Physician Compare National (NPI:1154397701)

HEALTHCARE PROVIDER: SAM HANSEN 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	1154397701
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2567540453
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080417000247
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HANSEN
	Individual professional last name
Provider First Name	SAM
	Individual professional first 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	1983
	Individual professional's medical school graduation year
Primary Specialty	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERNAL MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	ST VINCENT MEDICAL GROUP INC
	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	7012047640
	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	703
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	8330 NAAB RD
	Group Practice or individual's line 1 address
Marker of address line 2 suppression	Y
	Marker that address as reported may be incomplete
City	INDIANAPOLIS
	Group Practice or individual's city
State	IN
	Group Practice or individual's state
Zip Code	462601932
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	150109
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	FRANCISCAN ST ELIZABETH HEALTH - LAFAYETTE EAST
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	151312
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	INDIANA UNIVERSITY HEALTH WHITE MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	151324
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	FRANCISCAN HEALTH RENSSELAER, INC
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	150173
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	INDIANA UNIVERSITY HEALTH ARNETT HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	151307
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	ST. VINCENT WILLIAMSPORT HOSPITAL, INC.
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1154397701)

HEALTHCARE PROVIDER: SAM HANSEN MD

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information