Physician Compare National (NPI:1225120991)

HEALTHCARE PROVIDER: CAROL JOAN PEITZMAN APRN, CNS

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

Individual Professional Information
NPI	1225120991
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9830148642
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050119000754
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PEITZMAN
	Individual professional last name
Provider First Name	CAROL
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.
Provider Credential Text	CNS
	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	OTHER
	Individual professional's medical school
Graduation Year	2002
	Individual professional's medical school graduation year
Primary Specialty	CERTIFIED CLINICAL NURSE SPECIALIST (CNS)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	SOUTHERN CITIES CLINIC
	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	7517912991
	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	5
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	400 4TH ST NW
	Group Practice or individual's line 1 address
City	FARIBAULT
	Group Practice or individual's city
State	MN
	Group Practice or individual's state
Zip Code	550215031
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5073846830
	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	240004
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HENNEPIN COUNTY MEDICAL CENTER 1
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	240057
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ABBOTT NORTHWESTERN HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	240043
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	MAYO CLINIC HEALTH SYSTEM - ALBERT LEA AND AUSTIN
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	240080
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	UNIVERSITY OF MINNESOTA MEDICAL CENTER, FAIRVIEW
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y