Physician Compare National (NPI:1548240054)

HEALTHCARE PROVIDER: MICHAEL R CRIST 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	1548240054
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9133260581
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100106000820
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CRIST
	Individual professional last name
Provider First Name	MICHAEL
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	AT STILL UNIVERSITY OF HEALTH SCIENCES, COLLEGE OF OSTEO MED, KIRKSVILLE
	Individual professional's medical school
Graduation Year	1978
	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	OSTEOPATHIC MANIPULATIVE MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	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	814 FAIRLANE DR
	Group Practice or individual's line 1 address
City	BROOKFIELD
	Group Practice or individual's city
State	MO
	Group Practice or individual's state
Zip Code	646282318
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6602583397
	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	261307
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PERSHING MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	260068
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BOONE HOSPITAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	260141
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	UNIVERSITY OF MISSOURI HOSPITAL & CLINICS
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y