Physician Compare National (NPI:1578538690)

HEALTHCARE PROVIDER: KEVIN MICHEAL TRAYNOR 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	1578538690
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3173712734
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110112000862
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	TRAYNOR
	Individual professional last name
Provider First Name	KEVIN
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY CENTRAL DEL CARIBE ESCUELA DE MEDICINA
	Individual professional's medical school
Graduation Year	1981
	Individual professional's medical school graduation year
Primary Specialty	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1559 SE LENNARD RD
	Group Practice or individual's line 1 address
City	PORT SAINT LUCIE
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	349526542
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7723350505
	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	100044
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MARTIN MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	100260
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ST LUCIE MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y