Physician Compare National (NPI:1598821266)

HEALTHCARE PROVIDER:

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

Individual Professional Information
NPI	1598821266
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3577693605
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100616000068
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MCCALLISTER
	Individual professional last name
Provider First Name	LARRY
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	INDIANA UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1959
	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	217 S CHERRY ST
	Group Practice or individual's line 1 address
City	MUNCIE
	Group Practice or individual's city
State	IN
	Group Practice or individual's state
Zip Code	473051506
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7652841348
	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	150089
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	INDIANA UNIVERSITY HEALTH BALL MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	M