Physician Compare National (NPI:1194996900)

HEALTHCARE PROVIDER: ANN REVARD LCSW

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

Individual Professional Information
NPI	1194996900
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1850451758
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20081121000693
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	REVARD
	Individual professional last name
Provider First Name	ANN
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF SOUTHERN CALIFORNIA KECK SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2002
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1533 MERRIMAC CIR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 101
	Group Practice or individual's line 2 address
City	FORT WORTH
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	761076506
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8178100030
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y