Physician Compare National (NPI:1457309007)

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	1457309007
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4688729247
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090902000692
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DAVIES
	Individual professional last name
Provider First Name	OLWYN
	Individual professional first name
Provider Middle Name	K
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OREGON HEALTH SCIENCES UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1955
	Individual professional's medical school graduation year
Primary Specialty	GENERAL PRACTICE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	410 WELCH ST
	Group Practice or individual's line 1 address
City	SILVERTON
	Group Practice or individual's city
State	OR
	Group Practice or individual's state
Zip Code	973811934
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	380029
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	LEGACY SILVERTON MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y