Performance Year |
Provider Type |
Provider Class |
Provider Legal Business Name |
Individual NPI |
Base Provider TIN |
Primary Care Services |
Specialty |
Effective Start Date |
|
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
MICHAEL WELCH |
1134100084 |
880103557 |
N |
OCCUPATIONAL THERAPIST IN PRIVATE PRACTICE |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
STEPHEN POWERS |
1942495247 |
880103557 |
Y |
PHYSICIAN ASSISTANT |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
MATTHEW SACHT |
1538388913 |
880103557 |
Y |
PHYSICIAN ASSISTANT |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
AMANDA KEEFER |
1164888756 |
880103557 |
Y |
NURSE PRACTITIONER |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
SARA SULLIVAN |
1821396466 |
880103557 |
Y |
PHYSICIAN ASSISTANT |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
RENEE COVEY |
1851666549 |
880103557 |
Y |
PHYSICIAN ASSISTANT |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
HEATHER CARROLL |
1023550704 |
880103557 |
Y |
NURSE PRACTITIONER |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
DAVIS AYERS |
1225227382 |
880103557 |
Y |
PHYSICIAN ASSISTANT |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
DANAE FOLEY |
1275086068 |
880103557 |
Y |
NURSE PRACTITIONER |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
GREGORY GRAVES |
1215351994 |
880103557 |
Y |
PHYSICIAN ASSISTANT |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
NATHAN NICOLET |
1861678153 |
880103557 |
Y |
PHYSICIAN ASSISTANT |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
NAOMI ALBERTSON |
1902905813 |
880103557 |
Y |
FAMILY MEDICINE |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
CORY WILCOX |
1770143356 |
880103557 |
Y |
PHYSICIAN ASSISTANT |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
CURT ERICKSON |
1881022143 |
880103557 |
Y |
PHYSICIAN ASSISTANT |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
PETER ANDERSON |
1861883530 |
880103557 |
N |
PHYSICAL THERAPIST IN PRIVATE PRACTICE |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
SUZANNE FLINT |
1194831529 |
880103557 |
Y |
PHYSICIAN ASSISTANT |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
TRACY HARIG |
1841545894 |
880103557 |
Y |
NURSE PRACTITIONER |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
MAEVE LYONS |
1730582586 |
880103557 |
Y |
PHYSICIAN ASSISTANT |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
AMY LOCKE |
1518537794 |
880103557 |
Y |
NURSE PRACTITIONER |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
SAMANTHA SCHULZE |
1154934313 |
880103557 |
Y |
PHYSICIAN ASSISTANT |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
ALEXANDRA JANAS |
1598050072 |
880103557 |
Y |
NURSE PRACTITIONER |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
SHANA FEARNLEY |
1861480642 |
880103557 |
Y |
PHYSICIAN ASSISTANT |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
JADEN MUSTACCHIO |
1700404936 |
880103557 |
Y |
PHYSICIAN ASSISTANT |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
TESS JONES |
1285256107 |
208628418 |
Y |
PHYSICIAN ASSISTANT |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
JEREMY REICHERT |
1215130802 |
208628418 |
Y |
PHYSICIAN ASSISTANT |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
ABIGAIL FREEMAN |
1487216719 |
208628418 |
Y |
PHYSICIAN ASSISTANT |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
ADAM CASEY |
1548735673 |
208628418 |
Y |
PHYSICIAN ASSISTANT |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
CORINNA JEWELL |
1982710349 |
208628418 |
Y |
PHYSICIAN ASSISTANT |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
LEXI JACOBSON |
1437711330 |
208628418 |
Y |
PHYSICIAN ASSISTANT |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
STEFFANIE ROBERTUS |
1093386823 |
208628418 |
Y |
PHYSICIAN ASSISTANT |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
ROXANN RICHARDSON |
1902428915 |
208628418 |
Y |
PHYSICIAN ASSISTANT |
January 01 , 2023 12:00 AM |
Renown Direct Contracting Entity , LLC |
PY2023 |
Individual Participant |
Preferred Provider |
DEREK GLAZIER |
1043731771 |
208628418 |
Y |
PHYSICIAN ASSISTANT |
January 01 , 2023 12:00 AM |