Physician Compare National (NPI:1386972016)

HEALTHCARE PROVIDER: BETHANY L GLASER PA-C

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

Individual Professional Information
NPI	1386972016
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7416082847
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100324000129
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GLASER
	Individual professional last name
Provider First Name	BETHANY
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2009
	Individual professional's medical school graduation year
Primary Specialty	PHYSICIAN ASSISTANT
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	KNOX CLINIC CORP
	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	6305813411
	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	22
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	834 N SEMINARY ST
	Group Practice or individual's line 1 address
Marker of address line 2 suppression	Y
	Marker that address as reported may be incomplete
City	GALESBURG
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	614012899
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	140040
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GALESBURG COTTAGE HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	140064
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ST MARY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	141318
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	OSF HOLY FAMILY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y