Physician Compare National (NPI:1629143284)

HEALTHCARE PROVIDER: JEAN L. KRISTELLER PH.D.

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

Individual Professional Information
NPI	1629143284
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6901932862
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100330000697
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KRISTELLER
	Individual professional last name
Provider First Name	JEAN
	Individual professional first name
Provider Middle Name	L
	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	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	INDIANA STATE UNIVERSITY
	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	8729177878
	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	3
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	424 N 7TH ST ROOT HALL
	Group Practice or individual's line 1 address
City	TERRE HAUTE
	Group Practice or individual's city
State	IN
	Group Practice or individual's state
Zip Code	478091928
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8122373317
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y