Physician Compare National (NPI:1205943289)

HEALTHCARE PROVIDER: JOE P ROUSE 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	1205943289
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3476680646
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100420000332
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ROUSE
	Individual professional last name
Provider First Name	JOE
	Individual professional first name
Provider Middle Name	P
	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 ARKANSAS COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1970
	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
Line 1 Street Address	767 W N ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 5
	Group Practice or individual's line 2 address
City	FAYETTEVILLE
	Group Practice or individual's city
State	AR
	Group Practice or individual's state
Zip Code	727011865
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	040010
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MERCY HOSPITAL NORTHWEST ARKANSAS
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	040022
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	NORTHWEST MEDICAL CENTER-SPRINGDALE
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	040004
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	WASHINGTON REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y