Physician Compare National (NPI:1114128725)

HEALTHCARE PROVIDER: KEILAH ISABEL GONZALEZ-BONILLA M.D.

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

Individual Professional Information
NPI	1114128725
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2062550296
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20091110000083
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GONZALEZ-BONILLA
	Individual professional last name
Provider First Name	KEILAH
	Individual professional first name
Provider Middle Name	I
	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	2000
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	HOSPICE/PALLIATIVE CARE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	HOSPICE/PALLIATIVE CARE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	8501 S NORTHSHORE DR
	Group Practice or individual's line 1 address
City	KNOXVILLE
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	379226006
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8656700504
	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	440110
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	FORT LOUDOUN MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	440173
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	PARKWEST MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y