Physician Compare National (NPI:1013069939)

HEALTHCARE PROVIDER: ROBERT KENNETH NICHOLS JR. M.D.

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

Individual Professional Information
NPI	1013069939
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8426238924
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110215000490
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	NICHOLS
	Individual professional last name
Provider First Name	ROBERT
	Individual professional first name
Provider Middle Name	K
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF ALABAMA SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1982
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	GENERAL PRACTICE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	GENERAL PRACTICE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	120 E MAIN ST
	Group Practice or individual's line 1 address
City	PRATTVILLE
	Group Practice or individual's city
State	AL
	Group Practice or individual's state
Zip Code	360673114
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3343610986
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	010108
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PRATTVILLE BAPTIST HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y