Physician Compare National (NPI:1518943554)

HEALTHCARE PROVIDER: MAUREEN E KELLY 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	1518943554
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0345159034
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070427000442
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KELLY
	Individual professional last name
Provider First Name	MAUREEN
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	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	UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1987
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	PARKVIEW ANCILLARY SERVICES CORPORATION
	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	4385722511
	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	237
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	4491 BENT BROTHERS BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	PARKVIEW INTERNAL MEDICINE
	Group Practice or individual's line 2 address
City	COLORADO CITY
	Group Practice or individual's city
State	CO
	Group Practice or individual's state
Zip Code	810199990
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7195957525
	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	061316
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SPANISH PEAKS REGIONAL HEALTH CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	060020
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	PARKVIEW MEDICAL CENTER INC
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	060012
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ST MARY CORWIN MED CTR, CENTURA HEALTH
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y