Physician Compare National (NPI:1265443436)

HEALTHCARE PROVIDER: RICHARD L BRANDON MD

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

Individual Professional Information
NPI	1265443436
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1052494176
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100927000967
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BRANDON
	Individual professional last name
Provider First Name	RICHARD
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF SOUTH CAROLINA SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1983
	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
Organization Legal Name	MOUNTAIN REGION FAMILY MEDICINE P C
	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	5890699961
	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	20
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	444 CLINCHFIELD ST
	Group Practice or individual's line 1 address
City	KINGSPORT
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	376603858
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	440017
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WELLMONT HOLSTON VALLEY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	440176
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	INDIAN PATH MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y