Physician Compare National (NPI:1386190585)

HEALTHCARE PROVIDER: MATTHEW R BRADY AUD

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

Individual Professional Information
NPI	1386190585
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1456648419
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20160920001251
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BRADY
	Individual professional last name
Provider First Name	MATTHEW
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OHIO MEDICAL UNIVERSITY
	Individual professional's medical school
Graduation Year	2016
	Individual professional's medical school graduation year
Primary Specialty	QUALIFIED AUDIOLOGIST
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	301 LOUIS ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 101
	Group Practice or individual's line 2 address
City	KINGSPORT
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	376605195
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M