Physician Compare National (NPI:1699826032)

HEALTHCARE PROVIDER: CAROL A ROACH CRNP

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

Individual Professional Information
NPI	1699826032
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8628137353
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20081110000311
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ROACH
	Individual professional last name
Provider First Name	CAROL
	Individual professional first name
Provider Middle Name	A
	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	2000
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	3933 PERKIOMEN AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 101
	Group Practice or individual's line 2 address
City	READING
	Group Practice or individual's city
State	PA
	Group Practice or individual's state
Zip Code	196062754
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	390044
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	READING HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	390096
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ST JOSEPH MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y