Physician Compare National (NPI:1205940467)

HEALTHCARE PROVIDER: JUDE COOK 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	1205940467
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4587730700
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20151030000245
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	COOK
	Individual professional last name
Provider First Name	JUDE
	Individual professional first name
Provider Middle Name	THOMAS
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF NEBRASKA COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1992
	Individual professional's medical school graduation year
Primary Specialty	PHYSICAL MEDICINE AND REHABILITATION
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	8338 W 13TH N ST
	Group Practice or individual's line 1 address
City	WICHITA
	Group Practice or individual's city
State	KS
	Group Practice or individual's state
Zip Code	672122900
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	170123
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WESLEY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	170122
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	VIA CHRISTI HOSPITAL-WICHITA
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y