Physician Compare National (NPI:1063521631)

HEALTHCARE PROVIDER: KENNETH L GROTZ MD

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

Individual Professional Information
NPI	1063521631
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7618052945
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080311000555
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GROTZ
	Individual professional last name
Provider First Name	KENNETH
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	TEMPLE UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1987
	Individual professional's medical school graduation year
Primary Specialty	EMERGENCY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	ERX GROUP LLC
	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	9335037571
	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	19
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	163 E TOLLISON ST
	Group Practice or individual's line 1 address
City	BAXLEY
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	315130120
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9123679841
	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	110071
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	APPLING HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	110073
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	DORMINY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	110025
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	SOUTHEAST GEORGIA HEALTH SYSTEM- BRUNSWICK CAMPUS
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y