Physician Compare National (NPI:1417205642)

HEALTHCARE PROVIDER: COLEMAN OLIVER CLOUGHERTY D.P.M.

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

Individual Professional Information
NPI	1417205642
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4183935588
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150723007002
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CLOUGHERTY
	Individual professional last name
Provider First Name	COLEMAN
	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	2012
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	PLASTIC AND RECONSTRUCTIVE SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 2	UNDERSEA AND HYPERBARIC MEDICINE
	Second secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	PLASTIC AND RECONSTRUCTIVE SURGERY, UNDERSEA AND HYPERBARIC MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	BELLEVUE PROFESSIONAL SERVICES 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	3779485099
	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	18
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	420 W MCPHERSON HWY
	Group Practice or individual's line 1 address
City	CLYDE
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	434101133
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4194845430
	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	360107
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BELLEVUE HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	360041
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	PARMA COMMUNITY GENERAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	M