Physician Compare National (NPI:1104231513)

HEALTHCARE PROVIDER: ASHLEY WALTERS NP

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

Individual Professional Information
NPI	1104231513
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2961728175
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150306000247
	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	ASHLEY
	Individual professional first name
Provider Middle Name	W
	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	2014
	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	PERMIAN PREMIER HEALTH SERVICES INC
	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	8426051293
	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	135
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1409 S HWY 69
	Group Practice or individual's line 1 address
Line 2 Street Address	STEWARD MEDICAL GROUP OF TEXAS
	Group Practice or individual's line 2 address
City	NEDERLAND
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	776277842
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4097274422
	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	450034
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CHRISTUS HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	450518
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	THE MEDICAL CENTER OF SOUTHEAST TEXAS
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y