Physician Compare National (NPI:1477517118)

HEALTHCARE PROVIDER: THEODORE S MARTY III MD

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

Individual Professional Information
NPI	1477517118
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3678649993
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080910000042
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MARTY
	Individual professional last name
Provider First Name	THEODORE
	Individual professional first name
Provider Middle Name	S
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OHIO STATE UNIVERSITY COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1986
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1507 SPRINGFIELD PIKE
	Group Practice or individual's line 1 address
City	CINCINNATI
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	452151437
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	360179
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BETHESDA NORTH
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	360163
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	CHRIST HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	360016
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	JEWISH HOSPITAL, LLC
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	360354
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	WEST CHESTER HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	360056
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	MERCY HOSPITAL FAIRFIELD
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1477517118)

HEALTHCARE PROVIDER: THEODORE S MARTY III MD

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information