Physician Compare National (NPI:1114085693)

HEALTHCARE PROVIDER: TAMARA SUE WHEELER 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	1114085693
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8628116571
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20091112000587
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WHEELER
	Individual professional last name
Provider First Name	TAMARA
	Individual professional first name
Provider Middle Name	S
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF NEBRASKA COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	2000
	Individual professional's medical school graduation year
Primary Specialty	DIAGNOSTIC RADIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL
	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	7214825371
	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	13
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1000 HEALTH CTR RD
	Group Practice or individual's line 1 address
City	KYLE
	Group Practice or individual's city
State	SD
	Group Practice or individual's state
Zip Code	577520540
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6044552451
	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	430084
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PHS INDIAN HOSPITAL AT ROSEBUD
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	430077
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	REGIONAL HEALTH RAPID CITY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	430027
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	SANFORD USD MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	430016
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	AVERA MCKENNAN HOSPITAL & UNIVERSITY HEALTH CENTER
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y