Physician Compare National (NPI:1366585713)

HEALTHCARE PROVIDER: LOUISE ISENBERG DALLAIRE MD

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

Individual Professional Information
NPI	1366585713
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8527014497
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20160229001832
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DALLAIRE
	Individual professional last name
Provider First Name	LOUISE
	Individual professional first name
Provider Gender	F
	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	STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1976
	Individual professional's medical school graduation year
Primary Specialty	DIAGNOSTIC RADIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	OLEAN RADIOLOGY PC
	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	9133118862
	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	20
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	515 MAIN ST
	Group Practice or individual's line 1 address
City	OLEAN
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	147601513
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7163763166
	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	330197
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CANTON-POTSDAM HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	330103
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	OLEAN GENERAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	330008
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	WYOMING COUNTY COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y