Nevada Medicaid Revalidation Report 02-03-2020
NPI
1417996018 1033404421 1912954553 1326023417 1235221276 1891107892 1710420542 1013204395 1851652051 1851473938 1508300146 1841724622 1427390715 1699218230 1548497241 1427114164 1811422181 1922035104 1346788411 1508858192 1003233040 1134359094 1699757146 1437131174 1508300195 1972605772 1972036663 1356763197 1336198779 1962485284 1730565375 1346776481 1447232152 1144590977 1073041836 1316179344 1609136035 1043756984 1578099354 1871868067 1336119858 1528594009 1922067768 1811442171 1285160994 1215460100 1720529704 1629252846 1285976332 1346449956 1033296652 1356637581 1356882328 1538207782 1336482645 1003159666 1699765586 1316902208 1780949297 1558563817 1477714483 1174794127 1568806404 1225328750 1548572274 1457644932 1033165899 1073545703 1336689447 1922062215 1427098011 1033473574 1730166562 1326161217 1689975047 1629048046 1023027307 1770511743 1679919666 1639603467 1184067373 1346596848
Revalidation
Name
Due Date
06/10/2022
BALLEHR
LISA O
06/10/2022
PRECISION SPECIALTY PHARMACY
06/12/2022
MERCY ST ANNE HOSPITAL
06/12/2022
HOCHHALTER
BENJAMIN J
06/12/2022
SIERRA PATHOLOGY ASSOC INC
06/12/2022
VANDERVELDE
KATHRYN A
06/12/2022
MANIAGO
VERNON Y
06/13/2022
HUIZAR
MARIA D
06/13/2022
KULKARNI
NEIL A
06/13/2022
MIRCHOU
RAFAEL
06/13/2022
LEON LOPEZ
MAYELIN
06/13/2022
TAYLOR
JENNIFER
06/13/2022
KRAMER
JOANNA L
06/13/2022
BENNETT
MARY A
06/13/2022
RADER
KENDALL H
06/13/2022
YOUNG
NORMAN
06/13/2022
CHILDRENS CABINET
06/13/2022
JOHNSON
DAVID A
06/13/2022
NEW FRONTIER
06/13/2022
PEINE
STEVEN D
06/13/2022
CARPENTER
KAITLIN E
06/13/2022
NGUYEN
ALBERT P
06/14/2022
KLAIN
ELLIOTT H
06/14/2022
HANDELMAN
BRUCE H
06/14/2022
KEARNEY
JOSEPH
06/14/2022
VAN HIRTUM-DAS
MICHELE
06/14/2022
MURRAY
ASHLEY
06/14/2022
LAWSON
EVIE T
06/14/2022
LUTHER
ROSS D II
06/14/2022
CROSSLEY
DAVID M
06/14/2022
NELLIS
GABRIELLA
06/14/2022
HUNN
JASMINE
06/14/2022
COSTAS-CENTIVANY ANDRES F
06/14/2022
MANIBUSAN
ROWENA E
06/14/2022
REANEY-SMITH
ROBIN T
06/14/2022
NELSON
SCOTT
06/14/2022
REKINDLED HOPE
06/14/2022
ONEIL
JENNIFER
06/15/2022
GRAHAM
HEATHER
06/15/2022
EVANS
CARON
06/15/2022
SUREK
CHRISTOPHE
06/15/2022
BELLEROSE
TINA M
06/15/2022
MORRIS
HOWARD
06/15/2022
TRINIDAD
SUSANA
06/15/2022
CHAMPLIN
JON-THOMAS
06/15/2022
SARAON
SIMRIT K
06/15/2022
RAVELO-FERNANDEZ
YANEISY
06/15/2022
TOLLESON
ANGELLA
06/15/2022
MCCORQUODALE
DONALD S
06/16/2022
WHITE
RYAN E
06/16/2022
SUAREZ
VIRGINIA
06/16/2022
MOVAHED
HOSSEIN
06/16/2022
OJITO-LEZCANO
MIDALYS
06/16/2022
PERALTA
WILBUR
06/17/2022
RUNYAN
RICHARD W
06/17/2022
SINGLETON
MICHAEL N
06/17/2022
MERRELL
ROBERT
06/19/2022
ARIZONA KIDNEY DISEASE & HYPERTENSION
06/19/2022
KLEIN
NATHANIEL
06/19/2022
SYED
ATIQ
06/19/2022
NELSON
TODD A
06/19/2022
PETERSON
BRYANT L
06/19/2022
PECHA
TRAVIS J
06/19/2022
AUGENSTEIN
JULIE A
06/19/2022
BHANDARI
UMESH C
06/19/2022
GOTARDO
ANNA
06/20/2022
PARHAM
DAVID
06/20/2022
BOSTICK
MARC W
06/20/2022
ROOKS
ANDREW
06/20/2022
LIEBERSTEIN
LOTH E
06/20/2022
PEREZ-JOHNSON
MARIA E
06/20/2022
FERIA-ARIAS
ENRIQUE
06/20/2022
SANDE
CRAIG M
06/20/2022
CHAIZE
ROBIN L
06/20/2022
MARTINEZ
MONA
06/20/2022
CUMBRIA
WAYNE
06/20/2022
PAREKH
SHEHZAD M
06/20/2022
NOVAK
CHARLES C
06/20/2022
BARTONE
SOPHIA A
06/20/2022
JONES
TAMECA
06/20/2022
CHRISTIANSEN
JOSHUA T
06/21/2022
HILDEBRAND
MEGAN
06/2022
Nevada Medicaid Provider Revalidation Report
Provider Type
20 28 11 77 20 20 24 14 20 20 14 14 20 14 20 20 54 20 17 20 20 20 20 20 14 20 14 24 20 20 85 85 20 14 77 77 82 14 14 26 20 14 20 82 85 24 14 24 20 72 22 20 14 20 20 20 20 20 20 20 20 72 20 20 20 20 20 20 14 20 20 20 20 20 14 20 20 20 14 14 20 14
Provider Type Description
Physician, M.D., Osteopath, D.O. Pharmacy Hospital, Inpatient Physician Assistant Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Advanced Practice Registered Nurses Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Targeted Case Management Physician, M.D., Osteopath, D.O. Special Clinics Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Advanced Practice Registered Nurses Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Applied Behavior Analysis (ABA) Applied Behavior Analysis (ABA) Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician Assistant Physician Assistant Behavioral Health Rehabilitative Treatment Behavioral Health Outpatient Treatment Behavioral Health Outpatient Treatment Psychologist Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Behavioral Health Rehabilitative Treatment Applied Behavior Analysis (ABA) Advanced Practice Registered Nurses Behavioral Health Outpatient Treatment Advanced Practice Registered Nurses Physician, M.D., Osteopath, D.O. Nurse Anesthetist Dentist Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Nurse Anesthetist Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment
Provider Specialty 072 928 911 977 066 139 023 301 135 060 302 302 139 300 111 064 237 157 188 059 139 057 057 057 301 126 300 023 111 057 314 314 057 300 977 977 882 301 301 400 400 301 060 302 314 023 302 400 126 972 078 114 302 060 057 057 125 125 062 125 057 972 057 139 146 053 066 146 302 114 139 064 114 139 307 125 060 146 306 301 057 301
Phone Number
Address
7024336944 7024059500 4194072400 7023833645 7753343450 6029330777 7023803210 7029227015 6029330970 7026411240 7023650600 7028436500 6029330945 7027616467 2085052000 7757863040 7756880463 2088148475 7754231412 7022556647 8016623645 9184297518 7028780070 7028780070 7026465437 3236602450 7022917121 7023842238 9095584000 7028780070 7029989505 7756880327 7028780070 7028309740 7758875140 8012138841 7024292654 7756772216 7756772216 7024868900 7757732005 7022947135 9287632273 7758300999 7756880327 7024836000 7024379654 7757732005 8015856387 2083676416 7026483701 7028775199 7024379654 7608735811 8015816393 8015816393 7028771887 9287637722 7022553547 9287637722 8015077000 8015816393 8015816393 6029331900 2087346760 7028775199 3236602450 2083812222 7022682915 7758524848 7027318000 9167342011 7753294600 7759824100 7756862425 9287637722 9287637722 2083812222 7027238822 7024374673 8015816393 7758259995
3560 E FLAMINGO RD STE 100, 2775 S JONES BLVD STE 100A, 3404 W SYLVANIA AVE, 4180 S RAINBOW BLVD STE 810, 475 KIRMAN AVE, 1919 E THOMAS RD, 2851 EL CAMINO AVE STE 101, 2801 S VALLEY VIEW BLVD STE 6, 1919 E THOMAS RD,AMBULATORY BLDG 7488 W SAHARA AVE, 6655 W SAHARA AVE STE D110, 4344 W CHEYENNE AVE, 1919 E THOMAS RD,AMBULATORY BLDG 6767 W TROPICANA SW STE 100, 9850 ST LUKES DR, 350 W 6TH ST, 480 GALLETTI WAY BLDG 2A, 775 POLE LINE RD W STE 213, 1490 GRIMES ST, 6460 MEDICAL CENTER ST STE 350, 100 N MARIO CAPECCHI DR, 200 W ARBOR DR, 9127 W RUSSELL RD STE 110, 9127 W RUSSELL RD STE 110, 3680 N RANCHO DR, 4650 W SUNSET BLVD, 5412 BOULDER HWY, 2725 S JONES BLVD STE 104, 11234 ANDERSON ST, 9127 W RUSSELL RD STE 110, 630 S RANCHO DR STE A, 3416 GONI RD D-132, 9127 W RUSSELL RD STE 110, 4780 S ARVILLE ST STE B, 3325 RESEARCH WAY, 1525 W 2100 S, 8107 CIMARRON MEADOWS WAY, 4773 CAUGHLIN PKWY STE 2, 4773 CAUGHLIN PKWY STE 2, 2655 ENTERPRISE RD, PO BOX C 1025 HOSPITAL RD, 200 WILSON CIR, 2735 SILVER CREEK RD, 1630 VAN NESS AVE, 3416 GONI RD D-132, 888 W BONNEVILLE AVE, 620 E TWAIN AVE STE C, PO BOX C 1025 HOSPITAL RD, 50 N MEDICAL DR, 1055 N CURTIS RD, 1070 N RANCHO DR, 4750 W OAKEY BLVD STE 3B, 620 E TWAIN AVE STE C, 150 PIONEER LN, 50 N MEDICAL DR, 50 N MEDICAL DR, 500 S RANCHO DR STE 12, 2580 HIGHWAY 95 STE 224, 9260 W SUNSET RD STE 200, 2580 HIGHWAY 95 STE 224, 5121 S COTTONWOOD ST, 50 N MEDICAL DR, 50 N MEDICAL DR, 1919 E THOMAS RD, 228 SHOUP AVE W, 4750 W OAKEY BLVD STE 2A, 4650 W SUNSET BLVD, 190 E BANNOCK ST, 5135 CAMINO AL NORTE STE 287, 10619 PROFESSIONAL CIR, 3186 S MARYLAND PKWY, 2315 STOCKTON BLVD, 880 RYLAND ST, 1155 MILL ST FL 2 BLDG 55, 200 S VIRGINIA ST FL 8, 2580 HIGHWAY 95 STE 224, 2580 HIGHWAY 95 STE 224, 190 E BANNOCK ST, 1180 N TOWN CENTER DR STE 100, 6600 W CHARLESTON BLVD STE 140, 50 N MEDICAL DR, 4600 KIETZKE LN STE O260,
City
LAS VEGAS LAS VEGAS TOLEDO LAS VEGAS RENO PHOENIX LAS VEGAS LAS VEGAS PHOENIX LAS VEGAS LAS VEGAS N LAS VEGAS PHOENIX LAS VEGAS NAMPA RENO SPARKS TWIN FALLS FALLON LAS VEGAS SALT LAKE CITY SAN DIEGO LAS VEGAS LAS VEGAS LAS VEGAS LOS ANGELES LAS VEGAS LAS VEGAS LOMA LINDA LAS VEGAS LAS VEGAS CARSON CITY LAS VEGAS LAS VEGAS CARSON CITY SALT LAKE CITY LAS VEGAS RENO RENO RENO SCHURZ BOULDER CITY BULLHEAD CITY RENO CARSON CITY LAS VEGAS LAS VEGAS SCHURZ SALT LAKE CITY BOISE LAS VEGAS LAS VEGAS LAS VEGAS BISHOP SALT LAKE CITY SALT LAKE CITY LAS VEGAS BULLHEAD CITY LAS VEGAS BULLHEAD CITY MURRAY SALT LAKE CITY SALT LAKE CITY PHOENIX TWIN FALLS LAS VEGAS LOS ANGELES BOISE LAS VEGAS RENO LAS VEGAS SACRAMENTO RENO RENO RENO BULLHEAD CITY BULLHEAD CITY BOISE LAS VEGAS LAS VEGAS SALT LAKE CITY RENO
State
Zip Code
NV
89121
NV
89146
OH
43623
NV
89103
NV
89502
AZ
85016
NV
89102
NV
89102
AZ
85016
NV
89117
NV
89146
NV
89032
AZ
85016
NV
89103
ID
83687
NV
89503
NV
89431
ID
83301
NV
89406
NV
89148
UT
84113
CA
92103
NV
89148
NV
89148
NV
89130
CA
90027
NV
89122
NV
89146
CA
92354
NV
89148
NV
89106
NV
89706
NV
89148
NV
89103
NV
89706
UT
84119
NV
89147
NV
89519
NV
89519
NV
89512
NV
89427
NV
89005
AZ
86442
NV
89503
NV
89706
NV
89106
NV
89169
NV
89427
UT
84132
ID
83706
NV
89106
NV
89102
NV
89169
CA
93514
UT
84132
UT
84132
NV
89106
AZ
86442
NV
89148
AZ
86442
UT
84107
UT
84132
UT
84132
AZ
85016
ID
83301
NV
89102
CA
90027
ID
83712
NV
89081
NV
89521
NV
89109
CA
95817
NV
89502
NV
89502
NV
89501
AZ
86442
AZ
86442
ID
83712
NV
89144
NV
89146
UT
84132
NV
89502
Page 1 of 487
NPI
1710417423 1114211687 1043575186 1689115321 1396299384 1497071773 1962938696 1497049175 1649569583 1790979979 1538100193 1538314372 1629253075 1467987487 1477083210 1043396906 1639556855 1245424597 1245689116 1952590804 1801193883 1770825184 1245761873 1811300387 1184159493 1710287248 1558891689 1932657475 1245762350 1588095798 1710229851 1104801414 1497288047 1780030163 1003342890 1326365545 1336693811 1578903449 1417193228 1083144190 1003072018 1871743369 1588196539 1316375744 1497985048 1720517915 1912445073 1881132207 1629360912 1740729417 1104358969 1750339131 1437548864 1417489196 1114457348 1245502145 1437395407 1609317718 1457799215 1871013086 1952733024 1205946175 1275805723 1871031906 1851548648 1215311915 1801320940 1508196882 1073925533 1194074443 1336169283 1154341048 1730488743 1104824531 1952342891 1679890206 1811080526 1518379429 1992158687 1063636512 1659652931 1598117723
Revalidation
Name
Due Date
06/21/2022
DAVIS
ROBYN E
06/21/2022
TAYLOR
KEVIN W
06/21/2022
KIM
YEONSOO J
06/21/2022
RODRIGUEZ-PIORNO
CARMEN
06/21/2022
POTHIER
MAIA
06/21/2022
HUDSON
MICHAEL L
06/22/2022
TREASURE HOUSE LLC
06/22/2022
CARROLL
JOSHUA L
06/22/2022
MARTIN
JARED T
06/22/2022
SHAH
RACHANA P
06/22/2022
POPOVIC
JADRANKA
06/22/2022
CAVITYBUSTERS
06/22/2022
KITHAS
JOSEPH A
06/22/2022
TAN
JUDITH L
06/22/2022
KEOGH
ABIGAIL O
06/22/2022
BUI
QUANG D
06/22/2022
KINAHAN
CONSUELO A
06/23/2022
HEBL
VIRGINIA
06/23/2022
GIVENS
ALEXANDRA
06/23/2022
PARKIN
CRAIG S
06/23/2022
DIRIG
NICHOLAS J
06/23/2022
TOMBERG
SPENCER
06/23/2022
PEREZ LUJAN
LEVI
06/23/2022
SHEAR
MARNI
06/23/2022
LINDQUIST
KIMBALL
06/23/2022
EWING
BRANDIE
06/23/2022
TREJO-CHAVEZ
JACQUELINE
06/23/2022
PHILLIPS
JAMIE R
06/23/2022
SHUMWAY
RILEY
06/23/2022
LAWRENCE
KALA
06/23/2022
JOHNSON
SKYLER
06/24/2022
LI
JOHN
06/24/2022
VESCIO
JOHN
06/24/2022
AVELLA OF DEER VALLEY, INC.
06/26/2022
AUNE
SAGE
06/26/2022
MATIN
MAHAN
06/26/2022
DYSON
ROSALIND
06/26/2022
KADAS
KAREN
06/26/2022
VOORHIES
BENJAMIN N
06/26/2022
HOSSAY
ALISA
06/26/2022
FECAROTTA
CHRISTOPHE M
06/26/2022
SORENSEN
JENNIFER
06/26/2022
VIDONI
KIM
06/26/2022
PORTES
PEDRO
06/27/2022
PINION REHABILITATION LLC
06/27/2022
TUUK VELARDE
DEMI
06/27/2022
VITALITY CERTIFIED COMMUNITY CLINIC CCBH
06/27/2022
THOMSEN
JASON
06/27/2022
RIVERA
NANCY
06/27/2022
MCKINNEY
TAYLOR
06/27/2022
ZIMMERMAN
LEZA
06/27/2022
WHITE PINE CARE CENTER
06/27/2022
GAYE
JEANNIE M
06/27/2022
GARCIA
ALISSA
06/27/2022
MATTINGLY
CHELSEY R
06/27/2022
BAIN
NICOLA M
06/27/2022
PEARSON
ERIK G
06/27/2022
NORTHWEST THERAPY AND PSYCHOLOGICAL SER
06/28/2022
FERRARA
PETER B
06/28/2022
KING
WESLEY
06/28/2022
UVINO
LISA
06/28/2022
RZEWNICKI
DOROTHY
06/28/2022
BRANDT
ZACHARIA
06/28/2022
MVP PRIMARY CARE LLC
06/28/2022
FALL
MICHAEL J
06/28/2022
STEGGERDA
JUSTIN
06/28/2022
NOOTENBOOM
KANA
06/28/2022
JOHNSON
YOULANDA Y
06/28/2022
GALAXY HOSPICE INC
06/28/2022
CRANE
HEATHER A
06/28/2022
GANCHAN
RICHARD P
06/28/2022
WILLIAMSON
JOHN S
06/28/2022
SHARMA
UMANGA
06/28/2022
CHANDRASEKHAR
SUDHA
06/28/2022
BATRA
RENU S
06/29/2022
SEXTON
SANDRA R
06/29/2022
CHILDRENS HOSPITAL OF ORANGE COUNTY
06/29/2022
KAUR
AMANJOT
06/29/2022
BAY
SARAH L
06/29/2022
LIAO
TINA Y
06/29/2022
MILLER
ASHLEY
06/29/2022
BENNER
JENNICA
06/2022
Nevada Medicaid Provider Revalidation Report
Provider Type
14 20 20 14 14 20 14 20 20 20 20 22 20 24 34 22 20 20 85 34 20 20 14 20 14 14 85 14 85 24 20 20 14 33 14 20 14 24 20 14 20 77 14 24 34 14 17 14 20 85 14 19 14 14 34 24 20 14 20 14 85 24 14 20 20 20 14 14 64 24 20 20 20 20 20 24 11 20 24 20 14 14
Provider Type Description
Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Dentist Physician, M.D., Osteopath, D.O. Advanced Practice Registered Nurses Therapy Dentist Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Applied Behavior Analysis (ABA) Therapy Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Behavioral Health Outpatient Treatment Applied Behavior Analysis (ABA) Behavioral Health Outpatient Treatment Applied Behavior Analysis (ABA) Advanced Practice Registered Nurses Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment DME, Disposable, Prosthetics Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Advanced Practice Registered Nurses Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician Assistant Behavioral Health Outpatient Treatment Advanced Practice Registered Nurses Therapy Behavioral Health Outpatient Treatment Special Clinics Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Applied Behavior Analysis (ABA) Behavioral Health Outpatient Treatment Nursing Facility Behavioral Health Outpatient Treatment Behavioral Health Outpatient Treatment Therapy Advanced Practice Registered Nurses Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Applied Behavior Analysis (ABA) Advanced Practice Registered Nurses Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Behavioral Health Outpatient Treatment Hospice Advanced Practice Registered Nurses Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Advanced Practice Registered Nurses Hospital, Inpatient Physician, M.D., Osteopath, D.O. Advanced Practice Registered Nurses Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Behavioral Health Outpatient Treatment
Provider Specialty 306 072 072 302 300 072 814 114 111 120 139 173 146 023 028 173 053 060 314 400 064 111 300 139 300 301 314 301 314 023 111 109 300 933 301 066 301 023 131 301 063 977 300 023 027 301 188 302 109 314 302 184 300 301 028 023 138 814 053 301 314 023 302 053 149 073 306 300 964 023 106 106 060 139 139 023 911 060 023 139 301 302
Phone Number
Address
7757229446 7027326000 7027326000 7024379654 7023314277 7027326000 7753296303 6029330940 2147122728 3236602450 2083817340 7023625437 7024554654 7028771887 7023601137 7023625437 7022601261 8014424267 7022703219 8012386603 7757836190 8015812292 7028488515 3236602450 7024313626 7756881633 7024961367 7024860000 7756870550 3376092122 3376092122 3236602450 7024860000 8777196349 7755621115 9167349200 7025628181 7758821324 8015850100 7756772216 4808350709 8015850100 7754633191 9167349200 7757384494 7022835048 7757778477 7022917121 7023697152 7752000935 7026465437 7752898801 7028221556 7756248200 7758294700 7756352550 7022338101 7025035099 2088149800 7022947135 7024961367 4809636668 7026465437 7025188831 2083233767 3236602450 7025301255 7028537092 7029886789 9283475793 7759822400 7759827878 7757810092 4809636668 7027320173 4809636668 7145083182 7753275000 6029331900 6029335730 7024333038 7026853459
506 HOLCOMB AVE, 2950 S MARYLAND PKWY, 2950 S MARYLAND PKWY, 620 E TWAIN AVE STE C, 4250 E BONANZA RD STE 17, 2950 S MARYLAND PKWY, 10044 HUMITE LN, 1919 E THOMAS RD RD MAIN BLDG, 1050 W GALLERIA DR, 4650 W SUNSET BLVD, 125 E IDAHO ST STE 200, 6910 S RAINBOW BLVD STE 104, 601 N PECOS RD, 500 S RANCHO DR STE STE 12, 2012 S JONES BLVD, 6910 S RAINBOW BLVD STE 104, 7040 S DURANGO DR, 5121 S COTTONWOOD ST, 2110 E FLAMINGO RD STE 150, PO BOX 511258, 973 MICA DR STE 201, 50 N MEDICAL DR, 4019 PATTERSON AVE, 4650 W SUNSET BLVD, 2320 PASEO DEL PRADO, 480 GALLETTI WAY BLDG 8N, 2350 S JONES BLVD OFC 206B, 6171 W CHARLESTON BLVD,BLDG 12-14 C/O OASIS PRGRM 3416 GONI RD D-132, 2735 SILVER CREEK RD, 2735 SILVER CREEK RD, 4650 W SUNSET BLVD, 6171 W CHARLESTON BLVD BLDG 10, 24416 N 19TH AVE, 850 MILL ST STE 200, 2315 STOCKTON BLVD, 7465 W LAKE MEAD BLVD STE 121, 1200 MOUNTAIN ST, 1950 CIRCLE OF HOPE DR, 4773 CAUGHLIN PKWY STE 2, 9305 W THOMAS RD STE 460, 1950 CIRCLE OF HOPE DR, 215 W BRIDGE ST STE 5, 2315 STOCKTON BLVD, 1775 BROWNING WAY STE 203, 7040 LAREDO ST STE K, 215 BLUFFS AVE STE 200, 5412 BOULDER HWY, 3196 S MARYLAND PKWY STE 101A, 4600 KIETZKE LN STE O260, 3680 NORTH RANCHO DR, 1500 AVENUE G, 2810 W CHARLESTON BLVD STE 64, 1530 E SIXTH ST, 3700 GRANT DR, 535 S HUMBOLDT ST, 653 N TOWN CENTER DR STE 412, 3295 N FORT APACHE RD STE 110, 132 5TH AVE W STE 1, 200 WILSON CIR, 2350 S JONES BLVD, 205 S DOBSON RD STE 1, 3680 N RANCHO DR, 7495 W AZURE DR STE 232, 2347 E GALA ST, 4650 W SUNSET BLVD, 2637 W HORIZON RIDGE PKWY,STE 130 5135 CAMINO AL NORTE STE 259, 4055 SPENCER ST STE 217, 3272 E RIO VIRGIN RD, 10085 DOUBLE R BLVD STE 365, 1155 MILL ST, 1001 MOUNTAIN ST, 205 S DOBSON RD STE 1, 3650 S EASTERN AVE STE 230, 205 S DOBSON RD STE 1, 1201 W. LA VETA AVE., 1500 E 2ND ST STE 302, 1919 E THOMAS RD, 3811 E BELL RD STE 109, 98 E LAKE MEAD PKWY STE 201, 4285 N RANCHO DR STE 160,
City
RENO LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS RENO PHOENIX HENDERSON LOS ANGELES BOISE LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS MURRAY LAS VEGAS LOS ANGELES CARSON CITY SALT LAKE CITY LAS VEGAS LOS ANGELES LAS VEGAS SPARKS LAS VEGAS LAS VEGAS CARSON CITY BULLHEAD CITY BULLHEAD CITY LOS ANGELES LAS VEGAS PHOENIX RENO SACRAMENTO LAS VEGAS CARSON CITY SALT LAKE CITY RENO PHOENIX SALT LAKE CITY YERINGTON SACRAMENTO ELKO LAS VEGAS ELKO LAS VEGAS LAS VEGAS RENO LAS VEGAS ELY LAS VEGAS RENO RENO BATTLE MOUNTAIN LAS VEGAS LAS VEGAS JEROME BOULDER CITY LAS VEGAS CHANDLER LAS VEGAS LAS VEGAS MERIDIAN LOS ANGELES HENDERSON N LAS VEGAS LAS VEGAS BEAVER DAM RENO RENO CARSON CITY CHANDLER LAS VEGAS CHANDLER ORANGE RENO PHOENIX PHOENIX HENDERSON LAS VEGAS
State
Zip Code
NV
89502
NV
89109
NV
89109
NV
89169
NV
89110
NV
89109
NV
89506
AZ
85016
NV
89011
CA
90027
ID
83712
NV
89118
NV
89101
NV
89106
NV
89146
NV
89118
NV
89113
UT
84107
NV
89119
CA
90051
NV
89705
UT
84132
NV
89104
CA
90027
NV
89102
NV
89431
NV
89146
NV
89146
NV
89706
AZ
86442
AZ
86442
CA
90027
NV
89146
AZ
85085
NV
89502
CA
95817
NV
89128
NV
89703
UT
84112
NV
89519
AZ
85037
UT
84112
NV
89447
CA
95817
NV
89801
NV
89117
NV
89801
NV
89122
NV
89109
NV
89502
NV
89130
NV
89301
NV
89102
NV
89512
NV
89509
NV
89820
NV
89144
NV
89129
ID
83338
NV
89005
NV
89146
AZ
85224
NV
89130
NV
89130
ID
83642
CA
90027
NV
89052
NV
89031
NV
89119
AZ
86432
NV
89521
NV
89502
NV
89703
AZ
85224
NV
89169
AZ
85224
CA
92868
NV
89502
AZ
85016
AZ
85032
NV
89015
NV
89130
Page 2 of 487
NPI
1801092085 1316359813 1083721765 1306285234 1598097206 1811285331 1639150568 1942290382 1902056245 1073770657 1831496736 1235149410 1972512390 1689987794 1790915684 1447478458 1619219847 1124467949 1871975953 1366761751 1952713802 1457708182 1235667908 1306137153 1295025138 1659891596 1902842461 1740718535 1932635539 1508945569 1801317888 1528449642 1114066115 1306192430 1033353032 1417312315 1851401525 1538696307 1487942496 1750311957 1578009718 1275833592 1184152274 1952424004 1093736571 1720499601 1851811525 1831528538 1588656870 1043579386 1265847800 1992794929 1932560117 1346528437 1902844467 1386019958 1922338698 1043450760 1346776549 1841727526 1538108154 1821518606 1730363466 1760417950 1225569593 1497207393 1710915368 1790153146 1174054563 1336670330 1265982771 1689103608 1326578329 1376075812 1578094504 1548306582 1730477944 1942748082 1104826767 1376078196 1578004792 1447798350
Revalidation
Name
Due Date
06/29/2022
METILDI
CRISTINA
06/30/2022
DIULIO
HEATHER
06/30/2022
JAYAPRAKASH
MOODALAGIR
06/30/2022
STOKER
ROBERT E
06/30/2022
LINDFORS
HEIDI L
06/30/2022
CHILDRESS
SHERITA
06/30/2022
BRAY
TIMOTHY
06/30/2022
REMBETSKI
THOMAS E
06/30/2022
KUNKEL
DAVID C
06/30/2022
CARY
KELLY C
06/30/2022
WINFIELD
VICTORIA
06/30/2022
ALLEN
HEATHER J
06/30/2022
MICHAEL
PAUL E
07/01/2022
ATKINS
DAVID S
07/01/2022
BASSAM
SHAKIL
07/01/2022
HOLDSTOCK
BRIAN R
07/01/2022
WAHEED
MARK
07/01/2022
MCPHAIL-CIUFO
MARY M
07/01/2022
DHILLON
MANNIMRAT
07/01/2022
BETCHER
ALEKSANDRA
07/01/2022
DUBOIS
JACK P
07/01/2022
SHAHINIAN
ADENA
07/01/2022
CAO
YEN
T
07/01/2022
MALLIK
ATUL K
07/01/2022
NEUMANN
JULIE A
07/01/2022
CHOA
JACQUELINE
07/01/2022
ALLEN
EDITH P
07/01/2022
NILESHWAR
PRIYA
07/01/2022
LEUNG
BO
07/01/2022
NGUYEN
THANH
07/01/2022
ELNAGGAR
MOHAMED B
07/01/2022
ALBRIGHT
MATTHEW
07/01/2022
AMISSAH
IMMANUEL
07/02/2022
PETER L GALLARELLO DPM PLLC
07/03/2022
PETERSON
EMILY
07/03/2022
STEPHENS
SHASTA
07/03/2022
RALEYS
07/03/2022
SHIRIN RAHMAN MD
07/03/2022
ENDER ANESTHESIOLOGY PC
07/03/2022
PATTI
ROBERT W
07/03/2022
TAYLOR
KELLI A
07/03/2022
HENDERSON
NICHOLE
07/03/2022
UNLV MEDICINE
07/03/2022
NGUYEN
STEPHANIE T
07/03/2022
MCKENNA
MICHAEL J
07/03/2022
GIBB
NATHAN
07/03/2022
UNLV MEDICINE
07/05/2022
LAKE MEAD HEALTH AND REHABILITATION CENT
07/05/2022
UNIVERSITY OF UTAH HOSPITALS AND CLINICS
07/05/2022
TAMEZ
CRISTINA E
07/05/2022
KAUR
JASLEEN
07/05/2022
SMITH
PRESTON S
07/05/2022
MEKKONNEN
ENANU
07/05/2022
CROSSMAN
NICHOLAS W
07/05/2022
GROOFF
PAUL N
07/05/2022
BELL
ANTANIC
07/05/2022
PENICK
BRIDGET E
07/05/2022
CHRISTENSEN
WILLIAM B
07/05/2022
CHRISTENSEN CHIROPRACTIC PLLC
07/05/2022
JOHNSON
SOLOMON
07/05/2022
BATRA
ANIL K
07/05/2022
HEMED
ALIZA
07/05/2022
OSTMARK
KELLY
07/05/2022
BATTAGLIA
MICHAEL
07/06/2022
ALMADA
FRENCIA Y
07/06/2022
LAVERGNE
MORAGAN
07/06/2022
HYSON
MORTON I
07/06/2022
CALE
HEATHER
07/06/2022
PISIPATI
SAILAJA
07/06/2022
OGUNDIMU
OLOLADE
07/06/2022
JOHNSON
DANIEL T
07/06/2022
TING
MICHAEL
07/06/2022
RODRIGUEZ
MARINES A
07/06/2022
FARAHI
JESSICA M
07/06/2022
KOTA
SANDHYA
07/06/2022
VAN EPPS
LEE
07/06/2022
FERRIS
JESSICA
07/06/2022
BISEN
ANCHAL S
07/06/2022
PIERCE
PATRICIA
07/06/2022
CARLILE
MARANDA S
07/06/2022
RENDON
CASEY
07/06/2022
ESTRADA
JESSICA
06/2022
Nevada Medicaid Provider Revalidation Report
Provider Type
20 22 20 20 24 14 20 20 20 20 14 20 20 77 20 24 20 20 22 20 20 20 20 20 20 20 20 20 20 20 20 20 20 21 20 24 28 20 20 20 77 14 28 20 20 20 14 19 32 20 20 77 14 20 20 14 24 24 36 14 20 34 24 20 14 14 20 20 20 20 34 20 20 20 20 20 20 34 20 24 20 85
Provider Type Description
Physician, M.D., Osteopath, D.O. Dentist Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Advanced Practice Registered Nurses Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician Assistant Physician, M.D., Osteopath, D.O. Advanced Practice Registered Nurses Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Dentist Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Podiatrist Physician, M.D., Osteopath, D.O. Advanced Practice Registered Nurses Pharmacy Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician Assistant Behavioral Health Outpatient Treatment Pharmacy Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Nursing Facility Ambulance, Air or Ground Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician Assistant Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Advanced Practice Registered Nurses Advanced Practice Registered Nurses Chiropractor Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Therapy Advanced Practice Registered Nurses Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Therapy Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Therapy Physician, M.D., Osteopath, D.O. Advanced Practice Registered Nurses Physician, M.D., Osteopath, D.O. Applied Behavior Analysis (ABA)
Provider Specialty 138 078 057 057 400 305 064 157 114 400 302 131 131 977 920 023 126 126 078 400 400 400 400 072 064 400 139 400 400 060 400 400 053 821 139 023 928 122 057 064 977 300 928 139 134 060 814 184 932 139 400 977 300 064 218 302 023 023 836 302 149 028 400 057 302 301 126 400 400 400 027 400 400 400 400 060 112 027 124 023 400 314
Phone Number
Address
7022338101 7754611180 8015077000 8015012600 8014424627 7029941931 7757863040 7753240288 9184297518 3179624792 7752245940 7029523400 7029521251 2087066300 9287637722 4358438380 8015856387 9167349200 7028703811 7023884512 7757857104 7023884512 7026712345 8015817553 8015877109 7026712345 6029330777 7024776571 7026712345 6022434231 7757857104 7024476571 7024597424 7029713668 7026165870 9167349200 7756778750 7026498009 7024494284 7025587823 7027318000 7022783622 7028951316 9167349200 7023077700 2083815015 7029685051 7025658555 8012386603 4809636668 7757857104 2083817011 7029721774 7027311616 7024836000 7026465437 7023460800 4352511000 7757277959 7756881633 7027327560 7022274477 8014424267 7022553547 7027785300 7027785300 7023871757 7753275174 7753275174 7753275174 7027342732 7753275174 7753275174 7753275174 7753275174 7759828256 3236602450 7027342732 7023823200 9283475971 7753275174 7756870550
653 N TOWN CENTER DR STE 412, 3405 MARKET ST STE 102, 5121 S COTTONWOOD ST, 9660 S 1300 E, 100 N MARIO CAPECCHI DR, 3606 N RANCHO DR STE 102, 555 N ARLINGTON AVE, 6554 S MCCARRAN BLVD STE B, 200 W ARBOR DR, 250 N SHADELAND AVE, 7105 GAZIN CT, 3730 S EASTERN AVE, 9280 W SUNSET RD STE 100, 520 S EAGLE RD STE 2207, 2580 HIGHWAY 95 STE 224, 2356 N 400 E STE 202, 50 N MEDICAL DR, 2315 STOCKTON BLVD, 860 S RANCHO DR STE 4, 620 SHADOW LN, 975 KIRMAN AVE MAIL STOP 18, 620 SHADOW LN, 1701 W CHARLESTON BLVD STE 230,UNLV SCHOOL OF MEDICINE 50 N MEDICAL DR, 590 S WAKARA WAY, UNLV LAS VEGAS,SCHOOL OF MEDICINE 1919 E THOMAS RD, 620 SHADOW LN,VALLEY HOSPITAL MEDICAL CENTER 1701 W CHARLESTON BLVD STE 230, C/O HACIENDA HEALTHCARE,1402 E SOUTH MOUNTAIN AVE 975 KIRMAN AVE MAIL STOP 18, 620 SHADOW LN, 540 N NELLIS BLVD, 1703 CIVIC CENTER DR STE 3, 10001 S EASTERN AVE STE 101, 2315 STOCKTON BLVD, 1075 N HILLS BLVD STE 270, 1700 E DESERT INN RD STE 301, 1930 VILLAGE CENTER CIR,STE 3-395 301 E MIDDLETON DR, 3186 S MARYLAND PKWY, 9414 W LAKE MEAD BLVD, 4000 E CHARLESTON BLVD,STE B130 2315 STOCKTON BLVD, 6070 S FORT APACHE RD STE 100, 520 S EAGLE RD, 4000 E CHARLESTON BLVD STE 230, 1180 E LAKE MEAD PKWY, 50 N MEDICAL DR, 205 S DOBSON RD STE 1, 975 KIRMAN AVE MAIL STOP 18, 100 E IDAHO ST, 911 N BUFFALO DR UNIT 213, 2800 E DESERT INN RD STE 100, 888 W BONNEVILLE AVE, 3680 N RANCHO DR, 1301 BERTHA HOWE AVE STE 1, 1380 E MEDICAL CENTER DR, 2080 E CALVADA BLVD, 480 GALLETTI WAY, 3650 S EASTERN AVE STE 230, 366 E MESA VERDE LN, 100 N MARIO CAPECCHI DR, 9260 W SUNSET RD STE 200, 3606 N RANCHO DR STE 142, 3606 N RANCHO DR, 701 SHADOW LN STE 170, 1155 MILL ST W11, 1155 MILL ST W11, 1155 MILL ST W11, 4000 S EASTERN AVE STE 300, 1155 MILL ST W11, 1155 MILL ST W11, 1155 MILL ST W11, 1155 MILL ST W11, 6570 S MCCARRAN BLVD, 4650 W SUNSET BLVD, 4000 S EASTERN AVE STE 300, 2011 PINTO LN STE 200, 3272 E RIO VIRGIN RD, 1155 MILL ST W11, 3416 GONI RD D-132,
City
LAS VEGAS CARSON CITY MURRAY SANDY SALT LAKE CITY LAS VEGAS RENO RENO SAN DIEGO INDIANAPOLIS RENO LAS VEGAS LAS VEGAS MERIDIAN BULLHEAD CITY TOOELE SALT LAKE CITY SACRAMENTO LAS VEGAS LAS VEGAS RENO LAS VEGAS LAS VEGAS SALT LAKE CITY SALT LAKE CITY LAS VEGAS PHOENIX LAS VEGAS LAS VEGAS PHOENIX RENO LAS VEGAS LAS VEGAS NORTH LAS VEGAS HENDERSON SACRAMENTO RENO LAS VEGAS LAS VEGAS HENDERSON LAS VEGAS LAS VEGAS LAS VEGAS SACRAMENTO LAS VEGAS MERIDIAN LAS VEGAS HENDERSON SALT LAKE CITY CHANDLER RENO BOISE LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS MESQUITE SAINT GEORGE PAHRUMP SPARKS LAS VEGAS LAS VEGAS SALT LAKE CITY LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS RENO RENO RENO LAS VEGAS RENO RENO RENO RENO RENO LOS ANGELES LAS VEGAS LAS VEGAS BEAVER DAM RENO CARSON CITY
State
Zip Code
NV
89144
NV
89706
UT
84107
UT
84094
UT
84113
NV
89130
NV
89503
NV
89509
CA
92103
IN
46219
NV
89506
NV
89169
NV
89148
ID
83642
AZ
86442
UT
84074
UT
84132
CA
95817
NV
89106
NV
89106
NV
89502
NV
89106
NV
89102
UT
84132
UT
84108
NV
89102
AZ
85016
NV
89106
NV
89102
AZ
85042
NV
89502
NV
89106
NV
89110
NV
89030
NV
89052
CA
95817
NV
89506
NV
89169
NV
89134
NV
89015
NV
89109
NV
89134
NV
89104
CA
95817
NV
89148
ID
83642
NV
89104
NV
89015
UT
84132
AZ
85224
NV
89502
ID
83712
NV
89128
NV
89121
NV
89106
NV
89130
NV
89027
UT
84790
NV
89048
NV
89431
NV
89169
NV
89123
UT
84113
NV
89148
NV
89130
NV
89130
NV
89106
NV
89502
NV
89502
NV
89502
NV
89119
NV
89502
NV
89502
NV
89502
NV
89502
NV
89509
CA
90027
NV
89119
NV
89106
AZ
86432
NV
89502
NV
89706
Page 3 of 487
NPI
1336318583 1417305624 1679007801 1821405010 1427502715 1578004073 1740546480 1205156056 1891893939 1669837019 1821187279 1427578152 1801084678 1891714507 1851811525 1659380772 1417485657 1215466511 1639434053 1184777120 1366963548 1881996361 1902059934 1982779591 1922478171 1972896272 1437684131 1326056573 1750519732 1912279928 1861940942 1427255959 1194986109 1326331133 1255690038 1518401520 1669887790 1184815011 1760777882 1295265692 1689103269 1891222618 1316474133 1427080175 1750481198 1861929952 1669530242 1518340322 1285851386 1588195424 1588191936 1215464037 1922098896 1013374800 1083134845 1861921256 1700313160 1023490059 1841348224 1912343658 1619266467 1316395569 1649709072 1104236215 1508394123 1972036317 1760699912 1245771476 1841644747 1497280036 1831289461 1225140312 1053770586 1467544122 1801152566 1487947966 1366973430 1053771824 1548502701 1750815874 1467988824 1801152566
Revalidation
Name
Due Date
07/06/2022
LETKO
VALERIE
07/06/2022
AKELLA
PYDI
07/06/2022
NAKAMURA
RYAN
07/06/2022
FALL
ALIOUNE
07/07/2022
LAS VEGAS PHYSICAL THERAPY & SPORTS PLLC
07/07/2022
CAVIN
LISA
07/07/2022
DIXON
ZAMORA
07/07/2022
CHRISTENSEN
CODY
07/07/2022
DONATELLI
ROBERT A
07/07/2022
LAW
MICHELLE
07/07/2022
TON
DUONG D
07/07/2022
JONES
ADRIANNA
07/07/2022
CORDOVA
CHARLES JR
07/07/2022
PAYNE
SHERRI
07/07/2022
UNLV MEDICINE
07/08/2022
CAREMED PHARMACEUTICAL SERVICES
07/08/2022
MCNERNEY
PATRICK
07/10/2022
TANG
GALA
07/10/2022
SENDA
JONATHAN
07/10/2022
JONES
STEPHANIE A
07/10/2022
THOMAS
ASHARI
07/10/2022
GREEN
LINDA
07/10/2022
NICHOLAS
COURTNEY J
07/10/2022
CRAIG
WILLIAM W
07/10/2022
HISAKA
RYAN
07/10/2022
ZWAYNE
NOOR H
07/10/2022
BROWN
SHANICE
07/10/2022
NAINANI
STEPHANIE
07/10/2022
MOGAL
SUVARNA A
07/11/2022
GABLER
CHRISTOPHER R
07/11/2022
LANIER
JACQUESHA
07/11/2022
HANOWELL
JONATHAN
07/11/2022
HUANG
NELSON
07/11/2022
HARRISON
JONATHAN H
07/11/2022
STEPNEY
EVELYN
07/11/2022
HERNANDEZ
EVONNE E
07/11/2022
BARQADLE
FATUMA
07/11/2022
MAHIEU
NATALIE A
07/11/2022
COX
MONIQUE
07/11/2022
LAROCA
VALERIE
07/12/2022
OCHOA
HECTOR
07/12/2022
VILLANO
SVETLANA
07/12/2022
EUDY
ADAM
07/12/2022
ROSS
JAMIE L
07/12/2022
WARM SPRINGS ROAD CVS, L.L.C.
07/12/2022
GROSHNER
MICHAEL
07/12/2022
BAHOORA
KEVEN
07/12/2022
PROSHKINA
ELENA
07/12/2022
HUNTRIDGE DRUG
07/12/2022
AL-KHAYYAT
MOHAMMED
07/12/2022
MCDONALD
AMBER
07/12/2022
GOHAR
HAMZA
07/12/2022
BECKER
STEVEN E
07/12/2022
JAISWAL
ARPANA
07/12/2022
DR SCOTT WILSON DDS
07/12/2022
TASHEEN
SIDRA
07/12/2022
TRAN
PHUC
07/12/2022
ATTRI
PRIYANKA
07/12/2022
WIESEN
KIMBERLY A
07/12/2022
HARDWICK
JOHN R
07/12/2022
SCIASCIA
ANTHONY M
07/12/2022
ORTEZA
OLIVIA
07/12/2022
RUMKER
SARA
07/12/2022
CRUZ
RICARDO
07/12/2022
HARASYM
CHRIS
07/12/2022
KHAN
ANAM A
07/12/2022
PERUMBETI
AJAY
07/12/2022
AL-MASHHADANI
ARSHAD
07/12/2022
ULANJA
MARK B
07/13/2022
PATIL
POOJA
07/13/2022
STOESSER
KIRSTEN L
07/13/2022
PERRIN
RICHARD G
07/13/2022
A NOVO CARE LLC
07/13/2022
BRADFORD
AMANDA B
07/13/2022
SAINT MARYS REGIONAL MEDICAL CENTER
07/13/2022
BHARUCHA
NEIL J
07/13/2022
PETTY
KATE
07/13/2022
AHRENDT
LAUREN
07/13/2022
RUSSI
DANIELA C
07/13/2022
BELA
JOHN
07/13/2022
HUGDAL
STEPHEN
07/13/2022
SAINT MARYS REGIONAL MEDICAL CENTER
06/2022
Nevada Medicaid Provider Revalidation Report
Provider Type
77 20 14 14 34 77 14 20 34 24 22 14 22 77 85 28 20 14 14 20 14 14 20 20 14 20 14 20 20 77 14 20 20 20 14 14 20 20 14 14 14 20 20 20 33 20 36 20 28 20 20 20 20 20 22 20 20 20 34 20 20 20 14 20 20 20 20 20 20 20 20 20 48 77 11 20 20 34 20 14 20 10
Provider Type Description
Physician Assistant Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Behavioral Health Outpatient Treatment Therapy Physician Assistant Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Therapy Advanced Practice Registered Nurses Dentist Behavioral Health Outpatient Treatment Dentist Physician Assistant Applied Behavior Analysis (ABA) Pharmacy Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician Assistant Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Behavioral Health Outpatient Treatment Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. DME, Disposable, Prosthetics Physician, M.D., Osteopath, D.O. Chiropractor Physician, M.D., Osteopath, D.O. Pharmacy Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Dentist Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Therapy Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Waiver for the Frail Elderly Physician Assistant Hospital, Inpatient Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Therapy Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Outpatient Surgery, Hospital Based
Provider Specialty 977 400 301 302 027 977 301 072 027 023 078 301 078 977 885 928 400 301 305 138 301 302 067 139 301 117 301 062 139 977 301 111 111 072 301 301 139 218 306 300 301 400 400 125 933 400 936 400 928 400 400 400 133 400 079 400 400 400 027 111 111 400 301 053 400 400 066 400 400 400 053 061 039 977 911 064 400 027 059 301 400 910
Phone Number
Address
7759977300 7753275174 7756772216 7023191555 7025862177 7759822808 7022220034 8012256246 7025862177 7757703327 7758821111 7028151550 7753295437 3376092122 7029989505 8772273405 7753275174 7024333038 7026465437 7022502500 7026465437 7026465437 3236602450 7028624636 7755621115 6029332728 7027715578 7758677740 4809636668 7029523400 7026122208 2088149500 7026164600 7027598600 7029920576 7028481696 3236602450 3233616927 7023241541 7028065268 7027540807 7024776571 7023884512 9167349200 7026492625 7024776571 7023960277 7753275174 7023827373 7753275174 7024776571 7024776571 7023823221 7753275174 7022887200 7024776571 7024776571 7024776571 7027682928 7759824182 7759824182 7024776571 7756772216 7028775199 7023884512 7753275174 3236602450 7753275174 7753275174 7026712385 8012138841 7753232080 7028710002 7028780393 7757703000 7757863040 7026712385 7028707050 6029330895 7029989667 7753275174 7757703000
2244 ODDIE BLVD, 1155 MILL ST W11, 4773 CAUGHLIN PKWY STE 2, 5426 VEGAS DR, 7229 W SAHARA AVE STE 105, 1500 E 2ND ST STE 300, 8720 SPANISH RIDGE AVE, 560 W 800 N, 7229 W SAHARA AVE STE 105, 18653 WEDGE PKWY, 314 W FIFTH ST, 1901 S JONES BLVD, 3362 S MCCARRAN BLVD, 2735 SILVER CREEK RD, 630 S RANCHO DR STE A, 1981 MARCUS AVE STE 225, 1155 MILL ST W11, 98 E LAKE MEAD PKWY STE 302, 3680 N RANCHO DR, 3121 S MARYLAND PKWY STE 400, 3680 N RANCHO DR, 3680 N RANCHO DR, 4650 W SUNSET BLVD, 3201 S MARYLAND PKWY STE 624, 850 MILL ST STE 200, 1919 E THOMAS RD,AMBULATORY BLDG 801 S RANCHO DR STE E 2B, 801 E WILLIAMS AVE, 205 S DOBSON RD STE 1, 3730 S EASTERN AVE, 2405 PARASAIL POINT AVE, 801 POLE LINE RD W, 102 E LAKE MEAD PKWY, 2020 PALOMINO LN STE 100, 3155 E PATRICK LN STE 1, 4525 S SANDHILL RD STE 106, 4650 W SUNSET BLVD, 4650 W SUNSET BLVD, 2680 CHANDLER AVE STE 2, 5426 VEGAS DR, 8685 S EASTERN AVE, 620 SHADOW LN, 620 SHADOW LN, 2315 STOCKTON BLVD, 5545 CAMINO AL NORTE, 620 SHADOW LN,VALLEY HOSPITAL MEDICAL CENTER 7035 WEST ANN RD STE 160, 1155 MILL ST W11, 1144 E CHARLESTON BLVD, 155 MILL ST W11, 620 SHADOW LN,VALLEY HOSPITAL MEDICAL CENTER 620 SHADOW LN,VALLEY HOSPITAL MEDICAL CENTER 700 SHADOW LN STE 235, 155 MILL ST W11, 6386 W SAHARA AVE STE 6388, 620 SHADOW LN, 620 SHADOW LN, 620 SHADOW LN,VALLEY HOSPITAL MEDICAL CENTER 1636 PALMALES CT, 1155 MILL ST, 1155 MILL ST, 620 SHADOW LN, 4773 CAUGHLIN PKWY STE 2, 2845 SIENA HEIGHTS DR, 620 SHADOW LN,VALLEY HOSPITAL MEDICAL CENTER 155 MILL ST W11, 4650 W SUNSET BLVD, 1155 MILL ST W11, 1155 MILL ST W11, 1707 W CHARLESTON BLVD, STE 12,DEPARTMENT OF OBGYN 1525 W 2100 S, 5590 KIETZKE LN, 6431 W SAHARA AVE STE 200, 7455 W WASHINGTON AVE STE 160, 235 W 6TH ST, 555 N ARLINGTON AVE, 1707 W CHARLESTON BLVD STE 120,DEPARTMENT OF OB/GYN 7281 W CHARLESTON BLVD, 1919 E THOMAS RD RD MAIN BLDG, 1500 E TROPICANA AVE STE 238, 1155 MILL ST W11, 235 W 6TH ST,
City
SPARKS RENO RENO LAS VEGAS LAS VEGAS RENO LAS VEGAS OREM LAS VEGAS RENO CARSON CITY LAS VEGAS RENO BULLHEAD CITY LAS VEGAS NEW HYDE PARK RENO HENDERSON LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LOS ANGELES LAS VEGAS RENO PHOENIX LAS VEGAS FALLON CHANDLER LAS VEGAS NORTH LAS VEGAS TWIN FALLS HENDERSON LAS VEGAS LAS VEGAS LAS VEGAS LOS ANGELES LOS ANGELES LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS SACRAMENTO NORTH LAS VEGAS LAS VEGAS LAS VEGAS RENO LAS VEGAS RENO LAS VEGAS LAS VEGAS LAS VEGAS RENO LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS RENO RENO LAS VEGAS RENO HENDERSON LAS VEGAS RENO LOS ANGELES RENO RENO LAS VEGAS SALT LAKE CITY RENO LAS VEGAS LAS VEGAS RENO RENO LAS VEGAS LAS VEGAS PHOENIX LAS VEGAS RENO RENO
State
Zip Code
NV
89431
NV
89502
NV
89519
NV
89108
NV
89117
NV
89502
NV
89148
UT
84057
NV
89117
NV
89511
NV
89703
NV
89146
NV
89502
AZ
86442
NV
89106
NY
11042
NV
89502
NV
89015
NV
89130
NV
89109
NV
89130
NV
89130
CA
90027
NV
89109
NV
89502
AZ
85016
NV
89106
NV
89406
AZ
85224
NV
89169
NV
89031
ID
83301
NV
89015
NV
89106
NV
89120
NV
89121
CA
90027
CA
90027
NV
89120
NV
89108
NV
89123
NV
89106
NV
89106
CA
95817
NV
89031
NV
89106
NV
89130
NV
89502
NV
89104
NV
89502
NV
89106
NV
89106
NV
89106
NV
89502
NV
89146
NV
89106
NV
89106
NV
89106
NV
89128
NV
89502
NV
89502
NV
89106
NV
89519
NV
89052
NV
89106
NV
89502
CA
90027
NV
89502
NV
89502
NV
89102
UT
84119
NV
89511
NV
89146
NV
89128
NV
89503
NV
89503
NV
89102
NV
89117
AZ
85016
NV
89119
NV
89502
NV
89503
Page 4 of 487
NPI
1558894030 1104964204 1447664859 1396004461 1366739609 1801152566 1255760427 1740510528 1427598267 1558881490 1568760213 1770998478 1265953624 1013113026 1629418280 1831200641 1114451713 1851749089 1346772597 1518975127 1336674969 1689934812 1467973834 1215465026 1912362245 1912117359 1417483769 1639181506 1619982675 1851308738 1194773010 1437423670 1598935702 1295957645 1629125042 1841402625 1366728636 1609821180 1972037091 1326008905 1568877397 1043474158 1871700823 1568984888 1518362664 1215039045 1114016938 1184696189 1942686449 1801839956 1538255500 1184774150 1013357102 1558576157 1528589579 1740625946 1245643642 1346414562 1164465324 1720508286 1265476519 1356780076 1053831966 1093158487 1699813865 1518487594 1942627922 1922414895 1558890954 1578003190 1902154909 1336460278 1497143788 1902337462 1255496014 1720408891 1437576584 1316982028 1013437474 1437251220 1245210400 1457664005
Revalidation
Name
Due Date
07/13/2022
FRANCO
RICARDO H
07/13/2022
NORRIS
WENDI M
07/13/2022
LANE
MICHAEL L
07/13/2022
PERKINS
SAUNDRA L
07/13/2022
MONGEON
SHEILA A
07/13/2022
SAINT MARYS REGIONAL MEDICAL CENTER
07/13/2022
HELMS
SARAH
07/13/2022
MILLER
STACY L
07/14/2022
ABEYTA
JOSETTE M
07/14/2022
SANCHEZ
RACHELLE A
07/14/2022
STROPE
SUSAN
07/14/2022
PANICCO
JORDAN R
07/14/2022
STREUBER
GABRIELLE C
07/14/2022
SONG
YOUNG
07/14/2022
FEUERBORN
ETHAN T
07/14/2022
OLSEN
PHILLIP G
07/14/2022
COMMUNITY HEALTH ALLIANCE
07/14/2022
JACOVETTY
ERICA
07/14/2022
LIU
ANGELA H
07/14/2022
ORGAIN
NICOLE G
07/14/2022
BRAR
BOBBY K
07/14/2022
FISHER
CLAYTON
07/14/2022
HADDOCK
JENNA
07/15/2022
COMPLETE CARE OBGYN
07/15/2022
BACK IN STEP
07/15/2022
WILLCOURT
ROBIN J
07/15/2022
NINETE
CRYSTAL L
07/15/2022
SAFEWAY INC
07/15/2022
WALGREENS 04137
07/15/2022
WALGREENS #05015
07/15/2022
MITA
SHAH M
07/16/2022
COMMUNITY A WALGREENS PHARMACY 15312
07/16/2022
ADVANCED PROSTHETICS AND ORTHOTICS
07/17/2022
RENO FAMILY EYE CARE R ANDREW BOREN OD
07/17/2022
TRZEBINSKA
DANUTA
07/17/2022
KIERNAN
JAMES
07/17/2022
TORGERSEN
MICHELLE
07/17/2022
MAZZORANA
VICKI
07/17/2022
MVP BEHAVIORAL HEALTH SERVICES LLC
07/17/2022
SOBREDO
SERGIO A JR
07/17/2022
PETERSON
JENNIFER
07/17/2022
KELLEY DUNAY DMD PC
07/17/2022
DE JONG
ANN
07/17/2022
FERRAND
VERLISHA A
07/17/2022
MEARSE
JACOB
07/17/2022
NOORI
SHAHAB
07/17/2022
TRADUP
NICOLE A
07/17/2022
WETMORE
CYNTHIA J
07/18/2022
REID
DAVID G
07/18/2022
ODONNELL
JOHN N
07/18/2022
ERICKSON
JOHN
07/18/2022
MOLONEY
AMANDA
07/18/2022
KUO
TIM
S
07/18/2022
CHIN
BRIAN M
07/18/2022
BURT
REBECCA
07/18/2022
BRIA
CARLEY A
07/18/2022
JOYNER
JAMES R
07/18/2022
AKHAVAN-HEIDARI
MEHDI
07/18/2022
PALOSAARI
DAVID
07/18/2022
OSAYAREN
ESEOSA
07/18/2022
NEVADA CVS PHARMACY, L.L.C.
07/18/2022
SMITH
CHRISTOPHE B
07/18/2022
CROTEAU
JENNIFER
07/18/2022
HASSMAN
LYNN
07/18/2022
BETANCOURT
DAMIAN
07/18/2022
DILLIE-GOODRICH
CHERYL L
07/18/2022
PRINCE
VICTORIA L
07/18/2022
CHAN
MARBELO
07/18/2022
SERRATO
JEANETTE
07/18/2022
MCFARLAND-BINGHAM DE KESHA M
07/18/2022
CALBAY
ALDY
07/19/2022
SHAFER
SAULENA S
07/19/2022
SILLITOE
JOSHUA S
07/19/2022
ROGERS
STEPHANIE L
07/19/2022
SAFKO
MARTIN J
07/19/2022
ALFECHE
ROBYN L
07/19/2022
PRASCH
ANDREA E
07/19/2022
ANDRUS
KYLE D
07/19/2022
DAVIS
JANIA N
07/19/2022
SCHROEDER
LAURA F
07/19/2022
WELLS
BRITTON
07/19/2022
RADHAKRISHNAN
SABARINATH V
06/2022
Nevada Medicaid Provider Revalidation Report
Provider Type
20 20 20 14 34 12 14 26 24 34 34 21 85 20 20 20 17 20 20 77 20 22 34 20 33 20 14 33 33 33 20 33 33 25 20 14 23 20 14 20 20 22 20 14 24 20 25 20 14 20 20 77 20 20 24 20 20 20 20 85 33 20 14 20 22 14 20 14 14 14 14 20 14 20 20 20 20 25 24 14 20 20
Provider Type Description
Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Therapy Hospital, Outpatient Behavioral Health Outpatient Treatment Psychologist Advanced Practice Registered Nurses Therapy Therapy Podiatrist Applied Behavior Analysis (ABA) Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Special Clinics Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician Assistant Physician, M.D., Osteopath, D.O. Dentist Therapy Physician, M.D., Osteopath, D.O. DME, Disposable, Prosthetics Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment DME, Disposable, Prosthetics DME, Disposable, Prosthetics DME, Disposable, Prosthetics Physician, M.D., Osteopath, D.O. DME, Disposable, Prosthetics DME, Disposable, Prosthetics Optometrist Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Hearing Aid Dispenser and Related Supplies Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Dentist Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Advanced Practice Registered Nurses Physician, M.D., Osteopath, D.O. Optometrist Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician Assistant Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Advanced Practice Registered Nurses Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Applied Behavior Analysis (ABA) DME, Disposable, Prosthetics Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Dentist Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Behavioral Health Outpatient Treatment Behavioral Health Outpatient Treatment Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Optometrist Advanced Practice Registered Nurses Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O.
Provider Specialty 400 149 060 300 027 912 400 162 023 028 028 921 314 072 060 053 181 400 400 977 400 922 028 062 933 053 302 933 933 933 125 933 933 825 125 400 400 111 814 053 059 822 053 301 023 067 400 142 300 066 117 977 111 072 023 111 053 074 066 314 933 063 300 063 078 300 060 302 301 300 302 126 300 400 059 139 139 925 023 300 064 120
Phone Number
Address
7753275174 2083233767 8014424267 7028233910 8014424267 7757703000 7024868900 7757572415 4809636668 7023601137 7022274477 7027311616 7025476971 7608735811 2083815015 7024762800 7753242599 7026712385 7026712385 8015850100 7026712385 7753296300 7022274477 7026885570 7142874827 7756352424 7022917121 7755861088 7022338935 7029149797 9184297518 7024717828 7757512030 7757879137 9184297518 7752658622 6122623851 8504377731 7029485011 8504377731 7023602100 7753584600 7027019509 7025785720 7022917121 3233612450 7752658622 6029330920 7755251616 7753343450 7753296241 8012138841 7026164600 8015817553 8012138841 7027318000 8012138841 7253338465 7753343450 7022703219 7026581229 8015812352 7026296982 8015812352 7023072273 7025389474 8012138841 7024333038 7026465437 7026052766 7026465437 8015856387 7022518000 7757841533 7027310933 6029330777 2088841030 7757386727 6029330990 7022940433 2087062663 8015853229
1155 MILL ST W11, 2347 E GALA ST, 5121 S COTTONWOOD ST, 3017 W CHARLESTON BLVD STE 70, 1380 E MEDICAL CENTER DR, 235 W 6TH ST, 2655 ENTERPRISE RD, 1623 HOSPITAL LOOP, 205 S DOBSON RD STE 1, 2012 S JONES BLVD, 366 E MESA VERDE LN, 2800 E DESERT INN RD STE 100, 731 MALL RING CIR STE 215, 150 PIONEER LN, 190 E BANNOCK ST, 10652 S EASTERN AVE STE A, 335 RECORD ST STE 254, 1707 W CHARLESTON BLVD STE 120, 1707 W CHARLESTON BLVD STE 120, 1950 CIRCLE OF HOPE DR, 1707 W CHARLESTON BLVD STE 120, 1055 S WELLS AVE, 366 E MESA VERDE LN, 1528 W WARM SPRINGS RD STE 100, 2820 W CHARLESTON BLVD STE 32, 535 S HUMBOLDT ST, 5412 BOULDER HWY, 212 ELKS POINT RD, 9415 W DESERT INN, 9305 S EASTERN AVE, 200 W ARBOR DR, 901 S RANCHO DR STE 20, 2281 POSTAL DR STE 5, 6360 MAE ANNE AVE STE 1, 200 W ARBOR DR, 1559 WATASHEAMU, 2925 CHICAGO AVE ROUTE 10202, 360 S LOLA LN, 2595 S CIMARRON RD STE 200, 360 S LOLA LN, 2650 N TENAYA WAY STE 208, 685 E PRATER WAY STE 103, 4075 S DURANGO DR STE 108, 1833 LUNA ALEGRE ST, 5412 BOULDER HWY, 4650 W SUNSET BLVD, 1559 WATASHEAMU, 1919 E THOMAS RD,AMBULATORY BLDG 418 CHENEY ST, 475 KIRMAN AVE, 645 N ARLINGTON AVE STE 400, 1525 W 2100 S, 102 E LAKE MEAD PKWY, 50 N MEDICAL DR, 1525 W 2100 S, 3186 S MARYLAND PKWY, 1525 W 2100 S, 5380 S RAINBOW BLVD STE 110, 475 KIRMAN AVE, 2110 E FLAMINGO RD STE 150, 8320 W CHEYENNE AVE, 100 N MARIO CAPECCHI DR, 6655 W SAHARA AVE STE B200, 100 N MARIO CAPECCHI DR, 5001 E BONANZA RD STE 160, 1140 ALMOND TREE LN STE 306, 1525 W 2100 S, 3737 PECOS MCLEOD STE 103, 3680 N RANCHO DR, 2501 N GREEN VALLEY PKWY,BLDG DSTE 116-EMPOWERMENT CTR 3680 N RANCHO DR, 50 N MEDICAL DR, 3041 W HORIZON RIDGE PKWY,STE 104A 1664 N VIRGINIA ST BRIGHAM BLD, 2110 E FLAMINGO RD STE 100, 1919 E THOMAS RD, 1620 S CELEBRATION AVE, 1657 MOUNTAIN CITY HWY STE 101, 1919 E THOMAS RD, 2360 W HORIZON RIDGE PKWY,STE 120 600 N ROBBINS RD STE 10, 1950 CIRCLE OF HOPE DR,
City
RENO MERIDIAN MURRAY LAS VEGAS SAINT GEORGE RENO RENO OWYHEE CHANDLER LAS VEGAS LAS VEGAS LAS VEGAS HENDERSON BISHOP BOISE HENDERSON RENO LAS VEGAS LAS VEGAS SALT LAKE CITY LAS VEGAS RENO LAS VEGAS HENDERSON LAS VEGAS BATTLE MOUNTAIN LAS VEGAS ZEPHYR COVE LAS VEGAS LAS VEGAS SAN DIEGO LAS VEGAS PAHRUMP RENO SAN DIEGO GARDNERVILLE MINNEAPOLIS PAHRUMP LAS VEGAS PAHRUMP LAS VEGAS SPARKS LAS VEGAS LAS VEGAS LAS VEGAS LOS ANGELES GARDNERVILLE PHOENIX RENO RENO RENO SALT LAKE CITY HENDERSON SALT LAKE CITY SALT LAKE CITY LAS VEGAS SALT LAKE CITY LAS VEGAS RENO LAS VEGAS LAS VEGAS SALT LAKE CITY LAS VEGAS SALT LAKE CITY LAS VEGAS LAS VEGAS SALT LAKE CITY LAS VEGAS LAS VEGAS HENDERSON LAS VEGAS SALT LAKE CITY HENDERSON RENO LAS VEGAS PHOENIX MERIDIAN ELKO PHOENIX HENDERSON BOISE SALT LAKE CITY
State
Zip Code
NV
89502
ID
83642
UT
84107
NV
89102
UT
84790
NV
89503
NV
89512
NV
89832
AZ
85224
NV
89146
NV
89123
NV
89121
NV
89014
CA
93514
ID
83712
NV
89052
NV
89512
NV
89102
NV
89102
UT
84112
NV
89102
NV
89502
NV
89123
NV
89014
NV
89102
NV
89820
NV
89122
NV
89448
NV
89117
NV
89123
CA
92103
NV
89106
NV
89048
NV
89523
CA
92103
NV
89460
MN
55407
NV
89048
NV
89117
NV
89048
NV
89128
NV
89431
NV
89147
NV
89115
NV
89122
CA
90027
NV
89460
AZ
85016
NV
89502
NV
89502
NV
89503
UT
84119
NV
89015
UT
84132
UT
84119
NV
89109
UT
84119
NV
89118
NV
89502
NV
89119
NV
89129
UT
84113
NV
89146
UT
84113
NV
89110
NV
89104
UT
84119
NV
89121
NV
89130
NV
89014
NV
89130
UT
84132
NV
89052
NV
89557
NV
89119
AZ
85016
ID
83642
NV
89801
AZ
85016
NV
89052
ID
83702
UT
84112
Page 5 of 487
NPI
1437488251 1790005353 1891114666 1801189691 1508908591 1184989519 1942684808 1942402870 1013301514 1558377309 1164764742 1841731155 1255871604 1881932721 1356301675 1467741975 1760702229 1427314186 1386936649 1700223146 1215242086 1700186517 1417305442 1184169807 1851721013 1447791876 1417217738 1063683209 1225550577 1437440492 1174823132 1427432012 1457766222 1619405966 1780090571 1205254828 1134562903 1376592477 1083087944 1275629255 1548579147 1679870745 1477979821 1760578991 1568697886 1972864510 1356885842 1407304926 1982952529 1851826580 1598926503 1043677610 1508129248 1265870877 1881138865 1073049235 1033386016 1508270265 1851387500 1396006417 1851822969 1366963076 1861682494 1578663910 1487754826 1023118460 1669572004 1871588400 1871014688 1568561876 1346688371 1659663466 1528134319 1972032233 1932209376 1477533867 1982680765 1457748725 1013259431 1235650037 1992227524 1063877983
Revalidation
Name
Due Date
07/19/2022
HAMILTON
TIMOTHY
07/19/2022
BENT
MELISSA
07/19/2022
KING
JONATHAN R
07/19/2022
WILSON
ROCHELLE
07/19/2022
SHRINERS HOSPITALS FOR CHILDREN
07/19/2022
REYES
EDITH
07/19/2022
UY
KATHLEEN
07/20/2022
RIDEOUT
BENJAMIN A
07/20/2022
SCHEIDECKER
JESSE
07/20/2022
BLATTER
GRANT L
07/20/2022
KAISER
JENNIFER E
07/20/2022
RENO
ADAM
07/20/2022
JACOBS
JASMINE
07/20/2022
NEVADA EM-I SILVER-HOMANSKY MEDICAL SERV
07/20/2022
FERRARO
PATRICIA
07/20/2022
BREWER
ZACHARY
07/20/2022
SAVAGE
JOHANNA M
07/20/2022
BANNER HEALTH PHYSICIANS WEST LLC
07/20/2022
GRASU
BEATRICE L
07/20/2022
FIERRO-FINE
GABRIEL
07/20/2022
RUSH
AUBREY B
07/20/2022
SMITH
ERIN
07/20/2022
ASBURY
KYLA
07/20/2022
PREFERRED HOMECARE INFUSION
07/20/2022
WIESE
TODD M
07/20/2022
MAGNUSON
MARJA-LIIS
07/20/2022
PICHEL
ANNA
07/20/2022
KLATT
JOSHUA W
07/20/2022
MILES
LEEANNA
07/20/2022
MARASHI
KEYAN B
07/21/2022
WOODLIFF
TRICIA
07/21/2022
VISTA ADULT CARE
07/21/2022
MITCHELL
CANDIS
07/21/2022
JOHNSON
KATHRYN
07/21/2022
DETIERRA
CAROLYN
07/21/2022
OKELBERRY
ERIC
07/21/2022
ANDERSON
MARK W
07/21/2022
WILLOUGHBY
WALTER J JR
07/21/2022
BROADHEAD
CASSIE
07/21/2022
EDNEY
SALLY W
07/21/2022
SIVERTSEN
ERIK
07/21/2022
CORDELL
ANDREA
07/21/2022
BELTRAMO
FERNANDO
07/21/2022
CRAYCROFT
MARIAH D
07/21/2022
CHANG
SHIRONG
07/21/2022
CHIANG
MICHAEL
07/21/2022
CRUZ
ARLENE H
07/21/2022
DAVID
CHRISTINA
07/21/2022
FIGUEROA
APRIL M
07/21/2022
SPEVAK
HAILEY J
07/21/2022
LINDEN
ALLISON
07/21/2022
MCDONALD
AARON T
07/21/2022
BAIRD
JOANN M
07/21/2022
SCHOENFELD
CHALISE C
07/21/2022
CHURCH
CODY
07/21/2022
VANDENBELD
KLAAS H
07/21/2022
FOULKS
MATTHEW N
07/22/2022
MURPHY
AMANDA M
07/22/2022
GUPTE
MANJUSHA A
07/22/2022
HODGES
KIMBERLY
07/22/2022
HOSOTANI
HANNAH
07/22/2022
LIZARDO
YOLANDA
07/22/2022
DOSS
CHRIS A
07/22/2022
WARM SPRINGS ROAD CVS, L.L.C.
07/23/2022
WARM SPRINGS ROAD CVS, L.L.C.
07/23/2022
WARM SPRINGS ROAD CVS, L.L.C.
07/23/2022
WARM SPRINGS ROAD CVS, L.L.C.
07/24/2022
WHITESIDE
JAMES
07/24/2022
ROBERTSON
THOMAS
07/24/2022
WARM SPRINGS ROAD CVS, L.L.C.
07/24/2022
BENARON
DAVID J
07/24/2022
DICKSON
MATTHEW C
07/24/2022
EDMISTON
RICHARD
07/24/2022
SANCHEZ
MARILAN
07/24/2022
WARM SPRINGS ROAD CVS, L.L.C.
07/24/2022
DOWNEY
WILLIAM L JR
07/24/2022
GRAY
JOHN F
07/24/2022
FUTURE FOUNDATION SERVICES LLC
07/24/2022
INGALSBE
GRAHAM S
07/24/2022
ROBERTSON
COURTNEY
07/24/2022
CHEE
VERNA
07/24/2022
RUEHL
LISA
06/2022
Nevada Medicaid Provider Revalidation Report
Provider Type
14 20 20 20 11 14 22 20 34 34 20 20 24 24 21 20 20 20 20 20 24 14 34 28 72 20 14 20 14 20 14 57 14 76 14 20 14 20 77 24 77 24 20 34 20 20 14 34 24 24 20 34 14 34 34 24 34 20 20 82 20 14 14 33 33 33 33 20 14 33 20 20 20 14 33 20 20 20 20 14 14 14
Provider Type Description
Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Hospital, Inpatient Behavioral Health Outpatient Treatment Dentist Physician, M.D., Osteopath, D.O. Therapy Therapy Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Advanced Practice Registered Nurses Advanced Practice Registered Nurses Podiatrist Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Advanced Practice Registered Nurses Behavioral Health Outpatient Treatment Therapy Pharmacy Nurse Anesthetist Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Waiver for Adult Group Care Behavioral Health Outpatient Treatment Audiologist Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician Assistant Advanced Practice Registered Nurses Physician Assistant Advanced Practice Registered Nurses Physician, M.D., Osteopath, D.O. Therapy Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Therapy Advanced Practice Registered Nurses Advanced Practice Registered Nurses Physician, M.D., Osteopath, D.O. Therapy Behavioral Health Outpatient Treatment Therapy Therapy Advanced Practice Registered Nurses Therapy Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Rehabilitative Treatment Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Behavioral Health Outpatient Treatment DME, Disposable, Prosthetics DME, Disposable, Prosthetics DME, Disposable, Prosthetics DME, Disposable, Prosthetics Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment DME, Disposable, Prosthetics Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment DME, Disposable, Prosthetics Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Behavioral Health Outpatient Treatment Behavioral Health Outpatient Treatment
Provider Specialty 300 139 060 112 911 301 922 057 027 027 062 400 023 023 400 107 066 053 064 057 023 300 027 928 972 400 302 064 302 072 307 957 300 976 400 111 306 149 977 023 977 023 109 027 138 218 301 027 023 023 073 027 300 400 027 023 400 111 060 302 400 301 300 933 933 933 933 126 302 933 111 218 218 302 933 139 114 062 111 302 302 300
Phone Number
7028065268 3236602450 2088148600 6029330935 2133883151 7024867865 7029982237 8015077000 7024594900 4359864133 8012132995 7757841533 7029620000 7757517500 7752658621 7757864200 8015812507 4806845062 8015877109 8015816369 2083812711 7027540807 7026559456 7022148899 8015816393 7757841533 7024326463 8015877109 7027582992 8015817553 7752006677 7753383886 7023314874 8015817514 7752658621 8014424267 7025410061 7029981400 4358433859 7758701000 8015815311 7757374707 3236602450 7029403000 7022502500 3236602450 7024108400 7022021280 2083450715 2088144100 3236602450 7026559456 7756367767 8012386603 7027984778 2083853510 8012386603 7759824182 2083815015 7752245940 7029926875 7022488866 7027637443 4017709978 7026420641 7027320653 7026317098 2083817335 7023855331 7022700163 7759824182 7027326000 7753564904 7026565683 7027340258 7022604525 7758524848 8883374551 7759824182 7023855331 7023855331 7027785300
5426 VEGAS DR, 4650 W SUNSET BLVD, 775 POLE LINE RD W STE 312, 1920 E CAMBRIDGE AVE STE 301, 3160 GENEVA ST, 6171 W CHARLESTON BLVD BLDG 10, 6127 S RAINBOW BLVD STE 100, 5121 S COTTONWOOD ST, 375 N STEPHANIE ST STE 111, 1449 N 1400 W STE 21, 50 N MEDICAL DR, 1664 N VIRGINIA ST BRIGHAM BLD, 3006 S MARYLAND PKWY STE 320, 360 S LOLA LN, 1559 WATASHEAMU, 75 PRINGLE WAY STE 510, 50 N MEDICAL DR, 801 E WILLIAMS AVE, 590 S WAKARA WAY, 50 N MEDICAL DR, 100 E IDAHO ST, 8685 S EASTERN AVE, 7455 W WASHINGTON AVE STE 100, 871 GRIER DR STE B2, 50 N MEDICAL DR, 1664 N VIRGINIA ST BRIGHAM BLD, 3670 N RANCHO DR STE 105, 590 S WAKARA WAY, 2725 S JONES BLVD STE 109, 50 N MEDICAL DR, 200 S VIRGINIA STE 856, 1079 RICCO DR, 7040 LAREDO ST STE K, 50 N MEDICAL DR, 1559 WATASHEAMU, 5121 S COTTONWOOD ST, 6633 BLACK OAKS ST, 10105 BANBURRY CROSS DR,STE 355 1929 N AARON DR STE L, 730 WILLOW ST, 50 N MEDICAL DR, 3725 LAKESIDE DR, 4650 W SUNSET BLVD, 7301 PEAK DR STE 101, 3121 S MARYLAND PKWY FL 3, 4650 W SUNSET BLVD, 1091 S CIMARRON RD STE A6, 1525 E WINDMILL LN STE 202, 100 E IDAHO ST STE 401, 801 POLE LINE RD W, 4650 W SUNSET BLVD, 7455 W WASHINGTON AVE STE 100, 65 REGENCY WAY STE A, PO BOX 511258, 5546 S FORT APACHE RD STE 100B, 3277 E LOUISE DR STE 410, PO BOX 511258, 1155 MILL ST, 520 S EAGLE RD, 7105 GAZIN CT, 2410 FIRE MESA STE 180, 2740 S JONES BLVD, 4170 S DECATUR BLVD STE D9, 4755 W ANN RD, 7285 ALIANTE PKWY, 2735 S MARYLAND PKWY, 6391 W LAKE MEAD BLVD, 125 E IDAHO ST STE 300, 4285 N RANCHO DR STE 130, 7295 S RAINBOW BLVD, 1155 MILL ST, 2950 S MARYLAND PKWY, 2375 E PRATER WAY, 3620 N RANCHO DR STE 107, 2425 E DESERT INN RD, 10105 BANBURRY CROSS DR,STE 370 10619 PROFESSIONAL CIR, 3230 S BUFFALO DR STE 101, 1155 MILL ST, 4285 N RANCHO DR STE 130, 4285 N RANCHO DR STE 130, 3606 N RANCHO DR STE 142,
Address
City
LAS VEGAS LOS ANGELES TWIN FALLS PHOENIX LOS ANGELES LAS VEGAS LAS VEGAS MURRAY HENDERSON SAINT GEORGE SALT LAKE CITY RENO LAS VEGAS PAHRUMP GARDNERVILLE RENO SALT LAKE CITY FALLON SALT LAKE CITY SALT LAKE CITY BOISE LAS VEGAS LAS VEGAS LAS VEGAS SALT LAKE CITY RENO LAS VEGAS SALT LAKE CITY LAS VEGAS SALT LAKE CITY RENO SPARKS LAS VEGAS SALT LAKE CITY GARDNERVILLE MURRAY N LAS VEGAS LAS VEGAS TOOELE RENO SALT LAKE CITY RENO LOS ANGELES LAS VEGAS LAS VEGAS LOS ANGELES LAS VEGAS LAS VEGAS BOISE TWIN FALLS LOS ANGELES LAS VEGAS RENO LOS ANGELES LAS VEGAS MERIDIAN LOS ANGELES RENO MERIDIAN RENO LAS VEGAS LAS VEGAS LAS VEGAS NORTH LAS VEGAS NORTH LAS VEGAS LAS VEGAS LAS VEGAS BOISE LAS VEGAS LAS VEGAS RENO LAS VEGAS SPARKS LAS VEGAS LAS VEGAS LAS VEGAS RENO LAS VEGAS RENO LAS VEGAS LAS VEGAS LAS VEGAS
State
Zip Code
NV
89108
CA
90027
ID
83301
AZ
85006
CA
90020
NV
89146
NV
89118
UT
84107
NV
89014
UT
84770
UT
84132
NV
89557
NV
89109
NV
89048
NV
89460
NV
89502
UT
84132
NV
89406
UT
84108
UT
84132
ID
83712
NV
89123
NV
89128
NV
89119
UT
84132
NV
89557
NV
89130
UT
84108
NV
89146
UT
84132
NV
89501
NV
89434
NV
89117
UT
84132
NV
89460
UT
84107
NV
89084
NV
89144
UT
84074
NV
89502
UT
84132
NV
89509
CA
90027
NV
89128
NV
89109
CA
90027
NV
89145
NV
89123
ID
83712
ID
83301
CA
90027
NV
89128
NV
89509
CA
90051
NV
89148
ID
83642
CA
90051
NV
89502
ID
83642
NV
89506
NV
89128
NV
89146
NV
89103
NV
89031
NV
89084
NV
89109
NV
89108
ID
83712
NV
89130
NV
89118
NV
89502
NV
89109
NV
89434
NV
89130
NV
89121
NV
89144
NV
89521
NV
89117
NV
89502
NV
89130
NV
89130
NV
89130
Page 6 of 487
NPI
1780106310 1972044295 1033644901 1639242035 1073860920 1669771879 1861856601 1861606592 1003915315 1316475072 1992228449 1356863211 1942488838 1265476618 1538132022 1578662888 1700290947 1336179662 1821197138 1134532476 1265409593 1417479320 1508975749 1700203858 1467551770 1417374323 1477652782 1326572892 1922257336 1013355445 1326561671 1902163918 1215190236 1700149713 1336574250 1356334577 1821409285 1780607481 1306964788 1316301914 1013005446 1194245969 1225019995 1720130594 1457382723 1073542007 1386691558 1114288867 1124447073 1285171686 1720492184 1003337635 1942644760 1144522954 1104867076 1447320023 1891739140 1265954341 1396087979 1962446104 1407274210 1760903587 1619061876 1518387885 1962663633 1407380850 1508255068 1841600996 1215140819 1619402732 1336503713 1538694575 1942503388 1801128871 1598056848 1700143930 1255322640 1386080935 1275859654 1184915217 1497916712 1982878021
Revalidation
Name
Due Date
07/24/2022
WASHINGTON
KAMARA
07/24/2022
LU
KUANCHANG
07/24/2022
OWENS
TANE
07/25/2022
HOWEY
SUSAN
07/25/2022
ANDREWS
DAVID I
07/25/2022
NAGIEL
AARON
07/25/2022
LU
KEPENG
07/25/2022
LONGS DRUG STORES CALIFORNIA, L.L.C.
07/25/2022
WASHINGTON LAMB CVS, L.L.C.
07/25/2022
LAU
CYNTHIA
07/25/2022
WARNER
JORDIN N
07/25/2022
JENKINS
FREDERICK
07/25/2022
KEISTER
LAWRENCE J
07/25/2022
LONGS DRUG STORES CALIFORNIA, L.L.C.
07/25/2022
MALONE
DANIEL
07/25/2022
WARM SPRINGS ROAD CVS, L.L.C.
07/25/2022
POULTER
LUKE A
07/25/2022
JODELE
SONATA
07/25/2022
WARM SPRINGS ROAD CVS, L.L.C.
07/25/2022
BYINGTON
SINDY K
07/25/2022
SOKELL
GERI A
07/25/2022
DACANAY
RHODA
07/25/2022
SHADDY
ROBERT E
07/25/2022
GOULD
AIDEN S
07/25/2022
WARM SPRINGS ROAD CVS, L.L.C.
07/25/2022
WILLER
ROBERT J
07/25/2022
WARM SPRINGS ROAD CVS, L.L.C.
07/25/2022
BROOKS
TREVOR
07/25/2022
BOYD
STEVEN
07/26/2022
PINARD
KRSITA
07/26/2022
ALOHA ADULT DAY HEALTHCARE CENTER
07/26/2022
ALLAN
ERIC C
07/26/2022
STICKLAND
RONALD W
07/26/2022
HYMAS
RICHARD V
07/26/2022
WRIGHT
BROOKS E
07/26/2022
MINIMED DISTRIBUTION CORP
07/26/2022
VACCARELLI
CHAD
07/26/2022
HANSEN
MATTHEW
07/26/2022
AVALOS
CECILIA
07/26/2022
ROSS
NICOLE
07/26/2022
BUCAIN
BRETT J
07/26/2022
GREEN
SHANNON
07/26/2022
DORAME
ERNEST J
07/26/2022
CLOTHIER
ELDON W
07/26/2022
GILES
JONATHAN
07/26/2022
SAFEWAY INC
07/26/2022
JEFFERDS
ANN
07/26/2022
AVELAR
TAURINO N
07/26/2022
DIULIO
JONATHON J
07/26/2022
BURK
LENA
07/26/2022
UM
JONG
07/26/2022
WILLIAMS
LANECHA
07/26/2022
ADERANGI
FAEGH
07/26/2022
ANTOINE
BEVERLEY
07/26/2022
NEVADA CVS PHARMACY, L.L.C.
07/26/2022
MURDOCK
RAYMOND W
07/26/2022
NEVADA CVS PHARMACY, L.L.C.
07/26/2022
MARTZ
RYAN
07/26/2022
SHOO
ANTHONY
07/26/2022
COOPER
CLIVE
07/26/2022
FRIEL
MEAGHEN M
07/26/2022
THE LEARNING CONSULTANTS
07/26/2022
SHIFLETT
BRYAN M
07/26/2022
NUSSBAUM
CHRISTINA L
07/26/2022
HELFER
TAMARA S
07/26/2022
PETTY
KAREN
07/26/2022
CHASE
TRAVIS G
07/26/2022
LEBARON
JORDAN G
07/26/2022
SCHWARTZ
BARBARA
07/27/2022
WATERS
BRENTON
07/27/2022
BON
TAO
R
07/27/2022
UNLV MEDICINE
07/27/2022
MCVEIGH
VICKI
07/27/2022
POCHIRO
JENELLE
07/27/2022
PECKHAM
MIRIAM E
07/27/2022
SMITH
TREVOR R
07/27/2022
FRY
PAUL
III
07/27/2022
MARCUS
BRIAN J
07/27/2022
MAURER
KATHRYN A
07/27/2022
WHITNEY
RACHEL E
07/27/2022
LECROY
ADAM
07/27/2022
STRINGHAM
JOHN R
06/2022
Nevada Medicaid Provider Revalidation Report
Provider Type
14 20 34 21 20 20 77 33 33 34 58 14 72 33 20 33 20 20 33 20 34 14 20 20 33 20 33 85 14 20 48 20 14 20 20 33 20 20 24 20 26 14 20 22 20 33 20 20 20 77 22 14 20 14 33 20 33 22 20 20 20 85 20 20 20 14 24 20 34 77 34 54 14 14 20 20 20 20 20 20 77 20
Provider Type Description
Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Therapy Podiatrist Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician Assistant DME, Disposable, Prosthetics DME, Disposable, Prosthetics Therapy Waiver for Persons with Physical Disabilities Behavioral Health Outpatient Treatment Nurse Anesthetist DME, Disposable, Prosthetics Physician, M.D., Osteopath, D.O. DME, Disposable, Prosthetics Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. DME, Disposable, Prosthetics Physician, M.D., Osteopath, D.O. Therapy Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. DME, Disposable, Prosthetics Physician, M.D., Osteopath, D.O. DME, Disposable, Prosthetics Applied Behavior Analysis (ABA) Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Waiver for the Frail Elderly Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. DME, Disposable, Prosthetics Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Advanced Practice Registered Nurses Physician, M.D., Osteopath, D.O. Psychologist Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Dentist Physician, M.D., Osteopath, D.O. DME, Disposable, Prosthetics Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician Assistant Dentist Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment DME, Disposable, Prosthetics Physician, M.D., Osteopath, D.O. DME, Disposable, Prosthetics Dentist Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Applied Behavior Analysis (ABA) Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Advanced Practice Registered Nurses Physician, M.D., Osteopath, D.O. Therapy Physician Assistant Therapy Targeted Case Management Behavioral Health Outpatient Treatment Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician Assistant Physician, M.D., Osteopath, D.O.
Provider Specialty 302 400 027 921 059 063 977 933 933 028 189 302 972 933 060 933 053 120 933 060 027 302 141 111 933 139 933 314 300 146 209 131 305 131 111 933 400 142 023 139 162 302 139 922 073 933 149 125 400 977 078 300 053 306 933 400 933 078 139 060 060 885 111 111 147 301 023 066 029 977 027 237 302 305 072 125 064 126 117 111 977 107
Phone Number
Address
7023855331 7029926875 7027984778 8014424267 6029330895 3236602450 7028051880 7758822299 7024522937 7028707050
7026465437 2088149750 7758250557 7028775199 7024356927 2084637330 3236612450 7022629284 2088144100 7023846330 7026465437 3236602450 7759824182 7026381295 8016623645 7022543084 7022703219 7756882001 7027902701 7023312855 2088141600 7027902701 2088141600 7027318000 8009333322 7757841533 2083812782 6029237730 3236602450 2088147100 7024867664 6029237730 7022931437 2083643000 7753528475 8015817806 7028771877 7757841533 7029488660 7028134795 7022917121 7026171227 7027341542 7025470220 7752658621 7024336536 7025150553 7025662400 2083853329 2083815015 7756578030 2083849022 7029625000 2083815970 7024892117 7025236301 8014424267 7025981622 8015852626 7025688450 7028951316 7754995525 7027902701 8015817553 8015816709 7757836190 8015856387 8012132995 8016621234 8015876336 8015815311
4285 N RANCHO DR STE 130, 2410 FIRE MESA ST, 5546 S FORT APACHE RD STE 100B, 1380 E MEDICAL CENTER DR, 1919 E THOMAS RD RD MAIN BLDG, 4650 W SUNSET BLVD, 2995 S JONES BLVD STE A, 1980 N CARSON ST, 4391 E WASHINGTON AVE, 7281 W CHARLESTON BLVD, 2700 HIGHLAND DR, 3680 NORTH RANCHO DR, 709 N LINCOLN AVE, 3360 S MCCARRAN BLVD, 4835 S DURANGO DR, 4595 E FLAMINGO RD, 3165 E GREENHURST RD, 4650 W SUNSET BLVD, 3758 LAS VEGAS BLVD S, 801 POLE LINE RD W, 600 S TONOPAH DR STE 350, 3680 N RANCHO DR, 4650 W SUNSET BLVD, 1155 MILL ST, 3655 W CRAIG RD, 100 N MARIO CAPECCHI DR, 3290 S FORT APACHE RD, 2110 E FLAMINGO RD STE 150, 480 GALLETTI WAY, 3016 W CHARLESTON BLVD STE 150, 930 W OWENS AVE, 725 POLE LINE RD W, 3016 W CHARLESTON BLVD STE 150, 725 POLE LINE RD W, 3186 S MARYLAND PKWY, 18000 DEVONSHIRE ST, 1664 N VIRGINIA ST BRIGHAM BLD, 100 E IDAHO ST, 3805 E BELL RD STE 5100, 4650 W SUNSET BLVD, 738 N COLLEGE RD, 6171 W CHARLESTON BLVD,BLDG 12-14 3805 E BELL RD STE 5100, 1150 ARIZONA ST, 3399 E LOUISE DR STE 400, 2858 VISTA BLVD, 50 N MEDICAL DR, 500 S RANCHO DR STE 12, 1664 N VIRGINIA ST BRIGHAM BLD, 6120 S FORT APACHE RD STE 100, 5001 E BONANZA RD STE 120, 5412 BOULDER HWY, 2845 SIENA HEIGHTS DR, 2980 SUN LAKE DR, 6705 E LAKE MEAD BLVD, 1559 WATASHEAMU, 1551 W SUNSET RD, 7101 W CRAIG RD STE 102, 10001 S EASTERN AVE STE 310, 600 N ROBBINS RD STE 301, 190 E BANNOCK ST, 2435 PYRAMID WAY STE B, 190 E BANNOCK ST, 3100 N TENAYA WAY, 610 W HAYS ST, 6871 W CHARLESTON BLVD, 2021 S JONES BLVD, 1380 E MEDICAL CENTER DR, 501 S RANCHO DR STE I60, 1950 CIRCLE OF HOPE DR, 7151 CASCADE VALLEY CT STE 200, 4000 E CHARLESTON BLVD, 1200 ROCK BLVD STE 3, 3016 W CHARLESTON BLVD STE 150, 50 N MEDICAL DR, 50 N MEDICAL DR, 973 MICA DR STE 201, 50 N MEDICAL DR, 50 N MEDICAL DR, 100 N MARIO CAPECCHI DR, 1525 W 2100 S, 50 N MEDICAL DR,
City
LAS VEGAS LAS VEGAS LAS VEGAS SAINT GEORGE PHOENIX LOS ANGELES LAS VEGAS CARSON CITY LAS VEGAS LAS VEGAS FALLON LAS VEGAS JEROME RENO LAS VEGAS LAS VEGAS NAMPA LOS ANGELES LAS VEGAS TWIN FALLS LAS VEGAS LAS VEGAS LOS ANGELES RENO NORTH LAS VEGAS SALT LAKE CITY LAS VEGAS LAS VEGAS SPARKS LAS VEGAS LAS VEGAS TWIN FALLS LAS VEGAS TWIN FALLS LAS VEGAS NORTHRIDGE RENO BOISE PHOENIX LOS ANGELES TWIN FALLS LAS VEGAS PHOENIX BOULDER CITY MERIDIAN SPARKS SALT LAKE CITY LAS VEGAS RENO LAS VEGAS LAS VEGAS LAS VEGAS HENDERSON LAS VEGAS LAS VEGAS GARDNERVILLE HENDERSON LAS VEGAS HENDERSON BOISE BOISE SPARKS BOISE LAS VEGAS BOISE LAS VEGAS LAS VEGAS SAINT GEORGE LAS VEGAS SALT LAKE CITY LAS VEGAS LAS VEGAS SPARKS LAS VEGAS SALT LAKE CITY SALT LAKE CITY CARSON CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY
State
Zip Code
NV
89130
NV
89128
NV
89148
UT
84790
AZ
85016
CA
90027
NV
89146
NV
89701
NV
89110
NV
89117
NV
89406
NV
89130
ID
83338
NV
89502
NV
89147
NV
89121
ID
83686
CA
90027
NV
89109
ID
83301
NV
89106
NV
89130
CA
90027
NV
89502
NV
89032
UT
84113
NV
89117
NV
89119
NV
89431
NV
89102
NV
89106
ID
83301
NV
89102
ID
83301
NV
89109
CA
91325
NV
89557
ID
83712
AZ
85032
CA
90027
ID
83301
NV
89146
AZ
85032
NV
89005
ID
83642
NV
89434
UT
84132
NV
89106
NV
89557
NV
89148
NV
89110
NV
89122
NV
89052
NV
89128
NV
89156
NV
89460
NV
89014
NV
89129
NV
89052
ID
83702
ID
83712
NV
89431
ID
83712
NV
89128
ID
83702
NV
89117
NV
89146
UT
84790
NV
89106
UT
84112
NV
89128
NV
89104
NV
89431
NV
89102
UT
84132
UT
84132
NV
89705
UT
84132
UT
84132
UT
84113
UT
84119
UT
84132
Page 7 of 487
NPI
1184012965 1619402732 1437608726 1851752463 1821529983 1144517517 1053385351 1053840611 1821315268 1497746226 1821420175 1386866184 1811166283 1760809958 1518941343 1386888147 1457682866 1750304408 1154858017 1417016825 1669432753 1255872628 1245620830 1427085281 1912429093 1760431357 1972837003 1104907096 1376074955 1457406142 1740382993 1982053377 1548204894 1083611859 1578753612 1356383541 1447292636 1083655989 1902840259 1013958982 1831130707 1710084603 1346655420 1053840801 1346789492 1265526131 1164959045 1891054037 1154348100 1073033528 1154483477 1063468619 1013350818 1710918545 1831558204 1275053274 1831168970 1841320900 1952674814 1235659624 1215465117 1215070214 1972709582 1356652788 1427587260 1861644619 1235527227 1528296191 1598968380 1013437318 1578908935 1487095279 1336318914 1891055760 1780097725 1326318601 1730601584 1689996720 1134658610 1063502680 1376833160 1528580420
Revalidation
Name
Due Date
07/27/2022
KIRKLAND
MELANIE
07/27/2022
SHARMA
VIKAS
07/27/2022
LOPEZ
LORENAMAE
07/27/2022
PABUSTAN
JOHN P
07/27/2022
REZAIE
AIDA
07/27/2022
SANDERS
LINDSAY
07/27/2022
WIEBE
DAVID P
07/27/2022
NEW LEAF FAMILY SERVICES & WELLNESS CENT
07/27/2022
WHIPPLE
NICHOLAS S
07/27/2022
EDEN HOME HEALTH
07/27/2022
OCONNOR
LAUREN
07/27/2022
HOGAN
PATRICIA
07/27/2022
NEVADA CVS PHARMACY, L.L.C.
07/28/2022
SHOEBRIDGE
NICHOLAS
07/28/2022
SPENCER
BYRON R
07/28/2022
ANNABERDYEV
SHAHRAT
07/28/2022
MEHINOVIC
DZENIS
07/28/2022
KHERADPOUR
ALBERT
07/28/2022
LEDEE
DANIEL A
07/28/2022
KIDSPEACE CHILDRENS HOSPITAL INC
07/28/2022
SOUTH LYON MEDICAL CENTER
07/28/2022
DELILLE
IMANI
07/28/2022
TAYLOR
TORI K
07/28/2022
VERNER
REESE A
07/28/2022
ROCK & ROWLES PEDIATRICS PC
07/28/2022
SCHANK
JOANN
07/28/2022
DOHRMAN
MONICA G
07/28/2022
HIMELRIGHT
LANCE
07/28/2022
ALLURI
DEEPTI
07/28/2022
DEACH
BONNIE J
07/28/2022
UCSD MEDICAL GROUP
07/29/2022
CARTWRIGHT
SAMUEL
07/29/2022
NEVADA CVS PHARMACY, L.L.C.
07/29/2022
DODDY
KAREN R
07/29/2022
VAUGHN
JEFFREY M
07/30/2022
NEVADA CVS PHARMACY, L.L.C.
07/30/2022
NEVADA CVS PHARMACY, L.L.C.
07/30/2022
NEVADA CVS PHARMACY, L.L.C.
07/30/2022
NEVADA CVS PHARMACY, L.L.C.
07/30/2022
NEVADA CVS PHARMACY, L.L.C.
07/30/2022
NEVADA CVS PHARMACY, L.L.C.
07/31/2022
MANNIKKO
DANIEL D
07/31/2022
FOX
CHRISTOPHE L
07/31/2022
OZAKI
KYLE
07/31/2022
GRANT
NAJEMA
07/31/2022
PRYSTAS
ELIZABETH M
07/31/2022
FILOCAMO
ROBERT
07/31/2022
DOBSON
ANDREW D
07/31/2022
BERNDT
THEODORE B
07/31/2022
MULLISSA CHILDRESS
07/31/2022
SULLIVAN
WILLIAM R II
07/31/2022
ALBERTSONS LLC
07/31/2022
MEISEL
ERIN
07/31/2022
UC DAVIS MEDICAL CENTER
07/31/2022
EDWARDS
ELISA A
07/31/2022
DURHAM TAYLOR
PATRICIA
07/31/2022
BESSETTE
RICHARD
07/31/2022
OLSEN
SHANE C
07/31/2022
GUARINO
SUSANNA
07/31/2022
ASPEN CARE GROUP LLC
07/31/2022
POST ACUTE NETWORK PHYSICIANS PLLC
07/31/2022
BIONDI
TRACI
08/01/2022
LEDUC
JESSICA L
08/01/2022
PEPITO
DON LEO S
08/01/2022
DONLEY
BRITTANY
08/01/2022
ONKENDI
JOI
S
08/01/2022
SOLEO HEALTH INC
08/01/2022
FOSTER
HEATHER N
08/01/2022
ALT
JEREMIAH A
08/01/2022
HYMON
KRYSTAL
08/01/2022
SCOTT
JOHN R
08/01/2022
HA
ANNIE
08/01/2022
RYAN
ANDREW M
08/01/2022
STENSON
TRINA R
08/01/2022
NEWBY
QUIN T
08/01/2022
BEEVERS
SOLANGE
08/01/2022
ALCOCER
KARINA
08/01/2022
GAW
SHIRLEY C
08/01/2022
LEAVITT
SETH
08/01/2022
PAEGLE
RITA
08/01/2022
KNIGHT
WILSON
08/01/2022
DACANAY
WILLY
06/2022
Nevada Medicaid Provider Revalidation Report
Provider Type
14 20 85 85 20 20 20 14 20 29 34 24 33 20 20 20 72 20 76 13 19 14 72 20 20 14 24 34 20 34 20 34 33 20 20 33 33 33 33 33 33 22 20 34 14 20 14 20 20 24 20 33 20 11 24 24 20 20 14 38 20 20 20 20 14 24 28 20 20 14 20 22 77 82 20 14 14 34 20 74 20 14
Provider Type Description
Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Applied Behavior Analysis (ABA) Applied Behavior Analysis (ABA) Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Home Health Agency Therapy Advanced Practice Registered Nurses DME, Disposable, Prosthetics Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Nurse Anesthetist Physician, M.D., Osteopath, D.O. Audiologist Psychiatric Hospital, Inpatient Nursing Facility Behavioral Health Outpatient Treatment Nurse Anesthetist Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Advanced Practice Registered Nurses Therapy Physician, M.D., Osteopath, D.O. Therapy Physician, M.D., Osteopath, D.O. Therapy DME, Disposable, Prosthetics Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. DME, Disposable, Prosthetics DME, Disposable, Prosthetics DME, Disposable, Prosthetics DME, Disposable, Prosthetics DME, Disposable, Prosthetics DME, Disposable, Prosthetics Dentist Physician, M.D., Osteopath, D.O. Therapy Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Advanced Practice Registered Nurses Physician, M.D., Osteopath, D.O. DME, Disposable, Prosthetics Physician, M.D., Osteopath, D.O. Hospital, Inpatient Advanced Practice Registered Nurses Advanced Practice Registered Nurses Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Waiver for Intellectual Disabilities and Related Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Advanced Practice Registered Nurses Pharmacy Physician, M.D., Osteopath, D.O. Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Physician, M.D., Osteopath, D.O. Dentist Physician Assistant Behavioral Health Rehabilitative Treatment Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment Behavioral Health Outpatient Treatment Therapy Physician, M.D., Osteopath, D.O. Nurse Midwife Physician, M.D., Osteopath, D.O. Behavioral Health Outpatient Treatment
Provider Specialty 306 107 314 314 400 125 111 814 142 929 219 023 933 060 126 058 972 139 245 913 185 301 972 073 139 301 023 027 400 029 820 027 933 068 064 933 933 933 933 933 933 400 111 027 301 120 301 057 106 023 146 933 064 911 023 023 073 130 301 216 820 057 111 060 302 023 928 400 133 302 400 078 977 302 111 300 301 027 400 974 053 302
Phone Number
Address
7029178929 8015815311 7024444710 7022703219 7753275174 7753224550 7023832085 7022074458 8016624700 7758281000 7028707050 8015816709 7023994776 2083815015 2085055200 7025866688 8015816393 9095584000 7027357668 8008543123 7754632301 7026052766 8015816393 2087062333 7022557399 7024860000 6029237730 4355251877 7753275174 7758294700 6195431882 7024030023 7024525652 7026296992 6029333033 7022565521 7024503299 7028735917 7758871000 7026169660 7024344933 7752658621 7023884500 7023463105 7029550628 8015850100 7024867965 4352511000 7759827878 7029309363 2087346760 7028387548 3236602450 9167342011 8014424267 7753372394 7752205842 2085052712 7029684000 8188364240 7028490008 7757703000 7023884500 7023042144 7753224650 7023884500 5103627360 7026532775 8015817514 7024867664 7756883307 7028989200 2085052000 7025506700 7026164600 7028932002 7023314277 7028707050 7026532775 8015858425 7023836240 7026465437
STE 211,2620 REGATTA DR 50 N MEDICAL DR, 6897 W CHARLESTON BLVD, 210 E FLAMINGO RD STE 150, 1155 MILL ST W11, 670 SIERRA ROSE DR, 1800 W CHARLESTON BLVD, 3435 W CRAIG RD STE B, 100 N MARIO CAPECCHI DR, 500 DAMONTE RANCH PKWY STE 929, 7281 W CHARLESTON BLVD, 50 N MEDICAL DR, 6432 LOSEE RD, 190 E BANNOCK ST, 9850 ST LUKES DR, 6080 S DURANGO DR STE 105, 50 N MEDICAL DR, 11234 ANDERSON ST, 3692 E SUNSET RD, 5300 KIDSPEACE DR, 213 S WHITACRE ST, 2501 N GREEN VALLEY PKWY,D116-118 50 N MEDICAL DR, 190 E BANNOCK ST, 7690 CARMEN BLVD, 6171 W CHARLESTON BLVD,BLDG 12-14 3805 E BELL RD STE 5100, 780 N 2860 E STE 202, 1155 MILL ST W11, 3700 GRANT DR, 200 W ARBOR DR, 7301 PEAK DR STE 101, 4411 E BONANZA RD, 2004 GLENVIEW DR, 1919 E THOMAS RD FL 2, 2525 S BUFFALO DR, 3810 E SUNSET RD, 4014 S RAINBOW BLVD, 220 FAIRVIEW DR, 2662 W HORIZON RIDGE PKWY, 5681 BOULDER HWY, 1559 WATASHEAMU, 620 SHADOW LN, 340 FALCON RIDGE PKWY STE 500, 3365 W CRAIG RD STE 9, 1950 CIRCLE OF HOPE DR, 6171 W CHARLESTON BLVD, 1380 E MEDICAL CENTER DR, 1155 MILL ST, 2225 E FLAMINGO RD STE 105, 228 SHOUP AVE W, 10250 W CHARLESTON BLVD, 4650 W SUNSET BLVD, 2315 STOCKTON BLVD, 1380 E MEDICAL CENTER DR, 1101 W MOANA LN STE 2, 775 FLEISCHMANN WAY, 9850 ST LUKES DR STE 207, 4000 E CHARLESTON BLVD STE 230, 3482 ALCUDIA BAY AVE, 8687 W SAHARA AVE STE 200, 235 W 6TH ST, 620 SHADOW LN, 7391 W CHARLESTON BLVD STE 140, 2261 PYRAMID WAY STE 5, 620 SHADOW LN, 1324 W WINTON AVE, 4700 LAS VEGAS BLVD N,NELLIS FAMILY MED RESIDENCY 50 N MEDICAL DR, 6171 W CHARLESTON BLVD,BLDG 12-14 OASIS 500 GALLETTI WAY, 3730 E FLAMINGO RD, 9850 ST LUKES DR, 3920 W ANN RD STE 100, 102 E LAKE MEAD PKWY, 1455 E TROPICANA AVE STE 175B, 4250 E BONANZA RD STE 17, 7281 W CHARLESTON BLVD, 4700 LAS VEGAS BLVD N,NELLIS FAMILY MED RESIDENCY 50 N MEDICAL DR, 61 N NELLIS BLVD, 3680 N RANCHO DR,
City
LAS VEGAS SALT LAKE CITY LAS VEGAS LAS VEGAS RENO RENO LAS VEGAS NORTH LAS VEGAS SALT LAKE CITY RENO LAS VEGAS SALT LAKE CITY NORTH LAS VEGAS BOISE NAMPA LAS VEGAS SALT LAKE CITY LOMA LINDA LAS VEGAS OREFIELD YERINGTON HENDERSON SALT LAKE CITY BOISE LAS VEGAS LAS VEGAS PHOENIX ST GEORGE RENO RENO SAN DIEGO LAS VEGAS LAS VEGAS LAS VEGAS PHOENIX LAS VEGAS LAS VEGAS LAS VEGAS CARSON CITY HENDERSON LAS VEGAS GARDNERVILLE LAS VEGAS MESQUITE NORTH LAS VEGAS SALT LAKE CITY LAS VEGAS SAINT GEORGE RENO LAS VEGAS TWIN FALLS LAS VEGAS LOS ANGELES SACRAMENTO SAINT GEORGE RENO CARSON CITY NAMPA LAS VEGAS LAS VEGAS LAS VEGAS RENO LAS VEGAS LAS VEGAS SPARKS LAS VEGAS HAYWARD NELLIS AFB SALT LAKE CITY LAS VEGAS SPARKS LAS VEGAS NAMPA LAS VEGAS HENDERSON LAS VEGAS LAS VEGAS LAS VEGAS NELLIS AFB SALT LAKE CITY LAS VEGAS LAS VEGAS
State
Zip Code
NV
89128
UT
84132
NV
89117
NV
89169
NV
89502
NV
89511
NV
89102
NV
89032
UT
84113
NV
89521
NV
89117
UT
84132
NV
89086
ID
83712
ID
83687
NV
89113
UT
84132
CA
92354
NV
89120
PA
18069
NV
89447
NV
89014
UT
84132
ID
83712
NV
89128
NV
89146
AZ
85032
UT
84790
NV
89502
NV
89509
CA
92103
NV
89128
NV
89110
NV
89134
AZ
85016
NV
89117
NV
89120
NV
89103
NV
89701
NV
89052
NV
89122
NV
89460
NV
89106
NV
89027
NV
89032
UT
84112
NV
89146
UT
84790
NV
89502
NV
89119
ID
83301
NV
89135
CA
90027
CA
95817
UT
84790
NV
89509
NV
89703
ID
83687
NV
89104
NV
89141
NV
89117
NV
89503
NV
89106
NV
89117
NV
89431
NV
89106
CA
94545
NV
89191
UT
84132
NV
89146
NV
89431
NV
89121
ID
83687
NV
89081
NV
89015
NV
89119
NV
89110
NV
89117
NV
89191
UT
84132
NV
89110
NV
89130
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