Physician Compare National (NPI:1972967966)

HEALTHCARE PROVIDER: KELLI HUNTER 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	1972967966
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0345573432
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190604002729
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HUNTER
	Individual professional last name
Provider First Name	KELLI
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	MOREHOUSE SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2016
	Individual professional's medical school graduation year
Primary Specialty	EMERGENCY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	JAX EMERGENCY PHYSICIANS, 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	1951682293
	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	34
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	8300 RED BUD LAKE RD
	Group Practice or individual's line 1 address
City	OVIEDO
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	327656801
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4073596010
	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	100256
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	REGIONAL MEDICAL CENTER BAYONET POINT
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	110087
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	GWINNETT MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	100329
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	OVIEDO MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y