Physician Compare National (NPI:1124401948)

HEALTHCARE PROVIDER: DEVIN CHRISTOPHER CARROLL DPM

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

Individual Professional Information
NPI	1124401948
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8628325511
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180724001638
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CARROLL
	Individual professional last name
Provider First Name	DAVIN
	Individual professional first name
Provider Middle Name	C
	Individual professional middle 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	2015
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	SPORTS MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	SPORTS MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	1FOOT 2FOOT CENTRE FOR FOOT AND ANKLE CARE, 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	7315042835
	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	6
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	171 N MAIN ST
	Group Practice or individual's line 1 address
City	SUFFOLK
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	234344507
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7579340768
	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	490093
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SENTARA CAREPLEX HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	490017
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BON SECOURS MARYVIEW MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	490044
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	SENTARA OBICI HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y