Physician Compare National (NPI:1295714012)

HEALTHCARE PROVIDER: LORI A FANNIN DPM

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

Individual Professional Information
NPI	1295714012
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9537340682
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110222000792
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FANNIN
	Individual professional last name
Provider First Name	LORI
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	KENT STATE UNIVERSITY COLLEGE OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	1990
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	315 N MARKET ST
	Group Practice or individual's line 1 address
City	GALION
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	448331923
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	361325
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GALION COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y