Physician Compare National (NPI:1164454401)

HEALTHCARE PROVIDER:

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

Individual Professional Information
NPI	1164454401
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8729168315
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090911000467
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ROSE
	Individual professional last name
Provider First Name	EDWARD
	Individual professional first name
Provider Middle Name	PHILIP
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	WASHINGTON UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1974
	Individual professional's medical school graduation year
Primary Specialty	RHEUMATOLOGY
	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
Line 1 Street Address	4600 MEMORIAL DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 480
	Group Practice or individual's line 2 address
City	BELLEVILLE
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	622265366
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	140185
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	140002
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ALTON MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	140307
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	METRO-EAST SERVICES INC
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	140187
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	HSHS ST ELIZABETH'S HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	140145
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	ST JOSEPHS HOSPITAL
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1164454401)

HEALTHCARE PROVIDER:

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information