Physician Compare National (NPI:1083967806)

HEALTHCARE PROVIDER: JOLENE KEIKO GORANOVIC AA-C

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

Individual Professional Information
NPI	1083967806
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1052562139
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20121120000101
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GORANOVIC
	Individual professional last name
Provider First Name	JOLENE
	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	2012
	Individual professional's medical school graduation year
Primary Specialty	ANESTHESIOLOGY ASSISTANT
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	BREVARD PHYSICIAN ASSOCIATES PLLC
	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	1850535048
	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	154
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1051 S HICKORY ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE F
	Group Practice or individual's line 2 address
City	MELBOURNE
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	329011962
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3214347100
	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	100019
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HOLMES REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y