Physician Compare National (NPI:1154562080)

HEALTHCARE PROVIDER: ROY JAMES BARDWELL JR. D.O.

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

Individual Professional Information
NPI	1154562080
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2769516905
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100810000723
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BARDWELL
	Individual professional last name
Provider First Name	ROY
	Individual professional first name
Provider Middle Name	J
	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	2007
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	PAIN MANAGEMENT
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	PAIN MANAGEMENT
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	CAMPBELL HEALTH SOLUTIONS SC
	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	4981821931
	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	4340 MORSAY DR
	Group Practice or individual's line 1 address
City	ROCKFORD
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	611074877
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8153978132
	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	140172
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	FRANCISCAN HEALTH OLYMPIA & CHICAGO HEIGHTS
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	140191
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	INGALLS MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	140250
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ADVOCATE SOUTH SUBURBAN HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y