Physician Compare National (NPI:1235614264)

HEALTHCARE PROVIDER: TIFFANY MARIE MARTIN CRNA

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1235614264
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7113261421
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20181127002323
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MARTIN
	Individual professional last name
Provider First Name	TIFFANY
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF TENNESSEE, HSC, COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	2018
	Individual professional's medical school graduation year
Primary Specialty	CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MAHASKA COUNTY HOSPITAL
	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	2769388677
	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	23
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1229 C AVE E
	Group Practice or individual's line 1 address
Line 2 Street Address	MAHASKA HEALTH PARTNERSHIP
	Group Practice or individual's line 2 address
City	OSKALOOSA
	Group Practice or individual's city
State	IA
	Group Practice or individual's state
Zip Code	525774298
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y