Physician Compare National (NPI:1437128857)

HEALTHCARE PROVIDER: MITCHAEL LEE VICKERS CRNA

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

Individual Professional Information
NPI	1437128857
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3274576590
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050608000191
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	VICKERS
	Individual professional last name
Provider First Name	MITCHAEL
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	CNA
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1998
	Individual professional's medical school graduation year
Primary Specialty	CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	SOUTHCARE ANESTHESIA SERVICES 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	0345504494
	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	3825 MEDICAL PARK DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 300
	Group Practice or individual's line 2 address
City	AUSTELL
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	301066831
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7709414810
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y