Physician Compare National (NPI:1396853453)

HEALTHCARE PROVIDER:

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

Individual Professional Information
NPI	1396853453
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9739099805
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20081210000384
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	NOTEBOOM
	Individual professional last name
Provider First Name	DENNIS
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1970
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1001 RIVER DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 100
	Group Practice or individual's line 2 address
City	LIVINGSTON
	Group Practice or individual's city
State	MT
	Group Practice or individual's state
Zip Code	590473716
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	271317
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	LIVINGSTON HEALTHCARE
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y