Physician Compare National (NPI:1629079512)

HEALTHCARE PROVIDER: BETH A MIKKELSEN 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	1629079512
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1052440229
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100526000557
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MIKKELSEN
	Individual professional last name
Provider First Name	BETH
	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	1983
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	HOSPICE/PALLIATIVE CARE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	HOSPICE/PALLIATIVE CARE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	SACRED HEART HEALTH SERVICES
	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	6103729066
	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	65
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	501 SUMMIT ST
	Group Practice or individual's line 1 address
City	YANKTON
	Group Practice or individual's city
State	SD
	Group Practice or individual's state
Zip Code	570783855
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	430012
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	AVERA SACRED HEART HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y