Physician Compare National (NPI:1508218504)

HEALTHCARE PROVIDER: BRENTLEY FROSSARD D.O.

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

Individual Professional Information
NPI	1508218504
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9436414000
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180531002419
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FROSSARD
	Individual professional last name
Provider First Name	BRENTLEY
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE, ERIE
	Individual professional's medical school
Graduation Year	2016
	Individual professional's medical school graduation year
Primary Specialty	EMERGENCY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	TISHOMINGO HEALTH SERVICES, 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	2466354303
	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	8
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1777 CURTIS DR
	Group Practice or individual's line 1 address
Line 2 Street Address	IUKA HOSPITAL
	Group Practice or individual's line 2 address
City	IUKA
	Group Practice or individual's city
State	MS
	Group Practice or individual's state
Zip Code	388527546
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6624236051
	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	250009
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MAGNOLIA REGIONAL HEALTH CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	250002
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	TISHOMINGO HEALTH SERVICES INC
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	251337
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	TIPPAH COUNTY HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	440109
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	HARDIN MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	250004
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	NORTH MISSISSIPPI MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1508218504)

HEALTHCARE PROVIDER: BRENTLEY FROSSARD D.O.

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information