Physician Compare National (NPI:1518958651)

HEALTHCARE PROVIDER: STEPHEN T NITZ M.D.

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

Individual Professional Information
NPI	1518958651
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7719060144
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080208000211
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	NITZ
	Individual professional last name
Provider First Name	STEPHEN
	Individual professional first name
Provider Middle Name	T
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
	Individual professional's medical school
Graduation Year	1999
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	EMERGENCY MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	EMERGENCY MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	7177 CRIMSON RIDGE DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 5
	Group Practice or individual's line 2 address
City	ROCKFORD
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	611076235
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	140242
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CENTRAL DUPAGE HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	141329
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MORRISON COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	141304
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	GENESIS MEDICAL CENTER, ALEDO
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	521304
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	GUNDERSEN ST JOSEPHS HOSPITAL AND CLINICS
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y