Physician Compare National (NPI:1124412234)

HEALTHCARE PROVIDER: CHARLES C MARTIN IV MD

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

Individual Professional Information
NPI	1124412234
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2769798024
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20191021000734
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MARTIN
	Individual professional last name
Provider First Name	CHARLES
	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	UNIVERSITY OF MISSISSIPPI SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2015
	Individual professional's medical school graduation year
Primary Specialty	ANESTHESIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERVENTIONAL PAIN MANAGEMENT
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERVENTIONAL PAIN MANAGEMENT
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	SOUTHERN PAIN ASSOCIATES, PLLC
	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	1456328210
	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	8
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1001 14TH ST
	Group Practice or individual's line 1 address
City	MERIDIAN
	Group Practice or individual's city
State	MS
	Group Practice or individual's state
Zip Code	393014458
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6014829224
	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	250104
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ANDERSON REGIONAL MEDICAL CTR
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y