Physician Compare National (NPI:1578743159)

HEALTHCARE PROVIDER: GLEN POWELL JR. MD

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

Individual Professional Information
NPI	1578743159
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4183798291
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080808000044
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	POWELL
	Individual professional last name
Provider First Name	GLEN
	Individual professional first name
Provider Middle Name	ELLIS
	Individual professional middle name
Provider Name Suffix Text	II
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF LOUISVILLE SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2004
	Individual professional's medical school graduation year
Primary Specialty	OBSTETRICS/GYNECOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	OBHG NORTH CAROLINA 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	3577721034
	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	23
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	8800 N TRYON ST
	Group Practice or individual's line 1 address
City	CHARLOTTE
	Group Practice or individual's city
State	NC
	Group Practice or individual's state
Zip Code	282623300
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7048636000
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y