Physician Compare National (NPI:1093786055)

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	1093786055
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9537351259
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101012001349
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	TALLEY
	Individual professional last name
Provider First Name	HERMAN
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Name Suffix Text	II
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF ARKANSAS COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1971
	Individual professional's medical school graduation year
Primary Specialty	OBSTETRICS/GYNECOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	403 W OAK ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 303
	Group Practice or individual's line 2 address
City	EL DORADO
	Group Practice or individual's city
State	AR
	Group Practice or individual's state
Zip Code	717304575
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8708620150
	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	040088
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MEDICAL CENTER OF SOUTH ARKANSAS
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	040114
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BAPTIST HEALTH MEDICAL CENTER-LITTLE ROCK
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	040067
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	MAGNOLIA HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y