Physician Compare National (NPI:1811225717)

HEALTHCARE PROVIDER: KRISTI JO NISSLEY 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	1811225717
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3577698349
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100318000323
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	NISSLEY
	Individual professional last name
Provider First Name	KRISTI
	Individual professional first name
Provider Middle Name	JO
	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	2008
	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	FC INDIANA 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	8820360001
	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	27
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1202 E TIPTON ST
	Group Practice or individual's line 1 address
City	SEYMOUR
	Group Practice or individual's city
State	IN
	Group Practice or individual's state
Zip Code	472743540
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8126724933
	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	151335
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST VINCENT DUNN HOSPITAL INC
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	151306
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	INDIANA UNIVERSITY HEALTH PAOLI HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	151328
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	INDIANA UNIVERSITY HEALTH BEDFORD HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y