Physician Compare National (NPI:1619910890)

HEALTHCARE PROVIDER: JANE H LISKO 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	1619910890
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3274620281
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110415000232
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	LISKO
	Individual professional last name
Provider First Name	JANE
	Individual professional first name
Provider Middle Name	H
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF MINNESOTA MEDICAL SCHOOL
	Individual professional's medical school
Graduation Year	1997
	Individual professional's medical school graduation year
Primary Specialty	DERMATOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	ASSOCIATED SKIN CARE SPECIALISTS
	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	8921908047
	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	18
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	9600 UPLAND N LN
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 250
	Group Practice or individual's line 2 address
City	MAPLE GROVE
	Group Practice or individual's city
State	MN
	Group Practice or individual's state
Zip Code	553694497
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7635714000
	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	240057
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ABBOTT NORTHWESTERN HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y