Physician Compare National (NPI:1306208707)

HEALTHCARE PROVIDER: CHARLES ROESEL

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

Individual Professional Information
NPI	1306208707
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4183918998
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20160802001200
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ROESEL
	Individual professional last name
Provider First Name	CHARLES
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2016
	Individual professional's medical school graduation year
Primary Specialty	CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	ANESTHESIA ASSOCIATES NORTHWEST LLC
	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	7618908484
	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	37
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	10150 SE 32ND AVE
	Group Practice or individual's line 1 address
City	MILWAUKIE
	Group Practice or individual's city
State	OR
	Group Practice or individual's state
Zip Code	972226516
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5033711756
	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	381302
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SAMARITAN NORTH LINCOLN HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y