Physician Compare National (NPI:1164498473)

HEALTHCARE PROVIDER: KEVIN PATRICK GREENE MD

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

Individual Professional Information
NPI	1164498473
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0143113498
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110322000234
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GREENE
	Individual professional last name
Provider First Name	KEVIN
	Individual professional first name
Provider Middle Name	P
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	GEORGETOWN UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1991
	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
Organization Legal Name	FEEL WELL HEALTH CENTER OF SOUTHINGTON PC
	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	8527951870
	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	4
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	710 MAIN ST
	Group Practice or individual's line 1 address
Line 2 Street Address	BLDG 4
	Group Practice or individual's line 2 address
City	PLANTSVILLE
	Group Practice or individual's city
State	CT
	Group Practice or individual's state
Zip Code	064791567
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8603782891
	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	070035
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	THE HOSPITAL OF CENTRAL CONNECTICUT
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y