Physician Compare National (NPI:1689767675)

HEALTHCARE PROVIDER: BRENDA G WATSON CRNA

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

Individual Professional Information
NPI	1689767675
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3173584059
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20041023000300
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WATSON
	Individual professional last name
Provider First Name	BRENDA
	Individual professional first name
Provider Middle Name	G
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.
Provider Credential Text	CNA
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1995
	Individual professional's medical school graduation year
Primary Specialty	CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	PAINTSVILLE HMA PHYSICIAN MANAGEMENT, 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	8820092026
	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	24
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	625 JAMES TRIMBLE BLVD
	Group Practice or individual's line 1 address
City	PAINTSVILLE
	Group Practice or individual's city
State	KY
	Group Practice or individual's state
Zip Code	412401055
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6067893511
	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	180078
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PAUL B HALL REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y