Physician Compare National (NPI:1053840959)

HEALTHCARE PROVIDER: ROBERTA ANNE WALTERS 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	1053840959
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6103190491
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170926001310
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WALTERS
	Individual professional last name
Provider First Name	ROBERTA
	Individual professional first name
Provider Middle Name	A
	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	TRANSITIONAL CARE PHYSICIANS OF GEORGIA, PC
	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	4486895083
	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	30
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	704 BREEDLOVE DR A
	Group Practice or individual's line 1 address
City	MONROE
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	306552054
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8887720076
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y