Physician Compare National (NPI:1629094552)

HEALTHCARE PROVIDER: JOHN BRUCE ADDISON D.O.

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

Individual Professional Information
NPI	1629094552
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7214990852
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20041108000361
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ADDISON
	Individual professional last name
Provider First Name	JOHN
	Individual professional first name
Provider Middle Name	B
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	DO
	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	AT STILL UNIVERSITY OF HEALTH SCIENCES, COLLEGE OF OSTEO MED, KIRKSVILLE
	Individual professional's medical school
Graduation Year	1991
	Individual professional's medical school graduation year
Primary Specialty	EMERGENCY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	FAMILY MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	FAMILY MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	MCCAMEY COUNTY HOSPITAL DISTRICT
	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	8628062320
	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	4
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	2500 HWY 305 S
	Group Practice or individual's line 1 address
City	MCCAMEY
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	797520000
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9156528626
	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	451309
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MC CAMEY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y