Physician Compare National (NPI:1023190220)

HEALTHCARE PROVIDER: STEVEN CRAIG VANDER WAAL 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	1023190220
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7810030541
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100203000744
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	VANDER WAAL
	Individual professional last name
Provider First Name	STEVEN
	Individual professional first name
Provider Middle Name	C
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF IOWA, RJ & L CARVER COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1976
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	3619 HWY 101 N
	Group Practice or individual's line 1 address
Line 2 Street Address	PACIFIC MEDICAL AND SURGICAL GROUP
	Group Practice or individual's line 2 address
City	GEARHART
	Group Practice or individual's city
State	OR
	Group Practice or individual's state
Zip Code	971384321
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5037383832
	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	380061
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PROVIDENCE PORTLAND MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	381303
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	PROVIDENCE SEASIDE HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	381320
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	COLUMBIA MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y