Physician Compare National (NPI:1437494457)

HEALTHCARE PROVIDER: MARY BETH ROEHLING

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

Individual Professional Information
NPI	1437494457
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1557515301
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20130204000374
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ROEHLING
	Individual professional last name
Provider First Name	MARY
	Individual professional first name
Provider Middle Name	B
	Individual professional middle name
Provider Gender	F
	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	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2040 E HOLGATE CT
	Group Practice or individual's line 1 address
City	EAGLE
	Group Practice or individual's city
State	ID
	Group Practice or individual's state
Zip Code	836163956
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	130007
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SAINT ALPHONSUS REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	131318
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	VALOR HEALTH
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y