Physician Compare National (NPI:1912498767)

HEALTHCARE PROVIDER: MELISSA ANN RENZI FNP-BC

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

Individual Professional Information
NPI	1912498767
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0042558249
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200518001659
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	RENZI
	Individual professional last name
Provider First Name	MELISSA
	Individual professional first 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	2017
	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
Organization Legal Name	KENNEDY MEDICAL GROUP PRACTICE, P.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	2860616877
	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	290
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	301 ROUTE 73 N
	Group Practice or individual's line 1 address
Line 2 Street Address	WEST BERLIN PANDS CARE
	Group Practice or individual's line 2 address
City	WEST BERLIN
	Group Practice or individual's city
State	NJ
	Group Practice or individual's state
Zip Code	08091
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8569220058
	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	390174
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	THOMAS JEFFERSON UNIVERSITY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y