Physician Compare National (NPI:1407949720)

HEALTHCARE PROVIDER: CHRISTIAN ROBERT LOCKE LCSW

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

Individual Professional Information
NPI	1407949720
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6002813607
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20061024000299
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	LOCKE
	Individual professional last name
Provider First Name	CHRISTIAN
	Individual professional first name
Provider Middle Name	R
	Individual professional middle 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	1999
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	INNOVATIVE BEHAVIORAL HEALTH, P.C.
	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	7911904503
	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	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	58 CHICAGO RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 2
	Group Practice or individual's line 2 address
City	OSWEGO
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	605438611
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6309137045
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y