Physician Compare National (NPI:1265552210)

HEALTHCARE PROVIDER: GERALD STEELE KIDD III PA-C

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

Individual Professional Information
NPI	1265552210
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4789603812
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20141215001693
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KIDD
	Individual professional last name
Provider First Name	GERALD
	Individual professional first name
Provider Middle Name	S
	Individual professional middle name
Provider Name Suffix Text	III
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	PA
	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	2005
	Individual professional's medical school graduation year
Primary Specialty	PHYSICIAN ASSISTANT
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	BOULDER VALLEY GASTROENTEROLOGY INC.
	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	4688577174
	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	27
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	13952 DENVER W PKWY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 100 BLDG 53
	Group Practice or individual's line 2 address
City	LAKEWOOD
	Group Practice or individual's city
State	CO
	Group Practice or individual's state
Zip Code	804013141
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3036045000
	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	060022
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	UCH-MEMORIAL HEALTH SYSTEM
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y