Physician Compare National (NPI:1063771889)

HEALTHCARE PROVIDER: JILL SARA FAY 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	1063771889
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9830468313
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180702003124
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FAY
	Individual professional last name
Provider First Name	JILL
	Individual professional first name
Provider Middle Name	S
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	PERELMAN SCHOOL OF MED AT THE UNIVERSITY OF PENNSYLVANIA
	Individual professional's medical school
Graduation Year	2007
	Individual professional's medical school graduation year
Primary Specialty	DIAGNOSTIC RADIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	404 S 4TH ST
	Group Practice or individual's line 1 address
City	KLAMATH FALLS
	Group Practice or individual's city
State	OR
	Group Practice or individual's state
Zip Code	976016168
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y