Physician Compare National (NPI:1528583846)

HEALTHCARE PROVIDER: ANNETTE MARIE LARSON PA-C

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

Individual Professional Information
NPI	1528583846
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2567737109
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180822000528
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	LARSON
	Individual professional last name
Provider First Name	ANNETTE
	Individual professional first name
Provider Middle Name	MARIE
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2017
	Individual professional's medical school graduation year
Primary Specialty	PHYSICIAN ASSISTANT
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	WILLIAM NOYES, MD PC
	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	6800875345
	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	3
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1451 44TH AVE S
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE E
	Group Practice or individual's line 2 address
City	GRAND FORKS
	Group Practice or individual's city
State	ND
	Group Practice or individual's state
Zip Code	582013434
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7017875800
	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	241344
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	LIFECARE MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y