Physician Compare National (NPI:1508867052)

HEALTHCARE PROVIDER:

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

Individual Professional Information
NPI	1508867052
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1850340126
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050113000999
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HUDGENS
	Individual professional last name
Provider First Name	GLENN
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
	Individual professional's medical school
Graduation Year	1961
	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	26415 CARMEL RANCHO BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE D
	Group Practice or individual's line 2 address
City	CARMEL
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	939238733
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8316241597
	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	050145
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	M