Physician Compare National (NPI:1922055730)

HEALTHCARE PROVIDER: PHYLLIS JEAN KAPELLEN 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	1922055730
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3577573849
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080827000402
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KAPELLEN
	Individual professional last name
Provider First Name	PHYLLIS
	Individual professional first name
Provider Middle Name	JEAN
	Individual professional middle name
Provider Gender	F
	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 ARIZONA COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1999
	Individual professional's medical school graduation year
Primary Specialty	INTERVENTIONAL RADIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MUSCULOSKELETAL IMAGING AND INTERVENTIONAL LLC
	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	2466463617
	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	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	105 S BRYANT
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 404K
	Group Practice or individual's line 2 address
City	EDMOND
	Group Practice or individual's city
State	OK
	Group Practice or individual's state
Zip Code	730346309
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2813597788
	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	370225
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SUMMIT MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y