Physician Compare National (NPI:1124011804)

HEALTHCARE PROVIDER: IRENE VASILY KARDASHIAN 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	1124011804
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5395894356
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090521000301
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KARDASHIAN
	Individual professional last name
Provider First Name	IRENE
	Individual professional first 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	1977
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	14100 FIVAY RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 100
	Group Practice or individual's line 2 address
City	HUDSON
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	346677159
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	100032
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BAYFRONT HEALTH - ST PETERSBURG
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	100256
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	REGIONAL MEDICAL CENTER BAYONET POINT
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	100127
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	MORTON PLANT HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y