Physician Compare National (NPI:1356701221)

HEALTHCARE PROVIDER: BETSY JILL CHAPPELL 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	1356701221
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1254638687
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20160329002271
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CHAPPELL
	Individual professional last name
Provider First Name	BETSY
	Individual professional first name
Provider Middle Name	JILL
	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	2015
	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	ETMC PHYSICIAN GROUP, 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	4486915600
	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	205
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	406 E HWY 243
	Group Practice or individual's line 1 address
City	CANTON
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	751032409
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9035674784
	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	450083
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	EAST TEXAS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	450389
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	EAST TEXAS MEDICAL CENTER ATHENS
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y