Physician Compare National (NPI:1053604819)

HEALTHCARE PROVIDER: ADAM TODD NICKEL 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	1053604819
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4688826142
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20121207000044
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	NICKEL
	Individual professional last name
Provider First Name	ADAM
	Individual professional first name
Provider Middle Name	T
	Individual professional middle 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	2008
	Individual professional's medical school graduation year
Primary Specialty	OBSTETRICS/GYNECOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	222 N J ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE A
	Group Practice or individual's line 2 address
City	TACOMA
	Group Practice or individual's city
State	WA
	Group Practice or individual's state
Zip Code	984031984
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2535724664
	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	500129
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	TACOMA GENERAL ALLENMORE HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y