Physician Compare National (NPI:1497841845)

HEALTHCARE PROVIDER: GAYLEEN KOLACZEWSKI 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	1497841845
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5395878912
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100803001182
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KOLACZEWSKI
	Individual professional last name
Provider First Name	GAYLEEN
	Individual professional first name
Provider Gender	F
	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	1981
	Individual professional's medical school graduation year
Primary Specialty	GASTROENTEROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERNAL MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	265 N MAIN ST
	Group Practice or individual's line 1 address
City	MONROE FALLS
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	442621077
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3306863038
	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	360020
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SUMMA HEALTH SYSTEM
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	360027
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	AKRON GENERAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	360150
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	SUMMA WESTERN RESERVE HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	360078
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	UNIVERSITY HOSPITALS PORTAGE MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y