Physician Compare National (NPI:1154424240)

HEALTHCARE PROVIDER: ROGER I LANE 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	1154424240
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1759426950
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100422000757
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	LANE
	Individual professional last name
Provider First Name	ROGER
	Individual professional first name
Provider Middle Name	I
	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 SOUTHERN CALIFORNIA KECK SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1991
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2030 VIBORG RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 205
	Group Practice or individual's line 2 address
City	SOLVANG
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	934632220
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	051331
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SANTA YNEZ VALLEY COTTAGE HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050107
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MARIAN REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	050110
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	LOMPOC VALLEY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y