Physician Compare National (NPI:1306101571)

HEALTHCARE PROVIDER: STEVEN SHANE MOORE 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	1306101571
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6305084591
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150709002596
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MOORE
	Individual professional last name
Provider First Name	STEVEN
	Individual professional first name
Provider Middle Name	SHANE
	Individual professional middle name
Provider Gender	M
	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	2012
	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	519 ROSE LN
	Group Practice or individual's line 1 address
City	WICKENBURG
	Group Practice or individual's city
State	AZ
	Group Practice or individual's state
Zip Code	853901448
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	030061
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BANNER BOSWELL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	031300
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	WICKENBURG COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y