Physician Compare National (NPI:1134111768)

HEALTHCARE PROVIDER: MARK R GRUBB 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	1134111768
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3779489315
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20031216000019
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GRUBB
	Individual professional last name
Provider First Name	MARK
	Individual professional first name
Provider Middle Name	RICHARD
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	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	OHIO STATE UNIVERSITY COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1989
	Individual professional's medical school graduation year
Primary Specialty	ORTHOPEDIC SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	150 SPRINGSIDE DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 225B
	Group Practice or individual's line 2 address
City	AKRON
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	443334517
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	360037
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST VINCENT CHARITY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	360070
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MERCY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	360027
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	AKRON GENERAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	360020
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	SUMMA HEALTH SYSTEM
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y