Physician Compare National (NPI:1609175579)

HEALTHCARE PROVIDER: MATTHEW MCCLANAHAN M.D.

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

Individual Professional Information
NPI	1609175579
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2062653389
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150730013475
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MCCLANAHAN
	Individual professional last name
Provider First Name	MATTHEW
	Individual professional first name
Provider Middle Name	WAYNE
	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	2010
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	5025 KEYSTONE BLVD
	Group Practice or individual's line 1 address
City	COVINGTON
	Group Practice or individual's city
State	LA
	Group Practice or individual's state
Zip Code	704337517
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	190045
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST TAMMANY PARISH HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	191313
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	RIVERSIDE MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	190176
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	TULANE MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y