Physician Compare National (NPI:1851463707)

HEALTHCARE PROVIDER:

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

Individual Professional Information
NPI	1851463707
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0941326987
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100927001152
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PACE
	Individual professional last name
Provider First Name	BRANTLEY
	Individual professional first name
Provider Middle Name	BERNARD
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF MISSISSIPPI SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1958
	Individual professional's medical school graduation year
Primary Specialty	GENERAL PRACTICE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	713 WATTS ST
	Group Practice or individual's line 1 address
City	MONTICELLO
	Group Practice or individual's city
State	MS
	Group Practice or individual's state
Zip Code	396540518
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6015877795
	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	251305
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	LAWRENCE COUNTY HOSPITAL CAH
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	250057
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	KING'S DAUGHTERS MEDICAL CENTER-BROOKHAVEN
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y