Physician Compare National (NPI:1891199519)

HEALTHCARE PROVIDER: JESSICA ROOT AU.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	1891199519
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8224361357
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190605000676
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ELLIOTT
	Individual professional last name
Provider First Name	JESSICA
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	RUSH MEDICAL COLLEGE OF RUSH UNIVERSITY
	Individual professional's medical school
Graduation Year	2014
	Individual professional's medical school graduation year
Primary Specialty	QUALIFIED AUDIOLOGIST
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	LAKE COUNTY HEAD AND NECK SPECIALISTS S.C.
	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	3476640459
	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	7
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	222 S GREENLEAF ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 102
	Group Practice or individual's line 2 address
City	GURNEE
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	600315705
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8476624442
	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	140130
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	NORTHWESTERN LAKE FOREST HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y