Physician Compare National (NPI:1275509275)

HEALTHCARE PROVIDER: TRACY L NEUENDORF D.O.

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

Individual Professional Information
NPI	1275509275
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3971417858
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040707001566
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	NEUENDORF
	Individual professional last name
Provider First Name	TRACY
	Individual professional first name
Provider Middle Name	LEE
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	DO
	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	OHIO UNIVERSITY, COLLEGE OF OSTEOPATHIC MEDICINE
	Individual professional's medical school
Graduation Year	1982
	Individual professional's medical school graduation year
Primary Specialty	ANESTHESIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	PAIN MANAGEMENT
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	PAIN MANAGEMENT
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	964 N MARKET ST
	Group Practice or individual's line 1 address
City	LISBON
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	444329363
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	360161
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST JOSEPH WARREN HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	360064
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ST ELIZABETH YOUNGSTOWN HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	M