Physician Compare National (NPI:1497758460)

HEALTHCARE PROVIDER: THAD DAVID HARDIN 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	1497758460
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8426192121
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100609000435
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HARDIN
	Individual professional last name
Provider First Name	THAD
	Individual professional first name
Provider Middle Name	D
	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	1993
	Individual professional's medical school graduation year
Primary Specialty	OPHTHALMOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	CHARLES L. HEATON , M.D. P.A.
	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	1557257615
	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	11
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1260 S PALESTINE ST
	Group Practice or individual's line 1 address
City	ATHENS
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	757513619
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9036758111
	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	450389
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	EAST TEXAS MEDICAL CENTER ATHENS
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y