Physician Compare National (NPI:1619944485)

HEALTHCARE PROVIDER: ROBERT HART KELLY 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	1619944485
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3173647997
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100901000072
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KELLY
	Individual professional last name
Provider First Name	ROBERT
	Individual professional first name
Provider Middle Name	HART
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF TEXAS MEDICAL SCHOOL AT HOUSTON
	Individual professional's medical school
Graduation Year	1981
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	929 COLLEGE AVE
	Group Practice or individual's line 1 address
City	FORT WORTH
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	761043011
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	450135
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y