Individual Professional Information |
|
NPI
|
1578062246
|
|
Unique healthcare provider (clinician) ID assigned by NPPES
|
|
PECOS UID
|
8820359250
|
|
Unique individual clinician ID assigned by PECOS
|
|
Professional Enrollment ID
|
I20180228001267
|
|
Unique ID for the individual professional enrollment that is the source for the data in the observation
|
|
Provider Last Name
|
GAMMILL
|
|
Individual professional last name
|
|
Provider First Name
|
PATRICK
|
|
Individual professional first name
|
|
Provider Middle Name
|
NEILL
|
|
Individual professional middle name
|
|
Provider Gender
|
M
|
|
The provider's gender if the provider is a person.
|
Practice Information |
|
Organization Legal Name
|
DMCTX2, PLLC
|
|
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
|
6002149135
|
|
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
|
410 GASLIGHT BLVD
|
|
Group Practice or individual's line 1 address
|
|
City
|
LUFKIN
|
|
Group Practice or individual's city
|
|
State
|
TX
|
|
Group Practice or individual's state
|
|
Zip Code
|
759043123
|
|
Group Practice or individual's zip code (9 digits when available)
|
|
Phone Number
|
9366395150
|
|
Phone number is listed only when there is a single phone number available for the practice location address
|