Physician Compare National (NPI:1548261191)

HEALTHCARE PROVIDER: KENNETH REED GRAVETT DO

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

Individual Professional Information
NPI	1548261191
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4385770437
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100329000712
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GRAVETT
	Individual professional last name
Provider First Name	KENNETH
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	KANSAS CITY COLLEGE OF MEDICINE AND SURGERY
	Individual professional's medical school
Graduation Year	1980
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	517 WASHINGTON ST
	Group Practice or individual's line 1 address
City	SHELBYVILLE
	Group Practice or individual's city
State	KY
	Group Practice or individual's state
Zip Code	400651129
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5026330120
	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	180016
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	JEWISH HOSPITAL - SHELBYVILLE
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	M