Physician Compare National (NPI:1639366321)

HEALTHCARE PROVIDER: JUSTIN EHMKE PA-C

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

Individual Professional Information
NPI	1639366321
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8426139338
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20141030001773
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	EHMKE
	Individual professional last name
Provider First Name	JUSTIN
	Individual professional first name
Provider Middle Name	T
	Individual professional middle name
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	2007
	Individual professional's medical school graduation year
Primary Specialty	PHYSICIAN ASSISTANT
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	BANNER PRIMARY CARE PHYSICIANS ARIZONA 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	6406020155
	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	170
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	3493 S MERCY RD
	Group Practice or individual's line 1 address
Line 2 Street Address	BLDG 15
	Group Practice or individual's line 2 address
City	GILBERT
	Group Practice or individual's city
State	AZ
	Group Practice or individual's state
Zip Code	852970434
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4808275042
	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	030122
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BANNER GATEWAY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y