Physician Compare National (NPI:1215472253)

HEALTHCARE PROVIDER: JONI MICHELLE SANDOVAL

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

Individual Professional Information
NPI	1215472253
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1850673476
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170116000578
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SANDOVAL
	Individual professional last name
Provider First Name	JONI
	Individual professional first name
Provider Middle Name	M
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2015
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MIDLANDS FAMILY MEDICINE
	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	9830115500
	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	10
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	611 W FRANCIS ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 100
	Group Practice or individual's line 2 address
City	NORTH PLATTE
	Group Practice or individual's city
State	NE
	Group Practice or individual's state
Zip Code	691010614
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3085342532
	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	280065
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GREAT PLAINS HEALTH
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	280013
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	THE NEBRASKA MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y