Physician Compare National (NPI:1508062043)

HEALTHCARE PROVIDER: NEIL JAMES RENNICK DO

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

Individual Professional Information
NPI	1508062043
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7012199227
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110309000682
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	RENNICK
	Individual professional last name
Provider First Name	NEIL
	Individual professional first name
Provider Middle Name	JAMES
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1983
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	OSTEOPATHIC MANIPULATIVE MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	OSTEOPATHIC MANIPULATIVE MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	123 WOLF RUN
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 5
	Group Practice or individual's line 2 address
City	MUKWONAGO
	Group Practice or individual's city
State	WI
	Group Practice or individual's state
Zip Code	531498479
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	520008
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WAUKESHA MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	520102
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	AURORA LAKELAND MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y