Physician Compare National (NPI:1336153386)

HEALTHCARE PROVIDER: TYLER T DEWHURST APRN

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

Individual Professional Information
NPI	1336153386
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5698735959
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20111227000130
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DEWHURST
	Individual professional last name
Provider First Name	TYLER
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	NP
	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	2000
	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	COLLINS MEDICAL ASSOCIATES 2 PC
	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	3779486345
	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	38
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	43 WOODLAND ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 120 4TH FLOOR
	Group Practice or individual's line 2 address
City	HARTFORD
	Group Practice or individual's city
State	CT
	Group Practice or individual's state
Zip Code	061052300
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8604718030
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y