Physician Compare National (NPI:1205984366)

HEALTHCARE PROVIDER: STANLEY ANSEL KRISTIANSEN CRNA

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

Individual Professional Information
NPI	1205984366
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6608972088
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100915000772
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KRISTIANSEN
	Individual professional last name
Provider First Name	STANLEY
	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.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2006
	Individual professional's medical school graduation year
Primary Specialty	CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	KENTUCKY ANESTHESIA GROUP PSC
	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	4082527890
	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	48
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	320 LORETTO RD
	Group Practice or individual's line 1 address
City	LEBANON
	Group Practice or individual's city
State	KY
	Group Practice or individual's state
Zip Code	400331300
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2706923161
	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	150082
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	DEACONESS HOSPITAL INC
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	180024
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SPRING VIEW HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y