Physician Compare National (NPI:1417186305)

HEALTHCARE PROVIDER: BRENT J BEDKE MD

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

Individual Professional Information
NPI	1417186305
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6406041888
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20140703001803
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BEDKE
	Individual professional last name
Provider First Name	BRENT
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF UTAH SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2009
	Individual professional's medical school graduation year
Primary Specialty	PATHOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MONOLITH DIAGNOSTICS PC
	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	6709174337
	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	1740 SYCAMORE AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE C
	Group Practice or individual's line 2 address
City	KINGMAN
	Group Practice or individual's city
State	AZ
	Group Practice or individual's state
Zip Code	864091039
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9283770433
	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	030055
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	KINGMAN REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	030013
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	YUMA REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y