Physician Compare National (NPI:1407810641)

HEALTHCARE PROVIDER: DEREK LEWIS M.D.

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

Individual Professional Information
NPI	1407810641
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8022903020
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20071120000713
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	LEWIS
	Individual professional last name
Provider First Name	DEREK
	Individual professional first 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	1984
	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	6209 W
	Group Practice or individual's line 1 address
Line 2 Street Address	12TH
	Group Practice or individual's line 2 address
City	LITTLE ROCK
	Group Practice or individual's city
State	AR
	Group Practice or individual's state
Zip Code	722041505
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5016635221
	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	040007
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CHI-ST VINCENT INFIRMARY
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	040114
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BAPTIST HEALTH MEDICAL CENTER-LITTLE ROCK
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y