Physician Compare National (NPI:1306884176)

HEALTHCARE PROVIDER: MARIBETH MAZZETTA OT

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

Individual Professional Information
NPI	1306884176
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7315960960
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20060110000118
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MAZZETTA
	Individual professional last name
Provider First Name	MARIBETH
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.
Provider Credential Text	OT
	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	OTHER
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	OCCUPATIONAL THERAPY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	ILLINOIS BONE AND JOINT INSTITUTE 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	6002814878
	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	384
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	350 S GREENLEAF ST
	Group Practice or individual's line 1 address
Marker of address line 2 suppression	Y
	Marker that address as reported may be incomplete
City	GURNEE
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	600315709
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y