Physician Compare National (NPI:1407955487)

HEALTHCARE PROVIDER: LARRY DAVID KETNER 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	1407955487
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0749370229
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20071220000475
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KETNER
	Individual professional last name
Provider First Name	LARRY
	Individual professional first name
Provider Middle Name	D
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	WILLIAM M. SCHOLL COLLEGE OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	1988
	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	2011 ROCK ST
	Group Practice or individual's line 1 address
Line 2 Street Address	D1
	Group Practice or individual's line 2 address
City	PERU
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	613541392
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	140234
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ILLINOIS VALLEY COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	141310
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	OSF SAINT PAUL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y