Physician Compare National (NPI:1497831242)

HEALTHCARE PROVIDER: CHARLES W DINWIDDIE CRNA

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

Individual Professional Information
NPI	1497831242
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1355247560
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20031212000103
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DINWIDDIE
	Individual professional last name
Provider First Name	CHARLES
	Individual professional first name
Provider Middle Name	W
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	CNA
	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	OTHER
	Individual professional's medical school
Graduation Year	1976
	Individual professional's medical school graduation year
Primary Specialty	CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MID STATE ENDO UAP LLC
	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	3577787431
	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	5
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1115 DOW ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE A
	Group Practice or individual's line 2 address
City	MURFREESBORO
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	371302487
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6158489234
	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	440137
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	TENNOVA HEALTHCARE-SHELBYVILLE
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y