Physician Compare National (NPI:1467773853)

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	1467773853
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7517254642
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20160916002294
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HAGAN
	Individual professional last name
Provider First Name	MICHAEL
	Individual professional first name
Provider Middle Name	T
	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 KANSAS SCHOOL OF MED (KC/WICH/SAL)
	Individual professional's medical school
Graduation Year	2010
	Individual professional's medical school graduation year
Primary Specialty	GASTROENTEROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2800 CLAY EDWARDS DR
	Group Practice or individual's line 1 address
City	NORTH KANSAS CITY
	Group Practice or individual's city
State	MO
	Group Practice or individual's state
Zip Code	641163220
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	260096
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	NORTH KANSAS CITY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y