Physician Compare National (NPI:1518939313)

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	1518939313
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0446373757
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101005000542
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GROVE
	Individual professional last name
Provider First Name	RUSSELL
	Individual professional first name
Provider Middle Name	EUGENE
	Individual professional middle name
Provider Name Suffix Text	JR.
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	PENNSYLVANIA COLLEGE OF OPTOMETRY
	Individual professional's medical school
Graduation Year	1971
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	180 LEADERS HEIGHTS RD
	Group Practice or individual's line 1 address
City	YORK
	Group Practice or individual's city
State	PA
	Group Practice or individual's state
Zip Code	174024742
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7177470533
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y