Physician Compare National (NPI:1124371067)

HEALTHCARE PROVIDER: MICHAEL WAYNE DAUGHERTY 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	1124371067
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8022363050
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180615001068
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DAUGHERTY
	Individual professional last name
Provider First Name	MICHAEL
	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 KENTUCKY COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	2012
	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	EVANSVILLE RADIOLOGY PC
	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	6406826031
	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	18
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	350 W COLUMBIA ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 420
	Group Practice or individual's line 2 address
City	EVANSVILLE
	Group Practice or individual's city
State	IN
	Group Practice or individual's state
Zip Code	477101782
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8124223254
	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	150149
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WOMEN'S HOSPITAL THE
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	150082
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	DEACONESS HOSPITAL INC
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	151319
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	GIBSON GENERAL HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	150100
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	ST. MARY'S HEALTH, INC.
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y