Physician Compare National (NPI:1245267624)

HEALTHCARE PROVIDER: DAVID GERARD PROVAZNIK DO

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

Individual Professional Information
NPI	1245267624
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8729080684
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20091230000638
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PROVAZNIK
	Individual professional last name
Provider First Name	DAVID
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	AT STILL UNIVERSITY OF HEALTH SCIENCES, COLLEGE OF OSTEO MED, KIRKSVILLE
	Individual professional's medical school
Graduation Year	1987
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1242 CRESCENT DR
	Group Practice or individual's line 1 address
City	WHEELERSBURG
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	456949376
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	360008
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SOUTHERN OHIO MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	360361
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	KINGS DAUGHTERS MEDICAL CENTER OHIO
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	180009
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	KING'S DAUGHTERS' MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y