Physician Compare National (NPI:1053436931)

HEALTHCARE PROVIDER: C TYSON MD

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

Individual Professional Information
NPI	1053436931
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8921181041
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080213000368
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	TYSON
	Individual professional last name
Provider First Name	C
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1983
	Individual professional's medical school graduation year
Primary Specialty	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	8012 S CRANDON AVE
	Group Practice or individual's line 1 address
City	CHICAGO
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	606171124
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	140224
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PRESENCE SAINT JOSEPH HOSPITAL - CHICAGO
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	140181
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SOUTH SHORE HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	140068
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ROSELAND COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	140208
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	ADVOCATE CHRIST HOSPITAL & MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	140088
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	THE UNIVERSITY OF CHICAGO MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1053436931)

HEALTHCARE PROVIDER: C TYSON MD

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information