Physician Compare National (NPI:1528599099)

HEALTHCARE PROVIDER: PATRICK RUTKA D.O.

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

Individual Professional Information
NPI	1528599099
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0941621668
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200605000514
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	RUTKA
	Individual professional last name
Provider First Name	PATRICK
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	WEST VIRGINIA SCHOOL OF OSTEOPATHIC MEDICINE
	Individual professional's medical school
Graduation Year	2017
	Individual professional's medical school graduation year
Primary Specialty	HOSPITALIST
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERNAL MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	MEETING HOUSE LANE MEDICAL PRACTICE 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	6800972589
	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	95
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	201 MANOR PL
	Group Practice or individual's line 1 address
City	GREENPORT
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	119441222
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6317268717
	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	330393
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SUNY/STONY BROOK UNIVERSITY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y