Physician Compare National (NPI:1356717862)

HEALTHCARE PROVIDER: KIMBERLY DAWN SMITH ARNP

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

Individual Professional Information
NPI	1356717862
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3375844277
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20151218000672
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SMITH
	Individual professional last name
Provider First Name	KIMBERLY
	Individual professional first name
Provider Middle Name	D
	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	NORTHWEST FLORIDA PRIMARY CARE LLC
	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	0143379537
	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	3
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	4400 HWY 20 E
	Group Practice or individual's line 1 address
Line 2 Street Address	STE 203 AND 204
	Group Practice or individual's line 2 address
City	NICEVILLE
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	325788779
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8508973678
	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	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
Professional Accepts Medicare Assignment	Y