Practice Information |
|
Organization Legal Name
|
ST CHARLES HEALTH SYSTEM INC
|
|
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
|
8729111513
|
|
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
|
174
|
|
Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
|
|
Line 1 Street Address
|
211 NW LARCH AVE
|
|
Group Practice or individual's line 1 address
|
|
Marker of address line 2 suppression
|
Y
|
|
Marker that address as reported may be incomplete
|
|
City
|
REDMOND
|
|
Group Practice or individual's city
|
|
State
|
OR
|
|
Group Practice or individual's state
|
|
Zip Code
|
977561357
|
|
Group Practice or individual's zip code (9 digits when available)
|
Hospital(s) Affiliation Information |
|
Hospital Affiliation CCN 1
|
380040
|
|
Medicare CCN of hospital where individual professional provides service 1
|
|
Hospital Affiliation LBN 1
|
ST CHARLES REDMOND
|
|
Legal business name of hospital where individual professional provides service 1
|
|
Hospital Affiliation CCN 2
|
380047
|
|
Medicare CCN of hospital where individual professional provides service 2
|
|
Hospital Affiliation LBN 2
|
ST CHARLES MEDICAL CENTER - BEND
|
|
Legal business name of hospital where individual professional provides service 2
|
|
Hospital Affiliation CCN 3
|
381313
|
|
Medicare CCN of hospital where individual professional provides service 3
|
|
Hospital Affiliation LBN 3
|
ST CHARLES PRINEVILLE
|
|
Legal business name of hospital where individual professional provides service 3
|
|
Professional Accepts Medicare Assignment
|
Y
|
|
|