Physician Compare National (NPI:1053358853)

HEALTHCARE PROVIDER: ROBERT C MASTERSON DO

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

Individual Professional Information
NPI	1053358853
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2668449414
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100928000324
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MASTERSON
	Individual professional last name
Provider First Name	ROBERT
	Individual professional first name
Provider Middle Name	CALVIN
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	AT STILL UNIVERSITY OF HEALTH SCIENCES, COLLEGE OF OSTEO MED, KIRKSVILLE
	Individual professional's medical school
Graduation Year	1992
	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
Line 1 Street Address	1901 MISSION
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 66
	Group Practice or individual's line 2 address
City	VICKSBURG
	Group Practice or individual's city
State	MS
	Group Practice or individual's state
Zip Code	391803711
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	250031
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MERIT HEALTH RIVER REGION
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y