Physician Compare National (NPI:1225196777)

HEALTHCARE PROVIDER: TIMMIE JOE CONRAD 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	1225196777
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9335228253
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100902000994
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CONRAD
	Individual professional last name
Provider First Name	TIMMIE
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	DUKE UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1991
	Individual professional's medical school graduation year
Primary Specialty	OPHTHALMOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	204 BRECKENRIDGE LN
	Group Practice or individual's line 1 address
City	LOUISVILLE
	Group Practice or individual's city
State	KY
	Group Practice or individual's state
Zip Code	402073825
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5028997778
	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	180088
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	NORTON HOSPITALS, INC
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	150044
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BAPTIST HEALTH FLOYD
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	180130
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	BAPTIST HEALTH LOUISVILLE
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	150172
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	PHYSICIANS' MEDICAL CENTER LLC
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y