Physician Compare National (NPI:1053329094)

HEALTHCARE PROVIDER: ANDREW CHRISTIAN STANISLAV D.P.M.

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

Individual Professional Information
NPI	1053329094
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4284534181
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20111118000059
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	STANISLAV
	Individual professional last name
Provider First Name	ANDREW
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	DPM
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	COLLEGE OF PODIATRIC MED AND SURGERY, DES MOINES UNIVERSITY
	Individual professional's medical school
Graduation Year	1997
	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	SWFAC PLC
	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	6608776505
	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	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	502 E REED ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SOUTHWEST FOOT AND ANKLE CENTER
	Group Practice or individual's line 2 address
City	RED OAK
	Group Practice or individual's city
State	IA
	Group Practice or individual's state
Zip Code	515662350
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7126235178
	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	161366
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SHENANDOAH MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	161363
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MONTGOMERY COUNTY MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y