Physician Compare National (NPI:1306005137)

HEALTHCARE PROVIDER: CHARLES AARON ROSS 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	1306005137
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7719155845
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110715000579
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ROSS
	Individual professional last name
Provider First Name	CHARLES
	Individual professional first name
Provider Middle Name	A
	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 PIKEVILLE, KENTUCKY COLLEGE OF OSTEOPATHIC MED
	Individual professional's medical school
Graduation Year	2008
	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
Line 1 Street Address	1335 E CTR ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 1
	Group Practice or individual's line 2 address
City	KINGSPORT
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	376642489
	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
Professional Accepts Medicare Assignment	Y