Physician Compare National (NPI:1245261015)

HEALTHCARE PROVIDER: STJEPAN GARDILCIC 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	1245261015
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3678556743
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101015000080
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GARDILCIC
	Individual professional last name
Provider First Name	STJEPAN
	Individual professional first 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	1991
	Individual professional's medical school graduation year
Primary Specialty	UROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	UROLOGY ASSOCIATES OF NORTH CENTRAL OHIO, INC.
	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	9234112301
	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	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	675 BALLY ROW
	Group Practice or individual's line 1 address
City	MANSFIELD
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	449062967
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4197564999
	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	360118
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	OHIOHEALTH MANSFIELD HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	361324
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	OHIOHEALTH SHELBY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	360002
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	UNIVERSITY HOSPITALS SAMARITAN MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y