Physician Compare National (NPI:1730529892)

HEALTHCARE PROVIDER: CHANTEL DERISE DIXON FNP

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

Individual Professional Information
NPI	1730529892
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5496989352
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20131008000783
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DIXON
	Individual professional last name
Provider First Name	CHANTEL
	Individual professional first name
Provider Middle Name	DERISE
	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	2012
	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
Organization Legal Name	TIDEWATER GASTROENTEROLOGY, PLLC
	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	4284682899
	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	19
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	112 GAINSBOROUGH SQ
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 200
	Group Practice or individual's line 2 address
City	CHESAPEAKE
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	233201706
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7575470798
	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	490120
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CHESAPEAKE REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y