Physician Compare National (NPI:1588209563)

HEALTHCARE PROVIDER: ROSALYN A INGRAM APRN

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

Individual Professional Information
NPI	1588209563
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0143654210
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200211001721
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	INGRAM
	Individual professional last name
Provider First Name	ROSALYN
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2019
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	CONNECTICUT GI PC
	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	9830110758
	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	120
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	25 NEWELL RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE E36
	Group Practice or individual's line 2 address
City	BRISTOL
	Group Practice or individual's city
State	CT
	Group Practice or individual's state
Zip Code	060105132
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8605839252
	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	070029
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BRISTOL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y