Physician Compare National (NPI:1184745143)

HEALTHCARE PROVIDER: BRIAN EDWARD BURTCH M.D.

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

Individual Professional Information
NPI	1184745143
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8224192067
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090122000778
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BURTCH
	Individual professional last name
Provider First Name	BRIAN
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OHIO MEDICAL UNIVERSITY
	Individual professional's medical school
Graduation Year	2002
	Individual professional's medical school graduation year
Primary Specialty	ENDOCRINOLOGY
	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
Organization Legal Name	LAKE HOSPITAL SYSTEM, INC.
	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	6002713922
	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	173
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	8300 TYLER BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 300
	Group Practice or individual's line 2 address
City	MENTOR
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	440604251
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4402051529
	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	360098
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	LAKE HEALTH
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	360125
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ASHTABULA COUNTY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y