Physician Compare National (NPI:1609816735)

HEALTHCARE PROVIDER: JAMES R CARROLL 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	1609816735
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8820029754
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050830000636
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CARROLL
	Individual professional last name
Provider First Name	JAMES
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	MEDICAL UNIVERSITY OF SOUTH CAROLINA COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1980
	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	2845 E HWY 76
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 2
	Group Practice or individual's line 2 address
City	MULLINS
	Group Practice or individual's city
State	SC
	Group Practice or individual's state
Zip Code	295746037
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	420055
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CAROLINAS HOSPITAL SYSTEM MARION
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	420105
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MCLEOD LORIS HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	420051
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	MCLEOD REGIONAL MEDICAL CENTER-PEE DEE
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	420085
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	GRAND STRAND REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y