HAVANA IL 626440530 20 1629724901 0 Nurse Practitioners Fluoride varnish 20 1629724901 0 Nurse Practitioners Healthy Kids Services 20 1629724901 0 Nurse Practitioners Nurse Practitioners Services 20 1629724901 0 Nurse Practitioners Physician Services 00 1629727201 0 HOXHA INES 2023176 9999999 B 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Physicians Optical Supplies 20 1629728092 0 Physicians Physician Services 00 1629728241 0 ALIAJ MEGI 2022176 9999999 B 10 1629728241 0 PO BOX 3039 OAK BROOK IL 605223039 20 1629728241 0 Physicians Anesthesia Services 20 1629728241 0 Physicians Fluoride varnish 20 1629728241 0 Physicians Healthy Kids Services 20 1629728241 0 Physicians Optical Supplies 20 1629728241 0 Physicians Physician Services 00 1629730585 0 INGRAM JENNIFER A 2022032 9999999 B 10 1629730585 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1629730585 0 Nurse Practitioners Fluoride varnish 20 1629730585 0 Nurse Practitioners Healthy Kids Services 20 1629730585 0 Nurse Practitioners Nurse Practitioners Services 20 1629730585 0 Nurse Practitioners Physician Services 00 1629731203 0 CARONONGAN SAMMY 2021319 9999999 B 10 1629731203 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1629731203 0 Occupational Therapists Medical Supplies 20 1629731203 0 Occupational Therapists Medical equipment/prosthetic devices 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Practitioners Nurse Practitioners Services 20 1629738018 0 Nurse Practitioners Physician Services 00 1629738661 0 WOLF ELYSE 2022048 9999999 B 10 1629738661 0 600 N COLLEGE AVE GENESEO IL 612541091 20 1629738661 0 Nurse Practitioners Fluoride varnish 20 1629738661 0 Nurse Practitioners Healthy Kids Services 20 1629738661 0 Nurse Practitioners Nurse Practitioners Services 20 1629738661 0 Nurse Practitioners Physician Services 00 1629740790 0 ROWE SHAUNA 2022025 9999999 B 10 1629740790 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1629740790 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1629743315 0 MCCOY ELISHA 2023123 9999999 B 10 1629743315 0 520 VALLEY VIEW DR MOLINE IL 612656152 20 1629743315 0 Physician Assistant Only Fluoride varnish 20 1629743315 0 Physician Assistant Only Healthy Kids Services 20 1629743315 0 Physician Assistant Only Physician Services 00 1629744396 0 CALLAHAN CLAIRE 2021273 9999999 B 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Nurse Practitioners Fluoride varnish 20 1629750542 0 Nurse Practitioners Healthy Kids Services 20 1629750542 0 Nurse Practitioners Nurse Practitioners Services 20 1629750542 0 Nurse Practitioners Physician Services 00 1629751193 0 BOUHAFA YASMINA 2023226 9999999 B 10 1629751193 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1629751193 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1629751441 0 BURKE NAOMI L 2023241 9999999 B 10 1629751441 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1629751441 0 Nurse Practitioners Fluoride varnish 20 1629751441 0 Nurse Practitioners Healthy Kids Services 20 1629751441 0 Nurse Practitioners Nurse Practitioners Services 20 1629751441 0 Nurse Practitioners Physician Services 00 1629751656 0 BARTOLI ELAINA 2024331 9999999 B 10 1629751656 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1629751656 0 Nurse Practitioners Fluoride varnish 20 1629751656 0 Nurse Practitioners Healthy Kids Services 20 1629751656 0 Nurse Practitioners Nurse Practitioners Services 20 1629751656 0 Nurse Practitioners Physician Services 00 1629752191 0 CHANSIRI STEPHANIE 2023174 9999999 B 10 1629752191 0 14840 SHEPARD DR DOLTON IL 604192467 20 1629752191 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1629753322 0 IANNOPOLLO EMILY 2023203 9999999 B 10 1629753322 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1629753322 0 Physicians Anesthesia Services 20 1629753322 0 Physicians Healthy Kids Services 20 1629753322 0 Physicians Optical Supplies 20 1629753322 0 Physicians Physician Services 20 1629753322 0 Physicians Physicians Psychiatric Services 00 1629754874 0 GUPTA RAKESH K 2023244 9999999 B 10 1629754874 0 1003 MARTIN LUTHER KING DR BLOOMINGTON IL 617011429 20 1629754874 0 Physicians Anesthesia Services 20 1629754874 0 Physicians Fluoride varnish 20 1629754874 0 Physicians Healthy Kids Services 20 1629754874 0 Physicians Optical Supplies 20 1629754874 0 Physicians Physician Services 00 1629756655 0 PALAMAR OLESIA 2023223 9999999 B 10 1629756655 0 1414 MAIN ST MELROSE PARK IL 601603902 20 1629756655 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1629759022 0 DEBROCK RYAN L 2023234 9999999 B 10 1629759022 0 5777 DEPT CAROL STREAM IL 601220021 20 1629759022 0 Nurse Practitioners Fluoride varnish 20 1629759022 0 Nurse Practitioners Healthy Kids Services 20 1629759022 0 Nurse Practitioners Nurse Practitioners Services 20 1629759022 0 Nurse Practitioners Physician Services 00 1629759717 0 BEYLER GRACE A 2023213 9999999 B 10 1629759717 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1629759717 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1629761572 0 APDIK TUGCE 2023186 9999999 B 10 1629761572 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1629761572 0 Physicians Anesthesia Services 20 1629761572 0 Physicians Healthy Kids Services 20 1629761572 0 Physicians Optical Supplies 20 1629761572 0 Physicians Physician Services 00 1629762273 0 BROWN CANDACE 2023167 9999999 B 10 1629762273 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1629762273 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1629762273 0 Other behavior health professional Social work service 00 1629762299 0 SUELLENTROP ALEXANDRA 2024221 9999999 B 10 1629762299 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1629762299 0 Physical Therapists Medical Supplies 20 1629762299 0 Physical Therapists Medical equipment/prosthetic devices 20 1629762299 0 Physical Therapists Physical Therapy Services 00 1629762786 0 MCMURRAY MARY GRACE C 2023199 9999999 B 10 1629762786 0 5777 DEPT CAROL STREAM IL 601220021 20 1629762786 0 Nurse Practitioners Healthy Kids Services 20 1629762786 0 Nurse Practitioners Nurse Practitioners Services 20 1629762786 0 Nurse Practitioners Physician Services 00 1629764576 0 BLANFORD EMILY 2023193 9999999 B 10 1629764576 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1629764576 0 Physicians Anesthesia Services 20 1629764576 0 Physicians Healthy Kids Services 20 1629764576 0 Physicians Optical Supplies 20 1629764576 0 Physicians Physician Services 00 1629764642 0 SOLIZ SARAH J 2023116 9999999 B 10 1629764642 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1629764642 0 Nurse Practitioners Fluoride varnish 20 1629764642 0 Nurse Practitioners Healthy Kids Services 20 1629764642 0 Nurse Practitioners Nurse Practitioners Services 20 1629764642 0 Nurse Practitioners Physician Services 00 1629766290 0 GRAHAM NATHAN J 2023175 9999999 B 10 1629766290 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1629766290 0 Physicians Anesthesia Services 20 1629766290 0 Physicians Healthy Kids Services 20 1629766290 0 Physicians Optical Supplies 20 1629766290 0 Physicians Physician Services 00 1629766720 0 NGUYEN NUONG 2023254 9999999 B 10 1629766720 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1629766720 0 Nurse Practitioners Healthy Kids Services 20 1629766720 0 Nurse Practitioners Nurse Practitioners Services 20 1629766720 0 Nurse Practitioners Physician Services 00 1629767363 0 MILLETT MATTHEW A 2024026 9999999 B 10 1629767363 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1629767363 0 Physicians Anesthesia Services 20 1629767363 0 Physicians Healthy Kids Services 20 1629767363 0 Physicians Optical Supplies 20 1629767363 0 Physicians Physician Services 00 1629769047 0 MUDBHARI BABINA 2023248 9999999 B 10 1629769047 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1629769047 0 Nurse Practitioners Fluoride varnish 20 1629769047 0 Nurse Practitioners Healthy Kids Services 20 1629769047 0 Nurse Practitioners Nurse Practitioners Services 20 1629769047 0 Nurse Practitioners Physician Services 00 1629770177 0 SHAUGHNESSY CATHERINE 2024190 9999999 B 10 1629770177 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1629770177 0 Physicians Anesthesia Services 20 1629770177 0 Physicians Healthy Kids Services 20 1629770177 0 Physicians Optical Supplies 20 1629770177 0 Physicians Physician Services 20 1629770177 0 Physicians Physicians Psychiatric Services 00 1629770243 0 MENCZER JORDAN E 2023163 9999999 B 10 1629770243 0 4698 DEPT CAROL STREAM IL 601220021 20 1629770243 0 Physicians Anesthesia Services 20 1629770243 0 Physicians Healthy Kids Services 20 1629770243 0 Physicians Optical Supplies 20 1629770243 0 Physicians Physician Services 00 1629770482 0 GRAEBER SARAH 2023201 9999999 B 10 1629770482 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1629770482 0 Physicians Anesthesia Services 20 1629770482 0 Physicians Fluoride varnish 20 1629770482 0 Physicians Healthy Kids Services 20 1629770482 0 Physicians Optical Supplies 20 1629770482 0 Physicians Physician Services 00 1629770623 0 TORRES RAFAEL 2023164 9999999 B 10 1629770623 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1629770623 0 Physicians Anesthesia Services 20 1629770623 0 Physicians Fluoride varnish 20 1629770623 0 Physicians Healthy Kids Services 20 1629770623 0 Physicians Optical Supplies 20 1629770623 0 Physicians Physician Services 00 1629773486 0 BALLAL DEVESH S 2023213 9999999 B 10 1629773486 0 PO BOX 3039 OAK BROOK IL 605223039 20 1629773486 0 Physicians Anesthesia Services 20 1629773486 0 Physicians Healthy Kids Services 20 1629773486 0 Physicians Optical Supplies 20 1629773486 0 Physicians Physician Services 00 1629776059 0 HARANDI HAMED 2024257 9999999 B 10 1629776059 0 611 W PARK ST URBANA IL 618012529 20 1629776059 0 Physicians Anesthesia Services 20 1629776059 0 Physicians Healthy Kids Services 20 1629776059 0 Physicians Optical Supplies 20 1629776059 0 Physicians Physician Services 00 1629776604 0 HARVEY LAUREN J 2023196 9999999 B 10 1629776604 0 6024 RIDGE AVE STE 116-356 PHILADELPHIA PA 191281601 20 1629776604 0 Physician Assistant Only Fluoride varnish 20 1629776604 0 Physician Assistant Only Healthy Kids Services 20 1629776604 0 Physician Assistant Only Physician Services 00 1629781059 0 NWIA SARAH 2024176 9999999 B 10 1629781059 0 4698 DEPT CAROL STREAM IL 601220021 20 1629781059 0 Physicians Anesthesia Services 20 1629781059 0 Physicians Healthy Kids Services 20 1629781059 0 Physicians Optical Supplies 20 1629781059 0 Physicians Physician Services 00 1629782602 0 SCOTT SASHA E 2023195 9999999 B 10 1629782602 0 33 E 114TH ST CHICAGO IL 606284921 20 1629782602 0 Physician Assistant Only Fluoride varnish 20 1629782602 0 Physician Assistant Only Healthy Kids Services 20 1629782602 0 Physician Assistant Only Physician Services 00 1629782909 0 FERREL KHEELI D 2023145 9999999 B 10 1629782909 0 PO BOX 736216 DALLAS TX 753736216 20 1629782909 0 Nurse Practitioners Fluoride varnish 20 1629782909 0 Nurse Practitioners Healthy Kids Services 20 1629782909 0 Nurse Practitioners Nurse Practitioners Services 20 1629782909 0 Nurse Practitioners Physician Services 00 1629785720 0 KOEHLER RENAE J 2024193 9999999 B 10 1629785720 0 1701 LACEY ST CAPE GIRARDEAU MO 637015230 20 1629785720 0 Physician Assistant Only Fluoride varnish 20 1629785720 0 Physician Assistant Only Healthy Kids Services 20 1629785720 0 Physician Assistant Only Physician Services 00 1629786223 0 TRUDEAU DANIELLE E 2023186 9999999 B 10 1629786223 0 122 S MICHIGAN AVE STE 1441 CHICAGO IL 606036173 20 1629786223 0 Other behavior health professional LCPC/LMFT services 20 1629786223 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1629786371 0 MICHEL EMILY 2022321 9999999 B 10 1629786371 0 1039 BROOK FOREST AVE SHOREWOOD IL 604048849 20 1629786371 0 Nurse Practitioners Healthy Kids Services 20 1629786371 0 Nurse Practitioners Nurse Practitioners Services 20 1629786371 0 Nurse Practitioners Physician Services 00 1629788146 0 SIDDIQUI IMAN 2023255 9999999 B 10 1629788146 0 2744 W 63RD ST CHICAGO IL 606292343 20 1629788146 0 Physician Assistant Only Fluoride varnish 20 1629788146 0 Physician Assistant Only Healthy Kids Services 20 1629788146 0 Physician Assistant Only Physician Services 00 1629790175 0 LAGEMANN ADDISON P 2022270 9999999 B 10 1629790175 0 2327 S 48TH ST QUINCY IL 623056691 20 1629790175 0 Physical Therapists Medical Supplies 20 1629790175 0 Physical Therapists Medical equipment/prosthetic devices 20 1629790175 0 Physical Therapists Physical Therapy Services 00 1629790670 0 MUNOZ JESSICA 2022273 9999999 B 10 1629790670 0 # 8496 CHICAGO IL 606778004 20 1629790670 0 Clinical Social Worker Social work service 00 1629791843 0 CAMPBELL LENELL 2022313 9999999 B 10 1629791843 0 2100 POWELL ST STE 400 EMERYVILLE CA 946081826 20 1629791843 0 Physician Assistant Only Fluoride varnish 20 1629791843 0 Physician Assistant Only Healthy Kids Services 20 1629791843 0 Physician Assistant Only Physician Services 00 1629792577 0 BRIZ ANNA M 2023061 9999999 B 10 1629792577 0 11053 S MILLARD AVE CHICAGO IL 606553327 20 1629792577 0 Occupational Therapists Medical Supplies 20 1629792577 0 Occupational Therapists Medical equipment/prosthetic devices 20 1629792577 0 Occupational Therapists Occupational Therapy Services 00 1629795422 0 CHUN EMILY 2022306 9999999 B 10 1629795422 0 1400 W GREENLEAF AVE CHICAGO IL 606262805 20 1629795422 0 Occupational Therapists Medical Supplies 20 1629795422 0 Occupational Therapists Medical equipment/prosthetic devices 20 1629795422 0 Occupational Therapists Occupational Therapy Services 00 1629796636 0 SAROL VINESSA 2022251 9999999 B 10 1629796636 0 611 W PARK ST URBANA IL 618012529 20 1629796636 0 Nurse Practitioners Healthy Kids Services 20 1629796636 0 Nurse Practitioners Nurse Practitioners Services 20 1629796636 0 Nurse Practitioners Physician Services 00 1629797089 0 CRUMRINE CLAUDIA G 2022285 9999999 B 10 1629797089 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1629797089 0 Physician Assistant Only Fluoride varnish 20 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VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1629810395 0 Physicians Anesthesia Services 20 1629810395 0 Physicians Healthy Kids Services 20 1629810395 0 Physicians Optical Supplies 20 1629810395 0 Physicians Physician Services 00 1629810502 0 READ KEATON 2024200 9999999 B 10 1629810502 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1629810502 0 Physicians Anesthesia Services 20 1629810502 0 Physicians Fluoride varnish 20 1629810502 0 Physicians Healthy Kids Services 20 1629810502 0 Physicians Optical Supplies 20 1629810502 0 Physicians Physician Services 00 1629811005 0 MACKAY MICAELA M 2024169 9999999 B 10 1629811005 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1629811005 0 Physicians Anesthesia Services 20 1629811005 0 Physicians Fluoride varnish 20 1629811005 0 Physicians Healthy Kids Services 20 1629811005 0 Physicians Optical Supplies 20 1629811005 0 Physicians Physician Services 00 1629811450 0 LARKIN GRACE 2024176 9999999 B 10 1629811450 0 100 S GRAND AVE E 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1639148356 0 Physicians Physician Services 00 1639148372 0 JAGGARD PETER 1982201 2029273 B 10 1639148372 0 3200 GRANT ST EVANSTON IL 602011903 20 1639148372 0 Physicians Anesthesia Services 20 1639148372 0 Physicians Fluoride varnish 20 1639148372 0 Physicians Healthy Kids Services 20 1639148372 0 Physicians Optical Supplies 20 1639148372 0 Physicians Physician Services 00 1639148810 0 HERMANN MARK 1996183 9999999 B 10 1639148810 0 1515 DELHI ST STE 100 DUBUQUE IA 520016320 20 1639148810 0 Physicians Anesthesia Services 20 1639148810 0 Physicians Healthy Kids Services 20 1639148810 0 Physicians Optical Supplies 20 1639148810 0 Physicians Physician Services 00 1639149628 0 PARVEZ SHAHEEN 1989335 9999999 B 10 1639149628 0 55 E 86TH AVE MERRILLVILLE IN 464106382 20 1639149628 0 Physicians Anesthesia Services 20 1639149628 0 Physicians Fluoride varnish 20 1639149628 0 Physicians Healthy Kids Services 20 1639149628 0 Physicians Optical Supplies 20 1639149628 0 Physicians Physician Services 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ROBERT A 2024074 9999999 B 10 1639151517 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1639151517 0 Physicians Anesthesia Services 20 1639151517 0 Physicians Healthy Kids Services 20 1639151517 0 Physicians Optical Supplies 20 1639151517 0 Physicians Physician Services 00 1639152549 0 STAGEMAN JAMES 2022025 9999999 B 10 1639152549 0 PO BOX 4037 PORTLAND OR 972084037 20 1639152549 0 Physicians Anesthesia Services 20 1639152549 0 Physicians Fluoride varnish 20 1639152549 0 Physicians Healthy Kids Services 20 1639152549 0 Physicians Optical Supplies 20 1639152549 0 Physicians Physician Services 00 1639152952 0 LAESCH WALTER 1992197 9999999 B 10 1639152952 0 2200 JACOBSSEN DR STE B SUITE B NORMAL IL 617615516 20 1639152952 0 Nurse Practitioners Anesthesia Services 20 1639152952 0 Nurse Practitioners Nurse Practitioners Services 20 1639152952 0 Nurse Practitioners Nursing service 20 1639152952 0 Nurse Practitioners Physician Services 20 1639152952 0 Nurse Practitioners Waiver service 00 1639153216 0 FAROKHI FARHAD 2000290 9999999 B 10 1639153216 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1639153216 0 Physicians Anesthesia Services 20 1639153216 0 Physicians Fluoride varnish 20 1639153216 0 Physicians Healthy Kids Services 20 1639153216 0 Physicians Optical Supplies 20 1639153216 0 Physicians Physician Services 00 1639153646 0 WENCK MARK E 2018011 9999999 B 10 1639153646 0 515 22ND AVE MONROE WI 535661569 20 1639153646 0 Physicians Anesthesia Services 20 1639153646 0 Physicians Healthy Kids Services 20 1639153646 0 Physicians Optical Supplies 20 1639153646 0 Physicians Physician Services 00 1639153802 0 SHARMA SANDEEP 2002137 9999999 B 10 1639153802 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1639153802 0 Physicians Anesthesia Services 20 1639153802 0 Physicians Healthy Kids Services 20 1639153802 0 Physicians Optical Supplies 20 1639153802 0 Physicians Physician Services 00 1639153877 0 SPILLER MARY 2006314 9999999 B 10 1639153877 0 5777 DEPT CAROL STREAM IL 601228942 20 1639153877 0 Nurse Practitioners Fluoride varnish 20 1639153877 0 Nurse Practitioners Healthy Kids Services 20 1639153877 0 Nurse Practitioners Nurse Practitioners Services 20 1639153877 0 Nurse Practitioners Physician Services 00 1639154156 0 ROGERS LAURA H 2002182 9999999 B 10 1639154156 0 PO BOX 11097 CHICAGO IL 606110097 20 1639154156 0 Physicians Anesthesia Services 20 1639154156 0 Physicians Fluoride varnish 20 1639154156 0 Physicians Healthy Kids Services 20 1639154156 0 Physicians Optical Supplies 20 1639154156 0 Physicians Physician Services 00 1639154370 0 TRACY MELISSA J 2013010 9999999 B 10 1639154370 0 16969 VON KARMAN AVE STE 220 IRVINE CA 926064948 20 1639154370 0 Physicians Anesthesia Services 20 1639154370 0 Physicians Fluoride varnish 20 1639154370 0 Physicians Healthy Kids Services 20 1639154370 0 Physicians Optical Supplies 20 1639154370 0 Physicians Physician Services 00 1639154982 0 SHAFFREY JULIE K 2009182 9999999 B 10 1639154982 0 2330 UTAH AVE STE 200 EL SEGUNDO CA 902454817 20 1639154982 0 Physicians Anesthesia Services 20 1639154982 0 Physicians Healthy Kids Services 20 1639154982 0 Physicians Optical Supplies 20 1639154982 0 Physicians Physician Services 00 1639155328 0 PINS MICHAEL 1996183 9999999 B 10 1639155328 0 PO BOX 578 PARK RIDGE IL 600680578 20 1639155328 0 Physicians Anesthesia Services 20 1639155328 0 Physicians Healthy Kids Services 20 1639155328 0 Physicians Optical Supplies 20 1639155328 0 Physicians Physician Services 00 1639155534 0 REYNOLDS ALBERT L 1984244 9999999 B 10 1639155534 0 55 E 86TH AVE STE E SUITE E MERRILLVILLE IN 464106265 20 1639155534 0 Physicians Anesthesia Services 20 1639155534 0 Physicians Fluoride varnish 20 1639155534 0 Physicians Healthy Kids Services 20 1639155534 0 Physicians Optical Supplies 20 1639155534 0 Physicians Physician Services 00 1639155807 0 IBRAHIM MOHAMED A 2008245 9999999 B 10 1639155807 0 PO BOX 488 WORTH IL 604820488 20 1639155807 0 Physical Therapists Medical Supplies 20 1639155807 0 Physical Therapists Medical equipment/prosthetic devices 20 1639155807 0 Physical Therapists Physical Therapy Services 00 1639156383 0 FRIYE PAMELA 1998213 9999999 B 10 1639156383 0 1025 MAINE ST QUINCY IL 623014038 20 1639156383 0 Physicians Anesthesia Services 20 1639156383 0 Physicians Healthy Kids Services 20 1639156383 0 Physicians Optical Supplies 20 1639156383 0 Physicians Physician Services 00 1639157241 0 AVERY EDWIN G 2022348 9999999 B 10 1639157241 0 PO BOX 790126 SAINT LOUIS MO 631790126 20 1639157241 0 Physicians Anesthesia Services 20 1639157241 0 Physicians Healthy Kids Services 20 1639157241 0 Physicians Optical Supplies 20 1639157241 0 Physicians Physician Services 00 1639157928 0 PIANOSI PAOLO 2024258 9999999 B 10 1639157928 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1639157928 0 Physicians Anesthesia Services 20 1639157928 0 Physicians Fluoride varnish 20 1639157928 0 Physicians Healthy Kids Services 20 1639157928 0 Physicians Optical Supplies 20 1639157928 0 Physicians Physician Services 00 1639158199 0 BULKLEY REGINALD THORNTON 1990046 9999999 B 10 1639158199 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1639158199 0 Physicians Anesthesia Services 20 1639158199 0 Physicians Healthy Kids Services 20 1639158199 0 Physicians Optical Supplies 20 1639158199 0 Physicians Physician Services 00 1639158314 0 BAHK JANE K 2000300 9999999 B 10 1639158314 0 1 ERIE CT STE 6140 OAK PARK IL 603022510 20 1639158314 0 Physicians Anesthesia Services 20 1639158314 0 Physicians Healthy Kids Services 20 1639158314 0 Physicians Optical Supplies 20 1639158314 0 Physicians Physician Services 00 1639158728 0 PILDITCH MATTHEW E 1997181 9999999 B 10 1639158728 0 PO BOX 698 HINSDALE IL 605220698 20 1639158728 0 Physicians Anesthesia Services 20 1639158728 0 Physicians Fluoride varnish 20 1639158728 0 Physicians Healthy Kids Services 20 1639158728 0 Physicians Optical Supplies 20 1639158728 0 Physicians Physician Services 00 1639158777 0 QADIR KHURRAM 1995249 9999999 B 10 1639158777 0 5777 DEPT CAROL STREAM IL 601220021 20 1639158777 0 Physicians Anesthesia Services 20 1639158777 0 Physicians Fluoride varnish 20 1639158777 0 Physicians Healthy Kids Services 20 1639158777 0 Physicians Optical Supplies 20 1639158777 0 Physicians Physician Services 00 1639158918 0 SCHNELL THOMAS 1998213 9999999 B 10 1639158918 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1639158918 0 Physicians Anesthesia Services 20 1639158918 0 Physicians Fluoride varnish 20 1639158918 0 Physicians Healthy Kids Services 20 1639158918 0 Physicians Optical Supplies 20 1639158918 0 Physicians Physician Services 00 1639159221 0 SUASTEGUI-MURSULI ISABEL C 1990208 9999999 B 10 1639159221 0 1835 BROADWAY ST STE 210 MELROSE PARK IL 601602040 20 1639159221 0 Dentists Dental Services 20 1639159221 0 Dentists Physician Services 00 1639159247 0 AL-RAHHAL KWSAI 2005244 9999999 B 10 1639159247 0 301 JOHN ST BOX 42 KALAMAZOO MI 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1639160781 0 Physicians Anesthesia Services 20 1639160781 0 Physicians Healthy Kids Services 20 1639160781 0 Physicians Optical Supplies 20 1639160781 0 Physicians Physician Services 00 1639161110 0 GONZALEZ MIGUEL GUDELIO 2002182 9999999 B 10 1639161110 0 PO BOX 578 PARK RIDGE IL 600680578 20 1639161110 0 Physicians Anesthesia Services 20 1639161110 0 Physicians Healthy Kids Services 20 1639161110 0 Physicians Optical Supplies 20 1639161110 0 Physicians Physician Services 00 1639161235 0 YALOWITZ BRUCE R 1994213 9999999 B 10 1639161235 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1639161235 0 Physicians Anesthesia Services 20 1639161235 0 Physicians Healthy Kids Services 20 1639161235 0 Physicians Optical Supplies 20 1639161235 0 Physicians Physician Services 00 1639161433 0 DOTY CHRISTOPHER 2023266 9999999 B 10 1639161433 0 PO BOX 43230 PHOENIX AZ 850803230 20 1639161433 0 Physicians Anesthesia Services 20 1639161433 0 Physicians Healthy Kids Services 20 1639161433 0 Physicians Optical Supplies 20 1639161433 0 Physicians Physician Services 00 1639162530 0 KING THOMAS E 1996153 9999999 B 10 1639162530 0 11133 DUNN RD SAINT LOUIS MO 631366163 20 1639162530 0 Physicians Anesthesia Services 20 1639162530 0 Physicians Fluoride varnish 20 1639162530 0 Physicians Healthy Kids Services 20 1639162530 0 Physicians Optical Supplies 20 1639162530 0 Physicians Physician Services 00 1639162753 0 POPP JAMES E 2016348 9999999 B 10 1639162753 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1639162753 0 Physicians Anesthesia Services 20 1639162753 0 Physicians Healthy Kids Services 20 1639162753 0 Physicians Optical Supplies 20 1639162753 0 Physicians Physician Services 00 1639163850 0 TOMLIN JEFFREY S 1996197 9999999 B 10 1639163850 0 3707 DOTY RD STE F WOODSTOCK IL 600987530 20 1639163850 0 Physicians Anesthesia Services 20 1639163850 0 Physicians Fluoride varnish 20 1639163850 0 Physicians Healthy Kids Services 20 1639163850 0 Physicians Optical Supplies 20 1639163850 0 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1993187 9999999 B 10 1639164601 0 8100 W 119TH ST STE 400 PALOS PARK IL 604643080 20 1639164601 0 Physicians Anesthesia Services 20 1639164601 0 Physicians Fluoride varnish 20 1639164601 0 Physicians Healthy Kids Services 20 1639164601 0 Physicians Optical Supplies 20 1639164601 0 Physicians Physician Services 00 1639164817 0 NIAZI TAHIR 1995233 9999999 B 10 1639164817 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1639164817 0 Physicians Anesthesia Services 20 1639164817 0 Physicians Fluoride varnish 20 1639164817 0 Physicians Healthy Kids Services 20 1639164817 0 Physicians Optical Supplies 20 1639164817 0 Physicians Physician Services 00 1639165285 0 CHRISTENSEN LORI A 2001213 9999999 B 10 1639165285 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1639165285 0 Physicians Anesthesia Services 20 1639165285 0 Physicians Fluoride varnish 20 1639165285 0 Physicians Healthy Kids Services 20 1639165285 0 Physicians Optical Supplies 20 1639165285 0 Physicians Physician Services 00 1639165467 0 VINCI SAMUEL 1985051 9999999 B 10 1639165467 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1639165467 0 Podiatrists Podiatric Services 00 1639165947 0 CHUNG PHILLIP Y 2001182 9999999 B 10 1639165947 0 6308 8TH AVE KENOSHA WI 531435031 20 1639165947 0 Physicians Anesthesia Services 20 1639165947 0 Physicians Fluoride varnish 20 1639165947 0 Physicians Healthy Kids Services 20 1639165947 0 Physicians Optical Supplies 20 1639165947 0 Physicians Physician Services 00 1639165954 0 MAXEY ROBERT 2004249 9999999 B 10 1639165954 0 PO BOX 778791 CHICAGO IL 606776473 20 1639165954 0 Physicians Anesthesia Services 20 1639165954 0 Physicians Healthy Kids Services 20 1639165954 0 Physicians Optical Supplies 20 1639165954 0 Physicians Physician Services 00 1639166226 0 SCHAIDLE KENNETH 1994213 9999999 B 10 1639166226 0 8309 N KNOXVILLE AVE PEORIA IL 616152170 20 1639166226 0 Optometrists Optical Supplies 20 1639166226 0 Optometrists Optometric Services 20 1639166226 0 Optometrists Physician Services 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43230 PHOENIX AZ 850803230 20 1639166531 0 Physicians Anesthesia Services 20 1639166531 0 Physicians Healthy Kids Services 20 1639166531 0 Physicians Optical Supplies 20 1639166531 0 Physicians Physician Services 00 1639167570 0 HAEGE DOLPH D 1997057 9999999 B 10 1639167570 0 4313 ALDER PL BELLEVILLE IL 622267851 20 1639167570 0 Physicians Anesthesia Services 20 1639167570 0 Physicians Healthy Kids Services 20 1639167570 0 Physicians Optical Supplies 20 1639167570 0 Physicians Physician Services 00 1639168503 0 SINK CYNTHIA 1989108 9999999 B 10 1639168503 0 10760 W 143RD ST STE 60 ORLAND PARK IL 604621920 20 1639168503 0 Podiatrists Podiatric Services 00 1639168560 0 JOHNSON HOWARD 2025036 9999999 B 10 1639168560 0 1969 W HART RD BELOIT WI 535112230 20 1639168560 0 Physicians Anesthesia Services 20 1639168560 0 Physicians Healthy Kids Services 20 1639168560 0 Physicians Optical Supplies 20 1639168560 0 Physicians Physician Services 00 1639169279 0 SWANTEK SANDRA 1993274 9999999 B 10 1639169279 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1639169279 0 Physicians Anesthesia Services 20 1639169279 0 Physicians Healthy Kids Services 20 1639169279 0 Physicians Optical Supplies 20 1639169279 0 Physicians Physician Services 20 1639169279 0 Physicians Physicians Psychiatric Services 00 1639169956 0 REVICH YELENA 2004092 9999999 B 10 1639169956 0 1029 HOWARD ST EVANSTON IL 602023877 20 1639169956 0 Dentists Dental Services 20 1639169956 0 Dentists Physician Services 00 1639169998 0 WEINGART RONALD 1995236 9999999 B 10 1639169998 0 1603 N ALPINE RD ST121 ROCKFORD IL 611071439 20 1639169998 0 Optometrists Optical Supplies 20 1639169998 0 Optometrists Optometric Services 20 1639169998 0 Optometrists Physician Services 00 1639170335 0 BOYSEN LAWRENCE 1986244 9999999 B 10 1639170335 0 5777 DEPT CAROL STREAM IL 601228942 20 1639170335 0 Physicians Anesthesia Services 20 1639170335 0 Physicians Healthy Kids Services 20 1639170335 0 Physicians Optical Supplies 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BRYN MAWR AVE STE 800 STE 800 CHICAGO IL 606313222 20 1639177603 0 Physicians Anesthesia Services 20 1639177603 0 Physicians Healthy Kids Services 20 1639177603 0 Physicians Optical Supplies 20 1639177603 0 Physicians Physician Services 00 1639177652 0 WARDELL STEVEN 1997001 9999999 B 10 1639177652 0 8550 W BRYN MAWR AVE STE 800 STE 800 CHICAGO IL 606313222 20 1639177652 0 Physicians Anesthesia Services 20 1639177652 0 Physicians Healthy Kids Services 20 1639177652 0 Physicians Optical Supplies 20 1639177652 0 Physicians Physician Services 00 1639177884 0 REMMEL KERRI 2024236 9999999 B 10 1639177884 0 1160 E SAINT CLAIR ST VINCENNES IN 475914853 20 1639177884 0 Physicians Anesthesia Services 20 1639177884 0 Physicians Healthy Kids Services 20 1639177884 0 Physicians Optical Supplies 20 1639177884 0 Physicians Physician Services 20 1639177884 0 Physicians Physicians Psychiatric Services 00 1639178585 0 BOYD KELLY J 2021338 9999999 B 10 1639178585 0 250 N SHADELAND AVE INDIANAPOLIS IN 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0 Physicians Anesthesia Services 20 1639180722 0 Physicians Healthy Kids Services 20 1639180722 0 Physicians Optical Supplies 20 1639180722 0 Physicians Physician Services 00 1639181084 0 KAPLAN EDWARD H 1988183 9999999 B 10 1639181084 0 PO BOX 74008983 CHICAGO IL 606740001 20 1639181084 0 Physicians Anesthesia Services 20 1639181084 0 Physicians Fluoride varnish 20 1639181084 0 Physicians Healthy Kids Services 20 1639181084 0 Physicians Optical Supplies 20 1639181084 0 Physicians Physician Services 00 1639181605 0 STOTZ AIMEE 1997182 9999999 B 10 1639181605 0 PO BOX 443 BEDFORD PARK IL 604990443 20 1639181605 0 Physicians Anesthesia Services 20 1639181605 0 Physicians Healthy Kids Services 20 1639181605 0 Physicians Optical Supplies 20 1639181605 0 Physicians Physician Services 00 1639181621 0 HEISER RUDOLF N 2024137 9999999 B 10 1639181621 0 5775 WAYZATA BLVD STE 400 SAINT LOUIS PAR MN 554161271 20 1639181621 0 Chiropractors Chiropractic Services 00 1639181647 0 SEELBACH-AGNICH 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Anesthesia Services 20 1639295025 0 Physicians Healthy Kids Services 20 1639295025 0 Physicians Optical Supplies 20 1639295025 0 Physicians Physician Services 00 1639295116 0 RELIGIOSO ERICA 2004166 9999999 B 10 1639295116 0 611 W PARK ST BWPC URBANA IL 618012529 20 1639295116 0 Physical Therapists Medical Supplies 20 1639295116 0 Physical Therapists Medical equipment/prosthetic devices 20 1639295116 0 Physical Therapists Physical Therapy Services 00 1639296551 0 RAZZANO BARBARA 2017339 9999999 B 10 1639296551 0 501 7TH ST ROCKFORD IL 611041242 20 1639296551 0 Speech Therapists Medical Supplies 20 1639296551 0 Speech Therapists Medical equipment/prosthetic devices 20 1639296551 0 Speech Therapists Speech Therapy/Pathology Services 00 1639299209 0 KAPUR SEEMA 2023045 9999999 B 10 1639299209 0 62311 COLLECTION CENTER DR CHICAGO IL 606930001 20 1639299209 0 Physicians Anesthesia Services 20 1639299209 0 Physicians Healthy Kids Services 20 1639299209 0 Physicians Optical Supplies 20 1639299209 0 Physicians Physician Services 00 1639299761 0 STOJILJKOVIC LJUBA 2008336 9999999 B 10 1639299761 0 5777 DEPT CAROL STREAM IL 601220021 20 1639299761 0 Physicians Anesthesia Services 20 1639299761 0 Physicians Healthy Kids Services 20 1639299761 0 Physicians Optical Supplies 20 1639299761 0 Physicians Physician Services 00 1639299977 0 DYBIS JOHN 2007182 9999999 B 10 1639299977 0 2300 N EDWARD ST DECATUR IL 625264163 20 1639299977 0 Physicians Anesthesia Services 20 1639299977 0 Physicians Healthy Kids Services 20 1639299977 0 Physicians Optical Supplies 20 1639299977 0 Physicians Physician Services 00 1639300262 0 LONG ROBERT 2012212 9999999 B 10 1639300262 0 500 PORTER AVE AURORA MO 656052365 20 1639300262 0 Physicians Anesthesia Services 20 1639300262 0 Physicians Fluoride varnish 20 1639300262 0 Physicians Healthy Kids Services 20 1639300262 0 Physicians Optical Supplies 20 1639300262 0 Physicians Physician Services 00 1639300577 0 BUNIS MICHAEL S 2015098 9999999 B 10 1639300577 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1639300577 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639300585 0 HANSEN KIRK 2010001 9999999 B 10 1639300585 0 1830 6TH AVE MOLINE IL 612652105 20 1639300585 0 Dentists Dental Services 20 1639300585 0 Dentists Physician Services 00 1639301096 0 LEONG NICOLE M 2009303 9999999 B 10 1639301096 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1639301096 0 Physicians Anesthesia Services 20 1639301096 0 Physicians Healthy Kids Services 20 1639301096 0 Physicians Optical Supplies 20 1639301096 0 Physicians Physician Services 00 1639301328 0 JAKKULA MADHAVI 2020110 9999999 B 10 1639301328 0 PO BOX 43230 PHOENIX AZ 850803230 20 1639301328 0 Physicians Anesthesia Services 20 1639301328 0 Physicians Healthy Kids Services 20 1639301328 0 Physicians Optical Supplies 20 1639301328 0 Physicians Physician Services 00 1639302797 0 WEESNER VALERIE 2024324 9999999 B 10 1639302797 0 PO BOX 778912 CHICAGO IL 606778912 20 1639302797 0 Psychologist Psychologist service 00 1639302862 0 DOLEHANTY CAROLE A 2017091 9999999 B 10 1639302862 0 2560 24TH ST STE 102 ROCK ISLAND IL 612015389 20 1639302862 0 Nurse Practitioners Healthy Kids Services 20 1639302862 0 Nurse Practitioners Nurse Practitioners Services 20 1639302862 0 Nurse Practitioners Physician Services 00 1639303829 0 AL-NASSIR KALIL I 2018270 9999999 B 10 1639303829 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1639303829 0 Physicians Anesthesia Services 20 1639303829 0 Physicians Fluoride varnish 20 1639303829 0 Physicians Healthy Kids Services 20 1639303829 0 Physicians Optical Supplies 20 1639303829 0 Physicians Physician Services 00 1639304090 0 HALES MELISSA 2024068 9999999 B 10 1639304090 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1639304090 0 Physical Therapists Medical Supplies 20 1639304090 0 Physical Therapists Medical equipment/prosthetic devices 20 1639304090 0 Physical Therapists Physical Therapy Services 00 1639304488 0 HOANG TROY T 2015152 9999999 B 10 1639304488 0 29373 NETWORK PL CHICAGO IL 606733039 20 1639304488 0 Physicians Anesthesia Services 20 1639304488 0 Physicians Healthy Kids Services 20 1639304488 0 Physicians Optical Supplies 20 1639304488 0 Physicians Physician Services 20 1639304488 0 Physicians Physicians Psychiatric Services 00 1639306293 0 BOMMASAMUDRAM PAVANKUMAR 2024290 9999999 B 10 1639306293 0 1160 E SAINT CLAIR ST VINCENNES IN 475914853 20 1639306293 0 Physicians Anesthesia Services 20 1639306293 0 Physicians Fluoride varnish 20 1639306293 0 Physicians Healthy Kids Services 20 1639306293 0 Physicians Optical Supplies 20 1639306293 0 Physicians Physician Services 00 1639306442 0 HALANE MOHAMED 2022353 9999999 B 10 1639306442 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1639306442 0 Physicians Anesthesia Services 20 1639306442 0 Physicians Fluoride varnish 20 1639306442 0 Physicians Healthy Kids Services 20 1639306442 0 Physicians Optical Supplies 20 1639306442 0 Physicians Physician Services 00 1639306574 0 BROWN MEREDITH G 2020353 9999999 B 10 1639306574 0 PO BOX 301208 DALLAS TX 753031208 20 1639306574 0 Physicians Anesthesia Services 20 1639306574 0 Physicians Healthy Kids Services 20 1639306574 0 Physicians Optical Supplies 20 1639306574 0 Physicians Physician Services 00 1639306616 0 HOFF MARIBETH L 2009194 9999999 B 10 1639306616 0 6021 S 74TH AVE SUMMIT ARGO IL 605011500 20 1639306616 0 Speech Therapists Medical Supplies 20 1639306616 0 Speech Therapists Medical equipment/prosthetic devices 20 1639306616 0 Speech Therapists Speech Therapy/Pathology Services 00 1639307044 0 GEIST ALLISON M 2019235 9999999 B 10 1639307044 0 108 DEVON LN NAPERVILLE IL 605405840 20 1639307044 0 Occupational Therapists Medical Supplies 20 1639307044 0 Occupational Therapists Medical equipment/prosthetic devices 20 1639307044 0 Occupational Therapists Occupational Therapy Services 00 1639307069 0 ROBB LINDSEY L 2018091 9999999 B 10 1639307069 0 625 S GILBERT ST STE 2 IOWA CITY IA 522401747 20 1639307069 0 Physician Assistant Only Fluoride varnish 20 1639307069 0 Physician Assistant Only Healthy Kids Services 20 1639307069 0 Physician Assistant Only Physician Services 00 1639307168 0 ATTA FYNN ROSEMARY 2014259 9999999 B 10 1639307168 0 5777 DEPT CAROL STREAM IL 601228942 20 1639307168 0 Physicians Anesthesia Services 20 1639307168 0 Physicians Fluoride varnish 20 1639307168 0 Physicians Healthy Kids Services 20 1639307168 0 Physicians Optical Supplies 20 1639307168 0 Physicians Physician Services 00 1639307283 0 MENA LORA ALFREDO 2015182 9999999 B 10 1639307283 0 2875 W 19TH ST CHICAGO IL 606233501 20 1639307283 0 Physicians All Kids application agent 20 1639307283 0 Physicians Anesthesia Services 20 1639307283 0 Physicians Fluoride varnish 20 1639307283 0 Physicians Healthy Kids Services 20 1639307283 0 Physicians Optical Supplies 20 1639307283 0 Physicians Physician Services 00 1639308323 0 ESTRADA ROBIN 2012297 9999999 B 10 1639308323 0 525 TYLER RD SAINT CHARLES IL 601743305 20 1639308323 0 Speech Therapists Medical Supplies 20 1639308323 0 Speech Therapists Medical equipment/prosthetic devices 20 1639308323 0 Speech Therapists Speech Therapy/Pathology Services 00 1639308737 0 KROW-RODNEY ABENA A 2019163 9999999 B 10 1639308737 0 1200 E TREMONT ST HILLSBORO IL 620491912 20 1639308737 0 Physicians Anesthesia Services 20 1639308737 0 Physicians Fluoride varnish 20 1639308737 0 Physicians Healthy Kids Services 20 1639308737 0 Physicians Optical Supplies 20 1639308737 0 Physicians Physician Services 00 1639309180 0 DAMPER WALTER C 2024253 9999999 B 10 1639309180 0 355 E ERIE ST CHICAGO IL 606113167 20 1639309180 0 Physicians Anesthesia Services 20 1639309180 0 Physicians Healthy Kids Services 20 1639309180 0 Physicians Optical Supplies 20 1639309180 0 Physicians Physician Services 00 1639309941 0 ARKIN LISA M 2014213 9999999 B 10 1639309941 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1639309941 0 Physicians Anesthesia Services 20 1639309941 0 Physicians Healthy Kids Services 20 1639309941 0 Physicians Optical Supplies 20 1639309941 0 Physicians Physician Services 00 1639311509 0 ZALZALA SAJAD M 2019282 9999999 B 10 1639311509 0 111 W JACKSON BLVD CHICAGO IL 606043589 20 1639311509 0 Physicians Anesthesia Services 20 1639311509 0 Physicians Fluoride varnish 20 1639311509 0 Physicians Healthy Kids Services 20 1639311509 0 Physicians Optical Supplies 20 1639311509 0 Physicians Physician Services 00 1639311699 0 ARSLANAGIC ALMA 2012275 9999999 B 10 1639311699 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1639311699 0 Physicians Anesthesia Services 20 1639311699 0 Physicians Fluoride varnish 20 1639311699 0 Physicians Healthy Kids Services 20 1639311699 0 Physicians Optical Supplies 20 1639311699 0 Physicians Physician Services 00 1639312036 0 SCHWARTZ DOUGLAS 2022286 9999999 B 10 1639312036 0 1232 W STATE ROAD 2 LA PORTE IN 463505469 20 1639312036 0 Physicians Anesthesia Services 20 1639312036 0 Physicians Healthy Kids Services 20 1639312036 0 Physicians Optical Supplies 20 1639312036 0 Physicians Physician Services 00 1639312408 0 PARR VALERIE E 2021298 9999999 B 10 1639312408 0 PO BOX 43230 PHOENIX AZ 850803230 20 1639312408 0 Physicians Anesthesia Services 20 1639312408 0 Physicians Fluoride varnish 20 1639312408 0 Physicians Healthy Kids Services 20 1639312408 0 Physicians Optical Supplies 20 1639312408 0 Physicians Physician Services 00 1639312481 0 FAN YUAN 2014001 9999999 B 10 1639312481 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1639312481 0 Physicians Anesthesia Services 20 1639312481 0 Physicians Healthy Kids Services 20 1639312481 0 Physicians Optical Supplies 20 1639312481 0 Physicians Physician Services 20 1639312481 0 Physicians Physicians Psychiatric Services 00 1639312556 0 AHMED OMAR 2012183 9999999 B 10 1639312556 0 26895 NETWORK PL CHICAGO IL 606731268 20 1639312556 0 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1639320591 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1639320591 0 Physicians Anesthesia Services 20 1639320591 0 Physicians Healthy Kids Services 20 1639320591 0 Physicians Optical Supplies 20 1639320591 0 Physicians Physician Services 00 1639320757 0 THIELMANN CAROLYN A 2020069 9999999 B 10 1639320757 0 15100 S 94TH AVE ORLAND PARK IL 604623291 20 1639320757 0 Speech Therapists Medical Supplies 20 1639320757 0 Speech Therapists Medical equipment/prosthetic devices 20 1639320757 0 Speech Therapists Speech Therapy/Pathology Services 00 1639321045 0 MAKARIAN ALEXANDRE 2024298 9999999 B 10 1639321045 0 PO BOX 1257 HANNIBAL MO 634011257 20 1639321045 0 Physicians Anesthesia Services 20 1639321045 0 Physicians Healthy Kids Services 20 1639321045 0 Physicians Optical Supplies 20 1639321045 0 Physicians Physician Services 00 1639321482 0 WHARTON STACIE 2020245 9999999 B 10 1639321482 0 1 TRANSAM PLAZA DR STE 100 OAKBROOK TERRAC IL 601814286 20 1639321482 0 Physician Assistant 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EUCLID AVE SAINT LOUIS MO 631101010 20 1639332968 0 Physicians Anesthesia Services 20 1639332968 0 Physicians Fluoride varnish 20 1639332968 0 Physicians Healthy Kids Services 20 1639332968 0 Physicians Optical Supplies 20 1639332968 0 Physicians Physician Services 00 1639333263 0 SIEGEL MATTHEW 2016060 9999999 B 10 1639333263 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1639333263 0 Physicians Anesthesia Services 20 1639333263 0 Physicians Fluoride varnish 20 1639333263 0 Physicians Healthy Kids Services 20 1639333263 0 Physicians Optical Supplies 20 1639333263 0 Physicians Physician Services 00 1639333578 0 MONROE HEATHER A 2009274 9999999 B 10 1639333578 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1639333578 0 Audiologists Audiology Services 20 1639333578 0 Audiologists Medical Supplies 20 1639333578 0 Audiologists Medical equipment/prosthetic devices 00 1639333826 0 FRITZ HEATHER T 2008183 9999999 B 10 1639333826 0 PO BOX 775231 CHICAGO IL 606775231 20 1639333826 0 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1639343346 0 Physicians Healthy Kids Services 20 1639343346 0 Physicians Optical Supplies 20 1639343346 0 Physicians Physician Services 00 1639343403 0 SAUTNER JEREMY S 2022121 9999999 B 10 1639343403 0 PO BOX 43230 PHOENIX AZ 850803230 20 1639343403 0 Physicians Anesthesia Services 20 1639343403 0 Physicians Healthy Kids Services 20 1639343403 0 Physicians Optical Supplies 20 1639343403 0 Physicians Physician Services 00 1639343874 0 ANASTASI AMBER 2011360 9999999 B 10 1639343874 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1639343874 0 Physicians Anesthesia Services 20 1639343874 0 Physicians Fluoride varnish 20 1639343874 0 Physicians Healthy Kids Services 20 1639343874 0 Physicians Optical Supplies 20 1639343874 0 Physicians Physician Services 00 1639345598 0 HARSHA VARDHAN SINDHUJA 2016186 9999999 B 10 1639345598 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1639345598 0 Physicians Anesthesia Services 20 1639345598 0 Physicians Fluoride varnish 20 1639345598 0 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1639358427 0 Physicians Fluoride varnish 20 1639358427 0 Physicians Healthy Kids Services 20 1639358427 0 Physicians Optical Supplies 20 1639358427 0 Physicians Physician Services 00 1639358914 0 GRANT MOLLY J 2014136 9999999 B 10 1639358914 0 PO BOX 8500 LOCKBOX 7642 PHILADELPHIA PA 191787642 20 1639358914 0 Nurse Practitioners Healthy Kids Services 20 1639358914 0 Nurse Practitioners Nurse Practitioners Services 20 1639358914 0 Nurse Practitioners Physician Services 00 1639359094 0 SHETH HARSHAL 2009182 9999999 B 10 1639359094 0 29373 NETWORK PL CHICAGO IL 606733039 20 1639359094 0 Physicians Anesthesia Services 20 1639359094 0 Physicians Fluoride varnish 20 1639359094 0 Physicians Healthy Kids Services 20 1639359094 0 Physicians Optical Supplies 20 1639359094 0 Physicians Physician Services 00 1639359698 0 WILLIAMS NINA M 2022118 9999999 B 10 1639359698 0 7272 WURZBACH RD STE 601 SAN ANTONIO TX 782404803 20 1639359698 0 Clinical Social Worker Social work service 00 1639361413 0 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Services 20 1639371529 0 Physicians Optical Supplies 20 1639371529 0 Physicians Physician Services 00 1639373228 0 THAMPI BETSY 2008183 9999999 B 10 1639373228 0 PO BOX 5588 BELFAST ME 049155500 20 1639373228 0 Physicians Anesthesia Services 20 1639373228 0 Physicians Fluoride varnish 20 1639373228 0 Physicians Healthy Kids Services 20 1639373228 0 Physicians Optical Supplies 20 1639373228 0 Physicians Physician Services 00 1639373699 0 BANAYAN JENNIFER 2011206 9999999 B 10 1639373699 0 5777 DEPT CAROL STREAM IL 601220021 20 1639373699 0 Physicians Anesthesia Services 20 1639373699 0 Physicians Healthy Kids Services 20 1639373699 0 Physicians Optical Supplies 20 1639373699 0 Physicians Physician Services 00 1639374242 0 OHEMENG AARON N 1990001 9999999 B 10 1639374242 0 6429 NORTH AVE STE 104 OAK PARK IL 603021012 20 1639374242 0 Dentists Dental Services 20 1639374242 0 Dentists Physician Services 00 1639375140 0 LEACOCK BENJAMIN WILLIAM 2010182 9999999 B 10 1639375140 0 3015 N BALLAS 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Fluoride varnish 20 1639376551 0 Physicians Healthy Kids Services 20 1639376551 0 Physicians Optical Supplies 20 1639376551 0 Physicians Physician Services 00 1639377021 0 HURST KATHERINE 2014286 9999999 B 10 1639377021 0 1118 11TH ST DE WITT IA 527421353 20 1639377021 0 Physicians Anesthesia Services 20 1639377021 0 Physicians Healthy Kids Services 20 1639377021 0 Physicians Optical Supplies 20 1639377021 0 Physicians Physician Services 00 1639377260 0 CHIRANAND PAULPOJ 2011182 9999999 B 10 1639377260 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1639377260 0 Physicians Anesthesia Services 20 1639377260 0 Physicians Healthy Kids Services 20 1639377260 0 Physicians Optical Supplies 20 1639377260 0 Physicians Physician Services 00 1639377971 0 JOSEPH MERRIL J 2008218 9999999 B 10 1639377971 0 544 NUNDA TRL CRYSTAL LAKE IL 600123795 20 1639377971 0 Speech Therapists Medical Supplies 20 1639377971 0 Speech Therapists Medical equipment/prosthetic devices 20 1639377971 0 Speech 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Services 00 1639381817 0 QURESHI MARYAM 2009305 9999999 B 10 1639381817 0 2300 N EDWARD ST DECATUR IL 625264163 20 1639381817 0 Physicians Anesthesia Services 20 1639381817 0 Physicians Fluoride varnish 20 1639381817 0 Physicians Healthy Kids Services 20 1639381817 0 Physicians Optical Supplies 20 1639381817 0 Physicians Physician Services 00 1639382146 0 WHITE MEGAN M 2007121 9999999 B 10 1639382146 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1639382146 0 Nurse Practitioners Healthy Kids Services 20 1639382146 0 Nurse Practitioners Nurse Practitioners Services 20 1639382146 0 Nurse Practitioners Physician Services 00 1639383631 0 AHMED IRAM A 2009335 9999999 B 10 1639383631 0 2500 S HIGHLAND AVE STE 230 LOMBARD IL 601485363 20 1639383631 0 Physicians Anesthesia Services 20 1639383631 0 Physicians Fluoride varnish 20 1639383631 0 Physicians Healthy Kids Services 20 1639383631 0 Physicians Optical Supplies 20 1639383631 0 Physicians Physician Services 00 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varnish 20 1639390388 0 Physicians Healthy Kids Services 20 1639390388 0 Physicians Optical Supplies 20 1639390388 0 Physicians Physician Services 00 1639391006 0 FREY JAMIE L 2010182 9999999 B 10 1639391006 0 5401 N KNOXVILLE AVE STE 115 SUITE 115 PEORIA IL 616145068 20 1639391006 0 Physicians Anesthesia Services 20 1639391006 0 Physicians Healthy Kids Services 20 1639391006 0 Physicians Optical Supplies 20 1639391006 0 Physicians Physician Services 00 1639392376 0 MOSELEY JENNIFER 2016194 9999999 B 10 1639392376 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1639392376 0 Physical Therapists Medical Supplies 20 1639392376 0 Physical Therapists Medical equipment/prosthetic devices 20 1639392376 0 Physical Therapists Physical Therapy Services 00 1639392400 0 WILLIAMS REGAN 2025043 9999999 B 10 1639392400 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1639392400 0 Physicians Anesthesia Services 20 1639392400 0 Physicians Healthy Kids Services 20 1639392400 0 Physicians Optical 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2016224 9999999 B 10 1639397359 0 2605 KENTUCKY AVE STE 306 PADUCAH KY 420033802 20 1639397359 0 Physicians Anesthesia Services 20 1639397359 0 Physicians Healthy Kids Services 20 1639397359 0 Physicians Optical Supplies 20 1639397359 0 Physicians Physician Services 00 1639397391 0 SPICER DORIS E 2013001 9999999 B 10 1639397391 0 5777 DEPT CAROL STREAM IL 601220021 20 1639397391 0 Nurse Practitioners Healthy Kids Services 20 1639397391 0 Nurse Practitioners Nurse Practitioners Services 20 1639397391 0 Nurse Practitioners Physician Services 00 1639402738 0 DAVIS JEFFREY 2010158 9999999 B 10 1639402738 0 1400 LEMAY FERRY RD SAINT LOUIS MO 631252408 20 1639402738 0 Nurse Practitioners Fluoride varnish 20 1639402738 0 Nurse Practitioners Healthy Kids Services 20 1639402738 0 Nurse Practitioners Nurse Practitioners Services 20 1639402738 0 Nurse Practitioners Physician Services 00 1639402977 0 DEWOLFE TARA MARIE 2009336 9999999 B 10 1639402977 0 4022 W NEWPORT AVE CHICAGO IL 606414021 20 1639402977 0 Physical Therapists Medical Supplies 20 1639402977 0 Physical Therapists Medical equipment/prosthetic devices 20 1639402977 0 Physical Therapists Physical Therapy Services 00 1639403355 0 HOUSE SARAH BETH 2016292 9999999 B 10 1639403355 0 448 ELA ST APT 1S BARRINGTON IL 600103370 20 1639403355 0 Physical Therapists Medical Supplies 20 1639403355 0 Physical Therapists Medical equipment/prosthetic devices 20 1639403355 0 Physical Therapists Physical Therapy Services 00 1639403710 0 BUCKHALTER ANSLEY 2020023 9999999 B 10 1639403710 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1639403710 0 Physician Assistant Only Fluoride varnish 20 1639403710 0 Physician Assistant Only Healthy Kids Services 20 1639403710 0 Physician Assistant Only Physician Services 00 1639404908 0 JOHNSON KATHERINE E 2013240 9999999 B 10 1639404908 0 1101 W 40TH ST UNIT 2225 CHATTANOOGA TN 374091379 20 1639404908 0 Clinical Social Worker Social work service 00 1639406879 0 MANK KIM M 2011103 9999999 B 10 1639406879 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1639406879 0 Nurse Practitioners Healthy Kids Services 20 1639406879 0 Nurse Practitioners Nurse Practitioners Services 20 1639406879 0 Nurse Practitioners Physician Services 00 1639407174 0 EAGEN KELLENE 2020092 9999999 B 10 1639407174 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1639407174 0 Physicians Anesthesia Services 20 1639407174 0 Physicians Fluoride varnish 20 1639407174 0 Physicians Healthy Kids Services 20 1639407174 0 Physicians Optical Supplies 20 1639407174 0 Physicians Physician Services 00 1639410772 0 DE JAYNES STEPHEN L 2020335 9999999 B 10 1639410772 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1639410772 0 Other behavior health professional LCPC/LMFT services 00 1639411838 0 KIM LARRY J 2017209 9999999 B 10 1639411838 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1639411838 0 Physicians Anesthesia Services 20 1639411838 0 Physicians Healthy Kids Services 20 1639411838 0 Physicians Optical Supplies 20 1639411838 0 Physicians Physician Services 00 1639412364 0 LUX KIMBERLY 2015027 9999999 B 10 1639412364 0 4025 N SHERIDAN RD CHICAGO IL 606132010 20 1639412364 0 Clinical Social Worker Social work service 00 1639412745 0 ISSA RASHA N 2016286 9999999 B 10 1639412745 0 700 E OGDEN AVE STE 202 WESTMONT IL 605591296 20 1639412745 0 Physicians Anesthesia Services 20 1639412745 0 Physicians Fluoride varnish 20 1639412745 0 Physicians Healthy Kids Services 20 1639412745 0 Physicians Optical Supplies 20 1639412745 0 Physicians Physician Services 00 1639412778 0 SUMSKI CHRISTOPHER ALAN 2017001 9999999 B 10 1639412778 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1639412778 0 Physicians Anesthesia Services 20 1639412778 0 Physicians Fluoride varnish 20 1639412778 0 Physicians Healthy Kids Services 20 1639412778 0 Physicians Optical Supplies 20 1639412778 0 Physicians Physician Services 00 1639412802 0 VELARDE SERGIO A 2018004 9999999 B 10 1639412802 0 110 S HAGER AVE STE 103 BARRINGTON IL 600104170 20 1639412802 0 Clinical Social Worker Social work service 00 1639415979 0 JAMES MARY SHIELLAH B 2022049 9999999 B 10 1639415979 0 1000 REMINGTON BLVD STE 110 SUITE 110 BOLINGBROOK IL 604404708 20 1639415979 0 Nurse Practitioners Fluoride varnish 20 1639415979 0 Nurse Practitioners Healthy Kids Services 20 1639415979 0 Nurse Practitioners Nurse Practitioners Services 20 1639415979 0 Nurse Practitioners Physician Services 00 1639419443 0 SCOGGIN-CHANG CHELSIE 2014156 9999999 B 10 1639419443 0 3436 N KENNICOTT AVE STE 114 STE 114 ARLINGTON HEIGH IL 600047814 20 1639419443 0 Other behavior health professional LCPC/LMFT services 00 1639422215 0 LAMAR MELISSA 2015176 9999999 B 10 1639422215 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1639422215 0 Psychologist Psychologist service 00 1639423239 0 MEREDITH REBECCA 2018032 9999999 B 10 1639423239 0 101 E STATE ST KENNETT SQUARE PA 193483109 20 1639423239 0 Occupational Therapists Medical Supplies 20 1639423239 0 Occupational Therapists Medical equipment/prosthetic devices 20 1639423239 0 Occupational Therapists Occupational Therapy Services 00 1639423866 0 PAULUS SARA M 2016360 9999999 B 10 1639423866 0 2414 KOHLER MEMORIAL DR SHEBOYGAN WI 530813129 20 1639423866 0 Physician Assistant Only Fluoride varnish 20 1639423866 0 Physician Assistant Only Healthy Kids Services 20 1639423866 0 Physician Assistant Only Physician Services 00 1639424203 0 HATAYAMA CHAD 2012183 9999999 B 10 1639424203 0 15 APEX DR HIGHLAND IL 622491282 20 1639424203 0 Physical Therapists Medical Supplies 20 1639424203 0 Physical Therapists Medical equipment/prosthetic devices 20 1639424203 0 Physical Therapists Physical Therapy Services 00 1639424211 0 FIRWANA BELAL 2018198 9999999 B 10 1639424211 0 2605 KENTUCKY AVE STE 306 PADUCAH KY 420033802 20 1639424211 0 Physicians Anesthesia Services 20 1639424211 0 Physicians Fluoride varnish 20 1639424211 0 Physicians Healthy Kids Services 20 1639424211 0 Physicians Optical Supplies 20 1639424211 0 Physicians Physician Services 00 1639424435 0 ALDAGHLAWI FADI 2014097 9999999 B 10 1639424435 0 5777 DEPT CAROL STREAM IL 601228942 20 1639424435 0 Physicians Anesthesia Services 20 1639424435 0 Physicians Fluoride varnish 20 1639424435 0 Physicians Healthy Kids Services 20 1639424435 0 Physicians Optical Supplies 20 1639424435 0 Physicians Physician Services 00 1639424476 0 EGLI DIANE N 2016146 9999999 B 10 1639424476 0 5777 DEPT CAROL STREAM IL 601228942 20 1639424476 0 Physician Assistant Only Fluoride varnish 20 1639424476 0 Physician Assistant Only Healthy Kids Services 20 1639424476 0 Physician Assistant Only Physician Services 00 1639425366 0 GREENE HEATHER J 2022013 9999999 B 10 1639425366 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1639425366 0 Speech Therapists Medical Supplies 20 1639425366 0 Speech Therapists Medical equipment/prosthetic devices 20 1639425366 0 Speech Therapists Speech Therapy/Pathology Services 00 1639425499 0 SLOAN MEGAN M 2020336 9999999 B 10 1639425499 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1639425499 0 Nurse Practitioners Healthy Kids Services 20 1639425499 0 Nurse Practitioners Nurse Practitioners Services 20 1639425499 0 Nurse Practitioners Physician Services 00 1639425978 0 NAWAZ AAMIR 2017301 9999999 B 10 1639425978 0 PO BOX 8742 FORT WORTH TX 761240742 20 1639425978 0 Physicians Anesthesia Services 20 1639425978 0 Physicians Healthy Kids Services 20 1639425978 0 Physicians Optical Supplies 20 1639425978 0 Physicians Physician Services 00 1639426455 0 ZERULL KATHERINE A 2016042 9999999 B 10 1639426455 0 2560 24TH ST STE 101 ROCK ISLAND IL 612015389 20 1639426455 0 Clinical Social Worker Social work service 00 1639426661 0 WHIPPLE LEAH C 2016067 9999999 B 10 1639426661 0 1025 MAINE ST QUINCY IL 623014038 20 1639426661 0 Physical Therapists Medical Supplies 20 1639426661 0 Physical Therapists Medical equipment/prosthetic devices 20 1639426661 0 Physical Therapists Physical Therapy Services 00 1639428949 0 ALMEIDA MICHAEL J 2012212 9999999 B 10 1639428949 0 400 10TH ST E WACONIA MN 553874552 20 1639428949 0 Nurse Practitioners Anesthesia Services 20 1639428949 0 Nurse Practitioners Nurse Practitioners Services 20 1639428949 0 Nurse Practitioners Physician Services 00 1639429855 0 JORDAL DANIELLE D 2013065 9999999 B 10 1639429855 0 1S450 SUMMIT AVE STE 270 OAKBROOK TERRAC IL 601813959 20 1639429855 0 Nurse Practitioners Healthy Kids Services 20 1639429855 0 Nurse Practitioners Nurse Practitioners Services 20 1639429855 0 Nurse Practitioners Physician Services 00 1639429897 0 THEKKEDAM SUCHETA 2022320 9999999 B 10 1639429897 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1639429897 0 Psychologist Psychologist service 00 1639431000 0 MYERS DANIEL 2024122 9999999 B 10 1639431000 0 175 E HOUSTON ST SAN ANTONIO TX 782052255 20 1639431000 0 Optometrists Optical Supplies 20 1639431000 0 Optometrists Optometric Services 20 1639431000 0 Optometrists Physician Services 00 1639431059 0 AGBE-DAVIES OLANREWAJU 2023089 9999999 B 10 1639431059 0 PO BOX 781076 DETROIT MI 482781076 20 1639431059 0 Physicians Anesthesia Services 20 1639431059 0 Physicians Healthy Kids Services 20 1639431059 0 Physicians Optical Supplies 20 1639431059 0 Physicians Physician Services 20 1639431059 0 Physicians Physicians Psychiatric Services 00 1639432032 0 AHMAD MUNEEB 2018215 9999999 B 10 1639432032 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1639432032 0 Physicians Anesthesia Services 20 1639432032 0 Physicians Fluoride varnish 20 1639432032 0 Physicians Healthy Kids Services 20 1639432032 0 Physicians Optical Supplies 20 1639432032 0 Physicians Physician Services 00 1639432107 0 OYEDIRAN BABATUNDE 2022217 9999999 B 10 1639432107 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1639432107 0 Physicians Anesthesia Services 20 1639432107 0 Physicians Healthy Kids Services 20 1639432107 0 Physicians Optical Supplies 20 1639432107 0 Physicians Physician Services 00 1639432180 0 HAUSPURG-JANICKI ALISSE 2021222 9999999 B 10 1639432180 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1639432180 0 Physicians Anesthesia Services 20 1639432180 0 Physicians Healthy Kids Services 20 1639432180 0 Physicians Optical Supplies 20 1639432180 0 Physicians Physician Services 00 1639432909 0 DICHTL JOHN 2016243 9999999 B 10 1639432909 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1639432909 0 Other behavior health professional LCPC/LMFT services 20 1639432909 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639433907 0 HUSSEIN OMAR M 2023346 9999999 B 10 1639433907 0 5777 DEPT CAROL STREAM IL 601220021 20 1639433907 0 Physicians Anesthesia Services 20 1639433907 0 Physicians Healthy Kids Services 20 1639433907 0 Physicians Optical Supplies 20 1639433907 0 Physicians Physician Services 20 1639433907 0 Physicians Physicians Psychiatric Services 00 1639433923 0 SERRATO SARAH 2012263 9999999 B 10 1639433923 0 1000 HART RD STE 205 BARRINGTON IL 600102675 20 1639433923 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639434244 0 OPPERMAN ADELINE 2017321 9999999 B 10 1639434244 0 501 7TH ST ROCKFORD IL 611041242 20 1639434244 0 Speech Therapists Medical Supplies 20 1639434244 0 Speech Therapists Medical equipment/prosthetic devices 20 1639434244 0 Speech Therapists Speech Therapy/Pathology Services 00 1639435209 0 VILLA EDWARD C 2015226 9999999 B 10 1639435209 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1639435209 0 Physicians All Kids application agent 20 1639435209 0 Physicians Anesthesia Services 20 1639435209 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1639435209 0 Physicians Fluoride varnish 20 1639435209 0 Physicians Healthy Kids Services 20 1639435209 0 Physicians Optical Supplies 20 1639435209 0 Physicians Physician Services 00 1639435381 0 NORD MICHAEL T 2022144 9999999 B 10 1639435381 0 6024 RIDGE AVE STE 116-356 PHILADELPHIA PA 191281601 20 1639435381 0 Physicians Anesthesia Services 20 1639435381 0 Physicians Healthy Kids Services 20 1639435381 0 Physicians Optical Supplies 20 1639435381 0 Physicians Physician Services 00 1639435837 0 HUMERA SUBUHI F 2015236 9999999 B 10 1639435837 0 29373 NETWORK PL CHICAGO IL 606733039 20 1639435837 0 Physicians Anesthesia Services 20 1639435837 0 Physicians Fluoride varnish 20 1639435837 0 Physicians Healthy Kids Services 20 1639435837 0 Physicians Optical Supplies 20 1639435837 0 Physicians Physician Services 00 1639436058 0 DIDION RACHEL A 2013324 9999999 B 10 1639436058 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1639436058 0 Nurse Practitioners Fluoride varnish 20 1639436058 0 Nurse Practitioners Healthy Kids Services 20 1639436058 0 Nurse Practitioners Nurse Practitioners Services 20 1639436058 0 Nurse Practitioners Physician Services 00 1639436199 0 TANAKA SHOICHIRO A 2021119 9999999 B 10 1639436199 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1639436199 0 Physicians Anesthesia Services 20 1639436199 0 Physicians Healthy Kids Services 20 1639436199 0 Physicians Optical Supplies 20 1639436199 0 Physicians Physician Services 00 1639436629 0 BELLINI GEOFFREY 2022161 9999999 B 10 1639436629 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1639436629 0 Physicians Anesthesia Services 20 1639436629 0 Physicians Healthy Kids Services 20 1639436629 0 Physicians Optical Supplies 20 1639436629 0 Physicians Physician Services 00 1639436694 0 ELLIOTT JAMIE L 2017116 9999999 B 10 1639436694 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1639436694 0 Physicians Anesthesia Services 20 1639436694 0 Physicians Healthy Kids Services 20 1639436694 0 Physicians Optical Supplies 20 1639436694 0 Physicians Physician Services 20 1639436694 0 Physicians Physicians Psychiatric Services 00 1639436777 0 FAROOQ ASIM V 2015189 9999999 B 10 1639436777 0 150 HARVESTER DR STE 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1639438997 0 Physicians Optical Supplies 20 1639438997 0 Physicians Physician Services 00 1639439177 0 BUMATAYO ARLI M 2014244 9999999 B 10 1639439177 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1639439177 0 Physicians All Kids application agent 20 1639439177 0 Physicians Anesthesia Services 20 1639439177 0 Physicians Fluoride varnish 20 1639439177 0 Physicians Healthy Kids Services 20 1639439177 0 Physicians Optical Supplies 20 1639439177 0 Physicians Physician Services 00 1639440506 0 MOLINA CAMILO A 2020199 9999999 B 10 1639440506 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1639440506 0 Physicians Anesthesia Services 20 1639440506 0 Physicians Healthy Kids Services 20 1639440506 0 Physicians Optical Supplies 20 1639440506 0 Physicians Physician Services 00 1639442510 0 MARASIGAN AGATONA V 2012142 9999999 H 10 1639442510 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1639442510 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639442643 0 MOSLEY ELVIRA 2011286 9999999 B 10 1639442643 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1639442643 0 Other behavior health professional All Kids application agent 20 1639442643 0 Other behavior health professional LCPC/LMFT services 00 1639443138 0 HODGES DAMASO ALLEN 2017276 9999999 B 10 1639443138 0 7300 W COLLEGE DR PALOS HEIGHTS IL 604631152 20 1639443138 0 Clinical Social Worker Social work service 00 1639443245 0 DARKO LAURA N 2015251 9999999 B 10 1639443245 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1639443245 0 Physicians Anesthesia Services 20 1639443245 0 Physicians Healthy Kids Services 20 1639443245 0 Physicians Optical Supplies 20 1639443245 0 Physicians Physician Services 00 1639443484 0 CHRZANOWSKI KARI D. 2012044 9999999 B 10 1639443484 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1639443484 0 Nurse Practitioners Anesthesia Services 20 1639443484 0 Nurse Practitioners Nurse Practitioners Services 20 1639443484 0 Nurse Practitioners Physician Services 00 1639443567 0 TELLEZ ANDRES 2012142 9999999 H 10 1639443567 0 3010 GRAND AVE WAUKEGAN IL 600852321 20 1639443567 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639443799 0 SETTERGREN EMILY 2022283 9999999 B 10 1639443799 0 5777 DEPT CAROL STREAM IL 601228942 20 1639443799 0 Psychologist Psychologist service 00 1639444110 0 MARCIANO JANETTE S 2017159 9999999 B 10 1639444110 0 2041 GOOSE LAKE RD SAUGET IL 622062822 20 1639444110 0 Physician Assistant Only All Kids application agent 20 1639444110 0 Physician Assistant Only Fluoride varnish 20 1639444110 0 Physician Assistant Only Healthy Kids Services 20 1639444110 0 Physician Assistant Only Physician Services 00 1639445331 0 LIRA SOREL 2015233 9999999 B 10 1639445331 0 2875 W 19TH ST CHICAGO IL 606233501 20 1639445331 0 Physicians All Kids application agent 20 1639445331 0 Physicians Anesthesia Services 20 1639445331 0 Physicians Fluoride varnish 20 1639445331 0 Physicians Healthy Kids Services 20 1639445331 0 Physicians Optical Supplies 20 1639445331 0 Physicians Physician Services 00 1639445406 0 GORE STEPHEN 2015244 9999999 B 10 1639445406 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1639445406 0 Physicians Anesthesia Services 20 1639445406 0 Physicians Healthy Kids Services 20 1639445406 0 Physicians Optical Supplies 20 1639445406 0 Physicians Physician Services 00 1639445877 0 RIVAS JOSEPH R 2021110 9999999 B 10 1639445877 0 1207 W LELAND AVE CHICAGO IL 606407043 20 1639445877 0 Physicians Anesthesia Services 20 1639445877 0 Physicians Healthy Kids Services 20 1639445877 0 Physicians Optical Supplies 20 1639445877 0 Physicians Physician Services 00 1639447790 0 ELMORE BETH 2022069 9999999 B 10 1639447790 0 9835 MANCHESTER RD SAINT LOUIS MO 631191243 20 1639447790 0 Speech Therapists Medical Supplies 20 1639447790 0 Speech Therapists Medical equipment/prosthetic devices 20 1639447790 0 Speech Therapists Speech Therapy/Pathology Services 00 1639448020 0 SALEEM ALI 2015335 9999999 B 10 1639448020 0 44000 GARFIELD RD CLINTON TOWNSHI MI 480381125 20 1639448020 0 Physicians Anesthesia Services 20 1639448020 0 Physicians Healthy Kids Services 20 1639448020 0 Physicians Optical Supplies 20 1639448020 0 Physicians Physician Services 00 1639448970 0 FRON GINA 2011276 9999999 B 10 1639448970 0 36494 VIA VERDE TEMECULA CA 925927844 20 1639448970 0 Psychologist Psychologist service 00 1639449911 0 EDGESON-STEINER TAWANA 2012095 9999999 B 10 1639449911 0 36494 VIA VERDE TEMECULA CA 925927844 20 1639449911 0 Psychologist All Kids application agent 20 1639449911 0 Psychologist Psychologist service 00 1639450778 0 MARCHIOLI MARC 2025055 9999999 B 10 1639450778 0 14050 NW 14TH ST STE 190 SUNRISE FL 333232851 20 1639450778 0 Physician Assistant Only Fluoride varnish 20 1639450778 0 Physician Assistant Only Healthy Kids Services 20 1639450778 0 Physician Assistant Only Physician Services 00 1639451214 0 LALL AJAY 2017219 9999999 B 10 1639451214 0 999 E TOUHY AVE STE 450 DES PLAINES IL 600182748 20 1639451214 0 Physicians Anesthesia Services 20 1639451214 0 Physicians Healthy Kids Services 20 1639451214 0 Physicians Optical Supplies 20 1639451214 0 Physicians Physician Services 00 1639451552 0 MCKNIGHT CYNTHIA 2016061 9999999 B 10 1639451552 0 1850 W WINCHESTER RD STE 108 LIBERTYVILLE IL 600485355 20 1639451552 0 Other behavior health professional LCPC/LMFT services 00 1639452139 0 SYLVESTER BRENT 2015195 9999999 B 10 1639452139 0 611 W PARK ST URBANA IL 618012529 20 1639452139 0 Psychologist Psychologist service 00 1639452386 0 HOENIG JENNIFER A 2021081 9999999 B 10 1639452386 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1639452386 0 Nurse Practitioners Healthy Kids Services 20 1639452386 0 Nurse Practitioners Nurse Practitioners Services 20 1639452386 0 Nurse Practitioners Physician Services 00 1639452535 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2014215 9999999 B 10 1639462443 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1639462443 0 Physicians Anesthesia Services 20 1639462443 0 Physicians Fluoride varnish 20 1639462443 0 Physicians Healthy Kids Services 20 1639462443 0 Physicians Optical Supplies 20 1639462443 0 Physicians Physician Services 00 1639462450 0 JOHNSON EVAN 2024345 9999999 B 10 1639462450 0 1044 N FRANCISCO AVE CHICAGO IL 606222743 20 1639462450 0 Physicians Anesthesia Services 20 1639462450 0 Physicians Healthy Kids Services 20 1639462450 0 Physicians Optical Supplies 20 1639462450 0 Physicians Physician Services 00 1639463342 0 MURFF JENNIFER 2012214 9999999 B 10 1639463342 0 22W008 TERRACE DR GLEN ELLYN IL 601377093 20 1639463342 0 Speech Therapists Medical Supplies 20 1639463342 0 Speech Therapists Medical equipment/prosthetic devices 20 1639463342 0 Speech Therapists Speech Therapy/Pathology Services 00 1639463458 0 BERTINI MATTHEW 2013305 9999999 B 10 1639463458 0 700 E OGDEN AVE STE 202 WESTMONT IL 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Physicians Anesthesia Services 20 1639465115 0 Physicians Healthy Kids Services 20 1639465115 0 Physicians Optical Supplies 20 1639465115 0 Physicians Physician Services 00 1639465131 0 JOHNSON ANDREW C 2015201 9999999 B 10 1639465131 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1639465131 0 Physicians Anesthesia Services 20 1639465131 0 Physicians Fluoride varnish 20 1639465131 0 Physicians Healthy Kids Services 20 1639465131 0 Physicians Optical Supplies 20 1639465131 0 Physicians Physician Services 00 1639465669 0 BRECKNER FRITZ 2023205 9999999 B 10 1639465669 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1639465669 0 Physicians Anesthesia Services 20 1639465669 0 Physicians Healthy Kids Services 20 1639465669 0 Physicians Optical Supplies 20 1639465669 0 Physicians Physician Services 00 1639465776 0 KIELTYKA JUDE 2015251 9999999 B 10 1639465776 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1639465776 0 Physicians Anesthesia Services 20 1639465776 0 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1639487903 0 247 DUNDEE AVE ELGIN IL 601204235 20 1639487903 0 Dentists Dental Services 20 1639487903 0 Dentists Physician Services 00 1639487911 0 VISWANATHAN AVINASH 2013244 9999999 B 10 1639487911 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1639487911 0 Physicians Anesthesia Services 20 1639487911 0 Physicians Fluoride varnish 20 1639487911 0 Physicians Healthy Kids Services 20 1639487911 0 Physicians Optical Supplies 20 1639487911 0 Physicians Physician Services 00 1639488521 0 BELL SARA 2004245 9999999 B 10 1639488521 0 101 E STATE ST KENNETT SQUARE PA 193483109 20 1639488521 0 Physical Therapists Medical Supplies 20 1639488521 0 Physical Therapists Medical equipment/prosthetic devices 20 1639488521 0 Physical Therapists Physical Therapy Services 00 1639490170 0 NEVEU MELISSA 2016183 9999999 B 10 1639490170 0 PO BOX 8500 LOCKBOX 7642 PHILADELPHIA PA 191787642 20 1639490170 0 Physicians Anesthesia Services 20 1639490170 0 Physicians Healthy Kids Services 20 1639490170 0 Physicians 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COLLING KRISTIN 2020245 9999999 B 10 1639494362 0 PO BOX 1437 COLUMBUS GA 319021437 20 1639494362 0 Physicians Anesthesia Services 20 1639494362 0 Physicians Healthy Kids Services 20 1639494362 0 Physicians Optical Supplies 20 1639494362 0 Physicians Physician Services 00 1639494917 0 BARNETT AIMEE E 2017173 9999999 B 10 1639494917 0 PO BOX 781076 DETROIT MI 482781076 20 1639494917 0 Nurse Practitioners Fluoride varnish 20 1639494917 0 Nurse Practitioners Healthy Kids Services 20 1639494917 0 Nurse Practitioners Nurse Practitioners Services 20 1639494917 0 Nurse Practitioners Physician Services 00 1639495971 0 SONANI BHAVIN V 2012176 9999999 B 10 1639495971 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1639495971 0 Physicians Anesthesia Services 20 1639495971 0 Physicians Fluoride varnish 20 1639495971 0 Physicians Healthy Kids Services 20 1639495971 0 Physicians Optical Supplies 20 1639495971 0 Physicians Physician Services 00 1639497241 0 MONTGOMERY JEFFREY 2024085 9999999 B 10 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1639574155 0 Physician Assistant Only Fluoride varnish 20 1639574155 0 Physician Assistant Only Healthy Kids Services 20 1639574155 0 Physician Assistant Only Physician Services 00 1639575947 0 BAKER SARAH 2014350 9999999 B 10 1639575947 0 1013 ADAMS ST OTTAWA IL 613504304 20 1639575947 0 Speech Therapists Medical Supplies 20 1639575947 0 Speech Therapists Medical equipment/prosthetic devices 20 1639575947 0 Speech Therapists Speech Therapy/Pathology Services 00 1639576473 0 KRAMER HANNAH 2016118 9999999 B 10 1639576473 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1639576473 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639576689 0 STEELE Y JESSICA 2016004 9999999 B 10 1639576689 0 1660 FEEHANVILLE DR STE 200 MOUNT PROSPECT IL 600566036 20 1639576689 0 Physician Assistant Only Fluoride varnish 20 1639576689 0 Physician Assistant Only Healthy Kids Services 20 1639576689 0 Physician Assistant Only Physician Services 00 1639578362 0 WACHOWIAK REBECCA A 2021222 9999999 B 10 1639578362 0 4701 DEPT CAROL STREAM IL 601220021 20 1639578362 0 Physician Assistant Only Fluoride varnish 20 1639578362 0 Physician Assistant Only Healthy Kids Services 20 1639578362 0 Physician Assistant Only Physician Services 00 1639580368 0 SONI VIHANG 2023019 9999999 B 10 1639580368 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1639580368 0 Physicians Anesthesia Services 20 1639580368 0 Physicians Fluoride varnish 20 1639580368 0 Physicians Healthy Kids Services 20 1639580368 0 Physicians Optical Supplies 20 1639580368 0 Physicians Physician Services 00 1639581127 0 BOLTON ALEXANDER 2021032 9999999 B 10 1639581127 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1639581127 0 Physicians Anesthesia Services 20 1639581127 0 Physicians Fluoride varnish 20 1639581127 0 Physicians Healthy Kids Services 20 1639581127 0 Physicians Optical Supplies 20 1639581127 0 Physicians Physician Services 00 1639581739 0 MCNEIL 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2021217 9999999 B 10 1639583321 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1639583321 0 Physicians Anesthesia Services 20 1639583321 0 Physicians Fluoride varnish 20 1639583321 0 Physicians Healthy Kids Services 20 1639583321 0 Physicians Optical Supplies 20 1639583321 0 Physicians Physician Services 00 1639583560 0 ALCALA CARMEN A 2018001 9999999 B 10 1639583560 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1639583560 0 Physicians All Kids application agent 20 1639583560 0 Physicians Anesthesia Services 20 1639583560 0 Physicians Healthy Kids Services 20 1639583560 0 Physicians Optical Supplies 20 1639583560 0 Physicians Physician Services 00 1639583578 0 HENDERSON JOSEPH 2020149 9999999 B 10 1639583578 0 PO BOX 43230 PHOENIX AZ 850803230 20 1639583578 0 Physicians Anesthesia Services 20 1639583578 0 Physicians Healthy Kids Services 20 1639583578 0 Physicians Optical Supplies 20 1639583578 0 Physicians Physician Services 00 1639583586 0 REILLY LAUREN M 2021355 9999999 B 10 1639583586 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1639583586 0 Physicians Anesthesia Services 20 1639583586 0 Physicians Healthy Kids Services 20 1639583586 0 Physicians Optical Supplies 20 1639583586 0 Physicians Physician Services 00 1639583750 0 PATEL VINAY 2020223 9999999 B 10 1639583750 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1639583750 0 Physicians Anesthesia Services 20 1639583750 0 Physicians Fluoride varnish 20 1639583750 0 Physicians Healthy Kids Services 20 1639583750 0 Physicians Optical Supplies 20 1639583750 0 Physicians Physician Services 00 1639584014 0 TETANGCO EULA P 2020169 9999999 B 10 1639584014 0 PO BOX 631767 CINCINNATI OH 452631767 20 1639584014 0 Physicians Anesthesia Services 20 1639584014 0 Physicians Fluoride varnish 20 1639584014 0 Physicians Healthy Kids Services 20 1639584014 0 Physicians Optical Supplies 20 1639584014 0 Physicians Physician Services 00 1639584030 0 ROSELMAN JONATHAN M 2018305 9999999 B 10 1639584030 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1639584030 0 Physicians Anesthesia Services 20 1639584030 0 Physicians Fluoride varnish 20 1639584030 0 Physicians Healthy Kids Services 20 1639584030 0 Physicians Optical Supplies 20 1639584030 0 Physicians Physician Services 00 1639584832 0 ISKANDER MINA H 2018064 9999999 B 10 1639584832 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1639584832 0 Physicians Anesthesia Services 20 1639584832 0 Physicians Fluoride varnish 20 1639584832 0 Physicians Healthy Kids Services 20 1639584832 0 Physicians Optical Supplies 20 1639584832 0 Physicians Physician Services 00 1639584899 0 SINGHAL MADHAVI 2017182 9999999 B 10 1639584899 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1639584899 0 Physicians Anesthesia Services 20 1639584899 0 Physicians Fluoride varnish 20 1639584899 0 Physicians Healthy Kids Services 20 1639584899 0 Physicians Optical Supplies 20 1639584899 0 Physicians Physician Services 00 1639585136 0 ISAWI DANNY 2017276 9999999 B 10 1639585136 0 PO BOX 268 FREEPORT IL 610320268 20 1639585136 0 Physicians Anesthesia Services 20 1639585136 0 Physicians Fluoride varnish 20 1639585136 0 Physicians Healthy Kids Services 20 1639585136 0 Physicians Optical Supplies 20 1639585136 0 Physicians Physician Services 00 1639585946 0 KOLOSSO MICHELLE 2014188 9999999 B 10 1639585946 0 17 N STATE ST STE 500 CHICAGO IL 606023384 20 1639585946 0 Nurse Practitioners Family Planning Counseling 20 1639585946 0 Nurse Practitioners Healthy Kids Services 20 1639585946 0 Nurse Practitioners Midwife Services 20 1639585946 0 Nurse Practitioners Nurse Practitioners Services 20 1639585946 0 Nurse Practitioners Physician Services 00 1639586399 0 REYNOLDS CORA M 2014202 9999999 B 10 1639586399 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1639586399 0 Nurse Practitioners Healthy Kids Services 20 1639586399 0 Nurse Practitioners Nurse Practitioners Services 20 1639586399 0 Nurse Practitioners Physician Services 00 1639586555 0 OSMUN SARAH J 2020113 9999999 B 10 1639586555 0 5777 DEPT CAROL STREAM IL 601220021 20 1639586555 0 Physician Assistant Only Fluoride varnish 20 1639586555 0 Physician Assistant Only Healthy Kids Services 20 1639586555 0 Physician Assistant Only Physician Services 00 1639587009 0 MURPHY SEAN P 2019161 9999999 B 10 1639587009 0 1220 S WOOD ST CHICAGO IL 606081202 20 1639587009 0 Nurse Practitioners Healthy Kids Services 20 1639587009 0 Nurse Practitioners Nurse Practitioners Services 20 1639587009 0 Nurse Practitioners Physician Services 00 1639588023 0 BERGER ABIGAIL 2019093 9999999 B 10 1639588023 0 PO BOX 781076 DETROIT MI 482781076 20 1639588023 0 Physician Assistant Only Fluoride varnish 20 1639588023 0 Physician Assistant Only Healthy Kids Services 20 1639588023 0 Physician Assistant Only Physician Services 00 1639589104 0 STEIN MATTHEW K 2020188 9999999 B 10 1639589104 0 3015 N BALLAS RD SAINT LOUIS MO 631312329 20 1639589104 0 Physicians Anesthesia Services 20 1639589104 0 Physicians Fluoride varnish 20 1639589104 0 Physicians Healthy Kids Services 20 1639589104 0 Physicians Optical Supplies 20 1639589104 0 Physicians Physician Services 00 1639589484 0 BLUM ASHER B 2021323 9999999 B 10 1639589484 0 PO BOX 43230 PHOENIX AZ 850803230 20 1639589484 0 Physicians Anesthesia Services 20 1639589484 0 Physicians Fluoride varnish 20 1639589484 0 Physicians Healthy Kids Services 20 1639589484 0 Physicians Optical Supplies 20 1639589484 0 Physicians Physician Services 00 1639589948 0 TARHUNI ALAEDDIN 2021031 9999999 B 10 1639589948 0 PO BOX 411637 SAINT LOUIS MO 631411637 20 1639589948 0 Physicians Anesthesia Services 20 1639589948 0 Physicians Healthy Kids Services 20 1639589948 0 Physicians Optical Supplies 20 1639589948 0 Physicians Physician Services 00 1639593395 0 TELESFORD NATASHA A 2017004 9999999 B 10 1639593395 0 1701 LACEY ST CAPE GIRARDEAU MO 637015230 20 1639593395 0 Physicians Anesthesia Services 20 1639593395 0 Physicians Fluoride varnish 20 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0 2500 W HIGGINS RD STE 555 HOFFMAN ESTATES IL 601697220 20 1639595549 0 Physical Therapists Medical Supplies 20 1639595549 0 Physical Therapists Medical equipment/prosthetic devices 20 1639595549 0 Physical Therapists Physical Therapy Services 00 1639596471 0 AMARASEKERA CHANNA 2018269 9999999 B 10 1639596471 0 5777 DEPT CAROL STREAM IL 601220021 20 1639596471 0 Physicians Anesthesia Services 20 1639596471 0 Physicians Healthy Kids Services 20 1639596471 0 Physicians Optical Supplies 20 1639596471 0 Physicians Physician Services 00 1639596679 0 ANDERSON LAUREN R 2020023 9999999 B 10 1639596679 0 PO BOX 110429 AURORA CO 800420429 20 1639596679 0 Physicians Anesthesia Services 20 1639596679 0 Physicians Fluoride varnish 20 1639596679 0 Physicians Healthy Kids Services 20 1639596679 0 Physicians Optical Supplies 20 1639596679 0 Physicians Physician Services 00 1639597099 0 BOUGES SHENIKQUA 2020268 9999999 B 10 1639597099 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1639597099 0 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2018352 9999999 B 10 1639662562 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1639662562 0 Physicians Anesthesia Services 20 1639662562 0 Physicians Healthy Kids Services 20 1639662562 0 Physicians Optical Supplies 20 1639662562 0 Physicians Physician Services 00 1639662695 0 YEPES MORENO ISAAC 2021097 9999999 B 10 1639662695 0 PO BOX 3039 OAK BROOK IL 605223039 20 1639662695 0 Physicians Anesthesia Services 20 1639662695 0 Physicians Fluoride varnish 20 1639662695 0 Physicians Healthy Kids Services 20 1639662695 0 Physicians Optical Supplies 20 1639662695 0 Physicians Physician Services 00 1639663511 0 MORRIS JERRID O 2018206 9999999 B 10 1639663511 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1639663511 0 Nurse Practitioners Anesthesia Services 20 1639663511 0 Nurse Practitioners Nurse Practitioners Services 20 1639663511 0 Nurse Practitioners Physician Services 00 1639663974 0 PATEL TRINA 2018182 9999999 B 10 1639663974 0 101 E STATE ST KENNETT SQUARE PA 193483109 20 1639663974 0 Occupational Therapists Medical Supplies 20 1639663974 0 Occupational Therapists Medical equipment/prosthetic devices 20 1639663974 0 Occupational Therapists Occupational Therapy Services 00 1639664501 0 GAFFNEY MATTHEW R 2019295 9999999 B 10 1639664501 0 124 SW ADAMS ST PEORIA IL 616021308 20 1639664501 0 Physicians Anesthesia Services 20 1639664501 0 Physicians Fluoride varnish 20 1639664501 0 Physicians Healthy Kids Services 20 1639664501 0 Physicians Optical Supplies 20 1639664501 0 Physicians Physician Services 00 1639664774 0 XU KEVIN Y 2018182 9999999 B 10 1639664774 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1639664774 0 Physicians Anesthesia Services 20 1639664774 0 Physicians Healthy Kids Services 20 1639664774 0 Physicians Optical Supplies 20 1639664774 0 Physicians Physician Services 20 1639664774 0 Physicians Physicians Psychiatric Services 00 1639664873 0 LAZAR TODD 2011342 9999999 B 10 1639664873 0 145 S 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Anesthesia Services 20 1639669732 0 Physicians Fluoride varnish 20 1639669732 0 Physicians Healthy Kids Services 20 1639669732 0 Physicians Optical Supplies 20 1639669732 0 Physicians Physician Services 00 1639669831 0 ZAROUR CHRISTOPHER C 2023159 9999999 B 10 1639669831 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1639669831 0 Physicians Anesthesia Services 20 1639669831 0 Physicians Healthy Kids Services 20 1639669831 0 Physicians Optical Supplies 20 1639669831 0 Physicians Physician Services 00 1639672371 0 BALASUBRAMANIAN SENNARAJ 2018091 9999999 B 10 1639672371 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1639672371 0 Physicians Anesthesia Services 20 1639672371 0 Physicians Healthy Kids Services 20 1639672371 0 Physicians Optical Supplies 20 1639672371 0 Physicians Physician Services 00 1639672405 0 HARP HANNAH 2018362 9999999 B 10 1639672405 0 2001 S CALIFORNIA AVE STE 100 CHICAGO IL 606082486 20 1639672405 0 Physicians Anesthesia Services 20 1639672405 0 Physicians Fluoride varnish 20 1639672405 0 Physicians Healthy Kids Services 20 1639672405 0 Physicians Optical Supplies 20 1639672405 0 Physicians Physician Services 00 1639673189 0 KIM SEUNGJUN 2020227 9999999 B 10 1639673189 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1639673189 0 Physicians Anesthesia Services 20 1639673189 0 Physicians Healthy Kids Services 20 1639673189 0 Physicians Optical Supplies 20 1639673189 0 Physicians Physician Services 00 1639673643 0 LASH SHREYA B 2023263 9999999 B 10 1639673643 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1639673643 0 Physicians Anesthesia Services 20 1639673643 0 Physicians Fluoride varnish 20 1639673643 0 Physicians Healthy Kids Services 20 1639673643 0 Physicians Optical Supplies 20 1639673643 0 Physicians Physician Services 00 1639673742 0 NGUYEN JESSICA 2022143 9999999 B 10 1639673742 0 5777 DEPT CAROL STREAM IL 601220021 20 1639673742 0 Physicians Anesthesia Services 20 1639673742 0 Physicians 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0 Physicians Fluoride varnish 20 1639674476 0 Physicians Healthy Kids Services 20 1639674476 0 Physicians Optical Supplies 20 1639674476 0 Physicians Physician Services 00 1639674567 0 LUONG JACKY 2018182 9999999 B 10 1639674567 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1639674567 0 Physicians Anesthesia Services 20 1639674567 0 Physicians Fluoride varnish 20 1639674567 0 Physicians Healthy Kids Services 20 1639674567 0 Physicians Optical Supplies 20 1639674567 0 Physicians Physician Services 00 1639674575 0 MICHALIK DANIEL 2022182 9999999 B 10 1639674575 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1639674575 0 Physicians Anesthesia Services 20 1639674575 0 Physicians Healthy Kids Services 20 1639674575 0 Physicians Optical Supplies 20 1639674575 0 Physicians Physician Services 00 1639675432 0 LEVON PRECIOUS 2018169 9999999 B 10 1639675432 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1639675432 0 Nurse Practitioners Healthy Kids Services 20 1639675432 0 Nurse Practitioners Nurse Practitioners Services 20 1639675432 0 Nurse Practitioners Physician Services 00 1639675846 0 RAMIREZ-FRANCO JOSE M 2023128 9999999 B 10 1639675846 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1639675846 0 Physicians Anesthesia Services 20 1639675846 0 Physicians Healthy Kids Services 20 1639675846 0 Physicians Optical Supplies 20 1639675846 0 Physicians Physician Services 00 1639678162 0 FRY MELISSA 2019304 9999999 B 10 1639678162 0 15732 S HOWARD ST PLAINFIELD IL 605442399 20 1639678162 0 Speech Therapists Medical Supplies 20 1639678162 0 Speech Therapists Medical equipment/prosthetic devices 20 1639678162 0 Speech Therapists Speech Therapy/Pathology Services 00 1639678451 0 ROSER ALLYSON L 2018071 9999999 B 10 1639678451 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1639678451 0 Physician Assistant Only Fluoride varnish 20 1639678451 0 Physician Assistant Only Healthy Kids Services 20 1639678451 0 Physician Assistant Only Physician Services 00 1639679756 0 MAHER AMY MARIE 2018100 9999999 B 10 1639679756 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1639679756 0 Nurse Practitioners Fluoride varnish 20 1639679756 0 Nurse Practitioners Healthy Kids Services 20 1639679756 0 Nurse Practitioners Nurse Practitioners Services 20 1639679756 0 Nurse Practitioners Physician Services 00 1639680275 0 LYELL KELLY 2022047 9999999 B 10 1639680275 0 115 55TH ST CLARENDON HILLS IL 605141593 20 1639680275 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1639680309 0 KRZOSEK KELLY 2018129 9999999 B 10 1639680309 0 555 BIESTERFIELD RD ELK GROVE VILLA IL 600073306 20 1639680309 0 Nurse Practitioners Healthy Kids Services 20 1639680309 0 Nurse Practitioners Nurse Practitioners Services 20 1639680309 0 Nurse Practitioners Physician Services 00 1639680960 0 NOBLE MARGARET 2017286 9999999 B 10 1639680960 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1639680960 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639681018 0 SHIVJI SHAZIA 2018056 9999999 B 10 1639681018 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1639681018 0 Physicians Anesthesia Services 20 1639681018 0 Physicians Fluoride varnish 20 1639681018 0 Physicians Healthy Kids Services 20 1639681018 0 Physicians Optical Supplies 20 1639681018 0 Physicians Physician Services 00 1639681117 0 GARMON MELISSA R 2018008 9999999 B 10 1639681117 0 124 SW ADAMS ST FL 2 PEORIA IL 616021308 20 1639681117 0 Physician Assistant Only Fluoride varnish 20 1639681117 0 Physician Assistant Only Healthy Kids Services 20 1639681117 0 Physician Assistant Only Physician Services 00 1639681836 0 PAPASTEFAN CHRISTINA A 2019365 9999999 B 10 1639681836 0 5777 DEPT CAROL STREAM IL 601220021 20 1639681836 0 Nurse Practitioners Healthy Kids Services 20 1639681836 0 Nurse Practitioners Nurse Practitioners Services 20 1639681836 0 Nurse Practitioners Physician Services 00 1639682586 0 KEARNEY KAITLIN 2017356 9999999 B 10 1639682586 0 543 N WOOD DALE RD WOOD DALE IL 601911535 20 1639682586 0 Speech Therapists Medical Supplies 20 1639682586 0 Speech Therapists Medical equipment/prosthetic devices 20 1639682586 0 Speech Therapists Speech Therapy/Pathology Services 00 1639683006 0 DANIELLE JONES 2017335 9999999 B 10 1639683006 0 655 DEERFIELD RD STE 100-303 DEERFIELD IL 600153241 20 1639683006 0 Clinical Social Worker Social work service 00 1639683352 0 SLY MICHAEL 2017340 9999999 B 10 1639683352 0 201 W CLAY ST COLLINSVILLE IL 622343219 20 1639683352 0 Speech Therapists Medical Supplies 20 1639683352 0 Speech Therapists Medical equipment/prosthetic devices 20 1639683352 0 Speech Therapists Speech Therapy/Pathology Services 00 1639684368 0 ZEPPO NICOLE C 2017342 9999999 B 10 1639684368 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1639684368 0 Nurse Practitioners Anesthesia Services 20 1639684368 0 Nurse Practitioners Nurse Practitioners Services 20 1639684368 0 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N 2017290 9999999 B 10 1639688021 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1639688021 0 Nurse Practitioners Healthy Kids Services 20 1639688021 0 Nurse Practitioners Nurse Practitioners Services 20 1639688021 0 Nurse Practitioners Physician Services 00 1639688195 0 JENNINGS LORINDA L 2017304 9999999 B 10 1639688195 0 1311 VANDALIA RD HILLSBORO IL 620492034 20 1639688195 0 Speech Therapists Medical Supplies 20 1639688195 0 Speech Therapists Medical equipment/prosthetic devices 20 1639688195 0 Speech Therapists Speech Therapy/Pathology Services 00 1639688252 0 LAWRENCE TROY A 2017305 9999999 B 10 1639688252 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1639688252 0 Nurse Practitioners Healthy Kids Services 20 1639688252 0 Nurse Practitioners Nurse Practitioners Services 20 1639688252 0 Nurse Practitioners Physician Services 00 1639689276 0 ABOAGYE SADIK 2021239 9999999 H 10 1639689276 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1639689276 0 Other behavior health 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Physician Services 00 1639690514 0 SIEGEL CHRISTIAN M 2020035 9999999 B 10 1639690514 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1639690514 0 Physicians Anesthesia Services 20 1639690514 0 Physicians Healthy Kids Services 20 1639690514 0 Physicians Optical Supplies 20 1639690514 0 Physicians Physician Services 00 1639690639 0 SYED GULRANA 2018182 9999999 B 10 1639690639 0 5777 DEPT CAROL STREAM IL 601220021 20 1639690639 0 Physicians Anesthesia Services 20 1639690639 0 Physicians Healthy Kids Services 20 1639690639 0 Physicians Optical Supplies 20 1639690639 0 Physicians Physician Services 20 1639690639 0 Physicians Physicians Psychiatric Services 00 1639691090 0 RHODES KELLY C 2019093 9999999 B 10 1639691090 0 350 N WALL ST KANKAKEE IL 609012901 20 1639691090 0 Physicians Anesthesia Services 20 1639691090 0 Physicians Healthy Kids Services 20 1639691090 0 Physicians Optical Supplies 20 1639691090 0 Physicians Physician Services 20 1639691090 0 Physicians Physicians Psychiatric Services 00 1639691413 0 SMITH GINGER 2020342 9999999 B 10 1639691413 0 PO BOX 781076 DETROIT MI 482781076 20 1639691413 0 Nurse Practitioners Fluoride varnish 20 1639691413 0 Nurse Practitioners Healthy Kids Services 20 1639691413 0 Nurse Practitioners Nurse Practitioners Services 20 1639691413 0 Nurse Practitioners Physician Services 00 1639693237 0 PATEL HARSHIL V 2017212 9999999 B 10 1639693237 0 2937 N STATE ROUTE 178 UNIT 2 UTICA IL 613739708 20 1639693237 0 Dentists Dental Services 20 1639693237 0 Dentists Physician Services 00 1639693617 0 LONGNECKER MONICA L 2017242 9999999 B 10 1639693617 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1639693617 0 Nurse Practitioners Healthy Kids Services 20 1639693617 0 Nurse Practitioners Nurse Practitioners Services 20 1639693617 0 Nurse Practitioners Physician Services 00 1639693849 0 VOGEL-WILSON THEODORE 2022081 9999999 B 10 1639693849 0 2560 24TH ST STE 101 ROCK ISLAND IL 612015389 20 1639693849 0 Other behavior health 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Physicians Healthy Kids Services 20 1639706120 0 Physicians Optical Supplies 20 1639706120 0 Physicians Physician Services 00 1639706278 0 KINI MITALI 2020175 9999999 B 10 1639706278 0 4698 DEPT CAROL STREAM IL 601220021 20 1639706278 0 Physicians Anesthesia Services 20 1639706278 0 Physicians Healthy Kids Services 20 1639706278 0 Physicians Optical Supplies 20 1639706278 0 Physicians Physician Services 00 1639706815 0 PETERS KYLE 2024061 9999999 B 10 1639706815 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1639706815 0 Physicians Anesthesia Services 20 1639706815 0 Physicians Healthy Kids Services 20 1639706815 0 Physicians Optical Supplies 20 1639706815 0 Physicians Physician Services 00 1639706914 0 HA LARRY 2025013 9999999 B 10 1639706914 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1639706914 0 Physicians Anesthesia Services 20 1639706914 0 Physicians Healthy Kids Services 20 1639706914 0 Physicians Optical Supplies 20 1639706914 0 Physicians Physician Services 00 1639707466 0 GIRGIS DANIELLE E 2020162 9999999 B 10 1639707466 0 PO BOX 3039 OAK BROOK IL 605223039 20 1639707466 0 Physicians Anesthesia Services 20 1639707466 0 Physicians Healthy Kids Services 20 1639707466 0 Physicians Optical Supplies 20 1639707466 0 Physicians Physician Services 20 1639707466 0 Physicians Physicians Psychiatric Services 00 1639707532 0 QASEM ABDELKHALIQ 2020233 9999999 B 10 1639707532 0 PO BOX 920289 DALLAS TX 753920289 20 1639707532 0 Physicians Anesthesia Services 20 1639707532 0 Physicians Fluoride varnish 20 1639707532 0 Physicians Healthy Kids Services 20 1639707532 0 Physicians Optical Supplies 20 1639707532 0 Physicians Physician Services 00 1639707730 0 DONZAL DEANA 2021315 9999999 B 10 1639707730 0 1400 E IRVING PARK RD STREAMWOOD IL 601073201 20 1639707730 0 Other behavior health professional LCPC/LMFT services 00 1639708175 0 MANTOOTH MELINDA M 2024243 9999999 B 10 1639708175 0 PO BOX 5009 BRENTWOOD TN 370245009 20 1639708175 0 Physicians Anesthesia Services 20 1639708175 0 Physicians Fluoride varnish 20 1639708175 0 Physicians Healthy Kids Services 20 1639708175 0 Physicians Optical Supplies 20 1639708175 0 Physicians Physician Services 00 1639708290 0 O'CONNOR TIMOTHY 2020220 9999999 B 10 1639708290 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1639708290 0 Physicians Anesthesia Services 20 1639708290 0 Physicians Fluoride varnish 20 1639708290 0 Physicians Healthy Kids Services 20 1639708290 0 Physicians Optical Supplies 20 1639708290 0 Physicians Physician Services 00 1639708688 0 WILLIAMS KIRSTIE 2020318 9999999 B 10 1639708688 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1639708688 0 Nurse Practitioners Fluoride varnish 20 1639708688 0 Nurse Practitioners Healthy Kids Services 20 1639708688 0 Nurse Practitioners Nurse Practitioners Services 20 1639708688 0 Nurse Practitioners Physician Services 00 1639708712 0 MURPHY JESSICA 2024079 9999999 B 10 1639708712 0 PO BOX 43230 PHOENIX AZ 850803230 20 1639708712 0 Physicians Anesthesia Services 20 1639708712 0 Physicians Healthy Kids Services 20 1639708712 0 Physicians Optical Supplies 20 1639708712 0 Physicians Physician Services 00 1639708951 0 DUKES DAVID 2023201 9999999 B 10 1639708951 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1639708951 0 Physicians Anesthesia Services 20 1639708951 0 Physicians Healthy Kids Services 20 1639708951 0 Physicians Optical Supplies 20 1639708951 0 Physicians Physician Services 00 1639711146 0 MURPHY ANN MARIE M 2020003 9999999 B 10 1639711146 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1639711146 0 Speech Therapists Medical Supplies 20 1639711146 0 Speech Therapists Medical equipment/prosthetic devices 20 1639711146 0 Speech Therapists Speech Therapy/Pathology Services 00 1639711963 0 LADOWITZ STACI J 2019316 9999999 B 10 1639711963 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1639711963 0 Physician Assistant Only Fluoride varnish 20 1639711963 0 Physician Assistant Only Healthy Kids Services 20 1639711963 0 Physician Assistant Only Physician Services 00 1639714629 0 SEKHON NAMNEET 2024086 9999999 B 10 1639714629 0 99 HAWLEY LN STE 1102 STRATFORD CT 066141204 20 1639714629 0 Nurse Practitioners Healthy Kids Services 20 1639714629 0 Nurse Practitioners Nurse Practitioners Services 20 1639714629 0 Nurse Practitioners Physician Services 00 1639716624 0 BAILEY MELANIE L 2021188 9999999 B 10 1639716624 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1639716624 0 Other behavior health professional LCPC/LMFT services 00 1639717184 0 QUAN CHRISTINA 2020006 9999999 B 10 1639717184 0 719 N MARION ST OAK PARK IL 603021530 20 1639717184 0 Physical Therapists Medical Supplies 20 1639717184 0 Physical Therapists Medical equipment/prosthetic devices 20 1639717184 0 Physical Therapists Physical Therapy Services 00 1639717598 0 HANAWALT MICHELLE L 2022110 9999999 B 10 1639717598 0 PO BOX 953 ADDISON IL 601010953 20 1639717598 0 Occupational Therapists Medical Supplies 20 1639717598 0 Occupational Therapists Medical equipment/prosthetic devices 20 1639717598 0 Occupational Therapists Occupational Therapy Services 00 1639718612 0 HARTLEY TARA L 2019357 9999999 B 10 1639718612 0 PO BOX 3988 CARBONDALE IL 629023988 20 1639718612 0 Clinical Social Worker Social work service 00 1639718653 0 TIMMONS TYLER APRIL 2021176 9999999 B 10 1639718653 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1639718653 0 Other behavior health professional Psychologist service 00 1639718679 0 LOWE STACEY 2024004 9999999 B 10 1639718679 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1639718679 0 Nurse Practitioners Healthy Kids Services 20 1639718679 0 Nurse Practitioners Nurse Practitioners Services 20 1639718679 0 Nurse Practitioners Physician Services 00 1639719834 0 SABRY COURTNEY 2020069 9999999 B 10 1639719834 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1639719834 0 Physician Assistant Only Fluoride varnish 20 1639719834 0 Physician Assistant Only Healthy Kids Services 20 1639719834 0 Physician Assistant Only Physician Services 00 1639720972 0 BOTTOS MARISSA 2021131 9999999 B 10 1639720972 0 55 E 86TH AVE STE E SUITE E MERRILLVILLE IN 464106265 20 1639720972 0 Nurse Practitioners Healthy Kids Services 20 1639720972 0 Nurse Practitioners Nurse Practitioners Services 20 1639720972 0 Nurse Practitioners Physician Services 00 1639721939 0 PALCHECK TARA 2019203 9999999 B 10 1639721939 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1639721939 0 Speech Therapists Medical Supplies 20 1639721939 0 Speech Therapists Medical equipment/prosthetic devices 20 1639721939 0 Speech Therapists Speech Therapy/Pathology Services 00 1639725567 0 KHAJA ABRAR 2023187 9999999 B 10 1639725567 0 PO BOX 3039 OAK BROOK IL 605223039 20 1639725567 0 Physicians Anesthesia Services 20 1639725567 0 Physicians Fluoride varnish 20 1639725567 0 Physicians Healthy Kids Services 20 1639725567 0 Physicians Optical Supplies 20 1639725567 0 Physicians Physician Services 00 1639728025 0 SLOAN ERIN 2021110 9999999 B 10 1639728025 0 884 W NIPPERSINK RD ROUND LAKE IL 600733701 20 1639728025 0 Speech Therapists Medical Supplies 20 1639728025 0 Speech Therapists Medical equipment/prosthetic devices 20 1639728025 0 Speech Therapists Speech Therapy/Pathology Services 00 1639729395 0 CROSS PATRICE 2020014 9999999 B 10 1639729395 0 5730 W ROOSEVELT RD BUSINESS OFFICE CHICAGO IL 606441580 20 1639729395 0 Other behavior health professional LCPC/LMFT services 00 1639730013 0 SHAW ANGELA 2023291 9999999 B 10 1639730013 0 2100 POWELL ST STE 400 EMERYVILLE CA 946081872 20 1639730013 0 Nurse Practitioners Healthy Kids Services 20 1639730013 0 Nurse Practitioners Nurse Practitioners Services 20 1639730013 0 Nurse Practitioners Physician Services 00 1639730302 0 IDUSUYI BRITTANY 2019326 9999999 B 10 1639730302 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1639730302 0 Physicians Anesthesia Services 20 1639730302 0 Physicians Healthy Kids Services 20 1639730302 0 Physicians Optical Supplies 20 1639730302 0 Physicians Physician Services 00 1639730328 0 UNTERREINER MONICA A 2022196 9999999 B 10 1639730328 0 PO BOX 776084 CHICAGO IL 606776084 20 1639730328 0 Physicians Anesthesia Services 20 1639730328 0 Physicians Fluoride varnish 20 1639730328 0 Physicians Healthy Kids Services 20 1639730328 0 Physicians Optical Supplies 20 1639730328 0 Physicians Physician Services 00 1639730542 0 QAPAJA THABET J M 2024184 9999999 B 10 1639730542 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1639730542 0 Physicians Anesthesia Services 20 1639730542 0 Physicians Fluoride varnish 20 1639730542 0 Physicians Healthy Kids Services 20 1639730542 0 Physicians Optical Supplies 20 1639730542 0 Physicians Physician Services 00 1639731177 0 WARN SAMUEL 2024192 9999999 B 10 1639731177 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1639731177 0 Physicians Anesthesia Services 20 1639731177 0 Physicians Healthy Kids Services 20 1639731177 0 Physicians Optical Supplies 20 1639731177 0 Physicians Physician Services 20 1639731177 0 Physicians Physicians Psychiatric Services 00 1639731441 0 RONEN NATALI 2023184 9999999 B 10 1639731441 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1639731441 0 Physicians Anesthesia Services 20 1639731441 0 Physicians Healthy Kids Services 20 1639731441 0 Physicians Optical Supplies 20 1639731441 0 Physicians Physician Services 00 1639731474 0 BACKFISCH MICHELLE 2021027 9999999 B 10 1639731474 0 1701 LACEY ST CAPE GIRARDEAU MO 637015230 20 1639731474 0 Nurse Practitioners Fluoride varnish 20 1639731474 0 Nurse Practitioners Healthy Kids Services 20 1639731474 0 Nurse Practitioners Nurse Practitioners Services 20 1639731474 0 Nurse Practitioners Physician Services 00 1639732043 0 SRINIVASAN SHREYAS 2022251 9999999 B 10 1639732043 0 403 E 1ST ST DIXON IL 610213116 20 1639732043 0 Physicians Anesthesia Services 20 1639732043 0 Physicians Fluoride varnish 20 1639732043 0 Physicians Healthy Kids Services 20 1639732043 0 Physicians Optical Supplies 20 1639732043 0 Physicians Physician Services 00 1639733249 0 BICKEL SCOTT 2021316 9999999 B 10 1639733249 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1639733249 0 Physicians Anesthesia Services 20 1639733249 0 Physicians Healthy Kids Services 20 1639733249 0 Physicians Optical Supplies 20 1639733249 0 Physicians Physician Services 00 1639733371 0 WILSON MICHELLE MARIE 2019123 9999999 B 10 1639733371 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1639733371 0 Occupational Therapists Medical Supplies 20 1639733371 0 Occupational Therapists Medical equipment/prosthetic devices 20 1639733371 0 Occupational Therapists Occupational Therapy Services 00 1639736234 0 WELSH WILLIAM J 2019350 9999999 B 10 1639736234 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1639736234 0 Physicians Anesthesia Services 20 1639736234 0 Physicians Healthy Kids Services 20 1639736234 0 Physicians Optical Supplies 20 1639736234 0 Physicians Physician Services 20 1639736234 0 Physicians Physicians Psychiatric Services 00 1639736309 0 SCHETTLE MATTHEW 2023354 9999999 B 10 1639736309 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1639736309 0 Physicians Anesthesia Services 20 1639736309 0 Physicians Healthy Kids Services 20 1639736309 0 Physicians Optical Supplies 20 1639736309 0 Physicians Physician Services 00 1639736531 0 FRANKLIN TIFFANY 2024240 9999999 B 10 1639736531 0 1951 NW 7TH AVE STE 300 MIAMI FL 331361112 20 1639736531 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639737265 0 HAMMOND ALLYNDA L 2020204 9999999 B 10 1639737265 0 29373 NETWORK PL CHICAGO IL 606733039 20 1639737265 0 Nurse Practitioners Healthy Kids Services 20 1639737265 0 Nurse Practitioners Nurse Practitioners Services 20 1639737265 0 Nurse Practitioners Physician Services 00 1639737596 0 WOLCOTT ALLYSON L 2019219 9999999 B 10 1639737596 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1639737596 0 Nurse Practitioners Fluoride varnish 20 1639737596 0 Nurse Practitioners Healthy Kids Services 20 1639737596 0 Nurse Practitioners Nurse Practitioners Services 20 1639737596 0 Nurse Practitioners Physician Services 00 1639738875 0 KATKAR MANSI 2020177 9999999 B 10 1639738875 0 PO BOX 3039 OAK BROOK IL 605223039 20 1639738875 0 Physicians Anesthesia Services 20 1639738875 0 Physicians Fluoride varnish 20 1639738875 0 Physicians Healthy Kids Services 20 1639738875 0 Physicians Optical Supplies 20 1639738875 0 Physicians Physician Services 00 1639739154 0 HUITZACUA AUSTIN 2024248 9999999 B 10 1639739154 0 PO BOX 2777 BOISE ID 837012777 20 1639739154 0 Physicians Anesthesia Services 20 1639739154 0 Physicians Fluoride varnish 20 1639739154 0 Physicians Healthy Kids Services 20 1639739154 0 Physicians Optical Supplies 20 1639739154 0 Physicians Physician Services 00 1639739485 0 AHMAD ANAM 2022144 9999999 B 10 1639739485 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1639739485 0 Physicians Anesthesia Services 20 1639739485 0 Physicians Fluoride varnish 20 1639739485 0 Physicians Healthy Kids Services 20 1639739485 0 Physicians Optical Supplies 20 1639739485 0 Physicians Physician Services 00 1639739600 0 ZIA HARIS 2019276 9999999 B 10 1639739600 0 2050 E ALGONQUIN RD STE 610 SCHAUMBURG IL 601734166 20 1639739600 0 Dentists Dental Services 20 1639739600 0 Dentists Physician Services 00 1639739733 0 WIESEHAN REBECCA M 2019171 9999999 B 10 1639739733 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1639739733 0 Physicians Anesthesia Services 20 1639739733 0 Physicians Fluoride varnish 20 1639739733 0 Physicians Healthy Kids Services 20 1639739733 0 Physicians Optical Supplies 20 1639739733 0 Physicians Physician Services 00 1639740053 0 HUSSER KAITLIN A 2021188 9999999 H 10 1639740053 0 PO BOX 146 WATERLOO IL 622980146 20 1639740053 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639741218 0 ABU HAMAD MOHD 2024138 9999999 B 10 1639741218 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1639741218 0 Physicians Anesthesia Services 20 1639741218 0 Physicians Fluoride varnish 20 1639741218 0 Physicians Healthy Kids Services 20 1639741218 0 Physicians Optical Supplies 20 1639741218 0 Physicians Physician Services 00 1639741341 0 GRAY IAN J 2021224 9999999 B 10 1639741341 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1639741341 0 Nurse Practitioners Healthy Kids Services 20 1639741341 0 Nurse Practitioners Nurse Practitioners Services 20 1639741341 0 Nurse Practitioners Physician Services 00 1639741564 0 SHAMSAEI TEENA 2024158 9999999 B 10 1639741564 0 101 MADISON ST STE 300 OAK PARK IL 603024210 20 1639741564 0 Physicians Anesthesia Services 20 1639741564 0 Physicians Fluoride varnish 20 1639741564 0 Physicians Healthy Kids Services 20 1639741564 0 Physicians Optical Supplies 20 1639741564 0 Physicians Physician Services 00 1639743107 0 BOLADALE OLADUNNI 2022087 9999999 B 10 1639743107 0 429 N WEBER RD # 409 ROMEOVILLE IL 604463902 20 1639743107 0 Nurse Practitioners Healthy Kids Services 20 1639743107 0 Nurse Practitioners Nurse Practitioners Services 20 1639743107 0 Nurse Practitioners Physician Services 00 1639743131 0 PIERRE-GRAY DINA 2021146 9999999 B 10 1639743131 0 1044 N FRANCISCO AVE CHICAGO IL 606222743 20 1639743131 0 Nurse Practitioners Healthy Kids Services 20 1639743131 0 Nurse Practitioners Nurse Practitioners Services 20 1639743131 0 Nurse Practitioners Physician Services 00 1639743909 0 SWANSON KAREN L 2021214 9999999 B 10 1639743909 0 5777 DEPT CAROL STREAM IL 601228942 20 1639743909 0 Nurse Practitioners Healthy Kids Services 20 1639743909 0 Nurse Practitioners Nurse Practitioners Services 20 1639743909 0 Nurse Practitioners Physician Services 00 1639744493 0 NISSAN NINOS 2021189 9999999 B 10 1639744493 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1639744493 0 Physicians Anesthesia Services 20 1639744493 0 Physicians Fluoride varnish 20 1639744493 0 Physicians Healthy Kids Services 20 1639744493 0 Physicians Optical Supplies 20 1639744493 0 Physicians Physician Services 00 1639744618 0 GARCIA JAMES 2021203 9999999 B 10 1639744618 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1639744618 0 Optometrists Anesthesia Services 20 1639744618 0 Optometrists Healthy Kids Services 20 1639744618 0 Optometrists Optical Supplies 20 1639744618 0 Optometrists Physician Services 00 1639745227 0 COUCH SARAH 2024204 9999999 B 10 1639745227 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1639745227 0 Physicians Anesthesia Services 20 1639745227 0 Physicians Fluoride varnish 20 1639745227 0 Physicians Healthy Kids Services 20 1639745227 0 Physicians Optical Supplies 20 1639745227 0 Physicians Physician Services 00 1639745276 0 LAMBERT BEN 2022055 9999999 B 10 1639745276 0 70 S RIVER ST AURORA IL 605065185 20 1639745276 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639745318 0 DOWNS DARRELL 2024191 9999999 B 10 1639745318 0 124 SW ADAMS ST PEORIA IL 616021308 20 1639745318 0 Physicians Anesthesia Services 20 1639745318 0 Physicians Fluoride varnish 20 1639745318 0 Physicians Healthy Kids Services 20 1639745318 0 Physicians Optical Supplies 20 1639745318 0 Physicians Physician Services 00 1639746506 0 YANG JOHN K 2023221 9999999 B 10 1639746506 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1639746506 0 Physicians Anesthesia Services 20 1639746506 0 Physicians Healthy Kids Services 20 1639746506 0 Physicians Optical Supplies 20 1639746506 0 Physicians Physician Services 20 1639746506 0 Physicians Physicians Psychiatric Services 00 1639746761 0 MCFIELD ROBERT 2021355 9999999 B 10 1639746761 0 160 BUDDIE AVE SAINT LOUIS MO 631351015 20 1639746761 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639746852 0 MOK TIFFANY 2021162 9999999 H 10 1639746852 0 2028 N SEMINARY AVE WOODSTOCK IL 600982626 20 1639746852 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639747439 0 HENDRICKSON ELIZABETH 2021176 9999999 B 10 1639747439 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1639747439 0 Physicians Anesthesia Services 20 1639747439 0 Physicians Fluoride varnish 20 1639747439 0 Physicians Healthy Kids Services 20 1639747439 0 Physicians Optical Supplies 20 1639747439 0 Physicians Physician Services 00 1639747991 0 FERRIS CHLOE K 2021207 9999999 B 10 1639747991 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1639747991 0 Physicians Anesthesia Services 20 1639747991 0 Physicians Fluoride varnish 20 1639747991 0 Physicians Healthy Kids Services 20 1639747991 0 Physicians Optical Supplies 20 1639747991 0 Physicians Physician Services 00 1639748338 0 ALUKO SHEUN 2021230 9999999 B 10 1639748338 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1639748338 0 Physicians Anesthesia Services 20 1639748338 0 Physicians Fluoride varnish 20 1639748338 0 Physicians Healthy Kids Services 20 1639748338 0 Physicians Optical Supplies 20 1639748338 0 Physicians Physician Services 00 1639748502 0 ULSES SARAH 2021207 9999999 B 10 1639748502 0 500 PORTER AVE AURORA MO 656052365 20 1639748502 0 Nurse Practitioners Fluoride varnish 20 1639748502 0 Nurse Practitioners Healthy Kids Services 20 1639748502 0 Nurse Practitioners Nurse Practitioners Services 20 1639748502 0 Nurse Practitioners Physician Services 00 1639749823 0 BRAVO ARAUJO DANIELA 2021187 9999999 B 10 1639749823 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1639749823 0 Physicians Anesthesia Services 20 1639749823 0 Physicians Fluoride varnish 20 1639749823 0 Physicians Healthy Kids Services 20 1639749823 0 Physicians Optical Supplies 20 1639749823 0 Physicians Physician Services 00 1639749989 0 ARGUELLO BIANCA M 2022189 9999999 B 10 1639749989 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1639749989 0 Physicians Anesthesia Services 20 1639749989 0 Physicians Fluoride varnish 20 1639749989 0 Physicians Healthy Kids Services 20 1639749989 0 Physicians Optical Supplies 20 1639749989 0 Physicians Physician Services 00 1639750532 0 RYALL JACOB 2022182 9999999 B 10 1639750532 0 4698 DEPT CAROL STREAM IL 601220021 20 1639750532 0 Physicians Anesthesia Services 20 1639750532 0 Physicians Healthy Kids Services 20 1639750532 0 Physicians Optical Supplies 20 1639750532 0 Physicians Physician Services 00 1639750961 0 BROWN ZOE 2021160 9999999 B 10 1639750961 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1639750961 0 Physicians Anesthesia Services 20 1639750961 0 Physicians Fluoride varnish 20 1639750961 0 Physicians Healthy Kids Services 20 1639750961 0 Physicians Optical Supplies 20 1639750961 0 Physicians Physician Services 00 1639751456 0 ABUHALAWEH MUTASEM 2024163 9999999 B 10 1639751456 0 611 W PARK ST URBANA IL 618012529 20 1639751456 0 Physicians Anesthesia Services 20 1639751456 0 Physicians Fluoride varnish 20 1639751456 0 Physicians Healthy Kids Services 20 1639751456 0 Physicians Optical Supplies 20 1639751456 0 Physicians Physician Services 00 1639751860 0 MATHEW JESSEY 2021222 9999999 B 10 1639751860 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1639751860 0 Physicians Anesthesia Services 20 1639751860 0 Physicians Fluoride varnish 20 1639751860 0 Physicians Healthy Kids Services 20 1639751860 0 Physicians Optical Supplies 20 1639751860 0 Physicians Physician Services 00 1639752009 0 NOLAN IAN T 2022202 9999999 B 10 1639752009 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1639752009 0 Physicians Anesthesia Services 20 1639752009 0 Physicians Healthy Kids Services 20 1639752009 0 Physicians Optical Supplies 20 1639752009 0 Physicians Physician Services 00 1639752140 0 BAJWA TANVIR ABDULLAH 2022312 9999999 B 10 1639752140 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1639752140 0 Physicians Anesthesia Services 20 1639752140 0 Physicians Fluoride varnish 20 1639752140 0 Physicians Healthy Kids Services 20 1639752140 0 Physicians Optical Supplies 20 1639752140 0 Physicians Physician Services 00 1639752751 0 ENWEZOR CHUKWUEMEKA J 2021182 9999999 B 10 1639752751 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1639752751 0 Physicians Anesthesia Services 20 1639752751 0 Physicians Fluoride varnish 20 1639752751 0 Physicians Healthy Kids Services 20 1639752751 0 Physicians Optical Supplies 20 1639752751 0 Physicians Physician Services 00 1639755077 0 BHAYANI SIDDHARTH A 2021175 9999999 B 10 1639755077 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1639755077 0 Physicians Anesthesia Services 20 1639755077 0 Physicians Fluoride varnish 20 1639755077 0 Physicians Healthy Kids Services 20 1639755077 0 Physicians Optical Supplies 20 1639755077 0 Physicians Physician Services 00 1639755176 0 ALI SYEDA TOOBA 2021208 9999999 B 10 1639755176 0 4698 DEPT CAROL STREAM IL 601224698 20 1639755176 0 Physicians Anesthesia Services 20 1639755176 0 Physicians Fluoride varnish 20 1639755176 0 Physicians Healthy Kids Services 20 1639755176 0 Physicians Optical Supplies 20 1639755176 0 Physicians Physician Services 00 1639755200 0 SEDAGHAT ARIANA 2024037 9999999 B 10 1639755200 0 4698 DEPT CAROL STREAM IL 601220021 20 1639755200 0 Physicians Anesthesia Services 20 1639755200 0 Physicians Healthy Kids Services 20 1639755200 0 Physicians Optical Supplies 20 1639755200 0 Physicians Physician Services 00 1639755648 0 OZOIGBO PHILIP U 2023137 9999999 B 10 1639755648 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1639755648 0 Physical Therapists Medical Supplies 20 1639755648 0 Physical Therapists Medical equipment/prosthetic devices 20 1639755648 0 Physical Therapists Physical Therapy Services 00 1639755671 0 KAUSHAL SURAJ 2021217 9999999 B 10 1639755671 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1639755671 0 Physicians Anesthesia Services 20 1639755671 0 Physicians Healthy Kids Services 20 1639755671 0 Physicians Optical Supplies 20 1639755671 0 Physicians Physician Services 00 1639755747 0 BRUSS HEATHER M 2021139 9999999 B 10 1639755747 0 2635 LINCOLN WAY STE A CLINTON IA 527327229 20 1639755747 0 Nurse Practitioners Fluoride varnish 20 1639755747 0 Nurse Practitioners Healthy Kids Services 20 1639755747 0 Nurse Practitioners Nurse Practitioners Services 20 1639755747 0 Nurse Practitioners Physician Services 00 1639756117 0 HUSSAIN UMAR 2022221 9999999 B 10 1639756117 0 PO BOX 3039 OAK BROOK IL 605223039 20 1639756117 0 Physicians Anesthesia Services 20 1639756117 0 Physicians Fluoride varnish 20 1639756117 0 Physicians Healthy Kids Services 20 1639756117 0 Physicians Optical Supplies 20 1639756117 0 Physicians Physician Services 00 1639756182 0 KIM SANGRI 2021172 9999999 B 10 1639756182 0 4698 DEPT CAROL STREAM IL 601220021 20 1639756182 0 Physicians Anesthesia Services 20 1639756182 0 Physicians Fluoride varnish 20 1639756182 0 Physicians Healthy Kids Services 20 1639756182 0 Physicians Optical Supplies 20 1639756182 0 Physicians Physician Services 00 1639756679 0 BRUSS DAVID M 2021176 9999999 B 10 1639756679 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1639756679 0 Physicians Anesthesia Services 20 1639756679 0 Physicians Healthy Kids Services 20 1639756679 0 Physicians Optical Supplies 20 1639756679 0 Physicians Physician Services 00 1639757149 0 BARNETT THOMAS 2021175 9999999 B 10 1639757149 0 4698 DEPT CAROL STREAM IL 601220021 20 1639757149 0 Physicians Anesthesia Services 20 1639757149 0 Physicians Healthy Kids Services 20 1639757149 0 Physicians Optical Supplies 20 1639757149 0 Physicians Physician Services 20 1639757149 0 Physicians Physicians Psychiatric Services 00 1639757172 0 GURALNIK GENNADIY 2021187 9999999 B 10 1639757172 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1639757172 0 Physicians Anesthesia Services 20 1639757172 0 Physicians Healthy Kids Services 20 1639757172 0 Physicians Optical Supplies 20 1639757172 0 Physicians Physician Services 00 1639757339 0 SINGH ANJANYA D 2024250 9999999 B 10 1639757339 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1639757339 0 Physicians Anesthesia Services 20 1639757339 0 Physicians Fluoride varnish 20 1639757339 0 Physicians Healthy Kids Services 20 1639757339 0 Physicians Optical Supplies 20 1639757339 0 Physicians Physician Services 00 1639757503 0 SHAH AMI 2021172 9999999 B 10 1639757503 0 29373 NETWORK PL CHICAGO IL 606733039 20 1639757503 0 Physicians Anesthesia Services 20 1639757503 0 Physicians Fluoride varnish 20 1639757503 0 Physicians Healthy Kids Services 20 1639757503 0 Physicians Optical Supplies 20 1639757503 0 Physicians Physician Services 00 1639757958 0 DALE MAURICE 2024220 9999999 B 10 1639757958 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1639757958 0 Physicians Anesthesia Services 20 1639757958 0 Physicians Healthy Kids Services 20 1639757958 0 Physicians Optical Supplies 20 1639757958 0 Physicians Physician Services 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1639800519 0 ROMERO CARL 2022363 9999999 B 10 1639800519 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1639800519 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639800550 0 O'NEIL ASHLEY 2022188 9999999 B 10 1639800550 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1639800550 0 Physicians Anesthesia Services 20 1639800550 0 Physicians Fluoride varnish 20 1639800550 0 Physicians Healthy Kids Services 20 1639800550 0 Physicians Optical Supplies 20 1639800550 0 Physicians Physician Services 00 1639801343 0 LENTZ GYNGER 2024038 9999999 B 10 1639801343 0 180 S MAIN ST CANTON IL 615202608 20 1639801343 0 Nurse Practitioners Fluoride varnish 20 1639801343 0 Nurse Practitioners Healthy Kids Services 20 1639801343 0 Nurse Practitioners Nurse Practitioners Services 20 1639801343 0 Nurse Practitioners Physician Services 00 1639801533 0 TORRES RICHIE 2022202 9999999 B 10 1639801533 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 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Services 20 1639826035 0 Nurse Practitioners Nurse Practitioners Services 20 1639826035 0 Nurse Practitioners Physician Services 00 1639826159 0 PINZAS LAUREN 2023190 9999999 B 10 1639826159 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1639826159 0 Physicians Anesthesia Services 20 1639826159 0 Physicians Healthy Kids Services 20 1639826159 0 Physicians Optical Supplies 20 1639826159 0 Physicians Physician Services 00 1639826704 0 PATEL KISHAN N 2024193 9999999 B 10 1639826704 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1639826704 0 Physicians Anesthesia Services 20 1639826704 0 Physicians Healthy Kids Services 20 1639826704 0 Physicians Optical Supplies 20 1639826704 0 Physicians Physician Services 00 1639827025 0 KURIAN SHAWN 2023193 9999999 B 10 1639827025 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1639827025 0 Physicians Anesthesia Services 20 1639827025 0 Physicians Healthy Kids Services 20 1639827025 0 Physicians Optical Supplies 20 1639827025 0 Physicians 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00 1639827249 0 ALTIERI EMMA J 2023199 9999999 B 10 1639827249 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1639827249 0 Physicians Anesthesia Services 20 1639827249 0 Physicians Healthy Kids Services 20 1639827249 0 Physicians Optical Supplies 20 1639827249 0 Physicians Physician Services 00 1639827421 0 BENES TARA L 2022258 9999999 B 10 1639827421 0 1390 US HIGHWAY 61 STE G1500 FESTUS MO 630284138 20 1639827421 0 Physician Assistant Only Fluoride varnish 20 1639827421 0 Physician Assistant Only Healthy Kids Services 20 1639827421 0 Physician Assistant Only Physician Services 00 1639827447 0 CORDON AJIMIE U 2022145 9999999 B 10 1639827447 0 29373 NETWORK PL CHICAGO IL 606733039 20 1639827447 0 Nurse Practitioners Fluoride varnish 20 1639827447 0 Nurse Practitioners Healthy Kids Services 20 1639827447 0 Nurse Practitioners Nurse Practitioners Services 20 1639827447 0 Nurse Practitioners Physician Services 00 1639827827 0 PELSER NICOLE L 2022105 9999999 B 10 1639827827 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1639827827 0 Nurse Practitioners Fluoride varnish 20 1639827827 0 Nurse Practitioners Healthy Kids Services 20 1639827827 0 Nurse Practitioners Nurse Practitioners Services 20 1639827827 0 Nurse Practitioners Physician Services 00 1639828650 0 KONG DANIEL S 2022195 9999999 B 10 1639828650 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1639828650 0 Physicians Anesthesia Services 20 1639828650 0 Physicians Healthy Kids Services 20 1639828650 0 Physicians Optical Supplies 20 1639828650 0 Physicians Physician Services 00 1639829526 0 MARTINI OMAR Z 2022213 9999999 B 10 1639829526 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1639829526 0 Physicians Anesthesia Services 20 1639829526 0 Physicians Healthy Kids Services 20 1639829526 0 Physicians Optical Supplies 20 1639829526 0 Physicians Physician Services 00 1639829898 0 HEJNA EMILY E 2022197 9999999 B 10 1639829898 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1639829898 0 Physicians Anesthesia Services 20 1639829898 0 Physicians Healthy Kids Services 20 1639829898 0 Physicians Optical Supplies 20 1639829898 0 Physicians Physician Services 00 1639830904 0 VARNADO BRENDA 2023244 9999999 B 10 1639830904 0 31 W 155TH ST HARVEY IL 604263556 20 1639830904 0 Other behavior health professional LCPC/LMFT services 20 1639830904 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639832025 0 BANNON KATHY K 2021334 9999999 B 10 1639832025 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1639832025 0 Nurse Practitioners Fluoride varnish 20 1639832025 0 Nurse Practitioners Healthy Kids Services 20 1639832025 0 Nurse Practitioners Nurse Practitioners Services 20 1639832025 0 Nurse Practitioners Physician Services 00 1639833536 0 REMORIN ASHLEY 2021354 9999999 B 10 1639833536 0 901 PATIENTS FIRST DR WASHINGTON MO 630904700 20 1639833536 0 Nurse Practitioners Fluoride varnish 20 1639833536 0 Nurse Practitioners Healthy Kids Services 20 1639833536 0 Nurse Practitioners Nurse Practitioners Services 20 1639833536 0 Nurse Practitioners Physician Services 00 1639833601 0 LEVESQUE MATHIEU 2021308 9999999 B 10 1639833601 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1639833601 0 Physicians Anesthesia Services 20 1639833601 0 Physicians Healthy Kids Services 20 1639833601 0 Physicians Optical Supplies 20 1639833601 0 Physicians Physician Services 20 1639833601 0 Physicians Physicians Psychiatric Services 00 1639835226 0 HEDRICK ANN MARIE 2022038 9999999 B 10 1639835226 0 29373 NETWORK PL CHICAGO IL 606733039 20 1639835226 0 Nurse Practitioners Fluoride varnish 20 1639835226 0 Nurse Practitioners Healthy Kids Services 20 1639835226 0 Nurse Practitioners Nurse Practitioners Services 20 1639835226 0 Nurse Practitioners Physician Services 00 1639835481 0 JACOBS JOANN 2023072 9999999 B 10 1639835481 0 54 N WOLF RD HILLSIDE IL 601621630 20 1639835481 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639838196 0 SIMPRI OLIVIA 2024215 9999999 B 10 1639838196 0 PO BOX 1239 TROY MI 480991239 20 1639838196 0 Nurse Practitioners Fluoride varnish 20 1639838196 0 Nurse Practitioners Healthy Kids Services 20 1639838196 0 Nurse Practitioners Nurse Practitioners Services 20 1639838196 0 Nurse Practitioners Physician Services 00 1639839186 0 AUGUSTIN KATHIANA 2022005 9999999 B 10 1639839186 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1639839186 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639839251 0 TYLER KARI C 2023199 9999999 B 10 1639839251 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1639839251 0 Physicians Anesthesia Services 20 1639839251 0 Physicians Fluoride varnish 20 1639839251 0 Physicians Healthy Kids Services 20 1639839251 0 Physicians Optical Supplies 20 1639839251 0 Physicians Physician Services 00 1639841646 0 TIMM JUSTINA 2022031 9999999 B 10 1639841646 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1639841646 0 Nurse Practitioners Fluoride varnish 20 1639841646 0 Nurse Practitioners Healthy Kids Services 20 1639841646 0 Nurse Practitioners Nurse Practitioners Services 20 1639841646 0 Nurse Practitioners Physician Services 00 1639842743 0 KHAIRALLAH AMER 2023318 9999999 B 10 1639842743 0 PO BOX 775618 CHICAGO IL 606775618 20 1639842743 0 Physician Assistant Only Fluoride varnish 20 1639842743 0 Physician Assistant Only Healthy Kids Services 20 1639842743 0 Physician Assistant Only Physician Services 00 1639845316 0 CIRRINTANO ERICA 2022217 9999999 B 10 1639845316 0 7600 W COLLEGE DR STE 5 PALOS HEIGHTS IL 604631035 20 1639845316 0 Nurse Practitioners Fluoride varnish 20 1639845316 0 Nurse Practitioners Healthy Kids Services 20 1639845316 0 Nurse Practitioners Nurse Practitioners Services 20 1639845316 0 Nurse Practitioners Physician Services 00 1639846173 0 BUZA KEITH 2021273 9999999 B 10 1639846173 0 350 N WALL ST KANKAKEE IL 609012901 20 1639846173 0 Nurse Practitioners Healthy Kids Services 20 1639846173 0 Nurse Practitioners Nurse Practitioners Services 20 1639846173 0 Nurse Practitioners Physician Services 00 1639847114 0 AXELROD ZACHARY 2022096 9999999 B 10 1639847114 0 4885 HOFFMAN BLVD STE 400 HOFFMAN ESTATES IL 601923727 20 1639847114 0 Physician Assistant Only Fluoride varnish 20 1639847114 0 Physician Assistant Only Healthy Kids Services 20 1639847114 0 Physician Assistant Only Physician Services 00 1639847155 0 LUALLIN STEPHANIE 2022131 9999999 B 10 1639847155 0 2301 W BRADLEY AVE CHAMPAIGN IL 618211849 20 1639847155 0 Psychologist Psychologist service 00 1639847759 0 SABER EMILIA 2023016 9999999 B 10 1639847759 0 10001 GRAND AVE ATTN: BILLING DEPARTMENT FRANKLIN PARK IL 601312563 20 1639847759 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639848401 0 HINTON EMILY 2022013 9999999 B 10 1639848401 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1639848401 0 Nurse Practitioners Healthy Kids Services 20 1639848401 0 Nurse Practitioners Nurse Practitioners Services 20 1639848401 0 Nurse Practitioners Physician Services 00 1639849003 0 RODEA-RUIZ ELIZABETH 2021260 9999999 B 10 1639849003 0 50 S MAIN ST STE 200 NAPERVILLE IL 605405485 20 1639849003 0 Occupational Therapists Medical Supplies 20 1639849003 0 Occupational Therapists Medical equipment/prosthetic devices 20 1639849003 0 Occupational Therapists Occupational Therapy Services 00 1639850852 0 WOJCIAK ELLEN ELIZABETH 2023230 9999999 B 10 1639850852 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1639850852 0 Nurse Practitioners Healthy Kids Services 20 1639850852 0 Nurse Practitioners Nurse Practitioners Services 20 1639850852 0 Nurse Practitioners Physician Services 00 1639851066 0 MORAN MARY K 2023333 9999999 B 10 1639851066 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1639851066 0 Speech Therapists Speech Therapy/Pathology Services 00 1639851736 0 O'ROURKE KELLSEY E 2024184 9999999 B 10 1639851736 0 13400 S ROUTE 59 STE 116-326 PLAINFIELD IL 605855826 20 1639851736 0 Speech Therapists Medical Supplies 20 1639851736 0 Speech Therapists Medical equipment/prosthetic devices 20 1639851736 0 Speech Therapists Speech Therapy/Pathology Services 00 1639853880 0 BOMMAVEDDI SHRAVYA 2023194 9999999 B 10 1639853880 0 PO BOX 775248 CHICAGO IL 606775248 20 1639853880 0 Physicians Anesthesia Services 20 1639853880 0 Physicians Fluoride varnish 20 1639853880 0 Physicians Healthy Kids Services 20 1639853880 0 Physicians Optical Supplies 20 1639853880 0 Physicians Physician Services 00 1639853948 0 ROSE BRITTANY KAY 2023317 9999999 B 10 1639853948 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1639853948 0 Nurse Practitioners Healthy Kids Services 20 1639853948 0 Nurse Practitioners Nurse Practitioners Services 20 1639853948 0 Nurse Practitioners Physician Services 00 1639854433 0 WHITELAW BRENDAN S 2024007 9999999 B 10 1639854433 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1639854433 0 Physicians Anesthesia Services 20 1639854433 0 Physicians Healthy Kids Services 20 1639854433 0 Physicians Optical Supplies 20 1639854433 0 Physicians Physician Services 20 1639854433 0 Physicians Physicians Psychiatric Services 00 1639854615 0 BERNAL MARIA L 2024296 9999999 B 10 1639854615 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1639854615 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639854888 0 ELMANSOURI SABRI 2023202 9999999 B 10 1639854888 0 PO BOX 778791 CHICAGO IL 606776473 20 1639854888 0 Physicians Anesthesia Services 20 1639854888 0 Physicians Fluoride varnish 20 1639854888 0 Physicians Healthy Kids Services 20 1639854888 0 Physicians Optical Supplies 20 1639854888 0 Physicians Physician Services 00 1639854987 0 EMAMI RACHEL M 2024177 9999999 B 10 1639854987 0 PO BOX 3039 OAK BROOK IL 605223039 20 1639854987 0 Physicians Anesthesia Services 20 1639854987 0 Physicians Fluoride varnish 20 1639854987 0 Physicians Healthy Kids Services 20 1639854987 0 Physicians Optical Supplies 20 1639854987 0 Physicians Physician Services 00 1639855356 0 VONACHEN MATTHEW 2023179 9999999 B 10 1639855356 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1639855356 0 Nurse Practitioners Healthy Kids Services 20 1639855356 0 Nurse Practitioners Nurse Practitioners Services 20 1639855356 0 Nurse Practitioners Physician Services 00 1639855547 0 TEMPEST CHANDLER 2023198 9999999 B 10 1639855547 0 5745 W BELMONT AVE CHICAGO IL 606345211 20 1639855547 0 Dentists Dental Services 20 1639855547 0 Dentists Physician Services 00 1639855711 0 GRAULICH BETHANY 2024198 9999999 B 10 1639855711 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1639855711 0 Physicians Anesthesia Services 20 1639855711 0 Physicians Fluoride varnish 20 1639855711 0 Physicians Healthy Kids Services 20 1639855711 0 Physicians Optical Supplies 20 1639855711 0 Physicians Physician Services 00 1639855893 0 MARTIN ZIMA MARIA 2023226 9999999 B 10 1639855893 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1639855893 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639856032 0 GENEVICIUTE INDRE 2023286 9999999 B 10 1639856032 0 10759 WINTERSET DR ORLAND PARK IL 604671106 20 1639856032 0 Dentists Dental Services 20 1639856032 0 Dentists Physician Services 00 1639856289 0 ROLAND CLAYTON 2023202 9999999 B 10 1639856289 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1639856289 0 Physicians Anesthesia Services 20 1639856289 0 Physicians Fluoride varnish 20 1639856289 0 Physicians Healthy Kids Services 20 1639856289 0 Physicians Optical Supplies 20 1639856289 0 Physicians Physician Services 00 1639857097 0 DEVRIES SARAH MARIE 2023207 9999999 B 10 1639857097 0 2640 183RD ST HOMEWOOD IL 604302914 20 1639857097 0 Optometrists Optical Supplies 20 1639857097 0 Optometrists Optometric Services 20 1639857097 0 Optometrists Physician Services 00 1639857469 0 MARTIN ANNA K 2024180 9999999 B 10 1639857469 0 325 IL ROUTE 2 DIXON IL 610219118 20 1639857469 0 Registered nurse Nursing service 20 1639857469 0 Registered nurse Waiver service 00 1639857956 0 KADAM KAJAL 2023202 9999999 B 10 1639857956 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1639857956 0 Physicians Anesthesia Services 20 1639857956 0 Physicians Fluoride varnish 20 1639857956 0 Physicians Healthy Kids Services 20 1639857956 0 Physicians Optical Supplies 20 1639857956 0 Physicians Physician Services 00 1639858111 0 PATEL ROSHANI 2023325 9999999 B 10 1639858111 0 107 S MCLEAN BLVD STE B SOUTH ELGIN IL 601771822 20 1639858111 0 Nurse Practitioners Fluoride varnish 20 1639858111 0 Nurse Practitioners Healthy Kids Services 20 1639858111 0 Nurse Practitioners Nurse Practitioners Services 20 1639858111 0 Nurse Practitioners Physician Services 00 1639858319 0 BULLOCK CHA-GA N 2023289 9999999 B 10 1639858319 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1639858319 0 Nurse Practitioners Fluoride varnish 20 1639858319 0 Nurse Practitioners Healthy Kids Services 20 1639858319 0 Nurse Practitioners Nurse Practitioners Services 20 1639858319 0 Nurse Practitioners Physician Services 00 1639858798 0 BASTOLA SATISH 2023201 9999999 B 10 1639858798 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1639858798 0 Physicians Anesthesia Services 20 1639858798 0 Physicians Fluoride varnish 20 1639858798 0 Physicians Healthy Kids Services 20 1639858798 0 Physicians Optical Supplies 20 1639858798 0 Physicians Physician Services 00 1639859283 0 CARPIO HYACINTH 2024043 9999999 B 10 1639859283 0 1111 SUPERIOR ST STE 507 MELROSE PARK IL 601604159 20 1639859283 0 Nurse Practitioners Healthy Kids Services 20 1639859283 0 Nurse Practitioners Nurse Practitioners Services 20 1639859283 0 Nurse Practitioners Physician Services 00 1639859606 0 SUAREZ CHEYENNE 2023209 9999999 B 10 1639859606 0 1812 N 19TH AVE MELROSE PARK IL 601602039 20 1639859606 0 Dentists Dental Services 20 1639859606 0 Dentists Physician Services 00 1639859788 0 MARTINEZ ANN M 2023352 9999999 B 10 1639859788 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1639859788 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639860356 0 WAHBA CHANTAL 2024199 9999999 B 10 1639860356 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1639860356 0 Physicians Anesthesia Services 20 1639860356 0 Physicians Fluoride varnish 20 1639860356 0 Physicians Healthy Kids Services 20 1639860356 0 Physicians Optical Supplies 20 1639860356 0 Physicians Physician Services 00 1639861073 0 WILLIAMS ANDREW H 2023187 9999999 B 10 1639861073 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1639861073 0 Physicians Anesthesia Services 20 1639861073 0 Physicians Healthy Kids Services 20 1639861073 0 Physicians Optical Supplies 20 1639861073 0 Physicians Physician Services 00 1639862428 0 LOSEY CLARISSA 2023159 9999999 B 10 1639862428 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1639862428 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639864010 0 LOR JENNIFER 2024191 9999999 B 10 1639864010 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1639864010 0 Physicians Anesthesia Services 20 1639864010 0 Physicians Fluoride varnish 20 1639864010 0 Physicians Healthy Kids Services 20 1639864010 0 Physicians Optical Supplies 20 1639864010 0 Physicians Physician Services 00 1639864911 0 OKOYE VIVIAN O 2023236 9999999 B 10 1639864911 0 8496 SOLUTIONS CTR LOCKBOX 778496 CHICAGO IL 606778004 20 1639864911 0 Physician Assistant Only Fluoride varnish 20 1639864911 0 Physician Assistant Only Healthy Kids Services 20 1639864911 0 Physician Assistant Only Physician Services 00 1639865769 0 SMITH CALLIE 2023208 9999999 B 10 1639865769 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1639865769 0 Nurse Practitioners Fluoride varnish 20 1639865769 0 Nurse Practitioners Healthy Kids Services 20 1639865769 0 Nurse Practitioners Nurse Practitioners Services 20 1639865769 0 Nurse Practitioners Physician Services 00 1639866502 0 SKITT RALPH J 2024256 9999999 B 10 1639866502 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1639866502 0 Physician Assistant Only Fluoride varnish 20 1639866502 0 Physician Assistant Only Healthy Kids Services 20 1639866502 0 Physician Assistant Only Physician Services 00 1639866635 0 ISMAIL MANAR F 2023205 9999999 B 10 1639866635 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1639866635 0 Physicians Anesthesia Services 20 1639866635 0 Physicians Fluoride varnish 20 1639866635 0 Physicians Healthy Kids Services 20 1639866635 0 Physicians Optical Supplies 20 1639866635 0 Physicians Physician Services 00 1639867377 0 BLONIARZ NICHOLAS J 2023121 9999999 B 10 1639867377 0 70 S RIVER ST AURORA IL 605065185 20 1639867377 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639867690 0 SMITH LINDY 2023123 9999999 B 10 1639867690 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1639867690 0 Physicians Anesthesia Services 20 1639867690 0 Physicians Fluoride varnish 20 1639867690 0 Physicians Healthy Kids Services 20 1639867690 0 Physicians Optical Supplies 20 1639867690 0 Physicians Physician Services 20 1639867690 0 Physicians Physicians Psychiatric Services 00 1639869407 0 BRICKNELL LAURA 2024018 9999999 B 10 1639869407 0 28100 TORCH PKWY STE 600 WARRENVILLE IL 605554030 20 1639869407 0 Occupational Therapists Medical Supplies 20 1639869407 0 Occupational Therapists Medical equipment/prosthetic devices 20 1639869407 0 Occupational Therapists Occupational Therapy Services 00 1639871171 0 ELLIS CODY 2023345 9999999 B 10 1639871171 0 4698 DEPT CAROL STREAM IL 601220021 20 1639871171 0 Physicians Anesthesia Services 20 1639871171 0 Physicians Healthy Kids Services 20 1639871171 0 Physicians Optical Supplies 20 1639871171 0 Physicians Physician Services 00 1639871205 0 COTOIA JOHN 2024199 9999999 B 10 1639871205 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1639871205 0 Physicians Anesthesia Services 20 1639871205 0 Physicians Fluoride varnish 20 1639871205 0 Physicians Healthy Kids Services 20 1639871205 0 Physicians Optical Supplies 20 1639871205 0 Physicians Physician Services 00 1639871619 0 SULLIVAN MOIRA ELIZABETH 2023174 9999999 B 10 1639871619 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1639871619 0 Physicians Anesthesia Services 20 1639871619 0 Physicians Healthy Kids Services 20 1639871619 0 Physicians Optical Supplies 20 1639871619 0 Physicians Physician Services 00 1639872120 0 SUDA BRADLEY S 2024183 9999999 B 10 1639872120 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1639872120 0 Physicians Anesthesia Services 20 1639872120 0 Physicians Healthy Kids Services 20 1639872120 0 Physicians Optical Supplies 20 1639872120 0 Physicians Physician Services 00 1639873151 0 GAUR AASNA 2023208 9999999 B 10 1639873151 0 221 NE GLEN OAK AVE PEORIA IL 616360002 20 1639873151 0 Physicians Anesthesia Services 20 1639873151 0 Physicians Healthy Kids Services 20 1639873151 0 Physicians Optical Supplies 20 1639873151 0 Physicians Physician Services 20 1639873151 0 Physicians Physicians Psychiatric Services 00 1639873441 0 STONEWALL KEVEN J 2023174 9999999 B 10 1639873441 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1639873441 0 Physicians Anesthesia Services 20 1639873441 0 Physicians Fluoride varnish 20 1639873441 0 Physicians Healthy Kids Services 20 1639873441 0 Physicians Optical Supplies 20 1639873441 0 Physicians Physician Services 00 1639873581 0 TEMPLE KIMBERLEY 2023139 9999999 B 10 1639873581 0 615 S NEW BALLAS RD STE 1400 SAINT LOUIS MO 631418221 20 1639873581 0 Nurse Practitioners Healthy Kids Services 20 1639873581 0 Nurse Practitioners Midwife Services 20 1639873581 0 Nurse Practitioners Nurse Practitioners Services 20 1639873581 0 Nurse Practitioners Physician Services 00 1639873714 0 JABR DANIEL A 2023182 9999999 B 10 1639873714 0 PO BOX 3039 OAK BROOK IL 605223039 20 1639873714 0 Physicians Anesthesia Services 20 1639873714 0 Physicians Fluoride varnish 20 1639873714 0 Physicians Healthy Kids Services 20 1639873714 0 Physicians Optical Supplies 20 1639873714 0 Physicians Physician Services 00 1639876428 0 JEONG DAVID 2023207 9999999 B 10 1639876428 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112386 20 1639876428 0 Dentists Dental Services 20 1639876428 0 Dentists Physician Services 00 1639878671 0 LANGE JOSEPH 2024054 9999999 B 10 1639878671 0 1110 W SCHICK RD BARTLETT IL 601033007 20 1639878671 0 Physician Assistant Only Fluoride varnish 20 1639878671 0 Physician Assistant Only Healthy Kids Services 20 1639878671 0 Physician Assistant Only Physician Services 00 1639878846 0 CHERRY BRIGITTA 2023065 9999999 B 10 1639878846 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1639878846 0 Nurse Practitioners Fluoride varnish 20 1639878846 0 Nurse Practitioners Healthy Kids Services 20 1639878846 0 Nurse Practitioners Nurse Practitioners Services 20 1639878846 0 Nurse Practitioners Physician Services 00 1639879299 0 DORSEY MEGAN 2023062 9999999 B 10 1639879299 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1639879299 0 Physical Therapists Medical Supplies 20 1639879299 0 Physical Therapists Medical equipment/prosthetic devices 20 1639879299 0 Physical Therapists Physical Therapy Services 00 1639882129 0 ROSS LILLIE N 2023305 9999999 B 10 1639882129 0 PO BOX 778912 CHICAGO IL 606778912 20 1639882129 0 Physician Assistant Only Fluoride varnish 20 1639882129 0 Physician Assistant Only Healthy Kids Services 20 1639882129 0 Physician Assistant Only Physician Services 00 1639882566 0 KAVANAUGH CHRISTINE 2023013 9999999 B 10 1639882566 0 800 BIESTERFIELD RD STE G01 ELK GROVE VILLA IL 600073372 20 1639882566 0 Nurse Practitioners Fluoride varnish 20 1639882566 0 Nurse Practitioners Healthy Kids Services 20 1639882566 0 Nurse Practitioners Nurse Practitioners Services 20 1639882566 0 Nurse Practitioners Physician Services 00 1639887847 0 SEALS PORCIA V 2023072 9999999 B 10 1639887847 0 39465 W 14 MILE RD NOVI MI 483771600 20 1639887847 0 Clinical Social Worker Social work service 00 1639890965 0 RODRIGUEZ MARSHA A 2022263 9999999 B 10 1639890965 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1639890965 0 Nurse Practitioners Fluoride varnish 20 1639890965 0 Nurse Practitioners Healthy Kids Services 20 1639890965 0 Nurse Practitioners Nurse Practitioners Services 20 1639890965 0 Nurse Practitioners Physician Services 00 1639891526 0 HANSEN NICOLE 2023258 9999999 B 10 1639891526 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1639891526 0 Speech Therapists Adaptive behavior support clinician services 20 1639891526 0 Speech Therapists Medical Supplies 20 1639891526 0 Speech Therapists Medical equipment/prosthetic devices 20 1639891526 0 Speech Therapists Speech Therapy/Pathology Services 00 1639894017 0 EGIERSKI MEGHAN 2023017 9999999 B 10 1639894017 0 611 W PARK ST BWPC URBANA IL 618012529 20 1639894017 0 Speech Therapists Medical Supplies 20 1639894017 0 Speech Therapists Medical equipment/prosthetic devices 20 1639894017 0 Speech Therapists Speech Therapy/Pathology Services 00 1639894496 0 BHIDE MADHULI 2022298 9999999 B 10 1639894496 0 23 W ROLLINS RD ROUND LAKE BEAC IL 600731350 20 1639894496 0 Dentists Dental Services 20 1639894496 0 Dentists Physician Services 00 1639894769 0 LITTLE JAKOB D 2022291 9999999 B 10 1639894769 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1639894769 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639895915 0 GOODS MELISSA 2023012 9999999 B 10 1639895915 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1639895915 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639897010 0 GARMON KRYSTALANN M 2023223 9999999 B 10 1639897010 0 5801 MOUNT PLEASANT LN BELLEVILLE IL 622233944 20 1639897010 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639897267 0 PRADO JASON 2024250 9999999 B 10 1639897267 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1639897267 0 Physical Therapists Medical Supplies 20 1639897267 0 Physical Therapists Medical equipment/prosthetic devices 20 1639897267 0 Physical Therapists Physical Therapy Services 00 1639899966 0 RAPPOLD KRISTEN L 2022277 9999999 B 10 1639899966 0 1500 S SANGAMON ST CRETE IL 604172831 20 1639899966 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1639900863 0 MARQUIS DEBRA L 2024291 9999999 B 10 1639900863 0 611 W PARK ST URBANA IL 618012529 20 1639900863 0 Physical Therapists Medical Supplies 20 1639900863 0 Physical Therapists Medical equipment/prosthetic devices 20 1639900863 0 Physical Therapists Physical Therapy Services 00 1639904006 0 MARTILLARO EMILY ANNE 2024291 9999999 B 10 1639904006 0 5777 DEPT CAROL STREAM IL 601228942 20 1639904006 0 Nurse Practitioners Healthy Kids Services 20 1639904006 0 Nurse Practitioners Nurse Practitioners Services 20 1639904006 0 Nurse Practitioners Physician Services 00 1639904840 0 HAHNDORF MELANIE 2024261 9999999 B 10 1639904840 0 420 FRONT ST MCHENRY IL 600505528 20 1639904840 0 Speech Therapists Medical Supplies 20 1639904840 0 Speech Therapists Medical equipment/prosthetic devices 20 1639904840 0 Speech Therapists Speech Therapy/Pathology Services 00 1639905458 0 GOODWIN ELISE 2024297 9999999 B 10 1639905458 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1639905458 0 Nurse Practitioners Anesthesia Services 20 1639905458 0 Nurse Practitioners Nurse Practitioners Services 20 1639905458 0 Nurse Practitioners Physician Services 00 1639905706 0 KEYS PAMELA P 2024260 9999999 B 10 1639905706 0 710 N 8TH ST SPRINGFIELD IL 627026324 20 1639905706 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639907512 0 CLAVIJO ANDREW 2025024 9999999 B 10 1639907512 0 PO BOX 9412 NAPERVILLE IL 605670412 20 1639907512 0 Nurse Practitioners Healthy Kids Services 20 1639907512 0 Nurse Practitioners Nurse Practitioners Services 20 1639907512 0 Nurse Practitioners Physician Services 00 1639909138 0 TSANG LILINA 2024306 9999999 B 10 1639909138 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1639909138 0 Physician Assistant Only Fluoride varnish 20 1639909138 0 Physician Assistant Only Healthy Kids Services 20 1639909138 0 Physician Assistant Only Physician Services 00 1639909724 0 CONANT SARAH 2025007 9999999 B 10 1639909724 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1639909724 0 Physician Assistant Only Fluoride varnish 20 1639909724 0 Physician Assistant Only Healthy Kids Services 20 1639909724 0 Physician Assistant Only Physician Services 00 1639910193 0 SCOTT STEVETTA 2025001 9999999 B 10 1639910193 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1639910193 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639912058 0 VAWTER KATELYN 2024173 9999999 B 10 1639912058 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1639912058 0 Physicians Anesthesia Services 20 1639912058 0 Physicians Healthy Kids Services 20 1639912058 0 Physicians Optical Supplies 20 1639912058 0 Physicians Physician Services 00 1639912074 0 RAJESH NISHI 2024191 9999999 B 10 1639912074 0 PO BOX 775257 CHICAGO IL 606775257 20 1639912074 0 Physicians Anesthesia Services 20 1639912074 0 Physicians Fluoride varnish 20 1639912074 0 Physicians Healthy Kids Services 20 1639912074 0 Physicians Optical Supplies 20 1639912074 0 Physicians Physician Services 00 1639912264 0 MACIOLEK CHLOE 2024211 9999999 B 10 1639912264 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1639912264 0 Occupational Therapists Medical Supplies 20 1639912264 0 Occupational Therapists Medical equipment/prosthetic devices 20 1639912264 0 Occupational Therapists Occupational Therapy Services 00 1639913254 0 TEDESCHI THOMAS 2024199 9999999 B 10 1639913254 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1639913254 0 Physicians Anesthesia Services 20 1639913254 0 Physicians Fluoride varnish 20 1639913254 0 Physicians Healthy Kids Services 20 1639913254 0 Physicians Optical Supplies 20 1639913254 0 Physicians Physician Services 00 1639914062 0 PARHAM AMARI S 2024262 9999999 B 10 1639914062 0 PO BOX 322 323 WEST MULBERRY ST WATSEKA IL 609700322 20 1639914062 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639914393 0 HOLLAND DIANA M 2025014 9999999 B 10 1639914393 0 325 IL ROUTE 2 DIXON IL 610219118 20 1639914393 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639914609 0 BELFANCHA MONTACER 2024344 9999999 B 10 1639914609 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1639914609 0 Nurse Practitioners Healthy Kids Services 20 1639914609 0 Nurse Practitioners Nurse Practitioners Services 20 1639914609 0 Nurse Practitioners Physician Services 00 1639916273 0 SCHMIDT KYLLIE 2024264 9999999 B 10 1639916273 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1639916273 0 Nurse Practitioners Fluoride varnish 20 1639916273 0 Nurse Practitioners Healthy Kids Services 20 1639916273 0 Nurse Practitioners Nurse Practitioners Services 20 1639916273 0 Nurse Practitioners Physician Services 00 1639916786 0 OZGEN DEVRON L 2024256 9999999 B 10 1639916786 0 1002 N 129TH INFANTRY DR STE A JOLIET IL 604353130 20 1639916786 0 Dentists Dental Services 20 1639916786 0 Dentists Physician Services 00 1639916844 0 HALLING JESSICA 2024239 9999999 B 10 1639916844 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1639916844 0 Nurse Practitioners Healthy Kids Services 20 1639916844 0 Nurse Practitioners Nurse Practitioners Services 20 1639916844 0 Nurse Practitioners Physician Services 00 1639918022 0 CAPLICE MADELINE 2024242 9999999 B 10 1639918022 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1639918022 0 Nurse Practitioners Healthy Kids Services 20 1639918022 0 Nurse Practitioners Nurse Practitioners Services 20 1639918022 0 Nurse Practitioners Physician Services 00 1639918352 0 NUNEZ DENISE 2024207 9999999 B 10 1639918352 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1639918352 0 Physicians Anesthesia Services 20 1639918352 0 Physicians Fluoride varnish 20 1639918352 0 Physicians Healthy Kids Services 20 1639918352 0 Physicians Optical Supplies 20 1639918352 0 Physicians Physician Services 00 1639920895 0 FERKETA MERON 2024184 9999999 B 10 1639920895 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1639920895 0 Physicians Anesthesia Services 20 1639920895 0 Physicians Fluoride varnish 20 1639920895 0 Physicians Healthy Kids Services 20 1639920895 0 Physicians Optical Supplies 20 1639920895 0 Physicians Physician Services 00 1639921158 0 YOKLEY JORDAN 2024194 9999999 B 10 1639921158 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1639921158 0 Physicians Anesthesia Services 20 1639921158 0 Physicians Healthy Kids Services 20 1639921158 0 Physicians Optical Supplies 20 1639921158 0 Physicians Physician Services 00 1639921927 0 HORN KAYLEE 2024110 9999999 B 10 1639921927 0 611 W PARK ST URBANA IL 618012529 20 1639921927 0 Speech Therapists Medical Supplies 20 1639921927 0 Speech Therapists Medical equipment/prosthetic devices 20 1639921927 0 Speech Therapists Speech Therapy/Pathology Services 00 1639922305 0 MEISTER MARY 2024238 9999999 B 10 1639922305 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1639922305 0 Physicians Anesthesia Services 20 1639922305 0 Physicians Fluoride varnish 20 1639922305 0 Physicians Healthy Kids Services 20 1639922305 0 Physicians Optical Supplies 20 1639922305 0 Physicians Physician Services 00 1639923600 0 NIX CHAD D 2024180 9999999 B 10 1639923600 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1639923600 0 Physicians Anesthesia Services 20 1639923600 0 Physicians Healthy Kids Services 20 1639923600 0 Physicians Optical Supplies 20 1639923600 0 Physicians Physician Services 00 1639924111 0 RIMMELIN MICHELE 2024285 9999999 B 10 1639924111 0 29373 NETWORK PL CHICAGO IL 606733039 20 1639924111 0 Nurse Practitioners Healthy Kids Services 20 1639924111 0 Nurse Practitioners Nurse Practitioners Services 20 1639924111 0 Nurse Practitioners Physician Services 00 1639926587 0 PORSCHE TIM L 2024188 9999999 B 10 1639926587 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1639926587 0 Physicians Anesthesia Services 20 1639926587 0 Physicians Healthy Kids Services 20 1639926587 0 Physicians Optical Supplies 20 1639926587 0 Physicians Physician Services 20 1639926587 0 Physicians Physicians Psychiatric Services 00 1639929045 0 FREEMAN ALYSSA 2024180 9999999 B 10 1639929045 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1639929045 0 Physicians Anesthesia Services 20 1639929045 0 Physicians Fluoride varnish 20 1639929045 0 Physicians Healthy Kids Services 20 1639929045 0 Physicians Optical Supplies 20 1639929045 0 Physicians Physician Services 00 1639929656 0 BUKOWSKI JARED E 2024181 9999999 B 10 1639929656 0 PO BOX 3039 OAK BROOK IL 605223039 20 1639929656 0 Physicians Anesthesia Services 20 1639929656 0 Physicians Fluoride varnish 20 1639929656 0 Physicians Healthy Kids Services 20 1639929656 0 Physicians Optical Supplies 20 1639929656 0 Physicians Physician Services 00 1639929797 0 DOAN THUY DUONG 2024214 9999999 B 10 1639929797 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1639929797 0 Physicians Anesthesia Services 20 1639929797 0 Physicians Healthy Kids Services 20 1639929797 0 Physicians Optical Supplies 20 1639929797 0 Physicians Physician Services 00 1639929870 0 KIMBROUGH TE''ERICKA 2024133 9999999 B 10 1639929870 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1639929870 0 Other behavior health professional Social work service 00 1639934425 0 TAYLOR ALLISON 2024063 9999999 B 10 1639934425 0 4701 DEPT CAROL STREAM IL 601220021 20 1639934425 0 Nurse Practitioners Fluoride varnish 20 1639934425 0 Nurse Practitioners Healthy Kids Services 20 1639934425 0 Nurse Practitioners Nurse Practitioners Services 20 1639934425 0 Nurse Practitioners Physician Services 00 1639935810 0 PARDUCCI LUCIA R 2024319 9999999 B 10 1639935810 0 5777 DEPT CAROL STREAM IL 601228942 20 1639935810 0 Nurse Practitioners Healthy Kids Services 20 1639935810 0 Nurse Practitioners Nurse Practitioners Services 20 1639935810 0 Nurse Practitioners Physician Services 00 1639936131 0 BEK SVETLANA 2024109 9999999 B 10 1639936131 0 1643 NW 136TH AVE STE 200 SUNRISE FL 333232857 20 1639936131 0 Nurse Practitioners Healthy Kids Services 20 1639936131 0 Nurse Practitioners Nurse Practitioners Services 20 1639936131 0 Nurse Practitioners Physician Services 00 1639936313 0 PEREZ ALEXIS 2024064 9999999 B 10 1639936313 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1639936313 0 Physician Assistant Only Fluoride varnish 20 1639936313 0 Physician Assistant Only Healthy Kids Services 20 1639936313 0 Physician Assistant Only Physician Services 00 1639940059 0 JOHNSON SIMEON S 2024032 9999999 B 10 1639940059 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1639940059 0 Nurse Practitioners Fluoride varnish 20 1639940059 0 Nurse Practitioners Healthy Kids Services 20 1639940059 0 Nurse Practitioners Nurse Practitioners Services 20 1639940059 0 Nurse Practitioners Physician Services 00 1639942220 0 CALDWELL RENATA S 2024099 9999999 B 10 1639942220 0 2900 FRANK SCOTT PKWY W BELLEVILLE IL 622235000 20 1639942220 0 Other behavior health professional LCPC/LMFT services 00 1639944119 0 MACIAS JASMIN 2024219 9999999 B 10 1639944119 0 70 S RIVER ST AURORA IL 605065185 20 1639944119 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639951031 0 SWANSON AFTON 2023326 9999999 B 10 1639951031 0 350 N WALL ST KANKAKEE IL 609012901 20 1639951031 0 Nurse Practitioners Fluoride varnish 20 1639951031 0 Nurse Practitioners Healthy Kids Services 20 1639951031 0 Nurse Practitioners Nurse Practitioners Services 20 1639951031 0 Nurse Practitioners Physician Services 00 1639951841 0 ANSELMO ELEANOR 2024022 9999999 B 10 1639951841 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1639951841 0 Nurse Practitioners Fluoride varnish 20 1639951841 0 Nurse Practitioners Healthy Kids Services 20 1639951841 0 Nurse Practitioners Nurse Practitioners Services 20 1639951841 0 Nurse Practitioners Physician Services 00 1639954894 0 MARIN-HUNTER MELISSA 2024170 9999999 B 10 1639954894 0 601 WILLOW ST FRANKFORT IL 604231140 20 1639954894 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1639954969 0 GOLDSMITH MORGAN 2023286 9999999 B 10 1639954969 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1639954969 0 Nurse Practitioners Fluoride varnish 20 1639954969 0 Nurse Practitioners Healthy Kids Services 20 1639954969 0 Nurse Practitioners Nurse Practitioners Services 20 1639954969 0 Nurse Practitioners Physician Services 00 1639959836 0 ELFMAN SARAH M 2023284 9999999 B 10 1639959836 0 522 W CHESTNUT ST STE 2A HINSDALE IL 605213173 20 1639959836 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1639987274 0 HARGITT CHELSEA 2025016 9999999 B 10 1639987274 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1639987274 0 Clinical Social Worker Social work service 00 1639987878 0 CARNES KELSEY 2025042 9999999 B 10 1639987878 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1639987878 0 Physician Assistant Only Fluoride varnish 20 1639987878 0 Physician Assistant Only Healthy Kids Services 20 1639987878 0 Physician Assistant Only Physician Services 00 1639989171 0 HART MEGAN D 2025073 9999999 B 10 1639989171 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1639989171 0 Audiologists Audiology Services 20 1639989171 0 Audiologists Medical Supplies 20 1639989171 0 Audiologists Medical equipment/prosthetic devices 00 1639989742 0 METCALFE REBECCA 2025013 9999999 B 10 1639989742 0 15732 S HOWARD ST PLAINFIELD IL 605442399 20 1639989742 0 Speech Therapists Medical Supplies 20 1639989742 0 Speech Therapists Medical equipment/prosthetic devices 20 1639989742 0 Speech Therapists Speech Therapy/Pathology Services 00 1639995459 0 NIKOLOVA SYLVIA 2024336 9999999 B 10 1639995459 0 1270 NORTHLAND DR STE 250 MENDOTA HEIGHTS MN 551201156 20 1639995459 0 Nurse Practitioners Fluoride varnish 20 1639995459 0 Nurse Practitioners Healthy Kids Services 20 1639995459 0 Nurse Practitioners Nurse Practitioners Services 20 1639995459 0 Nurse Practitioners Physician Services 00 1639996721 0 EZEANYAGU CYRIL 2024282 9999999 B 10 1639996721 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1639996721 0 Nurse Practitioners Fluoride varnish 20 1639996721 0 Nurse Practitioners Healthy Kids Services 20 1639996721 0 Nurse Practitioners Nurse Practitioners Services 20 1639996721 0 Nurse Practitioners Physician Services 00 1639997430 0 MCCRIGHT KYRSTEN 2024347 9999999 B 10 1639997430 0 124 SW ADAMS ST PEORIA IL 616021320 20 1639997430 0 Clinical Social Worker Social work service 00 1639997786 0 SCHEFFLER JULIE 2024281 9999999 B 10 1639997786 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1639997786 0 Occupational Therapists Medical Supplies 20 1639997786 0 Occupational Therapists Medical equipment/prosthetic devices 20 1639997786 0 Occupational Therapists Occupational Therapy Services 00 1639998966 0 ALMETER EVA 2024304 9999999 B 10 1639998966 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1639998966 0 Physical Therapists Medical Supplies 20 1639998966 0 Physical Therapists Medical equipment/prosthetic devices 20 1639998966 0 Physical Therapists Physical Therapy Services 00 1649000746 0 BATLINER CHRISTINE M 2025006 9999999 B 10 1649000746 0 5777 DEPT CAROL STREAM IL 601220021 20 1649000746 0 Physician Assistant Only Fluoride varnish 20 1649000746 0 Physician Assistant Only Healthy Kids Services 20 1649000746 0 Physician Assistant Only Physician Services 00 1649001074 0 PANERU CHANDRA P 2024347 2027180 B 10 1649001074 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1649001074 0 Physicians Anesthesia Services 20 1649001074 0 Physicians Fluoride varnish 20 1649001074 0 Physicians Healthy Kids Services 20 1649001074 0 Physicians Optical Supplies 20 1649001074 0 Physicians Physician Services 00 1649001876 0 STILP ALYSSA A 2024261 9999999 B 10 1649001876 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1649001876 0 Nurse Practitioners Healthy Kids Services 20 1649001876 0 Nurse Practitioners Nurse Practitioners Services 20 1649001876 0 Nurse Practitioners Physician Services 00 1649003138 0 MAROGIL ALYSSA 2024319 9999999 B 10 1649003138 0 PO BOX 781076 DETROIT MI 482781076 20 1649003138 0 Physician Assistant Only Fluoride varnish 20 1649003138 0 Physician Assistant Only Healthy Kids Services 20 1649003138 0 Physician Assistant Only Physician Services 00 1649004599 0 PATEL EVITA 2024262 9999999 B 10 1649004599 0 400 N HIGHLAND AVE AURORA IL 605063814 20 1649004599 0 Nurse Practitioners Fluoride varnish 20 1649004599 0 Nurse Practitioners Healthy Kids Services 20 1649004599 0 Nurse Practitioners Nurse Practitioners Services 20 1649004599 0 Nurse Practitioners Physician Services 00 1649008335 0 GATAN MONDO BENILEN 2024248 9999999 B 10 1649008335 0 5777 DEPT CAROL STREAM IL 601228942 20 1649008335 0 Nurse Practitioners Healthy Kids Services 20 1649008335 0 Nurse Practitioners Nurse Practitioners Services 20 1649008335 0 Nurse Practitioners Physician Services 00 1649009473 0 TONG BRIAN 2024247 9999999 B 10 1649009473 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1649009473 0 Physical Therapists Medical Supplies 20 1649009473 0 Physical Therapists Medical equipment/prosthetic devices 20 1649009473 0 Physical Therapists Physical Therapy Services 00 1649012808 0 ORTH ALLYSON G 2024199 9999999 B 10 1649012808 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1649012808 0 Occupational Therapists Medical Supplies 20 1649012808 0 Occupational Therapists Medical equipment/prosthetic devices 20 1649012808 0 Occupational Therapists Occupational Therapy Services 00 1649012956 0 CHATMAN MARIAH T 2024165 9999999 B 10 1649012956 0 414 PLAZA DR STE 301 WESTMONT IL 605595508 20 1649012956 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1649016528 0 RODRIGUEZ KESSIE 2024324 9999999 B 10 1649016528 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1649016528 0 Physician Assistant Only Fluoride varnish 20 1649016528 0 Physician Assistant Only Healthy Kids Services 20 1649016528 0 Physician Assistant Only Physician Services 00 1649017799 0 MOHAMMED MARYAM 2024278 9999999 B 10 1649017799 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1649017799 0 Physicians Anesthesia Services 20 1649017799 0 Physicians Healthy Kids Services 20 1649017799 0 Physicians Optical Supplies 20 1649017799 0 Physicians Physician Services 00 1649018391 0 CARROLL JAMES B 2024309 9999999 B 10 1649018391 0 6201 W 95TH ST OAK LAWN IL 604532701 20 1649018391 0 Optometrists Optical Supplies 20 1649018391 0 Optometrists Optometric Services 20 1649018391 0 Optometrists Physician Services 00 1649018748 0 KAZMI SIBTAIN 2024199 9999999 B 10 1649018748 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1649018748 0 Physicians Anesthesia Services 20 1649018748 0 Physicians Healthy Kids Services 20 1649018748 0 Physicians Optical Supplies 20 1649018748 0 Physicians Physician Services 20 1649018748 0 Physicians Physicians Psychiatric Services 00 1649019498 0 NGUYEN VAN 2024226 9999999 B 10 1649019498 0 630 MILWAUKEE AVE STE 130 GLENVIEW IL 600255655 20 1649019498 0 Dentists Dental Services 20 1649019498 0 Dentists Physician Services 00 1649019654 0 HALVERSON COURTNEY 2024185 9999999 B 10 1649019654 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1649019654 0 Physicians Anesthesia Services 20 1649019654 0 Physicians Healthy Kids Services 20 1649019654 0 Physicians Optical Supplies 20 1649019654 0 Physicians Physician Services 00 1649020710 0 YOUNAN JOSEPH 2024177 9999999 B 10 1649020710 0 PO BOX 3039 OAK BROOK IL 605223039 20 1649020710 0 Physicians Anesthesia Services 20 1649020710 0 Physicians Fluoride varnish 20 1649020710 0 Physicians Healthy Kids Services 20 1649020710 0 Physicians Optical Supplies 20 1649020710 0 Physicians Physician Services 00 1649020918 0 GAETA EMMANUEL D 2024238 9999999 B 10 1649020918 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1649020918 0 Physicians Anesthesia Services 20 1649020918 0 Physicians Healthy Kids Services 20 1649020918 0 Physicians Optical Supplies 20 1649020918 0 Physicians Physician Services 00 1649021270 0 ENGELHARDT ANNABEL 2024190 9999999 B 10 1649021270 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1649021270 0 Physicians Anesthesia Services 20 1649021270 0 Physicians Healthy Kids Services 20 1649021270 0 Physicians Optical Supplies 20 1649021270 0 Physicians Physician Services 00 1649022799 0 DASKALOVA BILYANA 2024183 9999999 B 10 1649022799 0 7732 SOLUTION CENTER CHICAGO IL 606777007 20 1649022799 0 Dentists Dental Services 20 1649022799 0 Dentists Physician Services 00 1649023698 0 LIU XIAOYAN 2024197 9999999 B 10 1649023698 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1649023698 0 Physician Assistant Only Fluoride varnish 20 1649023698 0 Physician Assistant Only Healthy Kids Services 20 1649023698 0 Physician Assistant Only Physician Services 00 1649023870 0 NATHANSON AMANDA 2024149 9999999 B 10 1649023870 0 811 W EVERGREEN AVE STE 306 SUITE 306 CHICAGO IL 606423757 20 1649023870 0 Speech Therapists Medical 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1649641507 0 Dentists Dental Services 20 1649641507 0 Dentists Physician Services 00 1649641515 0 BLACKBURN MICHAEL C. 2016001 9999999 B 10 1649641515 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1649641515 0 Audiologists Audiology Services 20 1649641515 0 Audiologists Medical Supplies 20 1649641515 0 Audiologists Medical equipment/prosthetic devices 00 1649641580 0 HAVERA KILEY 2016263 9999999 B 10 1649641580 0 PO BOX 504469 SAINT LOUIS MO 631504469 20 1649641580 0 Occupational Therapists Medical Supplies 20 1649641580 0 Occupational Therapists Medical equipment/prosthetic devices 20 1649641580 0 Occupational Therapists Occupational Therapy Services 00 1649641747 0 AKAEZE DOROTHY M 2016075 9999999 B 10 1649641747 0 89 MARY CT SAUK VILLAGE IL 604115083 20 1649641747 0 Nurse Practitioners Fluoride varnish 20 1649641747 0 Nurse Practitioners Healthy Kids Services 20 1649641747 0 Nurse Practitioners Nurse Practitioners Services 20 1649641747 0 Nurse Practitioners Physician Services 00 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Occupational Therapists Medical Supplies 20 1649670332 0 Occupational Therapists Medical equipment/prosthetic devices 20 1649670332 0 Occupational Therapists Occupational Therapy Services 00 1649671207 0 ANDERSON RYLEA J 2020035 9999999 B 10 1649671207 0 350 N GRANDVIEW AVE DUBUQUE IA 520016388 20 1649671207 0 Nurse Practitioners Healthy Kids Services 20 1649671207 0 Nurse Practitioners Nurse Practitioners Services 20 1649671207 0 Nurse Practitioners Physician Services 00 1649672056 0 MONTGOMERY KERI H 2015266 9999999 B 10 1649672056 0 PO BOX 631767 CINCINNATI OH 452631767 20 1649672056 0 Nurse Practitioners Fluoride varnish 20 1649672056 0 Nurse Practitioners Healthy Kids Services 20 1649672056 0 Nurse Practitioners Nurse Practitioners Services 20 1649672056 0 Nurse Practitioners Physician Services 00 1649672668 0 OTTO KIMBERLY 2014271 9999999 B 10 1649672668 0 3471 EAGLE WAY CHICAGO IL 606781034 20 1649672668 0 Nurse Practitioners Healthy Kids Services 20 1649672668 0 Nurse 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1649683962 0 Physicians Optical Supplies 20 1649683962 0 Physicians Physician Services 00 1649683970 0 BRUNER JOSHUA 2014153 9999999 B 10 1649683970 0 350 N GRANDVIEW AVE DUBUQUE IA 520016388 20 1649683970 0 Physical Therapists Medical Supplies 20 1649683970 0 Physical Therapists Medical equipment/prosthetic devices 20 1649683970 0 Physical Therapists Physical Therapy Services 00 1649684200 0 ABBOUD RAMZI 2019303 9999999 B 10 1649684200 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1649684200 0 Physicians Anesthesia Services 20 1649684200 0 Physicians Fluoride varnish 20 1649684200 0 Physicians Healthy Kids Services 20 1649684200 0 Physicians Optical Supplies 20 1649684200 0 Physicians Physician Services 00 1649684788 0 CORCORAN DWAYNE P 2018152 9999999 B 10 1649684788 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1649684788 0 Physicians Anesthesia Services 20 1649684788 0 Physicians Healthy Kids Services 20 1649684788 0 Physicians Optical Supplies 20 1649684788 0 Physicians Physician Services 00 1649684945 0 DEVRIES CLARABELLE A 2019009 9999999 B 10 1649684945 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1649684945 0 Physicians Anesthesia Services 20 1649684945 0 Physicians Healthy Kids Services 20 1649684945 0 Physicians Optical Supplies 20 1649684945 0 Physicians Physician Services 00 1649685033 0 ESMERO VERONICA M 2018182 9999999 B 10 1649685033 0 75 REMITTANCE DR DEPT 1620 SUITE 1620 CHICAGO IL 606751620 20 1649685033 0 Physicians Anesthesia Services 20 1649685033 0 Physicians Fluoride varnish 20 1649685033 0 Physicians Healthy Kids Services 20 1649685033 0 Physicians Optical Supplies 20 1649685033 0 Physicians Physician Services 00 1649685306 0 BECHIR GEORGE H 2017190 9999999 B 10 1649685306 0 611 W PARK ST URBANA IL 618012529 20 1649685306 0 Physicians Anesthesia Services 20 1649685306 0 Physicians Fluoride varnish 20 1649685306 0 Physicians Healthy Kids Services 20 1649685306 0 Physicians Optical Supplies 20 1649685306 0 Physicians 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CHOI RAYMOND 2023170 9999999 B 10 1649690157 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1649690157 0 Physicians Anesthesia Services 20 1649690157 0 Physicians Healthy Kids Services 20 1649690157 0 Physicians Optical Supplies 20 1649690157 0 Physicians Physician Services 00 1649690181 0 LARSEN ELIZABETH R 2018338 9999999 B 10 1649690181 0 PO BOX 70 LAKE FOREST IL 600450070 20 1649690181 0 Physicians Anesthesia Services 20 1649690181 0 Physicians Healthy Kids Services 20 1649690181 0 Physicians Optical Supplies 20 1649690181 0 Physicians Physician Services 00 1649690686 0 ABDUL-WAHAB MUHAMMAD 2024227 9999999 B 10 1649690686 0 PO BOX 360382 PITTSBURGH PA 152516382 20 1649690686 0 Physicians Anesthesia Services 20 1649690686 0 Physicians Healthy Kids Services 20 1649690686 0 Physicians Optical Supplies 20 1649690686 0 Physicians Physician Services 00 1649690827 0 GREENWALD REETI 2018351 9999999 B 10 1649690827 0 5777 DEPT CAROL STREAM IL 601228942 20 1649690827 0 Physicians 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1649711888 0 Physicians Healthy Kids Services 20 1649711888 0 Physicians Optical Supplies 20 1649711888 0 Physicians Physician Services 00 1649711995 0 SALIBA BRIAN 2020023 9999999 B 10 1649711995 0 351 GREENLEAF ST PARK CITY IL 600855701 20 1649711995 0 Physicians Anesthesia Services 20 1649711995 0 Physicians Healthy Kids Services 20 1649711995 0 Physicians Optical Supplies 20 1649711995 0 Physicians Physician Services 00 1649712373 0 DAVIDOV RAFIE D 2016306 9999999 B 10 1649712373 0 800 BIESTERFIELD RD STE G01 ELK GROVE VILLA IL 600073372 20 1649712373 0 Nurse Practitioners Healthy Kids Services 20 1649712373 0 Nurse Practitioners Nurse Practitioners Services 20 1649712373 0 Nurse Practitioners Physician Services 00 1649714460 0 HANSBERRY THOMAS 2016219 9999999 B 10 1649714460 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1649714460 0 Clinical Social Worker Social work service 00 1649715921 0 MICHALOWSKI MORGAN E. 2017012 9999999 B 10 1649715921 0 121 S WILKE RD STE 600 ARLINGTON 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Practitioners Fluoride varnish 20 1649724857 0 Nurse Practitioners Healthy Kids Services 20 1649724857 0 Nurse Practitioners Nurse Practitioners Services 20 1649724857 0 Nurse Practitioners Physician Services 00 1649725037 0 CHEN QUINN K 2017191 9999999 B 10 1649725037 0 2661 W STEPHENSON ST FREEPORT IL 610324502 20 1649725037 0 Dentists Dental Services 20 1649725037 0 Dentists Physician Services 00 1649725151 0 ALLAN STUART A 2020161 9999999 B 10 1649725151 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1649725151 0 Nurse Practitioners Fluoride varnish 20 1649725151 0 Nurse Practitioners Healthy Kids Services 20 1649725151 0 Nurse Practitioners Nurse Practitioners Services 20 1649725151 0 Nurse Practitioners Physician Services 00 1649725805 0 FAULKNER GRACE W 2021176 9999999 B 10 1649725805 0 555 WILSON LN DES PLAINES IL 600164729 20 1649725805 0 Physicians Anesthesia Services 20 1649725805 0 Physicians Healthy Kids Services 20 1649725805 0 Physicians Optical Supplies 20 1649725805 0 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Physicians Anesthesia Services 20 1649731944 0 Physicians Healthy Kids Services 20 1649731944 0 Physicians Optical Supplies 20 1649731944 0 Physicians Physician Services 00 1649732900 0 NEAL LACEY 2019121 9999999 B 10 1649732900 0 850 43RD AVE STE 100 MOLINE IL 612658401 20 1649732900 0 Physical Therapists Medical Supplies 20 1649732900 0 Physical Therapists Medical equipment/prosthetic devices 20 1649732900 0 Physical Therapists Physical Therapy Services 00 1649733353 0 PATEL PARISHI R 2020111 9999999 B 10 1649733353 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1649733353 0 Physicians Anesthesia Services 20 1649733353 0 Physicians Fluoride varnish 20 1649733353 0 Physicians Healthy Kids Services 20 1649733353 0 Physicians Optical Supplies 20 1649733353 0 Physicians Physician Services 00 1649733890 0 MOTZKUS CHRISTINE 2023013 9999999 B 10 1649733890 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1649733890 0 Physicians Anesthesia Services 20 1649733890 0 Physicians 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2019063 9999999 B 10 1649736760 0 PO BOX 5081 JANESVILLE WI 535475081 20 1649736760 0 Occupational Therapists Medical Supplies 20 1649736760 0 Occupational Therapists Medical equipment/prosthetic devices 20 1649736760 0 Occupational Therapists Occupational Therapy Services 00 1649736828 0 STEWART HANNAH 2025038 9999999 B 10 1649736828 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1649736828 0 Clinical Social Worker Social work service 00 1649739095 0 SCHUMACHER BETH A 2019263 9999999 B 10 1649739095 0 1106 N MERCHANT ST PO BOX 665 EFFINGHAM IL 624012128 20 1649739095 0 Nurse Practitioners Fluoride varnish 20 1649739095 0 Nurse Practitioners Healthy Kids Services 20 1649739095 0 Nurse Practitioners Nurse Practitioners Services 20 1649739095 0 Nurse Practitioners Physician Services 00 1649739913 0 HALE EVAN J 2018353 9999999 B 10 1649739913 0 5777 DEPT CAROL STREAM IL 601228942 20 1649739913 0 Physicians Anesthesia Services 20 1649739913 0 Physicians Fluoride varnish 20 1649739913 0 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20 1649751462 0 Nurse Practitioners Healthy Kids Services 20 1649751462 0 Nurse Practitioners Nurse Practitioners Services 20 1649751462 0 Nurse Practitioners Physician Services 00 1649752023 0 QUEZADA NANCY 2019037 9999999 B 10 1649752023 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1649752023 0 Nurse Practitioners Fluoride varnish 20 1649752023 0 Nurse Practitioners Healthy Kids Services 20 1649752023 0 Nurse Practitioners Nurse Practitioners Services 20 1649752023 0 Nurse Practitioners Physician Services 00 1649753435 0 WAKSMUNDZKI MICHELLE N 2018311 9999999 B 10 1649753435 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1649753435 0 Nurse Practitioners Anesthesia Services 20 1649753435 0 Nurse Practitioners Nurse Practitioners Services 20 1649753435 0 Nurse Practitioners Physician Services 00 1649754474 0 DILLON AMANDA 2019023 9999999 B 10 1649754474 0 1160 E SAINT CLAIR ST VINCENNES IN 475914853 20 1649754474 0 Nurse Practitioners Healthy Kids Services 20 1649754474 0 Nurse 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SPRINGFIELD IL 627621000 20 1649803560 0 Nurse Practitioners Fluoride varnish 20 1649803560 0 Nurse Practitioners Healthy Kids Services 20 1649803560 0 Nurse Practitioners Nurse Practitioners Services 20 1649803560 0 Nurse Practitioners Physician Services 00 1649803651 0 HUPP JULIE A 1999001 9999999 B 10 1649803651 0 470 N LAKE ST MUNDELEIN IL 600601825 20 1649803651 0 Occupational Therapists Medical Supplies 20 1649803651 0 Occupational Therapists Medical equipment/prosthetic devices 20 1649803651 0 Occupational Therapists Occupational Therapy Services 00 1649805623 0 SIKORSKI KIMBERLY S 2020114 9999999 B 10 1649805623 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1649805623 0 Nurse Practitioners Fluoride varnish 20 1649805623 0 Nurse Practitioners Healthy Kids Services 20 1649805623 0 Nurse Practitioners Nurse Practitioners Services 20 1649805623 0 Nurse Practitioners Physician Services 00 1649805706 0 ALPEN SARAH 2020090 9999999 B 10 1649805706 0 1518 MULBERRY AVE MUSCATINE IA 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Healthy Kids Services 20 1649807009 0 Physicians Optical Supplies 20 1649807009 0 Physicians Physician Services 00 1649807488 0 HALLER COLLEEN M 2020246 9999999 B 10 1649807488 0 1301 W DEVON AVE CHICAGO IL 606601329 20 1649807488 0 Physicians Anesthesia Services 20 1649807488 0 Physicians Fluoride varnish 20 1649807488 0 Physicians Healthy Kids Services 20 1649807488 0 Physicians Optical Supplies 20 1649807488 0 Physicians Physician Services 00 1649807579 0 BIJLANI PRIYESHA 2024193 9999999 B 10 1649807579 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1649807579 0 Physicians Anesthesia Services 20 1649807579 0 Physicians Fluoride varnish 20 1649807579 0 Physicians Healthy Kids Services 20 1649807579 0 Physicians Optical Supplies 20 1649807579 0 Physicians Physician Services 00 1649807744 0 HASSOUN NATALIE 2020286 9999999 B 10 1649807744 0 350 N WALL ST KANKAKEE IL 609012901 20 1649807744 0 Nurse Practitioners Fluoride varnish 20 1649807744 0 Nurse Practitioners Healthy Kids Services 20 1649807744 0 Nurse Practitioners Nurse Practitioners Services 20 1649807744 0 Nurse Practitioners Physician Services 00 1649807793 0 O''DONNELL BRIANA 2020220 9999999 B 10 1649807793 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1649807793 0 Physicians Anesthesia Services 20 1649807793 0 Physicians Fluoride varnish 20 1649807793 0 Physicians Healthy Kids Services 20 1649807793 0 Physicians Optical Supplies 20 1649807793 0 Physicians Physician Services 00 1649807942 0 ILYAS OMAIR 2024317 9999999 B 10 1649807942 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1649807942 0 Physicians Anesthesia Services 20 1649807942 0 Physicians Healthy Kids Services 20 1649807942 0 Physicians Optical Supplies 20 1649807942 0 Physicians Physician Services 00 1649808023 0 HUFFORD BENJAMIN 2024206 9999999 B 10 1649808023 0 PO BOX 78838 DETROIT MI 482780838 20 1649808023 0 Physicians Anesthesia Services 20 1649808023 0 Physicians Healthy Kids Services 20 1649808023 0 Physicians Optical Supplies 20 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20 1649839952 0 Physicians Anesthesia Services 20 1649839952 0 Physicians Healthy Kids Services 20 1649839952 0 Physicians Optical Supplies 20 1649839952 0 Physicians Physician Services 00 1649840042 0 ROUIE MIAB GOLNESA 2021267 9999999 B 10 1649840042 0 2050 E ALGONQUIN RD STE 610 SCHAUMBURG IL 601734166 20 1649840042 0 Dentists Dental Services 20 1649840042 0 Dentists Physician Services 00 1649841339 0 QAMARUDDIN ARSHNOOR R 2021258 9999999 B 10 1649841339 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1649841339 0 Nurse Practitioners Anesthesia Services 20 1649841339 0 Nurse Practitioners Nurse Practitioners Services 20 1649841339 0 Nurse Practitioners Physician Services 00 1649841602 0 BEELER JOHN S 2021207 9999999 B 10 1649841602 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1649841602 0 Physicians Anesthesia Services 20 1649841602 0 Physicians Fluoride varnish 20 1649841602 0 Physicians Healthy Kids Services 20 1649841602 0 Physicians Optical Supplies 20 1649841602 0 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Assistant Only Healthy Kids Services 20 1659037018 0 Physician Assistant Only Physician Services 00 1659038735 0 LAKDAWALA RACHEL B 2024093 9999999 B 10 1659038735 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1659038735 0 Speech Therapists Medical Supplies 20 1659038735 0 Speech Therapists Medical equipment/prosthetic devices 20 1659038735 0 Speech Therapists Speech Therapy/Pathology Services 00 1659040020 0 KOZLOW MAUREEN E 2021280 9999999 B 10 1659040020 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1659040020 0 Physician Assistant Only Fluoride varnish 20 1659040020 0 Physician Assistant Only Healthy Kids Services 20 1659040020 0 Physician Assistant Only Physician Services 00 1659040467 0 FUNK CHRISTOPHER A 2021265 9999999 B 10 1659040467 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1659040467 0 Psychologist Psychologist service 00 1659041432 0 RICH JESSICA 2021288 9999999 B 10 1659041432 0 320 E CENTRAL AVE DECATUR IL 625214665 20 1659041432 0 Nurse Practitioners Fluoride 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Practitioners Services 20 1659061273 0 Nurse Practitioners Physician Services 00 1659061893 0 MYERS EMILY 2023152 9999999 B 10 1659061893 0 7344 SOLUTIONS CTR CHICAGO IL 606777003 20 1659061893 0 Nurse Practitioners Fluoride varnish 20 1659061893 0 Nurse Practitioners Healthy Kids Services 20 1659061893 0 Nurse Practitioners Nurse Practitioners Services 20 1659061893 0 Nurse Practitioners Physician Services 00 1659062057 0 TOOR AMANDEEP 2023199 9999999 B 10 1659062057 0 2211 N ELSTON AVE STE 301 CHICAGO IL 606149278 20 1659062057 0 Physicians Anesthesia Services 20 1659062057 0 Physicians Fluoride varnish 20 1659062057 0 Physicians Healthy Kids Services 20 1659062057 0 Physicians Optical Supplies 20 1659062057 0 Physicians Physician Services 00 1659062339 0 ROJAS MARCELA 2023152 9999999 B 10 1659062339 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1659062339 0 Registered nurse Nursing service 20 1659062339 0 Registered nurse Waiver service 00 1659062388 0 ATKINS DEVON 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Practitioners Healthy Kids Services 20 1659064483 0 Nurse Practitioners Nurse Practitioners Services 20 1659064483 0 Nurse Practitioners Physician Services 00 1659066603 0 MACKO KLAUDIA 2024323 9999999 B 10 1659066603 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1659066603 0 Speech Therapists Medical Supplies 20 1659066603 0 Speech Therapists Medical equipment/prosthetic devices 20 1659066603 0 Speech Therapists Speech Therapy/Pathology Services 00 1659067494 0 TIMMERMANN EMILY 2023208 9999999 B 10 1659067494 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1659067494 0 Occupational Therapists Medical Supplies 20 1659067494 0 Occupational Therapists Medical equipment/prosthetic devices 20 1659067494 0 Occupational Therapists Occupational Therapy Services 00 1659067585 0 MICHELS RACHEL 2023124 9999999 B 10 1659067585 0 6300 N RIDGE AVE CHICAGO IL 606601017 20 1659067585 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1659068252 0 SHEN MICHAEL 2023180 9999999 B 10 1659068252 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1659068252 0 Physicians Anesthesia Services 20 1659068252 0 Physicians Fluoride varnish 20 1659068252 0 Physicians Healthy Kids Services 20 1659068252 0 Physicians Optical Supplies 20 1659068252 0 Physicians Physician Services 00 1659068369 0 THORSNESS KENDYL J 2023115 9999999 B 10 1659068369 0 414 PLAZA DR STE 301 WESTMONT IL 605595508 20 1659068369 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1659069177 0 POCKLINGTON WENDY A 2023298 9999999 B 10 1659069177 0 124 SW ADAMS ST PEORIA IL 616021308 20 1659069177 0 Physicians Anesthesia Services 20 1659069177 0 Physicians Fluoride varnish 20 1659069177 0 Physicians Healthy Kids Services 20 1659069177 0 Physicians Optical Supplies 20 1659069177 0 Physicians Physician Services 00 1659069961 0 SCHIAVONE JOHN 2023233 9999999 B 10 1659069961 0 13450 S 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Physicians Fluoride varnish 20 1659073559 0 Physicians Healthy Kids Services 20 1659073559 0 Physicians Optical Supplies 20 1659073559 0 Physicians Physician Services 00 1659073815 0 MALLORY JONATHAN PORTER 2023192 9999999 B 10 1659073815 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1659073815 0 Physicians Anesthesia Services 20 1659073815 0 Physicians Fluoride varnish 20 1659073815 0 Physicians Healthy Kids Services 20 1659073815 0 Physicians Optical Supplies 20 1659073815 0 Physicians Physician Services 00 1659073849 0 BRUE KELLIE A 2023207 9999999 B 10 1659073849 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1659073849 0 Physicians Anesthesia Services 20 1659073849 0 Physicians Healthy Kids Services 20 1659073849 0 Physicians Optical Supplies 20 1659073849 0 Physicians Physician Services 00 1659073971 0 KERRUISH ROBERT DEAN 2023209 9999999 B 10 1659073971 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1659073971 0 Physicians Anesthesia Services 20 1659073971 0 Physicians Fluoride varnish 20 1659073971 0 Physicians Healthy Kids Services 20 1659073971 0 Physicians Optical Supplies 20 1659073971 0 Physicians Physician Services 00 1659074300 0 ARNOLD CHRISTOPHER JOSEPH 2023263 9999999 B 10 1659074300 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1659074300 0 Physicians Anesthesia Services 20 1659074300 0 Physicians Fluoride varnish 20 1659074300 0 Physicians Healthy Kids Services 20 1659074300 0 Physicians Optical Supplies 20 1659074300 0 Physicians Physician Services 00 1659074722 0 EL ZOGHBI REBECCA F 2023176 9999999 B 10 1659074722 0 PO BOX 3039 OAK BROOK IL 605223039 20 1659074722 0 Physicians Anesthesia Services 20 1659074722 0 Physicians Healthy Kids Services 20 1659074722 0 Physicians Optical Supplies 20 1659074722 0 Physicians Physician Services 20 1659074722 0 Physicians Physicians Psychiatric Services 00 1659074854 0 PERRY JOHN 2023179 9999999 B 10 1659074854 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1659074854 0 Physicians Anesthesia Services 20 1659074854 0 Physicians Fluoride varnish 20 1659074854 0 Physicians Healthy Kids Services 20 1659074854 0 Physicians Optical Supplies 20 1659074854 0 Physicians Physician Services 00 1659074888 0 ALI WALID A 2023192 9999999 B 10 1659074888 0 4701 DEPT CAROL STREAM IL 601220021 20 1659074888 0 Physicians Anesthesia Services 20 1659074888 0 Physicians Fluoride varnish 20 1659074888 0 Physicians Healthy Kids Services 20 1659074888 0 Physicians Optical Supplies 20 1659074888 0 Physicians Physician Services 00 1659075042 0 JAIN AAKANGSHA 2023192 9999999 B 10 1659075042 0 PO BOX 3039 OAK BROOK IL 605223039 20 1659075042 0 Physicians Anesthesia Services 20 1659075042 0 Physicians Healthy Kids Services 20 1659075042 0 Physicians Optical Supplies 20 1659075042 0 Physicians Physician Services 00 1659075109 0 DUTKO ALECSANDER 2023101 9999999 B 10 1659075109 0 2001 BUTTERFIELD RD STE 1600 DOWNERS GROVE IL 605151211 20 1659075109 0 Physical Therapists Medical Supplies 20 1659075109 0 Physical Therapists Medical equipment/prosthetic devices 20 1659075109 0 Physical Therapists Physical Therapy Services 00 1659075570 0 HERNANDEZ FELIPE 2023362 9999999 B 10 1659075570 0 124 SW ADAMS ST PEORIA IL 616021308 20 1659075570 0 Physicians Anesthesia Services 20 1659075570 0 Physicians Fluoride varnish 20 1659075570 0 Physicians Healthy Kids Services 20 1659075570 0 Physicians Optical Supplies 20 1659075570 0 Physicians Physician Services 00 1659075752 0 CANNON FREDERICK 2023167 9999999 B 10 1659075752 0 47 W POLK ST STE 250 CHICAGO IL 606052765 20 1659075752 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1659075943 0 KNIGHTON FELTON 2023226 9999999 B 10 1659075943 0 29373 NETWORK PL CHICAGO IL 606733039 20 1659075943 0 Physician Assistant Only Fluoride varnish 20 1659075943 0 Physician Assistant Only Healthy Kids Services 20 1659075943 0 Physician Assistant Only Physician Services 00 1659076255 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Services 20 1659548089 0 Physicians Optical Supplies 20 1659548089 0 Physicians Physician Services 00 1659550283 0 CABIYA MARIE 2008246 9999999 B 10 1659550283 0 29373 NETWORK PL CHICAGO IL 606733039 20 1659550283 0 Physicians Anesthesia Services 20 1659550283 0 Physicians Healthy Kids Services 20 1659550283 0 Physicians Optical Supplies 20 1659550283 0 Physicians Physician Services 00 1659550374 0 GURVICH LEON 2007283 9999999 B 10 1659550374 0 604 PHEASANT LN DEERFIELD IL 600153637 20 1659550374 0 Nurse Practitioners Healthy Kids Services 20 1659550374 0 Nurse Practitioners Nurse Practitioners Services 20 1659550374 0 Nurse Practitioners Physician Services 00 1659550812 0 KOUMANTOS MARIA 2008197 9999999 B 10 1659550812 0 8707 SKOKIE BLVD STE 402 SKOKIE IL 600772269 20 1659550812 0 Occupational Therapists Medical Supplies 20 1659550812 0 Occupational Therapists Medical equipment/prosthetic devices 20 1659550812 0 Occupational Therapists Occupational Therapy Services 00 1659553378 0 CHOR JULIE 2008183 9999999 B 10 1659553378 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1659553378 0 Physicians Anesthesia Services 20 1659553378 0 Physicians Healthy Kids Services 20 1659553378 0 Physicians Optical Supplies 20 1659553378 0 Physicians Physician Services 00 1659554921 0 CALLISTO JESSICA 2018177 9999999 B 10 1659554921 0 1446 N RANDALL AVE JANESVILLE WI 535451122 20 1659554921 0 Physician Assistant Only Fluoride varnish 20 1659554921 0 Physician Assistant Only Healthy Kids Services 20 1659554921 0 Physician Assistant Only Physician Services 00 1659555993 0 FORD JASON 2008220 9999999 B 10 1659555993 0 250 N SHADELAND AVE STE 200 INDIANAPOLIS IN 462194959 20 1659555993 0 Physicians Anesthesia Services 20 1659555993 0 Physicians Healthy Kids Services 20 1659555993 0 Physicians Optical Supplies 20 1659555993 0 Physicians Physician Services 00 1659557916 0 COLINO KATHERINE A 2015274 9999999 B 10 1659557916 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1659557916 0 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Physicians Anesthesia Services 20 1659692663 0 Physicians Healthy Kids Services 20 1659692663 0 Physicians Optical Supplies 20 1659692663 0 Physicians Physician Services 00 1659692945 0 FLEUREN ANDREA 2013182 9999999 B 10 1659692945 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1659692945 0 Physicians Anesthesia Services 20 1659692945 0 Physicians Fluoride varnish 20 1659692945 0 Physicians Healthy Kids Services 20 1659692945 0 Physicians Optical Supplies 20 1659692945 0 Physicians Physician Services 00 1659693414 0 ANDERSON PAMELA S 2019011 9999999 B 10 1659693414 0 250 W 96TH ST STE 520 INDIANAPOLIS IN 462601317 20 1659693414 0 Nurse Practitioners Healthy Kids Services 20 1659693414 0 Nurse Practitioners Nurse Practitioners Services 20 1659693414 0 Nurse Practitioners Physician Services 00 1659693612 0 OLIVAS ANDREA D 2019001 9999999 B 10 1659693612 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1659693612 0 Physicians Anesthesia Services 20 1659693612 0 Physicians Healthy 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00 1659710929 0 MA NINGNING 2016105 9999999 B 10 1659710929 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1659710929 0 Physicians Anesthesia Services 20 1659710929 0 Physicians Fluoride varnish 20 1659710929 0 Physicians Healthy Kids Services 20 1659710929 0 Physicians Optical Supplies 20 1659710929 0 Physicians Physician Services 00 1659711042 0 MINTZ CARRIE M 2017362 9999999 B 10 1659711042 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1659711042 0 Physicians Anesthesia Services 20 1659711042 0 Physicians Healthy Kids Services 20 1659711042 0 Physicians Optical Supplies 20 1659711042 0 Physicians Physician Services 20 1659711042 0 Physicians Physicians Psychiatric Services 00 1659711513 0 DAS MANJUSHA 2016166 9999999 B 10 1659711513 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1659711513 0 Physicians Anesthesia Services 20 1659711513 0 Physicians Fluoride varnish 20 1659711513 0 Physicians Healthy Kids Services 20 1659711513 0 Physicians 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20 1659713139 0 Nurse Practitioners Healthy Kids Services 20 1659713139 0 Nurse Practitioners Nurse Practitioners Services 20 1659713139 0 Nurse Practitioners Physician Services 00 1659713758 0 SHAPIRO NICOLE T 2018158 9999999 B 10 1659713758 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1659713758 0 Nurse Practitioners Healthy Kids Services 20 1659713758 0 Nurse Practitioners Midwife Services 20 1659713758 0 Nurse Practitioners Nurse Practitioners Services 20 1659713758 0 Nurse Practitioners Physician Services 00 1659715928 0 JUNG CHRISTINE 2018113 9999999 B 10 1659715928 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1659715928 0 Physicians Anesthesia Services 20 1659715928 0 Physicians Healthy Kids Services 20 1659715928 0 Physicians Optical Supplies 20 1659715928 0 Physicians Physician Services 00 1659716728 0 MAN ANDREA M 2016291 9999999 B 10 1659716728 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1659716728 0 Physicians Anesthesia Services 20 1659716728 0 Physicians Fluoride 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KATHERINE 2019189 9999999 B 10 1669025920 0 2001 S CALIFORNIA AVE CHICAGO IL 606082486 20 1669025920 0 Dentists Dental Services 20 1669025920 0 Dentists Physician Services 00 1669026084 0 GERAIS YASMIN A 2019365 9999999 B 10 1669026084 0 1000 REMINGTON BLVD STE 110 BOLINGBROOK IL 604404708 20 1669026084 0 Physicians Anesthesia Services 20 1669026084 0 Physicians Fluoride varnish 20 1669026084 0 Physicians Healthy Kids Services 20 1669026084 0 Physicians Optical Supplies 20 1669026084 0 Physicians Physician Services 00 1669026795 0 BRADLEY CHELSEA S 2020189 9999999 B 10 1669026795 0 3241 S MICHIGAN AVE CHICAGO IL 606164201 20 1669026795 0 Optometrists Optical Supplies 20 1669026795 0 Optometrists Optometric Services 20 1669026795 0 Optometrists Physician Services 00 1669026852 0 POULOS NICHOLAS 2019219 9999999 B 10 1669026852 0 5470 W MADISON ST CHICAGO IL 606444026 20 1669026852 0 Dentists Dental Services 20 1669026852 0 Dentists Physician Services 00 1669026944 0 WILCOX AMBER 2020268 9999999 B 10 1669026944 0 2723 S 7TH ST STE A TERRE HAUTE IN 478023558 20 1669026944 0 Physician Assistant Only Fluoride varnish 20 1669026944 0 Physician Assistant Only Healthy Kids Services 20 1669026944 0 Physician Assistant Only Physician Services 00 1669028312 0 GAYLES KEYONA 2019268 9999999 B 10 1669028312 0 PO BOX 73488 PUYALLUP WA 983730488 20 1669028312 0 Nurse Practitioners Fluoride varnish 20 1669028312 0 Nurse Practitioners Healthy Kids Services 20 1669028312 0 Nurse Practitioners Nurse Practitioners Services 20 1669028312 0 Nurse Practitioners Physician Services 00 1669028924 0 MEZA JULIO 2023174 9999999 B 10 1669028924 0 4698 DEPT CAROL STREAM IL 601220021 20 1669028924 0 Physicians Anesthesia Services 20 1669028924 0 Physicians Healthy Kids Services 20 1669028924 0 Physicians Optical Supplies 20 1669028924 0 Physicians Physician Services 00 1669030680 0 MEI JESSICA 2022235 9999999 B 10 1669030680 0 400 N HIGHLAND AVE AURORA IL 605063814 20 1669030680 0 Physicians Anesthesia Services 20 1669030680 0 Physicians Fluoride varnish 20 1669030680 0 Physicians Healthy Kids Services 20 1669030680 0 Physicians Optical Supplies 20 1669030680 0 Physicians Physician Services 00 1669031506 0 KARBOWSKI CHRISTINA M 2023011 9999999 B 10 1669031506 0 355 E CHICAGO ST ELGIN IL 601206543 20 1669031506 0 Speech Therapists Medical Supplies 20 1669031506 0 Speech Therapists Medical equipment/prosthetic devices 20 1669031506 0 Speech Therapists Speech Therapy/Pathology Services 00 1669031597 0 ROBINSON JENNIFER L 2019211 9999999 B 10 1669031597 0 1039 BROOK FOREST AVE SHOREWOOD IL 604048849 20 1669031597 0 Nurse Practitioners Fluoride varnish 20 1669031597 0 Nurse Practitioners Healthy Kids Services 20 1669031597 0 Nurse Practitioners Nurse Practitioners Services 20 1669031597 0 Nurse Practitioners Physician Services 00 1669031738 0 KHADRA MAHER 2025034 9999999 B 10 1669031738 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1669031738 0 Physicians Anesthesia Services 20 1669031738 0 Physicians Healthy Kids Services 20 1669031738 0 Physicians Optical Supplies 20 1669031738 0 Physicians Physician Services 00 1669032082 0 MALLARD MATTHEW 2020226 9999999 B 10 1669032082 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1669032082 0 Physicians Anesthesia Services 20 1669032082 0 Physicians Healthy Kids Services 20 1669032082 0 Physicians Optical Supplies 20 1669032082 0 Physicians Physician Services 00 1669032769 0 HERMES RALPH 2022291 9999999 B 10 1669032769 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1669032769 0 Physicians Anesthesia Services 20 1669032769 0 Physicians Fluoride varnish 20 1669032769 0 Physicians Healthy Kids Services 20 1669032769 0 Physicians Optical Supplies 20 1669032769 0 Physicians Physician Services 00 1669032991 0 RYAN RACHAEL A 2022276 9999999 B 10 1669032991 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1669032991 0 Physicians Anesthesia Services 20 1669032991 0 Physicians Fluoride varnish 20 1669032991 0 Physicians Healthy Kids 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9999999 B 10 1669036257 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1669036257 0 Physicians Anesthesia Services 20 1669036257 0 Physicians Healthy Kids Services 20 1669036257 0 Physicians Optical Supplies 20 1669036257 0 Physicians Physician Services 00 1669036331 0 SADECKI-LUND CORINNE 2020212 9999999 B 10 1669036331 0 7444 W WILSON AVE STE 102 HARWOOD HEIGHTS IL 607064500 20 1669036331 0 Nurse Practitioners Fluoride varnish 20 1669036331 0 Nurse Practitioners Healthy Kids Services 20 1669036331 0 Nurse Practitioners Nurse Practitioners Services 20 1669036331 0 Nurse Practitioners Physician Services 00 1669036695 0 DEMANES ABRIELLA M 2024257 9999999 B 10 1669036695 0 5777 DEPT CAROL STREAM IL 601220021 20 1669036695 0 Physicians Anesthesia Services 20 1669036695 0 Physicians Fluoride varnish 20 1669036695 0 Physicians Healthy Kids Services 20 1669036695 0 Physicians Optical Supplies 20 1669036695 0 Physicians Physician Services 00 1669037131 0 ROMAN NICOLE M 2019283 9999999 B 10 1669037131 0 16001 108TH AVE ORLAND PARK IL 604678788 20 1669037131 0 Physician Assistant Only Fluoride varnish 20 1669037131 0 Physician Assistant Only Healthy Kids Services 20 1669037131 0 Physician Assistant Only Physician Services 00 1669037206 0 ROLANDELLI AUDREY LEE 2019339 9999999 B 10 1669037206 0 PO BOX 2477 SHELTON CT 064841477 20 1669037206 0 Nurse Practitioners Healthy Kids Services 20 1669037206 0 Nurse Practitioners Nurse Practitioners Services 20 1669037206 0 Nurse Practitioners Physician Services 00 1669037933 0 MEYERS NICOLE 2021040 9999999 H 10 1669037933 0 4209 W SHAMROCK LN UNIT C MCHENRY IL 600508700 20 1669037933 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1669038097 0 MATHEW RENY MARY 2022234 9999999 B 10 1669038097 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1669038097 0 Physicians Anesthesia Services 20 1669038097 0 Physicians Fluoride varnish 20 1669038097 0 Physicians Healthy Kids Services 20 1669038097 0 Physicians Optical Supplies 20 1669038097 0 Physicians Physician Services 00 1669038634 0 GALEA VICTORIA 2024276 9999999 B 10 1669038634 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1669038634 0 Physicians Anesthesia Services 20 1669038634 0 Physicians Healthy Kids Services 20 1669038634 0 Physicians Optical Supplies 20 1669038634 0 Physicians Physician Services 00 1669038840 0 BACHUR CATHERINE 2019274 9999999 B 10 1669038840 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1669038840 0 Physicians Anesthesia Services 20 1669038840 0 Physicians Healthy Kids Services 20 1669038840 0 Physicians Optical Supplies 20 1669038840 0 Physicians Physician Services 00 1669039020 0 MEDINA NIKOLINA 2021071 9999999 B 10 1669039020 0 2906 HIGHWAY AVE HIGHLAND IN 463221631 20 1669039020 0 Speech Therapists Medical Supplies 20 1669039020 0 Speech Therapists Medical equipment/prosthetic devices 20 1669039020 0 Speech Therapists Speech Therapy/Pathology Services 00 1669039822 0 BOEDER DANIEL T 2019178 9999999 B 10 1669039822 0 1005 BROADWAY ST QUINCY IL 623012834 20 1669039822 0 Physicians Anesthesia Services 20 1669039822 0 Physicians Healthy Kids Services 20 1669039822 0 Physicians Optical Supplies 20 1669039822 0 Physicians Physician Services 20 1669039822 0 Physicians Physicians Psychiatric Services 00 1669039871 0 AYDT KATIE 2021035 9999999 B 10 1669039871 0 1301 N ALLEN ST ROBINSON IL 624541001 20 1669039871 0 Speech Therapists Medical Supplies 20 1669039871 0 Speech Therapists Medical equipment/prosthetic devices 20 1669039871 0 Speech Therapists Speech Therapy/Pathology Services 00 1669041224 0 SLOAN ANNA 2024095 9999999 B 10 1669041224 0 975 W HAWTHORN DR ITASCA IL 601432056 20 1669041224 0 Other behavior health professional Adaptive behavior support technician services 00 1669041307 0 STANDEFER ZACHARY 2021222 9999999 B 10 1669041307 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1669041307 0 Nurse Practitioners Anesthesia Services 20 1669041307 0 Nurse Practitioners Nurse Practitioners Services 20 1669041307 0 Nurse Practitioners Physician Services 00 1669041315 0 HU JESSE 2021237 9999999 B 10 1669041315 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1669041315 0 Physicians Anesthesia Services 20 1669041315 0 Physicians Healthy Kids Services 20 1669041315 0 Physicians Optical Supplies 20 1669041315 0 Physicians Physician Services 00 1669043030 0 LAMBERT CASSILYN NICOLE 2021214 9999999 B 10 1669043030 0 3800 VENETIAN WAY NEWBURGH IN 476308257 20 1669043030 0 Nurse Practitioners Healthy Kids Services 20 1669043030 0 Nurse Practitioners Nurse Practitioners Services 20 1669043030 0 Nurse Practitioners Physician Services 00 1669044723 0 HOPKINS BAILEY 2022258 9999999 B 10 1669044723 0 101 E STATE ST KENNETT SQUARE PA 193483109 20 1669044723 0 Occupational Therapists Medical Supplies 20 1669044723 0 Occupational Therapists Medical equipment/prosthetic devices 20 1669044723 0 Occupational Therapists 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1239 TROY MI 480991239 20 1669047460 0 Nurse Practitioners Fluoride varnish 20 1669047460 0 Nurse Practitioners Healthy Kids Services 20 1669047460 0 Nurse Practitioners Nurse Practitioners Services 20 1669047460 0 Nurse Practitioners Physician Services 00 1669048922 0 UKWADE DIRIN 2022191 9999999 B 10 1669048922 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1669048922 0 Physicians Anesthesia Services 20 1669048922 0 Physicians Fluoride varnish 20 1669048922 0 Physicians Healthy Kids Services 20 1669048922 0 Physicians Optical Supplies 20 1669048922 0 Physicians Physician Services 00 1669050225 0 GRESIK EMILY 2021092 9999999 B 10 1669050225 0 1311 MAMARONECK AVE STE 140 WHITE PLAINS NY 106055224 20 1669050225 0 Physical Therapists Medical Supplies 20 1669050225 0 Physical Therapists Medical equipment/prosthetic devices 20 1669050225 0 Physical Therapists Physical Therapy Services 00 1669050241 0 ARBIT EVAN B 2021159 9999999 B 10 1669050241 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 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20 1669054995 0 Physicians Physician Services 00 1669057014 0 SAMONS JISSEL 2021152 9999999 B 10 1669057014 0 3600 WOODVIEW TRCE STE 400 INDIANAPOLIS IN 462683124 20 1669057014 0 Nurse Practitioners Anesthesia Services 20 1669057014 0 Nurse Practitioners Nurse Practitioners Services 20 1669057014 0 Nurse Practitioners Physician Services 00 1669057675 0 D''AMICO NICOLE 2021305 9999999 B 10 1669057675 0 8558 BROADWAY MERRILLVILLE IN 464107032 20 1669057675 0 Nurse Practitioners Anesthesia Services 20 1669057675 0 Nurse Practitioners Nurse Practitioners Services 20 1669057675 0 Nurse Practitioners Physician Services 00 1669058889 0 KALLAN ANJU B 2021231 9999999 B 10 1669058889 0 55 E JACKSON BLVD STE 1500 CHICAGO IL 606044184 20 1669058889 0 Nurse Practitioners Fluoride varnish 20 1669058889 0 Nurse Practitioners Healthy Kids Services 20 1669058889 0 Nurse Practitioners Nurse Practitioners Services 20 1669058889 0 Nurse Practitioners Physician Services 00 1669059184 0 LEE DANIEL Z 2021146 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1669146106 0 Physicians Optical Supplies 20 1669146106 0 Physicians Physician Services 00 1669148359 0 ZEINA MOHAMMAD 2023213 9999999 B 10 1669148359 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1669148359 0 Nurse Practitioners Anesthesia Services 20 1669148359 0 Nurse Practitioners Nurse Practitioners Services 20 1669148359 0 Nurse Practitioners Physician Services 00 1669149134 0 FOUTCH DANIEL 2021265 9999999 B 10 1669149134 0 809 W CHURCH ST CHAMPAIGN IL 618203320 20 1669149134 0 Nurse Practitioners Healthy Kids Services 20 1669149134 0 Nurse Practitioners Nurse Practitioners Services 20 1669149134 0 Nurse Practitioners Physician Services 00 1669150918 0 ROMERO YESENIA 2024046 9999999 B 10 1669150918 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1669150918 0 Registered nurse Nursing service 20 1669150918 0 Registered nurse Waiver service 00 1669152336 0 ONEIL GAVIN 2023229 9999999 B 10 1669152336 0 1450 N COUNTY ROAD 2050 E CARTHAGE IL 623213551 20 1669152336 0 Clinical Social 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Assistant Only Physician Services 00 1669156808 0 EL AMRI HAJAR 2024211 9999999 B 10 1669156808 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1669156808 0 Physicians Anesthesia Services 20 1669156808 0 Physicians Fluoride varnish 20 1669156808 0 Physicians Healthy Kids Services 20 1669156808 0 Physicians Optical Supplies 20 1669156808 0 Physicians Physician Services 00 1669157327 0 ZHANG ZIJING 2023219 9999999 B 10 1669157327 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1669157327 0 Physicians Anesthesia Services 20 1669157327 0 Physicians Healthy Kids Services 20 1669157327 0 Physicians Optical Supplies 20 1669157327 0 Physicians Physician Services 00 1669157467 0 HAMPTON JACQUELINE M 2023195 9999999 B 10 1669157467 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1669157467 0 Physicians Anesthesia Services 20 1669157467 0 Physicians Fluoride varnish 20 1669157467 0 Physicians Healthy Kids Services 20 1669157467 0 Physicians Optical Supplies 20 1669157467 0 Physicians Physician Services 00 1669157483 0 ZHENG NIANYE 2023194 9999999 B 10 1669157483 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1669157483 0 Physicians Anesthesia Services 20 1669157483 0 Physicians Healthy Kids Services 20 1669157483 0 Physicians Optical Supplies 20 1669157483 0 Physicians Physician Services 00 1669158697 0 CHOPRA JAY 2024199 9999999 B 10 1669158697 0 3249 OAK PARK AVE BERWYN IL 604023429 20 1669158697 0 Physicians Anesthesia Services 20 1669158697 0 Physicians Fluoride varnish 20 1669158697 0 Physicians Healthy Kids Services 20 1669158697 0 Physicians Optical Supplies 20 1669158697 0 Physicians Physician Services 00 1669163200 0 METCALF RORY 2023191 9999999 B 10 1669163200 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1669163200 0 Physicians Anesthesia Services 20 1669163200 0 Physicians Healthy Kids Services 20 1669163200 0 Physicians Optical Supplies 20 1669163200 0 Physicians Physician Services 00 1669163614 0 MANGAN ALEX 2023156 9999999 B 10 1669163614 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1669163614 0 Physicians Anesthesia Services 20 1669163614 0 Physicians Fluoride varnish 20 1669163614 0 Physicians Healthy Kids Services 20 1669163614 0 Physicians Optical Supplies 20 1669163614 0 Physicians Physician Services 00 1669164596 0 MILLER REBECCA K 2024078 9999999 B 10 1669164596 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1669164596 0 Physician Assistant Only Fluoride varnish 20 1669164596 0 Physician Assistant Only Healthy Kids Services 20 1669164596 0 Physician Assistant Only Physician Services 00 1669165254 0 WOUDENBERG KIMBERLY 2023193 9999999 B 10 1669165254 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1669165254 0 Physicians Anesthesia Services 20 1669165254 0 Physicians Fluoride varnish 20 1669165254 0 Physicians Healthy Kids Services 20 1669165254 0 Physicians Optical Supplies 20 1669165254 0 Physicians Physician Services 20 1669165254 0 Physicians Physicians Psychiatric Services 00 1669166799 0 LERCH AMELIA B 2023195 9999999 B 10 1669166799 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1669166799 0 Physicians Anesthesia Services 20 1669166799 0 Physicians Fluoride varnish 20 1669166799 0 Physicians Healthy Kids Services 20 1669166799 0 Physicians Optical Supplies 20 1669166799 0 Physicians Physician Services 00 1669167656 0 OREJUDOS JULIUS M 2023175 9999999 B 10 1669167656 0 PO BOX 3039 OAK BROOK IL 605223039 20 1669167656 0 Podiatrists Podiatric Services 00 1669167904 0 FARRINGTON SYDNEY C 2024178 9999999 B 10 1669167904 0 4698 DEPT CAROL STREAM IL 601220021 20 1669167904 0 Physicians Anesthesia Services 20 1669167904 0 Physicians Healthy Kids Services 20 1669167904 0 Physicians Optical Supplies 20 1669167904 0 Physicians Physician Services 00 1669169413 0 NESTEL JOY 2024316 9999999 B 10 1669169413 0 16001 108TH AVE ORLAND PARK IL 604678788 20 1669169413 0 Nurse Practitioners Fluoride varnish 20 1669169413 0 Nurse Practitioners Healthy Kids Services 20 1669169413 0 Nurse Practitioners Nurse Practitioners Services 20 1669169413 0 Nurse Practitioners Physician Services 00 1669169801 0 TARAR DANIA 2024190 9999999 B 10 1669169801 0 PO BOX 855795 MINNEAPOLIS MN 554851296 20 1669169801 0 Physicians Anesthesia Services 20 1669169801 0 Physicians Fluoride varnish 20 1669169801 0 Physicians Healthy Kids Services 20 1669169801 0 Physicians Optical Supplies 20 1669169801 0 Physicians Physician Services 00 1669170858 0 ROBBINS CINDY L 2023163 9999999 B 10 1669170858 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1669170858 0 Nurse Practitioners Fluoride varnish 20 1669170858 0 Nurse Practitioners Healthy Kids Services 20 1669170858 0 Nurse Practitioners Nurse Practitioners Services 20 1669170858 0 Nurse Practitioners Physician Services 00 1669171138 0 SCHLICHKER MARGARET E 2023088 9999999 B 10 1669171138 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1669171138 0 Physician Assistant Only Fluoride varnish 20 1669171138 0 Physician Assistant Only Healthy Kids Services 20 1669171138 0 Physician Assistant Only Physician Services 00 1669173688 0 BIGGERSTAFF KIMBERLY 2024005 9999999 B 10 1669173688 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1669173688 0 Nurse Practitioners Fluoride varnish 20 1669173688 0 Nurse Practitioners Healthy Kids Services 20 1669173688 0 Nurse Practitioners Nurse Practitioners Services 20 1669173688 0 Nurse Practitioners Physician Services 00 1669173985 0 CASSIDY MICHAEL F 2024236 9999999 B 10 1669173985 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1669173985 0 Physicians Anesthesia Services 20 1669173985 0 Physicians Healthy Kids Services 20 1669173985 0 Physicians Optical Supplies 20 1669173985 0 Physicians Physician Services 00 1669174934 0 PAN ERIC 2023163 9999999 B 10 1669174934 0 4698 DEPT CAROL STREAM IL 601220021 20 1669174934 0 Physicians Anesthesia Services 20 1669174934 0 Physicians Healthy Kids Services 20 1669174934 0 Physicians Optical Supplies 20 1669174934 0 Physicians Physician Services 20 1669174934 0 Physicians Physicians Psychiatric Services 00 1669175121 0 LIM JOO HYANG 2023279 9999999 B 10 1669175121 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1669175121 0 Nurse Practitioners Healthy Kids Services 20 1669175121 0 Nurse Practitioners Nurse Practitioners Services 20 1669175121 0 Nurse Practitioners Physician Services 00 1669175816 0 SALEM EDWARD 2023227 9999999 B 10 1669175816 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1669175816 0 Physicians Anesthesia Services 20 1669175816 0 Physicians Fluoride varnish 20 1669175816 0 Physicians Healthy Kids Services 20 1669175816 0 Physicians Optical Supplies 20 1669175816 0 Physicians Physician Services 00 1669176046 0 WILEY STACY M 2023268 9999999 B 10 1669176046 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1669176046 0 Nurse Practitioners Healthy Kids Services 20 1669176046 0 Nurse Practitioners Nurse Practitioners Services 20 1669176046 0 Nurse Practitioners Physician Services 00 1669176632 0 NWANDU LOFANNA E 2024238 9999999 B 10 1669176632 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1669176632 0 Physicians Anesthesia Services 20 1669176632 0 Physicians Fluoride varnish 20 1669176632 0 Physicians Healthy Kids Services 20 1669176632 0 Physicians Optical Supplies 20 1669176632 0 Physicians Physician Services 00 1669177523 0 VELASCO ROSE 2023227 9999999 B 10 1669177523 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1669177523 0 Physicians Anesthesia Services 20 1669177523 0 Physicians Fluoride varnish 20 1669177523 0 Physicians Healthy Kids Services 20 1669177523 0 Physicians Optical Supplies 20 1669177523 0 Physicians Physician Services 00 1669181194 0 SNODGRASS ERICA 2023363 9999999 B 10 1669181194 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1669181194 0 Nurse Practitioners Fluoride varnish 20 1669181194 0 Nurse Practitioners Healthy Kids Services 20 1669181194 0 Nurse Practitioners Nurse Practitioners Services 20 1669181194 0 Nurse Practitioners Physician Services 00 1669182200 0 NIKA BEATA 2023020 9999999 B 10 1669182200 0 PO BOX 314 VALPARAISO IN 463840314 20 1669182200 0 Physical Therapists Medical Supplies 20 1669182200 0 Physical Therapists Medical equipment/prosthetic devices 20 1669182200 0 Physical Therapists Physical Therapy Services 00 1669182978 0 TIESKOETTER JESSICA L 2024002 9999999 B 10 1669182978 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1669182978 0 Nurse Practitioners Fluoride varnish 20 1669182978 0 Nurse Practitioners Healthy Kids Services 20 1669182978 0 Nurse Practitioners Nurse Practitioners Services 20 1669182978 0 Nurse Practitioners Physician Services 00 1669183455 0 FOUSHEE NINA 2022347 9999999 B 10 1669183455 0 122 S MICHIGAN AVE STE 1441 CHICAGO IL 606036173 20 1669183455 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1669183737 0 THILMONY MEGAN M 2023228 9999999 B 10 1669183737 0 611 W PARK ST URBANA IL 618012529 20 1669183737 0 Physician Assistant Only 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Services 20 1669487310 0 Physicians Fluoride varnish 20 1669487310 0 Physicians Healthy Kids Services 20 1669487310 0 Physicians Optical Supplies 20 1669487310 0 Physicians Physician Services 00 1669488003 0 WILLIAMS MALLORY 2024144 9999999 B 10 1669488003 0 1900 W POLK ST STE 220 CHICAGO IL 60612 20 1669488003 0 Physicians Anesthesia Services 20 1669488003 0 Physicians Healthy Kids Services 20 1669488003 0 Physicians Optical Supplies 20 1669488003 0 Physicians Physician Services 00 1669488045 0 PIPER ROSEMARIE 2002079 9999999 B 10 1669488045 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1669488045 0 Physical Therapists Medical Supplies 20 1669488045 0 Physical Therapists Medical equipment/prosthetic devices 20 1669488045 0 Physical Therapists Physical Therapy Services 00 1669488417 0 NISHIDA TAKASHI 1984104 9999999 B 10 1669488417 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1669488417 0 Physicians Anesthesia Services 20 1669488417 0 Physicians Healthy Kids 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MADISON AVE STE 301 GRANITE CITY IL 620404713 20 1669490421 0 Physicians Anesthesia Services 20 1669490421 0 Physicians Fluoride varnish 20 1669490421 0 Physicians Healthy Kids Services 20 1669490421 0 Physicians Optical Supplies 20 1669490421 0 Physicians Physician Services 00 1669491130 0 BENJAKUL AILEEN 2005122 9999999 B 10 1669491130 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1669491130 0 Physicians Anesthesia Services 20 1669491130 0 Physicians Healthy Kids Services 20 1669491130 0 Physicians Optical Supplies 20 1669491130 0 Physicians Physician Services 00 1669491239 0 DOWLING PATRICK 2001244 9999999 B 10 1669491239 0 6300 RIDGLEA PL STE 201 FORT WORTH TX 761165707 20 1669491239 0 Physicians Anesthesia Services 20 1669491239 0 Physicians Healthy Kids Services 20 1669491239 0 Physicians Optical Supplies 20 1669491239 0 Physicians Physician Services 00 1669491320 0 HALABI SAFWAN S 2008301 9999999 B 10 1669491320 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 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varnish 20 1669493359 0 Physicians Healthy Kids Services 20 1669493359 0 Physicians Optical Supplies 20 1669493359 0 Physicians Physician Services 00 1669494100 0 DONOGHUE AARON 2013336 9999999 B 10 1669494100 0 100 E PENN SQ PHILADELPHIA PA 191073323 20 1669494100 0 Physicians Anesthesia Services 20 1669494100 0 Physicians Fluoride varnish 20 1669494100 0 Physicians Healthy Kids Services 20 1669494100 0 Physicians Optical Supplies 20 1669494100 0 Physicians Physician Services 00 1669494241 0 DIEMER DAVID 2017180 9999999 B 10 1669494241 0 55 W PORT PLZ STE 300 SUITE 300 SAINT LOUIS MO 631463119 20 1669494241 0 Physicians Anesthesia Services 20 1669494241 0 Physicians Healthy Kids Services 20 1669494241 0 Physicians Optical Supplies 20 1669494241 0 Physicians Physician Services 00 1669494845 0 SANKARI ABDUL K 2021041 9999999 B 10 1669494845 0 PO BOX 781076 DETROIT MI 482781076 20 1669494845 0 Physicians Anesthesia Services 20 1669494845 0 Physicians Fluoride varnish 20 1669494845 0 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Physicians Healthy Kids Services 20 1669495743 0 Physicians Optical Supplies 20 1669495743 0 Physicians Physician Services 00 1669496675 0 MURRAY DAVID R 2004245 9999999 B 10 1669496675 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1669496675 0 Physicians Anesthesia Services 20 1669496675 0 Physicians Fluoride varnish 20 1669496675 0 Physicians Healthy Kids Services 20 1669496675 0 Physicians Optical Supplies 20 1669496675 0 Physicians Physician Services 00 1669497087 0 SHERIDAN ANITA 2000187 9999999 B 10 1669497087 0 5777 DEPT CAROL STREAM IL 601220021 20 1669497087 0 Nurse Practitioners Anesthesia Services 20 1669497087 0 Nurse Practitioners Nurse Practitioners Services 20 1669497087 0 Nurse Practitioners Physician Services 00 1669497921 0 PITZELE HENRY Z 2002298 9999999 B 10 1669497921 0 29373 NETWORK PL CHICAGO IL 606733039 20 1669497921 0 Physicians Anesthesia Services 20 1669497921 0 Physicians Healthy Kids Services 20 1669497921 0 Physicians Optical Supplies 20 1669497921 0 Physicians Physician Services 00 1669498093 0 OTS MAX E 1990173 9999999 B 10 1669498093 0 PO BOX 28900 GREEN BAY WI 543240900 20 1669498093 0 Physicians Anesthesia Services 20 1669498093 0 Physicians Healthy Kids Services 20 1669498093 0 Physicians Optical Supplies 20 1669498093 0 Physicians Physician Services 00 1669498887 0 MUTCH MATTHEW 2002213 9999999 B 10 1669498887 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1669498887 0 Physicians Anesthesia Services 20 1669498887 0 Physicians Healthy Kids Services 20 1669498887 0 Physicians Optical Supplies 20 1669498887 0 Physicians Physician Services 00 1669498895 0 LENSCHOW DEBORAH J 2003335 9999999 B 10 1669498895 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1669498895 0 Physicians Anesthesia Services 20 1669498895 0 Physicians Fluoride varnish 20 1669498895 0 Physicians Healthy Kids Services 20 1669498895 0 Physicians Optical Supplies 20 1669498895 0 Physicians Physician Services 00 1669498960 0 HRACH CHRISTINE M 2005182 9999999 B 10 1669498960 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1669498960 0 Physicians Anesthesia Services 20 1669498960 0 Physicians Fluoride varnish 20 1669498960 0 Physicians Healthy Kids Services 20 1669498960 0 Physicians Optical Supplies 20 1669498960 0 Physicians Physician Services 00 1669499190 0 WARREN DAVID K 2001182 9999999 B 10 1669499190 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1669499190 0 Physicians Anesthesia Services 20 1669499190 0 Physicians Fluoride varnish 20 1669499190 0 Physicians Healthy Kids Services 20 1669499190 0 Physicians Optical Supplies 20 1669499190 0 Physicians Physician Services 00 1669499265 0 THOMAS DAVID L 1996275 9999999 B 10 1669499265 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1669499265 0 Physicians Anesthesia Services 20 1669499265 0 Physicians Fluoride varnish 20 1669499265 0 Physicians Healthy Kids Services 20 1669499265 0 Physicians Optical Supplies 20 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Physicians Anesthesia Services 20 1669521480 0 Physicians Healthy Kids Services 20 1669521480 0 Physicians Optical Supplies 20 1669521480 0 Physicians Physician Services 20 1669521480 0 Physicians Physicians Psychiatric Services 00 1669522603 0 GOKHALE RANJANA R 1996244 9999999 B 10 1669522603 0 29373 NETWORK PL CHICAGO IL 606733039 20 1669522603 0 Physicians Anesthesia Services 20 1669522603 0 Physicians Fluoride varnish 20 1669522603 0 Physicians Healthy Kids Services 20 1669522603 0 Physicians Optical Supplies 20 1669522603 0 Physicians Physician Services 00 1669523692 0 PAUL THEODORE 1996001 9999999 B 10 1669523692 0 1009 LORAS DR FREEPORT IL 610326923 20 1669523692 0 Chiropractors Chiropractic Services 00 1669523825 0 AZAD HEMA 2007190 9999999 B 10 1669523825 0 1440 W NORTH AVE STE 305 MELROSE PARK IL 601601426 20 1669523825 0 Physicians Anesthesia Services 20 1669523825 0 Physicians Fluoride varnish 20 1669523825 0 Physicians Healthy Kids Services 20 1669523825 0 Physicians 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20 1669547287 0 Physicians Healthy Kids Services 20 1669547287 0 Physicians Optical Supplies 20 1669547287 0 Physicians Physician Services 00 1669548970 0 ALON ALLISON 2003177 9999999 B 10 1669548970 0 601 DEERFIELD PKWY BUFFALO GROVE IL 600897500 20 1669548970 0 Speech Therapists Medical Supplies 20 1669548970 0 Speech Therapists Medical equipment/prosthetic devices 20 1669548970 0 Speech Therapists Speech Therapy/Pathology Services 00 1669552055 0 CHO CAROLINE 2008087 9999999 B 10 1669552055 0 207 S ADDISON RD ADDISON IL 601013809 20 1669552055 0 Optometrists Optical Supplies 20 1669552055 0 Optometrists Optometric Services 20 1669552055 0 Optometrists Physician Services 00 1669553012 0 MCSHANE GERALD J 1981258 9999999 B 10 1669553012 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1669553012 0 Physicians Anesthesia Services 20 1669553012 0 Physicians Fluoride varnish 20 1669553012 0 Physicians Healthy Kids Services 20 1669553012 0 Physicians Optical Supplies 20 1669553012 0 Physicians Physician Services 00 1669553590 0 LUU KIMBERLY 2025036 9999999 B 10 1669553590 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1669553590 0 Physician Assistant Only Fluoride varnish 20 1669553590 0 Physician Assistant Only Healthy Kids Services 20 1669553590 0 Physician Assistant Only Physician Services 00 1669553848 0 RICHARDS KATIE 2021120 9999999 B 10 1669553848 0 PO BOX 43230 PHOENIX AZ 850803230 20 1669553848 0 Physicians Anesthesia Services 20 1669553848 0 Physicians Healthy Kids Services 20 1669553848 0 Physicians Optical Supplies 20 1669553848 0 Physicians Physician Services 00 1669553863 0 WILK JOANNA 2001196 9999999 B 10 1669553863 0 PO BOX 713388 CHICAGO IL 606771525 20 1669553863 0 Physicians Anesthesia Services 20 1669553863 0 Physicians Fluoride varnish 20 1669553863 0 Physicians Healthy Kids Services 20 1669553863 0 Physicians Optical Supplies 20 1669553863 0 Physicians Physician Services 00 1669554465 0 ROBERTS ERIC D 2015320 9999999 B 10 1669554465 0 2650 RIDGE AVE # 1223 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Services 00 1669560355 0 MISSYGAR JOANNE S 2020318 9999999 B 10 1669560355 0 380 E NORTHWEST HWY STE 200 DES PLAINES IL 600162274 20 1669560355 0 Physician Assistant Only Fluoride varnish 20 1669560355 0 Physician Assistant Only Healthy Kids Services 20 1669560355 0 Physician Assistant Only Physician Services 00 1669560827 0 COX JENNIFER 2024029 9999999 B 10 1669560827 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1669560827 0 Physicians Anesthesia Services 20 1669560827 0 Physicians Fluoride varnish 20 1669560827 0 Physicians Healthy Kids Services 20 1669560827 0 Physicians Optical Supplies 20 1669560827 0 Physicians Physician Services 00 1669561080 0 PLEASANT DIANE S 2018093 9999999 B 10 1669561080 0 335 E WOOD ST STE B DECATUR IL 625231431 20 1669561080 0 Other behavior health professional LCPC/LMFT services 20 1669561080 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1669561452 0 COOPER WILLIAM A 2022180 9999999 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AVE CARBONDALE IL 629015612 20 1669664843 0 Physicians Anesthesia Services 20 1669664843 0 Physicians Healthy Kids Services 20 1669664843 0 Physicians Optical Supplies 20 1669664843 0 Physicians Physician Services 00 1669664892 0 KOULIEV TIMUR 2007244 9999999 B 10 1669664892 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1669664892 0 Physicians Anesthesia Services 20 1669664892 0 Physicians Healthy Kids Services 20 1669664892 0 Physicians Optical Supplies 20 1669664892 0 Physicians Physician Services 00 1669665444 0 ALEXANDER BOZANA 2007254 9999999 B 10 1669665444 0 35078 EAGLE WAY CHICAGO IL 606780001 20 1669665444 0 Physicians Anesthesia Services 20 1669665444 0 Physicians Healthy Kids Services 20 1669665444 0 Physicians Optical Supplies 20 1669665444 0 Physicians Physician Services 00 1669667242 0 ETHIRAJ RAJESH K 2012183 9999999 B 10 1669667242 0 1005 BROADWAY ST QUINCY IL 623012834 20 1669667242 0 Physicians Anesthesia Services 20 1669667242 0 Physicians Healthy Kids 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1669678694 0 Physicians Healthy Kids Services 20 1669678694 0 Physicians Optical Supplies 20 1669678694 0 Physicians Physician Services 00 1669679437 0 KRISHNAMOORTHI VENKATESAN R 2014009 9999999 B 10 1669679437 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1669679437 0 Physicians Anesthesia Services 20 1669679437 0 Physicians Fluoride varnish 20 1669679437 0 Physicians Healthy Kids Services 20 1669679437 0 Physicians Optical Supplies 20 1669679437 0 Physicians Physician Services 00 1669680757 0 FERNANDES TIMOTHY 2018067 9999999 B 10 1669680757 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1669680757 0 Physicians Anesthesia Services 20 1669680757 0 Physicians Fluoride varnish 20 1669680757 0 Physicians Healthy Kids Services 20 1669680757 0 Physicians Optical Supplies 20 1669680757 0 Physicians Physician Services 00 1669681482 0 LOHMEIER MICHAEL 2009220 9999999 B 10 1669681482 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1669681482 0 Physicians Anesthesia Services 20 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B 10 1669713798 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1669713798 0 Nurse Practitioners Anesthesia Services 20 1669713798 0 Nurse Practitioners Nurse Practitioners Services 20 1669713798 0 Nurse Practitioners Physician Services 00 1669714234 0 WAGENAAR BRIAN L. 2016245 9999999 B 10 1669714234 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1669714234 0 Physicians Anesthesia Services 20 1669714234 0 Physicians Fluoride varnish 20 1669714234 0 Physicians Healthy Kids Services 20 1669714234 0 Physicians Optical Supplies 20 1669714234 0 Physicians Physician Services 00 1669714895 0 FAN BETTY 2023181 9999999 B 10 1669714895 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1669714895 0 Physicians Anesthesia Services 20 1669714895 0 Physicians Healthy Kids Services 20 1669714895 0 Physicians Optical Supplies 20 1669714895 0 Physicians Physician Services 00 1669714978 0 MCCRACKEN WARD H. 2017221 9999999 B 10 1669714978 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1669714978 0 Physicians Anesthesia Services 20 1669714978 0 Physicians Fluoride varnish 20 1669714978 0 Physicians Healthy Kids Services 20 1669714978 0 Physicians Optical Supplies 20 1669714978 0 Physicians Physician Services 00 1669715173 0 NORMAN JESSICA 2018068 9999999 B 10 1669715173 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1669715173 0 Other behavior health professional LCPC/LMFT services 00 1669715959 0 JACOBS EMILY 2020259 9999999 B 10 1669715959 0 4401 S HARLEM AVE STICKNEY IL 604024250 20 1669715959 0 Physicians Anesthesia Services 20 1669715959 0 Physicians Healthy Kids Services 20 1669715959 0 Physicians Optical Supplies 20 1669715959 0 Physicians Physician Services 00 1669716452 0 SPACAPAN RENEE 2013105 9999999 B 10 1669716452 0 120 W 22ND ST OAK BROOK IL 605231557 20 1669716452 0 Nurse Practitioners Healthy Kids Services 20 1669716452 0 Nurse Practitioners Nurse Practitioners Services 20 1669716452 0 Nurse Practitioners Physician Services 00 1669716858 0 ALMANASIF MOHAMMED 2020267 9999999 B 10 1669716858 0 PO BOX 1510 EVANSVILLE IN 477061510 20 1669716858 0 Physicians Anesthesia Services 20 1669716858 0 Physicians Fluoride varnish 20 1669716858 0 Physicians Healthy Kids Services 20 1669716858 0 Physicians Optical Supplies 20 1669716858 0 Physicians Physician Services 00 1669717328 0 TUCKER JUSTIN 2022024 9999999 B 10 1669717328 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1669717328 0 Physician Assistant Only Fluoride varnish 20 1669717328 0 Physician Assistant Only Healthy Kids Services 20 1669717328 0 Physician Assistant Only Physician Services 00 1669719258 0 SMITH JOSHUA PORTER 2022016 9999999 B 10 1669719258 0 DEPT AT 40379 ATLANTA GA 311920379 20 1669719258 0 Physicians Anesthesia Services 20 1669719258 0 Physicians Healthy Kids Services 20 1669719258 0 Physicians Optical Supplies 20 1669719258 0 Physicians Physician Services 00 1669720017 0 AHN JIN H 2015105 9999999 B 10 1669720017 0 611 W PARK ST URBANA IL 618012529 20 1669720017 0 Physicians Anesthesia Services 20 1669720017 0 Physicians Fluoride varnish 20 1669720017 0 Physicians Healthy Kids Services 20 1669720017 0 Physicians Optical Supplies 20 1669720017 0 Physicians Physician Services 00 1669720041 0 FELTON-WILKS ANGELIA 2020183 9999999 B 10 1669720041 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1669720041 0 Nurse Practitioners Fluoride varnish 20 1669720041 0 Nurse Practitioners Healthy Kids Services 20 1669720041 0 Nurse Practitioners Nurse Practitioners Services 20 1669720041 0 Nurse Practitioners Physician Services 00 1669720272 0 DEXTER MARIE 2013352 9999999 H 10 1669720272 0 12 HEALTH SERVICES DEKALB IL 601159637 20 1669720272 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1669720694 0 NOGUCHI RYOKO 2016179 9999999 B 10 1669720694 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1669720694 0 Physicians Anesthesia Services 20 1669720694 0 Physicians Fluoride varnish 20 1669720694 0 Physicians Healthy Kids Services 20 1669720694 0 Physicians Optical Supplies 20 1669720694 0 Physicians Physician Services 00 1669720777 0 SCHLUETER AIMEE 2023072 9999999 B 10 1669720777 0 12640 S ROUTE 59 UNIT 110 PLAINFIELD IL 605855408 20 1669720777 0 Physical Therapists Medical Supplies 20 1669720777 0 Physical Therapists Medical equipment/prosthetic devices 20 1669720777 0 Physical Therapists Physical Therapy Services 00 1669720991 0 VANA GWEN 2018117 9999999 B 10 1669720991 0 1642 E 56TH ST STE 110 CHICAGO IL 606375049 20 1669720991 0 Clinical Social Worker Social work service 00 1669721213 0 HEUERMAN ANGELA 2020009 9999999 B 10 1669721213 0 421 W EXCHANGE ST FREEPORT IL 610324008 20 1669721213 0 Nurse Practitioners Healthy Kids Services 20 1669721213 0 Nurse Practitioners Nurse Practitioners Services 20 1669721213 0 Nurse Practitioners Physician Services 00 1669723128 0 FASAN LAUREN 2012299 9999999 B 10 1669723128 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1669723128 0 Occupational Therapists Medical Supplies 20 1669723128 0 Occupational Therapists Medical equipment/prosthetic devices 20 1669723128 0 Occupational Therapists Occupational Therapy Services 00 1669723268 0 LOPEZ DALILA 2021081 9999999 B 10 1669723268 0 2900 OGDEN AVE LISLE IL 605321631 20 1669723268 0 Speech Therapists Medical Supplies 20 1669723268 0 Speech Therapists Medical equipment/prosthetic devices 20 1669723268 0 Speech Therapists Speech Therapy/Pathology Services 00 1669723573 0 BODNER ALLA 2013213 9999999 B 10 1669723573 0 2801 LAKESIDE DR STE 209 BANNOCKBURN IL 600151271 20 1669723573 0 Physicians All Kids application agent 20 1669723573 0 Physicians Anesthesia Services 20 1669723573 0 Physicians Healthy Kids Services 20 1669723573 0 Physicians Optical Supplies 20 1669723573 0 Physicians Physician Services 00 1669726097 0 GOENKA AJAY 2022269 9999999 B 10 1669726097 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1669726097 0 Physicians Anesthesia Services 20 1669726097 0 Physicians Healthy Kids Services 20 1669726097 0 Physicians Optical Supplies 20 1669726097 0 Physicians Physician Services 20 1669726097 0 Physicians Physicians Psychiatric Services 00 1669727145 0 BOUSKA MICHAEL 2022121 9999999 B 10 1669727145 0 PO BOX 43230 PHOENIX AZ 850803230 20 1669727145 0 Physicians Anesthesia Services 20 1669727145 0 Physicians Healthy Kids Services 20 1669727145 0 Physicians Optical Supplies 20 1669727145 0 Physicians Physician Services 00 1669727590 0 KHAN MUHAMMAD SAAD 2024282 9999999 B 10 1669727590 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1669727590 0 Physicians Anesthesia Services 20 1669727590 0 Physicians Fluoride varnish 20 1669727590 0 Physicians Healthy Kids Services 20 1669727590 0 Physicians Optical Supplies 20 1669727590 0 Physicians Physician Services 00 1669728937 0 POSTEL BRANDON 2023101 9999999 B 10 1669728937 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1669728937 0 Physical Therapists Medical Supplies 20 1669728937 0 Physical Therapists Medical equipment/prosthetic devices 20 1669728937 0 Physical Therapists Physical Therapy Services 00 1669729653 0 BUAC MILIJANA 2023069 9999999 B 10 1669729653 0 3100 SYCAMORE RD DEKALB IL 601159621 20 1669729653 0 Speech Therapists Medical Supplies 20 1669729653 0 Speech Therapists Medical equipment/prosthetic devices 20 1669729653 0 Speech Therapists Speech Therapy/Pathology Services 00 1669730198 0 FISH KERRIE D 2019274 9999999 B 10 1669730198 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1669730198 0 Clinical Social Worker Social work service 00 1669730925 0 LASOFF DANIEL 2017335 9999999 B 10 1669730925 0 440 STEVENS AVE STE 150 SOLANA BEACH CA 920752058 20 1669730925 0 Physicians Anesthesia Services 20 1669730925 0 Physicians Healthy Kids Services 20 1669730925 0 Physicians Optical Supplies 20 1669730925 0 Physicians Physician Services 00 1669730982 0 CAMARA JOSE SALVADOR 2023171 9999999 B 10 1669730982 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1669730982 0 Physical Therapists Medical Supplies 20 1669730982 0 Physical Therapists Medical equipment/prosthetic devices 20 1669730982 0 Physical Therapists Physical Therapy Services 00 1669731394 0 MATTA ELIAS 2021214 9999999 B 10 1669731394 0 PO BOX 947935 ATLANTA GA 303947935 20 1669731394 0 Physicians Anesthesia Services 20 1669731394 0 Physicians Fluoride varnish 20 1669731394 0 Physicians Healthy Kids Services 20 1669731394 0 Physicians Optical Supplies 20 1669731394 0 Physicians Physician Services 00 1669731618 0 RESERVA JEAVE L 2020231 9999999 B 10 1669731618 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1669731618 0 Physicians Anesthesia Services 20 1669731618 0 Physicians Healthy Kids Services 20 1669731618 0 Physicians Optical Supplies 20 1669731618 0 Physicians Physician Services 00 1669732657 0 PELTIER DANIEL 2022129 9999999 B 10 1669732657 0 PO BOX 778912 CHICAGO IL 606778912 20 1669732657 0 Physicians Anesthesia Services 20 1669732657 0 Physicians Fluoride varnish 20 1669732657 0 Physicians Healthy Kids Services 20 1669732657 0 Physicians Optical Supplies 20 1669732657 0 Physicians Physician Services 00 1669732970 0 BOGALE SAIVIVEK R 2018155 9999999 B 10 1669732970 0 611 W PARK ST URBANA IL 618012529 20 1669732970 0 Physicians Anesthesia Services 20 1669732970 0 Physicians Healthy Kids Services 20 1669732970 0 Physicians Optical Supplies 20 1669732970 0 Physicians Physician Services 00 1669733184 0 SHETH SUJAY K 2017274 9999999 B 10 1669733184 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1669733184 0 Physicians Anesthesia Services 20 1669733184 0 Physicians Healthy Kids Services 20 1669733184 0 Physicians Optical Supplies 20 1669733184 0 Physicians Physician Services 00 1669734851 0 LAI VINCE 2022003 9999999 B 10 1669734851 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1669734851 0 Physicians Anesthesia Services 20 1669734851 0 Physicians Healthy Kids Services 20 1669734851 0 Physicians Optical Supplies 20 1669734851 0 Physicians Physician Services 00 1669734968 0 JOHANS CARRIE 2018152 9999999 B 10 1669734968 0 607 S NEW BALLAS RD STE 3100 SAINT LOUIS MO 631418219 20 1669734968 0 Physicians Anesthesia Services 20 1669734968 0 Physicians Healthy Kids Services 20 1669734968 0 Physicians Optical Supplies 20 1669734968 0 Physicians Physician Services 00 1669735205 0 VENTURA DOREEN 2018296 9999999 B 10 1669735205 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1669735205 0 Physicians Anesthesia Services 20 1669735205 0 Physicians Fluoride varnish 20 1669735205 0 Physicians Healthy Kids Services 20 1669735205 0 Physicians Optical Supplies 20 1669735205 0 Physicians Physician Services 00 1669735809 0 RANGINWALA SAAD 2018244 9999999 B 10 1669735809 0 PO BOX 8500 LOCKBOX 7642 PHILADELPHIA PA 191787642 20 1669735809 0 Physicians Anesthesia Services 20 1669735809 0 Physicians Healthy Kids Services 20 1669735809 0 Physicians Optical Supplies 20 1669735809 0 Physicians Physician Services 00 1669736021 0 HAZRA ANIRUDDHA 2015182 9999999 B 10 1669736021 0 4025 N SHERIDAN RD CHICAGO IL 606132010 20 1669736021 0 Physicians Anesthesia Services 20 1669736021 0 Physicians Fluoride varnish 20 1669736021 0 Physicians Healthy Kids Services 20 1669736021 0 Physicians Optical Supplies 20 1669736021 0 Physicians Physician Services 00 1669736088 0 SUBRAMANI RATHIDEVI 2012203 9999999 B 10 1669736088 0 1336 N ROUTE 59 STE 100 NAPERVILLE IL 605634282 20 1669736088 0 Dentists Dental Services 20 1669736088 0 Dentists Physician Services 00 1669736583 0 FROGAMENI ALEXANDRA A 2018137 9999999 B 10 1669736583 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1669736583 0 Physicians Anesthesia Services 20 1669736583 0 Physicians Fluoride varnish 20 1669736583 0 Physicians Healthy Kids Services 20 1669736583 0 Physicians Optical Supplies 20 1669736583 0 Physicians Physician Services 00 1669736609 0 KIRKPATRICK ANDREW 2022179 9999999 B 10 1669736609 0 PO BOX 28900 GREEN BAY WI 543240900 20 1669736609 0 Physicians Anesthesia Services 20 1669736609 0 Physicians Healthy Kids Services 20 1669736609 0 Physicians Optical Supplies 20 1669736609 0 Physicians Physician Services 00 1669736948 0 CHADWICK NICHOLSON 2018130 9999999 B 10 1669736948 0 1 ZOTEC WAY CARMEL IN 460320052 20 1669736948 0 Physicians Anesthesia Services 20 1669736948 0 Physicians Healthy Kids Services 20 1669736948 0 Physicians Optical Supplies 20 1669736948 0 Physicians Physician Services 00 1669737243 0 SALAMAT ARSALAN 2018277 9999999 B 10 1669737243 0 PO BOX 3988 CARBONDALE IL 629023988 20 1669737243 0 Physicians Anesthesia Services 20 1669737243 0 Physicians Healthy Kids Services 20 1669737243 0 Physicians Optical Supplies 20 1669737243 0 Physicians Physician Services 00 1669737474 0 RAUBER KENDRA 2015257 9999999 B 10 1669737474 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1669737474 0 Physicians Anesthesia Services 20 1669737474 0 Physicians Fluoride varnish 20 1669737474 0 Physicians Healthy Kids Services 20 1669737474 0 Physicians Optical Supplies 20 1669737474 0 Physicians Physician Services 00 1669737706 0 NUKALA VAMSI 2017083 9999999 B 10 1669737706 0 6810 STATE ROUTE 162 STE 215 MARYVILLE IL 620628566 20 1669737706 0 Physicians Anesthesia Services 20 1669737706 0 Physicians Fluoride varnish 20 1669737706 0 Physicians Healthy Kids Services 20 1669737706 0 Physicians Optical Supplies 20 1669737706 0 Physicians Physician Services 00 1669738043 0 JOACHIM FREDERICK 2017305 9999999 B 10 1669738043 0 PO BOX 678268 DALLAS TX 752678268 20 1669738043 0 Physicians Anesthesia Services 20 1669738043 0 Physicians Healthy Kids Services 20 1669738043 0 Physicians Optical Supplies 20 1669738043 0 Physicians Physician Services 00 1669738118 0 BRAY MALLORY S 2017212 9999999 B 10 1669738118 0 520 MARY ST STE 520 EVANSVILLE IN 477101682 20 1669738118 0 Physicians Anesthesia Services 20 1669738118 0 Physicians Healthy Kids Services 20 1669738118 0 Physicians Optical Supplies 20 1669738118 0 Physicians Physician Services 00 1669738241 0 NARAMORE SARA K 2018183 9999999 B 10 1669738241 0 PO BOX 778912 CHICAGO IL 606778912 20 1669738241 0 Physicians Anesthesia Services 20 1669738241 0 Physicians Fluoride varnish 20 1669738241 0 Physicians Healthy Kids Services 20 1669738241 0 Physicians Optical Supplies 20 1669738241 0 Physicians Physician Services 00 1669739371 0 SLADE DAVID 2017165 9999999 B 10 1669739371 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1669739371 0 Physicians Anesthesia Services 20 1669739371 0 Physicians Fluoride varnish 20 1669739371 0 Physicians Healthy Kids Services 20 1669739371 0 Physicians Optical Supplies 20 1669739371 0 Physicians Physician Services 00 1669740957 0 KREMER COURTNEY E 2017032 9999999 B 10 1669740957 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1669740957 0 Nurse Practitioners Fluoride varnish 20 1669740957 0 Nurse Practitioners Healthy Kids Services 20 1669740957 0 Nurse Practitioners Nurse 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00 1669755310 0 SENDIC SHOSHANA 2012003 9999999 B 10 1669755310 0 2834 W CHASE AVE CHICAGO IL 606451212 20 1669755310 0 Speech Therapists Medical Supplies 20 1669755310 0 Speech Therapists Medical equipment/prosthetic devices 20 1669755310 0 Speech Therapists Speech Therapy/Pathology Services 00 1669759981 0 CODA JOSEPH J 2023019 9999999 B 10 1669759981 0 28594 NETWORK PL CHICAGO IL 606731285 20 1669759981 0 Psychologist Psychologist service 00 1669761177 0 STETSON BETHANY T 2018151 9999999 B 10 1669761177 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1669761177 0 Physicians Anesthesia Services 20 1669761177 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1669761177 0 Physicians Healthy Kids Services 20 1669761177 0 Physicians Optical Supplies 20 1669761177 0 Physicians Physician Services 00 1669761417 0 DZEBA MAXIM 2017182 9999999 B 10 1669761417 0 PO BOX 80309 PHILADELPHIA PA 191011309 20 1669761417 0 Physicians Anesthesia Services 20 1669761417 0 Physicians Fluoride varnish 20 1669761417 0 Physicians Healthy Kids Services 20 1669761417 0 Physicians Optical Supplies 20 1669761417 0 Physicians Physician Services 00 1669761441 0 RAWSKI JENNA M 2017109 9999999 B 10 1669761441 0 PO BOX 772 MC2295 WOONSOCKET RI 028950784 20 1669761441 0 Nurse Practitioners Fluoride varnish 20 1669761441 0 Nurse Practitioners Healthy Kids Services 20 1669761441 0 Nurse Practitioners Nurse Practitioners Services 20 1669761441 0 Nurse Practitioners Physician Services 00 1669761706 0 AGARWAL PRATIBHA 2023269 9999999 B 10 1669761706 0 PO BOX 43230 PHOENIX AZ 850803230 20 1669761706 0 Physicians Anesthesia Services 20 1669761706 0 Physicians Healthy Kids Services 20 1669761706 0 Physicians Optical Supplies 20 1669761706 0 Physicians Physician Services 20 1669761706 0 Physicians Physicians Psychiatric Services 00 1669761912 0 WATERS JAMES D 2022066 9999999 B 10 1669761912 0 PO BOX 1649 CHEYENNE WY 820031649 20 1669761912 0 Physicians Anesthesia Services 20 1669761912 0 Physicians Healthy Kids Services 20 1669761912 0 Physicians Optical Supplies 20 1669761912 0 Physicians Physician Services 00 1669761938 0 HAMPTON KATARZYNA A 2021137 9999999 B 10 1669761938 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1669761938 0 Physicians Anesthesia Services 20 1669761938 0 Physicians Healthy Kids Services 20 1669761938 0 Physicians Optical Supplies 20 1669761938 0 Physicians Physician Services 00 1669762548 0 PAGE LAURA C 2022354 9999999 B 10 1669762548 0 5213 S ALSTON AVE DURHAM NC 277134430 20 1669762548 0 Physicians Anesthesia Services 20 1669762548 0 Physicians Fluoride varnish 20 1669762548 0 Physicians Healthy Kids Services 20 1669762548 0 Physicians Optical Supplies 20 1669762548 0 Physicians Physician Services 00 1669762555 0 CHI EUNA 2014227 9999999 B 10 1669762555 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1669762555 0 Physicians Anesthesia Services 20 1669762555 0 Physicians Fluoride varnish 20 1669762555 0 Physicians Healthy Kids Services 20 1669762555 0 Physicians Optical Supplies 20 1669762555 0 Physicians Physician Services 00 1669762605 0 KEIM AMY L 2017187 9999999 B 10 1669762605 0 701 S NEW BALLAS RD STE 310 SAINT LOUIS MO 631418701 20 1669762605 0 Nurse Practitioners Fluoride varnish 20 1669762605 0 Nurse Practitioners Healthy Kids Services 20 1669762605 0 Nurse Practitioners Nurse Practitioners Services 20 1669762605 0 Nurse Practitioners Physician Services 00 1669762795 0 DAMARLA VIJAY K 2018163 9999999 B 10 1669762795 0 8940 N WOOD SAGE RD PEORIA IL 616157822 20 1669762795 0 Physicians Anesthesia Services 20 1669762795 0 Physicians Fluoride varnish 20 1669762795 0 Physicians Healthy Kids Services 20 1669762795 0 Physicians Optical Supplies 20 1669762795 0 Physicians Physician Services 00 1669762977 0 NAVIDI TINA D 2024337 9999999 B 10 1669762977 0 1 HOLLOW LN STE 301 NEW HYDE PARK NY 110421215 20 1669762977 0 Physicians Anesthesia Services 20 1669762977 0 Physicians Fluoride varnish 20 1669762977 0 Physicians Healthy Kids Services 20 1669762977 0 Physicians Optical Supplies 20 1669762977 0 Physicians Physician Services 00 1669763082 0 SISSON GEORGE A 2017236 9999999 B 10 1669763082 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1669763082 0 Physicians Anesthesia Services 20 1669763082 0 Physicians Fluoride varnish 20 1669763082 0 Physicians Healthy Kids Services 20 1669763082 0 Physicians Optical Supplies 20 1669763082 0 Physicians Physician Services 00 1669763751 0 GAUGH RHONDA 2017186 9999999 B 10 1669763751 0 621 S NEW BALLAS RD STE 6017B SAINT LOUIS MO 631418274 20 1669763751 0 Physicians Anesthesia Services 20 1669763751 0 Physicians Fluoride varnish 20 1669763751 0 Physicians Healthy Kids Services 20 1669763751 0 Physicians Optical Supplies 20 1669763751 0 Physicians Physician Services 00 1669763983 0 PANT MAMTA 2018365 9999999 B 10 1669763983 0 PO BOX 578 PARK RIDGE IL 600680578 20 1669763983 0 Physicians Anesthesia Services 20 1669763983 0 Physicians Healthy Kids Services 20 1669763983 0 Physicians Optical Supplies 20 1669763983 0 Physicians Physician Services 00 1669764106 0 BEASLEY GARY 2018257 9999999 B 10 1669764106 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1669764106 0 Physicians Anesthesia Services 20 1669764106 0 Physicians Fluoride varnish 20 1669764106 0 Physicians Healthy Kids Services 20 1669764106 0 Physicians Optical Supplies 20 1669764106 0 Physicians Physician Services 00 1669764635 0 SELVARAJAH ANDREW N 2019085 9999999 B 10 1669764635 0 5777 DEPT CAROL STREAM IL 601220021 20 1669764635 0 Physicians Anesthesia Services 20 1669764635 0 Physicians Fluoride varnish 20 1669764635 0 Physicians Healthy Kids Services 20 1669764635 0 Physicians Optical Supplies 20 1669764635 0 Physicians Physician Services 00 1669764791 0 BERGER KINLEY 2015182 9999999 B 10 1669764791 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1669764791 0 Physicians Anesthesia Services 20 1669764791 0 Physicians Healthy Kids Services 20 1669764791 0 Physicians Optical Supplies 20 1669764791 0 Physicians Physician Services 00 1669764817 0 FAUST HILARY E 2019213 9999999 B 10 1669764817 0 PO BOX 857 FREEPORT IL 610320857 20 1669764817 0 Physicians Anesthesia Services 20 1669764817 0 Physicians Fluoride varnish 20 1669764817 0 Physicians Healthy Kids Services 20 1669764817 0 Physicians Optical Supplies 20 1669764817 0 Physicians Physician Services 00 1669765103 0 JEGADEESH NARESH 2016263 9999999 B 10 1669765103 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1669765103 0 Physicians Anesthesia Services 20 1669765103 0 Physicians Healthy Kids Services 20 1669765103 0 Physicians Optical Supplies 20 1669765103 0 Physicians Physician Services 00 1669767174 0 SKAY COLLEEN E 2015279 9999999 B 10 1669767174 0 777 LOWNDES HILL RD BLDG 1 GREENVILLE SC 296072101 20 1669767174 0 Physicians Anesthesia Services 20 1669767174 0 Physicians Healthy Kids Services 20 1669767174 0 Physicians Optical Supplies 20 1669767174 0 Physicians Physician Services 00 1669767562 0 DIAL SAMANTHA J 2016194 9999999 B 10 1669767562 0 2605 KENTUCKY AVE STE 306 PADUCAH KY 420033802 20 1669767562 0 Physicians Anesthesia Services 20 1669767562 0 Physicians Healthy Kids Services 20 1669767562 0 Physicians Optical Supplies 20 1669767562 0 Physicians Physician Services 20 1669767562 0 Physicians Physicians Psychiatric Services 00 1669767802 0 ALLSPAUGH LAUREL 2017293 9999999 B 10 1669767802 0 1900 W LE FEVRE RD STE A STERLING IL 610819202 20 1669767802 0 Speech Therapists Medical Supplies 20 1669767802 0 Speech Therapists Medical equipment/prosthetic devices 20 1669767802 0 Speech Therapists Speech Therapy/Pathology Services 00 1669768321 0 KOKORUZ LISA E 2004041 9999999 B 10 1669768321 0 25807 N DIAMOND LAKE RD MUNDELEIN IL 600609415 20 1669768321 0 Speech Therapists Medical Supplies 20 1669768321 0 Speech Therapists Medical equipment/prosthetic devices 20 1669768321 0 Speech Therapists Speech Therapy/Pathology Services 00 1669768644 0 BUEDEFELDT-POLLARD JESSE 2016277 9999999 B 10 1669768644 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1669768644 0 Physicians Anesthesia Services 20 1669768644 0 Physicians Healthy Kids Services 20 1669768644 0 Physicians Optical Supplies 20 1669768644 0 Physicians Physician Services 00 1669768669 0 FILIPPONI SHANNON MARIE 2016323 9999999 B 10 1669768669 0 1500 N CLYBOURN AVE UNIT C105 CHICAGO IL 606102295 20 1669768669 0 Speech Therapists Medical Supplies 20 1669768669 0 Speech Therapists Medical equipment/prosthetic devices 20 1669768669 0 Speech Therapists Speech Therapy/Pathology Services 00 1669769246 0 GHARAIBEH KAMEL A 2018073 9999999 B 10 1669769246 0 5410 MARYLAND WAY STE 300 BRENTWOOD TN 370275339 20 1669769246 0 Physicians Anesthesia Services 20 1669769246 0 Physicians Fluoride varnish 20 1669769246 0 Physicians Healthy Kids Services 20 1669769246 0 Physicians Optical Supplies 20 1669769246 0 Physicians Physician Services 00 1669769295 0 HUSAIN INNA A 2015222 9999999 B 10 1669769295 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1669769295 0 Physicians Anesthesia Services 20 1669769295 0 Physicians Healthy Kids Services 20 1669769295 0 Physicians Optical Supplies 20 1669769295 0 Physicians Physician Services 00 1669769519 0 PUSATERI JOSEPH 2023187 9999999 B 10 1669769519 0 PO BOX 43230 PHOENIX AZ 850803230 20 1669769519 0 Podiatrists Podiatric Services 00 1669769824 0 FAROOQ SABA 2020268 9999999 B 10 1669769824 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1669769824 0 Physicians Anesthesia Services 20 1669769824 0 Physicians Fluoride varnish 20 1669769824 0 Physicians Healthy Kids Services 20 1669769824 0 Physicians Optical Supplies 20 1669769824 0 Physicians Physician Services 00 1669770947 0 TOMKO STUART 2017159 9999999 B 10 1669770947 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1669770947 0 Physicians Anesthesia Services 20 1669770947 0 Physicians Healthy Kids Services 20 1669770947 0 Physicians Optical Supplies 20 1669770947 0 Physicians Physician Services 20 1669770947 0 Physicians Physicians Psychiatric Services 00 1669771010 0 HARE GLENNA 2011024 9999999 B 10 1669771010 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1669771010 0 Nurse Practitioners Fluoride varnish 20 1669771010 0 Nurse Practitioners Healthy Kids Services 20 1669771010 0 Nurse Practitioners Nurse Practitioners Services 20 1669771010 0 Nurse Practitioners Physician Services 00 1669777074 0 WAN ALAN 2016180 9999999 B 10 1669777074 0 5777 DEPT CAROL STREAM IL 601220021 20 1669777074 0 Physicians Anesthesia Services 20 1669777074 0 Physicians Fluoride varnish 20 1669777074 0 Physicians Healthy Kids Services 20 1669777074 0 Physicians Optical Supplies 20 1669777074 0 Physicians Physician Services 00 1669777447 0 MAYBERRY TINA 2016053 9999999 B 10 1669777447 0 PO BOX 504469 SAINT LOUIS MO 631504469 20 1669777447 0 Speech Therapists Medical Supplies 20 1669777447 0 Speech Therapists Medical equipment/prosthetic devices 20 1669777447 0 Speech Therapists Speech Therapy/Pathology Services 00 1669781050 0 DIAMANTE OLIVER 2015196 9999999 B 10 1669781050 0 55 E 86TH AVE MERRILLVILLE IN 464106382 20 1669781050 0 Physicians Anesthesia Services 20 1669781050 0 Physicians Fluoride varnish 20 1669781050 0 Physicians Healthy Kids Services 20 1669781050 0 Physicians Optical Supplies 20 1669781050 0 Physicians Physician Services 00 1669782017 0 AMANTE GRELINDA 2010245 9999999 B 10 1669782017 0 1005 BROADWAY ST QUINCY IL 623012834 20 1669782017 0 Nurse Practitioners Anesthesia Services 20 1669782017 0 Nurse Practitioners Nurse Practitioners Services 20 1669782017 0 Nurse Practitioners Physician Services 00 1669782751 0 STICHTER SARAH 2010326 9999999 B 10 1669782751 0 1900 W LE FEVRE RD STE A STERLING IL 610819202 20 1669782751 0 Speech Therapists Medical Supplies 20 1669782751 0 Speech Therapists Medical equipment/prosthetic devices 20 1669782751 0 Speech Therapists Speech Therapy/Pathology Services 00 1669783130 0 VAN HEUKELOM JESSE 2019133 9999999 B 10 1669783130 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1669783130 0 Physicians Anesthesia Services 20 1669783130 0 Physicians Fluoride varnish 20 1669783130 0 Physicians Healthy Kids Services 20 1669783130 0 Physicians Optical Supplies 20 1669783130 0 Physicians Physician Services 00 1669783437 0 HERMSEN ADAM R 2022063 9999999 B 10 1669783437 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1669783437 0 Physician Assistant Only Fluoride varnish 20 1669783437 0 Physician Assistant Only Healthy Kids Services 20 1669783437 0 Physician Assistant Only Physician Services 00 1669784112 0 BLOCHOWICZ PETER 2019047 9999999 B 10 1669784112 0 225 S EXECUTIVE DR BROOKFIELD WI 530054257 20 1669784112 0 Nurse Practitioners Anesthesia Services 20 1669784112 0 Nurse Practitioners Nurse Practitioners Services 20 1669784112 0 Nurse Practitioners Physician Services 00 1669784153 0 WEITZMAN DENA 2010213 9999999 B 10 1669784153 0 3450 LACEY RD DOWNERS GROVE IL 605155430 20 1669784153 0 Optometrists Optical Supplies 20 1669784153 0 Optometrists Optometric Services 20 1669784153 0 Optometrists Physician Services 00 1669784559 0 ALLAM HESHAM 2017080 9999999 B 10 1669784559 0 2300 N EDWARD ST DECATUR IL 625264163 20 1669784559 0 Physicians Anesthesia Services 20 1669784559 0 Physicians Healthy Kids Services 20 1669784559 0 Physicians Optical Supplies 20 1669784559 0 Physicians Physician Services 20 1669784559 0 Physicians Physicians Psychiatric Services 00 1669784872 0 UDDIN SHAHAAB M 2015231 9999999 B 10 1669784872 0 1S072 LUTHER AVE LOMBARD IL 601484164 20 1669784872 0 Physicians Anesthesia Services 20 1669784872 0 Physicians Fluoride varnish 20 1669784872 0 Physicians Healthy Kids Services 20 1669784872 0 Physicians Optical Supplies 20 1669784872 0 Physicians Physician Services 00 1669784971 0 TUCKER ANNELL 2013362 9999999 B 10 1669784971 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1669784971 0 Podiatrists Podiatric Services 00 1669784989 0 SEVIER GLENN 2010200 9999999 B 10 1669784989 0 2007 W GREENLEAF AVE CHICAGO IL 606453509 20 1669784989 0 Clinical Social Worker Social work service 00 1669785408 0 ASSIOUN BASSIM 2015200 9999999 B 10 1669785408 0 3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047452 20 1669785408 0 Physicians Anesthesia Services 20 1669785408 0 Physicians Fluoride varnish 20 1669785408 0 Physicians Healthy Kids Services 20 1669785408 0 Physicians Optical Supplies 20 1669785408 0 Physicians Physician Services 00 1669788162 0 GUERRA KATHLEEN 2017182 9999999 B 10 1669788162 0 1750 N RANDALL RD STE 120 ELGIN IL 601237900 20 1669788162 0 Physician Assistant Only Fluoride varnish 20 1669788162 0 Physician Assistant Only Healthy Kids Services 20 1669788162 0 Physician Assistant Only Physician Services 00 1669788709 0 MANCHANDA AARTI 2015274 9999999 B 10 1669788709 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1669788709 0 Physicians Anesthesia Services 20 1669788709 0 Physicians Fluoride varnish 20 1669788709 0 Physicians Healthy Kids Services 20 1669788709 0 Physicians Optical Supplies 20 1669788709 0 Physicians Physician Services 00 1669789020 0 GOMEZ-VALENCIA JAVIER 2012290 9999999 B 10 1669789020 0 PO BOX 6500 DEPT 1007 CHICAGO IL 606806500 20 1669789020 0 Physicians Anesthesia Services 20 1669789020 0 Physicians Healthy Kids Services 20 1669789020 0 Physicians Optical Supplies 20 1669789020 0 Physicians Physician Services 00 1669789327 0 SHIMA MARK T 2017124 9999999 B 10 1669789327 0 611 W PARK ST URBANA IL 618012529 20 1669789327 0 Physicians Anesthesia Services 20 1669789327 0 Physicians Healthy Kids Services 20 1669789327 0 Physicians Optical Supplies 20 1669789327 0 Physicians Physician Services 00 1669789616 0 KEEDY NICOLE H 2016153 9999999 B 10 1669789616 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1669789616 0 Psychologist Psychologist service 00 1669790697 0 KENNELL KELLY A 2016162 9999999 B 10 1669790697 0 111 OAKWOOD RD EAST PEORIA IL 616111853 20 1669790697 0 Physicians Anesthesia Services 20 1669790697 0 Physicians Healthy Kids Services 20 1669790697 0 Physicians Optical Supplies 20 1669790697 0 Physicians Physician Services 00 1669790796 0 MANLEY MARKOWSKI RENEE 2013182 9999999 B 10 1669790796 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1669790796 0 Physicians Anesthesia Services 20 1669790796 0 Physicians Fluoride varnish 20 1669790796 0 Physicians Healthy Kids Services 20 1669790796 0 Physicians Optical Supplies 20 1669790796 0 Physicians Physician Services 00 1669791000 0 SCHANOWITZ LIEBA G 2024211 9999999 B 10 1669791000 0 42 W MADISON ST FL 2 CHICAGO IL 606024309 20 1669791000 0 Speech Therapists Medical Supplies 20 1669791000 0 Speech Therapists Medical equipment/prosthetic devices 20 1669791000 0 Speech Therapists Speech Therapy/Pathology Services 00 1669791166 0 FULLAN SEAN 2013238 9999999 B 10 1669791166 0 611 W PARK ST URBANA IL 618012529 20 1669791166 0 Physicians Anesthesia Services 20 1669791166 0 Physicians Fluoride varnish 20 1669791166 0 Physicians Healthy Kids Services 20 1669791166 0 Physicians Optical Supplies 20 1669791166 0 Physicians Physician Services 00 1669791893 0 MCCONNELL MICHAEL F 2016183 9999999 B 10 1669791893 0 19111 TOWN CENTER DR APPLE VALLEY CA 923088989 20 1669791893 0 Physicians Anesthesia Services 20 1669791893 0 Physicians Healthy Kids Services 20 1669791893 0 Physicians Optical Supplies 20 1669791893 0 Physicians Physician Services 00 1669793147 0 KEEN DONALD E 2021019 9999999 B 10 1669793147 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1669793147 0 Physicians Anesthesia Services 20 1669793147 0 Physicians Healthy Kids Services 20 1669793147 0 Physicians Optical Supplies 20 1669793147 0 Physicians Physician Services 00 1669793170 0 ORGAN COLLEEN T 2020206 9999999 B 10 1669793170 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1669793170 0 Physical Therapists Medical Supplies 20 1669793170 0 Physical Therapists Medical equipment/prosthetic devices 20 1669793170 0 Physical Therapists Physical Therapy Services 00 1669794095 0 CRUSEN AMANDA M 2018193 9999999 B 10 1669794095 0 4450 N PROSPECT RD STE B1 PEORIA HEIGHTS IL 616166578 20 1669794095 0 Clinical Social Worker Social work service 00 1669795423 0 KAPUR AVNIT S 2012275 9999999 B 10 1669795423 0 254 REPUBLIC AVE JOLIET IL 604356518 20 1669795423 0 Physicians Anesthesia Services 20 1669795423 0 Physicians Healthy Kids Services 20 1669795423 0 Physicians Optical Supplies 20 1669795423 0 Physicians Physician Services 00 1669796751 0 HOLDEN REBECCA H 2014034 9999999 B 10 1669796751 0 5777 DEPT CAROL STREAM IL 601220021 20 1669796751 0 Nurse Practitioners Healthy Kids Services 20 1669796751 0 Nurse Practitioners Nurse Practitioners Services 20 1669796751 0 Nurse Practitioners Physician Services 00 1669797577 0 PEACHER DIONNE F 2017213 9999999 B 10 1669797577 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1669797577 0 Physicians Anesthesia Services 20 1669797577 0 Physicians Healthy Kids Services 20 1669797577 0 Physicians Optical Supplies 20 1669797577 0 Physicians Physician Services 00 1669797585 0 TOWNS DANIEL S 2022243 9999999 B 10 1669797585 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1669797585 0 Physicians Anesthesia Services 20 1669797585 0 Physicians Healthy Kids Services 20 1669797585 0 Physicians Optical Supplies 20 1669797585 0 Physicians Physician Services 20 1669797585 0 Physicians Physicians Psychiatric Services 00 1669797619 0 LARKIN JOHN S 2022350 9999999 B 10 1669797619 0 PO BOX 301208 DALLAS TX 753031208 20 1669797619 0 Physicians Anesthesia Services 20 1669797619 0 Physicians Healthy Kids Services 20 1669797619 0 Physicians Optical Supplies 20 1669797619 0 Physicians Physician Services 00 1669798062 0 MARWAHA GAURAV 2015243 9999999 B 10 1669798062 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1669798062 0 Physicians Anesthesia Services 20 1669798062 0 Physicians Healthy Kids Services 20 1669798062 0 Physicians Optical Supplies 20 1669798062 0 Physicians Physician Services 00 1669798542 0 SYED HASSNAIN S 2010162 9999999 B 10 1669798542 0 250 WATER STONE CIR JOLIET IL 604318313 20 1669798542 0 Physicians Anesthesia Services 20 1669798542 0 Physicians Fluoride varnish 20 1669798542 0 Physicians Healthy Kids Services 20 1669798542 0 Physicians Optical Supplies 20 1669798542 0 Physicians Physician Services 00 1669799532 0 BOULDIN STEVEN 2017269 9999999 B 10 1669799532 0 5380 TECH DATA DR STE 101 CLEARWATER FL 337603122 20 1669799532 0 Physicians Anesthesia Services 20 1669799532 0 Physicians Healthy Kids Services 20 1669799532 0 Physicians Optical Supplies 20 1669799532 0 Physicians Physician Services 00 1669799581 0 TRISNA MARK P 2023006 9999999 B 10 1669799581 0 PO BOX 43230 PHOENIX AZ 850803230 20 1669799581 0 Physicians Anesthesia Services 20 1669799581 0 Physicians Fluoride varnish 20 1669799581 0 Physicians Healthy Kids Services 20 1669799581 0 Physicians Optical Supplies 20 1669799581 0 Physicians Physician Services 00 1669800587 0 GURNEY SARAH M 2014032 9999999 B 10 1669800587 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1669800587 0 Nurse Practitioners Healthy Kids Services 20 1669800587 0 Nurse Practitioners Nurse Practitioners Services 20 1669800587 0 Nurse Practitioners Physician Services 00 1669801171 0 POOL ROBERTA A 2017196 9999999 B 10 1669801171 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1669801171 0 Other behavior health professional LCPC/LMFT services 00 1669802344 0 LINDLEY CRAIG 2014188 9999999 H 10 1669802344 0 822 W HILLGROVE AVE WESTERN SPRINGS IL 605581464 20 1669802344 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1669802492 0 TURNER BRANDI M 2018274 9999999 B 10 1669802492 0 3005 S RIVERSIDE DR STE 206 BELOIT WI 535111500 20 1669802492 0 Nurse Practitioners Anesthesia Services 20 1669802492 0 Nurse Practitioners Nurse Practitioners Services 20 1669802492 0 Nurse Practitioners Physician Services 00 1669802682 0 BOERSEN KARI M 2016096 9999999 B 10 1669802682 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1669802682 0 Physician Assistant Only Fluoride varnish 20 1669802682 0 Physician Assistant Only Healthy Kids Services 20 1669802682 0 Physician Assistant Only Physician Services 00 1669803037 0 WOLFINSOHN JOSHUA A. 2016251 9999999 A 10 1669803037 0 3248 VANDEVER AVE PEKIN IL 615546257 20 1669803037 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1669803284 0 VANCE LINDSEY B 2014120 9999999 B 10 1669803284 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1669803284 0 Physical Therapists Medical Supplies 20 1669803284 0 Physical Therapists Medical equipment/prosthetic devices 20 1669803284 0 Physical Therapists Physical Therapy Services 00 1669804589 0 HONG KEVIN 2018200 9999999 B 10 1669804589 0 175 E HOUSTON ST SAN ANTONIO TX 782052255 20 1669804589 0 Optometrists Optical Supplies 20 1669804589 0 Optometrists Optometric Services 20 1669804589 0 Optometrists Physician Services 00 1669804902 0 MILLER MINDY 2019203 9999999 B 10 1669804902 0 3990 N ILLINOIS ST SWANSEA IL 622261919 20 1669804902 0 Optometrists Optical Supplies 20 1669804902 0 Optometrists Optometric Services 20 1669804902 0 Optometrists Physician Services 00 1669805057 0 QURAISHI SYRAH I. 2016146 9999999 B 10 1669805057 0 1090 NORTHCHASE PKWY SE MARIETTA GA 300676405 20 1669805057 0 Dentists Dental Services 20 1669805057 0 Dentists Physician Services 00 1669805313 0 WARNER EMILY A 2013224 9999999 B 10 1669805313 0 PO BOX 557 DECATUR IL 625250557 20 1669805313 0 Nurse Practitioners Anesthesia Services 20 1669805313 0 Nurse Practitioners Nurse Practitioners Services 20 1669805313 0 Nurse Practitioners Physician Services 00 1669805768 0 WILLIAMS AMBER 2014073 9999999 H 10 1669805768 0 3062 E 91ST STREET CHICAGO IL 606174401 20 1669805768 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT 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1669810495 0 TURNER DAVID 2021171 9999999 B 10 1669810495 0 PO BOX 43230 PHOENIX AZ 850803230 20 1669810495 0 Physicians Anesthesia Services 20 1669810495 0 Physicians Healthy Kids Services 20 1669810495 0 Physicians Optical Supplies 20 1669810495 0 Physicians Physician Services 00 1669811816 0 CROCK LARA W 2018227 9999999 B 10 1669811816 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1669811816 0 Physicians Anesthesia Services 20 1669811816 0 Physicians Healthy Kids Services 20 1669811816 0 Physicians Optical Supplies 20 1669811816 0 Physicians Physician Services 00 1669811949 0 HUNTER ELIZABETH R 2023011 9999999 B 10 1669811949 0 PO BOX 1131 TRAVERSE CITY MI 496851131 20 1669811949 0 Physicians Anesthesia Services 20 1669811949 0 Physicians Fluoride varnish 20 1669811949 0 Physicians Healthy Kids Services 20 1669811949 0 Physicians Optical Supplies 20 1669811949 0 Physicians Physician Services 00 1669812038 0 OCHS PATRICIA B 2013182 9999999 B 10 1669812038 0 520 S 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Physicians Anesthesia Services 20 1669853230 0 Physicians Healthy Kids Services 20 1669853230 0 Physicians Optical Supplies 20 1669853230 0 Physicians Physician Services 00 1669853289 0 BRESCIA ALEXANDER 2023298 9999999 B 10 1669853289 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1669853289 0 Physicians Anesthesia Services 20 1669853289 0 Physicians Healthy Kids Services 20 1669853289 0 Physicians Optical Supplies 20 1669853289 0 Physicians Physician Services 00 1669853602 0 LUST HANNAH 2020007 9999999 B 10 1669853602 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1669853602 0 Physicians Anesthesia Services 20 1669853602 0 Physicians Fluoride varnish 20 1669853602 0 Physicians Healthy Kids Services 20 1669853602 0 Physicians Optical Supplies 20 1669853602 0 Physicians Physician Services 00 1669853636 0 MOHAMED KUMAIL 2021187 9999999 B 10 1669853636 0 PO BOX 43230 PHOENIX AZ 850803230 20 1669853636 0 Physicians Anesthesia Services 20 1669853636 0 Physicians Fluoride varnish 20 1669853636 0 Physicians Healthy Kids Services 20 1669853636 0 Physicians Optical Supplies 20 1669853636 0 Physicians Physician Services 00 1669853875 0 BAIYEWU PATRICIA 2016251 9999999 B 10 1669853875 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1669853875 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1669853891 0 SALZVERG BRIAN J 2018352 9999999 B 10 1669853891 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1669853891 0 Physicians Anesthesia Services 20 1669853891 0 Physicians Healthy Kids Services 20 1669853891 0 Physicians Optical Supplies 20 1669853891 0 Physicians Physician Services 20 1669853891 0 Physicians Physicians Psychiatric Services 00 1669854097 0 TOLEFREE SYDNEI E 2022027 9999999 B 10 1669854097 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1669854097 0 Physicians Anesthesia Services 20 1669854097 0 Physicians Healthy Kids Services 20 1669854097 0 Physicians Optical Supplies 20 1669854097 0 Physicians Physician Services 00 1669854402 0 ALHAJRI SANA A 2018240 9999999 B 10 1669854402 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1669854402 0 Physicians Anesthesia Services 20 1669854402 0 Physicians Fluoride varnish 20 1669854402 0 Physicians Healthy Kids Services 20 1669854402 0 Physicians Optical Supplies 20 1669854402 0 Physicians Physician Services 00 1669854576 0 KENDRIGAN TIFFANY E 2015274 9999999 B 10 1669854576 0 155 E BRUSH HILL RD 155 E BRUSH HILL RD ELMHURST IL 601265658 20 1669854576 0 Nurse Practitioners Fluoride varnish 20 1669854576 0 Nurse Practitioners Healthy Kids Services 20 1669854576 0 Nurse Practitioners Nurse Practitioners Services 20 1669854576 0 Nurse Practitioners Physician Services 00 1669854667 0 OKUBANJO OYINKANSOLA 2018123 9999999 B 10 1669854667 0 PO BOX 1027 BEDFORD PARK IL 604991027 20 1669854667 0 Physicians Anesthesia Services 20 1669854667 0 Physicians Healthy Kids Services 20 1669854667 0 Physicians Optical Supplies 20 1669854667 0 Physicians Physician Services 00 1669854840 0 COX JEREMIAH 2019211 9999999 B 10 1669854840 0 615 S NEW BALLAS RD STE 1400 SAINT LOUIS MO 631418221 20 1669854840 0 Physicians Anesthesia Services 20 1669854840 0 Physicians Healthy Kids Services 20 1669854840 0 Physicians Optical Supplies 20 1669854840 0 Physicians Physician Services 00 1669855276 0 MAJEED SYED A 2015271 9999999 B 10 1669855276 0 3065 FALLING WATERS BLVD LINDENHURST IL 600466793 20 1669855276 0 Dentists Dental Services 20 1669855276 0 Dentists Physician Services 00 1669855482 0 RAMIREZ-GALLEGUILLOS MARCIA 2021245 9999999 B 10 1669855482 0 1400 E IRVING PARK RD STREAMWOOD IL 601073201 20 1669855482 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1669855599 0 LOVETT-VERZAK GINA A 2018163 9999999 B 10 1669855599 0 10031 HUNTINGTON CT ORLAND PARK IL 604623105 20 1669855599 0 Clinical Social Worker Social work service 00 1669856431 0 GASPARRO VALENTINA 2020296 9999999 B 10 1669856431 0 7272 WURZBACH RD STE 601 SAN ANTONIO TX 782404803 20 1669856431 0 Other behavior health professional LCPC/LMFT services 00 1669856837 0 OI NATHAN 2017091 9999999 B 10 1669856837 0 33900 HARPER AVE STE 104 CLINTON TOWNSHI MI 480354258 20 1669856837 0 Physical Therapists Medical Supplies 20 1669856837 0 Physical Therapists Medical equipment/prosthetic devices 20 1669856837 0 Physical Therapists Physical Therapy Services 00 1669857447 0 TAHIR USAMA 2023121 9999999 B 10 1669857447 0 PO BOX 43230 PHOENIX AZ 850803230 20 1669857447 0 Physicians Anesthesia Services 20 1669857447 0 Physicians Healthy Kids Services 20 1669857447 0 Physicians Optical Supplies 20 1669857447 0 Physicians Physician Services 00 1669858098 0 CHANG KWANG K 2016047 9999999 B 10 1669858098 0 6020 W DIVERSEY AVE CHICAGO IL 606391108 20 1669858098 0 Dentists Dental Services 20 1669858098 0 Dentists Physician Services 00 1669858791 0 LOEHMAN HILLARY 2015272 9999999 B 10 1669858791 0 801 S WASHINGTON ST NAPERVILLE IL 605407430 20 1669858791 0 Nurse Practitioners Fluoride varnish 20 1669858791 0 Nurse Practitioners Healthy Kids Services 20 1669858791 0 Nurse Practitioners Nurse Practitioners Services 20 1669858791 0 Nurse Practitioners Physician Services 00 1669860292 0 JARKA MAURA 2015186 9999999 B 10 1669860292 0 2650 WARRENVILLE RD STE 280 DOWNERS GROVE IL 605152075 20 1669860292 0 Nurse Practitioners Fluoride varnish 20 1669860292 0 Nurse Practitioners Healthy Kids Services 20 1669860292 0 Nurse Practitioners Nurse Practitioners Services 20 1669860292 0 Nurse Practitioners Physician Services 00 1669861407 0 MONTOYA LILIANA 2018335 9999999 B 10 1669861407 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1669861407 0 Physicians Anesthesia Services 20 1669861407 0 Physicians Fluoride varnish 20 1669861407 0 Physicians Healthy Kids Services 20 1669861407 0 Physicians Optical Supplies 20 1669861407 0 Physicians Physician Services 00 1669861449 0 BREEN MICHAEL J 2019205 9999999 B 10 1669861449 0 29373 NETWORK PL CHICAGO IL 606733039 20 1669861449 0 Physicians Anesthesia Services 20 1669861449 0 Physicians Fluoride varnish 20 1669861449 0 Physicians Healthy Kids Services 20 1669861449 0 Physicians Optical Supplies 20 1669861449 0 Physicians Physician Services 00 1669861886 0 RIGGS DOUGLAS K 2017199 9999999 B 10 1669861886 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1669861886 0 Physical Therapists Medical Supplies 20 1669861886 0 Physical Therapists Medical equipment/prosthetic devices 20 1669861886 0 Physical Therapists Physical Therapy Services 00 1669862264 0 VANDEGRIFT ALISON 2015289 9999999 B 10 1669862264 0 520 VALLEY VIEW DR MOLINE IL 612656152 20 1669862264 0 Physical Therapists Medical Supplies 20 1669862264 0 Physical Therapists Medical equipment/prosthetic devices 20 1669862264 0 Physical Therapists Physical Therapy Services 00 1669862348 0 DEMARTINO DARRELL 2017229 9999999 B 10 1669862348 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1669862348 0 Nurse Practitioners Healthy Kids Services 20 1669862348 0 Nurse Practitioners Nurse Practitioners Services 20 1669862348 0 Nurse Practitioners Physician Services 00 1669863320 0 RANDOLPH AMANDA H 2019018 9999999 B 10 1669863320 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1669863320 0 Physicians Anesthesia Services 20 1669863320 0 Physicians Healthy Kids Services 20 1669863320 0 Physicians Optical Supplies 20 1669863320 0 Physicians Physician Services 00 1669863437 0 ARMANETTI STEPHANIE 2015161 9999999 B 10 1669863437 0 420 AIRPORT RD STE C-D ELGIN IL 601239329 20 1669863437 0 Clinical Social Worker Social work service 00 1669865861 0 DAVIS GINA D 2021234 9999999 B 10 1669865861 0 621 S NEW BALLAS RD STE 560A SUITE 560A SAINT LOUIS MO 631418261 20 1669865861 0 Physicians Anesthesia Services 20 1669865861 0 Physicians Healthy Kids Services 20 1669865861 0 Physicians Optical Supplies 20 1669865861 0 Physicians Physician Services 00 1669866836 0 REISH NICHOLAS J 2018325 9999999 B 10 1669866836 0 5777 DEPT CAROL STREAM IL 601220021 20 1669866836 0 Physicians Anesthesia Services 20 1669866836 0 Physicians Healthy Kids Services 20 1669866836 0 Physicians Optical Supplies 20 1669866836 0 Physicians Physician Services 20 1669866836 0 Physicians Physicians Psychiatric Services 00 1669867313 0 POTOCNIK ELIZABETH 2022215 9999999 B 10 1669867313 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1669867313 0 Physicians Anesthesia Services 20 1669867313 0 Physicians Healthy Kids Services 20 1669867313 0 Physicians Optical Supplies 20 1669867313 0 Physicians Physician Services 00 1669867354 0 STRINGER RICHARD T 2022276 9999999 B 10 1669867354 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1669867354 0 Physicians Anesthesia Services 20 1669867354 0 Physicians Fluoride varnish 20 1669867354 0 Physicians Healthy Kids Services 20 1669867354 0 Physicians Optical Supplies 20 1669867354 0 Physicians Physician Services 00 1669867693 0 ESCHBACHER KATHRYN 2022181 9999999 B 10 1669867693 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1669867693 0 Physicians Anesthesia Services 20 1669867693 0 Physicians Healthy Kids Services 20 1669867693 0 Physicians Optical Supplies 20 1669867693 0 Physicians Physician Services 00 1669867917 0 VAIL MATTHEW R 2019191 9999999 B 10 1669867917 0 75 REMITTANCE DR DEPT 1611 CHICAGO IL 606751611 20 1669867917 0 Clinical Social Worker Social work service 00 1669867974 0 REGIS JUDE 2020134 9999999 B 10 1669867974 0 PO BOX 80309 PHILADELPHIA PA 191011309 20 1669867974 0 Physicians Anesthesia Services 20 1669867974 0 Physicians Healthy Kids Services 20 1669867974 0 Physicians Optical Supplies 20 1669867974 0 Physicians Physician Services 00 1669867990 0 GEGIOS ALISON R 2019203 9999999 B 10 1669867990 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1669867990 0 Physicians Anesthesia Services 20 1669867990 0 Physicians Healthy Kids Services 20 1669867990 0 Physicians Optical Supplies 20 1669867990 0 Physicians Physician Services 00 1669868709 0 BABCHENKO OKSANA 2022027 9999999 B 10 1669868709 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1669868709 0 Physicians Anesthesia Services 20 1669868709 0 Physicians Healthy Kids Services 20 1669868709 0 Physicians Optical Supplies 20 1669868709 0 Physicians Physician Services 00 1669868790 0 HOFFMANN JENNIFER KAYE OLIVIA 2019284 9999999 B 10 1669868790 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1669868790 0 Physicians Anesthesia Services 20 1669868790 0 Physicians Family Planning Counseling 20 1669868790 0 Physicians Healthy Kids Services 20 1669868790 0 Physicians Optical Supplies 20 1669868790 0 Physicians Physician Services 00 1669869061 0 SHUBERT BIANCA M 2023128 9999999 B 10 1669869061 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1669869061 0 Physicians Anesthesia Services 20 1669869061 0 Physicians Healthy Kids Services 20 1669869061 0 Physicians Optical Supplies 20 1669869061 0 Physicians Physician Services 00 1669871471 0 BOWERS KATHERINE 2022089 9999999 B 10 1669871471 0 854 TECHNOLOGY WAY LIBERTYVILLE IL 600485350 20 1669871471 0 Other behavior health professional LCPC/LMFT services 00 1669874608 0 VORAC HEIDI F 2014305 9999999 B 10 1669874608 0 600 N COLLEGE AVE GENESEO IL 612541091 20 1669874608 0 Nurse Practitioners Fluoride varnish 20 1669874608 0 Nurse Practitioners Healthy Kids Services 20 1669874608 0 Nurse Practitioners Nurse Practitioners Services 20 1669874608 0 Nurse Practitioners Physician Services 00 1669877502 0 VASQUEZ ALYSSA K 2017312 9999999 B 10 1669877502 0 5777 DEPT CAROL STREAM IL 601220021 20 1669877502 0 Physician Assistant Only Fluoride varnish 20 1669877502 0 Physician Assistant Only Healthy Kids Services 20 1669877502 0 Physician Assistant Only Physician Services 00 1669878435 0 TARANUM ARSHIA 2015026 9999999 B 10 1669878435 0 6051 W BELMONT AVE CHICAGO IL 606345116 20 1669878435 0 Dentists Dental Services 20 1669878435 0 Dentists Physician Services 00 1669879417 0 COLLAZO LINDA 2016228 9999999 B 10 1669879417 0 17746 OAK PARK AVE TINLEY PARK IL 604773936 20 1669879417 0 Licensed Practical Nurses Nursing service 00 1669880951 0 SUNIL DHANYA 2014254 9999999 B 10 1669880951 0 28594 NETWORK PL CHICAGO IL 606731285 20 1669880951 0 Nurse Practitioners Fluoride varnish 20 1669880951 0 Nurse Practitioners Healthy Kids Services 20 1669880951 0 Nurse Practitioners Nurse Practitioners Services 20 1669880951 0 Nurse Practitioners Physician Services 00 1669881470 0 DICKSON MIRIAM A 2022133 9999999 B 10 1669881470 0 7825 SOLUTION CTR CHICAGO IL 606777007 20 1669881470 0 Physicians Anesthesia Services 20 1669881470 0 Physicians Healthy Kids Services 20 1669881470 0 Physicians Optical Supplies 20 1669881470 0 Physicians Physician Services 20 1669881470 0 Physicians Physicians Psychiatric Services 00 1669881702 0 KUMARI DIVYA 2019182 9999999 B 10 1669881702 0 PO BOX 5588 BELFAST ME 049155500 20 1669881702 0 Physicians Anesthesia Services 20 1669881702 0 Physicians Healthy Kids Services 20 1669881702 0 Physicians Optical Supplies 20 1669881702 0 Physicians Physician Services 00 1669882205 0 GRADY JUSTIN 2019063 9999999 B 10 1669882205 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1669882205 0 Physicians Anesthesia Services 20 1669882205 0 Physicians Fluoride varnish 20 1669882205 0 Physicians Healthy Kids Services 20 1669882205 0 Physicians Optical Supplies 20 1669882205 0 Physicians Physician Services 00 1669883112 0 FERNANDEZ KAREN 2014182 9999999 B 10 1669883112 0 1 CVS DR # MC2295 WOONSOCKET RI 028956146 20 1669883112 0 Nurse Practitioners Fluoride varnish 20 1669883112 0 Nurse Practitioners Healthy Kids Services 20 1669883112 0 Nurse Practitioners Nurse Practitioners Services 20 1669883112 0 Nurse Practitioners Physician Services 00 1669883898 0 KIM RYAN 2021271 9999999 B 10 1669883898 0 111 OAKWOOD RD EAST PEORIA IL 616111853 20 1669883898 0 Physicians Anesthesia Services 20 1669883898 0 Physicians Healthy Kids Services 20 1669883898 0 Physicians Optical Supplies 20 1669883898 0 Physicians Physician Services 20 1669883898 0 Physicians Physicians Psychiatric Services 00 1669883914 0 DE LOS REYES SAMANTHA 2018182 9999999 B 10 1669883914 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1669883914 0 Physicians Anesthesia Services 20 1669883914 0 Physicians Healthy Kids Services 20 1669883914 0 Physicians Optical Supplies 20 1669883914 0 Physicians Physician Services 00 1669883971 0 RAJU JENNA M 2016187 9999999 B 10 1669883971 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1669883971 0 Physician Assistant Only Fluoride varnish 20 1669883971 0 Physician Assistant Only Healthy Kids Services 20 1669883971 0 Physician Assistant Only Physician Services 00 1669884276 0 LEVENSON ANNE 2019057 9999999 B 10 1669884276 0 541 N FAIRBANKS CT PFS 25TH FLOOR CHICAGO IL 606113319 20 1669884276 0 Physicians Anesthesia Services 20 1669884276 0 Physicians Fluoride varnish 20 1669884276 0 Physicians Healthy Kids Services 20 1669884276 0 Physicians Optical Supplies 20 1669884276 0 Physicians Physician Services 00 1669884623 0 BUSCHER JAMES F 2022267 9999999 B 10 1669884623 0 PO BOX 43230 PHOENIX AZ 850803230 20 1669884623 0 Physicians Anesthesia Services 20 1669884623 0 Physicians Fluoride varnish 20 1669884623 0 Physicians Healthy Kids Services 20 1669884623 0 Physicians Optical Supplies 20 1669884623 0 Physicians Physician Services 00 1669884896 0 GREENBERG LAWRENCE A 2021266 9999999 B 10 1669884896 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1669884896 0 Physicians Anesthesia Services 20 1669884896 0 Physicians Fluoride varnish 20 1669884896 0 Physicians Healthy Kids Services 20 1669884896 0 Physicians Optical Supplies 20 1669884896 0 Physicians Physician Services 00 1669885273 0 KHURANA RAJWINDER 2015268 9999999 B 10 1669885273 0 822 MEADOWRIDGE DR AURORA IL 605045356 20 1669885273 0 Psychologist Psychologist service 00 1669886404 0 YUAN KEVIN Z 2017177 9999999 B 10 1669886404 0 4240 DUNCAN AVE STE 301 SAINT LOUIS MO 631101123 20 1669886404 0 Physicians Anesthesia Services 20 1669886404 0 Physicians Fluoride varnish 20 1669886404 0 Physicians Healthy Kids Services 20 1669886404 0 Physicians Optical Supplies 20 1669886404 0 Physicians Physician Services 00 1669886628 0 SCHWARTZ DANIEL JOSEPH 2017082 9999999 B 10 1669886628 0 2100 POWELL ST STE 400 EMERYVILLE CA 946081826 20 1669886628 0 Physicians Anesthesia Services 20 1669886628 0 Physicians Healthy Kids Services 20 1669886628 0 Physicians Optical Supplies 20 1669886628 0 Physicians Physician Services 00 1669886677 0 KRAMER- SMOTHERMAN DANIELLE N 2017156 9999999 B 10 1669886677 0 607 S NEW BALLAS RD STE 3300 SAINT LOUIS MO 631418219 20 1669886677 0 Physicians Anesthesia Services 20 1669886677 0 Physicians Fluoride varnish 20 1669886677 0 Physicians Healthy Kids Services 20 1669886677 0 Physicians Optical Supplies 20 1669886677 0 Physicians Physician Services 00 1669886818 0 KONERU SRAVANTIKA 2017188 9999999 B 10 1669886818 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1669886818 0 Physicians Anesthesia Services 20 1669886818 0 Physicians Fluoride varnish 20 1669886818 0 Physicians Healthy Kids Services 20 1669886818 0 Physicians Optical Supplies 20 1669886818 0 Physicians Physician Services 00 1669887337 0 EDELHEIT ARI 2018001 9999999 B 10 1669887337 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1669887337 0 Physicians Anesthesia Services 20 1669887337 0 Physicians Healthy Kids Services 20 1669887337 0 Physicians Optical Supplies 20 1669887337 0 Physicians Physician Services 00 1669887527 0 DWYER ROZANA H 2019169 9999999 B 10 1669887527 0 PO BOX 530 HAVANA IL 626440530 20 1669887527 0 Physicians Anesthesia Services 20 1669887527 0 Physicians Healthy Kids Services 20 1669887527 0 Physicians Optical Supplies 20 1669887527 0 Physicians Physician Services 00 1669887980 0 BROWN LUANN J 2019121 9999999 B 10 1669887980 0 1414 MAIN ST MELROSE PARK IL 601603902 20 1669887980 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1669888327 0 AHMAD THAER R 2017187 9999999 B 10 1669888327 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1669888327 0 Physicians Anesthesia Services 20 1669888327 0 Physicians Healthy Kids Services 20 1669888327 0 Physicians Optical Supplies 20 1669888327 0 Physicians Physician Services 00 1669888400 0 HENNING ELLEN 2022250 9999999 B 10 1669888400 0 3100 SYCAMORE RD DEKALB IL 601159621 20 1669888400 0 Speech Therapists Medical Supplies 20 1669888400 0 Speech Therapists Medical equipment/prosthetic devices 20 1669888400 0 Speech Therapists Speech Therapy/Pathology Services 00 1669888491 0 SHAH RAJU K 2017079 9999999 B 10 1669888491 0 PO BOX 775257 CHICAGO IL 606775257 20 1669888491 0 Physicians Anesthesia Services 20 1669888491 0 Physicians Fluoride varnish 20 1669888491 0 Physicians Healthy Kids Services 20 1669888491 0 Physicians Optical Supplies 20 1669888491 0 Physicians Physician Services 00 1669888558 0 CHANG JENNIFER 2019030 9999999 B 10 1669888558 0 5777 DEPT CAROL STREAM IL 601220021 20 1669888558 0 Physician Assistant Only Fluoride varnish 20 1669888558 0 Physician Assistant Only Healthy Kids Services 20 1669888558 0 Physician Assistant Only Physician Services 00 1669888921 0 LARISH AMY M 2014293 9999999 B 10 1669888921 0 1002 POPES CREEK CIR GRAYSLAKE IL 600301143 20 1669888921 0 Physical Therapists Medical Supplies 20 1669888921 0 Physical Therapists Medical equipment/prosthetic devices 20 1669888921 0 Physical Therapists Physical Therapy Services 00 1669889440 0 PATEL SHIRIN 2019060 9999999 B 10 1669889440 0 4712 LAUREL AVE GLENVIEW IL 600251419 20 1669889440 0 Optometrists Optical Supplies 20 1669889440 0 Optometrists Optometric Services 20 1669889440 0 Optometrists Physician Services 00 1669890067 0 BADYAL NAVROOP K 2023056 9999999 B 10 1669890067 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1669890067 0 Physicians Anesthesia Services 20 1669890067 0 Physicians Fluoride varnish 20 1669890067 0 Physicians Healthy Kids Services 20 1669890067 0 Physicians Optical Supplies 20 1669890067 0 Physicians Physician Services 00 1669890745 0 GUPTA ASHISH 2023046 9999999 B 10 1669890745 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1669890745 0 Physicians Anesthesia Services 20 1669890745 0 Physicians Fluoride varnish 20 1669890745 0 Physicians Healthy Kids Services 20 1669890745 0 Physicians Optical Supplies 20 1669890745 0 Physicians Physician Services 00 1669891107 0 VERSALLE MARISSA 2018219 9999999 B 10 1669891107 0 5777 DEPT CAROL STREAM IL 601220021 20 1669891107 0 Physicians Anesthesia Services 20 1669891107 0 Physicians Healthy Kids Services 20 1669891107 0 Physicians Optical Supplies 20 1669891107 0 Physicians Physician Services 00 1669891131 0 HOVELSON ELISE 2017305 9999999 B 10 1669891131 0 7444 W WILSON AVE STE 102 HARWOOD HEIGHTS IL 607064500 20 1669891131 0 Physician Assistant Only Fluoride varnish 20 1669891131 0 Physician Assistant Only Healthy Kids Services 20 1669891131 0 Physician Assistant Only Physician Services 00 1669891388 0 METCALF-DOETSCH WILLIAM N 2022293 9999999 B 10 1669891388 0 5777 DEPT CAROL STREAM IL 601220021 20 1669891388 0 Physicians Anesthesia Services 20 1669891388 0 Physicians Healthy Kids Services 20 1669891388 0 Physicians Optical Supplies 20 1669891388 0 Physicians Physician Services 00 1669891800 0 MOY ANDREW 2017163 9999999 B 10 1669891800 0 33900 HARPER AVE STE 104 CLINTON TOWNSHI MI 480354258 20 1669891800 0 Physical Therapists Medical Supplies 20 1669891800 0 Physical Therapists Medical equipment/prosthetic devices 20 1669891800 0 Physical Therapists Physical Therapy Services 00 1669892055 0 REDDY CHARITHA D 2024305 9999999 B 10 1669892055 0 500 PASTEUR DR PALO ALTO CA 943041048 20 1669892055 0 Physicians Anesthesia Services 20 1669892055 0 Physicians Fluoride varnish 20 1669892055 0 Physicians Healthy Kids Services 20 1669892055 0 Physicians Optical Supplies 20 1669892055 0 Physicians Physician Services 00 1669892683 0 AGARWAL ANUBHA 2019283 9999999 B 10 1669892683 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1669892683 0 Physicians Anesthesia Services 20 1669892683 0 Physicians Fluoride varnish 20 1669892683 0 Physicians Healthy Kids Services 20 1669892683 0 Physicians Optical Supplies 20 1669892683 0 Physicians Physician Services 00 1669892766 0 CHO YOON-JEONG 2024054 9999999 B 10 1669892766 0 29373 NETWORK PL CHICAGO IL 606733039 20 1669892766 0 Physicians Anesthesia Services 20 1669892766 0 Physicians Healthy Kids Services 20 1669892766 0 Physicians Optical Supplies 20 1669892766 0 Physicians Physician Services 00 1669895165 0 ROGINSKY EUGENE B 2023167 9999999 B 10 1669895165 0 1020 MILWAUKEE AVE STE 229 DEERFIELD IL 600153513 20 1669895165 0 Clinical Social Worker Social work service 00 1669895769 0 MCCLURE ROBERT I 2023164 9999999 B 10 1669895769 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1669895769 0 Physicians Anesthesia Services 20 1669895769 0 Physicians Healthy Kids Services 20 1669895769 0 Physicians Optical Supplies 20 1669895769 0 Physicians Physician Services 00 1669896031 0 DIETZ DAVID 2017233 9999999 B 10 1669896031 0 PO BOX 504469 SAINT LOUIS MO 631504469 20 1669896031 0 Occupational Therapists Medical Supplies 20 1669896031 0 Occupational Therapists Medical equipment/prosthetic devices 20 1669896031 0 Occupational Therapists Occupational Therapy Services 00 1669897930 0 PAPIS KRISTINE M 2014048 9999999 B 10 1669897930 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1669897930 0 Nurse Practitioners Fluoride varnish 20 1669897930 0 Nurse Practitioners Healthy Kids Services 20 1669897930 0 Nurse Practitioners Nurse Practitioners Services 20 1669897930 0 Nurse Practitioners Physician Services 00 1669899159 0 THALHEIMER JASON B 2018324 9999999 B 10 1669899159 0 1S376 SUMMIT AVE STE 4C OAKBROOK TERRAC IL 601813966 20 1669899159 0 Physicians Anesthesia Services 20 1669899159 0 Physicians Fluoride varnish 20 1669899159 0 Physicians Healthy Kids Services 20 1669899159 0 Physicians Optical Supplies 20 1669899159 0 Physicians Physician Services 00 1669899316 0 CHANDRAN MEGAN 2019154 9999999 B 10 1669899316 0 PO BOX 208807 DALLAS TX 753208807 20 1669899316 0 Physicians Anesthesia Services 20 1669899316 0 Physicians Healthy Kids Services 20 1669899316 0 Physicians Optical Supplies 20 1669899316 0 Physicians Physician Services 00 1669899803 0 NESEMEIER BRADLEY 2025063 9999999 B 10 1669899803 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1669899803 0 Physicians Anesthesia Services 20 1669899803 0 Physicians Healthy Kids Services 20 1669899803 0 Physicians Optical Supplies 20 1669899803 0 Physicians Physician Services 00 1669899878 0 ROY RENE M 2019001 9999999 B 10 1669899878 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1669899878 0 Physicians Anesthesia Services 20 1669899878 0 Physicians Fluoride varnish 20 1669899878 0 Physicians Healthy Kids Services 20 1669899878 0 Physicians Optical Supplies 20 1669899878 0 Physicians Physician Services 00 1669899944 0 DUKE GINA 2017254 9999999 B 10 1669899944 0 29373 NETWORK PL CHICAGO IL 606733039 20 1669899944 0 Physicians Anesthesia Services 20 1669899944 0 Physicians Fluoride varnish 20 1669899944 0 Physicians Healthy Kids Services 20 1669899944 0 Physicians Optical Supplies 20 1669899944 0 Physicians Physician Services 00 1669901104 0 HUDSON EDNA 2017178 9999999 B 10 1669901104 0 8713 W BURLEIGH ST LOWR MILWAUKEE WI 532223736 20 1669901104 0 Registered nurse Nursing service 20 1669901104 0 Registered nurse Waiver service 00 1669901450 0 EZIUKWU STANLEY C 2024352 9999999 B 10 1669901450 0 611 W PARK ST URBANA IL 618012529 20 1669901450 0 Physicians Anesthesia Services 20 1669901450 0 Physicians Fluoride varnish 20 1669901450 0 Physicians Healthy Kids Services 20 1669901450 0 Physicians Optical Supplies 20 1669901450 0 Physicians Physician 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9999999 B 10 1669962023 0 PO BOX 856 ANTIOCH IL 600020856 20 1669962023 0 Clinical Social Worker Social work service 00 1669962908 0 MORRIS TANYA 2022074 9999999 B 10 1669962908 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1669962908 0 Nurse Practitioners Fluoride varnish 20 1669962908 0 Nurse Practitioners Healthy Kids Services 20 1669962908 0 Nurse Practitioners Nurse Practitioners Services 20 1669962908 0 Nurse Practitioners Physician Services 00 1669963765 0 NAVA VARGAS ALBERTO R 2018229 9999999 B 10 1669963765 0 PO BOX 955860 SAINT LOUIS MO 631955860 20 1669963765 0 Nurse Practitioners Fluoride varnish 20 1669963765 0 Nurse Practitioners Healthy Kids Services 20 1669963765 0 Nurse Practitioners Nurse Practitioners Services 20 1669963765 0 Nurse Practitioners Physician Services 00 1669964441 0 SAED MOHAMMED 2021138 9999999 B 10 1669964441 0 150 W HIGH ST MORRIS IL 604501463 20 1669964441 0 Physicians Anesthesia Services 20 1669964441 0 Physicians Fluoride varnish 20 1669964441 0 Physicians Healthy Kids Services 20 1669964441 0 Physicians Optical Supplies 20 1669964441 0 Physicians Physician Services 00 1669965042 0 SPELLMAN SAMANTHA 2020266 9999999 B 10 1669965042 0 320 E CENTRAL AVE DECATUR IL 625214665 20 1669965042 0 Clinical Social Worker Social work service 00 1669965422 0 OCHIOBI CHINENYE 2023030 9999999 B 10 1669965422 0 4 FOSTER PLZ PITTSBURGH PA 152202749 20 1669965422 0 Physicians Anesthesia Services 20 1669965422 0 Physicians Fluoride varnish 20 1669965422 0 Physicians Healthy Kids Services 20 1669965422 0 Physicians Optical Supplies 20 1669965422 0 Physicians Physician Services 00 1669966081 0 MUIA MARIE A 2021056 9999999 B 10 1669966081 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1669966081 0 Nurse Practitioners Healthy Kids Services 20 1669966081 0 Nurse Practitioners Nurse Practitioners Services 20 1669966081 0 Nurse Practitioners Physician Services 00 1669966123 0 BOOTH SARAH 2020217 9999999 B 10 1669966123 0 PO BOX 328 EVANSVILLE IN 477020328 20 1669966123 0 Nurse Practitioners Fluoride varnish 20 1669966123 0 Nurse Practitioners Healthy Kids Services 20 1669966123 0 Nurse Practitioners Nurse Practitioners Services 20 1669966123 0 Nurse Practitioners Physician Services 00 1669967113 0 SIRHAN LAMA R 2018352 9999999 B 10 1669967113 0 5777 DEPT CAROL STREAM IL 601220021 20 1669967113 0 Physicians Anesthesia Services 20 1669967113 0 Physicians Fluoride varnish 20 1669967113 0 Physicians Healthy Kids Services 20 1669967113 0 Physicians Optical Supplies 20 1669967113 0 Physicians Physician Services 00 1669967543 0 HEARD SHASHANNA 2018351 9999999 B 10 1669967543 0 5250 OLD ORCHARD RD STE 300 SKOKIE IL 600774462 20 1669967543 0 Nurse Practitioners Fluoride varnish 20 1669967543 0 Nurse Practitioners Healthy Kids Services 20 1669967543 0 Nurse Practitioners Nurse Practitioners Services 20 1669967543 0 Nurse Practitioners Physician Services 00 1669967683 0 SHAH AYUSH N 2018351 9999999 B 10 1669967683 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1669967683 0 Physicians Anesthesia Services 20 1669967683 0 Physicians Fluoride varnish 20 1669967683 0 Physicians Healthy Kids Services 20 1669967683 0 Physicians Optical Supplies 20 1669967683 0 Physicians Physician Services 00 1669968160 0 MALLUM CHINDO B 2023205 9999999 B 10 1669968160 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1669968160 0 Physicians Anesthesia Services 20 1669968160 0 Physicians Healthy Kids Services 20 1669968160 0 Physicians Optical Supplies 20 1669968160 0 Physicians Physician Services 20 1669968160 0 Physicians Physicians Psychiatric Services 00 1669968186 0 BOLLIGER JANYNE R 2018190 9999999 B 10 1669968186 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1669968186 0 Physician Assistant Only Fluoride varnish 20 1669968186 0 Physician Assistant Only Healthy Kids Services 20 1669968186 0 Physician Assistant Only Physician Services 00 1669968459 0 MAUREN NATHAN 2021145 9999999 B 10 1669968459 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1669968459 0 Podiatrists Podiatric Services 00 1669969234 0 BAUTISTA CATALINO 2025017 9999999 B 10 1669969234 0 901 MACARTHUR BLVD MUNSTER IN 463212901 20 1669969234 0 Physicians Anesthesia Services 20 1669969234 0 Physicians Healthy Kids Services 20 1669969234 0 Physicians Optical Supplies 20 1669969234 0 Physicians Physician Services 00 1669969275 0 WEIDNER JACLYN 2018121 9999999 B 10 1669969275 0 4701 DEPT CAROL STREAM IL 601220021 20 1669969275 0 Nurse Practitioners Healthy Kids Services 20 1669969275 0 Nurse Practitioners Nurse Practitioners Services 20 1669969275 0 Nurse Practitioners Physician Services 00 1669969333 0 FISTER RACHEL M 2018170 9999999 B 10 1669969333 0 13545 BARRETT PARKWAY DR STE 1 BALLWIN MO 630213823 20 1669969333 0 Nurse Practitioners Anesthesia Services 20 1669969333 0 Nurse Practitioners Nurse Practitioners Services 20 1669969333 0 Nurse Practitioners Physician Services 00 1669971115 0 BERGER MOLLY A 2019162 9999999 B 10 1669971115 0 611 W PARK ST URBANA IL 618012529 20 1669971115 0 Physician Assistant Only Fluoride varnish 20 1669971115 0 Physician Assistant Only Healthy Kids Services 20 1669971115 0 Physician Assistant Only Physician Services 00 1669971503 0 SCHROEDTER BLAKE S 2018036 9999999 B 10 1669971503 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1669971503 0 Psychologist Psychologist service 00 1669974838 0 MALONE MORGAN 2019184 9999999 B 10 1669974838 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1669974838 0 Occupational Therapists Medical Supplies 20 1669974838 0 Occupational Therapists Medical equipment/prosthetic devices 20 1669974838 0 Occupational Therapists Occupational Therapy Services 00 1669975454 0 NOWICKI BRITTNEY A 2018174 9999999 B 10 1669975454 0 1395 NW 167TH ST MIAMI FL 331695710 20 1669975454 0 Physicians Anesthesia Services 20 1669975454 0 Physicians Fluoride varnish 20 1669975454 0 Physicians Healthy Kids Services 20 1669975454 0 Physicians Optical Supplies 20 1669975454 0 Physicians Physician Services 00 1669975736 0 SABU STACEY M 2018136 9999999 B 10 1669975736 0 908 N HEMLOCK LN MOUNT PROSPECT IL 600561406 20 1669975736 0 Occupational Therapists Medical Supplies 20 1669975736 0 Occupational Therapists Medical equipment/prosthetic devices 20 1669975736 0 Occupational Therapists Occupational Therapy Services 00 1669976023 0 BOLK KODY G 2024159 9999999 B 10 1669976023 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1669976023 0 Physicians Anesthesia Services 20 1669976023 0 Physicians Healthy Kids Services 20 1669976023 0 Physicians Optical Supplies 20 1669976023 0 Physicians Physician Services 00 1669976577 0 ROTUNNO GIULIANA 2023206 9999999 B 10 1669976577 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1669976577 0 Physicians Anesthesia Services 20 1669976577 0 Physicians Healthy Kids Services 20 1669976577 0 Physicians Optical Supplies 20 1669976577 0 Physicians Physician Services 00 1669977104 0 LONG ZACHARY J 2020027 9999999 B 10 1669977104 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1669977104 0 Physicians Anesthesia Services 20 1669977104 0 Physicians Fluoride varnish 20 1669977104 0 Physicians Healthy Kids Services 20 1669977104 0 Physicians Optical Supplies 20 1669977104 0 Physicians Physician Services 00 1669977211 0 TANDON ANKITA 2021210 9999999 B 10 1669977211 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1669977211 0 Physicians Anesthesia Services 20 1669977211 0 Physicians Fluoride varnish 20 1669977211 0 Physicians Healthy Kids Services 20 1669977211 0 Physicians Optical Supplies 20 1669977211 0 Physicians Physician Services 00 1669977302 0 TRIPP MICHAEL 2022173 9999999 B 10 1669977302 0 PO BOX 411637 SAINT LOUIS MO 631411637 20 1669977302 0 Physicians Anesthesia Services 20 1669977302 0 Physicians Healthy Kids Services 20 1669977302 0 Physicians Optical Supplies 20 1669977302 0 Physicians Physician Services 00 1669977336 0 BARLOW RYAN T 2023178 9999999 B 10 1669977336 0 PO BOX 43230 PHOENIX AZ 850803230 20 1669977336 0 Physicians Anesthesia Services 20 1669977336 0 Physicians Healthy Kids Services 20 1669977336 0 Physicians Optical Supplies 20 1669977336 0 Physicians Physician Services 00 1669977948 0 DAVELIS EFTIHIA 2020045 9999999 B 10 1669977948 0 1256 WATERFORD DR STE 230 AURORA IL 605044511 20 1669977948 0 Physicians Anesthesia Services 20 1669977948 0 Physicians Fluoride varnish 20 1669977948 0 Physicians Healthy Kids Services 20 1669977948 0 Physicians Optical Supplies 20 1669977948 0 Physicians Physician Services 00 1669978144 0 REGENT-SMITH ANDREW 2024192 9999999 B 10 1669978144 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1669978144 0 Physicians Anesthesia Services 20 1669978144 0 Physicians Healthy Kids Services 20 1669978144 0 Physicians Optical Supplies 20 1669978144 0 Physicians Physician Services 00 1669978268 0 HESS MATTHEW C 2023286 9999999 B 10 1669978268 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1669978268 0 Physicians Anesthesia Services 20 1669978268 0 Physicians Healthy Kids Services 20 1669978268 0 Physicians Optical Supplies 20 1669978268 0 Physicians Physician Services 00 1669978680 0 QAYUM OMAR 2022157 9999999 B 10 1669978680 0 4698 DEPT CAROL STREAM IL 601220021 20 1669978680 0 Physicians Anesthesia Services 20 1669978680 0 Physicians Healthy Kids Services 20 1669978680 0 Physicians Optical Supplies 20 1669978680 0 Physicians Physician Services 00 1669978763 0 FLEURANT ERIN 2023051 9999999 B 10 1669978763 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1669978763 0 Physicians Anesthesia Services 20 1669978763 0 Physicians Healthy Kids Services 20 1669978763 0 Physicians Optical Supplies 20 1669978763 0 Physicians Physician Services 00 1669979118 0 WALDECK PAULINE R 2018128 9999999 B 10 1669979118 0 3015 N BALLAS RD SAINT LOUIS MO 631312329 20 1669979118 0 Nurse Practitioners Anesthesia Services 20 1669979118 0 Nurse Practitioners Nurse Practitioners Services 20 1669979118 0 Nurse Practitioners Physician Services 00 1669979340 0 FARLEY JORDAN D 2022202 9999999 B 10 1669979340 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1669979340 0 Physicians Anesthesia Services 20 1669979340 0 Physicians Healthy Kids Services 20 1669979340 0 Physicians Optical Supplies 20 1669979340 0 Physicians Physician Services 00 1669979456 0 GILBERT MOLLY ETLING 2021202 9999999 B 10 1669979456 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1669979456 0 Physicians Anesthesia Services 20 1669979456 0 Physicians Fluoride varnish 20 1669979456 0 Physicians Healthy Kids Services 20 1669979456 0 Physicians Optical Supplies 20 1669979456 0 Physicians Physician Services 00 1669980033 0 GHAYAL HIREN 2018033 9999999 B 10 1669980033 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1669980033 0 Psychologist Psychologist service 00 1669980116 0 ANDERSON ELISE 2020224 9999999 B 10 1669980116 0 21600 OXNARD ST STE 1800 WOODLAND HILLS CA 913677807 20 1669980116 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT 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CHICAGO IL 606740018 20 1669981916 0 Nurse Practitioners Fluoride varnish 20 1669981916 0 Nurse Practitioners Healthy Kids Services 20 1669981916 0 Nurse Practitioners Nurse Practitioners Services 20 1669981916 0 Nurse Practitioners Physician Services 00 1669982427 0 MUNOZ MARISOL 2017355 9999999 B 10 1669982427 0 5777 DEPT CAROL STREAM IL 601220021 20 1669982427 0 Nurse Practitioners Fluoride varnish 20 1669982427 0 Nurse Practitioners Healthy Kids Services 20 1669982427 0 Nurse Practitioners Nurse Practitioners Services 20 1669982427 0 Nurse Practitioners Physician Services 00 1669983789 0 STUART ELIZABETH L 2017297 9999999 B 10 1669983789 0 124 SW ADAMS ST PEORIA IL 616021308 20 1669983789 0 Nurse Practitioners Fluoride varnish 20 1669983789 0 Nurse Practitioners Healthy Kids Services 20 1669983789 0 Nurse Practitioners Nurse Practitioners Services 20 1669983789 0 Nurse Practitioners Physician Services 00 1669985073 0 HORN ELIZABETH 2017312 9999999 B 10 1669985073 0 105 W A ST BELLEVILLE IL 622201326 20 1669985073 0 Speech Therapists Medical Supplies 20 1669985073 0 Speech Therapists Medical equipment/prosthetic devices 20 1669985073 0 Speech Therapists Speech Therapy/Pathology Services 00 1669985339 0 SAVAIANO JANET 2020164 9999999 B 10 1669985339 0 501 7TH ST ROCKFORD IL 611041242 20 1669985339 0 Speech Therapists Medical Supplies 20 1669985339 0 Speech Therapists Medical equipment/prosthetic devices 20 1669985339 0 Speech Therapists Speech Therapy/Pathology Services 00 1669985958 0 CLARK IAN 2022220 9999999 B 10 1669985958 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1669985958 0 Physicians Anesthesia Services 20 1669985958 0 Physicians Healthy Kids Services 20 1669985958 0 Physicians Optical Supplies 20 1669985958 0 Physicians Physician Services 00 1669986121 0 KOEHLER MEGAN 2018001 9999999 B 10 1669986121 0 2801 LAKESIDE DR STE 209 BANNOCKBURN IL 600151271 20 1669986121 0 Nurse Practitioners Healthy Kids Services 20 1669986121 0 Nurse Practitioners Midwife Services 20 1669986121 0 Nurse Practitioners Nurse Practitioners Services 20 1669986121 0 Nurse Practitioners Physician Services 00 1669986162 0 BERNARD JARRED M. 2017342 9999999 B 10 1669986162 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1669986162 0 Physical Therapists Medical Supplies 20 1669986162 0 Physical Therapists Medical equipment/prosthetic devices 20 1669986162 0 Physical Therapists Physical Therapy Services 00 1669986618 0 WATTERS NICOLE M 2019301 9999999 B 10 1669986618 0 4601 SAUK TRL RICHTON PARK IL 604711470 20 1669986618 0 Speech Therapists Medical Supplies 20 1669986618 0 Speech Therapists Medical equipment/prosthetic devices 20 1669986618 0 Speech Therapists Speech Therapy/Pathology Services 00 1669986915 0 MAYA-VESKOVIC GUADALUPE 2018043 9999999 B 10 1669986915 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1669986915 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1669987335 0 BROWN JASON B 2022321 9999999 B 10 1669987335 0 2250 N ILLINOIS AVE CARBONDALE IL 629015612 20 1669987335 0 Physicians Anesthesia Services 20 1669987335 0 Physicians Fluoride varnish 20 1669987335 0 Physicians Healthy Kids Services 20 1669987335 0 Physicians Optical Supplies 20 1669987335 0 Physicians Physician Services 00 1669987814 0 ANDERSON HANNAH KATE 2017345 9999999 B 10 1669987814 0 2200 JEFFERSON AVE TOLEDO OH 436047101 20 1669987814 0 Nurse Practitioners Fluoride varnish 20 1669987814 0 Nurse Practitioners Healthy Kids Services 20 1669987814 0 Nurse Practitioners Nurse Practitioners Services 20 1669987814 0 Nurse Practitioners Physician Services 00 1669988572 0 MEARS PATRICIA 2001128 9999999 B 10 1669988572 0 420 FRONT ST MCHENRY IL 600505528 20 1669988572 0 Speech Therapists Medical Supplies 20 1669988572 0 Speech Therapists Medical equipment/prosthetic devices 20 1669988572 0 Speech Therapists Speech Therapy/Pathology Services 00 1669990396 0 GAUBA ARJUN 2017250 9999999 B 10 1669990396 0 141 E PERSHING RD DECATUR IL 625263213 20 1669990396 0 Dentists Dental Services 20 1669990396 0 Dentists Physician Services 00 1669991774 0 ELTON JOAN 2003238 9999999 B 10 1669991774 0 350 W 154TH ST SOUTH HOLLAND IL 604731229 20 1669991774 0 Speech Therapists Medical Supplies 20 1669991774 0 Speech Therapists Medical equipment/prosthetic devices 20 1669991774 0 Speech Therapists Speech Therapy/Pathology Services 00 1669992004 0 CAPODARCO HEIDI 2017258 9999999 B 10 1669992004 0 6308 8TH AVE KENOSHA WI 531435031 20 1669992004 0 Nurse Practitioners Healthy Kids Services 20 1669992004 0 Nurse Practitioners Nurse Practitioners Services 20 1669992004 0 Nurse Practitioners Physician Services 00 1669992343 0 DATEY-CHAKRABARTY ASHIMA 2017201 9999999 B 10 1669992343 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1669992343 0 Physicians Anesthesia Services 20 1669992343 0 Physicians Fluoride varnish 20 1669992343 0 Physicians Healthy Kids Services 20 1669992343 0 Physicians Optical Supplies 20 1669992343 0 Physicians Physician Services 20 1669992343 0 Physicians Physicians Psychiatric Services 00 1669992640 0 KRAUSE JOHNSON MONICA 2024124 9999999 B 10 1669992640 0 988102 NEBRASKA MEDICAL CTR OMAHA NE 681988102 20 1669992640 0 Physicians Anesthesia Services 20 1669992640 0 Physicians Healthy Kids Services 20 1669992640 0 Physicians Optical Supplies 20 1669992640 0 Physicians Physician Services 20 1669992640 0 Physicians Physicians Psychiatric Services 00 1669993929 0 HONKANEN IIRO 2022214 9999999 B 10 1669993929 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1669993929 0 Physicians Anesthesia Services 20 1669993929 0 Physicians Fluoride varnish 20 1669993929 0 Physicians Healthy Kids Services 20 1669993929 0 Physicians Optical Supplies 20 1669993929 0 Physicians Physician Services 00 1669994364 0 GHIDANAC LUCRETIA 2022024 9999999 B 10 1669994364 0 3407 MOMENTUM PL CHICAGO IL 606890001 20 1669994364 0 Physicians Anesthesia Services 20 1669994364 0 Physicians Healthy Kids Services 20 1669994364 0 Physicians Optical Supplies 20 1669994364 0 Physicians Physician Services 00 1669995528 0 GHANNAM MALIK 2023186 9999999 B 10 1669995528 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1669995528 0 Physicians Anesthesia Services 20 1669995528 0 Physicians Healthy Kids Services 20 1669995528 0 Physicians Optical Supplies 20 1669995528 0 Physicians Physician Services 20 1669995528 0 Physicians Physicians Psychiatric Services 00 1669995650 0 OBLEADA KATRINA 2023334 9999999 B 10 1669995650 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1669995650 0 Other behavior health professional Psychologist service 00 1669996708 0 MELGOZA ESTELA 2018141 9999999 B 10 1669996708 0 966 W 21ST ST CHICAGO IL 606084511 20 1669996708 0 Other behavior health professional LCPC/LMFT services 00 1669996781 0 MYERS RACHEL K 2017227 9999999 B 10 1669996781 0 6300 RIDGLEA PL STE 201 FORT WORTH TX 761165707 20 1669996781 0 Nurse Practitioners Healthy Kids Services 20 1669996781 0 Nurse Practitioners Nurse Practitioners Services 20 1669996781 0 Nurse Practitioners Physician Services 00 1669997003 0 HAILEY JADE 2017352 9999999 B 10 1669997003 0 4701 DEPT CAROL STREAM IL 601220021 20 1669997003 0 Physical Therapists Medical Supplies 20 1669997003 0 Physical Therapists Medical equipment/prosthetic devices 20 1669997003 0 Physical Therapists Physical Therapy Services 00 1669997219 0 PATEL SONAL B. 2017213 9999999 B 10 1669997219 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1669997219 0 Nurse Practitioners Fluoride varnish 20 1669997219 0 Nurse Practitioners Healthy Kids Services 20 1669997219 0 Nurse Practitioners Nurse Practitioners Services 20 1669997219 0 Nurse Practitioners Physician Services 00 1669997268 0 BRAINARD KIRSTIN M 2017227 9999999 B 10 1669997268 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1669997268 0 Nurse Practitioners Healthy Kids Services 20 1669997268 0 Nurse Practitioners Nurse Practitioners Services 20 1669997268 0 Nurse Practitioners Physician Services 00 1669997383 0 SCHULTE TRISHA 2021203 9999999 B 10 1669997383 0 822 WHISPERING PINES DR CHATHAM IL 626299688 20 1669997383 0 Occupational Therapists Medical Supplies 20 1669997383 0 Occupational Therapists Medical equipment/prosthetic devices 20 1669997383 0 Occupational Therapists Occupational Therapy Services 00 1679000525 0 RAYNER JESSICA E 2020156 9999999 B 10 1679000525 0 10010 DON S POWERS DR MUNSTER IN 463214054 20 1679000525 0 Nurse Practitioners Fluoride varnish 20 1679000525 0 Nurse Practitioners Healthy Kids Services 20 1679000525 0 Nurse Practitioners Nurse Practitioners Services 20 1679000525 0 Nurse Practitioners Physician Services 00 1679000806 0 SADAT SAYED 2023237 9999999 B 10 1679000806 0 19111 TOWN CENTER DR APPLE VALLEY CA 923088989 20 1679000806 0 Physicians Anesthesia Services 20 1679000806 0 Physicians Healthy Kids Services 20 1679000806 0 Physicians Optical Supplies 20 1679000806 0 Physicians Physician Services 00 1679002000 0 GREGORY DAVID L 2021292 9999999 B 10 1679002000 0 1232 W STATE ROAD 2 LA PORTE IN 463505469 20 1679002000 0 Physicians Anesthesia Services 20 1679002000 0 Physicians Healthy Kids Services 20 1679002000 0 Physicians Optical Supplies 20 1679002000 0 Physicians Physician Services 00 1679003073 0 MUJAHID HASSAN 2023306 9999999 B 10 1679003073 0 1701 LACEY ST CAPE GIRARDEAU MO 637015230 20 1679003073 0 Physicians Anesthesia Services 20 1679003073 0 Physicians Fluoride varnish 20 1679003073 0 Physicians Healthy Kids Services 20 1679003073 0 Physicians Optical Supplies 20 1679003073 0 Physicians Physician Services 00 1679003347 0 LICATA KRISTEN E 2018018 9999999 B 10 1679003347 0 385 WINNETKA AVE WINNETKA IL 600934238 20 1679003347 0 Speech Therapists Medical Supplies 20 1679003347 0 Speech Therapists Medical equipment/prosthetic devices 20 1679003347 0 Speech Therapists Speech Therapy/Pathology Services 00 1679003388 0 MUNDHENKE PEARCE 2020241 9999999 B 10 1679003388 0 1400 US HIGHWAY 61 FESTUS MO 630284100 20 1679003388 0 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0 Physicians Healthy Kids Services 20 1679204937 0 Physicians Optical Supplies 20 1679204937 0 Physicians Physician Services 00 1679205140 0 BENFORD CANDACE D 2022265 9999999 B 10 1679205140 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1679205140 0 Nurse Practitioners Healthy Kids Services 20 1679205140 0 Nurse Practitioners Nurse Practitioners Services 20 1679205140 0 Nurse Practitioners Physician Services 00 1679205991 0 FAKHOURI MICHAEL S 2022178 9999999 B 10 1679205991 0 504 WAVERLY DR ELGIN IL 601204082 20 1679205991 0 Dentists Dental Services 20 1679205991 0 Dentists Physician Services 00 1679206296 0 MCCARTHY JOHN 2024200 9999999 B 10 1679206296 0 PO BOX 5081 JANESVILLE WI 535475081 20 1679206296 0 Physician Assistant Only Fluoride varnish 20 1679206296 0 Physician Assistant Only Healthy Kids Services 20 1679206296 0 Physician Assistant Only Physician Services 00 1679206668 0 MCDERMOTT MEGAN E 2022194 9999999 B 10 1679206668 0 1701 LACEY ST CAPE GIRARDEAU 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601220021 20 1679223630 0 Physicians Anesthesia Services 20 1679223630 0 Physicians Healthy Kids Services 20 1679223630 0 Physicians Optical Supplies 20 1679223630 0 Physicians Physician Services 00 1679223838 0 MATZ BROOKE L 2022176 9999999 B 10 1679223838 0 PO BOX 3039 OAK BROOK IL 605223039 20 1679223838 0 Physicians Anesthesia Services 20 1679223838 0 Physicians Fluoride varnish 20 1679223838 0 Physicians Healthy Kids Services 20 1679223838 0 Physicians Optical Supplies 20 1679223838 0 Physicians Physician Services 00 1679223861 0 LUCAS ALEX 2022179 9999999 B 10 1679223861 0 800 E LOCUST ST OLNEY IL 624502553 20 1679223861 0 Physicians Anesthesia Services 20 1679223861 0 Physicians Healthy Kids Services 20 1679223861 0 Physicians Optical Supplies 20 1679223861 0 Physicians Physician Services 00 1679226930 0 EILERS CASSANDRA L 2022091 9999999 B 10 1679226930 0 201 E MADISON ST STE 300 SPRINGFIELD IL 627025131 20 1679226930 0 Other behavior health professional Other Behavioral Health 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Assistant Only Fluoride varnish 20 1679235360 0 Physician Assistant Only Healthy Kids Services 20 1679235360 0 Physician Assistant Only Physician Services 00 1679235717 0 SMITH BRITTANY 2023109 9999999 B 10 1679235717 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1679235717 0 Nurse Practitioners Healthy Kids Services 20 1679235717 0 Nurse Practitioners Nurse Practitioners Services 20 1679235717 0 Nurse Practitioners Physician Services 00 1679236889 0 MCMARTIN TYLER CHRISTIAN 2023213 9999999 B 10 1679236889 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1679236889 0 Physicians Anesthesia Services 20 1679236889 0 Physicians Healthy Kids Services 20 1679236889 0 Physicians Optical Supplies 20 1679236889 0 Physicians Physician Services 00 1679240089 0 AWOYOMI MOYOSOLUWA I 2021360 9999999 B 10 1679240089 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1679240089 0 Physicians Anesthesia Services 20 1679240089 0 Physicians Fluoride varnish 20 1679240089 0 Physicians Healthy Kids Services 20 1679240089 0 Physicians Optical Supplies 20 1679240089 0 Physicians Physician Services 00 1679240303 0 JOSEPH MELITA 2024323 9999999 B 10 1679240303 0 29373 NETWORK PL CHICAGO IL 606733039 20 1679240303 0 Physical Therapists Medical Supplies 20 1679240303 0 Physical Therapists Medical equipment/prosthetic devices 20 1679240303 0 Physical Therapists Physical Therapy Services 00 1679241400 0 BREISCH JORDAN 2022174 9999999 B 10 1679241400 0 5777 DEPT CAROL STREAM IL 601220021 20 1679241400 0 Physician Assistant Only Fluoride varnish 20 1679241400 0 Physician Assistant Only Healthy Kids Services 20 1679241400 0 Physician Assistant Only Physician Services 00 1679242119 0 COELLO ALEXANDRA LEWIS 2024229 9999999 B 10 1679242119 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1679242119 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1679243661 0 NIXON JORDAN 2022250 9999999 B 10 1679243661 0 PO BOX 778912 CHICAGO IL 606778912 20 1679243661 0 Nurse Practitioners Fluoride varnish 20 1679243661 0 Nurse Practitioners Healthy Kids Services 20 1679243661 0 Nurse Practitioners Nurse Practitioners Services 20 1679243661 0 Nurse Practitioners Physician Services 00 1679244248 0 TAYLOR LATOSHMA 2021291 9999999 B 10 1679244248 0 17746 OAK PARK AVE TINLEY PARK IL 604773936 20 1679244248 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1679244461 0 WRIGHTINGTON TATIANA D 2021265 9999999 H 10 1679244461 0 14840 SHEPARD DR DOLTON IL 604192467 20 1679244461 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1679246003 0 NILSEN OLIVIA M 2022168 9999999 B 10 1679246003 0 544 NUNDA TRL CRYSTAL LAKE IL 600123795 20 1679246003 0 Speech Therapists Medical Supplies 20 1679246003 0 Speech Therapists Medical equipment/prosthetic devices 20 1679246003 0 Speech Therapists Speech Therapy/Pathology Services 00 1679246581 0 LI EVA 2021260 9999999 B 10 1679246581 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1679246581 0 Physician Assistant Only Fluoride varnish 20 1679246581 0 Physician Assistant Only Healthy Kids Services 20 1679246581 0 Physician Assistant Only Physician Services 00 1679246979 0 BATAYEH JOSHUA J 2021257 9999999 B 10 1679246979 0 29373 NETWORK PL CHICAGO IL 606733039 20 1679246979 0 Nurse Practitioners Healthy Kids Services 20 1679246979 0 Nurse Practitioners Nurse Practitioners Services 20 1679246979 0 Nurse Practitioners Physician Services 00 1679247423 0 ROBLES ANN M 2021235 9999999 B 10 1679247423 0 PO BOX 500 ELLICOTTVILLE NY 147310500 20 1679247423 0 Nurse Practitioners Fluoride varnish 20 1679247423 0 Nurse Practitioners Healthy Kids Services 20 1679247423 0 Nurse Practitioners Nurse Practitioners Services 20 1679247423 0 Nurse Practitioners Physician Services 00 1679247936 0 WHITE JUERITA 2021253 9999999 B 10 1679247936 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1679247936 0 Clinical Social Worker Social work service 00 1679247993 0 GORDON ALYSSA 2025036 9999999 B 10 1679247993 0 1437 W GRAND AVE APT 1S CHICAGO IL 606426318 20 1679247993 0 Nurse Practitioners Fluoride varnish 20 1679247993 0 Nurse Practitioners Healthy Kids Services 20 1679247993 0 Nurse Practitioners Nurse Practitioners Services 20 1679247993 0 Nurse Practitioners Physician Services 00 1679250625 0 KUMAR KARAN 2023240 9999999 B 10 1679250625 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1679250625 0 Physicians Anesthesia Services 20 1679250625 0 Physicians Fluoride varnish 20 1679250625 0 Physicians Healthy Kids Services 20 1679250625 0 Physicians Optical Supplies 20 1679250625 0 Physicians Physician Services 00 1679254098 0 ARAUJO DE O SANTANA MARCELA 2024059 9999999 B 10 1679254098 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1679254098 0 Physicians Anesthesia Services 20 1679254098 0 Physicians Fluoride varnish 20 1679254098 0 Physicians Healthy Kids Services 20 1679254098 0 Physicians Optical Supplies 20 1679254098 0 Physicians Physician Services 00 1679256093 0 CUMMINGS LEAH M 2023249 9999999 B 10 1679256093 0 611 W PARK ST URBANA IL 618012529 20 1679256093 0 Nurse Practitioners Fluoride varnish 20 1679256093 0 Nurse Practitioners Healthy Kids Services 20 1679256093 0 Nurse Practitioners Nurse Practitioners Services 20 1679256093 0 Nurse Practitioners Physician Services 00 1679257190 0 ELSHEIKH AHMED 2023197 9999999 B 10 1679257190 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1679257190 0 Physicians Anesthesia Services 20 1679257190 0 Physicians Fluoride varnish 20 1679257190 0 Physicians Healthy Kids Services 20 1679257190 0 Physicians Optical Supplies 20 1679257190 0 Physicians Physician Services 00 1679258263 0 WILSDORF NICHOLAS 2023277 9999999 B 10 1679258263 0 PO BOX 18412 PALATINE IL 600558412 20 1679258263 0 Dentists Dental Services 20 1679258263 0 Dentists Physician Services 00 1679258669 0 LIANG JONATHAN J 2023191 9999999 B 10 1679258669 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1679258669 0 Physicians Anesthesia Services 20 1679258669 0 Physicians Fluoride varnish 20 1679258669 0 Physicians Healthy Kids Services 20 1679258669 0 Physicians Optical Supplies 20 1679258669 0 Physicians Physician Services 00 1679258735 0 HAMAD HANAN T 2025026 9999999 B 10 1679258735 0 8800 W 119TH ST PALOS PARK IL 604641081 20 1679258735 0 Speech Therapists Medical Supplies 20 1679258735 0 Speech Therapists Medical equipment/prosthetic devices 20 1679258735 0 Speech Therapists Speech Therapy/Pathology Services 00 1679259550 0 ABUNADA JEANAN 2023296 9999999 B 10 1679259550 0 19950 GOVERNORS HWY OLYMPIA FIELDS IL 604611031 20 1679259550 0 Optometrists Optical Supplies 20 1679259550 0 Optometrists Optometric Services 20 1679259550 0 Optometrists Physician Services 00 1679260467 0 BANKS MARLLYS A 2024025 9999999 B 10 1679260467 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1679260467 0 Speech Therapists Medical Supplies 20 1679260467 0 Speech Therapists Medical equipment/prosthetic devices 20 1679260467 0 Speech Therapists Speech Therapy/Pathology Services 00 1679260699 0 PATEL JANKI 2023110 9999999 B 10 1679260699 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1679260699 0 Nurse Practitioners Healthy Kids Services 20 1679260699 0 Nurse Practitioners Nurse Practitioners Services 20 1679260699 0 Nurse Practitioners Physician Services 00 1679261770 0 ANNOR EUGENE N 2023297 9999999 B 10 1679261770 0 124 SW ADAMS ST PEORIA IL 616021308 20 1679261770 0 Physicians Anesthesia Services 20 1679261770 0 Physicians Fluoride varnish 20 1679261770 0 Physicians Healthy Kids Services 20 1679261770 0 Physicians Optical Supplies 20 1679261770 0 Physicians Physician Services 00 1679262224 0 VENUGOPAL SANJAY N 2023195 9999999 B 10 1679262224 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1679262224 0 Physicians Anesthesia Services 20 1679262224 0 Physicians Fluoride varnish 20 1679262224 0 Physicians Healthy Kids Services 20 1679262224 0 Physicians Optical Supplies 20 1679262224 0 Physicians Physician Services 00 1679262901 0 MCMEEN ALISON 2024008 9999999 B 10 1679262901 0 725 SCHOOL ST MORRIS IL 604501218 20 1679262901 0 Speech Therapists Speech Therapy/Pathology Services 00 1679263651 0 TEIXEIRA MALTA RAFAEL ANTONIO 2024341 9999999 B 10 1679263651 0 4698 DEPT CAROL STREAM IL 601220021 20 1679263651 0 Physicians Anesthesia Services 20 1679263651 0 Physicians Healthy Kids Services 20 1679263651 0 Physicians Optical Supplies 20 1679263651 0 Physicians Physician Services 00 1679263891 0 MATTA RAGHAV 2023224 2026181 B 10 1679263891 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1679263891 0 Physicians Anesthesia Services 20 1679263891 0 Physicians Fluoride varnish 20 1679263891 0 Physicians Healthy Kids Services 20 1679263891 0 Physicians Optical Supplies 20 1679263891 0 Physicians Physician Services 00 1679265771 0 AHMED UZMA UROOJ 2023182 9999999 B 10 1679265771 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1679265771 0 Physicians Anesthesia Services 20 1679265771 0 Physicians Fluoride varnish 20 1679265771 0 Physicians Healthy Kids Services 20 1679265771 0 Physicians Optical Supplies 20 1679265771 0 Physicians Physician Services 00 1679268205 0 CHU GIANNA 2024030 9999999 B 10 1679268205 0 1200 S DUNTON AVE ARLINGTON HEIGH IL 600053111 20 1679268205 0 Speech Therapists Medical Supplies 20 1679268205 0 Speech Therapists Medical equipment/prosthetic devices 20 1679268205 0 Speech Therapists Speech Therapy/Pathology Services 00 1679268486 0 CHEBEL ROY 2023302 9999999 B 10 1679268486 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1679268486 0 Physicians Anesthesia Services 20 1679268486 0 Physicians Healthy Kids Services 20 1679268486 0 Physicians Optical Supplies 20 1679268486 0 Physicians Physician Services 00 1679268916 0 PEARSON KYLE 2023135 9999999 B 10 1679268916 0 4211 N PROSPECT RD PEORIA HEIGHTS IL 616167754 20 1679268916 0 Other behavior health professional LCPC/LMFT services 00 1679272959 0 MORAIS DAELON 2024183 9999999 B 10 1679272959 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1679272959 0 Physicians Anesthesia Services 20 1679272959 0 Physicians Healthy Kids Services 20 1679272959 0 Physicians Optical Supplies 20 1679272959 0 Physicians Physician Services 00 1679274583 0 GRACE HYLAND 2023261 9999999 B 10 1679274583 0 966 W 21ST ST CHICAGO IL 606084511 20 1679274583 0 Nurse Practitioners Healthy Kids Services 20 1679274583 0 Nurse Practitioners Midwife Services 20 1679274583 0 Nurse Practitioners Nurse Practitioners Services 20 1679274583 0 Nurse Practitioners Physician Services 00 1679276430 0 HILGER JOSEPH EDWARD 2023207 9999999 B 10 1679276430 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1679276430 0 Physicians Anesthesia Services 20 1679276430 0 Physicians Healthy Kids Services 20 1679276430 0 Physicians Optical Supplies 20 1679276430 0 Physicians Physician Services 20 1679276430 0 Physicians Physicians Psychiatric Services 00 1679276489 0 WALSH DANIEL 2023191 9999999 B 10 1679276489 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1679276489 0 Physicians Anesthesia Services 20 1679276489 0 Physicians Healthy Kids Services 20 1679276489 0 Physicians Optical Supplies 20 1679276489 0 Physicians Physician Services 00 1679277230 0 MORRIS EDDIE 2023206 9999999 B 10 1679277230 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1679277230 0 Physicians Anesthesia Services 20 1679277230 0 Physicians Healthy Kids Services 20 1679277230 0 Physicians Optical Supplies 20 1679277230 0 Physicians Physician Services 00 1679277347 0 SMITH ANNA 2024283 9999999 B 10 1679277347 0 2001 BUTTERFIELD RD STE 1600 DOWNERS GROVE IL 605151211 20 1679277347 0 Physical Therapists Medical Supplies 20 1679277347 0 Physical Therapists Medical equipment/prosthetic devices 20 1679277347 0 Physical Therapists Physical Therapy Services 00 1679277578 0 BEASLEY LEANNE 2023179 9999999 B 10 1679277578 0 4698 DEPT CAROL STREAM IL 601224698 20 1679277578 0 Physicians Anesthesia Services 20 1679277578 0 Physicians Fluoride varnish 20 1679277578 0 Physicians Healthy Kids Services 20 1679277578 0 Physicians Optical Supplies 20 1679277578 0 Physicians Physician Services 00 1679277594 0 MORENO BRIAN 2024183 9999999 B 10 1679277594 0 355 E ERIE ST CHICAGO IL 606113167 20 1679277594 0 Physicians Anesthesia Services 20 1679277594 0 Physicians Healthy Kids Services 20 1679277594 0 Physicians Optical Supplies 20 1679277594 0 Physicians Physician Services 00 1679277693 0 PEI MITCHELL B 2023125 9999999 B 10 1679277693 0 PO BOX 3039 OAK BROOK IL 605223039 20 1679277693 0 Physicians Anesthesia Services 20 1679277693 0 Physicians Fluoride varnish 20 1679277693 0 Physicians Healthy Kids Services 20 1679277693 0 Physicians Optical Supplies 20 1679277693 0 Physicians Physician Services 00 1679278352 0 GUTHRIE SHELBY 2023110 9999999 B 10 1679278352 0 605 N MINE ST SANDOVAL IL 628821103 20 1679278352 0 Nurse Practitioners Fluoride varnish 20 1679278352 0 Nurse Practitioners Healthy Kids Services 20 1679278352 0 Nurse Practitioners Nurse Practitioners Services 20 1679278352 0 Nurse Practitioners Physician Services 00 1679280309 0 KRUSEC CAMDEN 2022306 9999999 B 10 1679280309 0 1400 W GREENLEAF AVE CHICAGO IL 606262805 20 1679280309 0 Clinical Social Worker Social work service 00 1679280838 0 BRIZ RIA MARA 2025045 9999999 B 10 1679280838 0 14315 108TH AVE STE 215 ORLAND PARK IL 604675701 20 1679280838 0 Nurse Practitioners Healthy Kids Services 20 1679280838 0 Nurse Practitioners Nurse Practitioners Services 20 1679280838 0 Nurse Practitioners Physician Services 00 1679282198 0 IRVING RYAN 2022350 9999999 B 10 1679282198 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1679282198 0 Physician Assistant Only Fluoride varnish 20 1679282198 0 Physician Assistant Only Healthy Kids Services 20 1679282198 0 Physician Assistant Only Physician Services 00 1679285183 0 RIEKENA KELSEY M 2023318 9999999 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1679294268 0 LE EMMY 2023237 9999999 B 10 1679294268 0 1836 LACKLAND HILL PKWY SAINT LOUIS MO 631463572 20 1679294268 0 Nurse Practitioners Healthy Kids Services 20 1679294268 0 Nurse Practitioners Nurse Practitioners Services 20 1679294268 0 Nurse Practitioners Physician Services 00 1679294557 0 PATEL ZEEL 2022251 9999999 B 10 1679294557 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1679294557 0 Physician Assistant Only Fluoride varnish 20 1679294557 0 Physician Assistant Only Healthy Kids Services 20 1679294557 0 Physician Assistant Only Physician Services 00 1679295018 0 WUNDERLICH ALEXA 2023277 9999999 B 10 1679295018 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1679295018 0 Physician Assistant Only Fluoride varnish 20 1679295018 0 Physician Assistant Only Healthy Kids Services 20 1679295018 0 Physician Assistant Only Physician Services 00 1679296743 0 LEBAK LAUREN 2022284 9999999 B 10 1679296743 0 PO BOX 5588 BELFAST ME 049155500 20 1679296743 0 Physical Therapists Medical Supplies 20 1679296743 0 Physical Therapists Medical equipment/prosthetic devices 20 1679296743 0 Physical Therapists Physical Therapy Services 00 1679299606 0 ADAMSON TIFFANY R 2022321 9999999 B 10 1679299606 0 5777 DEPT CAROL STREAM IL 601220021 20 1679299606 0 Nurse Practitioners Fluoride varnish 20 1679299606 0 Nurse Practitioners Healthy Kids Services 20 1679299606 0 Nurse Practitioners Nurse Practitioners Services 20 1679299606 0 Nurse Practitioners Physician Services 00 1679300073 0 PIASECKI ANTHONY 2025028 9999999 B 10 1679300073 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1679300073 0 Physician Assistant Only Fluoride varnish 20 1679300073 0 Physician Assistant Only Healthy Kids Services 20 1679300073 0 Physician Assistant Only Physician Services 00 1679301667 0 ZAHDAN ELIZABETH J 2025031 9999999 B 10 1679301667 0 909 RIDGEBROOK RD STE 300 SPARKS MD 211529477 20 1679301667 0 Nurse Practitioners Fluoride varnish 20 1679301667 0 Nurse Practitioners Healthy Kids Services 20 1679301667 0 Nurse Practitioners Nurse Practitioners Services 20 1679301667 0 Nurse Practitioners Physician Services 00 1679301980 0 REUSCHEL VICTORIA L 2024247 9999999 B 10 1679301980 0 3202 N WISCONSIN AVE PEORIA IL 616031260 20 1679301980 0 Speech Therapists Medical Supplies 20 1679301980 0 Speech Therapists Medical equipment/prosthetic devices 20 1679301980 0 Speech Therapists Speech Therapy/Pathology Services 00 1679302145 0 MOORE EMILEE L 2024217 9999999 B 10 1679302145 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1679302145 0 Occupational Therapists Medical Supplies 20 1679302145 0 Occupational Therapists Medical equipment/prosthetic devices 20 1679302145 0 Occupational Therapists Occupational Therapy Services 00 1679304737 0 ALASHEH ACIL 2024234 9999999 B 10 1679304737 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1679304737 0 Physicians Anesthesia Services 20 1679304737 0 Physicians Healthy Kids Services 20 1679304737 0 Physicians Optical Supplies 20 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Physicians Fluoride varnish 20 1679837470 0 Physicians Healthy Kids Services 20 1679837470 0 Physicians Optical Supplies 20 1679837470 0 Physicians Physician Services 00 1679837629 0 WEST MALINDA 2017132 9999999 B 10 1679837629 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1679837629 0 Physicians Anesthesia Services 20 1679837629 0 Physicians Fluoride varnish 20 1679837629 0 Physicians Healthy Kids Services 20 1679837629 0 Physicians Optical Supplies 20 1679837629 0 Physicians Physician Services 00 1679838122 0 JACOBS KRISTAL A 2017290 9999999 B 10 1679838122 0 224 S LOCUST ST CENTRALIA IL 628013509 20 1679838122 0 Speech Therapists Medical Supplies 20 1679838122 0 Speech Therapists Medical equipment/prosthetic devices 20 1679838122 0 Speech Therapists Speech Therapy/Pathology Services 00 1679839047 0 LASTER JANESE 2018211 9999999 B 10 1679839047 0 4701 DEPT CAROL STREAM IL 601220021 20 1679839047 0 Physicians Anesthesia Services 20 1679839047 0 Physicians Fluoride varnish 20 1679839047 0 Physicians Healthy Kids Services 20 1679839047 0 Physicians Optical Supplies 20 1679839047 0 Physicians Physician Services 00 1679839914 0 MCCLUGAGE SAMUEL G 2025064 9999999 B 10 1679839914 0 2450 HOLCOMBE BLVD STE MN-34L HOUSTON TX 770212039 20 1679839914 0 Physicians Anesthesia Services 20 1679839914 0 Physicians Healthy Kids Services 20 1679839914 0 Physicians Optical Supplies 20 1679839914 0 Physicians Physician Services 00 1679840391 0 KING KELLY ELIZABETH 2024303 9999999 B 10 1679840391 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1679840391 0 Psychologist Psychologist service 00 1679840680 0 STICKLING GABRIEL 2011318 9999999 B 10 1679840680 0 124 SW ADAMS ST PEORIA IL 616021308 20 1679840680 0 Occupational Therapists Medical Supplies 20 1679840680 0 Occupational Therapists Medical equipment/prosthetic devices 20 1679840680 0 Occupational Therapists Occupational Therapy Services 00 1679841142 0 VAN WYK BRYNNA L 2017177 9999999 B 10 1679841142 0 200 HAWKINS DR 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Therapy Services 00 1679857486 0 ZITNY BROOKE 2011286 9999999 B 10 1679857486 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1679857486 0 Clinical Social Worker All Kids application agent 20 1679857486 0 Clinical Social Worker Social work service 00 1679857577 0 DEWEY MELANIE A 2024009 9999999 B 10 1679857577 0 28594 NETWORK PL CHICAGO IL 606731285 20 1679857577 0 Other behavior health professional LCPC/LMFT services 00 1679860795 0 FORBES-AMRHEIN MONICA MARY 2018018 9999999 B 10 1679860795 0 250 N SHADELAND AVE STE 200 INDIANAPOLIS IN 462194959 20 1679860795 0 Physicians Anesthesia Services 20 1679860795 0 Physicians Healthy Kids Services 20 1679860795 0 Physicians Optical Supplies 20 1679860795 0 Physicians Physician Services 00 1679861785 0 GRIGERY CHELSEA 2014213 9999999 B 10 1679861785 0 PO BOX 776084 CHICAGO IL 606776084 20 1679861785 0 Physicians Anesthesia Services 20 1679861785 0 Physicians Fluoride varnish 20 1679861785 0 Physicians Healthy Kids Services 20 1679861785 0 Physicians Optical Supplies 20 1679861785 0 Physicians Physician Services 00 1679862296 0 KHADIR MOHAMMED M 2017107 9999999 B 10 1679862296 0 8930 WAUKEGAN RD STE 130 MORTON GROVE IL 600532132 20 1679862296 0 Physicians Anesthesia Services 20 1679862296 0 Physicians Healthy Kids Services 20 1679862296 0 Physicians Optical Supplies 20 1679862296 0 Physicians Physician Services 00 1679862767 0 BAKIR MAY REEM 2019192 9999999 B 10 1679862767 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1679862767 0 Physicians Anesthesia Services 20 1679862767 0 Physicians Fluoride varnish 20 1679862767 0 Physicians Healthy Kids Services 20 1679862767 0 Physicians Optical Supplies 20 1679862767 0 Physicians Physician Services 00 1679863542 0 SMITH DANIELLE A 2025028 9999999 B 10 1679863542 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1679863542 0 Physicians Anesthesia Services 20 1679863542 0 Physicians Healthy Kids Services 20 1679863542 0 Physicians Optical Supplies 20 1679863542 0 Physicians 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10 1679984199 0 1436 LOCUST ST TERRE HAUTE IN 478071648 20 1679984199 0 Dentists Dental Services 20 1679984199 0 Dentists Physician Services 00 1679984843 0 HUSSAIN ASIYA 2017305 9999999 B 10 1679984843 0 PO BOX 775231 CHICAGO IL 606775231 20 1679984843 0 Physicians Anesthesia Services 20 1679984843 0 Physicians Fluoride varnish 20 1679984843 0 Physicians Healthy Kids Services 20 1679984843 0 Physicians Optical Supplies 20 1679984843 0 Physicians Physician Services 00 1679984884 0 PANNAPARA JOSEPH 2020328 9999999 B 10 1679984884 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1679984884 0 Nurse Practitioners Anesthesia Services 20 1679984884 0 Nurse Practitioners Nurse Practitioners Services 20 1679984884 0 Nurse Practitioners Physician Services 00 1679987374 0 BENJAMIN JOHN 2023138 9999999 B 10 1679987374 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1679987374 0 Physicians Anesthesia Services 20 1679987374 0 Physicians Healthy Kids Services 20 1679987374 0 Physicians Optical Supplies 20 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SPARACIO CARMEL S 2018087 9999999 B 10 1689172512 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1689172512 0 Nurse Practitioners Anesthesia Services 20 1689172512 0 Nurse Practitioners Nurse Practitioners Services 20 1689172512 0 Nurse Practitioners Physician Services 00 1689172835 0 AYALA CAROLINA 2020048 9999999 B 10 1689172835 0 # 8496 CHICAGO IL 606778004 20 1689172835 0 Physician Assistant Only Fluoride varnish 20 1689172835 0 Physician Assistant Only Healthy Kids Services 20 1689172835 0 Physician Assistant Only Physician Services 00 1689173965 0 SLATTERY SARAH ANN 2019015 9999999 B 10 1689173965 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1689173965 0 Nurse Practitioners Healthy Kids Services 20 1689173965 0 Nurse Practitioners Nurse Practitioners Services 20 1689173965 0 Nurse Practitioners Physician Services 00 1689174682 0 NIKOLIC JELENA 2020015 9999999 B 10 1689174682 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1689174682 0 Physicians Anesthesia 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1689179335 0 Physicians Healthy Kids Services 20 1689179335 0 Physicians Optical Supplies 20 1689179335 0 Physicians Physician Services 00 1689179772 0 SAYED AAIMA 2020014 9999999 B 10 1689179772 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1689179772 0 Physicians Anesthesia Services 20 1689179772 0 Physicians Healthy Kids Services 20 1689179772 0 Physicians Optical Supplies 20 1689179772 0 Physicians Physician Services 20 1689179772 0 Physicians Physicians Psychiatric Services 00 1689179848 0 LENEHAN CARLEE P 2021182 9999999 B 10 1689179848 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1689179848 0 Physicians Anesthesia Services 20 1689179848 0 Physicians Fluoride varnish 20 1689179848 0 Physicians Healthy Kids Services 20 1689179848 0 Physicians Optical Supplies 20 1689179848 0 Physicians Physician Services 00 1689180580 0 PEVSNER JANET H 1981227 9999999 B 10 1689180580 0 301 E COLUMBIA ST ARTHUR IL 619111403 20 1689180580 0 Speech Therapists Medical Supplies 20 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Physicians Healthy Kids Services 20 1689298853 0 Physicians Optical Supplies 20 1689298853 0 Physicians Physician Services 00 1689300535 0 DAILY SARAH J 2022220 9999999 B 10 1689300535 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1689300535 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1689302663 0 SAPKOTA ASHOK 2022235 9999999 B 10 1689302663 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1689302663 0 Physicians Anesthesia Services 20 1689302663 0 Physicians Fluoride varnish 20 1689302663 0 Physicians Healthy Kids Services 20 1689302663 0 Physicians Optical Supplies 20 1689302663 0 Physicians Physician Services 00 1689303273 0 JUAREZ CRYSTAL 2022199 9999999 B 10 1689303273 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1689303273 0 Physicians Anesthesia Services 20 1689303273 0 Physicians Fluoride varnish 20 1689303273 0 Physicians Healthy Kids Services 20 1689303273 0 Physicians Optical Supplies 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Services 20 1689314916 0 Physicians Optical Supplies 20 1689314916 0 Physicians Physician Services 00 1689315392 0 PALTE ILAN C 2023176 9999999 B 10 1689315392 0 355 E ERIE ST CHICAGO IL 606113167 20 1689315392 0 Physicians Anesthesia Services 20 1689315392 0 Physicians Healthy Kids Services 20 1689315392 0 Physicians Optical Supplies 20 1689315392 0 Physicians Physician Services 00 1689317422 0 GRAY STERLING D 2022208 9999999 B 10 1689317422 0 7732 SOLUTION CENTER CHICAGO IL 606777007 20 1689317422 0 Dentists Dental Services 20 1689317422 0 Dentists Physician Services 00 1689318875 0 THOMPSON AMANDA K 2022202 9999999 B 10 1689318875 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1689318875 0 Nurse Practitioners Fluoride varnish 20 1689318875 0 Nurse Practitioners Healthy Kids Services 20 1689318875 0 Nurse Practitioners Nurse Practitioners Services 20 1689318875 0 Nurse Practitioners Physician Services 00 1689318917 0 NODA CHRISTOPHER H 2022227 9999999 B 10 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IL 605275965 20 1689319949 0 Physicians Anesthesia Services 20 1689319949 0 Physicians Healthy Kids Services 20 1689319949 0 Physicians Optical Supplies 20 1689319949 0 Physicians Physician Services 00 1689320442 0 RUSSELL BRENNA 2022214 9999999 B 10 1689320442 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1689320442 0 Physician Assistant Only Fluoride varnish 20 1689320442 0 Physician Assistant Only Healthy Kids Services 20 1689320442 0 Physician Assistant Only Physician Services 00 1689321754 0 KIRSCHNER RACHELLE 2022144 9999999 B 10 1689321754 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1689321754 0 Nurse Practitioners Healthy Kids Services 20 1689321754 0 Nurse Practitioners Nurse Practitioners Services 20 1689321754 0 Nurse Practitioners Physician Services 00 1689322281 0 BROW KATHERINE 2023346 9999999 B 10 1689322281 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1689322281 0 Physicians Anesthesia Services 20 1689322281 0 Physicians Healthy Kids Services 20 1689322281 0 Physicians Optical Supplies 20 1689322281 0 Physicians Physician Services 00 1689323586 0 RAVICHANDRAN NANDITHA 2023213 9999999 B 10 1689323586 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1689323586 0 Physicians Anesthesia Services 20 1689323586 0 Physicians Healthy Kids Services 20 1689323586 0 Physicians Optical Supplies 20 1689323586 0 Physicians Physician Services 00 1689323768 0 GRAD SARI MICHELLE 2022173 9999999 B 10 1689323768 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1689323768 0 Physicians Anesthesia Services 20 1689323768 0 Physicians Healthy Kids Services 20 1689323768 0 Physicians Optical Supplies 20 1689323768 0 Physicians Physician Services 20 1689323768 0 Physicians Physicians Psychiatric Services 00 1689324121 0 LEE JANE 2022176 9999999 B 10 1689324121 0 4698 DEPT CAROL STREAM IL 601224698 20 1689324121 0 Physicians Anesthesia Services 20 1689324121 0 Physicians Fluoride varnish 20 1689324121 0 Physicians Healthy Kids Services 20 1689324121 0 Physicians Optical Supplies 20 1689324121 0 Physicians Physician Services 00 1689324246 0 SCHORSCH CAITLIN 2023275 9999999 B 10 1689324246 0 PO BOX 3039 OAK BROOK IL 605223039 20 1689324246 0 Physicians Anesthesia Services 20 1689324246 0 Physicians Fluoride varnish 20 1689324246 0 Physicians Healthy Kids Services 20 1689324246 0 Physicians Optical Supplies 20 1689324246 0 Physicians Physician Services 00 1689324451 0 SINGH SOMI 2022179 9999999 B 10 1689324451 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1689324451 0 Physicians Anesthesia Services 20 1689324451 0 Physicians Fluoride varnish 20 1689324451 0 Physicians Healthy Kids Services 20 1689324451 0 Physicians Optical Supplies 20 1689324451 0 Physicians Physician Services 00 1689324469 0 ZALL EMILY 2022202 9999999 B 10 1689324469 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1689324469 0 Dentists Dental Services 20 1689324469 0 Dentists Physician Services 00 1689324972 0 PORADA KRISTINA M 2022210 9999999 B 10 1689324972 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1689324972 0 Physicians Anesthesia Services 20 1689324972 0 Physicians Healthy Kids Services 20 1689324972 0 Physicians Optical Supplies 20 1689324972 0 Physicians Physician Services 00 1689325250 0 FELESENA NICHOLAS D 2022069 9999999 B 10 1689325250 0 PO BOX 500 ELLICOTTVILLE NY 147310500 20 1689325250 0 Physician Assistant Only Fluoride varnish 20 1689325250 0 Physician Assistant Only Healthy Kids Services 20 1689325250 0 Physician Assistant Only Physician Services 00 1689325821 0 CURTIS TIMOTHY 2022011 9999999 B 10 1689325821 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1689325821 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1689326415 0 KAAG SADIE 2022196 9999999 B 10 1689326415 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1689326415 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1689326464 0 KESSLER LEXIE A 2023338 9999999 B 10 1689326464 0 4698 DEPT CAROL STREAM IL 601220021 20 1689326464 0 Physicians Anesthesia Services 20 1689326464 0 Physicians Healthy Kids Services 20 1689326464 0 Physicians Optical Supplies 20 1689326464 0 Physicians Physician Services 00 1689327736 0 MANLEY BROOKE L 2022343 9999999 B 10 1689327736 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1689327736 0 Physical Therapists Medical Supplies 20 1689327736 0 Physical Therapists Medical equipment/prosthetic devices 20 1689327736 0 Physical Therapists Physical Therapy Services 00 1689328627 0 ORTEGA BRENDA 2023124 9999999 B 10 1689328627 0 450 E 22ND ST STE 158 LOMBARD IL 601486175 20 1689328627 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1689329484 0 CACH GINA 2023177 9999999 B 10 1689329484 0 4698 DEPT CAROL STREAM IL 601220021 20 1689329484 0 Physicians Anesthesia Services 20 1689329484 0 Physicians Healthy Kids Services 20 1689329484 0 Physicians Optical Supplies 20 1689329484 0 Physicians Physician Services 00 1689329575 0 COHEN-HEATH CAREN 2022088 9999999 H 10 1689329575 0 801 N WALNUT ST CHAMPAIGN IL 618203055 20 1689329575 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1689332520 0 PATEL KRUPALI 2024190 9999999 B 10 1689332520 0 24014 W RENWICK RD PLAINFIELD IL 605448708 20 1689332520 0 Physical Therapists Medical Supplies 20 1689332520 0 Physical Therapists Medical equipment/prosthetic devices 20 1689332520 0 Physical Therapists Physical Therapy Services 00 1689334880 0 SPRECHER MEGAN 2022047 9999999 B 10 1689334880 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1689334880 0 Nurse Practitioners Healthy Kids Services 20 1689334880 0 Nurse Practitioners Nurse Practitioners Services 20 1689334880 0 Nurse Practitioners Physician Services 00 1689335556 0 MIKKELSEN HAILEE 2022005 9999999 B 10 1689335556 0 1969 W HART RD BELOIT WI 535112230 20 1689335556 0 Nurse Practitioners Fluoride varnish 20 1689335556 0 Nurse Practitioners Healthy Kids Services 20 1689335556 0 Nurse Practitioners Nurse Practitioners Services 20 1689335556 0 Nurse Practitioners Physician Services 00 1689337974 0 SANTOS AMANDA 2021364 9999999 B 10 1689337974 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1689337974 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1689338139 0 BEGAY SHANDIIN 2022032 9999999 B 10 1689338139 0 4326 W MONTROSE AVE CHICAGO IL 606412016 20 1689338139 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1689338808 0 SANDINE JULIE 2011103 9999999 B 10 1689338808 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1689338808 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1689341174 0 GARCES CHRISTINE 2021280 9999999 B 10 1689341174 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1689341174 0 Nurse Practitioners Fluoride varnish 20 1689341174 0 Nurse Practitioners Healthy Kids Services 20 1689341174 0 Nurse Practitioners Nurse Practitioners Services 20 1689341174 0 Nurse Practitioners Physician Services 00 1689342354 0 GECHEVA DESSISLAVA 2022258 9999999 B 10 1689342354 0 9518 FRANKLIN AVE FRANKLIN PARK IL 601312705 20 1689342354 0 Nurse Practitioners Fluoride varnish 20 1689342354 0 Nurse Practitioners Healthy Kids Services 20 1689342354 0 Nurse Practitioners Nurse Practitioners Services 20 1689342354 0 Nurse Practitioners Physician Services 00 1689343543 0 RUSSO KATE J 2021349 9999999 B 10 1689343543 0 PO BOX 3990 NAPERVILLE IL 605673990 20 1689343543 0 Speech Therapists Medical Supplies 20 1689343543 0 Speech Therapists Medical equipment/prosthetic devices 20 1689343543 0 Speech Therapists Speech Therapy/Pathology Services 00 1689345670 0 CETTA GINA M 2022171 9999999 B 10 1689345670 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1689345670 0 Nurse Practitioners Healthy Kids Services 20 1689345670 0 Nurse Practitioners Nurse Practitioners Services 20 1689345670 0 Nurse Practitioners Physician Services 00 1689345779 0 VAN WIE BRIAN 2022223 9999999 B 10 1689345779 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1689345779 0 Nurse Practitioners Healthy Kids Services 20 1689345779 0 Nurse Practitioners Nurse Practitioners Services 20 1689345779 0 Nurse Practitioners Physician Services 00 1689345985 0 CIHOCKI NICOLE 2021323 9999999 B 10 1689345985 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1689345985 0 Nurse Practitioners Fluoride varnish 20 1689345985 0 Nurse Practitioners Healthy Kids Services 20 1689345985 0 Nurse Practitioners Nurse Practitioners Services 20 1689345985 0 Nurse Practitioners Physician Services 00 1689348567 0 SCHULTZ BENJAMIN C 2021228 9999999 B 10 1689348567 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1689348567 0 Nurse Practitioners Healthy Kids Services 20 1689348567 0 Nurse Practitioners Nurse Practitioners Services 20 1689348567 0 Nurse Practitioners Physician Services 00 1689348633 0 ERNST SHONA 2022110 9999999 B 10 1689348633 0 PO BOX 4028 ROCK ISLAND IL 612044028 20 1689348633 0 Nurse Practitioners Fluoride varnish 20 1689348633 0 Nurse Practitioners Healthy Kids Services 20 1689348633 0 Nurse Practitioners Nurse Practitioners Services 20 1689348633 0 Nurse Practitioners Physician Services 00 1689348922 0 MCKINNEY SCOTT KATHLEEN 2021238 9999999 B 10 1689348922 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1689348922 0 Nurse Practitioners Healthy Kids Services 20 1689348922 0 Nurse Practitioners Nurse Practitioners Services 20 1689348922 0 Nurse Practitioners Physician Services 00 1689349409 0 KENNEDY ROXANNE 2021257 9999999 B 10 1689349409 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1689349409 0 Other behavior health professional LCPC/LMFT services 00 1689349888 0 ELFALLAH SHERIF 2021231 9999999 B 10 1689349888 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1689349888 0 Physicians Anesthesia Services 20 1689349888 0 Physicians Fluoride varnish 20 1689349888 0 Physicians Healthy Kids Services 20 1689349888 0 Physicians Optical Supplies 20 1689349888 0 Physicians Physician Services 00 1689350134 0 REILY ALISON 2023199 9999999 B 10 1689350134 0 29373 NETWORK PL CHICAGO IL 606733039 20 1689350134 0 Physical Therapists Medical Supplies 20 1689350134 0 Physical Therapists Medical equipment/prosthetic devices 20 1689350134 0 Physical Therapists Physical Therapy Services 00 1689350464 0 MEMON RAMIZ A 2023181 9999999 B 10 1689350464 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1689350464 0 Physicians Anesthesia Services 20 1689350464 0 Physicians Healthy Kids Services 20 1689350464 0 Physicians Optical Supplies 20 1689350464 0 Physicians Physician Services 00 1689350704 0 BURRIS AUDREY MARIE 2023296 9999999 B 10 1689350704 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1689350704 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1689351306 0 POLANCO PUMAROL DIEGO J 2023193 9999999 B 10 1689351306 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1689351306 0 Physicians Anesthesia Services 20 1689351306 0 Physicians Healthy Kids Services 20 1689351306 0 Physicians Optical Supplies 20 1689351306 0 Physicians Physician Services 00 1689352106 0 SAPKOTA ABHIN 2023235 9999999 B 10 1689352106 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1689352106 0 Physicians Anesthesia Services 20 1689352106 0 Physicians Fluoride varnish 20 1689352106 0 Physicians Healthy Kids Services 20 1689352106 0 Physicians Optical Supplies 20 1689352106 0 Physicians Physician Services 00 1689352239 0 QUANE BRIAN JOSEPH 2023188 9999999 B 10 1689352239 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1689352239 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1689352668 0 TURNER KIMBERLY 2023290 9999999 B 10 1689352668 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1689352668 0 Nurse Practitioners Healthy Kids Services 20 1689352668 0 Nurse Practitioners Nurse Practitioners Services 20 1689352668 0 Nurse Practitioners Physician Services 00 1689353005 0 PATEL RAHUL 2024121 9999999 B 10 1689353005 0 32705 COLLECTION CENTER DR CHICAGO IL 606930327 20 1689353005 0 Physical Therapists Medical Supplies 20 1689353005 0 Physical Therapists Medical equipment/prosthetic devices 20 1689353005 0 Physical Therapists Physical Therapy Services 00 1689355448 0 KIMCHI GIL 2023214 9999999 B 10 1689355448 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1689355448 0 Physicians Anesthesia Services 20 1689355448 0 Physicians Healthy Kids Services 20 1689355448 0 Physicians Optical Supplies 20 1689355448 0 Physicians Physician Services 00 1689356313 0 MCCURRY ANITRA 2024138 9999999 B 10 1689356313 0 400 N PINE ST MOMENCE IL 609541158 20 1689356313 0 Speech Therapists Speech Therapy/Pathology Services 00 1689356404 0 HIBBS ALISEA M 2024309 9999999 B 10 1689356404 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1689356404 0 Physician Assistant Only Fluoride varnish 20 1689356404 0 Physician Assistant Only Healthy Kids Services 20 1689356404 0 Physician Assistant Only Physician Services 00 1689356578 0 DUERINCK JESSICA R 2023214 9999999 B 10 1689356578 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1689356578 0 Audiologists Audiology Services 20 1689356578 0 Audiologists Medical Supplies 20 1689356578 0 Audiologists Medical equipment/prosthetic devices 00 1689357972 0 STARK YOCELYNG P 2023233 9999999 B 10 1689357972 0 620 E GARFIELD AVE DECATUR IL 625264550 20 1689357972 0 Speech Therapists Medical Supplies 20 1689357972 0 Speech Therapists Medical equipment/prosthetic devices 20 1689357972 0 Speech Therapists Speech Therapy/Pathology Services 00 1689359267 0 BUZZARD MACKENZIE C 2023244 9999999 B 10 1689359267 0 PO BOX 372 MATTOON IL 619380372 20 1689359267 0 Nurse Practitioners Fluoride varnish 20 1689359267 0 Nurse Practitioners Healthy Kids Services 20 1689359267 0 Nurse Practitioners Nurse Practitioners Services 20 1689359267 0 Nurse Practitioners Physician Services 00 1689359366 0 SCHMAUS JENNIFER A 2024271 9999999 B 10 1689359366 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1689359366 0 Psychologist Psychologist service 00 1689359465 0 XIONG JIA QI 2023200 9999999 B 10 1689359465 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1689359465 0 Physicians Anesthesia Services 20 1689359465 0 Physicians Fluoride varnish 20 1689359465 0 Physicians Healthy Kids Services 20 1689359465 0 Physicians Optical Supplies 20 1689359465 0 Physicians Physician Services 00 1689359671 0 ULLAND MARGARET C 2023191 9999999 B 10 1689359671 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1689359671 0 Physicians Anesthesia Services 20 1689359671 0 Physicians Fluoride varnish 20 1689359671 0 Physicians Healthy Kids Services 20 1689359671 0 Physicians Optical Supplies 20 1689359671 0 Physicians Physician Services 00 1689361735 0 WORDEKEMPER BRITTANY 2024184 9999999 B 10 1689361735 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1689361735 0 Physicians Anesthesia Services 20 1689361735 0 Physicians Healthy Kids Services 20 1689361735 0 Physicians Optical Supplies 20 1689361735 0 Physicians Physician Services 00 1689362253 0 CHEN MICHAEL Z 2023177 9999999 B 10 1689362253 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1689362253 0 Physicians Anesthesia Services 20 1689362253 0 Physicians Fluoride varnish 20 1689362253 0 Physicians Healthy Kids Services 20 1689362253 0 Physicians Optical Supplies 20 1689362253 0 Physicians Physician Services 00 1689362410 0 SHRAMEK CRYSTAL 2023137 9999999 B 10 1689362410 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1689362410 0 Nurse Practitioners Healthy Kids Services 20 1689362410 0 Nurse Practitioners Nurse Practitioners Services 20 1689362410 0 Nurse Practitioners Physician Services 00 1689363319 0 PANDYA SHAN A 2023187 9999999 B 10 1689363319 0 5145 N CALIFORNIA AVE CHICAGO IL 606253661 20 1689363319 0 Physicians Anesthesia Services 20 1689363319 0 Physicians Fluoride varnish 20 1689363319 0 Physicians Healthy Kids Services 20 1689363319 0 Physicians Optical Supplies 20 1689363319 0 Physicians Physician Services 00 1689363509 0 TIPSWORD KARA 2023212 9999999 B 10 1689363509 0 PO BOX 34156 BELFAST ME 049150619 20 1689363509 0 Nurse Practitioners Fluoride varnish 20 1689363509 0 Nurse Practitioners Healthy Kids Services 20 1689363509 0 Nurse Practitioners Nurse Practitioners Services 20 1689363509 0 Nurse Practitioners Physician Services 00 1689363921 0 DYCUS JENNILEE 2023128 9999999 B 10 1689363921 0 PO BOX 146 WATERLOO IL 622980146 20 1689363921 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1689364564 0 PONS TORRES MARIA DEL CARMEN 2023175 9999999 B 10 1689364564 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1689364564 0 Physicians Anesthesia Services 20 1689364564 0 Physicians Healthy Kids Services 20 1689364564 0 Physicians Optical Supplies 20 1689364564 0 Physicians Physician Services 00 1689365074 0 LAWSON-SEEBARAN IRIS 2023191 9999999 B 10 1689365074 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1689365074 0 Physicians Anesthesia Services 20 1689365074 0 Physicians Healthy Kids Services 20 1689365074 0 Physicians Optical Supplies 20 1689365074 0 Physicians Physician Services 00 1689365918 0 MEYER SYDNEY N 2023138 9999999 B 10 1689365918 0 1025 MAINE ST QUINCY IL 623014038 20 1689365918 0 Other behavior health professional LCPC/LMFT services 00 1689366049 0 KLONOSKI OLIVIA 2024205 9999999 B 10 1689366049 0 PO BOX 1109 DEKALB IL 601157109 20 1689366049 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1689368292 0 WILSON DARIA 2023171 9999999 B 10 1689368292 0 2001 BUTTERFIELD RD STE 1600 DOWNERS GROVE IL 605151211 20 1689368292 0 Physical Therapists Medical Supplies 20 1689368292 0 Physical Therapists Medical equipment/prosthetic devices 20 1689368292 0 Physical Therapists Physical Therapy Services 00 1689369555 0 HENDERSON CALEB G 2023298 9999999 B 10 1689369555 0 124 SW ADAMS ST PEORIA IL 616021308 20 1689369555 0 Physicians Anesthesia Services 20 1689369555 0 Physicians Healthy Kids Services 20 1689369555 0 Physicians Optical Supplies 20 1689369555 0 Physicians Physician Services 00 1689371445 0 ASKAR HOLLY 2023173 9999999 B 10 1689371445 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1689371445 0 Nurse Practitioners Fluoride varnish 20 1689371445 0 Nurse Practitioners Healthy Kids Services 20 1689371445 0 Nurse Practitioners Nurse Practitioners Services 20 1689371445 0 Nurse Practitioners Physician Services 00 1689371700 0 MOSES MORGAN 2023200 9999999 B 10 1689371700 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1689371700 0 Physicians Anesthesia Services 20 1689371700 0 Physicians Healthy Kids Services 20 1689371700 0 Physicians Optical Supplies 20 1689371700 0 Physicians Physician Services 00 1689372211 0 BARNES KELLY A 2023055 9999999 B 10 1689372211 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1689372211 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1689372765 0 ZINK NATALIE 2024178 9999999 B 10 1689372765 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1689372765 0 Physicians Anesthesia Services 20 1689372765 0 Physicians Healthy Kids Services 20 1689372765 0 Physicians Optical Supplies 20 1689372765 0 Physicians Physician Services 00 1689373763 0 LOTTMANN JOSHUA 2024229 9999999 B 10 1689373763 0 901 E 5TH ST WASHINGTON MO 630903127 20 1689373763 0 Physician Assistant Only Fluoride varnish 20 1689373763 0 Physician Assistant Only Healthy Kids Services 20 1689373763 0 Physician Assistant Only Physician Services 00 1689374076 0 GUTIERREZ JORGE A 2024176 9999999 B 10 1689374076 0 4698 DEPT CAROL STREAM IL 601220021 20 1689374076 0 Physicians Anesthesia Services 20 1689374076 0 Physicians Healthy Kids Services 20 1689374076 0 Physicians Optical Supplies 20 1689374076 0 Physicians Physician Services 00 1689374506 0 ZASADA JESSICA M 2023087 9999999 B 10 1689374506 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1689374506 0 Physician Assistant Only Fluoride varnish 20 1689374506 0 Physician Assistant Only Healthy Kids Services 20 1689374506 0 Physician Assistant Only Physician Services 00 1689374894 0 TERIAN EMILY 2024188 9999999 B 10 1689374894 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1689374894 0 Physicians Anesthesia Services 20 1689374894 0 Physicians Healthy Kids Services 20 1689374894 0 Physicians Optical Supplies 20 1689374894 0 Physicians Physician Services 00 1689375198 0 MYERS EMILY E 2023088 9999999 B 10 1689375198 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1689375198 0 Nurse Practitioners Healthy Kids Services 20 1689375198 0 Nurse Practitioners Nurse Practitioners Services 20 1689375198 0 Nurse Practitioners Physician Services 00 1689375289 0 JOSHI CHITANG 2023264 9999999 B 10 1689375289 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1689375289 0 Physicians Anesthesia Services 20 1689375289 0 Physicians Healthy Kids Services 20 1689375289 0 Physicians Optical Supplies 20 1689375289 0 Physicians Physician Services 00 1689375628 0 MANGAT JASKARAN 2024157 9999999 B 10 1689375628 0 PO BOX 3039 OAK BROOK IL 605223039 20 1689375628 0 Physicians Anesthesia Services 20 1689375628 0 Physicians Healthy Kids Services 20 1689375628 0 Physicians Optical Supplies 20 1689375628 0 Physicians Physician Services 00 1689376345 0 ZIEMER TREVAR K 2023145 9999999 B 10 1689376345 0 4698 DEPT CAROL STREAM IL 601220021 20 1689376345 0 Physicians Anesthesia Services 20 1689376345 0 Physicians Healthy Kids Services 20 1689376345 0 Physicians Optical Supplies 20 1689376345 0 Physicians Physician Services 20 1689376345 0 Physicians Physicians Psychiatric Services 00 1689376618 0 GANGADHAR MEGHA K 2023177 9999999 B 10 1689376618 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1689376618 0 Physicians Anesthesia Services 20 1689376618 0 Physicians Fluoride varnish 20 1689376618 0 Physicians Healthy Kids Services 20 1689376618 0 Physicians Optical Supplies 20 1689376618 0 Physicians Physician Services 00 1689376857 0 WINFREY SARA ROSE 2023209 9999999 B 10 1689376857 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1689376857 0 Physicians Anesthesia Services 20 1689376857 0 Physicians Healthy Kids Services 20 1689376857 0 Physicians Optical Supplies 20 1689376857 0 Physicians Physician Services 00 1689376972 0 ROBERTSON PEYTON 2023200 9999999 B 10 1689376972 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1689376972 0 Physicians Anesthesia Services 20 1689376972 0 Physicians Healthy Kids Services 20 1689376972 0 Physicians Optical Supplies 20 1689376972 0 Physicians Physician Services 20 1689376972 0 Physicians Physicians Psychiatric Services 00 1689377319 0 GUZMAN LARA 2023178 9999999 B 10 1689377319 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1689377319 0 Dentists Dental Services 20 1689377319 0 Dentists Physician Services 00 1689377889 0 CARLSON BRADLEY 2023351 9999999 B 10 1689377889 0 4698 DEPT CAROL STREAM IL 601220021 20 1689377889 0 Physicians Anesthesia Services 20 1689377889 0 Physicians Healthy Kids Services 20 1689377889 0 Physicians Optical Supplies 20 1689377889 0 Physicians Physician Services 00 1689378408 0 RAMSAROOP TAYLOR 2023224 2026181 B 10 1689378408 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1689378408 0 Physicians Anesthesia Services 20 1689378408 0 Physicians Fluoride varnish 20 1689378408 0 Physicians Healthy Kids Services 20 1689378408 0 Physicians Optical Supplies 20 1689378408 0 Physicians Physician Services 00 1689378556 0 RASHID SAAD 2023182 9999999 B 10 1689378556 0 4701 DEPT CAROL STREAM IL 601220021 20 1689378556 0 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Physicians Anesthesia Services 20 1689379778 0 Physicians Fluoride varnish 20 1689379778 0 Physicians Healthy Kids Services 20 1689379778 0 Physicians Optical Supplies 20 1689379778 0 Physicians Physician Services 00 1689379943 0 ELLIOTT JACOB J 2023178 9999999 B 10 1689379943 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1689379943 0 Physicians Anesthesia Services 20 1689379943 0 Physicians Fluoride varnish 20 1689379943 0 Physicians Healthy Kids Services 20 1689379943 0 Physicians Optical Supplies 20 1689379943 0 Physicians Physician Services 00 1689380933 0 STUBE ALYSSA 2023136 9999999 B 10 1689380933 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1689380933 0 Occupational Therapists Medical Supplies 20 1689380933 0 Occupational Therapists Medical equipment/prosthetic devices 20 1689380933 0 Occupational Therapists Occupational Therapy Services 00 1689381618 0 MCCARTHY COLIN 2023102 9999999 B 10 1689381618 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1689381618 0 Physical 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20 1689385700 0 Physical Therapists Medical equipment/prosthetic devices 20 1689385700 0 Physical Therapists Physical Therapy Services 00 1689387094 0 BRODZIK CHRISTINA E 2023032 9999999 B 10 1689387094 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1689387094 0 Nurse Practitioners Anesthesia Services 20 1689387094 0 Nurse Practitioners Nurse Practitioners Services 20 1689387094 0 Nurse Practitioners Physician Services 00 1689388092 0 WRAGE SHANNON 2023017 9999999 B 10 1689388092 0 507 E ARMSTRONG AVE PEORIA IL 616033201 20 1689388092 0 Speech Therapists Medical Supplies 20 1689388092 0 Speech Therapists Medical equipment/prosthetic devices 20 1689388092 0 Speech Therapists Speech Therapy/Pathology Services 00 1689388175 0 COSMAS PAIGE N 2023011 9999999 B 10 1689388175 0 6810 STATE ROUTE 162 STE 215 MARYVILLE IL 620628566 20 1689388175 0 Nurse Practitioners Fluoride varnish 20 1689388175 0 Nurse Practitioners Healthy Kids Services 20 1689388175 0 Nurse Practitioners Nurse Practitioners Services 20 1689388175 0 Nurse Practitioners Physician Services 00 1689388670 0 MARTIN JAMES R 2023017 9999999 B 10 1689388670 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1689388670 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1689389629 0 ADEYEMI OMOLOLA 2023207 9999999 B 10 1689389629 0 1 TIFFANY PT STE 110 BLOOMINGDALE IL 601082915 20 1689389629 0 Nurse Practitioners Healthy Kids Services 20 1689389629 0 Nurse Practitioners Nurse Practitioners Services 20 1689389629 0 Nurse Practitioners Physician Services 00 1689390957 0 BANCROFT STEPHEN K 2023034 9999999 B 10 1689390957 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1689390957 0 Physician Assistant Only Fluoride varnish 20 1689390957 0 Physician Assistant Only Healthy Kids Services 20 1689390957 0 Physician Assistant Only Physician Services 00 1689391039 0 GIANNESE AGATHA L 2024240 9999999 B 10 1689391039 0 4700 EXCHANGE CT STE 110 BOCA RATON FL 334314450 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Practitioners Fluoride varnish 20 1689393233 0 Nurse Practitioners Healthy Kids Services 20 1689393233 0 Nurse Practitioners Nurse Practitioners Services 20 1689393233 0 Nurse Practitioners Physician Services 00 1689393506 0 FLYNN KATHERINE 2022322 9999999 B 10 1689393506 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1689393506 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1689393522 0 WERRIES TAYLOR 2022270 9999999 B 10 1689393522 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1689393522 0 Nurse Practitioners Healthy Kids Services 20 1689393522 0 Nurse Practitioners Nurse Practitioners Services 20 1689393522 0 Nurse Practitioners Physician Services 00 1689396483 0 HUFF QUINCY E 2023213 9999999 B 10 1689396483 0 PO BOX 871 SALEM IL 628810871 20 1689396483 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1689398521 0 KAUCHAK SAMANTHA R 2022346 9999999 B 10 1689398521 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1689398521 0 Nurse Practitioners Fluoride varnish 20 1689398521 0 Nurse Practitioners Healthy Kids Services 20 1689398521 0 Nurse Practitioners Nurse Practitioners Services 20 1689398521 0 Nurse Practitioners Physician Services 00 1689403479 0 MCGUIRE NICOLLE 2024302 9999999 B 10 1689403479 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1689403479 0 Physician Assistant Only Fluoride varnish 20 1689403479 0 Physician Assistant Only Healthy Kids Services 20 1689403479 0 Physician Assistant Only Physician Services 00 1689404691 0 WILEY MICAH 2024263 9999999 B 10 1689404691 0 12 W HARRISON ST SULLIVAN IL 619511907 20 1689404691 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1689406001 0 STANTON AMANDA K 2024243 9999999 B 10 1689406001 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1689406001 0 Nurse Practitioners Healthy Kids Services 20 1689406001 0 Nurse Practitioners Nurse Practitioners Services 20 1689406001 0 Nurse Practitioners Physician Services 00 1689409948 0 ODGERS KATE 2024304 9999999 B 10 1689409948 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1689409948 0 Physician Assistant Only Fluoride varnish 20 1689409948 0 Physician Assistant Only Healthy Kids Services 20 1689409948 0 Physician Assistant Only Physician Services 00 1689410581 0 MERENDINO KATHERINE 2024284 9999999 B 10 1689410581 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1689410581 0 Nurse Practitioners Healthy Kids Services 20 1689410581 0 Nurse Practitioners Nurse Practitioners Services 20 1689410581 0 Nurse Practitioners Physician Services 00 1689410748 0 FREY MICHAELA 2024194 9999999 B 10 1689410748 0 PO BOX 372 MATTOON IL 619380372 20 1689410748 0 Nurse Practitioners Fluoride varnish 20 1689410748 0 Nurse Practitioners Healthy Kids Services 20 1689410748 0 Nurse Practitioners Nurse Practitioners Services 20 1689410748 0 Nurse Practitioners Physician Services 00 1689410912 0 MATHEWS FRANCES 2024187 9999999 B 10 1689410912 0 2038 221ST ST SAUK VILLAGE IL 604115064 20 1689410912 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1689411548 0 O'NEIL JENNIFER N 2024321 9999999 B 10 1689411548 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1689411548 0 Nurse Practitioners Fluoride varnish 20 1689411548 0 Nurse Practitioners Healthy Kids Services 20 1689411548 0 Nurse Practitioners Nurse Practitioners Services 20 1689411548 0 Nurse Practitioners Physician Services 00 1689411993 0 KUMAR NAINIKA 2024274 9999999 B 10 1689411993 0 5777 DEPT CAROL STREAM IL 601220021 20 1689411993 0 Physician Assistant Only Fluoride varnish 20 1689411993 0 Physician Assistant Only Healthy Kids Services 20 1689411993 0 Physician Assistant Only Physician Services 00 1689412991 0 ROBINSON VITA L 2025042 9999999 B 10 1689412991 0 1899 VILLAGE CENTER PKWY UNIT MONTGOMERY IL 605383806 20 1689412991 0 Clinical Social Worker Social work service 00 1689415051 0 MA EMILY 2024177 9999999 B 10 1689415051 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1689415051 0 Physicians Anesthesia Services 20 1689415051 0 Physicians Healthy Kids Services 20 1689415051 0 Physicians Optical Supplies 20 1689415051 0 Physicians Physician Services 00 1689415812 0 HUNTER RYLEE 2024236 9999999 B 10 1689415812 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1689415812 0 Nurse Practitioners Healthy Kids Services 20 1689415812 0 Nurse Practitioners Nurse Practitioners Services 20 1689415812 0 Nurse Practitioners Physician Services 00 1689416323 0 JARROUJ GEORGE 2024169 9999999 B 10 1689416323 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1689416323 0 Physicians Anesthesia Services 20 1689416323 0 Physicians Healthy Kids Services 20 1689416323 0 Physicians Optical Supplies 20 1689416323 0 Physicians Physician Services 00 1689417917 0 NGO ISAAC J 2024193 9999999 B 10 1689417917 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1689417917 0 Physicians Anesthesia Services 20 1689417917 0 Physicians Fluoride varnish 20 1689417917 0 Physicians Healthy Kids Services 20 1689417917 0 Physicians Optical Supplies 20 1689417917 0 Physicians Physician Services 00 1689417974 0 YANG KAROLIINA X 2024167 9999999 B 10 1689417974 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1689417974 0 Physicians Anesthesia Services 20 1689417974 0 Physicians Fluoride varnish 20 1689417974 0 Physicians Healthy Kids Services 20 1689417974 0 Physicians Optical Supplies 20 1689417974 0 Physicians Physician Services 00 1689420135 0 MILHAN AHAMED 2024183 9999999 B 10 1689420135 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1689420135 0 Physicians Anesthesia Services 20 1689420135 0 Physicians Fluoride varnish 20 1689420135 0 Physicians Healthy Kids Services 20 1689420135 0 Physicians Optical Supplies 20 1689420135 0 Physicians Physician Services 00 1689423188 0 MOELLER MAGGIE E 2024165 9999999 B 10 1689423188 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1689423188 0 Occupational Therapists Medical Supplies 20 1689423188 0 Occupational Therapists Medical equipment/prosthetic devices 20 1689423188 0 Occupational Therapists Occupational Therapy Services 00 1689423923 0 MEJIA ARCE CARLOS 2024199 9999999 B 10 1689423923 0 1 MEMORIAL DR ALTON IL 620026722 20 1689423923 0 Physicians Anesthesia Services 20 1689423923 0 Physicians Fluoride varnish 20 1689423923 0 Physicians Healthy Kids Services 20 1689423923 0 Physicians Optical Supplies 20 1689423923 0 Physicians Physician Services 00 1689424368 0 CHIU ANDREW 2024185 9999999 B 10 1689424368 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1689424368 0 Physicians Anesthesia Services 20 1689424368 0 Physicians Healthy Kids Services 20 1689424368 0 Physicians Optical Supplies 20 1689424368 0 Physicians Physician Services 00 1689425167 0 ELKINS ISAAC S 2024238 9999999 B 10 1689425167 0 124 SW ADAMS ST PEORIA IL 616021308 20 1689425167 0 Physicians Anesthesia Services 20 1689425167 0 Physicians Fluoride varnish 20 1689425167 0 Physicians Healthy Kids Services 20 1689425167 0 Physicians Optical Supplies 20 1689425167 0 Physicians Physician Services 00 1689426769 0 TURNER LUCAS 2024183 9999999 B 10 1689426769 0 PO BOX 3039 OAK BROOK IL 605223039 20 1689426769 0 Physicians Anesthesia Services 20 1689426769 0 Physicians Healthy Kids Services 20 1689426769 0 Physicians Optical Supplies 20 1689426769 0 Physicians Physician Services 00 1689426843 0 BESHERS CAROLINE 2024184 9999999 B 10 1689426843 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1689426843 0 Physicians Anesthesia Services 20 1689426843 0 Physicians Fluoride varnish 20 1689426843 0 Physicians Healthy Kids Services 20 1689426843 0 Physicians Optical Supplies 20 1689426843 0 Physicians Physician Services 00 1689427999 0 BUCHBERGER LAUREN 2024243 9999999 B 10 1689427999 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1689427999 0 Nurse Practitioners Fluoride varnish 20 1689427999 0 Nurse Practitioners Healthy Kids Services 20 1689427999 0 Nurse Practitioners Nurse Practitioners Services 20 1689427999 0 Nurse Practitioners Physician Services 00 1689428229 0 ARNOLD LIAM 2024254 9999999 B 10 1689428229 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1689428229 0 Physicians Anesthesia Services 20 1689428229 0 Physicians Fluoride varnish 20 1689428229 0 Physicians Healthy Kids Services 20 1689428229 0 Physicians Optical Supplies 20 1689428229 0 Physicians Physician Services 00 1689428294 0 LEMONS MACKENZIE 2024222 9999999 B 10 1689428294 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1689428294 0 Nurse Practitioners Healthy Kids Services 20 1689428294 0 Nurse Practitioners Nurse Practitioners Services 20 1689428294 0 Nurse Practitioners Physician Services 00 1689429086 0 BEETZ BAILEY A 2024239 9999999 B 10 1689429086 0 124 SW ADAMS ST PEORIA IL 616021308 20 1689429086 0 Physicians Anesthesia Services 20 1689429086 0 Physicians Fluoride varnish 20 1689429086 0 Physicians Healthy Kids Services 20 1689429086 0 Physicians Optical Supplies 20 1689429086 0 Physicians Physician Services 00 1689429136 0 FLOWERS ERIC 2024117 9999999 B 10 1689429136 0 PO BOX 775253 CHICAGO IL 606775253 20 1689429136 0 Nurse Practitioners Healthy Kids Services 20 1689429136 0 Nurse Practitioners Nurse Practitioners Services 20 1689429136 0 Nurse Practitioners Physician Services 00 1689429813 0 CHIANG TAYLOR 2024194 9999999 B 10 1689429813 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1689429813 0 Physicians Anesthesia Services 20 1689429813 0 Physicians Healthy Kids Services 20 1689429813 0 Physicians Optical Supplies 20 1689429813 0 Physicians Physician Services 00 1689431199 0 BLACK EMERSON 2024240 9999999 B 10 1689431199 0 1951 NW 7TH AVE STE 300 MIAMI FL 331361112 20 1689431199 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1689432783 0 MERSBERGER TESSA 2024114 9999999 B 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1689455024 0 Nurse Practitioners Healthy Kids Services 20 1689455024 0 Nurse Practitioners Nurse Practitioners Services 20 1689455024 0 Nurse Practitioners Physician Services 00 1689457673 0 JONES COURTNEY N 2024281 9999999 B 10 1689457673 0 2901 FINLEY RD STE 102 DOWNERS GROVE IL 605151774 20 1689457673 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1689457855 0 ROCHON NATASHA 2023277 9999999 B 10 1689457855 0 P O BOX 771858 CHICAGO IL 606770001 20 1689457855 0 Nurse Practitioners Healthy Kids Services 20 1689457855 0 Nurse Practitioners Nurse Practitioners Services 20 1689457855 0 Nurse Practitioners Physician Services 00 1689458572 0 DUNCAN ZACHARY 2023268 9999999 B 10 1689458572 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1689458572 0 Physician Assistant Only Fluoride varnish 20 1689458572 0 Physician Assistant Only Healthy Kids Services 20 1689458572 0 Physician Assistant Only Physician Services 00 1689481541 0 BHATTI RIJA TARIQ 2025024 9999999 B 10 1689481541 0 1730 PARK ST STE 106 NAPERVILLE IL 605632609 20 1689481541 0 Dentists Dental Services 20 1689481541 0 Dentists Physician Services 00 1689492233 0 SWANSTROM ADALEE M 2024353 9999999 B 10 1689492233 0 1201 N SHERIDAN RD WAUKEGAN IL 600852081 20 1689492233 0 Speech Therapists Medical Supplies 20 1689492233 0 Speech Therapists Medical equipment/prosthetic devices 20 1689492233 0 Speech Therapists Speech Therapy/Pathology Services 00 1689494700 0 HARRIS JARED S 2024312 9999999 B 10 1689494700 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1689494700 0 Nurse Practitioners Fluoride varnish 20 1689494700 0 Nurse Practitioners Healthy Kids Services 20 1689494700 0 Nurse Practitioners Nurse Practitioners Services 20 1689494700 0 Nurse Practitioners Physician Services 00 1689494957 0 KUHLMAN ELEANOR 2024339 9999999 B 10 1689494957 0 PO BOX 3988 CARBONDALE IL 629023988 20 1689494957 0 Physician Assistant Only Fluoride varnish 20 1689494957 0 Physician Assistant Only Healthy Kids Services 20 1689494957 0 Physician Assistant Only Physician Services 00 1689495046 0 SEO JI YOUNG 2024309 9999999 B 10 1689495046 0 PO BOX 5588 BELFAST ME 049155500 20 1689495046 0 Nurse Practitioners Healthy Kids Services 20 1689495046 0 Nurse Practitioners Nurse Practitioners Services 20 1689495046 0 Nurse Practitioners Physician Services 00 1689496655 0 FERNQUIST DAVID 2025009 9999999 B 10 1689496655 0 8170 MCCORMICK BLVD STE 112 SKOKIE IL 600762914 20 1689496655 0 Occupational Therapists Medical Supplies 20 1689496655 0 Occupational Therapists Medical equipment/prosthetic devices 20 1689496655 0 Occupational Therapists Occupational Therapy Services 00 1689600017 0 TEHENG RAYMUNDO J 2024253 9999999 B 10 1689600017 0 1025 MAINE ST QUINCY IL 623014038 20 1689600017 0 Nurse Practitioners Anesthesia Services 20 1689600017 0 Nurse Practitioners Nurse Practitioners Services 20 1689600017 0 Nurse Practitioners Physician Services 00 1689600611 0 LESS MICHAEL A 1987132 9999999 B 10 1689600611 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1689600611 0 Physicians Anesthesia Services 20 1689600611 0 Physicians Healthy Kids Services 20 1689600611 0 Physicians Optical Supplies 20 1689600611 0 Physicians Physician Services 00 1689600835 0 DUDAR IRINA 2006091 9999999 B 10 1689600835 0 4433 W TOUHY AVE STE 235 LINCOLNWOOD IL 607121830 20 1689600835 0 Physicians Anesthesia Services 20 1689600835 0 Physicians Healthy Kids Services 20 1689600835 0 Physicians Optical Supplies 20 1689600835 0 Physicians Physician Services 00 1689601502 0 RETHY MICHAEL C 2013060 9999999 B 10 1689601502 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1689601502 0 Physicians Anesthesia Services 20 1689601502 0 Physicians Healthy Kids Services 20 1689601502 0 Physicians Optical Supplies 20 1689601502 0 Physicians Physician Services 00 1689602005 0 WINTER JENNIFER 2007258 9999999 B 10 1689602005 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1689602005 0 Nurse Practitioners Healthy Kids Services 20 1689602005 0 Nurse Practitioners Nurse Practitioners Services 20 1689602005 0 Nurse Practitioners Physician Services 00 1689602146 0 SHOWEL JOHN 1981227 9999999 B 10 1689602146 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1689602146 0 Physicians Anesthesia Services 20 1689602146 0 Physicians Fluoride varnish 20 1689602146 0 Physicians Healthy Kids Services 20 1689602146 0 Physicians Optical Supplies 20 1689602146 0 Physicians Physician Services 00 1689602468 0 CLARK FRANCES 2017143 9999999 B 10 1689602468 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1689602468 0 Nurse Practitioners Fluoride varnish 20 1689602468 0 Nurse Practitioners Healthy Kids Services 20 1689602468 0 Nurse Practitioners Nurse Practitioners Services 20 1689602468 0 Nurse Practitioners Physician Services 00 1689602781 0 FERGUSON JULIE R 2006259 9999999 B 10 1689602781 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1689602781 0 Physicians Anesthesia Services 20 1689602781 0 Physicians Fluoride varnish 20 1689602781 0 Physicians Healthy Kids Services 20 1689602781 0 Physicians Optical Supplies 20 1689602781 0 Physicians Physician Services 00 1689603268 0 ALEPPO GRAZIA 2002006 9999999 B 10 1689603268 0 5777 DEPT CAROL STREAM IL 601220021 20 1689603268 0 Physicians Anesthesia Services 20 1689603268 0 Physicians Fluoride varnish 20 1689603268 0 Physicians Healthy Kids Services 20 1689603268 0 Physicians Optical Supplies 20 1689603268 0 Physicians Physician Services 00 1689603276 0 TRUWIT CHARLES 2016278 9999999 B 10 1689603276 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1689603276 0 Physicians Anesthesia Services 20 1689603276 0 Physicians Healthy Kids Services 20 1689603276 0 Physicians Optical Supplies 20 1689603276 0 Physicians Physician Services 00 1689604100 0 HAQUE MOHAMMED 2002308 9999999 B 10 1689604100 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1689604100 0 Physicians Anesthesia Services 20 1689604100 0 Physicians Healthy Kids Services 20 1689604100 0 Physicians Optical Supplies 20 1689604100 0 Physicians Physician Services 00 1689605594 0 GARCIA FRANCISCO 2020125 9999999 B 10 1689605594 0 PO BOX 43230 PHOENIX AZ 850803230 20 1689605594 0 Physicians Anesthesia Services 20 1689605594 0 Physicians Healthy Kids Services 20 1689605594 0 Physicians Optical Supplies 20 1689605594 0 Physicians Physician Services 00 1689606972 0 LEVINE MATTHEW R 2001182 9999999 B 10 1689606972 0 5777 DEPT CAROL STREAM IL 601220021 20 1689606972 0 Physicians Anesthesia Services 20 1689606972 0 Physicians Healthy Kids Services 20 1689606972 0 Physicians Optical Supplies 20 1689606972 0 Physicians Physician Services 00 1689607152 0 SHEVRIN DANIEL H 1984107 9999999 B 10 1689607152 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1689607152 0 Physicians Anesthesia Services 20 1689607152 0 Physicians Fluoride varnish 20 1689607152 0 Physicians Healthy Kids Services 20 1689607152 0 Physicians Optical Supplies 20 1689607152 0 Physicians Physician Services 00 1689607277 0 LIFITS-PODOROZHANSKY YULIA 2006213 9999999 B 10 1689607277 0 300 WINDING WOODS DR STE 200 O FALLON MO 633665081 20 1689607277 0 Physicians Anesthesia Services 20 1689607277 0 Physicians Healthy Kids Services 20 1689607277 0 Physicians Optical Supplies 20 1689607277 0 Physicians Physician Services 00 1689607731 0 SOPER MARILYN C 1994259 9999999 B 10 1689607731 0 5N341 MARTINGALE DR BARTLETT IL 601033019 20 1689607731 0 Physical Therapists Medical Supplies 20 1689607731 0 Physical Therapists Medical equipment/prosthetic devices 20 1689607731 0 Physical Therapists Physical Therapy Services 00 1689608713 0 ALEXIS JOHN 1998060 9999999 B 10 1689608713 0 PO BOX 85297 CHICAGO IL 606895297 20 1689608713 0 Physicians Anesthesia Services 20 1689608713 0 Physicians Fluoride varnish 20 1689608713 0 Physicians Healthy Kids Services 20 1689608713 0 Physicians Optical Supplies 20 1689608713 0 Physicians Physician Services 00 1689609794 0 SORRELL CATHERINE D 2005182 9999999 B 10 1689609794 0 111 OAKWOOD RD EAST PEORIA IL 616111853 20 1689609794 0 Physicians Anesthesia Services 20 1689609794 0 Physicians Healthy Kids Services 20 1689609794 0 Physicians Optical Supplies 20 1689609794 0 Physicians Physician Services 00 1689611345 0 ZINK JEFFREY 2012245 9999999 B 10 1689611345 0 1945 CEI DR BLUE ASH OH 452425664 20 1689611345 0 Physicians Anesthesia Services 20 1689611345 0 Physicians Healthy Kids Services 20 1689611345 0 Physicians Optical Supplies 20 1689611345 0 Physicians Physician Services 00 1689611840 0 ANDRUS CHARLES 1986182 9999999 B 10 1689611840 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1689611840 0 Physicians Anesthesia Services 20 1689611840 0 Physicians Healthy Kids Services 20 1689611840 0 Physicians Optical Supplies 20 1689611840 0 Physicians Physician Services 00 1689611865 0 BUCHANAN DAVID A 1997274 9999999 B 10 1689611865 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1689611865 0 Physicians Anesthesia Services 20 1689611865 0 Physicians Fluoride varnish 20 1689611865 0 Physicians Healthy Kids Services 20 1689611865 0 Physicians Optical Supplies 20 1689611865 0 Physicians Physician Services 00 1689612004 0 BURROWS NICOLE E 2015266 9999999 B 10 1689612004 0 62647 COLLECTION CENTER DR CHICAGO IL 606930626 20 1689612004 0 Physician Assistant Only Fluoride varnish 20 1689612004 0 Physician Assistant Only Healthy Kids Services 20 1689612004 0 Physician Assistant Only Physician Services 00 1689612434 0 HUTCHINSON KURT 2002001 9999999 B 10 1689612434 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1689612434 0 Physical Therapists Medical Supplies 20 1689612434 0 Physical Therapists Medical equipment/prosthetic devices 20 1689612434 0 Physical Therapists Physical Therapy Services 00 1689612459 0 LICHT SHERRY 1992013 9999999 B 10 1689612459 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1689612459 0 Physicians Anesthesia Services 20 1689612459 0 Physicians Healthy Kids Services 20 1689612459 0 Physicians Optical Supplies 20 1689612459 0 Physicians Physician Services 00 1689612608 0 STRYCZEK SONYA R 2016043 9999999 B 10 1689612608 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1689612608 0 Physician Assistant Only Fluoride varnish 20 1689612608 0 Physician Assistant Only Healthy Kids Services 20 1689612608 0 Physician Assistant Only Physician Services 00 1689613150 0 WARD MARGARET 2000214 9999999 B 10 1689613150 0 201 E OGDEN AVE STE 220 HINSDALE IL 605213661 20 1689613150 0 Physicians Anesthesia Services 20 1689613150 0 Physicians Healthy Kids Services 20 1689613150 0 Physicians Optical Supplies 20 1689613150 0 Physicians Physician Services 20 1689613150 0 Physicians Physicians Psychiatric Services 00 1689614794 0 LOCKMAN STEVEN 2016122 9999999 B 10 1689614794 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1689614794 0 Physicians Anesthesia Services 20 1689614794 0 Physicians Healthy Kids Services 20 1689614794 0 Physicians Optical Supplies 20 1689614794 0 Physicians Physician Services 00 1689614828 0 HUDSON HILTON M 1994213 9999999 B 10 1689614828 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1689614828 0 Physicians Anesthesia Services 20 1689614828 0 Physicians Healthy Kids Services 20 1689614828 0 Physicians Optical Supplies 20 1689614828 0 Physicians Physician Services 00 1689614851 0 CHAN MICHAEL 2022332 9999999 B 10 1689614851 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1689614851 0 Physicians Anesthesia Services 20 1689614851 0 Physicians Healthy Kids Services 20 1689614851 0 Physicians Optical Supplies 20 1689614851 0 Physicians Physician Services 20 1689614851 0 Physicians Physicians Psychiatric Services 00 1689615163 0 HALPERIN THOMAS 1981258 9999999 B 10 1689615163 0 221 NE GLEN OAK AVE ATTN: STEPHEN CIRONE GOMP 100 PEORIA IL 616360001 20 1689615163 0 Physicians Anesthesia Services 20 1689615163 0 Physicians Fluoride varnish 20 1689615163 0 Physicians Healthy Kids Services 20 1689615163 0 Physicians Optical Supplies 20 1689615163 0 Physicians Physician Services 00 1689615585 0 DEL RIOS MARINA 2008183 9999999 B 10 1689615585 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1689615585 0 Physicians Anesthesia Services 20 1689615585 0 Physicians Healthy Kids Services 20 1689615585 0 Physicians Optical Supplies 20 1689615585 0 Physicians Physician Services 00 1689615767 0 SHERRICK ANDREW 1995191 9999999 B 10 1689615767 0 1000 N ALLEN ST ROBINSON IL 624541114 20 1689615767 0 Physicians Anesthesia Services 20 1689615767 0 Physicians Healthy Kids Services 20 1689615767 0 Physicians Optical Supplies 20 1689615767 0 Physicians Physician Services 00 1689616195 0 WILCOXON CYNTHIA B 2000045 9999999 B 10 1689616195 0 21052 CLAYPOOL ST GREENVIEW IL 626429687 20 1689616195 0 Speech Therapists Medical Supplies 20 1689616195 0 Speech Therapists Medical equipment/prosthetic devices 20 1689616195 0 Speech Therapists Speech Therapy/Pathology Services 00 1689616302 0 RIESENBERGER TIMOTHY 2021103 9999999 B 10 1689616302 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1689616302 0 Physicians Anesthesia Services 20 1689616302 0 Physicians Healthy Kids Services 20 1689616302 0 Physicians Optical Supplies 20 1689616302 0 Physicians Physician Services 00 1689616815 0 FLEISCHLI JOHN G 1997121 9999999 B 10 1689616815 0 3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047452 20 1689616815 0 Podiatrists Podiatric Services 00 1689617375 0 HYDERI ATHA 2004239 9999999 B 10 1689617375 0 27W185 GENEVA RD WINFIELD IL 601902058 20 1689617375 0 Optometrists Optical Supplies 20 1689617375 0 Optometrists Optometric Services 20 1689617375 0 Optometrists Physician Services 00 1689617508 0 WILLIAMS BRUCE E 2014113 9999999 B 10 1689617508 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1689617508 0 Podiatrists Podiatric Services 00 1689617706 0 SCHEMMEL JAMES C 2016233 9999999 B 10 1689617706 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1689617706 0 Physicians Anesthesia Services 20 1689617706 0 Physicians Healthy Kids Services 20 1689617706 0 Physicians Optical Supplies 20 1689617706 0 Physicians Physician Services 00 1689618076 0 LACOSTE ROBERT 2022045 9999999 B 10 1689618076 0 39465 W 14 MILE RD NOVI MI 483771600 20 1689618076 0 Physicians Anesthesia Services 20 1689618076 0 Physicians Healthy Kids Services 20 1689618076 0 Physicians Optical Supplies 20 1689618076 0 Physicians Physician Services 20 1689618076 0 Physicians Physicians Psychiatric Services 00 1689618290 0 ZAIDI SYED 1991152 9999999 B 10 1689618290 0 2000 OGDEN AVE AURORA IL 605047222 20 1689618290 0 Physicians Anesthesia Services 20 1689618290 0 Physicians Fluoride varnish 20 1689618290 0 Physicians Healthy Kids Services 20 1689618290 0 Physicians Optical Supplies 20 1689618290 0 Physicians Physician Services 00 1689618761 0 LEWANDOWSKI ROBERT 2006205 9999999 B 10 1689618761 0 5777 DEPT CAROL STREAM IL 601220021 20 1689618761 0 Physicians Anesthesia Services 20 1689618761 0 Physicians Healthy Kids Services 20 1689618761 0 Physicians Optical Supplies 20 1689618761 0 Physicians Physician Services 00 1689619314 0 AMLESHI PARISA M 2012289 9999999 B 10 1689619314 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1689619314 0 Physicians Anesthesia Services 20 1689619314 0 Physicians Fluoride varnish 20 1689619314 0 Physicians Healthy Kids Services 20 1689619314 0 Physicians Optical Supplies 20 1689619314 0 Physicians Physician Services 00 1689619439 0 SIMPSON SCOTT 2005213 9999999 B 10 1689619439 0 PO BOX 208807 DALLAS TX 753208807 20 1689619439 0 Physicians Anesthesia Services 20 1689619439 0 Physicians Healthy Kids Services 20 1689619439 0 Physicians Optical Supplies 20 1689619439 0 Physicians Physician Services 00 1689619728 0 ZALIK LEONARD A 1988183 9999999 B 10 1689619728 0 387 SHUMAN BLVD STE 240W NAPERVILLE IL 605638113 20 1689619728 0 Physicians Anesthesia Services 20 1689619728 0 Physicians Healthy Kids Services 20 1689619728 0 Physicians Optical Supplies 20 1689619728 0 Physicians Physician Services 00 1689620049 0 KESSLER HOWARD D 2017182 9999999 B 10 1689620049 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1689620049 0 Physicians Anesthesia Services 20 1689620049 0 Physicians Healthy Kids Services 20 1689620049 0 Physicians Optical Supplies 20 1689620049 0 Physicians Physician Services 00 1689620874 0 WINTERROWD DONNA Y 2023005 9999999 B 10 1689620874 0 10010 DON S POWERS DR MUNSTER IN 463214054 20 1689620874 0 Nurse Practitioners Healthy Kids Services 20 1689620874 0 Nurse Practitioners Nurse Practitioners Services 20 1689620874 0 Nurse Practitioners Physician Services 00 1689622029 0 SRIPADA TERESA L 1981227 9999999 B 10 1689622029 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1689622029 0 Physicians Anesthesia Services 20 1689622029 0 Physicians Healthy Kids Services 20 1689622029 0 Physicians Optical Supplies 20 1689622029 0 Physicians Physician Services 20 1689622029 0 Physicians Physicians Psychiatric Services 00 1689622094 0 KATZ ALLEN C 2017065 9999999 B 10 1689622094 0 PO BOX 3272 INDIANAPOLIS IN 462063272 20 1689622094 0 Physicians Anesthesia Services 20 1689622094 0 Physicians Healthy Kids Services 20 1689622094 0 Physicians Optical Supplies 20 1689622094 0 Physicians Physician Services 00 1689622250 0 MEISENBACH JOSEPH 1981258 9999999 B 10 1689622250 0 455 W COURT ST STE 202 KANKAKEE IL 609013693 20 1689622250 0 Physicians Anesthesia Services 20 1689622250 0 Physicians Fluoride varnish 20 1689622250 0 Physicians Healthy Kids Services 20 1689622250 0 Physicians Optical Supplies 20 1689622250 0 Physicians Physician Services 00 1689622755 0 HOTCHKISS LAURA A 2013152 9999999 A 10 1689622755 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1689622755 0 Physicians Anesthesia Services 20 1689622755 0 Physicians Healthy Kids Services 20 1689622755 0 Physicians Optical Supplies 20 1689622755 0 Physicians Physician Services 00 1689623316 0 PELSANG CHESTER A 2016279 9999999 B 10 1689623316 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1689623316 0 Podiatrists Podiatric Services 00 1689623472 0 GHAUS TALAT D 1995191 9999999 B 10 1689623472 0 555 PLAINFIELD RD STE F WILLOWBROOK IL 605277616 20 1689623472 0 Physicians Anesthesia Services 20 1689623472 0 Physicians Healthy Kids Services 20 1689623472 0 Physicians Optical Supplies 20 1689623472 0 Physicians Physician Services 20 1689623472 0 Physicians Physicians Psychiatric Services 00 1689623803 0 PERRY ANTHONY 1994178 9999999 B 10 1689623803 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1689623803 0 Physicians Anesthesia Services 20 1689623803 0 Physicians Fluoride varnish 20 1689623803 0 Physicians Healthy Kids Services 20 1689623803 0 Physicians Optical Supplies 20 1689623803 0 Physicians Physician Services 00 1689624116 0 VARMA SREELATHA 2016210 9999999 B 10 1689624116 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1689624116 0 Physicians Anesthesia Services 20 1689624116 0 Physicians Fluoride varnish 20 1689624116 0 Physicians Healthy Kids Services 20 1689624116 0 Physicians Optical Supplies 20 1689624116 0 Physicians Physician Services 00 1689624850 0 JUNG FRANK 2004153 9999999 B 10 1689624850 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1689624850 0 Physicians Anesthesia Services 20 1689624850 0 Physicians Fluoride varnish 20 1689624850 0 Physicians Healthy Kids Services 20 1689624850 0 Physicians Optical Supplies 20 1689624850 0 Physicians Physician Services 00 1689626046 0 COULTER STEVEN 2019260 9999999 B 10 1689626046 0 515 E GRANT ST STE 111 MACOMB IL 614553315 20 1689626046 0 Physicians Anesthesia Services 20 1689626046 0 Physicians Healthy Kids Services 20 1689626046 0 Physicians Optical Supplies 20 1689626046 0 Physicians Physician Services 00 1689626095 0 FRANKLIN STEPHANIE L 2000001 9999999 B 10 1689626095 0 PO BOX 3988 CARBONDALE IL 629023988 20 1689626095 0 Nurse Practitioners Fluoride varnish 20 1689626095 0 Nurse Practitioners Healthy Kids Services 20 1689626095 0 Nurse Practitioners Nurse Practitioners Services 20 1689626095 0 Nurse Practitioners Physician Services 00 1689626194 0 TENCZAR ALAN 1984232 9999999 B 10 1689626194 0 1660 FEEHANVILLE DR STE 450 MOUNT PROSPECT IL 600566023 20 1689626194 0 Podiatrists Podiatric Services 00 1689626574 0 GARDEZI SYED 2008245 9999999 B 10 1689626574 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1689626574 0 Physicians Anesthesia Services 20 1689626574 0 Physicians Fluoride varnish 20 1689626574 0 Physicians Healthy Kids Services 20 1689626574 0 Physicians Optical Supplies 20 1689626574 0 Physicians Physician Services 00 1689626905 0 SARROS ATHANASIA 2007204 9999999 B 10 1689626905 0 645 S CENTRAL AVE CHICAGO IL 606445059 20 1689626905 0 Podiatrists Podiatric Services 00 1689627010 0 MATHUR VIRENDRA 1991294 9999999 B 10 1689627010 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1689627010 0 Physicians Anesthesia Services 20 1689627010 0 Physicians Healthy Kids Services 20 1689627010 0 Physicians Optical Supplies 20 1689627010 0 Physicians Physician Services 00 1689627226 0 KATZ SAMUEL R 2001108 9999999 B 10 1689627226 0 2800 W MAIN ST CARBONDALE IL 629011087 20 1689627226 0 Physicians Anesthesia Services 20 1689627226 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1689627226 0 Physicians Fluoride varnish 20 1689627226 0 Physicians Healthy Kids Services 20 1689627226 0 Physicians Optical Supplies 20 1689627226 0 Physicians Physician Services 00 1689628018 0 STEFANESCU BEATRICE M 2019031 9999999 B 10 1689628018 0 PO BOX 778912 CHICAGO IL 606778912 20 1689628018 0 Physicians Anesthesia Services 20 1689628018 0 Physicians Fluoride varnish 20 1689628018 0 Physicians Healthy Kids Services 20 1689628018 0 Physicians Optical Supplies 20 1689628018 0 Physicians Physician Services 00 1689629107 0 SIEFKEN PHILIP 2001239 9999999 B 10 1689629107 0 1000 RED BALL TRL GREENVILLE IL 622462781 20 1689629107 0 Physicians Anesthesia Services 20 1689629107 0 Physicians Fluoride varnish 20 1689629107 0 Physicians Healthy Kids Services 20 1689629107 0 Physicians Optical Supplies 20 1689629107 0 Physicians Physician Services 00 1689629859 0 WILLIAMS CRAIG 1996336 9999999 B 10 1689629859 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1689629859 0 Physicians Anesthesia Services 20 1689629859 0 Physicians Healthy Kids Services 20 1689629859 0 Physicians Optical Supplies 20 1689629859 0 Physicians Physician Services 00 1689629933 0 RIES ANDREA 2009274 9999999 B 10 1689629933 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1689629933 0 Physicians Anesthesia Services 20 1689629933 0 Physicians Healthy Kids Services 20 1689629933 0 Physicians Optical Supplies 20 1689629933 0 Physicians Physician Services 00 1689630915 0 FARAH BEHZAD 1981227 9999999 B 10 1689630915 0 27401 W HIGHWAY 22 STE 108 BARRINGTON IL 600105934 20 1689630915 0 Physicians Anesthesia Services 20 1689630915 0 Physicians Fluoride varnish 20 1689630915 0 Physicians Healthy Kids Services 20 1689630915 0 Physicians Optical Supplies 20 1689630915 0 Physicians Physician Services 00 1689631079 0 KILANI RAMZI A 2016008 9999999 B 10 1689631079 0 1000 HADDONFIELD BERLIN RD STE VOORHEES NJ 080433520 20 1689631079 0 Physicians Anesthesia Services 20 1689631079 0 Physicians Fluoride varnish 20 1689631079 0 Physicians Healthy Kids Services 20 1689631079 0 Physicians Optical Supplies 20 1689631079 0 Physicians Physician Services 00 1689631129 0 ANDERSON ROBERT 2001213 9999999 B 10 1689631129 0 850 43RD AVE STE 100 MOLINE IL 612658401 20 1689631129 0 Physical Therapists Medical Supplies 20 1689631129 0 Physical Therapists Medical equipment/prosthetic devices 20 1689631129 0 Physical Therapists Physical Therapy Services 00 1689631681 0 HARTMANN RICHARD A 1999152 9999999 B 10 1689631681 0 24014 W RENWICK RD PLAINFIELD IL 605448708 20 1689631681 0 Physical Therapists Medical Supplies 20 1689631681 0 Physical Therapists Medical equipment/prosthetic devices 20 1689631681 0 Physical Therapists Physical Therapy Services 00 1689632564 0 SCLAMBERG JOY S 2003030 9999999 B 10 1689632564 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1689632564 0 Physicians Anesthesia Services 20 1689632564 0 Physicians Healthy Kids Services 20 1689632564 0 Physicians Optical Supplies 20 1689632564 0 Physicians Physician Services 00 1689634750 0 HAMBURG MARC C 2007325 9999999 B 10 1689634750 0 PO BOX 781076 DETROIT MI 482781076 20 1689634750 0 Physicians Anesthesia Services 20 1689634750 0 Physicians Healthy Kids Services 20 1689634750 0 Physicians Optical Supplies 20 1689634750 0 Physicians Physician Services 00 1689635401 0 HOLZ SARA 2006182 9999999 B 10 1689635401 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1689635401 0 Physicians Anesthesia Services 20 1689635401 0 Physicians Healthy Kids Services 20 1689635401 0 Physicians Optical Supplies 20 1689635401 0 Physicians Physician Services 00 1689635591 0 SEIBERT CHRISTINE S 1995288 9999999 B 10 1689635591 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1689635591 0 Physicians Anesthesia Services 20 1689635591 0 Physicians Fluoride varnish 20 1689635591 0 Physicians Healthy Kids Services 20 1689635591 0 Physicians Optical Supplies 20 1689635591 0 Physicians Physician Services 00 1689635856 0 YORULMAZOGLU EROL 1996153 9999999 B 10 1689635856 0 3701 ALGONQUIN RD STE 900 SUITE 900 ROLLING MEADOWS IL 600083193 20 1689635856 0 Physicians Anesthesia Services 20 1689635856 0 Physicians Fluoride varnish 20 1689635856 0 Physicians Healthy Kids Services 20 1689635856 0 Physicians Optical Supplies 20 1689635856 0 Physicians Physician Services 00 1689636904 0 OLDHAM LISA M 2001182 9999999 B 10 1689636904 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1689636904 0 Physicians Anesthesia Services 20 1689636904 0 Physicians Family Planning Counseling 20 1689636904 0 Physicians Healthy Kids Services 20 1689636904 0 Physicians Optical Supplies 20 1689636904 0 Physicians Physician Services 00 1689637217 0 CLARKE ELSBURGH O 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1689674541 0 Physicians Fluoride varnish 20 1689674541 0 Physicians Healthy Kids Services 20 1689674541 0 Physicians Optical Supplies 20 1689674541 0 Physicians Physician Services 00 1689674608 0 CONNERY MARC 2001169 9999999 B 10 1689674608 0 300 W 80TH PL STE A MERRILLVILLE IN 464105476 20 1689674608 0 Physicians Anesthesia Services 20 1689674608 0 Physicians Fluoride varnish 20 1689674608 0 Physicians Healthy Kids Services 20 1689674608 0 Physicians Optical Supplies 20 1689674608 0 Physicians Physician Services 00 1689674970 0 SHAH DHRULATA R 1996032 9999999 B 10 1689674970 0 10821 CORTLAND LN HUNTLEY IL 601424076 20 1689674970 0 Physicians Anesthesia Services 20 1689674970 0 Physicians Fluoride varnish 20 1689674970 0 Physicians Healthy Kids Services 20 1689674970 0 Physicians Optical Supplies 20 1689674970 0 Physicians Physician Services 00 1689675266 0 ONEY KELLY 2022290 9999999 B 10 1689675266 0 1950 45TH AVE STE 205 MUNSTER IN 463213927 20 1689675266 0 Nurse Practitioners 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Therapists Medical Supplies 20 1689737801 0 Speech Therapists Medical equipment/prosthetic devices 20 1689737801 0 Speech Therapists Speech Therapy/Pathology Services 00 1689739054 0 TASLIMI MASOUD 2014335 9999999 B 10 1689739054 0 611 W PARK ST URBANA IL 618012529 20 1689739054 0 Physicians Anesthesia Services 20 1689739054 0 Physicians Healthy Kids Services 20 1689739054 0 Physicians Optical Supplies 20 1689739054 0 Physicians Physician Services 00 1689739427 0 SUSKIND DANA L 1997182 9999999 B 10 1689739427 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1689739427 0 Physicians Anesthesia Services 20 1689739427 0 Physicians Healthy Kids Services 20 1689739427 0 Physicians Optical Supplies 20 1689739427 0 Physicians Physician Services 00 1689739781 0 LEKOVIC MARKO A 2000130 9999999 B 10 1689739781 0 5777 DEPT CAROL STREAM IL 601228942 20 1689739781 0 Physicians Anesthesia Services 20 1689739781 0 Physicians Healthy Kids Services 20 1689739781 0 Physicians Optical Supplies 20 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1689839680 0 Physicians Optical Supplies 20 1689839680 0 Physicians Physician Services 00 1689840704 0 ELION JOY M 2009196 9999999 B 10 1689840704 0 800 E 55TH ST CHICAGO IL 606154906 20 1689840704 0 Physicians Anesthesia Services 20 1689840704 0 Physicians Fluoride varnish 20 1689840704 0 Physicians Healthy Kids Services 20 1689840704 0 Physicians Optical Supplies 20 1689840704 0 Physicians Physician Services 00 1689841082 0 MANNING KAREN 2019296 9999999 B 10 1689841082 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1689841082 0 Nurse Practitioners Fluoride varnish 20 1689841082 0 Nurse Practitioners Healthy Kids Services 20 1689841082 0 Nurse Practitioners Nurse Practitioners Services 20 1689841082 0 Nurse Practitioners Physician Services 00 1689841314 0 SIEMIONOW KRZYSZTOF 2010190 9999999 B 10 1689841314 0 1000 REMINGTON BLVD STE 110 BOLINGBROOK IL 604404708 20 1689841314 0 Physicians Anesthesia Services 20 1689841314 0 Physicians Healthy Kids Services 20 1689841314 0 Physicians 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1689845695 0 SHAH ANKIT 2003335 9999999 B 10 1689845695 0 4446 W DIVERSEY AVE CHICAGO IL 606391939 20 1689845695 0 Dentists Dental Services 20 1689845695 0 Dentists Physician Services 00 1689845976 0 PAPANICOLAOU BETTY 1994001 9999999 B 10 1689845976 0 1229 N ASHLAND AVE CHICAGO IL 606222204 20 1689845976 0 Dentists Dental Services 20 1689845976 0 Dentists Physician Services 00 1689846693 0 HOLTGRAVE PHILIP GERARD 2013003 9999999 B 10 1689846693 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1689846693 0 Nurse Practitioners Fluoride varnish 20 1689846693 0 Nurse Practitioners Healthy Kids Services 20 1689846693 0 Nurse Practitioners Nurse Practitioners Services 20 1689846693 0 Nurse Practitioners Physician Services 00 1689846834 0 VANDERWEELE DAVID 2013199 9999999 B 10 1689846834 0 5777 DEPT CAROL STREAM IL 601220021 20 1689846834 0 Physicians Anesthesia Services 20 1689846834 0 Physicians Fluoride varnish 20 1689846834 0 Physicians Healthy Kids Services 20 1689846834 0 Physicians Optical Supplies 20 1689846834 0 Physicians Physician Services 00 1689847147 0 JOYCE HEATHER R 2010277 9999999 B 10 1689847147 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1689847147 0 Physicians Anesthesia Services 20 1689847147 0 Physicians Fluoride varnish 20 1689847147 0 Physicians Healthy Kids Services 20 1689847147 0 Physicians Optical Supplies 20 1689847147 0 Physicians Physician Services 00 1689847287 0 KHANDKER SAMIUR 2023214 9999999 B 10 1689847287 0 5445 ALMEDA RD STE 200 HOUSTON TX 770047469 20 1689847287 0 Physicians Anesthesia Services 20 1689847287 0 Physicians Healthy Kids Services 20 1689847287 0 Physicians Optical Supplies 20 1689847287 0 Physicians Physician Services 00 1689847873 0 ROBINSON-RAINEY CARLA 2008153 9999999 B 10 1689847873 0 2100 POWELL ST SUITE 900 EMERYVILLE CA 946081826 20 1689847873 0 Nurse Practitioners Healthy Kids Services 20 1689847873 0 Nurse Practitioners Nurse Practitioners Services 20 1689847873 0 Nurse Practitioners Physician Services 00 1689848897 0 GOLDSTEIN JEFFREY 2014213 9999999 B 10 1689848897 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1689848897 0 Physicians Anesthesia Services 20 1689848897 0 Physicians Healthy Kids Services 20 1689848897 0 Physicians Optical Supplies 20 1689848897 0 Physicians Physician Services 00 1689849127 0 GIES STRASSER MAUREEN S 2011091 9999999 B 10 1689849127 0 900 RAND RD STE 300 DES PLAINES IL 600162359 20 1689849127 0 Physical Therapists Medical Supplies 20 1689849127 0 Physical Therapists Medical equipment/prosthetic devices 20 1689849127 0 Physical Therapists Physical Therapy Services 00 1689849796 0 MASHRUWALA ANAR 2011244 9999999 B 10 1689849796 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1689849796 0 Physicians Anesthesia Services 20 1689849796 0 Physicians Fluoride varnish 20 1689849796 0 Physicians Healthy Kids Services 20 1689849796 0 Physicians Optical Supplies 20 1689849796 0 Physicians Physician Services 00 1689851131 0 DESCHENES AMANDA 2008178 9999999 B 10 1689851131 0 1701 LACEY ST CAPE GIRARDEAU MO 637015230 20 1689851131 0 Nurse Practitioners Anesthesia Services 20 1689851131 0 Nurse Practitioners Nurse Practitioners Services 20 1689851131 0 Nurse Practitioners Physician Services 00 1689852253 0 WOODROME STACEY E 2016217 9999999 B 10 1689852253 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1689852253 0 Psychologist Psychologist service 00 1689853111 0 SANGHVI SONAL 2016266 9999999 B 10 1689853111 0 PO BOX 4176 HOUMA LA 703614176 20 1689853111 0 Physician Assistant Only Fluoride varnish 20 1689853111 0 Physician Assistant Only Healthy Kids Services 20 1689853111 0 Physician Assistant Only Physician Services 00 1689856049 0 CHOI JAEHYUK 2015279 9999999 B 10 1689856049 0 5777 DEPT CAROL STREAM IL 601220021 20 1689856049 0 Physicians Anesthesia Services 20 1689856049 0 Physicians Healthy Kids Services 20 1689856049 0 Physicians Optical Supplies 20 1689856049 0 Physicians Physician Services 00 1689856437 0 MULDOWNEY MARTHA M 1981258 9999999 B 10 1689856437 0 3957 N MULFORD RD STE A SUITE A ROCKFORD IL 611148004 20 1689856437 0 Dentists Dental Services 20 1689856437 0 Dentists Physician Services 00 1689857336 0 PAGE CHARTRAND KRISTIN 2021126 9999999 B 10 1689857336 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1689857336 0 Physicians Anesthesia Services 20 1689857336 0 Physicians Fluoride varnish 20 1689857336 0 Physicians Healthy Kids Services 20 1689857336 0 Physicians Optical Supplies 20 1689857336 0 Physicians Physician Services 00 1689859290 0 ATTALLA MAMDOUH 1990200 9999999 B 10 1689859290 0 2117 E 71ST ST # 497010 CHICAGO IL 606492103 20 1689859290 0 Dentists Dental Services 20 1689859290 0 Dentists Physician Services 00 1689860405 0 HABANSKY ELIZABETH URSO 1999010 9999999 B 10 1689860405 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1689860405 0 Physical Therapists Medical Supplies 20 1689860405 0 Physical Therapists Medical equipment/prosthetic devices 20 1689860405 0 Physical Therapists Physical Therapy Services 00 1689863029 0 CHUY FRANCISCO L 1994244 9999999 B 10 1689863029 0 3919 W TOUHY AVE LINCOLNWOOD IL 607121027 20 1689863029 0 Physicians Anesthesia Services 20 1689863029 0 Physicians Fluoride varnish 20 1689863029 0 Physicians Healthy Kids Services 20 1689863029 0 Physicians Optical Supplies 20 1689863029 0 Physicians Physician Services 00 1689863425 0 BANSAL MANISH 2023349 9999999 B 10 1689863425 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1689863425 0 Physicians Anesthesia Services 20 1689863425 0 Physicians Fluoride varnish 20 1689863425 0 Physicians Healthy Kids Services 20 1689863425 0 Physicians Optical Supplies 20 1689863425 0 Physicians Physician Services 00 1689864266 0 DEMPSEY AMY E 2017038 9999999 B 10 1689864266 0 PO BOX 713388 CHICAGO IL 606771525 20 1689864266 0 Physician Assistant Only Fluoride varnish 20 1689864266 0 Physician Assistant Only Healthy Kids Services 20 1689864266 0 Physician Assistant Only Physician Services 00 1689864357 0 LAWSON JOHN K 2020106 9999999 B 10 1689864357 0 500 SKOKIE BLVD STE 140 NORTHBROOK IL 600622811 20 1689864357 0 Physicians Anesthesia Services 20 1689864357 0 Physicians Healthy Kids Services 20 1689864357 0 Physicians Optical Supplies 20 1689864357 0 Physicians Physician Services 00 1689864761 0 LONG ANGELA 2008023 9999999 B 10 1689864761 0 1506 E ROOSEVELT RD WHEATON IL 601876806 20 1689864761 0 Physicians Anesthesia Services 20 1689864761 0 Physicians Healthy Kids Services 20 1689864761 0 Physicians Optical Supplies 20 1689864761 0 Physicians Physician Services 00 1689864787 0 KATHPALIA PARU P 2012183 9999999 B 10 1689864787 0 PO BOX 776473 CHICAGO IL 606776473 20 1689864787 0 Physicians Anesthesia Services 20 1689864787 0 Physicians Fluoride varnish 20 1689864787 0 Physicians Healthy Kids Services 20 1689864787 0 Physicians Optical Supplies 20 1689864787 0 Physicians Physician Services 00 1689865636 0 OGLES MITCHELL L 2012183 9999999 B 10 1689865636 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1689865636 0 Physicians Anesthesia Services 20 1689865636 0 Physicians Healthy Kids Services 20 1689865636 0 Physicians Optical Supplies 20 1689865636 0 Physicians Physician Services 00 1689865834 0 BEECHY CHRISTOPHER 2020214 9999999 B 10 1689865834 0 PO BOX 43230 PHOENIX AZ 850803230 20 1689865834 0 Physicians Anesthesia Services 20 1689865834 0 Physicians Healthy Kids Services 20 1689865834 0 Physicians Optical Supplies 20 1689865834 0 Physicians Physician Services 00 1689866493 0 SHARMA DEEPA 2022234 9999999 B 10 1689866493 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1689866493 0 Physicians Anesthesia Services 20 1689866493 0 Physicians Healthy Kids Services 20 1689866493 0 Physicians Optical Supplies 20 1689866493 0 Physicians Physician Services 00 1689866717 0 STASZKIEWICZ ANDRZEJ 2009125 9999999 B 10 1689866717 0 6742 N FROSTWOOD PKWY PEORIA IL 616152402 20 1689866717 0 Physicians Anesthesia Services 20 1689866717 0 Physicians Healthy Kids Services 20 1689866717 0 Physicians Optical Supplies 20 1689866717 0 Physicians Physician Services 00 1689867541 0 AHMED SYED M 2008032 9999999 B 10 1689867541 0 5777 DEPT CAROL STREAM IL 601220021 20 1689867541 0 Physicians Anesthesia Services 20 1689867541 0 Physicians Fluoride varnish 20 1689867541 0 Physicians Healthy Kids Services 20 1689867541 0 Physicians Optical Supplies 20 1689867541 0 Physicians Physician Services 00 1689867772 0 FISHER THERESA C 2002301 9999999 B 10 1689867772 0 420 FRONT ST MCHENRY IL 600505528 20 1689867772 0 Speech Therapists Medical Supplies 20 1689867772 0 Speech Therapists Medical equipment/prosthetic devices 20 1689867772 0 Speech Therapists Speech Therapy/Pathology Services 00 1689868689 0 COJANU CARMEN 2024365 9999999 B 10 1689868689 0 8140 S HOLLY ST CENTENNIAL CO 801224004 20 1689868689 0 Physicians Anesthesia Services 20 1689868689 0 Physicians Fluoride varnish 20 1689868689 0 Physicians Healthy Kids Services 20 1689868689 0 Physicians Optical Supplies 20 1689868689 0 Physicians Physician Services 00 1689869588 0 STULTS VANESSA M 2020288 9999999 B 10 1689869588 0 3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047452 20 1689869588 0 Physician Assistant Only Fluoride varnish 20 1689869588 0 Physician Assistant Only Healthy Kids Services 20 1689869588 0 Physician Assistant Only Physician Services 00 1689871212 0 ONAGAN MARIA 2010263 9999999 B 10 1689871212 0 25872 NETWORK PL CHICAGO IL 606731258 20 1689871212 0 Physicians Anesthesia Services 20 1689871212 0 Physicians Fluoride varnish 20 1689871212 0 Physicians Healthy Kids Services 20 1689871212 0 Physicians Optical Supplies 20 1689871212 0 Physicians Physician Services 00 1689871360 0 HALATCHEV ILIA G 2014213 9999999 B 10 1689871360 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1689871360 0 Physicians Anesthesia Services 20 1689871360 0 Physicians Fluoride varnish 20 1689871360 0 Physicians Healthy Kids Services 20 1689871360 0 Physicians Optical Supplies 20 1689871360 0 Physicians Physician Services 00 1689871923 0 COSTA YARA R 2024004 9999999 B 10 1689871923 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1689871923 0 Psychologist Psychologist service 00 1689871998 0 SWEENEY JUSTIN M 2022182 9999999 B 10 1689871998 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1689871998 0 Physicians Anesthesia Services 20 1689871998 0 Physicians Healthy Kids Services 20 1689871998 0 Physicians Optical Supplies 20 1689871998 0 Physicians Physician Services 00 1689872368 0 CHI JOHN J 2013213 9999999 B 10 1689872368 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1689872368 0 Physicians Anesthesia Services 20 1689872368 0 Physicians Healthy Kids Services 20 1689872368 0 Physicians Optical Supplies 20 1689872368 0 Physicians Physician Services 00 1689872723 0 HANSEN CHRISTY J 2007260 9999999 B 10 1689872723 0 110 CARVER LN EAST PEORIA IL 616113052 20 1689872723 0 Occupational Therapists Medical Supplies 20 1689872723 0 Occupational Therapists Medical equipment/prosthetic devices 20 1689872723 0 Occupational Therapists Occupational Therapy Services 00 1689872905 0 PACHECO PAUL 2012233 9999999 B 10 1689872905 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1689872905 0 Physicians Anesthesia Services 20 1689872905 0 Physicians Healthy Kids Services 20 1689872905 0 Physicians Optical Supplies 20 1689872905 0 Physicians Physician Services 00 1689872970 0 WOODLAND JAY H 2009244 9999999 B 10 1689872970 0 1418 COLLEGE DR MOUNT CARMEL IL 628632638 20 1689872970 0 Physicians Anesthesia Services 20 1689872970 0 Physicians Healthy Kids Services 20 1689872970 0 Physicians Optical Supplies 20 1689872970 0 Physicians Physician Services 00 1689873267 0 SOHAIL ROMINA 2012107 9999999 B 10 1689873267 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1689873267 0 Physicians Anesthesia Services 20 1689873267 0 Physicians Fluoride varnish 20 1689873267 0 Physicians Healthy Kids Services 20 1689873267 0 Physicians 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SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1689937641 0 Physicians Anesthesia Services 20 1689937641 0 Physicians Fluoride varnish 20 1689937641 0 Physicians Healthy Kids Services 20 1689937641 0 Physicians Optical Supplies 20 1689937641 0 Physicians Physician Services 00 1689938193 0 LUST CHRISTOPHER 2018091 9999999 B 10 1689938193 0 5901 LINCOLN DR EDINA MN 554361611 20 1689938193 0 Physicians Anesthesia Services 20 1689938193 0 Physicians Fluoride varnish 20 1689938193 0 Physicians Healthy Kids Services 20 1689938193 0 Physicians Optical Supplies 20 1689938193 0 Physicians Physician Services 00 1689938383 0 KHAN ARSALAN J 2015208 9999999 B 10 1689938383 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1689938383 0 Physicians Anesthesia Services 20 1689938383 0 Physicians Fluoride varnish 20 1689938383 0 Physicians Healthy Kids Services 20 1689938383 0 Physicians Optical Supplies 20 1689938383 0 Physicians Physician Services 00 1689938672 0 CASSELLA JOHNSON DONNA 2014218 9999999 H 10 1689938672 0 634 OAKWOOD STREET MINOOKA IL 604471229 20 1689938672 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1689938938 0 SHUJA ASIM 2018182 9999999 B 10 1689938938 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1689938938 0 Physicians Anesthesia Services 20 1689938938 0 Physicians Fluoride varnish 20 1689938938 0 Physicians Healthy Kids Services 20 1689938938 0 Physicians Optical Supplies 20 1689938938 0 Physicians Physician Services 00 1689940009 0 D''SOUZA AMBER M 2018183 9999999 B 10 1689940009 0 1 ILLINI DR PEORIA IL 616052576 20 1689940009 0 Physicians Anesthesia Services 20 1689940009 0 Physicians Fluoride varnish 20 1689940009 0 Physicians Healthy Kids Services 20 1689940009 0 Physicians Optical Supplies 20 1689940009 0 Physicians Physician Services 00 1689940181 0 STAMM DEBORAH 2014126 9999999 B 10 1689940181 0 8550 W BRYN MAWR AVE STE 800 SUITE 800 CHICAGO IL 606313222 20 1689940181 0 Nurse Practitioners Healthy Kids Services 20 1689940181 0 Nurse Practitioners Nurse Practitioners Services 20 1689940181 0 Nurse Practitioners Physician Services 00 1689940561 0 BETA ELIO 2018136 9999999 B 10 1689940561 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1689940561 0 Physicians Anesthesia Services 20 1689940561 0 Physicians Healthy Kids Services 20 1689940561 0 Physicians Optical Supplies 20 1689940561 0 Physicians Physician Services 00 1689941668 0 PERRY MATTHEW T 2023355 9999999 B 10 1689941668 0 PO BOX 43230 PHOENIX AZ 850803230 20 1689941668 0 Physicians Anesthesia Services 20 1689941668 0 Physicians Healthy Kids Services 20 1689941668 0 Physicians Optical Supplies 20 1689941668 0 Physicians Physician Services 20 1689941668 0 Physicians Physicians Psychiatric Services 00 1689943649 0 WODYNSKI JOHN C 2020183 9999999 B 10 1689943649 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1689943649 0 Physician Assistant Only Fluoride varnish 20 1689943649 0 Physician Assistant Only Healthy Kids Services 20 1689943649 0 Physician Assistant Only Physician Services 00 1689943722 0 IRVINE CRAIG 2011335 2099273 B 10 1689943722 0 31 W 155TH ST HARVEY IL 604263556 20 1689943722 0 Dentists Dental Services 20 1689943722 0 Dentists Physician Services 00 1689945339 0 JANKOWSKI LACI 2015152 9999999 B 10 1689945339 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1689945339 0 Nurse Practitioners Healthy Kids Services 20 1689945339 0 Nurse Practitioners Nurse Practitioners Services 20 1689945339 0 Nurse Practitioners Nursing service 20 1689945339 0 Nurse Practitioners Physician Services 20 1689945339 0 Nurse Practitioners Waiver service 00 1689945792 0 CHOUSSAL-GONZALEZ RODOLFO 2021238 9999999 B 10 1689945792 0 5145 N CALIFORNIA AVE CHICAGO IL 606253661 20 1689945792 0 Physicians Anesthesia Services 20 1689945792 0 Physicians Fluoride varnish 20 1689945792 0 Physicians Healthy Kids Services 20 1689945792 0 Physicians Optical Supplies 20 1689945792 0 Physicians Physician Services 00 1689946931 0 AUCH MICHELE 2000062 9999999 B 10 1689946931 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1689946931 0 Occupational Therapists Medical Supplies 20 1689946931 0 Occupational Therapists Medical equipment/prosthetic devices 20 1689946931 0 Occupational Therapists Occupational Therapy Services 00 1689947517 0 SKRZECZ HELEN 2012249 9999999 B 10 1689947517 0 5777 DEPT CAROL STREAM IL 601220021 20 1689947517 0 Nurse Practitioners Fluoride varnish 20 1689947517 0 Nurse Practitioners Healthy Kids Services 20 1689947517 0 Nurse Practitioners Nurse Practitioners Services 20 1689947517 0 Nurse Practitioners Physician Services 00 1689948770 0 SUTPHEN SEAN A 2018212 9999999 B 10 1689948770 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1689948770 0 Physicians Anesthesia Services 20 1689948770 0 Physicians Healthy Kids Services 20 1689948770 0 Physicians Optical Supplies 20 1689948770 0 Physicians Physician Services 00 1689949448 0 SHUTT BRENNAN J 2023141 9999999 B 10 1689949448 0 3300 OAKDALE AVE N ROBBINSDALE MN 554222926 20 1689949448 0 Physicians Anesthesia Services 20 1689949448 0 Physicians Fluoride varnish 20 1689949448 0 Physicians Healthy Kids Services 20 1689949448 0 Physicians Optical Supplies 20 1689949448 0 Physicians Physician Services 00 1689949828 0 KAMAL SAAD 2017125 9999999 B 10 1689949828 0 40 SHUMAN BLVD STE 275 SUITE 275 NAPERVILLE IL 605638669 20 1689949828 0 Physicians Anesthesia Services 20 1689949828 0 Physicians Healthy Kids Services 20 1689949828 0 Physicians Optical Supplies 20 1689949828 0 Physicians Physician Services 00 1689951519 0 KLEIN JESSE 2015176 9999999 B 10 1689951519 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1689951519 0 Psychologist Psychologist service 00 1689953234 0 HERMSEN LAURA 2019106 9999999 B 10 1689953234 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1689953234 0 Physician Assistant Only Fluoride varnish 20 1689953234 0 Physician Assistant Only Healthy Kids Services 20 1689953234 0 Physician Assistant Only Physician Services 00 1689954489 0 FOULKER BRIANNE 2023137 9999999 B 10 1689954489 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1689954489 0 Nurse Practitioners Fluoride varnish 20 1689954489 0 Nurse Practitioners Healthy Kids Services 20 1689954489 0 Nurse Practitioners Nurse Practitioners Services 20 1689954489 0 Nurse Practitioners Physician Services 00 1689959116 0 PATEL CHIRAG A 2018141 9999999 B 10 1689959116 0 19111 TOWN CENTER DR APPLE VALLEY CA 923088989 20 1689959116 0 Physicians Anesthesia Services 20 1689959116 0 Physicians Healthy Kids Services 20 1689959116 0 Physicians Optical Supplies 20 1689959116 0 Physicians Physician Services 00 1689959900 0 SHAH KETAN 2011221 9999999 B 10 1689959900 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1689959900 0 Nurse Practitioners Healthy Kids Services 20 1689959900 0 Nurse Practitioners Nurse Practitioners Services 20 1689959900 0 Nurse Practitioners Physician Services 00 1689960023 0 HOLZNECHT CATHERINE B 2016144 9999999 B 10 1689960023 0 PO BOX 2400 WATERLOO IA 507042400 20 1689960023 0 Physicians Anesthesia Services 20 1689960023 0 Physicians Healthy Kids Services 20 1689960023 0 Physicians Optical Supplies 20 1689960023 0 Physicians Physician Services 00 1689960205 0 BASUNDHRA SAURABH 2022313 9999999 B 10 1689960205 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1689960205 0 Physicians Anesthesia Services 20 1689960205 0 Physicians Fluoride varnish 20 1689960205 0 Physicians Healthy Kids Services 20 1689960205 0 Physicians Optical Supplies 20 1689960205 0 Physicians Physician Services 00 1689960650 0 FORD CLAYTON T 2014213 9999999 B 10 1689960650 0 1201 PINE ST ELDORADO IL 629301634 20 1689960650 0 Physicians Anesthesia Services 20 1689960650 0 Physicians Fluoride varnish 20 1689960650 0 Physicians Healthy Kids Services 20 1689960650 0 Physicians Optical Supplies 20 1689960650 0 Physicians Physician Services 00 1689961088 0 AMADI UZOCHUKWU 2022261 9999999 B 10 1689961088 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1689961088 0 Physicians Anesthesia Services 20 1689961088 0 Physicians Fluoride varnish 20 1689961088 0 Physicians Healthy Kids Services 20 1689961088 0 Physicians Optical Supplies 20 1689961088 0 Physicians Physician Services 00 1689961179 0 GHAVAM AHMENEH 2017209 9999999 B 10 1689961179 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1689961179 0 Physicians Anesthesia Services 20 1689961179 0 Physicians Fluoride varnish 20 1689961179 0 Physicians Healthy Kids Services 20 1689961179 0 Physicians Optical Supplies 20 1689961179 0 Physicians Physician Services 00 1689962151 0 OLTEAN ANTHONY P 2021213 9999999 B 10 1689962151 0 3353 S MORGAN ST UNIT 1 CHICAGO IL 606086885 20 1689962151 0 Clinical Social Worker Social work service 00 1689962441 0 TADI PRASANNA 2023185 9999999 B 10 1689962441 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1689962441 0 Physicians Anesthesia Services 20 1689962441 0 Physicians Healthy Kids Services 20 1689962441 0 Physicians Optical Supplies 20 1689962441 0 Physicians Physician Services 20 1689962441 0 Physicians Physicians Psychiatric Services 00 1689964637 0 LEE ALEXANDER Y 2019312 9999999 B 10 1689964637 0 1250 S MICHIGAN AVE CHICAGO IL 606052548 20 1689964637 0 Physicians Anesthesia Services 20 1689964637 0 Physicians Healthy Kids Services 20 1689964637 0 Physicians Optical Supplies 20 1689964637 0 Physicians Physician Services 00 1689964900 0 RAYANNAVAR ARPANA 2022365 9999999 B 10 1689964900 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1689964900 0 Physicians Anesthesia Services 20 1689964900 0 Physicians Fluoride varnish 20 1689964900 0 Physicians Healthy Kids Services 20 1689964900 0 Physicians Optical Supplies 20 1689964900 0 Physicians Physician Services 00 1689965071 0 PIHLAJA-OLSON MICHELLE D 2018353 9999999 B 10 1689965071 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1689965071 0 Clinical Social Worker Social work service 00 1689965790 0 SCALZITTI NICHOLAS 2017298 9999999 B 10 1689965790 0 PO BOX 3988 CARBONDALE IL 629023988 20 1689965790 0 Physicians Anesthesia Services 20 1689965790 0 Physicians Healthy Kids Services 20 1689965790 0 Physicians Optical Supplies 20 1689965790 0 Physicians Physician Services 00 1689967069 0 ZIMMERMAN MATTHEW T 2015357 9999999 B 10 1689967069 0 965 MATTOX DR SULLIVAN MO 630802365 20 1689967069 0 Physicians Anesthesia Services 20 1689967069 0 Physicians Fluoride varnish 20 1689967069 0 Physicians Healthy Kids Services 20 1689967069 0 Physicians Optical Supplies 20 1689967069 0 Physicians Physician Services 00 1689967234 0 SCHARLE ELIZABETH A 2019182 9999999 B 10 1689967234 0 5777 DEPT CAROL STREAM IL 601220021 20 1689967234 0 Physicians Anesthesia Services 20 1689967234 0 Physicians Fluoride varnish 20 1689967234 0 Physicians Healthy Kids Services 20 1689967234 0 Physicians Optical Supplies 20 1689967234 0 Physicians Physician Services 00 1689967705 0 ALSARA OSAMA 2018211 9999999 B 10 1689967705 0 1000 MEDICAL CENTER DR MONTICELLO IL 618562116 20 1689967705 0 Physicians Anesthesia Services 20 1689967705 0 Physicians Fluoride varnish 20 1689967705 0 Physicians Healthy Kids Services 20 1689967705 0 Physicians Optical Supplies 20 1689967705 0 Physicians Physician Services 00 1689967721 0 HELBIG SHARI 2011153 9999999 B 10 1689967721 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1689967721 0 Nurse Practitioners Fluoride varnish 20 1689967721 0 Nurse Practitioners Healthy Kids Services 20 1689967721 0 Nurse Practitioners Nurse Practitioners Services 20 1689967721 0 Nurse Practitioners Physician Services 00 1689968430 0 SHAIK SHAISTA 2017032 9999999 B 10 1689968430 0 1 ILLINI DR PEORIA IL 616052576 20 1689968430 0 Physicians Anesthesia Services 20 1689968430 0 Physicians Fluoride varnish 20 1689968430 0 Physicians Healthy Kids Services 20 1689968430 0 Physicians Optical Supplies 20 1689968430 0 Physicians Physician Services 00 1689968778 0 GARDNER MONIQUE ANNE M 2022001 9999999 B 10 1689968778 0 100 E PENN SQ PHILADELPHIA PA 191073323 20 1689968778 0 Physicians Anesthesia Services 20 1689968778 0 Physicians Fluoride varnish 20 1689968778 0 Physicians Healthy Kids Services 20 1689968778 0 Physicians Optical Supplies 20 1689968778 0 Physicians Physician Services 00 1689968984 0 ASHURST TICE 2022098 9999999 B 10 1689968984 0 5121 MARYLAND WAY STE 300 BRENTWOOD TN 370277516 20 1689968984 0 Physicians Anesthesia Services 20 1689968984 0 Physicians Healthy Kids Services 20 1689968984 0 Physicians Optical Supplies 20 1689968984 0 Physicians Physician Services 00 1689969206 0 SOKOL ELIZABETH A 2017195 9999999 B 10 1689969206 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1689969206 0 Physicians Anesthesia Services 20 1689969206 0 Physicians Fluoride varnish 20 1689969206 0 Physicians Healthy Kids Services 20 1689969206 0 Physicians Optical Supplies 20 1689969206 0 Physicians Physician Services 00 1689969743 0 RAGHURAMAN NANDINI 2018164 9999999 B 10 1689969743 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1689969743 0 Physicians Anesthesia Services 20 1689969743 0 Physicians Healthy Kids Services 20 1689969743 0 Physicians Optical Supplies 20 1689969743 0 Physicians Physician Services 00 1689970543 0 ZWAGERMAN NATHAN 2019052 9999999 B 10 1689970543 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1689970543 0 Physicians Anesthesia Services 20 1689970543 0 Physicians Healthy Kids Services 20 1689970543 0 Physicians Optical Supplies 20 1689970543 0 Physicians Physician Services 00 1689972861 0 PEREZ ANA L 2011090 9999999 B 10 1689972861 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1689972861 0 Other behavior health professional LCPC/LMFT services 00 1689973026 0 GADALEAN CHRISTINA 2018091 9999999 B 10 1689973026 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1689973026 0 Physicians Anesthesia Services 20 1689973026 0 Physicians Healthy Kids Services 20 1689973026 0 Physicians Optical Supplies 20 1689973026 0 Physicians Physician Services 00 1689974388 0 KAVANAUGH MARGARET M 2011001 9999999 B 10 1689974388 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1689974388 0 Nurse Practitioners Healthy Kids Services 20 1689974388 0 Nurse Practitioners Nurse Practitioners Services 20 1689974388 0 Nurse Practitioners Physician Services 00 1689975310 0 DAVID JACQUELINE 2021089 9999999 B 10 1689975310 0 PO BOX 43230 PHOENIX AZ 850803230 20 1689975310 0 Physicians Anesthesia Services 20 1689975310 0 Physicians Fluoride varnish 20 1689975310 0 Physicians Healthy Kids Services 20 1689975310 0 Physicians Optical Supplies 20 1689975310 0 Physicians Physician Services 00 1689976193 0 BURROW KIMBERLY 2010305 9999999 B 10 1689976193 0 PO BOX 631767 CINCINNATI OH 452631767 20 1689976193 0 Nurse Practitioners Healthy Kids Services 20 1689976193 0 Nurse Practitioners Nurse Practitioners Services 20 1689976193 0 Nurse Practitioners Physician Services 00 1689976391 0 SAUER AMANDA 2021082 9999999 B 10 1689976391 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1689976391 0 Nurse Practitioners Healthy Kids Services 20 1689976391 0 Nurse Practitioners Nurse Practitioners Services 20 1689976391 0 Nurse Practitioners Physician Services 00 1689976649 0 LIYANAPATABENDI CHOOL 2012167 9999999 B 10 1689976649 0 1875 DEMPSTER ST STE 605 PARK RIDGE IL 600681168 20 1689976649 0 Physicians Anesthesia Services 20 1689976649 0 Physicians Fluoride varnish 20 1689976649 0 Physicians Healthy Kids Services 20 1689976649 0 Physicians Optical Supplies 20 1689976649 0 Physicians Physician Services 00 1689979841 0 WILSON MELISSA 2016011 9999999 B 10 1689979841 0 2605 KENTUCKY AVE STE 306 PADUCAH KY 420033802 20 1689979841 0 Nurse Practitioners Fluoride varnish 20 1689979841 0 Nurse Practitioners Healthy Kids Services 20 1689979841 0 Nurse Practitioners Nurse Practitioners Services 20 1689979841 0 Nurse Practitioners Physician Services 00 1689979916 0 LEITCH AMY M 2014197 9999999 B 10 1689979916 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1689979916 0 Nurse Practitioners Healthy Kids Services 20 1689979916 0 Nurse Practitioners Nurse Practitioners Services 20 1689979916 0 Nurse Practitioners Physician Services 00 1689981029 0 LYNCH JAKLYN B 2017190 9999999 B 10 1689981029 0 5777 DEPT CAROL STREAM IL 601220021 20 1689981029 0 Physician Assistant Only Fluoride varnish 20 1689981029 0 Physician Assistant Only Healthy Kids Services 20 1689981029 0 Physician Assistant Only Physician Services 00 1689981045 0 NJOKU EMMANUEL N 2011006 9999999 B 10 1689981045 0 2361 PAYSPHERE CIR CHICAGO IL 606740023 20 1689981045 0 Physicians Anesthesia Services 20 1689981045 0 Physicians Fluoride varnish 20 1689981045 0 Physicians Healthy Kids Services 20 1689981045 0 Physicians Optical Supplies 20 1689981045 0 Physicians Physician Services 00 1689981508 0 ALARCON MANGINI JORGE L 2024365 9999999 B 10 1689981508 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1689981508 0 Physicians Anesthesia Services 20 1689981508 0 Physicians Healthy Kids Services 20 1689981508 0 Physicians Optical Supplies 20 1689981508 0 Physicians Physician Services 00 1689982282 0 HANICHAK RENEE 2011256 9999999 B 10 1689982282 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1689982282 0 Speech Therapists Medical Supplies 20 1689982282 0 Speech Therapists Medical equipment/prosthetic devices 20 1689982282 0 Speech Therapists Speech Therapy/Pathology Services 00 1689982621 0 HURKS NOELLE 2013332 9999999 B 10 1689982621 0 PO BOX 778791 CHICAGO IL 606776473 20 1689982621 0 Physicians Anesthesia Services 20 1689982621 0 Physicians Healthy Kids Services 20 1689982621 0 Physicians Optical Supplies 20 1689982621 0 Physicians Physician Services 00 1689982829 0 PEREZ ARIZMENDI IGNACIO 2014188 9999999 B 10 1689982829 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1689982829 0 Clinical Social Worker All Kids application agent 20 1689982829 0 Clinical Social Worker Social work service 00 1689984783 0 WILLIAMS JOHN L 2016112 9999999 B 10 1689984783 0 PO BOX 1125 MARYLAND HEIGHT MO 630430125 20 1689984783 0 Nurse Practitioners Anesthesia Services 20 1689984783 0 Nurse Practitioners Nurse Practitioners Services 20 1689984783 0 Nurse Practitioners Physician Services 00 1689985012 0 BUCCI TIMOTHY J 2013203 9999999 B 10 1689985012 0 901 E 5TH ST WASHINGTON MO 630903127 20 1689985012 0 Physicians Anesthesia Services 20 1689985012 0 Physicians Fluoride varnish 20 1689985012 0 Physicians Healthy Kids Services 20 1689985012 0 Physicians Optical Supplies 20 1689985012 0 Physicians Physician Services 00 1689985350 0 OLADEJI OLATUNJI 2021361 9999999 B 10 1689985350 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1689985350 0 Physicians Anesthesia Services 20 1689985350 0 Physicians Fluoride varnish 20 1689985350 0 Physicians Healthy Kids Services 20 1689985350 0 Physicians Optical Supplies 20 1689985350 0 Physicians Physician Services 00 1689985962 0 GALLARDO JOSHUAE G 2023191 9999999 B 10 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SUMMIT MO 640642323 20 1689990558 0 Physicians Anesthesia Services 20 1689990558 0 Physicians Healthy Kids Services 20 1689990558 0 Physicians Optical Supplies 20 1689990558 0 Physicians Physician Services 00 1689990590 0 HAHN MICHELLE 2021041 9999999 B 10 1689990590 0 PO BOX 500 ELLICOTTVILLE NY 147310500 20 1689990590 0 Nurse Practitioners Fluoride varnish 20 1689990590 0 Nurse Practitioners Healthy Kids Services 20 1689990590 0 Nurse Practitioners Nurse Practitioners Services 20 1689990590 0 Nurse Practitioners Physician Services 00 1689991150 0 POLICK ANNE M 2014182 9999999 B 10 1689991150 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1689991150 0 Physicians Anesthesia Services 20 1689991150 0 Physicians Fluoride varnish 20 1689991150 0 Physicians Healthy Kids Services 20 1689991150 0 Physicians Optical Supplies 20 1689991150 0 Physicians Physician Services 00 1689992174 0 ANDERSON ZACHARY 2020143 9999999 B 10 1689992174 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1689992174 0 Physicians Anesthesia Services 20 1689992174 0 Physicians Healthy Kids Services 20 1689992174 0 Physicians Optical Supplies 20 1689992174 0 Physicians Physician Services 00 1689992687 0 MUJEEB IMAAD B 1996183 9999999 B 10 1689992687 0 5777 DEPT CAROL STREAM IL 601220021 20 1689992687 0 Physicians Anesthesia Services 20 1689992687 0 Physicians Healthy Kids Services 20 1689992687 0 Physicians Optical Supplies 20 1689992687 0 Physicians Physician Services 00 1689992885 0 PARIKH RUCHI 2013217 9999999 B 10 1689992885 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1689992885 0 Physicians Anesthesia Services 20 1689992885 0 Physicians Fluoride varnish 20 1689992885 0 Physicians Healthy Kids Services 20 1689992885 0 Physicians Optical Supplies 20 1689992885 0 Physicians Physician Services 00 1689993677 0 STEWART JOYCE A 2020245 9999999 B 10 1689993677 0 645 BERKSHIRE BLVD STE 645 EAST ALTON IL 620241324 20 1689993677 0 Other behavior health professional Social work service 00 1689993768 0 ALPER SETH J 2016183 9999999 B 10 1689993768 0 44000 GARFIELD RD CLINTON TOWNSHI MI 480381125 20 1689993768 0 Physicians Anesthesia Services 20 1689993768 0 Physicians Healthy Kids Services 20 1689993768 0 Physicians Optical Supplies 20 1689993768 0 Physicians Physician Services 00 1689993818 0 BEAUDETTE NGUYEN LISA M 2011166 9999999 B 10 1689993818 0 6301 N WESTERN AVE CHICAGO IL 606592009 20 1689993818 0 Dentists Dental Services 20 1689993818 0 Dentists Physician Services 00 1689993883 0 RACSA LORI 2015342 9999999 B 10 1689993883 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1689993883 0 Physicians Anesthesia Services 20 1689993883 0 Physicians Healthy Kids Services 20 1689993883 0 Physicians Optical Supplies 20 1689993883 0 Physicians Physician Services 00 1689994014 0 BRAMHAM AMANDA M 2013246 9999999 B 10 1689994014 0 13100 S DOTY AVE CHICAGO IL 608271597 20 1689994014 0 Physicians All Kids application agent 20 1689994014 0 Physicians Anesthesia Services 20 1689994014 0 Physicians Fluoride varnish 20 1689994014 0 Physicians Healthy Kids Services 20 1689994014 0 Physicians Optical Supplies 20 1689994014 0 Physicians Physician Services 00 1689994162 0 SEARS SAMUEL A 2013196 9999999 B 10 1689994162 0 124 SW ADAMS ST FL 2 PEORIA IL 616021308 20 1689994162 0 Physicians Anesthesia Services 20 1689994162 0 Physicians Healthy Kids Services 20 1689994162 0 Physicians Optical Supplies 20 1689994162 0 Physicians Physician Services 20 1689994162 0 Physicians Physicians Psychiatric Services 00 1689994808 0 WEBB TIMOTHY TONY 2018032 9999999 B 10 1689994808 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1689994808 0 Physicians Anesthesia Services 20 1689994808 0 Physicians Healthy Kids Services 20 1689994808 0 Physicians Optical Supplies 20 1689994808 0 Physicians Physician Services 00 1689995441 0 MCNICKLE ALLISON G 2024155 9999999 B 10 1689995441 0 1800 W CHARLESTON BLVD LAS VEGAS NV 891022329 20 1689995441 0 Physicians Anesthesia Services 20 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Psychiatric Services 00 1699017178 0 LOCONTO ELIZABETH M 2016214 9999999 B 10 1699017178 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1699017178 0 Physicians Anesthesia Services 20 1699017178 0 Physicians Fluoride varnish 20 1699017178 0 Physicians Healthy Kids Services 20 1699017178 0 Physicians Optical Supplies 20 1699017178 0 Physicians Physician Services 00 1699017624 0 RUMORA EMILY L 2016223 9999999 B 10 1699017624 0 15740 S OUTER 40 RD CHESTERFIELD MO 630172004 20 1699017624 0 Physicians Anesthesia Services 20 1699017624 0 Physicians Fluoride varnish 20 1699017624 0 Physicians Healthy Kids Services 20 1699017624 0 Physicians Optical Supplies 20 1699017624 0 Physicians Physician Services 00 1699017715 0 ROSENBERG ARI J 2019114 9999999 B 10 1699017715 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1699017715 0 Physicians Anesthesia Services 20 1699017715 0 Physicians Fluoride varnish 20 1699017715 0 Physicians Healthy Kids Services 20 1699017715 0 Physicians Optical 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Physicians Physician Services 20 1699018317 0 Physicians Physicians Psychiatric Services 00 1699018614 0 TREVINO CHRISTOPHER 2023163 9999999 B 10 1699018614 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1699018614 0 Physicians Anesthesia Services 20 1699018614 0 Physicians Healthy Kids Services 20 1699018614 0 Physicians Optical Supplies 20 1699018614 0 Physicians Physician Services 20 1699018614 0 Physicians Physicians Psychiatric Services 00 1699018689 0 THOMAS JESYKA 2016144 9999999 B 10 1699018689 0 5228 S BLACKSTONE AVE STE Y CHICAGO IL 606154106 20 1699018689 0 Speech Therapists Medical Supplies 20 1699018689 0 Speech Therapists Medical equipment/prosthetic devices 20 1699018689 0 Speech Therapists Speech Therapy/Pathology Services 00 1699020305 0 GOSNELL MICHAEL 2017087 9999999 B 10 1699020305 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1699020305 0 Physical Therapists Medical Supplies 20 1699020305 0 Physical Therapists Medical equipment/prosthetic devices 20 1699020305 0 Physical Therapists Physical Therapy Services 00 1699020776 0 ANBARI HASSAN 2023351 9999999 B 10 1699020776 0 3621 S STATE ST ANN ARBOR MI 481081633 20 1699020776 0 Physicians Anesthesia Services 20 1699020776 0 Physicians Healthy Kids Services 20 1699020776 0 Physicians Optical Supplies 20 1699020776 0 Physicians Physician Services 00 1699020800 0 DZAKA-DIZDAREVIC EMA 2016217 9999999 B 10 1699020800 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1699020800 0 Physicians Anesthesia Services 20 1699020800 0 Physicians Fluoride varnish 20 1699020800 0 Physicians Healthy Kids Services 20 1699020800 0 Physicians Optical Supplies 20 1699020800 0 Physicians Physician Services 00 1699022129 0 WESTMORELAND DANIELLE 2022105 9999999 B 10 1699022129 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1699022129 0 Nurse Practitioners Healthy Kids Services 20 1699022129 0 Nurse Practitioners Nurse Practitioners Services 20 1699022129 0 Nurse Practitioners Physician Services 00 1699023283 0 FRIEBEL JENNIFER 2024337 9999999 B 10 1699023283 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1699023283 0 Nurse Practitioners Healthy Kids Services 20 1699023283 0 Nurse Practitioners Nurse Practitioners Services 20 1699023283 0 Nurse Practitioners Physician Services 00 1699024497 0 RICKERTSEN TIFFANY K 2016118 9999999 B 10 1699024497 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1699024497 0 Nurse Practitioners Fluoride varnish 20 1699024497 0 Nurse Practitioners Healthy Kids Services 20 1699024497 0 Nurse Practitioners Nurse Practitioners Services 20 1699024497 0 Nurse Practitioners Physician Services 00 1699025866 0 LYLE EBONEE 2022353 9999999 B 10 1699025866 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1699025866 0 Clinical Social Worker Social work service 00 1699026302 0 BARSA GEORGE E 2014105 9999999 B 10 1699026302 0 3190 N ELSTON AVE CHICAGO IL 606185845 20 1699026302 0 Dentists Dental Services 20 1699026302 0 Dentists Physician Services 00 1699027391 0 GOSHALIA EESHA 2017090 9999999 B 10 1699027391 0 810 E WOODFIELD RD SCHAUMBURG IL 601734714 20 1699027391 0 Physical Therapists Medical Supplies 20 1699027391 0 Physical Therapists Medical equipment/prosthetic devices 20 1699027391 0 Physical Therapists Physical Therapy Services 00 1699028936 0 BRENNAN KERRY 2019001 9999999 B 10 1699028936 0 4043 S ROUTE 59 NAPERVILLE IL 605645802 20 1699028936 0 Nurse Practitioners Fluoride varnish 20 1699028936 0 Nurse Practitioners Healthy Kids Services 20 1699028936 0 Nurse Practitioners Nurse Practitioners Services 20 1699028936 0 Nurse Practitioners Physician Services 00 1699030379 0 ASHWORTH RACHEL C 2015223 9999999 B 10 1699030379 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1699030379 0 Physicians Anesthesia Services 20 1699030379 0 Physicians Fluoride varnish 20 1699030379 0 Physicians Healthy Kids Services 20 1699030379 0 Physicians Optical Supplies 20 1699030379 0 Physicians Physician Services 00 1699030551 0 KIMPLE DANIEL 2017152 9999999 B 10 1699030551 0 238 S CONGRESS ST RUSHVILLE IL 626811465 20 1699030551 0 Physicians Anesthesia Services 20 1699030551 0 Physicians Healthy Kids Services 20 1699030551 0 Physicians Optical Supplies 20 1699030551 0 Physicians Physician Services 20 1699030551 0 Physicians Physicians Psychiatric Services 00 1699030759 0 TOMBLINSON COURTNEY 2024065 9999999 B 10 1699030759 0 DEPT AT 40379 ATLANTA GA 311920001 20 1699030759 0 Physicians Anesthesia Services 20 1699030759 0 Physicians Healthy Kids Services 20 1699030759 0 Physicians Optical Supplies 20 1699030759 0 Physicians Physician Services 00 1699030882 0 SATZER MICHAEL 2021091 9999999 B 10 1699030882 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1699030882 0 Physicians Anesthesia Services 20 1699030882 0 Physicians Fluoride varnish 20 1699030882 0 Physicians Healthy Kids Services 20 1699030882 0 Physicians Optical Supplies 20 1699030882 0 Physicians Physician Services 00 1699031039 0 WRIGHT MELISSA ADRIANNE 2022306 9999999 B 10 1699031039 0 PO BOX 110429 AURORA CO 800420429 20 1699031039 0 Physicians Anesthesia Services 20 1699031039 0 Physicians Healthy Kids Services 20 1699031039 0 Physicians Optical Supplies 20 1699031039 0 Physicians Physician Services 20 1699031039 0 Physicians Physicians Psychiatric Services 00 1699031583 0 MAZULIS ANDREW A 2018335 9999999 B 10 1699031583 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1699031583 0 Physicians Anesthesia Services 20 1699031583 0 Physicians Fluoride varnish 20 1699031583 0 Physicians Healthy Kids Services 20 1699031583 0 Physicians Optical Supplies 20 1699031583 0 Physicians Physician Services 00 1699032516 0 KUMAR MADAN 2018172 9999999 B 10 1699032516 0 6501 S PROMONTORY DR CHICAGO IL 606491003 20 1699032516 0 Physicians Anesthesia Services 20 1699032516 0 Physicians Fluoride varnish 20 1699032516 0 Physicians Healthy Kids Services 20 1699032516 0 Physicians Optical Supplies 20 1699032516 0 Physicians Physician Services 00 1699033761 0 SHAH AMISHA 2015243 9999999 B 10 1699033761 0 28592 NETWORK PL CHICAGO IL 606731285 20 1699033761 0 Physicians Anesthesia Services 20 1699033761 0 Physicians Fluoride varnish 20 1699033761 0 Physicians Healthy Kids Services 20 1699033761 0 Physicians Optical Supplies 20 1699033761 0 Physicians Physician Services 00 1699034132 0 NETZLY LISA 2012143 9999999 B 10 1699034132 0 2374 SHERMER RD NORTHBROOK IL 600626729 20 1699034132 0 Speech Therapists Medical Supplies 20 1699034132 0 Speech Therapists Medical equipment/prosthetic devices 20 1699034132 0 Speech Therapists Speech Therapy/Pathology Services 00 1699035030 0 WILSON THEODORE E 2018313 9999999 B 10 1699035030 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1699035030 0 Physicians Anesthesia Services 20 1699035030 0 Physicians Fluoride varnish 20 1699035030 0 Physicians Healthy Kids Services 20 1699035030 0 Physicians Optical Supplies 20 1699035030 0 Physicians Physician Services 00 1699036558 0 BARHIGHT MATHEW 2018152 9999999 B 10 1699036558 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1699036558 0 Physicians Anesthesia Services 20 1699036558 0 Physicians Fluoride varnish 20 1699036558 0 Physicians Healthy Kids Services 20 1699036558 0 Physicians Optical Supplies 20 1699036558 0 Physicians Physician Services 00 1699036574 0 GOODLOE JEAN 2016180 9999999 B 10 1699036574 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1699036574 0 Physicians Anesthesia Services 20 1699036574 0 Physicians Healthy Kids Services 20 1699036574 0 Physicians Optical Supplies 20 1699036574 0 Physicians Physician Services 00 1699036731 0 WILLIAMS TIMOTHY J 2016201 9999999 B 10 1699036731 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1699036731 0 Physicians Anesthesia Services 20 1699036731 0 Physicians Fluoride varnish 20 1699036731 0 Physicians Healthy Kids Services 20 1699036731 0 Physicians Optical Supplies 20 1699036731 0 Physicians Physician Services 00 1699038505 0 LIM DIEGO 2022189 9999999 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9999999 B 10 1699299297 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1699299297 0 Physician Assistant Only Fluoride varnish 20 1699299297 0 Physician Assistant Only Healthy Kids Services 20 1699299297 0 Physician Assistant Only Physician Services 00 1699299586 0 SANDERS RENITA J 2019114 9999999 B 10 1699299586 0 1074 W TAYLOR ST STE 238 CHICAGO IL 606074336 20 1699299586 0 Other behavior health professional LCPC/LMFT services 20 1699299586 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1699299776 0 KOSHIYA CHAITALI 2017235 9999999 B 10 1699299776 0 298 W NORTH AVE # 4 VILLA PARK IL 601811159 20 1699299776 0 Dentists Dental Services 20 1699299776 0 Dentists Physician Services 00 1699300087 0 DYKSTRA CARLEY 2024036 9999999 B 10 1699300087 0 9701 W HIGGINS RD STE 270 STE 270 ROSEMONT IL 600184703 20 1699300087 0 Physician Assistant Only Fluoride varnish 20 1699300087 0 Physician Assistant Only Healthy Kids Services 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CHICAGO IL 606731296 20 1699302968 0 Physicians Anesthesia Services 20 1699302968 0 Physicians Healthy Kids Services 20 1699302968 0 Physicians Optical Supplies 20 1699302968 0 Physicians Physician Services 00 1699303016 0 GUEORGUIEVA PAOULA J 2020160 9999999 B 10 1699303016 0 29373 NETWORK PL CHICAGO IL 606733039 20 1699303016 0 Physicians Anesthesia Services 20 1699303016 0 Physicians Healthy Kids Services 20 1699303016 0 Physicians Optical Supplies 20 1699303016 0 Physicians Physician Services 00 1699303040 0 SILVA JONATHAN 2020233 9999999 B 10 1699303040 0 555 WILSON LN DES PLAINES IL 600164729 20 1699303040 0 Physicians Anesthesia Services 20 1699303040 0 Physicians Healthy Kids Services 20 1699303040 0 Physicians Optical Supplies 20 1699303040 0 Physicians Physician Services 20 1699303040 0 Physicians Physicians Psychiatric Services 00 1699303149 0 PETERS XANE 2020216 9999999 B 10 1699303149 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1699303149 0 Physicians Anesthesia Services 20 1699303149 0 Physicians Healthy Kids Services 20 1699303149 0 Physicians Optical Supplies 20 1699303149 0 Physicians Physician Services 00 1699303164 0 KARAMANIS MARINA 2020260 9999999 B 10 1699303164 0 4701 DEPT CAROL STREAM IL 601220021 20 1699303164 0 Physicians Anesthesia Services 20 1699303164 0 Physicians Healthy Kids Services 20 1699303164 0 Physicians Optical Supplies 20 1699303164 0 Physicians Physician Services 00 1699303230 0 HARMAN SARA 2023221 9999999 B 10 1699303230 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1699303230 0 Physicians Anesthesia Services 20 1699303230 0 Physicians Fluoride varnish 20 1699303230 0 Physicians Healthy Kids Services 20 1699303230 0 Physicians Optical Supplies 20 1699303230 0 Physicians Physician Services 00 1699303479 0 PATEL AESHA D 2020219 9999999 B 10 1699303479 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1699303479 0 Physicians Anesthesia Services 20 1699303479 0 Physicians Healthy Kids Services 20 1699303479 0 Physicians Optical Supplies 20 1699303479 0 Physicians Physician Services 00 1699303495 0 ELAHI SHABNAM 2024232 9999999 B 10 1699303495 0 4698 DEPT CAROL STREAM IL 601220021 20 1699303495 0 Physicians Anesthesia Services 20 1699303495 0 Physicians Fluoride varnish 20 1699303495 0 Physicians Healthy Kids Services 20 1699303495 0 Physicians Optical Supplies 20 1699303495 0 Physicians Physician Services 00 1699303693 0 NOLAN KIMBERLY 2023278 9999999 B 10 1699303693 0 750 E TERRA COTTA AVE STE C CRYSTAL LAKE IL 600143621 20 1699303693 0 Podiatrists Podiatric Services 00 1699304048 0 BEAN JERO M 2023156 9999999 B 10 1699304048 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1699304048 0 Physicians Anesthesia Services 20 1699304048 0 Physicians Fluoride varnish 20 1699304048 0 Physicians Healthy Kids Services 20 1699304048 0 Physicians Optical Supplies 20 1699304048 0 Physicians Physician Services 00 1699305136 0 JENAMAN KAILA 2020079 9999999 B 10 1699305136 0 PO BOX 4238 ROCK ISLAND IL 612044238 20 1699305136 0 Nurse Practitioners Healthy Kids Services 20 1699305136 0 Nurse Practitioners Nurse Practitioners Services 20 1699305136 0 Nurse Practitioners Physician Services 00 1699305334 0 SCHUSTER LISA M 2022001 9999999 B 10 1699305334 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1699305334 0 Nurse Practitioners Healthy Kids Services 20 1699305334 0 Nurse Practitioners Nurse Practitioners Services 20 1699305334 0 Nurse Practitioners Physician Services 00 1699307231 0 ZACK BRENNA N 2020084 9999999 B 10 1699307231 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1699307231 0 Nurse Practitioners Healthy Kids Services 20 1699307231 0 Nurse Practitioners Nurse Practitioners Services 20 1699307231 0 Nurse Practitioners Physician Services 00 1699309377 0 MUELLER MARIE L 2020134 9999999 B 10 1699309377 0 PO BOX 4028 ROCK ISLAND IL 612044028 20 1699309377 0 Nurse Practitioners Fluoride varnish 20 1699309377 0 Nurse Practitioners Healthy Kids Services 20 1699309377 0 Nurse Practitioners Nurse Practitioners Services 20 1699309377 0 Nurse Practitioners Physician Services 00 1699310201 0 BROWN ANGELA M 2019318 9999999 B 10 1699310201 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1699310201 0 Nurse Practitioners Healthy Kids Services 20 1699310201 0 Nurse Practitioners Nurse Practitioners Services 20 1699310201 0 Nurse Practitioners Physician Services 00 1699310979 0 SARMIENTO RACHEL 2019323 9999999 B 10 1699310979 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1699310979 0 Nurse Practitioners Healthy Kids Services 20 1699310979 0 Nurse Practitioners Nurse Practitioners Services 20 1699310979 0 Nurse Practitioners Physician Services 00 1699311217 0 VROOM JORI 2021214 9999999 B 10 1699311217 0 2906 HIGHWAY AVE HIGHLAND IN 463221631 20 1699311217 0 Speech Therapists Medical Supplies 20 1699311217 0 Speech Therapists Medical equipment/prosthetic devices 20 1699311217 0 Speech Therapists Speech Therapy/Pathology Services 00 1699313825 0 ROUSHIA SHANA 2020009 9999999 B 10 1699313825 0 119 S WESTERN AVE UNIT 1 CHICAGO IL 606124644 20 1699313825 0 Nurse Practitioners Fluoride varnish 20 1699313825 0 Nurse Practitioners Healthy Kids Services 20 1699313825 0 Nurse Practitioners Nurse Practitioners Services 20 1699313825 0 Nurse Practitioners Physician Services 00 1699313981 0 BAUGHER JESSICA L 2020021 9999999 B 10 1699313981 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1699313981 0 Nurse Practitioners Fluoride varnish 20 1699313981 0 Nurse Practitioners Healthy Kids Services 20 1699313981 0 Nurse Practitioners Nurse Practitioners Services 20 1699313981 0 Nurse Practitioners Physician Services 00 1699314377 0 JENNINGS RACHEL K 2020233 9999999 B 10 1699314377 0 4714 GETTYSBURG RD MECHANICSBURG PA 170554325 20 1699314377 0 Speech Therapists Medical Supplies 20 1699314377 0 Speech Therapists Medical equipment/prosthetic devices 20 1699314377 0 Speech Therapists Speech Therapy/Pathology Services 00 1699316588 0 GOLDEN-BARNETT MELISSA 2019282 9999999 B 10 1699316588 0 350 BLAIR LN BOLINGBROOK IL 604401801 20 1699316588 0 Nurse Practitioners Family Planning Counseling 20 1699316588 0 Nurse Practitioners Fluoride varnish 20 1699316588 0 Nurse Practitioners Healthy Kids Services 20 1699316588 0 Nurse Practitioners Nurse Practitioners Services 20 1699316588 0 Nurse Practitioners Physician Services 00 1699316877 0 GLENN TERRY 2019274 9999999 B 10 1699316877 0 1003 MARTIN LUTHER KING DR BLOOMINGTON IL 617011429 20 1699316877 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1699317107 0 ZIADE ZEINA T 2022131 9999999 B 10 1699317107 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1699317107 0 Physician Assistant Only Fluoride varnish 20 1699317107 0 Physician Assistant Only Healthy Kids Services 20 1699317107 0 Physician Assistant Only Physician Services 00 1699317131 0 WOODS CASSIDY 2023151 9999999 B 10 1699317131 0 105 W A ST BELLEVILLE IL 622201326 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GREIDER CAMILLE 2022054 9999999 B 10 1699319004 0 PO BOX 955860 SAINT LOUIS MO 631955860 20 1699319004 0 Nurse Practitioners Fluoride varnish 20 1699319004 0 Nurse Practitioners Healthy Kids Services 20 1699319004 0 Nurse Practitioners Nurse Practitioners Services 20 1699319004 0 Nurse Practitioners Physician Services 00 1699319111 0 RUMBAUGH ELIZABETH 2023284 9999999 B 10 1699319111 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1699319111 0 Speech Therapists Medical Supplies 20 1699319111 0 Speech Therapists Medical equipment/prosthetic devices 20 1699319111 0 Speech Therapists Speech Therapy/Pathology Services 00 1699319723 0 LUDWIKOWSKA PATRICIA D 2020028 9999999 B 10 1699319723 0 9500 BRYN MAWR AVE STE 300 ROSEMONT IL 600185257 20 1699319723 0 Nurse Practitioners Fluoride varnish 20 1699319723 0 Nurse Practitioners Healthy Kids Services 20 1699319723 0 Nurse Practitioners Nurse Practitioners Services 20 1699319723 0 Nurse Practitioners Physician Services 00 1699320234 0 RINCKER 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1500 S DOUGLAS RD STE 230 CORAL GABLES FL 331344108 20 1699325605 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1699327304 0 MADDEN ANN 2019284 9999999 B 10 1699327304 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1699327304 0 Nurse Practitioners Anesthesia Services 20 1699327304 0 Nurse Practitioners Nurse Practitioners Services 20 1699327304 0 Nurse Practitioners Physician Services 00 1699327528 0 BERGERON BRYCE 2022289 9999999 B 10 1699327528 0 PO BOX 43230 PHOENIX AZ 850803230 20 1699327528 0 Physicians Anesthesia Services 20 1699327528 0 Physicians Healthy Kids Services 20 1699327528 0 Physicians Optical Supplies 20 1699327528 0 Physicians Physician Services 00 1699328666 0 WU ARIEL D 2019280 9999999 B 10 1699328666 0 5700 SOUTHWYCK BLVD TOLEDO OH 436141509 20 1699328666 0 Physicians Anesthesia Services 20 1699328666 0 Physicians Healthy Kids Services 20 1699328666 0 Physicians Optical Supplies 20 1699328666 0 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Anesthesia Services 20 1699331736 0 Physicians Fluoride varnish 20 1699331736 0 Physicians Healthy Kids Services 20 1699331736 0 Physicians Optical Supplies 20 1699331736 0 Physicians Physician Services 00 1699331835 0 VEGA CARLOS A 2024183 9999999 B 10 1699331835 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1699331835 0 Physicians Anesthesia Services 20 1699331835 0 Physicians Healthy Kids Services 20 1699331835 0 Physicians Optical Supplies 20 1699331835 0 Physicians Physician Services 00 1699332411 0 BAXTER QUANEICEY 2022192 9999999 B 10 1699332411 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1699332411 0 Physicians Anesthesia Services 20 1699332411 0 Physicians Fluoride varnish 20 1699332411 0 Physicians Healthy Kids Services 20 1699332411 0 Physicians Optical Supplies 20 1699332411 0 Physicians Physician Services 00 1699333245 0 RASHID SABIR 2019289 9999999 B 10 1699333245 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1699333245 0 Physicians Anesthesia Services 20 1699333245 0 Physicians Fluoride varnish 20 1699333245 0 Physicians Healthy Kids Services 20 1699333245 0 Physicians Optical Supplies 20 1699333245 0 Physicians Physician Services 00 1699333476 0 PATEL REEMA 2020001 9999999 B 10 1699333476 0 5777 DEPT CAROL STREAM IL 601220021 20 1699333476 0 Physicians Anesthesia Services 20 1699333476 0 Physicians Fluoride varnish 20 1699333476 0 Physicians Healthy Kids Services 20 1699333476 0 Physicians Optical Supplies 20 1699333476 0 Physicians Physician Services 00 1699333872 0 LINDAL BRIANNE M 2019165 9999999 B 10 1699333872 0 15118 W AUSTIN DR LOCKPORT IL 604411331 20 1699333872 0 Occupational Therapists Medical Supplies 20 1699333872 0 Occupational Therapists Medical equipment/prosthetic devices 20 1699333872 0 Occupational Therapists Occupational Therapy Services 00 1699334086 0 CHAMBERS BRANDON 2019182 9999999 B 10 1699334086 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1699334086 0 Physicians Anesthesia Services 20 1699334086 0 Physicians Healthy Kids Services 20 1699334086 0 Physicians Optical Supplies 20 1699334086 0 Physicians Physician Services 00 1699334367 0 MAHMOOD IRUM 2023344 9999999 B 10 1699334367 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1699334367 0 Physicians Anesthesia Services 20 1699334367 0 Physicians Fluoride varnish 20 1699334367 0 Physicians Healthy Kids Services 20 1699334367 0 Physicians Optical Supplies 20 1699334367 0 Physicians Physician Services 00 1699334557 0 MCGOWAN JESSICA L 2022287 9999999 B 10 1699334557 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1699334557 0 Nurse Practitioners Healthy Kids Services 20 1699334557 0 Nurse Practitioners Nurse Practitioners Services 20 1699334557 0 Nurse Practitioners Physician Services 00 1699334755 0 POPESCU RAZVAN D 2024016 9999999 B 10 1699334755 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1699334755 0 Physicians Anesthesia Services 20 1699334755 0 Physicians Healthy Kids Services 20 1699334755 0 Physicians Optical Supplies 20 1699334755 0 Physicians Physician Services 20 1699334755 0 Physicians Physicians Psychiatric Services 00 1699335018 0 ZIMMERMAN DINA L 2022005 9999999 B 10 1699335018 0 8019 RIDGEWAY AVE STE E SKOKIE IL 600763408 20 1699335018 0 Nurse Practitioners Fluoride varnish 20 1699335018 0 Nurse Practitioners Healthy Kids Services 20 1699335018 0 Nurse Practitioners Nurse Practitioners Services 20 1699335018 0 Nurse Practitioners Physician Services 00 1699335323 0 GRITHER WHITNEY 2019291 9999999 B 10 1699335323 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1699335323 0 Physicians Anesthesia Services 20 1699335323 0 Physicians Healthy Kids Services 20 1699335323 0 Physicians Optical Supplies 20 1699335323 0 Physicians Physician Services 00 1699336164 0 MAHOOFZ FAISAL 2025057 9999999 B 10 1699336164 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1699336164 0 Physicians Anesthesia Services 20 1699336164 0 Physicians Fluoride varnish 20 1699336164 0 Physicians Healthy Kids Services 20 1699336164 0 Physicians Optical Supplies 20 1699336164 0 Physicians Physician Services 00 1699336446 0 HURTTE EDWARD 2019161 9999999 B 10 1699336446 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1699336446 0 Physicians Anesthesia Services 20 1699336446 0 Physicians Healthy Kids Services 20 1699336446 0 Physicians Optical Supplies 20 1699336446 0 Physicians Physician Services 00 1699337329 0 HERNANDEZ ROSE M 2022307 9999999 B 10 1699337329 0 675 W NORTH AVE STE 309 MELROSE PARK IL 601601623 20 1699337329 0 Nurse Practitioners Fluoride varnish 20 1699337329 0 Nurse Practitioners Healthy Kids Services 20 1699337329 0 Nurse Practitioners Nurse Practitioners Services 20 1699337329 0 Nurse Practitioners Physician Services 00 1699337683 0 MAHMOOD RIZWAN 2020014 9999999 B 10 1699337683 0 29373 NETWORK PL CHICAGO IL 606733039 20 1699337683 0 Physicians Anesthesia Services 20 1699337683 0 Physicians Fluoride varnish 20 1699337683 0 Physicians Healthy Kids Services 20 1699337683 0 Physicians Optical Supplies 20 1699337683 0 Physicians Physician Services 00 1699338566 0 BUTZ MELANIE A 2022180 9999999 B 10 1699338566 0 PO BOX 778912 CHICAGO IL 606778912 20 1699338566 0 Physicians Anesthesia Services 20 1699338566 0 Physicians Fluoride varnish 20 1699338566 0 Physicians Healthy Kids Services 20 1699338566 0 Physicians Optical Supplies 20 1699338566 0 Physicians Physician Services 00 1699339093 0 ROSSI DAVID 2024134 9999999 B 10 1699339093 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1699339093 0 Physicians Anesthesia Services 20 1699339093 0 Physicians Healthy Kids Services 20 1699339093 0 Physicians Optical Supplies 20 1699339093 0 Physicians Physician Services 00 1699339895 0 FAUX NANCY 2023124 9999999 B 10 1699339895 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1699339895 0 Physicians Anesthesia Services 20 1699339895 0 Physicians Healthy Kids Services 20 1699339895 0 Physicians Optical Supplies 20 1699339895 0 Physicians Physician Services 00 1699339978 0 GONZALEZ AUTUMN 2020020 9999999 B 10 1699339978 0 2560 24TH ST STE 101 ROCK ISLAND IL 612015389 20 1699339978 0 Other behavior health professional LCPC/LMFT services 00 1699340018 0 KOVDRYN NATALIYA 2021307 9999999 B 10 1699340018 0 64 SHEFFIELD LN OAK BROOK IL 605232354 20 1699340018 0 Nurse Practitioners Healthy Kids Services 20 1699340018 0 Nurse Practitioners Nurse Practitioners Services 20 1699340018 0 Nurse Practitioners Physician Services 00 1699340687 0 WU KEVIN 2022179 9999999 B 10 1699340687 0 PO BOX 855795 MINNEAPOLIS MN 554851296 20 1699340687 0 Physicians Anesthesia Services 20 1699340687 0 Physicians Fluoride varnish 20 1699340687 0 Physicians Healthy Kids Services 20 1699340687 0 Physicians Optical Supplies 20 1699340687 0 Physicians Physician Services 00 1699340828 0 LOZANO ARVIZU FRANCISCO J 2021222 9999999 B 10 1699340828 0 3249 OAK PARK AVE BERWYN IL 604023429 20 1699340828 0 Physicians Anesthesia Services 20 1699340828 0 Physicians Fluoride varnish 20 1699340828 0 Physicians Healthy Kids Services 20 1699340828 0 Physicians Optical Supplies 20 1699340828 0 Physicians Physician Services 00 1699340984 0 MARKO MELISSA 2021256 9999999 B 10 1699340984 0 PO BOX 60352 SAINT LOUIS MO 631600352 20 1699340984 0 Audiologists Audiology Services 20 1699340984 0 Audiologists Medical Supplies 20 1699340984 0 Audiologists Medical equipment/prosthetic devices 00 1699342519 0 SETHUPATHI SHEETAL K 2022144 9999999 B 10 1699342519 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1699342519 0 Physicians Anesthesia Services 20 1699342519 0 Physicians Healthy Kids Services 20 1699342519 0 Physicians Optical Supplies 20 1699342519 0 Physicians Physician Services 00 1699342618 0 AL KADHIM NOORI 2022212 9999999 B 10 1699342618 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1699342618 0 Physicians Anesthesia Services 20 1699342618 0 Physicians Healthy Kids Services 20 1699342618 0 Physicians Optical Supplies 20 1699342618 0 Physicians Physician Services 00 1699342667 0 KRZYSCIAK MALLORY 2021197 9999999 B 10 1699342667 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1699342667 0 Speech Therapists Medical Supplies 20 1699342667 0 Speech Therapists Medical equipment/prosthetic devices 20 1699342667 0 Speech Therapists Speech Therapy/Pathology Services 00 1699342741 0 MCCOY SEVERIN LYDELL 2022305 9999999 B 10 1699342741 0 2050 E ALGONQUIN RD STE 610 SCHAUMBURG IL 601734166 20 1699342741 0 Dentists Dental Services 20 1699342741 0 Dentists Physician Services 00 1699343400 0 SMOLEN ALYSSA M 2021336 9999999 B 10 1699343400 0 124 SW ADAMS ST PEORIA IL 616021308 20 1699343400 0 Nurse Practitioners Fluoride varnish 20 1699343400 0 Nurse Practitioners Healthy Kids Services 20 1699343400 0 Nurse Practitioners Nurse Practitioners Services 20 1699343400 0 Nurse Practitioners Physician Services 00 1699343855 0 SHEA LANDON 2024094 9999999 B 10 1699343855 0 515 22ND AVE MONROE WI 535661569 20 1699343855 0 Physicians Anesthesia Services 20 1699343855 0 Physicians Fluoride varnish 20 1699343855 0 Physicians Healthy Kids Services 20 1699343855 0 Physicians Optical Supplies 20 1699343855 0 Physicians Physician Services 00 1699343939 0 DANIEL EDWARD 2021207 9999999 B 10 1699343939 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1699343939 0 Physicians Anesthesia Services 20 1699343939 0 Physicians Fluoride varnish 20 1699343939 0 Physicians Healthy Kids Services 20 1699343939 0 Physicians Optical Supplies 20 1699343939 0 Physicians Physician Services 00 1699344069 0 OUTHMAN BASMA 2023261 9999999 B 10 1699344069 0 7667 W 95TH ST STE 209 HICKORY HILLS IL 604572281 20 1699344069 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1699344994 0 KARADEMIR IBRAHIM 2021183 9999999 B 10 1699344994 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1699344994 0 Physicians Anesthesia Services 20 1699344994 0 Physicians Healthy Kids 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20 1699352922 0 Physicians Fluoride varnish 20 1699352922 0 Physicians Healthy Kids Services 20 1699352922 0 Physicians Optical Supplies 20 1699352922 0 Physicians Physician Services 00 1699353284 0 MANDICH MADALYN 2024235 9999999 B 10 1699353284 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1699353284 0 Physicians Anesthesia Services 20 1699353284 0 Physicians Healthy Kids Services 20 1699353284 0 Physicians Optical Supplies 20 1699353284 0 Physicians Physician Services 00 1699353425 0 SMITH MELANIE 2022188 9999999 B 10 1699353425 0 4025 N SHERIDAN RD CHICAGO IL 606132010 20 1699353425 0 Nurse Practitioners Fluoride varnish 20 1699353425 0 Nurse Practitioners Healthy Kids Services 20 1699353425 0 Nurse Practitioners Nurse Practitioners Services 20 1699353425 0 Nurse Practitioners Physician Services 00 1699353581 0 HILL MATTHEW R 2021229 9999999 B 10 1699353581 0 5777 DEPT CAROL STREAM IL 601220021 20 1699353581 0 Physicians Anesthesia Services 20 1699353581 0 Physicians 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Physicians Anesthesia Services 20 1699355131 0 Physicians Fluoride varnish 20 1699355131 0 Physicians Healthy Kids Services 20 1699355131 0 Physicians Optical Supplies 20 1699355131 0 Physicians Physician Services 00 1699355396 0 UZOARU CHIJIOKE 2021189 9999999 B 10 1699355396 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1699355396 0 Physicians Anesthesia Services 20 1699355396 0 Physicians Healthy Kids Services 20 1699355396 0 Physicians Optical Supplies 20 1699355396 0 Physicians Physician Services 00 1699356030 0 SUBASHCHANDRAN VARUN 2021179 9999999 B 10 1699356030 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1699356030 0 Physicians Anesthesia Services 20 1699356030 0 Physicians Fluoride varnish 20 1699356030 0 Physicians Healthy Kids Services 20 1699356030 0 Physicians Optical Supplies 20 1699356030 0 Physicians Physician Services 00 1699356196 0 NWABA ADAURE 2022174 9999999 B 10 1699356196 0 4698 DEPT CAROL STREAM IL 601220021 20 1699356196 0 Physicians Anesthesia 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1699358184 0 Nurse Practitioners Nurse Practitioners Services 20 1699358184 0 Nurse Practitioners Physician Services 00 1699358226 0 WINFIELD TOYIA 2021131 9999999 B 10 1699358226 0 5220 EAST AVE STE 1 COUNTRYSIDE IL 605253133 20 1699358226 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1699358234 0 BRYANT QUINLAND 2022021 9999999 B 10 1699358234 0 PO BOX 75098 CHICAGO IL 606755098 20 1699358234 0 Nurse Practitioners Anesthesia Services 20 1699358234 0 Nurse Practitioners Nurse Practitioners Services 20 1699358234 0 Nurse Practitioners Physician Services 00 1699359240 0 WOOD BRITTA N 2021250 9999999 B 10 1699359240 0 5979 NEBESHONE LN ROCKFORD IL 611038926 20 1699359240 0 Nurse Practitioners Healthy Kids Services 20 1699359240 0 Nurse Practitioners Nurse Practitioners Services 20 1699359240 0 Nurse Practitioners Physician Services 00 1699359695 0 ZEIDAN TAMAM 2022157 9999999 B 10 1699359695 0 9701 W HIGGINS RD STE 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1699422857 0 Nurse Practitioners Healthy Kids Services 20 1699422857 0 Nurse Practitioners Nurse Practitioners Services 20 1699422857 0 Nurse Practitioners Physician Services 00 1699422907 0 DICKSTEIN ALEXA 2022138 9999999 B 10 1699422907 0 1311 MAMARONECK AVE STE 140 WHITE PLAINS NY 106055224 20 1699422907 0 Occupational Therapists Medical Supplies 20 1699422907 0 Occupational Therapists Medical equipment/prosthetic devices 20 1699422907 0 Occupational Therapists Occupational Therapy Services 00 1699422980 0 LENIHAN KYLE 2024040 9999999 B 10 1699422980 0 611 W PARK ST URBANA IL 618012529 20 1699422980 0 Physical Therapists Medical Supplies 20 1699422980 0 Physical Therapists Medical equipment/prosthetic devices 20 1699422980 0 Physical Therapists Physical Therapy Services 00 1699423061 0 LIN MICHELLE 2023229 9999999 B 10 1699423061 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1699423061 0 Physicians Anesthesia Services 20 1699423061 0 Physicians Fluoride varnish 20 1699423061 0 Physicians Healthy Kids Services 20 1699423061 0 Physicians Optical Supplies 20 1699423061 0 Physicians Physician Services 00 1699424051 0 SHAIKH NIDA 2023205 9999999 B 10 1699424051 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1699424051 0 Physicians Anesthesia Services 20 1699424051 0 Physicians Healthy Kids Services 20 1699424051 0 Physicians Optical Supplies 20 1699424051 0 Physicians Physician Services 00 1699424077 0 ARGANA TOM C 2022221 9999999 B 10 1699424077 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1699424077 0 Physicians Anesthesia Services 20 1699424077 0 Physicians Fluoride varnish 20 1699424077 0 Physicians Healthy Kids Services 20 1699424077 0 Physicians Optical Supplies 20 1699424077 0 Physicians Physician Services 00 1699424200 0 WHITCOMB CODY RONALD 2022179 9999999 B 10 1699424200 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1699424200 0 Physicians Anesthesia Services 20 1699424200 0 Physicians Fluoride varnish 20 1699424200 0 Physicians Healthy Kids Services 20 1699424200 0 Physicians Optical Supplies 20 1699424200 0 Physicians Physician Services 00 1699424234 0 PIETRYKOWSKI JOHN W 2022171 9999999 B 10 1699424234 0 4698 DEPT CAROL STREAM IL 601220021 20 1699424234 0 Physicians Anesthesia Services 20 1699424234 0 Physicians Fluoride varnish 20 1699424234 0 Physicians Healthy Kids Services 20 1699424234 0 Physicians Optical Supplies 20 1699424234 0 Physicians Physician Services 00 1699424846 0 HIRCH YONATAN 2022175 9999999 B 10 1699424846 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1699424846 0 Physicians Anesthesia Services 20 1699424846 0 Physicians Fluoride varnish 20 1699424846 0 Physicians Healthy Kids Services 20 1699424846 0 Physicians Optical Supplies 20 1699424846 0 Physicians Physician Services 00 1699425173 0 KYI ALEXANDER L 2022182 9999999 B 10 1699425173 0 4698 DEPT CAROL STREAM IL 601220021 20 1699425173 0 Physicians Anesthesia Services 20 1699425173 0 Physicians Fluoride varnish 20 1699425173 0 Physicians Healthy Kids Services 20 1699425173 0 Physicians Optical Supplies 20 1699425173 0 Physicians Physician Services 00 1699425215 0 WALBRIDGE JENNIFER 2022167 9999999 H 10 1699425215 0 411 E PARK ST STE 106 CHAMPAIGN IL 618203862 20 1699425215 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1699425603 0 KASCHKE SARAH 2022207 9999999 B 10 1699425603 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1699425603 0 Physicians Anesthesia Services 20 1699425603 0 Physicians Fluoride varnish 20 1699425603 0 Physicians Healthy Kids Services 20 1699425603 0 Physicians Optical Supplies 20 1699425603 0 Physicians Physician Services 00 1699428854 0 PYTLOWANY EMMALYNNE N 2022075 9999999 B 10 1699428854 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1699428854 0 Physician Assistant Only Fluoride varnish 20 1699428854 0 Physician Assistant Only Healthy Kids Services 20 1699428854 0 Physician Assistant Only Physician Services 00 1699430934 0 HAMIE LAMIAA 2022019 9999999 B 10 1699430934 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1699430934 0 Physicians Anesthesia Services 20 1699430934 0 Physicians Healthy Kids Services 20 1699430934 0 Physicians Optical Supplies 20 1699430934 0 Physicians Physician Services 00 1699431056 0 WHITTIER KYLE M 2023234 9999999 B 10 1699431056 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1699431056 0 Physician Assistant Only Fluoride varnish 20 1699431056 0 Physician Assistant Only Healthy Kids Services 20 1699431056 0 Physician Assistant Only Physician Services 00 1699431064 0 WILSON SHILOH 2022363 9999999 B 10 1699431064 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1699431064 0 Speech Therapists Medical Supplies 20 1699431064 0 Speech Therapists Medical equipment/prosthetic devices 20 1699431064 0 Speech Therapists Speech Therapy/Pathology Services 00 1699434266 0 VEGA SULLY 2022069 9999999 B 10 1699434266 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1699434266 0 Nurse Practitioners Fluoride varnish 20 1699434266 0 Nurse Practitioners Healthy Kids Services 20 1699434266 0 Nurse Practitioners Nurse Practitioners Services 20 1699434266 0 Nurse Practitioners Physician Services 00 1699434563 0 BOYER TORI 2022031 9999999 B 10 1699434563 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1699434563 0 Nurse Practitioners Fluoride varnish 20 1699434563 0 Nurse Practitioners Healthy Kids Services 20 1699434563 0 Nurse Practitioners Nurse Practitioners Services 20 1699434563 0 Nurse Practitioners Physician Services 00 1699435438 0 WATERS DANIEL S 2022073 9999999 B 10 1699435438 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1699435438 0 Other behavior health professional LCPC/LMFT services 00 1699436113 0 PATEL BINITA M 2022010 9999999 B 10 1699436113 0 2720 W DIVISION ST CHICAGO IL 606222853 20 1699436113 0 Nurse Practitioners Fluoride varnish 20 1699436113 0 Nurse Practitioners Healthy Kids Services 20 1699436113 0 Nurse Practitioners Nurse Practitioners Services 20 1699436113 0 Nurse Practitioners Physician Services 00 1699436436 0 BARROW JANELLI K 2023188 9999999 B 10 1699436436 0 5777 DEPT CAROL STREAM IL 601220021 20 1699436436 0 Nurse Practitioners Healthy Kids Services 20 1699436436 0 Nurse Practitioners Midwife Services 20 1699436436 0 Nurse Practitioners Nurse Practitioners Services 20 1699436436 0 Nurse Practitioners Physician Services 00 1699436949 0 GUGALA VICTORIA A 2022056 9999999 B 10 1699436949 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1699436949 0 Physician Assistant Only Fluoride varnish 20 1699436949 0 Physician Assistant Only Healthy Kids Services 20 1699436949 0 Physician Assistant Only Physician Services 00 1699437194 0 GARCIA YANEZ MARIA FERNANDA 2025006 9999999 B 10 1699437194 0 1411 N CAMPBELL AVE CHICAGO IL 606221753 20 1699437194 0 Other behavior health professional Adaptive behavior support clinician services 20 1699437194 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1699438697 0 MIERKOWSKI ASHLEY 2023058 9999999 B 10 1699438697 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1699438697 0 Nurse Practitioners Fluoride varnish 20 1699438697 0 Nurse Practitioners Healthy Kids Services 20 1699438697 0 Nurse Practitioners Nurse Practitioners Services 20 1699438697 0 Nurse Practitioners Physician Services 00 1699439752 0 EDOIGIAWERIE OLUWAKEMI 2021312 9999999 B 10 1699439752 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1699439752 0 Nurse Practitioners Fluoride varnish 20 1699439752 0 Nurse Practitioners Healthy Kids Services 20 1699439752 0 Nurse Practitioners Nurse Practitioners Services 20 1699439752 0 Nurse Practitioners Physician Services 00 1699439968 0 WINNING STACI R 2023019 9999999 B 10 1699439968 0 1818 N 6TH ST TERRE HAUTE IN 478044021 20 1699439968 0 Nurse Practitioners Healthy Kids Services 20 1699439968 0 Nurse Practitioners Nurse Practitioners Services 20 1699439968 0 Nurse Practitioners Physician Services 00 1699440404 0 ANTUNEZ PABLO 2021239 9999999 H 10 1699440404 0 721 N LA SALLE DR CHICAGO IL 606543503 20 1699440404 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1699440891 0 SERNA BECKY D 2021242 9999999 B 10 1699440891 0 1940 S WESTERN AVE STE 205 CHICAGO IL 606082503 20 1699440891 0 Nurse Practitioners Fluoride varnish 20 1699440891 0 Nurse Practitioners Healthy Kids Services 20 1699440891 0 Nurse Practitioners Nurse Practitioners Services 20 1699440891 0 Nurse Practitioners Physician Services 00 1699441485 0 HERSCHELMAN BRIANNA M 2021235 9999999 B 10 1699441485 0 PO BOX 448 LITCHFIELD IL 620560448 20 1699441485 0 Speech Therapists Medical Supplies 20 1699441485 0 Speech Therapists Medical equipment/prosthetic devices 20 1699441485 0 Speech Therapists Speech Therapy/Pathology Services 00 1699441931 0 NINKOVSKA TEODORA 2021328 9999999 B 10 1699441931 0 370 SUMMIT ST # 1 ELGIN IL 601203843 20 1699441931 0 Nurse Practitioners Fluoride varnish 20 1699441931 0 Nurse Practitioners Healthy Kids Services 20 1699441931 0 Nurse Practitioners Nurse Practitioners Services 20 1699441931 0 Nurse Practitioners Physician Services 00 1699442509 0 CHENG STEPHANIE E 2023257 9999999 B 10 1699442509 0 2506 N CLARK ST # 158 CHICAGO IL 606141848 20 1699442509 0 Speech Therapists Medical Supplies 20 1699442509 0 Speech Therapists Medical equipment/prosthetic devices 20 1699442509 0 Speech Therapists Speech Therapy/Pathology Services 00 1699445502 0 BENISCH CLAIRE E 2022206 9999999 B 10 1699445502 0 4450 48TH AVENUE CT ROCK ISLAND IL 612019213 20 1699445502 0 Speech Therapists Medical Supplies 20 1699445502 0 Speech Therapists Medical equipment/prosthetic devices 20 1699445502 0 Speech Therapists Speech Therapy/Pathology Services 00 1699447755 0 YOUNG ANIYAH E 2021277 9999999 B 10 1699447755 0 14840 SHEPARD DR DOLTON IL 604192467 20 1699447755 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1699448928 0 HOOPER PATRICIA A 2021221 9999999 B 10 1699448928 0 618 W MAIN ST TEUTOPOLIS IL 624671210 20 1699448928 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1699449819 0 HAMPTON DANIELLE 2021223 9999999 B 10 1699449819 0 212 BARNEY DR JOLIET IL 604355271 20 1699449819 0 Occupational Therapists Medical Supplies 20 1699449819 0 Occupational Therapists Medical equipment/prosthetic devices 20 1699449819 0 Occupational Therapists Occupational Therapy Services 00 1699450692 0 SIDDIQUE FAAIZA 2024193 9999999 B 10 1699450692 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1699450692 0 Physicians Anesthesia Services 20 1699450692 0 Physicians Healthy Kids Services 20 1699450692 0 Physicians Optical Supplies 20 1699450692 0 Physicians Physician Services 00 1699450890 0 GADALLAH ABDELRAHMAN M 2024143 9999999 B 10 1699450890 0 6420 CLAYTON RD SAINT LOUIS MO 631171811 20 1699450890 0 Physicians Anesthesia Services 20 1699450890 0 Physicians Fluoride varnish 20 1699450890 0 Physicians Healthy Kids Services 20 1699450890 0 Physicians Optical Supplies 20 1699450890 0 Physicians Physician Services 00 1699451039 0 HAMLET HANNAH 2023208 9999999 B 10 1699451039 0 3010 GRAND AVE WAUKEGAN IL 600852321 20 1699451039 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1699452722 0 EVANGELOPOULOS ANJELIKA A 2023219 9999999 B 10 1699452722 0 PO BOX 3039 OAK BROOK IL 605223039 20 1699452722 0 Physicians Anesthesia Services 20 1699452722 0 Physicians Fluoride varnish 20 1699452722 0 Physicians Healthy Kids Services 20 1699452722 0 Physicians Optical Supplies 20 1699452722 0 Physicians Physician Services 00 1699453829 0 GLUNZ MELYSSA 2023262 9999999 B 10 1699453829 0 8940 N WOOD SAGE RD PEORIA IL 616157822 20 1699453829 0 Nurse Practitioners Fluoride varnish 20 1699453829 0 Nurse Practitioners Healthy Kids Services 20 1699453829 0 Nurse Practitioners Nurse Practitioners Services 20 1699453829 0 Nurse Practitioners Physician Services 00 1699453852 0 MALINOWSKI ERIN 2023193 9999999 B 10 1699453852 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1699453852 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1699454363 0 ROBINSON IMANI D 2023206 9999999 B 10 1699454363 0 5113 S HARPER AVE STE 2C CHICAGO IL 606154119 20 1699454363 0 Other behavior health professional Adaptive behavior support clinician services 00 1699454819 0 AL-HAMDAN OLIVIA 2023262 9999999 B 10 1699454819 0 PO BOX 775253 CHICAGO IL 606775253 20 1699454819 0 Nurse Practitioners Fluoride varnish 20 1699454819 0 Nurse Practitioners Healthy Kids Services 20 1699454819 0 Nurse Practitioners Nurse Practitioners Services 20 1699454819 0 Nurse Practitioners Physician Services 00 1699455295 0 BIONDO VICTORIA 2024170 9999999 B 10 1699455295 0 3832 N LINCOLN AVE CHICAGO IL 606133520 20 1699455295 0 Nurse Practitioners Fluoride varnish 20 1699455295 0 Nurse Practitioners Healthy Kids Services 20 1699455295 0 Nurse Practitioners Midwife Services 20 1699455295 0 Nurse Practitioners Nurse Practitioners Services 20 1699455295 0 Nurse Practitioners Physician Services 00 1699455592 0 WEBER TYLER D 2024190 9999999 B 10 1699455592 0 6742 N FROSTWOOD PKWY PEORIA IL 616152402 20 1699455592 0 Nurse Practitioners Anesthesia Services 20 1699455592 0 Nurse Practitioners Nurse Practitioners Services 20 1699455592 0 Nurse Practitioners Physician Services 00 1699457226 0 TRAINOR SYDNEY 2023341 9999999 B 10 1699457226 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1699457226 0 Physician Assistant Only Fluoride varnish 20 1699457226 0 Physician Assistant Only Healthy Kids Services 20 1699457226 0 Physician Assistant Only Physician Services 00 1699457572 0 BLUMSTEIN ALYSSA 2024152 9999999 B 10 1699457572 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1699457572 0 Physician Assistant Only Fluoride varnish 20 1699457572 0 Physician Assistant Only Healthy Kids Services 20 1699457572 0 Physician Assistant Only Physician Services 00 1699459636 0 ANDERSON MICHAEL V 2023165 9999999 B 10 1699459636 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1699459636 0 Nurse Practitioners Healthy Kids Services 20 1699459636 0 Nurse Practitioners Nurse Practitioners Services 20 1699459636 0 Nurse Practitioners Physician Services 00 1699459834 0 KAPADIA MURTI 2024019 9999999 B 10 1699459834 0 17W679 ROOSEVELT RD OAKBROOK TERRAC IL 601813545 20 1699459834 0 Dentists Dental Services 20 1699459834 0 Dentists Physician Services 00 1699460121 0 OWOYEMI SHOLA A 2024029 9999999 B 10 1699460121 0 20855 S LAGRANGE RD STE 205 FRANKFORT IL 604232043 20 1699460121 0 Nurse Practitioners Healthy Kids Services 20 1699460121 0 Nurse Practitioners Nurse Practitioners Services 20 1699460121 0 Nurse Practitioners Physician Services 00 1699460766 0 DUHAMEL SHAELYNN 2023298 9999999 B 10 1699460766 0 124 SW ADAMS ST PEORIA IL 616021308 20 1699460766 0 Physicians Anesthesia Services 20 1699460766 0 Physicians Healthy Kids Services 20 1699460766 0 Physicians Optical Supplies 20 1699460766 0 Physicians Physician Services 00 1699460923 0 CAPOTOSTI MADISON B 2024241 9999999 B 10 1699460923 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1699460923 0 Physicians Anesthesia Services 20 1699460923 0 Physicians Fluoride varnish 20 1699460923 0 Physicians Healthy Kids Services 20 1699460923 0 Physicians Optical Supplies 20 1699460923 0 Physicians Physician Services 00 1699460956 0 TARIB IMANE 2024047 9999999 B 10 1699460956 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1699460956 0 Physicians Anesthesia Services 20 1699460956 0 Physicians Healthy Kids Services 20 1699460956 0 Physicians Optical Supplies 20 1699460956 0 Physicians Physician Services 00 1699461749 0 PAHAN PRIYANKA 2024163 9999999 B 10 1699461749 0 4701 DEPT CAROL STREAM IL 601220021 20 1699461749 0 Physicians Anesthesia Services 20 1699461749 0 Physicians Fluoride varnish 20 1699461749 0 Physicians Healthy Kids Services 20 1699461749 0 Physicians Optical Supplies 20 1699461749 0 Physicians Physician Services 00 1699461889 0 HILL SAMUEL L 2023194 9999999 B 10 1699461889 0 PO BOX 775248 CHICAGO IL 606775248 20 1699461889 0 Physicians Anesthesia Services 20 1699461889 0 Physicians Fluoride varnish 20 1699461889 0 Physicians Healthy Kids Services 20 1699461889 0 Physicians Optical Supplies 20 1699461889 0 Physicians Physician Services 00 1699462168 0 DETTMER ALEXIS J 2023115 9999999 B 10 1699462168 0 793 N MAIN ST GLEN ELLYN IL 601373900 20 1699462168 0 Speech Therapists Medical Supplies 20 1699462168 0 Speech Therapists Medical equipment/prosthetic devices 20 1699462168 0 Speech Therapists Speech Therapy/Pathology Services 00 1699464735 0 PECORIN PAUL J 2023205 9999999 B 10 1699464735 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1699464735 0 Physicians Anesthesia Services 20 1699464735 0 Physicians Fluoride varnish 20 1699464735 0 Physicians Healthy Kids Services 20 1699464735 0 Physicians Optical Supplies 20 1699464735 0 Physicians Physician Services 00 1699465492 0 PARIKH MEGHA D 2023159 9999999 B 10 1699465492 0 5777 DEPT CAROL STREAM IL 601220021 20 1699465492 0 Physical Therapists Medical Supplies 20 1699465492 0 Physical Therapists Medical equipment/prosthetic devices 20 1699465492 0 Physical Therapists Physical Therapy Services 00 1699466649 0 ZUCCHETTI ELISA 2023300 9999999 B 10 1699466649 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1699466649 0 Physicians Anesthesia Services 20 1699466649 0 Physicians Fluoride varnish 20 1699466649 0 Physicians Healthy Kids Services 20 1699466649 0 Physicians Optical Supplies 20 1699466649 0 Physicians Physician Services 00 1699467118 0 HOMANN MCCLAIN 2023143 9999999 B 10 1699467118 0 215 RED COACH DR MISHAWAKA IN 465458307 20 1699467118 0 Other behavior health professional Adaptive behavior support technician services 20 1699467118 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1699468249 0 ATANGAN JOSEPH A 2023187 9999999 B 10 1699468249 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1699468249 0 Physicians Anesthesia Services 20 1699468249 0 Physicians Healthy Kids Services 20 1699468249 0 Physicians Optical Supplies 20 1699468249 0 Physicians Physician Services 00 1699469205 0 BEECHLER JENNIFER 2025047 9999999 B 10 1699469205 0 4121 UNION RD STE 225 SAINT LOUIS MO 631291093 20 1699469205 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1699469395 0 HAYES MIRENA 2023188 9999999 B 10 1699469395 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1699469395 0 Physicians Anesthesia Services 20 1699469395 0 Physicians Healthy Kids Services 20 1699469395 0 Physicians Optical Supplies 20 1699469395 0 Physicians Physician Services 00 1699470054 0 GUPTA MEGHA 2024046 9999999 B 10 1699470054 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1699470054 0 Physicians Anesthesia Services 20 1699470054 0 Physicians Healthy Kids Services 20 1699470054 0 Physicians Optical Supplies 20 1699470054 0 Physicians Physician Services 00 1699470443 0 MITROLLARI KRISTJANA 2023182 9999999 B 10 1699470443 0 PO BOX 3039 OAK BROOK IL 605223039 20 1699470443 0 Physicians Anesthesia Services 20 1699470443 0 Physicians Fluoride varnish 20 1699470443 0 Physicians Healthy Kids Services 20 1699470443 0 Physicians Optical Supplies 20 1699470443 0 Physicians Physician Services 00 1699472282 0 SKINNER RYAN 2023194 9999999 B 10 1699472282 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1699472282 0 Physicians Anesthesia Services 20 1699472282 0 Physicians Fluoride varnish 20 1699472282 0 Physicians Healthy Kids Services 20 1699472282 0 Physicians Optical Supplies 20 1699472282 0 Physicians Physician Services 00 1699472308 0 AGNEW KRYSTAL J 2024229 9999999 B 10 1699472308 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1699472308 0 Nurse Practitioners Fluoride varnish 20 1699472308 0 Nurse Practitioners Healthy Kids Services 20 1699472308 0 Nurse Practitioners Nurse Practitioners Services 20 1699472308 0 Nurse Practitioners Physician Services 00 1699472589 0 APPLEBAUM SAMUEL 2023223 9999999 B 10 1699472589 0 1414 MAIN ST MELROSE PARK IL 601603902 20 1699472589 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1699473900 0 LAWLER ELIZABETH A 2023164 9999999 B 10 1699473900 0 619 E MASON ST STE 4P57 SPRINGFIELD IL 627011034 20 1699473900 0 Nurse Practitioners Fluoride varnish 20 1699473900 0 Nurse Practitioners Healthy Kids Services 20 1699473900 0 Nurse Practitioners Nurse Practitioners Services 20 1699473900 0 Nurse Practitioners Physician Services 00 1699475723 0 LEE JERELYN 2023083 9999999 B 10 1699475723 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1699475723 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1699476804 0 BRUCE LEXIS M 2023216 9999999 B 10 1699476804 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1699476804 0 Nurse Practitioners Anesthesia Services 20 1699476804 0 Nurse Practitioners Nurse Practitioners Services 20 1699476804 0 Nurse Practitioners Physician Services 00 1699477117 0 MISHKOV YELENA 2023191 9999999 B 10 1699477117 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1699477117 0 Physicians Anesthesia Services 20 1699477117 0 Physicians Healthy Kids Services 20 1699477117 0 Physicians Optical Supplies 20 1699477117 0 Physicians Physician Services 00 1699478438 0 SAID EBRAM 2023262 9999999 B 10 1699478438 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1699478438 0 Physicians Anesthesia Services 20 1699478438 0 Physicians Fluoride varnish 20 1699478438 0 Physicians Healthy Kids Services 20 1699478438 0 Physicians Optical Supplies 20 1699478438 0 Physicians Physician Services 00 1699479071 0 BIGGERS AMBER N 2023265 9999999 B 10 1699479071 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1699479071 0 Nurse Practitioners Fluoride varnish 20 1699479071 0 Nurse Practitioners Healthy Kids Services 20 1699479071 0 Nurse Practitioners Nurse Practitioners Services 20 1699479071 0 Nurse Practitioners Physician Services 00 1699479865 0 LE DAVID 2023201 9999999 B 10 1699479865 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1699479865 0 Physicians Anesthesia Services 20 1699479865 0 Physicians Healthy Kids Services 20 1699479865 0 Physicians Optical Supplies 20 1699479865 0 Physicians Physician Services 00 1699483099 0 LANG MISTY 2023195 9999999 B 10 1699483099 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1699483099 0 Physicians Anesthesia Services 20 1699483099 0 Physicians Healthy Kids Services 20 1699483099 0 Physicians Optical Supplies 20 1699483099 0 Physicians Physician Services 00 1699483677 0 AGOSTO VIVIAN 2022313 9999999 B 10 1699483677 0 5220 EAST AVE COUNTRYSIDE IL 605253133 20 1699483677 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1699483990 0 ZAK SOFYA 2023009 9999999 B 10 1699483990 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1699483990 0 Nurse Practitioners Fluoride varnish 20 1699483990 0 Nurse Practitioners Healthy Kids Services 20 1699483990 0 Nurse Practitioners Nurse Practitioners Services 20 1699483990 0 Nurse Practitioners Physician Services 00 1699484162 0 DAVIS BRENDA S 2023360 9999999 B 10 1699484162 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1699484162 0 Clinical Social Worker Social work service 00 1699484485 0 WACLAW AGNIESZKA M 2023010 9999999 B 10 1699484485 0 PO BOX 775253 CHICAGO IL 606775253 20 1699484485 0 Nurse Practitioners Healthy Kids Services 20 1699484485 0 Nurse Practitioners Nurse Practitioners Services 20 1699484485 0 Nurse Practitioners Physician Services 00 1699484980 0 ANICH ALLISON 2022327 9999999 B 10 1699484980 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1699484980 0 Clinical Social Worker Social work service 00 1699485524 0 KHAN ANETA 2024324 9999999 B 10 1699485524 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1699485524 0 Clinical Social Worker Social work service 00 1699485631 0 ADAMSICK ALEXIS 2023034 9999999 B 10 1699485631 0 5777 DEPT CAROL STREAM IL 601220021 20 1699485631 0 Nurse Practitioners Fluoride varnish 20 1699485631 0 Nurse Practitioners Healthy Kids Services 20 1699485631 0 Nurse Practitioners Nurse Practitioners Services 20 1699485631 0 Nurse Practitioners Physician Services 00 1699486407 0 ENGLISH JENNA 2023055 9999999 B 10 1699486407 0 111 OAKWOOD RD EAST PEORIA IL 616111853 20 1699486407 0 Nurse Practitioners Fluoride varnish 20 1699486407 0 Nurse Practitioners Healthy Kids Services 20 1699486407 0 Nurse Practitioners Nurse Practitioners Services 20 1699486407 0 Nurse Practitioners Physician Services 00 1699486472 0 BEDNARZ NINA 2022346 9999999 B 10 1699486472 0 122 S MICHIGAN AVE STE 1441 CHICAGO IL 606036173 20 1699486472 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1699486936 0 ATILGAN DENIZ 2025014 9999999 B 10 1699486936 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1699486936 0 Physicians Anesthesia Services 20 1699486936 0 Physicians Healthy Kids Services 20 1699486936 0 Physicians Optical Supplies 20 1699486936 0 Physicians Physician Services 20 1699486936 0 Physicians Physicians Psychiatric Services 00 1699488197 0 BEARD MAYA 2022363 9999999 B 10 1699488197 0 PO BOX 1109 DEKALB IL 601157109 20 1699488197 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1699489773 0 RYAN ERIN E 2023012 9999999 B 10 1699489773 0 1025 MAINE ST QUINCY IL 623014038 20 1699489773 0 Occupational Therapists Medical Supplies 20 1699489773 0 Occupational Therapists Medical equipment/prosthetic devices 20 1699489773 0 Occupational Therapists Occupational Therapy Services 00 1699490284 0 COLVIN WALLACE 2024136 9999999 B 10 1699490284 0 2866 N MILWAUKEE AVE CHICAGO IL 606187413 20 1699490284 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1699492819 0 MCMILLIAN JAMES 2025045 9999999 B 10 1699492819 0 655 W IRVING PARK RD APT 4304 CHICAGO IL 606136300 20 1699492819 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1699493320 0 REISING BROOKE A 2023017 9999999 B 10 1699493320 0 5229 W 105TH PL STE 150 OAK LAWN IL 604535145 20 1699493320 0 Nurse Practitioners Fluoride varnish 20 1699493320 0 Nurse Practitioners Healthy Kids Services 20 1699493320 0 Nurse Practitioners Nurse Practitioners Services 20 1699493320 0 Nurse Practitioners Physician Services 00 1699493833 0 DEE MEGHAN 2022239 9999999 B 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Services 20 1699510230 0 Physicians Optical Supplies 20 1699510230 0 Physicians Physician Services 00 1699510784 0 NASIR OMAR 2024218 9999999 B 10 1699510784 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1699510784 0 Physicians Anesthesia Services 20 1699510784 0 Physicians Fluoride varnish 20 1699510784 0 Physicians Healthy Kids Services 20 1699510784 0 Physicians Optical Supplies 20 1699510784 0 Physicians Physician Services 00 1699511279 0 WILSON HAYDEN 2024239 9999999 B 10 1699511279 0 PO BOX 79591 BALTIMORE MD 212790591 20 1699511279 0 Optometrists Optical Supplies 20 1699511279 0 Optometrists Optometric Services 20 1699511279 0 Optometrists Physician Services 00 1699511766 0 HARDIEK LAURA 2024198 9999999 B 10 1699511766 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1699511766 0 Nurse Practitioners Fluoride varnish 20 1699511766 0 Nurse Practitioners Healthy Kids Services 20 1699511766 0 Nurse Practitioners Nurse Practitioners Services 20 1699511766 0 Nurse Practitioners Physician Services 00 1699512095 0 LEGANSKI LAUREN 2024233 9999999 B 10 1699512095 0 PO BOX 702 MONTGOMERY IL 605380702 20 1699512095 0 Speech Therapists Medical Supplies 20 1699512095 0 Speech Therapists Medical equipment/prosthetic devices 20 1699512095 0 Speech Therapists Speech Therapy/Pathology Services 00 1699515593 0 WITTEN HOLLY E 2024234 9999999 B 10 1699515593 0 520 MARY ST STE 520 EVANSVILLE IN 477101682 20 1699515593 0 Physician Assistant Only Fluoride varnish 20 1699515593 0 Physician Assistant Only Healthy Kids Services 20 1699515593 0 Physician Assistant Only Physician Services 00 1699518175 0 NASH ALYSON L 2024169 9999999 B 10 1699518175 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1699518175 0 Nurse Practitioners Fluoride varnish 20 1699518175 0 Nurse Practitioners Healthy Kids Services 20 1699518175 0 Nurse Practitioners Nurse Practitioners Services 20 1699518175 0 Nurse Practitioners Physician Services 00 1699519157 0 SWEENEY ALLISON M 2024192 9999999 B 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1699521328 0 Nurse Practitioners Fluoride varnish 20 1699521328 0 Nurse Practitioners Healthy Kids Services 20 1699521328 0 Nurse Practitioners Nurse Practitioners Services 20 1699521328 0 Nurse Practitioners Physician Services 00 1699521997 0 DREWELOW ALYSSA 2024177 9999999 B 10 1699521997 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1699521997 0 Physicians Anesthesia Services 20 1699521997 0 Physicians Healthy Kids Services 20 1699521997 0 Physicians Optical Supplies 20 1699521997 0 Physicians Physician Services 00 1699522342 0 OKABE YUDAI 2024193 9999999 B 10 1699522342 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1699522342 0 Physicians Anesthesia Services 20 1699522342 0 Physicians Fluoride varnish 20 1699522342 0 Physicians Healthy Kids Services 20 1699522342 0 Physicians Optical Supplies 20 1699522342 0 Physicians Physician Services 00 1699525121 0 OMMEN HAYDAN E 2024106 9999999 B 10 1699525121 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1699525121 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9999999 B 10 1699705293 0 11115 NEW HALLS FERRY RD FLORISSANT MO 630337613 20 1699705293 0 Physicians Anesthesia Services 20 1699705293 0 Physicians Fluoride varnish 20 1699705293 0 Physicians Healthy Kids Services 20 1699705293 0 Physicians Optical Supplies 20 1699705293 0 Physicians Physician Services 00 1699705491 0 MEHROTRA AVANTI 2024093 9999999 B 10 1699705491 0 3300 OAKDALE AVE N ROBBINSDALE MN 554222926 20 1699705491 0 Physicians Anesthesia Services 20 1699705491 0 Physicians Fluoride varnish 20 1699705491 0 Physicians Healthy Kids Services 20 1699705491 0 Physicians Optical Supplies 20 1699705491 0 Physicians Physician Services 00 1699705764 0 ANSANI MICHAEL 2022021 9999999 B 10 1699705764 0 2741 W LAYTON AVE MILWAUKEE WI 532212600 20 1699705764 0 Physicians Anesthesia Services 20 1699705764 0 Physicians Fluoride varnish 20 1699705764 0 Physicians Healthy Kids Services 20 1699705764 0 Physicians Optical Supplies 20 1699705764 0 Physicians Physician Services 00 1699706101 0 BAUTISTA CATALINO 2002305 9999999 B 10 1699706101 0 5455 W NORTH AVE CHICAGO IL 606394346 20 1699706101 0 Physicians Anesthesia Services 20 1699706101 0 Physicians Fluoride varnish 20 1699706101 0 Physicians Healthy Kids Services 20 1699706101 0 Physicians Optical Supplies 20 1699706101 0 Physicians Physician Services 00 1699706523 0 AKHTAR SAMEENA 1995001 9999999 B 10 1699706523 0 29373 NETWORK PL CHICAGO IL 606733039 20 1699706523 0 Physicians Anesthesia Services 20 1699706523 0 Physicians Fluoride varnish 20 1699706523 0 Physicians Healthy Kids Services 20 1699706523 0 Physicians Optical Supplies 20 1699706523 0 Physicians Physician Services 00 1699706820 0 SWEE ROBERT J 1990091 9999999 B 10 1699706820 0 5777 DEPT CAROL STREAM IL 601220021 20 1699706820 0 Physicians Anesthesia Services 20 1699706820 0 Physicians Healthy Kids Services 20 1699706820 0 Physicians Optical Supplies 20 1699706820 0 Physicians Physician Services 00 1699707638 0 WHITWORTH JOHN R 2017061 9999999 B 10 1699707638 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1699707638 0 Physicians Anesthesia Services 20 1699707638 0 Physicians Fluoride varnish 20 1699707638 0 Physicians Healthy Kids Services 20 1699707638 0 Physicians Optical Supplies 20 1699707638 0 Physicians Physician Services 00 1699707851 0 SABAHAT ALVIA 2005001 9999999 B 10 1699707851 0 9211 WAUKEGAN RD MORTON GROVE IL 600532102 20 1699707851 0 Physicians Anesthesia Services 20 1699707851 0 Physicians Fluoride varnish 20 1699707851 0 Physicians Healthy Kids Services 20 1699707851 0 Physicians Optical Supplies 20 1699707851 0 Physicians Physician Services 00 1699708149 0 LEVERENTZ TODD M 1983122 9999999 B 10 1699708149 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1699708149 0 Physicians Anesthesia Services 20 1699708149 0 Physicians Fluoride varnish 20 1699708149 0 Physicians Healthy Kids Services 20 1699708149 0 Physicians Optical Supplies 20 1699708149 0 Physicians Physician Services 00 1699708271 0 LIPSCHER RANDOLPH B 2012017 9999999 B 10 1699708271 0 PO BOX 776084 CHICAGO IL 606776084 20 1699708271 0 Physicians Anesthesia Services 20 1699708271 0 Physicians Healthy Kids Services 20 1699708271 0 Physicians Optical Supplies 20 1699708271 0 Physicians Physician Services 00 1699708636 0 LUCIETTO-SIERADZKI THERESE M 2001213 9999999 B 10 1699708636 0 205 CADILLAC CT STE 7 BELVIDERE IL 610081733 20 1699708636 0 Physicians Anesthesia Services 20 1699708636 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1699708636 0 Physicians Fluoride varnish 20 1699708636 0 Physicians Healthy Kids Services 20 1699708636 0 Physicians Optical Supplies 20 1699708636 0 Physicians Physician Services 00 1699710178 0 PETERSIDE IYALLA 2005074 9999999 B 10 1699710178 0 100 E PENN SQ FL 9 PHILADELPHIA PA 191073377 20 1699710178 0 Physicians Anesthesia Services 20 1699710178 0 Physicians Fluoride varnish 20 1699710178 0 Physicians Healthy Kids Services 20 1699710178 0 Physicians Optical Supplies 20 1699710178 0 Physicians Physician Services 00 1699710319 0 NEESE KEVIN D 1998182 9999999 B 10 1699710319 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1699710319 0 Physicians Anesthesia Services 20 1699710319 0 Physicians Fluoride varnish 20 1699710319 0 Physicians Healthy Kids Services 20 1699710319 0 Physicians Optical Supplies 20 1699710319 0 Physicians Physician Services 00 1699711648 0 GERVAIS JACQUELINE Y 1987213 9999999 B 10 1699711648 0 9119 S EXCHANGE AVE CHICAGO IL 606174225 20 1699711648 0 Physicians Anesthesia Services 20 1699711648 0 Physicians Healthy Kids Services 20 1699711648 0 Physicians Optical Supplies 20 1699711648 0 Physicians Physician Services 00 1699712646 0 FERGUSON MICHAEL A 2022213 9999999 B 10 1699712646 0 300 LONGWOOD AVE BOSTON MA 021155724 20 1699712646 0 Physicians Anesthesia Services 20 1699712646 0 Physicians Fluoride varnish 20 1699712646 0 Physicians Healthy Kids Services 20 1699712646 0 Physicians Optical Supplies 20 1699712646 0 Physicians Physician Services 00 1699713347 0 GEWARGES PAULA C 1995221 9999999 B 10 1699713347 0 28594 NETWORK PL CHICAGO IL 606731285 20 1699713347 0 Physicians Anesthesia Services 20 1699713347 0 Physicians Healthy Kids Services 20 1699713347 0 Physicians Optical Supplies 20 1699713347 0 Physicians Physician Services 20 1699713347 0 Physicians Physicians Psychiatric Services 00 1699714790 0 THOMPSON LISA 2006086 9999999 B 10 1699714790 0 3241 S MICHIGAN AVE CHICAGO IL 606164201 20 1699714790 0 Physicians Anesthesia Services 20 1699714790 0 Physicians Healthy Kids Services 20 1699714790 0 Physicians Optical Supplies 20 1699714790 0 Physicians Physician Services 00 1699714907 0 GIBSON MARY E 2006152 9999999 B 10 1699714907 0 4749 LINCOLN MALL DR STE 204 MATTESON IL 604433806 20 1699714907 0 Nurse Practitioners Healthy Kids Services 20 1699714907 0 Nurse Practitioners Nurse Practitioners Services 20 1699714907 0 Nurse Practitioners Physician Services 00 1699715441 0 KOKOCHAROV STOYAN 2009032 9999999 B 10 1699715441 0 2500 W HIGGINS RD STE 910 HOFFMAN ESTATES IL 601692048 20 1699715441 0 Physicians Anesthesia Services 20 1699715441 0 Physicians Healthy Kids Services 20 1699715441 0 Physicians Optical Supplies 20 1699715441 0 Physicians Physician Services 00 1699715870 0 DOMBROWSKI ANTHONY 1989152 9999999 B 10 1699715870 0 520 E 22ND ST LOMBARD IL 601486110 20 1699715870 0 Physicians Anesthesia Services 20 1699715870 0 Physicians Healthy Kids Services 20 1699715870 0 Physicians Optical Supplies 20 1699715870 0 Physicians Physician Services 00 1699717363 0 MAES EARL 2006182 9999999 B 10 1699717363 0 111 OAKWOOD RD EAST PEORIA IL 616111853 20 1699717363 0 Physicians Anesthesia Services 20 1699717363 0 Physicians Healthy Kids Services 20 1699717363 0 Physicians Optical Supplies 20 1699717363 0 Physicians Physician Services 00 1699717413 0 EVALEN VAL Z 1995310 9999999 B 10 1699717413 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1699717413 0 Physicians Anesthesia Services 20 1699717413 0 Physicians Healthy Kids Services 20 1699717413 0 Physicians Optical Supplies 20 1699717413 0 Physicians Physician Services 00 1699718692 0 BARTON LAURA P 2005182 9999999 B 10 1699718692 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1699718692 0 Physicians Anesthesia Services 20 1699718692 0 Physicians Fluoride varnish 20 1699718692 0 Physicians Healthy Kids Services 20 1699718692 0 Physicians Optical Supplies 20 1699718692 0 Physicians Physician Services 00 1699719971 0 GIAIMO NANCY S 2011001 9999999 B 10 1699719971 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1699719971 0 Nurse Practitioners Fluoride varnish 20 1699719971 0 Nurse Practitioners Healthy Kids Services 20 1699719971 0 Nurse Practitioners Nurse Practitioners Services 20 1699719971 0 Nurse Practitioners Physician Services 00 1699720144 0 MARCOTTE GARY A 1981227 9999999 B 10 1699720144 0 15900 W 101ST AVE DYER IN 463113065 20 1699720144 0 Physicians Anesthesia Services 20 1699720144 0 Physicians Fluoride varnish 20 1699720144 0 Physicians Healthy Kids Services 20 1699720144 0 Physicians Optical Supplies 20 1699720144 0 Physicians Physician Services 00 1699720300 0 JAVED BADR 2004001 9999999 B 10 1699720300 0 1120 N MELVIN ST GIBSON CITY IL 609361477 20 1699720300 0 Physicians Anesthesia Services 20 1699720300 0 Physicians Healthy Kids Services 20 1699720300 0 Physicians Optical Supplies 20 1699720300 0 Physicians Physician Services 20 1699720300 0 Physicians Physicians Psychiatric Services 00 1699720896 0 ALMUSADDY MOUSAB 2010152 9999999 B 10 1699720896 0 29373 NETWORK PL CHICAGO IL 606733039 20 1699720896 0 Physicians Anesthesia Services 20 1699720896 0 Physicians Fluoride varnish 20 1699720896 0 Physicians Healthy Kids Services 20 1699720896 0 Physicians Optical Supplies 20 1699720896 0 Physicians Physician Services 00 1699720938 0 MCGUIRE KENT B 1987305 9999999 B 10 1699720938 0 29373 NETWORK PL CHICAGO IL 606733039 20 1699720938 0 Physicians Anesthesia Services 20 1699720938 0 Physicians Fluoride varnish 20 1699720938 0 Physicians Healthy Kids Services 20 1699720938 0 Physicians Optical Supplies 20 1699720938 0 Physicians Physician Services 00 1699721142 0 MADAPPALLIL MEERA G 2001258 9999999 B 10 1699721142 0 2425 W 22ND ST STE 211 OAK BROOK IL 605234657 20 1699721142 0 Physicians Anesthesia Services 20 1699721142 0 Physicians Fluoride varnish 20 1699721142 0 Physicians Healthy Kids Services 20 1699721142 0 Physicians Optical Supplies 20 1699721142 0 Physicians Physician Services 00 1699721472 0 DAVIDSON JEFFREY 2021146 9999999 B 10 1699721472 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1699721472 0 Physicians Anesthesia Services 20 1699721472 0 Physicians Healthy Kids Services 20 1699721472 0 Physicians Optical Supplies 20 1699721472 0 Physicians Physician Services 00 1699722777 0 JOO MIN J 2005182 9999999 B 10 1699722777 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1699722777 0 Physicians Anesthesia Services 20 1699722777 0 Physicians Fluoride varnish 20 1699722777 0 Physicians Healthy Kids Services 20 1699722777 0 Physicians Optical Supplies 20 1699722777 0 Physicians Physician Services 00 1699723247 0 ARCHDEACON MICHAEL 2018021 9999999 B 10 1699723247 0 2830 VICTORY PKWY STE 119 CINCINNATI OH 452061785 20 1699723247 0 Physicians Anesthesia Services 20 1699723247 0 Physicians Healthy Kids Services 20 1699723247 0 Physicians Optical Supplies 20 1699723247 0 Physicians Physician Services 00 1699723478 0 WESTERHEIDE ROBERT 2015155 9999999 B 10 1699723478 0 621 S NEW BALLAS RD STE 228A SAINT LOUIS MO 631418256 20 1699723478 0 Nurse Practitioners Healthy Kids Services 20 1699723478 0 Nurse Practitioners Nurse Practitioners Services 20 1699723478 0 Nurse Practitioners Physician Services 00 1699723486 0 KHAJA AZAMUDDIN 2023332 9999999 B 10 1699723486 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1699723486 0 Physicians Anesthesia Services 20 1699723486 0 Physicians Fluoride varnish 20 1699723486 0 Physicians Healthy Kids Services 20 1699723486 0 Physicians Optical Supplies 20 1699723486 0 Physicians Physician Services 00 1699723890 0 DMELLO DAYTON 2006158 9999999 B 10 1699723890 0 621 S NEW BALLAS RD STE 7020 SAINT LOUIS MO 631418232 20 1699723890 0 Physicians Anesthesia Services 20 1699723890 0 Physicians Fluoride varnish 20 1699723890 0 Physicians Healthy Kids Services 20 1699723890 0 Physicians Optical Supplies 20 1699723890 0 Physicians Physician Services 00 1699723965 0 CARDONE BRUCE 1991182 9999999 B 10 1699723965 0 PO BOX 857 FREEPORT IL 610320857 20 1699723965 0 Physicians Anesthesia Services 20 1699723965 0 Physicians Healthy Kids Services 20 1699723965 0 Physicians Optical Supplies 20 1699723965 0 Physicians Physician Services 00 1699724070 0 MARTINI SEIF 1994182 9999999 B 10 1699724070 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1699724070 0 Physicians Anesthesia Services 20 1699724070 0 Physicians Fluoride varnish 20 1699724070 0 Physicians Healthy Kids Services 20 1699724070 0 Physicians Optical Supplies 20 1699724070 0 Physicians Physician Services 00 1699724138 0 LATCHAMSETTY KALYAN 2006001 9999999 B 10 1699724138 0 2000 OGDEN AVE AURORA IL 605047222 20 1699724138 0 Physicians Anesthesia Services 20 1699724138 0 Physicians Healthy Kids Services 20 1699724138 0 Physicians Optical Supplies 20 1699724138 0 Physicians Physician Services 00 1699724161 0 WARRIER MANOJ 2008245 9999999 B 10 1699724161 0 PO BOX 874797 KANSAS CITY MO 641874797 20 1699724161 0 Physicians Anesthesia Services 20 1699724161 0 Physicians Fluoride varnish 20 1699724161 0 Physicians Healthy Kids Services 20 1699724161 0 Physicians Optical Supplies 20 1699724161 0 Physicians Physician Services 00 1699724211 0 OKE KERI D 2002134 9999999 B 10 1699724211 0 1261 AVERILL DR BATAVIA IL 605104500 20 1699724211 0 Audiologists Audiology Services 20 1699724211 0 Audiologists Medical Supplies 20 1699724211 0 Audiologists Medical equipment/prosthetic devices 00 1699724773 0 FUECHTMAN MARGARET 2007158 9999999 B 10 1699724773 0 8558 BROADWAY MERRILLVILLE IN 464107032 20 1699724773 0 Nurse Practitioners Anesthesia Services 20 1699724773 0 Nurse Practitioners Nurse Practitioners Services 20 1699724773 0 Nurse Practitioners Physician Services 00 1699724930 0 FAHMY EMAD 1994001 9999999 B 10 1699724930 0 1005 BROADWAY ST QUINCY IL 623012834 20 1699724930 0 Physicians Anesthesia Services 20 1699724930 0 Physicians Fluoride varnish 20 1699724930 0 Physicians Healthy Kids Services 20 1699724930 0 Physicians Optical Supplies 20 1699724930 0 Physicians Physician Services 00 1699725549 0 KUHNS ERIC 2000153 9999999 B 10 1699725549 0 101 E MILLER RD STERLING IL 610811252 20 1699725549 0 Physicians Anesthesia Services 20 1699725549 0 Physicians Fluoride varnish 20 1699725549 0 Physicians Healthy Kids Services 20 1699725549 0 Physicians Optical Supplies 20 1699725549 0 Physicians Physician Services 00 1699725903 0 KHOLOMYANSKY BORIS 2022053 9999999 B 10 1699725903 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1699725903 0 Physicians Anesthesia Services 20 1699725903 0 Physicians Healthy Kids Services 20 1699725903 0 Physicians Optical Supplies 20 1699725903 0 Physicians Physician Services 20 1699725903 0 Physicians Physicians Psychiatric Services 00 1699726505 0 SCURLOCK WILLIAM 1984124 9999999 B 10 1699726505 0 110 S 17TH ST SAINT CHARLES IL 601742526 20 1699726505 0 Physicians Anesthesia Services 20 1699726505 0 Physicians Fluoride varnish 20 1699726505 0 Physicians Healthy Kids Services 20 1699726505 0 Physicians Optical Supplies 20 1699726505 0 Physicians Physician Services 00 1699726547 0 FRANCO JOSE 1997199 9999999 B 10 1699726547 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1699726547 0 Physicians Anesthesia Services 20 1699726547 0 Physicians Fluoride varnish 20 1699726547 0 Physicians Healthy Kids Services 20 1699726547 0 Physicians Optical Supplies 20 1699726547 0 Physicians Physician Services 00 1699727503 0 MCINERNEY JOHN V 1985182 9999999 B 10 1699727503 0 11824 SOUTHWEST HWY PALOS HEIGHTS IL 604631055 20 1699727503 0 Physicians Anesthesia Services 20 1699727503 0 Physicians Healthy Kids Services 20 1699727503 0 Physicians Optical Supplies 20 1699727503 0 Physicians Physician Services 00 1699727800 0 EVANS HELEN L 2006065 9999999 B 10 1699727800 0 1525 E 53RD ST STE 533 CHICAGO IL 606154530 20 1699727800 0 Psychologist Psychologist service 00 1699728485 0 GRIESEMER ROBERT W 1982244 9999999 B 10 1699728485 0 387 SHUMAN BLVD STE 240W NAPERVILLE IL 605638113 20 1699728485 0 Physicians Anesthesia Services 20 1699728485 0 Physicians Healthy Kids Services 20 1699728485 0 Physicians Optical Supplies 20 1699728485 0 Physicians Physician Services 00 1699728667 0 CAUDILL KAREN A 2002274 9999999 B 10 1699728667 0 11475 OLDE CABIN RD STE 200 SAINT LOUIS MO 631417129 20 1699728667 0 Physicians Anesthesia Services 20 1699728667 0 Physicians Healthy Kids Services 20 1699728667 0 Physicians Optical Supplies 20 1699728667 0 Physicians Physician Services 00 1699728881 0 PACE STEVEN A 2021260 9999999 B 10 1699728881 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1699728881 0 Physicians Anesthesia Services 20 1699728881 0 Physicians Healthy Kids Services 20 1699728881 0 Physicians Optical Supplies 20 1699728881 0 Physicians Physician Services 00 1699730200 0 O'HARA CHRISTINE M 2017352 9999999 B 10 1699730200 0 3248 VANDEVER AVE PEKIN IL 615546257 20 1699730200 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1699732305 0 FOGELFELD LEON A 1993232 9999999 B 10 1699732305 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1699732305 0 Physicians Anesthesia Services 20 1699732305 0 Physicians Healthy Kids Services 20 1699732305 0 Physicians Optical Supplies 20 1699732305 0 Physicians Physician Services 00 1699732529 0 WETHAL KATY 2008275 9999999 B 10 1699732529 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1699732529 0 Nurse Practitioners Fluoride varnish 20 1699732529 0 Nurse Practitioners Healthy Kids Services 20 1699732529 0 Nurse Practitioners Nurse Practitioners Services 20 1699732529 0 Nurse Practitioners Physician Services 00 1699732925 0 PARKEY JOE E 2012092 9999999 B 10 1699732925 0 11995 SINGLETREE LN STE 500 SUITE 500 EDEN PRAIRIE MN 553445349 20 1699732925 0 Physicians Anesthesia Services 20 1699732925 0 Physicians Healthy Kids Services 20 1699732925 0 Physicians Optical Supplies 20 1699732925 0 Physicians Physician Services 00 1699733063 0 MYERS LUCAS 2023236 9999999 B 10 1699733063 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1699733063 0 Physical Therapists Medical Supplies 20 1699733063 0 Physical Therapists Medical equipment/prosthetic devices 20 1699733063 0 Physical Therapists Physical Therapy Services 00 1699733188 0 CHIAO GENE Z 1995159 9999999 B 10 1699733188 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1699733188 0 Physicians Anesthesia Services 20 1699733188 0 Physicians Fluoride varnish 20 1699733188 0 Physicians Healthy Kids Services 20 1699733188 0 Physicians Optical Supplies 20 1699733188 0 Physicians Physician Services 00 1699733691 0 ZUKOWSKA DANUTA 2006032 9999999 B 10 1699733691 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1699733691 0 Physicians Anesthesia Services 20 1699733691 0 Physicians Fluoride varnish 20 1699733691 0 Physicians Healthy Kids Services 20 1699733691 0 Physicians Optical Supplies 20 1699733691 0 Physicians Physician Services 00 1699734582 0 CHILSON KELLY L 2006182 9999999 B 10 1699734582 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1699734582 0 Physicians Anesthesia Services 20 1699734582 0 Physicians Healthy Kids Services 20 1699734582 0 Physicians Optical Supplies 20 1699734582 0 Physicians Physician Services 00 1699735316 0 FERGUSON THIMJON 1998173 2099364 B 10 1699735316 0 PO BOX 1085 EVANSVILLE IN 477061085 20 1699735316 0 Physicians Anesthesia Services 20 1699735316 0 Physicians Healthy Kids Services 20 1699735316 0 Physicians Optical Supplies 20 1699735316 0 Physicians Physician Services 00 1699735795 0 SPEARS CHESTER A 2024054 9999999 B 10 1699735795 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1699735795 0 Physicians Anesthesia Services 20 1699735795 0 Physicians Healthy Kids Services 20 1699735795 0 Physicians Optical Supplies 20 1699735795 0 Physicians Physician Services 00 1699735860 0 PAIGE TODD E 2023045 9999999 B 10 1699735860 0 850 HARVARD WAY # MST5 RENO NV 895022055 20 1699735860 0 Physicians Anesthesia Services 20 1699735860 0 Physicians Healthy Kids Services 20 1699735860 0 Physicians Optical Supplies 20 1699735860 0 Physicians Physician Services 00 1699735886 0 TRAN JOHN 1999060 9999999 B 10 1699735886 0 5852 N BROADWAY ST STE 1 CHICAGO IL 606604062 20 1699735886 0 Dentists Dental Services 20 1699735886 0 Dentists Physician Services 00 1699736074 0 RAVAL AMISH N 2005213 9999999 B 10 1699736074 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1699736074 0 Physicians Anesthesia Services 20 1699736074 0 Physicians Fluoride varnish 20 1699736074 0 Physicians Healthy Kids Services 20 1699736074 0 Physicians Optical Supplies 20 1699736074 0 Physicians Physician Services 00 1699736090 0 SHEEHAN JOHN P 1993182 9999999 B 10 1699736090 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1699736090 0 Physicians Anesthesia Services 20 1699736090 0 Physicians Fluoride varnish 20 1699736090 0 Physicians Healthy Kids Services 20 1699736090 0 Physicians Optical Supplies 20 1699736090 0 Physicians Physician Services 00 1699736165 0 VIDAURRE JORGE A 2021122 9999999 B 10 1699736165 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1699736165 0 Physicians Anesthesia Services 20 1699736165 0 Physicians Healthy Kids Services 20 1699736165 0 Physicians Optical Supplies 20 1699736165 0 Physicians Physician Services 20 1699736165 0 Physicians Physicians Psychiatric Services 00 1699736488 0 HARRIS ALAN 1981227 9999999 B 10 1699736488 0 75 REMITTANCE DR DEPT 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0 1585 BARRINGTON RD DOCTORS BLDG 2 STE 501 HOFFMAN ESTATES IL 601691090 20 1699738351 0 Physicians Anesthesia Services 20 1699738351 0 Physicians Fluoride varnish 20 1699738351 0 Physicians Healthy Kids Services 20 1699738351 0 Physicians Optical Supplies 20 1699738351 0 Physicians Physician Services 00 1699738823 0 WOOD ROBERT M 2006305 9999999 B 10 1699738823 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1699738823 0 Physicians Anesthesia Services 20 1699738823 0 Physicians Healthy Kids Services 20 1699738823 0 Physicians Optical Supplies 20 1699738823 0 Physicians Physician Services 00 1699738922 0 ZELLER W PATRICK 1981227 9999999 B 10 1699738922 0 29373 NETWORK PL CHICAGO IL 606733039 20 1699738922 0 Physicians Anesthesia Services 20 1699738922 0 Physicians Fluoride varnish 20 1699738922 0 Physicians Healthy Kids Services 20 1699738922 0 Physicians Optical Supplies 20 1699738922 0 Physicians Physician Services 00 1699738997 0 DEMAY TAMI 2024291 9999999 B 10 1699738997 0 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631600352 20 1699793158 0 Physicians Anesthesia Services 20 1699793158 0 Physicians Healthy Kids Services 20 1699793158 0 Physicians Optical Supplies 20 1699793158 0 Physicians Physician Services 20 1699793158 0 Physicians Physicians Psychiatric Services 00 1699794206 0 LAMB JACOB W 2007001 9999999 B 10 1699794206 0 5139 MATTIS RD STE 102 SAINT LOUIS MO 631282250 20 1699794206 0 Podiatrists Podiatric Services 00 1699794495 0 SOBLE JEFFREY S 1991182 9999999 B 10 1699794495 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1699794495 0 Physicians Anesthesia Services 20 1699794495 0 Physicians Fluoride varnish 20 1699794495 0 Physicians Healthy Kids Services 20 1699794495 0 Physicians Optical Supplies 20 1699794495 0 Physicians Physician Services 00 1699795898 0 MURRAY ANNE E 2017001 9999999 B 10 1699795898 0 10097 MANCHESTER RD STE 102A SAINT LOUIS MO 631221828 20 1699795898 0 Audiologists Audiology Services 20 1699795898 0 Audiologists Medical Supplies 20 1699795898 0 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20 1699807685 0 Physicians Optical Supplies 20 1699807685 0 Physicians Physician Services 00 1699809616 0 ARDEN APRIL 2000049 9999999 B 10 1699809616 0 2357 HASSELL RD STE 202 HOFFMAN ESTATES IL 601692172 20 1699809616 0 Occupational Therapists Medical Supplies 20 1699809616 0 Occupational Therapists Medical equipment/prosthetic devices 20 1699809616 0 Occupational Therapists Occupational Therapy Services 00 1699809806 0 PATEL SUNIL S 2010182 9999999 B 10 1699809806 0 401 ROXBURY RD ROCKFORD IL 611075075 20 1699809806 0 Physicians Anesthesia Services 20 1699809806 0 Physicians Fluoride varnish 20 1699809806 0 Physicians Healthy Kids Services 20 1699809806 0 Physicians Optical Supplies 20 1699809806 0 Physicians Physician Services 00 1699810168 0 COX JILL B 2001018 9999999 B 10 1699810168 0 936 W MICHIGAN AVE JACKSONVILLE IL 626503113 20 1699810168 0 Speech Therapists Medical Supplies 20 1699810168 0 Speech Therapists Medical equipment/prosthetic devices 20 1699810168 0 Speech 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20 1699821546 0 Physicians Anesthesia Services 20 1699821546 0 Physicians Healthy Kids Services 20 1699821546 0 Physicians Optical Supplies 20 1699821546 0 Physicians Physician Services 20 1699821546 0 Physicians Physicians Psychiatric Services 00 1699822320 0 HOVERSLAND JON M 2017065 9999999 B 10 1699822320 0 PO BOX 781076 DETROIT MI 482781076 20 1699822320 0 Physicians Anesthesia Services 20 1699822320 0 Physicians Healthy Kids Services 20 1699822320 0 Physicians Optical Supplies 20 1699822320 0 Physicians Physician Services 00 1699822551 0 HARBISON ELIZABETH H 2024102 9999999 B 10 1699822551 0 350 N GRANDVIEW AVE DUBUQUE IA 520016388 20 1699822551 0 Physicians Anesthesia Services 20 1699822551 0 Physicians Healthy Kids Services 20 1699822551 0 Physicians Optical Supplies 20 1699822551 0 Physicians Physician Services 00 1699823849 0 MINOR-WANNA LESLIE A 2000220 9999999 B 10 1699823849 0 668 SUSSEX CIR VERNON HILLS IL 600612943 20 1699823849 0 Speech Therapists Medical Supplies 20 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Services 00 1699833970 0 SANDOZI SHAKEEL 2005060 9999999 B 10 1699833970 0 5383 STATE ROUTE 154 PINCKNEYVILLE IL 622743342 20 1699833970 0 Physicians Anesthesia Services 20 1699833970 0 Physicians Healthy Kids Services 20 1699833970 0 Physicians Optical Supplies 20 1699833970 0 Physicians Physician Services 00 1699834739 0 BAUERLE STEPHANIE 2015089 9999999 B 10 1699834739 0 12101 WOODCREST EXECUTIVE DR S SUITE 210 SAINT LOUIS MO 631415047 20 1699834739 0 Physicians Anesthesia Services 20 1699834739 0 Physicians Healthy Kids Services 20 1699834739 0 Physicians Optical Supplies 20 1699834739 0 Physicians Physician Services 00 1699835181 0 PARCIAK KEVIN R 2004092 9999999 B 10 1699835181 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1699835181 0 Physicians Anesthesia Services 20 1699835181 0 Physicians Healthy Kids Services 20 1699835181 0 Physicians Optical Supplies 20 1699835181 0 Physicians Physician Services 00 1699835298 0 CHAPMAN BILLYE R 2024295 9999999 B 10 1699835298 0 2 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4701 DEPT CAROL STREAM IL 601220021 20 1699926493 0 Physician Assistant Only Fluoride varnish 20 1699926493 0 Physician Assistant Only Healthy Kids Services 20 1699926493 0 Physician Assistant Only Physician Services 00 1699926824 0 BANSAL ANISH 2022273 9999999 B 10 1699926824 0 1005 BROADWAY ST QUINCY IL 623012834 20 1699926824 0 Physicians Anesthesia Services 20 1699926824 0 Physicians Healthy Kids Services 20 1699926824 0 Physicians Optical Supplies 20 1699926824 0 Physicians Physician Services 00 1699926881 0 GROSSMAN DANIEL BENJAMIN 2024061 9999999 B 10 1699926881 0 1270 NORTHLAND DR STE 250 MENDOTA HEIGHTS MN 551201156 20 1699926881 0 Physicians Anesthesia Services 20 1699926881 0 Physicians Healthy Kids Services 20 1699926881 0 Physicians Optical Supplies 20 1699926881 0 Physicians Physician Services 00 1699927020 0 JACKUPS RONALD 2012183 9999999 B 10 1699927020 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1699927020 0 Physicians Anesthesia Services 20 1699927020 0 Physicians 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1699942482 0 Physicians Healthy Kids Services 20 1699942482 0 Physicians Optical Supplies 20 1699942482 0 Physicians Physician Services 00 1699943308 0 LARSON ERIC B 2017027 9999999 B 10 1699943308 0 5777 DEPT CAROL STREAM IL 601228942 20 1699943308 0 Psychologist Psychologist service 00 1699943902 0 NASO MARK 2017235 9999999 B 10 1699943902 0 2111 OGDEN AVE AURORA IL 605047597 20 1699943902 0 Occupational Therapists Medical Supplies 20 1699943902 0 Occupational Therapists Medical equipment/prosthetic devices 20 1699943902 0 Occupational Therapists Occupational Therapy Services 00 1699945469 0 ROSE WILLIAM N 2011305 9999999 B 10 1699945469 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1699945469 0 Physicians Anesthesia Services 20 1699945469 0 Physicians Fluoride varnish 20 1699945469 0 Physicians Healthy Kids Services 20 1699945469 0 Physicians Optical Supplies 20 1699945469 0 Physicians Physician Services 00 1699948786 0 GROVES ANNE 2008101 9999999 B 10 1699948786 0 7732 SOLUTION CTR 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29373 NETWORK PL CHICAGO IL 606733039 20 1699950535 0 Nurse Practitioners Fluoride varnish 20 1699950535 0 Nurse Practitioners Healthy Kids Services 20 1699950535 0 Nurse Practitioners Nurse Practitioners Services 20 1699950535 0 Nurse Practitioners Physician Services 00 1699950576 0 MAIDA ANNE MARIE 2009121 9999999 B 10 1699950576 0 PO BOX 772 MC2295 WOONSOCKET RI 028950784 20 1699950576 0 Nurse Practitioners Fluoride varnish 20 1699950576 0 Nurse Practitioners Healthy Kids Services 20 1699950576 0 Nurse Practitioners Nurse Practitioners Services 20 1699950576 0 Nurse Practitioners Physician Services 00 1699951418 0 TRAN TAI T 2009019 9999999 B 10 1699951418 0 2900 W OKLAHOMA AVE MILWAUKEE WI 532154330 20 1699951418 0 Physicians Anesthesia Services 20 1699951418 0 Physicians Healthy Kids Services 20 1699951418 0 Physicians Optical Supplies 20 1699951418 0 Physicians Physician Services 00 1699952143 0 PETERSON JULIA S 2015285 9999999 B 10 1699952143 0 2650 RIDGE AVE # 1223 EVANSTON IL 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Physician Services 00 1699974279 0 REYNOLDS PAMELA 1981227 9999999 B 10 1699974279 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112323 20 1699974279 0 Dentists Dental Services 20 1699974279 0 Dentists Physician Services 00 1699975086 0 MENET MARK W 2011305 9999999 B 10 1699975086 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1699975086 0 Physicians Anesthesia Services 20 1699975086 0 Physicians Fluoride varnish 20 1699975086 0 Physicians Healthy Kids Services 20 1699975086 0 Physicians Optical Supplies 20 1699975086 0 Physicians Physician Services 00 1699976787 0 SANCHEZ DIANNE 2001338 9999999 B 10 1699976787 0 212 BARNEY DR JOLIET IL 604355271 20 1699976787 0 Physical Therapists Medical Supplies 20 1699976787 0 Physical Therapists Medical equipment/prosthetic devices 20 1699976787 0 Physical Therapists Physical Therapy Services 00 1699977413 0 DHAMIJA MANISH 2012291 9999999 B 10 1699977413 0 3000 N HALSTED ST STE 625 CHICAGO IL 606575196 20 1699977413 0 Physicians Anesthesia Services 20 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varnish 20 1699978916 0 Physicians Healthy Kids Services 20 1699978916 0 Physicians Optical Supplies 20 1699978916 0 Physicians Physician Services 00 1699979583 0 LEE MARY 1999042 9999999 B 10 1699979583 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1699979583 0 Speech Therapists Medical Supplies 20 1699979583 0 Speech Therapists Medical equipment/prosthetic devices 20 1699979583 0 Speech Therapists Speech Therapy/Pathology Services 00 1699979898 0 CUBE CESAR 2013305 9999999 B 10 1699979898 0 44000 GARFIELD RD CLINTON TOWNSHI MI 480381125 20 1699979898 0 Physicians Anesthesia Services 20 1699979898 0 Physicians Healthy Kids Services 20 1699979898 0 Physicians Optical Supplies 20 1699979898 0 Physicians Physician Services 00 1699980243 0 DAVIS-NELSON SHAREECE A 2024303 9999999 B 10 1699980243 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1699980243 0 Physicians Anesthesia Services 20 1699980243 0 Physicians Healthy Kids Services 20 1699980243 0 Physicians Optical Supplies 20 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9999999 B 10 1700484847 0 1952 MC DOWELL RD STE 305 NAPERVILLE IL 605636507 20 1700484847 0 Clinical Social Worker Social work service 00 1700485794 0 SUTTON HEATHER 2025001 9999999 B 10 1700485794 0 2605 KENTUCKY AVE STE 306 PADUCAH KY 420033802 20 1700485794 0 Nurse Practitioners Fluoride varnish 20 1700485794 0 Nurse Practitioners Healthy Kids Services 20 1700485794 0 Nurse Practitioners Nurse Practitioners Services 20 1700485794 0 Nurse Practitioners Physician Services 00 1700487030 0 MEEKS KIARA S 2021284 9999999 B 10 1700487030 0 70 S RIVER ST AURORA IL 605065185 20 1700487030 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1700489093 0 GRAVES ABBEY 2022066 9999999 B 10 1700489093 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1700489093 0 Physician Assistant Only Fluoride varnish 20 1700489093 0 Physician Assistant Only Healthy Kids Services 20 1700489093 0 Physician Assistant Only Physician Services 00 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Physicians Anesthesia Services 20 1700805249 0 Physicians Fluoride varnish 20 1700805249 0 Physicians Healthy Kids Services 20 1700805249 0 Physicians Optical Supplies 20 1700805249 0 Physicians Physician Services 00 1700805512 0 JANKOWSKI WALTER 2010021 9999999 B 10 1700805512 0 5011 N ILLINOIS ST STE 1 FAIRVIEW HEIGHT IL 622083419 20 1700805512 0 Dentists Dental Services 20 1700805512 0 Dentists Physician Services 00 1700805827 0 ROSS STEVEN M 2022131 9999999 B 10 1700805827 0 PO BOX 43230 PHOENIX AZ 850803230 20 1700805827 0 Physicians Anesthesia Services 20 1700805827 0 Physicians Healthy Kids Services 20 1700805827 0 Physicians Optical Supplies 20 1700805827 0 Physicians Physician Services 20 1700805827 0 Physicians Physicians Psychiatric Services 00 1700806254 0 STILSON SHIRLEY 2003244 9999999 B 10 1700806254 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1700806254 0 Physicians Anesthesia Services 20 1700806254 0 Physicians Fluoride varnish 20 1700806254 0 Physicians Healthy 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EVANSTON IL 602011700 20 1700814126 0 Physicians Anesthesia Services 20 1700814126 0 Physicians Healthy Kids Services 20 1700814126 0 Physicians Optical Supplies 20 1700814126 0 Physicians Physician Services 00 1700814183 0 TAMAYO RAUL 1998001 9999999 B 10 1700814183 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1700814183 0 Physicians Anesthesia Services 20 1700814183 0 Physicians Fluoride varnish 20 1700814183 0 Physicians Healthy Kids Services 20 1700814183 0 Physicians Optical Supplies 20 1700814183 0 Physicians Physician Services 00 1700814225 0 HILL GREGORY A 1995335 9999999 B 10 1700814225 0 522 N NEW BALLAS RD STE 113 CREVE COEUR MO 631416820 20 1700814225 0 Physicians Anesthesia Services 20 1700814225 0 Physicians Healthy Kids Services 20 1700814225 0 Physicians Optical Supplies 20 1700814225 0 Physicians Physician Services 00 1700814332 0 GREEN MARIANNE W 1997274 9999999 B 10 1700814332 0 5777 DEPT CAROL STREAM IL 601220021 20 1700814332 0 Physicians Anesthesia Services 20 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Anesthesia Services 20 1700865268 0 Physicians Healthy Kids Services 20 1700865268 0 Physicians Optical Supplies 20 1700865268 0 Physicians Physician Services 00 1700865573 0 REILLY EILEEN T 2022325 9999999 B 10 1700865573 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1700865573 0 Physicians Anesthesia Services 20 1700865573 0 Physicians Healthy Kids Services 20 1700865573 0 Physicians Optical Supplies 20 1700865573 0 Physicians Physician Services 00 1700865656 0 SENATORE PETER 1981258 9999999 B 10 1700865656 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1700865656 0 Physicians Anesthesia Services 20 1700865656 0 Physicians Fluoride varnish 20 1700865656 0 Physicians Healthy Kids Services 20 1700865656 0 Physicians Optical Supplies 20 1700865656 0 Physicians Physician Services 00 1700866126 0 ANDERSON PETER I 2023188 9999999 B 10 1700866126 0 PO BOX 41220 PHOENIX AZ 850801220 20 1700866126 0 Physicians Anesthesia Services 20 1700866126 0 Physicians Healthy Kids Services 20 1700866126 0 Physicians Optical Supplies 20 1700866126 0 Physicians Physician Services 00 1700866167 0 MILLER GUY 2005213 9999999 B 10 1700866167 0 801 S WASHINGTON ST NAPERVILLE IL 605407430 20 1700866167 0 Physicians Anesthesia Services 20 1700866167 0 Physicians Healthy Kids Services 20 1700866167 0 Physicians Optical Supplies 20 1700866167 0 Physicians Physician Services 00 1700866258 0 MODERT SARA 1991231 9999999 B 10 1700866258 0 PO BOX 802 MOUNT VERNON IL 628640017 20 1700866258 0 Physicians Anesthesia Services 20 1700866258 0 Physicians Fluoride varnish 20 1700866258 0 Physicians Healthy Kids Services 20 1700866258 0 Physicians Optical Supplies 20 1700866258 0 Physicians Physician Services 00 1700867694 0 ARROYO MARTHA 2010032 9999999 B 10 1700867694 0 801 YORK ST MANITOWOC WI 542204630 20 1700867694 0 Physicians Anesthesia Services 20 1700867694 0 Physicians Healthy Kids Services 20 1700867694 0 Physicians Optical Supplies 20 1700867694 0 Physicians Physician Services 00 1700868023 0 AHMAD NADEEM 2001274 9999999 B 10 1700868023 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1700868023 0 Physicians Anesthesia Services 20 1700868023 0 Physicians Healthy Kids Services 20 1700868023 0 Physicians Optical Supplies 20 1700868023 0 Physicians Physician Services 00 1700868650 0 BARRELLA AMANDA L 2023221 9999999 B 10 1700868650 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1700868650 0 Physicians Anesthesia Services 20 1700868650 0 Physicians Healthy Kids Services 20 1700868650 0 Physicians Optical Supplies 20 1700868650 0 Physicians Physician Services 00 1700869112 0 KANUMURI RAGHU 1998121 9999999 B 10 1700869112 0 2100 MADISON AVE STE 301 GRANITE CITY IL 620404713 20 1700869112 0 Physicians Anesthesia Services 20 1700869112 0 Physicians Fluoride varnish 20 1700869112 0 Physicians Healthy Kids Services 20 1700869112 0 Physicians Optical Supplies 20 1700869112 0 Physicians Physician Services 00 1700869195 0 RAGHEB-MUELLER NAWAL E 2005242 9999999 B 10 1700869195 0 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1700871175 0 Physicians Healthy Kids Services 20 1700871175 0 Physicians Optical Supplies 20 1700871175 0 Physicians Physician Services 00 1700871514 0 NORDBROCK HEIDI 1996183 9999999 B 10 1700871514 0 7750 SOLUTION CTR CHICAGO IL 606777007 20 1700871514 0 Physicians Anesthesia Services 20 1700871514 0 Physicians Healthy Kids Services 20 1700871514 0 Physicians Optical Supplies 20 1700871514 0 Physicians Physician Services 00 1700871688 0 HARDING ELIZABETH 2019009 9999999 B 10 1700871688 0 PO BOX 43230 PHOENIX AZ 850803230 20 1700871688 0 Physicians Anesthesia Services 20 1700871688 0 Physicians Fluoride varnish 20 1700871688 0 Physicians Healthy Kids Services 20 1700871688 0 Physicians Optical Supplies 20 1700871688 0 Physicians Physician Services 00 1700871787 0 RIOJA LIGIA N 2000153 9999999 B 10 1700871787 0 5777 DEPT CAROL STREAM IL 601220021 20 1700871787 0 Physicians Anesthesia Services 20 1700871787 0 Physicians Healthy Kids Services 20 1700871787 0 Physicians Optical Supplies 20 1700871787 0 Physicians Physician Services 20 1700871787 0 Physicians Physicians Psychiatric Services 00 1700872272 0 AHMED ZAFAR 1996183 9999999 B 10 1700872272 0 PO BOX 1033 YORKVILLE IL 605600896 20 1700872272 0 Physicians Anesthesia Services 20 1700872272 0 Physicians Fluoride varnish 20 1700872272 0 Physicians Healthy Kids Services 20 1700872272 0 Physicians Optical Supplies 20 1700872272 0 Physicians Physician Services 00 1700872348 0 FLAUM MICHAEL 1988230 9999999 B 10 1700872348 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1700872348 0 Physicians Anesthesia Services 20 1700872348 0 Physicians Healthy Kids Services 20 1700872348 0 Physicians Optical Supplies 20 1700872348 0 Physicians Physician Services 20 1700872348 0 Physicians Physicians Psychiatric Services 00 1700872595 0 BURANOSKY DALE 1997213 9999999 B 10 1700872595 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1700872595 0 Podiatrists Podiatric Services 00 1700872611 0 LIDDELL JERRY 2020028 9999999 B 10 1700872611 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1700872611 0 Physicians Anesthesia Services 20 1700872611 0 Physicians Healthy Kids Services 20 1700872611 0 Physicians Optical Supplies 20 1700872611 0 Physicians Physician Services 00 1700872769 0 NGUYEN THACH 1991247 9999999 B 10 1700872769 0 55 E 86TH AVE STE E SUITE E MERRILLVILLE IN 464106265 20 1700872769 0 Physicians Anesthesia Services 20 1700872769 0 Physicians Fluoride varnish 20 1700872769 0 Physicians Healthy Kids Services 20 1700872769 0 Physicians Optical Supplies 20 1700872769 0 Physicians Physician Services 00 1700872900 0 EGUES DARLENE 2001182 9999999 B 10 1700872900 0 1916 W IRVING PARK RD CHICAGO IL 606132408 20 1700872900 0 Physicians Anesthesia Services 20 1700872900 0 Physicians Fluoride varnish 20 1700872900 0 Physicians Healthy Kids Services 20 1700872900 0 Physicians Optical Supplies 20 1700872900 0 Physicians Physician Services 00 1700873643 0 KAHN MICHAEL 1988193 9999999 B 10 1700873643 0 5777 DEPT CAROL STREAM IL 601220021 20 1700873643 0 Physicians Anesthesia Services 20 1700873643 0 Physicians Fluoride varnish 20 1700873643 0 Physicians Healthy Kids Services 20 1700873643 0 Physicians Optical Supplies 20 1700873643 0 Physicians Physician Services 00 1700874328 0 WILSON SCOTT 1994258 9999999 B 10 1700874328 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1700874328 0 Physicians Anesthesia Services 20 1700874328 0 Physicians Healthy Kids Services 20 1700874328 0 Physicians Optical Supplies 20 1700874328 0 Physicians Physician Services 00 1700874922 0 GOLDSTEIN JAMES R R 1981258 9999999 B 10 1700874922 0 1120 LAKE LAND BLVD STE 1 MATTOON IL 619385562 20 1700874922 0 Optometrists Optical Supplies 20 1700874922 0 Optometrists Optometric Services 20 1700874922 0 Optometrists Physician Services 00 1700874971 0 BEEBE LUCIUS C 2021306 9999999 B 10 1700874971 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1700874971 0 Physicians Anesthesia Services 20 1700874971 0 Physicians Healthy Kids Services 20 1700874971 0 Physicians Optical Supplies 20 1700874971 0 Physicians Physician Services 00 1700875416 0 HU STEPHEN 2023298 9999999 B 10 1700875416 0 PO BOX 208807 DALLAS TX 753208807 20 1700875416 0 Physicians Anesthesia Services 20 1700875416 0 Physicians Healthy Kids Services 20 1700875416 0 Physicians Optical Supplies 20 1700875416 0 Physicians Physician Services 00 1700875713 0 WU RICHARD 1990178 9999999 B 10 1700875713 0 5777 DEPT CAROL STREAM IL 601220021 20 1700875713 0 Physicians Anesthesia Services 20 1700875713 0 Physicians Healthy Kids Services 20 1700875713 0 Physicians Optical Supplies 20 1700875713 0 Physicians Physician Services 00 1700875747 0 MEYER RICKY A 2023159 9999999 B 10 1700875747 0 PO BOX 632122 CINCINNATI OH 452632122 20 1700875747 0 Physicians Anesthesia Services 20 1700875747 0 Physicians Fluoride varnish 20 1700875747 0 Physicians Healthy Kids Services 20 1700875747 0 Physicians Optical Supplies 20 1700875747 0 Physicians Physician Services 00 1700876166 0 KIM HANNAH 2003135 9999999 B 10 1700876166 0 1608 23RD ST ZION IL 600992345 20 1700876166 0 Dentists Dental Services 20 1700876166 0 Dentists Physician Services 00 1700876190 0 MICKELSON JUDITH K 2021293 9999999 B 10 1700876190 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1700876190 0 Physicians Anesthesia Services 20 1700876190 0 Physicians Fluoride varnish 20 1700876190 0 Physicians Healthy Kids Services 20 1700876190 0 Physicians Optical Supplies 20 1700876190 0 Physicians Physician Services 00 1700876307 0 BUTTIN BARBARA M 2005182 9999999 B 10 1700876307 0 2361 PAYSPHERE CIR CHICAGO IL 606740023 20 1700876307 0 Physicians Anesthesia Services 20 1700876307 0 Physicians Healthy Kids Services 20 1700876307 0 Physicians Optical Supplies 20 1700876307 0 Physicians Physician Services 00 1700876661 0 ANDERSON ALEXANDRA 2004061 9999999 B 10 1700876661 0 PO BOX 564 LAKE BLUFF IL 600440564 20 1700876661 0 Dentists Dental Services 20 1700876661 0 Dentists Physician Services 00 1700877024 0 FERNANDES HUBERT N 1997258 9999999 B 10 1700877024 0 645 S CENTRAL AVE CHICAGO IL 606445059 20 1700877024 0 Physicians Anesthesia Services 20 1700877024 0 Physicians Fluoride varnish 20 1700877024 0 Physicians Healthy Kids Services 20 1700877024 0 Physicians Optical Supplies 20 1700877024 0 Physicians Physician Services 00 1700877222 0 EULIEN HAROLD 1985001 9999999 B 10 1700877222 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1700877222 0 Physicians Anesthesia Services 20 1700877222 0 Physicians Fluoride varnish 20 1700877222 0 Physicians Healthy Kids Services 20 1700877222 0 Physicians Optical Supplies 20 1700877222 0 Physicians Physician Services 00 1700877933 0 GOLDMAN BRAD 2024261 9999999 B 10 1700877933 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1700877933 0 Physicians Anesthesia Services 20 1700877933 0 Physicians Healthy Kids Services 20 1700877933 0 Physicians Optical Supplies 20 1700877933 0 Physicians Physician Services 00 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1700879434 0 29373 NETWORK PL CHICAGO IL 606733039 20 1700879434 0 Physicians Anesthesia Services 20 1700879434 0 Physicians Fluoride varnish 20 1700879434 0 Physicians Healthy Kids Services 20 1700879434 0 Physicians Optical Supplies 20 1700879434 0 Physicians Physician Services 00 1700880036 0 SIMONEAUX JENNIFER D 2022112 9999999 B 10 1700880036 0 PO BOX 1510 EVANSVILLE IN 477061510 20 1700880036 0 Physicians Anesthesia Services 20 1700880036 0 Physicians Fluoride varnish 20 1700880036 0 Physicians Healthy Kids Services 20 1700880036 0 Physicians Optical Supplies 20 1700880036 0 Physicians Physician Services 00 1700880309 0 LEBUHN CARL B 1995172 2025365 B 10 1700880309 0 2605 KENTUCKY AVE STE 306 PADUCAH KY 420033802 20 1700880309 0 Physicians Anesthesia Services 20 1700880309 0 Physicians Fluoride varnish 20 1700880309 0 Physicians Healthy Kids Services 20 1700880309 0 Physicians Optical Supplies 20 1700880309 0 Physicians Physician Services 00 1700880358 0 WILLIAMSON HEATHER C 2007032 9999999 B 10 1700880358 0 500 PORTER AVE AURORA MO 656052365 20 1700880358 0 Physicians Anesthesia Services 20 1700880358 0 Physicians Fluoride varnish 20 1700880358 0 Physicians Healthy Kids Services 20 1700880358 0 Physicians Optical Supplies 20 1700880358 0 Physicians Physician Services 00 1700881737 0 KRAMER ANDREW J 1992202 9999999 B 10 1700881737 0 1665 SOUTH ST GENEVA IL 601342542 20 1700881737 0 Physicians Anesthesia Services 20 1700881737 0 Physicians Healthy Kids Services 20 1700881737 0 Physicians Optical Supplies 20 1700881737 0 Physicians Physician Services 00 1700882107 0 DEME ADRIAN 1994213 9999999 B 10 1700882107 0 1606 N ARLINGTON HEIGHTS RD ARLINGTON HEIGH IL 600043908 20 1700882107 0 Physicians Anesthesia Services 20 1700882107 0 Physicians Healthy Kids Services 20 1700882107 0 Physicians Optical Supplies 20 1700882107 0 Physicians Physician Services 00 1700882602 0 LACEY MICHAEL GEORGE 2017251 9999999 B 10 1700882602 0 750 E TERRA COTTA AVE STE C CRYSTAL 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1710024062 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1710024062 0 Physicians Anesthesia Services 20 1710024062 0 Physicians Healthy Kids Services 20 1710024062 0 Physicians Optical Supplies 20 1710024062 0 Physicians Physician Services 00 1710024674 0 PILLER JOSEPH V 2017001 9999999 B 10 1710024674 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1710024674 0 Physician Assistant Only Fluoride varnish 20 1710024674 0 Physician Assistant Only Healthy Kids Services 20 1710024674 0 Physician Assistant Only Physician Services 00 1710026430 0 GONZAGA JASON 2014093 9999999 B 10 1710026430 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1710026430 0 Physicians Anesthesia Services 20 1710026430 0 Physicians Fluoride varnish 20 1710026430 0 Physicians Healthy Kids Services 20 1710026430 0 Physicians Optical Supplies 20 1710026430 0 Physicians Physician Services 00 1710027412 0 THOMMES JAMES E 1988001 9999999 B 10 1710027412 0 770 BUSSE HWY PARK RIDGE IL 600682441 20 1710027412 0 Dentists 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0 Physicians Anesthesia Services 20 1710032131 0 Physicians Fluoride varnish 20 1710032131 0 Physicians Healthy Kids Services 20 1710032131 0 Physicians Optical Supplies 20 1710032131 0 Physicians Physician Services 00 1710032404 0 ROSENMANN PATRICIA E 2004092 9999999 B 10 1710032404 0 28594 NETWORK PL CHICAGO IL 606731285 20 1710032404 0 Other behavior health professional LCPC/LMFT services 00 1710034954 0 HENDERSON HOLLY 2020157 9999999 B 10 1710034954 0 1005 BROADWAY ST QUINCY IL 623012834 20 1710034954 0 Nurse Practitioners Fluoride varnish 20 1710034954 0 Nurse Practitioners Healthy Kids Services 20 1710034954 0 Nurse Practitioners Nurse Practitioners Services 20 1710034954 0 Nurse Practitioners Physician Services 00 1710036025 0 HEGDE IRMADY BIJOY 2002165 9999999 B 10 1710036025 0 PO BOX 798114 SAINT LOUIS MO 631798001 20 1710036025 0 Physicians Anesthesia Services 20 1710036025 0 Physicians Healthy Kids Services 20 1710036025 0 Physicians Optical Supplies 20 1710036025 0 Physicians Physician Services 00 1710036892 0 OBEIUS MARCUS 2016306 9999999 B 10 1710036892 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1710036892 0 Physicians Anesthesia Services 20 1710036892 0 Physicians Healthy Kids Services 20 1710036892 0 Physicians Optical Supplies 20 1710036892 0 Physicians Physician Services 00 1710037742 0 ABDULLA RA-ID 1992183 9999999 B 10 1710037742 0 737 N MICHIGAN AVE STE 2040 CHICAGO IL 606116649 20 1710037742 0 Physicians Anesthesia Services 20 1710037742 0 Physicians Healthy Kids Services 20 1710037742 0 Physicians Optical Supplies 20 1710037742 0 Physicians Physician Services 00 1710038690 0 ORTIZ TIMOTHY P 1991196 9999999 B 10 1710038690 0 880 BEDFORD RD MORRIS IL 604501209 20 1710038690 0 Optometrists Optical Supplies 20 1710038690 0 Optometrists Optometric Services 20 1710038690 0 Optometrists Physician Services 00 1710038781 0 DACHMAN ABRAHAM H 1993190 9999999 B 10 1710038781 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1710038781 0 Physicians Anesthesia Services 20 1710038781 0 Physicians Healthy Kids Services 20 1710038781 0 Physicians Optical Supplies 20 1710038781 0 Physicians Physician Services 00 1710038997 0 FELDMAN ROBERT 2014269 9999999 B 10 1710038997 0 1440 TECHNY RD NORTHBROOK IL 600625447 20 1710038997 0 Psychologist Psychologist service 00 1710039003 0 KLEIN DREW 1981227 9999999 B 10 1710039003 0 2225 W MARKET ST BLOOMINGTON IL 617055014 20 1710039003 0 Optometrists Optical Supplies 20 1710039003 0 Optometrists Optometric Services 20 1710039003 0 Optometrists Physician Services 00 1710041892 0 HANNA DIMA 2007244 9999999 B 10 1710041892 0 811 WESTERN AVE NORTHBROOK IL 600623448 20 1710041892 0 Physicians Anesthesia Services 20 1710041892 0 Physicians Fluoride varnish 20 1710041892 0 Physicians Healthy Kids Services 20 1710041892 0 Physicians Optical Supplies 20 1710041892 0 Physicians Physician Services 00 1710042726 0 LUCAS ELIZABETH A 2004183 9999999 B 10 1710042726 0 1200 E TREMONT ST HILLSBORO IL 620491912 20 1710042726 0 Physicians Anesthesia Services 20 1710042726 0 Physicians Fluoride varnish 20 1710042726 0 Physicians Healthy Kids Services 20 1710042726 0 Physicians Optical Supplies 20 1710042726 0 Physicians Physician Services 00 1710043013 0 WHITE SARAH B 2011154 9999999 B 10 1710043013 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1710043013 0 Physicians Anesthesia Services 20 1710043013 0 Physicians Healthy Kids Services 20 1710043013 0 Physicians Optical Supplies 20 1710043013 0 Physicians Physician Services 00 1710043658 0 PITRE CORY J 2005274 9999999 B 10 1710043658 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1710043658 0 Physicians Anesthesia Services 20 1710043658 0 Physicians Healthy Kids Services 20 1710043658 0 Physicians Optical Supplies 20 1710043658 0 Physicians Physician Services 00 1710046818 0 LOBO ANN-MARIE 2015240 9999999 B 10 1710046818 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1710046818 0 Physicians Anesthesia Services 20 1710046818 0 Physicians Healthy Kids Services 20 1710046818 0 Physicians Optical Supplies 20 1710046818 0 Physicians Physician Services 00 1710046859 0 LUGTHART PAUL K 1989170 9999999 B 10 1710046859 0 5777 DEPT CAROL STREAM IL 601220021 20 1710046859 0 Physicians Anesthesia Services 20 1710046859 0 Physicians Healthy Kids Services 20 1710046859 0 Physicians Optical Supplies 20 1710046859 0 Physicians Physician Services 00 1710048145 0 TIEMERSMA AMY C 2016088 9999999 B 10 1710048145 0 12927 S MONITOR AVE PALOS HEIGHTS IL 604632434 20 1710048145 0 Other behavior health professional Social work service 00 1710048822 0 HUANG KUO 2024214 9999999 B 10 1710048822 0 625 S NEW BALLAS RD STE R-7040 SAINT LOUIS MO 631418253 20 1710048822 0 Physicians Anesthesia Services 20 1710048822 0 Physicians Healthy Kids Services 20 1710048822 0 Physicians Optical Supplies 20 1710048822 0 Physicians Physician Services 00 1710051099 0 GREENSPAN BENNY 1992220 9999999 B 10 1710051099 0 2010 N HARLEM AVE ELMWOOD PARK IL 607073119 20 1710051099 0 Podiatrists Podiatric Services 00 1710051552 0 GARG SUMEET 2015152 9999999 B 10 1710051552 0 PO BOX 110429 AURORA CO 800420429 20 1710051552 0 Physicians Anesthesia Services 20 1710051552 0 Physicians Healthy Kids Services 20 1710051552 0 Physicians Optical Supplies 20 1710051552 0 Physicians Physician Services 00 1710052436 0 MAVI HARBANS S 1993060 9999999 B 10 1710052436 0 1015 S EVERGREEN AVE ARLINGTON HEIGH IL 600053144 20 1710052436 0 Physicians Anesthesia Services 20 1710052436 0 Physicians Fluoride varnish 20 1710052436 0 Physicians Healthy Kids Services 20 1710052436 0 Physicians Optical Supplies 20 1710052436 0 Physicians Physician Services 00 1710052980 0 KANG HIEJIN 2004275 9999999 B 10 1710052980 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1710052980 0 Physicians Anesthesia Services 20 1710052980 0 Physicians Fluoride varnish 20 1710052980 0 Physicians Healthy Kids Services 20 1710052980 0 Physicians Optical Supplies 20 1710052980 0 Physicians Physician Services 00 1710058961 0 LATTIMORE SEAN 2000199 9999999 B 10 1710058961 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1710058961 0 Physicians Anesthesia Services 20 1710058961 0 Physicians Fluoride varnish 20 1710058961 0 Physicians Healthy Kids Services 20 1710058961 0 Physicians Optical Supplies 20 1710058961 0 Physicians Physician Services 00 1710058979 0 HESS ERIC J 1998152 9999999 B 10 1710058979 0 PO BOX 43230 PHOENIX AZ 850803230 20 1710058979 0 Physicians Anesthesia Services 20 1710058979 0 Physicians Healthy Kids Services 20 1710058979 0 Physicians Optical Supplies 20 1710058979 0 Physicians Physician Services 00 1710060165 0 OEN ROGER 2017228 9999999 B 10 1710060165 0 12230 WORLD TRADE DR STE 250 SAN DIEGO CA 921283799 20 1710060165 0 Physicians Anesthesia Services 20 1710060165 0 Physicians Fluoride varnish 20 1710060165 0 Physicians Healthy Kids Services 20 1710060165 0 Physicians Optical Supplies 20 1710060165 0 Physicians Physician Services 00 1710061486 0 KEMP DAVID E 2014244 9999999 B 10 1710061486 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1710061486 0 Physicians Anesthesia Services 20 1710061486 0 Physicians Healthy Kids Services 20 1710061486 0 Physicians Optical Supplies 20 1710061486 0 Physicians Physician Services 20 1710061486 0 Physicians Physicians Psychiatric Services 00 1710061551 0 WALSTON DAWN 2013290 9999999 B 10 1710061551 0 1701 LACEY ST CAPE GIRARDEAU MO 637015230 20 1710061551 0 Nurse Practitioners Healthy Kids Services 20 1710061551 0 Nurse Practitioners Nurse Practitioners Services 20 1710061551 0 Nurse Practitioners Physician Services 00 1710061650 0 CHANDAN RITU 1998244 9999999 B 10 1710061650 0 350 N WALL ST KANKAKEE IL 609012901 20 1710061650 0 Physicians Anesthesia Services 20 1710061650 0 Physicians Fluoride varnish 20 1710061650 0 Physicians Healthy Kids Services 20 1710061650 0 Physicians Optical Supplies 20 1710061650 0 Physicians Physician Services 00 1710063011 0 GRONBERG VIOLET 2005333 9999999 B 10 1710063011 0 568 WESTFIELD CRSE GENEVA IL 601343425 20 1710063011 0 Speech Therapists Medical Supplies 20 1710063011 0 Speech Therapists Medical equipment/prosthetic devices 20 1710063011 0 Speech Therapists Speech Therapy/Pathology Services 00 1710063292 0 SAQIB ZAHID 1981258 9999999 B 10 1710063292 0 PO BOX 3276 EVANSVILLE IN 477313276 20 1710063292 0 Physicians Anesthesia Services 20 1710063292 0 Physicians Healthy Kids Services 20 1710063292 0 Physicians Optical Supplies 20 1710063292 0 Physicians Physician Services 00 1710063714 0 BANGAYAN LORRAINE 2000336 9999999 B 10 1710063714 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1710063714 0 Physicians Anesthesia Services 20 1710063714 0 Physicians Fluoride varnish 20 1710063714 0 Physicians Healthy Kids Services 20 1710063714 0 Physicians Optical Supplies 20 1710063714 0 Physicians Physician Services 00 1710064530 0 STAPLES SCOTT A 2017292 9999999 B 10 1710064530 0 1095 HIGHWAY 15 S HUTCHINSON MN 553505000 20 1710064530 0 Physicians Anesthesia Services 20 1710064530 0 Physicians Fluoride varnish 20 1710064530 0 Physicians Healthy Kids Services 20 1710064530 0 Physicians Optical Supplies 20 1710064530 0 Physicians Physician Services 00 1710065024 0 ROHATGI GAUTAM 2021075 9999999 B 10 1710065024 0 9735 LANDMARK PARKWAY DR STE 2 SAINT LOUIS MO 631271666 20 1710065024 0 Physicians Anesthesia Services 20 1710065024 0 Physicians Healthy Kids Services 20 1710065024 0 Physicians Optical Supplies 20 1710065024 0 Physicians Physician Services 20 1710065024 0 Physicians Physicians Psychiatric Services 00 1710065206 0 JUNIA JODY A 2023053 9999999 B 10 1710065206 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1710065206 0 Physicians Anesthesia Services 20 1710065206 0 Physicians Healthy Kids Services 20 1710065206 0 Physicians Optical Supplies 20 1710065206 0 Physicians Physician Services 00 1710067343 0 PITSENBERGER ANGELA 2010067 9999999 B 10 1710067343 0 155 E IROQUOIS ST SHELDON IL 609668187 20 1710067343 0 Clinical Social Worker Social work service 00 1710067723 0 CATANESE RONALD 2024302 9999999 B 10 1710067723 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1710067723 0 Physicians Anesthesia Services 20 1710067723 0 Physicians Healthy Kids Services 20 1710067723 0 Physicians Optical Supplies 20 1710067723 0 Physicians Physician Services 00 1710067830 0 HUTCHISON THERESA A 2019056 9999999 B 10 1710067830 0 1160 E SAINT CLAIR ST VINCENNES IN 475914853 20 1710067830 0 Nurse Practitioners Fluoride varnish 20 1710067830 0 Nurse Practitioners Healthy Kids Services 20 1710067830 0 Nurse Practitioners Nurse Practitioners Services 20 1710067830 0 Nurse Practitioners Physician Services 00 1710069026 0 CHURCH NANCY R 1996001 9999999 B 10 1710069026 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1710069026 0 Physicians Anesthesia Services 20 1710069026 0 Physicians Healthy Kids Services 20 1710069026 0 Physicians Optical Supplies 20 1710069026 0 Physicians Physician Services 00 1710070057 0 KENNEY TOM 1986205 9999999 B 10 1710070057 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1710070057 0 Physicians Anesthesia Services 20 1710070057 0 Physicians Fluoride varnish 20 1710070057 0 Physicians Healthy Kids Services 20 1710070057 0 Physicians Optical Supplies 20 1710070057 0 Physicians Physician Services 00 1710070289 0 BOHOLST PANOPIO PHOEBE 2005001 9999999 B 10 1710070289 0 ISU HLTH SERV PHARMACY CAMPUS BOX 2540 NORMAL IL 617902540 20 1710070289 0 Physicians Anesthesia Services 20 1710070289 0 Physicians Fluoride varnish 20 1710070289 0 Physicians Healthy Kids Services 20 1710070289 0 Physicians Optical Supplies 20 1710070289 0 Physicians Physician Services 00 1710071048 0 MITCHELL JOHN D 2022032 9999999 B 10 1710071048 0 PO BOX 110429 AURORA CO 800420429 20 1710071048 0 Physicians Anesthesia Services 20 1710071048 0 Physicians Healthy Kids Services 20 1710071048 0 Physicians Optical Supplies 20 1710071048 0 Physicians Physician Services 00 1710071535 0 DUFFY PATRICK 2016259 9999999 B 10 1710071535 0 175 E HOUSTON ST SAN ANTONIO TX 782052255 20 1710071535 0 Optometrists Optical Supplies 20 1710071535 0 Optometrists Optometric Services 20 1710071535 0 Optometrists Physician Services 00 1710072624 0 HADDAD RAMI 2004136 9999999 B 10 1710072624 0 62647 COLLECTION CENTER DR CHICAGO IL 606930626 20 1710072624 0 Physicians Anesthesia Services 20 1710072624 0 Physicians Fluoride varnish 20 1710072624 0 Physicians Healthy Kids Services 20 1710072624 0 Physicians Optical Supplies 20 1710072624 0 Physicians Physician Services 00 1710072996 0 VAN DUSEN MD LAURA 2001078 9999999 B 10 1710072996 0 1440 RENAISSANCE DR STE 220 PARK RIDGE IL 600681452 20 1710072996 0 Physicians Anesthesia Services 20 1710072996 0 Physicians Healthy Kids Services 20 1710072996 0 Physicians Optical Supplies 20 1710072996 0 Physicians Physician Services 20 1710072996 0 Physicians Physicians Psychiatric Services 00 1710073416 0 MONTALTO GREGG J 2019001 9999999 B 10 1710073416 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1710073416 0 Physicians Anesthesia Services 20 1710073416 0 Physicians Fluoride varnish 20 1710073416 0 Physicians Healthy Kids Services 20 1710073416 0 Physicians Optical Supplies 20 1710073416 0 Physicians Physician Services 00 1710073838 0 LEVINSON DEBORAH 2014269 9999999 H 10 1710073838 0 999 OAKMONT PLAZA DR SUITE 100 WESTMONT IL 605591381 20 1710073838 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1710073952 0 BIRHANU KIDANU 1992183 9999999 B 10 1710073952 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1710073952 0 Physicians Anesthesia Services 20 1710073952 0 Physicians Fluoride varnish 20 1710073952 0 Physicians Healthy Kids Services 20 1710073952 0 Physicians Optical Supplies 20 1710073952 0 Physicians Physician Services 00 1710075791 0 ROBINSON TIFFANY 2007211 9999999 A 10 1710075791 0 21899 TORRENCE AVE SAUK VILLAGE IL 604114489 20 1710075791 0 Speech Therapists Medical Supplies 20 1710075791 0 Speech Therapists Medical equipment/prosthetic devices 20 1710075791 0 Speech Therapists Speech Therapy/Pathology Services 00 1710076237 0 BERGER DANIEL S 1991182 9999999 B 10 1710076237 0 2835 N SHEFFIELD AVE CHICAGO IL 606575081 20 1710076237 0 Physicians Anesthesia Services 20 1710076237 0 Physicians Healthy Kids Services 20 1710076237 0 Physicians Optical Supplies 20 1710076237 0 Physicians Physician Services 00 1710076567 0 DY PHILIP A 1998182 9999999 B 10 1710076567 0 210 W MCKINLEY AVE STE 1 DECATUR IL 625265858 20 1710076567 0 Physicians Anesthesia Services 20 1710076567 0 Physicians Fluoride varnish 20 1710076567 0 Physicians Healthy Kids Services 20 1710076567 0 Physicians Optical Supplies 20 1710076567 0 Physicians Physician Services 00 1710078746 0 STRIGEL ROBERTA 2010352 9999999 B 10 1710078746 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1710078746 0 Physicians Anesthesia Services 20 1710078746 0 Physicians Healthy Kids Services 20 1710078746 0 Physicians Optical Supplies 20 1710078746 0 Physicians Physician Services 00 1710080064 0 BAUER KRISTI 2003177 9999999 B 10 1710080064 0 1525 W MEADOWVIEW DR DUNLAP IL 615259004 20 1710080064 0 Occupational Therapists Medical Supplies 20 1710080064 0 Occupational Therapists Medical equipment/prosthetic devices 20 1710080064 0 Occupational Therapists Occupational Therapy Services 00 1710080288 0 DECASTRO ALAIN E 1999060 9999999 B 10 1710080288 0 4711 GOLF RD STE 400 SKOKIE IL 600761242 20 1710080288 0 Physicians Anesthesia Services 20 1710080288 0 Physicians Healthy Kids Services 20 1710080288 0 Physicians Optical Supplies 20 1710080288 0 Physicians Physician Services 20 1710080288 0 Physicians Physicians Psychiatric Services 00 1710082433 0 NICKELL JENNIFER 2024199 9999999 B 10 1710082433 0 2605 KENTUCKY AVE STE 306 PADUCAH KY 420033802 20 1710082433 0 Physicians Anesthesia Services 20 1710082433 0 Physicians Healthy Kids Services 20 1710082433 0 Physicians Optical Supplies 20 1710082433 0 Physicians Physician Services 00 1710082474 0 BOULES GRETCHEN 2022026 9999999 B 10 1710082474 0 3436 N KENNICOTT AVE STE 114 STE 114 ARLINGTON HEIGH IL 600047814 20 1710082474 0 Psychologist Psychologist service 00 1710082615 0 GUERRIERO VITTORIO 1983073 9999999 B 10 1710082615 0 45 W 111TH ST CHICAGO IL 606284200 20 1710082615 0 Physicians Anesthesia Services 20 1710082615 0 Physicians Healthy Kids Services 20 1710082615 0 Physicians Optical Supplies 20 1710082615 0 Physicians Physician Services 00 1710082953 0 NABOLOTNY VALERIA 2013080 9999999 B 10 1710082953 0 822 MEADOWRIDGE DR AURORA IL 605045356 20 1710082953 0 Psychologist Psychologist service 00 1710082987 0 KUTTEH WILLIAM HANNA 2016063 9999999 B 10 1710082987 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1710082987 0 Physicians Anesthesia Services 20 1710082987 0 Physicians Healthy Kids Services 20 1710082987 0 Physicians Optical Supplies 20 1710082987 0 Physicians Physician Services 00 1710083563 0 SEMANS BRUCE 1999001 9999999 B 10 1710083563 0 101 E MAIN ST ROCHESTER IL 625639507 20 1710083563 0 Physicians Anesthesia Services 20 1710083563 0 Physicians Healthy Kids Services 20 1710083563 0 Physicians Optical Supplies 20 1710083563 0 Physicians Physician Services 00 1710083951 0 UNGER NICOLLE 2004001 9999999 B 10 1710083951 0 28594 NETWORK PL CHICAGO IL 606731285 20 1710083951 0 Occupational Therapists Medical Supplies 20 1710083951 0 Occupational Therapists Medical equipment/prosthetic devices 20 1710083951 0 Occupational Therapists Occupational Therapy Services 00 1710085048 0 EJERCITO MICHAEL P 2011305 9999999 B 10 1710085048 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1710085048 0 Physicians Anesthesia Services 20 1710085048 0 Physicians Healthy Kids Services 20 1710085048 0 Physicians Optical Supplies 20 1710085048 0 Physicians Physician Services 00 1710085170 0 OVERTON MELISSA 2012032 9999999 B 10 1710085170 0 1160 E SAINT CLAIR ST VINCENNES IN 475914853 20 1710085170 0 Physician Assistant Only Fluoride varnish 20 1710085170 0 Physician Assistant Only Healthy Kids Services 20 1710085170 0 Physician Assistant Only Physician Services 00 1710085535 0 SY RHODORA R 1997213 9999999 B 10 1710085535 0 25872 NETWORK PL CHICAGO IL 606731258 20 1710085535 0 Physicians Anesthesia Services 20 1710085535 0 Physicians Fluoride varnish 20 1710085535 0 Physicians Healthy Kids Services 20 1710085535 0 Physicians Optical Supplies 20 1710085535 0 Physicians Physician Services 00 1710085600 0 ARLA MOHANA R 2016051 9999999 B 10 1710085600 0 170 DR ARLA WAY STE 101 LOUISVILLE KY 402295427 20 1710085600 0 Physicians Anesthesia Services 20 1710085600 0 Physicians Fluoride varnish 20 1710085600 0 Physicians Healthy Kids Services 20 1710085600 0 Physicians Optical Supplies 20 1710085600 0 Physicians Physician Services 00 1710085998 0 VEENSTRA BRITTNEY 2009257 9999999 B 10 1710085998 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1710085998 0 Nurse Practitioners Healthy Kids Services 20 1710085998 0 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KHORANA CHITRA 2008168 9999999 B 10 1710142674 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1710142674 0 Occupational Therapists Medical Supplies 20 1710142674 0 Occupational Therapists Medical equipment/prosthetic devices 20 1710142674 0 Occupational Therapists Occupational Therapy Services 00 1710142740 0 MARTENS MONICA A 2013006 9999999 B 10 1710142740 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1710142740 0 Physicians Anesthesia Services 20 1710142740 0 Physicians Fluoride varnish 20 1710142740 0 Physicians Healthy Kids Services 20 1710142740 0 Physicians Optical Supplies 20 1710142740 0 Physicians Physician Services 00 1710142799 0 BOUCHER DEBORA 2009150 9999999 B 10 1710142799 0 40826 N RIDGE CIR ANTIOCH IL 600029545 20 1710142799 0 Nurse Practitioners Healthy Kids Services 20 1710142799 0 Nurse Practitioners Midwife Services 20 1710142799 0 Nurse Practitioners Nurse Practitioners Services 20 1710142799 0 Nurse Practitioners Physician Services 00 1710143193 0 LAKHA ASIF M 2014247 9999999 B 10 1710143193 0 29373 NETWORK PL CHICAGO IL 606733039 20 1710143193 0 Physicians Anesthesia Services 20 1710143193 0 Physicians Fluoride varnish 20 1710143193 0 Physicians Healthy Kids Services 20 1710143193 0 Physicians Optical Supplies 20 1710143193 0 Physicians Physician Services 00 1710143367 0 MULLINS KERI J 2010004 9999999 B 10 1710143367 0 1366 E 1050TH AVE OBLONG IL 624492409 20 1710143367 0 Nurse Practitioners Fluoride varnish 20 1710143367 0 Nurse Practitioners Healthy Kids Services 20 1710143367 0 Nurse Practitioners Nurse Practitioners Services 20 1710143367 0 Nurse Practitioners Physician Services 00 1710143383 0 DEVANAGONDI RAJIV 2025011 9999999 B 10 1710143383 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1710143383 0 Physicians Anesthesia Services 20 1710143383 0 Physicians Fluoride varnish 20 1710143383 0 Physicians Healthy Kids Services 20 1710143383 0 Physicians Optical Supplies 20 1710143383 0 Physicians Physician Services 00 1710143565 0 THUMMALAKUNTA LAXMI 2012262 9999999 B 10 1710143565 0 2100 POWELL ST STE 900 EMERYVILLE CA 946081844 20 1710143565 0 Physicians Anesthesia Services 20 1710143565 0 Physicians Fluoride varnish 20 1710143565 0 Physicians Healthy Kids Services 20 1710143565 0 Physicians Optical Supplies 20 1710143565 0 Physicians Physician Services 00 1710143904 0 ABRAHAM ANUB A 2008245 9999999 B 10 1710143904 0 5777 DEPT CAROL STREAM IL 601220021 20 1710143904 0 Physicians Anesthesia Services 20 1710143904 0 Physicians Fluoride varnish 20 1710143904 0 Physicians Healthy Kids Services 20 1710143904 0 Physicians Optical Supplies 20 1710143904 0 Physicians Physician Services 00 1710144233 0 HARANO JOANN 1990135 9999999 B 10 1710144233 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1710144233 0 Audiologists Audiology Services 20 1710144233 0 Audiologists Medical Supplies 20 1710144233 0 Audiologists Medical equipment/prosthetic devices 00 1710144324 0 GARCIA THOMAS 2021274 9999999 B 10 1710144324 0 5665 NEW 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CITY IA 522421009 20 1710145115 0 Physicians Anesthesia Services 20 1710145115 0 Physicians Fluoride varnish 20 1710145115 0 Physicians Healthy Kids Services 20 1710145115 0 Physicians Optical Supplies 20 1710145115 0 Physicians Physician Services 00 1710145743 0 MARTIN JEFFREY 2014188 9999999 B 10 1710145743 0 585 TOLLGATE RD ELGIN IL 601239323 20 1710145743 0 Clinical Social Worker Social work service 00 1710145826 0 KIM MIRIAM Y 2017227 9999999 B 10 1710145826 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1710145826 0 Physicians Anesthesia Services 20 1710145826 0 Physicians Fluoride varnish 20 1710145826 0 Physicians Healthy Kids Services 20 1710145826 0 Physicians Optical Supplies 20 1710145826 0 Physicians Physician Services 00 1710146360 0 DAMEWOOD SARA C 2012092 9999999 B 10 1710146360 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1710146360 0 Physicians Anesthesia Services 20 1710146360 0 Physicians Healthy Kids Services 20 1710146360 0 Physicians Optical 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1710148010 0 Physicians Fluoride varnish 20 1710148010 0 Physicians Healthy Kids Services 20 1710148010 0 Physicians Optical Supplies 20 1710148010 0 Physicians Physician Services 00 1710148739 0 STAMS VICTOR E 2019218 9999999 B 10 1710148739 0 611 W PARK ST URBANA IL 618012529 20 1710148739 0 Physicians Anesthesia Services 20 1710148739 0 Physicians Healthy Kids Services 20 1710148739 0 Physicians Optical Supplies 20 1710148739 0 Physicians Physician Services 00 1710148804 0 BEER SARA L 2018045 9999999 B 10 1710148804 0 421 W HARNETT ST MASCOUTAH IL 622581362 20 1710148804 0 Speech Therapists Medical Supplies 20 1710148804 0 Speech Therapists Medical equipment/prosthetic devices 20 1710148804 0 Speech Therapists Speech Therapy/Pathology Services 00 1710149224 0 JAVED MAHWESH 2011182 9999999 B 10 1710149224 0 62311 COLLECTION CENTER DR CHICAGO IL 606930001 20 1710149224 0 Physicians All Kids application agent 20 1710149224 0 Physicians Anesthesia Services 20 1710149224 0 Physicians Fluoride varnish 20 1710149224 0 Physicians Healthy Kids Services 20 1710149224 0 Physicians Optical Supplies 20 1710149224 0 Physicians Physician Services 00 1710149968 0 PARK LEONARD CATHERINE 2012336 9999999 B 10 1710149968 0 5777 DEPT CAROL STREAM IL 601220021 20 1710149968 0 Physicians Anesthesia Services 20 1710149968 0 Physicians Healthy Kids Services 20 1710149968 0 Physicians Optical Supplies 20 1710149968 0 Physicians Physician Services 00 1710150420 0 PINKERTON CAROLYN 2016092 9999999 B 10 1710150420 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1710150420 0 Physicians Anesthesia Services 20 1710150420 0 Physicians Healthy Kids Services 20 1710150420 0 Physicians Optical Supplies 20 1710150420 0 Physicians Physician Services 00 1710150438 0 ASI KHALED 2016275 9999999 B 10 1710150438 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1710150438 0 Physicians Anesthesia Services 20 1710150438 0 Physicians Healthy Kids Services 20 1710150438 0 Physicians Optical Supplies 20 1710150438 0 Physicians Physician Services 20 1710150438 0 Physicians Physicians Psychiatric Services 00 1710150719 0 HERRMAN KRISTINE L 2008120 9999999 B 10 1710150719 0 2300 N EDWARD ST DECATUR IL 625264163 20 1710150719 0 Audiologists Audiology Services 20 1710150719 0 Audiologists Medical Supplies 20 1710150719 0 Audiologists Medical equipment/prosthetic devices 00 1710151105 0 MA IRENE Q 2011227 9999999 B 10 1710151105 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1710151105 0 Physicians Anesthesia Services 20 1710151105 0 Physicians Fluoride varnish 20 1710151105 0 Physicians Healthy Kids Services 20 1710151105 0 Physicians Optical Supplies 20 1710151105 0 Physicians Physician Services 00 1710151550 0 HERETIS KATHERINE 2015213 9999999 B 10 1710151550 0 804 E WOODFIELD RD STE 300 SCHAUMBURG IL 601734776 20 1710151550 0 Physicians Anesthesia Services 20 1710151550 0 Physicians Fluoride varnish 20 1710151550 0 Physicians Healthy Kids Services 20 1710151550 0 Physicians Optical Supplies 20 1710151550 0 Physicians Physician Services 00 1710151675 0 REIS BRADY 2008183 9999999 B 10 1710151675 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1710151675 0 Physicians Anesthesia Services 20 1710151675 0 Physicians Healthy Kids Services 20 1710151675 0 Physicians Optical Supplies 20 1710151675 0 Physicians Physician Services 00 1710152020 0 KLUCK HEATHER L 2016076 9999999 B 10 1710152020 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1710152020 0 Physician Assistant Only Fluoride varnish 20 1710152020 0 Physician Assistant Only Healthy Kids Services 20 1710152020 0 Physician Assistant Only Physician Services 00 1710152343 0 MIKHAIL ALLEN T 2011365 9999999 B 10 1710152343 0 2357 SEQUOIA DR AURORA IL 605066222 20 1710152343 0 Physicians Anesthesia Services 20 1710152343 0 Physicians Healthy Kids Services 20 1710152343 0 Physicians Optical Supplies 20 1710152343 0 Physicians Physician Services 00 1710154240 0 GANDHI SEEMA R 2013182 9999999 B 10 1710154240 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1710154240 0 Physicians Anesthesia Services 20 1710154240 0 Physicians Healthy Kids Services 20 1710154240 0 Physicians Optical Supplies 20 1710154240 0 Physicians Physician Services 00 1710154331 0 LEONARD JAMES 2012214 9999999 B 10 1710154331 0 8550 W BRYN MAWR AVE STE 800 STE 800 CHICAGO IL 606313222 20 1710154331 0 Physicians Anesthesia Services 20 1710154331 0 Physicians Healthy Kids Services 20 1710154331 0 Physicians Optical Supplies 20 1710154331 0 Physicians Physician Services 00 1710154794 0 IM MICHAEL 2023335 9999999 B 10 1710154794 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1710154794 0 Physicians Anesthesia Services 20 1710154794 0 Physicians Healthy Kids Services 20 1710154794 0 Physicians Optical Supplies 20 1710154794 0 Physicians Physician Services 00 1710157631 0 SKRYPEK THOMAS M 2011191 9999999 B 10 1710157631 0 5901 LINCOLN DR EDINA MN 554361611 20 1710157631 0 Physicians Anesthesia Services 20 1710157631 0 Physicians Healthy Kids Services 20 1710157631 0 Physicians Optical Supplies 20 1710157631 0 Physicians Physician Services 00 1710158233 0 DAVIS JOSEPH 2012087 9999999 B 10 1710158233 0 515 22ND AVE MONROE WI 535661569 20 1710158233 0 Physical Therapists Medical Supplies 20 1710158233 0 Physical Therapists Medical equipment/prosthetic devices 20 1710158233 0 Physical Therapists Physical Therapy Services 00 1710158274 0 ROBINSON TIFFANY L 2015352 9999999 B 10 1710158274 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1710158274 0 Physicians Anesthesia Services 20 1710158274 0 Physicians Healthy Kids Services 20 1710158274 0 Physicians Optical Supplies 20 1710158274 0 Physicians Physician Services 00 1710159512 0 VAN HOOK YVETTE Y 2010055 9999999 B 10 1710159512 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1710159512 0 Nurse Practitioners Healthy Kids Services 20 1710159512 0 Nurse Practitioners Nurse Practitioners Services 20 1710159512 0 Nurse Practitioners Physician Services 00 1710160239 0 LUX BRIAN T 2017206 9999999 B 10 1710160239 0 1605 W WILSON ST STE 106 BATAVIA IL 605101608 20 1710160239 0 Other behavior health professional LCPC/LMFT services 00 1710160429 0 NEUSCHLER ERIN 2009213 9999999 B 10 1710160429 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1710160429 0 Physicians Anesthesia Services 20 1710160429 0 Physicians Healthy Kids Services 20 1710160429 0 Physicians Optical Supplies 20 1710160429 0 Physicians Physician Services 00 1710160437 0 SWANSON SUSAN R 2007335 9999999 B 10 1710160437 0 4701 DEPT CAROL STREAM IL 601220021 20 1710160437 0 Nurse Practitioners All Kids application agent 20 1710160437 0 Nurse Practitioners Healthy Kids Services 20 1710160437 0 Nurse Practitioners Nurse Practitioners Services 20 1710160437 0 Nurse Practitioners Physician Services 00 1710161039 0 GEORGE JOBY 2011343 9999999 B 10 1710161039 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1710161039 0 Physicians Anesthesia Services 20 1710161039 0 Physicians Healthy Kids Services 20 1710161039 0 Physicians Optical Supplies 20 1710161039 0 Physicians Physician Services 00 1710163837 0 AL-KHARRAT MOHAMMAD 2014260 9999999 B 10 1710163837 0 318 MAXWELL RD STE 500 ALPHARETTA GA 300092064 20 1710163837 0 Physicians Anesthesia Services 20 1710163837 0 Physicians Healthy Kids Services 20 1710163837 0 Physicians Optical Supplies 20 1710163837 0 Physicians Physician Services 00 1710165030 0 HO ALBERT 2023053 9999999 B 10 1710165030 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1710165030 0 Physicians Anesthesia Services 20 1710165030 0 Physicians Fluoride varnish 20 1710165030 0 Physicians Healthy Kids Services 20 1710165030 0 Physicians Optical Supplies 20 1710165030 0 Physicians Physician Services 00 1710166731 0 ZAMOS DAVID T 2022261 9999999 B 10 1710166731 0 611 W PARK ST URBANA IL 618012529 20 1710166731 0 Physicians Anesthesia Services 20 1710166731 0 Physicians Healthy Kids Services 20 1710166731 0 Physicians Optical Supplies 20 1710166731 0 Physicians Physician Services 00 1710167655 0 JOHNSON BRADLEY T 2016225 9999999 B 10 1710167655 0 PO BOX 431 JANESVILLE WI 535470431 20 1710167655 0 Physician Assistant Only Fluoride varnish 20 1710167655 0 Physician Assistant Only Healthy Kids Services 20 1710167655 0 Physician Assistant Only Physician Services 00 1710167895 0 BRADLEY BROOKE 2014091 9999999 B 10 1710167895 0 1518 MULBERRY AVE MUSCATINE IA 527613433 20 1710167895 0 Nurse Practitioners Fluoride varnish 20 1710167895 0 Nurse Practitioners Healthy Kids Services 20 1710167895 0 Nurse Practitioners Nurse Practitioners Services 20 1710167895 0 Nurse Practitioners Physician Services 00 1710170600 0 MORGAN LORRAINE 2006100 9999999 B 10 1710170600 0 201 N MISSISSIPPI ST PITTSFIELD IL 623631410 20 1710170600 0 Physical Therapists Medical Supplies 20 1710170600 0 Physical Therapists Medical equipment/prosthetic devices 20 1710170600 0 Physical Therapists Physical Therapy Services 00 1710171699 0 GREENLY JASON 2024234 9999999 B 10 1710171699 0 801 N WALNUT ST CHAMPAIGN IL 618203055 20 1710171699 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1710172325 0 WENDT DONALD 2016092 9999999 B 10 1710172325 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1710172325 0 Physician Assistant Only Fluoride varnish 20 1710172325 0 Physician Assistant Only Healthy Kids Services 20 1710172325 0 Physician Assistant Only Physician Services 00 1710172515 0 MAZUR ALEXANDER 2007339 9999999 B 10 1710172515 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1710172515 0 Physicians Anesthesia Services 20 1710172515 0 Physicians Fluoride varnish 20 1710172515 0 Physicians Healthy Kids Services 20 1710172515 0 Physicians Optical Supplies 20 1710172515 0 Physicians Physician Services 00 1710172564 0 STELLE BETMAN MARGARET 2012153 9999999 B 10 1710172564 0 29373 NETWORK PL CHICAGO IL 606733039 20 1710172564 0 Nurse Practitioners Healthy Kids Services 20 1710172564 0 Nurse Practitioners Nurse Practitioners Services 20 1710172564 0 Nurse Practitioners Physician Services 00 1710173653 0 MCCLAIN MORGAN W 2024230 9999999 B 10 1710173653 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1710173653 0 Physicians Anesthesia Services 20 1710173653 0 Physicians Healthy Kids Services 20 1710173653 0 Physicians Optical Supplies 20 1710173653 0 Physicians Physician Services 00 1710174248 0 FRISELLA BRITTANY N 2007213 9999999 B 10 1710174248 0 1220 S WOOD ST CHICAGO IL 606081202 20 1710174248 0 Nurse Practitioners Healthy Kids Services 20 1710174248 0 Nurse Practitioners Nurse Practitioners Services 20 1710174248 0 Nurse Practitioners Physician Services 00 1710174933 0 WEYANT MICHELLE 2007253 9999999 B 10 1710174933 0 124 SW ADAMS ST PEORIA IL 616021308 20 1710174933 0 Physical Therapists Medical Supplies 20 1710174933 0 Physical Therapists Medical equipment/prosthetic devices 20 1710174933 0 Physical Therapists Physical Therapy Services 00 1710175864 0 ANHALT BROOKELYN 2007355 9999999 B 10 1710175864 0 16931 GRISSOM DR TINLEY PARK IL 604772318 20 1710175864 0 Speech Therapists Speech Therapy/Pathology Services 00 1710176615 0 REISINGER GENE A 1990303 9999999 B 10 1710176615 0 1122 WESTGATE ST STE 200 OAK PARK IL 603011082 20 1710176615 0 Dentists Dental Services 20 1710176615 0 Dentists Physician Services 00 1710176839 0 ANUMULA SAILA 2007274 9999999 B 10 1710176839 0 522 E NORTH AVE GLENDALE HEIGHT IL 601393119 20 1710176839 0 Dentists Dental Services 20 1710176839 0 Dentists Physician Services 00 1710178496 0 HOKENSON MICHAEL 2020125 9999999 B 10 1710178496 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1710178496 0 Physicians Anesthesia Services 20 1710178496 0 Physicians Fluoride varnish 20 1710178496 0 Physicians Healthy Kids Services 20 1710178496 0 Physicians Optical Supplies 20 1710178496 0 Physicians Physician Services 00 1710178702 0 PATEL DIVYANSU 2025037 9999999 B 10 1710178702 0 7877 WILLOW CHASE BLVD HOUSTON TX 770705934 20 1710178702 0 Physicians Anesthesia Services 20 1710178702 0 Physicians Healthy Kids Services 20 1710178702 0 Physicians Optical Supplies 20 1710178702 0 Physicians Physician Services 20 1710178702 0 Physicians Physicians Psychiatric Services 00 1710180252 0 HOWELL ALAN C 2025028 9999999 B 10 1710180252 0 15740 S OUTER 40 RD CHESTERFIELD MO 630172004 20 1710180252 0 Physicians Anesthesia Services 20 1710180252 0 Physicians Fluoride varnish 20 1710180252 0 Physicians Healthy Kids Services 20 1710180252 0 Physicians Optical Supplies 20 1710180252 0 Physicians Physician Services 00 1710180856 0 KAECH DONNA M 2007204 9999999 B 10 1710180856 0 17314 KEDZIE AVE HAZEL CREST IL 604291619 20 1710180856 0 Occupational Therapists Medical Supplies 20 1710180856 0 Occupational Therapists Medical equipment/prosthetic devices 20 1710180856 0 Occupational Therapists Occupational Therapy Services 00 1710181318 0 VERMA DIVYA 2022031 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PO BOX 8500 LOCKBOX 7642 PHILADELPHIA PA 191787642 20 1710183009 0 Physicians Anesthesia Services 20 1710183009 0 Physicians Healthy Kids Services 20 1710183009 0 Physicians Optical Supplies 20 1710183009 0 Physicians Physician Services 00 1710183330 0 MOHAN RAVI 2013315 9999999 B 10 1710183330 0 5665 NEW NORTHSIDE DR STE 320 ATLANTA GA 303285834 20 1710183330 0 Physicians Anesthesia Services 20 1710183330 0 Physicians Fluoride varnish 20 1710183330 0 Physicians Healthy Kids Services 20 1710183330 0 Physicians Optical Supplies 20 1710183330 0 Physicians Physician Services 00 1710183637 0 BETHEL LEAH 2024097 9999999 B 10 1710183637 0 1229 C AVE E OSKALOOSA IA 525774246 20 1710183637 0 Physicians Anesthesia Services 20 1710183637 0 Physicians Healthy Kids Services 20 1710183637 0 Physicians Optical Supplies 20 1710183637 0 Physicians Physician Services 00 1710183975 0 CLEMENTS ELENA L 2012142 9999999 B 10 1710183975 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1710183975 0 Registered nurse Nursing service 20 1710183975 0 Registered nurse Waiver service 00 1710184197 0 SHARMA JAYA 2015182 9999999 B 10 1710184197 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1710184197 0 Physicians Anesthesia Services 20 1710184197 0 Physicians Fluoride varnish 20 1710184197 0 Physicians Healthy Kids Services 20 1710184197 0 Physicians Optical Supplies 20 1710184197 0 Physicians Physician Services 00 1710184908 0 BLACK STEPHANIE A 2017138 9999999 B 10 1710184908 0 100 E PENN SQ PHILADELPHIA PA 191073323 20 1710184908 0 Physicians Anesthesia Services 20 1710184908 0 Physicians Healthy Kids Services 20 1710184908 0 Physicians Optical Supplies 20 1710184908 0 Physicians Physician Services 00 1710185392 0 VRECENAK JESSE 2017212 9999999 B 10 1710185392 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1710185392 0 Physicians Anesthesia Services 20 1710185392 0 Physicians Healthy Kids Services 20 1710185392 0 Physicians Optical Supplies 20 1710185392 0 Physicians Physician Services 00 1710185764 0 WALLACE HUDSON ANNIE 2014156 9999999 B 10 1710185764 0 111 W JACKSON BLVD CHICAGO IL 606043589 20 1710185764 0 Clinical Social Worker Social work service 00 1710187018 0 TATTERSALL MATTHEW C 2014182 9999999 B 10 1710187018 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1710187018 0 Physicians Anesthesia Services 20 1710187018 0 Physicians Fluoride varnish 20 1710187018 0 Physicians Healthy Kids Services 20 1710187018 0 Physicians Optical Supplies 20 1710187018 0 Physicians Physician Services 00 1710187836 0 DANDEKAR VINEET K 2013217 9999999 B 10 1710187836 0 29373 NETWORK PL CHICAGO IL 606733039 20 1710187836 0 Physicians Anesthesia Services 20 1710187836 0 Physicians Fluoride varnish 20 1710187836 0 Physicians Healthy Kids Services 20 1710187836 0 Physicians Optical Supplies 20 1710187836 0 Physicians Physician Services 00 1710188446 0 WILLIAMS-HAMPTON ERICKA 2013197 9999999 B 10 1710188446 0 1901 W HARRISON ST CHICAGO IL 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20 1710191408 0 Physicians Anesthesia Services 20 1710191408 0 Physicians Healthy Kids Services 20 1710191408 0 Physicians Optical Supplies 20 1710191408 0 Physicians Physician Services 00 1710191705 0 DEY LUCY 2006182 9999999 B 10 1710191705 0 202 N HAMMES AVE UNIT C JOLIET IL 604358136 20 1710191705 0 Physicians Anesthesia Services 20 1710191705 0 Physicians Fluoride varnish 20 1710191705 0 Physicians Healthy Kids Services 20 1710191705 0 Physicians Optical Supplies 20 1710191705 0 Physicians Physician Services 00 1710192349 0 CURRY RAYMOND H 1985182 9999999 B 10 1710192349 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1710192349 0 Physicians Anesthesia Services 20 1710192349 0 Physicians Fluoride varnish 20 1710192349 0 Physicians Healthy Kids Services 20 1710192349 0 Physicians Optical Supplies 20 1710192349 0 Physicians Physician Services 00 1710192471 0 SHUMAN TRACY 2022339 9999999 B 10 1710192471 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1710192471 0 Physicians 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1710255906 0 1501 S CALIFORNIA AVE # 6119 NR6119 CHICAGO IL 606081732 20 1710255906 0 Psychologist Psychologist service 00 1710256631 0 MISKELL JESSICA 2012021 9999999 B 10 1710256631 0 218 W MADISON ST OTTAWA IL 613502819 20 1710256631 0 Nurse Practitioners Healthy Kids Services 20 1710256631 0 Nurse Practitioners Nurse Practitioners Services 20 1710256631 0 Nurse Practitioners Physician Services 00 1710257266 0 KATER SHARON 2012055 9999999 B 10 1710257266 0 8324 SKOKIE BLVD SKOKIE IL 600772545 20 1710257266 0 Clinical Social Worker Social work service 00 1710258637 0 TACUBOY HAROLD 2017026 9999999 B 10 1710258637 0 1400 E IRVING PARK RD STREAMWOOD IL 601073201 20 1710258637 0 Nurse Practitioners Healthy Kids Services 20 1710258637 0 Nurse Practitioners Nurse Practitioners Services 20 1710258637 0 Nurse Practitioners Physician Services 00 1710261938 0 RISSMAN NICOLE 2012137 9999999 B 10 1710261938 0 903 COMMERCE DR STE 333 SUITE 333 OAK BROOK IL 605238723 20 1710261938 0 Nurse 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0 Physicians Optical Supplies 20 1710272372 0 Physicians Physician Services 00 1710272760 0 ADAMS ADRIENNE J 2023335 9999999 B 10 1710272760 0 5777 DEPT CAROL STREAM IL 601220021 20 1710272760 0 Physicians Anesthesia Services 20 1710272760 0 Physicians Healthy Kids Services 20 1710272760 0 Physicians Optical Supplies 20 1710272760 0 Physicians Physician Services 00 1710272778 0 PUFAHL KAITLYN 2024285 9999999 B 10 1710272778 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1710272778 0 Nurse Practitioners Fluoride varnish 20 1710272778 0 Nurse Practitioners Healthy Kids Services 20 1710272778 0 Nurse Practitioners Nurse Practitioners Services 20 1710272778 0 Nurse Practitioners Physician Services 00 1710272992 0 PIERSON JOSEPH S 2014234 9999999 B 10 1710272992 0 9145 COLLECTION CENTER DR CHICAGO IL 606930091 20 1710272992 0 Physicians Anesthesia Services 20 1710272992 0 Physicians Healthy Kids Services 20 1710272992 0 Physicians Optical Supplies 20 1710272992 0 Physicians Physician 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1710550355 0 Nurse Practitioners Healthy Kids Services 20 1710550355 0 Nurse Practitioners Nurse Practitioners Services 20 1710550355 0 Nurse Practitioners Physician Services 00 1710550447 0 DEENADAYALAN VAISHALI 2021231 9999999 B 10 1710550447 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1710550447 0 Physicians Anesthesia Services 20 1710550447 0 Physicians Fluoride varnish 20 1710550447 0 Physicians Healthy Kids Services 20 1710550447 0 Physicians Optical Supplies 20 1710550447 0 Physicians Physician Services 00 1710550561 0 DORON OMER M 2024211 9999999 B 10 1710550561 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1710550561 0 Physicians Anesthesia Services 20 1710550561 0 Physicians Healthy Kids Services 20 1710550561 0 Physicians Optical Supplies 20 1710550561 0 Physicians Physician Services 00 1710551403 0 ROSENTHAL ANNE M 2023242 9999999 B 10 1710551403 0 1301 W DEVON AVE CHICAGO IL 606601329 20 1710551403 0 Nurse Practitioners Fluoride varnish 20 1710551403 0 Nurse 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Practitioners Nurse Practitioners Services 20 1710552781 0 Nurse Practitioners Physician Services 00 1710554019 0 BRIGHAM LARISSA 2023013 9999999 B 10 1710554019 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1710554019 0 Optometrists Optical Supplies 20 1710554019 0 Optometrists Optometric Services 20 1710554019 0 Optometrists Physician Services 00 1710554589 0 DRUZINSKY RACHAEL 2021251 9999999 B 10 1710554589 0 5777 DEPT CAROL STREAM IL 601220021 20 1710554589 0 Nurse Practitioners Anesthesia Services 20 1710554589 0 Nurse Practitioners Nurse Practitioners Services 20 1710554589 0 Nurse Practitioners Physician Services 00 1710554746 0 WOLF ERIN A 2021209 9999999 B 10 1710554746 0 520 MARY ST STE 520 EVANSVILLE IN 477101682 20 1710554746 0 Physician Assistant Only Fluoride varnish 20 1710554746 0 Physician Assistant Only Healthy Kids Services 20 1710554746 0 Physician Assistant Only Physician Services 00 1710554902 0 KIRBY RICHARD N 2021250 9999999 B 10 1710554902 0 541 OTIS BOWEN DR 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Kids Services 20 1710584081 0 Nurse Practitioners Nurse Practitioners Services 20 1710584081 0 Nurse Practitioners Physician Services 00 1710584297 0 IZQUIERDO NATALIA 2020283 9999999 B 10 1710584297 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1710584297 0 Nurse Practitioners Anesthesia Services 20 1710584297 0 Nurse Practitioners Nurse Practitioners Services 20 1710584297 0 Nurse Practitioners Physician Services 00 1710584834 0 NANDAR MYA YEE 2021305 9999999 B 10 1710584834 0 309 NEW INDIAN TRAIL CT AURORA IL 605062411 20 1710584834 0 Nurse Practitioners Fluoride varnish 20 1710584834 0 Nurse Practitioners Healthy Kids Services 20 1710584834 0 Nurse Practitioners Nurse Practitioners Services 20 1710584834 0 Nurse Practitioners Physician Services 00 1710584917 0 LANE JESSICA L 2020322 9999999 B 10 1710584917 0 5290 WILLIAMS DR ROSCOE IL 610739222 20 1710584917 0 Other behavior health professional LCPC/LMFT services 00 1710586128 0 RIGG JESSICA 2020338 9999999 B 10 1710586128 0 109 CALIFORNIA ST CARTERVILLE IL 629181923 20 1710586128 0 Nurse Practitioners Family Planning Counseling 20 1710586128 0 Nurse Practitioners Fluoride varnish 20 1710586128 0 Nurse Practitioners Healthy Kids Services 20 1710586128 0 Nurse Practitioners Nurse Practitioners Services 20 1710586128 0 Nurse Practitioners Physician Services 00 1710586151 0 MORITA DANE 2024009 9999999 B 10 1710586151 0 28100 TORCH PKWY STE 600 WARRENVILLE IL 605554030 20 1710586151 0 Physical Therapists Medical Supplies 20 1710586151 0 Physical Therapists Medical equipment/prosthetic devices 20 1710586151 0 Physical Therapists Physical Therapy Services 00 1710587464 0 SCHULTE CARRIE 2020311 9999999 B 10 1710587464 0 1256 WATERFORD DR STE 230 AURORA IL 605044511 20 1710587464 0 Nurse Practitioners Fluoride varnish 20 1710587464 0 Nurse Practitioners Healthy Kids Services 20 1710587464 0 Nurse Practitioners Nurse Practitioners Services 20 1710587464 0 Nurse Practitioners Physician Services 00 1710591854 0 HOMAN TRISHA 2020255 9999999 B 10 1710591854 0 1643 NW 136TH AVE BLDG H SUNRISE FL 333232857 20 1710591854 0 Nurse Practitioners Healthy Kids Services 20 1710591854 0 Nurse Practitioners Nurse Practitioners Services 20 1710591854 0 Nurse Practitioners Physician Services 00 1710592175 0 MALONEY MARY E 2021316 9999999 B 10 1710592175 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1710592175 0 Nurse Practitioners Healthy Kids Services 20 1710592175 0 Nurse Practitioners Nurse Practitioners Services 20 1710592175 0 Nurse Practitioners Physician Services 00 1710592423 0 NAJRABI KHATERA 2021032 9999999 B 10 1710592423 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1710592423 0 Nurse Practitioners Anesthesia Services 20 1710592423 0 Nurse Practitioners Nurse Practitioners Services 20 1710592423 0 Nurse Practitioners Physician Services 00 1710593124 0 LEEZER ANDREA N 2020301 9999999 B 10 1710593124 0 1005 BROADWAY ST QUINCY IL 623012834 20 1710593124 0 Clinical Social Worker Social work service 00 1710594445 0 BLAKELY INDIA B 2022276 9999999 B 10 1710594445 0 18300 S HALSTED ST STE B GLENWOOD IL 604251051 20 1710594445 0 Other behavior health professional LCPC/LMFT services 00 1710594767 0 SMOCK BROOKLYNN 2020309 9999999 B 10 1710594767 0 PO BOX 781076 DETROIT MI 482781076 20 1710594767 0 Nurse Practitioners Fluoride varnish 20 1710594767 0 Nurse Practitioners Healthy Kids Services 20 1710594767 0 Nurse Practitioners Nurse Practitioners Services 20 1710594767 0 Nurse Practitioners Physician Services 00 1710595111 0 BLYTHE NICOLE 2024219 9999999 B 10 1710595111 0 510 HEMPSTEAD TPKE RM 203 WEST HEMPSTEAD NY 115521152 20 1710595111 0 Nurse Practitioners Healthy Kids Services 20 1710595111 0 Nurse Practitioners Nurse Practitioners Services 20 1710595111 0 Nurse Practitioners Physician Services 00 1710595129 0 MCCULLERS DEVEN S 2021182 9999999 B 10 1710595129 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1710595129 0 Physicians Anesthesia Services 20 1710595129 0 Physicians Fluoride varnish 20 1710595129 0 Physicians Healthy Kids Services 20 1710595129 0 Physicians Optical Supplies 20 1710595129 0 Physicians Physician Services 00 1710595368 0 PATEL ARPIT 2022096 9999999 B 10 1710595368 0 175 E HOUSTON ST SAN ANTONIO TX 782052255 20 1710595368 0 Optometrists Optical Supplies 20 1710595368 0 Optometrists Optometric Services 20 1710595368 0 Optometrists Physician Services 00 1710595442 0 KRAUSS HEIDI 2024124 9999999 B 10 1710595442 0 5777 DEPT CAROL STREAM IL 601220021 20 1710595442 0 Clinical Social Worker Social work service 00 1710596028 0 GOLDADE PAULA 2022252 9999999 B 10 1710596028 0 818 5TH AVE SUITE 200 DES MOINES IA 503091307 20 1710596028 0 Nurse Practitioners Healthy Kids Services 20 1710596028 0 Nurse Practitioners Midwife Services 20 1710596028 0 Nurse Practitioners Nurse Practitioners Services 20 1710596028 0 Nurse Practitioners Physician Services 00 1710596424 0 THORNBURG CLAY 2022125 9999999 B 10 1710596424 0 100 MEDICAL DR HANNIBAL MO 634016877 20 1710596424 0 Nurse Practitioners Healthy Kids Services 20 1710596424 0 Nurse Practitioners Nurse Practitioners Services 20 1710596424 0 Nurse Practitioners Physician Services 00 1710596572 0 SPECIALE NICHOL K 2023138 9999999 B 10 1710596572 0 5801 MOUNT PLEASANT LN BELLEVILLE IL 622233944 20 1710596572 0 Other behavior health professional Social work service 00 1710596804 0 MILES SHANIQUA C 2021062 9999999 B 10 1710596804 0 PO BOX 856 ANTIOCH IL 600020856 20 1710596804 0 Clinical Social Worker Social work service 00 1710597059 0 MCGINNIS TIMOTHY 2020216 9999999 B 10 1710597059 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1710597059 0 Physical Therapists Medical Supplies 20 1710597059 0 Physical Therapists Medical equipment/prosthetic devices 20 1710597059 0 Physical Therapists Physical Therapy Services 00 1710597174 0 VALENZUELA CORTEZ GUILLERMO 2023300 9999999 B 10 1710597174 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1710597174 0 Physicians Anesthesia Services 20 1710597174 0 Physicians Healthy Kids Services 20 1710597174 0 Physicians Optical Supplies 20 1710597174 0 Physicians Physician Services 00 1710597281 0 OJOMALADE ADEPEJU 2021301 9999999 B 10 1710597281 0 9119 S EXCHANGE AVE CHICAGO IL 606174225 20 1710597281 0 Nurse Practitioners Fluoride varnish 20 1710597281 0 Nurse Practitioners Healthy Kids Services 20 1710597281 0 Nurse Practitioners Nurse Practitioners Services 20 1710597281 0 Nurse Practitioners Physician Services 00 1710597943 0 SEVIER LATOYA 2024164 9999999 B 10 1710597943 0 17941 WENTWORTH AVE LANSING IL 604383938 20 1710597943 0 Other behavior health professional LCPC/LMFT services 00 1710598123 0 MALONE MEGHAN 2020315 9999999 B 10 1710598123 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1710598123 0 Nurse Practitioners Healthy Kids Services 20 1710598123 0 Nurse Practitioners Nurse Practitioners Services 20 1710598123 0 Nurse Practitioners Physician Services 00 1710599386 0 JOHNSON BRIANNA 2022199 9999999 B 10 1710599386 0 3500 QUAKERBRIDGE RD STE 105 HAMILTON NJ 086191206 20 1710599386 0 Nurse Practitioners Healthy Kids Services 20 1710599386 0 Nurse Practitioners Nurse Practitioners Services 20 1710599386 0 Nurse Practitioners Physician Services 00 1710599600 0 CHEN-PATTERSON ANGIE L 2024180 9999999 B 10 1710599600 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1710599600 0 Physicians Anesthesia Services 20 1710599600 0 Physicians Fluoride varnish 20 1710599600 0 Physicians Healthy Kids Services 20 1710599600 0 Physicians Optical Supplies 20 1710599600 0 Physicians Physician Services 00 1710600267 0 SUTOWSKI NICOLE O 2023018 9999999 B 10 1710600267 0 1701 W WISE RD SCHAUMBURG IL 601933553 20 1710600267 0 Nurse Practitioners Fluoride varnish 20 1710600267 0 Nurse Practitioners Healthy Kids Services 20 1710600267 0 Nurse Practitioners Nurse Practitioners Services 20 1710600267 0 Nurse Practitioners Physician Services 00 1710602040 0 SANGALANG MARC 2025064 9999999 B 10 1710602040 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1710602040 0 Nurse Practitioners Healthy Kids Services 20 1710602040 0 Nurse Practitioners Nurse Practitioners Services 20 1710602040 0 Nurse Practitioners Physician Services 00 1710602206 0 DICICCO ANNA 2022363 9999999 B 10 1710602206 0 5777 DEPT CAROL STREAM IL 601220021 20 1710602206 0 Nurse Practitioners Healthy Kids Services 20 1710602206 0 Nurse Practitioners Nurse Practitioners Services 20 1710602206 0 Nurse Practitioners Physician Services 00 1710603121 0 GRIESMAN MEGAN P 2022292 9999999 B 10 1710603121 0 4701 DEPT CAROL STREAM IL 601220021 20 1710603121 0 Nurse Practitioners Fluoride varnish 20 1710603121 0 Nurse Practitioners Healthy Kids Services 20 1710603121 0 Nurse Practitioners Nurse Practitioners Services 20 1710603121 0 Nurse Practitioners Physician Services 00 1710604061 0 BRADSTREET LAURA J 2022307 9999999 B 10 1710604061 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1710604061 0 Nurse Practitioners Fluoride varnish 20 1710604061 0 Nurse Practitioners Healthy Kids Services 20 1710604061 0 Nurse Practitioners Nurse Practitioners Services 20 1710604061 0 Nurse Practitioners Physician Services 00 1710604780 0 WILSON LAURA A 2023136 9999999 B 10 1710604780 0 2100 MADISON AVE STE 301 GRANITE CITY IL 620404713 20 1710604780 0 Nurse Practitioners Fluoride varnish 20 1710604780 0 Nurse Practitioners Healthy Kids Services 20 1710604780 0 Nurse Practitioners Nurse Practitioners Services 20 1710604780 0 Nurse Practitioners Physician Services 00 1710604822 0 NOESKA ALISSA B 2023065 9999999 B 10 1710604822 0 1430 N ARLINGTON HEIGHTS RD ST ARLINGTON HEIGH IL 600044823 20 1710604822 0 Nurse Practitioners Fluoride varnish 20 1710604822 0 Nurse Practitioners Healthy Kids Services 20 1710604822 0 Nurse Practitioners Nurse Practitioners Services 20 1710604822 0 Nurse Practitioners Physician Services 00 1710605720 0 JOHNSON RIANA 2024039 9999999 B 10 1710605720 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1710605720 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1710605951 0 DERUBEIS JENNIFER J 2022242 9999999 B 10 1710605951 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1710605951 0 Nurse Practitioners Fluoride varnish 20 1710605951 0 Nurse Practitioners Healthy Kids Services 20 1710605951 0 Nurse Practitioners Nurse Practitioners Services 20 1710605951 0 Nurse Practitioners Physician Services 00 1710606793 0 DICKMAN MAUREEN 2022238 9999999 B 10 1710606793 0 1 AVIATION CTR RANTOUL IL 618663481 20 1710606793 0 Speech Therapists Medical Supplies 20 1710606793 0 Speech Therapists Medical equipment/prosthetic devices 20 1710606793 0 Speech Therapists Speech Therapy/Pathology Services 00 1710607213 0 STANCZAK LAURA 2023131 9999999 B 10 1710607213 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1710607213 0 Nurse Practitioners Fluoride varnish 20 1710607213 0 Nurse Practitioners Healthy Kids Services 20 1710607213 0 Nurse Practitioners Nurse Practitioners Services 20 1710607213 0 Nurse Practitioners Physician Services 00 1710607437 0 DUNN MEGHAN P 2022244 9999999 B 10 1710607437 0 325 IL ROUTE 2 DIXON IL 610219118 20 1710607437 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1710608096 0 GARCIA CHRISTIAN 2022319 9999999 B 10 1710608096 0 5777 DEPT CAROL STREAM IL 601220021 20 1710608096 0 Nurse Practitioners Anesthesia Services 20 1710608096 0 Nurse Practitioners Nurse Practitioners Services 20 1710608096 0 Nurse Practitioners Physician Services 00 1710608104 0 BRIDGEMAN MEGAN S 2022290 9999999 B 10 1710608104 0 1025 MAINE ST QUINCY IL 623014038 20 1710608104 0 Nurse Practitioners Fluoride varnish 20 1710608104 0 Nurse Practitioners Healthy Kids Services 20 1710608104 0 Nurse Practitioners Nurse Practitioners Services 20 1710608104 0 Nurse Practitioners Physician Services 00 1710609193 0 GOGA DANIELLE K 2022257 9999999 B 10 1710609193 0 18350 CROSSING DR TINLEY PARK IL 604876294 20 1710609193 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1710610282 0 STRANGSTALIEN CLAIRE 2024229 9999999 B 10 1710610282 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1710610282 0 Physician Assistant Only Fluoride varnish 20 1710610282 0 Physician Assistant Only Healthy Kids Services 20 1710610282 0 Physician Assistant Only Physician Services 00 1710610407 0 DOMBROWSKI MATTHEW J 2025020 9999999 B 10 1710610407 0 1000 N OAK AVE MARSHFIELD WI 544495703 20 1710610407 0 Physician Assistant Only Fluoride varnish 20 1710610407 0 Physician Assistant Only Healthy Kids Services 20 1710610407 0 Physician Assistant Only Physician Services 00 1710611066 0 UDOVENKO VALERIYA 2023348 9999999 B 10 1710611066 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1710611066 0 Physician Assistant Only Fluoride varnish 20 1710611066 0 Physician Assistant Only Healthy Kids Services 20 1710611066 0 Physician Assistant Only Physician Services 00 1710613591 0 SZYNAL SARAH 2024180 9999999 B 10 1710613591 0 PO BOX 781076 DETROIT MI 482781076 20 1710613591 0 Nurse Practitioners Fluoride varnish 20 1710613591 0 Nurse Practitioners Healthy Kids Services 20 1710613591 0 Nurse Practitioners Nurse Practitioners Services 20 1710613591 0 Nurse Practitioners Physician Services 00 1710614789 0 DIMAYUGA RACHEL 2022224 9999999 B 10 1710614789 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1710614789 0 Other behavior health professional LCPC/LMFT services 00 1710617519 0 FERRERO SABRINA 2023184 9999999 B 10 1710617519 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1710617519 0 Audiologists Audiology Services 20 1710617519 0 Audiologists Medical Supplies 20 1710617519 0 Audiologists Medical equipment/prosthetic devices 00 1710618566 0 VALDEZ JOSHUA P 2022189 9999999 B 10 1710618566 0 201 E MADISON ST STE 300 SPRINGFIELD IL 627025131 20 1710618566 0 Physicians Anesthesia Services 20 1710618566 0 Physicians Fluoride varnish 20 1710618566 0 Physicians Healthy Kids Services 20 1710618566 0 Physicians Optical Supplies 20 1710618566 0 Physicians Physician Services 00 1710620927 0 RUSSELL ROBERT C 2022239 9999999 B 10 1710620927 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1710620927 0 Physicians Anesthesia Services 20 1710620927 0 Physicians Healthy Kids Services 20 1710620927 0 Physicians Optical Supplies 20 1710620927 0 Physicians Physician Services 00 1710621271 0 WILLMORE EVAN M 2022112 9999999 B 10 1710621271 0 1003 MARTIN LUTHER KING DR BLOOMINGTON IL 617011429 20 1710621271 0 Clinical Social Worker Social work service 00 1710621289 0 VOGEL JENNA 2022270 9999999 B 10 1710621289 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1710621289 0 Nurse Practitioners Fluoride varnish 20 1710621289 0 Nurse Practitioners Healthy Kids Services 20 1710621289 0 Nurse Practitioners Nurse Practitioners Services 20 1710621289 0 Nurse Practitioners Physician Services 00 1710621784 0 SPAETH CRYSTAL 2022264 9999999 B 10 1710621784 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1710621784 0 Nurse Practitioners Fluoride varnish 20 1710621784 0 Nurse Practitioners Healthy Kids Services 20 1710621784 0 Nurse Practitioners Nurse Practitioners Services 20 1710621784 0 Nurse Practitioners Physician Services 00 1710621842 0 HOLDEN PAYTON 2022201 9999999 B 10 1710621842 0 3241 S MICHIGAN AVE CHICAGO IL 606164201 20 1710621842 0 Optometrists Optical Supplies 20 1710621842 0 Optometrists Optometric Services 20 1710621842 0 Optometrists Physician Services 00 1710621867 0 ALEXANDER CHRISTOPHER 2024140 9999999 B 10 1710621867 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1710621867 0 Physicians Anesthesia Services 20 1710621867 0 Physicians Healthy Kids Services 20 1710621867 0 Physicians Optical Supplies 20 1710621867 0 Physicians Physician Services 20 1710621867 0 Physicians Physicians Psychiatric Services 00 1710622329 0 STOOPS EVA G 2022146 9999999 B 10 1710622329 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1710622329 0 Physicians Anesthesia Services 20 1710622329 0 Physicians Fluoride varnish 20 1710622329 0 Physicians Healthy Kids Services 20 1710622329 0 Physicians Optical Supplies 20 1710622329 0 Physicians Physician Services 00 1710622352 0 MORRIS MARTIN 2022178 9999999 B 10 1710622352 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1710622352 0 Physicians Anesthesia Services 20 1710622352 0 Physicians Healthy Kids Services 20 1710622352 0 Physicians Optical Supplies 20 1710622352 0 Physicians Physician Services 00 1710622386 0 HALLINE CHRISTOPHER G 2022175 9999999 B 10 1710622386 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1710622386 0 Physicians Anesthesia Services 20 1710622386 0 Physicians Healthy Kids Services 20 1710622386 0 Physicians Optical Supplies 20 1710622386 0 Physicians Physician Services 00 1710622394 0 GONZALES-PORTILLO GABRIEL 2023254 9999999 B 10 1710622394 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1710622394 0 Physicians Anesthesia Services 20 1710622394 0 Physicians Healthy Kids Services 20 1710622394 0 Physicians Optical Supplies 20 1710622394 0 Physicians Physician Services 00 1710622733 0 LEMON JANICE F 2022164 9999999 H 10 1710622733 0 70 S RIVER ST AURORA IL 605065185 20 1710622733 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1710623400 0 MATHESON JAROM 2022153 9999999 B 10 1710623400 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1710623400 0 Clinical Social Worker Social work service 00 1710625686 0 DHAN ANISHA 2022223 9999999 B 10 1710625686 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1710625686 0 Nurse Practitioners Healthy Kids Services 20 1710625686 0 Nurse Practitioners Nurse Practitioners Services 20 1710625686 0 Nurse Practitioners Physician Services 00 1710626551 0 CHIEN CHRISTINE 2023201 2027181 B 10 1710626551 0 611 W PARK ST URBANA IL 618012529 20 1710626551 0 Physicians Anesthesia Services 20 1710626551 0 Physicians Healthy Kids Services 20 1710626551 0 Physicians Optical Supplies 20 1710626551 0 Physicians Physician Services 00 1710627195 0 TAVAKOLI MARIO 2022187 9999999 B 10 1710627195 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1710627195 0 Physicians Anesthesia Services 20 1710627195 0 Physicians Fluoride varnish 20 1710627195 0 Physicians Healthy Kids Services 20 1710627195 0 Physicians Optical Supplies 20 1710627195 0 Physicians Physician Services 00 1710627278 0 ROYECA JOSEPH MATTHEW 2022178 9999999 B 10 1710627278 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1710627278 0 Physicians Anesthesia Services 20 1710627278 0 Physicians Healthy Kids Services 20 1710627278 0 Physicians Optical Supplies 20 1710627278 0 Physicians Physician Services 00 1710628227 0 LOPEZ VANESSA 2022154 9999999 B 10 1710628227 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1710628227 0 Other behavior health professional LCPC/LMFT services 00 1710629571 0 WHITE DAKIRA K 2022151 9999999 B 10 1710629571 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1710629571 0 Nurse Practitioners Fluoride varnish 20 1710629571 0 Nurse Practitioners Healthy Kids Services 20 1710629571 0 Nurse Practitioners Nurse Practitioners Services 20 1710629571 0 Nurse Practitioners Physician Services 00 1710629639 0 SULLIVAN OLIVIA C 2022112 9999999 B 10 1710629639 0 1100 S JOHNSON ST MACOMB IL 614553258 20 1710629639 0 Speech Therapists Medical Supplies 20 1710629639 0 Speech Therapists Medical equipment/prosthetic devices 20 1710629639 0 Speech Therapists Speech Therapy/Pathology Services 00 1710630157 0 SUMMERVILLE LATIA 2022167 9999999 B 10 1710630157 0 727 E COURT ST PARIS IL 619442460 20 1710630157 0 Nurse Practitioners Fluoride varnish 20 1710630157 0 Nurse Practitioners Healthy Kids Services 20 1710630157 0 Nurse Practitioners Nurse Practitioners Services 20 1710630157 0 Nurse Practitioners Physician Services 00 1710632989 0 SOMOLSKI JACKIE A 2023026 9999999 B 10 1710632989 0 1318 W 6TH ST KEWANEE IL 614431261 20 1710632989 0 Speech Therapists Medical Supplies 20 1710632989 0 Speech Therapists Medical equipment/prosthetic devices 20 1710632989 0 Speech Therapists Speech Therapy/Pathology Services 00 1710634704 0 GEBHARDS MAUREEN A 2024107 9999999 B 10 1710634704 0 3716 W BRIGHTON AVE PEORIA IL 616152938 20 1710634704 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1710635230 0 SAYYED ADAAH 2023195 9999999 B 10 1710635230 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1710635230 0 Physicians Anesthesia Services 20 1710635230 0 Physicians Healthy Kids Services 20 1710635230 0 Physicians Optical Supplies 20 1710635230 0 Physicians Physician Services 00 1710636360 0 OLINGER TANNER 2022342 9999999 B 10 1710636360 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1710636360 0 Physicians Anesthesia Services 20 1710636360 0 Physicians Healthy Kids Services 20 1710636360 0 Physicians Optical Supplies 20 1710636360 0 Physicians Physician Services 00 1710636535 0 PICKETT CARLEY R 2022196 9999999 B 10 1710636535 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1710636535 0 Physicians Anesthesia Services 20 1710636535 0 Physicians Fluoride varnish 20 1710636535 0 Physicians Healthy Kids Services 20 1710636535 0 Physicians Optical Supplies 20 1710636535 0 Physicians Physician Services 00 1710636667 0 HAMATI FADI J 2022174 9999999 B 10 1710636667 0 555 WILSON LN DES PLAINES IL 600164729 20 1710636667 0 Physicians Anesthesia Services 20 1710636667 0 Physicians Healthy Kids Services 20 1710636667 0 Physicians Optical Supplies 20 1710636667 0 Physicians Physician Services 20 1710636667 0 Physicians Physicians Psychiatric Services 00 1710636725 0 CAVANAUGH SYDNEY 2023067 9999999 B 10 1710636725 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1710636725 0 Physician Assistant Only Fluoride varnish 20 1710636725 0 Physician Assistant Only Healthy Kids Services 20 1710636725 0 Physician Assistant Only Physician Services 00 1710636915 0 BUI MARY 2022182 9999999 B 10 1710636915 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1710636915 0 Physicians Anesthesia Services 20 1710636915 0 Physicians Fluoride varnish 20 1710636915 0 Physicians Healthy Kids Services 20 1710636915 0 Physicians Optical Supplies 20 1710636915 0 Physicians Physician Services 00 1710637327 0 RUBIO GERARDO 2022294 9999999 B 10 1710637327 0 4701 DEPT CAROL STREAM IL 601220021 20 1710637327 0 Physicians Anesthesia Services 20 1710637327 0 Physicians Fluoride varnish 20 1710637327 0 Physicians Healthy Kids Services 20 1710637327 0 Physicians Optical Supplies 20 1710637327 0 Physicians Physician Services 00 1710637798 0 DEY SHIRIN A 2022171 9999999 B 10 1710637798 0 4698 DEPT CAROL STREAM IL 601220021 20 1710637798 0 Physicians Anesthesia Services 20 1710637798 0 Physicians Fluoride varnish 20 1710637798 0 Physicians Healthy Kids Services 20 1710637798 0 Physicians Optical Supplies 20 1710637798 0 Physicians Physician Services 00 1710637988 0 CARRERAS-SIMONS KELSEY J 2022202 9999999 B 10 1710637988 0 PO BOX 3039 OAK BROOK IL 605223039 20 1710637988 0 Dentists Dental Services 20 1710637988 0 Dentists Physician Services 00 1710637988 0 CARRERAS-SIMONS KELSEY J 2022202 9999999 B 10 1710637988 0 22393 NETWORK PL CHICAGO IL 606735147 20 1710637988 0 Dentists Dental Services 20 1710637988 0 Dentists Physician Services 00 1710639349 0 MILLER LAUREN 2022025 9999999 B 10 1710639349 0 4025 N SHERIDAN RD CHICAGO IL 606132010 20 1710639349 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1710642103 0 WEIR OLIVIA R 2022085 9999999 B 10 1710642103 0 11401 BLUEGRASS PKWY LOUISVILLE KY 402992349 20 1710642103 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1710645239 0 LAMACKI AMANDA 2022010 9999999 B 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Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1710649496 0 RATCLIFFE BROOKE 2024035 9999999 B 10 1710649496 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1710649496 0 Nurse Practitioners Healthy Kids Services 20 1710649496 0 Nurse Practitioners Nurse Practitioners Services 20 1710649496 0 Nurse Practitioners Physician Services 00 1710649827 0 MAEL YALE S 2021315 9999999 B 10 1710649827 0 7421 MADISON ST FOREST PARK IL 601301575 20 1710649827 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1710650338 0 SHAO LUNAN 2021214 9999999 B 10 1710650338 0 502 RIVERSIDE DR EAST PEORIA IL 616112068 20 1710650338 0 Dentists Dental Services 20 1710650338 0 Dentists Physician Services 00 1710650577 0 CUNNINGHAM KATHERINE N 2021279 9999999 B 10 1710650577 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1710650577 0 Nurse Practitioners Healthy Kids Services 20 1710650577 0 Nurse 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UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1710658919 0 Nurse Practitioners Fluoride varnish 20 1710658919 0 Nurse Practitioners Healthy Kids Services 20 1710658919 0 Nurse Practitioners Nurse Practitioners Services 20 1710658919 0 Nurse Practitioners Physician Services 00 1710659495 0 STARCEVICH ANNA 2022062 9999999 B 10 1710659495 0 PO BOX 4028 ROCK ISLAND IL 612044028 20 1710659495 0 Nurse Practitioners Fluoride varnish 20 1710659495 0 Nurse Practitioners Healthy Kids Services 20 1710659495 0 Nurse Practitioners Nurse Practitioners Services 20 1710659495 0 Nurse Practitioners Physician Services 00 1710660303 0 KEMMERER SARAH 2023317 9999999 B 10 1710660303 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1710660303 0 Physical Therapists Medical Supplies 20 1710660303 0 Physical Therapists Medical equipment/prosthetic devices 20 1710660303 0 Physical Therapists Physical Therapy Services 00 1710661053 0 STALLWORTH OJHANAE 2024128 9999999 B 10 1710661053 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1710661053 0 Physician Assistant Only Fluoride varnish 20 1710661053 0 Physician Assistant Only Healthy Kids Services 20 1710661053 0 Physician Assistant Only Physician Services 00 1710661889 0 BOTELLO LORENA 2024345 9999999 B 10 1710661889 0 5777 DEPT CAROL STREAM IL 601220021 20 1710661889 0 Nurse Practitioners Fluoride varnish 20 1710661889 0 Nurse Practitioners Healthy Kids Services 20 1710661889 0 Nurse Practitioners Nurse Practitioners Services 20 1710661889 0 Nurse Practitioners Physician Services 00 1710661939 0 O'GRADY KATELYN E 2023201 9999999 B 10 1710661939 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1710661939 0 Physicians Anesthesia Services 20 1710661939 0 Physicians Healthy Kids Services 20 1710661939 0 Physicians Optical Supplies 20 1710661939 0 Physicians Physician Services 20 1710661939 0 Physicians Physicians Psychiatric Services 00 1710662994 0 ARIF MUHAMMAD HAMZA 2023346 9999999 B 10 1710662994 0 1044 N FRANCISCO AVE CHICAGO IL 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GMURCZYK ALEKSANDRA W 2009244 9999999 B 10 1720259617 0 5777 DEPT CAROL STREAM IL 601220021 20 1720259617 0 Physicians Anesthesia Services 20 1720259617 0 Physicians Fluoride varnish 20 1720259617 0 Physicians Healthy Kids Services 20 1720259617 0 Physicians Optical Supplies 20 1720259617 0 Physicians Physician Services 00 1720261779 0 SHOAPS JAY M 2021073 9999999 B 10 1720261779 0 PO BOX 1437 COLUMBUS GA 319021437 20 1720261779 0 Physicians Anesthesia Services 20 1720261779 0 Physicians Healthy Kids Services 20 1720261779 0 Physicians Optical Supplies 20 1720261779 0 Physicians Physician Services 00 1720262652 0 KAUFMAN DIANA 2012122 9999999 B 10 1720262652 0 200 E FAIRMAN AVE WATSEKA IL 609701644 20 1720262652 0 Nurse Practitioners Fluoride varnish 20 1720262652 0 Nurse Practitioners Healthy Kids Services 20 1720262652 0 Nurse Practitioners Nurse Practitioners Services 20 1720262652 0 Nurse Practitioners Physician Services 00 1720262827 0 BARRETT KIMBERLY 2011137 9999999 B 10 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1720343783 0 Physicians Anesthesia Services 20 1720343783 0 Physicians Fluoride varnish 20 1720343783 0 Physicians Healthy Kids Services 20 1720343783 0 Physicians Optical Supplies 20 1720343783 0 Physicians Physician Services 00 1720344104 0 SINGLETON ROBERT E 2016201 9999999 B 10 1720344104 0 PO BOX 548 INDIANAPOLIS IN 462060548 20 1720344104 0 Physicians Anesthesia Services 20 1720344104 0 Physicians Healthy Kids Services 20 1720344104 0 Physicians Optical Supplies 20 1720344104 0 Physicians Physician Services 00 1720344260 0 BARTHOLOMEW ERIK C 2020280 9999999 B 10 1720344260 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1720344260 0 Physicians Anesthesia Services 20 1720344260 0 Physicians Fluoride varnish 20 1720344260 0 Physicians Healthy Kids Services 20 1720344260 0 Physicians Optical Supplies 20 1720344260 0 Physicians Physician Services 00 1720344336 0 KHATIB QUTAIBAH 2015213 9999999 B 10 1720344336 0 5220 BELFORT RD STE 130 JACKSONVILLE FL 322566018 20 1720344336 0 Physicians Anesthesia Services 20 1720344336 0 Physicians Fluoride varnish 20 1720344336 0 Physicians Healthy Kids Services 20 1720344336 0 Physicians Optical Supplies 20 1720344336 0 Physicians Physician Services 00 1720344526 0 TAMRAGOURI PRASHANTH R 2017294 9999999 B 10 1720344526 0 1909 OGDEN AVE STE A DOWNERS GROVE IL 605152602 20 1720344526 0 Physicians Anesthesia Services 20 1720344526 0 Physicians Healthy Kids Services 20 1720344526 0 Physicians Optical Supplies 20 1720344526 0 Physicians Physician Services 20 1720344526 0 Physicians Physicians Psychiatric Services 00 1720344971 0 HIPPENSTEEL JOSEPH A 2020268 9999999 B 10 1720344971 0 PO BOX 110429 AURORA CO 800420429 20 1720344971 0 Physicians Anesthesia Services 20 1720344971 0 Physicians Fluoride varnish 20 1720344971 0 Physicians Healthy Kids Services 20 1720344971 0 Physicians Optical Supplies 20 1720344971 0 Physicians Physician Services 00 1720345085 0 MILLER MELINDA D 2017201 9999999 B 10 1720345085 0 800 E LOCUST ST 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2013213 9999999 B 10 1720425994 0 6501 S PROMONTORY DR CHICAGO IL 606491003 20 1720425994 0 Nurse Practitioners Fluoride varnish 20 1720425994 0 Nurse Practitioners Healthy Kids Services 20 1720425994 0 Nurse Practitioners Nurse Practitioners Services 20 1720425994 0 Nurse Practitioners Physician Services 00 1720426315 0 HANNAN ALEXANDER J 2022299 9999999 B 10 1720426315 0 1025 MAINE ST QUINCY IL 623014038 20 1720426315 0 Physicians Anesthesia Services 20 1720426315 0 Physicians Fluoride varnish 20 1720426315 0 Physicians Healthy Kids Services 20 1720426315 0 Physicians Optical Supplies 20 1720426315 0 Physicians Physician Services 00 1720426513 0 JELINEK MICHAEL J 2018351 9999999 B 10 1720426513 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1720426513 0 Physicians Anesthesia Services 20 1720426513 0 Physicians Fluoride varnish 20 1720426513 0 Physicians Healthy Kids Services 20 1720426513 0 Physicians Optical Supplies 20 1720426513 0 Physicians Physician Services 00 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Practitioners Healthy Kids Services 20 1720644297 0 Nurse Practitioners Nurse Practitioners Services 20 1720644297 0 Nurse Practitioners Physician Services 00 1720644875 0 O'MARA CAITLIN 2021270 9999999 B 10 1720644875 0 906 WALTON ST MELROSE PARK IL 601603540 20 1720644875 0 Speech Therapists Medical Supplies 20 1720644875 0 Speech Therapists Medical equipment/prosthetic devices 20 1720644875 0 Speech Therapists Speech Therapy/Pathology Services 00 1720647092 0 AGGARWAL TIRUMALA 2019217 9999999 B 10 1720647092 0 3074 W IL ROUTE 60 MUNDELEIN IL 600604270 20 1720647092 0 Dentists Dental Services 20 1720647092 0 Dentists Physician Services 00 1720647233 0 JORDAN LEWIS A 2020077 9999999 B 10 1720647233 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1720647233 0 Physicians Anesthesia Services 20 1720647233 0 Physicians Healthy Kids Services 20 1720647233 0 Physicians Optical Supplies 20 1720647233 0 Physicians Physician Services 00 1720647571 0 PEIFER STEPHANIE E 2019207 9999999 B 10 1720647571 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1720647571 0 Physician Assistant Only Fluoride varnish 20 1720647571 0 Physician Assistant Only Healthy Kids Services 20 1720647571 0 Physician Assistant Only Physician Services 00 1720647605 0 MARTIN HALEY M 2021281 9999999 B 10 1720647605 0 29373 NETWORK PL CHICAGO IL 606733039 20 1720647605 0 Physician Assistant Only Fluoride varnish 20 1720647605 0 Physician Assistant Only Healthy Kids Services 20 1720647605 0 Physician Assistant Only Physician Services 00 1720648157 0 COBB NATHAN A 2022195 9999999 B 10 1720648157 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1720648157 0 Physicians Anesthesia Services 20 1720648157 0 Physicians Fluoride varnish 20 1720648157 0 Physicians Healthy Kids Services 20 1720648157 0 Physicians Optical Supplies 20 1720648157 0 Physicians Physician Services 00 1720648603 0 AYESH HAZEM 2024345 9999999 B 10 1720648603 0 PO BOX 1230 EVANSVILLE IN 477061230 20 1720648603 0 Physicians Anesthesia Services 20 1720648603 0 Physicians Fluoride varnish 20 1720648603 0 Physicians Healthy Kids Services 20 1720648603 0 Physicians Optical Supplies 20 1720648603 0 Physicians Physician Services 00 1720648918 0 VEGUNTA AISHWARIYA 2024155 9999999 B 10 1720648918 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1720648918 0 Physicians Anesthesia Services 20 1720648918 0 Physicians Healthy Kids Services 20 1720648918 0 Physicians Optical Supplies 20 1720648918 0 Physicians Physician Services 00 1720649320 0 PAPADOPOULOS KONSTANTINOS 2022213 9999999 B 10 1720649320 0 5777 DEPT CAROL STREAM IL 601228942 20 1720649320 0 Physicians Anesthesia Services 20 1720649320 0 Physicians Fluoride varnish 20 1720649320 0 Physicians Healthy Kids Services 20 1720649320 0 Physicians Optical Supplies 20 1720649320 0 Physicians Physician Services 00 1720649411 0 METCALFE JENNA L 2020181 9999999 B 10 1720649411 0 671 S LEWIS AVE WAUKEGAN IL 600856101 20 1720649411 0 Other behavior health professional 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953586411 20 1720654478 0 Physician Assistant Only Fluoride varnish 20 1720654478 0 Physician Assistant Only Healthy Kids Services 20 1720654478 0 Physician Assistant Only Physician Services 00 1720655608 0 CHOKSI NISHA M 2024218 9999999 B 10 1720655608 0 1220 S WOOD ST CHICAGO IL 606081202 20 1720655608 0 Dentists Dental Services 20 1720655608 0 Dentists Physician Services 00 1720656283 0 ENOCHS ABIGAIL E 2024330 9999999 B 10 1720656283 0 28594 NETWORK PL CHICAGO IL 606731285 20 1720656283 0 Physical Therapists Medical Supplies 20 1720656283 0 Physical Therapists Medical equipment/prosthetic devices 20 1720656283 0 Physical Therapists Physical Therapy Services 00 1720657497 0 SKOLD DANA 2025035 9999999 B 10 1720657497 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1720657497 0 Physicians Anesthesia Services 20 1720657497 0 Physicians Healthy Kids Services 20 1720657497 0 Physicians Optical Supplies 20 1720657497 0 Physicians Physician Services 00 1720659063 0 WOODMAN GABRIELLE R 2022054 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1720661051 0 Physicians Physician Services 00 1720661598 0 DUDEK PAUL CAMPION 2023004 9999999 B 10 1720661598 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1720661598 0 Physicians Anesthesia Services 20 1720661598 0 Physicians Healthy Kids Services 20 1720661598 0 Physicians Optical Supplies 20 1720661598 0 Physicians Physician Services 00 1720661630 0 NELSON JAIMI 2022112 9999999 B 10 1720661630 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1720661630 0 Occupational Therapists Medical Supplies 20 1720661630 0 Occupational Therapists Medical equipment/prosthetic devices 20 1720661630 0 Occupational Therapists Occupational Therapy Services 00 1720663024 0 BRAIDA PATRICIA 2021103 9999999 B 10 1720663024 0 PO BOX 8209 VIENNA VA 221832058 20 1720663024 0 Nurse Practitioners Healthy Kids Services 20 1720663024 0 Nurse Practitioners Nurse Practitioners Services 20 1720663024 0 Nurse Practitioners Physician Services 00 1720664923 0 MONNIER MAGGIE 2021356 9999999 B 10 1720664923 0 325 IL ROUTE 2 DIXON IL 610219118 20 1720664923 0 Clinical Social Worker Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1720664923 0 Clinical Social Worker Social work service 00 1720665391 0 PRIDDY ANNA M 2021203 9999999 B 10 1720665391 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1720665391 0 Physicians Anesthesia Services 20 1720665391 0 Physicians Fluoride varnish 20 1720665391 0 Physicians Healthy Kids Services 20 1720665391 0 Physicians Optical Supplies 20 1720665391 0 Physicians Physician Services 00 1720665458 0 SUGHROUE ALEXA 2024149 9999999 B 10 1720665458 0 5777 DEPT CAROL STREAM IL 601220021 20 1720665458 0 Physicians Anesthesia Services 20 1720665458 0 Physicians Healthy Kids Services 20 1720665458 0 Physicians Optical Supplies 20 1720665458 0 Physicians Physician Services 00 1720665474 0 MCCOOK LESLEY-ANN 2024191 9999999 B 10 1720665474 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1720665474 0 Physicians Anesthesia Services 20 1720665474 0 Physicians Fluoride varnish 20 1720665474 0 Physicians Healthy Kids Services 20 1720665474 0 Physicians Optical Supplies 20 1720665474 0 Physicians Physician Services 00 1720665557 0 SINK MOLLY L 2021163 9999999 B 10 1720665557 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1720665557 0 Nurse Practitioners Healthy Kids Services 20 1720665557 0 Nurse Practitioners Nurse Practitioners Services 20 1720665557 0 Nurse Practitioners Physician Services 00 1720665797 0 CHEEKS MORGAN L 2021174 9999999 B 10 1720665797 0 4698 DEPT CAROL STREAM IL 601220021 20 1720665797 0 Physicians Anesthesia Services 20 1720665797 0 Physicians Healthy Kids Services 20 1720665797 0 Physicians Optical Supplies 20 1720665797 0 Physicians Physician Services 00 1720665805 0 KEELE JARED W 2022199 9999999 B 10 1720665805 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1720665805 0 Physicians Anesthesia Services 20 1720665805 0 Physicians Healthy Kids Services 20 1720665805 0 Physicians Optical Supplies 20 1720665805 0 Physicians Physician Services 00 1720667074 0 FOY MICHAEL P 2022213 9999999 B 10 1720667074 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1720667074 0 Physicians Anesthesia Services 20 1720667074 0 Physicians Healthy Kids Services 20 1720667074 0 Physicians Optical Supplies 20 1720667074 0 Physicians Physician Services 00 1720667280 0 HERNANDEZ MARIA P 2022243 9999999 B 10 1720667280 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1720667280 0 Physicians Anesthesia Services 20 1720667280 0 Physicians Fluoride varnish 20 1720667280 0 Physicians Healthy Kids Services 20 1720667280 0 Physicians Optical Supplies 20 1720667280 0 Physicians Physician Services 00 1720668247 0 RITTMEYER HANNAH 2021215 9999999 B 10 1720668247 0 29373 NETWORK PL CHICAGO IL 606733039 20 1720668247 0 Physicians Anesthesia Services 20 1720668247 0 Physicians Fluoride varnish 20 1720668247 0 Physicians Healthy Kids Services 20 1720668247 0 Physicians Optical Supplies 20 1720668247 0 Physicians Physician Services 00 1720668841 0 MEYERS JESSICA 2024214 9999999 B 10 1720668841 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1720668841 0 Physicians Anesthesia Services 20 1720668841 0 Physicians Healthy Kids Services 20 1720668841 0 Physicians Optical Supplies 20 1720668841 0 Physicians Physician Services 00 1720669369 0 NILSSON PASCAL 2024107 9999999 B 10 1720669369 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1720669369 0 Physicians Anesthesia Services 20 1720669369 0 Physicians Healthy Kids Services 20 1720669369 0 Physicians Optical Supplies 20 1720669369 0 Physicians Physician Services 20 1720669369 0 Physicians Physicians Psychiatric Services 00 1720669492 0 ZACARIAS-HOLLINS ELIZABETH 2021106 9999999 B 10 1720669492 0 42 W MADISON ST FL 2 CHICAGO IL 606024309 20 1720669492 0 Speech Therapists Medical Supplies 20 1720669492 0 Speech Therapists Medical equipment/prosthetic devices 20 1720669492 0 Speech Therapists 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Services 00 1720773468 0 MCCAFFERTY ALLISON C 2023298 9999999 B 10 1720773468 0 124 SW ADAMS ST PEORIA IL 616021308 20 1720773468 0 Physicians Anesthesia Services 20 1720773468 0 Physicians Healthy Kids Services 20 1720773468 0 Physicians Optical Supplies 20 1720773468 0 Physicians Physician Services 00 1720773658 0 SINGH MANISHA 2024260 9999999 B 10 1720773658 0 PO BOX 3039 OAK BROOK IL 605223039 20 1720773658 0 Physicians Anesthesia Services 20 1720773658 0 Physicians Fluoride varnish 20 1720773658 0 Physicians Healthy Kids Services 20 1720773658 0 Physicians Optical Supplies 20 1720773658 0 Physicians Physician Services 00 1720775919 0 REYNOLDS COURTNEY 2023132 9999999 B 10 1720775919 0 210 W WALNUT ST CANTON IL 615202444 20 1720775919 0 Nurse Practitioners Fluoride varnish 20 1720775919 0 Nurse Practitioners Healthy Kids Services 20 1720775919 0 Nurse Practitioners Nurse Practitioners Services 20 1720775919 0 Nurse Practitioners Physician Services 00 1720775950 0 NASIR ABDULRAFEY 2023296 9999999 B 10 1720775950 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1720775950 0 Physician Assistant Only Fluoride varnish 20 1720775950 0 Physician Assistant Only Healthy Kids Services 20 1720775950 0 Physician Assistant Only Physician Services 00 1720776974 0 HILGART JANEMARIE M 2023138 9999999 B 10 1720776974 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1720776974 0 Nurse Practitioners Healthy Kids Services 20 1720776974 0 Nurse Practitioners Nurse Practitioners Services 20 1720776974 0 Nurse Practitioners Physician Services 00 1720777022 0 BARTON MICHAEL F 2023132 9999999 B 10 1720777022 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1720777022 0 Physicians Anesthesia Services 20 1720777022 0 Physicians Healthy Kids Services 20 1720777022 0 Physicians Optical Supplies 20 1720777022 0 Physicians Physician Services 00 1720778988 0 BONNEMA JACOB A 2024016 9999999 B 10 1720778988 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1720778988 0 Nurse Practitioners Anesthesia Services 20 1720778988 0 Nurse Practitioners Nurse Practitioners Services 20 1720778988 0 Nurse Practitioners Physician Services 00 1720780026 0 HIPP BRYANNA H 2024174 9999999 B 10 1720780026 0 PO BOX 3039 OAK BROOK IL 605223039 20 1720780026 0 Physicians Anesthesia Services 20 1720780026 0 Physicians Healthy Kids Services 20 1720780026 0 Physicians Optical Supplies 20 1720780026 0 Physicians Physician Services 00 1720780158 0 DEL GRECO CARSON J 2023143 9999999 B 10 1720780158 0 4698 DEPT CAROL STREAM IL 601220021 20 1720780158 0 Physicians Anesthesia Services 20 1720780158 0 Physicians Healthy Kids Services 20 1720780158 0 Physicians Optical Supplies 20 1720780158 0 Physicians Physician Services 00 1720780281 0 KOSTER HUNTER ROY 2023207 9999999 B 10 1720780281 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1720780281 0 Physicians Anesthesia Services 20 1720780281 0 Physicians Healthy Kids Services 20 1720780281 0 Physicians Optical Supplies 20 1720780281 0 Physicians Physician Services 00 1720780380 0 BAUMER MEGHAN 2023193 9999999 B 10 1720780380 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1720780380 0 Physicians Anesthesia Services 20 1720780380 0 Physicians Healthy Kids Services 20 1720780380 0 Physicians Optical Supplies 20 1720780380 0 Physicians Physician Services 00 1720780935 0 BHARDWAJ PRANSHU 2023179 9999999 B 10 1720780935 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1720780935 0 Physicians Anesthesia Services 20 1720780935 0 Physicians Fluoride varnish 20 1720780935 0 Physicians Healthy Kids Services 20 1720780935 0 Physicians Optical Supplies 20 1720780935 0 Physicians Physician Services 00 1720781396 0 KONDAPALLI KARISHMA R 2024347 9999999 B 10 1720781396 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1720781396 0 Physicians Anesthesia Services 20 1720781396 0 Physicians Healthy Kids Services 20 1720781396 0 Physicians Optical Supplies 20 1720781396 0 Physicians Physician Services 00 1720781453 0 DERRETT BREAN 2023215 9999999 B 10 1720781453 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1720781453 0 Physicians Anesthesia Services 20 1720781453 0 Physicians Fluoride varnish 20 1720781453 0 Physicians Healthy Kids Services 20 1720781453 0 Physicians Optical Supplies 20 1720781453 0 Physicians Physician Services 00 1720782154 0 ESTRADA CRYSTAL 2023324 9999999 B 10 1720782154 0 9701 W HIGGINS RD STE 270 STE 270 ROSEMONT IL 600184703 20 1720782154 0 Nurse Practitioners Fluoride varnish 20 1720782154 0 Nurse Practitioners Healthy Kids Services 20 1720782154 0 Nurse Practitioners Nurse Practitioners Services 20 1720782154 0 Nurse Practitioners Physician Services 00 1720782444 0 CARTER DANA M 2025084 9999999 B 10 1720782444 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1720782444 0 Nurse Practitioners Fluoride varnish 20 1720782444 0 Nurse Practitioners Healthy Kids Services 20 1720782444 0 Nurse Practitioners Nurse Practitioners Services 20 1720782444 0 Nurse Practitioners Physician Services 00 1720783681 0 KELLY KYLE 2023339 9999999 B 10 1720783681 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1720783681 0 Physicians Anesthesia Services 20 1720783681 0 Physicians Healthy Kids Services 20 1720783681 0 Physicians Optical Supplies 20 1720783681 0 Physicians Physician Services 00 1720786239 0 STANTON VERONICA 2023342 9999999 B 10 1720786239 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1720786239 0 Nurse Practitioners Fluoride varnish 20 1720786239 0 Nurse Practitioners Healthy Kids Services 20 1720786239 0 Nurse Practitioners Nurse Practitioners Services 20 1720786239 0 Nurse Practitioners Physician Services 00 1720788813 0 MILLARE FRANCESCA 2023307 9999999 B 10 1720788813 0 750 FLETCHER DR STE 200 ELGIN IL 601234703 20 1720788813 0 Physician Assistant Only Physician Services 00 1720791577 0 DEAN JENNA N 2023347 9999999 B 10 1720791577 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1720791577 0 Nurse Practitioners Fluoride varnish 20 1720791577 0 Nurse Practitioners Healthy Kids Services 20 1720791577 0 Nurse Practitioners Nurse Practitioners Services 20 1720791577 0 Nurse Practitioners Physician Services 00 1720791742 0 BRAUMAN SETH 2024326 9999999 B 10 1720791742 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1720791742 0 Physicians Anesthesia Services 20 1720791742 0 Physicians Fluoride varnish 20 1720791742 0 Physicians Healthy Kids Services 20 1720791742 0 Physicians Optical Supplies 20 1720791742 0 Physicians Physician Services 00 1720792617 0 PAULEY KENDRA 2023094 9999999 B 10 1720792617 0 350 N WALL ST KANKAKEE IL 609012901 20 1720792617 0 Nurse Practitioners Fluoride varnish 20 1720792617 0 Nurse Practitioners Healthy Kids Services 20 1720792617 0 Nurse Practitioners Nurse Practitioners Services 20 1720792617 0 Nurse Practitioners Physician Services 00 1720792716 0 RZANY AMANDA 2023223 9999999 B 10 1720792716 0 1944 W 163RD ST MARKHAM IL 604285647 20 1720792716 0 Nurse Practitioners Healthy Kids Services 20 1720792716 0 Nurse Practitioners Nurse Practitioners Services 20 1720792716 0 Nurse Practitioners Physician Services 00 1720793052 0 GUDGEL JENNIFER M 2023058 9999999 B 10 1720793052 0 1001 AVENUE OF MID AMERICA STE EFFINGHAM IL 624014634 20 1720793052 0 Nurse Practitioners Fluoride varnish 20 1720793052 0 Nurse Practitioners Healthy Kids Services 20 1720793052 0 Nurse Practitioners Nurse Practitioners Services 20 1720793052 0 Nurse Practitioners Physician Services 00 1720796923 0 SPEAKMAN JULIA N 2022346 9999999 B 10 1720796923 0 5010 ROSE LN COULTERVILLE IL 622372746 20 1720796923 0 Clinical Social Worker Social work service 00 1720797350 0 MCKINLEY ALLISON 2024085 9999999 B 10 1720797350 0 12640 S ROUTE 59 UNIT 110 PLAINFIELD IL 605855408 20 1720797350 0 Physical Therapists Medical Supplies 20 1720797350 0 Physical Therapists Medical equipment/prosthetic devices 20 1720797350 0 Physical Therapists Physical Therapy Services 00 1720798341 0 KELLENBERGER NATHAN E 2022340 9999999 B 10 1720798341 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1720798341 0 Nurse Practitioners Fluoride varnish 20 1720798341 0 Nurse Practitioners Healthy Kids Services 20 1720798341 0 Nurse Practitioners Nurse Practitioners Services 20 1720798341 0 Nurse Practitioners Physician Services 00 1720798556 0 HELF STACEY 2023004 9999999 B 10 1720798556 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1720798556 0 Nurse Practitioners Healthy Kids Services 20 1720798556 0 Nurse Practitioners Nurse Practitioners Services 20 1720798556 0 Nurse Practitioners Physician Services 00 1720808546 0 ZHENG JENNIFER 2024304 9999999 B 10 1720808546 0 1951 NW 7TH AVE STE 300 MIAMI FL 331361112 20 1720808546 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1720810419 0 HANIFORD CASSANDRA E 2024256 9999999 B 10 1720810419 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1720810419 0 Nurse Practitioners Fluoride varnish 20 1720810419 0 Nurse Practitioners Healthy Kids Services 20 1720810419 0 Nurse Practitioners Nurse Practitioners Services 20 1720810419 0 Nurse Practitioners Physician Services 00 1720812738 0 TOMACRUZ ISABELLE DOMINIQUE 2024250 9999999 B 10 1720812738 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1720812738 0 Physicians Anesthesia Services 20 1720812738 0 Physicians Fluoride varnish 20 1720812738 0 Physicians Healthy Kids Services 20 1720812738 0 Physicians Optical Supplies 20 1720812738 0 Physicians Physician Services 00 1720816382 0 GARDYNSKI KELLY A 2024214 9999999 B 10 1720816382 0 473 W ARMY TRAIL RD STE 103 BLOOMINGDALE IL 601082674 20 1720816382 0 Nurse Practitioners Fluoride varnish 20 1720816382 0 Nurse Practitioners Healthy Kids Services 20 1720816382 0 Nurse Practitioners Nurse Practitioners Services 20 1720816382 0 Nurse Practitioners Physician Services 00 1720817059 0 SCHAEFER KATIE 2024211 9999999 B 10 1720817059 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1720817059 0 Nurse Practitioners Healthy Kids Services 20 1720817059 0 Nurse Practitioners Nurse Practitioners Services 20 1720817059 0 Nurse Practitioners Physician Services 00 1720818644 0 JOBRE BILAIN 2024229 9999999 B 10 1720818644 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1720818644 0 Physicians Anesthesia Services 20 1720818644 0 Physicians Fluoride varnish 20 1720818644 0 Physicians Healthy Kids Services 20 1720818644 0 Physicians Optical Supplies 20 1720818644 0 Physicians Physician Services 00 1720820962 0 HARRIS BRENIQUE 2024162 9999999 B 10 1720820962 0 405 S WILDWOOD AVE KANKAKEE IL 609015362 20 1720820962 0 Licensed Practical Nurses Nursing service 00 1720821929 0 IBANOGLU ONUR 2024191 9999999 B 10 1720821929 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1720821929 0 Physicians Anesthesia Services 20 1720821929 0 Physicians Healthy Kids Services 20 1720821929 0 Physicians Optical Supplies 20 1720821929 0 Physicians Physician Services 00 1720822075 0 VALDEZ ZERPA MIGUEL A 2024175 9999999 B 10 1720822075 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1720822075 0 Physicians Anesthesia Services 20 1720822075 0 Physicians Healthy Kids Services 20 1720822075 0 Physicians Optical Supplies 20 1720822075 0 Physicians Physician Services 00 1720822620 0 BONE ERICA 2024295 9999999 B 10 1720822620 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1720822620 0 Nurse Practitioners Anesthesia Services 20 1720822620 0 Nurse Practitioners Nurse Practitioners Services 20 1720822620 0 Nurse Practitioners Physician Services 00 1720822760 0 MORRISON MARK 2024176 9999999 B 10 1720822760 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1720822760 0 Physicians Anesthesia Services 20 1720822760 0 Physicians Healthy Kids Services 20 1720822760 0 Physicians Optical Supplies 20 1720822760 0 Physicians Physician Services 00 1720823271 0 MURRAY MEGHAN H 2024179 9999999 B 10 1720823271 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1720823271 0 Physicians Anesthesia Services 20 1720823271 0 Physicians Healthy Kids Services 20 1720823271 0 Physicians Optical Supplies 20 1720823271 0 Physicians Physician Services 20 1720823271 0 Physicians Physicians Psychiatric Services 00 1720826506 0 COLVIS LOGAN 2024199 9999999 B 10 1720826506 0 109 CALIFORNIA ST CARTERVILLE IL 629181923 20 1720826506 0 Physician Assistant Only Family Planning Counseling 20 1720826506 0 Physician Assistant Only Fluoride varnish 20 1720826506 0 Physician Assistant Only Healthy Kids Services 20 1720826506 0 Physician Assistant Only Physician Services 00 1720828163 0 DESBIENS KATHRYN 2024239 9999999 B 10 1720828163 0 830 S ADDISON AVE VILLA PARK IL 601812877 20 1720828163 0 Speech Therapists Medical Supplies 20 1720828163 0 Speech Therapists Medical equipment/prosthetic devices 20 1720828163 0 Speech Therapists Speech Therapy/Pathology Services 00 1720829351 0 BARRIA MARISSA 2024366 9999999 B 10 1720829351 0 29373 NETWORK PL CHICAGO IL 606733039 20 1720829351 0 Physician Assistant Only Fluoride varnish 20 1720829351 0 Physician Assistant Only Healthy Kids Services 20 1720829351 0 Physician Assistant Only Physician Services 00 1720829385 0 ALFORD-BICHSEL OWEN 2024194 9999999 B 10 1720829385 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1720829385 0 Physicians Anesthesia Services 20 1720829385 0 Physicians Fluoride varnish 20 1720829385 0 Physicians Healthy Kids Services 20 1720829385 0 Physicians Optical Supplies 20 1720829385 0 Physicians Physician Services 00 1720829518 0 MOON MATTHEW YOON 2024199 9999999 B 10 1720829518 0 611 W PARK ST URBANA IL 618012529 20 1720829518 0 Physicians Anesthesia Services 20 1720829518 0 Physicians Healthy Kids Services 20 1720829518 0 Physicians Optical Supplies 20 1720829518 0 Physicians Physician Services 20 1720829518 0 Physicians Physicians Psychiatric Services 00 1720831308 0 DAVIS SARAH 2024248 9999999 B 10 1720831308 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1720831308 0 Physicians Anesthesia Services 20 1720831308 0 Physicians Healthy Kids Services 20 1720831308 0 Physicians Optical Supplies 20 1720831308 0 Physicians Physician Services 00 1720831902 0 ACAR SIMGE 2024178 9999999 B 10 1720831902 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1720831902 0 Physicians Anesthesia Services 20 1720831902 0 Physicians Fluoride varnish 20 1720831902 0 Physicians Healthy Kids Services 20 1720831902 0 Physicians Optical Supplies 20 1720831902 0 Physicians Physician Services 00 1720832173 0 CHAPARRO LARGAESPADA JASMINE S 2024185 9999999 B 10 1720832173 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1720832173 0 Physicians Anesthesia Services 20 1720832173 0 Physicians Fluoride varnish 20 1720832173 0 Physicians Healthy Kids Services 20 1720832173 0 Physicians Optical Supplies 20 1720832173 0 Physicians Physician Services 00 1720835325 0 HAKE WHITNEY 2024206 9999999 B 10 1720835325 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1720835325 0 Nurse Practitioners Anesthesia Services 20 1720835325 0 Nurse Practitioners Nurse Practitioners Services 20 1720835325 0 Nurse Practitioners Physician Services 00 1720835374 0 KUMAR VAROON 2024205 9999999 B 10 1720835374 0 2211 N ELSTON AVE STE 301 CHICAGO IL 606149278 20 1720835374 0 Physicians Anesthesia Services 20 1720835374 0 Physicians Fluoride varnish 20 1720835374 0 Physicians Healthy Kids Services 20 1720835374 0 Physicians Optical Supplies 20 1720835374 0 Physicians Physician Services 00 1720835606 0 NATARAJAN BALAGANESH 2024222 9999999 B 10 1720835606 0 611 W PARK ST URBANA IL 618012529 20 1720835606 0 Physicians Anesthesia Services 20 1720835606 0 Physicians Fluoride varnish 20 1720835606 0 Physicians Healthy Kids Services 20 1720835606 0 Physicians Optical Supplies 20 1720835606 0 Physicians Physician Services 00 1720836877 0 JACKSON TIONNA 2024353 9999999 B 10 1720836877 0 411 E PARK ST STE 106 CHAMPAIGN IL 618203862 20 1720836877 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1720838097 0 KWARTENG PRISCILLA O 2024183 9999999 B 10 1720838097 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1720838097 0 Physicians Anesthesia Services 20 1720838097 0 Physicians Fluoride varnish 20 1720838097 0 Physicians Healthy Kids Services 20 1720838097 0 Physicians Optical Supplies 20 1720838097 0 Physicians Physician Services 00 1720838634 0 LORD VICTORIA K 2024183 9999999 B 10 1720838634 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1720838634 0 Physicians Anesthesia Services 20 1720838634 0 Physicians Fluoride varnish 20 1720838634 0 Physicians Healthy Kids Services 20 1720838634 0 Physicians Optical Supplies 20 1720838634 0 Physicians Physician Services 00 1720838840 0 WADI NOOR 2024198 9999999 B 10 1720838840 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1720838840 0 Physicians Anesthesia Services 20 1720838840 0 Physicians Fluoride varnish 20 1720838840 0 Physicians Healthy Kids Services 20 1720838840 0 Physicians Optical Supplies 20 1720838840 0 Physicians Physician Services 00 1720838907 0 MOUSSI SAAD ELIAS 2024214 9999999 B 10 1720838907 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1720838907 0 Physicians Anesthesia Services 20 1720838907 0 Physicians Fluoride varnish 20 1720838907 0 Physicians Healthy Kids Services 20 1720838907 0 Physicians Optical Supplies 20 1720838907 0 Physicians Physician Services 00 1720838949 0 YORK MELISSA 2024088 9999999 B 10 1720838949 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1720838949 0 Licensed Practical Nurses Nursing service 00 1720839111 0 PLEZIA GEREW ALEXANDRA 2024172 9999999 B 10 1720839111 0 PO BOX 3039 OAK BROOK IL 605223039 20 1720839111 0 Physicians Anesthesia Services 20 1720839111 0 Physicians Healthy Kids Services 20 1720839111 0 Physicians Optical Supplies 20 1720839111 0 Physicians Physician Services 00 1720840622 0 SHARP SHARON A 2024183 9999999 B 10 1720840622 0 29373 NETWORK PL CHICAGO IL 606733039 20 1720840622 0 Clinical Social Worker Social work service 00 1720840754 0 SCHROEDER KATELYN 2024201 9999999 B 10 1720840754 0 1S450 SUMMIT AVE STE 270 OAKBROOK TERRAC IL 601813959 20 1720840754 0 Nurse Practitioners Fluoride varnish 20 1720840754 0 Nurse Practitioners Healthy Kids Services 20 1720840754 0 Nurse Practitioners Nurse Practitioners Services 20 1720840754 0 Nurse Practitioners Physician Services 00 1720842834 0 BOWDEN STACIE E 2024045 9999999 B 10 1720842834 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1720842834 0 Nurse Practitioners Anesthesia Services 20 1720842834 0 Nurse Practitioners Nurse Practitioners Services 20 1720842834 0 Nurse Practitioners Physician Services 00 1720844368 0 WEBER KIMBERLY M 2024059 9999999 B 10 1720844368 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1720844368 0 Other behavior health professional LCPC/LMFT services 20 1720844368 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1720845175 0 MAGRUDER SAMANTHA 2024219 9999999 B 10 1720845175 0 7300 W COLLEGE DR PALOS HEIGHTS IL 604631152 20 1720845175 0 Nurse Practitioners Fluoride varnish 20 1720845175 0 Nurse Practitioners Healthy Kids Services 20 1720845175 0 Nurse Practitioners Nurse Practitioners Services 20 1720845175 0 Nurse Practitioners Physician Services 00 1720846546 0 TITO TIMA A 2024138 9999999 B 10 1720846546 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1720846546 0 Nurse Practitioners Anesthesia Services 20 1720846546 0 Nurse Practitioners Nurse Practitioners Services 20 1720846546 0 Nurse Practitioners Physician Services 00 1720848013 0 PHAN CHRISTOPHER 2024192 9999999 B 10 1720848013 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1720848013 0 Physicians Anesthesia Services 20 1720848013 0 Physicians Fluoride varnish 20 1720848013 0 Physicians Healthy Kids Services 20 1720848013 0 Physicians Optical Supplies 20 1720848013 0 Physicians Physician Services 00 1720849318 0 OGUIKE NICOLE 2024032 9999999 B 10 1720849318 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1720849318 0 Nurse Practitioners Healthy Kids Services 20 1720849318 0 Nurse Practitioners Nurse Practitioners Services 20 1720849318 0 Nurse Practitioners Physician Services 00 1720849888 0 EIGENMANN PRAIRIE 2024074 9999999 B 10 1720849888 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1720849888 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1720853351 0 ELLIOTT ERICA N 2023349 9999999 B 10 1720853351 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1720853351 0 Nurse Practitioners Fluoride varnish 20 1720853351 0 Nurse Practitioners Healthy Kids Services 20 1720853351 0 Nurse Practitioners Nurse Practitioners Services 20 1720853351 0 Nurse Practitioners Physician Services 00 1720853369 0 CURA KAREN D 2024011 9999999 B 10 1720853369 0 1289 WINDHAM PKWY ROMEOVILLE IL 604461763 20 1720853369 0 Clinical Social Worker Social work service 00 1720854052 0 ROCK ASHLEY 2024022 9999999 B 10 1720854052 0 1541 RIVERBOAT CENTER DR JOLIET IL 604319341 20 1720854052 0 Nurse Practitioners Fluoride varnish 20 1720854052 0 Nurse Practitioners Healthy Kids Services 20 1720854052 0 Nurse Practitioners Nurse Practitioners Services 20 1720854052 0 Nurse Practitioners Physician Services 00 1720854508 0 JONES JESSICA 2024106 9999999 B 10 1720854508 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1720854508 0 Nurse Practitioners Fluoride varnish 20 1720854508 0 Nurse Practitioners Healthy Kids Services 20 1720854508 0 Nurse Practitioners Nurse Practitioners Services 20 1720854508 0 Nurse Practitioners Physician Services 00 1720857048 0 DE LA VEGA AUDRONE 2023363 9999999 B 10 1720857048 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1720857048 0 Nurse Practitioners Healthy Kids Services 20 1720857048 0 Nurse Practitioners Nurse Practitioners Services 20 1720857048 0 Nurse Practitioners Physician Services 00 1720859150 0 KOCH THOMAS M 2024103 9999999 B 10 1720859150 0 PO BOX 120288 DALLAS TX 753120288 20 1720859150 0 Physician Assistant Only Fluoride varnish 20 1720859150 0 Physician Assistant Only Healthy Kids Services 20 1720859150 0 Physician Assistant Only Physician Services 00 1720859895 0 MENIE CAROLINE 2024351 9999999 B 10 1720859895 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1720859895 0 Physician Assistant Only Fluoride varnish 20 1720859895 0 Physician Assistant Only Healthy Kids Services 20 1720859895 0 Physician Assistant Only Physician Services 00 1720861123 0 EHLERT SHANNON 2024325 9999999 B 10 1720861123 0 1400 W GREENLEAF AVE CHICAGO IL 606262805 20 1720861123 0 Clinical Social Worker Social work service 00 1720861206 0 NULL EMILY B 2023270 9999999 B 10 1720861206 0 PO BOX 155 CHRISTOPHER IL 628220155 20 1720861206 0 Physician Assistant Only Fluoride varnish 20 1720861206 0 Physician Assistant Only Healthy Kids Services 20 1720861206 0 Physician Assistant Only Physician Services 00 1720862626 0 PHILLIPS KARA 2024243 9999999 B 10 1720862626 0 850 HAYES AVE SOUTH BELOIT IL 610802119 20 1720862626 0 Physical Therapists Medical Supplies 20 1720862626 0 Physical Therapists Medical equipment/prosthetic devices 20 1720862626 0 Physical Therapists Speech Therapy/Pathology Services 00 1720866106 0 NEDADUR RASHMI 2024011 9999999 B 10 1720866106 0 5777 DEPT CAROL STREAM IL 601220021 20 1720866106 0 Physicians Anesthesia Services 20 1720866106 0 Physicians Healthy Kids Services 20 1720866106 0 Physicians Optical Supplies 20 1720866106 0 Physicians Physician Services 00 1720869423 0 PHILLIPS MEGAN 2023292 9999999 B 10 1720869423 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1720869423 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1720869506 0 JOHNSON CHRISTI 2023283 9999999 B 10 1720869506 0 7667 W 95TH ST STE 209 HICKORY HILLS IL 604572281 20 1720869506 0 Other behavior health professional LCPC/LMFT services 20 1720869506 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1720885270 0 FRETZ VALERIE 2025064 9999999 B 10 1720885270 0 6810 STATE ROUTE 162 STE 215 MARYVILLE IL 620628566 20 1720885270 0 Nurse Practitioners Fluoride varnish 20 1720885270 0 Nurse Practitioners Healthy Kids Services 20 1720885270 0 Nurse Practitioners Nurse Practitioners Services 20 1720885270 0 Nurse Practitioners Physician Services 00 1720894686 0 RASOUL ADAM 2024352 9999999 B 10 1720894686 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1720894686 0 Physical Therapists Medical Supplies 20 1720894686 0 Physical Therapists Medical equipment/prosthetic devices 20 1720894686 0 Physical Therapists Physical Therapy Services 00 1720895063 0 MCPHILLIPS ASHLEY 2024359 9999999 B 10 1720895063 0 PO BOX 1109 CROWN POINT IN 463081109 20 1720895063 0 Nurse Practitioners Fluoride varnish 20 1720895063 0 Nurse Practitioners Healthy Kids Services 20 1720895063 0 Nurse Practitioners Nurse Practitioners Services 20 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601159602 20 1730101114 0 Nurse Practitioners Anesthesia Services 20 1730101114 0 Nurse Practitioners Nurse Practitioners Services 20 1730101114 0 Nurse Practitioners Physician Services 00 1730101874 0 RODEMANN JOSEPH F 2023272 9999999 B 10 1730101874 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1730101874 0 Physicians Anesthesia Services 20 1730101874 0 Physicians Fluoride varnish 20 1730101874 0 Physicians Healthy Kids Services 20 1730101874 0 Physicians Optical Supplies 20 1730101874 0 Physicians Physician Services 00 1730102070 0 DATTA YVONNE 2023137 9999999 B 10 1730102070 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1730102070 0 Physicians Anesthesia Services 20 1730102070 0 Physicians Fluoride varnish 20 1730102070 0 Physicians Healthy Kids Services 20 1730102070 0 Physicians Optical Supplies 20 1730102070 0 Physicians Physician Services 00 1730102468 0 MURRAY MARY R 2017190 9999999 B 10 1730102468 0 3207 LAKE AVE WILMETTE IL 600911082 20 1730102468 0 Physician Assistant Only Fluoride varnish 20 1730102468 0 Physician Assistant Only Healthy Kids Services 20 1730102468 0 Physician Assistant Only Physician Services 00 1730102856 0 ODLAND RICK 2017186 9999999 B 10 1730102856 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1730102856 0 Physicians Anesthesia Services 20 1730102856 0 Physicians Healthy Kids Services 20 1730102856 0 Physicians Optical Supplies 20 1730102856 0 Physicians Physician Services 00 1730103201 0 BELLAFIORE FRANK J 1995196 9999999 B 10 1730103201 0 1000 MEDICAL CENTER DR MONTICELLO IL 618562116 20 1730103201 0 Physicians Anesthesia Services 20 1730103201 0 Physicians Healthy Kids Services 20 1730103201 0 Physicians Optical Supplies 20 1730103201 0 Physicians Physician Services 00 1730103722 0 BARNETT JAMES W 1990274 9999999 B 10 1730103722 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1730103722 0 Physicians Anesthesia Services 20 1730103722 0 Physicians Fluoride varnish 20 1730103722 0 Physicians Healthy Kids Services 20 1730103722 0 Physicians Optical Supplies 20 1730103722 0 Physicians Physician Services 00 1730104076 0 MOURAD MAHER 2009160 9999999 B 10 1730104076 0 PO BOX 775231 CHICAGO IL 606775231 20 1730104076 0 Physicians Anesthesia Services 20 1730104076 0 Physicians Fluoride varnish 20 1730104076 0 Physicians Healthy Kids Services 20 1730104076 0 Physicians Optical Supplies 20 1730104076 0 Physicians Physician Services 00 1730104902 0 PERSON ERICA 2023332 9999999 B 10 1730104902 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1730104902 0 Physicians Anesthesia Services 20 1730104902 0 Physicians Healthy Kids Services 20 1730104902 0 Physicians Optical Supplies 20 1730104902 0 Physicians Physician Services 00 1730105032 0 SENGUPTA ALOK M 1999060 9999999 B 10 1730105032 0 500 PORTER AVE AURORA MO 656052365 20 1730105032 0 Physicians Anesthesia Services 20 1730105032 0 Physicians Healthy Kids Services 20 1730105032 0 Physicians Optical Supplies 20 1730105032 0 Physicians Physician Services 00 1730105875 0 CANNON CHRISTOPHER B 2004183 9999999 B 10 1730105875 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1730105875 0 Physicians Anesthesia Services 20 1730105875 0 Physicians Healthy Kids Services 20 1730105875 0 Physicians Optical Supplies 20 1730105875 0 Physicians Physician Services 00 1730105966 0 LUDBROOK PHILIP A 1981182 9999999 B 10 1730105966 0 1020 N MASON RD STE 210 CREVE COEUR MO 631416300 20 1730105966 0 Physicians Anesthesia Services 20 1730105966 0 Physicians Fluoride varnish 20 1730105966 0 Physicians Healthy Kids Services 20 1730105966 0 Physicians Optical Supplies 20 1730105966 0 Physicians Physician Services 00 1730105990 0 VOELS MALESEVIC KARYN 1996096 9999999 B 10 1730105990 0 309 NEW INDIAN TRAIL CT AURORA IL 605062411 20 1730105990 0 Audiologists Audiology Services 20 1730105990 0 Audiologists Medical Supplies 20 1730105990 0 Audiologists Medical equipment/prosthetic devices 00 1730106238 0 SEED PATRICK 2017006 9999999 B 10 1730106238 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1730106238 0 Physicians Anesthesia Services 20 1730106238 0 Physicians Fluoride varnish 20 1730106238 0 Physicians Healthy Kids Services 20 1730106238 0 Physicians Optical Supplies 20 1730106238 0 Physicians Physician Services 00 1730106287 0 CLIPPARD MICHAEL J 2001197 9999999 B 10 1730106287 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1730106287 0 Physicians Anesthesia Services 20 1730106287 0 Physicians Fluoride varnish 20 1730106287 0 Physicians Healthy Kids Services 20 1730106287 0 Physicians Optical Supplies 20 1730106287 0 Physicians Physician Services 00 1730106295 0 DIPERSIO JOHN F 1994060 9999999 B 10 1730106295 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1730106295 0 Physicians Anesthesia Services 20 1730106295 0 Physicians Fluoride varnish 20 1730106295 0 Physicians Healthy Kids Services 20 1730106295 0 Physicians Optical Supplies 20 1730106295 0 Physicians Physician Services 00 1730106410 0 STEPHANIAN ERICK 1994038 9999999 B 10 1730106410 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1730106410 0 Physicians Anesthesia Services 20 1730106410 0 Physicians Healthy Kids Services 20 1730106410 0 Physicians Optical Supplies 20 1730106410 0 Physicians Physician Services 00 1730107202 0 SIEGEL BARRY 2002182 9999999 B 10 1730107202 0 PO BOX 60352 SAINT LOUIS MO 631600352 20 1730107202 0 Physicians Anesthesia Services 20 1730107202 0 Physicians Healthy Kids Services 20 1730107202 0 Physicians Optical Supplies 20 1730107202 0 Physicians Physician Services 00 1730107376 0 SPARKMAN JAYME 2010001 9999999 B 10 1730107376 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1730107376 0 Nurse Practitioners Healthy Kids Services 20 1730107376 0 Nurse Practitioners Nurse Practitioners Services 20 1730107376 0 Nurse Practitioners Physician Services 00 1730107715 0 SHAH UDAY 1982306 9999999 B 10 1730107715 0 9133 S STONY ISLAND AVE CHICAGO IL 606173512 20 1730107715 0 Physicians Anesthesia Services 20 1730107715 0 Physicians Healthy Kids Services 20 1730107715 0 Physicians Optical Supplies 20 1730107715 0 Physicians Physician Services 00 1730108101 0 FRANKLIN TUERE A. 2016335 9999999 B 10 1730108101 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1730108101 0 Physicians Anesthesia Services 20 1730108101 0 Physicians Healthy Kids Services 20 1730108101 0 Physicians Optical Supplies 20 1730108101 0 Physicians Physician Services 00 1730108952 0 BUENAVENTURA BRIAN 2011213 9999999 B 10 1730108952 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1730108952 0 Nurse Practitioners Anesthesia Services 20 1730108952 0 Nurse Practitioners Nurse Practitioners Services 20 1730108952 0 Nurse Practitioners Physician Services 00 1730109851 0 BERGER RONALD G 2005182 9999999 B 10 1730109851 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1730109851 0 Physicians Anesthesia Services 20 1730109851 0 Physicians Fluoride varnish 20 1730109851 0 Physicians Healthy Kids 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00 1730111253 0 RANI SWAROOP 2024087 9999999 B 10 1730111253 0 6742 N FROSTWOOD PKWY PEORIA IL 616152402 20 1730111253 0 Physicians Anesthesia Services 20 1730111253 0 Physicians Healthy Kids Services 20 1730111253 0 Physicians Optical Supplies 20 1730111253 0 Physicians Physician Services 00 1730111576 0 REZAI KATAYOUN 2011213 9999999 B 10 1730111576 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1730111576 0 Physicians Anesthesia Services 20 1730111576 0 Physicians Healthy Kids Services 20 1730111576 0 Physicians Optical Supplies 20 1730111576 0 Physicians Physician Services 00 1730112210 0 MATUSHEK MARCIA A 2007018 9999999 B 10 1730112210 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1730112210 0 Nurse Practitioners Anesthesia Services 20 1730112210 0 Nurse Practitioners Nurse Practitioners Services 20 1730112210 0 Nurse Practitioners Physician Services 00 1730112269 0 XIN WEI 2025041 9999999 B 10 1730112269 0 525 VALLEY VIEW DR MOLINE IL 612656138 20 1730112269 0 Physicians Anesthesia Services 20 1730112269 0 Physicians Healthy Kids Services 20 1730112269 0 Physicians Optical Supplies 20 1730112269 0 Physicians Physician Services 00 1730112277 0 CUASAY THAD L 2022343 9999999 B 10 1730112277 0 28594 NETWORK PL CHICAGO IL 606731285 20 1730112277 0 Physician Assistant Only Fluoride varnish 20 1730112277 0 Physician Assistant Only Healthy Kids Services 20 1730112277 0 Physician Assistant Only Physician Services 00 1730112525 0 PERROTT CHARLES A 2000321 9999999 B 10 1730112525 0 PO BOX 451 NORTHBROOK IL 600650451 20 1730112525 0 Physicians Anesthesia Services 20 1730112525 0 Physicians Healthy Kids Services 20 1730112525 0 Physicians Optical Supplies 20 1730112525 0 Physicians Physician Services 00 1730112616 0 HARPER LINDA L 2016337 9999999 B 10 1730112616 0 1445 ROSS AVE STE 1400 STE 1400 DALLAS TX 752022703 20 1730112616 0 Psychologist Psychologist service 00 1730112996 0 BELEW MARK EDWARD 2015231 9999999 B 10 1730112996 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1730112996 0 Physicians Anesthesia Services 20 1730112996 0 Physicians Healthy Kids Services 20 1730112996 0 Physicians Optical Supplies 20 1730112996 0 Physicians Physician Services 00 1730114448 0 GRILLO MARSHALL 2025107 9999999 B 10 1730114448 0 1300 HRC PLAZA DR LAKE ST LOUIS MO 633671869 20 1730114448 0 Physicians Anesthesia Services 20 1730114448 0 Physicians Healthy Kids Services 20 1730114448 0 Physicians Optical Supplies 20 1730114448 0 Physicians Physician Services 00 1730114612 0 ASBURY JOSEPH 2009320 9999999 B 10 1730114612 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1730114612 0 Physicians Anesthesia Services 20 1730114612 0 Physicians Fluoride varnish 20 1730114612 0 Physicians Healthy Kids Services 20 1730114612 0 Physicians Optical Supplies 20 1730114612 0 Physicians Physician Services 00 1730115643 0 GAINES SAM 1996306 9999999 B 10 1730115643 0 4350 FOWLER ST FORT MYERS FL 339012699 20 1730115643 0 Physicians Anesthesia Services 20 1730115643 0 Physicians Fluoride varnish 20 1730115643 0 Physicians Healthy Kids Services 20 1730115643 0 Physicians Optical Supplies 20 1730115643 0 Physicians Physician Services 00 1730115791 0 HASAN SYED A 2007244 9999999 B 10 1730115791 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1730115791 0 Physicians Anesthesia Services 20 1730115791 0 Physicians Fluoride varnish 20 1730115791 0 Physicians Healthy Kids Services 20 1730115791 0 Physicians Optical Supplies 20 1730115791 0 Physicians Physician Services 00 1730116401 0 GADEK LISA 1998305 9999999 B 10 1730116401 0 917 SHERWOOD DR LAKE BLUFF IL 600442203 20 1730116401 0 Physicians Anesthesia Services 20 1730116401 0 Physicians Fluoride varnish 20 1730116401 0 Physicians Healthy Kids Services 20 1730116401 0 Physicians Optical Supplies 20 1730116401 0 Physicians Physician Services 00 1730119066 0 FRIEDMAN JORDANA 2001213 9999999 B 10 1730119066 0 5777 DEPT CAROL STREAM IL 601220021 20 1730119066 0 Physicians Anesthesia Services 20 1730119066 0 Physicians Fluoride varnish 20 1730119066 0 Physicians Healthy Kids Services 20 1730119066 0 Physicians Optical Supplies 20 1730119066 0 Physicians Physician Services 00 1730119124 0 COMBS SHELIA 2024123 9999999 B 10 1730119124 0 290 BIG RUN RD LEXINGTON KY 405032903 20 1730119124 0 Physicians Anesthesia Services 20 1730119124 0 Physicians Healthy Kids Services 20 1730119124 0 Physicians Optical Supplies 20 1730119124 0 Physicians Physician Services 00 1730119561 0 GEGENHEIMER ALAN 1999326 9999999 B 10 1730119561 0 6308 8TH AVE KENOSHA WI 531435031 20 1730119561 0 Physicians Anesthesia Services 20 1730119561 0 Physicians Healthy Kids Services 20 1730119561 0 Physicians Optical Supplies 20 1730119561 0 Physicians Physician Services 00 1730119884 0 NAHEED ZAHRA J 2002001 9999999 B 10 1730119884 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1730119884 0 Physicians Anesthesia Services 20 1730119884 0 Physicians Healthy Kids Services 20 1730119884 0 Physicians Optical Supplies 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1730127945 0 Physicians Healthy Kids Services 20 1730127945 0 Physicians Optical Supplies 20 1730127945 0 Physicians Physician Services 00 1730128356 0 WOLFE ROBERT M. 1994182 9999999 B 10 1730128356 0 2650 RIDGE AVE STE 1223 EVANSTON IL 602011718 20 1730128356 0 Physicians Anesthesia Services 20 1730128356 0 Physicians Fluoride varnish 20 1730128356 0 Physicians Healthy Kids Services 20 1730128356 0 Physicians Optical Supplies 20 1730128356 0 Physicians Physician Services 00 1730128687 0 STAMBAUGH SARAH 2000199 9999999 B 10 1730128687 0 1025 MAINE ST QUINCY IL 623014038 20 1730128687 0 Nurse Practitioners Anesthesia Services 20 1730128687 0 Nurse Practitioners Nurse Practitioners Services 20 1730128687 0 Nurse Practitioners Physician Services 00 1730128919 0 SMITH KEITH R 2022229 9999999 B 10 1730128919 0 6150 E BROAD ST COLUMBUS OH 432131574 20 1730128919 0 Physicians Anesthesia Services 20 1730128919 0 Physicians Healthy Kids Services 20 1730128919 0 Physicians Optical Supplies 20 1730128919 0 Physicians Physician Services 00 1730128943 0 GROSS CATHY L 2006091 9999999 B 10 1730128943 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1730128943 0 Nurse Practitioners Fluoride varnish 20 1730128943 0 Nurse Practitioners Healthy Kids Services 20 1730128943 0 Nurse Practitioners Nurse Practitioners Services 20 1730128943 0 Nurse Practitioners Physician Services 00 1730129560 0 KOPNICK MITCHELL 1992183 9999999 B 10 1730129560 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1730129560 0 Physicians Anesthesia Services 20 1730129560 0 Physicians Healthy Kids Services 20 1730129560 0 Physicians Optical Supplies 20 1730129560 0 Physicians Physician Services 00 1730130253 0 KIMBLE SUMMER J 2018271 9999999 B 10 1730130253 0 150 S SUNNY SLOPE RD STE 136 BROOKFIELD WI 530054858 20 1730130253 0 Physician Assistant Only Fluoride varnish 20 1730130253 0 Physician Assistant Only Healthy Kids Services 20 1730130253 0 Physician Assistant Only Physician Services 00 1730131152 0 GIDLEY JENNIFER 2011348 9999999 B 10 1730131152 0 4121 VETERANS MEMORIAL DR MOUNT VERNON IL 628646262 20 1730131152 0 Physical Therapists Medical Supplies 20 1730131152 0 Physical Therapists Medical equipment/prosthetic devices 20 1730131152 0 Physical Therapists Physical Therapy Services 00 1730131160 0 MULHOLLAND KIMBERLY 2000364 9999999 B 10 1730131160 0 621 S ILLINOIS AVE STE 103 MASON CITY IA 504015489 20 1730131160 0 Nurse Practitioners Healthy Kids Services 20 1730131160 0 Nurse Practitioners Nurse Practitioners Services 20 1730131160 0 Nurse Practitioners Physician Services 00 1730131434 0 RAASCH WILLIAM G 1993032 9999999 B 10 1730131434 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1730131434 0 Physicians Anesthesia Services 20 1730131434 0 Physicians Healthy Kids Services 20 1730131434 0 Physicians Optical Supplies 20 1730131434 0 Physicians Physician Services 00 1730131509 0 HORTON AMANDA L 2009236 9999999 B 10 1730131509 0 5777 DEPT CAROL STREAM IL 601220021 20 1730131509 0 Physicians Anesthesia Services 20 1730131509 0 Physicians Healthy Kids Services 20 1730131509 0 Physicians Optical Supplies 20 1730131509 0 Physicians Physician Services 00 1730131699 0 CARRUTHERS COLLEEN 2005213 9999999 B 10 1730131699 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1730131699 0 Nurse Practitioners Anesthesia Services 20 1730131699 0 Nurse Practitioners Nurse Practitioners Services 20 1730131699 0 Nurse Practitioners Physician Services 00 1730131889 0 SAKLECHA ASEEM 1999182 9999999 B 10 1730131889 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1730131889 0 Physicians Anesthesia Services 20 1730131889 0 Physicians Healthy Kids Services 20 1730131889 0 Physicians Optical Supplies 20 1730131889 0 Physicians Physician Services 00 1730132333 0 LENEVE CHERYL 2016058 9999999 B 10 1730132333 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1730132333 0 Physician Assistant Only Fluoride varnish 20 1730132333 0 Physician Assistant Only Healthy Kids Services 20 1730132333 0 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1730333949 0 Dentists Physician Services 00 1730334020 0 CALLIS MARY CHARLINE 2012079 9999999 B 10 1730334020 0 5665 NEW NORTHSIDE DR ATLANTA GA 303285831 20 1730334020 0 Physicians Anesthesia Services 20 1730334020 0 Physicians Healthy Kids Services 20 1730334020 0 Physicians Optical Supplies 20 1730334020 0 Physicians Physician Services 00 1730334541 0 HAMPER PATRICK 2008275 9999999 B 10 1730334541 0 PO BOX 674 TOLUCA IL 613690674 20 1730334541 0 Dentists Dental Services 20 1730334541 0 Dentists Physician Services 00 1730334962 0 HARREN HEATHER L 2008183 9999999 B 10 1730334962 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1730334962 0 Nurse Practitioners Fluoride varnish 20 1730334962 0 Nurse Practitioners Healthy Kids Services 20 1730334962 0 Nurse Practitioners Nurse Practitioners Services 20 1730334962 0 Nurse Practitioners Physician Services 00 1730336322 0 MIRANDA ERIC VINCENT T 2012290 9999999 B 10 1730336322 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1730336322 0 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1730337569 0 Physicians Healthy Kids Services 20 1730337569 0 Physicians Optical Supplies 20 1730337569 0 Physicians Physician Services 20 1730337569 0 Physicians Physicians Psychiatric Services 00 1730338989 0 JOHNSON CAMERON 2016319 9999999 B 10 1730338989 0 4230 11TH ST ROCK ISLAND IL 612016746 20 1730338989 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1730339482 0 HARVEY KIMBERLY 2021244 9999999 B 10 1730339482 0 250 W 96TH ST STE 520 INDIANAPOLIS IN 462601317 20 1730339482 0 Physician Assistant Only Fluoride varnish 20 1730339482 0 Physician Assistant Only Healthy Kids Services 20 1730339482 0 Physician Assistant Only Physician Services 00 1730340498 0 SAMS JACOB D 2013213 9999999 B 10 1730340498 0 101 E 9TH ST PANA IL 625571716 20 1730340498 0 Physicians Anesthesia Services 20 1730340498 0 Physicians Healthy Kids Services 20 1730340498 0 Physicians Optical Supplies 20 1730340498 0 Physicians Physician 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1730812215 0 Physicians Optical Supplies 20 1730812215 0 Physicians Physician Services 20 1730812215 0 Physicians Physicians Psychiatric Services 00 1730813155 0 ELTAYEF SHAHAD J 2023233 9999999 B 10 1730813155 0 1029 HOWARD ST EVANSTON IL 602023877 20 1730813155 0 Dentists Dental Services 20 1730813155 0 Dentists Physician Services 00 1730813213 0 SCHAUS SYDNEY 2022266 9999999 B 10 1730813213 0 102 N LOGAN AVE DANVILLE IL 618328513 20 1730813213 0 Nurse Practitioners Fluoride varnish 20 1730813213 0 Nurse Practitioners Healthy Kids Services 20 1730813213 0 Nurse Practitioners Nurse Practitioners Services 20 1730813213 0 Nurse Practitioners Physician Services 00 1730815101 0 CHUNG MAXWELL 2023206 9999999 B 10 1730815101 0 715 LAKE ST STE 800 OAK PARK IL 603011417 20 1730815101 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1730818287 0 KELLER SARMIENTO IGNACIO J 2022226 9999999 B 10 1730818287 0 5777 DEPT CAROL STREAM IL 601220021 20 1730818287 0 Physicians Anesthesia Services 20 1730818287 0 Physicians Healthy Kids Services 20 1730818287 0 Physicians Optical Supplies 20 1730818287 0 Physicians Physician Services 20 1730818287 0 Physicians Physicians Psychiatric Services 00 1730818865 0 NGUYEN HOANG 2022182 9999999 B 10 1730818865 0 PO BOX 855795 MINNEAPOLIS MN 554851296 20 1730818865 0 Physicians Anesthesia Services 20 1730818865 0 Physicians Fluoride varnish 20 1730818865 0 Physicians Healthy Kids Services 20 1730818865 0 Physicians Optical Supplies 20 1730818865 0 Physicians Physician Services 00 1730818972 0 ISKANDER JOHN 2022185 9999999 B 10 1730818972 0 1 MEMORIAL DR ALTON IL 620026722 20 1730818972 0 Physicians Anesthesia Services 20 1730818972 0 Physicians Fluoride varnish 20 1730818972 0 Physicians Healthy Kids Services 20 1730818972 0 Physicians Optical Supplies 20 1730818972 0 Physicians Physician Services 00 1730820028 0 CAREY GRACE 2024281 9999999 B 10 1730820028 0 PO BOX 5081 JANESVILLE WI 535475081 20 1730820028 0 Physicians Anesthesia Services 20 1730820028 0 Physicians Healthy Kids Services 20 1730820028 0 Physicians Optical Supplies 20 1730820028 0 Physicians Physician Services 00 1730820481 0 SUMMERS LAUREN N 2022232 9999999 B 10 1730820481 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1730820481 0 Physicians Anesthesia Services 20 1730820481 0 Physicians Healthy Kids Services 20 1730820481 0 Physicians Optical Supplies 20 1730820481 0 Physicians Physician Services 00 1730821059 0 PATEL TRUSHAR 2022215 9999999 B 10 1730821059 0 3880 SALEM LAKE DR STE F LONG GROVE IL 600475292 20 1730821059 0 Nurse Practitioners Healthy Kids Services 20 1730821059 0 Nurse Practitioners Nurse Practitioners Services 20 1730821059 0 Nurse Practitioners Physician Services 00 1730821158 0 MERCURIO MARIA 2023191 9999999 B 10 1730821158 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1730821158 0 Physicians Anesthesia Services 20 1730821158 0 Physicians Healthy Kids Services 20 1730821158 0 Physicians Optical Supplies 20 1730821158 0 Physicians Physician Services 00 1730822263 0 FIEDLER CHERIE L 2023333 9999999 B 10 1730822263 0 29373 NETWORK PL CHICAGO IL 606733039 20 1730822263 0 Nurse Practitioners Healthy Kids Services 20 1730822263 0 Nurse Practitioners Nurse Practitioners Services 20 1730822263 0 Nurse Practitioners Physician Services 00 1730822727 0 MAYFIELD HANNAH E 2023068 9999999 B 10 1730822727 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1730822727 0 Nurse Practitioners Fluoride varnish 20 1730822727 0 Nurse Practitioners Healthy Kids Services 20 1730822727 0 Nurse Practitioners Nurse Practitioners Services 20 1730822727 0 Nurse Practitioners Physician Services 00 1730822925 0 KORO SAMI 2023204 9999999 B 10 1730822925 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1730822925 0 Physicians Anesthesia Services 20 1730822925 0 Physicians Healthy Kids Services 20 1730822925 0 Physicians Optical Supplies 20 1730822925 0 Physicians Physician Services 00 1730823204 0 SOGGE ALYSSA 2023291 9999999 B 10 1730823204 0 PO BOX 5081 JANESVILLE WI 535475081 20 1730823204 0 Speech Therapists Medical Supplies 20 1730823204 0 Speech Therapists Medical equipment/prosthetic devices 20 1730823204 0 Speech Therapists Speech Therapy/Pathology Services 00 1730823717 0 FOX GREGORY C 2024346 9999999 B 10 1730823717 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1730823717 0 Physicians Anesthesia Services 20 1730823717 0 Physicians Fluoride varnish 20 1730823717 0 Physicians Healthy Kids Services 20 1730823717 0 Physicians Optical Supplies 20 1730823717 0 Physicians Physician Services 00 1730823840 0 BRYANT ELIZABETH A 2022227 9999999 B 10 1730823840 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1730823840 0 Physicians Anesthesia Services 20 1730823840 0 Physicians Fluoride varnish 20 1730823840 0 Physicians Healthy Kids Services 20 1730823840 0 Physicians Optical Supplies 20 1730823840 0 Physicians Physician Services 00 1730824616 0 MOORE COLEEN 2023293 9999999 B 10 1730824616 0 2000 JACOBSSEN DR NORMAL IL 617616277 20 1730824616 0 Other behavior health professional LCPC/LMFT services 00 1730825548 0 KOTB AHMED 2024185 9999999 B 10 1730825548 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1730825548 0 Physicians Anesthesia Services 20 1730825548 0 Physicians Healthy Kids Services 20 1730825548 0 Physicians Optical Supplies 20 1730825548 0 Physicians Physician Services 00 1730826900 0 BHALLA RAHUL 2022186 9999999 B 10 1730826900 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1730826900 0 Physicians Anesthesia Services 20 1730826900 0 Physicians Fluoride varnish 20 1730826900 0 Physicians Healthy Kids Services 20 1730826900 0 Physicians Optical Supplies 20 1730826900 0 Physicians Physician Services 00 1730827361 0 SWALLA HARRISON J 2022297 9999999 B 10 1730827361 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1730827361 0 Physician Assistant Only Fluoride varnish 20 1730827361 0 Physician Assistant Only Healthy Kids Services 20 1730827361 0 Physician Assistant Only Physician Services 00 1730828047 0 MCCAFFREY BRADY M 2022202 9999999 B 10 1730828047 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1730828047 0 Physicians Anesthesia Services 20 1730828047 0 Physicians Healthy Kids Services 20 1730828047 0 Physicians Optical Supplies 20 1730828047 0 Physicians Physician Services 00 1730828062 0 LOGGIE BRITTANY Y 2022257 9999999 B 10 1730828062 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1730828062 0 Nurse Practitioners Healthy Kids Services 20 1730828062 0 Nurse Practitioners Nurse Practitioners Services 20 1730828062 0 Nurse Practitioners Physician Services 00 1730828070 0 PATEL RAM A 2022206 9999999 B 10 1730828070 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1730828070 0 Physicians Anesthesia Services 20 1730828070 0 Physicians Healthy Kids Services 20 1730828070 0 Physicians Optical Supplies 20 1730828070 0 Physicians Physician Services 00 1730829151 0 HARRISON ISAIAH 2022187 9999999 B 10 1730829151 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1730829151 0 Physicians Anesthesia Services 20 1730829151 0 Physicians Fluoride varnish 20 1730829151 0 Physicians Healthy Kids Services 20 1730829151 0 Physicians Optical Supplies 20 1730829151 0 Physicians Physician Services 00 1730829631 0 POZIN JACOB JEROME 2023207 9999999 B 10 1730829631 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1730829631 0 Physicians Anesthesia Services 20 1730829631 0 Physicians Fluoride varnish 20 1730829631 0 Physicians Healthy Kids Services 20 1730829631 0 Physicians Optical Supplies 20 1730829631 0 Physicians Physician Services 00 1730829979 0 PAREDES FLORES MANUEL A 2022129 9999999 B 10 1730829979 0 PO BOX 3039 OAK BROOK IL 605223039 20 1730829979 0 Physicians Anesthesia Services 20 1730829979 0 Physicians Fluoride varnish 20 1730829979 0 Physicians Healthy Kids Services 20 1730829979 0 Physicians Optical Supplies 20 1730829979 0 Physicians Physician Services 00 1730831835 0 FRAGOSO CAITRINA M 2022021 9999999 B 10 1730831835 0 10001 GRAND AVE FRANKLIN PARK IL 601312563 20 1730831835 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1730834847 0 OLIVARES PAULA 2025023 9999999 B 10 1730834847 0 501 7TH ST ROCKFORD IL 611041242 20 1730834847 0 Speech Therapists Medical Supplies 20 1730834847 0 Speech Therapists Medical equipment/prosthetic devices 20 1730834847 0 Speech Therapists Speech Therapy/Pathology Services 00 1730835588 0 OLEARY BAUMAN CATHERINE 2022350 9999999 B 10 1730835588 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1730835588 0 Nurse Practitioners Healthy Kids Services 20 1730835588 0 Nurse Practitioners Nurse Practitioners Services 20 1730835588 0 Nurse Practitioners Physician Services 00 1730835711 0 CALDWELL MAURA E 2024010 9999999 B 10 1730835711 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1730835711 0 Other behavior health 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1730837634 0 Nurse Practitioners Physician Services 00 1730837915 0 COMPTON CARRIE A 2022096 9999999 B 10 1730837915 0 PO BOX 546 HOPKINS PARK IL 609440546 20 1730837915 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1730838129 0 GIVENS JOCQUIL 2022171 9999999 B 10 1730838129 0 4698 DEPT CAROL STREAM IL 601220021 20 1730838129 0 Physicians Anesthesia Services 20 1730838129 0 Physicians Healthy Kids Services 20 1730838129 0 Physicians Optical Supplies 20 1730838129 0 Physicians Physician Services 00 1730838699 0 DINH-DANG DUYEN H 2022172 9999999 B 10 1730838699 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1730838699 0 Physicians Anesthesia Services 20 1730838699 0 Physicians Fluoride varnish 20 1730838699 0 Physicians Healthy Kids Services 20 1730838699 0 Physicians Optical Supplies 20 1730838699 0 Physicians Physician Services 00 1730839341 0 ALEXANDER RACHEL 2022178 9999999 B 10 1730839341 0 PO BOX 70508 CHICAGO 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Fluoride varnish 20 1730839598 0 Physicians Healthy Kids Services 20 1730839598 0 Physicians Optical Supplies 20 1730839598 0 Physicians Physician Services 00 1730839960 0 HATCHER COURTNEY 2022213 9999999 B 10 1730839960 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1730839960 0 Physicians Anesthesia Services 20 1730839960 0 Physicians Fluoride varnish 20 1730839960 0 Physicians Healthy Kids Services 20 1730839960 0 Physicians Optical Supplies 20 1730839960 0 Physicians Physician Services 00 1730840745 0 JACOBS ASHTON 2022068 9999999 B 10 1730840745 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1730840745 0 Nurse Practitioners Fluoride varnish 20 1730840745 0 Nurse Practitioners Healthy Kids Services 20 1730840745 0 Nurse Practitioners Nurse Practitioners Services 20 1730840745 0 Nurse Practitioners Physician Services 00 1730841370 0 KING MICHELLE L 2022168 9999999 B 10 1730841370 0 8940 N WOOD SAGE RD PEORIA IL 616157822 20 1730841370 0 Nurse Practitioners Healthy Kids Services 20 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Physician Assistant Only Fluoride varnish 20 1730852377 0 Physician Assistant Only Healthy Kids Services 20 1730852377 0 Physician Assistant Only Physician Services 00 1730852617 0 EICHELBERG CHRISTINA 2024095 9999999 B 10 1730852617 0 3832 N LINCOLN AVE CHICAGO IL 606133520 20 1730852617 0 Nurse Practitioners Healthy Kids Services 20 1730852617 0 Nurse Practitioners Midwife Services 20 1730852617 0 Nurse Practitioners Nurse Practitioners Services 20 1730852617 0 Nurse Practitioners Physician Services 00 1730853508 0 HOLLANDER NICOLE 2023233 9999999 B 10 1730853508 0 10400 SOUTHWEST HWY CHICAGO RIDGE IL 604151367 20 1730853508 0 Nurse Practitioners Fluoride varnish 20 1730853508 0 Nurse Practitioners Healthy Kids Services 20 1730853508 0 Nurse Practitioners Nurse Practitioners Services 20 1730853508 0 Nurse Practitioners Physician Services 00 1730855404 0 REED VALERIE A 2021267 9999999 B 10 1730855404 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1730855404 0 Nurse Practitioners 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Services 20 1730863069 0 Physicians Optical Supplies 20 1730863069 0 Physicians Physician Services 00 1730863358 0 OLSON MADELINE 2024200 9999999 B 10 1730863358 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1730863358 0 Nurse Practitioners Anesthesia Services 20 1730863358 0 Nurse Practitioners Nurse Practitioners Services 20 1730863358 0 Nurse Practitioners Physician Services 00 1730864521 0 ZHUANG KATHLYN 2023349 9999999 B 10 1730864521 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1730864521 0 Physicians Anesthesia Services 20 1730864521 0 Physicians Fluoride varnish 20 1730864521 0 Physicians Healthy Kids Services 20 1730864521 0 Physicians Optical Supplies 20 1730864521 0 Physicians Physician Services 00 1730865478 0 MASTERSON MEGAN 2023201 9999999 B 10 1730865478 0 5777 DEPT CAROL STREAM IL 601220021 20 1730865478 0 Nurse Practitioners Healthy Kids Services 20 1730865478 0 Nurse Practitioners Nurse Practitioners Services 20 1730865478 0 Nurse Practitioners Physician Services 00 1730868860 0 BOEGER BRIDGET 2024193 9999999 B 10 1730868860 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1730868860 0 Physicians Anesthesia Services 20 1730868860 0 Physicians Healthy Kids Services 20 1730868860 0 Physicians Optical Supplies 20 1730868860 0 Physicians Physician Services 00 1730869264 0 ZYMANTAS MARIUS 2023349 9999999 B 10 1730869264 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1730869264 0 Nurse Practitioners Anesthesia Services 20 1730869264 0 Nurse Practitioners Nurse Practitioners Services 20 1730869264 0 Nurse Practitioners Physician Services 00 1730871179 0 PATEL TULSI 2023193 9999999 B 10 1730871179 0 PO BOX 775257 CHICAGO IL 606775257 20 1730871179 0 Physicians Anesthesia Services 20 1730871179 0 Physicians Fluoride varnish 20 1730871179 0 Physicians Healthy Kids Services 20 1730871179 0 Physicians Optical Supplies 20 1730871179 0 Physicians Physician Services 00 1730871187 0 MARATHU KRANTHI K 2023213 9999999 B 10 1730871187 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1730871187 0 Physicians Anesthesia Services 20 1730871187 0 Physicians Healthy Kids Services 20 1730871187 0 Physicians Optical Supplies 20 1730871187 0 Physicians Physician Services 00 1730871435 0 LIN MEGAN 2023159 9999999 B 10 1730871435 0 250 W 96TH ST STE 520 INDIANAPOLIS IN 462601317 20 1730871435 0 Speech Therapists Medical Supplies 20 1730871435 0 Speech Therapists Medical equipment/prosthetic devices 20 1730871435 0 Speech Therapists Speech Therapy/Pathology Services 00 1730871666 0 TRIPLITT RAISA 2023236 9999999 B 10 1730871666 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1730871666 0 Nurse Practitioners Healthy Kids Services 20 1730871666 0 Nurse Practitioners Nurse Practitioners Services 20 1730871666 0 Nurse Practitioners Physician Services 00 1730872029 0 MCCLAIN CASEY C 2024320 9999999 B 10 1730872029 0 1250 E US HIGHWAY 36 TUSCOLA IL 619538020 20 1730872029 0 Other behavior health professional LCPC/LMFT services 00 1730874504 0 LAROW ANDREW 2023363 9999999 B 10 1730874504 0 124 SW ADAMS ST PEORIA IL 616021308 20 1730874504 0 Physicians Anesthesia Services 20 1730874504 0 Physicians Fluoride varnish 20 1730874504 0 Physicians Healthy Kids Services 20 1730874504 0 Physicians Optical Supplies 20 1730874504 0 Physicians Physician Services 00 1730874785 0 ASH ASHLEY 2025010 9999999 B 10 1730874785 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1730874785 0 Nurse Practitioners Healthy Kids Services 20 1730874785 0 Nurse Practitioners Nurse Practitioners Services 20 1730874785 0 Nurse Practitioners Physician Services 00 1730874991 0 PARK JONATHAN 2024202 9999999 B 10 1730874991 0 4698 DEPT CAROL STREAM IL 601220021 20 1730874991 0 Physicians Anesthesia Services 20 1730874991 0 Physicians Healthy Kids Services 20 1730874991 0 Physicians Optical Supplies 20 1730874991 0 Physicians Physician Services 00 1730875998 0 STEENO DANIEL 2023286 9999999 B 10 1730875998 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1730875998 0 Physicians Anesthesia Services 20 1730875998 0 Physicians Healthy Kids Services 20 1730875998 0 Physicians Optical Supplies 20 1730875998 0 Physicians Physician Services 00 1730876731 0 HAZENFIELD THOMAS 2023292 2026174 B 10 1730876731 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1730876731 0 Physicians Anesthesia Services 20 1730876731 0 Physicians Healthy Kids Services 20 1730876731 0 Physicians Optical Supplies 20 1730876731 0 Physicians Physician Services 00 1730876962 0 NAGISETTY CHERISHMA 2023195 9999999 B 10 1730876962 0 PO BOX 775248 CHICAGO IL 606775248 20 1730876962 0 Physicians Anesthesia Services 20 1730876962 0 Physicians Fluoride varnish 20 1730876962 0 Physicians Healthy Kids Services 20 1730876962 0 Physicians Optical Supplies 20 1730876962 0 Physicians Physician Services 00 1730877309 0 SHASHOUA NED D 2023156 9999999 B 10 1730877309 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1730877309 0 Physicians Anesthesia Services 20 1730877309 0 Physicians Healthy Kids Services 20 1730877309 0 Physicians Optical Supplies 20 1730877309 0 Physicians Physician Services 00 1730880303 0 THOMAS PAUL 2024202 9999999 B 10 1730880303 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1730880303 0 Physicians Anesthesia Services 20 1730880303 0 Physicians Healthy Kids Services 20 1730880303 0 Physicians Optical Supplies 20 1730880303 0 Physicians Physician Services 00 1730880519 0 MASKET DIANE 2024295 9999999 B 10 1730880519 0 2650 RIDGE AVE # G949 EVANSTON IL 602011718 20 1730880519 0 Physicians Anesthesia Services 20 1730880519 0 Physicians Fluoride varnish 20 1730880519 0 Physicians Healthy Kids Services 20 1730880519 0 Physicians Optical Supplies 20 1730880519 0 Physicians Physician Services 00 1730881004 0 TANG CHRISTIE 2023174 9999999 B 10 1730881004 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1730881004 0 Physicians Anesthesia Services 20 1730881004 0 Physicians Fluoride varnish 20 1730881004 0 Physicians Healthy Kids Services 20 1730881004 0 Physicians Optical Supplies 20 1730881004 0 Physicians Physician Services 00 1730881988 0 HOWE EDMUND 2023199 9999999 B 10 1730881988 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1730881988 0 Physicians Anesthesia Services 20 1730881988 0 Physicians Healthy Kids Services 20 1730881988 0 Physicians Optical Supplies 20 1730881988 0 Physicians Physician Services 00 1730882341 0 HYDE ADAM 2023263 9999999 B 10 1730882341 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1730882341 0 Physicians Anesthesia Services 20 1730882341 0 Physicians Healthy Kids Services 20 1730882341 0 Physicians Optical Supplies 20 1730882341 0 Physicians Physician Services 20 1730882341 0 Physicians Physicians Psychiatric Services 00 1730883026 0 PATTON CHEZLYN 2023334 9999999 B 10 1730883026 0 4698 DEPT CAROL STREAM IL 601220021 20 1730883026 0 Physicians Anesthesia Services 20 1730883026 0 Physicians Healthy Kids Services 20 1730883026 0 Physicians Optical Supplies 20 1730883026 0 Physicians Physician Services 00 1730883315 0 SOMAYAJI KHYATI 2023172 9999999 B 10 1730883315 0 4698 DEPT CAROL STREAM IL 601220021 20 1730883315 0 Physicians Anesthesia Services 20 1730883315 0 Physicians Fluoride varnish 20 1730883315 0 Physicians Healthy Kids Services 20 1730883315 0 Physicians Optical Supplies 20 1730883315 0 Physicians Physician Services 00 1730883570 0 ARNOLD DENICE 2023249 9999999 B 10 1730883570 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1730883570 0 Physicians Anesthesia Services 20 1730883570 0 Physicians Healthy Kids Services 20 1730883570 0 Physicians Optical Supplies 20 1730883570 0 Physicians Physician Services 00 1730883919 0 HUNG CHING ANGIE C 2023123 9999999 B 10 1730883919 0 PO BOX 3039 OAK BROOK IL 605223039 20 1730883919 0 Physicians Anesthesia Services 20 1730883919 0 Physicians Fluoride varnish 20 1730883919 0 Physicians Healthy Kids Services 20 1730883919 0 Physicians Optical Supplies 20 1730883919 0 Physicians Physician Services 00 1730886177 0 TOMA SHEENA 2023069 9999999 B 10 1730886177 0 PO BOX 775253 CHICAGO IL 606775253 20 1730886177 0 Nurse Practitioners Healthy Kids Services 20 1730886177 0 Nurse Practitioners Nurse Practitioners Services 20 1730886177 0 Nurse Practitioners Physician Services 00 1730887464 0 LOWE MEGHAN 2023278 9999999 B 10 1730887464 0 6308 8TH AVE KENOSHA WI 531435031 20 1730887464 0 Physician Assistant Only Fluoride varnish 20 1730887464 0 Physician Assistant Only Healthy Kids Services 20 1730887464 0 Physician Assistant Only Physician Services 00 1730888314 0 KATZ MORGAN 2023226 9999999 B 10 1730888314 0 3436 N KENNICOTT AVE STE 114 STE 114 ARLINGTON HEIGH IL 600047814 20 1730888314 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1730888710 0 STYRCZULA DOMINIKA K 2023283 9999999 B 10 1730888710 0 PO BOX 4176 HOUMA LA 703614176 20 1730888710 0 Nurse Practitioners Healthy Kids Services 20 1730888710 0 Nurse Practitioners Nurse Practitioners Services 20 1730888710 0 Nurse Practitioners Physician Services 00 1730889650 0 VU JENNIFER 2024207 9999999 B 10 1730889650 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1730889650 0 Physicians Anesthesia Services 20 1730889650 0 Physicians Fluoride varnish 20 1730889650 0 Physicians Healthy Kids Services 20 1730889650 0 Physicians Optical Supplies 20 1730889650 0 Physicians Physician Services 00 1730890898 0 AJIERE QUEEN T 2022360 9999999 B 10 1730890898 0 10209 W LINCOLN HWY FRANKFORT IL 604231279 20 1730890898 0 Nurse Practitioners Healthy Kids Services 20 1730890898 0 Nurse Practitioners Nurse Practitioners Services 20 1730890898 0 Nurse Practitioners Physician Services 00 1730893330 0 HARGIS-CANATA VICTORIA R 2023025 9999999 B 10 1730893330 0 1325 SYCAMORE RD DEKALB IL 601152483 20 1730893330 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1730898370 0 MOORE ARON 2024130 9999999 B 10 1730898370 0 7373 N LINCOLN AVE LINCOLNWOOD IL 607121715 20 1730898370 0 Clinical Social Worker Social work service 00 1730899949 0 KOVACS JULIA 2023003 9999999 B 10 1730899949 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1730899949 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1730908963 0 SCHWAB EMILY K 2024289 9999999 B 10 1730908963 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1730908963 0 Occupational Therapists Medical Supplies 20 1730908963 0 Occupational Therapists Medical equipment/prosthetic devices 20 1730908963 0 Occupational Therapists Occupational Therapy Services 00 1730914318 0 PORPORIS RAQUEL 2024338 9999999 B 10 1730914318 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1730914318 0 Nurse Practitioners Healthy Kids Services 20 1730914318 0 Nurse Practitioners Nurse Practitioners Services 20 1730914318 0 Nurse Practitioners Physician Services 00 1730916206 0 ARIF NORA Q 2025016 9999999 B 10 1730916206 0 5777 DEPT CAROL STREAM IL 601220021 20 1730916206 0 Nurse Practitioners Fluoride varnish 20 1730916206 0 Nurse Practitioners Healthy Kids Services 20 1730916206 0 Nurse Practitioners Nurse Practitioners Services 20 1730916206 0 Nurse Practitioners Physician Services 00 1730918533 0 PETERSEN GRACE 2025035 9999999 B 10 1730918533 0 723 BURGESS DR UTICA IL 613739560 20 1730918533 0 Speech Therapists Adaptive behavior support clinician services 20 1730918533 0 Speech Therapists Medical Supplies 20 1730918533 0 Speech Therapists Medical equipment/prosthetic devices 20 1730918533 0 Speech Therapists Speech Therapy/Pathology Services 00 1730918590 0 KARABULUT NEVZAT 2024231 9999999 B 10 1730918590 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1730918590 0 Physicians Anesthesia Services 20 1730918590 0 Physicians Healthy Kids Services 20 1730918590 0 Physicians Optical Supplies 20 1730918590 0 Physicians Physician Services 00 1730919325 0 FAHAD SYED M 2025051 9999999 B 10 1730919325 0 16101 WEBER RD CREST HILL IL 604038812 20 1730919325 0 Physical Therapists Medical Supplies 20 1730919325 0 Physical Therapists Medical equipment/prosthetic devices 20 1730919325 0 Physical Therapists Physical Therapy Services 00 1730920919 0 THOPE NIKHIL K 2024238 9999999 B 10 1730920919 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1730920919 0 Physicians Anesthesia Services 20 1730920919 0 Physicians Fluoride varnish 20 1730920919 0 Physicians Healthy Kids Services 20 1730920919 0 Physicians Optical Supplies 20 1730920919 0 Physicians Physician Services 00 1730921925 0 KILPATRICK NORAH 2024235 9999999 B 10 1730921925 0 5777 DEPT CAROL STREAM IL 601220021 20 1730921925 0 Nurse Practitioners Healthy Kids Services 20 1730921925 0 Nurse Practitioners Midwife Services 20 1730921925 0 Nurse Practitioners Nurse Practitioners Services 20 1730921925 0 Nurse Practitioners Physician Services 00 1730923566 0 MORGAN ASHLEY A 2024243 9999999 B 10 1730923566 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1730923566 0 Nurse Practitioners Healthy Kids Services 20 1730923566 0 Nurse Practitioners Nurse Practitioners Services 20 1730923566 0 Nurse Practitioners Physician Services 00 1730923665 0 KABUYE ARUTHUR 2024211 9999999 B 10 1730923665 0 448 WYLIE DR NORMAL IL 617615405 20 1730923665 0 Physicians Anesthesia Services 20 1730923665 0 Physicians Fluoride varnish 20 1730923665 0 Physicians Healthy Kids Services 20 1730923665 0 Physicians Optical Supplies 20 1730923665 0 Physicians Physician Services 00 1730926064 0 GANDHI ISHANDEEP S 2024194 9999999 B 10 1730926064 0 201 E MADISON ST STE 300 SPRINGFIELD IL 627025131 20 1730926064 0 Physicians Anesthesia Services 20 1730926064 0 Physicians Fluoride varnish 20 1730926064 0 Physicians Healthy Kids Services 20 1730926064 0 Physicians Optical Supplies 20 1730926064 0 Physicians Physician Services 00 1730926536 0 BOLLONE ALANA 2024345 9999999 B 10 1730926536 0 2100 MADISON AVE STE 301 GRANITE CITY IL 620404713 20 1730926536 0 Physician Assistant Only Fluoride varnish 20 1730926536 0 Physician Assistant Only Healthy Kids Services 20 1730926536 0 Physician Assistant Only Physician Services 00 1730928029 0 PIRAINO MEGAN K 2024211 9999999 B 10 1730928029 0 3241 S MICHIGAN AVE CHICAGO IL 606164201 20 1730928029 0 Optometrists Optical Supplies 20 1730928029 0 Optometrists Optometric Services 20 1730928029 0 Optometrists Physician Services 00 1730928417 0 THOMAS CAROLYN M 2024190 9999999 B 10 1730928417 0 PO BOX 17633 BELFAST ME 049154071 20 1730928417 0 Nurse Practitioners Healthy Kids Services 20 1730928417 0 Nurse Practitioners Nurse Practitioners Services 20 1730928417 0 Nurse Practitioners Physician Services 00 1730930728 0 PATEL BHUMI 2024192 9999999 B 10 1730930728 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1730930728 0 Physicians Anesthesia Services 20 1730930728 0 Physicians Fluoride varnish 20 1730930728 0 Physicians Healthy Kids Services 20 1730930728 0 Physicians Optical Supplies 20 1730930728 0 Physicians Physician Services 00 1730930876 0 MARTINEZ ANDREINA 2024290 9999999 B 10 1730930876 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1730930876 0 Nurse Practitioners Fluoride varnish 20 1730930876 0 Nurse Practitioners Healthy Kids Services 20 1730930876 0 Nurse Practitioners Nurse Practitioners Services 20 1730930876 0 Nurse Practitioners Physician Services 00 1730931056 0 SPIESS EMMA 2024187 9999999 B 10 1730931056 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1730931056 0 Physicians Anesthesia Services 20 1730931056 0 Physicians Healthy Kids Services 20 1730931056 0 Physicians Optical Supplies 20 1730931056 0 Physicians Physician Services 00 1730932005 0 WRIGHT GILLIAN 2024242 2028183 B 10 1730932005 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1730932005 0 Physicians Anesthesia Services 20 1730932005 0 Physicians Healthy Kids Services 20 1730932005 0 Physicians Optical Supplies 20 1730932005 0 Physicians Physician Services 00 1730933029 0 KARIMABADY KEON 2024224 9999999 B 10 1730933029 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1730933029 0 Physicians Anesthesia Services 20 1730933029 0 Physicians Fluoride varnish 20 1730933029 0 Physicians Healthy Kids Services 20 1730933029 0 Physicians Optical Supplies 20 1730933029 0 Physicians Physician Services 00 1730933292 0 VENTURA MOISES 2024282 9999999 B 10 1730933292 0 1044 N FRANCISCO AVE CHICAGO IL 606222743 20 1730933292 0 Other behavior health professional LCPC/LMFT services 20 1730933292 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1730933466 0 WALKER TIMOTHY 2024253 9999999 B 10 1730933466 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1730933466 0 Physicians Anesthesia Services 20 1730933466 0 Physicians Healthy Kids Services 20 1730933466 0 Physicians Optical Supplies 20 1730933466 0 Physicians Physician Services 00 1730934019 0 UZDAVINIS SUZANNE 2024176 9999999 B 10 1730934019 0 PO BOX 597315 CHICAGO IL 606597315 20 1730934019 0 Nurse Practitioners Fluoride varnish 20 1730934019 0 Nurse Practitioners Healthy Kids Services 20 1730934019 0 Nurse Practitioners Nurse Practitioners Services 20 1730934019 0 Nurse Practitioners Physician Services 00 1730934373 0 FERGUSON RILEY 2024209 9999999 B 10 1730934373 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1730934373 0 Physicians Anesthesia Services 20 1730934373 0 Physicians Healthy Kids Services 20 1730934373 0 Physicians Optical Supplies 20 1730934373 0 Physicians Physician Services 00 1730935875 0 RUSHING JIMMIE E 2024222 9999999 B 10 1730935875 0 837 N LOMBARD AVE OAK PARK IL 603021430 20 1730935875 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1730936477 0 MAJID NAWAL 2024205 9999999 B 10 1730936477 0 2211 N ELSTON AVE STE 301 CHICAGO IL 606149278 20 1730936477 0 Physicians Anesthesia Services 20 1730936477 0 Physicians Fluoride varnish 20 1730936477 0 Physicians Healthy Kids Services 20 1730936477 0 Physicians Optical Supplies 20 1730936477 0 Physicians Physician Services 00 1730937103 0 HINTON CHRISTA 1994060 9999999 B 10 1730937103 0 719 N MARION ST OAK PARK IL 603021530 20 1730937103 0 Occupational Therapists Medical Supplies 20 1730937103 0 Occupational Therapists Medical equipment/prosthetic devices 20 1730937103 0 Occupational Therapists Occupational Therapy Services 00 1730937731 0 PADILLA ADRIANA V 2024131 9999999 B 10 1730937731 0 2141 S TAN CT CHICAGO IL 606161998 20 1730937731 0 Clinical Social Worker Social work service 00 1730938325 0 JONGUE EDEM M 2024208 9999999 B 10 1730938325 0 3500 W PETERSON AVE STE 401 CHICAGO IL 606593307 20 1730938325 0 Optometrists Optical Supplies 20 1730938325 0 Optometrists Optometric Services 20 1730938325 0 Optometrists Physician Services 00 1730939448 0 STONE ANDRE 2024211 9999999 B 10 1730939448 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1730939448 0 Physicians Anesthesia Services 20 1730939448 0 Physicians Healthy Kids Services 20 1730939448 0 Physicians Optical Supplies 20 1730939448 0 Physicians Physician Services 00 1730941766 0 CIPRA ALEAH G 2024113 9999999 B 10 1730941766 0 1120 E MAIN ST ST CHARLES IL 601742287 20 1730941766 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1730948027 0 WESTRICK MIRANDA 2024183 9999999 B 10 1730948027 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1730948027 0 Physicians Anesthesia Services 20 1730948027 0 Physicians Fluoride varnish 20 1730948027 0 Physicians Healthy Kids Services 20 1730948027 0 Physicians Optical Supplies 20 1730948027 0 Physicians Physician Services 00 1730949272 0 GONZALEZ JULIAN 2024183 9999999 B 10 1730949272 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1730949272 0 Physicians Anesthesia Services 20 1730949272 0 Physicians Healthy Kids Services 20 1730949272 0 Physicians Optical Supplies 20 1730949272 0 Physicians Physician Services 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Nurse Practitioners Healthy Kids Services 20 1730951567 0 Nurse Practitioners Nurse Practitioners Services 20 1730951567 0 Nurse Practitioners Physician Services 00 1730952821 0 NICHOLSON RACHAEL 2023351 9999999 B 10 1730952821 0 PO BOX 1209 MARYLAND HEIGHT MO 630430209 20 1730952821 0 Nurse Practitioners Fluoride varnish 20 1730952821 0 Nurse Practitioners Healthy Kids Services 20 1730952821 0 Nurse Practitioners Nurse Practitioners Services 20 1730952821 0 Nurse Practitioners Physician Services 00 1730953761 0 MANLEY JONATHAN 2024303 9999999 B 10 1730953761 0 781 S MCHENRY AVE CRYSTAL LAKE IL 600147444 20 1730953761 0 Nurse Practitioners Fluoride varnish 20 1730953761 0 Nurse Practitioners Healthy Kids Services 20 1730953761 0 Nurse Practitioners Nurse Practitioners Services 20 1730953761 0 Nurse Practitioners Physician Services 00 1730955816 0 WILS BRITTANY 2023361 9999999 B 10 1730955816 0 101 MADISON ST STE 300 OAK PARK IL 603024210 20 1730955816 0 Nurse Practitioners Healthy Kids 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1740257245 0 Physicians Healthy Kids Services 20 1740257245 0 Physicians Optical Supplies 20 1740257245 0 Physicians Physician Services 00 1740257385 0 BAJWA TANVIR 1986047 9999999 B 10 1740257385 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1740257385 0 Physicians Anesthesia Services 20 1740257385 0 Physicians Fluoride varnish 20 1740257385 0 Physicians Healthy Kids Services 20 1740257385 0 Physicians Optical Supplies 20 1740257385 0 Physicians Physician Services 00 1740257419 0 CRNICH CHRISTOPHER 2005182 9999999 B 10 1740257419 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1740257419 0 Physicians Anesthesia Services 20 1740257419 0 Physicians Fluoride varnish 20 1740257419 0 Physicians Healthy Kids Services 20 1740257419 0 Physicians Optical Supplies 20 1740257419 0 Physicians Physician Services 00 1740257484 0 SLOM TREVOR 1999305 9999999 B 10 1740257484 0 880 W CENTRAL RD STE 8100 ARLINGTON HEIGH IL 600052391 20 1740257484 0 Physicians Anesthesia Services 20 1740257484 0 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HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1740490051 0 Physicians Anesthesia Services 20 1740490051 0 Physicians Fluoride varnish 20 1740490051 0 Physicians Healthy Kids Services 20 1740490051 0 Physicians Optical Supplies 20 1740490051 0 Physicians Physician Services 00 1740490697 0 ZENGA JESSICA A 2012183 9999999 B 10 1740490697 0 10000 W INNOVATION DR STE 300 MILWAUKEE WI 532264837 20 1740490697 0 Physicians Anesthesia Services 20 1740490697 0 Physicians Healthy Kids Services 20 1740490697 0 Physicians Optical Supplies 20 1740490697 0 Physicians Physician Services 00 1740490879 0 ROSEN DIANE 2012245 9999999 B 10 1740490879 0 300 WINDING WOODS DR STE 200 O FALLON MO 633665081 20 1740490879 0 Physicians Anesthesia Services 20 1740490879 0 Physicians Healthy Kids Services 20 1740490879 0 Physicians Optical Supplies 20 1740490879 0 Physicians Physician Services 00 1740491117 0 GOZA THERESA M 2018297 9999999 B 10 1740491117 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 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1740779156 0 Physicians Healthy Kids Services 20 1740779156 0 Physicians Optical Supplies 20 1740779156 0 Physicians Physician Services 00 1740781889 0 VALIENTE LISA A 2018067 9999999 B 10 1740781889 0 7373 N LINCOLN AVE LINCOLNWOOD IL 607121715 20 1740781889 0 Clinical Social Worker Social work service 00 1740784313 0 CHENG RENEE G 2018151 9999999 B 10 1740784313 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1740784313 0 Physicians Anesthesia Services 20 1740784313 0 Physicians Fluoride varnish 20 1740784313 0 Physicians Healthy Kids Services 20 1740784313 0 Physicians Optical Supplies 20 1740784313 0 Physicians Physician Services 00 1740784362 0 ELAHI SAFIYA 2018152 9999999 B 10 1740784362 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1740784362 0 Physicians Anesthesia Services 20 1740784362 0 Physicians Fluoride varnish 20 1740784362 0 Physicians Healthy Kids Services 20 1740784362 0 Physicians Optical Supplies 20 1740784362 0 Physicians Physician Services 00 1740784552 0 SALAZAR CHRISTINA A 2018159 9999999 B 10 1740784552 0 5777 DEPT CAROL STREAM IL 601220021 20 1740784552 0 Physicians Anesthesia Services 20 1740784552 0 Physicians Fluoride varnish 20 1740784552 0 Physicians Healthy Kids Services 20 1740784552 0 Physicians Optical Supplies 20 1740784552 0 Physicians Physician Services 00 1740784685 0 ALVI RABIA 2022242 9999999 B 10 1740784685 0 1395 NW 167TH ST MIAMI FL 331695710 20 1740784685 0 Physicians Anesthesia Services 20 1740784685 0 Physicians Fluoride varnish 20 1740784685 0 Physicians Healthy Kids Services 20 1740784685 0 Physicians Optical Supplies 20 1740784685 0 Physicians Physician Services 00 1740784933 0 GREENE JOSEPH P 2024003 9999999 B 10 1740784933 0 PO BOX 41220 PHOENIX AZ 850801220 20 1740784933 0 Physicians Anesthesia Services 20 1740784933 0 Physicians Healthy Kids Services 20 1740784933 0 Physicians Optical Supplies 20 1740784933 0 Physicians Physician Services 00 1740785005 0 LEAL CHANCHI MAYELA 2024110 9999999 B 10 1740785005 0 1 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Physicians Healthy Kids Services 20 1740809524 0 Physicians Optical Supplies 20 1740809524 0 Physicians Physician Services 00 1740811785 0 ANTIOR KATLYN R 2020051 9999999 B 10 1740811785 0 PO BOX 778912 CHICAGO IL 606778912 20 1740811785 0 Nurse Practitioners Fluoride varnish 20 1740811785 0 Nurse Practitioners Healthy Kids Services 20 1740811785 0 Nurse Practitioners Nurse Practitioners Services 20 1740811785 0 Nurse Practitioners Physician Services 00 1740812148 0 MARMEL MIRIAM 2021252 9999999 B 10 1740812148 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1740812148 0 Speech Therapists Medical Supplies 20 1740812148 0 Speech Therapists Medical equipment/prosthetic devices 20 1740812148 0 Speech Therapists Speech Therapy/Pathology Services 00 1740812197 0 KIM JOON HYUK 2024099 9999999 B 10 1740812197 0 2215 W SCHAUMBURG RD SCHAUMBURG IL 601943891 20 1740812197 0 Dentists Dental Services 20 1740812197 0 Dentists Physician Services 00 1740812502 0 PETERLIN JENNIFER J 2020174 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0 NOWONTNIK SHAWN LEON 2022052 9999999 B 10 1740947373 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1740947373 0 Clinical Social Worker Social work service 00 1740948090 0 BRAHMBHATT SHAIL Y 2021350 9999999 B 10 1740948090 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1740948090 0 Physical Therapists Medical Supplies 20 1740948090 0 Physical Therapists Medical equipment/prosthetic devices 20 1740948090 0 Physical Therapists Physical Therapy Services 00 1740948165 0 MORALES MIRANDA 2022129 9999999 B 10 1740948165 0 420 N RAYNOR AVE JOLIET IL 604356065 20 1740948165 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1740949734 0 UNGER RACHEL R 2024241 9999999 B 10 1740949734 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1740949734 0 Physician Assistant Only Family Planning Counseling 20 1740949734 0 Physician Assistant Only Fluoride varnish 20 1740949734 0 Physician Assistant Only Healthy Kids Services 20 1740949734 0 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Healthy Kids Services 20 1750065934 0 Physicians Optical Supplies 20 1750065934 0 Physicians Physician Services 00 1750066346 0 LIANG MIRANDA 2023195 9999999 B 10 1750066346 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1750066346 0 Physicians Anesthesia Services 20 1750066346 0 Physicians Healthy Kids Services 20 1750066346 0 Physicians Optical Supplies 20 1750066346 0 Physicians Physician Services 20 1750066346 0 Physicians Physicians Psychiatric Services 00 1750066643 0 HANSON TAYLOR N 2023191 9999999 B 10 1750066643 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1750066643 0 Physicians Anesthesia Services 20 1750066643 0 Physicians Fluoride varnish 20 1750066643 0 Physicians Healthy Kids Services 20 1750066643 0 Physicians Optical Supplies 20 1750066643 0 Physicians Physician Services 00 1750066742 0 DULIN MADELYN E 2023191 9999999 B 10 1750066742 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1750066742 0 Physicians Anesthesia Services 20 1750066742 0 Physicians Fluoride varnish 20 1750066742 0 Physicians Healthy Kids Services 20 1750066742 0 Physicians Optical Supplies 20 1750066742 0 Physicians Physician Services 00 1750066791 0 FARBMAN EMILY B 2023192 9999999 B 10 1750066791 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1750066791 0 Physicians Anesthesia Services 20 1750066791 0 Physicians Fluoride varnish 20 1750066791 0 Physicians Healthy Kids Services 20 1750066791 0 Physicians Optical Supplies 20 1750066791 0 Physicians Physician Services 00 1750066874 0 IKE IFEOMA 2023182 9999999 B 10 1750066874 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1750066874 0 Physicians Anesthesia Services 20 1750066874 0 Physicians Fluoride varnish 20 1750066874 0 Physicians Healthy Kids Services 20 1750066874 0 Physicians Optical Supplies 20 1750066874 0 Physicians Physician Services 00 1750068631 0 JAVEED SAAD 2023206 9999999 B 10 1750068631 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1750068631 0 Physicians Anesthesia Services 20 1750068631 0 Physicians Healthy Kids Services 20 1750068631 0 Physicians Optical Supplies 20 1750068631 0 Physicians Physician Services 00 1750069134 0 SARGENT STEVEN 2023234 9999999 B 10 1750069134 0 1850 W ROOSEVELT RD CHICAGO IL 606081200 20 1750069134 0 Optometrists Optical Supplies 20 1750069134 0 Optometrists Optometric Services 20 1750069134 0 Optometrists Physician Services 00 1750070082 0 SOMMER KATHRYN 2023235 9999999 B 10 1750070082 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1750070082 0 Physicians Anesthesia Services 20 1750070082 0 Physicians Fluoride varnish 20 1750070082 0 Physicians Healthy Kids Services 20 1750070082 0 Physicians Optical Supplies 20 1750070082 0 Physicians Physician Services 00 1750070777 0 ADELAKUN CATHERINE 2024325 9999999 B 10 1750070777 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1750070777 0 Nurse Practitioners Healthy Kids Services 20 1750070777 0 Nurse Practitioners Midwife Services 20 1750070777 0 Nurse Practitioners Nurse Practitioners Services 20 1750070777 0 Nurse Practitioners Physician Services 00 1750072039 0 THRO GABRIELLE F 2023188 9999999 B 10 1750072039 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1750072039 0 Physicians Anesthesia Services 20 1750072039 0 Physicians Healthy Kids Services 20 1750072039 0 Physicians Optical Supplies 20 1750072039 0 Physicians Physician Services 00 1750072435 0 PHEN CAMERON 2024240 9999999 B 10 1750072435 0 7732 SOLUTION CENTER CHICAGO IL 606777007 20 1750072435 0 Dentists Dental Services 20 1750072435 0 Dentists Physician Services 00 1750072534 0 WRIGHT LYNDEE 2025048 9999999 B 10 1750072534 0 5801 MOUNT PLEASANT LN BELLEVILLE IL 622233944 20 1750072534 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1750075792 0 SHETH ADIT 2024311 9999999 B 10 1750075792 0 3020 W MONTROSE AVE CHICAGO IL 606181312 20 1750075792 0 Dentists Dental Services 20 1750075792 0 Dentists Physician Services 00 1750075941 0 SIBLINI HIBA G 2023207 9999999 B 10 1750075941 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1750075941 0 Physicians Anesthesia Services 20 1750075941 0 Physicians Healthy Kids Services 20 1750075941 0 Physicians Optical Supplies 20 1750075941 0 Physicians Physician Services 00 1750076006 0 O'DONNELL KELSEY 2024331 9999999 B 10 1750076006 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1750076006 0 Speech Therapists Medical Supplies 20 1750076006 0 Speech Therapists Medical equipment/prosthetic devices 20 1750076006 0 Speech Therapists Speech Therapy/Pathology Services 00 1750076337 0 BRADY JOSHUA R 2023183 9999999 B 10 1750076337 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1750076337 0 Physicians Anesthesia Services 20 1750076337 0 Physicians Healthy Kids Services 20 1750076337 0 Physicians Optical Supplies 20 1750076337 0 Physicians Physician Services 00 1750076485 0 AKAT AYUK-NJE 2023150 9999999 B 10 1750076485 0 6033 N SHERIDAN RD STE N6 SUITE N6 CHICAGO IL 606603013 20 1750076485 0 Nurse Practitioners Healthy Kids Services 20 1750076485 0 Nurse Practitioners Nurse Practitioners Services 20 1750076485 0 Nurse Practitioners Physician Services 00 1750076964 0 BRANSON SYDNEY E 2024054 9999999 B 10 1750076964 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1750076964 0 Speech Therapists Medical Supplies 20 1750076964 0 Speech Therapists Medical equipment/prosthetic devices 20 1750076964 0 Speech Therapists Speech Therapy/Pathology Services 00 1750077962 0 KLOSTERMAN ABIGAIL 2023193 9999999 B 10 1750077962 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1750077962 0 Physicians Anesthesia Services 20 1750077962 0 Physicians Healthy Kids Services 20 1750077962 0 Physicians Optical Supplies 20 1750077962 0 Physicians Physician Services 00 1750078226 0 FAGBEMI OLADIPO 2023182 9999999 B 10 1750078226 0 1900 W POLK ST STE 220 CHICAGO IN 60612 20 1750078226 0 Physicians Anesthesia Services 20 1750078226 0 Physicians Fluoride varnish 20 1750078226 0 Physicians Healthy Kids Services 20 1750078226 0 Physicians Optical Supplies 20 1750078226 0 Physicians Physician Services 00 1750078770 0 DONNELLY KYLE J 2023340 9999999 B 10 1750078770 0 414 PLAZA DR STE 301 WESTMONT IL 605595508 20 1750078770 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1750079448 0 LUKIC NIKOLA 2023206 9999999 H 10 1750079448 0 1900 W POLK ST STE 220C CHICAGO IL 60612 20 1750079448 0 Physician Assistant Only Fluoride varnish 20 1750079448 0 Physician Assistant Only Healthy Kids Services 20 1750079448 0 Physician Assistant Only Physician Services 00 1750079596 0 WISCH ANN 2023191 9999999 B 10 1750079596 0 PO BOX 1033 YORKVILLE IL 605600896 20 1750079596 0 Nurse Practitioners Fluoride varnish 20 1750079596 0 Nurse Practitioners Healthy Kids Services 20 1750079596 0 Nurse Practitioners Nurse Practitioners Services 20 1750079596 0 Nurse Practitioners Physician Services 00 1750079703 0 SERAPHIN AMY 2023186 9999999 B 10 1750079703 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1750079703 0 Nurse Practitioners Fluoride varnish 20 1750079703 0 Nurse Practitioners Healthy Kids Services 20 1750079703 0 Nurse Practitioners Nurse Practitioners Services 20 1750079703 0 Nurse Practitioners Physician Services 00 1750079943 0 COOK AMBER A 2023121 9999999 B 10 1750079943 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1750079943 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1750082962 0 FITCH JARRED L 2023256 9999999 B 10 1750082962 0 4009 N BROADWAY ST CHICAGO IL 606132110 20 1750082962 0 Clinical Social Worker Social work service 00 1750083143 0 BEHBAHANI HUSHYAR 2023192 9999999 B 10 1750083143 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1750083143 0 Physicians Anesthesia Services 20 1750083143 0 Physicians Healthy Kids Services 20 1750083143 0 Physicians Optical Supplies 20 1750083143 0 Physicians Physician Services 20 1750083143 0 Physicians Physicians Psychiatric Services 00 1750083259 0 WILBUR ANDREW 2023157 9999999 B 10 1750083259 0 4698 DEPT CAROL STREAM IL 601220021 20 1750083259 0 Physicians Anesthesia Services 20 1750083259 0 Physicians Fluoride varnish 20 1750083259 0 Physicians Healthy Kids Services 20 1750083259 0 Physicians Optical Supplies 20 1750083259 0 Physicians Physician Services 00 1750083465 0 ROGERS LANERICA 2023201 9999999 B 10 1750083465 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1750083465 0 Physicians Anesthesia Services 20 1750083465 0 Physicians Fluoride varnish 20 1750083465 0 Physicians Healthy Kids Services 20 1750083465 0 Physicians Optical Supplies 20 1750083465 0 Physicians Physician Services 00 1750083747 0 HOJATI ASHKHAN 2023213 9999999 B 10 1750083747 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1750083747 0 Physicians Anesthesia Services 20 1750083747 0 Physicians Healthy Kids Services 20 1750083747 0 Physicians Optical Supplies 20 1750083747 0 Physicians Physician Services 00 1750084463 0 GALLINATI JAMIE L 2023180 9999999 B 10 1750084463 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1750084463 0 Nurse Practitioners Fluoride varnish 20 1750084463 0 Nurse Practitioners Healthy Kids Services 20 1750084463 0 Nurse Practitioners Nurse Practitioners Services 20 1750084463 0 Nurse Practitioners Physician Services 00 1750084588 0 MARCUS ALEXANDRA 2023153 9999999 B 10 1750084588 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1750084588 0 Nurse Practitioners Healthy Kids Services 20 1750084588 0 Nurse Practitioners Nurse Practitioners Services 20 1750084588 0 Nurse Practitioners Physician Services 00 1750084612 0 HARTMAN TIMOTHY 2023179 9999999 B 10 1750084612 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1750084612 0 Physicians Anesthesia Services 20 1750084612 0 Physicians Fluoride varnish 20 1750084612 0 Physicians Healthy Kids Services 20 1750084612 0 Physicians Optical Supplies 20 1750084612 0 Physicians Physician Services 00 1750084638 0 FRITZ KATHRYN QUINN 2023174 9999999 B 10 1750084638 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1750084638 0 Physicians Anesthesia Services 20 1750084638 0 Physicians Fluoride varnish 20 1750084638 0 Physicians Healthy Kids Services 20 1750084638 0 Physicians Optical Supplies 20 1750084638 0 Physicians Physician Services 00 1750084679 0 BENNION JESSICA 2023200 9999999 B 10 1750084679 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1750084679 0 Physicians Anesthesia Services 20 1750084679 0 Physicians Healthy Kids Services 20 1750084679 0 Physicians Optical Supplies 20 1750084679 0 Physicians Physician Services 00 1750084844 0 SIGALA LOZANO JUAN 2024004 9999999 B 10 1750084844 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1750084844 0 Physicians Anesthesia Services 20 1750084844 0 Physicians Healthy Kids Services 20 1750084844 0 Physicians Optical Supplies 20 1750084844 0 Physicians Physician Services 00 1750084893 0 ZARNOWSKI OSKAR A 2023176 9999999 B 10 1750084893 0 PO BOX 3039 OAK BROOK IL 605223039 20 1750084893 0 Physicians Anesthesia Services 20 1750084893 0 Physicians Fluoride varnish 20 1750084893 0 Physicians Healthy Kids Services 20 1750084893 0 Physicians Optical Supplies 20 1750084893 0 Physicians Physician Services 00 1750085346 0 LOPEZ DAVID 2023224 9999999 B 10 1750085346 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1750085346 0 Physicians Anesthesia Services 20 1750085346 0 Physicians Fluoride varnish 20 1750085346 0 Physicians Healthy Kids Services 20 1750085346 0 Physicians Optical Supplies 20 1750085346 0 Physicians Physician Services 00 1750085668 0 RIZVI SYED 2023224 2026181 B 10 1750085668 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1750085668 0 Physicians Anesthesia Services 20 1750085668 0 Physicians Fluoride varnish 20 1750085668 0 Physicians Healthy Kids Services 20 1750085668 0 Physicians Optical Supplies 20 1750085668 0 Physicians Physician Services 00 1750085684 0 KRZYWIEC ANNA A 2023220 9999999 B 10 1750085684 0 PO BOX 3039 OAK BROOK IL 605223039 20 1750085684 0 Physicians Anesthesia Services 20 1750085684 0 Physicians Healthy Kids Services 20 1750085684 0 Physicians Optical Supplies 20 1750085684 0 Physicians Physician Services 00 1750085692 0 XU ZHEYUAN 2023193 9999999 B 10 1750085692 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1750085692 0 Physicians Anesthesia Services 20 1750085692 0 Physicians Fluoride varnish 20 1750085692 0 Physicians Healthy Kids Services 20 1750085692 0 Physicians Optical Supplies 20 1750085692 0 Physicians Physician Services 00 1750086013 0 SAAD MUSTAFA 2023094 9999999 B 10 1750086013 0 2001 S CALIFORNIA AVE CHICAGO IL 606082486 20 1750086013 0 Dentists Dental Services 20 1750086013 0 Dentists Physician Services 00 1750086260 0 SAHN HENRY 2023159 9999999 B 10 1750086260 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1750086260 0 Physicians Anesthesia Services 20 1750086260 0 Physicians Fluoride varnish 20 1750086260 0 Physicians Healthy Kids Services 20 1750086260 0 Physicians Optical Supplies 20 1750086260 0 Physicians Physician Services 00 1750086922 0 GUPTA NEIL 2023286 9999999 B 10 1750086922 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1750086922 0 Physicians Anesthesia Services 20 1750086922 0 Physicians Fluoride varnish 20 1750086922 0 Physicians Healthy Kids Services 20 1750086922 0 Physicians Optical Supplies 20 1750086922 0 Physicians Physician Services 00 1750087565 0 ZAMMICHIELI MELISSA 2023037 9999999 B 10 1750087565 0 1301 W DEVON AVE CHICAGO IL 606601329 20 1750087565 0 Nurse Practitioners Fluoride varnish 20 1750087565 0 Nurse Practitioners Healthy Kids Services 20 1750087565 0 Nurse Practitioners Nurse Practitioners Services 20 1750087565 0 Nurse Practitioners Physician Services 00 1750089124 0 BROWNLEE LASHAWN 2024212 9999999 B 10 1750089124 0 1900 W POLK ST STE 220 CHICAGO IL 60612 20 1750089124 0 Nurse Practitioners Anesthesia Services 20 1750089124 0 Nurse Practitioners Nurse Practitioners Services 20 1750089124 0 Nurse Practitioners Physician Services 00 1750089736 0 KAHLE ELLIE 2024117 9999999 B 10 1750089736 0 835 S VAN BUREN ST GREEN BAY WI 543013526 20 1750089736 0 Physician Assistant Only Fluoride varnish 20 1750089736 0 Physician Assistant Only Healthy Kids Services 20 1750089736 0 Physician Assistant Only Physician Services 00 1750092318 0 VILLEGAS ORYANA 2023040 9999999 B 10 1750092318 0 501 7TH ST ROCKFORD IL 611041242 20 1750092318 0 Speech Therapists Medical Supplies 20 1750092318 0 Speech Therapists Medical equipment/prosthetic devices 20 1750092318 0 Speech Therapists Speech Therapy/Pathology Services 00 1750092649 0 DIXON WHINTER 2023044 9999999 B 10 1750092649 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1750092649 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1750093662 0 LEVI MICHAEL 2023107 9999999 B 10 1750093662 0 1541 MARKET ST DES PLAINES IL 600164608 20 1750093662 0 Dentists Dental Services 20 1750093662 0 Dentists Physician Services 00 1750097226 0 RAPP LAUREN 2023027 9999999 B 10 1750097226 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1750097226 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1750098257 0 JANG INJUNG 2022333 9999999 B 10 1750098257 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1750098257 0 Occupational Therapists Medical Supplies 20 1750098257 0 Occupational Therapists Medical equipment/prosthetic devices 20 1750098257 0 Occupational Therapists Occupational Therapy Services 00 1750100749 0 CLAUSIUS OLIVIA M 2024288 9999999 B 10 1750100749 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1750100749 0 Physician Assistant Only Fluoride varnish 20 1750100749 0 Physician Assistant Only Healthy Kids Services 20 1750100749 0 Physician Assistant Only Physician Services 00 1750106464 0 LITVAN JACQUELINE 2024325 9999999 B 10 1750106464 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1750106464 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1750108726 0 FEDDELER DANIELLE 2024318 9999999 B 10 1750108726 0 PO BOX 775342 CHICAGO IL 606775342 20 1750108726 0 Nurse Practitioners Healthy Kids Services 20 1750108726 0 Nurse Practitioners Nurse Practitioners Services 20 1750108726 0 Nurse Practitioners Physician Services 00 1750114310 0 LAYTON ELISABETH 2024236 9999999 B 10 1750114310 0 370 SUMMIT ST # 1 ELGIN IL 601203843 20 1750114310 0 Physician Assistant Only Fluoride varnish 20 1750114310 0 Physician Assistant Only Healthy Kids Services 20 1750114310 0 Physician Assistant Only Physician Services 00 1750114484 0 GIAMETTE MOLLY R 2024239 9999999 B 10 1750114484 0 348 S 4TH ST PEKIN IL 615544220 20 1750114484 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1750115341 0 HOT MELISA 2024304 9999999 B 10 1750115341 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1750115341 0 Physician Assistant Only Fluoride varnish 20 1750115341 0 Physician Assistant Only Healthy Kids Services 20 1750115341 0 Physician Assistant Only Physician Services 00 1750124111 0 GALLAGHER RYAN T 2024178 9999999 B 10 1750124111 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1750124111 0 Nurse Practitioners Healthy Kids Services 20 1750124111 0 Nurse Practitioners Nurse Practitioners Services 20 1750124111 0 Nurse Practitioners Physician Services 00 1750124269 0 LAZENBY KEVIN A 2024165 9999999 B 10 1750124269 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1750124269 0 Physicians Anesthesia Services 20 1750124269 0 Physicians Healthy Kids Services 20 1750124269 0 Physicians Optical Supplies 20 1750124269 0 Physicians Physician Services 00 1750124491 0 WHITE EMILY 2024191 9999999 B 10 1750124491 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1750124491 0 Physicians Anesthesia Services 20 1750124491 0 Physicians Healthy Kids Services 20 1750124491 0 Physicians Optical Supplies 20 1750124491 0 Physicians Physician Services 00 1750125860 0 GORMAN SHELBY 2024281 9999999 B 10 1750125860 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1750125860 0 Physician Assistant Only Fluoride varnish 20 1750125860 0 Physician Assistant Only Healthy Kids Services 20 1750125860 0 Physician Assistant Only Physician Services 00 1750125993 0 SINGAL ASHISH 2024211 9999999 B 10 1750125993 0 448 WYLIE DR NORMAL IL 617615405 20 1750125993 0 Physicians Anesthesia Services 20 1750125993 0 Physicians Fluoride varnish 20 1750125993 0 Physicians Healthy Kids Services 20 1750125993 0 Physicians Optical Supplies 20 1750125993 0 Physicians Physician Services 00 1750126009 0 PRUTCH JEROD 2024199 9999999 B 10 1750126009 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1750126009 0 Physicians Anesthesia Services 20 1750126009 0 Physicians Fluoride 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CHICAGO IL 606094234 20 1750364014 0 Dentists Dental Services 20 1750364014 0 Dentists Physician Services 00 1750364584 0 PATEL DILIP 2002158 9999999 B 10 1750364584 0 7531 LEMONT RD DARIEN IL 605614397 20 1750364584 0 Dentists Dental Services 20 1750364584 0 Dentists Physician Services 00 1750365490 0 KUT JOSEPH 1993152 9999999 B 10 1750365490 0 9855 W ROOSEVELT RD WESTCHESTER IL 601542758 20 1750365490 0 Physicians Anesthesia Services 20 1750365490 0 Physicians Healthy Kids Services 20 1750365490 0 Physicians Optical Supplies 20 1750365490 0 Physicians Physician Services 20 1750365490 0 Physicians Physicians Psychiatric Services 00 1750365680 0 DIEMER DONALD O 2016165 9999999 B 10 1750365680 0 PO BOX 277 DONGOLA IL 629260277 20 1750365680 0 Physician Assistant Only Family Planning Counseling 20 1750365680 0 Physician Assistant Only Fluoride varnish 20 1750365680 0 Physician Assistant Only Healthy Kids Services 20 1750365680 0 Physician Assistant Only Physician Services 00 1750365862 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FEEHANVILLE DR STE 450 MOUNT PROSPECT IL 600566023 20 1750491288 0 Podiatrists Podiatric Services 00 1750491940 0 MATSON JONATHAN 2002335 9999999 B 10 1750491940 0 PO BOX 857 FREEPORT IL 610320857 20 1750491940 0 Physicians Anesthesia Services 20 1750491940 0 Physicians Fluoride varnish 20 1750491940 0 Physicians Healthy Kids Services 20 1750491940 0 Physicians Optical Supplies 20 1750491940 0 Physicians Physician Services 00 1750492328 0 SOOD ROMIL 1993270 9999999 B 10 1750492328 0 8330 LINCOLN AVE SKOKIE IL 600772436 20 1750492328 0 Physical Therapists Medical Supplies 20 1750492328 0 Physical Therapists Medical equipment/prosthetic devices 20 1750492328 0 Physical Therapists Physical Therapy Services 00 1750492856 0 BLACKWELL CHARLES D 2001182 9999999 B 10 1750492856 0 5901 LINCOLN DR EDINA MN 554361611 20 1750492856 0 Physicians Anesthesia Services 20 1750492856 0 Physicians Fluoride varnish 20 1750492856 0 Physicians Healthy Kids Services 20 1750492856 0 Physicians Optical 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XELENIA 2017227 9999999 B 10 1750778973 0 2211 N ELSTON AVE STE 301 CHICAGO IL 606149278 20 1750778973 0 Physicians Anesthesia Services 20 1750778973 0 Physicians Fluoride varnish 20 1750778973 0 Physicians Healthy Kids Services 20 1750778973 0 Physicians Optical Supplies 20 1750778973 0 Physicians Physician Services 00 1750779377 0 CONRAD MICHELLE 2015055 9999999 B 10 1750779377 0 9611 165TH ST STE 16 ORLAND PARK IL 604675685 20 1750779377 0 Other behavior health professional LCPC/LMFT services 00 1750779856 0 SIMON ELLIOT M 2017243 9999999 B 10 1750779856 0 6308 8TH AVE KENOSHA WI 531435031 20 1750779856 0 Physician Assistant Only Fluoride varnish 20 1750779856 0 Physician Assistant Only Healthy Kids Services 20 1750779856 0 Physician Assistant Only Physician Services 00 1750780326 0 RHINEHART ASHLEY J 2014251 9999999 B 10 1750780326 0 PO BOX 909 LOUISVILLE KY 402010909 20 1750780326 0 Nurse Practitioners Fluoride varnish 20 1750780326 0 Nurse Practitioners Healthy Kids Services 20 1750780326 0 Nurse Practitioners Nurse Practitioners Services 20 1750780326 0 Nurse Practitioners Physician Services 00 1750781050 0 JOSEPH AMELIA 2018270 9999999 B 10 1750781050 0 5220 EAST AVE COUNTRYSIDE IL 605253133 20 1750781050 0 Clinical Social Worker Social work service 00 1750781506 0 MORROW DEREK N 2015240 9999999 B 10 1750781506 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1750781506 0 Physician Assistant Only Fluoride varnish 20 1750781506 0 Physician Assistant Only Healthy Kids Services 20 1750781506 0 Physician Assistant Only Physician Services 00 1750781993 0 WOODBURY RHONDA 2015252 9999999 B 10 1750781993 0 221 NE GLEN OAK AVE PEORIA IL 616360002 20 1750781993 0 Nurse Practitioners Fluoride varnish 20 1750781993 0 Nurse Practitioners Healthy Kids Services 20 1750781993 0 Nurse Practitioners Nurse Practitioners Services 20 1750781993 0 Nurse Practitioners Physician Services 00 1750782678 0 FINDLEY-SYKES ERIN 2023089 9999999 B 10 1750782678 0 8400 LOUISIANA ST MERRILLVILLE IN 464106385 20 1750782678 0 Other behavior health professional LCPC/LMFT services 00 1750786208 0 GEYE CHESTON T 2017088 9999999 B 10 1750786208 0 PO BOX 7411347 CHICAGO IL 606743347 20 1750786208 0 Nurse Practitioners Anesthesia Services 20 1750786208 0 Nurse Practitioners Nurse Practitioners Services 20 1750786208 0 Nurse Practitioners Physician Services 00 1750787909 0 THOMAS TEMPE H 2017338 9999999 B 10 1750787909 0 8701 MENARD AVE MORTON GROVE IL 600533052 20 1750787909 0 Speech Therapists Medical Supplies 20 1750787909 0 Speech Therapists Medical equipment/prosthetic devices 20 1750787909 0 Speech Therapists Speech Therapy/Pathology Services 00 1750789186 0 VANCE CALVIN 2015002 9999999 B 10 1750789186 0 10110 S BENSLEY AVE CHICAGO IL 606175349 20 1750789186 0 Optometrists Optical Supplies 20 1750789186 0 Optometrists Optometric Services 20 1750789186 0 Optometrists Physician Services 00 1750789756 0 LIMON NICOLE 2017003 9999999 B 10 1750789756 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1750789756 0 Nurse Practitioners Fluoride varnish 20 1750789756 0 Nurse Practitioners Healthy Kids Services 20 1750789756 0 Nurse Practitioners Nurse Practitioners Services 20 1750789756 0 Nurse Practitioners Physician Services 00 1750789798 0 DEFRANCESCHI ELINA RACHAEL 2024036 9999999 B 10 1750789798 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1750789798 0 Physician Assistant Only Fluoride varnish 20 1750789798 0 Physician Assistant Only Healthy Kids Services 20 1750789798 0 Physician Assistant Only Physician Services 00 1750792081 0 MCGRATH BRIDGET A 2017236 9999999 B 10 1750792081 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1750792081 0 Physician Assistant Only Fluoride varnish 20 1750792081 0 Physician Assistant Only Healthy Kids Services 20 1750792081 0 Physician Assistant Only Physician Services 00 1750792974 0 KIKAS NICOLE 2016049 9999999 B 10 1750792974 0 PO BOX 60352 SAINT LOUIS MO 631600352 20 1750792974 0 Physician Assistant Only Fluoride varnish 20 1750792974 0 Physician Assistant Only Healthy Kids Services 20 1750792974 0 Physician Assistant Only Physician Services 00 1750793253 0 BARFIELD ANDREW J 2023167 9999999 B 10 1750793253 0 PO BOX 3988 CARBONDALE IL 629023988 20 1750793253 0 Physicians Anesthesia Services 20 1750793253 0 Physicians Fluoride varnish 20 1750793253 0 Physicians Healthy Kids Services 20 1750793253 0 Physicians Optical Supplies 20 1750793253 0 Physicians Physician Services 00 1750793543 0 SULLIVAN KATHLEEN 2014227 9999999 B 10 1750793543 0 501 7TH ST ROCKFORD IL 611041242 20 1750793543 0 Speech Therapists Medical Supplies 20 1750793543 0 Speech Therapists Medical equipment/prosthetic devices 20 1750793543 0 Speech Therapists Speech Therapy/Pathology Services 00 1750794087 0 VORA ADITYA 2023319 9999999 B 10 1750794087 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1750794087 0 Physicians Anesthesia Services 20 1750794087 0 Physicians Healthy Kids Services 20 1750794087 0 Physicians Optical Supplies 20 1750794087 0 Physicians Physician Services 20 1750794087 0 Physicians Physicians Psychiatric Services 00 1750794137 0 SMYTH SARAH E 2018232 9999999 B 10 1750794137 0 5777 DEPT CAROL STREAM IL 601220021 20 1750794137 0 Nurse Practitioners Healthy Kids Services 20 1750794137 0 Nurse Practitioners Nurse Practitioners Services 20 1750794137 0 Nurse Practitioners Physician Services 00 1750794152 0 SALEM ABDELRAHMAN 2014162 9999999 B 10 1750794152 0 3332 N WESTERN AVE CHICAGO IL 606186213 20 1750794152 0 Dentists Dental Services 20 1750794152 0 Dentists Physician Services 00 1750794244 0 AHMED MOIZ 2024325 9999999 B 10 1750794244 0 PO BOX 781076 DETROIT MI 482781076 20 1750794244 0 Physicians Anesthesia Services 20 1750794244 0 Physicians Fluoride varnish 20 1750794244 0 Physicians Healthy Kids Services 20 1750794244 0 Physicians Optical Supplies 20 1750794244 0 Physicians Physician Services 00 1750794962 0 BEARDMORE DANIEL B 2018181 9999999 B 10 1750794962 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1750794962 0 Physicians Anesthesia Services 20 1750794962 0 Physicians Fluoride varnish 20 1750794962 0 Physicians Healthy Kids Services 20 1750794962 0 Physicians Optical Supplies 20 1750794962 0 Physicians Physician Services 00 1750795696 0 THAKKAR JIGISHA 2018268 9999999 B 10 1750795696 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1750795696 0 Physicians Anesthesia Services 20 1750795696 0 Physicians Healthy Kids Services 20 1750795696 0 Physicians Optical Supplies 20 1750795696 0 Physicians Physician Services 20 1750795696 0 Physicians Physicians Psychiatric Services 00 1750796132 0 LEE FRANKLIN I 2021346 9999999 B 10 1750796132 0 6024 RIDGE AVE STE 116-356 PHILADELPHIA PA 191281601 20 1750796132 0 Physicians Anesthesia Services 20 1750796132 0 Physicians Healthy Kids Services 20 1750796132 0 Physicians Optical Supplies 20 1750796132 0 Physicians Physician Services 00 1750796249 0 HARTMANN AMANDA C 2017005 9999999 B 10 1750796249 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1750796249 0 Nurse Practitioners Fluoride varnish 20 1750796249 0 Nurse Practitioners Healthy Kids Services 20 1750796249 0 Nurse Practitioners Nurse Practitioners Services 20 1750796249 0 Nurse Practitioners Physician Services 00 1750796603 0 MICHAEL ALEX 2017074 9999999 B 10 1750796603 0 621 S NEW BALLAS RD STE 7011B SAINT LOUIS MO 631418275 20 1750796603 0 Physicians Anesthesia Services 20 1750796603 0 Physicians Healthy Kids Services 20 1750796603 0 Physicians Optical Supplies 20 1750796603 0 Physicians Physician Services 00 1750796645 0 MIRZA NADEEM 2024284 2099365 B 10 1750796645 0 387 SHUMAN BLVD STE 240W NAPERVILLE IL 605638113 20 1750796645 0 Physicians Anesthesia Services 20 1750796645 0 Physicians Healthy Kids Services 20 1750796645 0 Physicians Optical Supplies 20 1750796645 0 Physicians Physician Services 00 1750796660 0 BENTLEY DAVID 2022308 9999999 B 10 1750796660 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1750796660 0 Podiatrists Podiatric Services 00 1750797262 0 DURRANI JIBRAN K 2021120 9999999 B 10 1750797262 0 PO BOX 781076 DETROIT MI 482781076 20 1750797262 0 Physicians Anesthesia Services 20 1750797262 0 Physicians Fluoride varnish 20 1750797262 0 Physicians Healthy Kids Services 20 1750797262 0 Physicians Optical Supplies 20 1750797262 0 Physicians Physician Services 00 1750798351 0 CHANG KENNETH 2021002 9999999 B 10 1750798351 0 PO BOX 301208 DALLAS TX 753031208 20 1750798351 0 Physicians Anesthesia Services 20 1750798351 0 Physicians Healthy Kids Services 20 1750798351 0 Physicians Optical Supplies 20 1750798351 0 Physicians Physician Services 00 1750798831 0 ANAYA ANA 2021042 9999999 H 10 1750798831 0 125 WINDSOR DR STE 111 OAK BROOK IL 605234081 20 1750798831 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1750798872 0 SMITH ELISA M 2017241 9999999 B 10 1750798872 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1750798872 0 Physicians Anesthesia Services 20 1750798872 0 Physicians Healthy Kids Services 20 1750798872 0 Physicians Optical Supplies 20 1750798872 0 Physicians Physician Services 00 1750799870 0 GLASS EMILY 2024019 9999999 B 10 1750799870 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1750799870 0 Physician Assistant Only Fluoride varnish 20 1750799870 0 Physician Assistant Only Healthy Kids Services 20 1750799870 0 Physician Assistant Only Physician Services 00 1750799920 0 EDWARD BRITTANY A 2016041 9999999 B 10 1750799920 0 PO BOX 684 BEDFORD PARK IL 604990684 20 1750799920 0 Nurse Practitioners Fluoride varnish 20 1750799920 0 Nurse Practitioners Healthy Kids Services 20 1750799920 0 Nurse Practitioners Nurse Practitioners Services 20 1750799920 0 Nurse Practitioners Physician Services 00 1750800462 0 SCHROEDER JENNIFER 2017311 9999999 B 10 1750800462 0 1919 CATON FARM RD CREST HILL IL 604031700 20 1750800462 0 Speech Therapists Medical Supplies 20 1750800462 0 Speech Therapists Medical equipment/prosthetic devices 20 1750800462 0 Speech Therapists Speech Therapy/Pathology Services 00 1750800496 0 NGUYEN MOIRA M 2018143 9999999 B 10 1750800496 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1750800496 0 Nurse Practitioners Fluoride varnish 20 1750800496 0 Nurse Practitioners Healthy Kids Services 20 1750800496 0 Nurse Practitioners Nurse Practitioners Services 20 1750800496 0 Nurse Practitioners Physician Services 00 1750800769 0 EBACH LAURA 2022074 9999999 B 10 1750800769 0 1113 S MILWAUKEE AVE STE 104 LIBERTYVILLE IL 600483759 20 1750800769 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1750800819 0 MASCOTE ELIZABETH 2017304 9999999 B 10 1750800819 0 1008 N HENA ST GREENVILLE IL 622461378 20 1750800819 0 Speech Therapists Medical Supplies 20 1750800819 0 Speech Therapists Medical equipment/prosthetic devices 20 1750800819 0 Speech Therapists Speech Therapy/Pathology Services 00 1750800868 0 BUDNEY CRYSTAL M 2017254 9999999 B 10 1750800868 0 350 W 154TH ST SOUTH HOLLAND IL 604731229 20 1750800868 0 Speech Therapists Medical Supplies 20 1750800868 0 Speech Therapists Medical equipment/prosthetic devices 20 1750800868 0 Speech Therapists Speech Therapy/Pathology Services 00 1750800884 0 REPPAS CHRISTOS 2017282 9999999 B 10 1750800884 0 6308 8TH AVE KENOSHA WI 531435031 20 1750800884 0 Physician Assistant Only Fluoride varnish 20 1750800884 0 Physician Assistant Only Healthy Kids Services 20 1750800884 0 Physician Assistant Only Physician Services 00 1750801619 0 LANKA HEMATHEJA 2020258 9999999 B 10 1750801619 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1750801619 0 Physicians Anesthesia Services 20 1750801619 0 Physicians Fluoride varnish 20 1750801619 0 Physicians Healthy Kids Services 20 1750801619 0 Physicians Optical Supplies 20 1750801619 0 Physicians Physician Services 00 1750801692 0 KURCZ BRIAN P 2017249 9999999 B 10 1750801692 0 PO BOX 28900 GREEN BAY WI 543240900 20 1750801692 0 Physicians Anesthesia Services 20 1750801692 0 Physicians Healthy Kids Services 20 1750801692 0 Physicians Optical Supplies 20 1750801692 0 Physicians Physician Services 00 1750801833 0 WOLF BETHANY 2017354 9999999 B 10 1750801833 0 4230 11TH ST ROCK ISLAND IL 612016746 20 1750801833 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1750802237 0 RAMANI NIRALI BABUBHAI 2017177 9999999 B 10 1750802237 0 3401 CONIFER DR SPRINGFIELD IL 627118300 20 1750802237 0 Physicians Anesthesia Services 20 1750802237 0 Physicians Fluoride varnish 20 1750802237 0 Physicians Healthy Kids Services 20 1750802237 0 Physicians Optical Supplies 20 1750802237 0 Physicians Physician Services 00 1750802674 0 WILSON SARAH M 2017240 9999999 B 10 1750802674 0 124 SW ADAMS ST FL 2 PEORIA IL 616021308 20 1750802674 0 Nurse Practitioners Fluoride varnish 20 1750802674 0 Nurse Practitioners Healthy Kids Services 20 1750802674 0 Nurse Practitioners Nurse Practitioners Services 20 1750802674 0 Nurse Practitioners Physician Services 00 1750802849 0 MUKHTAR UMER 2017191 9999999 B 10 1750802849 0 2315 ENTERPRISE DR STE 110 SUITE 110 WESTCHESTER IL 601545809 20 1750802849 0 Physicians Anesthesia Services 20 1750802849 0 Physicians Fluoride varnish 20 1750802849 0 Physicians Healthy Kids Services 20 1750802849 0 Physicians Optical Supplies 20 1750802849 0 Physicians Physician Services 00 1750803474 0 PETERSON MATTHEW D 2017251 9999999 B 10 1750803474 0 PO BOX 80269 PHILADELPHIA PA 191011269 20 1750803474 0 Physician Assistant Only Fluoride varnish 20 1750803474 0 Physician Assistant Only Healthy Kids Services 20 1750803474 0 Physician Assistant Only Physician Services 00 1750803490 0 CADAYONA JOSEPH 2017198 9999999 B 10 1750803490 0 PO BOX 713388 CHICAGO IL 606771525 20 1750803490 0 Nurse Practitioners Fluoride varnish 20 1750803490 0 Nurse Practitioners Healthy Kids Services 20 1750803490 0 Nurse Practitioners Nurse Practitioners Services 20 1750803490 0 Nurse Practitioners Physician Services 00 1750804043 0 PATEL HETAL 2023199 9999999 B 10 1750804043 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1750804043 0 Speech Therapists Medical Supplies 20 1750804043 0 Speech Therapists Medical equipment/prosthetic devices 20 1750804043 0 Speech Therapists Speech Therapy/Pathology Services 00 1750804167 0 KREKLOW YOLANTA 2018025 9999999 B 10 1750804167 0 5730 W ROOSEVELT RD BUSINESS OFFICE CHICAGO IL 606441580 20 1750804167 0 Nurse Practitioners Healthy Kids Services 20 1750804167 0 Nurse Practitioners Nurse Practitioners Services 20 1750804167 0 Nurse Practitioners Physician Services 00 1750805206 0 KABIR LAMA ALGHANEM 2017355 9999999 B 10 1750805206 0 11 W DOWNER PL AURORA IL 605065134 20 1750805206 0 Dentists Dental Services 20 1750805206 0 Dentists Physician Services 00 1750806923 0 MURPHY SHEEBA 2017235 9999999 B 10 1750806923 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1750806923 0 Nurse Practitioners Fluoride varnish 20 1750806923 0 Nurse Practitioners Healthy Kids Services 20 1750806923 0 Nurse Practitioners Nurse Practitioners Services 20 1750806923 0 Nurse Practitioners Physician Services 00 1750807848 0 MILLER LORI E 2017241 9999999 B 10 1750807848 0 1854 E BROADWAY ALTON IL 620026664 20 1750807848 0 Speech Therapists Medical Supplies 20 1750807848 0 Speech Therapists Medical equipment/prosthetic devices 20 1750807848 0 Speech Therapists Speech Therapy/Pathology Services 00 1750808127 0 SCOTT LINDSEY M 2018128 9999999 B 10 1750808127 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1750808127 0 Physician Assistant Only Fluoride varnish 20 1750808127 0 Physician Assistant Only Healthy Kids Services 20 1750808127 0 Physician Assistant Only Physician Services 00 1750808382 0 MARCUS STEPHANIE 2018239 9999999 B 10 1750808382 0 2374 SHERMER RD NORTHBROOK IL 600626729 20 1750808382 0 Speech Therapists Medical Supplies 20 1750808382 0 Speech Therapists Medical equipment/prosthetic devices 20 1750808382 0 Speech Therapists Speech Therapy/Pathology Services 00 1750808838 0 BECKER KAMI 2017250 9999999 B 10 1750808838 0 PO BOX 239 TISKILWA IL 613680239 20 1750808838 0 Speech Therapists Medical Supplies 20 1750808838 0 Speech Therapists Medical equipment/prosthetic devices 20 1750808838 0 Speech Therapists Speech Therapy/Pathology Services 00 1750808887 0 O''NEILL THARP KRISTI 2017240 9999999 B 10 1750808887 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1750808887 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1750808960 0 GAO HELEN X 2021236 9999999 B 10 1750808960 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1750808960 0 Physicians Anesthesia Services 20 1750808960 0 Physicians Healthy Kids Services 20 1750808960 0 Physicians Optical Supplies 20 1750808960 0 Physicians Physician Services 00 1750809224 0 KNOTTS MARK 2017274 9999999 B 10 1750809224 0 1011 BOWLES AVE STE 220 FENTON MO 630262384 20 1750809224 0 Nurse Practitioners Healthy Kids Services 20 1750809224 0 Nurse Practitioners Nurse Practitioners Services 20 1750809224 0 Nurse Practitioners Physician Services 00 1750809711 0 LICHTY CARRIN E 2017243 9999999 B 10 1750809711 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1750809711 0 Occupational Therapists Medical Supplies 20 1750809711 0 Occupational Therapists Medical equipment/prosthetic devices 20 1750809711 0 Occupational Therapists Occupational Therapy Services 00 1750809794 0 REGGANIE BERNADETTE 2017274 9999999 B 10 1750809794 0 12251 S 80TH AVE STE 1630 PALOS HEIGHTS IL 604631256 20 1750809794 0 Clinical Social Worker Social work service 00 1750810883 0 SAHRAOUI NOUR EL-HOUDA 2018353 9999999 B 10 1750810883 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1750810883 0 Physicians Anesthesia Services 20 1750810883 0 Physicians Fluoride varnish 20 1750810883 0 Physicians Healthy Kids Services 20 1750810883 0 Physicians Optical Supplies 20 1750810883 0 Physicians Physician Services 00 1750811683 0 CARBAJAL SOTELO GABRIELA 2017170 9999999 B 10 1750811683 0 1507 E 53RD ST CHICAGO IL 606154573 20 1750811683 0 Speech Therapists Medical Supplies 20 1750811683 0 Speech Therapists Medical equipment/prosthetic devices 20 1750811683 0 Speech Therapists Speech Therapy/Pathology Services 00 1750812145 0 TOBIN JAMES ROBERT 2017163 9999999 B 10 1750812145 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1750812145 0 Physicians Anesthesia Services 20 1750812145 0 Physicians Fluoride varnish 20 1750812145 0 Physicians Healthy Kids Services 20 1750812145 0 Physicians Optical Supplies 20 1750812145 0 Physicians Physician Services 00 1750812285 0 BUNTEN ELIZABETH J 2020061 9999999 B 10 1750812285 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1750812285 0 Physicians Anesthesia Services 20 1750812285 0 Physicians Healthy Kids Services 20 1750812285 0 Physicians Optical Supplies 20 1750812285 0 Physicians Physician Services 00 1750812798 0 SANOFSKY BENJAMIN 2022217 9999999 B 10 1750812798 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1750812798 0 Physicians Anesthesia Services 20 1750812798 0 Physicians Healthy Kids Services 20 1750812798 0 Physicians Optical Supplies 20 1750812798 0 Physicians Physician Services 00 1750812822 0 MORREALE CHAD V 2020042 9999999 B 10 1750812822 0 PO BOX 3039 OAK BROOK IL 605223039 20 1750812822 0 Physicians Anesthesia Services 20 1750812822 0 Physicians Fluoride varnish 20 1750812822 0 Physicians Healthy Kids Services 20 1750812822 0 Physicians Optical Supplies 20 1750812822 0 Physicians Physician Services 00 1750812905 0 CAVANAUGH MARY 2018345 9999999 B 10 1750812905 0 2001 S CALIFORNIA AVE STE 100 CHICAGO IL 606082486 20 1750812905 0 Physicians Anesthesia Services 20 1750812905 0 Physicians Fluoride varnish 20 1750812905 0 Physicians Healthy Kids Services 20 1750812905 0 Physicians Optical Supplies 20 1750812905 0 Physicians Physician Services 00 1750813184 0 AUSTENFELD EMMA 2023114 9999999 B 10 1750813184 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1750813184 0 Physicians Anesthesia Services 20 1750813184 0 Physicians Fluoride varnish 20 1750813184 0 Physicians Healthy Kids Services 20 1750813184 0 Physicians Optical Supplies 20 1750813184 0 Physicians Physician Services 00 1750813432 0 WADOOD ZARA 2022144 9999999 B 10 1750813432 0 5777 DEPT CAROL STREAM IL 601220021 20 1750813432 0 Physicians Anesthesia Services 20 1750813432 0 Physicians Healthy Kids Services 20 1750813432 0 Physicians Optical Supplies 20 1750813432 0 Physicians Physician Services 00 1750813580 0 KANADY INGRID C 2017104 9999999 B 10 1750813580 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1750813580 0 Nurse Practitioners Healthy Kids Services 20 1750813580 0 Nurse Practitioners Nurse Practitioners Services 20 1750813580 0 Nurse Practitioners Physician Services 00 1750813739 0 MULWA EGGERS CATHERINE NDANU 2017166 9999999 B 10 1750813739 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1750813739 0 Physicians Anesthesia Services 20 1750813739 0 Physicians Healthy Kids Services 20 1750813739 0 Physicians Optical Supplies 20 1750813739 0 Physicians Physician Services 00 1750813960 0 ROY AMIT 2018355 9999999 B 10 1750813960 0 11475 OLDE CABIN RD STE 200 SAINT LOUIS MO 631417129 20 1750813960 0 Physicians Anesthesia Services 20 1750813960 0 Physicians Healthy Kids Services 20 1750813960 0 Physicians Optical Supplies 20 1750813960 0 Physicians Physician Services 00 1750814158 0 KROPF CHARLES W 2021364 9999999 B 10 1750814158 0 700 KMS PL ANN ARBOR MI 481081652 20 1750814158 0 Physicians Anesthesia Services 20 1750814158 0 Physicians Healthy Kids Services 20 1750814158 0 Physicians Optical Supplies 20 1750814158 0 Physicians Physician Services 00 1750814299 0 YATES ELIZABETH 2024217 9999999 B 10 1750814299 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1750814299 0 Physicians Anesthesia Services 20 1750814299 0 Physicians Healthy Kids Services 20 1750814299 0 Physicians Optical Supplies 20 1750814299 0 Physicians Physician Services 00 1750814869 0 SMITH ANTONIO 2020234 9999999 B 10 1750814869 0 PO BOX 708760 SANDY UT 840708760 20 1750814869 0 Physicians Anesthesia Services 20 1750814869 0 Physicians Fluoride varnish 20 1750814869 0 Physicians Healthy Kids Services 20 1750814869 0 Physicians Optical Supplies 20 1750814869 0 Physicians Physician Services 00 1750815221 0 DIROFF LAUREN 2023202 9999999 B 10 1750815221 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1750815221 0 Physicians Anesthesia Services 20 1750815221 0 Physicians Healthy Kids Services 20 1750815221 0 Physicians Optical Supplies 20 1750815221 0 Physicians Physician Services 00 1750815924 0 MANIKAS ANN R 2017349 9999999 B 10 1750815924 0 5777 DEPT CAROL STREAM IL 601220021 20 1750815924 0 Physician Assistant Only Fluoride varnish 20 1750815924 0 Physician Assistant Only Healthy Kids Services 20 1750815924 0 Physician Assistant Only Physician Services 00 1750815981 0 SUTHAR CINDY 2017125 9999999 B 10 1750815981 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1750815981 0 Nurse Practitioners Fluoride varnish 20 1750815981 0 Nurse Practitioners Healthy Kids Services 20 1750815981 0 Nurse Practitioners Nurse Practitioners Services 20 1750815981 0 Nurse Practitioners Physician Services 00 1750816146 0 BESST RAY 2021211 9999999 B 10 1750816146 0 101 E STATE ST KENNETT SQUARE PA 193483109 20 1750816146 0 Physical Therapists Medical Supplies 20 1750816146 0 Physical Therapists Medical equipment/prosthetic devices 20 1750816146 0 Physical Therapists Physical Therapy Services 00 1750817359 0 BALDWIN DUANE 2017324 9999999 B 10 1750817359 0 1276 N CLYBOURN AVE CHICAGO IL 606102089 20 1750817359 0 Other behavior health professional LCPC/LMFT services 00 1750817474 0 PARKINS GREGORY S 2022009 9999999 B 10 1750817474 0 1340 HAL GREER BLVD HUNTINGTON WV 257013800 20 1750817474 0 Physicians Anesthesia Services 20 1750817474 0 Physicians Fluoride varnish 20 1750817474 0 Physicians Healthy Kids Services 20 1750817474 0 Physicians Optical Supplies 20 1750817474 0 Physicians Physician Services 00 1750818522 0 EYERS KAYCEE 2017208 9999999 B 10 1750818522 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1750818522 0 Nurse Practitioners Fluoride varnish 20 1750818522 0 Nurse Practitioners Healthy Kids Services 20 1750818522 0 Nurse Practitioners Nurse Practitioners Services 20 1750818522 0 Nurse Practitioners Physician Services 00 1750818555 0 IJAZ AMBER 2020009 9999999 B 10 1750818555 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1750818555 0 Physicians Anesthesia Services 20 1750818555 0 Physicians Fluoride varnish 20 1750818555 0 Physicians Healthy Kids Services 20 1750818555 0 Physicians Optical Supplies 20 1750818555 0 Physicians Physician Services 00 1750818563 0 FIGLEWICZ ADAM P 2018166 9999999 B 10 1750818563 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1750818563 0 Other 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Physicians Optical Supplies 20 1750874749 0 Physicians Physician Services 00 1750875167 0 GUHA ARITRA 2021169 9999999 B 10 1750875167 0 PO BOX 708760 SANDY UT 840708760 20 1750875167 0 Physicians Anesthesia Services 20 1750875167 0 Physicians Fluoride varnish 20 1750875167 0 Physicians Healthy Kids Services 20 1750875167 0 Physicians Optical Supplies 20 1750875167 0 Physicians Physician Services 00 1750875340 0 GOWAN NICOLE M 2018172 9999999 B 10 1750875340 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1750875340 0 Nurse Practitioners Fluoride varnish 20 1750875340 0 Nurse Practitioners Healthy Kids Services 20 1750875340 0 Nurse Practitioners Nurse Practitioners Services 20 1750875340 0 Nurse Practitioners Physician Services 00 1750876306 0 FREDMAN ELI 2018345 9999999 B 10 1750876306 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1750876306 0 Physicians Anesthesia Services 20 1750876306 0 Physicians Fluoride varnish 20 1750876306 0 Physicians Healthy Kids Services 20 1750876306 0 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1836 VICTORIA LN CHARLESTON IL 619202964 20 1750886719 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1750886750 0 MASSEY SABRINA 2018071 9999999 B 10 1750886750 0 10001 GRAND AVE ATTN: BILLING DEPARTMENT FRANKLIN PARK IL 601312563 20 1750886750 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1750887097 0 SHAW JOSEPH 2020236 9999999 B 10 1750887097 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1750887097 0 Physicians Anesthesia Services 20 1750887097 0 Physicians Fluoride varnish 20 1750887097 0 Physicians Healthy Kids Services 20 1750887097 0 Physicians Optical Supplies 20 1750887097 0 Physicians Physician Services 00 1750887592 0 ABDALHADI HANEEN 2024267 9999999 B 10 1750887592 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1750887592 0 Physicians Anesthesia Services 20 1750887592 0 Physicians Fluoride varnish 20 1750887592 0 Physicians Healthy Kids 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Psychologist Psychologist service 00 1750894747 0 ARIAS ANDREA 2020281 9999999 B 10 1750894747 0 2201 MAIN ST EVANSTON IL 602021519 20 1750894747 0 Nurse Practitioners Fluoride varnish 20 1750894747 0 Nurse Practitioners Healthy Kids Services 20 1750894747 0 Nurse Practitioners Nurse Practitioners Services 20 1750894747 0 Nurse Practitioners Physician Services 00 1750894952 0 TOMAN MATTHEW 2020164 9999999 B 10 1750894952 0 PO BOX 4535 OAK BROOK IL 605224535 20 1750894952 0 Nurse Practitioners Fluoride varnish 20 1750894952 0 Nurse Practitioners Healthy Kids Services 20 1750894952 0 Nurse Practitioners Nurse Practitioners Services 20 1750894952 0 Nurse Practitioners Physician Services 00 1750894994 0 VANETTEN-KAHL CATHERINE M 2020226 9999999 B 10 1750894994 0 15732 S HOWARD ST PLAINFIELD IL 605442399 20 1750894994 0 Speech Therapists Medical Supplies 20 1750894994 0 Speech Therapists Medical equipment/prosthetic devices 20 1750894994 0 Speech Therapists Speech Therapy/Pathology Services 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Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1750896452 0 JOHN ABBIE 2020083 9999999 B 10 1750896452 0 1416 MAINE ST QUINCY IL 623014261 20 1750896452 0 Psychologist Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1750896452 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1750896874 0 STONE CHERIE 2017354 9999999 B 10 1750896874 0 524 E SCHAUMBURG RD SCHAUMBURG IL 601943510 20 1750896874 0 Speech Therapists Medical Supplies 20 1750896874 0 Speech Therapists Medical equipment/prosthetic devices 20 1750896874 0 Speech Therapists Speech Therapy/Pathology Services 00 1750897468 0 WOOD SHERRY L 2019249 9999999 B 10 1750897468 0 1802 CEDAR ST LAWRENCEVILLE IL 624392157 20 1750897468 0 Speech Therapists Medical Supplies 20 1750897468 0 Speech Therapists Medical equipment/prosthetic devices 20 1750897468 0 Speech Therapists Speech 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1750944625 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1750944625 0 Physicians Anesthesia Services 20 1750944625 0 Physicians Fluoride varnish 20 1750944625 0 Physicians Healthy Kids Services 20 1750944625 0 Physicians Optical Supplies 20 1750944625 0 Physicians Physician Services 00 1750944773 0 MESSERLY TERRELL 2024214 9999999 B 10 1750944773 0 515 22ND AVE MONROE WI 535661569 20 1750944773 0 Physicians Anesthesia Services 20 1750944773 0 Physicians Fluoride varnish 20 1750944773 0 Physicians Healthy Kids Services 20 1750944773 0 Physicians Optical Supplies 20 1750944773 0 Physicians Physician Services 00 1750944831 0 VENKAT DIVYA 2022234 9999999 B 10 1750944831 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1750944831 0 Physicians Anesthesia Services 20 1750944831 0 Physicians Fluoride varnish 20 1750944831 0 Physicians Healthy Kids Services 20 1750944831 0 Physicians Optical Supplies 20 1750944831 0 Physicians Physician Services 00 1750944930 0 HYBARGER ANDREW 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Practitioners Nurse Practitioners Services 20 1760041941 0 Nurse Practitioners Physician Services 00 1760042352 0 SANDGREN JEREMY 2022190 9999999 B 10 1760042352 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1760042352 0 Physicians Anesthesia Services 20 1760042352 0 Physicians Fluoride varnish 20 1760042352 0 Physicians Healthy Kids Services 20 1760042352 0 Physicians Optical Supplies 20 1760042352 0 Physicians Physician Services 00 1760043178 0 SCANLON ALYSSA N 2019190 9999999 B 10 1760043178 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1760043178 0 Physician Assistant Only Fluoride varnish 20 1760043178 0 Physician Assistant Only Healthy Kids Services 20 1760043178 0 Physician Assistant Only Physician Services 00 1760043566 0 MILLER ALEXANDRA M 2019200 9999999 B 10 1760043566 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1760043566 0 Physician Assistant Only Fluoride varnish 20 1760043566 0 Physician Assistant Only Healthy Kids Services 20 1760043566 0 Physician Assistant 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925810486 20 1760411599 0 Physicians Anesthesia Services 20 1760411599 0 Physicians Fluoride varnish 20 1760411599 0 Physicians Healthy Kids Services 20 1760411599 0 Physicians Optical Supplies 20 1760411599 0 Physicians Physician Services 00 1760412407 0 PERRIN JANE 1996275 9999999 B 10 1760412407 0 600 W FULTON ST STE 200 CHICAGO IL 606611262 20 1760412407 0 Physicians Anesthesia Services 20 1760412407 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1760412407 0 Physicians Fluoride varnish 20 1760412407 0 Physicians Healthy Kids Services 20 1760412407 0 Physicians Optical Supplies 20 1760412407 0 Physicians Physician Services 00 1760412563 0 WASSE HAIMANOT 2014311 9999999 B 10 1760412563 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1760412563 0 Physicians Anesthesia Services 20 1760412563 0 Physicians Fluoride varnish 20 1760412563 0 Physicians Healthy Kids Services 20 1760412563 0 Physicians Optical Supplies 20 1760412563 0 Physicians 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9999999 B 10 1760821490 0 328 LINDEN AVE WILMETTE IL 600912895 20 1760821490 0 Physicians Anesthesia Services 20 1760821490 0 Physicians Healthy Kids Services 20 1760821490 0 Physicians Optical Supplies 20 1760821490 0 Physicians Physician Services 00 1760821698 0 CLOKE TIA 2013189 9999999 B 10 1760821698 0 400 N 17TH ST KEOKUK IA 526323452 20 1760821698 0 Nurse Practitioners Fluoride varnish 20 1760821698 0 Nurse Practitioners Healthy Kids Services 20 1760821698 0 Nurse Practitioners Nurse Practitioners Services 20 1760821698 0 Nurse Practitioners Physician Services 00 1760821946 0 STREET BRANDI E 2020114 9999999 B 10 1760821946 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1760821946 0 Physicians Anesthesia Services 20 1760821946 0 Physicians Fluoride varnish 20 1760821946 0 Physicians Healthy Kids Services 20 1760821946 0 Physicians Optical Supplies 20 1760821946 0 Physicians Physician Services 00 1760822365 0 BHIMANI RICKY 2022025 9999999 B 10 1760822365 0 727 E COURT ST PARIS IL 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CHICAGO AVE # 118 CHICAGO IL 606112991 20 1760823801 0 Physicians Anesthesia Services 20 1760823801 0 Physicians Fluoride varnish 20 1760823801 0 Physicians Healthy Kids Services 20 1760823801 0 Physicians Optical Supplies 20 1760823801 0 Physicians Physician Services 00 1760824114 0 GEORGIAFANDIS KAITLIN 2016365 9999999 B 10 1760824114 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1760824114 0 Physician Assistant Only Fluoride varnish 20 1760824114 0 Physician Assistant Only Healthy Kids Services 20 1760824114 0 Physician Assistant Only Physician Services 00 1760824924 0 MURASHITA TAKASHI 2023249 9999999 B 10 1760824924 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1760824924 0 Physicians Anesthesia Services 20 1760824924 0 Physicians Healthy Kids Services 20 1760824924 0 Physicians Optical Supplies 20 1760824924 0 Physicians Physician Services 00 1760826226 0 VANECKO MARY C 2015274 9999999 B 10 1760826226 0 5777 DEPT CAROL STREAM IL 601220021 20 1760826226 0 Nurse Practitioners Healthy 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1760834006 0 Nurse Practitioners Fluoride varnish 20 1760834006 0 Nurse Practitioners Healthy Kids Services 20 1760834006 0 Nurse Practitioners Nurse Practitioners Services 20 1760834006 0 Nurse Practitioners Physician Services 00 1760834527 0 PARTHASARATHY PRARTHANA 2022200 9999999 B 10 1760834527 0 PO BOX 778912 CHICAGO IL 606778912 20 1760834527 0 Physicians Anesthesia Services 20 1760834527 0 Physicians Fluoride varnish 20 1760834527 0 Physicians Healthy Kids Services 20 1760834527 0 Physicians Optical Supplies 20 1760834527 0 Physicians Physician Services 00 1760834691 0 LISKA ALEXIS R 2020017 9999999 B 10 1760834691 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1760834691 0 Physician Assistant Only Fluoride varnish 20 1760834691 0 Physician Assistant Only Healthy Kids Services 20 1760834691 0 Physician Assistant Only Physician Services 00 1760834964 0 CURTIS CARLA J 2021324 9999999 B 10 1760834964 0 134 W LAKE ST STE 100-10 BLOOMINGDALE IL 601081003 20 1760834964 0 Other 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Healthy Kids Services 20 1770076994 0 Physicians Optical Supplies 20 1770076994 0 Physicians Physician Services 00 1770077208 0 LAURIDSEN LUKE N 2018352 9999999 B 10 1770077208 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1770077208 0 Physicians Anesthesia Services 20 1770077208 0 Physicians Healthy Kids Services 20 1770077208 0 Physicians Optical Supplies 20 1770077208 0 Physicians Physician Services 00 1770078297 0 SWARTZ SUMMERS TAYLOR 2024215 9999999 B 10 1770078297 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1770078297 0 Physicians Anesthesia Services 20 1770078297 0 Physicians Healthy Kids Services 20 1770078297 0 Physicians Optical Supplies 20 1770078297 0 Physicians Physician Services 00 1770078586 0 KIM EUN EE 2024275 9999999 B 10 1770078586 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1770078586 0 Physicians Anesthesia Services 20 1770078586 0 Physicians Healthy Kids Services 20 1770078586 0 Physicians Optical Supplies 20 1770078586 0 Physicians Physician Services 00 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Physician Services 00 1770334328 0 ELKADY DJONI 2024199 9999999 B 10 1770334328 0 3249 OAK PARK AVE BERWYN IL 604023429 20 1770334328 0 Physicians Anesthesia Services 20 1770334328 0 Physicians Fluoride varnish 20 1770334328 0 Physicians Healthy Kids Services 20 1770334328 0 Physicians Optical Supplies 20 1770334328 0 Physicians Physician Services 00 1770335739 0 ALMARAZ MANSI 2024144 9999999 B 10 1770335739 0 5777 DEPT CAROL STREAM IL 601220021 20 1770335739 0 Nurse Practitioners Healthy Kids Services 20 1770335739 0 Nurse Practitioners Nurse Practitioners Services 20 1770335739 0 Nurse Practitioners Physician Services 00 1770337305 0 CASSIMATIS THOMAS 2024194 9999999 B 10 1770337305 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1770337305 0 Physicians Anesthesia Services 20 1770337305 0 Physicians Fluoride varnish 20 1770337305 0 Physicians Healthy Kids Services 20 1770337305 0 Physicians Optical Supplies 20 1770337305 0 Physicians Physician Services 00 1770343246 0 MCENANEY 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1770549420 0 Physicians Optical Supplies 20 1770549420 0 Physicians Physician Services 00 1770549594 0 ETON DARWIN 1991182 9999999 B 10 1770549594 0 2740 W FOSTER AVE LL7 CHICAGO IL 606253500 20 1770549594 0 Physicians Anesthesia Services 20 1770549594 0 Physicians Healthy Kids Services 20 1770549594 0 Physicians Optical Supplies 20 1770549594 0 Physicians Physician Services 00 1770549735 0 WOOD III JAMES 2024059 9999999 B 10 1770549735 0 287 PARK AVE S FL 3 NEW YORK NY 100104573 20 1770549735 0 Physicians Anesthesia Services 20 1770549735 0 Physicians Fluoride varnish 20 1770549735 0 Physicians Healthy Kids Services 20 1770549735 0 Physicians Optical Supplies 20 1770549735 0 Physicians Physician Services 00 1770549958 0 FEDINEC SUSAN 1998194 9999999 B 10 1770549958 0 3471 EAGLE WAY CHICAGO IL 606781034 20 1770549958 0 Physicians Anesthesia Services 20 1770549958 0 Physicians Healthy Kids Services 20 1770549958 0 Physicians Optical Supplies 20 1770549958 0 Physicians Physician Services 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2013035 9999999 B 10 1770553737 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1770553737 0 Physicians Anesthesia Services 20 1770553737 0 Physicians Fluoride varnish 20 1770553737 0 Physicians Healthy Kids Services 20 1770553737 0 Physicians Optical Supplies 20 1770553737 0 Physicians Physician Services 00 1770554024 0 WALDEN DAVID T. 1995182 9999999 B 10 1770554024 0 615 S NEW BALLAS RD STE 1200 SAINT LOUIS MO 631418221 20 1770554024 0 Physicians Anesthesia Services 20 1770554024 0 Physicians Fluoride varnish 20 1770554024 0 Physicians Healthy Kids Services 20 1770554024 0 Physicians Optical Supplies 20 1770554024 0 Physicians Physician Services 00 1770554446 0 NGONE EWANE C 2016295 9999999 B 10 1770554446 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1770554446 0 Physicians Anesthesia Services 20 1770554446 0 Physicians Fluoride varnish 20 1770554446 0 Physicians Healthy Kids Services 20 1770554446 0 Physicians Optical Supplies 20 1770554446 0 Physicians Physician 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1770558496 0 Physicians Healthy Kids Services 20 1770558496 0 Physicians Optical Supplies 20 1770558496 0 Physicians Physician Services 00 1770558603 0 GRIFFIN ANTHONY 1992223 9999999 B 10 1770558603 0 PO BOX 708760 SANDY UT 840708760 20 1770558603 0 Physicians Anesthesia Services 20 1770558603 0 Physicians Fluoride varnish 20 1770558603 0 Physicians Healthy Kids Services 20 1770558603 0 Physicians Optical Supplies 20 1770558603 0 Physicians Physician Services 00 1770558660 0 FRAHER KIMBERLY 2002077 9999999 B 10 1770558660 0 PO BOX 702 MONTGOMERY IL 605380702 20 1770558660 0 Speech Therapists Medical Supplies 20 1770558660 0 Speech Therapists Medical equipment/prosthetic devices 20 1770558660 0 Speech Therapists Speech Therapy/Pathology Services 00 1770559031 0 HANIF SOHAIL 1997166 9999999 B 10 1770559031 0 403 E 1ST ST DIXON IL 610213116 20 1770559031 0 Physicians Anesthesia Services 20 1770559031 0 Physicians Fluoride varnish 20 1770559031 0 Physicians Healthy Kids Services 20 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1770562332 0 Physicians Healthy Kids Services 20 1770562332 0 Physicians Optical Supplies 20 1770562332 0 Physicians Physician Services 00 1770562902 0 LIFE KYMBERLY 2023087 9999999 B 10 1770562902 0 1229 C AVE E OSKALOOSA IA 525774246 20 1770562902 0 Physicians Anesthesia Services 20 1770562902 0 Physicians Healthy Kids Services 20 1770562902 0 Physicians Optical Supplies 20 1770562902 0 Physicians Physician Services 00 1770563009 0 WAGENER OSVALDO 1998032 9999999 B 10 1770563009 0 1111 SUPERIOR ST STE 204 MELROSE PARK IL 601604156 20 1770563009 0 Physicians Anesthesia Services 20 1770563009 0 Physicians Fluoride varnish 20 1770563009 0 Physicians Healthy Kids Services 20 1770563009 0 Physicians Optical Supplies 20 1770563009 0 Physicians Physician Services 00 1770563462 0 BURDO-HARTMAN WENDELIN A 2016322 9999999 B 10 1770563462 0 507 E ARMSTRONG AVE PEORIA IL 616033201 20 1770563462 0 Physicians Anesthesia Services 20 1770563462 0 Physicians Fluoride varnish 20 1770563462 0 Physicians Healthy Kids Services 20 1770563462 0 Physicians Optical Supplies 20 1770563462 0 Physicians Physician Services 00 1770563678 0 CRUMMY TIMOTHY 2005001 9999999 B 10 1770563678 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1770563678 0 Physicians Anesthesia Services 20 1770563678 0 Physicians Healthy Kids Services 20 1770563678 0 Physicians Optical Supplies 20 1770563678 0 Physicians Physician Services 00 1770563819 0 WALKER GEORGE H 1994152 9999999 B 10 1770563819 0 PO BOX 10010 GLENDALE AZ 853180010 20 1770563819 0 Physicians Anesthesia Services 20 1770563819 0 Physicians Healthy Kids Services 20 1770563819 0 Physicians Optical Supplies 20 1770563819 0 Physicians Physician Services 00 1770565525 0 MULLER NANCY C 2010213 9999999 B 10 1770565525 0 PO BOX 144333 ORLANDO FL 328144333 20 1770565525 0 Physicians Anesthesia Services 20 1770565525 0 Physicians Healthy Kids Services 20 1770565525 0 Physicians Optical Supplies 20 1770565525 0 Physicians Physician Services 00 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637035049 20 1770569048 0 Physicians Anesthesia Services 20 1770569048 0 Physicians Fluoride varnish 20 1770569048 0 Physicians Healthy Kids Services 20 1770569048 0 Physicians Optical Supplies 20 1770569048 0 Physicians Physician Services 00 1770569550 0 POAG JOHN 1998152 9999999 B 10 1770569550 0 1401 EASTLAND DR BLOOMINGTON IL 617013552 20 1770569550 0 Physicians Anesthesia Services 20 1770569550 0 Physicians Fluoride varnish 20 1770569550 0 Physicians Healthy Kids Services 20 1770569550 0 Physicians Optical Supplies 20 1770569550 0 Physicians Physician Services 00 1770570061 0 STAPELFELDT WOLF H. 2013284 9999999 B 10 1770570061 0 1831 CHESTNUT ST STE 650 SAINT LOUIS MO 631032236 20 1770570061 0 Physicians Anesthesia Services 20 1770570061 0 Physicians Healthy Kids Services 20 1770570061 0 Physicians Optical Supplies 20 1770570061 0 Physicians Physician Services 00 1770570095 0 PATEL RAJNIKANT K 1992037 9999999 B 10 1770570095 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1770570095 0 Physicians Anesthesia Services 20 1770570095 0 Physicians Fluoride varnish 20 1770570095 0 Physicians Healthy Kids Services 20 1770570095 0 Physicians Optical Supplies 20 1770570095 0 Physicians Physician Services 00 1770570368 0 PUDLO JOSEPH 1987189 9999999 B 10 1770570368 0 6145 N MILWAUKEE AVE CHICAGO IL 606463804 20 1770570368 0 Physicians Anesthesia Services 20 1770570368 0 Physicians Fluoride varnish 20 1770570368 0 Physicians Healthy Kids Services 20 1770570368 0 Physicians Optical Supplies 20 1770570368 0 Physicians Physician Services 00 1770570616 0 ROWDON GREGORY A 2018280 9999999 B 10 1770570616 0 PO BOX 781076 DETROIT MI 482781076 20 1770570616 0 Physicians Anesthesia Services 20 1770570616 0 Physicians Fluoride varnish 20 1770570616 0 Physicians Healthy Kids Services 20 1770570616 0 Physicians Optical Supplies 20 1770570616 0 Physicians Physician Services 00 1770570699 0 MIZ GEORGE S 1986335 9999999 B 10 1770570699 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1770570699 0 Physicians Anesthesia Services 20 1770570699 0 Physicians Healthy Kids Services 20 1770570699 0 Physicians Optical Supplies 20 1770570699 0 Physicians Physician Services 00 1770571630 0 MORITA CRAIG T 1998362 9999999 B 10 1770571630 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1770571630 0 Physicians Anesthesia Services 20 1770571630 0 Physicians Fluoride varnish 20 1770571630 0 Physicians Healthy Kids Services 20 1770571630 0 Physicians Optical Supplies 20 1770571630 0 Physicians Physician Services 00 1770571648 0 SMITH LEX SANDRA 2003213 9999999 B 10 1770571648 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1770571648 0 Nurse Practitioners Anesthesia Services 20 1770571648 0 Nurse Practitioners Nurse Practitioners Services 20 1770571648 0 Nurse Practitioners Physician Services 00 1770572257 0 LAW TERESA MURRAY 1991182 9999999 B 10 1770572257 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1770572257 0 Physicians Anesthesia Services 20 1770572257 0 Physicians Fluoride varnish 20 1770572257 0 Physicians Healthy Kids Services 20 1770572257 0 Physicians Optical Supplies 20 1770572257 0 Physicians Physician Services 00 1770572620 0 RIEGER MARY 2000059 9999999 B 10 1770572620 0 2 ASPEN CT FAIRBURY IL 617391487 20 1770572620 0 Optometrists Optical Supplies 20 1770572620 0 Optometrists Optometric Services 20 1770572620 0 Optometrists Physician Services 00 1770572679 0 LAFAYETTE STEVEN R 2005152 9999999 B 10 1770572679 0 2015 N MAIN ST WHEATON IL 601873152 20 1770572679 0 Physicians Anesthesia Services 20 1770572679 0 Physicians Healthy Kids Services 20 1770572679 0 Physicians Optical Supplies 20 1770572679 0 Physicians Physician Services 00 1770573305 0 LEVITSKY JOSH 2002182 9999999 B 10 1770573305 0 5777 DEPT CAROL STREAM IL 601220021 20 1770573305 0 Physicians Anesthesia Services 20 1770573305 0 Physicians Fluoride varnish 20 1770573305 0 Physicians Healthy Kids Services 20 1770573305 0 Physicians Optical Supplies 20 1770573305 0 Physicians Physician Services 00 1770573875 0 HAHM YONGBIN C 2005135 9999999 B 10 1770573875 0 2605 GRAND AVE STE A WAUKEGAN IL 600852410 20 1770573875 0 Dentists Anesthesia Services 20 1770573875 0 Dentists Dental Services 20 1770573875 0 Dentists Physician Services 00 1770574576 0 RADA ROBERT E 1988070 9999999 B 10 1770574576 0 3115 SUNNYSIDE AVE BROOKFIELD IL 605131327 20 1770574576 0 Dentists Dental Services 20 1770574576 0 Dentists Physician Services 00 1770574758 0 HIRSCH ARICA 2001001 9999999 B 10 1770574758 0 5777 DEPT CAROL STREAM IL 601220021 20 1770574758 0 Physicians Anesthesia Services 20 1770574758 0 Physicians Healthy Kids Services 20 1770574758 0 Physicians Optical Supplies 20 1770574758 0 Physicians Physician Services 00 1770574881 0 HARTSELL WILLIAM F 1989031 9999999 B 10 1770574881 0 4455 WEAVER PKWY WARRENVILLE IL 605553269 20 1770574881 0 Physicians Anesthesia Services 20 1770574881 0 Physicians Healthy Kids Services 20 1770574881 0 Physicians Optical Supplies 20 1770574881 0 Physicians Physician Services 00 1770575136 0 WEISENBERG ELLIOT 1994182 9999999 B 10 1770575136 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1770575136 0 Physicians Anesthesia Services 20 1770575136 0 Physicians Healthy Kids Services 20 1770575136 0 Physicians Optical Supplies 20 1770575136 0 Physicians Physician Services 00 1770575524 0 VAJAYARAJ SUGANTHI 2012046 9999999 B 10 1770575524 0 PO BOX 781076 DETROIT MI 482781076 20 1770575524 0 Physicians Anesthesia Services 20 1770575524 0 Physicians Fluoride varnish 20 1770575524 0 Physicians Healthy Kids Services 20 1770575524 0 Physicians Optical Supplies 20 1770575524 0 Physicians Physician Services 00 1770575797 0 STROHMAYER EILEEN 1993213 9999999 B 10 1770575797 0 801 S MILWAUKEE AVE STE 100 LIBERTYVILLE IL 600483204 20 1770575797 0 Physicians Anesthesia Services 20 1770575797 0 Physicians Healthy Kids Services 20 1770575797 0 Physicians Optical Supplies 20 1770575797 0 Physicians Physician Services 00 1770576613 0 WIKOFF CATHERINE L 2005182 9999999 B 10 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0 MADDOX MIKELLE A 2019222 9999999 B 10 1770578726 0 PO BOX 689022 FRANKLIN TN 370689022 20 1770578726 0 Physicians Anesthesia Services 20 1770578726 0 Physicians Fluoride varnish 20 1770578726 0 Physicians Healthy Kids Services 20 1770578726 0 Physicians Optical Supplies 20 1770578726 0 Physicians Physician Services 00 1770578775 0 SALTZMAN DAVID 1989274 9999999 B 10 1770578775 0 2215 SANDERS RD STE 105 SUITE 105 NORTHBROOK IL 600626194 20 1770578775 0 Physicians Anesthesia Services 20 1770578775 0 Physicians Fluoride varnish 20 1770578775 0 Physicians Healthy Kids Services 20 1770578775 0 Physicians Optical Supplies 20 1770578775 0 Physicians Physician Services 00 1770578825 0 BORIN CHAD 2021075 9999999 B 10 1770578825 0 7310 RITCHIE HWY STE 802 GLEN BURNIE MD 210613129 20 1770578825 0 Physicians Anesthesia Services 20 1770578825 0 Physicians Healthy Kids Services 20 1770578825 0 Physicians Optical Supplies 20 1770578825 0 Physicians Physician Services 00 1770578858 0 COY DALE 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1770579922 0 1969 W HART RD BELOIT WI 535112230 20 1770579922 0 Physicians Anesthesia Services 20 1770579922 0 Physicians Fluoride varnish 20 1770579922 0 Physicians Healthy Kids Services 20 1770579922 0 Physicians Optical Supplies 20 1770579922 0 Physicians Physician Services 00 1770580029 0 ATIA GEORGE N 1998213 9999999 B 10 1770580029 0 200 FOX GLEN CT BARRINGTON IL 600101809 20 1770580029 0 Physicians Anesthesia Services 20 1770580029 0 Physicians Fluoride varnish 20 1770580029 0 Physicians Healthy Kids Services 20 1770580029 0 Physicians Optical Supplies 20 1770580029 0 Physicians Physician Services 00 1770580326 0 SPIEGEL ALAN M 1999182 9999999 B 10 1770580326 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1770580326 0 Physicians Anesthesia Services 20 1770580326 0 Physicians Fluoride varnish 20 1770580326 0 Physicians Healthy Kids Services 20 1770580326 0 Physicians Optical Supplies 20 1770580326 0 Physicians Physician Services 00 1770580672 0 RAHMAN MOHAMED A 1989274 9999999 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1770581282 0 Physicians Optical Supplies 20 1770581282 0 Physicians Physician Services 00 1770581456 0 BOYD MARC 1993182 9999999 B 10 1770581456 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1770581456 0 Physicians Anesthesia Services 20 1770581456 0 Physicians Healthy Kids Services 20 1770581456 0 Physicians Optical Supplies 20 1770581456 0 Physicians Physician Services 00 1770582223 0 LUGO JOSEPH G 2003001 9999999 B 10 1770582223 0 222 S WOODS MILL RD STE 550N CHESTERFIELD MO 630173641 20 1770582223 0 Physicians Anesthesia Services 20 1770582223 0 Physicians Healthy Kids Services 20 1770582223 0 Physicians Optical Supplies 20 1770582223 0 Physicians Physician Services 00 1770582314 0 HOBEN JENNIFER 2002001 9999999 B 10 1770582314 0 4812 PFEIFFER RD BARTONVILLE IL 616072647 20 1770582314 0 Speech Therapists Medical Supplies 20 1770582314 0 Speech Therapists Medical equipment/prosthetic devices 20 1770582314 0 Speech Therapists Speech Therapy/Pathology Services 00 1770582777 0 RANDALL 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1770773871 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1770773871 0 Physicians Anesthesia Services 20 1770773871 0 Physicians Fluoride varnish 20 1770773871 0 Physicians Healthy Kids Services 20 1770773871 0 Physicians Optical Supplies 20 1770773871 0 Physicians Physician Services 00 1770777294 0 ALBA GARCIA MIGUEL M 2022338 9999999 B 10 1770777294 0 PO BOX 43230 PHOENIX AZ 850803230 20 1770777294 0 Physicians Anesthesia Services 20 1770777294 0 Physicians Fluoride varnish 20 1770777294 0 Physicians Healthy Kids Services 20 1770777294 0 Physicians Optical Supplies 20 1770777294 0 Physicians Physician Services 00 1770777377 0 SIDDIQUI RUMANA 2009335 9999999 B 10 1770777377 0 1585 BARRINGTON RD STE 306 HOFFMAN ESTATES IL 601695019 20 1770777377 0 Physicians Anesthesia Services 20 1770777377 0 Physicians Fluoride varnish 20 1770777377 0 Physicians Healthy Kids Services 20 1770777377 0 Physicians Optical Supplies 20 1770777377 0 Physicians Physician Services 00 1770777658 0 KHATUA 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ELGIN IL 601203843 20 1770788234 0 Nurse Practitioners Electronic Home Response/EHR Installation, MPE Certification 20 1770788234 0 Nurse Practitioners Healthy Kids Services 20 1770788234 0 Nurse Practitioners Nurse Practitioners Services 20 1770788234 0 Nurse Practitioners Physician Services 00 1770788267 0 ARNOLD DOUGLAS 2024033 9999999 B 10 1770788267 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1770788267 0 Physicians Anesthesia Services 20 1770788267 0 Physicians Healthy Kids Services 20 1770788267 0 Physicians Optical Supplies 20 1770788267 0 Physicians Physician Services 00 1770788317 0 KHILWANI ASHOK K 2007182 9999999 B 10 1770788317 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1770788317 0 Physicians Anesthesia Services 20 1770788317 0 Physicians Fluoride varnish 20 1770788317 0 Physicians Healthy Kids Services 20 1770788317 0 Physicians Optical Supplies 20 1770788317 0 Physicians Physician Services 00 1770788440 0 PATTERSON PAMALA 2007219 9999999 B 10 1770788440 0 8 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Services 20 1780167478 0 Nurse Practitioners Physician Services 00 1780167825 0 NYE LANA 2023082 9999999 B 10 1780167825 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1780167825 0 Clinical Social Worker Social work service 00 1780167957 0 BIRCH BRETT 2020269 9999999 B 10 1780167957 0 2100 POWELL ST STE 400 EMERYVILLE CA 946081826 20 1780167957 0 Physician Assistant Only Fluoride varnish 20 1780167957 0 Physician Assistant Only Healthy Kids Services 20 1780167957 0 Physician Assistant Only Physician Services 00 1780168245 0 GJORGJEVIK SARA 2018244 9999999 H 10 1780168245 0 1120 RANDALL CT GENEVA IL 601343911 20 1780168245 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1780168468 0 HOUSE PAMELA R 2019044 9999999 B 10 1780168468 0 401 N MICHIGAN AVE STE 1200 CHICAGO IL 606114264 20 1780168468 0 Nurse Practitioners Fluoride varnish 20 1780168468 0 Nurse Practitioners Healthy Kids Services 20 1780168468 0 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Services 20 1780215251 0 Nurse Practitioners Physician Services 00 1780216010 0 SIMPSON MILO 2020183 9999999 B 10 1780216010 0 18167 US HIGHWAY 19 N STE 650 CLEARWATER FL 337646576 20 1780216010 0 Physician Assistant Only Fluoride varnish 20 1780216010 0 Physician Assistant Only Healthy Kids Services 20 1780216010 0 Physician Assistant Only Physician Services 00 1780217877 0 HEDBERG TREVOR 2021252 9999999 B 10 1780217877 0 5777 DEPT CAROL STREAM IL 601220021 20 1780217877 0 Physician Assistant Only Fluoride varnish 20 1780217877 0 Physician Assistant Only Healthy Kids Services 20 1780217877 0 Physician Assistant Only Physician Services 00 1780217992 0 WALSH TIFFANY 2020139 9999999 B 10 1780217992 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1780217992 0 Nurse Practitioners Healthy Kids Services 20 1780217992 0 Nurse Practitioners Nurse Practitioners Services 20 1780217992 0 Nurse Practitioners Physician Services 00 1780223115 0 DANDINIDIS DIMITRIOS 2023186 9999999 B 10 1780223115 0 5820 W IRVING PARK RD CHICAGO IL 606342616 20 1780223115 0 Occupational Therapists Medical Supplies 20 1780223115 0 Occupational Therapists Medical equipment/prosthetic devices 20 1780223115 0 Occupational Therapists Occupational Therapy Services 00 1780223289 0 RANIER DAWN 2021106 9999999 B 10 1780223289 0 PO BOX 776473 CHICAGO IL 606776473 20 1780223289 0 Nurse Practitioners Fluoride varnish 20 1780223289 0 Nurse Practitioners Healthy Kids Services 20 1780223289 0 Nurse Practitioners Nurse Practitioners Services 20 1780223289 0 Nurse Practitioners Physician Services 00 1780229831 0 HOEKSTRA ABIGAIL 2020007 9999999 B 10 1780229831 0 611 W PARK ST URBANA IL 618012529 20 1780229831 0 Nurse Practitioners Fluoride varnish 20 1780229831 0 Nurse Practitioners Healthy Kids Services 20 1780229831 0 Nurse Practitioners Nurse Practitioners Services 20 1780229831 0 Nurse Practitioners Physician Services 00 1780230227 0 VAN CURA NICOLE 2019231 9999999 B 10 1780230227 0 502 WAVERLY DR ELGIN IL 601204082 20 1780230227 0 Optometrists Optical Supplies 20 1780230227 0 Optometrists Optometric Services 20 1780230227 0 Optometrists Physician Services 00 1780231134 0 RODRIGUEZ LINDSAY 2019275 9999999 B 10 1780231134 0 101 E MILLER RD STERLING IL 610811252 20 1780231134 0 Nurse Practitioners Healthy Kids Services 20 1780231134 0 Nurse Practitioners Nurse Practitioners Services 20 1780231134 0 Nurse Practitioners Physician Services 00 1780231886 0 GUILD MICHELLE A 2019270 9999999 B 10 1780231886 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1780231886 0 Nurse Practitioners Fluoride varnish 20 1780231886 0 Nurse Practitioners Healthy Kids Services 20 1780231886 0 Nurse Practitioners Nurse Practitioners Services 20 1780231886 0 Nurse Practitioners Physician Services 00 1780231969 0 PHILLIPS SHRONDA 2019281 9999999 B 10 1780231969 0 PO BOX 9727 PEORIA IL 616129727 20 1780231969 0 Nurse Practitioners Fluoride varnish 20 1780231969 0 Nurse Practitioners Healthy Kids Services 20 1780231969 0 Nurse Practitioners Nurse Practitioners Services 20 1780231969 0 Nurse Practitioners Physician Services 00 1780232926 0 ARTNER REBECCA 2019254 9999999 B 10 1780232926 0 4215 NEWBURG RD ROCKFORD IL 611086479 20 1780232926 0 Nurse Practitioners Fluoride varnish 20 1780232926 0 Nurse Practitioners Healthy Kids Services 20 1780232926 0 Nurse Practitioners Nurse Practitioners Services 20 1780232926 0 Nurse Practitioners Physician Services 00 1780233171 0 PAVLAKIS ADAM 2023097 9999999 B 10 1780233171 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1780233171 0 Physical Therapists Medical Supplies 20 1780233171 0 Physical Therapists Medical equipment/prosthetic devices 20 1780233171 0 Physical Therapists Physical Therapy Services 00 1780234054 0 RIEDESEL EMMA 2019261 9999999 B 10 1780234054 0 725 SCHOOL ST MORRIS IL 604501218 20 1780234054 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1780236687 0 REHR ANDREA F 2019261 9999999 B 10 1780236687 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1780236687 0 Physical Therapists Medical Supplies 20 1780236687 0 Physical Therapists Medical equipment/prosthetic devices 20 1780236687 0 Physical Therapists Physical Therapy Services 00 1780237198 0 CARPENTER LORI A 2019261 9999999 B 10 1780237198 0 2200 STATE ST LAWRENCEVILLE IL 624391852 20 1780237198 0 Nurse Practitioners Fluoride varnish 20 1780237198 0 Nurse Practitioners Healthy Kids Services 20 1780237198 0 Nurse Practitioners Nurse Practitioners Services 20 1780237198 0 Nurse Practitioners Physician Services 00 1780239434 0 MATTHEWS MAGGIE K 2019240 9999999 B 10 1780239434 0 2300 N EDWARD ST DECATUR IL 625264163 20 1780239434 0 Nurse Practitioners Healthy Kids Services 20 1780239434 0 Nurse Practitioners Nurse Practitioners Services 20 1780239434 0 Nurse Practitioners Physician Services 00 1780240804 0 BARTHEL JASMIN 2020224 9999999 B 10 1780240804 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1780240804 0 Physician Assistant Only Fluoride varnish 20 1780240804 0 Physician Assistant Only Healthy Kids Services 20 1780240804 0 Physician Assistant Only Physician Services 00 1780240929 0 ASIF ABUZAR A 2019266 9999999 B 10 1780240929 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1780240929 0 Physicians Anesthesia Services 20 1780240929 0 Physicians Fluoride varnish 20 1780240929 0 Physicians Healthy Kids Services 20 1780240929 0 Physicians Optical Supplies 20 1780240929 0 Physicians Physician Services 00 1780242776 0 POLAVARAPU SURYA T 2019183 9999999 B 10 1780242776 0 1005 BROADWAY ST QUINCY IL 623012834 20 1780242776 0 Physicians Anesthesia Services 20 1780242776 0 Physicians Fluoride varnish 20 1780242776 0 Physicians Healthy Kids Services 20 1780242776 0 Physicians Optical Supplies 20 1780242776 0 Physicians Physician Services 00 1780243535 0 ALAIWI MOHAMMED 2023135 9999999 B 10 1780243535 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1780243535 0 Physical Therapists Medical Supplies 20 1780243535 0 Physical Therapists Medical equipment/prosthetic devices 20 1780243535 0 Physical Therapists Physical Therapy Services 00 1780244020 0 PARK EUGENE 2022277 9999999 B 10 1780244020 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1780244020 0 Physicians Anesthesia Services 20 1780244020 0 Physicians Fluoride varnish 20 1780244020 0 Physicians Healthy Kids Services 20 1780244020 0 Physicians Optical Supplies 20 1780244020 0 Physicians Physician Services 00 1780244244 0 IGNELL DANIEL P 2019182 9999999 B 10 1780244244 0 4646 N MARINE DR CHICAGO IL 606405759 20 1780244244 0 Physicians Anesthesia Services 20 1780244244 0 Physicians Fluoride varnish 20 1780244244 0 Physicians Healthy Kids Services 20 1780244244 0 Physicians Optical Supplies 20 1780244244 0 Physicians Physician Services 20 1780244244 0 Physicians Physicians Psychiatric Services 00 1780244384 0 GILS INGRID 2019365 9999999 B 10 1780244384 0 2740 W FOSTER AVE STE 401 CHICAGO IL 606253591 20 1780244384 0 Physicians Anesthesia Services 20 1780244384 0 Physicians Fluoride varnish 20 1780244384 0 Physicians Healthy Kids Services 20 1780244384 0 Physicians Optical Supplies 20 1780244384 0 Physicians Physician Services 00 1780244434 0 CAVALERI HANNAH 2022356 9999999 B 10 1780244434 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1780244434 0 Physician Assistant Only Fluoride varnish 20 1780244434 0 Physician Assistant Only Healthy Kids Services 20 1780244434 0 Physician Assistant Only Physician Services 00 1780245050 0 HASHIM ASMA S 2020008 9999999 B 10 1780245050 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1780245050 0 Physicians Anesthesia Services 20 1780245050 0 Physicians Healthy Kids Services 20 1780245050 0 Physicians Optical Supplies 20 1780245050 0 Physicians Physician Services 00 1780245613 0 STUDENY VITALIY 2024235 9999999 B 10 1780245613 0 5777 DEPT CAROL STREAM IL 601220021 20 1780245613 0 Physicians Anesthesia Services 20 1780245613 0 Physicians Healthy Kids 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Practitioners Fluoride varnish 20 1780246488 0 Nurse Practitioners Healthy Kids Services 20 1780246488 0 Nurse Practitioners Nurse Practitioners Services 20 1780246488 0 Nurse Practitioners Physician Services 00 1780247973 0 PEULER ALLISON 2023138 9999999 B 10 1780247973 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1780247973 0 Occupational Therapists Medical Supplies 20 1780247973 0 Occupational Therapists Medical equipment/prosthetic devices 20 1780247973 0 Occupational Therapists Occupational Therapy Services 00 1780248005 0 TSCHOPP EMILY M 2019291 9999999 B 10 1780248005 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1780248005 0 Nurse Practitioners Healthy Kids Services 20 1780248005 0 Nurse Practitioners Nurse Practitioners Services 20 1780248005 0 Nurse Practitioners Physician Services 00 1780248815 0 SERINO JOSEPH 2019326 9999999 B 10 1780248815 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1780248815 0 Physicians Anesthesia Services 20 1780248815 0 Physicians Healthy 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Fluoride varnish 20 1780256412 0 Nurse Practitioners Healthy Kids Services 20 1780256412 0 Nurse Practitioners Nurse Practitioners Services 20 1780256412 0 Nurse Practitioners Physician Services 00 1780256586 0 KESTELMAN FABIOLA P 2021182 9999999 B 10 1780256586 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1780256586 0 Physicians Anesthesia Services 20 1780256586 0 Physicians Healthy Kids Services 20 1780256586 0 Physicians Optical Supplies 20 1780256586 0 Physicians Physician Services 00 1780257329 0 CHILD ALEXI F 2022080 9999999 B 10 1780257329 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1780257329 0 Physician Assistant Only Fluoride varnish 20 1780257329 0 Physician Assistant Only Healthy Kids Services 20 1780257329 0 Physician Assistant Only Physician Services 00 1780257535 0 FRANDSEN JENNIFER 2021291 9999999 B 10 1780257535 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1780257535 0 Nurse Practitioners Healthy Kids Services 20 1780257535 0 Nurse Practitioners 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0 Physicians Healthy Kids Services 20 1780259762 0 Physicians Optical Supplies 20 1780259762 0 Physicians Physician Services 00 1780260430 0 SORENSEN MORGAN 2021201 9999999 B 10 1780260430 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1780260430 0 Physicians Anesthesia Services 20 1780260430 0 Physicians Healthy Kids Services 20 1780260430 0 Physicians Optical Supplies 20 1780260430 0 Physicians Physician Services 00 1780260638 0 GEEVER BRETT W 2021174 9999999 B 10 1780260638 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1780260638 0 Physicians Anesthesia Services 20 1780260638 0 Physicians Healthy Kids Services 20 1780260638 0 Physicians Optical Supplies 20 1780260638 0 Physicians Physician Services 00 1780261065 0 HAMIDI NASEEM 2021215 9999999 B 10 1780261065 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1780261065 0 Physicians Anesthesia Services 20 1780261065 0 Physicians Fluoride varnish 20 1780261065 0 Physicians Healthy Kids Services 20 1780261065 0 Physicians 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1780261537 0 Physicians Physician Services 00 1780261974 0 BORODA NICKOLAS 2021176 2026174 B 10 1780261974 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1780261974 0 Physicians Anesthesia Services 20 1780261974 0 Physicians Healthy Kids Services 20 1780261974 0 Physicians Optical Supplies 20 1780261974 0 Physicians Physician Services 00 1780262550 0 LABCHUK ANDRII 2021176 9999999 B 10 1780262550 0 PO BOX 3039 OAK BROOK IL 605223039 20 1780262550 0 Physicians Anesthesia Services 20 1780262550 0 Physicians Fluoride varnish 20 1780262550 0 Physicians Healthy Kids Services 20 1780262550 0 Physicians Optical Supplies 20 1780262550 0 Physicians Physician Services 00 1780263228 0 PENA CHRISTIEN 2025015 9999999 B 10 1780263228 0 PO BOX 7167 CAROL STREAM IL 601977167 20 1780263228 0 Physicians Anesthesia Services 20 1780263228 0 Physicians Healthy Kids Services 20 1780263228 0 Physicians Optical Supplies 20 1780263228 0 Physicians Physician Services 00 1780263327 0 KING VANESSA A 2022178 9999999 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201 MAYWOOD IL 601533328 20 1780264010 0 Physicians Anesthesia Services 20 1780264010 0 Physicians Healthy Kids Services 20 1780264010 0 Physicians Optical Supplies 20 1780264010 0 Physicians Physician Services 00 1780264077 0 GOSS SHANNON 2022048 9999999 B 10 1780264077 0 1518 MULBERRY AVE MUSCATINE IA 527613433 20 1780264077 0 Nurse Practitioners Fluoride varnish 20 1780264077 0 Nurse Practitioners Healthy Kids Services 20 1780264077 0 Nurse Practitioners Nurse Practitioners Services 20 1780264077 0 Nurse Practitioners Physician Services 00 1780264374 0 CALIBUGAR HAZEL 2022216 9999999 B 10 1780264374 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1780264374 0 Nurse Practitioners Healthy Kids Services 20 1780264374 0 Nurse Practitioners Nurse Practitioners Services 20 1780264374 0 Nurse Practitioners Physician Services 00 1780264580 0 MAERZ BRADLEY J 2024183 9999999 B 10 1780264580 0 6024 RIDGE AVE STE 116-356 PHILADELPHIA PA 191281601 20 1780264580 0 Physicians Anesthesia Services 20 1780264580 0 Physicians Healthy Kids Services 20 1780264580 0 Physicians Optical Supplies 20 1780264580 0 Physicians Physician Services 00 1780265082 0 KESSLER SKYLER H 2022174 9999999 B 10 1780265082 0 4698 DEPT CAROL STREAM IL 601220021 20 1780265082 0 Physicians Anesthesia Services 20 1780265082 0 Physicians Healthy Kids Services 20 1780265082 0 Physicians Optical Supplies 20 1780265082 0 Physicians Physician Services 00 1780265561 0 TIFT BEN 2021247 9999999 B 10 1780265561 0 530 NE GLEN OAK AVE PEORIA IL 616370001 20 1780265561 0 Physicians Anesthesia Services 20 1780265561 0 Physicians Fluoride varnish 20 1780265561 0 Physicians Healthy Kids Services 20 1780265561 0 Physicians Optical Supplies 20 1780265561 0 Physicians Physician Services 00 1780266981 0 ZOLOTAREVSKY MITCHELLE 2022175 9999999 B 10 1780266981 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1780266981 0 Physicians Anesthesia Services 20 1780266981 0 Physicians Fluoride varnish 20 1780266981 0 Physicians Healthy Kids Services 20 1780266981 0 Physicians Optical Supplies 20 1780266981 0 Physicians Physician Services 00 1780267294 0 LANGBO WILLIAM A 2023198 9999999 B 10 1780267294 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1780267294 0 Physicians Anesthesia Services 20 1780267294 0 Physicians Healthy Kids Services 20 1780267294 0 Physicians Optical Supplies 20 1780267294 0 Physicians Physician Services 00 1780267526 0 KRIPPEL SARAH M 2021133 9999999 B 10 1780267526 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1780267526 0 Nurse Practitioners Fluoride varnish 20 1780267526 0 Nurse Practitioners Healthy Kids Services 20 1780267526 0 Nurse Practitioners Nurse Practitioners Services 20 1780267526 0 Nurse Practitioners Physician Services 00 1780268953 0 DETMER ELEANOR 2021132 9999999 H 10 1780268953 0 PO BOX 146 WATERLOO IL 622980146 20 1780268953 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1780269084 0 ISHAM AYANA 2024319 9999999 B 10 1780269084 0 2003 W FULTON ST STE 303 CHICAGO IL 606122345 20 1780269084 0 Nurse Practitioners Healthy Kids Services 20 1780269084 0 Nurse Practitioners Nurse Practitioners Services 20 1780269084 0 Nurse Practitioners Physician Services 00 1780269746 0 BOIX GARIBO RICARDO 2023215 9999999 B 10 1780269746 0 5777 DEPT CAROL STREAM IL 601220021 20 1780269746 0 Physicians Anesthesia Services 20 1780269746 0 Physicians Healthy Kids Services 20 1780269746 0 Physicians Optical Supplies 20 1780269746 0 Physicians Physician Services 00 1780270033 0 WHITE KELSIE 2022301 9999999 B 10 1780270033 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1780270033 0 Physician Assistant Only Fluoride varnish 20 1780270033 0 Physician Assistant Only Healthy Kids Services 20 1780270033 0 Physician Assistant Only Physician Services 00 1780271247 0 WHITE ANNIE 2021029 9999999 B 10 1780271247 0 800 W FULTON MARKET FL 12 CHICAGO IL 606071302 20 1780271247 0 Nurse Practitioners Fluoride varnish 20 1780271247 0 Nurse Practitioners Healthy Kids Services 20 1780271247 0 Nurse Practitioners Nurse Practitioners Services 20 1780271247 0 Nurse Practitioners Physician Services 00 1780272294 0 ALAO TAWAKALIT 2021308 9999999 B 10 1780272294 0 600 HOLIDAY PLAZA DR STE 200 MATTESON IL 604432237 20 1780272294 0 Nurse Practitioners Fluoride varnish 20 1780272294 0 Nurse Practitioners Healthy Kids Services 20 1780272294 0 Nurse Practitioners Nurse Practitioners Services 20 1780272294 0 Nurse Practitioners Physician Services 00 1780274175 0 SHUI KEVIN 2021050 9999999 B 10 1780274175 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1780274175 0 Nurse Practitioners Anesthesia Services 20 1780274175 0 Nurse Practitioners Nurse Practitioners Services 20 1780274175 0 Nurse Practitioners Physician Services 00 1780274860 0 FINCH KATHERINE 2021119 9999999 B 10 1780274860 0 850 43RD AVE STE 100 MOLINE IL 612658401 20 1780274860 0 Physical Therapists Medical Supplies 20 1780274860 0 Physical Therapists 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Assistant Only Physician Services 00 1780282095 0 POWER ALISON D 2024059 9999999 B 10 1780282095 0 PO BOX 43230 PHOENIX AZ 850803230 20 1780282095 0 Physician Assistant Only Fluoride varnish 20 1780282095 0 Physician Assistant Only Healthy Kids Services 20 1780282095 0 Physician Assistant Only Physician Services 00 1780283184 0 KIMBEL JUSTIN 2020351 9999999 B 10 1780283184 0 2025 WASHINGTON ST WAUKEGAN IL 600855131 20 1780283184 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1780286534 0 WALLIN ERIN R 2021196 9999999 B 10 1780286534 0 PO BOX 22407 SAINT LOUIS MO 631260407 20 1780286534 0 Nurse Practitioners Anesthesia Services 20 1780286534 0 Nurse Practitioners Nurse Practitioners Services 20 1780286534 0 Nurse Practitioners Physician Services 00 1780286583 0 SANDERS LEAH 2021089 9999999 B 10 1780286583 0 501 7TH ST ROCKFORD IL 611041242 20 1780286583 0 Speech Therapists Medical Supplies 20 1780286583 0 Speech Therapists Medical equipment/prosthetic devices 20 1780286583 0 Speech Therapists Speech Therapy/Pathology Services 00 1780289694 0 BAILS MORGAN 2021234 9999999 B 10 1780289694 0 201 W MULBERRY ST CHATHAM IL 626291329 20 1780289694 0 Speech Therapists Medical Supplies 20 1780289694 0 Speech Therapists Medical equipment/prosthetic devices 20 1780289694 0 Speech Therapists Speech Therapy/Pathology Services 00 1780290387 0 SCHINKE LAURA 2023202 9999999 B 10 1780290387 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1780290387 0 Physician Assistant Only Fluoride varnish 20 1780290387 0 Physician Assistant Only Healthy Kids Services 20 1780290387 0 Physician Assistant Only Physician Services 00 1780291617 0 LAVIGNE LORETTA 2021243 9999999 B 10 1780291617 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1780291617 0 Clinical Social Worker Social work service 00 1780292425 0 EVANS DOYLE 2020234 9999999 B 10 1780292425 0 2560 24TH ST STE 101 ROCK ISLAND IL 612015389 20 1780292425 0 Clinical 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1780298844 0 Physicians Healthy Kids Services 20 1780298844 0 Physicians Optical Supplies 20 1780298844 0 Physicians Physician Services 00 1780299248 0 CLINE KIM 2020275 9999999 B 10 1780299248 0 999 W DUNDEE RD WHEELING IL 600903986 20 1780299248 0 Speech Therapists Medical Supplies 20 1780299248 0 Speech Therapists Medical equipment/prosthetic devices 20 1780299248 0 Speech Therapists Speech Therapy/Pathology Services 00 1780300459 0 HODGES AUSTIN 2023017 9999999 B 10 1780300459 0 2245 ENTERPRISE DR STE 4506 WESTCHESTER IL 601545803 20 1780300459 0 Physician Assistant Only Fluoride varnish 20 1780300459 0 Physician Assistant Only Healthy Kids Services 20 1780300459 0 Physician Assistant Only Physician Services 00 1780301028 0 IDEN NICHOLAS 2022343 9999999 B 10 1780301028 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1780301028 0 Nurse Practitioners Anesthesia Services 20 1780301028 0 Nurse Practitioners Nurse Practitioners Services 20 1780301028 0 Nurse Practitioners Physician 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Nurse Practitioners Healthy Kids Services 20 1780305656 0 Nurse Practitioners Nurse Practitioners Services 20 1780305656 0 Nurse Practitioners Physician Services 00 1780306761 0 CARR JENNIFER 2022347 9999999 B 10 1780306761 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1780306761 0 Nurse Practitioners Fluoride varnish 20 1780306761 0 Nurse Practitioners Healthy Kids Services 20 1780306761 0 Nurse Practitioners Nurse Practitioners Services 20 1780306761 0 Nurse Practitioners Physician Services 00 1780306928 0 FIELDS BROWN SHERRY 2023228 9999999 B 10 1780306928 0 1400 LEMAY FERRY RD SAINT LOUIS MO 631252408 20 1780306928 0 Nurse Practitioners Healthy Kids Services 20 1780306928 0 Nurse Practitioners Nurse Practitioners Services 20 1780306928 0 Nurse Practitioners Physician Services 00 1780309989 0 HONG AMY 2025038 9999999 B 10 1780309989 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1780309989 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT 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Assistant Only Healthy Kids Services 20 1780313593 0 Physician Assistant Only Physician Services 00 1780313809 0 KHAN SHIKEBA 2022179 9999999 B 10 1780313809 0 PO BOX 855795 MINNEAPOLIS MN 554851296 20 1780313809 0 Physicians Anesthesia Services 20 1780313809 0 Physicians Fluoride varnish 20 1780313809 0 Physicians Healthy Kids Services 20 1780313809 0 Physicians Optical Supplies 20 1780313809 0 Physicians Physician Services 00 1780314013 0 VIECELI NICOLE L 2022273 9999999 B 10 1780314013 0 400 N HIGHLAND AVE AURORA IL 605063814 20 1780314013 0 Nurse Practitioners Fluoride varnish 20 1780314013 0 Nurse Practitioners Healthy Kids Services 20 1780314013 0 Nurse Practitioners Nurse Practitioners Services 20 1780314013 0 Nurse Practitioners Physician Services 00 1780314088 0 GARCIA ALICEA MICHAEL A 2022195 9999999 B 10 1780314088 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1780314088 0 Physicians Anesthesia Services 20 1780314088 0 Physicians Fluoride varnish 20 1780314088 0 Physicians Healthy Kids Services 20 1780314088 0 Physicians Optical Supplies 20 1780314088 0 Physicians Physician Services 00 1780315572 0 PALMER SHANA 2022252 9999999 B 10 1780315572 0 818 5TH AVE STE 200 DES MOINES IA 503091307 20 1780315572 0 Nurse Practitioners Fluoride varnish 20 1780315572 0 Nurse Practitioners Healthy Kids Services 20 1780315572 0 Nurse Practitioners Nurse Practitioners Services 20 1780315572 0 Nurse Practitioners Physician Services 00 1780316414 0 DAVIS JULENE 2022280 9999999 B 10 1780316414 0 14 LAKE ST OAK PARK IL 603022606 20 1780316414 0 Nurse Practitioners Healthy Kids Services 20 1780316414 0 Nurse Practitioners Nurse Practitioners Services 20 1780316414 0 Nurse Practitioners Physician Services 00 1780316950 0 TAILOR JAYUL 2022189 9999999 B 10 1780316950 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1780316950 0 Physicians Anesthesia Services 20 1780316950 0 Physicians Fluoride varnish 20 1780316950 0 Physicians Healthy Kids Services 20 1780316950 0 Physicians Optical Supplies 20 1780316950 0 Physicians Physician Services 00 1780317016 0 RHODES MIA 2022231 9999999 B 10 1780317016 0 20733 N BROAD ST CARLINVILLE IL 626263710 20 1780317016 0 Nurse Practitioners Fluoride varnish 20 1780317016 0 Nurse Practitioners Healthy Kids Services 20 1780317016 0 Nurse Practitioners Nurse Practitioners Services 20 1780317016 0 Nurse Practitioners Physician Services 00 1780317453 0 GANDHI AMIE 2022200 9999999 B 10 1780317453 0 111 E 4TH ST STE 440 ALTON IL 620026206 20 1780317453 0 Optometrists Optical Supplies 20 1780317453 0 Optometrists Optometric Services 20 1780317453 0 Optometrists Physician Services 00 1780318501 0 HASHIMOTO RINTARO 2022213 9999999 B 10 1780318501 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1780318501 0 Physicians Anesthesia Services 20 1780318501 0 Physicians Fluoride varnish 20 1780318501 0 Physicians Healthy Kids Services 20 1780318501 0 Physicians Optical Supplies 20 1780318501 0 Physicians Physician Services 00 1780319145 0 PATEL SHIVANI 2022325 9999999 B 10 1780319145 0 PO BOX 79591 BALTIMORE MD 212790591 20 1780319145 0 Optometrists Optical Supplies 20 1780319145 0 Optometrists Optometric Services 20 1780319145 0 Optometrists Physician Services 00 1780319715 0 BAUER KATLYN C 2024204 9999999 B 10 1780319715 0 29373 NETWORK PL CHICAGO IL 606733039 20 1780319715 0 Nurse Practitioners Fluoride varnish 20 1780319715 0 Nurse Practitioners Healthy Kids Services 20 1780319715 0 Nurse Practitioners Nurse Practitioners Services 20 1780319715 0 Nurse Practitioners Physician Services 00 1780319962 0 HUERTA ANAYELI 2024269 9999999 B 10 1780319962 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1780319962 0 Speech Therapists Medical Supplies 20 1780319962 0 Speech Therapists Medical equipment/prosthetic devices 20 1780319962 0 Speech Therapists Speech Therapy/Pathology Services 00 1780320028 0 VAUGHN KORIN ELISSE 2023013 9999999 B 10 1780320028 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1780320028 0 Physician Assistant Only Fluoride varnish 20 1780320028 0 Physician Assistant Only Healthy Kids Services 20 1780320028 0 Physician Assistant Only Physician Services 00 1780320606 0 MEYER SAMANTHA 2023045 9999999 B 10 1780320606 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1780320606 0 Physician Assistant Only Physician Services 00 1780320887 0 PRICE JUNE 2022235 9999999 B 10 1780320887 0 PO BOX 856 ANTIOCH IL 600020856 20 1780320887 0 Clinical Social Worker Social work service 00 1780321000 0 CHANG RACHEL S 2022178 9999999 B 10 1780321000 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1780321000 0 Physicians Anesthesia Services 20 1780321000 0 Physicians Fluoride varnish 20 1780321000 0 Physicians Healthy Kids Services 20 1780321000 0 Physicians Optical Supplies 20 1780321000 0 Physicians Physician Services 00 1780321547 0 BACHUL PIOTR J 2024254 9999999 B 10 1780321547 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1780321547 0 Physicians Anesthesia Services 20 1780321547 0 Physicians Healthy Kids Services 20 1780321547 0 Physicians Optical Supplies 20 1780321547 0 Physicians Physician Services 00 1780321703 0 TAYLOR SADARA 2022182 9999999 B 10 1780321703 0 1901 W HARRISON ST CHICAGO IN 60612 20 1780321703 0 Physicians Anesthesia Services 20 1780321703 0 Physicians Healthy Kids Services 20 1780321703 0 Physicians Optical Supplies 20 1780321703 0 Physicians Physician Services 00 1780322438 0 SCACCIANOCE BRIANA 2022229 9999999 H 10 1780322438 0 5404 W ELM ST STE H MCHENRY IL 600504007 20 1780322438 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1780322891 0 KHALID YOUSRA 2022214 9999999 B 10 1780322891 0 611 W PARK ST URBANA IL 618012529 20 1780322891 0 Physicians Anesthesia Services 20 1780322891 0 Physicians Fluoride varnish 20 1780322891 0 Physicians Healthy Kids Services 20 1780322891 0 Physicians Optical Supplies 20 1780322891 0 Physicians Physician Services 00 1780322925 0 DIXON ABBOTT 2023163 9999999 B 10 1780322925 0 7660 GROSS POINT RD SKOKIE IL 600772613 20 1780322925 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1780323717 0 MYLAVARAPU ROHAN 2024183 9999999 B 10 1780323717 0 4701 DEPT CAROL STREAM IL 601220021 20 1780323717 0 Physicians Anesthesia Services 20 1780323717 0 Physicians Fluoride varnish 20 1780323717 0 Physicians Healthy Kids Services 20 1780323717 0 Physicians Optical Supplies 20 1780323717 0 Physicians Physician Services 00 1780324152 0 DEL CASTILLO KRYSTAL L 2022231 9999999 B 10 1780324152 0 7825 SOLUTION CTR CHICAGO IL 606777007 20 1780324152 0 Physicians Anesthesia Services 20 1780324152 0 Physicians Healthy Kids Services 20 1780324152 0 Physicians Optical Supplies 20 1780324152 0 Physicians Physician Services 20 1780324152 0 Physicians Physicians Psychiatric Services 00 1780324806 0 TUMULURU PRIYA 2022200 9999999 B 10 1780324806 0 225 E CHICAGO 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Psychologist service 00 1780326652 0 RESHETAR JACOB C 2022239 9999999 B 10 1780326652 0 124 SW ADAMS ST PEORIA IL 616021308 20 1780326652 0 Physicians Anesthesia Services 20 1780326652 0 Physicians Healthy Kids Services 20 1780326652 0 Physicians Optical Supplies 20 1780326652 0 Physicians Physician Services 00 1780328047 0 PADI AKHILA 2024011 9999999 B 10 1780328047 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1780328047 0 Physicians Anesthesia Services 20 1780328047 0 Physicians Fluoride varnish 20 1780328047 0 Physicians Healthy Kids Services 20 1780328047 0 Physicians Optical Supplies 20 1780328047 0 Physicians Physician Services 00 1780328419 0 KATHURA AKSHAR 2023224 9999999 B 10 1780328419 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1780328419 0 Physicians Anesthesia Services 20 1780328419 0 Physicians Fluoride varnish 20 1780328419 0 Physicians Healthy Kids Services 20 1780328419 0 Physicians Optical Supplies 20 1780328419 0 Physicians Physician Services 00 1780329243 0 HERNANDEZ JOSE BIEN RAFAELO RA 2022175 9999999 B 10 1780329243 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1780329243 0 Physicians Anesthesia Services 20 1780329243 0 Physicians Healthy Kids Services 20 1780329243 0 Physicians Optical Supplies 20 1780329243 0 Physicians Physician Services 00 1780329953 0 AGWARAMGBO EZINNE U 2022175 9999999 B 10 1780329953 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1780329953 0 Physicians Anesthesia Services 20 1780329953 0 Physicians Fluoride varnish 20 1780329953 0 Physicians Healthy Kids Services 20 1780329953 0 Physicians Optical Supplies 20 1780329953 0 Physicians Physician Services 00 1780330670 0 KUTSCH SYDNEY 2022308 9999999 B 10 1780330670 0 29373 NETWORK PL CHICAGO IL 606733039 20 1780330670 0 Physician Assistant Only Fluoride varnish 20 1780330670 0 Physician Assistant Only Healthy Kids Services 20 1780330670 0 Physician Assistant Only Physician Services 00 1780331033 0 DHILLON DAVINDER K 2022157 9999999 B 10 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20 1780663609 0 Physicians Healthy Kids Services 20 1780663609 0 Physicians Optical Supplies 20 1780663609 0 Physicians Physician Services 00 1780663963 0 SIMPSON KAREEN 2001218 9999999 B 10 1780663963 0 210 S DESPLAINES ST CHICAGO IL 606615500 20 1780663963 0 Physicians Anesthesia Services 20 1780663963 0 Physicians Fluoride varnish 20 1780663963 0 Physicians Healthy Kids Services 20 1780663963 0 Physicians Optical Supplies 20 1780663963 0 Physicians Physician Services 00 1780664029 0 FRIAL-LOPEZ NORWIL 2012058 9999999 B 10 1780664029 0 8324 SKOKIE BLVD SKOKIE IL 600772545 20 1780664029 0 Psychologist Psychologist service 00 1780664342 0 PLAISIER BRIAN 2021011 9999999 B 10 1780664342 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1780664342 0 Physicians Anesthesia Services 20 1780664342 0 Physicians Healthy Kids Services 20 1780664342 0 Physicians Optical Supplies 20 1780664342 0 Physicians Physician Services 00 1780665901 0 YABLONSKY DAVID B 2006060 9999999 B 10 1780665901 0 6810 STATE ROUTE 162 STE 215 MARYVILLE IL 620628566 20 1780665901 0 Physicians Anesthesia Services 20 1780665901 0 Physicians Fluoride varnish 20 1780665901 0 Physicians Healthy Kids Services 20 1780665901 0 Physicians Optical Supplies 20 1780665901 0 Physicians Physician Services 00 1780666560 0 KELLEY WILLIAM 1998001 9999999 B 10 1780666560 0 PO BOX 208807 DALLAS TX 753208807 20 1780666560 0 Physicians Anesthesia Services 20 1780666560 0 Physicians Healthy Kids Services 20 1780666560 0 Physicians Optical Supplies 20 1780666560 0 Physicians Physician Services 00 1780668244 0 PATEL PARESH A 1996197 9999999 B 10 1780668244 0 1300 GREENBROOK BLVD STE 204 HANOVER PARK IL 601335456 20 1780668244 0 Physicians Anesthesia Services 20 1780668244 0 Physicians Healthy Kids Services 20 1780668244 0 Physicians Optical Supplies 20 1780668244 0 Physicians Physician Services 00 1780668251 0 LANG JAMES 1990182 9999999 B 10 1780668251 0 PO BOX 21844 BELFAST ME 049154115 20 1780668251 0 Physicians All Kids 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BOX 843151 KANSAS CITY MO 641843151 20 1780792911 0 Physicians Anesthesia Services 20 1780792911 0 Physicians Healthy Kids Services 20 1780792911 0 Physicians Optical Supplies 20 1780792911 0 Physicians Physician Services 00 1780793737 0 DIAZ JUAN F 1985182 9999999 B 10 1780793737 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1780793737 0 Physicians Anesthesia Services 20 1780793737 0 Physicians Fluoride varnish 20 1780793737 0 Physicians Healthy Kids Services 20 1780793737 0 Physicians Optical Supplies 20 1780793737 0 Physicians Physician Services 00 1780793869 0 BALLINGER SUSAN R 1994213 9999999 B 10 1780793869 0 PO BOX 778912 CHICAGO IL 606778912 20 1780793869 0 Physicians Anesthesia Services 20 1780793869 0 Physicians Fluoride varnish 20 1780793869 0 Physicians Healthy Kids Services 20 1780793869 0 Physicians Optical Supplies 20 1780793869 0 Physicians Physician Services 00 1780795724 0 BERGELSON BRUCE A 1991182 9999999 B 10 1780795724 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 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Physicians Anesthesia Services 20 1780799387 0 Physicians Fluoride varnish 20 1780799387 0 Physicians Healthy Kids Services 20 1780799387 0 Physicians Optical Supplies 20 1780799387 0 Physicians Physician Services 00 1780800391 0 VALLE JOSE 1993182 9999999 B 10 1780800391 0 800 KIRTS BLVD STE 650 TROY MI 480844878 20 1780800391 0 Dentists Dental Services 20 1780800391 0 Dentists Physician Services 00 1780802579 0 FUNNEL AMY 2007125 9999999 B 10 1780802579 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1780802579 0 Audiologists Audiology Services 20 1780802579 0 Audiologists Medical Supplies 20 1780802579 0 Audiologists Medical equipment/prosthetic devices 00 1780802991 0 TURNER MELISSA 2010238 9999999 B 10 1780802991 0 1614 W CENTRAL RD STE 209 ARLINGTON HEIGH IL 600052453 20 1780802991 0 Physicians Anesthesia Services 20 1780802991 0 Physicians Fluoride varnish 20 1780802991 0 Physicians Healthy Kids Services 20 1780802991 0 Physicians Optical Supplies 20 1780802991 0 Physicians Physician Services 00 1780804930 0 FREEMAN BRUCE J 2014357 9999999 B 10 1780804930 0 611 W PARK ST URBANA IL 618012529 20 1780804930 0 Clinical Social Worker Social work service 00 1780806448 0 KLESKEN DEBORAH 2020310 9999999 B 10 1780806448 0 1415 PALATINE RD HOFFMAN ESTATES IL 601921196 20 1780806448 0 Optometrists Optical Supplies 20 1780806448 0 Optometrists Optometric Services 20 1780806448 0 Optometrists Physician Services 00 1780806539 0 HOGDEN CANDICE R 2012142 9999999 B 10 1780806539 0 2560 24TH ST STE 101 ROCK ISLAND IL 612015389 20 1780806539 0 Other behavior health professional LCPC/LMFT services 00 1780806968 0 STONE MELISSA 2024303 9999999 B 10 1780806968 0 1044 N FRANCISCO AVE CHICAGO IL 606222743 20 1780806968 0 Physicians Anesthesia Services 20 1780806968 0 Physicians Healthy Kids Services 20 1780806968 0 Physicians Optical Supplies 20 1780806968 0 Physicians Physician Services 00 1780807222 0 HORTENSTINE-GROHLER JENNIFER 2020076 9999999 B 10 1780807222 0 611 W PARK ST 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DR STE SAINT LOUIS MO 631418512 20 1790109247 0 Physicians Anesthesia Services 20 1790109247 0 Physicians Fluoride varnish 20 1790109247 0 Physicians Healthy Kids Services 20 1790109247 0 Physicians Optical Supplies 20 1790109247 0 Physicians Physician Services 00 1790111490 0 WINSTON LAUREAN J 2021085 9999999 B 10 1790111490 0 210 W MCKINLEY AVE STE 1 DECATUR IL 625265858 20 1790111490 0 Physician Assistant Only Fluoride varnish 20 1790111490 0 Physician Assistant Only Healthy Kids Services 20 1790111490 0 Physician Assistant Only Physician Services 00 1790111508 0 AMBROSE MATTHEW 2023097 9999999 B 10 1790111508 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1790111508 0 Physical Therapists Medical Supplies 20 1790111508 0 Physical Therapists Medical equipment/prosthetic devices 20 1790111508 0 Physical Therapists Physical Therapy Services 00 1790111631 0 MCCOY RICHARD L 2017223 9999999 B 10 1790111631 0 645 MCHENRY AVE WOODSTOCK IL 600982922 20 1790111631 0 Other behavior health professional LCPC/LMFT services 00 1790112050 0 PETERSON ERIC L 2017088 9999999 B 10 1790112050 0 PO BOX 28900 GREEN BAY WI 543240900 20 1790112050 0 Nurse Practitioners Fluoride varnish 20 1790112050 0 Nurse Practitioners Healthy Kids Services 20 1790112050 0 Nurse Practitioners Nurse Practitioners Services 20 1790112050 0 Nurse Practitioners Physician Services 00 1790112258 0 STEINGRABER-PHARR MAGGIE S 2014034 9999999 B 10 1790112258 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1790112258 0 Nurse Practitioners Fluoride varnish 20 1790112258 0 Nurse Practitioners Healthy Kids Services 20 1790112258 0 Nurse Practitioners Nurse Practitioners Services 20 1790112258 0 Nurse Practitioners Physician Services 00 1790112274 0 WELLER CAITLIN ANNE 2015348 9999999 B 10 1790112274 0 3040 W SALT CREEK LN ARLINGTON HEIGH IL 600051069 20 1790112274 0 Physician Assistant Only Fluoride varnish 20 1790112274 0 Physician Assistant Only Healthy Kids Services 20 1790112274 0 Physician Assistant Only Physician Services 00 1790113793 0 SCHRAMKE KIMBERLY 2013294 9999999 B 10 1790113793 0 316 E FRANKLIN ST DU QUOIN IL 628322302 20 1790113793 0 Nurse Practitioners Fluoride varnish 20 1790113793 0 Nurse Practitioners Healthy Kids Services 20 1790113793 0 Nurse Practitioners Nurse Practitioners Services 20 1790113793 0 Nurse Practitioners Physician Services 00 1790114601 0 MARINARO JENNIFER 2014236 9999999 B 10 1790114601 0 387 SHUMAN BLVD STE 275 NAPERVILLE IL 605638450 20 1790114601 0 Nurse Practitioners Anesthesia Services 20 1790114601 0 Nurse Practitioners Nurse Practitioners Services 20 1790114601 0 Nurse Practitioners Physician Services 00 1790115293 0 MEYERS STACEY M 2022229 9999999 B 10 1790115293 0 5777 DEPT CAROL STREAM IL 601220021 20 1790115293 0 Nurse Practitioners Healthy Kids Services 20 1790115293 0 Nurse Practitioners Nurse Practitioners Services 20 1790115293 0 Nurse Practitioners Physician Services 00 1790116481 0 KORTH KATHRYN A 2018169 9999999 B 10 1790116481 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1790116481 0 Clinical Social Worker Social work service 00 1790117422 0 ROCK CAITLIN S 2013221 9999999 B 10 1790117422 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1790117422 0 Audiologists Audiology Services 20 1790117422 0 Audiologists Medical Supplies 20 1790117422 0 Audiologists Medical equipment/prosthetic devices 00 1790117703 0 WINGENDER LAUREN 2024305 9999999 B 10 1790117703 0 302 N JACKSON ST MILWAUKEE WI 532025904 20 1790117703 0 Nurse Practitioners Healthy Kids Services 20 1790117703 0 Nurse Practitioners Nurse Practitioners Services 20 1790117703 0 Nurse Practitioners Physician Services 00 1790118370 0 FORSBERG AMY 2016001 9999999 B 10 1790118370 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1790118370 0 Physician Assistant Only Fluoride varnish 20 1790118370 0 Physician Assistant Only Healthy Kids Services 20 1790118370 0 Physician Assistant Only Physician Services 00 1790118586 0 KOVALASKE ANASTASIA 2016150 9999999 B 10 1790118586 0 1401 EASTLAND DR STE B BLOOMINGTON IL 617013553 20 1790118586 0 Nurse Practitioners Healthy Kids Services 20 1790118586 0 Nurse Practitioners Nurse Practitioners Services 20 1790118586 0 Nurse Practitioners Physician Services 00 1790120012 0 AHSAN SUNDUS 2019094 9999999 B 10 1790120012 0 PO BOX 778791 CHICAGO IL 606776473 20 1790120012 0 Physician Assistant Only Fluoride varnish 20 1790120012 0 Physician Assistant Only Healthy Kids Services 20 1790120012 0 Physician Assistant Only Physician Services 00 1790120293 0 KILGORE KELLI M 2017188 9999999 B 10 1790120293 0 22285 N PEPPER RD STE 111 SUITE 111 LAKE BARRINGTON IL 600102539 20 1790120293 0 Physicians Anesthesia Services 20 1790120293 0 Physicians Healthy Kids Services 20 1790120293 0 Physicians Optical Supplies 20 1790120293 0 Physicians Physician Services 00 1790120574 0 GUILD RACHEL W 2021218 9999999 B 10 1790120574 0 5777 DEPT CAROL STREAM IL 601228942 20 1790120574 0 Physicians Anesthesia Services 20 1790120574 0 Physicians Healthy Kids Services 20 1790120574 0 Physicians Optical Supplies 20 1790120574 0 Physicians Physician Services 00 1790120673 0 BROKAW NANETTE H 2017034 9999999 B 10 1790120673 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1790120673 0 Nurse Practitioners Fluoride varnish 20 1790120673 0 Nurse Practitioners Healthy Kids Services 20 1790120673 0 Nurse Practitioners Nurse Practitioners Services 20 1790120673 0 Nurse Practitioners Physician Services 00 1790121663 0 MCSORLEY ASHLEY L 2018152 9999999 B 10 1790121663 0 2414 KOHLER MEMORIAL DR SHEBOYGAN WI 530813129 20 1790121663 0 Physicians Anesthesia Services 20 1790121663 0 Physicians Healthy Kids Services 20 1790121663 0 Physicians Optical Supplies 20 1790121663 0 Physicians Physician Services 00 1790122125 0 WICKS JENNIFER 2016183 9999999 B 10 1790122125 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1790122125 0 Physicians Anesthesia Services 20 1790122125 0 Physicians Healthy Kids Services 20 1790122125 0 Physicians Optical Supplies 20 1790122125 0 Physicians Physician Services 00 1790122935 0 OURANOS HOSSEIN 2024276 9999999 B 10 1790122935 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1790122935 0 Physicians Anesthesia Services 20 1790122935 0 Physicians Fluoride varnish 20 1790122935 0 Physicians Healthy Kids Services 20 1790122935 0 Physicians Optical Supplies 20 1790122935 0 Physicians Physician Services 00 1790124709 0 FARRIS RYAN 2013175 9999999 B 10 1790124709 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1790124709 0 Audiologists Audiology Services 20 1790124709 0 Audiologists Medical Supplies 20 1790124709 0 Audiologists Medical equipment/prosthetic devices 00 1790125193 0 VORIS JOHN 2016291 9999999 B 10 1790125193 0 600 FAYETTE ST PEORIA IL 616033610 20 1790125193 0 Physicians Anesthesia Services 20 1790125193 0 Physicians Fluoride varnish 20 1790125193 0 Physicians Healthy Kids Services 20 1790125193 0 Physicians Optical Supplies 20 1790125193 0 Physicians Physician Services 00 1790125318 0 VADDI SUMAN 2019281 9999999 B 10 1790125318 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1790125318 0 Physicians Anesthesia Services 20 1790125318 0 Physicians Fluoride varnish 20 1790125318 0 Physicians Healthy Kids Services 20 1790125318 0 Physicians Optical Supplies 20 1790125318 0 Physicians Physician Services 00 1790125367 0 PEREIRA RODRIGUES OTAVIO 2020223 9999999 B 10 1790125367 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1790125367 0 Physicians Anesthesia Services 20 1790125367 0 Physicians Fluoride varnish 20 1790125367 0 Physicians Healthy Kids Services 20 1790125367 0 Physicians Optical Supplies 20 1790125367 0 Physicians Physician Services 00 1790125474 0 RAJASINGAM NIROSUTHAN 2016354 9999999 B 10 1790125474 0 PO BOX 34098 LOUISVILLE KY 402324098 20 1790125474 0 Physicians Anesthesia Services 20 1790125474 0 Physicians Fluoride varnish 20 1790125474 0 Physicians Healthy Kids Services 20 1790125474 0 Physicians Optical Supplies 20 1790125474 0 Physicians Physician Services 00 1790125771 0 DAI YUE 2018184 9999999 B 10 1790125771 0 7725 W RENO AVE OKLAHOMA CITY OK 731279711 20 1790125771 0 Physicians Anesthesia Services 20 1790125771 0 Physicians Healthy Kids Services 20 1790125771 0 Physicians Optical Supplies 20 1790125771 0 Physicians Physician Services 00 1790125870 0 CATANA MACOVEI ALINA 2015054 9999999 B 10 1790125870 0 1276 N CLYBOURN AVE CHICAGO IL 606102089 20 1790125870 0 Dentists Dental Services 20 1790125870 0 Dentists Physician Services 00 1790128098 0 MAIRURA LINAH KWAMBOKA 2024351 9999999 B 10 1790128098 0 800 E LOCUST ST OLNEY IL 624502553 20 1790128098 0 Physicians Anesthesia Services 20 1790128098 0 Physicians Fluoride varnish 20 1790128098 0 Physicians Healthy Kids Services 20 1790128098 0 Physicians Optical Supplies 20 1790128098 0 Physicians Physician Services 00 1790128387 0 CHURCH DANE J 2019164 9999999 B 10 1790128387 0 1301 S KOKE MILL RD SPRINGFIELD IL 627119252 20 1790128387 0 Physicians Anesthesia Services 20 1790128387 0 Physicians Healthy Kids Services 20 1790128387 0 Physicians Optical Supplies 20 1790128387 0 Physicians Physician Services 00 1790128502 0 TAJAMMUL WASEEMA 2016153 9999999 B 10 1790128502 0 PO BOX 776473 CHICAGO IL 606776473 20 1790128502 0 Nurse Practitioners Fluoride varnish 20 1790128502 0 Nurse Practitioners Healthy Kids Services 20 1790128502 0 Nurse Practitioners Nurse Practitioners Services 20 1790128502 0 Nurse Practitioners Physician Services 00 1790129195 0 ELLIS NICOLA 2017353 9999999 B 10 1790129195 0 5730 W ROOSEVELT RD CHICAGO IL 606441580 20 1790129195 0 Clinical Social Worker Social work service 00 1790129526 0 CH''ANG JUDY H 2023342 9999999 B 10 1790129526 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1790129526 0 Physicians Anesthesia Services 20 1790129526 0 Physicians Healthy Kids Services 20 1790129526 0 Physicians Optical Supplies 20 1790129526 0 Physicians Physician Services 20 1790129526 0 Physicians Physicians Psychiatric Services 00 1790130078 0 LOVIK KIMBERLY 2023208 9999999 B 10 1790130078 0 PO BOX 43230 PHOENIX AZ 850803230 20 1790130078 0 Physicians Anesthesia Services 20 1790130078 0 Physicians Healthy Kids Services 20 1790130078 0 Physicians Optical Supplies 20 1790130078 0 Physicians Physician Services 00 1790131134 0 COLAIANNI LOUIS 2021122 9999999 B 10 1790131134 0 350 BONAR AVE WAYNESBURG PA 153701608 20 1790131134 0 Physicians Anesthesia Services 20 1790131134 0 Physicians Healthy Kids Services 20 1790131134 0 Physicians Optical Supplies 20 1790131134 0 Physicians Physician Services 00 1790131753 0 PATEL KRISHNA 2018182 9999999 B 10 1790131753 0 903 COMMERCE DR STE 333 OAK BROOK IL 605238723 20 1790131753 0 Physicians Anesthesia Services 20 1790131753 0 Physicians Healthy Kids Services 20 1790131753 0 Physicians Optical Supplies 20 1790131753 0 Physicians Physician Services 00 1790131779 0 DERBAS LAITH A 2020190 9999999 B 10 1790131779 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1790131779 0 Physicians Anesthesia Services 20 1790131779 0 Physicians Fluoride varnish 20 1790131779 0 Physicians Healthy Kids Services 20 1790131779 0 Physicians Optical Supplies 20 1790131779 0 Physicians Physician Services 00 1790132959 0 GORDON JASON R 2019121 9999999 B 10 1790132959 0 PO BOX 4195 SAN DIMAS CA 917738195 20 1790132959 0 Physicians Anesthesia Services 20 1790132959 0 Physicians Healthy Kids Services 20 1790132959 0 Physicians Optical Supplies 20 1790132959 0 Physicians Physician Services 00 1790133288 0 KLEIN MICHAEL W 2019249 9999999 B 10 1790133288 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1790133288 0 Physicians Anesthesia Services 20 1790133288 0 Physicians Fluoride varnish 20 1790133288 0 Physicians Healthy Kids Services 20 1790133288 0 Physicians Optical Supplies 20 1790133288 0 Physicians Physician Services 00 1790133296 0 LINDBERG COREY 2021347 9999999 B 10 1790133296 0 PO BOX 2777 BOISE ID 837012777 20 1790133296 0 Physicians Anesthesia Services 20 1790133296 0 Physicians Healthy Kids Services 20 1790133296 0 Physicians Optical Supplies 20 1790133296 0 Physicians Physician Services 00 1790133429 0 KHATTAK ANMOL SABA 2016153 9999999 B 10 1790133429 0 5777 DEPT CAROL STREAM IL 601220021 20 1790133429 0 Physicians Anesthesia Services 20 1790133429 0 Physicians Fluoride varnish 20 1790133429 0 Physicians Healthy Kids Services 20 1790133429 0 Physicians Optical Supplies 20 1790133429 0 Physicians Physician Services 00 1790134039 0 SWIDERSKA DOROTHEA 2017121 9999999 B 10 1790134039 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1790134039 0 Clinical Social Worker Social work service 00 1790134096 0 OSTERGAARD PETER J 2022220 9999999 B 10 1790134096 0 5777 DEPT CAROL STREAM IL 601220021 20 1790134096 0 Physicians Anesthesia Services 20 1790134096 0 Physicians Healthy Kids Services 20 1790134096 0 Physicians Optical Supplies 20 1790134096 0 Physicians Physician Services 00 1790134120 0 FLORES GONZALEZ JUAN R 2023283 9999999 B 10 1790134120 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1790134120 0 Physicians Anesthesia Services 20 1790134120 0 Physicians Healthy Kids Services 20 1790134120 0 Physicians Optical Supplies 20 1790134120 0 Physicians Physician Services 00 1790134377 0 SHAH MAULI K 2022005 9999999 B 10 1790134377 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1790134377 0 Physicians Anesthesia Services 20 1790134377 0 Physicians Healthy Kids Services 20 1790134377 0 Physicians Optical Supplies 20 1790134377 0 Physicians Physician Services 00 1790135499 0 ABDULNABI ZAKARIA 2019001 9999999 B 10 1790135499 0 611 W PARK ST URBANA IL 618012529 20 1790135499 0 Physicians Anesthesia Services 20 1790135499 0 Physicians Healthy Kids Services 20 1790135499 0 Physicians Optical Supplies 20 1790135499 0 Physicians Physician Services 00 1790135762 0 DONG ROBIN 2023345 9999999 B 10 1790135762 0 PO BOX 32861 CHARLOTTE NC 282322861 20 1790135762 0 Physicians Anesthesia Services 20 1790135762 0 Physicians Healthy Kids Services 20 1790135762 0 Physicians Optical Supplies 20 1790135762 0 Physicians Physician Services 00 1790136455 0 MATHEWS RYAN R 2017088 9999999 B 10 1790136455 0 PO BOX 28900 GREEN BAY WI 543240900 20 1790136455 0 Nurse Practitioners Anesthesia Services 20 1790136455 0 Nurse Practitioners Nurse Practitioners Services 20 1790136455 0 Nurse Practitioners Physician Services 00 1790136927 0 WISER ROBERT 2023358 9999999 B 10 1790136927 0 1324 LAKELAND HILLS BLVD LAKELAND FL 338054543 20 1790136927 0 Physicians Anesthesia Services 20 1790136927 0 Physicians Fluoride varnish 20 1790136927 0 Physicians Healthy Kids Services 20 1790136927 0 Physicians Optical Supplies 20 1790136927 0 Physicians Physician Services 00 1790137156 0 POMAGIER KRISTINA 2019095 9999999 B 10 1790137156 0 5404 W ELM ST STE H MCHENRY IL 600504007 20 1790137156 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1790137545 0 JANG ADRIANNA 2018339 9999999 B 10 1790137545 0 5917 S PULASKI RD CHICAGO IL 606294515 20 1790137545 0 Dentists Dental Services 20 1790137545 0 Dentists Physician Services 00 1790138451 0 WAJE MELESSE B 2019196 9999999 B 10 1790138451 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1790138451 0 Physicians Anesthesia Services 20 1790138451 0 Physicians Healthy Kids Services 20 1790138451 0 Physicians Optical Supplies 20 1790138451 0 Physicians Physician Services 00 1790138964 0 EDWARDS CINDY N 2016221 9999999 B 10 1790138964 0 520 N RIDGEWAY AVE CHICAGO IL 606241232 20 1790138964 0 Nurse Practitioners Healthy Kids Services 20 1790138964 0 Nurse Practitioners Nurse Practitioners Services 20 1790138964 0 Nurse Practitioners Physician Services 00 1790139269 0 RAY JOCELYN 2021215 9999999 B 10 1790139269 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1790139269 0 Physicians Anesthesia Services 20 1790139269 0 Physicians Healthy Kids Services 20 1790139269 0 Physicians Optical Supplies 20 1790139269 0 Physicians Physician Services 00 1790139384 0 FORD JENNA N 2016175 9999999 B 10 1790139384 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1790139384 0 Nurse Practitioners Fluoride varnish 20 1790139384 0 Nurse Practitioners Healthy Kids Services 20 1790139384 0 Nurse Practitioners Nurse Practitioners Services 20 1790139384 0 Nurse Practitioners Physician Services 00 1790140093 0 WARREN MATTHEW 2023284 9999999 B 10 1790140093 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1790140093 0 Occupational Therapists Medical Supplies 20 1790140093 0 Occupational Therapists Medical equipment/prosthetic devices 20 1790140093 0 Occupational Therapists Occupational Therapy Services 00 1790140580 0 ENGELS-ARTEAGA CAITLIN J 2016032 9999999 B 10 1790140580 0 800 W FULTON MARKET FL 12 CHICAGO IL 606071302 20 1790140580 0 Physician Assistant Only Fluoride varnish 20 1790140580 0 Physician Assistant Only Healthy Kids Services 20 1790140580 0 Physician Assistant Only Physician Services 00 1790140911 0 DOERFLER MATTHEW 2019268 9999999 B 10 1790140911 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1790140911 0 Physicians Anesthesia Services 20 1790140911 0 Physicians Fluoride varnish 20 1790140911 0 Physicians Healthy Kids Services 20 1790140911 0 Physicians Optical Supplies 20 1790140911 0 Physicians Physician Services 00 1790141083 0 THOMPSON VICTORIA G 2018174 9999999 B 10 1790141083 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1790141083 0 Nurse Practitioners Fluoride varnish 20 1790141083 0 Nurse Practitioners Healthy Kids Services 20 1790141083 0 Nurse Practitioners Nurse Practitioners Services 20 1790141083 0 Nurse Practitioners Physician Services 00 1790142164 0 FINK MALLORY 2022018 9999999 B 10 1790142164 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1790142164 0 Nurse Practitioners Anesthesia Services 20 1790142164 0 Nurse Practitioners Nurse Practitioners Services 20 1790142164 0 Nurse Practitioners Physician Services 00 1790143790 0 SHEETS TRACY A 2017200 9999999 B 10 1790143790 0 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1790280881 0 Physicians Fluoride varnish 20 1790280881 0 Physicians Healthy Kids Services 20 1790280881 0 Physicians Optical Supplies 20 1790280881 0 Physicians Physician Services 00 1790282796 0 BIGELOW BEAU M 2019289 9999999 B 10 1790282796 0 1S450 SUMMIT AVE STE 270 OAKBROOK TERRAC IL 601813959 20 1790282796 0 Physicians Anesthesia Services 20 1790282796 0 Physicians Healthy Kids Services 20 1790282796 0 Physicians Optical Supplies 20 1790282796 0 Physicians Physician Services 00 1790282937 0 CARNEY LISA L 2018155 9999999 B 10 1790282937 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1790282937 0 Nurse Practitioners Healthy Kids Services 20 1790282937 0 Nurse Practitioners Nurse Practitioners Services 20 1790282937 0 Nurse Practitioners Physician Services 00 1790284487 0 CAPPARELLI DANIEL 2018043 9999999 B 10 1790284487 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1790284487 0 Physical Therapists Medical Supplies 20 1790284487 0 Physical Therapists Medical equipment/prosthetic devices 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Only Fluoride varnish 20 1790288595 0 Physician Assistant Only Healthy Kids Services 20 1790288595 0 Physician Assistant Only Physician Services 00 1790289361 0 REID BENJAMIN 2018182 9999999 B 10 1790289361 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1790289361 0 Physicians Anesthesia Services 20 1790289361 0 Physicians Fluoride varnish 20 1790289361 0 Physicians Healthy Kids Services 20 1790289361 0 Physicians Optical Supplies 20 1790289361 0 Physicians Physician Services 00 1790290385 0 LYMAN ANNA 2017355 9999999 B 10 1790290385 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1790290385 0 Other behavior health professional All Kids application agent 20 1790290385 0 Other behavior health professional LCPC/LMFT services 00 1790290765 0 NELSON ERINN 2017352 9999999 B 10 1790290765 0 600 N MORROW ST PONTIAC IL 617641451 20 1790290765 0 Speech Therapists Medical Supplies 20 1790290765 0 Speech Therapists Medical equipment/prosthetic devices 20 1790290765 0 Speech Therapists Speech 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ST ROCK ISLAND IL 612016746 20 1790293181 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1790294403 0 KNEIP SARAH E 2017277 9999999 B 10 1790294403 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1790294403 0 Nurse Practitioners Fluoride varnish 20 1790294403 0 Nurse Practitioners Healthy Kids Services 20 1790294403 0 Nurse Practitioners Nurse Practitioners Services 20 1790294403 0 Nurse Practitioners Physician Services 00 1790294684 0 DAHMS KELLY J 2017275 9999999 B 10 1790294684 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1790294684 0 Nurse Practitioners Fluoride varnish 20 1790294684 0 Nurse Practitioners Healthy Kids Services 20 1790294684 0 Nurse Practitioners Physician Services 00 1790295178 0 GODFREY JOAQUIM 2017321 9999999 B 10 1790295178 0 350 W 154TH ST SOUTH HOLLAND IL 604731229 20 1790295178 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1790295301 0 PETERS MORGAN C 2017282 9999999 B 10 1790295301 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1790295301 0 Physician Assistant Only Fluoride varnish 20 1790295301 0 Physician Assistant Only Healthy Kids Services 20 1790295301 0 Physician Assistant Only Physician Services 00 1790295871 0 STEWART TATUM M 2017277 9999999 B 10 1790295871 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1790295871 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1790295871 0 Other behavior health professional Social work service 00 1790295921 0 WAHL KIMBERLY A 2020234 9999999 B 10 1790295921 0 PO BOX 3990 NAPERVILLE IL 605673990 20 1790295921 0 Speech Therapists Medical Supplies 20 1790295921 0 Speech Therapists Medical equipment/prosthetic devices 20 1790295921 0 Speech Therapists Speech Therapy/Pathology Services 00 1790297331 0 DEGRAVE JULI M 2018310 9999999 B 10 1790297331 0 6308 8TH AVE KENOSHA WI 531435031 20 1790297331 0 Nurse Practitioners Fluoride varnish 20 1790297331 0 Nurse Practitioners Healthy Kids Services 20 1790297331 0 Nurse Practitioners Nurse Practitioners Services 20 1790297331 0 Nurse Practitioners Physician Services 00 1790297463 0 RICHARDSON ROSALINE 2018274 9999999 B 10 1790297463 0 PO BOX 1239 TROY MI 480991239 20 1790297463 0 Nurse Practitioners Fluoride varnish 20 1790297463 0 Nurse Practitioners Healthy Kids Services 20 1790297463 0 Nurse Practitioners Nurse Practitioners Services 20 1790297463 0 Nurse Practitioners Physician Services 00 1790297562 0 BYRD KRISTINA M 2017296 9999999 B 10 1790297562 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1790297562 0 Clinical Social Worker Social work service 00 1790297703 0 LOTHE ANGELA 2023289 9999999 B 10 1790297703 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1790297703 0 Nurse Practitioners Healthy Kids Services 20 1790297703 0 Nurse Practitioners Nurse Practitioners Services 20 1790297703 0 Nurse Practitioners Physician Services 00 1790297794 0 JACQUES KRISTIANNA 2022251 9999999 B 10 1790297794 0 1551 BOND ST STE 151 NAPERVILLE IL 605630137 20 1790297794 0 Other behavior health professional LCPC/LMFT services 00 1790298636 0 HAUSLER LINDA M 2017319 9999999 B 10 1790298636 0 2900 OGDEN AVE LISLE IL 605321676 20 1790298636 0 Speech Therapists Medical Supplies 20 1790298636 0 Speech Therapists Medical equipment/prosthetic devices 20 1790298636 0 Speech Therapists Speech Therapy/Pathology Services 00 1790300358 0 IQBAL SARA FATIMA 2021187 9999999 B 10 1790300358 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1790300358 0 Physicians Anesthesia Services 20 1790300358 0 Physicians Healthy Kids Services 20 1790300358 0 Physicians Optical Supplies 20 1790300358 0 Physicians Physician Services 00 1790300515 0 ROGERS TYSON R 2020178 9999999 B 10 1790300515 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1790300515 0 Nurse Practitioners Anesthesia Services 20 1790300515 0 Nurse Practitioners Nurse Practitioners Services 20 1790300515 0 Nurse Practitioners Physician Services 00 1790301000 0 QUICK SAMANTHA 2023180 9999999 B 10 1790301000 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1790301000 0 Physical Therapists Medical Supplies 20 1790301000 0 Physical Therapists Medical equipment/prosthetic devices 20 1790301000 0 Physical Therapists Physical Therapy Services 00 1790301232 0 KNETZER MEGAN SAMANTHA 2021319 9999999 B 10 1790301232 0 6810 STATE ROUTE 162 STE 215 MARYVILLE IL 620628566 20 1790301232 0 Nurse Practitioners Fluoride varnish 20 1790301232 0 Nurse Practitioners Healthy Kids Services 20 1790301232 0 Nurse Practitioners Nurse Practitioners Services 20 1790301232 0 Nurse Practitioners Physician Services 00 1790301331 0 EGUIA CLAUDYN 2020275 9999999 B 10 1790301331 0 900 W IL ROUTE 22 STE 100 LAKE ZURICH IL 600473416 20 1790301331 0 Nurse Practitioners Fluoride varnish 20 1790301331 0 Nurse Practitioners Healthy Kids Services 20 1790301331 0 Nurse Practitioners Nurse Practitioners Services 20 1790301331 0 Nurse Practitioners Physician Services 00 1790301521 0 ORR JONAH P 2020333 9999999 B 10 1790301521 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1790301521 0 Physicians Anesthesia Services 20 1790301521 0 Physicians Healthy Kids Services 20 1790301521 0 Physicians Optical Supplies 20 1790301521 0 Physicians Physician Services 00 1790302370 0 DEMSKI SABRINA 2021039 9999999 B 10 1790302370 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1790302370 0 Physical Therapists Medical Supplies 20 1790302370 0 Physical Therapists Medical equipment/prosthetic devices 20 1790302370 0 Physical Therapists Physical Therapy Services 00 1790303493 0 NUGENT CAROLINE G 2020287 9999999 B 10 1790303493 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1790303493 0 Physicians Anesthesia Services 20 1790303493 0 Physicians Fluoride varnish 20 1790303493 0 Physicians Healthy Kids Services 20 1790303493 0 Physicians Optical Supplies 20 1790303493 0 Physicians Physician Services 00 1790303824 0 HOCK JAMES G 2021286 9999999 B 10 1790303824 0 200 W MONROE ST STE 1150 CHICAGO IL 606065036 20 1790303824 0 Clinical Social Worker Social work service 00 1790304095 0 SLEBODNICK LAUREN J 2022177 9999999 B 10 1790304095 0 30 LOCUST ST NORTHAMPTON MA 010602052 20 1790304095 0 Physician Assistant Only Fluoride varnish 20 1790304095 0 Physician Assistant Only Healthy Kids Services 20 1790304095 0 Physician Assistant Only Physician Services 00 1790304178 0 STEFANITSIS CHRISTINA 2023102 9999999 B 10 1790304178 0 2001 BUTTERFIELD RD STE 1600 DOWNERS GROVE IL 605151211 20 1790304178 0 Physical Therapists Medical Supplies 20 1790304178 0 Physical Therapists Medical equipment/prosthetic devices 20 1790304178 0 Physical Therapists Physical Therapy Services 00 1790304327 0 GLAIT LYALL 2020232 9999999 B 10 1790304327 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1790304327 0 Physicians Anesthesia Services 20 1790304327 0 Physicians Fluoride varnish 20 1790304327 0 Physicians Healthy Kids Services 20 1790304327 0 Physicians Optical Supplies 20 1790304327 0 Physicians Physician Services 00 1790304657 0 MAJEED MEHR AMER 2022278 9999999 B 10 1790304657 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1790304657 0 Physicians Anesthesia Services 20 1790304657 0 Physicians Fluoride varnish 20 1790304657 0 Physicians Healthy Kids Services 20 1790304657 0 Physicians Optical Supplies 20 1790304657 0 Physicians Physician Services 00 1790305563 0 DERDER JADE 2020120 9999999 B 10 1790305563 0 611 W PARK ST BWPC URBANA IL 618012529 20 1790305563 0 Physical Therapists Medical Supplies 20 1790305563 0 Physical Therapists Medical equipment/prosthetic devices 20 1790305563 0 Physical Therapists Physical Therapy Services 00 1790305704 0 TKACZYK EVAN D 2022006 9999999 B 10 1790305704 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1790305704 0 Physician Assistant Only Fluoride varnish 20 1790305704 0 Physician Assistant Only Healthy Kids Services 20 1790305704 0 Physician Assistant Only Physician Services 00 1790307387 0 DIXON BRETT K 2020184 9999999 B 10 1790307387 0 29373 NETWORK PL CHICAGO IL 606733039 20 1790307387 0 Physician Assistant Only Fluoride varnish 20 1790307387 0 Physician Assistant Only Healthy Kids Services 20 1790307387 0 Physician Assistant Only Physician Services 00 1790307858 0 EZURIKE NWAMAKA 2020183 9999999 B 10 1790307858 0 29373 NETWORK PL CHICAGO IL 606733039 20 1790307858 0 Physicians Anesthesia Services 20 1790307858 0 Physicians Fluoride varnish 20 1790307858 0 Physicians Healthy Kids Services 20 1790307858 0 Physicians Optical Supplies 20 1790307858 0 Physicians Physician Services 00 1790308161 0 HEIRONIMUS SUE A 2022145 9999999 B 10 1790308161 0 29373 NETWORK PL CHICAGO IL 606733039 20 1790308161 0 Physician Assistant Only Fluoride varnish 20 1790308161 0 Physician Assistant Only Healthy Kids Services 20 1790308161 0 Physician Assistant Only Physician Services 00 1790308658 0 WILSON PILLON AUSTIN 2024233 9999999 B 10 1790308658 0 PO BOX 5081 JANESVILLE WI 535475081 20 1790308658 0 Physicians Anesthesia Services 20 1790308658 0 Physicians Fluoride varnish 20 1790308658 0 Physicians Healthy Kids Services 20 1790308658 0 Physicians Optical Supplies 20 1790308658 0 Physicians Physician Services 00 1790308948 0 MERENDA CHRISTINA 2024218 9999999 B 10 1790308948 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1790308948 0 Physicians Anesthesia Services 20 1790308948 0 Physicians Healthy Kids Services 20 1790308948 0 Physicians Optical Supplies 20 1790308948 0 Physicians Physician Services 20 1790308948 0 Physicians Physicians Psychiatric Services 00 1790309847 0 IRVING SAMUEL 2023209 9999999 B 10 1790309847 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1790309847 0 Physicians Anesthesia Services 20 1790309847 0 Physicians Healthy Kids Services 20 1790309847 0 Physicians Optical Supplies 20 1790309847 0 Physicians Physician Services 00 1790309920 0 SAMPATH ROSHNI 2020233 9999999 B 10 1790309920 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1790309920 0 Physicians Anesthesia Services 20 1790309920 0 Physicians Fluoride varnish 20 1790309920 0 Physicians Healthy Kids Services 20 1790309920 0 Physicians Optical Supplies 20 1790309920 0 Physicians Physician Services 00 1790311017 0 CAMINS JOSHUA S 2021273 9999999 B 10 1790311017 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1790311017 0 Psychologist Psychologist service 00 1790311702 0 HOLLAND LINDSAY S 2020167 9999999 B 10 1790311702 0 4698 DEPT CAROL STREAM IL 601220021 20 1790311702 0 Physicians Anesthesia Services 20 1790311702 0 Physicians Healthy Kids Services 20 1790311702 0 Physicians Optical Supplies 20 1790311702 0 Physicians Physician Services 00 1790311710 0 ONUGHA JASON K 2021018 9999999 B 10 1790311710 0 5777 DEPT CAROL STREAM IL 601220021 20 1790311710 0 Physicians Anesthesia Services 20 1790311710 0 Physicians Healthy Kids Services 20 1790311710 0 Physicians Optical Supplies 20 1790311710 0 Physicians Physician Services 20 1790311710 0 Physicians Physicians Psychiatric Services 00 1790312155 0 GRABB DECLAN 2020175 9999999 B 10 1790312155 0 4698 DEPT CAROL STREAM IL 601220021 20 1790312155 0 Physicians Anesthesia Services 20 1790312155 0 Physicians Healthy Kids Services 20 1790312155 0 Physicians Optical Supplies 20 1790312155 0 Physicians Physician Services 20 1790312155 0 Physicians Physicians Psychiatric Services 00 1790312627 0 VYAS SONAM 2023178 9999999 B 10 1790312627 0 8311 ROOSEVELT RD FOREST PARK IL 601302529 20 1790312627 0 Physicians Anesthesia Services 20 1790312627 0 Physicians Healthy Kids Services 20 1790312627 0 Physicians Optical Supplies 20 1790312627 0 Physicians Physician Services 20 1790312627 0 Physicians Physicians Psychiatric Services 00 1790312825 0 LI YANGCHUN 2021216 9999999 B 10 1790312825 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1790312825 0 Physicians Anesthesia Services 20 1790312825 0 Physicians Healthy Kids Services 20 1790312825 0 Physicians Optical Supplies 20 1790312825 0 Physicians Physician Services 00 1790313054 0 EDWARDS ELIZABETH A 2020224 9999999 B 10 1790313054 0 1 ILLINI DR PEORIA IL 616052576 20 1790313054 0 Physicians Anesthesia Services 20 1790313054 0 Physicians Healthy Kids Services 20 1790313054 0 Physicians Optical Supplies 20 1790313054 0 Physicians Physician Services 20 1790313054 0 Physicians Physicians Psychiatric Services 00 1790313203 0 AKINROTIMI OLATOYOSI GRACE 2020301 9999999 B 10 1790313203 0 1029 E 130TH ST CHICAGO IL 606286908 20 1790313203 0 Physician Assistant Only Fluoride varnish 20 1790313203 0 Physician Assistant Only Healthy Kids Services 20 1790313203 0 Physician Assistant Only Physician Services 00 1790313625 0 SESOLAK BRIAN 2022067 9999999 B 10 1790313625 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1790313625 0 Physician Assistant Only Fluoride varnish 20 1790313625 0 Physician Assistant Only Healthy Kids Services 20 1790313625 0 Physician Assistant Only Physician Services 00 1790313674 0 MANUYAG JOLENE K 2020273 9999999 B 10 1790313674 0 20 TOWER CT STE F SUITE F GURNEE IL 600315711 20 1790313674 0 Nurse Practitioners Healthy Kids Services 20 1790313674 0 Nurse Practitioners Nurse Practitioners Services 20 1790313674 0 Nurse Practitioners Physician Services 00 1790313849 0 MAGSAM CYNTHIA 2024240 9999999 B 10 1790313849 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1790313849 0 Physicians Anesthesia Services 20 1790313849 0 Physicians Healthy Kids Services 20 1790313849 0 Physicians Optical Supplies 20 1790313849 0 Physicians Physician Services 00 1790314086 0 SEJO CORY S 2023221 9999999 B 10 1790314086 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1790314086 0 Physicians Anesthesia Services 20 1790314086 0 Physicians Fluoride varnish 20 1790314086 0 Physicians Healthy Kids Services 20 1790314086 0 Physicians Optical Supplies 20 1790314086 0 Physicians Physician Services 00 1790314359 0 BARBER EMILY R 2021004 9999999 B 10 1790314359 0 355 E ERIE ST CHICAGO IL 606113167 20 1790314359 0 Physician Assistant Only Fluoride varnish 20 1790314359 0 Physician Assistant Only Healthy Kids Services 20 1790314359 0 Physician Assistant Only Physician Services 00 1790314490 0 SINGH SAUMYA 2023166 9999999 B 10 1790314490 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1790314490 0 Nurse Practitioners Anesthesia Services 20 1790314490 0 Nurse Practitioners Healthy Kids Services 20 1790314490 0 Nurse Practitioners Optical Supplies 20 1790314490 0 Nurse Practitioners Physician Services 00 1790314631 0 HUGHART TONI 2022017 9999999 B 10 1790314631 0 333 N SUMMIT ST FL 7 TOLEDO OH 436041531 20 1790314631 0 Nurse Practitioners Healthy Kids Services 20 1790314631 0 Nurse Practitioners Nurse Practitioners Services 20 1790314631 0 Nurse Practitioners Physician Services 00 1790314896 0 CALDWELL MARGARET 2020260 9999999 B 10 1790314896 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1790314896 0 Physicians Anesthesia Services 20 1790314896 0 Physicians Fluoride varnish 20 1790314896 0 Physicians Healthy Kids Services 20 1790314896 0 Physicians Optical Supplies 20 1790314896 0 Physicians Physician Services 00 1790315018 0 EDWARDS LUCAS B 2020036 9999999 B 10 1790315018 0 1 SAINT ANTHONYS WAY ALTON IL 620024568 20 1790315018 0 Physician Assistant Only Fluoride varnish 20 1790315018 0 Physician Assistant Only Healthy Kids Services 20 1790315018 0 Physician Assistant Only Physician Services 00 1790315794 0 ADLER DAVID 2021160 9999999 B 10 1790315794 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1790315794 0 Physicians Anesthesia Services 20 1790315794 0 Physicians Healthy Kids Services 20 1790315794 0 Physicians Optical Supplies 20 1790315794 0 Physicians Physician Services 00 1790316677 0 NEWHOFF NICOLET 2023017 9999999 B 10 1790316677 0 PO BOX 7428 CAROL STREAM IL 601977428 20 1790316677 0 Nurse Practitioners Anesthesia Services 20 1790316677 0 Nurse Practitioners Nurse Practitioners Services 20 1790316677 0 Nurse Practitioners Physician Services 00 1790317295 0 HEITZMAN SHAUN 2024365 9999999 B 10 1790317295 0 28W671 GARYS MILL RD WINFIELD IL 601901564 20 1790317295 0 Other behavior health professional LCPC/LMFT services 00 1790318525 0 ROY CASSANDRA 2022146 9999999 B 10 1790318525 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1790318525 0 Nurse Practitioners Healthy Kids Services 20 1790318525 0 Nurse Practitioners Nurse Practitioners Services 20 1790318525 0 Nurse Practitioners Physician Services 00 1790318707 0 DAWSON BRANDI 2020079 9999999 B 10 1790318707 0 611 W PARK ST URBANA IL 618012529 20 1790318707 0 Nurse Practitioners Anesthesia Services 20 1790318707 0 Nurse Practitioners Nurse Practitioners Services 20 1790318707 0 Nurse Practitioners Physician Services 00 1790320067 0 JOACHIM ANDRE 2021097 9999999 B 10 1790320067 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1790320067 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1790321693 0 HAMILTON ABIGAIL M 2019353 9999999 B 10 1790321693 0 2259 W TAYLOR ST CHICAGO IL 606124233 20 1790321693 0 Nurse Practitioners Fluoride varnish 20 1790321693 0 Nurse Practitioners Healthy Kids Services 20 1790321693 0 Nurse Practitioners Nurse Practitioners Services 20 1790321693 0 Nurse Practitioners Physician Services 00 1790322469 0 HOPPE NELSON SARAH 2021203 9999999 B 10 1790322469 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1790322469 0 Occupational Therapists Medical Supplies 20 1790322469 0 Occupational Therapists Medical equipment/prosthetic devices 20 1790322469 0 Occupational Therapists Occupational Therapy Services 00 1790322709 0 TRENKLER MELANIE 2020326 9999999 B 10 1790322709 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1790322709 0 Clinical Social Worker Social work service 00 1790323301 0 HUGHES LAURA 2020043 9999999 B 10 1790323301 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1790323301 0 Nurse Practitioners 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NORTH AVE # 4 VILLA PARK IL 601811159 20 1790327336 0 Dentists Dental Services 20 1790327336 0 Dentists Physician Services 00 1790332450 0 DOTY REBEKAH E 2019310 9999999 B 10 1790332450 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1790332450 0 Nurse Practitioners Fluoride varnish 20 1790332450 0 Nurse Practitioners Healthy Kids Services 20 1790332450 0 Nurse Practitioners Nurse Practitioners Services 20 1790332450 0 Nurse Practitioners Physician Services 00 1790332807 0 DIVAN BRANDON W 2019352 9999999 B 10 1790332807 0 611 W PARK ST BWPC URBANA IL 618012529 20 1790332807 0 Physical Therapists Medical Supplies 20 1790332807 0 Physical Therapists Medical equipment/prosthetic devices 20 1790332807 0 Physical Therapists Physical Therapy Services 00 1790333540 0 SMITH KRISTINA 2022073 9999999 B 10 1790333540 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1790333540 0 Nurse Practitioners Fluoride varnish 20 1790333540 0 Nurse Practitioners Healthy Kids Services 20 1790333540 0 Nurse Practitioners Nurse Practitioners Services 20 1790333540 0 Nurse Practitioners Physician Services 00 1790334118 0 NELSON CODY L 2020248 9999999 B 10 1790334118 0 PO BOX 781076 DETROIT MI 482781076 20 1790334118 0 Nurse Practitioners Healthy Kids Services 20 1790334118 0 Nurse Practitioners Nurse Practitioners Services 20 1790334118 0 Nurse Practitioners Physician Services 00 1790334944 0 HAGERMAN DANIEL A 2019281 9999999 B 10 1790334944 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1790334944 0 Physician Assistant Only Fluoride varnish 20 1790334944 0 Physician Assistant Only Healthy Kids Services 20 1790334944 0 Physician Assistant Only Physician Services 00 1790335008 0 EVANS JENNIFER V 2019268 9999999 B 10 1790335008 0 333 N SUMMIT ST FL 7 TOLEDO OH 436041531 20 1790335008 0 Nurse Practitioners Fluoride varnish 20 1790335008 0 Nurse Practitioners Healthy Kids Services 20 1790335008 0 Nurse Practitioners Nurse Practitioners Services 20 1790335008 0 Nurse Practitioners Physician Services 00 1790336378 0 NGUYEN HAN 2019270 9999999 B 10 1790336378 0 11301 S HARLEM AVE WORTH IL 604822001 20 1790336378 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1790336683 0 VELASCO MONICA 2022056 9999999 B 10 1790336683 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1790336683 0 Physical Therapists Medical Supplies 20 1790336683 0 Physical Therapists Medical equipment/prosthetic devices 20 1790336683 0 Physical Therapists Physical Therapy Services 00 1790337228 0 VALENCIA TOMASA 2020203 9999999 B 10 1790337228 0 1044 N FRANCISCO AVE CHICAGO IL 606222743 20 1790337228 0 Nurse Practitioners Healthy Kids Services 20 1790337228 0 Nurse Practitioners Nurse Practitioners Services 20 1790337228 0 Nurse Practitioners Physician Services 00 1790337483 0 SIDHU MANDEEP K 2022306 9999999 B 10 1790337483 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1790337483 0 Physicians Anesthesia Services 20 1790337483 0 Physicians Fluoride varnish 20 1790337483 0 Physicians Healthy Kids Services 20 1790337483 0 Physicians Optical Supplies 20 1790337483 0 Physicians Physician Services 00 1790337988 0 OGUN AMINAT 2019199 9999999 B 10 1790337988 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1790337988 0 Physicians Anesthesia Services 20 1790337988 0 Physicians Fluoride varnish 20 1790337988 0 Physicians Healthy Kids Services 20 1790337988 0 Physicians Optical Supplies 20 1790337988 0 Physicians Physician Services 00 1790338580 0 LOPEZ KATYA M 2025042 9999999 B 10 1790338580 0 17800 SARAH LN COUNTRY CLUB HI IL 604784945 20 1790338580 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1790338622 0 TSIGISTRAS MARIANA 2024136 9999999 B 10 1790338622 0 70 S RIVER ST AURORA IL 605065185 20 1790338622 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1790339083 0 BAHNICK PATRICIA 2021299 9999999 B 10 1790339083 0 715 E GOLF RD SCHAUMBURG IL 601734597 20 1790339083 0 Other behavior health professional LCPC/LMFT services 00 1790340339 0 MALAPUR BINA 2022186 9999999 B 10 1790340339 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1790340339 0 Physicians Anesthesia Services 20 1790340339 0 Physicians Fluoride varnish 20 1790340339 0 Physicians Healthy Kids Services 20 1790340339 0 Physicians Optical Supplies 20 1790340339 0 Physicians Physician Services 00 1790340651 0 PHU HAI-THIEN 2024010 9999999 B 10 1790340651 0 8170 33RD AVE S MINNEAPOLIS MN 554254516 20 1790340651 0 Physicians Anesthesia Services 20 1790340651 0 Physicians Fluoride varnish 20 1790340651 0 Physicians Healthy Kids Services 20 1790340651 0 Physicians Optical Supplies 20 1790340651 0 Physicians Physician Services 00 1790341584 0 WEATHERBY PAUL 2024115 9999999 B 10 1790341584 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1790341584 0 Physicians Anesthesia Services 20 1790341584 0 Physicians Healthy Kids Services 20 1790341584 0 Physicians Optical Supplies 20 1790341584 0 Physicians Physician Services 00 1790342434 0 MCKINNEY MATTHEW 2022186 9999999 B 10 1790342434 0 1518 MULBERRY AVE MUSCATINE IA 527613433 20 1790342434 0 Physicians Anesthesia Services 20 1790342434 0 Physicians Fluoride varnish 20 1790342434 0 Physicians Healthy Kids Services 20 1790342434 0 Physicians Optical Supplies 20 1790342434 0 Physicians Physician Services 00 1790343176 0 VALENCIA YVETTE 2019148 9999999 B 10 1790343176 0 6857 S PULASKI RD CHICAGO IL 606294151 20 1790343176 0 Dentists Dental Services 20 1790343176 0 Dentists Physician Services 00 1790343689 0 BJORK SARAH T 2022179 9999999 B 10 1790343689 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1790343689 0 Physicians Anesthesia Services 20 1790343689 0 Physicians Fluoride varnish 20 1790343689 0 Physicians Healthy Kids Services 20 1790343689 0 Physicians Optical Supplies 20 1790343689 0 Physicians Physician Services 00 1790343838 0 CHASE BECK W 2019176 9999999 B 10 1790343838 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1790343838 0 Physical Therapists Medical Supplies 20 1790343838 0 Physical Therapists Medical equipment/prosthetic devices 20 1790343838 0 Physical Therapists Physical Therapy Services 00 1790344018 0 NGUEMEGNI GUYSELA 2021005 9999999 B 10 1790344018 0 PO BOX 772 MC2295 WOONSOCKET RI 028950784 20 1790344018 0 Nurse Practitioners Fluoride varnish 20 1790344018 0 Nurse Practitioners Healthy Kids Services 20 1790344018 0 Nurse Practitioners Nurse Practitioners Services 20 1790344018 0 Nurse Practitioners Physician Services 00 1790344471 0 ABEDRABO SABREE 2019191 9999999 B 10 1790344471 0 PO BOX 3039 OAK BROOK IL 605223039 20 1790344471 0 Physicians Anesthesia Services 20 1790344471 0 Physicians Fluoride varnish 20 1790344471 0 Physicians Healthy Kids Services 20 1790344471 0 Physicians Optical Supplies 20 1790344471 0 Physicians Physician Services 00 1790344968 0 ZVIRAWA CHIDOCHOMOYO 2023331 9999999 B 10 1790344968 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1790344968 0 Nurse Practitioners Healthy Kids Services 20 1790344968 0 Nurse Practitioners Nurse Practitioners Services 20 1790344968 0 Nurse Practitioners Physician Services 00 1790344992 0 ARADI MUDERI A 2023006 9999999 B 10 1790344992 0 2222 W DIVISION ST CHICAGO IL 606222717 20 1790344992 0 Podiatrists Podiatric Services 00 1790345478 0 MOLL JESSICA 2023213 9999999 B 10 1790345478 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1790345478 0 Physicians Anesthesia Services 20 1790345478 0 Physicians Healthy Kids Services 20 1790345478 0 Physicians Optical Supplies 20 1790345478 0 Physicians Physician Services 00 1790345726 0 LONG GILLIAN 2019162 9999999 B 10 1790345726 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1790345726 0 Nurse Practitioners Fluoride varnish 20 1790345726 0 Nurse Practitioners Healthy Kids Services 20 1790345726 0 Nurse Practitioners Nurse Practitioners Services 20 1790345726 0 Nurse Practitioners Physician Services 00 1790346526 0 AUKSTUOLIS MARTYNAS 2019246 9999999 B 10 1790346526 0 2045 W GRAND AVE STE B CHICAGO IL 606121577 20 1790346526 0 Clinical Social Worker Social work service 00 1790346682 0 LU KRISTEN 2019192 9999999 B 10 1790346682 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1790346682 0 Physicians Anesthesia Services 20 1790346682 0 Physicians Fluoride varnish 20 1790346682 0 Physicians Healthy Kids Services 20 1790346682 0 Physicians Optical Supplies 20 1790346682 0 Physicians Physician Services 20 1790346682 0 Physicians Physicians Psychiatric Services 00 1790346724 0 CHANG ZENAN L 2019171 9999999 B 10 1790346724 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1790346724 0 Physicians Anesthesia Services 20 1790346724 0 Physicians Fluoride varnish 20 1790346724 0 Physicians Healthy Kids Services 20 1790346724 0 Physicians Optical Supplies 20 1790346724 0 Physicians Physician Services 00 1790347458 0 MORTON-JONES MARIAH E 2025023 9999999 B 10 1790347458 0 5777 DEPT CAROL STREAM IL 601220021 20 1790347458 0 Speech Therapists Medical Supplies 20 1790347458 0 Speech Therapists Medical equipment/prosthetic devices 20 1790347458 0 Speech Therapists Speech Therapy/Pathology Services 00 1790347722 0 JACKSON MICHELLE L 2019212 9999999 B 10 1790347722 0 221 NE GLEN OAK AVE ATTN: STEPHEN CIRONE GOMP 100 PEORIA IL 616360001 20 1790347722 0 Nurse Practitioners Fluoride varnish 20 1790347722 0 Nurse Practitioners Healthy Kids Services 20 1790347722 0 Nurse Practitioners Nurse Practitioners Services 20 1790347722 0 Nurse Practitioners Physician Services 00 1790348407 0 MORRISON STEVEN L 2022180 9999999 B 10 1790348407 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1790348407 0 Physicians Anesthesia Services 20 1790348407 0 Physicians Healthy Kids Services 20 1790348407 0 Physicians Optical Supplies 20 1790348407 0 Physicians Physician Services 00 1790348902 0 SCHNEIDER NATHAN 2020064 9999999 B 10 1790348902 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1790348902 0 Physicians Anesthesia Services 20 1790348902 0 Physicians Healthy Kids Services 20 1790348902 0 Physicians Optical Supplies 20 1790348902 0 Physicians Physician Services 00 1790349033 0 VANANTWERP MICHAEL P 2022172 9999999 B 10 1790349033 0 1900 STATE ST CHESTER IL 622331116 20 1790349033 0 Physicians Anesthesia Services 20 1790349033 0 Physicians Healthy Kids Services 20 1790349033 0 Physicians Optical Supplies 20 1790349033 0 Physicians Physician Services 00 1790349157 0 LANG JONATHAN R 2021182 9999999 B 10 1790349157 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1790349157 0 Nurse Practitioners Anesthesia Services 20 1790349157 0 Nurse Practitioners Nurse Practitioners Services 20 1790349157 0 Nurse Practitioners Physician Services 00 1790349520 0 BROOKS JINEE 2021243 9999999 B 10 1790349520 0 PO BOX 632122 CINCINNATI OH 452632122 20 1790349520 0 Physicians Anesthesia Services 20 1790349520 0 Physicians Healthy Kids Services 20 1790349520 0 Physicians Optical Supplies 20 1790349520 0 Physicians Physician Services 00 1790349744 0 MEYER MARGARET A 2022258 9999999 B 10 1790349744 0 1500 S DOUGLAS RD STE 230 CORAL GABLES FL 331344108 20 1790349744 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1790349967 0 GEBKE BRANDON M 2019129 9999999 B 10 1790349967 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1790349967 0 Nurse Practitioners Anesthesia Services 20 1790349967 0 Nurse Practitioners Nurse Practitioners Services 20 1790349967 0 Nurse Practitioners Physician Services 00 1790351138 0 MARCUM MICHAEL L 2023311 9999999 B 10 1790351138 0 5010 ROSE LN COULTERVILLE IL 622372746 20 1790351138 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1790351674 0 MILLER CARLY 2023055 9999999 B 10 1790351674 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1790351674 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1790351674 0 Other behavior health professional Social work service 00 1790351708 0 EILER ELIJAH 2024024 9999999 B 10 1790351708 0 7127 S SAINT LAWRENCE AVE CHICAGO IL 606191102 20 1790351708 0 Clinical Social Worker Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1790353027 0 LAMBERT DAVID S 2021230 9999999 B 10 1790353027 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1790353027 0 Physicians Anesthesia Services 20 1790353027 0 Physicians Fluoride varnish 20 1790353027 0 Physicians Healthy Kids Services 20 1790353027 0 Physicians Optical Supplies 20 1790353027 0 Physicians Physician Services 00 1790353654 0 KUPRASERTKUL INKKARUCH 2021243 9999999 B 10 1790353654 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1790353654 0 Physicians Anesthesia Services 20 1790353654 0 Physicians Healthy Kids Services 20 1790353654 0 Physicians Optical Supplies 20 1790353654 0 Physicians Physician Services 00 1790353712 0 GOODMAN JARED V 2021235 9999999 B 10 1790353712 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1790353712 0 Physicians Anesthesia Services 20 1790353712 0 Physicians Healthy Kids Services 20 1790353712 0 Physicians Optical Supplies 20 1790353712 0 Physicians Physician Services 20 1790353712 0 Physicians Physicians Psychiatric Services 00 1790353738 0 ROMANO DANIEL R 2021221 9999999 B 10 1790353738 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1790353738 0 Physicians Anesthesia Services 20 1790353738 0 Physicians Healthy Kids Services 20 1790353738 0 Physicians Optical Supplies 20 1790353738 0 Physicians Physician Services 00 1790353910 0 JABR ABED 2024099 9999999 B 10 1790353910 0 5777 DEPT CAROL STREAM IL 601228942 20 1790353910 0 Physicians Anesthesia Services 20 1790353910 0 Physicians Fluoride varnish 20 1790353910 0 Physicians Healthy Kids Services 20 1790353910 0 Physicians Optical Supplies 20 1790353910 0 Physicians Physician Services 00 1790354058 0 CAPPERINO GIANNA 2024345 9999999 B 10 1790354058 0 210 N HAMMES AVE STE 205 SUITE 205 JOLIET IL 604358139 20 1790354058 0 Nurse Practitioners Healthy Kids Services 20 1790354058 0 Nurse Practitioners Nurse Practitioners Services 20 1790354058 0 Nurse Practitioners Physician Services 00 1790354694 0 AREKOOTI HASITA 2025059 9999999 B 10 1790354694 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1790354694 0 Physicians Anesthesia Services 20 1790354694 0 Physicians Fluoride varnish 20 1790354694 0 Physicians Healthy Kids Services 20 1790354694 0 Physicians Optical Supplies 20 1790354694 0 Physicians Physician Services 00 1790355295 0 NELSON CAITLIN 2022236 9999999 B 10 1790355295 0 10332 LAVERGNE AVE OAK LAWN IL 604534711 20 1790355295 0 Speech Therapists Medical Supplies 20 1790355295 0 Speech Therapists Medical equipment/prosthetic devices 20 1790355295 0 Speech Therapists Speech Therapy/Pathology Services 00 1790355980 0 GOVIND NIRALI V 2024262 9999999 B 10 1790355980 0 6700 WASHINGTON AVE S EDEN PRAIRIE MN 553443405 20 1790355980 0 Audiologists Audiology Services 20 1790355980 0 Audiologists Medical Supplies 20 1790355980 0 Audiologists Medical equipment/prosthetic devices 00 1790356210 0 HIGGINS JENNIFER C 2022230 9999999 B 10 1790356210 0 19990 GOVERNORS HWY OLYMPIA FIELDS IL 604611021 20 1790356210 0 Other behavior health professional LCPC/LMFT services 00 1790356947 0 STEPHAN JENNIFER S 2024016 9999999 B 10 1790356947 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1790356947 0 Nurse Practitioners Anesthesia Services 20 1790356947 0 Nurse Practitioners Nurse Practitioners Services 20 1790356947 0 Nurse Practitioners Physician Services 00 1790357028 0 ALKHAURRI BASHAR L 2021201 9999999 B 10 1790357028 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1790357028 0 Physicians Anesthesia Services 20 1790357028 0 Physicians Fluoride varnish 20 1790357028 0 Physicians Healthy Kids 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MIDDLETON WI 535625531 20 1790359040 0 Physicians Anesthesia Services 20 1790359040 0 Physicians Fluoride varnish 20 1790359040 0 Physicians Healthy Kids Services 20 1790359040 0 Physicians Optical Supplies 20 1790359040 0 Physicians Physician Services 00 1790359495 0 LOGAN TIFFANY 2022234 9999999 B 10 1790359495 0 611 W PARK ST URBANA IL 618012529 20 1790359495 0 Nurse Practitioners Healthy Kids Services 20 1790359495 0 Nurse Practitioners Nurse Practitioners Services 20 1790359495 0 Nurse Practitioners Physician Services 00 1790361178 0 SENARA - ROZENS CARLEEN P 2021083 9999999 B 10 1790361178 0 29373 NETWORK PL CHICAGO IL 606733039 20 1790361178 0 Nurse Practitioners Healthy Kids Services 20 1790361178 0 Nurse Practitioners Nurse Practitioners Services 20 1790361178 0 Nurse Practitioners Physician Services 00 1790361285 0 STECHER JOHANNA S 2021175 9999999 B 10 1790361285 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1790361285 0 Physicians Anesthesia Services 20 1790361285 0 Physicians Healthy Kids Services 20 1790361285 0 Physicians Optical Supplies 20 1790361285 0 Physicians Physician Services 00 1790361293 0 KAUL PRANAV 2021159 9999999 B 10 1790361293 0 541 N FAIRBANKS CT PFS 25TH FLOOR CHICAGO IL 606113319 20 1790361293 0 Physicians Anesthesia Services 20 1790361293 0 Physicians Healthy Kids Services 20 1790361293 0 Physicians Optical Supplies 20 1790361293 0 Physicians Physician Services 00 1790361426 0 DEITZ THEODORE 2021214 9999999 B 10 1790361426 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1790361426 0 Physicians Anesthesia Services 20 1790361426 0 Physicians Fluoride varnish 20 1790361426 0 Physicians Healthy Kids Services 20 1790361426 0 Physicians Optical Supplies 20 1790361426 0 Physicians Physician Services 00 1790362416 0 DENT BRITTANY 2021138 9999999 B 10 1790362416 0 14840 SHEPARD DR DOLTON IL 604192467 20 1790362416 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 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601220021 20 1790362978 0 Physicians Anesthesia Services 20 1790362978 0 Physicians Healthy Kids Services 20 1790362978 0 Physicians Optical Supplies 20 1790362978 0 Physicians Physician Services 00 1790363851 0 HOOVER ALENA N 2021123 9999999 B 10 1790363851 0 29373 NETWORK PL CHICAGO IL 606733039 20 1790363851 0 Physicians Anesthesia Services 20 1790363851 0 Physicians Healthy Kids Services 20 1790363851 0 Physicians Optical Supplies 20 1790363851 0 Physicians Physician Services 00 1790364297 0 NGUYEN VICTORIA 2023257 9999999 B 10 1790364297 0 355 E ERIE ST CHICAGO IL 606113167 20 1790364297 0 Physicians Anesthesia Services 20 1790364297 0 Physicians Healthy Kids Services 20 1790364297 0 Physicians Optical Supplies 20 1790364297 0 Physicians Physician Services 00 1790364602 0 SPITILLI STEFANIE 2025055 9999999 B 10 1790364602 0 1 CVS DR # MC2295 WOONSOCKET RI 028956146 20 1790364602 0 Other behavior health professional Social work service 00 1790365559 0 WANG LYON 2021182 9999999 B 10 1790365559 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1790365559 0 Physicians Anesthesia Services 20 1790365559 0 Physicians Fluoride varnish 20 1790365559 0 Physicians Healthy Kids Services 20 1790365559 0 Physicians Optical Supplies 20 1790365559 0 Physicians Physician Services 00 1790366128 0 THOMPSON SEAN R 2021181 9999999 B 10 1790366128 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1790366128 0 Physicians Anesthesia Services 20 1790366128 0 Physicians Healthy Kids Services 20 1790366128 0 Physicians Optical Supplies 20 1790366128 0 Physicians Physician Services 00 1790366136 0 CUELLAR LETICIA M 2022193 9999999 B 10 1790366136 0 611 W PARK ST URBANA IL 618012529 20 1790366136 0 Dentists Dental Services 20 1790366136 0 Dentists Physician Services 00 1790366342 0 ABARICIA NIKKA 2021182 9999999 B 10 1790366342 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1790366342 0 Physicians Anesthesia Services 20 1790366342 0 Physicians Fluoride varnish 20 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Practitioners Physician Services 00 1790369288 0 RYAN BENJAMIN 2021181 9999999 B 10 1790369288 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1790369288 0 Physicians Anesthesia Services 20 1790369288 0 Physicians Healthy Kids Services 20 1790369288 0 Physicians Optical Supplies 20 1790369288 0 Physicians Physician Services 00 1790370575 0 PHILPOT JOANNE L 2024243 9999999 B 10 1790370575 0 PO BOX 3988 CARBONDALE IL 629023988 20 1790370575 0 Nurse Practitioners Healthy Kids Services 20 1790370575 0 Nurse Practitioners Nurse Practitioners Services 20 1790370575 0 Nurse Practitioners Physician Services 00 1790374767 0 LOVE GREGORY E 2025020 9999999 B 10 1790374767 0 1021 N MULFORD RD ROCKFORD IL 611073874 20 1790374767 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1790374783 0 WILLIAMS SHELLIAH 2025028 9999999 B 10 1790374783 0 4401 N CLARK ST CHICAGO IL 606405466 20 1790374783 0 Other behavior health professional LCPC/LMFT 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Services 00 1790457190 0 ANTCZAK PAUL E 2021348 9999999 B 10 1790457190 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1790457190 0 Nurse Practitioners Healthy Kids Services 20 1790457190 0 Nurse Practitioners Nurse Practitioners Services 20 1790457190 0 Nurse Practitioners Physician Services 00 1790457950 0 WAIBEL JULEE 2021332 9999999 B 10 1790457950 0 520 VALLEY VIEW DR MOLINE IL 612656152 20 1790457950 0 Nurse Practitioners Fluoride varnish 20 1790457950 0 Nurse Practitioners Healthy Kids Services 20 1790457950 0 Nurse Practitioners Nurse Practitioners Services 20 1790457950 0 Nurse Practitioners Physician Services 00 1790458222 0 LANTZ ABBI 2021274 9999999 B 10 1790458222 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1790458222 0 Nurse Practitioners Healthy Kids Services 20 1790458222 0 Nurse Practitioners Nurse Practitioners Services 20 1790458222 0 Nurse Practitioners Physician Services 00 1790459790 0 REUTER KELSEY L 2021300 9999999 B 10 1790459790 0 403 E 1ST ST DIXON IL 610213116 20 1790459790 0 Clinical Social Worker Social work service 00 1790461705 0 BATURA UMESH 2023202 9999999 B 10 1790461705 0 611 W PARK ST URBANA IL 618012529 20 1790461705 0 Physicians Anesthesia Services 20 1790461705 0 Physicians Fluoride varnish 20 1790461705 0 Physicians Healthy Kids Services 20 1790461705 0 Physicians Optical Supplies 20 1790461705 0 Physicians Physician Services 00 1790461739 0 DEL PILAR ARNOLD 2023220 9999999 B 10 1790461739 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1790461739 0 Physicians Anesthesia Services 20 1790461739 0 Physicians Fluoride varnish 20 1790461739 0 Physicians Healthy Kids Services 20 1790461739 0 Physicians Optical Supplies 20 1790461739 0 Physicians Physician Services 00 1790462133 0 READ SARAH 2023313 9999999 B 10 1790462133 0 900 ROYAL HEIGHTS RD BELLEVILLE IL 622265457 20 1790462133 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1790462406 0 SCARANO PEREIRA JUAN PABLO 2023195 9999999 B 10 1790462406 0 PO BOX 3039 OAK BROOK IL 605223039 20 1790462406 0 Physicians Anesthesia Services 20 1790462406 0 Physicians Fluoride varnish 20 1790462406 0 Physicians Healthy Kids Services 20 1790462406 0 Physicians Optical Supplies 20 1790462406 0 Physicians Physician Services 00 1790462729 0 SELLERS SARAH 2023219 9999999 B 10 1790462729 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1790462729 0 Nurse Practitioners Fluoride varnish 20 1790462729 0 Nurse Practitioners Healthy Kids Services 20 1790462729 0 Nurse Practitioners Nurse Practitioners Services 20 1790462729 0 Nurse Practitioners Physician Services 00 1790463461 0 PETERS NATALIE 2023220 9999999 B 10 1790463461 0 PO BOX 778912 CHICAGO IL 606778912 20 1790463461 0 Psychologist Psychologist service 00 1790463834 0 SARAI ANINDER K 2023229 9999999 B 10 1790463834 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1790463834 0 Physicians Anesthesia Services 20 1790463834 0 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UVIN ARNO Z 2024175 9999999 B 10 1790471159 0 4698 DEPT CAROL STREAM IL 601220021 20 1790471159 0 Physicians Anesthesia Services 20 1790471159 0 Physicians Healthy Kids Services 20 1790471159 0 Physicians Optical Supplies 20 1790471159 0 Physicians Physician Services 00 1790474294 0 HAHN EMILY 2023236 9999999 B 10 1790474294 0 1900 W POLK ST STE 220C CHICAGO IL 60612 20 1790474294 0 Physicians Anesthesia Services 20 1790474294 0 Physicians Healthy Kids Services 20 1790474294 0 Physicians Optical Supplies 20 1790474294 0 Physicians Physician Services 00 1790475226 0 MARWAHA SURAJ 2023198 9999999 B 10 1790475226 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1790475226 0 Physicians Anesthesia Services 20 1790475226 0 Physicians Healthy Kids Services 20 1790475226 0 Physicians Optical Supplies 20 1790475226 0 Physicians Physician Services 20 1790475226 0 Physicians Physicians Psychiatric Services 00 1790476083 0 GHAZALI SERENA 2023233 9999999 B 10 1790476083 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1790476083 0 Nurse Practitioners Healthy Kids Services 20 1790476083 0 Nurse Practitioners Nurse Practitioners Services 20 1790476083 0 Nurse Practitioners Physician Services 00 1790477669 0 MUSHARRAF SYED H 2023201 9999999 B 10 1790477669 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1790477669 0 Physicians Anesthesia Services 20 1790477669 0 Physicians Healthy Kids Services 20 1790477669 0 Physicians Optical Supplies 20 1790477669 0 Physicians Physician Services 00 1790478550 0 BROAD SIERRA R 2023187 9999999 B 10 1790478550 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1790478550 0 Physicians Anesthesia Services 20 1790478550 0 Physicians Healthy Kids Services 20 1790478550 0 Physicians Optical Supplies 20 1790478550 0 Physicians Physician Services 00 1790479723 0 FORCHETTI MASON V 2023254 9999999 B 10 1790479723 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1790479723 0 Physicians Anesthesia Services 20 1790479723 0 Physicians Healthy 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1790485530 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1790485530 0 Speech Therapists Medical Supplies 20 1790485530 0 Speech Therapists Medical equipment/prosthetic devices 20 1790485530 0 Speech Therapists Speech Therapy/Pathology Services 00 1790485696 0 BUTCHER NICOLE 2023086 9999999 B 10 1790485696 0 PO BOX 702 MONTGOMERY IL 605380702 20 1790485696 0 Occupational Therapists Medical Supplies 20 1790485696 0 Occupational Therapists Medical equipment/prosthetic devices 20 1790485696 0 Occupational Therapists Occupational Therapy Services 00 1790486694 0 ADEMA CHARLOTTE 2024355 9999999 B 10 1790486694 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1790486694 0 Physicians Anesthesia Services 20 1790486694 0 Physicians Healthy Kids Services 20 1790486694 0 Physicians Optical Supplies 20 1790486694 0 Physicians Physician Services 00 1790487239 0 REITZ CHRISTINE 2023087 9999999 B 10 1790487239 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1790487239 0 Occupational 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Physicians Healthy Kids Services 20 1790488245 0 Physicians Optical Supplies 20 1790488245 0 Physicians Physician Services 00 1790488617 0 VANAPELDOORN TRACY L 2023086 9999999 B 10 1790488617 0 1001 AVENUE OF MID AMERICA STE EFFINGHAM IL 624014634 20 1790488617 0 Nurse Practitioners Fluoride varnish 20 1790488617 0 Nurse Practitioners Healthy Kids Services 20 1790488617 0 Nurse Practitioners Nurse Practitioners Services 20 1790488617 0 Nurse Practitioners Physician Services 00 1790488823 0 DUPONT MARISSA 2023250 9999999 B 10 1790488823 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1790488823 0 Physicians Anesthesia Services 20 1790488823 0 Physicians Fluoride varnish 20 1790488823 0 Physicians Healthy Kids Services 20 1790488823 0 Physicians Optical Supplies 20 1790488823 0 Physicians Physician Services 00 1790488849 0 SIGALE STEPHANIE 2023340 9999999 B 10 1790488849 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1790488849 0 Physicians Anesthesia Services 20 1790488849 0 Physicians Fluoride varnish 20 1790488849 0 Physicians Healthy Kids Services 20 1790488849 0 Physicians Optical Supplies 20 1790488849 0 Physicians Physician Services 00 1790489102 0 KIM NOAH E 2023271 9999999 B 10 1790489102 0 5777 DEPT CAROL STREAM IL 601228942 20 1790489102 0 Physician Assistant Only Fluoride varnish 20 1790489102 0 Physician Assistant Only Healthy Kids Services 20 1790489102 0 Physician Assistant Only Physician Services 00 1790489748 0 LAKHDHIR MARIAM 2023290 9999999 B 10 1790489748 0 120 E OGDEN AVE STE 101 HINSDALE IL 605213892 20 1790489748 0 Physician Assistant Only Fluoride varnish 20 1790489748 0 Physician Assistant Only Healthy Kids Services 20 1790489748 0 Physician Assistant Only Physician Services 00 1790490522 0 FISHBACK LISA 2023131 9999999 B 10 1790490522 0 500 SKOKIE BLVD STE 140 NORTHBROOK IL 600622811 20 1790490522 0 Nurse Practitioners Healthy Kids Services 20 1790490522 0 Nurse Practitioners Nurse Practitioners Services 20 1790490522 0 Nurse Practitioners 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9999999 B 10 1801417217 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1801417217 0 Physicians Anesthesia Services 20 1801417217 0 Physicians Fluoride varnish 20 1801417217 0 Physicians Healthy Kids Services 20 1801417217 0 Physicians Optical Supplies 20 1801417217 0 Physicians Physician Services 00 1801417241 0 BREWER CHRISTOPHER TRENT 2020224 9999999 B 10 1801417241 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1801417241 0 Physicians Anesthesia Services 20 1801417241 0 Physicians Fluoride varnish 20 1801417241 0 Physicians Healthy Kids Services 20 1801417241 0 Physicians Optical Supplies 20 1801417241 0 Physicians Physician Services 00 1801418926 0 HOROWITZ JASON 2020234 9999999 B 10 1801418926 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1801418926 0 Physicians Anesthesia Services 20 1801418926 0 Physicians Healthy Kids Services 20 1801418926 0 Physicians Optical Supplies 20 1801418926 0 Physicians Physician Services 00 1801418975 0 MATHUS JANELL M 2020185 9999999 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Nurse Practitioners Nurse Practitioners Services 20 1821306028 0 Nurse Practitioners Physician Services 00 1821308354 0 KISSEL JODIE A 2017274 9999999 B 10 1821308354 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1821308354 0 Clinical Social Worker Social work service 00 1821309279 0 LAOHATHAI CHRISTOPHER 2016245 9999999 B 10 1821309279 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1821309279 0 Physicians Anesthesia Services 20 1821309279 0 Physicians Healthy Kids Services 20 1821309279 0 Physicians Optical Supplies 20 1821309279 0 Physicians Physician Services 20 1821309279 0 Physicians Physicians Psychiatric Services 00 1821309790 0 RINABERGER ALISON 2014244 9999999 B 10 1821309790 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1821309790 0 Physicians Anesthesia Services 20 1821309790 0 Physicians Healthy Kids Services 20 1821309790 0 Physicians Optical Supplies 20 1821309790 0 Physicians Physician Services 00 1821312000 0 RACETTE CHRISTINE A 2010252 9999999 B 10 1821312000 0 150 HARVESTER DR 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Physicians Optical Supplies 20 1821353889 0 Physicians Physician Services 00 1821354184 0 MAYES ANGELA 2015298 9999999 B 10 1821354184 0 621 S NEW BALLAS RD STE 6017B SAINT LOUIS MO 631418274 20 1821354184 0 Nurse Practitioners Fluoride varnish 20 1821354184 0 Nurse Practitioners Healthy Kids Services 20 1821354184 0 Nurse Practitioners Nurse Practitioners Services 20 1821354184 0 Nurse Practitioners Physician Services 00 1821355066 0 NOVY CELLI CYNTHIA M 2019316 9999999 B 10 1821355066 0 5777 DEPT CAROL STREAM IL 601228942 20 1821355066 0 Nurse Practitioners Healthy Kids Services 20 1821355066 0 Nurse Practitioners Nurse Practitioners Services 20 1821355066 0 Nurse Practitioners Physician Services 00 1821355082 0 GOTTLIEB MICHAEL A. 2015182 9999999 B 10 1821355082 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1821355082 0 Physicians Anesthesia Services 20 1821355082 0 Physicians Healthy Kids Services 20 1821355082 0 Physicians Optical Supplies 20 1821355082 0 Physicians Physician Services 00 1821355363 0 PATIL SACHIN V 2023336 9999999 B 10 1821355363 0 1890 SILVER CROSS BLVD STE 410 NEW LENOX IL 604519547 20 1821355363 0 Physicians Anesthesia Services 20 1821355363 0 Physicians Healthy Kids Services 20 1821355363 0 Physicians Optical Supplies 20 1821355363 0 Physicians Physician Services 00 1821355660 0 BADAWY SHERIF M 2016153 9999999 B 10 1821355660 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1821355660 0 Physicians Anesthesia Services 20 1821355660 0 Physicians Fluoride varnish 20 1821355660 0 Physicians Healthy Kids Services 20 1821355660 0 Physicians Optical Supplies 20 1821355660 0 Physicians Physician Services 00 1821355959 0 JORDAN MATTHEW P 2025030 9999999 B 10 1821355959 0 1800 W CHARLESTON BLVD LAS VEGAS NV 891022329 20 1821355959 0 Physicians Anesthesia Services 20 1821355959 0 Physicians Healthy Kids Services 20 1821355959 0 Physicians Optical Supplies 20 1821355959 0 Physicians Physician Services 00 1821356015 0 WHALEN BRANDON C 2015350 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Practitioners Services 20 1821719147 0 Nurse Practitioners Physician Services 00 1821720335 0 CLARKE CASELEY JAIME C 2022196 9999999 B 10 1821720335 0 201 E MADISON ST STE 300 SPRINGFIELD IL 627025131 20 1821720335 0 Physicians Anesthesia Services 20 1821720335 0 Physicians Fluoride varnish 20 1821720335 0 Physicians Healthy Kids Services 20 1821720335 0 Physicians Optical Supplies 20 1821720335 0 Physicians Physician Services 00 1821720491 0 SCHWEITZER DONNA J 2022265 9999999 B 10 1821720491 0 611 W PARK ST URBANA IL 618012529 20 1821720491 0 Nurse Practitioners Healthy Kids Services 20 1821720491 0 Nurse Practitioners Nurse Practitioners Services 20 1821720491 0 Nurse Practitioners Physician Services 00 1821721739 0 COLE CAROLYN 2022334 9999999 B 10 1821721739 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1821721739 0 Physician Assistant Only Fluoride varnish 20 1821721739 0 Physician Assistant Only Healthy Kids Services 20 1821721739 0 Physician Assistant Only Physician Services 00 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varnish 20 1831509009 0 Physicians Healthy Kids Services 20 1831509009 0 Physicians Optical Supplies 20 1831509009 0 Physicians Physician Services 00 1831509090 0 DARRELL CAITLIN M 2019182 9999999 B 10 1831509090 0 PO BOX 578 PARK RIDGE IL 600680578 20 1831509090 0 Physicians Anesthesia Services 20 1831509090 0 Physicians Healthy Kids Services 20 1831509090 0 Physicians Optical Supplies 20 1831509090 0 Physicians Physician Services 00 1831509314 0 EAST LAUREN M 2020216 9999999 B 10 1831509314 0 9500 BRYN MAWR AVE STE 300 ROSEMONT IL 600185257 20 1831509314 0 Physicians Anesthesia Services 20 1831509314 0 Physicians Healthy Kids Services 20 1831509314 0 Physicians Optical Supplies 20 1831509314 0 Physicians Physician Services 00 1831509843 0 BOWERS BARRY J 2017037 9999999 B 10 1831509843 0 12640 S ROUTE 59 UNIT 110 PLAINFIELD IL 605855408 20 1831509843 0 Physical Therapists Medical Supplies 20 1831509843 0 Physical Therapists Medical equipment/prosthetic devices 20 1831509843 0 Physical 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2019325 9999999 B 10 1831517051 0 619 E MASON ST STE 4P57 SPRINGFIELD IL 627011034 20 1831517051 0 Physicians Anesthesia Services 20 1831517051 0 Physicians Fluoride varnish 20 1831517051 0 Physicians Healthy Kids Services 20 1831517051 0 Physicians Optical Supplies 20 1831517051 0 Physicians Physician Services 00 1831517085 0 RODRIGUEZ LIZ M 2022011 9999999 B 10 1831517085 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1831517085 0 Physicians Anesthesia Services 20 1831517085 0 Physicians Fluoride varnish 20 1831517085 0 Physicians Healthy Kids Services 20 1831517085 0 Physicians Optical Supplies 20 1831517085 0 Physicians Physician Services 00 1831517234 0 BLAUEL EMILY ROSE 2024092 9999999 B 10 1831517234 0 PO BOX 110429 AURORA CO 800420429 20 1831517234 0 Physicians Anesthesia Services 20 1831517234 0 Physicians Fluoride varnish 20 1831517234 0 Physicians Healthy Kids Services 20 1831517234 0 Physicians Optical Supplies 20 1831517234 0 Physicians Physician Services 00 1831517341 0 MOORE ARTHUR G 2021118 9999999 B 10 1831517341 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1831517341 0 Physicians Anesthesia Services 20 1831517341 0 Physicians Healthy Kids Services 20 1831517341 0 Physicians Optical Supplies 20 1831517341 0 Physicians Physician Services 00 1831517580 0 KWAK STEPHEN B 2018066 9999999 B 10 1831517580 0 5777 DEPT CAROL STREAM IL 601220021 20 1831517580 0 Physicians Anesthesia Services 20 1831517580 0 Physicians Healthy Kids Services 20 1831517580 0 Physicians Optical Supplies 20 1831517580 0 Physicians Physician Services 00 1831517754 0 NAMBOODIRI SREELA 2015105 9999999 B 10 1831517754 0 1301 W DEVON AVE CHICAGO IL 606601329 20 1831517754 0 Physicians Anesthesia Services 20 1831517754 0 Physicians Fluoride varnish 20 1831517754 0 Physicians Healthy Kids Services 20 1831517754 0 Physicians Optical Supplies 20 1831517754 0 Physicians Physician Services 00 1831517770 0 NAZEER SALIK 2023124 9999999 B 10 1831517770 0 PO BOX 713160 CHICAGO IL 606770360 20 1831517770 0 Physicians Anesthesia Services 20 1831517770 0 Physicians Healthy Kids Services 20 1831517770 0 Physicians Optical Supplies 20 1831517770 0 Physicians Physician Services 00 1831518430 0 KRAMBECK COLLEEN 2017204 9999999 B 10 1831518430 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1831518430 0 Physical Therapists Medical Supplies 20 1831518430 0 Physical Therapists Medical equipment/prosthetic devices 20 1831518430 0 Physical Therapists Physical Therapy Services 00 1831518539 0 GUPTA ANITA 2014001 9999999 B 10 1831518539 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1831518539 0 Physicians Anesthesia Services 20 1831518539 0 Physicians Fluoride varnish 20 1831518539 0 Physicians Healthy Kids Services 20 1831518539 0 Physicians Optical Supplies 20 1831518539 0 Physicians Physician Services 00 1831519388 0 RAJENDER ARCHANA 2022304 9999999 B 10 1831519388 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1831519388 0 Physicians Anesthesia Services 20 1831519388 0 Physicians 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Services 20 1831839570 0 Physicians Healthy Kids Services 20 1831839570 0 Physicians Optical Supplies 20 1831839570 0 Physicians Physician Services 20 1831839570 0 Physicians Physicians Psychiatric Services 00 1831840172 0 LEVIN AMANDA M 2022178 9999999 B 10 1831840172 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1831840172 0 Nurse Practitioners Fluoride varnish 20 1831840172 0 Nurse Practitioners Healthy Kids Services 20 1831840172 0 Nurse Practitioners Nurse Practitioners Services 20 1831840172 0 Nurse Practitioners Physician Services 00 1831841139 0 PROBST MORGAN A 2022026 9999999 B 10 1831841139 0 1106 N MERCHANT ST PO BOX 665 EFFINGHAM IL 624012128 20 1831841139 0 Clinical Social Worker Social work service 00 1831841378 0 BRISTER NICOLE MARIE 2023060 9999999 B 10 1831841378 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1831841378 0 Speech Therapists Medical Supplies 20 1831841378 0 Speech Therapists Medical equipment/prosthetic devices 20 1831841378 0 Speech Therapists 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COURTNEY M 2024051 9999999 B 10 1831856822 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1831856822 0 Physician Assistant Only Fluoride varnish 20 1831856822 0 Physician Assistant Only Healthy Kids Services 20 1831856822 0 Physician Assistant Only Physician Services 00 1831859479 0 RAHMAN MUSTAFIJUR 2024214 9999999 B 10 1831859479 0 7732 SOLUTION CENTER CHICAGO IL 606770001 20 1831859479 0 Physicians Anesthesia Services 20 1831859479 0 Physicians Healthy Kids Services 20 1831859479 0 Physicians Optical Supplies 20 1831859479 0 Physicians Physician Services 00 1831860949 0 GANSMAN MADELINE C 2022004 9999999 B 10 1831860949 0 1431 CENTERPOINT BLVD STE 100 KNOXVILLE TN 379321983 20 1831860949 0 Nurse Practitioners Fluoride varnish 20 1831860949 0 Nurse Practitioners Healthy Kids Services 20 1831860949 0 Nurse Practitioners Nurse Practitioners Services 20 1831860949 0 Nurse Practitioners Physician Services 00 1831861343 0 MORGAN JENNA BARRATT 2023025 9999999 B 10 1831861343 0 1501 S 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Services 00 1831876028 0 RIAZ ARBAZ 2023181 9999999 B 10 1831876028 0 201 E MADISON ST STE 300 SPRINGFIELD IL 627025131 20 1831876028 0 Physicians Anesthesia Services 20 1831876028 0 Physicians Fluoride varnish 20 1831876028 0 Physicians Healthy Kids Services 20 1831876028 0 Physicians Optical Supplies 20 1831876028 0 Physicians Physician Services 00 1831876598 0 PATEL SHAMA 2023240 9999999 B 10 1831876598 0 PO BOX 79591 BALTIMORE MD 212790591 20 1831876598 0 Optometrists Optical Supplies 20 1831876598 0 Optometrists Optometric Services 20 1831876598 0 Optometrists Physician Services 00 1831877232 0 ROSENFELD AMANDA J 2023201 9999999 B 10 1831877232 0 611 W PARK ST URBANA IL 618012529 20 1831877232 0 Dentists Dental Services 20 1831877232 0 Dentists Physician Services 00 1831877349 0 ALLAM SARAH M 2024319 9999999 B 10 1831877349 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1831877349 0 Physician Assistant Only Fluoride varnish 20 1831877349 0 Physician Assistant Only Healthy 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20 1841428885 0 Physicians Optical Supplies 20 1841428885 0 Physicians Physician Services 00 1841428992 0 ZAHEDI RUBINA SYEDA 2016200 9999999 B 10 1841428992 0 PO BOX 223800 PITTSBURGH PA 152510001 20 1841428992 0 Physicians Anesthesia Services 20 1841428992 0 Physicians Healthy Kids Services 20 1841428992 0 Physicians Optical Supplies 20 1841428992 0 Physicians Physician Services 00 1841429339 0 KENT MICHAEL G 2016092 9999999 B 10 1841429339 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1841429339 0 Physicians Anesthesia Services 20 1841429339 0 Physicians Healthy Kids Services 20 1841429339 0 Physicians Optical Supplies 20 1841429339 0 Physicians Physician Services 00 1841429412 0 MAQSOOD MUHAMMAD A 2016336 9999999 B 10 1841429412 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1841429412 0 Physicians Anesthesia Services 20 1841429412 0 Physicians Healthy Kids Services 20 1841429412 0 Physicians Optical Supplies 20 1841429412 0 Physicians Physician Services 00 1841429479 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Services 00 1841440575 0 GUSTAFSON TERRI 2008336 9999999 B 10 1841440575 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1841440575 0 Physical Therapists Medical Supplies 20 1841440575 0 Physical Therapists Medical equipment/prosthetic devices 20 1841440575 0 Physical Therapists Physical Therapy Services 00 1841441615 0 ALVAREZ ELIZABETH N 2009007 9999999 B 10 1841441615 0 711 WASHINGTON BLVD APT 3E OAK PARK IL 603023993 20 1841441615 0 Speech Therapists Medical Supplies 20 1841441615 0 Speech Therapists Medical equipment/prosthetic devices 20 1841441615 0 Speech Therapists Speech Therapy/Pathology Services 00 1841442159 0 YUN HELLEN 2009182 9999999 B 10 1841442159 0 3711 W LAWRENCE AVE CHICAGO IL 606255712 20 1841442159 0 Optometrists Optical Supplies 20 1841442159 0 Optometrists Optometric Services 20 1841442159 0 Optometrists Physician Services 00 1841442936 0 BALONZO LEAH 2024144 9999999 B 10 1841442936 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1841442936 0 Physical Therapists 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10 1841446788 0 5777 DEPT CAROL STREAM IL 601220021 20 1841446788 0 Physicians Anesthesia Services 20 1841446788 0 Physicians Fluoride varnish 20 1841446788 0 Physicians Healthy Kids Services 20 1841446788 0 Physicians Optical Supplies 20 1841446788 0 Physicians Physician Services 00 1841446853 0 RATNER JULIA 2010237 9999999 B 10 1841446853 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1841446853 0 Physicians Anesthesia Services 20 1841446853 0 Physicians Fluoride varnish 20 1841446853 0 Physicians Healthy Kids Services 20 1841446853 0 Physicians Optical Supplies 20 1841446853 0 Physicians Physician Services 00 1841447455 0 NGUYEN BIC 2008259 9999999 B 10 1841447455 0 834 W MONTROSE AVE CHICAGO IL 606135813 20 1841447455 0 Dentists Dental Services 20 1841447455 0 Dentists Physician Services 00 1841448180 0 GODAMBE ANJALI S 2013323 9999999 B 10 1841448180 0 14275 MIDWAY RD STE 400 ADDISON TX 750013676 20 1841448180 0 Physicians Anesthesia Services 20 1841448180 0 Physicians Healthy Kids Services 20 1841448180 0 Physicians Optical Supplies 20 1841448180 0 Physicians Physician Services 00 1841449394 0 DE LOS REYES ALEXANDER 2011186 9999999 B 10 1841449394 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1841449394 0 Physicians Anesthesia Services 20 1841449394 0 Physicians Fluoride varnish 20 1841449394 0 Physicians Healthy Kids Services 20 1841449394 0 Physicians Optical Supplies 20 1841449394 0 Physicians Physician Services 00 1841449451 0 GUTTI PADMAJA 2005241 9999999 B 10 1841449451 0 5777 DEPT CAROL STREAM IL 601220021 20 1841449451 0 Physicians Anesthesia Services 20 1841449451 0 Physicians Fluoride varnish 20 1841449451 0 Physicians Healthy Kids Services 20 1841449451 0 Physicians Optical Supplies 20 1841449451 0 Physicians Physician Services 20 1841449451 0 Physicians Physicians Psychiatric Services 00 1841449493 0 ASAD ANSUL 2009001 9999999 B 10 1841449493 0 124 SW ADAMS ST PEORIA IL 616021320 20 1841449493 0 Physicians Anesthesia Services 20 1841449493 0 Physicians Fluoride varnish 20 1841449493 0 Physicians Healthy Kids Services 20 1841449493 0 Physicians Optical Supplies 20 1841449493 0 Physicians Physician Services 00 1841450525 0 BENSON JONAS 2014274 9999999 B 10 1841450525 0 PO BOX 95439 GRAPEVINE TX 760999735 20 1841450525 0 Physicians Anesthesia Services 20 1841450525 0 Physicians Healthy Kids Services 20 1841450525 0 Physicians Optical Supplies 20 1841450525 0 Physicians Physician Services 00 1841450574 0 YU JANE 2021057 9999999 B 10 1841450574 0 225 E CHICAGO AVE CHICAGO IL 606112991 20 1841450574 0 Physicians Anesthesia Services 20 1841450574 0 Physicians Healthy Kids Services 20 1841450574 0 Physicians Optical Supplies 20 1841450574 0 Physicians Physician Services 00 1841450632 0 KING NICOLE 2025036 9999999 B 10 1841450632 0 120 BRENTWOOD COMMONS WAY STE BRENTWOOD TN 370272023 20 1841450632 0 Physicians Anesthesia Services 20 1841450632 0 Physicians Healthy Kids Services 20 1841450632 0 Physicians Optical 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1841452489 0 28594 NETWORK PL CHICAGO IL 606731081 20 1841452489 0 Physicians Anesthesia Services 20 1841452489 0 Physicians Healthy Kids Services 20 1841452489 0 Physicians Optical Supplies 20 1841452489 0 Physicians Physician Services 00 1841452927 0 HOSMER JAMIE B 2014118 9999999 B 10 1841452927 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1841452927 0 Physicians Anesthesia Services 20 1841452927 0 Physicians Healthy Kids Services 20 1841452927 0 Physicians Optical Supplies 20 1841452927 0 Physicians Physician Services 00 1841453008 0 BRIONES MELISSA 2014213 9999999 B 10 1841453008 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1841453008 0 Physicians Anesthesia Services 20 1841453008 0 Physicians Fluoride varnish 20 1841453008 0 Physicians Healthy Kids Services 20 1841453008 0 Physicians Optical Supplies 20 1841453008 0 Physicians Physician Services 00 1841453560 0 SINTON JAMIE 2022237 9999999 B 10 1841453560 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1841453560 0 Physicians Anesthesia Services 20 1841453560 0 Physicians Healthy Kids Services 20 1841453560 0 Physicians Optical Supplies 20 1841453560 0 Physicians Physician Services 00 1841453750 0 HAMMES PETER 2012166 9999999 B 10 1841453750 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112386 20 1841453750 0 Dentists Dental Services 20 1841453750 0 Dentists Physician Services 00 1841453909 0 KULIK CARLOS ANNA 2011244 9999999 B 10 1841453909 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1841453909 0 Physicians Anesthesia Services 20 1841453909 0 Physicians Fluoride varnish 20 1841453909 0 Physicians Healthy Kids Services 20 1841453909 0 Physicians Optical Supplies 20 1841453909 0 Physicians Physician Services 00 1841454303 0 LIOTTA MARGARET 2011227 9999999 B 10 1841454303 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1841454303 0 Physicians Anesthesia Services 20 1841454303 0 Physicians Healthy Kids Services 20 1841454303 0 Physicians Optical Supplies 20 1841454303 0 Physicians Physician 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Physician Assistant Only Physician Services 00 1861035685 0 MALINOWSKI TARA 2020052 9999999 B 10 1861035685 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1861035685 0 Nurse Practitioners Fluoride varnish 20 1861035685 0 Nurse Practitioners Healthy Kids Services 20 1861035685 0 Nurse Practitioners Nurse Practitioners Services 20 1861035685 0 Nurse Practitioners Physician Services 00 1861035693 0 WYSOCKI COLLEEN 2019297 9999999 B 10 1861035693 0 4100 JOLIET AVE LYONS IL 605341513 20 1861035693 0 Speech Therapists Medical Supplies 20 1861035693 0 Speech Therapists Medical equipment/prosthetic devices 20 1861035693 0 Speech Therapists Speech Therapy/Pathology Services 00 1861035974 0 ROBINSON KATELYN A 2022076 9999999 B 10 1861035974 0 5801 MOUNT PLEASANT LN BELLEVILLE IL 622233944 20 1861035974 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1861036519 0 KEEFE CATHERINE M 2019329 9999999 B 10 1861036519 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1861036519 0 Physician Assistant Only Fluoride varnish 20 1861036519 0 Physician Assistant Only Healthy Kids Services 20 1861036519 0 Physician Assistant Only Physician Services 00 1861038341 0 SCALCHAS ALLISON T 2019329 9999999 B 10 1861038341 0 PO BOX 775342 CHICAGO IL 606775342 20 1861038341 0 Nurse Practitioners Fluoride varnish 20 1861038341 0 Nurse Practitioners Healthy Kids Services 20 1861038341 0 Nurse Practitioners Nurse Practitioners Services 20 1861038341 0 Nurse Practitioners Physician Services 00 1861040248 0 JAEGER JESSICA 2023005 9999999 B 10 1861040248 0 29373 NETWORK PL CHICAGO IL 606733039 20 1861040248 0 Physician Assistant Only Fluoride varnish 20 1861040248 0 Physician Assistant Only Healthy Kids Services 20 1861040248 0 Physician Assistant Only Physician Services 00 1861041022 0 ABELL BRADLEY 2019266 9999999 B 10 1861041022 0 PO BOX 146 WATERLOO IL 622980146 20 1861041022 0 Other behavior health professional Other 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9999999 B 10 1861043028 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1861043028 0 Physical Therapists Medical Supplies 20 1861043028 0 Physical Therapists Medical equipment/prosthetic devices 20 1861043028 0 Physical Therapists Physical Therapy Services 00 1861044547 0 MEWA FATEMA 2019197 9999999 B 10 1861044547 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1861044547 0 Physicians Anesthesia Services 20 1861044547 0 Physicians Fluoride varnish 20 1861044547 0 Physicians Healthy Kids Services 20 1861044547 0 Physicians Optical Supplies 20 1861044547 0 Physicians Physician Services 00 1861044588 0 ARACKAL JOCELYN 2019280 9999999 B 10 1861044588 0 PO BOX 772 MC2295 WOONSOCKET RI 028950784 20 1861044588 0 Nurse Practitioners Fluoride varnish 20 1861044588 0 Nurse Practitioners Healthy Kids Services 20 1861044588 0 Nurse Practitioners Nurse Practitioners Services 20 1861044588 0 Nurse Practitioners Physician Services 00 1861046070 0 VEIHL DIANA M 2019233 9999999 B 10 1861046070 0 1025 MAINE ST QUINCY IL 623014038 20 1861046070 0 Nurse Practitioners Healthy Kids Services 20 1861046070 0 Nurse Practitioners Nurse Practitioners Services 20 1861046070 0 Nurse Practitioners Physician Services 00 1861048225 0 ONYEMA OTUOMASIRICHI E 2022165 9999999 B 10 1861048225 0 1601 OLD SOUTH RIVER RD SAINT CHARLES MO 633034120 20 1861048225 0 Nurse Practitioners Fluoride varnish 20 1861048225 0 Nurse Practitioners Healthy Kids Services 20 1861048225 0 Nurse Practitioners Nurse Practitioners Services 20 1861048225 0 Nurse Practitioners Physician Services 00 1861048605 0 MEHOCHKO ASHLEY N 2020071 9999999 B 10 1861048605 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1861048605 0 Nurse Practitioners Healthy Kids Services 20 1861048605 0 Nurse Practitioners Nurse Practitioners Services 20 1861048605 0 Nurse Practitioners Physician Services 00 1861051773 0 GRIDER ANDREA 2021048 9999999 B 10 1861051773 0 2371 BOWES RD STE 400 SUITE 400 ELGIN IL 601235523 20 1861051773 0 Optometrists Optical Supplies 20 1861051773 0 Optometrists Optometric Services 20 1861051773 0 Optometrists Physician Services 00 1861052409 0 TURICH AMANDA 2019182 9999999 B 10 1861052409 0 PO BOX 775342 CHICAGO IL 606775342 20 1861052409 0 Nurse Practitioners Fluoride varnish 20 1861052409 0 Nurse Practitioners Healthy Kids Services 20 1861052409 0 Nurse Practitioners Nurse Practitioners Services 20 1861052409 0 Nurse Practitioners Physician Services 00 1861052441 0 FARHAT WALID A 2019182 9999999 B 10 1861052441 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1861052441 0 Physicians Anesthesia Services 20 1861052441 0 Physicians Healthy Kids Services 20 1861052441 0 Physicians Optical Supplies 20 1861052441 0 Physicians Physician Services 00 1861052524 0 HUA MIAO J 2021182 9999999 B 10 1861052524 0 4009 N BROADWAY ST CHICAGO IL 606132110 20 1861052524 0 Physicians Anesthesia Services 20 1861052524 0 Physicians Fluoride varnish 20 1861052524 0 Physicians Healthy Kids Services 20 1861052524 0 Physicians Optical Supplies 20 1861052524 0 Physicians Physician Services 00 1861052854 0 KING BROOKE A 2019175 9999999 H 10 1861052854 0 421 W EXCHANGE ST FREEPORT IL 610324008 20 1861052854 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1861053068 0 KOONTZ MEREDITH 2021165 9999999 B 10 1861053068 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1861053068 0 Nurse Practitioners Fluoride varnish 20 1861053068 0 Nurse Practitioners Healthy Kids Services 20 1861053068 0 Nurse Practitioners Nurse Practitioners Services 20 1861053068 0 Nurse Practitioners Physician Services 00 1861054835 0 SWEENEY MATTHEW 2019193 9999999 B 10 1861054835 0 PO BOX 400 DOWNERS GROVE IL 605150400 20 1861054835 0 Dentists Dental Services 20 1861054835 0 Dentists Physician Services 00 1861055253 0 DEHART DUSTIN 2019182 9999999 B 10 1861055253 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1861055253 0 Physicians Anesthesia Services 20 1861055253 0 Physicians Healthy Kids Services 20 1861055253 0 Physicians Optical Supplies 20 1861055253 0 Physicians Physician Services 00 1861055428 0 BURGESS ALEXANDRA E 2023257 9999999 B 10 1861055428 0 400 N HIGHLAND AVE AURORA IL 605063814 20 1861055428 0 Physicians Anesthesia Services 20 1861055428 0 Physicians Healthy Kids Services 20 1861055428 0 Physicians Optical Supplies 20 1861055428 0 Physicians Physician Services 00 1861056012 0 GEORGE MARY K 2023355 9999999 B 10 1861056012 0 1836 SOUTH AVE LA CROSSE WI 546015429 20 1861056012 0 Physicians Anesthesia Services 20 1861056012 0 Physicians Fluoride varnish 20 1861056012 0 Physicians Healthy Kids Services 20 1861056012 0 Physicians Optical Supplies 20 1861056012 0 Physicians Physician Services 00 1861057002 0 SCHULMAN JACOB H 2021176 9999999 B 10 1861057002 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1861057002 0 Physicians Anesthesia Services 20 1861057002 0 Physicians Fluoride varnish 20 1861057002 0 Physicians Healthy Kids Services 20 1861057002 0 Physicians Optical Supplies 20 1861057002 0 Physicians Physician Services 00 1861058950 0 LYFORD PAIGE A 2019227 9999999 B 10 1861058950 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1861058950 0 Physical Therapists Medical Supplies 20 1861058950 0 Physical Therapists Medical equipment/prosthetic devices 20 1861058950 0 Physical Therapists Physical Therapy Services 00 1861059503 0 SURAJU MOHAMMED O 2019274 9999999 B 10 1861059503 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1861059503 0 Physicians Anesthesia Services 20 1861059503 0 Physicians Healthy Kids Services 20 1861059503 0 Physicians Optical Supplies 20 1861059503 0 Physicians Physician Services 00 1861059578 0 BASEER IMAAN M 2019261 9999999 B 10 1861059578 0 29373 NETWORK PL CHICAGO IL 606733039 20 1861059578 0 Physicians Anesthesia Services 20 1861059578 0 Physicians Fluoride varnish 20 1861059578 0 Physicians Healthy Kids Services 20 1861059578 0 Physicians Optical Supplies 20 1861059578 0 Physicians Physician Services 00 1861059834 0 KHAN SHAHEERA 2020078 9999999 B 10 1861059834 0 PO BOX 3855 CAROL STREAM IL 601323855 20 1861059834 0 Podiatrists Podiatric Services 00 1861060881 0 MIRKIN EVGENI 2021197 9999999 B 10 1861060881 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1861060881 0 Physicians Anesthesia Services 20 1861060881 0 Physicians Fluoride varnish 20 1861060881 0 Physicians Healthy Kids Services 20 1861060881 0 Physicians Optical Supplies 20 1861060881 0 Physicians Physician Services 00 1861060915 0 RAVINDRAN RAHUL 2022329 9999999 B 10 1861060915 0 1 WESTBROOK CORPORATE CTR STE 240 WESTCHESTER IL 601545745 20 1861060915 0 Physical Therapists Medical Supplies 20 1861060915 0 Physical Therapists Medical equipment/prosthetic devices 20 1861060915 0 Physical Therapists Physical Therapy Services 00 1861061301 0 PANNI USMAN Y 2021229 9999999 B 10 1861061301 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1861061301 0 Physicians Anesthesia Services 20 1861061301 0 Physicians Healthy Kids Services 20 1861061301 0 Physicians Optical Supplies 20 1861061301 0 Physicians Physician Services 00 1861061558 0 LI HELEN W 2021228 9999999 B 10 1861061558 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1861061558 0 Physicians Anesthesia Services 20 1861061558 0 Physicians Healthy Kids Services 20 1861061558 0 Physicians Optical Supplies 20 1861061558 0 Physicians Physician Services 00 1861062424 0 WOLPERS JACOB S 2021179 9999999 B 10 1861062424 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1861062424 0 Nurse Practitioners Anesthesia Services 20 1861062424 0 Nurse Practitioners Nurse Practitioners Services 20 1861062424 0 Nurse Practitioners Physician Services 00 1861062457 0 MATLOCK ROBERT Y 2024219 9999999 B 10 1861062457 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1861062457 0 Nurse Practitioners Anesthesia Services 20 1861062457 0 Nurse Practitioners Nurse Practitioners Services 20 1861062457 0 Nurse Practitioners Physician Services 00 1861062929 0 FRICK ROBERT 2021221 9999999 B 10 1861062929 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1861062929 0 Physicians Anesthesia Services 20 1861062929 0 Physicians Healthy Kids Services 20 1861062929 0 Physicians Optical Supplies 20 1861062929 0 Physicians Physician Services 00 1861064131 0 BOVINO MARIO 2021245 9999999 B 10 1861064131 0 PO BOX 855671 MINNEAPOLIS MN 554851153 20 1861064131 0 Physicians Anesthesia Services 20 1861064131 0 Physicians Fluoride varnish 20 1861064131 0 Physicians Healthy Kids Services 20 1861064131 0 Physicians Optical Supplies 20 1861064131 0 Physicians Physician Services 00 1861066698 0 BURKE KERI 2022334 9999999 B 10 1861066698 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1861066698 0 Physician Assistant Only Fluoride varnish 20 1861066698 0 Physician Assistant Only Healthy Kids Services 20 1861066698 0 Physician Assistant Only Physician Services 00 1861068678 0 DESAI PURAV T 2024247 9999999 B 10 1861068678 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1861068678 0 Physicians Anesthesia Services 20 1861068678 0 Physicians Fluoride varnish 20 1861068678 0 Physicians Healthy Kids Services 20 1861068678 0 Physicians Optical Supplies 20 1861068678 0 Physicians Physician Services 00 1861070120 0 KLINE RACHEL I 2022213 9999999 B 10 1861070120 0 210 W MCKINLEY AVE STE 1 DECATUR IL 625265858 20 1861070120 0 Nurse Practitioners Healthy Kids Services 20 1861070120 0 Nurse Practitioners Nurse Practitioners Services 20 1861070120 0 Nurse Practitioners Physician Services 00 1861070161 0 MURRAY JANICE A 2022005 9999999 B 10 1861070161 0 221 NE GLEN OAK AVE ATTN: STEPHEN CIRONE GOMP 100 PEORIA IL 616360001 20 1861070161 0 Nurse Practitioners Fluoride varnish 20 1861070161 0 Nurse Practitioners Healthy Kids Services 20 1861070161 0 Nurse Practitioners Nurse Practitioners Services 20 1861070161 0 Nurse Practitioners Physician Services 00 1861070591 0 PHAN QUAN ANH 2021239 9999999 B 10 1861070591 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1861070591 0 Physicians Anesthesia Services 20 1861070591 0 Physicians Healthy Kids Services 20 1861070591 0 Physicians Optical Supplies 20 1861070591 0 Physicians Physician Services 00 1861071110 0 PHILLIPS WHITNEY 2024086 9999999 B 10 1861071110 0 PO BOX 778912 CHICAGO IL 606778912 20 1861071110 0 Physicians Anesthesia Services 20 1861071110 0 Physicians Fluoride varnish 20 1861071110 0 Physicians Healthy Kids Services 20 1861071110 0 Physicians Optical Supplies 20 1861071110 0 Physicians Physician Services 00 1861071151 0 COTTER DANIEL 2024163 9999999 B 10 1861071151 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1861071151 0 Physicians Anesthesia Services 20 1861071151 0 Physicians Healthy Kids Services 20 1861071151 0 Physicians Optical Supplies 20 1861071151 0 Physicians Physician Services 00 1861071326 0 DOOZANDEH HAMIDEH 2021182 9999999 B 10 1861071326 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1861071326 0 Physicians Anesthesia Services 20 1861071326 0 Physicians Healthy Kids Services 20 1861071326 0 Physicians Optical Supplies 20 1861071326 0 Physicians Physician Services 00 1861071409 0 LEE ALICE 2024183 9999999 B 10 1861071409 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1861071409 0 Physicians Anesthesia Services 20 1861071409 0 Physicians Healthy Kids Services 20 1861071409 0 Physicians Optical Supplies 20 1861071409 0 Physicians Physician Services 00 1861071490 0 SANDOZI MUDASSAR K 2021203 9999999 B 10 1861071490 0 4701 DEPT CAROL STREAM IL 601220021 20 1861071490 0 Physicians Anesthesia Services 20 1861071490 0 Physicians Fluoride varnish 20 1861071490 0 Physicians Healthy Kids Services 20 1861071490 0 Physicians Optical Supplies 20 1861071490 0 Physicians Physician Services 00 1861071896 0 NGUYEN ANNY 2022125 9999999 B 10 1861071896 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1861071896 0 Nurse Practitioners Fluoride varnish 20 1861071896 0 Nurse Practitioners Healthy Kids Services 20 1861071896 0 Nurse Practitioners Nurse Practitioners Services 20 1861071896 0 Nurse Practitioners Physician Services 00 1861073256 0 MATTHEWS HANNAH C 2021175 9999999 B 10 1861073256 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1861073256 0 Physicians Anesthesia Services 20 1861073256 0 Physicians Fluoride varnish 20 1861073256 0 Physicians Healthy Kids Services 20 1861073256 0 Physicians Optical Supplies 20 1861073256 0 Physicians Physician Services 00 1861073686 0 CHIEN DIANE 2021247 9999999 B 10 1861073686 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1861073686 0 Physicians Anesthesia Services 20 1861073686 0 Physicians Fluoride varnish 20 1861073686 0 Physicians Healthy Kids Services 20 1861073686 0 Physicians Optical Supplies 20 1861073686 0 Physicians Physician Services 00 1861073744 0 MERCHANT KRYSTAL 2021314 9999999 B 10 1861073744 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1861073744 0 Registered nurse Nursing service 20 1861073744 0 Registered nurse Waiver service 00 1861074502 0 AXELROD JENNA LEIGH 2021169 9999999 B 10 1861074502 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1861074502 0 Physician Assistant Only Physician Services 20 1861074502 0 Physician Assistant Only Psychologist service 00 1861075871 0 WAZ SYLWIA MALGORZATA 2021180 9999999 B 10 1861075871 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1861075871 0 Physicians Anesthesia Services 20 1861075871 0 Physicians Fluoride varnish 20 1861075871 0 Physicians Healthy Kids Services 20 1861075871 0 Physicians Optical Supplies 20 1861075871 0 Physicians Physician Services 00 1861076093 0 GETSOV LEAH 2021182 9999999 B 10 1861076093 0 75 REMITTANCE DR DEPT 1296 CHICAGO IL 606751296 20 1861076093 0 Physicians Anesthesia Services 20 1861076093 0 Physicians Fluoride varnish 20 1861076093 0 Physicians Healthy Kids Services 20 1861076093 0 Physicians Optical Supplies 20 1861076093 0 Physicians Physician Services 00 1861076119 0 DONMEZ 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EVANSTON IL 602011700 20 1861834152 0 Physicians Anesthesia Services 20 1861834152 0 Physicians Healthy Kids Services 20 1861834152 0 Physicians Optical Supplies 20 1861834152 0 Physicians Physician Services 20 1861834152 0 Physicians Physicians Psychiatric Services 00 1861834855 0 KELLIHER BRENDAN WILLIAM 2013335 9999999 B 10 1861834855 0 PO BOX 2477 SHELTON CT 064841477 20 1861834855 0 Nurse Practitioners Healthy Kids Services 20 1861834855 0 Nurse Practitioners Nurse Practitioners Services 20 1861834855 0 Nurse Practitioners Physician Services 00 1861834897 0 POTU KALYAN C 2019128 9999999 B 10 1861834897 0 221 NE GLEN OAK AVE PEORIA IL 616360002 20 1861834897 0 Physicians Anesthesia Services 20 1861834897 0 Physicians Fluoride varnish 20 1861834897 0 Physicians Healthy Kids Services 20 1861834897 0 Physicians Optical Supplies 20 1861834897 0 Physicians Physician Services 00 1861835340 0 CALLOW STEPHANIE 2021032 9999999 B 10 1861835340 0 3333 BURNET AVE ML 5021 CINCINNATI OH 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1861835985 0 Physicians Fluoride varnish 20 1861835985 0 Physicians Healthy Kids Services 20 1861835985 0 Physicians Optical Supplies 20 1861835985 0 Physicians Physician Services 00 1861836033 0 THOMAS GEORGE N 2016214 9999999 B 10 1861836033 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1861836033 0 Physicians Anesthesia Services 20 1861836033 0 Physicians Fluoride varnish 20 1861836033 0 Physicians Healthy Kids Services 20 1861836033 0 Physicians Optical Supplies 20 1861836033 0 Physicians Physician Services 00 1861836058 0 ABRAHAM VIDTHYA C 2016131 9999999 B 10 1861836058 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1861836058 0 Physicians Anesthesia Services 20 1861836058 0 Physicians Fluoride varnish 20 1861836058 0 Physicians Healthy Kids Services 20 1861836058 0 Physicians Optical Supplies 20 1861836058 0 Physicians Physician Services 00 1861836405 0 RIETVELD ADAM J 2016074 9999999 B 10 1861836405 0 101 N VIRGINIA ST STE 110 CRYSTAL LAKE IL 600143454 20 1861836405 0 Other 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1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1861842387 0 Clinical Social Worker Social work service 00 1861842940 0 JOHNSON APRIL 2025042 9999999 B 10 1861842940 0 175 E HOUSTON ST SAN ANTONIO TX 782052255 20 1861842940 0 Optometrists Optical Supplies 20 1861842940 0 Optometrists Optometric Services 20 1861842940 0 Optometrists Physician Services 00 1861843898 0 INOZEMTSEV KONSTANTIN 2018059 9999999 B 10 1861843898 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1861843898 0 Physicians Anesthesia Services 20 1861843898 0 Physicians Healthy Kids Services 20 1861843898 0 Physicians Optical Supplies 20 1861843898 0 Physicians Physician Services 00 1861844201 0 OBIEKEZIE OBINNA V 2023089 9999999 B 10 1861844201 0 PO BOX 3039 OAK BROOK IL 605223039 20 1861844201 0 Physicians Anesthesia Services 20 1861844201 0 Physicians Fluoride varnish 20 1861844201 0 Physicians Healthy Kids Services 20 1861844201 0 Physicians Optical Supplies 20 1861844201 0 Physicians Physician Services 00 1861844516 0 BYRNES CHERYL 2021144 9999999 B 10 1861844516 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1861844516 0 Nurse Practitioners Fluoride varnish 20 1861844516 0 Nurse Practitioners Healthy Kids Services 20 1861844516 0 Nurse Practitioners Nurse Practitioners Services 20 1861844516 0 Nurse Practitioners Physician Services 00 1861844607 0 CARTAGENA BIANCA 2018157 9999999 B 10 1861844607 0 2002 N PULASKI RD CHICAGO IL 606393767 20 1861844607 0 Nurse Practitioners Healthy Kids Services 20 1861844607 0 Nurse Practitioners Nurse Practitioners Services 20 1861844607 0 Nurse Practitioners Physician Services 00 1861844730 0 CHEN EMILY 2016190 9999999 B 10 1861844730 0 1000 REMINGTON BLVD STE 110 BOLINGBROOK IL 604404708 20 1861844730 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1861845000 0 REEVES MICHAEL 2016347 9999999 B 10 1861845000 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1861845000 0 Other behavior health 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20 1861848871 0 Physicians Physician Services 00 1861849515 0 JONES SHANDA 2024011 9999999 B 10 1861849515 0 2045 W GRAND AVE STE B CHICAGO IL 606121577 20 1861849515 0 Clinical Social Worker Social work service 00 1861850331 0 BARGER KATRINA 2021039 9999999 B 10 1861850331 0 2361 PAYSPHERE CIR CHICAGO IL 606740023 20 1861850331 0 Physician Assistant Only Fluoride varnish 20 1861850331 0 Physician Assistant Only Healthy Kids Services 20 1861850331 0 Physician Assistant Only Physician Services 00 1861850851 0 AHMED HUMAA A 2017291 9999999 B 10 1861850851 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1861850851 0 Physician Assistant Only Fluoride varnish 20 1861850851 0 Physician Assistant Only Healthy Kids Services 20 1861850851 0 Physician Assistant Only Physician Services 00 1861851248 0 MCANDREW BRIANNE B. 2016053 9999999 B 10 1861851248 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1861851248 0 Nurse Practitioners Anesthesia Services 20 1861851248 0 Nurse 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Services 00 1861853541 0 CHUNG HEIDI HYE YOUNG 2016054 9999999 B 10 1861853541 0 3105 N WILKE RD STE H ARLINGTON HEIGH IL 600041450 20 1861853541 0 Occupational Therapists Medical Supplies 20 1861853541 0 Occupational Therapists Medical equipment/prosthetic devices 20 1861853541 0 Occupational Therapists Occupational Therapy Services 00 1861854028 0 MACADAMS CAMERON T 2022014 9999999 B 10 1861854028 0 5701 W TALAVI BLVD STE 120 GLENDALE AZ 853061888 20 1861854028 0 Physicians Anesthesia Services 20 1861854028 0 Physicians Healthy Kids Services 20 1861854028 0 Physicians Optical Supplies 20 1861854028 0 Physicians Physician Services 00 1861854549 0 WEAVER JESSALYN 2023259 9999999 B 10 1861854549 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1861854549 0 Physicians Anesthesia Services 20 1861854549 0 Physicians Fluoride varnish 20 1861854549 0 Physicians Healthy Kids Services 20 1861854549 0 Physicians Optical Supplies 20 1861854549 0 Physicians Physician Services 00 1861854556 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1861990129 0 2424 W PETERSON AVE CHICAGO IL 606594100 20 1861990129 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1861992190 0 KOH DONGLIM 2018046 9999999 B 10 1861992190 0 2424 W PETERSON AVE CHICAGO IL 606594100 20 1861992190 0 Other behavior health professional LCPC/LMFT services 00 1861994741 0 PEIFER LILY 2021069 9999999 B 10 1861994741 0 1400 W GREENLEAF AVE CHICAGO IL 606262805 20 1861994741 0 Clinical Social Worker Social work service 00 1861995235 0 CHRISTOPHER MEGHAN 2018091 9999999 B 10 1861995235 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1861995235 0 Nurse Practitioners Anesthesia Services 20 1861995235 0 Nurse Practitioners Nurse Practitioners Services 20 1861995235 0 Nurse Practitioners Physician Services 00 1861995672 0 SCHROEDER MATTHEW K 2022160 9999999 B 10 1861995672 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1861995672 0 Physicians Anesthesia Services 20 1861995672 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1861997256 0 Physicians Optical Supplies 20 1861997256 0 Physicians Physician Services 00 1861997272 0 AZERA BRIDGET A 2021326 9999999 B 10 1861997272 0 133 ROLLINS AVE STE 3 ROCKVILLE MD 208524040 20 1861997272 0 Physicians Anesthesia Services 20 1861997272 0 Physicians Fluoride varnish 20 1861997272 0 Physicians Healthy Kids Services 20 1861997272 0 Physicians Optical Supplies 20 1861997272 0 Physicians Physician Services 00 1861997504 0 SCHIFRIEN BRADLEY A 2023188 9999999 B 10 1861997504 0 29373 NETWORK PL CHICAGO IL 606733039 20 1861997504 0 Physicians Anesthesia Services 20 1861997504 0 Physicians Healthy Kids Services 20 1861997504 0 Physicians Optical Supplies 20 1861997504 0 Physicians Physician Services 00 1861997546 0 PATEL DHRUVESH 2023184 9999999 B 10 1861997546 0 387 SHUMAN BLVD STE 240W NAPERVILLE IL 605638113 20 1861997546 0 Physicians Anesthesia Services 20 1861997546 0 Physicians Healthy Kids Services 20 1861997546 0 Physicians Optical Supplies 20 1861997546 0 Physicians Physician Services 00 1861997553 0 WAGENAAR AMY E 2023269 9999999 B 10 1861997553 0 5777 DEPT CAROL STREAM IL 601220021 20 1861997553 0 Physicians Anesthesia Services 20 1861997553 0 Physicians Healthy Kids Services 20 1861997553 0 Physicians Optical Supplies 20 1861997553 0 Physicians Physician Services 00 1861998577 0 ARSHAD NABIYA 2020013 9999999 B 10 1861998577 0 29373 NETWORK PL CHICAGO IL 606733039 20 1861998577 0 Physicians Anesthesia Services 20 1861998577 0 Physicians Fluoride varnish 20 1861998577 0 Physicians Healthy Kids Services 20 1861998577 0 Physicians Optical Supplies 20 1861998577 0 Physicians Physician Services 00 1861998932 0 MULLER BRADLEY 2023137 9999999 B 10 1861998932 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1861998932 0 Physicians Anesthesia Services 20 1861998932 0 Physicians Fluoride varnish 20 1861998932 0 Physicians Healthy Kids Services 20 1861998932 0 Physicians Optical Supplies 20 1861998932 0 Physicians Physician Services 00 1861999310 0 BRIDGES LAUREN 2022230 9999999 B 10 1861999310 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1861999310 0 Physicians Anesthesia Services 20 1861999310 0 Physicians Fluoride varnish 20 1861999310 0 Physicians Healthy Kids Services 20 1861999310 0 Physicians Optical Supplies 20 1861999310 0 Physicians Physician Services 00 1861999344 0 STREET MARCIA A 2018288 9999999 B 10 1861999344 0 100 S MAIN ST WEST SALEM IL 624761202 20 1861999344 0 Nurse Practitioners Fluoride varnish 20 1861999344 0 Nurse Practitioners Healthy Kids Services 20 1861999344 0 Nurse Practitioners Nurse Practitioners Services 20 1861999344 0 Nurse Practitioners Physician Services 00 1861999575 0 GEBHARDT ANNA M 2018253 9999999 B 10 1861999575 0 830 S ADDISON AVE VILLA PARK IL 601812877 20 1861999575 0 Speech Therapists Medical Supplies 20 1861999575 0 Speech Therapists Medical equipment/prosthetic devices 20 1861999575 0 Speech Therapists Speech Therapy/Pathology Services 00 1871000133 0 CHRISTIAN BENJAMIN 2024170 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Medical Supplies 20 1871002014 0 Speech Therapists Medical equipment/prosthetic devices 20 1871002014 0 Speech Therapists Speech Therapy/Pathology Services 00 1871002048 0 REGGUINTI BREANNA 2017269 9999999 B 10 1871002048 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1871002048 0 Nurse Practitioners Fluoride varnish 20 1871002048 0 Nurse Practitioners Healthy Kids Services 20 1871002048 0 Nurse Practitioners Nurse Practitioners Services 20 1871002048 0 Nurse Practitioners Physician Services 00 1871002097 0 HUBERT HILLARY 2017263 9999999 B 10 1871002097 0 PO BOX 71 SAINT ANNE IL 609640071 20 1871002097 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1871002097 0 Other behavior health professional Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1871002097 0 HUBERT HILLARY 2017263 9999999 B 10 1871002097 0 PO BOX 71 SAINT ANNE IL 609640071 20 1871002097 0 Psychologist Other 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behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1871006338 0 ACOSTA SUZANNA E 2017325 9999999 B 10 1871006338 0 4005 167TH ST COUNTRY CLUB HI IL 604782071 20 1871006338 0 Optometrists Optical Supplies 20 1871006338 0 Optometrists Optometric Services 20 1871006338 0 Optometrists Physician Services 00 1871006478 0 NELSON AMBER L 2021253 9999999 B 10 1871006478 0 15501 E AVENUE L LEWISTOWN IL 615429454 20 1871006478 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1871006577 0 KELLER PAIGE 2017140 9999999 B 10 1871006577 0 111 BUCKLIN ST STE 1 LA SALLE IL 613012382 20 1871006577 0 Speech Therapists Medical Supplies 20 1871006577 0 Speech Therapists Medical equipment/prosthetic devices 20 1871006577 0 Speech Therapists Speech Therapy/Pathology Services 00 1871007591 0 SABO GWEN 2017342 9999999 B 10 1871007591 0 201 W CLAY ST COLLINSVILLE IL 622343219 20 1871007591 0 Speech Therapists Medical Supplies 20 1871007591 0 Speech Therapists Medical equipment/prosthetic devices 20 1871007591 0 Speech Therapists Speech Therapy/Pathology Services 00 1871007930 0 SARGENT CHEQUALEIS 2022036 9999999 B 10 1871007930 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1871007930 0 Nurse Practitioners Healthy Kids Services 20 1871007930 0 Nurse Practitioners Nurse Practitioners Services 20 1871007930 0 Nurse Practitioners Physician Services 00 1871008110 0 CONNELL NICOLE 2018227 9999999 B 10 1871008110 0 417 N COLFAX ST BYRON IL 610101438 20 1871008110 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1871008441 0 BASLEY JOI 2020242 9999999 B 10 1871008441 0 4750 N SHERIDAN RD STE 449 CHICAGO IL 606405078 20 1871008441 0 Clinical Social Worker Social work service 00 1871008466 0 BENSON PENNY 2017213 9999999 B 10 1871008466 0 8701 MENARD AVE MORTON GROVE IL 600533052 20 1871008466 0 Speech Therapists Medical 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1871014191 0 TRELA KRISTIN C 2022258 9999999 B 10 1871014191 0 5777 DEPT CAROL STREAM IL 601220021 20 1871014191 0 Physicians Anesthesia Services 20 1871014191 0 Physicians Healthy Kids Services 20 1871014191 0 Physicians Optical Supplies 20 1871014191 0 Physicians Physician Services 00 1871014324 0 SYLA ADMIR 2023071 9999999 B 10 1871014324 0 PO BOX 43230 PHOENIX AZ 850803230 20 1871014324 0 Physicians Anesthesia Services 20 1871014324 0 Physicians Fluoride varnish 20 1871014324 0 Physicians Healthy Kids Services 20 1871014324 0 Physicians Optical Supplies 20 1871014324 0 Physicians Physician Services 00 1871014654 0 ARENDOVICH NIKOLAI 2018365 9999999 B 10 1871014654 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1871014654 0 Physicians Anesthesia Services 20 1871014654 0 Physicians Healthy Kids Services 20 1871014654 0 Physicians Optical Supplies 20 1871014654 0 Physicians Physician Services 00 1871014910 0 FINO KELLY 2017354 9999999 B 10 1871014910 0 15100 S 94TH AVE ORLAND PARK IL 604623291 20 1871014910 0 Speech Therapists Medical Supplies 20 1871014910 0 Speech Therapists Medical equipment/prosthetic devices 20 1871014910 0 Speech Therapists Speech Therapy/Pathology Services 00 1871015214 0 BRODZIK PAUL 2017182 9999999 B 10 1871015214 0 PO BOX 21844 BELFAST ME 049154115 20 1871015214 0 Physicians Anesthesia Services 20 1871015214 0 Physicians Fluoride varnish 20 1871015214 0 Physicians Healthy Kids Services 20 1871015214 0 Physicians Optical Supplies 20 1871015214 0 Physicians Physician Services 00 1871015396 0 CLUSKEY JACLYN 2017207 9999999 B 10 1871015396 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1871015396 0 Nurse Practitioners Healthy Kids Services 20 1871015396 0 Nurse Practitioners Nurse Practitioners Services 20 1871015396 0 Nurse Practitioners Physician Services 00 1871015453 0 TERWILLIGER ASHLEY A 2017263 9999999 B 10 1871015453 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1871015453 0 Nurse Practitioners Fluoride varnish 20 1871015453 0 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Practitioners Nurse Practitioners Services 20 1871330381 0 Nurse Practitioners Physician Services 00 1871331942 0 CARROLL MARY K 2024284 9999999 B 10 1871331942 0 5777 DEPT CAROL STREAM IL 601220021 20 1871331942 0 Nurse Practitioners Fluoride varnish 20 1871331942 0 Nurse Practitioners Healthy Kids Services 20 1871331942 0 Nurse Practitioners Nurse Practitioners Services 20 1871331942 0 Nurse Practitioners Physician Services 00 1871333120 0 ALIAJ ROVENA 2024263 9999999 B 10 1871333120 0 28594 NETWORK PL CHICAGO IL 606731285 20 1871333120 0 Nurse Practitioners Fluoride varnish 20 1871333120 0 Nurse Practitioners Healthy Kids Services 20 1871333120 0 Nurse Practitioners Nurse Practitioners Services 20 1871333120 0 Nurse Practitioners Physician Services 00 1871333427 0 MERLE MONETT L 2024183 9999999 B 10 1871333427 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1871333427 0 Physicians Anesthesia Services 20 1871333427 0 Physicians Fluoride varnish 20 1871333427 0 Physicians Healthy Kids 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2024283 9999999 B 10 1871334672 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1871334672 0 Physician Assistant Only Family Planning Counseling 20 1871334672 0 Physician Assistant Only Fluoride varnish 20 1871334672 0 Physician Assistant Only Healthy Kids Services 20 1871334672 0 Physician Assistant Only Physician Services 00 1871335224 0 AMIN ANYA T 2024184 9999999 B 10 1871335224 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1871335224 0 Physicians Anesthesia Services 20 1871335224 0 Physicians Healthy Kids Services 20 1871335224 0 Physicians Optical Supplies 20 1871335224 0 Physicians Physician Services 20 1871335224 0 Physicians Physicians Psychiatric Services 00 1871336040 0 ELIAS GRANT C 2024169 9999999 B 10 1871336040 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1871336040 0 Physicians Anesthesia Services 20 1871336040 0 Physicians Fluoride varnish 20 1871336040 0 Physicians Healthy Kids Services 20 1871336040 0 Physicians Optical Supplies 20 1871336040 0 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Physicians Optical Supplies 20 1871337105 0 Physicians Physician Services 00 1871337238 0 RENDA MICHAEL MOHAN 2024272 9999999 B 10 1871337238 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1871337238 0 Physicians Anesthesia Services 20 1871337238 0 Physicians Healthy Kids Services 20 1871337238 0 Physicians Optical Supplies 20 1871337238 0 Physicians Physician Services 00 1871338509 0 PATEL KHUSHBU C 2024211 9999999 B 10 1871338509 0 448 WYLIE DR NORMAL IL 617615405 20 1871338509 0 Physicians Anesthesia Services 20 1871338509 0 Physicians Fluoride varnish 20 1871338509 0 Physicians Healthy Kids Services 20 1871338509 0 Physicians Optical Supplies 20 1871338509 0 Physicians Physician Services 00 1871339440 0 AGADI KUCHALAMBAL 2024255 9999999 B 10 1871339440 0 PO BOX 855671 MINNEAPOLIS MN 554851153 20 1871339440 0 Physicians Anesthesia Services 20 1871339440 0 Physicians Fluoride varnish 20 1871339440 0 Physicians Healthy Kids Services 20 1871339440 0 Physicians Optical Supplies 20 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Services 20 1871545954 0 Physicians Optical Supplies 20 1871545954 0 Physicians Physician Services 00 1871546390 0 GIACALONE LAURA 2001121 9999999 B 10 1871546390 0 5777 DEPT CAROL STREAM IL 601220021 20 1871546390 0 Nurse Practitioners Anesthesia Services 20 1871546390 0 Nurse Practitioners Nurse Practitioners Services 20 1871546390 0 Nurse Practitioners Physician Services 00 1871547125 0 SCHENCK JASON 2023188 9999999 B 10 1871547125 0 PO BOX 1437 COLUMBUS GA 319021437 20 1871547125 0 Physicians Anesthesia Services 20 1871547125 0 Physicians Healthy Kids Services 20 1871547125 0 Physicians Optical Supplies 20 1871547125 0 Physicians Physician Services 00 1871547224 0 DSILVA JOSEPH 1986219 9999999 B 10 1871547224 0 1044 N FRANCISCO AVE CHICAGO IL 606222743 20 1871547224 0 Physicians Anesthesia Services 20 1871547224 0 Physicians Healthy Kids Services 20 1871547224 0 Physicians Optical Supplies 20 1871547224 0 Physicians Physician Services 00 1871547505 0 PETROVAS DEMETRIOS 1995001 9999999 B 10 1871547505 0 5962 N LINCOLN AVE CHICAGO IL 606593711 20 1871547505 0 Physicians Anesthesia Services 20 1871547505 0 Physicians Fluoride varnish 20 1871547505 0 Physicians Healthy Kids Services 20 1871547505 0 Physicians Optical Supplies 20 1871547505 0 Physicians Physician Services 00 1871547604 0 DAYAN ALYSSA N 2006182 9999999 B 10 1871547604 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1871547604 0 Physicians Anesthesia Services 20 1871547604 0 Physicians Healthy Kids Services 20 1871547604 0 Physicians Optical Supplies 20 1871547604 0 Physicians Physician Services 00 1871547638 0 MALIK FARAH H 2004173 9999999 B 10 1871547638 0 207 HILLCREST AVE STE A YORKVILLE IL 605601393 20 1871547638 0 Physicians Anesthesia Services 20 1871547638 0 Physicians Fluoride varnish 20 1871547638 0 Physicians Healthy Kids Services 20 1871547638 0 Physicians Optical Supplies 20 1871547638 0 Physicians Physician Services 00 1871548230 0 GRAUER REBECCA 2006091 9999999 B 10 1871548230 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1871548230 0 Physicians Anesthesia Services 20 1871548230 0 Physicians Fluoride varnish 20 1871548230 0 Physicians Healthy Kids Services 20 1871548230 0 Physicians Optical Supplies 20 1871548230 0 Physicians Physician Services 00 1871548875 0 OLINGER JOSEPH W 1999274 9999999 B 10 1871548875 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1871548875 0 Physicians Anesthesia Services 20 1871548875 0 Physicians Fluoride varnish 20 1871548875 0 Physicians Healthy Kids Services 20 1871548875 0 Physicians Optical Supplies 20 1871548875 0 Physicians Physician Services 00 1871548990 0 WEISS RONALD A 2018325 9999999 B 10 1871548990 0 705 S GRAND ST NASHVILLE IL 622631534 20 1871548990 0 Physicians Anesthesia Services 20 1871548990 0 Physicians Fluoride varnish 20 1871548990 0 Physicians Healthy Kids Services 20 1871548990 0 Physicians Optical Supplies 20 1871548990 0 Physicians Physician Services 00 1871549238 0 GREATHOUSE-WILLIAMS DEIRDRA L 2005244 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1871552174 0 Optometrists Optical Supplies 20 1871552174 0 Optometrists Optometric Services 20 1871552174 0 Optometrists Physician Services 00 1871552638 0 TRUPP JEFFERSON 2024264 9999999 B 10 1871552638 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1871552638 0 Physicians Anesthesia Services 20 1871552638 0 Physicians Healthy Kids Services 20 1871552638 0 Physicians Optical Supplies 20 1871552638 0 Physicians Physician Services 00 1871552885 0 BHATT MANEESHA 2016305 9999999 B 10 1871552885 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1871552885 0 Physicians Anesthesia Services 20 1871552885 0 Physicians Healthy Kids Services 20 1871552885 0 Physicians Optical Supplies 20 1871552885 0 Physicians Physician Services 00 1871553263 0 DUNDOO LAKSHMI 2017095 2050365 B 10 1871553263 0 4251 FOREST PARK AVE SAINT LOUIS MO 631082810 20 1871553263 0 Physicians Anesthesia Services 20 1871553263 0 Physicians Healthy Kids Services 20 1871553263 0 Physicians Optical Supplies 20 1871553263 0 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9999999 B 10 1871560060 0 8944 N WISNER ST NILES IL 607141767 20 1871560060 0 Physicians Anesthesia Services 20 1871560060 0 Physicians Fluoride varnish 20 1871560060 0 Physicians Healthy Kids Services 20 1871560060 0 Physicians Optical Supplies 20 1871560060 0 Physicians Physician Services 00 1871560169 0 SETIA SUMAN 1996228 2040001 B 10 1871560169 0 3360 W 95TH ST EVERGREEN PARK IL 608052236 20 1871560169 0 Physicians Anesthesia Services 20 1871560169 0 Physicians Fluoride varnish 20 1871560169 0 Physicians Healthy Kids Services 20 1871560169 0 Physicians Optical Supplies 20 1871560169 0 Physicians Physician Services 00 1871561340 0 FRADER JOEL 1997188 9999999 B 10 1871561340 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1871561340 0 Physicians Anesthesia Services 20 1871561340 0 Physicians Fluoride varnish 20 1871561340 0 Physicians Healthy Kids Services 20 1871561340 0 Physicians Optical Supplies 20 1871561340 0 Physicians Physician Services 00 1871561431 0 THORNE STEVEN R 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Physician Services 00 1881325496 0 RECTOR LINDSEY B 2023228 9999999 B 10 1881325496 0 540 W NORTH ST STE 209 MANHATTAN IL 604428202 20 1881325496 0 Optometrists Optical Supplies 20 1881325496 0 Optometrists Optometric Services 20 1881325496 0 Optometrists Physician Services 00 1881325819 0 MEYER RENATTA J 2023061 9999999 B 10 1881325819 0 4701 DEPT CAROL STREAM IL 601220021 20 1881325819 0 Nurse Practitioners Fluoride varnish 20 1881325819 0 Nurse Practitioners Healthy Kids Services 20 1881325819 0 Nurse Practitioners Nurse Practitioners Services 20 1881325819 0 Nurse Practitioners Physician Services 00 1881327393 0 MARYALA SHASHI 2022195 9999999 B 10 1881327393 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1881327393 0 Physicians Anesthesia Services 20 1881327393 0 Physicians Healthy Kids Services 20 1881327393 0 Physicians Optical Supplies 20 1881327393 0 Physicians Physician Services 20 1881327393 0 Physicians Physicians Psychiatric Services 00 1881327492 0 STANLEY RACHEL 2024229 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Only Physician Services 00 1881377034 0 JOHANSON KELLY 2024263 9999999 B 10 1881377034 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1881377034 0 Nurse Practitioners Fluoride varnish 20 1881377034 0 Nurse Practitioners Healthy Kids Services 20 1881377034 0 Nurse Practitioners Nurse Practitioners Services 20 1881377034 0 Nurse Practitioners Physician Services 00 1881378032 0 WAHL CHLOE 2023202 9999999 B 10 1881378032 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1881378032 0 Physicians Anesthesia Services 20 1881378032 0 Physicians Fluoride varnish 20 1881378032 0 Physicians Healthy Kids Services 20 1881378032 0 Physicians Optical Supplies 20 1881378032 0 Physicians Physician Services 00 1881378214 0 SULLIVAN BREANNA M 2023177 9999999 B 10 1881378214 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1881378214 0 Physicians Anesthesia Services 20 1881378214 0 Physicians Healthy Kids Services 20 1881378214 0 Physicians Optical Supplies 20 1881378214 0 Physicians Physician Services 00 1881378636 0 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1881380137 0 Nurse Practitioners Nurse Practitioners Services 20 1881380137 0 Nurse Practitioners Physician Services 00 1881380251 0 MEHTA RUSHIL 2024191 9999999 B 10 1881380251 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1881380251 0 Dentists Dental Services 20 1881380251 0 Dentists Physician Services 00 1881382943 0 CYGAN PAULINA M 2023214 9999999 B 10 1881382943 0 350 E DEVON AVE ITASCA IL 601431249 20 1881382943 0 Physician Assistant Only Family Planning Counseling 20 1881382943 0 Physician Assistant Only Fluoride varnish 20 1881382943 0 Physician Assistant Only Healthy Kids Services 20 1881382943 0 Physician Assistant Only Physician Services 00 1881383123 0 LEADBETTER JOSHUA E 2023123 9999999 B 10 1881383123 0 PO BOX 146 WATERLOO IL 622980146 20 1881383123 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1881383230 0 DYE KAISI 2024116 9999999 B 10 1881383230 0 PO BOX 372 MATTOON IL 619380372 20 1881383230 0 Nurse Practitioners Anesthesia Services 20 1881383230 0 Nurse Practitioners Nurse Practitioners Services 20 1881383230 0 Nurse Practitioners Physician Services 00 1881383404 0 EL GHAZZAOUI ALI 2023156 9999999 B 10 1881383404 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1881383404 0 Physicians Anesthesia Services 20 1881383404 0 Physicians Healthy Kids Services 20 1881383404 0 Physicians Optical Supplies 20 1881383404 0 Physicians Physician Services 00 1881383586 0 ABDELKAFI BUHISA 2023156 9999999 B 10 1881383586 0 1812 N 19TH AVE MELROSE PARK IL 601602039 20 1881383586 0 Dentists Dental Services 20 1881383586 0 Dentists Physician Services 00 1881384055 0 WHITMER ALEXANDRIA R 2024354 9999999 B 10 1881384055 0 1418 COLLEGE DR MOUNT CARMEL IL 628632638 20 1881384055 0 Physical Therapists Medical Supplies 20 1881384055 0 Physical Therapists Medical equipment/prosthetic devices 20 1881384055 0 Physical Therapists Physical Therapy Services 00 1881386332 0 DALLA SHIV 2024183 9999999 B 10 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1881388726 0 Physicians Healthy Kids Services 20 1881388726 0 Physicians Optical Supplies 20 1881388726 0 Physicians Physician Services 00 1881391142 0 ST PETERS MARISSA 2023093 9999999 B 10 1881391142 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1881391142 0 Nurse Practitioners Fluoride varnish 20 1881391142 0 Nurse Practitioners Healthy Kids Services 20 1881391142 0 Nurse Practitioners Nurse Practitioners Services 20 1881391142 0 Nurse Practitioners Physician Services 00 1881392504 0 NEIGEBAUER LISA 2023248 9999999 B 10 1881392504 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1881392504 0 Nurse Practitioners Healthy Kids Services 20 1881392504 0 Nurse Practitioners Midwife Services 20 1881392504 0 Nurse Practitioners Nurse Practitioners Services 20 1881392504 0 Nurse Practitioners Physician Services 00 1881392942 0 BHATTACHARYA PARAMITA 2023236 9999999 B 10 1881392942 0 5435 BULL VALLEY RD STE 230 MCHENRY IL 600507435 20 1881392942 0 Clinical Social Worker Social work 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BUTSIC VIRGINIA 2024316 9999999 B 10 1881420966 0 10001 W INNOVATION DR STE 200 WAUWATOSA WI 532264851 20 1881420966 0 Nurse Practitioners Healthy Kids Services 20 1881420966 0 Nurse Practitioners Nurse Practitioners Services 20 1881420966 0 Nurse Practitioners Physician Services 00 1881421675 0 BAXLEY BRANDY M 2024275 9999999 B 10 1881421675 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1881421675 0 Nurse Practitioners Fluoride varnish 20 1881421675 0 Nurse Practitioners Healthy Kids Services 20 1881421675 0 Nurse Practitioners Nurse Practitioners Services 20 1881421675 0 Nurse Practitioners Physician Services 00 1881422814 0 DAVIDSON NICHOLE RAE 2024296 9999999 B 10 1881422814 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1881422814 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1881425148 0 DOMIN MADISON 2024355 9999999 B 10 1881425148 0 29373 NETWORK PL CHICAGO IL 606733039 20 1881425148 0 Physician Assistant Only 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Kids Services 20 1881443174 0 Physicians Optical Supplies 20 1881443174 0 Physicians Physician Services 00 1881443315 0 BUETTNER ALYSSA M 2024177 9999999 B 10 1881443315 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1881443315 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1881444784 0 BENTSEN CHRISTOPHER G 2024177 9999999 B 10 1881444784 0 PO BOX 3039 OAK BROOK IL 605223039 20 1881444784 0 Physicians Anesthesia Services 20 1881444784 0 Physicians Fluoride varnish 20 1881444784 0 Physicians Healthy Kids Services 20 1881444784 0 Physicians Optical Supplies 20 1881444784 0 Physicians Physician Services 00 1881447324 0 BLAKE KAYLA MARIE 2025061 9999999 B 10 1881447324 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1881447324 0 Physician Assistant Only Fluoride varnish 20 1881447324 0 Physician Assistant Only Healthy Kids Services 20 1881447324 0 Physician Assistant Only Physician Services 00 1881448900 0 HUANG SHUN 2024170 9999999 B 10 1881448900 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1881448900 0 Physicians Anesthesia Services 20 1881448900 0 Physicians Healthy Kids Services 20 1881448900 0 Physicians Optical Supplies 20 1881448900 0 Physicians Physician Services 00 1881449593 0 LOPEZ OMAR 2024288 9999999 B 10 1881449593 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1881449593 0 Physicians Anesthesia Services 20 1881449593 0 Physicians Fluoride varnish 20 1881449593 0 Physicians Healthy Kids Services 20 1881449593 0 Physicians Optical Supplies 20 1881449593 0 Physicians Physician Services 00 1881450799 0 MAHMOOD MARIA 2024068 9999999 B 10 1881450799 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1881450799 0 Registered nurse Nursing service 20 1881450799 0 Registered nurse Waiver service 00 1881451847 0 MATSON TODD 2024297 9999999 B 10 1881451847 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1881451847 0 Registered nurse Nursing service 20 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Physicians Fluoride varnish 20 1902036577 0 Physicians Healthy Kids Services 20 1902036577 0 Physicians Optical Supplies 20 1902036577 0 Physicians Physician Services 00 1902037476 0 CLAYTON DAVID J 2020352 9999999 B 10 1902037476 0 PO BOX 95590 SOUTH JORDAN UT 840950590 20 1902037476 0 Physicians Anesthesia Services 20 1902037476 0 Physicians Fluoride varnish 20 1902037476 0 Physicians Healthy Kids Services 20 1902037476 0 Physicians Optical Supplies 20 1902037476 0 Physicians Physician Services 00 1902037542 0 KUPFERBERG JODY L 2020357 9999999 B 10 1902037542 0 PO BOX 781076 DETROIT MI 482781076 20 1902037542 0 Nurse Practitioners Healthy Kids Services 20 1902037542 0 Nurse Practitioners Nurse Practitioners Services 20 1902037542 0 Nurse Practitioners Physician Services 00 1902038094 0 O''SULLIVAN KATIE L 2017213 9999999 B 10 1902038094 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1902038094 0 Physicians Anesthesia Services 20 1902038094 0 Physicians Fluoride varnish 20 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1902046246 0 Physicians Fluoride varnish 20 1902046246 0 Physicians Healthy Kids Services 20 1902046246 0 Physicians Optical Supplies 20 1902046246 0 Physicians Physician Services 00 1902048267 0 WILLIAMS LAUREN R 2020058 9999999 B 10 1902048267 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1902048267 0 Physicians Anesthesia Services 20 1902048267 0 Physicians Fluoride varnish 20 1902048267 0 Physicians Healthy Kids Services 20 1902048267 0 Physicians Optical Supplies 20 1902048267 0 Physicians Physician Services 00 1902048325 0 HUSKINS JORDAN C 2014182 9999999 B 10 1902048325 0 PO BOX 778912 CHICAGO IL 606778912 20 1902048325 0 Physicians Anesthesia Services 20 1902048325 0 Physicians Fluoride varnish 20 1902048325 0 Physicians Healthy Kids Services 20 1902048325 0 Physicians Optical Supplies 20 1902048325 0 Physicians Physician Services 00 1902048986 0 WHITE JESSICA 2012248 9999999 B 10 1902048986 0 124 SW ADAMS ST PEORIA IL 616021308 20 1902048986 0 Physicians Anesthesia Services 20 1902048986 0 Physicians Fluoride varnish 20 1902048986 0 Physicians Healthy Kids Services 20 1902048986 0 Physicians Optical Supplies 20 1902048986 0 Physicians Physician Services 00 1902049653 0 SULLIVAN JENNIFER 2019105 9999999 B 10 1902049653 0 881 PARKVIEW BLVD LOMBARD IL 601483230 20 1902049653 0 Other behavior health professional Adaptive behavior support clinician services 20 1902049653 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1902051022 0 DESHPANDE ANUPAMA 2010182 9999999 B 10 1902051022 0 2500 W HIGGINS RD STE 480 SUITE # 480 HOFFMAN ESTATES IL 601697208 20 1902051022 0 Physicians Anesthesia Services 20 1902051022 0 Physicians Fluoride varnish 20 1902051022 0 Physicians Healthy Kids Services 20 1902051022 0 Physicians Optical Supplies 20 1902051022 0 Physicians Physician Services 00 1902051543 0 ROBISON RICCI 2024361 9999999 B 10 1902051543 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1902051543 0 Registered nurse Nursing service 20 1902051543 0 Registered nurse Waiver service 00 1902052038 0 DUNN TRICIA L 2023062 9999999 B 10 1902052038 0 PO BOX 301208 DALLAS TX 753031208 20 1902052038 0 Physicians Anesthesia Services 20 1902052038 0 Physicians Healthy Kids Services 20 1902052038 0 Physicians Optical Supplies 20 1902052038 0 Physicians Physician Services 00 1902053077 0 VARGHESE SAJOY 2014121 9999999 B 10 1902053077 0 62311 COLLECTION CENTER DR CHICAGO IL 606930001 20 1902053077 0 Physicians Anesthesia Services 20 1902053077 0 Physicians Healthy Kids Services 20 1902053077 0 Physicians Optical Supplies 20 1902053077 0 Physicians Physician Services 20 1902053077 0 Physicians Physicians Psychiatric Services 00 1902053614 0 ROTSTEIN JASON L 2010242 9999999 B 10 1902053614 0 929 W HIGGINS RD SCHAUMBURG IL 601953203 20 1902053614 0 Physicians Anesthesia Services 20 1902053614 0 Physicians Healthy Kids Services 20 1902053614 0 Physicians Optical Supplies 20 1902053614 0 Physicians Physician Services 00 1902054216 0 NELSON MICHAEL E. 2011032 9999999 B 10 1902054216 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1902054216 0 Physicians Anesthesia Services 20 1902054216 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1902054216 0 Physicians Healthy Kids Services 20 1902054216 0 Physicians Optical Supplies 20 1902054216 0 Physicians Physician Services 00 1902054414 0 ROJAS MATIAS 2023225 9999999 B 10 1902054414 0 PO BOX 43230 PHOENIX AZ 850803230 20 1902054414 0 Physicians Anesthesia Services 20 1902054414 0 Physicians Fluoride varnish 20 1902054414 0 Physicians Healthy Kids Services 20 1902054414 0 Physicians Optical Supplies 20 1902054414 0 Physicians Physician Services 00 1902054463 0 VOSS MARLA 2018179 9999999 B 10 1902054463 0 PO BOX 1109 DEKALB IL 601157109 20 1902054463 0 Clinical Social Worker Social work service 00 1902056096 0 SINGH ARMEET P 2009222 9999999 B 10 1902056096 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1902056096 0 Physicians Anesthesia Services 20 1902056096 0 Physicians Fluoride varnish 20 1902056096 0 Physicians Healthy Kids Services 20 1902056096 0 Physicians Optical Supplies 20 1902056096 0 Physicians Physician Services 00 1902056138 0 COWGER JAMES E 2013091 9999999 B 10 1902056138 0 2250 N ILLINOIS AVE CARBONDALE IL 629015612 20 1902056138 0 Nurse Practitioners Fluoride varnish 20 1902056138 0 Nurse Practitioners Healthy Kids Services 20 1902056138 0 Nurse Practitioners Nurse Practitioners Services 20 1902056138 0 Nurse Practitioners Physician Services 00 1902056591 0 GEORGE LISA 2013182 9999999 B 10 1902056591 0 370 SUMMIT ST # 1 ELGIN IL 601203843 20 1902056591 0 Dentists Dental Services 20 1902056591 0 Dentists Physician Services 00 1902056971 0 SHAHNAWAZ ATIF 2022196 9999999 B 10 1902056971 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1902056971 0 Physicians Anesthesia Services 20 1902056971 0 Physicians Fluoride varnish 20 1902056971 0 Physicians Healthy 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Physicians Healthy Kids Services 20 1902062037 0 Physicians Optical Supplies 20 1902062037 0 Physicians Physician Services 00 1902062193 0 GHODE REENA 2013163 9999999 B 10 1902062193 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1902062193 0 Physicians Anesthesia Services 20 1902062193 0 Physicians Healthy Kids Services 20 1902062193 0 Physicians Optical Supplies 20 1902062193 0 Physicians Physician Services 00 1902062227 0 HUSSAIN SULEMAN 2010228 9999999 B 10 1902062227 0 520 VALLEY VIEW DR MOLINE IL 612656152 20 1902062227 0 Physicians Anesthesia Services 20 1902062227 0 Physicians Healthy Kids Services 20 1902062227 0 Physicians Optical Supplies 20 1902062227 0 Physicians Physician Services 00 1902062276 0 DRAGOVIC SANJA 2011182 9999999 B 10 1902062276 0 5777 DEPT CAROL STREAM IL 601220021 20 1902062276 0 Physicians All Kids application agent 20 1902062276 0 Physicians Anesthesia Services 20 1902062276 0 Physicians Healthy Kids Services 20 1902062276 0 Physicians Optical Supplies 20 1902062276 0 Physicians Physician Services 00 1902062516 0 HALL KENDRA L 2011182 9999999 B 10 1902062516 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1902062516 0 Physicians Anesthesia Services 20 1902062516 0 Physicians Healthy Kids Services 20 1902062516 0 Physicians Optical Supplies 20 1902062516 0 Physicians Physician Services 00 1902062714 0 MARTIN ALICIA 2009213 9999999 B 10 1902062714 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1902062714 0 Physicians Anesthesia Services 20 1902062714 0 Physicians Fluoride varnish 20 1902062714 0 Physicians Healthy Kids Services 20 1902062714 0 Physicians Optical Supplies 20 1902062714 0 Physicians Physician Services 00 1902062847 0 POPESCU ANDRADA AND JOHN 2011152 9999999 B 10 1902062847 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1902062847 0 Physicians Anesthesia Services 20 1902062847 0 Physicians Fluoride varnish 20 1902062847 0 Physicians Healthy Kids Services 20 1902062847 0 Physicians Optical Supplies 20 1902062847 0 Physicians Physician Services 00 1902062862 0 KUMARAGURU PRIYA 2011213 9999999 B 10 1902062862 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1902062862 0 Physicians Anesthesia Services 20 1902062862 0 Physicians Fluoride varnish 20 1902062862 0 Physicians Healthy Kids Services 20 1902062862 0 Physicians Optical Supplies 20 1902062862 0 Physicians Physician Services 00 1902062888 0 GLERUM STEVEN 2023019 9999999 B 10 1902062888 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1902062888 0 Physicians Anesthesia Services 20 1902062888 0 Physicians Healthy Kids Services 20 1902062888 0 Physicians Optical Supplies 20 1902062888 0 Physicians Physician Services 00 1902063225 0 EADS TODD 2020220 9999999 B 10 1902063225 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1902063225 0 Physicians Anesthesia Services 20 1902063225 0 Physicians Healthy Kids Services 20 1902063225 0 Physicians Optical Supplies 20 1902063225 0 Physicians Physician Services 00 1902063571 0 QUINN TRACY 2011276 9999999 B 10 1902063571 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1902063571 0 Physicians Anesthesia Services 20 1902063571 0 Physicians Fluoride varnish 20 1902063571 0 Physicians Healthy Kids Services 20 1902063571 0 Physicians Optical Supplies 20 1902063571 0 Physicians Physician Services 00 1902063621 0 PIENKOWSKI ALMA 1981227 9999999 B 10 1902063621 0 1101 W IRVING PARK RD BENSENVILLE IL 601061763 20 1902063621 0 Dentists Dental Services 20 1902063621 0 Dentists Physician Services 00 1902063639 0 TENCH KEVIN R 2023263 9999999 B 10 1902063639 0 14502 W MEEKER BLVD SUN CITY AZ 853755282 20 1902063639 0 Physicians Anesthesia Services 20 1902063639 0 Physicians Healthy Kids Services 20 1902063639 0 Physicians Optical Supplies 20 1902063639 0 Physicians Physician Services 00 1902063753 0 SCHAFFNIT BLAKE 2021025 9999999 B 10 1902063753 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1902063753 0 Chiropractors Chiropractic Services 00 1902067002 0 CHATMAN MICAELA T 2020061 9999999 B 10 1902067002 0 2720 FAIRVIEW AVE N STE 100 ROSEVILLE MN 551131306 20 1902067002 0 Physicians Anesthesia Services 20 1902067002 0 Physicians Healthy Kids Services 20 1902067002 0 Physicians Optical Supplies 20 1902067002 0 Physicians Physician Services 20 1902067002 0 Physicians Physicians Psychiatric Services 00 1902067218 0 KRIEZELMAN JUSTIN D 2008183 9999999 B 10 1902067218 0 PO BOX 120288 DALLAS TX 753120288 20 1902067218 0 Physicians Anesthesia Services 20 1902067218 0 Physicians Healthy Kids Services 20 1902067218 0 Physicians Optical Supplies 20 1902067218 0 Physicians Physician Services 00 1902067374 0 ALLI VAMSI VENKATARAGHAVA 2024295 9999999 B 10 1902067374 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1902067374 0 Physicians Anesthesia Services 20 1902067374 0 Physicians Healthy Kids Services 20 1902067374 0 Physicians Optical Supplies 20 1902067374 0 Physicians Physician Services 00 1902067697 0 REYNA CHANTAL 2023076 9999999 B 10 1902067697 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1902067697 0 Physicians Anesthesia Services 20 1902067697 0 Physicians Healthy Kids Services 20 1902067697 0 Physicians Optical Supplies 20 1902067697 0 Physicians Physician Services 00 1902068810 0 LEIGH KARRIE K 2016152 9999999 B 10 1902068810 0 100 E LEFEVRE RD STERLING IL 610811278 20 1902068810 0 Physician Assistant Only Fluoride varnish 20 1902068810 0 Physician Assistant Only Healthy Kids Services 20 1902068810 0 Physician Assistant Only Physician Services 00 1902069016 0 ABDULRAZZAK AMEED 2024282 9999999 B 10 1902069016 0 PO BOX 43230 PHOENIX AZ 850803230 20 1902069016 0 Physicians Anesthesia Services 20 1902069016 0 Physicians Fluoride varnish 20 1902069016 0 Physicians Healthy Kids Services 20 1902069016 0 Physicians Optical Supplies 20 1902069016 0 Physicians Physician Services 00 1902069412 0 GOLDKIND ADAM 2011199 9999999 B 10 1902069412 0 1585 N BARRINGTON RD STE 305 HOFFMAN ESTATES IL 601695019 20 1902069412 0 Podiatrists Podiatric Services 00 1902069537 0 TRAN BENSON D 2018121 9999999 B 10 1902069537 0 PO BOX 208807 DALLAS TX 753208807 20 1902069537 0 Physicians Anesthesia Services 20 1902069537 0 Physicians Healthy Kids Services 20 1902069537 0 Physicians Optical Supplies 20 1902069537 0 Physicians Physician Services 00 1902069677 0 PAIK EUN SUN 2016052 9999999 B 10 1902069677 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1902069677 0 Physicians Anesthesia Services 20 1902069677 0 Physicians Healthy Kids Services 20 1902069677 0 Physicians Optical Supplies 20 1902069677 0 Physicians Physician Services 20 1902069677 0 Physicians Physicians Psychiatric Services 00 1902069875 0 IMBOREK KATHERINE L 2011264 9999999 B 10 1902069875 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1902069875 0 Physicians Anesthesia Services 20 1902069875 0 Physicians Fluoride varnish 20 1902069875 0 Physicians Healthy Kids Services 20 1902069875 0 Physicians Optical Supplies 20 1902069875 0 Physicians Physician Services 00 1902069982 0 WU MEREDITH L 2014121 9999999 B 10 1902069982 0 5777 DEPT CAROL STREAM IL 601220021 20 1902069982 0 Nurse Practitioners Healthy Kids Services 20 1902069982 0 Nurse Practitioners Midwife Services 20 1902069982 0 Nurse Practitioners Nurse Practitioners Services 20 1902069982 0 Nurse Practitioners Physician Services 00 1902070089 0 TEKULVE KRISTYN 2020181 9999999 B 10 1902070089 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1902070089 0 Physicians Anesthesia Services 20 1902070089 0 Physicians Healthy Kids Services 20 1902070089 0 Physicians Optical Supplies 20 1902070089 0 Physicians Physician Services 20 1902070089 0 Physicians Physicians Psychiatric Services 00 1902070519 0 SHKUROVICH SERGEY 2019247 9999999 B 10 1902070519 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1902070519 0 Physicians Anesthesia Services 20 1902070519 0 Physicians Healthy Kids Services 20 1902070519 0 Physicians Optical Supplies 20 1902070519 0 Physicians Physician Services 00 1902071269 0 HODGKINS KAVITA 2008153 9999999 B 10 1902071269 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1902071269 0 Physicians Anesthesia Services 20 1902071269 0 Physicians Fluoride varnish 20 1902071269 0 Physicians Healthy Kids Services 20 1902071269 0 Physicians Optical Supplies 20 1902071269 0 Physicians Physician Services 00 1902073216 0 GELLER FELIX ARON 2025009 9999999 B 10 1902073216 0 PO BOX 5081 JANESVILLE WI 535475081 20 1902073216 0 Physicians Anesthesia Services 20 1902073216 0 Physicians Healthy Kids Services 20 1902073216 0 Physicians Optical Supplies 20 1902073216 0 Physicians Physician Services 20 1902073216 0 Physicians Physicians Psychiatric Services 00 1902073240 0 CHATMAN HELEN 2010121 9999999 B 10 1902073240 0 414 ORCHARD AVE OSWEGO IL 605438869 20 1902073240 0 Speech Therapists Speech Therapy/Pathology Services 00 1902074503 0 SANCHEZ WILLIAM 2021183 9999999 B 10 1902074503 0 78 REGENCY PKWY MANSFIELD TX 760637816 20 1902074503 0 Physicians Anesthesia Services 20 1902074503 0 Physicians Healthy Kids Services 20 1902074503 0 Physicians Optical Supplies 20 1902074503 0 Physicians Physician Services 00 1902076128 0 AREF MICHAEL 2009229 9999999 B 10 1902076128 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1902076128 0 Physicians Anesthesia Services 20 1902076128 0 Physicians Fluoride varnish 20 1902076128 0 Physicians Healthy Kids Services 20 1902076128 0 Physicians Optical Supplies 20 1902076128 0 Physicians Physician Services 00 1902076300 0 MORGAN SARAH E 2022182 9999999 B 10 1902076300 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1902076300 0 Physicians Anesthesia Services 20 1902076300 0 Physicians Healthy Kids Services 20 1902076300 0 Physicians Optical Supplies 20 1902076300 0 Physicians Physician Services 00 1902076730 0 CULBERG CAROLYN M 2016192 9999999 B 10 1902076730 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1902076730 0 Physician Assistant Only Fluoride varnish 20 1902076730 0 Physician Assistant Only Healthy Kids Services 20 1902076730 0 Physician Assistant Only Physician Services 00 1902077654 0 MOTANKY GUY U 2016141 9999999 B 10 1902077654 0 8170 MCCORMICK BLVD STE NO.204 SKOKIE IL 600762961 20 1902077654 0 Psychologist Psychologist service 00 1902079064 0 BETTS AARON M 2017335 9999999 B 10 1902079064 0 44000 GARFIELD RD CLINTON TOWNSHI MI 480381125 20 1902079064 0 Physicians Anesthesia Services 20 1902079064 0 Physicians Healthy Kids Services 20 1902079064 0 Physicians Optical Supplies 20 1902079064 0 Physicians Physician Services 00 1902079338 0 AURAND ELIZABETH 2023103 9999999 B 10 1902079338 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1902079338 0 Occupational Therapists Medical Supplies 20 1902079338 0 Occupational Therapists Medical equipment/prosthetic devices 20 1902079338 0 Occupational Therapists Occupational Therapy Services 00 1902079619 0 SMITH JAMES L 2009178 9999999 B 10 1902079619 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1902079619 0 Physicians Anesthesia Services 20 1902079619 0 Physicians Fluoride varnish 20 1902079619 0 Physicians Healthy Kids Services 20 1902079619 0 Physicians Optical Supplies 20 1902079619 0 Physicians Physician Services 00 1902083348 0 LACHANCE BROOKE 2009182 9999999 B 10 1902083348 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1902083348 0 Nurse Practitioners Healthy Kids Services 20 1902083348 0 Nurse Practitioners Nurse Practitioners Services 20 1902083348 0 Nurse Practitioners Physician Services 00 1902083538 0 KROPP JEFFREY F 2008041 9999999 B 10 1902083538 0 120 W 22ND ST OAK BROOK IL 605231557 20 1902083538 0 Physicians Anesthesia Services 20 1902083538 0 Physicians Fluoride varnish 20 1902083538 0 Physicians Healthy Kids Services 20 1902083538 0 Physicians Optical Supplies 20 1902083538 0 Physicians Physician Services 00 1902083827 0 HARDER SHERI 2009364 9999999 B 10 1902083827 0 268 W HOSPITALITY LN STE 300 SAN BERNARDINO CA 924083234 20 1902083827 0 Physicians Anesthesia Services 20 1902083827 0 Physicians Healthy Kids 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Anesthesia Services 20 1902480544 0 Physicians Healthy Kids Services 20 1902480544 0 Physicians Optical Supplies 20 1902480544 0 Physicians Physician Services 20 1902480544 0 Physicians Physicians Psychiatric Services 00 1902482128 0 KINGSLEY BETHANY 2021088 9999999 B 10 1902482128 0 2157 N DAMEN AVE STE 2C CHICAGO IL 606476916 20 1902482128 0 Occupational Therapists Medical Supplies 20 1902482128 0 Occupational Therapists Medical equipment/prosthetic devices 20 1902482128 0 Occupational Therapists Occupational Therapy Services 00 1902482433 0 ZHANG SAMANTHA 2021182 9999999 B 10 1902482433 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1902482433 0 Physicians Anesthesia Services 20 1902482433 0 Physicians Fluoride varnish 20 1902482433 0 Physicians Healthy Kids Services 20 1902482433 0 Physicians Optical Supplies 20 1902482433 0 Physicians Physician Services 00 1902482607 0 HOWELL JOHN J 2021182 9999999 B 10 1902482607 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1902482607 0 Physicians Anesthesia Services 20 1902482607 0 Physicians Healthy Kids Services 20 1902482607 0 Physicians Optical Supplies 20 1902482607 0 Physicians Physician Services 00 1902482706 0 DA SILVA PABLO L 2021174 9999999 B 10 1902482706 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1902482706 0 Physicians Anesthesia Services 20 1902482706 0 Physicians Fluoride varnish 20 1902482706 0 Physicians Healthy Kids Services 20 1902482706 0 Physicians Optical Supplies 20 1902482706 0 Physicians Physician Services 00 1902482714 0 CHINNASWAMY KALA 2021217 9999999 B 10 1902482714 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1902482714 0 Physicians Anesthesia Services 20 1902482714 0 Physicians Healthy Kids Services 20 1902482714 0 Physicians Optical Supplies 20 1902482714 0 Physicians Physician Services 20 1902482714 0 Physicians Physicians Psychiatric Services 00 1902483597 0 CHING KEVIN 2024057 9999999 B 10 1902483597 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1902483597 0 Physicians Anesthesia Services 20 1902483597 0 Physicians Healthy Kids Services 20 1902483597 0 Physicians Optical Supplies 20 1902483597 0 Physicians Physician Services 00 1902483662 0 SONNE SCOTT 2021221 9999999 B 10 1902483662 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1902483662 0 Physicians Anesthesia Services 20 1902483662 0 Physicians Fluoride varnish 20 1902483662 0 Physicians Healthy Kids Services 20 1902483662 0 Physicians Optical Supplies 20 1902483662 0 Physicians Physician Services 00 1902484397 0 THORSON RACHAEL N 2021172 9999999 B 10 1902484397 0 PO BOX 101625 FORT WORTH TX 761851625 20 1902484397 0 Physicians Anesthesia Services 20 1902484397 0 Physicians Healthy Kids Services 20 1902484397 0 Physicians Optical Supplies 20 1902484397 0 Physicians Physician Services 00 1902484405 0 THOM DAVID 2024193 9999999 B 10 1902484405 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1902484405 0 Podiatrists Podiatric Services 00 1902484983 0 GRINER JOSHUA 2024341 9999999 B 10 1902484983 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1902484983 0 Physicians Anesthesia Services 20 1902484983 0 Physicians Healthy Kids Services 20 1902484983 0 Physicians Optical Supplies 20 1902484983 0 Physicians Physician Services 00 1902485048 0 PARK ROYCE 2021176 9999999 B 10 1902485048 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1902485048 0 Physicians Anesthesia Services 20 1902485048 0 Physicians Healthy Kids Services 20 1902485048 0 Physicians Optical Supplies 20 1902485048 0 Physicians Physician Services 00 1902485063 0 POLLEY SHAYNE ELIZABETH 2021181 9999999 B 10 1902485063 0 4440 W 95TH ST OAK LAWN IL 604532600 20 1902485063 0 Physicians Anesthesia Services 20 1902485063 0 Physicians Healthy Kids Services 20 1902485063 0 Physicians Optical Supplies 20 1902485063 0 Physicians Physician Services 00 1902485196 0 MCCLINTOCK ANDREW 2024256 9999999 B 10 1902485196 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1902485196 0 Physicians Anesthesia Services 20 1902485196 0 Physicians Fluoride varnish 20 1902485196 0 Physicians Healthy Kids Services 20 1902485196 0 Physicians Optical Supplies 20 1902485196 0 Physicians Physician Services 00 1902485238 0 VICENTY LAUREANO A 2024017 9999999 B 10 1902485238 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1902485238 0 Physicians Anesthesia Services 20 1902485238 0 Physicians Healthy Kids Services 20 1902485238 0 Physicians Optical Supplies 20 1902485238 0 Physicians Physician Services 00 1902485303 0 BATHEN HOLLY A 2021235 9999999 B 10 1902485303 0 1000 REMINGTON BLVD STE 110 BOLINGBROOK IL 604404708 20 1902485303 0 Physicians Anesthesia Services 20 1902485303 0 Physicians Healthy Kids Services 20 1902485303 0 Physicians Optical Supplies 20 1902485303 0 Physicians Physician Services 00 1902486814 0 THIEL VANESSA 2024163 9999999 B 10 1902486814 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1902486814 0 Physicians Anesthesia Services 20 1902486814 0 Physicians Fluoride varnish 20 1902486814 0 Physicians Healthy Kids Services 20 1902486814 0 Physicians Optical Supplies 20 1902486814 0 Physicians Physician Services 00 1902486830 0 TECHIRYAN GEORGE 2021176 9999999 B 10 1902486830 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1902486830 0 Physicians Anesthesia Services 20 1902486830 0 Physicians Fluoride varnish 20 1902486830 0 Physicians Healthy Kids Services 20 1902486830 0 Physicians Optical Supplies 20 1902486830 0 Physicians Physician Services 00 1902486889 0 MAISNER ROSE S 2022181 2029181 B 10 1902486889 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1902486889 0 Physicians Anesthesia Services 20 1902486889 0 Physicians Healthy Kids Services 20 1902486889 0 Physicians Optical Supplies 20 1902486889 0 Physicians Physician Services 00 1902487200 0 SEHGAL NEHA 2022227 9999999 B 10 1902487200 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1902487200 0 Physicians Anesthesia Services 20 1902487200 0 Physicians Fluoride varnish 20 1902487200 0 Physicians Healthy Kids Services 20 1902487200 0 Physicians Optical Supplies 20 1902487200 0 Physicians Physician Services 20 1902487200 0 Physicians Physicians Psychiatric Services 00 1902487689 0 NICKLES MELISSA A 2022199 9999999 B 10 1902487689 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1902487689 0 Physicians Anesthesia Services 20 1902487689 0 Physicians Healthy Kids Services 20 1902487689 0 Physicians Optical Supplies 20 1902487689 0 Physicians Physician Services 00 1902487754 0 LEBLANC VICTORIA 2022161 9999999 B 10 1902487754 0 530 NE GLEN OAK AVE PEORIA IL 616370001 20 1902487754 0 Physicians Anesthesia Services 20 1902487754 0 Physicians Fluoride varnish 20 1902487754 0 Physicians Healthy Kids Services 20 1902487754 0 Physicians Optical Supplies 20 1902487754 0 Physicians Physician Services 00 1902488315 0 TOLER MARY KATHERINE 2021201 9999999 B 10 1902488315 0 3015 N BALLAS RD SAINT LOUIS MO 631312329 20 1902488315 0 Nurse Practitioners Anesthesia Services 20 1902488315 0 Nurse Practitioners Nurse 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4698 DEPT CAROL STREAM IL 601220021 20 1902665326 0 Physicians Anesthesia Services 20 1902665326 0 Physicians Fluoride varnish 20 1902665326 0 Physicians Healthy Kids Services 20 1902665326 0 Physicians Optical Supplies 20 1902665326 0 Physicians Physician Services 00 1902665417 0 KNUCKLES ABIGAIL 2024190 9999999 B 10 1902665417 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1902665417 0 Physicians Anesthesia Services 20 1902665417 0 Physicians Healthy Kids Services 20 1902665417 0 Physicians Optical Supplies 20 1902665417 0 Physicians Physician Services 00 1902665466 0 LOVELL ALEXANDRIA 2024194 9999999 B 10 1902665466 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1902665466 0 Physicians Anesthesia Services 20 1902665466 0 Physicians Fluoride varnish 20 1902665466 0 Physicians Healthy Kids Services 20 1902665466 0 Physicians Optical Supplies 20 1902665466 0 Physicians Physician Services 00 1902666993 0 SCOTT SAMANTHA 2024357 9999999 B 10 1902666993 0 PO BOX 855671 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1922490200 0 Physician Assistant Only Healthy Kids Services 20 1922490200 0 Physician Assistant Only Physician Services 00 1922492123 0 WACHTER NATHANIEL 2021223 9999999 B 10 1922492123 0 621 S NEW BALLAS RD STE 5003B SAINT LOUIS MO 631418270 20 1922492123 0 Physicians Anesthesia Services 20 1922492123 0 Physicians Healthy Kids Services 20 1922492123 0 Physicians Optical Supplies 20 1922492123 0 Physicians Physician Services 20 1922492123 0 Physicians Physicians Psychiatric Services 00 1922492164 0 STEIN ANDREW 2021215 9999999 B 10 1922492164 0 1901 W HARRISON CHICAGO IL 60612 20 1922492164 0 Physicians Anesthesia Services 20 1922492164 0 Physicians Healthy Kids Services 20 1922492164 0 Physicians Optical Supplies 20 1922492164 0 Physicians Physician Services 00 1922492271 0 JACKSON JULIE A 2015300 9999999 B 10 1922492271 0 390 MAPLE SUMMIT RD JERSEYVILLE IL 620522000 20 1922492271 0 Nurse Practitioners Fluoride varnish 20 1922492271 0 Nurse Practitioners Healthy Kids Services 20 1922492271 0 Nurse Practitioners Nurse Practitioners Services 20 1922492271 0 Nurse Practitioners Physician Services 00 1922492297 0 CHEN XIUXU 2020174 9999999 B 10 1922492297 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1922492297 0 Physicians Anesthesia Services 20 1922492297 0 Physicians Healthy Kids Services 20 1922492297 0 Physicians Optical Supplies 20 1922492297 0 Physicians Physician Services 00 1922492396 0 SCHNITZLER ALLISON 2018145 9999999 B 10 1922492396 0 5777 DEPT CAROL STREAM IL 601228942 20 1922492396 0 Physicians Anesthesia Services 20 1922492396 0 Physicians Fluoride varnish 20 1922492396 0 Physicians Healthy Kids Services 20 1922492396 0 Physicians Optical Supplies 20 1922492396 0 Physicians Physician Services 00 1922492453 0 GARDNER YELTON SARAH E 2021063 9999999 B 10 1922492453 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1922492453 0 Physicians Anesthesia Services 20 1922492453 0 Physicians Fluoride varnish 20 1922492453 0 Physicians Healthy 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0 ROBLES HECTOR F 2018244 9999999 B 10 1922493386 0 5777 DEPT CAROL STREAM IL 601228942 20 1922493386 0 Physicians Anesthesia Services 20 1922493386 0 Physicians Fluoride varnish 20 1922493386 0 Physicians Healthy Kids Services 20 1922493386 0 Physicians Optical Supplies 20 1922493386 0 Physicians Physician Services 00 1922493758 0 CHEN ELIZABETH 2022047 9999999 B 10 1922493758 0 1800 W CHARLESTON BLVD LAS VEGAS NV 891022329 20 1922493758 0 Physicians Anesthesia Services 20 1922493758 0 Physicians Healthy Kids Services 20 1922493758 0 Physicians Optical Supplies 20 1922493758 0 Physicians Physician Services 00 1922494186 0 KLINE EMILY 2022271 9999999 B 10 1922494186 0 29373 NETWORK PL CHICAGO IL 606733039 20 1922494186 0 Physical Therapists Medical Supplies 20 1922494186 0 Physical Therapists Medical equipment/prosthetic devices 20 1922494186 0 Physical Therapists Physical Therapy Services 00 1922494624 0 BACA VANESSA 2021213 9999999 B 10 1922494624 0 2704 NE INDEPENDENCE AVE LEES 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ANDRADE-BEKKER MARY ANN 2016313 9999999 B 10 1922498690 0 4354 N SACRAMENTO AVE UNIT 1 CHICAGO IL 606181408 20 1922498690 0 Other behavior health professional LCPC/LMFT services 00 1922499938 0 RADDER MEGAN E 2015258 9999999 B 10 1922499938 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1922499938 0 Speech Therapists Medical Supplies 20 1922499938 0 Speech Therapists Medical equipment/prosthetic devices 20 1922499938 0 Speech Therapists Speech Therapy/Pathology Services 00 1922500347 0 JELINEK ANGELA N 2018152 9999999 B 10 1922500347 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1922500347 0 Nurse Practitioners Fluoride varnish 20 1922500347 0 Nurse Practitioners Healthy Kids Services 20 1922500347 0 Nurse Practitioners Nurse Practitioners Services 20 1922500347 0 Nurse Practitioners Physician Services 00 1922502145 0 PRASAD SWATHI 2022118 9999999 B 10 1922502145 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1922502145 0 Physicians Anesthesia Services 20 1922502145 0 Physicians Fluoride varnish 20 1922502145 0 Physicians Healthy Kids Services 20 1922502145 0 Physicians Optical Supplies 20 1922502145 0 Physicians Physician Services 00 1922503242 0 SOUTHARD KRISTOPHER M 2022182 9999999 B 10 1922503242 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1922503242 0 Physicians Anesthesia Services 20 1922503242 0 Physicians Healthy Kids Services 20 1922503242 0 Physicians Optical Supplies 20 1922503242 0 Physicians Physician Services 20 1922503242 0 Physicians Physicians Psychiatric Services 00 1922503424 0 BURDEN SIERRA C 2022323 9999999 B 10 1922503424 0 5701 W TALAVI BLVD STE 120 GLENDALE AZ 853061888 20 1922503424 0 Physicians Anesthesia Services 20 1922503424 0 Physicians Healthy Kids Services 20 1922503424 0 Physicians Optical Supplies 20 1922503424 0 Physicians Physician Services 00 1922503481 0 RODRIGUES PEREIRA SOPHIE G 2021251 9999999 B 10 1922503481 0 29373 NETWORK PL CHICAGO IL 606733039 20 1922503481 0 Physicians Anesthesia Services 20 1922503481 0 Physicians Fluoride varnish 20 1922503481 0 Physicians Healthy Kids Services 20 1922503481 0 Physicians Optical Supplies 20 1922503481 0 Physicians Physician Services 00 1922503887 0 HERRERA ALEXANDER 2020072 9999999 B 10 1922503887 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1922503887 0 Physicians Anesthesia Services 20 1922503887 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1922503887 0 Physicians Healthy Kids Services 20 1922503887 0 Physicians Optical Supplies 20 1922503887 0 Physicians Physician Services 00 1922504752 0 HENKE JONATHAN 2021207 9999999 B 10 1922504752 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1922504752 0 Physicians Anesthesia Services 20 1922504752 0 Physicians Fluoride varnish 20 1922504752 0 Physicians Healthy Kids Services 20 1922504752 0 Physicians Optical Supplies 20 1922504752 0 Physicians Physician Services 00 1922504760 0 TRAMMEL CASSANDRA J 2022124 9999999 B 10 1922504760 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1922504760 0 Physicians Anesthesia Services 20 1922504760 0 Physicians Healthy Kids Services 20 1922504760 0 Physicians Optical Supplies 20 1922504760 0 Physicians Physician Services 00 1922505254 0 ANDREWSKI ERIK D 2024176 9999999 B 10 1922505254 0 PO BOX 778912 CHICAGO IL 606778912 20 1922505254 0 Physicians Anesthesia Services 20 1922505254 0 Physicians Fluoride varnish 20 1922505254 0 Physicians Healthy Kids Services 20 1922505254 0 Physicians Optical Supplies 20 1922505254 0 Physicians Physician Services 00 1922505304 0 BROPHY JAMES 2023195 9999999 B 10 1922505304 0 1000 N ALLEN ST ROBINSON IL 624541114 20 1922505304 0 Physicians Anesthesia Services 20 1922505304 0 Physicians Healthy Kids Services 20 1922505304 0 Physicians Optical Supplies 20 1922505304 0 Physicians Physician Services 00 1922505965 0 PATEL ASHAKI 2023229 9999999 B 10 1922505965 0 820 SPRINGER DR LOMBARD IL 601486413 20 1922505965 0 Physicians Anesthesia Services 20 1922505965 0 Physicians Healthy Kids Services 20 1922505965 0 Physicians Optical Supplies 20 1922505965 0 Physicians Physician Services 00 1922506864 0 COLBRESE ALYSSA L 2018026 9999999 B 10 1922506864 0 520 VALLEY VIEW DR MOLINE IL 612656152 20 1922506864 0 Physical Therapists Medical Supplies 20 1922506864 0 Physical Therapists Medical equipment/prosthetic devices 20 1922506864 0 Physical Therapists Physical Therapy Services 00 1922508464 0 DE ASIS KATHLEN MMAE 2018078 9999999 B 10 1922508464 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1922508464 0 Physical Therapists Medical Supplies 20 1922508464 0 Physical Therapists Medical equipment/prosthetic devices 20 1922508464 0 Physical Therapists Physical Therapy Services 00 1922508480 0 ROWE MEGAN J 2019149 9999999 B 10 1922508480 0 124 SW ADAMS ST PEORIA IL 616021320 20 1922508480 0 Physical Therapists Medical Supplies 20 1922508480 0 Physical Therapists Medical equipment/prosthetic devices 20 1922508480 0 Physical Therapists Physical Therapy Services 00 1922510007 0 WEDLUND SHAWN C 2017305 9999999 B 10 1922510007 0 200 UNIVERSITY AVE E SAINT PAUL MN 551012507 20 1922510007 0 Nurse Practitioners Fluoride varnish 20 1922510007 0 Nurse Practitioners Healthy Kids Services 20 1922510007 0 Nurse Practitioners Nurse Practitioners Services 20 1922510007 0 Nurse Practitioners Physician Services 00 1922511955 0 KUSHNER CASSIDY 2017352 9999999 B 10 1922511955 0 18160 W GAGES LAKE RD GAGES LAKE IL 600301819 20 1922511955 0 Speech Therapists Medical Supplies 20 1922511955 0 Speech Therapists Medical equipment/prosthetic devices 20 1922511955 0 Speech Therapists Speech Therapy/Pathology Services 00 1922512060 0 CARY DIANA 2020247 9999999 B 10 1922512060 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1922512060 0 Nurse Practitioners Fluoride varnish 20 1922512060 0 Nurse Practitioners Healthy Kids Services 20 1922512060 0 Nurse Practitioners Nurse Practitioners Services 20 1922512060 0 Nurse Practitioners Physician Services 00 1922512177 0 MORK JOSEPH N 2017352 9999999 B 10 1922512177 0 5777 DEPT CAROL STREAM IL 601228942 20 1922512177 0 Physician Assistant Only Electronic Home Response/EHR Installation, MPE Certification 20 1922512177 0 Physician Assistant Only Fluoride varnish 20 1922512177 0 Physician Assistant Only Healthy Kids Services 20 1922512177 0 Physician Assistant Only Physician Services 00 1922512458 0 DOUGLASS JENNIFER M 2017331 9999999 B 10 1922512458 0 3040 W SALT CREEK LN ARLINGTON HEIGH IL 600051069 20 1922512458 0 Nurse Practitioners Fluoride varnish 20 1922512458 0 Nurse Practitioners Healthy Kids Services 20 1922512458 0 Nurse Practitioners Nurse Practitioners Services 20 1922512458 0 Nurse Practitioners Nursing service 20 1922512458 0 Nurse Practitioners Physician Services 20 1922512458 0 Nurse Practitioners Waiver service 00 1922513365 0 CONROYD TANNER 2017352 9999999 B 10 1922513365 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1922513365 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1922514082 0 INYART TRICIA 2020147 9999999 B 10 1922514082 0 1250 JUDY AVE BRIDGEPORT IL 624171321 20 1922514082 0 Speech Therapists Medical Supplies 20 1922514082 0 Speech Therapists Medical equipment/prosthetic devices 20 1922514082 0 Speech Therapists Speech Therapy/Pathology Services 00 1922514777 0 VILLARREAL NICOLE M 2019106 9999999 B 10 1922514777 0 420 N RAYNOR AVE JOLIET IL 604356065 20 1922514777 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1922514975 0 MOLAVI ANNA 2017193 9999999 B 10 1922514975 0 2731 MANNHEIM RD FRANKLIN PARK IL 601312219 20 1922514975 0 Dentists Dental Services 20 1922514975 0 Dentists Physician Services 00 1922515220 0 KRUEGER KATIE M 2018091 9999999 B 10 1922515220 0 6810 STATE ROUTE 162 MARYVILLE IL 620628501 20 1922515220 0 Nurse Practitioners Healthy Kids Services 20 1922515220 0 Nurse 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WALKER MICHAEL 2017248 9999999 B 10 1922517382 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1922517382 0 Registered nurse Nursing service 20 1922517382 0 Registered nurse Waiver service 00 1922517465 0 BIDNE SARAH 2017284 9999999 B 10 1922517465 0 1421 SPRING BAY RD EAST PEORIA IL 616119762 20 1922517465 0 Speech Therapists Medical Supplies 20 1922517465 0 Speech Therapists Medical equipment/prosthetic devices 20 1922517465 0 Speech Therapists Speech Therapy/Pathology Services 00 1922517689 0 DORSCH JOY 2017335 9999999 B 10 1922517689 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1922517689 0 Nurse Practitioners Fluoride varnish 20 1922517689 0 Nurse Practitioners Healthy Kids Services 20 1922517689 0 Nurse Practitioners Nurse Practitioners Services 20 1922517689 0 Nurse Practitioners Physician Services 00 1922517697 0 OTT RACHEL M 2021292 9999999 B 10 1922517697 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1922517697 0 Nurse Practitioners 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Practitioners Healthy Kids Services 20 1922520154 0 Nurse Practitioners Nurse Practitioners Services 20 1922520154 0 Nurse Practitioners Physician Services 00 1922520469 0 PATEL VRUSHTI P 2017182 9999999 B 10 1922520469 0 712 E 87TH ST CHICAGO IL 606196246 20 1922520469 0 Dentists Dental Services 20 1922520469 0 Dentists Physician Services 00 1922520857 0 SMITH KARA 2018065 9999999 H 10 1922520857 0 9550 S PARNELL AVE CHICAGO IL 606281134 20 1922520857 0 Other behavior health professional Development Therapy, Orientation and Mobility Services 20 1922520857 0 Other behavior health professional Early Intervention Services 20 1922520857 0 Other behavior health professional Targeted case management service 00 1922521442 0 ANDERSON BJORN 2021207 9999999 B 10 1922521442 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1922521442 0 Physicians Anesthesia Services 20 1922521442 0 Physicians Fluoride varnish 20 1922521442 0 Physicians Healthy Kids Services 20 1922521442 0 Physicians 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20 1942443676 0 Physicians Healthy Kids Services 20 1942443676 0 Physicians Optical Supplies 20 1942443676 0 Physicians Physician Services 00 1942444617 0 LE DOAN 2012214 9999999 B 10 1942444617 0 PO BOX 781076 DETROIT MI 482781076 20 1942444617 0 Physicians Anesthesia Services 20 1942444617 0 Physicians Healthy Kids Services 20 1942444617 0 Physicians Optical Supplies 20 1942444617 0 Physicians Physician Services 00 1942444724 0 RAVELLA SHALINI 2012296 9999999 B 10 1942444724 0 PO BOX 781076 DETROIT MI 482781076 20 1942444724 0 Physicians Anesthesia Services 20 1942444724 0 Physicians Fluoride varnish 20 1942444724 0 Physicians Healthy Kids Services 20 1942444724 0 Physicians Optical Supplies 20 1942444724 0 Physicians Physician Services 00 1942445234 0 PASSARELLI KRISTINA B 2009089 9999999 B 10 1942445234 0 990 GRAND CANYON PKWY STE 218 HOFFMAN ESTATES IL 601691735 20 1942445234 0 Nurse Practitioners Fluoride varnish 20 1942445234 0 Nurse Practitioners Healthy Kids Services 20 1942445234 0 Nurse Practitioners Nurse Practitioners Services 20 1942445234 0 Nurse Practitioners Physician Services 00 1942445630 0 EASTON KARA N 2010053 9999999 B 10 1942445630 0 5777 DEPT CAROL STREAM IL 601220021 20 1942445630 0 Nurse Practitioners Healthy Kids Services 20 1942445630 0 Nurse Practitioners Nurse Practitioners Services 20 1942445630 0 Nurse Practitioners Physician Services 00 1942445648 0 CAMPBELL NICHOLAS EARL 2012191 9999999 B 10 1942445648 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1942445648 0 Physicians Anesthesia Services 20 1942445648 0 Physicians Fluoride varnish 20 1942445648 0 Physicians Healthy Kids Services 20 1942445648 0 Physicians Optical Supplies 20 1942445648 0 Physicians Physician Services 00 1942445663 0 PAPINEAU EVA 2008364 9999999 B 10 1942445663 0 9145 COLLECTION CENTER DR CHICAGO IL 606930091 20 1942445663 0 Nurse Practitioners Anesthesia Services 20 1942445663 0 Nurse Practitioners Nurse Practitioners Services 20 1942445663 0 Nurse 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1942453022 0 Physicians Anesthesia Services 20 1942453022 0 Physicians Healthy Kids Services 20 1942453022 0 Physicians Optical Supplies 20 1942453022 0 Physicians Physician Services 00 1942454178 0 MCCORMICK SARAH 2010258 9999999 B 10 1942454178 0 355 E ERIE ST CHICAGO IL 606113167 20 1942454178 0 Physicians Anesthesia Services 20 1942454178 0 Physicians Healthy Kids Services 20 1942454178 0 Physicians Optical Supplies 20 1942454178 0 Physicians Physician Services 00 1942454186 0 SHAW KIMBERLY 2015349 9999999 B 10 1942454186 0 31 W 155TH ST HARVEY IL 604263556 20 1942454186 0 Physician Assistant Only Fluoride varnish 20 1942454186 0 Physician Assistant Only Healthy Kids Services 20 1942454186 0 Physician Assistant Only Physician Services 00 1942454624 0 AMES VANESSA M 2017255 9999999 B 10 1942454624 0 PO BOX 88848 CAROL STREAM IL 601880848 20 1942454624 0 Nurse Practitioners Anesthesia Services 20 1942454624 0 Nurse Practitioners Nurse Practitioners Services 20 1942454624 0 Nurse 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Anesthesia Services 20 1942456256 0 Physicians Fluoride varnish 20 1942456256 0 Physicians Healthy Kids Services 20 1942456256 0 Physicians Optical Supplies 20 1942456256 0 Physicians Physician Services 00 1942456595 0 FORBES CHRISTY 2012001 9999999 B 10 1942456595 0 3051 HOLLIS DR SPRINGFIELD IL 627047450 20 1942456595 0 Nurse Practitioners Fluoride varnish 20 1942456595 0 Nurse Practitioners Healthy Kids Services 20 1942456595 0 Nurse Practitioners Nurse Practitioners Services 20 1942456595 0 Nurse Practitioners Physician Services 00 1942456827 0 GEORGE ADIA G 2010228 9999999 B 10 1942456827 0 29373 NETWORK PL CHICAGO IL 606733039 20 1942456827 0 Physicians Anesthesia Services 20 1942456827 0 Physicians Fluoride varnish 20 1942456827 0 Physicians Healthy Kids Services 20 1942456827 0 Physicians Optical Supplies 20 1942456827 0 Physicians Physician Services 00 1942457221 0 AYALA JOSE 2009182 9999999 B 10 1942457221 0 5406 W FULLERTON AVE CHICAGO IL 606391427 20 1942457221 0 Physicians Anesthesia Services 20 1942457221 0 Physicians Fluoride varnish 20 1942457221 0 Physicians Healthy Kids Services 20 1942457221 0 Physicians Optical Supplies 20 1942457221 0 Physicians Physician Services 00 1942457411 0 MARTIN ANGELA 2008245 9999999 B 10 1942457411 0 500 JOHN DEERE RD MOLINE IL 612656892 20 1942457411 0 Physicians Anesthesia Services 20 1942457411 0 Physicians Healthy Kids Services 20 1942457411 0 Physicians Optical Supplies 20 1942457411 0 Physicians Physician Services 00 1942457734 0 MACZKO REBECCA S 2016001 9999999 B 10 1942457734 0 5777 DEPT CAROL STREAM IL 601228942 20 1942457734 0 Physician Assistant Only Fluoride varnish 20 1942457734 0 Physician Assistant Only Healthy Kids Services 20 1942457734 0 Physician Assistant Only Physician Services 00 1942457981 0 KALAIAH MUDAPPA K 2017096 9999999 B 10 1942457981 0 303 N JACKSON ST MORRISON IL 612703042 20 1942457981 0 Physicians Anesthesia Services 20 1942457981 0 Physicians Fluoride varnish 20 1942457981 0 Physicians 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1942467469 0 CADWALLADER JASON T 2017015 9999999 B 10 1942467469 0 1160 E SAINT CLAIR ST VINCENNES IN 475914853 20 1942467469 0 Physicians Anesthesia Services 20 1942467469 0 Physicians Fluoride varnish 20 1942467469 0 Physicians Healthy Kids Services 20 1942467469 0 Physicians Optical Supplies 20 1942467469 0 Physicians Physician Services 00 1942467576 0 KHASHABA OMAR A 2017169 9999999 B 10 1942467576 0 PO BOX 10010 GLENDALE AZ 853180010 20 1942467576 0 Physicians Anesthesia Services 20 1942467576 0 Physicians Healthy Kids Services 20 1942467576 0 Physicians Optical Supplies 20 1942467576 0 Physicians Physician Services 00 1942468145 0 JEGANMOHAN JANANDANA 2008145 9999999 B 10 1942468145 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1942468145 0 Physicians Anesthesia Services 20 1942468145 0 Physicians Fluoride varnish 20 1942468145 0 Physicians Healthy Kids Services 20 1942468145 0 Physicians Optical Supplies 20 1942468145 0 Physicians Physician Services 00 1942468426 0 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Physician Services 00 1942665245 0 SEVERING MATTHEW 2016244 9999999 B 10 1942665245 0 325 IL ROUTE 2 DIXON IL 610219118 20 1942665245 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1942666003 0 OLLIE AYESHA 2016158 9999999 B 10 1942666003 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1942666003 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1942666169 0 WEST SHERI L. 2016001 9999999 B 10 1942666169 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1942666169 0 Nurse Practitioners Healthy Kids Services 20 1942666169 0 Nurse Practitioners Nurse Practitioners Services 20 1942666169 0 Nurse Practitioners Physician Services 00 1942667498 0 SUTFIN JESSICA 2021041 9999999 B 10 1942667498 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1942667498 0 Physician Assistant Only Fluoride varnish 20 1942667498 0 Physician Assistant Only Healthy Kids Services 20 1942667498 0 Physician Assistant Only Physician Services 00 1942667563 0 SLATTERY JULIE M 2016064 9999999 B 10 1942667563 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1942667563 0 Nurse Practitioners Fluoride varnish 20 1942667563 0 Nurse Practitioners Healthy Kids Services 20 1942667563 0 Nurse Practitioners Nurse Practitioners Services 20 1942667563 0 Nurse Practitioners Physician Services 00 1942668314 0 WHITE KATHLEEN E 2016034 9999999 B 10 1942668314 0 2200 STATE ST LAWRENCEVILLE IL 624391852 20 1942668314 0 Nurse Practitioners Fluoride varnish 20 1942668314 0 Nurse Practitioners Healthy Kids Services 20 1942668314 0 Nurse Practitioners Nurse Practitioners Services 20 1942668314 0 Nurse Practitioners Physician Services 00 1942668355 0 DELANY JOANNE G 2017191 9999999 B 10 1942668355 0 P O BOX 771858 CHICAGO IL 606770001 20 1942668355 0 Nurse Practitioners Healthy Kids Services 20 1942668355 0 Nurse Practitioners Nurse Practitioners Services 20 1942668355 0 Nurse Practitioners 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Practitioners Nurse Practitioners Services 20 1942677984 0 Nurse Practitioners Physician Services 00 1942678404 0 KNOBLETT JAMIE R 2016056 9999999 B 10 1942678404 0 1000 N ALLEN ST ROBINSON IL 624541114 20 1942678404 0 Nurse Practitioners Fluoride varnish 20 1942678404 0 Nurse Practitioners Healthy Kids Services 20 1942678404 0 Nurse Practitioners Nurse Practitioners Services 20 1942678404 0 Nurse Practitioners Physician Services 00 1942678461 0 FRANK ADAM 2020185 9999999 B 10 1942678461 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1942678461 0 Dentists Dental Services 20 1942678461 0 Dentists Physician Services 00 1942678990 0 WALLENFANG JESSICA 2016336 9999999 B 10 1942678990 0 2835 N SHEFFIELD AVE STE 401 SUITE 401 CHICAGO IL 606575084 20 1942678990 0 Speech Therapists Medical Supplies 20 1942678990 0 Speech Therapists Medical equipment/prosthetic devices 20 1942678990 0 Speech Therapists Speech Therapy/Pathology Services 00 1942679253 0 SMITH ERICIA 2015273 9999999 B 10 1942679253 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Services 00 1942680640 0 AKHRAS ANWAR M 2019210 9999999 B 10 1942680640 0 29373 NETWORK PL CHICAGO IL 606733039 20 1942680640 0 Physicians Anesthesia Services 20 1942680640 0 Physicians Healthy Kids Services 20 1942680640 0 Physicians Optical Supplies 20 1942680640 0 Physicians Physician Services 00 1942681101 0 SONG XUYANG 2021223 9999999 B 10 1942681101 0 PO BOX 3693 CAROL STREAM IL 601323693 20 1942681101 0 Physicians Anesthesia Services 20 1942681101 0 Physicians Healthy Kids Services 20 1942681101 0 Physicians Optical Supplies 20 1942681101 0 Physicians Physician Services 00 1942681150 0 KENNEDY SEAN 2017079 9999999 B 10 1942681150 0 1256 WATERFORD DR STE 230 AURORA IL 605044511 20 1942681150 0 Physicians Anesthesia Services 20 1942681150 0 Physicians Fluoride varnish 20 1942681150 0 Physicians Healthy Kids Services 20 1942681150 0 Physicians Optical Supplies 20 1942681150 0 Physicians Physician Services 00 1942682224 0 AVGENACKIS EMILY 2022127 9999999 B 10 1942682224 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1942682224 0 Physician Assistant Only Fluoride varnish 20 1942682224 0 Physician Assistant Only Healthy Kids Services 20 1942682224 0 Physician Assistant Only Physician Services 00 1942682265 0 FOILES APRIL M 2017174 9999999 B 10 1942682265 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1942682265 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1942682331 0 WIDING AMANDA C 2019268 9999999 B 10 1942682331 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1942682331 0 Physicians Anesthesia Services 20 1942682331 0 Physicians Fluoride varnish 20 1942682331 0 Physicians Healthy Kids Services 20 1942682331 0 Physicians Optical Supplies 20 1942682331 0 Physicians Physician Services 00 1942683263 0 ALSOP JAMES V 2018197 9999999 B 10 1942683263 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1942683263 0 Physicians Anesthesia Services 20 1942683263 0 Physicians Fluoride varnish 20 1942683263 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PHOENIX AZ 850803230 20 1942695119 0 Physicians Anesthesia Services 20 1942695119 0 Physicians Healthy Kids Services 20 1942695119 0 Physicians Optical Supplies 20 1942695119 0 Physicians Physician Services 00 1942695424 0 CHEN KEVIN 2022235 9999999 B 10 1942695424 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1942695424 0 Physicians Anesthesia Services 20 1942695424 0 Physicians Healthy Kids Services 20 1942695424 0 Physicians Optical Supplies 20 1942695424 0 Physicians Physician Services 00 1942695440 0 SIRAJUDDIN HABEEBA 2015201 9999999 B 10 1942695440 0 611 W PARK ST URBANA IL 618012529 20 1942695440 0 Physicians All Kids application agent 20 1942695440 0 Physicians Anesthesia Services 20 1942695440 0 Physicians Fluoride varnish 20 1942695440 0 Physicians Healthy Kids Services 20 1942695440 0 Physicians Optical Supplies 20 1942695440 0 Physicians Physician Services 00 1942695507 0 MACDONALD JENNIFER 2017174 9999999 B 10 1942695507 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1942695507 0 Physicians Anesthesia Services 20 1942695507 0 Physicians Fluoride varnish 20 1942695507 0 Physicians Healthy Kids Services 20 1942695507 0 Physicians Optical Supplies 20 1942695507 0 Physicians Physician Services 00 1942695937 0 DUDERIJA ELDIN 2020112 9999999 B 10 1942695937 0 901 PATIENTS FIRST DR WASHINGTON MO 630904700 20 1942695937 0 Physicians Anesthesia Services 20 1942695937 0 Physicians Fluoride varnish 20 1942695937 0 Physicians Healthy Kids Services 20 1942695937 0 Physicians Optical Supplies 20 1942695937 0 Physicians Physician Services 00 1942696224 0 WILSON REBECCA 2015110 9999999 B 10 1942696224 0 1256 WATERFORD DR STE 230 AURORA IL 605044511 20 1942696224 0 Nurse Practitioners Fluoride varnish 20 1942696224 0 Nurse Practitioners Healthy Kids Services 20 1942696224 0 Nurse Practitioners Nurse Practitioners Services 20 1942696224 0 Nurse Practitioners Physician Services 00 1942696331 0 FRAZER AARON 2015110 9999999 B 10 1942696331 0 PO BOX 192 900 N WASHINGTON 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Physicians Healthy Kids Services 20 1942697149 0 Physicians Optical Supplies 20 1942697149 0 Physicians Physician Services 00 1942698980 0 OLADIPO ADEOLA 2015112 9999999 B 10 1942698980 0 5132 N ELSTON AVE CHICAGO IL 606302429 20 1942698980 0 Nurse Practitioners Fluoride varnish 20 1942698980 0 Nurse Practitioners Healthy Kids Services 20 1942698980 0 Nurse Practitioners Nurse Practitioners Services 20 1942698980 0 Nurse Practitioners Physician Services 00 1942699632 0 HENNES MORGAN 2024274 9999999 B 10 1942699632 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1942699632 0 Physician Assistant Only Fluoride varnish 20 1942699632 0 Physician Assistant Only Healthy Kids Services 20 1942699632 0 Physician Assistant Only Physician Services 00 1942702501 0 JANOUSCHEK HILDEGARD 2018065 9999999 B 10 1942702501 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1942702501 0 Physicians Anesthesia Services 20 1942702501 0 Physicians Healthy Kids Services 20 1942702501 0 Physicians Optical Supplies 20 1942702501 0 Physicians Physician Services 20 1942702501 0 Physicians Physicians Psychiatric Services 00 1942702717 0 SERRANO ALEXANDER 2018127 9999999 B 10 1942702717 0 2141 W NORTH AVE CHICAGO IL 606475415 20 1942702717 0 Clinical Social Worker Social work service 00 1942703285 0 FIELD TRISHA L. 2018099 9999999 B 10 1942703285 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1942703285 0 Nurse Practitioners Fluoride varnish 20 1942703285 0 Nurse Practitioners Healthy Kids Services 20 1942703285 0 Nurse Practitioners Nurse Practitioners Services 20 1942703285 0 Nurse Practitioners Physician Services 00 1942704093 0 GREGORY MELISSA 2017182 9999999 B 10 1942704093 0 15127 S 73RD AVE STE C SUITE C ORLAND PARK IL 604623463 20 1942704093 0 Other behavior health professional LCPC/LMFT services 00 1942704507 0 RANDALL SAMUEL J 2018174 9999999 B 10 1942704507 0 1905 E HUEBBE PKWY BELOIT WI 535111842 20 1942704507 0 Physicians Anesthesia Services 20 1942704507 0 Physicians Fluoride varnish 20 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9999999 B 10 1942862578 0 530 NE GLEN OAK AVE PEORIA IL 616370001 20 1942862578 0 Physicians Anesthesia Services 20 1942862578 0 Physicians Fluoride varnish 20 1942862578 0 Physicians Healthy Kids Services 20 1942862578 0 Physicians Optical Supplies 20 1942862578 0 Physicians Physician Services 00 1942862875 0 CARPENTER KENDAL R 2019249 9999999 B 10 1942862875 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1942862875 0 Physician Assistant Only Fluoride varnish 20 1942862875 0 Physician Assistant Only Healthy Kids Services 20 1942862875 0 Physician Assistant Only Physician Services 00 1942863469 0 HEO JAEYEONG 2021265 9999999 B 10 1942863469 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1942863469 0 Physicians Anesthesia Services 20 1942863469 0 Physicians Healthy Kids Services 20 1942863469 0 Physicians Optical Supplies 20 1942863469 0 Physicians Physician Services 00 1942864541 0 MENON HARI 2023181 9999999 B 10 1942864541 0 4701 DEPT CAROL STREAM IL 601220021 20 1942864541 0 Physicians Anesthesia Services 20 1942864541 0 Physicians Healthy Kids Services 20 1942864541 0 Physicians Optical Supplies 20 1942864541 0 Physicians Physician Services 00 1942864574 0 GAUR DIPIKA D 2021112 9999999 B 10 1942864574 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1942864574 0 Physicians Anesthesia Services 20 1942864574 0 Physicians Fluoride varnish 20 1942864574 0 Physicians Healthy Kids Services 20 1942864574 0 Physicians Optical Supplies 20 1942864574 0 Physicians Physician Services 00 1942865423 0 MAJCHRZAK KEVIN M 2022284 9999999 B 10 1942865423 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1942865423 0 Occupational Therapists Medical Supplies 20 1942865423 0 Occupational Therapists Medical equipment/prosthetic devices 20 1942865423 0 Occupational Therapists Occupational Therapy Services 00 1942865563 0 TAWAKLNA KENAN 2021244 9999999 B 10 1942865563 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1942865563 0 Physicians Anesthesia Services 20 1942865563 0 Physicians Healthy Kids Services 20 1942865563 0 Physicians Optical Supplies 20 1942865563 0 Physicians Physician Services 00 1942865647 0 MCLAUGHLIN WILLIAM M 2025009 9999999 B 10 1942865647 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1942865647 0 Physicians Anesthesia Services 20 1942865647 0 Physicians Healthy Kids Services 20 1942865647 0 Physicians Optical Supplies 20 1942865647 0 Physicians Physician Services 00 1942865852 0 CHANDLER WHITNEY 2024352 9999999 B 10 1942865852 0 PO BOX 301208 DALLAS TX 753031208 20 1942865852 0 Physicians Anesthesia Services 20 1942865852 0 Physicians Healthy Kids Services 20 1942865852 0 Physicians Optical Supplies 20 1942865852 0 Physicians Physician Services 00 1942865977 0 DEMOSS LINDSAY M 2024179 9999999 B 10 1942865977 0 1005 BROADWAY ST QUINCY IL 623012834 20 1942865977 0 Nurse Practitioners Fluoride varnish 20 1942865977 0 Nurse Practitioners Healthy Kids Services 20 1942865977 0 Nurse Practitioners Nurse Practitioners Services 20 1942865977 0 Nurse Practitioners Physician Services 00 1942867270 0 MOORE CLAIRE 2022098 9999999 B 10 1942867270 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1942867270 0 Physicians Anesthesia Services 20 1942867270 0 Physicians Fluoride varnish 20 1942867270 0 Physicians Healthy Kids Services 20 1942867270 0 Physicians Optical Supplies 20 1942867270 0 Physicians Physician Services 00 1942867494 0 PATEL ADITI R 2024151 9999999 B 10 1942867494 0 5777 DEPT CAROL STREAM IL 601220021 20 1942867494 0 Physicians Anesthesia Services 20 1942867494 0 Physicians Healthy Kids Services 20 1942867494 0 Physicians Optical Supplies 20 1942867494 0 Physicians Physician Services 00 1942867825 0 WEN PATRICK YULEI 2023209 9999999 B 10 1942867825 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1942867825 0 Physicians Anesthesia Services 20 1942867825 0 Physicians Healthy Kids Services 20 1942867825 0 Physicians Optical Supplies 20 1942867825 0 Physicians Physician Services 20 1942867825 0 Physicians Physicians Psychiatric Services 00 1942868476 0 BRUCE CLARISSA 2020094 9999999 B 10 1942868476 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1942868476 0 Physician Assistant Only Fluoride varnish 20 1942868476 0 Physician Assistant Only Healthy Kids Services 20 1942868476 0 Physician Assistant Only Physician Services 00 1942868633 0 MANNING JAKE A 2019261 9999999 B 10 1942868633 0 5777 DEPT CAROL STREAM IL 601228942 20 1942868633 0 Physicians Anesthesia Services 20 1942868633 0 Physicians Fluoride varnish 20 1942868633 0 Physicians Healthy Kids Services 20 1942868633 0 Physicians Optical Supplies 20 1942868633 0 Physicians Physician Services 00 1942868658 0 SHAH SUPRIYA 2019179 9999999 B 10 1942868658 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1942868658 0 Physicians Anesthesia Services 20 1942868658 0 Physicians Healthy Kids Services 20 1942868658 0 Physicians Optical Supplies 20 1942868658 0 Physicians Physician Services 00 1942869110 0 PALMER BENJAMIN A 2022200 9999999 B 10 1942869110 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1942869110 0 Physicians Anesthesia Services 20 1942869110 0 Physicians Fluoride varnish 20 1942869110 0 Physicians Healthy Kids Services 20 1942869110 0 Physicians Optical Supplies 20 1942869110 0 Physicians Physician Services 00 1942869573 0 SHANKER ERIN 2019182 9999999 B 10 1942869573 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1942869573 0 Physicians Anesthesia Services 20 1942869573 0 Physicians Fluoride varnish 20 1942869573 0 Physicians Healthy Kids Services 20 1942869573 0 Physicians Optical Supplies 20 1942869573 0 Physicians Physician Services 00 1942870167 0 REHAN HAMZAH 2022251 9999999 B 10 1942870167 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1942870167 0 Physicians Anesthesia Services 20 1942870167 0 Physicians Healthy Kids Services 20 1942870167 0 Physicians Optical Supplies 20 1942870167 0 Physicians Physician Services 00 1942870449 0 HOUSE MARCUS 2021197 9999999 B 10 1942870449 0 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Physicians Anesthesia Services 20 1942872049 0 Physicians Healthy Kids Services 20 1942872049 0 Physicians Optical Supplies 20 1942872049 0 Physicians Physician Services 00 1942872171 0 TRIAND CHRISTIAN 2021203 9999999 B 10 1942872171 0 5030 N MARINE DR APT 406 CHICAGO IL 606406310 20 1942872171 0 Dentists Dental Services 20 1942872171 0 Dentists Physician Services 00 1942872197 0 WEEGAR DAVID G 2021218 9999999 B 10 1942872197 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1942872197 0 Nurse Practitioners Healthy Kids Services 20 1942872197 0 Nurse Practitioners Nurse Practitioners Services 20 1942872197 0 Nurse Practitioners Physician Services 00 1942872601 0 MELAMED SABINA 2024218 9999999 B 10 1942872601 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1942872601 0 Clinical Social Worker Social work service 00 1942873112 0 ARON JACQUELYN 2021257 9999999 B 10 1942873112 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1942873112 0 Clinical Social Worker Social work service 00 1942873567 0 MAY 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W HARRISON ST CHICAGO IL 606123714 20 1942876792 0 Physicians Anesthesia Services 20 1942876792 0 Physicians Healthy Kids Services 20 1942876792 0 Physicians Optical Supplies 20 1942876792 0 Physicians Physician Services 00 1942877048 0 POLLACK ALISON 2021302 9999999 B 10 1942877048 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1942877048 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1942879150 0 TURNER TASHANA 2022152 9999999 H 10 1942879150 0 318 W WASHINGTON ST STE 1A BLOOMINGTON IL 617013893 20 1942879150 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1942879309 0 NIAZI AZFAR KHAN 2024351 9999999 B 10 1942879309 0 13000 DEERFIELD PKWY STE 100 ALPHARETTA GA 300046118 20 1942879309 0 Physicians Anesthesia Services 20 1942879309 0 Physicians Fluoride varnish 20 1942879309 0 Physicians Healthy Kids Services 20 1942879309 0 Physicians Optical Supplies 20 1942879309 0 Physicians Physician Services 00 1942880323 0 ADEYEMI ESTHER O 2024191 9999999 B 10 1942880323 0 29373 NETWORK PL CHICAGO IL 606733039 20 1942880323 0 Physicians Anesthesia Services 20 1942880323 0 Physicians Healthy Kids Services 20 1942880323 0 Physicians Optical Supplies 20 1942880323 0 Physicians Physician Services 00 1942880745 0 FARMER FELICIA 2021133 9999999 B 10 1942880745 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1942880745 0 Nurse Practitioners Fluoride varnish 20 1942880745 0 Nurse Practitioners Healthy Kids Services 20 1942880745 0 Nurse Practitioners Nurse Practitioners Services 20 1942880745 0 Nurse Practitioners Physician Services 00 1942881222 0 MILLER JEREMY 2021188 9999999 B 10 1942881222 0 5665 NEW NORTHSIDE DR STE 320 ATLANTA GA 303285834 20 1942881222 0 Physicians Anesthesia Services 20 1942881222 0 Physicians Fluoride varnish 20 1942881222 0 Physicians Healthy Kids Services 20 1942881222 0 Physicians Optical Supplies 20 1942881222 0 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Physician Services 00 1942883343 0 ROY ALEXA 2023206 9999999 B 10 1942883343 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1942883343 0 Physicians Anesthesia Services 20 1942883343 0 Physicians Healthy Kids Services 20 1942883343 0 Physicians Optical Supplies 20 1942883343 0 Physicians Physician Services 00 1942883459 0 GUIBAULT COLIN B 2022236 9999999 B 10 1942883459 0 1350 W HAWLEY ST MUNDELEIN IL 600601504 20 1942883459 0 Speech Therapists Medical Supplies 20 1942883459 0 Speech Therapists Medical equipment/prosthetic devices 20 1942883459 0 Speech Therapists Speech Therapy/Pathology Services 00 1942883970 0 BIRKHAHNROMMELFANGER DAVID T 2021125 9999999 B 10 1942883970 0 3436 N KENNICOTT AVE STE 114 STE 114 ARLINGTON HEIGH IL 600047814 20 1942883970 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1942884226 0 SCHNEIDER ROBIN A 2022201 9999999 B 10 1942884226 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1942884226 0 Physicians Anesthesia Services 20 1942884226 0 Physicians Healthy Kids Services 20 1942884226 0 Physicians Optical Supplies 20 1942884226 0 Physicians Physician Services 00 1942886049 0 FIORE KYLE M 2021123 9999999 B 10 1942886049 0 811 W JOHN ST YORKVILLE IL 605609249 20 1942886049 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1942886387 0 BAYLY BRYANA 2024184 9999999 B 10 1942886387 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1942886387 0 Physicians Anesthesia Services 20 1942886387 0 Physicians Healthy Kids Services 20 1942886387 0 Physicians Optical Supplies 20 1942886387 0 Physicians Physician Services 20 1942886387 0 Physicians Physicians Psychiatric Services 00 1942886668 0 BELL JOSEPH 2021191 9999999 B 10 1942886668 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1942886668 0 Physicians Anesthesia Services 20 1942886668 0 Physicians Healthy Kids Services 20 1942886668 0 Physicians Optical Supplies 20 1942886668 0 Physicians Physician Services 00 1942888169 0 DESAI JAY 2021223 9999999 B 10 1942888169 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1942888169 0 Physicians Anesthesia Services 20 1942888169 0 Physicians Healthy Kids Services 20 1942888169 0 Physicians Optical Supplies 20 1942888169 0 Physicians Physician Services 00 1942888375 0 JAMIL AYEZA 2021203 9999999 B 10 1942888375 0 PO BOX 5081 JANESVILLE WI 535475081 20 1942888375 0 Physicians Anesthesia Services 20 1942888375 0 Physicians Fluoride varnish 20 1942888375 0 Physicians Healthy Kids Services 20 1942888375 0 Physicians Optical Supplies 20 1942888375 0 Physicians Physician Services 00 1942888532 0 BEHLMER RICHARD J 2022031 9999999 B 10 1942888532 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1942888532 0 Physicians Anesthesia Services 20 1942888532 0 Physicians Healthy Kids Services 20 1942888532 0 Physicians Optical Supplies 20 1942888532 0 Physicians Physician Services 00 1942892385 0 ORNELAS EDUARDO 2022172 9999999 B 10 1942892385 0 PO BOX 5009 BRENTWOOD TN 370245009 20 1942892385 0 Nurse Practitioners Anesthesia Services 20 1942892385 0 Nurse Practitioners Nurse Practitioners Services 20 1942892385 0 Nurse Practitioners Physician Services 00 1942893607 0 HAVRYLYAN ANASTASIYA 2021172 9999999 B 10 1942893607 0 29373 NETWORK PL CHICAGO IL 606733039 20 1942893607 0 Nurse Practitioners Healthy Kids Services 20 1942893607 0 Nurse Practitioners Nurse Practitioners Services 20 1942893607 0 Nurse Practitioners Physician Services 00 1942893730 0 LACAVERA MARGEAUX 2024205 9999999 B 10 1942893730 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1942893730 0 Physicians Anesthesia Services 20 1942893730 0 Physicians Fluoride varnish 20 1942893730 0 Physicians Healthy Kids Services 20 1942893730 0 Physicians Optical Supplies 20 1942893730 0 Physicians Physician Services 00 1942895743 0 NOVOSELSKY CARLY 2021082 9999999 B 10 1942895743 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 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Physician Services 00 1942901996 0 PENN ANEESHA 2024183 9999999 B 10 1942901996 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1942901996 0 Physicians Anesthesia Services 20 1942901996 0 Physicians Healthy Kids Services 20 1942901996 0 Physicians Optical Supplies 20 1942901996 0 Physicians Physician Services 00 1942902184 0 OKEMATTI EMMANUEL 2023187 9999999 B 10 1942902184 0 4698 DEPT CAROL STREAM IL 601220021 20 1942902184 0 Physicians Anesthesia Services 20 1942902184 0 Physicians Fluoride varnish 20 1942902184 0 Physicians Healthy Kids Services 20 1942902184 0 Physicians Optical Supplies 20 1942902184 0 Physicians Physician Services 20 1942902184 0 Physicians Physicians Psychiatric Services 00 1942902606 0 ABDELSAYED GERGES 2024183 9999999 B 10 1942902606 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1942902606 0 Physicians Anesthesia Services 20 1942902606 0 Physicians Healthy Kids Services 20 1942902606 0 Physicians Optical Supplies 20 1942902606 0 Physicians Physician Services 00 1942904156 0 LISTELLO CAITLYNN 2024002 9999999 B 10 1942904156 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1942904156 0 Nurse Practitioners Fluoride varnish 20 1942904156 0 Nurse Practitioners Healthy Kids Services 20 1942904156 0 Nurse Practitioners Nurse Practitioners Services 20 1942904156 0 Nurse Practitioners Physician Services 00 1942905021 0 MICHALOPOULOS ALEXANDRA ZOE 2023186 9999999 B 10 1942905021 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1942905021 0 Podiatrists Podiatric Services 00 1942905062 0 FLEIGLE KAYLA 2023201 9999999 B 10 1942905062 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1942905062 0 Physical Therapists Medical Supplies 20 1942905062 0 Physical Therapists Medical equipment/prosthetic devices 20 1942905062 0 Physical Therapists Physical Therapy Services 00 1942905435 0 MAZURKIEWICZ EVAN B 2023186 9999999 B 10 1942905435 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1942905435 0 Physicians Anesthesia Services 20 1942905435 0 Physicians Healthy Kids Services 20 1942905435 0 Physicians Optical Supplies 20 1942905435 0 Physicians Physician Services 00 1942906094 0 FARRIES BRIAHNA MONAE 2023032 9999999 B 10 1942906094 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1942906094 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1942906151 0 JONES JENNIFER 2023130 9999999 B 10 1942906151 0 42 W MADISON ST FL 2 CHICAGO IL 606024309 20 1942906151 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1942908223 0 MAMICH LORRIE 2023115 9999999 B 10 1942908223 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1942908223 0 Nurse Practitioners Healthy Kids Services 20 1942908223 0 Nurse Practitioners Nurse Practitioners Services 20 1942908223 0 Nurse Practitioners Physician Services 00 1942908785 0 KIRLEW NICOLE DENISE 2024141 9999999 B 10 1942908785 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 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CHICAGO IL 606112991 20 1942916986 0 Nurse Practitioners Fluoride varnish 20 1942916986 0 Nurse Practitioners Healthy Kids Services 20 1942916986 0 Nurse Practitioners Nurse Practitioners Services 20 1942916986 0 Nurse Practitioners Physician Services 00 1942917836 0 WOOD ALYSSA 2023009 9999999 B 10 1942917836 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1942917836 0 Nurse Practitioners Fluoride varnish 20 1942917836 0 Nurse Practitioners Healthy Kids Services 20 1942917836 0 Nurse Practitioners Nurse Practitioners Services 20 1942917836 0 Nurse Practitioners Physician Services 00 1942917901 0 FITE DANIELLE 2024165 9999999 B 10 1942917901 0 2348 POST RD STE 107 WARWICK RI 028862271 20 1942917901 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1942920129 0 WORTHEN ROBERT 2023051 9999999 B 10 1942920129 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1942920129 0 Nurse Practitioners Fluoride varnish 20 1942920129 0 Nurse Practitioners Healthy Kids Services 20 1942920129 0 Nurse Practitioners Nurse Practitioners Services 20 1942920129 0 Nurse Practitioners Physician Services 00 1942921069 0 FLEMING MARIE S 2022255 9999999 B 10 1942921069 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1942921069 0 Speech Therapists Medical Supplies 20 1942921069 0 Speech Therapists Medical equipment/prosthetic devices 20 1942921069 0 Speech Therapists Speech Therapy/Pathology Services 00 1942921556 0 HERMANSON KARI 2023194 9999999 B 10 1942921556 0 PO BOX 411637 SAINT LOUIS MO 631411637 20 1942921556 0 Nurse Practitioners Anesthesia Services 20 1942921556 0 Nurse Practitioners Nurse Practitioners Services 20 1942921556 0 Nurse Practitioners Physician Services 00 1942924691 0 KRYGSHELD DANEEN 2022271 9999999 B 10 1942924691 0 18300 GREENBAY AVE LANSING IL 604383009 20 1942924691 0 Speech Therapists Medical Supplies 20 1942924691 0 Speech Therapists Medical equipment/prosthetic devices 20 1942924691 0 Speech Therapists Speech Therapy/Pathology Services 00 1942926068 0 LEE KWANG LIM 2022311 9999999 B 10 1942926068 0 502 RIVERSIDE DR EAST PEORIA IL 616112068 20 1942926068 0 Dentists Dental Services 20 1942926068 0 Dentists Physician Services 00 1942926571 0 ONESTI OLIVIA K 2022312 9999999 B 10 1942926571 0 122 S MICHIGAN AVE STE 1441 CHICAGO IL 606036173 20 1942926571 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1942927470 0 KIEL DANIELLE 2022300 9999999 B 10 1942927470 0 370 SUMMIT ST # 1 ELGIN IL 601203843 20 1942927470 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1942927470 0 Other behavior health professional Social work service 00 1942928858 0 TAPIA ROMERO KATIA 2023254 9999999 B 10 1942928858 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1942928858 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1942928866 0 ISHMAEL JENNA 2022234 9999999 B 10 1942928866 0 PO BOX 530 HAVANA IL 626440530 20 1942928866 0 Nurse Practitioners Fluoride varnish 20 1942928866 0 Nurse Practitioners Healthy Kids Services 20 1942928866 0 Nurse Practitioners Nurse Practitioners Services 20 1942928866 0 Nurse Practitioners Physician Services 00 1942929542 0 POLITO BRIDGET B 2022312 9999999 B 10 1942929542 0 4400 W 95TH ST STE 308 OAK LAWN IL 604532660 20 1942929542 0 Physician Assistant Only Fluoride varnish 20 1942929542 0 Physician Assistant Only Healthy Kids Services 20 1942929542 0 Physician Assistant Only Physician Services 00 1942930003 0 RAY MAKEDA 2023104 9999999 B 10 1942930003 0 7101 N CICERO AVE STE 202 LINCOLNWOOD IL 607122143 20 1942930003 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1942930052 0 JAMSHED ANEEZA 2022213 9999999 B 10 1942930052 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1942930052 0 Physicians Anesthesia Services 20 1942930052 0 Physicians Fluoride varnish 20 1942930052 0 Physicians Healthy Kids Services 20 1942930052 0 Physicians Optical Supplies 20 1942930052 0 Physicians Physician Services 00 1942930177 0 WARREN ANTONIA 2025024 9999999 B 10 1942930177 0 447 SUTTER ST STE 405 SAN FRANCISCO CA 941084618 20 1942930177 0 Clinical Social Worker Social work service 00 1942930649 0 MANDERNACH EMILY 2022173 9999999 B 10 1942930649 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1942930649 0 Nurse Practitioners Healthy Kids Services 20 1942930649 0 Nurse Practitioners Nurse Practitioners Services 20 1942930649 0 Nurse Practitioners Physician Services 00 1942930805 0 BULDAK AARON 2022266 9999999 B 10 1942930805 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1942930805 0 Physical Therapists Medical Supplies 20 1942930805 0 Physical Therapists Medical equipment/prosthetic devices 20 1942930805 0 Physical Therapists Physical Therapy Services 00 1942931852 0 PARACHA HAMZA 2023195 9999999 B 10 1942931852 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1942931852 0 Physicians Anesthesia Services 20 1942931852 0 Physicians Healthy Kids Services 20 1942931852 0 Physicians Optical Supplies 20 1942931852 0 Physicians Physician Services 20 1942931852 0 Physicians Physicians Psychiatric Services 00 1942932819 0 VILLA MARISOL 2024130 9999999 B 10 1942932819 0 5N233 BLUFF DR S ST CHARLES IL 601755189 20 1942932819 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1942932975 0 SCHNEIDER LEAH ANN 2022195 9999999 B 10 1942932975 0 1311 MAMARONECK AVE STE 140 WHITE PLAINS NY 106055224 20 1942932975 0 Occupational Therapists Medical Supplies 20 1942932975 0 Occupational Therapists Medical equipment/prosthetic devices 20 1942932975 0 Occupational Therapists Occupational Therapy Services 00 1942933775 0 MUSIC SANELA 2023183 9999999 B 10 1942933775 0 4698 DEPT CAROL STREAM IL 601220021 20 1942933775 0 Physicians Anesthesia Services 20 1942933775 0 Physicians Fluoride varnish 20 1942933775 0 Physicians Healthy Kids Services 20 1942933775 0 Physicians Optical Supplies 20 1942933775 0 Physicians Physician Services 00 1942934039 0 MIYATANI YUSUKE 2022364 9999999 B 10 1942934039 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1942934039 0 Physicians Anesthesia Services 20 1942934039 0 Physicians Fluoride varnish 20 1942934039 0 Physicians Healthy Kids Services 20 1942934039 0 Physicians Optical Supplies 20 1942934039 0 Physicians Physician Services 00 1942934047 0 SANTACRUZ CLAUDIA 2024214 9999999 B 10 1942934047 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1942934047 0 Physician Assistant Only Fluoride varnish 20 1942934047 0 Physician Assistant Only Healthy Kids Services 20 1942934047 0 Physician Assistant Only Physician Services 00 1942935291 0 HODGE VICTORIA 2023180 9999999 B 10 1942935291 0 634 N MAIN ST STE 3 O FALLON IL 622693746 20 1942935291 0 Speech Therapists Medical Supplies 20 1942935291 0 Speech Therapists Medical equipment/prosthetic devices 20 1942935291 0 Speech Therapists Speech Therapy/Pathology Services 00 1942936935 0 ROMANIAK MOLLY N 2022234 9999999 B 10 1942936935 0 2157 N DAMEN AVE STE 2C CHICAGO IL 606476916 20 1942936935 0 Physical Therapists Medical Supplies 20 1942936935 0 Physical Therapists Medical equipment/prosthetic devices 20 1942936935 0 Physical Therapists Physical Therapy Services 00 1942938261 0 KUYPERS KATHERINE 2023017 9999999 B 10 1942938261 0 PO BOX 775342 CHICAGO IL 606775342 20 1942938261 0 Nurse Practitioners Healthy Kids Services 20 1942938261 0 Nurse Practitioners Nurse Practitioners Services 20 1942938261 0 Nurse Practitioners Physician Services 00 1942938410 0 ESSER ALEXANDRA 2022298 9999999 B 10 1942938410 0 4701 DEPT CAROL STREAM IL 601220021 20 1942938410 0 Speech Therapists Medical Supplies 20 1942938410 0 Speech Therapists Medical equipment/prosthetic devices 20 1942938410 0 Speech Therapists Speech Therapy/Pathology Services 00 1942938527 0 SUN JEFFREY 2024152 9999999 B 10 1942938527 0 PO BOX 781076 DETROIT MI 482781076 20 1942938527 0 Nurse Practitioners Fluoride varnish 20 1942938527 0 Nurse Practitioners Healthy Kids Services 20 1942938527 0 Nurse Practitioners Nurse Practitioners Services 20 1942938527 0 Nurse Practitioners Physician Services 00 1942938626 0 JUNGE DAVID 2024100 9999999 B 10 1942938626 0 111 E 4TH ST STE 440 ALTON IL 620026206 20 1942938626 0 Optometrists Optical Supplies 20 1942938626 0 Optometrists Optometric Services 20 1942938626 0 Optometrists Physician Services 00 1942938709 0 PAPPAS MICHELLE 2022223 9999999 B 10 1942938709 0 15732 S HOWARD ST PLAINFIELD IL 605442399 20 1942938709 0 Speech Therapists Medical Supplies 20 1942938709 0 Speech Therapists Medical equipment/prosthetic devices 20 1942938709 0 Speech Therapists Speech Therapy/Pathology Services 00 1942940168 0 SCHOEPPL DRAKE 2022201 9999999 B 10 1942940168 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1942940168 0 Clinical Social Worker Social work service 00 1942940598 0 PALADUGU SREELEKHA 2022172 9999999 B 10 1942940598 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1942940598 0 Nurse Practitioners Anesthesia Services 20 1942940598 0 Nurse Practitioners Healthy Kids Services 20 1942940598 0 Nurse Practitioners Optical Supplies 20 1942940598 0 Nurse Practitioners Physician Services 00 1942941661 0 COLE TIFFANY 2023188 9999999 B 10 1942941661 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1942941661 0 Physicians Anesthesia Services 20 1942941661 0 Physicians Healthy Kids Services 20 1942941661 0 Physicians Optical Supplies 20 1942941661 0 Physicians Physician Services 00 1942942883 0 PAIK EUNICE 2022213 9999999 B 10 1942942883 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1942942883 0 Physicians Anesthesia Services 20 1942942883 0 Physicians Fluoride varnish 20 1942942883 0 Physicians Healthy Kids Services 20 1942942883 0 Physicians Optical Supplies 20 1942942883 0 Physicians Physician Services 00 1942943188 0 DEROIN LIA R 2022235 9999999 B 10 1942943188 0 7825 SOLUTION CTR CHICAGO IL 606777007 20 1942943188 0 Physicians Anesthesia Services 20 1942943188 0 Physicians Healthy Kids Services 20 1942943188 0 Physicians Optical Supplies 20 1942943188 0 Physicians Physician Services 20 1942943188 0 Physicians Physicians Psychiatric Services 00 1942943626 0 IMPERIAL ELIZABETH C 2022166 9999999 B 10 1942943626 0 2020 OGDEN AVE STE 360 SUITE 360 AURORA IL 605046486 20 1942943626 0 Physicians Anesthesia Services 20 1942943626 0 Physicians Fluoride varnish 20 1942943626 0 Physicians Healthy Kids Services 20 1942943626 0 Physicians Optical Supplies 20 1942943626 0 Physicians Physician Services 00 1942944863 0 SHARF SAIMA 2022182 9999999 B 10 1942944863 0 5145 N CALIFORNIA AVE CHICAGO IL 606253661 20 1942944863 0 Podiatrists Podiatric Services 00 1942945332 0 HAYATO UNSETH CRISTIANE 2022286 9999999 B 10 1942945332 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1942945332 0 Physician Assistant Only Fluoride varnish 20 1942945332 0 Physician Assistant Only Healthy Kids Services 20 1942945332 0 Physician Assistant Only Physician Services 00 1942945571 0 NGUYEN TUNG DUY 2022175 9999999 B 10 1942945571 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1942945571 0 Physicians Anesthesia Services 20 1942945571 0 Physicians Healthy Kids Services 20 1942945571 0 Physicians Optical Supplies 20 1942945571 0 Physicians Physician Services 00 1942946207 0 OLUGA OLABODE 2024232 9999999 B 10 1942946207 0 PO BOX 4238 ROCK ISLAND IL 612044238 20 1942946207 0 Nurse Practitioners Healthy Kids Services 20 1942946207 0 Nurse Practitioners Nurse Practitioners Services 20 1942946207 0 Nurse Practitioners Physician Services 00 1942946413 0 PARZIALE MELANIE P 2022186 9999999 B 10 1942946413 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1942946413 0 Physicians Anesthesia Services 20 1942946413 0 Physicians Fluoride varnish 20 1942946413 0 Physicians Healthy Kids Services 20 1942946413 0 Physicians Optical Supplies 20 1942946413 0 Physicians Physician Services 00 1942946538 0 RADLEY EMMA 2024176 9999999 B 10 1942946538 0 4698 DEPT CAROL STREAM IL 601220021 20 1942946538 0 Physicians Anesthesia Services 20 1942946538 0 Physicians Healthy Kids Services 20 1942946538 0 Physicians Optical Supplies 20 1942946538 0 Physicians Physician Services 20 1942946538 0 Physicians Physicians Psychiatric Services 00 1942946561 0 QI YAO 2024323 9999999 B 10 1942946561 0 4836 MAIN ST STE 1 SKOKIE IL 600772594 20 1942946561 0 Dentists Dental Services 20 1942946561 0 Dentists Physician Services 00 1942946603 0 DEMMER BRITTANY 2024239 9999999 B 10 1942946603 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1942946603 0 Nurse Practitioners Anesthesia Services 20 1942946603 0 Nurse Practitioners Nurse Practitioners Services 20 1942946603 0 Nurse Practitioners Physician Services 00 1942946843 0 SCHNEIDER SAMANTHA MORGAN 2022193 9999999 B 10 1942946843 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1942946843 0 Audiologists Audiology Services 20 1942946843 0 Audiologists Medical Supplies 20 1942946843 0 Audiologists Medical equipment/prosthetic devices 00 1942947684 0 LAKRITZ ARI S 2022231 9999999 B 10 1942947684 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1942947684 0 Psychologist Psychologist service 00 1942947866 0 SEEKER THERESA J 2022194 9999999 B 10 1942947866 0 1100 NW SOUTH OUTER RD BLUE SPRINGS MO 640153070 20 1942947866 0 Nurse Practitioners Healthy Kids Services 20 1942947866 0 Nurse Practitioners Nurse Practitioners Services 20 1942947866 0 Nurse Practitioners Physician Services 00 1942948237 0 BOTTORFF ABIGAIL 2024285 9999999 B 10 1942948237 0 1757 N KIMBALL AVE STE 202 CHICAGO IL 606474805 20 1942948237 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1942948450 0 ARREDONDO LIANA 2022245 9999999 B 10 1942948450 0 PO BOX 3990 NAPERVILLE IL 605673990 20 1942948450 0 Speech Therapists Medical Supplies 20 1942948450 0 Speech Therapists Medical equipment/prosthetic devices 20 1942948450 0 Speech Therapists Speech Therapy/Pathology Services 00 1942949342 0 COMERFORD SCHREIBER JILL 2023074 9999999 B 10 1942949342 0 182 S MAIN ST GLEN CARBON IL 620341419 20 1942949342 0 Clinical Social Worker Social work service 00 1942949870 0 TAJIK SHADEE 2022186 9999999 B 10 1942949870 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1942949870 0 Physicians Anesthesia Services 20 1942949870 0 Physicians Fluoride varnish 20 1942949870 0 Physicians Healthy Kids Services 20 1942949870 0 Physicians Optical Supplies 20 1942949870 0 Physicians Physician Services 00 1942949888 0 MCGREGOR KATHRYN R 2022182 9999999 B 10 1942949888 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1942949888 0 Physicians Anesthesia Services 20 1942949888 0 Physicians Healthy Kids Services 20 1942949888 0 Physicians Optical Supplies 20 1942949888 0 Physicians Physician Services 00 1942950118 0 LUU SANDRA 2022196 9999999 B 10 1942950118 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1942950118 0 Podiatrists Podiatric Services 00 1942950134 0 MATHEW VIPIN 2022178 9999999 B 10 1942950134 0 4698 DEPT CAROL STREAM IL 601224698 20 1942950134 0 Physicians Anesthesia Services 20 1942950134 0 Physicians Fluoride varnish 20 1942950134 0 Physicians Healthy Kids Services 20 1942950134 0 Physicians Optical Supplies 20 1942950134 0 Physicians Physician Services 00 1942950191 0 GARDNER SHANE 2022179 9999999 B 10 1942950191 0 PO BOX 3039 OAK BROOK IL 605223039 20 1942950191 0 Physicians Anesthesia Services 20 1942950191 0 Physicians Healthy Kids Services 20 1942950191 0 Physicians Optical Supplies 20 1942950191 0 Physicians Physician Services 00 1942951355 0 OLSTAD LARS 2022350 9999999 B 10 1942951355 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1942951355 0 Physical Therapists Medical Supplies 20 1942951355 0 Physical Therapists Medical equipment/prosthetic devices 20 1942951355 0 Physical Therapists Physical Therapy Services 00 1942951553 0 HUTTON VIRGINIA M 2023054 9999999 B 10 1942951553 0 4829 S COTTAGE GROVE AVE CHICAGO IL 606151600 20 1942951553 0 Nurse Practitioners Fluoride varnish 20 1942951553 0 Nurse Practitioners Healthy Kids Services 20 1942951553 0 Nurse Practitioners Nurse Practitioners Services 20 1942951553 0 Nurse Practitioners Physician Services 00 1942952403 0 GRYCZEWSKI ALISON 2022133 9999999 B 10 1942952403 0 619 E MASON ST STE 4P57 SPRINGFIELD IL 627011034 20 1942952403 0 Physician Assistant Only Fluoride varnish 20 1942952403 0 Physician Assistant Only Healthy Kids Services 20 1942952403 0 Physician Assistant Only Physician Services 00 1942954169 0 HAGERTY CAROLYN G 2022237 9999999 B 10 1942954169 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1942954169 0 Nurse Practitioners Fluoride varnish 20 1942954169 0 Nurse Practitioners Healthy Kids Services 20 1942954169 0 Nurse Practitioners Nurse Practitioners Services 20 1942954169 0 Nurse Practitioners Physician Services 00 1942954672 0 HURON SAMANTHA 2025042 9999999 B 10 1942954672 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1942954672 0 Nurse Practitioners Anesthesia Services 20 1942954672 0 Nurse Practitioners Nurse Practitioners Services 20 1942954672 0 Nurse Practitioners Physician Services 00 1942956735 0 BROWNE KATE C 2022102 9999999 B 10 1942956735 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1942956735 0 Nurse Practitioners Healthy Kids Services 20 1942956735 0 Nurse Practitioners Nurse Practitioners Services 20 1942956735 0 Nurse Practitioners Physician Services 00 1942958780 0 BARRY ASHLEY 2023101 9999999 B 10 1942958780 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1942958780 0 Physical Therapists Medical Supplies 20 1942958780 0 Physical Therapists Medical equipment/prosthetic devices 20 1942958780 0 Physical Therapists Physical Therapy Services 00 1942959713 0 BURSHTEIN JOSHUA 2024191 9999999 B 10 1942959713 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1942959713 0 Physicians Anesthesia Services 20 1942959713 0 Physicians Healthy Kids Services 20 1942959713 0 Physicians Optical Supplies 20 1942959713 0 Physicians Physician Services 00 1942959788 0 MOHAMEDALI ALAA 2022174 9999999 B 10 1942959788 0 4698 DEPT CAROL STREAM IL 601220021 20 1942959788 0 Physicians Anesthesia Services 20 1942959788 0 Physicians Healthy Kids Services 20 1942959788 0 Physicians Optical Supplies 20 1942959788 0 Physicians Physician Services 00 1942963137 0 STEVENS MAHAL 2023362 9999999 B 10 1942963137 0 228 E LAKE ST ADDISON IL 601012889 20 1942963137 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1942963228 0 HELTON SAVANNAH 2022322 9999999 B 10 1942963228 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1942963228 0 Clinical Social Worker Social work service 00 1942963632 0 GARCIA JAVON 2021292 9999999 H 10 1942963632 0 4025 N SHERIDAN RD CHICAGO IL 606132010 20 1942963632 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1942965355 0 FREEDMAN EMILY 2021341 9999999 B 10 1942965355 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1942965355 0 Speech Therapists Medical Supplies 20 1942965355 0 Speech Therapists Medical equipment/prosthetic devices 20 1942965355 0 Speech Therapists Speech Therapy/Pathology Services 00 1942966171 0 GUNDERSON SARAH 2022146 9999999 B 10 1942966171 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1942966171 0 Physical Therapists Medical Supplies 20 1942966171 0 Physical Therapists Medical equipment/prosthetic devices 20 1942966171 0 Physical Therapists Physical Therapy Services 00 1942966262 0 ENGEL MARGARET 2023265 9999999 B 10 1942966262 0 522 W CHESTNUT ST STE 2A HINSDALE IL 605213173 20 1942966262 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1942968839 0 DOYLE JAMILAH 2022321 9999999 B 10 1942968839 0 17 N STATE ST STE 500 CHICAGO IL 606023384 20 1942968839 0 Nurse Practitioners Family Planning Counseling 20 1942968839 0 Nurse Practitioners Fluoride varnish 20 1942968839 0 Nurse Practitioners Healthy Kids Services 20 1942968839 0 Nurse Practitioners Nurse Practitioners Services 20 1942968839 0 Nurse Practitioners Physician Services 00 1942971692 0 PHILBRICK KAYLA A 2021267 9999999 B 10 1942971692 0 863 CENTER CT UNIT D SHOREWOOD IL 604048512 20 1942971692 0 Occupational Therapists Medical Supplies 20 1942971692 0 Occupational Therapists Medical equipment/prosthetic devices 20 1942971692 0 Occupational Therapists Occupational Therapy Services 00 1942971981 0 IVERS MAUREEN M 2021273 9999999 B 10 1942971981 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1942971981 0 Nurse Practitioners Healthy Kids Services 20 1942971981 0 Nurse Practitioners Nurse Practitioners Services 20 1942971981 0 Nurse Practitioners Physician Services 00 1942972807 0 SHAKER MICHELLE C 2021340 9999999 B 10 1942972807 0 5777 DEPT CAROL STREAM IL 601220021 20 1942972807 0 Clinical Social Worker Social work service 00 1942972948 0 SNOWDEN KELSEY M 2023093 9999999 B 10 1942972948 0 1502 E US HIGHWAY 136 TABLE GROVE IL 614829612 20 1942972948 0 Speech Therapists Medical Supplies 20 1942972948 0 Speech Therapists Medical equipment/prosthetic devices 20 1942972948 0 Speech Therapists Speech Therapy/Pathology Services 00 1942973201 0 WEATHERSPOON DARLA 2024164 9999999 B 10 1942973201 0 939 GALENA SQUARE DR GALENA IL 610361355 20 1942973201 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1942973466 0 INYANG INIOBONG LAWRENCE 2024212 9999999 B 10 1942973466 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1942973466 0 Physicians Anesthesia Services 20 1942973466 0 Physicians Fluoride varnish 20 1942973466 0 Physicians Healthy Kids Services 20 1942973466 0 Physicians Optical Supplies 20 1942973466 0 Physicians Physician Services 00 1942974431 0 SVOB AMY L 2021307 9999999 B 10 1942974431 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1942974431 0 Nurse Practitioners Fluoride varnish 20 1942974431 0 Nurse Practitioners Healthy Kids Services 20 1942974431 0 Nurse Practitioners Nurse Practitioners Services 20 1942974431 0 Nurse Practitioners Physician Services 00 1942974647 0 CORRAL AMANDA 2022041 9999999 B 10 1942974647 0 370 SUMMIT ST # 1 ELGIN IL 601203843 20 1942974647 0 Physician Assistant Only Fluoride varnish 20 1942974647 0 Physician Assistant Only Healthy Kids Services 20 1942974647 0 Physician Assistant Only Physician Services 00 1942975578 0 GORSUCH STEPHANIE 2022270 9999999 B 10 1942975578 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1942975578 0 Nurse Practitioners Fluoride varnish 20 1942975578 0 Nurse Practitioners Healthy Kids Services 20 1942975578 0 Nurse Practitioners Nurse Practitioners Services 20 1942975578 0 Nurse Practitioners Physician Services 00 1942976527 0 RODRIGUEZ GWENDOLYN RP 2022013 9999999 B 10 1942976527 0 6301 HUMBERT RD GODFREY IL 620352163 20 1942976527 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1942976816 0 HUNTER JUSTIN 2023006 9999999 B 10 1942976816 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1942976816 0 Occupational Therapists Medical Supplies 20 1942976816 0 Occupational Therapists Medical equipment/prosthetic devices 20 1942976816 0 Occupational Therapists Occupational Therapy Services 00 1942978457 0 MARRO KAITLYN 2021250 9999999 B 10 1942978457 0 7421 MADISON ST FOREST PARK IL 601301575 20 1942978457 0 Speech Therapists Medical Supplies 20 1942978457 0 Speech Therapists Medical equipment/prosthetic devices 20 1942978457 0 Speech Therapists Speech Therapy/Pathology Services 00 1942978713 0 COHEN-BETMAN KAREN 2021252 9999999 B 10 1942978713 0 201 N SCOVILLE AVE OAK PARK IL 603022264 20 1942978713 0 Speech Therapists Medical Supplies 20 1942978713 0 Speech Therapists Medical equipment/prosthetic devices 20 1942978713 0 Speech Therapists Speech Therapy/Pathology Services 00 1942978770 0 MAUS KATHERINE 2024068 9999999 B 10 1942978770 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1942978770 0 Physical Therapists Medical Supplies 20 1942978770 0 Physical Therapists Medical equipment/prosthetic devices 20 1942978770 0 Physical Therapists Physical Therapy Services 00 1942981766 0 HUMPHRES DEREK 2023226 9999999 B 10 1942981766 0 6742 N FROSTWOOD PKWY PEORIA IL 616152402 20 1942981766 0 Nurse Practitioners Anesthesia Services 20 1942981766 0 Nurse Practitioners Nurse Practitioners Services 20 1942981766 0 Nurse Practitioners Physician Services 00 1942982913 0 TOMKO SKYLER 2023312 9999999 B 10 1942982913 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1942982913 0 Nurse Practitioners Fluoride varnish 20 1942982913 0 Nurse Practitioners Healthy Kids Services 20 1942982913 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SPRINGFIELD IL 627621000 20 1952674343 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1952675225 0 HAAS STEPHANIE N 2012177 9999999 B 10 1952675225 0 1605 S WASHINGTON ST LOCKPORT IL 604414241 20 1952675225 0 Speech Therapists Medical Supplies 20 1952675225 0 Speech Therapists Medical equipment/prosthetic devices 20 1952675225 0 Speech Therapists Speech Therapy/Pathology Services 00 1952675381 0 JONES DWIGHT M 2017213 9999999 B 10 1952675381 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1952675381 0 Nurse Practitioners Fluoride varnish 20 1952675381 0 Nurse Practitioners Healthy Kids Services 20 1952675381 0 Nurse Practitioners Nurse Practitioners Services 20 1952675381 0 Nurse Practitioners Physician Services 00 1952676280 0 PICHLER STEPHEN W 2015213 9999999 B 10 1952676280 0 29373 NETWORK PL CHICAGO IL 606733039 20 1952676280 0 Physicians Anesthesia Services 20 1952676280 0 Physicians Fluoride varnish 20 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9999999 B 10 1952681041 0 4137 SAUK TRL RICHTON PARK IL 604711253 20 1952681041 0 Clinical Social Worker Social work service 00 1952681215 0 KRONAS AMY 2011199 9999999 B 10 1952681215 0 611 W PARK ST BWPC URBANA IL 618012529 20 1952681215 0 Physical Therapists Medical Supplies 20 1952681215 0 Physical Therapists Medical equipment/prosthetic devices 20 1952681215 0 Physical Therapists Physical Therapy Services 00 1952682155 0 WELLS KENYA 2023135 9999999 B 10 1952682155 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1952682155 0 Occupational Therapists Medical Supplies 20 1952682155 0 Occupational Therapists Medical equipment/prosthetic devices 20 1952682155 0 Occupational Therapists Occupational Therapy Services 00 1952682742 0 MONHARDT MARIE 2012001 9999999 B 10 1952682742 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1952682742 0 Nurse Practitioners Healthy Kids Services 20 1952682742 0 Nurse Practitioners Nurse Practitioners Services 20 1952682742 0 Nurse Practitioners Physician 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2019291 9999999 B 10 1952835910 0 1307 E MCCORD ST CENTRALIA IL 628013610 20 1952835910 0 Nurse Practitioners Healthy Kids Services 20 1952835910 0 Nurse Practitioners Nurse Practitioners Services 20 1952835910 0 Nurse Practitioners Physician Services 00 1952837148 0 GROSPE GENA M 2020043 9999999 B 10 1952837148 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1952837148 0 Physicians Anesthesia Services 20 1952837148 0 Physicians Fluoride varnish 20 1952837148 0 Physicians Healthy Kids Services 20 1952837148 0 Physicians Optical Supplies 20 1952837148 0 Physicians Physician Services 00 1952837601 0 SETTIPALLE BHANU 2020239 9999999 B 10 1952837601 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1952837601 0 Physicians Anesthesia Services 20 1952837601 0 Physicians Fluoride varnish 20 1952837601 0 Physicians Healthy Kids Services 20 1952837601 0 Physicians Optical Supplies 20 1952837601 0 Physicians Physician Services 00 1952838047 0 KENSINGER SIERRA B 2022206 9999999 B 10 1952838047 0 150 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9999999 B 10 1952842155 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1952842155 0 Physicians Anesthesia Services 20 1952842155 0 Physicians Healthy Kids Services 20 1952842155 0 Physicians Optical Supplies 20 1952842155 0 Physicians Physician Services 00 1952842684 0 GROTHAUS MORGAN 2017091 9999999 B 10 1952842684 0 715 BROADWAY ST GILLESPIE IL 620331166 20 1952842684 0 Nurse Practitioners Fluoride varnish 20 1952842684 0 Nurse Practitioners Healthy Kids Services 20 1952842684 0 Nurse Practitioners Nurse Practitioners Services 20 1952842684 0 Nurse Practitioners Physician Services 00 1952843989 0 KAPLAN-LYMAN JOSHUA E 2017131 9999999 B 10 1952843989 0 5777 DEPT CAROL STREAM IL 601220021 20 1952843989 0 Clinical Social Worker Social work service 00 1952844094 0 BARB STEPHANIE 2017009 9999999 B 10 1952844094 0 1428 SCHOOL ST WASHINGTON IL 615719509 20 1952844094 0 Speech Therapists Medical Supplies 20 1952844094 0 Speech Therapists Medical equipment/prosthetic devices 20 1952844094 0 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3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047452 20 1952846016 0 Nurse Practitioners Fluoride varnish 20 1952846016 0 Nurse Practitioners Healthy Kids Services 20 1952846016 0 Nurse Practitioners Nurse Practitioners Services 20 1952846016 0 Nurse Practitioners Physician Services 00 1952846768 0 HILL SHANNON M 2019344 9999999 B 10 1952846768 0 5777 DEPT CAROL STREAM IL 601220021 20 1952846768 0 Clinical Social Worker Social work service 00 1952846776 0 KACMAR-FEDORCHAK VERONICA 2017333 9999999 B 10 1952846776 0 3215 WILLOWCREEK RD PORTAGE IN 463685013 20 1952846776 0 Podiatrists Podiatric Services 00 1952846909 0 CHAUDHARI PRIYA R 2019018 9999999 B 10 1952846909 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1952846909 0 Nurse Practitioners Healthy Kids Services 20 1952846909 0 Nurse Practitioners Nurse Practitioners Services 20 1952846909 0 Nurse Practitioners Physician Services 00 1952848707 0 PATTERSON AMBER 2023226 9999999 B 10 1952848707 0 1400 US HIGHWAY 61 FESTUS MO 630284100 20 1952848707 0 Nurse Practitioners Fluoride varnish 20 1952848707 0 Nurse Practitioners Healthy Kids Services 20 1952848707 0 Nurse Practitioners Nurse Practitioners Services 20 1952848707 0 Nurse Practitioners Physician Services 00 1952849002 0 DILL LAUREN 2023219 9999999 B 10 1952849002 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1952849002 0 Nurse Practitioners Fluoride varnish 20 1952849002 0 Nurse Practitioners Healthy Kids Services 20 1952849002 0 Nurse Practitioners Nurse Practitioners Services 20 1952849002 0 Nurse Practitioners Physician Services 00 1952849218 0 ZIMMERMAN RICHARD 2017182 9999999 B 10 1952849218 0 307 S EVERGREEN AVE WOODBURY NJ 080962739 20 1952849218 0 Nurse Practitioners Healthy Kids Services 20 1952849218 0 Nurse Practitioners Nurse Practitioners Services 20 1952849218 0 Nurse Practitioners Physician Services 00 1952850414 0 FANELLI JENNIFER 2017001 9999999 B 10 1952850414 0 225 E CHICAGO AVE CHICAGO IL 606112991 20 1952850414 0 Nurse Practitioners Fluoride varnish 20 1952850414 0 Nurse Practitioners Healthy Kids Services 20 1952850414 0 Nurse Practitioners Nurse Practitioners Services 20 1952850414 0 Nurse Practitioners Physician Services 00 1952851081 0 GIANNINI KIMBERLEY 2017121 9999999 B 10 1952851081 0 4209 W SHAMROCK LN UNIT C MCHENRY IL 600508700 20 1952851081 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1952852535 0 AHMED MOHAMMED 2017032 9999999 B 10 1952852535 0 106 19TH AVE STE 90 MOLINE IL 612653700 20 1952852535 0 Dentists Dental Services 20 1952852535 0 Dentists Physician Services 00 1952854150 0 HAMMAN REBECCA K 2017282 9999999 B 10 1952854150 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1952854150 0 Nurse Practitioners Fluoride varnish 20 1952854150 0 Nurse Practitioners Healthy Kids Services 20 1952854150 0 Nurse Practitioners Nurse Practitioners Services 20 1952854150 0 Nurse Practitioners Physician Services 00 1952855223 0 HANNEMANN TERRI J 2024124 9999999 B 10 1952855223 0 5777 DEPT CAROL STREAM IL 601220021 20 1952855223 0 Nurse Practitioners Fluoride varnish 20 1952855223 0 Nurse Practitioners Healthy Kids Services 20 1952855223 0 Nurse Practitioners Nurse Practitioners Services 20 1952855223 0 Nurse Practitioners Physician Services 00 1952856080 0 HECHT MEGAN M 2016273 9999999 B 10 1952856080 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1952856080 0 Nurse Practitioners Fluoride varnish 20 1952856080 0 Nurse Practitioners Healthy Kids Services 20 1952856080 0 Nurse Practitioners Nurse Practitioners Services 20 1952856080 0 Nurse Practitioners Physician Services 00 1952857450 0 GOLDFEDER TOBA 2022059 9999999 B 10 1952857450 0 510 HEMPSTEAD TPKE RM 203 WEST HEMPSTEAD NY 115521152 20 1952857450 0 Clinical Social Worker Social work service 00 1952858813 0 DUNCAN HEATHER 2022125 9999999 B 10 1952858813 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1952858813 0 Nurse Practitioners Fluoride 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B 10 1952861528 0 5777 DEPT CAROL STREAM IL 601220021 20 1952861528 0 Physicians Anesthesia Services 20 1952861528 0 Physicians Healthy Kids Services 20 1952861528 0 Physicians Optical Supplies 20 1952861528 0 Physicians Physician Services 00 1952861726 0 PAYA TEN CLAUDIA A 2023128 9999999 B 10 1952861726 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1952861726 0 Physicians Anesthesia Services 20 1952861726 0 Physicians Healthy Kids Services 20 1952861726 0 Physicians Optical Supplies 20 1952861726 0 Physicians Physician Services 00 1952861866 0 KENNY ELEANOR S 2019205 9999999 B 10 1952861866 0 5777 DEPT CAROL STREAM IL 601220021 20 1952861866 0 Physicians Anesthesia Services 20 1952861866 0 Physicians Healthy Kids Services 20 1952861866 0 Physicians Optical Supplies 20 1952861866 0 Physicians Physician Services 00 1952861965 0 WINTER MEGAN 2019085 9999999 B 10 1952861965 0 2200 STATE ST LAWRENCEVILLE IL 624391852 20 1952861965 0 Nurse Practitioners Fluoride varnish 20 1952861965 0 Nurse Practitioners Healthy Kids Services 20 1952861965 0 Nurse Practitioners Nurse Practitioners Services 20 1952861965 0 Nurse Practitioners Physician Services 00 1952862104 0 HILARIO RUBYLYN R 2021265 9999999 B 10 1952862104 0 2400 BIG TIMBER RD STE 200B ELGIN IL 601247835 20 1952862104 0 Nurse Practitioners Fluoride varnish 20 1952862104 0 Nurse Practitioners Healthy Kids Services 20 1952862104 0 Nurse Practitioners Nurse Practitioners Services 20 1952862104 0 Nurse Practitioners Physician Services 00 1952862468 0 LEVIN ADAM 2024107 9999999 B 10 1952862468 0 1750 N RANDALL RD STE 120 ELGIN IL 601237900 20 1952862468 0 Physicians Anesthesia Services 20 1952862468 0 Physicians Healthy Kids Services 20 1952862468 0 Physicians Optical Supplies 20 1952862468 0 Physicians Physician Services 00 1952862914 0 HONG DANIEL Y 2025009 9999999 B 10 1952862914 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1952862914 0 Physicians Anesthesia Services 20 1952862914 0 Physicians Healthy Kids Services 20 1952862914 0 Physicians Optical Supplies 20 1952862914 0 Physicians Physician Services 00 1952862989 0 WILES ALISON 2024198 9999999 B 10 1952862989 0 7732 SOLUTION CTR CHICAGO IL 606770001 20 1952862989 0 Physicians Anesthesia Services 20 1952862989 0 Physicians Healthy Kids Services 20 1952862989 0 Physicians Optical Supplies 20 1952862989 0 Physicians Physician Services 00 1952863268 0 KIM KYLE H 2022178 9999999 B 10 1952863268 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1952863268 0 Physicians Anesthesia Services 20 1952863268 0 Physicians Healthy Kids Services 20 1952863268 0 Physicians Optical Supplies 20 1952863268 0 Physicians Physician Services 00 1952863334 0 COBURN RACHEL 2023227 9999999 B 10 1952863334 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1952863334 0 Physicians Anesthesia Services 20 1952863334 0 Physicians Fluoride varnish 20 1952863334 0 Physicians Healthy Kids Services 20 1952863334 0 Physicians Optical Supplies 20 1952863334 0 Physicians Physician Services 00 1952863391 0 HJERPE STEPHEN 2022237 9999999 B 10 1952863391 0 PO BOX 43230 PHOENIX AZ 850803230 20 1952863391 0 Physicians Anesthesia Services 20 1952863391 0 Physicians Healthy Kids Services 20 1952863391 0 Physicians Optical Supplies 20 1952863391 0 Physicians Physician Services 00 1952863946 0 ANDERSON SHANE CORBIN 2024208 9999999 B 10 1952863946 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1952863946 0 Physicians Anesthesia Services 20 1952863946 0 Physicians Healthy Kids Services 20 1952863946 0 Physicians Optical Supplies 20 1952863946 0 Physicians Physician Services 00 1952867681 0 VITALE MELISSA M 2019098 9999999 B 10 1952867681 0 PO BOX 83 CROWN POINT IN 463080083 20 1952867681 0 Nurse Practitioners Healthy Kids Services 20 1952867681 0 Nurse Practitioners Nurse Practitioners Services 20 1952867681 0 Nurse Practitioners Physician Services 00 1952868911 0 RODHEIM EMILY 2019078 9999999 B 10 1952868911 0 8707 SKOKIE BLVD STE 402 SKOKIE IL 600772269 20 1952868911 0 Occupational Therapists Medical Supplies 20 1952868911 0 Occupational Therapists Medical equipment/prosthetic devices 20 1952868911 0 Occupational Therapists Occupational Therapy Services 00 1952868978 0 AVERY BRITTANY S 2019074 9999999 B 10 1952868978 0 8558 BROADWAY MERRILLVILLE IN 464107032 20 1952868978 0 Nurse Practitioners Anesthesia Services 20 1952868978 0 Nurse Practitioners Nurse Practitioners Services 20 1952868978 0 Nurse Practitioners Physician Services 00 1952869091 0 SERTICH AMY 2019077 9999999 B 10 1952869091 0 2045 W GRAND AVE STE B CHICAGO IL 606121577 20 1952869091 0 Clinical Social Worker Social work service 00 1952869224 0 BRANDT LORI L 2019098 9999999 B 10 1952869224 0 2239 E COOK ST SPRINGFIELD IL 627031944 20 1952869224 0 Clinical Social Worker Social work service 00 1952869893 0 MYERS THEA 2021132 9999999 B 10 1952869893 0 70 S RIVER ST AURORA IL 605065185 20 1952869893 0 Other behavior health professional 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work service 00 1952872830 0 TAN MELISSA J 2024297 9999999 B 10 1952872830 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1952872830 0 Clinical Social Worker Social work service 00 1952872962 0 KRZUS CARLY 2018353 9999999 B 10 1952872962 0 3015 W 163RD ST MARKHAM IL 604285626 20 1952872962 0 Speech Therapists Medical Supplies 20 1952872962 0 Speech Therapists Medical equipment/prosthetic devices 20 1952872962 0 Speech Therapists Speech Therapy/Pathology Services 00 1952873127 0 XU JANICE Q 2019084 9999999 B 10 1952873127 0 850 W IRVING PARK RD CHICAGO IL 606133077 20 1952873127 0 Nurse Practitioners All Kids application agent 20 1952873127 0 Nurse Practitioners Fluoride varnish 20 1952873127 0 Nurse Practitioners Healthy Kids Services 20 1952873127 0 Nurse Practitioners Nurse Practitioners Services 20 1952873127 0 Nurse Practitioners Physician Services 00 1952873267 0 WYATT KIMBERLY A 2019323 9999999 B 10 1952873267 0 5777 DEPT CAROL STREAM IL 601220021 20 1952873267 0 Physician Assistant Only Fluoride varnish 20 1952873267 0 Physician Assistant Only Healthy Kids Services 20 1952873267 0 Physician Assistant Only Physician Services 00 1952874315 0 CHISHOLM BRANDY A 2019101 9999999 B 10 1952874315 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1952874315 0 Nurse Practitioners Healthy Kids Services 20 1952874315 0 Nurse Practitioners Nurse Practitioners Services 20 1952874315 0 Nurse Practitioners Physician Services 00 1952874562 0 CONLIN SAMANTHA R 2019060 9999999 B 10 1952874562 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1952874562 0 Nurse Practitioners Fluoride varnish 20 1952874562 0 Nurse Practitioners Healthy Kids Services 20 1952874562 0 Nurse Practitioners Nurse Practitioners Services 20 1952874562 0 Nurse Practitioners Physician Services 00 1952877144 0 PAINTER DEBRA 2019163 9999999 B 10 1952877144 0 1160 E SAINT CLAIR ST VINCENNES IN 475914853 20 1952877144 0 Nurse Practitioners Fluoride varnish 20 1952877144 0 Nurse Practitioners Healthy Kids Services 20 1952877144 0 Nurse Practitioners Nurse Practitioners Services 20 1952877144 0 Nurse Practitioners Physician Services 00 1952878985 0 LASPROGATA JANIS 2018355 9999999 B 10 1952878985 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1952878985 0 Registered nurse Nursing service 20 1952878985 0 Registered nurse Waiver service 00 1952879199 0 KEYES SADE 2024351 9999999 B 10 1952879199 0 3300 WASHTENAW AVE STE 280 ANN ARBOR MI 481045184 20 1952879199 0 Physician Assistant Only Fluoride varnish 20 1952879199 0 Physician Assistant Only Healthy Kids Services 20 1952879199 0 Physician Assistant Only Physician Services 00 1952880460 0 GARIBAY EMILY 2018218 9999999 B 10 1952880460 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1952880460 0 Nurse Practitioners Healthy Kids Services 20 1952880460 0 Nurse Practitioners Nurse Practitioners Services 20 1952880460 0 Nurse Practitioners Physician Services 00 1952880536 0 BRUCE ERIN M. 2018227 9999999 B 10 1952880536 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1952880536 0 Nurse Practitioners Healthy Kids Services 20 1952880536 0 Nurse Practitioners Nurse Practitioners Services 20 1952880536 0 Nurse Practitioners Physician Services 00 1952884256 0 LYNN JOSEPH 2023167 9999999 B 10 1952884256 0 511 E HAWLEY ST MUNDELEIN IL 600602419 20 1952884256 0 Physical Therapists Medical Supplies 20 1952884256 0 Physical Therapists Medical equipment/prosthetic devices 20 1952884256 0 Physical Therapists Physical Therapy Services 00 1952884991 0 MYERS SARAH J 2021176 9999999 B 10 1952884991 0 PO BOX 781076 DETROIT MI 482781076 20 1952884991 0 Nurse Practitioners Fluoride varnish 20 1952884991 0 Nurse Practitioners Healthy Kids Services 20 1952884991 0 Nurse Practitioners Nurse Practitioners Services 20 1952884991 0 Nurse Practitioners Physician Services 00 1952885865 0 DURR-BAXTER ELSA E 2021011 9999999 B 10 1952885865 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1952885865 0 Nurse Practitioners Fluoride varnish 20 1952885865 0 Nurse Practitioners Healthy Kids Services 20 1952885865 0 Nurse Practitioners Nurse Practitioners Services 20 1952885865 0 Nurse Practitioners Physician Services 00 1952885949 0 WILEY LARETTA M 2019060 9999999 B 10 1952885949 0 600 HOLIDAY PLAZA DR STE 200 MATTESON IL 604432237 20 1952885949 0 Nurse Practitioners Fluoride varnish 20 1952885949 0 Nurse Practitioners Healthy Kids Services 20 1952885949 0 Nurse Practitioners Nurse Practitioners Services 20 1952885949 0 Nurse Practitioners Physician Services 00 1952886319 0 GOOD KIMBERLY 2018260 9999999 B 10 1952886319 0 1300 W 2ND ST ROCK FALLS IL 610711005 20 1952886319 0 Registered nurse Nursing service 20 1952886319 0 Registered nurse Waiver service 00 1952886590 0 TENG TIFFANY Z 2022231 9999999 B 10 1952886590 0 7825 SOLUTION CTR CHICAGO IL 606777007 20 1952886590 0 Physicians Anesthesia Services 20 1952886590 0 Physicians Healthy Kids Services 20 1952886590 0 Physicians Optical Supplies 20 1952886590 0 Physicians Physician Services 20 1952886590 0 Physicians Physicians Psychiatric Services 00 1952887093 0 MARCOULIDES DEMETRIUS 2021098 9999999 B 10 1952887093 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1952887093 0 Nurse Practitioners Healthy Kids Services 20 1952887093 0 Nurse Practitioners Nurse Practitioners Services 20 1952887093 0 Nurse Practitioners Physician Services 00 1952887333 0 WOOD AMANDA M 2018209 9999999 B 10 1952887333 0 500 PORTER AVE AURORA MO 656052365 20 1952887333 0 Physicians Anesthesia Services 20 1952887333 0 Physicians Healthy Kids Services 20 1952887333 0 Physicians Optical Supplies 20 1952887333 0 Physicians Physician Services 00 1952887416 0 TRAUM KATE E 2018277 9999999 B 10 1952887416 0 805 N BROAD ST CARLINVILLE IL 626261075 20 1952887416 0 Nurse Practitioners Fluoride varnish 20 1952887416 0 Nurse Practitioners Healthy Kids Services 20 1952887416 0 Nurse Practitioners Nurse Practitioners Services 20 1952887416 0 Nurse Practitioners Physician Services 00 1952887507 0 THOM KRISTIN 2018299 9999999 B 10 1952887507 0 2045 W GRAND AVE STE B CHICAGO IL 606121577 20 1952887507 0 Clinical Social Worker Social work service 00 1952888059 0 MENDOZA-ELIAS NASYA 2019247 9999999 B 10 1952888059 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1952888059 0 Physicians Anesthesia Services 20 1952888059 0 Physicians Healthy Kids Services 20 1952888059 0 Physicians Optical Supplies 20 1952888059 0 Physicians Physician Services 00 1952888224 0 WRIGHT DANIEL 2021152 9999999 B 10 1952888224 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1952888224 0 Physician Assistant Only Fluoride varnish 20 1952888224 0 Physician Assistant Only Healthy Kids Services 20 1952888224 0 Physician Assistant Only Physician Services 00 1952888299 0 WITTER DINA B 2018237 9999999 B 10 1952888299 0 311 E MAIN ST STE 409 GALESBURG IL 614014867 20 1952888299 0 Nurse Practitioners Family Planning Counseling 20 1952888299 0 Nurse Practitioners Fluoride 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DR STE 300 BURR RIDGE IL 605275965 20 1952953028 0 Physicians Anesthesia Services 20 1952953028 0 Physicians Fluoride varnish 20 1952953028 0 Physicians Healthy Kids Services 20 1952953028 0 Physicians Optical Supplies 20 1952953028 0 Physicians Physician Services 00 1952953176 0 ELSTON CODY S 2019239 9999999 B 10 1952953176 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1952953176 0 Audiologists Audiology Services 20 1952953176 0 Audiologists Medical Supplies 20 1952953176 0 Audiologists Medical equipment/prosthetic devices 00 1952953804 0 PRICHARD MONICA 2019287 9999999 B 10 1952953804 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1952953804 0 Physician Assistant Only Fluoride varnish 20 1952953804 0 Physician Assistant Only Healthy Kids Services 20 1952953804 0 Physician Assistant Only Physician Services 00 1952954208 0 JANSEN ABIGAIL L 2023163 9999999 B 10 1952954208 0 901 PATIENTS FIRST DR WASHINGTON MO 630904700 20 1952954208 0 Nurse Practitioners Fluoride varnish 20 1952954208 0 Nurse Practitioners Healthy Kids Services 20 1952954208 0 Nurse Practitioners Nurse Practitioners Services 20 1952954208 0 Nurse Practitioners Physician Services 00 1952954919 0 CHO NICOLE A 2019235 9999999 B 10 1952954919 0 5777 DEPT CAROL STREAM IL 601228942 20 1952954919 0 Physicians Anesthesia Services 20 1952954919 0 Physicians Fluoride varnish 20 1952954919 0 Physicians Healthy Kids Services 20 1952954919 0 Physicians Optical Supplies 20 1952954919 0 Physicians Physician Services 00 1952955528 0 OBE OLAJIDE T 2024009 9999999 B 10 1952955528 0 210 INTERSTATE NORTH PKWY SE S ATLANTA GA 303392233 20 1952955528 0 Dentists Dental Services 20 1952955528 0 Dentists Physician Services 00 1952956369 0 KOUNSAL AVIN 2019325 9999999 B 10 1952956369 0 5777 DEPT CAROL STREAM IL 601220021 20 1952956369 0 Physicians Anesthesia Services 20 1952956369 0 Physicians Healthy Kids Services 20 1952956369 0 Physicians Optical Supplies 20 1952956369 0 Physicians Physician Services 00 1952957896 0 BRAVO ANGELINA 2020006 9999999 B 10 1952957896 0 1940 S WESTERN AVE STE 205 CHICAGO IL 606082503 20 1952957896 0 Nurse Practitioners All Kids application agent 20 1952957896 0 Nurse Practitioners Fluoride varnish 20 1952957896 0 Nurse Practitioners Healthy Kids Services 20 1952957896 0 Nurse Practitioners Nurse Practitioners Services 20 1952957896 0 Nurse Practitioners Physician Services 00 1952958050 0 TRULSON EMILY L 2021243 9999999 B 10 1952958050 0 1 ILLINI DR PEORIA IL 616052576 20 1952958050 0 Other behavior health professional LCPC/LMFT services 00 1952958894 0 ALQAWASMEH SUHAIB I 2021077 9999999 B 10 1952958894 0 1812 N 19TH AVE MELROSE PARK IL 601602039 20 1952958894 0 Dentists Dental Services 20 1952958894 0 Dentists Physician Services 00 1952959033 0 ELEWA USAMA 2019289 9999999 B 10 1952959033 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1952959033 0 Physicians Anesthesia Services 20 1952959033 0 Physicians Fluoride varnish 20 1952959033 0 Physicians Healthy Kids Services 20 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3023 N CLARK ST STE 593 CHICAGO IL 606575200 20 1952966293 0 Physicians Anesthesia Services 20 1952966293 0 Physicians Healthy Kids Services 20 1952966293 0 Physicians Optical Supplies 20 1952966293 0 Physicians Physician Services 20 1952966293 0 Physicians Physicians Psychiatric Services 00 1952967523 0 KHANDWALA NIKHILA 2021176 9999999 B 10 1952967523 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1952967523 0 Physicians Anesthesia Services 20 1952967523 0 Physicians Healthy Kids Services 20 1952967523 0 Physicians Optical Supplies 20 1952967523 0 Physicians Physician Services 00 1952968075 0 O'KEEFE JACY 2022356 9999999 B 10 1952968075 0 8170 33RD AVE S MINNEAPOLIS MN 554254516 20 1952968075 0 Physicians Anesthesia Services 20 1952968075 0 Physicians Healthy Kids Services 20 1952968075 0 Physicians Optical Supplies 20 1952968075 0 Physicians Physician Services 00 1952968141 0 MAHSMAN HEATHER A 2020205 9999999 B 10 1952968141 0 1601 OLD SOUTH RIVER RD SAINT CHARLES MO 633034120 20 1952968141 0 Nurse Practitioners Fluoride varnish 20 1952968141 0 Nurse Practitioners Healthy Kids Services 20 1952968141 0 Nurse Practitioners Nurse Practitioners Services 20 1952968141 0 Nurse Practitioners Physician Services 00 1952969115 0 STORINO CAITLIN 2022214 9999999 B 10 1952969115 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1952969115 0 Physicians Anesthesia Services 20 1952969115 0 Physicians Fluoride varnish 20 1952969115 0 Physicians Healthy Kids Services 20 1952969115 0 Physicians Optical Supplies 20 1952969115 0 Physicians Physician Services 00 1952970303 0 GROSS JAMES T 2021243 9999999 B 10 1952970303 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1952970303 0 Physicians Anesthesia Services 20 1952970303 0 Physicians Healthy Kids Services 20 1952970303 0 Physicians Optical Supplies 20 1952970303 0 Physicians Physician Services 00 1952970493 0 KHAN HUSNA 2021202 9999999 B 10 1952970493 0 125 E IRVING PARK RD STREAMWOOD IL 601072950 20 1952970493 0 Dentists Dental Services 20 1952970493 0 Dentists Physician Services 00 1952970618 0 DE TOGNI ELISA S 2021230 9999999 B 10 1952970618 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1952970618 0 Physicians Anesthesia Services 20 1952970618 0 Physicians Healthy Kids Services 20 1952970618 0 Physicians Optical Supplies 20 1952970618 0 Physicians Physician Services 00 1952970642 0 SMITH ELIZABETH G 2024047 9999999 B 10 1952970642 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1952970642 0 Nurse Practitioners Anesthesia Services 20 1952970642 0 Nurse Practitioners Nurse Practitioners Services 20 1952970642 0 Nurse Practitioners Physician Services 00 1952971301 0 LE TUONG-KHANH 2023346 9999999 B 10 1952971301 0 PO BOX 10417 HOLYOKE MA 010412017 20 1952971301 0 Nurse Practitioners Fluoride varnish 20 1952971301 0 Nurse Practitioners Healthy Kids Services 20 1952971301 0 Nurse Practitioners Nurse Practitioners Services 20 1952971301 0 Nurse Practitioners Physician Services 00 1952972085 0 THOMAS BENJAMIN L 2023313 9999999 B 10 1952972085 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1952972085 0 Nurse Practitioners Anesthesia Services 20 1952972085 0 Nurse Practitioners Nurse Practitioners Services 20 1952972085 0 Nurse Practitioners Physician Services 00 1952972168 0 NWADIKE BENJAMIN A 2022196 9999999 B 10 1952972168 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1952972168 0 Physicians Anesthesia Services 20 1952972168 0 Physicians Healthy Kids Services 20 1952972168 0 Physicians Optical Supplies 20 1952972168 0 Physicians Physician Services 00 1952973117 0 LE ANNE LISE T 2022252 9999999 B 10 1952973117 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1952973117 0 Physician Assistant Only Fluoride varnish 20 1952973117 0 Physician Assistant Only Healthy Kids Services 20 1952973117 0 Physician Assistant Only Physician Services 00 1952973281 0 COTEY ELIZABETH A 2024302 9999999 B 10 1952973281 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1952973281 0 Other behavior health professional LCPC/LMFT services 00 1952974982 0 KHAN SAWLEHA ARSHI 2024144 9999999 B 10 1952974982 0 611 W PARK ST URBANA IL 618012529 20 1952974982 0 Physicians Anesthesia Services 20 1952974982 0 Physicians Healthy Kids Services 20 1952974982 0 Physicians Optical Supplies 20 1952974982 0 Physicians Physician Services 00 1952975179 0 CENTENO JOSE A 2021200 9999999 B 10 1952975179 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1952975179 0 Psychologist Psychologist service 00 1952975518 0 ELSAKKA AHMED 2024165 9999999 B 10 1952975518 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1952975518 0 Physicians Anesthesia Services 20 1952975518 0 Physicians Healthy Kids Services 20 1952975518 0 Physicians Optical Supplies 20 1952975518 0 Physicians Physician Services 00 1952976250 0 MENDEZ GONZALEZ GABRIELA 2024100 9999999 B 10 1952976250 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1952976250 0 Physicians Anesthesia Services 20 1952976250 0 Physicians Fluoride varnish 20 1952976250 0 Physicians Healthy Kids Services 20 1952976250 0 Physicians Optical Supplies 20 1952976250 0 Physicians Physician Services 00 1952977043 0 GHOSH KANAD 2021223 9999999 B 10 1952977043 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1952977043 0 Physicians Anesthesia Services 20 1952977043 0 Physicians Healthy Kids Services 20 1952977043 0 Physicians Optical Supplies 20 1952977043 0 Physicians Physician Services 00 1952978967 0 MURPHY BRIDGET L 2024296 9999999 B 10 1952978967 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1952978967 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1952979189 0 ALYAGOOB MOHAMMED 2021228 9999999 B 10 1952979189 0 9618 SOUTHWEST HWY OAK LAWN IL 604532862 20 1952979189 0 Dentists Dental Services 20 1952979189 0 Dentists Physician Services 00 1952979296 0 SHORT STEPHANIE 2021195 9999999 B 10 1952979296 0 PO 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9999999 B 10 1952980336 0 PO BOX 632122 CINCINNATI OH 452632122 20 1952980336 0 Physicians Anesthesia Services 20 1952980336 0 Physicians Fluoride varnish 20 1952980336 0 Physicians Healthy Kids Services 20 1952980336 0 Physicians Optical Supplies 20 1952980336 0 Physicians Physician Services 00 1952982183 0 SONG DAYOUNG 2021194 9999999 B 10 1952982183 0 5777 DEPT CAROL STREAM IL 601228942 20 1952982183 0 Physicians Anesthesia Services 20 1952982183 0 Physicians Fluoride varnish 20 1952982183 0 Physicians Healthy Kids Services 20 1952982183 0 Physicians Optical Supplies 20 1952982183 0 Physicians Physician Services 00 1952982274 0 STORCK JEREMY 2024155 9999999 B 10 1952982274 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1952982274 0 Physicians Anesthesia Services 20 1952982274 0 Physicians Healthy Kids Services 20 1952982274 0 Physicians Optical Supplies 20 1952982274 0 Physicians Physician Services 00 1952982308 0 YASEEN NAILA N 2021182 9999999 B 10 1952982308 0 PO BOX 778791 CHICAGO 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WADDELL MICHAEL 2018321 9999999 B 10 1962420141 0 PO BOX 781076 DETROIT MI 482781076 20 1962420141 0 Physicians Anesthesia Services 20 1962420141 0 Physicians Fluoride varnish 20 1962420141 0 Physicians Healthy Kids Services 20 1962420141 0 Physicians Optical Supplies 20 1962420141 0 Physicians Physician Services 00 1962420414 0 SCHWARTZ ALAN L 1986210 9999999 B 10 1962420414 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1962420414 0 Physicians Anesthesia Services 20 1962420414 0 Physicians Fluoride varnish 20 1962420414 0 Physicians Healthy Kids Services 20 1962420414 0 Physicians Optical Supplies 20 1962420414 0 Physicians Physician Services 00 1962420448 0 KOCH MATTHEW J 2002182 9999999 B 10 1962420448 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1962420448 0 Physicians Anesthesia Services 20 1962420448 0 Physicians Fluoride varnish 20 1962420448 0 Physicians Healthy Kids Services 20 1962420448 0 Physicians Optical Supplies 20 1962420448 0 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20 1962660480 0 Physicians Anesthesia Services 20 1962660480 0 Physicians Healthy Kids Services 20 1962660480 0 Physicians Optical Supplies 20 1962660480 0 Physicians Physician Services 00 1962660753 0 MACBEAN ULUNNA K 2018162 9999999 B 10 1962660753 0 515 E GRANT ST STE 213 MACOMB IL 614553378 20 1962660753 0 Physicians Anesthesia Services 20 1962660753 0 Physicians Healthy Kids Services 20 1962660753 0 Physicians Optical Supplies 20 1962660753 0 Physicians Physician Services 00 1962662304 0 RUDZIEWICZ DAVID 1994060 9999999 B 10 1962662304 0 8500 W 110TH ST STE 450 OVERLAND PARK KS 662104029 20 1962662304 0 Dentists Dental Services 20 1962662304 0 Dentists Physician Services 00 1962662726 0 DOLCE ALISON 2024347 9999999 B 10 1962662726 0 621 S ILLINOIS AVE STE 103 MASON CITY IA 504015489 20 1962662726 0 Physicians Anesthesia Services 20 1962662726 0 Physicians Healthy Kids Services 20 1962662726 0 Physicians Optical Supplies 20 1962662726 0 Physicians Physician Services 20 1962662726 0 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1962664540 0 KAO CHENG KAI 2011227 9999999 B 10 1962664540 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1962664540 0 Physicians Anesthesia Services 20 1962664540 0 Physicians Fluoride varnish 20 1962664540 0 Physicians Healthy Kids Services 20 1962664540 0 Physicians Optical Supplies 20 1962664540 0 Physicians Physician Services 00 1962664730 0 MCNICHOLAS COLLEEN P 2011182 9999999 B 10 1962664730 0 317 SALEM PL FAIRVIEW HEIGHT IL 622081367 20 1962664730 0 Physicians Anesthesia Services 20 1962664730 0 Physicians Healthy Kids Services 20 1962664730 0 Physicians Optical Supplies 20 1962664730 0 Physicians Physician Services 00 1962664789 0 EVANS JAMIE 2021034 9999999 B 10 1962664789 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1962664789 0 Physicians Anesthesia Services 20 1962664789 0 Physicians Healthy Kids Services 20 1962664789 0 Physicians Optical Supplies 20 1962664789 0 Physicians Physician Services 20 1962664789 0 Physicians Physicians Psychiatric Services 00 1962665364 0 LEA BRIAN A 2014213 9999999 B 10 1962665364 0 2605 KENTUCKY AVE STE 306 PADUCAH KY 420033802 20 1962665364 0 Physicians Anesthesia Services 20 1962665364 0 Physicians Fluoride varnish 20 1962665364 0 Physicians Healthy Kids Services 20 1962665364 0 Physicians Optical Supplies 20 1962665364 0 Physicians Physician Services 00 1962665596 0 BAZALAKOVA MIHAELA 2014216 9999999 B 10 1962665596 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1962665596 0 Physicians Anesthesia Services 20 1962665596 0 Physicians Healthy Kids Services 20 1962665596 0 Physicians Optical Supplies 20 1962665596 0 Physicians Physician Services 20 1962665596 0 Physicians Physicians Psychiatric Services 00 1962666420 0 EVANS CORY 2017076 9999999 B 10 1962666420 0 877 JEFFERSON AVE MEMPHIS TN 381032807 20 1962666420 0 Physicians Anesthesia Services 20 1962666420 0 Physicians Healthy Kids Services 20 1962666420 0 Physicians Optical Supplies 20 1962666420 0 Physicians Physician Services 00 1962666750 0 NEUKIRCH ANDREW 2022012 9999999 B 10 1962666750 0 111 E 4TH ST STE 440 ALTON IL 620026206 20 1962666750 0 Optometrists Optical Supplies 20 1962666750 0 Optometrists Optometric Services 20 1962666750 0 Optometrists Physician Services 00 1962666875 0 GUSTAFSON LISA K 2025027 9999999 B 10 1962666875 0 1401 E 12TH ST MENDOTA IL 613429216 20 1962666875 0 Other behavior health professional LCPC/LMFT services 00 1962666982 0 ZHUKOV IGOR O 2017317 9999999 B 10 1962666982 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1962666982 0 Physicians Anesthesia Services 20 1962666982 0 Physicians Healthy Kids Services 20 1962666982 0 Physicians Optical Supplies 20 1962666982 0 Physicians Physician Services 00 1962667030 0 SUM ADA C 2011255 9999999 B 10 1962667030 0 611 W PARK ST URBANA IL 618012529 20 1962667030 0 Physicians Anesthesia Services 20 1962667030 0 Physicians Fluoride varnish 20 1962667030 0 Physicians Healthy Kids Services 20 1962667030 0 Physicians Optical Supplies 20 1962667030 0 Physicians Physician Services 00 1962667428 0 SCHLEEF CATHY S 2008245 9999999 B 10 1962667428 0 PO BOX 840532 DALLAS TX 752840532 20 1962667428 0 Nurse Practitioners Healthy Kids Services 20 1962667428 0 Nurse Practitioners Nurse Practitioners Services 20 1962667428 0 Nurse Practitioners Physician Services 00 1962667519 0 DORGAN CHRISTOPHER S 2008183 9999999 B 10 1962667519 0 29373 NETWORK PL CHICAGO IL 606733039 20 1962667519 0 Physicians Anesthesia Services 20 1962667519 0 Physicians Healthy Kids Services 20 1962667519 0 Physicians Optical Supplies 20 1962667519 0 Physicians Physician Services 00 1962667808 0 LEEPER HEATHER E 2014182 9999999 B 10 1962667808 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1962667808 0 Physicians Anesthesia Services 20 1962667808 0 Physicians Healthy Kids Services 20 1962667808 0 Physicians Optical Supplies 20 1962667808 0 Physicians Physician Services 20 1962667808 0 Physicians Physicians Psychiatric Services 00 1962667956 0 STEIN ADAM 2013206 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Physicians Physician Services 00 1962778589 0 PRADHAN RACHANA 2016059 9999999 B 10 1962778589 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1962778589 0 Clinical Social Worker Social work service 00 1962780155 0 SCHWETYE KATHERINE 2016183 9999999 B 10 1962780155 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1962780155 0 Physicians Anesthesia Services 20 1962780155 0 Physicians Healthy Kids Services 20 1962780155 0 Physicians Optical Supplies 20 1962780155 0 Physicians Physician Services 00 1962780288 0 SAREEN POOJA 2016292 9999999 B 10 1962780288 0 1945 LAKEPOINTE DR STE 100 LEWISVILLE TX 750576424 20 1962780288 0 Physicians Anesthesia Services 20 1962780288 0 Physicians Fluoride varnish 20 1962780288 0 Physicians Healthy Kids Services 20 1962780288 0 Physicians Optical Supplies 20 1962780288 0 Physicians Physician Services 00 1962781138 0 SCHNAPP BENJAMIN H 2015182 9999999 B 10 1962781138 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1962781138 0 Physicians Anesthesia Services 20 1962781138 0 Physicians Family Planning Counseling 20 1962781138 0 Physicians Healthy Kids Services 20 1962781138 0 Physicians Optical Supplies 20 1962781138 0 Physicians Physician Services 00 1962781559 0 BHUPALI DEEPA 2017213 9999999 B 10 1962781559 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1962781559 0 Physicians Anesthesia Services 20 1962781559 0 Physicians Healthy Kids Services 20 1962781559 0 Physicians Optical Supplies 20 1962781559 0 Physicians Physician Services 20 1962781559 0 Physicians Physicians Psychiatric Services 00 1962781807 0 JOVANOVIC BOJANA 2023129 9999999 B 10 1962781807 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1962781807 0 Physicians Anesthesia Services 20 1962781807 0 Physicians Fluoride varnish 20 1962781807 0 Physicians Healthy Kids Services 20 1962781807 0 Physicians Optical Supplies 20 1962781807 0 Physicians Physician Services 00 1962783068 0 ARVIDSON MAZUR KIMBERLY 2014182 9999999 B 10 1962783068 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1962783068 0 Physicians Anesthesia Services 20 1962783068 0 Physicians Fluoride varnish 20 1962783068 0 Physicians Healthy Kids Services 20 1962783068 0 Physicians Optical Supplies 20 1962783068 0 Physicians Physician Services 00 1962784165 0 BEG RANA 2020314 9999999 B 10 1962784165 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1962784165 0 Physicians Anesthesia Services 20 1962784165 0 Physicians Fluoride varnish 20 1962784165 0 Physicians Healthy Kids Services 20 1962784165 0 Physicians Optical Supplies 20 1962784165 0 Physicians Physician Services 00 1962784447 0 KENNY JULIE 2011269 9999999 B 10 1962784447 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1962784447 0 Audiologists Audiology Services 20 1962784447 0 Audiologists Medical Supplies 20 1962784447 0 Audiologists Medical equipment/prosthetic devices 00 1962784868 0 SPUHLER CHRISTINE E 2016245 9999999 B 10 1962784868 0 29373 NETWORK PL CHICAGO IL 606733039 20 1962784868 0 Clinical Social Worker Social work service 00 1962785154 0 PHELPS KEELY R 2023343 9999999 B 10 1962785154 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1962785154 0 Physician Assistant Only Physician Services 00 1962785972 0 FRANK KATHERINE E 2013213 9999999 B 10 1962785972 0 29373 NETWORK PL CHICAGO IL 606733039 20 1962785972 0 Occupational Therapists Medical Supplies 20 1962785972 0 Occupational Therapists Medical equipment/prosthetic devices 20 1962785972 0 Occupational Therapists Occupational Therapy Services 00 1962788687 0 TO RICHARD G 2019347 9999999 B 10 1962788687 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1962788687 0 Physicians Anesthesia Services 20 1962788687 0 Physicians Fluoride varnish 20 1962788687 0 Physicians Healthy Kids Services 20 1962788687 0 Physicians Optical Supplies 20 1962788687 0 Physicians Physician Services 00 1962788893 0 HONAN BRIENNE 2011284 9999999 B 10 1962788893 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1962788893 0 Audiologists Audiology Services 20 1962788893 0 Audiologists Medical Supplies 20 1962788893 0 Audiologists Medical equipment/prosthetic devices 00 1962789990 0 WETZEL AMANDA 2016300 9999999 B 10 1962789990 0 1003 N CUMMINGS LN WASHINGTON IL 615719646 20 1962789990 0 Other behavior health professional LCPC/LMFT services 00 1962790022 0 AOUHAB ZINEB 2016130 9999999 B 10 1962790022 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1962790022 0 Physicians Anesthesia Services 20 1962790022 0 Physicians Fluoride varnish 20 1962790022 0 Physicians Healthy Kids Services 20 1962790022 0 Physicians Optical Supplies 20 1962790022 0 Physicians Physician Services 00 1962790329 0 KING ASHLEY R 2020234 9999999 B 10 1962790329 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1962790329 0 Physician Assistant Only Fluoride varnish 20 1962790329 0 Physician Assistant Only Healthy Kids Services 20 1962790329 0 Physician Assistant Only Physician Services 00 1962790709 0 BETHEL KRISTINA 2017099 9999999 B 10 1962790709 0 18167 US HIGHWAY 19 N STE 650 CLEARWATER FL 337646576 20 1962790709 0 Physicians Anesthesia Services 20 1962790709 0 Physicians Healthy Kids Services 20 1962790709 0 Physicians Optical Supplies 20 1962790709 0 Physicians Physician Services 00 1962791343 0 WONG JEREMY 2019309 9999999 B 10 1962791343 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1962791343 0 Physicians Anesthesia Services 20 1962791343 0 Physicians Fluoride varnish 20 1962791343 0 Physicians Healthy Kids Services 20 1962791343 0 Physicians Optical Supplies 20 1962791343 0 Physicians Physician Services 00 1962791368 0 ROWE CAROLINE 2018253 9999999 B 10 1962791368 0 300 WINDING WOODS DR STE 200 O FALLON MO 633665081 20 1962791368 0 Nurse Practitioners Fluoride varnish 20 1962791368 0 Nurse Practitioners Healthy Kids Services 20 1962791368 0 Nurse Practitioners Nurse Practitioners Services 20 1962791368 0 Nurse Practitioners Physician Services 00 1962791657 0 MARSHALL-BERGMAN BETH M 2014279 9999999 B 10 1962791657 0 75 REMITTANCE DR DEPT 1620 SUITE 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DANIEL 2019182 9999999 B 10 1962796631 0 675 W NORTH AVE STE 409 MELROSE PARK IL 601601624 20 1962796631 0 Podiatrists Podiatric Services 00 1962796920 0 PIERCE MICHAEL 2024254 9999999 B 10 1962796920 0 11995 SINGLETREE LN STE 500 SUITE 500 EDEN PRAIRIE MN 553445349 20 1962796920 0 Physicians Anesthesia Services 20 1962796920 0 Physicians Healthy Kids Services 20 1962796920 0 Physicians Optical Supplies 20 1962796920 0 Physicians Physician Services 00 1962797126 0 SNYDERS BRIAN J 2018156 9999999 B 10 1962797126 0 621 S NEW BALLAS RD STE 7020 SAINT LOUIS MO 631418232 20 1962797126 0 Physicians Anesthesia Services 20 1962797126 0 Physicians Fluoride varnish 20 1962797126 0 Physicians Healthy Kids Services 20 1962797126 0 Physicians Optical Supplies 20 1962797126 0 Physicians Physician Services 00 1962797308 0 COUGHLIN MEGAN 2023104 9999999 B 10 1962797308 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1962797308 0 Physicians Anesthesia Services 20 1962797308 0 Physicians Healthy Kids 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20 1962804419 0 Nurse Practitioners Nurse Practitioners Services 20 1962804419 0 Nurse Practitioners Physician Services 00 1962805275 0 BARAN DANIELLE M. 2015140 9999999 B 10 1962805275 0 29373 NETWORK PL CHICAGO IL 606733039 20 1962805275 0 Psychologist Psychologist service 00 1962807495 0 LOJO LUCIANO SHIRLEY 2022037 9999999 B 10 1962807495 0 PO BOX 43230 PHOENIX AZ 850803230 20 1962807495 0 Physicians Anesthesia Services 20 1962807495 0 Physicians Fluoride varnish 20 1962807495 0 Physicians Healthy Kids Services 20 1962807495 0 Physicians Optical Supplies 20 1962807495 0 Physicians Physician Services 00 1962808253 0 CROSSLEY KATRINA G 2023095 9999999 B 10 1962808253 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1962808253 0 Physical Therapists Medical Supplies 20 1962808253 0 Physical Therapists Medical equipment/prosthetic devices 20 1962808253 0 Physical Therapists Physical Therapy Services 00 1962809913 0 SANDHEINRICH TARYN G 2014335 9999999 B 10 1962809913 0 PO BOX 60352 660 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Anesthesia Services 20 1962897132 0 Physicians Healthy Kids Services 20 1962897132 0 Physicians Optical Supplies 20 1962897132 0 Physicians Physician Services 00 1962897272 0 ENGLE ALYSON M 2021250 9999999 B 10 1962897272 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1962897272 0 Physicians Anesthesia Services 20 1962897272 0 Physicians Healthy Kids Services 20 1962897272 0 Physicians Optical Supplies 20 1962897272 0 Physicians Physician Services 00 1962897348 0 HITCHINS LAUREN 2015324 9999999 B 10 1962897348 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1962897348 0 Nurse Practitioners Fluoride varnish 20 1962897348 0 Nurse Practitioners Healthy Kids Services 20 1962897348 0 Nurse Practitioners Nurse Practitioners Services 20 1962897348 0 Nurse Practitioners Physician Services 00 1962897561 0 WANG JENNIFER J 2018352 9999999 B 10 1962897561 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1962897561 0 Physicians Anesthesia Services 20 1962897561 0 Physicians Fluoride varnish 20 1962897561 0 Physicians Healthy Kids Services 20 1962897561 0 Physicians Optical Supplies 20 1962897561 0 Physicians Physician Services 00 1962898502 0 WINGARD DANIEL E 2021314 9999999 B 10 1962898502 0 1000 N ALLEN ST ROBINSON IL 624541114 20 1962898502 0 Physicians Anesthesia Services 20 1962898502 0 Physicians Healthy Kids Services 20 1962898502 0 Physicians Optical Supplies 20 1962898502 0 Physicians Physician Services 00 1962898825 0 VASSAR CHADRON J 2019306 9999999 B 10 1962898825 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1962898825 0 Physicians Anesthesia Services 20 1962898825 0 Physicians Healthy Kids Services 20 1962898825 0 Physicians Optical Supplies 20 1962898825 0 Physicians Physician Services 00 1962899104 0 PANCHAL NEIL MRUNAL 2018221 9999999 B 10 1962899104 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1962899104 0 Physicians Anesthesia Services 20 1962899104 0 Physicians Healthy Kids Services 20 1962899104 0 Physicians Optical Supplies 20 1962899104 0 Physicians 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SHADELAND AVE INDIANAPOLIS IN 462194959 20 1972099794 0 Physicians Anesthesia Services 20 1972099794 0 Physicians Fluoride varnish 20 1972099794 0 Physicians Healthy Kids Services 20 1972099794 0 Physicians Optical Supplies 20 1972099794 0 Physicians Physician Services 00 1972100436 0 JOHNSON REBECCA A 2024200 9999999 B 10 1972100436 0 28100 TORCH PKWY STE 600 WARRENVILLE IL 605554030 20 1972100436 0 Occupational Therapists Medical Supplies 20 1972100436 0 Occupational Therapists Medical equipment/prosthetic devices 20 1972100436 0 Occupational Therapists Occupational Therapy Services 00 1972104271 0 KASIA BEATA 2023160 9999999 B 10 1972104271 0 5777 DEPT CAROL STREAM IL 601220021 20 1972104271 0 Nurse Practitioners Healthy Kids Services 20 1972104271 0 Nurse Practitioners Nurse Practitioners Services 20 1972104271 0 Nurse Practitioners Physician Services 00 1972104792 0 HEMMER CORIE L 2021056 9999999 B 10 1972104792 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 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Services 20 1972123503 0 Physicians Optical Supplies 20 1972123503 0 Physicians Physician Services 00 1972123891 0 ABDUL-RASSOUL HUSSEIN 2020154 9999999 B 10 1972123891 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1972123891 0 Physicians Anesthesia Services 20 1972123891 0 Physicians Healthy Kids Services 20 1972123891 0 Physicians Optical Supplies 20 1972123891 0 Physicians Physician Services 00 1972123941 0 BECHTOLD ELLEN 2020182 9999999 B 10 1972123941 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1972123941 0 Physicians Anesthesia Services 20 1972123941 0 Physicians Healthy Kids Services 20 1972123941 0 Physicians Optical Supplies 20 1972123941 0 Physicians Physician Services 00 1972123958 0 SANCHEZ SARAH 2022152 9999999 B 10 1972123958 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1972123958 0 Physician Assistant Only Fluoride varnish 20 1972123958 0 Physician Assistant Only Healthy Kids Services 20 1972123958 0 Physician Assistant Only Physician Services 00 1972124501 0 MORAN CHESTER 2021089 9999999 B 10 1972124501 0 151 S PFINGSTEN RD STE A DEERFIELD IL 600154934 20 1972124501 0 Physical Therapists Medical Supplies 20 1972124501 0 Physical Therapists Medical equipment/prosthetic devices 20 1972124501 0 Physical Therapists Physical Therapy Services 00 1972124543 0 MUNIR MANAHIL 2022344 9999999 B 10 1972124543 0 1395 NW 167TH ST MIAMI FL 331695710 20 1972124543 0 Physicians Anesthesia Services 20 1972124543 0 Physicians Fluoride varnish 20 1972124543 0 Physicians Healthy Kids Services 20 1972124543 0 Physicians Optical Supplies 20 1972124543 0 Physicians Physician Services 00 1972124808 0 LOWERY KAMI 2024039 9999999 B 10 1972124808 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1972124808 0 Physicians Anesthesia Services 20 1972124808 0 Physicians Healthy Kids Services 20 1972124808 0 Physicians Optical Supplies 20 1972124808 0 Physicians Physician Services 00 1972125185 0 PATEL NOLAN D 2020153 9999999 B 10 1972125185 0 17653 TORRENCE AVE LANSING IL 604384839 20 1972125185 0 Dentists Dental Services 20 1972125185 0 Dentists Physician Services 00 1972125201 0 YOON HANNAH 2021189 9999999 B 10 1972125201 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1972125201 0 Optometrists Anesthesia Services 20 1972125201 0 Optometrists Healthy Kids Services 20 1972125201 0 Optometrists Optical Supplies 20 1972125201 0 Optometrists Optometric Services 20 1972125201 0 Optometrists Physician Services 00 1972126639 0 KLOTZ DANIELLE R 2021301 9999999 B 10 1972126639 0 PO BOX 431 JANESVILLE WI 535470431 20 1972126639 0 Physician Assistant Only Fluoride varnish 20 1972126639 0 Physician Assistant Only Healthy Kids Services 20 1972126639 0 Physician Assistant Only Physician Services 00 1972127165 0 GREENE-ROPER JACQUELINE 2020181 9999999 B 10 1972127165 0 75 REMITTANCE DR DEPT 1296 CHICAGO IL 606751296 20 1972127165 0 Physicians Anesthesia Services 20 1972127165 0 Physicians Fluoride varnish 20 1972127165 0 Physicians Healthy Kids 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Services 00 1972128742 0 CLOESSNER EMILY A 2022241 9999999 B 10 1972128742 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1972128742 0 Physicians Anesthesia Services 20 1972128742 0 Physicians Healthy Kids Services 20 1972128742 0 Physicians Optical Supplies 20 1972128742 0 Physicians Physician Services 00 1972129153 0 PERRIN COURTNEY L 2020181 9999999 H 10 1972129153 0 1845 GRANDSTAND PL ELGIN IL 601236603 20 1972129153 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972129518 0 LANDER DANIEL 2020227 9999999 B 10 1972129518 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1972129518 0 Physicians Anesthesia Services 20 1972129518 0 Physicians Healthy Kids Services 20 1972129518 0 Physicians Optical Supplies 20 1972129518 0 Physicians Physician Services 00 1972130086 0 NOVITSKY BRIANNA C 2020140 9999999 B 10 1972130086 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1972130086 0 Physicians Anesthesia Services 20 1972130086 0 Physicians Fluoride varnish 20 1972130086 0 Physicians Healthy Kids Services 20 1972130086 0 Physicians Optical Supplies 20 1972130086 0 Physicians Physician Services 00 1972130607 0 RANDOLPH KATHERINE 2020212 9999999 B 10 1972130607 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1972130607 0 Physicians Anesthesia Services 20 1972130607 0 Physicians Fluoride varnish 20 1972130607 0 Physicians Healthy Kids Services 20 1972130607 0 Physicians Optical Supplies 20 1972130607 0 Physicians Physician Services 00 1972130615 0 SOOD ANSHUM 2020246 9999999 B 10 1972130615 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1972130615 0 Physicians Anesthesia Services 20 1972130615 0 Physicians Healthy Kids Services 20 1972130615 0 Physicians Optical Supplies 20 1972130615 0 Physicians Physician Services 00 1972130730 0 CARTAGENOVA LUIS S 2020175 9999999 B 10 1972130730 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1972130730 0 Physicians Anesthesia 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Services 20 1972131787 0 Physicians Healthy Kids Services 20 1972131787 0 Physicians Optical Supplies 20 1972131787 0 Physicians Physician Services 00 1972132074 0 CAY EDWARD B 2023188 9999999 B 10 1972132074 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1972132074 0 Physicians Anesthesia Services 20 1972132074 0 Physicians Fluoride varnish 20 1972132074 0 Physicians Healthy Kids Services 20 1972132074 0 Physicians Optical Supplies 20 1972132074 0 Physicians Physician Services 00 1972132462 0 PATEL NIKITA 2023207 9999999 B 10 1972132462 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1972132462 0 Physicians Anesthesia Services 20 1972132462 0 Physicians Healthy Kids Services 20 1972132462 0 Physicians Optical Supplies 20 1972132462 0 Physicians Physician Services 20 1972132462 0 Physicians Physicians Psychiatric Services 00 1972132645 0 SHAH YASH D 2023192 9999999 B 10 1972132645 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1972132645 0 Physicians Anesthesia Services 20 1972132645 0 Physicians Fluoride varnish 20 1972132645 0 Physicians Healthy Kids Services 20 1972132645 0 Physicians Optical Supplies 20 1972132645 0 Physicians Physician Services 00 1972132777 0 MORRIS STEPHEN 2020246 9999999 B 10 1972132777 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1972132777 0 Physicians Anesthesia Services 20 1972132777 0 Physicians Healthy Kids Services 20 1972132777 0 Physicians Optical Supplies 20 1972132777 0 Physicians Physician Services 20 1972132777 0 Physicians Physicians Psychiatric Services 00 1972133031 0 CRAFT PATRICIA 2022244 9999999 B 10 1972133031 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1972133031 0 Physician Assistant Only Fluoride varnish 20 1972133031 0 Physician Assistant Only Healthy Kids Services 20 1972133031 0 Physician Assistant Only Physician Services 00 1972133262 0 ELITT MATTHEW S 2021156 9999999 B 10 1972133262 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1972133262 0 Physicians Anesthesia Services 20 1972133262 0 Physicians Healthy Kids Services 20 1972133262 0 Physicians Optical Supplies 20 1972133262 0 Physicians Physician Services 00 1972133452 0 ROVEY HANNAH M 2020023 9999999 B 10 1972133452 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1972133452 0 Clinical Social Worker Social work service 00 1972134187 0 GERGEL MELISSA A 2020148 9999999 B 10 1972134187 0 5777 DEPT CAROL STREAM IL 601220021 20 1972134187 0 Physician Assistant Only Fluoride varnish 20 1972134187 0 Physician Assistant Only Healthy Kids Services 20 1972134187 0 Physician Assistant Only Physician Services 00 1972136620 0 SMITH DOUG C 2020188 9999999 B 10 1972136620 0 819 BLOOMINGTON RD CHAMPAIGN IL 618202101 20 1972136620 0 Clinical Social Worker Social work service 00 1972137479 0 BRANHAM NICHOLAS S 2024200 9999999 B 10 1972137479 0 1 BARNES JEWISH HOSPITAL PLZ S SAINT LOUIS MO 631101003 20 1972137479 0 Dentists Dental Services 20 1972137479 0 Dentists Physician Services 00 1972139954 0 MARX JEREMY S 2020164 9999999 B 10 1972139954 0 4698 DEPT CAROL STREAM IL 601220021 20 1972139954 0 Physicians Anesthesia Services 20 1972139954 0 Physicians Healthy Kids Services 20 1972139954 0 Physicians Optical Supplies 20 1972139954 0 Physicians Physician Services 00 1972144491 0 SANCHEZ-GUZMAN KAITHYNN 2019283 9999999 B 10 1972144491 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1972144491 0 Registered nurse Nursing service 20 1972144491 0 Registered nurse Waiver service 00 1972144699 0 WROLSON ALLISON 2019277 9999999 B 10 1972144699 0 2900 OGDEN AVE LISLE IL 605321631 20 1972144699 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1972144715 0 MIRELES REBECCA A 2019325 9999999 B 10 1972144715 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1972144715 0 Nurse Practitioners Fluoride varnish 20 1972144715 0 Nurse Practitioners Healthy Kids Services 20 1972144715 0 Nurse Practitioners Nurse Practitioners Services 20 1972144715 0 Nurse Practitioners Physician Services 00 1972145787 0 CHERRY EMILY 2019288 9999999 B 10 1972145787 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1972145787 0 Nurse Practitioners Healthy Kids Services 20 1972145787 0 Nurse Practitioners Nurse Practitioners Services 20 1972145787 0 Nurse Practitioners Physician Services 00 1972149649 0 GARTZ JENNA 2021130 9999999 B 10 1972149649 0 5777 DEPT CAROL STREAM IL 601220021 20 1972149649 0 Nurse Practitioners Healthy Kids Services 20 1972149649 0 Nurse Practitioners Nurse Practitioners Services 20 1972149649 0 Nurse Practitioners Physician Services 00 1972150225 0 TRYON RACHEL 2024251 9999999 B 10 1972150225 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1972150225 0 Nurse Practitioners Healthy Kids Services 20 1972150225 0 Nurse Practitioners Nurse Practitioners Services 20 1972150225 0 Nurse Practitioners Physician Services 00 1972150712 0 MORAN EDITH 2021133 9999999 B 10 1972150712 0 PO BOX 856 ANTIOCH IL 600020856 20 1972150712 0 Clinical Social Worker Social work service 00 1972150936 0 PAULSEN DANIELLE 2020287 9999999 B 10 1972150936 0 29373 NETWORK PL CHICAGO IL 606733039 20 1972150936 0 Physician Assistant Only Fluoride varnish 20 1972150936 0 Physician Assistant Only Healthy Kids Services 20 1972150936 0 Physician Assistant Only Physician Services 00 1972151512 0 WISHNE LAUREN J 2019260 9999999 B 10 1972151512 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1972151512 0 Nurse Practitioners Fluoride varnish 20 1972151512 0 Nurse Practitioners Healthy Kids Services 20 1972151512 0 Nurse Practitioners Nurse Practitioners Services 20 1972151512 0 Nurse Practitioners Physician Services 00 1972152163 0 KIPPING STEPHANIE 2019260 9999999 B 10 1972152163 0 PO BOX 146 WATERLOO IL 622980146 20 1972152163 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972152189 0 MOORE BOBBI 2019261 9999999 B 10 1972152189 0 PO BOX 146 WATERLOO IL 622980146 20 1972152189 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972152874 0 ZIMMERMANN AMANDA 2019344 9999999 B 10 1972152874 0 1870 W WINCHESTER RD STE 247 LIBERTYVILLE IL 600485360 20 1972152874 0 Nurse Practitioners Healthy Kids Services 20 1972152874 0 Nurse Practitioners Nurse Practitioners Services 20 1972152874 0 Nurse Practitioners Physician Services 00 1972154540 0 LOTT TINA 2024187 9999999 B 10 1972154540 0 7550 E 53RD PL UNIT 5788 DENVER CO 802177430 20 1972154540 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972155455 0 HAMBURGER AYELET 2022018 9999999 B 10 1972155455 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1972155455 0 Audiologists Audiology Services 20 1972155455 0 Audiologists Medical Supplies 20 1972155455 0 Audiologists Medical equipment/prosthetic devices 00 1972160158 0 ROSARIO ELIZABETH LIZZETTE 2024296 9999999 B 10 1972160158 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1972160158 0 Clinical Social Worker Social work service 00 1972161156 0 KONOLD ANTHONY 2019232 9999999 B 10 1972161156 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1972161156 0 Physicians Anesthesia Services 20 1972161156 0 Physicians Fluoride varnish 20 1972161156 0 Physicians Healthy Kids Services 20 1972161156 0 Physicians Optical Supplies 20 1972161156 0 Physicians Physician Services 00 1972161347 0 SCHEMMEL ROBIN G 2019219 9999999 B 10 1972161347 0 5777 DEPT CAROL STREAM IL 601220021 20 1972161347 0 Physician Assistant Only Fluoride varnish 20 1972161347 0 Physician Assistant Only Healthy Kids Services 20 1972161347 0 Physician Assistant Only Physician Services 00 1972161750 0 AHRENS ELIVIA 2019220 9999999 B 10 1972161750 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1972161750 0 Other behavior health professional Social work service 00 1972162626 0 HENRICHSEN JACOB L 2019254 9999999 B 10 1972162626 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1972162626 0 Physicians Anesthesia Services 20 1972162626 0 Physicians Healthy Kids Services 20 1972162626 0 Physicians Optical Supplies 20 1972162626 0 Physicians Physician Services 00 1972165264 0 ROSSIO MEGAN A 2021014 9999999 B 10 1972165264 0 28594 NETWORK PL CHICAGO IL 606731285 20 1972165264 0 Audiologists Audiology Services 20 1972165264 0 Audiologists Medical Supplies 20 1972165264 0 Audiologists Medical equipment/prosthetic devices 00 1972165785 0 SHAHI ANOJ 2023054 9999999 B 10 1972165785 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1972165785 0 Physicians Anesthesia Services 20 1972165785 0 Physicians Fluoride varnish 20 1972165785 0 Physicians Healthy Kids Services 20 1972165785 0 Physicians Optical Supplies 20 1972165785 0 Physicians Physician Services 00 1972166197 0 PRESS BRITTANY 2019129 9999999 B 10 1972166197 0 PO BOX 775253 CHICAGO IL 606775253 20 1972166197 0 Nurse Practitioners Fluoride varnish 20 1972166197 0 Nurse Practitioners Healthy Kids Services 20 1972166197 0 Nurse Practitioners Nurse Practitioners Services 20 1972166197 0 Nurse Practitioners Physician Services 00 1972166510 0 KAPOOR RAHUL 2023278 9999999 B 10 1972166510 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1972166510 0 Physicians Anesthesia Services 20 1972166510 0 Physicians Healthy Kids Services 20 1972166510 0 Physicians Optical Supplies 20 1972166510 0 Physicians Physician Services 00 1972166791 0 SHARIFF ABDULLAH 2024131 9999999 B 10 1972166791 0 3600 MINNESOTA DR STE 800 MINNEAPOLIS MN 554357915 20 1972166791 0 Physicians Anesthesia Services 20 1972166791 0 Physicians Healthy Kids Services 20 1972166791 0 Physicians Optical Supplies 20 1972166791 0 Physicians Physician Services 00 1972167914 0 MAYS CAITLIN A 2019121 9999999 B 10 1972167914 0 405 LAKE ZURICH RD BARRINGTON IL 600103141 20 1972167914 0 Nurse Practitioners Healthy Kids Services 20 1972167914 0 Nurse Practitioners Nurse Practitioners Services 20 1972167914 0 Nurse Practitioners Physician Services 00 1972168169 0 GRAGE JENNIFER M 2020162 9999999 B 10 1972168169 0 4698 DEPT CAROL STREAM IL 601220021 20 1972168169 0 Physicians Anesthesia Services 20 1972168169 0 Physicians Fluoride varnish 20 1972168169 0 Physicians Healthy Kids Services 20 1972168169 0 Physicians Optical Supplies 20 1972168169 0 Physicians Physician Services 00 1972169274 0 FAROOQI HANNIA 2020305 9999999 B 10 1972169274 0 1643 NW 136TH AVE STE 100 SUNRISE FL 333232857 20 1972169274 0 Physicians Anesthesia Services 20 1972169274 0 Physicians Fluoride varnish 20 1972169274 0 Physicians Healthy Kids Services 20 1972169274 0 Physicians Optical Supplies 20 1972169274 0 Physicians Physician Services 00 1972169845 0 SADRE SARA Y 2022199 9999999 B 10 1972169845 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1972169845 0 Physicians Anesthesia Services 20 1972169845 0 Physicians Fluoride varnish 20 1972169845 0 Physicians Healthy Kids Services 20 1972169845 0 Physicians Optical Supplies 20 1972169845 0 Physicians Physician Services 00 1972170363 0 CARLIN ALMA 2021158 9999999 B 10 1972170363 0 2331 W CHICAGO AVE CHICAGO IL 606224723 20 1972170363 0 Nurse Practitioners Fluoride varnish 20 1972170363 0 Nurse Practitioners Healthy Kids Services 20 1972170363 0 Nurse Practitioners Nurse Practitioners Services 20 1972170363 0 Nurse Practitioners Physician Services 00 1972170611 0 SCHAPER JORDYN I 2021200 9999999 B 10 1972170611 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1972170611 0 Nurse Practitioners Healthy Kids Services 20 1972170611 0 Nurse Practitioners Nurse Practitioners Services 20 1972170611 0 Nurse Practitioners Physician Services 00 1972171189 0 WALLENKAMPF KARL C 2021231 9999999 B 10 1972171189 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1972171189 0 Physicians Anesthesia Services 20 1972171189 0 Physicians Fluoride varnish 20 1972171189 0 Physicians Healthy Kids Services 20 1972171189 0 Physicians Optical Supplies 20 1972171189 0 Physicians Physician Services 00 1972172021 0 YEOWARD JESSICA 2021203 9999999 B 10 1972172021 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1972172021 0 Nurse Practitioners Fluoride varnish 20 1972172021 0 Nurse Practitioners Healthy Kids Services 20 1972172021 0 Nurse Practitioners Nurse Practitioners Services 20 1972172021 0 Nurse Practitioners Physician Services 00 1972172567 0 FREEMON ERIC M 2022180 9999999 B 10 1972172567 0 PO BOX 3039 OAK BROOK IL 605223039 20 1972172567 0 Physicians Anesthesia Services 20 1972172567 0 Physicians Fluoride varnish 20 1972172567 0 Physicians Healthy Kids Services 20 1972172567 0 Physicians Optical Supplies 20 1972172567 0 Physicians Physician Services 00 1972172666 0 BACON NICKOLAS A 2021221 9999999 B 10 1972172666 0 1400 US HIGHWAY 61 FESTUS MO 630284100 20 1972172666 0 Physicians Anesthesia Services 20 1972172666 0 Physicians Fluoride varnish 20 1972172666 0 Physicians Healthy Kids Services 20 1972172666 0 Physicians Optical Supplies 20 1972172666 0 Physicians Physician Services 00 1972173698 0 SMITH KYLE 2021187 9999999 B 10 1972173698 0 1418 COLLEGE DR MOUNT CARMEL IL 628632638 20 1972173698 0 Nurse Practitioners Anesthesia Services 20 1972173698 0 Nurse Practitioners Nurse Practitioners Services 20 1972173698 0 Nurse Practitioners Physician Services 00 1972173797 0 BEIER NICOLE 2022257 9999999 B 10 1972173797 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1972173797 0 Speech Therapists Medical Supplies 20 1972173797 0 Speech Therapists Medical equipment/prosthetic devices 20 1972173797 0 Speech Therapists Speech Therapy/Pathology Services 00 1972174688 0 ACEVEDO MINA L 2021322 9999999 B 10 1972174688 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1972174688 0 Nurse Practitioners Fluoride varnish 20 1972174688 0 Nurse Practitioners Healthy Kids Services 20 1972174688 0 Nurse Practitioners Nurse Practitioners Services 20 1972174688 0 Nurse Practitioners Physician Services 00 1972174860 0 EKWEARIRI NNADOZIE REMY 2022199 9999999 B 10 1972174860 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1972174860 0 Physicians Anesthesia Services 20 1972174860 0 Physicians Healthy Kids Services 20 1972174860 0 Physicians Optical Supplies 20 1972174860 0 Physicians Physician Services 00 1972176212 0 RILEY DARRYELLE 2021211 9999999 B 10 1972176212 0 PO BOX 775253 CHICAGO IL 606775253 20 1972176212 0 Nurse Practitioners Fluoride varnish 20 1972176212 0 Nurse Practitioners Healthy Kids Services 20 1972176212 0 Nurse Practitioners Nurse Practitioners Services 20 1972176212 0 Nurse Practitioners Physician Services 00 1972176279 0 BURKE ELIZABETH L 2021223 9999999 B 10 1972176279 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1972176279 0 Nurse Practitioners Healthy Kids Services 20 1972176279 0 Nurse Practitioners Midwife Services 20 1972176279 0 Nurse Practitioners Nurse Practitioners Services 20 1972176279 0 Nurse Practitioners Physician Services 00 1972176691 0 INAYAT ASAD 2022053 9999999 B 10 1972176691 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1972176691 0 Physicians Anesthesia Services 20 1972176691 0 Physicians Fluoride varnish 20 1972176691 0 Physicians Healthy Kids Services 20 1972176691 0 Physicians Optical Supplies 20 1972176691 0 Physicians Physician Services 00 1972177582 0 CAMARDO NICOLE 2021230 9999999 B 10 1972177582 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1972177582 0 Nurse Practitioners Healthy Kids Services 20 1972177582 0 Nurse Practitioners Midwife Services 20 1972177582 0 Nurse Practitioners Nurse Practitioners Services 20 1972177582 0 Nurse Practitioners Physician Services 00 1972179315 0 KOJETIN SARAH 2021148 9999999 B 10 1972179315 0 1311 MAMARONECK AVE STE 140 WHITE PLAINS NY 106055224 20 1972179315 0 Physical Therapists Medical Supplies 20 1972179315 0 Physical Therapists Medical equipment/prosthetic devices 20 1972179315 0 Physical Therapists Physical Therapy Services 00 1972179604 0 MURPHY DANIEL 2021187 9999999 B 10 1972179604 0 2601 NAVISTAR DR LISLE IL 605323661 20 1972179604 0 Physicians Anesthesia Services 20 1972179604 0 Physicians Fluoride varnish 20 1972179604 0 Physicians Healthy Kids Services 20 1972179604 0 Physicians Optical Supplies 20 1972179604 0 Physicians Physician Services 00 1972179984 0 SAUER JOSEPH 2023331 9999999 B 10 1972179984 0 611 W PARK ST URBANA IL 618012529 20 1972179984 0 Physicians Anesthesia Services 20 1972179984 0 Physicians Healthy Kids Services 20 1972179984 0 Physicians Optical Supplies 20 1972179984 0 Physicians Physician Services 20 1972179984 0 Physicians Physicians Psychiatric Services 00 1972180198 0 MADDEN ABAIGAEL P 2021214 9999999 B 10 1972180198 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1972180198 0 Physicians Anesthesia Services 20 1972180198 0 Physicians Fluoride varnish 20 1972180198 0 Physicians Healthy Kids Services 20 1972180198 0 Physicians Optical Supplies 20 1972180198 0 Physicians Physician Services 00 1972180354 0 RODGERS WENDY 2021103 9999999 B 10 1972180354 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1972180354 0 Nurse Practitioners Fluoride varnish 20 1972180354 0 Nurse Practitioners Healthy Kids Services 20 1972180354 0 Nurse Practitioners Nurse Practitioners Services 20 1972180354 0 Nurse Practitioners Physician Services 00 1972180925 0 SANNI HABEEB 2024208 9999999 B 10 1972180925 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1972180925 0 Physicians Anesthesia Services 20 1972180925 0 Physicians Fluoride varnish 20 1972180925 0 Physicians Healthy Kids Services 20 1972180925 0 Physicians Optical Supplies 20 1972180925 0 Physicians Physician Services 00 1972180982 0 BAUGNON NICHOLAS 2021228 9999999 B 10 1972180982 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1972180982 0 Physicians Anesthesia Services 20 1972180982 0 Physicians Fluoride varnish 20 1972180982 0 Physicians Healthy Kids Services 20 1972180982 0 Physicians Optical Supplies 20 1972180982 0 Physicians Physician Services 00 1972181139 0 EL-BABA RAMI MOHAMMAD 2022202 9999999 B 10 1972181139 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1972181139 0 Physicians Anesthesia Services 20 1972181139 0 Physicians Healthy Kids Services 20 1972181139 0 Physicians Optical Supplies 20 1972181139 0 Physicians Physician Services 00 1972181162 0 FELDMAN MAYA 2024162 9999999 B 10 1972181162 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1972181162 0 Physicians Anesthesia Services 20 1972181162 0 Physicians Fluoride varnish 20 1972181162 0 Physicians Healthy Kids Services 20 1972181162 0 Physicians Optical Supplies 20 1972181162 0 Physicians Physician Services 00 1972181188 0 KELLER PATRICK C 2021172 9999999 B 10 1972181188 0 5777 DEPT CAROL STREAM IL 601220021 20 1972181188 0 Physicians Anesthesia Services 20 1972181188 0 Physicians Fluoride varnish 20 1972181188 0 Physicians Healthy Kids Services 20 1972181188 0 Physicians Optical Supplies 20 1972181188 0 Physicians Physician Services 00 1972181345 0 DUENAS RUIZ KAREN 2024206 9999999 B 10 1972181345 0 2434 W DIVISION ST CHICAGO IL 606222942 20 1972181345 0 Physicians Anesthesia Services 20 1972181345 0 Physicians Fluoride varnish 20 1972181345 0 Physicians Healthy Kids Services 20 1972181345 0 Physicians Optical Supplies 20 1972181345 0 Physicians Physician Services 00 1972182111 0 SHETH SHIVANI 2022319 9999999 B 10 1972182111 0 4650 SOUTHWEST HWY OAK LAWN IL 604531836 20 1972182111 0 Podiatrists Podiatric Services 00 1972182376 0 VALDIZON MORENA LETICIA 2021160 9999999 B 10 1972182376 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1972182376 0 Physicians Anesthesia Services 20 1972182376 0 Physicians Fluoride varnish 20 1972182376 0 Physicians Healthy Kids Services 20 1972182376 0 Physicians Optical Supplies 20 1972182376 0 Physicians Physician Services 00 1972184299 0 MURPHEY ANNIE 2021179 9999999 B 10 1972184299 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1972184299 0 Physicians Anesthesia Services 20 1972184299 0 Physicians Healthy Kids Services 20 1972184299 0 Physicians Optical Supplies 20 1972184299 0 Physicians Physician Services 00 1972185601 0 CALLEGARI ALISON K 2024214 9999999 B 10 1972185601 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1972185601 0 Physicians Anesthesia Services 20 1972185601 0 Physicians Fluoride varnish 20 1972185601 0 Physicians Healthy Kids Services 20 1972185601 0 Physicians Optical Supplies 20 1972185601 0 Physicians Physician Services 00 1972185890 0 DAVIS CLAYTON L 2023004 9999999 B 10 1972185890 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1972185890 0 Physicians Anesthesia Services 20 1972185890 0 Physicians Fluoride varnish 20 1972185890 0 Physicians Healthy Kids Services 20 1972185890 0 Physicians Optical Supplies 20 1972185890 0 Physicians Physician Services 00 1972185940 0 LEPPINK ERIC 2024036 9999999 B 10 1972185940 0 1203 W AUGUSTA BLVD UNIT 1 CHICAGO IL 606424327 20 1972185940 0 Physicians Anesthesia Services 20 1972185940 0 Physicians Healthy Kids Services 20 1972185940 0 Physicians Optical Supplies 20 1972185940 0 Physicians Physician Services 20 1972185940 0 Physicians Physicians Psychiatric Services 00 1972189066 0 AHMED FARAZ 2024204 9999999 B 10 1972189066 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1972189066 0 Physicians Anesthesia Services 20 1972189066 0 Physicians Fluoride varnish 20 1972189066 0 Physicians Healthy Kids Services 20 1972189066 0 Physicians Optical Supplies 20 1972189066 0 Physicians Physician Services 00 1972189314 0 PRASAD SUPRITHA P 2021176 9999999 B 10 1972189314 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1972189314 0 Physicians Anesthesia Services 20 1972189314 0 Physicians Fluoride varnish 20 1972189314 0 Physicians Healthy Kids Services 20 1972189314 0 Physicians Optical Supplies 20 1972189314 0 Physicians Physician Services 00 1972189934 0 PASCARELLA LAUREN 2023334 9999999 B 10 1972189934 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1972189934 0 Psychologist Psychologist service 00 1972190510 0 WOOD ERIN 2021043 9999999 B 10 1972190510 0 1005 BROADWAY ST QUINCY IL 623012834 20 1972190510 0 Nurse Practitioners Fluoride varnish 20 1972190510 0 Nurse Practitioners Healthy Kids Services 20 1972190510 0 Nurse Practitioners Nurse Practitioners Services 20 1972190510 0 Nurse Practitioners Physician Services 00 1972190767 0 HARAMIJA SHAUNA M 2023125 9999999 B 10 1972190767 0 PO BOX 53 WHEATON IL 601870053 20 1972190767 0 Nurse Practitioners Fluoride varnish 20 1972190767 0 Nurse Practitioners Healthy Kids Services 20 1972190767 0 Nurse Practitioners Nurse Practitioners Services 20 1972190767 0 Nurse Practitioners Physician Services 00 1972192078 0 SCOTT ELIZABETH I 2022152 9999999 B 10 1972192078 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1972192078 0 Physician Assistant Only Fluoride varnish 20 1972192078 0 Physician Assistant Only Healthy Kids Services 20 1972192078 0 Physician Assistant Only Physician Services 00 1972193514 0 BREDL MICHAEL 2024008 9999999 B 10 1972193514 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1972193514 0 Nurse Practitioners Anesthesia Services 20 1972193514 0 Nurse Practitioners Nurse Practitioners Services 20 1972193514 0 Nurse Practitioners Physician Services 00 1972193639 0 LIPPERT MORGAN E 2022216 9999999 B 10 1972193639 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1972193639 0 Nurse Practitioners Fluoride varnish 20 1972193639 0 Nurse Practitioners Healthy Kids Services 20 1972193639 0 Nurse Practitioners Nurse Practitioners Services 20 1972193639 0 Nurse Practitioners Physician Services 00 1972193936 0 SHAW LASHARA 2021169 9999999 B 10 1972193936 0 1755 PARK ST STE 200 NAPERVILLE IL 605638404 20 1972193936 0 Other behavior health professional LCPC/LMFT services 00 1972196871 0 LICHMAN DANIELLE E 2022054 9999999 B 10 1972196871 0 5547 N RAVENSWOOD AVE STE 103 CHICAGO IL 606401125 20 1972196871 0 Other behavior health professional Psychologist service 00 1972197929 0 CLINE ERIN 2022050 9999999 B 10 1972197929 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1972197929 0 Nurse Practitioners Healthy Kids Services 20 1972197929 0 Nurse Practitioners Nurse Practitioners Services 20 1972197929 0 Nurse Practitioners Physician Services 00 1972199461 0 KINDRED KATHERINE A 2021006 9999999 B 10 1972199461 0 8940 N WOOD SAGE RD PEORIA IL 616157822 20 1972199461 0 Nurse Practitioners Fluoride varnish 20 1972199461 0 Nurse Practitioners Healthy Kids Services 20 1972199461 0 Nurse Practitioners Nurse Practitioners Services 20 1972199461 0 Nurse Practitioners Physician Services 00 1972199578 0 BARFIELD BRYAN D 2020363 9999999 H 10 1972199578 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1972199578 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972201028 0 TONNE KELSEY 2023058 9999999 B 10 1972201028 0 684 S BARRINGTON RD STE 112 STREAMWOOD IL 601071841 20 1972201028 0 Clinical Social Worker Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972203065 0 KHAN LALARUKH 2023087 9999999 B 10 1972203065 0 7667 W 95TH ST STE 209 HICKORY HILLS IL 604572281 20 1972203065 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972203784 0 PATEL ANJALI R 2023196 9999999 B 10 1972203784 0 6024 RIDGE AVE STE 116-356 PHILADELPHIA PA 191281601 20 1972203784 0 Physician Assistant Only Fluoride varnish 20 1972203784 0 Physician Assistant Only Healthy Kids Services 20 1972203784 0 Physician Assistant Only Physician Services 00 1972204667 0 THIEU VINCENT 2024183 9999999 B 10 1972204667 0 PO BOX 3039 OAK BROOK IL 605223039 20 1972204667 0 Physicians Anesthesia Services 20 1972204667 0 Physicians Fluoride varnish 20 1972204667 0 Physicians Healthy Kids Services 20 1972204667 0 Physicians Optical Supplies 20 1972204667 0 Physicians Physician Services 00 1972205243 0 ZANDER ALISON KAYE 2023173 9999999 B 10 1972205243 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1972205243 0 Physicians Anesthesia Services 20 1972205243 0 Physicians Fluoride varnish 20 1972205243 0 Physicians Healthy Kids Services 20 1972205243 0 Physicians Optical Supplies 20 1972205243 0 Physicians Physician Services 00 1972205748 0 KILIANEK MELISSA M 2024185 9999999 B 10 1972205748 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1972205748 0 Physicians Anesthesia Services 20 1972205748 0 Physicians Healthy Kids Services 20 1972205748 0 Physicians Optical Supplies 20 1972205748 0 Physicians Physician Services 00 1972206050 0 NIAZI ZACKARIA 2023207 9999999 B 10 1972206050 0 PO BOX 3039 OAK BROOK IL 605223039 20 1972206050 0 Physicians Anesthesia Services 20 1972206050 0 Physicians Fluoride varnish 20 1972206050 0 Physicians Healthy Kids Services 20 1972206050 0 Physicians Optical Supplies 20 1972206050 0 Physicians Physician Services 00 1972206282 0 O'NEAL SYDNEY G 2023174 9999999 B 10 1972206282 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1972206282 0 Physicians Anesthesia Services 20 1972206282 0 Physicians Fluoride varnish 20 1972206282 0 Physicians Healthy Kids Services 20 1972206282 0 Physicians Optical Supplies 20 1972206282 0 Physicians Physician Services 00 1972206910 0 HABEEL SAMER 2023334 9999999 B 10 1972206910 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1972206910 0 Physicians Anesthesia Services 20 1972206910 0 Physicians Fluoride varnish 20 1972206910 0 Physicians Healthy Kids Services 20 1972206910 0 Physicians Optical Supplies 20 1972206910 0 Physicians Physician Services 00 1972207041 0 CHEVULA HARVEEN K 2023095 9999999 B 10 1972207041 0 24014 W RENWICK RD PLAINFIELD IL 605448708 20 1972207041 0 Physical Therapists Medical Supplies 20 1972207041 0 Physical Therapists Medical equipment/prosthetic devices 20 1972207041 0 Physical Therapists Physical Therapy Services 00 1972208494 0 ROHAIL HIRA 2024168 9999999 B 10 1972208494 0 PO BOX 3039 OAK BROOK IL 605223039 20 1972208494 0 Physicians Anesthesia Services 20 1972208494 0 Physicians Fluoride varnish 20 1972208494 0 Physicians Healthy Kids Services 20 1972208494 0 Physicians Optical Supplies 20 1972208494 0 Physicians Physician Services 00 1972209690 0 DORIETY MICHELLE 2023069 9999999 B 10 1972209690 0 6501 S PROMONTORY DR CHICAGO IL 606491003 20 1972209690 0 Nurse Practitioners Fluoride varnish 20 1972209690 0 Nurse Practitioners Healthy Kids Services 20 1972209690 0 Nurse Practitioners Nurse Practitioners Services 20 1972209690 0 Nurse Practitioners Physician Services 00 1972210755 0 GUEVARA KRISTINA NICOLE 2024092 9999999 B 10 1972210755 0 PO BOX 110429 AURORA CO 800420429 20 1972210755 0 Licensed Practical Nurses Nursing service 00 1972210847 0 GROECHEL KATHRYN 2022332 9999999 B 10 1972210847 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1972210847 0 Nurse Practitioners Anesthesia Services 20 1972210847 0 Nurse Practitioners Nurse Practitioners Services 20 1972210847 0 Nurse Practitioners Physician Services 00 1972210995 0 THOMPSON MACKENZIE 2022339 9999999 B 10 1972210995 0 363 N WEST ST OLNEY IL 624501160 20 1972210995 0 Physician Assistant Only Fluoride varnish 20 1972210995 0 Physician Assistant Only Healthy Kids Services 20 1972210995 0 Physician Assistant Only Physician Services 00 1972211910 0 GELBERG EMMA F 2023017 9999999 B 10 1972211910 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1972211910 0 Occupational Therapists Medical Supplies 20 1972211910 0 Occupational Therapists Medical equipment/prosthetic devices 20 1972211910 0 Occupational Therapists Occupational Therapy Services 00 1972213882 0 THOMPSON NATALIE A 2023027 9999999 B 10 1972213882 0 363 N WEST ST OLNEY IL 624501160 20 1972213882 0 Nurse Practitioners Fluoride varnish 20 1972213882 0 Nurse Practitioners Healthy Kids Services 20 1972213882 0 Nurse Practitioners Nurse Practitioners Services 20 1972213882 0 Nurse Practitioners Physician Services 00 1972214500 0 PACHECO ROBERTO GIORGIO 2024239 9999999 B 10 1972214500 0 415 W GOLF RD STE 52 ARLINGTON HEIGH IL 600053923 20 1972214500 0 Physical Therapists Medical Supplies 20 1972214500 0 Physical Therapists Medical equipment/prosthetic devices 20 1972214500 0 Physical Therapists Physical Therapy Services 00 1972215622 0 SHAVER JULIA 2024115 9999999 B 10 1972215622 0 PO BOX 959794 SAINT LOUIS MO 631959794 20 1972215622 0 Nurse Practitioners Fluoride varnish 20 1972215622 0 Nurse Practitioners Healthy Kids Services 20 1972215622 0 Nurse Practitioners Nurse Practitioners Services 20 1972215622 0 Nurse Practitioners Physician Services 00 1972216570 0 SKILLMAN LARISA A 2023051 9999999 B 10 1972216570 0 29373 NETWORK PL CHICAGO IL 606733039 20 1972216570 0 Nurse Practitioners Fluoride varnish 20 1972216570 0 Nurse Practitioners Healthy Kids Services 20 1972216570 0 Nurse Practitioners Nurse Practitioners Services 20 1972216570 0 Nurse Practitioners Physician Services 00 1972216737 0 MENDEZ FRANCHESKA A 2022361 9999999 B 10 1972216737 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1972216737 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972216901 0 OSMANSKI MARIA LYNN 2023009 9999999 B 10 1972216901 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1972216901 0 Clinical Social Worker Social work service 00 1972217735 0 MCPIKE MARISSA 2024151 9999999 B 10 1972217735 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1972217735 0 Physician Assistant Only Fluoride varnish 20 1972217735 0 Physician Assistant Only Healthy Kids Services 20 1972217735 0 Physician Assistant Only Physician Services 00 1972219624 0 MILLER ERIN 2023255 9999999 B 10 1972219624 0 3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047452 20 1972219624 0 Nurse Practitioners Fluoride varnish 20 1972219624 0 Nurse Practitioners Healthy Kids Services 20 1972219624 0 Nurse Practitioners Nurse Practitioners Services 20 1972219624 0 Nurse Practitioners Physician Services 00 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Practitioners Fluoride varnish 20 1972227882 0 Nurse Practitioners Healthy Kids Services 20 1972227882 0 Nurse Practitioners Nurse Practitioners Services 20 1972227882 0 Nurse Practitioners Physician Services 00 1972227965 0 TOBIAS LEAH C 2023097 9999999 B 10 1972227965 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1972227965 0 Physician Assistant Only Fluoride varnish 20 1972227965 0 Physician Assistant Only Healthy Kids Services 20 1972227965 0 Physician Assistant Only Physician Services 00 1972228286 0 ZEGLEN AGATA ZEGLEN 2024220 9999999 B 10 1972228286 0 2000 OGDEN AVE AURORA IL 605047222 20 1972228286 0 Nurse Practitioners Fluoride varnish 20 1972228286 0 Nurse Practitioners Healthy Kids Services 20 1972228286 0 Nurse Practitioners Nurse Practitioners Services 20 1972228286 0 Nurse Practitioners Physician Services 00 1972228732 0 PARK MELISSA R 2023104 9999999 B 10 1972228732 0 810 PHAETON PL NORMAL IL 617614836 20 1972228732 0 Speech Therapists Medical 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20 1972230860 0 Nurse Practitioners Nurse Practitioners Services 20 1972230860 0 Nurse Practitioners Physician Services 00 1972230886 0 PLUMMER JENAY 2022220 9999999 B 10 1972230886 0 14840 SHEPARD DR DOLTON IL 604192467 20 1972230886 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972232536 0 GRIFFON REBECCA 2022185 9999999 B 10 1972232536 0 1 MEMORIAL DR ALTON IL 620026722 20 1972232536 0 Physicians Anesthesia Services 20 1972232536 0 Physicians Fluoride varnish 20 1972232536 0 Physicians Healthy Kids Services 20 1972232536 0 Physicians Optical Supplies 20 1972232536 0 Physicians Physician Services 00 1972232684 0 FINCH JANIECIA 2022363 9999999 B 10 1972232684 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1972232684 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972232775 0 SHAW COURTNEY 2024080 9999999 B 10 1972232775 0 200 HAWKINS DR IOWA CITY IA 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Services 00 1972234292 0 BENTEL KATELYN 2024325 9999999 B 10 1972234292 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1972234292 0 Clinical Social Worker Social work service 00 1972235216 0 RIOS-FALCON ANDREA 2022216 9999999 B 10 1972235216 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1972235216 0 Physicians Anesthesia Services 20 1972235216 0 Physicians Fluoride varnish 20 1972235216 0 Physicians Healthy Kids Services 20 1972235216 0 Physicians Optical Supplies 20 1972235216 0 Physicians Physician Services 00 1972235299 0 UNANGST SAMANTHA K 2022182 9999999 B 10 1972235299 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1972235299 0 Physicians Anesthesia Services 20 1972235299 0 Physicians Fluoride varnish 20 1972235299 0 Physicians Healthy Kids Services 20 1972235299 0 Physicians Optical Supplies 20 1972235299 0 Physicians Physician Services 00 1972235828 0 CERVANTES ARISDELSI J 2024040 9999999 B 10 1972235828 0 3450 OAKTON ST STE 300 SKOKIE IL 600762951 20 1972235828 0 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Services 00 1972238442 0 SUMRALL RACHEL V 2023167 9999999 B 10 1972238442 0 520 N MARSHFIELD AVE CHICAGO IL 606226731 20 1972238442 0 Clinical Social Worker Social work service 00 1972240323 0 ROBINSON DIAMOND C 2022139 9999999 B 10 1972240323 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1972240323 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972240935 0 ARMES JORDAN 2024190 9999999 B 10 1972240935 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1972240935 0 Physicians Anesthesia Services 20 1972240935 0 Physicians Fluoride varnish 20 1972240935 0 Physicians Healthy Kids Services 20 1972240935 0 Physicians Optical Supplies 20 1972240935 0 Physicians Physician Services 00 1972241362 0 SPELTZ PAIZ REBECCA HELEN 2022229 9999999 B 10 1972241362 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1972241362 0 Physicians Anesthesia Services 20 1972241362 0 Physicians Healthy Kids Services 20 1972241362 0 Physicians Optical Supplies 20 1972241362 0 Physicians Physician Services 00 1972242188 0 CORONA EMILY A 2022192 9999999 B 10 1972242188 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1972242188 0 Nurse Practitioners Healthy Kids Services 20 1972242188 0 Nurse Practitioners Nurse Practitioners Services 20 1972242188 0 Nurse Practitioners Physician Services 00 1972242535 0 ZAIDI AJLAL 2022186 9999999 B 10 1972242535 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1972242535 0 Physicians Anesthesia Services 20 1972242535 0 Physicians Fluoride varnish 20 1972242535 0 Physicians Healthy Kids Services 20 1972242535 0 Physicians Optical Supplies 20 1972242535 0 Physicians Physician Services 00 1972243566 0 BOXLEY PETER J 2022276 9999999 B 10 1972243566 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1972243566 0 Physicians Anesthesia Services 20 1972243566 0 Physicians Fluoride varnish 20 1972243566 0 Physicians Healthy Kids Services 20 1972243566 0 Physicians Optical Supplies 20 1972243566 0 Physicians Physician Services 00 1972243798 0 WILLIFORD TYLER 2022180 9999999 B 10 1972243798 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1972243798 0 Physicians Anesthesia Services 20 1972243798 0 Physicians Fluoride varnish 20 1972243798 0 Physicians Healthy Kids Services 20 1972243798 0 Physicians Optical Supplies 20 1972243798 0 Physicians Physician Services 00 1972243939 0 WOO SHARON 2023289 9999999 B 10 1972243939 0 355 E ERIE ST CHICAGO IL 606113167 20 1972243939 0 Physicians Anesthesia Services 20 1972243939 0 Physicians Healthy Kids Services 20 1972243939 0 Physicians Optical Supplies 20 1972243939 0 Physicians Physician Services 00 1972244077 0 KALRA SUANGNA 2023114 9999999 B 10 1972244077 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1972244077 0 Clinical Social Worker Social work service 00 1972244481 0 WAYHART KATHRYN 2023136 9999999 B 10 1972244481 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1972244481 0 Occupational Therapists Medical Supplies 20 1972244481 0 Occupational Therapists Medical equipment/prosthetic devices 20 1972244481 0 Occupational Therapists Occupational Therapy Services 00 1972244952 0 BOSTOROS PETER AS 2022276 9999999 B 10 1972244952 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1972244952 0 Physicians Anesthesia Services 20 1972244952 0 Physicians Fluoride varnish 20 1972244952 0 Physicians Healthy Kids Services 20 1972244952 0 Physicians Optical Supplies 20 1972244952 0 Physicians Physician Services 00 1972245835 0 NORTEY JEREMY 2023174 9999999 B 10 1972245835 0 4698 DEPT CAROL STREAM IL 601220021 20 1972245835 0 Physicians Anesthesia Services 20 1972245835 0 Physicians Healthy Kids Services 20 1972245835 0 Physicians Optical Supplies 20 1972245835 0 Physicians Physician Services 00 1972245868 0 GARCIA SEBASTIAN 2022129 9999999 B 10 1972245868 0 902 W MAIN ST WEST FRANKFORT IL 628962210 20 1972245868 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972245884 0 AMONOO LESLIE A 2022195 9999999 B 10 1972245884 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1972245884 0 Physicians Anesthesia Services 20 1972245884 0 Physicians Fluoride varnish 20 1972245884 0 Physicians Healthy Kids Services 20 1972245884 0 Physicians Optical Supplies 20 1972245884 0 Physicians Physician Services 00 1972246197 0 BALKA ABIGAIL H 2022126 9999999 B 10 1972246197 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1972246197 0 Nurse Practitioners Fluoride varnish 20 1972246197 0 Nurse Practitioners Healthy Kids Services 20 1972246197 0 Nurse Practitioners Nurse Practitioners Services 20 1972246197 0 Nurse Practitioners Physician Services 00 1972246221 0 USTRZYNSKI ANNA 2022201 9999999 B 10 1972246221 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1972246221 0 Nurse Practitioners Healthy Kids Services 20 1972246221 0 Nurse Practitioners Nurse Practitioners Services 20 1972246221 0 Nurse Practitioners Physician Services 00 1972246486 0 TRY CASEY J 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1972248524 0 DESHPANDE NIKITA 2022178 9999999 B 10 1972248524 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1972248524 0 Physicians Anesthesia Services 20 1972248524 0 Physicians Fluoride varnish 20 1972248524 0 Physicians Healthy Kids Services 20 1972248524 0 Physicians Optical Supplies 20 1972248524 0 Physicians Physician Services 00 1972249548 0 BLOOMBERG ZACHARY 2022177 9999999 B 10 1972249548 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1972249548 0 Physicians Anesthesia Services 20 1972249548 0 Physicians Healthy Kids Services 20 1972249548 0 Physicians Optical Supplies 20 1972249548 0 Physicians Physician Services 20 1972249548 0 Physicians Physicians Psychiatric Services 00 1972250660 0 ERVIN KYLIE R 2023244 9999999 B 10 1972250660 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1972250660 0 Nurse Practitioners Fluoride varnish 20 1972250660 0 Nurse Practitioners Healthy Kids Services 20 1972250660 0 Nurse Practitioners Nurse Practitioners Services 20 1972250660 0 Nurse Practitioners Physician Services 00 1972250959 0 MARKELL RACHEL OLIVIA 2022182 9999999 B 10 1972250959 0 5777 DEPT CAROL STREAM IL 601220021 20 1972250959 0 Physician Assistant Only Fluoride varnish 20 1972250959 0 Physician Assistant Only Healthy Kids Services 20 1972250959 0 Physician Assistant Only Physician Services 00 1972252278 0 FAROOQUI ZUBAIR Z 2022207 9999999 B 10 1972252278 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1972252278 0 Physicians Anesthesia Services 20 1972252278 0 Physicians Fluoride varnish 20 1972252278 0 Physicians Healthy Kids Services 20 1972252278 0 Physicians Optical Supplies 20 1972252278 0 Physicians Physician Services 00 1972252484 0 O''NEILL CAROLYN M 2024072 9999999 B 10 1972252484 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1972252484 0 Physicians Anesthesia Services 20 1972252484 0 Physicians Healthy Kids Services 20 1972252484 0 Physicians Optical Supplies 20 1972252484 0 Physicians Physician Services 00 1972252872 0 ALTOMARE NICOLE 2022171 9999999 B 10 1972252872 0 4698 DEPT CAROL STREAM IL 601220021 20 1972252872 0 Physicians Anesthesia Services 20 1972252872 0 Physicians Fluoride varnish 20 1972252872 0 Physicians Healthy Kids Services 20 1972252872 0 Physicians Optical Supplies 20 1972252872 0 Physicians Physician Services 00 1972252963 0 RUDY VANESSA 2022118 9999999 B 10 1972252963 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1972252963 0 Speech Therapists Medical Supplies 20 1972252963 0 Speech Therapists Medical equipment/prosthetic devices 20 1972252963 0 Speech Therapists Speech Therapy/Pathology Services 00 1972253722 0 O'CONNOR CHRISTOPHER BROWNE 2022208 9999999 B 10 1972253722 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1972253722 0 Physicians Anesthesia Services 20 1972253722 0 Physicians Fluoride varnish 20 1972253722 0 Physicians Healthy Kids Services 20 1972253722 0 Physicians Optical Supplies 20 1972253722 0 Physicians Physician Services 00 1972254407 0 BURCHETTE LAUREN 2022332 9999999 B 10 1972254407 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1972254407 0 Nurse Practitioners Fluoride varnish 20 1972254407 0 Nurse Practitioners Healthy Kids Services 20 1972254407 0 Nurse Practitioners Nurse Practitioners Services 20 1972254407 0 Nurse Practitioners Physician Services 00 1972256394 0 BRAND-PADILLA KYLE B 2024270 9999999 B 10 1972256394 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1972256394 0 Clinical Social Worker Social work service 00 1972257681 0 BOGARD MAKAYLA B 2023159 9999999 B 10 1972257681 0 800 E LOCUST ST OLNEY IL 624502553 20 1972257681 0 Nurse Practitioners Healthy Kids Services 20 1972257681 0 Nurse Practitioners Nurse Practitioners Services 20 1972257681 0 Nurse Practitioners Physician Services 00 1972258325 0 SOTELO ERIKA 2022055 9999999 B 10 1972258325 0 120 W 22ND ST OAK BROOK IL 605231557 20 1972258325 0 Nurse Practitioners Fluoride varnish 20 1972258325 0 Nurse Practitioners Healthy Kids Services 20 1972258325 0 Nurse Practitioners Nurse Practitioners Services 20 1972258325 0 Nurse Practitioners Physician Services 00 1972258432 0 GOUNTOUNAS SYDNEY 2022241 9999999 B 10 1972258432 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1972258432 0 Physician Assistant Only Fluoride varnish 20 1972258432 0 Physician Assistant Only Healthy Kids Services 20 1972258432 0 Physician Assistant Only Physician Services 00 1972259968 0 WARNER ANDREA L 2022097 9999999 B 10 1972259968 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1972259968 0 Nurse Practitioners Fluoride varnish 20 1972259968 0 Nurse Practitioners Healthy Kids Services 20 1972259968 0 Nurse Practitioners Nurse Practitioners Services 20 1972259968 0 Nurse Practitioners Physician Services 00 1972260727 0 HARTWIG-MULLALLY CORINNA 2022046 9999999 B 10 1972260727 0 PO BOX 73488 PUYALLUP WA 983730488 20 1972260727 0 Nurse Practitioners Fluoride varnish 20 1972260727 0 Nurse Practitioners Healthy Kids Services 20 1972260727 0 Nurse Practitioners Nurse Practitioners Services 20 1972260727 0 Nurse Practitioners Physician Services 00 1972263432 0 VALENTINO DANIELLE L 2024085 9999999 B 10 1972263432 0 17517 80TH AVE STE D TINLEY PARK IL 604776502 20 1972263432 0 Other behavior health professional LCPC/LMFT services 20 1972263432 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972265635 0 PARKS LEAH 2021340 9999999 B 10 1972265635 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1972265635 0 Nurse Practitioners Anesthesia Services 20 1972265635 0 Nurse Practitioners Nurse Practitioners Services 20 1972265635 0 Nurse Practitioners Physician Services 00 1972265924 0 REMACLE COURTNEY 2024009 9999999 B 10 1972265924 0 7284 SKYLINE DR JUSTICE IL 604581173 20 1972265924 0 Clinical Social Worker Social work service 00 1972267656 0 MCCLOSKEY CHARLES J 2024214 9999999 B 10 1972267656 0 15740 S OUTER 40 RD CHESTERFIELD MO 630172004 20 1972267656 0 Nurse Practitioners Fluoride varnish 20 1972267656 0 Nurse Practitioners Healthy Kids Services 20 1972267656 0 Nurse Practitioners Nurse Practitioners Services 20 1972267656 0 Nurse Practitioners Physician Services 00 1972268357 0 HEFFNER ERIN 2022042 9999999 B 10 1972268357 0 PO BOX 781076 DETROIT MI 482781076 20 1972268357 0 Nurse Practitioners Healthy Kids Services 20 1972268357 0 Nurse Practitioners Nurse Practitioners Services 20 1972268357 0 Nurse Practitioners Physician Services 00 1972269181 0 PETERS STEPHANIE 2022011 9999999 B 10 1972269181 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1972269181 0 Nurse Practitioners Fluoride varnish 20 1972269181 0 Nurse Practitioners Healthy Kids Services 20 1972269181 0 Nurse Practitioners Nurse Practitioners Services 20 1972269181 0 Nurse Practitioners Physician Services 00 1972269488 0 NICKLES COURTNEY R 2021322 9999999 B 10 1972269488 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1972269488 0 Nurse Practitioners Fluoride varnish 20 1972269488 0 Nurse Practitioners Healthy Kids Services 20 1972269488 0 Nurse Practitioners Nurse Practitioners Services 20 1972269488 0 Nurse Practitioners Physician Services 00 1972270270 0 KOSROW MEGAN D 2021315 9999999 B 10 1972270270 0 PO BOX 5588 BELFAST ME 049155500 20 1972270270 0 Nurse Practitioners Fluoride varnish 20 1972270270 0 Nurse Practitioners Healthy Kids Services 20 1972270270 0 Nurse Practitioners Nurse Practitioners Services 20 1972270270 0 Nurse Practitioners Physician Services 00 1972270361 0 RODRIGUEZ SELINA 2021279 9999999 B 10 1972270361 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1972270361 0 Nurse Practitioners Fluoride varnish 20 1972270361 0 Nurse Practitioners Healthy Kids Services 20 1972270361 0 Nurse Practitioners Nurse Practitioners Services 20 1972270361 0 Nurse Practitioners Physician Services 00 1972272193 0 HOFFMAN MARY 2022038 9999999 H 10 1972272193 0 125 WINDSOR DR STE 111 OAK BROOK IL 605234081 20 1972272193 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972272466 0 LASKY HANNAH 2024204 9999999 B 10 1972272466 0 5777 DEPT CAROL STREAM IL 601220021 20 1972272466 0 Physical Therapists Medical Supplies 20 1972272466 0 Physical Therapists Medical equipment/prosthetic devices 20 1972272466 0 Physical Therapists Physical Therapy Services 00 1972273118 0 ELY KRISTEN 2022306 9999999 B 10 1972273118 0 PO BOX 778912 CHICAGO IL 606778912 20 1972273118 0 Nurse Practitioners Fluoride varnish 20 1972273118 0 Nurse Practitioners Healthy Kids Services 20 1972273118 0 Nurse Practitioners Nurse Practitioners Services 20 1972273118 0 Nurse Practitioners Physician Services 00 1972273548 0 PRESSLEY-WILLIAMS BRANDON 2024334 9999999 B 10 1972273548 0 1602 W COLONIAL PKWY STE 200 INVERNESS IL 600671215 20 1972273548 0 Nurse Practitioners Healthy Kids Services 20 1972273548 0 Nurse Practitioners Nurse Practitioners Services 20 1972273548 0 Nurse Practitioners Physician Services 00 1972274140 0 CHLON EWELINA 2022109 9999999 H 10 1972274140 0 1979 N MILL ST STE 202 NAPERVILLE IL 605638472 20 1972274140 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972274231 0 DURMUS MUHAMMED 2024290 9999999 B 10 1972274231 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1972274231 0 Physicians Anesthesia Services 20 1972274231 0 Physicians Fluoride varnish 20 1972274231 0 Physicians Healthy Kids Services 20 1972274231 0 Physicians Optical Supplies 20 1972274231 0 Physicians Physician Services 00 1972275808 0 RIVERA ANGELO A 2021274 9999999 B 10 1972275808 0 42 W MADISON ST FL 2 CHICAGO IL 606024309 20 1972275808 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1972276640 0 PATEL ROSHNI T 2022291 9999999 B 10 1972276640 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1972276640 0 Physician Assistant Only Fluoride varnish 20 1972276640 0 Physician Assistant Only Healthy Kids Services 20 1972276640 0 Physician Assistant Only Physician Services 00 1972277929 0 SURBEK STJEPAN 2021275 9999999 B 10 1972277929 0 1000 REMINGTON BLVD STE 110 BOLINGBROOK IL 604404708 20 1972277929 0 Physicians Anesthesia Services 20 1972277929 0 Physicians Fluoride varnish 20 1972277929 0 Physicians Healthy Kids Services 20 1972277929 0 Physicians Optical Supplies 20 1972277929 0 Physicians Physician Services 00 1972278620 0 HARRIGAN LINDSEY 2021259 9999999 B 10 1972278620 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1972278620 0 Nurse Practitioners Healthy Kids Services 20 1972278620 0 Nurse Practitioners Nurse Practitioners Services 20 1972278620 0 Nurse Practitioners Physician Services 00 1972278794 0 COOK AMY 2024058 9999999 B 10 1972278794 0 1201 PINE ST ELDORADO IL 629301634 20 1972278794 0 Nurse Practitioners Anesthesia Services 20 1972278794 0 Nurse Practitioners Nurse Practitioners Services 20 1972278794 0 Nurse Practitioners Physician Services 00 1972279768 0 BALDRIDGE EMILY 2025034 9999999 B 10 1972279768 0 10760 W 143RD ST STE 65 ORLAND PARK IL 604621918 20 1972279768 0 Nurse Practitioners Healthy Kids Services 20 1972279768 0 Nurse Practitioners Midwife Services 20 1972279768 0 Nurse Practitioners Nurse Practitioners Services 20 1972279768 0 Nurse Practitioners Physician Services 00 1972281004 0 SHERPA NINDA T 2023249 9999999 B 10 1972281004 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1972281004 0 Physicians Anesthesia Services 20 1972281004 0 Physicians Fluoride varnish 20 1972281004 0 Physicians Healthy Kids Services 20 1972281004 0 Physicians Optical Supplies 20 1972281004 0 Physicians Physician Services 00 1972281293 0 JACKSON JAMIA M 2023205 9999999 B 10 1972281293 0 414 PLAZA DR STE 301 WESTMONT IL 605595508 20 1972281293 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972283406 0 YEAGER TAMI 2025043 9999999 B 10 1972283406 0 405 CENTRAL AVE NORTHFIELD IL 600933006 20 1972283406 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972284164 0 RICH REBECCA 2023240 9999999 B 10 1972284164 0 4939 W FULLERTON AVE CHICAGO IL 606392505 20 1972284164 0 Clinical Social Worker Social work service 00 1972286482 0 PAVUR CYNTHIA L 2023250 9999999 B 10 1972286482 0 400 N HIGHLAND AVE AURORA IL 605063814 20 1972286482 0 Nurse Practitioners Fluoride varnish 20 1972286482 0 Nurse Practitioners Healthy Kids Services 20 1972286482 0 Nurse Practitioners Nurse Practitioners Services 20 1972286482 0 Nurse Practitioners Physician Services 00 1972287035 0 KUPTY AMIRA 2023237 9999999 B 10 1972287035 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1972287035 0 Physicians Anesthesia Services 20 1972287035 0 Physicians Healthy Kids Services 20 1972287035 0 Physicians Optical Supplies 20 1972287035 0 Physicians Physician Services 20 1972287035 0 Physicians Physicians Psychiatric Services 00 1972287480 0 WILSON ALIYAH 2023249 9999999 B 10 1972287480 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1972287480 0 Dentists Dental Services 20 1972287480 0 Dentists Physician Services 00 1972287910 0 MONTENEGRO DANIELA E 2023286 9999999 B 10 1972287910 0 1900 W POLK ST STE 220C CHICAGO IL 606123723 20 1972287910 0 Physicians Anesthesia Services 20 1972287910 0 Physicians Fluoride varnish 20 1972287910 0 Physicians Healthy Kids Services 20 1972287910 0 Physicians Optical Supplies 20 1972287910 0 Physicians Physician Services 00 1972288116 0 JANSSEN AMANDA J 2024261 9999999 B 10 1972288116 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1972288116 0 Nurse Practitioners Anesthesia Services 20 1972288116 0 Nurse Practitioners Nurse Practitioners Services 20 1972288116 0 Nurse Practitioners Physician Services 00 1972288272 0 MCDOWELL JANET LYNN 2023167 9999999 B 10 1972288272 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1972288272 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972288785 0 TRANCHINA EMILY 2023204 9999999 B 10 1972288785 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1972288785 0 Physicians Anesthesia Services 20 1972288785 0 Physicians Fluoride varnish 20 1972288785 0 Physicians Healthy Kids Services 20 1972288785 0 Physicians Optical Supplies 20 1972288785 0 Physicians Physician Services 00 1972288876 0 BEARD ASHLEY 2023192 9999999 B 10 1972288876 0 11401 BLUEGRASS PKWY LOUISVILLE KY 402992349 20 1972288876 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972288900 0 WANG EMILY Z 2023212 9999999 B 10 1972288900 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1972288900 0 Physicians Anesthesia Services 20 1972288900 0 Physicians Healthy Kids Services 20 1972288900 0 Physicians Optical Supplies 20 1972288900 0 Physicians Physician Services 20 1972288900 0 Physicians Physicians Psychiatric Services 00 1972290369 0 KALSBEEK ALYSSA 2024189 9999999 B 10 1972290369 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1972290369 0 Physicians Anesthesia Services 20 1972290369 0 Physicians Fluoride varnish 20 1972290369 0 Physicians Healthy Kids Services 20 1972290369 0 Physicians Optical Supplies 20 1972290369 0 Physicians Physician Services 00 1972290591 0 BONTZ SYDNEY 2023200 9999999 B 10 1972290591 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1972290591 0 Nurse Practitioners Anesthesia Services 20 1972290591 0 Nurse Practitioners Nurse Practitioners Services 20 1972290591 0 Nurse Practitioners Physician Services 00 1972290823 0 KACHAR CAMILLA 2023193 9999999 B 10 1972290823 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1972290823 0 Physicians Anesthesia Services 20 1972290823 0 Physicians Healthy Kids Services 20 1972290823 0 Physicians Optical Supplies 20 1972290823 0 Physicians Physician Services 00 1972291508 0 CAO DAVID 2023215 9999999 B 10 1972291508 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1972291508 0 Physicians Anesthesia Services 20 1972291508 0 Physicians Fluoride varnish 20 1972291508 0 Physicians Healthy Kids Services 20 1972291508 0 Physicians Optical Supplies 20 1972291508 0 Physicians Physician Services 00 1972293363 0 KAUR SAHIBNOOR 2024183 9999999 B 10 1972293363 0 PO BOX 3039 OAK BROOK IL 605223039 20 1972293363 0 Physicians Anesthesia Services 20 1972293363 0 Physicians Fluoride varnish 20 1972293363 0 Physicians Healthy Kids Services 20 1972293363 0 Physicians Optical Supplies 20 1972293363 0 Physicians Physician Services 00 1972293488 0 PHILLIPS JAREN 2023187 9999999 B 10 1972293488 0 611 W PARK ST URBANA IL 618012529 20 1972293488 0 Physicians Anesthesia Services 20 1972293488 0 Physicians Healthy Kids Services 20 1972293488 0 Physicians Optical Supplies 20 1972293488 0 Physicians Physician Services 00 1972293892 0 MCKEE MAYA NICOLE 2023189 9999999 B 10 1972293892 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1972293892 0 Physicians Anesthesia Services 20 1972293892 0 Physicians Fluoride varnish 20 1972293892 0 Physicians Healthy Kids Services 20 1972293892 0 Physicians Optical Supplies 20 1972293892 0 Physicians Physician Services 00 1972294254 0 MCFARLAND MARY 2023143 9999999 B 10 1972294254 0 2570 FOXFIELD RD STE 101 SAINT CHARLES IL 601741406 20 1972294254 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972294627 0 CLARK KATHRYN 2023230 9999999 B 10 1972294627 0 4714 GETTYSBURG RD MECHANICSBURG PA 170554325 20 1972294627 0 Nurse Practitioners Medical Supplies 20 1972294627 0 Nurse Practitioners Medical equipment/prosthetic devices 20 1972294627 0 Nurse Practitioners Speech Therapy/Pathology Services 00 1972295616 0 ROETTGER LINDSAY 2023144 9999999 B 10 1972295616 0 2348 POST RD STE 107 WARWICK RI 028862271 20 1972295616 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972296010 0 UDABOR ANITA O 2023187 9999999 B 10 1972296010 0 5145 N CALIFORNIA AVE CHICAGO IL 606253661 20 1972296010 0 Physicians Anesthesia Services 20 1972296010 0 Physicians Fluoride varnish 20 1972296010 0 Physicians Healthy Kids Services 20 1972296010 0 Physicians Optical Supplies 20 1972296010 0 Physicians Physician Services 00 1972298248 0 PETRAITIS ANNA K 2024236 9999999 B 10 1972298248 0 9760 SORENG AVE SCHILLER PARK IL 601762105 20 1972298248 0 Occupational Therapists Medical Supplies 20 1972298248 0 Occupational Therapists Medical equipment/prosthetic devices 20 1972298248 0 Occupational Therapists Occupational Therapy Services 00 1972298529 0 BALAPORIA RITA 2023100 9999999 B 10 1972298529 0 42 W MADISON ST FL 2 CHICAGO IL 606024309 20 1972298529 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1972299675 0 SZARZYNSKI KYLE 2023199 9999999 B 10 1972299675 0 20201 CRAWFORD AVE OLYMPIA FIELDS IL 604611010 20 1972299675 0 Physicians Anesthesia Services 20 1972299675 0 Physicians Fluoride varnish 20 1972299675 0 Physicians Healthy Kids Services 20 1972299675 0 Physicians Optical Supplies 20 1972299675 0 Physicians Physician Services 00 1972299790 0 DITSCH EMILY 2023227 9999999 B 10 1972299790 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1972299790 0 Physical Therapists Medical Supplies 20 1972299790 0 Physical Therapists Medical equipment/prosthetic devices 20 1972299790 0 Physical Therapists Physical Therapy Services 00 1972311603 0 WATSON ALICIA 2024362 9999999 B 10 1972311603 0 PO BOX 1109 DEKALB IL 601157109 20 1972311603 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972313187 0 DEGROOT QUINLAN 2025029 9999999 B 10 1972313187 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1972313187 0 Nurse Practitioners Fluoride varnish 20 1972313187 0 Nurse Practitioners Healthy Kids Services 20 1972313187 0 Nurse Practitioners Nurse Practitioners Services 20 1972313187 0 Nurse Practitioners Physician Services 00 1972321164 0 PAULEY JENNY R 2024337 9999999 B 10 1972321164 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1972321164 0 Nurse Practitioners Healthy Kids Services 20 1972321164 0 Nurse Practitioners Nurse Practitioners Services 20 1972321164 0 Nurse Practitioners Physician Services 00 1972323079 0 EMRICH LINDSEY 2024302 9999999 B 10 1972323079 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1972323079 0 Nurse Practitioners Fluoride varnish 20 1972323079 0 Nurse Practitioners Healthy Kids Services 20 1972323079 0 Nurse Practitioners Nurse Practitioners Services 20 1972323079 0 Nurse Practitioners Physician Services 00 1972323996 0 LOPEZ TIFFANY 2025009 9999999 B 10 1972323996 0 901 MACARTHUR BLVD MUNSTER IN 463212901 20 1972323996 0 Nurse Practitioners Fluoride varnish 20 1972323996 0 Nurse Practitioners Healthy Kids Services 20 1972323996 0 Nurse Practitioners Nurse Practitioners Services 20 1972323996 0 Nurse Practitioners Physician Services 00 1972324614 0 KEIM KAITLYN 2024339 9999999 B 10 1972324614 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1972324614 0 Nurse Practitioners Healthy Kids Services 20 1972324614 0 Nurse Practitioners Nurse Practitioners Services 20 1972324614 0 Nurse Practitioners Physician Services 00 1972325942 0 PIGUING WILORE ANNE A 2024354 9999999 B 10 1972325942 0 5777 DEPT CAROL STREAM IL 601220021 20 1972325942 0 Physical Therapists Medical Supplies 20 1972325942 0 Physical Therapists Medical equipment/prosthetic devices 20 1972325942 0 Physical Therapists Physical Therapy Services 00 1972328516 0 SALGADO JESSICA 2025042 9999999 B 10 1972328516 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1972328516 0 Nurse Practitioners Fluoride varnish 20 1972328516 0 Nurse Practitioners Healthy Kids Services 20 1972328516 0 Nurse Practitioners Nurse Practitioners Services 20 1972328516 0 Nurse Practitioners Physician Services 00 1972331023 0 PLASABAS LADY 2024247 9999999 B 10 1972331023 0 100 W CHICAGO AVE STE F EAST CHICAGO IN 463123261 20 1972331023 0 Nurse Practitioners Healthy Kids Services 20 1972331023 0 Nurse Practitioners Nurse Practitioners Services 20 1972331023 0 Nurse Practitioners Physician Services 00 1972333482 0 JEGLUM LEAH M 2024270 9999999 B 10 1972333482 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1972333482 0 Nurse Practitioners Fluoride varnish 20 1972333482 0 Nurse Practitioners Healthy Kids Services 20 1972333482 0 Nurse Practitioners Nurse Practitioners Services 20 1972333482 0 Nurse Practitioners Physician Services 00 1972333516 0 RAWLINS JESSIE 2024222 9999999 B 10 1972333516 0 6303 BLUE LAGOON DR STE 400 MIAMI FL 331266040 20 1972333516 0 Other behavior health professional Adaptive behavior support technician services 20 1972333516 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972334076 0 JOSEPH CHRISTINA 2024344 9999999 B 10 1972334076 0 5777 DEPT CAROL STREAM IL 601220021 20 1972334076 0 Physician Assistant Only Fluoride varnish 20 1972334076 0 Physician Assistant Only Healthy Kids Services 20 1972334076 0 Physician Assistant Only Physician Services 00 1972336543 0 HAYASHI YURI 2024251 9999999 B 10 1972336543 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1972336543 0 Physicians Anesthesia Services 20 1972336543 0 Physicians Healthy Kids Services 20 1972336543 0 Physicians Optical Supplies 20 1972336543 0 Physicians Physician Services 00 1972338267 0 ROCHE ALLYSON 2024267 9999999 B 10 1972338267 0 PO BOX 3990 NAPERVILLE IL 605673990 20 1972338267 0 Speech Therapists Medical Supplies 20 1972338267 0 Speech Therapists Medical equipment/prosthetic devices 20 1972338267 0 Speech Therapists Speech Therapy/Pathology Services 00 1972341204 0 MORSON CHRISZELLA 2025022 9999999 B 10 1972341204 0 854 TECHNOLOGY WAY LIBERTYVILLE IL 600485350 20 1972341204 0 Other behavior health professional Adaptive behavior support clinician services 20 1972341204 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972342491 0 HUSER SARA V 2024176 9999999 B 10 1972342491 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1972342491 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972345304 0 LINDVALL TYLER 2024191 9999999 B 10 1972345304 0 611 W PARK ST URBANA IL 618012529 20 1972345304 0 Physicians Anesthesia Services 20 1972345304 0 Physicians Healthy Kids Services 20 1972345304 0 Physicians Optical Supplies 20 1972345304 0 Physicians Physician Services 00 1972346112 0 BERTOY LAUREN J 2024175 9999999 B 10 1972346112 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1972346112 0 Physicians Anesthesia Services 20 1972346112 0 Physicians Healthy Kids Services 20 1972346112 0 Physicians Optical Supplies 20 1972346112 0 Physicians Physician Services 00 1972346260 0 LIRETTE BRENNAN 2024191 9999999 B 10 1972346260 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1972346260 0 Podiatrists Podiatric Services 00 1972346484 0 BARAJAS GRACE 2024172 9999999 B 10 1972346484 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1972346484 0 Registered nurse Nursing service 20 1972346484 0 Registered nurse Waiver service 00 1972346674 0 SILVA DIEGO B 2024204 9999999 B 10 1972346674 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1972346674 0 Physicians Anesthesia Services 20 1972346674 0 Physicians Fluoride varnish 20 1972346674 0 Physicians Healthy Kids Services 20 1972346674 0 Physicians Optical Supplies 20 1972346674 0 Physicians Physician Services 00 1972346724 0 MITRUKA DEV 2024191 9999999 B 10 1972346724 0 PO BOX 775257 CHICAGO IL 606775257 20 1972346724 0 Physicians Anesthesia Services 20 1972346724 0 Physicians Fluoride varnish 20 1972346724 0 Physicians Healthy Kids Services 20 1972346724 0 Physicians Optical Supplies 20 1972346724 0 Physicians Physician Services 00 1972347250 0 GILJA SHIVEE 2024177 9999999 B 10 1972347250 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1972347250 0 Physicians Anesthesia Services 20 1972347250 0 Physicians Healthy Kids Services 20 1972347250 0 Physicians Optical Supplies 20 1972347250 0 Physicians Physician Services 00 1972348571 0 GRBA MARIA 2024191 9999999 B 10 1972348571 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1972348571 0 Physicians Anesthesia Services 20 1972348571 0 Physicians Fluoride varnish 20 1972348571 0 Physicians Healthy Kids Services 20 1972348571 0 Physicians Optical Supplies 20 1972348571 0 Physicians Physician Services 00 1972351989 0 KRASNOV PIYANAN 2024304 9999999 B 10 1972351989 0 2003 W FULTON ST STE 303 CHICAGO IL 606122345 20 1972351989 0 Nurse Practitioners Healthy Kids Services 20 1972351989 0 Nurse Practitioners Nurse Practitioners Services 20 1972351989 0 Nurse Practitioners Physician Services 00 1972353142 0 KALINICH TYLER 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Physician Services 00 1972566156 0 LI JUNPING 2017030 9999999 B 10 1972566156 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1972566156 0 Physicians Anesthesia Services 20 1972566156 0 Physicians Healthy Kids Services 20 1972566156 0 Physicians Optical Supplies 20 1972566156 0 Physicians Physician Services 00 1972566388 0 CORDER PATRICIA G 2001178 9999999 B 10 1972566388 0 11475 OLDE CABIN RD STE 200 SAINT LOUIS MO 631417129 20 1972566388 0 Physicians Anesthesia Services 20 1972566388 0 Physicians Healthy Kids Services 20 1972566388 0 Physicians Optical Supplies 20 1972566388 0 Physicians Physician Services 00 1972567527 0 RUDIN NATHAN J 2001001 9999999 B 10 1972567527 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1972567527 0 Physicians Anesthesia Services 20 1972567527 0 Physicians Healthy Kids Services 20 1972567527 0 Physicians Optical Supplies 20 1972567527 0 Physicians Physician Services 00 1972568269 0 LOCONTE NOELLE K 2006182 9999999 B 10 1972568269 0 7974 UW HEALTH 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1972569754 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1972569754 0 Physicians Anesthesia Services 20 1972569754 0 Physicians Healthy Kids Services 20 1972569754 0 Physicians Optical Supplies 20 1972569754 0 Physicians Physician Services 00 1972570083 0 WISEMAN KIMBERLY S 2014091 9999999 B 10 1972570083 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1972570083 0 Nurse Practitioners Healthy Kids Services 20 1972570083 0 Nurse Practitioners Midwife Services 20 1972570083 0 Nurse Practitioners Nurse Practitioners Services 20 1972570083 0 Nurse Practitioners Physician Services 00 1972570596 0 BAILEY MIKAL 2021237 9999999 B 10 1972570596 0 2605 KENTUCKY AVE STE 306 SUITE 306 PADUCAH KY 420033802 20 1972570596 0 Physician Assistant Only Fluoride varnish 20 1972570596 0 Physician Assistant Only Healthy Kids Services 20 1972570596 0 Physician Assistant Only Physician Services 00 1972570786 0 WELLS JAMA R 2018165 9999999 B 10 1972570786 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1972570786 0 Physician Assistant Only Fluoride varnish 20 1972570786 0 Physician Assistant Only Healthy Kids Services 20 1972570786 0 Physician Assistant Only Physician Services 00 1972572113 0 HIRSCH LARRY 1981227 9999999 B 10 1972572113 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1972572113 0 Physicians Anesthesia Services 20 1972572113 0 Physicians Fluoride varnish 20 1972572113 0 Physicians Healthy Kids Services 20 1972572113 0 Physicians Optical Supplies 20 1972572113 0 Physicians Physician Services 00 1972572139 0 ALEXANDER TODD 1996183 9999999 B 10 1972572139 0 4701 DEPT CAROL STREAM IL 601220021 20 1972572139 0 Physicians Anesthesia Services 20 1972572139 0 Physicians Healthy Kids Services 20 1972572139 0 Physicians Optical Supplies 20 1972572139 0 Physicians Physician Services 00 1972572360 0 POLLACK JONATHAN 2004197 9999999 B 10 1972572360 0 500 PORTER AVE AURORA MO 656052365 20 1972572360 0 Physicians Anesthesia Services 20 1972572360 0 Physicians Healthy Kids 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1972574986 0 Physicians Physician Services 00 1972575025 0 MILLER SUZANNE L 2017003 9999999 B 10 1972575025 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1972575025 0 Physicians Anesthesia Services 20 1972575025 0 Physicians Fluoride varnish 20 1972575025 0 Physicians Healthy Kids Services 20 1972575025 0 Physicians Optical Supplies 20 1972575025 0 Physicians Physician Services 00 1972575157 0 FLEMING SARA 1998182 9999999 B 10 1972575157 0 PO BOX 857 FREEPORT IL 610320857 20 1972575157 0 Physicians Anesthesia Services 20 1972575157 0 Physicians Healthy Kids Services 20 1972575157 0 Physicians Optical Supplies 20 1972575157 0 Physicians Physician Services 00 1972576833 0 MCGEE EDWIN 2004194 9999999 B 10 1972576833 0 2160 S 1ST AVE MAYWOOD IL 601533328 20 1972576833 0 Physicians Anesthesia Services 20 1972576833 0 Physicians Healthy Kids Services 20 1972576833 0 Physicians Optical Supplies 20 1972576833 0 Physicians Physician Services 00 1972576890 0 MYLA 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1972580843 0 Physicians Anesthesia Services 20 1972580843 0 Physicians Fluoride varnish 20 1972580843 0 Physicians Healthy Kids Services 20 1972580843 0 Physicians Optical Supplies 20 1972580843 0 Physicians Physician Services 00 1972580991 0 MCCOMBS RICK J 1995199 9999999 B 10 1972580991 0 2605 KENTUCKY AVE STE 306 PADUCAH KY 420033802 20 1972580991 0 Physicians Anesthesia Services 20 1972580991 0 Physicians Fluoride varnish 20 1972580991 0 Physicians Healthy Kids Services 20 1972580991 0 Physicians Optical Supplies 20 1972580991 0 Physicians Physician Services 00 1972582062 0 WOJCIK EVA 1997182 9999999 B 10 1972582062 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1972582062 0 Physicians Anesthesia Services 20 1972582062 0 Physicians Healthy Kids Services 20 1972582062 0 Physicians Optical Supplies 20 1972582062 0 Physicians Physician Services 00 1972582567 0 HEERINGA KENNETH S 2023010 9999999 B 10 1972582567 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1972582567 0 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1972583755 0 Physicians Healthy Kids Services 20 1972583755 0 Physicians Optical Supplies 20 1972583755 0 Physicians Physician Services 00 1972583896 0 GALGON RICHARD E 2011182 9999999 B 10 1972583896 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1972583896 0 Physicians Anesthesia Services 20 1972583896 0 Physicians Healthy Kids Services 20 1972583896 0 Physicians Optical Supplies 20 1972583896 0 Physicians Physician Services 00 1972584381 0 ROBERTS DAVID 2016159 9999999 B 10 1972584381 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1972584381 0 Physicians Anesthesia Services 20 1972584381 0 Physicians Healthy Kids Services 20 1972584381 0 Physicians Optical Supplies 20 1972584381 0 Physicians Physician Services 00 1972584423 0 O'MALLEY TERRI 1997202 9999999 B 10 1972584423 0 5057 SHORELINE RD LAKE BARRINGTON IL 600101700 20 1972584423 0 Physicians Anesthesia Services 20 1972584423 0 Physicians Fluoride varnish 20 1972584423 0 Physicians Healthy Kids Services 20 1972584423 0 Physicians Optical Supplies 20 1972584423 0 Physicians Physician Services 00 1972584464 0 ABRAHAM MALIK 1986233 9999999 B 10 1972584464 0 3030 W SALT CREEK LN STE 100 ARLINGTON HEIGH IL 600055006 20 1972584464 0 Podiatrists Podiatric Services 00 1972585610 0 KHAN TAUSEEF 2004183 9999999 B 10 1972585610 0 350 N GRANDVIEW AVE STE G3300 DUBUQUE IA 520016388 20 1972585610 0 Physicians Anesthesia Services 20 1972585610 0 Physicians Healthy Kids Services 20 1972585610 0 Physicians Optical Supplies 20 1972585610 0 Physicians Physician Services 00 1972585677 0 SANDS DENNIS E 2016293 9999999 B 10 1972585677 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1972585677 0 Physicians Anesthesia Services 20 1972585677 0 Physicians Healthy Kids Services 20 1972585677 0 Physicians Optical Supplies 20 1972585677 0 Physicians Physician Services 00 1972585842 0 MARCUS HOWARD 2004122 9999999 B 10 1972585842 0 100 W CHICAGO AVE STE F EAST CHICAGO IN 463123261 20 1972585842 0 Physicians Anesthesia Services 20 1972585842 0 Physicians Healthy Kids Services 20 1972585842 0 Physicians Optical Supplies 20 1972585842 0 Physicians Physician Services 00 1972586121 0 MOENNING LISA 2018149 9999999 B 10 1972586121 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1972586121 0 Physician Assistant Only Fluoride varnish 20 1972586121 0 Physician Assistant Only Healthy Kids Services 20 1972586121 0 Physician Assistant Only Physician Services 00 1972586253 0 EDWARDS CHARMAINE E 2016270 9999999 B 10 1972586253 0 2100 MADISON AVE STE 301 GRANITE CITY IL 620404713 20 1972586253 0 Physicians Anesthesia Services 20 1972586253 0 Physicians Fluoride varnish 20 1972586253 0 Physicians Healthy Kids Services 20 1972586253 0 Physicians Optical Supplies 20 1972586253 0 Physicians Physician Services 00 1972586303 0 RUSKIN KEITH 2015213 9999999 B 10 1972586303 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1972586303 0 Physicians Anesthesia Services 20 1972586303 0 Physicians Healthy Kids Services 20 1972586303 0 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1972588176 0 PO BOX 28900 GREEN BAY WI 543240900 20 1972588176 0 Physicians Anesthesia Services 20 1972588176 0 Physicians Healthy Kids Services 20 1972588176 0 Physicians Optical Supplies 20 1972588176 0 Physicians Physician Services 00 1972588200 0 METZ RICHARD 2005109 9999999 B 10 1972588200 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1972588200 0 Physicians Anesthesia Services 20 1972588200 0 Physicians Fluoride varnish 20 1972588200 0 Physicians Healthy Kids Services 20 1972588200 0 Physicians Optical Supplies 20 1972588200 0 Physicians Physician Services 00 1972589042 0 ADE MD DAVID T 1983217 9999999 B 10 1972589042 0 550 30TH AVE STE 12 MOLINE IL 612655975 20 1972589042 0 Physicians Anesthesia Services 20 1972589042 0 Physicians Fluoride varnish 20 1972589042 0 Physicians Healthy Kids Services 20 1972589042 0 Physicians Optical Supplies 20 1972589042 0 Physicians Physician Services 00 1972589661 0 TREDUP CHRISTINE 1998274 9999999 B 10 1972589661 0 1845 GRANDSTAND PL ELGIN 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1972590362 0 Physicians Physician Services 00 1972590719 0 PRYKA MARY L 2017289 9999999 B 10 1972590719 0 25070 NETWORK PL CHICAGO IL 606731250 20 1972590719 0 Nurse Practitioners Healthy Kids Services 20 1972590719 0 Nurse Practitioners Nurse Practitioners Services 20 1972590719 0 Nurse Practitioners Physician Services 00 1972591287 0 WALDERA LORI J 2017037 9999999 B 10 1972591287 0 1095 HIGHWAY 15 S HUTCHINSON MN 553505000 20 1972591287 0 Nurse Practitioners Healthy Kids Services 20 1972591287 0 Nurse Practitioners Nurse Practitioners Services 20 1972591287 0 Nurse Practitioners Physician Services 00 1972591402 0 GLENN KEVIN 2001182 9999999 B 10 1972591402 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1972591402 0 Physicians Anesthesia Services 20 1972591402 0 Physicians Healthy Kids Services 20 1972591402 0 Physicians Optical Supplies 20 1972591402 0 Physicians Physician Services 00 1972591527 0 PIMENTEL DANTE A 2004183 9999999 B 10 1972591527 0 1434 COVENTRY CT DARIEN IL 605614458 20 1972591527 0 Physicians Anesthesia Services 20 1972591527 0 Physicians Fluoride varnish 20 1972591527 0 Physicians Healthy Kids Services 20 1972591527 0 Physicians Optical Supplies 20 1972591527 0 Physicians Physician Services 00 1972592004 0 STARNER TIMOTHY D 2001182 9999999 B 10 1972592004 0 611 W PARK ST URBANA IL 618012529 20 1972592004 0 Physicians Anesthesia Services 20 1972592004 0 Physicians Fluoride varnish 20 1972592004 0 Physicians Healthy Kids Services 20 1972592004 0 Physicians Optical Supplies 20 1972592004 0 Physicians Physician Services 00 1972592061 0 GRZESKOWIAK WOJCIECH Z 1992091 9999999 B 10 1972592061 0 5370 N MILWAUKEE AVE CHICAGO IL 606301250 20 1972592061 0 Physicians Anesthesia Services 20 1972592061 0 Physicians Fluoride varnish 20 1972592061 0 Physicians Healthy Kids Services 20 1972592061 0 Physicians Optical Supplies 20 1972592061 0 Physicians Physician Services 00 1972592210 0 ZAJAC DOROTHY J 1989151 9999999 B 10 1972592210 0 1315 LEHMEN DR CHESTER IL 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20 1972592921 0 Dentists Physician Services 00 1972593937 0 LEPKOWSKI JOSEPH 2000214 9999999 B 10 1972593937 0 6630 ROOSEVELT RD OAK PARK IL 603042059 20 1972593937 0 Dentists Dental Services 20 1972593937 0 Dentists Physician Services 00 1972594018 0 JOSUPAIT JOHN 1990152 9999999 B 10 1972594018 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1972594018 0 Physicians Anesthesia Services 20 1972594018 0 Physicians Healthy Kids Services 20 1972594018 0 Physicians Optical Supplies 20 1972594018 0 Physicians Physician Services 00 1972595296 0 AILES DINELLO AMY L 2016001 9999999 B 10 1972595296 0 10001 W INNOVATION DR STE 200 WAUWATOSA WI 532264851 20 1972595296 0 Physician Assistant Only Fluoride varnish 20 1972595296 0 Physician Assistant Only Healthy Kids Services 20 1972595296 0 Physician Assistant Only Physician Services 00 1972596021 0 MEHTA SEMIL B 2004183 9999999 B 10 1972596021 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1972596021 0 Physicians Anesthesia Services 20 1972596021 0 Physicians Fluoride varnish 20 1972596021 0 Physicians Healthy Kids Services 20 1972596021 0 Physicians Optical Supplies 20 1972596021 0 Physicians Physician Services 00 1972596294 0 LEE JONATHON T 1995182 2099365 B 10 1972596294 0 901 MACARTHUR BLVD MUNSTER IN 463212901 20 1972596294 0 Physicians Anesthesia Services 20 1972596294 0 Physicians Healthy Kids Services 20 1972596294 0 Physicians Optical Supplies 20 1972596294 0 Physicians Physician Services 00 1972596906 0 WO JOHN M 2002105 9999999 B 10 1972596906 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1972596906 0 Physicians Anesthesia Services 20 1972596906 0 Physicians Fluoride varnish 20 1972596906 0 Physicians Healthy Kids Services 20 1972596906 0 Physicians Optical Supplies 20 1972596906 0 Physicians Physician Services 00 1972597037 0 NEPOLA JAMES V 1984141 9999999 B 10 1972597037 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1972597037 0 Physicians Anesthesia Services 20 1972597037 0 Physicians Healthy Kids 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service 00 1972713386 0 SIDDIQUI AISHA 2009091 9999999 B 10 1972713386 0 777 LOWNDES HILL RD BLDG 1 GREENVILLE SC 296072101 20 1972713386 0 Physicians Anesthesia Services 20 1972713386 0 Physicians Healthy Kids Services 20 1972713386 0 Physicians Optical Supplies 20 1972713386 0 Physicians Physician Services 00 1972716017 0 TAORMINA MIA 2011122 9999999 B 10 1972716017 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1972716017 0 Physicians Anesthesia Services 20 1972716017 0 Physicians Fluoride varnish 20 1972716017 0 Physicians Healthy Kids Services 20 1972716017 0 Physicians Optical Supplies 20 1972716017 0 Physicians Physician Services 00 1972716033 0 ELLISON JOSHUA 2009091 9999999 B 10 1972716033 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1972716033 0 Physicians Anesthesia Services 20 1972716033 0 Physicians Fluoride varnish 20 1972716033 0 Physicians Healthy Kids Services 20 1972716033 0 Physicians Optical Supplies 20 1972716033 0 Physicians Physician Services 00 1972716470 0 BRAKKE NATHAN 2024115 9999999 B 10 1972716470 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1972716470 0 Physicians Anesthesia Services 20 1972716470 0 Physicians Healthy Kids Services 20 1972716470 0 Physicians Optical Supplies 20 1972716470 0 Physicians Physician Services 00 1972718955 0 STEWART MIKIA A 2023284 9999999 B 10 1972718955 0 2947 W 79TH ST CHICAGO IL 606521693 20 1972718955 0 Occupational Therapists Medical Supplies 20 1972718955 0 Occupational Therapists Medical equipment/prosthetic devices 20 1972718955 0 Occupational Therapists Occupational Therapy Services 00 1972722007 0 DZIEDZIC JACQUELINE 2011182 9999999 B 10 1972722007 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1972722007 0 Physicians Anesthesia Services 20 1972722007 0 Physicians Fluoride varnish 20 1972722007 0 Physicians Healthy Kids Services 20 1972722007 0 Physicians Optical Supplies 20 1972722007 0 Physicians Physician Services 00 1972723104 0 JUDKINS JEREMIAH 2016275 9999999 B 10 1972723104 0 5380 TECH DATA DR STE 101 CLEARWATER FL 337603122 20 1972723104 0 Physicians Anesthesia Services 20 1972723104 0 Physicians Healthy Kids Services 20 1972723104 0 Physicians Optical Supplies 20 1972723104 0 Physicians Physician Services 00 1972723765 0 LACASSE ALEXANDRE 2010001 9999999 B 10 1972723765 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1972723765 0 Physicians Anesthesia Services 20 1972723765 0 Physicians Fluoride varnish 20 1972723765 0 Physicians Healthy Kids Services 20 1972723765 0 Physicians Optical Supplies 20 1972723765 0 Physicians Physician Services 00 1972724045 0 KAPLAN RANDY 2021213 9999999 B 10 1972724045 0 2 S MAIN ST MILFORD MA 017573250 20 1972724045 0 Physicians Anesthesia Services 20 1972724045 0 Physicians Healthy Kids Services 20 1972724045 0 Physicians Optical Supplies 20 1972724045 0 Physicians Physician Services 00 1972724979 0 WHITAKER KIMBERLY 2010187 9999999 B 10 1972724979 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1972724979 0 Physicians 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778912 CHICAGO IL 606778912 20 1972726123 0 Physicians Anesthesia Services 20 1972726123 0 Physicians Fluoride varnish 20 1972726123 0 Physicians Healthy Kids Services 20 1972726123 0 Physicians Optical Supplies 20 1972726123 0 Physicians Physician Services 00 1972727428 0 ANAM SEEBA 2013274 9999999 B 10 1972727428 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1972727428 0 Physicians Anesthesia Services 20 1972727428 0 Physicians Healthy Kids Services 20 1972727428 0 Physicians Optical Supplies 20 1972727428 0 Physicians Physician Services 20 1972727428 0 Physicians Physicians Psychiatric Services 00 1972728665 0 SHEA LOUANN M 2011182 9999999 B 10 1972728665 0 5777 DEPT CAROL STREAM IL 601228942 20 1972728665 0 Nurse Practitioners Fluoride varnish 20 1972728665 0 Nurse Practitioners Healthy Kids Services 20 1972728665 0 Nurse Practitioners Nurse Practitioners Services 20 1972728665 0 Nurse Practitioners Physician Services 00 1972728863 0 VICKERY JOHN 2017038 9999999 B 10 1972728863 0 7732 SOLUTION CENTER CHICAGO IL 606777007 20 1972728863 0 Dentists Dental Services 20 1972728863 0 Dentists Physician Services 00 1972729283 0 MUSHYAM AMITHA S 2009091 9999999 B 10 1972729283 0 5777 DEPT CAROL STREAM IL 601228942 20 1972729283 0 Physicians Anesthesia Services 20 1972729283 0 Physicians Fluoride varnish 20 1972729283 0 Physicians Healthy Kids Services 20 1972729283 0 Physicians Optical Supplies 20 1972729283 0 Physicians Physician Services 00 1972729291 0 FRANKLIN BROCK 2009152 9999999 B 10 1972729291 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1972729291 0 Physicians Anesthesia Services 20 1972729291 0 Physicians Healthy Kids Services 20 1972729291 0 Physicians Optical Supplies 20 1972729291 0 Physicians Physician Services 00 1972729689 0 ANAND MAYA 2016122 9999999 B 10 1972729689 0 1 WESTBROOK CORPORATE CTR STE 240 WESTCHESTER IL 601545745 20 1972729689 0 Physical Therapists Medical Supplies 20 1972729689 0 Physical Therapists Medical 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1972730547 0 Physicians Optical Supplies 20 1972730547 0 Physicians Physician Services 00 1972730786 0 FABRICANTE MARY ELAINE 2020281 9999999 B 10 1972730786 0 101 E STATE ST KENNETT SQ PA 193483109 20 1972730786 0 Physical Therapists Medical Supplies 20 1972730786 0 Physical Therapists Medical equipment/prosthetic devices 20 1972730786 0 Physical Therapists Physical Therapy Services 00 1972730893 0 SHAH MIHIR B 2016275 9999999 B 10 1972730893 0 44000 GARFIELD RD CLINTON TOWNSHI MI 480381125 20 1972730893 0 Physicians Anesthesia Services 20 1972730893 0 Physicians Healthy Kids Services 20 1972730893 0 Physicians Optical Supplies 20 1972730893 0 Physicians Physician Services 00 1972731131 0 BELANI SONIA 2017031 9999999 B 10 1972731131 0 7732 SOLUTION CENTER CHICAGO IL 606777007 20 1972731131 0 Dentists Dental Services 20 1972731131 0 Dentists Physician Services 00 1972731172 0 ROBERSON KORTNEE Y 2012226 9999999 B 10 1972731172 0 4730 N WINTHROP AVE CHICAGO IL 606405034 20 1972731172 0 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Services 00 1972739647 0 GEISSLER KYLE 2013213 9999999 B 10 1972739647 0 5461 W LAKE ST CHICAGO IL 606442343 20 1972739647 0 Physicians Anesthesia Services 20 1972739647 0 Physicians Fluoride varnish 20 1972739647 0 Physicians Healthy Kids Services 20 1972739647 0 Physicians Optical Supplies 20 1972739647 0 Physicians Physician Services 00 1972739894 0 ELLIOTT AMANDA C 2014212 9999999 B 10 1972739894 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1972739894 0 Physicians Anesthesia Services 20 1972739894 0 Physicians Healthy Kids Services 20 1972739894 0 Physicians Optical Supplies 20 1972739894 0 Physicians Physician Services 20 1972739894 0 Physicians Physicians Psychiatric Services 00 1972740660 0 BAYAS MARIA 2011003 9999999 B 10 1972740660 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1972740660 0 Nurse Practitioners Healthy Kids Services 20 1972740660 0 Nurse Practitioners Nurse Practitioners Services 20 1972740660 0 Nurse Practitioners Physician Services 00 1972742856 0 BARRIOS ELLEN K 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1972750289 0 Physicians Anesthesia Services 20 1972750289 0 Physicians Healthy Kids Services 20 1972750289 0 Physicians Optical Supplies 20 1972750289 0 Physicians Physician Services 00 1972750578 0 KILLEEN JENNIFER 2016074 9999999 B 10 1972750578 0 615 S NEW BALLAS RD STE 1400 SAINT LOUIS MO 631418221 20 1972750578 0 Nurse Practitioners Healthy Kids Services 20 1972750578 0 Nurse Practitioners Midwife Services 20 1972750578 0 Nurse Practitioners Nurse Practitioners Services 20 1972750578 0 Nurse Practitioners Physician Services 00 1972750743 0 ERICSON ERIC J 2011193 9999999 B 10 1972750743 0 10660 W 143RD ST STE B ORLAND PARK IL 604621989 20 1972750743 0 Physicians Anesthesia Services 20 1972750743 0 Physicians Healthy Kids Services 20 1972750743 0 Physicians Optical Supplies 20 1972750743 0 Physicians Physician Services 20 1972750743 0 Physicians Physicians Psychiatric Services 00 1972751451 0 KULANDHAISAMY SURESH K 2020192 9999999 B 10 1972751451 0 238 S CONGRESS ST RUSHVILLE IL 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CHICAGO AVE # 118 CHICAGO IL 606112991 20 1972828002 0 Physicians Anesthesia Services 20 1972828002 0 Physicians Fluoride varnish 20 1972828002 0 Physicians Healthy Kids Services 20 1972828002 0 Physicians Optical Supplies 20 1972828002 0 Physicians Physician Services 00 1972828283 0 CAUGHLIN BENJAMIN 2018046 9999999 B 10 1972828283 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1972828283 0 Physicians Anesthesia Services 20 1972828283 0 Physicians Healthy Kids Services 20 1972828283 0 Physicians Optical Supplies 20 1972828283 0 Physicians Physician Services 00 1972828291 0 ELIAS YOUSSEF 2016257 9999999 B 10 1972828291 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1972828291 0 Physicians Anesthesia Services 20 1972828291 0 Physicians Healthy Kids Services 20 1972828291 0 Physicians Optical Supplies 20 1972828291 0 Physicians Physician Services 00 1972828549 0 HIBBS SHAYNA 2016179 2099365 B 10 1972828549 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1972828549 0 Physicians Anesthesia Services 20 1972828549 0 Physicians Fluoride varnish 20 1972828549 0 Physicians Healthy Kids Services 20 1972828549 0 Physicians Optical Supplies 20 1972828549 0 Physicians Physician Services 00 1972828671 0 MANTILLA NATHALIE 2017354 9999999 B 10 1972828671 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1972828671 0 Physicians Anesthesia Services 20 1972828671 0 Physicians Healthy Kids Services 20 1972828671 0 Physicians Optical Supplies 20 1972828671 0 Physicians Physician Services 00 1972828804 0 ROJAS ISABEL M 2010221 9999999 B 10 1972828804 0 4254 W 55TH ST CHICAGO IL 606324642 20 1972828804 0 Podiatrists Podiatric Services 00 1972829455 0 ENGLISH TESHA M 2017135 9999999 B 10 1972829455 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1972829455 0 Physicians Anesthesia Services 20 1972829455 0 Physicians Healthy Kids Services 20 1972829455 0 Physicians Optical Supplies 20 1972829455 0 Physicians Physician Services 00 1972829489 0 PATEL NEIL B 2013196 9999999 B 10 1972829489 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1972829489 0 Physicians Anesthesia Services 20 1972829489 0 Physicians Fluoride varnish 20 1972829489 0 Physicians Healthy Kids Services 20 1972829489 0 Physicians Optical Supplies 20 1972829489 0 Physicians Physician Services 00 1972829687 0 PERUMALSAMY PRIYA 2012214 9999999 B 10 1972829687 0 4535 DRESSLER RD NW CANTON OH 447182545 20 1972829687 0 Physicians Anesthesia Services 20 1972829687 0 Physicians Healthy Kids Services 20 1972829687 0 Physicians Optical Supplies 20 1972829687 0 Physicians Physician Services 00 1972830172 0 HERRON MARY 2016247 9999999 B 10 1972830172 0 1525 E 53RD ST STE 1005 CHICAGO IL 606154572 20 1972830172 0 Clinical Social Worker Social work service 00 1972830602 0 STEIN ANDREA 2015027 9999999 B 10 1972830602 0 4025 N SHERIDAN RD CHICAGO IL 606132010 20 1972830602 0 Clinical Social Worker Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972833770 0 KLUMP DANIELLE S 2010012 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FREEMAN ANDREW J 2011171 9999999 B 10 1972835494 0 917 W WASHINGTON BLVD # 310 CHICAGO IL 606072203 20 1972835494 0 Nurse Practitioners Anesthesia Services 20 1972835494 0 Nurse Practitioners Nurse Practitioners Services 20 1972835494 0 Nurse Practitioners Physician Services 00 1972837037 0 MEEHAN KAREN A 2019143 9999999 B 10 1972837037 0 PO BOX 713388 CHICAGO IL 606771525 20 1972837037 0 Nurse Practitioners Healthy Kids Services 20 1972837037 0 Nurse Practitioners Nurse Practitioners Services 20 1972837037 0 Nurse Practitioners Physician Services 00 1972839041 0 HASSAN BURHAN 2021232 9999999 B 10 1972839041 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1972839041 0 Physicians Anesthesia Services 20 1972839041 0 Physicians Healthy Kids Services 20 1972839041 0 Physicians Optical Supplies 20 1972839041 0 Physicians Physician Services 00 1972839934 0 CLARK SAUNDRA G 2020349 9999999 B 10 1972839934 0 100 W CHICAGO AVE STE F EAST CHICAGO IN 463123261 20 1972839934 0 Nurse Practitioners 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1972845287 0 Physicians Healthy Kids Services 20 1972845287 0 Physicians Optical Supplies 20 1972845287 0 Physicians Physician Services 00 1972846152 0 TENGERSTROM LINDSEY E 2019364 9999999 B 10 1972846152 0 7110 W 127TH ST STE 130 PALOS HEIGHTS IL 604631579 20 1972846152 0 Physicians Anesthesia Services 20 1972846152 0 Physicians Fluoride varnish 20 1972846152 0 Physicians Healthy Kids Services 20 1972846152 0 Physicians Optical Supplies 20 1972846152 0 Physicians Physician Services 00 1972846236 0 SOULII LIOUBOV 2017145 9999999 B 10 1972846236 0 1740 W TAYLOR ST STE 1400 CHICAGO IL 606127232 20 1972846236 0 Physicians Anesthesia Services 20 1972846236 0 Physicians Healthy Kids Services 20 1972846236 0 Physicians Optical Supplies 20 1972846236 0 Physicians Physician Services 00 1972846871 0 OMAR HINA 2016178 9999999 B 10 1972846871 0 5777 DEPT CAROL STREAM IL 601220021 20 1972846871 0 Physicians Anesthesia Services 20 1972846871 0 Physicians Fluoride varnish 20 1972846871 0 Physicians 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ALVAREZ LILIANA 2012273 9999999 B 10 1972859874 0 1220 S WOOD ST CHICAGO IL 606081202 20 1972859874 0 Nurse Practitioners Fluoride varnish 20 1972859874 0 Nurse Practitioners Healthy Kids Services 20 1972859874 0 Nurse Practitioners Nurse Practitioners Services 20 1972859874 0 Nurse Practitioners Physician Services 00 1972859890 0 BASHIR AHSAN 2020161 9999999 B 10 1972859890 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1972859890 0 Physicians Anesthesia Services 20 1972859890 0 Physicians Fluoride varnish 20 1972859890 0 Physicians Healthy Kids Services 20 1972859890 0 Physicians Optical Supplies 20 1972859890 0 Physicians Physician Services 00 1972860302 0 GUIDOTTI BRETING LESLIE M 2015194 9999999 B 10 1972860302 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1972860302 0 Psychologist Psychologist service 00 1972863124 0 WREN JAMES 2018264 9999999 B 10 1972863124 0 5777 DEPT CAROL STREAM IL 601220021 20 1972863124 0 Physicians Anesthesia Services 20 1972863124 0 Physicians Healthy Kids Services 20 1972863124 0 Physicians Optical Supplies 20 1972863124 0 Physicians Physician Services 00 1972864254 0 DURKIN SARAH E 2012199 9999999 B 10 1972864254 0 17430 92ND AVE TINLEY PARK IL 604875235 20 1972864254 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972864338 0 ADAMS CARMEN 2016238 9999999 B 10 1972864338 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1972864338 0 Physicians Anesthesia Services 20 1972864338 0 Physicians Healthy Kids Services 20 1972864338 0 Physicians Optical Supplies 20 1972864338 0 Physicians Physician Services 00 1972864874 0 PETKOVICH KATHERINE N 2005073 9999999 B 10 1972864874 0 524 E SCHAUMBURG RD SCHAUMBURG IL 601943510 20 1972864874 0 Speech Therapists Medical Supplies 20 1972864874 0 Speech Therapists Medical equipment/prosthetic devices 20 1972864874 0 Speech Therapists Speech Therapy/Pathology Services 00 1972865020 0 ANDERSON KRISTINA M 2015208 9999999 B 10 1972865020 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0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1972867315 0 Physicians Anesthesia Services 20 1972867315 0 Physicians Healthy Kids Services 20 1972867315 0 Physicians Optical Supplies 20 1972867315 0 Physicians Physician Services 00 1972867489 0 HARRISON PRINCE 2020285 9999999 B 10 1972867489 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1972867489 0 Physicians Anesthesia Services 20 1972867489 0 Physicians Fluoride varnish 20 1972867489 0 Physicians Healthy Kids Services 20 1972867489 0 Physicians Optical Supplies 20 1972867489 0 Physicians Physician Services 00 1972867943 0 PICHLER MICHAEL R 2020062 9999999 B 10 1972867943 0 988102 NEBRASKA MEDICAL CTR OMAHA NE 681988102 20 1972867943 0 Physicians Anesthesia Services 20 1972867943 0 Physicians Healthy Kids Services 20 1972867943 0 Physicians Optical Supplies 20 1972867943 0 Physicians Physician Services 20 1972867943 0 Physicians Physicians Psychiatric Services 00 1972872737 0 DEL RIO ANGELA THERESE 2016147 9999999 B 10 1972872737 0 1101 S CAPITAL OF TEXAS HWY ST WEST LAKE HILLS TX 787466445 20 1972872737 0 Occupational Therapists Medical Supplies 20 1972872737 0 Occupational Therapists Medical equipment/prosthetic devices 20 1972872737 0 Occupational Therapists Occupational Therapy Services 00 1972873735 0 KELLY ELIZABETH 2015001 9999999 B 10 1972873735 0 PO BOX 5588 BELFAST ME 049155500 20 1972873735 0 Nurse Practitioners Fluoride varnish 20 1972873735 0 Nurse Practitioners Healthy Kids Services 20 1972873735 0 Nurse Practitioners Nurse Practitioners Services 20 1972873735 0 Nurse Practitioners Physician Services 00 1972875516 0 CEPPARULO KATE 2020291 9999999 B 10 1972875516 0 PO BOX 43230 PHOENIX AZ 850803230 20 1972875516 0 Nurse Practitioners Fluoride varnish 20 1972875516 0 Nurse Practitioners Healthy Kids Services 20 1972875516 0 Nurse Practitioners Nurse Practitioners Services 20 1972875516 0 Nurse Practitioners Physician Services 00 1972878080 0 SYED MAARIA 2018260 9999999 B 10 1972878080 0 28594 NETWORK PL CHICAGO IL 606731285 20 1972878080 0 Physicians Anesthesia Services 20 1972878080 0 Physicians Healthy Kids Services 20 1972878080 0 Physicians Optical Supplies 20 1972878080 0 Physicians Physician Services 00 1972878288 0 LAURSEN LAURA E 2016253 9999999 B 10 1972878288 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1972878288 0 Physicians Anesthesia Services 20 1972878288 0 Physicians Family Planning Counseling 20 1972878288 0 Physicians Healthy Kids Services 20 1972878288 0 Physicians Optical Supplies 20 1972878288 0 Physicians Physician Services 00 1972878304 0 MAYER VALERIE 2012142 9999999 B 10 1972878304 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1972878304 0 Other behavior health professional Nursing service 20 1972878304 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1972878304 0 Other behavior health professional Waiver service 00 1972879088 0 THOMPSON MICHAEL D 2017198 9999999 B 10 1972879088 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1972879088 0 Physicians Anesthesia Services 20 1972879088 0 Physicians Fluoride varnish 20 1972879088 0 Physicians Healthy Kids Services 20 1972879088 0 Physicians Optical Supplies 20 1972879088 0 Physicians Physician Services 00 1972879625 0 KANNER LAUREN A 2018213 9999999 B 10 1972879625 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1972879625 0 Physicians Anesthesia Services 20 1972879625 0 Physicians Fluoride varnish 20 1972879625 0 Physicians Healthy Kids Services 20 1972879625 0 Physicians Optical Supplies 20 1972879625 0 Physicians Physician Services 00 1972880003 0 GRAELER MITZIE 2017017 9999999 B 10 1972880003 0 11365 DORSETT RD MARYLAND HTS MO 630433411 20 1972880003 0 Nurse Practitioners Fluoride varnish 20 1972880003 0 Nurse Practitioners Healthy Kids Services 20 1972880003 0 Nurse Practitioners Nurse Practitioners Services 20 1972880003 0 Nurse Practitioners Physician Services 00 1972881183 0 SANTARELLI MARY K 2022179 9999999 B 10 1972881183 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1972881183 0 Speech Therapists Medical Supplies 20 1972881183 0 Speech Therapists Medical equipment/prosthetic devices 20 1972881183 0 Speech Therapists Occupational Therapy Services 00 1972881670 0 ZATOR BRIAN 2011197 9999999 B 10 1972881670 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1972881670 0 Physicians Anesthesia Services 20 1972881670 0 Physicians Fluoride varnish 20 1972881670 0 Physicians Healthy Kids Services 20 1972881670 0 Physicians Optical Supplies 20 1972881670 0 Physicians Physician Services 00 1972882033 0 HOLCOMB CHELSEY 2021044 9999999 B 10 1972882033 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1972882033 0 Physician Assistant Only Fluoride varnish 20 1972882033 0 Physician Assistant Only Healthy Kids Services 20 1972882033 0 Physician Assistant Only Physician Services 00 1972882207 0 MALLER VINOD 2018249 9999999 B 10 1972882207 0 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1972891216 0 LADO JUAN 2017182 9999999 B 10 1972891216 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1972891216 0 Physicians Anesthesia Services 20 1972891216 0 Physicians Fluoride varnish 20 1972891216 0 Physicians Healthy Kids Services 20 1972891216 0 Physicians Optical Supplies 20 1972891216 0 Physicians Physician Services 00 1972891257 0 BARNETT DANIEL H 2016243 9999999 B 10 1972891257 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1972891257 0 Physicians Anesthesia Services 20 1972891257 0 Physicians Healthy Kids Services 20 1972891257 0 Physicians Optical Supplies 20 1972891257 0 Physicians Physician Services 00 1972892313 0 KISTNER JENNIFER 2012136 9999999 B 10 1972892313 0 3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047450 20 1972892313 0 Nurse Practitioners Healthy Kids Services 20 1972892313 0 Nurse Practitioners Nurse Practitioners Services 20 1972892313 0 Nurse Practitioners Physician Services 00 1972892677 0 MASLO ROBERT E 2014195 9999999 B 10 1972892677 0 100 S GRAND AVE 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1972958494 0 265 BROOKVIEW CENTRE WAY STE 2 KNOXVILLE TN 379194052 20 1972958494 0 Physicians Anesthesia Services 20 1972958494 0 Physicians Healthy Kids Services 20 1972958494 0 Physicians Optical Supplies 20 1972958494 0 Physicians Physician Services 00 1972958726 0 EVANS TIMOTHY R 2020203 9999999 B 10 1972958726 0 1 CHILDRENS PL SAINT LOUIS MO 631101002 20 1972958726 0 Physicians Anesthesia Services 20 1972958726 0 Physicians Fluoride varnish 20 1972958726 0 Physicians Healthy Kids Services 20 1972958726 0 Physicians Optical Supplies 20 1972958726 0 Physicians Physician Services 00 1972959336 0 LIN CHEN 2022243 9999999 B 10 1972959336 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1972959336 0 Physicians Anesthesia Services 20 1972959336 0 Physicians Healthy Kids Services 20 1972959336 0 Physicians Optical Supplies 20 1972959336 0 Physicians Physician Services 00 1972959377 0 COULSON JEANNE 2018170 9999999 B 10 1972959377 0 5404 W ELM ST STE H MCHENRY IL 600504007 20 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43230 PHOENIX AZ 850803230 20 1972966778 0 Physicians Anesthesia Services 20 1972966778 0 Physicians Healthy Kids Services 20 1972966778 0 Physicians Optical Supplies 20 1972966778 0 Physicians Physician Services 00 1972967057 0 GADODIA GAURAV 2022195 9999999 B 10 1972967057 0 2245 ENTERPRISE DR STE 4506 WESTCHESTER IL 601545803 20 1972967057 0 Physicians Anesthesia Services 20 1972967057 0 Physicians Healthy Kids Services 20 1972967057 0 Physicians Optical Supplies 20 1972967057 0 Physicians Physician Services 00 1972967602 0 LELE SOUMIL S 2020014 9999999 B 10 1972967602 0 15740 S OUTER 40 RD CHESTERFIELD MO 630172004 20 1972967602 0 Physicians Anesthesia Services 20 1972967602 0 Physicians Fluoride varnish 20 1972967602 0 Physicians Healthy Kids Services 20 1972967602 0 Physicians Optical Supplies 20 1972967602 0 Physicians Physician Services 00 1972967727 0 SOLIS MARITZA 2016090 9999999 B 10 1972967727 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1972967727 0 Clinical Social Worker 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1972973626 0 Physician Assistant Only Fluoride varnish 20 1972973626 0 Physician Assistant Only Healthy Kids Services 20 1972973626 0 Physician Assistant Only Physician Services 00 1972973881 0 COOPER LYNETTE P 2022006 9999999 B 10 1972973881 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1972973881 0 Nurse Practitioners Fluoride varnish 20 1972973881 0 Nurse Practitioners Healthy Kids Services 20 1972973881 0 Nurse Practitioners Nurse Practitioners Services 20 1972973881 0 Nurse Practitioners Nursing service 20 1972973881 0 Nurse Practitioners Physician Services 00 1972974244 0 ENATA NICHELLE M 2020237 9999999 B 10 1972974244 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1972974244 0 Physicians Anesthesia Services 20 1972974244 0 Physicians Healthy Kids Services 20 1972974244 0 Physicians Optical Supplies 20 1972974244 0 Physicians Physician Services 00 1972974368 0 MOLINARO CHRISTINA M 2017100 9999999 B 10 1972974368 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1972974368 0 Physician Assistant Only Fluoride varnish 20 1972974368 0 Physician Assistant Only Healthy Kids Services 20 1972974368 0 Physician Assistant Only Physician Services 00 1972975183 0 ORME MEGAN K 2015244 9999999 B 10 1972975183 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1972975183 0 Nurse Practitioners Healthy Kids Services 20 1972975183 0 Nurse Practitioners Nurse Practitioners Services 20 1972975183 0 Nurse Practitioners Physician Services 00 1972975480 0 ODIGIE JOAN 2016055 9999999 B 10 1972975480 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1972975480 0 Nurse Practitioners All Kids application agent 20 1972975480 0 Nurse Practitioners Healthy Kids Services 20 1972975480 0 Nurse Practitioners Nurse Practitioners Services 20 1972975480 0 Nurse Practitioners Physician Services 00 1972975639 0 STERES TONI 2016042 9999999 B 10 1972975639 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1972975639 0 Nurse Practitioners Fluoride varnish 20 1972975639 0 Nurse Practitioners Healthy Kids Services 20 1972975639 0 Nurse Practitioners Nurse Practitioners Services 20 1972975639 0 Nurse Practitioners Physician Services 00 1972977064 0 KELSEY KRISTINA 2004070 9999999 B 10 1972977064 0 12898 N 2020 BLVD ALLENDALE IL 624102014 20 1972977064 0 Speech Therapists Medical Supplies 20 1972977064 0 Speech Therapists Medical equipment/prosthetic devices 20 1972977064 0 Speech Therapists Speech Therapy/Pathology Services 00 1972977395 0 BARRIE MOLLY 2021229 9999999 B 10 1972977395 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1972977395 0 Nurse Practitioners Healthy Kids Services 20 1972977395 0 Nurse Practitioners Nurse Practitioners Services 20 1972977395 0 Nurse Practitioners Physician Services 00 1972978161 0 HENDERSON JAIME 2016258 9999999 B 10 1972978161 0 PO BOX 504469 SAINT LOUIS MO 631504469 20 1972978161 0 Speech Therapists Medical Supplies 20 1972978161 0 Speech Therapists Medical equipment/prosthetic devices 20 1972978161 0 Speech Therapists Speech Therapy/Pathology Services 00 1972979466 0 URIBE JUANITA 2016146 9999999 B 10 1972979466 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1972979466 0 Other behavior health professional Social work service 00 1972979557 0 MOORE KARI 2022039 9999999 B 10 1972979557 0 1160 E SAINT CLAIR ST VINCENNES IN 475914853 20 1972979557 0 Nurse Practitioners Healthy Kids Services 20 1972979557 0 Nurse Practitioners Nurse Practitioners Services 20 1972979557 0 Nurse Practitioners Physician Services 00 1972979664 0 SHARMA RUCHI 2020209 9999999 B 10 1972979664 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1972979664 0 Physicians Anesthesia Services 20 1972979664 0 Physicians Fluoride varnish 20 1972979664 0 Physicians Healthy Kids Services 20 1972979664 0 Physicians Optical Supplies 20 1972979664 0 Physicians Physician Services 00 1972980654 0 ELLIS ASHLEY 2022336 9999999 B 10 1972980654 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1972980654 0 Physicians Anesthesia Services 20 1972980654 0 Physicians Healthy Kids Services 20 1972980654 0 Physicians Optical Supplies 20 1972980654 0 Physicians Physician Services 00 1972981009 0 RIGERT ERIN M 2018267 9999999 B 10 1972981009 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1972981009 0 Physicians Anesthesia Services 20 1972981009 0 Physicians Healthy Kids Services 20 1972981009 0 Physicians Optical Supplies 20 1972981009 0 Physicians Physician Services 00 1972981397 0 GALLOWAY CHARLES J 2023241 9999999 B 10 1972981397 0 2521 E 15TH ST CASPER WY 826094126 20 1972981397 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1972982627 0 KRISTEN WHITWORTH 2020195 9999999 B 10 1972982627 0 PO BOX 43230 PHOENIX AZ 850803230 20 1972982627 0 Physicians Anesthesia Services 20 1972982627 0 Physicians Healthy Kids Services 20 1972982627 0 Physicians Optical Supplies 20 1972982627 0 Physicians Physician Services 00 1972983377 0 YOUNG DANIEL JEFFREY 2019151 9999999 B 10 1972983377 0 1717 MAIN ST 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Physicians Healthy Kids Services 20 1972985596 0 Physicians Optical Supplies 20 1972985596 0 Physicians Physician Services 20 1972985596 0 Physicians Physicians Psychiatric Services 00 1972987303 0 HOBBIE MARK A 2020003 9999999 B 10 1972987303 0 5924 REVERE RD PO BOX 518 CLINTON IL 617272914 20 1972987303 0 Dentists Dental Services 20 1972987303 0 Dentists Physician Services 00 1972987436 0 DICKINSON JESSICA J 2021102 9999999 B 10 1972987436 0 PO BOX 80309 PHILADELPHIA PA 191011309 20 1972987436 0 Nurse Practitioners Fluoride varnish 20 1972987436 0 Nurse Practitioners Healthy Kids Services 20 1972987436 0 Nurse Practitioners Nurse Practitioners Services 20 1972987436 0 Nurse Practitioners Physician Services 00 1972988418 0 MELLENS JOSEPH W 2015323 9999999 B 10 1972988418 0 9145 COLLECTION CENTER DR CHICAGO IL 606930091 20 1972988418 0 Nurse Practitioners Anesthesia Services 20 1972988418 0 Nurse Practitioners Nurse Practitioners Services 20 1972988418 0 Nurse Practitioners Physician Services 00 1972988665 0 BURNS KRUEGER JENNIFER 2020316 9999999 B 10 1972988665 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1972988665 0 Audiologists Audiology Services 20 1972988665 0 Audiologists Medical Supplies 20 1972988665 0 Audiologists Medical equipment/prosthetic devices 00 1972988772 0 HOOD JANEISHA 2024358 9999999 B 10 1972988772 0 2201 MAIN ST EVANSTON IL 602021519 20 1972988772 0 Other behavior health professional LCPC/LMFT services 00 1972988913 0 CLARK KELLY M 2015251 9999999 B 10 1972988913 0 PO BOX 778912 CHICAGO IL 606778912 20 1972988913 0 Nurse Practitioners Healthy Kids Services 20 1972988913 0 Nurse Practitioners Nurse Practitioners Services 20 1972988913 0 Nurse Practitioners Physician Services 00 1972989432 0 OOMS MARCIA 2024155 9999999 B 10 1972989432 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1972989432 0 Clinical Social Worker Social work service 00 1972989838 0 PRAY DANIELLE R. 2016094 9999999 B 10 1972989838 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1972989838 0 Nurse Practitioners Fluoride varnish 20 1972989838 0 Nurse Practitioners Healthy Kids Services 20 1972989838 0 Nurse Practitioners Nurse Practitioners Services 20 1972989838 0 Nurse Practitioners Physician Services 00 1972990570 0 GATZ KARA 2016014 9999999 B 10 1972990570 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1972990570 0 Registered nurse All Kids application agent 20 1972990570 0 Registered nurse Nursing service 20 1972990570 0 Registered nurse Waiver service 00 1972990745 0 HUBNER MIRIAM 2016012 9999999 B 10 1972990745 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1972990745 0 Registered nurse All Kids application agent 20 1972990745 0 Registered nurse Nursing service 20 1972990745 0 Registered nurse Waiver service 00 1972993434 0 LEE CHRISTINE 2015121 9999999 B 10 1972993434 0 PO BOX 5588 BELFAST ME 049155500 20 1972993434 0 Nurse Practitioners Fluoride varnish 20 1972993434 0 Nurse Practitioners Healthy Kids Services 20 1972993434 0 Nurse 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2015301 9999999 B 10 1982008454 0 3471 EAGLE WAY CHICAGO IL 606781034 20 1982008454 0 Physician Assistant Only Fluoride varnish 20 1982008454 0 Physician Assistant Only Healthy Kids Services 20 1982008454 0 Physician Assistant Only Physician Services 00 1982009197 0 KABBES JONATHAN R 2023233 9999999 B 10 1982009197 0 702 N KELLER DR # B EFFINGHAM IL 624011737 20 1982009197 0 Other behavior health professional LCPC/LMFT services 00 1982009296 0 ROTH BRENNAN KRISTIN 2024109 9999999 B 10 1982009296 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1982009296 0 Physician Assistant Only Fluoride varnish 20 1982009296 0 Physician Assistant Only Healthy Kids Services 20 1982009296 0 Physician Assistant Only Physician Services 00 1982010856 0 NANCE MARK 2014182 9999999 B 10 1982010856 0 6742 N FROSTWOOD PKWY PEORIA IL 616152402 20 1982010856 0 Nurse Practitioners Anesthesia Services 20 1982010856 0 Nurse Practitioners Nurse Practitioners Services 20 1982010856 0 Nurse Practitioners Physician Services 00 1982011482 0 SMITH LOVEA S 2017024 9999999 B 10 1982011482 0 800 E 55TH ST CHICAGO IL 606154906 20 1982011482 0 Other behavior health professional LCPC/LMFT services 00 1982012621 0 SAGI JAHNAVI 2017305 9999999 B 10 1982012621 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1982012621 0 Physicians Anesthesia Services 20 1982012621 0 Physicians Fluoride varnish 20 1982012621 0 Physicians Healthy Kids Services 20 1982012621 0 Physicians Optical Supplies 20 1982012621 0 Physicians Physician Services 00 1982012878 0 VANDER WAL HANNAH 2022279 9999999 B 10 1982012878 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1982012878 0 Physician Assistant Only Fluoride varnish 20 1982012878 0 Physician Assistant Only Healthy Kids Services 20 1982012878 0 Physician Assistant Only Physician Services 00 1982013090 0 WEBER KIMBERLY 2016013 9999999 B 10 1982013090 0 211 LANDMARK DR STE E3 NORMAL IL 617616165 20 1982013090 0 Physical Therapists Medical Supplies 20 1982013090 0 Physical Therapists Medical 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0 29373 NETWORK PL CHICAGO IL 606733039 20 1982015079 0 Physicians Anesthesia Services 20 1982015079 0 Physicians Healthy Kids Services 20 1982015079 0 Physicians Optical Supplies 20 1982015079 0 Physicians Physician Services 00 1982015186 0 ABRAMOVICI SERGIU 2023138 9999999 B 10 1982015186 0 250 N SHADELAND AVE INDIANAPOLIS IN 462194959 20 1982015186 0 Physicians Anesthesia Services 20 1982015186 0 Physicians Healthy Kids Services 20 1982015186 0 Physicians Optical Supplies 20 1982015186 0 Physicians Physician Services 20 1982015186 0 Physicians Physicians Psychiatric Services 00 1982015384 0 FULLER SHERRY 2014196 9999999 B 10 1982015384 0 2112 W GALENA BLVD AURORA IL 605063255 20 1982015384 0 Speech Therapists Medical Supplies 20 1982015384 0 Speech Therapists Medical equipment/prosthetic devices 20 1982015384 0 Speech Therapists Speech Therapy/Pathology Services 00 1982015624 0 GORDAN MARIA 2018267 9999999 B 10 1982015624 0 5777 DEPT CAROL STREAM IL 601220021 20 1982015624 0 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Healthy Kids Services 20 1982016325 0 Physician Assistant Only Physician Services 00 1982016499 0 LIPON AMANDA 2017157 9999999 B 10 1982016499 0 5665 NEW NORTHSIDE DR STE 320 ATLANTA GA 303285834 20 1982016499 0 Physicians Anesthesia Services 20 1982016499 0 Physicians Healthy Kids Services 20 1982016499 0 Physicians Optical Supplies 20 1982016499 0 Physicians Physician Services 00 1982016606 0 WEIDNER BRENDA 2021001 9999999 B 10 1982016606 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1982016606 0 Physicians Anesthesia Services 20 1982016606 0 Physicians Fluoride varnish 20 1982016606 0 Physicians Healthy Kids Services 20 1982016606 0 Physicians Optical Supplies 20 1982016606 0 Physicians Physician Services 00 1982017133 0 PONTELL MATTHEW 2025030 9999999 B 10 1982017133 0 DEPT AT 40379 ATLANTA GA 311920379 20 1982017133 0 Physicians Anesthesia Services 20 1982017133 0 Physicians Healthy Kids Services 20 1982017133 0 Physicians Optical Supplies 20 1982017133 0 Physicians Physician Services 00 1982017851 0 MACCI TEHNEIYAT J 2015323 9999999 B 10 1982017851 0 6233 CERMAK RD BERWYN IL 604022317 20 1982017851 0 Optometrists Optical Supplies 20 1982017851 0 Optometrists Optometric Services 20 1982017851 0 Optometrists Physician Services 00 1982017943 0 FROGGE NATHAN 2019283 9999999 B 10 1982017943 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1982017943 0 Physicians Anesthesia Services 20 1982017943 0 Physicians Fluoride varnish 20 1982017943 0 Physicians Healthy Kids Services 20 1982017943 0 Physicians Optical Supplies 20 1982017943 0 Physicians Physician Services 00 1982017976 0 TORBERT MARIANNE G 2015292 9999999 B 10 1982017976 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1982017976 0 Nurse Practitioners Fluoride varnish 20 1982017976 0 Nurse Practitioners Healthy Kids Services 20 1982017976 0 Nurse Practitioners Nurse Practitioners Services 20 1982017976 0 Nurse Practitioners Physician Services 00 1982018271 0 LOGEMAN ANDREW W 2019218 9999999 B 10 1982018271 0 800 E LOCUST ST OLNEY IL 624502553 20 1982018271 0 Physicians Anesthesia Services 20 1982018271 0 Physicians Healthy Kids Services 20 1982018271 0 Physicians Optical Supplies 20 1982018271 0 Physicians Physician Services 00 1982018834 0 MURRAY DAVID 2018059 9999999 B 10 1982018834 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1982018834 0 Physicians Anesthesia Services 20 1982018834 0 Physicians Healthy Kids Services 20 1982018834 0 Physicians Optical Supplies 20 1982018834 0 Physicians Physician Services 00 1982019063 0 NELSON LYNN R 2017154 9999999 B 10 1982019063 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1982019063 0 Nurse Practitioners Healthy Kids Services 20 1982019063 0 Nurse Practitioners Nurse Practitioners Services 20 1982019063 0 Nurse Practitioners Physician Services 00 1982020087 0 DONLON VINCENT R 2014125 9999999 B 10 1982020087 0 PO BOX 17632 BELFAST ME 049154071 20 1982020087 0 Nurse Practitioners Healthy Kids Services 20 1982020087 0 Nurse Practitioners Nurse Practitioners Services 20 1982020087 0 Nurse Practitioners Physician Services 00 1982021317 0 KORSCH ROBERT K 2019033 9999999 B 10 1982021317 0 PO BOX 781076 DETROIT MI 482781076 20 1982021317 0 Physicians Anesthesia Services 20 1982021317 0 Physicians Healthy Kids Services 20 1982021317 0 Physicians Optical Supplies 20 1982021317 0 Physicians Physician Services 00 1982021986 0 WHELAN RACHEL 2021209 9999999 B 10 1982021986 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1982021986 0 Physicians Anesthesia Services 20 1982021986 0 Physicians Fluoride varnish 20 1982021986 0 Physicians Healthy Kids Services 20 1982021986 0 Physicians Optical Supplies 20 1982021986 0 Physicians Physician Services 00 1982022109 0 RAGHU VIKRAM 2023044 9999999 B 10 1982022109 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1982022109 0 Physicians Anesthesia Services 20 1982022109 0 Physicians Fluoride varnish 20 1982022109 0 Physicians Healthy Kids Services 20 1982022109 0 Physicians Optical Supplies 20 1982022109 0 Physicians Physician Services 00 1982022471 0 EL TECLE NAJIB 2018040 9999999 B 10 1982022471 0 5777 DEPT CAROL STREAM IL 601228942 20 1982022471 0 Physicians Anesthesia Services 20 1982022471 0 Physicians Healthy Kids Services 20 1982022471 0 Physicians Optical Supplies 20 1982022471 0 Physicians Physician Services 00 1982022810 0 SHEPARD KIRK 2020058 9999999 B 10 1982022810 0 PO BOX 809094 CHICAGO IL 606809094 20 1982022810 0 Physicians Anesthesia Services 20 1982022810 0 Physicians Fluoride varnish 20 1982022810 0 Physicians Healthy Kids Services 20 1982022810 0 Physicians Optical Supplies 20 1982022810 0 Physicians Physician Services 00 1982022851 0 ROSS SHANA E 2017152 9999999 B 10 1982022851 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1982022851 0 Physicians Anesthesia Services 20 1982022851 0 Physicians Healthy Kids Services 20 1982022851 0 Physicians Optical Supplies 20 1982022851 0 Physicians Physician Services 00 1982023396 0 HAIDER SAMRAN 2020167 9999999 B 10 1982023396 0 PO BOX 778791 CHICAGO IL 606776473 20 1982023396 0 Physicians Anesthesia Services 20 1982023396 0 Physicians Fluoride varnish 20 1982023396 0 Physicians Healthy Kids Services 20 1982023396 0 Physicians Optical Supplies 20 1982023396 0 Physicians Physician Services 00 1982023552 0 RANGAN SUPREETI 2014104 9999999 B 10 1982023552 0 405 LAKE ZURICH RD BARRINGTON IL 600103141 20 1982023552 0 Nurse Practitioners Fluoride varnish 20 1982023552 0 Nurse Practitioners Healthy Kids Services 20 1982023552 0 Nurse Practitioners Nurse Practitioners Services 20 1982023552 0 Nurse Practitioners Physician Services 00 1982024394 0 FRERICHS ASHLEY 2014219 9999999 B 10 1982024394 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1982024394 0 Nurse Practitioners Healthy Kids Services 20 1982024394 0 Nurse Practitioners Midwife Services 20 1982024394 0 Nurse Practitioners Nurse Practitioners Services 20 1982024394 0 Nurse Practitioners Physician Services 00 1982024428 0 CERCONE ANGELICA 2021323 9999999 B 10 1982024428 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1982024428 0 Physicians Anesthesia Services 20 1982024428 0 Physicians Fluoride varnish 20 1982024428 0 Physicians Healthy Kids Services 20 1982024428 0 Physicians Optical Supplies 20 1982024428 0 Physicians Physician Services 00 1982024568 0 WALDO IZABELLA 2022096 9999999 B 10 1982024568 0 1951 NW 7TH AVE STE 300 MIAMI FL 331361112 20 1982024568 0 Nurse Practitioners Healthy Kids Services 20 1982024568 0 Nurse Practitioners Nurse Practitioners Services 20 1982024568 0 Nurse Practitioners Physician Services 00 1982024634 0 REDDY MANASA S 2022137 9999999 B 10 1982024634 0 250 N SHADELAND AVE STE 130 INDIANAPOLIS IN 462194959 20 1982024634 0 Physicians Anesthesia Services 20 1982024634 0 Physicians Healthy Kids Services 20 1982024634 0 Physicians Optical Supplies 20 1982024634 0 Physicians Physician Services 00 1982025680 0 SCHROETTER SHANNON J 2019274 9999999 B 10 1982025680 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1982025680 0 Nurse Practitioners Fluoride varnish 20 1982025680 0 Nurse Practitioners Healthy Kids Services 20 1982025680 0 Nurse Practitioners Nurse Practitioners Services 20 1982025680 0 Nurse Practitioners Physician Services 00 1982026696 0 REN ZHEN 2018283 9999999 B 10 1982026696 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1982026696 0 Physicians Anesthesia Services 20 1982026696 0 Physicians Fluoride varnish 20 1982026696 0 Physicians Healthy Kids Services 20 1982026696 0 Physicians Optical Supplies 20 1982026696 0 Physicians Physician Services 00 1982029856 0 CASEY JENNIFER 2016270 9999999 B 10 1982029856 0 1120 N MELVIN ST GIBSON CITY IL 609361477 20 1982029856 0 Nurse Practitioners Healthy Kids Services 20 1982029856 0 Nurse Practitioners Nurse Practitioners Services 20 1982029856 0 Nurse Practitioners Physician Services 00 1982029880 0 JEFFERY DEBORAH M 2023352 9999999 B 10 1982029880 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1982029880 0 Nurse Practitioners Healthy Kids Services 20 1982029880 0 Nurse Practitioners Nurse Practitioners Services 20 1982029880 0 Nurse Practitioners Physician Services 00 1982029997 0 WODRICH HEIDI 2016091 9999999 B 10 1982029997 0 1850 W WINCHESTER RD STE 108 LIBERTYVILLE IL 600485355 20 1982029997 0 Other behavior health professional LCPC/LMFT services 00 1982030037 0 LUCE STEPHANIE 2017220 9999999 B 10 1982030037 0 29373 NETWORK PL CHICAGO IL 606733039 20 1982030037 0 Nurse Practitioners Healthy Kids Services 20 1982030037 0 Nurse Practitioners Nurse Practitioners Services 20 1982030037 0 Nurse Practitioners Physician Services 00 1982030649 0 LEVIN RODION 2014283 9999999 B 10 1982030649 0 56 W DUNDEE RD BUFFALO GROVE IL 600893758 20 1982030649 0 Nurse Practitioners Fluoride varnish 20 1982030649 0 Nurse Practitioners Healthy Kids Services 20 1982030649 0 Nurse Practitioners Nurse Practitioners Services 20 1982030649 0 Nurse Practitioners Physician Services 00 1982030730 0 TAYLOR JENNIFER J 2013254 9999999 B 10 1982030730 0 1200 W STATE ST ROCKFORD IL 611022112 20 1982030730 0 Nurse Practitioners Fluoride varnish 20 1982030730 0 Nurse Practitioners Healthy Kids Services 20 1982030730 0 Nurse Practitioners Nurse Practitioners Services 20 1982030730 0 Nurse Practitioners Physician Services 00 1982030946 0 BESCH JACKLYN 2013273 9999999 B 10 1982030946 0 500 W RIVER DR DAVENPORT IA 528011014 20 1982030946 0 Nurse Practitioners Fluoride varnish 20 1982030946 0 Nurse Practitioners Healthy Kids Services 20 1982030946 0 Nurse Practitioners Nurse Practitioners Services 20 1982030946 0 Nurse Practitioners Physician Services 00 1982031241 0 FRANZEN ANNETTE G 2018214 9999999 B 10 1982031241 0 1220 S WOOD ST CHICAGO IL 606081202 20 1982031241 0 Psychologist Psychologist service 00 1982031571 0 SALLSTROM MARY 2023046 9999999 B 10 1982031571 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1982031571 0 Nurse Practitioners Fluoride varnish 20 1982031571 0 Nurse Practitioners Healthy Kids Services 20 1982031571 0 Nurse Practitioners Nurse Practitioners Services 20 1982031571 0 Nurse Practitioners Physician Services 00 1982036182 0 DELLARIA ANDREA T 2018129 9999999 B 10 1982036182 0 22285 N PEPPER RD STE 401 LAKE BARRINGTON IL 600102542 20 1982036182 0 Physicians Anesthesia Services 20 1982036182 0 Physicians Healthy Kids Services 20 1982036182 0 Physicians Optical Supplies 20 1982036182 0 Physicians Physician Services 20 1982036182 0 Physicians Physicians Psychiatric Services 00 1982037487 0 DANIELS CHELSEY 2018347 9999999 B 10 1982037487 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1982037487 0 Physician Assistant Only Fluoride varnish 20 1982037487 0 Physician Assistant Only Healthy Kids Services 20 1982037487 0 Physician Assistant Only Physician Services 00 1982038352 0 BOHN GARY MICHAEL 2025024 9999999 B 10 1982038352 0 PO BOX 9412 NAPERVILLE IL 605670412 20 1982038352 0 Other behavior health professional LCPC/LMFT services 00 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LAURA 2016238 9999999 B 10 1982041471 0 PO BOX 713388 CHICAGO IL 606771525 20 1982041471 0 Physicians Anesthesia Services 20 1982041471 0 Physicians Fluoride varnish 20 1982041471 0 Physicians Healthy Kids Services 20 1982041471 0 Physicians Optical Supplies 20 1982041471 0 Physicians Physician Services 00 1982041596 0 MCMULLIN CHRISTOPHER L 2015214 9999999 B 10 1982041596 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1982041596 0 Physicians Anesthesia Services 20 1982041596 0 Physicians Healthy Kids Services 20 1982041596 0 Physicians Optical Supplies 20 1982041596 0 Physicians Physician Services 00 1982041745 0 MALICAY MARGARET M 2020325 9999999 B 10 1982041745 0 402 W BOUGHTON RD BOLINGBROOK IL 604401872 20 1982041745 0 Physicians Anesthesia Services 20 1982041745 0 Physicians Fluoride varnish 20 1982041745 0 Physicians Healthy Kids Services 20 1982041745 0 Physicians Optical Supplies 20 1982041745 0 Physicians Physician Services 00 1982041851 0 HOLLIS SARA J 2020115 9999999 B 10 1982041851 0 1835 W CENTRAL RD ARLINGTON HEIGH IL 600052410 20 1982041851 0 Other behavior health professional LCPC/LMFT services 00 1982041893 0 LINDESMITH NANETTE 2018114 9999999 B 10 1982041893 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1982041893 0 Nurse Practitioners Fluoride varnish 20 1982041893 0 Nurse Practitioners Healthy Kids Services 20 1982041893 0 Nurse Practitioners Nurse Practitioners Services 20 1982041893 0 Nurse Practitioners Physician Services 00 1982042214 0 DECARLO KRISTEN E 2018219 9999999 B 10 1982042214 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1982042214 0 Physicians Anesthesia Services 20 1982042214 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1982042214 0 Physicians Fluoride varnish 20 1982042214 0 Physicians Healthy Kids Services 20 1982042214 0 Physicians Optical Supplies 20 1982042214 0 Physicians Physician Services 00 1982042438 0 RUSSELL DANIEL 2022299 9999999 B 10 1982042438 0 5700 SOUTHWYCK BLVD 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Services 20 1982043097 0 Physicians Healthy Kids Services 20 1982043097 0 Physicians Optical Supplies 20 1982043097 0 Physicians Physician Services 00 1982043105 0 BLUMENFELD-KOUCHNER FRANCOIS 2016153 9999999 B 10 1982043105 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1982043105 0 Physicians Anesthesia Services 20 1982043105 0 Physicians Fluoride varnish 20 1982043105 0 Physicians Healthy Kids Services 20 1982043105 0 Physicians Optical Supplies 20 1982043105 0 Physicians Physician Services 00 1982043154 0 OKAFOR CHUKWUEBUKA K 2017331 9999999 B 10 1982043154 0 PO BOX 1327 BROOKFIELD WI 530081327 20 1982043154 0 Physicians Anesthesia Services 20 1982043154 0 Physicians Fluoride varnish 20 1982043154 0 Physicians Healthy Kids Services 20 1982043154 0 Physicians Optical Supplies 20 1982043154 0 Physicians Physician Services 00 1982043782 0 KOHOUT KEITH M 2017186 9999999 B 10 1982043782 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1982043782 0 Physicians Anesthesia Services 20 1982043782 0 Physicians Healthy Kids Services 20 1982043782 0 Physicians Optical Supplies 20 1982043782 0 Physicians Physician Services 20 1982043782 0 Physicians Physicians Psychiatric Services 00 1982044848 0 ROBINSON CAROLINE N 2017073 9999999 B 10 1982044848 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1982044848 0 Physicians Anesthesia Services 20 1982044848 0 Physicians Healthy Kids Services 20 1982044848 0 Physicians Optical Supplies 20 1982044848 0 Physicians Physician Services 00 1982044962 0 LAL HAREESH 2016257 9999999 B 10 1982044962 0 611 W PARK ST URBANA IL 618012529 20 1982044962 0 Physicians Anesthesia Services 20 1982044962 0 Physicians Fluoride varnish 20 1982044962 0 Physicians Healthy Kids Services 20 1982044962 0 Physicians Optical Supplies 20 1982044962 0 Physicians Physician Services 00 1982045209 0 SINGH GURPREET 2016214 9999999 B 10 1982045209 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1982045209 0 Physicians Anesthesia Services 20 1982045209 0 Physicians 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2018335 9999999 B 10 1982048435 0 210 S DESPLAINES ST CHICAGO IL 606615500 20 1982048435 0 Physicians Anesthesia Services 20 1982048435 0 Physicians Fluoride varnish 20 1982048435 0 Physicians Healthy Kids Services 20 1982048435 0 Physicians Optical Supplies 20 1982048435 0 Physicians Physician Services 00 1982048617 0 PETERSON LAURA 2022122 9999999 B 10 1982048617 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1982048617 0 Physicians Anesthesia Services 20 1982048617 0 Physicians Fluoride varnish 20 1982048617 0 Physicians Healthy Kids Services 20 1982048617 0 Physicians Optical Supplies 20 1982048617 0 Physicians Physician Services 00 1982049268 0 LANE EMMA N 2013168 9999999 B 10 1982049268 0 110 CARVER LN EAST PEORIA IL 616113052 20 1982049268 0 Speech Therapists Medical Supplies 20 1982049268 0 Speech Therapists Medical equipment/prosthetic devices 20 1982049268 0 Speech Therapists Speech Therapy/Pathology Services 00 1982049458 0 AWOMOLO ARINOLA 2017156 9999999 B 10 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1982121521 0 Speech Therapists Medical equipment/prosthetic devices 20 1982121521 0 Speech Therapists Speech Therapy/Pathology Services 00 1982122511 0 HOLLAND KATE M 2017291 9999999 B 10 1982122511 0 6021 S 74TH AVE SUMMIT ARGO IL 605011500 20 1982122511 0 Speech Therapists Medical Supplies 20 1982122511 0 Speech Therapists Medical equipment/prosthetic devices 20 1982122511 0 Speech Therapists Speech Therapy/Pathology Services 00 1982123469 0 PARMAR BIJAL 2020304 9999999 B 10 1982123469 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1982123469 0 Physician Assistant Only Fluoride varnish 20 1982123469 0 Physician Assistant Only Healthy Kids Services 20 1982123469 0 Physician Assistant Only Physician Services 00 1982123899 0 LEWIS NICOLE M 2017242 9999999 B 10 1982123899 0 4321 COLLINGTON RD BOWIE MD 207162259 20 1982123899 0 Nurse Practitioners Fluoride varnish 20 1982123899 0 Nurse Practitioners Healthy Kids Services 20 1982123899 0 Nurse Practitioners Nurse Practitioners Services 20 1982123899 0 Nurse Practitioners Physician Services 00 1982124566 0 GIBSON DANA 2017186 9999999 B 10 1982124566 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1982124566 0 Nurse Practitioners Fluoride varnish 20 1982124566 0 Nurse Practitioners Healthy Kids Services 20 1982124566 0 Nurse Practitioners Nurse Practitioners Services 20 1982124566 0 Nurse Practitioners Physician Services 00 1982124657 0 WATSON CARA 2023153 9999999 B 10 1982124657 0 1 HOSPITAL DR COLUMBIA MO 652120001 20 1982124657 0 Physicians Anesthesia Services 20 1982124657 0 Physicians Healthy Kids Services 20 1982124657 0 Physicians Optical Supplies 20 1982124657 0 Physicians Physician Services 00 1982125159 0 SIEMBIDA JAKUB 2023188 9999999 B 10 1982125159 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1982125159 0 Physicians Anesthesia Services 20 1982125159 0 Physicians Healthy Kids Services 20 1982125159 0 Physicians Optical Supplies 20 1982125159 0 Physicians Physician Services 00 1982127114 0 RAICU OANA A 2020031 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20 1982128724 0 Clinical Social Worker Social work service 00 1982130324 0 KOTAGAL TARA 2018351 9999999 B 10 1982130324 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1982130324 0 Physicians Anesthesia Services 20 1982130324 0 Physicians Fluoride varnish 20 1982130324 0 Physicians Healthy Kids Services 20 1982130324 0 Physicians Optical Supplies 20 1982130324 0 Physicians Physician Services 00 1982130829 0 ROWE TIMOTHY J 2024141 9999999 B 10 1982130829 0 5777 DEPT CAROL STREAM IL 601220021 20 1982130829 0 Physicians Anesthesia Services 20 1982130829 0 Physicians Fluoride varnish 20 1982130829 0 Physicians Healthy Kids Services 20 1982130829 0 Physicians Optical Supplies 20 1982130829 0 Physicians Physician Services 00 1982131488 0 RUSSELL LUKE 2022102 9999999 B 10 1982131488 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1982131488 0 Physicians Anesthesia Services 20 1982131488 0 Physicians Fluoride varnish 20 1982131488 0 Physicians Healthy Kids Services 20 1982131488 0 Physicians Optical Supplies 20 1982131488 0 Physicians Physician Services 00 1982131835 0 SHAH RUTVIK 2023125 9999999 B 10 1982131835 0 PO BOX 17633 BELFAST ME 049154071 20 1982131835 0 Physicians Anesthesia Services 20 1982131835 0 Physicians Fluoride varnish 20 1982131835 0 Physicians Healthy Kids Services 20 1982131835 0 Physicians Optical Supplies 20 1982131835 0 Physicians Physician Services 00 1982132528 0 COLE MICHAEL 2020059 9999999 B 10 1982132528 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1982132528 0 Physicians Anesthesia Services 20 1982132528 0 Physicians Fluoride varnish 20 1982132528 0 Physicians Healthy Kids Services 20 1982132528 0 Physicians Optical Supplies 20 1982132528 0 Physicians Physician Services 20 1982132528 0 Physicians Physicians Psychiatric Services 00 1982133294 0 POBLOCKI ANGELA D 2024052 9999999 B 10 1982133294 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1982133294 0 Physician Assistant Only Fluoride varnish 20 1982133294 0 Physician Assistant Only Healthy Kids Services 20 1982133294 0 Physician Assistant Only Physician Services 00 1982134334 0 MENON NANDAKUMAR 2023191 9999999 B 10 1982134334 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1982134334 0 Physicians Anesthesia Services 20 1982134334 0 Physicians Healthy Kids Services 20 1982134334 0 Physicians Optical Supplies 20 1982134334 0 Physicians Physician Services 00 1982134557 0 TINSLEY JENNIFER J 2021119 9999999 B 10 1982134557 0 1000 HEALTH CENTER DR MATTOON IL 619384644 20 1982134557 0 Nurse Practitioners Healthy Kids Services 20 1982134557 0 Nurse Practitioners Nurse Practitioners Services 20 1982134557 0 Nurse Practitioners Physician Services 00 1982134953 0 FRAWLEY KATHERINE ANNE 2017213 9999999 B 10 1982134953 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1982134953 0 Physician Assistant Only Fluoride varnish 20 1982134953 0 Physician Assistant Only Healthy Kids Services 20 1982134953 0 Physician Assistant Only Physician Services 00 1982135067 0 AMIN SHETAL P 2023353 9999999 B 10 1982135067 0 PO BOX 5081 JANESVILLE WI 535475081 20 1982135067 0 Physicians Anesthesia Services 20 1982135067 0 Physicians Healthy Kids Services 20 1982135067 0 Physicians Optical Supplies 20 1982135067 0 Physicians Physician Services 20 1982135067 0 Physicians Physicians Psychiatric Services 00 1982135398 0 CONNOR SARA 2017093 9999999 B 10 1982135398 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1982135398 0 Occupational Therapists Medical Supplies 20 1982135398 0 Occupational Therapists Medical equipment/prosthetic devices 20 1982135398 0 Occupational Therapists Occupational Therapy Services 00 1982135927 0 SCANLON SAMANTHA 2024206 9999999 B 10 1982135927 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1982135927 0 Physicians Anesthesia Services 20 1982135927 0 Physicians Fluoride varnish 20 1982135927 0 Physicians Healthy Kids Services 20 1982135927 0 Physicians Optical Supplies 20 1982135927 0 Physicians Physician Services 00 1982136503 0 ABBO JOSEPH 2023120 9999999 B 10 1982136503 0 PO BOX 486 SAN JACINTO CA 925810486 20 1982136503 0 Physicians Anesthesia Services 20 1982136503 0 Physicians Healthy Kids Services 20 1982136503 0 Physicians Optical Supplies 20 1982136503 0 Physicians Physician Services 00 1982137147 0 DICKSON DANIEL A 2017242 9999999 B 10 1982137147 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1982137147 0 Psychologist Psychologist service 00 1982137220 0 KELSHEIMER CHRISTOPHER J 2021203 9999999 B 10 1982137220 0 339 CONSORT DR BALLWIN MO 630114439 20 1982137220 0 Physicians Anesthesia Services 20 1982137220 0 Physicians Healthy Kids Services 20 1982137220 0 Physicians Optical Supplies 20 1982137220 0 Physicians Physician Services 00 1982137428 0 LAMPERT JENNIFER L 2017226 9999999 B 10 1982137428 0 PO BOX 1510 EVANSVILLE IN 477061510 20 1982137428 0 Nurse Practitioners Healthy Kids Services 20 1982137428 0 Nurse Practitioners Nurse Practitioners Services 20 1982137428 0 Nurse Practitioners Physician Services 00 1982137436 0 LAI MONICA K 2020027 9999999 B 10 1982137436 0 29373 NETWORK PL CHICAGO IL 606733039 20 1982137436 0 Physicians Anesthesia Services 20 1982137436 0 Physicians Healthy Kids Services 20 1982137436 0 Physicians Optical Supplies 20 1982137436 0 Physicians Physician Services 00 1982137501 0 HUYNH PATRICK 2021321 9999999 B 10 1982137501 0 3825 N LAFAYETTE ST DENVER CO 802053316 20 1982137501 0 Nurse Practitioners Fluoride varnish 20 1982137501 0 Nurse Practitioners Healthy Kids Services 20 1982137501 0 Nurse Practitioners Nurse Practitioners Services 20 1982137501 0 Nurse Practitioners Physician Services 00 1982137618 0 CARROLL ELIZABETH E 2024183 9999999 B 10 1982137618 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1982137618 0 Physicians Anesthesia Services 20 1982137618 0 Physicians Healthy Kids Services 20 1982137618 0 Physicians Optical Supplies 20 1982137618 0 Physicians Physician Services 20 1982137618 0 Physicians Physicians Psychiatric Services 00 1982137766 0 SIEGEL AVIELLE 2019182 9999999 B 10 1982137766 0 44000 GARFIELD RD CLINTON TOWNSHI MI 480381125 20 1982137766 0 Physicians Anesthesia Services 20 1982137766 0 Physicians Healthy Kids Services 20 1982137766 0 Physicians Optical Supplies 20 1982137766 0 Physicians Physician Services 00 1982138921 0 CURRY TAYLOR A 2024254 9999999 B 10 1982138921 0 PO BOX 778912 CHICAGO IL 606778912 20 1982138921 0 Physicians Anesthesia Services 20 1982138921 0 Physicians Fluoride varnish 20 1982138921 0 Physicians Healthy Kids Services 20 1982138921 0 Physicians Optical Supplies 20 1982138921 0 Physicians Physician Services 00 1982138988 0 SRIVANGIPURAM SUDARSANA 2020242 9999999 B 10 1982138988 0 PO BOX 708760 SANDY UT 840708760 20 1982138988 0 Physicians Anesthesia Services 20 1982138988 0 Physicians Fluoride varnish 20 1982138988 0 Physicians Healthy Kids Services 20 1982138988 0 Physicians Optical Supplies 20 1982138988 0 Physicians Physician Services 00 1982139069 0 MADDEN NIGEL I 2021220 9999999 B 10 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AVE CALUMET CITY IL 604096218 20 1982142527 0 Nurse Practitioners Fluoride varnish 20 1982142527 0 Nurse Practitioners Healthy Kids Services 20 1982142527 0 Nurse Practitioners Nurse Practitioners Services 20 1982142527 0 Nurse Practitioners Physician Services 00 1982142923 0 ROLAND VALERIE S 2017041 9999999 B 10 1982142923 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1982142923 0 Clinical Social Worker Social work service 00 1982143335 0 CANTU-SANTOLI SHANNAN R 2017032 9999999 B 10 1982143335 0 3230 VETERANS MEMORIAL DR MOUNT VERNON IL 628645950 20 1982143335 0 Nurse Practitioners All Kids application agent 20 1982143335 0 Nurse Practitioners Healthy Kids Services 20 1982143335 0 Nurse Practitioners Midwife Services 20 1982143335 0 Nurse Practitioners Nurse Practitioners Services 20 1982143335 0 Nurse Practitioners Physician Services 00 1982143434 0 SCOTT CAITLIN 2017289 9999999 B 10 1982143434 0 330 SW WASHINGTON ST PEORIA IL 616021406 20 1982143434 0 Other behavior health professional LCPC/LMFT services 00 1982143582 0 ANUKWU IJEOMA 2017213 9999999 B 10 1982143582 0 430 E 162ND ST SOUTH HOLLAND IL 604732258 20 1982143582 0 Nurse Practitioners Fluoride varnish 20 1982143582 0 Nurse Practitioners Healthy Kids Services 20 1982143582 0 Nurse Practitioners Nurse Practitioners Services 20 1982143582 0 Nurse Practitioners Physician Services 00 1982144762 0 OSTRANDER LU ANN 2017060 9999999 B 10 1982144762 0 4701 DEPT CAROL STREAM IL 601220021 20 1982144762 0 Nurse Practitioners Family Planning Counseling 20 1982144762 0 Nurse Practitioners Healthy Kids Services 20 1982144762 0 Nurse Practitioners Nurse Practitioners Services 20 1982144762 0 Nurse Practitioners Physician Services 00 1982145280 0 MARMOL CHRISTINA 2020253 9999999 B 10 1982145280 0 PO BOX 21844 BELFAST ME 049154115 20 1982145280 0 Physicians Anesthesia Services 20 1982145280 0 Physicians Fluoride varnish 20 1982145280 0 Physicians Healthy Kids Services 20 1982145280 0 Physicians Optical Supplies 20 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Healthy Kids Services 20 1982167110 0 Physicians Optical Supplies 20 1982167110 0 Physicians Physician Services 00 1982167144 0 COFFEY SABRINA 2019105 9999999 B 10 1982167144 0 1940 S WESTERN AVE STE 205 CHICAGO IL 606082503 20 1982167144 0 Clinical Social Worker Social work service 00 1982167730 0 MURPHY DARRIAN 2024255 9999999 B 10 1982167730 0 29373 NETWORK PL CHICAGO IL 606733039 20 1982167730 0 Physicians Anesthesia Services 20 1982167730 0 Physicians Healthy Kids Services 20 1982167730 0 Physicians Optical Supplies 20 1982167730 0 Physicians Physician Services 20 1982167730 0 Physicians Physicians Psychiatric Services 00 1982167797 0 XIONG YAJING Y 2023163 9999999 B 10 1982167797 0 4698 DEPT CAROL STREAM IL 601220021 20 1982167797 0 Physicians Anesthesia Services 20 1982167797 0 Physicians Healthy Kids Services 20 1982167797 0 Physicians Optical Supplies 20 1982167797 0 Physicians Physician Services 20 1982167797 0 Physicians Physicians Psychiatric Services 00 1982167946 0 MUNROE ALEXANDRA M 2021306 9999999 B 10 1982167946 0 50 S MAIN ST STE 200 NAPERVILLE IL 605405485 20 1982167946 0 Speech Therapists Medical Supplies 20 1982167946 0 Speech Therapists Medical equipment/prosthetic devices 20 1982167946 0 Speech Therapists Speech Therapy/Pathology Services 00 1982169199 0 WHITE KEVIN 2020183 9999999 B 10 1982169199 0 1145 CORPORATE LAKE DR SAINT LOUIS MO 631322907 20 1982169199 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1982169769 0 CALPE JUSTIN 2023011 9999999 B 10 1982169769 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1982169769 0 Occupational Therapists Medical Supplies 20 1982169769 0 Occupational Therapists Medical equipment/prosthetic devices 20 1982169769 0 Occupational Therapists Occupational Therapy Services 00 1982170601 0 GARG DEEPALI 2020203 9999999 B 10 1982170601 0 PO BOX 411637 SAINT LOUIS MO 631411637 20 1982170601 0 Physicians Anesthesia Services 20 1982170601 0 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IL 627621000 20 1982175691 0 Physician Assistant Only Fluoride varnish 20 1982175691 0 Physician Assistant Only Healthy Kids Services 20 1982175691 0 Physician Assistant Only Physician Services 00 1982176889 0 ROMERO RAYMOND C 2018351 9999999 B 10 1982176889 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1982176889 0 Registered nurse Nursing service 20 1982176889 0 Registered nurse Waiver service 00 1982177135 0 PAPKE JACOB 2020122 9999999 B 10 1982177135 0 800 W FULTON MARKET FL 12 CHICAGO IL 606071302 20 1982177135 0 Physician Assistant Only Fluoride varnish 20 1982177135 0 Physician Assistant Only Healthy Kids Services 20 1982177135 0 Physician Assistant Only Physician Services 00 1982177473 0 ENOH CAROLINE 2018216 9999999 B 10 1982177473 0 6916 CERMAK RD BERWYN IL 604022244 20 1982177473 0 Nurse Practitioners Fluoride varnish 20 1982177473 0 Nurse Practitioners Healthy Kids Services 20 1982177473 0 Nurse Practitioners Nurse Practitioners Services 20 1982177473 0 Nurse Practitioners 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0 Speech Therapists Medical equipment/prosthetic devices 20 1982181178 0 Speech Therapists Speech Therapy/Pathology Services 00 1982181418 0 RAHMAN SYED ABDUL 2020027 9999999 B 10 1982181418 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1982181418 0 Physicians Anesthesia Services 20 1982181418 0 Physicians Healthy Kids Services 20 1982181418 0 Physicians Optical Supplies 20 1982181418 0 Physicians Physician Services 00 1982182085 0 GHELANI SEEMA 2023220 9999999 B 10 1982182085 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1982182085 0 Physicians Anesthesia Services 20 1982182085 0 Physicians Healthy Kids Services 20 1982182085 0 Physicians Optical Supplies 20 1982182085 0 Physicians Physician Services 00 1982182424 0 DALEY NICOLE 2018291 9999999 B 10 1982182424 0 5777 DEPT CAROL STREAM IL 601228942 20 1982182424 0 Nurse Practitioners Fluoride varnish 20 1982182424 0 Nurse Practitioners Healthy Kids Services 20 1982182424 0 Nurse Practitioners Nurse Practitioners Services 20 1982182424 0 Nurse Practitioners Physician Services 00 1982183562 0 OCONNER HEATHER 2018227 9999999 B 10 1982183562 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1982183562 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1982183711 0 GREGORIOU KIMBERLY 2021322 9999999 B 10 1982183711 0 PO BOX 713388 CHICAGO IL 606771525 20 1982183711 0 Nurse Practitioners Healthy Kids Services 20 1982183711 0 Nurse Practitioners Nurse Practitioners Services 20 1982183711 0 Nurse Practitioners Physician Services 00 1982183836 0 PETERSEN NATALIE M 2018339 9999999 B 10 1982183836 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1982183836 0 Nurse Practitioners Fluoride varnish 20 1982183836 0 Nurse Practitioners Healthy Kids Services 20 1982183836 0 Nurse Practitioners Nurse Practitioners Services 20 1982183836 0 Nurse Practitioners Physician Services 00 1982185450 0 PARAN CHRISTINE-MARY C 2018253 9999999 B 10 1982185450 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1982185450 0 Nurse Practitioners Fluoride varnish 20 1982185450 0 Nurse Practitioners Healthy Kids Services 20 1982185450 0 Nurse Practitioners Nurse Practitioners Services 20 1982185450 0 Nurse Practitioners Physician Services 00 1982186359 0 GERBER MICHAEL 2018288 9999999 B 10 1982186359 0 707 RIDGEVIEW DR MCHENRY IL 600507054 20 1982186359 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1982186375 0 BELKNAP KELLY 2018242 9999999 B 10 1982186375 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1982186375 0 Physical Therapists Medical Supplies 20 1982186375 0 Physical Therapists Medical equipment/prosthetic devices 20 1982186375 0 Physical Therapists Physical Therapy Services 00 1982187357 0 DENSON KAITLIN M 2018274 9999999 B 10 1982187357 0 909 RIDGEBROOK RD STE 300 SPARKS MD 211529477 20 1982187357 0 Nurse Practitioners Fluoride varnish 20 1982187357 0 Nurse 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SHUMAN BLVD STE 275 NAPERVILLE IL 605638669 20 1982192563 0 Physicians Anesthesia Services 20 1982192563 0 Physicians Healthy Kids Services 20 1982192563 0 Physicians Optical Supplies 20 1982192563 0 Physicians Physician Services 00 1982193231 0 FILATOV ASIA 2022341 9999999 B 10 1982193231 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1982193231 0 Physicians Anesthesia Services 20 1982193231 0 Physicians Healthy Kids Services 20 1982193231 0 Physicians Optical Supplies 20 1982193231 0 Physicians Physician Services 20 1982193231 0 Physicians Physicians Psychiatric Services 00 1982193389 0 SPENCER HAVEN W 2023210 9999999 B 10 1982193389 0 2 S MAIN ST MILFORD MA 017573771 20 1982193389 0 Physicians Anesthesia Services 20 1982193389 0 Physicians Healthy Kids Services 20 1982193389 0 Physicians Optical Supplies 20 1982193389 0 Physicians Physician Services 00 1982193611 0 HUGHES AILEEN 2018135 9999999 B 10 1982193611 0 PO BOX 504469 SAINT LOUIS MO 631504469 20 1982193611 0 Physical Therapists Medical Supplies 20 1982193611 0 Physical Therapists Medical equipment/prosthetic devices 20 1982193611 0 Physical Therapists Physical Therapy Services 00 1982193629 0 MCLAREN GRAHAM 2023215 9999999 B 10 1982193629 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1982193629 0 Physicians Anesthesia Services 20 1982193629 0 Physicians Healthy Kids Services 20 1982193629 0 Physicians Optical Supplies 20 1982193629 0 Physicians Physician Services 00 1982194593 0 GRAHAM CALELA 2018142 9999999 B 10 1982194593 0 1414 MAIN ST MELROSE PARK IL 601603902 20 1982194593 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1982194965 0 BARKER ERIN A 2018135 9999999 B 10 1982194965 0 301 E COLUMBIA ST ARTHUR IL 619111403 20 1982194965 0 Speech Therapists Medical Supplies 20 1982194965 0 Speech Therapists Medical equipment/prosthetic devices 20 1982194965 0 Speech Therapists Speech Therapy/Pathology Services 00 1982196499 0 ANDREATOS NIKOLAOS 2024214 9999999 B 10 1982196499 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1982196499 0 Physicians Anesthesia Services 20 1982196499 0 Physicians Fluoride varnish 20 1982196499 0 Physicians Healthy Kids Services 20 1982196499 0 Physicians Optical Supplies 20 1982196499 0 Physicians Physician Services 00 1982196614 0 BECK ELIN C 2021218 9999999 B 10 1982196614 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1982196614 0 Physicians Anesthesia Services 20 1982196614 0 Physicians Fluoride varnish 20 1982196614 0 Physicians Healthy Kids Services 20 1982196614 0 Physicians Optical Supplies 20 1982196614 0 Physicians Physician Services 00 1982197067 0 SANTOS JULIAN 2023345 9999999 B 10 1982197067 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1982197067 0 Physicians Anesthesia Services 20 1982197067 0 Physicians Fluoride varnish 20 1982197067 0 Physicians Healthy Kids Services 20 1982197067 0 Physicians Optical Supplies 20 1982197067 0 Physicians Physician Services 00 1982197216 0 BICHL JANNELL A. 2018213 9999999 B 10 1982197216 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1982197216 0 Nurse Practitioners Healthy Kids Services 20 1982197216 0 Nurse Practitioners Nurse Practitioners Services 20 1982197216 0 Nurse Practitioners Physician Services 00 1982197380 0 WOLFE ELIZABETH A 2018227 9999999 B 10 1982197380 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1982197380 0 Physician Assistant Only Fluoride varnish 20 1982197380 0 Physician Assistant Only Healthy Kids Services 20 1982197380 0 Physician Assistant Only Physician Services 00 1982198271 0 KHEMANI NEHA 2023143 9999999 B 10 1982198271 0 5777 DEPT CAROL STREAM IL 601220021 20 1982198271 0 Physicians Anesthesia Services 20 1982198271 0 Physicians Healthy Kids Services 20 1982198271 0 Physicians Optical Supplies 20 1982198271 0 Physicians Physician Services 00 1982198354 0 MIRZA TAHA 2019004 9999999 B 10 1982198354 0 825 PLAINFIELD RD JOLIET IL 604355900 20 1982198354 0 Dentists Dental Services 20 1982198354 0 Dentists Physician Services 00 1982198461 0 HOEFER LEA E 2018352 9999999 B 10 1982198461 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1982198461 0 Physicians Anesthesia Services 20 1982198461 0 Physicians Healthy Kids Services 20 1982198461 0 Physicians Optical Supplies 20 1982198461 0 Physicians Physician Services 00 1982198537 0 SHUMAN MIEKA 2022048 9999999 B 10 1982198537 0 3926 W TOUHY AVE STE 372 LINCOLNWOOD IL 607121028 20 1982198537 0 Physicians Anesthesia Services 20 1982198537 0 Physicians Fluoride varnish 20 1982198537 0 Physicians Healthy Kids Services 20 1982198537 0 Physicians Optical Supplies 20 1982198537 0 Physicians Physician Services 00 1982198727 0 QUATTROCCHI MICHELE K 2018199 9999999 B 10 1982198727 0 1021 N MULFORD RD ATTN: CONTRACTING DEPT. ROCKFORD IL 611073877 20 1982198727 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1982199287 0 KEYS JOYA A 2023202 9999999 B 10 1982199287 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1982199287 0 Physicians Anesthesia Services 20 1982199287 0 Physicians Fluoride varnish 20 1982199287 0 Physicians Healthy Kids Services 20 1982199287 0 Physicians Optical Supplies 20 1982199287 0 Physicians Physician Services 00 1982199618 0 HALE CHRISTINE M 2018260 9999999 B 10 1982199618 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1982199618 0 Nurse Practitioners Healthy Kids Services 20 1982199618 0 Nurse Practitioners Nurse Practitioners Services 20 1982199618 0 Nurse Practitioners Physician Services 00 1982201158 0 SHAH NIDHI 2023209 9999999 B 10 1982201158 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1982201158 0 Nurse Practitioners Fluoride varnish 20 1982201158 0 Nurse Practitioners Healthy Kids Services 20 1982201158 0 Nurse Practitioners Nurse Practitioners Services 20 1982201158 0 Nurse Practitioners Physician Services 00 1982201463 0 REYES LEILANI 2021165 9999999 B 10 1982201463 0 100 W CHICAGO AVE STE F EAST CHICAGO IN 463123261 20 1982201463 0 Nurse Practitioners Fluoride varnish 20 1982201463 0 Nurse Practitioners Healthy Kids Services 20 1982201463 0 Nurse Practitioners Nurse Practitioners Services 20 1982201463 0 Nurse Practitioners Physician Services 00 1982201505 0 RODRIGUEZ ASHLEY 2021011 9999999 B 10 1982201505 0 2001 S CALIFORNIA AVE CHICAGO IL 606082486 20 1982201505 0 Dentists Dental Services 20 1982201505 0 Dentists Physician Services 00 1982201638 0 BEDOLLA LAURA 2020290 9999999 B 10 1982201638 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1982201638 0 Physician Assistant Only Fluoride varnish 20 1982201638 0 Physician Assistant Only Healthy Kids Services 20 1982201638 0 Physician Assistant Only Physician Services 00 1982201851 0 SCOTT NICOLE 2024117 9999999 B 10 1982201851 0 4600 3RD ST MOLINE IL 612656106 20 1982201851 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1982202206 0 CHARLES SAMANTHA R 2021021 9999999 B 10 1982202206 0 5777 DEPT CAROL STREAM IL 601220021 20 1982202206 0 Nurse Practitioners Fluoride varnish 20 1982202206 0 Nurse Practitioners Healthy Kids Services 20 1982202206 0 Nurse Practitioners Nurse Practitioners Services 20 1982202206 0 Nurse Practitioners Physician Services 00 1982203410 0 ZMRHAL PEGGY 2020301 9999999 B 10 1982203410 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1982203410 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1982203493 0 JONES NATALIE R 2020308 9999999 B 10 1982203493 0 818 5TH AVE STE 200 DES MOINES IA 503091307 20 1982203493 0 Nurse Practitioners Fluoride varnish 20 1982203493 0 Nurse Practitioners Healthy Kids Services 20 1982203493 0 Nurse Practitioners Nurse Practitioners Services 20 1982203493 0 Nurse Practitioners Physician Services 00 1982204061 0 HODGES MARTHA D 2020358 9999999 B 10 1982204061 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1982204061 0 Nurse Practitioners Fluoride varnish 20 1982204061 0 Nurse Practitioners Healthy Kids Services 20 1982204061 0 Nurse Practitioners Nurse Practitioners Services 20 1982204061 0 Nurse Practitioners Physician Services 00 1982205514 0 LARSON BREANNE L 2020343 9999999 B 10 1982205514 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1982205514 0 Nurse Practitioners Fluoride varnish 20 1982205514 0 Nurse Practitioners Healthy Kids Services 20 1982205514 0 Nurse Practitioners Nurse Practitioners Services 20 1982205514 0 Nurse Practitioners Physician Services 00 1982206900 0 FLETCHER MADISON 2021190 9999999 B 10 1982206900 0 1000 REMINGTON BLVD STE 110 BOLINGBROOK IL 604404708 20 1982206900 0 Physicians Anesthesia Services 20 1982206900 0 Physicians Healthy Kids Services 20 1982206900 0 Physicians Optical Supplies 20 1982206900 0 Physicians Physician Services 00 1982207825 0 NKEMEH CHINEZE 2021307 9999999 B 10 1982207825 0 600 HOLIDAY PLAZA DR STE 200 MATTESON IL 604432237 20 1982207825 0 Nurse Practitioners Fluoride varnish 20 1982207825 0 Nurse Practitioners Healthy Kids Services 20 1982207825 0 Nurse Practitioners Nurse Practitioners Services 20 1982207825 0 Nurse Practitioners Physician Services 00 1982208609 0 KELLEY SARAH D 2021018 9999999 B 10 1982208609 0 901 MCCLINTOCK DR STE 202 SUITE 202 BURR RIDGE IL 605270872 20 1982208609 0 Physician Assistant Only Fluoride varnish 20 1982208609 0 Physician Assistant Only Healthy Kids Services 20 1982208609 0 Physician Assistant Only Physician Services 00 1982210514 0 OUVERSON CARLY K 2022136 9999999 B 10 1982210514 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1982210514 0 Physician Assistant Only Fluoride varnish 20 1982210514 0 Physician Assistant Only Healthy Kids Services 20 1982210514 0 Physician Assistant Only Physician Services 00 1982210662 0 EID MENNAALLAH 2023228 2026181 B 10 1982210662 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1982210662 0 Physicians Anesthesia Services 20 1982210662 0 Physicians Fluoride varnish 20 1982210662 0 Physicians Healthy Kids Services 20 1982210662 0 Physicians Optical Supplies 20 1982210662 0 Physicians Physician Services 00 1982211967 0 URVEN ALICIA C 2020289 9999999 B 10 1982211967 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1982211967 0 Other behavior health professional LCPC/LMFT services 00 1982212221 0 KUNZ RYAN P 2020364 9999999 B 10 1982212221 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1982212221 0 Physician Assistant Only Fluoride varnish 20 1982212221 0 Physician Assistant Only Healthy Kids Services 20 1982212221 0 Physician Assistant Only Physician Services 00 1982212460 0 DUFF CHANAE 2020226 9999999 H 10 1982212460 0 333 N LA GRANGE RD STE 1 SUITE ONE LA GRANGE PARK IL 605265653 20 1982212460 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1982214144 0 EREBHOLO ADEBIMPE F 2021053 9999999 B 10 1982214144 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1982214144 0 Nurse Practitioners Fluoride varnish 20 1982214144 0 Nurse Practitioners Healthy Kids Services 20 1982214144 0 Nurse Practitioners Nurse Practitioners Services 20 1982214144 0 Nurse Practitioners Physician Services 00 1982215026 0 MONTALBANO EMILY ANNE 2022364 9999999 B 10 1982215026 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1982215026 0 Speech Therapists Medical Supplies 20 1982215026 0 Speech Therapists Medical equipment/prosthetic devices 20 1982215026 0 Speech Therapists Speech Therapy/Pathology Services 00 1982216644 0 YOSHIDA TYLER K 2024158 9999999 B 10 1982216644 0 4698 DEPT CAROL STREAM IL 601220021 20 1982216644 0 Physicians Anesthesia Services 20 1982216644 0 Physicians Healthy Kids Services 20 1982216644 0 Physicians Optical Supplies 20 1982216644 0 Physicians Physician Services 00 1982216776 0 SABLOAK THWISHA 2024200 9999999 B 10 1982216776 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1982216776 0 Physicians Anesthesia Services 20 1982216776 0 Physicians Healthy Kids Services 20 1982216776 0 Physicians Optical Supplies 20 1982216776 0 Physicians Physician Services 00 1982216909 0 THOMAS ASHLY 2020269 9999999 B 10 1982216909 0 1875 DEMPSTER ST STE 605 PARK RIDGE IL 600681168 20 1982216909 0 Nurse Practitioners Healthy Kids Services 20 1982216909 0 Nurse Practitioners Nurse Practitioners Services 20 1982216909 0 Nurse Practitioners Physician Services 00 1982217634 0 O'SHEA EMILY 2022119 9999999 B 10 1982217634 0 1172 STANTON RD LAKE ZURICH IL 600471747 20 1982217634 0 Physical Therapists Medical Supplies 20 1982217634 0 Physical Therapists Medical equipment/prosthetic devices 20 1982217634 0 Physical Therapists Physical Therapy Services 00 1982219788 0 SOUTHWICK JOSEPHINE 2020297 9999999 B 10 1982219788 0 100 S GRAND AVE E SPRINGFIELD IL 627621000 20 1982219788 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1982219861 0 MARIANI DIANE M 2022249 9999999 B 10 1982219861 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1982219861 0 Clinical Social Worker Social work service 00 1982221685 0 SCHWABE MARIA 2020222 9999999 B 10 1982221685 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1982221685 0 Physicians Anesthesia Services 20 1982221685 0 Physicians Healthy Kids Services 20 1982221685 0 Physicians Optical Supplies 20 1982221685 0 Physicians Physician Services 00 1982223160 0 FAUSONE MAUREEN 2024170 9999999 B 10 1982223160 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1982223160 0 Physicians Anesthesia Services 20 1982223160 0 Physicians Fluoride varnish 20 1982223160 0 Physicians Healthy Kids Services 20 1982223160 0 Physicians Optical Supplies 20 1982223160 0 Physicians Physician Services 00 1982223269 0 HAYDEN JOHN P 2024164 9999999 B 10 1982223269 0 5777 DEPT CAROL STREAM IL 601220021 20 1982223269 0 Physicians Anesthesia Services 20 1982223269 0 Physicians Healthy Kids Services 20 1982223269 0 Physicians Optical Supplies 20 1982223269 0 Physicians Physician Services 00 1982223558 0 MODI KRISHNA 2020160 9999999 B 10 1982223558 0 PO BOX 713388 CHICAGO IL 606771525 20 1982223558 0 Physicians Anesthesia Services 20 1982223558 0 Physicians Fluoride varnish 20 1982223558 0 Physicians Healthy Kids Services 20 1982223558 0 Physicians Optical Supplies 20 1982223558 0 Physicians Physician Services 00 1982224192 0 FUJA CHRISTINE KAREN 2020182 9999999 B 10 1982224192 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1982224192 0 Physicians Anesthesia Services 20 1982224192 0 Physicians Healthy Kids Services 20 1982224192 0 Physicians Optical Supplies 20 1982224192 0 Physicians Physician Services 00 1982224622 0 FAROOQ ROOHI L 2021182 9999999 B 10 1982224622 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1982224622 0 Physicians Anesthesia Services 20 1982224622 0 Physicians Healthy Kids Services 20 1982224622 0 Physicians Optical Supplies 20 1982224622 0 Physicians Physician Services 20 1982224622 0 Physicians Physicians Psychiatric Services 00 1982225173 0 FERNANDEZ ANEURIN 2020254 9999999 B 10 1982225173 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1982225173 0 Physicians Anesthesia Services 20 1982225173 0 Physicians Fluoride varnish 20 1982225173 0 Physicians Healthy Kids Services 20 1982225173 0 Physicians Optical Supplies 20 1982225173 0 Physicians Physician Services 00 1982225744 0 HIGGINS COURTNEY 2021271 9999999 B 10 1982225744 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1982225744 0 Physician Assistant Only Fluoride varnish 20 1982225744 0 Physician Assistant Only Healthy Kids Services 20 1982225744 0 Physician Assistant Only Physician Services 00 1982226056 0 HOWARD SHALAYLA 2021195 9999999 B 10 1982226056 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1982226056 0 Physicians Anesthesia Services 20 1982226056 0 Physicians Fluoride varnish 20 1982226056 0 Physicians Healthy Kids Services 20 1982226056 0 Physicians Optical Supplies 20 1982226056 0 Physicians Physician Services 00 1982227120 0 MILLER SCOTT M 2020191 9999999 B 10 1982227120 0 5777 DEPT CAROL STREAM IL 601228942 20 1982227120 0 Physicians Anesthesia Services 20 1982227120 0 Physicians Fluoride varnish 20 1982227120 0 Physicians Healthy Kids Services 20 1982227120 0 Physicians Optical Supplies 20 1982227120 0 Physicians Physician Services 00 1982227567 0 STANLEY BRONSON 2025037 9999999 B 10 1982227567 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1982227567 0 Podiatrists Podiatric Services 00 1982228839 0 CULLEN TERENCEE 2023125 9999999 B 10 1982228839 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1982228839 0 Physicians Anesthesia Services 20 1982228839 0 Physicians Fluoride varnish 20 1982228839 0 Physicians Healthy Kids Services 20 1982228839 0 Physicians Optical Supplies 20 1982228839 0 Physicians Physician Services 00 1982228912 0 LYNCH JASON P 2022213 9999999 B 10 1982228912 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1982228912 0 Physician Assistant Only Fluoride varnish 20 1982228912 0 Physician Assistant Only Healthy Kids Services 20 1982228912 0 Physician Assistant Only Physician Services 00 1982229191 0 RUSSELL PIERCE 2021258 9999999 B 10 1982229191 0 1969 W HART RD BELOIT WI 535112230 20 1982229191 0 Physical Therapists Medical Supplies 20 1982229191 0 Physical Therapists Medical equipment/prosthetic devices 20 1982229191 0 Physical Therapists Physical Therapy Services 00 1982229258 0 EDEMOBI PAUL KAMSI YONNA 2020183 9999999 B 10 1982229258 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1982229258 0 Physicians Anesthesia Services 20 1982229258 0 Physicians Healthy Kids Services 20 1982229258 0 Physicians Optical Supplies 20 1982229258 0 Physicians Physician Services 00 1982229639 0 SAID ABDULLAH M 2021238 9999999 B 10 1982229639 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1982229639 0 Physicians Anesthesia Services 20 1982229639 0 Physicians Healthy Kids Services 20 1982229639 0 Physicians Optical Supplies 20 1982229639 0 Physicians Physician Services 00 1982229944 0 KLINE CLAYTON 2022012 9999999 B 10 1982229944 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1982229944 0 Physician Assistant Only Fluoride varnish 20 1982229944 0 Physician Assistant Only Healthy Kids Services 20 1982229944 0 Physician Assistant Only Physician Services 00 1982230124 0 THOMPSON BRADLEY DAVID 2020288 9999999 B 10 1982230124 0 611 W PARK ST URBANA IL 618012529 20 1982230124 0 Nurse Practitioners Healthy Kids Services 20 1982230124 0 Nurse Practitioners Nurse Practitioners Services 20 1982230124 0 Nurse Practitioners Physician Services 00 1982230629 0 HUSSAIN ATIZAZ 2024245 9999999 B 10 1982230629 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1982230629 0 Physicians Anesthesia Services 20 1982230629 0 Physicians Healthy Kids Services 20 1982230629 0 Physicians Optical Supplies 20 1982230629 0 Physicians Physician Services 00 1982231098 0 EDWARDS LEONARD 2024013 9999999 B 10 1982231098 0 340 W 10TH ST INDIANAPOLIS IN 462023082 20 1982231098 0 Physicians Anesthesia Services 20 1982231098 0 Physicians Healthy Kids Services 20 1982231098 0 Physicians Optical Supplies 20 1982231098 0 Physicians Physician Services 00 1982232187 0 BLINN PAIGE 2020231 9999999 B 10 1982232187 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1982232187 0 Physicians Anesthesia Services 20 1982232187 0 Physicians Healthy Kids Services 20 1982232187 0 Physicians Optical Supplies 20 1982232187 0 Physicians Physician Services 00 1982232385 0 AGUIRRE DESERAY E 2023202 9999999 B 10 1982232385 0 100 W 15TH ST BEARDSTOWN IL 626181774 20 1982232385 0 Physicians Anesthesia Services 20 1982232385 0 Physicians Fluoride varnish 20 1982232385 0 Physicians Healthy Kids Services 20 1982232385 0 Physicians Optical Supplies 20 1982232385 0 Physicians Physician Services 00 1982232740 0 HISH ALEXANDER J 2021292 9999999 B 10 1982232740 0 8311 ROOSEVELT RD FOREST PARK IL 601302529 20 1982232740 0 Physicians Anesthesia Services 20 1982232740 0 Physicians Healthy Kids Services 20 1982232740 0 Physicians Optical Supplies 20 1982232740 0 Physicians Physician Services 20 1982232740 0 Physicians Physicians Psychiatric Services 00 1982232955 0 MLADENOVA GIANNA 2021007 9999999 B 10 1982232955 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1982232955 0 Physician Assistant Only Fluoride varnish 20 1982232955 0 Physician Assistant Only Healthy Kids Services 20 1982232955 0 Physician Assistant Only Physician Services 00 1982233144 0 JELDEN KATELYN 2024090 9999999 B 10 1982233144 0 PO BOX 2777 BOISE ID 837012777 20 1982233144 0 Physicians Anesthesia Services 20 1982233144 0 Physicians Healthy Kids Services 20 1982233144 0 Physicians Optical Supplies 20 1982233144 0 Physicians Physician Services 00 1982233714 0 REHMAN SYED M 2020183 9999999 B 10 1982233714 0 1S450 SUMMIT AVE STE 270 OAKBROOK TERRAC IL 601813959 20 1982233714 0 Physicians Anesthesia Services 20 1982233714 0 Physicians Fluoride varnish 20 1982233714 0 Physicians Healthy Kids Services 20 1982233714 0 Physicians Optical Supplies 20 1982233714 0 Physicians Physician Services 00 1982233946 0 DEMATTEO CHRISTOPHER J 2024001 9999999 B 10 1982233946 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1982233946 0 Physicians Anesthesia Services 20 1982233946 0 Physicians Healthy Kids Services 20 1982233946 0 Physicians Optical Supplies 20 1982233946 0 Physicians Physician Services 00 1982236659 0 DEWALD JENELLE 2020055 9999999 B 10 1982236659 0 5777 DEPT CAROL STREAM IL 601220021 20 1982236659 0 Physician Assistant Only Fluoride varnish 20 1982236659 0 Physician Assistant Only Healthy Kids Services 20 1982236659 0 Physician Assistant Only Physician Services 00 1982237343 0 KARAM DEANNA 2024282 9999999 B 10 1982237343 0 2875 W 19TH ST CHICAGO IL 606233501 20 1982237343 0 Nurse Practitioners Healthy Kids Services 20 1982237343 0 Nurse Practitioners Midwife Services 20 1982237343 0 Nurse Practitioners Nurse Practitioners Services 20 1982237343 0 Nurse Practitioners Physician Services 00 1982238135 0 RANALLO RENA 2020122 9999999 B 10 1982238135 0 2525 KANEVILLE RD GENEVA IL 601342578 20 1982238135 0 Physician Assistant Only Fluoride varnish 20 1982238135 0 Physician Assistant Only Healthy Kids Services 20 1982238135 0 Physician Assistant Only Physician Services 00 1982239547 0 WEDDLE MAE A 2020112 9999999 B 10 1982239547 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1982239547 0 Nurse Practitioners Healthy Kids Services 20 1982239547 0 Nurse Practitioners Nurse Practitioners Services 20 1982239547 0 Nurse Practitioners Physician Services 00 1982239992 0 BREUNING KATELIN M 2021053 9999999 B 10 1982239992 0 PO BOX 1109 CROWN POINT IN 463081109 20 1982239992 0 Nurse Practitioners Fluoride varnish 20 1982239992 0 Nurse Practitioners Healthy Kids Services 20 1982239992 0 Nurse Practitioners Nurse Practitioners Services 20 1982239992 0 Nurse Practitioners Physician Services 00 1982241212 0 WAINER JESSICA D 2019343 9999999 B 10 1982241212 0 755 DALHART AVE ROMEOVILLE IL 604461156 20 1982241212 0 Psychologist Psychologist service 00 1982241469 0 FATIMA AISHA 2020246 9999999 B 10 1982241469 0 8901 W LINCOLN AVE MILWAUKEE WI 532272409 20 1982241469 0 Physicians Anesthesia Services 20 1982241469 0 Physicians Healthy Kids Services 20 1982241469 0 Physicians Optical Supplies 20 1982241469 0 Physicians Physician Services 00 1982243036 0 MCANDREW JENNIFER C 2020013 9999999 B 10 1982243036 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1982243036 0 Physician Assistant Only Fluoride varnish 20 1982243036 0 Physician Assistant Only Healthy Kids Services 20 1982243036 0 Physician Assistant Only Physician Services 00 1982243432 0 LIBERTY KEVIN DOUGLAS 2023016 9999999 B 10 1982243432 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1982243432 0 Podiatrists Podiatric Services 00 1982243861 0 LAMA SHALU 2020042 9999999 B 10 1982243861 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1982243861 0 Nurse Practitioners Healthy Kids Services 20 1982243861 0 Nurse Practitioners Nurse Practitioners Services 20 1982243861 0 Nurse Practitioners Physician Services 00 1982244091 0 GREEN SHERRY 2024201 9999999 B 10 1982244091 0 1761 S NAPERVILLE RD STE 103 WHEATON IL 601895846 20 1982244091 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1982244695 0 PETREE KELLY 2024164 9999999 B 10 1982244695 0 2323 S HARVARD AVE TULSA OK 741143301 20 1982244695 0 Nurse Practitioners Healthy Kids Services 20 1982244695 0 Nurse Practitioners Nurse Practitioners Services 20 1982244695 0 Nurse Practitioners Physician Services 00 1982247342 0 WALTHES CHRISTINE L 2020070 9999999 B 10 1982247342 0 3051 HOLLIS DR SPRINGFIELD IL 627047452 20 1982247342 0 Nurse Practitioners Fluoride varnish 20 1982247342 0 Nurse Practitioners Healthy Kids Services 20 1982247342 0 Nurse Practitioners Nurse Practitioners Services 20 1982247342 0 Nurse Practitioners Physician Services 00 1982247425 0 BOYCE THOMAS 2019310 9999999 B 10 1982247425 0 29373 NETWORK PL CHICAGO IL 606733039 20 1982247425 0 Nurse Practitioners Anesthesia Services 20 1982247425 0 Nurse Practitioners Nurse Practitioners Services 20 1982247425 0 Nurse Practitioners Physician Services 00 1982250148 0 MEI ANTHONY 2023153 9999999 B 10 1982250148 0 4698 DEPT CAROL STREAM IL 601220021 20 1982250148 0 Physicians Anesthesia Services 20 1982250148 0 Physicians Healthy Kids Services 20 1982250148 0 Physicians Optical Supplies 20 1982250148 0 Physicians Physician Services 20 1982250148 0 Physicians Physicians Psychiatric Services 00 1982250643 0 DICKSON JAMES M 2023174 9999999 B 10 1982250643 0 4698 DEPT CAROL STREAM IL 601220021 20 1982250643 0 Physicians Anesthesia Services 20 1982250643 0 Physicians Healthy Kids Services 20 1982250643 0 Physicians Optical Supplies 20 1982250643 0 Physicians Physician Services 20 1982250643 0 Physicians Physicians Psychiatric Services 00 1982251054 0 LEASE BERNARD B 2022137 9999999 B 10 1982251054 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1982251054 0 Nurse Practitioners Anesthesia Services 20 1982251054 0 Nurse Practitioners Nurse Practitioners Services 20 1982251054 0 Nurse Practitioners Physician Services 00 1982251864 0 THOMPSON MELINA H 2020035 9999999 B 10 1982251864 0 1 AVIATION CTR RANTOUL IL 618663481 20 1982251864 0 Speech Therapists Medical Supplies 20 1982251864 0 Speech Therapists Medical equipment/prosthetic devices 20 1982251864 0 Speech Therapists Speech Therapy/Pathology Services 00 1982252748 0 GILL ELIZABETH A 2022363 9999999 B 10 1982252748 0 5121 MARYLAND WAY STE 300 BRENTWOOD TN 370277516 20 1982252748 0 Nurse Practitioners Healthy Kids Services 20 1982252748 0 Nurse Practitioners Nurse Practitioners Services 20 1982252748 0 Nurse Practitioners Physician Services 00 1982253654 0 PETERSEN ALLISON 2024073 9999999 B 10 1982253654 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1982253654 0 Physician Assistant Only Fluoride varnish 20 1982253654 0 Physician Assistant Only Healthy Kids Services 20 1982253654 0 Physician Assistant Only Physician Services 00 1982253670 0 HARRIS CHRISTINE 2019295 9999999 B 10 1982253670 0 2720 S RIVER RD STE 128 DES PLAINES IL 600184110 20 1982253670 0 Nurse Practitioners Fluoride varnish 20 1982253670 0 Nurse Practitioners Healthy Kids Services 20 1982253670 0 Nurse Practitioners Nurse Practitioners Services 20 1982253670 0 Nurse Practitioners Physician Services 00 1982253969 0 ROESTEL CAROLINE 2025085 9999999 B 10 1982253969 0 PO BOX 3039 OAK BROOK IL 605223039 20 1982253969 0 Registered nurse Nursing service 20 1982253969 0 Registered nurse Waiver service 00 1982254090 0 ANDERSON SARAH A 2019274 9999999 B 10 1982254090 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1982254090 0 Nurse Practitioners Healthy Kids Services 20 1982254090 0 Nurse Practitioners Nurse Practitioners Services 20 1982254090 0 Nurse Practitioners Physician Services 00 1982255139 0 GIACOMO CARLY 2019338 9999999 B 10 1982255139 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1982255139 0 Physician Assistant Only Fluoride varnish 20 1982255139 0 Physician Assistant Only Healthy Kids Services 20 1982255139 0 Physician Assistant Only Physician Services 00 1982257044 0 CARROLL JORDAN 2020017 9999999 B 10 1982257044 0 5121 MARYLAND WAY STE 300 BRENTWOOD TN 370277516 20 1982257044 0 Physician Assistant Only Fluoride varnish 20 1982257044 0 Physician Assistant Only Healthy Kids Services 20 1982257044 0 Physician Assistant Only Physician Services 00 1982257325 0 OYEBOLU MOYOSOREOLUWA 2024200 9999999 B 10 1982257325 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112386 20 1982257325 0 Dentists Dental Services 20 1982257325 0 Dentists Physician Services 00 1982258687 0 WAGNER JULIA M 2019331 9999999 B 10 1982258687 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1982258687 0 Nurse Practitioners Fluoride varnish 20 1982258687 0 Nurse Practitioners Healthy Kids Services 20 1982258687 0 Nurse Practitioners Nurse Practitioners Services 20 1982258687 0 Nurse Practitioners Physician Services 00 1982261608 0 ENRIGHT-KARWAL SHRUTI K 2019261 9999999 B 10 1982261608 0 5777 DEPT CAROL STREAM IL 601228942 20 1982261608 0 Physicians Anesthesia Services 20 1982261608 0 Physicians Fluoride varnish 20 1982261608 0 Physicians Healthy Kids Services 20 1982261608 0 Physicians Optical Supplies 20 1982261608 0 Physicians Physician Services 00 1982262580 0 BAUMGARTNER NICHOLE 2019206 9999999 B 10 1982262580 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1982262580 0 Nurse Practitioners Fluoride varnish 20 1982262580 0 Nurse Practitioners Healthy Kids Services 20 1982262580 0 Nurse Practitioners Nurse Practitioners Services 20 1982262580 0 Nurse Practitioners Physician 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1982280053 0 WILLIAMS ANDREA I 2021084 9999999 B 10 1982280053 0 3600 WOODVIEW TRCE STE 400 INDIANAPOLIS IN 462683124 20 1982280053 0 Nurse Practitioners Anesthesia Services 20 1982280053 0 Nurse Practitioners Nurse Practitioners Services 20 1982280053 0 Nurse Practitioners Physician Services 00 1982280418 0 LAFLEUR CRYSTAL B 2022200 9999999 B 10 1982280418 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1982280418 0 Physicians Anesthesia Services 20 1982280418 0 Physicians Healthy Kids Services 20 1982280418 0 Physicians Optical Supplies 20 1982280418 0 Physicians Physician Services 00 1982280566 0 POURRIAHI MAHBOD 2021168 9999999 B 10 1982280566 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1982280566 0 Physicians Anesthesia Services 20 1982280566 0 Physicians Healthy Kids Services 20 1982280566 0 Physicians Optical Supplies 20 1982280566 0 Physicians Physician Services 00 1982281572 0 WANG SOPHIA 2021179 9999999 B 10 1982281572 0 4440 W 95TH ST OAK LAWN IL 604532600 20 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Services 20 1982285409 0 Physicians Optical Supplies 20 1982285409 0 Physicians Physician Services 00 1982285797 0 ZHOU JONATHAN 2022192 9999999 B 10 1982285797 0 1501 S CALIFORNIA AVE # 7-140 CHICAGO IL 606081732 20 1982285797 0 Physicians Anesthesia Services 20 1982285797 0 Physicians Healthy Kids Services 20 1982285797 0 Physicians Optical Supplies 20 1982285797 0 Physicians Physician Services 00 1982287140 0 ROY MELISSA 2022361 9999999 B 10 1982287140 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1982287140 0 Physicians Anesthesia Services 20 1982287140 0 Physicians Healthy Kids Services 20 1982287140 0 Physicians Optical Supplies 20 1982287140 0 Physicians Physician Services 00 1982289682 0 STRUS DANUTA T 2023200 9999999 B 10 1982289682 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1982289682 0 Registered nurse Fluoride varnish 20 1982289682 0 Registered nurse Healthy Kids Services 20 1982289682 0 Registered nurse Nurse Practitioners Services 20 1982289682 0 Registered nurse Physician Services 00 1982289757 0 SHAH AROOJ 2024320 9999999 B 10 1982289757 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1982289757 0 Physicians Anesthesia Services 20 1982289757 0 Physicians Fluoride varnish 20 1982289757 0 Physicians Healthy Kids Services 20 1982289757 0 Physicians Optical Supplies 20 1982289757 0 Physicians Physician Services 00 1982293825 0 ALBERSON DEVIN 2021026 9999999 B 10 1982293825 0 PO BOX 781076 DETROIT MI 482781076 20 1982293825 0 Nurse Practitioners Healthy Kids Services 20 1982293825 0 Nurse Practitioners Nurse Practitioners Services 20 1982293825 0 Nurse Practitioners Physician Services 00 1982295457 0 JACKSON-HILL REENEE M 2021028 9999999 B 10 1982295457 0 2517 ATHENS RD OLYMPIA FIELDS IL 604611955 20 1982295457 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1982295820 0 VICKERY MELISSA 2023171 9999999 B 10 1982295820 0 PO BOX 824246 PHILADELPHIA PA 191824246 20 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600846037 20 1982305462 0 Physician Assistant Only Fluoride varnish 20 1982305462 0 Physician Assistant Only Healthy Kids Services 20 1982305462 0 Physician Assistant Only Physician Services 00 1982305660 0 ROY ANNE 2023137 9999999 H 10 1982305660 0 1900 W POLK ST SUITE 220C CHICAGO IL 60612 20 1982305660 0 Physician Assistant Only Fluoride varnish 20 1982305660 0 Physician Assistant Only Healthy Kids Services 20 1982305660 0 Physician Assistant Only Physician Services 00 1982305900 0 ALABD ZAINAB 2023193 9999999 B 10 1982305900 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112386 20 1982305900 0 Dentists Dental Services 20 1982305900 0 Dentists Physician Services 00 1982306304 0 KAISER CALIE E 2024005 9999999 B 10 1982306304 0 10625 W NORTH AVE STE 101 MILWAUKEE WI 532262315 20 1982306304 0 Physician Assistant Only Fluoride varnish 20 1982306304 0 Physician Assistant Only Healthy Kids Services 20 1982306304 0 Physician Assistant Only Physician Services 00 1982306346 0 WATKINS EVAN 2023229 9999999 B 10 1982306346 0 4698 DEPT CAROL STREAM IL 601220021 20 1982306346 0 Physicians Anesthesia Services 20 1982306346 0 Physicians Healthy Kids Services 20 1982306346 0 Physicians Optical Supplies 20 1982306346 0 Physicians Physician Services 00 1982306577 0 KRANZ MICHAEL S 2024176 9999999 B 10 1982306577 0 4698 DEPT CAROL STREAM IL 601224698 20 1982306577 0 Physicians Anesthesia Services 20 1982306577 0 Physicians Fluoride varnish 20 1982306577 0 Physicians Healthy Kids Services 20 1982306577 0 Physicians Optical Supplies 20 1982306577 0 Physicians Physician Services 00 1982306627 0 PETERS JOHN 2023201 9999999 B 10 1982306627 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1982306627 0 Physicians Anesthesia Services 20 1982306627 0 Physicians Fluoride varnish 20 1982306627 0 Physicians Healthy Kids Services 20 1982306627 0 Physicians Optical Supplies 20 1982306627 0 Physicians Physician Services 00 1982306684 0 UJANO DANICA CECIL 2024168 9999999 B 10 1982306684 0 PO BOX 3039 OAK BROOK IL 605223039 20 1982306684 0 Physicians Anesthesia Services 20 1982306684 0 Physicians Fluoride varnish 20 1982306684 0 Physicians Healthy Kids Services 20 1982306684 0 Physicians Optical Supplies 20 1982306684 0 Physicians Physician Services 00 1982306759 0 TIAN WILLIAM M 2024176 9999999 B 10 1982306759 0 4698 DEPT CAROL STREAM IL 601220021 20 1982306759 0 Physicians Anesthesia Services 20 1982306759 0 Physicians Healthy Kids Services 20 1982306759 0 Physicians Optical Supplies 20 1982306759 0 Physicians Physician Services 00 1982306908 0 YANG BROOKE L 2023201 9999999 B 10 1982306908 0 4698 DEPT CAROL STREAM IL 601224698 20 1982306908 0 Physicians Anesthesia Services 20 1982306908 0 Physicians Fluoride varnish 20 1982306908 0 Physicians Healthy Kids Services 20 1982306908 0 Physicians Optical Supplies 20 1982306908 0 Physicians Physician Services 00 1982306916 0 LEE DAVID SM 2023143 9999999 B 10 1982306916 0 4698 DEPT CAROL STREAM IL 601220021 20 1982306916 0 Physicians Anesthesia Services 20 1982306916 0 Physicians Fluoride varnish 20 1982306916 0 Physicians Healthy Kids Services 20 1982306916 0 Physicians Optical Supplies 20 1982306916 0 Physicians Physician Services 00 1982307484 0 CHINEYEMBA PRAISE T 2023297 9999999 B 10 1982307484 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1982307484 0 Physicians Anesthesia Services 20 1982307484 0 Physicians Healthy Kids Services 20 1982307484 0 Physicians Optical Supplies 20 1982307484 0 Physicians Physician Services 00 1982307716 0 LEESTMA ERIN AMELIA 2023192 9999999 B 10 1982307716 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1982307716 0 Physicians Anesthesia Services 20 1982307716 0 Physicians Healthy Kids Services 20 1982307716 0 Physicians Optical Supplies 20 1982307716 0 Physicians Physician Services 20 1982307716 0 Physicians Physicians Psychiatric Services 00 1982307922 0 YUAN KLA 2023363 9999999 B 10 1982307922 0 124 SW ADAMS ST PEORIA IL 616021308 20 1982307922 0 Physicians Anesthesia Services 20 1982307922 0 Physicians Healthy Kids Services 20 1982307922 0 Physicians Optical Supplies 20 1982307922 0 Physicians Physician Services 20 1982307922 0 Physicians Physicians Psychiatric Services 00 1982307997 0 WIESER JOHN 2023108 9999999 B 10 1982307997 0 PO BOX 3039 OAK BROOK IL 605223039 20 1982307997 0 Physicians Anesthesia Services 20 1982307997 0 Physicians Fluoride varnish 20 1982307997 0 Physicians Healthy Kids Services 20 1982307997 0 Physicians Optical Supplies 20 1982307997 0 Physicians Physician Services 00 1982308060 0 SHENG ANN 2023136 9999999 B 10 1982308060 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1982308060 0 Physician Assistant Only Fluoride varnish 20 1982308060 0 Physician Assistant Only Healthy Kids Services 20 1982308060 0 Physician Assistant Only Physician Services 00 1982308920 0 SUKHWINDAR AJIMAL S 2023194 9999999 B 10 1982308920 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1982308920 0 Physicians Anesthesia Services 20 1982308920 0 Physicians Healthy Kids Services 20 1982308920 0 Physicians Optical Supplies 20 1982308920 0 Physicians Physician Services 00 1982309597 0 MARTINS-CORREIA ISLEY 2023182 9999999 B 10 1982309597 0 PO BOX 3039 OAK BROOK IL 605223039 20 1982309597 0 Physicians Anesthesia Services 20 1982309597 0 Physicians Fluoride varnish 20 1982309597 0 Physicians Healthy Kids Services 20 1982309597 0 Physicians Optical Supplies 20 1982309597 0 Physicians Physician Services 00 1982309746 0 CHRISTIAN HEIDI 2023182 9999999 B 10 1982309746 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1982309746 0 Physicians Anesthesia Services 20 1982309746 0 Physicians Healthy Kids Services 20 1982309746 0 Physicians Optical Supplies 20 1982309746 0 Physicians Physician Services 00 1982309878 0 BUCKINGHAM BROOKE 2024176 9999999 B 10 1982309878 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1982309878 0 Physicians Anesthesia Services 20 1982309878 0 Physicians Fluoride varnish 20 1982309878 0 Physicians Healthy Kids Services 20 1982309878 0 Physicians Optical Supplies 20 1982309878 0 Physicians Physician Services 00 1982310835 0 MCBEATH EMILY E 2023145 9999999 B 10 1982310835 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1982310835 0 Physician Assistant Only Fluoride varnish 20 1982310835 0 Physician Assistant Only Healthy Kids Services 20 1982310835 0 Physician Assistant Only Physician Services 00 1982310868 0 SETHI ZUBIN H 2024183 9999999 B 10 1982310868 0 PO BOX 3039 OAK BROOK IL 605223039 20 1982310868 0 Physicians Anesthesia Services 20 1982310868 0 Physicians Healthy Kids Services 20 1982310868 0 Physicians Optical Supplies 20 1982310868 0 Physicians Physician Services 00 1982313318 0 UDAGWUA JUDE 2022350 9999999 B 10 1982313318 0 600 HOLIDAY PLAZA DR STE 200 MATTESON IL 604432237 20 1982313318 0 Nurse Practitioners Fluoride varnish 20 1982313318 0 Nurse Practitioners Healthy Kids Services 20 1982313318 0 Nurse Practitioners Nurse Practitioners Services 20 1982313318 0 Nurse Practitioners Physician Services 00 1982319851 0 ROETHLISBERGER MEL 2023016 9999999 B 10 1982319851 0 4698 DEPT CAROL STREAM IL 601220021 20 1982319851 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1982320222 0 AMAANATH NASREEN 2023160 9999999 B 10 1982320222 0 1203 W AUGUSTA BLVD APT 2S CHICAGO IL 606424327 20 1982320222 0 Physician Assistant Only Fluoride varnish 20 1982320222 0 Physician Assistant Only Healthy Kids Services 20 1982320222 0 Physician Assistant Only Physician Services 00 1982320362 0 FAIRCHILD ALLYSON 2024088 9999999 B 10 1982320362 0 2600 DEKALB AVE STE J SYCAMORE IL 601783132 20 1982320362 0 Other behavior health professional LCPC/LMFT services 00 1982322327 0 PAGADALA JILLIAN L 2022237 9999999 B 10 1982322327 0 10150 DEE RD DES PLAINES IL 600161512 20 1982322327 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1982322723 0 SHIM RACHEL 2022239 9999999 B 10 1982322723 0 502 WAVERLY DR ELGIN IL 601204082 20 1982322723 0 Optometrists Optical Supplies 20 1982322723 0 Optometrists Optometric Services 20 1982322723 0 Optometrists Physician Services 00 1982324513 0 HACKL LAUREN 2022245 9999999 B 10 1982324513 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1982324513 0 Occupational Therapists Medical Supplies 20 1982324513 0 Occupational Therapists Medical equipment/prosthetic devices 20 1982324513 0 Occupational Therapists Occupational Therapy Services 00 1982324760 0 THREET DANA M 2024306 9999999 B 10 1982324760 0 28100 TORCH PKWY STE 600 WARRENVILLE IL 605554030 20 1982324760 0 Speech Therapists Medical Supplies 20 1982324760 0 Speech Therapists Medical equipment/prosthetic devices 20 1982324760 0 Speech Therapists Speech Therapy/Pathology Services 00 1982325171 0 JACKSON SHATOYA M 2022266 9999999 B 10 1982325171 0 1325 SYCAMORE RD DEKALB IL 601152483 20 1982325171 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1982325866 0 MCMURTRY ASHLEY 2024107 9999999 B 10 1982325866 0 719 W LAKE AVE PEORIA IL 616145941 20 1982325866 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1982329751 0 ACKERSON AARON 2023011 9999999 B 10 1982329751 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1982329751 0 Nurse Practitioners Healthy Kids Services 20 1982329751 0 Nurse Practitioners Nurse Practitioners Services 20 1982329751 0 Nurse Practitioners Physician Services 00 1982330163 0 REYES JENNIFER 2023059 9999999 B 10 1982330163 0 5906 ELAINE DR STE 103 ROCKFORD IL 611082467 20 1982330163 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1982332656 0 JONES RHONDA M 2022227 9999999 H 10 1982332656 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1982332656 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT 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AMANDA J 2024302 9999999 B 10 1982336665 0 5383 STATE ROUTE 154 PO BOX 437 PINCKNEYVILLE IL 622743342 20 1982336665 0 Nurse Practitioners Fluoride varnish 20 1982336665 0 Nurse Practitioners Healthy Kids Services 20 1982336665 0 Nurse Practitioners Nurse Practitioners Services 20 1982336665 0 Nurse Practitioners Physician Services 00 1982336855 0 INYANG MIRABEL 2022234 9999999 B 10 1982336855 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1982336855 0 Physicians Anesthesia Services 20 1982336855 0 Physicians Fluoride varnish 20 1982336855 0 Physicians Healthy Kids Services 20 1982336855 0 Physicians Optical Supplies 20 1982336855 0 Physicians Physician Services 00 1982337432 0 LONNEBOTN MYA 2024213 9999999 B 10 1982337432 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1982337432 0 Physician Assistant Only Fluoride varnish 20 1982337432 0 Physician Assistant Only Healthy Kids Services 20 1982337432 0 Physician Assistant Only Physician Services 00 1982337572 0 AGBOOLA ADEROJU F 2024254 9999999 B 10 1982337572 0 4259 S BERKELEY AVE CHICAGO IL 606533030 20 1982337572 0 Physician Assistant Only Fluoride varnish 20 1982337572 0 Physician Assistant Only Healthy Kids Services 20 1982337572 0 Physician Assistant Only Physician Services 00 1982338349 0 BROUSTIS PAIGE 2024039 9999999 B 10 1982338349 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1982338349 0 Physician Assistant Only Fluoride varnish 20 1982338349 0 Physician Assistant Only Healthy Kids Services 20 1982338349 0 Physician Assistant Only Physician Services 00 1982338844 0 BURKE TAYLOR R 2022227 9999999 B 10 1982338844 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1982338844 0 Nurse Practitioners Fluoride varnish 20 1982338844 0 Nurse Practitioners Healthy Kids Services 20 1982338844 0 Nurse Practitioners Nurse Practitioners Services 20 1982338844 0 Nurse Practitioners Physician Services 00 1982338877 0 HUNT DAVID 2022201 9999999 B 10 1982338877 0 PO BOX 3988 CARBONDALE IL 629023988 20 1982338877 0 Nurse Practitioners Healthy Kids Services 20 1982338877 0 Nurse Practitioners Nurse Practitioners Services 20 1982338877 0 Nurse Practitioners Physician Services 00 1982339339 0 SCHLOTTER MARGARET 2022201 9999999 H 10 1982339339 0 PO BOX 146 WATERLOO IL 622980146 20 1982339339 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1982339917 0 MERKEL COURTNEY 2022334 9999999 B 10 1982339917 0 PO BOX 3407 EVANSVILLE IN 477333407 20 1982339917 0 Nurse Practitioners Healthy Kids Services 20 1982339917 0 Nurse Practitioners Nurse Practitioners Services 20 1982339917 0 Nurse Practitioners Physician Services 00 1982339974 0 SCHROEDER MARISSA 2022333 9999999 B 10 1982339974 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1982339974 0 Nurse Practitioners Fluoride varnish 20 1982339974 0 Nurse Practitioners Healthy Kids Services 20 1982339974 0 Nurse Practitioners Nurse Practitioners Services 20 1982339974 0 Nurse Practitioners Physician Services 00 1982340360 0 TATAVARTHY MANVITA 2022207 9999999 B 10 1982340360 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1982340360 0 Physicians Anesthesia Services 20 1982340360 0 Physicians Fluoride varnish 20 1982340360 0 Physicians Healthy Kids Services 20 1982340360 0 Physicians Optical Supplies 20 1982340360 0 Physicians Physician Services 00 1982340790 0 MA CHRISTINE K 2023013 9999999 B 10 1982340790 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1982340790 0 Physicians Anesthesia Services 20 1982340790 0 Physicians Fluoride varnish 20 1982340790 0 Physicians Healthy Kids Services 20 1982340790 0 Physicians Optical Supplies 20 1982340790 0 Physicians Physician Services 00 1982340832 0 BULUSAN JEWEL 2024236 9999999 B 10 1982340832 0 415 W GOLF RD STE 52 ARLINGTON HEIGH IL 600053923 20 1982340832 0 Occupational Therapists Medical Supplies 20 1982340832 0 Occupational Therapists Medical equipment/prosthetic devices 20 1982340832 0 Occupational Therapists Occupational Therapy Services 00 1982342192 0 TURNER MATT 2022186 9999999 B 10 1982342192 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1982342192 0 Physicians Anesthesia Services 20 1982342192 0 Physicians Fluoride varnish 20 1982342192 0 Physicians Healthy Kids Services 20 1982342192 0 Physicians Optical Supplies 20 1982342192 0 Physicians Physician Services 00 1982343422 0 MORALES MARGARITA A 2024019 9999999 B 10 1982343422 0 17W679 ROOSEVELT RD OAKBROOK TERRAC IL 601813545 20 1982343422 0 Dentists Dental Services 20 1982343422 0 Dentists Physician Services 00 1982343935 0 HASHWEH NADER 2022179 9999999 B 10 1982343935 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1982343935 0 Physicians Anesthesia Services 20 1982343935 0 Physicians Healthy Kids Services 20 1982343935 0 Physicians Optical Supplies 20 1982343935 0 Physicians Physician Services 20 1982343935 0 Physicians Physicians Psychiatric Services 00 1982344214 0 COLBORN TIFFANY M 2022111 9999999 B 10 1982344214 0 PO BOX 3988 CARBONDALE IL 629023988 20 1982344214 0 Nurse Practitioners Healthy Kids Services 20 1982344214 0 Nurse Practitioners Nurse Practitioners Services 20 1982344214 0 Nurse Practitioners Physician Services 00 1982344537 0 YASIN ANEEQ 2023206 9999999 B 10 1982344537 0 PO BOX 19639 SPRINGFIELD IL 627949639 20 1982344537 0 Physicians Anesthesia Services 20 1982344537 0 Physicians Fluoride varnish 20 1982344537 0 Physicians Healthy Kids Services 20 1982344537 0 Physicians Optical Supplies 20 1982344537 0 Physicians Physician Services 00 1982344552 0 SUTFIN RYLEE 2023291 9999999 B 10 1982344552 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1982344552 0 Physician Assistant Only Fluoride varnish 20 1982344552 0 Physician Assistant Only Healthy Kids Services 20 1982344552 0 Physician Assistant Only Physician Services 00 1982344677 0 NGUYEN BRANDON 2023195 9999999 B 10 1982344677 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1982344677 0 Physicians Anesthesia Services 20 1982344677 0 Physicians Healthy Kids Services 20 1982344677 0 Physicians Optical Supplies 20 1982344677 0 Physicians Physician Services 00 1982344719 0 JEREMY KAO 2022187 9999999 B 10 1982344719 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1982344719 0 Physicians Anesthesia Services 20 1982344719 0 Physicians Fluoride varnish 20 1982344719 0 Physicians Healthy Kids Services 20 1982344719 0 Physicians Optical Supplies 20 1982344719 0 Physicians Physician Services 00 1982345138 0 CARNEY PATRICK 2022176 9999999 B 10 1982345138 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1982345138 0 Physicians Anesthesia Services 20 1982345138 0 Physicians Healthy Kids Services 20 1982345138 0 Physicians Optical Supplies 20 1982345138 0 Physicians Physician Services 00 1982345526 0 HERFURTH STEPHANIE 2022210 9999999 B 10 1982345526 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1982345526 0 Physicians Anesthesia Services 20 1982345526 0 Physicians Healthy Kids Services 20 1982345526 0 Physicians Optical Supplies 20 1982345526 0 Physicians Physician Services 00 1982345914 0 EVENHOUSE ANNIKA 2024193 9999999 B 10 1982345914 0 515 22ND AVE MONROE WI 535661569 20 1982345914 0 Physicians Anesthesia Services 20 1982345914 0 Physicians Fluoride varnish 20 1982345914 0 Physicians Healthy Kids Services 20 1982345914 0 Physicians Optical Supplies 20 1982345914 0 Physicians Physician Services 00 1982346342 0 GORE ASHLEIGH P 2023192 9999999 B 10 1982346342 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1982346342 0 Physicians Anesthesia Services 20 1982346342 0 Physicians Healthy Kids Services 20 1982346342 0 Physicians Optical Supplies 20 1982346342 0 Physicians Physician Services 00 1982346581 0 MACKE KAYLA 2022283 9999999 B 10 1982346581 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1982346581 0 Nurse Practitioners Fluoride varnish 20 1982346581 0 Nurse Practitioners Healthy Kids Services 20 1982346581 0 Nurse Practitioners Nurse Practitioners Services 20 1982346581 0 Nurse Practitioners Physician Services 00 1982346839 0 ZEDDIES EVAN A 2022239 9999999 B 10 1982346839 0 124 SW ADAMS ST PEORIA IL 616021308 20 1982346839 0 Physicians Anesthesia Services 20 1982346839 0 Physicians Healthy Kids Services 20 1982346839 0 Physicians Optical Supplies 20 1982346839 0 Physicians Physician Services 00 1982347431 0 KOTSONIS THOMAS 2024185 9999999 B 10 1982347431 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1982347431 0 Physicians Anesthesia Services 20 1982347431 0 Physicians Healthy Kids Services 20 1982347431 0 Physicians Optical Supplies 20 1982347431 0 Physicians Physician Services 00 1982348181 0 ROYCHOWDHURY PRITHWIJIT 2022230 9999999 B 10 1982348181 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1982348181 0 Physicians Anesthesia Services 20 1982348181 0 Physicians Healthy Kids Services 20 1982348181 0 Physicians Optical Supplies 20 1982348181 0 Physicians Physician Services 00 1982348256 0 KENSINGER MORGAN 2023361 9999999 B 10 1982348256 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1982348256 0 Physicians Anesthesia Services 20 1982348256 0 Physicians Fluoride varnish 20 1982348256 0 Physicians Healthy Kids Services 20 1982348256 0 Physicians Optical Supplies 20 1982348256 0 Physicians Physician Services 00 1982348637 0 TRAUT ALEX M 2022311 9999999 B 10 1982348637 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1982348637 0 Physician Assistant Only Fluoride varnish 20 1982348637 0 Physician Assistant Only Healthy Kids Services 20 1982348637 0 Physician Assistant Only Physician Services 00 1982348710 0 STACY NATHANIEL P 2022340 9999999 B 10 1982348710 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1982348710 0 Physicians Anesthesia Services 20 1982348710 0 Physicians Healthy Kids Services 20 1982348710 0 Physicians Optical Supplies 20 1982348710 0 Physicians Physician Services 20 1982348710 0 Physicians Physicians Psychiatric Services 00 1982350146 0 STASAITIS MARY C 2024100 9999999 B 10 1982350146 0 29373 NETWORK PL CHICAGO IL 606733039 20 1982350146 0 Nurse Practitioners Healthy Kids Services 20 1982350146 0 Nurse Practitioners Nurse Practitioners Services 20 1982350146 0 Nurse Practitioners Physician Services 00 1982352308 0 VIRDI RAVJOT KAUR 2023118 9999999 B 10 1982352308 0 PO BOX 3039 OAK BROOK IL 605223039 20 1982352308 0 Physicians Anesthesia Services 20 1982352308 0 Physicians Fluoride varnish 20 1982352308 0 Physicians Healthy Kids Services 20 1982352308 0 Physicians Optical Supplies 20 1982352308 0 Physicians Physician Services 00 1982352555 0 KLARE MOLLY K 2023197 9999999 B 10 1982352555 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1982352555 0 Physicians Anesthesia Services 20 1982352555 0 Physicians Healthy Kids Services 20 1982352555 0 Physicians Optical Supplies 20 1982352555 0 Physicians Physician Services 00 1982352597 0 WIETLISBACH LARISSA 2023163 9999999 B 10 1982352597 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1982352597 0 Physicians Anesthesia Services 20 1982352597 0 Physicians Healthy Kids Services 20 1982352597 0 Physicians Optical Supplies 20 1982352597 0 Physicians Physician Services 00 1982353330 0 BRATINA NAEVA E 2023202 9999999 B 10 1982353330 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1982353330 0 Physicians Anesthesia Services 20 1982353330 0 Physicians Healthy Kids Services 20 1982353330 0 Physicians Optical Supplies 20 1982353330 0 Physicians Physician Services 20 1982353330 0 Physicians Physicians Psychiatric Services 00 1982353397 0 HICKS HUNTER JAMES 2022181 9999999 B 10 1982353397 0 5777 DEPT CAROL STREAM IL 601228942 20 1982353397 0 Physicians Anesthesia Services 20 1982353397 0 Physicians Healthy Kids Services 20 1982353397 0 Physicians Optical Supplies 20 1982353397 0 Physicians Physician Services 00 1982354338 0 SPRATT FAITH A 2022210 9999999 B 10 1982354338 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1982354338 0 Physicians Anesthesia Services 20 1982354338 0 Physicians Healthy Kids Services 20 1982354338 0 Physicians Optical Supplies 20 1982354338 0 Physicians Physician Services 00 1982354437 0 SHERLOCK DANIEL E 2022210 9999999 B 10 1982354437 0 PO BOX 3039 OAK BROOK IL 605223039 20 1982354437 0 Physicians Anesthesia Services 20 1982354437 0 Physicians Fluoride varnish 20 1982354437 0 Physicians Healthy Kids Services 20 1982354437 0 Physicians Optical Supplies 20 1982354437 0 Physicians Physician Services 00 1982355988 0 ZIGANTO BERNICE 2023135 9999999 B 10 1982355988 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1982355988 0 Speech Therapists Medical Supplies 20 1982355988 0 Speech Therapists Medical equipment/prosthetic devices 20 1982355988 0 Speech Therapists Speech Therapy/Pathology Services 00 1982357737 0 GOODMAN ERICA 2024096 9999999 B 10 1982357737 0 2501 CHATHAM RD # 5212 SPRINGFIELD IL 627044188 20 1982357737 0 Psychologist Psychologist service 00 1982358057 0 FLINT KIRSTYN 2024159 9999999 B 10 1982358057 0 1 CVS DR # MC2295 WOONSOCKET RI 028956146 20 1982358057 0 Nurse Practitioners Fluoride varnish 20 1982358057 0 Nurse Practitioners Healthy Kids Services 20 1982358057 0 Nurse Practitioners Nurse Practitioners Services 20 1982358057 0 Nurse Practitioners Physician Services 00 1982359881 0 HARNESS LINDSAY 2023016 9999999 B 10 1982359881 0 PO BOX 781076 DETROIT MI 482781076 20 1982359881 0 Nurse Practitioners Fluoride varnish 20 1982359881 0 Nurse Practitioners Healthy Kids Services 20 1982359881 0 Nurse Practitioners Nurse Practitioners Services 20 1982359881 0 Nurse Practitioners Physician Services 00 1982362984 0 MYLES JESSICA 2022033 9999999 B 10 1982362984 0 PO BOX 775253 CHICAGO IL 606775253 20 1982362984 0 Nurse Practitioners Fluoride varnish 20 1982362984 0 Nurse Practitioners Healthy Kids Services 20 1982362984 0 Nurse Practitioners Nurse Practitioners Services 20 1982362984 0 Nurse Practitioners Physician Services 00 1982363644 0 VOSS SANDRA 2022094 9999999 B 10 1982363644 0 4600 3RD ST MOLINE IL 612656106 20 1982363644 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1982364824 0 BRAUN ASHLEY K 2023310 9999999 B 10 1982364824 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1982364824 0 Physician Assistant Only Fluoride varnish 20 1982364824 0 Physician Assistant Only Healthy Kids Services 20 1982364824 0 Physician Assistant Only Physician Services 00 1982368239 0 O'ROURKE SARAH 2021357 9999999 B 10 1982368239 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1982368239 0 Nurse Practitioners Healthy Kids Services 20 1982368239 0 Nurse Practitioners Nurse Practitioners Services 20 1982368239 0 Nurse Practitioners Physician Services 00 1982371167 0 GUPTA MEENU 2023268 9999999 B 10 1982371167 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1982371167 0 Physical Therapists Medical Supplies 20 1982371167 0 Physical Therapists Medical equipment/prosthetic devices 20 1982371167 0 Physical Therapists Physical Therapy Services 00 1982372587 0 CARRELL TOMMI AMANDA 2023353 9999999 B 10 1982372587 0 1602 21ST ST GRANITE CITY IL 620405304 20 1982372587 0 Nurse Practitioners Family Planning Counseling 20 1982372587 0 Nurse Practitioners Healthy Kids Services 20 1982372587 0 Nurse Practitioners Midwife Services 20 1982372587 0 Nurse Practitioners Nurse Practitioners Services 20 1982372587 0 Nurse Practitioners Physician Services 00 1982378170 0 LEON KAYLA 2021263 9999999 B 10 1982378170 0 621 S NEW BALLAS RD STE 7020 SAINT LOUIS MO 631418232 20 1982378170 0 Nurse Practitioners Fluoride varnish 20 1982378170 0 Nurse Practitioners Healthy Kids Services 20 1982378170 0 Nurse Practitioners Nurse Practitioners Services 20 1982378170 0 Nurse Practitioners Physician Services 00 1982378626 0 TANG MY K 2022020 9999999 B 10 1982378626 0 PO BOX 775253 CHICAGO IL 606775253 20 1982378626 0 Physician Assistant Only Fluoride varnish 20 1982378626 0 Physician Assistant Only Healthy Kids Services 20 1982378626 0 Physician Assistant Only Physician Services 00 1982378824 0 RICE KAYLA 2024337 9999999 B 10 1982378824 0 811 W JOHN ST YORKVILLE IL 605609249 20 1982378824 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1982379673 0 GROSWALD SARAH R 2022339 9999999 B 10 1982379673 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1982379673 0 Audiologists Audiology Services 20 1982379673 0 Audiologists Medical Supplies 20 1982379673 0 Audiologists Medical equipment/prosthetic devices 00 1982381620 0 VERHOEVEN TIFFANY L 2023186 9999999 B 10 1982381620 0 11401 BLUEGRASS PKWY LOUISVILLE KY 402992349 20 1982381620 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1982381893 0 NHAT LIHN 2023188 9999999 B 10 1982381893 0 2050 E ALGONQUIN RD STE 610 SCHAUMBURG IL 601734166 20 1982381893 0 Dentists Dental Services 20 1982381893 0 Dentists Physician Services 00 1982381950 0 SANTILLO NICOLE 2023208 9999999 B 10 1982381950 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1982381950 0 Occupational Therapists Medical Supplies 20 1982381950 0 Occupational Therapists Medical equipment/prosthetic devices 20 1982381950 0 Occupational Therapists Occupational Therapy Services 00 1982382156 0 IFTIKHAR SARA 2024212 9999999 B 10 1982382156 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1982382156 0 Dentists Dental Services 20 1982382156 0 Dentists Physician Services 00 1982382479 0 EFENEDO LAURA 2024030 9999999 B 10 1982382479 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1982382479 0 Nurse Practitioners Healthy Kids Services 20 1982382479 0 Nurse Practitioners Nurse Practitioners Services 20 1982382479 0 Nurse Practitioners Physician Services 00 1982382511 0 AGARWAL SHWETA 2023230 9999999 B 10 1982382511 0 213 N RACINE AVE # 100 CHICAGO IL 606071644 20 1982382511 0 Nurse Practitioners Healthy Kids Services 20 1982382511 0 Nurse Practitioners Nurse Practitioners Services 20 1982382511 0 Nurse Practitioners Physician Services 00 1982385035 0 WILLOUGHBY REBEKAH L 2023230 9999999 B 10 1982385035 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1982385035 0 Audiologists Audiology Services 20 1982385035 0 Audiologists Medical Supplies 20 1982385035 0 Audiologists Medical equipment/prosthetic devices 00 1982385282 0 RUDDY MARSHALL 2023220 9999999 B 10 1982385282 0 310 S MAIN ST STE D LOMBARD IL 601482692 20 1982385282 0 Speech Therapists Medical Supplies 20 1982385282 0 Speech Therapists Medical equipment/prosthetic devices 20 1982385282 0 Speech Therapists Speech Therapy/Pathology Services 00 1982387635 0 VAN ERT BRITTANY 2023285 9999999 B 10 1982387635 0 PO BOX 684 BEDFORD PARK IL 604990684 20 1982387635 0 Nurse Practitioners Healthy Kids Services 20 1982387635 0 Nurse Practitioners Nurse Practitioners Services 20 1982387635 0 Nurse Practitioners Physician Services 00 1982389110 0 ZETINA HUESCA JOAQUIN 2023212 9999999 B 10 1982389110 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1982389110 0 Physicians Anesthesia Services 20 1982389110 0 Physicians Fluoride varnish 20 1982389110 0 Physicians Healthy Kids Services 20 1982389110 0 Physicians Optical Supplies 20 1982389110 0 Physicians Physician Services 00 1982389169 0 GIANARAKIS MICHAEL 2023279 9999999 B 10 1982389169 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1982389169 0 Physicians Anesthesia Services 20 1982389169 0 Physicians Fluoride varnish 20 1982389169 0 Physicians Healthy Kids Services 20 1982389169 0 Physicians Optical Supplies 20 1982389169 0 Physicians Physician Services 00 1982389862 0 HOURANY ROULA 2023186 9999999 B 10 1982389862 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1982389862 0 Physicians Anesthesia Services 20 1982389862 0 Physicians Healthy Kids Services 20 1982389862 0 Physicians Optical Supplies 20 1982389862 0 Physicians Physician Services 00 1982390571 0 VENTO MCKENNA 2023257 9999999 B 10 1982390571 0 3445 N CENTRAL AVE UNIT C CHICAGO IL 606344420 20 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1982414439 0 Speech Therapists Speech Therapy/Pathology Services 00 1982417192 0 HARRIS JENNA 2025032 9999999 B 10 1982417192 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1982417192 0 Occupational Therapists Medical Supplies 20 1982417192 0 Occupational Therapists Medical equipment/prosthetic devices 20 1982417192 0 Occupational Therapists Occupational Therapy Services 00 1982421053 0 MONACHEN SAMSON 2025003 9999999 B 10 1982421053 0 2964 COMMERCE DR MCHENRY IL 600515409 20 1982421053 0 Dentists Dental Services 20 1982421053 0 Dentists Physician Services 00 1982422358 0 MACKAY ZACKER ZOE 2025008 9999999 B 10 1982422358 0 2100 POWELL ST EMERYVILLE CA 946081826 20 1982422358 0 Physician Assistant Only Fluoride varnish 20 1982422358 0 Physician Assistant Only Healthy Kids Services 20 1982422358 0 Physician Assistant Only Physician Services 00 1982422705 0 HEFLIN BAXTER 2025020 9999999 B 10 1982422705 0 PO BOX 3988 CARBONDALE IL 629023988 20 1982422705 0 Nurse Practitioners Healthy Kids 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Practitioners Nurse Practitioners Services 20 1982427704 0 Nurse Practitioners Physician Services 00 1982431284 0 BIRD CAITLIN 2024299 9999999 B 10 1982431284 0 3051 HOLLIS DR SPRINGFIELD IL 627047452 20 1982431284 0 Nurse Practitioners Fluoride varnish 20 1982431284 0 Nurse Practitioners Healthy Kids Services 20 1982431284 0 Nurse Practitioners Nurse Practitioners Services 20 1982431284 0 Nurse Practitioners Physician Services 00 1982433660 0 MODI NAISARGI S 2024270 9999999 B 10 1982433660 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1982433660 0 Physicians Anesthesia Services 20 1982433660 0 Physicians Fluoride varnish 20 1982433660 0 Physicians Healthy Kids Services 20 1982433660 0 Physicians Optical Supplies 20 1982433660 0 Physicians Physician Services 00 1982434809 0 MOUSSA RANA 2024274 9999999 B 10 1982434809 0 29777 NETWORK PL CHICAGO IL 606731297 20 1982434809 0 Nurse Practitioners Healthy Kids Services 20 1982434809 0 Nurse Practitioners Nurse Practitioners Services 20 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606733039 20 1982610861 0 Physicians Anesthesia Services 20 1982610861 0 Physicians Fluoride varnish 20 1982610861 0 Physicians Healthy Kids Services 20 1982610861 0 Physicians Optical Supplies 20 1982610861 0 Physicians Physician Services 00 1982611588 0 BARIGALA MARGUERITE 2004195 9999999 B 10 1982611588 0 3860 W OGDEN AVE CHICAGO IL 606232460 20 1982611588 0 Nurse Practitioners Fluoride varnish 20 1982611588 0 Nurse Practitioners Healthy Kids Services 20 1982611588 0 Nurse Practitioners Nurse Practitioners Services 20 1982611588 0 Nurse Practitioners Physician Services 00 1982611927 0 BARSKY DIANE 2018111 9999999 B 10 1982611927 0 100 E PENN SQ FL 9 PHILADELPHIA PA 191073377 20 1982611927 0 Physicians Anesthesia Services 20 1982611927 0 Physicians Fluoride varnish 20 1982611927 0 Physicians Healthy Kids Services 20 1982611927 0 Physicians Optical Supplies 20 1982611927 0 Physicians Physician Services 00 1982612420 0 STEINER ROBERT D 1992183 9999999 B 10 1982612420 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1982612420 0 Physicians Anesthesia Services 20 1982612420 0 Physicians Fluoride varnish 20 1982612420 0 Physicians Healthy Kids Services 20 1982612420 0 Physicians Optical Supplies 20 1982612420 0 Physicians Physician Services 00 1982612677 0 CHAUHAN VIJAI V 2001015 9999999 B 10 1982612677 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1982612677 0 Physicians Anesthesia Services 20 1982612677 0 Physicians Healthy Kids Services 20 1982612677 0 Physicians Optical Supplies 20 1982612677 0 Physicians Physician Services 00 1982612982 0 SWINGLER JAMES L 1984156 9999999 B 10 1982612982 0 7501 N UNIVERSITY ST STE 113 PEORIA IL 616141234 20 1982612982 0 Physicians Anesthesia Services 20 1982612982 0 Physicians Healthy Kids Services 20 1982612982 0 Physicians Optical Supplies 20 1982612982 0 Physicians Physician Services 00 1982613667 0 LASCH AMY J 2015274 9999999 B 10 1982613667 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1982613667 0 Physician Assistant Only 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1982618856 0 Physicians Fluoride varnish 20 1982618856 0 Physicians Healthy Kids Services 20 1982618856 0 Physicians Optical Supplies 20 1982618856 0 Physicians Physician Services 00 1982618930 0 DAWALIBI ANTOINE 1998182 9999999 B 10 1982618930 0 221 NE GLEN OAK AVE ATTN: STEPHEN CIRONE GOMP 100 PEORIA IL 616360001 20 1982618930 0 Physicians Anesthesia Services 20 1982618930 0 Physicians Fluoride varnish 20 1982618930 0 Physicians Healthy Kids Services 20 1982618930 0 Physicians Optical Supplies 20 1982618930 0 Physicians Physician Services 00 1982619623 0 REINKE ANNA 2016001 9999999 B 10 1982619623 0 5777 DEPT CAROL STREAM IL 601228942 20 1982619623 0 Physician Assistant Only Fluoride varnish 20 1982619623 0 Physician Assistant Only Healthy Kids Services 20 1982619623 0 Physician Assistant Only Physician Services 00 1982620209 0 DOWNEY JOAN C 1990182 9999999 B 10 1982620209 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1982620209 0 Physicians Anesthesia Services 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2012275 9999999 B 10 1982847042 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1982847042 0 Physicians Anesthesia Services 20 1982847042 0 Physicians Fluoride varnish 20 1982847042 0 Physicians Healthy Kids Services 20 1982847042 0 Physicians Optical Supplies 20 1982847042 0 Physicians Physician Services 00 1982847810 0 NANDANAN MOORTHIE MYDHILI 2012233 9999999 B 10 1982847810 0 5777 DEPT CAROL STREAM IL 601220021 20 1982847810 0 Physicians Anesthesia Services 20 1982847810 0 Physicians Fluoride varnish 20 1982847810 0 Physicians Healthy Kids Services 20 1982847810 0 Physicians Optical Supplies 20 1982847810 0 Physicians Physician Services 00 1982848206 0 QUINN MICHELLE 2013274 9999999 B 10 1982848206 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1982848206 0 Physicians Anesthesia Services 20 1982848206 0 Physicians Healthy Kids Services 20 1982848206 0 Physicians Optical Supplies 20 1982848206 0 Physicians Physician Services 00 1982850020 0 ZANDER JENNIFER B 2012254 9999999 B 10 1982850020 0 5777 DEPT CAROL STREAM IL 601228942 20 1982850020 0 Physicians Anesthesia Services 20 1982850020 0 Physicians Fluoride varnish 20 1982850020 0 Physicians Healthy Kids Services 20 1982850020 0 Physicians Optical Supplies 20 1982850020 0 Physicians Physician Services 00 1982850137 0 HANRAHAN AUSTIN 2008280 9999999 B 10 1982850137 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1982850137 0 Physicians Anesthesia Services 20 1982850137 0 Physicians Fluoride varnish 20 1982850137 0 Physicians Healthy Kids Services 20 1982850137 0 Physicians Optical Supplies 20 1982850137 0 Physicians Physician Services 00 1982851382 0 RAGNETTI LAUREN MARIE 2021285 9999999 B 10 1982851382 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1982851382 0 Audiologists Audiology Services 20 1982851382 0 Audiologists Medical Supplies 20 1982851382 0 Audiologists Medical equipment/prosthetic devices 00 1982851762 0 KARLIN ANDREA 2013260 9999999 B 10 1982851762 0 8780 W GOLF RD STE 200 SUITE 200 NILES IL 607145611 20 1982851762 0 Audiologists Audiology Services 20 1982851762 0 Audiologists Medical Supplies 20 1982851762 0 Audiologists Medical equipment/prosthetic devices 00 1982852208 0 NIKOUMANESH NASIM 2022319 9999999 B 10 1982852208 0 230 W DIVISION ST APT 704 CHICAGO IL 606107687 20 1982852208 0 Optometrists Optical Supplies 20 1982852208 0 Optometrists Optometric Services 20 1982852208 0 Optometrists Physician Services 00 1982852679 0 SHEEAN ANDREW 2023153 9999999 B 10 1982852679 0 PO BOX 889430 LOS ANGELES CA 900889430 20 1982852679 0 Physicians Anesthesia Services 20 1982852679 0 Physicians Healthy Kids Services 20 1982852679 0 Physicians Optical Supplies 20 1982852679 0 Physicians Physician Services 00 1982852828 0 RANA KUNTAL 2013182 9999999 B 10 1982852828 0 5777 DEPT CAROL STREAM IL 601220021 20 1982852828 0 Physicians Anesthesia Services 20 1982852828 0 Physicians Healthy Kids Services 20 1982852828 0 Physicians Optical Supplies 20 1982852828 0 Physicians Physician Services 00 1982856118 0 DAVIS VANESSA 2011213 9999999 B 10 1982856118 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1982856118 0 Physicians Anesthesia Services 20 1982856118 0 Physicians Healthy Kids Services 20 1982856118 0 Physicians Optical Supplies 20 1982856118 0 Physicians Physician Services 00 1982856803 0 CUNDALL LISA 2023136 9999999 B 10 1982856803 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1982856803 0 Speech Therapists Medical Supplies 20 1982856803 0 Speech Therapists Medical equipment/prosthetic devices 20 1982856803 0 Speech Therapists Speech Therapy/Pathology Services 00 1982857363 0 BUDNICK ELIOT 2023193 9999999 B 10 1982857363 0 PO BOX 208807 DALLAS TX 753208807 20 1982857363 0 Physicians Anesthesia Services 20 1982857363 0 Physicians Healthy Kids Services 20 1982857363 0 Physicians Optical Supplies 20 1982857363 0 Physicians Physician Services 00 1982857660 0 THOMAS CELESTE C 2014090 9999999 B 10 1982857660 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1982857660 0 Physicians Anesthesia Services 20 1982857660 0 Physicians Fluoride varnish 20 1982857660 0 Physicians Healthy Kids Services 20 1982857660 0 Physicians Optical Supplies 20 1982857660 0 Physicians Physician Services 00 1982857926 0 UGHREJA RAJ H 2011213 9999999 B 10 1982857926 0 680 N LAKE SHORE DR STE 1000 SUITE# 1000 CHICAGO IL 606118709 20 1982857926 0 Physicians Anesthesia Services 20 1982857926 0 Physicians Fluoride varnish 20 1982857926 0 Physicians Healthy Kids Services 20 1982857926 0 Physicians Optical Supplies 20 1982857926 0 Physicians Physician Services 00 1982859757 0 CALMA MICHELLE STA MARIA 2015345 9999999 B 10 1982859757 0 550 E BOUGHTON RD STE 110 BOLINGBROOK IL 604402194 20 1982859757 0 Physicians Anesthesia Services 20 1982859757 0 Physicians Fluoride varnish 20 1982859757 0 Physicians Healthy Kids Services 20 1982859757 0 Physicians Optical Supplies 20 1982859757 0 Physicians Physician Services 00 1982860086 0 RUBIN SHARON 2021293 9999999 B 10 1982860086 0 1020 MILWAUKEE AVE STE 235 DEERFIELD IL 600153555 20 1982860086 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1982860185 0 DEGEETER CATHERINE D 2013212 9999999 B 10 1982860185 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1982860185 0 Physicians Anesthesia Services 20 1982860185 0 Physicians Fluoride varnish 20 1982860185 0 Physicians Healthy Kids Services 20 1982860185 0 Physicians Optical Supplies 20 1982860185 0 Physicians Physician Services 00 1982860557 0 ERDMAN NATHANIEL 2013259 9999999 B 10 1982860557 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1982860557 0 Optometrists Optical Supplies 20 1982860557 0 Optometrists Optometric Services 20 1982860557 0 Optometrists Physician Services 00 1982860631 0 GURNANI PREETI 2017041 9999999 B 10 1982860631 0 55 E 86TH AVE MERRILLVILLE IN 464106382 20 1982860631 0 Physicians Anesthesia Services 20 1982860631 0 Physicians Fluoride varnish 20 1982860631 0 Physicians Healthy Kids Services 20 1982860631 0 Physicians Optical Supplies 20 1982860631 0 Physicians Physician Services 00 1982860755 0 PROZIALECK JOSHUA 2011001 9999999 B 10 1982860755 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1982860755 0 Physicians Anesthesia Services 20 1982860755 0 Physicians Fluoride varnish 20 1982860755 0 Physicians Healthy Kids Services 20 1982860755 0 Physicians Optical Supplies 20 1982860755 0 Physicians Physician Services 00 1982860920 0 SUMMERS KORI 2020335 9999999 B 10 1982860920 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1982860920 0 Physicians Anesthesia Services 20 1982860920 0 Physicians Fluoride varnish 20 1982860920 0 Physicians Healthy Kids Services 20 1982860920 0 Physicians Optical Supplies 20 1982860920 0 Physicians Physician Services 00 1982862918 0 CHEN KEVIN 2014244 9999999 B 10 1982862918 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1982862918 0 Physicians Anesthesia Services 20 1982862918 0 Physicians Healthy Kids Services 20 1982862918 0 Physicians Optical Supplies 20 1982862918 0 Physicians Physician Services 00 1982864088 0 WILSON ERIC 2016001 9999999 B 10 1982864088 0 13545 BARRETT PARKWAY DR STE 1 BALLWIN MO 630213823 20 1982864088 0 Nurse Practitioners Anesthesia Services 20 1982864088 0 Nurse Practitioners Nurse Practitioners Services 20 1982864088 0 Nurse Practitioners Physician Services 00 1982864476 0 POLAVARAPU HARSHA 2013196 9999999 B 10 1982864476 0 1005 BROADWAY ST QUINCY IL 623012834 20 1982864476 0 Physicians Anesthesia Services 20 1982864476 0 Physicians Healthy Kids Services 20 1982864476 0 Physicians Optical Supplies 20 1982864476 0 Physicians Physician Services 00 1982865481 0 PATEL HEEREN R 2013038 9999999 B 10 1982865481 0 5777 DEPT CAROL STREAM IL 601220021 20 1982865481 0 Physicians Anesthesia Services 20 1982865481 0 Physicians Healthy Kids Services 20 1982865481 0 Physicians Optical Supplies 20 1982865481 0 Physicians Physician Services 20 1982865481 0 Physicians Physicians Psychiatric Services 00 1982865846 0 WILLIAMS NICOLE 2013083 9999999 B 10 1982865846 0 7836 FRONTAGE RD SKOKIE IL 600772637 20 1982865846 0 Occupational Therapists Medical Supplies 20 1982865846 0 Occupational Therapists Medical equipment/prosthetic devices 20 1982865846 0 Occupational Therapists Occupational Therapy Services 00 1982866224 0 RICKLIS DAMIEN 2011206 9999999 B 10 1982866224 0 9735 LANDMARK PARKWAY DR STE 2 SAINT LOUIS MO 631271666 20 1982866224 0 Physicians Anesthesia Services 20 1982866224 0 Physicians Fluoride varnish 20 1982866224 0 Physicians Healthy Kids Services 20 1982866224 0 Physicians Optical Supplies 20 1982866224 0 Physicians Physician Services 00 1982866232 0 WALKER MICHAEL D 2011182 9999999 B 10 1982866232 0 5775 WAYZATA BLVD STE 400 SAINT LOUIS PAR MN 554161271 20 1982866232 0 Physicians Anesthesia Services 20 1982866232 0 Physicians Healthy Kids Services 20 1982866232 0 Physicians Optical Supplies 20 1982866232 0 Physicians Physician Services 00 1982866737 0 MCGRATH BRIAN P 2017306 9999999 B 10 1982866737 0 3407 MOMENTUM PL CHICAGO IL 606890001 20 1982866737 0 Physicians Anesthesia Services 20 1982866737 0 Physicians Healthy Kids Services 20 1982866737 0 Physicians Optical Supplies 20 1982866737 0 Physicians Physician Services 00 1982867347 0 GRAHAM TIMOTHY P 2013196 9999999 B 10 1982867347 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1982867347 0 Physicians Anesthesia Services 20 1982867347 0 Physicians Healthy Kids Services 20 1982867347 0 Physicians Optical Supplies 20 1982867347 0 Physicians Physician Services 00 1982867388 0 RAMIREZ MIGUEL 2015244 9999999 B 10 1982867388 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1982867388 0 Physicians Anesthesia Services 20 1982867388 0 Physicians Healthy Kids Services 20 1982867388 0 Physicians Optical Supplies 20 1982867388 0 Physicians Physician Services 00 1982867438 0 GANESH KEITH 2014213 9999999 B 10 1982867438 0 3753 S COTTAGE GROVE AVE STE 1 CHICAGO IL 606531662 20 1982867438 0 Physicians Anesthesia Services 20 1982867438 0 Physicians Fluoride varnish 20 1982867438 0 Physicians Healthy Kids Services 20 1982867438 0 Physicians Optical Supplies 20 1982867438 0 Physicians Physician Services 00 1982867446 0 SHUPE CASEY G 2012191 9999999 B 10 1982867446 0 2000 OGDEN AVE AURORA IL 605047222 20 1982867446 0 Physicians Anesthesia Services 20 1982867446 0 Physicians Healthy Kids Services 20 1982867446 0 Physicians Optical Supplies 20 1982867446 0 Physicians Physician Services 00 1982867479 0 CARRINGTON SANDRA L 2008259 9999999 B 10 1982867479 0 3202 N WISCONSIN AVE PEORIA IL 616031260 20 1982867479 0 Speech Therapists Medical Supplies 20 1982867479 0 Speech Therapists Medical equipment/prosthetic devices 20 1982867479 0 Speech Therapists Speech Therapy/Pathology Services 00 1982868436 0 CAWCUTT KELLY A 2020201 9999999 B 10 1982868436 0 988102 NEBRASKA MEDICAL CTR OMAHA NE 681988102 20 1982868436 0 Physicians Anesthesia Services 20 1982868436 0 Physicians Fluoride varnish 20 1982868436 0 Physicians Healthy Kids Services 20 1982868436 0 Physicians Optical Supplies 20 1982868436 0 Physicians Physician Services 00 1982868766 0 HASSANEIN ALADDIN 2017191 9999999 B 10 1982868766 0 545 BARNHILL DR # EH215 INDIANAPOLIS IN 462025112 20 1982868766 0 Physicians Anesthesia Services 20 1982868766 0 Physicians Healthy Kids Services 20 1982868766 0 Physicians Optical Supplies 20 1982868766 0 Physicians Physician Services 00 1982868840 0 AHN JONATHAN 2011213 9999999 B 10 1982868840 0 9669 KENTON AVE STE 405 STE 405 SKOKIE IL 600761267 20 1982868840 0 Physicians Anesthesia Services 20 1982868840 0 Physicians Fluoride varnish 20 1982868840 0 Physicians Healthy Kids Services 20 1982868840 0 Physicians Optical Supplies 20 1982868840 0 Physicians Physician Services 00 1982868873 0 RODRIGUEZ JAIRO 2024102 9999999 B 10 1982868873 0 1700 E HIGGINS RD STE 600 DES PLAINES IL 600185621 20 1982868873 0 Physician Assistant Only Fluoride varnish 20 1982868873 0 Physician Assistant Only Healthy Kids Services 20 1982868873 0 Physician Assistant Only Physician Services 00 1982869087 0 BUGAZIA AL 2013196 9999999 B 10 1982869087 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1982869087 0 Physicians Anesthesia Services 20 1982869087 0 Physicians Fluoride varnish 20 1982869087 0 Physicians Healthy Kids Services 20 1982869087 0 Physicians Optical Supplies 20 1982869087 0 Physicians Physician Services 00 1982869467 0 KELLY PETER 2020231 9999999 B 10 1982869467 0 515 VALLEY ST STE 203 MAPLEWOOD NJ 070404300 20 1982869467 0 Physicians Anesthesia Services 20 1982869467 0 Physicians Healthy Kids Services 20 1982869467 0 Physicians Optical Supplies 20 1982869467 0 Physicians Physician Services 00 1982869533 0 UNADKAT JIGNESH V 2023075 9999999 B 10 1982869533 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1982869533 0 Physicians Anesthesia Services 20 1982869533 0 Physicians Healthy Kids Services 20 1982869533 0 Physicians Optical Supplies 20 1982869533 0 Physicians Physician Services 00 1982870028 0 PETERSON SUSAN 2023314 9999999 B 10 1982870028 0 PO BOX 10010 GLENDALE AZ 853180010 20 1982870028 0 Physicians Anesthesia Services 20 1982870028 0 Physicians Fluoride varnish 20 1982870028 0 Physicians Healthy Kids Services 20 1982870028 0 Physicians Optical Supplies 20 1982870028 0 Physicians Physician Services 00 1982870119 0 JOHNSON JASON N 2016063 9999999 B 10 1982870119 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1982870119 0 Physicians Anesthesia Services 20 1982870119 0 Physicians Fluoride varnish 20 1982870119 0 Physicians Healthy Kids Services 20 1982870119 0 Physicians Optical Supplies 20 1982870119 0 Physicians Physician Services 00 1982870218 0 HENDRIX THOMAS 2011199 9999999 B 10 1982870218 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1982870218 0 Physicians Anesthesia Services 20 1982870218 0 Physicians Fluoride varnish 20 1982870218 0 Physicians Healthy Kids Services 20 1982870218 0 Physicians Optical Supplies 20 1982870218 0 Physicians Physician Services 00 1982870317 0 SORIN LUDA 2015137 9999999 B 10 1982870317 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1982870317 0 Physicians Anesthesia Services 20 1982870317 0 Physicians Healthy Kids Services 20 1982870317 0 Physicians Optical Supplies 20 1982870317 0 Physicians Physician Services 20 1982870317 0 Physicians Physicians Psychiatric Services 00 1982870325 0 UMNUS MEREDITH S 2018004 9999999 B 10 1982870325 0 PO BOX 5081 JANESVILLE WI 535475081 20 1982870325 0 Physical Therapists Medical Supplies 20 1982870325 0 Physical Therapists Medical equipment/prosthetic devices 20 1982870325 0 Physical Therapists Physical Therapy Services 00 1982871232 0 HOGUEISSON KAROLINA 2008235 9999999 B 10 1982871232 0 15020 S RAVINIA AVE STE 23 ORLAND PARK IL 604625352 20 1982871232 0 Other behavior health professional LCPC/LMFT services 00 1982874004 0 KAVINA BINAIFER 2020342 9999999 B 10 1982874004 0 10150 DEE RD DES PLAINES IL 600161512 20 1982874004 0 Speech Therapists Medical Supplies 20 1982874004 0 Speech Therapists Medical equipment/prosthetic devices 20 1982874004 0 Speech Therapists Speech Therapy/Pathology Services 00 1982876132 0 CHILLIS NIKYA 2015309 9999999 B 10 1982876132 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1982876132 0 Physician Assistant Only Electronic Home Response/EHR Installation, MPE Certification 20 1982876132 0 Physician Assistant Only Fluoride varnish 20 1982876132 0 Physician Assistant Only Healthy Kids Services 20 1982876132 0 Physician Assistant Only Physician Services 00 1982876397 0 CONNEELY KERRY 2008214 9999999 B 10 1982876397 0 9410 COMPUBILL DR ORLAND PARK IL 604622627 20 1982876397 0 Physicians Anesthesia Services 20 1982876397 0 Physicians Healthy Kids Services 20 1982876397 0 Physicians Optical Supplies 20 1982876397 0 Physicians Physician Services 00 1982877288 0 CARUSO DIANE 2005325 9999999 B 10 1982877288 0 200 W FRONT ST BLOOMINGTON IL 617015048 20 1982877288 0 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Physicians Anesthesia Services 20 1982878138 0 Physicians Healthy Kids Services 20 1982878138 0 Physicians Optical Supplies 20 1982878138 0 Physicians Physician Services 00 1982878898 0 ROCK ANDREA J 2019277 9999999 B 10 1982878898 0 515 22ND AVE MONROE WI 535661569 20 1982878898 0 Physicians Anesthesia Services 20 1982878898 0 Physicians Fluoride varnish 20 1982878898 0 Physicians Healthy Kids Services 20 1982878898 0 Physicians Optical Supplies 20 1982878898 0 Physicians Physician Services 00 1982879441 0 WALLIA AMISHA M 2011182 9999999 B 10 1982879441 0 5777 DEPT CAROL STREAM IL 601220021 20 1982879441 0 Physicians Anesthesia Services 20 1982879441 0 Physicians Fluoride varnish 20 1982879441 0 Physicians Healthy Kids Services 20 1982879441 0 Physicians Optical Supplies 20 1982879441 0 Physicians Physician Services 00 1982883237 0 RAMACHANDRAN SIMI 2021081 9999999 B 10 1982883237 0 PO BOX 43230 PHOENIX AZ 850803230 20 1982883237 0 Physicians Anesthesia Services 20 1982883237 0 Physicians Fluoride varnish 20 1982883237 0 Physicians Healthy Kids Services 20 1982883237 0 Physicians Optical Supplies 20 1982883237 0 Physicians Physician Services 00 1982884128 0 OMAIRA MOHAMMAD 2020329 9999999 B 10 1982884128 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1982884128 0 Physicians Anesthesia Services 20 1982884128 0 Physicians Fluoride varnish 20 1982884128 0 Physicians Healthy Kids Services 20 1982884128 0 Physicians Optical Supplies 20 1982884128 0 Physicians Physician Services 00 1982885257 0 SAID SUFYAN 2007362 9999999 B 10 1982885257 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1982885257 0 Physicians Anesthesia Services 20 1982885257 0 Physicians Fluoride varnish 20 1982885257 0 Physicians Healthy Kids Services 20 1982885257 0 Physicians Optical Supplies 20 1982885257 0 Physicians Physician Services 00 1982885794 0 GOVINDARAJAN GEETHA 2008245 9999999 B 10 1982885794 0 800 E 55TH ST CHICAGO IL 606154906 20 1982885794 0 Physicians Anesthesia Services 20 1982885794 0 Physicians Fluoride varnish 20 1982885794 0 Physicians Healthy Kids Services 20 1982885794 0 Physicians Optical Supplies 20 1982885794 0 Physicians Physician Services 00 1982890240 0 SMITH ANGELA 2021152 9999999 B 10 1982890240 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1982890240 0 Psychologist Psychologist service 00 1982890406 0 HEADINGS BRUCE 2009023 9999999 B 10 1982890406 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1982890406 0 Nurse Practitioners Anesthesia Services 20 1982890406 0 Nurse Practitioners Nurse Practitioners Services 20 1982890406 0 Nurse Practitioners Physician Services 00 1982890562 0 JOHNSON CAROLYN N 2022300 9999999 B 10 1982890562 0 411 E PARK ST STE 106 CHAMPAIGN IL 618203862 20 1982890562 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1982891271 0 VAHEESAN KIRUBAHARA 2012336 9999999 B 10 1982891271 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1982891271 0 Physicians Anesthesia Services 20 1982891271 0 Physicians Healthy Kids Services 20 1982891271 0 Physicians Optical Supplies 20 1982891271 0 Physicians Physician Services 00 1982892220 0 LAMPHIEAR ANDREA 2021307 9999999 B 10 1982892220 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1982892220 0 Physicians Anesthesia Services 20 1982892220 0 Physicians Healthy Kids Services 20 1982892220 0 Physicians Optical Supplies 20 1982892220 0 Physicians Physician Services 00 1982893608 0 MCCOOL PAMELA 2021210 9999999 B 10 1982893608 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1982893608 0 Physicians Anesthesia Services 20 1982893608 0 Physicians Healthy Kids Services 20 1982893608 0 Physicians Optical Supplies 20 1982893608 0 Physicians Physician Services 00 1982893913 0 CASEBOLT KEVIN 2024257 9999999 B 10 1982893913 0 PO BOX 43230 PHOENIX AZ 850803230 20 1982893913 0 Physicians Anesthesia Services 20 1982893913 0 Physicians Healthy Kids Services 20 1982893913 0 Physicians Optical Supplies 20 1982893913 0 Physicians Physician Services 00 1982894176 0 BARNES ABIGAIL 2016122 9999999 B 10 1982894176 0 2515 KLEIN RD SYCAMORE IL 601783184 20 1982894176 0 Optometrists Optical Supplies 20 1982894176 0 Optometrists Optometric Services 20 1982894176 0 Optometrists Physician Services 00 1982894226 0 COX JAMES 2016244 9999999 B 10 1982894226 0 325 IL ROUTE 2 DIXON IL 610219118 20 1982894226 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1982894762 0 AREKAPUDI SWATHI 2011274 9999999 B 10 1982894762 0 777 LOWNDES HILL RD BLDG 1 GREENVILLE SC 296072101 20 1982894762 0 Physicians Anesthesia Services 20 1982894762 0 Physicians Healthy Kids Services 20 1982894762 0 Physicians Optical Supplies 20 1982894762 0 Physicians Physician Services 00 1982894853 0 DONALDSON MATTHEW 2012183 9999999 B 10 1982894853 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1982894853 0 Physicians Anesthesia Services 20 1982894853 0 Physicians Healthy Kids Services 20 1982894853 0 Physicians Optical Supplies 20 1982894853 0 Physicians Physician Services 00 1982895751 0 WISINSKI KARI B 2008214 9999999 B 10 1982895751 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1982895751 0 Physicians Anesthesia Services 20 1982895751 0 Physicians Fluoride varnish 20 1982895751 0 Physicians Healthy Kids Services 20 1982895751 0 Physicians Optical Supplies 20 1982895751 0 Physicians Physician Services 00 1982896460 0 REAVEN DANIEL 2009060 9999999 B 10 1982896460 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1982896460 0 Physicians Anesthesia Services 20 1982896460 0 Physicians Healthy Kids Services 20 1982896460 0 Physicians Optical Supplies 20 1982896460 0 Physicians Physician Services 00 1982896551 0 BRUNE DANIEL 1988193 9999999 B 10 1982896551 0 120 WAGNER DR CREVE COEUR IL 616103966 20 1982896551 0 Physicians Anesthesia Services 20 1982896551 0 Physicians Family Planning Counseling 20 1982896551 0 Physicians Fluoride varnish 20 1982896551 0 Physicians Healthy Kids Services 20 1982896551 0 Physicians Optical Supplies 20 1982896551 0 Physicians Physician Services 00 1982896668 0 PALOIAN NEIL J 2015182 9999999 B 10 1982896668 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1982896668 0 Physicians Anesthesia Services 20 1982896668 0 Physicians Fluoride varnish 20 1982896668 0 Physicians Healthy Kids Services 20 1982896668 0 Physicians Optical Supplies 20 1982896668 0 Physicians Physician Services 00 1982896759 0 GUPTA SUSHIL 2020010 9999999 B 10 1982896759 0 PO BOX 1510 EVANSVILLE IN 477061510 20 1982896759 0 Physicians Anesthesia Services 20 1982896759 0 Physicians Fluoride varnish 20 1982896759 0 Physicians Healthy Kids Services 20 1982896759 0 Physicians Optical Supplies 20 1982896759 0 Physicians Physician Services 00 1982897047 0 MACHUT KERRI 2009335 9999999 B 10 1982897047 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1982897047 0 Physicians Anesthesia Services 20 1982897047 0 Physicians Fluoride varnish 20 1982897047 0 Physicians Healthy 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Practitioners Physician Services 00 1982912655 0 KHAN MOHAMMAD 2012306 9999999 B 10 1982912655 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1982912655 0 Physicians Anesthesia Services 20 1982912655 0 Physicians Healthy Kids Services 20 1982912655 0 Physicians Optical Supplies 20 1982912655 0 Physicians Physician Services 00 1982913661 0 GEORGE MEENA 2016259 9999999 B 10 1982913661 0 6320 159TH ST STE A OAK FOREST IL 604522780 20 1982913661 0 Physicians Anesthesia Services 20 1982913661 0 Physicians Healthy Kids Services 20 1982913661 0 Physicians Optical Supplies 20 1982913661 0 Physicians Physician Services 00 1982914644 0 STEPHENSON EVONNE 2015078 9999999 B 10 1982914644 0 4505 W DEYOUNG ST STE 203C MARION IL 629595899 20 1982914644 0 Other behavior health professional LCPC/LMFT services 00 1982914834 0 STALTER CARRIE N. 2013335 9999999 B 10 1982914834 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1982914834 0 Nurse Practitioners Fluoride varnish 20 1982914834 0 Nurse Practitioners Healthy Kids Services 20 1982914834 0 Nurse Practitioners Nurse Practitioners Services 20 1982914834 0 Nurse Practitioners Physician Services 00 1982914990 0 SMITH BRYAN A 2017306 9999999 B 10 1982914990 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1982914990 0 Physicians Anesthesia Services 20 1982914990 0 Physicians Fluoride varnish 20 1982914990 0 Physicians Healthy Kids Services 20 1982914990 0 Physicians Optical Supplies 20 1982914990 0 Physicians Physician Services 00 1982915013 0 HOANG DUY 2021193 9999999 B 10 1982915013 0 PO BOX 301208 DALLAS TX 753031501 20 1982915013 0 Physicians Anesthesia Services 20 1982915013 0 Physicians Healthy Kids Services 20 1982915013 0 Physicians Optical Supplies 20 1982915013 0 Physicians Physician Services 00 1982915120 0 BERGMANN LIISA 2018155 9999999 B 10 1982915120 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1982915120 0 Physicians Anesthesia Services 20 1982915120 0 Physicians Healthy Kids Services 20 1982915120 0 Physicians Optical Supplies 20 1982915120 0 Physicians Physician Services 00 1982915302 0 ZELKOVICH WILLIAM N 2016210 9999999 B 10 1982915302 0 1890 SILVER CROSS BLVD STE 255 NEW LENOX IL 604519528 20 1982915302 0 Physicians All Kids application agent 20 1982915302 0 Physicians Anesthesia Services 20 1982915302 0 Physicians Healthy Kids Services 20 1982915302 0 Physicians Optical Supplies 20 1982915302 0 Physicians Physician Services 00 1982916359 0 BRATHWAITE KIMBERLY P 2016122 9999999 B 10 1982916359 0 4991 LAKE BROOK DR GLEN ALLEN VA 230609290 20 1982916359 0 Physicians Anesthesia Services 20 1982916359 0 Physicians Fluoride varnish 20 1982916359 0 Physicians Healthy Kids Services 20 1982916359 0 Physicians Optical Supplies 20 1982916359 0 Physicians Physician Services 00 1982916409 0 LOFQUEST CASEY E 2012009 9999999 B 10 1982916409 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1982916409 0 Nurse Practitioners Fluoride varnish 20 1982916409 0 Nurse Practitioners Healthy Kids Services 20 1982916409 0 Nurse Practitioners Nurse Practitioners Services 20 1982916409 0 Nurse Practitioners Physician Services 00 1982916425 0 JABBAR UMAIR 2014182 9999999 B 10 1982916425 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1982916425 0 Physicians Anesthesia Services 20 1982916425 0 Physicians Healthy Kids Services 20 1982916425 0 Physicians Optical Supplies 20 1982916425 0 Physicians Physician Services 00 1982916466 0 AHMED AASMA 2017155 9999999 B 10 1982916466 0 101 W UNIVERSITY AVE CHAMPAIGN IL 618203909 20 1982916466 0 Physicians Anesthesia Services 20 1982916466 0 Physicians Fluoride varnish 20 1982916466 0 Physicians Healthy Kids Services 20 1982916466 0 Physicians Optical Supplies 20 1982916466 0 Physicians Physician Services 00 1982917043 0 ALBUREZ SOSA CESAR 2014155 9999999 B 10 1982917043 0 819 BLOOMINGTON RD CHAMPAIGN IL 618202101 20 1982917043 0 Dentists Dental Services 20 1982917043 0 Dentists Physician Services 00 1982917282 0 CHAUDHRY QURATULAIN 2017039 9999999 B 10 1982917282 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1982917282 0 Physicians Anesthesia Services 20 1982917282 0 Physicians Fluoride varnish 20 1982917282 0 Physicians Healthy Kids Services 20 1982917282 0 Physicians Optical Supplies 20 1982917282 0 Physicians Physician Services 00 1982918009 0 TAHER ALAIDDEN 2014024 9999999 B 10 1982918009 0 PO BOX 843151 KANSAS CITY MO 641843151 20 1982918009 0 Physicians Anesthesia Services 20 1982918009 0 Physicians Fluoride varnish 20 1982918009 0 Physicians Healthy Kids Services 20 1982918009 0 Physicians Optical Supplies 20 1982918009 0 Physicians Physician Services 00 1982918694 0 HILL GEOFFREY M 2015213 9999999 B 10 1982918694 0 522 N NEW BALLAS RD STE 113 CREVE COEUR MO 631416820 20 1982918694 0 Physicians Anesthesia Services 20 1982918694 0 Physicians Healthy Kids Services 20 1982918694 0 Physicians Optical Supplies 20 1982918694 0 Physicians Physician Services 00 1982919122 0 TILLBERG-MCCOY JENNIFER 2010223 9999999 B 10 1982919122 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1982919122 0 Nurse Practitioners Anesthesia Services 20 1982919122 0 Nurse Practitioners Nurse Practitioners Services 20 1982919122 0 Nurse Practitioners Physician Services 00 1982920344 0 FISCHER WILLIAM J 2020291 9999999 B 10 1982920344 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1982920344 0 Physicians Anesthesia Services 20 1982920344 0 Physicians Healthy Kids Services 20 1982920344 0 Physicians Optical Supplies 20 1982920344 0 Physicians Physician Services 00 1982921003 0 LEE SONIA J 2010130 9999999 B 10 1982921003 0 5777 DEPT CAROL STREAM IL 601220021 20 1982921003 0 Nurse Practitioners Healthy Kids Services 20 1982921003 0 Nurse Practitioners Nurse Practitioners Services 20 1982921003 0 Nurse Practitioners Physician Services 00 1982924056 0 GIBSON MEREDITH 2009274 9999999 B 10 1982924056 0 400 ELSIE AVE CREST HILL IL 604032573 20 1982924056 0 Speech Therapists Medical Supplies 20 1982924056 0 Speech Therapists 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20 1982925756 0 Physicians Physician Services 00 1982927448 0 HORN BRIAN P 2015237 9999999 B 10 1982927448 0 PO BOX 548 INDIANAPOLIS IN 462060548 20 1982927448 0 Nurse Practitioners Anesthesia Services 20 1982927448 0 Nurse Practitioners Nurse Practitioners Services 20 1982927448 0 Nurse Practitioners Physician Services 00 1982928404 0 CHAN JERRY 2010091 9999999 B 10 1982928404 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1982928404 0 Nurse Practitioners Healthy Kids Services 20 1982928404 0 Nurse Practitioners Nurse Practitioners Services 20 1982928404 0 Nurse Practitioners Physician Services 00 1982928917 0 WEAVER ADAM 2020041 9999999 B 10 1982928917 0 9701 W HIGGINS RD STE 270 STE 270 ROSEMONT IL 600184703 20 1982928917 0 Physician Assistant Only Fluoride varnish 20 1982928917 0 Physician Assistant Only Healthy Kids Services 20 1982928917 0 Physician Assistant Only Physician Services 00 1982929931 0 GOODFRIEND KARIN 2016122 9999999 B 10 1982929931 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1982929931 0 Physicians Anesthesia Services 20 1982929931 0 Physicians Healthy Kids Services 20 1982929931 0 Physicians Optical Supplies 20 1982929931 0 Physicians Physician Services 00 1982930509 0 DORAN ANNE K 2016074 9999999 B 10 1982930509 0 29373 NETWORK PL CHICAGO IL 606733039 20 1982930509 0 Physicians Anesthesia Services 20 1982930509 0 Physicians Fluoride varnish 20 1982930509 0 Physicians Healthy Kids Services 20 1982930509 0 Physicians Optical Supplies 20 1982930509 0 Physicians Physician Services 00 1982930863 0 BARNES JACINDA 1999238 9999999 B 10 1982930863 0 927 BROADWAY ST STE 100 SUITE 100 QUINCY IL 623012728 20 1982930863 0 Occupational Therapists Medical Supplies 20 1982930863 0 Occupational Therapists Medical equipment/prosthetic devices 20 1982930863 0 Occupational Therapists Occupational Therapy Services 00 1982932083 0 MEHTA MUDRESH 2016183 9999999 B 10 1982932083 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1982932083 0 Physicians Anesthesia Services 20 1982932083 0 Physicians Fluoride varnish 20 1982932083 0 Physicians Healthy Kids Services 20 1982932083 0 Physicians Optical Supplies 20 1982932083 0 Physicians Physician Services 00 1982932711 0 FRITCHER ANNE M 2017277 9999999 B 10 1982932711 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1982932711 0 Physician Assistant Only Fluoride varnish 20 1982932711 0 Physician Assistant Only Healthy Kids Services 20 1982932711 0 Physician Assistant Only Physician Services 00 1982933693 0 FLORO GEOFFREY M 2010025 9999999 B 10 1982933693 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1982933693 0 Nurse Practitioners Anesthesia Services 20 1982933693 0 Nurse Practitioners Nurse Practitioners Services 20 1982933693 0 Nurse Practitioners Physician Services 00 1982933974 0 GONZALEZ JENNIFER L 2016259 9999999 B 10 1982933974 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1982933974 0 Nurse Practitioners Fluoride varnish 20 1982933974 0 Nurse Practitioners Healthy Kids Services 20 1982933974 0 Nurse Practitioners Nurse Practitioners Services 20 1982933974 0 Nurse Practitioners Physician Services 00 1982937694 0 CASTILE CAROL 2016242 9999999 B 10 1982937694 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1982937694 0 Physician Assistant Only Fluoride varnish 20 1982937694 0 Physician Assistant Only Healthy Kids Services 20 1982937694 0 Physician Assistant Only Physician Services 00 1982938106 0 NELLETT MICHELLE E 2021022 9999999 B 10 1982938106 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1982938106 0 Nurse Practitioners Healthy Kids Services 20 1982938106 0 Nurse Practitioners Nurse Practitioners Services 20 1982938106 0 Nurse Practitioners Physician Services 00 1982939534 0 HESS JAMIE 2016180 9999999 B 10 1982939534 0 1900 STATE ST CHESTER IL 622331116 20 1982939534 0 Physician Assistant Only Fluoride varnish 20 1982939534 0 Physician Assistant Only Healthy Kids Services 20 1982939534 0 Physician Assistant Only Physician Services 00 1982940920 0 VERVOORT ANGELA K 2017096 9999999 B 10 1982940920 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1982940920 0 Physician Assistant Only Fluoride varnish 20 1982940920 0 Physician Assistant Only Healthy Kids Services 20 1982940920 0 Physician Assistant Only Physician Services 00 1982941597 0 KRUSE BRANDY 2014098 9999999 B 10 1982941597 0 118 N 2ND ST STE 200 SAINT CHARLES MO 633012894 20 1982941597 0 Other behavior health professional LCPC/LMFT services 00 1982943767 0 VOSICKY ANNE 2013042 9999999 B 10 1982943767 0 2156 DEEP WATER LN STE 110 UNIT 110 NAPERVILLE IL 605648507 20 1982943767 0 Occupational Therapists Medical Supplies 20 1982943767 0 Occupational Therapists Medical equipment/prosthetic devices 20 1982943767 0 Occupational Therapists Occupational Therapy Services 00 1982945903 0 FLEIG DENISE K 2017240 9999999 B 10 1982945903 0 29373 NETWORK PL CHICAGO IL 606733039 20 1982945903 0 Nurse Practitioners Fluoride varnish 20 1982945903 0 Nurse Practitioners Healthy Kids 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478074214 20 1982957130 0 Nurse Practitioners Healthy Kids Services 20 1982957130 0 Nurse Practitioners Nurse Practitioners Services 20 1982957130 0 Nurse Practitioners Physician Services 00 1982957478 0 QURESHI MARYAH 2019168 9999999 B 10 1982957478 0 30 W CHICAGO AVE CHICAGO IL 606543231 20 1982957478 0 Other behavior health professional Electronic Home Response/EHR Installation, MPE Certification 20 1982957478 0 Other behavior health professional LCPC/LMFT services 00 1982959219 0 DOMBROWSKI JAMES M 2018212 9999999 B 10 1982959219 0 PO BOX 713160 CHICAGO IL 606770360 20 1982959219 0 Physicians Anesthesia Services 20 1982959219 0 Physicians Healthy Kids Services 20 1982959219 0 Physicians Optical Supplies 20 1982959219 0 Physicians Physician Services 00 1982959433 0 FREEDMAN ANYA 2015303 9999999 B 10 1982959433 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1982959433 0 Physicians Anesthesia Services 20 1982959433 0 Physicians Fluoride varnish 20 1982959433 0 Physicians Healthy Kids 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532152843 20 1992105621 0 Nurse Practitioners Fluoride varnish 20 1992105621 0 Nurse Practitioners Healthy Kids Services 20 1992105621 0 Nurse Practitioners Nurse Practitioners Services 20 1992105621 0 Nurse Practitioners Physician Services 00 1992105696 0 DICKERSON KELCIE 2024087 9999999 B 10 1992105696 0 PO BOX 2777 BOISE ID 837012777 20 1992105696 0 Physician Assistant Only Fluoride varnish 20 1992105696 0 Physician Assistant Only Healthy Kids Services 20 1992105696 0 Physician Assistant Only Physician Services 00 1992106355 0 HOFFMAN MATTHEW 2022195 9999999 B 10 1992106355 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1992106355 0 Physicians Anesthesia Services 20 1992106355 0 Physicians Healthy Kids Services 20 1992106355 0 Physicians Optical Supplies 20 1992106355 0 Physicians Physician Services 00 1992106504 0 BUDO EMILY 2014258 9999999 B 10 1992106504 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1992106504 0 Nurse Practitioners Anesthesia Services 20 1992106504 0 Nurse 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0 PRITCHARD ROBERT 2023101 9999999 B 10 1992108781 0 790 REMINGTON BLVD BOLINGBROOK IL 604404909 20 1992108781 0 Physical Therapists Medical Supplies 20 1992108781 0 Physical Therapists Medical equipment/prosthetic devices 20 1992108781 0 Physical Therapists Physical Therapy Services 00 1992109326 0 SANDOVAL ANNA A 2021233 9999999 B 10 1992109326 0 520 VALLEY VIEW DR MOLINE IL 612656152 20 1992109326 0 Physician Assistant Only Fluoride varnish 20 1992109326 0 Physician Assistant Only Healthy Kids Services 20 1992109326 0 Physician Assistant Only Physician Services 00 1992109466 0 TAUCHEN JAMES 2015318 9999999 B 10 1992109466 0 1909 OGDEN AVE STE A DOWNERS GROVE IL 605152602 20 1992109466 0 Nurse Practitioners Healthy Kids Services 20 1992109466 0 Nurse Practitioners Nurse Practitioners Services 20 1992109466 0 Nurse Practitioners Physician Services 00 1992109565 0 GASCICH KATELYN J 2016013 9999999 B 10 1992109565 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1992109565 0 Speech 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1992118921 0 Physicians Fluoride varnish 20 1992118921 0 Physicians Healthy Kids Services 20 1992118921 0 Physicians Optical Supplies 20 1992118921 0 Physicians Physician Services 00 1992120091 0 WARREN NOELLE 2019274 9999999 B 10 1992120091 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1992120091 0 Occupational Therapists Medical Supplies 20 1992120091 0 Occupational Therapists Medical equipment/prosthetic devices 20 1992120091 0 Occupational Therapists Occupational Therapy Services 00 1992121057 0 WALLS KATHERINE 2024163 9999999 B 10 1992121057 0 PO BOX 19248 SPRINGFIELD IL 627949248 20 1992121057 0 Physician Assistant Only Fluoride varnish 20 1992121057 0 Physician Assistant Only Healthy Kids Services 20 1992121057 0 Physician Assistant Only Physician Services 00 1992121156 0 BOTTA VINCENT M 2014119 9999999 B 10 1992121156 0 28594 NETWORK PL CHICAGO IL 606731285 20 1992121156 0 Nurse Practitioners All Kids application agent 20 1992121156 0 Nurse Practitioners Family Planning Counseling 20 1992121156 0 Nurse Practitioners Fluoride varnish 20 1992121156 0 Nurse Practitioners Healthy Kids Services 20 1992121156 0 Nurse Practitioners Nurse Practitioners Services 20 1992121156 0 Nurse Practitioners Physician Services 00 1992122410 0 MITHAL DIVAKAR S 2019246 9999999 B 10 1992122410 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1992122410 0 Physicians Anesthesia Services 20 1992122410 0 Physicians Fluoride varnish 20 1992122410 0 Physicians Healthy Kids Services 20 1992122410 0 Physicians Optical Supplies 20 1992122410 0 Physicians Physician Services 00 1992122733 0 RAYNOLDS KRISTIN E 2014090 9999999 B 10 1992122733 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1992122733 0 Nurse Practitioners Anesthesia Services 20 1992122733 0 Nurse Practitioners Nurse Practitioners Services 20 1992122733 0 Nurse Practitioners Physician Services 00 1992122915 0 CHENG ELAINE 2021217 9999999 B 10 1992122915 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1992122915 0 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00 1992123723 0 CHAN DANIELA 2024075 9999999 B 10 1992123723 0 PO BOX 43230 PHOENIX AZ 850803230 20 1992123723 0 Physicians Anesthesia Services 20 1992123723 0 Physicians Fluoride varnish 20 1992123723 0 Physicians Healthy Kids Services 20 1992123723 0 Physicians Optical Supplies 20 1992123723 0 Physicians Physician Services 00 1992123830 0 MCFADDEN VANESSA C 2024234 9999999 B 10 1992123830 0 9000 W WISCONSIN AVE MILWAUKEE WI 532264874 20 1992123830 0 Physicians Anesthesia Services 20 1992123830 0 Physicians Fluoride varnish 20 1992123830 0 Physicians Healthy Kids Services 20 1992123830 0 Physicians Optical Supplies 20 1992123830 0 Physicians Physician Services 00 1992124093 0 EMELIFE NANCY 2021207 9999999 B 10 1992124093 0 525 E GRANT ST MACOMB IL 614553313 20 1992124093 0 Physicians Anesthesia Services 20 1992124093 0 Physicians Healthy Kids Services 20 1992124093 0 Physicians Optical Supplies 20 1992124093 0 Physicians Physician Services 00 1992124143 0 EJIDIKE MARYANNE N 2017066 9999999 B 10 1992124143 0 221 NE GLEN OAK AVE PEORIA IL 616360002 20 1992124143 0 Physicians Anesthesia Services 20 1992124143 0 Physicians Fluoride varnish 20 1992124143 0 Physicians Healthy Kids Services 20 1992124143 0 Physicians Optical Supplies 20 1992124143 0 Physicians Physician Services 00 1992124218 0 VEADE ASHLEY E 2018172 9999999 B 10 1992124218 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1992124218 0 Physicians Anesthesia Services 20 1992124218 0 Physicians Healthy Kids Services 20 1992124218 0 Physicians Optical Supplies 20 1992124218 0 Physicians Physician Services 00 1992124762 0 KHAN SHAJI M 2020301 9999999 B 10 1992124762 0 903 COMMERCE DR STE 333 SUITE 333 OAK BROOK IL 605238723 20 1992124762 0 Physicians Anesthesia Services 20 1992124762 0 Physicians Healthy Kids Services 20 1992124762 0 Physicians Optical Supplies 20 1992124762 0 Physicians Physician Services 00 1992124994 0 LYNCH NICHOLAS C 2019310 9999999 B 10 1992124994 0 1818 N 6TH ST TERRE HAUTE IN 478044021 20 1992124994 0 Physicians Anesthesia Services 20 1992124994 0 Physicians Healthy Kids Services 20 1992124994 0 Physicians Optical Supplies 20 1992124994 0 Physicians Physician Services 00 1992125066 0 LANIGAN ALEXANDER 2024264 9999999 B 10 1992125066 0 PO BOX 632122 CINCINNATI OH 452632122 20 1992125066 0 Physicians Anesthesia Services 20 1992125066 0 Physicians Healthy Kids Services 20 1992125066 0 Physicians Optical Supplies 20 1992125066 0 Physicians Physician Services 00 1992125728 0 NGUYEN KHOA 2022350 9999999 B 10 1992125728 0 PO BOX 301208 DALLAS TX 753031208 20 1992125728 0 Physicians Anesthesia Services 20 1992125728 0 Physicians Healthy Kids Services 20 1992125728 0 Physicians Optical Supplies 20 1992125728 0 Physicians Physician Services 00 1992125751 0 ROY DEBANSHU 2024065 9999999 B 10 1992125751 0 4701 DEPT CAROL STREAM IL 601220021 20 1992125751 0 Physicians Anesthesia Services 20 1992125751 0 Physicians Fluoride varnish 20 1992125751 0 Physicians Healthy Kids Services 20 1992125751 0 Physicians Optical Supplies 20 1992125751 0 Physicians Physician Services 00 1992125983 0 HOLMES MERRANDA 2024065 9999999 B 10 1992125983 0 DEPT AT 40379 ATLANTA GA 311920379 20 1992125983 0 Physicians Anesthesia Services 20 1992125983 0 Physicians Fluoride varnish 20 1992125983 0 Physicians Healthy Kids Services 20 1992125983 0 Physicians Optical Supplies 20 1992125983 0 Physicians Physician Services 00 1992126379 0 STEPHENSON KARA N 2014034 9999999 B 10 1992126379 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1992126379 0 Nurse Practitioners Anesthesia Services 20 1992126379 0 Nurse Practitioners Nurse Practitioners Services 20 1992126379 0 Nurse Practitioners Physician Services 00 1992126627 0 BRAASCH REBECCA 2014006 9999999 B 10 1992126627 0 400 N HIGHLAND AVE AURORA IL 605063814 20 1992126627 0 Nurse Practitioners Fluoride varnish 20 1992126627 0 Nurse Practitioners Healthy Kids Services 20 1992126627 0 Nurse Practitioners Nurse Practitioners Services 20 1992126627 0 Nurse Practitioners Physician Services 00 1992126635 0 SALLADE PEGGY 2023138 9999999 B 10 1992126635 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1992126635 0 Occupational Therapists Medical Supplies 20 1992126635 0 Occupational Therapists Medical equipment/prosthetic devices 20 1992126635 0 Occupational Therapists Occupational Therapy Services 00 1992127617 0 CURTIN MARGARET J 2015215 9999999 B 10 1992127617 0 PO BOX 713388 CHICAGO IL 606771525 20 1992127617 0 Nurse Practitioners Healthy Kids Services 20 1992127617 0 Nurse Practitioners Nurse Practitioners Services 20 1992127617 0 Nurse Practitioners Physician Services 00 1992128714 0 WAKADE LAKSHMI 2014195 9999999 B 10 1992128714 0 6311 WOODWARD AVE DOWNERS GROVE IL 605162311 20 1992128714 0 Dentists Dental Services 20 1992128714 0 Dentists Physician Services 00 1992129183 0 BOYER RACHEL E 2020276 9999999 B 10 1992129183 0 PO BOX 778912 CHICAGO IL 606778912 20 1992129183 0 Physician Assistant Only Fluoride varnish 20 1992129183 0 Physician Assistant Only Healthy Kids Services 20 1992129183 0 Physician Assistant Only Physician Services 00 1992129647 0 HENNEBERG DREW 2019001 9999999 B 10 1992129647 0 135 N WILLIAMSBURG DR BLOOMINGTON IL 617043528 20 1992129647 0 Physical Therapists Medical Supplies 20 1992129647 0 Physical Therapists Medical equipment/prosthetic devices 20 1992129647 0 Physical Therapists Physical Therapy Services 00 1992130231 0 CASS KATHRYN L 2014091 9999999 B 10 1992130231 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1992130231 0 Nurse Practitioners Anesthesia Services 20 1992130231 0 Nurse Practitioners Nurse Practitioners Services 20 1992130231 0 Nurse Practitioners Physician Services 00 1992130777 0 HOWARD TERI M 2016317 9999999 B 10 1992130777 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1992130777 0 Nurse Practitioners Healthy Kids Services 20 1992130777 0 Nurse Practitioners Nurse Practitioners Services 20 1992130777 0 Nurse Practitioners Physician Services 00 1992133243 0 HAGER LINDSAY 2018041 9999999 B 10 1992133243 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1992133243 0 Other behavior health professional LCPC/LMFT services 00 1992133607 0 BRAKEBILL CHRISTINA 2013305 9999999 B 10 1992133607 0 3048 N WILTON AVE FL 2 2ND FLOOR CHICAGO IL 606576710 20 1992133607 0 Nurse Practitioners Fluoride varnish 20 1992133607 0 Nurse Practitioners Healthy Kids Services 20 1992133607 0 Nurse Practitioners Nurse Practitioners Services 20 1992133607 0 Nurse Practitioners Physician Services 00 1992136121 0 CONDRON DANELL A 2018051 9999999 B 10 1992136121 0 1701 CHARLESTON AVE MATTOON IL 619383936 20 1992136121 0 Speech Therapists Medical Supplies 20 1992136121 0 Speech Therapists Medical equipment/prosthetic devices 20 1992136121 0 Speech Therapists Speech Therapy/Pathology Services 00 1992136493 0 BAUTISTA WELA 2023135 9999999 B 10 1992136493 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1992136493 0 Physical Therapists Medical Supplies 20 1992136493 0 Physical Therapists Medical equipment/prosthetic devices 20 1992136493 0 Physical Therapists Physical Therapy Services 00 1992137087 0 WALSH KATHLEEN M 2013213 9999999 B 10 1992137087 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1992137087 0 Speech Therapists Medical Supplies 20 1992137087 0 Speech Therapists Medical equipment/prosthetic devices 20 1992137087 0 Speech Therapists Speech Therapy/Pathology Services 00 1992138747 0 SCHLICKMAN SARAH 2015133 9999999 B 10 1992138747 0 PO BOX 4028 ROCK ISLAND IL 612044028 20 1992138747 0 Nurse Practitioners Fluoride varnish 20 1992138747 0 Nurse Practitioners Healthy Kids Services 20 1992138747 0 Nurse Practitioners Nurse Practitioners Services 20 1992138747 0 Nurse Practitioners Physician Services 00 1992139281 0 BOWERSOX KRISTINE 2016156 9999999 B 10 1992139281 0 5777 DEPT CAROL STREAM IL 601220021 20 1992139281 0 Physician Assistant Only Fluoride varnish 20 1992139281 0 Physician Assistant Only Healthy Kids Services 20 1992139281 0 Physician Assistant Only Physician Services 00 1992140107 0 RAMANUJAM ARCHANA 2022236 9999999 B 10 1992140107 0 2045 W GRAND AVE STE B CHICAGO IL 606121577 20 1992140107 0 Speech Therapists Medical Supplies 20 1992140107 0 Speech Therapists Medical equipment/prosthetic devices 20 1992140107 0 Speech Therapists Speech Therapy/Pathology Services 00 1992140750 0 FORREST LOUISE 2018261 9999999 H 10 1992140750 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1992140750 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1992140784 0 BJORNSTAD ERICA 2025031 9999999 B 10 1992140784 0 262 DANNY THOMAS PL MEMPHIS TN 381053678 20 1992140784 0 Physicians Anesthesia Services 20 1992140784 0 Physicians Fluoride varnish 20 1992140784 0 Physicians Healthy Kids Services 20 1992140784 0 Physicians Optical Supplies 20 1992140784 0 Physicians Physician Services 00 1992140958 0 LEE ANDREW R 2018157 9999999 B 10 1992140958 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1992140958 0 Physicians Anesthesia Services 20 1992140958 0 Physicians Healthy Kids Services 20 1992140958 0 Physicians Optical Supplies 20 1992140958 0 Physicians Physician Services 00 1992141832 0 SUNDLING KAITLIN E 2018163 9999999 B 10 1992141832 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1992141832 0 Physicians Anesthesia Services 20 1992141832 0 Physicians Healthy Kids Services 20 1992141832 0 Physicians Optical Supplies 20 1992141832 0 Physicians Physician Services 00 1992141907 0 ENZINGER ASHLEE 2021182 9999999 B 10 1992141907 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1992141907 0 Physicians Anesthesia Services 20 1992141907 0 Physicians Fluoride varnish 20 1992141907 0 Physicians Healthy Kids Services 20 1992141907 0 Physicians Optical Supplies 20 1992141907 0 Physicians Physician Services 00 1992142004 0 MUSTON HEATHER N 2019101 9999999 B 10 1992142004 0 PO BOX 1510 EVANSVILLE IN 477061510 20 1992142004 0 Physicians Anesthesia Services 20 1992142004 0 Physicians Fluoride varnish 20 1992142004 0 Physicians Healthy Kids Services 20 1992142004 0 Physicians Optical Supplies 20 1992142004 0 Physicians Physician Services 00 1992142376 0 CHOUDHRY KIRAN H 2015158 9999999 B 10 1992142376 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1992142376 0 Physicians Anesthesia Services 20 1992142376 0 Physicians Fluoride varnish 20 1992142376 0 Physicians Healthy Kids Services 20 1992142376 0 Physicians Optical Supplies 20 1992142376 0 Physicians Physician Services 00 1992142483 0 MALIK NIDA 2016285 9999999 B 10 1992142483 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1992142483 0 Physicians Anesthesia Services 20 1992142483 0 Physicians Fluoride varnish 20 1992142483 0 Physicians Healthy Kids Services 20 1992142483 0 Physicians Optical Supplies 20 1992142483 0 Physicians Physician Services 00 1992143028 0 KAUFMAN NATHAN A 2021214 9999999 B 10 1992143028 0 PO BOX 22487 GREEN BAY WI 543052487 20 1992143028 0 Physicians Anesthesia Services 20 1992143028 0 Physicians Healthy Kids Services 20 1992143028 0 Physicians Optical Supplies 20 1992143028 0 Physicians Physician Services 00 1992143531 0 LAZENBY DAVID 2021103 9999999 B 10 1992143531 0 2200 E SHOW LOW LAKE RD SHOW LOW AZ 859017831 20 1992143531 0 Physicians Anesthesia Services 20 1992143531 0 Physicians Healthy Kids Services 20 1992143531 0 Physicians Optical Supplies 20 1992143531 0 Physicians Physician Services 00 1992143861 0 SCHILL MATTHEW R 2019165 9999999 B 10 1992143861 0 660 S EUCLID AVE SAINT LOUIS MO 631101010 20 1992143861 0 Physicians Anesthesia Services 20 1992143861 0 Physicians Healthy Kids Services 20 1992143861 0 Physicians Optical Supplies 20 1992143861 0 Physicians Physician Services 00 1992144174 0 STASER KARL W 2017182 9999999 B 10 1992144174 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1992144174 0 Physicians Anesthesia Services 20 1992144174 0 Physicians Fluoride varnish 20 1992144174 0 Physicians Healthy Kids Services 20 1992144174 0 Physicians Optical Supplies 20 1992144174 0 Physicians Physician Services 00 1992144562 0 AGNELLO KELLY 2016212 9999999 B 10 1992144562 0 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 640642323 20 1992144562 0 Nurse Practitioners Fluoride varnish 20 1992144562 0 Nurse Practitioners Healthy Kids Services 20 1992144562 0 Nurse Practitioners Nurse Practitioners Services 20 1992144562 0 Nurse Practitioners Physician Services 00 1992144638 0 NEAL RYAN K 2017200 9999999 B 10 1992144638 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1992144638 0 Physicians Anesthesia Services 20 1992144638 0 Physicians Healthy Kids Services 20 1992144638 0 Physicians Optical Supplies 20 1992144638 0 Physicians Physician Services 00 1992144737 0 KECK KENDALL J 2019058 9999999 B 10 1992144737 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1992144737 0 Physicians Anesthesia Services 20 1992144737 0 Physicians Healthy Kids Services 20 1992144737 0 Physicians Optical Supplies 20 1992144737 0 Physicians Physician Services 00 1992144844 0 STRUPP MICHAEL S 2021209 9999999 B 10 1992144844 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1992144844 0 Physicians Anesthesia Services 20 1992144844 0 Physicians Fluoride varnish 20 1992144844 0 Physicians Healthy Kids Services 20 1992144844 0 Physicians Optical Supplies 20 1992144844 0 Physicians Physician Services 00 1992146500 0 RUIZ-QUINTERO SORY J 2019182 9999999 B 10 1992146500 0 PO BOX 578 PARK RIDGE IL 600680578 20 1992146500 0 Physicians Anesthesia Services 20 1992146500 0 Physicians Healthy Kids Services 20 1992146500 0 Physicians Optical Supplies 20 1992146500 0 Physicians Physician Services 00 1992146591 0 NAVE LEAH 2021244 9999999 B 10 1992146591 0 250 W 96TH ST # 520 INDIANAPOLIS IN 462601316 20 1992146591 0 Physicians Anesthesia Services 20 1992146591 0 Physicians Fluoride varnish 20 1992146591 0 Physicians Healthy Kids Services 20 1992146591 0 Physicians Optical Supplies 20 1992146591 0 Physicians Physician Services 00 1992147086 0 COLLEY BRIGETTE 2013213 9999999 B 10 1992147086 0 820 E JACKSON ST MACOMB IL 614552412 20 1992147086 0 Optometrists Optical Supplies 20 1992147086 0 Optometrists Optometric Services 20 1992147086 0 Optometrists Physician Services 00 1992147797 0 ANDERSON KERI 2021112 9999999 B 10 1992147797 0 111 17TH AVE E ALEXANDRIA MN 563085273 20 1992147797 0 Physician Assistant Only Fluoride varnish 20 1992147797 0 Physician Assistant Only Healthy Kids Services 20 1992147797 0 Physician Assistant Only Physician Services 00 1992148290 0 VALENTINO CAITLIN 2023184 9999999 B 10 1992148290 0 3333 BURNET AVE ML 5021 CINCINNATI OH 452293026 20 1992148290 0 Physicians Anesthesia Services 20 1992148290 0 Physicians Fluoride varnish 20 1992148290 0 Physicians Healthy Kids Services 20 1992148290 0 Physicians Optical Supplies 20 1992148290 0 Physicians Physician Services 00 1992148704 0 GOMEZ-TIMANA LUCY E 2016214 9999999 B 10 1992148704 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1992148704 0 Physicians Anesthesia Services 20 1992148704 0 Physicians Fluoride varnish 20 1992148704 0 Physicians Healthy Kids Services 20 1992148704 0 Physicians Optical Supplies 20 1992148704 0 Physicians Physician Services 00 1992149041 0 ZARZOUR AHMAD 2017159 9999999 B 10 1992149041 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1992149041 0 Physicians Anesthesia Services 20 1992149041 0 Physicians Fluoride varnish 20 1992149041 0 Physicians Healthy Kids Services 20 1992149041 0 Physicians Optical Supplies 20 1992149041 0 Physicians Physician Services 00 1992149116 0 DAVILA ALLISON 2024185 9999999 B 10 1992149116 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1992149116 0 Physicians Anesthesia Services 20 1992149116 0 Physicians Healthy Kids Services 20 1992149116 0 Physicians Optical Supplies 20 1992149116 0 Physicians Physician Services 00 1992149645 0 RECKER DAVID 2020255 9999999 B 10 1992149645 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1992149645 0 Physicians Anesthesia Services 20 1992149645 0 Physicians Fluoride varnish 20 1992149645 0 Physicians Healthy Kids Services 20 1992149645 0 Physicians Optical Supplies 20 1992149645 0 Physicians Physician Services 00 1992149702 0 MUDDARAJU MANJUNATH 2017229 9999999 B 10 1992149702 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1992149702 0 Physicians Anesthesia Services 20 1992149702 0 Physicians Fluoride varnish 20 1992149702 0 Physicians Healthy Kids Services 20 1992149702 0 Physicians Optical Supplies 20 1992149702 0 Physicians Physician Services 00 1992151518 0 ZARET LAVI 2017229 9999999 B 10 1992151518 0 5206 N LINCOLN AVE CHICAGO IL 606252406 20 1992151518 0 Dentists Dental Services 20 1992151518 0 Dentists Physician Services 00 1992151757 0 FAZLINEJAD ARIA 2023312 9999999 B 10 1992151757 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1992151757 0 Physicians Anesthesia Services 20 1992151757 0 Physicians Fluoride varnish 20 1992151757 0 Physicians Healthy Kids Services 20 1992151757 0 Physicians Optical Supplies 20 1992151757 0 Physicians Physician Services 00 1992152458 0 SHAABAN SARAH F 2019218 9999999 B 10 1992152458 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1992152458 0 Physicians Anesthesia Services 20 1992152458 0 Physicians Fluoride varnish 20 1992152458 0 Physicians Healthy Kids Services 20 1992152458 0 Physicians Optical Supplies 20 1992152458 0 Physicians Physician Services 00 1992152680 0 ZUNIGA ELIZABETH 2016166 9999999 B 10 1992152680 0 29373 NETWORK PL CHICAGO IL 606733039 20 1992152680 0 Speech Therapists Medical Supplies 20 1992152680 0 Speech Therapists Medical equipment/prosthetic devices 20 1992152680 0 Speech Therapists Speech Therapy/Pathology Services 00 1992153142 0 PATEL DHAVAL K 2019227 9999999 B 10 1992153142 0 1615 N CONVENT ST STE 1 STE 1 BOURBONNAIS IL 609141081 20 1992153142 0 Physicians Anesthesia Services 20 1992153142 0 Physicians Fluoride varnish 20 1992153142 0 Physicians Healthy Kids Services 20 1992153142 0 Physicians Optical Supplies 20 1992153142 0 Physicians Physician Services 00 1992153266 0 TOOR HARJYOT 2024229 9999999 B 10 1992153266 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1992153266 0 Physicians Anesthesia Services 20 1992153266 0 Physicians Healthy Kids Services 20 1992153266 0 Physicians Optical Supplies 20 1992153266 0 Physicians Physician Services 00 1992153308 0 MILEWSKI AMY 2018322 9999999 B 10 1992153308 0 387 SHUMAN BLVD STE 240W NAPERVILLE IL 605638113 20 1992153308 0 Nurse Practitioners Anesthesia Services 20 1992153308 0 Nurse Practitioners Nurse Practitioners Services 20 1992153308 0 Nurse Practitioners Physician Services 00 1992153639 0 DEGROOT MEGAN 2016275 9999999 B 10 1992153639 0 601 JAMES R THOMPSON BLVD STE BUILDING D, SUITE 2015 EAST SAINT LOUI IL 622011129 20 1992153639 0 Clinical Social Worker Social work service 00 1992153845 0 TRAWICK MARSHALL F 2017002 9999999 B 10 1992153845 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1992153845 0 Nurse Practitioners Fluoride varnish 20 1992153845 0 Nurse Practitioners Healthy Kids Services 20 1992153845 0 Nurse Practitioners Nurse Practitioners Services 20 1992153845 0 Nurse Practitioners Physician Services 00 1992154322 0 RUDEK SARAH 2016264 9999999 H 10 1992154322 0 3436 N KENNICOTT AVE STE 114 STE 114 ARLINGTON HEIGH IL 600047814 20 1992154322 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1992155352 0 HULL KELLY J 2016153 9999999 B 10 1992155352 0 1414 MAIN ST MELROSE PARK IL 601603902 20 1992155352 0 Other behavior health professional LCPC/LMFT services 00 1992155501 0 ENJETTI ALAN 2021047 9999999 B 10 1992155501 0 535 INDEPENDENCE PKWY STE 600 SUITE 600 CHESAPEAKE VA 233205181 20 1992155501 0 Physicians Anesthesia Services 20 1992155501 0 Physicians Healthy Kids Services 20 1992155501 0 Physicians Optical Supplies 20 1992155501 0 Physicians Physician Services 00 1992155923 0 LUONG PAUL DUY 2018271 9999999 B 10 1992155923 0 1 UNIVERSITY BLVD SAINT LOUIS MO 631214400 20 1992155923 0 Optometrists Optical Supplies 20 1992155923 0 Optometrists Optometric Services 20 1992155923 0 Optometrists Physician Services 00 1992156178 0 FLOREK JEFFREY 2021215 9999999 B 10 1992156178 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1992156178 0 Physicians Anesthesia Services 20 1992156178 0 Physicians Healthy Kids Services 20 1992156178 0 Physicians Optical Supplies 20 1992156178 0 Physicians Physician Services 00 1992156343 0 NELSEN DALTON J 2021345 9999999 B 10 1992156343 0 988102 NEBRASKA MEDICAL CTR OMAHA NE 681988102 20 1992156343 0 Physicians Anesthesia Services 20 1992156343 0 Physicians Healthy Kids Services 20 1992156343 0 Physicians Optical Supplies 20 1992156343 0 Physicians Physician Services 00 1992157283 0 MARTIN TINA D 2017266 9999999 B 10 1992157283 0 206 W 5TH ST METROPOLIS IL 629601810 20 1992157283 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1992157796 0 OBRADOVIC JOVANA 2024145 9999999 B 10 1992157796 0 PO BOX 43230 PHOENIX AZ 850803230 20 1992157796 0 Physicians Anesthesia Services 20 1992157796 0 Physicians Healthy Kids Services 20 1992157796 0 Physicians Optical Supplies 20 1992157796 0 Physicians Physician Services 00 1992158240 0 WASSON KATHRYN 2016207 9999999 B 10 1992158240 0 2827 MOMENTUM PL CHICAGO IL 606891100 20 1992158240 0 Physical Therapists Medical Supplies 20 1992158240 0 Physical Therapists Medical equipment/prosthetic devices 20 1992158240 0 Physical Therapists Physical Therapy Services 00 1992158737 0 RAVICHANDRAN SARANYA 2019107 9999999 B 10 1992158737 0 19990 GOVERNORS HWY OLYMPIA FIELDS IL 604611021 20 1992158737 0 Physicians Anesthesia Services 20 1992158737 0 Physicians Fluoride varnish 20 1992158737 0 Physicians Healthy Kids Services 20 1992158737 0 Physicians Optical Supplies 20 1992158737 0 Physicians Physician Services 00 1992159206 0 DALEY MICHAEL N 2018059 9999999 B 10 1992159206 0 100 E LEFEVRE RD STERLING IL 610811278 20 1992159206 0 Physicians Anesthesia Services 20 1992159206 0 Physicians Healthy Kids Services 20 1992159206 0 Physicians Optical Supplies 20 1992159206 0 Physicians Physician Services 00 1992159313 0 NISIMOVA LIANA 2020202 9999999 B 10 1992159313 0 5777 DEPT CAROL STREAM IL 601220021 20 1992159313 0 Physicians Anesthesia Services 20 1992159313 0 Physicians Fluoride varnish 20 1992159313 0 Physicians Healthy Kids Services 20 1992159313 0 Physicians Optical Supplies 20 1992159313 0 Physicians Physician Services 00 1992159537 0 PATEL KRISHNA 2018001 9999999 B 10 1992159537 0 1400 S MICHIGAN AVE APT 1203 CHICAGO IL 606053720 20 1992159537 0 Physicians Anesthesia Services 20 1992159537 0 Physicians Fluoride varnish 20 1992159537 0 Physicians Healthy Kids Services 20 1992159537 0 Physicians Optical Supplies 20 1992159537 0 Physicians Physician Services 00 1992162408 0 GARDNER LAURA L 2016075 9999999 B 10 1992162408 0 212 BARNEY DR JOLIET IL 604355271 20 1992162408 0 Clinical Social Worker Social work service 00 1992162457 0 SPRINGMAN KATHERINE K 2018081 9999999 B 10 1992162457 0 PO BOX 781076 DETROIT MI 482781076 20 1992162457 0 Nurse Practitioners Healthy Kids Services 20 1992162457 0 Nurse Practitioners Nurse Practitioners Services 20 1992162457 0 Nurse Practitioners Physician Services 00 1992162648 0 HENDERSON COLLEEN 2016252 9999999 B 10 1992162648 0 200 E FAIRMAN AVE WATSEKA IL 609701644 20 1992162648 0 Nurse Practitioners Fluoride varnish 20 1992162648 0 Nurse Practitioners Healthy Kids Services 20 1992162648 0 Nurse Practitioners Nurse Practitioners Services 20 1992162648 0 Nurse Practitioners Physician Services 00 1992162713 0 WOODSON JULIA R 2016284 9999999 B 10 1992162713 0 2339 N CALIFORNIA AVE UNIT 479 CHICAGO IL 606470360 20 1992162713 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1992164404 0 SPIELMAKER TERESA 2011336 9999999 B 10 1992164404 0 1301 W DEVON AVE CHICAGO IL 606601329 20 1992164404 0 Other behavior health professional LCPC/LMFT services 00 1992165773 0 JHAWAR NEHA 2023104 9999999 B 10 1992165773 0 PO BOX 79591 BALTIMORE MD 212790591 20 1992165773 0 Optometrists Optical Supplies 20 1992165773 0 Optometrists Optometric Services 20 1992165773 0 Optometrists Physician Services 00 1992167043 0 SALARI REZA 2021112 9999999 B 10 1992167043 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1992167043 0 Physicians Anesthesia Services 20 1992167043 0 Physicians Healthy Kids Services 20 1992167043 0 Physicians Optical Supplies 20 1992167043 0 Physicians Physician Services 00 1992167266 0 KREPLINE ASHLEY 2023163 9999999 B 10 1992167266 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1992167266 0 Physicians Anesthesia Services 20 1992167266 0 Physicians Healthy Kids Services 20 1992167266 0 Physicians Optical Supplies 20 1992167266 0 Physicians Physician Services 00 1992167696 0 HIGGINS LAURA C 2019274 9999999 B 10 1992167696 0 29373 NETWORK PL CHICAGO IL 606733039 20 1992167696 0 Nurse Practitioners Healthy Kids Services 20 1992167696 0 Nurse Practitioners Nurse Practitioners Services 20 1992167696 0 Nurse Practitioners Physician Services 00 1992168314 0 BROWN CORTLYN 2023152 9999999 B 10 1992168314 0 PO BOX 32861 CHARLOTTE NC 282322861 20 1992168314 0 Physicians Anesthesia Services 20 1992168314 0 Physicians Healthy Kids Services 20 1992168314 0 Physicians Optical Supplies 20 1992168314 0 Physicians Physician Services 00 1992168322 0 FYDA JACOB P 2018141 9999999 B 10 1992168322 0 1203 W AUGUSTA BLVD UNIT 1 CHICAGO IL 606424327 20 1992168322 0 Physicians Anesthesia Services 20 1992168322 0 Physicians Healthy Kids Services 20 1992168322 0 Physicians Optical Supplies 20 1992168322 0 Physicians Physician Services 20 1992168322 0 Physicians Physicians Psychiatric Services 00 1992168546 0 BARTON GREGORY J 2023158 9999999 B 10 1992168546 0 221 S 6TH ST TERRE HAUTE IN 478074214 20 1992168546 0 Physicians Anesthesia Services 20 1992168546 0 Physicians Healthy Kids Services 20 1992168546 0 Physicians Optical Supplies 20 1992168546 0 Physicians Physician Services 00 1992168553 0 RINEHART LUKE D 2023110 9999999 B 10 1992168553 0 PO BOX 208807 DALLAS TX 753208807 20 1992168553 0 Physicians Anesthesia Services 20 1992168553 0 Physicians Healthy Kids Services 20 1992168553 0 Physicians Optical Supplies 20 1992168553 0 Physicians Physician Services 00 1992168967 0 KUCZYNSKA AGATA 2016210 9999999 B 10 1992168967 0 7764 N NORA AVE NILES IL 607144740 20 1992168967 0 Physical Therapists Medical Supplies 20 1992168967 0 Physical Therapists Medical equipment/prosthetic devices 20 1992168967 0 Physical Therapists Speech Therapy/Pathology Services 00 1992169015 0 HELSTERN JARRET 2017030 9999999 B 10 1992169015 0 2319 S DAMEN AVE CHICAGO IL 606084209 20 1992169015 0 Nurse Practitioners Fluoride varnish 20 1992169015 0 Nurse Practitioners Healthy Kids Services 20 1992169015 0 Nurse Practitioners Nurse Practitioners Services 20 1992169015 0 Nurse Practitioners Physician Services 00 1992169304 0 HSU DIANE D 2020287 9999999 B 10 1992169304 0 12420 MILESTONE CENTER DR STE GERMANTOWN MD 208767111 20 1992169304 0 Physicians Anesthesia Services 20 1992169304 0 Physicians Healthy Kids Services 20 1992169304 0 Physicians Optical Supplies 20 1992169304 0 Physicians Physician Services 00 1992169767 0 KURZINSKI KATHERINE L 2023363 9999999 B 10 1992169767 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1992169767 0 Physicians Anesthesia Services 20 1992169767 0 Physicians Fluoride varnish 20 1992169767 0 Physicians Healthy Kids Services 20 1992169767 0 Physicians Optical Supplies 20 1992169767 0 Physicians Physician Services 00 1992170096 0 NG JOSEPH 2023353 9999999 B 10 1992170096 0 1501 DOGWOOD DR WOODRIDGE IL 605174649 20 1992170096 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1992170393 0 PATTERSON SHARMAINE L 2016123 9999999 B 10 1992170393 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1992170393 0 Nurse Practitioners Fluoride varnish 20 1992170393 0 Nurse Practitioners Healthy Kids Services 20 1992170393 0 Nurse Practitioners Nurse Practitioners Services 20 1992170393 0 Nurse Practitioners Physician Services 00 1992171326 0 HAMMOND CYNTHIA 2015295 9999999 B 10 1992171326 0 2201 MAIN ST EVANSTON IL 602021519 20 1992171326 0 Nurse Practitioners Fluoride varnish 20 1992171326 0 Nurse Practitioners Healthy Kids Services 20 1992171326 0 Nurse Practitioners Nurse Practitioners Services 20 1992171326 0 Nurse Practitioners Physician Services 00 1992171698 0 ELLIOTT-MCCANDLESS COLLEEN 2015182 9999999 B 10 1992171698 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1992171698 0 Nurse Practitioners Healthy Kids Services 20 1992171698 0 Nurse Practitioners Nurse Practitioners Services 20 1992171698 0 Nurse Practitioners Nursing service 20 1992171698 0 Nurse Practitioners Physician Services 20 1992171698 0 Nurse Practitioners Waiver service 00 1992172860 0 BEAN RYNE R 2016235 9999999 B 10 1992172860 0 29624 NETWORK PL LOCKBOX CHICAGO IL 606731296 20 1992172860 0 Physicians Anesthesia Services 20 1992172860 0 Physicians Fluoride varnish 20 1992172860 0 Physicians Healthy Kids Services 20 1992172860 0 Physicians Optical Supplies 20 1992172860 0 Physicians Physician Services 00 1992172944 0 DEATO MARY CHRISTINE 2015007 9999999 B 10 1992172944 0 3040 W SALT CREEK LN ARLINGTON HEIGH IL 600051069 20 1992172944 0 Nurse Practitioners Healthy Kids Services 20 1992172944 0 Nurse Practitioners Nurse Practitioners Services 20 1992172944 0 Nurse Practitioners Physician Services 00 1992174403 0 KIM JOHN H 2015293 9999999 B 10 1992174403 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1992174403 0 Nurse Practitioners Fluoride varnish 20 1992174403 0 Nurse Practitioners Healthy Kids Services 20 1992174403 0 Nurse Practitioners Nurse Practitioners Services 20 1992174403 0 Nurse Practitioners Physician Services 00 1992174536 0 AHUMADA SARA 2023195 9999999 B 10 1992174536 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1992174536 0 Nurse Practitioners Healthy Kids Services 20 1992174536 0 Nurse Practitioners Nurse Practitioners Services 20 1992174536 0 Nurse Practitioners Physician Services 00 1992175467 0 VAICKUS LINDA K 2016340 9999999 B 10 1992175467 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1992175467 0 Nurse Practitioners Healthy Kids Services 20 1992175467 0 Nurse Practitioners Nurse Practitioners Services 20 1992175467 0 Nurse Practitioners Physician Services 00 1992175715 0 REIDER JACLYN 2016284 9999999 B 10 1992175715 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1992175715 0 Nurse Practitioners Fluoride varnish 20 1992175715 0 Nurse Practitioners Healthy Kids Services 20 1992175715 0 Nurse Practitioners Nurse Practitioners Services 20 1992175715 0 Nurse Practitioners Physician Services 00 1992176366 0 KLEIN MATTHEW 2024079 9999999 H 10 1992176366 0 1135 W 69TH ST CHICAGO IL 606211147 20 1992176366 0 Physician Assistant Only Fluoride varnish 20 1992176366 0 Physician Assistant Only Healthy Kids Services 20 1992176366 0 Physician Assistant Only Physician Services 00 1992177398 0 SHANKER KAREN 2021068 9999999 B 10 1992177398 0 11365 DORSETT RD MARYLAND HEIGHT MO 630433411 20 1992177398 0 Nurse Practitioners Fluoride varnish 20 1992177398 0 Nurse Practitioners Healthy Kids Services 20 1992177398 0 Nurse Practitioners Nurse Practitioners Services 20 1992177398 0 Nurse Practitioners Physician Services 00 1992177422 0 LAKNER MICHELLE L 2018201 9999999 B 10 1992177422 0 1808 W BELTLINE HWY MADISON WI 537132334 20 1992177422 0 Nurse Practitioners Healthy Kids Services 20 1992177422 0 Nurse Practitioners Nurse Practitioners Services 20 1992177422 0 Nurse Practitioners Physician Services 00 1992178297 0 LICHTER LEAH 2023235 9999999 B 10 1992178297 0 250 SKILLMAN ST STE 204 BROOKLYN NY 112051218 20 1992178297 0 Physician Assistant Only Fluoride varnish 20 1992178297 0 Physician Assistant Only Healthy Kids Services 20 1992178297 0 Physician Assistant Only Physician Services 00 1992178826 0 KERBY REBECCA 2023283 9999999 B 10 1992178826 0 1518 MULBERRY AVE MUSCATINE IA 527613433 20 1992178826 0 Nurse Practitioners Healthy Kids Services 20 1992178826 0 Nurse Practitioners Nurse Practitioners Services 20 1992178826 0 Nurse Practitioners Physician Services 00 1992179881 0 COKER KATHRYN D 2021036 9999999 B 10 1992179881 0 221 NE GLEN OAK AVE PEORIA IL 616360001 20 1992179881 0 Physician Assistant Only Fluoride varnish 20 1992179881 0 Physician Assistant Only Healthy Kids Services 20 1992179881 0 Physician Assistant Only Physician Services 00 1992180806 0 KEMNELE STEPHEN 2021109 9999999 B 10 1992180806 0 PO BOX 3877 JOLIET IL 604343877 20 1992180806 0 Physicians Anesthesia Services 20 1992180806 0 Physicians Fluoride varnish 20 1992180806 0 Physicians Healthy Kids Services 20 1992180806 0 Physicians Optical Supplies 20 1992180806 0 Physicians Physician Services 00 1992181408 0 GELDER JAMES 2016349 9999999 B 10 1992181408 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1992181408 0 Physician Assistant Only Fluoride varnish 20 1992181408 0 Physician Assistant Only Healthy Kids Services 20 1992181408 0 Physician Assistant Only Physician Services 00 1992182331 0 WEBB ALYSON C 2015187 9999999 B 10 1992182331 0 3051 HOLLIS DR FL 2 SPRINGFIELD IL 627047452 20 1992182331 0 Nurse Practitioners Fluoride varnish 20 1992182331 0 Nurse Practitioners Healthy Kids Services 20 1992182331 0 Nurse Practitioners Nurse Practitioners Services 20 1992182331 0 Nurse Practitioners Physician Services 00 1992183503 0 BOTERO CAROLINA 2015213 9999999 B 10 1992183503 0 1120 N MELVIN ST GIBSON CITY IL 609361477 20 1992183503 0 Nurse Practitioners Anesthesia Services 20 1992183503 0 Nurse Practitioners Nurse Practitioners Services 20 1992183503 0 Nurse Practitioners Physician Services 00 1992184295 0 MARITIM-ADIPO HELEN 2023045 9999999 B 10 1992184295 0 3504 COMMERCIAL AVE NORTHBROOK IL 600621821 20 1992184295 0 Other behavior health professional LCPC/LMFT services 20 1992184295 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1992185128 0 NUNES VANESSA 2020077 9999999 B 10 1992185128 0 PO BOX 776473 CHICAGO IL 606776473 20 1992185128 0 Physicians Anesthesia Services 20 1992185128 0 Physicians Healthy Kids Services 20 1992185128 0 Physicians Optical Supplies 20 1992185128 0 Physicians Physician Services 00 1992185292 0 EDGINGTON JONATHAN 2019001 9999999 B 10 1992185292 0 9660 WICKER AVE SAINT JOHN IN 463739487 20 1992185292 0 Physicians Anesthesia Services 20 1992185292 0 Physicians Healthy Kids Services 20 1992185292 0 Physicians Optical Supplies 20 1992185292 0 Physicians Physician Services 00 1992187074 0 DESTEFANI MATTHEW THOMAS 2018156 9999999 B 10 1992187074 0 PO BOX 95279 DEPT A CHICAGO IL 606945279 20 1992187074 0 Physicians Anesthesia Services 20 1992187074 0 Physicians Healthy Kids Services 20 1992187074 0 Physicians Optical Supplies 20 1992187074 0 Physicians Physician Services 00 1992187397 0 MAQBOOL ASIA 2015194 9999999 B 10 1992187397 0 3880 SALEM LAKE DR STE F LONG GROVE IL 600475292 20 1992187397 0 Physicians Anesthesia Services 20 1992187397 0 Physicians Fluoride varnish 20 1992187397 0 Physicians Healthy Kids Services 20 1992187397 0 Physicians Optical Supplies 20 1992187397 0 Physicians Physician Services 00 1992187934 0 LEVEK KELLI 2018182 9999999 B 10 1992187934 0 200 STAHLHUT DR LINCOLN IL 626565066 20 1992187934 0 Physicians Anesthesia Services 20 1992187934 0 Physicians Healthy Kids Services 20 1992187934 0 Physicians Optical Supplies 20 1992187934 0 Physicians Physician Services 00 1992188288 0 RIEGER DEBRA L 2016271 9999999 B 10 1992188288 0 15740 S OUTER 40 RD CHESTERFIELD MO 630172004 20 1992188288 0 Nurse Practitioners Fluoride varnish 20 1992188288 0 Nurse Practitioners Healthy Kids Services 20 1992188288 0 Nurse Practitioners Nurse Practitioners Services 20 1992188288 0 Nurse Practitioners Physician Services 00 1992188338 0 DAVIS CARL R 2015202 9999999 B 10 1992188338 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1992188338 0 Nurse Practitioners Anesthesia Services 20 1992188338 0 Nurse Practitioners Nurse Practitioners Services 20 1992188338 0 Nurse Practitioners Physician Services 00 1992188395 0 MERCY PATHROSE RANA P 2018014 9999999 B 10 1992188395 0 3545 LINDELL BLVD FL 3 SAINT LOUIS MO 631031020 20 1992188395 0 Physicians Anesthesia Services 20 1992188395 0 Physicians Healthy Kids Services 20 1992188395 0 Physicians Optical Supplies 20 1992188395 0 Physicians Physician Services 20 1992188395 0 Physicians Physicians Psychiatric Services 00 1992189104 0 PATEL SHREYA V 2015300 2060001 B 10 1992189104 0 130 S MANNHEIM RD HILLSIDE IL 601621821 20 1992189104 0 Optometrists Optical Supplies 20 1992189104 0 Optometrists Optometric Services 20 1992189104 0 Optometrists Physician Services 00 1992189971 0 LOEPKER KAYLA G 2022038 9999999 B 10 1992189971 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1992189971 0 Nurse Practitioners Fluoride varnish 20 1992189971 0 Nurse Practitioners Healthy Kids Services 20 1992189971 0 Nurse Practitioners Nurse Practitioners Services 20 1992189971 0 Nurse Practitioners Physician Services 00 1992190789 0 PURTELL CHRISTOPHER S 2023226 9999999 B 10 1992190789 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1992190789 0 Physicians Anesthesia Services 20 1992190789 0 Physicians Fluoride varnish 20 1992190789 0 Physicians Healthy Kids Services 20 1992190789 0 Physicians Optical Supplies 20 1992190789 0 Physicians Physician Services 00 1992190888 0 AHANGARI ALI 2021063 9999999 B 10 1992190888 0 PO BOX 43230 PHOENIX AZ 850803230 20 1992190888 0 Physicians Anesthesia Services 20 1992190888 0 Physicians Healthy Kids Services 20 1992190888 0 Physicians Optical Supplies 20 1992190888 0 Physicians Physician Services 00 1992191050 0 ASCHENAKI BETHEAL G 2019070 9999999 B 10 1992191050 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1992191050 0 Physicians Anesthesia Services 20 1992191050 0 Physicians Fluoride varnish 20 1992191050 0 Physicians Healthy Kids Services 20 1992191050 0 Physicians Optical Supplies 20 1992191050 0 Physicians Physician Services 00 1992191266 0 LAPUCHA MATEUSZ 2021306 9999999 B 10 1992191266 0 222 N PACIFIC COAST HWY STE 21 EL SEGUNDO CA 902455639 20 1992191266 0 Physicians Anesthesia Services 20 1992191266 0 Physicians Healthy Kids Services 20 1992191266 0 Physicians Optical Supplies 20 1992191266 0 Physicians Physician Services 00 1992192256 0 TADEO NICHOLAS E 2021172 9999999 B 10 1992192256 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1992192256 0 Physicians Anesthesia Services 20 1992192256 0 Physicians Healthy Kids Services 20 1992192256 0 Physicians Optical Supplies 20 1992192256 0 Physicians Physician Services 00 1992192363 0 MOORE LAWRENCE 2018220 9999999 H 10 1992192363 0 333 N LA GRANGE RD STE 1 SUITE ONE LA GRANGE PARK IL 605265653 20 1992192363 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1992192546 0 CRAIGO KAYLEE 2023122 9999999 B 10 1992192546 0 2111 OGDEN AVE AURORA IL 605047597 20 1992192546 0 Physician Assistant Only Fluoride varnish 20 1992192546 0 Physician Assistant Only Healthy Kids Services 20 1992192546 0 Physician Assistant Only Physician Services 00 1992193429 0 HOFBAUER JOYCE 2016008 9999999 B 10 1992193429 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1992193429 0 Other behavior health professional All Kids application agent 20 1992193429 0 Other behavior health professional LCPC/LMFT services 00 1992194401 0 LOEPKER ALYSSA R 2016078 9999999 B 10 1992194401 0 6810 STATE ROUTE 162 STE 215 MARYVILLE IL 620628566 20 1992194401 0 Nurse Practitioners Fluoride varnish 20 1992194401 0 Nurse Practitioners Healthy Kids Services 20 1992194401 0 Nurse Practitioners Nurse Practitioners Services 20 1992194401 0 Nurse Practitioners Physician Services 00 1992195051 0 WHETSTINE CHRISTOPHER K 2016144 9999999 B 10 1992195051 0 PO BOX 1197 EVANSVILLE IN 477061197 20 1992195051 0 Nurse Practitioners Anesthesia Services 20 1992195051 0 Nurse Practitioners Nurse Practitioners Services 20 1992195051 0 Nurse Practitioners Physician Services 00 1992195085 0 WEYMER JEAN M 2016313 9999999 B 10 1992195085 0 11447 2ND ST STE 9B ROSCOE IL 610739522 20 1992195085 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1992195697 0 BOGACHKOV ABRAHAM 2020025 9999999 B 10 1992195697 0 44000 GARFIELD RD CLINTON TOWNSHI MI 480381125 20 1992195697 0 Physicians Anesthesia Services 20 1992195697 0 Physicians Healthy Kids Services 20 1992195697 0 Physicians Optical Supplies 20 1992195697 0 Physicians Physician Services 00 1992196463 0 DEYHOLOS CHRISTINE 2023132 9999999 B 10 1992196463 0 DEPT AT 40379 ATLANTA GA 311920379 20 1992196463 0 Physicians Anesthesia Services 20 1992196463 0 Physicians Healthy Kids Services 20 1992196463 0 Physicians Optical Supplies 20 1992196463 0 Physicians Physician Services 00 1992196661 0 WUN KELLY 2019174 9999999 B 10 1992196661 0 4698 DEPT CAROL STREAM IL 601220021 20 1992196661 0 Physicians Anesthesia Services 20 1992196661 0 Physicians Healthy Kids Services 20 1992196661 0 Physicians Optical Supplies 20 1992196661 0 Physicians Physician Services 00 1992196703 0 GUTIERREZ SCOTT 2015213 9999999 B 10 1992196703 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1992196703 0 Nurse Practitioners Anesthesia Services 20 1992196703 0 Nurse Practitioners Nurse Practitioners Services 20 1992196703 0 Nurse Practitioners Physician Services 00 1992196729 0 BAILEY ELIZABETH L 2016042 9999999 B 10 1992196729 0 2550 CHARLES ST ROCKFORD IL 611081673 20 1992196729 0 Physician Assistant Only Fluoride varnish 20 1992196729 0 Physician Assistant Only Healthy Kids Services 20 1992196729 0 Physician Assistant Only Physician Services 00 1992197339 0 MEYER KARA L 2021277 9999999 B 10 1992197339 0 1227 E RUSHOLME ST DAVENPORT IA 528032459 20 1992197339 0 Physical Therapists Medical Supplies 20 1992197339 0 Physical Therapists Medical equipment/prosthetic devices 20 1992197339 0 Physical Therapists Physical Therapy Services 00 1992197933 0 PATEL VANDANA B 2017215 9999999 B 10 1992197933 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1992197933 0 Nurse Practitioners Fluoride varnish 20 1992197933 0 Nurse Practitioners Healthy Kids Services 20 1992197933 0 Nurse Practitioners Nurse Practitioners Services 20 1992197933 0 Nurse Practitioners Physician Services 00 1992198352 0 ASTLE KIMBERLY 2022194 9999999 B 10 1992198352 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1992198352 0 Occupational Therapists Medical Supplies 20 1992198352 0 Occupational Therapists Medical equipment/prosthetic devices 20 1992198352 0 Occupational Therapists Occupational Therapy Services 00 1992198899 0 HESSION KELLI A 2019297 9999999 B 10 1992198899 0 PO BOX 778912 CHICAGO IL 606778912 20 1992198899 0 Nurse Practitioners Fluoride varnish 20 1992198899 0 Nurse Practitioners Healthy Kids Services 20 1992198899 0 Nurse Practitioners Nurse Practitioners Services 20 1992198899 0 Nurse Practitioners Physician Services 00 1992199947 0 JANDURA DAVID MARK 2017144 9999999 B 10 1992199947 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1992199947 0 Physicians Anesthesia Services 20 1992199947 0 Physicians Fluoride varnish 20 1992199947 0 Physicians Healthy Kids Services 20 1992199947 0 Physicians Optical Supplies 20 1992199947 0 Physicians Physician Services 00 1992200018 0 MOHR COURTNEY A 2018162 9999999 B 10 1992200018 0 101 E MILLER RD STERLING IL 610811252 20 1992200018 0 Nurse Practitioners Healthy Kids Services 20 1992200018 0 Nurse Practitioners Nurse Practitioners Services 20 1992200018 0 Nurse Practitioners Physician Services 00 1992200935 0 PHILPOTT DAVID C 2023240 9999999 B 10 1992200935 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1992200935 0 Physicians Anesthesia Services 20 1992200935 0 Physicians Fluoride varnish 20 1992200935 0 Physicians Healthy Kids Services 20 1992200935 0 Physicians Optical Supplies 20 1992200935 0 Physicians Physician Services 00 1992201040 0 PACHICANO MONICA 2019031 9999999 H 10 1992201040 0 333 N LA GRANGE RD STE 1 SUITE ONE LA GRANGE PARK IL 605265653 20 1992201040 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1992201180 0 NOWAK LINDSAY 2024324 9999999 B 10 1992201180 0 PO BOX 411637 SAINT LOUIS MO 631411637 20 1992201180 0 Physicians Anesthesia Services 20 1992201180 0 Physicians Healthy Kids Services 20 1992201180 0 Physicians Optical Supplies 20 1992201180 0 Physicians Physician Services 00 1992201479 0 MANHEIM VICTORIA NICOLE 2018155 9999999 B 10 1992201479 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1992201479 0 Other behavior health professional LCPC/LMFT services 00 1992201560 0 NIJHAWAN KARAN 2019182 9999999 B 10 1992201560 0 PO BOX 713160 CHICAGO IL 606770360 20 1992201560 0 Physicians Anesthesia Services 20 1992201560 0 Physicians Healthy Kids Services 20 1992201560 0 Physicians Optical Supplies 20 1992201560 0 Physicians Physician Services 00 1992202006 0 HUANG XIAO M 2022230 9999999 B 10 1992202006 0 PO BOX 713388 CHICAGO IL 606771525 20 1992202006 0 Physicians Anesthesia Services 20 1992202006 0 Physicians Healthy Kids Services 20 1992202006 0 Physicians Optical Supplies 20 1992202006 0 Physicians Physician Services 00 1992202097 0 PATEL DAVEL 2020059 9999999 B 10 1992202097 0 29373 NETWORK PL CHICAGO IL 606733039 20 1992202097 0 Physicians Anesthesia Services 20 1992202097 0 Physicians Fluoride varnish 20 1992202097 0 Physicians Healthy Kids Services 20 1992202097 0 Physicians Optical Supplies 20 1992202097 0 Physicians Physician Services 00 1992202188 0 CACIOPPO BRIAN 2022158 9999999 B 10 1992202188 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1992202188 0 Physicians Anesthesia Services 20 1992202188 0 Physicians Healthy Kids Services 20 1992202188 0 Physicians Optical Supplies 20 1992202188 0 Physicians Physician Services 00 1992202717 0 WYSOZAN TIMOTHY 2023194 9999999 B 10 1992202717 0 44000 GARFIELD RD CLINTON TOWNSHI MI 480381125 20 1992202717 0 Physicians Anesthesia Services 20 1992202717 0 Physicians Healthy Kids Services 20 1992202717 0 Physicians Optical Supplies 20 1992202717 0 Physicians Physician Services 00 1992203640 0 ECKHART KRISTEN 2018032 9999999 B 10 1992203640 0 PO BOX 3428 SPRINGFIELD IL 627083428 20 1992203640 0 Nurse Practitioners Anesthesia Services 20 1992203640 0 Nurse Practitioners Nurse Practitioners Services 20 1992203640 0 Nurse Practitioners Physician Services 00 1992203798 0 JOHNSON LORNA 2018113 9999999 B 10 1992203798 0 835 S WOLCOTT AVE RM W140 CHICAGO IL 606123748 20 1992203798 0 Nurse Practitioners Healthy Kids Services 20 1992203798 0 Nurse Practitioners Nurse Practitioners Services 20 1992203798 0 Nurse Practitioners Physician Services 00 1992208078 0 ZIMMERMAN SARAH E 2023153 9999999 B 10 1992208078 0 122 S MICHIGAN AVE STE 1441 CHICAGO IL 606036173 20 1992208078 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1992208771 0 MASLON VICTOR 2022295 9999999 B 10 1992208771 0 200 CORPORATE BLVD LAFAYETTE LA 705083870 20 1992208771 0 Physicians Anesthesia Services 20 1992208771 0 Physicians Healthy Kids Services 20 1992208771 0 Physicians Optical Supplies 20 1992208771 0 Physicians Physician Services 00 1992208938 0 HYNEK ELIZABETH A 2018122 9999999 B 10 1992208938 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1992208938 0 Nurse Practitioners Fluoride varnish 20 1992208938 0 Nurse Practitioners Healthy Kids Services 20 1992208938 0 Nurse Practitioners Nurse Practitioners Services 20 1992208938 0 Nurse Practitioners Physician Services 00 1992209167 0 KARVAR SERHAN 2023144 9999999 B 10 1992209167 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1992209167 0 Physicians Anesthesia Services 20 1992209167 0 Physicians Fluoride varnish 20 1992209167 0 Physicians Healthy Kids Services 20 1992209167 0 Physicians Optical Supplies 20 1992209167 0 Physicians Physician Services 00 1992209209 0 JENSEN DAVID 2024049 2026181 B 10 1992209209 0 DEPT AT 40379 ATLANTA GA 311920001 20 1992209209 0 Physicians Anesthesia Services 20 1992209209 0 Physicians Healthy Kids Services 20 1992209209 0 Physicians Optical Supplies 20 1992209209 0 Physicians Physician Services 00 1992209902 0 ABDL-HALEEM AHMAD A 2018163 9999999 B 10 1992209902 0 1301 W DEVON AVE CHICAGO IL 606601329 20 1992209902 0 Physicians Anesthesia Services 20 1992209902 0 Physicians Fluoride varnish 20 1992209902 0 Physicians Healthy Kids Services 20 1992209902 0 Physicians Optical Supplies 20 1992209902 0 Physicians Physician Services 00 1992209951 0 GUNDY KELSEY J 2022021 9999999 B 10 1992209951 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1992209951 0 Speech Therapists Medical Supplies 20 1992209951 0 Speech Therapists Medical equipment/prosthetic devices 20 1992209951 0 Speech Therapists Speech Therapy/Pathology Services 00 1992210934 0 CONWAY HOLLY L 2019155 9999999 B 10 1992210934 0 42 W MADISON ST FL 2 CHICAGO IL 606024309 20 1992210934 0 Psychologist Provider is enrolled with HFS as a ordering, rendering, or referring physician/practitioner. 00 1992211221 0 GABRIEL LAURA 2005263 9999999 B 10 1992211221 0 1207 N LARKIN AVE JOLIET IL 604353436 20 1992211221 0 Speech Therapists Medical Supplies 20 1992211221 0 Speech Therapists Medical equipment/prosthetic devices 20 1992211221 0 Speech Therapists Speech Therapy/Pathology Services 00 1992211700 0 DAVIS LAURIE A 2021337 9999999 B 10 1992211700 0 1431 CENTERPOINT BLVD STE 100 KNOXVILLE TN 379321983 20 1992211700 0 Nurse Practitioners Healthy Kids Services 20 1992211700 0 Nurse Practitioners Nurse Practitioners Services 20 1992211700 0 Nurse Practitioners Physician Services 00 1992211965 0 MARIETTA MEGAN E 2018274 9999999 B 10 1992211965 0 777 S MAIN ST STE 100 CLINTON IN 478422493 20 1992211965 0 Nurse Practitioners Fluoride varnish 20 1992211965 0 Nurse Practitioners Healthy Kids Services 20 1992211965 0 Nurse Practitioners Nurse Practitioners Services 20 1992211965 0 Nurse Practitioners Physician Services 00 1992213896 0 BASSLER JENNIFER M 2018091 9999999 B 10 1992213896 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1992213896 0 Nurse Practitioners Fluoride varnish 20 1992213896 0 Nurse Practitioners Healthy Kids Services 20 1992213896 0 Nurse Practitioners Nurse Practitioners Services 20 1992213896 0 Nurse Practitioners Physician Services 00 1992214373 0 SEBEK DANA 2017303 9999999 B 10 1992214373 0 PO BOX 1541 NORTHBROOK IL 600651541 20 1992214373 0 Nurse Practitioners Healthy Kids Services 20 1992214373 0 Nurse Practitioners Nurse Practitioners Services 20 1992214373 0 Nurse Practitioners Physician Services 00 1992214712 0 MITCHELL BRIANA R 2017305 9999999 B 10 1992214712 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1992214712 0 Nurse Practitioners Healthy Kids Services 20 1992214712 0 Nurse Practitioners Nurse Practitioners Services 20 1992214712 0 Nurse Practitioners Physician Services 00 1992214795 0 NAGENGAST ALYSSA R 2019051 9999999 B 10 1992214795 0 5777 DEPT CAROL STREAM IL 601220021 20 1992214795 0 Clinical Social Worker Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 20 1992214795 0 Clinical Social Worker Social work service 00 1992216816 0 BANSFIELD JOANNA G 2018032 9999999 B 10 1992216816 0 29373 NETWORK PL CHICAGO IL 606733039 20 1992216816 0 Nurse Practitioners Fluoride varnish 20 1992216816 0 Nurse Practitioners Healthy Kids Services 20 1992216816 0 Nurse Practitioners Nurse Practitioners Services 20 1992216816 0 Nurse Practitioners Physician Services 00 1992217111 0 SPICER ARON K 2017318 9999999 B 10 1992217111 0 PO BOX 130 2803 S BANKER EFFINGHAM IL 624010130 20 1992217111 0 Speech Therapists Medical Supplies 20 1992217111 0 Speech Therapists Medical equipment/prosthetic devices 20 1992217111 0 Speech Therapists Speech Therapy/Pathology Services 00 1992217178 0 MUSTAFA YASER R 2019227 9999999 B 10 1992217178 0 4701 DEPT CAROL STREAM IL 601220021 20 1992217178 0 Physicians Anesthesia Services 20 1992217178 0 Physicians Fluoride varnish 20 1992217178 0 Physicians Healthy Kids Services 20 1992217178 0 Physicians Optical Supplies 20 1992217178 0 Physicians Physician Services 00 1992217368 0 PIANO DANIELLE 2017303 9999999 B 10 1992217368 0 1775 GLENVIEW RD STE 103 GLENVIEW IL 600252943 20 1992217368 0 Dentists Dental Services 20 1992217368 0 Dentists Physician Services 00 1992218044 0 TEAGUE CARMEN 2018163 9999999 B 10 1992218044 0 1642 E 56TH ST STE 110 CHICAGO IL 606375049 20 1992218044 0 Other 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1992220438 0 Physicians Fluoride varnish 20 1992220438 0 Physicians Healthy Kids Services 20 1992220438 0 Physicians Optical Supplies 20 1992220438 0 Physicians Physician Services 00 1992221089 0 HERRING RACHEL 2017240 9999999 B 10 1992221089 0 1854 E BROADWAY ALTON IL 620026664 20 1992221089 0 Speech Therapists Medical Supplies 20 1992221089 0 Speech Therapists Medical equipment/prosthetic devices 20 1992221089 0 Speech Therapists Speech Therapy/Pathology Services 00 1992221543 0 VAZQUEZ MARGARITA 2017229 9999999 B 10 1992221543 0 3941 W DAYTON ST MCHENRY IL 600508377 20 1992221543 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1992223895 0 REED CASSANDRA K 2017243 9999999 B 10 1992223895 0 PO BOX 857 FREEPORT IL 610320857 20 1992223895 0 Nurse Practitioners Fluoride varnish 20 1992223895 0 Nurse Practitioners Healthy Kids Services 20 1992223895 0 Nurse Practitioners Nurse Practitioners Services 20 1992223895 0 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Services 00 1992238786 0 KUNZ BRANDON T 2020028 9999999 B 10 1992238786 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1992238786 0 Podiatrists Podiatric Services 00 1992238810 0 MCCORMICK ANGELA 2017128 9999999 B 10 1992238810 0 3051 HOLLIS DR SPRINGFIELD IL 627047452 20 1992238810 0 Nurse Practitioners Fluoride varnish 20 1992238810 0 Nurse Practitioners Healthy Kids Services 20 1992238810 0 Nurse Practitioners Nurse Practitioners Services 20 1992238810 0 Nurse Practitioners Physician Services 00 1992239370 0 KALTENECKER THOMAS C 2018022 9999999 B 10 1992239370 0 1021 N MULFORD RD ROCKFORD IL 611073877 20 1992239370 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1992239560 0 REYES PINZON SANDRA HELENA 2021186 9999999 B 10 1992239560 0 7825 SOLUTION CTR CHICAGO IL 606777007 20 1992239560 0 Physicians Anesthesia Services 20 1992239560 0 Physicians Healthy Kids Services 20 1992239560 0 Physicians Optical 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EVANSTON IL 602011700 20 1992268494 0 Physicians Anesthesia Services 20 1992268494 0 Physicians Healthy Kids Services 20 1992268494 0 Physicians Optical Supplies 20 1992268494 0 Physicians Physician Services 20 1992268494 0 Physicians Physicians Psychiatric Services 00 1992270102 0 MULLENS ERIKA J 2022272 9999999 B 10 1992270102 0 401 N MICHIGAN AVE STE 1200 CHICAGO IL 606114264 20 1992270102 0 Nurse Practitioners Healthy Kids Services 20 1992270102 0 Nurse Practitioners Nurse Practitioners Services 20 1992270102 0 Nurse Practitioners Physician Services 00 1992270383 0 CHRISTENSON BROOKE 2024046 9999999 B 10 1992270383 0 975 W HAWTHORN DR ITASCA IL 601432056 20 1992270383 0 Other behavior health professional Adaptive behavior support clinician services 00 1992270540 0 KEELER MARGARET A 2020008 9999999 B 10 1992270540 0 4332 N ELSTON AVE CHICAGO IL 606412144 20 1992270540 0 Physician Assistant Only Fluoride varnish 20 1992270540 0 Physician Assistant Only Healthy Kids Services 20 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CHRISTINE 2021277 9999999 B 10 1992319214 0 799 W KENSINGTON RD MT PROSPECT IL 600561111 20 1992319214 0 Speech Therapists Medical Supplies 20 1992319214 0 Speech Therapists Medical equipment/prosthetic devices 20 1992319214 0 Speech Therapists Speech Therapy/Pathology Services 00 1992320063 0 MANJUNATH SONAKSHI 2024289 9999999 B 10 1992320063 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1992320063 0 Physicians Anesthesia Services 20 1992320063 0 Physicians Fluoride varnish 20 1992320063 0 Physicians Healthy Kids Services 20 1992320063 0 Physicians Optical Supplies 20 1992320063 0 Physicians Physician Services 00 1992320394 0 KNITTER JOSHUA 2020234 9999999 B 10 1992320394 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1992320394 0 Physical Therapists Medical Supplies 20 1992320394 0 Physical Therapists Medical equipment/prosthetic devices 20 1992320394 0 Physical Therapists Physical Therapy Services 00 1992320485 0 DIAZ MAYRA 2020239 9999999 B 10 1992320485 0 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1992324214 0 Physicians Optical Supplies 20 1992324214 0 Physicians Physician Services 00 1992324289 0 GINZBURG MICHAEL 2020185 9999999 B 10 1992324289 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1992324289 0 Dentists Dental Services 20 1992324289 0 Dentists Physician Services 00 1992324560 0 SUH MICHELLE I 2023180 9999999 B 10 1992324560 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1992324560 0 Physicians Anesthesia Services 20 1992324560 0 Physicians Healthy Kids Services 20 1992324560 0 Physicians Optical Supplies 20 1992324560 0 Physicians Physician Services 00 1992324719 0 TAPE CHANTAL N 2024263 9999999 B 10 1992324719 0 2800 W MAIN ST CARBONDALE IL 629011087 20 1992324719 0 Physicians Anesthesia Services 20 1992324719 0 Physicians Fluoride varnish 20 1992324719 0 Physicians Healthy Kids Services 20 1992324719 0 Physicians Optical Supplies 20 1992324719 0 Physicians Physician Services 00 1992324941 0 MINIER RYAN J 2020167 9999999 B 10 1992324941 0 819 BLOOMINGTON RD CHAMPAIGN IL 618202101 20 1992324941 0 Physician Assistant Only Fluoride varnish 20 1992324941 0 Physician Assistant Only Healthy Kids Services 20 1992324941 0 Physician Assistant Only Physician Services 00 1992325294 0 GOLDSMITH PAUL 2020218 9999999 B 10 1992325294 0 221 NE GLEN OAK AVE ATTN: STEPHEN CIRONE GOMP 100 PEORIA IL 616360001 20 1992325294 0 Physicians Anesthesia Services 20 1992325294 0 Physicians Fluoride varnish 20 1992325294 0 Physicians Healthy Kids Services 20 1992325294 0 Physicians Optical Supplies 20 1992325294 0 Physicians Physician Services 00 1992325831 0 HIRSCH-GORZ BRITTANY 2020114 9999999 B 10 1992325831 0 111 N COUNTY FARM RD WHEATON IL 601873977 20 1992325831 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1992326151 0 HUTTUNEN DIANNA 2020150 9999999 B 10 1992326151 0 PO BOX 1109 DEKALB IL 601157109 20 1992326151 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1992326284 0 LARSON ROSS EUGENE 2020224 9999999 B 10 1992326284 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1992326284 0 Physicians Anesthesia Services 20 1992326284 0 Physicians Fluoride varnish 20 1992326284 0 Physicians Healthy Kids Services 20 1992326284 0 Physicians Optical Supplies 20 1992326284 0 Physicians Physician Services 00 1992326987 0 JACKMOVICH JOSEPH 2022210 9999999 B 10 1992326987 0 3600 N PROW RD BLOOMINGTON IN 474041616 20 1992326987 0 Physicians Anesthesia Services 20 1992326987 0 Physicians Healthy Kids Services 20 1992326987 0 Physicians Optical Supplies 20 1992326987 0 Physicians Physician Services 20 1992326987 0 Physicians Physicians Psychiatric Services 00 1992327506 0 OFFERMAN-IZZARELLI CHRISTINE A 2020168 9999999 B 10 1992327506 0 430 E 162ND ST SOUTH HOLLAND IL 604732258 20 1992327506 0 Nurse Practitioners Fluoride varnish 20 1992327506 0 Nurse Practitioners Healthy Kids Services 20 1992327506 0 Nurse Practitioners Nurse Practitioners Services 20 1992327506 0 Nurse Practitioners Physician Services 00 1992327951 0 FUHLER EMILY R 2022039 9999999 B 10 1992327951 0 265 BROOKVIEW CENTRE WAY STE 4 KNOXVILLE TN 379194052 20 1992327951 0 Physician Assistant Only Fluoride varnish 20 1992327951 0 Physician Assistant Only Healthy Kids Services 20 1992327951 0 Physician Assistant Only Physician Services 00 1992327993 0 ISAMA ANITA I 2020198 9999999 B 10 1992327993 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1992327993 0 Physicians Anesthesia Services 20 1992327993 0 Physicians Fluoride varnish 20 1992327993 0 Physicians Healthy Kids Services 20 1992327993 0 Physicians Optical Supplies 20 1992327993 0 Physicians Physician Services 00 1992328603 0 BROWNING AMANDA K 2021341 9999999 B 10 1992328603 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1992328603 0 Physician Assistant Only Fluoride varnish 20 1992328603 0 Physician Assistant Only Healthy Kids Services 20 1992328603 0 Physician Assistant Only Physician Services 00 1992328769 0 DEANGELO SEAN 2021200 9999999 B 10 1992328769 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1992328769 0 Physicians Anesthesia Services 20 1992328769 0 Physicians Fluoride varnish 20 1992328769 0 Physicians Healthy Kids Services 20 1992328769 0 Physicians Optical Supplies 20 1992328769 0 Physicians Physician Services 00 1992329072 0 HEDGE SCOTT 2020216 9999999 B 10 1992329072 0 9649 W 55TH ST COUNTRYSIDE IL 605253632 20 1992329072 0 Clinical Social Worker Social work service 00 1992329601 0 READING ANNELISE R 2021281 9999999 B 10 1992329601 0 PO BOX 634483 CINCINNATI OH 452634483 20 1992329601 0 Nurse Practitioners Anesthesia Services 20 1992329601 0 Nurse Practitioners Nurse Practitioners Services 20 1992329601 0 Nurse Practitioners Physician Services 00 1992329908 0 POWERS SARAH 2024347 9999999 B 10 1992329908 0 3300 WASHTENAW AVE STE 280 ANN ARBOR MI 481045184 20 1992329908 0 Nurse Practitioners Fluoride varnish 20 1992329908 0 Nurse Practitioners Healthy Kids Services 20 1992329908 0 Nurse Practitioners Nurse Practitioners Services 20 1992329908 0 Nurse Practitioners Physician Services 00 1992330583 0 PIERCE HEATHER R 2020107 9999999 B 10 1992330583 0 8940 N WOOD SAGE RD PEORIA IL 616157822 20 1992330583 0 Nurse Practitioners Fluoride varnish 20 1992330583 0 Nurse Practitioners Healthy Kids Services 20 1992330583 0 Nurse Practitioners Nurse Practitioners Services 20 1992330583 0 Nurse Practitioners Physician Services 00 1992330591 0 STONE MARY T 2023040 9999999 B 10 1992330591 0 1910 SOUTH AVE LA CROSSE WI 546015467 20 1992330591 0 Physician Assistant Only Fluoride varnish 20 1992330591 0 Physician Assistant Only Healthy Kids Services 20 1992330591 0 Physician Assistant Only Physician Services 00 1992331193 0 YAO ANNIE 2021187 9999999 B 10 1992331193 0 1700 W VAN BUREN ST STE 161 CHICAGO IL 606123228 20 1992331193 0 Physicians Anesthesia Services 20 1992331193 0 Physicians Healthy Kids Services 20 1992331193 0 Physicians Optical Supplies 20 1992331193 0 Physicians Physician Services 00 1992331847 0 KALINA JOANNE 2021140 9999999 B 10 1992331847 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1992331847 0 Physician Assistant Only Fluoride varnish 20 1992331847 0 Physician Assistant Only Healthy Kids Services 20 1992331847 0 Physician Assistant Only Physician Services 00 1992331854 0 VU YALAN N 2020174 9999999 B 10 1992331854 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1992331854 0 Physicians Anesthesia Services 20 1992331854 0 Physicians Healthy Kids Services 20 1992331854 0 Physicians Optical Supplies 20 1992331854 0 Physicians Physician Services 00 1992332068 0 CALLEGARI BRITTANY L 2020218 9999999 B 10 1992332068 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1992332068 0 Physicians Anesthesia Services 20 1992332068 0 Physicians Healthy Kids Services 20 1992332068 0 Physicians Optical Supplies 20 1992332068 0 Physicians Physician Services 00 1992332175 0 UELK MADELEINE M 2020240 9999999 B 10 1992332175 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1992332175 0 Physicians Anesthesia Services 20 1992332175 0 Physicians Fluoride varnish 20 1992332175 0 Physicians Healthy Kids Services 20 1992332175 0 Physicians Optical Supplies 20 1992332175 0 Physicians Physician Services 00 1992332274 0 FICENEC SARA 2024171 9999999 B 10 1992332274 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1992332274 0 Physicians Anesthesia Services 20 1992332274 0 Physicians Healthy Kids Services 20 1992332274 0 Physicians Optical Supplies 20 1992332274 0 Physicians Physician Services 00 1992332316 0 FAYAD MICHAEL 2020219 9999999 B 10 1992332316 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1992332316 0 Physicians Anesthesia Services 20 1992332316 0 Physicians Fluoride varnish 20 1992332316 0 Physicians Healthy Kids Services 20 1992332316 0 Physicians Optical Supplies 20 1992332316 0 Physicians Physician Services 00 1992332365 0 ONYEMA AMBLESSED 2023222 9999999 B 10 1992332365 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1992332365 0 Physicians Anesthesia Services 20 1992332365 0 Physicians Healthy Kids Services 20 1992332365 0 Physicians Optical Supplies 20 1992332365 0 Physicians Physician Services 00 1992332407 0 RYCZEK LAUREN C 2021076 9999999 B 10 1992332407 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1992332407 0 Nurse Practitioners Anesthesia Services 20 1992332407 0 Nurse Practitioners Nurse Practitioners Services 20 1992332407 0 Nurse Practitioners Physician Services 00 1992332779 0 SUSSMAN ELIZABETH A 2022152 9999999 B 10 1992332779 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1992332779 0 Nurse Practitioners Fluoride varnish 20 1992332779 0 Nurse Practitioners Healthy Kids Services 20 1992332779 0 Nurse Practitioners Nurse Practitioners Services 20 1992332779 0 Nurse Practitioners Physician Services 00 1992333439 0 MATHEWS ALEXANDRA 2020213 9999999 B 10 1992333439 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1992333439 0 Physicians Anesthesia Services 20 1992333439 0 Physicians Healthy Kids Services 20 1992333439 0 Physicians Optical Supplies 20 1992333439 0 Physicians Physician Services 00 1992333470 0 PATETTA MICHAEL 2020246 9999999 B 10 1992333470 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1992333470 0 Physicians Anesthesia Services 20 1992333470 0 Physicians Healthy Kids Services 20 1992333470 0 Physicians Optical Supplies 20 1992333470 0 Physicians Physician Services 00 1992333686 0 MIRZA MAHUM 2020160 9999999 B 10 1992333686 0 PO BOX 3039 OAK BROOK IL 605223039 20 1992333686 0 Physicians Anesthesia Services 20 1992333686 0 Physicians Fluoride varnish 20 1992333686 0 Physicians Healthy Kids Services 20 1992333686 0 Physicians Optical Supplies 20 1992333686 0 Physicians Physician Services 00 1992333728 0 HOOVER EMILY R 2020168 9999999 B 10 1992333728 0 801 S WASHINGTON ST NAPERVILLE IL 605407430 20 1992333728 0 Physicians Anesthesia Services 20 1992333728 0 Physicians Healthy Kids Services 20 1992333728 0 Physicians Optical Supplies 20 1992333728 0 Physicians Physician Services 00 1992333850 0 BULE MARIA 2020177 9999999 B 10 1992333850 0 PO BOX 3039 OAK BROOK IL 605223039 20 1992333850 0 Physicians Anesthesia Services 20 1992333850 0 Physicians Fluoride varnish 20 1992333850 0 Physicians Healthy Kids Services 20 1992333850 0 Physicians Optical Supplies 20 1992333850 0 Physicians Physician Services 00 1992333900 0 STANCHEVA SVETLANA G 2023219 9999999 B 10 1992333900 0 172 E SCHILLER ST ELMHURST IL 601262816 20 1992333900 0 Physicians Anesthesia Services 20 1992333900 0 Physicians Fluoride varnish 20 1992333900 0 Physicians Healthy Kids Services 20 1992333900 0 Physicians Optical Supplies 20 1992333900 0 Physicians Physician Services 00 1992334254 0 WALKER BROCK 2021065 9999999 B 10 1992334254 0 3600 WOODVIEW TRCE STE 400 INDIANAPOLIS IN 462683124 20 1992334254 0 Nurse Practitioners Anesthesia Services 20 1992334254 0 Nurse Practitioners Nurse Practitioners Services 20 1992334254 0 Nurse Practitioners Physician Services 00 1992334577 0 TEMPLE-WOOD EMILY R 2020162 9999999 B 10 1992334577 0 PO BOX 3039 OAK BROOK IL 605223039 20 1992334577 0 Physicians Anesthesia Services 20 1992334577 0 Physicians Fluoride varnish 20 1992334577 0 Physicians Healthy Kids Services 20 1992334577 0 Physicians Optical Supplies 20 1992334577 0 Physicians Physician Services 00 1992334676 0 RITTER BRIAN C 2020195 9999999 B 10 1992334676 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1992334676 0 Nurse Practitioners Anesthesia Services 20 1992334676 0 Nurse Practitioners Nurse Practitioners Services 20 1992334676 0 Nurse Practitioners Physician Services 00 1992334684 0 TURK LAURA M 2020211 9999999 B 10 1992334684 0 5777 DEPT CAROL STREAM IL 601220021 20 1992334684 0 Physician Assistant Only Fluoride varnish 20 1992334684 0 Physician Assistant Only Healthy Kids Services 20 1992334684 0 Physician Assistant Only Physician Services 00 1992334981 0 HARBERG CALVIN A 2024194 9999999 B 10 1992334981 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1992334981 0 Physicians Anesthesia Services 20 1992334981 0 Physicians Healthy Kids Services 20 1992334981 0 Physicians Optical Supplies 20 1992334981 0 Physicians Physician Services 00 1992335913 0 LENGERICH AMANDA B 2022143 9999999 B 10 1992335913 0 PO BOX 778912 CHICAGO IL 606778912 20 1992335913 0 Nurse Practitioners Fluoride varnish 20 1992335913 0 Nurse Practitioners Healthy Kids Services 20 1992335913 0 Nurse Practitioners Nurse Practitioners Services 20 1992335913 0 Nurse Practitioners Physician Services 00 1992336903 0 REID TUCKER 2020066 9999999 B 10 1992336903 0 850 43RD AVE STE 100 MOLINE IL 612658401 20 1992336903 0 Physical Therapists Medical Supplies 20 1992336903 0 Physical Therapists Medical equipment/prosthetic devices 20 1992336903 0 Physical Therapists Physical Therapy Services 00 1992339279 0 BURNS ANGELA 2022173 9999999 B 10 1992339279 0 PO BOX 34156 BELFAST ME 049150619 20 1992339279 0 Nurse Practitioners Fluoride varnish 20 1992339279 0 Nurse Practitioners Healthy Kids Services 20 1992339279 0 Nurse Practitioners Nurse Practitioners Services 20 1992339279 0 Nurse Practitioners Physician Services 00 1992340863 0 CURLEY LOREEN R 2019344 9999999 B 10 1992340863 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1992340863 0 Nurse Practitioners Fluoride varnish 20 1992340863 0 Nurse Practitioners Healthy Kids Services 20 1992340863 0 Nurse Practitioners Nurse Practitioners Services 20 1992340863 0 Nurse Practitioners Physician Services 00 1992342117 0 RAMANGI ARAS 2023081 9999999 B 10 1992342117 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1992342117 0 Occupational Therapists Medical Supplies 20 1992342117 0 Occupational Therapists Medical equipment/prosthetic devices 20 1992342117 0 Occupational Therapists Occupational Therapy Services 00 1992343248 0 FLINT MARYANNE F 2020141 9999999 B 10 1992343248 0 3230 VETERANS MEMORIAL DR MOUNT VERNON IL 628645950 20 1992343248 0 Nurse Practitioners Fluoride varnish 20 1992343248 0 Nurse Practitioners Healthy Kids Services 20 1992343248 0 Nurse Practitioners Nurse Practitioners Services 20 1992343248 0 Nurse Practitioners Physician Services 00 1992344147 0 SILBERMAN SCOTT ELENA E 2021356 9999999 B 10 1992344147 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1992344147 0 Other behavior health professional LCPC/LMFT services 00 1992344451 0 WILSON JESSICA L 2020045 9999999 B 10 1992344451 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1992344451 0 Nurse Practitioners Fluoride varnish 20 1992344451 0 Nurse Practitioners Healthy Kids Services 20 1992344451 0 Nurse Practitioners Nurse Practitioners Services 20 1992344451 0 Nurse Practitioners Physician Services 00 1992344543 0 MAHER LASMA 2022066 9999999 B 10 1992344543 0 1020 MILWAUKEE AVE STE 229 DEERFIELD IL 600153513 20 1992344543 0 Other behavior health professional LCPC/LMFT services 00 1992345177 0 WIESELER BRAEDON 2020064 9999999 B 10 1992345177 0 PO BOX 500 ELLICOTTVILLE NY 147310500 20 1992345177 0 Physician Assistant Only Fluoride varnish 20 1992345177 0 Physician Assistant Only Healthy Kids Services 20 1992345177 0 Physician Assistant Only Physician Services 00 1992345243 0 ROSS JESSICA 2024087 9999999 B 10 1992345243 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1992345243 0 Speech Therapists Medical Supplies 20 1992345243 0 Speech Therapists Medical equipment/prosthetic devices 20 1992345243 0 Speech Therapists Speech Therapy/Pathology Services 00 1992345342 0 MCLAUGHLIN JENNIFER N 2020258 9999999 B 10 1992345342 0 211 SAINT FRANCIS DR CAPE GIRARDEAU MO 637035049 20 1992345342 0 Nurse Practitioners Fluoride varnish 20 1992345342 0 Nurse Practitioners Healthy Kids Services 20 1992345342 0 Nurse Practitioners Nurse Practitioners Services 20 1992345342 0 Nurse Practitioners Physician Services 00 1992346605 0 KIMBLE CARA P 2023320 9999999 B 10 1992346605 0 1200 W STATE ST ROCKFORD IL 611022112 20 1992346605 0 Other behavior health professional LCPC/LMFT services 00 1992346993 0 ANSARITALESH AYLAR 2021343 9999999 B 10 1992346993 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1992346993 0 Physician Assistant Only Fluoride varnish 20 1992346993 0 Physician Assistant Only Healthy Kids Services 20 1992346993 0 Physician Assistant Only Physician Services 00 1992347637 0 ROSEN ALLISON L 2019329 9999999 B 10 1992347637 0 225 E CHICAGO AVE BOX 44 CHICAGO IL 606112991 20 1992347637 0 Occupational Therapists Medical Supplies 20 1992347637 0 Occupational Therapists Medical equipment/prosthetic devices 20 1992347637 0 Occupational Therapists Occupational Therapy Services 00 1992348973 0 DUCOMMUN DEBRA 2020247 9999999 B 10 1992348973 0 420 FRONT ST MCHENRY IL 600505528 20 1992348973 0 Occupational Therapists Medical Supplies 20 1992348973 0 Occupational Therapists Medical equipment/prosthetic devices 20 1992348973 0 Occupational Therapists Occupational Therapy Services 00 1992350722 0 DATO KATHERINE L 2019280 9999999 B 10 1992350722 0 75 REMITTANCE DR DEPT 1611 CHICAGO IL 606751611 20 1992350722 0 Nurse Practitioners Fluoride varnish 20 1992350722 0 Nurse Practitioners Healthy Kids Services 20 1992350722 0 Nurse Practitioners Nurse Practitioners Services 20 1992350722 0 Nurse Practitioners Physician Services 00 1992351605 0 MAZUREK CLAIRE J 2022214 9999999 B 10 1992351605 0 536 OLD HOWELL RD GREENVILLE SC 296151969 20 1992351605 0 Occupational Therapists Medical Supplies 20 1992351605 0 Occupational Therapists Medical equipment/prosthetic devices 20 1992351605 0 Occupational Therapists Occupational Therapy Services 00 1992351712 0 LEONE CHRISTINE 2021363 9999999 B 10 1992351712 0 235 CUSTER AVE APT 2S EVANSTON IL 602023597 20 1992351712 0 Clinical Social Worker Social work service 00 1992352595 0 SALGADO MELINA 2020314 9999999 B 10 1992352595 0 8496 SOLUTIONS CTR CHICAGO IL 606778004 20 1992352595 0 Physician Assistant Only Family Planning Counseling 20 1992352595 0 Physician Assistant Only Fluoride varnish 20 1992352595 0 Physician Assistant Only Healthy Kids Services 20 1992352595 0 Physician Assistant Only Physician Services 00 1992354104 0 BOLLMAN SUSAN M 2019297 9999999 B 10 1992354104 0 PO BOX 778912 CHICAGO IL 606778912 20 1992354104 0 Nurse Practitioners Fluoride varnish 20 1992354104 0 Nurse Practitioners Healthy Kids Services 20 1992354104 0 Nurse Practitioners Nurse Practitioners Services 20 1992354104 0 Nurse Practitioners Physician Services 00 1992354799 0 KEITH MELISSA L 2019282 9999999 B 10 1992354799 0 500 W RIVER DR DAVENPORT IA 528011014 20 1992354799 0 Nurse Practitioners Fluoride varnish 20 1992354799 0 Nurse Practitioners Healthy Kids Services 20 1992354799 0 Nurse Practitioners Nurse Practitioners Services 20 1992354799 0 Nurse Practitioners Physician Services 00 1992355317 0 SCHWARZSCHILD SARAH 2021287 9999999 B 10 1992355317 0 4025 N SHERIDAN RD CHICAGO IL 606132010 20 1992355317 0 Nurse Practitioners Fluoride varnish 20 1992355317 0 Nurse Practitioners Healthy Kids Services 20 1992355317 0 Nurse Practitioners Nurse Practitioners Services 20 1992355317 0 Nurse Practitioners Physician Services 00 1992355812 0 NKRUMAH GIDEON B 2019256 9999999 B 10 1992355812 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1992355812 0 Nurse Practitioners Anesthesia Services 20 1992355812 0 Nurse Practitioners Nurse Practitioners Services 20 1992355812 0 Nurse Practitioners Physician Services 00 1992355895 0 WATKINS AUDREY L 2019316 9999999 B 10 1992355895 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1992355895 0 Nurse Practitioners Fluoride varnish 20 1992355895 0 Nurse Practitioners Healthy Kids Services 20 1992355895 0 Nurse Practitioners Nurse Practitioners Services 20 1992355895 0 Nurse Practitioners Physician Services 00 1992356265 0 JANUSEVIC MADELINE J 2020239 9999999 B 10 1992356265 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1992356265 0 Physical Therapists Medical Supplies 20 1992356265 0 Physical Therapists 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LOUIS MO 631600352 20 1992357784 0 Physicians Anesthesia Services 20 1992357784 0 Physicians Healthy Kids Services 20 1992357784 0 Physicians Optical Supplies 20 1992357784 0 Physicians Physician Services 00 1992359327 0 COHEN THOMAS 2019203 9999999 B 10 1992359327 0 6233 CERMAK RD BERWYN IL 604022317 20 1992359327 0 Optometrists Optical Supplies 20 1992359327 0 Optometrists Optometric Services 20 1992359327 0 Optometrists Physician Services 00 1992360804 0 NADERI NEDA 2023257 9999999 B 10 1992360804 0 6308 8TH AVE KENOSHA WI 531435031 20 1992360804 0 Physicians Anesthesia Services 20 1992360804 0 Physicians Fluoride varnish 20 1992360804 0 Physicians Healthy Kids Services 20 1992360804 0 Physicians Optical Supplies 20 1992360804 0 Physicians Physician Services 00 1992360986 0 PARDO CORALIE 2021181 9999999 B 10 1992360986 0 75 REMITTANCE DR DEPT 1611 SUITE 1611 CHICAGO IL 606751611 20 1992360986 0 Physicians Anesthesia Services 20 1992360986 0 Physicians Healthy Kids Services 20 1992360986 0 Physicians Optical Supplies 20 1992360986 0 Physicians Physician Services 00 1992361562 0 VHORA ZUBAIR 2022326 9999999 B 10 1992361562 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1992361562 0 Physicians Anesthesia Services 20 1992361562 0 Physicians Fluoride varnish 20 1992361562 0 Physicians Healthy Kids Services 20 1992361562 0 Physicians Optical Supplies 20 1992361562 0 Physicians Physician Services 00 1992362396 0 MENEZES CHRISTIAN L 2022200 9999999 B 10 1992362396 0 1500 ASSOCIATES DR DUBUQUE IA 520022201 20 1992362396 0 Physicians Anesthesia Services 20 1992362396 0 Physicians Healthy Kids Services 20 1992362396 0 Physicians Optical Supplies 20 1992362396 0 Physicians Physician Services 00 1992362453 0 DHRUVA AASHANA U 2022279 9999999 B 10 1992362453 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1992362453 0 Physicians Anesthesia Services 20 1992362453 0 Physicians Fluoride varnish 20 1992362453 0 Physicians Healthy Kids Services 20 1992362453 0 Physicians Optical Supplies 20 1992362453 0 Physicians Physician Services 00 1992362651 0 THOMASON LORI 2019203 9999999 B 10 1992362651 0 2201 MAIN ST EVANSTON IL 602021519 20 1992362651 0 Clinical Social Worker Social work service 00 1992363584 0 EARL RACHEL 2023241 9999999 B 10 1992363584 0 16101 WEBER RD CREST HILL IL 604038812 20 1992363584 0 Nurse Practitioners Fluoride varnish 20 1992363584 0 Nurse Practitioners Healthy Kids Services 20 1992363584 0 Nurse Practitioners Nurse Practitioners Services 20 1992363584 0 Nurse Practitioners Physician Services 00 1992365571 0 SINGLETON QUANTE A 2019170 9999999 B 10 1992365571 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1992365571 0 Physicians Anesthesia Services 20 1992365571 0 Physicians Healthy Kids Services 20 1992365571 0 Physicians Optical Supplies 20 1992365571 0 Physicians Physician Services 00 1992365779 0 OJUKWU STANLEY 2024221 9999999 B 10 1992365779 0 2632 W DIVISION ST CHICAGO IL 606222850 20 1992365779 0 Dentists Dental Services 20 1992365779 0 Dentists Physician Services 00 1992366090 0 VOGT SARAH E 2019196 9999999 B 10 1992366090 0 1739 N ELSTON AVE CHICAGO IL 606421544 20 1992366090 0 Speech Therapists Medical Supplies 20 1992366090 0 Speech Therapists Medical equipment/prosthetic devices 20 1992366090 0 Speech Therapists Speech Therapy/Pathology Services 00 1992366132 0 MYERS KATHERINE A 2019213 9999999 B 10 1992366132 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1992366132 0 Speech Therapists Medical Supplies 20 1992366132 0 Speech Therapists Medical equipment/prosthetic devices 20 1992366132 0 Speech Therapists Speech Therapy/Pathology Services 00 1992366934 0 ROWE JACKSON 2020212 9999999 B 10 1992366934 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1992366934 0 Physicians Anesthesia Services 20 1992366934 0 Physicians Healthy Kids Services 20 1992366934 0 Physicians Optical Supplies 20 1992366934 0 Physicians Physician Services 00 1992368096 0 KAEB LIZABETH 2020018 9999999 B 10 1992368096 0 2214 N UNIVERSITY ST PEORIA IL 616043221 20 1992368096 0 Physicians Anesthesia Services 20 1992368096 0 Physicians Fluoride varnish 20 1992368096 0 Physicians Healthy Kids Services 20 1992368096 0 Physicians Optical Supplies 20 1992368096 0 Physicians Physician Services 00 1992368526 0 RINCY BENJAMIN 2021200 9999999 B 10 1992368526 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1992368526 0 Physicians Anesthesia Services 20 1992368526 0 Physicians Healthy Kids Services 20 1992368526 0 Physicians Optical Supplies 20 1992368526 0 Physicians Physician Services 00 1992369201 0 FICARRA MELINDA B 2021029 9999999 B 10 1992369201 0 2650 RIDGE AVE # 1223 EVANSTON IL 602011700 20 1992369201 0 Nurse Practitioners Fluoride varnish 20 1992369201 0 Nurse Practitioners Healthy Kids Services 20 1992369201 0 Nurse Practitioners Nurse Practitioners Services 20 1992369201 0 Nurse Practitioners Physician Services 00 1992370480 0 RUMMAN GEORGE 2022211 9999999 B 10 1992370480 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1992370480 0 Dentists Dental Services 20 1992370480 0 Dentists Physician Services 00 1992371819 0 BOU KARROUM SAMER 2024141 9999999 B 10 1992371819 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1992371819 0 Physicians Anesthesia Services 20 1992371819 0 Physicians Fluoride varnish 20 1992371819 0 Physicians Healthy Kids Services 20 1992371819 0 Physicians Optical Supplies 20 1992371819 0 Physicians Physician Services 00 1992372585 0 MENDEZ DESIREE 2022194 9999999 H 10 1992372585 0 120 S MARION ST OAK PARK IL 603022809 20 1992372585 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1992372817 0 RICE TAYLOR 2021160 9999999 B 10 1992372817 0 150 BLUFF AVE NORTH AUGUSTA SC 298413862 20 1992372817 0 Nurse Practitioners Anesthesia Services 20 1992372817 0 Nurse Practitioners Nurse Practitioners Services 20 1992372817 0 Nurse Practitioners Physician 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Physician Services 00 1992383558 0 MORAN MATTHEW R 2021174 9999999 B 10 1992383558 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1992383558 0 Physicians Anesthesia Services 20 1992383558 0 Physicians Fluoride varnish 20 1992383558 0 Physicians Healthy Kids Services 20 1992383558 0 Physicians Optical Supplies 20 1992383558 0 Physicians Physician Services 00 1992383814 0 ANEKAL ANKITA A 2024184 9999999 B 10 1992383814 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1992383814 0 Physicians Anesthesia Services 20 1992383814 0 Physicians Fluoride varnish 20 1992383814 0 Physicians Healthy Kids Services 20 1992383814 0 Physicians Optical Supplies 20 1992383814 0 Physicians Physician Services 00 1992384077 0 BENNETT CAREY DEBRA L 2022055 9999999 B 10 1992384077 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1992384077 0 Nurse Practitioners Fluoride varnish 20 1992384077 0 Nurse Practitioners Healthy Kids Services 20 1992384077 0 Nurse Practitioners Nurse Practitioners 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Therapists Occupational Therapy Services 00 1992391668 0 HANDLER DANIEL 2024169 9999999 B 10 1992391668 0 200 HAWKINS DR IOWA CITY IA 522421009 20 1992391668 0 Nurse Practitioners Healthy Kids Services 20 1992391668 0 Nurse Practitioners Nurse Practitioners Services 20 1992391668 0 Nurse Practitioners Physician Services 00 1992393003 0 MAGNIN PAIGE J 2023060 9999999 B 10 1992393003 0 29373 NETWORK PL CHICAGO IL 606733039 20 1992393003 0 Physician Assistant Only Fluoride varnish 20 1992393003 0 Physician Assistant Only Healthy Kids Services 20 1992393003 0 Physician Assistant Only Physician Services 00 1992395594 0 GUERRERO CHRISTINA 2023080 9999999 B 10 1992395594 0 19740 GOVERNORS HWY STE 116 FLOSSMOOR IL 604222085 20 1992395594 0 Nurse Practitioners Fluoride varnish 20 1992395594 0 Nurse Practitioners Healthy Kids Services 20 1992395594 0 Nurse Practitioners Nurse Practitioners Services 20 1992395594 0 Nurse Practitioners Physician Services 00 1992395727 0 MCCORMICK ALYNN 2023055 9999999 B 10 1992395727 0 451 N LA SALLE DR CHICAGO IL 606544510 20 1992395727 0 Other behavior health professional LCPC/LMFT services 00 1992397467 0 BROZEK CATHERINE A 2021144 9999999 B 10 1992397467 0 1305 WALT WHITMAN RD STE 300 MELVILLE NY 117474300 20 1992397467 0 Nurse Practitioners Anesthesia Services 20 1992397467 0 Nurse Practitioners Nurse Practitioners Services 20 1992397467 0 Nurse Practitioners Physician Services 00 1992397798 0 HAUSE CHRISTOPHER 2021053 9999999 B 10 1992397798 0 615 S NEW BALLAS RD SAINT LOUIS MO 631418221 20 1992397798 0 Nurse Practitioners Healthy Kids Services 20 1992397798 0 Nurse Practitioners Nurse Practitioners Services 20 1992397798 0 Nurse Practitioners Physician Services 00 1992398390 0 LUNAU ALISON 2023205 9999999 B 10 1992398390 0 225 E CHICAGO AVE # 118 CHICAGO IL 606112991 20 1992398390 0 Nurse Practitioners Fluoride varnish 20 1992398390 0 Nurse Practitioners Healthy Kids Services 20 1992398390 0 Nurse Practitioners Nurse Practitioners Services 20 1992398390 0 Nurse Practitioners Physician Services 00 1992400113 0 TOLSMA RACHAEL 2023180 9999999 B 10 1992400113 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1992400113 0 Physicians Anesthesia Services 20 1992400113 0 Physicians Healthy Kids Services 20 1992400113 0 Physicians Optical Supplies 20 1992400113 0 Physicians Physician Services 00 1992400329 0 COLLYMORE JERIANN 2024174 9999999 B 10 1992400329 0 1701 W SUPERIOR ST CHICAGO IL 606225646 20 1992400329 0 Physicians Anesthesia Services 20 1992400329 0 Physicians Fluoride varnish 20 1992400329 0 Physicians Healthy Kids Services 20 1992400329 0 Physicians Optical Supplies 20 1992400329 0 Physicians Physician Services 00 1992400998 0 KHAN FIDAK 2023207 9999999 B 10 1992400998 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1992400998 0 Physicians Anesthesia Services 20 1992400998 0 Physicians Healthy Kids Services 20 1992400998 0 Physicians Optical Supplies 20 1992400998 0 Physicians Physician Services 20 1992400998 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WILSON AVE STE 102 HARWOOD HEIGHTS IL 607064500 20 1992404636 0 Nurse Practitioners Fluoride varnish 20 1992404636 0 Nurse Practitioners Healthy Kids Services 20 1992404636 0 Nurse Practitioners Nurse Practitioners Services 20 1992404636 0 Nurse Practitioners Physician Services 00 1992405344 0 ANDOR ZACHARY T 2023081 9999999 B 10 1992405344 0 25070 NETWORK PL CHICAGO IL 606731250 20 1992405344 0 Physician Assistant Only Fluoride varnish 20 1992405344 0 Physician Assistant Only Healthy Kids Services 20 1992405344 0 Physician Assistant Only Physician Services 00 1992406748 0 TUCKER ROBERT 2024199 9999999 B 10 1992406748 0 1 CHILDRENS PL STE 3S-36 SAINT LOUIS MO 631101002 20 1992406748 0 Physicians Anesthesia Services 20 1992406748 0 Physicians Fluoride varnish 20 1992406748 0 Physicians Healthy Kids Services 20 1992406748 0 Physicians Optical Supplies 20 1992406748 0 Physicians Physician Services 00 1992407217 0 GARCIA ALEC 2023200 9999999 B 10 1992407217 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1992407217 0 Physicians Anesthesia Services 20 1992407217 0 Physicians Healthy Kids Services 20 1992407217 0 Physicians Optical Supplies 20 1992407217 0 Physicians Physician Services 00 1992407738 0 CORSOLINI AMY G 2023150 9999999 B 10 1992407738 0 1401 E 12TH ST MENDOTA IL 613429216 20 1992407738 0 Nurse Practitioners Fluoride varnish 20 1992407738 0 Nurse Practitioners Healthy Kids Services 20 1992407738 0 Nurse Practitioners Nurse Practitioners Services 20 1992407738 0 Nurse Practitioners Physician Services 00 1992407860 0 DEBOSSCHERE JAKE RYAN 2023240 9999999 B 10 1992407860 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1992407860 0 Physicians Anesthesia Services 20 1992407860 0 Physicians Fluoride varnish 20 1992407860 0 Physicians Healthy Kids Services 20 1992407860 0 Physicians Optical Supplies 20 1992407860 0 Physicians Physician Services 00 1992407993 0 HALLARE JERICHO 2023174 9999999 B 10 1992407993 0 2160 S 1ST AVE BLDG 201 MAYWOOD IL 601533328 20 1992407993 0 Physicians Anesthesia Services 20 1992407993 0 Physicians Healthy Kids Services 20 1992407993 0 Physicians Optical Supplies 20 1992407993 0 Physicians Physician Services 00 1992408223 0 WOJCIK NICOLE 2023227 9999999 B 10 1992408223 0 62311 COLLECTION CENTER DR CHICAGO IL 606930623 20 1992408223 0 Physicians Anesthesia Services 20 1992408223 0 Physicians Fluoride varnish 20 1992408223 0 Physicians Healthy Kids Services 20 1992408223 0 Physicians Optical Supplies 20 1992408223 0 Physicians Physician Services 00 1992410682 0 SHERROD BRIA 2024074 9999999 B 10 1992410682 0 3010 GRAND AVE ATTN: ADMINISTRATION WAUKEGAN IL 600852321 20 1992410682 0 Other behavior health professional Other Behavioral Health Services (excludes LCPC and LMFT IMPACT specialties) 00 1992411987 0 BAHENA VIRGINIA 2023103 9999999 B 10 1992411987 0 20660 CATON FARM RD UNIT F CREST HILL IL 604031201 20 1992411987 0 Nurse Practitioners Fluoride varnish 20 1992411987 0 Nurse Practitioners Healthy Kids Services 20 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0 4121 VETERANS MEMORIAL DR MOUNT VERNON IL 628646262 20 1992414304 0 Nurse Practitioners Healthy Kids Services 20 1992414304 0 Nurse Practitioners Nurse Practitioners Services 20 1992414304 0 Nurse Practitioners Physician Services 00 1992414437 0 DIXON CARA 2023058 9999999 B 10 1992414437 0 P O BOX 771858 CHICAGO IL 606770001 20 1992414437 0 Nurse Practitioners Fluoride varnish 20 1992414437 0 Nurse Practitioners Healthy Kids Services 20 1992414437 0 Nurse Practitioners Nurse Practitioners Services 20 1992414437 0 Nurse Practitioners Physician Services 00 1992414775 0 TRUJILLO YESENIA 2024326 9999999 B 10 1992414775 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1992414775 0 Registered nurse Nursing service 20 1992414775 0 Registered nurse Waiver service 00 1992414783 0 PATEL SWARA 2022350 9999999 B 10 1992414783 0 20 TOWER CT STE F SUITE F GURNEE IL 600315711 20 1992414783 0 Nurse Practitioners Fluoride varnish 20 1992414783 0 Nurse Practitioners Healthy Kids Services 20 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1992437644 0 Physicians Anesthesia Services 20 1992437644 0 Physicians Fluoride varnish 20 1992437644 0 Physicians Healthy Kids Services 20 1992437644 0 Physicians Optical Supplies 20 1992437644 0 Physicians Physician Services 00 1992437891 0 BETZ ROBIN E 2022220 9999999 B 10 1992437891 0 PO BOX 3366 EVANSVILLE IN 477323366 20 1992437891 0 Nurse Practitioners Anesthesia Services 20 1992437891 0 Nurse Practitioners Nurse Practitioners Services 20 1992437891 0 Nurse Practitioners Physician Services 00 1992437974 0 SMITH COREY L 2022196 9999999 B 10 1992437974 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1992437974 0 Nurse Practitioners Healthy Kids Services 20 1992437974 0 Nurse Practitioners Nurse Practitioners Services 20 1992437974 0 Nurse Practitioners Physician Services 00 1992438378 0 RIEGERT ASHLEY 2022229 9999999 B 10 1992438378 0 2227 VADALABENE DR STE 200 MARYVILLE IL 620625824 20 1992438378 0 Nurse Practitioners Fluoride varnish 20 1992438378 0 Nurse Practitioners Healthy 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1992559678 0 7732 SOLUTION CTR CHICAGO IL 606777007 20 1992559678 0 Physicians Anesthesia Services 20 1992559678 0 Physicians Fluoride varnish 20 1992559678 0 Physicians Healthy Kids Services 20 1992559678 0 Physicians Optical Supplies 20 1992559678 0 Physicians Physician Services 00 1992561229 0 BAGHERIHUT SARA 2024177 9999999 B 10 1992561229 0 120 E OGDEN AVE STE 101 HINSDALE IL 605213892 20 1992561229 0 Nurse Practitioners Fluoride varnish 20 1992561229 0 Nurse Practitioners Healthy Kids Services 20 1992561229 0 Nurse Practitioners Nurse Practitioners Services 20 1992561229 0 Nurse Practitioners Physician Services 00 1992561419 0 STEINBECKER ROBIN SUE 2024218 9999999 B 10 1992561419 0 1 BARNES JEWISH HOSPITAL PLZ SAINT LOUIS MO 631101003 20 1992561419 0 Nurse Practitioners Healthy Kids Services 20 1992561419 0 Nurse Practitioners Nurse Practitioners Services 20 1992561419 0 Nurse Practitioners Physician Services 00 1992564298 0 JAYAN DEVI 2024155 9999999 B 10 1992564298 0 150 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MANISUNDARAM KRISH K 2024177 9999999 B 10 1992565832 0 1901 W HARRISON ST CHICAGO IL 606123714 20 1992565832 0 Physicians Anesthesia Services 20 1992565832 0 Physicians Healthy Kids Services 20 1992565832 0 Physicians Optical Supplies 20 1992565832 0 Physicians Physician Services 00 1992567713 0 RICK SUSAN L 2024288 9999999 B 10 1992567713 0 473 N 2259TH RD APT SUITE OGLESBY IL 613489522 20 1992567713 0 Other behavior health professional LCPC/LMFT services 00 1992570022 0 AHMAD JIHAD 2023325 9999999 B 10 1992570022 0 567 W 14TH ST CHICAGO HEIGHTS IL 604112386 20 1992570022 0 Dentists Dental Services 20 1992570022 0 Dentists Physician Services 00 1992570261 0 GRANAT NISHA B 2024073 9999999 B 10 1992570261 0 3051 HOLLIS DR SPRINGFIELD IL 627047452 20 1992570261 0 Physician Assistant Only Fluoride varnish 20 1992570261 0 Physician Assistant Only Healthy Kids Services 20 1992570261 0 Physician Assistant Only Physician Services 00 1992570782 0 MENDOZA SAMANTHA 2023326 9999999 B 10 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10624 JACOB DR MOKENA IL 604489474 20 1992818694 0 Optometrists Optical Supplies 20 1992818694 0 Optometrists Optometric Services 20 1992818694 0 Optometrists Physician Services 00 1992818827 0 JOBANPUTRA KETAN N 2005032 9999999 B 10 1992818827 0 400 N HIGHLAND AVE AURORA IL 605063814 20 1992818827 0 Physicians All Kids application agent 20 1992818827 0 Physicians Anesthesia Services 20 1992818827 0 Physicians Family Planning Counseling 20 1992818827 0 Physicians Healthy Kids Services 20 1992818827 0 Physicians Optical Supplies 20 1992818827 0 Physicians Physician Services 00 1992818991 0 KUHN MATTHEW 1991152 9999999 B 10 1992818991 0 1005 BROADWAY ST QUINCY IL 623012834 20 1992818991 0 Physicians Anesthesia Services 20 1992818991 0 Physicians Healthy Kids Services 20 1992818991 0 Physicians Optical Supplies 20 1992818991 0 Physicians Physician Services 00 1992819916 0 JAPOUR CHRISTOPHER 2001001 9999999 B 10 1992819916 0 24039 W LOCKPORT ST PLAINFIELD IL 605441652 20 1992819916 0 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Physicians Fluoride varnish 20 1992902944 0 Physicians Healthy Kids Services 20 1992902944 0 Physicians Optical Supplies 20 1992902944 0 Physicians Physician Services 00 1992903082 0 VUKCEVIC ZORAN 2023131 9999999 B 10 1992903082 0 4055 VALLEY VIEW LN STE 400 DALLAS TX 752445071 20 1992903082 0 Physicians Anesthesia Services 20 1992903082 0 Physicians Healthy Kids Services 20 1992903082 0 Physicians Optical Supplies 20 1992903082 0 Physicians Physician Services 00 1992903470 0 GREER DAVID 2023083 9999999 B 10 1992903470 0 8400 LOUISIANA ST MERRILLVILLE IN 464106385 20 1992903470 0 Physicians Anesthesia Services 20 1992903470 0 Physicians Healthy Kids Services 20 1992903470 0 Physicians Optical Supplies 20 1992903470 0 Physicians Physician Services 20 1992903470 0 Physicians Physicians Psychiatric Services 00 1992903488 0 ISAWI HANNY 2011234 9999999 B 10 1992903488 0 PO BOX 268 FREEPORT IL 610320268 20 1992903488 0 Physicians Anesthesia Services 20 1992903488 0 Physicians Healthy Kids 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2016023 9999999 B 10 1992910061 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1992910061 0 Nurse Practitioners Healthy Kids Services 20 1992910061 0 Nurse Practitioners Nurse Practitioners Services 20 1992910061 0 Nurse Practitioners Physician Services 00 1992910475 0 BELL-CHEDDAR YOLANDEE 2022153 9999999 B 10 1992910475 0 2 HOT METAL ST PITTSBURGH PA 152032348 20 1992910475 0 Physicians Anesthesia Services 20 1992910475 0 Physicians Fluoride varnish 20 1992910475 0 Physicians Healthy Kids Services 20 1992910475 0 Physicians Optical Supplies 20 1992910475 0 Physicians Physician Services 00 1992911028 0 MCDERMOTT MARY 1992183 9999999 B 10 1992911028 0 5777 DEPT CAROL STREAM IL 601220021 20 1992911028 0 Physicians Anesthesia Services 20 1992911028 0 Physicians Fluoride varnish 20 1992911028 0 Physicians Healthy Kids Services 20 1992911028 0 Physicians Optical Supplies 20 1992911028 0 Physicians Physician Services 00 1992912901 0 ZUEGGE KARIN 2011274 9999999 B 10 1992912901 0 7974 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Fluoride varnish 20 1992913560 0 Physicians Healthy Kids Services 20 1992913560 0 Physicians Optical Supplies 20 1992913560 0 Physicians Physician Services 00 1992913842 0 FRITZ STEPHANIE A 2007182 9999999 B 10 1992913842 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1992913842 0 Physicians Anesthesia Services 20 1992913842 0 Physicians Fluoride varnish 20 1992913842 0 Physicians Healthy Kids Services 20 1992913842 0 Physicians Optical Supplies 20 1992913842 0 Physicians Physician Services 00 1992914352 0 LICIS AMY 2011182 9999999 B 10 1992914352 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1992914352 0 Physicians Anesthesia Services 20 1992914352 0 Physicians Healthy Kids Services 20 1992914352 0 Physicians Optical Supplies 20 1992914352 0 Physicians Physician Services 20 1992914352 0 Physicians Physicians Psychiatric Services 00 1992914626 0 FLINK CARL 2023062 9999999 B 10 1992914626 0 PO BOX 43230 CINCINNATI OH 452430230 20 1992914626 0 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1992915474 0 Physicians Healthy Kids Services 20 1992915474 0 Physicians Optical Supplies 20 1992915474 0 Physicians Physician Services 00 1992915805 0 LAREAU JUSTIN 2010060 9999999 B 10 1992915805 0 900 RAND RD STE 300 SUITE 300 DES PLAINES IL 600162359 20 1992915805 0 Physicians Anesthesia Services 20 1992915805 0 Physicians Healthy Kids Services 20 1992915805 0 Physicians Optical Supplies 20 1992915805 0 Physicians Physician Services 00 1992917009 0 KOGANTI USHASRI 1998317 9999999 B 10 1992917009 0 124 SW ADAMS ST PEORIA IL 616021308 20 1992917009 0 Physicians Anesthesia Services 20 1992917009 0 Physicians Fluoride varnish 20 1992917009 0 Physicians Healthy Kids Services 20 1992917009 0 Physicians Optical Supplies 20 1992917009 0 Physicians Physician Services 00 1992917785 0 HUNTER HEIDI J 2011213 9999999 B 10 1992917785 0 PO BOX 801143 KANSAS CITY MO 641801143 20 1992917785 0 Physicians Anesthesia Services 20 1992917785 0 Physicians Healthy Kids Services 20 1992917785 0 Physicians 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YANG CARINA W 2009182 9999999 B 10 1992920987 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1992920987 0 Physicians Anesthesia Services 20 1992920987 0 Physicians Healthy Kids Services 20 1992920987 0 Physicians Optical Supplies 20 1992920987 0 Physicians Physician Services 00 1992923288 0 BISHOF CHRISTINE P 2009182 9999999 B 10 1992923288 0 111 E WISCONSIN AVE STE 2000 MILWAUKEE WI 532024809 20 1992923288 0 Physicians Anesthesia Services 20 1992923288 0 Physicians Healthy Kids Services 20 1992923288 0 Physicians Optical Supplies 20 1992923288 0 Physicians Physician Services 00 1992924385 0 SZEMPLINSKI BARBARA 2006270 9999999 B 10 1992924385 0 0S521 PRESTON CIR GENEVA IL 601346147 20 1992924385 0 Speech Therapists Medical Supplies 20 1992924385 0 Speech Therapists Medical equipment/prosthetic devices 20 1992924385 0 Speech Therapists Speech Therapy/Pathology Services 00 1992924617 0 LOTUS THOMAS 2022339 9999999 B 10 1992924617 0 324 ROXBURY RD ROCKFORD IL 611075090 20 1992924617 0 Chiropractors Chiropractic Services 00 1992925366 0 CHANDRA RAHUL 2020059 9999999 B 10 1992925366 0 5590 S FORT APACHE RD LAS VEGAS NV 891487657 20 1992925366 0 Physicians Anesthesia Services 20 1992925366 0 Physicians Fluoride varnish 20 1992925366 0 Physicians Healthy Kids Services 20 1992925366 0 Physicians Optical Supplies 20 1992925366 0 Physicians Physician Services 00 1992925580 0 IL DEPT OF PUBLIC HEALTH 1992061 9999999 B 10 1992925580 0 535 WEST JEFFERSON ST SPRINGFIELD IL 627610999 20 1992925580 0 Physicians Anesthesia Services 20 1992925580 0 Physicians Healthy Kids Services 20 1992925580 0 Physicians Optical Supplies 20 1992925580 0 Physicians Physician Services 00 1992925994 0 LI JASLYNN M 2011192 9999999 B 10 1992925994 0 PO BOX 7784 CAROL STREAM IL 601977784 20 1992925994 0 Physicians Anesthesia Services 20 1992925994 0 Physicians Healthy Kids Services 20 1992925994 0 Physicians Optical Supplies 20 1992925994 0 Physicians Physician Services 00 1992926307 0 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STREAM IL 601220021 20 1992933006 0 Physicians Anesthesia Services 20 1992933006 0 Physicians Healthy Kids Services 20 1992933006 0 Physicians Optical Supplies 20 1992933006 0 Physicians Physician Services 00 1992933105 0 NUTH LALIN 2013014 9999999 B 10 1992933105 0 1860 PAYSPHERE CIR CHICAGO IL 606740018 20 1992933105 0 Physicians Anesthesia Services 20 1992933105 0 Physicians Fluoride varnish 20 1992933105 0 Physicians Healthy Kids Services 20 1992933105 0 Physicians Optical Supplies 20 1992933105 0 Physicians Physician Services 00 1992933188 0 JOHANSEN JENNIFER C 2009182 9999999 B 10 1992933188 0 119 S WESTERN AVE UNIT 1 CHICAGO IL 606124644 20 1992933188 0 Nurse Practitioners Healthy Kids Services 20 1992933188 0 Nurse Practitioners Nurse Practitioners Services 20 1992933188 0 Nurse Practitioners Physician Services 00 1992933204 0 MATHEW GINA 2013213 9999999 B 10 1992933204 0 PO BOX 5588 BELFAST ME 049155500 20 1992933204 0 Physicians Anesthesia Services 20 1992933204 0 Physicians 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Physicians Optical Supplies 20 1992934517 0 Physicians Physician Services 00 1992935001 0 NANDY NINA 2024073 9999999 B 10 1992935001 0 1420 W PIONEER PKWY PEORIA IL 616151941 20 1992935001 0 Physicians Anesthesia Services 20 1992935001 0 Physicians Fluoride varnish 20 1992935001 0 Physicians Healthy Kids Services 20 1992935001 0 Physicians Optical Supplies 20 1992935001 0 Physicians Physician Services 00 1992935217 0 MCCRACKEN KATHERINE 2020214 9999999 B 10 1992935217 0 700 CHILDRENS DR COLUMBUS OH 432052664 20 1992935217 0 Physicians Anesthesia Services 20 1992935217 0 Physicians Fluoride varnish 20 1992935217 0 Physicians Healthy Kids Services 20 1992935217 0 Physicians Optical Supplies 20 1992935217 0 Physicians Physician Services 00 1992936454 0 YONG GARY K 2009319 9999999 B 10 1992936454 0 366 DIXIE HWY CHICAGO HEIGHTS IL 604111758 20 1992936454 0 Optometrists Optical Supplies 20 1992936454 0 Optometrists Optometric Services 20 1992936454 0 Optometrists Physician Services 00 1992938682 0 EDWARDS TOUWANNA 2023018 9999999 B 10 1992938682 0 28594 NETWORK PL CHICAGO IL 606731285 20 1992938682 0 Clinical Social Worker Psychologist service 00 1992939011 0 COLLIER CASEY 2012187 9999999 B 10 1992939011 0 1601 CUMMINS DR STE D MODESTO CA 953586411 20 1992939011 0 Physicians Anesthesia Services 20 1992939011 0 Physicians Healthy Kids Services 20 1992939011 0 Physicians Optical Supplies 20 1992939011 0 Physicians Physician Services 00 1992939250 0 KINSINGER SARAH 2017032 9999999 B 10 1992939250 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1992939250 0 Psychologist Psychologist service 00 1992939953 0 STAHMER CHRISTOPHER 2013200 9999999 B 10 1992939953 0 PO BOX 88276 MILWAUKEE WI 532888276 20 1992939953 0 Physicians Anesthesia Services 20 1992939953 0 Physicians Healthy Kids Services 20 1992939953 0 Physicians Optical Supplies 20 1992939953 0 Physicians Physician Services 00 1992939995 0 DAVIS TENIKA 2009187 9999999 B 10 1992939995 0 540 SUPERIOR AVE 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1992950166 0 6308 8TH AVE KENOSHA WI 531435031 20 1992950166 0 Physicians Anesthesia Services 20 1992950166 0 Physicians Healthy Kids Services 20 1992950166 0 Physicians Optical Supplies 20 1992950166 0 Physicians Physician Services 20 1992950166 0 Physicians Physicians Psychiatric Services 00 1992951651 0 KIM EUGENE T 2014001 9999999 B 10 1992951651 0 3310 FIELDS SOUTH DR CHAMPAIGN IL 618223741 20 1992951651 0 Physicians Anesthesia Services 20 1992951651 0 Physicians Healthy Kids Services 20 1992951651 0 Physicians Optical Supplies 20 1992951651 0 Physicians Physician Services 00 1992951743 0 BRINKMAN AARON 2015334 9999999 B 10 1992951743 0 9119 S EXCHANGE AVE CHICAGO IL 606174225 20 1992951743 0 Physicians Anesthesia Services 20 1992951743 0 Physicians Electronic Home Response/EHR Installation, MPE Certification 20 1992951743 0 Physicians Fluoride varnish 20 1992951743 0 Physicians Healthy Kids Services 20 1992951743 0 Physicians Optical Supplies 20 1992951743 0 Physicians Physician Services 00 1992951909 0 MERCHANT AMINA I 2018083 9999999 B 10 1992951909 0 3301 W FOREST HOME AVE MILWAUKEE WI 532152843 20 1992951909 0 Physicians Anesthesia Services 20 1992951909 0 Physicians Healthy Kids Services 20 1992951909 0 Physicians Optical Supplies 20 1992951909 0 Physicians Physician Services 00 1992953152 0 THOMAS DIANE 2010091 9999999 B 10 1992953152 0 800 E 55TH ST CHICAGO IL 606154906 20 1992953152 0 Nurse Practitioners Fluoride varnish 20 1992953152 0 Nurse Practitioners Healthy Kids Services 20 1992953152 0 Nurse Practitioners Nurse Practitioners Services 20 1992953152 0 Nurse Practitioners Physician Services 00 1992953210 0 VERGARA GIMA E 2008275 9999999 B 10 1992953210 0 6610 N CLARK ST CHICAGO IL 606264062 20 1992953210 0 Audiologists Audiology Services 20 1992953210 0 Audiologists Medical Supplies 20 1992953210 0 Audiologists Medical equipment/prosthetic devices 00 1992954366 0 GEREN KARA I 2023018 9999999 B 10 1992954366 0 PO BOX 43230 PHOENIX AZ 850803230 20 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Practitioners Nurse Practitioners Services 20 1992961056 0 Nurse Practitioners Physician Services 00 1992961593 0 MURDAKES CHARLENE 2013259 9999999 B 10 1992961593 0 612 ROXBURY RD ROCKFORD IL 611075089 20 1992961593 0 Physicians Anesthesia Services 20 1992961593 0 Physicians Fluoride varnish 20 1992961593 0 Physicians Healthy Kids Services 20 1992961593 0 Physicians Optical Supplies 20 1992961593 0 Physicians Physician Services 00 1992961643 0 GORDON CYNTHIA 2009243 9999999 B 10 1992961643 0 6615 GRAND AVE STE 390 GURNEE IL 600314591 20 1992961643 0 Physicians Anesthesia Services 20 1992961643 0 Physicians Healthy Kids Services 20 1992961643 0 Physicians Optical Supplies 20 1992961643 0 Physicians Physician Services 20 1992961643 0 Physicians Physicians Psychiatric Services 00 1992962146 0 MUNOZ VICTOR 2008217 9999999 B 10 1992962146 0 2 WESTBROOK CORP CTR STE 600 WESTCHESTER IL 601545716 20 1992962146 0 Physicians Anesthesia Services 20 1992962146 0 Physicians Fluoride varnish 20 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1992966451 0 Physicians Anesthesia Services 20 1992966451 0 Physicians Fluoride varnish 20 1992966451 0 Physicians Healthy Kids Services 20 1992966451 0 Physicians Optical Supplies 20 1992966451 0 Physicians Physician Services 00 1992966592 0 BHAKTA KUNJAN S 2021321 9999999 B 10 1992966592 0 5777 DEPT CAROL STREAM IL 601220021 20 1992966592 0 Physicians Anesthesia Services 20 1992966592 0 Physicians Healthy Kids Services 20 1992966592 0 Physicians Optical Supplies 20 1992966592 0 Physicians Physician Services 00 1992967343 0 HESS JAMIE M 2012122 9999999 B 10 1992967343 0 7974 UW HEALTH CT MIDDLETON WI 535625531 20 1992967343 0 Physicians Anesthesia Services 20 1992967343 0 Physicians Healthy Kids Services 20 1992967343 0 Physicians Optical Supplies 20 1992967343 0 Physicians Physician Services 00 1992967632 0 MITIKE MESFIN 2016148 9999999 B 10 1992967632 0 PO BOX 955534 SAINT LOUIS MO 631955534 20 1992967632 0 Physicians Anesthesia Services 20 1992967632 0 Physicians Healthy Kids 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1992984363 0 Physicians Healthy Kids Services 20 1992984363 0 Physicians Optical Supplies 20 1992984363 0 Physicians Physician Services 00 1992985931 0 WETHERELL BRITTNEY 2007141 9999999 B 10 1992985931 0 100 S GRAND AVE E FL 1 SPRINGFIELD IL 627621000 20 1992985931 0 Speech Therapists Medical Supplies 20 1992985931 0 Speech Therapists Medical equipment/prosthetic devices 20 1992985931 0 Speech Therapists Speech Therapy/Pathology Services 00 1992988208 0 VANDERWALL AARON M 2021169 9999999 B 10 1992988208 0 6742 N FROSTWOOD PKWY PEORIA IL 616152402 20 1992988208 0 Nurse Practitioners Anesthesia Services 20 1992988208 0 Nurse Practitioners Nurse Practitioners Services 20 1992988208 0 Nurse Practitioners Physician Services 00 1992989370 0 RAO SAVITHA V 2010001 9999999 B 10 1992989370 0 660 MASON RIDGE CENTER DR STE SAINT LOUIS MO 631418512 20 1992989370 0 Physicians Anesthesia Services 20 1992989370 0 Physicians Fluoride varnish 20 1992989370 0 Physicians Healthy Kids Services 20 1992989370 0 Physicians Optical Supplies 20 1992989370 0 Physicians Physician Services 00 1992989933 0 PINCAVAGE AMBER T 2010182 9999999 B 10 1992989933 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1992989933 0 Physicians Anesthesia Services 20 1992989933 0 Physicians Fluoride varnish 20 1992989933 0 Physicians Healthy Kids Services 20 1992989933 0 Physicians Optical Supplies 20 1992989933 0 Physicians Physician Services 00 1992992804 0 MYREN MARK F 2016348 9999999 B 10 1992992804 0 150 HARVESTER DR STE 300 BURR RIDGE IL 605275965 20 1992992804 0 Physician Assistant Only Fluoride varnish 20 1992992804 0 Physician Assistant Only Healthy Kids Services 20 1992992804 0 Physician Assistant Only Physician Services 00 1992995039 0 ZINKUS TIMOTHY 2020074 9999999 B 10 1992995039 0 PO BOX 954467 SAINT LOUIS MO 631952334 20 1992995039 0 Physicians Anesthesia Services 20 1992995039 0 Physicians Healthy Kids Services 20 1992995039 0 Physicians Optical Supplies 20 1992995039 0 Physicians Physician Services 00 1992995393 0 HOUSE STACEY L 2011182 9999999 B 10 1992995393 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1992995393 0 Physicians Anesthesia Services 20 1992995393 0 Physicians Healthy Kids Services 20 1992995393 0 Physicians Optical Supplies 20 1992995393 0 Physicians Physician Services 00 1992995542 0 ITTIARA SHAUN T 2013210 9999999 B 10 1992995542 0 4429 W 95TH ST OAK LAWN IL 604532625 20 1992995542 0 Physicians Anesthesia Services 20 1992995542 0 Physicians Healthy Kids Services 20 1992995542 0 Physicians Optical Supplies 20 1992995542 0 Physicians Physician Services 00 1992995591 0 BEHNAM MARK T 2014304 9999999 B 10 1992995591 0 29373 NETWORK PL CHICAGO IL 606733039 20 1992995591 0 Physicians Anesthesia Services 20 1992995591 0 Physicians Healthy Kids Services 20 1992995591 0 Physicians Optical Supplies 20 1992995591 0 Physicians Physician Services 00 1992996219 0 DAY BRIAN 2012183 9999999 B 10 1992996219 0 PO BOX 60352 660 SOUTH EUCLID AVENUE SAINT LOUIS MO 631600352 20 1992996219 0 Physicians Anesthesia Services 20 1992996219 0 Physicians Healthy Kids Services 20 1992996219 0 Physicians Optical Supplies 20 1992996219 0 Physicians Physician Services 20 1992996219 0 Physicians Physicians Psychiatric Services 00 1992996383 0 PETROCZKY ELLEN 2013086 9999999 B 10 1992996383 0 111 E 4TH ST STE 440 ALTON IL 620026206 20 1992996383 0 Optometrists Optical Supplies 20 1992996383 0 Optometrists Optometric Services 20 1992996383 0 Optometrists Physician Services 00 1992996458 0 MATAVERDE PHILIP 2020225 9999999 B 10 1992996458 0 301 JOHN ST BOX 42 KALAMAZOO MI 490075295 20 1992996458 0 Physicians Anesthesia Services 20 1992996458 0 Physicians Fluoride varnish 20 1992996458 0 Physicians Healthy Kids Services 20 1992996458 0 Physicians Optical Supplies 20 1992996458 0 Physicians Physician Services 00 1992997175 0 SESSIONS NATALIE 2012345 9999999 B 10 1992997175 0 100 W CHICAGO AVE STE F EAST CHICAGO IN 463123261 20 1992997175 0 Physicians Anesthesia Services 20 1992997175 0 Physicians Fluoride varnish 20 1992997175 0 Physicians Healthy Kids Services 20 1992997175 0 Physicians Optical Supplies 20 1992997175 0 Physicians Physician Services 00 1992999148 0 SERPICO CHRISTOPHER 2016011 9999999 B 10 1992999148 0 8550 W BRYN MAWR AVE STE 800 STE 800 CHICAGO IL 606313222 20 1992999148 0 Physician Assistant Only Fluoride varnish 20 1992999148 0 Physician Assistant Only Healthy Kids Services 20 1992999148 0 Physician Assistant Only Physician Services