Physician Compare National (NPI:1528066255)

HEALTHCARE PROVIDER: SHANNON RAY MUELLER D.P.M.

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

Individual Professional Information
NPI	1528066255
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4183524002
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040110000071
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MUELLER
	Individual professional last name
Provider First Name	SHANNON
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	DPM
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	DES MOINES UNIVERSITY OF OSTEOPATHIC MEDICINE AND HEALTH SCIENCES
	Individual professional's medical school
Graduation Year	1999
	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	1201 MEDICAL PLAZA CT
	Group Practice or individual's line 1 address
City	GRANBURY
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	760485684
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	450451
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GLEN ROSE MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	450596
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	LAKE GRANBURY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y