Physician Compare National (NPI:1164460655)

HEALTHCARE PROVIDER: KIPP ALLEN VANCAMP DO

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

Individual Professional Information
NPI	1164460655
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5193764900
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050502000427
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	VAN CAMP
	Individual professional last name
Provider First Name	KIPP
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	DO
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	KANSAS CITY UNIVERSITY OF PHYSICIANS AND SURGEONS
	Individual professional's medical school
Graduation Year	1990
	Individual professional's medical school graduation year
Primary Specialty	DIAGNOSTIC RADIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	6800 HILLTOP RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 102
	Group Practice or individual's line 2 address
City	SHAWNEE
	Group Practice or individual's city
State	KS
	Group Practice or individual's state
Zip Code	662263571
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	170023
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST CATHERINE HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	170110
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BOB WILSON MEMORIAL GRANT COUNTY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y