Physician Compare National (NPI:1922516723)

HEALTHCARE PROVIDER: KEITHA DAVIS APRN, FNP-BC, FPA

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

Individual Professional Information
NPI	1922516723
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8628330115
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180321001057
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FARLEY
	Individual professional last name
Provider First Name	KEITHA
	Individual professional first name
Provider Middle Name	F
	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	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	ASSOCIATED UROLOGICAL SPECIALISTS 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	7416996889
	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	25
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	ONE INGALLS DR
	Group Practice or individual's line 1 address
City	HARVEY
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	604263558
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7085966860
	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	140191
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	INGALLS MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	140242
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	CENTRAL DUPAGE HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	140250
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ADVOCATE SOUTH SUBURBAN HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y