Physician Compare National (NPI:1629158340)

HEALTHCARE PROVIDER: EDWARD C. GREENLEAF 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	1629158340
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3173696135
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080723000926
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GREENLEAF
	Individual professional last name
Provider First Name	EDWARD
	Individual professional first name
Provider Middle Name	C
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF ALABAMA SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1976
	Individual professional's medical school graduation year
Primary Specialty	RADIATION ONCOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERNAL MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	2027 GRAND CANAL BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 25
	Group Practice or individual's line 2 address
City	STOCKTON
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	952076650
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050084
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST JOSEPHS MEDICAL CENTER OF STOCKTON
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y