Physician Compare National (NPI:1558429746)

HEALTHCARE PROVIDER: MARION I SHELLY DO

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

Individual Professional Information
NPI	1558429746
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4981637055
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100812000147
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SHELLY
	Individual professional last name
Provider First Name	MARION
	Individual professional first name
Provider Middle Name	I
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OHIO UNIVERSITY, COLLEGE OF OSTEOPATHIC MEDICINE
	Individual professional's medical school
Graduation Year	1996
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	132 GARAU ST
	Group Practice or individual's line 1 address
City	BLUFFTON
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	458171086
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	361322
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BLUFFTON HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	360095
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BLANCHARD VALLEY REGIONAL HEALTH CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	360009
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	LIMA MEMORIAL HEALTH SYSTEM
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	360066
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	ST RITA'S MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y