Physician Compare National (NPI:1396782488)

HEALTHCARE PROVIDER: CLYDE P. BLALOCK 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	1396782488
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4880583434
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110311000383
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BLALOCK
	Individual professional last name
Provider First Name	CLYDE
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	MEDICAL COLLEGE OF GEORGIA SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1979
	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	BEAUFORT MEDICAL IMAGING INC
	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	6901795541
	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	5
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	955 RIBAUT RD
	Group Practice or individual's line 1 address
City	BEAUFORT
	Group Practice or individual's city
State	SC
	Group Practice or individual's state
Zip Code	299025441
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8435225200
	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	420067
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BEAUFORT COUNTY MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	420004
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MUSC MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y