Physician Compare National (NPI:1336106954)

HEALTHCARE PROVIDER: MARK H SHELLEY 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	1336106954
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3173594991
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101022001186
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SHELLEY
	Individual professional last name
Provider First Name	MARK
	Individual professional first 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	1985
	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	1 WILLOW ST
	Group Practice or individual's line 1 address
Line 2 Street Address	BOX 307
	Group Practice or individual's line 2 address
City	PORT ALLEGANY
	Group Practice or individual's city
State	PA
	Group Practice or individual's state
Zip Code	167431332
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	391313
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CHARLES COLE MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	391315
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	PENN HIGHLANDS ELK
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	330103
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	OLEAN GENERAL HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y