Physician Compare National (NPI:1861532350)

HEALTHCARE PROVIDER: JEFFREY D KELLOGG MD

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

Individual Professional Information
NPI	1861532350
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3577620418
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090320000473
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KELLOGG
	Individual professional last name
Provider First Name	JEFFREY
	Individual professional first name
Provider Middle Name	D
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	ORAL ROBERTS UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	45 MADDEX DR
	Group Practice or individual's line 1 address
City	SHEPHERDSTOWN
	Group Practice or individual's city
State	WV
	Group Practice or individual's state
Zip Code	254434322
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3048769321
	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	510008
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BERKELEY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	511319
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	JEFFERSON MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y