Physician Compare National (NPI:1073537403)

HEALTHCARE PROVIDER: TOD WYN 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	1073537403
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4587557293
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070706000088
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WYN
	Individual professional last name
Provider First Name	TOD
	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	MICHIGAN STATE UNIVERSITY COLLEGE OF HUMAN MEDICINE
	Individual professional's medical school
Graduation Year	1992
	Individual professional's medical school graduation year
Primary Specialty	HOSPICE/PALLIATIVE CARE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	EMERGENCY MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	EMERGENCY MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	HOSPICE OF HOLLAND, INC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	9133132970
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	6
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	270 HOOVER BLVD
	Group Practice or individual's line 1 address
City	HOLLAND
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	494233719
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6163962972
	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	230072
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HOLLAND COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y