Physician Compare National (NPI:1528032604)

HEALTHCARE PROVIDER: DIANE HUNTINGTON CONLEY MD

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

Individual Professional Information
NPI	1528032604
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1355331273
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20160418000097
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CONLEY
	Individual professional last name
Provider First Name	DIANE
	Individual professional first name
Provider Middle Name	H
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF TEXAS MEDICAL SCHOOL AT HOUSTON
	Individual professional's medical school
Graduation Year	1983
	Individual professional's medical school graduation year
Primary Specialty	DIAGNOSTIC RADIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	THE FORT DEFIANCE INDIAN HOSPITAL BOARD, INCORPORATION
	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	0941336697
	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	148
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	CORNER OF ROUTE N12 AND N 7
	Group Practice or individual's line 1 address
City	FORT DEFIANCE
	Group Practice or individual's city
State	AZ
	Group Practice or individual's state
Zip Code	865040589
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9287298183
	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	340032
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GASTON MEMORIAL HOSPITAL, INC.
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	140184
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	HEARTLAND REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	160110
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ALLEN HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	340113
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	CAROLINAS MEDICAL CENTER/BEHAV HEALTH
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y