Individual Professional Information |
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NPI
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1013931088
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Unique healthcare provider (clinician) ID assigned by NPPES
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PECOS UID
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7113006479
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Unique individual clinician ID assigned by PECOS
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Professional Enrollment ID
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I20080512000468
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Unique ID for the individual professional enrollment that is the source for the data in the observation
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Provider Last Name
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MADONNA
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Individual professional last name
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Provider First Name
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ROBERT
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Individual professional first name
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Provider Middle Name
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C
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Individual professional middle name
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Provider Name Suffix Text
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JR.
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The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
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Provider Gender
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M
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The provider's gender if the provider is a person.
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Medical School Information |
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Medical School Name
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PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE
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Individual professional's medical school
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Graduation Year
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1992
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Individual professional's medical school graduation year
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Primary Specialty
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FAMILY MEDICINE
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Primary medical specialty reported by the individual professional in the selected enrollment
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Secondary Specialty 1
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GERIATRIC MEDICINE
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First secondary medical specialty reported by the individual professional in the selected enrollment
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All Secondary Specialties
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GERIATRIC MEDICINE
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All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas
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Hospital(s) Affiliation Information |
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Hospital Affiliation CCN 1
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390081
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Medicare CCN of hospital where individual professional provides service 1
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Hospital Affiliation LBN 1
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DELAWARE COUNTY MEMORIAL HOSPITAL
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Legal business name of hospital where individual professional provides service 1
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Hospital Affiliation CCN 2
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390195
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Medicare CCN of hospital where individual professional provides service 2
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Hospital Affiliation LBN 2
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MAIN LINE HOSPITAL LANKENAU
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Legal business name of hospital where individual professional provides service 2
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Hospital Affiliation CCN 3
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390139
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Medicare CCN of hospital where individual professional provides service 3
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Hospital Affiliation LBN 3
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BRYN MAWR HOSPITAL
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Legal business name of hospital where individual professional provides service 3
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Hospital Affiliation CCN 4
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390222
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Medicare CCN of hospital where individual professional provides service 4
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Hospital Affiliation LBN 4
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RIDDLE MEMORIAL HOSPITAL
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Legal business name of hospital where individual professional provides service 4
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Hospital Affiliation CCN 5
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390180
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Medicare CCN of hospital where individual professional provides service 5
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Hospital Affiliation LBN 5
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CROZER CHESTER MEDICAL CENTER
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Legal business name of hospital where individual professional provides service 5
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Professional Accepts Medicare Assignment
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Y
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