Physician Compare National (NPI:1083786156)

HEALTHCARE PROVIDER: KRISTIE WHEELER PA

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

Individual Professional Information
NPI	1083786156
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3577669423
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070509000425
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WHEELER
	Individual professional last name
Provider First Name	KRISTIE
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.
Provider Credential Text	PA
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1996
	Individual professional's medical school graduation year
Primary Specialty	PHYSICIAN ASSISTANT
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	BOURBON PHYSICIAN PRACTICE 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	8729226097
	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	8
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	22 CLINIC DR
	Group Practice or individual's line 1 address
City	PARIS
	Group Practice or individual's city
State	KY
	Group Practice or individual's state
Zip Code	403612161
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8599870074
	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	180046
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BOURBON COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y