Physician Compare National (NPI:1447262910)

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	1447262910
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2567558323
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080808000606
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MOUNTJOY
	Individual professional last name
Provider First Name	DENNIS
	Individual professional first name
Provider Middle Name	G
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF SOUTHERN CALIFORNIA KECK SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1976
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	HOSPITALIST
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	HOSPITALIST
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	1271 HIGHLAND AVE A
	Group Practice or individual's line 1 address
City	CLARKSTON
	Group Practice or individual's city
State	WA
	Group Practice or individual's state
Zip Code	994032846
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5097582343
	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	501332
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	TRI-STATE MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	130003
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ST JOSEPH REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	M