Physician Compare National (NPI:1104818806)

HEALTHCARE PROVIDER: MICHELLE E MASON-WOODARD M.D.

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

Individual Professional Information
NPI	1104818806
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5092849778
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100817000695
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MASON WOODARD
	Individual professional last name
Provider First Name	MICHELLE
	Individual professional first name
Provider Middle Name	ENDIRA
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	MERCER UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1997
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	DOCTOR ON DEMAND PROFESSIONALS, P.C.
	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	9436464567
	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	54
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	40 TECHNOLOGY PKWY S
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 300
	Group Practice or individual's line 2 address
City	NORCROSS
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	300922924
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4157428411
	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	111325
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WILLS MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	110111
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	110028
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	UNIVERSITY HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	420071
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	SELF REGIONAL HEALTHCARE
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y