Physician Compare National (NPI:1114966264)

HEALTHCARE PROVIDER: PETER JAMES JOHNSON D.P.M.

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

Individual Professional Information
NPI	1114966264
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6800899212
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20060824000011
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JOHNSON
	Individual professional last name
Provider First Name	PETER
	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.
Provider Credential Text	DPM
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	TEMPLE UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2003
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	107 W CENTRE ST
	Group Practice or individual's line 1 address
City	MAHANOY CITY
	Group Practice or individual's city
State	PA
	Group Practice or individual's state
Zip Code	179482605
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	390183
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST LUKE'S MINERS MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	390194
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BLUE MOUNTAIN HOSPITAL-GNADEN HUETTEN CAMPUS
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	390049
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ST LUKE'S HOSPITAL BETHLEHEM
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y