Physician Compare National (NPI:1255853081)

HEALTHCARE PROVIDER: LAURIE MARIE HOPPER FNP

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

Individual Professional Information
NPI	1255853081
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8123394590
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20171030003433
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HOPPER
	Individual professional last name
Provider First Name	LAURIE
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2017
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	GRANITE CITY PHYSICIANS CORP
	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	3274594643
	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	8
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	2044 MADISON AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 15
	Group Practice or individual's line 2 address
City	GRANITE CITY
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	620404641
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6184511500
	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	140125
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GATEWAY REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y