Physician Compare National (NPI:1396023446)

HEALTHCARE PROVIDER: KURT EARL KINGHORN DPM

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

Individual Professional Information
NPI	1396023446
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1254556186
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20140708002015
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KINGHORN
	Individual professional last name
Provider First Name	KURT
	Individual professional first name
Provider Middle Name	EARL
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	KENT STATE UNIVERSITY COLLEGE OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	2011
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1828 S MILLENIUM WAY
	Group Practice or individual's line 1 address
City	MERIDIAN
	Group Practice or individual's city
State	ID
	Group Practice or individual's state
Zip Code	836425036
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	130006
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST LUKE'S REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y