Physician Compare National (NPI:1265415624)

HEALTHCARE PROVIDER: WELLA AUGUSTINE PT

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

Individual Professional Information
NPI	1265415624
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4486675444
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100325000824
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	AUGUSTINE
	Individual professional last name
Provider First Name	WELLA
	Individual professional first name
Provider Middle Name	ALO
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.
Provider Credential Text	PT
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2005
	Individual professional's medical school graduation year
Primary Specialty	PHYSICAL THERAPY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	GOOD SAMARITAN HOSPITAL CORVALLIS
	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	1557270725
	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	265
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	3620 NW SAMARITAN DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 201
	Group Practice or individual's line 2 address
City	CORVALLIS
	Group Practice or individual's city
State	OR
	Group Practice or individual's state
Zip Code	973304714
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5417686300
	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	380014
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GOOD SAMARITAN REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y