Physician Compare National (NPI:1073556452)

HEALTHCARE PROVIDER: TIMOTHY JAMES DURKAN GREGORY 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	1073556452
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1658415336
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110315000347
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GREGORY
	Individual professional last name
Provider First Name	TIMOTHY
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	STATE UNIVERSITY OF NY UPSTATE MEDICAL UNIVERSITY
	Individual professional's medical school
Graduation Year	1996
	Individual professional's medical school graduation year
Primary Specialty	EMERGENCY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	19 MOSS CREEK VLG
	Group Practice or individual's line 1 address
Line 2 Street Address	B4
	Group Practice or individual's line 2 address
City	HILTON HEAD ISLAND
	Group Practice or individual's city
State	SC
	Group Practice or individual's state
Zip Code	299261155
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	420079
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	TRIDENT MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	420004
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MUSC MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y