Physician Compare National (NPI:1316488729)

HEALTHCARE PROVIDER: CAROL SUZANNE MCCRIMMON FNP-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	1316488729
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7113297508
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170718001025
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MCCRIMMON
	Individual professional last name
Provider First Name	CAROL
	Individual professional first name
Provider Middle Name	S
	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	2016
	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
Line 1 Street Address	52 COUNTY RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 74
	Group Practice or individual's line 2 address
City	MC CARLEY
	Group Practice or individual's city
State	MS
	Group Practice or individual's state
Zip Code	389436820
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	250099
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GREENWOOD LEFLORE HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	251312
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	TYLER HOLMES MEMORIAL HOSPITAL CAH
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y