Physician Compare National (NPI:1437143559)

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	1437143559
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7810185287
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101229000612
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MICKLE
	Individual professional last name
Provider First Name	JAMES
	Individual professional first name
Provider Middle Name	DOUGLAS
	Individual professional middle name
Provider Name Suffix Text	JR.
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	PENNSYLVANIA STATE UNIVERSITY COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1975
	Individual professional's medical school graduation year
Primary Specialty	GENERAL PRACTICE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	PREVENTATIVE MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	PREVENTATIVE MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	4 CALLE MEDICO
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE C
	Group Practice or individual's line 2 address
City	SANTA FE
	Group Practice or individual's city
State	NM
	Group Practice or individual's state
Zip Code	875054821
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5056991172
	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