Physician Compare National (NPI:1376644799)

HEALTHCARE PROVIDER: RUSSELL C DAVIS DPM

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

Individual Professional Information
NPI	1376644799
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9638230436
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20081212000058
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DAVIS
	Individual professional last name
Provider First Name	RUSSELL
	Individual professional first name
Provider Middle Name	C
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	CALIFORNIA SCHOOL OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	1981
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2 BON AIR RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 150
	Group Practice or individual's line 2 address
City	LARKSPUR
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	949391142
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4159275010
	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	050360
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MARIN GENERAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050131
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	NOVATO COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y