Physician Compare National (NPI:1033364674)

HEALTHCARE PROVIDER: DOUGLAS C BROWN D.O.

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

Individual Professional Information
NPI	1033364674
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5496941353
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101118000510
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BROWN
	Individual professional last name
Provider First Name	DOUGLAS
	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	KANSAS CITY COLLEGE OF MEDICINE AND SURGERY
	Individual professional's medical school
Graduation Year	2005
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP
	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	1658285671
	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	15
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1506 SIOUX DR
	Group Practice or individual's line 1 address
City	MARION
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	629595209
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6189975270
	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	140011
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SOUTHERN ILLINOIS HOSPITAL SERVICES DBA HERRIN HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	140164
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MEMORIAL HOSPITAL OF CARBONDALE
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y