Physician Compare National (NPI:1558367417)

HEALTHCARE PROVIDER: BERNARD GRUNSTRA 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	1558367417
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6305831819
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20111115000691
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GRUNSTRA
	Individual professional last name
Provider First Name	BERNARD
	Individual professional first name
Provider Middle Name	P
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	PEDIATRIC MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	PEDIATRIC MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	INTERNAL MEDICINE AND PEDIATRIC ASSOC OF BRISTOL
	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	9335114875
	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	350 STEELES RD
	Group Practice or individual's line 1 address
City	BRISTOL
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	376209532
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4238446700
	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	440012
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WELLMONT BRISTOL REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	440176
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	INDIAN PATH MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	490127
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	BUCHANAN GENERAL HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y