Physician Compare National (NPI:1295938892)

HEALTHCARE PROVIDER: MICHAEL JESSE MCNULTY IV 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	1295938892
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9739233230
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100722000264
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MCNULTY
	Individual professional last name
Provider First Name	MICHAEL
	Individual professional first name
Provider Middle Name	J
	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 TEXAS SOUTHWESTERN MEDICAL SCHOOL AT DALLAS
	Individual professional's medical school
Graduation Year	2004
	Individual professional's medical school graduation year
Primary Specialty	ORTHOPEDIC SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	SOUTHERN ORTHOPAEDIC SPECIALISTS APMC
	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	8123043841
	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	15
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1615 METAIRIE RD
	Group Practice or individual's line 1 address
City	METAIRIE
	Group Practice or individual's city
State	LA
	Group Practice or individual's state
Zip Code	700053974
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5048976351
	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	190036
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	OCHSNER MEDICAL CENTER NEW ORLEANS
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	190146
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	EAST JEFFERSON GENERAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y