Physician Compare National (NPI:1053748863)

HEALTHCARE PROVIDER: BETHANY KOSSICK SEALE CRNA

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

Individual Professional Information
NPI	1053748863
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7315174935
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20131205001063
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SEALE
	Individual professional last name
Provider First Name	BETHANY
	Individual professional first name
Provider Middle Name	K
	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	2013
	Individual professional's medical school graduation year
Primary Specialty	CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	ADVANCED ANESTHESIA SOLUTIONS 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	7315200664
	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	13
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1908 GRANBY RD
	Group Practice or individual's line 1 address
City	KINGSPORT
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	376651712
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4239159942
	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	440017
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WELLMONT HOLSTON VALLEY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y