Physician Compare National (NPI:1659344000)

HEALTHCARE PROVIDER: JOE T KELLEY III 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	1659344000
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6406998111
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100119000387
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KELLEY
	Individual professional last name
Provider First Name	JOE
	Individual professional first name
Provider Middle Name	THOMAS
	Individual professional middle name
Provider Name Suffix Text	III
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF TENNESSEE, HSC, COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1997
	Individual professional's medical school graduation year
Primary Specialty	RHEUMATOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	INTERCOASTAL 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	6305730912
	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	138
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	943 S BENEVA RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 201
	Group Practice or individual's line 2 address
City	SARASOTA
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	342322472
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9413663062
	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	100087
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SARASOTA MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y