Physician Compare National (NPI:1598731317)

HEALTHCARE PROVIDER:

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

Individual Professional Information
NPI	1598731317
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2769537059
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090910000407
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MILLER
	Individual professional last name
Provider First Name	KENNETH
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	CHICAGO COLLEGE OF MEDICINE AND SURGERY
	Individual professional's medical school
Graduation Year	1968
	Individual professional's medical school graduation year
Primary Specialty	NEPHROLOGY
	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	BONAVENTURE MEDICAL FOUNDATION LLC
	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	7517863178
	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	187
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1555 BARRINGTON RD
	Group Practice or individual's line 1 address
City	HOFFMAN ESTATE
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	601691019
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	140117
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PRESENCE RESURRECTION MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y