Physician Compare National (NPI:1578663977)

HEALTHCARE PROVIDER: SANDY JAY PENNER CRNA

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

Individual Professional Information
NPI	1578663977
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8527110634
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090721000690
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PENNER
	Individual professional last name
Provider First Name	SANDY
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1993
	Individual professional's medical school graduation year
Primary Specialty	CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	HANSON ANESTHESIA SERVICES 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	2466609912
	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	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	3701 E MAIN ST
	Group Practice or individual's line 1 address
Line 2 Street Address	WEATHERFORD REGIONAL ANESTHESIA SERVICES
	Group Practice or individual's line 2 address
City	WEATHERFORD
	Group Practice or individual's city
State	OK
	Group Practice or individual's state
Zip Code	730963309
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5807725551
	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	371323
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WEATHERFORD REGIONAL HOSPITAL, INC OF WEATHERFORD
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	371340
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MEMORIAL HOSPITAL OF TEXAS COUNTY AUTHORITY
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y