Physician Compare National (NPI:1306164470)

HEALTHCARE PROVIDER: MARY JANE BERONGAN SY PT

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

Individual Professional Information
NPI	1306164470
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9739349960
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180507000565
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SY
	Individual professional last name
Provider First Name	MARY JANE
	Individual professional first name
Provider Middle Name	BERONGAN
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2015
	Individual professional's medical school graduation year
Primary Specialty	PHYSICAL THERAPY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	174 CLUBHOUSE CIR
	Group Practice or individual's line 1 address
Line 2 Street Address	UNIT A
	Group Practice or individual's line 2 address
City	HOT SPRINGS
	Group Practice or individual's city
State	AR
	Group Practice or individual's state
Zip Code	719019247
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y