Physician Compare National (NPI:1184635880)

HEALTHCARE PROVIDER: JAMES R MOEN 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	1184635880
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8628105129
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100414000524
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MOEN
	Individual professional last name
Provider First Name	JAMES
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	WISCONSIN COLLEGE OF PHYSICIANS AND SURGEONS
	Individual professional's medical school
Graduation Year	1984
	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	GENERAL PRACTICE
	First secondary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 2	GENERAL SURGERY
	Second secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	GENERAL PRACTICE, GENERAL SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	1068 NATIONAL HWY
	Group Practice or individual's line 1 address
City	LAVALE
	Group Practice or individual's city
State	MD
	Group Practice or individual's state
Zip Code	215027501
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3017298380
	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	210027
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WESTERN MARYLAND REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	210017
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	GARRETT COUNTY MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	511315
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	POTOMAC VALLEY HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	511311
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	HAMPSHIRE MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y