Physician Compare National (NPI:1003301136)

HEALTHCARE PROVIDER: BETHANY JOY KENNEDY APRN

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1003301136
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1052660545
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190916001384
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KENNEDY
	Individual professional last name
Provider First Name	BETHANY
	Individual professional first name
Provider Middle Name	JOY
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2017
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	SILVER SPRING HEALTH CARE MANAGEMENT INC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	4688661127
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	97
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	100 KENYON AVE
	Group Practice or individual's line 1 address
City	WAKEFIELD
	Group Practice or individual's city
State	RI
	Group Practice or individual's state
Zip Code	028794216
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	070024
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WILLIAM W BACKUS HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	410008
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SOUTH COUNTY HOSPITAL INC
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	M