Physician Compare National (NPI:1497947998)

HEALTHCARE PROVIDER: MATTHEW C RIESEN 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	1497947998
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7810132685
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20130327000067
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	RIESEN
	Individual professional last name
Provider First Name	MATTHEW
	Individual professional first name
Provider Middle Name	C
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	TOLEDO MEDICAL COLLEGE
	Individual professional's medical school
Graduation Year	2007
	Individual professional's medical school graduation year
Primary Specialty	GENERAL PRACTICE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1132 HAGER ST
	Group Practice or individual's line 1 address
City	SAINT MARYS
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	458852423
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	360032
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GRAND LAKE HEALTH SYSTEM
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	360058
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MERCER COUNTY JOINT TOWNSHIP COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	360068
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	PROMEDICA TOLEDO HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	360009
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	LIMA MEMORIAL HEALTH SYSTEM
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y