Physician Compare National (NPI:1245586296)

HEALTHCARE PROVIDER: KINDRELL S TUCKER M.D.

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

Individual Professional Information
NPI	1245586296
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1254651466
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150629000149
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	TUCKER
	Individual professional last name
Provider First Name	KINDRELL
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF TEXAS MEDICAL SCHOOL AT HOUSTON
	Individual professional's medical school
Graduation Year	2012
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	KINDRELL S TUCKER MD PA
	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	4587936125
	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	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1320 S JOHN REDDITT DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE B
	Group Practice or individual's line 2 address
City	LUFKIN
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	759044368
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9362253657
	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	450484
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WOODLAND HEIGHTS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	450211
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	CHI ST LUKES HEALTH MEMORIAL LUFKIN
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y