Physician Compare National (NPI:1114956430)

HEALTHCARE PROVIDER: JACK MING HSU 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	1114956430
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6901993450
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150311000604
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HSU
	Individual professional last name
Provider First Name	JACK
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1996
	Individual professional's medical school graduation year
Primary Specialty	OTOLARYNGOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	WARREN MEMORIAL HOSPITAL, INC.
	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	2365330347
	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	27
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	120 N COMMERCE ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 230 245 255
	Group Practice or individual's line 2 address
City	FRONT ROYAL
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	226302660
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5406350800
	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	490033
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WARREN MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	490005
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	WINCHESTER MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y