Physician Compare National (NPI:1144703992)

HEALTHCARE PROVIDER: KATELYN ST MARTIN PA-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	1144703992
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5698017473
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190426000311
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ROSE
	Individual professional last name
Provider First Name	KATELYN
	Individual professional first name
Provider Middle Name	MICHELLE
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NOVA SOUTHEASTERN UNIV COLLEGE OF DENTAL MEDICINE
	Individual professional's medical school
Graduation Year	2018
	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	MIDLAND ORTHOPEDIC ASSOCIATES SC
	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	3971562430
	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	9
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	2850 S WABASH AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 100
	Group Practice or individual's line 2 address
City	CHICAGO
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	606162491
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3128424600
	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	140158
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MERCY HOSPITAL AND MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	140048
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ADVOCATE TRINITY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	140208
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ADVOCATE CHRIST HOSPITAL & MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y