Physician Compare National (NPI:1376807123)

HEALTHCARE PROVIDER: ROBERT D SELLEY D.O.

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

Individual Professional Information
NPI	1376807123
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1850534546
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180608000969
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SELLEY
	Individual professional last name
Provider First Name	ROBERT
	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	2012
	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	GENERAL RADIOLOGY ASSOCIATES P C
	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	4981518644
	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	10
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	36267 26 MILE RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 1
	Group Practice or individual's line 2 address
City	LENOX
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	480483253
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5864938000
	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	230227
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MCLAREN MACOMB
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	230207
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MCLAREN OAKLAND
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	230216
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	MCLAREN PORT HURON
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	230165
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	ST JOHN HOSPITAL AND MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y