Physician Compare National (NPI:1073816872)

HEALTHCARE PROVIDER: TRACI L. FORMAN 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	1073816872
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1052591963
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110210000099
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FORMAN
	Individual professional last name
Provider First Name	TRACI
	Individual professional first name
Provider Middle Name	LYNN
	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	2010
	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	TOPEKA ANESTHESIA AND PAIN TREATMENT, P.A.
	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	5496918427
	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	26
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1700 SW 7TH ST
	Group Practice or individual's line 1 address
City	TOPEKA
	Group Practice or individual's city
State	KS
	Group Practice or individual's state
Zip Code	666061690
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7852958000
	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	170016
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST FRANCIS HEALTH CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y