Physician Compare National (NPI:1366930174)

HEALTHCARE PROVIDER: KELLI RICH NP-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	1366930174
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1254686124
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180618000649
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	RICH
	Individual professional last name
Provider First Name	KELLI
	Individual professional first name
Provider Middle Name	NICOLE
	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	2017
	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	ST JOSEPH REGIONAL HEALTH CENTER
	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	5294727921
	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	146
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	4401 STATE HWY 6 S
	Group Practice or individual's line 1 address
Line 2 Street Address	CHI ST JOSEPH HEALTH EXPRESS CARE
	Group Practice or individual's line 2 address
City	COLLEGE STATION
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	778454428
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9797315200
	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	450011
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CHI ST JOSEPH HEALTH
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y