Physician Compare National (NPI:1013005867)

HEALTHCARE PROVIDER: DOUGLAS JOSEPH PACACCIO DPM

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

Individual Professional Information
NPI	1013005867
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2466533419
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080115000800
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PACACCIO
	Individual professional last name
Provider First Name	DOUGLAS
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	WILLIAM M. SCHOLL COLLEGE OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	2003
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	ADVANCED FOOT AND ANKLE SURGEONS, INC.
	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	7416093844
	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	4
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	2180 OAKLAND DR A
	Group Practice or individual's line 1 address
City	SYCAMORE
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	601783122
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8156694811
	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	140286
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	KISHWAUKEE COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	140029
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	COPLEY MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y