Physician Compare National (NPI:1235188525)

HEALTHCARE PROVIDER: MARK S OBRIEN 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	1235188525
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4183818461
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101101000190
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	OBRIEN
	Individual professional last name
Provider First Name	MARK
	Individual professional first name
Provider Middle Name	S
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1980
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	NEPHROLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	NEPHROLOGY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	4070 LAKE DR SE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 201
	Group Practice or individual's line 2 address
City	GRAND RAPIDS
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	495468294
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	230038
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SPECTRUM HEALTH-BUTTERWORTH CAMPUS
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	230059
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MERCY HEALTH SAINT MARY'S
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y