Physician Compare National (NPI:1861469017)

HEALTHCARE PROVIDER: CHARLES ROBERT KAELIN JR. 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	1861469017
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3375440340
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20031217000657
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KAELIN
	Individual professional last name
Provider First Name	CHARLES
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Name Suffix Text	JR.
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	UNIVERSITY OF LOUISVILLE SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1982
	Individual professional's medical school graduation year
Primary Specialty	ORTHOPEDIC SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	TENNESSEE SPORTS MEDICINE, PC
	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	8729103189
	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	3
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	5000 CROSSINGS CIR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 101
	Group Practice or individual's line 2 address
City	MT JULIET
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	371228591
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6157581010
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y