Physician Compare National (NPI:1780889808)

HEALTHCARE PROVIDER: KEVIN SCOTT CLIVE M.D.

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

Individual Professional Information
NPI	1780889808
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2365679586
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150505002455
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CLIVE
	Individual professional last name
Provider First Name	KEVIN
	Individual professional first name
Provider Middle Name	S
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	CINCINNATI COLLEGE OF MEDICINE AND SURGERY
	Individual professional's medical school
Graduation Year	2007
	Individual professional's medical school graduation year
Primary Specialty	GENERAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	FRANCISCAN MEDICAL GROUP
	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	0547173866
	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	990
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	2500 CHERRY AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 302
	Group Practice or individual's line 2 address
City	BREMERTON
	Group Practice or individual's city
State	WA
	Group Practice or individual's state
Zip Code	983104202
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3604795083
	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	500039
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HARRISON MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y