Physician Compare National (NPI:1336132570)

HEALTHCARE PROVIDER: WYNDAL K BLANKENSHIP MD

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

Individual Professional Information
NPI	1336132570
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7517958960
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040524000822
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BLANKENSHIP
	Individual professional last name
Provider First Name	WYNDAL
	Individual professional first name
Provider Middle Name	K
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	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	EASTERN VIRGINIA MEDICAL SCHOOL
	Individual professional's medical school
Graduation Year	1992
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	137 HOSPITAL DR NE
	Group Practice or individual's line 1 address
City	FORT WALTON BEACH
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	325485063
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	100054
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	TWIN CITIES HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	100292
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SACRED HEART HOSPITAL ON THE EMERALD COAST
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	100223
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	FORT WALTON BEACH MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	100122
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	NORTH OKALOOSA MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y