Physician Compare National (NPI:1134433204)

HEALTHCARE PROVIDER: CHRISTOPHER MICHAEL WILLKOMM 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	1134433204
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6608991252
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100920000432
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WILLKOMM
	Individual professional last name
Provider First Name	CHRISTOPHER
	Individual professional first name
Provider Middle Name	MICHAEL
	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 SOUTH FLORIDA COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	2005
	Individual professional's medical school graduation year
Primary Specialty	GENERAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	GULF COAST HMA PHYSICIAN MANAGEMENT LLC
	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	7911949466
	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	77
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	540 THE RIALTO
	Group Practice or individual's line 1 address
City	VENICE
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	342852900
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	100070
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	VENICE REGIONAL BAYFRONT HEALTH
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	100166
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	DOCTORS HOSPITAL OF SARASOTA
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y