Physician Compare National (NPI:1922255496)

HEALTHCARE PROVIDER: SHELLEY RENEE KOHLLEPPEL 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	1922255496
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5395878656
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100806000403
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KOHLLEPPEL
	Individual professional last name
Provider First Name	SHELLEY
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF TEXAS MEDICAL SCHOOL AT HOUSTON
	Individual professional's medical school
Graduation Year	2007
	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	146 LAUREL VISTA DR
	Group Practice or individual's line 1 address
City	PIPE CREEK
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	780636389
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	450007
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PETERSON REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y