Physician Compare National (NPI:1740760784)

HEALTHCARE PROVIDER: KAITLYN NEVILL FNP-C

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

Individual Professional Information
NPI	1740760784
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5496092074
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190122001254
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	NEVILL
	Individual professional last name
Provider First Name	KAITLYN
	Individual professional first name
Provider Middle Name	MARIE
	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	2018
	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	ST VINCENT 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	7012047640
	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	703
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1214 E NATIONAL AVE
	Group Practice or individual's line 1 address
Marker of address line 2 suppression	Y
	Marker that address as reported may be incomplete
City	BRAZIL
	Group Practice or individual's city
State	IN
	Group Practice or individual's state
Zip Code	478342700
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	151309
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST. VINCENT CLAY HOSPITAL INC
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	151333
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	PUTNAM COUNTY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y