Physician Compare National (NPI:1295939262)

HEALTHCARE PROVIDER: CLYDE SULLIVAN II M.D.

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

Individual Professional Information
NPI	1295939262
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5193876464
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20191114003005
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SULLIVAN
	Individual professional last name
Provider First Name	CLYDE
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF TENNESSEE, HSC, COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	2004
	Individual professional's medical school graduation year
Primary Specialty	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	NORTH PLATTE NEBRASKA HOSPITAL CORPORATION
	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	6507856697
	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	105
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	611 W FRANCIS ST
	Group Practice or individual's line 1 address
Marker of address line 2 suppression	Y
	Marker that address as reported may be incomplete
City	NORTH PLATTE
	Group Practice or individual's city
State	NE
	Group Practice or individual's state
Zip Code	691010614
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	280065
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GREAT PLAINS HEALTH
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	280061
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	REGIONAL WEST MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	280003
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	BRYAN MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	281363
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	281356
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	PERKINS COUNTY HEALTH SERVICES
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1295939262)

HEALTHCARE PROVIDER: CLYDE SULLIVAN II M.D.

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information