Physician Compare National (NPI:1124052212)

HEALTHCARE PROVIDER: MARK ARDEN BOETTLER 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	1124052212
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4284717174
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080215000326
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BOETTLER
	Individual professional last name
Provider First Name	MARK
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF CINCINNATI COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1986
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1237 N MONROE DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 202
	Group Practice or individual's line 2 address
City	XENIA
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	453851654
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9373721254
	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	360026
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GREENE MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	360079
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	KETTERING MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y