Physician Compare National (NPI:1053481432)

HEALTHCARE PROVIDER: MICHAEL A CLANCY

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

Individual Professional Information
NPI	1053481432
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0446351563
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070719000435
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CLANCY
	Individual professional last name
Provider First Name	MICHAEL
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	DES MOINES UNIVERSITY OF OSTEOPATHIC MEDICINE AND HEALTH SCIENCES
	Individual professional's medical school
Graduation Year	1978
	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	835 GEORGIANA ST
	Group Practice or individual's line 1 address
City	PORT ANGELES
	Group Practice or individual's city
State	WA
	Group Practice or individual's state
Zip Code	983623511
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3604528534
	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	500072
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	OLYMPIC MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y