Physician Compare National (NPI:1134438153)

HEALTHCARE PROVIDER: JOSEPH MICHAEL ELY ACSW, CPRP

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

Individual Professional Information
NPI	1134438153
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8527482520
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200723001775
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ELY
	Individual professional last name
Provider First Name	JOSEPH
	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	OTHER
	Individual professional's medical school
Graduation Year	2011
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	42151 SUMMER LN
	Group Practice or individual's line 1 address
City	LANCASTER
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	935363795
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6618747851
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y