Physician Compare National (NPI:1528171410)

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	1528171410
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3577724129
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120409000472
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WHITSON
	Individual professional last name
Provider First Name	ROBERT
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1980
	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	GENERAL PRACTICE
	First secondary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 2	OSTEOPATHIC MANIPULATIVE MEDICINE
	Second secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	GENERAL PRACTICE, OSTEOPATHIC MANIPULATIVE MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	846 STEVENS DR
	Group Practice or individual's line 1 address
City	RICHLAND
	Group Practice or individual's city
State	WA
	Group Practice or individual's state
Zip Code	993523507
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5099465233
	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	500058
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	KADLEC REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	M