Physician Compare National (NPI:1083673974)

HEALTHCARE PROVIDER:

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1083673974
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7618083064
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110203000627
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	VANDERLUGT
	Individual professional last name
Provider First Name	RONALD
	Individual professional first name
Provider Middle Name	LEE
	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 MICHIGAN MEDICAL SCHOOL
	Individual professional's medical school
Graduation Year	1982
	Individual professional's medical school graduation year
Primary Specialty	OPHTHALMOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1717 SHAFFER ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 207
	Group Practice or individual's line 2 address
City	KALAMAZOO
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	490481625
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2693831110
	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	230117
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BORGESS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y