Physician Compare National (NPI:1053370056)

HEALTHCARE PROVIDER: SEAN CHARLES DICRISTOFARO 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	1053370056
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9234030438
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040120000610
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DICRISTOFARO
	Individual professional last name
Provider First Name	SEAN
	Individual professional first name
Provider Middle Name	CHARLES
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	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	JC EDWARDS SCHOOL OF MEDICINE, MARSHALL UNIVERSITY
	Individual professional's medical school
Graduation Year	1997
	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	104 STATION PLACE WAY
	Group Practice or individual's line 1 address
City	HURRICANE
	Group Practice or individual's city
State	WV
	Group Practice or individual's state
Zip Code	255268747
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	510022
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CHARLESTON AREA MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	510007
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ST MARY'S MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	510029
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	THOMAS MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	510055
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	CABELL HUNTINGTON HOSPITAL INC
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y