Physician Compare National (NPI:1144279209)

HEALTHCARE PROVIDER: GARY RAYMOND DECKER 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	1144279209
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1153336912
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20111228000473
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DECKER
	Individual professional last name
Provider First Name	GARY
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	GEORGETOWN UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Primary Specialty	INFECTIOUS DISEASE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	WYOMING VALLEY INFECTIOUS DISEASE ASSOC, PC
	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	9234176058
	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	3
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	545 N RIVER ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 205
	Group Practice or individual's line 2 address
City	WILKES BARRE
	Group Practice or individual's city
State	PA
	Group Practice or individual's state
Zip Code	187022623
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5708226036
	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	390237
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	REGIONAL HOSPITAL OF SCRANTON
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	390119
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MOSES TAYLOR HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y