Physician Compare National (NPI:1306338736)

HEALTHCARE PROVIDER: KELLI KAY DUCRAY

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

Individual Professional Information
NPI	1306338736
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0143571026
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20191210002210
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DUCRAY
	Individual professional last name
Provider First Name	KELLI
	Individual professional first name
Provider Middle Name	K
	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	2018
	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	CARDIOJOST, 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	2062429913
	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	9
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	140 S POWER RD
	Group Practice or individual's line 1 address
City	MESA
	Group Practice or individual's city
State	AZ
	Group Practice or individual's state
Zip Code	852065297
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4809454343212
	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	030036
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CHANDLER REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y