Physician Compare National (NPI:1861815623)

HEALTHCARE PROVIDER: MICHELLE POOLE ROBERTS 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	1861815623
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2264599190
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20160627001135
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ROBERTS
	Individual professional last name
Provider First Name	MICHELLE
	Individual professional first name
Provider Middle Name	POOLE
	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	2013
	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
Line 1 Street Address	7908 HWY 334
	Group Practice or individual's line 1 address
City	TOCCOPOLA
	Group Practice or individual's city
State	MS
	Group Practice or individual's state
Zip Code	388740389
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	250034
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BAPTIST MEMORIAL HOSPITAL NORTH MS
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	251308
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	PONTOTOC HEALTH SERVICE INC CAH
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y