Physician Compare National (NPI:1649552621)

HEALTHCARE PROVIDER: JOLENE MILLER D.O.

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

Individual Professional Information
NPI	1649552621
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1153586912
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120628000116
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MILLER
	Individual professional last name
Provider First Name	JOLENE
	Individual professional first name
Provider Middle Name	I
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NEW YORK MEDICAL COLLEGE
	Individual professional's medical school
Graduation Year	2007
	Individual professional's medical school graduation year
Primary Specialty	EMERGENCY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERNAL MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	TEAM PHYSICIANS OF NORTHERN CALIFORNIA MEDICAL GROUP INC
	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	7113215146
	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	41
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	5555 GROSSMONT CTR DR
	Group Practice or individual's line 1 address
City	LA MESA
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	919423019
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6194650711
	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	050026
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GROSSMONT HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050039
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ENLOE MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y