Physician Compare National (NPI:1104890482)

HEALTHCARE PROVIDER: MARTIN CLEARY 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	1104890482
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7517879919
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20151223001664
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CLEARY
	Individual professional last name
Provider First Name	MARTIN
	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	ALBANY MEDICAL COLLEGE OF UNION UNIVERSITY
	Individual professional's medical school
Graduation Year	1982
	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	LAFAYETTE COUNTY
	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	9436054772
	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	14
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	800 CLAY ST
	Group Practice or individual's line 1 address
City	DARLINGTON
	Group Practice or individual's city
State	WI
	Group Practice or individual's state
Zip Code	535301228
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6087764466
	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	521312
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MEMORIAL HOSPITAL OF LAFAYETTE COUNTY
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	520098
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	UNIVERSITY OF WI HOSPITALS & CLINICS AUTHORITY
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	141302
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	MIDWEST MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y