Physician Compare National (NPI:1205199528)

HEALTHCARE PROVIDER: BLAIR YOUNG CLARK 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	1205199528
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2769759901
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170518002135
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CLARK
	Individual professional last name
Provider First Name	BLAIR
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	WEST VIRGINIA SCHOOL OF OSTEOPATHIC MEDICINE
	Individual professional's medical school
Graduation Year	2011
	Individual professional's medical school graduation year
Primary Specialty	OPHTHALMOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	WADE E YOUNG MD 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	4789719584
	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	60 ASHWOOD DR
	Group Practice or individual's line 1 address
City	TIFFIN
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	448831908
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4194488811
	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	360089
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MERCY TIFFIN HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y