Physician Compare National (NPI:1134131519)

HEALTHCARE PROVIDER: CAROL GAUT RYAN 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	1134131519
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9133311533
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101004000941
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	RYAN
	Individual professional last name
Provider First Name	CAROL
	Individual professional first name
Provider Middle Name	G
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	VIRGINIA COMMONWEALTH UNIVERSITY, SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1972
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	GERIATRIC MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	GERIATRIC MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	1360 E STROOP RD
	Group Practice or individual's line 1 address
City	KETTERING
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	454294926
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	360068
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PROMEDICA TOLEDO 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
Hospital Affiliation CCN 3	360133
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	GRANDVIEW AND SOUTHVIEW HOSPITALS
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y