Physician Compare National (NPI:1518251719)

HEALTHCARE PROVIDER: JACK E KEHL 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	1518251719
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6709033590
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20160831001264
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KEHL
	Individual professional last name
Provider First Name	JACK
	Individual professional first name
Provider Middle Name	EDWARD
	Individual professional middle name
Provider Name Suffix Text	III
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

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

Practice Information
Organization Legal Name	UNION PHYSICIAN 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	0143366591
	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	51
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	400 MEDICAL PARK DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 203
	Group Practice or individual's line 2 address
City	DOVER
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	446223207
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3306027702
	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	360010
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	UNION HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y