Physician Compare National (NPI:1992063267)

HEALTHCARE PROVIDER: JENNA BEASLEY MD

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

Individual Professional Information
NPI	1992063267
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1850534942
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20140925002100
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BEASLEY
	Individual professional last name
Provider First Name	JENNA
	Individual professional first name
Provider Middle Name	M
	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 SOUTH FLORIDA COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	2012
	Individual professional's medical school graduation year
Primary Specialty	DERMATOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	6202 N 9TH AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 2
	Group Practice or individual's line 2 address
City	PENSACOLA
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	325048291
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	100025
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SACRED HEART HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y