Physician Compare National (NPI:1235457037)

HEALTHCARE PROVIDER: RYAN DAVID TACKLA 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	1235457037
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4082853189
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170817000160
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	TACKLA
	Individual professional last name
Provider First Name	RYAN
	Individual professional first name
Provider Middle Name	D
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	CINCINNATI COLLEGE OF MEDICINE AND SURGERY
	Individual professional's medical school
Graduation Year	2010
	Individual professional's medical school graduation year
Primary Specialty	NEUROSURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	OKLAHOMA SPINE AND BRAIN INSTITUTE
	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	8729090527
	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	11
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	6802 S OLYMPIA AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 300
	Group Practice or individual's line 2 address
City	TULSA
	Group Practice or individual's city
State	OK
	Group Practice or individual's state
Zip Code	741321826
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9187490762
	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	370001
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HILLCREST MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	370216
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	TULSA SPINE & SPECIALTY HOSPITAL, LLC
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	360134
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	GOOD SAMARITAN HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y