Physician Compare National (NPI:1508953944)

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	1508953944
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8325154982
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101030000219
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	RYBCZYNSKI
	Individual professional last name
Provider First Name	JACOB
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	WILLIAM M. SCHOLL COLLEGE OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	1974
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	13724 FORT ST
	Group Practice or individual's line 1 address
City	SOUTHGATE
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	481951153
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	230146
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HENRY FORD WYANDOTTE HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y