Physician Compare National (NPI:1528060316)

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	1528060316
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3577628270
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090212000366
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HOLLING
	Individual professional last name
Provider First Name	KARL
	Individual professional first name
Provider Middle Name	H
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	LOYOLA UNIVERSITY OF CHICAGO, STRITCH SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	OPHTHALMOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	164 N MAIN ST
	Group Practice or individual's line 1 address
City	COLVILLE
	Group Practice or individual's city
State	WA
	Group Practice or individual's state
Zip Code	991142306
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5096843438
	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	501326
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PROVIDENCE MOUNT CARMEL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	501309
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	PROVIDENCE ST JOSEPH HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y