Physician Compare National (NPI:1609171677)

HEALTHCARE PROVIDER: LEROY GROOVER JR. CRNA

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

Individual Professional Information
NPI	1609171677
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4486832433
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110622000671
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GROOVER
	Individual professional last name
Provider First Name	LEROY
	Individual professional first name
Provider Name Suffix Text	JR.
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
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	2010
	Individual professional's medical school graduation year
Primary Specialty	CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	AMS SOUTHEAST 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	3870880792
	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	51
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1499 FAIR RD
	Group Practice or individual's line 1 address
City	STATESBORO
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	304581683
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9124861000
	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	110075
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	EAST GEORGIA REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	110036
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MEMORIAL UNIVERSITY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	M