Physician Compare National (NPI:1184621997)

HEALTHCARE PROVIDER: TRAVIS M DAISE 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	1184621997
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0143214239
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040412001397
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DAISE
	Individual professional last name
Provider First Name	TRAVIS
	Individual professional first name
Provider Middle Name	M
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	UNIVERSITY OF KANSAS SCHOOL OF MED (KC/WICH/SAL)
	Individual professional's medical school
Graduation Year	2000
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	GOODLAND REGIONAL MEDICAL CENTER
	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	3375535263
	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	18
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	106 WILLOW RD
	Group Practice or individual's line 1 address
City	GOODLAND
	Group Practice or individual's city
State	KS
	Group Practice or individual's state
Zip Code	677351518
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7858906012
	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	171370
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GOODLAND REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	171359
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	GREELEY COUNTY HEALTH SERVICES
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	171307
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	RAWLINS COUNTY HEALTH CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	171362
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	CITIZENS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y