Physician Compare National (NPI:1306862792)

HEALTHCARE PROVIDER: JOSEPH W IPPOLITO JR. 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	1306862792
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1557364809
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20060807000323
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	IPPOLITO
	Individual professional last name
Provider First Name	JOSEPH
	Individual professional first name
Provider Middle Name	W
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	CREIGHTON UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1990
	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	526 SHOUP AVE W
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE F
	Group Practice or individual's line 2 address
City	TWIN FALLS
	Group Practice or individual's city
State	ID
	Group Practice or individual's state
Zip Code	833014591
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	130002
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST LUKES MAGIC VALLEY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	131302
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	NORTH CANYON MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	131310
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ST LUKE'S JEROME
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y