Physician Compare National (NPI:1467483412)

HEALTHCARE PROVIDER: KEITH J POPOVICH M.D.

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

Individual Professional Information
NPI	1467483412
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9032013172
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170420001422
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	POPOVICH
	Individual professional last name
Provider First Name	KEITH
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	WEST VIRGINIA UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1979
	Individual professional's medical school graduation year
Primary Specialty	PULMONARY DISEASE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	TRI-STATE MEMORIAL HOSPITAL
	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	4082502422
	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	38
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1267 BELMONT WAY
	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	994032844
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5097585511
	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
Hospital Affiliation CCN 3	131320
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	CLEARWATER VALLEY HOSPITAL & CLINICS
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y