Physician Compare National (NPI:1114213469)

HEALTHCARE PROVIDER: GRECORI ANDERSON 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	1114213469
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9739318049
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190307003373
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ANDERSON
	Individual professional last name
Provider First Name	GRECORI
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF KANSAS SCHOOL OF MED (KC/WICH/SAL)
	Individual professional's medical school
Graduation Year	2011
	Individual professional's medical school graduation year
Primary Specialty	UROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	COLUMBIA LUTHERAN CHARITIES
	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	5294643359
	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	53
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	2265 EXCHANGE ST
	Group Practice or individual's line 1 address
City	ASTORIA
	Group Practice or individual's city
State	OR
	Group Practice or individual's state
Zip Code	971033331
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5033384060
	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	381320
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	COLUMBIA MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	501314
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	OCEAN BEACH HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y