Physician Compare National (NPI:1336390913)

HEALTHCARE PROVIDER: JUSTIN DANIEL ROSS PSY.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	1336390913
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5698099224
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150926000147
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ROSS
	Individual professional last name
Provider First Name	JUSTIN
	Individual professional first name
Provider Middle Name	D
	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	2007
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1828 CLARKSON ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 200
	Group Practice or individual's line 2 address
City	DENVER
	Group Practice or individual's city
State	CO
	Group Practice or individual's state
Zip Code	802181030
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	060024
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	UNIVERSITY OF COLORADO HOSPITAL AUTHORITY
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y