Physician Compare National (NPI:1083669592)

HEALTHCARE PROVIDER: LAWRENCE DAVID DICKINSON 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	1083669592
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9133387780
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120228000657
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DICKINSON
	Individual professional last name
Provider First Name	LAWRENCE
	Individual professional first name
Provider Middle Name	D
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF SOUTHERN CALIFORNIA KECK SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1987
	Individual professional's medical school graduation year
Primary Specialty	NEUROSURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	PACIFIC BRAIN AND SPINE MED GRP 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	5395793483
	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	3
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1320 EL CAPITAN DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 300
	Group Practice or individual's line 2 address
City	DANVILLE
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	945266258
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9258842360
	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	050488
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	EDEN MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050689
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SAN RAMON REGIONAL MEDICAL CTR
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	050523
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	SUTTER DELTA MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y